Transfer across perfused human placenta. 3. Effect of chain length on transfer of free fatty acids

The lipase cofactor CGI58 controls placental lipolysis

In eutherians, the placenta plays a critical role in the uptake, storage, and metabolism of lipids. These processes govern the availability of fatty acids to the developing fetus, where inadequate supply has been associated with substandard fetal growth. Whereas lipid droplets are essential for the storage of neutral lipids in the placenta and many other tissues, the processes that regulate placental lipid droplet lipolysis remain largely unknown. To assess the role of triglyceride lipases and their cofactors in determining placental lipid droplet and lipid accumulation, we assessed the role of patatin like phospholipase domain containing 2 (PNPLA2) and comparative gene identification-58 (CGI58) in lipid droplet dynamics in the human and mouse placenta. While both proteins are expressed in the placenta, the absence of CGI58, not PNPLA2, markedly increased placental lipid and lipid droplet accumulation. These changes were reversed upon restoration of CGI58 levels selectively in the CGI58-deficient mouse placenta. Using co-immunoprecipitation, we found that, in addition to PNPLA2, PNPLA9 interacts with CGI58. PNPLA9 was dispensable for lipolysis in the mouse placenta yet contributed to lipolysis in human placental trophoblasts. Our findings establish a crucial role for CGI58 in placental lipid droplet dynamics and, by extension, in nutrient supply to the developing fetus.

Transferred maternal fatty acids stimulate fetal adipogenesis and lead to neonatal and adult obesity

The prevalence of adult and childhood obesity are increasing. Most of the human newborn's body fat accumulates in the last half of intrauterine life. Fat in the fetus was thought to be mostly synthesized from glucose, but now it is commonly accepted that the bulk of it is the product of placental transfer of maternal fatty acids. Transported fatty acids originate in maternal plasma "free" fatty acids, fatty acids hydrolyzed from maternal plasma triglycerides, and the poly-unsaturated fatty acid component of maternal phospholipids. Glucose remains an important precursor of alpha-glycerol phosphate, to which most transported fatty acids are eventually esterified. Maternal plasma lipids are elevated in late pregnancy and even more in obese and diabetic pregnant women. This accelerates the placental transport of fatty acids. The hypothesis presented in this paper rests on the observations that the exponential increase in fat tissue in the human embryo's body occurs in time to parallel the increase of lipids in the mother's blood and depends on the chemical affinity of the transcription factor PPAR gamma to fatty acids and on fatty acid stimulation of adipocyte generation from precursor cells. The hypothesis asserts that transported maternal fatty acids activate the transcription factors in the fetus and initiate conversion of the mesenchymal stem cells into adipocytes. In obese and diabetic mothers, the higher plasma lipids facilitate increased placental fatty acid transfer. This will increase adipocyte generation and, through this, the prevalence of babies with increased fat cell size and number. Babies born with increased adipose tissue cellularity will have greater probability of growing up to become obese adolescents and adults. These newborns, whose obesity is hyperplastic as well as hypertrophic, as adults will have difficulty losing weight through diet and exercise or will regain the lost weight more quickly than others without these characteristics. Accordingly, increased placental fatty acid transfer and accelerated adipocyte generation may explain not only neonatal obesity, but some aspects of the adult obesity epidemic also. It is therefore recommended that prevention of fetal fat cell hyperplasia, by lowering maternal plasma lipids in mid and late pregnancy, should be attempted in pregnancies at risk for macrosomia.

The fetal glucose steal: an underappreciated phenomenon in diabetic pregnancy

Adverse neonatal outcomes continue to be high for mothers with type 1 and type 2 diabetes, and are far from eliminated in mothers with gestational diabetes mellitus. This is often despite seemingly satisfactory glycaemic control in the latter half of pregnancy. Here we argue that this could be a consequence of the early establishment of fetal hyperinsulinaemia, a driver that exaggerates the fetal glucose steal. Essentially, fetal hyperinsulinaemia, through its effect on lowering fetal glycaemia, will increase the glucose concentration gradient across the placenta and consequently the glucose flux to the fetus. While the steepness of this gradient and glucose flux will be greatest at times when maternal hyperglycaemia and fetal hyperinsulinaemia coexist, fetal hyperinsulinaemia will favour a persistently high glucose flux even at times when maternal blood glucose is normal. The obvious implication is that glycaemic control needs to be optimised very early in pregnancy to prevent the establishment of fetal hyperinsulinaemia, further supporting the need for pre-pregnancy planning and early establishment of maternal glycaemic control. An exaggerated glucose steal by a hyperinsulinaemic fetus could also attenuate maternal glucose levels during an OGTT, providing an explanation for why some mothers with fetuses with all the characteristics of diabetic fetopathy have 'normal' glucose tolerance.

In Vitro Models Using the Human Placenta to Study Fetal Exposure to Drugs

Over the recent years there has been a gradual rise in the use of pharmaceuticals during pregnancy. Knowledge on placental drug transfer and metabolism has increased during the past decades as well. Investigation of the transplacental transfer of any therapeutically useful drug is essential to the understanding of its metabolic processes and is a prerequisite for its use during pregnancy. The purpose of this review is to give insight on the various techniques that have been developed to evaluate transplacental transfer of drugs and xenobiotics.

How fatty acids of different chain length enter and leave cells by free diffusion

Opposing views exist as to how unesterified fatty acids (FA) enter and leave cells. It is commonly believed that for short- and medium-chain FA free diffusion suffices whereas it is questioned whether proteins are required to facilitate transport of long-chain fatty acid (LCFA). Furthermore, it is unclear whether these proteins facilitate binding to the plasma membrane, trans-membrane movement, dissociation into the cytosol and/or transport in the cytosol. In this mini-review we approach the controversy from a different point of view by focusing on the membrane permeability constant (P) of FA with different chain length. We compare experimentally derived values of the P of short and medium-chain FA with values of apparent permeability coefficients for LCFA calculated from their dissociation rate constant (k(off)), flip-flop rate constant (k(flip)) and partition coefficient (Kp) in phospholipid bilayers. It was found that Overton's rule is valid as long as k(flip)<<k(off). With increasing chain length, the permeability increases according to increasing Kp and reaches a maximum for LCFA with chain length of 18 carbons or longer. For fast flip-flop (e.g. k(flip)=15s(-1)), the apparent permeability constant for palmitic acid is very high (P(app)=1.61 cm/s). Even for a slow flip-flop rate constant (e.g. k(flip)=0.3s(-1)), the permeability constant of LCFA is still several orders of magnitude larger than the P of water and other small non-electrolytes. Since polyunsaturated FA have basically the same physico-chemical properties as LCFA, they have similar membrane permeabilities. The implications for theories involving proteins to facilitate uptake of FA are discussed.

Kinetics of palmitic acid transport in insulin-dependent diabetic pregnancies: in vitro study

BACKGROUND

The paucity of data relating to transport kinetics of free fatty acids (FFA) in pregnant diabetic women prompted the undertaking of the present study.

METHODS

Transport kinetics of a model FFA, palmitic acid, have been investigated in Type I diabetic pregnancies, using in vitro perfusion of isolated placental lobules. National Cancer Tissue Culture medium diluted with Earle's buffered salt solution was used as the perfusate and control placental lobules were perfused for comparison.

RESULTS

In five Type I diabetic women, the palmitic acid transport fraction (TF) averaged 5.6 +/- 0.42% of injected maternal bolus dose, representing 11.8 +/- 2.1% that of tritiated water used as reference. In control perfusions (n = 5), the palmitic acid TF represented 10.2 +/- 1.3% of tritiated water TF. Differential transport rates of palmitic acid for 10, 25, 50, 75 and 90% of efflux in fetal veins differed significantly from the corresponding values for tritiated water in both study and control series. However, palmitic acid transport rates for the various efflux fractions in the two series were not significantly different. For kinetic parameters, such as area under the curve, clearance, elimination constant, time for maximum response, absorption rate and elimination rate, the values for palmitic acid in the diabetic and control series also did not differ significantly.

CONCLUSION

Transport kinetics of palmitic acid in Type I human diabetic pregnancies in in vitro conditions do not differ significantly from those observed in normal pregnancies.

Transfer of methohexital across the perfused human placenta

STUDY OBJECTIVES

To evaluate the transfer properties of methohexital and the influence of protein binding using the in vitro human placental perfusion model.

DESIGN

Fresh term human placentae from healthy parturients were perfused bidirectionally via a cannulated fetal chorionic artery and vein and needles placed into the maternal intervillous space. Maternal-to-fetal (M-->F) and fetal-to-maternal (F-->M) transfer and ultimate distribution of methohexital was investigated using a closed (recirculating) placental perfusion model.

SETTING

Obstetric anesthesia laboratories of two university medical centers.

PATIENTS

No patient participation occurred as placentae were obtained after delivery.

INTERVENTION

M-->F and F-->M transfer of methohexital was compared in vitro in perfusates with equal protein concentrations (2 g/100 mL in both perfusates) or albumin-simulated physiologic protein binding concentrations (maternal 8 g/100 mL; fetal 4 g/100 mL).

MEASUREMENTS AND MAIN RESULTS

Data obtained consisted of measurements of methohexital and antipyrine concentrations by high-performance liquid chromatography. Glucose and lactate concentrations and perfusate loss were measured to assess placental viability. Methohexital protein binding was assessed at 2, 4, and 8 g/100 mL of albumin by equilibrium dialysis. The transfer index of 0.83 +/- 0.11 for the M-->F perfusions was significantly greater (p < or = 0.05) than in the F-->M direction (0.61 +/- 0.04) when albumin concentration was equal in both perfusates. This transfer asymmetry disappeared when albumin concentrations simulating maternal (8 g/100 mL) versus fetal (4 g/100 mL) protein concentrations in the perfusate were used (M-->F 0.87 +/- 0.12 and F-->M 0.95 +/- 0.11).

CONCLUSION

Methohexital readily crosses the placenta in both directions. Protein binding has significant effects on the degree of transfer of methohexital at any time when compared with antipyrine and its ultimate fetal/maternal distribution.

Effect of glucose load on the transport kinetics of palmitic acid in the human placenta: an in vitro study

1. A paucity of data relating to free fatty acid (FFA) transport in the human placenta in non-steady state conditions prompted us to undertake the present study. 2. The transport kinetics of palmitic acid in non-steady state conditions have been investigated in vitro using human perfused placental lobules. The effects of varying glucose concentrations on maternal-foetal transport of the FFA were also investigated to mimic the hyperglycaemic states of human diabetic pregnancies. 3. National Cancer Tissue Culture medium diluted with Earle's buffered salt solution was used as the perfusate. [14C]-Palmitic acid, along with tritiated water as a reference, was injected as a bolus into the maternal arterial perfusate and perfusate samples were collected from the venous outflow for a period of 5 min. 4. The transport fraction (TF) of palmitic acid, expressed as percentage of the injected bolus, averaged 3.45 +/- 0.15% in five perfusions, representing 9.2 +/- 1.3% of the corresponding reference marker TF. Kinetic parameters, as well as TF indices of palmitic acid expressed in relation to the reference substance, did not differ significantly between perfusions with a physiological glucose load and those with hyperglycaemic concentrations of glucose of 27.8 and 55.6 mmol/L. 5. The present study shows that hyperglycaemia per se does not significantly alter palmitic acid transport kinetics in vitro in the human perfused placental lobule.

Long-chain polyunsaturated fatty acid transport across the perfused human placenta

The role of the placenta in controlling the supply of fatty acids to the fetus was investigated in term placentae (n = 9) from normal pregnancies. The maternal side was perfused ex vivo for 90 min with a modified Krebs Ringer solution containing a physiological mixture of fatty acids and ratio of fatty acid to human albumin. There was no evidence of chain elongation and desaturation of the essential fatty acids. Relative to the value for oleic acid, the rate of transfer to the fetal circulation was: 1.30 +/- 0.02 (P < 0.001) for linoleic acid, 1.61 +/- 0.09 (P = 0.002) for alpha-linolenic acid, 0.67 +/- 0.10 (P = 0.033) for arachidonic acid and 2.10 +/- 0.16 (P = 0.003) for docosahexaenoic acid. For tissue accumulation the values were 1.47 +/- 0.39 (P < 0.001) for linoleic acid, 2.24 +/- 0.37 (P = 0.027) for alpha-linolenic acid, 9.84 +/- 1.03 (P = 0.001) for arachidonic acid, and 3.01 +/- 0.79 (P = 0.064) for docosahexaenoic acid. The order of selectivity for transfer from the maternal to the fetal circulation was docosahexaenoic > alpha-linolenic > linoleic > oleic > arachidonic acid. Such a mechanism would allow the preferential transfer of docosahexaenoic acid and the essential fatty acids to the fetal circulation, thereby protecting the polyunsaturated fatty acid supply to the fetus during a critical period of development.

Incorporation of first-order uptake rate constants from simple mammillary models into blood-flow limited physiological pharmacokinetic models via extraction efficiencies

Incorporation of First-Order Uptake Rate Constants from Simple Mammillary Models into Blood-Flow Limited Physiological Pharmacokinetic Models via Extraction Efficiencies. W. L. Roth, L. W. D. Weber, and K. Rozman (1995). Pharm. Res. 263-269. First-order rate constants obtained from classical pharmacokinetic models correspond to mammillary systems in which all of the blood (or plasma) is assumed to be located in a central compartment. In such models the rate at which chemicals are transported out of this pool and into another compartment is the product of the mass of chemical in the central compartment multiplied by a rate constant, which is not limited in magnitude by the blood flow, or the rate at which chemicals from the blood are delivered to the peripheral compartment. Most of the physiologically-based models published to date dispense with some of the information available from mammillary models by assuming that all of the chemical delivered by the flow of blood rapidly equilibrates and can be taken up by the tissue under the control of a "partition coefficient" (Rij = Cj/Ci). We show that the partition coefficient alone does not retain the uptake rate (kji) information available from a classical mammillary model, but that the uptake rate information can be incorporated via unitless extraction efficiency parameters, epsilon j.

Vitamin B12 among parturients and their newborns and its relationship with birthweight

Vitamin B12 (Cobalamin) is an essential nutrient in the diet of humans, particularly during pregnancy, nevertheless very few epidemiological studies have been reported, particularly concerning variation factors. The purpose of this study is to assess the role of vitamin B12 on birthweight after taking into account potential confounders, such as obstetrical, socioeconomic, and biological factors which will be identified. This study was conducted on 188 single births occurring during a 5-month period in an obstetrical care unit in Paris. Vitamin B12 plasma levels and folate plasma levels of mothers and cords along with haematological parameters were measured. Social and obstetrical features of the mothers as well as their tobacco exposure and alcohol consumption were recorded. Cord blood vitamin B12 levels were highly correlated with maternal levels (r = 0.63, P less than 0.001) and were 2-3-fold higher. Three variation factors of vitamin B12 were identified: maternal age, ethnicity and tobacco exposure. Negative correlations between birthweight and vitamin B12 levels were observed only among the smoker group (r mothers = -0.46, P less than 0.05 and r cords = -0.42, P less than 0.05). After adjustment for ethnicity and parity, birthweight remained negatively linked to vitamin B12 in smokers. This relationship could suggest that the availability of vitamin B12 for fetal development depends on certain biological factors present only in mothers who smoked. We hypothesized this relationship could be explained, in part, by lipid metabolism, particular to smokers.

[Supply, metabolism and biological effects of trans-isomeric fatty acids in infants]

Consumption of trans-fatty acids increased markedly during this century due to the widespread use of partially hydrogenated fats. A sensitive analytical method was developed which enables the precise determination of 7 trans-isomers in small sample volumes. With this method we documented the materno-fetal transfer of trans-fatty acids across the human placenta. The content in human milk depends on maternal diet and is lower in Germany than in the Sudan. The distribution in fore- and hind-milk, in milk fat fractions and within the triglyceride molecule was determined. The content of trans-fatty acids is lower in commercial and home-made infant formulae than in human milk, although there is a certain batch to batch variation in formulae. Infants absorb dietary trans-isomers and incorporate them into endogenous lipids, subcutaneous tissue and cell membranes. Trans-fatty acids in plasma lipids are significantly higher in infants fed human milk than in those fed formulae. African children have a lower exposure than Germans. The relative contribution of trans-octadecenoic acid is lower in plasma sterol esters than in triglycerides and phospholipids, pointing to a negative selectivity of plasmatic cholesterol esterification with this fatty acid. Thus, a high supply of trans-octadecenoic acid might have negative effects on the cholesterol levels. In premature infants we found an inverse correlation between trans-fatty acid exposure and birthweight, thus interference with intrauterine growth appears possible. A possible causative factor could be impaired biosynthesis of long-chain polyunsaturated fatty acids by trans-isomers, for which we found strong indications. The results of our investigations the question whether the consumption of trans-fatty acids in pregnant and lactating women and in infants is nutritionally safe.

Placental transfer of cefoperazone and sulbactam in the isolated in vitro perfused human placenta

The transfer of cefoperazone and sulbactam across the human placenta was studied qualitatively and quantitatively with the isolated in vitro bidirectionally perfused human placental lobule. Clearance indexes for both cefoperazone and sulbactam were derived. The absence of active transport and facilitated diffusion were documented, implying simple diffusion as the mechanism of placental transfer for both drugs. Placental tissue levels were also studied.

Calcium and phosphate fluxes across the fetal membranes of the guinea pig: in vitro measurement

Bidirectional calcium (45Ca) and phosphate (32P) fluxes across the amnion and visceral yolk sac of the guinea pig were measured in vitro in modified Ussing chambers. The net flux of these ions across both fetal membranes was in the maternal-to-fetal direction. The net flux of 45Ca and 32P across the yolk sac was significantly greater than that across the amnion. This difference was due to a greater maternal-to-fetal flux across the yolk sac. In addition, net 32P flux was greater than net 45Ca flux across the yolk sac, while in the amnion, there was no significant difference in the net flux of the two ions. It is suggested that the fetal membranes, especially the visceral yolk sac, contribute significantly to fetal acquisition of calcium and phosphate in mammals possessing a functional yolk sac placenta.

Placental transfer of steroids: effect of binding to serum albumin and to placenta

The transfer rates and placental retention of a series of steroids were measured using an in vitro perfusion system of an isolated cotyledon of human placenta. The steroids were added to the maternal inflow and rates of appearance in maternal and fetal outflows were measured, from which data were calculated the transfer rate and placental retention. With a low concentration of albumin (0.01 g/dl) in the maternal and fetal perfusates, transfer rates of diethylstilbestrol and ethynylestradiol were initially low, with considerable retention of the steroids within the placenta. Transfer rates increased with duration of perfusion. With high concentrations of albumin (1 g/dl), placental retention was greatly reduced and transfer rates very rapidly reached high levels. Albumin in the fetal circulation was the effective factor in increasing transfer rate; maternal albumin reduced it. The results with estrone and progesterone were qualitatively similar but not as striking, posssibly because of the large endogenous concentrations of these two hormones. Placental retention of dexamethasone, a more polar steroid that does not bind to placenta and binds poorly to albumin, was low and there was little difference between transfer from low- and high-protein perfusates.

Evidence for fatty acid transfer across the human placenta

Lipid analysis of blood from umbilical artery and vein, experiments on artificially perfused human placentas, measurements of fetal blood triglyceride concentrations and the relative percentage of essential fatty acids in fetal adipose tissue are all consistent with the view that fatty acids cross the human placenta and that the flow to the fetus is influenced by maternal blood concentrations of free fatty acids and triglycerides.