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Background: The matrix metalloproteinase (MMP) family is known to play a key role in tissue remodelling during embryonic development and in pathological conditions, such as cardiovascular disease, arthritis and cancer metastasis. It has been shown previously that p53 regulates positively or negatively the expression of different MMPs. Because of p53 overexpression in trophoblastic cells, and its potential role in regulating MMP-2 and MMP-9 expression in different cell lines, we hypothesized that the expression of MMP-9 could also be regulated by p53 in first trimester cytotrophoblasts (CTB)., Methods and Results: Transfection experiments in CTB demonstrated that wild-type p53 down-regulates the -670 (P < 0.001) but not the -531 and -90 human MMP-9 promoter/CAT reporter plasmid activity, whereas p53 mutants partially lost this repressive activity. However, endogenous p53 is not able to regulate MMP-9 expression in CTB. The presence of high molecular weight complexes of p53 in CTB suggests a potential mechanism of inactivation of p53 transcriptional activity towards MMPs in these cells., Conclusions: Although p53 is mutated in trophoblast, it is functionally incompetent towards MMPs in these cells.

Tumour invasion and trophoblastic invasion share the same biochemical mediators: the matrix metalloproteinases (MMP) and their inhibitors (TIMP). MMP are a family of enzymes capable of digesting the extracellular matrices of the host tissues. Human cytotrophoblastic cells are constitutively invasive and produce MMP. That MMP are causally related to trophoblast invasion in the endometrium is shown by the fact that TIMPs inhibit cytotrophoblastic invasion in vitro. In contrast to tumour invasion of a host tissue, trophoblastic invasion during implantation and placentation is stringently controlled both in space and time. The factors responsible for these important regulatory processes are unknown, but in-vitro studies point to autocrine (trophoblastic) and paracrine (endometrial) controls by cytokines and growth factors. These regulators exert their effects directly or indirectly by activating nuclear transcription factors. Transcription factors are proteins or protein complexes (often the products of oncogenes) that activate genes by binding to specific sites of the DNA located in the regulatory (5' flanking) region of genes. This review describes the different DNA binding domains of the MMP-9 gene, summarizes our knowledge about the transcription factors involved and speculates about a potential role of these transcription factors (particularly the oncogenes Jun and Fos) in regulating trophoblast invasion.

The source of CA125 synthesis is still debated. Endometrial, peritoneal, ovarian and amniotic cells have been demonstrated to produce and secrete CA125. Different studies show that the peritoneum is a source of CA125. The present study aimed at investigating in vivo and in vitro the peritoneal contribution to circulating CA125. Cultures of uterine peritoneum, abdominal peritoneum and myometrium explants were performed and CA125 measured in the culture medium. To modulate the potential production of CA125, the explants were cultured with or without cycloheximide, bacterial lipopolysaccharide (LPS) or ascitic fluid. In a prospective study, we compared a group of patients after abdominal surgery (n = 19; nine men, 10 women) with a group after extra-abdominal surgery (n = 21; 11 men, 10 women), in order to detect a postoperative increase of serum CA125. De-novo synthesis of CA125 could not be demonstrated in the cultures of uterine and abdominal peritoneum and in myometrium, but CA125 concentrations were detectable in the culture medium without being modulated by cycloheximide, LPS or ascitic fluid. After peritoneal surgery, the proportion of patients with increased serum CA125 was significantly higher (P < 0.03) after abdominal surgery as compared with extra-abdominal surgery. This is considered as indirect evidence for in-vivo production of CA125 by the peritoneum.

Previous reports have demonstrated the presence of DNA of the human helper virus-dependent adeno-associated parvovirus (AAV) in uterine tissue and curettage material from early miscarriage. To examine infection of embryonic tissue during pregnancy, amnion fluids were analysed for the presence of AAV. Using polymerase chain reaction, AAV DNA was detected in 64 out of 238 DNA samples extracted from amnion cells. DNA of helper viruses were found in 12% (papillomavirus) and 18% (cytomegalovirus) of the samples (double infections with AAV in eight and nine cases, respectively). Furthermore, infectious AAV virions were found in 13 out of 43 AAV DNA-containing samples. In mothers with AAV DNA-positive amnion fluids, premature amniorrhexis and premature labour occurred significantly more frequently (P < 0.001). Using an immunofluorescence assay, 24% of newborn sera (unrelated to the amnion fluid samples) were found to contain IgM antibodies to AAV, in most cases paralleled by IgM antibodies in the mother's sera. The data demonstrate that AAV infection can occur in utero at early and at late stages of pregnancy. The observed complications at delivery should encourage studies to clarify possible pathological consequences of AAV infection in pregnancy and a possible latent infection of the fetus.

The objective of this study was to evaluate the bioactivity of human chorionic gonadotrophin (HCG) during first trimester pregnancy. This was done by means of a retrospective analysis of sera from patients with first trimester normal intrauterine and ectopic pregnancies. Serum samples were obtained from 38 women with amenorrhoea of <10 weeks. From these, 19 had a normal intrauterine pregnancy (IUP) and 19 an ectopic pregnancy (EP). Cases were allocated to either low serum immunoreactive HCG (HCGi), intermediate HCGi or high HCGi concentrations (HCGi <5000 mUI/ml, between 5000 and 40,000 mIU/ml and >40,000 mIU/ml respectively). HCGi and oestradiol were measured by enzyme immunoassays and bioactive HCG by the mouse Leydig cell bioassay. All results were analysed by analysis of variance and unpaired Student's t-test. There was a significant difference between bioactive to immunoreactive HCG ratios (b/i ratio) between the subgroups of low, intermediate and high HCGi concentrations. Lower b/i ratios were found when HCGi concentrations were high (HCG b/i mean +/- SEM: high subgroup, 0.33 +/- 0.07 versus low subgroup: 1.50 +/- 0.12; P < 0.0001). Furthermore, the b/i ratios were inversely correlated with oestradiol (P < 0.0001) and HCGi (P < 0.0001) concentrations but not with gestational age. There was no difference in the b/i ratios when comparing IUP with EP. It is concluded that, in first trimester pregnancies, there is a likely modulation of HCG bioactivity which is inversely correlated with HCGi and oestradiol concentration. The underlying mechanisms and their physiological relevance remain to be elucidated.

Improved embryo culture protocols now render more feasible the possibility of obtaining human blastocysts after in-vitro fertilization. In this study we present: (i) results of blastocyst development from supernumerary embryos after co-culture on green monkey kidney epithelial cells and (ii) pregnancy rates after transfer of frozen blastocysts. In addition, we have examined the influence of the day of blastocyst freezing and the day of transfer after the luteinizing hormone (LH) peak on pregnancy and implantation rates. Of 423 supernumerary embryos, 200 developed to the blastocyst stage (47.3%). By days 5 and 6, 67% of the blastocysts had reached the blastocyst stage, and were frozen, compared to 28.5% by day 7. When we compared the cases where only blastocysts frozen on days 5 and 6 were transferred compared to those frozen and transferred on or after day 7 the pregnancy rates were 7/18 (38.9%) and 1/16 (6.2%) respectively. In contrast, when we examined the influence of the day of transfer we found that pregnancies were established from day 5 up to day 9 post LH peak. Based on these results, we suggest that every attempt should be made to increase the development rate of supernumerary embryos to the blastocyst stage, as it appears that the quality of blastocysts transferred, as shown in this study by rate of development, plays a more crucial role than the timing of transfer.

The aim of our study was to compare three protocols for second-trimester maternal serum screening for Down's syndrome in the same serum samples, using two triple tests [total human chorionic gonadotrophin (HCG), alpha-fetoprotein, unconjugated oestriol; and free beta-HCG, alpha-fetoprotein, unconjugated oestriol] and a double test (free beta-HCG and alpha-fetoprotein). The three protocols were compared in a series of 23 serum samples from Down's syndrome pregnancies and in a cohort of 2516 pregnant women receiving routine antenatal care between June 1992 and June 1993. Among the 23 affected cases, at a cut-off risk of 1:380, the detection rate of Down's syndrome was comparable with the double test (74%; 17/23) and the triple tests (65%; 15/23) (not significantly different). At the same cut-off risk, in the cohort of 2516 pregnant women screened between 15 and 18 weeks gestation, both protocols using free beta-HCG achieved a significant reduction of the number of false positive cases (P = 0.013 and 0.004 for double and triple tests respectively). We conclude that, compared to total HCG, alpha-fetoprotein and unconjugated oestriol, use of free beta-HCG and alpha-fetoprotein represents a better second-trimester screening test for Down's syndrome, because it significantly decreases the false positive rate at a lower running cost. The addition of unconjugated oestriol to the double test adds no further advantage.

Ovarian cancer marker CA 125 was measured in human seminal plasma, and the concentrations ranged between 22 and 1149 U/ml, and between 39 and 4711 U/ejaculate. This very high patient-to-patient variability was in contrast to a much lower within-patient variability, which was comparable to that of other semen parameters. No significant differences in CA 125 concentration were found in seminal plasma from normospermic patients, patients with male factors, vasectomized men, and in aliquots of samples which led to a pregnancy, via artificial insemination or in-vitro fertilization. The seminal plasma CA 125 concentration was not correlated with sperm count, motility and morphology. In contrast, seminal plasma CA 125 concentrations correlated with the age of the patient (P < 0.001) and inversely with the volume of the ejaculate (P < 0.001). These correlations were independent of each other. CA 125 did not correlate with the prostatic marker zinc, but did do so with the seminal vesicle marker fructose and the epididymal marker carnitine.

Collagenolytic activity of cytotrophoblasts is stimulated by glycoproteins of the extracellular matrix and since this stimulation can possibly occur through integrins, we measured the gelatinolytic activity of villous and extravillous cytotrophoblasts according to the type of integrins expressed on these cells. Cytotrophoblasts were isolated from legal abortions, immunopurified with anti-CD45, separated according to their expression of histocompatibility-linked antigen (HLA)-G, alpha 6 or alpha 5 integrin subunits and cultured for 5 days on plastic or agarose. Fetal fibronectin, human chorionic gonadotrophin (HCG) and the gelatinolytic activity were measured in the culture supernatants. Following immunopurification with anti-CD45, the gelatinolytic activity of cytotrophoblasts was significantly higher than before, indicating that contaminating lymphomyeloid cells secreted gelatinolytic inhibitors. HLA-G positive cells secreted significantly more gelatinases than HLA-G negative cells but their HCG secretion was similar. Compared to alpha 5 positive cells, alpha 6 positive cytotrophoblasts secreted significantly more gelatinases, significantly less fibronectin but similar amounts of HCG. We conclude that during trophoblast invasion, extravillous cytotrophoblasts (HLA-G positive) expressing the alpha 6 integrin subunit represent the invasive population of cells (high gelatinase and low fibronectin secretion). When expression of the alpha 5 integrin subunit is turned on, their invasive behaviour ceases and they secrete low amounts of gelatinases and high concentrations of fibronectin.

It is well known that luteinizing hormone (LH), like many other glycoproteins, is heterogeneous and presents several circulating isoforms. Recently, new sensitive immunometric assays measuring intact LH were developed. These assays have been found to underestimate or to be incapable of recognizing LH in some patients. This study was undertaken to determine the prevalence of such cases and to define their clinical characteristics. We compared three LH assays using as capture antibodies either a monoclonal antibody that reacts exclusively with intact LH (ES 600 Boehringer, Stratus Baxter) or a monoclonal antibody against the beta subunit of LH (IMX Abbott). In 17% of 90 patients tested, ES 600 measured > 50% lower LH concentrations when compared with the IMX. Moreover, in two cases LH was not detectable by ES 600 or Stratus, whereas it was normal with the IMX. We found another five such cases and discuss here the clinical data and results of different hormone measurements in these seven cases of 'invisible LH'. Although bioactive LH (mouse Leydig cell assay) was normal, the existence of low or even undetectable LH was clinically confusing and led to expensive complementary investigations such as gonadotrophin-releasing hormone analogue tests and magnetic resonance imaging. The uses and limitations of these assays are illustrated by different clinical situations in which the results of the different assays have been misleading.

It has been shown that rat and human endometria have the capacity to produce complement component 3 (C3). In rats, endometrial C3 is an oestrogen-dependent protein produced and secreted by glandular cells. The cell responsible for the synthesis and secretion of human endometrial C3 has not been clearly defined. Our study was aimed at answering this question. Samples of endometrium obtained from hysterectomies were either immunostained for C3 or digested with collagenase; then the stromal and glandular cells were separated and immunopurified (or not) with an antibody to CD45 coupled to magnetic beads to eliminate the endometrial lymphomyeloid cells. Cells were cultured for 2 weeks and C3 measured in the medium by an in-house radioimmunoassay. Glandular as well as stromal cells stained positively for C3 and released C3 in vitro. The release of C3 from both cell types could be inhibited by cycloheximide. Epithelial cells produced significantly more C3 than stromal cells, and endometrial C3 production was higher for both cell types when these were obtained from secretory as compared to proliferative endometria. Lymphomyeloid cells were possibly a source of C3 since after immunoadsorption of these cells, the remaining stromal or glandular cells produced significantly less C3. We conclude that endometrial stromal, glandular and lymphomyeloid cells all produce C3.

CA 125, a marker of ovarian cancer, is also increased in otherwise normal women suffering from, for example, pelvic inflammatory disease, endometriosis and adenomyosis. The tissues suspected of producing CA 125 in normal women include the endometrium, the ovary and the peritoneum. This study was based on the hypothesis that uterine myomata would distend the peritoneum covering the uterus and thereby increase the peripheral levels of CA 125. To verify this hypothesis we measured CA 125 by an immunoradiometric assay in eight normal women every second day throughout the cycle and in 26 women with uterine fibroids before and after hysterectomy and at 8 and 12 weeks during gonadotrophin releasing hormone (GnRH) analogue therapy. In normal women no difference was observed between CA 125 levels in the follicular phase or in the luteal phase of the cycle. Over one-third (10/26) of the patients with uterine fibroids had increased (greater than 90th centile of the controls) levels of CA 125 before GnRH therapy or hysterectomy. Removal of the uterus or administration of GnRH significantly decreased peripheral concentrations of CA 125 to levels below those observed in normal women. Furthermore, a significant positive correlation was observed between the levels of CA 125 and the volume of myomata as assessed by ultrasound. We conclude that in those cases of uterine fibroids where CA 125 is increased, monitoring this parameter during GnRH therapy is a good indirect measurement of regression of myomata.

The prediction of ovulation is necessary for oocyte aspiration in a spontaneous cycle and can be reliably achieved only by measuring luteinizing hormone (LH). Since radioimmunoassays of LH take too long for repeated measurements on the same day, we evaluated the possibility of adapting a rapid and fully automated assay of serum LH for use with urine samples. The study group comprised spontaneously ovulating women (38 cycles) who requested artificial insemination. Their serum oestradiol (E2) levels, ultrasound profile (US) and thrice daily urinary LH levels were determined from day 10 of their menstrual cycle. These patients were followed until US signs of follicular rupture were recorded. In all patients, a well-defined LH peak was measured in the urine. This peak lasted 12-15 h and was followed in 35 cycles (no US available for 3) by follicular rupture 9-51 h later. The data were grouped according to the time of the LH peak on day 0. Patients experiencing an LH peak between 0300 h and 0700 h on day 0 had significantly lower levels of E2 on day 0 compared to those with an LH peak between 2200 h and midnight. This is due to the fact that in the patients with an LH peak between 0300 h and 0700 h, E2 levels were already decreasing (from day 1 to day 0), whereas in those with the LH peak between 2200 h and midnight E2 levels were still increasing on the morning of day 0. We conclude that the 30-min IMX LH assay is a reliable, rapid and readily acceptable method for measuring urinary LH and for the prediction of ovulation.

Cancer antigen 125 (CA125) is an antigenic determinant defined by a murine monoclonal antibody and is present on the surface of some ovarian tumours. Using an immunoradiometric assay CA125 immunoreactivity was found in amniotic fluid and decidual extracts, hence the possibility of an endometrial origin of CA125 in pregnant and non-pregnant women was investigated. First-trimester decidual explants produced CA125 in vitro and cycloheximide significantly reduced the concentration of CA125 both in the medium and in the tissue. CA125 was also produced in primary culture of human endometrial stromal cells, its concentration in the medium being significantly higher with cells obtained during the proliferative and early secretory phases compared to those obtained during the late secretory phases. Medroxyprogesterone acetate (MPA, 1 mumol/l) induced a significant inhibition of CA125 production. This effect could be blocked by oestradiol (E2, 36 nmol/l) or the antiprogesterone RU486 (10 mumol/l). In women with endometriosis, the circulating levels of CA125 increased with the severity of the disease and were found to be significantly higher when compared to those of healthy volunteers. Gonadotrophin-releasing hormone or Danatrol therapy significantly reduced the CA125 levels. The endometrium, decidualized or not, seem to be capable of producing CA125, and this production is evidently correlated with endometrial cell growth and/or activity.

Pregnancy-associated plasma protein-A (PAPP-A) has been found in seminal fluid at concentrations 10-20 times higher than in plasma. This observation prompted us to undertake a morphological study of the male genital tract with the aid of the immunoperoxidase technique. Immunoreactive cells were found among the Leydig cell population, as well as among the epithelium of the rete testis, the head of the epididymis and the seminal vesicles. The relatively small number of weakly staining epithelial cells leaves open the question of whether PAPP-A is excreted by these cells or whether an active transfer mechanism - possibly in the seminal vesicles - is at work, the Leydig cells increasing the plasma concentration locally, by secretion of PAPP-A into the circulation.

RU486 [17 beta-hydroxy-11 beta-(4-dimethylaminophenyl)-17 alpha- (prop-1-ynyl)-oestra-4,9-dien-3-one] a potent progesterone antagonist, was shown to induce abortions in humans. Human chorionic gonadotrophin (HCG) and pregnancy-associated plasma protein-A (PAPP-A) decreased after RU486 administration, but it was not clear whether these effects were due to RU486 or secondary to trophoblast damage. To answer this question we tested the in-vitro effects of RU486 on short-term cultures of trophoblastic and decidual explants. It was observed that RU486 induced a significant inhibition of the trophoblastic production rate of beta HCG and PAPP-A but not human placental lactogen. This effect could be overcome by addition of progesterone (for PAPP-A and beta HCG) or cortisol (for beta HCG). Decidual prolactin (Prl) or PAPP-A secretions were also inhibited by RU486. Progesterone antagonized these effects, whereas cortisol was ineffective. These results suggest that PAPP-A is a progesterone-dependent protein and that the abortifacient effect of RU486 in humans could at least partially be due to an inhibition of the production of HCG and/or PAPP-A.

A human-SP1 immunoassay was used to detect SP1-like material (SP1) in the plasma of cynomolgus monkeys. In 27 females remaining non-pregnant during a mating period of 4 months, SP1 was occasionally detected at a mean concentration of 2.5 ng/ml. In 14 non-pregnant females of subsequent proven fertility, SP1 was detected 20 days following unfertile mating at a mean concentration of 4.8 ng/ml in 86% of cycles. At day 20 of proven pregnancies, SP1 was at 12 ng/ml in 93% of these animals. SP1 levels during pregnancy increased in two steps, a slow rise between days 20 and 50, followed by an abrupt rise between days 50 and 60 and afterwards a plateau at 600 ng/ml. Seven other pregnant monkeys received 10 mg/kg of the antiprogestin RU 486 at 28 days. Four aborted and the others continued their gestation. SP1 was always dramatically depressed by this treatment; in animals with abortion failure, it remained at a low concentration for 3 months, then the normal concentration range was recovered. The assay of SP1-like material does not allow early diagnosis of pregnancy, however, it remains interesting as a follow-up parameter after 60 days. Also, antiprogestins appear to be useful tools to analyse the metabolism of SP1.

Pregnancy-associated plasma protein-A (PAPP-A), a macromolecular glycoprotein of placental origin, was reported to be depressed in established ectopic pregnancies. CA 125 is a known marker for ovarian cancer found to be elevated during the first trimester of pregnancy and in women with pelvic inflammatory disease. The present study investigated the usefulness of these parameters to predict the outcome of pregnancy in asymptomatic patients with a positive pregnancy test after in-vitro fertilization and embryo transfer (IVF-ET). Blood samples (n = 159) were obtained at different periods of time post-ET from 39 women, 21 of whom experienced a normal pregnancy, 12 had an intrauterine abortion and six had an ectopic pregnancy. PAPP-A and CA 125 were measured by radioimmunoassays. From day 30 onwards in normal pregnancies, PAPP-A was significantly increased over non-pregnant controls. In the spontaneous abortion group, the levels of PAPP-A were significantly lower than in normal pregnancy but higher than in non-pregnant controls. In ectopic pregnancy, PAPP-A remained at the level of non-pregnant controls throughout the entire observation period. CA 125 was significantly increased in all types of pregnancy. However, in two cases of hyperstimulation followed by a normal pregnancy and in four cases of ectopic pregnancy with signs of peritoneal irritation (hydrosalpinx, ruptured ectopic or salpingitis) the levels of CA 125 were 15-50 times higher than in normal pregnancies.(ABSTRACT TRUNCATED AT 250 WORDS)