Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Although morning sickness is very unpleasant, the ‘old wives’ tale’ that it results in a healthy baby has now a credible scientific explanation. The tachykinins are an ancient family of important biologically active peptides that are usually restricted to neural tissue and have a variety of effects on the vasculature and the immune and endocrine systems, but they can also cause nausea and vomiting (Steinhoff et al. 2014). The tachykinin, endokinin, is expressed in many tissues throughout the body including the placenta and lung and in tumor cell lines derived from these tissues (Page et al. 2003). Thus, as its name suggests, it can behave as an endocrine hormone by being released into the blood stream. As the naturally secreted form of endokinin has been found in the placenta (Page et al. 2003), it would stimulate local tachykinin receptors to improve blood flow both in the placenta and uterus and may be involved in the further integrating vascularization that is important for efficient transfer of nutrients and gases. Unfortunately, this placental endokinin will also spill into the mother’s general circulation that would then stimulate the tachykinin receptors in the brain (Andrews & Rudd 2004) that are known to cause nausea/vomiting. In a recent preliminary report, after the inhalation of tobacco smoke, endokinin concentrations in blood of a non-smoker increased nearly 30-fold (Vaiyapuri et al. 2017). Thus, the nausea experienced by the inhalation of smoke would appear to due to endokinin being released from the lung into the bloodstream that then circulates stimulating the same receptors in the brain, that placental endokinin does in causing morning sickness. It is well known that smoking in pregnancy leads to poor placentation, fetal distress and post-partum problems (Abel 1980). Thus, it is feasible that the regular release of lung endokinin into the mother’s blood from smoking affects the very endokinin receptors in the uterus and placenta that are needed to be stimulated by placental endokinin to ensure a healthy pregnancy. There are maybe two possible explanations how this results in poor placentation: either the constant stimulation leads to downregulation of local tachykinin receptors such that they respond poorly to placental endokinin or high lung endokinin concentrations in uterine blood disrupts the local concentration gradient of placental endokinin that is necessary for the correct directional growth of the spiral arteries in the small finger like projections that ensure a healthy placentation at the placental/uterine interface. Similarly, drugs that block the effects of endokinin at its receptor should be avoided to treat morning sickness as they would also block the local beneficial effects of placental endokinin. In conclusion, it is hoped that this short commentary will give some psychological relief to pregnant ladies suffering from morning sickness but will also persuade smokers who are intending to have a baby to kick the habit well beforehand.

An efficient functioning placenta is essential for a healthy pregnancy and yet the way this is achieved has been the subject of much discussion and confusion, particularly with the occurrence of pathological conditions such as preeclampsia, morning sickness and hyperemesis/ptyalism gravidarum. We will attempt to explain the underlying physiology and the potential roles played by the placental tachykinins, neurokinin B and endokinin.

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

The remarkable conservation of the primary structures and anatomical location of dogfish α-melanocyte-stimulating hormone (MSH), corticotrophin-like intermediate lobe peptide (CLIP) and adrenocorticotrophic hormone (ACTH) compared with mammals reinforced the tissue-specific processing hypothesis of ACTH peptides in the pituitary gland. The cloning of dogfish pro-opiomelanocortin (POMC) led to the identification of δ-MSH and simultaneously revealed the high conservation of the γ-MSH sequence during evolution. These studies have also shown that β-MSH is much less conserved during evolution and in some species is not even processed from β-LPH. Human pro-γ-MSH potentiates the corticosteroidogenic activity of ACTH and peptides generated from its N-terminal, in particular big-γ-MSH, appear to have adrenal mitogenic activity. Human big-γ-MSH (from the zona intermedia) may also cause the adrenache. The review finishes with a cautionary note with regard to the misdiagnosis of the ectopic ACTH syndrome in which partial processing of ACTH can result in large concentrations of α-MSH and CLIP, which can interfere in the performance of two-site immunoassays, and the problem of the correct disulphide bridge arrangement in synthetic N-POMC peptides is also discussed.

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

The remarkable conservation of the primary structures and anatomical location of dogfish α-melanocyte-stimulating hormone (MSH), corticotrophin-like intermediate lobe peptide (CLIP) and adrenocorticotrophic hormone (ACTH) compared with mammals reinforced the tissue-specific processing hypothesis of ACTH peptides in the pituitary gland. The cloning of dogfish pro-opiomelanocortin (POMC) led to the identification of δ-MSH and simultaneously revealed the high conservation of the γ-MSH sequence during evolution. These studies have also shown that β-MSH is much less conserved during evolution and in some species is not even processed from β-LPH. Human pro-γ-MSH potentiates the corticosteroidogenic activity of ACTH and peptides generated from its N-terminal, in particular big-γ-MSH, appear to have adrenal mitogenic activity. Human big-γ-MSH (from the zona intermedia) may also cause the adrenache. The review finishes with a cautionary note with regard to the misdiagnosis of the ectopic ACTH syndrome in which partial processing of ACTH can result in large concentrations of α-MSH and CLIP, which can interfere in the performance of two-site immunoassays, and the problem of the correct disulphide bridge arrangement in synthetic N-POMC peptides is also discussed.

OBJECTIVES:To examine whether syncytin-1 has immune regulatory functions and is carried by human placental exosomes. Further, to examine whether corticotropin-releasing hormone (CRH) can induce the production of syncytin-1. STUDY DESIGN:Human placental exosomes were isolated from placental explant, primary trophoblast and BeWo cell cultures. The presence of exosomes was confirmed by transmission electron microscopy and western blotting. Exosomal protein was probed with 3 separate antibodies targeting syncytin-1. Syncytin-1 immunosuppression was tested, using either a syncytin-1 recombinant ectodomain protein or a synthetic peptide with the human syncytin-1 immunosuppressive domain sequence, in an in vitro human blood culture system immune challenged with LPS or PHA. The inhibition of cytokine production by syncytin-1 was determined by ELISA of TNF-α, IFN-γ and CXCL10. BeWo cells were stimulated with CRH or vehicle for 24 h. mRNA and Protein was extracted from the cells for real-time PCR and western blotting analysis while exosomes were extracted from conditioned media for analysis by western blotting. RESULTS:Protein expression of syncytin-1 was detected in exosomes isolated from placental explants, primary trophoblast and BeWo cell cultures. Syncytin-1 recombinant ectodomain was also shown to inhibit the production of the Th1 cytokines TNF-α and IFN-γ as well as the chemokine, CXCL10 in human blood cells. Finally, this study showed that syncytin-1 can be stimulated by CRH. CONCLUSIONS:The presence of syncytin-1 in placental exosomes provides a mechanism for syncytin-1 to reach and interact with target cells of the maternal immune system and represents a novel mechanism of endogenous retroviral mediated immunosuppression that may be relevant for maternal immune tolerance.

Neurokinin B (NKB) secreted by the placenta was previously found to be raised in preeclampsia and most of the symptoms in this disease appeared to be through progressive activation of the three neurokinin receptors. Further characterization of placental NKB revealed that placental NKB eluted in the approximate position of a 13mer and this was confirmed by TOF mass spectrometry which gave a mass of 1580. Although this is consistent with dimethylated NKB-Gly-Lys-Arg, further characterization (immunological and mass spectrometric fragment analysis) suggested a novel posttranslational modification containing phosphocholine (PC) with some evidence for glycerol and a coordinated alkene. The structure that fits all the data is that a form of platelet activating factor is attached to the aspartyl side chain at position 4 of NKB and thus now implicates placental NKB in the platelet pathology seen in preeclampsia. As it has been reported that it is the PC group per se attached to certain proteins secreted by filarial nematodes imparts them with immune inhibitory properties and thus survival in the host over long periods, attaching PC to placental secretory peptide hormones (also be found on the placental precursors of CRF, ACTH, and activin) may result in a similar situation.

As previous work had shown that extreme N-terminal fragments of the ACTH precursor pro-opiomelanocortin (POMC) not containing gamma-melanotropin (gamma-MSH) were active adrenal mitogens[1] but an antiserum raised against gamma-MSH paradoxically also inhibited adrenal growth we proposed that the adrenal mitogen is processed from pro-gamma-MSH by a neurally controlled protease at the growing adrenal. [2] To this end we have characterised a novel serine protease (named adrenal secretory protease (AsP) as Psort predicted a leader motif Which is expressed at the glomerulosa/fasciculata boundary where mitosis takes place. [3] The expression of AsP was also found to be essential for mitosis of the adrenal cortical tumor Y1 cell-line in POMC containing media and 3D homology modeling revealed the presence of a catalytic pocket flanked by the classical His/Asp/Ser motifs. An usual feature of the model was a cluster of arginine residues on the underside of the protease suggesting that this basically charged face would tend to retain it on the cell surface on secretion-immunocytochemistry using an antiserum raised against a synthetic peptide spanning residues 1-25 of AsP showed that this was the case for Y1 cells. Specificity of AsP (affinity purified from Y1 media) was demonstrated by its inability to cleave model substrates for either trypsin or pro-hormone converting enzymes but was able to cleave an internally quenched POMC (44-55) model peptide. Interestingly mass spectral analysis of products of the latter predicts that the protease cleaves between the bond between Val(52) and Met(53) suggesting the natural adrenal mitogen is POMC (1-52).

Platelets perform an essential role in haemostasis but also trigger arterial thrombosis that underlies heart attacks and strokes. Understanding of how the functions of platelets are regulated is key to the development of safe and effective means to prevent or treat these conditions. We have reported that platelets are activated by the tachykinin substance P (SP) and have proposed that SP released from platelets during activation mediates positive feedback stimulation ((1)). In this study we define a role for peripherally distributed members of the tachykinin family of peptides including SP, and the newly discovered endokinins A and B that are also present in platelets, in the activation of platelet function and thrombus formation.

CONTEXT:Pregnant tissues express corticotropin-releasing factor (CRF), a peptide modulating fetal and placental ACTH and cortisol secretion. These actions are modulated by the locally expressed CRF-binding protein (CRF-BP).OBJECTIVE:The objective of the study was to determine whether CRF, CRF-BP, ACTH, and cortisol concentrations change in amniotic fluid and umbilical cord plasma in the presence of intraamniotic infection/inflammation (IAI) in women with spontaneous labor at term.DESIGN:This was a cross-sectional study.SETTING:The study was conducted at a tertiary referral center for obstetric care.PATIENTS:Patients included women in active labor at term with (n = 39) and without (controls; n = 78) IAI.MAIN OUTCOME MEASURES:Amniotic fluid and umbilical cord plasma concentrations of CRF, CRF-BP, ACTH, and cortisol measured by RIA and immunoradiometric assays were measured.RESULTS:In patients with IAI, amniotic fluid CRF (0.97 +/- 0.18 ng/ml) and CRF-BP (33.06 +/- 5.54 nmol/liter) concentrations were significantly (P < 0.001) higher than in controls (CRF: 0.32 +/- 0.04 ng/ml; CRF-BP: 14.69 +/- 2.79 ml). The umbilical cord plasma CRF and CRF-BP concentrations were significantly (P < 0.001 for all) higher in women with IAI than in controls (CRF: 2.96 +/- 0.35 ng/ml vs. 0.38 +/- 0.18 ng/ml; CRF-BP: 152.12 +/- 5.94 nmol/liter vs. 106.9 +/- 5.97 nmol/liter). In contrast, amniotic fluid and umbilical cord plasma ACTH and cortisol concentrations did not differ between groups.CONCLUSIONS:Amniotic fluid and umbilical cord plasma CRF and CRF-BP concentrations are increased in women with spontaneous labor at term and IAI. CRF-BP may modulate CRF actions on ACTH and cortisol secretion, playing a pivotal role in limiting the inflammatory process and thus avoiding an overactivation of the fetal/placental hypothalamus-pituitary-adrenal axis at birth.

This paper will document the early scientific observations that kindled my neuroendocrinological interest in pre‐eclampsia, a life‐threatening disease that affects both mother and baby. My interest in this subject started with the placental origin of melanotrophin activity, moving on, through corticotrophin‐releasing factor and its binding protein, to a tachykinin modified specifically in the placenta by phosphocholine, a post‐translational moiety normally used by parasites to avoid immune surveillance and rejection. This work may finally have led to an understanding of the identity of the elusive placental factor that, whilst attempting to compensate for the poor implantation of the placenta, causes the many symptoms seen in the mother during pre‐eclampsia.

Platelets play an important role in hemostasis, with inappropriate platelet activation being a major contributor to debilitating and often fatal thrombosis by causing myocardial infarction and stroke. Although current antithrombotic treatment is generally well tolerated and effective, many patients still experience cardiovascular problems, which may reflect the existence of alternative underlying regulatory mechanisms in platelets to those targeted by existing drugs. In this study, we define a role for peripherally distributed members of the tachykinin family of peptides, namely substance P and the newly discovered endokinins A and B that are present in platelets, in the activation of platelet function and thrombus formation. We have reported previously that the preferred pharmacologically characterized receptor for these peptides, the NK1 receptor, is present on platelets. Inhibition or deficiency of the NK1 receptor, or SP agonist activity, resulted in substantially reduced thrombus formation in vitro under arterial flow conditions, increased bleeding time in mice, and a decrease in experimentally induced thromboembolism. Inhibition of the NK1 receptor may therefore provide benefit in patients vulnerable to thrombosis and may offer an alternative therapeutic target.

Placental neurokinin B appears to be post-translationally modified by phosphocholine (PC) attached to the aspartyl side chain at residue 4 of the mature peptide. Corticotrophin releasing factor (CRF) was found to be expressed by the rat placenta with the main secreted forms being phosphocholinated proCRF+/− one or two polysaccharide moieties. A combination of high-pressure liquid chromatography (HPLC) and two-site immunometric analysis suggested that PC was also attached to the placental precursors of adrenocorticotrophin, hemokinin, activin and follistatin. However, the fully processed forms of rat placental activin and CRF were free of PC. Formerly, the parasitic filarial nematodes have used PC as a post-translational modification, attached via the polysaccharide moiety of certain secretory glycoproteins to attenuate the host immune system allowing parasite survival, but it is the PC group itself which endows the carrier with the biological activity. The fact that treatment of proCRF peptides with phospholipase C but not endoglycosidase destroyed PC immunoreactivity suggested a simpler mode of attachment of PC to placental peptides than that used by nematodes. Thus, it is possible that by analogy the placenta uses its secreted phosphocholinated hormones to modulate the mother’s immune system and help protect the placenta from rejection.

OBJECTIVE:Placental corticotropin-releasing factor (CRF) affects myometrial contractility and the secretion of several uterotonins such as prostaglandins (PGs); however, the activity of CRF is counteracted by CRF-binding protein (CRF-BP). At term and pre-term labor, CRF levels in maternal plasma are highest whereas those of CRF-BP are falling, and the cause of this fall is unknown. Thus, in this study, we investigated the effect of PG administration for labor induction on maternal plasma CRF and CRF-BP concentrations.DESIGN:Maternal plasma CRF and CRF-BP levels were assayed before and after (2 h later) induction of labor by intracervical administration of prostaglandin E(2) (PGE(2)), and at delivery in a group of healthy post-term pregnancies (n=18). Controls were women at term out of labor (n=22), who subsequently progressed to deliver a healthy singleton baby.METHODS:CRF was measured by two-site immunoradiometric assay, and CRF-BP was assayed by radioimmunoassay.RESULTS:Maternal plasma CRF levels were significantly (P<0.0001) lower and CRF-BP significantly (P<0.0005) higher in post-term than in term pregnancies. With respect to induction of labor, 2 mg PGE(2) were sufficient to increase maternal plasma CRF levels at delivery (P<0.005). While 0.5 mg PGE(2) significantly decreased maternal plasma CRF-BP levels at delivery (P<0.001), 2.0 mg PGE(2) significantly reduced CRF-BP concentrations both after 2 h (P<0.05) and at delivery (P<0.0001).CONCLUSIONS:In the light of the well-known stimulation of prostaglandin release by CRF, these data suggest a positive feedback effect of PGE(2) on maternal CRF release during induced labor.