Objective: to investigate the morphological and immunohistochemical features of placental damage due to theincorporation of 137Cs depending on the scenario of pregnancy completion.
Materials and methods: The study material consisted of placentas from 60 women with reproductive losses inanamnesis and signs of termination of the current pregnancy (first group) and placental samples from 30 women with an uncomplicated gestation and an unencumbered anamnesis (control group). The detailed study required the distribution of placental samples from the first group into subgroups. Subgroup 1a included 38 placentas from women who gave birth at 37-40 weeks, despite signs of termination of the current pregnancy. Subgroup 1b - placentas of 13 women who gave birth at a gestation period of 28-36 weeks + 6 days. Subgroup 1c - 9 placental samples from women who gave birth at a gestation period of 22-27 weeks + 6 days. The volumetric activity of the 137Cs in the placentas was measured using β-spectrometer. The histology of the placenta was studied using a standard technique. The following expressions were studied in placenta: CD31 / PECAM-1, CD45 / T200 / LCA, CD56 / NCAM-1, CEA / CD66e Ab-2, Vimentin, using indirect streptavidin peroxidase detection method.
Results: Placentas accumulate 137Cs. The different volumetric activity of the isotope correlates with scenarios of pregnancy. Due to the action of incorporated 137Cs with a specific mass of more than 1.1 Bq/kg, placental dysfunction develops. The consequences of placental dysfunction depend on the volumetric activity of the 137Cs and the preservation of adaptive and compensatory reactions in the placenta. Morphological and immunohistochemical features of placental damage to incorporated 137Cs were established, depending on the scenario of completion of pregnancy. A marker of unfavorable completion of pregnancy is the expression of a carcinoembryonic antigen (CEA) in the placenta.
Conclusions: Premature termination of pregnancy (PTP) is a multifactorial pathology associated with pathological changes in immune and neuroendocrine regulation and hereditary, infectious, and environmental factors that disrupt the adaptation mechanisms in the mother-placenta-fetus system. Intraplacental irradiation of 137Cs is one of the factors in the multifactorial nature of reproductive losses. As a result of intraplacental irradiation of 137Cs, the architecture of the placenta is disturbed, the activity of pro-inflammatory cytokines CD45 and CD56 increases, and the coagulation cascade is activated. Extreme effects depend on the volumetric activity of the isotope incorporated in the placenta and the organ's compensatory capacity. Accumulation of up to 1.0 Bq/kg 137Cs does not affect the course of gestation. Internal irradiation with an activity of 4.5-10.4 Bq/kg 137Cs triggers late preterm labor. The nature of the damages corresponds to the category of «lesion of the maternal stroma» of the placenta. The volumetric activity of 137Cs over 10.4 Bq/kg is a probable cause of early preterm labor and antenatal fetal death. At the same time, the maternal and fetal structures of the placenta suffer damage. Expression of vimentin is a marker of placental destruction due to internal irradiation of 137Cs with a specific gravity of more than 4.5 Bq/kg. Expression of CEA in the structures of the placenta of women with PTP is a unique find and marker of premature birth and antenatal fetal death with intraplacental irradiation of 137Cs with an activity of more than 4.5 Bq/kg.
Meta: doslidyty morfologichni ta imuno-gistokhimichni osoblyvosti urazhennia platsenty vnaslidok inkorporuvannia 137Cs zalezhno vid stsenariiu zavershennia vagitnosti. Materialy ta metody. Material doslidzhennia – platsenty 60 zhinok z reproduktyvnymy vtratamy v anamnezi taoznakamy pereryvannia potochnoï vagitnosti (osnovna grupa) i platsenty 30 zhinok z neuskladnenym perebigomvagitnosti ta neobtiazhenym anamnezom (kontrol'na grupa). Dlia detal'nogo analizu zrazky platsenty osnovnoïgrupy podilyly na pidgrupy. Do pidgrupy 1a uviĭshly 38 platsent vid zhinok, iaki narodyly v termini 37–40 tyzhniv,nezvazhaiuchy na oznaky pereryvannia potochnoï vagitnosti. Pidgrupa 1b – platsenty 13 zhinok, iaki narodyly v termini vagitnosti 28–36 tyzhniv + 6 dniv. Pidgrupa 1c – 9 zrazkiv platsenty vid zhinok, iaki narodyly v termini vagitnosti 22–27 tyzhniv + 6 dniv. Ob’iemnu aktyvnist' inkorporovanogo 137Cs u platsenti vyznachaly za dopomogoiu β-spektrometriï. Gistologichne doslidzhennia platsenty provodyly za standartom. U platsenti doslidzhuvaly taki ekspresiï: CD31/PECAM-1, CD45/T200/LCA, CD56/NCAM-1, CEA/CD66e Ab-2, Vimentin, vykorystovuiuchy nepriamyĭmetod vyiavlennia streptavidynperoksydazy.Rezul'taty. Vstanovleno, shcho platsenty nakopychuiut' 137Cs. Rizna ob’iemna aktyvnist' izotopu koreliuie zi stsenariiamy vagitnosti. Vnaslidok diï inkorporovanogo 137Cs z pytomoiu masoiu ponad 1,1 Bk/kg rozvyvaiet'sia platsentarna dysfunktsiia. Naslidky platsentarnoï dysfunktsiï zalezhat' vid ob’iemnoï aktyvnosti 137Cs i zberezhennia adaptatsiĭno-kompensatornykh reaktsiĭ u platsenti. Zalezhno vid stsenariiu perebigu vagitnosti vstanovleno morfologichni ta imunogistokhimichni osoblyvosti urazhennia platsenty inkorporovanym 137Cs. Markerom nespryiatlyvogozavershennia vagitnosti ie ekspresiia rakovo-embrional'nogo antygenu (REA, CEA) v platsenti.Vysnovky. Nevynoshuvannia vagitnosti (NV) tse mul'tyfaktorna patologiia, pov’iazana z patologichnymy zminamyimunnoï ta neĭroendokrynnoï reguliatsiï, spadkovymy, infektsiĭnymy ta ekologichnymy faktoramy, iaki porushuiut'adaptatsiĭni mekhanizmy v systemi «maty–platsenta–plid». Intraplatsentarne oprominennia 137Cs – odyn iz chynnykiv u bagatofaktorniĭ pryrodi reproduktyvnykh vtrat. Vnaslidok vnutrishn'oplatsentarnogo oprominennia 137Cs porushuiet'sia arkhitektura platsenty, pidvyshchuiet'sia aktyvnist' prozapal'nykh tsytokiniv CD45 ĭ CD56, aktyvuiet'sia kaskad koaguliatsiï. Ekstremal'ni efekty zalezhat' vid ob’iemnoï aktyvnosti inkorporovanogo v platsenti izotopu ta kompensatornoï spromozhnosti organu. Nakopychennia do 1,0 Bk/kg 137Cs ne vplyvaie na perebig gestatsiï. Vnutrishnie oprominennia z aktyvnistiu 4,5–10,4 Bk/kg 137Cs vystupaie trygerom piznikh peredchasnykh pologiv. Kharakter poshkodzhen' nalezhyt' do kategoriï «Urazhennia materyns'koï stromy». Ob’iemna aktyvnist' 137Cs ponad 10,4 Bk/kg -ĭmovirna prychyna rannikh peredchasnykh pologiv ta antenatal'noï zagybeli ploda. V ts'omu vypadku, poshkodzhennia zaznaiut' materyns'ki ta plodovi struktury platsenty. Ekspresiia vimentynu – marker platsentarnoï destruktsiïvnaslidok vnutrishn'ogo oprominennia 137Cs pytomoiu masoiu ponad 4,5 Bk/kg. Ekspresiia REA v platsentakh zhinok zNV – unikal'na znakhidka i marker peredchasnykh pologiv ta antenatal'noï zagybeli ploda pry vnutrishn'oplatsentarnomu oprominenni 137Cs pytomoiu masoiu ponad 4,5 Bk/kg.
Keywords: 137Cs; CD31 PECAM-1; CD45 T200 LCA; CD56 NCAM-1; CEA CD66e Ab-2; Vimentin; placenta; pregnancy; reproductive losses.
A. A. Zhyvetska-Denysova, I. I. Vorobiova, N. Ya. Skrypchenko, T. D. Zadorozhna, V. B. Tkachenko, Yu. M. Bondarenko, S. K. Stryzhak.