Imperial College Parturition Research Group, Institute of Reproductive and Developmental Biology, Chelsea and Westminster Hospital, Academic Department of Obstetrics and Gynaecology, Imperial College, London, United Kingdom.
Biol Reprod. 2019 Oct 25;101(4):813-822. doi: 10.1093/biolre/ioz112.
Although progesterone (P4) supplementation is the most widely used therapy for the prevention of preterm labor (PTL), reports of its clinical efficacy have been conflicting. We have previously shown that the anti-inflammatory effects of P4 can be enhanced by increasing intracellular cyclic adenosine monophosphate (cAMP) levels in primary human myometrial cells. Here, we have examined whether adding aminophylline (Am), a non-specific phosphodiesterase inhibitor that increases intracellular cAMP levels, to P4 might improve its efficacy using in vivo and in vitro models of PTL. In a mouse model of lipopolysaccharide (LPS)-induced PTL, we found that the combination of P4 and Am delayed the onset of LPS-induced PTL, while the same dose of P4 and Am alone had no effect. Pup survival was not improved by either agent alone or in combination. Myometrial prolabor and inflammatory cytokine gene expression was reduced, but the reduction was similar in P4 and P4/Am treated mice. There was no effect of the combination of P4 and Am on an ex vivo assessment of myometrial contractility. In human myometrial cells and myometrial tissue explants, we found that the combination had marked anti-inflammatory effects, reducing cytokine and COX-2 mRNA and protein levels to a greater extent than either agent alone. These data suggest that the combination of P4 and Am has a more potent anti-inflammatory effect than either agent alone and may be an effective combination in women at high-risk of PTL.
虽然孕激素(P4)补充是预防早产(PTL)最广泛使用的治疗方法,但报告其临床疗效存在矛盾。我们之前已经表明,通过增加原代人子宫平滑肌细胞中环磷酸腺苷(cAMP)水平,可以增强 P4 的抗炎作用。在这里,我们研究了在 PTL 的体内和体外模型中,添加氨茶碱(Am)(一种增加细胞内 cAMP 水平的非特异性磷酸二酯酶抑制剂)是否可以提高 P4 的疗效。在脂多糖(LPS)诱导的 PTL 的小鼠模型中,我们发现 P4 和 Am 的组合延迟了 LPS 诱导的 PTL 的发作,而相同剂量的 P4 和 Am 单独使用则没有效果。单独使用任何一种药物或联合使用都不能提高幼仔的存活率。子宫收缩和促炎细胞因子基因表达减少,但 P4 和 P4/Am 治疗的小鼠减少程度相似。P4 和 Am 的组合对子宫平滑肌收缩性的离体评估没有影响。在人子宫平滑肌细胞和子宫组织外植体中,我们发现该组合具有明显的抗炎作用,可更大程度地降低细胞因子和 COX-2 mRNA 和蛋白水平,而不是单独使用任何一种药物。这些数据表明,P4 和 Am 的组合比单独使用任何一种药物具有更强的抗炎作用,并且可能是 PTL 高危妇女的有效组合。