Showing posts with label heparin. Show all posts
Showing posts with label heparin. Show all posts

Sunday, February 25, 2018

Placenta-on-a-chip paves the path forward for easy drug screening during pregnancy

Courtesy: Penn State News Letter
Going forward with the concept of ‘organs-on-chip’ that mimic the physiological conditions in-vivo, researchers at the University of Pennsylvania’s School of Engineering and Applied Science have developed ‘placenta-on-a-chip’ to look at the placental barrier and drug transport in pregnancy.  

This is a real breakthrough to study the maternal-fetal drug transport across the placenta, as the placental barrier can never be exactly replicated in the lab and in-vivo studies in humans are not ethical. Pregnant women are not included as research subjects because of the risk of teratogenicity. Animal models are not exactly able to mimic human physiology.

We are all aware of the famous ‘Thalidomide’ disaster, in which a drug for morning sickness, crossed the placental barrier in humans and caused multiple birth defects, collectively known as ‘fetal thalidomide syndrome’ and deaths.

To address these issues, a team of researchers led by Dan Huh, Wilf Family Term Assistant Professor in Bioengineering at Penn and Cassidy Blundell, a graduate student in the Huh lab have developed a placenta-on-a-chip, using microfluidic channels in silicone casing.

The study was also published in the journal Advanced Healthcare Materials.

The two channels house human trophoblast cells on one side and endothelial cells on the other separated by a porous membrane. The unit mimics placental barrier and hence the permeability of the barrier to different drugs can be tested.

A blood-like fluid flows through the maternal side of the channel and the researchers can experiment by adding different drugs to the fluid and see the rate, amount of drug transferred to the fetal side of the channel.

Ex vivo placental perfusion is a great method,” Huh said, “but it has a pretty high failure rate, and the experimental set-up is complicated: it’s prone to leaks and needs a high level of expertise. Most pharmaceutical companies are not going to be able to test their drugs using this method.”

Currently, to validate their model, the team has tested 2 drugs that they have already studied via ex vivo placental perfusion: heparin, an anticoagulant, and glyburide, used in the treatment of diabetes.

The placenta on the chip was able to simulate the drug transfer of these two drugs as it happens in human placenta and fetal interface. Heparin did not pass through the chip model as it is too large a molecule to breach the placental barrier and glyburide transfer was also limited as in real placenta to protect the fetus.

Huh further added, “We’re getting close, this study has given us confidence that the placenta-on-a-chip has tremendous potential as a screening platform to assess and predict drug transport in the human placenta.”

Besides its use by the pharmaceutical company to test various drugs, the ‘placenta-on-a-chip’ has tremendous potential in testing the transfer of supplements other than drugs like vitamins and nutritional supplement.

Sunday, January 29, 2017

The best agent to prevent preeclampsia: A systematic review and network meta-analysis--News from SMFM 2017, Las Vegas.

Calcium supplements 
Out of various agents used for prevention of preeclampsia calcium supplementation has got the highest likelihood of being successful in bringing down its incidence and perinatal mortality as per a study presented by Sanchez-Ramos L. et al. at the pregnancy meeting, SMFM 2017, Las Vegas.

Preeclampsia complicates approximately 3-5% of pregnancies, accounting for 10-15% of maternal deaths and 3% of perinatal deaths.

Numerous agents have been studied for their ability to prevent preeclampsia and conventional studies have gauged the effectiveness of these agents. But these have been small, single center trials.

This was a systematic review and network meta-analysis of large RCTs comparing the effectiveness of multiple treatment options in preventing preeclampsia. Only data from meta-analysis of large RCTs with more than 450 subjects were included.

The study was registered under PROSPERO,[1] an international prospective register of systematic reviews in areas of healthcare all around the world and guided by PRISMA guidelines.[2]

A search of electronic databases from 1966 through July15, 2016 picked up 27 large multicenter trials with total of 60, 425 pregnant women. This large cohort was used to compare various exposures against Placebo or no treatment for the development of preeclampsia. The secondary outcome studied were severity of preeclampsia and maternal and neonatal morbidity and mortality. The various agents studied were:
  • Low-dose aspirin: aspirin given at low doses (50-100mg) during pregnancy
  • Calcium supplementation: given at doses of 500-2000mg
  • Low molecular weight heparin: anticoagulant
  • Vitamin E/C: vitamin supplements in varying doses as defined by the study
  • Fish oil: supplement derived from fatty tissue of fish containing omega-3 fatty acids

Direct and indirect pairwise comparison was done using STATA for multivariate random effect models.

It was seen that women who regularly received Calcium supplementation had a 61% and 74% less odds of developing preeclampsia in direct and indirect comparison.

Women receiving calcium supplementation has 68% less likelihood of developing preeclampsia as compared to women receiving fish oil.  

Taking Calcium was also associated with less chances of perinatal mortality as compared to low-dose aspirin, vitamins C & E, and placebo. 




[1] https://systematicreviewsjournal.biomedcentral.com/articles/10.1186/2046-4053-1-2
[2] http://www.prisma-statement.org/