Successful Treatment of Caesarean Scar Pregnancies by Local Treatment Only

Background. Caesarean scar pregnancy (CSP) is a rare ectopic pregnancy associated with life-threatening complications. To date, no therapeutic protocols have been established. Sono-guided local methotrexate (MTX) injection is a relatively easy and low-invasive treatment. Additional systemic MTX is sometimes needed for CSP cases, especially when β-subunit human chorionic gonadotropin (β-hCG) levels are >20,000 mIU/ml at diagnosis. We report on six cases of CSP treated with local MTX injection, five of which received combined local treatment. Methods. Under intravenous anesthesia, six CSPs including a case with β-hCG levels >20,000 mIU/ml received MTX injection to the gestational sac. Five cases received gestational sac aspiration. Three cases had additional local potassium chloride injection and one case had a saline injection aiming at the fetal heart beat concurrent with MTX injection. MTX was administered weekly if β-hCG levels stayed beyond the expected values. Outcomes. All cases achieved β-hCG normalization without additional systemic MTX, with one case having a successful pregnancy after treatment. Conclusion. Sono-guided local MTX injection with concurrent local treatment might be a potentially effective approach for CSP cases. The accumulation of further cases is necessary to confirm this

IFPA meeting 2018 workshop report II: Abnormally invasive placenta; inflammation and infection; preeclampsia; gestational trophoblastic disease and drug delivery

Workshops are an important part of the IFPA annual meeting as they allow for discussion of specialized topics. At IFPA meeting 2018 there were nine themed workshops, five of which are summarised in this report. These workshops discussed new perspectives and knowledge in the following areas of research: 1) preeclampsia; 2) abnormally invasive placenta; 3) placental infection; 4) gestational trophoblastic disease; 4) drug delivery to treat placental dysfunction

インシュリン様成長因子とその結合蛋白 : 胎児発育に及ぼす生理学的役割について

IGF-1およびIGFBP-1の胎児発育に及ぼす生物学的特徴を検討するために,臍帯血中IGF-1およびIGFBP-1をIRMAおよびELISAで測定した.臍帯血中IGF-1のレベルは妊娠週数とともに増加し,またpercentile birth weightとも正の相関を示したのに対し,IGFBP-1の臍帯血中濃度は妊娠週数とともに減少し,percentile birth weightとも逆相関した.これらのことより,IGFBP-1は,胎児発育に負に働いていると考えられた.IGFBP-1を含むIGF結合蛋白の動態を更に臍帯血のWestern ligand blotを用いて分析した.正期産の正常発育児(appropriate-for-gestational-age (AGA)児)の臍帯血中には42/39, 34, 30, 24kDaの4つのIGFに対する結合活性が認められた.これらはそれぞれ,IGFBP-3, IGFBP-2, IGFBP-1, IGFBP-4と考えられた.これに対して,正期産の胎内発育遅延児(light-for-gestational-age (LGA)児)では,IGFBP-3の減少と,IGFBP-2の増加が認められた.逆に,糖尿病を合併した母体から生まれた正期産巨大児(heavy-for-gestational-age (HGA)児)ではIGFBP-3の増加とIGFGBP-2, IGFBP-1の減少を認めた.早産LGA児の臍帯血中においては,早産児AGAと比較してIGFBP-2が著明に増加していた.これらの結果から,IGF-1だけではなく,IGFBPもIGFの活性を修飾することによって胎児発達に重要な役割を果たしていることが示唆された.To evaluate physiological significance of insulin-like growth factor-I (IGF-I) and its binding proteins (IGFBPs), IGF-I and IGFBP-1 in cord sera were measured by immunoradiometeric assay (IRMA) and enzyme-linked immunosorbent assay (ELISA), respectively. Furthermore, IGFBPs in cord sera were analyzed by Western ligand blot. The levels of IGF-I in cord sera increased along with gestation and correlated with birth weight. In contrast, the levels of IGFBP-1 decreased with gestation and inversely correlated with birth weight. Western ligand blot revealed molecular forms of 42/39 kDa doublet, 34 kDa, 30 kDa and 24 kDa IGFBPs corresponding to IGFBP-3, IGFBP-2, IGFBP-1, and IGFBP-4, respectively. Term fetuses with light-for-gestational-age (LGA) revealed marked decrease in IGFBP-3 band with increase in IGFBP-2 band compared to those in fetuses with appropriate-for-gestational-age (AGA). In contrast, term fetuses with heavy-for-gestational-age (HGA) from mothers with diabetes mellitus showed increased IGFBP-3 with decreased IGFBP-2 and IGFBP-1. In preterm fetuses, IGFBP-2 was markedly increased especially in fetuses with LGA compared to AGA at preterm. These results suggest that IGF-I and IGFBPs reflect to growth and developmental stages of fetuses and may have important roles in fetal development

Non-essential and branched-chain amino acids differentially regulate insulin-like growth factor binding protein-1 production and phosphorylation in HepG2 cells

<p>Deprivation of branched-chain amino acids (BCAAs) induces insulin-like growth factor binding protein-1 (IGFBP-1) production in HepG2 cells, while the role of non-essential amino acids (NEAAs) remains unknown. We investigated changes in IGFBP-1 production and phosphorylation induced by NEAAs and also examined its significance on IGF-I activity in HepG2 cells. We demonstrated that decreased BCAAs and increased NEAAs stimulated phosphorylated IGFBP-1 secretion. We also revealed that decreased BCAA-to-NEAA ratios enhanced phosphorylated IGFBP-1 secretion, while changes in the total amount of amino acids (AAs) had no effect. Phosphorylation of IGF-I receptor β-subunits mediated by exogenous IGF-I in HepG2 cells was inhibited by decreased BCAAs, increased NEAAs, and decreased BCAA-to-NEAA ratios, while the total amount of AAs had no effect. In addition to BCAAs, NEAAs are also responsible for the regulation of IGFBP-1 secretion and phosphorylation in HepG2 cells. Moreover, the balance of BCAAs and NEAAs regulated IGFBP-1 secretion and phosphorylation.</p