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Costa E, Thrasivoulou C, Becker DL, Deprest JA, David AL, Chowdhury TT. Cx43 regulates mechanotransduction mechanisms in human preterm amniotic membrane defects. Prenat Diagn 2023; 43:1284-1295. [PMID: 37649228 DOI: 10.1002/pd.6429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 08/12/2023] [Accepted: 08/14/2023] [Indexed: 09/01/2023]
Abstract
OBJECTIVE The effects of mechanical stimulation in preterm amniotic membrane (AM) defects were explored. METHODS Preterm AM was collected from women undergoing planned preterm caesarean section (CS) due to fetal growth restriction or emergency CS after spontaneous preterm prelabour rupture of the membranes (sPPROM). AM explants near the cervix or placenta were subjected to trauma and/or mechanical stimulation with the Cx43 antisense. Markers for nuclear morphology (DAPI), myofibroblasts (αSMA), migration (Cx43), inflammation (PGE2 ) and repair (collagen, elastin and transforming growth factor β [TGFβ1 ]) were examined by confocal microscopy, second harmonic generation, qPCR and biochemical assays. RESULTS In preterm AM defects, myofibroblast nuclei were highly deformed and contractile and expressed αSMA and Cx43. Mechanical stimulation increased collagen fibre polarisation and the effects on matrix markers were dependent on tissue region, disease state, gestational age and the number of fetuses. PGE2 levels were broadly similar but reduced after co-treatment with Cx43 antisense in late sPPROM AM defects. TGFβ1 and Cx43 gene expression were significantly increased after trauma and mechanical stimulation but this response dependent on gestational age. CONCLUSION Mechanical stimulation affects Cx43 signalling and cell/collagen mechanics in preterm AM defects. Establishing how Cx43 regulates mechanosignalling could be an approach to repair tissue integrity after trauma.
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Affiliation(s)
- Eleni Costa
- Centre for Bioengineering, School of Engineering and Materials Science, Queen Mary University of London, London, UK
| | | | - David L Becker
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Jan A Deprest
- Department of Obstetrics and Gynaecology, University Hospitals Leuven, Leuven, Belgium
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, Medical School Building, London, UK
| | - Anna L David
- Department of Obstetrics and Gynaecology, University Hospitals Leuven, Leuven, Belgium
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, Medical School Building, London, UK
| | - Tina T Chowdhury
- Centre for Bioengineering, School of Engineering and Materials Science, Queen Mary University of London, London, UK
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Mu Y, Hu A, Kan H, Li Y, He Y, Fan W, Liu H, Li Q, Zheng Y. Preterm Prelabor Rupture of Membranes Linked to Vaginal Bacteriome of Pregnant Females in the Early Second Trimester: a Case-Cohort Design. Reprod Sci 2023; 30:2324-2335. [PMID: 36725814 PMCID: PMC9891760 DOI: 10.1007/s43032-022-01153-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 12/13/2022] [Indexed: 02/03/2023]
Abstract
Preterm prelabor rupture of membranes (PPROM) is a major cause of spontaneous preterm birth (sPTB), one of the greatest challenges facing obstetrics with complicated pathogenesis. This case-cohort study investigated the association between vaginal bacteriome of singleton pregnant females in the early second trimester and PPROM. The study included 35,255 and 180 pregnant females with PPROM as cases and term-birth without prelabor rupture of membranes (TWPROM) and term prelabor rupture of membranes (TPROM) pregnant females as controls, respectively. Using 16S rRNA sequencing, the vaginal microbiome traits were analyzed. Females with PPROM had higher alpha and beta diversity (P < 0.05) than TWPROM and TPROM. The presence of L. mulieris was associated with a decreased risk of PPROM (adjusted odds ratio [aOR] = 0.35; 95% confidence interval [CI]: 0.17-0.72) compared with TWPROM. Meanwhile, the presence of Megasphaera genus (aOR = 2.27; 95% CI: 1.09-4.70), Faecalibacterium genus (aOR = 3.29; 95% CI: 1.52-7.13), Bifidobacterium genus (aOR = 3.26; 95% CI: 1.47-7.24), Xanthomonadales genus (aOR = 2.76; 95% CI: 1.27-6.01), Gammaproteobacteria class (aOR = 2.36; 95% CI: 1.09-5.14), and Alphaproteobacteria class (aOR = 2.45; 95% CI: 1.14-5.26) was associated with an increased risk of PPROM compared with TWPROM. Our results indicated that the risk of PPROM can decrease with vaginal L. mulieris but increase with high alpha or beta diversity, and several vaginal bacteria in pregnant females may be involved in the occurrence of PPROM.
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Affiliation(s)
- Yutong Mu
- Key Laboratory for Health Technology Assessment, National Commission of Health and Family Planning, Fudan University, Shanghai, 200032, China
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai, 200032, China
| | - Anqun Hu
- Department of Clinical Laboratory, Anqing Municipal Hospital, Anqing, 246003, China
| | - Hui Kan
- Key Laboratory for Health Technology Assessment, National Commission of Health and Family Planning, Fudan University, Shanghai, 200032, China
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai, 200032, China
| | - Yijie Li
- Key Laboratory for Health Technology Assessment, National Commission of Health and Family Planning, Fudan University, Shanghai, 200032, China
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai, 200032, China
| | - Yining He
- Key Laboratory for Health Technology Assessment, National Commission of Health and Family Planning, Fudan University, Shanghai, 200032, China
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai, 200032, China
- Biostatistics Office, Clinical Research Unit, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200011, China
| | - Wei Fan
- Key Laboratory for Health Technology Assessment, National Commission of Health and Family Planning, Fudan University, Shanghai, 200032, China
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai, 200032, China
| | - Haiyan Liu
- Biostatistics Office, Clinical Research Unit, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200011, China.
- Department of Blood Transfusion, Anqing Municipal Hospital, Anqing, 246003, China.
| | - Qing Li
- Department of Obstetrics and Gynecology, Anqing Municipal Hospital, Anqing, 246003, China.
| | - Yingjie Zheng
- Key Laboratory for Health Technology Assessment, National Commission of Health and Family Planning, Fudan University, Shanghai, 200032, China.
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai, 200032, China.
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Wells HC, Sizeland KH, Kirby N, Haverkamp RG. Structure and Strength of Bovine and Equine Amniotic Membrane. BIOLOGY 2022; 11:biology11081096. [PMID: 35892952 PMCID: PMC9329871 DOI: 10.3390/biology11081096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 07/20/2022] [Accepted: 07/21/2022] [Indexed: 11/16/2022]
Abstract
Simple Summary Thin, strong scaffold materials are needed for surgical applications. There is a limited selection of available materials and new materials are required. Amnionic membrane from cattle and horses were investigated for this purpose. The structure of these materials was characterized with synchrotron techniques and the strength was measured. A possible relationship between the structure and strength was identified. These amnion materials from animal sources are strong, thin, and elastic materials, although weaker than some other collagen tissues. They may be suitable for use in surgery as an alternative to material from human donors. Abstract Thin, strong scaffold materials are needed for surgical applications. New materials are required, particularly those readily available, such as from non-human sources. Bovine amniotic membrane (antepartum) and equine amniotic membrane (postpartum) were characterized with tear and tensile tests. The structural arrangement of the collagen fibrils was determined by small-angle X-ray scattering, scanning electron microscopy, and ultrasonic imaging. Bovine amnion had a thickness-normalized tear strength of 12.6 (3.8) N/mm, while equine amnion was 14.8 (5.3) N/mm. SAXS analysis of the collagen fibril arrangement yielded an orientation index of 0.587 (0.06) and 0.681 (0.05) for bovine and equine, respectively. This may indicate a relationship between more highly aligned collagen fibrils and greater strength, as seen in other materials. Amnion from bovine or equine sources are strong, thin, elastic materials, although weaker than other collagen tissue materials commonly used, that may find application in surgery as an alternative to material from human donors.
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Affiliation(s)
- Hannah C. Wells
- School of Food and Advanced Technology, Massey University, Palmerston North 4442, New Zealand;
| | - Katie H. Sizeland
- ANSTO, Lucas Heights, NSW 2234, Australia;
- ANSTO, Clayton, VIC 3168, Australia;
| | | | - Richard G. Haverkamp
- School of Food and Advanced Technology, Massey University, Palmerston North 4442, New Zealand;
- Correspondence:
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Dadkhah A, Hashemi A. Does preconditioning lower the rupture resistance of chorioamniotic membrane? ACTA ACUST UNITED AC 2021; 65:643-652. [PMID: 32432560 DOI: 10.1515/bmt-2019-0337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Accepted: 02/04/2020] [Indexed: 11/15/2022]
Abstract
Premature rupture of fetal membrane occurs in about 3% of all pregnancies. The physical integrity of chorioamnion (CA) membrane should be retained until delivery for a healthy pregnancy. To explore the effect of pre-conditioning and probe size on the mechanical properties of human chorioamniotic sac, the mechanical properties of 17 human chorioamniotic membranes, collected from cesarean delivery, were examined using biaxial puncture tests with and without preconditioning by different probe sizes. For preconditioned samples, the mean ± std. of ultimate rupture stress was calculated to be 1.73 ± 0.13, 1.61 ± 0.29 and 1.78 ± 0.26 MPa for the probe sizes of 3, 5 and 7 mm, respectively. For samples with no preconditioning, these values were calculated to be 2.38 ± 0.29, 2.36 ± 0.37, and 2.59 ± 0.43 MPa for the above-mentioned probe sizes. The force to probe diameter for samples with no preconditioning was in the range of 1087-1301 N/m for the three probe diameters, well in the range of 850-1580 N/m reported by previous studies. Our results show that the preconditioned samples had significantly lower ultimate puncture force and ultimate stress compared to non-preconditioned samples. In addition, a correlation between the probe size and the magnitude of puncture force was observed, while the stress values were not significantly affected by changing probe size.
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Affiliation(s)
- Arash Dadkhah
- Department of Biomedical Engineering, Florida International University, Miami, FL 33174, USA
| | - Ata Hashemi
- Biomechanics Group, Department of Biomedical Engineering, Amirkabir University of Technology, Tehran, Iran
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Kumar D, Moore RM, Mercer BM, Mansour JM, Moore JJ. Mechanism of Human Fetal Membrane Biomechanical Weakening, Rupture and Potential Targets for Therapeutic Intervention. Obstet Gynecol Clin North Am 2021; 47:523-544. [PMID: 33121643 DOI: 10.1016/j.ogc.2020.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Using a novel in vitro model system combining biochemical/histologic with bioengineering approaches has provided significant insights into the physiology of fetal membrane weakening and rupture along with potential mechanistic reasons for lack of efficacy of currently clinically used agents to prevent preterm premature rupture of the membranes (pPROM) and preterm births. Likewise, the model has also facilitated screening of agents with potential for preventing pPROM and preterm birth.
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Affiliation(s)
- Deepak Kumar
- Department of Pediatrics, MetroHealth Medical Center, Case Western Reserve University, 2500 MetroHealth Drive, Cleveland, OH 44109, USA.
| | - Robert M Moore
- Department of Pediatrics, MetroHealth Medical Center, Case Western Reserve University, 2500 MetroHealth Drive, Cleveland, OH 44109, USA
| | - Brian M Mercer
- Department of Reproductive Biology, MetroHealth Medical Center, Case Western Reserve University, 2500 MetroHealth Drive, Cleveland, OH 44109, USA
| | - Joseph M Mansour
- Mechanical and Aerospace Engineering, Case Western Reserve University, Glennan 617, Cleveland, OH 44106, USA
| | - John J Moore
- Department of Pediatrics, MetroHealth Medical Center, Case Western Reserve University, 2500 MetroHealth Drive, Cleveland, OH 44109, USA; Department of Reproductive Biology, MetroHealth Medical Center, Case Western Reserve University, 2500 MetroHealth Drive, Cleveland, OH 44109, USA
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6
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Zhang T, Zhang Y, Yang J, Wen P, Li H, Wei N, Gao Y, Li B, Huo Y. Dynamic measurement of amnion thickness during loading by speckle pattern interferometry. Placenta 2021; 104:284-294. [PMID: 33486132 DOI: 10.1016/j.placenta.2021.01.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 11/27/2020] [Accepted: 01/04/2021] [Indexed: 11/16/2022]
Abstract
INTRODUCTION In previous studies on the mechanical parameters of amnions (AM), there is a limitation due to the lack of an accurate thickness measurement, which is an important parameter for determining AM-specific mechanical properties. As a bottleneck, the characterization of the basic mechanical properties of AM are greatly restricted, even with the proposal of fracture criteria. METHOD First, the initial thickness of the AM is estimated by the interpolated-volume-area method. Second, through combinations of our self-developed mini-biaxial tensile device with speckle pattern interferometry, this is the first time that researchers can accurately obtain the AM thickness at each transient moment in the process of loading. RESULTS Based on the experimental results, an accurate stress-strain curve could be obtained. Two important mechanical parameters-the fracture energy density and amnion rupture modulus-could be extracted as 0.184±0.036MPa and 108.57±17.32MPa, respectively. The fracture energy density and amnion rupture modulus provide objective criteria and a scientific basis for the evaluation of AM rupture. DISCUSSION The tensile stress-strain curve of a normal human amnion shows a distinct J-shape. This proves that the experimental results are basically reliable. Both important parameters --the fracture energy density and amnion rupture modulus, can be calculated from the stress-strain curve. Extracting these two parameters is critical for the evaluation and prediction of ROM, PROM and PPROM.
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Affiliation(s)
- Tong Zhang
- Institute of Solid Mechanics, School of Aeronautics Sciences and Engineering, Beihang University, Beijing, 100083, China.
| | - Yan Zhang
- Obstetrics and Gynecology Department, Peking University Third Hospital, Beijing, 100191, China.
| | - Jianhong Yang
- School of Mechanical Engineering, University of Science and Technology Beijing, Beijing 100083, China; Institute of Artificial Intelligence, University of Science and Technology Beijing, Beijing 100083, China.
| | - Pinjing Wen
- Institute of Semiconductor Manufacturing Research, Shenzhen University, Shenzhen, 518060, Guangdong, China; College of Physics and Optoelectronic Engineering, Shenzhen University, Shenzhen, 518060, Guangdong, China.
| | - Han Li
- Institute of Solid Mechanics, School of Aeronautics Sciences and Engineering, Beihang University, Beijing, 100083, China
| | - Ning Wei
- School of Mechanical Engineering, University of Science and Technology Beijing, Beijing 100083, China
| | - Yufei Gao
- Obstetrics and Gynecology Department, Peking University Third Hospital, Beijing, 100191, China
| | - Boqian Li
- Institute of Solid Mechanics, School of Aeronautics Sciences and Engineering, Beihang University, Beijing, 100083, China
| | - Yucheng Huo
- Institute of Solid Mechanics, School of Aeronautics Sciences and Engineering, Beihang University, Beijing, 100083, China
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7
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Bryant-Greenwood GD, Kern A, Yamamoto SY, Sadowsky DW, Novy MJ. Relaxin and the Human Fetal Membranes. Reprod Sci 2016; 14:42-5. [DOI: 10.1177/1933719107310821] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Gillian D. Bryant-Greenwood
- Department of Cell and Molecular Biology, John A. Burns
School of Medicine, University of Hawaii, Honolulu, Hawaii, National Primate Center, Oregon Health Sciences University,
Beaverton, Oregon,
| | - Andras Kern
- Department of Cell and Molecular Biology, John A. Burns
School of Medicine, University of Hawaii, Honolulu, Hawaii, National Primate Center, Oregon Health Sciences University,
Beaverton, Oregon
| | - Sandra Y. Yamamoto
- Department of Cell and Molecular Biology, John A. Burns
School of Medicine, University of Hawaii, Honolulu, Hawaii, National Primate Center, Oregon Health Sciences University,
Beaverton, Oregon
| | - Drew W. Sadowsky
- Department of Cell and Molecular Biology, John A. Burns
School of Medicine, University of Hawaii, Honolulu, Hawaii, National Primate Center, Oregon Health Sciences University,
Beaverton, Oregon
| | - Miles J. Novy
- Department of Cell and Molecular Biology, John A. Burns
School of Medicine, University of Hawaii, Honolulu, Hawaii, National Primate Center, Oregon Health Sciences University,
Beaverton, Oregon
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8
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Kendal-Wright CE. Stretching, Mechanotransduction, and Proinflammatory Cytokines in the Fetal Membranes. Reprod Sci 2016; 14:35-41. [DOI: 10.1177/1933719107310763] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Claire E. Kendal-Wright
- Developmental and Reproduction Biology, John A. Burns
School of Medicine, and the Pacific Biomedical Research Center, Honolulu,
Hawaii,
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Rouzaire M, Comptour A, Belville C, Bouvier D, Clairefond G, Ponelle F, Sapin V, Gallot D, Blanchon L. All-trans retinoic acid promotes wound healing of primary amniocytes through the induction of LOXL4, a member of the lysyl oxidase family. Int J Biochem Cell Biol 2016; 81:10-19. [PMID: 27769742 DOI: 10.1016/j.biocel.2016.10.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2016] [Revised: 07/23/2016] [Accepted: 10/07/2016] [Indexed: 01/19/2023]
Abstract
Thirty percent of preterm births directly result from preterm premature rupture of fetal membranes (PPROM). Clinical management currently proposes using a collagen plug to mechanically stop loss of amniotic fluid. Vitamin A and its active metabolite (retinoic acid) have well-known pro-healing properties and could thus make good candidates as a proposable adjuvant to this mechanical approach. Here we investigate the molecular mechanisms involved in the pro-healing properties of all-trans retinoic acid (atRA) in fetal membranes via an approach using an in vitro primary amniocyte wound model and transcriptomics. The results demonstrate that atRA promotes migration in primary amniocytes, improving wound healing in vitro by up to 90%. This effect is mediated by the induction of LOXL4, which plays a crucial role in the dynamics of the extracellular matrix by regulating collagen reticulation. This new insight into how atRA exerts its pro-healing properties prompts us to propose using atRA as a candidate strategy to help prevent future PPROM.
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Affiliation(s)
- Marion Rouzaire
- Clermont Université, Auvergne University, EA7281- Retinoids, Reproduction, Developmental Diseases, Medicine School, 63000 Clermont-Ferrand, France
| | - Aurélie Comptour
- Clermont Université, Auvergne University, EA7281- Retinoids, Reproduction, Developmental Diseases, Medicine School, 63000 Clermont-Ferrand, France
| | - Corinne Belville
- Clermont Université, Auvergne University, EA7281- Retinoids, Reproduction, Developmental Diseases, Medicine School, 63000 Clermont-Ferrand, France; Clermont Université, Auvergne University, GReD, 63000 Clermont-Ferrand, France
| | - Damien Bouvier
- Clermont Université, Auvergne University, EA7281- Retinoids, Reproduction, Developmental Diseases, Medicine School, 63000 Clermont-Ferrand, France; CHU Clermont-Ferrand, Biochemistry and Molecular Biology Department, 63000 Clermont-Ferrand, France
| | - Gaël Clairefond
- Clermont Université, Auvergne University, EA7281- Retinoids, Reproduction, Developmental Diseases, Medicine School, 63000 Clermont-Ferrand, France
| | - Flora Ponelle
- Clermont Université, Auvergne University, EA7281- Retinoids, Reproduction, Developmental Diseases, Medicine School, 63000 Clermont-Ferrand, France
| | - Vincent Sapin
- Clermont Université, Auvergne University, EA7281- Retinoids, Reproduction, Developmental Diseases, Medicine School, 63000 Clermont-Ferrand, France; CHU Clermont-Ferrand, Biochemistry and Molecular Biology Department, 63000 Clermont-Ferrand, France.
| | - Denis Gallot
- Clermont Université, Auvergne University, EA7281- Retinoids, Reproduction, Developmental Diseases, Medicine School, 63000 Clermont-Ferrand, France; CHU Clermont-Ferrand, Obstetrics and Gynecology Department, 63000 Clermont-Ferrand, France
| | - Loïc Blanchon
- Clermont Université, Auvergne University, EA7281- Retinoids, Reproduction, Developmental Diseases, Medicine School, 63000 Clermont-Ferrand, France
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10
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The physiology of fetal membrane weakening and rupture: Insights gained from the determination of physical properties revisited. Placenta 2016; 42:59-73. [PMID: 27238715 DOI: 10.1016/j.placenta.2016.03.015] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 03/05/2016] [Accepted: 03/31/2016] [Indexed: 01/14/2023]
Abstract
Rupture of the fetal membranes (FM) is precipitated by stretch forces acting upon biochemically mediated, pre-weakened tissue. Term FM develop a para-cervical weak zone, characterized by collagen remodeling and apoptosis, within which FM rupture is thought to initiate. Preterm FM also have a weak region but are stronger overall than term FM. Inflammation/infection and decidual bleeding/abruption are strongly associated with preterm premature FM rupture (pPROM), but the specific mechanisms causing FM weakening-rupture in pPROM are unknown. There are no animal models for study of FM weakening and rupture. Over a decade ago we developed equipment and methodology to test human FM strength and incorporated it into a FM explant system to create an in-vitro human FM weakening model system. Within this model TNF (modeling inflammation) and Thrombin (modeling bleeding) both weaken human FM with concomitant up regulation of MMP9 and cellular apoptosis, mimicking the characteristics of the spontaneous FM rupture site. The model has been enhanced so that test agents can be applied directionally to the choriodecidual side of the FM explant consistent with the in-vivo situation. With this enhanced system we have demonstrated that the pathways involving inflammation/TNF and bleeding/Thrombin induced FM weakening overlap. Furthermore GM-CSF production was demonstrated to be a critical common intermediate step in both the TNF and the Thrombin induced FM weakening pathways. This model system has also been used to test potential inhibitors of FM weakening and therefore pPROM. The dietary supplement α-lipoic acid and progestogens (P4, MPA and 17α-hydroxyprogesterone) have been shown to inhibit both TNF and Thrombin induced FM weakening. The progestogens act at multiple points by inhibiting both GM-CSF production and GM-CSF action. The use of a combined biomechanical/biochemical in-vitro human FM weakening model system has allowed the pathways of fetal membrane weakening to be delineated, and agents that may be of clinical use in inhibiting these pathways to be tested.
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Forman JL, Lopez-Valdes FJ, Duprey S, Bose D, Del Pozo de Dios E, Subit D, Gillispie T, Crandall JR, Segui-Gomez M. The tolerance of the human body to automobile collision impact - a systematic review of injury biomechanics research, 1990-2009. ACCIDENT; ANALYSIS AND PREVENTION 2015; 80:7-17. [PMID: 25846230 DOI: 10.1016/j.aap.2015.03.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Revised: 02/12/2015] [Accepted: 03/04/2015] [Indexed: 06/04/2023]
Abstract
Road traffic injuries account for 1.3 million deaths per year world-wide. Mitigating both fatalities and injuries requires a detailed understanding of the tolerance of the human body to external load. To identify research priorities, it is necessary to periodically compare trends in injury tolerance research to the characteristics of injuries occurring in the field. This study sought to perform a systematic review on the last twenty years of experimental injury tolerance research, and to evaluate those results relative to available epidemiologic data. Four hundred and eight experimental injury tolerance studies from 1990-2009 were identified from a reference index of over 68,000 papers. Examined variables included the body regions, ages, and genders studied; and the experimental models used. Most (20%) of the publications studied injury to the spine. There has also been a substantial volume of biomechanical research focused on upper and lower extremity injury, thoracic injury, and injury to the elderly - although these injury types still occur with regularity in the field. In contrast, information on pediatric injury and physiological injury (especially in the central nervous system) remains lacking. Given their frequency of injury in the field, future efforts should also include improving our understanding of tolerances and protection of vulnerable road users (e.g., motorcyclists, pedestrians).
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Affiliation(s)
- Jason L Forman
- University of Virginia Center for Applied Biomechanics, 4040 Lewis and Clark Dr., Charlottesville, VA 22911, USA.
| | | | - Sonia Duprey
- Laboratoire de Biomécanique et Mécanique des Chocs, IFSTTAR, Lyon, France.
| | - Dipan Bose
- Global Road Safety Facility, World Bank Group, Washington D.C., USA.
| | | | - Damien Subit
- LBM - Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers ParisTech, Paris, France.
| | - Tim Gillispie
- University of Virginia Center for Applied Biomechanics, 4040 Lewis and Clark Dr., Charlottesville, VA 22911, USA.
| | - Jeff R Crandall
- University of Virginia Center for Applied Biomechanics, 4040 Lewis and Clark Dr., Charlottesville, VA 22911, USA.
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Allen TK, Feng L, Nazzal M, Grotegut CA, Buhimschi IA, Murtha AP. The Effect of Progestins on Tumor Necrosis Factor α-Induced Matrix Metalloproteinase-9 Activity and Gene Expression in Human Primary Amnion and Chorion Cells In Vitro. Anesth Analg 2015; 120:1085-1094. [PMID: 25806402 PMCID: PMC4406818 DOI: 10.1213/ane.0000000000000708] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Current treatment modalities for preventing preterm premature rupture of membranes are limited, but progestins may play a role. Tumor necrosis factor α (TNFα) enhances matrix metalloproteinase-9 (MMP-9) gene expression and activity in fetal membranes, contributing to membrane weakening and rupture. We previously demonstrated that progestins attenuate TNFα-induced MMP-9 activity in a cytotrophoblast cell line. However, whether they have a similar effect in primary amnion and chorion cells of fetal membranes is unknown. In this study, we evaluated the effect of progestins on basal and TNFα-induced MMP-9 activity and gene expression in primary chorion and amnion cells harvested from the fetal membranes of term nonlaboring patients. METHODS Primary amnion and chorion cells were isolated from fetal membranes obtained from term uncomplicated nonlaboring patients following elective cesarean delivery (n = 11). Confluent primary amnion and chorion cell cultures were both pretreated with vehicle (control), progesterone (P4), 17α-hydroxyprogesterone caproate (17P), or medroxyprogesterone acetate (MPA) at 10 M concentration for 6 hours followed by stimulation with TNFα at 10 ng/mL for an additional 24 hours. Cell cultures pretreated with the vehicle only served as the unstimulated control and the vehicle stimulated with TNFα served as the stimulated control. Both controls were assigned a value of 100 units. Cell culture medium was harvested for MMP-9 enzymatic activity quantification using gelatin zymography. Total RNA was extracted for quantifying MMP-9 gene expression using real-time quantitative PCR. Basal MMP-9 activity and gene expression data were normalized to the unstimulated control. TNFα-stimulated MMP-9 activity and gene expression were normalized to the stimulated control. The primary outcome was the effect of progestins on TNFα-induced MMP-9 enzymatic activity in term human primary amnion and chorion cells in vitro. Secondary outcomes included the effect of progestin therapy on TNFα-induced MMP-9 gene expression and on basal MMP-9 activity and gene expression in primary amnion and chorion cells in vitro. RESULTS Primary cells were harvested from 11 patients. Compared with the unstimulated control, TNFα increased MMP-9 activity (P = 0.005 versus control in primary amnion cells and P < 0.001 versus control in primary chorion cells) and MMP-9 gene expression (P = 0.030 versus control in primary amnion cells, P < 0.001 versus control in primary chorion cells). Compared with the unstimulated controls, MPA, but not P4 or 17P, reduced basal MMP-9 activity [mean difference (95% CI) -49.6 (-81.9, -17.3) units, P = 0.001] and gene expression [mean difference (95% CI) -53.4 (-105.9, -0.9) units, P = 0.045] in primary amnion cells. Compared with the stimulated control, MPA also reduced TNFα-induced MMP-9 activity [mean difference (95% CI) -69.0 (-91.8, -46.3) units, P < 0.001] and gene expression [mean difference (95% CI) -86.0 (-120.7, -51.3) units, P < 0.001] in primary amnion cells. Progestin pretreatment had no significant effect on basal or TNFα-induced MMP-9 activity and gene expression in primary chorion cells. CONCLUSIONS The inhibitory effect of MPA on both basal and TNFα-induced MMP-9 activity and gene expression in primary amnion cells demonstrate a possible mechanism by which progestins may prevent fetal membrane weakening leading to preterm premature rupture of membranes.
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Affiliation(s)
- Terrence K Allen
- From the Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina; Department of Obstetrics and Gynecology Duke University Medical Center, Durham, North Carolina; Center for Perinatal Research, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio; and Departments of Pediatrics and Obstetrics/Gynecology, The Ohio State College of Medicine, Columbus, Ohio
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13
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Perrini M, Mauri A, Ehret AE, Ochsenbein-Kölble N, Zimmermann R, Ehrbar M, Mazza E. Mechanical and microstructural investigation of the cyclic behavior of human amnion. J Biomech Eng 2015; 137:061010. [PMID: 25780908 DOI: 10.1115/1.4030054] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Indexed: 11/08/2022]
Abstract
The structural and mechanical integrity of amnion is essential to prevent preterm premature rupture (PPROM) of the fetal membrane. In this study, the mechanical response of human amnion to repeated loading and the microstructural mechanisms determining its behavior were investigated. Inflation and uniaxial cyclic tests were combined with corresponding in situ experiments in a multiphoton microscope (MPM). Fresh unfixed amnion was imaged during loading and changes in thickness and collagen orientation were quantified. Mechanical and in situ experiments revealed differences between the investigated configurations in the deformation and microstructural mechanisms. Repeated inflation induces a significant but reversible volume change and is characterized by high energy dissipation. Under uniaxial tension, volume reduction is associated with low energy, unrecoverable in-plane fiber reorientation.
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Mauri A, Perrini M, Ehret AE, De Focatiis DSA, Mazza E. Time-dependent mechanical behavior of human amnion: macroscopic and microscopic characterization. Acta Biomater 2015; 11:314-23. [PMID: 25240983 DOI: 10.1016/j.actbio.2014.09.012] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Revised: 08/19/2014] [Accepted: 09/10/2014] [Indexed: 11/16/2022]
Abstract
Characterizing the mechanical response of the human amnion is essential to understand and to eventually prevent premature rupture of fetal membranes. In this study, a large set of macroscopic and microscopic mechanical tests have been carried out on fresh unfixed amnion to gain insight into the time-dependent material response and the underlying mechanisms. Creep and relaxation responses of amnion were characterized in macroscopic uniaxial tension, biaxial tension and inflation configurations. For the first time, these experiments were complemented by microstructural information from nonlinear laser scanning microscopy performed during in situ uniaxial relaxation tests. The amnion showed large tension reduction during relaxation and small inelastic strain accumulation in creep. The short-term relaxation response was related to a concomitant in-plane and out-of-plane contraction, and was dependent on the testing configuration. The microscopic investigation revealed a large volume reduction at the beginning, but no change of volume was measured long-term during relaxation. Tension-strain curves normalized with respect to the maximum strain were highly repeatable in all configurations and allowed the quantification of corresponding characteristic parameters. The present data indicate that dissipative behavior of human amnion is related to two mechanisms: (i) volume reduction due to water outflow (up to ∼20 s) and (ii) long-term dissipative behavior without macroscopic deformation and no systematic global reorientation of collagen fibers.
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Affiliation(s)
- Arabella Mauri
- Department of Mechanical and Process Engineering, ETH Zurich, 8092 Zurich, Switzerland.
| | - Michela Perrini
- Department of Mechanical and Process Engineering, ETH Zurich, 8092 Zurich, Switzerland; Department of Obstetrics, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Alexander E Ehret
- Department of Mechanical and Process Engineering, ETH Zurich, 8092 Zurich, Switzerland
| | - Davide S A De Focatiis
- Division of Materials, Mechanics and Structures, Faculty of Engineering, University of Nottingham, Nottingham NG7 2RD, UK
| | - Edoardo Mazza
- Department of Mechanical and Process Engineering, ETH Zurich, 8092 Zurich, Switzerland; Swiss Federal Laboratories for Materials Science and Technology, EMPA, 8600 Dübendorf, Switzerland
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15
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Bürzle W, Mazza E, Moore JJ. About Puncture Testing Applied for Mechanical Characterization of Fetal Membranes. J Biomech Eng 2014; 136:1901692. [DOI: 10.1115/1.4028446] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Accepted: 08/29/2014] [Indexed: 11/08/2022]
Abstract
Puncture testing has been applied in several studies for the mechanical characterization of human fetal membrane (FM) tissue, and significant knowledge has been gained from these investigations. When comparing results of mechanical testing (puncture, inflation, and uniaxial tension), we have observed discrepancies in the rupture sequence of FM tissue and significant differences in the deformation behavior. This study was undertaken to clarify these discrepancies. Puncture experiments on FM samples were performed to reproduce previous findings, and numerical simulations were carried out to rationalize particular aspects of membrane failure. The results demonstrate that both rupture sequence and resistance to deformation depend on the samples' fixation. Soft fixation leads to slippage in the clamping, which reduces mechanical loading of the amnion layer and results in chorion rupturing first. Conversely, the stiffer, stronger, and less extensible amnion layer fails first if tight fixation is used. The results provide a novel insight into the interpretation of ex vivo testing as well as in vivo membrane rupture.
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Affiliation(s)
- Wilfried Bürzle
- Department of Mechanical and Process Engineering, ETH Zurich, Zurich 8092, Switzerland
- Institute for Mechanical Systems, Tannenstrasse 3, CLA H 23.2, Zurich 8092, Switzerland e-mail:
| | - Edoardo Mazza
- Department of Mechanical and Process Engineering, ETH Zurich, Zurich 8092, Switzerland
- Institute for Mechanical Systems, Leonhardstrasse 21, LEE N 210, Zurich 8092, Switzerland e-mail:
| | - John J. Moore
- Division of Neonatology, Case Western Reserve University School of Medicine, 2500 MetroHealth Drive, Cleveland, OH 44109 e-mail:
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16
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Faturechi R, Hashemi A, Fatouraee N. Do mechanical properties of human fetal membrane depend on strain rate? J Obstet Gynaecol Res 2014; 41:84-91. [PMID: 25160512 DOI: 10.1111/jog.12498] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2013] [Accepted: 05/01/2014] [Indexed: 11/28/2022]
Abstract
AIM The objective of this study was to examine the effect of strain rate on the mechanical properties of human fetal membranes. METHODS Different strain rates were employed to quantify the stress-strain relation of the chorioamnion membrane. The mechanical properties of nine human amnion membranes, four collected from cesarean delivery and five collected from normal vaginal delivery, were examined in uniaxial tension tests under strain rates of 0.1, 1 and 10%/min. RESULTS Statistical analysis revealed significant (P < 0.05) correlation between the change in strain rate and the elastic modulus as well as failure strain of amnion samples. The rupture stress, though, did not show dependency on strain rates. CONCLUSION Human chorioamnion is strongly viscoelastic. By increasing the rate of the test, the stiffness of amnion increases considerably.
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Affiliation(s)
- Rahim Faturechi
- Biomedical Engineering Department, Amirkabir University of Technology, Tehran, Iran
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17
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Meinert M, Malmström A, Petersen AC, Eriksen GV, Uldbjerg N. Chorioamniontis in preterm delivery is associated with degradation of decorin and biglycan and depletion of hyaluronan in fetal membranes. Placenta 2014; 35:546-51. [PMID: 24920507 DOI: 10.1016/j.placenta.2014.05.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2012] [Revised: 05/05/2014] [Accepted: 05/06/2014] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The proteoglycan decorin stabilizes collagen whereas biglycan and hyaluronan disrupt well-organized collagen. The aim was to determine the concentrations of these constituents in fetal membranes in relation to gestational age, preterm labour, PPROM and chorioamnionitis. STUDY DESIGN Preterm fetal membranes (24-34 weeks gestation) were obtained from elective caesarean deliveries (N = 4), from PPROM (N = 14), and from preterm labour (N = 14). Term fetal membranes from elective caesarean deliveries (N = 9) and spontaneous vaginal deliveries (N = 11) were used for comparison. Chorioamnionitis was assessed histologically. The proteoglycans were analysed using alcian blue precipitation, SDS-PAGE and immunostaining. Hyaluronan was estimated by a radioimmunoassay. RESULTS Preterm amniotic membranes with chorioamnionitis displayed a 8-fold decrease in hyaluronan concentration as well as a pronounced (88%) degradation of decorin and biglycan (p < 0.05). The amnion from preterm elective caesarean sections had higher decorin (3.2 vs. 1.7 μg/mg, p < 0.05) and lower biglycan (0.4 vs. 1.0 μg/mg, p < 0.05) concentrations as compared to similar term amnion (p < 0.05), whereas the hyaluronan concentrations were not associated with gestational age. Also the chorio-decidua from preterm caesarean sections had higher decorin concentrations (1.8 vs. 1.0 μg/mg, p < 0.05) whereas the biglycan concentration was unchanged. Labour (term as well as preterm) was characterized by increased hyaluronan and biglycan concentrations in the amnion (not statistically significant). CONCLUSION The biglycan/decorin balance increases during third trimester of pregnancy and during active labour. This relation might contribute to mechanical weakening of the membranes. Chorioamnionitis induces dramatic degradation of both proteoglycans and hyaluronan, which can explain the decreased biomechanical strength.
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Affiliation(s)
- M Meinert
- Department of Obstetrics and Gynaecology, Aarhus University Hospital, 8200 Aarhus N, Denmark.
| | - A Malmström
- Department of Cell and Molecular Biology, Biomedical Center, C13, 221 84 Lund, Sweden
| | - A C Petersen
- Department of Pathology, Aalborg University Hospital, 9100 Aalborg, Denmark
| | - G V Eriksen
- Department of Obstetrics and Gynaecology, Aarhus University Hospital, 8200 Aarhus N, Denmark
| | - N Uldbjerg
- Department of Obstetrics and Gynaecology, Aarhus University Hospital, 8200 Aarhus N, Denmark
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Mogami H, Kishore AH, Shi H, Keller PW, Akgul Y, Word RA. Fetal fibronectin signaling induces matrix metalloproteases and cyclooxygenase-2 (COX-2) in amnion cells and preterm birth in mice. J Biol Chem 2012. [PMID: 23184961 DOI: 10.1074/jbc.m112.424366] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Fetal fibronectin (fFN) in cervical and vaginal secretions has been used as a predictor of preterm delivery. Here, we clarified the pathological function of fFN on cell type-specific matrix metalloproteinases (MMPs) and prostaglandin synthesis in fetal membranes. Treatment of amnion mesenchymal cells with fFN resulted in dramatic increases in MMP-1 and MMP-9 mRNA and enzymatic activity as well as COX-2 mRNA and prostaglandin E(2) synthesis, activating both NFκB and ERK1/2 signaling. Fetal FN-induced increases in MMPs and COX-2 were mediated through its extra domain A and Toll-like receptor 4 expressed in mesenchymal cells. Lipopolysaccharide and TNF-α increased the release of free FN in medium of amnion epithelial cells in culture. Finally, injection of fFN in pregnant mice resulted in preterm birth. Collectively, these results indicate that fFN is not only a marker of preterm delivery but also plays a significant role in the pathogenesis of preterm labor and premature rupture of fetal membranes.
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Affiliation(s)
- Haruta Mogami
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas 75390, USA
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Abstract
The extracellular matrix (ECM) plays an important role in determining cell and organ function: (1) it is an organizing substrate that provides tissue tensile strength; (2) it anchors cells and influences cell morphology and function via interaction with cell surface receptors; and (3) it is a reservoir for growth factors. Alterations in the content and the composition of the ECM determine its physical and biological properties, including strength and susceptibility to degradation. The ECM components themselves also harbor cryptic matrikines, which when exposed by conformational change or proteolysis have potent effects on cell function, including stimulating the production of cytokines and matrix metalloproteinases (MMPs). Collectively, these properties of the ECM reflect a dynamic tissue component that influences both tissue form and function. This review illustrates how defects in ECM synthesis and metabolism and the physiological process of ECM turnover contribute to changes in the fetal membranes that precede normal parturition and contribute to the pathological events leading to preterm premature rupture of membranes (PPROM).
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Affiliation(s)
- Jerome F Strauss
- Department of Obstetrics & Gynecology, Virginia Commonwealth University, Richmond, VA 23298, USA.
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20
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Rangaswamy N, Abdelrahim A, Moore RM, Uyen L, Mercer BM, Mansour JM, Kumar D, Sawady J, Moore JJ. [Biomechanical characteristics of human fetal membranes. Preterm fetal membranes are stronger than term fetal membranes]. ACTA ACUST UNITED AC 2011; 39:373-7. [PMID: 21602078 DOI: 10.1016/j.gyobfe.2011.04.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2011] [Accepted: 03/23/2011] [Indexed: 11/27/2022]
Abstract
The purpose of this study was to determine the biomechanical characteristics of human fetal membranes (FM) throughout gestation. Biomechanical properties were determined for 115 FM of 23-41 weeks gestation using our previously described methodology. The areas of membrane immediately adjacent to the strongest and weakest tested spots were sampled for histomorphometric analysis. Clinical data on the patients whose FM were examined were also collected. FM less than 28 weeks gestation were associated with higher incidence of abruption and chorioamnionitis. Topographically FM at all gestations had heterogeneous biomechanical characteristics over their surfaces with distinct weak areas. The most premature membranes were the strongest. FM strength represented by rupture force and work to rupture decreased with increasing gestation in both weak and strong regions of FM. This decrease in FM strength was most dramatic at more than 38 weeks gestation. The FM component amnion-chorion sublayers were thinner in the weak areas compared to strong areas. Compared to term FM, preterm FM are stronger but have similar heterogeneous weak and strong areas. Following a gradual increase in FM weakness with increasing gestation, there is a major drop-off at term 38 weeks gestation. The FM weak areas are thinner than the stronger areas. Whether the difference in thickness is enough to account for the strength differences is unknown.
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Affiliation(s)
- N Rangaswamy
- Department of pediatrics, MetroHealth medical center, Case Western Reserve University, 2500 MetroHealth-Drive, Cleveland, Ohio, USA
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Mercer BM, Abdelrahim A, Moore RM, Novak J, Kumar D, Mansour JM, Perez-Fournier M, Milluzzi CJ, Moore JJ. The impact of vitamin C supplementation in pregnancy and in vitro upon fetal membrane strength and remodeling. Reprod Sci 2010; 17:685-95. [PMID: 20581351 PMCID: PMC2930608 DOI: 10.1177/1933719110368870] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Generation of reactive oxygen species (ROS) has been suggested as a mechanism of fetal membrane (FM) weakening leading to rupture, particularly with preterm premature rupture of the fetal membranes (PROM). In vitro, FM incubation with tumor necrosis factor (TNF) mimics physiological FM weakening, concomitant with generation of ROS and collagen remodeling. Proinflammatory cytokines are also postulated to have a role in the development of the FM physiological weak zone where rupture normally initiates in-term gestations. We hypothesized that antioxidant treatment may block ROS development and resultant FM weakening. Two studies examining antioxidant effects upon FM strength were conducted, one in vivo and the other in vitro. Fetal membrane of patients enrolled in a multicenter placebo-controlled trial to determine the effect of vitamin C (1 g/day) and vitamin E (400 IU/day) upon complications of pre-eclampsia were examined for FM biomechanical properties and biochemical remodeling at birth. Separately, biomechanics and biochemical markers of remodeling were determined in FM fragments incubated with TNF with or without vitamin C preincubation. Supplemental dietary vitamin C in combination with vitamin E did not modify rupture strength, work to rupture, or matrix metalloproteinase-9 (MMP9; protein or activity) either within or outside the term FM physiological weak zone. In vitro, TNF decreased FM rupture strength by 50% while increasing MMP9 protein. Vitamin C did not inhibit these TNF-induced effects. Vitamin C alone had a weakening effect on FM in vitro. We speculate that vitamin C supplementation during pregnancy will not be useful in the prevention of preterm PROM.
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Affiliation(s)
- Brian M Mercer
- From the Department of Reproductive Biology, Case Western Reserve University, Cleveland, OH 44109, USA.
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22
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Chua WK, Oyen ML. Do we know the strength of the chorioamnion? Eur J Obstet Gynecol Reprod Biol 2009; 144 Suppl 1:S128-33. [DOI: 10.1016/j.ejogrb.2009.02.029] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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23
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Calvin SE, Oyen ML. Microstructure and mechanics of the chorioamnion membrane with an emphasis on fracture properties. Ann N Y Acad Sci 2007; 1101:166-85. [PMID: 17332077 DOI: 10.1196/annals.1389.009] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The normal mechanical functioning of an intact chorioamnion (CA) membrane is essential to successful human reproduction. The amnion and the chorion, separately and together as the bilayer chorioamnion, serve barrier and container functions throughout gestation, and these two important roles are required from conception to birth. The event associated with the "breaking of waters" is a landmark event in labor and delivery. Mechanical rupture of the CA membrane is part of the natural sequence of term delivery, but has serious implications when rupture occurs prior to term; preterm premature rupture of the CA membrane (PPROM) is associated with one-third of premature births. The current manuscript reviews PPROM from a clinical, anatomical, and mechanical perspective with a special focus on the clinically relevant fracture properties of these membranes. Emphasis is given to the link between membrane structure and properties at macroscopic and microscopic length scales. Because it has been demonstrated that the mechanical properties of prematurely failed membranes are not different from membranes of the same gestational age that have remained intact, membrane failure is a local process that must be explored in terms of local changes in structure and properties of isolated portions of the membrane. Future diagnostic techniques aimed at detection of changes in membrane structure (including thickness) and altered mechanical stiffness or strength may allow for prefailure diagnosis of membrane weak spots, thus opening the door for potential intervention and treatment techniques for preterm membrane rupture.
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Affiliation(s)
- Steven E Calvin
- Minnesota Perinatal Physicians--Allina Health System, Minneapolis, Minnesota, USA
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Oyen ML, Calvin SE, Landers DV. Premature rupture of the fetal membranes: is the amnion the major determinant? Am J Obstet Gynecol 2006; 195:510-5. [PMID: 16647685 DOI: 10.1016/j.ajog.2006.02.010] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2005] [Revised: 02/08/2006] [Accepted: 02/08/2006] [Indexed: 11/21/2022]
Abstract
OBJECTIVE The objective of the study was to evaluate the relative contributions of amnion and chorion to the strength of fetal membranes and to correlate these findings with gestational age. STUDY DESIGN Fetal membranes from 78 pregnancies were tested for biaxial puncture force using a blunt, instrumented probe with a low-force load cell connected through a load cell conditioner to an oscilloscope. The average of 2 to 4 tests performed on independent regions of the membrane was recorded. Means and SDs were calculated through the gestational age ranges of less than 32, 32 to 36, or 37 weeks or longer. Linear regression analysis was performed across gestational age after grouping data by labor and mode of delivery. RESULTS There were trends toward decreasing puncture force with gestational age for both chorioamnion and amnion for both vaginal deliveries and cesarean sections. The trends were significant by linear regression for labored deliveries but not unlabored cesarean sections for both chorioamnion and amnion alone. There was no trend in chorion puncture force with either gestational age or delivery mode and the mean puncture force values were, on average, half those for the amnion. CONCLUSION The amnion is significantly stronger than the chorion when subjected to biaxial strength testing. The amnion but not the chorion is significantly affected by the chemical and mechanical changes during gestation and the labor process. These data will help direct future studies on the effects of clinical and molecular modulators of inflammation on membrane rupture thresholds with special emphasis on the biochemical and structural changes in the amnion.
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Affiliation(s)
- Michelle L Oyen
- Department of Biophysical Sciences and Medical Physics, University of Minnesota, Minneapolis, USA
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Pressman EK, Cavanaugh JL, Mingione M, Norkus EP, Woods JR. Effects of maternal antioxidant supplementation on maternal and fetal antioxidant levels: a randomized, double-blind study. Am J Obstet Gynecol 2004; 189:1720-5. [PMID: 14710104 DOI: 10.1016/s0002-9378(03)00858-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE We sought to determine whether vitamins C and E could be delivered to the fetal-placental unit through maternal oral supplementation. STUDY DESIGN In a randomized, double-blind study, 20 women received a daily prenatal vitamin with or without 400 IU of vitamin E and 500 mg of vitamin C, starting at 35 weeks' gestation. At randomization, a nutritional questionnaire, plasma vitamin C and E and red blood cell (RBC) vitamin E levels were determined. At delivery, concentrations of maternal and fetal plasma vitamin C and E, maternal and fetal RBC vitamin E, amniotic fluid vitamin C, and chorioamnion vitamin E and tensile strength were determined. RESULTS Maternal plasma vitamin E levels increased in the supplemented women but not in the control subjects. No changes in maternal vitamin C levels were noted. Maternal plasma vitamin C concentrations at delivery correlated closely with amniotic fluid vitamin C levels. Similarly, maternal plasma vitamin E levels at delivery correlated with the chorioamnion concentration of vitamin E. CONCLUSIONS Maternal plasma vitamin E levels are increased by oral supplementation. Maternal plasma vitamin C and E concentrations correlate with the concentration of vitamin C in the amniotic fluid and vitamin E in the chorioamnion, respectively.
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Affiliation(s)
- Eva K Pressman
- Division of Maternal Fetal Medicine, University of Rochester Medical Center, Rochester, NY, USA
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Wall PD, Pressman EK, Woods JR. Preterm premature rupture of the membranes and antioxidants: the free radical connection. J Perinat Med 2003; 30:447-57. [PMID: 12530100 DOI: 10.1515/jpm.2002.071] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
AIM To discuss the role of oxidant stress in preterm, premature rupture of the membranes (PPROM). RESULTS There is evidence to suggest that preterm, premature rupture of the membranes occurs secondary to focal collagen damage in the fetal membranes. CONCLUSION Oxidant stress caused by increased ROS formation and/or antioxidant depletion may disrupt collagen and cause premature membrane rupture. We propose that supplementation with vitamins C and E may synergistically protect the fetal membranes, and decrease the risks of PPROM.
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Affiliation(s)
- Peter D Wall
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of Rochester Medical Center, Rochester, New York, USA.
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