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Mukosera GT, Clark TC, Ngo L, Liu T, Schroeder H, Power GG, Yellon SM, Parast MM, Blood AB. Nitric oxide metabolism in the human placenta during aberrant maternal inflammation. J Physiol 2020; 598:2223-2241. [PMID: 32118291 DOI: 10.1113/jp279057] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 02/25/2020] [Indexed: 12/27/2022] Open
Abstract
KEY POINTS Nitric oxide (NO) is a gasotransmitter with important physiological and pathophysiological roles in pregnancy. There is limited information available about the sources and metabolism of NO and its bioactive metabolites (NOx) in both normal and complicated pregnancies. The present study characterized and quantified endogenous NOx in human and mouse placenta following determination of the stability of exogenous NOx in placental homogenates. NOx have differential stability in placental homogenates. NO and iron nitrosyl species (FeNOs), are relatively unstable in placental homogenates from normal placentas. Exogenous NO, nitrite and nitrosothiols react with placental homogenates to form iron nitrosyl complexes. FeNOs were also detected endogenously in mouse and human placenta. NOx levels in placental villous tissue are increased in fetal growth restriction vs. placentas from women with normal pregnancies, particularly in fetal growth restriction associated with pre-eclampsia. Villitis was not associated, however, with an increase in NOx levels in either normotensive or pre-eclamptic placentas. The results call for further investigation of FeNOs in normal and complicated pregnancies. ABSTRACT Nitric oxide (NO) is a gasotransmitter with important roles in pregnancy under both physiological and pathophysiological conditions. Although products of NO metabolism (NOx) also have significant bioactivity, little is known about the role of NO and NOx under conditions of aberrant placental inflammation during pregnancy. An ozone-based chemiluminescence approach was used to investigate the stability and metabolic fate of NOx in human placental homogenates from uncomplicated pregnancies in healthy mothers compared to that in placental tissue from normotensive and pre-eclamptic pregnancies complicated with fetal growth restriction (FGR) with and without villitis of unknown aetiology. We hypothesized that placental NOx would be increased in FGR vs. normal tissue, and be further increased in villitis vs. non-villitis placentas. Findings indicate that nitrate, nitrite and nitrosothiols, but not NO or iron nitrosyl species (FeNOs), are relatively stable in placental homogenates from normal placentas, and that NO, nitrite and nitrosothiols react with placental homogenates to form iron nitrosyl complexes. Furthermore, NOx levels in placental villous tissue are increased in FGR vs. placentas from women with normal pregnancies, particularly in FGR associated with pre-eclampsia. However, in contrast to our hypothesis, villitis was not associated with an increase in NOx levels in either normotensive or pre-eclamptic placentas. Our results also strongly support the involvement of FeNOs in both mouse and human placenta, and call for their further study as a critical mechanistic link between pre-eclampsia and fetal growth restriction.
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Affiliation(s)
- George T Mukosera
- Lawrence D Longo Center for Perinatal Biology and Department of Pediatrics, Loma Linda University, 11175 Campus Street, Loma Linda, CA, 92354, USA
| | - Tatianna C Clark
- Lawrence D Longo Center for Perinatal Biology and Department of Pediatrics, Loma Linda University, 11175 Campus Street, Loma Linda, CA, 92354, USA
| | - Larry Ngo
- Lawrence D Longo Center for Perinatal Biology and Department of Pediatrics, Loma Linda University, 11175 Campus Street, Loma Linda, CA, 92354, USA
| | - Taiming Liu
- Lawrence D Longo Center for Perinatal Biology and Department of Pediatrics, Loma Linda University, 11175 Campus Street, Loma Linda, CA, 92354, USA
| | - Hobe Schroeder
- Lawrence D Longo Center for Perinatal Biology and Department of Pediatrics, Loma Linda University, 11175 Campus Street, Loma Linda, CA, 92354, USA
| | - Gordon G Power
- Lawrence D Longo Center for Perinatal Biology and Department of Pediatrics, Loma Linda University, 11175 Campus Street, Loma Linda, CA, 92354, USA
| | - Steven M Yellon
- Lawrence D Longo Center for Perinatal Biology and Department of Pediatrics, Loma Linda University, 11175 Campus Street, Loma Linda, CA, 92354, USA
| | - Mana M Parast
- Department of Pathology, University of California San Diego, 200 W Arbor Dr, San Diego, CA, 92103, USA
| | - Arlin B Blood
- Lawrence D Longo Center for Perinatal Biology and Department of Pediatrics, Loma Linda University, 11175 Campus Street, Loma Linda, CA, 92354, USA
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The Ca 2+-Binding S100B Protein: An Important Diagnostic and Prognostic Neurobiomarker in Pediatric Laboratory Medicine. Methods Mol Biol 2019; 1929:701-728. [PMID: 30710306 DOI: 10.1007/978-1-4939-9030-6_44] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
In recent decades a significant scientific effort has focused on projects regarding the use of neurobiomarkers in perinatal medicine with a view to understanding the mechanisms that interfere with physiological patterns of brain development and lead to ominous effects in several human diseases. Numerous potential neurobiomarkers have been proposed for use in monitoring high-risk fetuses and newborns, including markers of oxidative stress, neuroproteins, and vasoactive agents. Nonetheless, the use of these markers in clinical practice remains a matter of debate. Recently, the calcium-binding S100B protein has been proposed as being an ideal neurobiomarker, thanks to its simple availability and easy reproducibility, to the possibility of detecting it noninvasively in biological fluids with good reproducibility, and to the possibility of a longitudinal evaluation in relation to reference curves. The present chapter contains an overview of the most significant studies on the assessment of S100B in different biological fluids as a trophic factor and/or marker of brain damage in high-risk fetuses and newborns.
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Novakovic TR, Dolicanin ZC, Djordjevic NZ. Oxidative stress biomarkers in amniotic fluid of pregnant women with hypothyroidism. J Matern Fetal Neonatal Med 2017; 32:1105-1110. [PMID: 29141467 DOI: 10.1080/14767058.2017.1400005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Purpose: Hypothyroidism in pregnancy is the serious state that may lead to fetal morbidity and mortality. Oxidative stress biomarkers in the amniotic fluid can provide important information on the health, development and maturation of the fetus during pregnancy. In this study, we examined whether maternal hypothyroidism contributes to increased oxidative stress biomarkers in the amniotic fluid during the first trimester of pregnancy. Materials and methods: The study was conducted on healthy pregnant women and pregnant women with hypothyroidism (gestational age: 16-18 weeks). Oxidative stress biomarkers, such as superoxide anion (O2•-), hydrogen peroxide (H2O2), nitric oxide (NO), peroxynitrite (ONOO-), lipid peroxide (LPO), reduced glutathione (GSH) and oxidized glutathione (GSSG) were assayed in the amniotic fluid. Results: The results of this study indicated that concentrations of O2•- and NO are significantly higher, while the concentration of H2O2 is significantly lower in the amniotic fluid of pregnant women with hypothyroidism in comparison to healthy pregnant women. There were no differences in concentrations of LPO, GSH and GSSG among tested groups. Also, we found that amniotic fluid concentration of O2•- is negatively correlated with the body weight and Apgar score values of the newborns. Conclusion: These results suggest that pregnancy hypothyroidism is characterized by the amniotic fluid oxidative stress. Incorporation of the oxidative stress biomarkers measurement in the amniotic fluid may be of clinical importance in the management of pregnancy hypothyroidism.
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Affiliation(s)
- Tanja R Novakovic
- a Department for Cytogenetic Diagnostics , Clinical Centre "Kragujevac" , Kragujevac , Serbia
| | - Zana C Dolicanin
- b Department of Biomedical Sciences , State University of Novi Pazar , Novi Pazar , Serbia
| | - Natasa Z Djordjevic
- b Department of Biomedical Sciences , State University of Novi Pazar , Novi Pazar , Serbia
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Reyna-Villasmil E, Mejia-Montilla J, Santos-Bolívar J, Torres-Cepeda D, Navarro-Briceño Y, Reyna-Villasmil N, Cuevas-González A. Óxido nítrico plasmático y doppler de las arterias uterinas en preeclámpticas y embarazadas normotensas sanas. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2017. [DOI: 10.1016/j.gine.2016.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abdel-Ghani M, El-Sherry T, Hayder M, Abou-Khalil N. Profile of peroxidative injury and antioxidant indicators in singleton, twins and multiple bearing goats throughout pregnancy. ASIAN PACIFIC JOURNAL OF REPRODUCTION 2016. [DOI: 10.1016/j.apjr.2016.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Prediction of preterm delivery using levels of vascular endothelial growth factor and leptin in amniotic fluid from the second trimester. Arch Gynecol Obstet 2014; 291:265-71. [DOI: 10.1007/s00404-014-3439-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Accepted: 08/26/2014] [Indexed: 11/26/2022]
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Toda N, Toda H, Okamura T. Regulation of myometrial circulation and uterine vascular tone by constitutive nitric oxide. Eur J Pharmacol 2013; 714:414-23. [DOI: 10.1016/j.ejphar.2013.07.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2013] [Revised: 07/01/2013] [Accepted: 07/04/2013] [Indexed: 01/13/2023]
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Torrance HL, Pistorius L, Voorbij HAM, Visser GHA. Lactate to creatinine ratio in amniotic fluid: a pilot study. J Matern Fetal Neonatal Med 2013; 26:728-30. [PMID: 23327336 DOI: 10.3109/14767058.2013.766685] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Measurement of amniotic fluid (AF) lactate concentration in complicated pregnancies may provide information on the extent of fetal acidemia. However, normalisation for AF volume may be necessary by calculating the lactate:creatinine (L:C) ratio. We measured these AF parameters and compared them to arterial cord blood lactate in 28 term and 10 preterm pregnancies. Cord blood lactate was not correlated to AF lactate, but was correlated to the L:C ratio in the complete study population (R = 0.54, p = 0.001) and the subgroups. Correlation was strongest in a preterm intrauterine growth restricted subgroup (n = 7, R = 0.83, p = 0.02). The L:C ratio is more accurate in estimating fetal lacticaemia than AF lactate.
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Affiliation(s)
- Helen L Torrance
- Perinatal Center, University Medical Center, Utrecht, The Netherlands.
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Reyna E, Guerra M, Mejía J, Reyna N, Torres D, Santos J, Perozo J, Colmenares M, Delgado O. Modificaciones del flujo sanguíneo de las arterias uterina, umbilical y cerebral media fetal en preeclámpticas tratadas con parches de nitroglicerina. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2011. [DOI: 10.1016/j.gine.2009.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Salvolini E, Orciani M, Lucarini G, Vignini A, Tranquilli AL, Di Primio R. VEGF and nitric oxide synthase immunoexpression in Down's syndrome amniotic fluid stem cells. Eur J Clin Invest 2011; 41:23-9. [PMID: 20731701 DOI: 10.1111/j.1365-2362.2010.02370.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND It has been previously observed that the amniotic fluid obtained from Down's syndrome (DS) pregnancies showed lower levels of vascular endothelial growth factor (VEGF) and higher levels of nitric oxide (NO) with respect to the controls, suggesting the presence of an imbalance between placental vascularization and altered endothelial function. The aim of our study was to evaluate the immunohistochemical expression and localization of VEGF and nitric oxide synthase (NOS) isoforms in cultured amniotic fluid mesenchymal stem cells (AF-MSCs) isolated from normal euploid pregnancies and pregnancies complicated by trisomy 21. In addition, we measured the VEGF and NO content in cell culture supernatants to analyse their production by AF-MSCs. MATERIALS AND METHODS AF-MSCs were obtained from women with foetal DS and controls matched for age and gestation, and expanded in culture. The cells were then evaluated for the immunohistochemical expression of VEGF and NOS isoforms, as well as for the release of VEGF and NO. RESULTS Our analyses showed that both the VEGF expression and production were significantly lower in DS-AF-MSCs with respect to the controls. As regards NOS, immunohistochemical expression of eNOS was significantly reduced in DS-AF-MSCs, whereas the nNOS and iNOS were similarly immunoexpressed in both groups of cells. Moreover, we observed that the NO content was significantly higher in medium derived by DS-AF-MSCs. CONCLUSIONS Our study shows, for the first time, the differences between AF-MSCs isolated from control and trisomy 21 pregnancies and suggest an involvement of NO and VEGF in the physiopathological mechanisms associated with DS pregnancy.
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Affiliation(s)
- Eleonora Salvolini
- Department of Molecular Pathology and Innovative Therapies - Histology Section, Polytechnic University of Marche, Ancona, Italy.
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Di Iorio R, Marinoni E, Gazzolo D, Letizia C, Di Netta T, Cosmi EV. Maternal nitric oxide supplementation increases adrenomedullin concentrations in growth retarded fetuses. Gynecol Endocrinol 2009. [PMID: 12192890 DOI: 10.1080/gye.16.3.187.192] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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de Pace V, Chiossi G, Facchinetti F. Clinical use of nitric oxide donors and L-arginine in obstetrics. J Matern Fetal Neonatal Med 2007; 20:569-79. [PMID: 17674274 DOI: 10.1080/14767050701419458] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Nitric oxide (NO) is a free radical that plays a fundamental role in human physiology, being involved in the homeostasis of different functions. In obstetrics this molecule is determinant in the physiology of labor and cervical ripening; it possibly plays a fundamental role in the etiology of preeclampsia and intrauterine growth restriction, and it could also be utilized in view of its ability to induce smooth muscle relaxation. Several clinical trials have ascertained the ability of the topical application of NO donors to promote cervical ripening, and also labor induction. There is much less evidence on the use of NO donors in the vascular complications of pregnancy, either as prophylactics or therapeutic agents. Due to the capacity of NO to promote relaxation of smooth muscle, NO donors have been employed as tocolytics with performance similar to other agents. Moreover, although anecdotal, the experience of sudden uterine relaxation using NO donors in obstetric emergencies remains of great clinical value.
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Affiliation(s)
- Viviana de Pace
- Mother-Infant Department, University of Modena and Reggio Emilia, Modena, Italy
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Facchinetti F, Saade GR, Neri I, Pizzi C, Longo M, Volpe A. L-arginine supplementation in patients with gestational hypertension: a pilot study. Hypertens Pregnancy 2007; 26:121-30. [PMID: 17454224 DOI: 10.1080/10641950601147994] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To evaluate the effects of L-arginine (L-Arg) supplementation on clinical outcomes and blood pressure (BP) changes in patients with gestational hypertension. METHODS Patients with gestational hypertension and proteinuria (n = 28, >300 mg/24 h) and those without proteinuria (n = 46) were randomized in a double-blind design to receive either L-Arg (20g/500 mL intravenously daily, for 5 days followed by 4 g/day orally for 2 weeks) or placebo (PL). The primary outcome variable was time from randomization to delivery (Latency). Automated BP readings were obtained every 2 hours, between 8.00 am and 8.00 pm daily, untill the sixth day after treatment. RESULTS At inclusion, gestational age and proportions of patients with proteinuria did not differ significantly between the PL and L-Arg group. Latency was significantly longer in the L-Arg group compared with the PL group (19.5 +/- 16.9 vs. 31.7 +/- 25.2 days; p = 0.008). Compared with baseline, both systolic and diastolic BP 6 days after treatment were significantly reduced in the L-Arg group but not in the PL group. The subgroup of patients without proteinuria randomized to the group receiving L-Arg showed a trend to prolong pregnancy, to attenuate the evolution to PE, and to reduce the rate of low birth weight. CONCLUSIONS The treatment with L-Arg seems promising in prolonging pregnancy and reducing blood pressure, particularly in patients with gestational hypertension and without proteinuria. This benefit should be confirmed in larger studies with the power to evaluate the effectiveness of L-Arg in preventing the development to preeclampsia.
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Affiliation(s)
- Fabio Facchinetti
- Mother-Infant Dept., Section of Gynaecology and Obstetrics, University of Modena and Reggio Emilia, Italy.
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Marinoni E, Vellucci O, Letizia C, Sessa M, Moscarini M, Di Iorio R. The level of adrenomedullin immunoreactivity in seminal fluid is higher in oligozoospermic subjects and correlates with semen biochemical parameters. Eur J Obstet Gynecol Reprod Biol 2007; 131:169-75. [PMID: 16854513 DOI: 10.1016/j.ejogrb.2006.06.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2005] [Revised: 05/24/2006] [Accepted: 06/13/2006] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The newly discovered vasoactive peptide, adrenomedullin, and its receptors are widely distributed in various non-vascular tissues. Recent studies have suggested the possible regulatory role of adrenomedullin (AM) at several levels of the pituitary-gonadal axis. We determined the level of adrenomedullin-like immunoreactivity in the seminal fluid and examined its possible correlation with routine semen parameters, semen biochemical levels or plasma levels of FSH, LH, testosterone or prolactin. MATERIALS AND METHODS A total of 51 males were divided into three groups according to semen analysis: (i) normospermic (n=19); (ii) oligozoospermic (n=17); (iii) azoospermic (n=15). All the subjects were submitted to hormone analysis (LH, FSH, testosterone, prolactin), routine semen parameters and semen biochemical levels (fructosio, citric acid, L-carnitine, nitric oxide) evaluation. AM was determined in plasma and seminal fluid using a specific radioimmunoassay. RESULTS Mean AM concentration in seminal plasma was higher in oligozoospermic subjects than in normospermic males. In patients with non-obstructive azoospermia AM in semen was significantly lower than in patients with obstructive azoospermia. Semen AM levels correlated negatively with citric acid concentrations in oligozoospermic subjects. In patients with obstructive azoospermia AM in seminal fluid was correlated with citric acid levels. There was a relationship between plasma AM and prolactin. CONCLUSIONS We conclude that in human seminal fluid AM concentration is increased in infertile oligozoospermic patients and derives very likely from the prostate. Its role in the regulation of male fertility, however has to be understood.
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Affiliation(s)
- Emanuela Marinoni
- Department of Gynecology, Perinatology and Child Health, Viale Regina Elena 324, I-00161 Rome, Italy.
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Huber A, Grimm C, Jirecek S, Heim K, Zeillinger R, Husslein P, Hefler L. Polymorphisms of the Nos3 gene and unexplained late intrauterine fetal death. Eur J Obstet Gynecol Reprod Biol 2005; 122:151-5. [PMID: 16219514 DOI: 10.1016/j.ejogrb.2005.01.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2004] [Revised: 01/01/2005] [Accepted: 01/06/2005] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Genetic polymorphisms associated with vascular diseases have been proposed to be involved in the pathogenesis of late unexplained intrauterine fetal death (IUFD). The Nos3 gene is known to regulate vascular tone via the endothelial nitric oxide synthase/nitric oxide pathway. STUDY DESIGN In a multicenter case-control study, we evaluated two Nos3 polymorphisms (exon 7 Glu298Asp and a 27bp-repeat in intron 4) in 92 women with IUFD and 92 healthy control women. RESULTS The investigated Nos3 polymorphisms were not associated with the occurrence of IUFD. In the subgroup of pregnancies affected by IUFD, women with at least one mutant allele of the Nos3 intron 4 polymorphism were diagnosed with IUFD at a significantly earlier gestational age (31.8 [standard deviation (S.D.) = 4.9] weeks versus 34.6 [S.D. = 4.8] weeks, p = 0.02) and showed a significantly reduced birth weight (2113 g [S.D. = 1028] versus 1571 g [S.D. = 568], p = 0.03). CONCLUSION We are the first to report on Nos3 polymorphisms and IUFD. While not being associated with the incidence of IUFD overall, the intron 4 Nos3 polymorphism might modulate the timing of IUFD in affected pregnancies.
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Affiliation(s)
- Ambros Huber
- Department of Obstetrics and Gynecology, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
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Hascalik S, Celik O, Dogru MI, Kocagun Dogru A, Inan E, Yurekli M. Influence of misoprostol (PGE1) on amniotic fluid and maternal serum adrenomedullin levels. Acta Obstet Gynecol Scand 2005; 84:833-6. [PMID: 16097971 DOI: 10.1111/j.0001-6349.2005.00819.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The purpose of this study was to determine the levels of adrenomedullin (AdM) in amniotic fluid (AF) and maternal serum of misoprostol (PGE1)-induced pregnant women. MATERIALS AND METHODS A total of 40 women were included in the study: 20 were in active labor and were delivered vaginally and a further 20 were not in labor and misoprostol induction was performed. Women who were undergoing labor induction received 50 microg of misoprostol, which was placed in the posterior fornix of the vagina every 4 hrs until the onset of labor. In each patient, maternal plasma and AF samples were collected. Samples of AF were collected by transvaginal route at the time of rupture of the membranes. The labor was at the same stage in both the groups during the sample collection. In all pregnant subjects, maternal blood samples were drawn from the cubital vein at the time of AF sampling. Amniotic fluid and serum AdM concentration was measured by using reverse-phase high-performance liquid chromatography. RESULTS Misoprostol-induced pregnant women showed significantly higher AdM concentrations than control pregnant women in AF (79.48 +/- 6.14 pmol/ml versus 21.28 +/- 0.90 pmol/ml, P = 0.000) and maternal serum (88.20 +/- 4.34 pmol/ml versus 29.78 +/- 4.51 pmol/ml, P = 0.000). There was no significant difference between maternal serum and AF-AdM concentrations in misoprostol and control subjects. CONCLUSION Increased serum and AF-AdM concentrations may be necessary to initiate cervical ripening in misoprostol-induced pregnant women.
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Affiliation(s)
- Seyma Hascalik
- Department of Obstetrics and Gynecology, Turgut Ozal Medical Center, Inonu University, 44069 Malatya, Turkey.
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Tranquilli AL, Giannubilo SR, Bezzeccheri V, Ciavattini A, Scagnoli C, Mazzanti L. Amniotic levels of nitric oxide and vascular endothelial growth factor in pregnancy with subsequent intrauterine fetal death. Eur J Obstet Gynecol Reprod Biol 2004; 114:162-5. [PMID: 15140509 DOI: 10.1016/j.ejogrb.2003.10.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2003] [Revised: 10/09/2003] [Accepted: 10/28/2003] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Nitric oxide (NO) and vascular endothelial growth factor (VEGF) regulate angiogenesis and seem involved in the early stages of placentation. If angiogenesis is reduced, this may lead to poor placentation and fetal death. This study was aimed to determine whether VEGF and NO are associated to subsequent fetal death. STUDY DESIGN We retrospectively assessed NO and VEGF on midtrimetster amniotic fluid from seven women who had subsequently had intrauterine fetal death before 20 weeks, and compared the results with those of 14 controls matched for age and gestation. All women had undergone amniocentesis for maternal age. All were at 16 weeks of gestation. None had shown chromosomal abnormalities. Results (mean+/-S.D.) were tested for statistics with Student's t-test with significance at P<0.05. RESULTS Women with subsequent fetal death had both amniotic NO and VEGF lower than women with normal pregnancy (NO 3.28+/-1.20 microg/mg creatinine versus 6.02+/-1.57 microg/mg creatinine, P<0.05; VEGF 210.10+/-69.55 pg/ml versus 255.05+/-88.66 pg/ml). CONCLUSIONS An early reduction of both NO and VEGF may be responsible of an impaired placental vascular development and endothelial regulation that may lead to fetal death.
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Affiliation(s)
- Andrea L Tranquilli
- Department of Obstetrics and Gynecology, Polytechnic University of Marche, Salesi Hospital, via Corridoni 11, 60123 Ancona, Italy.
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Kähler C, Schleussner E, Möller A, Seewald HJ. Nitric oxide donors: effects on fetoplacental blood flow. Eur J Obstet Gynecol Reprod Biol 2004; 115:10-4. [PMID: 15223157 DOI: 10.1016/s0301-2115(02)00429-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2001] [Revised: 06/18/2002] [Accepted: 10/21/2002] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To investigate fetal and uteroplacental blood flow after transdermal administration of glyceroltrinitrate (GTN) in pregnancies at risk for preterm delivery. STUDY DESIGN Twenty-five pregnant women who received GTN patches (Nitroderm TTS 10) with a dosage of 0.8 mg/h, because of risk for preterm delivery, were included in the prospective study. Doppler measurements (resistance index, RI) of the umbilical artery (UA), the middle cerebral artery (MCA) and the uterine arteries of the placental (UTA-P) and the non-placental (UTA-NP) side, with calculation of the mean-RI (UTA-mean), were performed before and after 24, 48 and 72 h of the 1st GTN application. Wilcoxon test and Holm correction were used for statistical analysis. RESULTS The initial RI values were in the normal range. Significant decreases of the RI of UTA-NP ( P = 0.02 ) and UTA-mean ( P = 0.03) were observed 24h after GTN application. The other RI values did not show significant changes. CONCLUSION Transdermal nitroglycerine used for the treatment of preterm labour does only reduce uterine vascular impedance at the non-placental side with primary higher resistance. It does not affect fetal perfusion and uterine perfusion at the placental side with normal blood flow resistance.
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Affiliation(s)
- Chistiane Kähler
- Department of Obstetrics and Gynaecology, Friedrich Schiller University Jena, Bachstr. 18, 07740 Jena, Germany.
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Tranquilli AL, Bezzeccheri V, Giannubilo SR, Scagnoli C, Mazzanti L, Garzetti GG. Amniotic vascular endothelial growth factor (VEGF) and nitric oxide (NO) in women with subsequent preeclampsia. Eur J Obstet Gynecol Reprod Biol 2004; 113:17-20. [PMID: 15036704 DOI: 10.1016/s0301-2115(03)00369-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2002] [Revised: 04/29/2003] [Accepted: 05/23/2003] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To assess whether amniotic fluid concentrations of nitric oxide (NO) and vascular endothelial growth factor (VEGF) in early pregnancy correlate to subsequent preeclampsia. STUDY DESIGN We performed a retrospective study to assess VEGF and NO on the second trimester amniotic fluid of 15 healthy women, and 15 women who subsequently developed preeclampsia. RESULTS In women with subsequent preeclampsia, both VEGF (213.19+/-78.42 pg/ml) and NO concentrations (4.31+/-1.02 micromol/mg creatinine) were significantly lower than healthy controls (VEGF 255.05+/-88.66 pg/ml; NO 5.02+/-1.57 microg/mg creatinine; P<0.05). CONCLUSIONS Our findings suggest that reduced VEGF may be responsible, at least in part, for the impaired vascular development which occurs in preeclampsia. Low concentrations of VEGF and NO in the second trimester may represent an impaired stimulus to vascular formation and endothelial regulation that induce placental disease and preeclampsia.
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Affiliation(s)
- Andrea L Tranquilli
- Department of Obstetrics and Gynecology, University of Ancona, Salesi Hospital, via Corridoni 11, 60123 Ancona, Italy.
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Di Iorio R, Marinoni E, Letizia C, Cosmi EV. Adrenomedullin in perinatal medicine. REGULATORY PEPTIDES 2003; 112:103-13. [PMID: 12667631 DOI: 10.1016/s0167-0115(03)00028-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
This review will consider whether adrenomedullin (AM) plays a role in the different aspects of perinatal medicine: contributing to maternal systemic vasodilatation during pregnancy, regulating uterine and placental blood flow, being involved in the process of implantation and participating in uterine quiescence prior to parturition. In addition, this will also consider whether a modification of AM secretion contributes to some pathological conditions in pregnancy such as preeclampsia and impairment of fetal growth. The biosynthesis of AM increases in gravid rats and in pregnant women, and the placenta represents an important site of AM production during pregnancy. Both the peptide and its receptors have been found in the uterus, placenta, fetal membranes and cord vessels, and fetal membranes and placental tissues in culture secrete AM. AM contributes to maternal systemic vasodilatation, the placental vessels are relaxed by AM in a dose-dependent manner and AM is expressed in the fetoplacental and umbilical vascular endothelium where basal production of AM contributes to low fetoplacental vascular resistances. Controversy exists over the status of circulating and placental AM in preeclampsia and of the relative contribution of AM to impaired fetoplacental circulation and fetal growth. Moreover, the uterus expresses AM mRNA and exogenous AM relaxes the myometrium in a dose-dependent manner; however, clinical studies have shown that AM does not decrease before the onset of parturition. Rather, AM secretion increases during spontaneous labor and in preterm delivery.
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Affiliation(s)
- Romolo Di Iorio
- Laboratory of Perinatal Medicine and Molecular Biology, Institute of Gynecology, Perinatology and Child Health, University La Sapienza, Viale Regina Elena, 324, I-00161, Rome, Italy.
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Tranquilli AL, Bezzeccheri V, Giannubilo SR, Scagnoli C, Mazzanti L, Garzetti GG. Amniotic levels of nitric oxide in women with fetal intrauterine growth restriction. J Matern Fetal Neonatal Med 2003; 13:115-8. [PMID: 12735412 DOI: 10.1080/jmf.13.2.115.118] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Many biochemical observations have shown that nitric oxide (NO) is involved in the vascular angiogenic activity of the fetoplacental unit. The aim of this study was to determine whether NO is implicated in the pathogenesis of intrauterine growth restriction (IUGR). METHODS We retrospectively assessed amniotic fluid NO from second-trimester amniocentesis of 20 healthy normotensive women who subsequently developed IUGR and 20 controls. The same women were re-assessed at the third trimester when IUGR had developed and when the same 20 controls had shown normal pregnancy. Amniotic fluid NO was detected by discontinuous spectrophotometry and the Griess reaction. RESULTS At the second trimester, NO levels in women with subsequent IUGR were significantly lower than in controls (4.1 +/- 0.2 microg/mg creatinine vs. 6.02 +/- 1.57 microg/mg creatinine, p < 0.001). At the third trimester, in women with IUGR, NO levels were significantly higher than in normal pregnancies (7.4 +/- 1.5 vs. 5.02 +/- 0.9 microg/mg creatinine, p < 0.001), and directly correlated with gestational age when growth restriction was diagnosed (r = 0.69, p < 0.001). CONCLUSIONS Low levels of NO during the early second trimester may represent an impaired stimulus to vascular formation and endothelial regulation, inducing placental disease and subsequent fetal growth restriction. High levels of amniotic fluid NO during the third trimester may represent a compensation factor for maintaining adequate uteroplacental perfusion in pregnancies with IUGR.
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Affiliation(s)
- A L Tranquilli
- Department of Obstetrics and Gynecology, University of Ancona, Salesi Hospital, Ancona, Italy
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22
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Marinoni E, Di Iorio R, Villaccio B, Letizia C, Aragona C, Schimberni M, Cosmi EV. Follicular fluid adrenomedullin concentrations in spontaneous and stimulated cycles: relationship to ovarian function and endothelin-1 and nitric oxide. REGULATORY PEPTIDES 2002; 107:125-8. [PMID: 12137974 DOI: 10.1016/s0167-0115(02)00093-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The objective of this study was to determine concentration of adrenomedullin (AM) in follicular fluid and whether a correlation exists between AM and nitric oxide (NO) or endothelin-1 (ET-1) levels in follicular fluid, serum 17beta-estradiol or other parameters of ovarian function in spontaneous and gonadotrophin stimulated ovarian cycles. Follicular fluid samples were obtained at oocyte retrieval from 50 women who underwent an in vitro fertilization (IVF) program: 40 undergoing ovarian hyperstimulation with recombinant FSH and 10 had spontaneous ovarian cycles. AM, ET-1, and NO were detected in all of the follicular fluid samples and their concentrations were similar in spontaneous and stimulated cycles. In patients undergoing ovarian stimulation, follicular fluid AM levels correlated with serum 17beta-estradiol concentration. No correlation was found between follicular AM concentration and parameters of ovarian function. Similarly, no relationship was observed between ET-1, NO, and AM follicular fluid concentrations in either spontaneous or stimulated cycles. This study suggests a possible regulatory effect of the sexual hormones on AM production by the ovary during the ovulatory process. The site of AM secretion and its function (if any), however, remain to be established.
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Affiliation(s)
- Emanuela Marinoni
- Laboratory of Perinatal Medicine and Molecular Biology, 2nd Institute of Obstetrics and Gynecology, University La Sapienza, Viale Regina Elena, 324 I-00161, Rome, Italy.
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Garayoa M, Bodegas E, Cuttitta F, Montuenga LM. Adrenomedullin in mammalian embryogenesis. Microsc Res Tech 2002; 57:40-54. [PMID: 11921355 DOI: 10.1002/jemt.10050] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Here are summarized data supporting that adrenomedullin (AM) is a multifunctional factor involved in the complex regulatory mechanisms of mammalian development. During rodent embryogenesis, AM is first expressed in the heart, followed by a broader but also defined spatio-temporal pattern of expression in vascular, neural, and skeletal-forming tissues as well as in the main embryonic internal organs. AM pattern of expression is suggestive of its involvement in the control of embryonic invasion, proliferation, and differentiation processes, probably through autocrine or paracrine modes of action. AM levels in fetoplacental tissues, uterus, maternal and umbilical plasma are highly increased during normal gestation. These findings in addition to other physiological and gene targeting studies support the importance of AM as a vasorelaxant factor implicated in the regulation of maternal vascular adaptation to pregnancy, as well as of fetal and fetoplacental circulations. AM is also present in amniotic fluid and milk, which is suggestive of additional functions in the maturation and immunological protection of the fetus. Altered expression of AM has been found in some gestational pathologies, although it is not yet clear whether this corresponds to causative or compensatory mechanisms. Future studies in regard to the distribution and expression levels of the molecules known to function as AM receptors, together with data on the action of complement factor H (an AM binding protein), may help to better define the roles of AM during embryonic development.
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Affiliation(s)
- Mercedes Garayoa
- Department of Histology and Pathology, Carcinogenesis Unit, University of Navarra, 31080 Pamplona, Spain.
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Gazzolo D, Bruschettini M, Di Iorio R, Marinoni E, Lituania M, Marras M, Sarli R, Bruschettini PL, Michetti F. Maternal nitric oxide supplementation decreases cord blood S100B in intrauterine growth-retarded fetuses. Clin Chem 2002; 48:647-650. [PMID: 11901065 DOI: 10.1093/clinchem/48.4.647] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/17/2023]
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Hefler LA, Reyes CA, O'Brien WE, Gregg AR. Perinatal development of endothelial nitric oxide synthase-deficient mice. Biol Reprod 2001; 64:666-73. [PMID: 11159371 DOI: 10.1095/biolreprod64.2.666] [Citation(s) in RCA: 78] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
The purpose of this study was to evaluate the influence of endothelial nitric oxide synthase (eNOS) deficiency on fetal growth, perinatal survival, and limb development in a mouse model with a targeted mutagenesis of the Nos3 gene. Wild-type (Nos3+/+) and eNOS-deficient fetuses (Nos3-/-) were evaluated on Gestational Day (E)15 and E17, and newborn pups were observed on Day 1 of life (D1). The average term duration of pregnancy was 19 days. For the evaluation of postnatal development, a breeding scheme consisting of Nos3+/- x Nos3+/- and Nos3-/- x Nos3-/- mice was established, and offspring were observed for 3 wk. Southern blotting was used for genotyping. No significant differences in fetal weight, crown-rump lengths (CRL), and placental weight were seen between Nos3+/+ and Nos3-/- fetuses on E15. By E17, Nos3-/- fetuses showed significantly reduced fetal weights, CRL, and placental weights. This difference in body weight was also seen throughout the whole postnatal period. In pregnancies of Nos3-/- females, the average number of pups alive on D1 was significantly decreased compared to either E15 or E17. Placental histology revealed no abnormalities. On E15, E17, and D1, Nos3(-/-) fetuses demonstrated focal acute hemorrhages in the distal limbs in 0%, 2.6%, and 5.7%, respectively, of all mutant mice studied on the respective days. Bone measurements showed significantly shorter bones in the peripheral digits of hindpaws of Nos3-/- newborns. We conclude mice deficient for eNOS show characteristically abnormal prenatal and postnatal development including fetal growth restriction, reduced survival, and an increased rate of limb abnormalities. The development of this characteristic phenotype of eNOS-deficient mice dates back to the prenatal development during the late third trimester of pregnancy.
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Affiliation(s)
- L A Hefler
- Department of Obstetrics & Gynecology, Baylor College of Medicine, Houston, TX 77030, USA
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Marinoni E, Di Iorio R, Villaccio B, Alberini A, Rota F, Cosmi EV. Amniotic fluid nitric oxide metabolite levels and nitric oxide synthase localization in feto-placental tissues are modified in association with human labor. Eur J Obstet Gynecol Reprod Biol 2000; 89:47-54. [PMID: 10733023 DOI: 10.1016/s0301-2115(99)00186-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Nitric oxide (NO) has a relaxant effect on uterine smooth muscle and may be implicated in maintaining uterine quiescence during pregnancy. In order to investigate the role of nitric oxide in human parturition, we have measured NO metabolite levels in maternal and fetal compartments in association with labor, both at term and preterm. We have also examined the localization and distribution of NO synthase (NOS) isoforms in placentas and fetal membranes after term and preterm delivery by means of immunohistochemistry. Although no differences were present in maternal and fetal blood and in maternal urine among groups, we found that NO metabolite concentrations were higher in amniotic fluid collected from women in labor than in non-laboring patients, both at term (15.4+/-1.6 vs. 6.8+/-0.6 microM/mg creatinine) and preterm (16.7+/-2.0 vs. 7.0+/-0.8 microM/mg creatinine). Ir-bNOS staining appeared to be decreased in fetal membranes collected after spontaneous labor at term and preterm. In contrast, a stronger staining for iNOS was detected in trophoblast cells of fetal membranes from women in labor than in those from non-laboring women. We suggest that NOS isoenzymes in fetal placental tissues are differently regulated and might play different roles during pregnancy.
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Affiliation(s)
- E Marinoni
- Laboratory of Perinatal Medicine and Molecular Biology, 2nd Institute of Obstetrics and Gynaecology, University La Sapienza, Rome, Italy.
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Di Iorio R, Marinoni E, Letizia C, Gazzolo D, Lucchini C, Cosmi EV. Adrenomedullin is increased in the fetoplacental circulation in intrauterine growth restriction with abnormal umbilical artery waveforms. Am J Obstet Gynecol 2000; 182:650-4. [PMID: 10739524 DOI: 10.1067/mob.2000.103944] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To examine whether adrenomedullin, a novel vasoactive peptide produced by the placenta, participates in the uteroplacental hemodynamic alterations in intrauterine growth restriction, we studied the correlation between adrenomedullin levels and fetoplacental blood flow. STUDY DESIGN Maternal and umbilical blood samples were collected in pregnancies complicated by intrauterine growth restriction with abnormal umbilical artery Doppler findings and in control pregnancies. Adrenomedullin levels were measured by means of a specific radioimmunoassay, and flow velocimetry waveforms were recorded from uterine, umbilical, and fetal middle cerebral arteries. RESULTS Mean adrenomedullin values in umbilical plasma were higher (P <.05) in patients with intrauterine growth restriction (63.7 +/- 34.2 pg/mL; n = 16) than in control subjects (38.1 +/- 14.8 pg/mL; n = 16). A significant correlation was found between maternal adrenomedullin levels and umbilical artery pulsatility index. Moreover, fetal adrenomedullin concentrations correlated negatively with middle cerebral artery pulsatility index and positively with umbilical artery pulsatility index/middle cerebral artery pulsatility index ratio. CONCLUSION This study provides evidence that adrenomedullin is increased in fetuses with intrauterine growth restriction in response to reduced uteroplacental blood flow and suggests that it may participate in the fetal hemodynamic modifications.
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Affiliation(s)
- R Di Iorio
- Laboratory of Perinatal Medicine and Molecular Biology, 2nd Institute of Obstetrics and Gynecology, and the Department of Internal Medicine, University "La Sapienza," Rome, Italy
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Egberts J, van den Bosch N, Soederhuizen P. Amniotic fluid nitric oxide metabolites, cyclic guanosine 3',5' monophosphate and dimethylarginine in alloimmunized pregnancies. Eur J Obstet Gynecol Reprod Biol 1999; 85:209-14. [PMID: 10584637 DOI: 10.1016/s0301-2115(99)00033-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To determine the relationship between gestational age or the Liley index (the severity of fetal hemolysis) and the amniotic fluid total nitrite (NOx), cyclic guanosine 3',5 'monophosphate (cGMP) and dimethylarginine (DMA) concentrations. We hypothesized that the concentrations of these components change because of fetal growth or adaptation to fetal anemia. STUDY DESIGN Amniotic fluids (n=64) were obtained between 23 and 37 weeks from fifty-three patients at risk for alloimmunization. Amniotic fluids from the pregnancies with a Liley index=1 were considered as controls (n=17). Creatinine (C, microMol) was determined with the Jaffé reagent, nitrite (NOx, microMol) with the Griess reagent, cGMP (nMol) by an enzyme immunoassay and DMA (microMol) after HPLC. Multiple regression analysis was used for separating the effects of growth and the estimated degree of anemia. RESULTS The concentration of NOx, cGMP and DMA was not related to the Liley index or whether or not the fetuses needed blood transfusions. The concentrations of creatinine (C), NOx and cGMP increased during pregnancy (in weeks;W) (C=-69.2+6.28W; r2=0.532; P<0.0001, NOx=-17.6+1.29W; r2=0.106; P=0.01, cGMP=-20.9+1.05W; r2=0.414; P<0.0001). The DMA concentration (3.8+/-0.8(SD) and the NOx/creatinine ratio (181+/-110 mM/M) did not change with gestational age. The cGMP/creatinine ratios (microM/M) increased (cGMP/C=-41.8+4.31W; r2=0.134; P=0.007) whereas the DMA/creatinine ratio (mM/M) declined during pregnancy (DMA/C=73.1-1.34W; r2=0.278; P=0.0002). Consequently, the NOx/DMA and cGMP/DMA ratios increased (NOx/DMA=-6.96+0.43W; r2=0.105; P=0.02, cGMP/DMA=-5.9+0.29W; r2=0.391; P<0.0001). CONCLUSIONS The concentrations in amniotic fluid of cGMP and NOX, but not of DMA increase during gestation. The cGMP/creatinine ratio increases also whereas that of DMA decreases. The changes in products of the NO-cGMP pathway are independent of mild to moderate fetal hemolysis and may result from fetal growth as well as from reduced inhibition of NO synthase by DMA. Gestational age related effects should be taken into account when analyzing nitric oxide metabolites in amniotic fluids.
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Affiliation(s)
- J Egberts
- Department of Obstetrics and Gynecology, Leiden University Medical Center, The Netherlands.
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Di Iorio R, Marinoni E, Letizia C, Alò P, Villaccio B, Cosmi EV. Adrenomedullin, a new vasoactive peptide, is increased in preeclampsia. Hypertension 1998; 32:758-63. [PMID: 9774376 DOI: 10.1161/01.hyp.32.4.758] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Adrenomedullin is a novel peptide that elicits a long-lasting vasorelaxant activity. Recently, we found high concentrations of adrenomedullin in maternal and umbilical cord plasma and in amniotic fluid in full-term human pregnancy, indicating a role of this peptide during gestation. To investigate the possibility that adrenomedullin is involved in the pathophysiology of preeclampsia, we measured its concentration in maternal and fetoplacental compartments. We studied 12 normotensive nonpregnant women, 13 hypertensive nonpregnant subjects, 29 patients with preeclampsia, and 30 normotensive pregnant women. In all patients, plasma was collected from the cubital vein, and amniotic fluid samples were obtained by transabdominal amniocentesis or at elective cesarean section. Plasma samples from umbilical vein and placental tissues were collected at delivery. Adrenomedullin was assayed on plasma and amniotic fluid samples using a specific radioimmunoassay, and its localization and distribution on placental sections was determined by immunohistochemistry. Adrenomedullin concentrations were higher in hypertensive than in normotensive nonpregnant patients. Pregnant women had higher adrenomedullin levels than nonpregnant subjects, although maternal plasma adrenomedullin concentrations did not differ between normal pregnant and preeclamptic women. Preeclamptic patients showed higher concentrations (P<0.01) than normotensive pregnant women of adrenomedullin in amniotic fluid (252+/-29 versus 112+/-10 fmol/ micromol creatinine) and umbilical vein plasma (18.1+/-2.1 versus 8. 5+/-1.1 fmol/mL). Increased local production of adrenomedullin is associated with preeclampsia. The fetus seems to be responsible for the higher levels of this hormone. Increased adrenomedullin concentrations may be necessary to maintain placental vascular resistance and/or fetal circulation at a physiological level.
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Affiliation(s)
- R Di Iorio
- 2nd Institute of Obstetrics and Gynecology, the Department of Internal Medicine of Pathology and Experimental Medicine, University "La Sapienza," Rome, Italy
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