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Meng Q, Mitra S, Del Rosario I, Jerrett M, Janzen C, Devaskar SU, Ritz B. Urinary polycyclic aromatic hydrocarbon metabolites and their association with oxidative stress among pregnant women in Los Angeles. Res Sq 2024:rs.3.rs-4119505. [PMID: 38562764 PMCID: PMC10984082 DOI: 10.21203/rs.3.rs-4119505/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Background Polycyclic aromatic hydrocarbons (PAHs) have been linked to adverse birth outcomes, but few epidemiological studies to date have evaluated associations between urinary PAH metabolites and oxidative stress biomarkers in pregnancy. Methods We measured a total of 7 PAH metabolites and 2 oxidative stress biomarkers (malondialdehyde (MDA), 8-hydroxy-2'-deoxyguanosine (8-OHdG)) in urine samples collected up to three times during pregnancy in 159 women enrolled at antenatal clinics at the University of California Los Angeles during 2016-2019. Using multiple linear regression models, we estimated the percentage change (%) and 95% confidence interval (CI) in 8-OHdG and MDA measured at each sample collection time per doubling of PAH metabolite concentrations. Results Most PAH metabolites were positively associated with both urinary oxidative stress biomarkers, MDA and 8-OHdG, with stronger associations in early and late pregnancy. Women pregnant with male fetuses exhibited slightly larger increases in both MDA and 8-OHdG in association with PAH exposures in early and late pregnancy. Conclusion Urinary OH-PAH biomarkers are associated with increases in oxidative stress during pregnancy, especially in early and late pregnancy. Sex differences in associations between PAH exposures and oxidative stress need to be further explored in the future.
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Affiliation(s)
- Qi Meng
- University of California, Los Angeles
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Liu X, Nianogo R, Janzen C, Fei Z, Seamans M, Wen R, Li X, Chen L. Association Between Gestational Diabetes Mellitus and Hypertension: A Systematic Review and Meta-Analysis of Cohort Studies With a Quantitative Bias Analysis of Uncontrolled Confounding. Hypertension 2024. [PMID: 38501243 DOI: 10.1161/hypertensionaha.123.22418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 02/19/2024] [Indexed: 03/20/2024]
Abstract
BACKGROUND Whether individuals with gestational diabetes (GDM) had an increased risk of hypertension remains unclear. We conducted a systematic literature review and meta-analysis to examine the association between GDM and hypertension and performed a quantitative bias analysis to quantify the impact of uncontrolled confounding due to antenatal psychological stress. METHODS We searched databases (PUBMED, EMBASE, and Web of Science) through 2022/11. Eligible studies were cohort studies that reported the association of GDM with hypertension. We assessed the risk of bias using the Newcastle-Ottawa Scale for cohort studies. We pooled adjusted risk ratios with 95% CIs using a random effects model. We performed the quantitative bias analysis using the bias formula. RESULTS We included 15 cohort studies, with a total of 3 959 520 (GDM, 175 378; non-GDM, 3 784 142) individuals. During the follow-up of 2 to 20 years, 106 560 cases of hypertension were reported. We found that GDM was associated with a higher risk of hypertension (pooled risk ratio, 1.78 [95% CI, 1.47, 2.17]). The risk ratio was lower among cohorts assessing incident (1.58 [95% CI, 1.29, 1.95]) than prevalent hypertension (2.60 [95% CI, 2.40, 2.83]). However, other subgroup analyses showed no differences. The quantitative bias analysis revealed that if the uncontrolled confounder of antenatal psychological stress was additionally adjusted, the positive association between GDM and hypertension would attenuate slightly (≤18%) but remains positive. CONCLUSIONS Limitations of this study included residual confounding and discrepancies in GDM and hypertension ascertainments. Our findings indicate that GDM is positively associated with hypertension after the index pregnancy.
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Affiliation(s)
- Xinyue Liu
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles. (X. Liu, R.N., M.S., X. Li, L.C.)
| | - Roch Nianogo
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles. (X. Liu, R.N., M.S., X. Li, L.C.)
- California Center for Population Research, University of California, Los Angeles. (R.N.)
| | - Carla Janzen
- Department Obstetrics and Gynecology, David Geffen School of Medicine, University of California, Los Angeles. (C.J.)
| | - Zhe Fei
- Department of Statistics, University of California, Riverside (Z.F.)
| | - Marissa Seamans
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles. (X. Liu, R.N., M.S., X. Li, L.C.)
| | - Renee Wen
- Department of Biology, University of California, Los Angeles. (R.W.)
| | - Xiang Li
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles. (X. Liu, R.N., M.S., X. Li, L.C.)
| | - Liwei Chen
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles. (X. Liu, R.N., M.S., X. Li, L.C.)
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Liu X, Janzen C, Zhu Y, Seamans M, Fei Z, Nianogo R, Chen L. Prevalence of maternal hyperglycemic subtypes by race/ethnicity and associations between these subtypes with adverse pregnancy outcomes: Findings from a large retrospective multi-ethnic cohort in the United States. Diabetes Res Clin Pract 2024; 209:111576. [PMID: 38360094 DOI: 10.1016/j.diabres.2024.111576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 02/05/2024] [Accepted: 02/07/2024] [Indexed: 02/17/2024]
Abstract
AIMS With the two-step gestational diabetes mellitus (GDM) screening approach, hyperglycemic subtypes can be identified. We aimed to investigate racial/ethnic differences in the prevalence of hyperglycemic subtypes and to examine the associations between these subtypes and adverse pregnancy outcomes. METHODS In this retrospective cohort, 11,405 pregnancies were screened using the two-step approach. Hyperglycemic subtypes included: pregnancy-impaired glucose intolerance-I (PIGT-I), PIGT-II, GDM-I (abnormal post-load glucose only), and GDM-II (abnormal fasting & post-load glucose). Modified Poisson regressions with robust error variance were used to estimate age-adjusted prevalence ratios (PR) of hyperglycemic subtypes and multivariable-adjusted risk ratios (RR) of adverse pregnancy outcomes. RESULTS The prevalence of hyperglycemic subtypes was higher in Asians (PIGT-I: 1.51 [95% confidence interval 1.35-1.69]; PIGT-II: 2.18 [1.78-2.68]; GDM-I: 2.55 [2.10-3.10]; GDM-II: 1.55 [1.08-2.21]) and Hispanics (PIGT-I: 1.32 [1.16-1.50]; PIGT-II: 2.07 [1.67-2.57]; GDM-I: 1.69 [1.35-2.13]; GDM-II: 2.68 [1.93-3.71]) than non-Hispanic Whites (NHW). Despite low GDM prevalence, Japanese and Koreans had higher PIGT prevalence than NHW. PIGT-II was positively associated with hypertensive disorders of pregnancy (1.19 [1.02-1.38]), large-for-gestational age (1.73 [1.37-2.18]), and preterm birth (PB, 1.33 [1.05-1.68]). PIGT-I (1.23 [1.04-1.45]) and GDM-I (1.56 [0.87-1.71]) were positively related to PB. CONCLUSIONS The prevalence of hyperglycemic subtypes varies by race/ethnicity and they have distinct health implications.
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Affiliation(s)
- Xinyue Liu
- Department of Epidemiology, Fielding School of Public Health, UCLA, United States.
| | - Carla Janzen
- Obestetrics and Gynecology, David Geffen School of Medicine, UCLA, United States.
| | - Yeyi Zhu
- Division of Research, Kaiser Permanente Northern California, United States; Department of Epidemiology and Biostatistics, UCSF, United States.
| | - Marissa Seamans
- Department of Epidemiology, Fielding School of Public Health, UCLA, United States.
| | - Zhe Fei
- Department of Statistics, UCR, United States.
| | - Roch Nianogo
- Department of Epidemiology, Fielding School of Public Health, UCLA, United States; California Center for Population Research, UCLA, United States.
| | - Liwei Chen
- Department of Epidemiology, Fielding School of Public Health, UCLA, United States.
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Orimoloye HT, He D, Li T, Janzen C, Barjaktarevic I, Wang X, Hansen J, Heck JE. Alpha-1 antitrypsin deficiency and pregnancy complications and birth outcomes: A population-based cohort study in Denmark. PLoS One 2024; 19:e0296434. [PMID: 38166066 PMCID: PMC10760838 DOI: 10.1371/journal.pone.0296434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 12/13/2023] [Indexed: 01/04/2024] Open
Abstract
BACKGROUND Alpha-1 antitrypsin deficiency (AATD) is related to developing lung and liver disease, but no large-scale studies examine its association with birth outcomes. OBJECTIVE We investigated the risk of pregnancy complications and adverse birth outcomes in mothers and children with AATD. METHODS Using a large cohort data of Danish mothers and children with AATD from 1973 to 2013 (n = 2,027,229), with 559 cases (305 mothers and 254 children). We conducted Poisson regression to examine associations between alpha-1 antitrypsin deficiency, adverse birth outcomes, and pregnancy complications in mothers and children. RESULTS AATD was related to term low birth weight [<2500g; Risk Ratio(RR) = 2.04, 95% confidence interval (CI): 1.50-2.79], lowest quartile of abdominal circumference at birth in children of non-smoking mothers (RR = 1.55, 95% CI: 1.14-2.11), delivery via Cesarean-section (RR = 1.59, 95% CI: 1.05-2.40), preterm birth (RR = 1.54, 95% CI: 1.19-2.00) and preeclampsia (RR = 2.64, 95% CI: 1.76-3.94). CONCLUSIONS This emphasizes the need for mothers with AATD to be monitored closely during pregnancy to reduce the risk of adverse birth outcomes. Routine screening for alpha-1 antitrypsin in pregnancy may be considered among mothers with a pulmonary and liver disease history.
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Affiliation(s)
- Helen T. Orimoloye
- Department of Rehabilitation and Health Services, University of North Texas, Denton, Texas, United States of America
| | - Di He
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, California, United States of America
| | - Tong Li
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, California, United States of America
| | - Carla Janzen
- Department of Obstetrics and Gynecology, University of California, Los Angeles, Los Angeles, California, United States of America
| | - Igor Barjaktarevic
- Division of Pulmonary and Critical Care, University of California, Los Angeles, Los Angeles, California, United States of America
| | - Xuexia Wang
- Department of Biostatistics, Florida International University, Miami, Florida, United States of America
| | | | - Julia E. Heck
- Department of Rehabilitation and Health Services, University of North Texas, Denton, Texas, United States of America
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, California, United States of America
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Liu X, Zhu Y, Seamans M, Nianogo R, Janzen C, Fei Z, Chen L. Gestational diabetes mellitus and risk of neurodevelopmental disorders in young offspring: does the risk differ by race and ethnicity? Am J Obstet Gynecol MFM 2024; 6:101217. [PMID: 37940104 DOI: 10.1016/j.ajogmf.2023.101217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 10/31/2023] [Accepted: 11/02/2023] [Indexed: 11/10/2023]
Abstract
BACKGROUND Previous studies examined the associations of gestational diabetes mellitus with autism spectrum disorder and attention deficit hyperactivity disorder. However, the associations between gestational diabetes mellitus and other neurodevelopmental disorders, such as the common speech/language disorder and developmental coordination disorder, are rarely studied, and whether the associations vary by race/ethnicity remains unknown. OBJECTIVE This study aimed to examine the associations of gestational diabetes mellitus with individual neurodevelopmental disorders in young offspring, and to investigate whether the associations vary by race/ethnicity. STUDY DESIGN This retrospective cohort study (Glucose in Relation to Women and Babies' Health [GrownB]) included 14,480 mother-offspring pairs in a large medical center in the United States from March 1, 2013 to August 31, 2021. We ascertained gestational diabetes mellitus using the validated ICD (International Classification of Diseases) codes (ICD-9: 648.8x; ICD-10: O24.4x), and identified neurodevelopmental disorders (speech/language disorder, developmental coordination disorder, autism spectrum disorder, and other neurodevelopmental disorders [attention deficit hyperactivity disorder, behavioral disorder, intellectual disability, and learning difficulty]) and their combinations using validated algorithms. We compared the hazard of neurodevelopmental disorders during the entire follow-up period between offspring born to mothers with and without gestational diabetes mellitus using multivariable Cox regression models. RESULTS Among all mothers, 19.9% were Asian, 21.8% were Hispanic, 41.0% were non-Hispanic White, and 17.3% were of other/unknown race/ethnicity. During the median follow-up of 3.5 years (range, 1.0-6.3 years) after birth, 8.7% of offspring developed at least 1 neurodevelopmental disorder. Gestational diabetes mellitus was associated with a higher risk of speech/language disorder (adjusted hazard ratio, 1.59 [95% confidence interval, 1.07-2.35]), developmental coordination disorder (2.36 [1.37-4.04]), autism spectrum disorder (3.16 [1.36-7.37]), other neurodevelopmental disorders (3.12 [1.51-6.47]), any neurodevelopmental disorder (1.86 [1.36-2.53]), the combination of speech/language disorder and autism spectrum disorder (3.79 [1.35-10.61]), and the combination of speech/language disorder and developmental coordination disorder (4.22 [1.69-10.51]) among offspring born to non-Hispanic White mothers. No associations between gestational diabetes mellitus and any neurodevelopmental disorders or their combinations were observed among offspring born to mothers of other racial/ethnic groups. CONCLUSION We observed an elevated risk of neurodevelopmental disorders among young offspring born to non-Hispanic White mothers with gestational diabetes mellitus, but not among other racial/ethnic groups.
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Affiliation(s)
- Xinyue Liu
- Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA (Drs Liu, Seamans, Nianogo, and Chen)
| | - Yeyi Zhu
- Division of Research, Kaiser Permanente Northern California, Oakland, CA. (Dr Zhu); Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA (Dr Zhu)
| | - Marissa Seamans
- Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA (Drs Liu, Seamans, Nianogo, and Chen)
| | - Roch Nianogo
- Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA (Drs Liu, Seamans, Nianogo, and Chen); California Center for Population Research, University of California Los Angeles, Los Angeles, CA (Dr Nianogo)
| | - Carla Janzen
- Department of Obstetrics and Gynecology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA (Dr Janzen)
| | - Zhe Fei
- Department of Statistics, University of California Riverside, Riverside, CA (Dr Fei)
| | - Liwei Chen
- Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA (Drs Liu, Seamans, Nianogo, and Chen).
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Meng Q, Del Rosario I, Sung K, Janzen C, Devaskar SU, Carpenter CL, Ritz B. Maternal dietary patterns and placental outcomes among pregnant women in Los Angeles. Placenta 2024; 145:72-79. [PMID: 38100961 DOI: 10.1016/j.placenta.2023.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 11/11/2023] [Accepted: 12/01/2023] [Indexed: 12/17/2023]
Abstract
INTRODUCTION Epidemiological studies have linked prenatal maternal diet to fetal growth, but whether diet affects placental outcomes is poorly understood. METHODS We collected past month dietary intake from 148 women in mid-pregnancy enrolled at University of California Los Angeles (UCLA) antenatal clinics from 2016 to 2019. We employed the food frequency Diet History Questionnaire II and generated the Healthy Eating Index-2015 (HEI-2015), the Alternate Healthy Eating Index for Pregnancy (AHEI-P), and the Alternate Mediterranean Diet (aMED). We conducted T2-weighted magnetic resonance imaging (MRI) in mid-pregnancy (1st during 14-17 and 2nd during 19-24 gestational weeks) to evaluate placental volume (cm3) and we measured placenta weight (g) at delivery. We estimated change and 95 % confidence interval (CI) in placental volume and associations of placenta weight with all dietary index scores and diet items using linear regression models. RESULTS Placental volume in mid-pregnancy was associated with an 18.9 cm3 (95 % CI 5.1, 32.8) increase per 100 gestational days in women with a higher HEI-2015 (≥median), with stronger results for placentas of male fetuses. We estimated positive associations between placental volume at the 1st and 2nd MRI and higher intake of vegetables, high-fat fish, dairy, and dietary intake of B vitamins. A higher aMED (≥median) score was associated with a 40.5 g (95 % CI 8.5, 72.5) increase in placenta weight at delivery, which was mainly related to protein intake. DISCUSSION Placental growth represented by volume in mid-pregnancy and weight at birth is influenced by the quality and content of the maternal diet.
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Affiliation(s)
- Qi Meng
- Department of Epidemiology, University of California, Los Angeles, CA, 90095, USA
| | - Irish Del Rosario
- Department of Epidemiology, University of California, Los Angeles, CA, 90095, USA
| | - Kyunghyun Sung
- Department of Radiological Sciences, University of California, Los Angeles, CA, 90095, USA
| | - Carla Janzen
- Department of Obstetrics & Gynecology, University of California, Los Angeles, CA, 90095, USA
| | - Sherin U Devaskar
- Department of Pediatrics, University of California, Los Angeles, CA, 90095, USA
| | | | - Beate Ritz
- Department of Epidemiology, University of California, Los Angeles, CA, 90095, USA.
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Askins L, Orimoloye HT, Deng C, Hansen J, Olsen J, Ritz B, Janzen C, Heck JE. Preeclampsia, antihypertensive medication use in pregnancy and risk of childhood cancer in offspring. Cancer Causes Control 2024; 35:43-53. [PMID: 37535154 PMCID: PMC10764520 DOI: 10.1007/s10552-023-01745-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 06/26/2023] [Indexed: 08/04/2023]
Abstract
PURPOSE Preeclampsia is a serious pregnancy complication that presents a significant risk to both the mother and the fetus. Preeclampsia and medications associated with its treatment are potentially linked to increased childhood cancer risk. Therefore, we examined the association between preeclampsia, antihypertensive medications, and childhood cancer in offspring. METHODS Cases (n = 6,420) and controls (n = 160,484) were obtained from Danish national registries. We performed conditional logistic regression analyses to estimate the association between preeclampsia and childhood cancer risk, and examined the effects of antihypertensive medication use in pregnancy in relation to childhood cancer risk in the offspring with adjustment for relevant covariates. RESULTS We observed an increased risk of acute lymphoblastic leukemia (ALL) among those whose mothers had preeclampsia (OR = 1.36, 95% CI 1.03, 1.79), especially for severe preeclampsia (OR = 2.36, 95% CI 1.37, 4.08). We also estimated an increased cancer risk in children born to mothers who were prescribed diuretics during pregnancy [OR = 2.09, 95% confidence interval (CI) 1.39, 3.14]. Intake of other antihypertensive medications was not associated with childhood cancer (OR = 0.78, 95% CI 0.50, 1.23). Among women who did not take diuretics in pregnancy, preeclampsia was associated with neuroblastoma (OR = 2.22, 95% CI 1.08, 4.55). CONCLUSION Our findings suggested an increased risk for certain types of cancer in the offspring of mothers with preeclampsia and an increased risk of cancer with diuretic intake during pregnancy.
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Affiliation(s)
- Lexie Askins
- Department of Epidemiology, Fielding School of Public Health, University of California (UCLA), Box 951772, Los Angeles, CA, 90095-1772, USA
| | - Helen T Orimoloye
- College of Health and Public Service, University of North Texas, 1155 Union Circle #311340, Denton, TX, 76203-5017, USA
| | - Chuanjie Deng
- Department of Epidemiology, Fielding School of Public Health, University of California (UCLA), Box 951772, Los Angeles, CA, 90095-1772, USA
| | - Johnni Hansen
- Danish Cancer Society Research Center, Strandboulevarden 49, 2100, Copenhagen, Denmark
| | - Jorn Olsen
- Department of Clinical Epidemiology, Aarhus University, Olof Palmes Allé 43-45, 8200, Aarhus N, Denmark
| | - Beate Ritz
- Department of Epidemiology, Fielding School of Public Health, University of California (UCLA), Box 951772, Los Angeles, CA, 90095-1772, USA
| | - Carla Janzen
- Department of Obstetrics and Gynecology, University of California, Box 951740, Los Angeles, CA, USA
| | - Julia E Heck
- Department of Epidemiology, Fielding School of Public Health, University of California (UCLA), Box 951772, Los Angeles, CA, 90095-1772, USA.
- College of Health and Public Service, University of North Texas, 1155 Union Circle #311340, Denton, TX, 76203-5017, USA.
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Lee B, Janzen C, Aliabadi AR, Lei MYY, Wu H, Liu D, Vangala SS, Devaskar SU, Sung K. Early pregnancy imaging predicts ischemic placental disease. Placenta 2023; 140:90-99. [PMID: 37549442 DOI: 10.1016/j.placenta.2023.07.297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 07/13/2023] [Accepted: 07/29/2023] [Indexed: 08/09/2023]
Abstract
INTRODUCTION To characterize early-gestation changes in placental structure, perfusion, and oxygenation in the context of ischemic placental disease (IPD) as a composite outcome and in individual sub-groups. METHODS In a single-center prospective cohort study, 199 women were recruited from antenatal clinics between February 2017 and February 2019. Maternal magnetic resonance imaging (MRI) studies of the placenta were temporally conducted at two timepoints: 14-16 weeks gestational age (GA) and 19-24 weeks GA. The pregnancy was monitored via four additional study visits, including at delivery. Placental volume, perfusion, and oxygenation were assessed at both MRI timepoints. The primary outcome was defined as pregnancy complicated by IPD, with group assignment confirmed after delivery. RESULTS In early gestation, mothers with IPD who subsequently developed fetal growth restriction (FGR) and/or delivered small-for gestational age (SGA) infants showed significantly decreased MRI indices of placental volume, perfusion, and oxygenation compared to controls. The prediction of FGR or SGA by multiple logistic regression using placental volume, perfusion, and oxygenation revealed receiver operator characteristic curves with areas under the curve of 0.81 (Positive predictive value (PPV) = 0.84, negative predictive value (NPV) = 0.75) at 14-16 weeks GA and 0.66 (PPV = 0.78, NPV = 0.60) at 19-24 weeks GA. DISCUSSION MRI indices showing decreased placental volume, perfusion and oxygenation in early pregnancy were associated with subsequent onset of IPD, with the greatest deviation evident in subjects with FGR and/or SGA. These early-gestation MRI changes may be predictive of the subsequent development of FGR and/or SGA.
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Affiliation(s)
- Brian Lee
- Department of Pediatrics, David Geffen School of Medicine, University of California, 10833 Le Conte Ave, Los Angeles, CA, 90095, USA.
| | - Carla Janzen
- Department of Obstetrics and Gynecology, David Geffen School of Medicine, University of California Los Angeles, 10833 Le Conte Ave, Los Angeles, CA, 90095, USA.
| | - Arya R Aliabadi
- Department of Obstetrics and Gynecology, David Geffen School of Medicine, University of California Los Angeles, 10833 Le Conte Ave, Los Angeles, CA, 90095, USA.
| | - Margarida Y Y Lei
- Department of Obstetrics and Gynecology, David Geffen School of Medicine, University of California Los Angeles, 10833 Le Conte Ave, Los Angeles, CA, 90095, USA.
| | - Holden Wu
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, 300 Medical Plaza, B119, Los Angeles, CA 90095, USA.
| | - Dapeng Liu
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, 300 Medical Plaza, B119, Los Angeles, CA 90095, USA.
| | - Sitaram S Vangala
- Department of Medicine Statistical Core, David Geffen School of Medicine, University of California, 1100 Glendon Ave Suite 1820, Los Angeles, CA, 90095, USA.
| | - Sherin U Devaskar
- Department of Pediatrics, David Geffen School of Medicine, University of California, 10833 Le Conte Ave, Los Angeles, CA, 90095, USA.
| | - Kyunghyun Sung
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, 300 Medical Plaza, B119, Los Angeles, CA 90095, USA.
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Liu Y, Zabihollahy F, Yan R, Lee B, Janzen C, Devaskar SU, Sung K. Evaluation of Spatial Attentive Deep Learning for Automatic Placental Segmentation on Longitudinal MRI. J Magn Reson Imaging 2023; 57:1533-1540. [PMID: 37021577 PMCID: PMC10080136 DOI: 10.1002/jmri.28403] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 08/03/2022] [Accepted: 08/05/2022] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Automated segmentation of the placenta by MRI in early pregnancy may help predict normal and aberrant placenta function, which could improve the efficiency of placental assessment and the prediction of pregnancy outcomes. An automated segmentation method that works at one gestational age may not transfer effectively to other gestational ages. PURPOSE To evaluate a spatial attentive deep learning method (SADL) for automated placental segmentation on longitudinal placental MRI scans. STUDY TYPE Prospective, single-center. SUBJECTS A total of 154 pregnant women who underwent MRI scans at both 14-18 weeks of gestation and at 19-24 weeks of gestation, divided into training (N = 108), validation (N = 15), and independent testing datasets (N = 31). FIELD STRENGTH/SEQUENCE A 3 T, T2-weighted half Fourier single-shot turbo spin-echo (T2-HASTE) sequence. ASSESSMENT The reference standard of placental segmentation was manual delineation on T2-HASTE by a third-year neonatology clinical fellow (B.L.) under the supervision of an experienced maternal-fetal medicine specialist (C.J. with 20 years of experience) and an MRI scientist (K.S. with 19 years of experience). STATISTICAL TESTS The three-dimensional Dice similarity coefficient (DSC) was used to measure the automated segmentation performance compared to the manual placental segmentation. A paired t-test was used to compare the DSCs between SADL and U-Net methods. A Bland-Altman plot was used to analyze the agreement between manual and automated placental volume measurements. A P value < 0.05 was considered statistically significant. RESULTS In the testing dataset, SADL achieved average DSCs of 0.83 ± 0.06 and 0.84 ± 0.05 in the first and second MRI, which were significantly higher than those achieved by U-Net (0.77 ± 0.08 and 0.76 ± 0.10, respectively). A total of 6 out of 62 MRI scans (9.6%) had volume measurement differences between the SADL-based automated and manual volume measurements that were out of 95% limits of agreement. DATA CONCLUSIONS SADL can automatically detect and segment the placenta with high performance in MRI at two different gestational ages. LEVEL OF EVIDENCE 4 TECHNICAL EFFICACY STAGE: 2.
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Affiliation(s)
- Yongkai Liu
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
- Physics and Biology in Medicine IDP, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Fatemeh Zabihollahy
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Ran Yan
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
- Department of Bioengineering, Henry Samueli School of Engineering, University of California, Los Angeles, CA, USA
| | - Brian Lee
- Department of Pediatrics, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Carla Janzen
- Department of Obstetrics and Gynecology, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Sherin U. Devaskar
- Department of Pediatrics, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Kyunghyun Sung
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
- Physics and Biology in Medicine IDP, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
- Department of Bioengineering, Henry Samueli School of Engineering, University of California, Los Angeles, CA, USA
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10
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Lee B, Janzen C, Wu H, Vangala SS, Devaskar SU, Sung K. Utility of In Vivo Magnetic Resonance Imaging Is Predictive of Gestational Diabetes Mellitus During Early Pregnancy. J Clin Endocrinol Metab 2023; 108:281-294. [PMID: 36251771 PMCID: PMC9844964 DOI: 10.1210/clinem/dgac602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 10/11/2022] [Indexed: 01/22/2023]
Abstract
CONTEXT Gestational diabetes (GDM) imposes long-term adverse health effects on the mother and fetus. The role of magnetic resonance imaging (MRI) during early gestation in GDM has not been well-studied. OBJECTIVE To investigate the role of quantitative MRI measurements of placental volume and perfusion, with distribution of maternal adiposity, during early gestation in GDM. METHODS At UCLA outpatient antenatal obstetrics clinics, ∼200 pregnant women recruited in the first trimester were followed temporally through pregnancy until parturition. Two placental MRI scans were prospectively performed at 14 to 16 weeks and 19 to 24 weeks gestational age (GA). Placental volume and blood flow (PBF) were calculated from placental regions of interest; maternal adiposity distribution was assessed by subcutaneous fat area ratio (SFAR) and visceral fat area ratio (VFAR). Statistical comparisons were performed using the two-tailed t test. Predictive logistic regression modeling was evaluated by area under the curve (AUC). RESULTS Of a total 186 subjects, 21 subjects (11.3%) developed GDM. VFAR was higher in GDM vs the control group, at both time points (P < 0.001 each). Placental volume was greater in GDM vs the control group at 19 to 24 weeks GA (P = 0.01). Combining VFAR, placental volume and perfusion, improved the AUC to 0.83 at 14 to 16 weeks (positive predictive value [PPV] = 0.77, negative predictive value [NPV] = 0.83), and 0.81 at 19 to 24 weeks GA (PPV = 0.73, NPV = 0.86). CONCLUSION A combination of MRI-based placental volume, perfusion, and visceral adiposity during early pregnancy demonstrates significant changes in GDM and provides a proof of concept for predicting the subsequent development of GDM.
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Affiliation(s)
- Brian Lee
- Department of Pediatrics, David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA
| | - Carla Janzen
- Department of Obstetrics and Gynecology, Division of Perinatology Maternal Fetal Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA
| | - Holden Wu
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA
| | - Sitaram S Vangala
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA
| | - Sherin U Devaskar
- Correspondence: Sherin U. Devaskar, MD, Department of Pediatrics, David Geffen School of Medicine, University of California Los Angeles, 10833, Le Conte Avenue, Los Angeles, CA 90095-1752, USA.
| | - Kyunghyun Sung
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA
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11
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Janzen C, Lei MYY, Lee BR, Vangala S, DelRosario I, Meng Q, Ritz B, Liu J, Jerrett M, Chanlaw T, Choi S, Aliabadi A, Fortes PA, Sullivan PS, Murphy A, Vecchio GD, Thamotharan S, Sung K, Devaskar SU. A Description of the Imaging Innovations for Placental Assessment in Response to Environmental Pollution Study. Am J Perinatol 2022. [PMID: 36241211 DOI: 10.1055/a-1961-2059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVE The aim of Placental Assessment in Response to Environmental Pollution Study (PARENTs) was to determine whether imaging of the placenta by novel multiparametric magnetic resonance imaging (MRI) techniques in early pregnancy could help predict adverse pregnancy outcomes (APOs) due to ischemic placental disease (IPD). Additionally, we sought to determine maternal characteristics and environmental risk factors that contribute to IPD and secondary APOs. STUDY DESIGN Potential patients in their first trimester of pregnancy, who agreed to MRI of the placenta and measures of assessment of environmental pollution, were recruited into PARENTs, a prospective population-based cohort study. Participants were seen at three study visits during pregnancy and again at their delivery from 2015 to 2019. We collected data from interviews, chart abstractions, and imaging. Maternal biospecimens (serum, plasma, and urine) at antepartum study visits and delivery specimens (placenta, cord, and maternal blood) were collected, processed, and stored. The primary outcome was a composite of IPD, which included any of the following: placental abruption, hypertensive disease of pregnancy, fetal growth restriction, or a newborn of small for gestational age. RESULTS In this pilot cohort, of the 190 patients who completed pregnancy to viable delivery, 50 (26%) developed IPD. Among demographic characteristics, having a history of prior IPD in multiparous women was associated with the development of IPD. In the multiple novel perfusion measurements taken of the in vivo placenta using MRI, decreased high placental blood flow (mL/100 g/min) in early pregnancy (between 14 and 16 weeks) was found to be significantly associated with the later development of IPD. CONCLUSION Successful recruitment of the PARENTs prospective cohort demonstrated the feasibility and acceptability of the use of MRI in human pregnancy to study the placenta in vivo and at the same time collect environmental exposure data. Analysis is ongoing and we hope these methods will assist researchers in the design of prospective imaging studies of pregnancy. KEY POINTS · MRI was acceptable and feasible for the study of the human placenta in vivo.. · Functional imaging of the placenta by MRI showed a significant decrease in high placental blood flow.. · Measures of environmental exposures are further being analyzed to predict IPD..
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Affiliation(s)
- Carla Janzen
- Department of Obstetrics and Gynecology, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California
| | - Margarida Y Y Lei
- Department of Obstetrics and Gynecology, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California
| | - Brian R Lee
- Department of Pediatrics, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California
| | - Sitaram Vangala
- Department of Internal Medicine and Health Services Research, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California
| | - Irish DelRosario
- Department of Epidemiology, Jonathan Fielding School of Public Health at University of California Los Angeles, Los Angeles, California
| | - Qi Meng
- Department of Epidemiology, Jonathan Fielding School of Public Health at University of California Los Angeles, Los Angeles, California
| | - Beate Ritz
- Department of Epidemiology, Jonathan Fielding School of Public Health at University of California Los Angeles, Los Angeles, California
| | - Jonathan Liu
- Department of Environmental Health Sciences, Jonathan Fielding School of Public Health at University of California Los Angeles, Los Angeles, California
| | - Michael Jerrett
- Department of Environmental Health Sciences, Jonathan Fielding School of Public Health at University of California Los Angeles, Los Angeles, California
| | - Teresa Chanlaw
- Department of Pediatrics, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California
| | - Sarah Choi
- Department of Pediatrics, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California
| | - Arya Aliabadi
- Department of Internal Medicine and Health Services Research, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California
| | - Precious Ann Fortes
- Department of Pathology, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California
| | - Peggy S Sullivan
- Department of Pathology, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California
| | - Aisling Murphy
- Department of Obstetrics and Gynecology, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California
| | - Giorgia Del Vecchio
- Department of Pediatrics, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California
| | - Shanthie Thamotharan
- Department of Pediatrics, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California
| | - KyungHyun Sung
- Department of Radiology, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California
| | - Sherin U Devaskar
- Department of Pediatrics, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California
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12
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Thamotharan S, Ghosh S, James-Allan L, Lei MYY, Janzen C, Devaskar SU. Circulating extracellular vesicles exhibit a differential miRNA profile in gestational diabetes mellitus pregnancies. PLoS One 2022; 17:e0267564. [PMID: 35613088 PMCID: PMC9132306 DOI: 10.1371/journal.pone.0267564] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 04/11/2022] [Indexed: 11/27/2022] Open
Abstract
We undertook a prospective temporal study collecting blood samples from consenting pregnant women, to test the hypothesis that circulating extracellular vesicles (EVs) carrying specific non-coding microRNA signatures can underlie gestational diabetes mellitus (GDM). To test this hypothesis, miRNA cargo of isolated and characterized EVs revealed contributions from the placenta and differential expression at all three trimesters and at delivery between pregnant and non-pregnant states. Many miRNAs originate from the placental-specific chromosome 19 microRNA cluster (19MC) and chromosome 14 microRNA cluster (14MC). Further a positive correlation emerged between third trimester and at delivery EVs containing miRNAs and those expressed by the corresponding post-parturient placentas (R value = 0.63 to 0.69, p value = 2.2X10-16), in normal and GDM. In addition, distinct differences at all trimesters emerged between women who subsequently developed GDM. Analysis by logistic regression with leave-one-out-cross validation revealed the optimal combination of miRNAs using all the circulating miRNAs (miR-92a-3p, miR-192-5p, miR-451a, miR-122-5p), or using only the differentially expressed miRNAs (has-miR-92a-3p, hsa-miR-92b-3p, hsa-miR-100-5p and hsa-miR-125a-3p) in GDM during the first trimester. As an initial step, both sets of miRNAs demonstrated a predictive probability with an area under the curve of 0.95 to 0.96. These miRNAs targeted genes involved in cell metabolism, proliferation and immune tolerance. In particular genes of the P-I-3-Kinase, FOXO, insulin signaling and glucogenic pathways were targeted, suggestive of placental connectivity with various maternal organs/cells, altering physiology along with pathogenic mechanisms underlying the subsequent development of GDM. We conclude that circulating EVs originating from the placenta with their miRNA cargo communicate and regulate signaling pathways in maternal organs, thereby predetermining development of GDM.
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Affiliation(s)
- Shanthie Thamotharan
- Departments of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, California, United States of America
| | - Shubhamoy Ghosh
- Departments of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, California, United States of America
| | - Laura James-Allan
- Departments of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, California, United States of America
| | - Margarida Y. Y. Lei
- Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, Los Angeles, California, United States of America
| | - Carla Janzen
- Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, Los Angeles, California, United States of America
| | - Sherin U. Devaskar
- Departments of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, California, United States of America
- * E-mail:
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13
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Foo SS, Cambou MC, Mok T, Fajardo VM, Jung KL, Fuller T, Chen W, Kerin T, Mei J, Bhattacharya D, Choi Y, Wu X, Xia T, Shin WJ, Cranston J, Aldrovandi G, Tobin N, Contreras D, Ibarrondo FJ, Yang O, Yang S, Garner O, Cortado R, Bryson Y, Janzen C, Ghosh S, Devaskar S, Asilnejad B, Moreira ME, Vasconcelos Z, Soni PR, Gibson LC, Brasil P, Comhair SA, Arumugaswami V, Erzurum SC, Rao R, Jung JU, Nielsen-Saines K. The systemic inflammatory landscape of COVID-19 in pregnancy: Extensive serum proteomic profiling of mother-infant dyads with in utero SARS-CoV-2. Cell Rep Med 2021; 2:100453. [PMID: 34723226 PMCID: PMC8549189 DOI: 10.1016/j.xcrm.2021.100453] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 08/30/2021] [Accepted: 10/21/2021] [Indexed: 12/22/2022]
Abstract
While pregnancy increases the risk for severe COVID-19, the clinical and immunological implications of COVID-19 on maternal-fetal health remain unknown. Here, we present the clinical and immunological landscapes of 93 COVID-19 mothers and 45 of their SARS-CoV-2-exposed infants through comprehensive serum proteomics profiling for >1,400 cytokines of their peripheral and cord blood specimens. Prenatal SARS-CoV-2 infection triggers NF-κB-dependent proinflammatory immune activation. Pregnant women with severe COVID-19 show increased inflammation and unique IFN-λ antiviral signaling, with elevated levels of IFNL1 and IFNLR1. Furthermore, SARS-CoV-2 infection re-shapes maternal immunity at delivery, altering the expression of pregnancy complication-associated cytokines, inducing MMP7, MDK, and ESM1 and reducing BGN and CD209. Finally, COVID-19-exposed infants exhibit induction of T cell-associated cytokines (IL33, NFATC3, and CCL21), while some undergo IL-1β/IL-18/CASP1 axis-driven neonatal respiratory distress despite birth at term. Our findings demonstrate COVID-19-induced immune rewiring in both mothers and neonates, warranting long-term clinical follow-up to mitigate potential health risks.
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Affiliation(s)
- Suan-Sin Foo
- Department of Cancer Biology, Infection Biology Program, and Global Center for Pathogen Research and Human Health, Lerner Research Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Mary Catherine Cambou
- Department of Medicine, Division of Infectious Diseases, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - Thalia Mok
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - Viviana M. Fajardo
- Department of Pediatrics, Division of Neonatology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - Kyle L. Jung
- Department of Cancer Biology, Infection Biology Program, and Global Center for Pathogen Research and Human Health, Lerner Research Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Trevon Fuller
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Manguinhos, Rio de Janeiro 21040-360, Brazil
| | - Weiqiang Chen
- Department of Cancer Biology, Infection Biology Program, and Global Center for Pathogen Research and Human Health, Lerner Research Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Tara Kerin
- Department of Pediatrics, Division of Infectious Diseases, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - Jenny Mei
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - Debika Bhattacharya
- Department of Medicine, Division of Infectious Diseases, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - Younho Choi
- Department of Cancer Biology, Infection Biology Program, and Global Center for Pathogen Research and Human Health, Lerner Research Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Xin Wu
- Department of Cancer Biology, Infection Biology Program, and Global Center for Pathogen Research and Human Health, Lerner Research Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Tian Xia
- Department of Cancer Biology, Infection Biology Program, and Global Center for Pathogen Research and Human Health, Lerner Research Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Woo-Jin Shin
- Department of Cancer Biology, Infection Biology Program, and Global Center for Pathogen Research and Human Health, Lerner Research Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Jessica Cranston
- Department of Pediatrics, Division of Infectious Diseases, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - Grace Aldrovandi
- Department of Pediatrics, Division of Infectious Diseases, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - Nicole Tobin
- Department of Pediatrics, Division of Infectious Diseases, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - Deisy Contreras
- Department of Pediatrics, Division of Infectious Diseases, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - Francisco J. Ibarrondo
- Department of Medicine, Division of Infectious Diseases, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - Otto Yang
- Department of Medicine, Division of Infectious Diseases, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - Shangxin Yang
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - Omai Garner
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - Ruth Cortado
- Department of Pediatrics, Division of Infectious Diseases, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - Yvonne Bryson
- Department of Pediatrics, Division of Infectious Diseases, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - Carla Janzen
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - Shubhamoy Ghosh
- Department of Pediatrics, Division of Neonatology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - Sherin Devaskar
- Department of Pediatrics, Division of Neonatology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - Brenda Asilnejad
- Georgetown University School of Medicine, Washington, DC 20007, USA
| | | | - Zilton Vasconcelos
- Instituto Fernades Figueira, Fiocruz, Flamengo, Rio de Janeiro 20140-360, Brazil
| | - Priya R. Soni
- Department of Pediatrics, Cedars-Sinai Medical Center, Los Angeles, CA 90049, USA
| | - L. Caroline Gibson
- Department of Pediatrics, Cedars-Sinai Medical Center, Los Angeles, CA 90049, USA
| | - Patricia Brasil
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Manguinhos, Rio de Janeiro 21040-360, Brazil
| | - Suzy A.A. Comhair
- Respiratory Institute, Lerner Research Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Vaithilingaraja Arumugaswami
- Department of Molecular and Medical Pharmacology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - Serpil C. Erzurum
- Respiratory Institute, Lerner Research Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Rashmi Rao
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - Jae U. Jung
- Department of Cancer Biology, Infection Biology Program, and Global Center for Pathogen Research and Human Health, Lerner Research Institute, Cleveland Clinic, Cleveland, OH 44195, USA,Corresponding author
| | - Karin Nielsen-Saines
- Department of Pediatrics, Division of Infectious Diseases, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095, USA,Corresponding author
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14
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Fortes PA, Janzen C, Yong Lei MY, Devaskar S, Chanlaw T, Choi S, Vangala S, Sullivan P. Does Amsterdam criteria applied to largely unsubmitted term placentas with favorable fetal outcomes show significant maternal clinico-pathologic correlation? A case-controlled study. Placenta 2021. [DOI: 10.1016/j.placenta.2021.07.151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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15
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Kawahara B, Faull KF, Janzen C, Mascharak PK. Carbon Monoxide Inhibits Cytochrome P450 Enzymes CYP3A4/2C8 in Human Breast Cancer Cells, Increasing Sensitivity to Paclitaxel. J Med Chem 2021; 64:8437-8446. [PMID: 34097831 DOI: 10.1021/acs.jmedchem.1c00404] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Paclitaxel (PTX) is a first-line treatment in breast cancer, though resistance develops quickly and frequently. Cytochrome P450 enzymes CYP3A4 and CYP2C8, which metabolically inactivate PTX in hepatic tissue, are overexpressed in malignant breast tissues. CYP3A4 expression correlates with PTX therapy failure and poor outcomes, though no direct evidence of CYP3A4 contributing to PTX sensitivity exists. Because CYP3A4/2C8 is susceptible to carbon monoxide (CO)-mediated inhibition and CO (a gaseous signaling molecule) has previously exhibited drug-sensitizing effects in cancer cells, we hypothesized that CO-mediated inhibition of CYP3A4/2C8 could lead to enhanced drug sensitivity. Using a photo-activated CO-releasing molecule, we have assessed the ability of CO to alter the pharmacokinetics of PTX in breast cancer cells via inhibition of CYP3A4/2C8 and determined that CO does enhance sensitivity of breast cancer cells to PTX. Inhibition of CYP3A4/2C8 by CO could therefore be a promising therapeutic strategy to enhance PTX response in breast cancer.
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Affiliation(s)
- Brian Kawahara
- Department of Chemistry and Biochemistry, University of California, Santa Cruz, Santa Cruz, California 95064, United States
| | - Kym F Faull
- Pasarow Mass Spectrometry Laboratory, Jane and Terry Semel Institute for Neuroscience and Human Behavior and Department of Psychiatry & Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, California 90024, United States
| | - Carla Janzen
- Department of Obstetrics and Gynecology, David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, California 90095, United States
| | - Pradip K Mascharak
- Department of Chemistry and Biochemistry, University of California, Santa Cruz, Santa Cruz, California 95064, United States
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16
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Su L, Lin BR, Lin F, Tsui IK, Gaw SL, Janzen C, Sadda SR, Tsui I. Maternal Optical Coherence Tomography Angiography Changes Related to Small for Gestational Age Pregnancies. Transl Vis Sci Technol 2020; 9:4. [PMID: 33344048 PMCID: PMC7718826 DOI: 10.1167/tvst.9.13.4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Accepted: 10/14/2020] [Indexed: 11/24/2022] Open
Abstract
Purpose To study maternal retinal changes in pregnancies that resulted in a small for gestational age (SGA) infant. Methods Pregnant women with SGA infants at birth and age-matched pregnant women with appropriate for gestational age (AGA) infants at birth (controls) were enrolled. All subjects underwent spectral domain optical coherent tomography angiography (OCTA) imaging using a 10° × 10° scan pattern centered on the fovea. Vessel density (VD) and vessel length density (VLD) of the superficial capillary plexus (SCP), intermediate capillary plexus (ICP), and deep capillary plexus (DCP) were analyzed and compared between the two groups. Results Twelve eyes of eight subjects with SGA infants and 64 eyes of 44 age-matched subjects with AGA infants were included in this study. There was no significant difference in chronic hypertension (P = 1.0), gestational hypertension (P = 1.0), type 1/2 diabetes (P = 1.0), gestational diabetes (P = 0.97), or preeclampsia (P = 0.50) between the SGA group and AGA group. There were significant increases in both VD and VLD in the SCP and ICP layers when comparing the SGA group with the AGA group (P < 0.05). Conclusions In this pilot study, subjects with SGA infants had increases in selective retinal vasculature layers that may represent systemic perfusion changes compensating for placental insufficiency. Translational Relevance Additional assessment of maternal retinal changes in pregnancy using OCTA could prove the technology useful as a biomarker of fetal morbidity.
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Affiliation(s)
- Li Su
- Doheny Eye Institute, Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.,Department of Ophthalmology, Shanghai General Hospital (Shanghai First People's Hospital), Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Benjamin R Lin
- Doheny Eye Institute, Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Fei Lin
- Doheny Eye Institute, Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Ilene K Tsui
- Department of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Stephanie L Gaw
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences at UCSF, San Francisco, CA, USA
| | - Carla Janzen
- Department of Obstetrics and Gynecology, UCLA, Los Angeles, CA, USA
| | - SriniVas R Sadda
- Doheny Eye Institute, Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Irena Tsui
- Doheny Eye Institute, Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.,Stein Eye Institute, Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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17
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Del Vecchio G, Li Q, Li W, Thamotharan S, Tosevska A, Morselli M, Sung K, Janzen C, Zhou X, Pellegrini M, Devaskar SU. Cell-free DNA Methylation and Transcriptomic Signature Prediction of Pregnancies with Adverse Outcomes. Epigenetics 2020; 16:642-661. [PMID: 33045922 DOI: 10.1080/15592294.2020.1816774] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Although analysis of maternal plasma cell-free content has been employed for screening of genetic abnormalities within a pregnancy, limited attention has been paid to its use for the detection of adverse pregnancy outcomes (APOs) based on placental function. Here we investigated cell-free DNA and RNA content of 102 maternal and 25 cord plasma samples. Employing a novel deconvolution methodology, we found that during the first trimester, placenta-specific DNA increased prior to the subsequent development of gestational diabetes with no change in patients with preeclampsia while decreasing with maternal obesity. Moreover, using cell-free RNA sequencing, APOs revealed 71 differentially expressed genes early in pregnancy. We noticed the upregulation of S100A8, MS4A3, and MMP8 that have been already associated with APOs but also the upregulation of BCL2L15 and the downregulation of ALPL that have never been associated with APOs. We constructed a classifier with a positive predictive ability (AUC) of 0.91 for APOs, 0.86 for preeclampsia alone and 0.64 for GDM. We conclude that placenta-specific cell-free nucleic acids during early gestation provide the possibility of predicting APOs prior to the emergence of characteristic clinical features.
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Affiliation(s)
- Giorgia Del Vecchio
- Departments of Pediatrics David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Qingjiao Li
- The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Wenyuan Li
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Shanthie Thamotharan
- Departments of Pediatrics David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Anela Tosevska
- Departments of Molecular, Cellular and Developmental Biology, University of California Los Angeles, California, USA
| | - Marco Morselli
- Departments of Molecular, Cellular and Developmental Biology, University of California Los Angeles, California, USA
| | - Kyunghyun Sung
- Department of Radiological Sciences, University of California Los Angeles, California, USA
| | - Carla Janzen
- Department of Obstetrics & Gynecology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Xianghong Zhou
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Matteo Pellegrini
- Departments of Molecular, Cellular and Developmental Biology, University of California Los Angeles, California, USA
| | - Sherin U Devaskar
- Departments of Pediatrics David Geffen School of Medicine at UCLA, Los Angeles, California, USA
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18
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Kawahara B, Gao L, Cohn W, Whitelegge JP, Sen S, Janzen C, Mascharak PK. Diminished viability of human ovarian cancer cells by antigen-specific delivery of carbon monoxide with a family of photoactivatable antibody-photoCORM conjugates. Chem Sci 2019; 11:467-473. [PMID: 32190266 PMCID: PMC7067254 DOI: 10.1039/c9sc03166a] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 11/18/2019] [Indexed: 12/12/2022] Open
Abstract
Antibodies conjugated to a photoactive transition metal carbonyl complex afford antigen-directed delivery of cytotoxic carbon monoxide to ovarian cancer cells.
Carbon monoxide (CO)-releasing antibody conjugates were synthesized utilizing a photoactivatable CO-releasing molecule (photoCORM) and mouse monoclonal antibodies linked by a biotin-streptavidin system. Different monoclonal antibodies raised against different surface-expressed antigens that are implicated in ovarian cancer afforded a family of antibody-photoCORM conjugates (Ab-photoCORMs). In an immunosorbent/cell viability assay, Ab-photoCORMs accumulated onto ovarian cancer cells expressing the target antigens, delivering cytotoxic doses of CO in vitro. The results described here provide the first example of an “immunoCORM”, a proof-of-the-concept antibody-drug conjugate that delivers a gaseous molecule as a warhead to ovarian cancer.
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Affiliation(s)
- Brian Kawahara
- Department of Chemistry and Biochemistry , University of California , Santa Cruz , CA 95064 , USA .
| | - Lucy Gao
- Pasarow Mass Spectrometry Laboratory , Jane and Terry Semel Institute for Neuroscience and Human Behavior , University of California at Los Angeles , Los Angeles , CA 90095 , USA
| | - Whitaker Cohn
- Pasarow Mass Spectrometry Laboratory , Jane and Terry Semel Institute for Neuroscience and Human Behavior , University of California at Los Angeles , Los Angeles , CA 90095 , USA
| | - Julian P Whitelegge
- Pasarow Mass Spectrometry Laboratory , Jane and Terry Semel Institute for Neuroscience and Human Behavior , University of California at Los Angeles , Los Angeles , CA 90095 , USA
| | - Suvajit Sen
- Department of Obstetrics and Gynecology , David Geffen School of Medicine , University of California at Los Angeles , Los Angeles , CA 90095 , USA
| | - Carla Janzen
- Department of Obstetrics and Gynecology , David Geffen School of Medicine , University of California at Los Angeles , Los Angeles , CA 90095 , USA
| | - Pradip K Mascharak
- Department of Chemistry and Biochemistry , University of California , Santa Cruz , CA 95064 , USA .
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19
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Liu D, Shao X, Danyalov A, Chanlaw T, Masamed R, Wang DJJ, Janzen C, Devaskar SU, Sung K. Human Placenta Blood Flow During Early Gestation With Pseudocontinuous Arterial Spin Labeling MRI. J Magn Reson Imaging 2019; 51:1247-1257. [PMID: 31680405 DOI: 10.1002/jmri.26944] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 09/07/2019] [Accepted: 09/09/2019] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Noninvasive measurement of placental blood flow is the major technical challenge for predicting ischemic placenta (IPD). Pseudocontinuous arterial spin labeling (pCASL) MRI was recently shown to be promising, but the potential value in predicting the subsequence development of IPD is not known. PURPOSE To derive global and regional placental blood flow parameters from longitudinal measurements of pCASL MRI and to assess the associations between perfusion-related parameters and IPD. STUDY TYPE Prospective. POPULATION Eighty-four women completed two pCASL MRI scans (first; 14-18 weeks and second; 19-24 weeks) from prospectively recruited 118 subjects. A total of 69 subjects were included for the analysis, of which 15 subjects developed IPD. FIELD STRENGTH/SEQUENCE 3T/T2 -weighted half-Fourier single-shot turbo spin-echo (HASTE) and pCASL. ASSESSMENT Four perfusion-related parameters in the placenta were derived: placenta volume, placental blood flow (PBF), high PBF (hPBF), and relative hPBF. The longitudinal changes of the parameters and their association with IPD were tested after being normalizing to the 16th and 20th weeks of gestation. STATISTICAL TESTS Comparisons between two gestational ages within subjects were performed using the paired Wilcoxon tests, and comparisons between normal and IPD groups were performed using the unpaired Wilcoxon tests. RESULTS The difference between the first and second MRI scans was statistically significant for volume (156.6 cm3 vs. 269.7 cm3 , P < 0.001) and PBF (104.9 ml/100g/min vs. 111.3 ml/100g/min, P = 0.02) for normal subjects, indicating an increase in pregnancy with advancing gestation. Of the parameters tested, the difference between the normal and IPD subjects was most pronounced in hPBF (278.1 ml/100g/min vs. 180.7 ml/100g/min, P < 0.001) and relative hPBF (259.1% vs. 183.2%, P < 0.001) at 16 weeks. DATA CONCLUSION The high perfusion-related image parameters for IPD were significantly decreased from normal pregnancy at 14-18 weeks of gestation. LEVEL OF EVIDENCE 2 TECHNICAL EFFICACY STAGE: 1 J. Magn. Reson. Imaging 2020;51:1247-1257.
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Affiliation(s)
- Dapeng Liu
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Xingfeng Shao
- Laboratory of FMRI Technology (LOFT), Mark & Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, California, USA
| | - Alibek Danyalov
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Teresa Chanlaw
- Department of Pediatrics, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Rinat Masamed
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Danny J J Wang
- Laboratory of FMRI Technology (LOFT), Mark & Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, California, USA
| | - Carla Janzen
- Department of Obstetrics and Gynecology, Division of Perinatology Maternal Fetal Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Sherin U Devaskar
- Department of Pediatrics, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Kyunghyun Sung
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, California, USA
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20
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Chanwimol K, Balasubramanian S, Nassisi M, Gaw SL, Janzen C, Sarraf D, Sadda SR, Tsui I. Retinal Vascular Changes During Pregnancy Detected With Optical Coherence Tomography Angiography. ACTA ACUST UNITED AC 2019; 60:2726-2732. [DOI: 10.1167/iovs.19-26956] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Karntida Chanwimol
- Doheny Image Reading Center, University of California-Los Angeles (UCLA), Los Angeles, California, United States
- Department of Ophthalmology, Mettapracharak Hospital, Nakorn Pathom, Thailand
- Department of Ophthalmology, Stein Eye Institute, UCLA, Los Angeles, California, United States
| | - Siva Balasubramanian
- Doheny Image Reading Center, University of California-Los Angeles (UCLA), Los Angeles, California, United States
- Department of Ophthalmology, Stein Eye Institute, UCLA, Los Angeles, California, United States
| | - Marco Nassisi
- Doheny Image Reading Center, University of California-Los Angeles (UCLA), Los Angeles, California, United States
- Department of Ophthalmology, Stein Eye Institute, UCLA, Los Angeles, California, United States
| | - Stephanie L. Gaw
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, California, United States
| | - Carla Janzen
- Department of Obstetrics and Gynecology, UCLA, Los Angeles, California, United States
| | - David Sarraf
- Department of Ophthalmology, Stein Eye Institute, UCLA, Los Angeles, California, United States
| | - Srinivas R. Sadda
- Doheny Image Reading Center, University of California-Los Angeles (UCLA), Los Angeles, California, United States
- Department of Ophthalmology, Stein Eye Institute, UCLA, Los Angeles, California, United States
| | - Irena Tsui
- Doheny Image Reading Center, University of California-Los Angeles (UCLA), Los Angeles, California, United States
- Department of Ophthalmology, Stein Eye Institute, UCLA, Los Angeles, California, United States
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21
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Chu A, Najafzadeh P, Sullivan P, Cone B, Elshimali R, Shakeri H, Janzen C, Mah V, Wadehra M. Aldehyde dehydrogenase isoforms and inflammatory cell populations are differentially expressed in term human placentas affected by intrauterine growth restriction. Placenta 2019; 81:9-17. [PMID: 31138432 PMCID: PMC6719708 DOI: 10.1016/j.placenta.2019.03.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 03/21/2019] [Accepted: 03/28/2019] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Intrauterine growth restriction (IUGR) is a complication of pregnancy that has both short- and long-term sequelae for affected mothers and offspring. The pathophysiology of disease stems from poor nutrient and oxygen provision to the fetus, resulting in increased oxidative stress within the placenta. As the milieu within the local microenvironment alters macrophage differentiation, we hypothesized that macrophage plasticity may be altered in placentas associated with IUGR, and that macrophages would show hallmarks of lipid peroxidation including altered aldehyde metabolism. METHODS In human placentas taken from normal pregnancies resulting in appropriate-for-gestational-age (AGA) newborns and placentas associated with IUGR, placental macrophages were evaluated by immunohistochemistry and shown in IUGR to resemble pro-inflammatory activated M1-type macrophages. To link oxidative stress to macrophages, the expression of aldehyde dehydrogenase (ALDHs) isozymes ALDH1, ALDH2, and ALDH3 was assessed. RESULTS All three isozymes displayed preferential staining for distinct cellular populations within the term human placenta. ALDH1 and ALDH2 were strongly expressed in placental Hofbauer and decidual stromal cells. ALDH3, in contrast, was present in extravillous trophoblasts. Comparing AGA and IUGR-associated placentas, ALDH1 and ALDH2 trended to have greater expression in macrophage populations but lower expression in decidual cell populations in IUGR-associated placentas. ALDH3 had higher expression in IUGR-associated placentas but localized specifically to extravillous trophoblast populations. CONCLUSION Therefore, we speculate that specific ALDH isozymes have cell-specific functions related to differentiation, inflammation, or oxidative stress responses that are altered in IUGR-associated term human placentas. This family of isozymes may be a novel method to identify human placentas affected by placental insufficiency/IUGR.
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Affiliation(s)
- Alison Chu
- Department of Pediatrics, Division of Neonatology and Developmental Biology, David Geffen School of Medicine at UCLA, 10833 LeConte Avenue, Room B2-375 MDCC, Los Angeles, CA, 90095, USA.
| | - Parisa Najafzadeh
- Department of Pathology and Laboratory Medicine, 4525 MacDonald Research Laboratories, Geffen School of Medicine at UCLA, Los Angeles, CA, 90095, USA.
| | - Peggy Sullivan
- Department of Pathology and Laboratory Medicine, 4525 MacDonald Research Laboratories, Geffen School of Medicine at UCLA, Los Angeles, CA, 90095, USA.
| | - Brian Cone
- Department of Pathology and Laboratory Medicine, 4525 MacDonald Research Laboratories, Geffen School of Medicine at UCLA, Los Angeles, CA, 90095, USA
| | - Ryan Elshimali
- Department of Pathology and Laboratory Medicine, 4525 MacDonald Research Laboratories, Geffen School of Medicine at UCLA, Los Angeles, CA, 90095, USA.
| | - Hania Shakeri
- Department of Pathology and Laboratory Medicine, 4525 MacDonald Research Laboratories, Geffen School of Medicine at UCLA, Los Angeles, CA, 90095, USA.
| | - Carla Janzen
- Department of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, 10833 Le Conte Avenue, Room 22-172, Los Angeles, CA, 90095, USA.
| | - Vei Mah
- Department of Pathology and Laboratory Medicine, 4525 MacDonald Research Laboratories, Geffen School of Medicine at UCLA, Los Angeles, CA, 90095, USA.
| | - Madhuri Wadehra
- Department of Pathology and Laboratory Medicine, 4525 MacDonald Research Laboratories, Geffen School of Medicine at UCLA, Los Angeles, CA, 90095, USA; Jonsson Comprehensive Cancer Center, David Geffen School of Medicine at UCLA, 8-684 Factor Building, Los Angeles, CA, 90095, USA; Center to Eliminate Cancer Health Disparities, Charles Drew University, 1731 East 120th Street, Los Angeles, CA, 90059, USA.
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22
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Heck JE, He D, Janzen C, Federman N, Olsen J, Ritz B, Hansen J. Fetal programming and Wilms tumor. Pediatr Blood Cancer 2019; 66:e27461. [PMID: 30255546 PMCID: PMC6530460 DOI: 10.1002/pbc.27461] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 08/27/2018] [Accepted: 08/28/2018] [Indexed: 12/23/2022]
Abstract
BACKGROUND The "fetal programming" hypothesis has been evaluated in many adult diseases including cancer, but not for Wilms tumor. Wilms tumor has been related to high birthweight, but little is known about other growth metrics such as a baby's birth length, ponderal index, or placenta size, which can shed additional light on growth patterns. METHODS Cases of Wilms tumor (N = 217) were taken from the Danish Cancer Registry, and controls (N = 4340) were randomly selected from the Population Register and matched to cases by sex and age. Linkage to the Medical Births Registry provided information on gestational factors and fetal growth measurements, while linkage to the Patient Register provided information on maternal and child health conditions. RESULTS Despite having typically normal to higher birthweights, Wilms tumor cases had smaller placentas (≤540 g; odds ratio (OR) = 4.24; 95% confidence interval (CI), 1.84-9.78) and a lower placenta-to-birthweight ratio (OR = 1.81; 95% CI, 1.17-2.82, per 1 SD decrease). Small placentas were more common among Wilms cases without congenital anomalies (OR = 6.43; 95% CI, 1.95-21.21). Wilms tumor cases had a higher prevalence of high birthweight (>4000 g; OR = 1.57; 95% CI, 1.11-2.22), birth length 55 cm or longer (OR = 1.74; 95% CI, 1.09-2.78), and being large for gestational age (OR = 1.79; 95% CI, 1.08-2.96). CONCLUSIONS Our study corroborates earlier studies showing associations with high birthweight and suggests associations between Wilms tumor and decreased placental size and low placenta-to-birthweight ratio.
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Affiliation(s)
- Julia E Heck
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, USA,Jonsson Comprehensive Cancer Center, University of California, Los Angeles, USA
| | - Di He
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, USA
| | - Carla Janzen
- Department of Obstetrics and Gynecology, Geffen School of Medicine, University of California, Los Angeles, USA
| | - Noah Federman
- Department of Pediatrics, Geffen School of Medicine, University of California, Los Angeles, USA
| | - Jorn Olsen
- Department of Clinical Epidemiology, Aarhus University, Denmark
| | - Beate Ritz
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, USA
| | - Johnni Hansen
- Danish Cancer Society Research Center, Copenhagen, Denmark
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23
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Tsui IK, Lin B, Lin M, Janzen C, Tsui I. 860: Retinal changes in women with vascular disease during pregnancy. Am J Obstet Gynecol 2019. [DOI: 10.1016/j.ajog.2018.11.883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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24
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Lopes Moreira ME, Nielsen-Saines K, Brasil P, Kerin T, Damasceno L, Pone M, Carvalho LMA, Pone SM, Vasconcelos Z, Ribeiro IP, Zin AA, Tsui I, Adachi K, Gaw SL, Halai UA, Salles TS, da Cunha DC, Bonaldo MC, Raja Gabaglia C, Guida L, Malacarne J, Costa RP, Gomes SC, Reis AB, Soares FVM, Hasue RH, Aizawa CYP, Genovesi FF, Aibe M, Einspieler C, Marschik PB, Pereira JP, Portari EA, Janzen C, Cherry JD. Neurodevelopment in Infants Exposed to Zika Virus In Utero. N Engl J Med 2018; 379:2377-2379. [PMID: 30575464 PMCID: PMC6478167 DOI: 10.1056/nejmc1800098] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
| | - Karin Nielsen-Saines
- David Geffen School of Medicine at the University of California, Los Angeles (UCLA), Los Angeles, CA
| | | | - Tara Kerin
- David Geffen School of Medicine at UCLA, Los Angeles, CA
| | | | - Marcos Pone
- Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | | | | | | | | | | | - Irena Tsui
- David Geffen School of Medicine at UCLA, Los Angeles, CA
| | | | - Stephanie L Gaw
- University of California, San Francisco, School of Medicine, San Francisco, CA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Mitsue Aibe
- Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | | | | | | | | | - Carla Janzen
- David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - James D Cherry
- David Geffen School of Medicine at UCLA, Los Angeles, CA
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25
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Datkhaeva I, Arboleda VA, Senaratne TN, Nikpour G, Meyerson C, Geng Y, Afshar Y, Scibetta E, Goldstein J, Quintero-Rivera F, Crandall BF, Grody WW, Deignan J, Janzen C. Identification of novel PIEZO1 variants using prenatal exome sequencing and correlation to ultrasound and autopsy findings of recurrent hydrops fetalis. Am J Med Genet A 2018; 176:2829-2834. [PMID: 30244526 DOI: 10.1002/ajmg.a.40533] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 07/19/2018] [Accepted: 08/10/2018] [Indexed: 01/07/2023]
Abstract
Nonimmune hydrops fetalis (NIHF) is a rare disorder with a high perinatal mortality of at least 50%. One cause of NIHF is generalized lymphatic dysplasia (GLD), a rare form of primary lymphedema of the extremities and systemic involvement including chylothoraces and pericardial effusions. An autosomal recessive form of GLD has been described, caused by variants in the PIEZO1 gene. It has been reported clinically to cause NIHF and childhood onset of facial and limb lymphedema, most of which were diagnosed postnatally. We present a case of a woman with recurrent pregnancies affected by NIHF because of novel compound heterozygous variants in the PIEZO1 gene diagnosed prenatally using exome sequencing (ES). Two variants in PIEZO1 (c.3206G>A and c.6208A>C) were identified that were inherited from the father and mother, and are predicted to cause a nonsense and missense change, respectively, in the PIEZO1 subunits. Ultrasound demonstrated severe bilateral pleural effusions, whole body edema and polyhydramnios. Histopathology revealed an increased number of lymphatic channels, many of which showed failure of luminal canalization. Sanger sequencing confirmed the same variants in a prior fetal demise. We provide phenotypic correlation with ultrasound and autopsy finding, review PIEZO1 variants as a cause of GLD and discuss the uses of prenatal ES to date.
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Affiliation(s)
- Ilina Datkhaeva
- Department of Obstetrics and Gynecology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Valerie A Arboleda
- Department of Pathology and Laboratory Medicine, UCLA Clinical Genomics Center, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - T Niroshi Senaratne
- Department of Pathology and Laboratory Medicine, UCLA Clinical Genomics Center, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Gelareh Nikpour
- Department of Obstetrics and Gynecology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Cherise Meyerson
- Department of Pathology and Laboratory Medicine, UCLA Clinical Genomics Center, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Yipeng Geng
- Department of Pathology and Laboratory Medicine, UCLA Clinical Genomics Center, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Yalda Afshar
- Department of Obstetrics and Gynecology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Emily Scibetta
- Department of Obstetrics and Gynecology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Jeffrey Goldstein
- Department of Pathology and Laboratory Medicine, UCLA Clinical Genomics Center, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Fabiola Quintero-Rivera
- Department of Pathology and Laboratory Medicine, UCLA Clinical Genomics Center, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Barbara F Crandall
- Department of Psychiatry, Prenatal Diagnosis Center, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Wayne W Grody
- Department of Pathology and Laboratory Medicine, UCLA Clinical Genomics Center, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California.,Department of Pediatrics, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California.,Department of Human Genetics, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Joshua Deignan
- Department of Pathology and Laboratory Medicine, UCLA Clinical Genomics Center, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Carla Janzen
- Department of Obstetrics and Gynecology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
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26
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Kawahara B, Ramadoss S, Chaudhuri G, Janzen C, Sen S, Mascharak PK. Carbon monoxide sensitizes cisplatin-resistant ovarian cancer cell lines toward cisplatin via attenuation of levels of glutathione and nuclear metallothionein. J Inorg Biochem 2018; 191:29-39. [PMID: 30458366 DOI: 10.1016/j.jinorgbio.2018.11.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 10/31/2018] [Accepted: 11/04/2018] [Indexed: 02/06/2023]
Abstract
Cisplatin resistance remains a major impediment to effective treatment of ovarian cancer. Despite initial platinum responsiveness, thiol-containing peptides and proteins, glutathione (GSH) and metallothionein (MT), bind and inactivate cisplatin in cancer cells. Indeed, high levels of GSH and MT in ovarian cancers impart cisplatin resistance and are predictive of poor prognosis. Cystathionine β-synthase (CBS), an enzyme involved in sulfur metabolism, is overexpressed in ovarian cancer tissues and is itself associated with cisplatin resistance. Treatment with exogenous carbon monoxide (CO), a known inhibitor of CBS, may mitigate cisplatin resistance in ovarian cancer cells by attenuation of GSH and MT levels. Using a photo-activated CO-releasing molecule (photoCORM), [Mn(CO)3(phen)(PTA)]CF3SO3 (phen = 1,10-phenanthroline, PTA = 1,3,5-triza-7-phosphaadamantane) we assessed the ability of CO to sensitize established cisplatin-resistant ovarian cancer cell lines to cisplatin. Cisplatin-resistant cells, treated with both cisplatin and CO, exhibited significantly lower cell viability and increased poly (ADP-ribose) polymerase (PARP) cleavage versus those treated with cisplatin alone. These cisplatin-resistant cell lines overexpressed CBS and had increased steady state levels of GSH and expression of nuclear MT. Both CO treatment and lentiviral-mediated silencing of CBS attenuated GSH and nuclear MT expression in cisplatin resistant cells. We have demonstrated that CO, delivered from a photoCORM, sensitizes established cisplatin-resistant cell lines to cisplatin. Furthermore, we have presented strong evidence that the effects of CO in circumventing chemotherapeutic drug resistance is at least in part mediated by the inactivation of endogenous CBS.
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Affiliation(s)
- Brian Kawahara
- Contribution from Department of Chemistry and Biochemistry, University of California, Santa Cruz, CA 95064, United States of America
| | - Sivakumar Ramadoss
- Department of Obstetrics and Gynecology, David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, CA 90095, United States of America
| | - Gautam Chaudhuri
- Department of Obstetrics and Gynecology, David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, CA 90095, United States of America
| | - Carla Janzen
- Department of Obstetrics and Gynecology, David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, CA 90095, United States of America
| | - Suvajit Sen
- Department of Obstetrics and Gynecology, David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, CA 90095, United States of America.
| | - Pradip K Mascharak
- Contribution from Department of Chemistry and Biochemistry, University of California, Santa Cruz, CA 95064, United States of America.
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27
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Armstrong T, Liu D, Martin T, Masamed R, Janzen C, Wong C, Chanlaw T, Devaskar SU, Sung K, Wu HH. 3D R 2 * mapping of the placenta during early gestation using free-breathing multiecho stack-of-radial MRI at 3T. J Magn Reson Imaging 2018; 49:291-303. [PMID: 30142239 DOI: 10.1002/jmri.26203] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 05/08/2018] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Multiecho gradient-echo Cartesian MRI characterizes placental oxygenation by quantifying R 2 * . Previous research was performed at 1.5T using breath-held 2D imaging during later gestational age (GA). PURPOSE To evaluate the accuracy and repeatability of a free-breathing (FB) 3D multiecho gradient-echo stack-of-radial technique (radial) for placental R 2 * mapping at 3T and report placental R 2 * during early GA. STUDY TYPE Prospective. POPULATION Thirty subjects with normal pregnancies and three subjects with ischemic placental disease (IPD) were scanned twice: between 14-18 and 19-23 weeks GA. FIELD STRENGTH 3T. SEQUENCE FB radial. ASSESSMENT Linear correlation (concordance coefficient, ρc ) and Bland-Altman analyses (mean difference, MD) were performed to evaluate radial R 2 * mapping accuracy compared to Cartesian in a phantom. Radial R 2 * mapping repeatability was characterized using the coefficient of repeatability (CR) between back-to-back scans. The mean and spatial coefficient of variation (CV) of R 2 * was determined for all subjects, and separately for anterior and posterior placentas, at each GA range. STATISTICAL TESTS ρc was tested for significance. Differences in mean R 2 * and CV were tested using Wilcoxon Signed-Rank and Rank-Sum tests. P < 0.05 was considered significant. Z-scores for the IPD subjects were determined. RESULTS FB radial demonstrated accurate (ρc ≥0.996; P < 0.001; |MD|<0.2s-1 ) and repeatable (CR<4s-1 ) R 2 * mapping in a phantom, and repeatable (CR≤4.6s-1 ) R 2 * mapping in normal subjects. At 3T, placental R 2 * mean ± standard deviation was 12.9s-1 ± 2.7s-1 for 14-18 and 13.2s-1 ± 1.9s-1 for 19-23 weeks GA. The CV was significantly greater (P = 0.043) at 14-18 (0.63 ± 0.12) than 19-23 (0.58 ± 0.13) weeks GA. At 19-23 weeks, the CV was significantly lower (P < 0.001) for anterior (0.49 ± 0.08) than posterior (0.67 ± 0.11) placentas. One IPD subject had a lower mean R 2 * than normal subjects at both GA ranges (Z<-2). DATA CONCLUSION FB radial provides accurate and repeatable 3D R 2 * mapping for the entire placenta at 3T during early GA. LEVEL OF EVIDENCE 2 Technical Efficacy: Stage 1 J. Magn. Reson. Imaging 2019;49:291-303.
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Affiliation(s)
- Tess Armstrong
- Department of Radiological Sciences, University of California Los Angeles, Los Angeles, California, USA.,Department of Physics and Biology in Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Dapeng Liu
- Department of Radiological Sciences, University of California Los Angeles, Los Angeles, California, USA
| | - Thomas Martin
- Department of Radiological Sciences, University of California Los Angeles, Los Angeles, California, USA.,Department of Physics and Biology in Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Rinat Masamed
- Department of Radiological Sciences, University of California Los Angeles, Los Angeles, California, USA
| | - Carla Janzen
- Department of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Cass Wong
- Department of Radiological Sciences, University of California Los Angeles, Los Angeles, California, USA
| | - Teresa Chanlaw
- Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Sherin U Devaskar
- Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Kyunghyun Sung
- Department of Radiological Sciences, University of California Los Angeles, Los Angeles, California, USA.,Department of Physics and Biology in Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Holden H Wu
- Department of Radiological Sciences, University of California Los Angeles, Los Angeles, California, USA.,Department of Physics and Biology in Medicine, University of California Los Angeles, Los Angeles, California, USA
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Blumenthal E, Rao R, Murphy A, Gornbein J, Hong R, Moriarty JM, Kahn DA, Janzen C. Pilot Study of Intra-Aortic Balloon Occlusion to Limit Morbidity in Patients with Adherent Placentation Undergoing Cesarean Hysterectomy. AJP Rep 2018; 8:e57-e63. [PMID: 29651358 PMCID: PMC5895466 DOI: 10.1055/s-0038-1641736] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 02/23/2018] [Indexed: 11/11/2022] Open
Abstract
Objective We study whether using an intra-aortic balloon (IAB) during cesarean hysterectomy decreases delivery morbidity in patients with suspected morbidly adherent placentation. Study Design This is a retrospective cohort study of deliveries complicated by suspected abnormal placentation between 2009 and 2016 comparing maternal and neonatal outcomes with an IAB placed prior to cesarean hysterectomy versus no IAB. The primary outcome included quantified blood loss (QBL). Results Thirty-five cases were reviewed, 16 with IAB and 19 without IAB. No difference was seen in median QBL between the two groups (1,351 vs. 1,397 mL; p = 0.90). There were no significant differences in overall surgical complications (19% IAB, 21% no IAB; p = 0.86), bladder complications (12 vs. 21%; p = 0.66), intensive care unit admissions (12 vs. 26%; p = 0.41), surgical duration (2.9 vs. 2.8 hour; p = 0.83), or blood transfusions (median 2 vs. 2; p = 0.27) between the two groups. There was one groin hematoma at the balloon site that was managed conservatively. There were no complications involving thrombosis or limb ischemia in the IAB group. Conclusion While we did not detect statistically significant differences, larger studies may be warranted given the potential for extreme morbidity in these cases. This study highlights the potential use of an IAB in the management of these cases.
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Affiliation(s)
- Elizabeth Blumenthal
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of California, Irvine, Orange County
| | - Rashmi Rao
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of California, Los Angeles, California
| | - Aisling Murphy
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of California, Los Angeles, California
| | - Jeffrey Gornbein
- Department of Biomathematics, University of California, Los Angeles, California
| | - Richard Hong
- Department of Anesthesia, University of California, Los Angeles, California
| | - John M Moriarty
- Department of Interventional Radiology; University of California, Los Angeles, California
| | - Daniel A Kahn
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of California, Los Angeles, California
| | - Carla Janzen
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of California, Los Angeles, California
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Janzen C, Lei MYY, Jeong ISD, Ganguly A, Sullivan P, Paharkova V, Capodanno G, Nakamura H, Perry A, Shin BC, Lee KW, Devaskar SU. Humanin (HN) and glucose transporter 8 (GLUT8) in pregnancies complicated by intrauterine growth restriction. PLoS One 2018; 13:e0193583. [PMID: 29590129 PMCID: PMC5873989 DOI: 10.1371/journal.pone.0193583] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 02/14/2018] [Indexed: 12/20/2022] Open
Abstract
Background Intrauterine growth restriction (IUGR) results from a lack of nutrients transferred to the developing fetus, particularly oxygen and glucose. Increased expression of the cytoprotective mitochondrial peptide, humanin (HN), and the glucose transporter 8, GLUT8, has been reported under conditions of hypoxic stress. However, the presence and cellular localization of HN and GLUT8 in IUGR-related placental pathology remain unexplored. Thus, we undertook this study to investigate placental expression of HN and GLUT8 in IUGR-affected versus normal pregnancies. Results We found 1) increased HN expression in human IUGR-affected pregnancies on the maternal aspect of the placenta (extravillous trophoblastic (EVT) cytoplasm) compared to control (i.e. appropriate for gestational age) pregnancies, and a concomitant increase in GLUT8 expression in the same compartment, 2) HN and GLUT8 showed a protein-protein interaction by co-immunoprecipitation, 3) elevated HN and GLUT8 levels in vitro under simulated hypoxia in human EVT cells, HTR8/SVneo, and 4) increased HN expression but attenuated GLUT8 expression in vitro under serum deprivation in HTR8/SVneo cells. Conclusions There was elevated HN expression with cytoplasmic localization to EVTs on the maternal aspect of the human placenta affected by IUGR, also associated with increased GLUT8 expression. We found that while hypoxia increased both HN and GLUT8, serum deprivation increased HN expression alone. Also, a protein-protein interaction between HN and GLUT8 suggests that their interaction may fulfill a biologic role that requires interdependency. Future investigations delineating molecular interactions between these proteins are required to fully uncover their role in IUGR-affected pregnancies.
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Affiliation(s)
- Carla Janzen
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, United States of America
- * E-mail:
| | - Margarida Y. Y. Lei
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, United States of America
| | - Il Seok D. Jeong
- Department of Pediatrics, Division of Endocrinology, David Geffen School of Medicine at UCLA, Los Angeles, California, United States of America
- Neonatal Research Center of the UCLA Children’s Discovery and Innovation Institute, David Geffen School of Medicine at UCLA, Los Angeles, California, United States of America
| | - Amit Ganguly
- Neonatal Research Center of the UCLA Children’s Discovery and Innovation Institute, David Geffen School of Medicine at UCLA, Los Angeles, California, United States of America
- Department of Pediatrics, Division of Neonatology, David Geffen School of Medicine at UCLA, Los Angeles, California, United States of America
| | - Peggy Sullivan
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, United States of America
| | - Vladislava Paharkova
- Department of Pediatrics, Division of Endocrinology, David Geffen School of Medicine at UCLA, Los Angeles, California, United States of America
- Neonatal Research Center of the UCLA Children’s Discovery and Innovation Institute, David Geffen School of Medicine at UCLA, Los Angeles, California, United States of America
| | - Gina Capodanno
- Department of Pediatrics, Division of Endocrinology, David Geffen School of Medicine at UCLA, Los Angeles, California, United States of America
- Neonatal Research Center of the UCLA Children’s Discovery and Innovation Institute, David Geffen School of Medicine at UCLA, Los Angeles, California, United States of America
| | - Hiromi Nakamura
- Department of Pediatrics, Division of Endocrinology, David Geffen School of Medicine at UCLA, Los Angeles, California, United States of America
- Neonatal Research Center of the UCLA Children’s Discovery and Innovation Institute, David Geffen School of Medicine at UCLA, Los Angeles, California, United States of America
| | - Alix Perry
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, United States of America
| | - Bo-Chul Shin
- Neonatal Research Center of the UCLA Children’s Discovery and Innovation Institute, David Geffen School of Medicine at UCLA, Los Angeles, California, United States of America
- Department of Pediatrics, Division of Neonatology, David Geffen School of Medicine at UCLA, Los Angeles, California, United States of America
| | - Kuk-Wha Lee
- Department of Pediatrics, Division of Endocrinology, David Geffen School of Medicine at UCLA, Los Angeles, California, United States of America
- Neonatal Research Center of the UCLA Children’s Discovery and Innovation Institute, David Geffen School of Medicine at UCLA, Los Angeles, California, United States of America
| | - Sherin U. Devaskar
- Neonatal Research Center of the UCLA Children’s Discovery and Innovation Institute, David Geffen School of Medicine at UCLA, Los Angeles, California, United States of America
- Department of Pediatrics, Division of Neonatology, David Geffen School of Medicine at UCLA, Los Angeles, California, United States of America
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Shao X, Liu D, Martin T, Chanlaw T, Devaskar SU, Janzen C, Murphy AM, Margolis D, Sung K, Wang DJJ. Measuring human placental blood flow with multidelay 3D GRASE pseudocontinuous arterial spin labeling at 3T. J Magn Reson Imaging 2017; 47:1667-1676. [PMID: 29135072 DOI: 10.1002/jmri.25893] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 10/26/2017] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Placenta influences the health of both a woman and her fetus during pregnancy. Maternal blood supply to placenta can be measured noninvasively using arterial spin labeling (ASL). PURPOSE To present a multidelay pseudocontinuous arterial spin labeling (pCASL) combined with a fast 3D inner-volume gradient- and spin-echo (GRASE) imaging technique to simultaneously measure placental blood flow (PBF) and arterial transit time (ATT), and to study PBF and ATT evolution with gestational age during the second trimester. The PBF values were compared with uterine arterial Doppler ultrasound to assess its potential clinical utility. STUDY TYPE This was a prospective study. SUBJECTS Thirty-four pregnant women. FIELD STRENGTH/SEQUENCE Multidelay 3D inner-volume GRASE pCASL sequence on 3T MR scanners. ASSESSMENT Subjects underwent two longitudinal MRI scans within the second trimester, conducted between 14-16 and 19-22 weeks of gestational age, respectively. Placental perfusion was measured using the free-breathing pCASL sequence at three postlabeling delays (PLDs), followed by offline motion correction and model fitting for estimation of PBF and ATT. STATISTICAL TESTS A paired t-test was conducted to evaluate the significance of PBF/ATT variations with placental development. A two-sample t-test was conducted to evaluate the significance of PBF difference in subjects with and without early diastolic notch. RESULTS The mean PBF and ATT for the second trimester were 111.4 ± 26.7 ml/100g/min and 1387.5 ± 88.0 msec, respectively. The average PBF increased by 10.4% (P < 0.05), while no significant change in ATT (P = 0.72) was found along gestational ages during the second trimester. PBF decreased 20.3% (P < 0.01) in subjects with early diastolic notches in ultrasound flow waveform patterns. DATA CONCLUSION Multidelay pCASL with inner-volume 3D GRASE is promising for noninvasive assessment of PBF during pregnancy. Its clinical use for the detection of aberrations in placental function and prediction of fetal developmental disorders awaits evaluation. LEVEL OF EVIDENCE 1 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2018;47:1667-1676.
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Affiliation(s)
- Xingfeng Shao
- Laboratory of FMRI Technology (LOFT), Mark & Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Dapeng Liu
- Department of Radiology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Thomas Martin
- Department of Radiology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Teresa Chanlaw
- Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Sherin U Devaskar
- Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Carla Janzen
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Aisling M Murphy
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Daniel Margolis
- Department of Radiology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Kyunghyun Sung
- Department of Radiology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Danny J J Wang
- Laboratory of FMRI Technology (LOFT), Mark & Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
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Chen PY, Chu A, Liao WW, Rubbi L, Janzen C, Hsu FM, Thamotharan S, Ganguly A, Lam L, Montoya D, Pellegrini M, Devaskar SU. Prenatal Growth Patterns and Birthweight Are Associated With Differential DNA Methylation and Gene Expression of Cardiometabolic Risk Genes in Human Placentas: A Discovery-Based Approach. Reprod Sci 2017; 25:523-539. [PMID: 28693373 DOI: 10.1177/1933719117716779] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Inherent genetic programming and environmental factors affect fetal growth in utero. Epidemiologic data in growth-altered fetuses, either intrauterine growth restricted (IUGR) or large for gestational age (LGA), demonstrate that these newborns are at increased risk of cardiometabolic disease in adulthood. There is growing evidence that the in utero environment leads to epigenetic modification, contributing to eventual risk of developing heart disease or diabetes. In this study, we used reduced representation bisulfite sequencing to examine genome-wide DNA methylation variation in placental samples from offspring born IUGR, LGA, and appropriate for gestational age (AGA) and to identify differential methylation of genes important for conferring risk of cardiometabolic disease. We found that there were distinct methylation signatures for IUGR, LGA, and AGA groups and identified over 500 differentially methylated genes (DMGs) among these group comparisons. Functional and gene network analyses revealed expected relationships of DMGs to placental physiology and transport, but also identified novel pathways with biologic plausibility and potential clinical importance to cardiometabolic disease. Specific loci for DMGs of interest had methylation patterns that were strongly associated with anthropometric presentations. We further validated altered gene expression of these specific DMGs contributing to vascular and metabolic diseases (SLC36A1, PTPRN2, CASZ1, IL10), thereby establishing transcriptional effects toward assigning functional significance. Our results suggest that the gene expression and methylation state of the human placenta are related and sensitive to the intrauterine environment, as it affects fetal growth patterns. We speculate that these observed changes may affect risk for offspring in developing adult cardiometabolic disease.
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Affiliation(s)
- Pao-Yang Chen
- 1 Institute of Plant and Microbial Biology, Academia Sinica, Taipei, Taiwan
| | - Alison Chu
- 2 Division of Neonatology and Developmental Biology, Department of Pediatrics, Neonatal Research Center of the UCLA Children's Discovery and Innovation Institute, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Wen-Wei Liao
- 1 Institute of Plant and Microbial Biology, Academia Sinica, Taipei, Taiwan
| | - Liudmilla Rubbi
- 3 Department of Molecular, Cell, and Developmental Biology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Carla Janzen
- 4 Department of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Fei-Man Hsu
- 1 Institute of Plant and Microbial Biology, Academia Sinica, Taipei, Taiwan
| | - Shanthie Thamotharan
- 2 Division of Neonatology and Developmental Biology, Department of Pediatrics, Neonatal Research Center of the UCLA Children's Discovery and Innovation Institute, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Amit Ganguly
- 2 Division of Neonatology and Developmental Biology, Department of Pediatrics, Neonatal Research Center of the UCLA Children's Discovery and Innovation Institute, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Larry Lam
- 3 Department of Molecular, Cell, and Developmental Biology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Dennis Montoya
- 3 Department of Molecular, Cell, and Developmental Biology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Matteo Pellegrini
- 3 Department of Molecular, Cell, and Developmental Biology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Sherin U Devaskar
- 2 Division of Neonatology and Developmental Biology, Department of Pediatrics, Neonatal Research Center of the UCLA Children's Discovery and Innovation Institute, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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Williams CJ, Chu A, Jefferson WN, Casero D, Sudhakar D, Khurana N, Hogue CP, Aryasomayajula C, Patel P, Sullivan P, Padilla-Banks E, Mohandessi S, Janzen C, Wadehra M. Epithelial membrane protein 2 (EMP2) deficiency alters placental angiogenesis, mimicking features of human placental insufficiency. J Pathol 2017; 242:246-259. [PMID: 28295343 DOI: 10.1002/path.4893] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Revised: 02/07/2017] [Accepted: 02/23/2017] [Indexed: 01/21/2023]
Abstract
Epithelial membrane protein-2 (EMP2) is a tetraspan protein predicted to regulate placental development. Highly expressed in secretory endometrium and trophectoderm cells, previous studies suggest that it may regulate implantation by orchestrating the surface expression of integrins and other membrane proteins. In order to test the role of EMP2 in pregnancy, mice lacking EMP2 (Emp2-/- ) were generated. Emp2-/- females are fertile but have reduced litter sizes when carrying Emp2-/- but not Emp2+/- fetuses. Placentas of Emp2-/- fetuses exhibit dysregulation in pathways related to neoangiogenesis, coagulation, and oxidative stress, and have increased fibrin deposition and altered vasculature. Given that these findings often occur due to placental insufficiency resulting in an oxygen-poor environment, the expression of hypoxia-inducible factor-1 alpha (HIF-1α) was examined. Placentas from Emp2-/- fetuses had increased total HIF-1α expression in large part through an increase in uterine NK (uNK) cells, demonstrating a unique interplay between uNK cells and trophoblasts modulated through EMP2. To determine if these results translated to human pregnancy, placentas from normal, term deliveries or those complicated by placental insufficiency resulting in intrauterine growth restriction (IUGR) were stained for EMP2. EMP2 was significantly reduced in both villous and extravillous trophoblast populations in IUGR placentas. Experiments in vitro using human trophoblast cells lines indicate that EMP2 modulates angiogenesis by altering HIF-1α expression. Our results reveal a novel role for EMP2 in regulating trophoblast function and vascular development in mice and humans, and suggest that it may be a new biomarker for placental insufficiency. Copyright © 2017 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd.
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Affiliation(s)
- Carmen J Williams
- Reproductive Medicine Group, Reproductive & Developmental Biology Laboratory, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC, 27709, USA
| | - Alison Chu
- Department of Pediatrics and Neonatology, Geffen School of Medicine at UCLA, Los Angeles, CA, 90095, USA
| | - Wendy N Jefferson
- Reproductive Medicine Group, Reproductive & Developmental Biology Laboratory, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC, 27709, USA
| | - David Casero
- Department of Pathology and Laboratory Medicine, Geffen School of Medicine at UCLA, Los Angeles, CA, 90095, USA
| | - Deepthi Sudhakar
- Department of Pathology and Laboratory Medicine, Geffen School of Medicine at UCLA, Los Angeles, CA, 90095, USA
| | - Nevil Khurana
- Department of Pathology and Laboratory Medicine, Geffen School of Medicine at UCLA, Los Angeles, CA, 90095, USA
| | - Claire P Hogue
- Department of Pathology and Laboratory Medicine, Geffen School of Medicine at UCLA, Los Angeles, CA, 90095, USA
| | - Chinmayi Aryasomayajula
- Department of Pathology and Laboratory Medicine, Geffen School of Medicine at UCLA, Los Angeles, CA, 90095, USA
| | - Priya Patel
- Department of Pathology and Laboratory Medicine, Geffen School of Medicine at UCLA, Los Angeles, CA, 90095, USA
| | - Peggy Sullivan
- Department of Pathology and Laboratory Medicine, Geffen School of Medicine at UCLA, Los Angeles, CA, 90095, USA
| | - Elizabeth Padilla-Banks
- Reproductive Medicine Group, Reproductive & Developmental Biology Laboratory, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC, 27709, USA
| | - Shabnam Mohandessi
- Department of Pathology and Laboratory Medicine, Geffen School of Medicine at UCLA, Los Angeles, CA, 90095, USA
| | - Carla Janzen
- Obstetrics and Gynecology, Geffen School of Medicine at UCLA, Los Angeles, CA, 90095, USA
| | - Madhuri Wadehra
- Department of Pathology and Laboratory Medicine, Geffen School of Medicine at UCLA, Los Angeles, CA, 90095, USA.,Jonsson Comprehensive Cancer Center, Geffen School of Medicine at UCLA, Los Angeles, CA, 90095, USA
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Thamotharan S, Chu A, Kempf K, Janzen C, Grogan T, Elashoff DA, Devaskar SU. Differential microRNA expression in human placentas of term intra-uterine growth restriction that regulates target genes mediating angiogenesis and amino acid transport. PLoS One 2017; 12:e0176493. [PMID: 28463968 PMCID: PMC5413012 DOI: 10.1371/journal.pone.0176493] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Accepted: 04/11/2017] [Indexed: 12/17/2022] Open
Abstract
Placental insufficiency leading to intrauterine growth restriction (IUGR) demonstrates perturbed gene expression affecting placental angiogenesis and nutrient transfer from mother to fetus. To understand the post-transcriptional mechanisms underlying such placental gene expression changes, our objective was to identify key non-coding microRNAs that express biological function. To this end, we initially undertook microarrays targeting microRNAs in a small sub-set of placentas of appropriate (AGA) versus small for gestational age (SGA) weight infants, and observed up-regulation of 97 miRs and down-regulation of 44 miRs in SGA versus AGA. In a larger cohort of samples (AGA, n = 21; SGA, n = 11; IUGR subset, n = 5), we validated by qRT-PCR differential expression of three specific microRNAs (miR-10b, -363 and -149) that target genes mediating angiogenesis and nutrient transfer. Validation yielded an increase in miR-10b and -363 expression of ~2.5-fold (p<0.02 each) in SGA versus AGA, and of ~3-fold (p<0.005) in IUGR versus AGA, with no significant change despite a trending increase in miR-149. To further establish a cause-and-effect paradigm, employing human HTR8 trophoblast cells, we assessed the effect of nutrient deprivation on miR expression and inhibition of endogenous miRs on target gene expression. In-vitro nutrient deprivation (~50%) increased the expression of miR-10b and miR-149 by 1.5-fold (p<0.02) while decreasing miR-363 (p<0.0001). Inhibition of endogenous miRs employing antisense sequences against miR-10b, -363 and -149 revealed an increase respectively in the expression of the target genes KLF-4 (transcription factor which regulates angiogenesis), SNAT1 and 2 (sodium coupled neutral amino acid transporters) and LAT2 (leucine amino acid transporter), which translated into a similar change in the corresponding proteins. Finally to establish functional significance we performed dual-luciferase reporter assays with 3'-insertion of miR-10b alone and observed a ~10% reduction in the 5'-luciferase activity versus the control. Lastly, we further validated by microarray and employing MirWalk software that the pathways and target genes identified by differentially expressed miRs in SGA/IUGR compared to AGA are consistent in a larger cohort. We have established the biological significance of various miRs that target common transcripts mediating pathways of importance, which are perturbed in the human IUGR placenta.
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Affiliation(s)
- Shanthie Thamotharan
- Department of Pediatrics, Division of Neonatology & Developmental Biology, David Geffen School of Medicine at UCLA, Los Angeles, California, United States of America
| | - Alison Chu
- Department of Pediatrics, Division of Neonatology & Developmental Biology, David Geffen School of Medicine at UCLA, Los Angeles, California, United States of America
| | - Katie Kempf
- Department of Pediatrics, Division of Neonatology & Developmental Biology, David Geffen School of Medicine at UCLA, Los Angeles, California, United States of America
| | - Carla Janzen
- Department of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, Los Angeles, California, United States of America
| | - Tristan Grogan
- Department of Medicine Statistics Core, David Geffen School of Medicine, University of California, Los Angeles, California, United States of America
| | - David A. Elashoff
- Department of Medicine Statistics Core, David Geffen School of Medicine, University of California, Los Angeles, California, United States of America
| | - Sherin U. Devaskar
- Department of Pediatrics, Division of Neonatology & Developmental Biology, David Geffen School of Medicine at UCLA, Los Angeles, California, United States of America
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Janzen C, Sen S, Lei MYY, Gagliardi de Assumpcao M, Challis J, Chaudhuri G. The Role of Epithelial to Mesenchymal Transition in Human Amniotic Membrane Rupture. J Clin Endocrinol Metab 2017; 102:1261-1269. [PMID: 28388726 PMCID: PMC5460731 DOI: 10.1210/jc.2016-3150] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 12/15/2016] [Indexed: 12/20/2022]
Abstract
CONTEXT Biochemical weakening of the amnion is a major factor preceding preterm premature rupture of membranes (PPROMs), leading to preterm birth. Activation of matrix metalloproteinases (MMPs) is known to play a key role in collagen degradation of the amnion; however, epithelial to mesenchymal transition (EMT) that is also induced by MMP activation has not been investigated as a mechanism for amnion weakening. OBJECTIVE To measure amniotic EMT associated with vaginal delivery (VD) compared with unlabored cesarean sections (CSs), and to assess changes in amniotic mechanical strength with pharmacologic inhibitors and inducers of EMT, thus testing the hypothesis that EMT is a key biochemical event that promotes amniotic rupture. FINDINGS (1) Amnions taken from VD contained a significantly increased number of mesenchymal cells relative to epithelial cells compared with unlabored CS by fluorescence-activated cell sorting analysis (60% vs 10%); (2) tumor necrosis factor (TNF)-α stimulation of amniotic epithelial cells increased expression of the mesenchymal marker vimentin after 2 days; (3) EMT inhibitor, etodolac, significantly increased the time and mechanical pressure required to rupture the amnion; and (4) TNF-α and another pharmacologic EMT inducer, ethacridine, decreased the time and mechanical pressure required for amnion rupture, further confirming that the mesenchymal phenotype significantly weakens the amnion. CONCLUSIONS This work demonstrated amniotic cell EMT was associated with labor and EMT decreased the tensile strength of the amnion. These findings suggest a role for EMT in the pathophysiology of PPROM and may provide a basis for development of therapies to prevent preterm labor.
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Affiliation(s)
- Carla Janzen
- Department of Obstetrics and Gynecology, David Geffen School of Medicine, University of California 90095, Los Angeles, Los Angeles, California
| | - Suvajit Sen
- Department of Obstetrics and Gynecology, David Geffen School of Medicine, University of California 90095, Los Angeles, Los Angeles, California
| | - Margarida Y Y Lei
- Department of Obstetrics and Gynecology, David Geffen School of Medicine, University of California 90095, Los Angeles, Los Angeles, California
| | | | - John Challis
- University of Western Australia and Curtin University, Crawley, Western Australia 6009, Australia
| | - Gautam Chaudhuri
- Department of Obstetrics and Gynecology, David Geffen School of Medicine, University of California 90095, Los Angeles, Los Angeles, California
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Brasil P, Pereira JP, Moreira ME, Ribeiro Nogueira RM, Damasceno L, Wakimoto M, Rabello RS, Valderramos SG, Halai UA, Salles TS, Zin AA, Horovitz D, Daltro P, Boechat M, Raja Gabaglia C, Carvalho de Sequeira P, Pilotto JH, Medialdea-Carrera R, Cotrim da Cunha D, Abreu de Carvalho LM, Pone M, Machado Siqueira A, Calvet GA, Rodrigues Baião AE, Neves ES, Nassar de Carvalho PR, Hasue RH, Marschik PB, Einspieler C, Janzen C, Cherry JD, Bispo de Filippis AM, Nielsen-Saines K. Zika Virus Infection in Pregnant Women in Rio de Janeiro. N Engl J Med 2016; 375:2321-2334. [PMID: 26943629 PMCID: PMC5323261 DOI: 10.1056/nejmoa1602412] [Citation(s) in RCA: 1342] [Impact Index Per Article: 167.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Zika virus (ZIKV) has been linked to central nervous system malformations in fetuses. To characterize the spectrum of ZIKV disease in pregnant women and infants, we followed patients in Rio de Janeiro to describe clinical manifestations in mothers and repercussions of acute ZIKV infection in infants. METHODS We enrolled pregnant women in whom a rash had developed within the previous 5 days and tested blood and urine specimens for ZIKV by reverse-transcriptase-polymerase-chain-reaction assays. We followed women prospectively to obtain data on pregnancy and infant outcomes. RESULTS A total of 345 women were enrolled from September 2015 through May 2016; of these, 182 women (53%) tested positive for ZIKV in blood, urine, or both. The timing of acute ZIKV infection ranged from 6 to 39 weeks of gestation. Predominant maternal clinical features included a pruritic descending macular or maculopapular rash, arthralgias, conjunctival injection, and headache; 27% had fever (short-term and low-grade). By July 2016, a total of 134 ZIKV-affected pregnancies and 73 ZIKV-unaffected pregnancies had reached completion, with outcomes known for 125 ZIKV-affected and 61 ZIKV-unaffected pregnancies. Infection with chikungunya virus was identified in 42% of women without ZIKV infection versus 3% of women with ZIKV infection (P<0.001). Rates of fetal death were 7% in both groups; overall adverse outcomes were 46% among offspring of ZIKV-positive women versus 11.5% among offspring of ZIKV-negative women (P<0.001). Among 117 live infants born to 116 ZIKV-positive women, 42% were found to have grossly abnormal clinical or brain imaging findings or both, including 4 infants with microcephaly. Adverse outcomes were noted regardless of the trimester during which the women were infected with ZIKV (55% of pregnancies had adverse outcomes after maternal infection in the first trimester, 52% after infection in the second trimester, and 29% after infection in the third trimester). CONCLUSIONS Despite mild clinical symptoms in the mother, ZIKV infection during pregnancy is deleterious to the fetus and is associated with fetal death, fetal growth restriction, and a spectrum of central nervous system abnormalities. (Funded by Ministério da Saúde do Brasil and others.).
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Affiliation(s)
- Patrícia Brasil
- From Fundação Oswaldo Cruz (P.B., J.P.P., M.E.M., R.M.R.N., L.D., M.W., R.S.R., T.S.S, A.A.Z., D.H., M.B., P.C.S., J.H.P., R.M.-C., D.C.C., L.M.A.C., M.P., A.M.S., G.A.C., A.E.R.B., E.S.N., P.R.N.C., A.M.B.F.); and Clinica de Diagnostico por Imagem (P.D.) - both in Rio de Janeiro; David Geffen UCLA School of Medicine, Los Angeles (S.G.V., U.-A.H., C.J., J.D.C., K.N.-S.), and Biomedical Research Institute of Southern California, Oceanside (C.R.G.) - both in California; Faculty of Medicine, University of São Paulo, São Paulo (R.H.H.); Medical University of Graz, Graz, Austria (P.B.M., C.E.), and Karolinska Institutet, Stockholm (P.B.M.)
| | - José P Pereira
- From Fundação Oswaldo Cruz (P.B., J.P.P., M.E.M., R.M.R.N., L.D., M.W., R.S.R., T.S.S, A.A.Z., D.H., M.B., P.C.S., J.H.P., R.M.-C., D.C.C., L.M.A.C., M.P., A.M.S., G.A.C., A.E.R.B., E.S.N., P.R.N.C., A.M.B.F.); and Clinica de Diagnostico por Imagem (P.D.) - both in Rio de Janeiro; David Geffen UCLA School of Medicine, Los Angeles (S.G.V., U.-A.H., C.J., J.D.C., K.N.-S.), and Biomedical Research Institute of Southern California, Oceanside (C.R.G.) - both in California; Faculty of Medicine, University of São Paulo, São Paulo (R.H.H.); Medical University of Graz, Graz, Austria (P.B.M., C.E.), and Karolinska Institutet, Stockholm (P.B.M.)
| | - M Elisabeth Moreira
- From Fundação Oswaldo Cruz (P.B., J.P.P., M.E.M., R.M.R.N., L.D., M.W., R.S.R., T.S.S, A.A.Z., D.H., M.B., P.C.S., J.H.P., R.M.-C., D.C.C., L.M.A.C., M.P., A.M.S., G.A.C., A.E.R.B., E.S.N., P.R.N.C., A.M.B.F.); and Clinica de Diagnostico por Imagem (P.D.) - both in Rio de Janeiro; David Geffen UCLA School of Medicine, Los Angeles (S.G.V., U.-A.H., C.J., J.D.C., K.N.-S.), and Biomedical Research Institute of Southern California, Oceanside (C.R.G.) - both in California; Faculty of Medicine, University of São Paulo, São Paulo (R.H.H.); Medical University of Graz, Graz, Austria (P.B.M., C.E.), and Karolinska Institutet, Stockholm (P.B.M.)
| | - Rita M Ribeiro Nogueira
- From Fundação Oswaldo Cruz (P.B., J.P.P., M.E.M., R.M.R.N., L.D., M.W., R.S.R., T.S.S, A.A.Z., D.H., M.B., P.C.S., J.H.P., R.M.-C., D.C.C., L.M.A.C., M.P., A.M.S., G.A.C., A.E.R.B., E.S.N., P.R.N.C., A.M.B.F.); and Clinica de Diagnostico por Imagem (P.D.) - both in Rio de Janeiro; David Geffen UCLA School of Medicine, Los Angeles (S.G.V., U.-A.H., C.J., J.D.C., K.N.-S.), and Biomedical Research Institute of Southern California, Oceanside (C.R.G.) - both in California; Faculty of Medicine, University of São Paulo, São Paulo (R.H.H.); Medical University of Graz, Graz, Austria (P.B.M., C.E.), and Karolinska Institutet, Stockholm (P.B.M.)
| | - Luana Damasceno
- From Fundação Oswaldo Cruz (P.B., J.P.P., M.E.M., R.M.R.N., L.D., M.W., R.S.R., T.S.S, A.A.Z., D.H., M.B., P.C.S., J.H.P., R.M.-C., D.C.C., L.M.A.C., M.P., A.M.S., G.A.C., A.E.R.B., E.S.N., P.R.N.C., A.M.B.F.); and Clinica de Diagnostico por Imagem (P.D.) - both in Rio de Janeiro; David Geffen UCLA School of Medicine, Los Angeles (S.G.V., U.-A.H., C.J., J.D.C., K.N.-S.), and Biomedical Research Institute of Southern California, Oceanside (C.R.G.) - both in California; Faculty of Medicine, University of São Paulo, São Paulo (R.H.H.); Medical University of Graz, Graz, Austria (P.B.M., C.E.), and Karolinska Institutet, Stockholm (P.B.M.)
| | - Mayumi Wakimoto
- From Fundação Oswaldo Cruz (P.B., J.P.P., M.E.M., R.M.R.N., L.D., M.W., R.S.R., T.S.S, A.A.Z., D.H., M.B., P.C.S., J.H.P., R.M.-C., D.C.C., L.M.A.C., M.P., A.M.S., G.A.C., A.E.R.B., E.S.N., P.R.N.C., A.M.B.F.); and Clinica de Diagnostico por Imagem (P.D.) - both in Rio de Janeiro; David Geffen UCLA School of Medicine, Los Angeles (S.G.V., U.-A.H., C.J., J.D.C., K.N.-S.), and Biomedical Research Institute of Southern California, Oceanside (C.R.G.) - both in California; Faculty of Medicine, University of São Paulo, São Paulo (R.H.H.); Medical University of Graz, Graz, Austria (P.B.M., C.E.), and Karolinska Institutet, Stockholm (P.B.M.)
| | - Renata S Rabello
- From Fundação Oswaldo Cruz (P.B., J.P.P., M.E.M., R.M.R.N., L.D., M.W., R.S.R., T.S.S, A.A.Z., D.H., M.B., P.C.S., J.H.P., R.M.-C., D.C.C., L.M.A.C., M.P., A.M.S., G.A.C., A.E.R.B., E.S.N., P.R.N.C., A.M.B.F.); and Clinica de Diagnostico por Imagem (P.D.) - both in Rio de Janeiro; David Geffen UCLA School of Medicine, Los Angeles (S.G.V., U.-A.H., C.J., J.D.C., K.N.-S.), and Biomedical Research Institute of Southern California, Oceanside (C.R.G.) - both in California; Faculty of Medicine, University of São Paulo, São Paulo (R.H.H.); Medical University of Graz, Graz, Austria (P.B.M., C.E.), and Karolinska Institutet, Stockholm (P.B.M.)
| | - Stephanie G Valderramos
- From Fundação Oswaldo Cruz (P.B., J.P.P., M.E.M., R.M.R.N., L.D., M.W., R.S.R., T.S.S, A.A.Z., D.H., M.B., P.C.S., J.H.P., R.M.-C., D.C.C., L.M.A.C., M.P., A.M.S., G.A.C., A.E.R.B., E.S.N., P.R.N.C., A.M.B.F.); and Clinica de Diagnostico por Imagem (P.D.) - both in Rio de Janeiro; David Geffen UCLA School of Medicine, Los Angeles (S.G.V., U.-A.H., C.J., J.D.C., K.N.-S.), and Biomedical Research Institute of Southern California, Oceanside (C.R.G.) - both in California; Faculty of Medicine, University of São Paulo, São Paulo (R.H.H.); Medical University of Graz, Graz, Austria (P.B.M., C.E.), and Karolinska Institutet, Stockholm (P.B.M.)
| | - Umme-Aiman Halai
- From Fundação Oswaldo Cruz (P.B., J.P.P., M.E.M., R.M.R.N., L.D., M.W., R.S.R., T.S.S, A.A.Z., D.H., M.B., P.C.S., J.H.P., R.M.-C., D.C.C., L.M.A.C., M.P., A.M.S., G.A.C., A.E.R.B., E.S.N., P.R.N.C., A.M.B.F.); and Clinica de Diagnostico por Imagem (P.D.) - both in Rio de Janeiro; David Geffen UCLA School of Medicine, Los Angeles (S.G.V., U.-A.H., C.J., J.D.C., K.N.-S.), and Biomedical Research Institute of Southern California, Oceanside (C.R.G.) - both in California; Faculty of Medicine, University of São Paulo, São Paulo (R.H.H.); Medical University of Graz, Graz, Austria (P.B.M., C.E.), and Karolinska Institutet, Stockholm (P.B.M.)
| | - Tania S Salles
- From Fundação Oswaldo Cruz (P.B., J.P.P., M.E.M., R.M.R.N., L.D., M.W., R.S.R., T.S.S, A.A.Z., D.H., M.B., P.C.S., J.H.P., R.M.-C., D.C.C., L.M.A.C., M.P., A.M.S., G.A.C., A.E.R.B., E.S.N., P.R.N.C., A.M.B.F.); and Clinica de Diagnostico por Imagem (P.D.) - both in Rio de Janeiro; David Geffen UCLA School of Medicine, Los Angeles (S.G.V., U.-A.H., C.J., J.D.C., K.N.-S.), and Biomedical Research Institute of Southern California, Oceanside (C.R.G.) - both in California; Faculty of Medicine, University of São Paulo, São Paulo (R.H.H.); Medical University of Graz, Graz, Austria (P.B.M., C.E.), and Karolinska Institutet, Stockholm (P.B.M.)
| | - Andrea A Zin
- From Fundação Oswaldo Cruz (P.B., J.P.P., M.E.M., R.M.R.N., L.D., M.W., R.S.R., T.S.S, A.A.Z., D.H., M.B., P.C.S., J.H.P., R.M.-C., D.C.C., L.M.A.C., M.P., A.M.S., G.A.C., A.E.R.B., E.S.N., P.R.N.C., A.M.B.F.); and Clinica de Diagnostico por Imagem (P.D.) - both in Rio de Janeiro; David Geffen UCLA School of Medicine, Los Angeles (S.G.V., U.-A.H., C.J., J.D.C., K.N.-S.), and Biomedical Research Institute of Southern California, Oceanside (C.R.G.) - both in California; Faculty of Medicine, University of São Paulo, São Paulo (R.H.H.); Medical University of Graz, Graz, Austria (P.B.M., C.E.), and Karolinska Institutet, Stockholm (P.B.M.)
| | - Dafne Horovitz
- From Fundação Oswaldo Cruz (P.B., J.P.P., M.E.M., R.M.R.N., L.D., M.W., R.S.R., T.S.S, A.A.Z., D.H., M.B., P.C.S., J.H.P., R.M.-C., D.C.C., L.M.A.C., M.P., A.M.S., G.A.C., A.E.R.B., E.S.N., P.R.N.C., A.M.B.F.); and Clinica de Diagnostico por Imagem (P.D.) - both in Rio de Janeiro; David Geffen UCLA School of Medicine, Los Angeles (S.G.V., U.-A.H., C.J., J.D.C., K.N.-S.), and Biomedical Research Institute of Southern California, Oceanside (C.R.G.) - both in California; Faculty of Medicine, University of São Paulo, São Paulo (R.H.H.); Medical University of Graz, Graz, Austria (P.B.M., C.E.), and Karolinska Institutet, Stockholm (P.B.M.)
| | - Pedro Daltro
- From Fundação Oswaldo Cruz (P.B., J.P.P., M.E.M., R.M.R.N., L.D., M.W., R.S.R., T.S.S, A.A.Z., D.H., M.B., P.C.S., J.H.P., R.M.-C., D.C.C., L.M.A.C., M.P., A.M.S., G.A.C., A.E.R.B., E.S.N., P.R.N.C., A.M.B.F.); and Clinica de Diagnostico por Imagem (P.D.) - both in Rio de Janeiro; David Geffen UCLA School of Medicine, Los Angeles (S.G.V., U.-A.H., C.J., J.D.C., K.N.-S.), and Biomedical Research Institute of Southern California, Oceanside (C.R.G.) - both in California; Faculty of Medicine, University of São Paulo, São Paulo (R.H.H.); Medical University of Graz, Graz, Austria (P.B.M., C.E.), and Karolinska Institutet, Stockholm (P.B.M.)
| | - Marcia Boechat
- From Fundação Oswaldo Cruz (P.B., J.P.P., M.E.M., R.M.R.N., L.D., M.W., R.S.R., T.S.S, A.A.Z., D.H., M.B., P.C.S., J.H.P., R.M.-C., D.C.C., L.M.A.C., M.P., A.M.S., G.A.C., A.E.R.B., E.S.N., P.R.N.C., A.M.B.F.); and Clinica de Diagnostico por Imagem (P.D.) - both in Rio de Janeiro; David Geffen UCLA School of Medicine, Los Angeles (S.G.V., U.-A.H., C.J., J.D.C., K.N.-S.), and Biomedical Research Institute of Southern California, Oceanside (C.R.G.) - both in California; Faculty of Medicine, University of São Paulo, São Paulo (R.H.H.); Medical University of Graz, Graz, Austria (P.B.M., C.E.), and Karolinska Institutet, Stockholm (P.B.M.)
| | - Claudia Raja Gabaglia
- From Fundação Oswaldo Cruz (P.B., J.P.P., M.E.M., R.M.R.N., L.D., M.W., R.S.R., T.S.S, A.A.Z., D.H., M.B., P.C.S., J.H.P., R.M.-C., D.C.C., L.M.A.C., M.P., A.M.S., G.A.C., A.E.R.B., E.S.N., P.R.N.C., A.M.B.F.); and Clinica de Diagnostico por Imagem (P.D.) - both in Rio de Janeiro; David Geffen UCLA School of Medicine, Los Angeles (S.G.V., U.-A.H., C.J., J.D.C., K.N.-S.), and Biomedical Research Institute of Southern California, Oceanside (C.R.G.) - both in California; Faculty of Medicine, University of São Paulo, São Paulo (R.H.H.); Medical University of Graz, Graz, Austria (P.B.M., C.E.), and Karolinska Institutet, Stockholm (P.B.M.)
| | - Patrícia Carvalho de Sequeira
- From Fundação Oswaldo Cruz (P.B., J.P.P., M.E.M., R.M.R.N., L.D., M.W., R.S.R., T.S.S, A.A.Z., D.H., M.B., P.C.S., J.H.P., R.M.-C., D.C.C., L.M.A.C., M.P., A.M.S., G.A.C., A.E.R.B., E.S.N., P.R.N.C., A.M.B.F.); and Clinica de Diagnostico por Imagem (P.D.) - both in Rio de Janeiro; David Geffen UCLA School of Medicine, Los Angeles (S.G.V., U.-A.H., C.J., J.D.C., K.N.-S.), and Biomedical Research Institute of Southern California, Oceanside (C.R.G.) - both in California; Faculty of Medicine, University of São Paulo, São Paulo (R.H.H.); Medical University of Graz, Graz, Austria (P.B.M., C.E.), and Karolinska Institutet, Stockholm (P.B.M.)
| | - José H Pilotto
- From Fundação Oswaldo Cruz (P.B., J.P.P., M.E.M., R.M.R.N., L.D., M.W., R.S.R., T.S.S, A.A.Z., D.H., M.B., P.C.S., J.H.P., R.M.-C., D.C.C., L.M.A.C., M.P., A.M.S., G.A.C., A.E.R.B., E.S.N., P.R.N.C., A.M.B.F.); and Clinica de Diagnostico por Imagem (P.D.) - both in Rio de Janeiro; David Geffen UCLA School of Medicine, Los Angeles (S.G.V., U.-A.H., C.J., J.D.C., K.N.-S.), and Biomedical Research Institute of Southern California, Oceanside (C.R.G.) - both in California; Faculty of Medicine, University of São Paulo, São Paulo (R.H.H.); Medical University of Graz, Graz, Austria (P.B.M., C.E.), and Karolinska Institutet, Stockholm (P.B.M.)
| | - Raquel Medialdea-Carrera
- From Fundação Oswaldo Cruz (P.B., J.P.P., M.E.M., R.M.R.N., L.D., M.W., R.S.R., T.S.S, A.A.Z., D.H., M.B., P.C.S., J.H.P., R.M.-C., D.C.C., L.M.A.C., M.P., A.M.S., G.A.C., A.E.R.B., E.S.N., P.R.N.C., A.M.B.F.); and Clinica de Diagnostico por Imagem (P.D.) - both in Rio de Janeiro; David Geffen UCLA School of Medicine, Los Angeles (S.G.V., U.-A.H., C.J., J.D.C., K.N.-S.), and Biomedical Research Institute of Southern California, Oceanside (C.R.G.) - both in California; Faculty of Medicine, University of São Paulo, São Paulo (R.H.H.); Medical University of Graz, Graz, Austria (P.B.M., C.E.), and Karolinska Institutet, Stockholm (P.B.M.)
| | - Denise Cotrim da Cunha
- From Fundação Oswaldo Cruz (P.B., J.P.P., M.E.M., R.M.R.N., L.D., M.W., R.S.R., T.S.S, A.A.Z., D.H., M.B., P.C.S., J.H.P., R.M.-C., D.C.C., L.M.A.C., M.P., A.M.S., G.A.C., A.E.R.B., E.S.N., P.R.N.C., A.M.B.F.); and Clinica de Diagnostico por Imagem (P.D.) - both in Rio de Janeiro; David Geffen UCLA School of Medicine, Los Angeles (S.G.V., U.-A.H., C.J., J.D.C., K.N.-S.), and Biomedical Research Institute of Southern California, Oceanside (C.R.G.) - both in California; Faculty of Medicine, University of São Paulo, São Paulo (R.H.H.); Medical University of Graz, Graz, Austria (P.B.M., C.E.), and Karolinska Institutet, Stockholm (P.B.M.)
| | - Liege M Abreu de Carvalho
- From Fundação Oswaldo Cruz (P.B., J.P.P., M.E.M., R.M.R.N., L.D., M.W., R.S.R., T.S.S, A.A.Z., D.H., M.B., P.C.S., J.H.P., R.M.-C., D.C.C., L.M.A.C., M.P., A.M.S., G.A.C., A.E.R.B., E.S.N., P.R.N.C., A.M.B.F.); and Clinica de Diagnostico por Imagem (P.D.) - both in Rio de Janeiro; David Geffen UCLA School of Medicine, Los Angeles (S.G.V., U.-A.H., C.J., J.D.C., K.N.-S.), and Biomedical Research Institute of Southern California, Oceanside (C.R.G.) - both in California; Faculty of Medicine, University of São Paulo, São Paulo (R.H.H.); Medical University of Graz, Graz, Austria (P.B.M., C.E.), and Karolinska Institutet, Stockholm (P.B.M.)
| | - Marcos Pone
- From Fundação Oswaldo Cruz (P.B., J.P.P., M.E.M., R.M.R.N., L.D., M.W., R.S.R., T.S.S, A.A.Z., D.H., M.B., P.C.S., J.H.P., R.M.-C., D.C.C., L.M.A.C., M.P., A.M.S., G.A.C., A.E.R.B., E.S.N., P.R.N.C., A.M.B.F.); and Clinica de Diagnostico por Imagem (P.D.) - both in Rio de Janeiro; David Geffen UCLA School of Medicine, Los Angeles (S.G.V., U.-A.H., C.J., J.D.C., K.N.-S.), and Biomedical Research Institute of Southern California, Oceanside (C.R.G.) - both in California; Faculty of Medicine, University of São Paulo, São Paulo (R.H.H.); Medical University of Graz, Graz, Austria (P.B.M., C.E.), and Karolinska Institutet, Stockholm (P.B.M.)
| | - André Machado Siqueira
- From Fundação Oswaldo Cruz (P.B., J.P.P., M.E.M., R.M.R.N., L.D., M.W., R.S.R., T.S.S, A.A.Z., D.H., M.B., P.C.S., J.H.P., R.M.-C., D.C.C., L.M.A.C., M.P., A.M.S., G.A.C., A.E.R.B., E.S.N., P.R.N.C., A.M.B.F.); and Clinica de Diagnostico por Imagem (P.D.) - both in Rio de Janeiro; David Geffen UCLA School of Medicine, Los Angeles (S.G.V., U.-A.H., C.J., J.D.C., K.N.-S.), and Biomedical Research Institute of Southern California, Oceanside (C.R.G.) - both in California; Faculty of Medicine, University of São Paulo, São Paulo (R.H.H.); Medical University of Graz, Graz, Austria (P.B.M., C.E.), and Karolinska Institutet, Stockholm (P.B.M.)
| | - Guilherme A Calvet
- From Fundação Oswaldo Cruz (P.B., J.P.P., M.E.M., R.M.R.N., L.D., M.W., R.S.R., T.S.S, A.A.Z., D.H., M.B., P.C.S., J.H.P., R.M.-C., D.C.C., L.M.A.C., M.P., A.M.S., G.A.C., A.E.R.B., E.S.N., P.R.N.C., A.M.B.F.); and Clinica de Diagnostico por Imagem (P.D.) - both in Rio de Janeiro; David Geffen UCLA School of Medicine, Los Angeles (S.G.V., U.-A.H., C.J., J.D.C., K.N.-S.), and Biomedical Research Institute of Southern California, Oceanside (C.R.G.) - both in California; Faculty of Medicine, University of São Paulo, São Paulo (R.H.H.); Medical University of Graz, Graz, Austria (P.B.M., C.E.), and Karolinska Institutet, Stockholm (P.B.M.)
| | - Ana E Rodrigues Baião
- From Fundação Oswaldo Cruz (P.B., J.P.P., M.E.M., R.M.R.N., L.D., M.W., R.S.R., T.S.S, A.A.Z., D.H., M.B., P.C.S., J.H.P., R.M.-C., D.C.C., L.M.A.C., M.P., A.M.S., G.A.C., A.E.R.B., E.S.N., P.R.N.C., A.M.B.F.); and Clinica de Diagnostico por Imagem (P.D.) - both in Rio de Janeiro; David Geffen UCLA School of Medicine, Los Angeles (S.G.V., U.-A.H., C.J., J.D.C., K.N.-S.), and Biomedical Research Institute of Southern California, Oceanside (C.R.G.) - both in California; Faculty of Medicine, University of São Paulo, São Paulo (R.H.H.); Medical University of Graz, Graz, Austria (P.B.M., C.E.), and Karolinska Institutet, Stockholm (P.B.M.)
| | - Elizabeth S Neves
- From Fundação Oswaldo Cruz (P.B., J.P.P., M.E.M., R.M.R.N., L.D., M.W., R.S.R., T.S.S, A.A.Z., D.H., M.B., P.C.S., J.H.P., R.M.-C., D.C.C., L.M.A.C., M.P., A.M.S., G.A.C., A.E.R.B., E.S.N., P.R.N.C., A.M.B.F.); and Clinica de Diagnostico por Imagem (P.D.) - both in Rio de Janeiro; David Geffen UCLA School of Medicine, Los Angeles (S.G.V., U.-A.H., C.J., J.D.C., K.N.-S.), and Biomedical Research Institute of Southern California, Oceanside (C.R.G.) - both in California; Faculty of Medicine, University of São Paulo, São Paulo (R.H.H.); Medical University of Graz, Graz, Austria (P.B.M., C.E.), and Karolinska Institutet, Stockholm (P.B.M.)
| | - Paulo R Nassar de Carvalho
- From Fundação Oswaldo Cruz (P.B., J.P.P., M.E.M., R.M.R.N., L.D., M.W., R.S.R., T.S.S, A.A.Z., D.H., M.B., P.C.S., J.H.P., R.M.-C., D.C.C., L.M.A.C., M.P., A.M.S., G.A.C., A.E.R.B., E.S.N., P.R.N.C., A.M.B.F.); and Clinica de Diagnostico por Imagem (P.D.) - both in Rio de Janeiro; David Geffen UCLA School of Medicine, Los Angeles (S.G.V., U.-A.H., C.J., J.D.C., K.N.-S.), and Biomedical Research Institute of Southern California, Oceanside (C.R.G.) - both in California; Faculty of Medicine, University of São Paulo, São Paulo (R.H.H.); Medical University of Graz, Graz, Austria (P.B.M., C.E.), and Karolinska Institutet, Stockholm (P.B.M.)
| | - Renata H Hasue
- From Fundação Oswaldo Cruz (P.B., J.P.P., M.E.M., R.M.R.N., L.D., M.W., R.S.R., T.S.S, A.A.Z., D.H., M.B., P.C.S., J.H.P., R.M.-C., D.C.C., L.M.A.C., M.P., A.M.S., G.A.C., A.E.R.B., E.S.N., P.R.N.C., A.M.B.F.); and Clinica de Diagnostico por Imagem (P.D.) - both in Rio de Janeiro; David Geffen UCLA School of Medicine, Los Angeles (S.G.V., U.-A.H., C.J., J.D.C., K.N.-S.), and Biomedical Research Institute of Southern California, Oceanside (C.R.G.) - both in California; Faculty of Medicine, University of São Paulo, São Paulo (R.H.H.); Medical University of Graz, Graz, Austria (P.B.M., C.E.), and Karolinska Institutet, Stockholm (P.B.M.)
| | - Peter B Marschik
- From Fundação Oswaldo Cruz (P.B., J.P.P., M.E.M., R.M.R.N., L.D., M.W., R.S.R., T.S.S, A.A.Z., D.H., M.B., P.C.S., J.H.P., R.M.-C., D.C.C., L.M.A.C., M.P., A.M.S., G.A.C., A.E.R.B., E.S.N., P.R.N.C., A.M.B.F.); and Clinica de Diagnostico por Imagem (P.D.) - both in Rio de Janeiro; David Geffen UCLA School of Medicine, Los Angeles (S.G.V., U.-A.H., C.J., J.D.C., K.N.-S.), and Biomedical Research Institute of Southern California, Oceanside (C.R.G.) - both in California; Faculty of Medicine, University of São Paulo, São Paulo (R.H.H.); Medical University of Graz, Graz, Austria (P.B.M., C.E.), and Karolinska Institutet, Stockholm (P.B.M.)
| | - Christa Einspieler
- From Fundação Oswaldo Cruz (P.B., J.P.P., M.E.M., R.M.R.N., L.D., M.W., R.S.R., T.S.S, A.A.Z., D.H., M.B., P.C.S., J.H.P., R.M.-C., D.C.C., L.M.A.C., M.P., A.M.S., G.A.C., A.E.R.B., E.S.N., P.R.N.C., A.M.B.F.); and Clinica de Diagnostico por Imagem (P.D.) - both in Rio de Janeiro; David Geffen UCLA School of Medicine, Los Angeles (S.G.V., U.-A.H., C.J., J.D.C., K.N.-S.), and Biomedical Research Institute of Southern California, Oceanside (C.R.G.) - both in California; Faculty of Medicine, University of São Paulo, São Paulo (R.H.H.); Medical University of Graz, Graz, Austria (P.B.M., C.E.), and Karolinska Institutet, Stockholm (P.B.M.)
| | - Carla Janzen
- From Fundação Oswaldo Cruz (P.B., J.P.P., M.E.M., R.M.R.N., L.D., M.W., R.S.R., T.S.S, A.A.Z., D.H., M.B., P.C.S., J.H.P., R.M.-C., D.C.C., L.M.A.C., M.P., A.M.S., G.A.C., A.E.R.B., E.S.N., P.R.N.C., A.M.B.F.); and Clinica de Diagnostico por Imagem (P.D.) - both in Rio de Janeiro; David Geffen UCLA School of Medicine, Los Angeles (S.G.V., U.-A.H., C.J., J.D.C., K.N.-S.), and Biomedical Research Institute of Southern California, Oceanside (C.R.G.) - both in California; Faculty of Medicine, University of São Paulo, São Paulo (R.H.H.); Medical University of Graz, Graz, Austria (P.B.M., C.E.), and Karolinska Institutet, Stockholm (P.B.M.)
| | - James D Cherry
- From Fundação Oswaldo Cruz (P.B., J.P.P., M.E.M., R.M.R.N., L.D., M.W., R.S.R., T.S.S, A.A.Z., D.H., M.B., P.C.S., J.H.P., R.M.-C., D.C.C., L.M.A.C., M.P., A.M.S., G.A.C., A.E.R.B., E.S.N., P.R.N.C., A.M.B.F.); and Clinica de Diagnostico por Imagem (P.D.) - both in Rio de Janeiro; David Geffen UCLA School of Medicine, Los Angeles (S.G.V., U.-A.H., C.J., J.D.C., K.N.-S.), and Biomedical Research Institute of Southern California, Oceanside (C.R.G.) - both in California; Faculty of Medicine, University of São Paulo, São Paulo (R.H.H.); Medical University of Graz, Graz, Austria (P.B.M., C.E.), and Karolinska Institutet, Stockholm (P.B.M.)
| | - Ana M Bispo de Filippis
- From Fundação Oswaldo Cruz (P.B., J.P.P., M.E.M., R.M.R.N., L.D., M.W., R.S.R., T.S.S, A.A.Z., D.H., M.B., P.C.S., J.H.P., R.M.-C., D.C.C., L.M.A.C., M.P., A.M.S., G.A.C., A.E.R.B., E.S.N., P.R.N.C., A.M.B.F.); and Clinica de Diagnostico por Imagem (P.D.) - both in Rio de Janeiro; David Geffen UCLA School of Medicine, Los Angeles (S.G.V., U.-A.H., C.J., J.D.C., K.N.-S.), and Biomedical Research Institute of Southern California, Oceanside (C.R.G.) - both in California; Faculty of Medicine, University of São Paulo, São Paulo (R.H.H.); Medical University of Graz, Graz, Austria (P.B.M., C.E.), and Karolinska Institutet, Stockholm (P.B.M.)
| | - Karin Nielsen-Saines
- From Fundação Oswaldo Cruz (P.B., J.P.P., M.E.M., R.M.R.N., L.D., M.W., R.S.R., T.S.S, A.A.Z., D.H., M.B., P.C.S., J.H.P., R.M.-C., D.C.C., L.M.A.C., M.P., A.M.S., G.A.C., A.E.R.B., E.S.N., P.R.N.C., A.M.B.F.); and Clinica de Diagnostico por Imagem (P.D.) - both in Rio de Janeiro; David Geffen UCLA School of Medicine, Los Angeles (S.G.V., U.-A.H., C.J., J.D.C., K.N.-S.), and Biomedical Research Institute of Southern California, Oceanside (C.R.G.) - both in California; Faculty of Medicine, University of São Paulo, São Paulo (R.H.H.); Medical University of Graz, Graz, Austria (P.B.M., C.E.), and Karolinska Institutet, Stockholm (P.B.M.)
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Edling KL, Korenman SG, Janzen C, Sohsman MY, Apple SK, Bhuta S, Yeh MW. A pregnant dilemma: primary hyperparathyroidism due to parathyromatosis in pregnancy. Endocr Pract 2016; 20:e14-7. [PMID: 24013984 DOI: 10.4158/ep13105.cr] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
OBJECTIVE To describe an exceedingly rare case of parathyromatosis in pregnancy and the limited medical treatment options available for such cases that are refractory to surgery. METHODS Case presentation and description of clinical course with brief review of the literature. RESULTS A 21-year-old woman with a history of 3.5 gland parathyroidectomy presented with severe hyperemesis during her first trimester of pregnancy and was found to have primary hyperparathyroidism attributable to parathyromatosis. We describe the diagnostic and management dilemmas associated with this case, which included localization of the culprit lesions, a technically challenging surgical resection and subsequent medical management with cinacalcet when symptomatic hypercalcemia recurred during the third trimester. To our knowledge, this is only the third report of the successful use of cinacalcet during pregnancy, and the first case report of parathyromatosis presenting during pregnancy. CONCLUSION Cinacalcet was used safely and effectively during the third trimester of pregnancy to treat symptomatic hypercalcemia due to parathyromatosis.
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Affiliation(s)
- Kari L Edling
- Division of Endocrinology, Diabetes & Hypertension, Department of Medicine, UCLA David Geffen School of Medicine, Los Angeles, California
| | - Stanley G Korenman
- Division of Endocrinology, Diabetes & Hypertension, Department of Medicine, UCLA David Geffen School of Medicine, Los Angeles, California
| | - Carla Janzen
- Department of Obstetrics & Gynecology, UCLA David Geffen School of Medicine, Los Angeles, California
| | - Marie Y Sohsman
- Department of Pathology & Laboratory Medicine, UCLA David Geffen School of Medicine, Los Angeles, California
| | - Sophia K Apple
- Department of Pathology & Laboratory Medicine, UCLA David Geffen School of Medicine, Los Angeles, California
| | - Sunita Bhuta
- Department of Pathology & Laboratory Medicine, UCLA David Geffen School of Medicine, Los Angeles, California
| | - Michael W Yeh
- Division of Endocrinology, Diabetes & Hypertension, Department of Medicine, UCLA David Geffen School of Medicine, Los Angeles, California Section of Endocrine Surgery, UCLA David Geffen School of Medicine, Los Angeles, California
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Blumenthal E, Rao R, Hong R, Moriarty J, Kahn D, Janzen C. Intra-Aortic Balloon Placement and Management of Placenta Percreta [10L]. Obstet Gynecol 2016. [DOI: 10.1097/01.aog.0000483419.85525.31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Assumpcao MG, Lei MY, Sen S, Challis J, Chaudhuri G, Janzen C. 246: The role of epithelial to mesenchymal transition (EMT) in amniotic membrane rupture. Am J Obstet Gynecol 2016. [DOI: 10.1016/j.ajog.2015.10.284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Lei MY, Sen S, Chaudhuri G, Janzen C. 821: Oxidative stress in pregnancies affected by IUGR and macrosomia. Am J Obstet Gynecol 2014. [DOI: 10.1016/j.ajog.2013.10.854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Janzen C, Lei MYY, Cho J, Sullivan P, Shin BC, Devaskar SU. Placental glucose transporter 3 (GLUT3) is up-regulated in human pregnancies complicated by late-onset intrauterine growth restriction. Placenta 2013; 34:1072-8. [PMID: 24011442 DOI: 10.1016/j.placenta.2013.08.010] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2012] [Revised: 08/10/2013] [Accepted: 08/14/2013] [Indexed: 01/19/2023]
Abstract
INTRODUCTION Transport of glucose from maternal blood across the placental trophoblastic tissue barrier is critical to sustain fetal growth. The mechanism by which GLUTs are regulated in trophoblasts in response to ischemic hypoxia encountered with intrauterine growth restriction (IUGR) has not been suitably investigated. OBJECTIVE To investigate placental expression of GLUT1, GLUT3 and GLUT4 and possible mechanisms of GLUT regulation in idiopathic IUGR. METHODS We analyzed clinical, biochemical and histological data from placentas collected from women affected by idiopathic full-term IUGR (n = 10) and gestational age-matched healthy controls (n = 10). RESULTS We found increased GLUT3 protein expression in the trophoblast (cytotrophoblast greater than syncytiotrophoblast) on the maternal aspect of the placenta in IUGR compared to normal placenta, but no differences in GLUT1 or GLUT4 were found. No differential methylation of the GLUT3 promoter between normal and IUGR placentas was observed. Increased GLUT3 expression was associated with an increased nuclear concentration of HIF-1α, suggesting hypoxia may play a role in the up-regulation of GLUT3. DISCUSSION Further studies are needed to elucidate whether increased GLUT3 expression in IUGR is a marker for defective villous maturation or an adaptive response of the trophoblast in response to chronic hypoxia. CONCLUSIONS Patients with IUGR have increased trophoblast expression of GLUT3, as found under the low-oxygen conditions of the first trimester.
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Affiliation(s)
- C Janzen
- Department of Obstetrics and Gynecology, Division of Perinatology, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA.
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Kelley-Quon LI, Tseng CH, Janzen C, Shew SB. Congenital malformations associated with assisted reproductive technology: a California statewide analysis. J Pediatr Surg 2013; 48:1218-24. [PMID: 23845610 DOI: 10.1016/j.jpedsurg.2013.03.017] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2013] [Accepted: 03/08/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND Management of congenital malformations comprises a large part of pediatric surgical care. Despite increasing utilization of assisted reproductive technology (ART) and fertility-related services (FRS), associations with birth defects are poorly understood. METHODS Infants born after ART or FRS were identified from the California Linked Birth Cohort Dataset from 2006 to 2007 and compared to propensity matched infants conceived naturally. Factors associated with major congenital malformations were evaluated using Firth logistic regression. RESULTS With a cohort of 4,795 infants born after ART and 46,025 naturally conceived matched controls, major congenital malformations were identified in 3,463 infants. Malformations were increased for ART infants (9.0% vs. 6.6%, p<0.001). After adjusting for infant and maternal factors, ART infants exhibited increased odds of major malformations overall (OR 1.25, 95% CI 1.12-1.39), specifically defects of the eye (OR 1.81, 95% CI 1.04-3.16), head and neck (OR 1.37, 95% CI 1.00-1.86), heart (OR 1.41, 95% CI 1.22-1.64), and genitourinary system (OR 1.40, 95% CI 1.09-1.82). The likelihood of birth defects was increased for multiples (OR 1.35, 95% CI 1.18-1.54) and not singletons. Odds of congenital malformation after FRS alone (n=1,749) were non-significant. CONCLUSION ART contributes a significant risk of congenital malformation and may be more pronounced for multiples. Accurate counseling for parents considering ART and multidisciplinary coordination of care prior to delivery are warranted.
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Affiliation(s)
- Lorraine I Kelley-Quon
- Division of Pediatric Surgery, Department of Surgery, Mattel Children's Hospital, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095-7098, USA
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Arnold CW, Nguyen T, Janzen C. BabySTEPS: a sugar tracking electronic portal system for gestational diabetes. Stud Health Technol Inform 2013; 192:1123. [PMID: 23920897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Gestational diabetes is a condition occurring in up to 18% [1] of pregnant women that results in an increase in blood glucose levels due to the body's inability to produce sufficient insulin given the additional needs of the baby, and/or hormonal changes that lower the body's sensitivity to insulin. If left untreated, the growing baby may become too large, increasing the risk of injury to the mother and baby during delivery. Controlling blood glucose can be a challenging task, especially for women with no previous experience and who may have unhealthy diets. An opportunity exists to further encourage compliance by providing patients electronic access to data generated during their pregnancy. Previous studies have shown the potential of portals for managing general diabetes [2], but no work has targeted glucose control in pregnant women. We present BabySTEPS (Sugar Tracking Electronic Portal System), a patient portal focused on engaging women with gestational diabetes that provides personalized feedback with the goal of reducing complications at birth and subsequent medical problems resulting from poor glucose control.
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Affiliation(s)
- Corey W Arnold
- Medical Imaging Informatics Group, University of California - Los Angeles, USA
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Hoffmann K, Schlömer P, Janzen C. Optische Messmethoden für die rationale Evaluierung von Kristallisationsbedingungen. CHEM-ING-TECH 2012. [DOI: 10.1002/cite.201250496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Janzen C, Sen S, Cuevas J, Reddy ST, Chaudhuri G. Protein phosphatase 2A promotes endothelial survival via stabilization of translational inhibitor 4E-BP1 following exposure to tumor necrosis factor-α. Arterioscler Thromb Vasc Biol 2012; 31:2586-94. [PMID: 21903942 DOI: 10.1161/atvbaha.111.230946] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Tumor necrosis factor-α (TNFα) may change from a stimulator of reversible activation of endothelial cells (ECs) to a killer when combined with cycloheximide (CHX). The means by which endothelial cells are destined to either the survival pathway or the apoptotic pathway are not fully understood. We investigated the role of p38 mitogen-activated protein kinase (MAPK) and protein phosphatase 2A (PP2A) activation and their regulation of 4E-BP1 stability in ECs to determine whether this pathway contributes to apoptosis induced by TNFα and CHX. METHODS AND RESULTS Apoptosis was induced in human umbilical vein ECs (HUVECs) by treating them with a combination of TNFα and CHX (TNFα/CHX). Activation of p38 MAPK was increased in HUVECs undergoing apoptosis, which was associated with degradation of eukaryotic initiation factor 4A regulator 4E-BP1 in a p38 MAPK-dependent manner. CHX attenuated a TNFα-stimulated increase in the expression and activity of PP2A. Silencing PP2A expression with small interfering RNA transfection mimicked CHX sensitization, increasing HUVEC apoptosis with TNFα stimulation and suggesting a protective role for PP2A in the apoptotic process. CONCLUSION Our data suggest that (1) TNFα stimulates PP2A and HUVECs elude apoptosis by PP2A-dependent dephosphorylation of p38 MAPK, and (2) CHX-induced inhibition of PP2A leads to maintenance of p38 activity and degradation of 4E-BP1, resulting in enhanced TNFα-induced apoptosis.
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Affiliation(s)
- Carla Janzen
- Department of Obstetrics and Gynecology, David Geffen School of Medicine at University of California, Los Angeles, CA 90095, USA
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Marr HK, Stiles CR, Boyar MA, Braun TC, Hagen NA, Janzen C, Whitten LM, Pereira JL. Feasibility of administering zoledronic acid in palliative patients being cared for in the community: results of a pilot study. ACTA ACUST UNITED AC 2011; 17:69-74. [PMID: 20404982 DOI: 10.3747/co.v17i2.507] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Tumour-induced hypercalcemia (TIH) and pain from bone metastases are common complications of advanced malignancy and have a significant negative impact on quality of life. Many cancer patients in the advanced stages of their palliative illness prefer to avoid hospitalization and to receive their care in the community setting. This small open-label prospective pilot study explored the feasibility of administering zoledronic acid intravenously in the community setting (home and residential hospices). It enrolled a convenience sample of 12 patients with advanced cancer and TIH (n = 7), malignant bone pain (n = 3), or TIH and malignant bone pain (n = 2). The mean duration of infusion was 15 minutes (range: 14-30 minutes). The total nursing time required was 95 minutes, and the mean total cost, including nursing time, travel time, and drug costs was $708.97 per infusion. This cost was compared with costs for clodronate and pamidronate ($402.52 and $406.12 respectively). Calcium fell from a mean of 2.97 mmol/L on day 0 to 2.63 mmol/L on day 4 and to 2.54 mmol/L on day 10. Delirium resolved in 2 of 5 patients with TIH-associated delirium. Intravenous zoledronic acid administered in the community to palliative patients at the end of life is feasible and safe, and the short duration of infusion offers advantages to patients and nursing resources alike. The higher cost of zoledronic acid per infusion may be offset by the advantage of its short infusion time.
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Affiliation(s)
- H K Marr
- Division of Palliative Medicine, University of Calgary, Calgary, AB.
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Janzen C, Zafar P, Shew S, Tabsh K. 408: Preterm delivery does not improve neonatal outcome in the newborn with gastroschisis. Am J Obstet Gynecol 2009. [DOI: 10.1016/j.ajog.2009.10.574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Otto A, Janzen C, Szabados I, Hopfner U, Pritzlaff S, Wolf B. Tumor cell growth and metabolism at low growth factor and nutrient levels. EJC Suppl 2008. [DOI: 10.1016/s1359-6349(08)71651-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Hoffmann KMV, Janzen C, Delbrück H, Kupper MB, Noll R, Fischer R. A process for the rational crystallization of biological macromolecules. Acta Crystallogr A 2006. [DOI: 10.1107/s0108767306099740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Souter I, Janzen C, Martinez-Maza O, Breen EC, Stanczyk F, Chaudhuri G, Nathan L. Serum levels of soluble vascular cell adhesion molecule-1 are decreased in women receiving oral contraceptives compared with normally menstruating women: implications in atherosclerosis. Fertil Steril 2005; 83:1480-8. [PMID: 15866588 DOI: 10.1016/j.fertnstert.2004.11.048] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2004] [Revised: 11/12/2004] [Accepted: 11/12/2004] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The primary objective was to assess whether short-term changes in estradiol (E2), such as those observed in the menstrual cycle, alter serum levels of soluble vascular cell adhesion molecule-1 (sVCAM-1), and whether VCAM-1 expression is suppressed in long-term users of exogenous estrogens. The secondary objective was to assess the association, if any, between inflammatory cytokines and expression of sVCAM-1. DESIGN Prospective collection of serum samples in healthy volunteers. SETTING University hospital. PATIENTS(S) Thirty-one normally menstruating women and 37 oral contraceptive (OC) users. Interventions included serum collection in the early follicular, late follicular, and midluteal phases of the menstrual cycle and once in oral contraceptive users. MAIN OUTCOME MEASURE(S) Samples were assayed for sVCAM-1, tumor necrosis factor alpha (TNF-alpha), and interleukin (IL)-6 by enzyme-linked immunoabsorbent assay (ELISA). Estradiol (E2) was measured by radioimmunoassay (RIA). RESULT(S) Oral contraceptive users had significantly lower serum levels of sVCAM-1 compared with normally menstruating women. No significant change was noted in the mean values of sVCAM-1 throughout the menstrual cycle, despite the significant change in 17beta-estradiol levels. Throughout the menstrual cycle, a significant correlation was noted between the serum levels of TNF-alpha and sVCAM-1. The serum levels of IL-6 correlated with those of sVCAM-1 in the late follicular and midluteal phase of the cycle. Similar correlations were observed in OC users. CONCLUSION(S) Long-term exposure to exogenous estrogens suppresses serum levels of sVCAM-1. Short-term changes in endogenous estrogens, as observed during the menstrual cycle, may not alter VCAM-1 expression; TNF-alpha and IL-6 may play a role in the regulation of VCAM-1 expression in vivo.
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Affiliation(s)
- Irene Souter
- Department of Obstetrics and Gynecology, David Geffen School of Medicine, University of California, Los Angeles, California 90095, USA
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Souter I, Janzen C, Martinez-Maza O, Stanczyk F, Chaudhuri G, Nathan L. Effect of endogenous and exogenous estrogens on serum levels of vascular cell adhesion molecule-1 (sVCAM-1). Fertil Steril 2003. [DOI: 10.1016/s0015-0282(03)00091-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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