Follow-up of Hydatidiform Mole by Radioimmunoassay of Human Chorionic Gonadotrophin

An improved method for the follow-up of patients delivered of a hydatidiform mole using radioimmunoassay of human chorionic gonadotrophin is employed to ensure adequate sensitivity. Four illustrative case histories are described. Their HCG findings are presented to show that this is the principal basis on which decisions should be made.There are three aspects to the work of the laboratory. The technical work of the assay, the clerical effort of patient follow-up, and the clinical interpretation of results. The laboratory keeps a close check on follow-up (one of its most important functions) and receives specimens direct from patients. Overall control of all three aspects is by a clinician. It has been found useful to organize a special clinic for these patients to be seen. In this region it has been possible for this to be run by the same clinician.     

葡萄胎中MBD2表达及其相关基因甲基化芯片研究

用Real-time RT-PCR、Western blot和免疫组织化学方法分别检测了去甲基化酶MBD2(methyl-CpG-binding domain 2,MBD2)在完全型葡萄胎(complete hydatidiform mole,CHM)和正常早期妊娠绒毛中的表达,用甲基化DNA免疫沉淀MeDIP(methylated DNA immunoprecipitation)-甲基化芯片分析完全型葡萄胎和正常早期妊娠绒毛中相关基因的甲基化情况,用生物信息学分析筛选了差异甲基化基因并进行功能分类。MBD2的mRNA在完全型葡萄胎中的表达明显高于正常早期妊娠绒毛(P=0.0083),Western blot(P=0.0005)和免疫组织化学(P=0.0091)检测到MBD2蛋白表达与Real-time RT-PCR结果一致。结果显示MBD2在完全型葡萄胎中的表达显著高于正常早期妊娠绒毛组织(P<0.01),与正常早期妊娠绒毛组织相比较,完全型葡萄胎组织中相对有89个基因发生了去甲基化,其中85个基因可被映射到基因组图谱中,MBD2在完全型葡萄胎中的高表达及部分基因的去甲基化可能在完全型葡萄胎的发生中扮演了重...     

Inhibin: a new circulating marker of hydatidiform mole?

OBJECTIVE--To define the concentrations of inhibin in serum and tissue of patients with hydatidiform mole and assess their value as a clinical marker of the condition. DESIGN--Prospective study of new patients with hydatidiform mole, comparison of paired observations, and case-control analysis. SETTING--A university hospital, two large public hospitals, and a private women''s clinic in Japan. PATIENTS--Seven consecutive referred patients seen over four months with newly diagnosed complete hydatidiform mole, including one in whom the mole was accompanied by viable twin fetuses (case excluded from statistical analysis because of unique clinical features). All patients followed up for six months after evacuation of molar tissue. END POINT--Correlation of serum inhibin concentrations with trophoblastic disease. MEASUREMENTS AND MAIN RESULTS--Serum concentrations of inhibin, human chorionic gonadotrophin, and follicle stimulating hormone were compared before and seven to 10 days after evacuation of the mole. Before evacuation the serum inhibin concentrations (median 8.3 U/ml; 95% confidence interval 2.4 to 34.5) were significantly greater than in 21 normal women at the same stage of pregnancy (2.8 U/ml; 2.1 to 3.6), and inhibin in molar tissue was also present in high concentrations (578 U/ml cytosol; 158 to 1162). Seven to 10 days after evacuation inhibin concentrations in serum samples from the same patients declined significantly to values (0.4 U/ml; 0.1 to 1.4) similar to those seen in the follicular phase of normal menstrual cycles. None of the four patients whose serum inhibin concentrations were 0.4 U/ml or less after evacuation developed persistent trophoblastic disease. Though serum human chorionic gonadotrophin concentrations declined after evacuation (6.6 x 10(3) IU/l; 0.8 x 10(3) to 32.6 x 10(3], they remained far higher than in non-pregnant women. Serum follicle stimulating hormone concentrations remained suppressed. CONCLUSIONS--In this small study serum inhibin concentrations higher than those found in the early follicular phase one to two weeks after evacuation of a hydatidiform mole seemed to be specific for persistent trophoblastic disease. Further data are needed to confirm these promising results.     

9个多态性STR基因座用于完全性葡萄胎的亲代来源鉴定

选取9个多态性STR基因座,应用多重PCR技术和聚丙烯酰胺凝胶电泳结合银染显色的方法,对33例病理学诊断为完全性葡萄胎的组织标本及夫妇双方外周血标本进行分子病理学分析研究,判定其DNA来源。结果表明,33例病理学上的完全性葡萄胎有27例DNA为单纯性父方来源,占81.8%(27/33),其中,纯合子完全性葡萄胎为22例,占66.7%(22/33),杂合子完全性葡萄胎5例,占15.1%(5/33);其余6例的DNA来自双亲,占18.2%(6/33)。葡萄胎的组织病理学诊断与其分子病理学诊断存在差异,提示9个多态性STR基因座分析法适用于鉴定葡萄胎DNA来源,具有准确可靠、快速、简便等优点,为进一步研究其恶变趋势提供可靠线索。
Abstract: To explore the genetic origin of hydatidiform mole (CHM), 33 cases of CHM were collected mainly from Harbin Red Cross Central hospital from 1998.6 to 2001.5 and studied by multiplex–PCR, products were separated using denaturing polyacrylamide gel and were detected by silver stain for 9 different STR loci analysis. Among 33 samples of CHM, DNA from only paternal origin was found in 27 cases (81.8%, 27/33), and from both parents in 6 cases (18.2%, 6/33); and in the former, the homozygous CHM and the heterozygous CHM were 22 cases (66.7%, 22/33) and 5 cases (15.1%, 5/33), respectively. There was difference between analysis of microsatellite DNA polymorphism and pathological diagnosis in hydatidiform moles’ classification. The results suggest that the analysis of 9 polymorphic STR loci is suitable for genetic original identification of hydatidiform moles.     

Cytological distribution of chorionic gonadotropin subunit and placental lactogen messenger RNA in neoplasms derived from human placenta

Normal trophoblast of the human placenta elaborates at least two major protein hormones, chorionic gonadotropin (hCG), and placental lactogen (hPL). There are several gestational trophoblastic diseases of the placenta called hydatidiform mole, invasive mole, and choriocarcinoma. Molar and choriocarcinoma tissues characteristically synthesize large amounts of hCG and small quantities of hPL. To examine the role of trophoblast differentiation in the expression of the hCG and hPL genes, we studied the cytological distribution of their messenger RNA (mRNA) in tissue sections of human hydatidiform mole and choriocarcinoma by in situ hybridization. Histologically, these tissues are in different stages of cellular differentiation. In normal placenta, hCG alpha and - beta mRNA can be localized to some cytotrophoblasts and primarily to the syncytium, whereas hPL mRNA appears only in the syncytial layer. In hydatidiform mole, which still retains placental villous morphology, the hPL gene and hCG alpha and -beta genes are expressed but are poorly localized because of the admixture of cyto- and syncytiotrophoblasts. By contrast, choriocarcinoma, which is devoid of placental villous pattern but in which the cyto- and syncytiotrophoblast-like components are distinguishable, expresses hCG alpha and -beta in the syncytial- like areas but little, if any, hPL. These results suggest that a certain level of trophoblast differentiation, such as villous formation, is associated with hPL expression, while the hCG alpha gene and the hCG beta gene can be expressed in more disorganized tissues that contain cytotrophoblastic elements.     

Comparative study of the mucin-type sugar chains of human chorionic gonadotropin present in the urine of patients with trophoblastic diseases and healthy pregnant women

Human chorionic gonadotropins (hCGs) highly purified from the urine of patients with trophoblastic diseases and of healthy pregnant women contain approximately four mucin-type sugar chains in one molecule. The structures of these sugar chains were studied comparatively by using a new sensitive method to obtain mucin-type sugar chains quantitatively as radioactive oligosaccharides from a small amount of glycoproteins. The mucin-type sugar chains of all hCGs include sialylated and nonsialylated Gal beta 1----3GalNAc and Gal beta 1----4GlcNAc beta 1----6(Gal beta 1----3)GalNAc. In the case of normal hCG and hydatidiform mole hCG, oligosaccharides containing the tetrasaccharide core occupy approximately 10% of the total mucin-type sugar chains. The ratio of the tetrasaccharide containing oligosaccharides is increased prominently to approximately 60% in choriocarcinoma hCG. The proportion in invasive mole hCG was also increased, but less than the proportion of choriocarcinoma hCG.     

131I]metaiodobenzylguanidine therapy after conventional therapy for neuroblastoma.

[131I]Metaiodobenzylguanidine (131I-MIBG) is used for diagnostic scintigraphy and targeted therapy in a range of neural crest tumors, which exhibit an active uptake-1 mechanism at the cell membrane and cytoplasmatic storage in neurosecretory granules. A good and selective concentration and a long retention in the tumor, as is generally the case in neuroblastoma, are the basis for successful 131I-MIBG treatment. At The Netherlands Cancer Institute a phase II study was carried out in 53 patients with progressive recurrent disease after conventional therapy had failed. Despite the unfavorable basis for treatment, 131I-MIBG therapy induced 7 complete remissions, 23 partial remissions and arrest of disease (no change) in 10. Nine patients had progressive disease and one patient was lost to follow-up. The palliative effect of the treatment under these conditions was impressive. The duration of remissions varied from 2 to 38 months. The best results were obtained in patients with voluminous soft tissue disease. In general the treatment was well tolerated by children and the toxicity was mild, provided the bone marrow was not invaded by the disease. It is concluded that 131I-MIBG therapy has a definitive place in the treatment of neuroblastoma after conventional treatment has failed. As the invasiveness and toxicity of this therapy compare favorably with that of chemotherapy, immunotherapy and external beam radiotherapy, 131I-MIBG therapy is the best palliative treatment for patients with advanced recurrent neuroblastoma.     

The clinical evaluation of the simultaneous measurements of human chorionic gonadotropin (hCG) and its alpha-subunit in sera of patients with trophoblastic diseases

The concentrations of human chorionic gonadotropin (hCG) and its free immunoreactive alpha-subunit (hCG-alpha) in the sera of patients with trophoblastic diseases were measured by hCG and hCG-alpha radioimmunoassay (RIA), respectively. In the sera of 12 women with hydatidiform mole large amounts of hCG and considerably high level of hCG-alpha were detected in all cases. After the evacuation of mole the serum level of these glycoproteins decreased, the leve of hCG-alpha declined more rapidly than hcg. in the sera of patients with destructive mole the concentration of hCG-alpha was usually lower than that of hCG. After hysterectomy and chemotherapy the levels of hCG-alpha declined practically paralleling that of hCG. However, when hCG had decreased to undetectable level, hCG-alpha could no longer be detected in all cases. Although in the serum of patient with choriocarcinoma involving the uterus and lungs the concentration of hCG-alpha was almost as high as that of hCG, the secretory pattern of hCG and hCG-alpha might not be closely related. The changes in the serum level of free hCG-alpha as well as that of hCG parelled the clinical course of the patients examined in this study. The present results suggest that measurements of the serum free hCG-alpha may be a useful parameter to follow the clinical course and to evaluate the efficacy of treatments of trophoblastic diseases.     

Hydatidiform mole metastasizing to the lung.

Pulmonary lesions developed in three patients with an invasive hydatidiform mole. At open thoracotomy the modules were found to contain molar tissue. Therapy with twice-weekly methotrexate induced complete clinical and biologic remission of the disease in all three patients.     

Failure of contraceptive steroids to modify human chorionic gonadotrophin secretion by hydatidiform mole tissue and choriocarcinoma cells in culture

The effect of steroids contained in oral contraceptives, namely ethinylestradiol:17α-ethinyl-1,3,5(10)-estratriene-3, 17-diol (E) and norethindrone acetate: 17β-acetoxy-17-ethinyl-4-estren-3-one (N), on cell replication and human chorionic gonadotropin (hCG) secretion by choriocarcinoma cells in monolayer culture and by hydatidiform mole tissue maintained in organ culture were studied. The steroids were added to the culture medium individually or in combination to achieve a range of concentrations (10^?10 to 10^?4), within and beyond the presumed concentration of these substances in the blood of women taking oral contraceptives. The effect of luteinizing hormone releasing hormone (LHRH) on hCG secretion by choriocarcinoma cells in monolayer culture also was investigated. The rate of hCG production by either choriocarcinoma cells in monolayer culture or by hydatidiform mole tissue maintained in organ culture was not affected by the hormones used in this study; indeed hCG secretion remained reasonably unchanged even with high concentrations of steroids (up to 10^?14 M) or LHRH (up to 10^?4 mg × ml^?1). Cell replication, as measured by increase in amount of cellular protein and DNA, was not stimulated by either of these compounds.     

Prophylactic effect of bestatin on the onset of invasive mole — clinical and fundamental studies

This study was performed to determine whether bestatin (Ubenimex) has clinical prophylactic effects on the onset of invasive mole and a direct inhibitory effect on the growth of hydatidiform molar cells. A total of 49 patients with hydatidiform mole treated at Nagoya University Hospital from 1984 to 1990 were randomly divided into two groups, a bestatin administered-group and a bestatin non-administered group. Patients in the bestatin group were given 30 mg of bestatin orally and daily for three months just after their molar deliveries. There was no significant difference in age, gravidity, parity and gestational weeks between the two groups. There was also no significant difference in the duration of human chorionic gonadotropin (hCG) negative conversion in patients without invasive mole between the two groups. However, the incidence of invasive mole in the bestatin group (2/25, 8%) was significantly lower than that of the non-bestatin group (7/24, 29.2%). Nevertheless, there was no significant difference between the two groups in such immunological parameters as PHA skin test, PPD skin test, PHA stimulation index (PHA-SI), white blood cell (WBC) count lymphocytes % per WBC, OKT 3% per lymphocytes, OKT 4% per lymphocytes, OKT4/OKT8 and Leu 11% per lymphocytes. In vitro studies were performed with primary cultured hydatidiform moles. The result was that bestatin inhibited the secretion of hCG and³H-thymidine uptake of hydatidiform molar cells. Thus, a possibility was suggested that bestatin directly inhibits the growth of hydatidiform molar cells and prevents the onset of invasive mole.     

A controlled trial of Bestatin in hydatidiform mole

Summary A prospective randomized controlled trial was conducted to study whether Bestatin, an immunomodifier, can reduce the incidence of persistent gestational trophoblastic disease in patients with hydatidiform mole. A group of 21 patients (Bestatin group) received 30 mg Bestatin daily after evacuation of the hydatidiform mole. A second group of 23 patients (control group) did not receive any drug. Blood was taken for white cell counts, differential counts, lymphocyte subset counts (CD2⁺, CD4⁺, CD8⁺ and B cells) and natural killer cell activity before evacuation of the hydatidiform moles. The tests were repeated every 4 weeks after evacuation until the serum subunit of human chorionic gonadotropin (hCG) had returned to normal or until the patient had to receive chemotherapy because of persistent gestational trophoblastic disease. There was no significant difference in the age of the patients, the pre-evacuation serum hCG, or the gestational age between the two groups. Chemotherapy was needed by 6 patients in the Bestatin group (28.6%) and 3 patients in the control group (13%) because of persistent gestational trophoblastic disease. There was no significant difference in any of the immunological parameters between the two groups before or after evacuation. We conclude that Bestatin at this dosage does not improve the immunological functions or clinical outcome in patients with hydatidiform mole.     

HLA and molar pregnancies (triploidies, hydatidiform moles and choriocarcinoma). Etiological and epidemiological study

Etiological and epidemiological studies of triploid and hydatidiform molar conceptuses were done using HLA polymorphism. The segregation of HLA markers allowed to know the etiology of 25 triploidies and 19 hydatidiform moles. Five other moles and a post molar choriocarcinoma were also studied by molecular hybridization. This confirms that triploidies in about 3/4 of the cases involved two sets of paternal chromosomes mainly by di-sperm. Hydatidiform moles from Algeria, France and Senegal were all of androgenic origin excepted for one case. DNA analysis of the choriocarcinoma demonstrated the presence of a paternal marker suggesting for this case a direct cellular lineage from the mole. Positive associations with HLA A 28 and B 7 were found which could be related to gametogenesis-fecundation dysfunction. A slight excess of antigens shared by parents of triploidies was shown. This was not observed for parents of hydatidiform moles but when they shared HLA antigens a preferential inheritance in the mole of the shared specificities was observed. This relative compatibility of the molar conceptus with the mother may be an element of the process that prevent its early rejection.     

A phase III comparison of methyl-CCNU + vincristine with or without BCG + allogeneic tumor cells in metastatic melanoma

Summary Sixty-two patients with metastatic malignant melanoma were randomized to treatment with either (a) methyl-CCNU (200 mg/m², PO every 8 weeks) plus vincristine (2 mg IV every 4 weeks), or (b) the same chemotherapy plus intradermal (ID) injections of irradiated (15,000 rads) allogeneic (fresh-frozen) melanoma cells (1–2×10⁸) admixed with BCG (Glaxo, 2–4.5×10⁶ organisms) every 2 weeks. Treatment cycles were repeated every 8 weeks until tumor progression. Seven (2 CR, 5 PR) objective remissions were noted among 31 patients (22.5%) treated with chemotherapy alone, whereas six (3 CR, 3 PR) objective remissions were noted among 31 patients (19%) treated with chemoimmunotherapy (P>0.05). The medians for remission duration (6 months) and survival (6.5 months) in the chemotherapy group did not differ significantly from the medians for remission duration (8 months) and survival (8 months) in the chemoimmunotherapy group. The patients manifested no unexpected toxicity. Hematologic toxicity was experienced by patients on both regimens; however, those receiving chemoimmunotherapy rebounded more quickly.     

Defective Pericyte Recruitment of Villous Stromal Vessels as the Possible Etiologic Cause of Hydropic Change in Complete Hydatidiform Mole

The pathogenetic mechanism underlying the hydropic change in complete hydatidiform moles (CHMs) is poorly understood. A growing body of data suggests that pericytes play a role in vascular maturation. Since maturation of villous stromal vessels in CHMs is markedly impaired at early stages, we postulated that a defect in pericytes around stromal vessels in chorionic villi might cause vascular immaturity and subsequent hydropic change. To investigate this, we examined several markers of pericytes, namely, α-smooth muscle actin (α-SMA), platelet-derived growth factor receptor-β (PDGFR-β), and desmin, in 61 normally developing placentas and 41 CHMs with gestational ages of 4–12 weeks. The ultrastructure of villous stromal vessels was also examined. Mature blood vessels from normal placentas show patent vascular lumens and formed hematopoietic components in the villous stroma. α-SMA and PDGFR-β expression in the villous stroma gradually increased and extended from the chorionic plate to peripheral villous branches. The labeled cells formed a reticular network in the villous stroma and, after week 7, encircled villous stromal vessels. In comparison, α-SMA and PDGFR-β expression in the villous stroma and stromal vessels of CHMs was significantly lower (p<0.05). Ultrastructurally, endothelial cells in villous stromal vessels in normal placentas were consistently attached by pericytes after week 7 when the vessels formed distinct lumen, whereas the villous stromal vessels in CHMs consisted of linear chains of endothelial cells, often disclosing primitive clefts without hematopoietic cells inside, and neither pericytes nor basal lamina surrounded the endothelial cells at any gestational age studied. This suggests that pericytes recruitment around villous stromal vessels is defective in CHMs and links to the persistent vascular immaturity of the villous stroma in CHMs, which in turns leads to hydropic villi.     

Structures, function, and transformational changes of the sugar chains of glycohormones

Human chorionic gonadotropin (hCG), human luteinizing hormone, human thyroid-stimulating hormone, and human follicle-stimulating hormone are closely related family of proteins which share a common alpha-subunit. However, their sugar moieties are quite different. hCG contains five acidic asparagine-linked sugar chains. These five sugar chains are derived by sialylation from three neutral oligosaccharides: two biantennary (N-1 and N-2) and one monoantennary (N-3) complex-type oligosaccharides. Although hCG purified from the urine of pregnant women is more enriched in sialylated sugar chains than that purified from placenta, the molar ratio of N-1, N-2, and N-3 of these two hCGs are the same (1:2:1). Comparative study of the sugar moieties of the alpha- and beta-subunits of hCG revealed that alpha contains 1 mol each of N-2 and N-3, while beta contains 1 mol each of N-1 and N-2. This specific distribution of oligosaccharides at the four asparagine loci of the hCG molecule is now helping us to consider the functional role of the sugar moiety of glycohormones. hCG is produced not only by the trophoblast but also by various trophoblastic diseases. The hCGs purified from the urine of patients with hydatidiform mole contain the same oligosaccharides as normal hCG. However, those from the urine of choriocarcinoma patients contain five additional neutral oligosaccharides. In contrast, hCGs from invasive-mole patients contain three of the five oligosaccharides, specifically found in choriocarcinoma hCGs. The malignant transformational change of the sugar moiety of hCG can be explained by an increase of a fucosyltransferase, which forms the Fuc alpha 1----6GlcNAc group and by ectopic expression and subsequent modification of N-acetylglucosaminyltransferase IV. The appearance of tumor-specific sugar chains of hCG has been used to develop a new diagnostic method for invasive mole and choriocarcinoma.     

Heterogeneity of human chorionic gonadotropin in various biological fluids as revealed by chromatofocusing

This study demonstrates that chromatofocusing is powerful in analyzing multiple forms of hCG from biological fluids. For analyzing hCG from biological fluids, it is necessary to perform chromatofocusing, in the range of pH 6.2-3.0 and pH 9.0-6.0. By chromatofocusing, highly purified hCG (CR121) was found to be acidic, in the range of pI 4.22-3.8, and hCG beta was more acidic, in the range of pI 4.0-3.2. Moreover, hCG from the first trimester pregnancy, hydatidiform mole or choriocarcinoma was also mainly acidic. Therefore, chromatofocusing in the range of 6.2-3.0 was suitable for analyzing purified hCG, hCG beta, and urinary hCG from the first trimester pregnancy, hydatidiform mole and choriocarcinoma. On the other hand, because hCG in the third trimester pregnancy and the toxemia of pregnancy were mainly alkaline, the chromatofocusing system in the range of pH 9.0-6.0 was suitable for analyzing hCG from the third trimester pregnancy and the toxemia of pregnancy.     

Partial hydatidiform mole in a pregnant chimpanzee (Pan troglodytes)

Until now, the occurrence of hydatidiform mole in non-human primates has not been documented. This report presents a case in which a stillborn fetus, associated with a partial hydatidiform mole, was found at necropsy in the uterus of a pregnant chimpanzee (Pan troglodytes) which had suddenly died. Hydropic swelling of the chorionic villi and proliferation of trophoblastic cells were present. The trophoblast was stained enzyme-immunohistochemically with human chorionic gonadotropin (hCG) and pregnancy-specific-β1-glycoprotein (SP1). The concentrations of hCG and SP1 in maternal serum were high, 1,350 mIU/ml and 1,000 ng/ml, respectively. The distribution of DNA content of the cytotrophoblast in the molar villi shifted from diploid to an aneuploid pattern. © 1993 Wiley-Liss, Inc.     

hCG对绒癌细胞系MMP-2和MMP-8表达的影响

为了探讨人绒毛膜促性腺激素（hCG)对绒并且吕细胞侵袭性相关基因表达的影响作用。采用逆转录多聚酶链反应（RT-PCR）检测方法,观察了不同浓度hCG不同处理时间对JEG-3绒癌细胞系表达基质金属蛋白酶（MMP-2和MMP-8）的影响。结果显示,绒癌细胞系JEG-3表达MMP-2和MMP-8;分别用0、50、500、5000、25000IU/LhCG处理48h后,JEG-3细胞中MMP-2mRNA的含量无明显变化。MMP-8mRNA的表达则被诱导,并随hCG作用浓度增高而增强,进一步研究处理时间对MMP表达的影响。结果发现经25000IU/LhCG处理的JEG-3细胞,MMP-8的表达随处理时间的延长逐渐增强,而MMP-2的表达则在第6h被显著诱导后逐渐降低,以上结果提示,hCG可诱导绒癌细胞系JEG-3中MMP-2和MMP-8两种基质金属蛋白酶的表达,并因此可能对绒癌细胞系的侵袭性具有影响作用。然而hCG对这两者表达的影响规律并不完全一致。