Mechanical and metabolic viability of a placental perfusion system in vitro under oxygenated and anoxic conditions

Maternal body mass index, birthweight, and placental glucose metabolism: evidence for a role of placental hexokinase

BACKGROUND

The principal fetal energy source is glucose provided by the placental transfer of maternal glucose. However, the placenta's glucose consumption exhibits considerable variation. Hexokinase is the first and one of the rate-limiting enzymes of glycolysis that phosphorylates glucose to glucose-6-phosphate. The role of placental hexokinase activity in human placental glucose metabolism is unknown.

OBJECTIVE

This study aimed to test the hypothesis that placental hexokinase activity is related to maternal body mass index, placental glucose uptake and consumption, and birthweight.

STUDY DESIGN

Overall, 67 healthy pregnant participants at term were included in this study at Oslo University Hospital, Oslo, Norway. Placental hexokinase activity was measured by using a colorimetric assay. The mass of glucose taken up by the uteroplacental unit and the fetus was obtained by measuring arteriovenous glucose differences combined with Doppler assessment of uterine and umbilical blood flow. Blood samples were obtained from the maternal radial artery, uterine vein, and umbilical artery and vein. The uteroplacental glucose consumption constituted the difference between uteroplacental and fetal glucose uptakes. The Spearman rank correlation was performed for statistical analyses to study the correlation of placental hexokinase activity (milliunit per milligram of protein) with prepregnancy body mass index, maternal glucose and insulin, birthweight, uteroplacental glucose uptake and consumption, and fetal glucose uptake (micromole per minute). Partial rank correlation analysis was performed when controlling for hours of fasting or placental weight.

RESULTS

Hexokinase activity was detectable in all placental tissue samples. The mean activity was 19.6 (standard deviation, 4.64) mU/mg protein. Placental hexokinase activity correlated positively with prepregnancy body mass index (Spearman rho=0.33; P=.006). On controlling for hours of fasting, hexokinase activity showed positive correlations with both maternal glucose (r=0.30; P=.01) and insulin (r=0.28; P=.02). Hexokinase activity was positively correlated with uteroplacental glucose uptake (Spearman rho=0.31; P=.01) and consumption (Spearman rho=0.28; P=.02). Hexokinase activity did not correlate with fetal glucose uptake. On controlling for placental weight, hexokinase activity showed a positive correlation with birthweight (r=0.31; P=.01).

CONCLUSION

Our findings suggest that placental hexokinase, being crucial for uteroplacental retention of glucose for disposition, is related to both maternal body mass index and birthweight independent of placental weight. Placental hexokinase may play a central role in the relationship between maternal glucose dysregulation and fetal growth. Thus, the current study supports the need to develop clinically useful tools to assess the metabolic properties of the placenta.

Transplacental transport of paracetamol and its phase II metabolites using the ex vivo placenta perfusion model

In Europe, 50-60% of pregnant women uses paracetamol (PCM), also known as acetaminophen. While it was considered to be safe, recent studies have shown an association between prenatal exposure to PCM and increased incidences of autism, cryptorchidism, asthma and ADHD. In this study the transplacental transfer of PCM and its metabolites was investigated using an ex vivo human placenta perfusion model (closed circuit; n = 38). Maternal-to-foetal (M-F) and foetal-to-maternal (F-M) transplacental transfer was determined at a concentration correlating with the maximum and steady state concentration in normal clinical use. Antipyrine (AP) was added as reference compound. Samples of the foetal and maternal perfusion medium were taken until 210 (PCM) or 360 min (paracetamol sulphate (PCM-S) and paracetamol glucuronide (PCM-G). PCM and AP concentrations reached an equilibrium between foetal and maternal compartments within the duration of the perfusion experiment and irrespective of the transfer direction. The percentage placental transfer of PCM was 45% (M-F and F-M). For PCM-S, transfer was 39% (M-F) and 28% (F-M), while the PCM-G transfer was 34% (M-F) and 25% (F-M). During placenta perfusions with the metabolites slight conversion (3.5-4.1%) to PCM was observed. In conclusion, PCM crosses the placental barrier rapidly via passive diffusion. Differences in flow rate and villous placental structure explain the significantly faster M-F transfer than F-M transfer of PCM. The larger and more hydrophilic molecules PCM-S and PCM-G cross the placenta at a significantly lower rate. Moreover, their F-M transport is about 40% slower than M-F transport, suggesting involvement of a transporter.

Soluble Fms-Like Tyrosine Kinase-1 Alters Cellular Metabolism and Mitochondrial Bioenergetics in Preeclampsia

Preeclampsia is a maternal hypertensive disorder that affects up to 1 out of 12 pregnancies worldwide. It is characterized by proteinuria, endothelial dysfunction, and elevated levels of the soluble form of the vascular endothelial growth factor receptor-1 (VEGFR-1, known as sFlt-1). sFlt-1 effects are mediated in part by decreasing VEGF signaling. The direct effects of sFlt-1 on cellular metabolism and bioenergetics in preeclampsia, have not been established. The goal of this study was to evaluate whether sFlt-1 causes mitochondrial dysfunction leading to disruption of normal functioning in endothelial and placental cells in preeclampsia. Endothelial cells (ECs) and first-trimester trophoblast (HTR-8/SVneo) were treated with serum from preeclamptic women rich in sFlt-1 or with the recombinant protein. sFlt-1, dose-dependently inhibited ECs respiration and acidification rates indicating a metabolic phenotype switch enhancing glycolytic flux. HTR-8/SVneo displayed a strong basal glycolytic metabolism, remaining less sensitive to sFlt-1-induced mitochondrial impairment. Moreover, results obtained in ECs exposed to serum from preeclamptic subjects demonstrated that increased sFlt-1 leads to metabolic perturbations accountable for mitochondrial dysfunction observed in preeclampsia. sFlt-1 exacerbated mitochondrial reactive oxygen species (ROS) formation and mitochondrial membrane potential dissipation in ECs and trophoblasts exposed to serum from preeclamptic women. Forcing oxidative metabolism by culturing cells in galactose media, further sensitized cells to sFlt-1. This approach let us establish that sFlt-1 targets mitochondrial function in ECs. Effects of sFlt-1 on HTR-8/SVneo cells metabolism were amplified in galactose, demonstrating that sFlt-1 only target cells that rely mainly on oxidative metabolism. Together, our results establish the early metabolic perturbations induced by sFlt-1 and the resulting endothelial and mitochondrial dysfunction in preeclampsia.

Differential expression of calcium transport channels in placenta primary cells and tissues derived from preeclamptic placenta

Preeclampsia is a pregnancy-specific disease characterized by hypertension, proteinuria, and oxidative stress in the placenta. During the last trimester of gestation, calcium (Ca(2+)) transport from mother to fetus increases dramatically in response to the increased demand for Ca(2+) caused by bone mineralization in the fetus. Ca(2+) supplementation can significantly reduce the incidence and severity of preeclampsia or delay its onset. Ca(2+) transport channels (CTCs) include transient receptor potential vanilloid 6 (TRPV6), plasma membrane Ca(2+) ATPase (PMCA1), and Na(+)/Ca(2+) exchangers (NCKX3 or NCX1). We hypothesized that trans-placental Ca(2+) exchange in preeclamptic trophoblasts may be compensated for successful fetal bone mineralization. The roles of cell membrane channels (TRPV6, PMCA1, NCKX3 and NCX1) were examined in placental primary cells and in normotensive and preeclamptic placentas. The biomarker gene for preeclampsia, soluble fms-like tyrosine kinase-1 (sFLT1) or marker for oxygen-sensitive gene, hypoxia-sensitive inducible factor 1α (HIF-1α), were up-regulated in the preeclamptic placentas and hypoxic cells. The detection of sFLT1 and HIF-1α genes demonstrated that our experimental conditions were suitable to verify a preeclamptic condition. In women experiencing preterm labor, CTC expressions was found to be increased in the fetal and maternal regions of the preeclamptic placenta compared to the observed in normotensive placenta. During term labor, TRPV6 and PMCA1 were highly expressed in the fetal and maternal sections of preeclamptic placenta, while the expression of NCKX3 and NCX1 was reduced. In addition, the expression of CTCs was altered in hypoxia-stressed placental cells. Taken together, our findings demonstrated that the expression of CTCs was regulated by hypoxia stress in placenta tissues and cells, suggesting that our experimental in vitro hypoxic conditions were similar to those of preeclampsia. Furthermore, impaired Ca(2+) metabolism found in preeclamptic syncytiotrophoblasts was resulted from hypoxic stress, which may induce expression of Ca(2+) transport proteins in the placenta to maintain the balance between maternal and fetal Ca(2+) demand during pregnancy.

Placental metabolic reprogramming: do changes in the mix of energy-generating substrates modulate fetal growth?

Insufficient oxygen leads to the cessation of growth in favor of cellular survival. Our unique model of high-altitude human pregnancy indicates that hypoxia-induced reductions in fetal growth occur at higher levels of oxygen than previously described. Fetal PO(2) is surprisingly high and fetal oxygen consumption unaffected by high altitude, whereas fetal glucose delivery and consumption decrease. Placental delivery of energy-generating substrates to the fetus is thus altered by mild hypoxia, resulting in maintained fetal oxygenation but a relative fetal hypoglycemia. Our data point to this altered mix of substrates as a potential initiating factor in reduced fetal growth, since oxygen delivery is adequate. These data support the existence, in the placenta, of metabolic reprogramming mechanisms, previously documented in tumor cells, whereby HIF-1 stimulates reductions in mitochondrial oxygen consumption at the cost of increased glucose consumption. Decreased oxygen consumption is not due to substrate (oxygen) limitation but rather results from active inhibition of mitochondrial oxygen utilization. We suggest that under hypoxic conditions, metabolic reprogramming in the placenta decreases mitochondrial oxygen consumption and increases anerobic glucose consumption, altering the mix of energy-generating substrates available for transfer to the fetus. Increased oxygen is available to support the fetus, but at the cost of less glucose availability, leading to a hypoglycemia-mediated decrease in fetal growth. Our data suggest that metabolic reprogramming may be an initiating step in the progression to more severe forms of fetal growth restriction and points to the placenta as the pivotal source of fetal programming in response to an adverse intrauterine environment.

Amniotic fluid amino acid concentrations are modified by maternal dietary glucose, gestational age, and fetal growth in rats

Amniotic fluid (AF) contains free amino acids that enter via transplacental and transmembranous routes from maternal sources; subsequently, the developing fetus "ingests" these amino acids early in gestation through unkeratinized skin and later through continuous AF swallowing. Our objectives were as follows: 1) to determine whether a restriction of maternal dietary glucose modulates the free AF amino acid pool, and 2) to establish whether any diet-induced changes were predictive of fetal weight near term (d 21.5). To produce varying in utero growth rates, pregnant rat dams were fed varying levels of glucose (0, 12, 24, 60%) throughout pregnancy. AF samples, collected on gestational days 18-21, were precolumn derivatized by 9-fluorenylmethyloxychloroformate to produce stable primary and secondary amino acid derivatives required for HPLC detection at low amino acid concentrations. Eighteen amino acids were identified. A 2-way ANOVA with main effects of diet (< or =12% and > or =24% glucose) and gestational age (d 18/19 and 20/21) showed that 2 AF amino acids, methionine and phenylalanine, and 12 AF amino acids were independently modified by diet and gestational age, respectively. Of note were the 364% increase in AF methionine and the constant decline in AF taurine as both gestational age lengthened and fetal weight increased. Multiple regression demonstrated that in addition to methionine, 3 specific AF amino acids, cysteine, lysine, and tyrosine, predicted fetal weight. These results demonstrate that the AF amino acid pool can be modified by the glucose content of the maternal diet and that specific AF amino acids are associated with gestational age and fetal growth.

Human placental glucuronidation and transport of 3'azido-3'-deoxythymidine and uridine diphosphate glucuronic acid

These studies were performed to characterize the contribution of the uridine diphosphate glucuronosyltransferase (UGT) enzymes to the clearance of 3'-azido-3'-deoxythymidine (AZT) in vivo and to assess the regulation of UGT activity [including the disposition of the cofactor uridine diphosphate glucuronic acid (UDPGA)] in the placenta. Transport of AZT and the cofactor UDPGA across the human placenta and the glucuronidation capacity of the placenta for AZT were assessed using a human placental cell line (JEG-3), primary cultures of villous term placenta, placental subcellular fractions, and a recirculating perfusion model. Glucuronidation of AZT was consistently observed at approximately 2% of the dose administered. High levels of AZT in cultured primary placental cells and lines caused autoinhibition of AZT metabolism. AZT crossed the perfused placenta in a bidirectional fashion and was at equilibrium after 3 h, whereas the AZT-glucuronide metabolite was excreted preferentially into the maternal compartment. In contrast, UDPGA (10 microM) was rapidly transferred from the maternal to the fetal circulation, being complete after 4 h of perfusion. AZT is transported and glucuronidated by the human placenta, but that placental metabolism of the drug is not significant for whole-body clearance. Likewise therapeutic failure of AZT (5-15%) is not due to placental obstruction of drug passage. Finally, the activity of the UGT enzymes in the placenta is not rate-limited by the supply of UDPGA cofactor, whereas the preferential transport of UDPGA toward the fetus observed here may indicate a role in fetal development.

Transepithelial glucose transport and metabolism in BeWo choriocarcinoma cells

Glucose transporters in the placental, epithelial syncytiotrophoblast barrier are asymmetrically arranged (microvillous>basal), leading to the hypothesis of a rate-limiting role for the basal membrane in transepithelial transport. This is significant since the changes which have been observed in basal membrane glucose transporter expression over gestation and in conditions such as diabetes would generate changes in maternal-to-foetal glucose transport. This study was designed to test whether the basal membrane of the syncytiotrophoblast is the rate-limiting step in transepithelial transport and to investigate the effects of metabolism on transpithelial transport. In the absence of a transporting syncytiotrophoblast monolayer, the BeWo choriocarcinoma cell line, derived from trophoblast and plated on a permeable support, was used as a model since it has an asymmetric distribution of glucose transporter activity, similar to the syncytiotrophoblast. Inhibition of basal membrane glucose transport with p -chloromercuribenzene-sulfonate (p CMBS) produced a proportional change in transepithelial transport, whereas this latter parameter was relatively insensitive to inhibition of microvillous membrane glucose transporters. These data demonstrate that the basal membrane is the rate-limiting step in transepithelial glucose transport. Experiments involving stimulation and inhibition of cellular glucose consumption demonstrated that there is a single intracellular glucose pool in BeWo cells, supplying both metabolism and transcellular transport.

Placental oxygen consumption. Part II: in vitro studies--a review

The human placenta in vivo consumes large amounts of oxygen. After delivery the placenta is exposed to anoxia and under in vitro experimental conditions oxygen consumption is only a fraction of in vivo estimates. In spite of a reduced oxygen supply, structural and functional integrity of the tissue is surprisingly well preserved. Special metabolic adjustments in the sense of 'partial metabolic arrest' may be the explanation for a remarkable survival capacity of placental tissue and reduction of protein synthesis seems to be an important component of metabolic slowdown. The potential significance of this special feature of placental metabolism for the in vivo situation is discussed.

Protein transport across the in vitro perfused human placenta

PROBLEM

Placental transport of various proteins present in human serum, such as immunoglobulins (IgG, IgA), specific anti-tetanus IgG (anti-TT-IgG), and tetanus toxoid-antigen (TT-AG), was investigated. In addition, the transport of IgG modified with biotin (IgG-BT) and 14C-bovine serum albumin (14C-BSA, a permeability marker for macromolecules), was assessed.

METHOD OF STUDY

During the perfusion of an isolated cotyledon from human term placenta the perfusate was recirculated on both maternal and fetal sides. After an initial stabilisation phase of 2 hr (control phase), media on both sides were exchanged and perfusion was continued comparing two different conditions (experimental phase). In the first group (control experiments [A, n = 3]), no test proteins were added during the experimental phase (4-6 hr). In the second group (B, n = 5), during the experimental phase (6 hr) the maternal perfusion medium contained IgG (Sandoglobuline, 6-10 g/L), anti-TT-IgG (21-25 mg/L), TT-AG (0.19-0.24 mg/L), and IgA (0.13-0.19 g/L). IgG-BT (2 g/L) and 14C-BSA (30-40 nCi/ml) were added to the medium on the maternal side. IgGs and TT-AG were determined by specific enzyme-linked immunosorbent assay.

RESULTS

Both groups showed stable metabolic conditions with constant rates of glucose consumption, lactate production, and hormone (human chorionic gonadotropin, human placental lactogen) release observed throughout the experiment. Washout levels of endogenous IgG and IgA observed in the maternal circuit at the end of the control period were 5 and 1000 times higher than in the fetal circuit. In the experimental phase these levels remained constant at 50-80% of control levels with no change in the last 4 hr of perfusion (group A). In group B, with addition of extra proteins, trace amounts of IgG-BT, IgA, and 14C-BSA were detectable in the fetal circuit within 1 hr, with no significant further increase in circulating levels in the following 4 hr of the perfusion. In contrast, the detection of IgGs in the fetal circuit was delayed by 2 hr; thereafter, a continuous linear increase was observed for all IgGs. TT-AG in fetal perfusate was below the detection limit. TT-AG was found on the fetal side only after ultrafiltration of samples obtained at the end of the experiment. For permeability comparison, the ratio between concentrations on the fetal and maternal side multiplied by 100 ([F:M] x 100), as detected after 6 hr of perfusion, was assessed (n = 5, mean +/- SD). Labelling of IgG with biotin (IgG-BT) reduced its placental transfer by a factor 10 (0.04 +/- 0.01) when compared with the natural IgG (0.49 +/- 0.08) or the specific antibody (anti-TT-IgG). The relative fetal-to-maternal ratio found for TT-AG (0.48 +/- 0.12) was similar to anti-TT-IgG (0.46 +/- 0.11), and approximately 4 and 50 times that of 14C-BSA (0.12 +/- 0.03) and IgA (0.01 +/- 0.01), respectively. Considering that the molecular weights of TT-AG and anti-TT-IgG were at least twice that of BSA and similar to IgA, the difference in transfer suggests a specific mechanism of transport.

CONCLUSIONS

Compared with other proteins there is a significantly increased transfer of IgGs across the in vitro perfused human placenta from the maternal to the fetal side, indicating a specific transport mechanism. The similarity in transfer of anti-TT-IgG and tetanus antigen may suggest the transport as antibody-antigen complex.

Microvillous membrane potential (Em) in villi from first trimester human placenta: comparison to Em at term

The microvillous membrane (MVM) potential (Em) of first trimester human placental villi was measured and compared with that in villi from term human placentas. The median Em in first trimester villi (-28 mV) was significantly more negative than that at term (-21 mV; P < 0.001). The median Em measured in villi from early (weeks 6-11) first trimester (-32 mV) was significantly more negative than that in late (weeks 12 and 13) first trimester villi (-24 mV; P < 0.001). Elevating extracellular KCl concentration induced a significant depolarization of Em in both first trimester and term villi (P < 0.05 and P < 0.001, respectively). The magnitude of this depolarization was greater in first trimester than at term, indicating that the ion conductance of the MVM changes with gestation. Exposure to ouabain induced a significant depolarization of Em (3 mV: P < 0.05) in first trimester villi but had little effect at term. These results suggest that microvillous membrane electrophysiology changes with placental development. An alteration in the relative K+:Cl- conductance of the MVM is likely to be a major contributor to the change in the magnitude of Em.

The effect of hypoxia on human trophoblast in culture: morphology, glucose transport and metabolism

The response to hypoxia of trophoblast isolated from term placenta and maintained in culture was studied. Trophoblast exposed to normoxic (PO2 120-130 mmHg) or hypoxic (PO2 12-14 mmHg) conditions were examined by electron microscopy. After 48 h, the cytoplasm of the hypoxic cells was more electron-dense with increased numbers of mitochondria, lysosomes and vacuoles. Compared to normoxic cells, the surface microvilli of the hypoxic cells were sparse, short and unevenly distributed. [3H]thymidine incorporation by both hypoxic and normoxic trophoblast fell rapidly and equivalently after 2 days in culture. The percentage of cells with the proliferation-associated nuclear antigen, Ki 67, also decreased, but remained higher in hypoxic cells suggesting that hypoxia retarded completion of the cell cycle (normoxia, 10.80 +/- 2.51 s.e.; hypoxia, 19.87 +/- 2.73, P < 0.01). Glucose consumption was elevated in hypoxia (3.73 +/- 1.07 s.e. mumol/10(6) cells/24 h) as compared to normoxia (1.46 +/- 0.83, P = 0.01). Although lactate production was consistently higher in hypoxia, the difference was not statistically significant (hypoxia 5.38 +/- 1.54 mumol/10(6) cells/24 h versus normoxia, 1.52 +/- 0.29, P = 0.07). After 48 h, uptake of [3H]2-deoxglucose ([3H]2DG) by hypoxic cells was reduced to 12 per cent +/- 4.3 s.e. of that in normoxic cells; return to normoxia resulted in recovery within 10 min. Lineweaver-Burk plots of [3H]2DG uptake indicated high affinity (KM 2.2 +/- 0.4 x 10(-4) M) and low affinity transporters (KM 4.5 +/- 1.6 x 10(-3) M). Northern blot analysis identified mRNA for GLUT1 and GLUT3. In hypoxia, steady-state GLUT1 and GLUT3 mRNA were approximately three- and 10-fold higher than in normoxia respectively. Inhibitors of oxidative metabolism of glucose increased the uptake of [3H]2DG within 2 h, whereas hypoxia reduced uptake. Hence, trophoblast in culture survives in extreme hypoxia, but manifests striking changes in morphology and in glucose metabolism and transport. Completion of cell cycle appears to be retarded.

O2 consumption in the in-vitro fetal side human placenta

The relative dependence of placental O2 consumption (MO2) on O2 supply (SupO2) parameters, and the fraction of aerobic O2 utilization, was studied by in-vitro perfusion of the fetal side of term human placental lobes. Placental MO2 was a function of the combined effect of SupO2 parameters (PO2, perfusate flow rate, perfusate effective O2 solubility) and not of each separately. At SupO2 greater than 800 microliters/(min.lobe), MO2 saturated at 260 microliters/(min.lobe). No accumulation of O2 debt could be detected even after 2 h anoxia. Adding CN- or CO to perfusate did not abolish MO2, and a residual MO2 of 31-37% of control MO2 was measured. In its MO2, the placenta is a typical conformer tissue. This conformity enables conservation of O2 transfer to the embryo even when placental SupO2 is radically reduced. Only about 60-70% of placental MO2 is utilized in the aerobic respiratory pathway, while about 30-40% of the oxygen is used in other pathways.

Determinants of placental drug transfer: studies in the isolated perfused human placenta

There is little information on the effects of maternal and fetal placental blood flow rates, which can change independently, on the placental transfer rate of drugs of different placental permeabilities. We examined the effects of varying maternal and fetal perfusion flow rates on the placental transfer of three model compounds; antipyrine (high permeability), diclofenac (intermediate permeability), and cimetidine (low permeability) in the single-pass, dual-perfused lobule of the isolated human placenta. In variable flow ratio experiments (n = 9) fetal perfusate flow rate was held constant while a different maternal flow rate was used in each of five 25-min phases such that the maternal/fetal flow ratio ranged from 0.16 to 3.3. In constant flow ratio experiments (n = 4), the flow ratio was kept at 2.0, while maternal and fetal flow rates were varied from 4-18 and 2-9 mL/min, respectively. In the variable flow ratio experiments, the fetal transfer fraction (fetal venous/maternal arterial drug concentrations) varied approximately fivefold among the five phases for each of the three drugs. Therefore, placental transfer was flow dependent regardless of placental drug permeability. By contrast, in the constant flow ratio experiments, fetal transfer fraction was unchanged throughout the five phases for each of the three drugs. Of the various kinetic models that have been formulated to account for the different possible vessel geometries, the double pool flow model, which is a venous equilibrium model and predicts the least efficient drug transfer rate of those proposed, together with a small maternal arteriovenous shunt, produced the best fit overall.(ABSTRACT TRUNCATED AT 250 WORDS)

Markers of physical integrity and metabolic viability of the perfused human placental lobule

1. Peripheral lobules of term placentae obtained from healthy females at Caesarian section were perfused using separate maternal and fetal circulations for 6 h periods under either oxygenated or anoxic conditions. 2. Markers of physical integrity during setting-up and initial perfusion were establishment of dual perfusion within 25 min of placental delivery, pressure in the fetal capillary network less than 40 mmHg, leakage of perfusate from fetal to maternal compartments less than or equal to 2 ml/h, and overlap of maternal with fetal perfusion as indicated visually by appropriate blanching and verified by a fetal artery to vein oxygen gradient of greater than or equal to 90 mmHg. 3. Post-perfusion markers of metabolic viability were most reliably indicated by glucose consumption (oxygenated 7.8 +/- 1.5, anoxic 17.7 +/- 1.2 mmol/kg per h), lactate production (oxygenated 8.5 +/- 1.4, anoxic 33.9 +/- 2.5 mmol/kg per h) and human placental lactogen production (oxygenated 41.2 +/- 9.8, anoxic 12.2 +/- 3.4 mg/kg per h).

Observations on the energy and redox state and protein synthetic rate in animal and human placentas

The energy and redox states of placentas in newly anesthetized or sacrificed guinea pigs and sheep were compared with that of human placentas immediately after delivery. Subsequently the effect of ischemia was observed in both human and animal placentas. The influence of perfusion, using a fluid containing oxygenated red cells (adult human) was studied in the human placenta. Adenine nucleotide precursors were added to the perfusion fluid in an attempt to improve the energy and redox states and the mixed protein synthetic rate of the tissue. The ATP and lactate concentrations in guinea pig placental tissue taken immediately after nembutal anesthesia were 1.16 and 3.59 mmol kg-1 wet weight respectively. One minute's ischemia caused a fall in ATP to 0.7 and a rise in lactate to 6.5 mmol kg-1. The concentration of ATP in human placental tissue, 30 secs to 3 minutes after delivery of the organ, was 0.52 and of lactate 4.8 mmol kg-1 wet weight, suggesting that some biochemical deterioration had already occurred. A further fall in ATP to 0.21 and rise in lactate to 6.4 mmol kg-1 wet weight took place during 20 mins of ischemia; thereafter the ATP level remained constant while the lactate continued to rise to 11 mmol kg-1 wet weight by 1 1/2 hours. The initial energy charge was similar in both animal and human placentas, 0.8-0.9, and was only reduced during prolonged hypoxia at 37 degrees C. Since the AMP did not rise to the same extent as in other tissues, it is suggested that the Atkinson equation used in the calculation of energy charge may not be applicable to the placenta, and that the most sensitive indication of deterioration in energy status is the swift fall in ATP concentration. Rapid establishment of maternal intervillous perfusion of an isolated lobule of the human placenta using ixygenated RBCS in the perfusion fluid, enabled the ATP and lactate levels to be maintained near to 'in vivo' values during one hour, with a protein turnover rate of 40% day-1, two thirds of that observed 'in vivo' in the sheep. The addition of 1.0-50 microM adenosine to the perfusion fluid improved the energy state of the tissue, but not its redox state nor protein synthetic rate. 1.5 microM inosine in the perfusion medium did not alter the energy state but caused a marked reduction in lactate production.

Calcium transport across the isolated dually perfused human placental lobule

1. Movements of 45Ca and 3H2O in maternal to fetal (M----F) and fetal to maternal (F----M) directions across the dually perfused isolated human placental lobule were measured under steady-state conditions. 2. M----F values of the clearances (CR) and extractions (ER) of 45Ca relative to 3H2O were 0.371 +/- 0.056 and 0.492 +/- 0.086 (mean +/- S.E. of mean) respectively. The corresponding values for F----M movements were 0.277 +/- 0.017 and 0.251 +/- 0.010 respectively. The F----M perfusion flow ratio (QF/QM) was 0.34 +/- 0.01 throughout. Comparison with previously published data indicated a significant degree of membrane limitation to Ca transfers. 3. There was evidence of a mismatch between tissues receiving a fetal and those receiving a maternal perfusion. 4. The relative extraction ER was markedly and reversibly enhanced when perfusate total Ca was reduced from 2.4 to 0.1 mM. The effect was present in both M----F and F----M transfers and provided evidence for carrier-mediated uptake of Ca on both aspects of the placental barrier. Small and transient decreases in the relative clearance CR were observed on changing from 2.4 to 0.1 mM-Ca in M----F and to a lesser extent F----M transfers while transient increases were seen on changing from 0.1 back to 2.4 mM-Ca. 5. Measurement of net changes in Ca levels in closed-circuit studies indicated a significant release of both ionized (Ca2+) and total (CaT) Ca into the fetal perfusate at total Ringer solution concentrations of 1.4, 1.9 and 2.4 mM-Ca. Release of Ca into the maternal circuit was also observed using 1.4 mM-Ca Ringer solution but when 1.9 and 2.4 mM-Ca Ringer solution was used a net uptake occurred. 6. These findings strongly suggest that mechanisms by which Ca is transferred from M----F circulations in vivo are at least partly preserved in the in vitro human placental preparation. They indicate that this preparation is suitable for the study of these mechanisms and their regulation by hormonal and other factors.

Measurement of unidirectional transplacental flux: a simplified method

A simple method for determining unidirectional transplacental flux in the in vitro perfusion (transfer factor analysis) has been derived from a general treatment of non-compartmental analysis describing transfer between two accessible pools. This method was validated by comparison of the unidirectional transfer fractions for Evans Blue in a two-pool hydraulic model with the true transfer fractions determined from the pump flow rates in the model. There was excellent agreement between calculated and true transfer fractions. Transfer fractions obtained using this method were also compared to the fractions determined by a previously described technique, deconvolution analysis, for a hydraulic model in which a third, inaccessible pool was interposed between the two accessible pools. Good agreement was found between the two methods. Similar agreement was found for the fractional transfer of [14C]L-lactate in the in vitro perfused human placenta, calculated using transfer factor and deconvolution analysis. The sample collection and data processing are much simpler using the former method but the quality of information obtained is reduced accordingly.

Condition and performance of the perfused human placental cotyledon

The perfused human placental cotyledon was examined with respect to its viability, metabolic state, and performance. During the ischemic period before the start of perfusion, tissue adenosine triphosphate concentration and other measures of energy state fell rapidly to about half of the estimated in vivo value. During the subsequent perfusion, energy levels remained relatively stable but did not recover appreciably toward in vivo values. A very low transplacental leakage of inulin and a small cellular potassium loss indicate relative intactness of membrane function, but there were differences from the in vivo state in levels and balance of metabolic regulators adenosine triphosphate, adenosine monophosphate, and adenosine triphosphate/adenosine monophosphate ratio, and a more reduced cytoplasmic reduced nicotinamide adenine dinucleotide/ionized nicotinamide adenine dinucleotide couple. However, rates of oxygen and glucose consumption and lactate production and the maintenance of physiologic upward maternal-to-fetal concentration gradients of amino acids lead us to conclude that despite differences in energy and metabolic states the perfused cotyledon remains substantially intact and functions in certain respects comparably with the in vivo state.

Lactate transfer across the perfused human placenta

The transfer of lactate across the human placenta was investigated using an in vitro dually-perfused placental preparation. Using a novel technique, the unidirectional flux of L-lactate was found to be linearly dependent on L-lactate concentration. In addition, unidirectional transfer rates were found to be the same in both maternal-to-fetal and fetal-to-maternal directions at the same lactate concentration. Transfer of [14C]L-lactate was decreased by approximately 15 per cent in competition with unlabelled L-lactate. Stereospecificity and permeability experiments demonstrated the existence of a transfer mechanism which could distinguish between the L- and D-isomers of lactate. Our data suggest that, while a stereospecific carrier for lactate exists in the perfused placenta, the bulk of transplacental lactate transfer takes place by non-carrier-mediated diffusion.

Human placental mitochondrial respiration and its regulation by adenine nucleotides

Respiratory parameters were studied in mitochondria from human placenta. Respiratory control and ADP/O ratios were low in this preparation. The adenine nucleotide content of placental mitochondria was found to be only one quarter of that found for adult uterine muscle tissue mitochondria prepared in the same way. Loading placental mitochondria with adenine nucleotides by incubation in the presence of ATP produced increased respiratory control ratios but no improvement in ADP/O ratios. Our evidence is consistent with the developmental changes shown to occur in rat liver, in which an increased concentration of adenine nucleotides is responsible for changes in respiratory parameters.

A new method for measuring unidirectional transplacental flux

A new method for measuring unidirectional transplacental flux has been developed. Unlike indicator-dilution techniques, it does not depend on the use of a second reference tracer to study the substance of interest, nor on assumptions that the placenta can be modelled as a series of long, parallel, tubular capillaries. The only assumptions required are that the placenta behaves as a linear, time-invariant system and does not distinguish between tracer and tracee. The method was validated by measuring unidirectional flux rates of Evans Blue dye in an hydraulic model in which the true flux rates were controlled by peristaltic pumps. There was excellent agreement between the calculated and true flux rates. A preliminary experiment was carried out in vitro using a dually perfused human placenta to measure the unidirectional flux rates of L-lactate. At a steady state lactate concentration of 25.5 mM, maternal to foetal flux rate was 30.1 mumol min-1 and foetal to maternal flux rate was 34.0 mumol min-1, in agreement with measurements reported by other workers.

Long-term culture of human trophoblast cells

A technique is presented for the preparation of cultures of replicating human trophoblast cells from term placentas. The adherent cells obtained were very slow growing (doubling time 12.5 days) as measured by the rate of increase in cell protein, [14C]-leucine uptake and cell number. Cells from individual placentas have been maintained in continuous culture for up to 1 year (10-12 passages) and have been successfully recultured after storage in liquid nitrogen. Cultured cells showed positive immunofluorescent staining for human placental lactogen, human chorionic gonadotrophin, transferrin and type IV collagen. The adenine nucleotide content indicated that energetically the cells were in balance even after prolonged culture.

Permeability of the human placenta to bicarbonate: in-vitro perfusion studies

The effect of maternal acidosis on fetal acid-base balance was studied in a dual circuit perfusion of a single cotyledon in normal, term, human placentas. Both the fetal and maternal (intervillous) circulations were perfused with a Krebs-Ringer solution adjusted to pH values between 7.35 and 7.45. After a control period, the perfusate in the maternal circulation was replaced by an acidified medium (mean pH 7.06) for 30 min. This was followed by a second control period of 30 min during which the acidified maternal perfusate was replaced with the original medium. During the 30 min of maternal acidosis, fetal vein pH was not significantly altered despite the large decrease in maternal artery pH, but there was an efflux of total CO2 (tCO2) from the placenta into the maternal circulation which was not matched by an influx of tCO2 from the fetal circulation. The tCO2 transferred was in the form of bicarbonate rather than dissolved CO2, but the maximal rate of tCO2 transfer of in the form of bicarbonate was lower than the rate of placental transfer of tCO2 necessary in vivo. It is probable therefore that bicarbonate does not play a major role in placental CO2 transfer but the placental tissue bicarbonate pool may play an important part in buffering the fetus against changes in maternal pH or blood gas status.