Elastase induced lung epithelial cell apoptosis and emphysema through placenta growth factor

Chronic pulmonary obstructive disease (COPD) is the fourth leading cause of death worldwide, however, the pathogenic factors and mechanisms are not fully understood. Pulmonary emphysema is one of the major components of COPD and is thought to result from oxidative stress, chronic inflammation, protease–antiprotease imbalance and lung epithelial (LE) cell apoptosis. In our previous studies, COPD patients were noted to have higher levels of placenta growth factor (PlGF) in serum and bronchoalveolar lavage fluid than controls. In addition, transgenic mice overexpressing PlGF developed pulmonary emphysema and exposure to PlGF in LE cells induced apoptosis. Furthermore, intratracheal instillation of porcine pancreatic elastase (PPE) on to PlGF wild type mice induced emphysema, but not in PlGF knockout mice. Therefore, we hypothesized that PPE generates pulmonary emphysema through the upregulation of PlGF expression in LE cells. The elevation of PlGF then leads to LE cell apoptosis. In the present study, we investigated whether PPE induces PlGF expression, whether PlGF induces apoptosis and whether the downstream mechanisms of PlGF are related to LE cell apoptosis. We found that PPE increased PlGF secretion and expression both in vivo and in vitro. Moreover, PlGF-induced LE cell apoptosis and PPE-induced emphysema in the mice were mediated by c-Jun N-terminal kinase (JNK) and p38 mitogen-activated protein kinase (p38 MAPK) pathways. Given these findings, we suggest that the increase in PlGF and PlGF-induced JNK and p38 MAPK pathways contribute to PPE-induced LE cell apoptosis and emphysema. Regulatory control of PlGF and agents against its downstream signals may be potential therapeutic targets for COPD.     

Elastase induces lung epithelial cell autophagy through placental growth factor: A new insight of emphysema pathogenesis

Chronic obstructive pulmonary disease (COPD) is a devastating disease, which is associated with increasing mortality and morbidity. Therefore, there is a need to clearly define the COPD pathogenic mechanism and to explore effective therapies. Previous studies indicated that cigarette smoke (CS) induces autophagy and apoptosis in lung epithelial (LE) cells. Excessive ELANE/HNE (elastase, neutrophil elastase), a factor involved in protease-antiprotease imbalance and the pathogenesis of COPD, causes LE cell apoptosis and upregulates the expression of several stimulus-responsive genes. However, whether or not elastase induces autophagy in LE cell remains unknown. The level of PGF (placental growth factor) is higher in COPD patients than non-COPD controls. We hypothesize that elastase induces PGF expression and causes autophagy in LE cells. In this study, we demonstrated that porcine pancreatic elastase (PPE) induced PGF expression and secretion in LE cells in vitro and in vivo. The activation of MAPK8/JNK1 (mitogen-activated protein kinase 8) and MAPK14/p38alpha MAPK signaling pathways was involved in the PGF mediated regulation of the TSC (tuberous sclerosis complex) pathway and autophagy in LE cells. Notably, PGF-induced MAPK8 and MAPK14 signaling pathways mediated the inactivation of MTOR (mechanistic target of rapamycin), the upregulation of MAP1LC3B/LC3B (microtubule-associated protein 1 light chain 3 β) and the increase of autophagosome formation in mice. Furthermore, the PPE-induced autophagy promotes further apoptosis in vitro and in vivo. In summary, elastase-induced autophagy promotes LE cell apoptosis and pulmonary emphysema through the upregulation of PGF. PGF and its downstream MAPK8 and MAPK14 signaling pathways are potential therapeutic targets for the treatment of emphysema and COPD.     

Regulation of lung epithelial cell senescence in smoking-induced COPD/emphysema by microR-125a-5p via Sp1 mediation of SIRT1/HIF-1a

Chronic obstructive pulmonary disease (COPD) affects the health of more than 300 million people worldwide; at present, there is no effective drug to treat COPD. Smoking is the most important risk factor, but the molecular mechanism by which smoking causes the disease is unclear. The senescence of lung epithelial cells is related to development of COPD. Regulation of miRNAs is the main epigenetic mechanism related to aging. β-Galactose staining showed that the lung tissues of smokers have a higher degree of cellular senescence, and the expression of miR-125a-5p is high. This effect is obvious for smokers with COPD/emphysema, and there is a negative correlation between miR-125a-5p levels and values for forced expiratory volume in one second (FEV1)/forced vital capacity (FVC). After Balb/c mice were chronically exposed to various concentrations of cigarette smoke (CS), plethysmography showed that lung function was impaired, lung tissue senescence was increased, and the senescence-associated secretory phenotype (SASP) in bronchoalveolar lavage fluid was increased. For mouse lung epithelial (MLE)-12 cells treated with cigarette smoke extract (CSE), Sp1 and SIRT1 levels were low, HIF-1α acetylation levels were high, and cell senescence and secretion of SASP factors were elevated. Down-regulation of miR-125a-5p or up-regulation of Sp1 reversed these effects. In addition, compared with mice exposed to CS, knockdown of miR-125a-5p reduced lung epithelial cell senescence and COPD/emphysema. Therefore, in smoking-induced COPD, elevated miR-125a-5p participates in the senescence of lung epithelial cells through Sp1/SIRT1/HIF-1α. These findings provide evidence related to the pathogenesis of COPD/emphysema caused by chronic smoking.     

Role of CD69 in the pathogenesis of elastase-induced pulmonary inflammation and emphysema

Cluster of differentiation 69 (CD69), known as an early activation marker of lymphocytes, has been demonstrated to regulate inflammatory events in various disease models. Although the increased number of CD69-expressed T lymphocytes in the lungs of patients with chronic obstructive pulmonary disease (COPD) has been reported, a functional role of CD69 in the pathogenesis of COPD remains unknown. To address to this question, CD69-deficient (CD69KO) mice and wild-type (WT) mice were subjected to a mouse model of porcine pancreatic elastase (PPE)-induced pulmonary inflammation and emphysema. In the two genotypes, PPE increased counts of macrophages, neutrophils and lymphocytes in bronchoalveolar lavage fluid (BALF) and induced emphysematous changes in the lung, whereas those two pathological signs were significantly enhanced in CD69KO mice compared to WT mice. Moreover, the PPE-induced levels of IL-17 and IL-6 in BALF were significantly higher in CD69KO mice than in WT mice at the acute inflammatory phase. Immunofluorescent studies showed that IL-17 and IL-6 were predominantly expressed in CD4⁺ and γδ T cells and macrophages, respectively. Concomitant administration of IL-17- and IL-6-neutralizing antibodies significantly attenuated the PPE-induced emphysematous changes in the two genotypes. These findings suggest that CD69 negatively regulates the development of PPE-induced emphysema in part at least through modulating function of IL-17-producing T cells.     

Rate of progression of CT-quantified emphysema in male current and ex-smokers: a follow-up study

Background

Little is known about the factors associated with CT-quantified emphysema progression in heavy smokers. The objective of this study was to investigate the effect of length of smoking cessation and clinical / demographical factors on the rate of emphysema progression and FEV₁-decline in male heavy smokers.

Methods

3,670 male smokers with mean (SD) 40.8 (17.9) packyears underwent chest CT scans and pulmonary function tests at baseline and after 1 and 3 years follow-up. Smoking status (quitted ≥5, ≥1-<5, <1 years or current smoker) was noted. Rate of progression of emphysema and FEV₁-decline after follow-up were assessed by analysis of variance adjusting for age, height, baseline pulmonary function and emphysema severity, packyears, years in study and respiratory symptoms. The quitted ≥5 group was used as reference.

Results

Median (Q1-Q3) emphysema severity,<-950 HU, was 8.8 (5.1 – 14.1) and mean (SD) FEV₁ was 3.4 (0.73) L or 98.5 (18.5) % of predicted. The group quitted ‘>5 years’ showed significantly lower rates of progression of emphysema compared to current smokers, 1.07% and 1.12% per year, respectively (p<0.001). Current smokers had a yearly FEV₁-decline of 69 ml, while subjects quit smoking >5 years had a yearly decline of 57.5 ml (p<0.001).

Conclusion

Quit smoking >5 years significantly slows the rate of emphysema progression and lung function decline.

Trial registration

Registered at http://www.trialregister.nl with trial number ISRCTN63545820.     

人中性粒细胞弹性蛋白酶诱导气道黏液高分 泌细胞模型的建立及其机制的初步研究

目的：以人中性粒细胞弹性蛋白酶(HNE)为诱导因素,研究建立黏蛋白(MUC)5AC和5B高表达的细胞模型,同时对黏蛋白高表达机制进行初步研究。方法：培养人肺腺癌细胞A549,以HNE为刺激因素,EGFR中和抗体、表皮细胞生长因子受体（EGFR）磷酸化阻断剂AG1478为干预因素,分组培养。采用四甲基偶氮唑盐光吸收法（MTT法）检测HNE对细胞活性的影响;逆转录-聚合酶链反应（RT-PCR）检测MUC5AC mRNA、MUC5B mRNA的变化;酶联免疫吸附测定法(ELISA)定量分析MUC5AC和MUC5B蛋白含量的差异;细胞免疫化学以及激光共聚焦技术进一步直观观察MUC5AC、MUC5B、p-EGFR蛋白表达的变化。结果：HNE对A549细胞活力的影响呈剂量依赖性;HNE刺激组的MUC5AC、MUC5B基因转录和蛋白表达水平均明显高于对照组,差异有统计学意义（均P<0.01）;HNE刺激组p-EGFR蛋白表达显著增多,EGFR中和抗体、AG1478能显著降低HNE诱导的MUC5AC高表达,但对MUC5B高表达无干预作用。结论：人肺腺癌细胞A549同时表达MUC5AC和MUC5B,HNE能有效刺激A549细胞高表达MUC5AC和MUC5B,黏蛋白高表达细胞模型的建立为研究气道粘液高分泌疾病提供了实验基础。HNE通过激活EGFR信号转导通路诱导MUC5AC的高表达,但MUC5B高表达机制与之不同,有待进一步研究。     

Mir-29b mediates the regulation of Nrf2 on airway epithelial remodeling and Th1/Th2 differentiation in COPD rats

COPD, or Chronic obstructive pulmonary disease, is an inflammation-related disease and lead to cachexia and muscle wasting. Altered nuclear factor erythroid 2-related factor 2 (Nrf2) expression is found in patients of COPD because it is involved in pulmonary protective effects. MiR-29b could be activated by Nrf2. We hypothesized that miR-29b might mediate the regulation of Nrf2 on Th1/Th2 differentiation and airway epithelial remodeling in COPD rats. SD rats were exposed to smoke for COPD induction. Expression of Nrf2 mRNA and miR-29b in lung tissues was quantified. Expression of Nrf2 and matrix metalloproteinase 2 (MMP2) were also detected by immunohistochemistry and western blot. Th1 markers and Th2 markers were measured by ELISA in peripheral blood. Flow cytometry was used to detect the Th1/Th2 ratio. miR-29b and Nrf2 was manipulated at mRNA level in A549 cells using transfection. Cellular growth and migration were measured in transfectants. In lung tissues of COPD rats, expression of Nrf2 and miR-29b decreased. MMP2, a target of miR-29b, had an opposite expression to miR-29b in peripheral blood. Levels of inflammatory factors and Th1/Th2 ratio increased. MiR-29b mediated the regulation of Nrf2 on remodeling of lung epithelial cells. Blocking Nrf2 expression in A549 cells led to the opposite expression of miR-29b and further decreased MMP2 production; meanwhile, cell growth and motility were improved. Different miR-29b levels affected MMP2 expression and cellular characteristics. The findings suggested that miR-29b was a regulator the pathological progress of COPD. It mediates the effect of Nrf2 on Th1/Th2 differentiation and on remodeling process of airway epithelial cells.     

ABHD2 基因与慢性阻塞性肺疾病关系的研究进展

ABHD2是在人体内表达的一种水解酶蛋白(/hydrolase protein),尽管底物尚不清楚,但其与慢性阻塞性肺疾病(COPD)的发生具有密切的相关性。ABHD2基因在肺部主要表达在肺泡II型细胞和肺支气管的非管型平滑肌细胞,参与调节肺泡表面活性物质的合成和分泌。相关研究显示ABHD2基因敲除小鼠可自发形成肺气肿表型。此外,人ABHD2基因的rs12442260多态性可增加COPD的发病风险。因此,ABHD2基因在慢性阻塞性肺疾病的发生发展过程中起着重要的作用。本文主要就ABHD2基因表达与COPD、肺气肿等疾病的相关性进行综述。     

Computer quantification of airway collapse on forced expiration to predict the presence of emphysema

Background

Spirometric parameters are the mainstay for diagnosis of COPD, but cannot distinguish airway obstruction from emphysema. We aimed to develop a computer model that quantifies airway collapse on forced expiratory flow–volume loops. We then explored and validated the relationship of airway collapse with computed tomography (CT) diagnosed emphysema in two large independent cohorts.

Methods

A computer model was developed in 513 Caucasian individuals with ≥15 pack-years who performed spirometry, diffusion capacity and CT scans to quantify emphysema presence. The model computed the two best fitting regression lines on the expiratory phase of the flow-volume loop and calculated the angle between them. The collapse was expressed as an Angle of collapse (AC) which was then correlated with the presence of emphysema. Findings were validated in an independent group of 340 individuals.

Results

AC in emphysema subjects (N = 251) was significantly lower (131° ± 14°) compared to AC in subjects without emphysema (N = 223), (152° ± 10°) (p < 0.0001). Multivariate regression analysis revealed AC as best indicator of visually scored emphysema (R² = 0.505, p < 0.0001) with little significant contribution of K_CO, %predicted and FEV_1, %predicted to the total model (total R² = 0.626, p < 0.0001). Similar associations were obtained when using CT-automated density scores for emphysema assessment. Receiver operating characteristic (ROC) curves pointed to 131° as the best cut-off for emphysema (95.5% positive predictive value, 97% specificity and 51% sensitivity). Validation in a second group confirmed the significant difference in mean AC between emphysema and non-emphysema subjects. When applying the 131° cut-off, a positive predictive value of 95.6%, a specificity of 96% and a sensitivity of 59% were demonstrated.

Conclusions

Airway collapse on forced expiration quantified by a computer model correlates with emphysema. An AC below 131° can be considered as a specific cut-off for predicting the presence of emphysema in heavy smokers.     

阻塞性肺气肿模型的制作

目的在2周内对国际标准实验动物Beagle犬进行肺气肿模型的制作,建立较为标准的肺气肿模型,从而为治疗慢性阻塞性肺疾病（COPD）的方法提供良好的动物模型。方法Beagle犬8只,雌雄各半,2岁,体重13～18kg,雾化吸人木瓜蛋白酶12000U/kg,1次,周,共2周。实验前后测量试验动物肺功能,做胸部CT及病理学比较。结果实验前后动物肺功能,CT及病理学检查均显示较大的差异。8例实验动物的功能残气量（FRC）、肺总量（TLC）、功能残气量比肺总量（FRC/TLC％）、潮气量（VT）和呼吸频率（BR）,在肺气肿模型制作前后做两两比较,结果显示均有统计学差异P〈0.05,血氧饱和度（SpO2）0.05两者间无统计学差异。CT显示肺体积增大,局部肺野透亮度增加有肺大泡形成。试验后病理学检查显示肺泡壁破坏,肺泡间质断裂,肺泡融合,形成典型的全小叶型肺气肿改变。实验后动物出现肺气肿征表现,如气喘,咳嗽及上呼吸道分泌物增等。结论在标准实验动物身上可以较为准确、快速地复制出近似于人类阻塞性肺气肿病理改变的动物模型。     

Divergent effect of mometasone on human eosinophil and neutrophil apoptosis

Mometasone is a potent synthetic glucocorticoid, which is under development as an inhaled preparation for the treatment of asthma. Previous studies have suggested that glucocorticoids have direct effects on human eosinophil and neutrophil apoptosis. The present study was designed to characterize the effects of mometasone on constitutive apoptosis and cytokine-afforded survival in isolated human eosinophils and neutrophils. The isolated eosinophils or neutrophils were cultured in vitro, and apoptosis was assessed by flow cytometric analysis of relative DNA content, by annexin-V binding and morphological analysis. Mometasone enhanced constitutive human eosinophil apoptosis in a concentration-dependent manner. The maximal enhancement of eosinophil apoptosis was 2.1-fold with an EC(50) value of 5.63 +/- 2.33 nM. This enhancing effect was reversed by the glucocorticoid receptor antagonist, mifepristone. In the presence of added cytokines, mometasone reversed tumor necrosis factor -alpha-induced eosinophil survival but not that afforded by interleukin -5. In contrast, mometasone inhibited human neutrophil apoptosis in a concentration-dependent manner. The maximal inhibition of neutrophil apoptosis was 50% with an EC(50) value of 0.17 +/- 0.03 nM. The inhibitory effect was partly reversed by mifepristone. In the presence of added cytokines, mometasone further enhanced neutrophil survival induced by the granulocyte-macrophage colony-stimulating factor and leukotriene B(4). The present data suggests that mometasone has opposite effects on apoptosis of human eosinophils and neutrophils at clinically relevant drug concentrations via an effect on glucocorticoid receptor.     

烟雾暴露所致肺气肿小鼠模型的建立与评价

目的探讨单纯烟雾暴露所致肺气肿小鼠模型建立及病理学、气道炎症及肺功能评价,并进行支气管肺泡灌洗(bronchoalveolar lavage,BAL)技术的改进。方法 20只C57BL/6J小鼠随机分为正常对照及烟雾暴露组,烟雾暴露90d并观察30d后行小鼠肺功能检查、应用改进方法留取BALF行细胞计数及行肺组织病理切片观察,并与正常对照组进行比较。结果烟雾暴露组小鼠气道阻力(Raw)较正常对照组增高,动态肺顺应性(Cdyn)降低;BALF中细胞总数高于正常对照组,巨噬细胞数(AM)、中性粒细胞数(N)、中性粒细胞所占比例(N%)也高于对照组,差异均有统计学意义;病理学观察示烟雾暴露组肺泡腔扩大、部分肺泡间隔断裂、肺泡腔融合、肺气肿形成,气道上皮排列紊乱、部分气道上皮增生、周围炎症细胞浸润并伴有平滑肌增生;形态学计量分析示烟雾暴露组平均内衬间隔(MLI)及肺泡破坏指数(DI)较正常对照组增加。应用改进技术行BAL成功率100%,回收率高达90%。结论单纯烟雾暴露可以成功建立小鼠肺气肿模型且稳定可靠,与人类慢性阻塞性肺病相似性好,经BAL技术改进后该模型可行性高。     

盐酸氨溴索对烟所致慢性阻塞性肺疾病大鼠肺组织细胞凋亡和血管重塑的作用机制研究

目的:盐酸氨溴索对烟所致慢性阻塞性肺疾病(chronic obstructive pulmonary disease, COPD)大鼠肺组织细胞凋亡和血管重塑的作用机制研究。方法:将SD大鼠随机分为4组,每组20只,依次为正常组、模型组、实验组、对照组。模型组、实验组、对照组大鼠采延安香烟烟熏64天构建慢性阻塞性肺大鼠模型,正常组大鼠室温下正常饲养。烟熏结束后,实验组、对照组大鼠每日分别皮下注射5ml盐酸氨溴索(20 mg/kg)和5 m L的盐酸班布特罗(20 mg/kg),正常组、模型组分别腹腔注射等剂量的生理盐水。在药物干预28天后,苏木精-伊红染色(hematoxylin-eosinstaining,HE)、弹力纤维(elastic van gieson,EVG)染色、TUNNEL染色、免疫组化染色、Western blot检测各组大鼠肺组织病理、血管重塑、肺组织的细胞凋亡、α-平滑肌肌动蛋白(α-smoothmus-cleactin,α-SMA)和血管内皮生长因子(Vascular endothelial growth factor,VEGF)的表达、以及Caspase-3、Bax和Bcl-2的表达水平。结果:与正常组相比,模型组肺组织损伤明显,肺小动脉中膜厚度明显增加,血管肌化程度、细胞的凋亡率、α-SMA和VEGF、Caspase-3、Bax的表达明显升高,Bcl-2的表达明显降低,差异均具有统计学意义(P0.05);与模型组相比,实验组和对照组大鼠肺组织损伤明显改善,肺小动脉中膜厚度明显减小,血管肌化程度、细胞的凋亡率、α-SMA和VEGF、Caspase-3、Bax的表达明显降低,Bcl-2的表达明显升高,差异均具有统计学意义(P0.05)。结论:盐酸氨溴索能抑制肺组织的细胞凋亡以及改善其血管重塑,保护COPD大鼠的肺组织。     

Nix/BNIP3L-dependent mitophagy accounts for airway epithelial cell injury induced by cigarette smoke

Cigarette smoke-induced airway epithelial cell mitophagy is an important mechanism in the pathogenesis of chronic obstructive pulmonary disease (COPD). Mitochondrial protein Nix (also known as BNIP3L) is a selective autophagy receptor and participates in several human diseases. However, little is known about the role of Nix in airway epithelial cell injury during the development of COPD. The aim of the present study is to investigate the effects of Nix on mitophagy and mitochondrial function in airway epithelial cells exposed to cigarette smoke extract (CSE). Our present study has found that CSE could increase Nix protein expression and induce mitophagy in airway epithelial cells. And Nix siRNA significantly inhibited mitophagy and attenuated mitochondrial dysfunction and cell injury when airway epithelial cells were stimulated with 7.5% CSE. In contrast, Nix overexpression enhanced mitophagy and aggravated mitochondrial dysfunction and cell injury when airway epithelial cells were incubated with 7.5% CSE. These data suggest that Nix-dependent mitophagy promotes airway epithelial cell and mitochondria injury induced by cigarette smoke, and may be involved in the pathogenesis of COPD and other cigarette smoke-associated diseases.     

慢性阻塞性肺疾病患者疾病认知水平调查及其影响因素分析

摘要 目的：调查慢性阻塞性肺疾病（COPD）患者疾病认知水平,分析COPD患者疾病认知水平的影响因素。方法：选择2018年10月至2020年11月我院收治的162例COPD患者,采用自行设计的一般资料调查问卷和COPD疾病认知问卷（BCKQ）收集患者信息和评估COPD疾病认知水平。采用单因素及多因素Logistic回归分析COPD患者疾病认知水平的影响因素。结果：共发放162份问卷,有效回收160份,有效回收率98.77%（160/162）。COPD患者BCKQ总分为（31.01±2.16）分,单因素分析结果显示不同年龄、职业、文化教育程度、居住地、家庭月收入、健康信息获得途径、每年急性发作次数、每年医疗支出的COPD患者BCKQ总分差异显著（P＜0.05）。进一步多因素Logistic回归分析结果显示职业、文化教育程度、家庭月收入、健康信息获得途径、每年急性发作次数是COPD患者疾病认知水平的影响因素（P＜0.05）。结论：COPD患者对疾病认知水平偏低,且受多种因素影响,临床工作者应结合相关因素进行针对性健康宣教,以提供患者对疾病的认知水平。     

Epidermal growth factor rescues trophoblast apoptosis induced by reactive oxygen species

Pre-eclampsia and intrauterine growth restriction are associated with increased apoptosis of placental villous trophoblast. This may result from placental hypoperfusion, leading to the generation of reactive oxygen species (ROS). Apoptosis can be induced in villous trophoblast following exposure to oxidative stress. Epidermal growth factor (EGF) reduces trophoblast apoptosis resulting from exposure to hypoxia. We hypothesised that exposure to hydrogen peroxide, a potent generator of ROS, would induce apoptosis in term placental villous explants and that this could be reduced by treatment with EGF. Placental explants were taken from normal term pregnancies and exposed to increasing doses of hydrogen peroxide (0–1,000 μM) or to a combination of increasing doses of hydrogen peroxide and EGF (0–100 ng/ml) for either 6 or 48 h. Apoptosis was assessed by TUNEL, proliferation by Ki-67 immunostaining, necrosis by lactate dehydrogenase activity and trophoblast differentiation by human chorionic gonadotrophin (hCG) secretion in conditioned culture media. Immunoperoxidase staining was performed to identify phosphorylated-AKT (p-AKT) and phosphorylated-PI3 kinase (p-PI3k). Exposure to 1,000 μM hydrogen peroxide for 48 h induced apoptosis in placental explants. The increase in TUNEL positive nuclei predominantly localised to syncytiotrophoblast. The amount of apoptosis was reduced to control levels by treatment with 10 and 100 ng/ml EGF. Proliferation of cytotrophoblasts within villous explants was significantly reduced following exposure to 1,000 μM hydrogen peroxide, this was restored to control levels by simultaneous treatment with 10 or 100 ng/ml EGF. Neither exposure to hydrogen peroxide or EGF altered the amount of necrosis. There was increased immunostaining for pPI3K following treatment with EGF. This study shows that apoptosis may be induced in villous trophoblast following exposure to ROS, and demonstrates the anti-apoptotic effect of EGF in trophoblast, the maintenance of which is essential for normal pregnancy.