Bruce C. Nisula

Measuring early pregnancy loss: laboratory and field methods *

We intensively studied 30 women attempting pregnancy in order to lay groundwork for larger studies of early pregnancy loss. These women collected first morning urine specimens for up to 6 months after discontinuing use of birth control. Urine specimens were successfully collected for 98% of the woman-days in the study. Three assays for human chorionic gonadotropin (hCG) were performed on each urine specimen. An immunoradiometric assay (IRMA) specific to the carboxyterminal peptide of the hCG beta-chain proved to be more sensitive and more specific than two radioimmunoassays (RIAs). Using the IRMA, we found four cases in which hCG rose and fell over successive days, consistent with early pregnancy loss. For three of these four cases, the level of hCG was too low to be detectable with the RIAs. Among the control group of five women with tubal ligations, there was no detectable hCG above threshold with the IRMA. Thus, the enhanced sensitivity and specificity of the IRMA allows very early pregnancy losses to be identified that would otherwise be undetectable. Furthermore, its effectiveness with small quantities of first morning urine makes the IRMA a useful tool for epidemiologic studies.

The binding properties of pyrethroids to human skin fibroblast androgen receptors and to sex hormone binding globulin

The pyrethroids are a class of natural and synthetic pesticides which were associated with an epidemic of gynecomastia in Haitian men in 1981. In the present study we tested several pyrethroids for their ability to interact with androgen binding sites in dispersed, intact human genital skin fibroblasts and in human plasma to sex hormone binding globulin (SHBG). All the pyrethroids tested inhibited fibroblast binding of [3H]methyltrienolone (R1881) at 22 degrees C with the following rank order of potency:pyrethrins greater than bioallethrin greater than fenvalerate greater than fenothrin greater than fluvalinate greater than permethrin greater than resmethrin. 50% displacement of [3H]R1881 binding to fibroblast androgen receptors was achieved by 1.5-44 x 10(-5) M concentrations of the competitors, respectively. Previous studies with cimetidine, a known inhibitor of androgen receptor binding, showed 50% competition at a concentration of 1.4 x 10(-4) M in this system. Scatchard analysis of binding experiments performed with increasing concentrations of [3H]R1881 in the presence of the pyrethroids indicated that the binding inhibition was competitive. On the other hand, of the pyrethroids examined only the pyrethrins (50% inhibition) and bioallethrin (43% inhibition) were able to displace [3H]testosterone from SHBG when tested at a concentration of 10(-4) M. These data indicate that a novel class of non-steroidal compounds, the pyrethroids, can interact competitively with human androgen receptors and SHBG. These findings provide a mechanism by which chronic exposure of humans or animals to pesticides containing these compounds may result in disturbances in endocrine effects relating to androgen action.

Thyroid-Stimulating Activity and Chorionic Gonadotropin

The nature of the substance with thyroid-stimulating activity (TSA) present in human chorionic gonadotropin (hCG) prepared from pregnancy urine was investigated. In the mouse thyrotropin bioassay, the characteristic maximum of blood radioactivity obtained with the TSA in hCG preparations occurred after that obtained with pituitary thyrotropin (hTSH) but before that obtained with long-acting thyroid stimulator. Antiserum to the alpha subunit of hCG produced significant neutralization of the TSA in hCG. Significant antagonism of hTSH biologic activity was achieved with certain doses of hCG, suggesting that the TSA in hCG was a partial agonist of hTSH. This antagonism was neutralized by antiserum to the beta subunit of hCG. These immunologic results suggest that the substance with TSA in hCG preparations contains antigenic determinants similar to those of both the alpha and the beta subunit of hCG. Amounts of highly purified hCG and crude commercial hCG of equal immunologic activity were biologically indistinguishable in the bioassay for TSA. Both hCG immunoreactivity and the TSA in hCG adsorbed to concanavalin A and eluted with 0.2 M methyl alpha-D-glucopyranoside. These results are consistent with the hypothesis that TSA is an intrinsic property of hCG or of a glycoprotein molecule physicochemically, biologically, and immunologically similar to hCG.

Solid phase method for measurement of the binding capacity of testosterone-estradiol binding globulin in human serum

Abstract A solid phase method for measuring the binding capacity of serum testosterone-estradiol binding globulin (TeBG) is described and compared with other methods. TeBG, a glycoprotein, is adsorbed from serum or plasma onto a solid phase matrix of concanavalin-A, a carbohydrate-specific adsorbent. The TeBG binding capacity is determined by Scatchard analysis of the binding of radioactive testosterone at physiologic pH, in standard test tubes, and without the addition of albumin. Transcortin binding of testosterone is inhibited by the addition of cortisol. The levels of TeBG binding capacity determined with this solid phase method showed an excellent correlation with levels determined by procedures using equilibrium dialysis (with added cortisol) or ammonium sulphate precipitation. The serum TeBG binding capacity was 0.798±0.064 (mean±SE) μg/100 mL in men (n=32), 1.06±0.13 in women (n=10), 2.18±0.19 in women taking oral contraceptives (n=4), 6.2±2.9 in hyperthyroid women (n=2), and 11.6±3.1 in pregnant women (n=5). The serum TeBG binding capacity determined in heparinized plasma did not differ from that determined in serum. The within-assay variation is 9.6% and the between-assay variation is 11.2%. This solid phase method for measurement of serum TeBG binding capacity is simple, precise, and reproducible, and gives values which correlate well with those determined by other methods.

Thyroid function in gestational trophoblastic neoplasia: Evidence that the thyrotropic activity of chorionic gonadotropin mediates the thyrotoxicosis of choriocarcinoma

An investigation was made of thyroid function in 20 patients with gestational trophoblastic neoplasia. Two patients were judged to be overtly thyrotoxic on the basis of the symptoms and physical findings; both patients had widely metastatic choriocarcinoma, markedly increased serum T4 levels (21.4 and 27.7 micrograms/100 ml), and extremely high levels of serum human chorionic gonadotropin (hCG) (3,220 and 6,720 IU/ml) relative to those of normal gestation(< 100 IU/ml). Three other patients had moderately increased serum T4 levels (13 to 17.1 micrograms/100 ml), moderately increased serum hCG levels (110 to 310 IU/ml), and findings on clinical examination which suggested euthyroidism. Using the mouse thyroid bioassay, we found that the biologic characteristics of the thyroid-stimulating factor were those of purified hCG, and that the levels of thyroid-stimulating activity in both serum and urine correlated closely with the levels of hCG. These results provide evidence that the thyroid-stimulating activity intrinsic to the hCG molecule plays the central pathophysiologic role in choriocarcinoma-associated thyrotoxicosis.

Metabolic fate of human choriogonadotropin.

Review of the literature reveals a number of recent insights concerning the metabolic fate of human choriogonadotropin (hCG). In man, only a fraction (21.7%) of the circulating hCG molecules is excreted in urine. Results from animal studies indicate that the retained hCG is taken up by various tissues, principally kidney, liver, and ovary, where degradation occurs. Ovarian uptake is receptor mediated and saturable. Hepatic uptake of hCG is not preceded by desialylation, and blockade of hepatic receptors for galactose-terminated glycoproteins does not impair hepatic accumulation of hCG. Kidney uptake is quantitatively the most important; parenchymal metabolism, as well as excretion in urine constitute major renal components of hCG disposal. The intracellular products of hCG catabolism in kidney include certain fragments of the hCG molecule that exhibit relative resistance to processing by degradative enzymes. These products are fragments of the hCG beta subunit that lack the hCG beta carboxyterminal antigenic determinant, but retain an hCG beta core antigenic determinant, and, thus, they are designated beta-core molecules. Both kidney from hCG-infused rat and urine from pregnant women contain beta-core molecules in great abundance, in fact, in greater abundance than hCG, itself. Structural characterizations of the beta-core purified from pregnancy urine indicate a mol. wt of about 10,000 and an absence of sialic acid, galactose, and carboxyterminal peptide region, including O-linked oligosaccharides. Human volunteers given purified hCG or hCG beta by infusion excrete beta-core in their urines, which establishes the existence of catabolic pathways in humans for the production of beta-core. Thus, urinary excretion of beta-core may reflect an important fate for the metabolic products of hCG degradation.

Characterization of a carboxyterminal peptide fragment of the human choriogonadotropin beta-subunit excreted in the urine of a woman with choriocarcinoma.

We have observed low-molecular weight carboxyterminal fragments of the human choriogonadotropin (hCG) beta-subunit in the urines of several women with choriocarcinoma, and we have characterized one fragment in detail. Its apparent molecular weight by gel chromatography on Sephadex G-100 was 14,200. The fragment was not adsorbed to concanavalin A-Sepharose, indicating that it lacked the asparagine-linked carbohydrate groups of intact hCG beta. It was active in radioimmunoassays (RIA) using antisera either to the hCG beta carboxyterminal peptide (CTP) or to the desialylated hCG beta CTP (hCG beta as-CTP), indicating the presence of not only the hCG beta carboxyterminus but also desialylated O-serine-linked carbohydrate side chains on the fragment. It lacked luteinizing hormone/choriogonadotropin radioreceptor activity and hCG beta conformational immunoreactivity (SB6 RIA). On Sephadex G-100 gel chromatography, the elution profiles of this fragment and the hCG beta as-CTP(115-145) prepared by trypsin digestion of as-hCG were essentially indistinguishable (apparent molecular weights 14,200 and 14,000, respectively). The immunological characteristics of the fragment in both hCG beta CTP and hCG beta as-CTP RIA were indistinguishable from those of the hCG beta as-CTP(115-145) glycopeptide. Carboxyterminal fragments of hCG beta were evident in urine specimens obtained from 10 of 11 patients with choriocarcinoma but not in those obtained from normal subjects who were given an intravenous infusion of highly purified hCG. Of six pregnant women, only the one at term excreted carboxyterminal fragments of hCG beta and then only in trace amounts. We conclude that hCG beta carboxyterminal fragments, including one that is indistinguishable from the tryptic glycopeptide hCG beta as-CTP(115-145), can occur naturally in the urine of patients with choriocarcinoma.

Standardization Of Protein Immunoprocedures Choriogonadotropin (Cg)

The objectives of this report is to improve the quality of immunochemical determinations of proteins. Procedures for determination of the various molecular forms hCG were chosen as the subject of a detailed study, with the aim as using this report as a model for similar future projects. The aim of this undertaking is to improve the reliability and reproducibility of the results and, as a result of this, to enhance the clinical usefulness of hCG determinations. The following means will be used to achieve these goals: (a) establishing uniform nomenclature and abbreviations for various molecular forms of hCG, (b) preparation of new calibrators for these and establishing of methods for determining the amount of substance concentration in mol/L, (c) improving quality assessment materials and procedures, (d) definition of methods for characterization of hCG measurement procedures.

Activities of deglycosylated thyrotropin at the thyroid membrane receptor-adenylate cyclase system

A bovine thyrotropin (bTSH) preparation was deglycosylated by treatment with anhydrous hydrogen fluoride (HF) in the presence of anisole. The resulting material consisted of TSH derivatives that exhibited different molecular sizes, all smaller than the native hormone. The majority (62%) of the deglycosylated TSH derivatives did not bind to the lectin concanavalin A, while 98% of the native TSH was able to bind. The deglycosylated TSH derivatives bound to the high affinity-high specificity TSH binding sites in human thyroid membranes with a potency more than twice that of equivalent immunological amounts of the native bTSH. Despite the enhanced binding affinity for the TSH receptor, the deglycosylated TSH derivatives were unable to stimulate adenylate cyclase fully. Maximal stimulation achieved with bTSH derivatives was only 9 to 17% of the’maximal stimulation achieved with native bTSH. Further, the deglycosylated derivatives competitively inhibited stimulation of the thyroidal adenylate cyclase by native bTSH. We conclude that HF treatment of bTSH results in partially deglycosylated TSH derivatives that exhibit enhanced ability to bind to the TSH receptor and markedly diminished adenylate cyclase-stimulating activity.

Radioimmunoassay of Human Thyrotropin: Analytical and Clinical Developments

Recent modifications of the radioimmunoassay systems for TSH have greatly extended the clinical utility of the measurement of this hormone, so that its use is no longer limited to the diagnosis of primary hypothyroidism. The newer assays provide improved sensitivity and specificity, such that it is now possible to distinguish TSH levels that are within the normal range from those that are suppressed, e.g., in thyrotoxicosis. New vistas of clinical applications are being revealed as we improve our understanding of human thyroid physiology and pathophysiology. It is the purpose of this communication to summarize information about the improved TSH radioimmunoassay, to demonstrate the new observations available regarding TSH concentrations in various normal and diseased conditions, and finally, to illustrate the various ways in which the assay provides more accurate guidance in the clinical diagnosis and management of thyroid and nonthyroid disease.