Robert A. Brace

Vascular endothelial growth factor gene expression in ovine placenta and fetal membranes

OBJECTIVE The purpose of this study was to explore the gene expression of vascular endothelial growth factor (VEGF) in placental cotyledon, chorion, and amnion of the ovine fetus. STUDY DESIGN Time-dated pregnant sheep with singleton or twin fetuses at a gestational age ranging from 100 to 140 days were used for the study. Placental cotyledonary, chorionic, and amniotic tissues were collected and processed for messenger ribonucleic acid analysis by Northern blotting and reverse transcription-polymerase chain reaction. RESULTS By use of a phosphorus 32-labeled human VEGF complementary deoxyribonucleic acid probe, a prominent VEGF messenger ribonucleic acid transcript of 3.7 kb was detected in the cotyledon, chorion, and amnion. A minor band of 1.7 kb was also found but only in the cotyledon and chorion. The abundance of messenger ribonucleic acid encoding VEGF was highest (p < 0.001) in the cotyledon and lowest in the amnion. In these tissues polymerase chain reaction-amplified products corresponding to VEGF121, VEGF165, VEGF189, and VEGF206 were identified by ethidium bromide. In addition, a polymerase chain reaction fragment corresponding to VEGF145 was observed. These fragments produced specific hybridization signals with the human VEGF radioactive probe where the intensity of the signal was strongest for VEGF165 and weakest for VEGF189. CONCLUSIONS VEGF gene expression was detected in the cotyledon, chorion, and amnion of the near-term ovine fetus. These findings suggest that vascular endothelial growth factor may play a role in the induction of angiogenesis and promotion of permeability in the microvessels that perfuse the placental and fetal membranes.

Progress toward understanding the regulation of amniotic fluid volume: Water and solute fluxes in and through the fetal membranes

Presently the regulation of amniotic fluid volume is poorly understood. There are multiple reasons for this: (1) the volume regulatory mechanisms are complex because there are multiple pathways over which water and solute exchanges occur simultaneously; (2) the volume regulatory mechanisms differ dramatically in early compared to late gestation; (3) diffusional water movement across the membranes has sometimes been confused with net water movement (which is orders of magnitude less); and (4) there appears to be extensive and rapid exchanges between amniotic fluid and fetal blood which occur on the fetal surface of the placenta and within the vascularized fetal membranes (for those species in which the membranes are vascularized) which have not been fully recognized. Knowledge of the direct exchange between amniotic fluid and fetal blood is undergoing significant expansion. Over the past S-10 years, there have been major advances which show that reabsorption of amniotic water and solutes into fetal blood within the membranes and into the fetal surface of the placenta is an important contributor to amniotic homeostasis. Further, there is an accumulating body of data characterizing exchange (i.e. the lack of) between amniotic fluid and the maternal uterine wall. Thus, the present review attempts to clarify these issues by integrating available information regarding fluxes within and across the fetal membranes. Since a large majority of the new data is from the last half of pregnancy, only data derived during that time period will be considered below. Further, although data from humans, monkeys and sheep are discussed, it is important to recognize that a large majority of the data generated during the past few years has been derived from the chronically catheterized fetal sheep. Several of these recent studies have used the sheep model where the urachus was ligated or fetal urine was diverted into the amniotic sac so that no allantoic fluid was present. This represents an improved animal model in comparison with the normal ovine fetus for studying the dynamics and control of amniotic fluid volume and composition.

National Institute of Child Health and Development Conference summary: Amniotic fluid biology - basic and clinical aspects

This report summarizes the National Institute of Child Health and Development sponsored conference on amniotic fluid (AF) biology, held 28-29 September 1999, in Detroit, Michigan. National and international investigators with expertise in AF biology addressed the regulation of AF volume and composition as well as the clinical aspects of interpreting fetal health and well-being from AF indices. A major purpose of the meeting was to consider future directions and opportunities for basic and clinical research which focus on understanding the physiology and pathophysiology and providing therapeutic interventions for abnormalities of AF volume. To achieve this, the workshop participants addressed the current state of knowledge, recent scientific advances and priorities for major questions for which answers must be sought. The fact that it is not known whether AF volume is regulated or what volume-regulatory mechanisms might be involved is a major problem that needs addressing. In the later half of gestation, potential AF volume-regulatory pathways include the two major inflows into the amniotic compartment, i.e. fetal urine and lung liquid, and the two major outflows, i.e. fetal swallowing and intramembranous absorption. If AF volume is regulated, then this must occur through regulation of intramembranous flow, because the other three flows are regulated by the fetus to meet fetal needs. Regulation of AF composition is similarly unknown. In clinical practice, a variety of ultrasonographic indices of AF volume are used, but the relationships of these indices to AF volume have not been determined, nor have their dependency on fetal size, shape or position within the uterus. Further, although aberrations in AF volume both above and below normal are associated with increased fetal and neonatal morbidity and mortality, the predictive utility of the various AF indices remains low and there is little consensus on which is best utilized under conditions of oligohydramnios, normal AF volumes, or polyhydramnios. Further, various clinical AF therapies remain largely experimental and their optimization and utilization need exploration. This report is a condensation of the views presented by the conference participants.

Rapid intramembranous absorption into the fetal circulation of arginine vasopressin injected intraamniotically

Recently an intramembranous pathway was reported in the ovine fetus as a route for the movement of a significant volume of water from the amniotic cavity directly into the fetal blood, which perfuses the fetal membranes and fetal surface of the placenta. To test whether this pathway could be an avenue for the movement of arginine vasopressin from the amniotic cavity into the fetal circulation, we injected 1 to 25 micrograms of arginine vasopressin into the amniotic cavity of two groups of chronically catheterized fetal sheep: a control group of seven animals and a group of seven animals with surgical ligation of the fetal esophagus. We found similar and highly significant increases of arginine vasopressin concentrations in both control and surgically ligated fetuses in amniotic fluid (p less than 0.00001), fetal plasma (p less than 0.0001), and fetal urine (p less than 0.0001). Both groups had similar increases in arterial (p less than 0.0001) and venous (p less than 0.003) pressures with simultaneous decreases in urine flow (p less than 0.001) and heart rate (p less than 0.0001) after the intraamniotic injection of arginine vasopressin. We conclude that amniotic arginine vasopressin can be rapidly absorbed in its biologically active form directly into the fetal circulation through the intramembranous pathway. Furthermore, the observation that esophageal ligation did not alter this absorption suggests that the intramembranous pathway may be important in the regulation of amniotic fluid volume and composition.

Fetal hypoxia elevates plasma atrial natriuretic factor concentration

Acute hypoxia in the fetus is associated with a reduction in fetal blood volume. We hypothesized that atrial natriuretic factor in the fetal circulation may be one of the factors that mediate this blood volume decrease. Thus the present study was designed to determine the effects of hypoxia on circulating concentrations of atrial natriuretic factor in fetal sheep and correlate these changes with fetal blood volume. Hypoxia was induced in chronically catheterized sheep fetuses by infusing nitrogen containing CO2 into the trachea of the ewe for 30 minutes. Fetal arterial PO2 decreased by 10.2 +/- 1.3 (SE) mm Hg. Plasma atrial natriuretic factor concentration rose concurrently with the fall in PO2 such that atrial natriuretic factor increased to 565 +/- 196 pg/ml from a basal level of 127 +/- 13 pg/ml (p less than 0.001). Fetal blood volume was reduced by 7.2% +/- 2.1% and was significantly related to changes in atrial natriuretic factor levels (p less than 0.0001). At the termination of hypoxia, PO2 returned to normal levels before plasma concentrations of atrial natriuretic factor fell to baseline values. Therefore fetal hypoxia appears to be a potent stimulus for elevating plasma concentration of atrial natriuretic factor in the fetus, and this rise in atrial natriuretic factor in the circulation may be partially responsible for the reduction in fetal blood volume observed during hypoxia.

Developmental expression of vascular endothelial growth factor and its receptors in ovine placenta and fetal membranes.

Objectives: Vascularity of the surface of the placenta in humans and of the placenta and fetal membranes in several species including sheep is an important determinant of intramembranous absorption of amniotic fluid. Our previous studies have shown that the total blood vessel surface area in ovine amnion and chorion increases with advancing gestation. Vascular endothelial growth factor (VEGF) is a potent angiogenic and pemeability factor and is found to be expressed in the ovine placenta and fetal membranes. To investigate the role of VEGF in maintaining the absorptive function of the intramembranous microvessels, the present study was undertaken to determine the gestational change in gene expression of VEGF and its receptors, kinase insert domain-containing receptor (KDR) and fms-like tyrosine kinase (Flt-1), in ovine placenta, chorion, and amnion. Methods: Total RNA was extracted from placental cotyledon, chorion, and amnion of ovine fetuses at 60-140 days of gestation. The relative abundance of VEGF, KDR, and Flt-1 mRNA was determined by Northern blot analysis, and VEGF molecular forms expressed were identified by reverse transcriptase polymerase chain reaction. The gestational changes in mRNA levels of VEGF and its receptors were analyzed by regression analysis. Results: In ovine placenta, chorion, and amnion, VEGF mRNA levels increased significantly from 60 to 140 days. The major VEGF molecular form expressed in these tissues was VEGF164, whereas VEGF120, VEGF144, and VEGF188 were present at lower levels. In the placenta, KDR was the primary VEGF receptor expressed, although Flt-1 was also detected at very low levels. In the amnion and chorion, KDR was the only receptor expressed. A gestational-dependent change in VEGF receptor expression was not observed in the placenta and membranes. Conclusions: The increase in VEGF gene expression with advancing gestation in the amnion and chorion where KDR is expressed suggests that VEGF and its receptor are important determinants of vascularity and permeability, and thus exchange capacity, of the intramembranous pathway.

Amniotic fluid composition changes during urine drainage and tracheoesophageal occlusion in fetal sheep

OBJECTIVE Recently an intramembranous pathway was reported in the ovine fetus as a route for the rapid exchange of water, ions, and molecules between the amniotic fluid and the fetal blood that perfuses the fetal surface of the placenta and the fetal membranes. Our study was designed to test the hypothesis that the amniotic fluid composition would gradually equilibrate with fetal plasma when the major flows to and from the amniotic compartment were eliminated. STUDY DESIGN Eleven near-term fetal sheep underwent ligation of the urachus to eliminate the allantoic fluid. An inflatable cuff was placed around the esophagus and trachea, and catheters were placed in the fetal urinary bladder, fetal circulation, and maternal circulation. At > or = 5 days after surgery the animals were subjected to either a control experiment or a continuous urine drainage plus tracheoesophageal occlusion for 8 hours. RESULTS During the urine drainage plus occlusion study, amniotic fluid osmolality (p < 0.0001), Na+ (p < 0.0001), K+ (p < 0.01) Cl- (p < 0.001), and lactate (p < 0.001) increased compared with the control experiment. These corresponded to 50% reductions in the gradients for osmolality and Na+ between fetal plasma and amniotic fluid; the K+ gradient increased, and the Cl- gradient reversed. The percentage increases in amniotic Na+, K+, Cl-, and lactate were all 10% at 8 hours. CONCLUSION These observations suggest that water is absorbed from the amniotic fluid through the intramembranous pathway into the fetal circulation at a rate of 1.25% of the total amniotic volume per hour or approximately 240 ml/day.

Renal and placental secretion of erythropoietin during anemia or hypoxia in the ovine fetus

OBJECTIVE The source of the erythropoietin (EPO) that circulates in the fetus is unknown although it is known that EPO does not cross the placenta and that fetal kidneys, liver, and placenta express the EPO gene. This study tested to what extent in vivo EPO secretion by the fetal kidneys and placenta can be demonstrated under normoxic and hypoxic conditions. STUDY DESIGN Renal arterial and venous EPO concentrations were determined in eight late-gestation chronically catheterized fetal sheep made progressively anemic by exchange transfusion with saline solution over 5 to 8 days. In a separate additional series of experiments, umbilical arterial and venous EPO concentrations were determined in nine normoxic fetuses and in nine fetuses subjected to 12 hours of hypoxia induced by lowering maternal-inspired oxygen content. Organ secretion rates were calculated as the product of plasma flow rate and the arteriovenous concentration differences. RESULTS Renal vein plasma EPO concentration was higher than the arterial concentration in 36 of 40 paired samples (P<.0001) by 16.3%+/-2.7% (mean+/-SE). This difference was concentration independent over a range of 12 to 4100 mU/mL. Renal EPO secretion rates were variable and averaged 155+/-105 mU/min when hematocrit was 31.3%+/-1.6% (n=5) and 1124+/-300 mU/min post-exchange transfusion when hematocrit was 15.6%+/-0.8% (n=12). In contrast, umbilical venous and arterial EPO concentrations (range 9-35 mU/mL), although highly correlated (r=0.94), were not different during normoxia (Po(2)=21.6+/-0.5 mm Hg, n=9). Under hypoxic conditions (Po(2)=15.6+/-0.4 mm Hg, n=9), umbilical vein EPO concentration (range 151-1245 mU/mL) was higher than arterial concentration (range 140-951 mU/mL) in eight of nine paired samples by 13.6%+/-3.3% (P<.01). Under these conditions, estimated umbilical EPO secretion rate was 27,900+/-11,500 mU/min. CONCLUSION Under nonanemic, normoxic basal conditions, the kidneys secreted EPO into the fetal circulation, whereas secretion by the placenta was not demonstrated. In the phlebotomy-induced fetal anemia experiments, the kidney demonstrated marked, progressive increases in the rate of EPO production. Similarly, in the fetal hypoxemia experiments, the placenta demonstrated progressive increases--albeit an order of magnitude greater than the kidneys--in EPO production rate. As an extension of these findings, we speculate that the hypoproliferative neonatal anemia that invariably occurs in the early weeks after birth is in part the result of loss of EPO production by the placenta.

Ovine Vascular Endothelial Growth Factor: Nucleotide Sequence and Expression in Fetal Tissues

To examine the role of vascular endothelial growth factor (VEGF) in mediating angiogenesis and vascular permeability during fetal development, we determined the gene expression of VEGF in ovine fetal tissues. Further, we cloned and sequenced the ovine VEGF cDNA encoding VEGF164 from sheep placenta. VEGF protein was localized in epithelial cells of the placenta and fetal kidney, and in hepatocytes of the fetal liver. By Northern analysis, a major VEGF mRNA species of 3.7 kb was identified in all tissues examined, with abundance highest in the lung and lowest in the liver. The most prominent molecular form expressed in ovine fetal tissues appeared to be VEGF164 with low levels of expression of VEGF120 and VEGF188. Cloning and sequence analysis of the most abundant form of ovine VEGF cDNA in the placenta confirmed the prediction of a 164-amino acid peptide, with a putative N-terminal signal sequence of 26 amino acids. Comparison of the VEGF cDNA sequence among different species revealed that VEGF is highly conserved suggesting an important role in development.

Swallowing, urine flow, and amniotic fluid volume responses to prolonged hypoxia in the ovine fetus.

OBJECTIVE Four days of hypoxia produce an extensive fetal polyuria with little change in amniotic fluid volume in the ovine fetus. We hypothesized that fetal swallowing and intramembranous absorption would increase with prolonged hypoxia to offset the polyuria. STUDY DESIGN After a 24-hour normoxic period, nine ovine fetuses were subjected to 4 days of hypoxia induced by lowering maternal inspired oxygen content. Seven fetuses were monitored for 5 days as normoxic time controls. Measurements included fetal swallowed volume by a computerized system with Transonic flow probes, urine production by gravity drainage, and amniotic fluid volume by an indicator dilution technique. Data were averaged over 12-hour intervals, and a three-factor repeated-measures analysis of variance was used for statistical testing. RESULTS During days 2 to 5, arterial oxygen tension was 20.7+/-1.1 (SE) mm Hg in the normoxic and 13.9+/-0.8 mm Hg in the hypoxic fetuses (P<.0001). Urine flow was unchanged over time in the normoxic fetuses and increased gradually from 693+/-88 to 2189+/-679 mL per day during hypoxia (P<.0001). The prehypoxia swallowed volume was similar in the two groups, averaging 447+/-95 mL per day. Although transiently decreased in eight of nine hypoxic fetuses, the 12-hour average swallowed volumes were not significantly different at any time in the hypoxic versus normoxic fetuses (P=.62). Amniotic fluid volume increased in the hypoxic fetuses relative to that in the normoxic fetuses (520+/-338 mL vs -226+/-136 mL, P<.01), although the increase was small (P<.01) relative to the excess volume of urine (4269+/-1306 mL). Estimated intramembranous absorption increased from 209+/-95 mL per day during normoxia to average 1032+/-396 mL per day during hypoxia. CONCLUSIONS The current study supports the concept that prolonged hypoxia produces a progressive fetal polyuria with relatively small changes in amniotic fluid volume. Concomitantly, hypoxia does not induce prolonged changes in fetal swallowing; rather, intramembranous absorption greatly increases, thereby preventing severe polyhydramnios.