Kanahashi T, Yamada S, Yoneyama A, Takakuwa T. Relationship Between Physiological Umbilical Herniation and Liver Morphogenesis During the Human Embryonic Period: A Morphological and Morphometric Study. Anat Rec 2019, 302, 1968-1976. doi: 10.1002/ar.24149.
肝臓無形成でも生理的臍帯ヘルニアがみられる
ABSTRACT
It is widely hypothesized that physiological umbilical herniation (PUH) in humans occurs, because the liver occupies a large space in the abdominal cavity, which pushes the intestine into the extraembryonic coelom during the embryonic period. We have recently shown the presence of the intestinal loop in the extraembryonic coelom in embryos with liver malformation. Here, we analyzed the relationship between the liver and the PUH at Carnegie stage 21 of four embryos with liver malformation, including two with hypogenesis (HY1, HY2) and two with agenesis (AG1, AG2), using phase-contrast X-ray computed tomography and compared them with two control embryos. The intestinal loop morphology in the malformed embryos differed from that in the control embryos, except in HY1. The length of the digestive tract in the extraembryonic coelom of the embryos with liver malformation was similar to or longer than that of the controls. The rate of intestinal loop lengthening in the extraembryonic coelom compared with that of the total digestive tract in all embryos with liver malformation was similar to or higher than that of the controls. The estimated total abdominal cavity volume in the embryos with liver malformation was considerably smaller than that of the controls, while the intestinal volume was similar. The cardia and proximal portion of the pancreas connecting to the duodenum were located at almost identical positions in all the embryos, whereas other parts of the upper digestive tract deviated in the embryos with abnormal livers. Thus, our results provided evidence that PUH occurred independently of liver volume.
Suzuki Y, Matsubayashi J, Ji X, Yamada S, Yoneyama A, Imai H, Matsuda T, Aoyama T, Takakuwa T Morphogenesis of the femur at different stages of normal human development, PLoS ONE, 14(8): e0221569. https://doi.org/10.1371/journal. pone.0221569
Abstract
The present study aimed to better characterize the morphogenesis of the femur from the embryonic to the early fetal periods. Sixty-two human fetal specimens (crown–rump length [CRL] range: 11.4–185 mm) from the Kyoto Collection were used for this study. The morphogenesis and internal differentiation process of the femur were analyzed in 3D using phase-contrast X-ray computed tomography and magnetic resonance imaging. The cartilaginous femur was first observed at Carnegie stage 18. Major anatomical landmarks were formed prior to the initiation of ossification at the center of the diaphysis (CRL, 40 mm), as described by Bardeen. The region with very high signal intensity (phase 5 according to Streeter’s classification; i.e., area described as cartilage disintegration) emerged at the center of the diaphysis, which split the region with slightly low signal intensity (phase 4; i.e., cartilage cells of maximum size) in fetuses with a CRL of 40.0 mm. The phase 4 and phase 5 regions became confined to the metaphysis, which might become the epiphyseal cartilage plate. Femur length and ossified shaft length (OSL) showed a strong positive correlation with CRL. The OSL-to-femur length ratio rapidly increased in fetuses with CRL between 40 and 75 mm, which became moderately increased in fetuses with a CRL of ≥75 mm. Cartilage canal invasion occurred earlier at the proximal epiphysis (CRL, 62 mm) than at the distal epiphysis (CRL, 75 mm). Morphometry and Procrustes analysis indicated that changes in the femur shape after ossification were limited, which were mainly detected at the time of initial ossification and shortly after that. In contrast, femoral neck anteversion and torsion of the femoral head continuously changed during the fetal period. Our data could aid in understanding the morphogenesis of the femur and in differentiating normal and abnormal development during the early fetal period.
第59回先天異常学会で、発表しました(2019.7.26-28, 名古屋）The 13th World Congress of the International Cleft Lip and Palate Foundation -CLEFT 2019-と合同開催でした。
Nohara A, Owaki N, Manesco C, Katsube M, Yamada S, Imai H, Matsuda T, Yoneyama A, Takakuwa T, Relationship between fusion of lateral palatal shelves and growth of Mandible (Meckel’s cartilage)
PUH occurred independently of liver
Takakuwa T. Intestinal loop formation: herniation into the extraembryonic coelom and return to the abdominal coelom (招待講演）
Drastic changes occur during the development of the intestinal loop (IL), including physiological umbilical herniation (PUH) and its return. The present study was designed to analyze such developments three-dimensionally during human embryonic and early fetal period.
Materials and Methods: The software AMIRA was used to analyze the 3D digitalized data (high-resolution MRI, phase-contrast X-ray CT) obtained from the Kyoto Collection.
Results and Discussion: Based on the results of our analysis, the following time line and main features of IL formation were revealed:
Herniate phase (Carnegie stage (CS)14-CS23, Crown-rump length (CRL) < 35 mm): IL rotation was initially observed as a slight deviation of the duodenum and colorectum from the median plane up to CS16. The PUH was noticeable after CS16. The IL displayed a hairpin-like structure, with the superior mesenteric artery (SMA) running parallel to the straight part and the cecum located to the left at CS18. The IL rotated around the SMA only during the early stages (until CS19). The IL gradually moved away, running transversely after CS19. Embryos with liver malformation showed PUH, which indicated that PUH occurred independent of liver volume.
Transition phase (CRL = 37, 41, and 43 mm): Intestinal return began from proximal to distal part in samples with CRL of 37 mm. The cecum returned before the distal end of the small intestine (ileum) in samples with CRLs of 41 and 43 mm.
Return phase: The cecum immediately reached its final position in the right lower quadrant of the abdomen (the adult position). The anti-clockwise “en-bloc rotation” described by descent and fixation of the cecum in the abdominal cavity may not exist. A rapid increase in the space available for the intestine in the abdominal coelom that exceeded the intestinal volume in the extraembryonic coelom was observed. The height of the umbilical ring increased in a stepwise manner between the transition and return phases and its height in the return phase was comparable to or higher than that of the hernia tip during the herniation phase. We speculated that the space is generated to accommodate the herniated portion of the intestine, similar to the intestine wrapping into the abdominal coelom as the height of the umbilical ring increases.
Conclusion: The data obtained in the present study demonstrate the precise timeline of IL formations, which indicate several points of discrepancy in the results of previous studies.
42. Nagata A, Hatta S, Imai H, Yamada S, Takakuwa T. Position of the cecum in the extraembryonic and abdominal coelom in the early fetal period. Congenit Anom 2020, 60 (3) 87-88. doi: 10.1111/cga.12348.
35. Nagata A, Hatta S, Ji X, Ishikawa A, Sakamoto R, Yamada S, Imai H, Matsuda T, Takakuwa T. Return of the intestinal loop to the abdominal coelom after physiological umbilical herniation in the early fetal period. J Anat, 2019, 234, 456-464.doi: 10.1111/joa.12940.
Abstract
The intestine elongates during the early fetal period, herniates into the extraembryonic coelom, and subsequently returns to the abdominal coelom. The manner of herniation is well-known; however, the process by which the intestinal loop returns to the abdomen is not clear. Thus, the present study was designed to document and measure intestinal movements in the early fetal period in three dimensions to elucidate the intestinal loop return process. Magnetic resonance images from human fetuses whose intestinal loops herniated (herniated phase; n = 5) while returning to the abdominal coelom [transition phase; n = 3, crown–rump length (CRL)] 37, 41, and 43 mm] and those whose intestinal loops returned to the abdominal coelom normally (return phase; n = 12) were selected from the Kyoto Collection. Intestinal return began from proximal to distal in samples with CRL of 37 mm. Only the ileum ends were observed in the extraembryonic coelom in samples with CRLs of 41 and 43 mm, whereas the ceca were already located in the abdominal coeloms. The entire intestinal tract had returned to the abdominal coelom in samples with CRL > 43 mm. The intestinal length increased almost linearly with fetal growth irrespective of the phase (R2 = 0.90). The ratio of the intestinal length in the extraembryonic coelom to the entire intestinal length was maximal in samples with CRLs of 32 mm (77%). This ratio rapidly decreased in three of the samples that were in the transition phase. The abdominal volumes increased exponentially (to the third power) during development. The intestinal volumes accounted for 33–41% of the abdominal volumes among samples in the herniated phase. The proportion of the intestine in the abdominal cavity increased, whereas that in the liver decreased, both without any break or plateau. The amount of space available for the intestine by the end of the transition phase was approximately 200 mm3. The amount of space available for the intestine in the abdominal coelom appeared to be sufficient at the beginning of the return phase in samples with CRLs of approximately 43 mm compared with the maximum intestinal volume available for the extraembryonic coelom in the herniated phase, which was 25.8 mm3 in samples with CRLs of 32 mm. A rapid increase in the space available for the intestine in the abdominal coelom that exceeded the intestinal volume in the extraembryonic coelom generated an inward force, leading to a ‘sucked back’ mechanism acting as the driving force. The height of the hernia tip increased to 8.9 mm at a maximum fetal CRL of 37 mm. The height of the umbilical ring increased in a stepwise manner between the transition and return phases and its height in the return phase was comparable to or higher than that of the hernia tip during the herniation phase. We surmised that the space was generated in the aforementioned manner to accommodate the herniated portion of the intestine, much like the intestine wrapping into the abdominal coelom as the height of the umbilical ring increased.
