Hypoxia induced activin secretion by the fetoplacental unit: differential responses related to gestation

Activin A in Mammalian Physiology

Activins are dimeric glycoproteins belonging to the transforming growth factor beta superfamily and resulting from the assembly of two beta subunits, which may also be combined with alpha subunits to form inhibins. Activins were discovered in 1986 following the isolation of inhibins from porcine follicular fluid, and were characterized as ovarian hormones that stimulate follicle stimulating hormone (FSH) release by the pituitary gland. In particular, activin A was shown to be the isoform of greater physiological importance in humans. The current understanding of activin A surpasses the reproductive system and allows its classification as a hormone, a growth factor, and a cytokine. In more than 30 yr of intense research, activin A was localized in female and male reproductive organs but also in other organs and systems as diverse as the brain, liver, lung, bone, and gut. Moreover, its roles include embryonic differentiation, trophoblast invasion of the uterine wall in early pregnancy, and fetal/neonate brain protection in hypoxic conditions. It is now recognized that activin A overexpression may be either cytostatic or mitogenic, depending on the cell type, with important implications for tumor biology. Activin A also regulates bone formation and regeneration, enhances joint inflammation in rheumatoid arthritis, and triggers pathogenic mechanisms in the respiratory system. In this 30-yr review, we analyze the evidence for physiological roles of activin A and the potential use of activin agonists and antagonists as therapeutic agents.

Changes in concentrations of follistatin in maternal plasma and foetal fluids during pregnancy and parturition in sheep

Studies have shown that follistatin may be involved in the regulation of ovarian development, pregnancy and parturition. The aim of the present study was to measure follistatin levels in maternal plasma and foetal fluids during pregnancy and parturition in sheep. Using a previously described follistatin radioimmunoassay, we found that follistatin in foetal plasma and allantoic fluid was higher in the female than in the male at days 50-75 of gestation. Follistatin concentrations in maternal plasma declined from -9 to -3h before the completion of lamb delivery, and increased from 21 to 39 h after parturition. These results suggest that follistatin may play a role in femaleness development, and that follistatin may be involved in the mechanism of normal parturition and in regulation of the tissue repair after parturition.

Identification of fetal cerebral lactate using magnetic resonance spectroscopy

Proton magnetic resonance spectroscopy has the potential to evaluate the cerebral metabolic status in the at-risk fetus. Cerebral lactate, a marker for hypoxia, has been identified by proton magnetic resonance spectroscopy in the brain of fetal animals subject to hypoxic conditions, but not in the human fetus. We report a case of a fetus with gastroschesis with elevated cerebral lactate on proton magnetic resonance spectroscopy.

Maternal serum activin A and the prediction of intrauterine growth restriction

BACKGROUND

Differentiating between the small healthy fetus and the high risk growth restricted fetus remains a significant obstetric challenge. It has been previously shown that maternal activin A levels are increased in association with fetal growth restriction.

AIM

To evaluate maternal serum activin A as a marker of fetal growth restriction.

METHODS

Prospective cohort study of 62 women referred for fetal assessment because of a clinical suspicion of a small for gestation fetus. Maternal serum levels of activin A were measured with an ELISA.

RESULTS

Activin A levels, expressed as median (95% CI) MoMs, were similar in the women with a normal-sized fetus and in those with a healthy small for gestational age fetus, 1.14 (95% CI 1.0-1.5) and 1.31 (95% CI 0.8-2.1), respectively (P = 0.97). Compared to the women with a normal-sized fetus or a healthy small fetus, activin A levels were significantly elevated in the women who had an intrauterine fetal growth restriction fetus 2.37 (95% CI 1.6-3.7; P = 0.01 compared to normal and P = 0.04 compared to healthy small).

CONCLUSIONS

These data confirm that circulating activin A is increased in association with fetal growth restriction. However, a single blood sample for activin A will not efficiently discern between healthy and compromised small fetuses.

Chronic fetal hypoxia increases activin A concentrations in the late-pregnant sheep

OBJECTIVE

To determine whether activin A concentrations are altered in chronic fetal hypoxemia and intrauterine fetal growth restriction (IUGR).

DESIGN

In vivo animal experimental model.

SETTING

Department of Physiology, Monash University.

POPULATION

Chronically catherised fetal sheep in late pregnancy.

METHODS

Chronic fetal hypoxia and IUGR were experimentally induced by single umbilical artery ligation (SUAL) in catheterised fetal sheep. Maternal and fetal blood samples and amniotic fluid (AF) samples were collected during surgery and thereafter on alternate days, until the time of delivery for analyte measurement. Fetal blood gas parameters were measured daily.

MAIN OUTCOME MEASURES

Plasma and AF was used to analyse activin A, prostaglandin E2 (PGE2) and cortisol and fetal blood gas analysis was undertaken in whole blood.

RESULTS

SUAL produced asymmetric IUGR and non-acidaemic chronic fetal hypoxia and resulted in preterm labour (129 [3] days). AF activin A concentrations were 10-fold higher in the SUAL group than in controls whereas levels in the fetal and maternal circulations were similar between groups.

CONCLUSIONS

SUAL-induced IUGR and fetal hypoxaemia increases AF activin A. This may be an important adaptive or protective response to IUGR.