PLACENTA--ANTI-HIV THERAPY

抗HIV治疗[最初，双脱氧腺苷（DDI），联合DDI和 齐多夫定（AZT）和可能达特抑制剂]将在 妊娠6-15周和足月的人胎盘 （38-40周）。 这些研究将解决经胎盘 这些疗法的通过，以及它们在人体内的代谢， 胎盘和这些药物对胎盘本身的毒性。 将采取多种方法来确定动力学和毒性 反应：1）正常人胎盘（HIV阴性）：两种技术将 用于研究代谢、转移、细胞分布， 毒性：切片研究和双小叶胎盘灌注。 切片 研究将比较早期和足月妊娠的胎盘， 组织结合/掺入、代谢、细胞 分布和对滋养层的毒性作用。 双重灌注 研究将利用足月组织建立双向转移 在治疗血液中，母体到胎儿和胎儿到母体的DDI 和潜在的血液毒性水平。 因为灌注可以 进行为期24小时，我们将能够评估DDI是否 对胎盘有任何直接的毒性作用，特别是因为我们有 能够证明在这些灌注下发生的细胞分裂 条件2)胎盘并发症：胎盘 还将评估宫内生长迟缓（IUGR）妊娠。 人们认识到IUGR不一定有共同的机制 但这些研究可能近似于妊娠受损， 与艾滋病毒阳性女性有关。 如上所述的类似研究， 对于灌注研究，将进行研究受损 胎盘及其改变转移/代谢的不同能力 的DDI。3)植入模型：该实验室最近开发了一种 滋养层细胞三维立体功能化培养新技术 人子宫内膜单细胞。 这种文化提供了 有机会研究滋养层，人类子宫内膜， “植入过程”受到药物的影响。 这些研究将 提供机会，以确定如何抗艾滋病毒药物可能不利 通过对胎盘产生不利影响来影响发育过程 和/或子宫内膜。 未来拟议的研究将审查新的抗艾滋病毒 治疗，例如，达特抑制剂和免疫球蛋白，因为这些药物成为 临床上更相关。

Anti-HIV therapy [initially, dideoxyadenosine (DDI) , combination DDI and zidovudine (AZT), and possibly TAT inhibitors] will be investigated in the human placenta in vitro from 6-15 weeks of gestation and at term (38-40 weeks). These studies will address the issues of transplacental passage of these therapies, as well as their metabolism by the human placenta and the toxicity of these agents on the placenta itself. Multiple approaches will be undertaken to determine the kinetic and toxic responses: 1) Normal Human Placentas (HIV-Negative): Two technics will be used to study metabolism, transfer, cellular distribution, and toxicity: slice studies and dual lobular placental perfusion. Slice studies will compare placentas from early and term pregnancies for differences in tissue binding/incorporation, metabolism, cellular distribution, and toxic effects on the trophoblast. Dual perfusion studies will utilize term tissue to establish the bidirectional transfer of DDI from mother to fetus and from fetus to mother at therapeutic blood levels and potentially toxic blood levels. Since the perfusions can be performed for periods of 24 hrs, we will be able to evaluate whether DDI has any direct toxic effect on the placenta, especially since we have been able to demonstrate cell division occurring under these perfusion conditions. 2) Intercurrent Disease Placentae: Placentas from intrauterine growth retarded (IUGR) pregnancies will also be evaluated. It is recognized that IUGR does not necessarily have a common mechanism of origin, but such studies may approximate compromised pregnancies associated with HIV positive women. Similar studies as described above, for the perfusion studies, will be performed to study compromised placentas and their differential ability to alter the transfer/metabolism of DDI. 3) Implantation Model: This laboratory has recently developed a novel culture technic for trophoblast in three-dimension and functioning human endometrium from single cells. Such cultures provide the opportunity for studying how the trophoblast, the human endometrium, and the "implantation process" are affected by the drugs. Such studies would provide the opportunity to determine how anti-HIV drugs may adversely affect the developmental process via adversely affecting the placenta and/or endometrium. Future proposed studies would examine new anti-HIV therapy, e.g., TAT inhibitors and immunoglobulins, as these agents become clinically more relevant.