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AIM: To evaluate the feasibility and potential value of two-dimensional (2D) parametric parenchymal blood flow (2D-PPBF) for the assessment of perfusion changes during transarterial chemoembolisation with drug-eluting beads (DEB-TACE) and to analyse correlations of 2D-PPBF parameters and tumour response. MATERIALS AND METHODS: Thirty-two patients (six women, 26 men, mean age: 67±8.9 years) with unresectable hepatocellular carcinoma (HCC) who underwent their first DEB-TACE were included in this study. To quantify perfusion changes using 2D-PPBF, the acquired digital subtraction angiography (DSA) series were post-processed. Ratios were calculated between the reference region of interest (ROI) and the wash-in rate (WIR), the arrival to peak (AP) and the area under the curve (AUC) of the generated time-density curves. Comparisons between pre- and post-embolisation data were made using the Wilcoxon signed-rank test. Tumour response was assessed at 3 months using the modified Response Evaluation Criteria in Solid Tumours (mRECIST) and correlated to changes of 2D-PPBF parameters. RESULTS: All 2D-PPBF parameters derived from the ROI-based time-attenuation curves were significantly different pre-versus post-DEB-TACE. Although the AUC, the WIR and target lesion size measured in accordance with mRECIST decreased (p≤0.0001) significantly, AP values showed a significant increase (p = 0.0033). Tumour response after DEB-TACE correlated with changes in the AUC (p = 0.01, r = -0.45). CONCLUSION: 2D-PPBF offers an objective approach to analyse perfusion changes of embolised tumour tissue following DEB-TACE and can therefore be used to predict tumour response.

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AIM: To evaluate the feasibility of two-dimensional parametric parenchymal blood flow (2D-PPBF) to quantify perfusion changes in the lung parenchyma following balloon pulmonary angioplasty (BPA) for treatment of chronic thromboembolic pulmonary hypertension. MATERIALS AND METHODS: Overall, 35 consecutive interventions in 18 patients with 98 treated pulmonary arteries were included. To quantify changes in pulmonary blood flow using 2D-PPBF, the acquired digital subtraction angiography (DSA) series were post-processed using dedicated software. A reference region of interest (ROI; arterial inflow) in the treated pulmonary artery and a distal target ROI, including the whole lung parenchyma distal to the targeted stenosis, were placed in corresponding areas on DSA pre- and post-BPA. Half-peak density (HPD), wash-in rate (WIR), arrival to peak (AP), area under the curve (AUC), and mean transit time (MTT) were assessed. The ratios of the reference ROI to the target ROI (HPDparenchyma/HPDinflow, WIRparenchyma/WIRinflow; APparenchyma/APinflow, AUCparenchyma/AUCinflow, MTTparenchyma/MTTinflow) were calculated. The relative differences of the 2D-PPBF parameters were correlated to changes in the pulmonary flow grade score. RESULTS: The pulmonary flow grade score improved significantly after BPA (1 versus 3; p<0.0001). Likewise, the mean HPDparenchyma/HPDinflow (-10.2%; p<0.0001), APparenchyma/APinflow (-24.4%; p=0.0007), and MTTparenchyma/MTTinflow (-3.5%; p=0.0449) decreased significantly, whereas WIRparenchyma/WIRinflow (+82.4%) and AUCparenchyma/AUCinflow (+58.6%) showed a significant increase (p<0.0001). Furthermore, a significant correlation between changes of the pulmonary flow grade score and changes of HPDparenchyma/HPDinflow (ρ=-0.21, p=0.04), WIRparenchyma/WIRinflow (ρ=0.43, p<0.0001), APparenchyma/APinflow (ρ=-0.22, p=0.03), AUCparenchyma/AUCinflow (ρ=0.48, p<0.0001), and MTTparenchyma/MTTinflow (ρ=-0.39, p<0.0001) could be observed. CONCLUSION: The 2D-PPBF technique is feasible for the quantification of perfusion changes following BPA and has the potential to improve monitoring of BPA.

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Interactions of vascular endothelial growth factor (VEGF) with its receptors VEGFR-1 and VEGFR-2 promoting angiogenesis have been described in placentation of human, mink and pig. The bovine placenta is multiplex, villous and synepitheliochorial due to migratory trophoblast giant cells (TGC). To determine the role of VEGF in bovine implantation and placentation, placentomes and interplacentomal areas from 33 cows from early implantation until near term were evaluated by immunohistochemistry. VEGF immunoreactivity was detected in fetal and maternal blood vessel tissues during implantation and throughout gestation, and in preimplantatory trophoblast cells and uterine epithelium. After implantation the immunoreaction was confined to TGC and uterine epithelium. An antibody against bovine VEGF revealed a strong reactivity in the stroma of maternal caruncular septa in early and mid-gestation, which distinctly decreased near term. In interplacentomal areas, VEGF was found in luminal and glandular epithelia as well as in trophoblast, with distinctly higher reactivity in giant cells. VEGFR-1 was observed in trophoblast and uterine epithelium around implantation. Later, in definite placentomes, VEGFR-1 was localized in TGC near the chorionic plate and in maternal endothelial cells in the center of the placentome. VEGFR-1 and VEGFR-2 were co-localized in uterine epithelium and trophoblast as well as in blood vessel tissue and uterine glands. The presence of VEGF, VEGFR-1 and VEGFR-2 at the feto-maternal interface and in vasculature indicates that in the bovine VEGF may have (1) classic functions in angiogenesis and vascular permeability, (2) growth factor properties, facilitating feto-maternal exchange via paracrine action, (3) chemotactic activity on capillary endothelium, and (4) an autocrine influence on TGC migratory activity.

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Angiotensin (Ang) II may modulate reproductive function in the bovine ovary. Therefore, expression and localization of a local ovarian renin-angiotensin system (RAS) were investigated by elucidating the influence of the estrus cycle, pregnancy, and the presence of follicular cysts. Receptor analysis and autoradiography were used to characterize and localize Ang II receptors. Cyclic variations in the density of ovarian Ang II receptors were found with a higher value in estrus than in diestrus. The density in ovaries with follicular cysts was in the same order of magnitude as in estrus. The Ang II receptor type 2 (AT(2)) dominated in all three groups. Autoradiography showed that the majority of antral follicles and follicular cysts had intense AT(2) receptor binding in the theca externa. Binding was less intense in the theca interna, whereas there was no binding in the granulosa layer. In the corpora lutea, the AT(2) receptor was dominant in the capsule and in connective tissue infoldings, whereas no binding was observed in the luteal tissue. The type 1 Ang II receptor (AT(1)) was dominant in the stroma and showed no cyclic changes. Angiotensin-converting enzyme (ACE) activity was detected in all aspirated follicular fluids and homogenates of ovarian tissue. Autoradiography showed that most of the ACE was localized on endothelial cells. Renin immunoreactivity was found in granulosa and thecal cells of antral follicles and in luteal cells. Furthermore, solitary cells in the stroma, presumably macrophages, displayed intense staining. Our finding of cyclic changes support the concept of an active and regulated RAS in the bovine ovary.

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Placental angiogenesis plays an important role in placental development and morphogenesis. Vascular endothelial growth factor (VEGF) is a well-known angiogenic growth factor, which has previously been localized in different epitheliochorial and haemochorial placenta types. In the present study VEGF and its Flt-1(VEGFR-1) and KDR (VEGFR-2) receptors were immunolocalized in the endotheliochorial mink placenta throughout gestation. VEGF, Flt-1 and KDR co-localized to fetal and maternal microvascular endothelial cells, but with a temporal difference, displaying KDR in endothelial cells throughout gestation, whereas the VEGF and Flt-1 maternal endothelial cell staining was most intense during late gestation. Additionally, KDR was found in vascular related mesenchymal cells. The VEGF-receptors were also localized in non-endothelial cells, e.g. the uterine luminal and glandular epithelium as well as the trophoblast. Our results are in agreement with former studies, showing the different effects of the Flt-1-and KDR receptors in respect of angiogenesis. More importantly, the present study of the endotheliochorial placenta localizes the VEGF-ligand-receptor system in non-endothelial cells, and thereby strengthen the hypothesis that VEGF, apart from its well-established angiogenic properties, must also have additional functional roles in the establishment and development of the placenta.

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The early morphological events in pig placental development are summarized and related to the known data on differences in placental vascular efficiency between Meishan and US breeds. The activation and localization of a number of factors, the ligands and their receptors, such as insulin-like growth factor (IGF), transforming growth factor beta (TGF beta), platelet-derived growth factor (PDGF) and vascular endothelial growth factor (VEGF), as well as retinoids and calcium, is described. The comparison between these factors gives a strong impression of their complex interactions and hormonal relationships during placentation and vascular development in pigs. This review also emphasizes that retinoids are of great importance for placental function and that the transport of vitamin A appears to take place in the areolar gland complex only, whereas based on histochemistry and electron energy dispersive analysis, the calcium transport may be confined to the interareolar route across the interhaemal barrier.

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Maternal stem arteries and arterioles of the endotheliochorial mink placenta have been shown to lack smooth muscle cells, suggesting a muscle-free attenuation of the maternal arterial pulse wave of the placenta. Since the endotheliochorial type of placenta by definition does not contain any maternal supportive tissue (e.g. connective tissue), except for the specialized interstitial layer, the aim of this study was to reveal cytoskeletal components able to compensate for the lack of conventional regulatory mechanisms of maternal placental blood flow. The study was undertaken on buffered formalin fixed tissues from 19 minks by immunohistochemistry and transmission electron microscopy to localize three major cytoskeletal filaments (desmin, vimentin and alpha-smooth muscle actin (alpha-sm-actin)) in non-pregnant uteri and placenta. The contractile alpha-sm-actin was immunodetected in the maternal subepithelial and periglandular connective tissue cells of the cyclic endometrium and during early gestation. During the transition from early- to mid gestation, maternal periendothelial cells appeared and showed alpha-sm-actin immuno-positivity; however, in late gestation, this activity could not be detected because the periendothelial cells had disappeared. Fetal endothelial cells displayed intense alpha-sm-actin immunoreactivity, which was in contrast to the alpha-sm-actin negative maternal endothelial cells. Allantochorionic mesenchymal cells also exhibited intense alpha-sm-actin immunostaining. Vimentin was immunohistochemically expressed in endothelial cells (maternal as well as fetal), maternal periendothelial cells, allantochorionic mesenchymal cells, and maternal connective tissue cells from early gestation. Desmin was not immunohistochemically detectable in cyclic endometrium and placental tissues. Transmission electron microscopy revealed the periendothelial cells to be enclosed by a thin interstitial layer. Additionally, the maternal endothelial cells displayed actin myofilament-like structures anchored basally. From our data we conclude that maternal periendothelial cells, immunoreactive for contractile actin, and maternal endothelial cells, possessing actin myofilament-like ultrastructures, act as supportive systems in the maternal vessel walls, probably influencing the regulation of the maternal blood flow.

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Placental angiogenesis and growth are crucial elements in embryonic and later fetal development. Vascular endothelial growth factor (VEGF) and its specific receptors Flt-1 (VEGFR-1) and KDR (VEGFR-2) compose potent ligand receptor systems involved in angiogenesis and microvascular hyperpermeability. In the present immunohistochemical study, VEGF, Flt-1 and KDR were localized in uterus of cyclic non-pregnant pigs and in the porcine epitheliochorial placenta throughout gestation. Emphasis was placed on early gestational stages, where morphological studies have demonstrated extensive angiogenesis during initial placentation. The results revealed a high correlation in spatiotemporal distribution between the ligand and its receptors and a surprising demonstration of VEGF receptors in several non-endothelial cells. In non-pregnant pigs, VEGF, Flt-1 and KDR exhibited moderate to intense staining in uterine luminal epithelium and smooth muscle cells of the vessel walls. Endothelial cells of arteries and arterioles revealed labelling for Flt-1 and KDR, whereas the uterine glandular epithelium displayed intense KDR immunoreactivity at the late luteal phase. During gestation the uterine luminal epithelium demonstrated weak ligand and receptor immunostaining in the first half of early gestation [< or = 21 days post coitus (p.c.)], whereas later stages (> or = 21 days p.c.) displayed intense immunolabelling. Endothelial cells, smooth muscle cells of the vessel walls and uterine glandular epithelium revealed intense ligand and receptor immunoreactivity throughout gestation. In the fetal part of the placenta, VEGF, Flt-1 and KDR immunostaining displayed moderate to intense reactivity in the trophoblast throughout gestation, except during the second half of early gestation (days 21-30 p.c.). Fetal vessel walls were also immunopositive for VEGF, Flt-1 and KDR. Taken together, the results imply that the VEGF, Flt-1 and KDR ligand receptor system participate in the regulations of porcine placentation and that it in addition to its angiogenic properties also may influence the cellular differentiation and transport capabilities in uterine luminal as well as glandular epithelium and the trophoblast.

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The development of the mink endotheliochorial placenta has been studied by means of light microscopy and scanning electron microscopy of maternal vascular corrosion casts. The placental blood vessels of three groups of mink, representing early, intermediate and near-term gestational ages were either perfusion fixed for histology, or instilled with liquid plastic in order to prepare vascular casts, which were examined qualitatively and/or quantitatively. The maternal component of the placental vascular system evolves from preimplantation blood vessels between the endometrial glands, into which the initial feto-maternal contact is made. The influence of highly invasive syncytiotrophoblast provokes a transition of the maternal capillaries into extensively anastomosing sinusoids with a subsequent modification of their endothelial cells into large cells with luminal protrusions. Three-dimensionally, the sinusoids are arranged as vascular crypts. This implies a villous-crypt type of interdigitation for the mink, but since the fetal capillaries surround the maternal sinusoids as a dense network a labyrinth is formed. The vascular crypts are supplied by very short arterioles, branching from maternal stem arteries, which arise from branches of the uterine artery and move straight to the surface of the endometrium. Venous outlets of the sinusoids converge onto venules and large stem veins in the deepest portion of the endometrium. This architectural pattern persists until term. Morphometry was used to confirm the qualitative observations in vascular casts. The diameter of maternal vascular crypts significantly increased from 137.3+/-21.9 microm in early gestation up to 217.8+/-80.9 microm in the intermediate stage and 431.8+/-119.5 microm near-term, when compared to the paraplacental zone in early gestation (82.2+/-19.5 microm). The capillary or sinusoidal diameter also increased significantly from intermediate stage (42.9+/-11.8 microm) to near term (60.1+/-16.7 microm), whereas the difference in the paraplacental zone (7.3+/-2.1 microm) and early gestation (13.0+/-3.2 microm) was not statistically significant.

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The present study was undertaken to characterize, determine and localize angiotensin II receptors in the nonpregnant and pregnant bovine uterus. In addition, the concentration of active renin, which is responsible for the generation of angiotensin, was determined. Autoradiography and angiotensin II receptor binding studies showed that all compartments of the bovine uterus contained high concentrations of angiotensin II receptors. In general, the type 1 angiotensin II receptor (AT1) predominated over the AT2 receptor. In the endometrium, the highest density was found in the caruncles and the AT1 receptor was always predominant. The density of angiotensin II receptors in the endometrium increased at the beginning of pregnancy, but decreased and reached values similar to those in nonpregnant animals near term. In the myometrium, the density of angiotensin II receptors was highest at or near the endometrial-myometrial junction. In this area, the predominant type of angiotensin II receptor in the uterus of cyclic cows varied, whereas the AT1 receptor always predominated during pregnancy. Non-AT1 and non-AT2 binding sites were found in the same locations as the angiotensin II receptors, but at lower densities. With the exception of the pregnant endometrium, all compartments contained higher active renin concentrations than found in plasma, indicating local synthesis of renin. This study demonstrates a difference in the expression of types of angiotensin II receptor in the bovine uterus compared with other species. The high densities of angiotensin II receptors localized in several important areas imply that the renin-angiotensin system participates in regulation of growth and tissue function in the bovine uterus.

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Autoradiography and angiotensin (Ang) II receptor binding studies showed that all parts of the bovine placenta and fetal membranes contained high densities of Ang II receptors throughout gestation. The receptors were predominantly subtype 2 (AT2) receptors in the fetal and subtype 1 (AT1) receptors in the maternal compartment. In the allantoamnionic membrane, Ang II receptors were evenly distributed in the mesenchymal tissue, with the highest expression around the few arteries. In the intercotyledonary and cotyledonary allantochorionic membrane, AT2 receptors as well as the less-expressed AT1 receptors were located on mesenchymal cells, especially adjacent to the allantoic endoderm, trophoblast cell layer, and arteries. In the mesenchymal tissue of the placentome, Ang II receptors were mostly expressed at the main branches of the fetal villi of the cotyledons. In the maternal part of the placentome, mainly AT1 receptors but also low densities of AT2 receptors and non-AT1/non-AT2 Ang II binding sites were found close to the stalk and at the main branches of the maternal crypts. Autoradiography revealed no changes in the pattern of distribution of the Ang II receptors throughout gestation. It is suggested that Ang II has an effect on regulatory as well as growth processes in these tissues.

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The microvasculature of the near-term zonary placenta of the mink has been studied using light microscopy and scanning electron microscopy of corrosion casts, prepared from maternal and fetal vessel systems, respectively. The zonary area, most important for placental exchange, includes a characteristic labyrinth. The labyrinth is composed of lobules oriented in a maternal-fetal direction. One maternal stem artery serves as the central axis of a lobule, and about six pairs of fetal stem arteries and stem veins of the chorionic primary villi mark the periphery of the lobule. Viewed from the fetal side of the labyrinth, this lobular structure presents a roughly hexagonal pattern, with the central maternal stem artery and radially oriented arteriolar branches giving the lobule the shape of a star. These arterioles frequently form bridges to neighboring lobular systems; however, the majority continue into the feto-maternally oriented three-dimensional network of maternal capillary sinusoids, which converge on the outlets of the maternal stem veins on the maternal side of the labyrinth. Maternal main crypts are delimited by the rays of the star-shaped lobules containing chorionic primary villi. The latter penetrate into maternal crypts from the fetal side, and are characterized by their axial arterial and venous stem vessels. Fetal secondary villi are arranged at different levels from these stem vessels. The secondary villi are characterized by arterioles and venules branching in pairs from the stem vessels and supply the tributary capillary complexes of terminal villi. The lobular structure of the placental labyrinth provides a three-dimensional framework of vessels where maternal capillary sinusoids and fetal capillaries meet in a one-way cross-current arrangement. The blood flow conditions and the peculiarities of the mink placenta interhemal membrane are compared to those of other carnivores and discussed with respect to the efficiency of the endotheliochorial placenta.

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1. The aim of the present study was to characterize the angiotensin II (AngII) receptor subtypes in the porcine uterus and the variation of receptor densities and renin concentrations during gestation. 2. In myometrium from non-pregnant sows, the AngII receptors were almost exclusively AT2 receptors. During gestation, the AngII receptor density was decreased and the AT1 receptor became predominant in the last part of gestation as a result of a down-regulation of the AT2 receptor. 3. In the endometrium, the AT1 receptor was predominant both in non-pregnant sows and throughout gestation. The AngII receptor density was decreased during gestation as a consequence of down-regulation of the AT1 receptor. 4. The renin concentrations in the myometrium and endometrium of pregnant sows did not differ from those in non-pregnant animals. 5. The finding of enzymatically active renin and high densities of AngII receptors in the porcine uterus is in accordance with a functional renin-angiotensin system (RAS), which may be important for an increased vascular permeability and stimulated angiogenesis in early pregnancy and for contraction of the myometrial smooth muscle cells during parturition. The predominance of AT1 receptors in the endometrium of non-pregnant sows differs from an earlier finding in non-pregnant women, where AT2 receptors were predominant in the endometrium. This is in accordance with earlier studies, indicating species differences in the expression and possibly also the physiological roles of the RAS in reproductive tissues.

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The present study was undertaken in order to characterize and determine angiotensin (Ang) II receptors and renin in the porcine placenta and fetal membranes. High densities of Ang II receptors of subtype 2 (AT2 receptors) were demonstrated in all parts of the placenta and fetal membranes throughout gestation. AT1 receptors (subtype 1) were only found in the first part of the gestation and only in the allantochorion-endometrium at low densities. The total Ang II receptor density was increased in the allantochorion-endometrium in the last stage of gestation. Except for this finding the Ang II receptor density did not vary during gestation. Some of the highest receptor densities were found in the allantoamnionic membrane. The Ang II receptor densities did not correlate with the duration of the gestation in any part of the placenta. Enzymatically active renin was found in all parts of the porcine placenta and fetal membranes in concentrations similar to those found earlier in the blood plasma. The renin concentrations did not correlate with the Ang II receptor densities or the duration of the gestation in any part of the placenta. Compared with the human placenta, where the Ang II receptors are almost exclusively AT1 receptors and low receptor densities are found in the fetal membranes, the present results indicate profound species differences in the expression and function of the renin-angiotensin system in the placenta and fetal membranes.

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