1
|
Groten T, Lehmann T, Städtler M, Komar M, Winkler JL, Condic M, Strizek B, Seeger S, Jäger Y, Pecks U, Eckmann-Scholz C, Kagan KO, Hoopmann M, von Kaisenberg CS, Hertel B, Tauscher A, Schrey-Petersen S, Friebe-Hoffmann U, Lato K, Hübener C, Delius M, Verlohren S, Sroka D, Schlembach D, de Vries L, Kraft K, Seliger G, Schleußner E. Pentaerythrityl tetranitrate improves the outcome of children born to mothers with compromised uterine perfusion-12-months follow-up and safety data of the double-blind randomized PETN trial. Am J Obstet Gynecol MFM 2024; 6:101332. [PMID: 38460823 DOI: 10.1016/j.ajogmf.2024.101332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 02/06/2024] [Accepted: 02/27/2024] [Indexed: 03/11/2024]
Abstract
BACKGROUND This is a follow-up study to the pentaerythrityl tetranitrate randomized controlled multicenter trial that reports neonatal outcome data of newborns admitted to neonatal intensive care units and outcome data of the offspring at 12 months of age. OBJECTIVE We present data on adverse events reported during the study to document the safety of pentaerythrityl tetranitrate treatment during pregnancy. To further evaluate the effects of pentaerythrityl tetranitrate on neonatal and long-term outcomes, we present follow up data from of 240 children at 12 months of age, including information on height, weight, head circumference, developmental milestones, and the presence of chronic disease and of 144 newborns admitted to the neonatal intensive care unit during the trial. STUDY DESIGN The pentaerythrityl tetranitrate trial was a randomized, double-blind, placebo-controlled study designed to assess the efficacy and safety of the nitric oxide-donor pentaerythrityl tetranitrate in the prevention of fetal growth restriction and perinatal death in pregnancies complicated by abnormal placental perfusion. RESULTS Results at 12 months demonstrated that significantly more children were age appropriately developed without impairments in the pentaerythrityl tetranitrate group (P=.018). In addition, the presence of chronic disease was lower in the pentaerythrityl tetranitrate group (P=.041). Outcome data of the 144 newborns admitted to the neonatal intensive care unit did not reveal differences between the treatment and placebo groups. There were no differences in the number or nature of reported adverse events between the study groups. CONCLUSION The analysis shows that study children born in the pentaerythrityl tetranitrate cohort have a clear advantage compared with the placebo group at the age of 12 months, as evidenced by the increased incidence of normal development without the presence of chronic disease. Although safety has been proven, further follow-up studies are necessary to justify pentaerythrityl tetranitrate treatment during pregnancies complicated by impaired uterine perfusion.
Collapse
Affiliation(s)
- Tanja Groten
- Department of Obstetrics, Jena University Hospital (Prof. Groten and Prof. Schleußner), Jena, Germany.
| | - Thomas Lehmann
- Institute of Medical Statistics and Computer Science, Jena University Hospital (Dr Lehmann), Jena, Germany; Center for Clinical Studies, Jena University Hospital (Dr Lehmann and Mrs Städtler), Jena, Germany
| | - Mariann Städtler
- Center for Clinical Studies, Jena University Hospital (Dr Lehmann and Mrs Städtler), Jena, Germany
| | - Matej Komar
- Department of Gynecology and Obstetrics, Technische Universität Dresden (Dr Komar and Dr Winkler), Dresden, Germany
| | - Jennifer Lucia Winkler
- Department of Gynecology and Obstetrics, Technische Universität Dresden (Dr Komar and Dr Winkler), Dresden, Germany
| | - Mateja Condic
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn (Dr Condic and Prof. Strizek), Germany
| | - Brigitte Strizek
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn (Dr Condic and Prof. Strizek), Germany
| | - Sven Seeger
- Department of Gynaecology and Obstetrics, Perinatal Centre, St. Elisabeth and St. Barbara Halle (Drs Seeger and Jäger), Halle (Saale), Germany
| | - Yvonne Jäger
- Department of Gynaecology and Obstetrics, Perinatal Centre, St. Elisabeth and St. Barbara Halle (Drs Seeger and Jäger), Halle (Saale), Germany
| | - Ulrich Pecks
- Department of Obstetrics and Gynaecology and Department of Maternal Health and Midwifery, University Medical Centre Würzburg (Prof. Pecks), Würzburg, Germany
| | - Christel Eckmann-Scholz
- Department of Obstetrics, Christian-Albrechts-University of Kiel (Dr Eckmann-Scholz), Kiel, Germany
| | - Karl Oliver Kagan
- Department of Feto-Maternal Medicine, Women's University Hospital Tübingen (Profs Kagan and Hoopmann), Tübingen, Germany
| | - Markus Hoopmann
- Department of Feto-Maternal Medicine, Women's University Hospital Tübingen (Profs Kagan and Hoopmann), Tübingen, Germany
| | - Constantin S von Kaisenberg
- Department of Obstetrics, Gynecology and Reproductive Medicine, Hannover Medical School (Prof. von Kaisenberg and Dr. Hertel), Hannover, Germany
| | - Bettina Hertel
- Department of Obstetrics, Gynecology and Reproductive Medicine, Hannover Medical School (Prof. von Kaisenberg and Dr. Hertel), Hannover, Germany
| | - Anne Tauscher
- Department of Obstetrics and Gynecology, University of Leipzig (Drs Tauscher and Schrey-Petersen), Leipzig, Germany
| | - Susanne Schrey-Petersen
- Department of Obstetrics and Gynecology, University of Leipzig (Drs Tauscher and Schrey-Petersen), Leipzig, Germany
| | - Ulrike Friebe-Hoffmann
- Department of Gynecology and Obstetrics, Ulm University Hospital (Prof. Friebe-Hoffmann and Dr. Lato), Ulm, Germany
| | - Krisztian Lato
- Department of Gynecology and Obstetrics, Ulm University Hospital (Prof. Friebe-Hoffmann and Dr. Lato), Ulm, Germany
| | - Christoph Hübener
- Department of Obstetrics and Gynecology, Perinatal Center, University Hospital, Campus Grosshadern, LMU Munich (Prof. Hübener and Dr. Delius), Munich, Germany
| | - Maria Delius
- Department of Obstetrics and Gynecology, Perinatal Center, University Hospital, Campus Grosshadern, LMU Munich (Prof. Hübener and Dr. Delius), Munich, Germany
| | - Stefan Verlohren
- Department of Obstetrics, Charité - Universitätsmedizin Berlin (Prof. Verlohren and Dr. Sroka), Berlin, Germany
| | - Dorota Sroka
- Department of Obstetrics, Charité - Universitätsmedizin Berlin (Prof. Verlohren and Dr. Sroka), Berlin, Germany
| | - Dietmar Schlembach
- Vivantes Network of Health GmbH, Clinicum Neukoelln, Clinic for Obstetric Medicine (Dr Schlembach), Berlin, Germany
| | - Laura de Vries
- Department of Obstetrics and Gynecology Städtisches Klinikum Harlaching Munich (Dr de Vries), Germany
| | - Katrina Kraft
- Department of Obstetrics and Gynecology, University Hospital Schleswig-Holstein (Dr Kraft), Lübeck, Germany
| | - Gregor Seliger
- Center for Reproductive Medicine and Andrology, University Medical Center Halle (Saale) (Prof. Seliger), Halle (Saale), Germany
| | - Ekkehard Schleußner
- Department of Obstetrics, Jena University Hospital (Prof. Groten and Prof. Schleußner), Jena, Germany
| |
Collapse
|
2
|
Abdin SM, Paasch D, Kloos A, Oliveira MC, Jang MS, Ackermann M, Stamopoulou A, Mroch PJ, Falk CS, von Kaisenberg CS, Schambach A, Heuser M, Moritz T, Hansen G, Morgan M, Lachmann N. Scalable generation of functional human iPSC-derived CAR-macrophages that efficiently eradicate CD19-positive leukemia. J Immunother Cancer 2023; 11:e007705. [PMID: 38135346 DOI: 10.1136/jitc-2023-007705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/04/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND Macrophages have recently become attractive therapeutics in cancer immunotherapy. The potential of macrophages to infiltrate and influence solid malignancies makes them promising targets for the chimeric antigen receptor (CAR) technology to redirect their stage of polarization, thus enhancing their anticancer capacities. Given the emerging interest for CAR-macrophages, generation of such cells so far mainly depends on peripheral blood monocytes, which are isolated from the respective donor prior to genetic manipulation. This procedure is time-intensive and cost-intensive, while, in some cases, insufficient monocyte amounts can be recovered from the donor, thus hampering the broad applicability of this technology. Hence, we demonstrate the generation and effectiveness of CAR-macrophages from various stem cell sources using also modern upscaling technologies for next generation immune cell farming. METHODS Primary human hematopoietic stem and progenitor cells and induced pluripotent stem cells were used to derive anti-CD19 CAR-macrophages. Anticancer activity of the cells was demonstrated in co-culture systems, including primary material from patients with leukemia. Generation of CAR-macrophages was facilitated by bioreactor technologies and single-cell RNA (scRNA) sequencing was used to characterize in-depth response and behavior of CAR-macrophages. RESULTS Irrespective of the stem-cell source, CAR-macrophages exhibited enhanced and antigen-dependent phagocytosis of CD19+ target cancer cells with increased pro-inflammatory responses. Phagocytic capacity of CAR-macrophages was dependent on target cell CD19 expression levels with superior function of CAR-macrophages against CD19+ cancer cell lines and patient-derived acute lymphocytic leukemia cancer cells. scRNA sequencing revealed CAR-macrophages to be distinct from eGFP control cells after co-culture with target cells, which includes the activation of pro-inflammatory pathways and upregulation of chemokines and cytokines associated with adaptive immune cell recruitment, favoring the repolarization of CAR-macrophages to a pro-inflammatory state. Taken together, the data highlight the unique features of CAR-macrophages in combination with the successful upscaling of the production pipeline using a three-dimensional differentiation protocol and intermediate scale bioreactors. CONCLUSION In summary, our work provides insights into the seminal use and behavior of CAR-macrophages which are derived from various sources of stem cells, while introducing a unique technology for CAR-macrophage manufacturing, all dedicated to the clinical translation of CAR-macrophages within the field of anticancer immunotherapies.
Collapse
Affiliation(s)
- Shifaa M Abdin
- Department of Pediatric Pneumology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany
- Center for Translational and Regenerative Medicine, Hannover Medical School, Hannover, Germany
| | - Daniela Paasch
- Department of Pediatric Pneumology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany
- Center for Translational and Regenerative Medicine, Hannover Medical School, Hannover, Germany
| | - Arnold Kloos
- Department of Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany
| | - Marco Carvalho Oliveira
- Department of Pediatric Pneumology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany
- Center for Translational and Regenerative Medicine, Hannover Medical School, Hannover, Germany
| | - Mi-Sun Jang
- Department of Pediatric Pneumology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany
- Center for Translational and Regenerative Medicine, Hannover Medical School, Hannover, Germany
| | - Mania Ackermann
- Department of Pediatric Pneumology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany
- Fraunhofer Institute for Toxicology and Experimental Medicine ITEM, Hannover, Germany
| | - Andriana Stamopoulou
- Institute of Experimental Hematology, Hannover Medical School, Hannover, Germany
| | - Philipp J Mroch
- Fraunhofer Institute for Toxicology and Experimental Medicine ITEM, Hannover, Germany
| | - Christine S Falk
- Institute of Transplant Immunology, Hannover Medical School, Hannover, Germany
| | | | - Axel Schambach
- Center for Translational and Regenerative Medicine, Hannover Medical School, Hannover, Germany
- Institute of Experimental Hematology, Hannover Medical School, Hannover, Germany
- Division of Hematology/Oncology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Michael Heuser
- Department of Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany
| | - Thomas Moritz
- Institute of Experimental Hematology, Hannover Medical School, Hannover, Germany
| | - Gesine Hansen
- Department of Pediatric Pneumology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany
- RESIST, Cluster of Excellence, Hannover Medical School, Hannover, Germany
| | - Michael Morgan
- Center for Translational and Regenerative Medicine, Hannover Medical School, Hannover, Germany
- Institute of Experimental Hematology, Hannover Medical School, Hannover, Germany
| | - Nico Lachmann
- Department of Pediatric Pneumology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany
- Center for Translational and Regenerative Medicine, Hannover Medical School, Hannover, Germany
- Fraunhofer Institute for Toxicology and Experimental Medicine ITEM, Hannover, Germany
- RESIST, Cluster of Excellence, Hannover Medical School, Hannover, Germany
| |
Collapse
|
3
|
Głowska-Ciemny J, Szymanski M, Kuszerska A, Rzepka R, von Kaisenberg CS, Kocyłowski R. Role of Alpha-Fetoprotein (AFP) in Diagnosing Childhood Cancers and Genetic-Related Chronic Diseases. Cancers (Basel) 2023; 15:4302. [PMID: 37686577 PMCID: PMC10486785 DOI: 10.3390/cancers15174302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Revised: 07/25/2023] [Accepted: 08/23/2023] [Indexed: 09/10/2023] Open
Abstract
Alpha-fetoprotein (AFP) is a protein commonly found during fetal development, but its role extends beyond birth. Throughout the first year of life, AFP levels can remain high, which can potentially mask various conditions from the neurological, metabolic, hematological, endocrine, and early childhood cancer groups. Although AFP reference values and clinical utility have been established in adults, evaluating AFP levels in children during the diagnostic process, treatment, and post-treatment surveillance is still associated with numerous diagnostic pitfalls. These challenges arise from the presence of physiologically elevated AFP levels, inconsistent data obtained from different laboratory tests, and the limited population of children with oncologic diseases that have been studied. To address these issues, it is essential to establish updated reference ranges for AFP in this specific age group. A population-based study involving a statistically representative group of patients could serve as a valuable solution for this purpose.
Collapse
Affiliation(s)
- Joanna Głowska-Ciemny
- PreMediCare Prenatal Research Center, ul. Czarna Rola 21, 61-625 Poznań, Poland; (M.S.); (A.K.); (R.K.)
- New Med Medical Center, ul. Szamotulska 100, 60-566 Poznań, Poland
| | - Marcin Szymanski
- PreMediCare Prenatal Research Center, ul. Czarna Rola 21, 61-625 Poznań, Poland; (M.S.); (A.K.); (R.K.)
| | - Agata Kuszerska
- PreMediCare Prenatal Research Center, ul. Czarna Rola 21, 61-625 Poznań, Poland; (M.S.); (A.K.); (R.K.)
- Department of Gynecology and Obstetrics, Institute of Medical Sciences, University of Zielona Gora, ul. Zyty 28, 65-046 Zielona Góra, Poland;
| | - Rafał Rzepka
- Department of Gynecology and Obstetrics, Institute of Medical Sciences, University of Zielona Gora, ul. Zyty 28, 65-046 Zielona Góra, Poland;
| | - Constantin S. von Kaisenberg
- Department of Obstetrics and Gynecology, Hannover Medical School, Carl-Neuberg-Str. 1, D-30625 Hannover, Germany;
| | - Rafał Kocyłowski
- PreMediCare Prenatal Research Center, ul. Czarna Rola 21, 61-625 Poznań, Poland; (M.S.); (A.K.); (R.K.)
- New Med Medical Center, ul. Szamotulska 100, 60-566 Poznań, Poland
| |
Collapse
|
4
|
Groten T, Lehmann T, Städtler M, Komar M, Winkler JL, Condic M, Strizek B, Seeger S, Jäger Y, Pecks U, Eckmann-Scholz C, Kagan KO, Hoopmann M, von Kaisenberg CS, Brodowski L, Tauscher A, Schrey-Petersen S, Friebe-Hoffmann U, Lato K, Hübener C, Delius M, Verlohren S, Sroka D, Schlembach D, de Vries L, Kraft K, Seliger G, Schleußner E. Effect of pentaerythritol tetranitrate (PETN) on the development of fetal growth restriction in pregnancies with impaired uteroplacental perfusion at midgestation-a randomized trial. Am J Obstet Gynecol 2023; 228:84.e1-84.e12. [PMID: 35931132 DOI: 10.1016/j.ajog.2022.07.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 07/12/2022] [Accepted: 07/16/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND Fetal growth restriction is strongly associated with impaired placentation and abnormal uteroplacental blood flow. Nitric oxide donors such as pentaerythritol tetranitrate are strong vasodilators and protect the endothelium. Recently, we demonstrated in a randomized controlled pilot study a 38% relative risk reduction for the development of fetal growth restriction or perinatal death following administration of pentaerythritol tetranitrate to pregnant women at risk, identified by impaired uterine perfusion at midgestation. Results of this monocenter study prompted the hypothesis that pentaerythritol tetranitrate might have an effect in pregnancies with compromised placental function as a secondary prophylaxis. OBJECTIVE This study aimed to test the hypothesis that the nitric oxide donor pentaerythritol tetranitrate reduces fetal growth restriction and perinatal death in pregnant women with impaired placental perfusion at midgestation in a multicenter trial. STUDY DESIGN In this multicenter, randomized, double-blind, placebo-controlled trial, 2 parallel groups of pregnant women presenting with a mean uterine artery pulsatility index >95th percentile at 19+0 to 22+6 weeks of gestation were randomized to 50-mg Pentalong or placebo twice daily. Participants were assigned to high- or low-risk groups according to their medical history before randomization was performed block-wise with a fixed block length stratified by center and risk group. The primary efficacy endpoint was the composite outcome of perinatal death or development of fetal growth restriction. Secondary endpoints were neonatal and maternal outcome parameters. RESULTS Between August 2017 and March 2020, 317 participants were included in the study and 307 were analyzed. The cumulative incidence of the primary outcome was 41.1% in the pentaerythritol tetranitrate group and 45.5% in the placebo group (unadjusted relative risk, 0.90; 95% confidence interval, 0.69-1.17; adjusted relative risk, 0.90; 95% confidence interval, 0.69-1.17; P=.43). Secondary outcomes such as preterm birth (unadjusted relative risk, 0.73; 95% confidence interval, 0.56-0.94; adjusted relative risk, 0.73; 95% confidence interval, 0.56-0.94; P=.01) and pregnancy-induced hypertension (unadjusted relative risk, 0.65; 95% confidence interval, 0.46-0.93; adjusted relative risk, 0.65; 95% confidence interval, 0.46-0.92; P=0.01) were reduced. CONCLUSION Our study failed to show an impact of pentaerythritol tetranitrate on the development of fetal growth restriction and perinatal death in pregnant women with impaired uterine perfusion at midgestation. Pentaerythritol tetranitrate significantly reduced secondary outcome parameters such as the incidence of preterm birth and pregnancy-induced hypertension in these pregnancies.
Collapse
Affiliation(s)
- Tanja Groten
- Department of Obstetrics, Jena University Hospital, Jena, Germany.
| | - Thomas Lehmann
- Institute of Medical Statistics and Computer Science, Jena University Hospital, Jena, Germany; Center for Clinical Studies, Jena University Hospital, Jena, Germany
| | - Mariann Städtler
- Center for Clinical Studies, Jena University Hospital, Jena, Germany
| | - Matej Komar
- Department of Gynecology and Obstetrics, Technische Universität Dresden, Dresden, Germany
| | - Jennifer Lucia Winkler
- Department of Gynecology and Obstetrics, Technische Universität Dresden, Dresden, Germany
| | - Mateja Condic
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Bonn, Germany
| | - Brigitte Strizek
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Bonn, Germany
| | - Sven Seeger
- Department of Gynaecology and Obstetrics, Perinatal Centre, Hospital St. Elisabeth and St. Barbara, Halle (Saale), Germany
| | - Yvonne Jäger
- Department of Gynaecology and Obstetrics, Perinatal Centre, Hospital St. Elisabeth and St. Barbara, Halle (Saale), Germany
| | - Ulrich Pecks
- Department of Obstetrics, Christian-Albrecht University of Kiel, Kiel, Germany
| | | | - Karl Oliver Kagan
- Department of Feto-Maternal Medicine, Women's University Hospital Tübingen, Tübingen, Germany
| | - Markus Hoopmann
- Department of Feto-Maternal Medicine, Women's University Hospital Tübingen, Tübingen, Germany
| | | | - Lars Brodowski
- Department of Obstetrics, Gynecology and Reproductive Medicine, Hannover Medical School, Hannover, Germany
| | - Anne Tauscher
- Department of Obstetrics and Gynecology, University of Leipzig, Leipzig, Germany
| | | | | | - Krisztian Lato
- Department of Gynecology and Obstetrics, Ulm University Hospital, Ulm, Germany
| | - Christoph Hübener
- Department of Obstetrics and Gynecology, Perinatal Center, University Hospital, Campus Grosshadern, Ludwig Maximilian University of Munich, Munich, Germany
| | - Maria Delius
- Department of Obstetrics and Gynecology, Perinatal Center, University Hospital, Campus Grosshadern, Ludwig Maximilian University of Munich, Munich, Germany
| | - Stefan Verlohren
- Department of Obstetrics, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Dorota Sroka
- Department of Obstetrics, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Dietmar Schlembach
- Vivantes Network for Health GmbH, Klinikum Neukölln, Clinic for Obstetric Medicine, Berlin, Germany
| | - Laura de Vries
- Department of Obstetrics and Gynecology, München Klinik Harlaching, Munich, Germany
| | - Katrina Kraft
- Department of Obstetrics and Gynecology, München Klinik Harlaching, Munich, Germany
| | - Gregor Seliger
- Center for Reproductive Medicine and Andrology, University Medical Center Halle (Saale), Halle (Saale), Germany
| | | | | |
Collapse
|
5
|
Fard D, Borchers CS, Philippeit JC, Philippeit AV, Kaukemüller LR, Higgins-Wood LR, Papageorgiou S, Hillemanns P, von Kaisenberg CS, Klapdor R. Comparing forces on the fetal neck in breech delivery in lithotomy versus all-fours position: a simulation model. Arch Gynecol Obstet 2022; 308:91-99. [PMID: 35857095 DOI: 10.1007/s00404-022-06671-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 06/14/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE To measure forces applied to the fetal neck, in a simulation model for breech delivery, in both lithotomy versus all-fours position. METHODS We used a Laerdal SimMom simulator and a Birthing Baby together with PROMPT Flex Software. The descent of the fetus was accomplished using the Automatic Delivery Module 2. The baby was always in breech position; the SimMom in either all-fours or lithotomy positions. Sensors were located inside the fetal neck region to simulate forces applied to the plexus. RESULTS The lowest force on the fetal neck region was recorded for the delivery in all-fours position without further maneuvers (mean force 58.70 Newton, standard deviation 2.54 N). As weight was added to the baby, the force increased (i.e. + 500 g, mean force 71.8 N, SD 3.08 N, p < 0.001). Delivery in lithotomy position resulted in a mean force of 81.56 N (SD 19.55 N). The force significantly increased in case of delivery of the head without assistance from contractions (mean force 127.93 N, SD 23.10 N). In all-fours position, the delivery of the fetal head from pelvic floor level without contractions (Frank's Nudge maneuver) resulted in a mean force of 118.45 N (SD 15.48 N, p = 0.02). Maneuvers for shoulder dystocia (the inverted type that can occur during breech delivery) led to significantly higher mean forces independent from birthing positions. CONCLUSION Breech delivery in all-fours position was associated with the lowest force acting on the fetal neck in our simulation model.
Collapse
Affiliation(s)
- Delnaz Fard
- Department of Obstetrics, Gynecology and Reproductive Medicine, Hanover Medical School, Carl-Neuberg-Str. 1, 30625, Hanover, Germany
| | - Chiara S Borchers
- Department of Obstetrics, Gynecology and Reproductive Medicine, Hanover Medical School, Carl-Neuberg-Str. 1, 30625, Hanover, Germany
| | - Jill-Caren Philippeit
- Department of Obstetrics, Gynecology and Reproductive Medicine, Hanover Medical School, Carl-Neuberg-Str. 1, 30625, Hanover, Germany
| | - Anja V Philippeit
- Department of Obstetrics, Gynecology and Reproductive Medicine, Hanover Medical School, Carl-Neuberg-Str. 1, 30625, Hanover, Germany
| | - Laura R Kaukemüller
- Department of Obstetrics, Gynecology and Reproductive Medicine, Hanover Medical School, Carl-Neuberg-Str. 1, 30625, Hanover, Germany
| | - Lara R Higgins-Wood
- Department of Obstetrics, Gynecology and Reproductive Medicine, Hanover Medical School, Carl-Neuberg-Str. 1, 30625, Hanover, Germany
| | - Spyridon Papageorgiou
- Department of Obstetrics, Gynecology and Reproductive Medicine, Hanover Medical School, Carl-Neuberg-Str. 1, 30625, Hanover, Germany
| | - Peter Hillemanns
- Department of Obstetrics, Gynecology and Reproductive Medicine, Hanover Medical School, Carl-Neuberg-Str. 1, 30625, Hanover, Germany
| | - Constantin S von Kaisenberg
- Department of Obstetrics, Gynecology and Reproductive Medicine, Hanover Medical School, Carl-Neuberg-Str. 1, 30625, Hanover, Germany
| | - Rüdiger Klapdor
- Department of Obstetrics, Gynecology and Reproductive Medicine, Hanover Medical School, Carl-Neuberg-Str. 1, 30625, Hanover, Germany.
| |
Collapse
|
6
|
Schröder-Heurich B, Büder T, Meyer N, Vu TH, Richter K, Ramachandran D, Brodowski L, von Kaisenberg CS, von Versen-Höynck F. Downregulation of miR-1270 mediates endothelial progenitor cell function in preeclampsia: Role for ATM in the Src/VE-cadherin axis. FASEB J 2022; 36:e22379. [PMID: 35648632 DOI: 10.1096/fj.202200040rr] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 05/06/2022] [Accepted: 05/16/2022] [Indexed: 11/11/2022]
Abstract
Preeclampsia, a pregnancy-related hypertensive disorder, is associated with endothelial dysfunction and increased cardiovascular risk of the offspring in adulthood. In preeclampsia, endothelial colony-forming cells (ECFC) are reduced in number and function. Recently, we have shown that miR-1270, which is involved in cancer in vitro proliferation, migration, and tumor progression, is downregulated in fetal ECFC from preeclamptic pregnancies. We now hypothesize that miR-1270 dysregulation contributes to vascular endothelial dysfunction occurring after preeclampsia via ATM (ataxia telangiectasia mutated) overexpression, the key kinase of DNA damage repair. Here, we show that miR-1270 silencing in normal ECFC and downregulation in preeclamptic ECFC are accompanied by an increase in the expression levels of ATM. Furthermore, ATM activation correlates with upregulated tyrosine kinase Src leading to phosphorylation and internalization of VE-cadherin (vascular endothelial-cadherin) which subsequently compromises endothelial barrier permeability and morphodynamic cell parameters. Treatment with specific ATM inhibitors reveals a novel role of ATM upstream of tyrosine kinase Src activation. Subsequently, Src phosphorylation and internalization of VE-cadherin compromise endothelial barrier permeability. Our findings suggest that downregulation of miR-1270 contributes to impaired ECFC function via the associated ATM overexpression, which further identifies ATM as a novel and critical factor for ECFC defects in preeclampsia. Our study provides new insights into the understanding of ECFC impairment associated with cardiovascular risk in preeclamptic offspring and identifies potential novel therapeutic targets.
Collapse
Affiliation(s)
| | - Tim Büder
- Gynecology Research Unit, Hannover Medical School, Hannover, Germany
| | - Nadia Meyer
- Gynecology Research Unit, Hannover Medical School, Hannover, Germany
| | - Thu Huong Vu
- Gynecology Research Unit, Hannover Medical School, Hannover, Germany.,Department of Obstetrics and Gynecology, Hannover Medical School, Hannover, Germany
| | - Katja Richter
- Gynecology Research Unit, Hannover Medical School, Hannover, Germany
| | | | - Lars Brodowski
- Department of Obstetrics and Gynecology, Hannover Medical School, Hannover, Germany
| | | | - Frauke von Versen-Höynck
- Gynecology Research Unit, Hannover Medical School, Hannover, Germany.,Department of Obstetrics and Gynecology, Hannover Medical School, Hannover, Germany
| |
Collapse
|
7
|
Brodowski L, Rochow N, Yousuf EI, Kohls F, von Kaisenberg CS, Berlage S, Voigt M. The impact of parity and maternal obesity on the fetal outcomes of a non-selected Lower Saxony population. J Perinat Med 2022; 50:167-175. [PMID: 34695308 DOI: 10.1515/jpm-2020-0614] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 10/05/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Maternal obesity during pregnancy is associated with adverse intrauterine events and fetal outcomes and may increase the risk of obesity and metabolic disease development in offspring. Higher parity, regardless of socioeconomic status, is associated with increased maternal body mass index (BMI). In this study, we examined the relationship between parity, maternal obesity, and fetal outcomes in a large sample of mother-neonate pairs from Lower Saxony, Germany. METHODS This retrospective cohort study examined pseudonymized data of a non-selected singleton cohort from Lower Saxony's statewide quality assurance initiative. 448,963 cases were included. Newborn outcomes were assessed in relation to maternal BMI and parity. RESULTS Maternal obesity was associated with an increased risk of placental insufficiency, chorioamnionitis, and fetal distress while giving birth. This effect was present across all parity groups. Fetal presentation did not differ between BMI groups, except for the increased risk of high longitudinal position and shoulder dystocia in obese women. Maternal obesity was also associated with an increased risk of premature birth, low arterial cord blood pH and low 5-min APGAR scores. CONCLUSIONS Maternal obesity increases the risk of adverse neonatal outcomes. There is a positive correlation between parity and increased maternal BMI. Weight-dependent fetal risk factors increase with parity, while parity-dependent outcomes occur less frequently in multipara. Prevention and intervention programs for women planning to become pregnant can be promising measures to reduce pregnancy and birth complications.
Collapse
Affiliation(s)
- Lars Brodowski
- Department of Obstetrics, Gynecology and Reproductive Medicine, Hannover Medical School, Hannover, Germany
| | - Niels Rochow
- Department of Pediatrics, Paracelsus Medical University, Nuremberg, Germany.,Department of Pediatrics, Univesity Hospital Rostock, Rostock, Germany.,Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | - Efrah I Yousuf
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada.,Centre for Metabolism, Obesity and Diabetes Research, McMaster University, Hamilton, ON, Canada
| | - Fabian Kohls
- Department of Obstetrics, Gynecology and Reproductive Medicine, Hannover Medical School, Hannover, Germany
| | | | - Silvia Berlage
- Center for Quality and Management in Health Care, Ärztekammer Niedersachsen, Hannover, Germany
| | - Manfred Voigt
- Faculty of Medicine, Department of Obstetrics and Gynecology, University Medical Center Freiburg, University of Freiburg, Freiburg, Germany.,Biological Anthropology, Medical Faculty, University of Freiburg, Freiburg, Germany
| |
Collapse
|
8
|
Brodowski L, Rochow N, Yousuf EI, Kohls F, von Kaisenberg CS, Schild RL, Berlage S, Hagenah HP, Voigt M. The cumulative impact of parity on the body mass index (BMI) in a non-selected Lower Saxony population. J Perinat Med 2021; 49:460-467. [PMID: 33554575 DOI: 10.1515/jpm-2020-0261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 10/23/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVES During the last decade obesity has been continuously rising in adults in industrial countries. The increased occurrence of perinatal complications caused by maternal obesity poses a major challenge for obstetricians during pregnancy and childbirth. This study aims to examine the association between parity, pregnancy, birth risks, and body mass index (BMI) of women from Lower Saxony, Germany. METHODS This retrospective cohort study examined pseudonymized data of a non-selected singleton cohort from Lower Saxony's statewide quality assurance initiative. Mothers were categorized according to BMI as normal weight (18.5 to <25 kg/m2) or obese (≥30 kg/m2). RESULTS Most of the mothers in this study population were either in their first (33.9%) or second pregnancy (43.4%). The mean age of women giving birth for the first time was 28.3 years. Maternal age increased with increasing parity. The proportion of pregnant women with a BMI over 30 was 11% in primiparous women, 14.3% in second para, 17.3% in third para and 24.1% in fourth para or more women. Increasing parity was positively correlated with the incidence of classical diseases related to obesity, namely diabetes mellitus, gestational diabetes, hypertension, pregnancy-related hypertension and urinary protein excretion. An increased risk of primary or secondary cesarean section was observed in the obese women, particularly during the first deliveries. CONCLUSIONS There is a positive and significant correlation between parity and increased maternal BMI. The highest weight gain happens during the first pregnancy. The rate of operative deliveries and complications during delivery is increased in obese pregnant women.
Collapse
Affiliation(s)
- Lars Brodowski
- Department of Obstetrics, Gynecology and Reproductive Medicine, Hannover Medical School, Hannover, Germany
| | - Niels Rochow
- Department of Pediatrics, Paracelsus Medical University, Nuremberg, Germany.,Department of Pediatrics, Univesity Hospital Rostock, Rostock, Germany.,Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Efrah I Yousuf
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada.,Centre for Metabolism, Obesity and Diabetes Research, McMaster University, Hamilton, Canada
| | - Fabian Kohls
- Department of Obstetrics, Gynecology and Reproductive Medicine, Hannover Medical School, Hannover, Germany
| | | | - Ralf L Schild
- Obstetrics and Gynecology, Diakovere Hospital Hannover, Hannover, Germany
| | - Silvia Berlage
- Center for Quality and Management in Health Care, Ärztekammer Niedersachsen, Hannover, Germany
| | - Hans Peter Hagenah
- Department of Obstetrics, Agaplesion Diakonieklinikum Rotenburg, Rotenburg, Germany
| | - Manfred Voigt
- Department of Obstetrics and Gynecology, Faculty of Medicine, University Medical Center Freiburg, University of Freiburg, Freiburg, Germany.,Biological Anthropology, Medical Faculty, University of Freiburg, Freiburg, Germany
| |
Collapse
|
9
|
Brodowski L, Schröder-Heurich B, von Hardenberg S, Richter K, von Kaisenberg CS, Dittrich-Breiholz O, Meyer N, Dörk T, von Versen-Höynck F. MicroRNA Profiles of Maternal and Neonatal Endothelial Progenitor Cells in Preeclampsia. Int J Mol Sci 2021; 22:ijms22105320. [PMID: 34070163 PMCID: PMC8158476 DOI: 10.3390/ijms22105320] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 05/11/2021] [Accepted: 05/12/2021] [Indexed: 01/08/2023] Open
Abstract
Preeclampsia is associated with an increased cardiovascular morbidity of mother and offspring, thus contributing to a substantial burden in women and children’s health. It has been proven that endothelial progenitor cell (EPC) numbers and functional characteristics are impaired in cardiovascular disease and preeclampsia, although causative factors for the latter have remained elusive. MicroRNA (miRNA) modifications are a potential mechanism through which exposure to an altered environment translates into the development of chronic disease. In this study, we examined whether development of preeclampsia corresponds to alterations of miRNAs in maternal- and cord-blood-derived EPC. To test this end, we analyzed maternal and neonatal miRNAs via RNA sequencing from endothelial cells of preeclamptic and healthy controls in different cell culture passages. We were able to demonstrate differentially represented miRNAs in all groups. Hsa-miR-1270 showed significantly different levels in cord blood EPC from preeclampsia versus control and was negatively correlated with mRNA levels of its predicted targets ANGPTL7 and TFRC. Transfection with an hsa-miR-1270 inhibitor decreased the tube formation capacity and chemotactic motility but did not change proliferation in vitro. Target predictions and gene set enrichment analyses identified alternative splicing as a significantly enriched pathway for hsa-miR-1270. The top miRNAs in three other groups were predicted to target transcriptional and developmental pathways. Here, we showed for the first time significantly different levels of miRNAs and differently represented mRNA levels of predicted target genes in EPC derived from preeclampsia. Understanding the effects of preeclampsia on the epigenetic mechanisms of EPC will be crucial and may provide initial insights for further evaluation of the benefits of therapies targeting this cell population.
Collapse
Affiliation(s)
- Lars Brodowski
- Gynecology Research Unit, Hannover Medical School, Carl-Neuberg-Strasse 1, D-30625 Hannover, Germany; (L.B.); (B.S.-H.); (S.v.H.); (K.R.); (N.M.); (T.D.)
- Department of Obstetrics and Gynecology, Hannover Medical School, Carl-Neuberg-Strasse 1, D-30625 Hannover, Germany;
| | - Bianca Schröder-Heurich
- Gynecology Research Unit, Hannover Medical School, Carl-Neuberg-Strasse 1, D-30625 Hannover, Germany; (L.B.); (B.S.-H.); (S.v.H.); (K.R.); (N.M.); (T.D.)
| | - Sandra von Hardenberg
- Gynecology Research Unit, Hannover Medical School, Carl-Neuberg-Strasse 1, D-30625 Hannover, Germany; (L.B.); (B.S.-H.); (S.v.H.); (K.R.); (N.M.); (T.D.)
| | - Katja Richter
- Gynecology Research Unit, Hannover Medical School, Carl-Neuberg-Strasse 1, D-30625 Hannover, Germany; (L.B.); (B.S.-H.); (S.v.H.); (K.R.); (N.M.); (T.D.)
| | - Constantin S. von Kaisenberg
- Department of Obstetrics and Gynecology, Hannover Medical School, Carl-Neuberg-Strasse 1, D-30625 Hannover, Germany;
| | - Oliver Dittrich-Breiholz
- Research Core Unit Genomics, Hannover Medical School, Carl-Neuberg-Strasse 1, D-30625 Hannover, Germany;
| | - Nadia Meyer
- Gynecology Research Unit, Hannover Medical School, Carl-Neuberg-Strasse 1, D-30625 Hannover, Germany; (L.B.); (B.S.-H.); (S.v.H.); (K.R.); (N.M.); (T.D.)
| | - Thilo Dörk
- Gynecology Research Unit, Hannover Medical School, Carl-Neuberg-Strasse 1, D-30625 Hannover, Germany; (L.B.); (B.S.-H.); (S.v.H.); (K.R.); (N.M.); (T.D.)
| | - Frauke von Versen-Höynck
- Gynecology Research Unit, Hannover Medical School, Carl-Neuberg-Strasse 1, D-30625 Hannover, Germany; (L.B.); (B.S.-H.); (S.v.H.); (K.R.); (N.M.); (T.D.)
- Department of Obstetrics and Gynecology, Hannover Medical School, Carl-Neuberg-Strasse 1, D-30625 Hannover, Germany;
- Correspondence: ; Tel.: +49-511-532-8703; Fax: +49-511-532-6081
| |
Collapse
|
10
|
Schröder-Heurich B, von Hardenberg S, Brodowski L, Kipke B, Meyer N, Borns K, von Kaisenberg CS, Brinkmann H, Claus P, von Versen-Höynck F. Vitamin D improves endothelial barrier integrity and counteracts inflammatory effects on endothelial progenitor cells. FASEB J 2019; 33:9142-9153. [PMID: 31084577 DOI: 10.1096/fj.201802750rr] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Endothelial colony-forming cells (ECFCs), a proliferative subpopulation of endothelial progenitor cells, are involved in angiogenesis and endothelial repair. In this study, we investigated endothelial barrier characteristics of ECFCs, whether vitamin D supports cell-cell adhesion and barrier integrity, and how it affects ECFC mobilization and actin dynamics. Although ECFC barrier was disrupted under inflammatory conditions, this effect was rescued by vitamin D treatment, leading to higher stability of an ECFC monolayer. Furthermore, vitamin D enhanced ECFC mobilization toward directional migration. In addition, immunocytochemistry, quantitative real-time PCR, and immunoblotting analysis showed that vitamin D increased endothelial interconnections through vascular endothelial cadherin (VE-cadherin) junctions and by impacting cell dynamics through cofilin and VE-cadherin phosphorylation. Our results suggest that vitamin D treatment efficiently counteracts inflammation in an ECFC monolayer, resulting in higher ECFC barrier integrity. This study provides evidence of a new beneficial effect of vitamin D for ECFC homeostasis.-Schröder-Heurich, B., von Hardenberg, S., Brodowski, L., Kipke, B., Meyer, N., Borns, K., von Kaisenberg, C. S., Brinkmann, H., Claus, P., von Versen-Höynck, F. Vitamin D improves endothelial barrier integrity and counteracts inflammatory effects on endothelial progenitor cells.
Collapse
Affiliation(s)
| | | | - Lars Brodowski
- Gynecology Research Unit, Hannover Medical School, Hannover, Germany.,Department of Obstetrics and Gynecology, Hannover Medical School, Hannover, Germany
| | - Berina Kipke
- Gynecology Research Unit, Hannover Medical School, Hannover, Germany
| | - Nadia Meyer
- Gynecology Research Unit, Hannover Medical School, Hannover, Germany
| | - Katja Borns
- Gynecology Research Unit, Hannover Medical School, Hannover, Germany
| | | | - Hella Brinkmann
- Institute of Neuroanatomy and Cell Biology, Hannover Medical School, Hannover, Germany
| | - Peter Claus
- Institute of Neuroanatomy and Cell Biology, Hannover Medical School, Hannover, Germany
| | - Frauke von Versen-Höynck
- Gynecology Research Unit, Hannover Medical School, Hannover, Germany.,Department of Obstetrics and Gynecology, Hannover Medical School, Hannover, Germany
| |
Collapse
|
11
|
Brodowski L, Zindler T, von Hardenberg S, Schröder-Heurich B, von Kaisenberg CS, Frieling H, Hubel CA, Dörk T, von Versen-Höynck F. Preeclampsia-Associated Alteration of DNA Methylation in Fetal Endothelial Progenitor Cells. Front Cell Dev Biol 2019; 7:32. [PMID: 30949477 PMCID: PMC6436196 DOI: 10.3389/fcell.2019.00032] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Accepted: 02/25/2019] [Indexed: 01/06/2023] Open
Abstract
Objective The pregnancy complication preeclampsia represents an independent risk factor for cardiovascular disease. Our previous research shows a diminished function of fetal endothelial colony-forming cells (ECFC), a proliferative subgroup of endothelial progenitor cells (EPC) in preeclampsia. The aim of this study was to further investigate whether DNA methylation of fetal EPC is affected in preeclampsia. Methods The genomic methylation pattern of fetal ECFC from uncomplicated and preeclamptic pregnancies was compared for 865918 CpG sites, and genes were classified into gene networks. Low and advanced cell culture passages were compared to explore whether expansion of fetal ECFC in cell culture leads to changes in global methylation status and if methylation characteristics in preeclampsia are maintained with increasing passage. Results A differential methylation pattern of fetal ECFC from preeclampsia compared to uncomplicated pregnancy was detected for a total of 1266 CpG sites in passage 3, and for 2362 sites in passage 5. Key features of primary networks implicated by methylation differences included cell metabolism, cell cycle and transcription and, more specifically, genes involved in cell-cell interaction and Wnt signaling. We identified an overlap between differentially regulated pathways in preeclampsia and cardiovascular system development and function. Cell culture passages 3 and 5 showed similar gene network profiles, and 1260 out of 1266 preeclampsia-associated methylation changes detected in passage 3 were confirmed in passage 5. Conclusion Methylation modification caused by preeclampsia is stable and detectable even in higher cell culture passages. An epigenetically modified endothelial precursor may influence both normal morphogenesis and postnatal vascular repair capacity. Further studies on epigenetic modifications in complicated pregnancies are needed to facilitate development of EPC based therapies for cardiovascular alterations.
Collapse
Affiliation(s)
- Lars Brodowski
- Department of Obstetrics and Gynecology, Hannover Medical School, Hanover, Germany
| | - Tristan Zindler
- Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hanover, Germany
| | | | | | | | - Helge Frieling
- Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hanover, Germany
| | - Carl A Hubel
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Magee-Womens Research Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Thilo Dörk
- Department of Obstetrics and Gynecology, Hannover Medical School, Hanover, Germany
| | | |
Collapse
|
12
|
Kocylowski R, Grzesiak M, Gaj Z, Lorenc W, Bakinowska E, Barałkiewicz D, von Kaisenberg CS, Lamers Y, Suliburska J. Associations between the Level of Trace Elements and Minerals and Folate in Maternal Serum and Amniotic Fluid and Congenital Abnormalities. Nutrients 2019; 11:E328. [PMID: 30717440 PMCID: PMC6413094 DOI: 10.3390/nu11020328] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 01/24/2019] [Accepted: 01/28/2019] [Indexed: 12/27/2022] Open
Abstract
Congenital birth defects may result in a critical condition affecting the baby, including severe fetal/neonatal handicap and mortality. Several studies have shown that genetic, nutritional, and environmental factors may have an impact on fetal development and neonatal health. The relevance of essential and toxic elements on fetal development has not yet been fully investigated, and the results of recent research indicate that these elements may be crucial in the assessment of the risk of malformations in neonates. We determined the association between essential and toxic elements and the level of folate in maternal serum (MS) and amniotic fluid (AF), along with neonatal abnormalities. A total of 258 pregnant Polish women in the age group of 17⁻42 years participated in this study. AF and MS were collected during vaginal delivery or during cesarean section. An inductively coupled plasma mass spectrometry technique was used to determine the levels of various elements in AF and MS. The results of this exploratory study indicate that the levels of essential and toxic elements are associated with fetal and newborn anatomical abnormalities and growth disorders.
Collapse
Affiliation(s)
- Rafal Kocylowski
- Department of Obstetrics, Perinatology and Gynecology, Polish Mother's Memorial Hospital Research Institute, ul. Rzgowska 281/289, 93-338 Lodz, Poland.
- PreMediCare New Med Medical Center, ul. Drużbickiego 13, 61-693 Poznan, Poland.
| | - Mariusz Grzesiak
- Department of Obstetrics, Perinatology and Gynecology, Polish Mother's Memorial Hospital Research Institute, ul. Rzgowska 281/289, 93-338 Lodz, Poland.
| | - Zuzanna Gaj
- Department of Obstetrics, Perinatology and Gynecology, Polish Mother's Memorial Hospital Research Institute, ul. Rzgowska 281/289, 93-338 Lodz, Poland.
- Scientific Laboratory of the Center of Medical Laboratory Diagnostics and Screening, Polish Mother's Memorial Hospital Research Institute, ul. Rzgowska 281/289, 93-338 Lodz, Poland.
| | - Wiktor Lorenc
- Department of Trace Element Analysis by Spectroscopy Method, Faculty of Chemistry, Adam Mickiewicz University in Poznan, ul. Umultowska 89b, 61-614 Poznan, Poland.
| | - Ewa Bakinowska
- Institute of Mathematics, Poznan University of Technology, ul. Piotrowo 3A, 60-965 Poznan, Poland.
| | - Danuta Barałkiewicz
- Department of Trace Element Analysis by Spectroscopy Method, Faculty of Chemistry, Adam Mickiewicz University in Poznan, ul. Umultowska 89b, 61-614 Poznan, Poland.
| | - Constantin S von Kaisenberg
- Department of Obstetrics and Gynecology, Hannover Medical School, Carl-Neuberg-Str. 1, D-30625 Hannover, Germany.
| | - Yvonne Lamers
- Food, Nutrition and Health Program, Faculty of Land and Food Systems, The University of British Columbia, Vancouver, BC V6T 1Z4, Canada.
- British Columbia Children's Hospital Research Institute, Vancouver, BC V5Z 4H4, Canada.
| | - Joanna Suliburska
- Institute of Human Nutrition and Dietetics, Poznan University of Life Sciences, Poznan, Poland, ul. Wojska Polskiego 31, 60-624 Poznan, Poland.
| |
Collapse
|
13
|
Ulas T, Pirr S, Fehlhaber B, Bickes MS, Loof TG, Vogl T, Mellinger L, Heinemann AS, Burgmann J, Schöning J, Schreek S, Pfeifer S, Reuner F, Völlger L, Stanulla M, von Köckritz-Blickwede M, Glander S, Barczyk-Kahlert K, von Kaisenberg CS, Friesenhagen J, Fischer-Riepe L, Zenker S, Schultze JL, Roth J, Viemann D. Corrigendum: S100-alarmin-induced innate immune programming protects newborn infants from sepsis. Nat Immunol 2017; 18:1173. [PMID: 28926540 DOI: 10.1038/ni1017-1173b] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
|
14
|
Heinemann AS, Pirr S, Fehlhaber B, Mellinger L, Burgmann J, Busse M, Ginzel M, Friesenhagen J, von Köckritz-Blickwede M, Ulas T, von Kaisenberg CS, Roth J, Vogl T, Viemann D. In neonates S100A8/S100A9 alarmins prevent the expansion of a specific inflammatory monocyte population promoting septic shock. FASEB J 2016; 31:1153-1164. [PMID: 27993995 DOI: 10.1096/fj.201601083r] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2016] [Accepted: 11/28/2016] [Indexed: 12/28/2022]
Abstract
The high susceptibility of newborn infants to sepsis is ascribed to an immaturity of the neonatal immune system, but the molecular mechanisms remain unclear. Newborn monocytes massively release the alarmins S100A8/S100A9. In adults, these are major regulators of immunosuppressive myeloid-derived suppressor cells (MDSCs). We investigated whether S100A8/S100A9 cause an expansion of monocytic MDSCs (Mo-MDSCs) in neonates, thereby contributing to an immunocompromised state. Mo-MDSCs have been assigned to CD14+/human leukocyte antigen (HLA)-DR-/low/CD33+ monocytes in humans and to CD11b+/Gr-1int/Ly6G-/Ly6Chi cells in mice. We found monocytes with these phenotypes significantly expanded in their respective newborns. Functionally, however, they did not prove immunosuppressive but rather responded inflammatorily to microbial stimulation. Their expansion did not correlate with high S100A8/S100A9 levels in cord blood. Murine studies revealed an excessive expansion of CD11b+/Gr-1int/Ly6G-/Ly6Chi monocytes in S100A9-/- neonates compared to wild-type neonates. This strong baseline expansion was associated with hyperinflammatory responses during endotoxemia and fatal septic courses. Treating S100A9-/- neonates directly after birth with S100A8/S100A9 alarmins prevented excessive expansion of this inflammatory monocyte population and death from septic shock. Our data suggest that a specific population of inflammatory monocytes promotes fatal courses of sepsis in neonates if its expansion is not regulated by S100A8/S100A9 alarmins.-Heinemann, A. S., Pirr, S., Fehlhaber, B., Mellinger, L., Burgmann, J., Busse, M., Ginzel, M., Friesenhagen, J., von Köckritz-Blickwede, M., Ulas, T., von Kaisenberg, C. S., Roth, J., Vogl, T., Viemann, D. In neonates S100A8/S100A9 alarmins prevent the expansion of a specific inflammatory monocyte population promoting septic shock.
Collapse
Affiliation(s)
- Anna S Heinemann
- Department of Pediatric Pneumology, Allergy, and Neonatology, Hannover Medical School, Hannover, Germany
| | - Sabine Pirr
- Department of Pediatric Pneumology, Allergy, and Neonatology, Hannover Medical School, Hannover, Germany
| | - Beate Fehlhaber
- Department of Pediatric Pneumology, Allergy, and Neonatology, Hannover Medical School, Hannover, Germany
| | - Lara Mellinger
- Department of Pediatric Pneumology, Allergy, and Neonatology, Hannover Medical School, Hannover, Germany
| | - Johanna Burgmann
- Department of Pediatric Pneumology, Allergy, and Neonatology, Hannover Medical School, Hannover, Germany
| | - Mandy Busse
- Department of Pediatric Pneumology, Allergy, and Neonatology, Hannover Medical School, Hannover, Germany
| | - Marco Ginzel
- Department of Pediatric Pneumology, Allergy, and Neonatology, Hannover Medical School, Hannover, Germany
| | - Judith Friesenhagen
- Department of Pediatric Pneumology, Allergy, and Neonatology, Hannover Medical School, Hannover, Germany
| | - Maren von Köckritz-Blickwede
- Department of Physiological Chemistry, University of Veterinary Medicine Hannover, Hannover, Germany.,Research Center for Emerging Infections and Zoonoses (RIZ), University of Veterinary Medicine Hannover, Hannover, Germany
| | - Thomas Ulas
- Genomics and Immunoregulation, Life and Medical Sciences Institute, University of Bonn, Bonn, Germany
| | | | - Johannes Roth
- Institute of Immunology, University of Münster, Münster, Germany.,Interdisciplinary Centre for Clinical Research, University of Münster, Münster, Germany; and
| | - Thomas Vogl
- Institute of Immunology, University of Münster, Münster, Germany.,Interdisciplinary Centre for Clinical Research, University of Münster, Münster, Germany; and
| | - Dorothee Viemann
- Department of Pediatric Pneumology, Allergy, and Neonatology, Hannover Medical School, Hannover, Germany;
| |
Collapse
|
15
|
Hupe MC, Merseburger AS, Günter HH, Wüstemann M, von Kaisenberg CS. Successful Pregnancy and Neobladder Subsequent to Muscle Invasive Bladder Cancer and Fertility Preserving Surgery: Case Report and Review of the Literature. Urol Int 2015; 96:488-91. [PMID: 26044131 DOI: 10.1159/000430921] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Accepted: 04/24/2015] [Indexed: 11/19/2022]
Abstract
We report a successful pregnancy and birth subsequent to fertility-preserving cystectomy and neobladder formation in a muscle-invasive sarcomatoid urothelial carcinoma.
Collapse
Affiliation(s)
- Marie C Hupe
- Department of Urology and Urologic Oncology, Hannover Medical School, Hannover, Germany
| | | | | | | | | |
Collapse
|
16
|
Hilfiker-Kleiner D, Westhoff-Bleck M, Gunter HH, von Kaisenberg CS, Bohnhorst B, Hoeltje M, Kuehn C. A management algorithm for acute heart failure in pregnancy. The Hannover experience. Eur Heart J 2015; 36:769-770. [PMID: 26000354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/04/2023] Open
|
17
|
Austermann J, Friesenhagen J, Fassl SK, Petersen B, Ortkras T, Burgmann J, Barczyk-Kahlert K, Faist E, Zedler S, Pirr S, Rohde C, Müller-Tidow C, von Köckritz-Blickwede M, von Kaisenberg CS, Flohé SB, Ulas T, Schultze JL, Roth J, Vogl T, Viemann D. Alarmins MRP8 and MRP14 induce stress tolerance in phagocytes under sterile inflammatory conditions. Cell Rep 2014; 9:2112-23. [PMID: 25497086 DOI: 10.1016/j.celrep.2014.11.020] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Revised: 10/17/2014] [Accepted: 11/11/2014] [Indexed: 01/06/2023] Open
Abstract
Hyporesponsiveness by phagocytes is a well-known phenomenon in sepsis that is frequently induced by low-dose endotoxin stimulation of Toll-like receptor 4 (TLR4) but can also be found under sterile inflammatory conditions. We now demonstrate that the endogenous alarmins MRP8 and MRP14 induce phagocyte hyporesponsiveness via chromatin modifications in a TLR4-dependent manner that results in enhanced survival to septic shock in mice. During sterile inflammation, polytrauma and burn trauma patients initially present with high serum concentrations of myeloid-related proteins (MRPs). Human neonatal phagocytes are primed for hyporesponsiveness by increased peripartal MRP concentrations, which was confirmed in murine neonatal endotoxinemia in wild-type and MRP14(-/-) mice. Our data therefore indicate that alarmin-triggered phagocyte tolerance represents a regulatory mechanism for the susceptibility of neonates during systemic infections and sterile inflammation.
Collapse
Affiliation(s)
- Judith Austermann
- Institute of Immunology, University of Münster, 48149 Münster, Germany; Interdisciplinary Centre for Clinical Research, University of Münster, 48149 Münster, Germany.
| | - Judith Friesenhagen
- Department of Pediatric Pneumology, Allergy and Neonatology, Hannover Medical School, 30625 Hannover, Germany
| | | | | | - Theresa Ortkras
- Institute of Immunology, University of Münster, 48149 Münster, Germany
| | - Johanna Burgmann
- Department of Pediatric Pneumology, Allergy and Neonatology, Hannover Medical School, 30625 Hannover, Germany
| | | | - Eugen Faist
- Department of Surgery and Clinical Study Center, Ludwig-Maximilian University, 81377 Munich, Germany
| | - Siegfried Zedler
- Department of Surgery and Clinical Study Center, Ludwig-Maximilian University, 81377 Munich, Germany
| | - Sabine Pirr
- Department of Pediatric Pneumology, Allergy and Neonatology, Hannover Medical School, 30625 Hannover, Germany
| | - Christian Rohde
- Department of Molecular Haematology and Oncology, Internal Medicine Clinic IV, University Medical Center Halle (Saale), 06120 Halle, Germany
| | - Carsten Müller-Tidow
- Department of Molecular Haematology and Oncology, Internal Medicine Clinic IV, University Medical Center Halle (Saale), 06120 Halle, Germany
| | | | | | - Stefanie B Flohé
- Surgical Research, Department of Trauma Surgery, University Hospital Essen, University Duisburg-Essen, 45147 Essen, Germany
| | - Thomas Ulas
- Genomics and Immunoregulation, LIMES-Institute, University of Bonn, 53115 Bonn, Germany
| | - Joachim L Schultze
- Genomics and Immunoregulation, LIMES-Institute, University of Bonn, 53115 Bonn, Germany
| | - Johannes Roth
- Institute of Immunology, University of Münster, 48149 Münster, Germany; Interdisciplinary Centre for Clinical Research, University of Münster, 48149 Münster, Germany
| | - Thomas Vogl
- Institute of Immunology, University of Münster, 48149 Münster, Germany; Interdisciplinary Centre for Clinical Research, University of Münster, 48149 Münster, Germany
| | - Dorothee Viemann
- Department of Pediatric Pneumology, Allergy and Neonatology, Hannover Medical School, 30625 Hannover, Germany
| |
Collapse
|
18
|
Kleppa MJ, Erlenwein SV, Darashchonak N, von Kaisenberg CS, von Versen-Höynck F. Hypoxia and the anticoagulants dalteparin and acetylsalicylic acid affect human placental amino acid transport. PLoS One 2014; 9:e99217. [PMID: 24901243 PMCID: PMC4047053 DOI: 10.1371/journal.pone.0099217] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Accepted: 05/12/2014] [Indexed: 01/12/2023] Open
Abstract
Background Anticoagulants, e.g. low-molecular weight heparins (LMWHs) and acetylsalicylic acid (ASA) are prescribed to women at risk for pregnancy complications that are associated with impaired placentation and placental hypoxia. Beyond their role as anticoagulants these compounds exhibit direct effects on trophoblast but their impact on placental function is unknown. The amino acid transport systems A and L, which preferably transfer essential amino acids, are well-described models to study placental nutrient transport. We aimed to examine the effect of hypoxia, LMWHs and ASA on the activity of the placental amino acid transport systems A and L and associated signalling mechanisms. Methods The uptake of C14-MeAIB (system A) or H3-leucin (system L) was investigated after incubation of primary villous fragments isolated from term placentas. Villous tissue was incubated at 2% O2 (hypoxia), 8% O2 and standard culture conditions (21% O2) or at 2% O2 and 21% O2 with dalteparin or ASA. Activation of the JAK/STAT or mTOR signalling pathways was determined by Western analysis of total and phosphorylated STAT3 or Raptor. Results Hypoxia decreased system A mediated MeAIB uptake and increased system L mediated leucine uptake compared to standard culture conditions (21% O2). This was accompanied by an impairment of STAT3 and a stimulation of Raptor signalling. System L activity increased at 8% O2. Dalteparin treatment reduced system A and system L activity under normoxic conditions and ASA (1 mM) decreased system A and L transporter activity under normoxic and hypoxic conditions. Conclusions Our data underline the dependency of placental function on oxygen supply. LMWHs and ASA are not able to reverse the effects of hypoxia on placental amino acid transport. These findings and the uncovering of the signalling mechanisms in more detail will help to understand the impact of LMWHs and ASA on placental function and fetal growth.
Collapse
Affiliation(s)
- Marc-Jens Kleppa
- Department of Obstetrics and Gynecology, Hannover Medical School, Hannover, Germany
| | | | | | | | | |
Collapse
|
19
|
Brodowski L, Burlakov J, Myerski AC, von Kaisenberg CS, Grundmann M, Hubel CA, von Versen-Höynck F. Vitamin D prevents endothelial progenitor cell dysfunction induced by sera from women with preeclampsia or conditioned media from hypoxic placenta. PLoS One 2014; 9:e98527. [PMID: 24887145 PMCID: PMC4041729 DOI: 10.1371/journal.pone.0098527] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Accepted: 05/01/2014] [Indexed: 01/17/2023] Open
Abstract
CONTEXT Placenta-derived circulating factors contribute to the maternal endothelial dysfunction underlying preeclampsia. Endothelial colony forming cells (ECFC), a sub-population of endothelial progenitor cells (EPCs), are thought to be involved in vasculogenesis and endothelial repair. Low vitamin D concentrations are associated with an increased risk for preeclampsia. OBJECTIVE We hypothesized that the function of human fetal ECFCs in culture would be suppressed by exposure to preeclampsia-related factors--preeclampsia serum or hypoxic placental conditioned medium--in a fashion reversed by vitamin D. DESIGN, SETTING, PATIENTS ECFCs were isolated from cord blood of uncomplicated pregnancies and expanded in culture. Uncomplicated pregnancy villous placenta in explant culture were exposed to either 2% (hypoxic), 8% (normoxic) or 21% (hyperoxic) O2 for 48 h, after which the conditioned media (CM) was collected. OUTCOME MEASURES ECFC tubule formation (Matrigel assay) and migration were examined in the presence of either maternal serum from preeclampsia cases or uncomplicated pregnancy controls, or pooled CM, in the presence or absence of 1,25(OH)2 vitamin D3. RESULTS 1,25(OH)2 vitamin D3 reversed the adverse effects of preeclampsia serum or CM from hypoxic placenta on ECFCs capillary-tube formation and migration. Silencing of VDR expression by VDR siRNA, VDR blockade, or VEGF pathway blockade reduced ECFC functional abilities. Effects of VDR or VEGF blockade were partially prevented by vitamin D. CONCLUSION Vitamin D promotes the capillary-like tubule formation and migration of ECFCs in culture, minimizing the negative effects of exposure to preeclampsia-related factors. Further evaluation of the role of vitamin D in ECFC regulation and preeclampsia is warranted.
Collapse
Affiliation(s)
- Lars Brodowski
- Department of Obstetrics and Gynecology, Hannover Medical School, Hannover, Germany
| | - Jennifer Burlakov
- Department of Obstetrics and Gynecology, Hannover Medical School, Hannover, Germany
| | - Ashley C. Myerski
- Magee- Womens Research Institute and Foundation, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | | | - Magdalena Grundmann
- Department of Obstetrics and Gynecology, Hannover Medical School, Hannover, Germany
| | - Carl A. Hubel
- Magee- Womens Research Institute and Foundation, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | | |
Collapse
|
20
|
Heidrich MB, Wenzel D, von Kaisenberg CS, Schippert C, von Versen-Höynck FM. Preeclampsia and long-term risk of cardiovascular disease: what do obstetrician-gynecologists know? BMC Pregnancy Childbirth 2013; 13:61. [PMID: 23497157 PMCID: PMC3605330 DOI: 10.1186/1471-2393-13-61] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2013] [Accepted: 03/04/2013] [Indexed: 11/21/2022] Open
Abstract
Background Preeclampsia (PE), a hypertensive disorder of pregnancy affects 2-8% of women and is associated with increased cardiovascular disease (CVD) risk later in life. There is little information about the knowledge of obstetrician-gynecologists in German outpatient care setting regarding the future health risk of PE and knowledge of the current guidelines on treatment and counseling patients post PE. This study aimed to assess whether obstetrician-gynecologists are aware of PE’s association with maternal long-term adverse outcomes and providing appropriate counseling. Methods A random sample of 500 obstetrician-gynecologists in the federal state of Lower Saxony was mailed a survey and a reminder with a second copy of the survey. The questionnaire elicited both personal information, and knowledge on future disease risks, e.g. cardiovascular disease (CVD) and current guidelines as well as on counseling practice. Descriptive analysis was used to analyze the responses. Results A total of 212 obstetrician-gynecologists (42.4%) responded to the questionnaire. A large proportion of physicians stated that PE was associated with a higher risk for the development for hypertension (86.6%), stroke (78.5%) and kidney disease (78.0%). Of the participants 75.8% reported that women after PE have a shorter life expectancy. Respondents with knowledge of the current guidelines of the German Association of Obstetrics and Gynecology concerning follow up and risk management of PE (45.2%) were more often aware of the development of CVD and stroke and counseled patients on self -blood-pressure measurement, meaning and long-term-risks of PE and attached importance to family history of PE compared to physicians with no knowledge of the guidelines. Conclusion Although the majority of obstetrician-gynecologists were aware of higher CVD risk after PE, weaknesses exist in the follow up care and counseling of these patients. These deficiencies would be amendable to directed educational activities to improve the implementation of current guidelines.
Collapse
Affiliation(s)
- May-Britt Heidrich
- Department of Obstetrics and Gynecology, Hannover Medical School, Carl-Neuberg-Str, 1, Hannover, 30625, Germany
| | | | | | | | | |
Collapse
|
21
|
Tzialidou-Palermo I, von Kaisenberg CS, Garcia-Rocha GJ, Schloesser HW, Baehr I, Schippert C. Diagnostic challenges of hemihematocolpos and dysmenorrhea in adolescents: obstructed hemivagina, didelphys or bicornuate uterus and renal aplasia is a rare female genital malformation. Arch Gynecol Obstet 2012; 286:785-91. [DOI: 10.1007/s00404-012-2392-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2011] [Accepted: 05/16/2012] [Indexed: 11/28/2022]
|
22
|
Eckmann-Scholz C, von Kaisenberg CS, Alkatout I, Jonat W, Rajabi-Wieckhorst A. Pathologic ultrasound findings and risk for congenital anomalies in teenage pregnancies. J Matern Fetal Neonatal Med 2012; 25:1950-2. [PMID: 22471556 DOI: 10.3109/14767058.2012.678436] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To detect the number and diagnosis of fetal malformations in teenage pregnancies and to evaluate whether low maternal age or epigenetic factors have an influence on this issue. MATERIALS AND METHODS We performed a retrospective analysis in a single center for prenatal diagnostics in Northern Germany. We searched our electronic databank for all pregnancies with maternal age under 20 years. Pregnancy outcome and fetal malformations are described. RESULTS The incidence of teenage pregnancies in our study was 638 patients (4.4%). The total of fetal malformations in teenage pregnancies was 51(8.3%). Chromosomal aberrations were found in 5 cases (0.9%). 9 cases of fetal gastroschisis as one of the most frequent malformations were followed up and neonatal outcome was uneventful. Furthermore we found 16 cases with different heart defects and 30 cases with other malformations. Patients' body mass indices showed an increase over the years and nicotine consumption was testified in more than 50% of the patients. CONCLUSIONS Teenage pregnancies are at risk for fetal non-chromosomal and chromosomal abnormalities. As these might be detected by first-trimester-screening prenatal care in teenage pregnancies should include at least early ultrasound examination. Epigenetic factors may play a key role in certain fetal malformations.
Collapse
Affiliation(s)
- Christel Eckmann-Scholz
- Department of Gynecology and Obstetrics, University Hospitals Schleswig-Holstein, Campus Kiel, Germany.
| | | | | | | | | |
Collapse
|
23
|
Eckmann-Scholz C, Mallek J, von Kaisenberg CS, Arnold NK, Jonat W, Reiner S, Caliebe A, Heidemann S. Chromosomal mosaicisms in prenatal diagnosis: correlation with first trimester screening and clinical outcome. J Perinat Med 2012; 40:215-23. [PMID: 22505498 DOI: 10.1515/jpm.2011.130] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2011] [Accepted: 10/24/2011] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To investigate the outcome of pregnancy after detection of chromosomal mosaicism and to determine the correlation between human chorionic gonadotropin (free β-HCG) and pregnancy-associated plasma protein-A (PAPP-A) levels from first-trimester-screening with pregnancy outcome. METHODS In a single-center, retrospective survey of the results of prenatal diagnostics performed between January 2000 and March 2011, we identified a total of 40 pregnancies with chromosomal mosaicism. Clinical characteristics and results of first-trimester screening, as well as the outcome of these cases, are described. RESULTS Out of 40 cases, 21 were defined as confined placental mosaicism, 10 classified as true mosaicism and nine were not classifiable cases. Nuchal translucency (NT) was ≥2.5 mm in 8/30 cases with respective measurements. PAPP-A levels were ≤0.4 MoM in 9/26 cases, with respective measurements, two of them being newborns with growth restriction. Remarkably, in pregnancies of all four children born with severe growth retardation, <3rd percentile PAPP-A levels were below 0.52 MoM. CONCLUSIONS Our observations show mosaic pregnancy outcomes to be very heterogeneous. Nevertheless, a combination of low PAPP-A and interpretation of chromosomal mosaicism might identify pregnancies at particular risk for fetal growth restriction.
Collapse
Affiliation(s)
- Christel Eckmann-Scholz
- Department of Gynecology and Obstetrics, University Hospital Schleswig-Holstein, Campus Kiel and Christian-Albrechts-University Kiel, Kiel, Germany.
| | | | | | | | | | | | | | | |
Collapse
|
24
|
Weimer J, Heidemann S, von Kaisenberg CS, Grote W, Arnold N, Bens S, Caliebe A. Isolated trisomy 7q21.2-31.31 resulting from a complex familial rearrangement involving chromosomes 7, 9 and 10. Mol Cytogenet 2011; 4:28. [PMID: 22136633 PMCID: PMC3261807 DOI: 10.1186/1755-8166-4-28] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2011] [Accepted: 12/05/2011] [Indexed: 11/22/2022] Open
Abstract
Background Genotype-phenotype correlations for chromosomal imbalances are often limited by overlapping effects of partial trisomy and monosomy resulting from unbalanced translocations and by poor resolution of banding analysis for breakpoint designation. Here we report the clinical features of isolated partial trisomy 7q21.2 to 7q31.31 without overlapping phenotypic effects of partial monosomy in an 8 years old girl. The breakpoints of the unbalanced rearranged chromosome 7 could be defined precisely by array-CGH and a further imbalance could be excluded. The breakpoints of the balanced rearranged chromosomes 9 and 10 were identified by microdissection of fluorescence labelled derivative chromosomes 9 and 10. Results The proband's mother showed a complex balanced translocation t(9;10)(p13;q23) with insertion of 7q21.2-31.31 at the translocation breakpoint at 9p13. The daughter inherited the rearranged chromosomes 9 and 10 but the normal chromosome 7 from her mother, resulting in partial trisomy 7q21.2 to 7q31.31. The phenotype of the patient consisted of marked developmental retardation, facial dysmorphism, short stature, strabism, and hyperextensible metacarpophalangeal joints. Discussion For better understanding of genotype-phenotype correlation a new classification of 7q duplications which will be based on findings of molecular karyotyping is needed. Therefore, the description of well-defined patients is valuable. This case shows that FISH-microdissection is of great benefit for precise breakpoint designation in balanced rearrangements.
Collapse
Affiliation(s)
- Jörg Weimer
- Department of Obstetrics and Gynaecology, Christian-Albrechts-University of Kiel, University Hospital of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str.3, Haus 24, Kiel, Germany
| | - Simone Heidemann
- Institute of Human Genetics, Christian-Albrechts-University of Kiel, University Hospital Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str.3, Haus 10, Kiel, Germany
| | - Constantin S von Kaisenberg
- Department of Obstetrics and Gynaecology, Christian-Albrechts-University of Kiel, University Hospital of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str.3, Haus 24, Kiel, Germany.,Department of Obstetrics, Gynaecology and Reproductive Medicine, Hannover Medical School, Hannover, Germany
| | - Werner Grote
- Institute of Human Genetics, Christian-Albrechts-University of Kiel, University Hospital Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str.3, Haus 10, Kiel, Germany
| | - Norbert Arnold
- Department of Obstetrics and Gynaecology, Christian-Albrechts-University of Kiel, University Hospital of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str.3, Haus 24, Kiel, Germany
| | - Susanne Bens
- Institute of Human Genetics, Christian-Albrechts-University of Kiel, University Hospital Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str.3, Haus 10, Kiel, Germany
| | - Almuth Caliebe
- Institute of Human Genetics, Christian-Albrechts-University of Kiel, University Hospital Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str.3, Haus 10, Kiel, Germany
| |
Collapse
|
25
|
Bräutigam K, Biernath-Wüpping J, Bauerschlag DO, von Kaisenberg CS, Jonat W, Maass N, Arnold N, Meinhold-Heerlein I. Combined treatment with TRAIL and PPARγ ligands overcomes chemoresistance of ovarian cancer cell lines. J Cancer Res Clin Oncol 2010; 137:875-86. [PMID: 20878528 DOI: 10.1007/s00432-010-0952-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2010] [Accepted: 09/16/2010] [Indexed: 01/24/2023]
Abstract
PURPOSE Ovarian cancer accounts for the highest mortality among all gynecological cancers, mainly due to the fast developing chemoresistance. The death ligand TRAIL induces apoptosis and is able to sensitize tumor cells to cytostatic drugs without affecting physiological tissue. Combined treatment of TRAIL and the antidiabetic acting PPARγ ligands was shown to induce apoptosis synergistically in different ovarian cancer cell lines. METHODS To investigate feasible TRAIL-dependent inhibition of proliferation and induction of apoptosis in chemoresistant ovarian cancer cell lines, the drug- and TRAIL-sensitive HEY cell line was utilized to develop subclones with selective resistance against cisplatin, etoposide, docetaxel, paclitaxel, gemcitabine and pemetrexed, as well as against TRAIL as control cell line. Expression of the key factors of the TRAIL signaling pathway, TRAIL receptors 1-4, caspase-8, FLIP and XIAP, was analyzed before and after TRAIL treatment by immunoblotting. RESULTS Cell proliferation experiments showed TRAIL-dependent inhibition that was further increased by combination treatment with the PPARγ ligands. Simultaneous exposure of TRAIL and the PPARγ ligands also resulted in enhanced induction of apoptosis even in partial TRAIL-resistant HEY cell lines. In the parental HEY cell line, additional treatment with the PPARγ ligands led to an increased protein expression of DR5 and a further decline of XIAP expression. CONCLUSION Therefore, the combinational treatment with TRAIL and PPARγ ligands might be a promising experimental therapy because the PPARγ ligands, especially d15-PGJ(2), sensitize drug-resistant ovarian cancer cells to TRAIL-induced apoptosis.
Collapse
Affiliation(s)
- Karen Bräutigam
- Department of Gynecology and Obstetrics, University Hospital Aachen, Pauwelsstr. 30, 52074, Aachen, Germany.
| | | | | | | | | | | | | | | |
Collapse
|
26
|
Kocylowski RD, Dubiel M, Gudmundsson S, Sieg I, Fritzer E, Alkasi O, Breborowicz GH, von Kaisenberg CS. Biochemical tissue-specific injury markers of the heart and brain in postpartum cord blood. Am J Obstet Gynecol 2009; 200:273.e1-273.e25. [PMID: 19167692 DOI: 10.1016/j.ajog.2008.10.009] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2008] [Revised: 08/02/2008] [Accepted: 10/03/2008] [Indexed: 11/15/2022]
Abstract
OBJECTIVE We sought to establish references ranges and to test the hypothesis that biochemical tissue-specific markers for the heart in umbilical cord blood of newborns with cardiac defects and intrauterine growth restriction (IUGR) are abnormal. STUDY DESIGN A prospective study was conducted. Serum samples of the umbilical vein (n = 280) and artery (n = 156) from 599 healthy newborns at 37(+0)-42(+0) weeks of gestation were collected. Total creatine kinase (CK), CK-MB heart type (CK-MB), cardiac troponin T (cTnT), myoglobin, N-terminal pro-B-type natriuretic peptide (NT-proBNP), and S100 were measured. Reference ranges for each marker were constructed. Concentrations of tissue-specific markers from umbilical cord blood of neonates with cardiac defects (n = 10) and IUGR (n = 41) were plotted against the established reference ranges. RESULTS Reference ranges for each studied marker were established for both umbilical artery and vein. In fetuses with cardiac defects, both NT-proBNP (4/6 [66%] in the artery, 7/10 [70%] in the vein) and cTnT (2/10 [20%] in the vein) were increased. In fetuses with IUGR in the vein, NT-proBNP (10/41 [24%]) and cTnT (5/41 [12%]) were increased, whereas S100 (9/41 [21%]) was decreased. CONCLUSION In a subset of neonates with cardiac defects or growth restriction, irrespective of the pH at birth, tissue-specific injury markers for the heart in umbilical cord blood are abnormal.
Collapse
Affiliation(s)
- Rafal D Kocylowski
- Department of Obstetrics and Gynecology, Poznan University of Medical Sciences, Poznan, Poland
| | | | | | | | | | | | | | | |
Collapse
|
27
|
Beck C, Alkasi O, Nikischin W, Engler S, Caliebe A, Leuschner I, von Kaisenberg CS. Congenital diaphragmatic hernia, etiology and management, a 10-year analysis of a single center. Arch Gynecol Obstet 2007; 277:55-63. [PMID: 17680260 DOI: 10.1007/s00404-007-0407-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2007] [Accepted: 06/12/2007] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To analyze congenital diaphragmatic hernia (CDH) during a 10-year period at the University of Kiel, from 1995 through 2004, in order to develop a strategy to improve prenatal diagnosis, to be able to consider endoscopical treatment for selected cases and to assess the current postnatal treatment strategies. METHODS Data were obtained from the fetal medicine ultrasound department, from the birth registry, from the postmortem registry, from the neonatal intensive care unit, from pediatric surgery and from the genetic database. Data were subselected for chromosomes, genetic syndromes, for isolated CDH and for associated anomalies, the lung to head ratio and lung volumes were assessed. Data were analyzed respectively for gestation at diagnosis, the type of CDH, the perinatal management and the postnatal outcome. RESULTS There were 29 cases of CDH, in 10/29 (34%) the parents requested termination of pregnancy of which two had already died during pregnancy, 12/19 (63%) survived, which was defined as discharge from the neonatal intensive care unit, seven newborns 7/19 (37%) died in the hospital, 5 of these 5/7 (71%) were delivered in Kiel. A prenatal diagnosis was performed in 16/29 (55%), 1/16 (6%), 7/16 (43%) and 8/16 (50%) in the 1st, 2nd and 3rd trimester, respectively; in 10/29 (34%) diagnosis was performed postpartum, in 3/29 (10%) the diagnosis was performed at autopsy following termination of pregnancy. When the liver was in the abdomen, 9/10 (90%) of the children survived, compared to only 3/8 (43%) when the liver was located in the thorax. A lung to head ratio of 0.81 at 24 weeks resulted in death due to pulmonary hypoplasia. CONCLUSIONS The overall survival in CDH is around 50%, antenatal endoscopical therapy may only be considered, if the diagnosis is performed in the early second trimester, and selection criteria such as the lung to head ratio, associated defects and the chromosomal status can be applied.
Collapse
MESH Headings
- Abortion, Induced
- Autopsy
- Chromosomes, Human, Pair 18
- Female
- Fetal Death
- Germany/epidemiology
- Hernia, Diaphragmatic/diagnosis
- Hernia, Diaphragmatic/mortality
- Hernia, Diaphragmatic/therapy
- Hernias, Diaphragmatic, Congenital
- Hospital Mortality
- Humans
- Infant, Newborn
- Intensive Care Units, Neonatal
- Karyotyping
- Liver/abnormalities
- Lung Volume Measurements
- Pregnancy
- Pregnancy Trimesters
- Prenatal Diagnosis
- Trisomy
Collapse
Affiliation(s)
- Cornelia Beck
- Department of Obstetrics and Gynecology, University of Schleswig-Holstein, Campus Kiel, Michaelisstrasse 16, Kiel, Germany
| | | | | | | | | | | | | |
Collapse
|
28
|
von Kaisenberg CS, Grebe S, Schleider S, Kuhling-von Kaisenberg H, Venhoff L, Meinhold-Heerlein I. Successful Intrauterine Intracardiac Transfusion in Monochorionic Twins Affected by Parvovirus B19. Fetal Diagn Ther 2007; 22:420-4. [PMID: 17652928 DOI: 10.1159/000106346] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2006] [Accepted: 08/16/2006] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To assess the possibility to correct for fetal anemia using an intracardiac approach in twin pregnancies affected by fetal Parvovirus B19 infection. METHODS A monochorionic twin pregnancy affected by fetal Parvovirus B19 infection and hydrops was treated using an intraabdominal approach and by intracardiac transfusions. Access to the umbilical cord was not possible. RESULTS In one fetus, hydrops resolved after intraabdominal transfusions, in the other however, hydrops was progressive. After intracardiac transfusions, both fetuses normalized. CONCLUSIONS In multiple gestation affected by anemia, intracardiac transfusion is a possible and alternative technique, if access to the cord is impossible.
Collapse
|
29
|
Meinhold-Heerlein I, Bauerschlag D, Zhou Y, Sapinoso LM, Ching K, Frierson H, Bräutigam K, Sehouli J, Stickeler E, Könsgen D, Hilpert F, von Kaisenberg CS, Pfisterer J, Bauknecht T, Jonat W, Arnold N, Hampton GM. An integrated clinical-genomics approach identifies a candidate multi-analyte blood test for serous ovarian carcinoma. Clin Cancer Res 2007; 13:458-66. [PMID: 17255266 DOI: 10.1158/1078-0432.ccr-06-0691] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Cancer of the ovary confers the worst prognosis among women with gynecologic malignancies, underscoring the need to develop new biomarkers for detection of early disease, particularly those that can be readily monitored in the blood. EXPERIMENTAL DESIGN We developed an algorithm to identify secreted proteins encoded among approximately 22,500 genes on commercial oligonucleotide arrays and applied it to gene expression profiles of 67 stage I to IV serous papillary carcinomas and 9 crudely enriched normal ovarian tissues, to identify putative diagnostic markers. ELISAs were used to validate increased levels of secreted proteins in patient sera encoded by genes with differentially high expression. RESULTS We identified 275 genes predicted to encode secreted proteins with increased/decreased expression in ovarian cancers (<0.5- or >2-fold, P < 0.001). The serum levels of four of these proteins (matrix metalloproteinase-7, osteopontin, secretory leukoprotease inhibitor, and kallikrein 10) were significantly elevated in a series of 67 independent patients with serous ovarian carcinomas compared with 67 healthy controls (P < 0.001, Wilcoxon rank sum test). Optimized support vector machine classifiers with as few as two of these markers (osteopontin or kallikrein 10/matrix metalloproteinase-7) in combination with CA-125 yielded sensitivity and specificity values ranging from 96% to 98.7% and 99.7% to 100%, respectively, with the ability to discern early-stage disease from normal, healthy controls. CONCLUSIONS Our data suggest that this assay combination warrants further investigation as a multi-analyte diagnostic test for serous ovarian adenocarcinoma.
Collapse
Affiliation(s)
- Ivo Meinhold-Heerlein
- Department of Gynecology and Obstetrics, University Hospital Schleswig-Holstein, Kiel, Germany.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
30
|
Abstract
In patients with cystic ovarian pathology, such as endometriomas, polycystic ovary syndrome, teratomas or benign tumors, there is a tendency towards abnormal ovarian function. Anovulation and sterility may occur. This review will summarize the normal physiology of the female gonad and the development of oogenesis from initial reproductive age to the menopause. Furthermore, the interaction between ovarian pathology and endocrinology will be described. The main focus is on the technique of ovarian-preserving surgery by laparoscopy. In addition, alternative therapeutic approaches and screening tests will be discussed.
Collapse
Affiliation(s)
- Liselotte Mettler
- a Professor, University Hospitals Schleswig-Holstein, Campus Kiel, Department of Obstetrics and Gynecology, Michaelisstr. 16, 24105 Kiel, Germany.
| | - Antonio Garzon
- a Professor, University Hospitals Schleswig-Holstein, Campus Kiel, Department of Obstetrics and Gynecology, Michaelisstr. 16, 24105 Kiel, Germany.
| | - Heidi Kühling-von Kaisenberg
- a Professor, University Hospitals Schleswig-Holstein, Campus Kiel, Department of Obstetrics and Gynecology, Michaelisstr. 16, 24105 Kiel, Germany.
| | - Constantin S von Kaisenberg
- a Professor, University Hospitals Schleswig-Holstein, Campus Kiel, Department of Obstetrics and Gynecology, Michaelisstr. 16, 24105 Kiel, Germany.
| |
Collapse
|
31
|
Grebe S, Ichida F, Grabitz R, Bültmann B, Heideman S, von Kaisenberg CS. Reversed Pulmonary Artery Flow in Isolated Noncompaction of the Ventricular Myocardium. Fetal Diagn Ther 2006; 22:29-32. [PMID: 17003552 DOI: 10.1159/000095839] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2006] [Accepted: 03/13/2006] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To investigate the morphology and genetics of a fetus at 22 weeks. This fetus demonstrated progressive fetal hydrops and cardiomegaly with retrograde flow in the pulmonary artery and progressive myocardial deterioration and heart failure. METHODS Postmortem examination, light and electron microscopy of the myocardium, karyotyping, fetal DNA analysis, screening for mutations in the G4.5 gene, alpha-dystrobrevin gene, FKBP 12 gene, Desmin, Syntrophin and Cypher/ZASP genes, which have been described as being associated with noncompaction ventricular myocardium, using single-strand DNA conformation polymorphism analysis and DNA sequencing. RESULTS The morphological diagnosis was compatible with noncompaction ventricular myocardium or spongyforme myopathy. The karyotype was normal. Mutation analysis in exons and introns of all six genes did not show any known mutation. CONCLUSION Noncompaction ventricular myocardium or spongyforme myopathy may be associated with mutations in genes which have previously not been thought to be associated with this phenotype. Alternatively, this disease could be the result of abnormal cardiac hemodynamics.
Collapse
Affiliation(s)
- Sandra Grebe
- Department of Obstetrics and Gynecology, University of Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | | | | | | | | | | |
Collapse
|
32
|
Buttler K, Kreysing A, von Kaisenberg CS, Schweigerer L, Gale N, Papoutsi M, Wilting J. Mesenchymal cells with leukocyte and lymphendothelial characteristics in murine embryos. Dev Dyn 2006; 235:1554-62. [PMID: 16502417 DOI: 10.1002/dvdy.20737] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The development of lymphatic endothelial cells (LECs) from deep embryonic veins or mesenchymal lymphangioblasts is controversially discussed. Studies employing quail-chick grafting experiments have shown that various mesodermal compartments of the embryo possess lymphangiogenic potential, whereas studies on murine embryos have been in favor of a venous origin of LECs. We have investigated NMRI mice from embryonic day (ED) 9.5 to 13.5 with antibodies against the leukocyte marker CD45, the pan-endothelial marker CD31, and the lymphendothelial markers Prox1 and Lyve-1. Early signs of the development of lymphatics are the Lyve-1- and Prox1-positive segments of the jugular and vitelline veins. Then, lymph sacs, which are found in the jugular region of ED 11.5 mice, express Prox1, Lyve-1, and CD31. Furthermore, scattered cells positive for all of the four markers are present in the mesenchyme of the dermatomes and the mediastinum before lymphatic vessels are present in these regions. Their number increases during development. A gradient of increasing CD31 expression can be seen the closer the cells are located to the lymph sacs. Our studies provide evidence for the existence of scattered mesenchymal cells, which up-regulate lymphendothelial and down-regulate leukocyte characteristics when they integrate into growing murine lymphatics. Such stem cells may also be present in the human and may be the cell of origin in post-transplantation Kaposi sarcoma.
Collapse
Affiliation(s)
- Kerstin Buttler
- Children's Hospital, Pediatrics I, University of Goettingen, Goettingen, Germany
| | | | | | | | | | | | | |
Collapse
|
33
|
von Kaisenberg CS, Kuhling-von Kaisenberg H, Fritzer E, Schemm S, Meinhold-Heerlein I, Jonat W. Fetal transabdominal anatomy scanning using standard views at 11 to 14 weeks' gestation. Am J Obstet Gynecol 2005; 192:535-42. [PMID: 15695999 DOI: 10.1016/j.ajog.2004.08.034] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES This study was undertaken to investigate fetal anatomy with the use of standard views and a scoring system, to investigate interobserver variability, and to compare ultrasound modes simultaneously with the measurement of nuchal translucency (11-14 weeks' gestation). STUDY DESIGN Twelve fetal anatomic regions were defined as standard views (n = 60) and assessed with the use of a scoring system (1 = not seen, 2 = seen uncertainly, 3 = seen acceptably, 4 = well seen, and 5 = very well seen). The variation of scores and interobserver variability were analyzed (n = 40), the B-mode was compared with tissue harmonic and compound imaging (n = 60). RESULTS The overall average score (11 + 0 to 13 + 6 weeks) with tissue harmonic and compound imaging was 3.56 (well seen) and increased with gestation. The highest score was for the neck and the lowest for the cerebellum. The proportion of identical scores for each given region showed a range of 58% to 83%. Tissue harmonic and compound imaging was significantly better than the plain B-mode, P < .001 (sign test). CONCLUSION Transabdominal fetal anatomy scanning with standard fetal anatomy views at 11 to 14 weeks of gestation is possible with good reproducibility and demonstrability when harmonic and compound imaging are used.
Collapse
|
34
|
Wilting J, Papoutsi M, Christ B, Nicolaides KH, von Kaisenberg CS, Borges J, Stark GB, Alitalo K, Tomarev SI, Niemeyer C, Rössler J. The transcription factor Prox1 is a marker for lymphatic endothelial cells in normal and diseased human tissues. FASEB J 2002; 16:1271-3. [PMID: 12060670 DOI: 10.1096/fj.01-1010fje] [Citation(s) in RCA: 148] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Detection of lymphatic endothelal cells (LECs) has been problematic because of the lack of specific markers. The homeobox transcription factor Prox1 is expressed in LECs of murine and avian embryos. We have studied expression of Prox1 in human tissues with immunofluorescence. In 19-wk-old human fetuses, Prox1 and vascular endothelial growth factor receptor-3 (VEGFR-3) are coexpressed in LECs of lymphatic trunks and lymphatic capillaries. Prox1 is located in the nucleus, and its expression is mutually exclusive with that of the blood vascular marker PAL-E. Prox1 is a constitutive marker of LECs and is found in tissues of healthy adults and lymphedema patients. Blood vascular endothelial cells (BECs) of hemangiomas express CD31 and CD34, but not Prox1. A subset of these cells is positive for VEGFR-3. Lymphatics in the periphery of hemangiomas express Prox1 and CD31, but not CD34. In lymphangiomas, LECs express Prox1, CD31, and VEGFR-3, but rarely CD34. In the stroma, spindle-shaped CD34-positive cells are present. We show that Prox1 is a reliable marker for LECs in normal and pathologic human tissues, coexpressed with VEGFR-3 and CD31. VEGFR-3 and CD34 are less reliable markers for LECs and BECs, respectively, because exceptions from their normal expression patterns are found in pathologic tissues.
Collapse
Affiliation(s)
- Jörg Wilting
- Anatomisches Institut, Albert-Ludwigs-Universität Freiburg, 79104 Freiburg, Germany.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|