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Clinical outcome of confined placental mosaicism (CPM) is varied, from normal pregnancy to intrauterine fetal death. It has been suggested that CPM for trisomy 2 is less likely to cause serious adverse effect on pregnancy. We hereby report a case of CPM for trisomy 2, which presented severe fetal growth restriction (FGR) and placental abnormalities. A 30-year-old woman was referred to our hospital at 17⁺² weeks because of marked FGR. Ultrasonography demonstrated prominent placental hypertrophy with multiple focal defects without any fetal structural abnormalities. Amniocentesis at 18⁺³ weeks revealed normal karyotype. Fetal growth rate worsened with gestational weeks, reaching -7 standard deviation at 36 weeks. At 37 weeks, the fetal condition suddenly deteriorated, ending in a stillbirth of a 756-g female baby. Postnatal cytogenetic analysis by array comparative genomic hybridization revealed trisomy 2 of the chorionic villi, and CPM for trisomy 2 was suggested as the cause of FGR and placental abnormalities., (© 2013 The Authors. Journal of Obstetrics and Gynaecology Research © 2013 Japan Society of Obstetrics and Gynecology.)

Problem: Lysophosphatidic acid (LPA) is a bioactive lipid mediator and thought to play an important role in pregnancy. Plasma LPA is produced by autotaxin (ATX), and ATX activity in plasma increases during pregnancy paralleled with gestational weeks and decreases to near the non-pregnant level soon after delivery. However, the source of increased ATX during pregnancy is still uncertain. We hypothesized that the source of increased ATX might be placenta., Method of Study: We investigated the protein and mRNA expression of ATX in human placenta using immunohistochemistry and RT-PCR, respectively., Results: At all 3 gestational trimesters, immunohistochemical staining for placenta tissues revealed the most marked positive staining of ATX protein in trophoblasts. Real-time PCR revealed that mRNA amounts of ATX in placenta tissues paralleled with gestational weeks, i.e. ATX level in plasma., Conclusion: These findings suggest that trophoblasts might produce ATX and its bioactive resultant substance, LPA, paralleled with gestational weeks.

Background: Recently, multifractal analysis based on generalized concepts of fractals has been applied to biological tissues composed of complex structures., Methods: Using digitized images of the maternal surface of 278 placentas, multifractal parameters were measured with a fractal analysis software., Results: The values of alpha(min), alpha(0), alpha(max) and the degree of multifractality given by the alpha(max) - alpha(min) difference calculated from 278 placentas were 1.840 +/- 0.068, 2.089 +/- 0.034, 2.856 +/- 0.128 and 1.017 +/- 0.136, respectively. A significant decrease of alpha(min) and as a consequence a significant increase in the degree of multifractality were observed according to gestational age. The alpha(0) value of the placenta complicated by pregnancy-induced hypertension (PIH) was significantly higher than that without PIH. The alpha(min) and alpha(0) values of the placenta having intrauterine growth restriction (IUGR) were significantly higher than those without IUGR. On the other hand, the presence of chorioamnionitis did not change multifractal properties of the maternal surface of the placenta., Conclusion: The multifractal parameters may be objective indices of the heterogeneity or complexity of the macroscopic morphology of the maternal surface of the placenta. Multifractal analysis holds a promise for quantitatively evaluating physiological and pathological development of the placenta., ((c) 2008 S. Karger AG, Basel.)

To understand a mechanism for the difference in clinical manifestations of congenital cytomegalovirus (CMV) infection between dizygotic twins, the placentas of the dizygotic twins were evaluated for the number of the cells infected with CMV by immunohistochemical and in situ hybridization studies. A Japanese woman with dizygotic twin pregnancy had immunoglobulin M antibodies to CMV at 15 weeks gestation. Intrauterine growth retardation was noted only in the first twin. At birth, CMV was isolated from urine culture in both twins. Clinical manifestations for CMV, such as petechiae, jaundice, hepatosplenomegaly, and deafness were more pronounced in the first twin than in the second twin. Immunohistochemical and in situ hybridization studies showed CMV-positive cells two or three times more densely distributed in the placenta of the first twin compared with the second twin. These data suggest the severity of CMV manifestations of dizygotic twins may be in accord with the number of CMV-positive cells in the placenta.

Problem Human leukocyte antigen (HLA)-F together with other class 1b HLAs may play a pivotal role in immunological interaction at feto-maternal interface. However, it is not elucidated whether HLA-F is expressed on cell surface of extra-villous trophoblasts (EVTs). Method of study The localization of HLA-F in placenta of each trimester was investigated by immunohistochemistry. The expression modality of HLA-F molecule was compared with that of HLA-G in cultured EVTs using flowcytometry. Results and conclusion In immunohistochemical study, remarkable staining for HLA-F was confirmed in EVTs throughout gestation. HLA-F expression was restricted to be intracellular in cultured EVTs. HLA-F expression was increased with time in culture, which was accompanied by the increase of cell surface HLA-G. Consequently, HLA-F lacking in cell surface expression on EVTs may not contribute to the direct cell-to-cell immune reaction but might work supportively modifying the function of HLA-G. [ABSTRACT FROM AUTHOR]

Abstract: CD1d is a specific ligand for the invariant Vα24Vβ11-natural killer T (iNKT) cells that play an important role in placental development during early human pregnancy. The localization and regulation of placental CD1d expression remain unclear. Immunohistochemistry of human early gestational placentas revealed CD1d was present in villous and extravillous trophoblast (EVT) but not in syncytiotrophoblast or decidual cells. CD1d immunoreactivity in EVT cells decreased with EVT differentiation. Flow cytometry of primary cultured human trophoblast cells confirmed cell-surface expression of CD1d decreased with time in culture. These changes in CD1d expression occur at the level of transcription. TGF-β1 secreted from the cultured EVT cells accumulated with time in culture and directly suppressed CD1d expression, as evidenced by monoclonal antibody neutralization of TGF-β1 effects. Thus, trophoblast differentiation is characterized by TGF-β1-mediated decreases in trophoblast cell CD1d expression. This effect may support appropriate activation of decidual iNKT cells at the maternal-fetal interface. [Copyright &y& Elsevier]

Placental hypoxia following the immature remodeling of spiral arteries by extravillous cytotrophoblasts (CTs) is focused on the pathogenesis of pre-eclampsia. At the same time, the expression of human leukocyte antigen (HLA)-G is decreased at the protein and mRNA levels in the pre-eclamptic placenta. In view of the potential function of HLA-G in immunological tolerance in the feto–maternal interface, we were much concerned to find whether the lowered expression of HLA-G in the pre-eclamptic placenta is a precursor or the result of placental hypoxia. The effect of oxygen on the expression of membrane-bound (mb) and soluble (s) HLA-G was investigated in primary cultures of extravillous CTs. The undifferentiated CTs isolated from the first-trimester placenta were cultured with different concentrations of oxygen (20%, 8% and 2%). The protein expression of mbHLA-G and of sHLA-G was assessed using flow cytometry, and mRNA expression was analyzed using real-time PCR. Expression of mbHLA-G and of sHLA-G protein was intensified with time in culture regardless of the oxygen concentration, and the expression intensities were synchronized between the 20% and the 2% oxygen concentrations at each time point. The mRNA expressions of mbHLA-G1 and sHLA-G1 at 2% oxygen were increased to twice those with 20% oxygen.Our findings demonstrate that no reduction of HLA-G was induced in CTs by short-term exposure to hypoxia, although further study may be required to find the effect of chronic hypoxia. [Copyright &y& Elsevier]