Comparative pathogenomic analysis reveals a highly tetanus toxin-producing clade of Clostridium tetani isolates in Japan

IMPORTANCE

C. tetani is a spore-forming, anaerobic bacterium that produces a toxin causing muscle stiffness and paralysis. Tetanus is preventable with the toxoid vaccine, but it remains a significant public health threat in regions with low vaccine coverage. However, there are relatively few isolates and limited genomic information available worldwide. In Japan, about 100 cases are reported each year, but there have been no nationwide surveys of isolates, and no genomic information from Japanese isolates has been published. In our study, we analyzed the genomes of 151 strains from a limited survey of soil in Kumamoto, Japan. Our findings revealed a high degree of genetic diversity, and we also identified a subset of strains that produced significantly more toxin, which provides new insights into the pathogenesis of tetanus. Our findings lay the foundation for future studies to investigate the distribution and evolution of C. tetani in Japan and neighboring countries.

SARS-CoV-2 intra-host diversity, antibody response, and disease severity after reinfection by the variant of concern Gamma in Brazil

The rapid spread of the SARS-CoV-2 Variant of Concern (VOC) Gamma in Amazonas during early 2021 fueled a second large COVID-19 epidemic wave and raised concern about the potential role of reinfections. Very few cases of reinfection associated with the VOC Gamma have been reported to date, and their potential impact on clinical, immunological, and virological parameters remains largely unexplored. Here we describe 25 cases of SARS-CoV-2 reinfection in Brazil. SARS-CoV-2 genomic analysis confirmed that individuals were primo-infected with distinct viral lineages between March and December 2020 (B.1.1, B.1.1.28, B.1.1.33, B.1.195, and P.2) and reinfected with the VOC Gamma between 3 to 12 months after primo-infection. We found a similar mean cycle threshold (Ct) value and limited intra-host viral diversity in both primo-infection and reinfection samples. Sera of 14 patients tested 10-75 days after reinfection displayed detectable neutralizing antibodies (NAb) titers against SARS-CoV-2 variants that circulated before (B.1.*), during (Gamma), and after (Delta and Omicron) the second epidemic wave in Brazil. All individuals had milder or no symptoms after reinfection, and none required hospitalization. These findings demonstrate that individuals reinfected with the VOC Gamma may display relatively high RNA viral loads at the upper respiratory tract after reinfection, thus contributing to onward viral transmissions. Despite this, our study points to a low overall risk of severe Gamma reinfections, supporting that the abrupt increase in hospital admissions and deaths observed in Amazonas and other Brazilian states during the Gamma wave was mostly driven by primary infections. Our findings also indicate that most individuals analyzed developed a high anti-SARS-CoV-2 NAb response after reinfection that may provide some protection against reinfection or disease by different SARS-CoV-2 variants.

Comprehensive Genome and Plasmidome Analysis of Antimicrobial Resistant Bacteria in Wastewater Treatment Plant Effluent of Tokyo

To characterize environmental antimicrobial resistance (AMR) in urban areas, extended-spectrum β-lactamase- (ESBL)/carbapenemase-producing bacteria (EPB/CPB, respectively) from urban wastewater treatment plant effluents in Tokyo were isolated on CHROMagar ESBL plate. Complete genome sequence analysis, including plasmids, indicated that 126 CTX-M-positive isolates (31%) were identified among the 404 obtained isolates. The CTX-M-9 group was predominant (n = 65, 52%), followed by the CTX-M-1 group (n = 44, 35%). Comparative genome analysis revealed that CTX-M-27-positive E. coli O16:H5-ST131-fimH41 exhibited a stable genome structure and clonal-global dissemination. Plasmidome network analysis revealed that 304 complete plasmid sequences among 85 isolates were grouped into 14 incompatibility (Inc) network communities (Co1 to Co14). Co10 consisted of primarily IncFIA/IncFIB plasmids harboring bla_CTX-M in E. coli, whereas Co12 consisted primarily of IncFIA(HI1)/Inc FIB(K) plasmids harboring bla_CTX-M, bla_KPC, and bla_GES in Klebsiella spp. Co11 was markedly located around Co10 and Co12. Co11 exhibited bla_CTX-M, bla_KPC, and bla_NDM, and was mainly detected in E. coli and Klebsiella spp. from human and animal sources, suggesting a mutual role of Co11 in horizontal gene transfer between E. coli and Klebsiella spp. This comprehensive resistome analysis uncovers the mode of relational transfer among bacterial species, highlighting the potential source of AMR burden on public health in urban communities.

Metagenomic Analysis of Urban Wastewater Treatment Plant Effluents in Tokyo

Purpose

Urban wastewater treatment plant (WWTP) effluents, even with proper treatment, may cause antimicrobial resistance (AMR) burden, with a high frequency of acquired antimicrobial resistance genes (ARGs). The dissemination of ARGs into the environment increases the risk of infectious diseases; however, there is little direct evidence regarding their epidemiological effects. This study aimed to assess effluents from urban WWTPs around the Tama River and Tokyo Bay using metagenomic analysis of (AMR) genes (ARGs) and heavy-metal resistance genes.

Methods

Metagenomic DNA-seq analysis of water samples and resistome analysis were performed.

Results

The most prevalent ARG was the sulfonamide resistance gene, sul1, followed by the quaternary ammonium compound resistance gene, qacE, suggesting that basic gene sets (sul1 and ∆qacE) in the class 1 integrons are the predominant ARGs. The aminoglycoside resistance genes, aadA and aph, and macrolide resistance genes, msr(E) and mph(E), were the predominant ARGs against each antimicrobial. bla _OXA and bla _GES were frequently detected, whereas the bla _CTX-M cluster was faintly detected. Non-metric multidimensional scaling plot analysis and canonical correspondence analysis results suggested that marked differences in ARGs could be involved in the seasonal differences; qnrS2, aac(6')-Ib, and mef(C) increased markedly in summer, whereas msr(E) was more frequently detected in winter. Heavy-metal (Hg and Cu) resistance genes (HMRGs) were significantly detected in effluents from all WWTPs.

Conclusion

We characterized a baseline level of the environmental ARG/HMRG profile in the overall community, suggesting that environmental AMR surveillance, particularly in urban WWTPs, is a valuable first step in monitoring the AMR dissemination of bacteria from predominantly healthy individuals carrying notable ARG/Bs.

A discernable increase in the severe acute respiratory syndrome coronavirus 2 R.1 lineage carrying an E484K spike protein mutation in Japan

Three COVID-19 waves in Japan have been characterized by the presence of distinct PANGO lineages (B.1.1. 162, B.1.1.284, and B.1.1.214). Recently, in addition to the B.1.1.7 lineage, which shows 25% abundance, an R.1 lineage carrying the E484K mutation in the spike protein was found to show up to 40% predominance. E484K could be a pivotal amino acid substitution with the potential to mediate immune escape; thus, more attention should be paid to such potential variants of concern to avoid the emergence of mutants of concern. Such comprehensive real-time genome surveillance has become essential for the containment of COVID-19 clusters.

Identification of a mecA/mecC-positive MRSA ST1-t127 isolate from a racehorse in Japan

OBJECTIVES

MRSA is a known pathogen that affects horses. We investigated an equine MRSA isolate for potential antimicrobial resistance genes, classified the staphylococcal cassette chromosome mec (SCCmec) and identified the strain-specific dissemination in the horse community based on WGS.

METHODS

WGS, using short-read sequencing, and subsequent long-read sequencing by hybrid assembly, was conducted to obtain a complete genome sequence. Pairwise sequence alignment of relative SCCmec sequences and core-genome phylogenetic analysis were performed to highlight transmission routes of the SCCmec and MRSA strain-specific lineages.

RESULTS

In 2018, we isolated the MRSA JRA307 strain from the pus of a wound on a racehorse and the complete genome sequence suggests that it is a clinically relevant pvl-negative ST1-t127 MRSA that harbours both mecA and mecC on SCCmec-307. SCCmec-307 exhibited marked sequence identity to the previously reported SCCmec-mecC in the Staphylococcus sciuri GVGS2 strain isolated from cattle. The JRA307 mecC gene was classified as a mecC allotype of S. sciuri rather than that of Staphylococcus aureus.

CONCLUSIONS

We demonstrated the complete genome sequence of equine isolate JRA307, which is a clinically relevant MRSA harbouring mecA and mecC on SCCmec-307. The finding of mecC MRSA suggests a possible SCCmec transmission between distinct staphylococcal species. To the best of our knowledge, this is the first report of mecC detection in Japan.

Haplotype Explorer: an infection cluster visualization tool for spatiotemporal dissection of the COVID-19 pandemic

The worldwide eruption of coronavirus disease 2019 (COVID-19) that began in Wuhan, China in late 2019 reached 10 million cases by late June 2020. In order to understand the epidemiological landscape of the COVID-19 pandemic, many studies have attempted to elucidate phylogenetic relationships between collected viral genome sequences using haplotype networks. However, currently available applications for network visualization are not suited to understand the COVID-19 epidemic spatiotemporally due to functional limitations that motivated us to develop Haplotype Explorer, an intuitive tool for visualizing and exploring haplotype networks. Haplotype Explorer enables to dissect epidemiological consequences via interactive node filters and provides the perspective on infectious disease dynamics depend on regions and time, such as introduction, outbreak, expansion, and containment. Here, we demonstrate the effectiveness of Haplotype Explorer by showing features and an example of visualization. The demo using severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) genomes are available at https://github.com/TKSjp/HaplotypeExplorer/blob/master/Example/. There are several examples using SARS-CoV-2 genomes and Dengue virus serotype 1 E-genes sequence.

COVID-19 genome surveillance at international airport quarantine stations in Japan

A coronavirus disease (COVID-19) genome surveillance has been conducted at four international airports in Japan, revealing a potential imported COVID-19 risk from multiple countries. The quarantine surveillance based on genome sequencing can enhance sequencing efforts worldwide, as returning travelers may serve as excellent sentinels for the global pandemic.

A Genome Epidemiological Study of SARS-CoV-2 Introduction into Japan

After the first case of coronavirus disease 2019 (COVID-19) in Japan on 15 January 2020, multiple nationwide COVID-19 clusters were identified by the end of February. The Japanese government focused on mitigating the emerging COVID-19 clusters by conducting active nationwide epidemiological surveillance. However, an increasing number of cases continued to appear until early April 2020, many with unclear infection routes and no recent history of travel outside Japan. We aimed to evaluate the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) genome sequences from the COVID-19 cases that appeared until early April 2020 and to characterize their genealogical networks in order to demonstrate possible routes of spread in Japan. Nasopharyngeal specimens were collected from patients, and reverse transcription-quantitative PCR tests for SARS-CoV-2 were performed. Positive RNA samples were subjected to whole-genome sequencing, and a haplotype network analysis was performed. Some of the primary clusters identified during January and February 2020 in Japan descended directly from the Wuhan-Hu-1-related isolates from China and other distinct clusters. Clusters were almost contained until mid-March; the haplotype network analysis demonstrated that the COVID-19 cases from late March through early April may have created an additional large cluster related to the outbreak in Europe, leading to additional spread within Japan. In conclusion, genome surveillance has suggested that there were at least two distinct SARS-CoV-2 introductions into Japan from China and other countries.IMPORTANCE This study aimed to evaluate the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) genome sequences from COVID-19 cases and to characterize their genealogical networks to demonstrate possible routes of spread in Japan. We found that there were at least two distinct SARS-CoV-2 introductions into Japan, initially from China and subsequently from other countries, including Europe. Our findings can help understand how SARS-CoV-2 entered Japan and contribute to increased knowledge of SARS-CoV-2 in Asia and its association with implemented stay-at-home/shelter-in-place/self-restraint/lockdown measures. This study suggested that it is necessary to formulate a more efficient containment strategy using real-time genome surveillance to support epidemiological field investigations in order to highlight potential infection linkages and mitigate the next wave of COVID-19 in Japan.

Disentangling primer interactions improves SARS-CoV-2 genome sequencing by multiplex tiling PCR

Since December 2019, the coronavirus disease 2019 (COVID-19) caused by a novel coronavirus SARS-CoV-2 has rapidly spread to almost every nation in the world. Soon after the pandemic was recognized by epidemiologists, a group of biologists comprising the ARTIC Network, has devised a multiplexed polymerase chain reaction (PCR) protocol and primer set for targeted whole-genome amplification of SARS-CoV-2. The ARTIC primer set amplifies 98 amplicons, which are separated only in two PCRs, across a nearly entire viral genome. The original primer set and protocol showed a fairly small amplification bias when clinical samples with relatively high viral loads were used. However, as sample's viral load become low, rapid decrease in abundances of several amplicons were seen. In this report, we will show that dimer formations between some primers are the major cause of coverage bias in the multiplex PCR. Based on this, we propose 12 alternative primers in total in the ARTIC primer set that were predicted to be involved in 14 primer interactions. The resulting primer set, version N1 (NIID-1), exhibits improved overall coverage compared to the ARTIC Network's original (V1) and modified (V3) primer set.

Neurogenic pulmonary edema following febrile status epilepticus in a 22-month-old infant with multiple respiratory virus co-detection: a case report

BACKGROUND

Neurogenic pulmonary edema is a rare but serious complication of febrile status epilepticus in children. Comprehensive screening for viral pathogens is seldomly performed in the work-up of febrile children.

CASE PRESENTATION

A 22-month-old girl presented with her first episode of febrile status epilepticus, after which she developed acute pulmonary edema and respiratory failure. After the termination of seizure activity, the patient was intubated and managed on mechanical ventilation in the emergency room. The resolution of respiratory failure, as well as the neurological recovery, was achieved 9 h after admission, and the patient was discharged 6 days after admission without any complications. Molecular biological diagnostic methods identified the presence of human coronavirus HKU1, influenza C virus, and human parainfluenza virus 2 from the patient's nasopharyngeal specimens.

CONCLUSIONS

Neurogenic pulmonary edema following febrile status epilepticus was suspected to be the etiology of our patient's acute pulmonary edema and respiratory failure. Timely seizure termination and rapid airway and respiratory intervention resulted in favorable outcomes of the patient. Molecular biological diagnostic methods identified three respiratory viruses; however, their relevance and association with clinical symptoms remain speculative.

Potential KPC-2 carbapenemase reservoir of environmental Aeromonas hydrophila and Aeromonas caviae isolates from the effluent of an urban wastewater treatment plant in Japan

Aeromonas hydrophila and Aeromonas caviae adapt to saline water environments and are the most predominant Aeromonas species isolated from estuaries. Here, we isolated antimicrobial-resistant (AMR) Aeromonas strains (A. hydrophila GSH8-2 and A. caviae GSH8M-1) carrying the carabapenemase bla_KPC-2 gene from a wastewater treatment plant (WWTP) effluent in Tokyo Bay (Japan) and determined their complete genome sequences. GSH8-2 and GSH8M-1 were classified as newly assigned sequence types ST558 and ST13, suggesting no supportive evidence of clonal dissemination. The strains appear to have acquired bla_KPC-2 -positive IncP-6-relative plasmids (pGSH8-2 and pGSH8M-1-2) that share a common backbone with plasmids in Aeromonas sp. ASNIH3 isolated from hospital wastewater in the United States, A. hydrophila WCHAH045096 isolated from sewage in China, other clinical isolates (Klebsiella, Enterobacter and Escherichia coli), and wastewater isolates (Citrobacter, Pseudomonas and other Aeromonas spp.). In addition to bla_KPC-2 , pGSH8M-1-2 carries an IS26-mediated composite transposon including a macrolide resistance gene, mph(A). Although Aeromonas species are opportunistic pathogens, they could serve as potential environmental reservoir bacteria for carbapenemase and AMR genes. AMR monitoring from WWTP effluents will contribute to the detection of ongoing AMR dissemination in the environment and might provide an early warning of potential dissemination in clinical settings and communities.

Streptococcal toxic shock syndrome caused by the dissemination of an invasive emm3/ST15 strain of Streptococcus pyogenes

BACKGROUND

Streptococcus pyogenes (group A Streptococcus [GAS]) is a major human pathogen that causes a wide spectrum of clinical manifestations. Although invasive GAS (iGAS) infections are relatively uncommon, emm3/ST15 GAS is a highly virulent, invasive, and pathogenic strain. Global molecular epidemiology analysis has suggested that the frequency of emm3 GAS has been recently increasing.

CASE PRESENTATION

A 14-year-old patient was diagnosed with streptococcal toxic shock syndrome and severe pneumonia, impaired renal function, and rhabdomyolysis. GAS was isolated from a culture of endotracheal aspirates and designated as KS030. Comparative genome analysis suggested that KS030 is classified as emm3 (emm-type) and ST15 (multilocus sequencing typing [MLST]), which is similar to iGAS isolates identified in the UK (2013) and Switzerland (2015).

CONCLUSIONS

We conclude that the global dissemination of emm3/ST15 GAS strain has the potential to cause invasive disease.

Rapid and affordable size-selected PacBio single-molecule real-time sequencing template library construction using the bead-beating DNA extraction method

This study demonstrated that bead-beating method facilitates a simple and rapid protocol for genomic DNA isolation for Pacific BioSciences (PacBio) sequencing with library construction of sufficient length. The protocol may also be beneficial for inactivating pathogens by simultaneous and instant DNA fragmentation, with no special equipment required to obtain large DNA fragments. This protocol was comparable in terms of quality to the standard protocol suggested by PacBio and represents an alternative, rapid shortcut for performing accurate PacBio sequencing.

Contribution of methionine sulfoxide reductase B (MsrB) to Francisella tularensis infection in mice

The essential mechanisms and virulence factors enabling Francisella species to replicate inside host macrophages are not fully understood. Methionine sulfoxide reductase (Msr) is an antioxidant enzyme that converts oxidized methionine into methionine. Francisella tularensis carries msrA and msrB in different parts of its chromosome. In this study, single and double mutants of msrA and msrB were constructed, and the characteristics of these mutants were investigated. The msrB mutant exhibited decreased in vitro growth, exogenous oxidative stress resistance and intracellular growth in macrophages, whereas the msrA mutant displayed little difference with wild-type strain. The double mutant exhibited the same characteristics as the msrB mutant. The bacterial count of the msrB mutant was significantly lower than that of the wild-type strain in the liver and spleen of mice. The bacterial count of the msrA mutant was lower than that of the wild-type strain in the liver, but not in the spleen, of mice. These results suggest that MsrB has an important role in the intracellular replication of F. tularensis in macrophages and infection in mice.

Detection of Francisella tularensis and analysis of bacterial growth in ticks in Japan

Francisella tularensis is distributed in the Northern hemisphere and it is the bacterial agent responsible for tularaemia, a zoonotic disease. We collected 4 527 samples of DNA from ticks in Japan, which were then analysed by real-time PCR and nested PCR. Francisella DNA was detected by real-time PCR in 2·15% (45/2 093) of Ixodes ovatus, 0·66% (14/2 107) of I. persulcatus, 8·22% (6/73) of I. monospinosus and 0·72% (1/138) of Haemaphysalis flava specimens. Finally, Francisella DNA was detected by nested PCR in 42 and five samples I. ovatus and I. persulcatus, respectively, which were positive according to real-time PCR. Phylogenetic analysis showed that the sequence from I. ovatus and I. persulcatus were clustered with F. tularensis type B strains distributed in Eurasia. Microinjected live F. tularensis persisted in ticks, whereas heat-killed F. tularensis decreased. Microinjected F. tularensis hlyD mutant decreased in ticks significantly compared to parent strain, thereby suggesting that HlyD in F. tularensis contributes to the adaptation or survive of bacterial infection in ticks.

SIGNIFICANCE AND IMPACTS OF THE STUDY

Francisella tularensis has been detected in ticks, suggesting that it is a tick-borne pathogen. However, F. tularensis has not been detected in ticks in Japan since 1991. In this study, we performed a large-scale analysis of DNA isolated from ticks in Japan and detected F. tularensis by real-time polymerase chain reaction (PCR) and nested PCR. We found that F. tularensis could survive in ticks based on an experimental tick-infection model. We also identified a bacterial factor that contributes to survival in ticks. Our results suggest that ticks are candidate vectors that mediate F. tularensis infection in Japan.

Inactivation of the MAPK signaling pathway by Listeria monocytogenes infection promotes trophoblast giant cell death

Listeria monocytogenes has a well-characterized ability to cross the placental barrier, resulting in spontaneous abortion and fetal infections. However, the mechanisms resulting in infection-associated abortion are not fully understood. In this study, we demonstrate that the dephosphorylation of MAPK family proteins caused by L. monocytogenes infection of trophoblast giant (TG) cells, which are placental immune cells, contributes to infectious abortion. Dephosphorylation of c-Jun, p38, and ERK1/2 was observed in infected TG cells, causing the downregulation of cytoprotective heme oxygenase (HO)-1. Blocking the dephosphorylation of proteins, including MAPK family proteins, inhibited the decrease in HO-1 expression. Treatment with MAPK inhibitors inhibited bacterial internalization into TG cells. Moreover, Toll-like receptor 2 involved in the expression of MAPK family proteins. Infection with a listeriolysin O-deleted mutant impaired dephosphorylation of MAPK family proteins in TG cells and did not induce infectious abortion in a mouse model. These results suggest that inactivation of the MAPK pathway by L. monocytogenes induces TG cell death and causes infectious abortion.

Mannose receptor, C type 1 contributes to bacterial uptake by placental trophoblast giant cells

During pregnancy, maternal immune function is strictly controlled and immune tolerance is induced. Trophoblast giant (TG) cells exhibit phagocytic activity and show macrophage-like activity against microorganisms in the placenta. However, details of molecular receptors and mechanisms for uptake by TG cells have not been clarified. In this study, we investigated the involvement of the mannose receptor, C type 1 (MRC1), in the uptake of the abortion-inducible bacterium Listeria monocytogenes and abortion-uninducible bacteria Bacillus subtilis and Escherichia coli by TG cells differentiated from a mouse trophoblast stem cell line in vitro. Knockdown of MRC1 inhibited the uptake of all of these bacteria, as did the blocking of MRC1 by MRC1 ligands. The uptake of bacteria by MRC1 delayed the maturation of phagolysosomes. These findings suggest that MRC1 plays an important role in the uptake of various bacteria by TG cells and may provide an opportunity for those bacteria to escape from phagosomes.

Vertical transmission of Brucella abortus causes sterility in pregnant mice

The mechanisms of abortion and sterility induced by bacterial infection are largely unknown. In the present study, we found that Brucella abortus, a causative agent of brucellosis and facultative intracellular pathogen, caused sterility in pregnant mice. We have recently established a mouse model for abortion induced by B. abortus infection and high rates of abortion are observed for bacterial infection on day 4.5 of gestation, but not for other days. Infected newborn (first generation) mice showed poor growth compared with uninfected newborn mice and bacterial replication in the spleen of the former was observed over a long period. When infected first generation female mice were mated to infected first generation male mice, the number of fetuses was significantly less than that in uninfected first generation mice. These infected second generation mice also showed poor growth. These results suggest that vertical transmission of B. abostus causes sterility in pregnant mice and our mouse model would be useful for the investigating of brucellosis.

[Changes in the values of estrogen stimulated neurophysin, oxytocin and prostaglandin in the maternal blood after the administration of dehydroepiandrosterone-sulfate to the pregnant women near term]

In order to examine the effect of dehydroepiandrosterone-sulfate (DHA-S) on the production of uterus-contractive substances in perinatal women, the concentrations of estrogen stimulated neurophysin (ESN), oxytocin, 13, 14-dihydro-15-keto-Prostaglandin F2 alpha(PGF2 alpha) and DHA-S related steroids in the maternal blood of 12 cases of primigravida were serially estimated after intravenous administration of 200mg DHA-S twice a week from 38 weeks of gestation till the onset of labor.

RESULTS

1) The duration of labor was significantly shortened in the DHA-S group (mean; 9.3 +/- 2.8 hours) compared to the 11 control cases (13.5 +/- 5.2 hours). 2) i) The ESN concentration, which correlated well with that of free estradiol-17 beta, increased significantly at 1 week after the Ist administration. ii) The oxytocin concentration, which correlated well with that of ESN, increased significantly at 39 weeks of gestation, the first stage of labor and especially at delivery compared to the control. iii) The PGF2 alpha concentration, which increased in parallel with those of DHA-S, estrone-S and pregnenolone-S, increased significantly at delivery in comparison with the control and correlated well with estrone-S in the DHA-S group.

CONCLUSION

These findings suggest that DHA-S administration to perinatal women may enhance the production of ESN, oxytocin and PGF2 alpha in the fetoplacento-maternal compartment, which may result in the shortening of labor.

[19-Hydroxyandrostenedione in human ovarian vein measured by GC-MS]

Nineteen-hydroxyandrostenedione (19-OHA) is considered to be an obligatory intermediate of estrogen synthesis. To clarify the role of 19-OHA in the human ovary, the following experiments were undertaken. Ovarian and peripheral vein blood in mid follicular and luteal phase were obtained from 14 women during gynecological surgery. The concentrations of androstenedione (A), testosterone (T), 19-OHA, estrone (E1) and estradiol (E2) were measured by gas chromatography mass spectrometry using deuterium-labeled steroids as internal standard. The effect of human chorionic gonadotropin (hCG) on those steroids was also studied in mid luteal phase. The concentrations of 19-OHA in ovarian vein were 1.20 +/- 0.16 ng/ml (mean +/- SE) in mid follicular and 0.78 +/- 0.18 ng/ml in mid luteal phase. The steroid levels measured in ovarian vein were significantly higher than those in peripheral vein. Though the administration of hCG in mid luteal phase enhanced A and E2 levels in ovarian vein, the levels of T, 19-OHA and E1 were not altered. Significant correlation between the levels of E2 and A was observed while none of the steroids correlated with 19-OHA. These results suggest, for the first time, that 19-OHA is produced and secreted from the human ovary. The question as to the physiological and biosynthetic role of ovarian 19-OHA has to be answered in the future.

[A study of non-aromatizing androgen C10-19lyase in adrenal tissue]

The conversion of androgen to estrogen is mediated by aromatase activity, and 19-hydroxylase and C10-19lyase are seen to be involved in C19-demethylation. The present study is to demonstrate C10-19lyase activity in adrenal tissue. Fetal bovine and pig adrenal tissue homogenates were incubated with 14C-androstenedione(A) and NADPH under air. The products 14C-19-OHA, 14C-19-norA, with added carrier standard 3H-19-OHA, 3H-19-norA were separated and purified by T.L.C.. The identification of 19-norA was established by recrystallization and that of 19-OHA by C.C.D.. The 3H/14C ratios of the products 19-norA were found to be constant in repeated crystallization. The amount of 19-OHA from A in fetal adrenal tissue was 30.0nmol/h/g protein, and that of 19-norA from A was 12.59pmol/h/g protein. C10-19lyase activity from 19-OHA, calculated by the amounts of 19-norA in fetal, bovine and pig adrenal tissue, was 49.7, 3.50, 10.3pmol/h/g protein, respectively. This is the first report to demonstrate androgen C10-19lyase in human fetal adrenal tissue, and it is assumed that fetal adrenal tissue forms 19-norA via 19-OHA.

Serum level of 19-hydroxyandrostenedione during pregnancy and at delivery determined by gas chromatography/mass spectrometry

19-Hydroxyandrostenedione (19-OHA) is secreted from the adrenal glands in men and women and also from the placenta during pregnancy. It has been found to cause hypertension in animal models. We have synthesized [7,7-2H2]-19-OHA with high deuterium content and, together with [7,7-2H2]A and [9,11-2H2]estrone (E1), have developed a quantitative assay of serum level 19-OHA, A, and E1 using the gas chromatography/mass spectrometry-mass fragmentography method to monitor individual subjects throughout pregnancy. The labeled 19-OHA, used as internal standard, showed only 6.73% of unlabeled compound. Recovery of standard 19-OHA, A, and E1 (5,000 pg each) added to male plasma was 97.4 +/- 2.3%, 96.3 +/- 2.1%, and 100.1 +/- 4.1% (mean +/- SD), respectively; the intraassay coefficient of variation was 2.1%, 3.5%, and 3.8%, respectively. Ten pregnant subjects without complications and 10 pregnant subjects near term with hypertension were selected (with informed consent). The 19-OHA and E1 serum concentrations of maternal venous blood from uncomplicated pregnancies increased significantly as gestation progressed (19-OHA: first trimester, 225 +/- 72; second trimester, 656 +/- 325; third trimester, 1,518 +/- 544 pg/ml), reaching the highest level at delivery (19-OHA: 1,735 +/- 684 pg/ml). Whereas a positive correlation was found between the level of 19-OHA and E1, no apparent change of the A level was observed during pregnancy. Levels of the three steroid hormones in pregnancy complicated by hypertension in the second and third trimester were not found to be significantly different from those of normal pregnancy (19-OHA of hypertensive subjects: second trimester, 762 +/- 349; third trimester, 1,473 +/- 491 pg/ml).(ABSTRACT TRUNCATED AT 250 WORDS)

Effects of DHA-S on placental 3 beta-hydroxysteroid dehydrogenase activity, progesterone and 20 alpha-dihydroprogesterone concentrations in placenta and serum

To study the effects of dehydroepiandrosterone sulfate (DHA-S) on placental steroid metabolism and maternal steroidal profiles at term, the following in vivo and in vitro experiments were performed. Two hundred mg of DHA-S was given to five pregnant women 30 minutes prior to delivery. After delivery, the placenta was collected and 3 beta-hydroxysteroid dehydrogenase (3 beta-HSD) and sulfatase activity was determined by measuring the rate of conversion of pregnenolone to progesterone and DHA-S to DHA. The amount of C21-delta 4-steroid in the placental tissue was measured by gas chromatography mass spectrometry (GC-MS) and compared with the control groups. The maternal serum concentration of several steroids was also measured by GC-MS before and after the administration of DHA-S. 3 beta-HSD activity in the placentae from the mothers who received DHA-S before delivery was significantly lower than in the controls. On the other hand, no significant change was observed in the activity of sulfatase. The serum concentration of progesterone (P) and 20 alpha-dihydro-P (20-P) before DHA-S loading decreased following the administration whereas estradiol (E), DHA, and androstenedione (A) levels increased. To study the direct effect of DHA-S and its related steroids on placental 3 beta-HSD activity, placental tissue samples were incubated with pregnenolone in vitro. Several other steroids were added simultaneously into the medium. It was observed that placental 3 beta-HSD activity was directly inhibited by DHA-S. These results indicate that DHA-S inhibits 3 beta-HSD activity in the placenta and subsequently causes a reduction in P and 20-P.

[Correlation between the levels of catecholamines (noradrenaline, adrenaline) and adrenal steroids (DHA-S, cortisol) in maternal and fetal blood during pregnancy and labor]

It is known that both catecholamines (CA) and cortisol (F) levels elevate during labor. To determine the correlation between adrenal steroids and medullary function, maternal blood was collected during pregnancy, first stage of labor (MVI) and at delivery (MVII). Umbilical arterial and venous blood (UA, UV) was also obtained at delivery. Further, ACTH or dexamethasone (Dx) was given during the first stage of labor, and maternal blood was collected before and 30 minutes after the administration. Plasma levels of CA[noradrenaline (NA), adrenaline (Ad)] were extracted by trihydroxyindole method and were measured by HPLC. DHA-S and F levels were determined by specific RIA. Results are as follows: 1. No apparent change was observed in maternal NA and Ad levels throughout pregnancy. DHA-S levels were high in first trimester and decreased as pregnancy advanced, while F levels showed an increase trend as pregnancy progressed. 2. All hormone levels in maternal blood increased remarkably during labor. A significant negative correlation between F and Ad levels at delivery was noted. When F levels were elevated by ACTH administration, Ad levels decreased. Ad levels elevated when F levels were suppressed by Dx administration. 3. NA, Ad and DHA-S levels in cord blood were higher than those in MVII. Levels of F in maternal blood were higher than those in cord blood. A significant correlation of F in MVII and UA was observed. These results indicate that the suppressive effect of F may be involved in the mechanism of Ad secretion, though the secretion of Ad increased with F in the course of labor. The response of fetal adrenal to the stress of labor may be different from that of maternal adrenal since a significant correlation was not noticed between the levels of Ad and cortisol in cord blood as was found in maternal blood.

[The newly developed method of 19-OH-A as intermediate of estrone biosynthesis by GC-MS]

To study the serum levels of 19-hydroxyandrostenedione (19-OH-A), known as an obligatory intermediate of estrogen biosynthesis and considered to be one of the hypertensinogens, a method using GC-MS with application of synthesized [7,7-d2]androstenedione (A), [7,7-d2] 19-OH-A and [9,11-d2]estrone(E1) as internal standards was newly developed. Normal pregnant women and pregnant women complicated with hypertension near term were selected for the study. The levels of 19-OH-A and E1 increased significantly as gestation progressed [19-OH-A; 224.7 +/- 72.1 (1st trimester), 655.5 +/- 325.4 (2nd trimester). 1517.8 +/- 543.6 (3rd trimester)pg/ml], and a positive correlation was found between the levels of the two steroids. No apparent change was observed in A levels during the course of pregnancy. The mean levels of 19-OH-A in pregnancy complicated with hypertension at 2nd and 3rd trimester were 761.7 +/- 348.9 and 1473.0 +/- 491.4 pg/ml, which were compatible with those in normal pregnancy. The levels of 19-OH-A at delivery in maternal vein (MV) were 1735.1 +/- 683.9 pg/ml. Significantly higher levels of 19-OH-A were found in umbilical vein (UV) (1977.2 +/- 564.9 pg/ml) than those in umbilical artery (109.7 +/- 49.1 pg/ml). 19-OH-A concentration in term placental tissue was 16.3 ng/g.w.w. tissue. This is the first report to demonstrate the serum 19-OH-A levels measured by GC-MS and also to demonstrate the levels in the cord blood. The results indicate that 19-OH-A may be the product of pregnancy and may be derived from the feto-placental compartment.

[Serum concentrations of delta 5C21 steroids during pregnancy and at delivery]

In order to study the changes of C21-steroid levels which included Pregnenolone (P5), 20 alpha dihydropregnenolone (20P5), 16 alpha hydroxypregnenolone (16P5), progesterone (P4) and 20 alpha dihydroprogesterone (20P4) in maternal peripheral blood during pregnancy and at delivery, these steroids were measured by GC-MASS with application of deuterated steroids as internal standard. The accuracy of GC-MASS method of these steroids was satisfactory with C.V. value of less than 6%. Total delta 5C21 steroid concentrations in course of pregnancy and at delivery were as follows; P5 (mean +/- S.D. ng/ml): 66.6 +/- 36.2 (1st trimester), 80.9 +/- 24.6 (2nd trimester), 147.7 +/- 30.1 (3rd trimester) and 299.7 +/- 178.3 ng/ml (at delivery), 20Ps: 212.6 +/- 102.5, 143.4 +/- 53.9, 248.9 +/- 58.8, 563.4 +/- 198.2 ng/ml, 16P5: 8.6 +/- 8.6, 8.1 +/- 5.2, 124.3 +/- 40.3, 378.5 +/- 180.0 ng/ml, respectively. P4 (43.0 +/- 28.0 ng/ml) and 20P4 (8.0 +/- 4.0 ng/ml) in 1st trimester showed gradual increase to maximum level (P4: 138.2 +/- 30.1 ng/ml, 20P4: 105.4 +/- 21.6 ng/ml) at pre-pain period, afterward decreased rapidly (P4: 70.9 +/- 23.2 ng/ml, 20P4: 59.8 +/- 19.3 ng/ml) at delivery. P5, 20P5 and 16P5 levels were found to be significantly higher in umbilical artery (UA) as well as in umbilical vein (UV) than those in maternal vein (MV) regardless of labor pain. P4 and 20P4 did not show any differences in MV regardless of labor pain. P4 in UV (pain+) and 20P4 in UA (pain-), however, showed significantly higher than P4 in UV (pain-) and 20P4 in UA (pain+). P5, 20P5, 16P5 and 20P4 levels were significantly lower in the case of anencephalic pregnancy (ANC) at 3rd trimester than in normal pregnancy, especially 16P5 levels (22.2 +/- 5.0 ng/ml) showed 1/5 of those in normal pregnancy. From the results obtained above, it is suggested that these delta 5C21 steroids are actively produced in the feto-placental unit in the course of pregnancy. The levels of these steroids reached maximum at delivery, but the levels of P4, 20P4 decreased toward delivery after maximum levels were shown in the stage of pre-labor pain. No significant difference of P4 level in the case of ANC suggested that P4 production correlated with placenta as well as maternal and fetal precursor. Decreasing of 20P4 and P4 level after the stage of pre-labor pain suggested that activity of 3 beta hydroxysteroid dehydrogenase was reflected by uterine contraction during labor.

[Changes in maternal plasma levels of C21 and C19 steroid hormones during pregnancy]

To study the changes in circulating steroid levels during pregnancy, ten steroids which included Progesterone (P4), 16 alpha OH-Progesterone (16P4), free and conjugated Pregnenolone (P5), 16 alpha OH-Pregnenolone (16P5), Dehydroepiandrosterone (DHA) and 16 alpha OH-Dehydroepiandrosterone (16DHA) were measured simultaneously by RIA in 84 normal pregnant women from the 5th to 41st week of gestation. Ratios steroid levels were also calculated. The results were as follows; 1. P4 increased as gestation advanced and reached the maximum (126 +/- 18.24 ng/ml) in the 28th week. The concentration 16P4 increased sharply after the 32nd week and reached the maximum (16.3 +/- 1.67 ng/ml) in the 39th week. 2. Both free and conjugated P5 levels did not show an increasing trend as pregnancy progresses. 3. The concentration of free and conjugated 16P5 increased rapidly after the 30th week and reached the maximum at 39th week (free 2.5 +/- 0.3 ng/ml conjugated 42.4 +/- 5.1 ng/ml). 4. Both free and conjugated DHA decreased as pregnancy progressed. On the other hand, the concentration of free and conjugated 16DHA increased as pregnancy progressed. 5. The ratio of 16P4 to P4, 16P5 to P5 and 16DHA to DHA significantly increased after 30 weeks of gestation.

[Determination of serum 16 alpha-hydroxydehydroepiandrosterone, 16 alpha-hydroxyestrone and estriol by gas chromatography-mass spectrometry and their perinatal movement]

In order to study the mechanism of estriol (E3) formation in the fetoplacental unit, a method for determining E3 and its precursors, 16 alpha-hydroxydehydroepiandrosterone (16 alpha-OH DHA) and 16 alpha-hydroxyestrone (16 alpha-OH E1) in blood using Gas Chromatography-Mass Spectrometry (GC-MS) was newly developed. Deuterium labelled steroids, 3.4.4.-d3-16 alpha-OH DHA 2.4.17.-d3-E2 and 2.4.-d2-E3 were synthesized and used as the internal standards. After removal of free steroids with ether, the residue was solvolyzed and extracted with ethyl acetate as free form. Steroids were analysed after the formation of T.M.S. and T.F.A. derivative. The values for each steroid in maternal peripheral vein blood (M.V.), umbilical artery blood (U.A.) and vein blood (U.V.) were studied. Conjugated steroid values in M.V. obtained at normal vaginal delivery (13 cases) were as follows: 16 alpha-OH DHA 230.3 +/- 76.3 ng/ml, 16 alpha-OH E1 19.34 +/- 7.00 ng/ml and E3 158.8 +/- 50.2 ng/ml (mean +/- S.D.), respectively. The levels of these three steroids in cord blood were significantly higher than those in maternal blood. These results show that the steroids are actively produced in the fetoplacental unit. A significant increase in all the steroids was associated with labor. None of the values for E3 precursors in umbilical blood correlated with that of conjugated E3 in maternal blood. The significance of 16 alpha-OH DHA and 16 alpha-OH E1 as intermediates of E3 formation in the fetoplacental unit is discussed.

[Changes in plasma 2-hydroxyestrone levels in pubertal females and correlation with sex hormones]

Plasma levels of 2-hydroxyestrone (2-OHE1) were measured by specific radioimmunoassay during puberty to elucidate the physiological role of this hormone on female sexual development. Plasma levels of FSH, LH, PRL and estradiol (E2) were also measured with an RI-kit. 67 girls between aged 6 and 16 were selected for this study. Blood samples were collected into tubes containing 0.1W/V% EDTA and 0.1W/V% ascorbic acid and immediately centrifuged. 2-OHE1 in plasma was extracted and separated with a Sephadex LH-20 column. RIA was applied using anti 2-OHE1-17-CMO-BSA. Plasma 2-OHE1 levels before menarche were low (6-7 pg/ml) until 10 years of age. The levels started to increase from 11 and reached 11.2 +/- 5.8pg/ml at 16 years of age. The levels of 2-OHE1 in girls after menarche were significantly higher than that before menarche (p less than 0.01). There was a significant correlation between 2-OHE1 and E2 in girls before menarche (p less than 0.001, r = 0.5416). However, the 2-OHE1 to E2 ratio decreased significantly from 9 to 10 years of age. These results indicate that during this period, the E2 increase is more predominant than that of 2-OHE1. There was a significant negative correlation between 2-OHE1 and PRL after menarche while no correlation between 2-OHE1 and FSH, LH was noticed. These results suggested that 2-OHE1 may play a role in sexual development after menarche rather than in the initiation of menarche.

[Determination of free and conjugated 16 alpha-hydroxyestrone (16 alpha-OH E1) in serum by mass fragmentography using gas chromatography mass spectrometry]

A simple, rapid and highly specific method for the determination of maternal and cord serum 16 alpha-hydroxyestrone (16 alpha-OH E1) during pregnancy and at delivery was developed by mass fragmentographic technique using a Gas chromatography--Mass spectrometry (GC-MS) with application of deuterated estradiol as an internal standard. The equipment used was Shimadzu LKB9000 GC-MS (MID-PM). The T.F.A. derivative of the compounds was analyzed using the GC-MS system equipped with a 1 m glass coil, 1% OV-1 on chromosorb w 60 approximately 80 mesh. The flow rate of carrier gas (helium) was 25 ml/min. The temperatures of column oven, separator and ionization source were kept at 190 degrees C, 270 degrees C and 290 degrees C, respectively. The ionization energy and trap current were 70 eV and 60 microA, respectively. The mass spectrum showed molecular ions at m/ e467 and m/ e478 corresponding to the T.F.A. derivatives of d3-E2 and 16 alpha-OH E1 respectively. Evaluation of the method assessed by recovery experiments was 99.2 percent when 10 ng of 16 alpha-OH E1 was added to 1.0 ml of male serum treated with charcoal. The coefficient of variation was 4.2 percent. Serum conjugated 16 alpha-OH E1 levels during pregnancy increased with progressing gestation. The levels in early pregnancy (5th approximately 15th week), middle pregnancy (16th approximately 27th week) and late pregnancy (28th approximately 42th week) were 1.72 +/- 0.43 ng/ml, 5.35 +/- 2.60 ng/ml, 11.92 +/- 3.93 ng/ml (mean +/- S.D.), respectively. Mean levels of 16 alpha-OH E1 in the umbilical artery were 11.61 +/- 5.17 ng/ml which were statistically higher than these in the maternal peripheral vein (6.06 +/- 4.72 ng/ml) and umbilical vein (9.16 +/- 3.77 ng/ml). Serum 16 alpha-OH E1 levels in the samples obtained from anencephalic pregnancy were significantly lower than those in normal pregnancy, suggesting that fetal adrenal function may be involved in the formation of this steroid during pregnancy.

[Determination of serum unconjugated estetrol by selected ion monitoring with application of deuterated estetrol as an internal standard]

A rapid and highly specific method for determination of serum estetrol during pregnancy and at delivery is developed using a gas chromatography-mass spectrometry with application of newly synthesized deuterated estetrol as an internal standard. Evaluation of the method assessed by recovery experiments was 102.4 and 103.0 percent when 2 and 4ng of estetrol was added to 0.5ml of male serum. The coefficient of variation were 2.54 and 2.84 percent, respectively. The results obtained by the present method are correlated well with those obtained by conventional RIA. Serum unconjugated estetrol levels during pregnancy increased with progressing gestation. The levels from the 36th to the 40th week were 749.8 +/- 281.5pg/ml (mean +/- S.D.) The levels in umbilical cord blood at delivery were also measured: Umbilical vein were 8,064.0 +/- 6,595.4pg/ml which were statistically higher than in umbilical artery (3,515.9 +/- 1,553.8pg/ml) and in maternal peripheral vein (1,209.0 +/- 530.3pg/ml).

Determination of serum unconjugated estrone, estradiol-17 beta and estriol during pregnancy by selected ion monitoring

A simple, rapid and highly specific method by selected ion monitoring (SIM), using 9 alpha, 11 alpha-[2H2]estrone, [2,4-2H2]estradiol-17 beta and 2,4-[2H2]estriol as internal standards, was developed for the determination of serum estrogens during pregnancy. Serum samples were submitted to a simple extraction procedure and were analysed after formation of the trifluoroacetic anhydride derivative. The inter-assay coefficients of variation for estrone, estradiol-17 beta and estriol were 3.73%, 3.42% and 3.49%, respectively. The results obtained by SIM were compared with analysis performed using radioimmunoassay.

[Changes of dehydroepiandrosterone (DHA), 16 alpha OH-DHA and estriol levels in maternal peripheral blood during late pregnancy and labor--measured by gas chromatography-mass spectrometry with application of deuterated steroids as internal standards (author's transl)]

Serum levels of DHA, 16 alpha OH-DHA and estriol (E3) were determined in maternal peripheral vein by gas chromatography-mass spectrometry (GC-MS) with application of deuterated steroids as internal standards during late pregnancy and labor. Deuterium labeled 3,4,4-d3-DHA, 3,4,4-d3-16 alpha OH-DHA and 2,4-d2-E3 were newly synthesized and highly specific method for determination of serum DHA, 16 alpha OH-DHA and E3 was developed by GC-MS. The mean total steroid concentrations in the third trimester (III), in the stage when patients had irregular contraction (P) and during the first stage of labor (1st) were as follows; DHA, 612.9 +/- 265.3, 877.5 +/- 365.6 and 1522.5 +/- 580.6, 16 alpha OH-DHA, 30.2 +/- 20.2, 49.4 +/- 21.9 and 161.3 +/- 43.6, E3, 50.9 +/0 25.7, 70.4 +/- 19.8 and 108.6 +/- 44.5 ng/ml (mean +/- S.D.). The values of these three steroids increased significantly from the III to the 1st. Correlation between the levels of total DHA and total E2 measured in ten patients individually in the III was 0.8665 (p less than 0.001) which changed to -0.6650 (p less than 0.01) and -0.5362 (p less than 0.05) in the stage of P and 1st. ACTH was given to eight pregnant women in the third trimester, and response of these steroids to ACTH was studied. In addition to these steroids, cortisol (F) levels were also measured by RIA. Following the administration, F increased significantly whereas no changes of DHA, 16 alpha OH-DHA and E3 levels were noticed suggesting that these steroids may not be influenced by maternal adrenal secretion. From the results obtained above, it is suggested that the endocrinological environment in maternal blood as indicated by correlations between DHA and E3 levels, changes prior to the onset of labor.