Changes in haemostasis during normal pregnancy: does homocysteine play a role in maintaining homeostasis?

Classification and immunotherapy assessment of lung adenocarcinoma based on coagulation-related genes

Introduction: This study on lung adenocarcinoma (LUAD), a common lung cancer subtype with high mortality. Aims: This study focuses on how tumor cell interactions affect immunotherapy responsiveness. Methods: Using public databases, we used non-negative matrix factorization clustering method, ssGSEA, CIBERSORT algorithm, immunophenotype score, survival analysis, protein-protein interaction network method to analyze gene expression data and coagulation-related genes. Results: We divided LUAD patients into three coagulation-related subgroups with varying immune characteristics and survival rates. A cluster of three patients, having the highest immune infiltration and survival rate, also showed the most potential for immunotherapy. We identified five key genes influencing patient survival using a protein-protein interaction network. Conclusion: This research offers valuable insights for forecasting prognosis and immunotherapy responsiveness in LUAD patients, helping to inform clinical treatment strategies.

Homocysteine Metabolism in Pregnancy and Developmental Impacts

Homocysteine is a metabolite generated by methionine cycle metabolism, comprising the demethylated derivative of methionine. Homocysteine can be metabolised by the transsulphuration pathway to cystathionine, which requires vitamin B6, or can undergo remethylation to methionine. Homocysteine remethylation to methionine is catalysed by methionine synthase activity which requires vitamin B12, regenerating methionine to allow synthesis of the universal methyl donor S-adenosylmethionine required for methylation and gene transcription regulation. The methyl-group donated for homocysteine remethylation comes from 5-methyltetrahydrofolate generated by the folate cycle, which allows tetrahydrofolate to be returned to the active folate pool for nucleotide biosynthesis. Therefore the integrated actions of the methionine and folate cycles, required to metabolise homocysteine, also perpetuate methylation and nucleotide synthesis, vitally important to support embryonic growth, proliferation and development. Dysregulated activities of these two interdependent metabolic cycles, arising from maternal suboptimal intake of nutrient co-factors such as folate and vitamin B12 or gene polymorphisms resulting in reduced enzymatic activity, leads to inefficient homocysteine metabolic conversion causing elevated concentrations, known as hyperhomocysteinemia. This condition is associated with multiple adverse pregnancy outcomes including neural tube defects (NTDs). Raised homocysteine is damaging to cellular function, binding to proteins thereby impairing their function, with perturbed homocysteine metabolism impacting negatively on embryonic development. This review discusses the "cross-talk" of maternal-fetal homocysteine interrelationships, describes the placental transport of homocysteine, homocysteine impacts on pregnancy outcomes, homocysteine and methylation effects linking to NTD risk and proposes a putative pathway for embryonic provision of folate and vitamin B12, homocysteine-modulating nutrients that ameliorate NTD risk.

Maternal Supplementation with Dietary Betaine during Gestation to Improve Twin Lamb Survival

Simple Summary

High incidences of twin lamb mortality constrain the reproductive efficiency and productivity of Merino sheep flocks. This study determined whether supplementing the diets of pregnant, twin-bearing ewes with 2 or 4 g/day of betaine would improve lamb viability and survival to weaning. Feeding ewes 2 g/day of betaine for the duration of pregnancy decreased lamb survival but increased lamb body weight at weaning. Whereas, lamb vigour and early post-natal survival were improved following ewe supplementation with 4 g/day of betaine during the second half of pregnancy. Maternal supplementation with 4 g/day of betaine during the second half of pregnancy may, therefore, be a useful strategy to improve twin lamb survival.

Abstract

Betaine increases the synthesis of creatine, an energy-rich amino acid that increases adenosine triphosphate (ATP) and has neuroprotective properties which may improve post-natal lamb survival. This study determined whether maternal betaine supplementation during gestation would improve body weight, thermoregulation, time to stand and suck, colostrum intake and survival to weaning of twin lambs. Twin-bearing Merino ewes received dietary betaine at either 0 g/day (Control, CTL), 2 g/day from ram introduction to parturition (Early betaine, EB) or 4 g/day from Day 80 of gestation to parturition (Late betaine, LB). Ewes were housed individually during parturition and measures were collected at 4, 24 and 72 h and Day 7 post-partum, and at marking (53.2 ± 0.2 days of age) and weaning (99.3 ± 0.2 days of age). The EB treatment resulted in heavier lambs at weaning compared with CTL and LB lambs (p < 0.05). Time to stand and suck from birth was longer in EB lambs (p < 0.05), whereas, the interval from birth to first suck was shorter for LB lambs (p < 0.05). Lamb survival rate was the highest for LB lambs at 72 h and Day 7 (p < 0.05), and lowest for EB lambs on Day 7 (p < 0.05). These data indicated that betaine supplementation at 4 g/day during the second half of pregnancy improved twin lamb survival to Day 7 and shortened the interval from birth to first suck; whereas feeding ewes 2 g/day of betaine for the duration of pregnancy increased twin lamb body weight at weaning, but increased both the time to attain behavioural milestones and mortalities before Day 7.

Sow performance in response to natural betaine fed during lactation and post-weaning during summer and non-summer months

Background

Two studies were conducted to evaluate the effects of dietary natural betaine on sow reproductive performance during summer (Exp. 1) and non-summer months (Exp. 2). Treatments were designed as a 2 × 2 factorial arrangement with factors including dietary betaine (0 or 0.2%) and period of supplementation (lactation or post-weaning until 35 days post-insemination). In Exp. 1, 322 and 327 sows and in Exp. 2, 300 and 327 sows representing young (parity 1 and 2) and mature (parity 3 to 6) sows, respectively, were used.

Results

In Exp. 1, supplementation of betaine during lactation increased sow body weight losses (− 11.95 vs. −14.63 kg; P = 0.024), reduced feed intake (4.12 vs. 4.28 kg/d; P = 0.052), and tended to reduce percentage of no-value pigs (P = 0.071). Betaine fed post-weaning reduced weaning-to-estrus interval (5.75 vs. 6.68 days; P = 0.054) and farrowing rate (86.74% vs. 91.36%; P = 0.060), regardless of parity group. Post-hoc analysis with sows clustered into 3 parity groups (1, 2 and 3, and 4+) indicated that betaine fed in lactation to parity 4+ sows (P = 0.026) and betaine fed post-weaning to parity 1 sows increased the number of pigs born in the subsequent cycle (P ≤ 0.05). In Exp. 2, betaine fed during lactation tended to reduce the weaning-to-estrus interval (6.64 vs. 7.50 days; P = 0.077) and farrowing rate (88.23% vs. 83.54%; P = 0.089), regardless of parity group. Feeding betaine post-weaning reduced number of pigs born (13.00 vs. 13.64; P = 0.04) and pigs born alive (12.30 vs. 12.82; P = 0.075), regardless of parity group.

Conclusions

Using 0.2% betaine during the non-summer months did not benefit sow performance. During the summer, betaine supplementation in lactation increased subsequent litter size in parity 4+ sows. Betaine fed during the post-weaning period reduced the wean-to-estrus interval and farrowing rate, increased total number of pigs born for parity 1 sows and reduced total number of pigs born to parity 4+ sows. Further research is needed to determine if the detrimental effects on feed intake and farrowing rate may be correlated and depend on dietary betaine level.

State of the Art Management of Mechanical Heart Valves During Pregnancy

PURPOSE OF THE REVIEW

To review the management of women with mechanical heart valves during pregnancy, from preconception counseling through delivery with a summary of the latest guidelines.

RECENT FINDINGS

The hypercoagulability of pregnancy combined with the imperfect choices of anticoagulant agents contribute to a high risk of complications in pregnant women with mechanical heart valves. Valve thrombosis remains a major concern, much of which occurs during the first trimester transition to heparin-based products. The safest method of anticoagulation, with the best balance of maternal and fetal risk, is use of low-dose vitamin K antagonists, but only if therapeutic anticoagulation can be achieved with warfarin doses of ≤ 5 mg/day. Management of mechanical heart valves in pregnancy remains fraught with difficult decisions involving balancing of maternal and fetal risks as well as a high risk of maternal and fetal complications. Preconception counseling and planning is imperative. A risk-benefit discussion with the patient will help guide the choice of anticoagulation and outline the plan for safe delivery options. A multidisciplinary approach to management is advisable with close follow-up and care in a tertiary center.

Hemostatic Abnormalities in Patients With Severe Preeclampsia

Preeclampsia is the most common medical disorder of pregnancy. Early onset preeclampsia is defined as presentation of hypertension and proteinuria before 34 weeks of gestation. Alterations of endothelial cells and fibrin deposition in microvasculature lead to enhanced activation of the coagulation cascade and impaired fibrinolysis associated with multiple organ dysfunctions. Plasma samples were obtained from 50 patients with severe preeclampsia before 34 weeks of gestation and in 61 patients with late preeclampsia. Factor VIIIR:Ag, fibrinogen, D-dimer, and thrombomodulin increased with advanced pregnancy. The platelet count is very important because of the close correlation with the activations parameters of D-dimer and antithrombin. Our results were consistent with activated coagulation and lowering of platelet count in severe cases with early onset preeclampsia. Women who develop early onset preeclampsia characterized a subgroup of patients with more and severe hematologic abnormalities than women with late preeclampsia (after 34 weeks of gestation).

Prenatal infectious and nutritional factors and risk of adult schizophrenia

Schizophrenia is a severely disabling psychiatric disorder. Despite a considerable amount of research on the underpinnings of the disorder, its etiology and pathogenesis remain unknown. In utero exposures, including infection and nutritional deficiencies, are emerging important risk factors for schizophrenia, in which neurodevelopmental influences probably play an important role. Our group and others have embarked on investigations aimed at identifying these risk factors and examining the mechanisms by which they increase vulnerability to this disorder. This work has the potential to lead to strategies aimed at preventing this disorder and to reveal new molecular targets for pharmacotherapeutic intervention.

Methyl donor supplementation of gestating sow diets improves pregnancy outcomes and litter size

Maternal intake of B-vitamin and methyl donors can affect sow prolificacy. A total of 1079 Large White/Landrace sows (parities 2–9 at mating) were used in a 2 by 2 by 2 factorial design to determine the effects of two levels of betaine supplementation (0 versus 3 g added betaine/kg feed), two levels of folic acid plus vitamin B12 supplementation (0 versus 20 mg/kg folic acid plus 150 µg/kg vitamin B12) during gestation, and two parity groups (parity 2 and 3 versus parity 4 and greater) on litter size and pregnancy outcomes. The number of sows returning to oestrus post-insemination, as well as the number of early (<Day 30) and late (>Day 30) pregnancy losses were recorded. At farrowing, the total number of piglets born, the number of piglets born alive and dead, as well as the number of mummified fetuses were recorded. Pre-prandial blood samples were collected from a subset of 20 sows/treatment on Days 3, 30 and 107 of gestation to analyse homocysteine. The incidence of early pregnancy loss was reduced (P < 0.001) by folic acid plus vitamin B12 supplementation (0.03 versus 0.07). There was a significant interaction between parity at mating (parities 2 and 3 versus parity 4 and greater) and the addition of betaine or folic acid plus vitamin B12 to the gestation diet on litter size. Litter size was higher (0.5 piglets; P < 0.05) for betaine supplemented, compared with unsupplemented, parity 4 plus sows. Folic acid plus vitamin B12-supplemented parity 2 and 3 sows gave birth to more (P < 0.05) piglets than all other treatment groups. Folic acid plus vitamin B12 supplementation decreased (P < 0.001) plasma homocysteine concentration by 2.2 and 2.8 μM, respectively, on Days 3 and 107 of gestation. However, betaine supplementation decreased (P < 0.05) homocysteine on Day 3 only. Overall, folic acid plus vitamin B12 supplementation decreased incidences of early pregnancy failure and increased litter size in early parity sows, while betaine increased litter size in older parity sows.

Hyperhomocysteinemia and methylenetetrahydrofolate reductase C677T polymorphism in cerebral veno-sinus thrombosis

There is limited data on the role of hyperhomocysteinemia as a risk factor for cerebral veno-sinus thrombosis (CVT) in Indians. We examined the association between plasma homocysteine (Hcy), methylenetetrahydrofolate reductase (MTHFR) C677T polymorphism, and CVT in 185 patients with aseptic CVT (puerperal 80 and nonpuerperal 105) and 248 healthy controls (puerperal 67 and nonpuerperal 181). Fasting Hcy was higher in patients compared to controls (20.25 ± 5.97 vs 9.81 ± 5.19 μmol/L, P < .001) and associated with 4.54-fold (95% confidence interval [CI]: 2.74-7.53) increase in risk of CVT. Risk was higher in puerperal (odds ratio [OR]: 8.7, 95% CI: 2.73-26.91) compared to nonpuerperal CVT (OR: 3.82, 95% CI: 2.09-6.96). Plasma Hcy was higher in MTHFR 677TT compared to 677CT and 677CC genotypes (34.44 ± 32.8 vs 25.81 ± 33.3 vs 18.50 ± 23.7 μmol/L, respectively, P < .001), but the risk associated with MTHFR 677TT was insignificant (OR: 1.91, 95% CI: 0.53-7.06). We conclude that hyperhomocysteinemia is a risk marker for Indian patients with aseptic CVT. MTHFR 677TT genotype is not linked with CVT but is a determinant of plasma Hcy.

Homocysteine is transported by the microvillous plasma membrane of human placenta

Elevated maternal plasma concentrations of homocysteine (Hcy) are associated with pregnancy complications and adverse neonatal outcomes. The postulate that we wish to advance here is that placental transport of Hcy, by competing with endogenous amino acids for transporter activity, may account for some of the damaging impacts of Hcy on placental metabolism and function as well as fetal development. In this article, we provide an overview of some recent studies characterising the transport mechanisms for Hcy across the microvillous plasma membrane (MVM) of the syncytiotrophoblast, the transporting epithelium of human placenta. Three Hcy transport systems have been identified, systems L, A and y(+)L. This was accomplished using a strategy of competitive inhibition to investigate the effects of Hcy on the uptake of well-characterised radiolabelled substrates for each transport system into isolated MVM vesicles. The reverse experiments were also performed, examining the effects of model substrates on [³⁵S]L-Hcy uptake. This article describes the evidence for systems L, A and y(+)L involvement in placental Hcy transport and discusses the physiological implications of these findings with respect to placental function and fetal development.

Blutungen während der Schwangerschaft

Hemorrhaging during pregnancy is often fulminant and life-threatening for mother and child. Of maternal deaths occurring during pregnancy, 25% are caused by hemorrhaging. All physicians involved in the interdisciplinary treatment of hemorrhaging during pregnancy need to be familiar with the specific pathophysiology of hemostatic changes during pregnancy, e.g. elevated hemostatic capacity, reduced anti-coagulation activity and severe alterations of the fibrinolysis system. Therapists must be able to perform a consequent, goal-directed interdisciplinary approach to prevent adverse maternal and fetal outcomes. The major issues of therapy are causal obstetric treatment of the bleeding, early detection and therapy of hyperfibrinolysis, optimization of fibrinogen and platelet levels and knowledge of the possibilities of a targeted coagulation therapy.

Hyperhomocysteinemia and venous thrombosis

It has been recognized, since the first description of the disease, that arterial and venous thrombosis are common in patients with homocysteinuria. Interest in the condition increased with reports from a large number of mainly retrospective studies showing that mildly elevated homocysteine levels are also associated with venous thromboembolism (VTE), thrombotic stroke, and peripheral vascular disease. This association is less strong when populations are studied prospectively. Vitamin supplementation, primarily with folic acid, and to a lesser degree with pyridoxine and vitamin B(12), is effective in reducing elevated levels of plasma homocysteine. Surprisingly, however, recent prospective intervention studies showed that despite lowering of the homocysteine level with such treatment, there was no impact on the risk of recurrence of venous or arterial disease.

A life cycle micronutrient perspective for women's health

Micronutrients not only benefit women's health during childbearing years and during pregnancy and lactation, but they also have substantial impact on women's health during adolescence and the aging years. Thus, for women, diet quality is important for health today and in the future. Realizing that there are many ways to improve the quality of a diet and to obtain adequate amounts of vitamins and minerals from foods, food-based approaches are still not attaining adequate intakes in most women, both in the United States and worldwide. Efforts are needed to improve diet quality, focusing on the diet as a whole, and not on single vitamins or minerals. However, consideration must be given to fortified foods and/or supplements to insure micronutrient adequacy.

Multiple micronutrients in pregnancy and lactation: an overview

This overview of multiple micronutrients during pregnancy and lactation emphasizes 2 relatively neglected issues. The first is that maternal micronutrient status in the periconceptional period, and throughout pregnancy and lactation, should be viewed as a continuum; too often these 3 stages are treated and discussed separately from both a scientific and a public health perspective. Iron and vitamin B-12 are included as examples to stress how status at conception affects maternal, fetal, and infant status and health until the child is weaned. The second issue is that while most attention has been focused on a few micronutrients, for example iron and folate as discussed elsewhere in this Supplement, multiple micronutrient deficiencies occur simultaneously when diets are poor. Some of these deserve more attention as causes of poor pregnancy outcome, including other B vitamin deficiencies that result in homocysteinemia, antioxidants, vitamin D, and iodine. In lactation, maternal status or intake of the B vitamins (except folate), vitamin A, selenium and iodine strongly affect the amount of these nutrients secreted in breast milk. This can result in the infant consuming substantially less than the recommended amounts and further depleting stores that were low at birth. While the optimal mode of meeting recommended micronutrient intakes is an adequate diet, in some situations supplementation is also important. Unfortunately, information is lacking on the optimal formulation of micronutrient supplements for pregnant women, and the need to continue these supplements during lactation is not recognized in many situations where maternal and infant health could benefit.