Comparison of expression patterns for placenta growth factor, vascular endothelial growth factor (VEGF), VEGF-B and VEGF-C in the human placenta throughout gestation

Angiogenesis and vascular transformation are important processes in the normal development of the placenta. Vascular endothelial growth factor (VEGF) is a potent angiogenic growth factor and is thought to be important for placental development. Recently several new members of this family have been described. In this study we used in situ hybridisation to localise which cells in the placenta expressed mRNA for VEGF, placenta growth factor (PlGF), VEGF-B and VEGF-C. We were unable to find any message for either VEGF-B or VEGF-C in the placenta, suggesting that only low levels are produced which this method was unable to detect. The mRNA encoding VEGF was found to be produced by cells within the villous mesenchyme, decidual macrophages and decidual glands but, in contrast to our previous findings, not by trophoblast. The mRNA encoding PlGF was produced in large amounts by villous cytotrophoblast, syncytiotrophoblast and extravillous trophoblast. The mRNAs encoding VEGF and PlGF were thus not co-localised and it appears that there is unlikely to be any significant production of VEGF/PlGF heterodimer in the placenta.

Hepatocyte growth factor levels during normal and intra-uterine growth-restricted pregnancies

Hepatocyte growth factor (HGF), also known as scatter factor, binds the c-met receptor. It has been shown to be involved in mesenchyme-epithelial interactions. HGF is produced by the villous mesenchyme of the placenta throughout pregnancy and its receptor located on the villous cytotrophoblast cells. In this study the levels of HGF were measured in consecutive samples of plasma taken from pregnant women. Normal pregnancies were compared with intrauterine growth restricted (IUGR) pregnancies (below the third centile). In both groups, the levels of HGF were found to increase significantly as pregnancy progressed and then fall post partum. There was a considerable amount of variation found between individual women but no significant difference (P=0.65) between the normal and IUGR pregnancies.

Expression and localization of the Th2-type cytokine interleukin-13 and its receptor in the placenta during human pregnancy

PROBLEM

To investigate the expression of the Th2-type cytokine interleukin (IL)-13 and its receptor in human placenta during gestation.

METHOD OF STUDY

Expression of IL-13 and its receptor was analyzed by reverse transcriptase (RT)-polymerase chain reaction (PCR), in situ hybridization and immunohistochemistry using human placental samples.

RESULTS

IL-13 mRNA was detected by RT-PCR in placental extracts from all stages of gestation. In situ hybridization revealed IL-13 mRNA in first trimester cytotrophoblast and syncytiotrophoblast. Few positive cells were found within decidual sections from the same pregnancy. Immunohistochemistry revealed a similar pattern to in situ hybridization. This was largely absent in second- and third-trimester placentae. IL-13 receptor alpha chain (IL-13R alpha) was detected by immunofluorescence on the surface of leukocytes in first-trimester villous core and decidua.

CONCLUSIONS

The expression of IL-13 is spatially and temporally regulated in the placenta, and associated with the close proximity of a receptor-bearing target leukocyte population.

Angiogenesis, vascular endothelial growth factor and the endometrium

Angiogenesis is an essential component of endometrial renewal. The formation of new vessels depends on interactions between various hormones and growth factors, and this review focuses on the expression of angiogenic growth factors in the human endometrium. Peptide and non-peptide angiogenic factors interact during endometrial renewal, including epidermal growth factor (EGF), transforming growth factors (e.g. TGF-beta), platelet-derived endothelial growth factor/thymidine phosphorylase (PD-ECGF/TP), tumour necrosis growth factors and vascular endothelial growth factor (VEGF). Their role in the proliferation and migration of endothelial cells from pre-existing vessels is described, concentrating on VGEF and its receptors (VEG-R1 and -R2), and the fibroblast growth factor (FGF) family. The actions of the products of the VEGF gene are outlined, and the hormonal and non-hormonal control of their localization in the human endometrium and biological actions on vasculature and coagulation are described. Finally, the role of VEGF in menorrhagia is assessed.

The role of leukemia inhibitory factor and interleukin-6 in human reproduction

There is now strong evidence that many of the actions of steroids in controlling reproduction are mediated by locally acting factors such as growth factors and cytokines. These have been shown to act both in an autocrine and paracrine manner to regulate preimplantation embryo development and migration which is necessary for placental development. The creation of mouse strains lacking genes for receptors or growth factors has proved important in defining which of these are essential in reproduction in this species and those that play a lesser role. Using this approach, a lack of leukemia inhibitory factor (LIF) in the murine endometrium has been shown to result in failed implantation. Evidence from infertile women supports the notion that abnormal expression of LIF, or the related cytokine interleukin-6 (IL-6) in the endometrium may underlie some forms of human infertility. This offers the opportunity for therapeutic intervention, if levels of these cytokines can be altered in a specific and controlled way. The recently described method of delivery of genes to the uterine epithelium provides a powerful new approach by which this could be achieved. The ability to regulate the function of specific genes in the endometrium by direct gene transfer raises the prospect of novel opportunities for therapeutic intervention.

A systematic review and meta-analysis of family history and risk of ovarian cancer

OBJECTIVE

To estimate the relative risk and lifetime risk of ovarian cancer in women with various categories of family history.

DESIGN

A meta-analysis of all published case-control and cohort studies.

METHODS

Pooled relative risk estimates were calculated for the case control studies, using the Mantel-Haenzel method. These estimates were combined with the relative risks from the cohort studies. The pooled estimates of relative risk were used to estimate lifetime risks of ovarian cancer from age 15 up to age 75, for various categories of family history.

MAIN OUTCOME MEASURES

Relative risks and lifetime risks of developing ovarian cancer were calculated for the categories of women with 1. an affected first degree relative; 2. an affected mother; 3. an affected sister; and 4. women with more than one affected relative.

RESULTS

The relative risk to first degree relatives is 3.1 (95% CI 2.6-3.7). There is some evidence that this relative risk declines with age. The relative risk to mothers of cases 1.1 (95% CI 0.8-1.6) was lower than the relative risks to sisters: 3.8 (95% CI 2.9-5.1), and daughters: 6.0 (95% CI 3.0-11.9); the explanation of this difference is unclear.

CONCLUSIONS

Women with a family history of ovarian cancer have a substantially higher risk of developing ovarian cancer compared with women without such a history. However the risk is small for most categories of family history, except for the small number of individuals who have more than one affected relative.

Activation of large-conductance potassium channels in pregnant human myometrium by pinacidil

OBJECTIVE

The aim was to investigate the effects of the potassium-channel opener pinacidil on single uterine potassium channels and the contribution of the latter to pinacidil-induced myometrial relaxation.

STUDY DESIGN

Myometrial strips and freshly dispersed uterine myocytes were prepared from the myometrial biopsy samples of women undergoing elective, nonlabor caesarean section at term gestation.

RESULTS

In isometric tension experiments pinacidil potently relaxed pregnant nonlabor human myometrial strips, with an agonist concentration yielding the half maximal response of 0.4 +/- 0.1 micromol/L. This effect was antagonized by 500 nmol/L charybdotoxin. Application of 10 micromol/L glibenclamide also inhibited the pinacidil-induced relaxation. Coapplication of charybdotoxin (500 nmol/L) and glibenclamide (10 micromol/L) produced a biphasic curve, which was fitted to a two-site model with values for agonist concentration yielding the half maximal response of 0.6 +/- 0.2 micromol/L and 189.7 +/- 0.8 micromol/L. Large-conductance calcium-dependent potassium channel activity was dramatically increased after application of pinacidil (between 10 and 100 micromol/L) to both inside-out and outside-out patches. The activation required the presence of calcium ions at the intracellular aspect of the membrane. Charybdotoxin but not glibenclamide blocked pinacidil-induced unitary large-conductance calcium-dependent potassium channel activity.

CONCLUSION

Pinacidil-mediated relaxation of human pregnant myometrial strips may be partially attributable to the opening of uterine large-conductance calcium-dependent potassium channels in addition to adenosine triphosphate potassium channel activation. Drugs with specific potassium channel-activating properties may have important clinical application as novel tocolytics in the treatment of preterm labor.

Contribution of calcium-sensitive potassium channels to NS1619-induced relaxation in human pregnant myometrium

Large-conductance, calcium-sensitive potassium channels (BK(Ca)) are found at high density in the pregnant human myometrium. We have investigated, using isolated myometrial strips and freshly dispersed human myometrial cells, the action of a novel drug (NS1619) which has potassium channel opening activity. Isometric tension experiments demonstrated that NS1619 has a potent, relaxant effect on the pregnant human myometrium. Using both the inside-out and outside-out configurations of the patch-clamp technique, NS1619 appears to act directly on myometrial BK(Ca) channels to stimulate channel activity by increasing the time spent in the open state by this group of potassium channels. Consequently, the myometrial BK(Ca) channel may be a novel target site for drug intervention in clinical conditions, e.g. failure to labour, preterm labour or dysmenorrhoea, which may require either the augmentation or inhibition of uterine K+ channel activity.

Angiogenesis

Endometriosis remains a significant cause of pain and ill health for women and is a significant factor in reducing quality of life for women. The ability of desquamated endometrium to attach and implant within the peritoneal cavity is dependent upon its ability to establish and maintain an adequate blood supply. New vascularization is therefore a key part in the progression of endometriosis. Increased angiogenic activity is present in the peritoneal cavity of patients who suffer from the disease and more recently the potent angiogenic growth factor VEGF has been shown to be increased in the peritoneal fluid in patients with this disease. Whilst the desquamated endometrium itself under the influence of hypoxia further to retrograde menstruation is a likely rich source of VEGF, activated peritoneal fluid macrophages and infiltrating macrophages are also a rich source of this angiogenic growth factor. Surprisingly, steroidal regulation of macrophage expression of VEGF also appears to be a feature of this disease.

Reduced cholinergic function in normal and Alzheimer's disease brain is associated with apolipoprotein E4 genotype

Apolipoprotein E (ApoE) is a potent risk factor for Alzheimer's disease. Since the loss of cholinergic function in Alzheimer's disease is known to occur at an early stage in the disease we have examined this function in normal subjects with an Apoepsilon4 allele to see if the deficit occurs in the absence of Alzheimer pathology or symptoms. We report that brain tissue obtained post-mortem from normal subjects and Alzheimer patients with an Apoepsilon4 allele has a lower cholinergic activity than tissue from those subjects without this allele. This has important significance for the interpretation of the cholinergic deficits found in Alzheimer's disease.

Further thoughts on simplicity and complexity in population projection models

"This article is a review of--and response to--a special issue of Mathematical Population Studies that focused on the relative performance of simpler vs. more complex population projection models. I do not attempt to summarize or comment on each of the articles in the special issue, but rather present an additional perspective on several points: definitions of simplicity and complexity, empirical evidence regarding population forecast accuracy, the costs and benefits of disaggregation, the potential benefits of combining forecasts, criteria for evaluating projection models, and issues of economic efficiency in the production of population projections."

Expression and localization of the vascular endothelial growth factor family in ovarian epithelial tumors

Vascular endothelial growth factor (VEGF) is an angiogenic factor secreted by various tumors, including epithelial tumors of the ovary, and is involved in tumor progression and maintenance. The significance and function of other members of the VEGF family in the ovary has not yet been elucidated. In the present study, we have defined the expression of mRNA encoding VEGF-B, VEGF-C, and placenta growth factor (PIGF), compared with that of VEGF mRNA, in normal ovary and a range of ovarian epithelial tumors. Analysis by reverse transcription-PCR indicated that mRNA encoding VEGF (isoforms 121 and 165), VEGF-B (isoforms 167 and 186), and VEGF-C, but not PIGF, were present in all ovarian tissues examined. By in situ hybridization, neither VEGF-C nor PIGF transcripts were detected in any of the samples. The expression pattern of VEGF-B mRNA was generally similar to that of VEGF mRNA, in that transcripts were readily detected in the epithelial cells of all histologic types of ovarian carcinoma, but could not be detected in normal or benign tumor epithelium. Specific differences in the expression of the two genes were noted in areas of tumor necrosis, in which the expression of VEGF mRNA, but not VEGF-B mRNA, was further enhanced, and in a sample in which VEGF-B mRNA was strongly expressed in tumor-associated macrophages that did not hybridize with the riboprobe to VEGF mRNA. These results imply that a second member of the VEGF family, VEGF-B, may play a significant role in the angiogenesis, progression, and maintenance of ovarian carcinomas.

Ca2+ dependence and pharmacology of large-conductance K+ channels in nonlabor and labor human uterine myocytes

Two populations, Ca(2+)-dependent (BKCa) and Ca(2+)-independent K+ (BK) channels of large conductance were identified in inside-out patches of nonlabor and labor freshly dispersed human pregnant myometrial cells, respectively. Cell-attached recordings from nonlabor myometrial cells frequently displayed BKCa channel openings characterized by a relatively low open-state probability, whereas similar recordings from labor tissue displayed either no channel openings or consistently high levels of channel activity that often exhibited clear, oscillatory activity. In inside-out patch recordings, Ba2+ (2-10 mM), 4-aminopyridine (0.1-1 mM), and Shaker B inactivating peptide ("ball peptide") blocked the BKCa channel but were much less effective on BK channels. Application of tetraethylammonium to inside-out membrane patches reduced unitary current amplitude of BKCa and BK channels, with dissociation constants of 46 mM and 53 microM, respectively. Tetraethylammonium applied to outside-out patches decreased the unitary conductance of BKCa and BK channels, with dissociation constants of 423 and 395 microM, respectively. These results demonstrate that the properties of human myometrial large-conductance K+ channels in myocytes isolated from laboring patients are significantly different from those isolated from nonlaboring patients.

Cyclooxygenase-1 and -2 in human placenta and placental bed after normal and pre-eclamptic pregnancies

In pre-eclampsia, the ratio of prostacyclin:thromboxane production rate is decreased favouring the vasoconstrictive thromboxane. One of the rate-limiting steps in prostaglandin synthesis is cyclooxygenase (COX) activity. Therefore, we investigated the expression of COX-1 and COX-2 in human placenta and placental bed. Tissue specimens from the 29th to 40th week of pregnancy were obtained from Caesarean sections after uncomplicated and pre-eclamptic pregnancies before the onset of labour. COX-1 and COX-2 were localized immunohistochemically with the identification of positive cells by double immunofluorescence staining. The protein and mRNA levels were analysed by immunoblotting and quantitative reverse transcriptase-polymerase chain reaction. Expression of both COX-1 and COX-2 could be observed in placenta and placental bed. COX-1-like immunoreactivity was observed in most cell types with strongest staining in macrophages. Only macrophages, endothelium, vascular leiomyocytes and fibroblasts stained positively for COX-2. In placenta, COX-1 and -2 expression was unchanged after pre-eclampsia. In placental bed, protein and mRNA levels of COX-1 were increased in the pre-eclamptic group (P < 0.05), whereas COX-2 expression did not differ significantly from normal pregnancies. An increased expression of COX-1 could be involved in the pathophysiology of pre-eclamptic changes within the placental bed. A therapy with drugs inhibiting COX-1 might be beneficial in this condition.

Evidence-based practice in perioperative nursing: a literature review and suggestions for change

Evidence-based practice (nursing practice that relies on information generated from the results of scientific research) is widely recommended as the method of nursing practice of the future. This is particularly the method of choice in perioperative nursing. In this article the literature on evidence-based practice is reviewed with particular emphasis on the role of the perioperative nurse, research utilization, and barriers to evidence-based practice. Suggestions for change to promote evidence-based practice are also outlined.

Hepatocyte growth factor stimulates motility, chemotaxis and mitogenesis in ovarian carcinoma cells expressing high levels of c-met

A proportion of ovarian carcinomas markedly overexpress the proto-oncogene c-met, which encodes the receptor for hepatocyte growth factor (HGF). HGF may either stimulate or inhibit the multiplication of its target cells, and may also promote motogenesis and morphogenesis. In this study, we established that the ovarian carcinoma-derived cell-line SK-OV-3 expressed about 20-fold higher levels of c-met protein than are expressed by a second line, CH1. This enabled us to test functional consequences of high-level expression of c-met in ovarian carcinoma cells. The addition of HGF to attached cultures of SK-OV-3 cells caused a change to a motile phenotype, that was evident after 4-6 hr and affected essentially all of the cells by 24 hr. When HGF was placed in the lower compartment of a migration chamber, it induced a 17-fold increase in the migration of SK-OV-3 cells to the lower surface of the filter. Finally, HGF stimulated the incorporation of [3H]-thymidine by cultures of SK-OV-3 cells incubated in medium containing either low (0.2%) or full (10%) FCS. None of these responses were obtained when HGF was added to CH1 cells. We conclude that high levels of c-met expression in ovarian cancer cells may lead to a range of responses to HGF that would promote tumour growth and dissemination.

Women's experiences of victimizing sexualization, Part I: Responses related to abuse and home and family environment

Qualitative, interpretive research was conducted with ten adult women who felt that their experiences of learning about themselves as female and sexual had been harmful. The term "victimizing sexualization" was developed to identify this experience, and a thematic description of these women's experiences was derived. Components of their experiences were described within four major categories, including perceptions and descriptions directly related to abuse experiences, home and family environments, community and cultural characteristics, and longer term personal impacts. This article reports on two of the major thematic categories: perceptions and descriptions related to abuse experiences and home and family environment. Findings of this study establish "victimizing sexualization" as a meaningful women's health construct with important connections to feminist perspectives on women's lives.

Women's experiences of victimizing sexualization, Part II: Community and longer term personal impacts

This is the second of a two-part article describing the results of a qualitative study on women's experiences of victimizing sexualization. Ten adult women described their experiences of harmful learning about themselves as female and sexual. A four-part thematic description of women's experiences of victimizing sexualization was derived. This article reports on two of the major categories: community and cultural characteristics and longer term personal impacts. Findings of the study support the feminist position that the enactment of gender itself at social and cultural levels sometimes places women at risk for victimization.

Single versus double insemination: a retrospective audit of pregnancy rates with two treatment protocols in donor insemination

Our objective was to evaluate the effect of a change in treatment protocols, suggested following an inspection visit by the regulatory authority, from single to double inseminations during donor insemination treatment cycles. We therefore conducted a retrospective audit of pregnancy rates in the reproductive medicine clinic of a major teaching hospital. All patients were treated for male factor infertility by donor insemination, without ovulation induction with gonadotrophins between October 1992 and December 1995. The main outcome measures were cumulative conception and live birth rates. During the study period 250 patients underwent treatment and 650 single insemination and 277 double insemination treatment cycles were undertaken. The pregnancy rate per cycle was 0.054 and 0.119 for single and double insemination respectively. After six cycles the cumulative pregnancy rates were 0.28 and 0.47 and the take-home baby rates were 0.25 and 0.37 for single and double inseminations respectively. The change in practice from single to double insemination resulted in a doubling of the pregnancy rate per treatment cycle. Cumulative pregnancy rates after two treatment cycles of double insemination were comparable with those achieved after six cycles of single insemination. These results have significant implications for both patients and purchasers.

Immunoglobulin-like domains define the nerve growth factor binding site of the TrkA receptor

Nerve growth factor (NGF) is involved in the development and maintenance of the nervous system. NGF binds with high affinity to the extracellular region of the tyrosine kinase receptor TrkA. This domain comprises leucine and cysteine rich motifs, followed by two immunoglobulin like (Ig-like) domains. We describe the expression and purification of recombinant Ig-like domains. Fluorescence and circular dichroism spectroscopy show that the protein is folded into a compact globular structure and contains mainly beta-sheet secondary structure. Recombinant protein binds to NGF and can inhibit NGF bioactivity both in vitro and in vivo.

Decreased levels of the potent regulator of monocyte/macrophage activation, interleukin-13, in the peritoneal fluid of patients with endometriosis

Endometriosis is characterized by an increase in the number, activation and secretory activity of peritoneal fluid macrophages. Factors regulating the activation of these cells may be important in the pathophysiology of this disease. In this study we measured by enzyme-linked immunosorbent assay the concentrations of the macrophage inhibitory factor interleukin (IL)-13 in the peritoneal fluid of women with and without endometriosis. It was found that women with endometriosis had significantly lower amounts of IL-13 (95 +/- 9.8 pg/ml) in peritoneal fluid, compared with women without endometriosis (115 +/- 30 pg/ml) (P < 0.01). No cycle-specific variation was evident for either group. Another macrophage inhibitory interleukin (IL-10) was also measured, but no differences between women with (16.1 +/- 13.2 pg/ml) or without (10.3 +/- 5.6 pg/ml) endometriosis were seen. The immunolocalization of IL-13 was assessed in eutopic and ectopic endometrium and in isolated peritoneal fluid cells. Glandular epithelial cells and stromal cells in both eutopic and ectopic endometrium were immunopositive for IL-13. No cycle-specific differences in the immunolocalization of IL-13 were seen. In conclusion, the reduced amounts of IL-13 in the peritoneal fluid of women with endometriosis may lead to a lack of suppression of macrophage activation, thereby contributing to the overall pathogenesis of this disease.

Bilaterality and recurrence rates for lobular breast cancer: considerations for treatment

BACKGROUND

The purpose of this study was to evaluate the tumor biology with respect to bilaterality and recurrence rates for bilateral infiltrating lobular (IL) breast carcinoma in comparison with other histological types.

METHODS

A prospectively accrued data base containing 1,548 breast cancer cases as well as H. Lee Moffitt Cancer Center's cancer registry compiled during the same period were queried for specific features relating to bilaterality and recurrence. The 116 patients in this study had been treated at the Comprehensive Breast Cancer Clinic and had documented bilateral breast cancer (invasive on situ).

RESULTS

Eighty-two of the patients (70.7%) had metachronous breast cancer, and 34 (29.3%) had synchronous cancer. Although median follow-up times were short, the risk of developing breast cancer in the contralateral breast after the diagnosis of cancer in the ipsilateral breast was estimated to be 0.7% per patient-year of follow-up. Recurrence rates for IL cancers were compared with those for invasive ductal (ID) and for ID + IL cancers. IL cancers recurred 8.1% of the time, whereas ID cancers recurred at a rate of 7.8%. Recurrences were equally divided between local and distant sites.

CONCLUSIONS

Although IL cancers have demonstrated insidious behavior, their incidence of bilaterality is only slightly higher than other histologies and their rates of recurrence are low when properly evaluated and treated. The risk to the opposite breast also appears to be low. These data do not support the routine use of blind contralateral biopsy or prophylactic mastectomy.

Isolation of macrophages (Hofbauer cells) from human term placenta and their prostaglandin E2 and thromboxane production

Placental macrophages (Hofbauer cells) are located close to trophoblast cells and fetal capillaries, which makes them ideal candidates for involvement in regulatory processes within the villous core. Their production of various cytokines and prostaglandin (PG) synthesizing enzymes has previously been shown immunohistochemically. Hofbauer cells were isolated from human placenta after term deliveries by Ficoll and Percoll gradient centrifugation. Remaining trophoblast cells were removed with anti-epidermal growth factor (EGF)-receptor-coated Dynabeads followed by differential adherence. The identity of isolated cells was investigated by immunohistochemistry with anti-CD68, which showed that >90% cells were positive. After a 36 h recovery period in either 20% O2 or 5% O2, fresh medium was applied and PGE2 and thromboxane (TXA2) production analysed by enzyme immunoassay at 4, 8, and 24 h. PGE2 and TXA2 were both produced by placental macrophages with PGE2 synthesis being predominant. Concentrations of both could be stimulated by lipopolysaccharide with maximum effect after 24 h. Culture in low oxygen caused decreased PGE2 concentrations, whereas TXA2 production remained unchanged. In conclusion, the presented isolation protocol allows further study of Hofbauer cell function. This study also presents novel findings regarding the prostaglandin production of term Hofbauer cells under normal and hypoxic conditions.