Increased levels of nectin-4 as a serological marker for pre-eclampsia

OBJECTIVES

Nectin-4 is a cell adhesion molecule with vital functions at adherens and tight junctions. Cumulative evidence now indicates that the NECTIN4 gene is overexpressed in a variety of cancers, and that the nectin-4 protein is both a disease marker and therapeutic target in a subset of these cancers. We previously demonstrated that NECTIN4 is overexpressed in placenta during pre-eclamptic pregnancy, which is one of the most serious obstetric disorders.

METHODS

Nectin-4 protein levels were measured in maternal sera from pregnant women with pre-eclampsia and its related disorder, unexplained fetal growth retardation.

RESULTS

Maternal serum concentrations of nectin-4 were significantly elevated in pre-eclamptic women compared with those with an uncomplicated normotensive pregnancy. However, no increase was observed in pregnancies with unexplained fetal growth retardation. Serum nectin-4 levels were higher in cases with early-onset pre-eclampsia that generally showed more severe clinical symptoms, but levels were not correlated to other clinical indicators of disease severity.

CONCLUSIONS

Nectin-4 is a potential new diagnostic and predictive biomarker for severe pre-eclampsia.

Longitudinal study of the vaginal microbiome in pregnancies involving preterm labor

Objectives

Alterations in the vaginal bacterial flora reflect the status of various obstetric conditions and are associated with mechanisms that underlie certain pregnancy-associated complications. These changes are also a predictive biomarker for clinical outcomes of these adverse events.

Methods

We examined the vaginal microbiome in samples from pregnant Japanese women with preterm labor.

Results

The microbiota composition in preterm delivery (PD) samples differed from those of control or threatened preterm delivery (TPD) samples in principal component analysis. An increase in Firmicutes and a decrease in Actinobacteria were significantly associated with PD only (both P<0.01). In the Firmicutes phylum, Lactobacillus tended to be abundant, and the abundance of L. iners and L. crispatus was especially high, whereas the L. gasseri population was low in PD samples. Longitudinal analysis showed that the abundance of L. iners decreased after commencing tocolytic treatment in TPD samples compared with before treatment, but it remained high in PD samples.

Conclusions

The vaginal microbiome may be a useful prognostic indicator of preterm labor and a monitoring tool for tocolytic treatment to prevent preterm birth.

Altered serum soluble furin and prorenin receptor levels in pregnancies with pre-eclampsia and fetal growth restriction

OBJECTIVE

The proprotein convertase furin is known to be involved in the processing of pro-B-type natriuretic peptide (proBNP) and prorenin receptor (PRR), suggesting that it has a potential function in blood pressure regulation. We investigated the role of furin in the etiology of pre-eclampsia and its related disorder, unexplained fetal growth restriction (FGR) without hypertension.

METHODS

We evaluated serum and placental furin levels in pre-eclampsia, FGR and uncomplicated pregnancy. Additionally, we investigated the correlation between the serum furin levels and products of furin enzymatic activity or clinical parameters.

RESULTS

We demonstrated that the maternal circulation in cases of pre-eclampsia and FGR had lower levels of soluble furin than uncomplicated pregnancies. Both NT-proBNP and soluble PRR were elevated in pre-eclampsia, whereas only soluble PRR was at higher levels in unexplained FGR. Linear regression analysis revealed a negative correlation between the serum furin level and that of NT-proBNP or soluble PRR. While we observed that the serum furin or soluble PRR level correlated with blood pressure, a stronger correlation was observed with birth and placental weights. Further to this, the FURIN mRNA levels were significantly reduced in placental pre-eclamptic placentas as well as in FGR cases.

CONCLUSION

These data suggest the possibility that reduced levels of furin may be the result of a negative feedback from the activation of the renin-angiotensin pathway that leads to feto-placental dysfunction with or without maternal hypertension. This may represent an etiologic pathway of pre-eclampsia and unexplained FGR.

Placental Genetic Variants in the Upstream Region of the FLT1 Gene in Pre-eclampsia

Background:

Soluble fms-like tyrosine kinase 1 (sFlt-1) is believed to be a prominent component in the pathogenesis of pre-eclampsia, although the precise etiology has remained elusive. In this study, the etiological role of FLT1 variant was further validated in pre-eclampsia by examining this association in a Japanese sample population.

Methods:

The genotypes of three variants (rs4769613, rs12050029 and rs149427560) were examined in the upstream region of the FLT1 gene in placentas from pre-eclamptic (n=47) or normotensive control (n=49) pregnancy samples. Additionally, FLT1 mRNA levels in placenta were determined by qRT-PCR. ELISA was further used to detect circulating sFlt-1 levels in maternal sera. The intergroup comparisons were made using the Mann-Whitney U test or one way analysis of variance and P values of less than 0.05 were considered statistically significant.

Results:

First, the rs4769613 (C>T) and rs12050029 (G>A) genotypes were examined in placentas but no significant differences were found in the genotype or allele-type frequencies. Next, nearby short tandem repeat, rs149427560, was examined which manifested four size variants. In the genotypewise analysis, the frequency of the 474/476 heterozygote was significantly lower in pre-eclampsia (p<0.05). As expected, the FLT1 mRNA levels were significantly elevated in the pre-eclamptic placentas and sFlt-1 was higher in pre-eclamptic maternal sera. However, the genotype of these variants did not affect the FLT1 mRNA or serum sFlt-1 levels.

Conclusion:

Our findings did not support the hypothesis that genetic variations around the FLT1 gene affect the subtle expression changes underlying the etiologic pathway of pre-eclampsia. The hypothesis deserves further investigation through a larger sample size.

Potential role for nectin-4 in the pathogenesis of pre-eclampsia: a molecular genetic study

BACKGROUND

Nectins are cell adhesion molecules that play a pivotal role in adherens junctions and tight junctions. Our previous study using whole-genome oligonucleotide microarrays revealed that nectin-4 was upregulated in pre-eclamptic placentas. We investigated the role of nectin-4 in the etiology of pre-eclampsia.

METHODS

We investigated the expression of nectin-4 using real-time RT-PCR, western blot and immunostaining. Additionally, we performed matrigel invasion assay and cytotoxicity assay using cells overexpressing the nectin-4.

RESULTS

NECTIN4 transcripts were elevated in pre-eclamptic placentas relative to uncomplicated pregnancies. Nectin-4 protein levels in pre-eclamptic placentas were higher on a semi-quantitative western blot. Nectin-4 was localized at the apical cell membrane in syncytiotrophoblast cells and not at the adherens junctions. Nectin-4 was also detected in cytotrophoblasts and a subset of cells in the decidua. Nectin-4 overexpressing trophoblast cells migrated normally in the matrix. However, Natural killer (NK) cells showed a strong cytotoxic effect against nectin-4 overexpressing trophoblast cells. No causative genetic variation was evident in the NECTIN4 gene from a pre-eclamptic placenta.

CONCLUSIONS

There are as yet unknown factors that induce nectin-4 overexpression in trophoblast cells that may contribute to abnormal placentation via an aberrant immune response and the onset of a pre-eclamptic pregnancy.

Validity and reproducibility of a quantitative food frequency questionnaire for a cohort study in Japan

BACKGROUND

A self-administered quantitative food frequency questionnaire (Qx) was developed for a population-based cohort study on cancer in Takayama, Japan.

METHODS

The Qx was tested among 58 male and 59 female volunteers. Average daily nutrient intakes for the previous year calculated from the Qx were compared with those from 3-day food records and four 24-h recalls. The Qx was also validated among 37 volunteers by comparing the nutrient intakes calculated from the Qx with 12 1-day food records during a year. We also calculated the intra-class correlation coefficients for various nutrients between the Qx and the second Qx administered by the same volunteers 1 year after the first survey.

RESULTS

Pearson correlation coefficients between total energy from the Qx and 3-day records were 0.38 for men and 0.25 for women and those between the Qx and 24-h recalls were 0.19 and -0.02 for men and women, respectively. Correlations between the several nutrients from the Qx and 3-day records ranged from 0.2 to 0.5 for both men and women. These correlations after energy adjustment ranged from 0.2 to 0.6 for men and from 0.1 to 0.7 for women. In general, the correlations for various nutrients between the Qx and 12 1-day records were higher than those described above. The intra-class correlation coefficients ranged from 0.46 to 0.78 in men and from 0.36 to 0.67, except for vitamin C in women. When the information on portion size was excluded, almost all of the above indices showed somewhat lower figures.

CONCLUSION

These results suggest that our food frequency questionnaire with portion size information can be used to estimate nutrient intakes of each individual.

Food diversity and validity of semiquantitative food frequency questionnaire

We hypothesized that validity of semiquantitative food frequency questionnaire would be affected by food diversity (variety of foods consumed), because greater food diversity may be related to greater within-individual variation of nutrient intake, which can attenuate the correlation coefficient measuring validity of the questionnaire. We obtained 12 one-day diet records over one year and responses to a semiquantitative food frequency questionnaire from 37 subjects. The food diversity score for each subject was determined by the total number of different foods consumed during the 12 days for the diet records, and the subjects were divided into two groups according to the score. The within-individual variances were similar in those with higher and lower food diversity scores. We never observed a significantly lower correlation coefficient for any nutrient in those with higher food diversity scores. The observed and corrected correlations for most of the micronutrients were higher in those with higher food diversity scores, and the differences were statistically significant for crude fiber, vitamin C, iron, and potassium. The validity of the semiquantitative food frequency questionnaire did not appear to be lowered greatly by greater food diversity.

Frequent hard physical activity lowered serum beta-carotene level in a population study of a rural city of Japan

To determine the effect of physical activity on serum beta-carotene, we analyzed data about life styles including 3-day food records and blood samples collected from 57 men and 74 women in a rural city of Japan. Physical activity was asked as mean frequency of hard physical activities per week last year. A declining trend in serum beta-carotene was observed with increasing frequency of hard physical activities in men. In multiple regression analyses, the frequency of hard physical activities showed a negative partial correlation coefficient (r = -0.38, p = 0.007) with serum beta-carotene in men when controlled by age, BMI (body mass index), dietary factors (carotene intake, alcohol consumption and vitamin supplements use), smoking status, serum total cholesterol and serum triglycerides. These results suggest that frequent hard physical activity decreases serum beta-carotene especially in men.

[Perioperative management of pediatric patient with vena cava superior thrombosis complicated with nephrotic syndrome]

Nephrotic syndrome is a disease which accompanies hypoproteinemia, edema, hyperlipidemia and coagulopathy. This syndrome has also been recognized in pediatric patient. We experienced recently a case of 11-year-old girl, who had insertion of a plasma exchange catheter because of secondary hyperlipidemia due to nephrotic syndrome. She suffered soon from a severe SVC obstruction by thrombosis grown up around the catheter and an emergency thrombectomy was planned under the cardiopulmonary bypass. Renal function was maintained preoperatively, in comparison with nephrotic syndrome in adult where some problems in perioperative management, such as difficulties in tracheal intubation, choice of anesthetic drugs, blood and fluid management, monitoring without CVP and weaning from ventilator are observed. Induction was carried out carefully under spontaneous breathing and the anesthetic method we used consisted of balanced technique using N2O, O2, fentanyl and pancuronium bromide with moderate hyperventilation. Intraoperative course was uneventful and the patient was extubated on the second day after the operation without any neurological defects.