Antiprostaglandin Drugs

Evidence for anti-inflammatory effects of firocoxib administered to mares with experimentally induced placentitis

PROBLEM

Minimal evidence exists supporting therapeutic selections for equine placentitis. The goal of this study was to characterize the anti-inflammatory effects of firocoxib when administered to mares with placentitis.

METHODS

Mares (gestation D270-300) were assigned to: INFECT (n = 6; placentitis, no treatment), FIRO (n = 6; placentitis, firocoxib, 0.1 mg/kg, PO, daily), and NORM (n = 6; no infection/treatment). Allantoic fluid (8 hours, 24 hours, birth) and amniotic fluid (birth) were collected from mares after infection. Concentrations of IL-1β, IL-6, TNF-α, IL-10, PGF_2α , and PGE₂ in fluids were measured by ELISA. mRNA expression of IL-1β, IL-6, TNF-α, IL-8, IL-10, matrix metalloproteinases (MMPs) -1, 3, and 9 in fetal membranes/fetuses was quantified using real-time PCR.

RESULTS

Allantoic TNF-α concentrations were lowest in FIRO at 8 hours and 24 hours post-infection; IL-6 concentrations were lower in FIRO than NORM at 8 hours, lower in FIRO than INFECT at 24 hours post-inoculation, and lower in NORM than FIRO or INFECT at birth. Marginal mean allantoic IL-β and IL-10 concentrations were lower in FIRO and NORM than INFECT. Amniotic fluid cytokines were lowest in NORM with all measurements in that group being below the limit of detection. Allantoic PGF_2α concentrations were lower in FIRO and INFECT than NORM at 8 hours post-inoculation, and lower in FIRO than INFECT or NORM at 24 hours post-inoculation. Allantoic PGE₂ concentrations were lower in FIRO than INFECT. Amniotic PGF_2α and PGE₂ concentrations were lower in NORM than INFECT. In fetal membranes, group differences with respect to IL-1β, IL-6, IL-8, and MMP1 were dependent on tissue type.

CONCLUSIONS

Data suggest a suppressive effect of firocoxib administration on cytokine and prostaglandin production in mares with placentitis.

Cyclo-oxygenase (COX) inhibitors for preventing preterm labour

BACKGROUND

Preventing preterm labour is the most important step in preventing preterm birth. Prostaglandins play an important role in labour and birth. Prostaglandin production can be obstructed by inhibition of the cyclo-oxygenase (COX) enzyme and this may arrest uterine contraction. A Cochrane review on COX inhibitors for the treatment of preterm labour found insufficient data to draw conclusions about its effectiveness.

OBJECTIVES

To assess the effectiveness and safety of COX inhibitors for preventing preterm labour in high-risk women.

SEARCH METHODS

We searched the Cochrane Pregnancy and Childbirth Group's Trial Register (30 June 2012).

SELECTION CRITERIA

All published and unpublished randomised trials evaluating administration of any COX inhibitor for prevention of preterm labour in pregnant women at gestational age less than 36 weeks at risk of, but not experiencing, preterm labour. Cluster-randomised trials were eligible for inclusion. Quasi-randomised trials and studies with cross-over designs were excluded.

DATA COLLECTION AND ANALYSIS

Two review authors (T Khanprakob and U Sangkomkamhang) independently assessed all potential studies for inclusion. Disagreement was resolved by discussion and, where necessary, by consultation with a third review author. Two review authors independently assessed trial quality and extracted data. Data were checked for accuracy.

MAIN RESULTS

We included one randomised trial (involving 98 women) that evaluated the effectiveness of one type of COX inhibitor (rofecoxib) for preventing preterm birth. The included study did not report any data for one of our primary outcomes: preterm labour. Rofecoxib use was associated with an increased risk for preterm birth and preterm premature rupture of membranes (PPROM). Rofecoxib was associated with a higher risk of oligohydramnios and low fetal urine production but the effects were reversible after stopping treatment. There were no differences in the number of women who discontinued treatment before 32 weeks of gestation. There was no difference in neonatal morbidities and admission to neonatal intensive care unit. There were no maternal adverse effects or perinatal mortalities in either group.

AUTHORS' CONCLUSIONS

There was very little evidence about using COX inhibitors for preventing preterm labour. There are inadequate data to make any recommendation about using COX inhibitor in practice to prevent preterm labour. Future research should include follow-up of the babies to examine the short-term and long-term effects of COX inhibitors.

Comparison of the efficacy and adverse effects of nifedipine and indomethacin for the treatment of preterm labor

OBJECTIVE

To compare the effectiveness and adverse effects of nifedipine versus indomethacin in the treatment of preterm labor.

METHODS

In a randomized clinical trial, 79 women with labor pain at 26-33 weeks of gestation were treated with either oral nifedipine (n=40) or rectal indomethacin (n=39).

RESULTS

Twenty-three (59%) women in the indomethacin group, and 10 (25%) in the nifedipine group did not respond to treatment (P=0.002). None of the 16 and 30 women remaining in the indomethacin and nifedipine groups, respectively, delivered during the subsequent 48 hours. Of these remaining women, 1 (6.25%) in the indomethacin group and 4 (13.3%) in the nifedipine group delivered between 48 hours and 7 days (P=0.162). For the women who responded to treatment, the mean gestational age at time of delivery was 238.5±19.4 days and 246.4±15.4 days in the nifedipine and indomethacin groups, respectively (P=0.182). Seventeen (42.5%) women in the nifedipine group, and 11 (28.2%) in the indomethacin group showed adverse effects (P=0.184).

CONCLUSION

Indomethacin was less effective than nifedipine for the fast treatment of preterm labor. For women who responded to treatment within 2 hours, however, the delaying of delivery by indomethacin was similar to that by nifedipine.

Retroperitoneoscopic radical nephrectomy for renal-cell carcinoma during twin pregnancy

Renal-cell carcinoma (RCC) is rarely reported during pregnancy. Both the open and the laparoscopic approach to nephrectomy have been used effectively and safely in pregnant patients with RCC. We report a unique case of a 52-year-old woman found to have RCC during twin gestation who was treated with retroperitoneoscopic radical nephrectomy, one of the first such cases managed by this approach.

Expression and characterization of vitamin C transporter in the human trophoblast cell line HTR-8/SVneo: effect of steroids, flavonoids and NSAIDs

Vitamin C plays an important role in embryogenesis and fetal growth as well as in the progression of pregnancy and delivery. Therefore, it is important to understand the mechanism that mediates its transport to the fetus as well as the possible influences by endogenous and exogenous substances on its placental uptake. The aim of this study was to investigate placental sodium-dependent vitamin C transporters (SVCT) 1 and 2. By means of RT-PCR, we found that SVCT2, but not SVCT1, mRNA is expressed in human trophoblast cell line HTR-8/SVneo. Our method was able to confirm SVCT2 mRNA expression in human first-trimester chorionic villi but not in term placental tissue. Cell line kinetic studies of [(14)C] ascorbic acid (AA) uptake indicated a one-site model and a saturable process. Fetal bovine serum (FBS) and epidermal growth factor (EGF) do not influence the transport properties, although they significantly increase the expression of SVCT2. Steroid hormones (17beta-estradiol, progesterone and cortisol), flavonoids (genistein and quercetin) and non-steroidal anti-inflammatory drugs (NSAIDs) (indomethacin and diclofenac) inhibit [(14)C]AA uptake in a dose-dependent and non-competitive manner. On the contrary, the process is not influenced by aspirin. Our study suggests the use of HTR-8/SVneo cells as a suitable model for trophoblast vitamin C transport investigation.