Fetal cells and cell-free fetal DNA in maternal blood: new insights into pre-eclampsia

The examination of fetal cells, specifically erythroblasts, and cell-free fetal DNA from the blood of pregnant women is currently the subject of intense research with the aim of developing new risk-free methods for prenatal diagnosis. An unexpected finding made during these studies was that the traffic of fetal erythroblasts into the maternal peripheral circulation was enhanced in pre-eclampsia. Independent prospective studies examining samples collected in the second trimester indicated that this perturbation in fetal cell trafficking occurs early in pregnancy, well before the onset of pre-eclampsia symptoms. The quantitative analysis of cell-free fetal and maternal DNA levels indicated that these concentrations were elevated in a co-ordinate manner in manifest pre-eclampsia, and that these elevations corresponded to disease severity. On the other hand, analysis of prospectively collected samples indicated that only cell-free fetal but not maternal DNA levels were elevated before onset of symptoms in pregnancies which subsequently developed pre-eclampsia. These data support hypotheses suggesting that pre-eclampsia is a multi-step disorder, initiated by a placental lesion that occurs early in pregnancy and which subsequently leads to a systemic maternal inflammatory response and associated endothelial cell damag

Decrease in lipid levels of syncytiotrophoblast micro-particles reduced their potential to inhibit endothelial cell proliferation

Background: Preeclampsia is characterized by damage to the maternal endothelium that has been suggested to be mediated in part by elevated shedding of inflammatory placental syncytiotrophoblast micro-particles (STBM) into the maternal circulation. Previously, we have shown that STBM, prepared by three different methods: mechanical dissection, in vitro placental explants culture and perfusion of placenta, can inhibit endothelial cell proliferation. Only mechanically prepared STBM induced apoptosis in the endothelial cells. Now, we have examined lipid levels in the three STBM preparations and their differential responses on endothelial cells. Methods: We examined the lipid levels in the three STBM preparations using thin layer chromatography. Furthermore, the effects of reduced lipid levels in the three STBM preparations using the pharmacological agent methyl-β-cyclodextrin were examined on endothelial cell proliferation and apoptosis. Results: Among the three STBM preparations, mechanical STBM contained highest levels of lipids. The reduction in lipid levels in mechanical STBM reduced their potential to inhibit human umbilical vein endothelial cells (HUVEC) proliferation and blocked their potential to induce apoptosis. No similar effect was observed following lipid reduction in the two other STBM preparations. Conclusions: As it has been suggested that mechanically derived STBM may more closely resemble placental micro-particles generated in preeclampsia, our data suggest that lipid content may play a role in the anti-endothelial defects present in this diseas

Prävention von Frühgeburten

Zusammenfassung: Die Frühgeburt stellt heute, obwohl große Fortschritte im medizinisch-technischen Bereich gemacht wurden, immer noch eine Hauptursache der perinatalen Mortalität und Morbidität dar. Trotz intensiver Bemühungen im therapeutischen Bereich ist die Rate der Frühgeburten in den westlichen Ländern stabil oder - wie in den USA - sogar ansteigend. Präventive Maßnahmen rücken deswegen immer stärker in den Blickpunkt. In der vorliegenden Übersichtsarbeit werden basierend auf randomisierten oder Beobachtungsstudien die aktuellen Strategien zur Prävention diskutiert. Nach den derzeit vorliegenden Metaanalysen wird die perinatale Morbidität durch präventive Maßnahmen nicht verbessert, wohl aber das Gestationsalter verlängert. Was dies an Vorteilen für das Neugeborene bringt, bleibt zu kläre

Role of placentally produced inflammatory and regulatory cytokines in pregnancy and the etiology of preeclampsia

Human pregnancy is a metabolic and immune challenge for the mother who has to accommodate in her womb a semi-allogeneic fetus whose energy needs increase tremendously with gestation. Recent compelling research has suggested that proper inflammatory changes and oxidative balance are a requisite for successful pregnancy. The placenta is an integral component of this inflammatory response as it actively produces a variety of cytokines and immunomodulatory hormones. In preeclampsia, a life-threatening disorder of pregnancy that is characterized by widespread damage and dysfunction of the maternal endothelium, placental oxidative stress and aberrant cytokine expression induces an exaggerated maternal systemic inflammatory response to pregnanc

Protease Activity in the Rhizosphere of Tomato Plants Is Independent from Nitrogen Status

Rhizoboxes were developed in order to analyse root system and corresponding protease activity in the rhizosphere of young tomato plants (Solanum lycopersicum cv. Moneymaker). The activity of proteases exuded by tomato roots applying in situ zymography was detected along the entire root system. The corresponding root architecture as well as root and shoot biomasses was determined to correlate protease activity with plant growth parameters under varying nitrogen supplies. With higher nitrate fertilisation, the proteases in the rhizosphere were more active than nitrogen-deficient plants. This may indicate that exuded proteases were not solely a plant response to nitrogen deficiency with the aim to increase nitrogen availability. Instead, they may have different roles, e.g. in root development

Diagnosis and treatment of iron-deficiency anaemia during pregnancy and postpartum

Introduction: Iron-deficiency anaemia during pregnancy and postpartum occurs frequently and may lead to severe maternal and foetal complications. New treatment regimens include intravenous iron administration in particular clinical situations. The aim of the study was to determine optimal diagnostic and therapeutic approaches to iron-deficiency anaemia during pregnancy and postpartum. Methods: The evidence from data available from published studies and recommendations regarding diagnosis and treatment were reviewed. As conclusions, recommendations are given by an expert panel. Results: During pregnancy, oral iron therapy is given as first-line treatment. In cases with lack of efficacy, unwarranted side effects or very low haemoglobin values, intravenous iron treatment with iron carboxymaltose is a preferable alternative, although data regarding safety are limited. In the postpartum period, haemoglobin values less than 95g/L are treated ideally by intravenous carboxymaltose, leading to more rapid haemoglobin recovery. Conclusion: New intravenous iron preparations such as iron carboxymaltose have an excellent efficacy, side effect profile and advantages as compared to oral iron preparations for particular clinical indication

Correlation of perineal ultrasound and lateral chain urethrocystography in the anatomical evaluation of the bladder neck

Although perineal ultrasound has been widely used, no standard values have been published. In 52 women with urinary stress incontinence the following parameters were measured during resting and straining: a) with ultrasound: distance (Dy) between bladder neck and central line of the symphysis, distance (Dx) between bladder neck and lower border of the symphysis, and retrovesical angle β; b) with urethrocystography (UCG): distance H between the bladder neck and the SCIPP line, inclination angle α and retrovesical angle β. Dy and H correlated during resting (r=0.608; p<0.001) and straining (r=0.575; p<0.001). The distance Dy of 11mm corresponded to a bladder neck position on the SQIPP line. A rotational descent was detectable when Dx increased from 13mm (± 6.5) during resting to 16mm (±7.8) during straining (p=0.009). It was concluded that perineal ultrasound is valuable for the anatomical evaluation of the bladder neck. This is the first report to better define the position of the bladder based on ultrasonographic measurement