Prediction of preeclampsia and its prevention with aspirin

Background: Preeclampsia (PE) affects 2-3% of all pregnancies and is a major cause of maternal and perinatal morbidity and mortality. The current approach to screening for PE is based on the identification of risk factors from maternal characteristics and medical history. This approach, however, fails to identify a high proportion of cases of PE and does not provide individualised, patient-specific results. An alternative approach is to combine maternal factors with biophysical and biochemical markers to estimate the individual probability of developing PE with higher detection rates. To date, no intervention is proven to reduce the risk of the disease, and several studies evaluating the use of aspirin for prevention of PE led to inconclusive results. Objectives: The aims of the studies included in this thesis are, first, to prospectively validate in a large European population a first-trimester algorithm for prediction of PE that combines maternal demographic characteristics and medical history with biophysical and biochemical markers; second, to compare this method of screening to the performance of currently used guidelines; third, to evaluate a possible beneficial effect of aspirin initiated at 11 to 14 weeks of gestation and at a dose of 150 mg in the prevention of PE in a multicentre, double-blind, placebo-controlled randomised trial; and fourth, to analyse a potential role of cell-free DNA testing in the prediction of PE. Methods: Combined screening for PE was applied in the first or second trimester, and women found to be at high-risk in the first trimester were offered participation in a double-blind trial of aspirin against placebo in six European countries. We have recorded maternal characteristics and history, measured the uterine artery pulsatility index (UtPI) on ultrasound, the mean arterial pressure (MAP), serum concentration of pregnancy-associated plasma protein A (PAPP-A) and placental growth factor (PLGF). Pregnancy outcomes were obtained from the hospital maternity records. Bayes theorem was used to combine the a priori risk from maternal factors with the results of biomarker measurements and estimate individual probabilities. In the randomised trial, the analysis was performed in an intention-to-treat basis and the treatment effect on the primary outcome (the development of PE with delivery before 37 weeks of gestation) was reported with 95% confidence interval (CI), and on secondary outcomes with 99% CI. Cell-free DNA fetal fraction was compared with other first trimester markers for PE and in a case-control study. Results: Detection rates of combined screening, for a false-positive rate (FPR) of 10%, were 89% (95% CI 79-96%), 75% (95% CI 70-80%) and 47% (95% CI 44- 51%) for PE <32 weeks, preterm PE and term disease, respectively. The performance of combined screening was superior to methods based on risk factors alone, both in the first and second trimesters. The use of aspirin by high-risk women reduced the incidence of preterm PE by 62% (adjusted odds ratio 0.38, 95% CI 0.20- 0.74). Secondary analyses have shown that the effect of aspirin was influenced by the level of compliance to treatment and was consistent in different subgroups according to maternal characteristics and obstetric history, but there was no evidence of beneficial effect of aspirin in women with chronic hypertension. Aspirin reduces the length of stay in NICU and costs through a reduction in premature births before 32 weeks due to PE. Fetal fraction on cell-free DNA testing correlates with other first trimester markers, but its role in screening for PE is uncertain. Conclusions: This thesis has demonstrated that combined screening for PE is superior to current guidelines based on maternal characteristics and history alone, and that aspirin, at a daily dose of 150 mg and given to high-risk patients from 11 to 14 weeks until 36 weeks of gestation, reduces the incidence preterm PE and the length of stay in NICU. The effect of the medication depends on good adherence to treatment and is questionable in patients with chronic hypertension

Retinal glia promote dorsal root ganglion axon regeneration.

Axon regeneration in the adult central nervous system (CNS) is limited by several factors including a lack of neurotrophic support. Recent studies have shown that glia from the adult rat CNS, specifically retinal astrocytes and Müller glia, can promote regeneration of retinal ganglion cell axons. In the present study we investigated whether retinal glia also exert a growth promoting effect outside the visual system. We found that retinal glial conditioned medium significantly enhanced neurite growth and branching of adult rat dorsal root ganglion neurons (DRG) in culture. Furthermore, transplantation of retinal glia significantly enhanced regeneration of DRG axons past the dorsal root entry zone after root crush in adult rats. To identify the factors that mediate the growth promoting effects of retinal glia, mass spectrometric analysis of retinal glial conditioned medium was performed. Apolipoprotein E and secreted protein acidic and rich in cysteine (SPARC) were found to be present in high abundance, a finding further confirmed by western blotting. Inhibition of Apolipoprotein E and SPARC significantly reduced the neuritogenic effects of retinal glial conditioned medium on DRG in culture, suggesting that Apolipoprotein E and SPARC are the major mediators of this regenerative response.This work was supported by a van Geest Fight for Sight Early Career Investigator Award, grant number 1868 [BL].This is the final version of the article. It first appeared at http://journals.plos.org/plosone/article?id=10.1371/journal.pone.011599

Evaluation of Cardiac Function in Women With a History of Preeclampsia : A Systematic Review and Meta-Analysis

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The accuracy of cell-free DNA screening for fetal segmental copy number variants : A systematic review and meta-analysis

Funding Information: BWM is supported by a NHMRC Investigator grant (GNT1176437). BWM reports consultancy for ObsEva and Merck and travel support and research grants from Merck. MM is employed as a genetic counsellor at a private genetic testing provider. DLR has received research grants from NHMRC and Norman‐Beischer Medical Research Foundation. The authors declare no competing interests. Completed disclosure of interest forms are available to view online as supporting information. Open access publishing facilitated by Monash University, as part of the Wiley - Monash University agreement via the Council of Australian University Librarians.Peer reviewedPublisher PD

Cell-free DNA screening for rare autosomal trisomies and segmental chromosome imbalances

Funding Information: Ben W. Mol is supported by a NHMRC Investigator grant (GNT1176437). Ben W. Mol reports consultancy for ObsEva and Merck and travel support and research grants from Merck. The authors declare no conflict of interest. The authors wish to acknowledge the staff of Monash Ultrasound for Women, Sydney Ultrasound for Women, and Ultrasound Care for their diligent and compassionate care of the women involved in this study. Open access publishing facilitated by Monash University, as part of the Wiley - Monash University agreement via the Council of Australian University Librarians.Peer reviewedPublisher PD

Listeria monocytogenes Traffics from Maternal Organs to the Placenta and Back

Infection with Listeria monocytogenes is a significant health problem during pregnancy. This study evaluates the role of trafficking between maternal organs and placenta in a pregnant guinea pig model of listeriosis. After intravenous inoculation of guinea pigs, the initial ratio of bacteria in maternal organs to placenta was 10(3)–10(4):1. Rapid increase of bacteria in the placenta changed the ratio to 1:1 after 24 h. Utilizing two wild-type strains, differentially marked by their susceptibility to erythromycin, we found that only a single bacterium was necessary to cause placental infection, and that L. monocytogenes trafficked from maternal organs to the placenta in small numbers. Surprisingly, bacteria trafficked in large numbers from the placenta to maternal organs. Bacterial growth, clearance, and transport between organs were simulated with a mathematical model showing that the rate of bacterial clearance relative to the rate of bacterial replication in the placenta was sufficient to explain the difference in the course of listeriosis in pregnant versus nonpregnant animals. These results provide the basis for a new model where the placenta is relatively protected from infection. Once colonized, the placenta becomes a nidus of infection resulting in massive reseeding of maternal organs, where L. monocytogenes cannot be cleared until trafficking is interrupted by expulsion of the infected placental tissues

The asparagine-transamidosome from Helicobacter pylori: a dual-kinetic mode in non-discriminating aspartyl-tRNA synthetase safeguards the genetic code

Helicobacter pylori catalyzes Asn-tRNAAsn formation by use of the indirect pathway that involves charging of Asp onto tRNAAsn by a non-discriminating aspartyl-tRNA synthetase (ND-AspRS), followed by conversion of the mischarged Asp into Asn by the GatCAB amidotransferase. We show that the partners of asparaginylation assemble into a dynamic Asn-transamidosome, which uses a different strategy than the Gln-transamidosome to prevent the release of the mischarged aminoacyl-tRNA intermediate. The complex is described by gel-filtration, dynamic light scattering and kinetic measurements. Two strategies for asparaginylation are shown: (i) tRNAAsn binds GatCAB first, allowing aminoacylation and immediate transamidation once ND-AspRS joins the complex; (ii) tRNAAsn is bound by ND-AspRS which releases the Asp-tRNAAsn product much slower than the cognate Asp-tRNAAsp; this kinetic peculiarity allows GatCAB to bind and transamidate Asp-tRNAAsn before its release by the ND-AspRS. These results are discussed in the context of the interrelation between the Asn and Gln-transamidosomes which use the same GatCAB in H. pylori, and shed light on a kinetic mechanism that ensures faithful codon reassignment for Asn

As Far as the Eye Can See: Relationship between Psychopathic Traits and Pupil Response to Affective Stimuli

Psychopathic individuals show a range of affective processing deficits, typically associated with the interpersonal/affective component of psychopathy. However, previous research has been inconsistent as to whether psychopathy, within both offender and community populations, is associated with deficient autonomic responses to the simple presentation of affective stimuli. Changes in pupil diameter occur in response to emotionally arousing stimuli and can be used as an objective indicator of physiological reactivity to emotion. This study used pupillometry to explore whether psychopathic traits within a community sample were associated with hypo-responsivity to the affective content of stimuli. Pupil activity was recorded for 102 adult (52 female) community participants in response to affective (both negative and positive affect) and affectively neutral stimuli, that included images of scenes, static facial expressions, dynamic facial expressions and sound-clips. Psychopathic traits were measured using the Triarchic Psychopathy Measure. Pupil diameter was larger in response to negative stimuli, but comparable pupil size was demonstrated across pleasant and neutral stimuli. A linear relationship between subjective arousal and pupil diameter was found in response to sound-clips, but was not evident in response to scenes. Contrary to predictions, psychopathy was unrelated to emotional modulation of pupil diameter across all stimuli. The findings were the same when participant gender was considered. This suggests that psychopathy within a community sample is not associated with autonomic hypo-responsivity to affective stimuli, and this effect is discussed in relation to later defensive/appetitive mobilisation deficits

Sequential evaluation of the cervix and test for phosphorylated insulin-like growth factor binding protein-1 in the prediction of preterm delivery

INTRODUÇÃO: O antecedente de parto prematuro espontâneo em gestação anterior é considerado o principal e mais importante fator de risco clínico para prematuridade, principal causa de morbidade e mortalidade neonatal. Cerca de 25% das pacientes que tiveram parto prematuro apresentarão recorrência. A prevenção secundária consiste na pesquisa de marcadores de maior risco, com o intuito de instituir medidas terapêuticas apropriadas e de evitar tratamentos desnecessários. A hipótese do presente estudo é a de que existe correlação entre os resultados da avaliação do colo uterino e do teste para proteína-1 fosforilada ligada ao fator de crescimento insulina-símile (phIGFBP-1) e que a utilização de ambos em associação possa predizer a ocorrência de parto prematuro com maior sensibilidade. OBJETIVOS: Averiguar a utilidade da medida do comprimento do colo uterino e do teste para phIGFBP-1 na predição do parto prematuro antes de 37 e de 34 semanas, a existência de relação dos testes entre si, o melhor valor de corte da medida do colo em diferentes idades gestacionais e a melhor época de realização de cada um dos exames. MÉTODO: Foram compilados e submetidos a análise secundária os dados de 101 gestantes com antecedente de parto prematuro atendidas no Setor de Baixo Peso Fetal da Clínica Obstétrica do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, entre 2003 e 2008. A medida do comprimento cervical e o teste para phIGFBP-1 foram realizados a cada três semanas, entre 24 e 34 semanas de gestação, e comparados com o desfecho de parto prematuro e nascimento com 34 semanas ou menos, e o melhor valor de corte do colo uterino foi estabelecido por meio de curva de características operacionais. RESULTADOS: Das 101 gestações estudadas, 25 (24,8%) terminaram em parto prematuro, das quais 12 (11,9%) ocorreram com 34 semanas ou menos. As idades gestacionais médias de avaliação foram de 24, 27, 30 e 33 semanas, e os valores de corte do colo uterino foram de 22, 21, 20 e 16 mm, respectivamente. A medida do comprimento do colo apresentou maior sensibilidade (cerca de 70%) e foi capaz de predizer o parto prematuro em todas as avaliações. O teste para phIGFBP-1 não foi útil com 24 semanas, porém foi capaz de detectar de forma independente o risco de prematuridade com 27, com 30 e com 33 semanas. Houve associação estatística dos exames entre si, de forma que o comprimento cervical médio foi menor em gestantes com teste positivo para phIGFBP-1. A associação dos exames elevou a sensibilidade e o valor preditivo negativo de forma significativa. CONCLUSÕES: A medida do comprimento do colo pela ultrassonografia transvaginal constitui bom marcador de risco para parto prematuro com 24 semanas, e o teste para phIGFBP-1 é útil após 27 semanas. A associação dos dois exames possui alta sensibilidade e alto valor preditivo negativo em gestantes de alto risco para prematuridade espontânea, e a realização do primeiro com 24 semanas e do segundo com 27 semanas constitui bom modelo preditivo para o parto prematuroINTRODUCTION: The history of spontaneous preterm birth in a previous pregnancy is considered the main and most important clinical risk factor for preterm birth, the leading cause of neonatal morbidity and mortality. About 25% of these patients will deliver prematurely again. Secondary prevention consists in the search for markers of increased risk, in order to institute appropriate therapeutic actions and to avoid unnecessary treatments. The hypothesis of this study is that there is a correlation between the results of the evaluation of the cervix and the test for phosphorylated insulin-like growth factor binding protein-1 (phIGFBP-1) and that the use of both in combination can predict the occurrence of preterm delivery with higher sensitivity. OBJECTIVES: To investigate the usefulness of the measurement of the cervical length and phIGFBP-1 rapid test in the prediction of preterm birth before 37 and 34 weeks, the existence of a relationship between the tests themselves, the best cutoff value of cervical length measurement at different gestational ages and the best time to carry out each of the exams. METHODS: Data of 101 women with previous preterm birth assisted at the Obstetrical Clinic of the Hospital das Clínicas, Faculty of Medicine, University of São Paulo between 2003 and 2008 were collected and subjected to secondary analysis. The measurement of cervical length and the phIGFBP-1 test were performed every three weeks, between 24 and 34 weeks gestation, and compared with the outcome of premature birth before 37 and 34 weeks, and the best cutoff value of the cervix was determined by receiver operator characteristic curves. RESULTS: Of the 101 pregnancies studied, 25 (24.8%) ended in preterm birth, of which 12 (11.9%) occurred at 34 weeks or less. The mean gestational age in each evaluation was 24, 27, 30 and 33 weeks, and the cutoff of the cervix were 22, 21, 20 and 16 millimeters, respectively. The measurement of cervical length showed the highest sensitivity (approximately 70%) and was able to predict preterm birth in all evaluations. The phIGFBP-1 test was not useful at 24 weeks, but was able to independently detect the risk of prematurity at 27, 30 and 33 weeks. Statistical association between the exams was observed, so that the mean cervical length was lower in pregnant women testing positive for phIGFBP-1. The combination of both tests significantly increased the sensitivity and negative predictive value. CONCLUSIONS: The measurement of cervical length by transvaginal ultrasound is a good marker of risk for preterm delivery at 24 weeks, and the test for phIGFBP-1 is useful after 27 weeks. The association of the two tests is valuable and shows high sensitivity and high negative predictive value in women at high risk for spontaneous preterm birth, when the first is preformed with 24 weeks, and the second with 27 week

Isolation, crystallization and preliminary X-ray analysis of the transamidosome, a ribonucleoprotein involved in asparagine formation

The isolation, crystallization and preliminary X-ray crystallographic data of the transamidosome from T. thermophilus, a ribonucleoprotein particle that provides the translational machinery with Asn-tRNAAsn, are reported