The teratogenic effects of valproic acid in human chondrogenesis in vitro

The anticonvulsant drug valproic acid (VPA) is a known teratogen in humans. In general, anticonvulsants effect major systems in the embryo causing craniofacial, cardiovascular, neurological, urogenital, and major and minor skeletal defects. The limb defects associated with in utero VPA exposure include digital hypoplasia, ectrodactyly, radial ray aplasia, and proximal phocomelia. Human studies are limited to case reports and to retrospective and/or prospective studies. Although animal studies have demonstrated a teratogenic effect of VPA on skeletogenesis, these doses were well above the human therapeutic dose which makes extrapolation from these studies to humans difficult. The purpose of this research was to evaluate the potential deleterious effects of VPA on chondrogenesis, a process that occurs in human limb formation. To accomplish this goal, human chondrocytes were cultured in a three dimensional agarose gel and treated with VPA. The use of this model system was a novel approach to evaluate the teratogenic potential of VPA during chondrogenesis. The influence of VPA on human chondrocytes was monitored using histochemical, immunocytochemical, and morphological techniques. There was a decrease in mitotic activity and the extracellular matrix was modified. At human therapeutic doses, immunofluorescence revealed that type II collagen was reduced, while type I collagen increased. In addition, the alcian blue-staining matrices (i.e., sulfated proteoglycans) were reduced. Moreover, the Golgi apparatus had swelling in the trans-face cisternae suggesting that proteoglycan synthesis may be altered.