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Boissiere J, Watkins V, Kuller JA, Dotters-Katz SK. Parvovirus B19 in Pregnancy. Obstet Gynecol Surv 2024; 79:281-289. [PMID: 38764205 DOI: 10.1097/ogx.0000000000001263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/21/2024]
Abstract
Importance Although the risk of parvovirus B19 infection during pregnancy and subsequent risk of adverse fetal outcome are low, understanding management practices is essential for proper treatment of fetuses with nonimmune hydrops fetalis. In addition, continued investigation into delivery management, breastfeeding recommendations, and congenital abnormalities associated with pregnancies complicated by parvovirus B19 infection is needed. Objective This review describes the risks associated with parvovirus B19 infection during pregnancy and the management strategies for fetuses with vertically transmitted infections. Evidence Acquisition Original articles were obtained from literature search in PubMed, Medline, and OVID; pertinent articles were reviewed. Results Parvovirus B19 is a viral infection associated with negative pregnancy outcomes. Up to 50% of people of reproductive age are susceptible to the virus. The incidence of B19 in pregnancy is between 0.61% and 1.24%, and, overall, there is 30% risk of vertical transmission when infection is acquired during pregnancy. Although most pregnancies progress without negative outcomes, viral infection of the fetus may result in severe anemia, congestive heart failure, and hydrops fetalis. In addition, vertical transmission carries a 5% to 10% chance of fetal loss. In pregnancies affected by fetal B19 infection, Doppler examination of the middle cerebral artery peak systolic velocity should be initiated to surveil for fetal anemia. In the case of severe fetal anemia, standard fetal therapy involves an intrauterine transfusion of red blood cells with the goal of raising hematocrit levels to approximately 40% to 50% of total blood volume. One transfusion is usually sufficient, although continued surveillance may indicate the need for subsequent transfusions. There are fewer epidemiologic data concerning neonatal risks of congenital parvovirus, although case reports have shown that fetuses with severe anemia in utero may have persistent anemia, thrombocytopenia, and edema in the neonatal period. Conclusions and Relevance Parvovirus B19 is a common virus; seropositivity in the geriatric population reportedly reaches 85%. Within the pregnant population, up to 50% of patients have not previously been exposed to the virus and consequently lack protective immunity. Concern for parvovirus B19 infection in pregnancy largely surrounds the consequences of vertical transmission of the virus to the fetus. Should vertical transmission occur, the overall risk of fetal loss is between 5% and 10%. Thus, understanding the incidence, risks, and management strategies of pregnancies complicated by parvovirus B19 is essential to optimizing care and outcomes. Further, there is currently a gap in evidence regarding delivery management, breastfeeding recommendations, and the risks of congenital abnormalities in pregnancies complicated by parvovirus B19. Additional investigations into optimal delivery management, feeding plans, and recommended neonatal surveillance are needed in this cohort of patients.
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Affiliation(s)
- Jaye Boissiere
- Medical Student, Duke University Medical School, Durham, NC
| | - Virginia Watkins
- Fellow, Department of Obstetrics and Gynecology, Duke University, Durham, NC
| | - Jeffrey A Kuller
- Professor, Department of Obstetrics and Gynecology, Duke University, Durham, NC
| | - Sarah K Dotters-Katz
- Associate Professor, Department of Obstetrics and Gynecology, Duke University, Durham, NC
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Heydarifard Z, Zadheidar S, Yavarian J, Shatizadeh Malekshahi S, Kalantari S, Mokhtari-Azad T, Shafiei-Jandaghi NZ. Potential role of viral infections in miscarriage and insights into the underlying molecular mechanisms. Congenit Anom (Kyoto) 2022; 62:54-67. [PMID: 34961973 DOI: 10.1111/cga.12458] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 11/19/2021] [Accepted: 12/06/2021] [Indexed: 11/30/2022]
Abstract
Intrauterine viruses can infect the decidua and placenta and cause adverse effects on the fetus during gestation. This review discusses the contribution of various viral infections to miscarriage and the molecular mechanisms by which viruses can cause devastating effects on healthy fetuses and induce miscarriage. Severe acute respiratory syndrome coronavirus 2 as newly emerged coronavirus was considered here, due to the concerns about its role during pregnancy and inducing miscarriage, as well. In this narrative review, an extensive literature search was conducted to find all studies investigating viral infections in miscarriage and their molecular mechanisms published over the past 20 years. The results of various studies investigating the roles of 20 viral infections in miscarriage are presented. Then, the mechanisms of pregnancy loss in viral infections were addressed, including alteration of trophoblast invasion and placental dysfunction, inducing excessive maternal immune response, and inducing apoptosis in the placental tissue. Viruses may cause pregnancy loss through different mechanisms and our knowledge about these mechanisms can be helpful for controlling or preventing viral infections and achieving a successful pregnancy.
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Affiliation(s)
- Zahra Heydarifard
- Virology Department, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Sevrin Zadheidar
- Virology Department, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Jila Yavarian
- Virology Department, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Shirin Kalantari
- Virology Department, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Talat Mokhtari-Azad
- Virology Department, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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Redman CW, Staff AC, Roberts JM. Syncytiotrophoblast stress in preeclampsia: the convergence point for multiple pathways. Am J Obstet Gynecol 2022; 226:S907-S927. [PMID: 33546842 DOI: 10.1016/j.ajog.2020.09.047] [Citation(s) in RCA: 119] [Impact Index Per Article: 59.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 09/14/2020] [Accepted: 09/19/2020] [Indexed: 12/29/2022]
Abstract
Preeclampsia evolves in 2 stages: a placental problem that generates signals to the mother to cause a range of responses that comprise the second stage (preeclampsia syndrome). The first stage of early-onset preeclampsia is poor placentation, which we here call malplacentation. The spiral arteries are incompletely remodeled, leading to later placental malperfusion, relatively early in the second half of pregnancy. The long duration of the first stage (several months) is unsurprisingly associated with fetal growth restriction. The first stage of late-onset preeclampsia, approximately 80% of total cases, is shorter (several weeks) and part of a process that is common to all pregnancies. Placental function declines as it outgrows uterine capacity, with increasing chorionic villous packing, compression of the intervillous space, and fetal hypoxia, and causes late-onset clinical presentations such as "unexplained" stillbirths, late-onset fetal growth restriction, or preeclampsia. The second stages of early- and late-onset preeclampsia share syncytiotrophoblast stress as the most relevant feature that causes the maternal syndrome. Syncytiotrophoblast stress signals in the maternal circulation are probably the most specific biomarkers for preeclampsia. In addition, soluble fms-like tyrosine kinase-1 (mainly produced by syncytiotrophoblast) is the best-known biomarker and is routinely used in clinical practice in many locations. How the stress signals change over time in normal pregnancies indicates that syncytiotrophoblast stress begins on average at 30 to 32 weeks' gestation and progresses to term. At term, syncytiotrophoblast shows increasing markers of stress, including apoptosis, pyroptosis, autophagy, syncytial knots, and necrosis. We label this phenotype the "twilight placenta" and argue that it accounts for the clinical problems of postmature pregnancies. Senescence as a stress response differs in multinuclear syncytiotrophoblast from that of mononuclear cells. Syncytiotrophoblast irreversibly acquires part of the senescence phenotype (cell cycle arrest) when it is formed by cell fusion. The 2 pathways converge on the common pathologic endpoint, syncytiotrophoblast stress, and contribute to preeclampsia subtypes. We highlight that the well-known heterogeneity of the preeclampsia syndrome arises from different pathways to this common endpoint, influenced by maternal genetics, epigenetics, lifestyle, and environmental factors with different fetal and maternal responses to the ensuing insults. This complexity mandates a reassessment of our approach to predicting and preventing preeclampsia, and we summarize research priorities to maximize what we can learn about these important issues.
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4
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Megli CJ, Coyne CB. Infections at the maternal-fetal interface: an overview of pathogenesis and defence. Nat Rev Microbiol 2021; 20:67-82. [PMID: 34433930 PMCID: PMC8386341 DOI: 10.1038/s41579-021-00610-y] [Citation(s) in RCA: 148] [Impact Index Per Article: 49.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/15/2021] [Indexed: 02/08/2023]
Abstract
Infections are a major threat to human reproductive health, and infections in pregnancy can cause prematurity or stillbirth, or can be vertically transmitted to the fetus leading to congenital infection and severe disease. The acronym ‘TORCH’ (Toxoplasma gondii, other, rubella virus, cytomegalovirus, herpes simplex virus) refers to pathogens directly associated with the development of congenital disease and includes diverse bacteria, viruses and parasites. The placenta restricts vertical transmission during pregnancy and has evolved robust mechanisms of microbial defence. However, microorganisms that cause congenital disease have likely evolved diverse mechanisms to bypass these defences. In this Review, we discuss how TORCH pathogens access the intra-amniotic space and overcome the placental defences that protect against microbial vertical transmission. Infections during pregnancy can be associated with devastating outcomes for the pregnant mother and developing fetus. In this Review, Megli and Coyne discuss placental defences and provide an overview of how various viral, bacterial and parasitic pathogens traverse the maternal–fetal interface and cause disease.
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Affiliation(s)
- Christina J Megli
- Division of Maternal-Fetal Medicine, Division of Reproductive Infectious Disease, Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine and the Magee Womens Research Institute, Pittsburgh, PA, USA.
| | - Carolyn B Coyne
- Department of Molecular Genetics and Microbiology and the Duke Human Vaccine Institute, Duke University School of Medicine, Durham, NC, USA.
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5
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Is the ZIKV Congenital Syndrome and Microcephaly Due to Syndemism with Latent Virus Coinfection? Viruses 2021; 13:v13040669. [PMID: 33924398 PMCID: PMC8069280 DOI: 10.3390/v13040669] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 04/02/2021] [Accepted: 04/10/2021] [Indexed: 01/04/2023] Open
Abstract
The emergence of the Zika virus (ZIKV) mirrors its evolutionary nature and, thus, its ability to grow in diversity or complexity (i.e., related to genome, host response, environment changes, tropism, and pathogenicity), leading to it recently joining the circle of closed congenital pathogens. The causal relation of ZIKV to microcephaly is still a much-debated issue. The identification of outbreak foci being in certain endemic urban areas characterized by a high-density population emphasizes that mixed infections might spearhead the recent appearance of a wide range of diseases that were initially attributed to ZIKV. Globally, such coinfections may have both positive and negative effects on viral replication, tropism, host response, and the viral genome. In other words, the possibility of coinfection may necessitate revisiting what is considered to be known regarding the pathogenesis and epidemiology of ZIKV diseases. ZIKV viral coinfections are already being reported with other arboviruses (e.g., chikungunya virus (CHIKV) and dengue virus (DENV)) as well as congenital pathogens (e.g., human immunodeficiency virus (HIV) and cytomegalovirus (HCMV)). However, descriptions of human latent viruses and their impacts on ZIKV disease outcomes in hosts are currently lacking. This review proposes to select some interesting human latent viruses (i.e., herpes simplex virus 2 (HSV-2), Epstein-Barr virus (EBV), human herpesvirus 6 (HHV-6), human parvovirus B19 (B19V), and human papillomavirus (HPV)), whose virological features and co-exposition with ZIKV may provide evidence of the syndemism process, shedding some light on the emergence of the ZIKV-induced global congenital syndrome in South America.
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Sabahi M, Salehipour A, Kazemi A, Sadeghi M, Decaro N, Mozhgani SH, Jalilian FA, Yaghoobi MH. Prevalence and disease association of human parvovirus B19 in Iran: a systematic review. Future Virol 2019. [DOI: 10.2217/fvl-2019-0046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Aim: The prevalence of human parvovirus B19 (B19V) and its association with other diseases in Iran are yet to be systematically assessed. This study aimed to evaluate the prevalence and disease association of B19V across Iran from 2000 to 2019. Methods: The literature search, based on different keywords in different databases, was performed. A total of 29 eligible studies were included and the essential information was collected from each article. Results: The results of this study show a relatively high prevalence of the B19V-associated diseases in all age groups of the Iranian population. Conclusion: The transmission of B19V and its complications should be prevented by developing preventative strategies.
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Affiliation(s)
- Mohammadmahdi Sabahi
- Student Research Committee, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Arash Salehipour
- Student Research Committee, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Azin Kazemi
- Student Research Committee, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Mohammadreza Sadeghi
- Department of Virology, Haartman Institute, University of Helsinki, Helsinki, Finland
| | - Nicola Decaro
- Department of Animal Health & Well-Being, Faculty of Veterinary Medicine of Bari, University of Bari, Bari, Italy
| | - Sayed-Hamidreza Mozhgani
- Department of Microbiology, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
- Non-Communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran
| | - Farid Azizi Jalilian
- Department of Virology, Faculty of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Mojtaba Hedayat Yaghoobi
- Department of Infectious Disease, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
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7
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Ye Y, Zhou Q, Feng L, Wu J, Xiong Y, Li X. Maternal serum bisphenol A levels and risk of pre-eclampsia: a nested case-control study. Eur J Public Health 2018; 27:1102-1107. [PMID: 29186464 PMCID: PMC5881734 DOI: 10.1093/eurpub/ckx148] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background Although recent studies have indicated the potential adverse effects of maternal bisphenol A (BPA) exposure on pregnancy such as increasing the risk of pre-eclampsia, epidemiological evidence is limited. We aimed to evaluate the relationship between maternal BPA exposure and the risk of pre-eclampsia. Methods We conducted a nested case-control study among 173 women (74 cases of pre-eclampsia and 99 controls). BPA concentrations were measured using liquid chromatography-mass spectrometry in the maternal serum samples collected during 16-20 gestational weeks. Multivariate logistic models were used to examine the relationship between maternal serum BPA concentrations and the risk of pre-eclampsia. Results BPA was detectable (>0.1 µg/l) in 78.6% of the maternal serum samples at three levels: low (<2.24 µg/l), medium (2.24-4.44 µg/l), and high (>4.44 µg/l). BPA concentrations were significantly higher in the serum samples collected from the pre-eclampsia cases than those from controls (median: 3.40 vs. 1.50 µg/l, P < 0.01). With adjustment for maternal age, primiparous and BMI, the odds of developing pre-eclampsia were significantly elevated in subjects with high serum BPA levels compared with those with low levels (adjusted OR = 16.46, 95%CI = 5.42-49.85) regardless of subcategories of pre-eclampsia including severity and onset time. Among the pre-eclampsia subjects, the maternal serum concentration of BPA was not different between the early- and late-onset subjects (median: 3.09 vs. 3.50 µg/l, P = 0.57), but surprisingly higher in mild pre-eclampsia subjects compared with severe pre-eclampsia subjects (median: 5.20 vs. 1.80 µg/l, P < 0.01). Conclusions These results demonstrated that maternal exposure to high level of BPA could be associated with an increased risk of pre-eclampsia.
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Affiliation(s)
- Yunzhen Ye
- Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China.,The Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, Shanghai, China
| | - Qiongjie Zhou
- Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China.,The Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, Shanghai, China.,Women's Health and Perinatology Research Group, Department of Clinical Medicine, UiT - The Arctic University of Norway, Tromso, Norway
| | - Liping Feng
- Department of Obstetrics and Gynecology, Duke University, Durham, NC, USA
| | - Jiangnan Wu
- Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China
| | - Yu Xiong
- Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China.,The Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, Shanghai, China
| | - Xiaotian Li
- Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China.,The Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, Shanghai, China.,The Shanghai Key Laboratory of Birth Defects, Shanghai, China.,Institute of Biochemical Sciences, Fudan University, Shanghai, China
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8
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Ornoy A, Ergaz Z. Parvovirus B19 infection during pregnancy and risks to the fetus. Birth Defects Res 2018; 109:311-323. [PMID: 28398685 DOI: 10.1002/bdra.23588] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 08/02/2016] [Accepted: 09/14/2016] [Indexed: 01/30/2023]
Abstract
Parvovirus B19 infects 1 to 5% of pregnant women, generally with normal pregnancy outcomes. During epidemics, the rate of infection is higher. Major congenital anomalies among offspring of infected mothers are rare, as the virus does not appear to be a significant teratogen. However, parvovirus B19 infection may cause significant fetal damage, and in rare cases, brain anomalies and neurodevelopmental insults, especially if infection occurs in the first 20 weeks of pregnancy. Parvovirus B19 is also an important cause of fetal loss, especially in the second half of pregnancy when spontaneous fetal loss from other causes is relatively rare. Parvovirus B19 infection may affect many fetal organs and can cause severe anemia, following fetal erythroid progenitor cells infection and apoptosis, especially in fetuses, that have shortened half-life of erythrocytes. Severe anemia may cause high output cardiac failure and nonimmune hydrops fetalis. In addition, parvovirus B19 may directly infect myocardial cells and produce myocarditis that further aggravates the cardiac failure. Intrauterine fetal transfusion is commonly used for the treatment of severe fetal anemia with survival rates of 75 to 90% and significant reduction of fetal morbidity. Only 66 cases were evaluated neurodevelopmentally, of which 10 (16%) had slight or severe neurodevelopmental problems. Because parvovirus B19 infection can cause severe fetal morbidity and mortality, it should be part of the routine work-up of pregnant women who have been exposed to the virus or of pregnancies with suspected fetal hydrops. Assessment for maternal infection during pregnancy is especially important during epidemics, when sero-conversion rates are high. Birth Defects Research 109:311-323, 2017. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Asher Ornoy
- Laboratory of Teratology, Department of Medical Neurobiology, Hebrew University Hadassah Medical School, Jerusalem, Israel
| | - Zivanit Ergaz
- Laboratory of Teratology, Department of Medical Neurobiology, Hebrew University Hadassah Medical School, Jerusalem, Israel.,Department of Neonatology, Hadassah University Hospital Mount Scopus, Jerusalem, Israel
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Clabault H, Flipo D, Guibourdenche J, Fournier T, Sanderson JT, Vaillancourt C. Effects of selective serotonin-reuptake inhibitors (SSRIs) on human villous trophoblasts syncytialization. Toxicol Appl Pharmacol 2018; 349:8-20. [PMID: 29679653 DOI: 10.1016/j.taap.2018.04.018] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 03/27/2018] [Accepted: 04/14/2018] [Indexed: 12/19/2022]
Abstract
Selective serotonin-reuptake inhibitors (SSRIs) are the most commonly prescribed antidepressants during pregnancy. The human placenta is a highly specialized organ supporting normal growth and development of the fetus. Therefore, this study aims to analyze the effects of SSRIs on villous cytotrophoblasts cells, using BeWo cells and human placental trophoblast cells in primary culture. The SSRIs fluoxetine and its metabolite norfluoxetine, sertraline and venlafaxine did not affect BeWo cell proliferation and viability, nor the percentage of M30-positive (apoptotic) primary trophoblast cells. None of the SSRIs affected basal or forskolin-stimulated BeWo cell fusion, whereas sertraline and venlafaxine increased the fusion of primary villous trophoblasts. Sertraline and venlafaxine also modified human chorionic gonadotropin beta (β-hCG) secretion by BeWo cells, whereas none of the SSRIs affected β-hCG secretion in primary trophoblasts. Norfluoxetine increased CGB (chorionic gonadotropin beta) and GJA1 (gap junction protein alpha 1) levels of gene expression (biomarkers of syncytialization) in BeWo cells, whereas in primary trophoblasts none of the SSRIs tested affected the expression of these genes. This study shows that SSRIs affect villous trophoblast syncytialization in a structure- and concentration-dependent manner and suggests that certain SSRIs may compromise placental health. In addition, it highlights the importance of using primary trophoblast cells instead of "trophoblast -like" cell lines to assess the effects of medications on human villous trophoblast function.
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Affiliation(s)
- Hélène Clabault
- INRS-Institut Armand-Frappier, 531 blvd des Prairies, Laval, QC, H7V 1B7, Canada; BioMed Research Centre, Université du Québec à Montréal, Montréal, QC H3C 3P8, Canada; Center for Interdisciplinary Research on Well-Being, Health, Society and Environment, Université du Québec à Montréal, Montréal, QC H3C 3P8, Canada.
| | - Denis Flipo
- BioMed Research Centre, Université du Québec à Montréal, Montréal, QC H3C 3P8, Canada; Département des Sciences Biologiques, Université du Québec à Montréal, Montréal, QC H3C 3P8, Canada.
| | - Jean Guibourdenche
- INSERM, UMR-S1139, Faculté de Pharmacie de Paris, Université Paris Descartes, Sorbonne Paris Cité, Paris F-75006, France; Service d'hormonologie Centre Hospitalier, Universitaire Cochin Broca Hôtel Dieu, Assistance Publique-Hôpital de Paris, Paris F-75014, France.
| | - Thierry Fournier
- INSERM, UMR-S1139, Faculté de Pharmacie de Paris, Université Paris Descartes, Sorbonne Paris Cité, Paris F-75006, France; Fondation PremUp, Paris F-75006, France.
| | - J Thomas Sanderson
- INRS-Institut Armand-Frappier, 531 blvd des Prairies, Laval, QC, H7V 1B7, Canada.
| | - Cathy Vaillancourt
- INRS-Institut Armand-Frappier, 531 blvd des Prairies, Laval, QC, H7V 1B7, Canada; BioMed Research Centre, Université du Québec à Montréal, Montréal, QC H3C 3P8, Canada; Center for Interdisciplinary Research on Well-Being, Health, Society and Environment, Université du Québec à Montréal, Montréal, QC H3C 3P8, Canada.
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León-Juárez M, Martínez–Castillo M, González-García LD, Helguera-Repetto AC, Zaga-Clavellina V, García-Cordero J, Flores-Pliego A, Herrera-Salazar A, Vázquez-Martínez ER, Reyes-Muñoz E. Cellular and molecular mechanisms of viral infection in the human placenta. Pathog Dis 2017; 75:4056146. [PMID: 28903546 PMCID: PMC7108519 DOI: 10.1093/femspd/ftx093] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 07/27/2017] [Indexed: 12/22/2022] Open
Abstract
The placenta is a highly specialized organ that is formed during human gestation for conferring protection and generating an optimal microenvironment to maintain the equilibrium between immunological and biochemical factors for fetal development. Diverse pathogens, including viruses, can infect several cellular components of the placenta, such as trophoblasts, syncytiotrophoblasts and other hematopoietic cells. Viral infections during pregnancy have been associated with fetal malformation and pregnancy complications such as preterm labor. In this minireview, we describe the most recent findings regarding virus-host interactions at the placental interface and investigate the mechanisms through which viruses may access trophoblasts and the pathogenic processes involved in viral dissemination at the maternal-fetal interface.
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Affiliation(s)
- Moises León-Juárez
- Departamento de Inmunobioquímica, Instituto Nacional de Perinatología “Isidro Espinosa de los Reyes”, Montes Urales 800, Col. Lomas Virreyes, CP 11000, Ciudad de México, México
| | - Macario Martínez–Castillo
- Departamento de Inmunobioquímica, Instituto Nacional de Perinatología “Isidro Espinosa de los Reyes”, Montes Urales 800, Col. Lomas Virreyes, CP 11000, Ciudad de México, México
| | - Luis Didier González-García
- Departamento de Inmunobioquímica, Instituto Nacional de Perinatología “Isidro Espinosa de los Reyes”, Montes Urales 800, Col. Lomas Virreyes, CP 11000, Ciudad de México, México
| | - Addy Cecilia Helguera-Repetto
- Departamento de Inmunobioquímica, Instituto Nacional de Perinatología “Isidro Espinosa de los Reyes”, Montes Urales 800, Col. Lomas Virreyes, CP 11000, Ciudad de México, México
| | - Verónica Zaga-Clavellina
- Departamento de Inmunobioquímica, Instituto Nacional de Perinatología “Isidro Espinosa de los Reyes”, Montes Urales 800, Col. Lomas Virreyes, CP 11000, Ciudad de México, México
| | - Julio García-Cordero
- Departamento de Biomedicina Molecular, Centro de Investigación y de Estudios Avanzados del I.P.N. Av. I.P.N 2508 Col. San Pedro Zacatenco, CP 07360 Ciudad de México, México
| | - Arturo Flores-Pliego
- Departamento de Inmunobioquímica, Instituto Nacional de Perinatología “Isidro Espinosa de los Reyes”, Montes Urales 800, Col. Lomas Virreyes, CP 11000, Ciudad de México, México
| | - Alma Herrera-Salazar
- Departamento de Infectología e Inmunología Instituto Nacional de Perinatología “Isidro Espinosa de los Reyes”, Montes Urales #800, Col. Lomas Virreyes, CP 11000. Ciudad de México, México
| | - Edgar Ricardo Vázquez-Martínez
- Unidad de Investigación en Reproducción Humana, Instituto Nacional de Perinatología-Facultad de Química UNAM, Ciudad de México, México
| | - Enrique Reyes-Muñoz
- Coordinación de Endocrinología, Instituto Nacional de Perinatología “Isidro Espinosa de los Reyes”, Montes Urales #800, Col. Lomas Virreyes, CP 11000. Ciudad de México. México
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11
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Tzang BS, Chiang SY, Chan HC, Liu CH, Hsu TC. Human parvovirus B19 antibodies induce altered membrane protein expression and apoptosis of BeWo trophoblasts. Mol Med Rep 2016; 14:4399-4406. [PMID: 27748859 DOI: 10.3892/mmr.2016.5787] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Accepted: 09/13/2016] [Indexed: 11/06/2022] Open
Abstract
Human parvovirus B19 (B19) is harmful during pregnancy since it can be vertically transmitted to the developing fetus. In addition, the anti‑B19 antibodies induced by B19 infection are believed to have a cytopathic role in B19 transmission; however, knowledge regarding the effects of anti‑B19 antibodies during pregnancy is limited. To investigate the possible roles of anti‑B19 antibodies during pregnancy, the present study examined the effects of anti‑B19‑VP1 unique region (VP1u), anti‑B19‑VP2 and anti‑B19‑nonstructural protein 1 (NS1) immunoglobulin G (IgG) antibodies on BeWo trophoblasts. Briefly, BeWo trophoblasts were incubated with purified IgG against B19‑VP1u, B19‑VP2 and B19‑NS1. Subsequently, the expression of surface proteins and apoptotic molecules were assessed in BeWo trophoblasts using flow cytometry, ELISA and western blotting. The expression levels of human leukocyte antigen (HLA)‑G were significantly increased on BeWo trophoblasts treated with rabbit anti‑B19‑VP1u IgG, and were unchanged in those treated with rabbit anti‑B19‑NS1 and anti‑B19‑VP2 IgG, as compared with the control group. Furthermore, the expression levels of globoside (P blood group antigen) and cluster of differentiation (CD)29 (β1 integrin) were significantly increased in BeWo trophoblasts treated with rabbit anti‑B19‑NS1 and anti‑B19‑VP2 IgG, whereas only CD29 was also significantly increased in cells treated with anti‑B19‑VP1u IgG. In addition, the number of cells at sub‑G1 phase; caspase‑3 activity; and the expression of intrinsic and extrinsic apoptotic molecules, including Fas‑associated death domain protein, activated caspase‑8, activated caspase‑3, B‑cell lymphoma 2‑associated X protein, cytochrome c, apoptotic peptidase activating factor 1 and activated caspase‑9, were significantly increased in BeWo trophoblasts treated with anti‑B19‑VP1u and anti‑B19‑NS1 IgG. In conclusion, the present study demonstrated that antibodies against B19 may have a crucial role in pathological processes during pregnancy. These findings may help to elucidate the mechanisms underlying transmission of the B19 virus during pregnancy.
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Affiliation(s)
- Bor-Show Tzang
- Institute of Biochemistry, Microbiology and Immunology, Chung Shan Medical University, Taichung 40201, Taiwan, R.O.C
| | - Szu-Yi Chiang
- Division of Neurology, Department of Internal Medicine, Chi Mei Medical Center, Liouying 73663, Taiwan, R.O.C
| | - Hsu-Chin Chan
- Department of Biochemistry, School of Medicine, China Medical University, Taichung 40402, Taiwan, R.O.C
| | - Chung-Hsien Liu
- Department of Obstetrics and Gynecology, Chung Shan Medical University and Chung Shan Medical University Hospital, Taichung 40201, Taiwan, R.O.C
| | - Tsai-Ching Hsu
- Institute of Biochemistry, Microbiology and Immunology, Chung Shan Medical University, Taichung 40201, Taiwan, R.O.C
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Kawabe A, Takai Y, Tamaru JI, Samejima K, Seki H. Placental abruption possibly due to parvovirus B19 infection. SPRINGERPLUS 2016; 5:1280. [PMID: 27547655 PMCID: PMC4977243 DOI: 10.1186/s40064-016-2946-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Accepted: 07/28/2016] [Indexed: 11/10/2022]
Abstract
BACKGROUND There is concern about the development of anemia-associated fetal hydrops associated with maternal parvovirus B19 infection. Parvovirus B19 infection occurs via the globoside (P antigen) receptor, the main glycolipid of erythroid cells, which induces apoptosis. Similar findings have been reported for the P antigen of globoside-containing placental trophoblast cells. CASE DESCRIPTION A 32-year-old woman was infected with human parvovirus B19 at week 32 of pregnancy, and had severe anemia at week 34. At week 37, an emergency cesarean section was performed because of sudden abdominal pain and fetal bradycardia; placental abruption was found. A live male infant was delivered with no sign of fetal hydrops or fetal infection. Placental tissue was positive for parvovirus B19 according to polymerase chain reaction. Immunohistochemical analysis using caspase-related M30 CytoDEATH monoclonal antibody revealed M30 staining of the placental villous trophoblasts. DISCUSSION AND EVALUATION Placental trophoblasts and erythroid precursor cells have been reported to express globoside (P antigen), which is necessary for parvovirus B19 infectivity, and to show apoptotic activity as a result of infection. Placentas from three other pregnancies with documented abruption showed no M30 staining. CONCLUSION The present case strongly suggests an association between placental abruption and apoptosis resulting from parvovirus B19 infection.
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Affiliation(s)
- Ayaka Kawabe
- Center for Maternal, Fetal and Neonatal Medicine, Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Kawagoe, Saitama 350-8550 Japan
| | - Yasushi Takai
- Department of Obstetrics and Gynecology, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan
| | - Jun-Ichi Tamaru
- Department of Pathology, Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Kawagoe, Saitama 350-8550 Japan
| | - Kouki Samejima
- Center for Maternal, Fetal and Neonatal Medicine, Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Kawagoe, Saitama 350-8550 Japan
| | - Hiroyuki Seki
- Center for Maternal, Fetal and Neonatal Medicine, Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Kawagoe, Saitama 350-8550 Japan
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13
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Acute hepatitis and myositis associated with Erythema infectiosum by Parvovirus B19 in an adolescent. BMC Pediatr 2014; 14:6. [PMID: 24410941 PMCID: PMC3937157 DOI: 10.1186/1471-2431-14-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Accepted: 12/14/2013] [Indexed: 12/19/2022] Open
Abstract
Background Erythema infectiosum is the most common clinical manifestation of Parvovirus B19 infection although it has also been associated with rheumatologic diseases and various types of systemic vasculitides. Acute hepatitis and benign myositis however are rarely reported in association with Parvovirus B19 infection. Case presentation Here we report a 14-year old male, who developed acute hepatitis and benign myositis associated with erythema infectiosum following Parvovirus B19 infection. Conclusion Parvovirus B19 infection has rarely been associated with acute hepatitis and exceptionally rarely with benign myositis. Parvovirus B19 should be considered in the differential diagnosis of acute non-A to E hepatitis and in the case of acute benign myositis presenting with a rash especially in children.
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14
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Abstract
Parvovirus B19 is a widespread human pathogenic virus, member of the Erythrovirus genus in the Parvoviridae family. Infection can be associated with an ample range of pathologies and clinical manifestations, whose characteristics and outcomes depend on the interplay between the pathogenetic potential of the virus, its adaptation to different cellular environments, and the physiological and immune status of the infected individuals. The scope of this review is the advances in knowledge on the biological characteristics of the virus and of virus-host relationships; in particular, the interactions of the virus with different cellular environments in terms of tropism and ability to achieve a productive replicative cycle, or, on the contrary, to establish persistence; the consequences of infection in terms of interference with the cell physiology; the process of recognition of the virus by the innate or adaptive immune system, hence the role of the immune system in controlling the infection or in the development of clinical manifestations. Linked to these issues is the continuous effort to develop better diagnostic algorithms and methods and the need for development of prophylactic and therapeutic options for B19V infections.
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Affiliation(s)
- Giorgio Gallinella
- Department of Pharmacy and Biotechnology, University of Bologna, and Microbiology, S.Orsola-Malpighi Hospital, Via Massarenti 9, 40138 Bologna, Italy
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15
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Dembinski J. Diagnosis of in utero Parvovirus B19 infection and maternal immune response - the relevance of linear epitopes and advanced serologic testing. ACTA ACUST UNITED AC 2013; 4:139-48. [PMID: 23484447 DOI: 10.1517/17530050903452190] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
IMPORTANCE OF THE FIELD Parvovirus B19 (B19V) infection in utero causing fetal anemia and non-immune hydrops fetalis (NIHF) is a potentially life-threatening event for the fetus. Postexpositional non-invasive diagnosis is based on maternal IgG/IgM response and detection of viral genome in maternal blood. Serologic testing directs prenatal follow-up. Fetal infection is confirmed by polymerase chain reaction or in situ hybridization in fetal blood and/or amniotic fluid cells. The performance of serologic tests is significant in order to direct pre- and perinatal care at rational use of resources. Timing of diagnostic procedures and knowledge of the time course of infection in pregnant, asymptomatic women are critical. IgM negative testing in the presence of prolonged viremia may complicate individual risk analysis in pregnancy. Recently, advanced IgG avidity assays and epitope-type specific assays (IgG ETS EIA) have been re-evaluated. AREAS COVERED IN THIS REVIEW Epidemiology, clinical relevance and management of B19V infection in pregnancy. A review of the current literature (November 1984 - May 2009) and evaluation of current information on performance and predictive value of molecular and VP1/VP2 antigen-based IgG tests directed at the diagnosis of materno-fetal B19V infection and detection of past immunity. New aspects of B19V-associated fetal disease other than anemia/NIHF are also covered. WHAT THE READER WILL GAIN An overview of immunology and clinical relevance of B19V infection in pregnancy, of the potential value of advanced serologic testing and fields of future research. TAKE HOME MESSAGE In the absence of a commercially available vaccine, serologic tests remain important tools in individual risk analysis of pregnant women exposed to B19V. Sequential application of IgG avidity and IgG ETS EIAs may improve risk stratification and timing of invasive testing in B19V-exposed pregnancies, in particular with IgM-negativity and/or persistent DNAemia. Prospective evaluation of these test systems correlated to fetal outcome in order to reduce fetal morbidity and mortality as well as the overall burden of disease of B19V with regard to fetal malformation may be subject to future research.
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Affiliation(s)
- Jörg Dembinski
- Clinic of Pediatrics, Klinikum Itzehoe, Academic Teaching Hospital of Universitätsklinikum Hamburg Eppendorf UKE / Universitätsklinikum Schleswig-Holstein UKSH +49 0 4821 772 2201 ; +49 0 4821 772 2209 ;
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Toledo M, Ventrucci G, Gomes-Marcondes M. Increased oxidative stress in the placenta tissue and cell culture of tumour-bearing pregnant rats. Placenta 2011; 32:859-64. [DOI: 10.1016/j.placenta.2011.08.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2011] [Revised: 08/17/2011] [Accepted: 08/18/2011] [Indexed: 10/17/2022]
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17
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Lamont RF, Sobel J, Vaisbuch E, Kusanovic JP, Mazaki-Tovi S, Kim SK, Uldbjerg N, Romero R. Parvovirus B19 infection in human pregnancy. BJOG 2011; 118:175-86. [PMID: 21040396 PMCID: PMC3059196 DOI: 10.1111/j.1471-0528.2010.02749.x] [Citation(s) in RCA: 92] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Human parvovirus B19 infection is widespread. Approximately 30-50% of pregnant women are nonimmune, and vertical transmission is common following maternal infection in pregnancy. Fetal infection may be associated with a normal outcome, but fetal death may also occur without ultrasound evidence of infectious sequelae. B19 infection should be considered in any case of nonimmune hydrops. Diagnosis is mainly through serology and polymerase chain reaction. Surveillance requires sequential ultrasound and Doppler screening for signs of fetal anaemia, heart failure and hydrops. Immunoglobulins, antiviral and vaccination are not yet available, but intrauterine transfusion in selected cases can be life saving.
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Affiliation(s)
- Ronald F. Lamont
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, Maryland and Detroit, Michigan, USA
- Wayne State University School of Medicine, Department of Obstetrics and Gynecology, Detroit, Michigan, USA
| | - Jack Sobel
- Wayne State University School of Medicine, Department of Infectious Diseases, Detroit, Michigan, USA
| | - Edi Vaisbuch
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, Maryland and Detroit, Michigan, USA
- Wayne State University School of Medicine, Department of Obstetrics and Gynecology, Detroit, Michigan, USA
| | - Juan Pedro Kusanovic
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, Maryland and Detroit, Michigan, USA
- Wayne State University School of Medicine, Department of Obstetrics and Gynecology, Detroit, Michigan, USA
| | - Shali Mazaki-Tovi
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, Maryland and Detroit, Michigan, USA
- Wayne State University School of Medicine, Department of Obstetrics and Gynecology, Detroit, Michigan, USA
| | - Sun Kwon Kim
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, Maryland and Detroit, Michigan, USA
| | - Niels Uldbjerg
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, Maryland and Detroit, Michigan, USA
| | - Roberto Romero
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, Maryland and Detroit, Michigan, USA
- Wayne State University School of Medicine, Department of Obstetrics and Gynecology, Detroit, Michigan, USA
- Center for Molecular Medicine and Genetics, Wayne State University, Detroit, Michigan, USA
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Abstract
Human parvovirus B19 (B19) is common in society. Among adults, more than 50% have contracted the infection and immunity is believed to last lifelong. Infection occurs in a few percent of pregnancies, and albeit rare it can then cause fetal anemia, non-immune fetal hydrops and fetal death. Among cases with fetal demise, B19 is found in significant numbers, especially in the second and third trimesters of pregnancy. There is no specific treatment or prophylaxis available against B19 infection, but counseling of non-immune mothers and active monitoring of confirmed maternal infections with intervention to correct fetal anemia is likely to decrease mortality. Passive immunization also has potential to resolve fetal complications, but needs further study.
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Affiliation(s)
- Thomas Tolfvenstam
- Department of Medicine, Solna, Unit of Infectious Diseases, Center for Molecular Medicine, Karolinska Institutet, Karolinska University Hospital, B2:00, SE-17176 Stockholm, Sweden.
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19
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Herse F, Verlohren S, Wenzel K, Pape J, Muller DN, Modrow S, Wallukat G, Luft FC, Redman CW, Dechend R. Prevalence of Agonistic Autoantibodies Against the Angiotensin II Type 1 Receptor and Soluble fms-Like Tyrosine Kinase 1 in a Gestational Age–Matched Case Study. Hypertension 2009; 53:393-8. [DOI: 10.1161/hypertensionaha.108.124115] [Citation(s) in RCA: 79] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
We showed earlier that activating autoantibodies against the angiotensin II type 1 (AT
1
) receptor (AT1-AA) circulate in preeclamptic women. They may be involved in the pathogenesis of preeclampsia. Protein alignment suggests that the binding site for AT1-AAs is highly homologous to the capsid protein VP2 of parvovirus B19. We performed a prospective, nested, case-control study of 30 gestational age–matched women with preeclampsia and 30 normotensive pregnant women. We measured AT1-AA, soluble fms-like tyrosine kinase 1 (sFlt-1), and serum immunoglobulin G against parvovirus B19 proteins. AT1-AAs were present in 70% of preeclamptic patients and absent in 80% of controls. Prediction by AT1-AA was improved in late-onset preeclampsia. The discrimination for sFlt-1 was 96%. We did not find an interaction between sFlt-1 and AT1-AA. A human monoclonal immunoglobulin G antibody against parvovirus B19 VP2-protein showed a positive reaction in the AT1-AA bioassay, which could be blocked by an AT
1
receptor blocker, as well as by the epitope amino acid sequence. Immunoglobulin G against parvovirus B19 proteins was similarly distributed between preeclamptic patients and controls and had no significant importance. We detected significantly more AT1-AA in women with an immune response corresponding with parvovirus B19 infection corresponding with a distant viral infection associated with virus elimination. We concluded that AT1-AAs were common in patients with preeclampsia in a prospective case-control study, although sFlt-1 was a superior biomarker. AT1-AA may represent a better marker for late disease, whereas sFlt1 is a better marker for early onset disease.
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Affiliation(s)
- Florian Herse
- From the Medical Faculty of the Charité (F.H., S.V., K.W., D.N.M., G.W., F.C.L., R.D.), Franz-Volhard Clinic, HELIOS Klinikum Berlin-Buch and Experimental and Clinical Research Center, Berlin, Germany; Department of Obstetrics (S.V., J.P.), Charité Campus Virchow-Clinic, Charité University Medicine, Berlin, Germany; Institute for Medical Microbiology and Hygiene (S.M.), University of Regensburg, Regensburg, Germany; and the Nuffield Department of Obstetrics and Gynaecology (C.W.G.R.), Oxford
| | - Stefan Verlohren
- From the Medical Faculty of the Charité (F.H., S.V., K.W., D.N.M., G.W., F.C.L., R.D.), Franz-Volhard Clinic, HELIOS Klinikum Berlin-Buch and Experimental and Clinical Research Center, Berlin, Germany; Department of Obstetrics (S.V., J.P.), Charité Campus Virchow-Clinic, Charité University Medicine, Berlin, Germany; Institute for Medical Microbiology and Hygiene (S.M.), University of Regensburg, Regensburg, Germany; and the Nuffield Department of Obstetrics and Gynaecology (C.W.G.R.), Oxford
| | - Katrin Wenzel
- From the Medical Faculty of the Charité (F.H., S.V., K.W., D.N.M., G.W., F.C.L., R.D.), Franz-Volhard Clinic, HELIOS Klinikum Berlin-Buch and Experimental and Clinical Research Center, Berlin, Germany; Department of Obstetrics (S.V., J.P.), Charité Campus Virchow-Clinic, Charité University Medicine, Berlin, Germany; Institute for Medical Microbiology and Hygiene (S.M.), University of Regensburg, Regensburg, Germany; and the Nuffield Department of Obstetrics and Gynaecology (C.W.G.R.), Oxford
| | - Juliane Pape
- From the Medical Faculty of the Charité (F.H., S.V., K.W., D.N.M., G.W., F.C.L., R.D.), Franz-Volhard Clinic, HELIOS Klinikum Berlin-Buch and Experimental and Clinical Research Center, Berlin, Germany; Department of Obstetrics (S.V., J.P.), Charité Campus Virchow-Clinic, Charité University Medicine, Berlin, Germany; Institute for Medical Microbiology and Hygiene (S.M.), University of Regensburg, Regensburg, Germany; and the Nuffield Department of Obstetrics and Gynaecology (C.W.G.R.), Oxford
| | - Dominik N. Muller
- From the Medical Faculty of the Charité (F.H., S.V., K.W., D.N.M., G.W., F.C.L., R.D.), Franz-Volhard Clinic, HELIOS Klinikum Berlin-Buch and Experimental and Clinical Research Center, Berlin, Germany; Department of Obstetrics (S.V., J.P.), Charité Campus Virchow-Clinic, Charité University Medicine, Berlin, Germany; Institute for Medical Microbiology and Hygiene (S.M.), University of Regensburg, Regensburg, Germany; and the Nuffield Department of Obstetrics and Gynaecology (C.W.G.R.), Oxford
| | - Susanne Modrow
- From the Medical Faculty of the Charité (F.H., S.V., K.W., D.N.M., G.W., F.C.L., R.D.), Franz-Volhard Clinic, HELIOS Klinikum Berlin-Buch and Experimental and Clinical Research Center, Berlin, Germany; Department of Obstetrics (S.V., J.P.), Charité Campus Virchow-Clinic, Charité University Medicine, Berlin, Germany; Institute for Medical Microbiology and Hygiene (S.M.), University of Regensburg, Regensburg, Germany; and the Nuffield Department of Obstetrics and Gynaecology (C.W.G.R.), Oxford
| | - Gerd Wallukat
- From the Medical Faculty of the Charité (F.H., S.V., K.W., D.N.M., G.W., F.C.L., R.D.), Franz-Volhard Clinic, HELIOS Klinikum Berlin-Buch and Experimental and Clinical Research Center, Berlin, Germany; Department of Obstetrics (S.V., J.P.), Charité Campus Virchow-Clinic, Charité University Medicine, Berlin, Germany; Institute for Medical Microbiology and Hygiene (S.M.), University of Regensburg, Regensburg, Germany; and the Nuffield Department of Obstetrics and Gynaecology (C.W.G.R.), Oxford
| | - Friedrich C. Luft
- From the Medical Faculty of the Charité (F.H., S.V., K.W., D.N.M., G.W., F.C.L., R.D.), Franz-Volhard Clinic, HELIOS Klinikum Berlin-Buch and Experimental and Clinical Research Center, Berlin, Germany; Department of Obstetrics (S.V., J.P.), Charité Campus Virchow-Clinic, Charité University Medicine, Berlin, Germany; Institute for Medical Microbiology and Hygiene (S.M.), University of Regensburg, Regensburg, Germany; and the Nuffield Department of Obstetrics and Gynaecology (C.W.G.R.), Oxford
| | - Christopher W.G. Redman
- From the Medical Faculty of the Charité (F.H., S.V., K.W., D.N.M., G.W., F.C.L., R.D.), Franz-Volhard Clinic, HELIOS Klinikum Berlin-Buch and Experimental and Clinical Research Center, Berlin, Germany; Department of Obstetrics (S.V., J.P.), Charité Campus Virchow-Clinic, Charité University Medicine, Berlin, Germany; Institute for Medical Microbiology and Hygiene (S.M.), University of Regensburg, Regensburg, Germany; and the Nuffield Department of Obstetrics and Gynaecology (C.W.G.R.), Oxford
| | - Ralf Dechend
- From the Medical Faculty of the Charité (F.H., S.V., K.W., D.N.M., G.W., F.C.L., R.D.), Franz-Volhard Clinic, HELIOS Klinikum Berlin-Buch and Experimental and Clinical Research Center, Berlin, Germany; Department of Obstetrics (S.V., J.P.), Charité Campus Virchow-Clinic, Charité University Medicine, Berlin, Germany; Institute for Medical Microbiology and Hygiene (S.M.), University of Regensburg, Regensburg, Germany; and the Nuffield Department of Obstetrics and Gynaecology (C.W.G.R.), Oxford
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Placental endothelial cells can be productively infected by Parvovirus B19. J Clin Virol 2009; 44:33-8. [DOI: 10.1016/j.jcv.2008.10.008] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2008] [Revised: 09/18/2008] [Accepted: 10/16/2008] [Indexed: 01/13/2023]
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Abstract
The placenta, as the vector for all maternal-fetal oxygen and nutrient exchange, is a principal influence on birthweight. Placental weight summarizes laterally expanding growth of the chorionic disc, and villous arborization yielding the nutrient exchange surface. These different growth dimensions alter fetoplacental weight ratio and ponderal index, and thus may modify placental functional efficiency. The placenta may show a range of histopathologies, some of which are also associated with fetal growth restriction. Different fetal intrinsic abilities to compensate for gross and histo-pathology may clarify the imperfect relationships between fetal growth and both intrauterine pathology, and the long-term health risks associated with poor fetal growth.
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Affiliation(s)
- Carolyn M Salafia
- Department of Epidemiology, Mailman School of Public Health, Columbia University College of Physicians and Surgeons, New York, New York 10032, USA.
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22
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Bai H, Zhang L, Ma L, Dou XG, Feng GH, Zhao GZ. Relationship of hepatitis B virus infection of placental barrier and hepatitis B virus intra-uterine transmission mechanism. World J Gastroenterol 2007; 13:3625-30. [PMID: 17659715 PMCID: PMC4146804 DOI: 10.3748/wjg.v13.i26.3625] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To explore the mechanism of intra-uterine transmission, the HBV infection status of placental tissue and in vitro cultured placental trophoblastic cells was tested through in vivo and in vitro experiments.
METHODS: A variety of methods, such as ELISA, RT-PCR, IHC staining and immunofluorescent staining were employed to test the HBV marker positive pregnant women's placenta and in vitro cultured placental trophoblastic cells.
RESULTS: The HBV DNA levels in pregnant women's serum and fetal cord blood were correlated. For those cord blood samples positive for HBV DNA, their maternal blood levels of HBV DNA were at a high level. The HBsAg IHC staining positive cells could be seen in the placental tissues and the presence of HBV DNA detected. After co-incubating the trophoblastic cells and HBV DNA positive serum in vitro, the expressions of both HBsAg and HBV DNA could be detected.
CONCLUSION: The mechanism of HBV intra-uterine infection may be due to that HBV breaches the placental barrier and infects the fetus.
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Affiliation(s)
- Han Bai
- Department of Infectious Diseases, Shengjing Hospital Affiliated to CMU, Shenyang 110004, Liaoning Province, China
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Bai H, Zhang L, He LX, Feng GH, Shi LL, Dou XG, Zhao GZ. Relationship between the infection and apoptosis of placental trophoblastic cells and the mechanism of hepatitis B virus intrauterine transmission. Shijie Huaren Xiaohua Zazhi 2007; 15:1695-1700. [DOI: 10.11569/wcjd.v15.i15.1695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To study the mechanism of hepatitis B virus (HBV) intrauterine transmission by infecting the cultured human trophoblastic cells in vitro.
METHODS: Primary cultured trophoblastic cells from human first-trimester placenta and serial subcultivation of JEG-3 cell line were investigated. The primary cultured and subcultured cells were cultured in the HBV-infected serum for 8 to 48 h. The appearance of the cells and intercellular conjunctions were observed under inverted microscope. The protein expression of HBsAg and HBcAg were detected by cell immunofluorescence and immunohistochemical staining. HBV DNA of the infected trophoblastic cells was detected by fluorescent quantitative polymerase chain reaction (FQ-PCR). Cell apoptosis was tested by TUNEL technique.
RESULTS: The appearance of the cells and intercellular conjunction were not obviously affected after co-culturing with HBV-positive serum. Cell immunofluorescence and immunohistochemistry showed that HBsAg and HBcAg can be detected in the trophoblastic cells after co-culturing with HBV-infected serum for 8, 24 and 48 h, and HBsAg-positive cells were at the most level after 24-h culturing (8 h: 18.0% ± 3.67%; 24 h: 30.6% ± 2.88%; 48 h: 24.8% ± 4.21%). FQ-PCR demonstrated the existence of HBV DNA in the infected cells. TUNEL exhibited that the co-culturing resulted in an increase of cell apoptosis (24 h: 18.6 % ± 3.05%; 48 h: 26.8% ± 2.86%; P < 0.01).
CONCLUSION: The infection of trophoblastic cells may be one of the routes for HBV passing through the placental membrane. HBV infection may induce the apoptosis of trophoblastic cells, which may be a protective mechanism for placental membrane to block up the vertical transmission of HBV.
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Abstract
Parvovirus B19 is a significant human pathogen that causes a wide spectrum of clinical complications ranging from mild, self-limiting erythema infectiosum in immunocompetent children to lethal cytopenias in immunocompromised patients and intrauterine foetal death in primary infected pregnant women. The infection may also be persistent and can mimic or trigger autoimmune inflammatory disorders. Another important clinical aspect to consider is the risk of infection through B19-contaminated blood products. Recent advances in diagnosis and pathogenesis, new insights in the cellular immune response and newly discovered genotypes of human parvoviruses form a platform for the development of modern therapeutic and prophylactic alternatives.
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Affiliation(s)
- K Broliden
- Department of Medicine, Solna, Unit of Infectious Diseases, Center for Molecular Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
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Toledo MT, Ventrucci G, Marcondes MCCG. Cancer during pregnancy alters the activity of rat placenta and enhances the expression of cleaved PARP, cytochrome-c and caspase 3. BMC Cancer 2006; 6:168. [PMID: 16800886 PMCID: PMC1534057 DOI: 10.1186/1471-2407-6-168] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2005] [Accepted: 06/26/2006] [Indexed: 02/08/2023] Open
Abstract
Background The presence of cancer makes it difficult to predict the progress of pregnancy and can be deleterious to the maternal-foetal relationship. Apoptosis may affect a range of placental functions and result in the retardation of foetal growth. In this work, we investigated the placental alterations produced by tumour growth and the effects on the expression of apoptotic factors in placental tissue. Methods Adult female Wistar rats (90 days old, n = 54) were allocated to control (C), tumour-bearing (W), or ascitic fluid-injected (A) groups and were killed on the 16th, 19th or 21st day of pregnancy. Placental tissues were analysed using biochemical and histochemical assays. Results The placental protein content and glutathione-S-transferase activity were decreased in groups W and A. Histochemical analysis showed an increase in the number of cells with cleaved PARP, caspase 3 and cytochrome-c in groups W and A, indicating that the tumour growth clearly damaged placental tissue and affected the levels of apoptotic factors. These results were confirmed by western blotting. Conclusion Since trophoblastic cells are responsible for maintaining a normal placental function, the uncontrolled death of these cells in response to tumour cell growth or substances derived from ascitic fluid could have a negative impact on foetal development. Further knowledge of these events may help to preserve the foetus and placenta during development.
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Affiliation(s)
- Mércia Tancredo Toledo
- Departamento de Fisiologia e Biofísica, Instituto de Biologia, Universidade Estadual de Campinas (UNICAMP), Campinas, CP 6109, 13083-970, SP, Brazil
| | - Gislaine Ventrucci
- Departamento de Fisiologia e Biofísica, Instituto de Biologia, Universidade Estadual de Campinas (UNICAMP), Campinas, CP 6109, 13083-970, SP, Brazil
| | - Maria Cristina Cintra Gomes Marcondes
- Departamento de Fisiologia e Biofísica, Instituto de Biologia, Universidade Estadual de Campinas (UNICAMP), Campinas, CP 6109, 13083-970, SP, Brazil
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Julander JG, Winger QA, Rickords LF, Shi PY, Tilgner M, Binduga-Gajewska I, Sidwell RW, Morrey JD. West Nile virus infection of the placenta. Virology 2006; 347:175-82. [PMID: 16406457 DOI: 10.1016/j.virol.2005.11.040] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2005] [Revised: 10/17/2005] [Accepted: 11/19/2005] [Indexed: 01/08/2023]
Abstract
Intrauterine infection of fetuses with West Nile virus (WNV) has been implicated in cases of women infected during pregnancy. Infection of timed-pregnant mice on 5.5, 7.5, and 9.5 days post-coitus (dpc) resulted in fetal infection. Infection of dams on 11.5 and 14.5 dpc resulted in little and no fetal infection, respectively. Pre-implantation embryos in culture were also infected with WNV after the blastocyst stage and the formation of trophectoderm. Green fluorescent protein (GFP) expression was observed in a trophoblast stem (TS) cell line after infection with a GFP-expressing WNV construct. However, no fluorescence was observed in differentiated trophoblast giant cell (TGC) cultures. GFP fluorescence was present in TGC cultures if infected TS cells were induced to differentiate. These results suggest that embryos are susceptible to WNV infection after the formation of the trophectoderm around 3.5 dpc through the formation of the functional placenta around 10.5 dpc.
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Affiliation(s)
- Justin G Julander
- The Institute for Antiviral Research, Utah State University, Logan, UT 84322, USA
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Wegner CC, Jordan JA. Human parvovirus B19 VP2 empty capsids bind to human villous trophoblast cells in vitro via the globoside receptor. Infect Dis Obstet Gynecol 2005; 12:69-78. [PMID: 15739820 PMCID: PMC1784598 DOI: 10.1080/10647440400009912] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND: Pregnant women acutely infected with human parvovirus B19 (B19) may transmit the virus to the developing fetus. The mechanism whereby the virus interacts with the placenta is unknown. It is known that globoside receptor is required for successful infection of the target cells, which are the highly undifferentiated, actively dividing colony and burst-form units of the erythroid series. Globoside is present on trophoblast cells which have intimate contact with maternal blood, and may therefore serve as a potential route for B19 transmission into the fetal compartment. OBJECTIVES: The purpose of this study was to determine whether B19 VP2 capsids could bind to villous trophoblast cells in vitro and whether globoside was involved. METHODS: Binding of B19 VP2 empty capsid to first-trimester villous trophoblast cells was assessed by multiple approaches, including ICC using either biotinylated B19 VP2 empty capsid or unlabeled B19 VP2 empty capsid. Quantification of viral binding involved I125-labeled B19 VP2 empty capsid. Competition studies included excess unlabeled empty capsids or pretreatment with globoside-specific IgM antibody. RESULTS: Linear binding of B19 VP2 capsid to purified villous trophoblast cells in vitro was clearly demonstrated (R2= 0.9524). Competition studies revealed specificity of I125-labeled B19 VP2 capsid binding to villous trophoblast cells when pretreatment with either 60-fold excess unlabeled B19 capsid or globoside-specific IgM antibody took place. The results illustrated B19's ability to bind in a specific manner to globoside-containing villous trophoblast cells. CONCLUSION: We speculate that the globoside present on trophoblast cells may play a role in viral binding in vivo, which may facilitate B19 transmission across the maternal-fetal interface.
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Affiliation(s)
- Carole C Wegner
- University of Pittsburgh, Department of Pathology, Pittsburgh, PA, USA
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Roth GA, Krenn C, Brunner M, Moser B, Ploder M, Spittler A, Pelinka L, Sautner T, Wolner E, Boltz-Nitulescu G, Ankersmit HJ. Elevated serum levels of epithelial cell apoptosis-specific cytokeratin 18 neoepitope m30 in critically ill patients. Shock 2005; 22:218-20. [PMID: 15316390 DOI: 10.1097/01.shk.0000136098.49672.0e] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Apoptosis of the epithelium is deemed to play a pivotal role in the pathogenesis of sepsis. A neoepitope in cytokeratin 18 (CK18), termed M30 neoantigen, becomes available at an early caspase cleavage event during apoptosis of epithelium-derived cells and is not detectable in vital or necrotic epithelial cells. A monoclonal antibody, M30, specifically recognizes a fragment of CK18 cleaved at Asp396 (M30 neoantigen). We used an enzyme-linked immunosorbent assay (ELISA) to measure M30 antigen levels in the sera of 15 septic patients. Healthy humans and critical ill patients suffering from severe trauma served as controls. Mann-Whitney U test was used to calculate significance, and a P value of <0.01 was considered to be statistically significant. Serum levels of the CK18 neoepitope M30 were significantly increased in septic patients (236.88 +/- 47.4 U/L) versus trauma (97.2 +/- 17.1 U/L) and healthy controls (66.9 +/- 9.2 U/L) (P < 0.01 and P < 0.008, respectively). The increased serum level of the CK18 neoepitope in septic patients indicates a heightened apoptotic turnover in epithelial cells as compared with trauma patients and healthy controls. Interestingly, nonsurviving trauma patients exhibited a significant increase in the M30 neoantigen as compared with survivors and healthy controls (P < 0.003 and P < 0.002, respectively). The detection of CK18 neoepitope M30 in the serum might be a useful marker in tracing apoptotic epithelium in septic patients.
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von Rango U, Krusche CA, Kertschanska S, Alfer J, Kaufmann P, Beier HM. Apoptosis of extravillous trophoblast cells limits the trophoblast invasion in uterine but not in tubal pregnancy during first trimester. Placenta 2004; 24:929-40. [PMID: 14580375 DOI: 10.1016/s0143-4004(03)00168-1] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
During the first trimester of pregnancy extravillous trophoblast cells (EVT) invade the maternal decidua. Invasion normally is reduced from the second trimester onwards and stops in the inner third of the myometrium. By contrast, in extrauterine tubal pregnancy, trophoblast invasion may even penetrate the tubal wall, which ultimately leads to the rupture of the fallopian tube. Induction of apoptosis of EVT cells, by maternal immune competent cells, may be an important mechanism to limit EVT invasion in uterine pregnancy. Tissue specimens from first and second trimester uterine pregnancy and first trimester tubal pregnancy were analyzed for apoptosis by TUNEL- and M30-staining. By immunohistochemical double labelling, maternal leukocyte subtypes were co-localized to apoptotic cells and in this context, the number of CD56(+)NK cells was analyzed. Our data show that apoptosis is confined to the decidua basalis. Most apoptotic cells are single cytokeratin-positive epithelial cells residing in the stromal compartment. Consequently these cells can only be EVT cells. Maternal leukocytes are not apoptotic. They are located in close contact to apoptotic cells. The number of apoptotic cells in the second trimester (1.8+/-0.7 per cent) is reduced compared to first trimester (5.6+/-0.7 per cent) of uterine pregnancy. In parallel, the number of NK cells declines from first (24.4+/-2.9) to second (12.4+/-1.8) trimester. Furthermore, apoptosis is significantly reduced in ectopic (0.9+/-0.3 per cent) compared to eutopic first trimester pregnancies. Consequently, we suggest that in first trimester uterine pregnancy, induction of EVT cell apoptosis by the maternal immune system is one mechanism to limit EVT invasion. During the second trimester, in parallel to declining numbers of NK cells, the mechanism changes. However, in tubal pregnancy due to differing immunological microenvironments at the ectopic implantation site, apoptosis induction fails, which deleteriously may result in uncontrolled invasion and penetration of the tubal wall.
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Affiliation(s)
- U von Rango
- Department of Anatomy and Reproductive Biology, RWTH University of Aachen, Wendlingweg 2, D-52057 Aachen, Germany.
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