Effect of endothelium-derived relaxing factor inhibition on the umbilical-placental circulation in fetal lambs in utero

Endothelial modulation of vascular tone and 5-hydroxytryptamine-induced responses in human chorionic arteries and veins

1. In vitro studies were undertaken to evaluate the potential role of endothelium through release of vasodilators compounds on basal tension and on vasoconstrictor response induced by 5-hydroxytryptamine (5-HT) in chorionic arteries and veins rings from normotensive gestants. 2. N omega-nitro-L-arginine (100 microM) and methylene blue (10 microM) increased significantly the basal tension in chorionic arteries but not in veins. However, indomethacin (10 microM) inhibited the basal tension in both kinds of vessels. 3. The sensitivity to 5-HT was significantly lower in placental arteries than in veins. Removal of endothelium increased the sensitivity of placental arteries to 5-HT in 2.2-fold; however, in veins denudation had no significant effect. 4. N omega-nitro-L-arginine potentiated the 5-HT-induced tone in both types of vessels, but the increase of contraction was greater in chorionic arteries than in veins. However, indomethacin decreased the 5-HT-induced contractions in arteries and veins. 5. These results indicate that NO is more important than vasodilators prostanoids in the control of vascular tone and in 5-HT-induced placental contractile response.

Nitric oxide inhibition causes intrauterine growth retardation and hind-limb disruptions in rats

OBJECTIVE

Our purpose was to determine the effects of nitric oxide synthase inhibition on maternal and fetal health in the last third of pregnancy.

STUDY DESIGN

Pregnant rats were treated from gestational day 13 to day 19 or 20 with the nitric oxide synthase inhibitor NG-nitro-L-arginine methyl ester, which was administered in the drinking water ad libitum. Control animals received the inactive enantiomer NG-nitro-D-arginine methyl ester or no treatment. Maternal blood pressure, blood chemistry studies, and placenta and pup size were determined. A separate group of rats received nitroprusside sodium in conjunction with NG-nitro-L-arginine methyl ester.

RESULTS

NG-nitro-L-arginine methyl ester caused a dose-dependent reduction in placenta and pup size. Amniotic fluid levels of cyclic guanosine monophosphate were significantly reduced at 0.1 mg/ml but not at higher doses. Hemorrhagic necrosis of fetal hind limbs occurred only with treatment with NG-nitro-L-arginine methyl ester and was prevented by coadministration of nitroprusside sodium. Maternal blood pressure and blood and urine chemistry studies were unaffected by NG-nitro-L-arginine methyl ester.

CONCLUSION

Chronic reductions of nitric oxide production in the last third of pregnancy result in significant intrauterine growth retardation and hemorrhagic disruptions of hind limbs. Maternal complications were minimal and did not mimic preeclampsia.

Interleukin-10 in amniotic fluid at midtrimester: immune activation and suppression in relation to fetal growth

OBJECTIVE

Low birth weight remains the leading cause of perinatal morbidity and mortality, but mechanisms mediating impaired fetal growth are poorly understood. To further define the role of abnormal immune activation and suppression in mediating impaired fetal growth, we measured levels of interleukin-10, a potent immunosuppressive cytokine not previously identified in association with pregnancy, in amniotic fluid samples obtained at genetic amniocentesis.

STUDY DESIGN

In a case-control study with an enzyme-linked immunoassay we compared amniotic fluid levels of interleukin-10 in midtrimester samples obtained from appropriate-for-gestational age (n = 42) and small-for-gestational-age (n = 24) pregnancies.

RESULTS

Interleukin-10 levels in small-for-gestational-age samples were elevated (median 78 pg/ml) compared with levels in control samples (median < 40 pg/ml), p = 0.02. In small-for-gestational-age pregnancies elevated levels were associated with nulliparity, p = 0.003.

CONCLUSION

Our data support the role of abnormal immune activation, as opposed to inadequate immune suppression, in mediating impaired fetal growth.

Properties of a lactate-induced relaxation in human placental arteries and veins

OBJECTIVE

Our purpose was to determine the vasoactive effects and mechanism of action of lactate in human placental vessels by means of isometric muscle bath studies.

STUDY DESIGN

Isolated 1 to 2 mm human placental arteries and veins from normal term pregnancies, precontracted with prostaglandin F2 alpha and incubated under a PO2 of approximately 35 torr were exposed to lactate, 1 to 10 mmol/L, (pH 7.4), pyruvate, hydrogen peroxide, nitroglycerin, or forskolin. The effects of endothelium removal or inhibitors of cyclooxygenase (indomethacin 10 mumol/L) and L-arginine metabolism (nitro-L-arginine 30 mumol/L) on the response to lactate and the effects of an antagonist of guanylate cyclase activation (methylene blue 10 mumol/L), cyanide (1 mmol/L), and hypoxia (PO2 8-10 torr) on responses to all agents were determined by analysis of variance and t test statistics.

RESULTS

Lactate-elicited dose-dependent relaxation was not inhibited by endothelium removal, indomethacin, or nitro-L-arginine but was attenuated by methylene blue, cyanide, and hypoxia. Relaxation to hydrogen peroxide was inhibited by methylene blue and cyanide but not hypoxia. Relaxation to nitroglycerin was inhibited only by methylene blue, and relaxation to forskolin was not inhibited by these probes. Pyruvate did not produce a significant relaxation.

CONCLUSIONS

These findings suggest that lactate causes relaxation in the human placental vessels by an oxygen and cyclic guanosine-3':5'-monophosphate-dependent mechanism, which may involve the generation of hydrogen peroxide but not the metabolism of arginine. Lactate-induced dilatation may be of importance during labor and in situations of acute and chronic fetal hypoxia.

The effect of cordocentesis on umbilical and middle cerebral artery blood flow velocity waveforms

OBJECTIVE

To investigate the effect of cordocentesis on the umbilical and fetal cerebral circulation.

DESIGN

Cross sectional study.

SETTING

Department of Obstetrics and Gynaecology, Regional Referral Centre for Fetal Medicine, Klagenfurt Hospital, Austria.

SUBJECTS

Thirty pregnant women undergoing diagnostic cordocentesis at 18 to 38 weeks' gestation.

INTERVENTIONS

The pulsatility index (PI) in the umbilical artery and fetal middle cerebral artery was measured by pulsed Doppler ultrasound before and immediately after cordocentesis.

MAIN OUTCOME MEASURES

Change in umbilical artery PI and middle cerebral artery PI.

RESULTS

Cordocentesis was associated with a significant decrease in both umbilical artery PI (median -0.18, range -2.21 to 1.5, P < 0.004) and middle cerebral artery PI (mean -0.15, SD 0.32, P < 0.03) and the decrease in umbilical artery PI was most marked when cordocentesis was performed transplacentally. In four cases, there were absent or reversed frequencies at the end of diastole (EDF) in the umbilical artery before cordocentesis, and in all cases there were positive EDF after the procedure. In contrast, one of the 26 cases with positive EDF developed reversed EDF following the procedure.

CONCLUSIONS

Acute alterations in the waveforms from both the umbilical and fetal cerebral circulation can be induced by cordocentesis. The decrease in resistance in the fetoplacental circulation could be attributed to the release of vasodilators, and the increase in resistance observed in some cases could be secondary to arterial vasospasm. Better understanding of the underlying mechanisms might help in making cordocentesis a safer procedure.

Nitric oxide regulates the expression of vasoconstrictors and growth factors by vascular endothelium under both normoxia and hypoxia

The mechanisms by which hypoxia causes vasoconstriction in vivo are not known. Accumulating evidence implicates the endothelium as a key regulator of vascular tone. Hypoxia induces the expression and secretion of endothelin-1 (ET-1), a potent vasoconstrictor in cultured human endothelial cells. We report here that nitric oxide (NO), an endothelial-derived relaxing factor, modifies this induction of ET-1. Whereas low oxygen tension (PO2 = 20-30 Torr) increases ET-1 expression four- to eightfold above that seen at normal oxygen tension (PO2 = 150 Torr), sodium nitroprusside, which releases NO, suppresses this effect. This inhibition of hypoxia-induced ET-1 expression occurs within the first hour of exposure of cells to sodium nitroprusside. Moreover, when the endogenous constitutive levels of NO made by endothelial cells are suppressed using N-omega-nitro-L-arginine, a potent competitive inhibitor of NO synthase, the baseline levels of ET-1 produced in normoxic environments are increased three- to fourfold. The effects of hypoxia and the NO synthase inhibitor on ET-1 expression are additive. The regulation of ET-1 production by NO appears to be at the level of transcription. Similar effects of NO were observed on the expression of the PDGF-B chain gene. PDGF-B expression was suppressed by NO in a hypoxic environment and induced by N-omega-nitro-L-arginine in both normoxic and hypoxic environments. These findings suggest that in addition to its role as a vasodilator, NO may also influence vascular tone via the regulated reciprocal production of ET-1 and PDGF-B in the vasculature.

Nitric oxide and prostacyclin inhibit fetal platelet aggregation: a response similar to that observed in adults

OBJECTIVE

We evaluated the relative importance of two endothelium-derived substances, prostacyclin and nitric oxide, in their ability to inhibit aggregation of fetal and maternal platelets.

STUDY DESIGN

The effects of various concentrations of prostacyclin and S-nitroso-N-acetylpenicillamine (which releases nitric oxide) on platelet aggregation were studied by means of platelet-rich plasma from at least five to six subjects per group. Fetal blood was collected from umbilical vein at delivery. Maternal venous blood was collected within 4 hours of delivery. Platelet aggregation was monitored with a platelet aggregation profiler. Adenosine diphosphate was used as the aggregating agent. Statistical differences between means were evaluated with two-way analysis of variance or Student t test.

RESULTS

Prostacyclin and S-nitroso-N-acetylpenicillamine inhibited aggregation of fetal and maternal platelets, but prostacyclin was more potent. Fetal platelets were more sensitive than maternal platelets to prostacyclin and S-nitroso-N-acetylpenicillamine.

CONCLUSION

Prostacyclin appears to be more important in preventing aggregation of platelets in the feto placental circulation.