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Peterson J, Smith DM, Johnstone ED, Mahaveer A. Perinatal optimisation for periviable birth and outcomes: a 4-year network analysis (2018-2021) across a change in national guidance. Front Pediatr 2024; 12:1365720. [PMID: 38694726 PMCID: PMC11061457 DOI: 10.3389/fped.2024.1365720] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 03/11/2024] [Indexed: 05/04/2024] Open
Abstract
Introduction The British Association of Perinatal Medicine (BAPM) released their revised framework for extremely preterm infant management in 2019. This revised framework promotes consideration of perinatal optimisation and survival-focused care from 22 weeks gestation onwards. This was a departure from the previous BAPM framework which recommended comfort care as the only recommended management for infants <23 + 0 weeks. Methods Our study evaluates the clinical impact that this updated framework has had across the Northwest of England. We utilised anonymised network data from periviable infants delivered across the region to examine changes in perinatal optimisation practices and survival outcomes following the release of the latest BAPM framework. Results Our data show that after the introduction of the updated framework there has been an increase in perinatal optimisation practices for periviable infants and an 80% increase in the number of infants born at 22 weeks receiving survival-focused care and admission to a neonatal unit. Discussion There remain significant discrepancies in optimisation practices by gestational age, which may be contributing to the static survival rates that were observed in the lowest gestational ages.
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Affiliation(s)
- J. Peterson
- Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
- St Mary’s Maternity Hospital, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - D. M. Smith
- Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | - E. D. Johnstone
- Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
- St Mary’s Maternity Hospital, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - A. Mahaveer
- Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
- St Mary’s Maternity Hospital, Manchester University NHS Foundation Trust, Manchester, United Kingdom
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Tun WM, Poologasundarampillai G, Bischof H, Nye G, King ONF, Basham M, Tokudome Y, Lewis RM, Johnstone ED, Brownbill P, Darrow M, Chernyavsky IL. A massively multi-scale approach to characterizing tissue architecture by synchrotron micro-CT applied to the human placenta. J R Soc Interface 2021; 18:20210140. [PMID: 34062108 PMCID: PMC8169212 DOI: 10.1098/rsif.2021.0140] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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: 02/16/2021] [Accepted: 05/06/2021] [Indexed: 12/03/2022] Open
Abstract
Multi-scale structural assessment of biological soft tissue is challenging but essential to gain insight into structure-function relationships of tissue/organ. Using the human placenta as an example, this study brings together sophisticated sample preparation protocols, advanced imaging and robust, validated machine-learning segmentation techniques to provide the first massively multi-scale and multi-domain information that enables detailed morphological and functional analyses of both maternal and fetal placental domains. Finally, we quantify the scale-dependent error in morphological metrics of heterogeneous placental tissue, estimating the minimal tissue scale needed in extracting meaningful biological data. The developed protocol is beneficial for high-throughput investigation of structure-function relationships in both normal and diseased placentas, allowing us to optimize therapeutic approaches for pathological pregnancies. In addition, the methodology presented is applicable in the characterization of tissue architecture and physiological behaviours of other complex organs with similarity to the placenta, where an exchange barrier possesses circulating vascular and avascular fluid spaces.
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Affiliation(s)
- W. M. Tun
- Diamond Light Source, Didcot OX11 0DE, UK
| | | | - H. Bischof
- Maternal and Fetal Health Research Centre, School of Medical Sciences, University of Manchester, Manchester, UK
- MAHSC, St Mary's Hospital, NHS MFT, Manchester M13 9WL, UK
| | - G. Nye
- Chester Medical School, University of Chester, Chester CH1 4BJ, UK
| | | | - M. Basham
- Diamond Light Source, Didcot OX11 0DE, UK
- Rosalind Franklin Institute, Didcot OX11 0DE, UK
| | - Y. Tokudome
- Department of Materials Science, Graduate School of Engineering, Osaka Prefecture University, Osaka 599-8531, Japan
| | - R. M. Lewis
- Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK
| | - E. D. Johnstone
- Maternal and Fetal Health Research Centre, School of Medical Sciences, University of Manchester, Manchester, UK
- MAHSC, St Mary's Hospital, NHS MFT, Manchester M13 9WL, UK
| | - P. Brownbill
- Maternal and Fetal Health Research Centre, School of Medical Sciences, University of Manchester, Manchester, UK
- MAHSC, St Mary's Hospital, NHS MFT, Manchester M13 9WL, UK
| | - M. Darrow
- SPT Labtech Ltd, Melbourn SG8 6HB, UK
| | - I. L. Chernyavsky
- Maternal and Fetal Health Research Centre, School of Medical Sciences, University of Manchester, Manchester, UK
- MAHSC, St Mary's Hospital, NHS MFT, Manchester M13 9WL, UK
- Department of Mathematics, University of Manchester, Manchester M13 9PL, UK
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3
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Khalil A, Sharp A, Cornforth C, Jackson R, Mousa H, Stock S, Harrold J, Turner MA, Kenny LC, Baker PN, Johnstone ED, Von Dadelszen P, Magee L, Papageorghiou AT, Alfirevic Z. Effect of sildenafil on maternal hemodynamics in pregnancies complicated by severe early-onset fetal growth restriction: planned subgroup analysis from a multicenter randomized placebo-controlled double-blind trial. Ultrasound Obstet Gynecol 2020; 55:198-209. [PMID: 31432556 DOI: 10.1002/uog.20851] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Revised: 07/07/2019] [Accepted: 08/09/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES Fetal growth restriction (FGR) is associated with maternal cardiovascular changes. Sildenafil, a phosphodiesterase type-5 inhibitor, potentiates the actions of nitric oxide, and it has been suggested that it alters maternal hemodynamics, potentially improving placental perfusion. Recently, the Dutch STRIDER trial was stopped prematurely owing to excess neonatal mortality secondary to pulmonary hypertension. The main aim of this study was to investigate the effect of sildenafil on maternal hemodynamics in pregnancies with severe early-onset FGR. METHODS This was a cardiovascular substudy within a UK multicenter, placebo-controlled trial, in which 135 women with a singleton pregnancy and severe early-onset FGR (defined as a combination of estimated fetal weight or abdominal circumference below the 10th centile and absent/reversed end-diastolic flow in the umbilical artery on Doppler velocimetry, diagnosed between 22 + 0 and 29 + 6 weeks' gestation) were assigned randomly to receive either 25 mg sildenafil three times daily or placebo until 32 + 0 weeks' gestation or delivery. Maternal blood pressure (BP), heart rate (HR), augmentation index, pulse wave velocity (PWV), cardiac output, stroke volume (SV) and total peripheral resistance were recorded before randomization, 1-2 h and 48-72 h post-randomization, and 24-48 h postnatally. For continuous data, analysis was performed using repeated measures ANOVA methods including terms for timepoint, treatment allocation and their interaction. RESULTS Included were 134 women assigned randomly to sildenafil (n = 69) or placebo (n = 65) who had maternal BP and HR recorded at baseline. At 1-2 h post-randomization, compared with baseline values, sildenafil increased maternal HR by 4 bpm more than did placebo (mean difference, 5.00 bpm (95% CI, 1.00-12.00 bpm) vs 1.25 bpm (95% CI, -5.38 to 7.88 bpm); P = 0.004) and reduced systolic BP by 1 mmHg more (mean difference, -4.13 mmHg (95% CI, -9.94 to 1.44 mmHg) vs -2.75 mmHg (95% CI, -7.50 to 5.25 mmHg); P = 0.048). Even after adjusting for maternal mean arterial pressure, sildenafil reduced aortic PWV by 0.60 m/s more than did placebo (mean difference, -0.90 m/s (95% CI, -1.31 to -0.51 m/s) vs -0.26 m/s (95% CI, -0.75 to 0.59 m/s); P = 0.001). Sildenafil was associated with a non-significantly greater decrease in SV index after 1-2 h post-randomization than was placebo (mean difference, -5.50 mL/m2 (95% CI, -11.00 to -0.50 mL/m2 ) vs 0.00 mL/m2 (95% CI, -5.00 to 4.00 mL/m2 ); P = 0.056). CONCLUSIONS Sildenafil in a dose of 25 mg three times daily increases HR, reduces BP and reduces arterial stiffness in pregnancies complicated by severe early-onset FGR. These changes are short term, modest and consistent with the anticipated vasodilatory effect. They have no short- or long-term clinical impact on the mother. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- 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
| | - A Sharp
- Department of Women's and Children's Health, University of Liverpool, Liverpool, UK
| | - C Cornforth
- Liverpool Clinical Trials Unit, University of Liverpool, Liverpool, UK
| | - R Jackson
- Liverpool Clinical Trials Unit, University of Liverpool, Liverpool, UK
| | - H Mousa
- Fetal Medicine Unit, University of Leicester, Leicester, UK
| | - S Stock
- The Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - J Harrold
- Liverpool Clinical Trials Unit, University of Liverpool, Liverpool, UK
| | - M A Turner
- Department of Women's and Children's Health, University of Liverpool, Liverpool, UK
| | - L C Kenny
- Department of Women's and Children's Health, University of Liverpool, Liverpool, UK
| | - P N Baker
- College of Life Sciences, University of Leicester, Leicester, UK
| | - E D Johnstone
- Maternal & Fetal Health Research Centre, University of Manchester, Manchester, UK
| | - P Von Dadelszen
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK
| | - L Magee
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK
| | - A T Papageorghiou
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, University of London, London, UK
| | - Z Alfirevic
- Department of Women's and Children's Health, University of Liverpool, Liverpool, UK
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Panitchob N, Widdows KL, Crocker IP, Johnstone ED, Please CP, Sibley CP, Glazier JD, Lewis RM, Sengers BG. Computational modelling of placental amino acid transfer as an integrated system. Biochim Biophys Acta 2016; 1858:1451-61. [PMID: 27045077 PMCID: PMC4884669 DOI: 10.1016/j.bbamem.2016.03.028] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 03/22/2016] [Accepted: 03/31/2016] [Indexed: 01/31/2023]
Abstract
Placental amino acid transfer is essential for fetal development and its impairment is associated with poor fetal growth. Amino acid transfer is mediated by a broad array of specific plasma membrane transporters with overlapping substrate specificity. However, it is not fully understood how these different transporters work together to mediate net flux across the placenta. Therefore the aim of this study was to develop a new computational model to describe how human placental amino acid transfer functions as an integrated system. Amino acid transfer from mother to fetus requires transport across the two plasma membranes of the placental syncytiotrophoblast, each of which contains a distinct complement of transporter proteins. A compartmental modelling approach was combined with a carrier based modelling framework to represent the kinetics of the individual accumulative, exchange and facilitative classes of transporters on each plasma membrane. The model successfully captured the principal features of transplacental transfer. Modelling results clearly demonstrate how modulating transporter activity and conditions such as phenylketonuria, can increase the transfer of certain groups of amino acids, but that this comes at the cost of decreasing the transfer of others, which has implications for developing clinical treatment options in the placenta and other transporting epithelia. First computational model of placental amino acid transfer as an integrated system Increased activity of a transporter does not mean increased transfer to the fetus. Increasing transfer of certain amino acids can reduce the transfer of others. Amino acid composition as well as concentration determines transfer to the fetus. Modelling of phenylketonuria suggests inhibition by excess maternal phenylalanine.
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Affiliation(s)
- N Panitchob
- Bioengineering Science Research Group, Faculty of Engineering and the Environment, University of Southampton, UK
| | - K L Widdows
- Maternal & Fetal Health Research Centre, Institute of Human Development, University of Manchester, UK; St. Mary's Hospital & Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, UK
| | - I P Crocker
- Maternal & Fetal Health Research Centre, Institute of Human Development, University of Manchester, UK; St. Mary's Hospital & Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, UK
| | - E D Johnstone
- Maternal & Fetal Health Research Centre, Institute of Human Development, University of Manchester, UK; St. Mary's Hospital & Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, UK
| | - C P Please
- Mathematical Institute, Oxford University, Oxford, UK
| | - C P Sibley
- Maternal & Fetal Health Research Centre, Institute of Human Development, University of Manchester, UK; St. Mary's Hospital & Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, UK
| | - J D Glazier
- Maternal & Fetal Health Research Centre, Institute of Human Development, University of Manchester, UK; St. Mary's Hospital & Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, UK
| | - R M Lewis
- Faculty of Medicine, University of Southampton, UK; Institute for Life Sciences, University of Southampton, UK
| | - B G Sengers
- Bioengineering Science Research Group, Faculty of Engineering and the Environment, University of Southampton, UK; Institute for Life Sciences, University of Southampton, UK.
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Papageorghiou AT, Khalil A, Forman M, Hulme R, Mazey R, Mousa HA, Johnstone ED, McKelvey A, Cohen KE, Risley M, Denman W, Kelly B. Clinical evaluation of the IONA test: a non-invasive prenatal screening test for trisomies 21, 18 and 13. Ultrasound Obstet Gynecol 2016; 47:188-193. [PMID: 26493543 PMCID: PMC5064629 DOI: 10.1002/uog.15791] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [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: 05/22/2015] [Revised: 10/08/2015] [Accepted: 10/13/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To evaluate the clinical accuracy of the IONA® test for aneuploidy screening. METHODS This was a multicenter blinded study in which plasma samples from pregnant women at increased risk of trisomy 21 underwent cell-free DNA analysis utilizing the IONA test. For each sample, the IONA software generated a likelihood ratio and a maternal age-adjusted probability risk score for trisomies 21, 18 and 13. All results from the IONA test were compared against accepted diagnostic karyotyping. RESULTS A total of 442 maternal samples were obtained, of which 437 had test results available for analysis and assessment of clinical accuracy. The IONA test had a detection rate of 100% for trisomies 21 (n = 43; 95% CI, 87.98-100%), 18 (n = 10; 95% CI, 58.72-100%) and 13 (n = 5; 95% CI, 35.88-100%) with cut-offs applied to likelihood ratio (cut-off > 1 considered high risk for trisomy) and probability risk score incorporating adjustment for maternal age (cut-off ≥ 1/150 considered high risk for trisomy). The false-positive rate (FPR) was 0% for trisomies 18 and 13 with both analysis outputs. For trisomy 21, a FPR of 0.3% was observed for the likelihood ratio, but became 0% with adjustment for maternal age. CONCLUSION This study indicates that the IONA test is suitable for trisomy screening in a high-risk screening population. The result-interpretation feature of the IONA software should facilitate wider implementation, particularly in local laboratories, and should be a useful addition to the current screening methods for trisomies 21, 18 and 13.
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Affiliation(s)
- A. T. Papageorghiou
- Fetal Medicine UnitSt George's University Foundation Hospitals NHS TrustLondonUK
- Nuffield Department of Obstetrics and GynaecologyJohn Radcliffe HospitalOxfordUK
| | - A. Khalil
- Fetal Medicine UnitSt George's University Foundation Hospitals NHS TrustLondonUK
| | | | - R. Hulme
- Premaitha Health plcManchesterUK
| | - R. Mazey
- Premaitha Health plcManchesterUK
| | - H. A. Mousa
- Department of Fetal and Maternal MedicineLeicester Royal InfirmaryLeicesterUK
| | - E. D. Johnstone
- Tommy's Research CentreCentral Manchester Foundation TrustManchesterUK
| | - A. McKelvey
- Fetal Medicine UnitNorfolk and Norwich University Hospitals Foundation TrustNorwichUK
| | - K. E. Cohen
- Department of Fetal MedicineLeeds General InfirmaryLeedsUK
| | | | | | - B. Kelly
- Nuffield Department of Obstetrics and GynaecologyJohn Radcliffe HospitalOxfordUK
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Lofthouse EM, Perazzolo S, Brooks S, Crocker IP, Glazier JD, Johnstone ED, Panitchob N, Sibley CP, Widdows KL, Sengers BG, Lewis RM. Phenylalanine transfer across the isolated perfused human placenta: an experimental and modeling investigation. Am J Physiol Regul Integr Comp Physiol 2015; 310:R828-36. [PMID: 26676251 PMCID: PMC5000773 DOI: 10.1152/ajpregu.00405.2015] [Citation(s) in RCA: 14] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Accepted: 12/13/2015] [Indexed: 12/15/2022]
Abstract
Membrane transporters are considered essential for placental amino acid transfer, but the contribution of other factors, such as blood flow and metabolism, is poorly defined. In this study we combine experimental and modeling approaches to understand the determinants of [(14)C]phenylalanine transfer across the isolated perfused human placenta. Transfer of [(14)C]phenylalanine across the isolated perfused human placenta was determined at different maternal and fetal flow rates. Maternal flow rate was set at 10, 14, and 18 ml/min for 1 h each. At each maternal flow rate, fetal flow rates were set at 3, 6, and 9 ml/min for 20 min each. Appearance of [(14)C]phenylalanine was measured in the maternal and fetal venous exudates. Computational modeling of phenylalanine transfer was undertaken to allow comparison of the experimental data with predicted phenylalanine uptake and transfer under different initial assumptions. Placental uptake (mol/min) of [(14)C]phenylalanine increased with maternal, but not fetal, flow. Delivery (mol/min) of [(14)C]phenylalanine to the fetal circulation was not associated with fetal or maternal flow. The absence of a relationship between placental phenylalanine uptake and net flux of phenylalanine to the fetal circulation suggests that factors other than flow or transporter-mediated uptake are important determinants of phenylalanine transfer. These observations could be explained by tight regulation of free amino acid levels within the placenta or properties of the facilitated transporters mediating phenylalanine transport. We suggest that amino acid metabolism, primarily incorporation into protein, is controlling free amino acid levels and, thus, placental transfer.
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Affiliation(s)
- E M Lofthouse
- Faculty of Medicine, University of Southampton, Southampton, United Kingdom; Institute for Life Sciences, University of Southampton, Southampton, United Kingdom
| | - S Perazzolo
- Bioengineering Science Research Group, Faculty of Engineering and the Environment, University of Southampton, Southampton, United Kingdom
| | - S Brooks
- Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - I P Crocker
- Maternal and Fetal Health Research Centre, Institute of Human Development, University of Manchester, and St. Mary's Hospital and Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom; and
| | - J D Glazier
- Maternal and Fetal Health Research Centre, Institute of Human Development, University of Manchester, and St. Mary's Hospital and Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom; and
| | - E D Johnstone
- Maternal and Fetal Health Research Centre, Institute of Human Development, University of Manchester, and St. Mary's Hospital and Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom; and
| | - N Panitchob
- Bioengineering Science Research Group, Faculty of Engineering and the Environment, University of Southampton, Southampton, United Kingdom
| | - C P Sibley
- Maternal and Fetal Health Research Centre, Institute of Human Development, University of Manchester, and St. Mary's Hospital and Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom; and
| | - K L Widdows
- Maternal and Fetal Health Research Centre, Institute of Human Development, University of Manchester, and St. Mary's Hospital and Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom; and
| | - B G Sengers
- Bioengineering Science Research Group, Faculty of Engineering and the Environment, University of Southampton, Southampton, United Kingdom; Institute for Life Sciences, University of Southampton, Southampton, United Kingdom
| | - R M Lewis
- Faculty of Medicine, University of Southampton, Southampton, United Kingdom; Institute for Life Sciences, University of Southampton, Southampton, United Kingdom
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Huen I, Morris DM, Wright C, Sibley CP, Naish JH, Johnstone ED. Absence ofPo2change in fetal brain despitePo2increase in placenta in response to maternal oxygen challenge. BJOG 2014; 121:1588-94. [PMID: 24816043 DOI: 10.1111/1471-0528.12804] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2013] [Indexed: 12/31/2022]
Affiliation(s)
- I Huen
- Centre for Imaging Sciences, University of Manchester, Manchester, UK; The University of Manchester Biomedical Imaging Institute, University of Manchester, Manchester, UK
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Johnstone ED, Jones EA. Ultrasound presentation of Pallister-Killian syndrome with a prominent sacral appendage. Ultrasound Obstet Gynecol 2012; 40:239-241. [PMID: 22253116 DOI: 10.1002/uog.11100] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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Acharya G, Albrecht C, Benton SJ, Cotechini T, Dechend R, Dilworth MR, Duttaroy AK, Grotmol T, Heazell AE, Jansson T, Johnstone ED, Jones HN, Jones RL, Lager S, Laine K, Nagirnaja L, Nystad M, Powell T, Redman C, Sadovsky Y, Sibley C, Troisi R, Wadsack C, Westwood M, Lash GE. IFPA Meeting 2011 workshop report I: Placenta: Predicting future health; roles of lipids in the growth and development of feto-placental unit; placental nutrient sensing; placental research to solve clinical problems--a translational approach. Placenta 2011; 33 Suppl:S4-8. [PMID: 22154691 DOI: 10.1016/j.placenta.2011.11.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2011] [Revised: 11/17/2011] [Accepted: 11/18/2011] [Indexed: 10/14/2022]
Abstract
Workshops are an important part of the IFPA annual meeting as they allow for discussion of specialized topics. At IFPA meeting 2011 there were twelve themed workshops, four of which are summarized in this report. These workshops related to both basic science and clinical research into placental growth and nutrient sensing and were divided into 1) placenta: predicting future health; 2) roles of lipids in the growth and development of feto-placental unit; 3) placental nutrient sensing; 4) placental research to solve clinical problems: a translational approach.
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Affiliation(s)
- G Acharya
- Women's Health & Perinatology Research Group, Department of Clinical Medicine, Faculty of Health Sciences, University of Tromsø, Tromsø, Norway
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Johnstone ED, Speake PF, Sibley CP. Epidermal growth factor and sphingosine-1-phosphate stimulate Na+/H+ exchanger activity in the human placental syncytiotrophoblast. Am J Physiol Regul Integr Comp Physiol 2007; 293:R2290-4. [PMID: 17913870 DOI: 10.1152/ajpregu.00328.2007] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The Na+/H+ exchanger (NHE) has a key role in intracellular pH ([pH]i) regulation of the syncytiotrophoblast in the human placenta and may have a role in the life cycle of this cell. In other cells the NHE (actually a family of up to 9 isoforms) is regulated by a variety of factors, but its regulation in the syncytiotrophoblast has not been studied. Here, we tested the hypotheses that EGF and sphingosine-1-phosphate (S1P), both of which affect trophoblast apoptosis and, in other cell types, NHE activity, stimulate syncytiotrophoblast NHE activity. Villous fragments from term human placentas were loaded with the pH-sensitive dye, BCECF. NHE activity was measured by following the recovery of syncytiotrophoblast [pH]i following an imposed acid load, in the presence and absence of EGF, S1P, and specific inhibitors of NHE activity. Both EGF and S1P caused a dose-dependent upregulation of NHE activity in the syncytiotrophoblast. These effects were blocked by amiloride 500 microM (a nonspecific NHE blocker) and HOE694 100 microM (NHE blocker with NHE1 and 2 isoform selectivity). Effects of EGF were also reduced by the NHE3 selective blocker S3226 (used at 1 microM). These data provide the first evidence that both EGF and S1P stimulate NHE activity in the syncytiotrophoblast; they appear to do so predominantly by activating the NHE1 isoform.
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Affiliation(s)
- E D Johnstone
- Maternal and Fetal Health Research Group, (Academic Unit of Child Health Univ. of Manchester, St. Mary's Hospital, Manchester M13 OJH
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Johnstone ED, Mackova M, Das S, Payne SG, Lowen B, Sibley CP, Chan G, Guilbert LJ. Multiple anti-apoptotic pathways stimulated by EGF in cytotrophoblasts. Placenta 2005; 26:548-55. [PMID: 15993704 DOI: 10.1016/j.placenta.2004.08.012] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [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] [Accepted: 08/24/2004] [Indexed: 10/26/2022]
Abstract
Epidermal growth factor (EGF) reduces apoptosis in primary cytotrophoblast (CT) in culture through two separate pathways: the extracellular signal related kinase (ERK) 1/2 and phosphatidyl inositol 3-kinase (PI-3 kinase) paths. Whether other pathways are involved in survival signalling is unknown. We here show that the c-Jun NH2 terminal kinase (JNK) and the mitogen activated kinase (MAPK) p38 are also activated by EGF as seen by increases in JNK and p38 phosphorylation. However, inhibition of JNK phosphorylation with the specific inhibitor SP600125 increases apoptosis in a manner refractory to the addition of EGF but inhibition of p38 phosphorylation with its specific inhibitor SB 203580 does not increase apoptosis. EGF also activates sphingosine kinase-1 (SPHK-1), which converts sphingosine to sphingosine-1-phosphate, and its inhibition with dimethyl sphingosine (DMS) increased trophoblast death. Inhibition of SPHK-1 also did not affect EGF stimulated phosphorylation of PI-3 kinase, Akt, ERK1/2 or p38 but inhibition of PI-3 kinase with a specific inhibitor LY294002 partly (40%) inhibited the EGF-stimulated increase in SPHK-1 activity. We conclude that, in addition to the PI-3 kinase and ERK1/2 pathways, EGF acts through its receptor to stimulate JNK, p38 and SPHK-1 pathways, but that the JNK and SPHK-1, and not the p38, pathways are involved in suppressing apoptosis. This information provides evidence that EGF stimulates survival along multiple pathways that differ in trophoblast and other cell types.
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Affiliation(s)
- E D Johnstone
- Department of Medical Microbiology and Immunology, and the University of Alberta Perinatal Research Centre, Edmonton, Alberta, Canada
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