Expression of metalloproteinases and their inhibitors in human trophoblast continuous cell lines

Trophoblasts cells which are derived from the outer layer of the blastocyst have developed mechanisms by which they can invade the uterus and tap into the maternal circulation. In contrast to tumor cell invasion trophoblast invasion is precisely regulated, being confined spatially to the uterus and temporally to early pregnancy. The invasive properties manifested by trophoblasts are made possible by the secretion of proteolytic enzymes which can degrade components of the extracellular matrix (ECM). A number of investigators have shown that the matrix metalloproteinases (MMPs) are important mediators of trophoblast invasion. The two type IV collagenases, MMP-2 and MMP-9, which specifically degrade type IV collagen and gelatins have been of particular interest in this respect. In this paper we examine the expression and regulation of MMPs and their inhibitors in a series of trophoblast continuous cell lines. These cell lines, ED27, ED31, ED77, and a choriocarcinoma cell line, BeWo, were initially characterized with respect to various properties, including cytokeratin, hCG, and hPL expression. We have looked at the expression of MMPs and their inhibitors in these cell lines and their in vitro invasive behavior. Using zymography and RT-PCR we show that the trophoblast cell lines produce both MMP-2 and MMP-9, while the BeWo produce only MMP-2. Using an in vitro invasion assay the trophoblast cell lines were shown to be capable of invading while the BeWo were unable to invade. These results suggest that expression of MMP-9 in these cells is crucial for invasion. We have also examined the regulation of MMP expression by cytokines and found that MMP-9 expression could be modulated by IL-1 beta in these cell lines. The data presented in this paper suggest that these trophoblast cell lines present an ideal model system to investigate the regulation of metalloproteinases in trophoblast invasion.

General practitioners' attitudes to the development of midwifery group practices

BACKGROUND

The report Changing childbirth (1993) has led to the development of midwifery-led schemes that aim to increase the continuity of maternity care.

AIM

To determine the impact of midwifery group practices on the work of general practitioners (GPs) and their perceptions of midwifery group practice care.

METHOD

Postal questionnaires were sent to 58 GPs referring women to the care of midwifery group practices (group-practice GPs), and a shorter questionnaire was sent to the remaining 67 GPs (non-group-practice GPs) within the same postcode area as a comparison group. In-depth interviews were conducted with 12 GPs.

RESULTS

Questionnaires were returned by 71% of group-practice GPs and 81% of non-group practice GPs. One third of the group practice GPs felt that they were seeing group practice women too few times, and 50% thought midwives discouraged women from visiting their GP for antenatal checks. Over 80% of group practice GPs believed that midwives had the skills to detect deviation from the normal, and 66% would confidently refer women to their care. However, only 14% of group practice GPs believed that their own role was clear, while 64% agreed that communication with group practice midwives was poor, and concerns were expressed about the level of consultation before establishing schemes. Of the non-group practice GPs, 87% said they would consider referring women to the care of a midwifery group practice in the future.

CONCLUSIONS

General practitioners were generally positive about the quality of care provided by midwifery group practices but identified issues that require addressing in developing this model of care.

Quality of midwifery led care: assessing the effects of different models of continuity for women's satisfaction

BACKGROUND

Changing Childbirth (1993), a report on the future of maternity services in the United Kingdom, endorsed the development of a primarily community based midwifery led service for normal pregnancy, with priority given to the provision of "woman centred care". This has led to the development of local schemes emphasising continuity of midwifery care and increased choice and control for women.

AIMS

To compare two models of midwifery group practices (shared caseload and personal caseload) in terms of: (a) the extent to which women see the same midwife antenatally and know the delivery midwife, and (b) women's preference for continuity and satisfaction with their care.

METHODS

A review of maternity case notes and survey of a cohort of women at 36 weeks of gestation and 2 weeks postpartum who attended the two midwifery group practices. Questionnaires were completed by 247 women antenatally (72% response) and 222 (68%) postnatally. Outcome measures were the level of continuity experienced during antenatal, intrapartum, and postnatal care, women's preferences for continuity of carer, and ratings of satisfaction with care.

RESULTS

The higher level of antenatal continuity of carer with personal caseload midwifery was associated with a lower percentage having previously met their main delivery midwife (60% v 74%). Women's preferences for antenatal continuity were significantly associated with their experiences. Postnatal rating of knowing the delivery midwife as "very important indeed" was associated with both previous antenatal ratings of its importance, and women's actual experiences. Personal continuity of carer was not a clear predictor of women's satisfaction with care. Of greater importance were women's expectations, their relations with midwives, communication, and involvement in decision making.

CONCLUSIONS

Midwifery led schemes based on both shared and personal caseloads are acceptable to women. More important determinants of quality and women's satisfaction are the ethos of care consistency of care, good communication, and participation in decisions.

Selective targeting of Kupffer cells with liposomal butyrate augments portal venous transfusion-induced immunosuppression

BACKGROUND

Enhanced Kupffer cell production of the immunosuppressive arachidonic acid metabolite prostaglandin E2 (PGE2) has been shown to be a mechanism of the immunosuppressive effect of portal venous transfusions (PVT). Butyrate, a four-carbon short-chain fatty acid, has received increased attention because of its ability to enhance gene transcription. This study tested the hypothesis that the intrahepatic delivery of butyrate enhances Kupffer cell PGE2 production and thus augments the immunosuppressive effect of PVT.

METHODS

Butyrate was incorporated into liposomes and administered intravenously to Lewis rats. Control rats were administered liposomes without butyrate. Twenty-four hours after liposome injection, rats were administered a PVT of 1 ml of Wistar-Furth blood. Kupffer cells were isolated, and PGE2 and tumor necrosis factor-alpha levels were measured in the culture medium after 24 hr. Additionally, Kupffer cells from butyrate-treated and control animals were added to one-way mixed lymphocyte reaction cultures.

RESULTS

Intrahepatic delivery of butyrate via liposomes increased Kupffer cell PGE2 (3800+/-1220 vs. 1010+/-119 pg/ml, P<0.05) and decreased tumor necrosis factor-alpha (1670+/-81 vs. 3360+/-415 pg/ml, P<0.01) production as compared with controls. Butyrate also augmented the Kupffer cell-mediated immunosuppression as demonstrated by significant depression of the mixed lymphocyte reaction (690+/-119 vs. 3850+/-148 cpm, P<0.01).

CONCLUSION

The results support the hypothesis that intrahepatic delivery of butyrate enhances Kupffer cell PGE2 production, and specific targeting of Kupffer cells with liposomes containing immunomodulating agents such as butyrate may be a useful means of augmenting immunosuppression protocols in organ transplantation.

Hydrogen peroxide enhances signal-responsive arachidonic acid release from neurons: role of mitogen-activated protein kinase

Hydrogen peroxide (H2O2) is a potent stimulator of signal-responsive phospholipase A2 (PLA2) in vascular smooth muscle and cultured endothelial cells. We investigated whether H2O2 plays a similar regulatory role in neurons. H2O2 did not stimulate a release of arachidonic acid from cultured neurons when applied alone but strongly enhanced the liberation of arachidonic acid evoked by maximally effective concentrations of either glutamate, the glutamate receptor agonist N-methyl-D-aspartate (NMDA), the muscarinic receptor agonist carbachol, the Na+-channel opener veratridine, or the Ca2+-ionophore ionomycin. The potentiating effects of H2O2 were strongly inhibited in the presence of the PLA2 inhibitor mepacrine, suggesting that the site of action was within the signal responsive arachidonic acid cascade. The enhancing effect of H2O2 was not reversed by protein kinase C inhibitors (chelerythrine chloride or GF 109203X) nor was it mimicked by phorbol ester treatment. H2O2 alone strongly enhanced the levels of immunodetectable activated mitogen-activated protein kinase (activated MAP kinases ERK1 and ERK2) in a Ca2+-dependent manner and this effect was additive with increases in the levels of activated MAP kinase evoked by glutamate. The enhanced release of arachidonic acid, however, was not clearly reversed by the MAP kinase kinase (MEK) inhibitor PD 98059, although this treatment effectively abolished H2O2 activation of MAP kinase. Thus, MAP kinase activation and Ca2+-dependent arachidonic acid release are regulated by oxidative stress in cultured striatal neurons.

"Depression" increases "craving" for sweet rewards in animal and human models of depression and craving

This study consisted of two experiments, one in rats and one in human volunteers, that used the identical progressive ratio (PR) operant procedure. In both experiments, responding was reinforced under a progressively increasing work requirement, and different groups of subjects received reinforcers that varied in sweetness. In experiment 1, rats were subjected to chronic mild stress, a well-validated animal model of depression. Performance under the PR schedule increased in subjects reinforced with conventional precision pellets (which contain 10% sucrose) or very sweet pellets, but not in subjects reinforced with sugar-free pellets. In experiment 2, volunteers were subjected to a depressive musical mood induction. Performance under the PR schedule increased in subjects reinforced with chocolate buttons, but not in subjects reinforced with with buttons made from the relatively unpalatable chocolate substitute carob. In experiment 2, depressive mood induction also increased chocolate craving, as measured by a novel questionnaire, and there were significant correlations between chocolate craving and chocolate-reinforced PR performance. These results suggest that performance under the PR schedule provides a measure of craving rather than reward, and that craving for sweet rewards is increased by depressive mood induction in both animal and human models. Implications for the interpretation of pharmacological studies using the PR procedure are also discussed.

Letrozole, a new oral aromatase inhibitor for advanced breast cancer: double-blind randomized trial showing a dose effect and improved efficacy and tolerability compared with megestrol acetate

PURPOSE

To compare two doses of letrozole and megestrol acetate (MA) as second-line therapy in postmenopausal women with advanced breast cancer previously treated with antiestrogens.

PATIENTS AND METHODS

Five hundred fifty-one patients with locally advanced, locoregionally recurrent or metastatic breast cancer were randomly assigned to receive letrozole 2.5 mg (n = 174), letrozole 0.5 mg (n = 188), or MA 160 mg (n = 189) once daily in a double-blind, multicenter trial. Data were analyzed for tumor response and safety variables up to 33 months of follow-up evaluation and for survival up to 45 months.

RESULTS

Letrozole 2.5 mg produced a significantly higher overall objective response rate (24%) compared with MA (16%; logistic regression, P = .04) or letrozole 0.5 mg (13%; P = .004). Duration of objective response was significantly longer for letrozole 2.5 mg compared with MA (Cox regression, P = .02). Letrozole 2.5 mg was significantly superior to MA and letrozole 0.5 mg in time to treatment failure (P = .04 and P = .002, respectively). For time to progression, letrozole 2.5 mg was superior to letrozole 0.5 mg (P = .02), but not to MA (P = .07). There was a significant dose effect in overall survival in favor of letrozole 2.5 mg (P = .03) compared with letrozole 0.5 mg. Letrozole was significantly better tolerated than MA with respect to serious adverse experiences, discontinuation due to poor tolerability, cardiovascular side effects, and weight gain.

CONCLUSION

The data show letrozole 2.5 mg once daily to be more effective and better tolerated than MA in the treatment of postmenopausal women with advanced breast cancer previously treated with antiestrogens.

A COSTAR interface using WWW technology

The concentration of industry on modern relational databases has left many nonrelational and proprietary databases without support for integration with new technologies. Emerging interface tools and data-access methodologies can be applied with difficulty to medical record systems which have proprietary data representation. Users of such medical record systems usually must access the clinical content of such record systems with keyboard-intensive and time-consuming interfaces. COSTAR is a legacy ambulatory medical record system developed over 25 years ago that is still popular and extensively used at the Massachusetts General Hospital. We define a model for using middle layer services to extract and cache data from non-relational databases, and present an intuitive World-Wide Web interface to COSTAR. This model has been implemented and successfully piloted in the Internal Medicine Associates at Massachusetts General Hospital.

Ethanol modulates N-methyl-D-aspartate-evoked arachidonic acid release from neurones

Glutamate-evokes a Ca2+-dependent release of arachidonic acid from cultured neurones via the activation of NMDA and AMPA receptors. In this study we investigated whether exposing cultured striatal neurones either acutely or chronically to ethanol would modify these responses. Acute ethanol (100 mM, 15 min) inhibited the liberation of arachidonic acid evoked by a maximally effective concentration of glutamate, an affect which appeared to be mediated primarily by a reduction in NMDA receptor responsiveness. In contrast, chronic ethanol exposure caused a dose-dependent increase in the glutamate, N-methyl-D-aspartate (NMDA) and alpha-amino-3-hydroxy-5-methylisoxazole-4-propionate (AMPA) evoked release of arachidonic acid, although ethanol was less potent at the AMPA response. Basal responses were not altered by acute or chronic ethanol and the concentrations of ethanol employed were not toxic. Chronic ethanol (100 mM, 48 h) increased NMDA-mediated neuronal damage at sub-maximal concentrations of the agonist, suggesting that an enhanced mobilisation of arachidonic acid may underly the potentiated excitotoxic neuronal loss observed following exposure to ethanol.

A group programme for postnatally distressed women and their partners

A group programme for postnatally distressed women and their partners is described. The programme consists of eight sessions, including one session for the couple. The concerns of the women centre around their anxieties and feelings towards their partners, their own mothers and their infants. Psychotherapeutic and cognitive-behavioural strategies are employed to assist them in dealing with these concerns. The concerns of the men centre around their attempts to provide emotional and practical support to their partner. Invariably such support results in an increase in tension between the partners, and the programme helps the men to understand why this happens. Formal measures show a decrease in maternal distress over time and an increase in their level of self-esteem. About half of the men show elevated levels of distress.

Progesterone metabolite allopregnanolone in women with premenstrual syndrome

OBJECTIVE

To evaluate the anxiolytic 3alpha-5alpha-reduced progesterone metabolite allopregnanolone in the luteal phase of the menstrual cycle in women with premenstrual syndrome (PMS) and controls.

METHODS

Thirty-five women with prospectively documented PMS and 36 controls were evaluated. Serum progesterone and allopregnanolone levels were measured on days 19 and 26 of the cycle as determined by urinary LH detection kits. Analysis of variance and Student t tests were used to analyze the data.

RESULTS

Allopregnanolone levels were significantly lower on day 26 in the PMS group than in controls (3.6 +/- 0.8 versus 7.5 +/- 1.3 ng/mL; P < .04). Significant differences in the ratio of the metabolite to progesterone also were noted, with a smaller ratio in the PMS subjects (0.9 +/- 0.3 versus 3.2 +/- 1.3 ng/mL; P < .05). There were no significant differences between the PMS and control groups with respect to serum progesterone levels.

CONCLUSION

Subjects with PMS manifested lower levels of the anxiolytic metabolite allopregnanolone in the luteal phase when compared with controls. Diminished concentrations of allopregnanolone in women with PMS may lead to an inability to enhance gamma aminobutyric acid-mediated inhibition during states of altered central nervous system excitability, such as ovulation or physiologic or psychological stress. The lowered metabolite levels could contribute to the genesis of various mood symptoms of the disorder, such as anxiety, tension, and depression.

Illness doesn't belong to us

There has been little research in Britain into the experiences of doctors who are ill. We conducted in-depth interviews with 64 doctors of all grades with a recent illness lasting one month or more. Whether the illness was physical or psychiatric, many expressed the idea that illness is inappropriate for doctors. This idea is a cultural value among doctors which is reinforced by the organization of medical work. It discourages doctors from seeking and obtaining appropriate help when they are ill.

In vitro assessment of the influence of nutrition, temperature and larval density on trapping of the infective larvae of Heligmosomoides polygyrus by Arthrobotrys oligospora, Duddingtonia flagrans and Monacrosporium megalosporum

The influence of nutrient level, temperature and larval density on the trapping of Heligmosomoides polygyrus L3 by the nematophagous fungi Arthrobotrys oligospora, Duddingtonia flagrans and Monacrosporium megalosporum were investigated by quantification of trapped nematodes. All 3 factors were found to have a significant effect on the number of larvae trapped by A. oligospora and M. megalosporum. Decreased nutrient concentrations resulted in increased trapping for these 2 fungi, but nutrient availability was not found to have a significant effect on trapping by D. flagrans. The 3 fungi were found to have similar responses to temperature, with peak trapping occurring at or near the optimum growth temperatures. Nematode trapping was found to be density dependent for all 3 fungi, with increased percentage trapping at increased larval densities. Comparison in a single experiment of the relative importance of these factors to each fungus showed that nutrient level was the main factor influencing trapping by A. oligospora, whereas D. flagrans and M. megalosporum were more dependent on larval density.

Sickness absence and 'working through' illness: a comparison of two professional groups

BACKGROUND

Few studies have investigated occupational groups reporting low rates of sickness absence because of an assumption that these rates indicate low morbidity. This is inconsistent with the view that sickness absence, which may be caused by social and psychological rather than medical factors, does not equate with morbidity. This paper investigates rates of sickness absence and factors influencing decisions not to take sick leave among doctors and a comparative professional group.

METHODS

A postal survey was sent to 670 general practitioners (GPs), 669 hospital doctors and 400 company 'fee earners'. Qualitative interviews were conducted with 64 doctors reporting an illness lasting one month or more in the last three years.

RESULTS

Self-reported health status was similar for both groups but GPs reported higher levels of occupational stress. However, doctors were significantly less likely to report short periods of sick leave in the previous year. Over 80 per cent of all respondents had 'worked through' illness, citing cultural and organizational factors behind their decision not to take sick leave. Barriers to sick leave among doctors included the difficulty of arranging cover and attitudes to their own health.

CONCLUSIONS

Considerable emphasis has been given to the role of social factors in contributing to rates of sickness absence. These may also contribute to the decision not to take sick leave, resulting in possible inappropriate non-use. Measures to encourage and enable doctors to take sick leave might improve the management of their own health.

Fatalism, current life satisfaction, and risk for HIV infection among gay and bisexual men

This study surveyed 430 men at an urban gay pride celebration to assess fatalism, current life satisfaction, and perceived expected years of life among men who have sex with men. Analyses showed that men who engaged in unprotected anal intercourse outside of exclusive relationships reported a greater fatalistic outlook, were more dissatisfied with life, and perceived a shorter life for themselves than men who practiced only safer sex and men who were in exclusive relationships. Gay men in exclusive relationships scored higher than nonexclusively partnered gay men on the measure of current life satisfaction. These results suggest that efforts to prevent HIV infection among gay men should include building personal self-worth, support of long-term relationships, and future goal orientations.

Portal venous transfusion up-regulates Kupffer cell cyclooxygenase activity: a mechanism of immunosuppression in organ transplantation

Portal venous transfusions (PVTs) of blood have been shown to induce significant immunosuppression in animal models of organ transplantation. A proposed mechanism of PVT-induced immunosuppression is via alteration of Kupffer cell arachidonic acid metabolism with increased secretion of the suppressive metabolite prostaglandin E2 (PGE2). This study assessed the hypothesis that PVT increases Kupffer cell PGE2 production via up-regulation of Kupffer cell phospholipase A2 (PLA2) as well as constitutive (COX1) and inducible (COX2) cyclooxygenase. Kupffer cells from Lewis rats were harvested 1 hr after PVT with either 1 ml of Wistar-Furth blood, systemic transfusion (SVT), or saline via portal vein (PVSal). After lipopolysaccharide stimulation, 24-hr Kupffer cell supernatant fractions were assayed for PGE2. PGE2 was increased after SVT (1465+/-234 pg/ml) compared with PVSal (597+/-99; P<0.01). PVT increased Kupffer cell PGE2 (5370+/-533; P<0.001 vs. SVT and vs. PVSal) even more substantially. Kupffer cells from PVT-treated rats were then cultured in the presence of inhibitors of PLA2, COX1, or COX2. When Kupffer cells were treated with mepacrine to inhibit PLA2 (5575+/-453 pg/ml), PGE2 production was not different from that by PVSal-treated controls (6467+/-614 pg/ml), but when Kupffer cells were incubated in the presence of the COX1 inhibitor flurbiprofen (3512+/-407 pg/ml) or the COX2 inhibitor nimesulide (2800+/-830 pg/ml), production was decreased 46.7% and 56.7%, respectively, over control activity without added inhibitor. PVT also increased Kupffer cells COX1 and COX2 mRNA as measured by Northern blot. Heart transplants were then performed from Wistar-Furth donors into Lewis recipients at the time of PVT, SVT, PVSal, or PVT + indomethacin (COX1/2 inhibitor). PVT prolonged allograft survival (12.0+/-0.9 days) compared with PVSal (6.3+/-0.3; P<0.01) or SVT (6.3+/-0.3; P<0.04). Indomethacin shortened graft survival when given with PVT (6.5+/-0.3 days). In summary, PVT increased Kupffer cell PGE2 production, up-regulated transcription of Kupffer cells COX1 and COX2 mRNA, and prolonged cardiac allograft survival. COX1/2 inhibition abrogated the effect of PVT. The results indicated that the immunosuppressive effect of PVT may be mediated by up-regulation of Kupffer cell COX1 and COX2. Manipulation of Kupffer cell arachidonic acid metabolism may be useful in augmentation of PVT-induced immunosuppression.