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Kyvernitakis I, Baschat AA, Malan M, Rath W, Berger R, Henrich W, Schleussner E, Yousefi B, Timmesfeld N, Maul H. Cervical pessary to prevent preterm birth and poor neonatal outcome: An integrity meta-analysis of randomized controlled trials focusing on adherence to the European Medical Device Regulation. Int J Gynaecol Obstet 2024; 165:607-620. [PMID: 37830250 DOI: 10.1002/ijgo.15169] [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: 06/09/2023] [Revised: 07/28/2023] [Accepted: 09/18/2023] [Indexed: 10/14/2023]
Abstract
BACKGROUND Findings from randomized trials (RCTs) on cervical pessary treatment to prevent spontaneous preterm birth are inconsistent. OBJECTIVES Our hypothesis suggests that adhering to the European Medical Device Regulation (MDR) and following the instructions for use are essential prerequisites for successful therapy. Conversely, the non-adherence to these guidelines will probably contribute to its failure. SEARCH STRATEGY AND SELECTION CRITERIA Based on validated criteria from integrity assessments we performed a systematic review identifying 14 RCTs evaluating the effect of cervical pessaries. DATA COLLECTION AND ANALYSIS We analyzed the implications of 14 criteria each accounting for 0-2 points of a score reflecting the clinical evaluation plan (CEP) as proposed by the MDR to evaluate the risk-benefit ratio of medical devices. MAIN RESULTS Seven RCTs in each singleton and twin pregnancies (5193 "cases") were included, detecting a high heterogeneity within control groups (I2 = 85% and 87%, respectively, P < 0.01). The CEP score varied from 11 to 26 points for all studies. The most common reasons for low scores and potential data compromise were poor recruitment rates, no (completed) power analysis, and no pre-registration, but mainly non-adherence to technical, biological, and clinical equivalence to the instructions for use as required by the MDR. All trials with score values greater than 20 had applied audit procedures. Within this group we found significantly reduced rates of spontaneous preterm birth at less than 34 weeks within the pessary group in singleton (odds ratio 0.28; 95% confidence interval 0.12-0.65) and twin pregnancies (odds ratio 0.30; 95% confidence interval 0.13-0.67). Similarly, there was a significant reduction in the composite poor neonatal outcome in singleton (odds ratio 0.25; 95% confidence interval 0.10-0.61) and twin pregnancies (odds ratio 0.54; 95% confidence interval 0.35-0.82) after a pessary as compared with controls. CONCLUSION Non-audited RCTs and meta-analyses mixing studies of different clinical quality as pre-defined by a CEP and the MDR pose the risk for erroneous conclusions.
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Affiliation(s)
- Ioannis Kyvernitakis
- Department of Obstetrics and Prenatal Medicine, Asklepios Clinic Barmbek, Asklepios Medical School, Hamburg, Germany
| | - Ahmet A Baschat
- Center for Fetal Therapy, Department of Gynecology & Obstetrics, Johns Hopkins University, Baltimore, Maryland, USA
| | - Marcel Malan
- Department of Obstetrics and Prenatal Medicine, Asklepios Clinic Barmbek, Asklepios Medical School, Hamburg, Germany
| | - Werner Rath
- Department of Obstetrics and Gynecology, University Hospital of Schleswig-Holstein, Kiel, Germany
| | - Richard Berger
- Department of Obstetrics and Gynecology, Marienhaus Klinikum St. Elisabeth, Neuwied, Germany
| | - Wolfgang Henrich
- Department of Obstetrics, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Ekkehard Schleussner
- Department of Obstetrics and Prenatal Medicine, University of Jena, Jena, Germany
| | - Bahareh Yousefi
- Department of Medical Informatics, Biometry and Epidemiology, Ruhr-University Bochum, Bochum, Germany
| | - Nina Timmesfeld
- Department of Medical Informatics, Biometry and Epidemiology, Ruhr-University Bochum, Bochum, Germany
| | - Holger Maul
- Department of Obstetrics and Prenatal Medicine, Asklepios Clinic Barmbek, Asklepios Medical School, Hamburg, Germany
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Germeshausen K, Linzbach A, Zöllkau J, Heimann Y, Schleussner E, Groten T, Weschenfelder F. SPAM-sub partual analgesia with meptazinol: a prospective cohort study comparing intramuscular with intravenous administration. Arch Gynecol Obstet 2024; 309:1873-1881. [PMID: 37160471 PMCID: PMC11018690 DOI: 10.1007/s00404-023-07056-y] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 04/25/2023] [Indexed: 05/11/2023]
Abstract
PURPOSE Safe and effective analgesia sub partu is one of the central issues in optimizing vaginal delivery birth experiences. Meptazinol is a common opiate approved for treating labor pain in the first stage of labor. According to the manufacturer, manual meptazinol can be applied intramuscularly or intravenously. The aim of this study was to compare the two application methods in terms of efficacy in pain relief, occurrence of side effects and treatment satisfaction. METHODS 132 patients with singleton term pregnancies and intended vaginal delivery, receiving meptazinol during first stage of labor were included in this prospective cohort study from 05/2020 to 01/2021. We evaluated effectiveness in pain relief and treatment satisfaction using numeric rating scales (NRS) and documented the occurrence of adverse effects. Chi-square test or Fisher exact test were used to compare categorical data and Mann-Whitney U test to compare continuous data between the two treatment groups. Statistical analysis was done by SPSS 27.0. A p value < 0.05 was considered to indicate statistical significance (two tailed). RESULTS Meptazinol decreased labor pain significantly from a NRS of 8 (IQR 8-10) to 6 (IQR 4.75-8) in both treatment groups with no difference in effectiveness between the groups. Frequency of effective pain reduction of a decrease of 2 or more on the NRS did not differ between groups (39.4% vs 54.5%, p = 0.116), as the occurrence of adverse effects. 12% of the newborns were admitted to NICU, the median NApH was 7.195. CONCLUSION Meptazinol significantly reduces labor pain regardless of the method of application: intramuscular or intravenous. According to our data, no preferable route could be identified. The comparably poorer perinatal outcome in our study cohort hinders us to confirm that meptazinol is safe and can be recommended without restrictions.
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Affiliation(s)
| | - Aissa Linzbach
- Department of Obstetrics, University Hospital Jena, Am Klinikum 1, 07747, Jena, Germany
| | - Janine Zöllkau
- Department of Obstetrics, University Hospital Jena, Am Klinikum 1, 07747, Jena, Germany
| | - Yvonne Heimann
- Department of Obstetrics, University Hospital Jena, Am Klinikum 1, 07747, Jena, Germany
| | - Ekkehard Schleussner
- Department of Obstetrics, University Hospital Jena, Am Klinikum 1, 07747, Jena, Germany
| | - Tanja Groten
- Department of Obstetrics, University Hospital Jena, Am Klinikum 1, 07747, Jena, Germany.
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Städtler M, Wissenbach D, Wissenbach DK, Franke L, Pastuschek J, Schleussner E, Allison B, Peters FT, Groten T. A liquid chromatographic-mass spectrometric procedure for analysis of pentaerythrityl tetranitrate metabolites - Development, validation and application to ovine serum and human plasma samples. J Chromatogr B Analyt Technol Biomed Life Sci 2024; 1234:124028. [PMID: 38330519 DOI: 10.1016/j.jchromb.2024.124028] [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: 08/23/2023] [Revised: 01/12/2024] [Accepted: 01/20/2024] [Indexed: 02/10/2024]
Abstract
Pentaerythrityl tetranitrate (PETN) is an established drug in the treatment of coronary heart disease and heart failure. It is assumed, that the vasodilative and vasoprotective effects of PETN also have a positive impact on pregnant patients with impaired placental perfusion and studies evaluating the effect of PETN in risk pregnancies have been carried out. In the context of these clinical trials, measuring of serum levels of PETN and its metabolites pentaerythrityl trinitrate (PETriN), pentaerythrityl dinitrate (PEDN), pentaerythrityl mononitrate (PEMN) and pentaerythritol (PE) were required. To evaluate the transfer of PETN and its metabolites (PEXN) from the mother to the fetus using samples from a human clinical trial and animal study, the present work aimed to develop a rapid and simple method to simultaneously analyze PEXN in human and ovine samples. A method employing a rapid and simple liquid-liquid extraction followed by reversed-phase (C18) liquid chromatography coupled to high-resolution mass spectrometry with negative electrospray ionization was developed and validated for the detection of PETN and PEXN in human and ovine samples. PE could only be qualitatively detected at higher concenrations. Method validation requirements, including accuracy, repeatability and intermediate precision were fulfilled in ovine and human samples for all other PEXN with exception PETriN in human samples. The recovery (RE) in ovine samples was 76.7 % ± 12 % for PEMN, 98 % ± 23 % for PEDN, 94 % ± 22 % for PETriN, in human samples RE was 59 % ± 16 % for PEMN, 67 % ± 19 % for PEDN, 71 % ± 17 %. The matrix effects (ME) in ovine samples were 90 % ± 11 % for PEMN, 70 % ± 30 % for PEDN, 107 % ± 17 % for PETriN, in human samples the ME were 93 % ± 13 % for PEMN, 84 % ± 17 % for PEDN, 98 % ± 16 % for PETriN. The limits of quantification (LOQ) in ovine samples were 1.0 ng/mL for PETriN and 0.1 ng/mL for PEMN and PEDN. The LOQs in human samples were 5.0 ng/mL for PETriN and 0.3 ng/mL for PEMN und PEDN. The newly developed method was used to analyze 184 ovine serum samples and 18 human plasma samples. In ovine maternal samples, the highest observed PEDN concentration was 3.5 ng/mL and the highest PEMN concentration was 10 ng/mL, the respective concentrations in fetal serum samples were 4.9 ng/mL for PEDN and 5.4 ng/mL for PEMN. PETriN was only detected in traces in maternal and fetal samples, whereas PETN could not be detected at all. In human maternal samples, the highest concentration for PEDN was 27 ng/mL and for PEMN 150 ng/mL. In umbilical cord plasma, concentrations of 2.3 ng/mL for PEDN and 73 ng/mL for PEMN were detected. Although the PEMN and PEDN concentrations in the human samples were several times higher than in ovine samples, neither PETN nor PETriN signals could be detected. These results demonstrated that the metabolites were transferred from mother to fetus with a slight time delay.
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Affiliation(s)
- Mariann Städtler
- Jena University Hospital, Center for Clinical Trials, Friedrich Schiller University Jena, Germany
| | - Daniela Wissenbach
- Jena University Hospital, Institute for Forensic Medicine, Friedrich Schiller University Jena, Germany
| | - Dirk K Wissenbach
- Jena University Hospital, Institute for Forensic Medicine, Friedrich Schiller University Jena, Germany
| | - Laura Franke
- Jena University Hospital, Institute for Forensic Medicine, Friedrich Schiller University Jena, Germany
| | - Jana Pastuschek
- Jena University Hospital, Department of Obstetrics, Friedrich Schiller University Jena, Germany
| | - Ekkehard Schleussner
- Jena University Hospital, Department of Obstetrics, Friedrich Schiller University Jena, Germany
| | - Beth Allison
- The Ritchie Centre Hudson Institute of Medical Research, Clayton, VIC, Australia
| | - Frank T Peters
- Jena University Hospital, Institute for Forensic Medicine, Friedrich Schiller University Jena, Germany.
| | - Tanja Groten
- Jena University Hospital, Department of Obstetrics, Friedrich Schiller University Jena, Germany
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Yüzen D, Graf I, Tallarek AC, Hollwitz B, Wiessner C, Schleussner E, Stammer D, Padula A, Hecher K, Arck PC, Diemert A. Increased late preterm birth risk and altered uterine blood flow upon exposure to heat stress. EBioMedicine 2023:104651. [PMID: 37355458 PMCID: PMC10363435 DOI: 10.1016/j.ebiom.2023.104651] [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: 02/28/2023] [Revised: 05/26/2023] [Accepted: 05/30/2023] [Indexed: 06/26/2023] Open
Abstract
BACKGROUND Climate change, in particular the exposure to heat, impacts on human health and can trigger diseases. Pregnant people are considered a vulnerable group given the physiological changes during pregnancy and the potentially long-lasting consequences for the offspring. Evidence published to date on higher risk of pregnancy complications upon heat stress exposure are from geographical areas with high ambient temperatures. Studies from geographic regions with temperate climates are sparse; however, these areas are critical since individuals may be less equipped to adapt to heat stress. This study addresses a significant gap in knowledge due to the temperature increase documented globally. METHODS Birth data of singleton pregnancies (n = 42,905) from a tertiary care centre in Hamburg, Germany, between 1999 and 2021 were retrospectively obtained and matched with climate data from the warmer season (March to September) provided by the adjacent federal meteorological station of the German National Meteorological Service to calculate the relative risk of heat-associated preterm birth. Heat events were defined by ascending temperature percentiles in combination with humidity over exposure periods of up to 5 days. Further, ultrasound data documented in a longitudinal prospective pregnancy cohort study (n = 612) since 2012 were used to identify pathophysiological causes of heat-induced preterm birth. FINDINGS Both extreme heat and prolonged periods of heat exposure increased the relative risk of preterm birth (RR: 1.59; 95% CI: 1.01-2.43; p = 0.045; RR: 1.20; 95% CI: 1.02-1.40; p = 0.025). We identified a critical period of heat exposure during gestational ages 34-37 weeks that resulted in increased risk of late preterm birth (RR: 1.67; 95% CI: 1.14-1.43; p = 0.009). Pregnancies with a female fetus were more prone to heat stress-associated preterm birth. We found heat exposure was associated with altered vascular resistance within the uterine artery. INTERPRETATION Heat stress caused by high ambient temperatures increases the risk of preterm birth in a geographical region with temperate climate. Prenatal routine care should be revised in such regions to provide active surveillance for women at risk. FUNDING Found in acknowledgements.
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Affiliation(s)
- Dennis Yüzen
- Department of Obstetrics and Fetal Medicine, Laboratory for Experimental Feto-Maternal Medicine, University Medical Centre of Hamburg-Eppendorf, Germany; Institute of Immunology, University Medical Centre of Hamburg-Eppendorf, Germany
| | - Isabel Graf
- Department of Obstetrics and Fetal Medicine, Laboratory for Experimental Feto-Maternal Medicine, University Medical Centre of Hamburg-Eppendorf, Germany
| | - Ann-Christin Tallarek
- Department of Obstetrics and Fetal Medicine, University Medical Centre of Hamburg-Eppendorf, Germany
| | - Bettina Hollwitz
- Department of Obstetrics and Fetal Medicine, University Medical Centre of Hamburg-Eppendorf, Germany
| | - Christian Wiessner
- Institute of Medical Biometry and Epidemiology, University Medical Centre of Hamburg-Eppendorf, Germany
| | | | - Detlef Stammer
- Centre for Earth System Research and Sustainability (CEN), University Hamburg, Germany
| | - Amy Padula
- Division of Maternal-Fetal Medicine, Department of Obstetrics, University of California, San Francisco, USA
| | - Kurt Hecher
- Department of Obstetrics and Fetal Medicine, University Medical Centre of Hamburg-Eppendorf, Germany
| | - Petra Clara Arck
- Department of Obstetrics and Fetal Medicine, Laboratory for Experimental Feto-Maternal Medicine, University Medical Centre of Hamburg-Eppendorf, Germany.
| | - Anke Diemert
- Department of Obstetrics and Fetal Medicine, University Medical Centre of Hamburg-Eppendorf, Germany
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Iannaccone A, Mand N, Schmidt B, Rüdiger M, Reisch B, Pecks U, Schleussner E. Is the risk of still and preterm birth affected by the timing of symptomatic SARS-CoV-2 infection during pregnancy? Data from the COVID-19 Related Obstetrics and Neonatal Outcome Study Network, Germany. Am J Obstet Gynecol 2023; 228:351-352.e2. [PMID: 36460095 PMCID: PMC9708612 DOI: 10.1016/j.ajog.2022.11.1301] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Accepted: 11/23/2022] [Indexed: 12/05/2022]
Affiliation(s)
- Antonella Iannaccone
- Department of Obstetrics and Gynecology, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45147 Essen, Germany.
| | - Nadine Mand
- Department of Pediatrics, Philipps University of Marburg, Marburg, Germany
| | - Börge Schmidt
- Institute for Medical Informatics, Biometry and Epidemiology, University of Duisburg-Essen, Essen, Germany
| | - Mario Rüdiger
- Saxony Center for Feto-Neonatal Health, Department for Neonatology and Pediatric Intensive Care, Faculty of Medicine Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - Beatrix Reisch
- Department of Obstetrics and Gynecology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Ulrich Pecks
- Department of Obstetrics and Gynecology, University Hospital of Schleswig-Holstein, Kiel, Germany
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Biedermann R, Schleussner E, Lauten A, Heimann Y, Lehmann T, Proquitté H, Weschenfelder F. Inadequate Timing Limits the Benefit of Antenatal Corticosteroids on Neonatal Outcome: Retrospective Analysis of a High-Risk Cohort of Preterm Infants in a Tertiary Center in
Germany. Geburtshilfe Frauenheilkd 2022; 82:317-325. [PMID: 35250380 PMCID: PMC8893984 DOI: 10.1055/a-1608-1138] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 08/22/2021] [Indexed: 11/04/2022] Open
Abstract
Introduction
A common problem in the treatment of threatened preterm birth is the timing and the unrestricted use of antenatal corticosteroids (ACS). This study was performed to
evaluate the independent effects of the distinct timing of antenatal corticosteroids on neonatal outcome parameters in a cohort of very low (VLBW; 1000 – 1500 g) and extreme low birth weight
infants (ELBW; < 1000 g). We hypothesize that a prolonged ACS-to-delivery interval leads to an increase in respiratory complications.
Materials and Methods
Main data source was the prospectively collected single center data for the German nosocomial infection surveillance system (KISS) between 2015 and 2018.
Multivariate regression analysis was performed to determine independent effects of the ACS-to-delivery interval on the need for ventilation, surfactant or the occurrence of bronchopulmonary
dysplasia, neonatal sepsis or necrotizing enterocolitis. Subgroup analysis was performed for ELBW and VLBW neonates.
Results
A total of 239 neonates were included. We demonstrate a significantly increased risk of respiratory distress characterized by the need for ventilation (OR 1.045; CI
1.011 – 1.080) and surfactant administration (OR 1.050, CI 1.018 – 1.083) depending on the ACS-to-delivery interval irrespective of other confounders. Every additional day between ACS and
delivery increased the risk for ventilation by 4.5% and for surfactant administration by 5%. Subgroup analysis revealed significant differences of respiratory complications in VLBW
infants.
Conclusions
Our data strongly support the deliberate use and timing of antenatal corticosteroids in pregnancies with threatened preterm birth versus a liberal strategy. When given
more than 7 days before birth, each day between application and delivery increases is relevant concerning major effects on the infant. Especially VLBW preterm neonates benefit from optimal
timing.
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Affiliation(s)
- Richard Biedermann
- University Hospital Jena, Unit Neonatology, Department of Paediatrics, Jena, Germany
| | | | - Angela Lauten
- University Hospital Jena, Department of Obstetrics, Jena, Germany
| | - Yvonne Heimann
- University Hospital Jena, Department of Obstetrics, Jena, Germany
| | - Thomas Lehmann
- University Hospital Jena, Institute of Medical Statistics and Computer Science, Jena, Germany
| | - Hans Proquitté
- University Hospital Jena, Unit Neonatology, Department of Paediatrics, Jena, Germany
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Abstract
Intrahepatic cholestasis of pregnancy (ICP) is a rare but potentially serious complication of pregnancy, the main symptom of which is intense pruritus with elevated serum levels of bile acids. The elevated serum bile acid concentration is regarded as a predictor for poor perinatal outcome including intrauterine death. Ursodeoxycholic acid (UDCA) has become established as the treatment of choice in clinical management to achieve a significant improvement in symptoms and reduce the cholestasis. Pregnant women with severe intrahepatic cholestasis should always be managed in a perinatal centre with close interdisciplinary monitoring and treatment involving perinatologists and hepatologists to minimise the markedly increased perinatal morbidity and mortality as well as maternal symptoms.
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Affiliation(s)
| | - Andreas E Kremer
- Medizinische Klinik 1, Universitätsklinikum Erlangen, Erlangen, Germany.,Klinik für Gastroenterologie und Hepatologie, Universitätsspital Zürich, Zürich, Switzerland
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Favaro RR, Morales-Prieto DM, Herrmann J, Sonnemann J, Schleussner E, Markert UR, Zorn TMT. Influence of high glucose in the expression of miRNAs and IGF1R signaling pathway in human myometrial explants. Arch Gynecol Obstet 2021; 303:1513-1522. [PMID: 33575847 PMCID: PMC8087607 DOI: 10.1007/s00404-020-05940-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 04/20/2020] [Accepted: 12/15/2020] [Indexed: 12/26/2022]
Abstract
PURPOSE Several roles are attributed to the myometrium including sperm and embryo transport, menstrual discharge, control of uterine blood flow, and labor. Although being a target of diabetes complications, the influence of high glucose on this compartment has been poorly investigated. Both miRNAs and IGF1R are associated with diabetic complications in different tissues. Herein, we examined the effects of high glucose on the expression of miRNAs and IGF1R signaling pathway in the human myometrium. METHODS Human myometrial explants were cultivated for 48 h under either high or low glucose conditions. Thereafter, the conditioned medium was collected for biochemical analyses and the myometrial samples were processed for histological examination as well as miRNA and mRNA expression profiling by qPCR. RESULTS Myometrial structure and morphology were well preserved after 48 h of cultivation in both high and low glucose conditions. Levels of lactate, creatinine, LDH and estrogen in the supernatant were similar between groups. An explorative screening by qPCR arrays revealed that 6 out of 754 investigated miRNAs were differentially expressed in the high glucose group. Data validation by single qPCR assays confirmed diminished expression of miR-215-5p and miR-296-5p, and also revealed reduced miR-497-3p levels. Accordingly, mRNA levels of IGF1R and its downstream mediators FOXO3 and PDCD4, which are potentially targeted by miR-497-3p, were elevated under high glucose conditions. In contrast, mRNA expression of IGF1, PTEN, and GLUT1 was unchanged. CONCLUSIONS The human myometrium responds to short-term exposure (48 h) to high glucose concentrations by regulating the expression of miRNAs, IGF1R and its downstream targets.
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Affiliation(s)
- Rodolfo R Favaro
- Placenta Lab, Department of Obstetrics, Jena University Hospital, Jena, Germany.
- Laboratory of Reproductive and Extracellular Matrix Biology, Department of Cell and Developmental Biology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil.
| | | | - Jörg Herrmann
- Department of Gynecology and Obstetrics, Hufeland Klinikum, Weimar, Germany
| | - Jürgen Sonnemann
- Department of Pediatric Hematology and Oncology, Children's Clinic, Jena University Hospital, Jena, Germany
| | | | - Udo R Markert
- Placenta Lab, Department of Obstetrics, Jena University Hospital, Jena, Germany
| | - Telma M T Zorn
- Laboratory of Reproductive and Extracellular Matrix Biology, Department of Cell and Developmental Biology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
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Zabel RR, Bär C, Ji J, Schultz R, Hammer M, Groten T, Schleussner E, Morales-Prieto DM, Markert UR, Favaro RR. Enrichment and characterization of extracellular vesicles from ex vivo one-sided human placenta perfusion. Am J Reprod Immunol 2020; 86:e13377. [PMID: 33175429 DOI: 10.1111/aji.13377] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 11/04/2020] [Accepted: 11/04/2020] [Indexed: 12/15/2022] Open
Abstract
PROBLEM Extracellular vesicles (EVs) released by the placenta are packed with biological information and play a major role in fetomaternal communication. Here, we describe a comprehensive set-up for the enrichment and characterization of EVs from human placenta perfusion and their application in further assays. METHOD OF STUDY Human term placentas were used for 3 h ex vivo one-sided perfusions to simulate the intervillous circulation. Thereafter, populations of small (sEVs) and large EV (lEVs) were enriched from placental perfusate via serial ultracentrifugation. Following, EV populations were characterized regarding their size, protein concentration, RNA levels, expression of surface markers as well as their uptake and miRNA transfer to recipient cells. RESULTS The sEV and lEV fractions from an entire perfusate yielded, respectively, 294 ± 32 µg and 525 ± 96 µg of protein equivalents and 2.6 ± 0.5 µg and 3.6 ± 0.9 µg of RNA. The sEV fraction had a mean diameter of 117 ± 47 nm, and the lEV fraction presented 236 ± 54 nm. CD63 was strongly detected by dot blot in sEVs, whereas only traces of this marker were found in lEVs. Both EV fractions were positive for the trophoblast marker PLAP (placental alkaline phosphatase) and annexin A1. EV internalization in immune cells was visualized by confocal microscopy, and the transfer of placental miRNAs was detected by quantitative real-time PCR (qPCR). CONCLUSIONS Enriched EV populations showed characteristic features of sEVs and lEVs. EV uptake and transfer of miRNAs to recipient cells demonstrated their functional integrity. Therefore, we advocate the ex vivo one-sided placenta perfusion as a robust approach for the collection of placental EVs.
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Affiliation(s)
- Rachel R Zabel
- Placenta-Lab, Department of Obstetrics, Jena University Hospital, Jena, Germany
| | - Christin Bär
- Placenta-Lab, Department of Obstetrics, Jena University Hospital, Jena, Germany
| | - Jinlu Ji
- Placenta-Lab, Department of Obstetrics, Jena University Hospital, Jena, Germany
| | - Rowena Schultz
- Department of Ophthalmology, Jena University Hospital, Jena, Germany
| | - Martin Hammer
- Department of Ophthalmology, Jena University Hospital, Jena, Germany
| | - Tanja Groten
- Placenta-Lab, Department of Obstetrics, Jena University Hospital, Jena, Germany
| | | | | | - Udo R Markert
- Placenta-Lab, Department of Obstetrics, Jena University Hospital, Jena, Germany
| | - Rodolfo R Favaro
- Placenta-Lab, Department of Obstetrics, Jena University Hospital, Jena, Germany
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Joel S, Weschenfelder F, Schleussner E, Hofmann GO, Weschenfelder W. NUT midline carcinoma in a young pregnant female: a case report. World J Surg Oncol 2020; 18:290. [PMID: 33160369 PMCID: PMC7648955 DOI: 10.1186/s12957-020-02065-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 10/26/2020] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION The NUT midline carcinoma is a rare tumor mostly reported in the midline of upper aerodigestive tract and mediastinum. Children as well as adolescents are affected without a gender distribution. A standard treatment is not established. So far, there exists no reported case of a pregnant female suffering from NUT midline carcinoma with musculoskeletal manifestation. CASE PRESENTATION A 34-year-old woman was referred to our outpatient clinic by the general practitioner during her 31st week of pregnancy suffering from shoulder pain and dyspnea. So far, dyspnea was interpreted as a typical pregnancy-related symptom. However, a chest X-ray showed a tumor mass in the right lung in close relation to the scapula. Further examinations found metastases in different areas of the body. No pregnancy-related complications were detected by obstetric examination. After an interdisciplinary perinatal case discussion, cesarean section was directly followed by an open biopsy of the right side scapula tumor lesion. A NUT midline carcinoma was diagnosed by immunohistochemistry. Due to disseminated tumor disease in multiple non-resectable locations, a palliative systemical chemotherapy was started by the oncological outpatient clinic. CONCLUSION This report presents the case of the very rare NUT midline carcinoma under pregnancy which made interdisciplinary case discussions indispensable for therapy planning.
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Affiliation(s)
- Sebastian Joel
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Jena, Jena, Germany
| | | | | | - Gunther O. Hofmann
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Jena, Jena, Germany
| | - Wolfram Weschenfelder
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Jena, Jena, Germany
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11
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Radan AP, Aleksandra Polowy J, Heverhagen A, Simillion C, Baumann M, Raio L, Schleussner E, Mueller M, Surbek D. Cervico-vaginal placental α-macroglobulin-1 combined with cervical length for the prediction of preterm birth in women with threatened preterm labor. Acta Obstet Gynecol Scand 2019; 99:357-363. [PMID: 31587255 DOI: 10.1111/aogs.13744] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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: 06/08/2019] [Revised: 09/23/2019] [Accepted: 09/27/2019] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Preterm birth is a major cause of neonatal morbidity and mortality. There is an urgent need to accurately predict imminent delivery to enable necessary interventions such as tocolytic, glucocorticoid, and magnesium sulfate administration. We aimed to evaluate placental α-macroglobulin-1 as a new diagnostic marker in the prediction of preterm birth. MATERIAL AND METHODS We performed a prospective observational trial in women with intact membranes between 24+0 and 36+6 weeks of gestation. We included both women with and without threatened preterm labor symptoms. We evaluated the test performance of placental α-macroglobulin-1 measurements in cervicovaginal fluid regarding three different presentation-to-delivery intervals: ≤2, ≤7, ≤14 days. In addition, we calculated placental α-macroglobulin-1 performance in combination with other prognostic factors such as ultrasonographic cervical length measurements. RESULTS We included 126 women in the study. We detected high specificity (97%-98%) and negative predictive value (89%-97%) for placental α-macroglobulin-1 at all time intervals. We assessed placental α-macroglobulin-1 in combination with cervical length measurements (≤15 mm) in the sub-group of women presenting with threatened preterm labor symptoms (n = 63) and detected high positive predictive values (100%) for 7- and 14-day presentation-to-delivery intervals. CONCLUSIONS Our study provides evidence that placental α-macroglobulin-1 testing in cervicovaginal fluid, in combination with cervical length measurements, accurately predicts preterm birth in women with preterm labor symptoms. This novel test combination may be used clinically to triage women presenting with threatened preterm labor, avoiding overtreatment and unnecessary hospitalizations.
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Affiliation(s)
- Anda-Petronela Radan
- Department of Obstetrics and Gynecology, University Hospital Bern and University of Bern, Bern, Switzerland
| | - Justyna Aleksandra Polowy
- Department of Obstetrics and Gynecology, University Hospital Bern and University of Bern, Bern, Switzerland
| | - Anneke Heverhagen
- Department of Obstetrics and Gynecology, University Hospital Bern and University of Bern, Bern, Switzerland
| | - Cedric Simillion
- Department for BioMedical Research (DBMR), University of Bern, Bern, Switzerland
| | - Marc Baumann
- Department of Obstetrics and Gynecology, University Hospital Bern and University of Bern, Bern, Switzerland
| | - Luigi Raio
- Department of Obstetrics and Gynecology, University Hospital Bern and University of Bern, Bern, Switzerland
| | | | - Martin Mueller
- Department of Obstetrics and Gynecology, University Hospital Bern and University of Bern, Bern, Switzerland.,Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, CT, USA
| | - Daniel Surbek
- Department of Obstetrics and Gynecology, University Hospital Bern and University of Bern, Bern, Switzerland
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12
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Weschenfelder F, Lehmann T, Schleussner E, Groten T. Gestational Weight Gain Particularly Affects the Risk of Large for Gestational Age Infants in Non-obese Mothers. Geburtshilfe Frauenheilkd 2019; 79:1183-1190. [PMID: 31736507 PMCID: PMC6846725 DOI: 10.1055/a-0891-0919] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Revised: 03/21/2019] [Accepted: 04/06/2019] [Indexed: 11/22/2022] Open
Abstract
Introduction
The birth of a large for gestational age (LGA) infant is a significant risk factor for birth complications and maternal morbidity and an even higher risk factor for offspring obesity, metabolic syndrome and cardiovascular disease in later life. Relevant factors affecting the risk of delivering an LGA infant are maternal pre-gravid obesity, excessive gestational weight gain exceeding the recommendations of the Institute of Medicine (IOM) and diabetes in pregnancy. We aimed to determine what matters most in terms of the risk of fetal overgrowth.
Materials and Methods
We performed a database analysis of 12 701 singleton term deliveries documented in our university hospital birth registry from 2003 to 2014. Multivariate logistic regression analysis was used to determine the adjusted odds ratios.
Results
Excessive weight gain had the strongest impact on LGA (OR: 1.249 [95% CI: 1.018 – 1.533]) compared to maternal pre-gravid body mass index (BMI) (OR: 1.083 [95% CI: 1.066 – 1.099]) and diabetes (OR: 1.315 [95% CI: 0.997 – 1.734]). Keeping gestational weight gain within the recommendations of the IOM resulted in a risk reduction for LGA of 20% (OR: 0.801 [95% CI: 0.652 – 0.982]). The risk for LGA increases by 6.9% with each kg weight gain. Normal weight women (BMI 18.5 – 24.9 kg/m
2
) and moderately overweight women (BMI 25 – 29.9 kg/m
2
) showed the highest increase in LGA rates per kg weight gain during pregnancy (OR: 1.078 [95% CI: 1.052 – 1.104] and OR: 1.058 [95% CI: 1.026 – 1.09], resp.). Only in underweight (< 18.5 kg/m
2
) and normal weight women the risk of LGA birth is strongly influenced by diabetes (OR 11.818 [95% CI: 1.156–120.782] and 1.564 [95% CI: 1.013–2.415]).
Conclusion
Excessive weight gain is particularly important for non-obese women. These women are therefore a target cohort for intervention, as each prevented additional kilogram weight gain reduces the risk of LGA by more than 5%.
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Affiliation(s)
| | - Thomas Lehmann
- Institute of Medical Statistics and Computer Science, University Hospital Jena, Friedrich Schiller University Jena, Jena, Germany
| | | | - Tanja Groten
- University Hospital Jena, Department of Obstetrics, Jena, Germany
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13
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Schütze ST, Groten T, Schleussner E, Battefeld W. Evaluation of Treatment Strategies to Manage Diabetes Mellitus in Pregnancy: Use of Fetal Sonography Compared to Monitoring of Maternal Blood Glucose Alone. Geburtshilfe Frauenheilkd 2019; 79:1199-1207. [PMID: 31736509 PMCID: PMC6846735 DOI: 10.1055/a-0865-4684] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 02/13/2019] [Accepted: 02/28/2019] [Indexed: 10/26/2022] Open
Abstract
Introduction When planning the treatment of women with gestational diabetes, the current standard approach also takes fetal growth development into account. The treatment of pregnant women with type 1 diabetes mellitus (DM) used to be based exclusively on maternal blood glucose values. This study investigated the impact of including fetal growth parameters in the monitoring of pregnant women with type 1 diabetes mellitus. Patients/Method 199 pregnant women with type 1 DM were included in a cohort study. The patient population was divided into two study cohorts. In the mBG cohort (n = 94; investigation period: 1994 - 2005) treatment was monitored using only maternal blood glucose (mBG) values; the aim was to achieve standard target glucose values (mean BG < 5.5 mmol/l, postprandial: at 1 h < 7.7 mmol/l, at 2 h < 6.6 mmol/l). In the fUS collective (n = 101, investigation period: 2006 - 2014) fetal growth parameters were additionally included when monitoring treatment from the 22nd week of gestation, and maternal target glucose values were then individually adjusted to take account of fetal growth. This study aimed to investigate the impact of these two different ways of monitoring treatment on perinatal and peripartum outcomes. Results 91.4% of all patients were normoglycemic at the time of delivery (HbA 1c < 6.7%); 58.9% of patients achieved strict normoglycemia (HbA 1c < 5.7%). No differences were found between the two study cohorts (fUS vs. mBG: HbA 1c < 6.7%: 93.9 vs. 88.4%, n. s.; mean blood glucose (BG): 5.4 ± 0.6 to 6.6 ± 1.1 vs. 5.9 ± 0.7 to 7.4 ± 1.9 mmol/l, n. s.). Patients from the fUS cohort required significantly lower weight-adjusted maximum insulin doses (0.9 ± 0.3 vs. 1.0 ± 0.4 IE/kg bodyweight, p < 0.05). Pregnancy complications occurred significantly less often in the fUS cohort (preeclampsia: 7.1 vs. 20.9%, p = 0.01; premature labor: 4.0 vs. 23.3%, p < 0.001; cervical insufficiency: 0.0 vs. 11.6%, p = 0.001), and there were significantly fewer cases with neonatal hyperbilirubinemia (19.2 vs. 40.7%, p = 0.001). There was no difference in the rates of LGA infants between the two cohorts (21.2 vs. 24.4%, n. s.). Conclusion Using maternal blood glucose values combined with fetal growth parameters to monitor DM treatment allows therapeutic interventions to be individualized and reduces the risk of maternal and infant morbidity. The metabolism of patients in the fUS cohort was significantly more stable and there were fewer variations in glucose values. It is possible that the detected benefits are due to this metabolic stabilization.
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Affiliation(s)
- Sarah Theresa Schütze
- Klinik für Frauenheilkunde und Geburtshilfe, Krankenhaus der Augustinerinnen Köln, Köln, Germany
| | - Tanja Groten
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Jena, Jena, Germany
| | - Ekkehard Schleussner
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Jena, Jena, Germany
| | - Wilgard Battefeld
- Medizinisches Versorgungszentrum Kempten-Allgäu, Kempten, Kempten, Germany
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14
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Dargel S, Schneider U, Herrmann A, Schleussner E. Postpartal dekompensierte Leberzirrhose und Colitis ulcerosa im akuten Schub. Geburtshilfe Frauenheilkd 2019. [DOI: 10.1055/s-0039-1692062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Affiliation(s)
| | | | - A Herrmann
- Klinik und Poliklinik für Innere Medizin IV, Jena
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15
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Köninger A, Iannaccone A, Hajder E, Frank M, Schmidt B, Schleussner E, Kimmig R, Gellhaus A, Dieplinger H. Afamin predicts gestational diabetes in polycystic ovary syndrome patients preconceptionally. Endocr Connect 2019; 8:616-624. [PMID: 30991357 PMCID: PMC6510713 DOI: 10.1530/ec-19-0064] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 04/16/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND Patients suffering from polycystic ovary syndrome (PCOS) are often insulin resistant and at elevated risk for developing gestational diabetes mellitus (GDM). The aim of this study was to explore afamin, which can be determined preconceptionally to indicate patients who will subsequently develop GDM. Serum concentrations of afamin are altered in conditions of oxidative stress like insulin resistance (IR) and correlate with the gold standard of IR determination, the HOMA index. METHODS Afamin serum concentrations and the HOMA index were analyzed post hoc in 63 PCOS patients with live births. Patients were treated at Essen University Hospital, Germany, between 2009 and 2018. Mann-Whitney U test, T test, Spearman's correlation, linear regression models and receiver-operating characteristic (ROC) analyses were performed for statistical analysis. RESULTS Patients who developed GDM showed significantly higher HOMA and serum afamin values before their pregnancy (P < 0.001, respectively). ROCs for afamin concentrations showed an area under the curve of 0.78 (95% confidence interval (CI) 0.65-0.90) and of 0.77 (95% CI 0.64-0.89) for the HOMA index. An afamin threshold of 88.6 mg/L distinguished between women who will develop GDM and those who will not with a sensitivity of 79.3% and a specificity of 79.4%. A HOMA index of 2.5 showed a sensitivity of 65.5% and a specificity of 88.2%. CONCLUSION The HOMA index and its surrogate parameter afamin are able to identify pre-pregnant PCOS patients who are at risk to develop GDM. Serum afamin concentrations are independent of fasting status and therefore an easily determinable biomarker.
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Affiliation(s)
- Angela Köninger
- Department of Gynecology and Obstetrics, University of Duisburg-Essen, Essen, Germany
| | - Antonella Iannaccone
- Department of Gynecology and Obstetrics, University of Duisburg-Essen, Essen, Germany
| | - Ensar Hajder
- Department of Gynecology and Obstetrics, University of Duisburg-Essen, Essen, Germany
| | - Mirjam Frank
- Institute for Medical Informatics, Biometry and Epidemiology (IMIBE), University of Duisburg-Essen, Essen, Germany
| | - Boerge Schmidt
- Institute for Medical Informatics, Biometry and Epidemiology (IMIBE), University of Duisburg-Essen, Essen, Germany
| | | | - Rainer Kimmig
- Department of Gynecology and Obstetrics, University of Duisburg-Essen, Essen, Germany
| | - Alexandra Gellhaus
- Department of Gynecology and Obstetrics, University of Duisburg-Essen, Essen, Germany
| | - Hans Dieplinger
- Division of Genetic Epidemiology, Medical University of Innsbruck, Innsbruck, Austria
- Correspondence should be addressed to H Dieplinger:
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16
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Bowkalow S, Schleussner E, Kähler C, Schneider U, Lehmann T, Groten T. Pentaerythrityltetranitrate (PETN) improves utero- and feto-placental Doppler parameters in pregnancies with impaired utero-placental perfusion in mid-gestation - a secondary analysis of the PETN-pilot trial. J Perinat Med 2018; 46:1004-1009. [PMID: 29272253 DOI: 10.1515/jpm-2017-0238] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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: 07/24/2017] [Accepted: 11/07/2017] [Indexed: 11/15/2022]
Abstract
AIM In pregnancies complicated by impaired utero-placental perfusion, pentaeritrithyltetranitrate (PETN) has been shown to reduce the risk of severe fetal growth restriction (FGR) and perinatal death by 39%. The effect is most likely related to the vasodilatative influence of PETN. To assess its impact on utero-placental and fetal perfusion, we analyzed the Doppler parameters measured during the PETN pilot-trial. METHODS One hundred and eleven pregnancies presenting impaired utero-placental resistance at mid-gestation were included in the trial. Fifty-four women received PETN, while 57 received a placebo. Doppler velocimetry measurements were monitored biweekly. Statistical analysis was performed using a mixed linear model. RESULTS Within the first week of treatment, the mean pulsatility index (PI) of the uterine artery (UtA) dropped more prominently in the PETN group [-0.20, 95% confidence interval (CI): -0.34 to -0.05, P=0.007). The adjusted relative risk (RR) for abnormal cerebro-placental ratio (CPR) was significantly reduced by PETN [RR 0.412 (95% CI: 0.181-0.941)]. Kaplan-Meier analysis demonstrates the postponement of absent end-diastolic flow (AED), absent or reverse end-diastolic flow (ARED), brain sparing and abnormal cerebroplacental ratio (CPR) in the PETN group. CONCLUSION The demonstrated effect of PETN on utero-placental and feto-placental perfusion strengthens the evidence for a positive impact in pregnancies complicated by impaired placental perfusion and might explain the effect on neonatal outcome, as shown in the PETN-pilot trial.
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Affiliation(s)
- Sandy Bowkalow
- Department of Obstetrics, University Hospital Jena, Friedrich Schiller University, Jena, Germany
| | - Ekkehard Schleussner
- Department of Obstetrics, University Hospital Jena, Friedrich Schiller University, Jena, Germany
| | | | - Uwe Schneider
- Department of Obstetrics, University Hospital Jena, Friedrich Schiller University, Jena, Germany
| | - Thomas Lehmann
- Institute of Medical Statistics and Computer Science, University Hospital Jena, Friedrich Schiller University, Jena, Germany
| | - Tanja Groten
- Department of Obstetrics, University Hospital Jena, Friedrich Schiller University, Jena, Germany
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17
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Melchor JC, Khalil A, Wing D, Schleussner E, Surbek D. Prediction of preterm delivery in symptomatic women using PAMG-1, fetal fibronectin and phIGFBP-1 tests: systematic review and meta-analysis. Ultrasound Obstet Gynecol 2018; 52:442-451. [PMID: 29920825 DOI: 10.1002/uog.19119] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 05/31/2018] [Accepted: 06/08/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To assess the accuracy of placental alpha microglobulin-1 (PAMG-1), fetal fibronectin (fFN) and phosphorylated insulin-like growth factor-binding protein-1 (phIGFBP-1) tests in predicting spontaneous preterm birth (sPTB) within 7 days of testing in women with symptoms of preterm labor, through a systematic review and meta-analysis of the literature. The test performance of each biomarker was also assessed according to pretest probability of sPTB ≤ 7 days. METHODS The Cochrane, MEDLINE, PubMed and ResearchGate bibliographic databases were searched from inception until October 2017. Cohort studies that reported on the predictive accuracy of PAMG-1, fFN and phIGFBP-1 for the prediction of sPTB within 7 days of testing in women with symptoms of preterm labor were included. Summary receiver-operating characteristics (ROC) curves and sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and positive (LR+) and negative (LR-) likelihood ratios were generated using indirect methods for the calculation of pooled effect sizes with a bivariate linear mixed model for the logit of sensitivity and specificity, with each diagnostic test as a covariate, as described by the Cochrane Handbook for Systematic Reviews of Diagnostic Test Accuracy. RESULTS Bivariate mixed model pooled sensitivity of PAMG-1, fFN and phIGFBP-1 for the prediction of sPTB ≤ 7 days was 76% (95% CI, 57-89%), 58% (95% CI, 47-68%) and 93% (95% CI, 88-96%), respectively; pooled specificity was 97% (95% CI, 95-98%), 84% (95% CI, 81-87%) and 76% (95% CI, 70-80%) respectively; pooled PPV was 76.3% (95% CI, 69-84%) (P < 0.05), 34.1% (95% CI, 29-39%) and 35.2% (95% CI, 31-40%), respectively; pooled NPV was 96.6% (95% CI, 94-99%), 93.3% (95% CI, 92-95%) and 98.7% (95% CI, 98-99%), respectively; pooled LR+ was 22.51 (95% CI, 15.09-33.60) (P < 0.05), 3.63 (95% CI, 2.93-4.50) and 3.80 (95% CI, 3.11-4.66), respectively; and pooled LR- was 0.24 (95% CI, 0.12-0.48) (P < 0.05), 0.50 (95% CI, 0.39-0.64) and 0.09 (95% CI, 0.05-0.16), respectively. The areas under the ROC curves for PAMG-1, fFN and phIGFBP-1 for sPTB ≤ 7 days were 0.961, 0.874 and 0.801, respectively. CONCLUSIONS In the prediction of sPTB within 7 days of testing in women with signs and symptoms of preterm labor, the PPV of PAMG-1 was significantly higher than that of phIGFBP-1 or fFN. Other diagnostic accuracy measures did not differ between the three biomarker tests. As prevalence affects the predictive performance of a diagnostic test, use of a highly specific assay for a lower-prevalence syndrome such as sPTB may optimize management. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- J C Melchor
- Cruces University Hospital (UPV/EHU), BioCruces Health Research Institute, Vizcaya, Spain
| | - A Khalil
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, University of London, London, UK
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
| | - D Wing
- Formerly of the University of California, Irvine, Orange, CA, USA
| | - E Schleussner
- Department of Obstetrics, Jena University Hospital, Jena, Germany
| | - D Surbek
- Department of Obstetrics and Gynecology, University Hospital, Inselspital, University of Bern, Bern, Switzerland
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18
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Morales-Prieto DM, Herrmann J, Osterwald H, Kochhar PS, Schleussner E, Markert UR, Oettel M. Comparison of dienogest effects upon 3,3'-diindolylmethane supplementation in models of endometriosis and clinical cases. Reprod Biol 2018; 18:252-258. [PMID: 30001982 DOI: 10.1016/j.repbio.2018.07.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [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: 03/22/2018] [Revised: 06/15/2018] [Accepted: 07/05/2018] [Indexed: 11/26/2022]
Abstract
Dienogest (DNG) administration is a well-established treatment for endometriosis but bleeding irregularities remain its main disadvantage. Changes in diet, mainly to vegetable consumption, are beneficial in the treatment of estrogen-related pathologies but their use for endometriosis has been poorly studied. In this study, addition of the phytochemical 3,3'-diindolylmethane (DIM) to DNG therapy has been investigated in in vitro and ex vivo models for endometriosis and in a small cohort of women with endometriosis. Endometrial Ishikawa cells were treated with DNG or DIM at dosages from 10-10 M to 10-5 M for up to 72 h. Cell proliferation was measured by assessing BrdU incorporation. Endometrial tissue from women with endometriosis and controls was incubated with DNG or a combination of DNG and DIM. Tissue viability was determined using a modified colorimetric MTS assay. 17β-estradiol secretion was quantified by an electro-chemiluminescence immunoassay. Finally, DNG as monotherapy or in combination with DIM was randomly administered to women with endometriosis (n = 8) over 3 months. Bleeding patterns and associated pelvic pain were assessed by Visual Analogue Scale (VAS). DNG and DIM significantly reduced cell proliferation in Ishikawa cells. Ex vivo, DIM reduced viability and estradiol secretion specifically in endometriotic but not in normal endometrial tissue. This effect was enhanced by combination with DNG. Endometriosis associated pelvic pain was significantly reduced in patients taking the DNG-DIM combination therapy compared to those taking DNG alone. Bleeding pattern (number and duration of episodes) was significantly improved by addition of DIM to the DNG treatment. In conclusion, addition of DIM enhances effects of DNG ex vivo and may ameliorate bleeding patterns in endometriosis patients.
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Affiliation(s)
| | - Joerg Herrmann
- Klinik für Gynäkologie und Geburtshilfe, Sophien- und Hufeland-Klinikum, Weimar, Germany
| | | | | | - Ekkehard Schleussner
- Placenta-Labor, Klinik für Geburtsmedizin, Universitätsklinikum Jena, Jena, Germany
| | - Udo R Markert
- Placenta-Labor, Klinik für Geburtsmedizin, Universitätsklinikum Jena, Jena, Germany.
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19
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Schmidt A, Schukat-Talamazzini EG, Zöllkau J, Pytlik A, Leibl S, Kumm K, Bode F, Kynass I, Witte OW, Schleussner E, Schneider U, Hoyer D. Universal characteristics of evolution and development are inherent in fetal autonomic brain maturation. Auton Neurosci 2018. [DOI: 10.1016/j.autneu.2018.02.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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20
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Baumgärtner B, Jäkel S, Schleussner E. Herausforderungen im Rahmen des Hebammenstudiums. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1645925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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21
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Stefanski AL, Specker C, Fischer-Betz R, Henrich W, Schleussner E, Dörner T. Maternal Thrombophilia and Recurrent Miscarriage - Is There Evidence That Heparin is Indicated as Prophylaxis against Recurrence? Geburtshilfe Frauenheilkd 2018; 78:274-282. [PMID: 29576632 PMCID: PMC5862552 DOI: 10.1055/s-0044-100919] [Citation(s) in RCA: 9] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 01/15/2018] [Accepted: 01/15/2018] [Indexed: 12/19/2022] Open
Abstract
Background
Recurrent miscarriage, also referred to as recurrent spontaneous abortion (RSA), affects 1 – 5% of couples and has a multifactorial genesis. Acquired and congenital thrombophilia have been discussed as hemostatic risk factors in the pathogenesis of RSA.
Method
This review article was based on a selective search of the literature in PubMed. There was a special focus on the current body of evidence studying the association between RSA and antiphospholipid syndrome and hereditary thrombophilia disorders.
Results
Antiphospholipid syndrome (APS) is an acquired autoimmune thrombophilia and recurrent miscarriage is one of its clinical classification criteria. The presence of lupus anticoagulant has been shown to be the most important serologic risk factor for developing complications of pregnancy. A combination of low-dose acetylsalicylic acid and heparin has shown significant benefits with regard to pregnancy outcomes and APS-related miscarriage. Some congenital thrombophilic disorders also have an increased associated risk of developing RSA, although the risk is lower than for APS. The current analysis does not sufficiently support the analogous administration of heparin as prophylaxis against miscarriage in women with congenital thrombophilia in the same way as it is used in antiphospholipid syndrome. The data on rare, combined or homozygous thrombophilias and their impact on RSA are still insufficient.
Conclusion
In contrast to antiphospholipid syndrome, the current data from studies on recurrent spontaneous abortion do not support the prophylactic administration of heparin to treat women with maternal hereditary thrombophilia in subsequent pregnancies. Nevertheless, the maternal risk of thromboembolic events must determine the indication for thrombosis prophylaxis in pregnancy.
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Affiliation(s)
- Ana-Luisa Stefanski
- Zentrum Innere Medizin, Medizinische Klinik mit Schwerpunkt Rheumatologie und Klinische Immunologie, Charité Berlin, Berlin, Germany.,Rheumatologie, klinische Immunologie und Allergologie, Inselspital Universitätsspital Bern, Bern, Switzerland
| | - Christoph Specker
- Krankenhaus St. Josef, Klinik für Rheumatologie und klinische Immunologie, Universitätsklinikum Essen, Essen, Germany
| | - Rebecca Fischer-Betz
- Poliklinik für Rheumatologie, Schwangerschaftsambulanz, Heinrich-Heine-Universität Düsseldorf Medizinische Fakultät, Düsseldorf, Germany
| | | | | | - Thomas Dörner
- Zentrum Innere Medizin, Medizinische Klinik mit Schwerpunkt Rheumatologie und Klinische Immunologie, Charité Berlin, Berlin, Germany
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22
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Köninger A, Mathan A, Mach P, Frank M, Schmidt B, Schleussner E, Kimmig R, Gellhaus A, Dieplinger H. Is Afamin a novel biomarker for gestational diabetes mellitus? A pilot study. Reprod Biol Endocrinol 2018; 16:30. [PMID: 29587878 PMCID: PMC5870691 DOI: 10.1186/s12958-018-0338-x] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 03/02/2018] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND In search of potential early biomarkers for timely prediction of gestational diabetes mellitus (GDM), we focused on afamin, a vitamin E-binding protein in human plasma.. Afamin plays a role in anti-apoptotic cellular processes related to oxidative stress and is associated with insulin resistance and other features of metabolic syndrome. During uncomplicated pregnancy its serum concentrations increase linearly. The aim of this study was to investigate the suitability of afamin as early marker for predicting GDM. METHODS In a first-trimester cohort from a prospective observational study of adverse pregnancy outcomes we secondarily analyzed afamin concentrations in 59 patients diagnosed with GDM and 51 controls. Additionally, afamin concentrations were cross-sectionally examined in a mid-trimester cohort of 105 women and compared with results from a simultaneously performed oral glucose tolerance test (OGTT). Subgroup analysis comparing patients treated with either insulin (iGDM) or dietary intervention (dGDM) was performed in both cohorts. Patients were recruited at the University Hospital Essen, Germany, between 2003 and 2016. RESULTS Results were adjusted for body-mass-index (BMI) and gestational age. First and mid-trimester cohorts yielded significantly elevated afamin concentrations in patients with pathological OGTT compared to patients without GDM (first trimester cohort: mean, 113.4 mg/l; 95% CI, 106.4-120.5 mg/l and 87.2 mg/l; 95% CI, 79.7-94.7 mg/l; mid-trimester cohort: mean, 182.9 mg/l; 95% CI, 169.6-196.2 mg/l and 157.3 mg/l; 95% CI, 149.1-165.4 mg/l, respectively). In the first-trimester cohort, patients developing iGDM later in pregnancy presented with significantly higher afamin concentrations compared to patients developing dGDM and compared to patients without GDM. In the mid-trimester cohort, mean concentrations of afamin differed significantly between patients with dGDM compared to controls and between patients with iGDM and controls. Patients with iGDM showed only slightly higher afamin levels compared to patients with dGDM. CONCLUSION Afamin may serve as a new early biomarker for pathological glucose metabolism during pregnancy. Further research is needed to determine afamin's concentrations during pregnancy, its predictive value for early detection of pregnancies at high risk to develop GDM and its diagnostic role during the second trimester.
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Affiliation(s)
- Angela Köninger
- Department of Gynecology and Obstetrics, University of Duisburg-Essen, Hufelandstrasse 55, 45122, Essen, Germany
| | - Annette Mathan
- Department of Gynecology and Obstetrics, University of Duisburg-Essen, Hufelandstrasse 55, 45122, Essen, Germany
- Department of Gynecology and Obstetrics, Klinikum Würzburg Mitte, Salvatorstrasse 7, 97074, Würzburg, Germany
| | - Pawel Mach
- Department of Gynecology and Obstetrics, University of Duisburg-Essen, Hufelandstrasse 55, 45122, Essen, Germany
| | - Mirjam Frank
- Institute for Medical Informatics, Biometry and Epidemiology (IMIBE), University of Duisburg-Essen, Hufelandstrasse 55, 45122, Essen, Germany
| | - Boerge Schmidt
- Institute for Medical Informatics, Biometry and Epidemiology (IMIBE), University of Duisburg-Essen, Hufelandstrasse 55, 45122, Essen, Germany
| | - Ekkehard Schleussner
- Department of Obstetrics, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
| | - Rainer Kimmig
- Department of Gynecology and Obstetrics, University of Duisburg-Essen, Hufelandstrasse 55, 45122, Essen, Germany
| | - Alexandra Gellhaus
- Department of Gynecology and Obstetrics, University of Duisburg-Essen, Hufelandstrasse 55, 45122, Essen, Germany
| | - Hans Dieplinger
- Division of Genetic Epidemiology, Department of Medical Genetics, Molecular and Clinical Pharmacology, Medical University of Innsbruck, Schöpfstrasse 41, 6020, Innsbruck, Austria.
- Vitateq Biotechnology GmbH, 6020, Innsbruck, Austria.
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Voigt A, Schleussner E, Schneppenheim R, Budde U, Beck JF, Stefanska-Windyga E, Windyga J, Kentouche K. Pregnancy in Upshaw-Schulman syndrome. Hamostaseologie 2018; 33:144-8. [DOI: 10.5482/hamo-13-04-0025] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Accepted: 05/06/2013] [Indexed: 11/05/2022] Open
Abstract
SummaryThe Upshaw Schulman syndrome (MIM #274150) is a hereditary deficiency of the von Willebrand factor cleaving protease (ADAMTS13) due to homozygous or compound heterozygous mutations in the ADAMTS13 gene. Patients are prone to bouts of thrombotic thrombocytopenic purpura. However, disease manifestation needs a second trigger event. Pregnancy is a known risk factor for TTP. Patients with USS may manifest during pregnancy and the postpartum period or relapse with a TTP bout. Before plasma therapy mortality for both the mother and the fetus was high, but even nowadays when plasma is delivered, therapy is challenging, still bearing a high risk for miscarriage or long term sequelae for the mother.In this report on pregnancies in three mothers with USS, plasma therapy was increased in frequency and amount given with regard to platelet count or ADAMTS13 activity, thus leading to a successful outcome.
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Abstract
SummaryThrombocytopenia during pregnancy is a common diagnostic and management problem. Several differential diagnosis must be considered including manifestations of thrombotic thrombocytopenic purpura (TTP). We report here on a case of a 21-year-old pregnant woman who presented initially severe thrombocytopenia (8 Gpt/l) in the 20th+1 week of gestation. The patient had an antibody against ADAMTS13, and enzyme activity was <5%. Immediate plasmapheresis treatment was initiated, followed by plasma infusions, and again plasmapheresis. A male neonate was delivered by caesarean section in the 32nd week of gestation. The child had an uncomplicated postnatal development. After delivery, the mother’s platelet count and ADAMTS13 activity increased to normal values. This case shows interesting aspects of TTP in pregnancy and a close cooperation between obstetricians, nephrologists and pediatricians is necessary for a successful outcome of the pregnancy.
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Chaiwangyen W, Morales-Prieto DM, Schleussner E, Markert UR. Effect of Extracellular Vesicles containing microRNA-21 on trophoblastic and immune cell functions. Placenta 2017. [DOI: 10.1016/j.placenta.2017.07.125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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26
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Mary Photini S, Chaiwangyen W, Weber M, Al-Kawlani B, Favaro RR, Jeschke U, Schleussner E, Morales-Prieto DM, Markert UR. PIM kinases 1, 2 and 3 in intracellular LIF signaling, proliferation and apoptosis in trophoblastic cells. Exp Cell Res 2017; 359:275-283. [PMID: 28729093 DOI: 10.1016/j.yexcr.2017.07.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [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: 12/31/2016] [Revised: 07/14/2017] [Accepted: 07/15/2017] [Indexed: 10/19/2022]
Abstract
Proviral insertion in murine (PIM) lymphoma proteins are mainly regulated by the Janus Kinase/Signal Transducer Activator of Transcription (JAK/STAT) signaling pathway, which can be activated by members of the Interleukin-6 (IL-6) family, including Leukemia Inhibitory Factor (LIF). Aim of the study was to compare PIM1, PIM2 and PIM3 expression and potential cellular functions in human first and third trimester trophoblast cells, the immortalized first trimester extravillous trophoblast cell line HTR8/SVneo and the choriocarcinoma cell line JEG-3. Expression was analyzed by qPCR and immunochemical staining. Functions were evaluated by PIM inhibition followed by analysis of kinetics of cell viability as assessed by MTS assay, proliferation by BrdU assay, and apoptosis by Western blotting for BAD, BCL-XL, (cleaved) PARP, CASP3 and c-MYC. Apoptosis and necrosis were tested by flow cytometry (annexin V/propidium iodide staining). All analyzed PIM kinases are expressed in primary trophoblast cells and both cell lines and are regulated upon stimulation with LIF. Inhibition of PIM kinases significantly reduces viability and proliferation and induces apoptosis. Simultaneously, phosphorylation of c-MYC was reduced. These results demonstrate the involvement of PIM kinases in LIF-induced regulation in different trophoblastic cell lines which may indicate similar functions in primary cells.
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Affiliation(s)
- Stella Mary Photini
- Placenta-Lab, Department of Obstetrics, Jena University Hospital, Am Klinikum 1, 07747 Jena, Germany
| | - Wittaya Chaiwangyen
- Placenta-Lab, Department of Obstetrics, Jena University Hospital, Am Klinikum 1, 07747 Jena, Germany; School of Medical Sciences, University of Phayao, Phayao 56000, Thailand
| | - Maja Weber
- Placenta-Lab, Department of Obstetrics, Jena University Hospital, Am Klinikum 1, 07747 Jena, Germany
| | - Boodor Al-Kawlani
- Placenta-Lab, Department of Obstetrics, Jena University Hospital, Am Klinikum 1, 07747 Jena, Germany
| | - Rodolfo R Favaro
- Placenta-Lab, Department of Obstetrics, Jena University Hospital, Am Klinikum 1, 07747 Jena, Germany; Laboratory of Reproductive and Extracellular Matrix Biology, Department of Cell and Developmental Biology, Institute of Biomedical Sciences, University of São Paulo, Brazil
| | - Udo Jeschke
- Ludwig Maximilians University of Munich, Department of Obstetrics and Gynecology, Maistrasse 11, 80337 Munich, Germany
| | - Ekkehard Schleussner
- Placenta-Lab, Department of Obstetrics, Jena University Hospital, Am Klinikum 1, 07747 Jena, Germany
| | - Diana M Morales-Prieto
- Placenta-Lab, Department of Obstetrics, Jena University Hospital, Am Klinikum 1, 07747 Jena, Germany
| | - Udo R Markert
- Placenta-Lab, Department of Obstetrics, Jena University Hospital, Am Klinikum 1, 07747 Jena, Germany.
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Pereira de Sousa FL, Chaiwangyen W, Morales-Prieto DM, Ospina-Prieto S, Weber M, Photini SM, Sass N, Daher S, Schleussner E, Markert UR. Involvement of STAT1 in proliferation and invasiveness of trophoblastic cells. Reprod Biol 2017; 17:218-224. [PMID: 28552376 DOI: 10.1016/j.repbio.2017.05.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [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: 01/12/2017] [Revised: 04/20/2017] [Accepted: 05/13/2017] [Indexed: 12/19/2022]
Abstract
Trophoblast proliferation and invasion are controlled by cytokines and growth factors present at the implantation site. Members of the Interleukin-6 (IL-6) family of cytokines trigger their effects through activation of intracellular cascades including the Janus Kinase/Signal Transducer and Activator of Transcription (JAK-STAT) pathway. Functions of several STAT molecules in trophoblast cells have been described, but the role of STAT1 remained unclear. Here, potential functions of STAT1 and its activation by Oncostatin M (OSM) have been investigated in an in vitro model. STAT1 expression and phosphorylation were analyzed in human term placenta tissue by immunohistochemistry. HTR-8/SVneo cells (immortalized human extravillous trophoblast cells) were stimulated with OSM, IL-6, IL-11, Leukemia Inhibitory Factor (LIF) and Granulocyte Macrophage Colony-Stimulating Factor. Expression and phosphorylation of STAT1 were analyzed by Western blotting and immunocytochemistry. Fludarabine and STAT1 siRNA were employed for STAT1 depletion. STAT1 transcriptional activity was evaluated by DNA-binding capacity assay. Cell viability and invasion were assessed by MTS and Matrigel assays, respectively. STAT1 was expressed in villous and extravillous trophoblast cells. Low phosphorylation was detectable exclusively in extravillous trophoblast cells. Only OSM and LIF induced phosphorylation of STAT1 in the in vitro model. Challenge with OSM increased cell invasion but not proliferation. Inhibition of STAT1 by fludarabine treatment or STAT1 siRNA transfection reduced cell viability and invasiveness in presence and absence of OSM. These results indicate the potential involvement of STAT1 in the regulation of trophoblast behavior. Furthermore, STAT 1 functions are more efficiently inhibited by blocking its expression than its phosphorylation.
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Affiliation(s)
- Francisco Lázaro Pereira de Sousa
- Placenta Lab, Department of Obstetrics, Jena University Hospital, Am Klinikum 1, 07747 Jena, Germany; Department of Obstetrics, Federal University of São Paulo, São Paulo, SP, Brazil
| | - Wittaya Chaiwangyen
- Placenta Lab, Department of Obstetrics, Jena University Hospital, Am Klinikum 1, 07747 Jena, Germany
| | - Diana M Morales-Prieto
- Placenta Lab, Department of Obstetrics, Jena University Hospital, Am Klinikum 1, 07747 Jena, Germany.
| | - Stephanie Ospina-Prieto
- Placenta Lab, Department of Obstetrics, Jena University Hospital, Am Klinikum 1, 07747 Jena, Germany
| | - Maja Weber
- Placenta Lab, Department of Obstetrics, Jena University Hospital, Am Klinikum 1, 07747 Jena, Germany
| | - Stella M Photini
- Placenta Lab, Department of Obstetrics, Jena University Hospital, Am Klinikum 1, 07747 Jena, Germany
| | - Nelson Sass
- Department of Obstetrics, Federal University of São Paulo, São Paulo, SP, Brazil
| | - Silvia Daher
- Department of Obstetrics, Federal University of São Paulo, São Paulo, SP, Brazil
| | - Ekkehard Schleussner
- Placenta Lab, Department of Obstetrics, Jena University Hospital, Am Klinikum 1, 07747 Jena, Germany
| | - Udo R Markert
- Placenta Lab, Department of Obstetrics, Jena University Hospital, Am Klinikum 1, 07747 Jena, Germany
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Liehr T, Lauten A, Schneider U, Schleussner E, Weise A. Noninvasive Prenatal Testing - When Is It Advantageous to Apply. Biomed Hub 2017; 2:1-11. [PMID: 31988902 PMCID: PMC6945944 DOI: 10.1159/000458432] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [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: 10/21/2016] [Accepted: 01/27/2017] [Indexed: 12/23/2022] Open
Abstract
Nowadays it is common sense in obstetrics that an increased risk for pregnancy loss due to invasive testing does not exist. Nonetheless, noninvasive prenatal testing (NIPT) is a hot topic, even though this approach does not provide a reduction of unintentionally induced abortions. NIPT has a number of shortcuts which are highlighted in this review, including: (1) in NIPT placental rather than fetal DNA is studied, (2) NIPT fails in 2–6% of cases, and (3) trisomy 21 accounts for only ∼50% of existing chromosomal aberrations. Thus, we agree with the literature that NIPT is a fascinating possibility to gain information on unborn life from minimal amounts of DNA. However, it remains a pure risk estimation test directed towards the detection of specific chromosomal abnormalities from peripheral blood of the pregnant woman. It is important to highlight that families buying this test, and getting a normal result, may be provided with a false sense of security. Thus, careful and comprehensive genetic counselling should be performed before the test is offered, and should include a clear explanation of the advantages and disadvantages, as well as limitations, compared to other methods.
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Affiliation(s)
- Thomas Liehr
- Institute of Human Genetics, Friedrich Schiller University, Jena, Germany
| | - Angela Lauten
- Institute of Clinic for Obstetrics and Gynecology, Jena University Hospital, Friedrich Schiller University, Jena, Germany
| | - Uwe Schneider
- Institute of Clinic for Obstetrics and Gynecology, Jena University Hospital, Friedrich Schiller University, Jena, Germany
| | - Ekkehard Schleussner
- Institute of Clinic for Obstetrics and Gynecology, Jena University Hospital, Friedrich Schiller University, Jena, Germany
| | - Anja Weise
- Institute of Human Genetics, Friedrich Schiller University, Jena, Germany
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Rogenhofer N, Markoff A, Wagner A, Klein HG, Petroff D, Schleussner E, Thaler C. OC-2b: Estimating the potential benefit of low-molecular-weight heparin in M2/ANXA5 haplotype carriers with recurrent pregnancy loss: a secondary analysis of the ETHIG II trial. Thromb Res 2017. [DOI: 10.1016/s0049-3848(17)30083-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Schleussner E, Kamin G, Seeger S, Petroff D. P-036: Lipoprotein (a) as a risk factor for recurrent miscarriage and the effect of low-molecular-weight heparin: an analysis of the ETHIG II trial. Thromb Res 2017. [DOI: 10.1016/s0049-3848(17)30134-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Rodger MA, Gris JC, de Vries JIP, Martinelli I, Rey É, Schleussner E, Middeldorp S, Kaaja R, Langlois NJ, Ramsay T, Mallick R, Bates SM, Abheiden CNH, Perna A, Petroff D, de Jong P, van Hoorn ME, Bezemer PD, Mayhew AD. Low-molecular-weight heparin and recurrent placenta-mediated pregnancy complications: a meta-analysis of individual patient data from randomised controlled trials. Lancet 2016; 388:2629-2641. [PMID: 27720497 DOI: 10.1016/s0140-6736(16)31139-4] [Citation(s) in RCA: 134] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Placenta-mediated pregnancy complications include pre-eclampsia, late pregnancy loss, placental abruption, and birth of a small-for-gestational-age (SGA) neonate. These complications are leading causes of maternal, fetal, and neonatal morbidity and mortality in high-income countries. Affected women are at high risk of recurrence in subsequent pregnancies; however, effective strategies to prevent recurrence are absent. Findings from our previous study-level meta-analysis suggested that low-molecular-weight heparin reduced the risk of recurrent placenta-mediated pregnancy complications. However, we identified significant heterogeneity in the results, possibly due to trial design or inclusion criteria. To identify which patients benefit from, and which outcomes are prevented by, low-molecular-weight heparin, we did an individual patient data meta-analysis. METHODS We did a systematic review in May, 2013, which identified eight eligible randomised trials done between 2000 and 2013 of low-molecular-weight heparin to prevent recurrent placenta-mediated pregnancy complications. We excluded studies on the basis of the wrong population, the study being ongoing, inability to confirm eligibility of participants, intervention stopped too early, and no response from the principal investigator. We requested individual patient data from the study authors for eligible women (women pregnant at the time of the study with a history of previous pregnancy that had been complicated by one or more of the following: pre-eclampsia, placental abruption, birth of an SGA neonate [<10th percentile], pregnancy loss after 16 weeks' gestation, or two losses after 12 weeks' gestation) and recoded, combined, and analysed the data for our meta-analysis. The primary outcome was a composite of early-onset (<34 weeks) or severe pre-eclampsia, birth of an SGA neonate (<5th percentile), late pregnancy loss (≥20 weeks' gestation), or placental abruption leading to delivery, assessed on an intention-to-treat basis. We assessed risk of bias with the Cochrane Risk of Bias tool. This study is registered with PROSPERO, number CRD42013006249. FINDINGS We analysed data from 963 eligible women in eight trials: 480 randomly assigned to low-molecular-weight heparin and 483 randomly assigned to no low-molecular-weight heparin. Overall, the risk of bias was not substantial enough to affect decisions regarding trial inclusion. Participants were mostly white (795/905; 88%) with a mean age of 30·9 years (SD 5·0) and 403/963 (42%) had thrombophilia. In the primary analysis, low-molecular-weight heparin did not significantly reduce the risk of recurrent placenta-mediated pregnancy complications (low-molecular-weight heparin 62/444 [14%] versus no low-molecular-weight heparin 95/443 (22%) absolute difference -8%, 95% CI -17·3 to 1·4, p=0·09; relative risk 0·64, 95% CI 0·36-1·11, p=0·11). We noted significant heterogeneity between single-centre and multicentre trials. In subgroup analyses, low-molecular-weight heparin in multicentre trials reduced the primary outcome in women with previous abruption (p=0·006) but not in any of the other subgroups of previous complications. INTERPRETATION Low-molecular-weight heparin does not seem to reduce the risk of recurrent placenta-mediated pregnancy complications in at-risk women. However, some decreases in event rates might have been too small for the power of our study to explore. FUNDING Canadian Institutes of Health Research.
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Affiliation(s)
- Marc A Rodger
- Ottawa Blood Disease Center, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada.
| | - Jean-Christophe Gris
- Consultations et Laboratoire d'Hématologie et Délégation à la Recherche Clinique et à l'Innovation, Nîmes cédex 09, France
| | - Johanna I P de Vries
- Department of Obstetrics and Gynaecology, VU University Medical Center, Amsterdam, Netherlands
| | - Ida Martinelli
- A. Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Ekkehard Schleussner
- Jena University Hospital, Department of Obstetrics and Gynaecology, Jena, Germany
| | - Saskia Middeldorp
- Academic Medical Center, Department of Vascular Medicine, Meibergdreef 9, Amsterdam, the Netherlands
| | - Risto Kaaja
- Turku University, Turku University Hospital, Åbo, Finland
| | - Nicole J Langlois
- Centre for Practice-Changing Research, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Timothy Ramsay
- Centre for Practice-Changing Research, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Ranjeeta Mallick
- Centre for Practice-Changing Research, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Shannon M Bates
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Carolien N H Abheiden
- Department of Obstetrics and Gynaecology, VU University Medical Center, Amsterdam, Netherlands
| | - Annalisa Perna
- Laboratorio di Biostatistica, Centro di Ricerche Cliniche per le Malattie Rare Aldo e Cele Daccò, IRCCS-Istituto di Ricerche Farmacologiche Mario Negri, Ranica, Italy
| | - David Petroff
- University of Leipzig, Clinical Trial Centre, Germany
| | - Paulien de Jong
- Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Marion E van Hoorn
- Department of Obstetrics and Gynaecology, VU University Medical Center, Amsterdam, Netherlands
| | - P Dick Bezemer
- Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, Netherlands
| | - Alain D Mayhew
- Centre for Practice-Changing Research, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
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Kuon RJ, Vomstein K, Weber M, Müller F, Seitz C, Wallwiener S, Strowitzki T, Schleussner E, Markert UR, Daniel V, Toth B. The "killer cell story" in recurrent miscarriage: Association between activated peripheral lymphocytes and uterine natural killer cells. J Reprod Immunol 2016; 119:9-14. [PMID: 27865124 DOI: 10.1016/j.jri.2016.11.002] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [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: 05/19/2016] [Revised: 10/27/2016] [Accepted: 11/02/2016] [Indexed: 01/02/2023]
Abstract
Peripheral and uterine NK cells (pNK, uNK) can be distinguished according to their receptor expression. Recent studies indicate an association of elevated pNK and uNK with recurrent miscarriage (RM). This study aimed to analyze pNK and uNK in patients with RM and healthy controls. Out of n=590 RM patients screened according to a standard diagnostic protocol, n=268 couples with ≥3 consecutive RM were identified. Subgroups consisted of n=151 primary RM (pRM), n=85 secondary RM (sRM), n=32 tertiary RM (tRM) and n=42 healthy controls. Finally, n=147 idiopathic RM (iRM) and n=121 non-iRM patients were identified. Peripheral blood levels of CD45+CD3-CD56+CD16+ NK cells were determined in non-pregnant patients and controls in the mid-luteal phase by FACS. In n=129 RM patients a uterine biopsy was taken to evaluate CD56+ NK cells by immunohistochemistry. PRM showed higher absolute pNK than sRM (median/μl (Q1;Q3): 234 (147;306) vs 176 (128;245), p=0.02). Further a trend towards higher pNK percentages in pRM was detected. UNK numbers did not differ between RM subgroups and did not correlate with pNK. However, the rate of highly elevated uNK was increased in iRM compared to non-iRM patients (p=0.04). Further, higher numbers of CD45+CD3-DR+ (p<0.01) and CD45+CD3+CD8+DR+ (p=0.04) peripheral lymphocytes were associated with higher uNK numbers. In conclusion, elevated pNK were present in pRM patients. Although pNK and uNK numbers did not correlate, the association between high CD45+CD3-DR+ and CD45+CD3+CD8+DR+ peripheral lymphocytes and uNK might indicate that activated NK, B and T cells provide cytokines for the differentiation of uNK.
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Affiliation(s)
- R J Kuon
- Department of Gynecological Endocrinology and Fertility Disorders, Ruprecht-Karls University Heidelberg, Im Neuenheimer Feld 440, 69120 Heidelberg, Germany
| | - K Vomstein
- Department of Gynecological Endocrinology and Fertility Disorders, Ruprecht-Karls University Heidelberg, Im Neuenheimer Feld 440, 69120 Heidelberg, Germany
| | - M Weber
- Placenta-Lab, Department of Obstetrics, University Hospital Jena, Bachstrasse 18, 07743 Jena, Germany
| | - F Müller
- Department of Gynecological Endocrinology and Fertility Disorders, Ruprecht-Karls University Heidelberg, Im Neuenheimer Feld 440, 69120 Heidelberg, Germany
| | - C Seitz
- Department of Neonatology, Ruprecht-Karls University Heidelberg, Im Neuenheimer Feld 430, 69120 Heidelberg, Germany
| | - S Wallwiener
- Department of Obstetrics and Gynecology, Ruprecht-Karls University Heidelberg, Im Neuenheimer Feld 440, 69120 Heidelberg, Germany
| | - T Strowitzki
- Department of Gynecological Endocrinology and Fertility Disorders, Ruprecht-Karls University Heidelberg, Im Neuenheimer Feld 440, 69120 Heidelberg, Germany
| | - E Schleussner
- Department of Obstetrics and Gynecology, University Hospital Jena, Bachstrasse 18, 07743 Jena, Germany
| | - U R Markert
- Placenta-Lab, Department of Obstetrics, University Hospital Jena, Bachstrasse 18, 07743 Jena, Germany
| | - V Daniel
- Transplantation-Immunology, Institute of Immunology, Ruprecht-Karls University Heidelberg, Im Neuenheimer Feld 672, 69120 Heidelberg, Germany
| | - B Toth
- Gynecological Endocrinology and Reproductive Medicine, Medical University Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria.
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Schmitz S, Groten T, Schleussner E, Battefeld W, Hillemanns P, Schippert C, von Versen-Höynck F. Gestational diabetes mellitus: an evaluation of gynecologists' knowledge of guidelines and counseling behavior. Arch Gynecol Obstet 2016; 294:1209-1217. [PMID: 27511382 DOI: 10.1007/s00404-016-4161-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 03/10/2016] [Accepted: 07/27/2016] [Indexed: 11/25/2022]
Abstract
PURPOSE Knowledge of risks, adequate pre- and post-partum care, and counseling is essential to reduce short- and long-term consequences for women with gestational diabetes mellitus (GDM) and their offspring. Our study explored the current GDM guideline knowledge and practiced patient counseling of private gynecologists in Germany. METHODS A survey assessing the GDM guidelines and patient counseling was mailed to 775 practicing gynecologists. We evaluated the knowledge of maternal and offspring disease risks, counseling practice, and guideline awareness. Descriptive statistics were used to analyze the responses and Chi-Square or Fisher exact test to explore differences between groups. RESULTS Of the 418 private gynecologists (54.1 % response rate) who responded, the majority was aware of obesity and GDM in the previous pregnancy as risk factors for GDM. To a lesser extent, risk factors like recurrent miscarriages and stillbirth were recalled. Eighty percent stated that GDM was associated with a higher risk for the development for hypertension and 96 % with type 2 diabetes in the mother. Respondents with knowledge of the current GDM guidelines were more often aware of the development of chronic diseases, counseled patients more frequently, and performed post-partum glucose screenings more regularly compared with private gynecologists with no knowledge of the guidelines. CONCLUSIONS The majority of participants incorporated recent recommendations into their practice patterns for GDM. Providing private gynecologists with additional training may further improve care for women with GDM-affected pregnancies.
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Affiliation(s)
- Sophie Schmitz
- Department of Obstetrics and Gynecology, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany
| | - Tanja Groten
- Department of Obstetrics and Gynecology, Friedrich-Schiller-Universität Jena, Bachstraße 18, 07740, Jena, Germany
| | - Ekkehard Schleussner
- Department of Obstetrics and Gynecology, Friedrich-Schiller-Universität Jena, Bachstraße 18, 07740, Jena, Germany
| | - Wilgard Battefeld
- Department of Endocrinology, Medical Care Centre, Robert-Weixler-Str. 19, 87439, Kempten, Germany
| | - Peter Hillemanns
- Department of Obstetrics and Gynecology, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany
| | - Cordula Schippert
- Department of Obstetrics and Gynecology, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany
| | - Frauke von Versen-Höynck
- Department of Obstetrics and Gynecology, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany.
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Rogenhofer N, Markoff A, Wagner A, Klein HG, Petroff D, Schleussner E, Thaler CJ. Möglicher Benefit einer niedermolekularen Heparinisierung in der Schwangerschaft bei habituellen Aborten und M2/Annexin-A5 (ANXA-5) Trägerschaft: post-hoc Analyse der EThiG-II-Studie. Geburtshilfe Frauenheilkd 2016. [DOI: 10.1055/s-0036-1592776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Mueller M, Polowy J, Heverhagen A, Schleussner E, Raio L, Surbek D. Placental alpha-microglobulin-1 in cervico-vaginal fluid predicts preterm birth in women with preterm labor and intact membranes. Geburtshilfe Frauenheilkd 2016. [DOI: 10.1055/s-0036-1592950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Photini SM, Chaiwangyen W, Al-kawlani B, Morales-Prieto DM, Schleussner E, Markert UR. PIM Kinases in Trophoblast cells. Placenta 2016. [DOI: 10.1016/j.placenta.2016.06.072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Chaiwangyen W, Morales-Prieto DM, Gutierrez-Samudio RN, Ospina-Prieto S, Photini SM, Schleussner E, Markert UR. MicroRNA-519d in trophoblastic cell functions and intercellular communication with immune cell via extracellular vesicles. Placenta 2016. [DOI: 10.1016/j.placenta.2016.06.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Abstract
This study presents sample size considerations derived from the Efficacy of Thromboprophylaxis as an Intervention during Gravidity (EThIGII) trial (ClinicalTrials.gov: NCT00400387) to address the question of low-molecular-weight heparin (LMWH) treatment in women with recurrent pregnancy loss (RPL) depending on the M2/ANXA5 haplotype. To evaluate the possible influence of such treatment on miscarriage rates of trial participants, a post hoc analysis of ANXA5 promoter genotypes in the light of M2/ANXA5 ( RPRGL3) distribution was performed using logistic models. DNA for genotyping was available from 129 LMWH and 95 control patients, 44 (19.6%) of whom were M2/ANXA5 carriers. Miscarriages occurred in 1 (4.0%) of 25 M2/ANXA5 carriers from the LMWH group compared to 4 (21.1%) of 19 in the control group, resulting in an odds ratio (95% confidence interval) for miscarriage of 0.16 (0.016-1.5) for women treated with LMWH. In noncarriers, miscarriage rates were 6 (5.8%) of 104 versus 7 (9.2%) of 76 for the LMWH and the control groups, respectively, corresponding to an odds ratio for miscarriage of 0.60 (0.19-1.9). The apparent beneficial effects of miscarriage rate reduction in M2/ANXA5 carriers with RPL concur with biological considerations about improvement in reduced ANXA5 function through LMWH treatment in an adequate murine model. The data obtained were instrumental to design proper assessment of the existence and magnitude of this effect.
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Affiliation(s)
- Nina Rogenhofer
- Division of Gynecological Endocrinology and Reproductive Medicine, Department of Gynecology and Obstetrics, Klinikum der Ludwig-Maximilians-Universität, Munich, Germany
| | - Arseni Markoff
- Insititute of Human Genetics, UKM and WWU Muenster, Muenster, Germany
| | - Annett Wagner
- Center for Human Genetics and Laboratory Diagnostics, Dr Klein, Dr Rost and Colleagues, Martinsried, Germany
| | - Hanns-Georg Klein
- Center for Human Genetics and Laboratory Diagnostics, Dr Klein, Dr Rost and Colleagues, Martinsried, Germany
| | - David Petroff
- Clinical Trial Centre, University of Leipzig, Leipzig, Germany
| | | | - Christian J. Thaler
- Division of Gynecological Endocrinology and Reproductive Medicine, Department of Gynecology and Obstetrics, Klinikum der Ludwig-Maximilians-Universität, Munich, Germany
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Ospina-Prieto S, Chaiwangyen W, Herrmann J, Groten T, Schleussner E, Markert UR, Morales-Prieto DM. MicroRNA-141 is upregulated in preeclamptic placentae and regulates trophoblast invasion and intercellular communication. Transl Res 2016; 172:61-72. [PMID: 27012474 DOI: 10.1016/j.trsl.2016.02.012] [Citation(s) in RCA: 90] [Impact Index Per Article: 11.3] [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: 07/30/2015] [Revised: 02/05/2016] [Accepted: 02/25/2016] [Indexed: 12/27/2022]
Abstract
Preeclampsia (PE) is one of the leading causes of maternal and perinatal morbidity and mortality worldwide. Abnormal expression of microRNAs (miRNAs) occurs in several pregnancy diseases including PE. Placental trophoblast cells express a specific set of miRNAs which changes during pregnancy. These miRNAs can be released within extracellular vesicles (EVs) and mediate intercellular communication. miR-141 is a pregnancy-related miRNA which is expressed by trophoblast cells at increased levels in maternal plasma in the third trimester. We hypothesize that miR-141 is abnormally expressed in PE placentae, controls trophoblast, and immune cell functions and is involved in the intercellular communication between fetal trophoblast and maternal immune cells. Expression of miR-141 was analyzed by quantitative real-time PCR (qPCR) in normal and preeclamptic placentae and in 2 different trophoblastic cell lines, JEG-3 and HTR-8/SVneo. Changes in JEG-3 and HTR-8/SVneo cell proliferation and invasion were investigated after miR-141 inhibition and overexpression by MTS-, BrdU-, and Matrigel assays. EVs from miR-141 transfected cells were isolated from supernatants and characterized by NanoSight analysis and qPCR. Proliferation of Jurkat T cells and invasion of HTR-8/SVneo cells were investigated after treatment with EVs containing different miR-141 levels. miR-141 expression was higher in placentae from PE patients compared with those from normal pregnancies. miR-141 inhibition in trophoblastic cells resulted in decreased cell viability and reduced invasion capability. After transfection with miR-141-mimic, trophoblastic cells secreted EVs with increased miR-141 content. These vesicles did not exert effects on trophoblastic cell invasion but reduced Jurkat T cell proliferation. In conclusion, miR-141 regulates major functions of trophoblastic and immune cells. Trophoblast cells release EVs whose miRNA content can be modified by transfection of origin cells. Furthermore, elevated levels of miR-141 can be transferred from trophoblast to immune cells by release and internalization of EVs suggesting their role in the immune regulation of normal and pathologic pregnancies.
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Affiliation(s)
- Stephanie Ospina-Prieto
- Placenta Lab, Department of Obstetrics, University Hospital Jena, Bachstraße 18, Jena 07743, Germany
| | - Wittaya Chaiwangyen
- Placenta Lab, Department of Obstetrics, University Hospital Jena, Bachstraße 18, Jena 07743, Germany; School of Medical Sciences, University of Phayao, Phayao 56000, Thailand
| | - Jörg Herrmann
- Department of Gynecology and Obstetrics, Hufeland Klinikum, Henry-van-de-Velde-Straße 2, Weimar 99425, Germany
| | - Tanja Groten
- Placenta Lab, Department of Obstetrics, University Hospital Jena, Bachstraße 18, Jena 07743, Germany
| | - Ekkehard Schleussner
- Placenta Lab, Department of Obstetrics, University Hospital Jena, Bachstraße 18, Jena 07743, Germany
| | - Udo R Markert
- Placenta Lab, Department of Obstetrics, University Hospital Jena, Bachstraße 18, Jena 07743, Germany.
| | - Diana M Morales-Prieto
- Placenta Lab, Department of Obstetrics, University Hospital Jena, Bachstraße 18, Jena 07743, Germany.
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Göhner C, Fitzgerald JS, Fledderus J, Weber M, Schleussner E, Markert UR, Scherjon SA, Plösch T, Faas MM. Syncytiotrophoblast extracellular vesicles induce a memory to pregnancy which is disturbed in preeclampsia. J Reprod Immunol 2016. [DOI: 10.1016/j.jri.2016.04.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Photini SM, Chaiwangyen W, Al-kawlani B, Favaro R, Schleussner E, Morales-Prieto DM, Markert UR. PIM kinases in trophoblast cells. J Reprod Immunol 2016. [DOI: 10.1016/j.jri.2016.04.260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Göhner C, Fitzgerald JS, Fledderus J, Weber M, Schleussner E, Markert UR, Scherjon SA, Plösch T, Faas MM. Syncytiotrophoblast extracellular vesicles induce a memory to pregnancy which is disturbed in preeclampsia. J Reprod Immunol 2016. [DOI: 10.1016/j.jri.2016.04.273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Photini SM, Chaiwangyen W, Al-kawlani B, Favaro R, Schleussner E, Morales-Prieto DM, Markert UR. PIM kinases in trophoblast cells. J Reprod Immunol 2016. [DOI: 10.1016/j.jri.2016.04.092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Pastuschek J, Butans A, Remane D, Peters FT, Markert UR, Schleussner E, Groten T. Placental transfer of ampicillin and cefotaxime. J Reprod Immunol 2016. [DOI: 10.1016/j.jri.2016.04.262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Muth I, Schleussner E. Veränderung der autonomen und humoralen Stressantwort bei Kindern nach pränataler Betamethason-Exposition. Geburtshilfe Frauenheilkd 2016. [DOI: 10.1055/s-0036-1583561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Jäkel S, Rabe M, Schneider U, Schleussner E. Peripartale fetale Asphyxie bei subpartu unauffälligem FHF-Muster. Geburtshilfe Frauenheilkd 2016. [DOI: 10.1055/s-0036-1583558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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47
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Jäkel S, Diamantis I, Schneider U, Schleussner E. Sektiohysterektomie bei Plazenta praevia e percreta unter temporärer Ballon-Okklusion der Arteria iliaca interna bds. Geburtshilfe Frauenheilkd 2016. [DOI: 10.1055/s-0036-1583559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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48
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Meinig S, Brenner M, Schleussner E. Die auffällige plazentare Nabelschnurinsertion im klinischen Alltag. Geburtshilfe Frauenheilkd 2016. [DOI: 10.1055/s-0036-1583842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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49
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Kudryavtseva E, Güllmar D, Fiedler A, Wagingner M, Renz D, Schleussner E, Schneider U, Mentzel H. Vergleich der Fruchtwasser-Volumetrie zwischen fetaler Sonografie (AFI) und MRT (FWMRT) und Korrelation zu Diffusionsparametern (ADC) der fetalen Niere. ROFO-FORTSCHR RONTG 2016. [DOI: 10.1055/s-0036-1581545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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50
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Weber M, Göhner C, San Martin S, Vattai A, Hutter S, Parraga M, Jeschke U, Schleussner E, Markert UR, Fitzgerald JS. Unique trophoblast stem cell- and pluripotency marker staining patterns depending on gestational age and placenta-associated pregnancy complications. Cell Adh Migr 2016; 10:56-65. [PMID: 26914354 DOI: 10.1080/19336918.2016.1142035] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [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: 10/22/2022] Open
Abstract
Preeclampsia (PE) and intrauterine growth retardation (IUGR) are rare but severe pregnancy complications that are associated with placental insufficiency often resulting in premature birth. The clinical pathologies are related to gross placental pathologies and trophoblastic deficiencies that might derive from inflammatory processes and oxidative stress injury. The mesenchymal core of placental villi has been identified as a possible niche for trophoblast progenitor cells that are called upon to replenish the injured syncytiotrophoblast layer. These progenitor cells are known to express trophoblast stem cell (CDX2) and pluripotency (SOX2, NANOG and OCT4A) markers, however only little data is available characterizing the expression of these transcription factors beyond the blastocyst stage. We aimed to describe the expression of these factors in healthy 1st and 3rd trimester placentae as well as PE, IUGR and combined PE+IUGR placentae. We analyzed 8 respective samples derived from 1st trimester (elective abortions), and 3rd trimester (healthy controls, PE, IUGR and combined PE+IUGR). We accomplished immunoperoxidase staining to detect the stem cell markers: CDX2 (trophectoderm), SOX2, NANOG and OCT4A (embryonal). Immunoreative scoring was used for objective analyses of staining patterns. All markers display clearly elevated signals in 1st trimester villous samples as compared to healthy 3rd trimester counterparts. Especially CDX2 and NANOG were specific to the cytotrophoblast layer and the mesenchymal core. Specific and differential expression patterns were visible in the villous/extravillous compartment of each placenta-associated pregnancy complication (PE: pan elevated expression; IUGR elevated SOX2 in basal plate; combined PE+IUGR pan loss of expression). Reduction of stem cell transcription factor expression in term placentae indicates temporal regulation, and probably a specific function which is yet to be elucidated. The differential expression patterns within placentae complicated with placenta-associated pregnancy complications indicate that PE, IUGR and combined PE+IUGR are separate entities. It is unclear whether the alterations are the cause or the effect of the clinical pathology.
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Affiliation(s)
- Maja Weber
- a Department of Obstetrics , Placenta Lab, University Hospital Jena , Jena , Germany
| | - Claudia Göhner
- a Department of Obstetrics , Placenta Lab, University Hospital Jena , Jena , Germany.,b Department of Obstetrics and Gynecology , University Medical Center Groningen, University of Groningen , Groningen , The Netherlands
| | - Sebastian San Martin
- c Biomedical Research Center, School of Medicine, Universidad de Valparaiso , Chile
| | - Aurelia Vattai
- d Department of Obstetrics and Gynecology , Ludwig Maximilians University of Munich , Munich , Germany
| | - Stefan Hutter
- d Department of Obstetrics and Gynecology , Ludwig Maximilians University of Munich , Munich , Germany
| | - Mario Parraga
- c Biomedical Research Center, School of Medicine, Universidad de Valparaiso , Chile
| | - Udo Jeschke
- d Department of Obstetrics and Gynecology , Ludwig Maximilians University of Munich , Munich , Germany
| | - Ekkehard Schleussner
- a Department of Obstetrics , Placenta Lab, University Hospital Jena , Jena , Germany
| | - Udo R Markert
- a Department of Obstetrics , Placenta Lab, University Hospital Jena , Jena , Germany
| | - Justine S Fitzgerald
- a Department of Obstetrics , Placenta Lab, University Hospital Jena , Jena , Germany.,e Praxisklinik am Anger, Kinderwunschzentrum Erfurt , Erfurt , Germany
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