Erythropoietin binding sites in human foetal tissues

[Pregnancy in patients on chronic haemodialysis: about 25 cases which occurred in the south of Tunisia]

INTRODUCTION

the occurrence of pregnancy in patients on chronic haemodialysis is rare. However, given the evolution in dialysis technique, improvement in fertility is possible. The purpose of our study was to report our experience concerning the occurrence of pregnancy in patients on dialysis and to identify factors involved in its success.

METHODS

we conducted a retrospective study on 25 spontaneous pregnancies occurred in 19 patients treated with periodical hemodialysis in different hemodialysis centers in the south of Tunisia over a period of 34 years.

RESULTS

maternal age at the onset of pregnancy was, on average, 35.6 years [23-44 years] with an average seniority in hemodialysis of 4.22 years [1-17 years]. Seven patients (37%) had residual diuresis (>500 ml/24h). The prescribed weekly number of hours of dialysis was ≥16 hours per week in 7 cases and ≥20 hours in 4 cases. Success of pregnancy (new-born surviving at least 28 days) was estimated at 56%. The median gestational age was 34 weeks of amenorrhea [28-38 WA]. The average neonatal weight was equal to 1970g [1500g-2300g]. Analytical study showed a significant correlation between the increase in the hours of dialysis per week and the success of pregnancy (R=0.59; p=0.002).

CONCLUSION

it was noted that with adequate support and in particular, increasing the number of sessions of dialysis, materno-fetal complications can be minimized and the balance risk-benefit can turn the chance for a woman on dyalisis to become pregnant.

[Pregnancy in chronic hemodialysis]

La survenue d'une grossesse en hémodialyse chronique (HDC) est rare, mais depuis la description du premier cas par Confortini en 1971, plusieurs observations ont été rapportées. L'hémodialyse a considérablement amélioré la fertilité de ces patientes. Nous rapportons l'expérience de douze grossesses survenues entre 1999 et 2014, chez douze patientes d’âge médian 34 ans (22-44), en hémodialyse (HD) depuis 40 mois (3-72), l’âge gestationnel moyen de diagnostic est de 16 semaines d'aménorrhée, la grossesse était compliquée dans 50% des cas par un hydramnios. Le terme moyen est de 35 semaine d'aménorrhée (SA) et l'accouchement a été réalisé dans 90% des grossesses par voie basse. Le poids moyen des nouveau-nés est de 1800g. De telles grossesses sont à haut risque du fait de la fréquence des complications. Elles devraient être contrôlées par les équipes multidisciplinaires, et la consultation prénatal ne devrait pas être négligée. L'objectif de ce travail est de rapporter notre expérience concernant la survenue d'une grossesse chez les patientes dialysées et de la confronter aux données de la littérature.

Expression of the erythropoietin receptor by trophoblast cellsin the human placenta

Nonclassical sites of erythropoietin (EPO) and erythropoietin receptor (EPO-R) expression have been described that suggest new physiological roles for this hormone unrelated to erythropoiesis. The recent finding of EPO expression by trophoblast cells in the human placenta prompted us to consider whether these cells also express EPO-R. With use of immunocytochemistry, EPO-R was identified in villous and extravillous cytotrophoblast cells, as well as in the syncytiotrophoblast at all gestational ages. EPO-R was also expressed by cells within the villous core, including endothelial cells of fetoplacental blood vessels. Placental tissues and isolated and immunopurified trophoblast cells, as well as trophoblast-derived choriocarcinoma Jar cells, expressed immunoreactive EPO-R on Western blot. EPO-R mRNA was also detected in the same placental tissues and trophoblast cells by nested-primer reverse transcription-polymerase chain reaction. Finally, EPO-R was functional insofar as the receptor was phosphorylated on tyrosine residues in response to exogenous EPO treatment of cultured trophoblast or Jar cells. Thus, the present findings support the hypothesis that trophoblast cells of the human placenta express EPO-R. In view of these results, taken together with previous work demonstrating EPO expression by the same cells, an autocrine role for this hormone in the survival, proliferation, or differentiation of placental trophoblast cells is proposed.

Lack of permeability of the human placenta for erythropoietin

Measurements of erythropoietin in fetal blood obtained by cordocentesis or in umbilical cordblood and maternal blood have shown a lack of correlation indicating an independent regulation of EPO concentration in fetal and maternal compartments. There is a good correlation between amniotic fluid EPO concentration in fetal blood levels. Fetal EPO concentration therefore might serve as an indicator of chronic fetal hypoxia with fetal EPO production being responsive to tissue hypoxia early on in pregnancy. The lack of human placental permeability for EPO was further investigated using a dual in vitro perfusion system of an isolated cotyledon in freshly delivered term placentae. With recirculation of both circuits trace amounts of EPO (0.04% of the amount added to the maternal compartment) were transferred to the fetal side during 4-5 hours of perfusion. This transfer is comparable to the rate determined in the same experiments for albumine, and the biological significance of this very slow transfer is questionable. A very low rate of diffusion across the human placenta has also been shown for dextran, horseradish peroxidase and heparin using an in vitro perfusion system. The only exception among macromolecules are immunoglobulines G, which towards the end of pregnancy are transferred by an Fc-receptor mediated transcellular mechanism from the mother to the fetus. It is concluded, that there is no easy exchange of EPO across the human placenta between maternal and fetal compartments. Changes in EPO concentration in the fetal compartment therefore could serve as indicator of fetal hypoxia. A therapeutic application of EPO in the mother for the treatment of chronic anemia would not have any effect on fetal tissues.(ABSTRACT TRUNCATED AT 250 WORDS)

Lack of transport of erythropoietin across the human placenta as studied by an in vitro perfusion system

The transfer of human recombinant erythropoietin (rhEPO) from the maternal to the fetal side was investigated using the technique of in vitro perfusion of an isolated cotyledon of human placenta, with recirculation of the perfusate (130 ml) in separate closed maternal and fetal circuits. rhEPO (221-512 U), together with [14C]BSA (bovine serum albumin, 44.8 kBq or 2,688,000 dpm), was added to the maternal circuit only. Despite a considerably lower molecular weight of EPO (mol. wt. = 30,400 Da) compared to BSA (mol. wt. = 69,000 Da), no difference was found in their transfer across the placenta from the maternal to the fetal side, which was very low for both macromolecules. The total transfer of rhEPO derived from the concentration measured in the samples taken from the fetal circuit at the end of 4-5 h of perfusion, was in the range of 0.04% of the amount initially added to the maternal compartment. A similar amount of transfer was determined for [14C]BSA (0.04-0.07%, n = 12). In conclusion, by direct determination in a dually in vitro perfused human placental cotyledon, no significant transfer of rhEPO from the maternal to the fetal side could be shown.

Establishment of an erythroid cell line (JK-1) that spontaneously differentiates to red cells

The authors established a new hemopoietic cell line (JK-1) from a patient with chronic myelogenous leukemia in erythroid crisis. This JK-1 line predominantly consists of immature cells, but a small number of mature erythroblasts and red cells can be consistently seen without any specific differentiation inducer. The JK-1 cells grow in suspension culture supplemented with human plasma and carry double Philadelphia chromosomes. Hemoglobin staining with benzidine was positive for about 20% of cells and the type of the hemoglobin was for the most part HbF. Surface-marker analysis revealed JK-1 cells positive for glycophorin A, EP-1, and HAE9. The proportion of mature cells was elevated by the addition of delta-aminolevulinic acid. Erythropoietin (EPO) enhanced the growth of JK-1 cells either in the suspension or in methylcellulose semisolid culture. The total number of EPO receptors was 940 per cell, of which 220 sites had an affinity higher than the other 720 sites. This is the first report of an established human erythroid cell line which spontaneously undergoes terminal differentiation.

Expression of the erythropoietin receptor on a human myeloma cell line

We demonstrated the expression of the erythropoietin (EPO) receptor by a human myeloma cell line (MM-S1) which was established in our laboratory. EPO dose-dependently stimulated the proliferation of MM-S1 cells. Binding of radioiodinated EPO (125I-Epo) to MM-S1 cells was competitively inhibited by unlabeled EPO, but not by other recombinant cytokines. Specific binding of 125I-Epo to MM-S1 cells was saturable, and the Scatchard analysis revealed 330 EPO binding sites per cell with a Kd of 0.56 nmol/L. Bound EPO was internalized by MM-S1 cells during incubation at 37 degrees C. This is the first report describing the expression of the EPO receptor by human cells other than those of the erythroid lineage.

Erythropoietin has a mitogenic and positive chemotactic effect on endothelial cells

Erythropoietin is known to be a hematopoietic growth factor with a singularly specific action on the proliferation and differentiation of erythroid progenitor cells. We have observed a dose-dependent proliferative action of human recombinant erythropoietin on human umbilical vein endothelial cells and bovine adrenal capillary endothelial cells. Binding studies with radioiodinated recombinant human erythropoietin revealed a large number (approximately 27,000) of an apparent single class of receptors with an affinity in the 10(-9) M range. Linkage of the radiolabeled ligand to its receptor via a bifunctional crosslinking agent allowed us to identify an endothelial cell protein of 45 kDa as the principal receptor associated with this mitogenic effect of erythropoietin. Recombinant human erythropoietin also enhanced the migration of endothelial cells.

Expression and characterization of erythropoietin receptors on normal human bone marrow cells

We studied the specific binding of 125I-labeled bioactive recombinant human erythropoietin (Epo) to human bone marrow mononuclear cells (BMNC) obtained from normal subjects. The 125I-labeled Epo bound specifically to the BMNC. Scatchard analysis of the data showed two classes of binding sites; one high affinity (Kd 0.07 nM) and the other low affinity (Kd 0.38 nM). The number of Epo binding sites per BMNC was 46 +/- 16 high-affinity receptors and 91 +/- 51 low-affinity receptors. The specific binding was displaced by unlabeled Epo, but not by other growth factors. Receptor internalization was observed significantly at 37 degrees C, but was prevented by the presence of 0.2% sodium azide. These findings indicate that human BMNC possess two classes of specific Epo receptors with characteristics of a hormone-receptor association.