Younger Women Living with Chronic Disease: Comparative Challenges, Resiliencies, and Needs in Heart Disease and Breast Cancer

Background: Younger women with chronic disease (<60 years of age), especially women with stereotypically "men's" heart disease (HD), are understudied. Unique difficulties may occur with HD, which is less commonly associated with women, compared with breast cancer (BC). Similarities may also exist across younger women, as chronic disease is less normative in younger people. Intersections of gender, age, and the specific disease experience require greater attention for improving women's health. This exploratory qualitative study compared younger women's experiences of HD or BC. Methods: Semistructured interviews with 20 women (n = 10 per disease) were analyzed using applied thematic analysis. Results: Amidst building careers, intimate relationships, and families, women felt thwarted by disease-related functional problems. Cognitive-behavioral coping strategies spurred resilience, including integrating the illness experience with self-identity. Barriers arose when medical professionals used representativeness heuristics (e.g., chronic disease occurs in older age). Important experiences in HD included worsened self-image from disability, negative impact of illness invisibility, and persisting isolation from lacking peer availability. Initial medical care reported by women with HD may reflect gender biases (e.g., HD missed in emergency settings and initial diagnostics). New information provided by the younger women includes limited illness-related optimism in women with HD facing age and gender stereotypes, as well as the advantages and disadvantages of peer availability in BC. Conclusions: Greater public awareness of younger women with chronic disease, alongside structural support and connection with similarly challenged peers, is suggested. As advocacy for BC awareness and action has strengthened over past decades, similar efforts are needed for younger women with HD.

GM-CSF and CSF-1 stimulate DNA synthesis but not cell proliferation in short-term cultures of mid-gestation murine trophoblast

Short-term cultures of purified murine trophoblast were used to investigate the potential trophic effects of a number of cytokines. Both granulocyte-macrophage colony stimulating factor (GM-CSF) and colony stimulating factor-1 (CSF-1) increased [3H]thymidine (TdR) uptake (3-8 times control values) by trophoblast harvested from placentae on day 12 or 14 of pregnancy. In contrast, interleukin-3 (IL-3) had only a mild stimulatory effect ([3H]TdR uptake 1.5 times control), and IL-2 did not alter the level of DNA synthesis in these cells. Immunocytochemical analysis confirmed that the cells engaged in DNA synthesis were cytokeratin-positive trophoblast cells and revealed that these cells predominantly bore markers (alkaline phosphatase, transferrin receptors) characteristic of trophoblast cells from the placental labyrinth. The increased DNA synthesis observed after exposure to GM-CSF or CSF-1 was not associated with a change in the proportion of nuclei involved in synthesis, nor did it result in significantly increased trophoblast cell numbers in the cultures. These findings suggest that DNA-synthesizing trophoblast cells were not proliferating, but were more likely engaged in endoreduplicative cycles leading to the formation of terminally differentiated trophoblast giant cells. These results caution against the presumption of proliferation when measuring [3H]thymidine incorporation by placental or trophoblast cells in standard in vitro cultures. In addition, taken together with the reports of high levels of CSF-1 in the pregnant uterus and the expression of the CSF-1 receptor on placental trophoblast cells, they suggest that the hemopoietic cytokines may play a role in the differentiation and/or function of trophoblast cells in the developing murine placenta.

Isolation of endothelial cells from human first trimester decidua using immunomagnetic beads

A technique was developed for the isolation of purified endothelial cells from first trimester decidual tissue, using QB End/40-coated magnetic polystyrene beads (Dynabeads). QB End/40 is an endothelial-specific monoclonal antibody which reacts with the coagulation cascade co-factor, thrombomodulin. Small endothelial cell aggregates were released from first trimester decidua by the sequential use of collagenase and trypsin. This dissociation method yielded 15-20% endothelial cells which were further purified to greater than 90% homogeneity by rosetting with QB End/40-Dynabeads. Cultures of purified decidual endothelial cells provide a useful tool for investigating cell-cell interaction in the first trimester placental bed.

Transferrin receptor expression in early postimplantation mouse trophoblast and associated tissues

The expression of the transferrin receptor (TR) was examined on murine trophoblast cells on days 6, 8 and 10 of gestation, using a monoclonal antibody visualized by indirect immunofluorescence on cryostat sections of the implant site. In the day 6 tissues, TR were observed on both the ectoplacental cone (EPC) and mural giant cell trophoblast populations, as well as on the embryonic ectoderm, anti-mesometrial decidual cells, uterine glandular epithelium and myometrium. By the 8th day of gestation, TR expression was weak, or undetectable on trophoblast giant cells (TGC), but remained strong on the proliferating cells of the EPC and embryo. In the definitive placenta (day 10), TR are expressed primarily on the differentiated labyrinthine trophoblast cells involved in the maternal-fetal transfer of iron.

Murine trophoblast cells are not killed by tumor necrosis factor-alpha

Purified midgestation murine trophoblast cannot be killed by a variety of cell-mediated effector mechanisms, with the exception of highly lytic effectors such as lymphokine-activated killer cells. We now report that this trophoblast population is also resistant to tumor necrosis factor (TNF)-alpha.

Murine trophoblast can be killed by lymphokine-activated killer cells

The ability of fetal trophoblast cells in the placenta to resist cell-mediated lysis may be important for successful pregnancy. Previous studies in this laboratory demonstrated that cultured midterm mouse trophoblast cells are not susceptible to allospecific CTL generated by standard in vitro protocols, to antibody-dependent cell-mediated cytotoxicity, or to naive or IFN-activated NK cells, despite expressing the requisite target structures. However, we now report that murine trophoblast can be killed, in a non-MHC-specific manner, by LAK cells. Normal mouse spleen cells cultured for 4 days in IL-2-containing lymphokine preparations characteristically killed both NK-sensitive (YAC-1) and NK-resistant (EL4, P815) target cells, and mediated significant lysis of both cultured and freshly isolated trophoblast cells (35 to 55%, E/T 100/1). Pretreatment of the LAK cells with anti-ASGM1 antibody and C markedly reduced the lysis of trophoblast and YAC-1 targets, suggesting that the responsible cells belonged to the NK lineage. The ability of IL-2-activated NK cells to kill midterm murine trophoblast cells was confirmed using a population of highly lytic NK cells generated by culturing spleen cells from severe combined immunodeficiency mice in 500 U/ml rIL-2 for 5 days. These effector cells killed YAC-1, EL4 and P815 target cells at much lower E/T ratios than was achieved with the normal splenic LAK cells, and mediated significant lysis of both freshly isolated (45 to 50%, E/T 20/1) and cultured trophoblast cells (68 to 76%, E/T 20/1). The susceptibility of trophoblast to LAK cells and IL-2-activated NK cells supports the need for suppressor mechanisms regulating IL-2 activity at the maternal-fetal interface.

Murine trophoblast can be killed by lymphokine-activated killer cells

The ability of fetal trophoblast cells in the placenta to resist cell-mediated lysis may be important for successful pregnancy. Previous studies in this laboratory demonstrated that cultured midterm mouse trophoblast cells are not susceptible to allospecific CTL generated by standard in vitro protocols, to antibody-dependent cell-mediated cytotoxicity, or to naive or IFN-activated NK cells, despite expressing the requisite target structures. However, we now report that murine trophoblast can be killed, in a non-MHC-specific manner, by LAK cells. Normal mouse spleen cells cultured for 4 days in IL-2-containing lymphokine preparations characteristically killed both NK-sensitive (YAC-1) and NK-resistant (EL4, P815) target cells, and mediated significant lysis of both cultured and freshly isolated trophoblast cells (35 to 55%, E/T 100/1). Pretreatment of the LAK cells with anti-ASGM1 antibody and C markedly reduced the lysis of trophoblast and YAC-1 targets, suggesting that the responsible cells belonged to the NK lineage. The ability of IL-2-activated NK cells to kill midterm murine trophoblast cells was confirmed using a population of highly lytic NK cells generated by culturing spleen cells from severe combined immunodeficiency mice in 500 U/ml rIL-2 for 5 days. These effector cells killed YAC-1, EL4 and P815 target cells at much lower E/T ratios than was achieved with the normal splenic LAK cells, and mediated significant lysis of both freshly isolated (45 to 50%, E/T 20/1) and cultured trophoblast cells (68 to 76%, E/T 20/1). The susceptibility of trophoblast to LAK cells and IL-2-activated NK cells supports the need for suppressor mechanisms regulating IL-2 activity at the maternal-fetal interface.

Differential expression of the class I MHC genes in the embryo and placenta during midgestational development in the mouse

A sensitive RNase mapping technique was used to investigate the expression of individual class I mRNA in the embryo and placenta of the mouse from day 7.5 through day 13 of gestation. Transcripts of the H-2Kd and -Dd genes appeared in both placental and embryonic tissues as early as day 7.5 post coitum and continued to be expressed thereafter. In contrast, H-2Ld mRNA was barely detectable in embryonic RNA until day 18 of pregnancy, although it was present in placental RNA samples on days 10 to 13 of gestation. Qa-region genes demonstrated a different pattern of expression than H-2Dd, -Kd, and -Ld. Transcripts of Q7, one of the genes encoding Qa-2 surface Ag, were detected in the developing embryo on days 9 to 11 post coitum but decreased thereafter. However, Q7d transcripts were not detected in placental tissues at any stage. Q6 mRNA was not detected in any of the tissues, and Q10 mRNA was detected only in day 12 to 13 embryos, where expression is known to be restricted to the fetal liver. Transcripts from T13, a Tla-region gene, and D2d, a D-region gene, were not detected in any of the samples tested. This study has revealed a complex pattern of class I gene regulation both within the genes of the MHC and between the embryo and placental lineages during the midgestational stages of development.

Differential expression of the class I MHC genes in the embryo and placenta during midgestational development in the mouse

A sensitive RNase mapping technique was used to investigate the expression of individual class I mRNA in the embryo and placenta of the mouse from day 7.5 through day 13 of gestation. Transcripts of the H-2Kd and -Dd genes appeared in both placental and embryonic tissues as early as day 7.5 post coitum and continued to be expressed thereafter. In contrast, H-2Ld mRNA was barely detectable in embryonic RNA until day 18 of pregnancy, although it was present in placental RNA samples on days 10 to 13 of gestation. Qa-region genes demonstrated a different pattern of expression than H-2Dd, -Kd, and -Ld. Transcripts of Q7, one of the genes encoding Qa-2 surface Ag, were detected in the developing embryo on days 9 to 11 post coitum but decreased thereafter. However, Q7d transcripts were not detected in placental tissues at any stage. Q6 mRNA was not detected in any of the tissues, and Q10 mRNA was detected only in day 12 to 13 embryos, where expression is known to be restricted to the fetal liver. Transcripts from T13, a Tla-region gene, and D2d, a D-region gene, were not detected in any of the samples tested. This study has revealed a complex pattern of class I gene regulation both within the genes of the MHC and between the embryo and placental lineages during the midgestational stages of development.

Murine trophoblast can be killed by allospecific cytotoxic T lymphocytes generated in GIBCO Opti-MEM medium

Previous work in this laboratory demonstrated that a population of cultured midterm murine trophoblast cells are not susceptible to lysis by allospecific cytotoxic T lymphocytes (CTL) generated by standard in vitro protocols. We now report that this trophoblast population is killed, in an MHC-dependent manner, by allospecific CTL generated in GIBCO Opti-MEM, a modified tissue culture medium designed to maintain cell growth and proliferation in the presence of low concentrations of fetal bovine serum (FBS).

Major histocompatibility antigens on trophoblast and their regulation: implications in the maternal-fetal relationship

Recent technological advances have provided methods of detecting antigens encoded by the major histocompatibility complex with greater precision, allowing the expression of such antigens on the components of the placenta to be clarified. Of specific interest is the expression of these antigens on trophoblast cells, the fetal-derived epithelial cells that confront maternal blood and tissues at the maternal-fetal interface. It is now clear that the different trophoblast subpopulations differentially express class I antigens, although none appear to express class II antigens. Class I antigens can be induced by exposure to interferons on some populations but apparently not others, suggesting that the regulation of their expression differs for subpopulations of trophoblast cells, depending on gestational stage and location. This restricted expression has important implications for maternal-fetal immune interactions during the different phases of pregnancy and perhaps also bears on physiological functions of the feto-placental unit, such as growth and differentiation.

Class I major histocompatibility complex antigen expression on early murine trophoblast and its induction by lymphokines in vitro. II. The role of gamma interferon in the responses of primary and secondary giant cells

The induction of paternal Class I and II MHC antigens by crude lymphokine preparations or purified recombinant gamma interferon was investigated on (C57BL/6J X CBA/H)F1 primary and secondary trophoblast giant cell outgrowths from 3.5-day post-coital (pc) blastocyst and 7.5-day pc ectoplacental cone preparations, respectively, using sensitive immunogold labelling techniques and electron microscopy. Class I MHC (but not Class II) antigens could readily be induced on secondary trophoblast giant cells, by incubation in vitro with gamma interferon for 40 h. However, repeated attempts to induce detectable MHC antigens on primary trophoblast giant cells failed. Mock-treated (C57BL/6J X CBA/H)F1 secondary trophoblast giant cell control preparations failed to express detectable MHC antigens. These findings suggest that, at the time of implantation, there is a time window during which MHC antigens are neither expressed constitutively nor are inducible by soluble factors which normally modulate cell surface MHC antigen concentration.

Class I major histocompatibility complex antigen expression on early murine trophoblast and its induction by lymphokines in vitro

The expression of paternal class I and class II major histocompatibility complex (MHC) antigens in cultures of murine ectoplacental cone trophoblast was examined using immunogold labelled antibodies and electron microscopy. Class I MHC antigens could be induced on ectoplacental cone derived trophoblast following exposure to concanavalin A stimulated T cell supernatants. Class I MHC antigens were not detected in untreated trophoblast cultures. Class II MHC antigens were never detected on trophoblast whether treated or untreated. This is the first report of the experimental induction of Class I MHC antigens on a population of normally MHC-negative trophoblast cells.

Phagocytic properties of cultured murine trophoblast

The phagocytic potential of cultured trophoblast from early (ectoplacental cone (EPC); day 7.5 post coitum) and mid-term (placenta; day 12 to 14 post coitum) pregnancy in the mouse has been examined using a variety of test particles and culture conditions. In suspension, small numbers (less than 1 per cent) of large placental trophoblast cells showed limited phagocytic uptake of Staphylococcus aureus but not of opsonized sheep red blood cells (RBCs). In contrast, trophoblast phagocytosis was never seen in monolayer placental cell culture. Placental macrophages consistently exhibited phagocytic uptake of both opsonized sheep RBCs and S. aureus under these conditions. In monolayer culture, EPC trophoblast phagocytosed S. aureus, but there was only limited uptake of RBCs (mouse or sheep) or spermatozoa. When cultured in a three-dimensional matrix (blood and plasma clots), however, EPC trophoblast demonstrated extensive phagocytosis of both RBCs and sperm. These results are discussed with reference to the use of in vitro systems for examining developmental processes, and a possible role for trophoblast phagocytosis in early gestation is proposed.

Adaptation of the Boyden chamber to flow conditions: rheological effects on chemotaxis

Although standard Boyden chambers assess chemotaxis under static fluid conditions they are routinely used as an experimental system to model the dynamic events associated with leukocyte extravasation in vivo. We have adapted the Boyden chamber system by incorporating it within the confines of a cone and plate viscometer which can then be employed to generate known shear conditions as the chemotactically responding cells migrate. Our results show that random locomotion of rat peritoneal exudate cells is stimulated under shear conditions within the range of 11.25-90/s relative to that under static conditions. Furthermore, chemotaxis to the synthetic tripeptide F-Met-Leu-Phe (FMLP) is also stimulated under shear conditions with the peak effect occurring near 22.5/s. This adaptation of the standard chamber system to allow the study of chemotaxis under flow conditions may provide further insight on the migratory properties of leukocytes in vivo.

Gross motor skills and hand grip in the elderly: a pilot study

The purpose of this pilot study was to investigate the possibility that a relationship exists between a lifetime of gross motor activity in the elderly and their current status of gross motor skills and gross hand grip strength. Ten elderly adults performed a series of six gross motor tests and answered a survey concerning their lifetime pattern of gross motor activities as determined by occupational performance components. Significant correlations were found between both the survey and the California Standing Balance Eyes Closed test and the survey and a nonstandardized cocontraction test. No significant relationships were found between the survey and the other tests used.