Pre-eclampsia : The role of soluble VEGF receptor-1 and related anti-angiogenic factors beyond

Pre-eclampsia is a pregnancy complication that affects about 5% of all pregnancies. It is known to be associated with alterations in angiogenesis -related factors, such as vascular endothelial growth factor (VEGF). An excess of antiangiogenic substances, especially the soluble receptor-1 of VEGF (sVEGFR-1), has been observed in maternal circulation after the onset of the disease, probably reflecting their increased placental production. Smoking reduces circulating concentrations of sVEGFR-1 in non-pregnant women, and in pregnant women it reduces the risk of pre-eclampsia. Soluble VEGFR-1 acts as a natural antagonist of VEGF and placental growth factor (PlGF) in human circulation, holding a promise for potential therapeutic use. In fact, it has been used as a model to generate a fusion protein, VEGF Trap , which has been found effective in anti-angiogenic treatment of certain tumors and ocular diseases. In the present study, we evaluated the potential use of maternal serum sVEGFR-1, Angiopoietin-2 (Ang-2) and endostatin, three central anti-angiogenic markers, in early prediction of subsequent pre-eclampsia. We also studied whether smoking affects circulating sVEGFR-1 concentrations in pregnant women or their first trimester placental secretion and expression in vitro. Last, in order to allow future discussion on the potential therapy based on sVEGFR-1, we determined the biological half-life of endogenous sVEGFR-1 in human circulation, and measured the concomitant changes in free VEGF concentrations. Blood or placental samples were collected from a total of 268 pregnant women between the years 2001 2007 in Helsinki University Central Hospital for the purposes above. The biomarkers were measured using commercially available enzyme-linked immunosorbent assays (ELISA). For the analyses of sVEGFR-1, Ang-2 and endostatin, a total of 3 240 pregnant women in the Helsinki area were admitted to blood sample collection during two routine ultrasoundscreening visits at 13.7 ± 0.5 (mean ± SD) and 19.2 ± 0.6 weeks of gestation. Of them, 49 women later developing pre-eclampsia were included in the study. Their disease was further classified as mild in 29 and severe in 20 patients. Isolated early-onset intrauterine growth retardation (IUGR) was diagnosed in 16 women with otherwise normal medical histories and uncomplicated pregnancies. Fifty-nine women remaining normotensive, non-proteinuric and finally giving birth to normal-weight infants were picked to serve as the control population of the study. Maternal serum concentrations of Ang-2, endostatin and sVEGFR-1, were increased already at 16 20 weeks of pregnancy, about 13 weeks before the clinical manifestation of preeclampsia. In addition, these biomarkers could be used to identify women at risk with a moderate precision. However, larger patient series are needed to determine whether these markers could be applied for clinical use to predict preeclampsia. Intrauterine growth retardation (IUGR), especially if noted at early stages of pregnancy and not secondary to any other pregnancy complication, has been suggested to be a form of preeclampsia compromising only the placental sufficiency and the fetus, but not affecting the maternal endothelium. In fact, IUGR and preeclampsia have been proposed to share a common vascular etiology in which factors regulating early placental angiogenesis are likely to play a central role. Thus, these factors have been suggested to be involved in the pathogenesis of IUGR. However, circulating sVEGFR-1, Ang-2 and endostatin concentrations were unaffected by subsequent IUGR at early second trimester. Furthermore, smoking was not associated with alterations in maternal circulating sVEGFR-1 or its placental production. The elimination of endogenous sVEGFR-1 after pregnancy was calculated from serial samples of eight pregnant women undergoing elective Caesarean section. As typical for proteins in human compartments, the elimination of sVEGFR-1 was biphasic, containing a rapid halflife of 3.4 h and a slow one of 29 h. The decline in sVEGFR-1 concentrations after mid-trimester legal termination of pregnancy was accompanied with a simultaneous increase in the serum levels of free VEGF so that within a few days after pregnancy VEGF dominated in the maternal circulation. Our study provides novel information on the kinetics of endogenous sVEGFR-1, which serves as a potential tool in the development of new strategies against diseases associated with angiogenic imbalance and alterations in VEGF signaling.

Pre-harvest measurement of pine stands for sawing production planning.

To enhance the utilization of the wood, the sawmills are forced to place more emphasis on planning to master the whole production chain from the forest to the end product. One significant obstacle to integrating the forest-sawmill-market production chain is the lack of appropriate information about forest stands. Since the wood procurement point of view in forest planning systems has been almost totally disregarded there has been a great need to develop an easy and efficient pre-harvest measurement method, allowing separate measurement of stands prior to harvesting. The main purpose of this study was to develop a measurement method for pine stands which forest managers could use in describing the properties of the standing trees for sawing production planning. Study materials were collected from ten Scots pine stands (Pinus sylvestris) located in North Häme and South Pohjanmaa, in southern Finland. The data comprise test sawing data on 314 pine stems, dbh and height measures of all trees and measures of the quality parameters of pine sawlog stems in all ten study stands as well as the locations of all trees in six stands. The study was divided into four sub-studies which deal with pine quality prediction, construction of diameter and dead branch height distributions, sampling designs and applying height and crown height models. The final proposal for the pre-harvest measurement method is a synthesis of the individual sub-studies. Quality analysis resulted in choosing dbh, distance from stump height to the first dead branch (dead branch height), crown height and tree height as the most appropriate quality characteristics of Scots pine. Dbh and dead branch height are measured from each pine sample tree while height and crown height are derived from dbh measures by aid of mixed height and crown height models. Pine and spruce diameter distribution as well as dead branch height distribution are most effectively predicted by the kernel function. Roughly 25 sample trees seems to be appropriate in pure pine stands. In mixed stands the number of sample trees needs to be increased in proportion to the intensity of pines in order to attain the same level of accuracy.

Mid-urethral slings for treatment of stress urinary incontinence : long- and mid-term follow-up

Urinary incontinence is a common problem, affecting one third of the women at least at some time during their lives. The prevalence of urinary incontinence increases with advancing age, and the everyday impact of incontinence on women and on health services is enormous. Urinary incontinence is usually divided into three different subtypes, of which stress urinary incontinence (SUI) is the most common. Surgical treatment is often needed to cure SUI, and modern mid-urethral sling procedures give the possibility to cure this condition with a low risk of adverse events, a problem often associated with the so-called traditional incontinence operations. Life expectancy among women in Western countries has grown beyond 80 years of age. Long-term efficacy of treatment options for urinary incontinence therefore becomes an important issue in a world with limited eco-nomic resources. The purpose of the present study was to prospectively evaluate the long-term efficacy and safety of the first minimally invasive mid-urethral tape procedure, the Tension-free Vaginal Tape (TVT) procedure. The long-term (5-year) follow-up results of the TVT procedure as a repeat operation af-ter an unsuccessful mid-urethral tape operation were studied and the reasons for failure of the first operation were analyzed. Another purpose was to compare the original TVT procedure with a newer modification, the Tension-free Vaginal Tape Obturator (TVT-O) procedure within a multi-centre, randomized context in order to find out possible differences between these procedures re-garding efficacy and complications and the effects on symptoms of urgency. The first study of the present thesis is a prospective, Nordic, three-centre follow-up study of 90 women suffering from SUI, who were treated by means of the TVT procedure. The mean follow-up time was more than eleven years, and the study is the first to be published in connection with more than ten years of follow-up. The second study is a retrospective analysis of 26 women who were treated with a repeat TVT procedure after an unsuccessful primary mid-urethral tape procedure. The third and fourth studies concern 273 women in seven centres in Finland who were ran-domly assigned to the TVT and TVT-O procedures, the 3-year follow-up results of which are pre-sented in this thesis. After eleven years of follow-up, 90% of the women had a negative cough stress test result and a negative 24-h pad test result. The subjective cure rate measured as the women s global impression of cure was 77%, the rate of improvement 20%, and only 3% thought that the treatment had failed. No late-onset adverse effects were found. The repeat TVT procedure was successful in 75% of the cases when women who were cured and women who were significantly improved were included. The reasons for failure of the first operation could be separated into four different groups: tape material-related, operation technique-related, concomitant illness-related and a group with no identifiable reason. There were no intra-operative complications during the repeat operation. In the randomized trial comparing the TVT with the TVT-O procedure a cough stress test results were negative in 94.6% and 89.5% of the women in the two groups, respectively, after a 3-year follow-up period. There were no statistical differences in the cure rate or the rate of complications be-tween the two procedures. Symptoms of urgency were analyzed more closely and the main finding was that the prevalence of urgency symptoms decreased significantly after both mid-urethral sling procedures. The TVT operation was found to be an effective and safe procedure even after eleven years of follow-up. Long-term follow-up after a repeat TVT procedure revealed that the TVT procedure can well be considered after an unsuccessful mid-urethra tape procedure, because 75% of the patients showed significantly improvement of their incontinence. The TVT and TVT-O procedures showed no statistically significant differences in efficacy and rate of complications after three years of follow-up. In most cases these procedures alleviate preoperative symptoms of urgency and the risk of developing de novo urgency is low.

Kirjallisuusosa: Alzheimerin taudin rottamallien vastaavuus tautiin ihmisessä ja mallien käyttökelpoisuus

Kirjallisuusosa: Alzheimerin taudin hoitoon olisi tarvetta uusille taudinkulkuun vaikuttaville lääkeaineille. Niiden kehittämiseksi tarvitaan eläinmalleja, joissa esiintyy taudin patofysiologisia piirteitä. Rottamalleista vanhemmat skopolamiini- tai MK-801-häirintä sekä ikääntyneiden rottien käyttö eivät kovin hyvin vastaa taudin patofysiologiaa, vaikka niissä eläimen muisti käyttäytymiskokeissa onkin heikentynyt. Uudemmat transgeeniset rottamallit ja mallit, joissa annetaan Aβ:a aivoihin, ilmentävät huomattavasti paremmin Alzheimerin taudin kaltaista tilaa aivoissa ainakin Aβ:n osalta. Taupatofysiologiaa ei silti kummassakaan näistä malleista juuri esiinny. Toisaalta Aβ:lla näyttäisi olevan huomattavasti tau:ta suurempi rooli taudissa, joten sen ilmeneminen mallissa onkin keskeisempi tekijä. Nämä mallit ilmentävät melko suurelti osin yhtä hyvin Alzheimerin taudin patofysiologiaa. Aβ:n antaminen on hieman yksinkertaisempi suorittaa käytännössä, sillä siinä ei tarvitse luoda transgeenista kantaa. Toisaalta transgeenisessa mallissa Aβ-patofysiologia syntyy enemmän Alzheimerin taudin kaltaisesti solujen sisällä eikä valmiita aggregoituvia Aβ-peptidejä anneta ulkopuolelta aivoihin. Molemmat mallit ovat kuitenkin käyttökelpoisia, ja soveltuvat erityisesti Aβ:an vaikuttavien lääkeaineiden kehittämiseen. Kokeellinen osa: Kokeen tarkoituksena oli validoida kohotettu ristikko-sokkelo (elevated plus-maze, EPM) hiirillä kognitiomallina. Kokeessa käytettiin kahden koekerran (trial, T) menetelmää, jossa koekertojen pituus oli viisi minuuttia. Näin saatiin useita oppimista kuvaavia parametreja. Hiirille yritettiin saada muistihäiriö aikaviiveen avulla (koekertojen väli 1-18 vrk) tai antamalla muskariinireseptoriantagonistia skopolamiinia (0,1-0,8 mg/kg i.p.) 30 minuuttia ennen T1:tä. Nämä kokeet suoritettiin sekä C57BL/6J- että ICR:(CD-1)-hiirillä. Aikaviivekokeissa ainut ryhmä, jolla oli viitettä unohtamisesta, oli ICR:(CD-1)-hiirien 18 vrk:n ryhmä. Tämän perusteella tutkittiin vielä 21 vuorokauden aikaväli, mutta selvää muistihäiriötä ei esiintynyt. Skopolamiini ei häirinnyt muistia ICR:(CD-1)-hiirillä, mutta C57BL/6J-hiirillä 0,2 mg/kg:n annoksesta ylöspäin merkitsevä muistihäiriö esiintyi. Näin ollen jatkokokeissa käytettäväksi valittiin skopolamiinin annos 0,2 mg/kg C57BL/6J-hiirillä, ja siinä tutkittiin donepetsiilin (0,3, 0,8 ja 1,5 mg/kg s.c), memantiinin (5,0 ja 10,0 mg/kg s.c) ja kokeellisen 5-HT6-antagonistin SB742457:n (1,5 ja 6,0 mg/kg s.c) muistia parantavia vaikutuksia. Tutkittavat lääkeaineet annettiin 40 minuuttia ennen T1:tä ja skopolamiini 30 minuuttia ennen. Memantiinilla (5,0 mg/kg) oli selkeä skopolamiinin heikentämää kognitiota parantava vaikutus ja donepetsiilillakin (1,5 mg/kg) suuntaus tähän. Tulosten perusteella malli näyttäisi soveltuvan muisti- ja oppimisvaikutusten tutkimiseen käytettäväksi malliksi.