Fetal growth restriction (FGR) is a common pregnancy complication resulting in increased neonatal mortality and morbidity. The aetiology of fetal growth restriction is not fully understood, but abnormalities in placental development are, leading to abnormalities in placental structure which are thought to affect supply of oxygen to the fetus. The source of fetal hypoxia is unknown due to the difficulty in obtaining oxygenation data in the context of pregnancy using existing techniques. There is also an absence of data relating to oxygenation in FGR pregnancies. Oxygen-Enhanced MRI (OE-MRI) and Blood Oxygen-Level Dependent (BOLD) MRI permit noninvasive acquisition of data related to changes in the concentration of dissolved oxygen (pO2) and changes in hemoglobin saturation (sO2) under air- and oxygen- breathing (hyperoxic challenge).The aim of this project was to determine whether MRI methods can provide information relating to placental oxygenation in normal and FGR-compromised pregnancy, to investigate fetal brain oxygenation and to assess the potential confound of placental perfusion changes under hyperoxic challenge. After optimization of sequences in non-pregnant volunteers, similar pO2 and sO2 increases under hyperoxic challenge were seen in normal and FGR pregnancy. This suggested placental oxygenation was similar and that fetal extraction of oxygen may be a likelier cause of fetal hypoxia. Normal fetal brain oxygenation was found not to increase under hyperoxic challenge, which may be due to hemodynamic adaptation to limit cerebral hyperoxygenation. Finally, the robustness of these oxygenation results was supported by the lack of placental perfusion changes observed under hyperoxia using Arterial Spin Labeling (ASL).In conclusion, MRI methods successfully provided information on placental and fetal oxygenation in normal and abnormal pregnancy, obtaining novel data informing the aetiology of FGR and the physiology of the fetal brain.

京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第22744号 / 医博第4662号 / 新制||医||1046(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 髙折 晃史, 教授 竹内 理, 教授 近藤 玄 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

Preeclampsia (PE), intrauterine growth restriction (IUGR) and gestational diabetes (GDM) increase the risk of maternal and fetal morbidity and mortality. The roles of Advanced Glycation End-products (AGEs) are already well documented concerning inflammation, hypoxia and oxidative stress. AGEs bind to its receptor, Receptor for Advanced Glycation End-products (RAGE), and activate an inflammatory pathway. This pathway alters the efficacy of invasive trophoblast cells and in the placenta and can result in placental dysfunction. We hypothesized that the placental dysfunction found in PE, IUGR, and GDM resulted from an over activation of the RAGE-mediated inflammatory pathway. Using human placental samples, we found that RAGE protein expression via western blotting was increased in PE and decreased in IUGR while GDM remained similar to that of control placentas. We then wanted to determine the efficacy of RAGE activation to alter the invasive nature of invasive cytotrophoblasts cells. We found that the addition of AGEs to SW71 cells decreases invasion through the activation of JNK and ERK cellular signaling pathways. Altogether these findings suggest that RAGE activation in trophoblast cells seems result in insufficient placental pathogenesis causing PE, however the IUGR and GDM samples we obtained did not seem to have resulted from RAGE activation. We also found that RAGE activation can alter the ability of invasive trophoblasts to invade, thus limiting the ability of the placental cells to remodel the maternal spiral arteries. We believe that further research into specific triggers of IUGR (smoking-induced) and un-treated diabetes could result in RAGE stimulated placental insufficiency.

Magister Scientiae (Medical Bioscience) - MSc(MBS) / Pregnancy associated maternal morbidity and mortality along with adverse pregnancy outcomes have gained momentum over the past few years, particularly in Sub-Saharan Africa and Southern Asia despite the advances in medical science. Adverse pregnancy outcomes are associated with low birth weight, growth restriction, developmental and cognitive abilities in infants and children. Medical care for preterm babies is costly, requires advanced equipment and qualified trained staff. Recently, levels/concentrations of cytokines have been used to predict and determine potential risk in various medical conditions. Biomarkers have shown to be helpful in many medical conditions and could be used to reduce the number of preterm deliveries in developing countries. The aim of this study was to determine whether a highly elevated CRP serum concentration was associated with preterm delivery in a population of Rwandan mothers.

Background: Pregnancy substance use is linked to low birth weight. However, less is known about relative contributions of various substances and whether effects are due to decreased gestational duration, restriction of fetal growth, or both. The study goal was to use causal modeling to evaluate the individual impact of alcohol, tobacco, cocaine, and marijuana on gestational duration and fetal growth. Methods: Participants were 3164 urban black women recruited at entry to prenatal care and followed to delivery, with all gestational dating ultrasound supported. Pregnancy substance use was assessed via self-report (alcohol, tobacco, cocaine, and marijuana). Results: Alcohol, cigarette, and cocaine use were all individually and negatively related to gestational age at delivery. However, only alcohol, cigarette, and marijuana use predicted fetal growth, with effects for alcohol and cigarette greater and more discrepant for older women. Overall, heavy cigarette smoking had the greatest individual impact on birth weight (up to 431 g). Heavy levels of use of all 4 substances by older women decreased birth weight by 26% (806 g). Conclusions: For perhaps the first time, reduced birth weight is apportioned both by type of substance and mechanism of effect. The use of alcohol and/or cigarettes was clearly more harmful to fetal growth than cocaine use. Findings demonstrate the need for continued emphasis on intervention efforts to address legal and illicit pregnancy substance use.

Introduction: Preeclampsia (PE) and fetal growth restriction (FGR) are common obstetrical complications, often with pathological features of maternal vascular malperfusion (MVM) in the placenta. Current placental clinical pathology methods involve a manual visual examination of histology sections, a practice that can be resource-intensive and demonstrate moderate-to-poor inter-pathologist agreement on diagnostic outcomes, dependant on the degree of pathologist sub-specialty training. Methods: This thesis aims to apply different machine learning (ML) feature extraction methods to classify digital images of placental histopathology specimens, collected from PE, FGR, PE + FGR, and healthy pregnancies, according to the presence or absence of MVM lesions. 166 digital images were captured from histological placental specimens, manually scored for MVM lesions (MVM- or MVM+) and used to develop various support vector machine (SVM) classifier models, differing in feature extraction methods. Classification performance of each model was assessed through accuracy, precision, and recall using confusion matrices. Results: SVM models demonstrated accuracies between 47-73% in MVM classification, with poorest performance observed on images with borderline MVM presence, as determined through manual observation. Data augmentation provided little to no improvement to the accuracies. Conclusion: The results are promising for the integration of ML methods into the placental histopathological examination process. Using this study as a proof-of-concept foundation will lead our group and others to carry ML models further in placental histopathology.

No description available.

This thesis will be organized into two chapters discussing the placental expression of two proteins, pyruvate kinase M2 (PKM2) and heat shock protein 27 (HSP 27), in human placentas. Understanding the mechanisms of placental metabolism in healthy and diseased placentas helps us understand how placenta disorders occur and how we can treat these disorders. The goal is to investigate these proteins to gain an understanding of their roles in placental disorders and help decrease maternal and fetal mortality rates. Chapter one covers the background of pyruvate kinase M2 (PKM2) in cancer and embryonic tissues, and the expression of PKM2 in the human placenta. Cancer PKM2 has been studied extensively, but little is know about the role of placental PKM2. Expression of PKM2 is confirmed in normal human placenta samples and described in preeclamptic and intrauterine growth restriction (IUGR) affected human placentas. Proteins associated with elevated PKM2 in cancer are also associated with elevated PKM2 in human placentas. Comparing normal and diseased placenta samples helps understand the similarities between cancer PKM2 and placental PKM2. Understanding the mechanisms of placental metabolism and PKM2 expression in the human placenta will clarify how the placenta is affected by preeclampsia and IUGR and the role placental PKM2 plays in each of these diseases. Chapter two will cover a paper that I wrote on the expression of phosphorylated heat shock protein 27 (HSP27) in the human placenta. Heat shock proteins are involved in the stress response and help inhibit apoptosis. The object of the study was to look for correlations between p-HSP27 and apoptosis in human and ovine placenta samples. P-HSP27 was quantified in human placenta samples and in placenta sampled collected from ovine models. Pregnant control and hyperthermic sheep models were used to quantify expression of p-HSP27 across gestation. This study showed similarities between human IUGR and our ovine IUGR model, suggesting a link between decreased p-HSP27 and increased apoptosis in IUGR.

The receptor for advanced glycation end-products (RAGE) is a transmembrane cell surface protein of the immunoglobulin superfamily that acts as part of both the innate and adaptive immune system. RAGE is highly expressed in lung tissue and is therefore of interest in the pulmonary immune response. Specifically, RAGE mediates several cell-signaling responses such as inflammation and apoptosis. This work sought to elucidate the role of RAGE in the setting of chronic pulmonary irritation such as that found in long-term exposure to secondhand smoke (SHS). This irritation has several shared characteristics with lung diseases such as chronic obstructive pulmonary disease (COPD) and is therefore of value in discovering potential mechanistic targets for future therapeutic treatments for exacerbations of the disease. We validated the extracellular signal-regulated kinase (ERK) pathway as a downstream RAGE cascade to activate the cellular transcription factor NF-B and excluded the protein kinase B (AKT) pathway in chronic pulmonary inflammation. We also identified several proinflammatory cytokines mediated by RAGE in long-term SHS exposure; these included increased expression of TNF-, MIP-1, IL-13, and IFN, among others. Furthermore, we identified semisynthetic glycosaminoglycan ethers (SAGEs) as effective RAGE inhibitors in acute pulmonary inflammation and the improvement of lung function. RAGE is also implicated in many other diseases such as type II diabetes mellitus, Alzheimer’s disease, atherosclerosis, and obstetric complications. We investigated its postnatal expression in pups that experienced SHS-induced intrauterine growth restriction (IUGR) antenatally. Increased expression of RAGE correlated with concomitant decreased heart and kidney weights at 4 weeks of age. By 12 weeks of age, weights had improved to age-expected measurements, and detected RAGE protein levels had decreased. These results implicate a potential role for RAGE in disease pathologies of adults who experienced antenatal IUGR due to maternal SHS exposure during pregnancy. In addition to the RAGE signaling pathways, we also investigated the Gas6/AXL pathway in the lungs of pregnant preeclamptic rodents. Gas6 is a ligand for the transmembrane AXL receptor and has been found in increased levels in the serum of pregnant women with preeclampsia (PE). Previous studies in our lab demonstrated a rodent Gas6 model of PE. Using this model, we established that the maternal lung from Gas6-induced preeclamptic rats experienced increased AXL mRNA as well as higher total cell counts, protein, and inflammatory cytokines in bronchoalveolar lavage fluid (BALF). These findings established a connection between lung inflammation and the development of preeclampsia that was previously unknown.

京都大学 / 新制・課程博士 / 博士(医学) / 甲第24835号 / 医博第5003号 / 新制||医||1068(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 浅野, 雅秀, 教授 柳田, 素子, 教授 近藤, 玄 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM