ABSTRACT
The study was undertaken to investigate the influence of lipopolysaccharide (LPS)
on the uterine contraction inhibitory effects of tocolytic agents such as ritodrine,
magnesium, and diethylamine/nitric oxide (DEA/NO), and on prostaglandin (PG) E2 and
nitric oxide (NO) metabolite (NOx) production in pregnant mice at midgestation. Pregnant
C57BL mice on day 14 of gestation were sacrificed 6 hours after intraperitoneal injection
of LPS (400 μg/kg) or vehicle. Uterine rings were equilibrated in Krebs-Henseleit
solution (37°C) bubbled with 20% O2 and 5% CO2 (pH ~7.4) for sampling and isometric tension recording. The concentration levels
of PGE2 and NOx in the solution were determined. Changes of spontaneous contractile
activity in response to cumulative concentrations of ritodrine, magnesium, and the
NO donor, DEA/NO, from the baseline were determined. Integral contractile activity
over 10 minutes at each concentration was calculated and expressed as percentage change
from basal activity. Statistical analysis was performed using one-way analysis of
variance (ANOVA) followed by the Dunnett test (significance: p < 0.05). LPS treatment significantly increased the production levels of PGE2 and
NOx (from 66.8 ± 6.7 pg/g tissue to 147.0 ± 29.0, from 51.0 ± 5.4 pmol/2 μL/g tissue
to 98.0 ± 16.2, respectively), p < 0.05). Ritodrine, magnesium, and DEA/NO inhibited spontaneous contractions concentration
dependently in uterine rings from both LPS-treated and -untreated animals. Treatment
with LPS significantly attenuated the maximal inhibition induced by DEA/NO in uterine
rings from pregnant mice. LPS significantly suppressed the uterine contraction inhibitory
effects of ritodrine at 10-8 M concentrations and of magnesium at 4.2 mmol concentration (p < 0.05). We concluded that the effects of ritodrine and magnesium may be reduced
under inflammatory conditions because LPS increases the production levels of PGE2
and NOx, which cause increased spontaneous contractions of the uterine myometrium.
Therefore, when uterine contractions are not controlled by tocolytics in pregnant
patients with preterm labor associated with inflammation, labor induction or pregnancy
termination may become significant options in clinical practice.
KEYWORDS
Ritodrine - magnesium - PGE2 - nitric oxide - contractility - lipopolysaccharides
- myometrium
REFERENCES
- 1
Gomez R, Romero R, Edwin S S, David C.
Pathogenesis of preterm labor and preterm premature rupture of membranes associated
with intraamniotic infection.
Infect Dis Clin North Am.
1997;
11
135-176
- 2
Klein L L, Gibbs R S.
Infection and preterm birth.
Obstet Gynecol Clin North Am.
2005;
32
397-410
- 3
Kazy Z, Puho E, Czeizel A E.
Effect of vaginal metronidazole + miconazole treatment during pregnancy for gestational
age and birth weight in a population-based study.
Arch Gynecol Obstet.
2005;
272
294-297
- 4
Kazy Z, Puho E H, Czeizel A E.
The possible preterm birth preventive effect of ampicillin during pregnancy.
Arch Gynecol Obstet.
2006;
274
215-221
- 5
Souney P F, Kaul A F, Osathanondh R.
Pharmacotherapy of preterm labor.
Clin Pharm.
1983;
2
29-44
- 6
Romero R, Mazor M, Wu Y K et al..
Infection in the pathogenesis of preterm labor.
Semin Perinatol.
1988;
12
262-279
- 7
Gibbs R S, Romero R, Hillier S L, Eschenbach D A, Sweet R L.
A review of premature birth and subclinical infection.
Am J Obstet Gynecol.
1992;
166
1515-1528
- 8
Wenstrom K D, Andrews W W, Hauth J C, Goldenberg R L, DuBard M B, Cliver S P.
Elevated second-trimester amniotic fluid interleukin-6 levels predict preterm delivery.
Am J Obstet Gynecol.
1998;
178
546-550
- 9
Okawa T, Suzuki H, Yanagida K et al..
Effect of lipopolysaccharide on uterine contractions and prostaglandin production
in pregnant rats.
Am J Obstet Gynecol.
2001;
184
84-89
- 10
Ross R G, Sathishkumar K, Naik A K et al..
Mechanism of lipopolysaccharide-induced changes in effect of contractile agonists
on pregnant rat myometrium.
Am J Obstet Gynecol.
2004;
190
523-540
- 11
Okawa T, Syal A, Vedernikov Y, Chwalisz K, Saade G R, Garfield R E.
The effect of nitric oxide on the contractility of isolated uterine and aortic rings
from pregnant rats.
Am J Obstet Gynecol.
1998;
179
721-726
- 12
Okawa T, Asano K, Takahashi H et al..
iNOS mRNA and inhibitory effect of NO on uterine contractile activity in rats are
determined by local rather than systemic factors of pregnancy.
J Pharmacol Sci.
2004;
95
349-354
- 13
Lees C C, Lojacono A, Thompson C et al..
Glyceryl trinitrate and ritodrine in tocolysis: an international multicenter randomized
study. GTN Preterm Labour Investigation Group.
Obstet Gynecol.
1999;
94
403-408
- 14
Leszczynska-Gorzelak B, Laskowska M, Marciniak B, Oleszczuk J.
Nitric oxide for treatment of threatened preterm labor.
Int J Gynaecol Obstet.
2001;
73
201-206
- 15
Minkoff H.
Prematurity: infection as an etiologic factor.
Obstet Gynecol.
1983;
62
137-144
- 16
Gomez R, Romero R, Edwin S S, David C.
Pathogenesis of preterm labor and preterm premature rupture of membranes associated
with intraamniotic infection.
Infect Dis Clin North Am.
1997;
11
135-176
- 17
Roberts J M.
Current understanding of pharmacologic mechanisms in the prevention of preterm birth.
Clin Obstet Gynecol.
1984;
27
592-605
- 18
Hall D G, McGaughey Jr H S, Corey E L.
The effects of magnesium therapy on the duration of labor.
Am J Obstet Gynecol.
1959;
78
27-32
- 19
Hollander D I, Nagey D A, Pupkin M J.
Magnesium sulfate and ritodrine hydrochloride: a randomized comparison.
Am J Obstet Gynecol.
1987;
156
631-637
- 20
Saade G R, Taskin O, Belfort M A, Erturan B, Moise Jr K J.
In vitro comparison of four tocolytic agents, alone and in combination.
Obstet Gynecol.
1994;
84
374-378
- 21
Colbert W E, Wilson B F, Williams P D, Williams G D.
Relationship between in vitro relaxation of the costo-uterine smooth muscle and mesovarial
leiomyoma formation in vivo by beta-receptor agonists.
Arch Toxicol.
1991;
65
575-579
- 22
Weiner C P, Thompson L P.
Nitric oxide and pregnancy.
Semin Perinatol.
1997;
21
367-380
- 23
Yallampalli C, Buhimschi I, Chwalisz K et al..
Preterm birth in rats produced by the synergistic action of a nitric oxide inhibitor
(NG-nitro-L-arginine methyl ester) and an antiprogestin (onapristone).
Am J Obstet Gynecol.
1996;
175
207-212
- 24
Tobai H, Nishiya I.
Nitric oxide mediates inhibitory effect of interleukin-1beta on estrogen production
in human granulosa-luteal cells.
J Obstet Gynaecol Res.
2001;
27
53-59
- 25
Jana B, Andronowska A, Kucharski J.
Immunoreactivity of iNOS in porcine uterus after infusions of Escherichia coli endotoxin.
Folia Histochem Cytobiol.
2001;
39
177-178
- 26
Nakatsuka M, Asagiri K, Noguchi S, Habara T, Kudo T.
Nafamostat mesilate, a serine protease inhibitor, suppresses lipopolysaccharide-induced
nitric oxide synthesis and apoptosis in cultured human trophoblasts.
Life Sci.
2000;
67
1243-1250
- 27
Chen G, Wang S H, Warner T D.
Regulation of iNOS mRNA levels in endothelial cells by glutathione, a double-edged
sword.
Free Radic Res.
2000;
32
223-234
- 28
Hameed C, Tejani N, Verma U L, Archbald F.
Silent chorioamnionitis as a cause of preterm labor refractory to tocolytic therapy.
Am J Obstet Gynecol.
1984;
149
726-730
Toshiaki Okawa M.D.
Department of Obstetrics & Gynecology, Fukushima Medical University School of Medicine
Hikarigaoka 1, Fukushima, 960-1295, Japan