In the middle of the night – strangely enough, it is often at night – the phone rings. Michelle Broekhuizen (30) puts on her clothes, jumps on her bike to the Erasmus MC in Rotterdam, sets up all the equipment in the lab, rushes to the gynecology department with a white bucket, waits there until someone comes out with a placenta and then take it to the pharmacology department as quickly as possible. She has about four hours for the experiments, that’s how long the placenta stays good. In the lab it may turn out that it is not sound enough for research. Then she got up for nothing. “But I would rather have that than no phone call at all, because the doctor forgot to warn me in the hectic of a crisis situation.” In five years, she and her team have handled 489 placentas.
Michelle Broekhuizen received her PhD earlier this year for her research into the placenta and now has the money and PhD students to continue with it. This Friday morning she shows the device that allows the placenta to function outside the uterus for a while. A container in which the placenta lies on a mat, with two bundles of tubes, just as in the womb the fetus and the mother each have their own blood circulation. “Here we can look at the effects of medications on the placenta, and whether a medication that you add to the mother’s side also reaches the fetus.” She can also look at the blood pressure in the placenta and narrowing of the blood vessels. “That says something about how it works in the body. If the vessels are narrowed, it is also difficult for the child to get blood through the placenta.”
Experimental cardiology
Further on there is another setup. “We hang the blood vessels there that we cut from the placenta, to measure how strongly they contract or dilate under the influence of certain medications.”
As a graduated medical biologist, Broekhuizen wanted to conduct research into the relationship between the heart and the blood vessels in the lungs, but there was no money at that time for experimental cardiology. There was room in neonatology, and an enthusiastic professor who saw that good treatment of premature children starts before birth. Moreover, the step was not that big. “Placenta research is also about blood vessels.” You could think of the placenta as the lungs of the fetus. “The blood circulation of mother and child flow close to each other, the vessels of the fetus float, as it were, in the mother’s blood, allowing oxygen and nutrients to reach the fetus. Good blood vessel function is therefore essential.”
An aura of quackery
Looking back, Broekhuizen is surprised at how little attention was paid to this disposable organ during her studies. “Maybe because it is only there during pregnancy, after giving birth it ends up in the garbage bin.” Rituals such as using the placenta as a breeding ground for a new tree, or using the placenta for supplements against mood swings, also give the placenta an aura of quackery. “While there is still so much to discover.”
About pregnancy poisoning (pre-eclampsia), for example. High blood pressure and protein in the urine, sometimes resulting in hospitalization and early termination of pregnancy. “We don’t know exactly what goes wrong that causes the placenta to not develop properly and to secrete the harmful substances that make the mother so ill.” In addition to identifying the causes, Broekhuizen hopes to improve the function of the placenta so that the child can stay in the womb longer. And find a treatment for preeclampsia. Because doctors cannot do more than combat the symptoms with blood pressure lowering drugs.
Immune cells with faces
Broekhuizen turned her five-year quest into pre-eclampsia, drug treatment, the immune system of sick and healthy placentas and the conversion of the building material tryptophan in the placenta into a magazine with own illustrations. “All those printed dissertations that no one reads – not sustainable at all.” With this magazine, family and friends immediately understand what Broekhuizen has been doing all this time.
For example, the illustrations of immune cells (with faces) show that in pre-eclampsia, to the researchers’ surprise, fewer inflammatory factors emerge than in healthy placentas. “There appears to be a separation between the mother’s defenses and that of the placenta itself.” Another finding: vasodilator drugs that they hoped would provide improvements had less effect in diseased placentas than in healthy ones. Disappointing, you might say. But Broekhuizen doesn’t think that way. She wanted to go into science to think, test ideas, and master a specialty. “The lack of improvement also shows something about what is happening in the placenta.”
In the near future, she will investigate, among other things, the effects of cannabis oil in the placenta. “We know that the placenta itself produces cannabis-like substances. Many women use cannabis oil against pregnancy complaints, against pain or nausea, and the assumption is that the oil is harmless. But we still have to find out exactly what the effects are – negative and positive.”