Immunochemical detection and characterization of pregnancy-associated endometrial alpha 1- and alpha 2-globulins secreted by human endometrium and decidua

Immunotherapy in endometrial cancer: rationale, practice and perspectives

Tumor immunotherapy has attracted more and more attention nowadays, and multiple clinical trials have confirmed its effect in a variety of solid tumors. Immune checkpoint inhibitors (ICIs), cancer vaccines, adoptive cell transfer (ACT), and lymphocyte-promoting cytokines are the main immunotherapy methods. Endometrial cancer (EC) is one of the most frequent tumors in women and the prognosis of recurrent or metastatic EC is poor. Since molecular classification has been applied to EC, immunotherapy for different EC subtypes (especially POLE and MSI-H) has gradually attracted attention. In this review, we focus on the expression and molecular basis of the main biomarkers in the immunotherapy of EC firstly, as well as their clinical application significance and limitations. Blocking tumor immune checkpoints is one of the most effective strategies for cancer treatment in recent years, and has now become the focus in the field of tumor research and treatment. We summarized clinical date of planned and ongoing clinical trials and introduced other common immunotherapy methods in EC, such as cancer vaccine and ACT. Hormone aberrations, metabolic syndrome (MetS) and p53 mutant and that affect the immunotherapy of endometrial cancer will also be discussed in this review.

β-Lactoglobulin and Glycodelin: Two Sides of the Same Coin?

The two lipocalins, β-lactoglobulin (βLg) and glycodelin (Gd), are possibly the most closely related members of the large and widely distributed lipocalin family, yet their functions appear to be substantially different. Indeed, the function of β-lactoglobulin, a major component of ruminant milk, is still unclear although neonatal nutrition is clearly important. On the other hand, glycodelin has several specific functions in reproduction conferred through distinct, tissue specific glycosylation of the polypeptide backbone. It is also associated with some cancer outcomes. The glycodelin gene, PAEP, reflecting one of its names, progestagen-associated endometrial protein, is expressed in many though not all primates, but the name has now also been adopted for the β-lactoglobulin gene (HGNC, www.genenames.org). After a general overview of the two proteins in the context of the lipocalin family, this review considers the properties of each in the light of their physiological functional significance, supplementing earlier reviews to include studies from the past decade. While the biological function of glycodelin is reasonably well defined, that of β-lactoglobulin remains elusive.

The Roles of Glycodelin in Cancer Development and Progression

Glycodelin is a kind of glycoprotein expressed in secretory endometrium, pregnancy deciduas, and amniotic fluid originally, which is vital for the maintenance of normal human reproductive activities. Recent researches have reported that glycodelin is specifically expressed in various malignancies, including female-specific cancers such as endometrial cancer, ovarian cancer and breast cancer, and non-gender specific cancers including lung cancer, and colon cancer, and glycodelin expression correlates with the diagnosis and prognosis of cancer patients. This review focuses on the expression of glycodelin in different cancers and its role in cancer development and progression. Glycodelin possesses the abilities to regulate cancer cell proliferation, differentiation, and invasion, promote cancer angiogenesis, and modulate the differentiation and function of immune cells including T cells, dendritic cells, monocyte-macrophages, natural killer cells and B cells participating in cancer development. The expression of glycodelin can be regulated by stromal cells, lysophosphatidic acid, histone deacetylase inhibitors, and relaxin. In summary, glycodelin is a promising biomarker for the diagnosis and prognosis of cancer patients, and depending on its distinct immunoregulatory effects, glycodelin can be a prospective target for cancer immunotherapy.

Endometrial protein PP14: a new test of endometrial function?

The human endometrium produces a number of proteins which are at least partly specific to that tissue. Two of these proteins have been the subject of much recent work. They were originally called ‘placental protein 12’ and ‘placental protein 14’ (PP12 and PP14) because they were isolated by Hans Bohn from extracts of whole placentae. However, it is now clear that they arise from the maternal endometrium (decidua) rather than the fetal trophoblast. Placental protein 12 has been shown to be identical to the insulin-like growth factor binding protein-1 (IGFBP-1). It is produced in many normal tissues and its measurement probably does not provide a specific index of endometrial function. By contrast, PP14 is detectable only in ‘reproductive’ tissues and, in theory, might be an excellent clinical test of endometrial function.

Differential regulation of insulin-like growth factor binding protein-1 and -2 by insulin in the baboon (Papio anubis) endometrium

BACKGROUND

The purpose of this study was to examine the effect of insulin on expression and synthesis of IGFBP-1 and IGFBP-2 in the baboon endometrium in vitro.

METHODS

Baboon endometrial explants collected from cycling, ovariectomized, steroid-treated, simulated-pregnant and pregnant animals were cultured for 48 h in the presence or absence of insulin, with or without estradiol, progesterone and hCG.

RESULTS

Insulin clearly inhibited IGFBP-1 production and mRNA expression in a time- and dose-dependent manner, whereas IGFBP-2 synthesis was not significantly affected. The inhibitory effects of insulin on IGFBP-1 were more evident in explants of non-pregnant tissue or tissue away from the implantation site. In the absence of insulin, synthesis of IGFBP-1 was induced in explants with low levels of de novo synthesis whereas IGFBP-2 synthesis was inhibited. This effect was potentiated by steroids and hCG in the explant cultures.

CONCLUSION

Insulin differentially regulates endometrial IGFBP-1 and IGFBP-2 secretion in the baboon.

Immunolocalization of glycodelin in the genital tract of rats

Glycodelin, also known as placental protein 14 has been predominantly localized to organs of the human genital tract. Unfortunately the physiological role of glycodelin is largely unknown since it depends on limited availability of tissues. Therefore, a suitable animal model to study the role of glycodelin would be desirable. Previously, it was shown that glycodelin mRNA is expressed in the genital tract of male and female rats. In the present study, we demonstrate the expression of glycodelin protein in male and female rats by immunohistochemistry and Western blot analysis. For this purpose a polyclonal antibody was generated against glycodelin peptide. In female rats, glycodelin was found in the epithelial gland cells of the uterus, epithelial cells of the fallopian tube as well as in corpora lutea, interstitial and theca cells of the ovary. Glycodelin was distributed in all epithelial cells of the epididymis and the seminal vesicle. In the seminiferous epithelium, glycodelin was seen in all developmental stages of spermatogonia and spermatocytes and in Sertoli cells. Whereas in the rat male reproductive tract glycodelin expression is slightly different from human or primate tissues, in organs of the rat female genital tract glycodelin expression is similar to humans and primates.

Glycodelin: a major lipocalin protein of the reproductive axis with diverse actions in cell recognition and differentiation

Glycodelin is a glycoprotein that belongs to the lipocalin superfamily. Depending on glycosylation, glycodelin appears in various isoforms. In the uterus, glycodelin-A is the major progesterone-regulated glycoprotein secreted into uterine luminal cavity by secretory/decidualized endometrial glands. The other tissues expressing glycodelin include fallopian tubes, ovary, breast, seminal vesicle, bone marrow, and eccrine glands. Glycodelin-A potently and dose-dependently inhibits human sperm-egg binding, whereas differently glycosylated glycodelin-S from seminal plasma has no such effect. Absence of contraceptive glycodelin-A in the uterus during periovulatory midcycle is consistent with an open "fertile window." Glycodelin induced by local or systemic administration of progestogens may potentially reduce the fertilizing capacity of sperm in any phase of the menstrual cycle. Glycodelin also has immunosuppressive activity. Its high concentration at the fetomaternal interface may contribute to protection of the embryonic semiallograft. Besides being an epithelial differentiation marker, glycodelin appears to play a role in glandular morphogenesis, as transfection of glycodelin cDNA into a glycodelin-negative breast cancer cells resulted in formation of gland-like structures, restricted proliferation, and induction of other epithelial markers. These various properties, as well as the chemistry, biology, and clinical aspects of glycodelin, continue to be areas of active investigation reviewed in this communication.

Hormone regulation and hormone antagonist effects on protein patterns of human endometrial secretion during receptivity

Endometrial receptivity is a particular stage of maturation during the luteal phase to permit implantation. We have studied endometrial protein secretion and its patterns evaluated by SDS-PAGE, laser densitometry and Western blots. Uterine secretion electrophoresis (USE) permits highly sophisticated analyses of the intrauterine milieu and allows clinical determination of the receptive stage of the endometrium. This technique reveals direct parameters by patterns of numerous individual protein bands, mainly resolved between 68.0 and 6.5 kD. Characteristic bands appear during the typical functional states of the menstrual cycle presenting evidence on the diagnostic capacity of this method to identify stages of adequate (= normal) or inadequate (= defective) luteal phase maturation. Several individual protein bands appear as characteristic markers for the receptive stage of the luteal phase. We have isolated and molecularly identified several of these proteins: histones H2A, H2B, H3 and H4. In order to identify the endocrine dependency of the protein bands, which significantly contribute to the "receptive stage pattern," patients were treated with the progesterone antagonist RU 486 at day LH +2. The assessment 4 days later revealed deficient USE patterns, particularly diminished and missing bands of the H2A-, H2B-, and H3-histones. These results demonstrate progesterone-dependent components of the endometrium at the receptive stage, which can be used as useful markers for an improved precision in luteal phase diagnostics. On the other hand, essential parts of the protein pattern may serve as new targets for successful contraceptive interventions ("endometrial contraception").

Morphology of the human endometrium in the peri-implantation period

Although the histology and ultrastructure of the human endometrium are well documented, it is clear that morphometry can reveal subtle changes in cellular biology, especially when combined with suitable sampling and dating of the specimen. These changes reflect functional events, such as protein secretion, which may be studied using the endometrial flushing technique. Although it is likely that further insights into the basic cell physiology of the reproductive tract will result from the use of appropriate in vitro models, the role of endometrial biopsy for clinical monitoring remains essential.

Use of metal-chelate affinity chromatography and hydrophobic interaction chromatography for purification of placental protein 12

Placental protein 12 was isolated from amniotic fluid. Albumin was removed by means of ion-exchange chromatography on DEAE-Sepharose and chromatography on Blue-Sepharose. Complete purification was obtained by metal-chelate affinity chromatography and hydrophobic interaction chromatography under mild conditions for desorption. Using this procedure large quantities of a highly purified preparation can be obtained in one run.

Characterisation of the differential expression of marker antigens by normal and malignant endometrial epithelium

In order to examine the production of marker proteins, a reproducible method has been established for culturing purified epithelial cells from normal and malignant endometrium. We have examined the differential expression of secretory proteins using immunohistochemistry in frozen tissue sections, immunocytochemistry in cell cultures derived from the same specimens and protein assays on the culture supernatants. Placental protein 14 (PP14) was produced by normal premenopausal epithelium but not by the post-menopausal or malignant endometrial epithelium. In contrast, placental alkaline phosphatase (PLAP) was produced by endometrial cancers and the endometrial adenocarcinoma-derived cell line Ishikawa, but not by the normal endometrial epithelium. Other markers such as CA-125, which was produced by both normal and malignant endometrium but not by the cell line, and human chorionic gonadotrophin (beta-hCG), which was produced by Ishikawa cells but not by any of the fresh tissues, were less cancer specific. Placental alkaline phosphatase is a direct product of endometrial cancers that can be readily assayed in serum using this two-site assay to test its clinical usefulness in monitoring patients at risk for endometrial cancer.

Concentration of endometrial protein PP14 in uterine flushings throughout the menstrual cycle in normal, fertile women

OBJECTIVE

To determine the variation in concentration of endometrial protein PP14 in uterine flushings throughout the menstrual cycle comparing this to concentrations in plasma samples.

DESIGN

Precise timing of all samples by the luteinising hormone surge.

SETTING

Jessop Hospital for Women, Sheffield.

SUBJECTS

Twenty-three regularly cycling, previously fertile volunteer women.

INTERVENTIONS

Observational study; 10 ml of physiological saline was used to flush the uterine cavity once or serially in the cycle of the study.

MAIN OUTCOME MEASURES

The measurement of PP14 levels by radioimmunoassay in uterine flushings and plasma samples.

RESULTS

In uterine flushing, PP14 levels were not detectable in significant amounts in the proliferative phase and the early luteal phase; after day LH + 6, the concentration rises rapidly with a doubling time of only 6.6 to 14.6 h in the midluteal phase. In the late luteal phase, the concentrations in uterine flushing were over a hundred times higher than the corresponding plasma samples.

CONCLUSIONS

The measurement of PP14 in uterine flushings is likely to be of greater value than the measurement in plasma samples; it may provide a valuable alternative to the evaluation of endometrial function.

An analysis of the variation of plasma concentrations of placental protein 14 in artificial cycles

OBJECTIVE

To analyze the factors affecting the variation of plasma concentration of placental protein 14 (PP14) in artificial cycles.

DESIGN

The effects of different hormone replacement therapy (HRT) regimens were examined in a crossover design.

SETTING

Jessop Hospital for Women, Sheffield, United Kingdom.

PATIENTS

Eighteen women with premature ovarian failure: 6 associated with Turner's syndrome and 12 with idiopathic premature ovarian failure.

INTERVENTIONS

Four different HRT regimens; 36 study cycles.

MAIN OUTCOME MEASURES

Plasma PP14 concentrations on days 1, 15, 19, and 29 of the artificial cycles.

RESULTS

In cycles treated with a standard HRT, the levels were similar to those of the natural cycle. Subjects with Turner's syndrome did not have elevated PP14 levels, whereas the majority (9/12 [75%]) of those with idiopathic premature ovarian failure had elevated levels on day 29 of the cycle. Levels of PP14 were reduced when either the doses of estradiol valerate were reduced to 1/3 or the doses of progesterone (P) were reduced to 1/5 of the standard HRT.

CONCLUSIONS

Plasma levels of PP14 are dependent not only on P stimulation but also on adequate estrogen priming.

Immunochemically detected placental proteins and their biological functions

During the last 20 years a systematic search for proteins occurring in human term placenta (afterbirth) has been performed in our laboratory. As a result more than 30 soluble placental proteins and at least 20 different solubilized antigens apparently derived from the placental membranes have been identified by immunochemical methods in extracts from human term placentas. Most of these proteins have already been isolated to purity and characterized by their physicochemical parameters. Specific antisera to these proteins were obtained by immunizing animals with the corresponding purified proteins. They were used detect and localize these antigens by immunochemical methods in the placenta and in other human tissues. Sensitive immunochemical assays have been developed to exactly quantitate the new proteins in body fluids and to find out the diagnostic significance of measurement of these proteins in pregnant women and in patients with tumors and other diseases. Another aim was to elucidate the biological functions of our immunochemically detected proteins. The results obtained thus far are reported.

Human granulosa cells contain insulin-like growth factor-binding protein (IGF BP-1) mRNA

Previous studies have demonstrated expression of insulin-like growth factor-binding protein (IGF BP-1) in secretory and decidualized endometrium, in adult and fetal liver, and in HepG2 liver cancer cells. We have studied the expression of IGF BP-1 in various types of ovarian neoplasias, normal ovary, and granulosa cells from hyperstimulated human ovarian follicles by RNA blot hybridization. A single 1.6 kb mRNA species, similar to that present in human decidua, was identified in poly(A)RNA-containing preparations of granulosa cells and of a borderline malignant ovarian cystadenoma. This finding verifies the postulated production of IGF BP-1 by the human ovary.

Circulating levels of placental protein 14 and progesterone following Mifepristone (RU38486) and Gemeprost for termination of first trimester pregnancy

Ten patients underwent successful termination of first trimester pregnancies with RU38486 (Mifepristone, Roussel Laboratories Ltd., Broadwater Park, Uxbridge, Middlesex, United Kingdom) followed 2 days later by a prostaglandin (Gemeprost, May and Baker Ltd., Dagenham, Essex, United Kingdom) pessary. Four hours after administration of RU38486, the levels of progesterone (P) started to fall and continued to show a gradual decline until the abortion was completed, when a steep fall to follicular phase values was observed. Levels of placental protein 14 remained unaltered until 2 days after RU38486 administration, when levels were increased. The rise in placental protein 14 in association with falling P concentrations suggests that the decidual secretion of placental protein 14 might be independent of P. Fertil Steril 52:66, 1989.

Monoclonal antibodies to human secretory "pregnancy-associated endometrial alpha 1-globulin," an insulin-like growth factor binding protein: characterization and use in radioimmunoassay, Western blots, and immunohistochemistry

Monoclonal antibodies were raised against pregnancy-associated endometrial alpha 1-globulin (alpha 1-PEG), a 32 KD insulin-like growth factor binding protein (IGF-BP), which represents a major secretory product of the human decidualized endometrium during pregnancy. This class of IGF-BP has been implicated in the modulation of action, inhibitory and stimulatory, of insulin-like growth factors. Immunization with the protein purified from pregnancy endometrium resulted after myeloma fusion in the isolation of six hybridoma clones and the antibodies produced were characterized. The Ka of the antibodies ranged between 4.75 x 10(9) M-1 and 0.7 x 10(8) M-1. In Western blots all monoclonal antibodies reacted with purified protein of molecular weight 32 KD and specifically detected this IGF-BP species in culture medium and cytosolic extracts of pregnancy endometrium and amniotic fluid. The monoclonal antibodies appear to define three epitope-bearing regions as evidenced by their reactivity to polypeptide fragments of the protein. After synthesis and secretion by tissue explants in vitro the protein is susceptible to cleavage into fragments possessing different monoclonal antibody-defined reactivity. Employing immunohistochemical techniques the protein was principally localized to decidual cells in tissue sections of pregnancy endometrium and solely to these cells after enzymic digestion of the tissue. The implications of these results are discussed with respect to potential role of IGF-BP in the action of IGF upon the IGF-1 receptor-bearing populations, including lymphocytes and trophoblast cells, D in the decidua.

Secretory proteins of the endometrium--potential markers for endometrial dysfunction

In contrast to our detailed knowledge of endometrial structure, the study of endometrial function is still in its infancy. It seems likely that most of the changes that occur in the endometrium during the cycle are directed towards the promotion of implantation, and that the proteins secreted by the tissue have a role to play in the maintenance of pregnancy. One approach to the study of these proteins has been the incubation of endometrium in vitro with labelled amino acid precursors, and this method has revealed that in early pregnancy two proteins are quantitatively more important than the others synthesized and secreted by the endometrium. One of these proteins is a homologue of beta-lactoglobulin, also known as alpha 2-PEG, PP14 or PEP. It is synthesized by endometrial glands and no other source has been identified. Its synthesis is induced in the luteal phase of the menstrual cycle, rises to a peak in the early weeks of pregnancy and then rapidly declines as the decidua spongiosa is replaced by decidua compacta. The direction of its secretion appears to be into the amniotic fluid, and its function may be to transport a vitamin or other essential substance to the early conceptus: another possible function is immunosuppression. The protein can be measured in peripheral blood and may be useful as a marker of the effect of progesterone-or its lack of effect, as in the inadequate luteal phase. The other quantitatively important endometrial protein is IGF binding protein, which is produced mainly by stromal fibroblasts in the late luteal phase of the cycle. During the cycle the contribution of the endometrium to serum levels of IGF-BP is slight, but in pregnancy, as the amount of decidua compacta increases, levels in peripheral blood rise, with peaks at 18-24 weeks and at 36-40 weeks. The function of the protein may be to protect the mother by inhibiting IGF, or to enable IGF to stimulate the growth of endometrial stroma. Links between this protein and disorders of fetal growth have been suggested. The diversity of the possible functions of these proteins, and the continuing uncertainty over their roles, underline the complexity of endometrial functions.(ABSTRACT TRUNCATED AT 400 WORDS)

A novel approach for monitoring the endometrial cycle and detecting ovulation

We report the presence of a cycle-dependent sialoglycoprotein in the endometrium. A monoclonal antibody (D9B1) to this glycoprotein has been derived and used to study tissue from 24 women with normal menstrual cycles. Results obtained with peroxidase immunohistochemistry suggest a highly significant variation in concentration of the glycoprotein, which is absent in the proliferative phase and present at maximal levels in the early secretory phase. The amount of antigen then diminishes slowly through the latter part of the secretory phase. The glycoprotein is produced in epithelial cells of glands and uterine lumen before being secreted across the apical cell surface. The secretory response is uniform in different areas of the tissue and within individual glands. However, considerable differences in secretory activity can be observed between adjacent glands in any part of the endometrium. Binding of the antibody is shown to be a new and novel parameter in characterization and standardization of the normal function of endometrium in response to ovarian hormones.

Two fetal antigens (FA-1 and FA-2) and endometrial proteins (PP12 and PP14) isolated from amniotic fluid; preliminary observations in fetal and maternal tissues

Rabbit antihuman antibodies were derived by the injection of fractions of second trimester amniotic fluid known to contain proteins of endometrial/decidual origin. Using standard separation and absorption procedures, two antibody preparations were generated which demonstrated specificities against two and three proteins, respectively, in line immunoelectrophoresis and crossed immunoelectrophoresis. Analysis against proteins of fetal, maternal, endometrial and placental origin revealed that the bispecific antiserum reacted only with placental protein 14 (PP14; also known as progestagen-dependent endometrial protein, PEP) and one other hitherto undescribed antigen referred to as Fetal Antigen 1 (FA-1) molecular mass 60 kDa; electrophoretic mobility: slow; alpha 1-alpha 2; fast, albumin. The trispecific antiserum demonstrated specifities against placental protein 12 (PP12), alpha-fetoprotein (AFP) and another previously undescribed antigen referred to as Fetal Antigen 2 (FA-2) molecular mass 35 and 140 kDa; electrophoretic mobility: albumin. Following purification, monospecific antisera against each of these proteins (with the exception of AFP) were derived in new rabbits. Maternal and fetal blood, amniotic fluid and aqueous extracts from endometrial/decidual and placental tissues were analysed in rocket immunoelectrophoresis using these antisera to examine the distribution in these tissues. The analyses demonstrated a pattern of distribution typical for proteins of endometrial/decidual origin in these compartments in the case of PP12 and PP14, but suggested that the primary source of origin of FA-1 and FA-2 may be the fetus.

Suppression of in vitro lymphocyte reactivity to phytohemagglutinin by placental protein 14

Crude human decidual extracts containing up to 26.6 mg/l of placental protein 14 (PP14) and purified PP14 were assessed for their effects on the in vitro lymphocyte reactivity to phytohemagglutinin (PHA). Both decidual extract and purified PP14 suppressed the mitogenic response to PHA with the suppression being dose-dependent over the range of PP14 concentrations investigated (0-26.6 mg/l). On the specific reduction of the PP14 content by a monoclonal anti-PP14 immunoadsorbant the suppression was reduced. The suppressive activity of PP14 was related to the degree of proliferation of the stimulated lymphocytes. These results suggest that PP14, which is present at peak levels in the first trimester of pregnancy and constitutes up to 10% of the soluble protein content of decidual tissue, may be an immunomodulator important for the survival of the implanting embryo and maintenance of early pregnancy.

Detection and characterization of human secretory "pregnancy-associated endometrial alpha 2-globulin" in uterine luminal fluid

Pregnancy-associated endometrial alpha 2-globulin (alpha 2-PEG), the major secretory protein of the human endometrium as assessed by in vitro de novo synthesis and secretion, during the mid- to late-luteal phase of the menstrual cycle and early first trimester pregnancy, has now been detected immunochemically in uterine luminal flushings during the luteal phase of the menstrual cycle. Physicochemical characterization of this immunoreactive alpha 2-PEG demonstrated that it exhibited identical properties to the protein isolated from either the cytosol of pregnancy endometrium or medium from in vitro cultures of pregnancy endometrium, i.e. native Mr 56 K, subunit Mr 28 K, eluted from an anion exchange column at 0.11 M NaCl and bound to concanavalin A. These findings, together with other evidence, suggest that a major route of secretion of alpha 2-PEG during the luteal phase of the menstrual cycle in vivo is into the lumen of the uterus. These results are discussed with reference to the hypothesis that alpha 2-PEG, derived from the endometrial glandular epithelium, may represent the human functional analogue of uteroglobin and to the implications for the human of the hypothesized immunosuppressive role of uteroglobin and transglutaminase (Factor XIII) in masking Class I MHC antigens on gametes and the conceptus.

Identification of placental protein 14 as an immunosuppressive factor in human reproduction

Extracts of human decidual tissue obtained in the first trimester of pregnancy showed potent suppressive activity in mixed lymphocyte cultures. These extracts contained substantial amounts of the decidual protein PP14. Purified PP14 also exhibited in vitro immunosuppressive activity, and such activity in decidual extract and purified PP14 preparations was removed by treatment with a monoclonal anti-PP14 antibody-based immunoadsorbent. PP14 was present in seminal plasma, which also exhibited immunosuppressive activity that could be reduced, but not removed, by the immunoadsorbent. PP14 may be an important immunomodulator in the human reproductive system.

Amniotic fluid concentrations of secreted pregnancy-associated endometrial alpha 1- and alpha 2-globulins (alpha 1- and alpha 2-PEG)

The levels of pregnancy-associated endometrial alpha 1- and alpha 2-globulins (alpha 1- and alpha 2-PEG), the two major proteins synthesized and secreted by the endometrium in vitro, have been assayed in 210 amniotic fluid specimens obtained at termination of pregnancy or by amniocentesis, or at delivery. alpha 1-PEG was undetectable until week 10 and thereafter rose to peak levels between weeks 20 and 24. Levels fell 15-fold by week 35 but substantial amounts were still present at parturition. alpha 2-PEG was present at highest levels during early pregnancy, at weeks 6-15, but thereafter levels rapidly fell until during weeks 31-42 alpha 2-PEG was detectable in only 3 of 25 specimens. During weeks 15-20, when alpha 2-PEG levels fell and alpha 1-PEG levels rose, a high correlation was observed between the week of gestation and the log of the ratios of the concentration of these proteins. These observations provide the opportunity to assess the role of endometrial and decidual dysfunction in the aetiology of pregnancy disorders.