Complement-inhibiting activity of human seminal plasma and semen quality

Human seminal plasma (SP) contains potent complement inhibitors. This study examined the complement-inhibiting activity of individual SP samples from 118 patients with infertility and analyzed them in relation to various semen parameters. When 25% complement-inhibiting activity was considered the cut off value, less than 1 SD unit from the mean percentage of inhibition of SP samples with normal semen quality, 32 samples (27%) showed low inhibiting activity. Among the lower group, incidences of patients with asthenozoospermia (66%) and oligozoospermia (31%) were significantly (p < .01) higher than those (36 and 10%) in the group whose SP showed significant inhibiting activity. Partial characterization revealed that the component responsible for complement inhibition was heat labile, trypsin resistant, high molecular weight (>10 kD) glycoprotein that can inhibit alternative as well as classical complement pathways. Furthermore, since in the majority of SP samples the anticomplementary activity was blocked by monoclonal antibody against membrane cofactor protein (MCP) or decay accelerating factor (DAF), the complement-inhibiting factors that were identified are likely to be MCP and/or DAF, which are known to be present in human SP. These results suggest that complement-regulatory proteins in SP such as MCP and DAF may protect sperm cells against complement attack in the male reproductive tract.

Inducible nitric oxide synthase in uterine smooth muscle

The expression of inducible nitric oxide synthase (iNOS) mRNA in rat uterus upon in vivo stimulation with lipopolysaccharide (LPS) was studied by reverse transcription and polymerase chain reaction. The injection of LPS induced an increase in mRNA levels of a macrophage-type iNOS. In unstimulated rats, low levels of iNOS mRNA was detected in the uterus and lungs, but absent or negligible in the kidneys and liver. NO was produced in the LPS-treated uterus by addition of 1 to 1000 microM L-arginine. The production of NO in uterine tissue that faces the outside of the body may provide a bacteriocidal protective function against microorganisms in physiological condition. However, NO produced in a large amounts by cytokine and LPS may play some pathological reaction during septic shock or infection.

Effect of prostaglandin E1 on ammonia concentration in blood of patients with hepatic resection

Plasma concentrations of ammonia were examined following prostaglandin E1 (PGE1) administration in 16 patients who received hepatectomy for hepatocellular carcinoma. PGE1 at 0.01-0.04 microgram/kg/min was administered for approximately 24 hr during the perioperative periods. The ammonia concentration was reduced a day after the operation following intravenous administration of PGE1 in cirrhotic patients compared to noncirrhotic patients with or without PGE1 injection. Serum liver function scores, glutamic pyruvic transaminase, and total bilirubin concentrations were decreased after PGE1 administration. A similar ammonia response due to PGE1 was obtained after operation in cirrhotic patient when PGE1 0.5 microgram/kg was administered intravenously for 30 min. These results suggest that PGE1 administration is useful in reducing the enhanced ammonia concentration associated with hepatic resection, and it is particularly effective in the case of liver cirrhosis.

[The effect of ACE inhibitors, beta blockers and calcium antagonists on the responses to pressor stress tests in the elderly hypertensive patients]

The purpose of the study was to elucidate the effects of antihypertensive drugs on the hemodynamics in elderly hypertensive patients. Forty-two elderly hypertensives (mean 72 +/- 5 years) were given either ACE inhibitors (A group: perindopril in 10 and captopril in 4 cases), beta blockers (B group: arotinolol in 15 cases) or calcium antagonists (C group: nifedipine in 3 and nitrendipine in 10 cases) for 8-12 weeks. The responses to handgrip and mental arithmetic stress and cardiac functional changes were determined by echocardiography before and after the medications. The decrease in blood pressure at rest and on the stress tests was similar among the three groups, though the hemodynamic responses to the stress tests showed some differences. In the A group, no hemodynamic changes were seen either at rest or on the stress tests after the medication. In the B group, the heart rate and the cardiac output were decreased at rest, and the increase of them on the stress tests were diminished after the medication. On the contrary, the heart rate and the cardiac output were increased, and showed exaggerated responses on the stress tests in the C group. In conclusion, in antihypertensive treatment of elderly hypertensive patients it is important to consider the effects of the antihypertensive drugs on the hemodynamics, although the comparable decrease in blood pressure is expected.

Arachidonate 12-lipoxygenase in porcine anterior pituitary cells: its localization and possible function in gonadotrophs

Arachidonate 12-lipoxygenase, which oxygenates positions 12 and 13 of arachidonic and linoleic acids, is present in porcine anterior pituitary cells. Colocalization of the 12-lipoxygenase with various pituitary hormones was examined by immunohistochemical double-staining using antibodies against 12-lipoxygenase and various anterior pituitary hormones. Under light microscopy, approximately 7% of the cells producing luteinizing hormone (LH) and follicle-stimulating hormone (FSH) were positive for 12-lipoxygenase, whereas the enzyme was detected in less than 2% of the cells producing thyrotrophin, prolactin, growth hormone (GH), and adrenocorticotrophin. In an attempt to examine the participation of 12-lipoxygenase metabolites in pituitary hormone release, we incubated the primary culture of porcine anterior pituitary cells with 12-hydroperoxy-arachidonic acid or 13-hydroperoxy-linoleic acid. Significant stimulation of LH and FSH release by these hydroperoxides was observed at 10 microM in a time-dependent manner. At doses around 10 microM these compounds produced responses of similar magnitude to 1 nM gonadotrophin-releasing hormone (GnRH), but higher concentrations (30 microM) of the compounds were required for GH release. In contrast, 12-hydroxy-arachidonic and 13-hydroxy-linoleic acids were almost ineffective. Furthermore, the gonadotrophin release by 1 nM GnRH was inhibited by nordihydroguaiaretic acid (a lipoxygenase inhibitor) with an IC50 of about 5 microM. Thus, the hydroperoxy (but not hydroxy) products of 12-lipoxygenase may be involved in the release of pituitary hormones especially LH and FSH.

Identification and localization of immunoglobulin binding factor in bronchoalveolar lavage fluid from healthy smokers

Immunoglobulin binding factor (IgBF), which is abundant in human seminal plasma, is known to bind immunoglobulin, interact with anti-Fc gamma RIII antibodies, and block pokeweed mitogen (PWM)-stimulated lymphocyte blastogenesis. In this study, we investigated whether IgBF is present in the lower respiratory tract, whose secretions come into contact with the external environment. For this, IgBF was measured in brochoalveolar lavage fluid (BALF) from 42 healthy normal subjects (23 nonsmokers and 19 smokers) by enzyme-linked immunosorbent assay (ELISA). IgBF was detected in BALF from these normal subjects, and its level was significantly higher in BALF from smokers (127.2 +/- 98.7 ng/ml versus 23.3 +/- 20.7 ng/ml). On gel filtration chromatography of BALF, IgBF was eluted in a region corresponding to a molecular weight of 27 kD. Western blot testing with a monoclonal antibody to IgBF indicated that IgBF in BALF had a molecular weight of 27 kD under nonreducing conditions and of 16 kD under reducing conditions. Thus, the migration pattern of IgBF in BALF corresponded to that of IgBF in seminal plasma. IgBF immunoreactivity was detected histochemically in mucus glands and goblet cells in the lower respiratory tract. These results demonstrate that IgBF is present in the lower respiratory tract, and that smoking may cause its increased production in this region.

Usefulness of recombinant human prolactin for treatment of poor puerperal lactation in a rat model

Recombinant human prolactin (r-hPRL) was produced by a line of murine C127 cells transfected with human PRL gene. To assess the biological efficacy of r-hPRL in vivo, we studied its influence on milk secretion using a rat model in which lactation was reduced by bromocriptine treatment. Puerperal rats were injected daily for 9 days after delivery with bromocriptine or bromocriptine plus r-hPRL, and lactational performance was assessed by weighing the pups. The concentrations of rat and human PRL in rat serum were measured by specific radioimmunoassays and the mammary glands were examined on postpartum day 10. Daily injection of bromocriptine (0.1 mg/rat) significantly reduced the endogenous level of rat PRL and impaired the weight gain of the pups. Administration of r-hPRL increased the serum level of human PRL. Daily injections of r-hPRL (50 micrograms/rat, twice a day) restored lactational performance and significantly increased the weight of the pups. The detrimental effect of bromocriptine on the mammary glands, assessed by both weight and histological appearance, was reversed by administration of r-hPRL. These results demonstrate that r-hPRL is biologically active in vivo and replacement therapy of r-hPRL is effective in improving the lactational performance in bromocriptine-treated rats, and also that r-hPRL may be useful for the treatment of women with poor lactation.

The liver regenerative response elicited by antisecretory agents in partially hepatectomized rats: a comparison between omeprazole and famotidine

Liver regeneration after omeprazole (OMP) or famotidine (FAM) administration was examined in 66% hepatectomized rats. The regeneration was evaluated by the liver weight as a percentage of body weight (LRR) and the proportion of hepatocytes in mitosis per 1,000 counts (MI). Administration of OMP 0.4 mg/kg per day for 3 or 7 days suppressed LRR and MI 3 and 7 days after hepatectomy. However, the administration of FAM 0.8 mg/kg per day for 3 or 7 days did not change either LRR or MI. Increased gastrin levels in the blood were seen only after OMP administration. The food intake was unchanged by OMP or FAM, but FAM increased water intake. The liver functional score, glutamic pyruvic transaminase and alkaline phosphatase in the blood all increased with OMP, but FAM had no apparent effect on the hepatic or renal function. These observations suggest that a large dosage of OMP suppresses liver regeneration, while FAM appears to have no meaningful effect on regeneration.

Induction of single ovulation by sequential follicle-stimulating hormone and pulsatile gonadotropin-releasing hormone treatment

OBJECTIVE

To induce single follicular ovulation by sequential treatment with FSH and pulsatile GnRH.

DESIGN

Prospective study.

PATIENTS

Eighteen hypogonadotropic anovulatory patients.

INTERVENTIONS

In sequential treatment, daily FSH injection was switched to pulsatile GnRH administration (20 micrograms/120 minutes SC) when the follicle diameter reached 11 mm. In conventional FSH treatment, daily FSH injection was continued. In both cycles, hCG was given when the diameter of the dominant follicle reached 18 mm.

MAIN OUTCOME MEASURES

Developed follicle numbers and serum FSH concentrations during treatment.

RESULTS

Single follicular development was achieved in 80.0% of cycles by sequential treatment but in no cycle by conventional FSH treatment. The number of developed follicles was 1.26 +/- 0.55 (mean +/- SD) on sequential treatment and 3.94 +/- 1.48 on conventional FSH treatment. Preovulatory FSH level was significantly lower on sequential treatment than on conventional FSH treatment (5.26 +/- 1.80 versus 11.55 +/- 3.43 mIU/mL [conversion factor to SI unit, 1.00]).

CONCLUSION

The sequential treatment achieved single follicular development without complications. The sequential FSH-pulsatile GnRH treatment may offer a better chance for development of a single dominant follicle and ovulation.

[Assessment of serum estrogen levels by RIA with HPLC during hormone replacement therapy]

We studied the serum estradiol and estrone levels in 146 peri and postmenopausal women, and in 38 women who had complained of various climacteric disturbance symptoms during daily hormone replacement therapy (HRT) with conjugated equine estrogen (CEE) 0.625 mg and medroxyprogesterone acetate (MPA) 2.5 mg. Serum estradiol and estrone were measured before treatment, and at 6 months, and after one year of the HRT therapy by HPLC-radioimmunoassay. In 146 peri and postmenopausal women, the serum level of estradiol was from 3 to 6pg/ml. The serum level of estradiol in 38 women after HRT significantly increased (p < 0.01) from 3.34 to 23.6 pg/ml at 6 months, and 21.5 pg/ml at 12 months. The serum level of estrone significantly increased (p < 0.01) from 26.6pg/ml to 156.7pg/ml at 6 months, and 137.2pg/ml at 12 month. These results are very useful for deciding on the doses of hormones and the expected serum estradiol level in HRT for Japanese women.

Prostaglandin E1 increases indocyanine green disappearance rate in patients with chronic liver disease

The plasma disappearance rate of indocyanine green was examined after prostaglandin E1 administration in 11 patients with chronic liver disease. The patients were divided into two groups according to the presence (n = 6) or absence (n = 5) of liver cirrhosis. Indocyanine green (0.1 mg/kg) was introduced as an intravenous bolus 5 min after prostaglandin E1 administration and the disappearance rate of indocyanine green (ICG-K) was determined by a finger-monitoring method. Saline was injected as the control. Prostaglandin E1 administration increased ICG-K, and this response was dose dependent when the prostaglandin E1 dose ranged from 0.01 to 0.05 micrograms/kg/min. When ICG-K after prostaglandin E1 relative to the ICG-K after saline (the control) was defined as the ICG-K ratio, the ICG-K ratio in the liver cirrhosis group was higher than that in the group without cirrhosis. These findings suggest that prostaglandin E1 increases the ICG-K of patients with chronic liver disease, and that this is strongest in patients with liver cirrhosis.

Increase of intracellular free [Ca2+] in single human motile spermatozoa treated with human follicular fluid

The intracellular free [Ca2+] concentration ([Ca2+]i) in individual human sperm was measured using a fluorescent Ca2+ indicator. In 18 of 23 motile sperm (78.3%), [Ca2+]i increased significantly and promptly after addition of 20% human follicular fluid (hFF), but in the others it did not increase. The mean resting [Ca2+]i level of sperm in which [Ca2+]i increased after addition of 20% hFF (the influx group) was significantly lower than those in which it did not increase (112.8 +/- 40.1 nM vs. 156.9 +/- 13.5 nM, p < .05). After addition of 20% hFF, the mean [Ca2+]i in the influx group reached a peak value of 210.7 +/- 24.7 nM within 30 s and then decreased slowly; the mean [Ca2+]i values 1, 5, 10, and 15 min after addition of 20% hFF were 179.3 +/- 31.4, 174.3 +/- 30.2, 172.5 +/- 27.8, and 175.1 +/- 27.2 nM, and all values were significantly higher than the resting level (p < .01). The frequency distribution of [Ca2+]i after addition of 20% hFF was shifted toward higher concentrations (p < .01). However, the addition of 20% hFF did not increase the percentage of live acrosome reaction (before 3.8 +/- 0.9% vs. after 2.9 +/- 0.5%, respectively). Thus, hFF increased [Ca2+]i in about 80% of the motile sperm. Relatively high [Ca2+]i levels persisted for at least 10-15 min after its addition. However, hFF did not trigger a rapid response in acrosome reaction.

Uterine artery Doppler velocimetry in relation to trophoblast migration into the myometrium of the placental bed

OBJECTIVE

To test the hypothesis that an abnormally high resistance in the uterine artery indicates impaired trophoblast migration into the myometrium of the placental bed.

METHODS

Doppler velocimetry in the uterine artery was carried out in 43 pregnant women within 7 days before cesarean delivery and placental bed biopsy. A pathologist evaluated the placental bed biopsies histologically. Trophoblast migration was absent in 28 cases (impaired migration group) and present in 15 (migration group). Clinical characteristics were compared between these two groups.

RESULTS

There was no significant difference in the mean gestational ages at delivery in the two groups, but those with impaired migration included a higher incidence of small for gestational age infants (46.4 versus 6.7%, P < .01) and a lower mean (+/- standard deviation) birth weight (1622 +/- 528 versus 2287 +/- 748 g, P < .01). The systolic-diastolic ratio (S/D) in the uterine artery was higher in the impaired migration group (2.45 +/- 0.81 versus 1.92 +/- 0.34, P < .05). The absence of migration could be deduced from the S/D of the uterine artery, with a predictive value of 92.3% when we set the cutoff value of the ratio at 2.5.

CONCLUSION

The results suggest that abnormal uterine artery flow velocity waveforms may indicate impaired trophoblast migration into the myometrium of the placental bed.

[Usefulness of the combined transfusion of autologous blood as pre-deposited and preoperatively diluted in gynecological surgery]

To eliminate the risks involved in homologous blood transfusion in gynecological surgery, we studied the effect of the combined transfusion of autologous blood as predeposited and preoperatively diluted. Thirty-nine cases were operated on and studied. In 27 cases, a total of 695 ml/person of autoblood was taken during the 15 preoperative days. In 39 cases, an average of 1,038 ml/person of autoblood was collected at the beginning of surgery. In 37 out of 39 cases, we were able to avoid homologous blood transfusion. In the remaining two cases with homologous blood transfusion, although more than 3,000 ml of operative blood loss was observed, only about 700 ml of homologous blood was needed. We did not find any serious side effect with autoblood transfusion. These results demonstrate the usefulness of the combined transfusion of autologous blood as predeposited and preoperatively diluted in gynecological surgery.

Noticeable hyperbilirubinemia following major hepatectomy in patients with biliary tract carcinoma

Serum bilirubin concentrations were examined in patients who received hepatectomy for biliary tract carcinoma. They were divided into two groups according to the presence or absence of preoperative obstructive jaundice (POJ): the POJ group (n = 14) and non-POJ group (n = 10). The POJ group underwent percutaneous transhepatic drainage to delineate jaundice before definitive surgery. Total bilirubin concentration in the POJ group had increased at 1, 3, 5, 7 and 14 days after operation compared to the non-POJ group; the direct bilirubin level had increased at 1, 3, 5 and 7 days, and the indirect bilirubin level had increased at 1 and 3 days. Liver functional data before and 14 days after the operation were similar for the two groups. The incidence of cholangitis was higher in the POJ group than in the non-POJ group. Blood loss was greater in the POJ group than in the non-POJ group. The morbidity rate in the POJ group was higher than that in the non-POJ group. These results suggest that characteristic hyperbilirubinemia developed after major hepatectomy in patients with biliary tract carcinoma, and the bilirubin response is evoked by underlying preoperative biliary passing disturbance.

Identification of activins and follistatin proteins in human follicular fluid and placenta

Follistatin, an activin-binding protein, is able to neutralize the various activities of activin by forming an inactive complex with it. The widespread tissue localization of follistatin is very similar to that of activin, which suggests that it plays a local modulatory role in the various paracrine/autocrine actions of activin. We detected significant activin-binding activities in human follicular fluid and placental homogenates, although they were much lower than those in porcine and bovine follicular fluids, which raised the possibility that follistatin is present in human follicular fluid and placenta. Therefore, we attempted to identify the protein molecules responsible for this activin-binding activity in human follicular fluid and placental homogenates. Human follicular fluid, collected from in vitro fertilization patients, was processed by affinity chromatography successive steps on sulfated gel matrices and reverse phase high performance liquid chromatography (HPLC). The final HPLC yielded abundant follistatin and almost equimolar amounts of activin-A, -AB, and -B. The follistatin protein showed characteristic multiple bands when analyzed using sodium dodecyl sulfate-polyacrylamide gel electrophoresis. The ability of each band to bind activin specifically was determined by activin binding assay and ligand blotting analysis. Several pieces of evidence, including the immunoblotting analysis and functional assay results, demonstrated the presence of three activin isoforms, A, AB, and B, in the follicular fluid. In contrast, human placental homogenates were found to contain follistatin and activin-A proteins only. Activin-AB and -B were not detected in any HPLC fraction, indicating that activin-A is the major form of activin in the human placenta. The present data indicate that the three activin isoforms and multiple forms of follistatin exist in human follicular fluid, and the activin-A isoform and follistatin exist in human placenta. They suggest that the physiological functions of the activin isoforms during embryonic development differ and that follistatin plays a functional role in the local control system(s) that regulates human reproduction.

Analysis of carbohydrate-intolerant profiles of mothers with normal glucose tolerance tests and their large for gestational age neonates

OBJECTIVE

To examine endocrine states of mothers with normal 75-g oral glucose tolerance tests (GTTs) who gave birth to large for gestational age (LGA) neonates (group I) and to examine those neonates.

METHODS

We examined plasma glucose levels and serum immunoreactive insulin responses after the 75-g oral GTT was given to group I mothers (N = 34), mothers with an abnormal oral GTT who gave birth to LGA neonates (group II, N = 21), and those with normal oral GTTs having appropriate for gestational age neonates (group III, N = 173). We also examined the infants, checking neonatal birth weight, levels of immunoreactive insulin and C-peptide immunoreactivity in cord sera at birth and the lowest blood sugar level after birth to see if a correlation existed between them.

RESULTS

Group I and II mothers showed higher titers in plasma glucose levels and remarkably enhanced ratios of 60- to 30-minute immunoreactive insulin values (immunoreactive insulin up-ratio) after load compared with those of group III mothers. Cord serum immunoreactive insulin and C-peptide immunoreactivity were significantly higher and the lowest blood sugar level was significantly reduced in group I and II neonates compared with those in group III. We observed a positive correlation between cord serum immunoreactive insulin, C-peptide immunoreactivity, and birth weight, but a negative correlation between cord serum immunoreactive insulin, birth weight, and the lowest blood sugar level in group I and II neonates (strongest tendency in group II), but not in group III neonates.

CONCLUSION

All of the abnormal carbohydrate metabolic responses in group I mothers and neonates may result in the promotion of growth in LGA fetuses similar to group II, but to a lesser extent. Identification of group I mothers by the immunoreactive insulin up-ratio after oral GTT will help predict the occurrence of LGA neonates and their possible hypoglycemia.

Gastric acid secretion caused by gastrin-17 injection into both sides of the hypothalamic paraventricular nucleus in rats

Gastric acid outputs were examined after gastrin-17 (gastrin) injection into either side of the hypothalamic paraventricular nucleus (PVN) or both sides of the PVN in bilaterally adrenalectomized rats. The acid output increased when 40 pM gastrin was unilaterally injected (10 s, 500 nl) into the PVN through a 28-gauge stainless steel tube. The acid output was also increased when 80 pM gastrin was iontophoretically injected (2 min, -50 nA) into the PVN through a glass tube. An additive increase in the acid output was elicited when an effective concentration of gastrin was simultaneously injected into both sides of the PVN. It was also noted that there was a significant increase in acid output when an ineffective concentration of gastrin was simultaneously injected into both sides of the PVN. Almost the same magnitude of acid response due to PVN gastrin was reproduced in normoglycemia, but it was diminished in hyperglycemia. These results suggest that PVN neurons sensitive to gastrin form a neural circuit in both sides of the nucleus, and the circuit acts to potentiate the stimulation of gastric acid which is dependent on the glycemic condition.

High implantation rate and consequently high pregnancy rate by in vitro fertilization-embryo transfer treatment in infertile women with antisperm antibody

OBJECTIVE

To examine the effect of antisperm immunity on postfertilization steps, such as implantation of embryos and fetal growth in IVF-ET treatment of women with sperm-immobilizing antibodies.

DESIGN

Retrospective analysis of clinical laboratory data.

SETTING

The IVF-ET program of the Department of Obstetrics and Gynecology. The University of Tokushima, School of Medicine.

PATIENTS

Eighteen women with sperm-immobilizing antibodies and 122 infertile patients with nonimmune etiology as controls. Infertile couples due to a male factor and with unknown etiology were excluded.

INTERVENTIONS

All patients received the same IVF-ET program with GnRH agonist.

MAIN OUTCOME MEASURES

Rates of fertilization and cleavage, implantation rate per embryo transferred and pregnancy rate (PR) in both test and comparison groups.

RESULTS

The rate of fertilization in the antisperm group (61.3%) was significantly lower than that in the comparison group (76.8%). But the implantation rate per embryo transferred (23.5%) and consequently the modified PR per oocyte recovery procedure (34.4%) in immunologically infertile women were significantly higher than those in the comparison group (7.9% and 17.8%, respectively).

CONCLUSIONS

Although sperm-immobilizing antibodies prevent sperm-egg interaction, they do not seem to have any adverse effects on achievement of pregnancy. Moreover, the existence of antisperm immunity in woman with antisperm antibodies is suggested to be favorable for successful pregnancy by the IVF-ET procedure.

Activation of K+ channels by ritodrine hydrochloride in uterine smooth muscle cells from pregnant women

This study investigated the mechanism of activation of K+ channels by ritodrine hydrochloride in human myometrial smooth muscle cells. The patch-clamp technique was used for recording single channel currents. Ritodrine (10(-5) M) activated two types of K+ channels in cultured uterine smooth muscle cells from pregnant women: the Ca(2+)-activated K+ (KCa) channel and the ATP-sensitive K+ (KATP) channel. Forskolin (10(-4) M), an activator of adenylate cyclase, and protein kinase A activated the KCa channel. In addition, 10(-4) M GTP activated the KCa channel in inside-out patches using a pipette containing 10(-5) M ritodrine. The KATP channel was activated by protein kinase A, but not by 10(-4) M GTP. The beta-adrenoceptor agonist ritodrine activates two types of K+ channels: the KCa channel via direct gating by GTP-binding proteins and possibly via cAMP-dependent phosphorylation, and the KATP channel possibly via cAMP-dependent phosphorylation. These mechanisms partially explain the relaxing effect of ritodrine hydrochloride.