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Malvasi A, Baldini GM, Cicinelli E, Di Naro E, Baldini D, Favilli A, Quellari PT, Sabbatini P, Fioretti B, Malgieri LE, Damiani GR, Dellino M, Trojano G, Tinelli A. Localization of Catecholaminergic Neurofibers in Pregnant Cervix as a Possible Myometrial Pacemaker. Int J Mol Sci 2024; 25:5630. [PMID: 38891818 PMCID: PMC11171499 DOI: 10.3390/ijms25115630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 04/27/2024] [Accepted: 05/14/2024] [Indexed: 06/21/2024] Open
Abstract
In eutocic labor, the autonomic nervous system is dominated by the parasympathetic system, which ensures optimal blood flow to the uterus and placenta. This study is focused on the detection of the quantitative presence of catecholamine (C) neurofibers in the internal uterine orifice (IUO) and in the lower uterine segment (LUS) of the pregnant uterus, which could play a role in labor and delivery. A total of 102 women were enrolled before their submission to a scheduled cesarean section (CS); patients showed a singleton fetus in a cephalic presentation outside labor. During CS, surgeons sampled two serial consecutive full-thickness sections 5 mm in depth (including the myometrial layer) on the LUS and two randomly selected samples of 5 mm depth from the IUO of the cervix. All histological samples were studied to quantify the distribution of A nerve fibers. The authors demonstrated a significant and notably higher concentration of A fibers in the IUO (46 ± 4.8) than in the LUS (21 ± 2.6), showing that the pregnant cervix has a greater concentration of A neurofibers than the at-term LUS. Pregnant women's mechanosensitive pacemakers can operate normally when the body is in a physiological state, which permits normal uterine contractions and eutocic delivery. The increased frequency of C neurofibers in the cervix may influence the smooth muscle cell bundles' activation, which could cause an aberrant mechano-sensitive pacemaker activation-deactivation cycle. Stressful circumstances (anxiety, tension, fetal head position) cause the sympathetic nervous system to become more active, working through these nerve fibers in the gravid cervix. They might interfere with the mechano-sensitive pacemakers, slowing down the uterine contractions and cervix ripening, which could result in dystocic labor.
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Affiliation(s)
- Antonio Malvasi
- 1st Unit of Gynecology and Obstetrics, Department of Interdisciplinary Medicine (DIM), University of Bari (BA), 70124 Bari, Italy; (A.M.); (G.M.B.); (E.C.); (E.D.N.); (G.R.D.); (M.D.)
| | - Giorgio Maria Baldini
- 1st Unit of Gynecology and Obstetrics, Department of Interdisciplinary Medicine (DIM), University of Bari (BA), 70124 Bari, Italy; (A.M.); (G.M.B.); (E.C.); (E.D.N.); (G.R.D.); (M.D.)
| | - Ettore Cicinelli
- 1st Unit of Gynecology and Obstetrics, Department of Interdisciplinary Medicine (DIM), University of Bari (BA), 70124 Bari, Italy; (A.M.); (G.M.B.); (E.C.); (E.D.N.); (G.R.D.); (M.D.)
| | - Edoardo Di Naro
- 1st Unit of Gynecology and Obstetrics, Department of Interdisciplinary Medicine (DIM), University of Bari (BA), 70124 Bari, Italy; (A.M.); (G.M.B.); (E.C.); (E.D.N.); (G.R.D.); (M.D.)
| | | | - Alessandro Favilli
- Department of Medicine and Surgery, Perugia Medical School, University of Perugia, Piazza Lucio Severi 1, 06132 Perugia, Italy; (A.F.); (P.T.Q.)
| | - Paola Tiziana Quellari
- Department of Medicine and Surgery, Perugia Medical School, University of Perugia, Piazza Lucio Severi 1, 06132 Perugia, Italy; (A.F.); (P.T.Q.)
- Department of Chemistry, Biology and Biotechnologies, University of Perugia, Via dell’Elce di Sotto 8, 06132 Perugia, Italy; (P.S.); (B.F.)
- ASST Grande Ospedale Metropolitano Niguarda, 20162 Milano, Italy
| | - Paola Sabbatini
- Department of Chemistry, Biology and Biotechnologies, University of Perugia, Via dell’Elce di Sotto 8, 06132 Perugia, Italy; (P.S.); (B.F.)
| | - Bernard Fioretti
- Department of Chemistry, Biology and Biotechnologies, University of Perugia, Via dell’Elce di Sotto 8, 06132 Perugia, Italy; (P.S.); (B.F.)
| | | | - Gianluca Raffaello Damiani
- 1st Unit of Gynecology and Obstetrics, Department of Interdisciplinary Medicine (DIM), University of Bari (BA), 70124 Bari, Italy; (A.M.); (G.M.B.); (E.C.); (E.D.N.); (G.R.D.); (M.D.)
| | - Miriam Dellino
- 1st Unit of Gynecology and Obstetrics, Department of Interdisciplinary Medicine (DIM), University of Bari (BA), 70124 Bari, Italy; (A.M.); (G.M.B.); (E.C.); (E.D.N.); (G.R.D.); (M.D.)
| | - Giuseppe Trojano
- Department of Maternal and Child, Madonna delle Grazie Hospital ASM, 75100 Matera, Italy;
| | - Andrea Tinelli
- Department of Gynaecology and Obstetrics, CERICSAL (CEntro di RIcerca Clinico SALentino), “Veris delli Ponti Hospital”, 73020 Lecce, Italy
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Malvasi A, Ballini A, Tinelli A, Fioretti B, Vimercati A, Gliozheni E, Baldini GM, Cascardi E, Dellino M, Bonetti M, Cicinelli E, Vitagliano A, Damiani GR. Oxytocin augmentation and neurotransmitters in prolonged delivery: An experimental appraisal. Eur J Obstet Gynecol Reprod Biol X 2024; 21:100273. [PMID: 38274243 PMCID: PMC10809121 DOI: 10.1016/j.eurox.2023.100273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 12/22/2023] [Indexed: 01/27/2024] Open
Abstract
The uterus is a highly innervated organ, and during labor, this innervation is at its highest level. Oxytocinergic fibers play an important role in labor and delivery and, in particular, the Lower Uterine Segment, cervix, and fundus are all controlled by motor neurofibers. Oxytocin is a neurohormone that acts on receptors located on the membrane of the smooth cells of the myometrium. During the stages of labor and delivery, its binding causes myofibers to contract, which enables the fundus of the uterus to act as a mediator. The aim of this study was to investigate the presence of oxytocinergic fibers in prolonged and non-prolonged dystocic delivery in a cohort of 90 patients, evaluated during the first and second stages of labor. Myometrial tissue samples were collected and evaluated by electron microscopy, in order to quantify differences in neurofibers concentrations between the investigated and control cohorts of patients. The authors of this experiment showed that the concentration of oxytocinergic fibers differs between non-prolonged and prolonged dystocic delivery. In particular, in prolonged dystocic delivery, compared to non-prolonged dystocic delivery, there is a lower amount of oxytocin fiber. The increase in oxytocin appeared to be ineffective in patients who experienced prolonged dystocic delivery, since the dystocic labor ended as a result of the altered presence of oxytocinergic fibers detected in this group of patients.
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Affiliation(s)
- Antonio Malvasi
- Department of Biomedical Sciences and Human Oncology, University of Bari, 70121 Bari, Italy
- Unit of Obstetrics and Gynecology, University of Bari, Bari, Italy
| | - Andrea Ballini
- Department of clinical and experimental medicine, University of Foggia, Foggia, 71122, Italy
| | - Andrea Tinelli
- Department of Obstetrics and Gynecology and CERICSAL (CEntro di RIcerca Clinico SALentino), Veris Delli Ponti Hospital, 73020 Scorrano, Italy
| | - Bernard Fioretti
- Department of Chemistry, Biology and Biotechnologies, University of Perugia, Via dell'Elce di Sotto 8, 06132 Perugia, Italy
| | - Antonella Vimercati
- Department of Biomedical Sciences and Human Oncology, University of Bari, 70121 Bari, Italy
- Unit of Obstetrics and Gynecology, University of Bari, Bari, Italy
| | - Elko Gliozheni
- Section of Obstetrics and Gynecology, Department of Medicine and Surgery, University of Perugia, 06156 Perugia, Italy
- University of Medicine of Tirana, Department of Obstetrics and Gynecology, Tirana, Albania
| | - Giorgio Maria Baldini
- Momo Fertilife, IVF Clinic, Bisceglie, 76011, Italy
- University of Bari Aldo Moro, 70121, Bari, Italy
| | - Eliano Cascardi
- Department of Precision and Regenerative Medicine and Ionian Area, University of Bari “Aldo Moro”, Policlinico of Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Miriam Dellino
- Department of Biomedical Sciences and Human Oncology, University of Bari, 70121 Bari, Italy
- Unit of Obstetrics and Gynecology, University of Bari, Bari, Italy
| | - Monica Bonetti
- Department of Biomedical Sciences and Human Oncology, University of Bari, 70121 Bari, Italy
- Unit of Obstetrics and Gynecology, University of Bari, Bari, Italy
| | - Ettore Cicinelli
- Department of Biomedical Sciences and Human Oncology, University of Bari, 70121 Bari, Italy
- Unit of Obstetrics and Gynecology, University of Bari, Bari, Italy
| | - Amerigo Vitagliano
- Department of Biomedical Sciences and Human Oncology, University of Bari, 70121 Bari, Italy
- Unit of Obstetrics and Gynecology, University of Bari, Bari, Italy
| | - Gianluca Raffaello Damiani
- Department of Biomedical Sciences and Human Oncology, University of Bari, 70121 Bari, Italy
- Unit of Obstetrics and Gynecology, University of Bari, Bari, Italy
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Giovannetti O, Tomalty D, Velikonja L, Jurkus C, Adams MA. The human cervix: Comprehensive review of innervation and clinical significance. Clin Anat 2023; 36:118-127. [PMID: 36200685 DOI: 10.1002/ca.23960] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 09/28/2022] [Accepted: 10/02/2022] [Indexed: 12/14/2022]
Abstract
Detailed knowledge regarding the innervation and histology of the human cervix is crucial given the surgical removal of this tissue for conditions such as cervical dysplasia. Recent evidence implicates the cervix in the sexual response, making it pertinent to characterize this region to elucidate its role. Despite this, literature describing the overall innervation of the cervix from anatomical and histological perspectives is lacking. The aim of this review was to consolidate descriptions pertaining to human cervix innervation and discuss possible mechanisms of dysfunction, as an unintended result of cervix removal. A detailed literature search of relevant articles describing human cervix innervation was conducted. 1597 articles were screened based on the keywords searched. Only 16 articles, containing information regarding specific evidence of the innervation of the human cervix, were included and categorized based on parameters of innervation (method, type, location). The published evidence demonstrates that the human cervix has sympathetic, parasympathetic, and sensory innervation, but does not characterize changes after surgical procedures. Despite the gaps in knowledge, it is relevant that associations linking clinical procedures, involving cervical removal and adverse sexual health outcomes, become an important focus for discussions between physicians and patients. Future work is needed to better detail the affected innervation as well as the neural pathway-specific relationship to symptoms of sexual dysfunction.
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Affiliation(s)
- Olivia Giovannetti
- Department of Biomedical and Molecular Science, Queen's University, Kingston, Canada
| | - Diane Tomalty
- Department of Biomedical and Molecular Science, Queen's University, Kingston, Canada
| | - Leah Velikonja
- Department of Biomedical and Molecular Science, Queen's University, Kingston, Canada
| | - Connor Jurkus
- Department of Biomedical and Molecular Science, Queen's University, Kingston, Canada
| | - Michael A Adams
- Department of Biomedical and Molecular Science, Queen's University, Kingston, Canada
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Malvasi A, Vimercati A, Ricci I, Picardi N, Cicinelli E, Kosmas I, Baldini GM, Tinelli A. Dystocic Labor and Adrenergic and Noradrenergic Neurotransmitters: A Morphological Experimental Study. Int J Mol Sci 2022; 23:ijms231911379. [PMID: 36232680 PMCID: PMC9569786 DOI: 10.3390/ijms231911379] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 09/16/2022] [Accepted: 09/22/2022] [Indexed: 11/18/2022] Open
Abstract
Authors investigated the catecholaminergic neurotransmitters (chNs) quantitative modifications in pregnant uterine Lower Uterine Segment (LUS) during prolonged labor (PL) with the fetus in an occiput-posterior position (OPP), in occiput transverse position (OTP) and in fetal head asynclitism, all diagnosed by Intrapartum Ultrasonography (IU). The chNs neurotransmitters, particularly adrenaline (or epinephrine-A) and noradrenaline (or norepinephrine-N), were evaluated in LUS fragments sampled during CS of 34 patients undergoing urgent cesarean section (CS) in PL, compared to chNs fibers in the LUS of 36 women submitted to elective CS. All results were statistically analyzed to understand the differences in neurotransmitters morphological analysis by scanning electronic microscopy examination (SEM). The LUS fragments analysis revealed a reduction of A and N fibers in LUS during PL, compared with the expression of A and N fibers in LUS during elective CS. The PL for OPP, the OTP and asynclitism, all positions causing dystocia in labor lead to a reduction in neurotransmitters in LUS, with a uterine vascularization modification and a reduction in the contractility of smooth uterine cells. The A and N neurotransmitters reduction observed in PL negatively interferes with uterine contraction during labor.
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Affiliation(s)
- Antonio Malvasi
- Department of Biomedical and Human Oncological Science (DIMO), Unit of Obstetrics and Gynecology, University of Bari, 70121 Bari, Italy
| | - Antonella Vimercati
- Department of Biomedical and Human Oncological Science (DIMO), Unit of Obstetrics and Gynecology, University of Bari, 70121 Bari, Italy
| | - Ilaria Ricci
- Department of Biomedical and Human Oncological Science (DIMO), Unit of Obstetrics and Gynecology, University of Bari, 70121 Bari, Italy
| | - Nico Picardi
- Department of Biomedical and Human Oncological Science (DIMO), Unit of Obstetrics and Gynecology, University of Bari, 70121 Bari, Italy
| | - Ettore Cicinelli
- Department of Biomedical and Human Oncological Science (DIMO), Unit of Obstetrics and Gynecology, University of Bari, 70121 Bari, Italy
| | - Ioannis Kosmas
- Department of Obstetrics and Gynecology, Ioannina State General Hospital G. Hatzikosta, University of Ioannina, 451 10 Ioannina, Greece
| | | | - Andrea Tinelli
- Department of Obstetrics and Gynecology, and CERICSAL (CEntro di RIcerca Clinico SALentino), Veris delli Ponti Hospital, 73020 Scorrano, Italy
- Department of Obstetrics and Gynecology, Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710049, China
- Correspondence:
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Pinsard M, Mouchet N, Dion L, Bessede T, Bertrand M, Darai E, Bellaud P, Loget P, Mazaud-Guittot S, Morandi X, Leveque J, Lavoué V, Duraes M, Nyangoh Timoh K. Anatomic and functional mapping of human uterine innervation. Fertil Steril 2022; 117:1279-1288. [PMID: 35367063 DOI: 10.1016/j.fertnstert.2022.02.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 02/09/2022] [Accepted: 02/10/2022] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To better understand the physiology of pain in pelvic pain pathological conditions, such as endometriosis, in which alterations of uterine innervation have been highlighted, we performed an anatomic and functional mapping of the macro- and microinnervation of the human uterus. Our aim was to provide a 3-dimensional reconstruction model of uterine innervation. DESIGN This was an experimental study. We dissected the pelvises of 4 human female fetuses into serial sections, and treated them with hematoxylin and eosin staining before immunostaining. SETTING Academic Research Unit. PATIENTS None. INTERVENTIONS None. MAIN OUTCOME MEASURES Detection of nerves (S100 +) and characterization of the types of nerves. The slices obtained were aligned to construct a 3-dimensional model. RESULTS A 3-dimensional model of uterine innervation was constructed. The nerve fibers appeared to have a centripetal path from the uterine serosa to the endometrium. Within the myometrium, innervation was dense. Endometrial innervation was sparse but present in the functional layer of the endometrium. Overall innervation was richest in the supravaginal cervix and rarer in the body of the uterus. Innervation was rich particularly laterally to the cervix next to the parametrium and paracervix. Four types of nerve fibers were identified: autonomic sympathetic (TH+), parasympathetic (VIP+), and sensitive (NPY+, CGRP1+ and VIP+). They were found in the 3 portions and the 3 layers of the uterus. CONCLUSIONS We constructed a 3-dimensional model of the human uterine innervation. This model could provide a solid base for studying uterine innervation in pathologic situations, in order to find new therapeutic approaches.
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Affiliation(s)
- Marion Pinsard
- Department of Obstetrics and Gynecology, Hopital Universitaire de Rennes, Rennes, France
| | - Nicolas Mouchet
- University Rennes 1, CNRS, Inserm UMS Biosit, France BioImaging, Core Facility H2P2 Rennes, France
| | - Ludivine Dion
- Department of Obstetrics and Gynecology, Hopital Universitaire de Rennes, Rennes, France; Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail) Rennes, France
| | - Thomas Bessede
- UMR 1195, University Paris-Sud, INSERM, Université Paris-Saclay, Le Kremlin-Bicetre, France; Urology Department, Hopitaux Universitaires Paris-Sud, Le Kremlin-Bicetre, France
| | | | - Emile Darai
- Service de gynécologie obstétrique et médecine de la reproduction, Hôpital Tenon, Paris, France; Centre de Recherche Saint-Antoine, Paris, France
| | - Pascale Bellaud
- University Rennes 1, CNRS, Inserm UMS Biosit, France BioImaging, Core Facility H2P2 Rennes, France
| | - Philippe Loget
- Service d'Anatomie et Cytologie Pathologiques, Rennes, France
| | - Séverine Mazaud-Guittot
- Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail) Rennes, France
| | - Xavier Morandi
- Laboratoire d'Anatomie et d'Organogenèse, Faculté de Médecine, Centre Hospitalier Universitaire de Rennes, Rennes, France; Department of Neurosurgery, Rennes University Hospital, Rennes, France
| | - Jean Leveque
- Department of Obstetrics and Gynecology, Hopital Universitaire de Rennes, Rennes, France
| | - Vincent Lavoué
- Department of Obstetrics and Gynecology, Hopital Universitaire de Rennes, Rennes, France; Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail) Rennes, France
| | - Martha Duraes
- Urology Department, Hopitaux Universitaires Paris-Sud, Le Kremlin-Bicetre, France
| | - Krystel Nyangoh Timoh
- Department of Obstetrics and Gynecology, Hopital Universitaire de Rennes, Rennes, France; Laboratoire d'Anatomie et d'Organogenèse, Faculté de Médecine, Centre Hospitalier Universitaire de Rennes, Rennes, France; University Rennes, INSERM, LTSI - UMR 1099, F35000, Rennes, France.
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Potential in vitro therapeutic effects of targeting SP/NK1R system in cervical cancer. Mol Biol Rep 2021; 49:1067-1076. [PMID: 34766230 DOI: 10.1007/s11033-021-06928-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 10/30/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Cervical cancer, an aggressive gynecological cancer, seriously threatens women's health worldwide. It is recently reported that neuropeptide substance P (SP) regulates many tumor-associated processes through neurokinin-1 receptor (NK1R). Therefore, we used cervical cancer cell line (HeLa) to investigate the functional relevance of the SP/NK1R system in cervical cancer pathogenesis. METHODS Cellular proliferation and cytotoxicity were analyzed by colorimetric MTT assay. Quantitative real-time PCR (qRT-PCR) was used to measure mRNA expression levels of desired genes. Cell cycle distribution and apoptosis were evaluated by flow cytometry. A wound-healing assay was employed to assess migration ability. RESULTS We found that the truncated isoform of NK1R(NK1R-Tr) is the dominantly expressed form of the receptor in Hela cells. We also indicated that that SP increased HeLa cell proliferation while treatment with NK1R antagonist, aprepitant, inhibited HeLa cell viability in a dose and time-dependent manner. SP also alters the levels of cell cycle regulators (up-regulation of cyclin B1 along with downregulation of p21) and apoptosis-related genes (up-regulation of Bcl-2 along with downregulation of Bax) while aprepitant reversed these effects. Aprepitant also induced arrest within the G2 phase of the cell cycle and subsequent apoptosis. Furthermore, SP promoted the migrative phenotype of HeLa cells and increased MMP-2 and MMP-9 expression while aprepitant exposure significantly reversed these effects. CONCLUSION Collectively, our results indicate the importance of the SP / NK1R system in promoting both proliferative and migrative phenotypes of cervical cancer cells and suggest that aprepitant may be developed as a novel treatment for combating cervical cancer.
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Palus K, Całka J, Jana B. Alterations in the relative abundance of the vasoactive intestinal peptide receptors (VPAC1 and VPAC2) and functions in uterine contractility during inflammation. Anim Reprod Sci 2020; 225:106680. [PMID: 33388613 DOI: 10.1016/j.anireprosci.2020.106680] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 12/14/2020] [Accepted: 12/14/2020] [Indexed: 12/11/2022]
Abstract
Vasoactive intestinal peptide (VIP) receptor (VPAC1, VPAC2) abundances in the myometrium and functions in the regulation of inflamed uterine contractility in pigs were studied. In the CON group with gilts, only laparotomy was performed. The gilts of SAL- and E. coli-treated groups were administered saline or E. coli into the uterine horns, respectively. The E. coli-induced endometritis resulted in a lesser myometrial relative abundance of VPAC1 and VPAC2 receptor mRNA transcripts and larger abundance of protein for these receptors. In the myometrium, treatment with VIP resulted in a lesser contractility amplitude than in the tissues of the CON- and SAL- and E. coli-treated groups and in frequency in the CON- and E.coli-treated group compared to the period before VIP treatment. Compared to when there was VIP treatment alone, treatment with VPAC1 and VPAC2 receptor antagonists resulted in a lesser inhibitory effect of VIP on contractility amplitude in the myometrium of the CON and SAL-treated groups and there was complete abolishment of the inhibitory VIP effect on frequency of myometrial contractility of the CON group. In the myometrium of E. coli-treated group, treatment with VPAC1 and VPAC2 receptor antagonists resulted in a reversal of the inhibitory effect of VIP on contractility amplitude, while treatment with VPAC2 receptor antagonist resulted in elimination of contractility and a lesser endometrium/myometrium inhibitory effect of VIP on frequency of these contractions. Results indicate VIP functions to decrease myometrial contractility of the inflamed pig uterus by having functions at VPAC1 and VPAC2 receptors.
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Affiliation(s)
- Katarzyna Palus
- Department of Clinical Physiology, Faculty of Veterinary Medicine, University of Warmia and Mazury, Oczapowskiego 13 Str., 10-718, Olsztyn, Poland
| | - Jarosław Całka
- Department of Clinical Physiology, Faculty of Veterinary Medicine, University of Warmia and Mazury, Oczapowskiego 13 Str., 10-718, Olsztyn, Poland
| | - Barbara Jana
- Division of Reproductive Biology, Institute of Animal Reproduction and Food Research of the Polish Academy of Sciences, Tuwima 10, 10-748 Olsztyn, Poland.
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Mynbaev OA, Sparic R, Stark M, Malvasi A, Marinelli E, Zaami S, Tinelli A. The Medical Device Applied to Uterine Fibroids Morcellation: Analysis of Critical Biological Issues and Drawbacks from A Medical-Legal Prospective. Curr Pharm Des 2020; 26:318-325. [PMID: 32013843 DOI: 10.2174/1381612826666200204093737] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Accepted: 01/27/2020] [Indexed: 12/23/2022]
Abstract
Following the FDA safety communication of 2014 increasing attention has been to the treatment of uterine fibroids, due to the suspicion of a potential leiomyosarcoma (ULM). FDA banned the use of power morcellation in the US, since this technique is likely to spread malignant cells from an unsuspected ULM. We criticized the medical legal consequences of this banning among gynecologists and patients, focusing on the drawbacks of biology and surgery. The authors analyzed literature data on one side, on the incidence, diagnosis and treatment of leiomyoma and ULM, and the other side, on the power morcellations and related critical issues, trying to highlight their main controversial aspects and to outline the possible impact on patients and on medical responsibility. The alternative methods to power morcellation are more invasive surgical solutions (as mini laparotomy or culdotomy), which inevitably involve associated risks with the surgical procedure as such and always request the containing bags. Although the in-bag morcellation is a promising technique, currently the used devices are largely off-label. This highlights the surgical risk, in case of complications, of suffering for malpractice claims both for not having used a containment system, favoring the spread of the neoplasm, and for its off-label use. Since the diagnosis of ULM is by histology after surgery, the fear of legal consequences or medical malpractice for unknown ULM power morcellation, should be targeted to analyze, in terms of cost/benefit ratio, the surgical priority. It should focus on the prevention of the risk of having a rare and statistically limited ULM or on the surgical-related complications, often linked to a slowdown minimally invasive surgery, or on the use of the authorized in-bag morcellations.
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Affiliation(s)
- Ospan A Mynbaev
- Laboratory of Human Physiology, Phystech BioMed School, Faculty of Biological & Medical Physics, Moscow Institute of Physics and Technology (State University), Dolgoprudny, Moscow Region, Russian Federation
| | | | - Michael Stark
- Department of Obstetrics and Gynecology, GVM Care & Research Santa Maria Hospital, Bari, Italy. Laboratory of Human Physiology, Phystech BioMed School, Faculty of Biological & Medical Physics, Moscow Institute of Physics and Technology (State University), Dolgoprudny, Moscow Region, Russian Federation
| | - Antonio Malvasi
- Clinical Centre of Serbia, Clinic for Gynecology and Obstetrics, and University of Belgrade, School of Medicine, Belgrade, Serbia
| | - Enrico Marinelli
- Department of Anatomical, Histological, Forensic and Orthopedic Sciences, Sapienza University of Rome, Rome, Italy
| | - Simona Zaami
- Department of Anatomical, Histological, Forensic and Orthopedic Sciences, Sapienza University of Rome, Rome, Italy
| | - Andrea Tinelli
- Department of Obstetrics and Gynecology, "Veris delli Ponti" Hospital, Scorrano, Lecce, Italy
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Yellon SM, Greaves E, Heuerman AC, Dobyns AE, Norman JE. Effects of macrophage depletion on characteristics of cervix remodeling and pregnancy in CD11b-dtr mice. Biol Reprod 2020; 100:1386-1394. [PMID: 30629144 DOI: 10.1093/biolre/ioz002] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 11/30/2018] [Accepted: 01/07/2019] [Indexed: 12/24/2022] Open
Abstract
To test the hypothesis that macrophages are essential for remodeling the cervix in preparation for birth, pregnant homozygous CD11b-dtr mice were injected with diphtheria toxin (DT) on days 14 and 16 postbreeding. On day 15 postbreeding, macrophages (F4/80+) were depleted in cervix and kidney, but not in liver, ovary, or other non-reproductive tissues in DT-compared to saline-treated dtr mice or wild-type controls given DT or saline. Within 24 h of DT-treatment, the density of cell nuclei and macrophages declined in cervix stroma in dtr mice versus controls, but birefringence of collagen, as an indication of extracellular cross-linked structure, remained unchanged. Only in the cervix of DT-treated dtr mice was an apoptotic morphology evident in macrophages. DT-treatment did not alter the sparse presence or morphology of neutrophils. By day 18 postbreeding, macrophages repopulated the cervix in DT-treated dtr mice so that the numbers were comparable to that in controls. However, at term, evidence of fetal mortality without cervix ripening occurred in most dtr mice given DT-a possible consequence of treatment effects on placental function. These findings suggest that CD11b+ F4/80+ macrophages are important to sustain pregnancy and are required for processes that remodel the cervix in preparation for parturition.
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Affiliation(s)
- S M Yellon
- Longo Center for Perinatal Biology.,Division of Physiology, Departments of Basic Sciences, and Pediatrics, Loma Linda University School of Medicine, Loma Linda, CA 92350, USA
| | - E Greaves
- MRC Centre for Reproductive Health, Queens Medical Research Institute, University of Edinburgh, Edinburgh, Scotland EH16 4TJ, United Kingdom
| | | | | | - J E Norman
- MRC Centre for Reproductive Health, Queens Medical Research Institute, University of Edinburgh, Edinburgh, Scotland EH16 4TJ, United Kingdom
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10
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Tinelli A. Pharmacological Scenarios in Translational Research: A Current Multidisciplinary Overview and Possible Developments. Curr Pharm Des 2020; 26:296-299. [PMID: 32213151 DOI: 10.2174/138161282603200306092551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Andrea Tinelli
- Department of Obstetrics and Gynecology, "Veris delli Ponti" Hospital, Scorrano, Lecce, Italy
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11
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Kosmas IP, Malvasi A, Vergara D, Mynbaev OA, Sparic R, Tinelli A. Adrenergic and Cholinergic Uterine Innervation and the Impact on Reproduction in Aged Women. Curr Pharm Des 2020; 26:358-362. [PMID: 32003664 DOI: 10.2174/1381612826666200128092256] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Accepted: 01/27/2020] [Indexed: 11/22/2022]
Abstract
In recent years, the development of Assisted Reproductive Technique, the egg and embryo donation changed substantially the role of the uterus in recent years. It provided a higher chance for a pregnancy even in women over 45 years or post-menopause. In fact, the number of aged patients and in peri/post-menopause in pregnancy is nowadays increasing, but it increases obstetrical and neonatal related problems. The human uterus is richly innervated and modified especially during pregnancy and labor, and it is endowed with different sensory, parasympathetic, sympathetic and peptidergic neurofibers. They are differently distributed in uterine fundus, body and cervix, and they are mainly observed in the stroma and around arterial vessel walls in the myometrial and endometrial layers. Many neurotransmitters playing important roles in reproductive physiology are released after stimulation by adrenergic or cholinergic nerve fibers (the so called sympathetic/parasympathetic co-transmission). Immunohistochemical study demonstrated the localization and quantitative distribution of neurofibers in the fundus, the body and cervix of young women of childbearing age. Adrenergic and cholinergic effects of the autonomous nervous system are the most implicated in the uterine functionality. In such aged women, the Adrenergic and AChE neurofibers distribution in the fundus, body and cervix is progressively reduced by increasing age. Adrenergic and AChE neurotransmitters were closely associated with the uterine arteries and myometrial smooth muscles, and they reduced markedly by ageing. The Adrenergic and AChE neurofibers decreasing has a dramatical and negative impact on uterine physiology, as the reduction of pregnancy chance and uterine growth, and the increase of abortion risk and prematurity.
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Affiliation(s)
- Ioannis P Kosmas
- Ioannina State General Hospital G. Hatzikosta, Department of Obstetrics and Gynecology, University of Ioannina, Greece
| | - Antonio Malvasi
- Department of Obstetrics & Gynecology, Santa Maria Hospital, GVM Care & Research, Bari, Italy; Laboratory of Human Physiology, Phystech BioMed School, Faculty of Biological & Medical Physics, Moscow Institute of Physics and Technology (State University), Dolgoprudny, Moscow Region, Russian Federation
| | - Daniele Vergara
- Department of Biological and Environmental Sciences and Technologies, University of Salento, Lecce, Italy; Laboratory of Clinical Proteomic, "Giovanni Paolo II" Hospital, ASL-, Lecce, Italy
| | - Ospan A Mynbaev
- Laboratory of Human Physiology, Phystech BioMed School, Faculty of Biological & Medical Physics, Moscow Institute of Physics and Technology (State University), Dolgoprudny, Moscow Region, Russian Federation
| | - Radmila Sparic
- Clinical Centre of Serbia, Clinic for Gynecology and Obstetrics, and University of Belgrade, School of Medicine, Belgrade, Serbia
| | - Andrea Tinelli
- Department of Obstetrics and Gynecology, "Veris delli Ponti" Hospital, Scorrano, Lecce, Italy
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12
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Vitale SG, Haimovich S, Riemma G, Ludwin A, Zizolfi B, De Angelis MC, Carugno J. Innovations in hysteroscopic surgery: expanding the meaning of "in-office". MINIM INVASIV THER 2020; 30:125-132. [PMID: 31971476 DOI: 10.1080/13645706.2020.1715437] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Surgical innovations in hysteroscopic surgery have radically changed the way of treating intrauterine pathologies, throughout the advent of the 'see-and-treat' philosophy, which transferred the advantages of inpatient surgery to the office setting. However, in-office operative hysteroscopy was mainly limited to minor pathology as a supplement to its diagnosis, whereas commonly larger abnormalities were left to be treated in the operating room. Nowadays, pre-surgical assessment of uterine pathology is based on modern ultrasound evaluation and the evolving role of in-office hysteroscopy as a well-planned treatment modality for larger lesions and more complex procedures. Office operative hysteroscopy has been accepted as a feasible, cost-effective, practical way to treat almost any intrauterine disease. Despite the growing role of other imaging tools in the proper evaluation of benign uterine diseases, especially extended beyond to direct hysteroscopic visualization, diagnostic hysteroscopy remains a valuable tool of direct endometrial sampling and may be used as the first line in the diagnosis of endometrial cancer and hyperplasia. Our aim is to describe the most recent innovations and future perspectives in the field of outpatient operative hysteroscopy: mini-resectoscopes, intrauterine morcellators, tissue retrieval systems, diode laser, new miniaturized mechanical instruments, endometrial ablation devices and portable and entry-level hysteroscopes.
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Affiliation(s)
- Salvatore Giovanni Vitale
- Obstetrics and Gynecology Unit, Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy
| | - Sergio Haimovich
- Hillel Yaffe Medical Center, Technion-Israel Technology Institute, Hadera, Israel
| | - Gaetano Riemma
- Department of Women, Child, and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Artur Ludwin
- Department of Gynecology and Oncology, Jagiellonian University, Krakow, Poland
| | - Brunella Zizolfi
- Department of Public Health, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Maria Chiara De Angelis
- Department of Public Health, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Jose Carugno
- Obstetrics, Gynecology and Reproductive Sciences Department, University of Miami, Miami, FL, USA
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13
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14
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Campbell MLH, Peachey L, Callan L, Wathes DC, de Mestre AM. Cyclical cervical function in the mare involves remodelling of collagen content, which is correlated with modification of oestrogen receptor 1 abundance. Anim Reprod Sci 2019; 210:106192. [PMID: 31635778 DOI: 10.1016/j.anireprosci.2019.106192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 08/28/2019] [Accepted: 09/11/2019] [Indexed: 11/18/2022]
Abstract
This study was conducted to elucidate mare cervical dilation mechanisms by testing two hypotheses: (i) the proportion of collagen staining in histological samples of mare cervices and (ii) the abundance of hormone receptors in the equine cervix differ with stage of the oestrous cycle and site within the cervix. Tissues and jugular vein blood samples were collected from 15 mares. Collagen content was assessed using Masson's Trichome staining. Receptor abundance was assessed using RT-PCR, qRT-PCR and immunohistochemistry. In sub-epithelial stroma, there was less collagen during the follicular than luteal phase, in the caudal- (P = 0.029), mid- (P = 0.0000) and cranial (P = 0.001) cervical tissue. In the deep stroma, there was less collagen staining during the follicular stage in the mid- (P = 0.004) and cranial- (P = 0.041) cervical regions. There were PTGER2, PTGER3, PGR and ESR1 mRNA transcripts in the cervix. A greater proportion of cells were positive for ESR1 protein during the follicular phase in sub-epithelial (P = 0.019) and deep (P = 0.013) stroma. The abundance of ESR1 in the epithelium was negatively correlated with collagen staining in sub-epithelial (P = 0.007) and deep (P = 0.005) stroma. The results of the study provide new information about the cervical biology of mares by increasing the knowledge about collagen content and the relationship between collagen content and ESR1 protein abundance during the oestrous cycle which indicates the ESR1 receptor is a candidate for involvement in control of cervical dilation.
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MESH Headings
- Animals
- Cervix Uteri/physiology
- Cloning, Molecular
- Collagen/physiology
- DNA, Complementary/genetics
- DNA, Complementary/metabolism
- Estrogen Receptor alpha/genetics
- Estrogen Receptor alpha/metabolism
- Estrogen Receptor beta/genetics
- Estrogen Receptor beta/metabolism
- Estrous Cycle/physiology
- Female
- Gene Expression Regulation/physiology
- Horses
- Labor Stage, First/physiology
- Luteinizing Hormone/genetics
- Luteinizing Hormone/metabolism
- Pregnancy
- Progesterone/metabolism
- RNA/genetics
- RNA/metabolism
- Receptors, FSH/genetics
- Receptors, FSH/metabolism
- Receptors, Prostaglandin E, EP2 Subtype/genetics
- Receptors, Prostaglandin E, EP2 Subtype/metabolism
- Receptors, Prostaglandin E, EP3 Subtype/genetics
- Receptors, Prostaglandin E, EP3 Subtype/metabolism
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Affiliation(s)
- M L H Campbell
- The Royal Veterinary College, Hawkshead Lane, North Mymms, Herts, AL9 7TA, UK; Department of Pathobiology and Population Sciences, UK.
| | - L Peachey
- The Royal Veterinary College, Hawkshead Lane, North Mymms, Herts, AL9 7TA, UK
| | - L Callan
- The Royal Veterinary College, Hawkshead Lane, North Mymms, Herts, AL9 7TA, UK
| | - D C Wathes
- The Royal Veterinary College, Hawkshead Lane, North Mymms, Herts, AL9 7TA, UK; Department of Pathobiology and Population Sciences, UK
| | - A M de Mestre
- The Royal Veterinary College, Hawkshead Lane, North Mymms, Herts, AL9 7TA, UK; Department of Comparative Biomedical Sciences, UK
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15
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Reyes-Lagos JJ, Ledesma-Ramírez CI, Pliego-Carrillo AC, Peña-Castillo MÁ, Echeverría JC, Becerril-Villanueva E, Pavón L, Pacheco-López G. Neuroautonomic activity evidences parturition as a complex and integrated neuro-immune-endocrine process. Ann N Y Acad Sci 2018; 1437:22-30. [DOI: 10.1111/nyas.13860] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Revised: 04/24/2018] [Accepted: 04/26/2018] [Indexed: 12/15/2022]
Affiliation(s)
| | | | | | - Miguel Ángel Peña-Castillo
- Basic Sciences and Engineering Division, Campus Iztapalapa; Metropolitan Autonomous University (UAM); Mexico City Mexico
| | - Juan Carlos Echeverría
- Basic Sciences and Engineering Division, Campus Iztapalapa; Metropolitan Autonomous University (UAM); Mexico City Mexico
| | - Enrique Becerril-Villanueva
- Department of Psychoimmunology; National Institute of Psychiatry (INP) Ramon de la Fuente; Mexico City Mexico
| | - Lenin Pavón
- Department of Psychoimmunology; National Institute of Psychiatry (INP) Ramon de la Fuente; Mexico City Mexico
| | - Gustavo Pacheco-López
- Biological and Health Sciences Division, Campus Lerma; Metropolitan Autonomous University (UAM); Lerma Mexico
- Department of Health Sciences, and Technology; Swiss Federal Institute of Technology (ETH) Zurich; Schwerzenbach Switzerland
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16
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Vink J, Mourad M. The pathophysiology of human premature cervical remodeling resulting in spontaneous preterm birth: Where are we now? Semin Perinatol 2017; 41:427-437. [PMID: 28826790 PMCID: PMC6007872 DOI: 10.1053/j.semperi.2017.07.014] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Approximately one in ten (approximately 500,000) pregnancies results in preterm birth (PTB) annually in the United States. Although we have seen a slight decrease in the U.S. PTB rate between 2007 and 2014, data from 2014 to 2015 shows the preterm birth rate has slightly increased. It is even more intriguing to note that the rate of PTB has not significantly decreased since the 1980s. In order to decrease the rate of spontaneous preterm birth (sPTB), it is imperative that we improve our understanding of normal and abnormal reproductive tissue structure and function and how these tissues interact with each other at a cellular and biochemical level. Since other chapters in this issue will be focusing on the myometrium and fetal membranes, the goal of this chapter is to focus on the compartment of the cervix. We will review the current literature on normal and abnormal human cervical tissue remodeling and identify gaps in knowledge. Our goal is also to introduce a revised paradigm of normal cervical tissue structure and function which will provide novel research opportunities that may ultimately lead to developing safe and effective interventions to significantly decrease the rate and complications of prematurity.
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Affiliation(s)
- Joy Vink
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University Medical Center, 622 West 168th St, PH16-66, New York, NY 10025.
| | - Mirella Mourad
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University Medical Center, 622 West 168th St, PH16-66, New York, NY 10025
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