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Zhao J, Zhang J, Xu Y, Dong J, Dong Q, Zhao G, Shi Y. Nanotechnological approaches for the treatment of placental dysfunction: recent trends and future perspectives. Nanomedicine (Lond) 2023; 18:1961-1978. [PMID: 37990993 DOI: 10.2217/nnm-2023-0194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2023] Open
Abstract
The transitory placenta develops during pregnancy and mediates the blood flow between the mother and the developing baby. Placental dysfunction, including but not limited to placenta accreta spectrum, fetal growth restriction, preeclampsia and gestational trophoblastic disease, arises from abnormal placental development and can result in significant adverse maternal and fetal health outcomes. Unfortunately, there is a lack of treatment alternatives for these disorders. Nanocarriers offer versatility, including extended circulation, organ-specific targeting and intracellular transport, finely tuning therapeutic placental interactions. This thorough review explores nanotechnological strategies for addressing placental disorders, encompassing dysfunction insights, potential drug-delivery targets and recent strides in placenta-targeted nanoparticle (NP) therapies, instilling hope for effective placental malfunction treatment.
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Affiliation(s)
- Jian Zhao
- Delivery Rooms, Shaoxing Maternity and Child Health Care Hospital, Shaoxing, 312000, China
| | - Jungang Zhang
- General Surgery, Cancer Center, Department of Hepatobiliary and Pancreatic Surgery and Minimally Invasive Surgery, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, 310014, China
| | - Yan Xu
- Medical Research Center, Zhoushan Hospital of Traditional Chinese Medicine Affiliated to Zhejiang Chinese Medical University, Zhoushan, 316000, China
| | - Juan Dong
- Delivery Rooms, Shaoxing Maternity and Child Health Care Hospital, Shaoxing, 312000, China
| | - Qichao Dong
- Delivery Rooms, Shaoxing Maternity and Child Health Care Hospital, Shaoxing, 312000, China
| | - Guoqiang Zhao
- Delivery Rooms, Shaoxing Maternity and Child Health Care Hospital, Shaoxing, 312000, China
| | - Ying Shi
- Center for Reproductive Medicine, Department of Obstetrics, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, 310014, China
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Tsuji M, Maki S, Enomoto N, Okamoto K, Kitamura A, Magawa S, Takakura S, Nii M, Tanaka K, Yodoya N, Tanaka H, Sawada H, Kondo E, Hirayama M, Ikeda T. Fetal Biometric Assessment and Infant Developmental Prognosis of the Tadalafil Treatment for Fetal Growth Restriction. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59050900. [PMID: 37241131 DOI: 10.3390/medicina59050900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 04/12/2023] [Accepted: 05/06/2023] [Indexed: 05/28/2023]
Abstract
Background and Objectives: Tadalafil is expected to treat fetal growth restriction (FGR), a risk factor for stillbirth and neonatal morbidity. This study aimed to evaluate the fetal biometric growth pattern of fetuses with FGR treated with tadalafil by ultrasonographic assessment. Materials and Methods: This was a retrospective study. Fifty fetuses diagnosed with FGR and treated by maternal administration of tadalafil and ten controls who received conventional treatment at Mie University Hospital from 2015 to 2019 were assessed. Fetal biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC), femur length (FL), and estimated fetal weight (EFW) at the start of treatment and at two weeks and four weeks of treatment were mainly assessed by ultrasound examination. The Wilcoxon signed-rank test was used to assess the measures. The Kyoto Scale of Psychological Development (KSPD) was used to assess the developmental prognosis on tadalafil-treated children at 1.5 years of corrected age (CA) and 3 years old. Results: The median gestational age at the start of treatment was 30 and 31 weeks in the tadalafil and control groups, respectively, and the median gestational age at delivery was 37 weeks in both groups. The Z-score of HC was significantly increased at 4 weeks of treatment (p = 0.005), and the umbilical artery resistance index was significantly decreased (p = 0.049), while no significant difference was observed in the control group. The number of cases with an abnormal score of less than 70 on the KSPD test was 19% for P-M, 8% for C-A, 19% for L-S, and 11% for total area at 1.5 years CA. At 3 years old, the respective scores were 16%, 21%, 16%, and 16%. Conclusions: Tadalafil treatment for FGR may maintain fetal HC growth and infants' neuro-developmental prognosis.
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Affiliation(s)
- Makoto Tsuji
- Department of Obstetrics and Gynecology, Mie University Graduate School of Medicine, Edobashi, Tsu 2-174, Mie, Japan
| | - Shintaro Maki
- Department of Obstetrics and Gynecology, Mie University Graduate School of Medicine, Edobashi, Tsu 2-174, Mie, Japan
| | - Naosuke Enomoto
- Department of Obstetrics and Gynecology, Mie University Graduate School of Medicine, Edobashi, Tsu 2-174, Mie, Japan
| | - Kota Okamoto
- Department of Obstetrics and Gynecology, Mie University Graduate School of Medicine, Edobashi, Tsu 2-174, Mie, Japan
| | - Asa Kitamura
- Department of Obstetrics and Gynecology, Mie University Graduate School of Medicine, Edobashi, Tsu 2-174, Mie, Japan
| | - Shoichi Magawa
- Department of Obstetrics and Gynecology, Mie University Graduate School of Medicine, Edobashi, Tsu 2-174, Mie, Japan
| | - Sho Takakura
- Department of Obstetrics and Gynecology, Mie University Graduate School of Medicine, Edobashi, Tsu 2-174, Mie, Japan
| | - Masafumi Nii
- Department of Obstetrics and Gynecology, Mie University Graduate School of Medicine, Edobashi, Tsu 2-174, Mie, Japan
| | - Kayo Tanaka
- Department of Obstetrics and Gynecology, Mie University Graduate School of Medicine, Edobashi, Tsu 2-174, Mie, Japan
| | - Noriko Yodoya
- Department of Pediatrics, Mie University Graduate School of Medicine, Edobashi, Tsu 2-174, Mie, Japan
| | - Hiroaki Tanaka
- Department of Obstetrics and Gynecology, Mie University Graduate School of Medicine, Edobashi, Tsu 2-174, Mie, Japan
| | - Hirofumi Sawada
- Department of Pediatrics, Mie University Graduate School of Medicine, Edobashi, Tsu 2-174, Mie, Japan
| | - Eiji Kondo
- Department of Obstetrics and Gynecology, Mie University Graduate School of Medicine, Edobashi, Tsu 2-174, Mie, Japan
| | - Masahiro Hirayama
- Department of Pediatrics, Mie University Graduate School of Medicine, Edobashi, Tsu 2-174, Mie, Japan
| | - Tomoaki Ikeda
- Department of Obstetrics and Gynecology, Mie University Graduate School of Medicine, Edobashi, Tsu 2-174, Mie, Japan
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Gatford KL, Kaur G, Falcão-Tebas F, Wadley GD, Wlodek ME, Laker RC, Ebeling PR, McConell GK. Exercise as an intervention to improve metabolic outcomes after intrauterine growth restriction. Am J Physiol Endocrinol Metab 2014; 306:E999-1012. [PMID: 24619880 DOI: 10.1152/ajpendo.00456.2013] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Individuals born after intrauterine growth restriction (IUGR) are at an increased risk of developing diabetes in their adult life. IUGR impairs β-cell function and reduces β-cell mass, thereby diminishing insulin secretion. IUGR also induces insulin resistance, with impaired insulin signaling in muscle in adult humans who were small for gestational age (SGA) and in rodent models of IUGR. There is epidemiological evidence in humans that exercise in adults can reduce the risk of metabolic disease following IUGR. However, it is not clear whether adult IUGR individuals benefit to the same extent from exercise as do normal-birth-weight individuals, as our rat studies suggest less of a benefit in those born IUGR. Importantly, however, there is some evidence from studies in rats that exercise in early life might be able to reverse or reprogram the long-term metabolic effects of IUGR. Studies are needed to address gaps in current knowledge, including determining the mechanisms involved in the reprogramming effects of early exercise in rats, whether exercise early in life or in adulthood has similar beneficial metabolic effects in larger animal models in which insulin resistance develops after IUGR. Human studies are also needed to determine whether exercise training improves insulin secretion and insulin sensitivity to the same extent in IUGR adults as in control populations. Such investigations will have implications for customizing the recommended level and timing of exercise to improve metabolic health after IUGR.
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Affiliation(s)
- Kathryn L Gatford
- Robinson Institute and School of Paediatrics and Reproductive Health, University of Adelaide, Adelaide, South Australia, Australia
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Horgan RP, Broadhurst DI, Walsh SK, Dunn WB, Brown M, Roberts CT, North RA, McCowan LM, Kell DB, Baker PN, Kenny LC. Metabolic profiling uncovers a phenotypic signature of small for gestational age in early pregnancy. J Proteome Res 2011; 10:3660-73. [PMID: 21671558 DOI: 10.1021/pr2002897] [Citation(s) in RCA: 91] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Being born small for gestational age (SGA) confers increased risks of perinatal morbidity and mortality and increases the risk of cardiovascular complications and diabetes in later life. Accumulating evidence suggests that the etiology of SGA is usually associated with poor placental vascular development in early pregnancy. We examined metabolomic profiles using ultra performance liquid chromatography-mass spectrometry (UPLC-MS) in three independent studies: (a) venous cord plasma from normal and SGA babies, (b) plasma from a rat model of placental insufficiency and controls, and (c) early pregnancy peripheral plasma samples from women who subsequently delivered a SGA baby and controls. Multivariate analysis by cross-validated Partial Least Squares Discriminant Analysis (PLS-DA) of all 3 studies showed a comprehensive and similar disruption of plasma metabolism. A multivariate predictive model combining 19 metabolites produced by a Genetic Algorithm-based search program gave an Odds Ratio for developing SGA of 44, with an area under the Receiver Operator Characteristic curve of 0.9. Sphingolipids, phospholipids, carnitines, and fatty acids were among this panel of metabolites. The finding of a consistent discriminatory metabolite signature in early pregnancy plasma preceding the onset of SGA offers insight into disease pathogenesis and offers the promise of a robust presymptomatic screening test.
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Affiliation(s)
- Richard P Horgan
- The Anu Research Centre, Department of Obstetrics and Gynaecology, University College Cork, Cork University Maternity Hospital, Cork, Ireland
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Horgan RP, Broadhurst DI, Dunn WB, Brown M, Heazell AEP, Kell DB, Baker PN, Kenny LC. Changes in the metabolic footprint of placental explant-conditioned medium cultured in different oxygen tensions from placentas of small for gestational age and normal pregnancies. Placenta 2010; 31:893-901. [PMID: 20708797 DOI: 10.1016/j.placenta.2010.07.002] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2010] [Revised: 06/11/2010] [Accepted: 07/08/2010] [Indexed: 01/27/2023]
Abstract
Being born small for gestational age (SGA) confers significantly increased risks of perinatal morbidity and mortality. Accumulating evidence suggests that an SGA fetus results from a poorly perfused and abnormally developed placenta. Some of the placental features seen in SGA, such as abnormal cell turnover and impaired nutrient transport, can be reproduced by culture of placental explants in hypoxic conditions. Metabolic footprinting offers a hypothesis-generating strategy to investigate factors absorbed by and released from this tissue in vitro. Previously, metabolic footprinting of the conditioned culture media has identified differences in placental explants cultured under normoxic and hypoxic conditions and between normal pregnancies and those complicated by pre-eclampsia. In this study we aimed to examine the differences in the metabolic footprint of placental villous explants cultured at different oxygen (O(2)) tensions between women who deliver an SGA baby (n = 9) and those from normal controls (n = 8). Placental villous explants from cases and controls were cultured for 96 h in 1% (hypoxic), 6% (normoxic) and 20% (hyperoxic) O(2). Metabolic footprints were analysed by Ultra Performance Liquid Chromatography coupled to an electrospray hybrid LTQ-Orbitrap Mass Spectrometry (UPLC-MS). 574 metabolite features showed significant difference between SGA and normal at one or more of the oxygen tensions. SGA explant media cultured under hypoxic conditions was observed, on a univariate level, to exhibit the same metabolic signature as controls cultured under normoxic conditions in 49% of the metabolites of interest, suggesting that SGA tissue is acclimatised to hypoxic conditions in vivo. No such behaviour was observed under hyperoxic culture conditions. Glycerophospholipid and tryptophan metabolism were highlighted as areas of particular interest.
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Affiliation(s)
- R P Horgan
- Department of Obstetrics and Gynaecology, University College Cork, Cork University Maternity Hospital, The Anu Research Centre, Cork, Ireland.
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Sankaran S, Kyle PM. Aetiology and pathogenesis of IUGR. Best Pract Res Clin Obstet Gynaecol 2009; 23:765-77. [PMID: 19666240 DOI: 10.1016/j.bpobgyn.2009.05.003] [Citation(s) in RCA: 120] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2008] [Revised: 04/02/2009] [Accepted: 05/04/2009] [Indexed: 01/06/2023]
Abstract
Intrauterine growth restriction (IUGR) is a major cause of perinatal mortality and morbidity. A complex and dynamic interaction of maternal, placental and fetal environment is involved in ensuring normal fetal growth. An imbalance or lack of coordination in this complex system may lead to IUGR. Animal studies have given us an insight into some aspects of the basic pathophysiology of IUGR, and recent technologies such as Doppler studies of maternal and fetal vessels have added further information. The aetiologies of IUGR are diverse, involving multiple complex mechanisms, which make understanding of the pathophysiology difficult. However, particular focus is placed on the mechanisms involved in uteroplacental insufficiency as a cause of IUGR, as (1) it is common, (2) outcome can be good if timing of delivery is optimal and (3) it may be amenable to therapy in the future. While the research into the pathophysiology of IUGR continues, there have been interesting discoveries related to the genetic contribution to IUGR and the intrauterine programming of adult-onset diseases attributed to IUGR.
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Affiliation(s)
- Srividhya Sankaran
- Guy's & St Thomas' NHS Foundation Trust, Westminster Bridge Road, London SE1 7EH, UK
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Abstract
Placental insufficiency is a process leading to progressive deterioration in placental function and a decrease in transplacental transfer of oxygen and nutrients to the fetus. The resulting fetal hypoxemia is the major stimulus involved in the reduction in fetal growth as an attempt to reduce metabolic demands by the growing fetus. Fetal growth restriction (FGR) is the second cause of perinatal death after prematurity and can complicate up to 6% of all pregnancies. It is becoming apparent that its occurrence has major impacts on the fetus and placenta with consequences on the cardiovascular, metabolic and neurological development up to adulthood. We are just starting to unveil some of the basic mechanisms involved in this complex adaptation that may lead to reprogramming of fetal organs development mostly the heart, pancreas, lungs and brain. It is becoming clear that future research is needed to develop strategies to improve antenatal detection of FGR, in addition to reduce the risk of abnormal neurodevelopment during childhood, and onset of common diseases in adulthood following pregnancies complicated with placental insufficiency.
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Affiliation(s)
- Robert Gagnon
- Departments of Obstetrics, Gynecology and Physiology, University of Western Ontario, St. Joseph's Health Care London, 268 Grosvenor Street, London, Ont., Canada N6A 4V2.
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