[Effectiveness of prenatal corticosteroid therapy on fetal organ maturity: treatment recommendations of the Austrian Society of Pre- and Perinatal Medicine].
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Adrenal Cortex Hormones↗
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Amniotic fluid biochemistry in second-trimester trisomic pregnancies: relationships to fetal organ maturation and dysfunction.
Protein and enzyme patterns were investigated in amniotic fluid samples of 12 trisomy 21 and five trisomy 18, between 11 and 16 weeks and of a control group of 50 chromosomally and anatomically normal pregnancies at the same gestational age. Positive correlations were found between gestational age and the concentration of urea (P<0.05), creatinine (P<0.01), beta2-microglobulin (P < 0.0001), hCG (P < 0.01), ALP (P < 0.001), LAP (P < 0.0001) and GGT (P <0.0005) in the amniotic fluid of euploid pregnancies. There were also significant correlations between the concentrations of the different variables measured except for hCG and AFP. Different protein and enzyme patterns were found in the amniotic fluid of aneuploid pregnancies where only beta2-microglobulin concentration was significantly correlated with advancing gestational age. The beta2-microglobulin concentration was significantly (P <0.05) higher in aneuploid fetuses presenting with hydrops compared to those without. These findings suggest that the changes in amniotic composition found during the fourth month of normal pregnancies reflect mainly the maturation of the fetal renal glomerular function and the arrival of enzymes from the digestive and respiratory tract into the amniotic cavity. In trisomy 21, there is evidence of a delay in the maturation of these organs whereas in trisomy 18, there is a reduced production of most proteins and enzymes.
Alkaline Phosphatase↗
MyoD-positive myoblasts are present in mature fetal organs lacking skeletal muscle.
The epiblast of the chick embryo gives rise to the ectoderm, mesoderm, and endoderm during gastrulation. Previous studies revealed that MyoD-positive cells were present throughout the epiblast, suggesting that skeletal muscle precursors would become incorporated into all three germ layers. The focus of the present study was to examine a variety of organs from the chicken fetus for the presence of myogenic cells. RT-PCR and in situ hybridizations demonstrated that MyoD-positive cells were present in the brain, lung, intestine, kidney, spleen, heart, and liver. When these organs were dissociated and placed in culture, a subpopulation of cells differentiated into skeletal muscle. The G8 antibody was used to label those cells that expressed MyoD in vivo and to follow their fate in vitro. Most, if not all, of the muscle that formed in culture arose from cells that expressed MyoD and G8 in vivo. Practically all of the G8-positive cells from the intestine differentiated after purification by FACS. This population of ectopically located cells appears to be distinct from multipotential stem cells and myofibroblasts. They closely resemble quiescent, stably programmed skeletal myoblasts with the capacity to differentiate when placed in a permissive environment.
Animals↗
[Assessment of fetal maturation].
Few organs or tissues are convenient to use for the pathologist to assess fetal maturity: the brain, particularly the external configuration of the cerebral hemispheres: the primary and secondary sulci appear in a definite chronologic order; the lungs; four developmental stages are defined: the last stage is characterized by attenuation of alveolar epithelial lining, and increase and superficial migration of capillaries. It must be reached necessarily to have postnatal respiration; the kidneys have a typical pattern of development, especially after 28 weeks, when it is possible to count the number of immature glomerular layers in the cortex; for the differentiation of the skin, specimens taken from special regions of the body are characteristic enough to determine the maturity, especially during the second trimester.
Brain↗
Intrinsic fluorescence of the amniotic fluid.
The intrinsic fluorescence of clear amniotic fluid from third-trimester pregnancy is reported. The fluorescence intensity peaked at 405 nm when excited by ultraviolet light in the range of 310 to 360 nm. All of the 33 samples tested fluoresced, and their emission spectrum had the same shape, varying only in magnitude. Changing sample temperature (20 to 50 C) and sample pH (7.2 to 7.7) had little effect on the emission spectrum. The same fluorescence, with higher intensity, was observed when some newborn urine was tested. The fluorescence of amniotic fluid may provide a new tool to determine fetal age, fetal organ maturation, and fetal distress.
Amniotic Fluid↗
Circadian rise in maternal glucocorticoid prevents pulmonary dysplasia in fetal mice with adrenal insufficiency.
The hypothalamic-pituitary-adrenal (HPA) axis, including hypothalamic corticotropin-releasing hormone (CRH) and pituitary corticotropin, is one of the first endocrine systems to develop during fetal life, probably because glucocorticoid secretion is necessary for the maturation of many essential fetal organs. Consistent with this, pregnant mice with an inactivating mutation in the Crh gene deliver CRH-deficient offspring that die at birth with dysplastic lungs, which can be prevented by prenatal maternal glucocorticoid treatment. But children lacking the ability to synthesize cortisol (because of various genetic defects in adrenal gland development or steroidogenesis) are not born with respiratory insufficiency or abnormal lung development, suggesting that the transfer of maternal glucocorticoid across the placenta might promote fetal organ maturation in the absence of fetal glucocorticoid production. We used pregnant mice with a normal HPA axis carrying fetuses with CRH deficiency to characterize the relative contributions of the fetal and maternal adrenal to the activity of the fetal HPA axis, and related these findings to fetal lung development. We found that in the presence of fetal adrenal insufficiency, normal fetal lung development is maintained by the transfer of maternal glucocorticoid to the fetus, specifically during the circadian peak in maternal glucocorticoid secretion.
Adrenal Insufficiency↗
Neuroendocrine regulation of pituitary-adrenal function during fetal life.
During late gestation there is a rise in the concentration of corticosteroids in the fetal circulation that is essential for the coordinated maturation of many fetal organ systems and is a key component in the endocrine pathway leading to the onset of birth. Fetal plasma concentrations of adrenocorticotrophin (ACTH) increase during late gestation and this rise precedes the increase in plasma corticosteroids. Paradoxically, ACTH and cortisol concentrations increase concomitantly even though cortisol would normally be expected to exert negative feedback effects to inhibit pituitary ACTH secretion. Elucidating the neuroendocrine signals that cause the increase in fetal ACTH, despite the elevated concentrations of cortisol at this time, will therefore provide vital clues as to the trigger for fetal organ maturation and birth. This article describes the normal ontogeny of the hypothalamo-pituitary-adrenal axis, discusses the neuroendocrine signals that trigger the increase in fetal ACTH secretion and provides potential explanations for the concomitant rise in ACTH and cortisol.
Adrenocorticotropic Hormone↗
Evidence for independent regulators of organ maturation in fetal rabbits.
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Animals↗
Maternal dexamethasone treatment in late gestation alters glucocorticoid and mineralocorticoid receptor mRNA in the fetal guinea pig brain.
Development of the fetal hypothalamo-pituitary-adrenocortical (HPA) axis is critical for fetal maturation and responses to stress. Guinea pigs, unlike rats, give birth to mature young, and peak brain growth occurs around days 48-52 (75%) of gestation. There is extensive development of the glucocorticoid receptor (GR) and mineralocorticoid receptor (MR) systems at the time of rapid brain growth in guinea pigs. Since approximately 10% of pregnant women are treated with synthetic glucocorticoids in late gestation, to promote fetal organ maturation, we tested the hypothesis that fetal exposure to glucocorticoids modifies developing GR and MR systems in the brain. Pregnant guinea pigs were subcutaneously injected with dexamethasone (dex; 1 mg/kg) or vehicle on days 50 and 51 of gestation (term=70 days). On day 52, guinea pigs were killed and the fetuses rapidly removed. Maternal dex treatment resulted in increased plasma cortisol concentrations in female fetuses, but decreased cortisol in male fetuses. Plasma thyroxine levels were increased in both female and male fetuses following maternal dex-treatment. Exposure to dex resulted in significant increases in MR and GR mRNA in the CA1-2 region of the hippocampus, and MR mRNA in the dentate gyrus in female fetuses. There was no effect of dex on GR or MR mRNA in the male fetuses. In conclusion, the effect of synthetic glucocorticoid on the developing brain GR and MR systems is sex-specific and is confined to very specific regions of the hippocampus. Since the hippocampus plays a central role in mediating glucocorticoid negative feedback of HPA function, alterations in the fetal development of corticosteroid receptors may form the basis of permanently modified HPA activity following fetal exposure to endogenous or synthetic glucocorticoid.
Adrenocorticotropic Hormone↗
ACOG committee opnion: antenatal corticosteroid therapy for fetal maturation.
The National Institute of Child Health and Human Development and the Office of Medical Applications of Research of the National Institutes of Health convened consensus conference in 1194 and 2000 that recommended giving a single course of corticosteriods to all pregnant women between 24 and 34 weeks of gestation who are at risk of preterm delivery within 7 days. Because of insufficient scientific evidence, the consensus panel also recommended that repeat corticosteroid courses, including so-called "rescue therapy," should not be routinely used but should be reserved for women enrolled in clinical trials. Betamethasone and dexamethasone have been most widely studied and have generally been the preferred corticosteroids for antenatal treatment to accelerate fetal organ maturation. The American College of Obstetricians and Gynecologists' Committee on Obstetric Practice supports the conclusions of the consensus conferences.
Betamethasone↗
Regulation of insulin-like growth factor-II gene expression in the ovine fetal adrenal gland by adrenocorticotropic hormone and cortisol.
Maturation and activation of the fetal adrenal gland is crucial to fetal organ maturation and the onset of parturition in sheep. Insulin-like growth factors (IGFs) have been demonstrated to promote fetal adrenal mitogenesis and steroidogenesis in some species. Our previous studies showed that IGF-II mRNA is expressed in the steroidogenic cells of the fetal sheep adrenal, suggesting that IGF-II may be an important regulator of fetal adrenal function. However, the regulation of IGF-II gene expression is poorly understood. In the present study we measured the changes in IGF-II mRNA level in fetal sheep adrenals during late gestation in response to ACTH and cortisol. Either saline (0.5 ml/h) or cortisol (1 mg/24 h) was infused for 100 h to fetal sheep beginning on day 95 or 96 of pregnancy, or saline (0.5 ml/h), ACTH (0.5 micrograms/h) or cortisol (1 mg/h) was infused for 84 h to fetal sheep beginning on days 120-125 of pregnancy (term = 145 days). Adrenal RNA was subjected to Northern blot analysis with an ovine IGF-II cDNA probe. The relative abundance of total IGF-II mRNA decreased significantly in the ACTH- and cortisol-treated fetuses. IGF-II mRNA was localized by in situ hybridization using a 35S-labeled antisense ovine IGF-II cRNA probe, and IGF-II peptide was localized by immunohistochemistry. There were no differences in the cellular distribution patterns of IGF-II mRNA and IGF-II peptide after treatments, but the intensity of the hybridization signal for IGF-II mRNA and of immunostaining for IGF-II peptide decreased in adrenals from fetuses treated with ACTH or cortisol. These results suggest that ACTH and cortisol decrease IGF-II gene expression in the ovine fetal adrenal. We speculate that the cortisol surge observed in the late gestation ovine fetus may be responsible for down-regulation of IGF-II gene expression in the fetal adrenal at or just before birth.
Adrenal Glands↗
Concentrations of aldosterone, corticosterone, 11-deoxycorticosterone, progesterone, 17-hydroxyprogesterone, 11-deoxycortisol, cortisol, and cortisone determined simultaneously in human amniotic fluid throughout gestation.
Corticosteroids (CS) are essential for fetal organ maturation; yet, knowledge of endogeneous CS and precursor levels throughout fetal life is limited. Therefore, unconjugated aldosterone (Aldo), corticosterone (B), 11-deoxycorticosterone (DOC), progesterone (P), 17 alpha-hydroxyprogesterone (17-OHP), 11-deoxycortisol (S), cortisol (F), and cortisone (E) were simultaneously determined by RIA after automated Sephadex LH-20 chromatography in 70 control samples of amniotic fluid (AF) obtained at all gestational ages between 14-42 weeks. Levels of the progestins P and 17-OHP slowly increased from means (+/- SE) of 14.7 +/- 2.8 and 1.63 +/- 0.21 ng/ml, respectively, in early gestation to maximum levels of 32.4 +/- 3.5 and 3.80 +/- 0.74 ng/ml at 36-38 weeks (P less than 0.005), then dropped significantly (P less than 0.01) to 19.2 +/- 2.2 and 1.58 +/- 0.22 ng/ml at term. All CS levels except E rose very markedly by 3- to 12-fold (P less than 0.0001) from the weeks 14-16 (DOC, 0.44 +/- 0.08; B, 1.49 +/- 0.23; Aldo, 0.043 +/- 0.012; S, 0.51 +/- 0.10; F, 5.96 +/- 0.93 ng/ml) until the 36-38th weeks (DOC, 3.50 +/- 0.66; B, 4.60 +/- 0.78; Aldo, 0.530 +/- 0.109; S, 6.00 +/- 0.75; F, 60.8 +/- 8.9 ng/ml). Term levels were significantly reduced (P less than 0.01) in the less active CS DOC (0.51 +/- 0.07 ng/ml), B (2.35 +/- 0.35 ng/ml), and S (1.14 +/- 0.14 ng/ml), whereas those of the biologically most potent CS Aldo and F declined less markedly (0.272 +/- 0.053 and 23.0 +/- 0.75 ng/ml, respectively, at 39-42 weeks). Levels of the inactive glucocorticoid E rose from 8.83 +/- 1.08 ng/ml at 14-16 weeks to 16.8 +/- 2.6 ng/ml at 31-35 weeks (P less than 0.01), then remained rather constant around 11.5 ng/ml until term. It is concluded that after the 25th week, large amounts of biologically active CS are available in AF which probably directly induce the final epithelial maturation of fetal lungs and intestinal tract.
Adrenal Cortex Hormones↗
Regulation of ovine fetal pituitary function by corticotrophin-releasing hormone, arginine vasopressin and cortisol in vitro.
Parturition and fetal organ maturation in sheep are associated with increased activity of the fetal hypothalamic-pituitary-adrenal (HPA) axis during late pregnancy. However, the factors responsible for HPA activation remain unclear. In the fetal pituitary, levels of pro-opiomelanocortin (POMC) mRNA increase, but the numbers of binding sites for corticotrophin-releasing hormone (CRH), and ACTH responsiveness to exogenous CRH decline during the last 20 days of pregnancy. We have examined regulation of CRH binding, pituitary ACTH responsiveness, and levels of POMC mRNA in cultures of adenohypophysial cells from term fetal sheep. After a 4-day stabilization period, output of immunoreactive (ir) ACTH was increased over 48 h in a dose-dependent fashion by both CRH and arginine vasopressin (AVP) but decreased by cortisol. Subsequent output of ir-ACTH to a 3-h challenge with 100 nM CRH was attenuated after pretreatments with CRH, AVP or cortisol; the effect of CRH being greater than that of cortisol or AVP. At the end of 48 h of treatment with CRH, AVP or cortisol, there was a 40-50% reduction in the number of CRH-binding sites, but the levels of POMC mRNA decreased significantly only after cortisol treatment and were not altered significantly by CRH or AVP. We conclude that under the conditions of these experiments, CRH and AVP increase ir-ACTH output without increasing the level of steady-state POMC mRNA, but may contribute to loss of pituitary responsiveness to CRH by down-regulation of CRH receptor number. Cortisol exerts negative feedback on POMC mRNA and decreases the number of CRH receptors. Thus, any one or all of CRH, AVP and cortisol could be responsible for the decline in CRH binding in the fetal sheep pituitary during late pregnancy. Although CRH and AVP may affect secretion of ir-ACTH, the present results do not support a role for these neuropeptides in affecting the level of POMC mRNA in the fetal sheep pituitary.
Adrenocorticotropic Hormone↗
Lung development following diaphragmatic hernia in the fetal rabbit.
Diaphragmatic hernia was created in 39 rabbit fetuses on day 23 of gestation. Fifteen fetuses underwent a sham thoracotomy (SHAM). Thirty-nine non-operated littermates served as internal controls (CTR). Fetuses were harvested by Caesarean section on days 25, 27, 29 and 30 of gestation. Pulmonary response was evaluated by lung to body weight ratio (LBWR), morphometry, and density of type II pneumocytes. No difference was found between CTR and SHAM fetuses at term. CDH fetuses had smaller lungs (LBWR 0.014 +/- 0.004 versus 0.030 +/- 0.04 in CTR, P < 0.0001), a less complex acinus [mean terminal bronchial density (MTBD) 1.786 +/- 0.408 versus 0.917 +/- 0. 188, P < 0.0001], thicker alveolar septa [mean wall transection length (LMW) 0.0221 +/- 0.008 versus 0.0142 +/- 0.002, P = 0.0003], and a lower type II cell count (144.5 +/- 19.33 versus 216.2 +/- 27.85 per high power field, P < 0.0001). The differences in MTBD and LMW were significant from gestational day 25 onwards, and the differences in type II cell count from day 27 onwards. Surgical diaphragmatic hernia in rabbit fetuses in the late pseudoglandular phase reproduces many features of the pulmonary hypoplasia associated with human congenital diaphragmatic hernia, including the delayed maturation. The effects are present within 2 days following experimental diaphragmatic hernia and progress over time.
Animals↗
Expression, distribution, regulation and function of IGFs in the ovine fetal pituitary.
Activation of the fetal pituitary-adrenal axis is crucial for fetal organ maturation and the onset of parturition in sheep. Many factors including corticotrophin-releasing hormone (CRH) and arginine vasopressin secreted from the hypothalamus, and growth factors produced within the pituitary may be involved in the regulation of maturation of the fetal pituitary gland. IGFs have mitogenic and differentiation-promoting capacities in a variety of organs and are synthesized as paracrine factors within developing tissues. However, there is little information concerning the synthesis, distribution, regulation and function of IGFs in the fetal pituitary gland at different times during pregnancy. Therefore, we have localized IGF-I and IGF-II mRNAs and peptides, and determined the effect of cortisol on the level of IGF-II mRNAs in the pituitary glands of developing sheep fetuses. We examined the possible effects of IGFs on corticotroph function in cultures of adenohypophysial cells from term fetuses. Seven species of IGF-II transcripts of 1.2-6.0 kb were identified by Northern blot analysis in the pituitary gland of fetuses between day 60 of gestation and term (day 145). The levels of IGF-II mRNAs did not change significantly during pregnancy, although there was a trend for the presence of higher levels of IGF-II mRNAs at day 60 of gestation. IGF-I mRNA was not detectable. By in situ hybridization, IGF-II mRNA was localized to non-endocrine cells and to cells lining the blood vessels of the pars distalis, to some presumed endocrine cells in the pars distalis and pars intermedia, and to clusters of cells in the pars nervosa. In contrast, IGF-I and IGF-II peptides were detected in the presumed endocrine cells in the pars distalis and pars intermedia but not in the pars nervosa. Incubation of adenohypophysial cells from term fetuses with IGF-I, but not IGF-II, for 48 h increased specific 125I-Tyr-ovine CRH binding. However, neither IGF-I nor IGF-II had any significant effects on the basal or CRH-stimulated immunoreactive (ir)-ACTH output, the level of POMC mRNA or the number of ir-ACTH positive cells. Infusion of cortisol to fetuses starting at day 96 of gestation for 100 h or at days 120-125 of gestation for 84 h did not affect the level of IGF-II mRNAs in the pars distalis but decreased the levels of POMC mRNA. These results are consistent with IGFs having the potential to influence fetal pituitary function, although probably on cell types other than the corticotrophs.(ABSTRACT TRUNCATED AT 400 WORDS)
Adrenocorticotropic Hormone↗
Stereological and immunohistochemical study of development of human fetal labial salivary glands and their S-100 protein reactivity.
Stereological and certain histochemical aspects of fetal growth and development of human labial salivary glands are reported. Stereological analysis showed a highly significant progressive increase in proportional gland volume occupied by acini from 27% at 20 weeks to 56% at 38 weeks (P < 0.0001), and a comparable having of the relative gland volume occupied by connective tissue in the same period (P < 0.0001). Linear regression fitted the data well (r2 = 0.59 and 0.47 respectively, n = 46). The change in relative volume occupied by ducts or by vascular tissue was small and did not reach significance. S-100 protein reactivity was demonstrated in the cytoplasm of cells of the labial gland primordia from their origin. As gland differentiation progressed, the S-100 reactivity became localized in basophil acinar cells and in proximal (intercalated and intralobular), but not in distal, duct cells. A gradual increase in intensity of S-100 protein activity at these sites during salivary gland development was observed. Morphological maturity seems to be complete before 29 weeks but myoepithelial cells could not be identified with certainty.
Biomarkers↗
Maturation of human fetal stomach in organ culture.
BACKGROUND: This investigation was undertaken to establish a serum-free organ culture technique allowing for the morphological and physiological maintenance of human fetal stomach in vitro. METHODS: Explants from gastric corpuses (12-17 weeks of gestation) were cultured in serum-free medium for periods of up to 15 days. RESULTS: After 15 days of culture, surface mucous cells were more mature, gastric glands were numerous and well developed, and all epithelial cell types were morphologically very well preserved. Morphometric measurements of the glands revealed an accelerated development in culture compared with that found in utero. Even though the incorporation of [3H]thymidine into total DNA decreased, the labeling indices determined by radioautography confirmed that epithelial cell proliferation was maintained especially in the pit/neck portion and at the base of the glandular compartments. A significant increase in total glycoprotein synthesis, as evaluated by the incorporation of [3H]glucosamine, was observed and correlated with the differentiation of the mucous cells. CONCLUSIONS: This investigation establishes for the first time that human gastric mucosa can be maintained up to 15 days in organ culture and that maturation of the gastric mucosa can be reproduced in chemically defined media.
Cell Differentiation↗
Fetal organ growth in response to oesophageal infusion of amniotic fluid, colostrum, milk or gastrin-releasing peptide: a study in fetal sheep.
The hypothesis of the present study was that the infusion of the biological fluids to which the developing gut is normally exposed (i.e. amniotic fluid, colostrum, milk) and a single growth factor (gastrin-releasing peptide), which is found in high concentrations in fetal fluids and milk, could ameliorate the altered growth induced by the elimination of swallowed input secondary to ligation of the oesophagus. At 108-110 days of gestation the fetal oesophagus was ligated and a catheter inserted towards the stomach (32 fetuses). At 117-119 days of gestation saline (n = 5), amniotic fluid (n = 5), colostral whey (n = 5), milk whey (n = 5) or gastrin-releasing peptide (3.6 nmol day(-1), n = 6), was infused for 7 days (4 x 20 mL day(-1)), or no infusion was given (ligated group, n = 6). A further 15 fetuses were not ligated (normal group, n = 15). All fetuses had carotid artery and/or jugular vein catheters implanted. At 124-126 days of gestation the fetus was delivered and fetal body and organ weights recorded. Analysing the results by ANOVA, there were no effects of either ligation alone or infusion after ligation on fetal weight, crown-rump length, or weight relative to bodyweight of heart, adrenal, pancreas, large intestine and cecum. There were significant differences between the infusion groups for lungs, kidney, pancreas, total gut, abomasum, small intestine, spleen, chest and neck thymus, and mesenteric lymph nodes. Ligation alone significantly reduced small intestinal growth and increased kidney and spleen growth. Colostrum infusion enhanced growth of most organs. Gastrin-releasing peptide significantly increased growth of all the immune organs studied. It was concluded that at an age when premature delivery could be encountered, the fetal gut is capable of significant adaptive growth, to varying degrees, depending on the enteral diet. Growth effects in organs distant to the gut suggest that either gastrointestinal uptake and transport of growth factors or altered nutrient uptake and/or availability can affect the growth of other major fetal organs.
Amniotic Fluid↗