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The Journal of Clinical Endocrinology & Metabolism Vol. 85, No. 10 3919-3924
Copyright © 2000 by The Endocrine Society


Original Studies

Expression of Vascular Endothelial Growth Factor and Its Receptors in the Human Corpus Luteum during the Menstrual Cycle and in Early Pregnancy1

Norihiro Sugino, Shiro Kashida, Shuji Takiguchi, Ayako Karube and Hiroshi Kato

Department of Obstetrics and Gynecology, Yamaguchi University School of Medicine, Ube 755-8505, Japan

Address correspondence and requests for reprints to: Norihiro Sugino, M.D., Department of Obstetrics and Gynecology, Yamaguchi University School of Medicine, Minamikogushi 1-1-1, Ube 755-8505, Japan. E-mail: obgyn{at}po.cc.yamaguchi-u.ac.jp


    Abstract
 Top
 Abstract
 Introduction
 Materials and Methods
 Results
 Discussion
 References
 
To investigate the possible role of vascular endothelial growth factor (VEGF) and its receptors in the human corpus luteum (CL), expression of VEGF and its receptors, the fms-like tyrosine kinase and the kinase insert domain-containing region (KDR), was analyzed in the CL during the menstrual cycle and in early pregnancy. Immunohistochemistry revealed that VEGF was localized in luteal cells and both flt-1 and KDR were also localized in luteal cells, in addition to vascular endothelial cells. Messenger RNA (mRNA) expression of VEGF, flt-1, and KDR remained constant in the CL during the luteal phase and was lower in the regression phase. In the pregnant CL, VEGF mRNA expression was higher compared with that in the midluteal phase, and mRNA expression of both flt-1 and KDR was the same as that in the midluteal phase. Western blot analyses revealed that the change in protein expression of VEGF, flt-1, and KDR was similar to that in their mRNA expression. To study the effect of human CG (hCG) on VEGF expression in the CL, corpora lutea obtained from the midluteal phase were incubated with hCG (1 IU/ml) for 6 h. hCG increased the expression of mRNA and protein of VEGF. In conclusion, VEGF and its receptors may play important roles in development and function of the CL, and VEGF may exert a paracrine-autocrine role in regulating luteal function. hCG may act to prolong the life span of the CL by stimulating VEGF expression when pregnancy occurs.


    Introduction
 Top
 Abstract
 Introduction
 Materials and Methods
 Results
 Discussion
 References
 
IT HAS BEEN reported that angiogenesis is important for the development of the corpus luteum (CL) and the maintenance of luteal function (1, 2, 3). Vascular endothelial growth factor (VEGF) is a recently identified protein that has the potential to play a dynamic role in the regulation of vascular endothelial growth, angiogenesis, and vascular permeability (4). Recent evidence has shown that VEGF is expressed in the human CL and luteinized granulosa cells, suggesting that VEGF plays important roles in the development of the CL and the maintenance of luteal function (5, 6, 7, 8, 9, 10). VEGF has two known receptors: the fms-like tyrosine kinase (flt-1) and the kinase insert domain-containing region (KDR), which are generally found on endothelial cells. However, little is known about the expression of VEGF and, in particular, its receptors in the human CL throughout the menstrual cycle and in early pregnancy. The mechanism about the prolongation of the life span of the CL when pregnancy occurs has been a matter of concern, although several factors, including human CG (hCG), have been reported to be involved in the rescue of the CL (11, 12, 13, 14, 15, 16, 17). In the pregnant CL, high vascularization seems to be necessary to provide luteal cells with the large amounts of cholesterol needed for progesterone synthesis and for the delivery of progesterone to the circulation. Therefore, it is important to know how the VEGF and its receptor system changes in the CL when pregnancy occurs. In the present study, to investigate the possible role of VEGF and its receptors in the human CL, changes in expression of messenger RNA (mRNA) and protein of VEGF, flt-1, and KDR were studied in the human CL throughout the menstrual cycle and in early pregnancy. We further examined the effect of hCG on VEGF expression in the human CL.


    Materials and Methods
 Top
 Abstract
 Introduction
 Materials and Methods
 Results
 Discussion
 References
 
This project was reviewed and approved by the committee on investigations involving human subjects of Yamaguchi University School of Medicine. Informed consent from the patient was obtained before collection of any tissue samples for this study.

Materials

RPMI 1640 was from Flow Laboratories Inc. (McLean, VA). Streptomycin, penicillin, deoxynucleotide triphosphates, and Moloney murine leukemia virus reverse transcriptase were from Life Technologies, Inc. (Grand Island, NY). hCG (catalog no. C1063) was from Sigma (St. Louis, MO). Random hexamer and Taq DNA polymerase were from Perkin-Elmer Corp. (Foster City, CA). [{alpha}-32P]deoxycytidine triphosphate was from Amersham Pharmacia Biotech (Arlington Heights, IL). Isogen was from Wako Pure Chemical Industries, Ltd. (Osaka, Japan).

Tissue samples

Corpora lutea were obtained at hysterectomy from normally cycling women, 39–49 yr of age, who underwent surgery for myoma uteri or cervical cancer. The menstrual history and the endometrial dating diagnosed histologically according to the criteria of Noyes et al. (18) were used to determine the age of the CL. Corpora lutea of the cycle were classified into four different groups according to their age: early luteal phase (days 14–18), midluteal phase (days 19–24), late luteal phase (days 25–28), and regression phase (days 3–7), with day 1 being the day of the onset of menstruation. Corpora lutea of early pregnancy (6–8 weeks) were obtained from the patients, 24–30 yr of age, with ectopic pregnancy. Tissue samples were washed with saline to remove blood and immediately frozen in liquid nitrogen and stored at -80 C until RNA isolation and Western blot analysis. In some patients, blood samples were obtained at surgery for determination of serum progesterone concentrations.

Immunohistochemistry

The immunohistochemical staining was performed on two to four tissue samples from the midluteal phase, regression phase, and early pregnancy. Corpora lutea were fixed in Carnoy solution and embedded in paraffin and sectioned (8 µm thick). The tissue sections were deparaffinized in xylene and dehydrated in a graded series of ethanol. Immunohistochemistry for VEGF and flt-1 was performed with a peroxidase-antiperoxidase method (DAKO PAP kit; DAKO Corp., Tokyo, Japan) using rabbit antihuman VEGF polyclonal antibodies or rabbit antihuman flt-1 polyclonal antibodies (Santa Cruz Biotechnology, Inc., Santa Cruz, CA). After inhibition of endogenous peroxidase activity with 0.3% H2O2 for 50 min, the sections were incubated with 10% normal swine serum for 10 min at room temperature to avoid nonspecific binding. The sections were then incubated with the primary antibodies, at a dilution of 1:50 in PBS-BSA (1%) overnight at 4 C. After three washes with PBS for 5 min each, the sections were incubated with swine antirabbit immunoglobulin for 30 min at room temperature, washed three times with PBS for 5 min each, and reacted with rabbit-peroxidase-antiperoxidase for 40 min at room temperature. Immunohistochemistry for KDR was performed with a streptavidin-biotin-peroxidase complex method (SAB-PO kit; Nichirei Co. Ltd., Tokyo, Japan) using mouse anti-human KDR monoclonal antibodies (Santa Cruz Biotechnology, Inc.). After inhibition of endogenous peroxidase activity with 0.3% H2O2 for 50 min, the sections were incubated with 10% normal rabbit serum for 10 min at room temperature to avoid nonspecific binding. The sections were incubated with the primary antibody at a dilution of 1:50 in PBS-BSA (1%) overnight at 4 C. After three washes with PBS for 5 min each, the sections were incubated with biotinylated rabbit antimouse immunoglobulin for 10 min at room temperature, washed three times with PBS for 5 min each, and reacted with peroxidase conjugated streptavidin for 5 min at room temperature. Peroxidase activity was visualized by incubating the sections with 3, 3' diaminobenzidine•4HCl (Nacalai Tesque Co. Ltd., Tokyo, Japan) in 0.05 M Tris-HCl buffer (pH 7.6) containing 0.01% H2O2 for 2–3 min. Control sections were incubated with normal rabbit serum for VEGF and flt-1, normal mouse serum for KDR, or PBS. Counterstaining was performed with Meyer’s hematoxylin.

Incubation of corpora lutea

Corpora lutea obtained from the midluteal phase were sliced into small pieces and incubated in serum-free RPMI 1640 (35–60 mg wet weight/mL·tube) at 37 C for 1 h under an atmosphere of 95% O2:5% CO2 in a shaking water bath. The medium was then changed to the test medium containing hCG (1 IU/mL), and the incubation was continued for 6 h under the same atmosphere, as described above. After incubation, the CL tissue was immediately frozen in liquid nitrogen and stored at -80 C until RNA isolation and Western blot analysis. The incubation was run in triplicate.

RT-PCR

Total RNA was isolated from the corpora lutea with Isogen by the method provided by the manufacturer. For mRNA analysis, RT-PCR was performed as reported previously (16) with the oligonucleotide primers for VEGF (5'-CACATAGGAGAGATGAGCTTC-3' and 5'-CCGCCTCGGCTTGTCACAT-3'), for flt-1 (5'-CTAGGATCCGTGACTTATTTTTTCTCAACAAGG-3' and 5'-CTCGAATTCAGATCTTCCATAGTGATGGGCTC-3'), and for KDR (5'-CGTGGATCCACCAAAGGGGCACGATTCCGTC-3' and 5'-CTCGAATTCTGTAACAGATGAGATGCTCCAAGG -3'), designed by Athanassiades et al. (19). Direct sequence analyses of the PCR products were performed for sequence verification. Two oligonucleotide primers (5'-CTGAAGGTCAAAGGGAATGTG-3' and 5'-GGACAGAGTCTTGATGATCTC-3') were also used to amplify ribosomal protein L19 as an internal control (20). In brief, 3 µg total RNA were reverse-transcribed at 42 C in a reaction mixture (single-strength PCR buffer, 2.5 mM deoxynucleotide triphosphate, 5 µM random hexamer primer, 1.5 mM MgCl2, and 200 U Moloney murine leukemia virus reverse-transcriptase). The RT product was aliquoted equally into two tubes for VEGF or flt-1 or KDR primers and L19 primers, and PCR was performed. For PCR amplification, a mixture containing the oligonucleotide primers (50 pmol), [{alpha}-32P]deoxycytidine triphosphate (2 µCi at 3000 Ci/mmol), and Taq DNA polymerase (2.5 U) was added to each reaction. Amplification was carried out for 25 cycles consisting of 94 C (1 min), 57 C (1 min) and 72 C (1 min) for VEGF, 28 cycles consisting of 94 C (1 min), 60 C (1 min) and 72 C (1 min) for flt-1 and 25 cycles consisting of 94 C (1 min), 60 C (1 min) and 72 C (1 min) for KDR, followed by 10 min of final extension at 72 C in a programmed temperature control system PC-800 (ASTEC, Fukuoka, Japan). The predicted sizes of the PCR-amplified products were 98 bp for VEGF121, 228 bp for VEGF165, 230 bp for flt-1, 209 bp for KDR, and 194 bp for L19. A linear curve was plotted using number of cycles of amplification vs. densitometric values of the PCR products, measured with a BAS2000 (Fuji Photo Film Co., Ltd., Tokyo, Japan). The optimal number of cycles for amplification that fit within the linear range was chosen for each sets of primers of VEGF, flt-1, KDR, and L19 (data not shown). Reaction products were electrophoresed on an 8% polyacrylamide nondenaturing gel.

Western blot analysis

Corpora lutea were homogenized with distilled water and centrifuged at 800 x g for 10 min at 4 C. The supernatant was used for Western blot analysis. Eighty micrograms of protein of the supernatant, determined by the Lowry’s method (21), was loaded in each sample and separated by SDS-PAGE in 15% gels for VEGF and in 7.5% gels for flt-1 and KDR under reduced conditions. The proteins on the gel were electrophoretically transferred to nitrocellulose membranes and reacted with antibodies used in the immunohistochemistry at a dilution of 1:50 with 0.5% skimmed milk in Tris-buffered saline (pH 7.5). The membranes were then immersed in the reaction buffer containing peroxidase-conjugated swine antirabbit immunoglobulin for VEGF and flt-1 or peroxidase-conjugated rabbit antimouse immunoglobulin for KDR. The reacted band was developed on a film with ECL kit (Amersham Pharmacia Biotech, Buckinghamshire, UK).

Progesterone assay

Progesterone concentrations in the serum and medium were determined by a specific RIA, as reported previously (22). The sensitivity of the assay was 100 pg/mL, and the intra- and interassay coefficients of variation were 7.0% and 14.4%, respectively.

Statistical analysis

Data were examined by ANOVA and Duncan’s new multiple range test. Where appropriate, Student’s t test was used. Differences were considered significant at P less than 0.05.


    Results
 Top
 Abstract
 Introduction
 Materials and Methods
 Results
 Discussion
 References
 
In this study, serum progesterone concentrations (mean ± SEM) were significantly (P < 0.01) higher in the midluteal phase (13.1 ± 1.8 ng/mL, n = 5) than in the early luteal phase (4.8 ± 1.5 ng/mL, n = 4) and the late luteal phase (3.2 ± 0.6 ng/mL, n = 5), whereas those of all patients in the regression phase were less than 1.0 ng/mL.

VEGF immunostaining was localized in luteal cells, with strong immunostaining at the midluteal phase and in early pregnancy (Fig. 1Go, A and C), whereas luteal cells of the regressing CL showed weak immunostaining (Fig. 1BGo). Negative control sections for VEGF were consistently free from staining (Fig. 1DGo). Immunostaining of flt-1 and KDR was localized in luteal cells and in vascular endothelial cells, with strong immunostaining at the midluteal phase and in early pregnancy (Fig. 1Go, E, G, I, and K), whereas the luteal cells of the regressing CL showed weak immunostaining (Fig. 1Go, F and J). Negative control sections for flt-1 and KDR were consistently free from staining (Fig. 1Go, H and L). No difference was observed in the intensity of those immunostaining in the luteal cells between granulosa lutein cell layer and theca lutein cell layer.



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Figure 1. Immunohistochemical staining for VEGF (A-D), flt-1 (E-H), and KDR (I-L) in the human CL from the midluteal phase (A, E, and I), the regression phase (B, F, and J) and early pregnancy (C, G, and K). Consistent results were obtained from two to four samples. D, H, and L, negative control. Original magnification, x200.

 
Figure 2Go shows a representative autoradiogram of RT-PCR for VEGF mRNA expression in corpora lutea prepared from early luteal phase (n = 3), midluteal phase (n = 4), late luteal phase (n = 3), regression phase (n = 5), and early pregnancy (n = 5). To date, four VEGF splice variants of 121, 165, 189, and 206 amino acids have been identified in human tissues (4). Using RT-PCR, strong bands corresponding to VEGF121 and VEGF165 were detected in the human CL (Fig. 2Go). The mRNA expression of both isoforms of VEGF in the CL remained constant from the early luteal to late luteal phase and was lower in the regression phase (Fig. 2Go). In the pregnant CL, VEGF mRNA expression was higher compared with that in other luteal phases (Fig. 2Go).



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Figure 2. VEGF mRNA expression in the human CL during the menstrual cycle and in early pregnancy. Samples were obtained from early luteal phase (days 14–18, n = 3), midluteal phase (days 19–24, n = 4), late luteal phase (days 25–28, n = 3), regression phase (days 3–7, n = 5) with day 1 being the day of the onset of menstruation, and early pregnancy (6–8 weeks of pregnancy, n = 5). Total RNA was isolated and subjected to RT-PCR. Ribosomal protein L19 was used as an internal control. The autoradiogram is a representative of early luteal phase (n = 3), midluteal phase (n = 4), late luteal phase (n = 3), regression phase (n = 5), and early pregnancy (n = 5).

 
mRNA expression of flt-1 and KDR in the CL was also examined by RT-PCR with the same total RNA as used in Fig. 2Go. flt-1 mRNA expression was detected at constant levels from the early luteal to late luteal phase and lower in the regressing CL (Fig. 3AGo). In the pregnant CL, flt-1 mRNA expression was the same level as that in the midluteal phase (Fig. 3AGo). KDR mRNA expression tended to be higher in the early luteal phase (Fig. 3BGo), but there was no significant difference when the intensity of the KDR signals measured by a bioimaging analyzer BAS2000 (Fuji Photo Film Co., Ltd.) was normalized to that of the internal control L19 and analyzed semiquantitatively (data not shown). The regressing CL showed lower KDR mRNA expression compared with other luteal phases (Fig. 3BGo). In the pregnant CL, KDR mRNA expression was the same level as that in the midluteal phase (Fig. 3BGo).



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Figure 3. mRNA expression of flt-1 (A) and KDR (B) in the human CL during the menstrual cycle and in early pregnancy. Samples were obtained from the same patients as described in the legend to Fig. 2Go. Total RNA was isolated and subjected to RT-PCR. Ribosomal protein L19 was used as an internal control. The autoradiogram is a representative of early luteal phase (n = 3), midluteal phase (n = 4), late luteal phase (n = 3), regression phase (n = 5), and early pregnancy (n = 5).

 
Figure 4Go shows representative immunoblots for VEGF, flt-1, and KDR protein in corpora lutea obtained from midluteal phase (n = 4), regression phase (n = 4), and early pregnancy (n = 5). VEGF was highly expressed in the pregnant CL compared with the midluteal phase CL (Fig. 4AGo). In contrast, VEGF expression was remarkably low in the regressing CL (Fig. 4AGo). flt-1 and KDR were barely detectable in the regressing CL, but they were clearly expressed in the midluteal phase and early pregnancy (Fig. 4Go, B and C). There was no significant difference in the expression of flt-1 and KDR between midluteal phase and early pregnancy when the reacted bands of flt-1 and KDR were scanned and their optical densities were measured by NIH Image (data not shown).



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Figure 4. Western blot analyses for VEGF (A), flt-1 (B), and KDR (C) in the CL obtained from the midluteal phase, regression phase, and early pregnancy. Samples were obtained from the midluteal phase (n = 4), regression phase (n = 4), and early pregnancy (n = 5). Equal amounts of protein (80 µg) were separated by SDS-PAGE, transferred to nitrocellulose membrane, and analyzed by Western blotting. Depicted are representative immunoblots of the midluteal phase (n = 4), regression phase (n = 4), and early pregnancy (n = 5).

 
To study whether hCG is involved in the change in mRNA and protein expression of VEGF seen in the pregnant CL, corpora lutea of the midluteal phase were incubated with hCG (1 IU/mL). Figure 5AGo shows a representative autoradiogram of RT-PCR and hCG increased the mRNA expression of both isoforms of VEGF. Figure 5BGo shows a representative immunoblot and hCG increased VEGF protein expression. Progesterone concentrations in the medium were also significantly (P < 0.01) increased by hCG (control, 3.0 ± 0.2 ng/mg wet wt; hCG, 5.7 ± 0.7 ng/mg wet wt; mean ± SEM, n = 3).



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Figure 5. Effects of hCG on VEGF mRNA expression (A) and VEGF protein expression (B) in the CL. Corpora lutea obtained from the midluteal phase were incubated with hCG (1 IU/mL) for 6 h. RT-PCR and Western blot analysis were performed for the determination of mRNA and protein levels of VEGF. The autoradiogram (A) and the immunoblot (B) are representative of three different experiments.

 

    Discussion
 Top
 Abstract
 Introduction
 Materials and Methods
 Results
 Discussion
 References
 
This is, to our knowledge, the first report showing the change in expression of VEGF, flt-1, and KDR in the human CL during the menstrual cycle and in early pregnancy. VEGF mRNA expression remained constant in the CL from the early luteal to late luteal phase and was lower in the regressing CL. The relatively high expression of VEGF mRNA in the CL from the early luteal to midluteal phase was consistent with the well known pattern of vasculature in the CL (10, 23, 24, 25). Because VEGF receptors, flt-1, and KDR were localized in the vascular endothelial cells, the VEGF system seems to be, at least, related to angiogenesis in the human CL. In contrast, VEGF expression was low in the regressing CL. The regression of the vascular network in the CL has been observed in the process of luteolysis (10, 25, 26, 27), and the decline in blood flow has also been reported to be involved in luteolysis (28, 29). Therefore, the decrease in actions of the VEGF system is likely to be involved in facilitating luteolysis.

hCG has been reported to be involved in the rescue of the CL when pregnancy occurs (11, 14, 16). The present study showed that VEGF expression in the pregnant CL was higher than that in the midluteal phase CL and that VEGF expression was increased by hCG in vitro. This is consistent with the report showing that VEGF expression in human luteinized granulosa cells was enhanced by increasing amounts of hCG, with maximum enhancement at 1 IU/mL (7). These findings may suggest that hCG maintains luteal function via the increase in VEGF expression when pregnancy occurs. As for the mechanism that hCG prolongs the CL function, Christenson and Stouffer (24) showed that no significant increase in proliferation of endothelial cells was observed in the primate CL maintained by hCG, and they suggested that endothelial cell proliferation is not a critical factor in the rescue of the CL by hCG. It has also been reported that VEGF is expressed in some tissues that are not undergoing active angiogenesis (30). VEGF may function to increase vascular permeability, which in turn facilitates not only the supply of large amounts of cholesterol required for progesterone synthesis but also the delivery of progesterone to the circulation when pregnancy occurs.

In the present in vitro study, the effects of hCG were small, although there were significant differences when the band intensities of RT-PCR and Western blotting were analyzed. This may be because there was no protein included in the incubation medium to prevent nonspecific adsorption of hCG to the incubation vessel.

The present study also showed that two VEGF receptors were expressed in luteal cells and that the expression of those receptors was high in the CL during the luteal phase and in early pregnancy compared with the regression phase, suggesting that VEGF may exert a paracrine-autocrine role in regulating luteal function. Expression of VEGF receptors has been reported in a variety of nonendothelial cells (31, 32, 33, 34). It is of interest to note that VEGF can act as a survival factor and inhibit apoptosis (35, 36). Recent evidence has suggested that apoptosis plays important roles in the determination of luteal life span in humans (37, 38). The high expression of VEGF in the pregnant CL, the induction of VEGF expression by hCG, and the decline of VEGF, flt-1, and KDR expression in the regressing CL suggest an additional possibility that VEGF may be involved in the prolongation of the life span of the CL as a survival factor when pregnancy occurs.

In conclusion, the present study suggests that VEGF and its receptors play important roles in the development and function of the CL and that VEGF may exert a paracrine-autocrine role in regulating luteal function. hCG may act to prolong the life span of the CL by stimulating VEGF expression when pregnancy occurs. However, additional studies are needed regarding the differential roles of VEGF in the regulation of angiogenesis, vascular permeability, and apoptosis in the human CL.


    Footnotes
 
1 Supported in part by a grant from the UBE Foundation and Grant-in-Aid 11671623 from the Ministry of Education, Science, and Culture, Japan. Back

Received December 22, 1999.

Revised February 25, 2000.

Revised June 6, 2000.

Accepted June 20, 2000.


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 Top
 Abstract
 Introduction
 Materials and Methods
 Results
 Discussion
 References
 

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