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Confocal and conventional immunofluorescent and immunogold electron microscopic localization of collagen types III and IV in human placenta
Citations from the Literature Division of Gynecology, Department Gynecology. Duke University Medical Durham, NC 27710, USA
of Obstetrics and Center, Box 3291,
AM J OBSTET GYNECOL 1992 16612(519-524) Objectives: We evaluated the relationship between clinically severe pelvic inflammatory disease and laparoscopic diagnosis and grading, comparative treatment with chndamycin plus cefamandole or doxycychne and a management protocol for inpatient pelvic inflammatory disease treatment. Study design: Thirty-three patients who met our clinical criteria for severe pelvic inflammatory disease underwent diagnostic laparoscopy. Pelvic inflammatory disease patients were randomized to double-blind treatment with clindamycin plus cefamandole or doxycycline within our management protocol; postdischarge oral antibiotics were omitted. Results: Laparoscopy confirmed pelvic inflammatory disease in 23 (70%) patients; 10 (44%) had mild pelvic inflammatory disease by laparoscopic grading. Laparoscopic grade alone predicted necessary duration of therapy to response: mild pelvic inflammatory disease, 2.3 f 0.5 days; moderate pelvic inflammatory disease, 2.7 * 1.5 days; and severe pelvic inflammatory disease, 3.9 f 1.5 days (P < 0.05). Using the management plan presented, response rates for both antibiotic regimens were 100%. Conclusions: Clinical diagnosis and grading of severe pelvic inflammatory disease has poor specificity. Laparoscopic grading of severity of pelvic inflammatory disease seems accurate. Both clindamycin plus cefamandole and clindamycin plus doxycycline are equally effective regimens for treatment of pelvic inflammatory disease and did not require supplementation after discharge. Our management plan is objective and practical; daily bimanual examination is the most sensitive indicator of persistent disease. The outcome of congenital cytomegnlovirus infection in relation to maternal antibady statu9 Fowler KB; Stagno S; Pass RF; Britt WJ; Boll TJ; Alford CA Department of Pediatrics, University of Alabama at Birmingham, 1600 Seventh Ave. S., Birmingham, AL 35294-0011, USA
NEW ENGL J MED 1992 326/10 (663-667) Background. Intrauterine transmission of cytomegalovirus (CMV) can occur whether a mother has prior immunity or acquires CMV for the first time during pregnancy. The degree of protection afforded an infected infant by the presence of antibody in the mother before conception is uncertain. Methods. We compared the outcomes of CMV-infected infants born to mothers who acquired primary CMV infection during pregnancy (primary-infection group) with those of CMV-infected infants born to mothers with immunity (recurrent-infection group). Screening for viruria identified 197 newborns with congenital CMV infection. Stored serum samples were used to categorize maternal infection as either primary or recurrent. We followed 125 infants from the primary-infection group and 64 from the recurrent-infection group. Serial medical, audiologic, psychometric and eye examinations were used to identify sequelae of CMV infection. Results. Only infants in the primary-infection group had symptomatic CMV infection at birth (18%). After a mean follow-up of 4.7 years, one or more sequelae were seen in 25% of the primary-infection group and
153
in 8% of the recurrent-infection group. Thirteen percent of infants whose mothers had primary infection during pregnancy had mental impairment (IQ s 70), as compared with none of those whose mothers had recurrent CMV infections. Sensorineural hearing loss was found in 15% of those in the primary-infection group and in only 5% of those in the recurrent-infection group. Bilateral hearing loss was identified only among children in the primary-infection group (8 percent). Conclusions. The presence of maternal antibody to CMV before conception provides substantial protection against damaging congenital CMV infection in the newborn. Primary maternal infection during pregnancy is associated with more severe sequelae of congenital CMV infection.
PYROLOGY OF THE PLACENTA Cmwnt topic: The regulation of placental eicosanoid biosynthesis Mitchell MD Department of Obstetrics and Gynecology, University of Utah School of Medicine, 50 North Medical Drive, Salt Lake City, UT 84132, USA
PLACENTA 1991 12l6 (557-572) Products of arachidonic acid metabolism (eicosanoids, e.g. some prostaglandins and leukotrienes) have important roles in the maintenance of pregnancy, the mechanism(s) of parturition and various diseases of pregnancy such as pregnancy-induced hypertension. The wealth of literature describing these relationships dictates that the present review be focused rather than global in nature. Only studies of human tissues will be discussed despite the limitations in experimental design that are imposed on such studies. Emphasis will be placed on studies of the cyclooxygenase and to a lesser extent lipoxygenase pathways of arachidonic acid metabolism mentioning only briefly the epoxygenase pathway and catabolic pathways. It should also be noted that many eicosanoids are not derived from arachidonic acid and will not be discussed here. The review of literature will not be comprehensive but rather selective in order to focus on specific issues of importance or controversy. In order to develop concepts of regulation I have focused a section on amnion since this tissue has received most attention for such studies. The significance of the products of the pathways described in the physiologic and pathophysiologic events of pregnancy will be described primarily in a section in which I have attempted to delineate those regulatory mechanisms that are considered most significant in, or specific to pregnancy and parturition. Finally, the reader is directed to several excellent reviews that concentrate on areas not emphasized in this review (Keirse, 1979; Challis and Patrick, 1980; Mitchell, 1982; Hammarstrom, 1983; Samuelsson and Funk, 1989; Smith, 1989; Myatt, 1990). Coafoeel and cowentional immmmfhorescent and immunogold electron microecopiclocaiization of collagen types III and IV in buman placenta Nanaev AK, Rukosuev VS; Shirinsky VP; Milovanov AP; Domogatsky SP; Duance VC; Bradbury FM; Yarrow P; Gardiner L; D’lacey C; Ckkleford CD Int J Gynecol Obstet 39
154
Citations from the Literature
Department of Anatomy, University of Leicester Medical School, University Road, Leicester LEl ?RH, GBR PLACENTA 1991 12/6 (573-595) Confocal and conventional indirect immunofluorescence and immunogold electron microscopic methods were applied to examine the distribution of extracellular matrix constituents (collagens types III and IV) in the villi of immature and term human placentas. The immunotluorescence study revealed that collagen type III is more distinct in the villous stroma of term placenta as compared with that of the first trimester. Collagen type IV was detected mainly in endothelial and epithelial basement membranes and interestingly also to a certain extent in the stroma. Results obtained using immunoelectron microscopy support the proposal that collagen types III and IV are characteristic of stromal and basement membranes, respectively. Stromal collagen type IV is apparently localized in association with the interstitial types of collagen (I and III) in the villous stroma of term placenta. Identification of two subtypes of protein kmase C in human placenta Nomura S; Tokumitsu H; Mizutani S; Narita 0; Tomada Y; Hidaka H Department of Pharmacology, Nagoya University School of Medicine, 65 Tsurumai-cho: Showa-ku. Nagoya 466, JPN PLACENTA 1991 1216(605-613) A purified protein kinase C (PKC) has been isolated from term human placental tissue, which is phospholipid and Ca’+dependent. Two subtypes of the enzyme were identified by hydroxyapatite column chromatography and using monoclonal antibodies with immunohistochemical techniques; subtype III is present in higher concentration than subtype II. Their ratio of 2.5 is very similar in second and third trimester placentas, but is higher, 6.5, in the first trimester. The subtype I was never expressed. Synthesis and secretion of apolipoprotein E by human placenta and choriocarcinomacell lines Rindler MJ; Traber MG; Esterman AL; Bersinger NA; Dancis J Department of Pediatrics, NYU Medical Center, 550 First Avenue, NY 10016. USA PLACENTA 1991 12/6 (615-624) The synthesis and secretion of apolipoproteins (apos) by cells from a human choriocarcinoma cell line, JAR, were examined by [3sS]methionine labeling followed by immunoprecipitation and SDS/PAGE. Apo E, but not apos A-I, A-IV, or B, was synthesized and secreted. Apo E was also synthesized by fragments of chorionic villi from human placenta and by another choriocarcinoma line BeWo. Pulse-chase experiments with JAR cells revealed that apo E was initially synthesized as a 33 kDa protein followed by a 34 kDa protein, probably the result of glycosylation. The latter was secreted into the medium where it was detected coincident with a 21/22 kDa doublet, possibly proteolytic fragments of apo E. Approximately 50% of the apo E in the medium was complexed with lipid as indicated by ultracentrifugation at a density of 1.21 g/ml. The amount of
Int J Gynecol Obstet 39
apo E produced by JAR was not affected by preincubation with dibutyryl CAMP and theophylline, or by the cholesterol content of the cells. Following perfusion of an isolated lobule of human placenta with [i4C]-labelled amino acids [ i4C]apo E was detected by immunoprecipitation of the maternal and fetal perfusates with 88% in the maternal perfusate. These studies suggest that apo E, which promotes receptor-mediated lipoprotein uptake, is secreted by the trophoblast to facilitate uptake of maternal lipoproteins. Syncytiotrophoblastmembraneprotein glycosylation patterns in normal human pregnancy and changes with gestational age and parturition Arkwright PD, Redman CWG; Williams PJ; Dwek RA; Rademacher TW Nuffield Department of Obstetrics, John Radcliffe Hospital, Headington, Oxford OX3 9DU GBR PLACENTA 1991 12J6 (637-651) The fetally derived syncytiotrophoblast in the placenta form the major interface with the maternal circulation. Cell surface N-linked oligosaccharides are known to influence cell-cell interactions in a variety of ways. The N-linked oligosaccharide component of the human syncytiotrophoblast membrane has been purified from term placentas and its biochemical structure analyzed. Ninety-five percent of structures were complex Nlinked oligosaccharides, with the remaining 5% being of the oligomannose type. Seventy-two percent of oligosaccharides were sialylated; 50% having two or more sialic acid residues. Such a population of N-linked oligosaccharides would be expected to provide a surface which inhibits interactions between trophoblast and maternal leukocytes. The temporal changes in syncytiotrophoblast N-linked oligosaccharides from the end of the second and through the third trimester (25-41 weeks) were analyzed, as were the changes which occur during parturition. There was no change in the degree of sialylation of these structures. The only significant change was a 37% decrease in core fucosylation of complex N-linked sugars during gestation (P < 0.005). Women delivered by cesarean section at term, had significantly higher levels of fucosylation (equivalent to women with a gestational age of 31-36 weeks), than those who laboured at term. Present knowledge of core fucosylation of N-linked oligosaccharides is discussed in relation to trophoblast functioning.
ENDOCRINOLOGY The responseof patients with polycystic ovarian disease to human menopausalgonadotropintherapy after ovarian electrocauteryor a lutebdzing hormone-releasinghormone agonist Gadir AA; Alnaser HMI; Mowati RS; Shaw RW Academic Department of Obstetrics and Gynaecology, Royal Free Hospital, Pond Street, London NW3 2QG GBR FERTIL STERIL 1992 57/2 (309-313) Objective: To compare the effect of ovarian electrocautery versus an intranasal (IN) luteinizing hormone-releasing hormone agonist (LH-RH-a) in the response of patients with
of Obstetrics and Center, Box 3291,
AM J OBSTET GYNECOL 1992 16612(519-524) Objectives: We evaluated the relationship between clinically severe pelvic inflammatory disease and laparoscopic diagnosis and grading, comparative treatment with chndamycin plus cefamandole or doxycychne and a management protocol for inpatient pelvic inflammatory disease treatment. Study design: Thirty-three patients who met our clinical criteria for severe pelvic inflammatory disease underwent diagnostic laparoscopy. Pelvic inflammatory disease patients were randomized to double-blind treatment with clindamycin plus cefamandole or doxycycline within our management protocol; postdischarge oral antibiotics were omitted. Results: Laparoscopy confirmed pelvic inflammatory disease in 23 (70%) patients; 10 (44%) had mild pelvic inflammatory disease by laparoscopic grading. Laparoscopic grade alone predicted necessary duration of therapy to response: mild pelvic inflammatory disease, 2.3 f 0.5 days; moderate pelvic inflammatory disease, 2.7 * 1.5 days; and severe pelvic inflammatory disease, 3.9 f 1.5 days (P < 0.05). Using the management plan presented, response rates for both antibiotic regimens were 100%. Conclusions: Clinical diagnosis and grading of severe pelvic inflammatory disease has poor specificity. Laparoscopic grading of severity of pelvic inflammatory disease seems accurate. Both clindamycin plus cefamandole and clindamycin plus doxycycline are equally effective regimens for treatment of pelvic inflammatory disease and did not require supplementation after discharge. Our management plan is objective and practical; daily bimanual examination is the most sensitive indicator of persistent disease. The outcome of congenital cytomegnlovirus infection in relation to maternal antibady statu9 Fowler KB; Stagno S; Pass RF; Britt WJ; Boll TJ; Alford CA Department of Pediatrics, University of Alabama at Birmingham, 1600 Seventh Ave. S., Birmingham, AL 35294-0011, USA
NEW ENGL J MED 1992 326/10 (663-667) Background. Intrauterine transmission of cytomegalovirus (CMV) can occur whether a mother has prior immunity or acquires CMV for the first time during pregnancy. The degree of protection afforded an infected infant by the presence of antibody in the mother before conception is uncertain. Methods. We compared the outcomes of CMV-infected infants born to mothers who acquired primary CMV infection during pregnancy (primary-infection group) with those of CMV-infected infants born to mothers with immunity (recurrent-infection group). Screening for viruria identified 197 newborns with congenital CMV infection. Stored serum samples were used to categorize maternal infection as either primary or recurrent. We followed 125 infants from the primary-infection group and 64 from the recurrent-infection group. Serial medical, audiologic, psychometric and eye examinations were used to identify sequelae of CMV infection. Results. Only infants in the primary-infection group had symptomatic CMV infection at birth (18%). After a mean follow-up of 4.7 years, one or more sequelae were seen in 25% of the primary-infection group and
153
in 8% of the recurrent-infection group. Thirteen percent of infants whose mothers had primary infection during pregnancy had mental impairment (IQ s 70), as compared with none of those whose mothers had recurrent CMV infections. Sensorineural hearing loss was found in 15% of those in the primary-infection group and in only 5% of those in the recurrent-infection group. Bilateral hearing loss was identified only among children in the primary-infection group (8 percent). Conclusions. The presence of maternal antibody to CMV before conception provides substantial protection against damaging congenital CMV infection in the newborn. Primary maternal infection during pregnancy is associated with more severe sequelae of congenital CMV infection.
PYROLOGY OF THE PLACENTA Cmwnt topic: The regulation of placental eicosanoid biosynthesis Mitchell MD Department of Obstetrics and Gynecology, University of Utah School of Medicine, 50 North Medical Drive, Salt Lake City, UT 84132, USA
PLACENTA 1991 12l6 (557-572) Products of arachidonic acid metabolism (eicosanoids, e.g. some prostaglandins and leukotrienes) have important roles in the maintenance of pregnancy, the mechanism(s) of parturition and various diseases of pregnancy such as pregnancy-induced hypertension. The wealth of literature describing these relationships dictates that the present review be focused rather than global in nature. Only studies of human tissues will be discussed despite the limitations in experimental design that are imposed on such studies. Emphasis will be placed on studies of the cyclooxygenase and to a lesser extent lipoxygenase pathways of arachidonic acid metabolism mentioning only briefly the epoxygenase pathway and catabolic pathways. It should also be noted that many eicosanoids are not derived from arachidonic acid and will not be discussed here. The review of literature will not be comprehensive but rather selective in order to focus on specific issues of importance or controversy. In order to develop concepts of regulation I have focused a section on amnion since this tissue has received most attention for such studies. The significance of the products of the pathways described in the physiologic and pathophysiologic events of pregnancy will be described primarily in a section in which I have attempted to delineate those regulatory mechanisms that are considered most significant in, or specific to pregnancy and parturition. Finally, the reader is directed to several excellent reviews that concentrate on areas not emphasized in this review (Keirse, 1979; Challis and Patrick, 1980; Mitchell, 1982; Hammarstrom, 1983; Samuelsson and Funk, 1989; Smith, 1989; Myatt, 1990). Coafoeel and cowentional immmmfhorescent and immunogold electron microecopiclocaiization of collagen types III and IV in buman placenta Nanaev AK, Rukosuev VS; Shirinsky VP; Milovanov AP; Domogatsky SP; Duance VC; Bradbury FM; Yarrow P; Gardiner L; D’lacey C; Ckkleford CD Int J Gynecol Obstet 39
154
Citations from the Literature
Department of Anatomy, University of Leicester Medical School, University Road, Leicester LEl ?RH, GBR PLACENTA 1991 12/6 (573-595) Confocal and conventional indirect immunofluorescence and immunogold electron microscopic methods were applied to examine the distribution of extracellular matrix constituents (collagens types III and IV) in the villi of immature and term human placentas. The immunotluorescence study revealed that collagen type III is more distinct in the villous stroma of term placenta as compared with that of the first trimester. Collagen type IV was detected mainly in endothelial and epithelial basement membranes and interestingly also to a certain extent in the stroma. Results obtained using immunoelectron microscopy support the proposal that collagen types III and IV are characteristic of stromal and basement membranes, respectively. Stromal collagen type IV is apparently localized in association with the interstitial types of collagen (I and III) in the villous stroma of term placenta. Identification of two subtypes of protein kmase C in human placenta Nomura S; Tokumitsu H; Mizutani S; Narita 0; Tomada Y; Hidaka H Department of Pharmacology, Nagoya University School of Medicine, 65 Tsurumai-cho: Showa-ku. Nagoya 466, JPN PLACENTA 1991 1216(605-613) A purified protein kinase C (PKC) has been isolated from term human placental tissue, which is phospholipid and Ca’+dependent. Two subtypes of the enzyme were identified by hydroxyapatite column chromatography and using monoclonal antibodies with immunohistochemical techniques; subtype III is present in higher concentration than subtype II. Their ratio of 2.5 is very similar in second and third trimester placentas, but is higher, 6.5, in the first trimester. The subtype I was never expressed. Synthesis and secretion of apolipoprotein E by human placenta and choriocarcinomacell lines Rindler MJ; Traber MG; Esterman AL; Bersinger NA; Dancis J Department of Pediatrics, NYU Medical Center, 550 First Avenue, NY 10016. USA PLACENTA 1991 12/6 (615-624) The synthesis and secretion of apolipoproteins (apos) by cells from a human choriocarcinoma cell line, JAR, were examined by [3sS]methionine labeling followed by immunoprecipitation and SDS/PAGE. Apo E, but not apos A-I, A-IV, or B, was synthesized and secreted. Apo E was also synthesized by fragments of chorionic villi from human placenta and by another choriocarcinoma line BeWo. Pulse-chase experiments with JAR cells revealed that apo E was initially synthesized as a 33 kDa protein followed by a 34 kDa protein, probably the result of glycosylation. The latter was secreted into the medium where it was detected coincident with a 21/22 kDa doublet, possibly proteolytic fragments of apo E. Approximately 50% of the apo E in the medium was complexed with lipid as indicated by ultracentrifugation at a density of 1.21 g/ml. The amount of
Int J Gynecol Obstet 39
apo E produced by JAR was not affected by preincubation with dibutyryl CAMP and theophylline, or by the cholesterol content of the cells. Following perfusion of an isolated lobule of human placenta with [i4C]-labelled amino acids [ i4C]apo E was detected by immunoprecipitation of the maternal and fetal perfusates with 88% in the maternal perfusate. These studies suggest that apo E, which promotes receptor-mediated lipoprotein uptake, is secreted by the trophoblast to facilitate uptake of maternal lipoproteins. Syncytiotrophoblastmembraneprotein glycosylation patterns in normal human pregnancy and changes with gestational age and parturition Arkwright PD, Redman CWG; Williams PJ; Dwek RA; Rademacher TW Nuffield Department of Obstetrics, John Radcliffe Hospital, Headington, Oxford OX3 9DU GBR PLACENTA 1991 12J6 (637-651) The fetally derived syncytiotrophoblast in the placenta form the major interface with the maternal circulation. Cell surface N-linked oligosaccharides are known to influence cell-cell interactions in a variety of ways. The N-linked oligosaccharide component of the human syncytiotrophoblast membrane has been purified from term placentas and its biochemical structure analyzed. Ninety-five percent of structures were complex Nlinked oligosaccharides, with the remaining 5% being of the oligomannose type. Seventy-two percent of oligosaccharides were sialylated; 50% having two or more sialic acid residues. Such a population of N-linked oligosaccharides would be expected to provide a surface which inhibits interactions between trophoblast and maternal leukocytes. The temporal changes in syncytiotrophoblast N-linked oligosaccharides from the end of the second and through the third trimester (25-41 weeks) were analyzed, as were the changes which occur during parturition. There was no change in the degree of sialylation of these structures. The only significant change was a 37% decrease in core fucosylation of complex N-linked sugars during gestation (P < 0.005). Women delivered by cesarean section at term, had significantly higher levels of fucosylation (equivalent to women with a gestational age of 31-36 weeks), than those who laboured at term. Present knowledge of core fucosylation of N-linked oligosaccharides is discussed in relation to trophoblast functioning.
ENDOCRINOLOGY The responseof patients with polycystic ovarian disease to human menopausalgonadotropintherapy after ovarian electrocauteryor a lutebdzing hormone-releasinghormone agonist Gadir AA; Alnaser HMI; Mowati RS; Shaw RW Academic Department of Obstetrics and Gynaecology, Royal Free Hospital, Pond Street, London NW3 2QG GBR FERTIL STERIL 1992 57/2 (309-313) Objective: To compare the effect of ovarian electrocautery versus an intranasal (IN) luteinizing hormone-releasing hormone agonist (LH-RH-a) in the response of patients with