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Tamblyn JA, Pilarski NS, Markland AD, Marson EJ, Devall A, Hewison M, Morris RK, Coomarasamy A. Vitamin D and miscarriage: a systematic review and meta-analysis. Fertil Steril 2022; 118:111-122. [DOI: 10.1016/j.fertnstert.2022.04.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 04/08/2022] [Accepted: 04/08/2022] [Indexed: 12/13/2022]
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2
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Ganguly A, Tamblyn JA, Shattock A, Joseph A, Larner DP, Jenkinson C, Gupta J, Gross SR, Hewison M. Trophoblast uptake of DBP regulates intracellular actin and promotes matrix invasion. J Endocrinol 2021; 249:43-55. [PMID: 33608491 DOI: 10.1530/joe-20-0626] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 02/05/2021] [Accepted: 02/12/2021] [Indexed: 11/08/2022]
Abstract
Early pregnancy is characterised by elevated circulating levels of vitamin D binding protein (DBP). The impact of this on maternal and fetal health is unclear but DBP is present in the placenta, and DBP gene variants have been linked to malplacentation disorders such as preeclampsia. The functional role of DBP in the placenta was investigated using trophoblastic JEG3, BeWo and HTR8 cells. All three cell lines showed intracellular DBP with increased expression and nuclear localisation of DBP in cells treated with the active form of vitamin D, 1,25-dihydroxyvitamin D (1,25D). When cultured in the serum of mice lacking DBP (DBP-/-), JEG3 cells showed no intracellular DBP indicating uptake of exogenous DBP. Inhibition of the membrane receptor for DBP, megalin, also suppressed intracellular DBP. Elimination of intracellular DBP with DBP-/- serum or megalin inhibitor suppressed matrix invasion by trophoblast cells and was associated with increased nuclear accumulation of G-actin. Conversely, treatment with 1,25D enhanced matrix invasion. This was independent of the nuclear vitamin D receptor but was associated with enhanced ERK phosphorylation, and inhibition of ERK kinase suppressed trophoblast matrix invasion. When cultured with serum from pregnant women, trophoblast matrix invasion correlated with DBP concentration, and DBP was lower in first-trimester serum from women who later developed preeclampsia. These data show that the trophoblast matrix invasion involves uptake of serum DBP and associated intracellular actin-binding and homeostasis. DBP is a potential marker of placentation disorders such as preeclampsia and may also provide a therapeutic option for improved placenta and pregnancy health.
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Affiliation(s)
- Ankana Ganguly
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
| | - Jennifer A Tamblyn
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
- Birmingham Women's & Children's Foundation Hospital Trust, Mindelsohn Way, Edgbaston, Birmingham, UK
- CEDAM, Birmingham Health Partners, University of Birmingham, Birmingham, UK
| | - Alexandra Shattock
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
| | - Annsha Joseph
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
| | - Dean P Larner
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
| | - Carl Jenkinson
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
| | - Janesh Gupta
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
- Birmingham Women's & Children's Foundation Hospital Trust, Mindelsohn Way, Edgbaston, Birmingham, UK
| | - Stephane R Gross
- School of Life and Health Sciences, Aston University, Birmingham, UK
| | - Martin Hewison
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
- CEDAM, Birmingham Health Partners, University of Birmingham, Birmingham, UK
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3
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Barnard L, Schiffer L, Louw du-Toit R, Tamblyn JA, Chen S, Africander D, Arlt W, Foster PA, Storbeck KH. 11-Oxygenated Estrogens Are a Novel Class of Human Estrogens but Do not Contribute to the Circulating Estrogen Pool. Endocrinology 2021; 162:6042237. [PMID: 33340399 PMCID: PMC7814299 DOI: 10.1210/endocr/bqaa231] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [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: 10/14/2020] [Indexed: 12/30/2022]
Abstract
Androgens are the obligatory precursors of estrogens. In humans, classic androgen biosynthesis yields testosterone, thought to represent the predominant circulating active androgen both in men and women. However, recent work has shown that 11-ketotestosterone, derived from the newly described 11-oxygenated androgen biosynthesis pathway, makes a substantial contribution to the active androgen pool in women. Considering that classic androgens are the obligatory substrates for estrogen biosynthesis catalyzed by cytochrome P450 aromatase, we hypothesized that 11-oxygenated androgens are aromatizable. Here we use steroid analysis by tandem mass spectrometry to demonstrate that human aromatase generates 11-oxygenated estrogens from 11-oxygenated androgens in 3 different cell-based aromatase expression systems and in human ex vivo placenta explant cultures. We also show that 11-oxygenated estrogens are generated as a byproduct of the aromatization of classic androgens. We show that 11β-hydroxy-17β-estradiol binds and activates estrogen receptors α and β and that 11β-hydroxy-17β-estradiol and the classic androgen pathway-derived active estrogen, 17β-estradiol, are equipotent in stimulating breast cancer cell line proliferation and expression of estrogen-responsive genes. 11-oxygenated estrogens were, however, not detectable in serum from individuals with high aromatase levels (pregnant women) and elevated 11-oxygenated androgen levels (patients with congenital adrenal hyperplasia or adrenocortical carcinoma). Our data show that while 11-oxygenated androgens are aromatizable in vitro and ex vivo, the resulting 11-oxygenated estrogens are not detectable in circulation, suggesting that 11-oxygenated androgens function primarily as androgens in vivo.
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Affiliation(s)
- Lise Barnard
- Department of Biochemistry, Stellenbosch University, Matieland, South Africa
| | - Lina Schiffer
- Institute of Metabolism and Systems Research (IMSR), College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Renate Louw du-Toit
- Department of Biochemistry, Stellenbosch University, Matieland, South Africa
| | - Jennifer A Tamblyn
- Institute of Metabolism and Systems Research (IMSR), College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- Centre for Women’s & Newborn Health, Birmingham Health Partners, Birmingham Women’s & Children’s NHS Foundation Trust, Birmingham, UK
- Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Shiuan Chen
- Department of Cancer Biology, Beckman Research Institute, Duarte, California USA
| | - Donita Africander
- Department of Biochemistry, Stellenbosch University, Matieland, South Africa
| | - Wiebke Arlt
- Institute of Metabolism and Systems Research (IMSR), College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- National Institute for Health Research (NIHR) Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK
| | - Paul A Foster
- Institute of Metabolism and Systems Research (IMSR), College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Karl-Heinz Storbeck
- Department of Biochemistry, Stellenbosch University, Matieland, South Africa
- Institute of Metabolism and Systems Research (IMSR), College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- Correspondence: Karl-Heinz Storbeck, PhD, Department of Biochemistry, Stellenbosch University, Private Bag X1, Matieland, 7602, South Africa.
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Zhang JY, Wu P, Chen D, Ning F, Lu Q, Qiu X, Hewison M, Tamblyn JA, Kilby MD, Lash GE. Vitamin D Promotes Trophoblast Cell Induced Separation of Vascular Smooth Muscle Cells in Vascular Remodeling via Induction of G-CSF. Front Cell Dev Biol 2020; 8:601043. [PMID: 33415106 PMCID: PMC7783206 DOI: 10.3389/fcell.2020.601043] [Citation(s) in RCA: 10] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 12/04/2020] [Indexed: 01/08/2023] Open
Abstract
Vitamin D deficiency is associated with complications of pregnancy such as pre-eclampsia, fetal growth restriction, and miscarriage, all of which are also associated with incomplete spiral artery (SpA) remodeling. We have previously shown that both uterine natural killer (uNK) cells and extravillous trophoblast cells (EVT) are required for successful SpA remodeling, but whether their activity in this process is modulated by vitamin D is not known. In the current study, we use a previously described chorionic plate artery (CPA) ex vivo model of vascular remodeling to determine the effects of 1,25(OH)2D treated uNK cell, placental explant (PEx), and uNK/PEx conditioned medium (CM) on vascular smooth muscle cell (VSMC) disorganization and phenotypic switching. Significant results were followed up in VSMCs in vitro. We demonstrate that 1,25(OH)2D can enhance the ability of PEx to induce SpA remodeling, via a mechanism associated with increased secretion of granulocyte-colony stimulating factor (G-CSF). G-CSF appears able to increase VSMC disorganization and phenotypic switching in both an ex vivo vascular model and in vitro VSMC cultures. The clinical relevance of these findings are still to be determined. G-CSF may have differential effects depending on dose and vascular bed, and vitamin D may play a role in potentiating these actions. G-CSF may be an interesting potential therapeutic target for facilitating physiological vascular remodeling for the prevention of adverse obstetric outcomes.
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Affiliation(s)
- Joy Yue Zhang
- Division of Uterine Vascular Biology, Guangzhou Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Peihuang Wu
- Division of Uterine Vascular Biology, Guangzhou Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Danyang Chen
- Division of Uterine Vascular Biology, Guangzhou Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Fen Ning
- Division of Uterine Vascular Biology, Guangzhou Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Qinsheng Lu
- Division of Uterine Vascular Biology, Guangzhou Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Xiu Qiu
- Born in Guangzhou Cohort, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Martin Hewison
- College of Medical and Dental Sciences, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, United Kingdom
| | - Jennifer A Tamblyn
- College of Medical and Dental Sciences, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, United Kingdom
| | - Mark D Kilby
- College of Medical and Dental Sciences, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, United Kingdom.,Fetal Medicine Centre, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, United Kingdom
| | - Gendie E Lash
- Division of Uterine Vascular Biology, Guangzhou Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
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Tamblyn JA, Jeffery LE, Susarla R, Lissauer DM, Coort SL, Garcia AM, Knoblich K, Fletcher AL, Bulmer JN, Kilby MD, Hewison M. Transcriptomic analysis of vitamin D responses in uterine and peripheral NK cells. Reproduction 2020; 158:211-221. [PMID: 31163399 DOI: 10.1530/rep-18-0509] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 06/03/2019] [Indexed: 12/19/2022]
Abstract
Vitamin D deficiency is prevalent in pregnant women and is associated with adverse pregnancy outcomes, in particular disorders of malplacentation. The active form of vitamin D, 1,25-dihydroxyvitamin D3 (1,25(OH)2D3), is a potent regulator of innate and adaptive immunity, but its immune effects during pregnancy remain poorly understood. During early gestation, the predominant immune cells in maternal decidua are uterine natural killer cells (uNK), but the responsivity of these cells to 1,25(OH)2D3 is unknown despite high levels of 1,25(OH)2D3 in decidua. Transcriptomic responses to 1,25(OH)2D3 were characterised in paired donor uNK and peripheral natural killer cells (pNK) following cytokine (CK) stimulation. RNA-seq analyses indicated 911 genes were differentially expressed in CK-stimulated uNK versus CK-stimulated pNK in the absence of 1,25(OH)2D3, with predominant differentially expressed pathways being associated with glycolysis and transforming growth factor β (TGFβ). RNA-seq also showed that the vitamin D receptor (VDR) and its heterodimer partner retinoid X receptor were differentially expressed in CK-stimulated uNK vs CK-stimulated pNK. Further analyses confirmed increased expression of VDR mRNA and protein, as well as VDR-RXR target in CK-stimulated uNK. RNA-seq analysis showed that in CK-stimulated pNK, 1,25(OH)2D3 induced 38 and suppressed 33 transcripts, whilst in CK-stimulated uNK 1,25(OH)2D3 induced 46 and suppressed 19 genes. However, multiple comparison analysis of transcriptomic data indicated that 1,25(OH)2D3 had no significant overall effect on gene expression in either CK-stimulated pNK or uNK. These data indicate that CK-stimulated uNK are transcriptionally distinct from pNK and, despite expressing abundant VDR, neither pNK nor uNK are sensitive targets for vitamin D.
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Affiliation(s)
- J A Tamblyn
- Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.,Centre for Women's & Newborn Health, Birmingham Health Partners, Birmingham Women's & Children's Foundation Hospital, Edgbaston, Birmingham, UK.,Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, UK
| | - L E Jeffery
- Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - R Susarla
- Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - D M Lissauer
- Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.,Centre for Women's & Newborn Health, Birmingham Health Partners, Birmingham Women's & Children's Foundation Hospital, Edgbaston, Birmingham, UK
| | - S L Coort
- Department of Bioinformatics-BiGCaT, NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, Netherlands
| | - A Muñoz Garcia
- Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.,Department of Bioinformatics-BiGCaT, NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, Netherlands
| | - K Knoblich
- Biomedicine Discovery Institute, Monash University, Clayton, Victoria, Australia
| | - A L Fletcher
- Biomedicine Discovery Institute, Monash University, Clayton, Victoria, Australia
| | - J N Bulmer
- Reproductive and Vascular Biology Group, Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - M D Kilby
- Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.,Centre for Women's & Newborn Health, Birmingham Health Partners, Birmingham Women's & Children's Foundation Hospital, Edgbaston, Birmingham, UK.,Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, UK.,Fetal Medicine Centre, Birmingham Women's & Children's Foundation Trust, Edgbaston, Birmingham, UK
| | - M Hewison
- Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.,Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, UK
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6
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Beentjes CHL, Taylor-King JP, Bayani A, Davis CN, Dunster JL, Jabbari S, Mirams GR, Jenkinson C, Kilby MD, Hewison M, Tamblyn JA. Defining vitamin D status using multi-metabolite mathematical modelling: A pregnancy perspective. J Steroid Biochem Mol Biol 2019; 190:152-160. [PMID: 30926429 PMCID: PMC7614536 DOI: 10.1016/j.jsbmb.2019.03.024] [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: 10/01/2018] [Revised: 02/11/2019] [Accepted: 03/25/2019] [Indexed: 11/21/2022]
Abstract
Vitamin D deficiency is linked to adverse pregnancy outcomes such as pre-eclampsia (PET) but remains defined by serum measurement of 25-hydroxyvitamin D3 (25(OH)D3) alone. To identify broader changes in vitamin D metabolism during normal and PET pregnancies we developed a relatively simple but fully parametrised mathematical model of the vitamin D metabolic pathway. The data used for parametrisation were serum vitamin D metabolites analysed for a cross-sectional group of women (n = 88); including normal pregnant women at 1 st (NP1, n = 25) and 3rd trimester (NP3, n = 21) and pregnant women with PET (n = 22), as well as non-pregnant female controls (n = 20). To account for the effects various metabolites have upon each other, data were analysed using an ordinary differential equation model of the vitamin D reaction network. Information obtained from the model was then also applied to serum vitamin D metabolome data (n = 50) obtained from a 2nd trimester pregnancy cohort, of which 25 prospectively developed PET. Statistical analysis of the data alone showed no significant difference between NP3 and PET for serum 25(OH)D3 and 24,25(OH)2D3 concentrations. Conversely, a statistical analysis informed by the reaction network model revealed that a better indicator of PET is the ratios of vitamin D metabolites in late pregnancy. Assessing the potential predicative value, no significant difference between NP3 and PET cases at 15 weeks gestation was found. Mathematical modelling offers a novel strategy for defining the impact of vitamin D metabolism on human health. This is particularly relevant within the context of pregnancy, where major changes in vitamin D metabolism occur across gestation, and dysregulated metabolism is evidenced in women with established PET.
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Affiliation(s)
- C H L Beentjes
- Mathematical Institute, University of Oxford, Oxford, UK
| | - J P Taylor-King
- Department of Chemical Engineering and Biotechnology, University of Cambridge, Cambridge, CB3 OAS, UK; Institute of Molecular Systems Biology, Department of Biology, ETHZ, CH-8093, Zurich, Switzerland
| | - A Bayani
- Department of Physics and Mathematics, School of Science and Technology, Nottingham Trent University, Nottingham, UK
| | - C N Davis
- MathSys CDT, Mathematics Institute, University of Warwick, Coventry, UK
| | - J L Dunster
- Institute for Cardiovascular and Metabolic Research, University of Reading, UK
| | - S Jabbari
- School of Mathematics and Institute of Microbiology and Infection, University of Birmingham, Birmingham, UK
| | - G R Mirams
- Centre for Mathematical Medicine & Biology, Mathematical Sciences, University of Nottingham, UK
| | - C Jenkinson
- Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - M D Kilby
- Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK; Centre for Women's & Newborn Health, Birmingham Health Partners, Birmingham Women's & Children's Foundation Hospital, Edgbaston, Birmingham, UK; Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, UK; Fetal Medicine Centre, Birmingham Women's & Children's Foundation Trust, Edgbaston, Birmingham, UK
| | - M Hewison
- Centre for Women's & Newborn Health, Birmingham Health Partners, Birmingham Women's & Children's Foundation Hospital, Edgbaston, Birmingham, UK; Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, UK
| | - J A Tamblyn
- Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK; Centre for Women's & Newborn Health, Birmingham Health Partners, Birmingham Women's & Children's Foundation Hospital, Edgbaston, Birmingham, UK; Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, UK.
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7
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Liu NQ, Larner DP, Yao Q, Chun RF, Ouyang Y, Zhou R, Tamblyn JA, Wagner CL, Hewison M. Vitamin D-deficiency and sex-specific dysregulation of placental inflammation. J Steroid Biochem Mol Biol 2018; 177:223-230. [PMID: 28676458 DOI: 10.1016/j.jsbmb.2017.06.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [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: 04/26/2017] [Revised: 06/14/2017] [Accepted: 06/18/2017] [Indexed: 12/21/2022]
Abstract
To investigate an immunomodulatory role for vitamin D in pregnancy we used mice raised on vitamin D-sufficient (SUFF), or -deficient (DEF) diets. At embryonic day 14, pregnant mice received intraperitoneal injection of lipopolysaccharide (LPS) or vehicle for 24h, with age-matched non-pregnant mice as controls. In non-pregnant mice, 6 serum analytes (IL-1β, IL-18, MDC/CCL22, MIP-1α/CCL3, EGF, IgA) were lower in DEF mice. In pregnant DEF mice only GH was higher. In non-pregnant mice LPS induced 28 analytes, with 5 (IL-18, IP-10/CXCL10, MCP-1/CCL2, MIP-1β/CCL4, MIP-3β/CCL19) being highest in DEF mice. In pregnant SUFF mice 16 serum analytes increased with LPS, and 6 of these (IP-10/CXCL10, MCP-1/CCL2, SAP, TIMP-1, VCAM-1, vWF) were higher and 1 (GCP-2/CXCL6) lower in DEF mice. Parallel analysis of placental mRNAs showed elevated mRNA for Il-6, Ccl2 and Cxcl10 in placentae from male and female fetuses in LPS-DEF mice. However, LPS-induced expression of Ifnγ, Tnfα, and Cxcl6 was only observed in female placentae from DEF mice. LPS-DEF mice also showed smaller litter sizes relative to control SUFF mice. Numbers of female fetuses per dam were significantly lower for DEF mice with or without LPS challenge. LPS had no effect on numbers of male fetuses from DEF mothers, but significantly decreased male fetuses from SUFF mothers. These data indicate that vitamin D is an important component of anti-inflammatory immune responses during pregnancy, with the placenta and fetal sex playing pivotal roles in this process.
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Affiliation(s)
- Nancy Q Liu
- Dept of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, 90095, USA
| | - Dean P Larner
- Institute of Metabolism and Systems Research, The University of Birmingham, Birmingham B15 2TT, UK; Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham B15 2TH, UK
| | - Qingqiang Yao
- Dept of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, 90095, USA
| | - Rene F Chun
- Dept of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, 90095, USA
| | - Yuxin Ouyang
- Dept of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, 90095, USA
| | - Rui Zhou
- Dept of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, 90095, USA
| | - Jennifer A Tamblyn
- Institute of Metabolism and Systems Research, The University of Birmingham, Birmingham B15 2TT, UK; Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham B15 2TH, UK
| | - Carol L Wagner
- Division of Neonatology, Department of Pediatrics, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Martin Hewison
- Dept of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, 90095, USA; Institute of Metabolism and Systems Research, The University of Birmingham, Birmingham B15 2TT, UK; Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham B15 2TH, UK.
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Ganguly A, Tamblyn JA, Finn-Sell S, Chan SY, Westwood M, Gupta J, Kilby MD, Gross SR, Hewison M. Vitamin D, the placenta and early pregnancy: effects on trophoblast function. J Endocrinol 2018; 236:R93-R103. [PMID: 29109081 DOI: 10.1530/joe-17-0491] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [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: 10/24/2017] [Accepted: 11/06/2017] [Indexed: 01/01/2023]
Abstract
Pregnancy is associated with significant changes in vitamin D metabolism, notably increased maternal serum levels of active vitamin D, 1,25-dihydroxyvitamin (1,25(OH)2D). This appears to be due primarily to increased renal activity of the enzyme 25-hydroxyvitamin D-1α-hydroxylase (CYP27B1) that catalyzes synthesis of 1,25(OH)2D, but CYP27B1 expression is also prominent in both the maternal decidua and fetal trophoblast components of the placenta. The precise function of placental synthesis of 1,25(OH)2D remains unclear, but is likely to involve localized tissue-specific responses with both decidua and trophoblast also expressing the vitamin D receptor (VDR) for 1,25(OH)2D. We have previously described immunomodulatory responses to 1,25(OH)2D by diverse populations of VDR-expressing cells within the decidua. The aim of the current review is to detail the role of vitamin D in pregnancy from a trophoblast perspective, with particular emphasis on the potential role of 1,25(OH)2D as a regulator of trophoblast invasion in early pregnancy. Vitamin D deficiency is common in pregnant women, and a wide range of studies have linked low vitamin D status to adverse events in pregnancy. To date, most of these studies have focused on adverse events later in pregnancy, but the current review will explore the potential impact of vitamin D on early pregnancy, and how this may influence implantation and miscarriage.
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Affiliation(s)
- Ankana Ganguly
- Institute of Metabolism and Systems ResearchThe University of Birmingham, Birmingham, UK
| | - Jennifer A Tamblyn
- Institute of Metabolism and Systems ResearchThe University of Birmingham, Birmingham, UK
- Fetal Medicine CentreBirmingham Women's NHS Foundation Trust, Birmingham, UK
- CEDAMBirmingham Health Partners, The University of Birmingham, Birmingham, UK
| | - Sarah Finn-Sell
- Division of Developmental Biology and MedicineMaternal and Fetal Health Research Centre, School of Medicine, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Shiao-Y Chan
- Department of Obstetrics and GynaecologyYong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Melissa Westwood
- Division of Developmental Biology and MedicineMaternal and Fetal Health Research Centre, School of Medicine, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Janesh Gupta
- Institute of Metabolism and Systems ResearchThe University of Birmingham, Birmingham, UK
- Fetal Medicine CentreBirmingham Women's NHS Foundation Trust, Birmingham, UK
| | - Mark D Kilby
- Institute of Metabolism and Systems ResearchThe University of Birmingham, Birmingham, UK
- Fetal Medicine CentreBirmingham Women's NHS Foundation Trust, Birmingham, UK
| | - Stephane R Gross
- School of Life and Health SciencesAston University, Birmingham, UK
| | - Martin Hewison
- Institute of Metabolism and Systems ResearchThe University of Birmingham, Birmingham, UK
- CEDAMBirmingham Health Partners, The University of Birmingham, Birmingham, UK
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9
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Tamblyn JA, Jenkinson C, Larner DP, Hewison M, Kilby MD. Serum and urine vitamin D metabolite analysis in early preeclampsia. Endocr Connect 2018; 7:199-210. [PMID: 29217650 PMCID: PMC5793806 DOI: 10.1530/ec-17-0308] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 12/07/2017] [Indexed: 12/18/2022]
Abstract
Vitamin D deficiency is common in pregnant women and may contribute to adverse events in pregnancy such as preeclampsia (PET). To date, studies of vitamin D and PET have focused primarily on serum concentrations vitamin D, 25-hydroxyvitamin D3 (25(OH)D3) later in pregnancy. The aim here was to determine whether a more comprehensive analysis of vitamin D metabolites earlier in pregnancy could provide predictors of PET. Using samples from the SCOPE pregnancy cohort, multiple vitamin D metabolites were quantified by liquid chromatography-tandem mass spectrometry in paired serum and urine prior to the onset of PET symptoms. Samples from 50 women at pregnancy week 15 were analysed, with 25 (50%) developing PET by the end of the pregnancy and 25 continuing with uncomplicated pregnancy. Paired serum and urine from non-pregnant women (n = 9) of reproductive age were also used as a control. Serum concentrations of 25(OH)D3, 25(OH)D2, 1,25(OH)2D3, 24,25(OH)2D3 and 3-epi-25(OH)D3 were measured and showed no significant difference between women with uncomplicated pregnancies and those developing PET. As previously reported, serum 1,25(OH)2D3 was higher in all pregnant women (in the second trimester), but serum 25(OH)D2 was also higher compared to non-pregnant women. In urine, 25(OH)D3 and 24,25(OH)2D3 were quantifiable, with both metabolites demonstrating significantly lower (P < 0.05) concentrations of both of these metabolites in those destined to develop PET. These data indicate that analysis of urinary metabolites provides an additional insight into vitamin D and the kidney, with lower urinary 25(OH)D3 and 24,25(OH)2D3 excretion being an early indicator of a predisposition towards developing PET.
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Affiliation(s)
- J A Tamblyn
- Institute of Metabolism and Systems Research (IMSR)College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- Birmingham Women's Foundation HospitalEdgbaston, Birmingham, UK
- Centre for EndocrinologyDiabetes and Metabolism, Birmingham Health Partners, Birmingham, UK
| | - C Jenkinson
- Birmingham Women's Foundation HospitalEdgbaston, Birmingham, UK
| | - D P Larner
- Birmingham Women's Foundation HospitalEdgbaston, Birmingham, UK
| | - M Hewison
- Institute of Metabolism and Systems Research (IMSR)College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- Centre for EndocrinologyDiabetes and Metabolism, Birmingham Health Partners, Birmingham, UK
| | - M D Kilby
- Institute of Metabolism and Systems Research (IMSR)College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- Birmingham Women's Foundation HospitalEdgbaston, Birmingham, UK
- Centre for EndocrinologyDiabetes and Metabolism, Birmingham Health Partners, Birmingham, UK
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10
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Al Wattar BH, Tamblyn JA, Parry-Smith W, Prior M, Van Der Nelson H. Management of obstetric postpartum hemorrhage: a national service evaluation of current practice in the UK. Risk Manag Healthc Policy 2017; 10:1-6. [PMID: 28176919 PMCID: PMC5261839 DOI: 10.2147/rmhp.s121737] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Postpartum hemorrhage (PPH) continues to be one of the major causes of maternal mortality and morbidity in obstetrics. Variations in practice often lead to adverse maternity outcomes following PPH. Our objective was to assess the current practice in managing PPH in the UK. METHODS We performed a national multicenter prospective service evaluation study over one calendar month and compared the current performance to national standards for managing PPH. We used a standardized data collection tool and collected data on patients' demographics, incidence of PPH, estimated blood loss (EBL), prophylactic and treatment measures, onset of labor, and mode of delivery. RESULTS We collected data from 98 obstetric units, including 3663 cases of primary PPH. Fifty percent of cases were minor PPH (EBL 500-1000 mL, n=1900/3613, 52.6%) and the remaining were moderate PPH (EBL >1000 to <2000 mL, n=1424/3613, 39.4%) and severe PPH (EBL >2000 mL, n=289/3613, 8%). The majority of women received active management of the third stage of labor (3504/3613, 97%) most commonly with Syntometrine intramuscular (1479/3613, 40.9%). More than half required one additional uterotonic agent (2364/3613, 65.4%) most commonly with Syntocinon intravenous infusion (1155/2364, 48.8%). There was a poor involvement of consultant obstetricians and anesthetists in managing PPH cases, which was more prevalent when managing major PPH (p=0.0001). CONCLUSION There are still variations in managing PPH in the UK against national guidelines. More senior doctor involvement and regular service evaluation are needed to improve maternal outcomes following PPH.
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Affiliation(s)
- Bassel H Al Wattar
- Women's Health Research Unit, Barts and the London School of Medicine and Dentistry, Queen Mary University London, London, UK
| | - Jennifer A Tamblyn
- Institute of Metabolism and Systems Research (IMSR), University of Birmingham, Birmingham, UK
| | - William Parry-Smith
- Institute of Metabolism and Systems Research (IMSR), University of Birmingham, Birmingham, UK
| | - Mathew Prior
- Division of Child Health, Obstetrics & Gynaecology, School of Medicine, University of Nottingham, Nottingham, UK
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11
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Tamblyn JA, Susarla R, Jenkinson C, Jeffery LE, Ohizua O, Chun RF, Chan SY, Kilby MD, Hewison M. Dysregulation of maternal and placental vitamin D metabolism in preeclampsia. Placenta 2016; 50:70-77. [PMID: 28161064 DOI: 10.1016/j.placenta.2016.12.019] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [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: 10/12/2016] [Revised: 11/27/2016] [Accepted: 12/17/2016] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Epidemiology has linked preeclampsia (PET) to decreased maternal serum 25-hydroxyvitamin D3 (25(OH)D3). However, alterations in systemic and placental/decidual transport and metabolism of 25(OH)D3 during pregnancy suggest that other forms of vitamin D may also contribute to the pathophysiology of PET. METHODS In a cross sectional analysis of normal pregnant women at 1st (n = 25) and 3rd trimester (n = 21), pregnant women with PET (n = 22), and non-pregnant female controls (n = 20) vitamin D metabolites were quantified in paired maternal serum, placental, and decidual tissue. RESULTS Serum 25(OH)D3 was not significantly different in sera across all four groups. In normal 3rd trimester pregnant women serum active 1,25-dihydroxyvitamin D3 (1,25(OH)2D3) was significantly higher than non-pregnant, normal 1st trimester pregnant, and PET women. Conversely, PET sera showed highest levels of the catabolites 3-epi-25(OH)D3 and 24,25-dihydroxyvitamin D3 (24,25(OH)2D3). Serum albumin was significantly lower in normal 3rd trimester pregnant women and PET relative to normal 1st trimester pregnant women, but there was no change in free/bioavailable 25(OH)D3. In PET placental tissue, 25(OH)D3 and 3-epi-25(OH)D3 were lower than normal 3rd trimester tissue, whilst placental 24,25(OH)2D3 was highest in PET. Tissue 1,25(OH)2D3 was detectable in 1st trimester decidua, which also showed 10-fold higher 25(OH)D3 relative to paired placentae. 3-epi-25(OH)D3 and 24,25(OH)2D3 were not different for decidua and placenta. In normal 3rd trimester pregnant women, total, free and bioavailable maternal 25(OH)D3 correlated with placental 25(OH)D3, but this was not conserved for PET. DISCUSSION These data indicate that PET is associated with decreased activation, increased catabolism, and impaired placental uptake of 25(OH)D3.
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Affiliation(s)
- J A Tamblyn
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, B15 2TT, UK; Fetal Medicine Centre, Birmingham Women's Foundation Trust, Edgbaston, Birmingham, B15 2TG, UK; Centre for Women's & Newborn Health, Birmingham Health Partners, Birmingham, B15 2TH, UK
| | - R Susarla
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, B15 2TT, UK
| | - C Jenkinson
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, B15 2TT, UK
| | - L E Jeffery
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, B15 2TT, UK
| | - O Ohizua
- Women, Children and Sexual Health Directorate, Walsall Hospitals NHS Trust, Walsall, WS2 9PS, UK
| | - R F Chun
- Department of Orthopaedic Surgery, University of California Los Angeles, Los Angeles, CA 90095, USA
| | - S Y Chan
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, B15 2TT, UK; Department of Obstetrics and Gynecology, National University of Singapore, 119228, Singapore
| | - M D Kilby
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, B15 2TT, UK; Fetal Medicine Centre, Birmingham Women's Foundation Trust, Edgbaston, Birmingham, B15 2TG, UK; Centre for Women's & Newborn Health, Birmingham Health Partners, Birmingham, B15 2TH, UK; Centre for Endocrinology Diabetes and Metabolism, Birmingham Health Partners, Birmingham, B15 2TH, UK
| | - M Hewison
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, B15 2TT, UK; Centre for Women's & Newborn Health, Birmingham Health Partners, Birmingham, B15 2TH, UK; Centre for Endocrinology Diabetes and Metabolism, Birmingham Health Partners, Birmingham, B15 2TH, UK.
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Tamblyn JA, Norton A, Spurgeon L, Donovan V, Bedford Russell A, Bonnici J, Perkins K, Vyas P, Roberts I, Kilby MD. Prenatal therapy in transient abnormal myelopoiesis: a systematic review. Arch Dis Child Fetal Neonatal Ed 2016; 101:F67-71. [PMID: 25956670 DOI: 10.1136/archdischild-2014-308004] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [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: 02/15/2015] [Accepted: 04/15/2015] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To systematically review current evidence regarding prenatal diagnosis and management of transient abnormal myelopoiesis (TAM) in fetuses with trisomy 21. A novel case of GATA1-positive TAM, in which following serial in utero blood transfusion clinical improvement and postnatal remission were observed, is included. SEARCH STRATEGY AND DATA COLLECTION A systematic search of electronic databases (inception to October 2014) and reference lists, hand-searching of journals and expert contact. All confirmed cases of prenatal TAM were included for analysis. Data on study characteristics, design and quality were obtained. RESULTS Of 73 potentially relevant citations identified, 22 studies were included, describing 39 fetuses. All studies included comprised single case or small cohort studies; overall quality was 'very low'. Fetal/neonatal outcome was poor; 12 stillbirths (30.8%), 4 neonatal deaths (10.2%) and 7 infant deaths (17.9%). In two cases, the pregnancy was terminated (5.1%). TAM was primarily detected in the third trimester (79.4%), and in 14 a retrospective diagnosis was made postpartum. Ultrasound features indicative of TAM included hepatomegaly±splenomegaly (79.5%), hydrops fetalis (30.8%), pericardial effusion (23.1%) and aberrant liquor volume (15.4%). When performed, liver function tests were abnormal in 91.6% of cases. CONCLUSIONS Prenatal TAM presents a challenging diagnosis, and prognosis is poor, with consistently high mortality. A low threshold to measure haematological and biochemical markers is advised when clinical features typical of TAM are detected in the context of trisomy 21. Larger prospective studies are warranted to accurately ascertain the role of GATA1 analysis and potential value of prenatal therapy.
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Affiliation(s)
- J A Tamblyn
- Centre for Women's & Children's Health, College of Medical & Dental Sciences, University of Birmingham, Birmingham, UK
| | - A Norton
- Birmingham Children's Hospital NHS Foundation Trust, Birmingham, UK
| | - L Spurgeon
- Centre for Women's & Children's Health, College of Medical & Dental Sciences, University of Birmingham, Birmingham, UK
| | - V Donovan
- Fetal Medicine Centre, Birmingham Women's Foundation Trust, Edgbaston, Birmingham, UK
| | - A Bedford Russell
- Department of Neonatal Paediatrics, Birmingham Women's Foundation Trust, Edgbaston, Birmingham, UK
| | - J Bonnici
- Department of Paediatrics, Children's Hospital and Molecular Haematology Unit, Weatherall Institute of Molecular Medicine, Oxford University and John Radcliffe Hospital, Oxford, UK
| | - K Perkins
- Department of Paediatrics, Children's Hospital and Molecular Haematology Unit, Weatherall Institute of Molecular Medicine, Oxford University and John Radcliffe Hospital, Oxford, UK
| | - P Vyas
- Department of Paediatrics, Children's Hospital and Molecular Haematology Unit, Weatherall Institute of Molecular Medicine, Oxford University and John Radcliffe Hospital, Oxford, UK
| | - I Roberts
- Department of Paediatrics, Children's Hospital and Molecular Haematology Unit, Weatherall Institute of Molecular Medicine, Oxford University and John Radcliffe Hospital, Oxford, UK
| | - M D Kilby
- Centre for Women's & Children's Health, College of Medical & Dental Sciences, University of Birmingham, Birmingham, UK Fetal Medicine Centre, Birmingham Women's Foundation Trust, Edgbaston, Birmingham, UK
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Abstract
During pregnancy, immune activity is tightly regulated so that antimicrobial protection of the mother and fetus is balanced with the need for immune tolerance to prevent fetal rejection. In this setting, the maternal-fetal interface, in the form of the uterine decidua, provides a heterogeneous immune cell population with the potential to mediate diverse activities throughout pregnancy. Recent studies have suggested that vitamin D may be a key regulator of immune function during pregnancy, with the fetal-maternal interface representing a prominent target. Among its non-classical actions are potent immunomodulatory effects, including induction of antibacterial responses and modulation of T-lymphocytes to suppress inflammation and promote tolerogenesis. Thus, vitamin D may play a pivotal role in normal decidual immune function by promoting innate responses to infection, while simultaneously preventing an over-elaboration of inflammatory adaptive immunity. Research to date has focused upon the potential role of vitamin D in preventing infectious diseases such as tuberculosis, as well as possibly suppressing of autoimmune disease. Nevertheless, vitamin D may also influence facets of immune function not immediately associated with primary innate responses. This review summarises our current understanding of decidual immune function with respect to the vitamin D metabolism and signalling, and as to how this may be affected by variations in maternal vitamin D status. There has recently been much interest in vitamin D supplementation of pregnant women, but our knowledge of how this may influence the function of decidua remains limited. Further insight into the immunomodulatory actions of vitamin D during pregnancy will help shed light upon this.
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Affiliation(s)
- J A Tamblyn
- College of Medical and Dental SciencesCentre for Women's and Children's HealthCollege of Medical and Dental SciencesCentre of Endocrinology, Diabetes and Metabolism (CEDAM), University of Birmingham, Edgbaston, Birmingham B15 2TT, UKDepartments of PediatricsBiochemistry, and Molecular Biology, Medical University of South Carolina, Charleston, South Carolina 29425, USAReproductive and Vascular Biology GroupInstitute of Cellular Medicine, Newcastle University, Newcastle upon Tyne NE2 4HH, UKFetal Medicine CentreBirmingham Women's Foundation Trust, Birmingham B15 2TG, UK College of Medical and Dental SciencesCentre for Women's and Children's HealthCollege of Medical and Dental SciencesCentre of Endocrinology, Diabetes and Metabolism (CEDAM), University of Birmingham, Edgbaston, Birmingham B15 2TT, UKDepartments of PediatricsBiochemistry, and Molecular Biology, Medical University of South Carolina, Charleston, South Carolina 29425, USAReproductive and Vascular Biology GroupInstitute of Cellular Medicine, Newcastle University, Newcastle upon Tyne NE2 4HH, UKFetal Medicine CentreBirmingham Women's Foundation Trust, Birmingham B15 2TG, UK
| | - M Hewison
- College of Medical and Dental SciencesCentre for Women's and Children's HealthCollege of Medical and Dental SciencesCentre of Endocrinology, Diabetes and Metabolism (CEDAM), University of Birmingham, Edgbaston, Birmingham B15 2TT, UKDepartments of PediatricsBiochemistry, and Molecular Biology, Medical University of South Carolina, Charleston, South Carolina 29425, USAReproductive and Vascular Biology GroupInstitute of Cellular Medicine, Newcastle University, Newcastle upon Tyne NE2 4HH, UKFetal Medicine CentreBirmingham Women's Foundation Trust, Birmingham B15 2TG, UK
| | - C L Wagner
- College of Medical and Dental SciencesCentre for Women's and Children's HealthCollege of Medical and Dental SciencesCentre of Endocrinology, Diabetes and Metabolism (CEDAM), University of Birmingham, Edgbaston, Birmingham B15 2TT, UKDepartments of PediatricsBiochemistry, and Molecular Biology, Medical University of South Carolina, Charleston, South Carolina 29425, USAReproductive and Vascular Biology GroupInstitute of Cellular Medicine, Newcastle University, Newcastle upon Tyne NE2 4HH, UKFetal Medicine CentreBirmingham Women's Foundation Trust, Birmingham B15 2TG, UK
| | - J N Bulmer
- College of Medical and Dental SciencesCentre for Women's and Children's HealthCollege of Medical and Dental SciencesCentre of Endocrinology, Diabetes and Metabolism (CEDAM), University of Birmingham, Edgbaston, Birmingham B15 2TT, UKDepartments of PediatricsBiochemistry, and Molecular Biology, Medical University of South Carolina, Charleston, South Carolina 29425, USAReproductive and Vascular Biology GroupInstitute of Cellular Medicine, Newcastle University, Newcastle upon Tyne NE2 4HH, UKFetal Medicine CentreBirmingham Women's Foundation Trust, Birmingham B15 2TG, UK
| | - M D Kilby
- College of Medical and Dental SciencesCentre for Women's and Children's HealthCollege of Medical and Dental SciencesCentre of Endocrinology, Diabetes and Metabolism (CEDAM), University of Birmingham, Edgbaston, Birmingham B15 2TT, UKDepartments of PediatricsBiochemistry, and Molecular Biology, Medical University of South Carolina, Charleston, South Carolina 29425, USAReproductive and Vascular Biology GroupInstitute of Cellular Medicine, Newcastle University, Newcastle upon Tyne NE2 4HH, UKFetal Medicine CentreBirmingham Women's Foundation Trust, Birmingham B15 2TG, UK College of Medical and Dental SciencesCentre for Women's and Children's HealthCollege of Medical and Dental SciencesCentre of Endocrinology, Diabetes and Metabolism (CEDAM), University of Birmingham, Edgbaston, Birmingham B15 2TT, UKDepartments of PediatricsBiochemistry, and Molecular Biology, Medical University of South Carolina, Charleston, South Carolina 29425, USAReproductive and Vascular Biology GroupInstitute of Cellular Medicine, Newcastle University, Newcastle upon Tyne NE2 4HH, UKFetal Medicine CentreBirmingham Women's Foundation Trust, Birmingham B15 2TG, UK College of Medical and Dental SciencesCentre for Women's and Children's HealthCollege of Medical and Dental SciencesCentre of Endocrinology, Diabetes and Metabolism (CEDAM), University of Birmingham, Edgbaston, Birmingham B15 2TT, UKDepartments of PediatricsBiochemistry, and Molecular Biology, Medical University of South Carolina, Charleston, South Carolina 29425, USAReproductive and Vascular Biology GroupInstitute of Cellular Medicine, Newcastle University, Newcastle upon Tyne NE2 4HH, UKFetal Medicine CentreBirmingham Women's Foundation Trust, Birmingham B15 2TG, UK
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Tamblyn JA, Lissauer DM, Powell R, Cox P, Kilby MD. The immunological basis of villitis of unknown etiology - review. Placenta 2013; 34:846-55. [PMID: 23891153 DOI: 10.1016/j.placenta.2013.07.002] [Citation(s) in RCA: 83] [Impact Index Per Article: 7.5] [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: 05/02/2013] [Revised: 07/04/2013] [Accepted: 07/05/2013] [Indexed: 01/22/2023]
Abstract
Villitis of unknown etiology (VUE) represents a common placental inflammatory lesion, primarily, but not exclusively, identifiable T lymphocytes at term. Despite considerable evidence to contest that this simply represents a benign pathological finding, VUE remains a significantly undervalued diagnosis. Given its association with adverse pregnancy outcomes; including fetal growth restriction, preterm birth, and recurrent pregnancy loss, an increased awareness amongst clinician obstetricians is certainly warranted. The underlying immunopathogenesis of VUE remains uncertain. Despite initial theories that this represents an infectious placental lesion of undiagnosed pathogenic source, a more complex sequence of events involving the "breakdown" of maternal-fetal tolerance is emerging. Characterization of a unique inflammatory phenomenon in which both maternal and fetal T lymphocytes and Höfbauer cells interact has captivated particular research interest and has generated analogies to both the problems of allograft rejection and graft-versus-host disease (GvHD). Within the context of VUE, this review evaluates how disruption of the multidimensional immunological mechanisms underlying feto-maternal tolerance may permit abnormal lymphocyte infiltration into placental villi. We shall review the existing evidence for these events in VUE and outline areas of certain future interest.
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Affiliation(s)
- J A Tamblyn
- Theme of Reproduction, Genes and Development, School of Clinical and Experimental Medicine, University of Birmingham, Birmingham B15 2TG, UK.
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