Responsiveness to norepinephrine of the vessels supplying the placenta of growth-retarded fetuses

Inhibition of mechanistic target of rapamycin signaling decreases levels of O-GlcNAc transferase and increases serotonin release in the human placenta

Changes in placental function, in particular down-regulation of placental O-linked N-acetylglucosamine (O-GlcNAc) transferase (OGT) in response to maternal stress and increased placental secretion of serotonin into the fetal circulation following maternal infection, have been mechanistically linked to adverse neurodevelopment in mice. We hypothesized that mechanistic target of rapamycin (mTOR) signaling is a key regulator of trophoblast serotonin synthesis and OGT protein expression and that serotonin is secreted by the human placenta into the fetal circulation. Placental homogenates (n=46) from elective terminations at 8-22 weeks of gestation and from healthy-term women were sexed and the protein levels of OGT and enzymes involved in serotonin synthesis was determined. Primary human trophoblast (PHT) cells were isolated from normal term placenta (n=27), cultured and transfected (n=8) with siRNA targeting a scramble sequence (control), raptor (inhibits mTOR Complex 1 (mTORC1)), or rictor (inhibits mTOR Complex 2 (mTORC2)). Subsequently, conditioned media and PHT cell lysates were collected. Free serotonin concentration was measured using ELISA in cell culture media and in platelet-depleted normal term umbilical vein and artery plasma (n=38). Both mTORC1 and mTORC2 inhibition down-regulated OGT levels in PHT cells. The level of serotonin synthesis enzyme tryptophan hydroxylase (TPH-1) was higher in early gestation female placentas and at term serotonin concentration was three-fold higher in the umbilical vein than in the umbilical artery. Inhibition of mTORC2, but not mTORC1, increased cultured PHT cell serotonin secretion. Our data are consistent with the model that mTOR signaling is a key regulator of trophoblast serotonin synthesis and OGT protein expression.

In Vivo Dynamic MRI Measurement of the Noradrenaline-induced Reduction in Placental Blood Flow in Mice

PURPOSE

We developed a new model for in vivo placental perfusion measurements based on dynamic MRI in mice. As noradrenaline has been implicated in the pathogenesis of preeclampsia, we examined whether it reduced placental perfusion in mice, and whether such a reduction could be detected with our MRI model.

MATERIALS AND METHODS

Mice at 16 days of gestation were injected intramuscularly with saline or noradrenaline solution. A conventional gadolinium chelate was then injected IV, and a single-slice T1-weighed 2D Fast SPGR sequence was acquired for 200 s. Signal intensity was measured on all the images and converted into contrast agent tissue concentrations in the maternal left ventricle (input function) and placentas. A one-compartment model was developed using compartmental and numerical modeling software. Mean blood flow (F) was calculated from a transfer constant.

RESULTS

Twenty-six mice were studied, yielding a total of 55 MRI measurements of placental perfusion (29 in the control group and 26 in the noradrenaline group). Mean placental blood flow (F) was significantly lower in the noradrenaline group (0.72+/-0.84 ml/min/g of placenta) than in the control group (1.26+/-0.54 ml/min/g of placenta).

CONCLUSION

Noradrenaline reduces placental perfusion in mice. Our MRI dynamic model might be useful for detecting and investigating abnormal placental blood flow, thereby avoiding the need for invasive procedures and animal sacrifice.

The effect of oxytocin, prostaglandin E2 and acetylsalicylic acid on flow distribution and on the transfer of alanine, glucose and water in isolated perfused guinea pig placentae

The influence of oxytocin (OXY), sulproston (SUL) and acetylsalicylic acid (ASA) on L-alanine- (ALA), D-glucose- (GLU) or water- (H(2)O) uptake (maternal side) in the isolated perfused guinea pig placenta was investigated. Uptake was measured with a single injection, paired tracer dilution method. 'T50' values were derived from venous concentration curves (extracellular marker) as the distance (sec) between two concentration values at 50 per cent of peak concentration. T50 values were regarded to reflect the change of flow distribution on the maternal side. On average, there was a significant apparent inhibition of GLU uptake (by 27.2 per cent from control values) by OXY as well as of ALA uptake by OXY (26. 0 per cent), by ASA (56.6 per cent), and by SUL (56.7 per cent). The respective mean T50 values decreased significantly in the above groups by 15.9 per cent, 18.7 per cent (ns), 42.2 per cent and 56.7 per cent. However, it was not possible to generate dose-response curves whereas significant correlations of uptake values with T50 values were found. There was no dose-response relationship between T50 values and OXY or ASA concentrations but decreased mean T50 values were found. For SUL a weak correlation of T50 and SUL concentration was found. The r -value of GLU uptake and T50 was 0.57, for H(2)O uptake this value was 0.70, for ALA uptake the r -values were 0.51 (OXY), 0.35 (SUL) and 0.31 (ASA). Correlation of uptake and concentrations were not significant. We conclude that the 'inhibitory' effects of OXY, ASA and probably SUL on placental transfer are unspecific and the consequence of flow shifts from the placental exchange area to the uterine muscle.

Placental biogenic amine transporters: cloning and expression

During intrauterine development, catecholamine turnover (production and clearance rates) is higher than under any other circumstances. This is mediated in large part by placental clearance of circulating catecholamines via a cocaine-sensitive, neuronal transporter-dependent mechanism. In order to confirm the molecular mechanisms for placental transport, we screened an ovine placental cDNA library for biogenic amine transporters. We report here the identification of two biogenic amine transporters with sequences very similar to their neuronal counterparts. One is an ovine serotonin transporter (oSERT) with > 90% homology to the human neuronal SERT. Expression studies confirm transport and competitive binding affinities consistent with a SERT transporter. We have also isolated a partial sequence for the ovine norepinephrine transporter (oNET). These results confirm the placental expression of plasma membrane biogenic amine transporters. We suggest the exaggerated fetal vulnerability to uptake inhibitors, like cocaine, may be due to blockade of placental biogenic amine transport.

Human placental norepinephrine transporter mRNA: expression and correlation with fetal condition at birth

The purpose of this study was to determine the primary form of human placental norepinephrine transporter (hNET) mRNA expressed in the human placenta and to compare the level of expression in normal pregnancies and in pregnancies complicated by drug exposure or other forms of physiological derangement. We used the hNET cDNA to measure RNA extracted from placenta and examined placental RNA following complicated and uncomplicated pregnancies. To compare transporter expression and its relation to fetal condition at birth, umbilical arterial plasma catecholamine levels, umbilical arterial blood gases and placental transporter mRNA level were compared by linear regression analysis. Uncomplicated pregnancies had a higher level of placental norepinephrine transporter mRNA than complicated pregnancies. An inverse relationship between umbilical cord norepinephrine level and transporter expression was demonstrated. We conclude that placental transporter expression represents an important and newly described metabolic function of the placenta. Placental catecholamine clearance mediated via the placental NET may be important in the pathophysiology of disorders associated with placental dysfunction, impaired placental blood flow or intrauterine growth retardation. This may also explain the adverse effects of drugs, such as cocaine, which block catecholamine transport.

Placental norepinephrine transporter development in the ovine fetus

The placenta has been shown to be a site of expression of several of the monoamine membrane uptake transporters. However, the development and relative contribution of transport-dependent mechanisms to placental catecholamine clearance in vivo have not been demonstrated. These studies were designed to determine the development of the placental norepinephrine transporter (NET) and the relative contribution of transport dependent mechanisms to whole body and placental catecholamine clearance. Norepinephrine clearance and production rate were determined in 122 +/- 1 day gestation chronically catheterized fetal sheep. Placental clearance was shown to account for over 40 per cent of total intrauterine clearance and, of the clearance in the placenta, nearly 50 per cent was uptake, transport-dependent as shown by specific pharmacologic blockade. NET transport expression was examined by measurement nisoxetine binding in placenta and compared with binding in the frontal cortex of fetal, newborn and adult animals. Nisoxetine is a selective ligand for the norepinephrine transporter. Nisoxetine binding was 20-fold greater in placenta than in frontal cortex. Placental transporter binding decreased modestly in between 99 days gestation and term (145 days) but did not change in frontal cortex. These results suggest that expression of the norepinephrine transporter in the placenta is associated with a significant capacity for neurotransmitter re-uptake in utero. Given the high fetal norepinephrine production rate, this capacity is important for fetal homeostasis. This site of transporter expression may be important in the pathogenesis of derangements in catecholamine production in the fetus and in the adverse effects on the fetus of drugs, such as cocaine, which block catecholamine re-uptake.

Responses of placental arteries from normotensive and preeclamptic women to endogenous vasoactive agents

OBJECTIVE

The hypothesis that preeclampsia may be associated with an increase in the response of the placental arteries to vasoconstrictors or a decrease in their response to vasodilators was tested.

STUDY DESIGN

Concentration-response curves to various agents were determined on helical strips of fetal placental arteries from normotensive (n = 33) and preeclamptic (n = 8) women to calculate the potencies and maximal effects of the agents.

RESULTS

Endothelin, prostaglandin F2 alpha, and serotonin caused concentration-dependent contractions; angiotensin II and norepinephrine produced little or no effects. The prostacyclin analog iloprost and atrial natriuretic factor, but not isoproterenol, relaxed placental arteries. Iloprost was more effective on preeclamptic than on normal arteries, but the effects of other agents on the two groups of arteries did not differ. Placental arteries exhibited spontaneous oscillations that were more marked in preeclamptic than in normal arteries and were inhibited by indomethacin.

CONCLUSION

Preeclampsia is not associated with an increase in the responses of fetal placental arteries to vasoconstrictors or a decrease in their response to vasodilators. However, placental arteries from preeclamptic subjects exhibit increased oscillations.

Low-dose infusion of atrial natriuretic peptide in the conscious guinea pig increases blood flow to the placenta of growth-retarded fetuses

OBJECTIVE

Our goal was to investigate the effects of low-dose infusion of atrial natriuretic peptide on maternal placental blood flow of normal-sized and growth-retarded fetuses.

STUDY DESIGN

Seventeen conscious, chronically catheterized guinea pigs were studied at day 50 of gestation after growth retardation was experimentally induced by unilateral uterine artery ligation at day 34.

RESULTS

In 12 experiments atrial natriuretic peptide infusion (15 ng/kg/min) increased blood flow (microsphere technique) to placentas of growth-retarded fetuses by 26% (p less than 0.01) while placental blood flow of normal-sized fetuses remained unchanged. This difference in responsiveness to atrial natriuretic peptide infusion was statistically significant (p less than 0.001). Blood pressure, heart rate, and myoendometrial and renal blood flows were unaffected. Plasma concentrations of immunoreactive atrial natriuretic peptide increased by 64%, indicating that physiologic concentrations were achieved. In five saline solution-treated controls none of the studied parameters changed.

CONCLUSION

Atrial natriuretic peptide in low doses selectively increases blood flow to placentas of growth-retarded fetuses in the conscious guinea pig. Infusion of atrial natriuretic peptide in a dose that results in plasma concentrations within the upper physiologic range may have a therapeutic value in pregnancies complicated by intrauterine growth retardation.

Prevention and treatment of pregnancy-associated hypertension: what have we learned in the last 10 years?

High blood pressure (BP) complicates approximately 10% of all pregnancies. Hypertension in pregnancy falls into four categories: (1) preeclampsia-eclampsia, (2) chronic hypertension of whatever cause, (3) preeclampsia-eclampsia superimposed to chronic hypertension or renal disease, and (4) transient or late hypertension (gestational hypertension). Preeclampsia, the association of hypertension, proteinuria, and edema, accounts for more than 50% of all the hypertensive disorders of pregnancy and is a major cause of fetal and maternal morbidity and mortality. Unfortunately, distinguishing between preeclampsia and other causes of hypertension on clinical grounds can be difficult because of the lack of specific tests for differential diagnosis. Increased vascular resistance has been claimed as the primary cause of preeclampsia; however, a variable hemodynamic profile with relatively high cardiac outputs, normal filling pressures, and inappropriately high systemic vascular resistances is now reported by most investigators. Imbalance between vasodilator and vasoconstrictor eicosanoids may account for platelet activation and increased responsiveness to pressor peptides. Altered prostacyclin (PGI2) to thromboxane A2 (TxA2) ratio in maternal uteroplacental vascular bed may favor local platelet activation and vasoconstriction contributing to placental insufficiency and fetal distress. Alternatively, recent evidence seems to suggest that fetal umbilical placental circulation may be the site of the primary vascular injury. Whether low-dose aspirin prevents preeclampsia because it inhibits the excessive maternal TxA2 or whether the partial inhibition of fetal TxA2 is also of therapeutic value remains to be established. Treatment of severe hypertension in pregnancy is probably important to prevent cardiac failure or cerebrovascular accidents in the mother. The need for pharmacological therapy of mild to moderate hypertension is still debated, since no formal studies are available to clarify whether pharmacological treatment in such instances effectively reduces maternal or fetal risk. For the treatment of preeclampsia, hydralazine and nifedipine may be used when delivery is not applicable. Labetalol and diazoxide are effective for hypertensive emergencies. Life-threatening hypertension that does not respond to more conventional therapy is an indication for the use of sodium nitroprusside. For chronic hypertension, alpha-methyldopa remains the treatment of choice; if ineffective, hydralazine or beta-blockers are suitable. Effectiveness and safety of other molecules remain elusive.

The microsphere technique in anaesthetized and awake pregnant guinea-pigs: reproducibility of repeated blood flow measurements

Repeated microsphere injections are extensively employed for measurements of uteroplacental blood flows in experimental animals. However, this technique has not been systematically validated in pregnancy. In the present series of experiments the effects of three consecutive microsphere injections on central haemodynamics and regional blood flows were studied in 43 late pregnant guinea-pigs. In group A (n = 13) experiments were carried out in the awake chronically catheterized animal. In group B (n = 8) animals were studied under anaesthesia. In two additional anaesthetized groups reference withdrawal rate (C, n = 7) and the amount of injected spheres (D, n = 7) were increased 2-3 fold. Cardiac output, mean arterial blood pressure, heart rate as well as regional blood flows to placenta, ovaries, kidneys, heart, liver and carcass remained unaltered in all protocols. Myoendometrial blood flow increased in group A and C and a similar pattern could be demonstrated in group B and D but was not statistically significant. Adrenal blood flow was enhanced in groups A and C and brain blood flow increased in group C and D. The gastrointestinal tract especially the stomach was sensitive to repeated microsphere injections since blood flow reductions were apparent in all groups but were statistically significant only for groups A and D. In group E (n = 8), the three microsphere labels were injected simultaneously. The coefficients of variability for these blood flow measurements were in the range of 3.6-6.8% for different organs. It is concluded that repeated microsphere injection in an ideal method to measure placental blood flow. However, the technique may provide inaccurate results with respect to the myoendometrium and gastrointestinal tract.