ultrasound
Visualizing The Placenta, a Critical but Poorly Understood Organ
Posted on by Diana W. Bianchi, M.D., Eunice Kennedy Shriver National Institute of Child Health and Human Development
The placenta is the Rodney Dangerfield of organs; it gets no respect, no respect at all. This short-lived but critical organ supports pregnancy by bringing nutrients and oxygen to the fetus, removing waste, providing immune protection, and producing hormones to support fetal development.
It also influences the lifelong health of both mother and child. Problems with the placenta can lead to preeclampsia, gestational diabetes, poor fetal growth, preterm birth, and stillbirth. Although we were all connected to one, the placenta is the least understood, and least studied, of all human organs.
What we do know about the human placenta largely comes from studying it after delivery. But that’s like studying the heart after it’s stopped beating. It doesn’t help us predict complications in time to avert a crisis.
To fill these knowledge gaps, NIH’s Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) developed the Human Placenta Project (HPP) to noninvasively study the placenta during pregnancy. Since 2014, this approximately $88 million collaborative research effort has been developing ultrasound, magnetic resonance imaging (MRI), and blood-based biomarker methods to study how the placenta functions in real time and in greater detail.
As illustrated in the image above, advanced ultrasound tools allowed HPP researchers at Eastern Virginia Medical School, Norfolk, and the University of Texas Medical Branch, Galveston, to gain a detailed look at the placenta’s intricate arrangement of blood vessels, or vasculature. By evaluating both fetal (left panel) and maternal (right panel) placental vasculature in 610 pregnant people starting at 13 weeks of gestation, the investigators aimed to identify early changes that predicted later complications.
They observed that such changes can start in the first trimester and affect both the vasculature and placental tissue. While further research is needed, these findings suggest that placental ultrasound monitoring can inform efforts to prevent and treat pregnancy complications.
Another HPP team led by Boston Children’s Hospital is developing an MRI strategy to monitor blood flow and oxygen transport through the placenta during pregnancy. Interpreting and visualizing MRI data of the placenta is challenging because of its variable shape, the tendency of muscles in the uterus to begin tightening or contracting well before labor [1], and other factors.
As shown in the video above, the researchers developed a way to account for the motion of the uterus and “freeze” the placenta to make it easier to study (left two panels of video) [2]. They also developed algorithms to better visualize the complex patterns of placental oxygen content during contractions (center panel) [3]. The scientists then carried out initial visualizations of blood flow through the placenta shortly after delivery (second panel from right) [4].
They now intend to map these MRI findings to the placenta itself after delivery (far right panel), which will allow them to explore how additional factors such as gene expression patterns and genetic variants contribute to placental function. Ultimately, they plan to apply these MRI techniques to monitor the placenta in real time during pregnancy and identify changes that indicate compromised function early enough to adjust maternal management as needed.
Other HPP efforts focus on identifying components in maternal blood that reflect the status of the placenta. For example, an HPP research team led by scientists at the University of California, Los Angeles, adapted non-invasive prenatal testing methods to analyze genetic material shed from the placenta into the maternal bloodstream. Their findings suggest that distinctive patterns in this genetic material detected early in pregnancy may indicate risk for later complications [5].
Another HPP team, led by investigators at Columbia University, New York, helped establish that extracellular RNAs (exRNAs) released by the placenta into maternal circulation reflect the placenta’s status at a cellular level beginning in the first trimester. To harness the potential of exRNA biomarkers, the investigators are optimizing methods to isolate, sequence, and analyze exRNAs in maternal blood.
These are just a few examples of the cutting-edge work being funded through the HPP, which complements NICHD’s longstanding investment in basic research to unravel the physiology of and real-time gene expression in the placenta. Unlocking the secrets of the placenta may one day help us to prevent and treat a range of common pregnancy complications, while also providing insights into other areas of science and medicine such as cardiovascular disease and aging. NICHD is committed to giving this important organ the respect it deserves.
References:
[1] Placental MRI: Effect of maternal position and uterine contractions on placental BOLD MRI measurements. Abaci Turk E, Abulnaga SM, Luo J, Stout JN, Feldman H, Turk A, Gagoski B, Wald LL, Adalsteinsson E, Roberts DJ, Bibbo C, Robinson JN, Golland P, Grant PE, Barth, Jr WH. Placenta. 2020 Jun 1; 95: 69-77.
[2] Spatiotemporal alignment of in utero BOLD-MRI series. Turk EA, Luo J, Gagoski B, Pascau J, Bibbo C, Robinson JN, Grant PE, Adalsteinsson E, Golland P, Malpica N. J Magn Reson Imaging. 2017 Aug;46(2):403-412.
[3] Volumetric parameterization of the placenta to a flattened template. Abulnaga SM, Turk EA, Bessmeltsev M, Grant PE, Solomon J, Golland P. IEEE transactions on medical imaging. 2022 April;41(4):925-936.
[4] Placental MRI: development of an MRI compatible ex vivo system for whole placenta dual perfusion. Stout JN, Rouhani S, Turk EA, Ha CG, Luo J, Rich K, Wald LL, Adalsteinsson E, Barth, Jr WH, Grant PE, Roberts DJ. Placenta. 2020 Nov 1; 101: 4-12.
[5] Cell-free DNA methylation and transcriptomic signature prediction of pregnancies with adverse outcomes. Del Vecchio G, Li Q, Li W, Thamotharan S, Tosevska A, Morselli M, Sung K, Janzen C, Zhou X, Pellegrini M, Devaskar SU. Epigenetics. 2021 Jun;16(6):642-661.
Links:
Human Placenta Project (Eunice Kennedy Shriver National Institute of Child Health and Human Development/NIH)
Preeclampsia (NICHD)
Understanding Gestational Diabetes (NICHD)
Preterm Labor and Birth (NICHD)
Stillbirth (NICHD)
Abuhamad Project Information (NIH RePORTER)
Grant Project Information (NIH RePORTER)
Devaskar Project Information (NIH RePORTER)
Williams Project Information (NIH RePORTER)
Note: Acting NIH Director Lawrence Tabak has asked the heads of NIH’s Institutes and Centers (ICs) to contribute occasional guest posts to the blog to highlight some of the interesting science that they support and conduct. This is the 10th in the series of NIH IC guest posts that will run until a new permanent NIH director is in place.
Wearable Ultrasound Patch Monitors Blood Pressure
Posted on by Dr. Francis Collins
Caption: Worn on the neck, the device records central blood pressure in the carotid artery (CA), internal jugular vein (Int JV) and external jugular vein (Ext JV).
Credit: Adapted from Wang et al, Nature Biomedical Engineering
There’s lots of excitement out there about wearable devices quietly keeping tabs on our health—morning, noon, and night. Most wearables monitor biological signals detectable right at the surface of the skin. But, the sensing capabilities of the “skin” patch featured here go far deeper than that.
As described recently in Nature Biomedical Engineering, when this small patch is worn on the neck, it measures blood pressure way down in the central arteries and veins more than an inch beneath the skin [1]. The patch works by emitting continuous ultrasound waves that monitor subtle, real-time changes in the shape and size of pulsing blood vessels, which indicate rises or drops in pressure.
Prostate Cancer: Designing a Smarter High-Tech Biopsy
Posted on by Dr. Francis Collins
Caption: When the biopsy is completed, a 3D data map is generated. In this actual example, what is shown is the contour of the prostate (red), location of the tumor (green), the location of the standard random prostate biopsies (white cores), and the location of the targeted fusion biopsies (yellow cores).
Credit: Peter A. Pinto, National Cancer Institute, NIH
Many of you probably know that prostate cancer is the most frequently diagnosed cancer in American men. But here’s something that might surprise you: the way in which doctors biopsy for prostate cancer hasn’t changed significantly in nearly 30 years—even though about a million such biopsies are conducted every year in the United States.
Unlike breast cancer biopsies, which sample tissue from a suspicious area seen on a mammogram, prostate cancer biopsies still are generally performed as random, 12-point searches to see if any cancerous cells might be lurking somewhere in the prostate gland. While random biopsies have helped to save many lives, NIH-supported research has developed a targeted approach that brings much-needed efficiency to the diagnostic process—and appears to be better at detecting aggressive, high-risk prostate cancer than current methods.
