Placental oxygen transport in sheep with different hemoglobin types R. B. Wilkening, R. D. Molina and G. Meschia Am J Physiol Regulatory Integrative Comp Physiol 254:585-589, 1988. You might find this additional information useful... Medline items on this article's topics can be found at http://highwire.stanford.edu/lists/artbytopic.dtl on the following topics: Physiology .. Hemoglobins Physiology .. Oxygen Transportation Physiology .. Pregnancy Medicine .. Cardiovascular Genetics Medicine .. Genetics Medicine .. Genes This information is current as of January 21, 2007 . The American Journal of Physiology - Regulatory, Integrative and Comparative Physiology publishes original investigations that illuminate normal or abnormal regulation and integration of physiological mechanisms at all levels of biological organization, ranging from molecules to humans, including clinical investigations. It is published 12 times a year (monthly) by the American Physiological Society, 9650 Rockville Pike, Bethesda MD 20814-3991. Copyright © 2005 by the American Physiological Society. ISSN: 0363-6119, ESSN: 1522-1490. Visit our website at http://www.the-aps.org/. Downloaded from ajpregu.physiology.org on January 21, 2007 Additional material and information about American Journal of Physiology - Regulatory, Integrative and Comparative Physiology can be found at: http://www.the-aps.org/publications/ajpregu Placental oxygen transport in sheep with different hemoglobin types RANDALL Departments University B. WILKENING, RICHARD D. MOLINA, AND GIACOMO of Pediatrics, Obstetrics and Gynecology, and Physiology, Division of Colorado School of Medicine, Denver, Colorado 80262 placenta; RANDALL oxyhemoglobin dissociation curve ADULT SHEEP carry two hemoglobin types (A hemoglobin and B hemoglobin) that are controlled by two autosomal codominant genes (10). The blood of hemoglobin A carriers (A sheep) has markedly higher 0, affinity than the blood of hemoglobin B carriers (B sheep) (17). In the erythrocytes of heterozygotes both hemoglobins are present in equimolar concentrations (17) and confer to blood an oxyhemoglobin dissociation curve that is intermediate to the curves of the homozygotes (17, 23). The frequency of each hemoglobin type in any given flock varies widely according to breed and location. In general, the reproductive success of A and B sheep is similar (11). However, the selection of A hemoglobin seems to be favored by cold, harsh environments (24). Theoretical models of placental O2 transfer (14, 16), as well as experimentally induced changes in the oxyhemoglobin dissociation curve of maternal blood in sheep (27) and rats (5, 13), have led to the conclusion that an increase in the O2 affinity of maternal hemoglobin is, by itself, a hindrance to fetal oxygenation and growth (5, 13). Therefore the good reproductive performance of A sheep suggests the hypothesis of chronic compensatory 0363-6119/88 $1.50 Copyright Medicine, mechanisms preventing the development of fetal hypoxia in ewes with high 0, affinity hemoglobin. The experiments described in this paper were designed to compare fetal oxygenation in A and B ewes that carry a single fetus and to verify the hypothesis of compensatory differences in the mechanisms of fetal O2 delivery, MATERIALS AND METHODS Selection of animals. The ewes for this study were selected over a Z-year period from a group of 250 Rambouillet-Columbia sheep raised on the Nebeker Ranch, Santa Monica, CA, (elevation 800 m) and transported to our laboratory in Denver, CO (elevation 1,500 m) at -80 days of gestation. The maternal hemoglobin type was determined at arrival by means of paper electrophoresis (23). Each of eight A sheep was paired with B sheep of similar age, body weight, parity, and length of gestation. The ewes of each pair were operated on consecutive days and studied at the same interval after surgery (5 to 7 days). Surgery and animal care. The ewes were fasted for 48 h before surgery. Under general intravenous pentobarbital sodium anesthesia and 1% tetracaine hydrochloride spinal anesthesia (lo-12 mg)Y polyvinyl catheters (1.4 mm OD) for blood sampling were placed in a maternal femoral artery with the catheter tip positioned in an external iliac artery, in the uterine veins draining the two uterine horns with the catheter tip positioned 4 cm below the level of the ovary, in a fetal hindlimb artery with the catheter tip positioned in the external iliac artery, and in an umbilical vein with the catheter tip positioned in the common umbilical vein. A polyvinyl catheter for infusion was placed in a fetal hindlimb vein with the catheter tip positioned in the external iliac vein. A catheter was also placed in the amniotic fluid cavity for instillation of antibiotic. The animals recovered promptly from surgery and were standing and feeding in their individual pens within 6 h. Antibiotic was administered and catheters maintained as previously described (31). The ewes were given water and fed ad libitum with a standard alfalfa pellet diet. On the day of the study a solution of ethanol in normal saline was delivered to the fetus via the hindlimb venous catheter at a constant rate (0.1 ml/min) by means of a syringe pump. The ethanol concentration in the infusate was adjusted based on estimates of fetal size and placental clearance to give a fetal arterial ethanol con- 0 1988 the American Physiological Society R585 Downloaded from ajpregu.physiology.org on January 21, 2007 B., RICHARD D. MOLINA, AND GIAPlacental oxygen transport in sheep with different hemoglobin types. Am. J. Physiol. 254 (Regulatory Integrative Comp. Physiol. 23): R585-R589, 1988.-To study the effect of genetic differences in the maternal oxyhemoglobin dissociation curve on fetal O2 supply, we compared eight pregnant ewes homozygous for high O2 affinity hemoglobin (A) with eight pregnant ewes homozygous for low O2 affinity hemoglobin (B). Each ewe carried a single fetus. Fetal weights were not significantly different (A, 3,000 t 170 g; B, 3,070 t 270 g). The A ewes had significantly higher arterial O2 saturation (95 vs. 89.4%), uterine blood flow per kilogram of fetus (464 vs. 374 ml/min), uterine venous O2 saturation (78.1 vs. 67.5%), and placental-to-fetal weight ratio (0.107 vs. 0.085). Uterine venous Pop was significantly less in A ewes (41.7 vs. 47.6 Torr), but umbilical venous and arterial Paz and fetal O2 uptake were virtually equal in the two groups. We conclude that the difference in O2 affinity between A and B hemoglobins is fully compensated for by differences in arterial O2 saturation, in the rate of perfusion of the pregnant uterus, and in the degree of Paz equilibration between the uterine and umbilical circulations so that the single fetuses of A and B hemoglobin carriers have equal levels of oxygenation. WILKENING, COMO MESCHIA. MESCHIA of Perinatal R586 FETAL OXYGENATION 0 2 = (Hb x So2/100) + 0.00131 Po2 where 0.00131 is the O2 solubility coefficient at 39.5OC and Po2 is in Torr. Po2, Pco~, and pH were analyzed at 39.5”C with a Radiometer BMS 3 MK 2 instrument (Radiometer, Copenhagen). Umbilical and uterine blood flows were calculated by application of the Fick principle to the steady-state diffusion of the test molecule (either ethanol or tritiated water) across the placenta (20,30). Uterine 0, extraction was calculated as the A-V/A 0, content ratio. Uterine and fetal O2 uptakes were calculated from the blood flow and O2 content data by application of the Fick principle to the uterine and umbilical circulations (20, 30). The rate of O2 delivery to the pregnant uterus was calculated as the uterine blood flow (ml/min) times arterial O2 content (mol/ml) product (31). Ethanol placental clearance (C; ml/min) was calcu- lated as C = Q/(a - A) where & is the rate of ethanol transfer from fetus to mother and (a - A) is the ethanol concentration difference between umbilical arterial and maternal arterial blood (7). Statistics. The significance (P < 0.05) of differences between the eight A sheep and the eight B sheep was determined using unpaired Student’s t test analysis and 14 degrees of freedom. RESULTS Maternal, fetal, and placental weights. The two groups did not differ significantly with respect to maternal weight and gestational age (Table 1). Mean fetal weights were virtually identical, but the weight of the placental cotyledons was significantly higher in the A sheep. The placental to fetal weight ratio was also significantly higher (0.107 vs. 0.085, P c 0.05). Maternal circulation data. The O2 saturation of arterial blood was significantly higher in the A sheep (95.0% vs. 89.4%, P < O.OOl), whereas O2 capacity, arterial Po2, Pco~, and pH were not significantly different (Table 2). Mean arterial 0, content was 8% higher in the A sheep but not significantly so. In A sheep the uterine venous O2 saturation was significantly higher (78.1 vs. 67.5, P < O.OOl), and the Pop significantly lower (41.7 vs. 47.6, P < 0.001) than in B sheep (Fig. 1). Mean uterine 0, uptakes were similar in the two groups, whereas uterine blood flow per kilogram of fetus and uterine O2 delivery rate were significantly higher in A sheep. The mean uterine arteriovenous difference of 0, content was 24% higher in B sheep (1.47 vs. 1.19 mM, P < 0.01). Because 0, arteriovenous differences represent the reciprocal of blood flow per millimole of 0, uptake, this finding implies that for equ.al values of uterine 0, requirements, uterine blood flow was 24% higher in A sheep. Similarly, mean uterine O2 extraction was 36% higher in B sheep (0.247 vs. 0.182, P c O.OOl), implying a 36% higher 0, delivery rate in A sheep. The measurements of absolute flows and 02 delivery rate gave comparable results. Mean uterine blood flow and mean O2 delivery rate were 21 and 31% higher, respectively, in the A sheep group. Fetal and uteroplacental data. In contrast to the uterine circulation data, umbilical arterial and venous 0, satuTABLE 1. Gestational age and weight data Maternal wt,kg Gestational age, days Fetal wt, g Placental wt, g No. of placental cotyledons Mean wt of placental cotyledons Placental/fetal wt A Sheep B Sheep P* 46.6k2.0 131.022.0 3,000~170 312H6 79.1rt3.6 3.97t0.16 0.107t0.007 48.1t1.8 133.0t1.0 3,070&270 255&19 79.3t2.3 3.2o-co.19 0.085~0.005 NS NS NS co.05 NS co.02 co.05 Values are means & SE. See text for definitions. difference between A and B means (unpaired t test). P > 0.05 were considered NS. * Significance of Differences with Downloaded from ajpregu.physiology.org on January 21, 2007 centration not exceeding 10 mg/dl at the conclusion of the experiment. Tritiated water in normal saline rather than ethanol was infused into fetuses of one pair of ewes as the test molecule. Approximately 60 min after starting the test molecule infusion, blood samples for test molecule concentration (1.0 ml in EDTA-coated syringes), for hemoglobin concentration and 0, saturation (0.5 ml into heparin-coated capillaries), and for yOZ, Pco~, and pH (0.5 ml into heparin-coated capillaries) were drawn simultaneously from the maternal arterial (A), uterine venous (V), fetal arterial (a), and umbilical venous (v) catheters. Four such sample sets were drawn at 20- to 30-min intervals. At the end of each study the animals were killed by an injection of euthanasia solution, at which time the condition and placement of the catheters were verified, fetal and placental weights were measured, and the number of cotyledons counted. Analytical methods and calculations. Blood ethanol was measured in triplicate using the enzymatic conversion of ethanol to acetaldehyde (Sigma Reagents) (7). The radioactivity due to tritiated water was determined on plasma samples in triplicate with the Packard Tri-Carb 460C liquid scintillation system and converted to counts per milliliter of blood as previously described (29). The PO, and Pco2 electrodes were calibrated with two gas mixtures having the composition 95% Nz-5% CO, and 83% Nz-10% CO,-7% 02, respectively. Blood hemoglobin concentration expressed as O2 capacity (Hb, mM) and oxyhemoglobin saturation (So2, %) were measured in duplicate by an a,utomatic, direct reading spectrophotometer (OSM-2, Radiometer, Copenhagen). The 0, capacity reading was calibrated by means of fully oxygenated blood whose hemoglobin content had been measured in a Beckman DU-7 spectrophotometer at wavelength 540 nm after conversion to cyanomethemoglobin. The molar extinction coefficient used in the cyanomethemoglobin measurement was 11.0 per millimolar solution of l-cm thickness. The 100 and 0% saturation readings were calibrated separately for A sheep, B sheep, and fetal blood. Blood O2 content (mM) was calculated as FETAL TABLE 2. Maternal circulation data --.w-._-- A Sheep _-.- BSheep P* 6.77-r-0.19 6.62-cO.24 NS 95.0t0.4 6.53t0.19 71.5Ikl.l 35.8ti.Q 7.45z!zo.O09 89.4k0.6 6.02zkO.24 71.7s.4 34.3-cl.2 7.47&0.004 ~0.003 NS NS NS NS 78.1*0.5 5.34kO.16 41.7t0.6 39.1t0.8 7.43kO.011 67.5+1.4 4.55-c-0.24 47.6-F-0.8 38.6t1.3 7.44kO.006 4u-nl ~0.02 60.001 NS NS 16.9t0.5 1.19~0.85 18.2~0.5 1,374+93 464k34 21.9t1.3 1.47H.07 24.7k1.4 1,132&83 374&E co.01 co.01 <O.OOl NS co.05 8.90t0.50 1.6lkO.09 6.81M.55 1.65t0.13 ~8.02 Ns Values are means t SE. See text for definitions. difference between A and B means (unpaired t test). P > 0.05 were considered NS. * Significance of Differences with mbilicol Vein 8o ?O “B 0 .O 0 0 0 Maternal z 0 ---I--~ 3. Fetal and uteroplacental data --.--..“.-- -OZ capacity of fetal blood, mM Umbilical venous blood 0, saturation, % 0, content, mM Po2, Torr Pco~, Torr PH Umbilical arterial blood O2 saturation, % O2 content, mM Po2, Torr Pco~, Torr PM Umbilical blood flow, ml/min Umbilical blood flow/kg fetus, ml/min Umbilical O2 uptake, mrnol/min Umbilical O2 uptake/kg fetus, mmol/min Uteroplacental OP consumption, mmol/min Placental ethanol clearancet, ml/min Uterine-umbilical venous PoB difference, Torr A Sheep ---6.7OdzO.22 BSheep P* 7.14k0.26 NS 81.2kl.5 5.46t0.14 27.5kO.9 42.3-t-0.9 7,411kO.O06 79.7Hi.O 5.74-t0.28 27.ls.4 42,0-c-1.1 7.4ldI.009 NS NS NS NS NS 56.1t1.7 3.78-1-0.17 19.2-r-0.6 47.421.1 7.38t0.006 634-+20 216-i-11 54.9k2.4 3.95t0.25 18.8tl.O 47.9-1.2 7.38t0.009 571k40 189rslO NS NS NS NS NS NS NS 1.06&0.05 0.359t0.020 1.02t0.09 0.329zkO.006 NS NS 0.55kO.06 0.63;610.06 NS 362210 296*21 <O.OZ 14.2-t-1.2 20.4zkl.2 co.01 --Values are means * SE. See text for definitions, * Significance of difference between A and B means (unpaired t test). Differences with P > 0.05 were considered NS. t Seven observations per group. IOO90- TABLE 1 P < 0.01). Estimates of uteroplacental 0, consumption (i.e., the difference between uterine and umbilical uptakes) were variable and not significantly different between the two groups. Placental ethanol clearance was significantly higher in A sheep, reflecting a higher level of placental perfusion in this group (7). Artery c a70K 2 DISCUSSION :: 60- Uterine Vein 0” lJmbilica1 Artery I 10 I I 20 30 I 40 Po2 (TORR) I 50 1 I I 60 70 80 FIG. 1. Plot of maternal and fetal blood O2 saturation vs. Paz in 8 pregnant ewes homozygous for high O2 affinity adult hemoglobin A (a) and 8 pregnant ewes homozygous for low 02 affinity adult hemoglobin B (0). Adult blood of A sheep has an oxyhemoglobin dissociation curve to the left of B sheep adult blood curve. Fetuses of A and B sheep have overlapping oxyhemoglobin dissociation curves because at gestational age of study most hemoglobin present in fetal blood is fetal hemoglobin. ration, O2 content, and Paz values were similar in both groups (Table 3 and Fig. 1). Umbilical O2 uptakes were also similar. Mean umbilical blood flow per kilogram of fetus was 14% higher in A sheep, but this difference did not attain the level of statistical significance. The Po2 difference between uterine venous and umbilical venous blood was significantlv less in A sheep (14.2 vs. 20.4 Torr. In sheep the uterine and umbilical circulations form an exchange system that tends to equilibrate uterine and umbilical venous Po2 and PCO~ (12, 14, 31). Even under normal physiological conditions, however, full equilibration is not attained, so that the venous concentrations of the diffusing molecules are consistently higher in the donor than in the recipient blood stream (7, 18, 31). Given this relatively ineffective system of respiratory exchange and the importance of the maternal oxyhemoglobin dissociation curve in determining uterine venous Po2, it may seem reasonable to assume that the level of fetal oxygenation is critically dependent on the 02 affinity of maternal blood. Contrary to this assumption, the present study demonstrates that in ewes with two widely different oxyhemoglobin dissociation curves fetal 02 pressures are equal and that several mechanisms contribute to this equality. The high O2 affinity hemoglobin carriers (A sheep) have some advantage in the uptake of O2 via the pulmonary circulation. At Denver altitude (1,500 m above sea level) arterial O2 saturation was higher in the A sheep with no significant differences in arterial Po2 and 02 capacity. Previous studies, which include observations at sea level as well as higher elevations, have also shown Downloaded from ajpregu.physiology.org on January 21, 2007 O2 capacity of maternal blood, mM Maternal arterial blood 0, saturation, % 0, content, mM PO,, Torr Pco~, Torr PH Uterine venous blood O2 saturation, % 0, content, mM PO,, Torr Pco~, Torr PH Uterine arteriovenous differences 0, saturation difference, % 0, content difference, mM Uterine O2 extraction, % Uterine blood flow, ml/min Uterine blood flow/kg fetus, ml/ min Uterine 0, delivery, mmol/min Uterine O2 uptake, mmol/min R587 OXYGENATION R588 FETAL OXYGENATION 19, 27) have not demonstrated the large decrease in uterine-umbilical venous Po2 difference that should occur if this difference were caused by umbilical vascular shunts and uneven perfusion (27). Furthermore, neither a countercurrent nor a concurrent model of placental exchange agree with histological evidence (28) and with the observation (21) that, in th.e ovine placenta artificially perfused via the umbilical circulation, reversing the direction of the perfusion does not change the clearance of NzO (26). Although shunts and uneven perfusion must contribute to the ineffectiveness of placental O2 exchange, we cannot exclude the possibility that placental 0, diffusing capacity is an important factor in determining the degree of equilibration between uterine and umbilical venous 0, pressures and that the smaller uterine-umbilical venous Paz difference in A sheep results from a greater placental O2 diffusing capacity. In favor of this suggestion is the finding that placental weight and the placental to fetal weight ratio were significantly greater in the A sheep. An increase in placental size is likely to imply an increase in diffusing capacity. It is interesting to note that the development of a high level of uterine perfusion and a small Paz gradient between maternal and fetal blood, which appear to be necessary for normal fetal oxygenation in A sheep, is inhibited in hot environments. Pregnant sheep exposed to high ambient temperatures from 45 to 120 days gestation had abnormally low uterine blood flows, small placentas, significantly larger uterine-umbilical venous Po2 differences, and fetal hypoxia and hypoglycemia (6). This suggests that different frequencies of ovine hemoglobins in different climates may result in part from the effect of environmental temperature on placental function. In humans, maternal blood with high O2 affinity hemoglobin is compatible with normal fetal development and growth (8, 22, 25), thus suggesting the presence of adaptive mechanisms similar to those observed in sheep. In apparent contrast to the evidence in sheep and humans are two studies in rats showing that maternal exchange transfusion with high 0, affinity carbamylated blood resulted in fetal growth retardation (5, 13). A possible explanation of this discrepancy is that the inheritance of high O2 affinity hemoglobins is linked with the inheritance of other traits that promote the growth of a well-perfused placenta with a relatively high O2 diffusing capacity. An alternative explanation, however, is suggested by a comparison of the two rat studies. In one study (5), exchange transfusion at day 19 of gestation resulted in an 18% reduction in fetal weight and no change in placental weight at day 21; whereas in the other study (13), exchange transfusion at day 9 resulted in a smaller decrease in fetal weight (10%) and a 20% increase in placental weight at day 21. These quantitatively different results suggest that placental O2 transfer mechanisms are capable of physiological adaptation to experimentally induced changes in the maternal oxyhemoglobin dissociation curve if sufficient time is allowed for the adaptation to develop. Figure 1 demonstrates that all fetuses had similar oxyhemoglobin dissociation curves, in marked contrast to the difference in 0, affinity between A and B ewes. In Downloaded from ajpregu.physiology.org on January 21, 2007 greater O2 saturations in the arterial blood of A sheep (3, 9). The comparison of 0, capacities has yielded less consistent results. Although no significant difference was present in our study, other investigations have indicated that higher 0, affinity tends to be associated with a higher mean hemoglobin content (1, 17). In relation to the problem of maintaining a high uterine venous Paz, the higher arterial 0, saturation of A sheep could not fully compensate for the greater 0, affinity of A hemoglobin. On the basis of the data in Fig. I, we estimate tha.t equal uterine arteriovenous differences of 0, saturation in A and B sheep would have resulted in a much lower uterine venous Po2 in the A sheep (37.0 vs, 47.6 Torr). The A sheep combined higher a.rterial O2 saturation with a higher rate of 0, delivery to the pregnant uterus to produce a uterine venous 0, saturation that was 10.5% greater than in B sheep (78.0 vs. 67.5%). Despite this greater venous O2 saturation, A sheep failed to attain the uterine venous Paz of B sheep (41.7 vs. 47.6 Torr). Note that the uterine venous blood of A sheep would have required -85% saturation to attain the mean 47.6 Torr Paz of B sheep (Fig. 1). Everything else being equal, the maintenance of an 85% saturation in uterine venous blood would have entailed a uterine blood flow of 2.3 l/min instead of the observed mean flow of L4 l/min. The significantly lower uterine venous Po2 of A sheep did not result in fetal hypoxia because their placenta was more effective than the B sheep placenta in equilibrating the 0, pressures of the uterine and umbilical circulations. The mean uterine-umbilical venous Po2 difference in B sheep was 20.4 Torr. An equally large vein-to-vein POT difference in A sheep would have produced an umbilical vein Po2 of 21.3 Torr (instead of 27.5 Torr) and a 68% umbilical venous 0, saturation (instead of 81.2%). Therefore better equilibration of uterine and umbilical venous O2 pressures represents a third local mechanism that combined with a greater arterial 0, saturation and a greater uterine O2 delivery rate to give as high a level of fetal oxygenation in A sheep as in B sheep. The exact nature of this third mechanism is unclear because there is inadequate knowledge of the factors that create the Paz difference between uterine and umbilical venous blood. According to one hypothesis, maternal and fetal O2 pressures are virtually equal at the venous end of the placental capillaries, and the uterine-umbilical venous PO, difference results from a combination of vascular shunts and uneven maternal to fetal perfusion ratios in different parts of the placenta (14, 16). If this hypothesis is correct, the placenta of A sheep would have less vascular shunting and a smaller degree of uneven perfusion than the placenta of B sheep. The major evidence in favor of the shunting-uneven perfusion hypothesis is that placental O2 diffusing capacity, estimated from studies of carbon monoxide placental transport, is sufficiently high to permit full equilibration of venous 0, pressures in a concurrent model of placental exchange (15). Other observations, however, suggest caution in accepting the validity of this hypothesis. Experiments designed to study placental Oz transport under conditions of hypoxia (27, 31) and a right shift in the fetal oxyhemoglobin dissociation curve (3, FETAL OXYGENATION fetal sheep the rapid synthesis of adult hemoglobin begins after MO days of gestation, and very small amounts of adult hemoglobin are actually present in fetal blood at that age (2). Therefore, the similarity of fetal oxyhemoglobin dissociation curves shown in Fig. 1 is due to a preponderance of fetal hemoglobin at the age of study. There is no evidence in our data suggesting that there is a sharply defined maternal O2 affinity that is optimal for fetal growth. The system of fetal 0, delivery seems capable of adapting successfully to a broad range of maternal O2 affinities. It is noteworthy, however, that this adaptation does not involve any significant change in fetal blood O2 pressure. 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Downloaded from ajpregu.physiology.org on January 21, 2007 This work was supported by National Institute of Child Health Human Development Grants HD-01866, HD-00781, and HD-20761; D. Molina was supported by Training Grant HD-07186. R589