Tissue localization of pregnancy-associated plasma protein-A (PAPP-A) in normal placenta

A sensitive time-resolved fluoroimmunoassay for determination of median levels of pregnancy-associated plasma protein a in pregnant women in China

Pregnancy-associated plasma protein A (PAPP-A) is an important serum marker for first trimester screening. Its weekly median value varies with ethnicity. A one-step time-resolved fluoroimmunoassay (TRFIA) using two monoclonal antibodies against PAPP-A with Eu(3+) chelates as labels has been developed. Using the assay described here, we evaluated 5,301 normal serum samples from Chinese women at 7-13 weeks of gestation. The detection limit using this assay was 1.2 mIU/L, and the maximum detection range was up to 10,000 mIU/L. The intra-assay and inter-assay coefficients of variation were <3.0% and <5.0%, respectively, and the mean recovery rate was 98.0%. PAPP-A concentrations measured in 516 maternal serum samples correlated well with those obtained by Dissociation-Enhanced Lanthanide Fluorescent Immunoassay (DELFIA) PAPP-A assay (r=0.988, P<0.001). The medians for 7-13 weeks of maternal serum PAPP-A were higher in the women from China compared to reports from other countries. The present assay possesses accuracy and high sensitivity and exhibits great potential for the clinical analysis of PAPP-A. Our investigation on the median concentrations of PAPP-A will help establish reference values that are specific for China and study the importance of ethnic factors in biochemical screening.

Optimisation of sandwich ELISA based on monoclonal antibodies for the specific measurement of pregnancy-associated plasma protein (PAPP-A) in acute coronary syndrome

OBJECTIVES

PAPP-A has become the principal biochemical serum marker in first trimester screening for Down syndrome, the original data being based on results of a radioimmunoassay (RIA). Recent observations using sandwich ELISA technology have proposed PAPP-A as a potential marker in patients with acute coronary syndrome (ACS). The aims of the present study were to demonstrate (i) the importance of antibody specificity, (ii) the potential pitfalls in changing assay technology, (iii) the importance of strict definition of technology, and (iv) the application of a well-defined assay technology on sera from patients with ACS.

DESIGN AND METHODS

Candidate monoclonal antibodies (Mab) were identified by immunohistochemistry, Western blot and the absence of positive signals (ELISA) with normal, non-pregnant serum as antigen source. The ELISA technology was standardized against the original PAPP-A RIA and the WHO reference preparation (WHO 78/610). Results different from those obtained by the original RIA led to ELISA modifications with respect to dilution buffer and enzymatic digestion of the Mab.

RESULTS

The first generation ELISA revealed serum measurements from a pool of non-pregnant (n=103) individuals which, compared to the RIA, seemed to be false positive. The false positive reaction was abolished by addition of bovine serum (BS) to the dilution buffer. Subsequent analysis of individual sera (n=103) indicated that 7/103 were still false positive. This reaction was eliminated by introduction of F(ab')(2)-fragment of the indicator antibody. This modified ELISA revealed that serum PAPP-A levels in ACS were statistically significantly higher than in controls (p<0.001). Moreover, serum PAPP-A in ACS patients with ST-segment elevation (STEMI) were higher (p<0.001) compared to patients without ST-segment elevation (NSTEMI). Immunohistochemical analysis failed to identify PAPP-A in the atherosclerotic plaques.

Comparative Biology of the IGF System in Endometrium, Decidua, and Placenta, and Clinical Implications for Foetal Growth and Implantation Disorders

The insulin like growth factors and their binding proteins appear to play a central role during implantation and establishment of pregnancy in all species studied. Although there are similarities among species in the cell types that express IGFs and IGFBPs and their regulation during implantation and pregnancy, there are also significant differences. Understanding of the role of the IGF system in placental function in the human is of immense clinical importance, because serious complications of pregnancy such as intrauterine growth restriction and pre-eclampsia are thought to be associated with alterations in IGF system during early pregnancy and later in gestation. Research in laboratory and domestic animals, including transgenic and gene targeting studies in mice, has significantly improved our understanding of the role of IGF system in placental and foetal development. This paper reviews the diversity in the expression and regulation of IGF system in the decidua and placenta at the foetal-maternal interface in the human and different animal species, which may benefit in directing future studies in understanding of various complications of human pregnancy.

Identification and regulation of the IGFBP-4 protease and its physiological inhibitor in human trophoblasts and endometrial stroma: evidence for paracrine regulation of IGF-II bioavailability in the placental bed during human implantation

The IGF family plays an important role in implantation and placental physiology. IGF-II is abundantly expressed by placental trophoblasts, and IGF binding protein (IGFBP)-4, a potent inhibitor of IGF actions, is the second most abundant IGFBP in the placental bed, expressed exclusively by the maternal decidua. Proteolysis of IGFBP-4 results in decreased affinity for IGF peptides, thereby enhancing IGF actions. In the current study, we have identified the IGFBP-4 protease and its inhibitor in human trophoblast and decidualized endometrial stromal cell cultures, and we have investigated their regulation in an effort to understand control of IGF-II bioavailability at the placental-decidual interface in human implantation. IGFBP-4 protease activity was detected in conditioned media (CM) from human trophoblasts and decidualized endometrial stromal cells using (125)I-IGFBP-4 substrate. Identification of the IGFBP-4 protease as pregnancy-associated plasma protein-A (PAPP-A) was confirmed by specific immunoinhibition and immunodepletion of the IGFBP-4 protease activity with specific PAPP-A antibodies. The IGFBP-4 protease activity was IGF-II-dependent in trophoblast CM. In decidualized stromal CM, PAPP-A/IGFBP-4 protease activity was also IGF-II-dependent, but was evident only when IGF-II was added in molar excess of the predominant IGFBP in decidualized stromal cell CM, IGFBP-1, supporting bioavailable IGF-II as a key cofactor of IGFBP-4 proteolysis by PAPP-A. Cultured first and second trimester human trophoblasts (n = 5) secreted PAPP-A into CM with mean +/- SEM levels of 172.4 +/- 32.8 mIU/liter.10(5) cells, determined by specific ELISA. PAPP-A in trophoblast CM (n = 3) and did not change in the presence of IGF-II (1-100 ng/ml). Cultured human endometrial stromal cells (n = 4) secreted low levels of PAPP-A (6.25 +/- 3.6 mIU/liter.10(5) cells). A physiological inhibitor of PAPP-A, the proform of eosinophil major basic protein (proMBP), was detected in trophoblast CM at levels of 1853 +/- 308 mIU/liter.10(5) cells, determined by specific ELISA, and was nearly undetectable in CM of human endometrial stromal cells. Upon in vitro decidualization of endometrial stromal cells with progesterone, PAPP-A levels in CM increased nearly 9-fold without a concomitant change in proMBP. In contrast to the experiments with trophoblasts, IGF-II and the IGF analogues, Leu(27) IGF-II, and Des (1-6) IGF-II, resulted in a dose-dependent decrease of PAPP-A levels in decidualized endometrial stromal CM by 70-90%, and a dose-dependent increase in proMBP of 14- to 41-fold. The data demonstrate conclusively that the IGF-II-dependent IGFBP-4 protease of human trophoblast and decidual origin is PAPP-A. Furthermore, the differential regulation of decidual PAPP-A and proMBP by insulin-like peptides supports a role for trophoblast-derived IGF-II as a paracrine regulator of these maternal decidual products that have the potential to regulate IGF-II bioavailability at the trophoblast-decidual interface. Overall, the data underscore potential roles for a complex family of enzyme (PAPP-A), substrate (IGFBP-4), inhibitor (proMBP), and cofactor (IGF-II) in the placental bed during human implantation.

Tumor-associated alpha-2-macroglobulin in human melanomas

We and others have previously shown that human melanoma cell lines in culture synthesize alpha-2-macroglobulin (alpha 2M). We have now studied melanomas from 30 patients for the presence of alpha 2M using the peroxidase anti-peroxidase technique on histologic sections from paraffin-embedded tissues and primary antibody raised against tumor-associated alpha 2M in rabbits. alpha 2M was detected in 10 of the 30 melanomas studied. In all but 2 cases the presence of alpha 2M was restricted to solitary tumor cells or to solitary foci of tumor tissue. In one case of melanoma almost all tumor cells were positive for alpha 2M, while in the others between 20% and 50% of tumor cells were positive. In all but one of the melanomas, the positivity was characteristic of epithelioid or large-cell type or was confined to this component in melanomas with more than one cell type. In 4 positive cases, differences in the extent of alpha 2M-containing tumor tissue were observed between primary tumor and metastases or metastases from different localizations, with equivocal trend. Clinical follow-up of the melanoma patients suggested that alpha 2M-positively tends to correlate with an unfavorable prognosis.

New placental proteins: chemistry, physiology and clinical use

In the past decade, several new placental proteins have been isolated and studied. The 'pregnancy-specific' beta 1-glycoprotein (SP1) is a major placental product with unusual physicochemical properties that has been extensively investigated, but its biological function remains uncertain. Pregnancy-associated plasma protein A (PAPP-A), a glycoprotein of mol. wt 400,000, has effects in vitro on the coagulation and complement cascades, probably by its properties of protease inhibition. Placental protein 5 (PP5) may be involved in the coagulation and fibrinolytic systems, and in follicle maturation and semen liquefaction. 'Placental protein 12' (PP12) is not a product of the placenta at all; it appears to be produced in the female genital tract under the influence of progesterone and may also be produced by proliferating liver cells. Further study may reveal new roles for these placental proteins beyond their traditional roles as tumour markers.

Comparison of different antibody preparations against pregnancy-associated plasma protein-A (PAPP-A) for use in localization and immunoassay studies

Four antibody preparations against pregnancy-associated plasma protein (PAPP-A) were compared in order to find an explanation for the contradictory results published on tissue localization, clinical usefulness and biological function of PAPP-A. One of the preparations studied was a rabbit anti-PAPP-A antiserum which has been offered for general scientific use (Bischof et al. 1979). Only the IgG fraction of anti-PAPP-A antisera which appeared to be monospecific and had been further absorbed with fetal connective tissue gave specific uniform staining of the cytoplasm of the syncytiotrophoblast exclusively. Circulating PAPP-A could not be detected by RIA employing this IgG preparation in the non-pregnant state, or before 18 days after conception. Circulating PAPP-A could be detected in all seven pregnant women studied within 4 weeks after conception. Identical results were obtained with a commercially available IgG fraction against PAPP-A.

Pulsatile secretion of pregnancy-associated plasma protein-A (PAPP-A) in non-pregnant women

No changes in PAPP-A levels could be detected when plasma samples were obtained every second day throughout the entire menstrual cycle in three healthy women. But when measured every 30 min throughout 12 consecutive hours, in four healthy women, PAPP-A followed a pulsatile pattern which may originate in the endometrium since no PAPP-A pulses were detected in a long-term hysterectomized woman, or in two men. The pulses were not related to levels of oestradiol, progesterone, FSH or LH.

Immunohistochemical aspects of immunological cross-reaction and masking of epitopes for localization studies on pregnancy-associated plasma protein A

The influence of antibody absorption procedures and proteolytic pre-treatment of formaldehyde-fixed placental tissue on the localization of pregnancy-associated plasma protein A by immunoperoxidase technique was examined. Apparently monospecific IgG fraction of the anti-plasma protein applied directly on fixed tissue resulted in staining of connective tissue and a thin apical rim of the syncytiotrophoblast. Further absorption of the antibody with foetal connective tissue abolished this staining reaction. Pre-treatment of the fixed placental tissue with trypsin prior to application of the antibody, which had been absorbed with connective tissue, resulted in staining within the cytoplasm of the syncytiotrophoblast exclusively. Identical staining was seen when this IgG preparation was used directly on frozen placental tissue. The results point to the importance of the specificity of the antibody preparations and of proteolytic unmasking of epitopes when fixed tissues are used for localization studies of pregnancy-associated plasma protein A by immunoperoxidase technique.

In vitro release of pregnancy-associated plasma protein-A (PAPP-A) by human endometrial cells

Evidence has now accumulated to sustain the idea that pregnancy-associated plasma protein-A (PAPP-A) is not pregnancy specific: it can be localized immunohistochemically in nonpregnant human endometrium. Thus, it was of interest to see if a primary cell culture of human endometrial cells was capable of producing PAPP-A. Immunoreactive PAPP-A-like material was detected in the culture medium of glandular as well as stromal cells. The presence of PAPP-A in endometrial culture medium was specific and could not be attributed to a nonspecific protease effect on the tracer used in radioimmunoassay. The production rate of PAPP-A by stromal cells could be enhanced by the addition of medroxyprogesterone acetate (MPA). Estradiol (E2) alone or in combination with MPA did not modify the production rate of PAPP-A. The production rate of PAPP-A by glandular cells remained unchanged after treatment with MPA and/or E2. These results confirm that in nonpregnant women PAPP-A is a progesterone-dependent protein produced by the endometrium.

In vitro production of pregnancy-associated plasma protein-A (PAPP-A) by trophoblastic cells

Pregnancy-associated plasma protein-A (PAPP-A) a high molecular weight glycoprotein, is found in high concentration in the maternal circulation during pregnancy. Immunohistochemically, PAPP-A can be localized in the trophoblast and in the decidua. Short term cultures of trophoblastic and decidual explants produce PAPP-A in vitro. It was thus of interest to see if long term cultures of primary monolayers of human trophoblast cells were capable of producing PAPP-A. Under our in vitro conditions, trophoblastic monolayers were producing both PAPP-A and beta hCG. During the first 3 days of culture PAPP-A levels increased in the medium whereas beta hCG levels decreased. The production of both proteins could be inhibited by cycloheximide. These results strongly suggest that the trophoblast is a source of PAPP-A in vivo.

Progesterone dependence and extratrophoblastic origin of pregnancy-associated plasma protein-A (PAPP-A) in early pregnancy

Pregnancy-associated plasma protein-A (PAPP-A) is a macromolecular glycoprotein produced in increasing concentration as pregnancy advances. PAPP-A is not specific to pregnancy since measurable levels have been found in non-pregnant females and in males. In non-pregnant females, PAPP-A is probably produced by the endometrium. The origin of PAPP-A in pregnant women is still controversial. In-vitro trophoblast and decidual explants both produce PAPP-A. So far, it is not known if the same applies to the in-vivo situation and to what extent these two tissues contribute to the circulating levels of PAPP-A. This study compares the circulating concentrations of PAPP-A and beta-hCG and progesterone in different pathological situations. In hydatidiform moles, beta-hCG levels are very high demonstrating an intense trophoblastic activity, whereas PAPP-A levels remain in the normal range. With spontaneous abortions, beta-hCG levels decline to very low values whereas PAPP-A continues to increase. These observations furnish indirect evidence for a major contribution to circulating PAPP-A levels by extratrophoblastic sites. Furthermore, PAPP-A levels decrease after administration of an anti-progesterone (RU486) either in-vivo or in-vitro. This is considered as a proof that PAPP-A levels in early pregnancy are progesterone dependent.

Binding of pregnancy-associated plasma protein-A (PAPP-A) to placental subfractions

Pregnancy-associated plasma protein-A (PAPP-A) has been shown to exert immunosuppressive effects both on complement and on lymphoblastogenesis. It was of interest to see whether this protein could bind to syncytiotrophoblast microvillous membranes since these represent the effective interface between fetal tissue and the immunocompetent mother. Placental subfractions were prepared according to established techniques. PAPP-A was purified from different sources (pregnancy serum and plasma, retroplacental serum, placental extracts) and labelled with radioactive iodine. It could be shown that radioactive PAPP-A, irrespective of its biological origin was primarily binding to brush border membrane preparations but that significant binding was also seen with plasma membrane preparations. The binding was specific since alpha 2-macroglobulin (a structurally related protein to PAPP-A) was unable to displace bound radioactive PAPP-A. Scatchard plot representation of the data indicated that the affinity of PAPP-A for its binding site was of the same order of magnitude as reported for the insulin or GnRH receptors of the trophoblast (Ka 2 10(7)-2.5 10(8) M-1). These results are in agreement with the immunohistochemical localization of PAPP-A on the trophoblast providing that the small binding to plasma membrane preparations is due to contamination.

The pattern of serum levels of pregnancy-associated plasma protein A (PAPP-A) during the ovulatory menstrual cycle

Pregnancy-associated plasma protein A (PAPP-A) was measured throughout the menstrual cycle in eight women at daily intervals. The protein could be detected in all serum samples, and one patient showed consistently high PAPP-A values during the entire observation period. Twenty-six more women were tested by measuring a single serum specimen. No further high PAPP-A levels were discovered in these. There is no significant difference in PAPP-A concentration between the follicular and the luteal phase of the cycle.

Observations on the source of pregnancy-associated plasma protein A (PAPP-A)

Pregnancy-associated plasma protein A (PAPP-A) was measured in 26 women before and after hysterectomy. The PAPP-A concentration declined significantly in 24 of them. It is concluded that the uterus is a source of the protein.

The localization of pregnancy proteins (hPL, SP1 and PAPP-A) in intra- and extrauterine pregnancies

The localization of human placental lactogen (hPL), pregnancy-specific beta-1 glycoprotein (Schwangerschaftsprotein 1, SP1) and pregnancy-associated protein A (PAPP-A) was examined in intrauterine and tubal ectopic gestation (n = 5) by the immunoperoxidase technique. The distribution of hPL and SP1 was identical in placental tissues obtained from intra- and extrauterine pregnancies, being uniformly seen throughout the syncytiotrophoblast. hPL and SP1 were not demonstrated in uterine decidual tissue from ectopic pregnancies. During early (week 8) intrauterine pregnancy, PAPP-A was not restricted to the mature syncytiotrophoblast, being observed also in some trophoblast-like cells adjacent to islands of syncytiotrophoblast. In contrast, in ectopic gestation, PAPP-A was observed in these cells at six weeks' gestation only. We were unable to detect PAPP-A in trophoblastic tissue of chorionic villi and uterine decidual tissue from ectopic gestation.

Immunohistochemical demonstration of pregnancy-associated plasma protein A (PAPP-A) in the syncytiotrophoblast of the normal placenta at different gestational ages

The immunoperoxidase technique was used to study the localization of pregnancy-associated plasma protein A (PAPP-A) in formaldehyde-fixed paraffin-embedded tissue from normal human placentae at the gestational age of 8, 15 and 40 weeks. Sections of formaldehyde-fixed tissue treated with a proteolytic enzyme and incubated in antiserum against PAPP-A either raised in goats or rabbits showed that PAPP-A was distributed in the cytoplasm of the syncytiotrophoblast. The protein was not found in the cytotrophoblast. Sections without pretreatment with trypsin and incubation in goat anti-PAPP-A showed no staining reaction, whereas incubation in rabbit anti-PAPP-A revealed a staining of the syncytiotrophoblast surface. The results indicate that PAPP-A is probably synthesized in the syncytiotrophoblast.

Pregnancy-associated plasma protein-A (PAPP-A): concentration in uterine fluid and immunohistochemical localization in the endometrium

Pregnancy-associated plasma protein-A (PAPP-A) was localized immunohistochemically in the endometrium and measured in uterine fluid of non-pregnant women. The variations of PAPP-A concentrations in uterine fluid during the menstrual cycle paralleled those found in the endometrium. In patients receiving hormone therapy there was a significant correlation between the uterine fluid PAPP-A concentration and the progestogen to oestrogen potency ratio of the hormonal treatment. The presence of PAPP-A in the uterine fluid cannot simply be explained by blood contamination or cell damage. These results are interpreted as indirect evidence for an exocrine as well as an endocrine secretion of PAPP-A by the endometrium which might be influenced by hormones.

An immunohistological comparison of the secretory capacity of villous and extravillous trophoblast in the human placenta

Using an immunoperoxidase technique the localization of hCG, hPL, SP1, PAPP-A and PP5 within villous and extravillous trophoblast has been studied. The villous syncytiotrophoblast appears to be the sole significant source of hCG, SP1, PAPP-A and PP5 but hPL is also present in the infiltrating extravillous trophoblast. Within the interstitial extravillous trophoblast the proportion of cells staining positively for hPL increases progressively as the cells extend deeper into the uterine tissues but all the vascular extravillous trophoblast within the lumina of the spiral arteries stains positively for hPL at all levels within the decidua and inner myometrium. It is not clear why the synthetic capacity of the infiltrating trophoblast is limited to the production of hPL. We suggest that this might be indicative of selectivity of a specific subpopulation of cytotrophoblastic cells. It is unlikely that the physiological effects of infiltrating trophoblast are mediated by hPL, this substance being probably only a marker of a cell population with a particular invasive capacity.

Immunohistochemical localization of pregnancy-associated plasma protein A (PAPP-A) in placentae from normal and pre-eclamptic pregnancies

An immunohistochemical method was used to locate pregnancy-associated plasma protein A (PAPP-A) in the placenta and uterus. In addition to 10 placentae and basal plates from normal pregnancies, ranging in gestational age from 37 to 40 weeks, the following specimens were studied: three uteri obtained by hysterectomy during early pregnancy; and three placentae from patients with severe hypertensive pre-eclampsia. In early gestation, PAPP-A was localized in the villous cytotrophoblastic cell layer and the endometrial glands but was not found in the villous syncytiotrophoblast, the cytotrophoblastic cell columns or the decidual cells. On histochemical examination of placentae from cases of pre-eclampsia with hypertension, an increased number of villous cytotrophoblastic cells and so-called X-cells was observed. The monospecific antiserum to PAPP-A reacted strongly and evenly with the cytoplasm of these cells. The present study strongly suggests that the active production sites of PAPP-A are the villous cytotrophoblastic cells and the X-cells.

Immunohistochemical localization of pregnancy-associated plasma protein A in decidua and trophoblast: comparison with human chorionic gonadotrophin and fibrin

In an immunoperoxidase study, pregnancy-associated placental protein A (PAPP-A) was localized to the cytoplasm of decidual stromal cells, the villous syncytiotrophoblast and on the surface of placental trophoblast. A decidual and a trophoblastic origin is suggested for PAPP-A, and its presence on the surface of the syncytiotrophoblast is interpreted as a possible immunoprotective layer.

Pregnancy-associated plasma protein A (PAPP-A) in non-pregnant subjects

A newly developed enzyme immunoassay technique was applied to the measurement of pregnancy-associated plasma protein A (PAPP-A) in the serum of women in the proliferative and luteal phases of the cycle, in hysterectomized and postmenopausal women and in the serum and seminal plasma of males. PAPP-A was detected in some individuals in all the categories of women and in seminal plasma but not in male serum. It is surmised that there must be a source of PAPP-A other than the placenta and that PAPP-A may be a maternal protein whose biosynthesis is stimulated by pregnancy rather than a product peculiar to the trophoblast.

In vitro production of pregnancy-associated plasma protein A by human decidua and trophoblast

Immunohistochemical techniques and direct measurements of pregnancy-associated plasma protein A (PAPP-A) have demonstrated the presence of PAPP-A in trophoblast and decidua. The purpose of the present study was to investigate the possibility that these tissues are capable of producing PAPP-A in vitro. Trophoblast and decidua were obtained from term deliveries and from legal surgical terminations of pregnancy (7 to 12 weeks). In addition to trophoblast and decidua, myometrium was also obtained during two hysterectomies in the first trimester of pregnancy. Tissues were incubated in medium 199 at 37 degrees C under an oxygen/carbon dioxide atmosphere. Media containing either pregnancy-associated serum or non-pregnancy-associated serum were changed after 8 hours of incubation in medium 199 alone. In addition to PAPP-A, human placental lactogen (hPL) and prolactin (Prl) were measured in homogenates and media by radioimmunoassays in order to confirm the viability of the cultured tissues. Addition of pregnancy-associated serum to the media induced a significant release of PAPP-A from trophoblast and decidua when compared to that in control cultures. Non-pregnancy-associated serum had no effect. Myometrium did not release any measurable PAPP-A into the medium even in the presence of pregnancy-associated serum. Cycloheximide added to pregnancy-associated serum significantly inhibited the release of PAPP-A from trophoblast and decidua. These last tissues, irrespective of the culture condition, released significantly more PAPP-A as well as hPL and Prl than was initially present in the tissue. These data demonstrate that PAPP-A is released in vitro by trophoblast and decidua (but not by myometrium) and that this release can be magnified by a factor present only in pregnancy-associated serum. The release of PAPP-A, hPL, and Prl is considered as a de novo production since concentration of these proteins are higher in media and tissues after incubation compared to concentrations initially present in the tissue before culture and since cycloheximide significantly inhibits the release of PAPP-A, Prl, and hPL from the cultured tissues.

Pregnancy-associated plasma protein A (PAPP-A) specifically inhibits the third component of human complement (C3)

Pregnancy-associated plasma protein A (PAPP-A), a macromolecular glycoprotein associated with pregnancy, was shown to inhibit complement-induced haemolysis and to bind heparin reversibly. Because of the inhibitory effects of heparin on the complement cascade it was not clear if the inhibition of complement activity observed with PAPP-A (isolated from heparin plasma) was attributable to the heparin moiety bound to PAPP-A. This work demonstrates that heparin exerts an inhibitory effect on complement activity but that heparin-free PAPP-A is also inhibitory. PAPP-A specifically inhibits C3 by binding to this complement subcomponent and not by inhibiting C3 convertase as demonstrated for C3 inactivator.

Biochemical aspects of conceptus--endometrial interactions

Mammalian conceptuses must provide a chemical signal to the maternal system to insure maintenance of corpus luteum (CL) function and of progesterone production and continuation of uterine endometrial secretory activity. These events insure that the developing conceptus is provided with appropriate nutrients, regulatory enzymes and endocrine state to allow successful establishment and maintenance of pregnancy. Pig blastocysts begin to produce estrogens by Day 11 of pregnancy, which prevents secretion of the uterine luteolytic factor (PGF2 alpha) in an endocrine direction, but allows secretion in an exocrine direction, i.e., into the uterine lumen. Therefore, CL are "protected." Blastocyst estrogens also trigger secretion of a group of proteins, including uteroferrin, an iron transport protein, and a family of protease inhibitors whose biosynthesis within the uterine glandular epithelium is under the control of progesterone. Estrogen also appears to promote accumulation of glucose and fructose within the uterine lumen. A complex in vivo "culture medium" is thereby established to promote conceptus development. Pig blastocysts do not undergo invasive implantation within the uterine lumen although they produce the protease, plasminogen activator. Invasion may be prevented by endometrial secretion of progesterone-induced protease inhibitors which are produced in large amounts. In addition to estrogens of conceptus origin, calcium and prostaglandins PGF2 alpha and E2 may affect the uterine vasculature, water and electrolyte transport, capillary permeability, conceptus steroid production, and related events during pregnancy. The blastocysts of the large domestic animals also secrete proteins which include a large glycoprotein (Mr approximately 600,000) and a small acidic protein (Mr approximately 17,000). The latter has been purified from sheep and named ovine trophoblast protein I. These proteins may play unique roles in early pregnancy with respect to establishment and maintenance of pregnancy in the ewe, sow, mare, and cow.

Accumulation of prolactin in human seminal vesicles as revealed by immunohistochemical studies

The immunoperoxidase technique was used to identify PRL in human seminal vesicles. PRL reactivity was seen as a strong, specific, perivascular staining in the venous plexuses of the invaginations between the folds in the seminal vesicle walls as well as a diffuse staining in the subepithelial stroma. The immunohistochemical staining methods used in this study do not allow any conclusive speculation on the mechanisms by which high concentrations of PRL in the seminal plasma arise, because no distinct cells could be identified as actively producing and secreting PRL by the current techniques.

Pregnancy-associated plasma protein A: a possible marker in the classification and prenatal diagnosis of Cornelia de Lange syndrome

The concentration of human platelet lactogen (hPL), pregnancy specific beta-1 glycoprotein (SP-1) and pregnancy-associated plasma protein A (PAPP-A) were analysed in consecutive serum samples from a patient who gave birth to a child with Cornelia de Lange syndrome. HPL and SP-1 were present in normal concentrations from week 20 to week 35 of gestation whereas PAPP-A could not be detected in any of the samples examined. Immunohistochemical examination of two placentae from Cornelia de Lange syndrome revealed normal localization of hPL and SP-1 but the absence of PAPP-A from the syncytiotrophoblast. The significance of association between Cornelia de Lange syndrome and compromised synthesis of PAPP-A is discussed.

Specific and reversible interaction between pregnancy-associated plasma protein A and heparin

An interaction between heparin and circulating pregnancy-associated plasma protein A (PAPP-A) has been observed. This interaction could be reversed by the addition of the specific heparin antagonist protamine sulphate. In the presence of heparin, crossed immunoelectrophoretic analysis revealed an alteration in the electrophoretic mobility of PAPP-A, while a significant increase (22 to 64 per cent, P less than 0.02) in measured levels of PAPP-A was seen in electroimmunoassays. These findings are discussed in relation to the optimal conditions for the precise measurement of PAPP-A.

Development of a radioimmunoassay for pregnancy-associated plasma protein A and establishment of normal levels in the first trimester of pregnancy

An accelerated double antibody method has been developed for the radioimmunoassay of pregnancy-associated plasma protein A (PAPP-A) in serum. The workable range for the assay was 0.04-1.8 mg/l of serum. PAPP-A levels were determined in single serum samples from 110 women with prospective normal pregnancies of between 7 and 14 weeks' gestation. The level of pregnancy specific beta 1 glycoprotein (SP1) was also measured in these samples and normal ranges for PAPP-A and SP1 were constructed from the results obtained.

Endometrial and plasma concentrations of pregnancy-associated plasma protein-A (PAPP-A)

Pregnancy-associated plasma protein-A (PAPP-A), oestradiol and progesterone levels have been measured by radioimmunoassay in plasma and in endometrial homogenates of 20 women undergoing hysterectomy. Results were grouped according to the histological stages of the endometrium. In plasma, oestradiol and progesterone concentrations changed from proliferative to secretory stages in the well-established pattern of the menstrual cycle, but PAPP-A levels did not change. In endometrium, oestradiol levels were high during the proliferative stage and low in inactive and secretory endometrium. Endometrial PAPP-A and progesterone concentrations increased from inactive to secretory stages, but only the increase in PAPP-A was statistically significant. A positive correlation observed between endometrial PAPP-A concentrations and plasma oestradiol/progesterone ratio suggests a possible hormonal control for the presence of PAPP-A in the uterus.

Retrovirus p30-related antigen in human syncytiotrophoblasts and IgG antibodies in cord-blood sera

Sensitive immunological techniques were used to detect retrovirus markers in human pregnancy. A total of 1,540 human cord-blood sera were tested for retrovirus-reactive IgG antibodies using solid-phase enzyme immunoassay and purified RD 114 virus as antigen. Of these, 118 (7.7%) sera were positive. Blocking assays with specific animal anti-p30 sera, use of control antigen, and electrophoretic protein experiments combined with immunological detection indicated that the human antibodies reacted specifically with the p30 protein. The occurrence of antibodies in cord-blood serum had a highly significant correlation to complications during pregnancy and also correlated to the number of previous abortions and stillbirths. When goat anti-RD 114 p30 serum was used in the peroxidase-anti-peroxidase tissue staining procedure, p30-related antigen was detected in sections of all placental specimens (early and term pregnancies, blighted ova, hydatidiform moles, destructive moles and choriocarcinomas). However, in each case only syncytiotrophoblastic cells were positive. These findings, supplemented with different types of blocking tests, lead us to conclude that retrovirus p30-related antigen is selectively expressed in the highly differentiated syncytiotrophoblasts, which in the normal placenta are directly exposed to maternal blood. It is suggested that retrovirus-reactive antibodies may represent an autoimmune-like immune response to the p30-related syncytiotrophoblast antigen escaping during cellular damage.

Pregnancy associated plasma protein-A: interaction with heparin in crossed affinity immunoelectrophoresis

A specific interaction between pregnancy associated plasma protein A- (PAPP A) and heparin has been demonstrated using heparin affinity crossed immunoelectrophoresis applied to late pregnancy serum. The presence of heparin in the first dimensional gel accelerated the anodic migration of six serum proteins with beta electrophoretic mobility and one protein in the alpha mobile region. Two of the six beta mobile proteins were identified as antithrombin III and beta lipoprotein, the alpha mobile protein being PAPP-A. The migration distance of other proteins originating in the placenta (pregnancy specific beta, glycoprotein), fetus (alpha-fetoprotein), leucocytes (pregnancy zone protein), or maternal liver (alpha, antitrypsin alpha 2 macroglobulin) was not altered. The interaction of PAPP-A with heparin was therefore independent of molecular size, charge, and site of origin indicating a specific high affinity interaction between PAPP-A and heparin. There results indicate that PAPP-A may be involved locally with the coagulation system in the maintenance of placental circulation.