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Šimják P, Cibula D, Pařízek A, Sláma J. Management of pregnancy after fertility-sparing surgery for cervical cancer. Acta Obstet Gynecol Scand 2020; 99:830-838. [PMID: 32416616 DOI: 10.1111/aogs.13917] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 04/17/2020] [Accepted: 05/12/2020] [Indexed: 12/14/2022]
Abstract
Cervical cancer is increasingly diagnosed in women who have not yet completed their reproductive plans. For women with early-stage disease (FIGO stage IA1-IB1), fertility-sparing procedures, such as conization, trachelectomy or radical trachelectomy, represent the treatments of choice. However, women who undergo repeated conization or trachelectomy represent a challenge for obstetricians because they are at increased risk of infertility, mid-trimester miscarriage, preterm premature rupture of membranes and preterm delivery. So far, the evidence-based guidance on the management of these pregnancies is limited. This article reviews the literature discussing pregnancy management in women after fertility-sparing surgery for early cervical cancer. Although the evidence is limited, certain measures are desirable, including screening and treatment of asymptomatic bacteriuria, screening for cervical incompetence and progressive cervical shortening by transvaginal ultrasonography, and fetal fibronectin testing. Vaginal progesterone supplementation should be primary prevention for all women after trachelectomy. Women with a history of preterm delivery or late miscarriage may benefit from cervical cerclage. Elective delivery by cesarean section in the early-term period is desirable.
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Affiliation(s)
- Patrik Šimják
- Department of Gynecology and Obstetrics, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - David Cibula
- Department of Gynecology and Obstetrics, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Antonín Pařízek
- Department of Gynecology and Obstetrics, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Jiří Sláma
- Department of Gynecology and Obstetrics, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
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Sara S, Mohammad K, Nader S, Maryam I, Marzieh S, Elham J, Neda S. Using the NGF/IL-6 ratio as a reliable criterion to show the beneficial effects of progesterone after experimental diffuse brain injury. Heliyon 2020; 6:e03844. [PMID: 32373743 PMCID: PMC7191606 DOI: 10.1016/j.heliyon.2020.e03844] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 10/08/2019] [Accepted: 04/21/2020] [Indexed: 01/19/2023] Open
Abstract
Acute progesterone injection has been shown to reduce brain edema following traumatic brain injury (TBI) due to its neuroprotective effect. We investigated the effects of sustained release of progesterone through implantation of subcutaneous capsules on rat's brain edema and alteration of cerebrospinal fluid (CSF), and serum ratio of NGF/IL-6 after TBI. This experiment was performed on ovariectomized (OVX) rats and the brain injury was induced by Marmarou's method. A high and a low dose of progesterone (HP and LP) was injected intraperitoneally two h after the brain injury. In addition, in the capsule progesterone-treated group (CP), the intervention was implemented 6 h after the brain injury. Brain edema, NGF and IL-6 biomarkers in serum and cerebrospinal fluid (CSF) were measured 48 h after the TBI in injection groups and one week after the TBI in the CP group. No significant difference was found in the two groups or in the admonition methods. After TBI, the NGF level increased and IL-6 level decreased by injection of both doses, as well as by taking the capsule. Ratio of NGF/IL-6 in CSF increased significantly by all forms of progesterone administration. The increase in the level of NGF and IL-6 after TBI was higher in CSF than in serum. These results indicated that effects of progesterone in capsule form were better than the injection form. Progesterone probably works by increasing NGF and reducing IL-6. Future studies should investigate the ratio of these biomarkers as a variable to determine the neuroprotective effects of another drug.
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Affiliation(s)
- Shirazpour Sara
- Neuroscience Research Center, Neuropharmacology Institute, Kerman University of Medical Sciences, Kerman, Iran
| | - Khaksari Mohammad
- Endocrinology and Metabolism Research Center, Institute of Basic and Clinical Physiology Sciences, Kerman University of Medical Sciences, Kerman, Iran
| | - Shahrokhi Nader
- Physiology Research Center, Institute of Basic and Clinical Physiology Sciences, Kerman University of Medical Sciences, Kerman, Iran
| | - Iranpour Maryam
- Pathology and Stem Cell Research Center, Department of Pathology, Kerman University of Medical Sciences, Kerman, Iran
| | - Shahryari Marzieh
- Department of Physiology, Neuroscience Research Center, Medical Faculty, Golestan University of Medical Sciences, Gorgan, Iran
| | - Jafari Elham
- Pathology and Stem Cell Research Center, Department of Pathology, Kerman University of Medical Sciences, Kerman, Iran
| | - Salmani Neda
- Department of Psychology, Genetic Institute, Islamic Azad University of Zarand, Keman, Iran
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Walton RB, Reed LC, Estrada SM, Schmiedecke SS, Villazana-Kretzer DL, Napolitano PG, Ieronimakis N. Evaluation of Sildenafil and Tadalafil for Reversing Constriction of Fetal Arteries in a Human Placenta Perfusion Model. Hypertension 2018; 72:167-176. [PMID: 29735634 DOI: 10.1161/hypertensionaha.117.10738] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 12/28/2017] [Accepted: 04/11/2018] [Indexed: 11/16/2022]
Abstract
Fetal growth restriction resulting from reduced placental blood perfusion is a major cause of neonatal morbidity and mortality. Aside from intense surveillance and early delivery, there is no treatment for fetal growth restriction. A potential treatment associated with placental vasoconstriction is the class of PDE5 (phosphodiesterase type 5) inhibitors such as sildenafil, which is known to cross the placenta. In contrast, tadalafil, a more potent and selective PDE5 inhibitor has not been studied in pregnancy or experimental models of fetal growth restriction. Therefore, we compared the efficacy of these 2 PDE5 inhibitors for reversing vasoconstriction in an ex vivo human placental model and evaluating molecular and physiological responses. Sildenafil and tadalafil were infused into the intervillous space in a preconstricted human placental dual cotyledon, dual perfusion assay for the comparison of arteriole pressures and molecular indicators of drug inhibition. Results indicate a decrease arterial pressure with sildenafil citrate compared with controls, whereas tadalafil showed no difference. PDE5 and endothelial nitric oxide synthase activity were altered with sildenafil but not tadalafil. Sildenafil citrate improved preconstricted placental arterial perfusion in a human placental model, whereas tadalafil showed no response. It is possible that tadalafil did not cross the human placental barrier or was degraded by trophoblasts. This study supports human clinical trials exploring sildenafil as a potential treatment for improving fetal blood flow in fetal growth restriction associated with vasoconstriction.
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Affiliation(s)
- Robert B Walton
- From the Department of Obstetrics and Gynecology (R.B.W., L.C.R., S.M.E., S.S.S., D.L.V.-K., P.G.N.)
| | - Luckey C Reed
- From the Department of Obstetrics and Gynecology (R.B.W., L.C.R., S.M.E., S.S.S., D.L.V.-K., P.G.N.)
| | - Sarah M Estrada
- From the Department of Obstetrics and Gynecology (R.B.W., L.C.R., S.M.E., S.S.S., D.L.V.-K., P.G.N.)
| | - Stacey S Schmiedecke
- From the Department of Obstetrics and Gynecology (R.B.W., L.C.R., S.M.E., S.S.S., D.L.V.-K., P.G.N.)
| | - Diana L Villazana-Kretzer
- From the Department of Obstetrics and Gynecology (R.B.W., L.C.R., S.M.E., S.S.S., D.L.V.-K., P.G.N.)
| | - Peter G Napolitano
- From the Department of Obstetrics and Gynecology (R.B.W., L.C.R., S.M.E., S.S.S., D.L.V.-K., P.G.N.)
| | - Nicholas Ieronimakis
- Department of Clinical Investigation (N.I.), Madigan Army Medical Center, Joint Base Lewis-McCord, Tacoma, WA.
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Kim YS. Use of progesterone as a preventive medicine and nifedipine as a treatment of preterm labor. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2018. [DOI: 10.5124/jkma.2018.61.3.214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Yun-Sook Kim
- Department of Obstetrics and Gynecology, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
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Preciado-Martínez E, García-Ruíz G, Flores-Espinosa P, Bermejo-Martínez L, Espejel-Nuñez A, Estrada-Gutiérrez G, Razo-Aguilera G, Granados-Cepeda M, Helguera-Repetto AC, Irles C, Zaga-Clavellina V. Progesterone suppresses the lipopolysaccharide-induced pro-inflammatory response in primary mononuclear cells isolated from human placental blood. Immunol Invest 2017; 47:181-195. [PMID: 29236553 DOI: 10.1080/08820139.2017.1413112] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Progesterone is an essential hormone that induces deep immune adaptations favoring pregnancy maintenance. We aimed at evaluating the effects of progesterone on the synthesis of pro- and anti-inflammatory cytokines by mononuclear cells isolated from human placental blood stimulated with lipopolysaccharide, emulating an infection-inflammation environment. Mononuclear cells isolated form human placental blood were obtained from nine women undergoing elective cesarean delivery at term (not in labor), isolated by density gradient sedimentation, cultured and co-stimulated with lipopolysaccharide (500 ng/ml) from Escherichia coli in the presence or not of progesterone (0.01, 0.1, or 1.0 µM) for 24 h. Culture supernatants were assayed for pro-inflammatory (IL-1β, TNFα, IL-6), anti-inflammatory (IL-10) cytokines, chemokines (IL-8, MIP-1α) and total MMP-9 by ELISA. In comparison with basal conditions, lipopolysaccharide treatment induced IL-1β, TNFα, IL-6, IL-8, MIP-1α, and MMP-9 synthesis. lipopolysaccharide co-treatment with progesterone significantly decreased the bacterial endotoxin-induced IL-1β, TNF-α, IL-6, IL-8, and MIP-1α secretion. In contrast, co-treatment with progesterone increased the level of IL-10 secreted to the culture medium. The present results support the concept that progesterone can modulate--partially--the inflammatory response of professional immune cells isolated from placental blood. Therefore, progesterone might be part of the natural compensatory mechanism that limits the cytotoxic effects associated with an intrauterine infection process during gestation.
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Affiliation(s)
- E Preciado-Martínez
- a Inmunobiochemistry Branch , Instituto Nacional de Perinatología "Isidro Espinosa de los Reyes" , México City , México.,b Facultad de Estudios Superiores Cuautitlán , Universidad Nacional Autónoma de México , Estado de México , México
| | - G García-Ruíz
- a Inmunobiochemistry Branch , Instituto Nacional de Perinatología "Isidro Espinosa de los Reyes" , México City , México.,b Facultad de Estudios Superiores Cuautitlán , Universidad Nacional Autónoma de México , Estado de México , México
| | - P Flores-Espinosa
- a Inmunobiochemistry Branch , Instituto Nacional de Perinatología "Isidro Espinosa de los Reyes" , México City , México
| | - L Bermejo-Martínez
- a Inmunobiochemistry Branch , Instituto Nacional de Perinatología "Isidro Espinosa de los Reyes" , México City , México
| | - A Espejel-Nuñez
- a Inmunobiochemistry Branch , Instituto Nacional de Perinatología "Isidro Espinosa de los Reyes" , México City , México
| | - G Estrada-Gutiérrez
- a Inmunobiochemistry Branch , Instituto Nacional de Perinatología "Isidro Espinosa de los Reyes" , México City , México
| | - G Razo-Aguilera
- c Human Genetic and Genomic Branch , Instituto Nacional de Perinatología "Isidro Espinosa de los Reyes" , México City , México
| | - M Granados-Cepeda
- d Neonatology Branch , Instituto Nacional de Perinatología "Isidro Espinosa de los Reyes" , México City , México
| | - A C Helguera-Repetto
- a Inmunobiochemistry Branch , Instituto Nacional de Perinatología "Isidro Espinosa de los Reyes" , México City , México
| | - C Irles
- e Physiology and Cellular Development Branch , Instituto Nacional de Perinatología "Isidro Espinosa de los Reyes" , México City , México
| | - V Zaga-Clavellina
- a Inmunobiochemistry Branch , Instituto Nacional de Perinatología "Isidro Espinosa de los Reyes" , México City , México
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Hung TH, Chen SF, Wu CP, Li MJ, Yeh YL, Hsieh TT. Micronized progesterone pretreatment affects the inflammatory response of human gestational tissues and the cervix to lipopolysaccharide stimulation. Placenta 2017; 57:1-8. [DOI: 10.1016/j.placenta.2017.05.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Revised: 05/16/2017] [Accepted: 05/17/2017] [Indexed: 12/30/2022]
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Kindinger LM, Bennett PR, Lee YS, Marchesi JR, Smith A, Cacciatore S, Holmes E, Nicholson JK, Teoh TG, MacIntyre DA. The interaction between vaginal microbiota, cervical length, and vaginal progesterone treatment for preterm birth risk. MICROBIOME 2017; 5:6. [PMID: 28103952 PMCID: PMC5244550 DOI: 10.1186/s40168-016-0223-9] [Citation(s) in RCA: 235] [Impact Index Per Article: 33.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 12/15/2016] [Indexed: 05/21/2023]
Abstract
BACKGROUND Preterm birth is the primary cause of infant death worldwide. A short cervix in the second trimester of pregnancy is a risk factor for preterm birth. In specific patient cohorts, vaginal progesterone reduces this risk. Using 16S rRNA gene sequencing, we undertook a prospective study in women at risk of preterm birth (n = 161) to assess (1) the relationship between vaginal microbiota and cervical length in the second trimester and preterm birth risk and (2) the impact of vaginal progesterone on vaginal bacterial communities in women with a short cervix. RESULTS Lactobacillus iners dominance at 16 weeks of gestation was significantly associated with both a short cervix <25 mm (n = 15, P < 0.05) and preterm birth <34+0 weeks (n = 18; P < 0.01; 69% PPV). In contrast, Lactobacillus crispatus dominance was highly predictive of term birth (n = 127, 98% PPV). Cervical shortening and preterm birth were not associated with vaginal dysbiosis. A longitudinal characterization of vaginal microbiota (<18, 22, 28, and 34 weeks) was then undertaken in women receiving vaginal progesterone (400 mg/OD, n = 25) versus controls (n = 42). Progesterone did not alter vaginal bacterial community structure nor reduce L. iners-associated preterm birth (<34 weeks). CONCLUSIONS L. iners dominance of the vaginal microbiota at 16 weeks of gestation is a risk factor for preterm birth, whereas L. crispatus dominance is protective against preterm birth. Vaginal progesterone does not appear to impact the pregnancy vaginal microbiota. Patients and clinicians who may be concerned about "infection risk" associated with the use of a vaginal pessary during high-risk pregnancy can be reassured.
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Affiliation(s)
- Lindsay M Kindinger
- Imperial College Parturition Research Group, Division of the Institute of Reproductive and Developmental Biology, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, Hammersmith Campus, London, W12 0NN, UK
- Queen Charlotte's Hospital, Imperial College Healthcare NHS Trust, London, UK
- Department of Obstetrics and Gynaecology, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Phillip R Bennett
- Imperial College Parturition Research Group, Division of the Institute of Reproductive and Developmental Biology, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, Hammersmith Campus, London, W12 0NN, UK
- Queen Charlotte's Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Yun S Lee
- Imperial College Parturition Research Group, Division of the Institute of Reproductive and Developmental Biology, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, Hammersmith Campus, London, W12 0NN, UK
| | - Julian R Marchesi
- Centre for Digestive and Gut Health, Department of Surgery and Cancer and the Institute of Global Health Innovation, Faculty of Medicine, Imperial College London, London, UK
- School of Biosciences, Cardiff University, Cardiff, UK
- Division of Computational Systems Medicine, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
| | - Ann Smith
- School of Biosciences, Cardiff University, Cardiff, UK
| | - Stefano Cacciatore
- Imperial College Parturition Research Group, Division of the Institute of Reproductive and Developmental Biology, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, Hammersmith Campus, London, W12 0NN, UK
| | - Elaine Holmes
- Centre for Digestive and Gut Health, Department of Surgery and Cancer and the Institute of Global Health Innovation, Faculty of Medicine, Imperial College London, London, UK
- Division of Computational Systems Medicine, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
| | - Jeremy K Nicholson
- Centre for Digestive and Gut Health, Department of Surgery and Cancer and the Institute of Global Health Innovation, Faculty of Medicine, Imperial College London, London, UK
- Division of Computational Systems Medicine, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
| | - T G Teoh
- Imperial College Parturition Research Group, Division of the Institute of Reproductive and Developmental Biology, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, Hammersmith Campus, London, W12 0NN, UK
- Department of Obstetrics and Gynaecology, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - David A MacIntyre
- Imperial College Parturition Research Group, Division of the Institute of Reproductive and Developmental Biology, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, Hammersmith Campus, London, W12 0NN, UK.
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Brubaker D, Barbaro A, R Chance M, Mesiano S. A dynamical systems model of progesterone receptor interactions with inflammation in human parturition. BMC SYSTEMS BIOLOGY 2016; 10:79. [PMID: 27543267 PMCID: PMC4992259 DOI: 10.1186/s12918-016-0320-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 07/14/2016] [Indexed: 12/29/2022]
Abstract
BACKGROUND Progesterone promotes uterine relaxation and is essential for the maintenance of pregnancy. Withdrawal of progesterone activity and increased inflammation within the uterine tissues are key triggers for parturition. Progesterone actions in myometrial cells are mediated by two progesterone receptor (PR) isoforms, PR-A and PR-B, that function as ligand-activated transcription factors. PR-B mediates relaxatory actions of progesterone, in part, by decreasing myometrial cell responsiveness to pro-inflammatory stimuli. These same pro-inflammatory stimuli promote the expression of PR-A which inhibits the anti-inflammatory activity of PR-B. Competitive interaction between the progesterone receptors then augments myometrial responsiveness to pro-inflammatory stimuli. The interaction between PR-B transcriptional activity and inflammation in the pregnancy myometrium is examined using a dynamical systems model in which quiescence and labor are represented as phase-space equilibrium points. Our model shows that PR-B transcriptional activity and the inflammatory load determine the stability of the quiescent and laboring phenotypes. The model is tested using published transcriptome datasets describing the mRNA abundances in the myometrium before and after the onset of labor at term. Surrogate transcripts were selected to reflect PR-B transcriptional activity and inflammation status. RESULTS The model coupling PR-B activity and inflammation predicts contractile status (i.e., laboring or quiescent) with high precision and recall and outperforms uncoupled single and two-gene classifiers. Linear stability analysis shows that phase space bifurcations exist in our model that may reflect the phenotypic states of the pregnancy uterus. The model describes a possible tipping point for the transition of the quiescent to the contractile laboring phenotype. CONCLUSIONS Our model describes the functional interaction between the PR-A:PR-B hypothesis and tissue level inflammation in the pregnancy uterus and is a first step in more sophisticated dynamical systems modeling of human partition. The model explains observed biochemical dynamics and as such will be useful for the development of a range of systems-based models using emerging data to predict preterm birth and identify strategies for its prevention.
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Affiliation(s)
- Douglas Brubaker
- Center for Proteomics and Bioinformatics, Case Western Reserve University, 11900 Euclid Avenue, Cleveland, 44106, OH, USA
| | | | - Mark R Chance
- Center for Proteomics and Bioinformatics, Case Western Reserve University, 11900 Euclid Avenue, Cleveland, 44106, OH, USA
| | - Sam Mesiano
- Department of Reproductive Biology, Case Western Reserve University, 11900 Euclid Avenue, Cleveland, 44106, OH, USA.
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Pineda-Torres M, Flores-Espinosa P, Espejel-Nunez A, Estrada-Gutierrez G, Flores-Pliego A, Maida-Claros R, Zaga-Clavellina V. Evidence of an immunosuppressive effect of progesterone upon in vitro secretion of proinflammatory and prodegradative factors in a model of choriodecidual infection. BJOG 2014; 122:1798-807. [PMID: 25315965 DOI: 10.1111/1471-0528.13113] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/04/2014] [Indexed: 01/29/2023]
Abstract
OBJECTIVE To evaluate whether progesterone (P4) is able to modulate the secretion of tumour necrosis factor α (TNF-α), interleukin-1β (IL-1β), IL-6, IL-8, IL-10 and matrix metalloproteinase-9 (MMP-9) after choriodecidual stimulation with lipopolysaccharide (LPS). DESIGN Chorioamnionitis-elicited preterm delivery is associated with an uncontrolled secretion of proinflammatory cytokines that may induce MMPs, which modify the fine immunological and structural equilibrium at the fetal-maternal interface. SETTING Instituto Nacional de Perinatología 'Isidro Espinosa de los Reyes', Mexico City. SAMPLE Twelve human fetal membranes at term from healthy patients were placed in a two-chamber culture system. METHODS Choriodecidual and amniotic regions were preincubated with 1.0, 0.1, or 0.01 μmol/l P4 for 24 hours; after which the choriodecidual region was costimulated with 1000 ng/ml of LPS for 24 hours. MAIN OUTCOME MEASURES Descriptive statistics were obtained for each variable. Data distribution was tested for normality using Kolmogorov-Smirnoff and Shapiro-Wilk tests. When distribution was normal, Student's t test was used to analyse for differences among groups. Mann-Whitney's U test was used when data were not normally distributed. RESULTS Pretreatment with 1.0 μmol/l P4 significantly blunted the secretion of TNF-α, IL-1β, IL-6, IL-8 and IL-10. MMP-9 was inhibited with 0.1 μmol/l P4. Mifepristone (RU486) blocked the immunosuppressive effect of P4, suggesting a P4 effect mediated by its receptor. CONCLUSION These results offer evidence to support the concept that P4 can protect the fetal-placental unit through a compensatory mechanism that partially limits the secretion of proinflammatory and prodegradative modulators.
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Affiliation(s)
- M Pineda-Torres
- Immunobiochemistry Branch, Instituto Nacional de Perinatología 'Isidro Espinosa de los Reyes', Mexico, DF, Mexico
| | - P Flores-Espinosa
- Immunobiochemistry Branch, Instituto Nacional de Perinatología 'Isidro Espinosa de los Reyes', Mexico, DF, Mexico
| | - A Espejel-Nunez
- Immunobiochemistry Branch, Instituto Nacional de Perinatología 'Isidro Espinosa de los Reyes', Mexico, DF, Mexico
| | - G Estrada-Gutierrez
- Immunobiochemistry Branch, Instituto Nacional de Perinatología 'Isidro Espinosa de los Reyes', Mexico, DF, Mexico
| | - A Flores-Pliego
- Immunobiochemistry Branch, Instituto Nacional de Perinatología 'Isidro Espinosa de los Reyes', Mexico, DF, Mexico
| | - R Maida-Claros
- Neonatology Branch, Instituto Nacional de Perinatología 'Isidro Espinosa de los Reyes', Mexico, DF, Mexico
| | - V Zaga-Clavellina
- Immunobiochemistry Branch, Instituto Nacional de Perinatología 'Isidro Espinosa de los Reyes', Mexico, DF, Mexico
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Rinaldi SF, Hutchinson JL, Rossi AG, Norman JE. Anti-inflammatory mediators as physiological and pharmacological regulators of parturition. Expert Rev Clin Immunol 2014; 7:675-96. [DOI: 10.1586/eci.11.58] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Flores-Espinosa P, Pineda-Torres M, Vega-Sánchez R, Estrada-Gutiérrez G, Espejel-Nuñez A, Flores-Pliego A, Maida-Claros R, Paredes-Vivas Y, Morales-Méndez I, Sosa-González I, Chávez-Mendoza A, Zaga-Clavellina V. Progesterone elicits an inhibitory effect upon LPS-induced innate immune response in pre-labor human amniotic epithelium. Am J Reprod Immunol 2013; 71:61-72. [PMID: 24128422 DOI: 10.1111/aji.12163] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2013] [Accepted: 09/09/2013] [Indexed: 12/19/2022] Open
Abstract
PROBLEM Infection of human fetal membranes elicits secretion of pro-inflammatory modulators through its innate immune capacities. We investigated the effect of lipopolysacharide (LPS) and progesterone (P4) upon expression of TLR-4/MyD88, TNFα, IL-6, IL-8, IL-10, and HBD2 on the human amniotic epithelium. METHOD OF STUDY Explants of the human amniotic epithelium were pre-treated with 0.01, 0.1, and 1.0 μM of P4; then cotreated with 1000 ng/mL LPS. TLR-4 was immuno-detected, and concentrations of MyD88, TNFα, IL-6, IL-8, IL-10, and HBD2 were quantified by ELISA. RESULTS P4 significantly reduced the expression of LPS-induced TLR-4/MyD88. LPS increased the concentrations of TNFα, IL-6, IL-8, IL-10, and HBD2 by factors of 30-, eight, three, three, and fivefold, respectively. P4 at 1.0 μM was the most effective dose to blunt the secretion of TNFα, IL-6, and HBD-2. RU-486 blocks the effect of P4. CONCLUSION P4 inhibited LPS-induced TLR-4/MyD88 and pro-inflammatory factors in the human amniotic epithelium. These results could explain partially how P4 can protect the amniotic region of fetal membranes and generate a compensatory mechanism that limits the secretion of pro-inflammatory modulators, which could jeopardize the immune privilege during pregnancy.
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Affiliation(s)
- Pilar Flores-Espinosa
- Department of Cell Biology, Instituto Nacional de Perinatología 'Isidro Espinosa de los Reyes', Mexico City, Mexico; Posgrado en Ciencias Biológicas, Universidad Nacional Autónoma de México, Mexico City, Mexico
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Goddard LM, Ton AN, Org T, Mikkola HKA, Iruela-Arispe ML. Selective suppression of endothelial cytokine production by progesterone receptor. Vascul Pharmacol 2013; 59:36-43. [PMID: 23747964 DOI: 10.1016/j.vph.2013.06.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2013] [Accepted: 06/01/2013] [Indexed: 01/01/2023]
Abstract
Steroid hormones are well-recognized suppressors of the inflammatory response, however, their cell- and tissue-specific effects in the regulation of inflammation are far less understood, particularly for the sex-related steroids. To determine the contribution of progesterone in the endothelium, we have characterized and validated an in vitro culture system in which human umbilical vein endothelial cells constitutively express human progesterone receptor (PR). Using next generation RNA-sequencing, we identified a selective group of cytokines that are suppressed by progesterone both under physiological conditions and during pathological activation by lipopolysaccharide. In particular, IL-6, IL-8, CXCL2/3, and CXCL1 were found to be direct targets of PR, as determined by ChIP-sequencing. Regulation of these cytokines by progesterone was also confirmed by bead-based multiplex cytokine assays and quantitative PCR. These findings provide a novel role for PR in the direct regulation of cytokine levels secreted by the endothelium. They also suggest that progesterone-PR signaling in the endothelium directly impacts leukocyte trafficking in PR-expressing tissues.
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Affiliation(s)
- Lauren M Goddard
- Department of Molecular, Cell and Developmental Biology, University of California, Los Angeles, Los Angeles, CA 90095, USA
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Bomba-Opon DA, Kosinska-Kaczynska K, Kosinski P, Wegrzyn P, Kaczynski B, Wielgos M. Vaginal progesterone after tocolytic therapy in threatened preterm labor. J Matern Fetal Neonatal Med 2012; 25:1156-9. [DOI: 10.3109/14767058.2011.629014] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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15
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Zhao XD, Zhou YT. Effects of progesterone on intestinal inflammatory response and mucosa structure alterations following SAH in male rats. J Surg Res 2011; 171:e47-53. [PMID: 21924739 DOI: 10.1016/j.jss.2011.07.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2011] [Revised: 06/18/2011] [Accepted: 07/11/2011] [Indexed: 10/17/2022]
Abstract
BACKGROUND Subarachnoid hemorrhage (SAH) can induce a persistent inflammatory response, histopathologic changes in the gut. This study investigated whether progesterone administration modulates intestinal proinflammatory cytokine expression and structure alternations following SAH in male rats. MATERIALS AND METHODS A total of 48 male rats were randomly divided into four groups: control group (n = 12), SAH group (n = 12), SAH+vehicle group (n = 12) and SAH+progesterone group (n = 12). We measured intestinal wet/dry weight ratio; the concentrations of IL-1β, TNF-α, and IL-6 by enzyme-linked immunosorbent assay; intestinal mucosal morphologic changes by histopathologic study and electron microscopy. RESULTS Administration of progesterone following SAH could increase the appetite scores of SAH rats and decrease concentrations of proinflammatory cytokines and wet/dry weight ratio in the gut. SAH-induced damage of gut structure was ameliorated after progesterone supplementation. CONCLUSIONS The results of the present study suggest that the therapeutic benefit of post-SAH progesterone supplementation might be due to its inhibitory effects on intestinal proinflammatory cytokine expression and gut structure amelioration.
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Affiliation(s)
- Xu-dong Zhao
- Department of Neurosurgery, Wuxi Second Hospital Affiliated Nanjing Medical University, Wuxi, Jiangsu Province, China.
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Golightly E, Jabbour HN, Norman JE. Endocrine immune interactions in human parturition. Mol Cell Endocrinol 2011; 335:52-9. [PMID: 20708653 DOI: 10.1016/j.mce.2010.08.005] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2010] [Accepted: 08/05/2010] [Indexed: 11/19/2022]
Abstract
Human parturition is an inflammatory event, modulated and influenced by a host of other environmental and physiological processes, including the endocrine hormones. Complex bidirectional communication occurs between the two systems to bring about some of the changes that are seen in labour, an event that is not yet fully understood. Preterm birth is a major problem in obstetrics and neonatology, with dysfunctional labour or prolonged pregnancy also making increasingly significant contributions to maternal morbidity. With better understanding of normal and abnormal parturition we may be able to develop novel ways of treating these complications of pregnancy and reduce maternal and neonatal morbidity and mortality. This review discusses the crucial role that endocrine-immune interaction plays in the process of labour and in the processes of abnormal and preterm labour. We propose that amongst these complex interactions it is the immune system that is the driving force behind human parturition.
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Affiliation(s)
- E Golightly
- University of Edinburgh, Division of Reproductive and Developmental Sciences, Centre for Reproductive Biology, 47 Little France Crescent, Edinburgh EH16 4TJ, United Kingdom
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Foglia LM, Ippolito DL, Stallings JD, Zelig CM, Napolitano PG. Intramuscular 17α-hydroxyprogesterone caproate administration attenuates immunoresponsiveness of maternal peripheral blood mononuclear cells. Am J Obstet Gynecol 2010; 203:561.e1-5. [PMID: 20810098 DOI: 10.1016/j.ajog.2010.07.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2010] [Revised: 05/17/2010] [Accepted: 07/15/2010] [Indexed: 11/24/2022]
Abstract
OBJECTIVE 17α-hydroxyprogesterone caproate (17P) may decrease risk of prematurity by suppressing maternal immunity. We hypothesized that in vivo 17P treatment attenuates immunoresponsiveness of peripheral blood mononuclear cells (PBMCs). STUDY DESIGN Study subjects were gravidas receiving weekly prophylactic intramuscular 17P injections. Peripheral blood samples were obtained at 21-27 weeks' gestation. Gestational age-matched, drug-naïve gravidas served as controls. To simulate infection, isolated PBMCs were stimulated with lipoteichoic acid (LTA) or lipopolysaccharide (LPS). Extracellular interleukin-6 (IL-6) concentrations were quantified by an enzyme-linked immunosorbent assay. RESULTS Unstimulated IL-6 levels were comparable in PBMCs derived from drug-naïve and 17P-treated subjects. LPS and LTA induced a dose-dependent elevation of IL-6 in control PBMCs. In patients who received exogenous 17P, LPS, and LTA stimulated induction of IL-6 was significantly decreased compared with controls (P = .005 and P = .02). CONCLUSION In vivo 17P attenuated immunoreactivity of PBMCs in our in vitro model of Gram-positive and Gram-negative bacterial infection.
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Dodd JM, Crowther CA. The role of progesterone in prevention of preterm birth. Int J Womens Health 2010; 1:73-84. [PMID: 21072277 PMCID: PMC2971700 DOI: 10.2147/ijwh.s4730] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2009] [Indexed: 11/23/2022] Open
Abstract
Preterm birth continues to provide an enormous challenge in the delivery of perinatal health care, and is associated with considerable short and long-term health consequences for surviving infants. Progesterone has a role in maintaining pregnancy, by suppression of the calcium-calmodulin-myosin light chain kinase system. Additionally, progesterone has recognized anti-inflammatory properties, raising a possible link between inflammatory processes, alterations in progesterone receptor expression and the onset of preterm labor. Systematic reviews of randomized controlled trials evaluating the use of intramuscular and vaginal progesterone in women considered to be at increased risk of preterm birth have been published, with primary outcomes of perinatal death, preterm birth <34 weeks, and neurodevelopmental handicap in childhood. Eleven randomized controlled trials were included in the systematic review, involving 2714 women and 3452 infants, with results presented according to the reason women were considered to be at increased risk of preterm birth. While there is a potential beneficial effect in the use of progesterone for some women considered to be at increased risk of preterm birth, primarily in the reduction in the risk of preterm birth before 34 weeks gestation, it remains unclear if the observed prolongation of pregnancy translates into improved health outcomes for the infant.
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Affiliation(s)
- Jodie M Dodd
- Discipline of Obstetrics and Gynaecology, The University of Adelaide, Adelaide, South Australia, Australia
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Jabbour HN, Sales KJ, Catalano RD, Norman JE. Inflammatory pathways in female reproductive health and disease. Reproduction 2009; 138:903-19. [PMID: 19793840 DOI: 10.1530/rep-09-0247] [Citation(s) in RCA: 220] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Inflammation involves alterations to vascular and immune cell function. It is well recognised that many physiological reproductive events such as ovulation, menstruation, implantation and onset of labour display hallmark signs of inflammation. These are orchestrated by specific molecular pathways involving a host of growth factors, cytokines, chemokines and lipid mediators. Resumption of normal reproductive function involves prompt and proper resolution of these inflammatory pathways. Recent literature confirms that resolution of inflammatory pathways involves specific biochemical events that are activated to re-establish homeostasis in the affected tissue. Moreover, initiation and maintenance of inflammatory pathways are the key components of many pathologies of the reproductive tract and elsewhere in the body. The onset of reproductive disorders or disease may be the result of exacerbated activation and maintenance of inflammatory pathways or their dysregulated resolution. This review will address the role of inflammatory events in normal reproductive function and its pathologies.
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Affiliation(s)
- Henry N Jabbour
- MRC Human Reproductive Sciences Unit Reproductive and Developmental Sciences, Queen's Medical Research Institute, The University of Edinburgh, 47 Little France Crescent, Edinburgh EH16 4TJ, UK.
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Schwartz N, Xue X, Elovitz MA, Dowling O, Metz CN. Progesterone suppresses the fetal inflammatory response ex vivo. Am J Obstet Gynecol 2009; 201:211.e1-9. [PMID: 19646573 DOI: 10.1016/j.ajog.2009.05.012] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2008] [Revised: 05/04/2009] [Accepted: 05/10/2009] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Progesterone supplementation has been shown to be efficacious in preventing preterm birth. We sought to investigate the effects of progesterone on fetal inflammatory responses. STUDY DESIGN Fetal mononuclear cells were isolated from umbilical cord blood and exposed to vehicle or progesterone (P4) for 1 hour prior to lipopolysaccharide (LPS) stimulation. Supernatants were assayed for tumor necrosis factor-alpha. Similar experiments were performed using cyclic adenosine monophosphate (cAMP) and progesterone modulators. The effect of P4 treatment on intracellular cAMP levels was also determined. RESULTS LPS treatment led to a significant increase in cytokine production by fetal mononuclear cells. Despite the lack of detectable nuclear progesterone receptors, P4 suppressed this inflammatory response. R5020 (progesterone agonist), forskolin (cAMP inducer), and dibutyryl cAMP (cAMP agonist) all achieved immunosuppression. The cAMP antagonist, Rp-cAMP, blocked the inhibitory effect of progesterone. P4 significantly increased intracellular cAMP levels. CONCLUSION Progesterone rapidly suppresses the fetal inflammatory response, possibly via nongenomic activation of the cAMP cascade.
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Pasquier JC, Doret M. [Fetal membranes: embryological development, structure and the physiopathology of the preterm premature rupture of membranes]. ACTA ACUST UNITED AC 2008; 37:579-88. [PMID: 18424017 DOI: 10.1016/j.jgyn.2007.12.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2007] [Revised: 07/13/2007] [Accepted: 12/06/2007] [Indexed: 12/17/2022]
Abstract
Fetal membranes development is a complex process. The amniotic and exo-celomic cavities are appearing first. The rapid growth of the amniotic cavity is leading to the disappearance of the exo-celomic cavity and the chorion is merging with the decidua. Fetal membranes consist of three layers: the amnion and the chorion, issued from fetal tissues and the decidua issued from maternal tissue. A balance between the synthesis and the degradation of membranes components is physiologic throughout the gestation. Two main mechanisms are involved in the degradation process: apoptosis in the cellular compartment and matrix metalloproteinase (MMP) in the extracellular matrix. Regulation of MMP is depending on factors increasing their expression (cytokines) and factors decreasing their activity tissue inhibitor of metalloproteinases (TIMPS). Particular conditions can induce an unbalance between synthesis and degradation leading to the weakening of the membranes. Different factors can be associated to induce this unbalance: infection, hormonal factors, default in membranes fusion, oxidative stress and mechanic factors. In fine, the spontaneous rupture of the membranes is always occurring in regard of the uterine cervix after a process started several weeks before.
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Affiliation(s)
- J-C Pasquier
- Département de gynécologie-obstétrique, faculté de médecine, université de Sherbrooke, Sherbrooke Qc 3001, J1H 5N4 Canada.
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Progesterone prevents traumatic brain injury-induced intestinal nuclear factor kappa B activation and proinflammatory cytokines expression in male rats. Mediators Inflamm 2008; 2007:93431. [PMID: 18274644 PMCID: PMC2222592 DOI: 10.1155/2007/93431] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2007] [Accepted: 07/02/2007] [Indexed: 01/19/2023] Open
Abstract
We have previously shown that traumatic brain injury (TBI) can induce an upregulation of nuclear factor kappa B (NF-κB) and proinflammatory cytokines in the gut, which play an important role in the pathogenesis of acute gut mucosal injury mediated by inflammation. In this work, we investigated whether progesterone administration modulated intestinal NF-κB activity and proinflammatory cytokines expression after TBI in male rats. As a result, we found that administration of progesterone following TBI could decrease NF-κB binding activity, NF-κB p65 protein expression, and concentrations of interleukin-1β (IL-1β), and tumor necrosis factor-α (TNF-α) in the gut. TBI-induced damages of gut structure were ameliorated after progesterone injections. The results of the present study suggest that the therapeutic benefit of post-TBI progesterone injections might be due to its inhibitory effects on intestinal NF-κB activation and proinflammatory cytokines expression.
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Abstract
The identification of women at risk of preterm labour remains an important challenge. While current prevention programmes rely on overt clinical and environmental parameters, the clustering of preterm labour within families and recurrence in susceptible women presents the case for a complex underlying genetic predisposition. Genetic polymorphisms are useful markers to identify high risk groups, although they provide little information either to their underlying functionality or the pathophysiological mechanisms involved; these must be validated through complementary analytical approaches. Data interpretation and inter-study comparisons must be made with caution, taking into account population size, study power, racial differences, inclusion/exclusion criteria and any underlying gene-environment and feto-maternal interactions. Large-scale, multicentre genetic studies coupled with high-throughput screening techniques are the most viable approaches to identify multilocus preterm labour susceptibility screening panels. Preventive strategies may then be applied to those women most likely to benefit from intervention.
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Affiliation(s)
- Nicolas M Orsi
- Perinatal Research Group, The YCR & Liz Dawn Pathology & Translational Sciences Centre Level 4, Leeds Institute of Molecular Medicine, St James's University Hospital, Leeds LS9 7TF, UK.
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Chen G, Shi JX, Qi M, Wang HX, Hang CH. Effects of progesterone on intestinal inflammatory response, mucosa structure alterations, and apoptosis following traumatic brain injury in male rats. J Surg Res 2007; 147:92-8. [PMID: 17868700 DOI: 10.1016/j.jss.2007.05.029] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2007] [Revised: 04/20/2007] [Accepted: 05/14/2007] [Indexed: 10/22/2022]
Abstract
BACKGROUND Traumatic brain injury (TBI) can induce a persistent inflammatory response, histopathological changes, and apoptosis in the gut. Progesterone given after TBI has been shown to reduce the cerebral inflammation and neuronal apoptosis in the brain. However, the effects of progesterone on the inflammatory response, structure alterations, and apoptosis in the intestinal mucosa following TBI has not been investigated. MATERIALS AND METHODS Right parietal cortical contusion in male rats was made by using the weight-dropping method. Rats were given 0 or 16 mg/kg injections of progesterone at postinjury at 1 and 6 hours and on days 1, 2, 3, 4, and 5. Gut samples were extracted at 5 days after trauma. We measured the concentrations of interleukin-1beta (IL-1beta), tumor necrosis factor-alpha, and interleukin-6 (IL-6) by enzyme-linked immunosorbent assay; intercellular adhesion molecule-1 expression by immunohistochemistry; intestinal mucosal morphological changes by histopathological study and electron microscopy; and apoptosis by terminal deoxynucleotidyl transferase-mediated dUTP nick end-labeling staining. RESULTS Administration of progesterone following TBI could decrease the intestinal concentrations of IL-1beta and tumor necrosis factor-alpha, but not IL-6. The level of intercellular adhesion molecule-1 expression in the gut was down-regulated by progesterone. TBI-induced damages of gut structure and apoptosis were attenuated after progesterone injections. CONCLUSIONS The results of the present study suggest that post-TBI progesterone administration could suppress the intestinal inflammation, protect the intestinal mucosal structure, and reduce the mucosa apoptosis.
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Affiliation(s)
- Gang Chen
- Department of Neurosurgery, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, Jiangsu Province, China
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