Metabolomics and first-trimester prediction of early-onset preeclampsia

OBJECTIVE

To evaluate the use of metabolomics for the first-trimester detection of maternal metabolic dysfunction and prediction of subsequent development of early-onset preeclampsia (PE).

STUDY DESIGN

This was a case-control study of maternal plasma samples collected at 11-13 weeks' gestation from 30 women who had subsequently developed PE requiring delivery before 34 weeks and 60 unaffected controls. Nuclear magnetic Resonance (NMR) spectroscopy was used to identify and quantify metabolomic changes in cases versus controls. Both genetic computing and standard statistical analyses were performed to predict the development of PE from the metabolite concentrations alone as well as the combination of metabolite concentrations with maternal characteristics and first-trimester uterine artery Doppler pulsatility index (PI).

RESULTS

Significant differences between cases and controls were found for 20 metabolites. A combination of four of these metabolites (citrate, glycerol, hydroxyisovalerate, and methionine) appeared highly predictive of PE with an estimated detection rate of 75.9%, at a false-positive rate (FPR) of 4.9%. The predictive performance was improved by the addition of uterine artery Doppler PI and fetal crown-rump length (CRL) and with an estimated detection rate of 82.6%, at a FPR of 1.6%.

CONCLUSION

A profound change in the first-trimester metabolite profile was noted in women who had subsequently developed early-onset PE. Preliminary algorithms appeared highly sensitive for first trimester prediction of early onset PE.

Amniotic fluid inflammation with negative culture and outcome after cervical cerclage

OBJECTIVE

To determine whether amniotic fluid (AF) inflammation, in the absence of infection, is associated with adverse pregnancy outcomes in nonelective cervical cerclage patients.

METHODS

A retrospective case-control study was carried out. The patient population included 82 singleton pregnancies with negative AF cultures. The variables used to define AF inflammation were white blood cell count (WBC) >50 cell/mm(3), glucose <14 mg/dl or interleukin-6 (IL-6) >11.3 ng/ml. The study group consisted of cases with intra-amniotic inflammation. Sub-analysis was performed for the groups in which IL-6 concentrations were measured. Adverse outcomes were evaluated with variables such as gestational age at delivery, interval from cerclage to delivery, chorioamnionitis and cumulative neonatal morbidity.

RESULTS

Elevated AF WBC was correlated with severe and extreme preterm delivery (p < 0.05). Decreased AF glucose was associated with histological chorioamnionitis and a decreased cerclage to delivery interval (p < 0.05). Elevated AF IL-6 correlated significantly with decreased gestational age at delivery (p < 0.012) and decreased cerclage to delivery interval (p < 0.001). Elevated IL-6 concentrations were associated with severe, extreme preterm delivery (p < 0.001) and neonatal death (p < 0.001).

CONCLUSION

Elevated AF IL-6, elevated WBC and low AF glucose, in the absence of a positive AF culture, are significantly associated with adverse pregnancy outcomes in patients undergoing nonelective cerclage.

High throughput, cell type-specific analysis of key proteins in human endometrial biopsies of women from fertile and infertile couples

BACKGROUND

Although histological dating of endometrial biopsies provides little help for prediction or diagnosis of infertility, analysis of individual endometrial proteins, proteomic profiling and transcriptome analysis have suggested several biomarkers with altered expression arising from intrinsic abnormalities, inadequate stimulation by or in response to gonadal steroids or altered function due to systemic disorders. The objective of this study was to delineate the developmental dynamics of potentially important proteins in the secretory phase of the menstrual cycle, utilizing a collection of endometrial biopsies from women of fertile (n = 89) and infertile (n = 89) couples.

METHODS AND RESULTS

Progesterone receptor-B (PGR-B), leukemia inhibitory factor, glycodelin/progestagen-associated endometrial protein (PAEP), homeobox A10, heparin-binding EGF-like growth factor, calcitonin and chemokine ligand 14 (CXCL14) were measured using a high-throughput, quantitative immunohistochemical method. Significant cyclic and tissue-specific regulation was documented for each protein, as well as their dysregulation in women of infertile couples. Infertile patients demonstrated a delay early in the secretory phase in the decline of PGR-B (P < 0.05) and premature mid-secretory increases in PAEP (P < 0.05) and CXCL14 (P < 0.05), suggesting that the implantation interval could be closing early. Correlation analysis identified potential interactions among certain proteins that were disrupted by infertility.

CONCLUSIONS

This approach overcomes the limitations of a small sample number. Protein expression and localization provided important insights into the potential roles of these proteins in normal and pathological development of the endometrium that is not attainable from transcriptome analysis, establishing a basis for biomarker, diagnostic and targeted drug development for women with infertility.

Is maternal diabetes a risk factor for childhood obesity?

OBJECTIVE

Our objective is to determine if there is a relationship between diabetes during pregnancy and childhood obesity, in our inner-city, African-American population.

METHODS

Pertinent child, neonatal and maternal pregnancy and delivery data were collected from mothers of children age 2-5 years old. Outcome variable definition was based on children's body mass index (BMI) subgroups; independent variable definition on birthweight subgroups based on customized growth percentiles. Covariates included pre and postnatal factors. Those covariates marginally related to diabetes (p < 0.2) by bivariate analyses, were allowed to compete in logistic regression, with p < 0.05 significant.

RESULTS

Four hundred and ninety-three patients were enrolled, of which 35 (7.1%) had diabetes during pregnancy. Children of diabetic mothers were more likely to be obese at age 2-5 years than those of non-diabetics (p = 0.004). Five of 20 covariates had p < 0.2 in bivariate setting. Following stepwise logistic regression, diabetes and maternal prepregnancy BMI were significant determinants of childhood obesity. When large-for-gestational age (LGA) was added into the model, diabetes was no longer significant (p = 0.105); only LGA (p = 0.008) and maternal prepregnancy BMI (p = 0.032) were significantly associated with childhood obesity.

CONCLUSIONS

In our inner-city, primarily African-American population, diabetes in pregnancy is significantly related to childhood obesity at age 2-5 years. Well-controlled diabetes during pregnancy that avoids macrosomia may lead to prevention of future childhood obesity as well.

Male gender significantly increases risk of oxidative stress related congenital anomalies in the non-diabetic population

OBJECTIVE

Oxidative stress (OS) is an important mechanism of teratogenesis. Recent work suggests increased OS in males. We evaluated whether male gender increased the risk of cyanotic congenital heart defects (CCHD) whose development is linked to OS and other common congenital anomalies (CA) in non-diabetic pregnancies.

METHODS

CDC-National Center for Health Statistics data for 19 states in 2006 were reviewed. CCHD, anencephaly, spina bifida, congenial diaphragmatic hernia (CDH), omphalocele, gastroschisis, limb defects, cleft lip with or without cleft palate (CL/P) and isolated cleft palate were evaluated. Adjusted odds ratio (OR) (95% CI) were calculated for CA in males with females as the reference group.

RESULTS

Of 1,194, 581, cases analyzed after exclusions, 3037 (0.25%) had major CA. Males had elevated adjusted OR (95% CI) for CCHD: 1.198 (1.027, 1.397), CDH: 1.487 (1.078, 2.051), and CL/P: 1.431 (1.24, 1.651). There was a significant interaction between cigarette use and (male) fetal gender and also with maternal age in the CL/P group.

CONCLUSIONS

In non-diabetic pregnancies, male gender appears to be an independent risk factor for some types of CA believed to be associated with OS. Cigarette smoking, a well recognized source of OS only increased the risk of CL/P in males.

Being too large for gestational age precedes childhood obesity in African Americans

OBJECTIVE

The purpose of this study was to investigate the association between large-for-gestational-age (LGA) infants and the development of childhood obesity in an inner-city primarily African American population.

STUDY DESIGN

Maternal, neonatal, socioeconomic, and nutritional histories were collected for mothers with children who were 2-5 years old. Associations between Alexander and customized birthweight percentiles and body mass index for the age of the child were examined.

RESULTS

One hundred ninety-five mother-child pairs were enrolled; the childhood obesity rate was 18%. Increasing Alexander and customized birthweight percentiles were related to increasing obesity. LGA newborn infants were 2.5 times more likely to be obese in childhood than average size newborn infants. Maternal smoking was also associated with childhood obesity.

CONCLUSION

LGA infants have the highest likelihood of childhood obesity in this inner-city predominantly African American population. Customized growth percentiles perform best in the identification of the highest risk population.

Complications, disease profile and histological yield from percutaneous renal biopsy under real-time US guidance: A retrospective analysis

Objective. The objective of the study was to evaluate (i) the technique used at Universitas Hospital in comparison with other international centres also performing renal biopsies, (ii) the disease profile in patients undergoing renal biopsies, (iii) the complications experienced during and/or after the procedure, and (iv) the histological yield of the biopsies (amount of nephrons per biopsy taken) using this technique. Design. A retrospective descriptive analysis of all patients who underwent percutaneous renal biopsy under ultrasound (US) guidance at the Interventional Radiology Unit, Universitas Hospital, Bloemfontein, was undertaken for the period 1 January 2003 - 31 December 2008. Data obtained from the patients’ files and histology reports were statistically analysed. Results. A total of 112 patients qualified for inclusion in the study, all of whom had proof of renal failure and then had percutaneous renal biopsy performed under US guidance. The histology was diagnostic in 111 (99.1%) of the cases, with more than 5 nephrons present in 105 (93.5%) of the cases. Minor complications were found in 29 (25.8%) of the patients, but no major complications were noted. Primary renal disease was found in 67 (59.8%) of patients, and the renal pathology and failure in 45 (40.2%) of the patients were shown histologically to be owing to systemic disease. Conclusion. The technique utilised for performing percutaneous renal biopsy under US guidance at the Interventional Radiology Unit was shown to be safe, with a diagnostic histological yield comparable with international standards. A small majority or patients suffered primary renal disease in comparison with renal failure owing to systemic illness.

158 DEVELOPMENT OF FIELD ASSAY FOR EVALUATION OF WHITE RHINOCEROS NEUTROPHIL FUNCTION AS A STRESS MARKER

Kruger National Park (KNP) is the primary source of translocated white rhinoceroses (Ceratotherium simum) in South Africa. Capture and transport of the rhinoceroses is a highly successful procedure. However, some relocated rhinoceroses present with fertility problems in the 1–2 years post capture. Novel research has shown that one can assess stress using respiratory neutrophil burst levels in several species (Huber et al. 2006 Protoplasma 229, 221–224; Weyts et al. 1998 Dev. Comp. Immunol. 22, 563–572). The hypothesis is that some rhinoceroses respond poorly to stress. The response to stress might be measurable by a neutrophil function (NF) assay, and NF depression might identify adversely stressed animals. The aim was to develop an in-the-bush test for NF and evaluate the changes in neutrophil activity during capture and loading into transportation crates. Neutrophil function was assayed using a portable luminometer (3M Clean-Trace™, 3M, St. Paul, MN, USA) while driving from one capture to the next. For the reaction mixture, 500 μL of PBS was incubated with 10 μL of fresh heparinized blood at 37.6°C. The incubator unit was power by a 230 V convertor in the vehicle. After 5 min of incubation, 100 μL of luminol was added. This sample was read in the luminometer as a blank and then to the sample, 100 μL of 12-O-tetradecanoylphorbol-13-acetate (TPA), also commonly known as phorbol 12-myristate 13-acetate (PMA), a diester of phorbol, was added. The luminescence readings or relative light units (RLU) were read at 2.5 min and then 5 min after PMA addition. All samples were prepared in triplicate. The readings were then taken every 5 min for 65 min. Two samples of blood were evaluated for each rhinoceros: the first sample at capture (anaesthetic induction) and then a second sample after loading of the rhinoceros into the transport crate, 20 to 30 min later. Two response curves were produced for each rhinoceros using the means of the triplicate readings. The curves were then transformed with a trend line and the area under the curve (AUC) was calculated. The 2 AUC for rhinoceros were then compared statistically using Wilcoxon rank regression, with P < 0.05 considered statistically different. Three distinct response curve patters were seen. Sixty-two percent (16/26) of the rhinoceroses had no statistical (P < 0.05) difference between capture and loading samples. In 5 of 26 (19%), the loading AUC was statistically greater than the capture sample, and in 5 of 26 (19%), the capture AUC was statistically greater than the loading sample. In conclusion, NF can be assayed in the field using the blood of wild caught rhinoceroses. The assay is repeatable and can distinguish 3 populations of wild caught rhinoceroses. The hope is that future research will allow us to identify rhinoceroses that have negative stress reactions and to change the capture conditions to make the process less stressful.

Delivery route preferences of urban women of low socioeconomic status

OBJECTIVE

To identify the main determinants of mode of delivery preference among urban dwelling women of lower socioeconomic status (SES).

METHODS

Over a 12-month period, a self-completion 36-item questionnaire was administered to a convenience sample of 308 women within the first 3 postpartum days. Non-parametric tests were used for analysis.

RESULTS

Study participants were mostly African American (>85%), single mothers (>75%), and unemployed (≥55%). Among the women, 85.7% had vaginal delivery (VD) and 14.3% had cesarean delivery (CD). Women who preferred CD (10%) were more likely to be concerned about a vaginal tear/episiotomy during VD, forceps, and a "big" baby compared with women who preferred VD, for whom "pushing the baby out myself" and "fear of cesarean" were the most important factors. In the final model of 7 factors, the 3 main factors found to positively impact maternal preference for CD were a vaginal cut during VD (P<0.001), higher mean BMI (P=0.001), and cesarean as the most recent delivery type (P<0.001). The total explained variance by this model was 46%.

CONCLUSIONS

Short-term complications of a VD, higher BMI, and a previous cesarean delivery are the most significant factors that impact the preferences of women of lower SES for future mode of delivery.

Evidence of fetal central nervous system injury in isolated congenital heart defects: microcephaly at birth

OBJECTIVE

We sought to ascertain the risk of reduced fetal brain growth in cases of isolated congenital heart defect (CHD) based on microcephaly at birth.

STUDY DESIGN

In a case-control study, head circumference was compared in 401 newborns with isolated CHD with 401 control subjects. Microcephaly was defined as head circumference below third percentile. The rates of microcephaly in multiple different categories of major CHD were ascertained along with logistic regression analyses to determine the specific types of cardiac defects that were significantly associated with microcephaly.

RESULTS

Isolated CHD in the fetus was associated with an increased risk of microcephaly as were tetralogy of Fallot, coarctation/aortic arch hypoplasia, and hypoplastic left ventricle syndrome. Tetralogy of Fallot odds ratio, 2.6; 95% confidence interval, 1.1-6.3; P < .04 and coarctation/aortic arch hypoplasia, odds ratio, 2.8; 95% confidence interval, 1.5-5.1; P < .001 were significant independent predictors of microcephaly.

CONCLUSION

The finding of microcephaly at birth in nonsyndromic CHD provides strong evidence in support of intrauterine hypoxic central nervous system damage. Potential changes in prenatal management including aggressive antepartum surveillance and earlier delivery warrant urgent consideration.

Enhancer of zeste homologue 2 ( EZH-2) expression in breast cancer: a novel marker and potential target

e22154

Background: EZH-2 is a protein involved in cell cycle regulation; it belongs to the Polycomb group of proteins and has been suggested to be associated with aggressive breast cancer. In hormone receptor negative (HR-) breast carcinomas, novel therapeutic targets are needed. Few markers have achieved the success of Her-2/neu as targeted therapy making the search for novel treatment strategies imperative. In our study we investigate the expression of EZH2 in a cohort of hormone receptor negative breast carcinomas. Methods: We identified a consecutive cohort of 84 cases of HR- breast carcinoma in 2005–2006, from the Pathology department archives. Tumor grade, size, presence or absence of DCIS, lymph node status and Her2/neu expression were documented. The race of the patients was also noted. Immunohistochemical staining for EZH2 was performed on paraffin embedded sections. Nuclear expression of EZH2 was considered as positive and the percentage of cells staining positive was estimated. Using the Mann-Whitney U test, the expression of EZH2 was correlated with the tumor characteristics listed above. Results: The mean expression of EZH2 in HR- tumors was estimated at 74% with a median of 80% (0–90). Most of these cases (n= 61) were triple negative; 23 cases were HER-2/neu positive by established criteria. Increasing expression of EZH2 was correlated with increase in tumor size (>2 cm) and increased incidence of lymph node metastasis. No correlation was seen with tumor grade, the presence or absence of DCIS and Her2/neu expression. Race did not appear to have an impact on EZH2 expression. Conclusions: Our findings suggest that EZH2 is expressed in the majority of HR - breast cancer and is associated with aggressive breast carcinomas. EZH2 could be an important therapeutic target in this patient population. The study is ongoing to further characterize EZH2‘s role and its association with survival.

No significant financial relationships to disclose.

Cyclooxygenase inhibitors and the exercise-induced stress response

Objective. This study investigated the effects of single dosages of the non-steroidal anti-inflammatory drug (NSAID) naproxen, and of the coxib, rofecoxib, on the exercise-induced stress response. Design. Eight subjects (age 20.9 ± 1.1 years, weight 70.4 ± 3.9 kg, height 170.9 ± 6.7 cm, body surface area 1.82 ± 0.09 m2, body mass index 24.1 ± 1.3 kg.m-2) took part in a double-blind, drug-placebo, cross-over design study. The experimental procedures were performed on 3 occasions on each volunteer, i.e. once on placebo, once on naproxen (single dose of 1 000 mg) and once on rofecoxib (single dose of 50 mg). Results. Mean post-exercise cortisol values were significantly higher than pre-exercise values with the subjects on placebo (p = 0.0365) and rofecoxib (p = 0.0208), but not on naproxen (p = 0.0732). Post-exercise oral temperatures were significantly higher than pre-exercise temperature values on placebo (p = 0.0153) and rofecoxib (p = 0.0424), but not on naproxen (p = 0.5444). Conclusion. The results of this study suggest a role for cyclooxygenase-1 (COX-1) in the exercise-induced cortisol and temperature response to exercise. South African Journal of Sports Medicine Vol. 18 (1) 2006: pp. 4-8