[Impact of a Guideline for Management of Pregnancy beyond Term and its Influence on Clinical Routine]. / Einfluss der Leitlinie zum Vorgehen bei Terminüberschreitung auf den klinischen Alltag.

PURPOSE: Many international guidelines recommend induction of labour beyond 41 weeks to reduce perinatal morbidity and mortality. In 2010, a new German guideline with this recommendation was published. The aim of this study was to investigate whether this recommendation influenced clinical outcome. MATERIAL AND METHODS: All cases with induction of labour beyond 40 weeks in 2008, 2009, 2011 and 2012 were examined. Multiple pregnancy and Caesarean section in the case history were exclusion criteria. The years before publication of the new German guideline (2008 and 2009) were compared with those afterwards (2011 and 2012) with regard to several outcome parameters like rate of labour induction, efficacy of induction of labour and foetal outcome. RESULTS: After publication of the guideline there were more inductions of labour undertaken (300 [11.2%] vs. 472 [15.4%], p<0.0001) with less pregnancies beyond 42 weeks (9 [3%] vs. 5 [1%], p=0.0489). However, there was no difference concerning the efficacy of induction of labour, e. g., the ratio of Caesarean sections was not increased. There was no impairment of foetal outcome, in contrast, the ratio of postpartal admission to NICU was decreased (42 [14.2%] vs. 31 [6.7%], p=0.0006). CONCLUSION: The new recommendation of the German guideline to induce labour beyond 41 weeks leads to more cases with induction of labour without any negative impact on its efficacy or foetal outcome.

Receptor-stimulated dissociation of GTP[S] from Gi-proteins in membranes of HL-60 cells.

Formyl peptides stimulate binding of the stable GTP analogue, guanosine 5'-O-[gamma-thio]triphosphate (GTP[S]), to G-proteins in membranes of myeloid differentiated human leukaemia (HL-60) cells. On the other hand, agonist-activated formyl peptide receptors can also cause rapid and substantial release of GTP[S] bound to HL-60 membrane G-proteins. For fMet-Leu-Phe-stimulated dissociation of labelled GTP[S], an additional guanine nucleotide, in the potency order, unlabelled GTP[S] >> GTP >> guanosine 5'-[beta,gamma-imino]triphosphate > or = guanosine 5'-O-[beta-thio]diphosphate > or = GDP > GMP = ATP (no effects at 1 mM), was absolutely necessary. While with unlabelled GTP[S] and GTP similar concentrations were required for control and fMet-Leu-Phe-stimulated release, about 50-100-fold higher concentrations of the other nucleotides were necessary for agonist-stimulated than for basal release of bound GTP[S]. The receptor action appeared to be catalytic, required Mg2+ and was pertussis toxin sensitive. The data indicate that binding of GTP[S] to HL-60 membrane G-proteins is reversible and that agonist-activated formyl peptide receptors can interact, either directly or indirectly, with GTP[S]-liganded Gi-proteins, resulting in release of bound GTP[S].

Dissociation of guanosine 5'-[gamma-thio]triphosphate from guanine-nucleotide-binding regulatory proteins in native cardiac membranes. Regulation by nucleotides and muscarinic acetylcholine receptors.

Binding of the poorly hydrolyzable GTP analog, guanosine 5'-[gamma-thio]triphosphate (GTP[S]), to purified guanine-nucleotide-binding regulatory proteins (G proteins) has been shown to be nonreversible in the presence of millimolar concentrations of Mg2+. In porcine atrial membranes, binding of [35S]GTP[S] to G proteins was stable in the presence of 1 mM Mg2+. However, either large dilution or, even more strongly, addition of unlabelled guanine nucleotides, in the potency order, GTP[S] greater than GTP greater than or equal to guanosine 5'-[beta,gamma-imino]triphosphate greater than GDP greater than or equal to guanosine 5'-[beta-thio]diphosphate greater than GMP, markedly enhanced the observed dissociation, with 20-30% of bound [35S]GTP[S] being released by unlabelled guanine nucleotide within 20 min at 25 degrees C. Most interestingly, dissociation of [35S]GTP[S] was rapidly and markedly stimulated by agonist (carbachol) activation of cardiac muscarinic acetylcholine receptors. Carbachol-stimulated release of [35S]GTP[S] was strictly dependent on the presence of Mg2+ and an unlabelled guanine nucleotide. Although having different potency and efficiency in releasing [35S]GTP[S] from the membranes by themselves, the guanine nucleoside triphosphates and diphosphates studied, at maximally effective concentrations, promoted the carbachol-induced dissociation to the same extent, while GMP and ATP were ineffective. GTP[S]-binding-saturation experiments indicated that one agonist-activated muscarinic acetylcholine receptor can cause release of bound GTP[S] from three to four G proteins. The data presented indicate that binding of GTP[S] to G proteins in intact membranes, in contrast to purified G proteins, is reversible, and that agonist-activated receptors can even, either directly or indirectly, interact with GTP[S]-bound G proteins, resulting in release of bound guanine nucleoside triphosphate.

SPARC (BM-40, osteonectin) inhibits the mitogenic effect of vascular endothelial growth factor on microvascular endothelial cells.

SPARC (secreted protein, acidic and rich in cysteine) is a matricellular protein that modulates cell adhesion and proliferation and is thought to function in tissue remodeling and angiogenesis. In this study, we demonstrate that SPARC inhibits DNA synthesis by >90% in human microvascular endothelial cells (HMEC) stimulated by the endothelial cell mitogen vascular endothelial growth factor (VEGF). Peptides derived from SPARC domain IV, which contains a disulfide-bonded EF-hand sequence and binds to endothelial cells, mimicked the effect of native SPARC. The inhibition was also observed with a peptide from the follistatin-like domain II, whereas peptides from SPARC domains I and III had no effect on VEGF-stimulated DNA synthesis. The inhibition of HMEC proliferation was mediated in part by the binding of VEGF to SPARC. The binding of 125I-VEGF to HMEC was reduced by SPARC and SPARC peptides from domain IV in a concentration-dependent manner. In a radioimmune precipitation assay, peptides from SPARC domains II and IV each competed with native SPARC for its binding to VEGF. It has been reported that VEGF stimulates the tyrosine phosphorylation and activation of mitogen-activated protein kinases Erk1 and Erk2. We now show that SPARC reduces this phosphorylation in VEGF-stimulated HMEC to levels of unstimulated controls. SPARC thus modulates the mitogenic activity of VEGF through a direct binding interaction and reduces the association of VEGF with its cell-surface receptors. Moreover, an additional diminution of VEGF activity by SPARC is accomplished through a reduction in the tyrosine phosphorylation of mitogen-activated protein kinases.

The proliferative effect of vascular endothelial growth factor requires protein kinase C-alpha and protein kinase C-zeta.

The heparin-binding protein vascular endothelial growth factor (VEGF) is a highly specific growth factor for endothelial cells. VEGF binds to specific tyrosine kinase receptors, which mediate intracellular signaling. We investigated 2 hypotheses: (1) VEGF affects intracellular calcium [Ca2+]i regulation and [Ca2+]i-dependent messenger systems; and (2) these mechanisms are important for VEGF's proliferative effects. [Ca2+]i was measured in human umbilical vein endothelial cells using fura-2 and fluo-3. Protein kinase C (PKC) activity was measured by histone-like pseudosubstrate phosphorylation. PKC isoform distribution was observed with confocal microscopy and Western blot. Inhibition of PKC isoforms was assessed by specific antisense oligonucleotides (ODN) for the PKC isoforms. VEGF (10 ng/mL) induced a transient increase in [Ca2+]i followed by a sustained elevation. The sustained [Ca2+]i plateau was abolished by EGTA. Pertussis toxin also abolished the plateau phase, whereas the initial peak was not affected. The PKC isoforms alpha, delta, epsilon, and zeta were identified in endothelial cells. VEGF induced a translocation of PKC-alpha and PKC-zeta toward the nucleus and the perinuclear area, whereas cellular distribution of PKC-delta and PKC-epsilon was not influenced. Cell exposure to TPA led to a down-regulation of PKC-alpha and reduced the proliferative effect of VEGF. VEGF-induced endothelial cell proliferation also was reduced by the PKC inhibitors staurosporine and calphostin C. Specific down-regulation of PKC-alpha and PKC-zeta with antisense ODN reduced the proliferative effect of VEGF significantly. Our data show that VEGF induces initial and sustained Ca2+ influx. VEGF leads to the translocation of the [Ca2+]i-sensitive PKC isoform alpha and the atypical PKC isoform zeta. Antisense ODN for these PKC isoforms block VEGF-induced proliferation. These findings suggest that PKC isoforms alpha and zeta are important for VEGF's angiogenic effects.