Dynamics of serum levels and reference ranges of copeptin in the 3rd trimester of pregnancy in healthy pregnant women with uncomplicated pregnancy and delivery.

OBJECTIVE: Copeptin is a stable fragment of vasopressin. Copeptin levels have been found to reflect the degree of endothelial stress in various conditions, including acute coronary syndrome. Copeptin may be a bio marker for endothelial stress during pregnancy. However, there is still a lack of understanding of its dynamics and levels throughout pregnancy. This study aims to describe intra-individual and longitudinal changes in copeptin levels at 30th and 36th gestational weeks in healthy pregnant women with uncomplicated pregnancy and delivery and to establish specific reference ranges. METHODS: A total of 125 pregnant women with uncomplicated pregnancy and delivery were included. These women were monitored throughout their pregnancy and gave birth at the Department of Obstetrics and Gynecology Olomouc University Hospital. The blood was taken at ~30 and ~36 gestational weeks. Serum copeptin levels were measured using a Kryptor Compact PLUS analyzer. For statistics, we used R software and the "referenceRanges" package. RESULTS: It was found that serum levels of copeptin were significantly higher in the 36th week group than in the 30th week group (P < 0.05). Cook's distance was used to eliminate outliers. The 30th week median was 3.377 pmol/l, reference range = 1.343-7.829 pmol/l, and the 36 week was median 4.735 pmol/l and reference range = 2.06-13.2 pmol/l. In the 36th week reference range, the median was higher than in healthy, non-pregnant women (P < 0.05). Copeptin values can exceed 10 pmol/l, particularly after the 36th week. In the 3rd trimester, this value may indicate cardiovascular and endothelial overload. CONCLUSION: Copeptin levels were found to vary significantly depending on gestational week. The proposed reference ranges take into account the increased secretion of vasopressin in pregnancy. The existence of specific upper reference limits represents a potential advantage in detecting pregnant women prone to hypertensive disease in the 3rd trimester.

Immunological principle of development of red blood cell alloimmunization in pregnancy, hemolytic disease of the fetus and prevention of RhD alloimmunization in RhD negative women.

DESIGN: Review article. SETTING: Department of Obstetrics and Gynecology, Palacky University Olomouc, Faculty of Medicine and Dentistry, University Hospital Olomouc. Methods, results: Every person exposed to a foreign red blood cell antigen (erythrocyte antigen) develops an antibody. If the contact with a foreign erythrocyte antigen occurs during pregnancy, the erythrocyte alloimmunization of the pregnant woman develops and, due to antibodies crossing through the placenta also Haemolytic disease of the foetus and newborn (HDFN) can occur. Antibodies are made by pregnant woman's immune system and their quantity and quality depend on many factors. Their function is to eliminate foetal "foreign" erythrocytes. Ways of elimination of antibody-labelled foetal erythrocytes are the same in the bloodstream of pregnant women and foetuses/newborns and their principle is type II hypersensitivity (cytotoxic), according to the Coombs and Gell classification. Severe forms of HDFN can lead to increased perinatal morbidity and mortality. Prevention of the development of RhD alloimmunization and severe forms of HDFN is based on the administration of polyclonal immunoglobulin (Ig) G anti-D in all potentially sensitizing events. It is assumed that the mechanism of anti-D IgG action is based on the rapid removal of the antigen by antibody overflow, and on antibody mediated immune suppression (AMIS). However, the exact immunological principle is not fully known yet. CONCLUSION: This article describes the development of irregular antibodies, methods of foetal erythrocytes destruction and the mechanism of prevention of anti-D immunoglobulin from the immunological point of view.

First-trimester screening for preeclampsia.

DESIGN: Review article. SETTING: Department of Clinical Biochemistry, University Hospital Olomouc; Department of Obstetrics and Gynecology, Palacky University Olomouc, Faculty of Medicine and Dentistry, University Hospital Olomouc; The Institute for the Care of Mother and Child and 3rd Faculty of Medicine Charles University, Prague; G-CENTRUM Olomouc, Olomouc; Genetika Plzeň, Pilsen. Methods, results: Preeclampsia (PE) is a multisystem disorder complicating pregnancy. It is the leading cause of maternal and perinatal mortality and morbidity worldwide. Recent studies have shown that high-risk pregnant women may benefit from low-dose acetylsalicylic acid early therapy in prevention of the development of severe forms of the disease. The risk group of pregnant women should be identified in 11-13 gestational week for effective prevention. The only procedure validated in many studies for performing PE screening with sufficient diagnostic accuracy in the first trimester of pregnancy is given by The Fetal Medicine Foundation (FMF) and has been adopted and published in a new recommendation by The International Federation of Gynecology and Obstetrics (FIGO). CONCLUSION: This article summarizes the recent findings and recommendation for performing screening of preeclampsia in 1st trimester of pregnancy and how to prevent the development of severe forms of PE by low-dose acetylsalicylic acid therapy.

[Application of the concetrations ratio of soluble receptor tyrosine kinase type 1, and placental growth factor for short-term prediction and diagnosis of preeclampsia]. / Vyuzití pomeru koncentrací solubilního receptoru tyrozinkinázového typu 1 a placentárního rustového faktoru pro krátkodobou predikci a diagnostiku preeklampsie.

OBJECTIVE: Bring a comprehensive overview of the available information about applications of the concetration ratio of soluble receptor tyrosine kinase type 1 (sFlt-1), and placental growth factor for short-term prediction and diagnosis of preeclampsia. DESIGN: Overview study. SETTINGS: Department of Midwifery, Faculty of Health Sciences, Olomouc; Department of Clinical Biochemistry, University Hospital Olomouc; Department of Obstetrics and Gynecology, University Hospital Olomouc; Department of Obstetrics and Gynecology, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital. METHODS: Analysis of literary sources and databases Ovid, Medline (2001-2016). CONCLUSION: Preeclampsia is a multisystem disease with not fully understood etiology. This disease occurs in 2-5% of pregnant women. Preeclampsia is one of the main causes of global maternal and perinatal morbidity and mortality. It manifests itself as a newborn hypertension and proteinuria after 20 weeks of pregnancy in previously normotensive women. The only effective treatment is the delivery of the child. Diagnosis of preeclampsia comprises measuring blood pressure and proteinuria. These indicators have low diagnostic sensitivity and specificity. In preeclampsia, there is a decrease of serum levels of placental growth factor (PlGF). Soluble receptor tyrosine kinase type 1 (sFlt-1) is an antagonist of PlGF. Increased levels of sFlt-1 in proportion to the reduced level of PlGF are associated with an increased risk of preeclampsia. The sFlt-1/PlGF ratio can be a better predictive marker in the diagnosis of pre-eclampsia after 20 weeks of gestation.

Opioid-receptor (OR) signaling cascades in rat cerebral cortex and model cell lines: the role of plasma membrane structure.

Large number of extracellular signals is received by plasma membrane receptors which, upon activation, transduce information into the target cell interior via trimeric G-proteins (GPCRs) and induce activation or inhibition of adenylyl cyclase enzyme activity (AC). Receptors for opioid drugs such as morphine (micro-OR, delta-OR and kappa-OR) belong to rhodopsin family of GPCRs. Our recent results indicated a specific up-regulation of AC I (8-fold) and AC II (2.5-fold) in plasma membranes (PM) isolated from rat brain cortex exposed to increasing doses of morphine (10-50 mg/kg) for 10 days. Increase of ACI and ACII represented the specific effect as the amount of ACIII-ACIX, prototypical PM marker Na, K-ATPase and trimeric G-protein alpha and beta subunits was unchanged. The up-regulation of ACI and ACII faded away after 20 days since the last dose of morphine. Proteomic analysis of these PM indicated that the brain cortex of morphine-treated animals cannot be regarded as being adapted to this drug because significant up-regulation of proteins functionally related to oxidative stress and alteration of brain energy metabolism occurred. The number of delta-OR was increased 2-fold and their sensitivity to monovalent cations was altered. Characterization of delta-OR-G-protein coupling in model HEK293 cell line indicated high ability of lithium to support affinity of delta-OR response to agonist stimulation. Our studies of PM structure and function in context with desensitization of GPCRs action were extended by data indicating participation of cholesterol-enriched membrane domains in agonist-specific internalization of delta-OR. In HEK293 cells stably expressing delta-OR-G(i)1alpha fusion protein, depletion of PM cholesterol was associated with the decrease in affinity of G-protein response to agonist stimulation, whereas maximum response was unchanged. Hydrophobic interior of isolated PM became more "fluid", chaotically organized and accessible to water molecules. Validity of this conclusion was supported by the analysis of an immediate PM environment of cholesterol molecules in living delta-OR-G(i)1alpha-HEK293 cells by fluorescent probes 22- and 25-NBD-cholesterol. The alteration of plasma membrane structure by cholesterol depletion made the membrane more hydrated. Understanding of the positive and negative feedback regulatory loops among different OR-initiated signaling cascades (micro-, delta-, and kappa-OR) is crucial for understanding of the long-term mechanisms of drug addiction as the decrease in functional activity of micro-OR may be compensated by increase of delta-OR and/or kappa-OR signaling.

Plasma membrane density of GABA(B)-R1a, GABA(B)-R1b, GABA-R2 and trimeric G-proteins in the course of postnatal development of rat brain cortex.

With the aim to understand the onset of expression and developmental profile of plasma membrane (PM) content /density of crucial components of GABA(B)-R signaling cascade, GABA(B)-R1a, GABA(B)-R1b, GABA(B)-R2, G(i)1/G(i)2alpha, G(i)3alpha, G(o)alpha, G(z)alpha and Gbeta subunit proteins were determined by quantitative immunoblotting and compared in PM isolated from brain cortex of rats of different ages: between postnatal-day-1 (PD1) and 90 (PD90). PM density of GABA(B)-R1a, GABA(B)-R2, G(i)1/G(i)2alpha, G(i)3alpha, G(o)alpha, G(z)alpha and Gbeta was high already at birth and further development was reflected in parallel decrease of both GABA(B)-R1a and GABA(B)-R2 subunits. The major decrease of GABA(B)-R1a and GABA(B)-R2 occurred between the birth and PD15: to 55 % (R1a, **) and 51 % (R2, **), respectively. Contrarily, PM level of the cognate G-proteins G(i)1/G(i)2alpha, G(i)3alpha, G(o)alpha, G(z)alpha and Gbeta was unchanged in the course of the whole postnatal period of brain cortex development. Maturation of GABA(B)-R cascade was substantially different from ontogenetic profile of prototypical plasma membrane marker, Na, K-ATPase, which was low at birth and further development was reflected in continuous increase of PM density of this enzyme. Major change occurred between the birth and PD25. In adult rats, membrane content of Na, K-ATPase was 3-times higher than around the birth.

Ontogenetic development of GABA(B)-receptor signaling cascade in plasma membranes isolated from rat brain cortex; the number of GABA(B)-receptors is high already shortly after the birth.

Our data indicate the significant intrinsic efficacy of GABA(B)-receptors in rat brain cortex already at birth (PD1, PD2). Subsequently, baclofen- and SKF97541-stimulated G-protein activity, measured by agonist-stimulated, high-affinity [(35)S]GTPgammaS binding assay, was increased; the highest level of both baclofen and SKF97541-stimulated [(35)S]GTPgammaS binding was detected between PD10 and PD15. In older rats, baclofen- and SKF97541-stimulated [(35)S]GTPgammaS binding was continuously decreased so, that the level in adult, 90-days old animals, was not different from that in newborn animals. The potency of G-protein response to baclofen (characterized by EC(50) values) was also high at birth but unchanged by further postnatal development. An individual variance among different agonists was observed in this respect as the potency of SKF97541 response was decreased between the birth and adulthood. Accordingly, the highest plasma membrane density of GABA(B)-R, determined by saturation binding assay with antagonist [(3)H]CGP54626, was measured in 1-day old animals (2.27+/-0.08 pmol · mg(-1)). The further development was reflected in a decrease of [(3)H]CGP54626 binding as the B(max) values of 1.38+/-0.05 and 0.93+/-0.04 pmol · mg(-1) were determined in PM isolated from 13- and 90-days old rats, respectively.