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Yarboro MT, Boatwright N, Sekulich DC, Hooper CW, Wong T, Poole SD, Berger CD, Brown AJ, Jetter CS, Sucre JMS, Shelton EL, Reese J. A novel role for PGE 2-EP 4 in the developmental programming of the mouse ductus arteriosus: consequences for vessel maturation and function. Am J Physiol Heart Circ Physiol 2023; 325:H687-H701. [PMID: 37566109 PMCID: PMC10643004 DOI: 10.1152/ajpheart.00294.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 07/11/2023] [Accepted: 07/24/2023] [Indexed: 08/12/2023]
Abstract
The ductus arteriosus (DA) is a vascular shunt that allows oxygenated blood to bypass the developing lungs in utero. Fetal DA patency requires vasodilatory signaling via the prostaglandin E2 (PGE2) receptor EP4. However, in humans and mice, disrupted PGE2-EP4 signaling in utero causes unexpected patency of the DA (PDA) after birth, suggesting another role for EP4 during development. We used EP4-knockout (KO) mice and acute versus chronic pharmacological approaches to investigate EP4 signaling in DA development and function. Expression analyses identified EP4 as the primary EP receptor in the DA from midgestation to term; inhibitor studies verified EP4 as the primary dilator during this period. Chronic antagonism recapitulated the EP4 KO phenotype and revealed a narrow developmental window when EP4 stimulation is required for postnatal DA closure. Myography studies indicate that despite reduced contractile properties, the EP4 KO DA maintains an intact oxygen response. In newborns, hyperoxia constricted the EP4 KO DA but survival was not improved, and permanent remodeling was disrupted. Vasomotion and increased nitric oxide (NO) sensitivity in the EP4 KO DA suggest incomplete DA development. Analysis of DA maturity markers confirmed a partially immature EP4 KO DA phenotype. Together, our data suggest that EP4 signaling in late gestation plays a key developmental role in establishing a functional term DA. When disrupted in EP4 KO mice, the postnatal DA exhibits signaling and contractile properties characteristic of an immature DA, including impairments in the first, muscular phase of DA closure, in addition to known abnormalities in the second permanent remodeling phase.NEW & NOTEWORTHY EP4 is the primary EP receptor in the ductus arteriosus (DA) and is critical during late gestation for its development and eventual closure. The "paradoxical" patent DA (PDA) phenotype of EP4-knockout mice arises from a combination of impaired contractile potential, altered signaling properties, and a failure to remodel associated with an underdeveloped immature vessel. These findings provide new mechanistic insights into women who receive NSAIDs to treat preterm labor, whose infants have unexplained PDA.
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Affiliation(s)
- Michael T Yarboro
- Department of Cell and Developmental Biology, Vanderbilt University, Nashville, Tennessee, United States
| | - Naoko Boatwright
- Division of Neonatology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | - Deanna C Sekulich
- Division of Neonatology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | - Christopher W Hooper
- Division of Neonatology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | - Ting Wong
- Division of Neonatology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | - Stanley D Poole
- Division of Neonatology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | - Courtney D Berger
- Division of Neonatology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | - Alexus J Brown
- Division of Neonatology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | - Christopher S Jetter
- Division of Neonatology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | - Jennifer M S Sucre
- Division of Neonatology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | - Elaine L Shelton
- Division of Neonatology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, United States
- Department of Pharmacology, Vanderbilt University, Nashville, Tennessee, United States
| | - Jeff Reese
- Department of Cell and Developmental Biology, Vanderbilt University, Nashville, Tennessee, United States
- Division of Neonatology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, United States
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Proença ICT, Miri MR, Marinho JP, Bock PM, de Abreu TM, Pinto MS, Blembeel AS, Ferreira AS, Andrades M, da Rosa Araújo AS, Funchal C, Pochmann D, Dani C. Gestational purple grape juice consumption does not change fetal ductus arteriosus constriction in Wistar rats. Birth Defects Res 2022; 114:525-535. [PMID: 35484956 DOI: 10.1002/bdr2.2018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 03/11/2022] [Accepted: 03/31/2022] [Indexed: 11/07/2022]
Abstract
Grape juice consumption may influence the early occurrence of ductal constriction during pregnancy, since the consumption of foods rich in polyphenols can be linked to the premature constriction of the ductus arteriosus. This study aimed to evaluate the effect of purple grape juice consumption during gestation on fetal ductus arteriosus closure, prostaglandin levels, and oxidative stress markers in Wistar rats. We divided 18 pregnant rats into four groups: a control group (C), a single-dose grape juice group (SDGJ), a two-dose grape juice group (TDGJ) of 7 μl/g body weight per day, and an indomethacin group (I). Blood was collected on gestational day (GD) 0, 14, and 20. Prostaglandin levels were measured, and the livers and hearts were removed from the mothers and fetuses for oxidative stress analysis; histology of the fetal ductus arteriosus was performed. Prostaglandin levels (pg/ml) at GD 20 were (C:1462.10 ± 314.61); (SDGJ:987.66 ± 86.25); (TDGJ:1290.00 ± 221.57), and (I:584.75 ± 46.77). Fetal ductus arteriosus closure occurred only in the indomethacin group. Lipid peroxidation evaluated through thiobarbituric acid reactive substances (nmol/mg protein) in maternal livers was lower in the grape juice groups (C: 4.11 ± 0.76 nmol/mg protein), (SDGJ: 2.34 ± 0.36), (TDGJ: 1.52 ± 0.18), and (I: 4.20 ± 0.76). Sulfhydryls (nmol/mg protein) were lower in the TDGJ group (C:763.59 ± 61.38 nmol/mg protein), (SDGJ:978.88 ± 158.81), (TDGJ:385.32 ± 86.78), and (I:727.72 ± 49.12). Also, superoxide dismutase activity (USOD/mg protein) was higher in fetal hearts in this group: (C:5.29 ± 0.33), (SDGJ:4.48 ± 0.47), (TDGJ:7.35 ± 0.43), and (I:6.00 ± 0.18). We conclude that grape juice consumption in pregnancy does not induce ductus arteriosus closure in the fetus and presented potential antioxidant effects.
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Affiliation(s)
| | - Malena Rostirola Miri
- Biochemistry Laboratory, Research Center, Methodist University Center, Porto Alegre Institute, Porto Alegre, RS, Brazil
| | - Jéssica Pereira Marinho
- Biochemistry Laboratory, Research Center, Methodist University Center, Porto Alegre Institute, Porto Alegre, RS, Brazil
| | | | - Tamires Marques de Abreu
- Biochemistry Laboratory, Research Center, Methodist University Center, Porto Alegre Institute, Porto Alegre, RS, Brazil
| | - Milene Santana Pinto
- Biochemistry Laboratory, Research Center, Methodist University Center, Porto Alegre Institute, Porto Alegre, RS, Brazil
| | - Amanda Stolzenberg Blembeel
- Biochemistry Laboratory, Research Center, Methodist University Center, Porto Alegre Institute, Porto Alegre, RS, Brazil
| | - Aimée Souto Ferreira
- Experimental Research Center, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | - Michael Andrades
- Experimental Research Center, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | | | - Cláudia Funchal
- Biochemistry Laboratory, Research Center, Methodist University Center, Porto Alegre Institute, Porto Alegre, RS, Brazil
| | - Daniela Pochmann
- Biochemistry Laboratory, Research Center, Methodist University Center, Porto Alegre Institute, Porto Alegre, RS, Brazil
| | - Caroline Dani
- Biochemistry Laboratory, Research Center, Methodist University Center, Porto Alegre Institute, Porto Alegre, RS, Brazil
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Zielinsky P, Martignoni FV, Markoski M, Zucatti KP, Dos Santos Marinho G, Pozzobon G, Magno PR, de Bittencourt Antunes V, Sulis NM, Cardoso A, Mattos D, Naujorks AA, von Frankenberg AD, Vian I. Maternal ingestion of cocoa causes constriction of fetal ductus arteriosus in rats. Sci Rep 2021; 11:9929. [PMID: 33976258 PMCID: PMC8113492 DOI: 10.1038/s41598-021-89309-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Accepted: 04/20/2021] [Indexed: 01/13/2023] Open
Abstract
Maternal consumption of polyphenol-rich foods has been associated with fetal ductus arteriosus constriction (DAC), but safety of chocolate exposure in fetal life has not been studied. This experimental study tested the hypothesis that maternal cocoa consumption in late pregnancy causes fetal DAC, with possible associated antioxidant effects. Pregnant Wistar rats, at the 21st gestational day, received by orogastric tube cocoa (720 mg/Kg) for 12 h, indomethacin (10 mg/Kg), for 8 h, or only water, before cesaren section. Immediately after withdrawal, every thorax was obtained and tissues were fixed and stained for histological analysis. The ratio of the narrowest part of the pulmonary artery to the fetal ductus inner diameter and increased ductal inner wall thickness characterized ductal constriction. Substances reactive to thiobarbituric acid were quantified. Statistical analysis used ANOVA and Tukey test. Cocoa (n = 33) and indomethacin (n = 7) reduced fetal internal ductus diameter when compared to control (water, n = 25) (p < 0.001) and cocoa alone increased ductus wall thickness (p < 0.001), but no change was noted in enzymes activity. This pharmacological study shows supporting evidences that there is a cause and effect relationship between maternal consumption of cocoa and fetal ductus arteriosus constriction. Habitual widespread use of chocolate during gestation could account for undetected ductus constriction and its potentially severe consequences, such as perinatal pulmonary hypertension, cardiac failure and even death. For this reason, dietary guidance in late pregnancy to avoid high chocolate intake, to prevent fetal ductal constriction, may represent the main translational aspect of this study.
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Affiliation(s)
- Paulo Zielinsky
- Fetal Cardiology Unit, Institute of Cardiology/FUC, Avenida Princesa Isabel, 370, Porto Alegre, CEP 90620-000, Brazil. .,Departament of Pediatrics, Federal University of Rio Grande do Sul, Porto Alegre, Brazil. .,Fetal Cardiology Unit, Institute of Cardiology/University Foundation of Cardiology, Avenida Princesa Isabel, 395 - Santana, Porto Alegre, CEP 90620-000, Brazil.
| | - Felipe Villa Martignoni
- Fetal Cardiology Unit, Institute of Cardiology/FUC, Avenida Princesa Isabel, 370, Porto Alegre, CEP 90620-000, Brazil.,Federal University of Santa Maria, Avenida Roraima, 1000, Santa Maria, CEP 97105-900, Brazil
| | - Melissa Markoski
- Basic Health Science, Federal University of Health Sciences of Porto Alegre, Avenida Sarmento Leite, 245, Porto Alegre, CEP 90050-170, Brazil
| | - Kelly Pozzer Zucatti
- Fetal Cardiology Unit, Institute of Cardiology/FUC, Avenida Princesa Isabel, 370, Porto Alegre, CEP 90620-000, Brazil
| | - Gabriela Dos Santos Marinho
- Fetal Cardiology Unit, Institute of Cardiology/FUC, Avenida Princesa Isabel, 370, Porto Alegre, CEP 90620-000, Brazil
| | - Gabriela Pozzobon
- Federal University of Santa Maria, Avenida Roraima, 1000, Santa Maria, CEP 97105-900, Brazil
| | - Pedro Rafael Magno
- Federal University of Santa Maria, Avenida Roraima, 1000, Santa Maria, CEP 97105-900, Brazil
| | | | - Natassia Miranda Sulis
- Fetal Cardiology Unit, Institute of Cardiology/FUC, Avenida Princesa Isabel, 370, Porto Alegre, CEP 90620-000, Brazil
| | - Alexandra Cardoso
- Federal University of Santa Maria, Avenida Roraima, 1000, Santa Maria, CEP 97105-900, Brazil
| | - Daniel Mattos
- Federal University of Santa Maria, Avenida Roraima, 1000, Santa Maria, CEP 97105-900, Brazil
| | - Alexandre Antônio Naujorks
- Fetal Cardiology Unit, Institute of Cardiology/FUC, Avenida Princesa Isabel, 370, Porto Alegre, CEP 90620-000, Brazil
| | - Anize Delfino von Frankenberg
- Fetal Cardiology Unit, Institute of Cardiology/FUC, Avenida Princesa Isabel, 370, Porto Alegre, CEP 90620-000, Brazil
| | - Izabele Vian
- Fetal Cardiology Unit, Institute of Cardiology/FUC, Avenida Princesa Isabel, 370, Porto Alegre, CEP 90620-000, Brazil
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Pedra SRFF, Zielinsky P, Binotto CN, Martins CN, Fonseca ESVBD, Guimarães ICB, Corrêa IVDS, Pedrosa KLM, Lopes LM, Nicoloso LHS, Barberato MFA, Zamith MM. Brazilian Fetal Cardiology Guidelines - 2019. Arq Bras Cardiol 2019; 112:600-648. [PMID: 31188968 PMCID: PMC6555576 DOI: 10.5935/abc.20190075] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Affiliation(s)
- Simone R F Fontes Pedra
- Instituto Dante Pazzanese de Cardiologia, São Paulo, SP - Brazil.,Hospital do Coração (HCor), São Paulo, SP - Brazil
| | - Paulo Zielinsky
- Instituto de Cardiologia do Rio Grande do Sul, Porto Alegre, RS - Brazil
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5
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Gijtenbeek M, Lopriore E, Steggerda SJ, Te Pas AB, Oepkes D, Haak MC. Persistent pulmonary hypertension of the newborn after fetomaternal hemorrhage. Transfusion 2018; 58:2819-2824. [PMID: 30315664 DOI: 10.1111/trf.14932] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 08/13/2018] [Accepted: 08/13/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND Newborns with anemia are at increased risk of persistent pulmonary hypertension of the newborn (PPHN), yet reports on the association between fetomaternal hemorrhage (FMH) and PPHN are rare. To optimize care for pregnancies complicated by FMH, clinicians should be aware of the risks of FMH and the possible diagnostic and therapeutic options. To increase the current knowledge, the incidence of PPHN and short-term neurologic injury in FMH cases were studied. STUDY DESIGN AND METHODS We included all FMH cases (≥30 mL fetal blood transfused into the maternal circulation) admitted to our neonatal unit between 2006 and 2018. First, we evaluated the incidence of PPHN and short-term neurologic injury. Second, we studied the potential effect of intrauterine transfusion (IUT). RESULTS PPHN occurred in 37.9% of newborns (11 of 29), respectively, 14.3% (one of seven) and 45.5% (10 of 22) in the IUT group and no-IUT group (p = 0.20). The mortality rate was 13.8% (4 of 29). Severe brain injury occurred in 34.5% (10 of 29), respectively, and 14.3% (one of seven) and 40.9% (nine of 22) in the IUT group and no-IUT group (p = 0.37). CONCLUSION Awareness should be raised among perinatologists and neonatologists about the possible life-threatening consequences of FMH, as more than one-third of neonates with anemia due to FMH experience PPHN and suffer from severe brain injury. Antenatal treatment with IUT seems to reduce these risks. Specialists should therefore always consider fetal anemia in FMH cases and refer patients to a fetal therapy center. If anemia is present at birth, it should be corrected promptly and neonatologists should be aware of signs of PPHN.
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Affiliation(s)
- Manon Gijtenbeek
- Division of Fetal Medicine, Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Enrico Lopriore
- Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Sylke J Steggerda
- Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Arjan B Te Pas
- Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Dick Oepkes
- Division of Fetal Medicine, Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Monique C Haak
- Division of Fetal Medicine, Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands
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Pohl O, Chollet A, Kim SH, Riaposova L, Spézia F, Gervais F, Guillaume P, Lluel P, Méen M, Lemaux F, Terzidou V, Bennett PR, Gotteland JP. OBE022, an Oral and Selective Prostaglandin F 2α Receptor Antagonist as an Effective and Safe Modality for the Treatment of Preterm Labor. J Pharmacol Exp Ther 2018; 366:349-364. [PMID: 29777040 DOI: 10.1124/jpet.118.247668] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 05/15/2018] [Indexed: 01/02/2023] Open
Abstract
Preterm birth is the major challenge in obstetrics, affecting ∼10% of pregnancies. Pan-prostaglandin synthesis inhibitors [nonsteroidal anti-inflammatory drugs (NSAIDs)] prevent preterm labor and prolong pregnancy but raise concerns about fetal renal and cardiovascular safety. We conducted preclinical studies examining the tocolytic effect and fetal safety of the oral prodrug candidate OBE022 [(S)-2-amino-3-methyl-butyric acid (S)-3-{[(S)-3-(biphenyl-4-sulfonyl)-thiazolidine-2-carbonyl]-amino}-3-(4-fluoro-phenyl)-propyl ester] and its parent OBE002 [(S)-3-(biphenyl-4-sulfonyl)-thiazolidine-2-carboxylic acid [(S)-1-(4-fluoro-phenyl)-3-hydroxy-propyl]-amide], both potent and highly selective antagonist of the contractile prostaglandin F2α (PGF2α ) receptor (FP). Efficacy of OBE022 and OBE002, alone and in combination with other tocolytics, was assessed in human tissues and pregnant animal models for inhibition of uterine contraction and delay of parturition. Selective safety of OBE022 and/or OBE002, compared with NSAID indomethacin, was assessed on renal function, closure of the ductus arteriosus, and inhibition of platelet aggregation. In in vitro studies, OBE002 inhibited spontaneous, oxytocin- and PGF2α -induced human myometrial contractions alone and was more effective in combination with atosiban or nifedipine. In in vivo studies, OBE022 and OBE002 reduced spontaneous contractions in near-term pregnant rats. In pregnant mice, OBE022 delayed RU486 [(8S,11R,13S,14S,17S)-11-[4-(dimethylamino)phenyl]-17-hydroxy-13-methyl-17-prop-1-ynyl-1,2,6,7,8,11,12,14,15,16-decahydrocyclopenta[a]phenanthren-3-one] -induced parturition and exerted synergistic effects in combination with nifedipine. OBE022 and/or OBE002 did not show the fetal side effects of ductus arteriosus constriction, impairment of kidney function, or inhibition of platelet aggregation observed with indomethacin. Orally active OBE022 and OBE002 exhibits potent tocolytic effects on human tissues ex vivo and animal models in vivo without causing the adverse fetal side effects seen with indomethacin. Selectively targeting the FP receptor in combination with existing tocolytics may be an effective strategy for preventing or delaying preterm delivery.
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Affiliation(s)
- Oliver Pohl
- ObsEva SA, Plan-les-Ouates, Geneva, Switzerland (O.P., A.C., J.-P.G.); Imperial College London, Parturition Research Group, Institute of Reproductive and Developmental Biology, Hammersmith Hospital Campus, East Acton, London, United Kingdom (S.H.K., L.R., V.T., P.R.B.); Citoxlab, Evreux, France (F.S., F.G.); Porsolt Research Laboratory, Le Genest-Saint-Isle, France (P.G.); Urosphere SAS, Toulouse, France (P.L., M.M.); BioTrial, Rennes, France (F.L.); and André Chollet Consulting, Tannay, Switzerland (A.C.)
| | - André Chollet
- ObsEva SA, Plan-les-Ouates, Geneva, Switzerland (O.P., A.C., J.-P.G.); Imperial College London, Parturition Research Group, Institute of Reproductive and Developmental Biology, Hammersmith Hospital Campus, East Acton, London, United Kingdom (S.H.K., L.R., V.T., P.R.B.); Citoxlab, Evreux, France (F.S., F.G.); Porsolt Research Laboratory, Le Genest-Saint-Isle, France (P.G.); Urosphere SAS, Toulouse, France (P.L., M.M.); BioTrial, Rennes, France (F.L.); and André Chollet Consulting, Tannay, Switzerland (A.C.)
| | - Sung Hye Kim
- ObsEva SA, Plan-les-Ouates, Geneva, Switzerland (O.P., A.C., J.-P.G.); Imperial College London, Parturition Research Group, Institute of Reproductive and Developmental Biology, Hammersmith Hospital Campus, East Acton, London, United Kingdom (S.H.K., L.R., V.T., P.R.B.); Citoxlab, Evreux, France (F.S., F.G.); Porsolt Research Laboratory, Le Genest-Saint-Isle, France (P.G.); Urosphere SAS, Toulouse, France (P.L., M.M.); BioTrial, Rennes, France (F.L.); and André Chollet Consulting, Tannay, Switzerland (A.C.)
| | - Lucia Riaposova
- ObsEva SA, Plan-les-Ouates, Geneva, Switzerland (O.P., A.C., J.-P.G.); Imperial College London, Parturition Research Group, Institute of Reproductive and Developmental Biology, Hammersmith Hospital Campus, East Acton, London, United Kingdom (S.H.K., L.R., V.T., P.R.B.); Citoxlab, Evreux, France (F.S., F.G.); Porsolt Research Laboratory, Le Genest-Saint-Isle, France (P.G.); Urosphere SAS, Toulouse, France (P.L., M.M.); BioTrial, Rennes, France (F.L.); and André Chollet Consulting, Tannay, Switzerland (A.C.)
| | - François Spézia
- ObsEva SA, Plan-les-Ouates, Geneva, Switzerland (O.P., A.C., J.-P.G.); Imperial College London, Parturition Research Group, Institute of Reproductive and Developmental Biology, Hammersmith Hospital Campus, East Acton, London, United Kingdom (S.H.K., L.R., V.T., P.R.B.); Citoxlab, Evreux, France (F.S., F.G.); Porsolt Research Laboratory, Le Genest-Saint-Isle, France (P.G.); Urosphere SAS, Toulouse, France (P.L., M.M.); BioTrial, Rennes, France (F.L.); and André Chollet Consulting, Tannay, Switzerland (A.C.)
| | - Frédéric Gervais
- ObsEva SA, Plan-les-Ouates, Geneva, Switzerland (O.P., A.C., J.-P.G.); Imperial College London, Parturition Research Group, Institute of Reproductive and Developmental Biology, Hammersmith Hospital Campus, East Acton, London, United Kingdom (S.H.K., L.R., V.T., P.R.B.); Citoxlab, Evreux, France (F.S., F.G.); Porsolt Research Laboratory, Le Genest-Saint-Isle, France (P.G.); Urosphere SAS, Toulouse, France (P.L., M.M.); BioTrial, Rennes, France (F.L.); and André Chollet Consulting, Tannay, Switzerland (A.C.)
| | - Philippe Guillaume
- ObsEva SA, Plan-les-Ouates, Geneva, Switzerland (O.P., A.C., J.-P.G.); Imperial College London, Parturition Research Group, Institute of Reproductive and Developmental Biology, Hammersmith Hospital Campus, East Acton, London, United Kingdom (S.H.K., L.R., V.T., P.R.B.); Citoxlab, Evreux, France (F.S., F.G.); Porsolt Research Laboratory, Le Genest-Saint-Isle, France (P.G.); Urosphere SAS, Toulouse, France (P.L., M.M.); BioTrial, Rennes, France (F.L.); and André Chollet Consulting, Tannay, Switzerland (A.C.)
| | - Philippe Lluel
- ObsEva SA, Plan-les-Ouates, Geneva, Switzerland (O.P., A.C., J.-P.G.); Imperial College London, Parturition Research Group, Institute of Reproductive and Developmental Biology, Hammersmith Hospital Campus, East Acton, London, United Kingdom (S.H.K., L.R., V.T., P.R.B.); Citoxlab, Evreux, France (F.S., F.G.); Porsolt Research Laboratory, Le Genest-Saint-Isle, France (P.G.); Urosphere SAS, Toulouse, France (P.L., M.M.); BioTrial, Rennes, France (F.L.); and André Chollet Consulting, Tannay, Switzerland (A.C.)
| | - Murielle Méen
- ObsEva SA, Plan-les-Ouates, Geneva, Switzerland (O.P., A.C., J.-P.G.); Imperial College London, Parturition Research Group, Institute of Reproductive and Developmental Biology, Hammersmith Hospital Campus, East Acton, London, United Kingdom (S.H.K., L.R., V.T., P.R.B.); Citoxlab, Evreux, France (F.S., F.G.); Porsolt Research Laboratory, Le Genest-Saint-Isle, France (P.G.); Urosphere SAS, Toulouse, France (P.L., M.M.); BioTrial, Rennes, France (F.L.); and André Chollet Consulting, Tannay, Switzerland (A.C.)
| | - Frédérique Lemaux
- ObsEva SA, Plan-les-Ouates, Geneva, Switzerland (O.P., A.C., J.-P.G.); Imperial College London, Parturition Research Group, Institute of Reproductive and Developmental Biology, Hammersmith Hospital Campus, East Acton, London, United Kingdom (S.H.K., L.R., V.T., P.R.B.); Citoxlab, Evreux, France (F.S., F.G.); Porsolt Research Laboratory, Le Genest-Saint-Isle, France (P.G.); Urosphere SAS, Toulouse, France (P.L., M.M.); BioTrial, Rennes, France (F.L.); and André Chollet Consulting, Tannay, Switzerland (A.C.)
| | - Vasso Terzidou
- ObsEva SA, Plan-les-Ouates, Geneva, Switzerland (O.P., A.C., J.-P.G.); Imperial College London, Parturition Research Group, Institute of Reproductive and Developmental Biology, Hammersmith Hospital Campus, East Acton, London, United Kingdom (S.H.K., L.R., V.T., P.R.B.); Citoxlab, Evreux, France (F.S., F.G.); Porsolt Research Laboratory, Le Genest-Saint-Isle, France (P.G.); Urosphere SAS, Toulouse, France (P.L., M.M.); BioTrial, Rennes, France (F.L.); and André Chollet Consulting, Tannay, Switzerland (A.C.)
| | - Phillip R Bennett
- ObsEva SA, Plan-les-Ouates, Geneva, Switzerland (O.P., A.C., J.-P.G.); Imperial College London, Parturition Research Group, Institute of Reproductive and Developmental Biology, Hammersmith Hospital Campus, East Acton, London, United Kingdom (S.H.K., L.R., V.T., P.R.B.); Citoxlab, Evreux, France (F.S., F.G.); Porsolt Research Laboratory, Le Genest-Saint-Isle, France (P.G.); Urosphere SAS, Toulouse, France (P.L., M.M.); BioTrial, Rennes, France (F.L.); and André Chollet Consulting, Tannay, Switzerland (A.C.)
| | - Jean-Pierre Gotteland
- ObsEva SA, Plan-les-Ouates, Geneva, Switzerland (O.P., A.C., J.-P.G.); Imperial College London, Parturition Research Group, Institute of Reproductive and Developmental Biology, Hammersmith Hospital Campus, East Acton, London, United Kingdom (S.H.K., L.R., V.T., P.R.B.); Citoxlab, Evreux, France (F.S., F.G.); Porsolt Research Laboratory, Le Genest-Saint-Isle, France (P.G.); Urosphere SAS, Toulouse, France (P.L., M.M.); BioTrial, Rennes, France (F.L.); and André Chollet Consulting, Tannay, Switzerland (A.C.)
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Tanaka S, Kanagawa T, Momma K, Hori S, Satoh H, Nagamatsu T, Fujii T, Kimura T, Sawada Y. Prediction of sustained fetal toxicity induced by ketoprofen based on PK/PD analysis using human placental perfusion and rat toxicity data. Br J Clin Pharmacol 2017. [PMID: 28635050 DOI: 10.1111/bcp.13352] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
AIM We encountered a case of fetal toxicity due to ductus arteriosus (DA) constriction in a 36-week pregnant woman who had applied multiple ketoprofen patches. The aim of the present study was to present the case and develop a model to predict quantitatively the fetal toxicity risk of transdermal administration of ketoprofen. METHODS Human placenta perfusion studies were conducted to estimate transplacental pharmacokinetic (PK) parameters. Using a developed model and these parameters, human fetal plasma concentration profiles of ketoprofen administered to mothers were simulated. Using pregnant rats, DA constriction and fetal plasma drug concentration after ketoprofen administration were measured, fitted to an Emax model, and extrapolated to humans. RESULTS Transplacental transfer value at the steady state of ketoprofen was 4.82%, which was approximately half that of antipyrine (passive marker). The model and PK parameters predicted almost equivalent mother and fetus drug concentrations at steady state after transdermal ketoprofen administration in humans. Maximum DA constriction and maximum plasma concentration of ketoprofen after administration to rat dams were observed at different times: 4 h and 1 h, respectively. The model accurately described the delay in DA constriction with respect to the fetal ketoprofen concentration profile. The model with effect compartment and the obtained parameters predicted that use of multiple ketoprofen patches could potentially cause severe DA constriction in the human fetus, and that fetal toxicity might persist after ketoprofen discontinuation by the mother, as observed in our case. CONCLUSION The present approach successfully described the sustained fetal toxicity after discontinuing the transdermal administration of ketoprofen.
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Affiliation(s)
- Shingo Tanaka
- Graduate School of Pharmaceutical Science, University of Tokyo, Tokyo, Japan
| | - Takeshi Kanagawa
- Department of Maternal-Fetal Medicine, Osaka Medical Center and Research Institute for Maternal and Child Health, Osaka, Japan
| | - Kazuo Momma
- Department of Pediatric Cardiology, Tokyo Women's Medical University Hospital, Tokyo, Japan
| | - Satoko Hori
- Graduate School of Pharmaceutical Science, University of Tokyo, Tokyo, Japan
| | - Hiroki Satoh
- Graduate School of Pharmaceutical Science, University of Tokyo, Tokyo, Japan
| | - Takeshi Nagamatsu
- Department of Obstetrics and Gynecology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Tomoyuki Fujii
- Department of Obstetrics and Gynecology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Tadashi Kimura
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yasufumi Sawada
- Graduate School of Pharmaceutical Science, University of Tokyo, Tokyo, Japan
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Inagaki M, Nishimura T, Akanuma SI, Nakanishi T, Tachikawa M, Tamai I, Hosoya KI, Nakashima E, Tomi M. Co-localization of microsomal prostaglandin E synthase-1 with cyclooxygenase-1 in layer II of murine placental syncytiotrophoblasts. Placenta 2017; 53:76-82. [PMID: 28487024 DOI: 10.1016/j.placenta.2017.04.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2017] [Revised: 03/31/2017] [Accepted: 04/04/2017] [Indexed: 11/15/2022]
Abstract
The placenta is an organ that secretes prostaglandin (PG) E2 into the fetal-placental circulation to regulate both vascular tone and remodeling of the fetal ductus arteriosus. Placental PGE2 synthesis might be mediated by microsomal PGE synthase-1 (mPGES-1), in addition to cyclooxygenase (COX) isoforms. Thus, the purpose of this study is to clarify the temporal and spatial expression patterns of mPGES-1, together with COX-1 and COX-2, in murine placenta. We found that mPGES-1 and COX-1 protein levels continuously increased in the placental labyrinth from gestational day (GD) 13.5 to GD19.5, becoming higher than in the decidua or the junctional zone by GD17.5. The PGE2 level at GD17.5 was also highest in the labyrinth. Immunofluorescence stainings for mPGES-1 and COX-1 in the labyrinth at GD17.5 overlapped and were located on the fetal side of the signals for connexin 26, which forms gap junctions between maternal-facing (SynT-I) and fetal-facing (SynT-II) syncytiotrophoblast layers, and on the maternal side of the signals for glucose transporter 1 on the basal plasma membrane of SynT-II. On the other hand, the signals for COX-2 did not overlap with those for mPGES-1. These results indicate that COX-1 and mPGES-1 are co-localized in murine placental SynT-II, facing the fetal-placental circulation. Therefore, SynT-II could contribute to placental synthesis of PGE2 for release into the fetal-placental circulation.
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Affiliation(s)
- Mai Inagaki
- Faculty of Pharmacy, Keio University, 1-5-30 Shibakoen, Minato-ku, Tokyo 105-8512, Japan
| | - Tomohiro Nishimura
- Faculty of Pharmacy, Keio University, 1-5-30 Shibakoen, Minato-ku, Tokyo 105-8512, Japan
| | - Shin-Ichi Akanuma
- Department of Pharmaceutics, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, 2630 Sugitani, Toyama 930-0194, Japan
| | - Takeo Nakanishi
- Faculty of Pharmaceutical Sciences, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kakuma-machi, Kanazawa 920-1192, Japan
| | - Masanori Tachikawa
- Division of Membrane Transport and Drug Targeting, Graduate School of Pharmaceutical Sciences, Tohoku University, 6-3 Aoba Aramaki, Aoba-ku, Sendai, Miyagi 980-8578, Japan
| | - Ikumi Tamai
- Faculty of Pharmaceutical Sciences, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kakuma-machi, Kanazawa 920-1192, Japan
| | - Ken-Ichi Hosoya
- Department of Pharmaceutics, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, 2630 Sugitani, Toyama 930-0194, Japan
| | - Emi Nakashima
- Faculty of Pharmacy, Keio University, 1-5-30 Shibakoen, Minato-ku, Tokyo 105-8512, Japan
| | - Masatoshi Tomi
- Faculty of Pharmacy, Keio University, 1-5-30 Shibakoen, Minato-ku, Tokyo 105-8512, Japan.
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9
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Gijtenbeek M, Haak MC, Ten Harkel DJ, Te Pas AB, Middeldorp JM, Klumper FJCM, van Geloven N, Oepkes D, Lopriore E. Persistent Pulmonary Hypertension of the Newborn in Twin-Twin Transfusion Syndrome: A Case-Control Study. Neonatology 2017; 112:402-408. [PMID: 28926832 DOI: 10.1159/000478844] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 06/20/2017] [Indexed: 12/29/2022]
Abstract
BACKGROUND Persistent pulmonary hypertension of the newborn (PPHN) is associated with severe morbidity and mortality. Twin-twin transfusion syndrome (TTTS) is suggested to increase the risk of PPHN. OBJECTIVES To describe the incidence of PPHN in TTTS twins and to identify risk factors in TTTS twins for the development of severe PPHN. METHODS Cases with severe PPHN were extracted from our monochorionic twin database (2002-2016). Severe PPHN was defined as severe hypoxaemia requiring mechanical ventilation and inhaled nitric oxide (iNO) treatment, confirmed by strict echocardiographic criteria. A case-control comparison within TTTS survivors was conducted to identify risk factors for PPHN. RESULTS The incidence of PPHN in TTTS twins was 4% (24/598, 95% confidence interval [CI] 2.7-5.9%) and 0.4% (2/493, 95% CI 0.1-1.5%) in uncomplicated monochorionic twins (odds ratio [OR] 10.3, 95% CI 2.4-43.9; p = 0.002). Two risk factors were independently associated with PPHN: severe prematurity (OR 3.3, 95% CI 1.0-11.4) and recipient status (OR 3.9, 95% CI 1.4-11.0). In TTTS recipients, another risk factor for PPHN is anaemia at birth (OR 7.2, 95% CI 1.8-29.6). CONCLUSION Clinicians caring for neonates with TTTS should be aware of the 10-fold increased risk of PPHN compared to uncomplicated monochorionic twins. PPHN occurs more often in case of premature delivery and in recipient twins, particularly in the presence of anaemia at birth. As the development of severe PPHN is difficult to predict, we advise that all TTTS twins should be delivered in a tertiary care centre with iNO treatment options.
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Affiliation(s)
- Manon Gijtenbeek
- Division of Fetal Medicine, Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands
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10
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Fujita S, Yokoyama U, Ishiwata R, Aoki R, Nagao K, Masukawa D, Umemura M, Fujita T, Iwasaki S, Nishimaki S, Seki K, Ito S, Goshima Y, Asou T, Masuda M, Ishikawa Y. Glutamate Promotes Contraction of the Rat Ductus Arteriosus. Circ J 2016; 80:2388-2396. [PMID: 27666597 DOI: 10.1253/circj.cj-16-0649] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Extremely preterm infants frequently have patent ductus arteriosus (PDA). Recent recommendations include immediately beginning amino acid supplementation in extremely preterm infants. However, the effect of amino acids on closure of the ductus arteriosus (DA) remains unknown.Methods and Results:Aminogram results in human neonates at day 2 revealed that the plasma glutamate concentration was significantly lower in extremely preterm infants (<28 weeks' gestation) with PDA than in those without PDA and relatively mature preterm infants (28-29 weeks gestation). To investigate the effect of glutamate on DA closure, glutamate receptor expression in fetal rats was examined and it was found that the glutamate inotropic receptor, α-amino-3-hydroxy-5-methyl-4-isoxazolepropionate (AMPA) type subunit 1 (GluR1), mRNA was highly expressed in the DA compared to the aorta on gestational day 19 (preterm) and gestational day 21 (term). GluR1 proteins were co-localized with tyrosine hydroxylase-positive autonomic nerve terminals in the rat and human DA. Intraperitoneal administration of glutamate increased noradrenaline production in the rat DA. A whole-body freezing method demonstrated that glutamate administration induced DA contraction in both preterm (gestational day 20) and term rat fetuses. Glutamate-induced DA contraction was attenuated by the calcium-sensitive GluR receptor antagonist, NASPM, or the adrenergic receptor α1 blocker, prazosin. CONCLUSIONS These data suggest that glutamate induces DA contraction through GluR-mediated noradrenaline production. Supplementation of glutamate might help to prevent PDA in extremely preterm infants. (Circ J 2016; 80: 2388-2396).
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Affiliation(s)
- Shujiro Fujita
- Cardiovascular Research Institute, Yokohama City University
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11
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Hahn M, Baierle M, Charão MF, Bubols GB, Gravina FS, Zielinsky P, Arbo MD, Cristina Garcia S. Polyphenol-rich food general and on pregnancy effects: a review. Drug Chem Toxicol 2016; 40:368-374. [DOI: 10.1080/01480545.2016.1212365] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Marla Hahn
- Laboratory of Toxicology (LATOX), Department of Analysis, Faculty of Pharmacy, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil,
| | - Marília Baierle
- Laboratory of Toxicology (LATOX), Department of Analysis, Faculty of Pharmacy, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil,
- Post-Graduate Program in Pharmaceutical Sciences (PPGCF), Faculty of Pharmacy, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil,
| | - Mariele F. Charão
- Laboratory of Toxicology (LATOX), Department of Analysis, Faculty of Pharmacy, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil,
- Toxicological Analysis Laboratory, Institute of Health Sciences, Feevale University, Novo Hamburgo, RS, Brazil,
| | - Guilherme B. Bubols
- Laboratory of Toxicology (LATOX), Department of Analysis, Faculty of Pharmacy, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil,
- Post-Graduate Program in Pharmaceutical Sciences (PPGCF), Faculty of Pharmacy, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil,
| | - Fernanda S. Gravina
- Laboratory of Toxicology (LATOX), Department of Analysis, Faculty of Pharmacy, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil,
| | - Paulo Zielinsky
- Cardiology Institute, University Foundation of Cardiology, Porto Alegre, RS, Brazil, and
| | - Marcelo D. Arbo
- Laboratory of Toxicology (LATOX), Department of Analysis, Faculty of Pharmacy, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil,
- Post-Graduate Program in Pharmaceutical Sciences (PPGCF), Faculty of Pharmacy, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil,
- Department of Veterinary Clinical Pathology, Faculty of Veterinary, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Solange Cristina Garcia
- Laboratory of Toxicology (LATOX), Department of Analysis, Faculty of Pharmacy, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil,
- Post-Graduate Program in Pharmaceutical Sciences (PPGCF), Faculty of Pharmacy, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil,
- Cardiology Institute, University Foundation of Cardiology, Porto Alegre, RS, Brazil, and
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12
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Genovese F, Marilli I, Benintende G, Privitera A, Gulino FA, Iozza I, Cimino C, Palumbo MA. Diagnosis and management of fetal ductus arteriosus constriction-closure. J Neonatal Perinatal Med 2015; 8:324352M572245181. [PMID: 25758002 DOI: 10.3233/npm-15814031] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Pathognomonic features of in utero premature restriction/closure of the ductus arteriosus (DA) are increased right ventricular afterload, impaired right ventricular function, and consequently tricuspid regurgitation and right heart dilation. The most common reason for constriction-closure of DA is maternal administration of non-steroidal anti-inflammatory drugs (NSAIDs) during the 3rd trimester of gestation. The idiopathic form is a rare event and, maybe, an underestimated abnormality that, if it is not promptly recognized, may result in severe fetal-neonatal compromise. We describe a case of a 38-year-old woman presenting at 34+0 weeks of gestation with a normally grown male fetus whose fetal echocardiography had shown right ventricular hypertrophy, a tortuous S-shaped DA and a significant pulmonary hyperflow. All signs were consistent of an idiopathic severe constriction of DA with a significant fetal cardiac involvement. The patient was admitted to a tertiary care center equipped with Neonatal Intensive Care Unit (NICU), and delivered by cesarean section at 34+4 weeks with a good maternal and neonatal outcome. Based on our experience and a review of the Literature we propose a management algorithm to use when dealing with preterm or early term pregnancy complicated by this fetal hemodynamic malfunction.
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Affiliation(s)
- F Genovese
- Institute of Obstetric and Gynecologic Pathology, Department of Surgery, Division of Obstetrics and Gynecology, S. Bambino Hospital, University of Catania, Catania, Italy
| | - I Marilli
- Institute of Obstetric and Gynecologic Pathology, Department of Surgery, Division of Obstetrics and Gynecology, S. Bambino Hospital, University of Catania, Catania, Italy
| | - G Benintende
- Complex Operative Unit of Prenatal Diagnosis and Medical Genetics, University Hospital Vittorio Emanuele, Catania, Italy
| | - A Privitera
- Department of Paediatric Cardiology, S. Bambino Hospital, University of Catania, Catania, Italy
| | - F A Gulino
- Institute of Obstetric and Gynecologic Pathology, Department of Surgery, Division of Obstetrics and Gynecology, S. Bambino Hospital, University of Catania, Catania, Italy
| | - I Iozza
- Institute of Obstetric and Gynecologic Pathology, Department of Surgery, Division of Obstetrics and Gynecology, S. Bambino Hospital, University of Catania, Catania, Italy
| | - C Cimino
- Department of Pediatrics, University of Catania, Catania, Italy
| | - M A Palumbo
- Institute of Obstetric and Gynecologic Pathology, Department of Surgery, Division of Obstetrics and Gynecology, S. Bambino Hospital, University of Catania, Catania, Italy
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13
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Kent AL, Koina ME, Gubhaju L, Cullen-McEwen LA, Bertram JF, Lynnhtun J, Shadbolt B, Falk MC, Dahlstrom JE. Indomethacin administered early in the postnatal period results in reduced glomerular number in the adult rat. Am J Physiol Renal Physiol 2014; 307:F1105-10. [PMID: 25186294 DOI: 10.1152/ajprenal.00328.2014] [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] [Indexed: 12/28/2022] Open
Abstract
Indomethacin and ibuprofen are administered to close a patent ductus arteriosus (PDA) during active glomerulogenesis. Light and electron microscopic glomerular changes with no change in glomerular number were seen following indomethacin and ibuprofen treatment during glomerulogenesis at 14 days after birth in a neonatal rat model. This present study aimed to determine whether longstanding renal structural changes are present at 30 days and 6 mo (equivalent to human adulthood). Rat pups were administered indomethacin or ibuprofen antenatally on days 18-20 (0.5 mg·kg(-1)·dose(-1) indomethacin; 10 mg·kg(-1)·dose(-1) ibuprofen) or postnatally intraperitoneally from day 1 to 3 or day 1 to 5 (0.2 mg·kg(-1)·dose(-1) indomethacin; 10 mg·kg(-1)·dose(-1) ibuprofen). Control groups received no treatment or normal saline intraperitoneally. Pups were killed at 30 days of age and 6 mo of age. Tissue blocks from right kidneys were prepared for light and electron microscopic examination, while total glomerular number was determined in left kidneys using unbiased stereology. Eight pups were included in each group from 14 maternal rats. At 30 days and 6 mo, there were persistent electron microscopy abnormalities of the glomerular basement membrane in those receiving postnatal indomethacin and ibuprofen. There were no significant light microscopy findings at 30 days or 6 mo. At 6 mo, there were significantly fewer glomeruli in those receiving postnatal indomethacin but not ibuprofen (P = 0.003). In conclusion, indomethacin administered during glomerulogenesis appears to reduce the number of glomeruli in adulthood. Alternative options for closing a PDA should be considered including ibuprofen as well as emerging therapies such as paracetamol.
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Affiliation(s)
- A L Kent
- Department of Neonatology, Canberra Hospital, Woden, ACT, Australia; Australian National University Medical School, Canberra, ACT, Australia
| | - M E Koina
- Department of Anatomical Pathology, Canberra Hospital, Woden, ACT, Australia
| | - L Gubhaju
- Department of Anatomy and Developmental Biology, Monash University, Melbourne, Victoria, Australia; and
| | - L A Cullen-McEwen
- Department of Anatomy and Developmental Biology, Monash University, Melbourne, Victoria, Australia; and
| | - J F Bertram
- Department of Anatomy and Developmental Biology, Monash University, Melbourne, Victoria, Australia; and
| | - J Lynnhtun
- Department of Anatomical Pathology, Canberra Hospital, Woden, ACT, Australia
| | - B Shadbolt
- Clinical Epidemiology Unit, Canberra Hospital, Woden, ACT, Australia; Australian National University Medical School, Canberra, ACT, Australia
| | - M C Falk
- Department of Renal Medicine, Canberra Hospital, Woden, ACT, Australia; Australian National University Medical School, Canberra, ACT, Australia
| | - J E Dahlstrom
- Department of Anatomical Pathology, Canberra Hospital, Woden, ACT, Australia; Australian National University Medical School, Canberra, ACT, Australia
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14
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Zielinsky P, Busato S. Prenatal effects of maternal consumption of polyphenol-rich foods in late pregnancy upon fetal ductus arteriosus. ACTA ACUST UNITED AC 2014; 99:256-74. [PMID: 24339037 PMCID: PMC4065350 DOI: 10.1002/bdrc.21051] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Accepted: 10/24/2013] [Indexed: 12/13/2022]
Abstract
Fetal circulation has characteristic features, being morphologically and functionally different from extrauterine circulation. The ductus arteriosus plays a fundamental role in directing the blood flow to fetal inferior body parts. Basically, the ductus arteriosus directs 80-85% of the right ventricular output arising from the superior vena cava, coronary sinus, and a small part from the inferior vena cava to descending aorta. Its histological structure is made up predominantly by a thick muscular layer, differently from the aorta and the pulmonary artery, which increases with gestational age. The fibers have a circumferential orientation, especially at the external layers, facilitating and making effective ductal constriction. These factors may generate lumen alterations which may cause fetal and neonatal complications, such as heart failure, hydrops, neonatal pulmonary hypertension, and even death. Classically, maternal administration of indomethacin and/or other antiinflammatory drugs interfere in prostaglandins metabolism, causing ductal constriction. However, many cases of fetal ductal constriction, as well as of persistent neonatal pulmonary artery hypertension, remain without an established etiology, being referred as "idiopathic." In recent years, a growing body of evidence has shown that herbs, fruits, nuts, and a wide diversity of substances commonly used in daily diets have definitive effects upon the metabolic pathway of inflammation, with consequent inhibition of prostaglandins synthesis. This antiinflammatory action, especially of polyphenols, when ingested during the third trimester of pregnancy, may influence the dynamics of fetal ductus arteriosus flow. The goal of this review is to present these new observations and findings, which may influence dietary orientation during pregnancy.
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Affiliation(s)
- Paulo Zielinsky
- are from the Fetal Cardiology Unit, Institute of Cardiology, Porto Alegre, Brazil
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15
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Santangelo C, Varì R, Scazzocchio B, Filesi C, Masella R. Management of reproduction and pregnancy complications in maternal obesity: which role for dietary polyphenols? Biofactors 2014; 40:79-102. [PMID: 23983164 DOI: 10.1002/biof.1126] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2013] [Revised: 06/28/2013] [Accepted: 07/02/2013] [Indexed: 02/06/2023]
Abstract
Obesity is a global and dramatic public health problem; maternal obesity represents one of the main risk factors of infertility and pregnancy complications as it is associated with adverse maternal and offspring outcomes. In the last few years, adipose tissue dysfunction associated with altered adipocytokine secretion has been suggested to play a critical role in all the phases of reproductive process. Obesity is a nutrition-related disorder. In this regard, dietary intervention strategies, such as high intake of fruit and vegetables, have shown significant effects in both preserving health and counteracting obesity-associated diseases. Evidence has been provided that polyphenols, important constituents of plant-derived food, can influence developmental program of oocyte and embryo, as well as pregnancy progression by modulating several cellular pathways. This review will examine the controversial results so far obtained on adipocytokine involvement in fertility impairment and pregnancy complications. Furthermore, the different effects exerted by polyphenols on oocyte, embryo, and pregnancy development will be also taken in account.
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Affiliation(s)
- Carmela Santangelo
- Department of Veterinary Public Health and Food Safety, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161, Rome, Italy
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16
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Zielinsky P, Piccoli AL, Vian I, Zílio AM, Naujorks AA, Nicoloso LH, Barbisan CW, Busato S, Lopes M, Klein C. Maternal restriction of polyphenols and fetal ductal dynamics in normal pregnancy: an open clinical trial. Arq Bras Cardiol 2013; 101:217-25. [PMID: 23949325 PMCID: PMC4032301 DOI: 10.5935/abc.20130166] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Accepted: 06/20/2013] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND We have recently demonstrated reversal of fetal ductal constriction after dietary maternal restriction of polyphenol-rich foods (PRF), due to its inhibitory action on prostaglandin synthesis. OBJECTIVE To test the hyphotesis that normal third trimester fetuses also improve ductus arteriosus dynamics after maternal restriction of polyphenols. METHODS Open clinical trial with 46 fetuses with gestational age (GA) > 28 weeks submitted to 2 Doppler echocardiographic studies with an interval of at least 2 weeks, being the examiners blinded to maternal dietary habits. A validated food frequency questionnaire was applied and a diet based on polyphenol-poor foods (<30 mg/100 mg) was recommended. A control group of 26 third trimester fetuses was submitted to the same protocol. Statistics used t test for independent samples. RESULTS Mean GA was 33 ± 2 weeks. Mean daily maternal estimated polyphenol intake (DMPI) was 1277 mg, decreasing to 126 mg after dietary orientation (p=0.0001). Significant decreases in systolic (SDV) and diastolic (DDV) ductal velocities, and RV/LV diameters ratio, as well as increase in ductal PI were observed [DSV = 1.2 ± 0.4 m/s (0.7-1.6) to 0.9 ± 0.3 m/s (0.6-1.3) (p = 0.018); DDV = 0.21 ± 0.09 m/s (0.15-0.32) to 0.18 ± 0.06 m/s (0.11-0.25) (p = 0.016); RV/LV ratio = 1.3 ± 0.2 (0.9-1.4) to 1.1 ± 0.2 (0.8-1.3) (p=0.004); ductal PI = 2.2 ± 0.03 (2.0-2.7) to 2.4 ± 0.4(2.2-2.9) (p = 0.04)]. In the control group, with GA of 32 ± 4 weeks, there were no significant differences in DMPI, mean SDV, DDV, PI and RV/LV ratio. CONCLUSION The oriented restriction of third trimester maternal ingestion of polyphenol-rich foods for a period of 2 weeks or more improve fetal ductus arteriosus flow dynamics and right ventricular dimensions.
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Affiliation(s)
- Paulo Zielinsky
- Mailing Address: Paulo Zielinsky, Av. Princesa Isabel, 370, Santana.
Postal Code 90620-000, Porto Alegre, RS - Brazil. E-mail:
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17
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Zielinsky P, Piccoli AL, Manica JLL, Nicoloso LH, Vian I, Bender L, Pizzato P, Pizzato M, Swarowsky F, Barbisan C, Mello A, Garcia SC. Reversal of fetal ductal constriction after maternal restriction of polyphenol-rich foods: an open clinical trial. J Perinatol 2012; 32:574-9. [PMID: 22052330 DOI: 10.1038/jp.2011.153] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To test the hypothesis that maternal restriction of polyphenol-rich foods (PRF), which, like non-steroidal anti-inflammatory drugs (NSAID), inhibit prostaglandin synthesis in the third trimester, reverse fetal ductal constriction (DC). STUDY DESIGN An open clinical trial of 51 third trimester fetuses with DC with no history of NSAID intake was designed. All mothers were submitted to a food frequency questionnaire and were oriented to withdrawl PRF, being reassessed after 3 weeks. Doppler parameters were assessed before and after discontinuation of these substances. A control group of 26 third trimester normal fetuses, with no ductus arteriosus (DA) constriction, in which no dietary intervention was offered, was reviewed after 3 weeks. Student's t-test and Wilcoxon's test were used. RESULT Mean gestational age was 32±3 weeks (28 to 37 weeks). After discontinuation of PRF (≥3 weeks), 48/51 fetuses (96%) showed complete reversal of DC, with decrease in mean ductal systolic velocity (1.74±0.20 m s(-1) to 1.31±0.34 m s(-1), P<0.001), mean diastolic velocity (0.33±0.09 m s(-1) to 0.21±0.07 m s(-1), P<0.001) and mean right to left ventricular dimension ratio (1.37±0.26 to 1.12±0.17, P<0.001) and increase in mean ductal pulsatility index (PI) (1.98±0.36 to 2.46±0.23, P<0.001). Median daily maternal consumption of PRF was 286 mg per day and decreased after orientation to 0 mg per day, P<0.001. In the control group, with GA of 32±4 w (29-37 w), there was no significant differences in median daily maternal consumption of PRF, mean ductal systolic velocitiy, diastolic velocity, PI and right ventricular to left ventricular diameter ratio (RV/LV) ratio. CONCLUSION Reduction of maternal PRF intake during pregnancy, especially in the third trimester, is followed by complete reversal of DC (wide open DA), which may influence maternal dietary habits in late pregnancy.
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Affiliation(s)
- P Zielinsky
- Fetal Cardiology Unit, Instituto de Cardiologia do Rio Grande do Sul/ FUC (IC/FUC), Porto Alegre, Brazil.
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Zielinsky P, Manica JLL, Piccoli AL, Nicoloso LHS, Barra M, Alievi MM, Vian I, Zilio A, Pizzato PE, Silva JS, Bender LP, Pizzato M, Menezes HS, Garcia SC. Fetal ductal constriction caused by maternal ingestion of green tea in late pregnancy: an experimental study. Prenat Diagn 2012; 32:921-6. [DOI: 10.1002/pd.3933] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2011] [Revised: 05/15/2012] [Accepted: 05/29/2012] [Indexed: 12/13/2022]
Affiliation(s)
- Paulo Zielinsky
- Fetal Cardiology Unit; Instituto de Cardiologia do Rio Grande do Sul/FUC (IC/FUC); Porto Alegre RS Brazil
| | - João L. L. Manica
- Fetal Cardiology Unit; Instituto de Cardiologia do Rio Grande do Sul/FUC (IC/FUC); Porto Alegre RS Brazil
| | - Antonio L. Piccoli
- Fetal Cardiology Unit; Instituto de Cardiologia do Rio Grande do Sul/FUC (IC/FUC); Porto Alegre RS Brazil
| | - Luiz Henrique S. Nicoloso
- Fetal Cardiology Unit; Instituto de Cardiologia do Rio Grande do Sul/FUC (IC/FUC); Porto Alegre RS Brazil
| | - Marinez Barra
- Fetal Cardiology Unit; Instituto de Cardiologia do Rio Grande do Sul/FUC (IC/FUC); Porto Alegre RS Brazil
| | - Marcelo M. Alievi
- Veterinary School; Universidade Federal do Rio Grande do Sul (UFRGS); Porto Alegre Brazil
| | - Izabele Vian
- Fetal Cardiology Unit; Instituto de Cardiologia do Rio Grande do Sul/FUC (IC/FUC); Porto Alegre RS Brazil
| | - Ana Zilio
- Fetal Cardiology Unit; Instituto de Cardiologia do Rio Grande do Sul/FUC (IC/FUC); Porto Alegre RS Brazil
| | - Patrícia E. Pizzato
- Fetal Cardiology Unit; Instituto de Cardiologia do Rio Grande do Sul/FUC (IC/FUC); Porto Alegre RS Brazil
| | - Júlia S. Silva
- Fetal Cardiology Unit; Instituto de Cardiologia do Rio Grande do Sul/FUC (IC/FUC); Porto Alegre RS Brazil
| | - Luciano P. Bender
- Fetal Cardiology Unit; Instituto de Cardiologia do Rio Grande do Sul/FUC (IC/FUC); Porto Alegre RS Brazil
| | - Marcelo Pizzato
- Fetal Cardiology Unit; Instituto de Cardiologia do Rio Grande do Sul/FUC (IC/FUC); Porto Alegre RS Brazil
| | - Honório S. Menezes
- Fetal Cardiology Unit; Instituto de Cardiologia do Rio Grande do Sul/FUC (IC/FUC); Porto Alegre RS Brazil
| | - Solange C. Garcia
- Fetal Cardiology Unit; Instituto de Cardiologia do Rio Grande do Sul/FUC (IC/FUC); Porto Alegre RS Brazil
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Zielinsky P, Piccoli AL, Manica JL, Nicoloso LH, Menezes H, Busato A, Moraes MR, Silva J, Bender L, Pizzato P, Aita L, Alievi M, Vian I, Almeida L. Maternal consumption of polyphenol-rich foods in late pregnancy and fetal ductus arteriosus flow dynamics. J Perinatol 2010; 30:17-21. [PMID: 19641513 PMCID: PMC2834346 DOI: 10.1038/jp.2009.101] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVE To test the hypothesis that maternal consumption of polyphenol-rich foods during third trimester interferes with fetal ductal dynamics by inhibition of prostaglandin synthesis. STUDY DESIGN In a prospective analysis, Doppler ductal velocities and right-to-left ventricular dimensions ratio of 102 fetuses exposed to polyphenol-rich foods (daily estimated maternal consumption >75th percentile, or 1089 mg) were compared with 41 unexposed fetuses (flavonoid ingestion <25th percentile, or 127 mg). RESULT In the exposed fetuses, ductal velocities were higher (systolic: 0.96+/-0.23 m/s; diastolic: 0.17+/-0.05 m/s) and right-to-left ventricular ratio was higher (1.23+/-0.23) than in unexposed fetuses (systolic: 0.61+/-0.18 m/s, P<0.001; diastolic: 0.11+/-0.04 m/s, P=0.011; right-to-left ventricular ratio: 0.94+/-0.14, P<0.001). CONCLUSION As maternal polyphenol-rich foods intake in late gestation may trigger alterations in fetal ductal dynamics, changes in perinatal dietary orientation are warranted.
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Affiliation(s)
- P Zielinsky
- Fetal Cardiology Unit, Institute of Cardiology of Rio Grande do Sul/FUC, Porto Alegre, Brazil.
| | - A L Piccoli
- Fetal Cardiology Unit, IC/FUC, Porto Alegre, Brazil
| | - J L Manica
- Fetal Cardiology Unit, IC/FUC, Porto Alegre, Brazil
| | - L H Nicoloso
- Fetal Cardiology Unit, IC/FUC, Porto Alegre, Brazil
| | - H Menezes
- Post-Graduation Program and Experimental Animal Laboratory, IC/FUC, Porto Alegre, Brazil
| | - A Busato
- Fetal Cardiology Unit, IC/FUC, Porto Alegre, Brazil
| | - M R Moraes
- Fetal Cardiology Unit, IC/FUC, Porto Alegre, Brazil
| | - J Silva
- Fetal Cardiology Unit, IC/FUC, Porto Alegre, Brazil
| | - L Bender
- Fetal Cardiology Unit, IC/FUC, Porto Alegre, Brazil
| | - P Pizzato
- Fetal Cardiology Unit, IC/FUC, Porto Alegre, Brazil
| | - L Aita
- Fetal Cardiology Unit, IC/FUC, Porto Alegre, Brazil
| | - M Alievi
- Veterinary School, Federal University of Rio Grande do Sul.(UFRGS), Porto Alegre, Brazil
| | - I Vian
- Nutrition Service, IC/FUC, Porto Alegre, Brazil
| | - L Almeida
- Nutrition Service, IC/FUC, Porto Alegre, Brazil
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