Placental aminopeptidase A as a possible barrier of angiotensin II between mother and fetus

Aminopeptidase A (AP-A EC 3.4.11.7), which is a membrane-bound zinc metalloprotease, is present in the placenta. AP-A selectively hydrolyzes N-terminal glutamyl and aspartyl residues and cleaves angiotensin II to form angiotensin III. To determine the role of placental aminopeptidase A under physiological and pathological conditions, we evaluated its immunolocalization and enzymatic activities in the placenta. AP-A was localized in the basal zone of the syncytiotrophoblast, in the membranes of the cytotrophoblast, and in fetal arterioles and venules within the stem villi. AP-A activity in the microsomal fraction of placental villi seemed to be remained essentially constant throughout gestation. The renin-angiotensin system is considered to be accelerated in pre-eclampsia. This AP-A activity was higher in pre-eclampsia (2.86+/-0.30 nmol beta NA/mg protein/h) than in uncomplicated pregnancy from 28 to 41 weeks of gestation (2.08+/-0.18 nmol beta NA/mg protein/h). Angiotensin II evoked AP-A activity in first trimester trophoblast, and Losartan and PD 123177 in combination significantly inhibited this induction of AP-A activity. The results of immunohistochemical evaluation and enzymatic activity suggested that placental aminopeptidase A may play a role as a component of the barrier of angiotensin II between mother and fetus.

Nerve growth factor functions as a chemoattractant for mast cells through both mitogen-activated protein kinase and phosphatidylinositol 3-kinase signaling pathways

Despite being a well-characterized neurotrophic factor, nerve growth factor (NGF) influences survival, differentiation, and functions of mast cells. We investigated whether NGF was able to induce directional migration of rat peritoneal mast cells (PMCs). NGF clearly induced chemotactic movement of PMCs in a dose-dependent manner with the drastic morphological change and distribution of F-actin, which was completely blocked by pretreatment with Clostridium botulinum C(2) toxin, an actin-polymerization inhibitor. Because PMCs constitutively express the NGF high-affinity receptor (TrkA) with a tyrosine kinase domain, we focused on downstream effectors in signaling cascades following the TrkA. NGF rapidly activated both mitogen-activated protein kinase (MAPK) and phosphatidylinositol 3-kinase (PI3K), and the addition of inhibitors specific for MAPK kinase and PI3K suppressed cell migration and these signals. In the coculture system with PMCs and fibroblasts, which produce biologically active NGF, directional migration of PMCs to fibroblasts was observed, and the addition of anti-NGF polyclonal antibodies significantly suppressed the migration of PMCs. These findings suggested that NGF initiated chemotactic movement of PMCs through both MAPK and PI3K signaling pathways following TrkA activation. Thus, locally produced NGF may play an important role in mast cell accumulation in allergic and nonallergic inflammatory conditions. (Blood. 2000;95:2052-2058)

Placental leucine aminopeptidase/oxytocinase in maternal serum and placenta during normal pregnancy

Placental leucine aminopeptidase (P-LAP), which is identical with cystine aminopeptidase as oxytocinase, was found to be homologous with rat insulin-regulated membrane aminopeptidase (IRAP) by sequence comparison. In the current study, we determined the P-LAP levels in maternal serum and placenta during healthy pregnancy. P-LAP activities in maternal serum increased with gestation and rose to the peak of 80 IU/ml at 38 weeks of gestation. Northern blot analysis revealed the increase of P-LAP mRNA levels in placenta in the third trimester compared to the first trimester. P-LAP protein and related activities could be detected in the conditioned medium of placental tissue, while they could not be detected in that of human umbilical vein endothelial cells. Immunohistochemically P-LAP was positively stained in the apical membrane of syncytiotrophoblast cells throughout the gestation. These results established the normal range of serum and tissue P-LAP levels during pregnancy and the possible source of serum P-LAP, which will be helpful to elucidate the physiological and clinical roles of P-LAP/oxytocinase/IRAP.

Human mast cells produce matrix metalloproteinase 9

Extracellular matrix-destructive enzymes, like matrix metalloproteinases (MMP), have been recognized in the process of inflammation and tissue remodeling and repair. The affected tissues often contain markedly increased numbers of mast cells. Although mast cells are capable of activating latent collagenase and proMMP, it has so far been unknown whether human mast cells themselves produce and secrete MMP9. In this study, MMP9 production by cord blood-derived cultured human mast cells and HMC-1 human mast cells was examined by reverse-transcriptase PCR, gelatin zymography and Western blot analysis using an antibody against MMP9. Cultured mast cells and HMC-1 cells treated with phorbol 12-myristate 13-acetate were shown to express MMP9 mRNA, and the cultured conditioned media from these cells showed gelatinolytic activity, identical with MMP9. Immunohistochemical examination was performed to detect MMP9 in tissue mast cells; mast cells localized in the skin, lung and synovial tissue showed strongly positive reactions for MMP9. Thus, these findings indicate that human mast cells can produce MMP9, which might contribute to extracellular matrix degradation and absorption in the process of allergic and nonallergic responses.

Fetal sacrococcygeal teratoma visualized by ultra-fast T2 weighted magnetic resonance imaging

We report here a fetal sacrococcygeal teratoma found at 26 weeks of gestation. An ultra-fast T2 weighted imaging method enables the clear visualization of morphological details of the fetus without motion artifacts. Complete surgical resection was performed immediately after cesarean birth, and no evidence of tumor recurrence was confirmed at 1 year of age.

IgE hyperproduction through enhanced tyrosine phosphorylation of Janus kinase 3 in NC/Nga mice, a model for human atopic dermatitis

IgE hyperproduction frequently observed in patients with atopic dermatitis (AD) may greatly contribute to the pathogenesis of AD, but its mechanisms are still unclear. NC/Nga mice raised in nonsterile circumstances spontaneously suffered from AD-like skin lesions with elevation of plasma IgE levels. We investigated mechanisms of the IgE hyperproduction in NC/Nga mice. Splenic T cells from SPF NC/Nga mice had a level of CD40 ligand (CD40L) expression comparable to that of BALB/c mice. Although there was no difference in the expression of CD40 on B cells between NC/Nga and BALB/c mice, B cells of NC/Nga mice produced much more IgE in the presence of soluble CD40L and IL-4. The stimulation with CD40L and/or IL-4 resulted in tyrosine phosphorylation of Janus kinase 3 (JAK3) in B cells, which was more strongly inducible in NC/Nga mice than in BALB/c mice. In B cells isolated from PBMC of AD patients with high serum IgE levels, JAK3 was constitutively phosphorylated at the tyrosine residue, and its phosphorylation was enhanced by the treatment with CD40L and/or IL-4 as was that in splenic B cells of NC/Nga mice with dermatitis and high IgE levels. Thus, it is suggested that constitutive and enhanced JAK3 phosphorylation in B cells highly sensitive to CD40L and IL-4 may be attributable to IgE hyperproduction in NC/Nga mice and patients with AD.

Possible involvement of placental proteases in bradykinin (BK) degradation

The hydrolysis of bradykinin (BK) by human placental subcellular fractions and pregnancy sera was studied in the presence of inhibitors by measuring amino acids liberated from BK by high-performance liquid chromatography. The effects of the inhibitors DL-2-mercaptomethyl-3-guanidinoethylthiopropionic acid (MGTA, for kininase I), phosphoramidon (for endopeptidase 24.11) and captopril and rentiapril (for angiotensin-converting enzyme [ACE, kininase II]) suggested the essential roles of the above three proteases in BK degradation: among the three proteases, kininase I and endopeptidase 24.11 appeared to be the most important in kininase action in the placenta microsomes, whereas kininase I and ACE appeared to be the most important in kininase action in the placental cytosol, lysosome and pregnancy serum. Measurements of BK concentrations in the umbilical arterial blood, umbilical venous blood and maternal plasma revealed higher concentrations in the mother than in the fetus. The present data suggest that degradation of BK in the placenta and pregnancy serum might contribute to the gradient of BK between mother and fetus.

Preeclampsia with fetal death in a patient with schistosomiasis japonica

A case of preeclampsia with fetal death at 32 weeks' gestation is reported. Liver examination of the patient revealed network patterns on ultrasonography and linear calcifications on unenhanced CT scans in the liver. These findings are typical of those of chronic schistosomal infection. Indeed, liver biopsy specimens showed eggs of schistosoma japonicum. We diagnosed her case as preeclampsia with liver cirrhosis due to chronic schistosomiasis japonica. Schistosomal placentitis may have been present and may have contributed to preeclampsia and fetal death.

Role of nerve growth factor in cutaneous wound healing: accelerating effects in normal and healing-impaired diabetic mice

Four full-thickness skin wounds made in normal mice led to the significant increase in levels of nerve growth factor (NGF) in sera and in wounded skin tissues. Since sialoadenectomy before the wounds inhibited the rise in serum levels of NGF, the NGF may be released from the salivary gland into the blood stream after the wounds. In contrast, the fact that messenger RNA and protein of NGF were detected in newly formed epithelial cells at the edge of the wound and fibroblasts consistent with the granulation tissue produced in the wound space, suggests that NGF was also produced at the wounded skin site. Topical application of NGF into the wounds accelerated the rate of wound healing in normal mice and in healing-impaired diabetic KK/Ta mice. This clinical effect of NGF was evaluated by histological examination; the increases in the degree of reepithelialization, the thickness of the granulation tissue, and the density of extracellular matrix were observed. NGF also increased the breaking strength of healing linear wounds in normal and diabetic mice. These findings suggested that NGF immediately and constitutively released in response to cutaneous injury may contribute to wound healing through broader biological activities, and NGF improved the diabetic impaired response of wound healing.

Hepatocyte growth factor in human amniotic fluid promotes the migration of fetal small intestinal epithelial cells

OBJECTIVE

Previously we reported on the abundant existence of hepatocyte growth factor in amniotic fluid. This study was conducted to clarify the effects of hepatocyte growth factor in amniotic fluid on fetal intestinal epithelial cells.

STUDY DESIGN

Amniotic fluid samples were obtained from 22 cases at various gestational ages. The effects of amniotic fluid and recombinant human hepatocyte growth factor on proliferation, migration, and morphogenesis of intestine 407 cells (a cell line derived from fetal intestinal epithelial cells) were investigated.

RESULTS

The mobility of intestine 407 cells was stimulated by amniotic fluid in proportion to the concentration of hepatocyte growth factor in amniotic fluid with the same effect observed with recombinant human hepatocyte growth factor. This activity was neutralized by addition of antihuman hepatocyte growth factor antibody. Neither increased deoxyribonucleic acid synthesis nor morphogenesis in response to amniotic fluid was identified under the conditions used.

CONCLUSION

Amniotic fluid stimulates intestinal epithelial cell migration by way of hepatocyte growth factor in amniotic fluid during development of the fetal intestine.

Involvement of hepatocyte growth factor in formation of bronchoalveolar structures in embryonic rat lung in primary culture

To clarify the role of hepatocyte growth factor (HGF) in embryonic lung development, organoids from fetal rat lung were cultured in collagen gels with or without HGF antisense oligonucleotides. Cyst-like structures formed within 24 h in organoids isolated from fetuses after 14 days' gestation, but this was abolished by the oligonucleotide addition, apparently by interference with the endogenous expression of HGF. Electron microscopy revealed two types of structure: an alveolar type characterized by osmiophilic lamellar bodies in the cytoplasm and lumen, and a bronchial type consisting of epithelial cells bearing microvilli on their apical surfaces. HGF mRNA was detectable from day 14 in fetal lung by RT-PCR. Our results suggest that HGF plays, coordinately with its expression, a crucial role in the morphogenesis of both alveolar and bronchial epithelia in the rat fetal lung.

Conservative handling of the uterus in a 10-week cervical pregnancy case

A patient with a living 10-week old cervical pregnancy who desired to preserve fertility was successfully treated with methotrexate, intraamniotic KCI injection and endocervical curettage. In the case of living cervical pregnancy even after 10 weeks, conservative treatment remains an option, although intensive management and care should be given.

Timing of insults causing abnormal outcome in preterm infants 1989-1992

OBJECTIVE

The purpose of this study was to clarify the influence of timing of brain insults causing abnormal outcome in preterm infants.

METHODS

One hundred and thirty-one preterm infants were examined. The timing of brain insult was estimated from EEG or clinical findings. Development was assessed until a corrected age of 48 months.

RESULTS

39% and 4% of infants, respectively, born before and after the 28-week time point subsequently died (P < 0.05). Abnormal development was observed in 16% of the first group and 13% of the second (N.S.). None of those born before 28 weeks showed intrauterine injuries while nine of the infants which were born after this time showed intrauterine injuries (P < 0.05). Fetal distress was noted in all infants suffering neonatal death born after 28 weeks.

CONCLUSION

Intrauterine brain insult was concluded to be the cause of neonatal death or abnormal development in many infants born after 28 weeks.

Levels of hepatocyte growth factor and its messenger ribonucleic acid in uncomplicated pregnancies and those complicated by preeclampsia

The purpose of this study was to elucidate the possible relationship between hepatocyte growth factor (HGF) expression and the pathogenesis of preeclampsia. The concentration of immunoreactive HGF was measured and the expression of HGF messenger ribonucleic acid (mRNA) assessed in human placentas obtained from two groups: uncomplicated and preeclamptic pregnancies at various gestational weeks. In addition, the localization of HGF mRNA and c-met protein was analyzed using in situ hybridization and immunohistochemical staining, respectively. The expression of HGF mRNA and the concentration of immunoreactive HGF were highest in second trimester and were significantly decreased in preeclamptic placentas compared with the uncomplicated cases in third trimester. HGF mRNA was localized to placental mesenchymal cells, whereas c-met protein was demonstrated on cytotrophoblast. These results provide evidence of an abnormality of HGF expression in the preeclamptic placentas. Such placentas exhibit the abnormally shallow trophoblast invasion of the uterus, and reduced expression of HGF could well account for this morphometric change.

Human amniotic fluid motogenic activity for fetal alveolar type II cells by way of hepatocyte growth factor

OBJECTIVE

To find out if hepatocyte growth factor (HGF) in amniotic fluid (HGF-AF) has a direct effect on fetal lung development, we investigated the effects of AF as well as recombinant human HGF (rhHGF) on proliferation, migration, and morphogenesis of fetal alveolar type II cells in vitro.

METHODS

Amniotic fluid samples were obtained from 37 women at various gestational ages. Mitogenic, motogenic, and morphogenic activity was investigated by 5-bromo-2'-deoxyuridine incorporation, Boyden chamber assay, and culture in collagen-gels, respectively.

RESULTS

The motility of AK-D cells was stimulated by AF from 14 to 31 weeks' gestation in proportion to the concentration of HGF-AF, and this effect was comparable to that observed with rhHGF. Furthermore, this activity was neutralized by anti-human HGF antibody. However, AF samples subsequent to 32 weeks had no motogenic influence despite the continued presence of immunoreactive HGF-AF. Neither increased DNA synthesis nor morphogenesis in response to AF was identified under the conditions used.

CONCLUSION

The present study suggests that AF stimulates alveolar type II cell migration by way of HGF-AF in vitro.

Increased mitochondrial damage by lipid peroxidation in trophoblast cells of preeclamptic placentas

Lipid peroxides and their related free radicals have been implicated in the pathogenesis of placental dysfunction in preeclampsia. Recent studies suggest that the placenta is a source of the increased lipid peroxides in the maternal circulation of women with preeclampsia. We examined intracellular localization of 4-hydroxy-2-nonenal (HNE: a major aldehydic product of lipid peroxidation)-modified proteins in human placentas by immunohistochemistry, and immunoblotting. The trophoblast layer of the chorionic villi showed intense immunoreactivity for HNE-modified proteins in 4 of 12 preeclamptic placentas, whereas no staining was observed in 12 normal placentas. Immunoblotting revealed that three immunoreactive proteins with apparent molecular mass of 110 kDa, 75 kDa, and 70 kDa were localized in the mitochondrial fraction. The present results indicate that the damage to mitochondrial proteins by lipid peroxidation by products and subsequent dysfunction of trophoblasts contribute to the pathophysiology of preeclampsia.

A live birth from intracytoplasmic injection of a testicular spermatozoon

Testicular sperm was retrieved from a man with complete epididymal obstruction, and intracytoplasmic sperm injection was performed on his wife's oocytes. In four mature treated, two fertilized eggs were obtained, and a clinical pregnancy was established with embryo transfers. One healthy girl (2715 g) was delivered by cesarean section at 38 weeks' gestation. Our case shows that the use of testicular sperm can result in a normal live birth.

Fetal heart rate patterns associated with periventricular leukomalacia

OBJECTIVE

Our purpose was to assess the applicability of fetal heart rate (FHR) monitoring to detect fetuses at risk of developing periventricular leukomalacia (PVL).

METHODS

FHR tracings obtained for babies delivered under 33 weeks' gestation and with a birth weight under 2000 g were assessed for baseline heart rate, variability, deceleration and "flip flap' (an oscillatory tracing pattern).

RESULTS

PVL developed in 19 of the 103 infants studied. All of these infants were among the fetuses who exhibited average and increased variability. In addition, PVL was detected in 10 (47.6%) of the 21 flip flap positive fetuses, and in 9 (11.0%) of the 82 flip flap negative fetuses. The incidence of PVL was significantly higher in the flip flap positive fetuses (P < 0.005).

CONCLUSION

The possibility that an unstable intrauterine environment, reflected by a flip flap pattern, is related to the subsequent development of PVL is indicated.

Timing of periventricular leukomalacia using neonatal electroencephalography

OBJECTIVE

To estimate the timing of brain damage involved in the onset of periventricular leukomalacia in the perinatal period we recorded and analyzed neonatal electroencephalograms (EEGs).

METHODS

Twenty-four preterm birth infants proved by real time ultrasonic examination or MRI to be suffering from periventricular leukomalacia underwent serial electroencephalography from soon after birth.

RESULTS

Thirteen (54%) demonstrated intrauterine injury patterns, 2 infants (8%) showed postnatal injury, and in the remaining 9 cases (38%) the time of injury could not be determined by electroencephalography. Antepartum maternal hemorrhage (6), premature rupture of membranes (3), twining (3), chorioamnionitis (2), and perinatal asphyxia (2) were complications encountered in the group with intrauterine injury patterns.

CONCLUSIONS

Our observations suggest that more than half of periventricular leukomalacia cases are associated with premature birth infants showing intrauterine injury patterns on electroencephalography, indicating the existence of intrauterine insult.

A prospective study on the relationship between intrapartum maternal group-B streptococcal concentration and signs of infection in neonates

OBJECTIVE

Our purpose was to examine the effects of intrapartum vaginal Group-B streptococcal (GBS) colonization on neonatal signs of infection.

STUDY DESIGN

We performed a quantitative GBS culture of vaginal specimens in 1,280 pregnancies within 24 hours before delivery and examined signs of neonatal infection within 48 hours after birth. Among them, 287 pregnant women had premature ruptures of membranes.

RESULTS

The rate of vaginal GBS colonization in groups with and without ruptured membranes was 22.0% and 11.3%, respectively. The incidence of neonates with signs of infection born to GBS-carrier women in each group was 28.6% and 8.8%, respectively. There were significant differences between the groups with regard to both the rate of colonization and the incidence of infection. Signs of neonatal infection increased in proportion to the maternal GBS concentration only in women with ruptured membranes.

CONCLUSION

This study suggests that there is an important association between maternal GBS concentration and mild neonatal infections after birth, especially in women with premature ruptures of membranes.

Relationship between the changes in maternal serum placental leucine aminopeptidase (P-LAP) activity and umbilical artery waveforms in normal pregnancy

The relation between placental leucine aminopeptidase (P-LAP) activity in maternal sera and umbilical artery waveforms (systolic/diastolic ratio, S/D) obtained by pulsed Doppler has been examined by cross-sectional study in 26 normal pregnancies during weeks 26-38. A negative correlation was seen to exist suggesting that P-LAP may have a role in the regulation of uteroplacental blood flow.

Oxytocin is hydrolyzed by an enzyme in human placenta that is identical to the oxytocinase of pregnancy serum

The hydrolysis of oxytocin (OT) by human placental subcellular fractions and pregnant sera was studied in the presence of bestatin, a potent inhibitor of aminopeptidases, and the antibody against pregnant serum oxyotocinase (P-LAP)(EC 3.4 11.3) by measuring liberated amino acids by high performance liquid chromatography (HPLC). Our immunotitration study and the effect of bastatin on the oxytocin-degrading protease showed that the initiating and responsible protease in oxyotocin degradation in human placenta and pregnant serum is P-LAP.

Trophoblast cell monolayers on polycarbonate membranes as a preparative approach for studies of transcellular transport

To investigate mechanisms of transplacental transfer, the trophoblast-derived cells were cultured on a polycarbonate membrane with 0.4 micron pores and medium on each side. The cells could form microscopically continuous cellular sheets over Transwell polycarbonate membranes. Permeability studies suggested however that the cell layer possesses a significant leak that must be controlled for. The results indicate that the transfer of substances through lateral intercellular spaces must be considered when studies of trans-trophoblast transfer are performed using cell monolayers.

Comparative study of fetal behaviour in a case of monozygotic twins, one being anencephalic

Fetal behavior in monozygotic twins, one being anencephalic, was serially recorded from 20 to 35 weeks of gestation and analyzed. The commencement of breathing movement was concluded to reflect the development of the medulla oblongata of the fetus.

Decrease in severity of intrauterine growth retardation in subsequent pregnancies

OBJECTIVE

Intrauterine growth retardation (IUGR) is likely to recur in a subsequent pregnancy. We investigated the obstetric features of recurrent cases and the severity of IUGR by comparing initial and subsequent deliveries.

METHODS

From a total of 12,567 deliveries, 95 women who were delivered of small-for-gestational-age (SGA) infants and who became pregnant again within 5 years, were enrolled. A retrospective, comparative study of recurrent and non-recurrent groups was performed.

RESULTS

Twenty-two of ninety-five women gave birth to SGA infants again, and a relatively high risk of recurrence was confirmed, but no single recurrence-associated features were revealed. Within the recurrent group, the degree of IUGR was more severe in only five cases in the subsequent pregnancy.

CONCLUSIONS

IUGR tends to recur, but does not increase in severity in most cases. We conclude that there is no need for excessive concern about the recurrence of IUGR.

Initiating and responsible enzyme of arginine vasopressin degradation in human placenta and pregnancy serum

The hydrolysis of arginine vasopressin (AVP) by human placental subcellular fractions and pregnancy sera was studied in the presence of selective inhibitors and the antibody against pregnancy serum oxytocinase (P-LAP) (EC 3.4.11.3) by measuring liberated amino acids by high-performance liquid chromatography (HPLC). AVP degradation by placental subcellular fractions and pregnancy sera was inhibited by bestatin. The IC50 values of bestatin on AVP degradation by placental subcellular fractions and pregnancy sera were similar to that of this inhibitor on the P-LAP measured by L-Leu-p-nitroamnilide as a substrate (LAP activity), which we reported previously. Our immunotitration study clearly showed that the initiating and responsible protease in AVP degradation in human placenta and pregnancy serum is P-LAP. Since N-benzylcarbonyl-valyl-prolinal (Z-Val-prolinal), a selective inhibitor of post-proline endopeptidase, and phosphoramidon, a putative endopeptidase-24.11 inhibitor, could not significantly influence the degradation of AVP by placental microsomal fractions. Neither enzyme seems to be actively involved in AVP degradation.

Levels of hepatocyte growth factor in maternal serum and amniotic fluid

OBJECTIVE

The purpose of our study was to investigate hepatocyte growth factor levels in maternal serum and amniotic fluid during pregnancy. We also demonstrated production and secretion of hepatocyte growth factor by placenta and amnion at different stages of gestation.

STUDY DESIGN

Hepatocyte growth factor levels in maternal serum (n = 219), cord blood (n = 20), and amniotic fluid samples (n = 90) were measured by an enzyme-linked immunosorbent assay. The secretion of hepatocyte growth factor by placenta and amnion was evaluated by measuring the amount released into the culture supernatant.

RESULTS

Most hepatocyte growth factor levels in maternal serum were below the detection limit before 10 weeks of pregnancy. Levels increased significantly thereafter and continued to increase until term. On the other hand, levels in amniotic fluid were significantly higher between 20 and 29 weeks of gestation than after 30 weeks. Hepatocyte growth factor secretion from the placental tissue per weight seemed unchanged throughout pregnancy. Its secretion from amnion was, however, approximately 300 to 400-fold higher in the second trimester compared with that at term.

CONCLUSION

Both placenta and amnion produce and secrete hepatocyte growth factor, suggesting its role in fetal growth and the growth and differentiation of placenta.

The concentration of hepatocyte growth factor (HGF) in human amniotic fluid at second trimester: relation to fetal birth weight

Hepatocyte growth factor (HGF) was measured in 28 samples of amniotic fluid, 1 of fetal urine and 5 of first neonatal urine. The mean level of HGF was 12.4 +/- 4.5 ng/ml (second trimester) and 10.5 +/- 6.6 ng/ml (third trimester). These values were extremely high compared to that in plasma from normal subjects and greater than the plasma levels from patients with acute hepatitis. The concentration of amniotic HGF at second trimester showed a significant inverse correlation both with birth weight (r = 0.47; p < 0.05) and birth weight deviation (r = 0.54; p < 0.02). The level of HGF in fetal urine (0.10 ng/ml) and in the first neonatal urine (0.08 +/- 0.02 ng/ml) were much less than that in amniotic fluid. HGF stimulated DNA synthesis of human fetal liver cells in vitro. While the effect was dose dependent, a maximal response was reached with about 0.2 ng/ml, attaining a 1.3-fold stimulation. The presence of extremely high levels of HGF in the amniotic fluid may be involved not in fetal growth, but rather in maturation of fetal organs such as the lung and the digestive tract.

[The levels of aztreonam in the cord bloods and tissues after administration to pregnant women]

The monobactam antibiotic aztreonam (AZT) was administered by intravenous drip infusion to women with intrauterine infections at 6-hour intervals and its concentrations in the maternal blood, umbilical blood, and umbilical tissue were determined at parturition to evaluate its transport to the umbilicus and fetus, and this accumulation in the tissue. Further, umbilical tissue was cultured to detect bacteria and examined histologically to evaluate the efficacy of AZT its treatment of omphalitis. Neither maternal nor umbilical blood showed any signs of drug accumulation, and there was a correlation between maternal and umbilical blood levels of AZT and time lapsed after most recent administration. Umbilical tissue levels of AZT tended to increase with time for about 12 hours after the start of administration, but showed no tendency to further rise thereafter. The umbilical tissue cultures were negative for causative pathogens 12 hours or more after the initial dosing. Histological examination of umbilical tissue was negative for omphalitis 12 hours or more after the start of administration in all but one patient. After the administration of AZT to pregnant women with intrauterine infections, it was detected in the umbilicus and fetus in high concentrations at parturition without appreciable tissue accumulation, newborn infection or adverse reaction. The overall results suggest that AZT is clinical effective when used in the treatment of omphalitis.

[Neonatal EEG findings soon after birth in the intrauterine growth retarded infant]

We performed electroencephalograms in 32 neonates of intrauterine growth retardation (IUGR) within seven days of birth. EEG findings were compared with those observed in neonatal brain damage. Seven EEGs had a dysmature pattern which is seen in the subacute and chronic stages of prolonged and mild neonatal brain depression, and five had a disorganized pattern which is seen in the subacute and chronic stages of severe neonatal brain depression. The other EEGs had a normal neonatal pattern. Seven neonates who had a dysmature pattern were severe IUGR (< or = 2.5 SD). Their head circumference was retarded at birth, and the S/D ratio of the umbilical artery increased, suggesting chronic brain damage in utero. On the other hand, five neonates displaying a disorganized pattern were preterm IUGR (< 37 weeks). They had NST abnormalities. The abnormal EEG pattern observed in IUGR was similar to that observed in postnatally injured neonates. The abnormalities in EEGs are correlated with the degree of later neurological sequelae. The present study suggested that the EEG of IUGR recorded immediately after birth was useful in evaluating their intrauterine environments and postnatal neurological outcome.

Interaction between pregnancy-induced bioactive peptides and the placental proteases

Studies have shown that placental proteases metabolize vasoactive peptides, possibly derived from the fetus, and protect the exchange of peptide hormones across the placenta in order to maintain feto-placental homeostasis. Changes in maternal serum protease activities were useful for monitoring pre-eclampsia and predicting the onset of labour. The study showed that possible role of oxytocinase in the maintenance of gestation and the possible involvement of angiotensinase in the attenuated pressor responses to angiotensin II during pregnancy, respectively. In addition, the ratio of peak systolic over least diastolic pressure (S/D) of uterine or umbilical artery assessed by the Doppler technique was closely correlated with the concentrations of maternal serum proteases in pre-eclampsia, which suggested that placental proteases might control utero-placental circulation via the regulation of concentrations of vasoactive peptides in uteroplacental circulation.

Differential diagnosis of ovarian tumors by transvaginal color-pulse Doppler sonography

To investigate the clinical significance of transvaginal color-pulse Doppler sonography in ovarian tumors, 109 patients were examined at Nagoya University Hospital. Ultrasonographic patterns were classified and the levels of three circulating tumor markers, CA125, CA72-4, and CA19-9, were simultaneously evaluated. In differentiating benign and malignant ovarian tumors, transvaginal color-pulse Doppler and ultrasonographic pattern classification were superior to the tumor markers. Of 49 cases with benign pattern, 45 were benign (91.8%). Of 60 cases with malignant pattern, 24 (40%) were benign and 36 (60%) were malignant or borderline malignant. In this group color-pulse Doppler sonography was the most useful procedure, and sensitivity, specificity, and accuracy were 75.0, 79.2, and 76.7%, respectively. Menopausal status and site of the arterial wave form in the tumor were also important. Transvaginal color-pulse Doppler sonography was a reliable diagnostic method for differentiating ovarian tumors.

Intrauterine growth retardation and fetal distress associated with the excessively long (160 cm) umbilical cord

We present a case report in which we described an abnormally long umbilical cord coiled eight times around the fetal neck. This occurrence was considered to have caused intrauterine growth retardation and fetal distress.

Improvement of ischemic myocardial dysfunction by nisoldipine

We examined the cardioprotective effect of nisoldipine against myocardial dysfunction during ischemia and reperfusion in Langendorff perfused rabbit hearts. Nisoldipine was administered to the hearts before 60 minutes of global ischemia. This agent inhibited the increase of end-diastolic pressure during ischemia and also improved the recovery of left ventricular developed pressure and coronary flow during reperfusion in a concentration-dependent manner. The maximal cardioprotective effect was observed in 10(-8) M nisoldipine. The beneficial effect was associated with an increase of coronary flow during reperfusion. Therefore, both the nisoldipine-increased coronary flow during reperfusion and the inhibition of ischemic contracture by nisoldipine seem to play a crucial role in improving myocardial dysfunction of ischemic-reperfused hearts.

Studies on transmission of hepatitis C virus from mother-to-child in the perinatal period

To elucidate whether breast milk, vaginal discharge and contamination with maternal blood at birth are possible routes of mother-to-child transmission of hepatitis C virus (HCV), we examined HCV RNA in the cord and peripheral blood of infants, and in the blood, vaginal discharge, and breast milk of anti-HCV seropositive mothers. From July 1991 to July 1992, we studied 20 healthy pregnant women, who were seropositive with the Ortho anti-HCV EIA, and their infants. Using a sensitive nested polymerase chain reaction (nested PCR), we investigated the presence or absence of hepatitis C virus in the above-mentioned specimens. Moderate elevation of aspartate aminotransferase (AST) and alanine aminotransferase (ALT) was observed in only one woman in the first and third trimesters. The nested PCR and subsequent Southern hybridization detected 0.5-5.5 copies of HCV c-DNA. HCV RNA was detected in 17/20 blood samples (85%), 7/14 vaginal discharge samples (50%) and 4/10 cord blood samples (40%). However, no HCV RNA was identified in the peripheral blood of infants or breast milk. The mother-to-child transmission of HCV at delivery or via breast milk does not appear to contribute much to maintaining the global HCV reservoir.