PreImplantation Factor (PIF*) endogenously prevents preeclampsia: Promotes trophoblast invasion and reduces oxidative stress.

Preeclampsia is a unique pregnancy disorder whose patho-physiology is initiated early in gestation, while clinical manifestations typically occur in mid-to-late pregnancy. Thus, prevention should optimally be initiated in early gestation. The intimate interaction between PIF, secreted early by viable embryos, and its host-mother provides insight into putative mechanisms of preeclampsia prevention. PIF is instrumental at the two critical events underlying preeclampsia. At first, shallow implantation leads to impaired placentation, oxidative stress, protein misfolding, and endothelial dysfunction. Later in gestation, hyper-oxygenation due to overflow of maternally derived oxygenated blood compromises the placenta. The first is likely involved in early preeclampsia occurrence due to reduced effectiveness of trophoblast/uterus interaction. The latter is observed with later-onset preeclampsia, caused by a breakdown in placental blood flow regulation. We reported that 1. PIF promotes implantation, endometrium receptivity, trophoblast invasion and increases pro-tolerance trophoblastic HLA-G expression and, 2. PIF protects against oxidative stress and protein misfolding, interacting with specific targets in embryo, 3. PIF regulates systemic immunity to reduce oxidative stress. Using PIF as an early preventative preeclampsia intervention could ameliorate or even prevent the disease, whose current main solution is early delivery.

Response of human ovarian carcinoma cell lines to antiprogestin mifepristone.

The effects of antiprogestin mifepristone (MF) on the growth, progesterone receptor expression and cell cycle kinetics of several human ovarian epithelial carcinoma (OEC) cell lines were evaluated. MF, a synthetic antiprogestin, has been shown to have some antiproliferative activity in breast tumors and in the endometrium, but its efficacy in ovarian carcinomas has not been explored previously. Continuous exposure of OEC cells to MF resulted in a dose- and time-dependent growth inhibition, as determined by MTT assay. Growth inhibition was apparent by day three following addition of MF to cultures in vitro. All cell lines used in this study expressed a progesterone receptor (PR). MF down regulated PR expression on these cells. Changes in the cell cycle kinetics of OEC cells exposed to MF correlated with the observed antiproliferative effects. MF blocked cells in a G0/G1 phase of the cell cycle and thus reduced the number of cells in the S phase. The efficacy of MF was compared with that of taxol and tamoxifen in the same human OEC cell lines. Continuous exposure of OEC cells to tamoxifen resulted in a varied cytostatic response and a transient change in the cell cycle. Taxol inhibited growth of some but not all of the cell lines. These results indicate that PR-positive human OEC cells are sensitive to MF in vitro and that MF may be an active agent against ovarian epithelial tumors.

PreImplantation Factor bolsters neuroprotection via modulating Protein Kinase A and Protein Kinase C signaling.

A synthetic peptide (sPIF) analogous to the mammalian embryo-derived PreImplantation Factor (PIF) enables neuroprotection in rodent models of experimental autoimmune encephalomyelitis and perinatal brain injury. The protective effects have been attributed, in part, to sPIF's ability to inhibit the biogenesis of microRNA let-7, which is released from injured cells during central nervous system (CNS) damage and induces neuronal death. Here, we uncover another novel mechanism of sPIF-mediated neuroprotection. Using a clinically relevant rat newborn brain injury model, we demonstrate that sPIF, when subcutaneously administrated, is able to reduce cell death, reverse neuronal loss and restore proper cortical architecture. We show, both in vivo and in vitro, that sPIF activates cyclic AMP dependent protein kinase (PKA) and calcium-dependent protein kinase (PKC) signaling, leading to increased phosphorylation of major neuroprotective substrates GAP-43, BAD and CREB. Phosphorylated CREB in turn facilitates expression of Gap43, Bdnf and Bcl2 known to have important roles in regulating neuronal growth, survival and remodeling. As is the case in sPIF-mediated let-7 repression, we provide evidence that sPIF-mediated PKA/PKC activation is dependent on TLR4 expression. Thus, we propose that sPIF imparts neuroprotection via multiple mechanisms at multiple levels downstream of TLR4. Given the recent FDA fast-track approval of sPIF for clinical trials, its potential clinical application for treating other CNS diseases can be envisioned.

Immune regulatory and neuroprotective properties of preimplantation factor: From newborn to adult.

Embryonic-maternal interaction from the earliest stages of gestation has a key, sustained role in neurologic development, persisting into adulthood. Early adverse events may be detrimental in adulthood. Protective factors present during gestation could significantly impact post-natal therapy. The role of PreImplantation Factor (PIF) within this context is herein examined. Secreted by viable early embryos, PIF establishes effective embryonic-maternal communication and exerts essential trophic and protective roles by reducing oxidative stress and protein misfolding and by blunting the nocive let-7 microRNA related pathway. PIF's effects on systemic immunity lead to comprehensive immune modulation, not immune suppression. We examine PIF's role in protecting embryos from adverse maternal environment, which can lead to neurological disorders that may only manifest post-nataly: Synthetic PIF successfully translates endogenous PIF features in both pregnant and non-pregnant clinically relevant models. Specifically PIF has neuroprotective effects in neonatal prematurity. In adult relapsing-remitting neuroinflammation, PIF reverses advanced paralysis while promoting neurogenesis. PIF reversed Mycobacterium smegmatis induced brain infection. In graft-vs.-host disease, PIF reduced skin ulceration, liver inflammation and colon ulceration while maintaining beneficial anti-cancer, graft-vs.-leukemia effect. Clinical-grade PIF has high-safety profile even at supraphysiological doses. The FDA awarded Fast-Track designation, and university-sponsored clinical trials for autoimmune disorder are ongoing. Altogether, PIF properties point to its determining regulatory role in immunity, inflammation and transplant acceptance. Specific plans for using PIF for the treatment of complex neurological disorders (ie. traumatic brain injury, progressive paralysis), including neuroprotection from newborn to adult, are presented.

Spontaneous, gonadotropin-releasing hormone-induced, and progesterone-inhibited pulsatile secretion of human chorionic gonadotropin in the first trimester placenta in vitro.

Using a multichannel superfusion apparatus, the secretion of human chorionic gonadotropin (hCG) was measured at 1-6 minute intervals in placental explants at 7-9 weeks of gestation. hCG was found to be secreted in distinct pulses (4-5 fold above baseline) every 11-23 minutes peak to peak. Addition of one minute pulses of GnRH analog significantly increased, whereas pulses of progesterone decreased, pulsatile hCG secretion.

The effect of dynorphin on placental pulsatile human chorionic gonadotropin secretion in vitro.

Using in vitro methods we have studied the effect of dynorphin (DYN) a natural k opioid receptor ligand upon hCG secretion in the first trimester placenta. In superfusion, where we have recently reported that hCG secretion is episodic, we found that the addition of 1-min pulses of DYN had a significant stimulatory effect upon pulsatile hCG secretion. This effect was seen at concentrations of 10(-8) mol/L-10(-11) mol/L. Higher doses (10(-6) mol/L) and lower doses (10(-12) mol/L) were ineffective. A 10-min administration was more effective than the 1-min pulses. Prolonged administration (90 min) caused an initial increase in pulsatile hCG secretion which was followed by a decrease to control values. However, upon stopping the prolonged opiate administration there was a substantial increase in hCG secretion. The involvement of opioid receptors in mediating the effect of DYN on hCG release was demonstrated by using naloxone, an opioid receptor antagonist. Coadministration of DYN, 10(-11) mol/L, and naloxone, 10(-10) mol/L, reduced markedly the effect of DYN. This was followed by a delayed increase in hCG secretion. Furthermore, des-tyrosine-DYN, the nonopioid derivative of DYN was 1000 times less potent in stimulating hCG release than DYN. The involvement of DYN in physiological control of placental hCG secretion is suggested.

The dual effect of epidermal growth factor upon human chorionic gonadotropin secretion by the first trimester placenta in vitro.

Epidermal growth factor (EGF) is believed to play an important role in the regulation of placental function. We have examined the effect of EGF upon first trimester (7-10 gestational weeks) placental hCG secretion and cellular differentiation using both static (explants and isolated cells) and kinetic (superfusion of explants) culture methods. In superfused explants, short (1-4 min) pulses of EGF increased both the rate and amplitude of spontaneous pulsatility of hCG. The frequency increased from 3/h to 5/h, and the amplitude increased compared to the control channels as calculated by the area under the curve. This effect was dose dependent and the concentration of 50 ng/ml, which was the lowest dose tested, was the most effective. In explants cultured for 24 h, EGF caused a 2-fold increase in hCG secretion, compared to control, P less than 0.05. In two different dispersed trophoblastic cell cultures, EGF added daily for the first week caused a 180% increase in hCG secretion, P less than 0.05. However, according to morphological criteria, i.e. light microscopy and vital staining, no significant effect upon the rate of differentiation to syncytiotrophoblast was observed in long-term cultures of one of these preparations. In conclusion, EGF plays a dual trophic role in stimulating hCG secretion in the first trimester. However, this effect is not dependent on cellular differentiation.

Progesterone, estradiol, and alpha-human chorionic gonadotropin secretion in patients with ectopic pregnancy.

Plasma free alpha hCG, estradiol (E2), and progesterone (P4) concentrations were measured in 38 patients with histologically confirmed ectopic pregnancy (EP). The menstrual gestational ages ranged from 6-10 weeks. Free alpha hCG levels, although significantly lower than those in women with a normal intrauterine pregnancy, increased markedly during this time period, from 1.5 to 11 ng/ml, a 7-fold increase. In women with an intrauterine pregnancy, only 0.6-fold increase occurred during the same time period. Plasma P4 and E2 concentrations in patients with EP were significantly lower, except at 6 weeks for E2 and in the sixth and seventh weeks for P4. The ectopically implanted trophoblast undergoes impairment of its ability to synthesize beta hCG, but not alpha hCG. The lack of utilization of alpha hCG in EP causes it to increase, while the level of intact hCG is low. These observations suggest that the levels of alpha hCG are a sensitive marker for placental well-being, and that it could serve as an additional diagnostic tool for the early diagnosis of EP. The placenta is only partially able to compensate for the reduced ovarian production of E2 and P4.

Increase in insulin binding and inhibition of the decrease in the phospholipid content of human term placental homogenates in culture by the sulfonylurea glipizide.

Term placental explants were cultivated for 48 hr without (control) and with various concentrations of glipizide. Maximum binding of [125I]-insulin in the control samples was decreased after 12 and 24 hr returning to initial values after 48 hr. In the presence of glipizide the binding was generally higher, reaching 180% (557 and 1000 nmol/L) of the corresponding control value (P < 0.01) after 48 hr owing to the presence of nearly 3-fold more (P < 0.05) receptors than in the untreated controls. Tissue cholesterol content was almost unaffected whereas both the phospholipid content and the corresponding phospholipid-to-cholesterol ratios were markedly, and in a time-dependent manner, increased by glipizide as compared to the controls. This was due to decreasing cholesterol and phospholipid concentrations in the controls during the time of culture as compared to initial values, and also to unchanged levels in glipizide-treated cultures. We conclude that glipizide affects placental insulin receptors and the phospholipid content of the tissue.

Stimulatory effect of prolactin on human placental progesterone secretion at term in vitro: possible inhibitory effect on oestradiol secretion.

Maternal and fetal circulating prolactin (PRL) increases 10-fold compared with the non-pregnant state. We examined the effect of PRL upon placental steroidogenesis. It had a significant (P less than 0.05) time-dependent stimulatory effect upon placental explants/P4 accumulation and secretion into the medium. The maximal stimulatory effect (two-fold) in dose-dependent experiments was found to be 200 ng/ml. The effect of PRL upon oestradiol secretion was mainly inhibitory. This inhibition was most pronounced at 200 ng/ml. In conclusion, placental steroid secretion is modulated by PRL. This effect occurs mainly at concentrations seen in the placenta at term, suggestive of its physiologic role.

The effect of insulin on oestradiol and progesterone release by normal and diabetic placentae in vitro.

In an attempt to define better the metabolic differences between normal, insulin-dependent and non-insulin-dependent diabetes, we have compared the effect of insulin on the secretion of oestradiol and progesterone in term placental explant culture. Placentae from non-diabetic and from diabetic, non-insulin-dependent diabetic patients demonstrated a similar response to incubation with insulin. This response consisted of a dose-dependent increase in both oestradiol and progesterone in the incubation media after 24 h. In contrast, the placentae of insulin-dependent diabetics showed a decrease in oestradiol and no change in progesterone secretion following exposure to insulin. These differences in response to insulin may underlie other metabolic differences between the placentae in the different groups.

Human embryonal extracts modulate placental function in the first trimester: effects of visceral tissues upon chorionic gonadotropin and progesterone secretion.

We investigated the effect of human first trimester fetal visceral organ extracts upon placental function, as evidenced by secretion of human chorionic gonadotropin and progesterone in explant cultures of 7-10 weeks gestational age trophoblast. Certain alcohol/water or water extracted embryonal tissues, in highly diluted solutions (1:100-1:2,000 final) had significant effects upon secretion of both hormones. The alcohol/water extract produced an opposite effect. This inhibitory effect was also seen when pulses of the water extract were added to the superfused trophoblast. Both heat inactivation at 57 degrees C and treatment with 10 microM p-chloromercurobenzoate eliminated the inhibitory effect, which suggests that the compounds in question are proteinaceous. Also dialysis with exclusion of less than 8,000 daltons abolished the inhibitory effect seen with the untreated water extract. The alcohol/water lung extract at 9 weeks inhibited, while at 10 weeks it stimulated P4 secretion. The water extracted lung had no effect upon P4 secretion. The alcohol/water extract of kidney had no consistent effect upon hCG secretion. The water extract effect was inhibitory. The effect of alcohol/water extract at 9 weeks upon P4 secretion was inhibitory while at 11 weeks it was stimulatory. The water extract had no effect upon P4 secretion. Both alcohol/water and water extracted adrenal inhibited hCG secretion. The alcohol/water extract also increased P4 secretion, while the water extract had no effect. The alcohol/water and water extract liver had no effect upon hCG secretion. The effect of alcohol/water upon P4 secretion was markedly stimulatory, while the water extract had no effect. In conclusion, fetal visceral organs in very dilute concentrations have a significant effect upon placental hormonal secretion in vitro. In case of the lung, the active compound(s) appears to be a protein with a molecular weight of less than 8,000 daltons. The role of the human embryo in modulating early trophoblastic function is suggested.

Human embryo modulates placental function in the first trimester; effects of neural tissues upon chorionic gonadotropin and progesterone secretion.

We investigated the effect of embryonal neural and adrenal tissues (7-14 weeks gestational age) upon beta hCG secretion by homologous placental explants in static and dynamic cultures. In static co-culture significant inhibition by SC and brain was noted at 7-9 weeks. Similarly, in superfusion, using a novel co-chambering technique there was a significant reduction in the area under the curve but not peak frequency of spontaneous pulsatile beta hCG secretion. Incubations with neural tissues 11 weeks and above caused a stimulatory effect upon beta hCG secretion in both models. The effect of adrenal tissue in static cultures was different, namely slightly inhibitory at 7-9 weeks and inhibitory at 11 weeks and above. In superfusion, the effect of adrenal tissue was not significant. Extracted neural tissue 7-9 weeks incubated with placental explants exhibited inhibitory effects upon beta hCG secretion as well. Buffer-based extracts of neural tissues effect was more pronounced than alcohol-based extracts regarding beta hCG secretion. The effect of extracts was dose-dependent and effects were noted up until a 2000-fold dilution. In contrast, the buffer SC extract had no effect on progesterone (P) secretion while the alcohol extract effect was inhibitory at 7-9 weeks and stimulatory at greater than 11 weeks. Superfused explants pattern of beta hCG secretion was inhibited by one minute pulse of the SC buffer extract. In conclusion, the human neural tissue of embryonal origin may modulate placental hCG and P secretion during early pregnancy.

The role of ACTH in placental steroidogenesis.

We have studied the possible function of the placental adrenocorticotrophic hormone-(ACTH-) like substance (PALS) in placental steroidogenesis by measuring oestradiol (E2) and progesterone (P4) in term human placental explants incubated with commercially available porcine ACTH I-39. There was a dose-dependent increase in the E2 and P4 released into the medium at 24 h as compared to controls. At 48 h, no significant effect was noted. Propranolol (10(-5) M) did not block the effect of ACTH on P4 release. The data suggest that ACTH may have a regulatory role on placental steroidogenesis. The possible mechanisms of action of PALS on the placenta and the adrenal are discussed, and the role of PALS in the maintenance of pregnancy and in maternal response to stress is suggested.

Modulatory action of benzodiazepines on human term placental steroidogenesis in vitro.

Peripheral benzodiazepine (BZ) binding sites (PBzS) were characterized on placental explant membranes. [3H]PK 11195, an isoquinoline carboxamide derivative, which is a ligand specific for PBzS, labeled these sites with an equilibrium dissociation constant of 2.1 nM; the maximal number of binding sites was 396 fmol/mg protein. The effect of various BZ ligands and PK 11195 on the secretion of progesterone (P4) and estradiol-17 beta (E2) from human term placental explants was studied. Exposure of placental explants to low doses (10(-8) M) of Ro 5-4864, a BZ ligand which binds with high affinity to PBzS, caused a significant (P less than 0.05) increase in the secretion of P4 and E2 into the media (2.4- and 1.4-fold, respectively). On the other hand, high doses (10(-5) M) of Ro 5-4864 caused a significant (P less than 0.05) decrease in the secretion of P4 and E2 into the media. Also, exposure of explants to diazepam (10(-7) M) and PK 11195 (10(-6) M) caused a significant increase in P4 and E2 secretion into the media. In contrast, clonazepam, a BZ ligand specific for the central-type receptors, had no effect on the secretion of either steroid. The combination of diazepam (10(-7) M) or Ro 5-4864 (10(-8) M) with PK 11195 (10(-6) M) did not enhance the stimulatory effects obtained with each agent alone. The effects exerted by Ro 5-4864, PK 11195, and diazepam may be mediated via PBzS.

Estrogen replacement and tardive dyskinesia.

A double-blind randomized clinical trial was conducted among 10 post-menopausal women with tardive dyskinesia (TD) to test the effect of estrogen replacement of the severity of abnormal movements and other outcome variables. After 3 weeks of treatment, the mean Abnormal Involuntary Movement Scale (AIMS) score decreased by 38% in the estrogen group and by 9% in the placebo group; the difference between groups was marginally significant (p less than 0.10). However, the small sample size and the imbalance between groups in baseline AIMS scores do not allow us to rule out the confounding effects of other prognostic factors. There were no significant differences between treatment groups for parkinsonian and psychological symptoms at any visit or for changes in these variables between visits. The findings of this preliminary trial are consistent with the results of other human and animal investigations, and they support the need for future research to understand the role of estrogens in the neuropathology and treatment of TD.

Long-term prognosis of infertile couples with normal basic investigations: a life-table analysis.

The long-term prognosis of 58 untreated infertile couples with normal medical histories and physical examinations, and normal basic infertility investigations, including biphasic basal body temperature, hysterosalpingogram, postcoital test, and semen analysis, was studied using life-table analysis. Of these women, 34% were pregnant by six months, 76% by two years, and 87% by five years. These rates of conception were found to be significantly higher than those found in a large infertile population (P = .001). However, compared with the ideal fertile population, the study group for the first two years had a significantly lower conception rate (P = .001). It required two years for the study group to achieve a 74% fertility rate, whereas only nine months were required for the fertile group to achieve the same rate. The individualized approach for investigating the infertile couple is stressed.

Placental and circulating pregnancy-associated plasma protein A concentrates in normal and pathological term pregnancies.

The relationship between placental and peripheral concentrations of pregnancy-associated plasma protein A (PAPP-A) was investigated, using specific radioimmunoassay techniques. At term, placental concentrations of PAPP-A were significantly lower in diabetic pregnancies; 1.9 +/- 0.2 micrograms/mg (mean +/- SE) placental protein as compared with controls (3.2 +/- 0.3). Similar findings were noted when results were analyzed per total placental weight. Patients with classes C-R (1.2 +/- 0.3) had significantly lower PAPP-A levels than in classes A, B (2.4 +/- 0.3 micrograms/mg protein, P = .02). Peripheral PAPP-A levels were measured in patients with chronic hypertension, toxemia, diabetes mellitus, and healthy controls. Overall, the distribution of PAPP-A values in patients with diabetes mellitus were different from controls. In addition, concentrations of PAPP-A in patients with classes B-D were significantly lower than in class A (P less than .001). In patients with chronic hypertension, some values of PAPP-A were lower than the tenth percentile, while patients with toxemia had a distribution which was similar to that of controls.

Successful delivery after age 50: a report of two cases as a result of oocyte donation.

BACKGROUND: Because of donor oocyte programs, women who previously were considered too old to successfully achieve conception and delivery can now bear children. To our knowledge, there have been no previous reports of pregnancy outcome in women over age 50 who conceived using donor oocytes. This study presents the pregnancy and delivery data on two women who delivered at age 52. CASES: Case 1 was a 51-year-old woman, gravida 3, para 3, whose three children had been conceived with her first husband more than 20 years previously. She had remarried 18 years before presentation and had been actively trying to conceive for the last 7 years. She was diagnosed as being in menopause based on elevated gonadotropins, amenorrhea, and failure to have progesterone-withdrawal menses. She conceived on her first embryo transfer cycle with embryos derived from donor oocytes and fertilized by her husband's sperm (oocytes were donated by a woman who was undergoing retrieval for in vitro fertilization). During pregnancy she remained healthy, but had uterine prolapse at 20 weeks. She delivered a normal healthy male at 40.5 weeks; cesarean was performed because of a presumptive diagnosis of fetal distress after 3 hours of labor, when monitoring revealed fetal heart decelerations. Case 2 was also a 51-year-old woman, gravida 6, para 4, who wished to conceive with her second husband's sperm through the donor oocyte program. She had amenorrhea of 2 years' duration and elevated gonadotropins. Conception occurred after fertilization of a donor oocyte by her husband's sperm. She had an uneventful pregnancy, but labor was induced at 38 weeks' gestation given the supposed high-risk status of this age group. Apgar scores were 8 and 9 at 1 and 5 minutes, respectively. CONCLUSION: Theoretically, the risks of pregnancy complications in older patients are magnified given the aging maternal cardiovascular system, which may predispose these women to placental insufficiency. These first two cases of donor oocyte pregnancies in women over age 50 found no maternal or fetal age-related complications. We hope these reports will encourage all researchers to share their findings so that prospective patients can make better, more informed decisions as to whether they want to participate in donor oocyte programs.

Delaying human chorionic gonadotropin administration in human menopausal gonadotropin-induced cycles decreases successful in vitro fertilization of human oocytes.

Correct timing of human chorionic gonadotropin (hCG) administration in induced cycles for in vitro fertilization is of crucial importance to oocyte maturation and normal luteal function. The purpose of this work was to compare the effect of hCG timing on follicular development, oocyte maturation, and fertilization in vitro, as well as on the pattern of luteal phase hormone secretion. Ovulation was induced in 32 normally cycling women by human menopausal gonadotropin (hMG)/hCG administration. In the first group (17 women) 10,000 IU hCG was administered 24 hours after the last injection of hMG and in the second group (15 women) 48 to 72 hours after the last hMG injection. Serum estradiol levels prior to oocyte aspiration were similar in both groups, as were the numbers of large follicles on the day of hCG administration (4.5 +/- 2.3 versus 4.1 +/- 1.9 follicles/woman, respectively). The distribution of oocyte-corona-cumulus complexes was similar in both groups and was comprised of 11% immature, 43% intermediate, and 45% mature complexes. The fertilization rate, however, was significantly (P less than 0.001) reduced in the group treated by delayed hCG injection (57% versus 84%), and the percentage of degenerated oocytes was increased (9% versus 1%). Luteal phase length as well as progesterone and estradiol levels were comparable in both groups. It is concluded that an interval longer than 24 hours between the last injection of hMG and the administration of an ovulatory dose of hCG does not affect follicular and luteal phase serum steroid patterns but may result in a decreased oocyte fertilization rate, possibly due to atretic changes in the follicles.