Zusammenfassung
Tocolysis with a beta-adrenergic receptor agonist is the most common
approach to premature labor management after the 25th wk of pregnancy.
However, prolonged treatment is associated with a marked loss of
efficacy. The biochemical mechanisms involved remain unclear. This
study was undertaken to investigate the effect of fenoterol on beta-adrenergic
receptor signal transduction in human myometrium. Myometrial biopsy
specimens were obtained from 40 women at cesarean section between
the 25th and 34th wk of pregnancy. Nineteen patients had received
no tocolysis (controls, group I) and 21 had been treated with fenoterol
(<48 h in 10, group II; > or = 48 h in 11, group III). As methods
we used membrane preparation, adenylyl cyclase assay and cAMP RIA.
Adenylyl cyclase activity was determined by the measurement of cAMP
levels to evaluate signal transduction after stimulation of beta-adrenergic
receptors with isoproterenol, G protein with GTP, and adenylyl cyclase
with forskolin. The functional activity of GTP-binding regulatory
proteins (G(s)) and adenylyl cyclase was not altered by fenoterol
treatment. In the control group, the increase in adenylyl cyclase
activity in response to GTP plus isoproterenol was greater than in
response to GTP alone. The increase was reduced by 50% in group II
and was insignificant in group III. There was no correlation between
gestational age and basal adenylyl cyclase activity. Intravenous
tocolysis with the beta2-adrenergic receptor agonist fenoterol leads
to complete desensitization of the beta-adrenergic receptor system.
In addition to the known reduction in receptor number (down-regulation)
as underlying mechanism, uncoupling of the receptor from the stimulatory
G protein G(s) was identified.
Nutzer