Review article: mechanisms of ion transfer by the rat placenta: a model for the human placenta?

Deletion of the Imprinted Phlda2 Gene Increases Placental Passive Permeability in the Mouse

Genomic imprinting, an epigenetic phenomenon that causes the expression of a small set of genes in a parent-of-origin-specific manner, is thought to have co-evolved with placentation. Many imprinted genes are expressed in the placenta, where they play diverse roles related to development and nutrient supply function. However, only a small number of imprinted genes have been functionally tested for a role in nutrient transfer capacity in relation to the structural characteristics of the exchange labyrinthine zone. Here, we examine the transfer capacity in a mouse model deficient for the maternally expressed Phlda2 gene, which results in placental overgrowth and a transient reduction in fetal growth. Using stereology, we show that the morphology of the labyrinthine zone in Phlda2^−/+ mutants is normal at E16 and E19. In vivo placental transfer of radiolabeled solutes ¹⁴C-methyl-D-glucose and ¹⁴C-MeAIB remains unaffected at both gestational time points. However, placental passive permeability, as measured using two inert hydrophilic solutes (¹⁴C-mannitol; ¹⁴C-inulin), is significantly higher in mutants. Importantly, this increase in passive permeability is associated with fetal catch-up growth. Our findings uncover a key role played by the imprinted Phlda2 gene in modifying placental passive permeability that may be important for determining fetal growth.

Trastuzumab in the Treatment of Pregnant Breast Cancer Patients - an Overview of the Literature

Breast cancer is one of the most common malignancies which appear during pregnancy. Since women are increasingly not giving birth until they are at a more advanced age, it can be assumed that the incidence of pregnancy-related breast cancers will continue to increase in the future. Because of pregnancy-induced changes and conservative diagnosis, these carcinomas are frequently not detected until they are at an advanced stage and thus generally require systemic adjuvant therapy. The available data on optimal chemotherapeutic management are limited. Particularly for the use of the target agent trastuzumab which could crucially contribute to improving the prognosis in the therapy of HER2-overexpressing breast cancer in non-pregnant women, there is a lack of definitive information regarding the profile of action and safety in pregnancy as well as with regard to any long-term effects on the child. Thirty-eight pregnancies on trastuzumab for the treatment of breast cancer were able to be analysed in the literature currently available. Information can be gained from this and conclusions can be drawn which can individualise and decisively improve therapeutic options in the future for the pregnant breast cancer patient.

Increased maternofetal calcium flux in parathyroid hormone-related protein-null mice

The role of parathyroid hormone-related protein (PTHrP) in fetal calcium homeostasis and placental calcium transport was examined in mice homozygous for the deletion of the PTHrP gene (PTHrP^−/− null; NL) compared to PTHrP^+/+ (wild-type; WT) and PTHrP^+/− (heterozygous; HZ) littermates. Fetal blood ionized calcium was significantly reduced in NL fetuses compared to WT and HZ groups at 18 days of pregnancy (dp) with abolition of the fetomaternal calcium gradient. In situ placental perfusion of the umbilical circulation at 18 dp was used to measure unidirectional clearance of ⁴⁵Ca across the placenta in maternofetal (^CaK_mf) and fetoplacental (^CaK_fp) directions; ^CaK_fp was < 5% of ^CaK_mf for all genotypes. At 18 dp, ^CaK_mf across perfused placenta and intact placenta (^CaK_mf(intact)) were similar and concordant with net calcium accretion rates in vivo. ^CaK_mf was significantly raised in NL fetuses compared to WT and HZ littermates. Calcium accretion was significantly elevated in NL fetuses by 19 dp. Placental calbindin-D_9K expression in NL fetuses was marginally enhanced (P < 0.07) but expression of TRPV6/ECaC2 and plasma membrane Ca²⁺-ATPase (PMCA) isoforms 1 and 4 were unaltered. We conclude that PTHrP is an important regulator of fetal calcium homeostasis with its predominant effect being on unidirectional maternofetal transfer, probably mediated by modifying placental calbindin-D_9K expression. In situ perfusion of mouse placenta is a robust methodology for allowing detailed dissection of placental transfer mechanisms in genetically modified mice.

Placental-specific insulin-like growth factor 2 (Igf2) regulates the diffusional exchange characteristics of the mouse placenta

Restricted fetal growth is associated with postnatal mortality and morbidity and may be directly related to alterations in the capacity of the placenta to supply nutrients. We proposed previously that imprinted genes can regulate nutrient supply by the placenta. Here, we tested the hypothesis that the insulin-like growth factor 2 gene (Igf2) transcribed from the placental-specific promoter (P0) regulates the development of the diffusional permeability properties of the mouse placenta. Using mice in which placental-specific Igf2 had been deleted (P0), we measured the transfer in vivo of three inert hydrophilic solutes of increasing size (14C-mannitol, 51CrEDTA, and 14C-inulin). At embryonic day 19, placental and fetal weights in P0 conceptuses were reduced to 66% and 76%, respectively, of wild type. In P0 mutants, the permeability.surface area product for the tracers at this stage of development was 68% of that of controls; this effect was independent of tracer size. Stereological analysis of histological sections revealed the surface area of the exchange barrier in the labyrinth of the mouse placenta to be reduced and thickness increased in P0 fetuses compared to wild type. As a result, the average theoretical diffusing capacity in P0 knockout placentas was dramatically reduced to 40% of that of wild-type placentas. These data show that placental Igf2 regulates the development of the diffusional exchange characteristics of the mouse placenta. This provides a mechanism for the role of imprinted genes in controlling placental nutrient supply and fetal growth. Altered placental Igf2 could be a cause of idiopathic intrauterine growth restriction in the human.

Oral hypoglycemic agents in pregnancy: their time has come

Oral agents are the mainstay of pharmacological treatment for non-pregnant women with type 2 diabetes. It has been proposed that, owing to the similarity between gestational and type 2 diabetes, some of these drugs could be used effectively and safely as alternatives to insulin therapy. This efficacious alternative provides the physician with more choices that, in turn, translate into more complex decision-making for the management of gestational diabetes. This article illustrates the pharmacological characteristics of oral hypoglycemic agents and placental transfer, provides evidence for the lack of association between congenital anomalies and the drugs, and reviews current studies and the clinical outcomes when these drugs are used.

The phosphatidylinositol 3-kinase/Akt signaling pathway modulates the endocrine differentiation of trophoblast cells

Activation of Lyn, a Src-related nonreceptor tyrosine kinase, in trophoblast cells is associated with trophoblast giant cell differentiation. The purpose of the present work was to use Lyn as a tool to identify signaling pathways regulating the endocrine differentiation of trophoblast cells. The Src homology 3 domain of Lyn was shown to display differentiation-dependent associations with other regulatory proteins, including phosphatidylinositol 3-kinase (PI3-K). PI3-K activation was dependent upon trophoblast giant cell differentiation. The downstream mediator of PI3-K, Akt/protein kinase B, also exhibited differentiation-dependent activation. Lyn is a potential regulator of the PI3-K/Akt signaling pathway, as are receptor tyrosine kinases. Protein tyrosine kinase profiling was used to identify two candidate regulators of the PI3-K/Akt pathway, fibroblast growth factor receptor-1 and Sky. At least part of the activation of Akt in differentiating trophoblast giant cells involves an autocrine growth arrest-specific-6-Sky signaling pathway. Inhibition of PI3-K activities via treatment with LY294002 disrupted Akt activation and interfered with the endocrine differentiation of trophoblast giant cells. In summary, activation of the PI3-K/Akt signaling pathway regulates the development of the differentiated trophoblast giant cell phenotype.

Oral hypoglycemic agents and the pregnant diabetic: "from bench to bedside"

Today, the criteria for diagnosis and treatment have evolved into an evidence-based medicine approach. The need for evidence-based information is especially critical in the management of gestational diabetes, in general, and especially in the use of oral hypoglycemic agents. These agents have been categorically contraindicated for decades in the United States based on anecdotal and/or weak evidence for these recommendations. In this article, the similarities between gestational and type 2 diabetes are described and the rationale for the use of oral hypoglycemic agents for the treatment of both are discussed. The author will show how research from basic sciences (placental transfers) to clinical studies (perinatal outcome) can lead to significant evidence on which to base management recommendations.

Calcium transport across the dental enamel epithelium

Dental enamel is the most highly calcified tissue in mammals, and its formation is an issue of fundamental biomedical importance. The enamel-forming cells must somehow supply calcium in bulk yet avoid the cytotoxic effects of excess calcium. Disrupted calcium transport could contribute to a variety of developmental defects in enamel, and the underlying cellular machinery is a potential target for drugs to improve enamel quality. The mechanisms used to transport calcium remain unclear despite much progress in our understanding of enamel formation. Here, current knowledge of how enamel cells handle calcium is reviewed in the context of findings from other epithelial calcium-transport systems. In the past, most attention has focused on approaches to boost the poor diffusion of calcium in cytosol. Recent biochemical findings led to an alternative proposal that calcium is routed through high-capacity stores associated with the endoplasmic reticulum. Research areas needing further attention and a working model are also discussed. Calcium-handling mechanisms in enamel cells are more generally relevant to the understanding of epithelial calcium transport, biomineralization, and calcium toxicity avoidance.

Functional analysis of placental 57-kDa Ca(2+)-binding protein: overexpression and downregulation in a trophoblastic cell line

The placental trophoblastic epithelium functions to transport nutrients needed by the fetus, including calcium, which is required in the greatest amounts during the last third of pregnancy when the majority of fetal skeletal mineralization occurs. The mechanism of placental calcium transport and the developmental changes in the trophoblast that facilitate this process are currently incompletely understood. We have previously identified a 57-kDa, Ca(2+)-binding protein (CaBP) functionally implicated in placental calcium transport and trophoblast differentiation. In this study we have directly examined the role of CaBP in these processes by (1) recombinantly overexpressing CaBP in an inducible manner and (2) downregulating CaBP expression using antisense technology, using the rat choriocarcinoma cell line Rcho-1 as a trophoblastic cell model system. Our results show that overexpression of CaBP stimulates both cellular calcium uptake and vectorial calcium transport activities in Rcho-1 cells. Those cells stably expressing CaBP also exhibit higher levels of steady-state intracellular calcium and enhanced calcium-buffering ability. In addition, prolonged overexpression of CaBP in Rcho-1 cultures promotes trophoblast differentiation. Conversely, downregulation of CaBP expression had a negative effect on calcium uptake, calcium transport, and trophoblast differentiation in Rcho-1 cells. These data indicate that CaBP plays a direct role in placental calcium transport, functioning both as an intracellular calcium buffer and as a shuttle. These results also support a more direct role for CaBP in the trophoblast differentiation pathway.

Controlling drug delivery across the placenta

A challenge in modern drug therapy is to develop strategies for safer and more selective targeting of drug delivery in pregnancy. Specifically, approaches are needed that would restrict unnecessary drug exposure to either mother or fetus. There is evidence emerging that indicates the placenta does express natural transport and metabolism processes that function to control drug and nutrient distribution between the mother and fetus. Further, in vitro techniques developed in the past 10 years now provide some of the tools necessary to elucidate transport and metabolism processes typical of the human placenta. As a consequence, pharmaceutical scientists are in a position to contribute significantly to the design and development of drugs for pregnancy.

Placental 57-kDa Ca(2+)-binding protein: regulation of expression and function in trophoblast calcium transport

During gestation, transport by placental trophoblasts is solely responsible for nutrient supply to the developing fetus. The calcium (Ca) transport machinery of the placenta thus represents the primary tissue site for regulating fetal Ca homeostasis. The exact mechanism of trophoblast Ca transport is not known. However, there is evidence suggesting that a developmentally expressed cytosolic, trophoblast-specific, high M(r) 57-kDa Ca-binding protein (CaBP) plays an important role in regulating and/or shuttling cytosolic Ca. We report here the cloning of a full-length cDNA of the mouse CaBP which shows significant homology with calreticulin, an endoplasmic reticulum-associated Ca binding protein. The functional role of CaBP in cellular Ca handling was investigated using a trophoblastic cell line, Rcho-1, derived from a rat choriocarcinoma. Upon differentiation, Rcho-1 cells exhibit enhanced Ca uptake compared to undifferentiated Rcho-1 stem cells, and CaBP expression is upregulated. To analyze the regulation of CaBP expression, placenta organ cultures and Rcho-1 cells were treated for 48 h in vitro with a series of agents implicated in Ca homeostasis. In both placenta organ cultures and undifferentiated as well as differentiated Rcho-1 cells, treatment with 1,25-dihydroxy vitamin D3, estrogen, parathyroid hormone (PTH), parathyroid hormone-related protein (PTHrP 1-34), and Ca had no effect on CaBP mRNA and protein levels, which were significantly stimulated by PTHrP 67-84. PTHrP 67-84-treated Rcho-1 cells also exhibited higher Ca uptake activity than untreated control cells. The upregulation of CaBP expression during and/or following the differentiation of Rcho-1 cells into trophoblastic giant cells supports the importance of CaBP in trophoblast maturation and the validity of the Rcho-1 rat model cell system. In addition, the action of PTHrP on placental trophoblast Ca transport is likely to involve the regulation of CaBP expression to handle the increasing Ca requirements of the developing fetus.

Gestational and smoking effects on peptidase activity in the placenta

Angiotensin converting enzyme (ACE) and leucine aminopeptidase (LAP) regulate fetally and maternally generated peptides in the placenta. In this study, ACE-like activity was found to be decreased and LAP-like activity increased with increasing days of gestation in rat placental tissues forming the fetal:maternal interface. Membrane-associated ACE-like and LAP-like activities in the placenta of smokers were also found to be significantly higher than their respective activities in placenta of nonsmokers. Our collective findings suggest that gestational and environmentally-induced changes in placental peptidase activities may account for variable peptide hormone and/or therapeutic peptide metabolism in the placenta.

Permeability properties of monolayers of the human trophoblast cell line BeWo

The BeWo cell line (b30 clone) has been examined as a potential in vitro system to study transplacental transport. At the light and electron microscope level, the cells were observed to form confluent monolayers on polycarbonate filters in approximately 5 days and morphologically resembled the typical human trophoblast. BeWo monolayers developed a modest transepithelial electrical resistance and a molecular size-dependent permeability to hydrophilic passive diffusion markers, fluorescein, and selected fluorescein-labeled dextrans. Linoleic acid permeation across BeWo monolayers was asymmetric, saturable, and inhibited by low temperature and excess competing fatty acid. Forskolin and 8-bromoadenosine 3',5'-cyclic monophosphate treatments stimulated morphological changes in BeWo cultures and enhanced the asymmetric passage of linoleic acid across the BeWo monolayers while having minimal effects on passive permeability, affirming that the differentiation state of the cells can influence membrane transporters and transmonolayer permeability. The basic permeability properties of the BeWo monolayers suggest that the cells grown on permeable supports may be examined as a convenient in vitro system to evaluate some transplacental transport mechanisms.

Permeability and metabolic properties of a trophoblast cell line (HRP-1) derived from normal rat placenta

The HRP-1 cell line is derived from normal rat placenta and appears morphologically similar to and retains characteristic expression of cellular markers of labyrinthine trophoblast cells. In this study, monolayers of HRP-1 cells grown on permeable supports were evaluated as a potential in vitro system to study trophoblast transport and metabolism. The cell line was shown to express and retain functional activity of the predominant placental cytochrome P450 isozyme, CYP1A1. Additionally, the HRP-1 cells retain functional activity of angiotensin I converting enzyme and carboxypeptidase N-like enzyme, peptidases characteristic of the trophoblast. The permeation of several hydrophilic, inert markers across the HRP-1 monolayers was observed to be dependent on effective molecular size and to be passive in nature. Functional asymmetry of the HRP-1 cells was illustrated by the predominant permeation of linoleic acid in the apical-to-basolateral direction across the monolayers. Transferrin passage across HRP-1 monolayers was concentration-dependent, was bidirectional, and could be inhibited by unlabeled transferrin, features typical of the trophoblast transport system for transferrin. Collectively, these properties suggest that the HRP-1 cell line may provide a useful tool for evaluating some of the permeability and metabolic properties of the trophoblast.

Placental transfer of phosphate in anaesthetized rats

Mechanisms of transfer of inorganic phosphate, Pi, across the placenta of rats at 21 days of gestation were studied using 32Pi. In one group of experiments the unidirectional transfer of Pi from mother to fetus was estimated from radioactivity in the fetus at various intervals after the tracer injection into the mother. At 15 min after tracer injection, the transfer rate was only slightly higher than the estimated rate of fetal accretion of Pi, and it decreased rapidly with the length of the experiment suggesting deterioration of the transfer mechanism under conditions of an acute experiment. In other experiments, transfer of 32Pi and 51Cr-EDTA (a marker of paracellular transfer) were measured across the dually-perfused placenta in the maternal-fetal direction. The transfer rate of 32Pi was an order of magnitude higher than the transfer of 51Cr-EDTA indicating that most of the Pi transfer is transcellular. The transfer of 32P decreased when the concentration of Na+ in the maternal perfusate was reduced, it was related inversely to the concentration of Pi on the fetal side of the placenta, and it was related directly to the concentration of Ca2+ on the fetal side. The maternal-fetal transfer of Pi exhibited saturation kinetics with a K(m) of about 0.4 mM suggesting that at a physiological concentration of Pi in maternal plasma the transfer mechanism is nearly saturated. The present observations are consistent with Pi being transferred in contransport with Na+. The maternal-fetal transport of Pi appears to be stabilized by the high affinity of the transport system to Pi, and controlled by a negative feedback between fetal concentration of Pi and the Pi transfer rate. It may also be controlled, to some degree, by the fetal plasma Ca2+.

Comparative aspects of placental exchange functions

The anatomic structure of the placenta varies widely at the macroscopic and microscopic levels, and these differences are often reflected in differences in exchange mechanisms. For example, placental iron transfer proceeds by three distinct mechanisms each associated with a distinctive anatomic feature. A number of factors also affect the exchange capacity per unit of placental tissue, these include boundary properties and the arrangement and rates of fetal and maternal placental blood flows. Generally, the exchange rate of a substrate is limited principally by the membranes or by blood flow but these interact in a complex fashion. When exchange occurs by relatively slow passive diffusion, the barrier thickness and exchange area per gram of placenta are most important. The T-diagram reveals that a counter- or crosscurrent arrangement of blood streams is most efficient. However, relatively few placentas make use of these high efficiency designs. It is suggested that only in animals such as rodents and shrews where a large fetus is produced in a short time by a small placenta does placental exchange capacity need to be pushed to its theoretical limits. We define an index termed the 'turbo factor' (= term fetal weight/[placental weight x days of gestation]) to express the extent to which growth taxes the placenta. A value of > 0.2 seems to require a placenta of the high-efficiency type and may predict that, in a given species, the placenta makes use of the most efficient arrangement of blood flows.