Human pregnancy-associated plasma proteins during the postpartum period

Pregnancy-associated plasma protein A (PAPP-A) and preeclampsia

Pregnancy-associated plasma protein A (PAPP-A) is a key regulator of insulin-like growth factor bioavailability essential for normal fetal development. In maternal blood, this protein increases with gestational age and then rapidly decreases after delivery. It is routinely used for Down syndrome screening in the first trimester of pregnancy, and its decrease compared to a normal pregnancy indicates an increased risk for both chromosomal anomalies and adverse pregnancy outcomes. It belongs to a group of biomarkers that predict later preeclampsia development, primarily early onset preeclampsia; however, it should be combined with a Doppler ultrasonography of the uterine artery (pulsatile index) and other biochemical and maternal factors to achieve a higher detection rate with an acceptable false positivity rate. Some studies have demonstrated an even more pronounced decrease of PAPP-A in the early second trimester of pregnancy in women who subsequently develop preeclampsia compared with women who do not develop preeclampsia. Conversely, during the last trimester of pregnancy, its concentration increases even more in patients with preeclampsia than in patients without. It is also detectable at very low levels in nonpregnant individuals, and a higher concentration indicates an adverse effect in patients with acute coronary syndromes or stable atherosclerotic disease and in patients with end-stage renal disease who are being treated with hemodialysis.

Effect of polyols and salts on the acid-induced state of human placental cystatin

Polyols (glycerol and sorbitol) and salts (magnesium sulfate, sodium sulfate, and magnesium chloride) have been used to study the refolding of the acid-induced state of human placental cystatin (HPC), which is a low molecular weight (12,500 daltons) thiol proteinase inhibitor, in terms of CD spectroscopy, binding of hydrophobic dye 1-anilinonaphthalene-8-sulfonic acid (ANS), and intrinsic fluorescence measurements. The helical content of acid-denatured HPC increased with increase in glycerol concentration (0-80%). At 80% glycerol concentration, the secondary structural features observed in the far UV-CD region are similar to those of the native state (pH 6.0). The intrinsic fluorescence and near UV-CD studies showed that this 80% glycerol-induced state has a significant amount of tertiary structure with decreased ANS binding compared to the acid-denatured state. It was found that glycerol is more effective in stabilizing the acid-denatured state of HPC as compared to sorbitol. Among salts the stability effect was more for MgCl(2) (used up to concentration of 3 M) compared to MgSO(4) and Na(2)SO(4) (used up to the concentration of 1.5 M due to restricted solubility of HPC at higher sulfate salt concentrations) as determined by CD studies and fluorescence measurements, which showed secondary and tertiary structural resemblance of this MgCl(2)-induced state close to native state and showed overall spectral features in between the native state and the acid-denatured state. This MgCl(2) (3 M)-induced state showed decreased ANS fluorescence as compared to the acid-denatured state but more than that of the native state. The results taken together suggest that the acid-denatured state of HPC in the presence of 80% glycerol or 3 M MgCl(2) has a conformation in between that of the native state (pH 6.0) and the acid-induced state at pH 2.0.

Molten globule state of human placental cystatin (HPC) at low pH conditions and the effects of trifluoroethanol (TFE) and methanol

Acid-induced conformational changes were studied in human placental cystatin (HPC) in terms of circular dichroism (CD) spectroscopy, the binding of hydrophobic dye 1-anilinonapthalene-8-sulphonic acid (ANS), and intrinsic fluorescence measurements. Our results show the formation of an acid-induced molten globule state at pH 2.0, with significant secondary and tertiary interactions that resemble the native state, exposed hydrophobic regions and the effects of trifluoroethanol (TFE) and methanol in conversion of the acid-denatured state of HPC to the alcohol-induced state, which is characterized by increased helical content, disrupted tertiary structure, and the absence of hydrophobic clusters. Alcohol-induced formation of α-helical structures at pH 2.0 is evident from the increase in the ellipticity values at 222 nm, with native-like secondary structural features at 40% TFE. The increase in helical content was observed up to 80% TFE concentration. The ability of TFE (40%) to refold acid-denatured HPC to native-state conformation is also supported by intrinsic and ANS fluorescence measurements.Key words: human placental cystatin, molten globule, acid-induced state, trifluoroethanol, methanol, CD spectroscopy, ANS fluorescence, pH, protein folding.

Pregnancy-associated plasma protein-E (PAPP-E)

A full-length cDNA encoding a novel human protein was cloned from placenta cDNA. The corresponding 1542 amino acid protein sequence was termed 'pregnancy-associated plasma protein-E' (PAPP-E) as it shows a 62% homology to the human pregnancy-associated plasma protein-A (PAPP-A) that is a diagnostic marker for trisomies, especially Down syndrome. The conserved domain structure contains five motifs related to the short consensus repeats of complement proteins and selectins, three motifs related to the lin-notch motifs of proteins regulating early tissue differentiation, and a putative zinc-binding motif and active site of the metzincin-superfamily of metalloproteases. The PAPP-E gene was localized to chromosome 1q23-25. Northern blot analysis showed that PAPP-E is predominantly expressed in placenta.

Complete cDNA sequence of the preproform of human pregnancy-associated plasma protein-A. Evidence for expression in the brain and induction by cAMP

A cDNA that encodes the prepropeptide of pregnancy-associated plasma protein-A (preproPAPP-A), a putative metalloproteinase, has been cloned and sequenced. PAPP-A is synthesized in the placenta as a 1627-residue precursor preproprotein with a putative 22-residue signal peptide and a highly basic propeptide of 58 residues. The prepro-PAPP-A-encoding transcript contains a region with an extremely high G+C content and has an unusually long 5' untranslated region with several upstream short ORF. No alternatively spliced products could be identified by means of Northern blotting experiments or with rapid amplification of 5' cDNA ends experiments. A stretch within the 5' untranslated region shows sequence identities to a partial cDNA isolated from brain and a to cAMP-inducible sequence from a choriocarcinoma cell line.

A sensitive enzyme immunoassay for pregnancy-associated plasma protein A (PAPP-A): a possible first trimester method of screening for Down syndrome and other trisomies

Pregnancy-associated plasma protein A (PAPP-A) is a large glycoprotein produced mainly by the trophoblast during pregnancy and released into the maternal circulation. Its biological function is unknown. In the second trimester i.e. when Down syndrome (DS) screening is routinely performed, the level of maternal serum PAPP-A was found to be within the normal range in pregnancies affected by fetal trisomy 21. However, PAPP-A was shown to be a potent marker for DS before 14 weeks of gestation. Only radioimmunoassays (RIAs) based on labelled antigen competition reached the required sensitivity for early pregnancy PAPP-A determinations; but they have a very short shelf life due to inherent tracer half-life and, in the case of PAPP-A, instability of the labelled antigen after three weeks. We describe a convenient and novel enzyme immunoassay (ELISA) with high sensitivity and a long shelf life.

Plasma protein binding of drugs in pregnancy and in neonates

Plasma protein binding of drugs has important implications for drug disposition and action since it is the first, and controlling, step in drug distribution. Physiological changes in pregnancy include significant changes in plasma composition which affect drug binding and subsequent drug response; the extent of these changes depends on the stage of gestation. Both albumin and alpha 1-acid glycoprotein fractions are reduced, and consequently the binding of both acidic and basic drugs may be affected. This may lead to difficulties in maintaining adequate plasma concentrations of highly protein-bound drugs, since the measurement of total drug concentration in plasma may no longer be a valid indicator for dose adjustment. The newborn infant displays a continually changing plasma profile. The presence of fetal proteins and endogenous substrates known to interfere with drug binding can lead to unexpected complications due to a higher than expected 'free' drug fraction. Furthermore, a decrease in the affinity of albumin for bilirubin during this period may lead to bilirubin displacement by drugs such as diazepam, sulphonamides and salicylate, resulting in clinical jaundice which would not occur beyond the neonatal period. Plasma composition and its effect on drug binding should be taken into account when prescribing highly protein bound drugs with narrow therapeutic: toxic ratios.

Clearance pattern of maternal serum pregnancy specific beta 1-glycoprotein after treatment in active and regressed tubal pregnancy

The clearance pattern of maternal serum pregnancy specific beta 1-glycoprotein (SP1) was studied in 16 cases of tubal pregnancy (9 active and 7 regressed) after 12, 24, 48, 72, 96, 120 and 192 h following surgery. The mean values of the hormone in both groups showed a statistically highly significant difference in all measurements before and after treatment (P less than 0.001), but they followed the same exponential regression pattern. The half-life of SP1 in active tubal pregnancies after salpingectomy was 36.2 h and in regressed tubal pregnancies after salpingostomy was 37.5 h.

The prognostic value of HCG, PAPP-A, oestradiol-17 beta and progesterone in early human pregnancy

Four serum parameters were assayed weekly from the 4th to the 12th week of pregnancy and finally at 16 weeks, to assess their relative prognostic values for predicting pregnancy outcome. Of 85 pregnancies generated following treatment for infertility, 16 cases had blighted ova and subsequently aborted at a mean age of 9.9 +/- 0.5 weeks. Serum HCG concentrations differentiated (p less than 0.005) between ongoing pregnancies and blighted ova as early as the 4th week which was often several weeks in advance of clinical abortion. PAPP-A, oestradiol-17 beta and progesterone did not differentiate between the 2 groups until 7 weeks (p less than 0.005, p less than 0.001 and p less than 0.001 respectively). PAPP-A measurements detected ongoing pregnancies at week 4 (16.5 +/- 5 micrograms/l) but HCG remains the more sensitive diagnostic test. The lower limits of oestradiol-17 beta and progesterone for ongoing pregnancies were 670 pmol/l and 37 nmol/l respectively. The circulating concentrations of all 4 serum markers were unaffected by administration of medroxyprogesterone acetate from 6 to 16 weeks in both ongoing and aborting pregnancies.

Immunohistochemical localization of pregnancy-associated plasma protein A (PAPP-A) in placentae from normal and pre-eclamptic pregnancies

An immunohistochemical method was used to locate pregnancy-associated plasma protein A (PAPP-A) in the placenta and uterus. In addition to 10 placentae and basal plates from normal pregnancies, ranging in gestational age from 37 to 40 weeks, the following specimens were studied: three uteri obtained by hysterectomy during early pregnancy; and three placentae from patients with severe hypertensive pre-eclampsia. In early gestation, PAPP-A was localized in the villous cytotrophoblastic cell layer and the endometrial glands but was not found in the villous syncytiotrophoblast, the cytotrophoblastic cell columns or the decidual cells. On histochemical examination of placentae from cases of pre-eclampsia with hypertension, an increased number of villous cytotrophoblastic cells and so-called X-cells was observed. The monospecific antiserum to PAPP-A reacted strongly and evenly with the cytoplasm of these cells. The present study strongly suggests that the active production sites of PAPP-A are the villous cytotrophoblastic cells and the X-cells.

Placental protein 5: disappearance from the circulation after delivery

Blood was collected from 8 women following delivery at term. The decline in serum concentrations of placental protein 5 following the delivery of the infant's head was studied for 12 h. Placental protein 5 levels fell very rapidly with a half-life of 5-39 min. In the majority of women placental protein 5 was undetectable after 12 h (i.e. less than 2 microgram/l).

Pregnancy-associated plasma protein A: circulating levels during normal pregnancy

The development of specific and sensitive electroimmunoassays for a recently identified high molecular weight alpha-2 mobile pregnancy-specific protein (pregnancy-associated plasma protein A, PAPP-A or SP4) is described. These assays have permitted the detection of circulating levels of PAPP-A (10 microgram/L) as early as the fifth week of pregnancy. In all 18 subjects studied, the levels of PAPP-A rose from first detection in the first trimester until delivery at term. The development of these assays now permit the evaluation of PAPP-A measurement as a diagnostic test of early pregnancy and as an index of fetal well-being throughout gestation.

Circulating levels of pregnancy zone protein: normal range and the influence of age and gender

Serum levels of pregnancy zone protein (PZP) were measured in 506 apparently normal males and 329 normal non-pregnant females, the age range being 18 to 70 years. The estimations of PZP were performed by sensitive radio-rocket-line immunoelectrophoresis. The distribution of the data had a marked positive skew in both sexes which was reduced following logarithmic transformation. Serum concentrations in both men and women were found to increase significantly with advancing age. This increase and the mean concentrations were significantly higher in females.

Purification and characterization of pregnancy associated plasma protein A (PAPP-A)

Pregnancy Associated Plasma Protein A (PAPP-A) has been isolated from late pregnancy plasma using ammonium sulphate precipitation, ion exchange chromatography, affinity chromatography on Concanavalin-A, gel filtration and negative affinity chromatography. It was found that PAPP-A is an alpha 2-glycoprotein of 750-820 000 MW, probably a dimer with each monomer being composed of 2 polypeptide chains of 218 000 MW. The amino acid composition as well as other physicochemical characteristics are similar to human alpha 2-macroglobulin. PAPP-A exhibits in vitro an inhibition of the activity of the complement system, of the caseinolytic activity of plasmin and possibly of the urokinase activation of plasminogen. The hypothesis that PAPP-A plays a role in the regulation of fibrinolysis during pregnancy is put forward.

Disappearance of pregnancy-specific beta 1 glycoprotein from the maternal circulation after delivery

It is likely that there are systematic differences between circulating pregnancy-specific beta 1 glycoprotein (SP1) levels measured by radioimmunoassay and immunoprecipitation systems. We have re-investigated the decline in circulating levels of SP1 following delivery of the placenta. Serial blood samples were collected for 120 hours from 10 women following Caesarean section or vaginal delivery at term. The apparent half-life of SP1 after delivery ranged between 17 and 45 hours.

The plasma half-life of placental hormones

Blood was collected from 12 women following Caesarean section or normal delivery at term. The decline in plasma concentration of total oestriol, oestriol sulphate, oestriol glucosiduronate, unconjugated oestriol, human placental lactogen and pregnancy specific beta1 glycoprotein following delivery of the placenta was studied for 120 hours. The steroids and human placental lactogen fell very rapidly but pregnancy specific beta1 glycoprotein declined much more slowly. Analysis of the curves of puerperal decline suggests that the oestriol moieties are distributed in many compartments of the mother but that the proteins penetrate only to the plasma and the interstitial fluid.

Placental localization of human pregnancy--associated plasma proteins

Frozen sections of human placenta were examined for the presence of four human pregnancy proteins, pregnancy-associated plasma proteins A and C (PAPP-A and PAPP-C), human chorionic somatomammotropin (hCS), and pregnancy zone protein (PZP), by the indirect immunofluorescence technique. Monospecific rabbit antiserums to PAPP-A, PAPP-C and hCS all stained the trophoblast cytoplasm equivalently in a continuous layer, usggesting that the same trophoblast cells synthesize all three pregnancy proteins. In contrast, PZP was localized in blood vessel walls, parenchymal structures within the villous, as well as in the trophoblast cytoplasm. Its distribution in the latter was relatively inhomogeneous, tending to be more intense on the basement membrane side.

Relation of obstetric parameters to the concentrations of four pregnancy-associated plasma proteins at term in normal gestation

The relations between normal obstetric parameters and the maternal levels of four pregnancy-associated plasma proteins (PAPP) were studied, with the use of plasma samples taken from 187 normal pregnant women within seven days before delivery. PAPP-A levels were correlated with placental and newborn weights. The levels of this pregnancy protein was higher in primigravid women and in groups with higher diastolic blood pressure than in other groups. Women with extremely high PAPP-A concentrations were likely to have extremely large placental weight was not necessarily associated with a high PAPP-A level. PAPP-C was not correlated with placental or newborn weight. The relationship between PAPP-C and maternal age, as well as maternal weight, was significant by one but not in the other three statistical analyses employed. The pregnancy zone protein was found to be correlated with parity. In primigravid women, this protein additionally showed an inverse correlation with the placental weight. Human chorionic somatomammotropin was significantly related to placental weight and inversely related to maternal weight. Its relationship with newborn weight was best seen in primigravid subjects. Other parameters (systolic blood pressure, one- and five-minute Apgar scores, weeks of gestation, days before delivery, newborn sex, and newborn bilirubin level) were not related to any of these pregnancy proteins.