E1 Infusion Research Articles

The decrease of fibrinogen is an early predictor of the severity of postpartum hemorrhage.

Postpartum hemorrhage (PPH) is a major source of maternal morbidity. This study's objective was to determine whether changes in hemostasis markers during the course of PPH are predictive of its severity. We enrolled 128 women with PPH requiring uterotonic prostaglandin E2 (sulprostone) infusion. Two groups were defined (severe and non-severe PPH) according to the outcome during the first 24 hours. According to our criteria, 50 of the 128 women had severe PPH. Serial coagulation tests were performed at enrollment (H0), and 1, 2, 4 and 24 hours thereafter. At H0, and through H4, women with severe PPH had significantly lower fibrinogen, factor V, antithrombin activity, protein C antigen, prolonged prothrombin time, and higher D-dimer and TAT complexes than women with non-severe PPH. In multivariate analysis, from H0 to H4, fibrinogen was the only marker associated with the occurrence of severe PPH. At H0, the risk for severe PPH was 2.63-fold higher for each 1 gL(-1) decrease of fibrinogen. The negative predictive value of a fibrinogen concentration >4 gL(-1) was 79% and the positive predictive value of a concentration <or=2 gL(-1) was 100%. These findings indicate that a simple fibrinogen measurement can anticipate the risk of severe bleeding in PPH.

17??-ESTRADIOL (E2) ADMINISTRATION AFTER MAJOR BLOOD LOSS IMPROVES LIVER ATP, 3-HOUR SURVIVAL AND ALSO LONG-TERM SURVIVAL FOLLOWING PROLONGED HYPOTENSION (3 HOUR) AND FLUID RESUSCITATION

Although E2 administration after trauma-hemorrhage (T-H) and fluid resuscitation produces salutary effects on organ functions, it is not known if E2 has any beneficial effects after major blood loss in the absence of fluid resuscitation. Male SD rats ∼250 g) underwent T-H (tissue trauma, BP 40 mmHg in 10 min and maintained at that BP by further blood withdrawal until maximum bleed out [MBO, 60% of total blood volume] occurred [45±5 min]). E2 i.v. (1 mg/Kg, 0.4 ml/Kg volume i.e., 120 μL/300 g BW) or vehicle (cyclodextrin, CD) was then infused. No additional fluid was given for 3 h. If rats survived, they received Ringer's lactate, 4 × the MBO volume. A customfabricated 31P coil was placed on the surface of the rat's liver after laparotomy in another group, and spectra acquired using 4.7T NMR spectroscopy via a 31P coil in real time before and during hemorrhagic shock. Shock increased phosphomonoester and Pi with a concomitant decrease in β-ATP in both groups. The β-ATP:Pi ratio was at a life-sustaining level in the E2 group as compared to the CD group. The 3-h survival is shown in Fig. Since E2 infusion after major blood loss maintains higher liver ATP levels during severe hypotension, markedly improves 3-h survival rates without fluid resuscitation and increases long-term survival after resuscitation, E2 is a novel hormone for preserving essential cellular energy status under conditions in which fluid resuscitation is not possible for a period of 3 hrs following severe blood loss. (DARPA W81XWH-05-2-0046). Approved for Public Release, Distribution Unlimited.Figure

Central estrogen attenuates Ang II‐induced hypertension in ovariectomized female mice

It has been shown that ovariectomy (OVX) exacerbates high blood pressure (BP), that estrogen replacement attenuates the course of hypertension, and that estrogen acts on several central nuclei involved in cardiovascular regulation. The present study tested the effects of central estrogen and its receptors on Ang II induced hypertension. Aortic BP was measured in conscious female mice with the use of telemetry implants. In OVX females 17β-estradiol (E2, 30 μg/kg/day, n=5) or E2 plus an estrogen receptors antagonist (ICI182,780,10 μM, n=5) were chronically infused into lateral ventricle by brain infusion assembly with attached osmotic pump. AngII(800 ng/kg/min) was infused subcutaneously via an osmotic pump. Resting BPs were similar in intact and OVX mice. After 7 days of systemic infusion, Ang II resulted in only 7.2± 2.0 mmHg increase in BP in intact mice (n=7, 102.4±1.1 to 114.2±2.5mmHg). But in OVX mice, Ang II increased significantly BP by 23±1 mmHg (n=5, 99.2±0.9 to 122.4±1.4 mmHg). Central infusions of E2, or E2+ICI182,780 did not change the basal BP. However, central infusion of E2 attenuated the pressor effect of Ang II (Δ MAP 7±0.4 mmHg n=4). This protective effect of E2 was prevented by co-administration of ICI(Δ MAP 18.8±1.5 mmHg n=4). Finally, ganglionic blockade on day 7 after beginning the Ang II infusions resulted in greater reduction in BP in OVX females administered E2+ICI centrally(−60.1±5.2 mmHg) as compared with OVX mice given just central E2 (−39.8±3.5 mmHg). This suggests a role for the sympathetic nervous system in this response. Taken together these results suggest central estrogen and/or its receptors may play a protective role in development of Ang II-induced hypertension in female mice. (Supported by NIH Grant 62261 and 59676)

Prostaglandins and acute pancreatitis--experimental and clinical studies.

Acute pancreatitis has a mortality of 10-20 per cent, and in cases of acute haemorrhagic pancreatitis this rises to 80-90 per cent. At present there is no reliable treatment for this condition. Based on the hypothesis that the release locally and systemically of the intracellularly activated pancreatic digestive enzymes is due to cell membrane instability, we have studied the cytoprotective (cell membrane stabilizing) role of prostaglandins in this condition. In the first part of this study, an animal model of acute pancreatitis with a mortality of 100 per cent by 14 days has been established by feeding mice a choline-deficient ethionine supplemented diet. Using this model we have demonstrated improved survival (16 out of 50 survived 14 days or longer) by administering prostaglandin E2 subcutaneously (P less than 0 X 02). We have demonstrated that the improved survival is dose-dependent, in the range 2 X 5-5 X 0 mg/kg body weight 8 hourly (P less than 0 X 02) and time-dependent, still being effective if treatment is delayed for 24 h (P less than 0 X 02). Great emphasis has been placed on not commencing treatment until after the induction of acute pancreatitis. In the second part we have used cell membrane marker enzymes to study the cell membrane stabilizing effect of prostaglandin E2 in the human. It has been demonstrated that cell membrane instability occurs. In 12 of 50 episodes treated by prostaglandin E2 infusion, the lysosomal, mitochondrial and cell membranes are stabilized, thus decreasing the release of intracellular enzymes.

Modulation of hypoglycemia‐induced increases in plasma epinephrine by estrogen in the female rat

Clinical studies have demonstrated that estrogen replacement therapy suppresses stress-induced increases in plasma catecholamines. The present study determined whether normal circulating levels of estrogen can modulate hypoglycemia-induced increases in plasma epinephrine (EPI). In anesthetized female rats, insulin-induced hypoglycemia (0.25 U/kg) increased plasma EPI concentration to a significantly greater extent in 14-day ovariectomized (OVEX) rats compared to that in sham-operated controls. In 17beta-estradiol (E2)-replaced OVEX rats, the hypoglycemia-induced rise in plasma EPI was reduced significantly when compared to that in vehicle-replaced OVEX rats. OVEX and E2 replacement had no effect on tyrosine hydroxylase or phenylethanolamine N-methyltransferase mRNA levels in the adrenal medulla. In isolated adrenal medullary chromaffin cells, agonist-induced increases in intracellular Ca2+ were unaffected by 48-hr exposure to 10 nM E2. In contrast, acute (3-min) exposure to micromolar concentrations of E2 dose-dependently and reversibly inhibited agonist-induced Ca2+ transients. In addition, in OVEX rats, a constant infusion of E2 significantly reduced the insulin-induced increase in plasma EPI concentration compared to that in vehicle-infused controls. These data demonstrate that physiologic levels of circulating E2 can modulate hypoglycemia-induced increases in plasma EPI. This effect seems independent of steroid influence on adrenal medullary secretion or biosynthesis. In contrast, acute exposure to high levels of E2 can also suppress hypoglycemia-induced increases in plasma epinephrine, due at least in part to inhibition of stimulus-secretion coupling.

Effects of oestrogen deficiency on osteoclastogenesis in the rat periodontium

This study was designed to investigate quantitative changes in osteoclast generation in rat periodontium following ovariectomy. Wistar rats, aged 9 weeks, were subjected to either ovariectomy (OVX) or sham surgery. Osmotic pumps were implanted in 24 rats and either 17β-oestradiol or vehicle solution were infused continuously. The rats were assigned to one of the following groups: (1) OVX+vehicle; (2) sham+vehicle; or (3) OVX+ 17β-oestradiol. On the days 7 and 14 after surgery, four rats in each group were killed. Mandibles were demineralized and embedded in paraffin. Frontal sections of alveolar bone in the region of the first molar were cut for enzyme histochemistry and immunohistochemistry. On day 7, there was no significant difference in the number of tartrate-resistant acid phosphatase (TRAP)-positive cells located on bone surfaces in either group. However, the number of TRAP-positive mononuclear cells that were separated from the bone surface was significantly higher in group 1 than in groups 2 and 3. On the day 14, the number of TRAP-positive cells in group 1, which were attached to the bone surface, was significantly higher than had been apparent on day 7. There were also significant increases in the number of nuclei of TRAP-positive cells attached to the bone in group 1 compared with groups 2 and 3 on day 14. These findings demonstrate that oestrogen deficiency induces of osteoclastogenesis in the rat periodontium and that quantitative changes in osteoclastogenesis could be prevented by E2 infusion.

Balloon Cervical Ripening With Extra-Amniotic Infusion of Saline or Prostaglandin E2

In Brief Objective To compare extra-amniotic infusion of diluted prostaglandin (PG) E2 solution with saline infusion in balloon cervical ripening and labor induction. Methods Women with pregnancy complications and Bishop scores of 3 or lower (n = 116) were assigned randomly to receive extra-amniotic infusion (1 mL/minute) of normal saline or PGE2 in saline (0.5 μg/mL) through a Foley catheter with a 30-mL inflated balloon. We induced labor using intravenous oxytocin only when labor had not developed by 6 hours after balloon expulsion. Analysis was by intent-to-treat. We assessed ripening efficiency and course of labor in women who had spontaneous balloon expulsion (n = 110) and trial of labor (n = 107), respectively. Results Ripening with PGE2 was associated with significantly shorter mean (± standard error of the mean [SEM]) time for balloon expulsion (4.7 ± 0.4 versus 6.5 ± 0.6 hours) and with significantly higher Bishop scores (P < .002), compared with ripening with saline. In the PGE2 group, rates of labor induction (15%) and oxytocin use (37%) were significantly lower than in the saline group (51% and 72%, respectively). The groups did not differ significantly in other labor abnormalities, labor duration, mode of delivery, birth weight, Apgar scores, and puerperal morbidity. Conclusion Cervical ripening by extra-amniotic balloon and PGE2 infusion is faster and more effective than by balloon and saline infusion, resulting in a higher rate of spontaneous labor and a lower rate of oxytocin use. Extra-amniotic prostaglandin E2 infusion is more rapid and effective than saline infusion for balloon cervical ripening, and has a higher rate of spontaneous, unaugmented labor.

Oestrogen upregulates noradrenaline release in the mediobasal hypothalamus and tyrosine hydroxylase gene expression in the brainstem of ovariectomized rhesus macaques.

Noradrenaline plays a key role in the initiation of ovulation in nonprimate species. A similar noradrenaline role in the primate has not been established experimentally. We utilized the ovariectomized-oestrogen-supplemented (OVX + E) rhesus macaque to examine the effects of intravenous (i.v.) infusion of oestradiol-17beta (E2) on the activity of the brain noradrenaline system. Experiment 1 established the induction of a preovulatory surge-like release of luteinizing hormone in OVX + E monkeys by i.v. infusion of E2 (OVX + E + E2). In experiment 2, a marked increase in hypothalamic microdialysate noradrenaline concentrations occurred after identical E2 infusion into the OVX + E monkeys that were used in experiment 1. In experiment 3, tyrosine hydroxylase (TH) mRNA expression in the locus coeruleus of the brainstem increased at various times after E2 infusion as determined by semiquantitative in situ hybridization. The amount of TH mRNA in OVX + E + E2 animals was higher (P < 0.05) than that in either the OVX + E or OVX monkeys; no difference was found in the latter two groups. Moreover, selected locus coeruleus sections from E2-infused monkeys were examined for the localization of oestrogen receptors (ER) by in situ hybridization. Both ER-alpha and ER-beta mRNAs were expressed in the locus coeruleus, although the expression was greater for ER-alpha than for ER-beta. We conclude that i.v. infusion of E2, which induces a preovulatory surge-like release of LH, stimulates brain noradrenaline activity; this enhanced activity likely involves an ER-mediated process and is reflected by hypothalamic noradrenaline release and locus coeruleus TH mRNA expression. The results support the concept that noradrenaline can influence the E2-stimulated ovulation in nonhuman primates and that the brainstem is one of the components in this neuroendocrine process.

Neutralization of prostaglandin E1 intravenous solution reduces infusion phlebitis.

Previous studies have shown moderate or severe phlebitis at the site of venipuncture in some patients who receiving prostaglandin E1 (PGE1) infusion therapy. Such phlebitis is sometimes severe enough to necessitate the cessation of PGE1 therapy. This study investigated how to continue PGE1 infusion therapy for 3 weeks with tolerable phlebitis. Although a 60 microg dose of PGE1 is usually dissolved in 500 mL of fluid to avoid phlebitis, we used 200 mL to prevent volume overload. This PGE1 solution was neutralized to pH 7.4 with 4 mL of 7% sodium bicarbonate. We examined the frequency and severity of phlebitis among patients who received a 2-h PGE1 infusion twice daily. Eighteen patients who were hospitalized for peripheral vascular disease between June 1998 and May 1999 were studied. All of them were men and their mean age was 63.3 +/- 8.9 years (range: 47-78 years). Fourteen patients had arteriosclerosis obliterans and four had Buerger's disease. When the severity of phlebitis was determined according to Dinley's criteria, two patients (11%) had grade 0, four patients (22%) had grade 1, eleven patients (61%) had grade 2, and one patient (6%) had grade 3 phlebitis. Usually, PGE1 infusion therapy is stopped when phlebitis reaches grade 4 or more, but there were no such cases in this study. We also found that aging was significantly correlated with a decrease in the severity of phlebitis (Spearman's rank correlation test: r = -0.545, p = 0.0193).

Estradiol improves pulmonary hemodynamics and vascular remodeling in perinatal pulmonary hypertension.

Partial ligation of the ductus arteriosus (DA) in the fetal lamb causes sustained elevation of pulmonary vascular resistance (PVR) and hypertensive structural changes in small pulmonary arteries, providing an animal model for persistent pulmonary hypertension of the newborn. Based on its vasodilator and antimitogenic properties in other experimental studies, we hypothesized that estradiol (E(2)) would attenuate the pulmonary vascular structural and hemodynamic changes caused by pulmonary hypertension in utero. To test our hypothesis, we treated chronically instrumented fetal lambs (128 days, term = 147 days) with daily infusions of E(2) (10 microg; E(2) group, n = 6) or saline (control group, n = 5) after partial ligation of the DA. We measured intrauterine pulmonary and systemic artery pressures in both groups throughout the study period. After 8 days, we delivered the study animals by cesarean section to measure their hemodynamic responses to birth-related stimuli. Although pulmonary and systemic arterial pressures were not different in utero, fetal PVR immediately before ventilation was reduced in the E(2)-treated group (2.43 +/- 0.79 vs. 1.48 +/- 0.26 mmHg. ml(-1). min, control vs. E(2), P < 0.05). During the subsequent delivery study, PVR was lower in the E(2)-treated group in response to ventilation with hypoxic gas but was not different between groups with ventilation with 100% O(2). During mechanical ventilation after delivery, arterial partial O(2) pressure was higher in E(2) animals than controls (41 +/- 11 vs. 80 +/- 35 Torr, control vs. E(2), P < 0. 05). Morphometric studies of hypertensive vascular changes revealed that E(2) treatment decreased wall thickness of small pulmonary arteries (59 +/- 1 vs. 48 +/- 1%, control vs. E(2), P < 0.01). We conclude that chronic E(2) treatment in utero attenuates the pulmonary hemodynamic and histological changes caused by DA ligation in fetal lambs.

Prolonged infusions of estradiol dilate the ovine fetal pulmonary circulation.

Factors mediating both the rapid and sustained fall in pulmonary vascular resistance (PVR) at birth are incompletely understood. Acute or prolonged estrogen treatment causes vasodilation of several vascular beds in adults. Although fetal estrogen levels rise in late gestation, their effects in the fetal pulmonary circulation have not been studied. To determine whether estrogens can cause pulmonary vasodilation in the fetus, we infused 17beta-estradiol (E2) into the left pulmonary artery (LPA) of chronically catheterized fetal lambs, measured pulmonary artery pressure and LPA blood flow, and calculated PVR. Brief E2 administration (1-, 10-, and 100-microg doses) did not change baseline pulmonary hemodynamics and failed to enhance endothelium-dependent vasodilation as assessed by the dilator response to acetylcholine. However, prolonged E2 infusion (2- 8 d) caused a 2.6-fold increase in pulmonary blood flow (73+/-6 versus 188+/-44 mL/min, baseline versus E2 treatment, p<0.05), and the response was sustained for at least several hours. Treatment with the nitric oxide synthase inhibitor nitro-L-arginine (L-NA) reversed the E2-induced fall in PVR (0.15+/-0.05 versus 0.51+/-0.15 mm Hg/mL/min; before versus after L-NA, p<0.05). Endothelial nitric oxide synthase expression and endothelin-1 content were not different in E2-responders and controls, suggesting that altered expression of these mediators did not account for the increased flow. We conclude that prolonged E2 infusion causes an unusual pattern of vasodilation in the ovine fetal lung. On the basis of these observations of exogenous E2 treatment, we speculate that endogenous E2 enhances pulmonary vasodilation at birth.

Embryo survival, and fetal and placental growth following elevation of maternal estradiol blood concentrations in the rat.

High doses of estrogens cause embryonic mortality, and fetal and placental growth retardation in rats. This study addresses the physiological relevance of such findings. Estradiol benzoate (EB), by s.c. injection, or estradiol-17beta (E2), delivered by a miniosmotic pump, raised maternal E2 concentrations from only slightly above control values to 5-fold. EB (1 microgram/day) over Days 6-13, 8-13, and 11-13, and continuous infusion of E2 (15 ng/h; Days 10-13) reduced fetal survival to 0%, 0%, 22%, and 75%, respectively. Single injections of EB showed that its lethal effect declined rapidly over Days 9 (44% survival) to 13 (90% survival). Embryos died within 48 h, but death was not due to luteal failure since progesterone levels were maintained and progesterone administered with EB did not reduce mortality. Administration of EB at 1 microgram/day (Days 14-21) or E2 at 40 ng/h (Days 13-16) retarded fetal and placental growth but did not affect survival. The rat embryo is highly sensitive to elevated maternal estradiol concentrations over much of gestation. The early lethal effect implies that endogenous E2 production is carefully regulated to maintain pregnancy; the latter growth-retarding effect suggests that E2 may have a role in the normal control of fetal growth.

Prostaglandin E2 mediates activation of hypothalamic histamine by interleukin-1beta in rats.

The present study was designed to investigate the effects of peripheral interleukin-1beta (IL-1beta) on hypothalamic histamine (HA) systems. Intraperitoneal injection of IL-1beta increased the turnover rate of hypothalamic HA, which was assessed by accumulation of tele-methylhistamine after pargyline treatment. IL-1beta increased the activities of both histidine decarboxylase (HDC), an HA synthesizing enzyme, and HA-N-methyltransferase (HMT), an HA catabolizing enzyme. Pretreatment with indomethacin completely blocked the effects induced by IL-1beta on hypothalamic HA. Infusion of prostaglandin E2 (PGE2) into the third cerebroventricle increased the hypothalamic HA turnover rate, and simultaneously activated both HDC and HMT dose-dependently, but intravenous infusion of PGE2 had no effect on the dynamics of hypothalamic HA turnover. These results indicate that hypothalamic PGE2 activated by peripheral administration of IL-1beta, but not by peripheral PGE2, may enhance synthesis and release of hypothalamic HA by activation of HDC, and may facilitate degradation of extracellular histamine by activation of HMT.

Effect of stress-like concentrations of cortisol on gonadotroph function in orchidectomized sheep.

The effect of stress-like concentrations of cortisol (C) on the feedback potency of estradiol (E2) was assessed using 32 orchidectomized sheep (wethers) assigned at random to 1 of 4 treatment groups in a 2 x 2 factorial design. Wethers received C (3. 6 mg/50 kg per hour; groups 2 and 4) or a comparable volume of C delivery vehicle (groups 1 and 3) as a continuous infusion for 7 days. During the final 48 h of infusion, wethers received E2 (0.3 microg/50 kg/h; groups 3 and 4) or E2 delivery vehicle (groups 1 and 2). The pattern of LH secretion was assessed during a 4-h period of intensive blood collection beginning 44 h after initiation of E2 infusion. Gonadotroph responsiveness (LH secretion induced by GnRH challenge [500 ng, i.v.]) was determined 48 h after E2 delivery was begun. Although the frequency of secretory episodes of LH was not affected (p > 0.05) by infusion of C or E2 alone, LH pulse frequency was significantly decreased in wethers receiving C and E2 in combination. In contrast, neither the magnitude of basal gonadotroph responsiveness nor the extent of E2-dependent augmentation of responsiveness was significantly affected by stress-like concentrations of C. In a second experiment, the effect of C on the magnitude of E2-induced increase in pituitary concentration of GnRH receptor and GnRH receptor mRNA was assessed using 32 additional wethers. Continuous infusion of E2 for 48 h increased (p < 0.05) tissue concentrations of GnRH receptor and GnRH receptor mRNA. Concurrent delivery of C did not affect (p > 0.05) E2-induced increase in GnRH receptor mRNA but significantly reduced the magnitude of the E2-dependent increase in pituitary concentration of GnRH receptor. Collectively, these data indicate that stress-like concentrations of C enhance the negative feedback potency of E2 and reduce estrogen-dependent augmentation of the concentration of GnRH receptor in pituitary tissue.

Effect of stress-like concentrations of cortisol on estradiol-dependent expression of gonadotropin-releasing hormone receptor in orchidectomized sheep.

The effect of stress-like concentrations of cortisol (C) on estrogen-dependent expression of GnRH receptor was evaluated using orchidectomized sheep (wethers; n = 6 animals per group). C (5.0 mg/50 kg per hour; groups 1-4) or a comparable volume of vehicle (groups 5-8) was delivered by continuous infusion for 48 h. During the final 24 h of infusion, animals received concurrent infusion of estradiol (E2) at rates of 0 (groups 1 and 5), 0.5 (groups 2 and 6), 2.0 (groups 3 and 7), or 8.0 (groups 4 and 8) microg/50 kg per hour. Pituitary tissue was collected at the end of infusion. Although C did not affect (p > 0.05) the basal concentration of GnRH receptor or GnRH receptor mRNA, it reduced (p < 0.05) the increase in receptor and receptor mRNA induced by concurrent administration of 0. 5 microg E2/50 kg per hour. In contrast, the increase in GnRH receptor expression induced by higher levels of estrogen stimulation was not affected (p > 0.05) by concurrent administration of C. The effect of C on the temporal pattern of E2-dependent increase in GnRH receptor expression was assessed using wethers receiving E2 (0.5 microg/50 kg per hour) by continuous infusion for 0 (groups 1 and 5), 24 (groups 2 and 6), 48 (groups 3 and 7), or 72 h (groups 4 and 8). Animals received C (5.0 mg/50 kg per hour; groups 1-4) or vehicle (groups 5-8) beginning 24 h before, and continuing throughout, the E2 delivery period. Stress-like concentrations of C reduced (p < 0. 05) the increase in GnRH receptor and receptor mRNA induced after 24 h of E2 stimulation. However, the suppressive effect of C was transient, and tissue levels of GnRH receptor and receptor mRNA were comparable after 72 h of E2 infusion in animals receiving C or vehicle alone. Collectively these observations demonstrate that C suppresses estrogen-dependent increase in tissue concentrations of GnRH receptor and receptor mRNA. However, this effect of C is transient and not evident in animals receiving moderate to high levels of estrogen stimulation. This transient suppression of GnRH receptor expression may account, at least in part, for the anti-gonadal effect of glucocorticoids.

Cytokine secretion by human fetal membranes, decidua and placenta at term.

Cytokines such as monocyte chemotactic peptide-1 (MCP-1), interleukin-8 (IL-8), RANTES (Regulated on Activation and Normally T-cells Expressed and presumably Secreted) and interleukin-10 (IL-10) are thought to play pivotal roles in immune recognition, acceptance of the fetal allograft, maintenance of pregnancy and parturition. Their secretion and regulation within the third trimester uterus is, however, less well defined. We therefore investigated the release of these cytokines by third trimester amnion, chorion, placenta and decidua, and studied the influence of prostaglandin E2 (PGE2) infusion on their release in a dynamic placental cotyledon perfusion system. MCP-1 was released predominately by the chorion (78.2 +/- 7.3 pg/mg wet tissue weight; mean +/- SEM), decidua (112.4 +/- 5.2 pg/mg) and placenta (101.8 +/- 5.0 pg/mg) with low amounts from the amnion (1.3 +/- 0.4 pg/mg). High concentrations of IL-8 were released by the amnion (39.9 +/- 5.3 pg/mg), chorion (52.8 +/- 1.9 pg/mg), decidua (42.2 +/- 1.5 pg/mg) and placenta (45 +/- 1.3 pg/mg). Release of RANTES was not detectable from the amnion but was detected in moderate amounts from the chorion (6.0 +/- 1.2 pg/mg), decidua (15.2 +/- 1.4 pg/mg) and placenta (26.9 +/- 1.6 pg/mg). Low concentrations of IL-10 were secreted by the chorion (6.8 +/- 0.8 pg/mg), decidua (9.0 +/- 0.9 pg/mg) and placenta (3.3 +/- 0.3 pg/mg) with none detectable from the amnion. MCP-1, IL-8, RANTES and IL-10 were all released by perfused placental cotyledons. PGE2 stimulated release of MCP-1, IL-8 and IL-10 into the maternal and of MCP-1 and IL-8 into the fetal circulation of the placenta but had no effect on RANTES release. It is suggested that MCP-1 and IL-8 may be involved in the inflammatory process of parturition and IL-10 in the protection of the fetal allograft. In addition, PGE2 may have an important immunomodulatory role within the uterus at term.

In pubertal girls, naloxone fails to reverse the suppression of luteinizing hormone secretion by estradiol.

Estradiol (E2) negative feedback on LH secretion was examined in 10 pubertal girls, testing the hypothesis that E2 suppresses LH pulse frequency and amplitude through opioid pathways. At 1000 h, a 32-h saline infusion was given, followed 1 week later by an E2 infusion at 13.8 nmol/m2 x h. During both infusions, four iv boluses of saline were given hourly beginning at 1200 h, and four naloxone iv boluses (0.1 mg/kg each) were given hourly beginning at 1200 h on the following day. Blood was obtained every 15 min for LH determination and every 60 min for E2 determination from 1200 h to the end of the infusion. E2 infusion increased the mean serum E2 concentration from 44+/-17 to 112+/-26 pmol/L (P < 0.01). The mean LH concentration between 2200-1200 h decreased from 3.19+/-0.89 to 1.99+/-0.65 IU/L (P = 0.014), and LH pulse amplitude decreased from 3.4+/-0.6 to 2.6+/-0.5 IU/L (P = 0.0076). Although there were 1.2 fewer pulses during E2 infusion compared to saline infusion, differences did not reach significance (P = 0.1; 95% confidence interval for the difference, -3.5, 1.1). Pituitary responsiveness to GnRH, assessed at the end of the infusion by administering 250 ng/kg GnRH iv, did not change during E2 infusion. The effect of naloxone blockade of opioid activity on LH secretion was determined by assessing the area under the curve (AUC) from 1200-1600 h. During saline infusion, the LH AUC was 1122+/-375 IU/L during saline boluses and 1575+/-403 IU/L during naloxone boluses (P = 0.39). When E2 was infused, the LH AUCs during saline and naloxone boluses were 865+/-249 and 866+/-250 IU/L, respectively. Thus, in pubertal girls: 1) E2 decreases the LH concentration and LH pulse amplitude; 2) the main site of negative feedback effect of E2 appears to be at the level of the hypothalamus; 3) an increase in LH secretion after naloxone administration could not be demonstrated in these girls and may depend on the maturity of the hypothalamic-pituitary-gonadal axis; and 4) opioid receptor blockade does not reverse the E2 inhibition of LH secretion even in the most mature girls. Thus, E2 suppression of LH secretion in pubertal girls appears to be mediated by a decrease in hypothalamic GnRH secretion that is independent of opioid pathways.

The effect of season and melatonin on GnRH-induced LH secretion in oestradiol-treated orchidectomized sheep.

The biphasic effect of oestradiol (E2) on gonadotrope responsiveness is clearly evident in orchidectomized sheep (wethers) receiving E2 and hourly pulses of GnRH. We hypothesized that the duration of E2-induced reduction in gonadotrope responsiveness differed between the breeding (November) and anoestrous (May) seasons in sheep. To test this hypothesis wethers (n = 6/group) were infused (i.v.) with E2 (2 micrograms/50 kg per h) and received hourly pulses of GnRH (200 ng/50 kg per pulse) or saline in May or November. The pattern of LH secretion during the 72 h infusion period was determined. Serum concentrations of LH did not differ with season in control wethers receiving vehicle alone. Similarly, continuous infusion of E2 resulted in a 3-fold reduction in serum LH, irrespective of season. This E2-induced suppression of serum LH was reversed by concurrent episodic delivery of GnRH. The interval between initiation of infusion and return of pretreatment concentrations of LH was taken as a measure of the duration of E2-induced suppression of gonadotrope responsiveness. The duration of this E2-dependent response varied with season, with suppression of gonadotrope responsiveness more prolonged (P < 0.05) in May (36.7 +/- 2.9 h) than in November (14.3 +/- 1.1 h). In a companion study we examined the effect of melatonin on the duration of E2-induced suppression of gonadotrope responsiveness. Wethers received blank or melatonin-containing implants in March. Sixty days after implant insertion (mid-May) wethers received E2 (2 micrograms/50 kg per h) and hourly pulses of GnRH (200 ng/50 kg per pulse) or saline for 72 h. Continuous delivery of E2 alone resulted in a 3-fold decrease in serum concentrations of LH in both control and melatonin-treated wethers. The duration of E2-induced suppression of gonadotrope responsiveness in animals receiving E2 and GnRH was extended (P < 0.05) in wethers with blank implants (48.0 +/- 0.7 h), relative to the duration of suppression in melatonin-treated wethers (14.5 +/- 1.0 h). Taken together these data indicate that E2-induced suppression of gonadotrope responsiveness is more extended during the anoestrous season. However, this seasonal effect can be reversed by continuous administration of melatonin.

Synergistic effects of prostaglandin F2alpha and tumor necrosis factor to induce luteolysis in the pig.

There is ample evidence that prostaglandin F2alpha (PGF2alpha) is a luteolytic substance in sows, however, there is also some evidence that it may stimulate progesterone (P4) secretion in young corpora lutea (CL). In vitro studies also suggested that tumor necrosis factor alpha (TNF) is inhibitory to luteal cell P4 and estradiol-17beta (E2) release. Since E2 is a strong luteotropic substance in porcine CL, we studied the effects of intraluteal application of PGF2alpha and TNF alone and in combination on the secretion of P4 and E2 in freely moving sows. Furthermore, the effects of intraluteal infusion of E2 and its stereoisomer, estradiol-17alpha, on luteal function, were also determined. Microdialysis systems were implanted into CL at Day 10 of the estrous cycle. After a 24-h recovery period, PGF2alpha (10(-6) M) or E2 (10(-6) M) was applied daily for 6 h into the CL. PGF2alpha caused a stimulation of E2 and P4, and E2 also stimulated P4 secretion at Days 11 and 12, but the stimulatory effect of both substances diminished as the CL approached luteolysis. Intraluteal TNF application resulted in a transient increase of P4 secretion, which was followed by a dramatic reduction of P4 release. When TNF-pretreated CL were exposed to PGF2alpha at Day 11 of the estrous cycle, the prostaglandin was no longer able to stimulate but rather inhibited E2 and P4 secretion. Intraluteal application of estradiol-17alpha had no effect on P4 secretion. These results are suggestive that the PGF2alpha-induced E2 secretion in young and middle-aged CL is stimulatory to P4 secretion. Under the influence of macrophage-derived TNF production, E2 secretion is inhibited, and thereby PGF2alpha and TNF cause functional luteolysis.

Prolonged Estradiol Infusion Causes a Marked and Sustained Increase in Pulmonary Blood Flow in Fetal Lambs • 1717

Estradiol (E2), a steroid hormone which causes vasodilation of many adult tissues, is present in high levels in the fetus and surges just prior to delivery. However, whether E2 contributes to the marked increase in pulmonary blood flow (PBF) which characterizes the normal transitional circulation at birth is not known. Because the surge in E2 immediately preceeds the fall in pulmonary vascular resistance (PVR), we hypothesized that E2 modulates the increase in PBF at birth. To study whether E2 causes pulmonary vasodilation in fetal lambs, we treated chronically prepared lambs with intrapulmonary infusions of E2 or vehicle (V) and measured their hemodynamic responses. Fetal surgery was performed at 128 d (term=147 d) and catheters were placed in the aorta, main pulmonary artery, and left atrium for pressure measurements and the left pulmonary artery (LPA) for local infusions of E2. An ultrasonic flow transducer was placed around the left pulmonary artery to measure blood flow. Aortic and pulmonary artery pressure (PAP), left atrial pressure (LAP), and left pulmonary blood flow (Qp) were measured daily. PVR in the left lung was calculated by (PAP-LAP)/Qp. After recovery from surgery, E2 (250 ng/hr; n=9) or vehicle (0.025% ethanol; n=4) was infused continuously into the LPA for 8 days or until PBF increased. E2 treatment increased left lung blood flow(195±44 vs. 55±12 ml/min, E2 vs. V, p<0.05) and decreased left lung PVR (0.31±0.07 vs. 0.93±0.20 mmHg/ml/min, E2 vs. V, p<0.05). The response of individual animals varied markedly and treated females responded earlier than did males (change in left lung PVR at 48 hours,-44±16 vs. 15±10%, female vs. male, p<0.05). In a second set of extremely premature animals (n=4), fetal surgery was performed at 114 d and E2 infusions started 3 d after surgery. 2 of these 4 animals responded, with PBF increasing from 53 and 73 to 186 and 173 ml/min, respectively. We conclude that continuous infusion of E2 causes marked and sustained pulmonary vasodilation in near-term fetal lambs, and that this effect can also be demonstrated in very premature fetal lambs. Because E2 causes acute nitric oxide (NO) release and endothelial nitric oxide synthase upregulation in isolated pulmonary artery endothelial cells from fetal lambs, we speculate that E2 mediates its vasoactive effects through endogenous NO release.