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Püschl IC, Thaneswaran Vyramuthu M, Bonde L, Lebech M, Iraqi Møller H, Vauvert F Hviid T, Lund Sørensen B, Macklon NS. Is salivary uric acid, a putative biomarker of pre-eclampsia, of maternal, placental, or fetal origin? Eur J Obstet Gynecol Reprod Biol 2024; 295:34-41. [PMID: 38330864 DOI: 10.1016/j.ejogrb.2024.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Revised: 01/29/2024] [Accepted: 02/02/2024] [Indexed: 02/10/2024]
Abstract
OBJECTIVES Increased salivary uric acid (sUA) represents a potential biomarker predictive of pre-eclampsia (PE), but its origin is unclear. The study explores whether sUA levels reflect maternal or feto-placental physiological stress and whether sUA levels in these cases correlate with amniotic fluid (fetal origin), maternal blood (maternal origin), or cord blood (fetal vs placental origin). STUDY DESIGN Pregnant women (n = 39) undergoing amniotomy or caesarean section after 34 gestational weeks were designated into three groups of either maternal, feto-placental, or no signs of physiological stress: women (n = 15) in the established first phase of active labour and without any signs of fetal growth restriction (FGR) or PE were assigned to the maternal stress group, women (n = 6) with an ultrasound-based diagnosis of FGR, with or without PE, were assigned to the feto-placental stress group, and women (n = 18) not yet in active labour and without any signs of FGR or PE, were assigned to the control group. Uric acid levels in corresponding samples of amniotic fluid, saliva, maternal blood, and cord blood were compared between groups and between body compartments within each group. RESULTS The feto-placental stress group showed increased UA levels in saliva (median, interquartile range [IQR]: 0.47 [0.38] mmol/L, P = 0.023) and maternal blood (0.42 [0.13] mmol/L, P = 0.032), but no differences in amniotic fluid or cord blood compared with the other groups. Within the control and maternal stress group, sUA levels were lower compared with maternal blood (0.20 [0.08] vs 0.25 [0.08] mmol/L, Pcontrol = 0.018; 0.20 [0.06] vs 0.26 [0.08] mmol/L, Pmaternal = 0.001) and highest in amniotic fluid (control group (0.49 [0.18] mmol/L): Pmaternal,blood = 0.001, Pumbilical,artery = <0.001, Pumbilical,vein = <0.001, Psaliva = <0.001) (maternal stress group (0.56 [0.23] mmol/L): Pmaternal,blood = 0.021, Pumbilical,artery = 0.006, Pumbilical,vein = 0.004, Psaliva = 0.003). Levels did not differ between compartments in the feto-placental stress group. CONCLUSIONS Salivary and maternal blood UA levels were increased in the feto-placental stress group with salivary levels increasing more than blood levels compared with the maternal stress and control groups, whilst UA in amniotic fluid were not different between the groups, suggesting a placental origin and potential use of sUA as a biomarker of placental dysfunction, including FGR and severe PE.
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Affiliation(s)
- Ida Catharina Püschl
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark; Department of Obstetrics and Gynaecology and ReproHealth Research Consortium, Zealand University Hospital, Sygehusvej 10, 4000 Roskilde, Denmark.
| | - Meera Thaneswaran Vyramuthu
- Department of Obstetrics and Gynaecology and ReproHealth Research Consortium, Zealand University Hospital, Sygehusvej 10, 4000 Roskilde, Denmark
| | - Lisbeth Bonde
- Department of Obstetrics and Gynaecology, Juliane Marie Centre, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Morten Lebech
- Department of Obstetrics and Gynaecology and ReproHealth Research Consortium, Zealand University Hospital, Sygehusvej 10, 4000 Roskilde, Denmark
| | - Hiba Iraqi Møller
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark; Department of Clinical Biochemistry and ReproHealth Research Consortium, Zealand University Hospital, Sygehusvej 10, 4000 Roskilde, Denmark
| | - Thomas Vauvert F Hviid
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark; Department of Clinical Biochemistry and ReproHealth Research Consortium, Zealand University Hospital, Sygehusvej 10, 4000 Roskilde, Denmark
| | - Bjarke Lund Sørensen
- Department of Obstetrics and Gynaecology and ReproHealth Research Consortium, Zealand University Hospital, Sygehusvej 10, 4000 Roskilde, Denmark
| | - Nicholas S Macklon
- Department of Obstetrics and Gynaecology and ReproHealth Research Consortium, Zealand University Hospital, Sygehusvej 10, 4000 Roskilde, Denmark; London Women's Clinic, 113-115 Harley St, London W1G 6AP, United Kingdom
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Pang TT, Zhou ZX, Li PS, Ma HT, Shen XY, Wan YC, Guo XL, Liu ZP, Chen GD. Associations of early pregnancy serum uric acid levels with risk of gestational diabetes and birth outcomes: a retrospective cohort study. BMC Endocr Disord 2023; 23:252. [PMID: 37985985 PMCID: PMC10658968 DOI: 10.1186/s12902-023-01502-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 10/31/2023] [Indexed: 11/22/2023] Open
Abstract
BACKGROUND Previous evidence suggests that higher blood uric acid (UA) levels are associated with adverse cardiovascular outcomes during pregnancy and subsequent birth outcomes. However, it has been relatively unclear whether these associations persist in normotensive pregnant women. METHODS The study was based on a retrospective analysis of 18,250 mother-infant pairs in a large obstetric center in China. Serum UA concentrations in early pregnancy (median: 17.6, IQR: 16.3, 18.6 gestational weeks) were assessed. Hyperuricemia was defined as ≥ one standard deviation (SD) of the reference value for the corresponding gestational age. Outcomes of gestational diabetes mellitus (GDM), preterm birth (PB), low birth weight (LBW), macrosomia, small for gestational age (SGA) and large for gestational age (LGA) were extracted from the medical records. RESULTS The mean maternal UA level was 0.22 ± 0.05 mmol/L, and 2,896 (15.9%) subjects had hyperuricemia. After adjustment for several covariates, UA was associated with several adverse outcomes. The ORs (95%CI) per one SD increase in serum UA concentration were 1.250 (1.136, 1.277) for GDM, 1.137 (1.060, 1.221) for PB, 1.134 (1.051, 1.223) for LBW, and 1.077 (1.020, 1.137) for SGA, respectively. Similar adverse associations were found between hyperuricemia and GDM, PB (ORs: 1.394 and 1.385, P < 0.001), but not for LBW, macrosomia, SGA, and LGA. Adverse associations tended to be more pronounced in subjects with higher BMI for outcomes including PB, LBW, and SGA (P interaction = 0.001-0.028). CONCLUSION Higher UA levels in early pregnancy were associated with higher risk of GDM, PB, LBW, and SGA in normotensive Chinese women.
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Affiliation(s)
- Ting-Ting Pang
- Department of Medical Records, Foshan Women and Children Hospital, Foshan city, Guangdong Province, 528000, China
| | - Zi-Xing Zhou
- Department of Obstetrics, Foshan Institute of Fetal Medicine, Foshan Women and Children Hospital, Foshan city, Guangdong Province, 528000, People's Republic of China
| | - Peng-Sheng Li
- Department of Obstetrics, Foshan Institute of Fetal Medicine, Foshan Women and Children Hospital, Foshan city, Guangdong Province, 528000, People's Republic of China
| | - Hui-Ting Ma
- Department of Obstetrics, Foshan Institute of Fetal Medicine, Foshan Women and Children Hospital, Foshan city, Guangdong Province, 528000, People's Republic of China
| | - Xiu-Yin Shen
- Department of Obstetrics, Foshan Institute of Fetal Medicine, Foshan Women and Children Hospital, Foshan city, Guangdong Province, 528000, People's Republic of China
| | - Ying-Chun Wan
- Department of Obstetrics, Foshan Institute of Fetal Medicine, Foshan Women and Children Hospital, Foshan city, Guangdong Province, 528000, People's Republic of China
| | - Xiao-Ling Guo
- Department of Obstetrics, Foshan Institute of Fetal Medicine, Foshan Women and Children Hospital, Foshan city, Guangdong Province, 528000, People's Republic of China
| | - Zheng-Ping Liu
- Department of Obstetrics, Foshan Institute of Fetal Medicine, Foshan Women and Children Hospital, Foshan city, Guangdong Province, 528000, People's Republic of China.
| | - Geng-Dong Chen
- Department of Obstetrics, Foshan Institute of Fetal Medicine, Foshan Women and Children Hospital, Foshan city, Guangdong Province, 528000, People's Republic of China.
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Amniotic fluid absorption and growth functions in humans: what can we indirectly learn from congenital digestive atresias? ANNALS OF PEDIATRIC SURGERY 2022. [DOI: 10.1186/s43159-022-00195-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Amniotic fluid (AF) was thought of just as a mechanical cushioning to the foetus. Nowadays, its role during pregnancy is getting more attention, suggesting hitherto unknown aspects. The aim of the study is to speculate on AF nutritional functions and its clinical repercussions based on what digestive tract (DT) atresias seem to suggest.
Methods
A retrospective analysis of the patients admitted to our department for DT atresias between 2000 and 2020 was conducted. Patients’ birth weight (BW), gestational age (GA) at birth and diagnosis were recorded. The following were excluded from the study: oesophageal atresias (OA) with tracheoesophageal fistula (TOF), colonic and anal atresias and patients with associated major comorbidities. A control group was made of patients admitted to our ward in the same period for congenital pulmonary airway malformations (CPAM). To standardize the BW, it was coupled with birth GA calculating the newborn percentiles. The mean newborn percentiles of OAs, duodenal atresias (DAs), jejunal atresias (JAs), and ileal atresias (IAs) were independently compared with the control group using Student’s t-test. Lastly, the significance of the frequencies’ distribution of newborns born small for gestational age (SGA) between the DT atresias and the control group was evaluated with the χ2 test, and the OR were calculated. A p-value < 0.05 was considered statistically significant.
Results
A total of 231 patients were eligible for the study: 36 OAs without TOF, mean BW 2488.8 ± 491 g (range 1630–3750 g), mean GA 36.8 ± 2.1 weeks (31–40 weeks), mean newborn percentile 18 ± 22 (1–75); 20 DAs, mean BW 2586.8 ± 577.9 g (1250–3462 g), mean GA 36.2 ± 2.5 weeks (31–40 weeks), mean newborn percentile 31 ± 23 (3–79); 17 JAs, mean BW 2483.5 ± 621.7 g (900–3205 g), mean GA 34.8 ± 2.1 weeks (30–38 weeks), mean newborn percentile 44 ± 28 (4–96); 17 IAs, mean BW 2646.1 ± 769.8 g (1162.0–3888 g), mean GA 35.9 ± 3.2 weeks (30–41 weeks), mean newborn percentile 44 ± 26 (1–82); and 141 CPAMs with mean BW 3287.4 ± 492.0 g (980–4580 g), mean GA 38.7 ± 1.8 weeks (26–41 weeks), mean newborn percentile 43 ± 26 (1–99). The number of SGA neonates was 18 between OA patients (50%), 4 between DAs (20%), 1 between JAs (6%), 2 between IAs (12%) and 11 between CPAMs (8%). The mean percentile of the OAs and DAs was lower than the control group with a p of < .01 and .03 while no statistical significance was found in the comparison between DAs, JAs, IAs and CPAMs with a p of .06, .86 and .59. The incidence of SGA in the control group resulted lower than the one in the DT atresias where it becomes higher the more proximal the atresia is (p < .05). The OR of SGA newborn in the OA group was 11.8, in DA 3.0, in JA 0.7 and in IA 1.6.
Conclusion
AF showed to have a great impact on foetal growth, and its preferred site of absorption seemed to be the stomach and duodenum. Its nutritional role could have an important predictive value in diagnosing DT atresia both prenatally and postnatally.
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Heazell AE, Hayes DJ, Whitworth M, Takwoingi Y, Bayliss SE, Davenport C. Biochemical tests of placental function versus ultrasound assessment of fetal size for stillbirth and small-for-gestational-age infants. Cochrane Database Syst Rev 2019; 5:CD012245. [PMID: 31087568 PMCID: PMC6515632 DOI: 10.1002/14651858.cd012245.pub2] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Stillbirth affects 2.6 million pregnancies worldwide each year. Whilst the majority of cases occur in low- and middle-income countries, stillbirth remains an important clinical issue for high-income countries (HICs) - with both the UK and the USA reporting rates above the mean for HICs. In HICs, the most frequently reported association with stillbirth is placental dysfunction. Placental dysfunction may be evident clinically as fetal growth restriction (FGR) and small-for-dates infants. It can be caused by placental abruption or hypertensive disorders of pregnancy and many other disorders and factorsPlacental abnormalities are noted in 11% to 65% of stillbirths. Identification of FGA is difficult in utero. Small-for-gestational age (SGA), as assessed after birth, is the most commonly used surrogate measure for this outcome. The degree of SGA is associated with the likelihood of FGR; 30% of infants with a birthweight < 10th centile are thought to be FGR, while 70% of infants with a birthweight < 3rd centile are thought to be FGR. Critically, SGA is the most significant antenatal risk factor for a stillborn infant. Correct identification of SGA infants is associated with a reduction in the perinatal mortality rate. However, currently used tests, such as measurement of symphysis-fundal height, have a low reported sensitivity and specificity for the identification of SGA infants. OBJECTIVES The primary objective was to assess and compare the diagnostic accuracy of ultrasound assessment of fetal growth by estimated fetal weight (EFW) and placental biomarkers alone and in any combination used after 24 weeks of pregnancy in the identification of placental dysfunction as evidenced by either stillbirth, or birth of a SGA infant. Secondary objectives were to investigate the effect of clinical and methodological factors on test performance. SEARCH METHODS We developed full search strategies with no language or date restrictions. The following sources were searched: MEDLINE, MEDLINE In Process and Embase via Ovid, Cochrane (Wiley) CENTRAL, Science Citation Index (Web of Science), CINAHL (EBSCO) with search strategies adapted for each database as required; ISRCTN Registry, UK Clinical Trials Gateway, WHO International Clinical Trials Portal and ClinicalTrials.gov for ongoing studies; specialist abstract and conference proceeding resources (British Library's ZETOC and Web of Science Conference Proceedings Citation Index). Search last conducted in Ocober 2016. SELECTION CRITERIA We included studies of pregnant women of any age with a gestation of at least 24 weeks if relevant outcomes of pregnancy (live birth/stillbirth; SGA infant) were assessed. Studies were included irrespective of whether pregnant women were deemed to be low or high risk for complications or were of mixed populations (low and high risk). Pregnancies complicated by fetal abnormalities and multi-fetal pregnancies were excluded as they have a higher risk of stillbirth from non-placental causes. With regard to biochemical tests, we included assays performed using any technique and at any threshold used to determine test positivity. DATA COLLECTION AND ANALYSIS We extracted the numbers of true positive, false positive, false negative, and true negative test results from each study. We assessed risk of bias and applicability using the QUADAS-2 tool. Meta-analyses were performed using the hierarchical summary ROC model to estimate and compare test accuracy. MAIN RESULTS We included 91 studies that evaluated seven tests - blood tests for human placental lactogen (hPL), oestriol, placental growth factor (PlGF) and uric acid, ultrasound EFW and placental grading and urinary oestriol - in a total of 175,426 pregnant women, in which 15,471 pregnancies ended in the birth of a small baby and 740 pregnancies which ended in stillbirth. The quality of included studies was variable with most domains at low risk of bias although 59% of studies were deemed to be of unclear risk of bias for the reference standard domain. Fifty-three per cent of studies were of high concern for applicability due to inclusion of only high- or low-risk women.Using all available data for SGA (86 studies; 159,490 pregnancies involving 15,471 SGA infants), there was evidence of a difference in accuracy (P < 0.0001) between the seven tests for detecting pregnancies that are SGA at birth. Ultrasound EFW was the most accurate test for detecting SGA at birth with a diagnostic odds ratio (DOR) of 21.3 (95% CI 13.1 to 34.6); hPL was the most accurate biochemical test with a DOR of 4.78 (95% CI 3.21 to 7.13). In a hypothetical cohort of 1000 pregnant women, at the median specificity of 0.88 and median prevalence of 19%, EFW, hPL, oestriol, urinary oestriol, uric acid, PlGF and placental grading will miss 50 (95% CI 32 to 68), 116 (97 to 133), 124 (108 to 137), 127 (95 to 152), 139 (118 to 154), 144 (118 to 161), and 144 (122 to 161) SGA infants, respectively. For the detection of pregnancies ending in stillbirth (21 studies; 100,687 pregnancies involving 740 stillbirths), in an indirect comparison of the four biochemical tests, PlGF was the most accurate test with a DOR of 49.2 (95% CI 12.7 to 191). In a hypothetical cohort of 1000 pregnant women, at the median specificity of 0.78 and median prevalence of 1.7%, PlGF, hPL, urinary oestriol and uric acid will miss 2 (95% CI 0 to 4), 4 (2 to 8), 6 (6 to 7) and 8 (3 to 13) stillbirths, respectively. No studies assessed the accuracy of ultrasound EFW for detection of pregnancy ending in stillbirth. AUTHORS' CONCLUSIONS Biochemical markers of placental dysfunction used alone have insufficient accuracy to identify pregnancies ending in SGA or stillbirth. Studies combining U and placental biomarkers are needed to determine whether this approach improves diagnostic accuracy over the use of ultrasound estimation of fetal size or biochemical markers of placental dysfunction used alone. Many of the studies included in this review were carried out between 1974 and 2016. Studies of placental substances were mostly carried out before 1991 and after 2013; earlier studies may not reflect developments in test technology.
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Affiliation(s)
- Alexander Ep Heazell
- Maternal and Fetal Health Research Centre, University of Manchester, 5th floor (Research), St Mary's Hospital, Oxford Road, Manchester, UK, M13 9WL
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Kubáň P, Dvořák M, Kubáň P. Capillary electrophoresis of small ions and molecules in less conventional human body fluid samples: A review. Anal Chim Acta 2019; 1075:1-26. [PMID: 31196414 DOI: 10.1016/j.aca.2019.05.004] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 05/02/2019] [Accepted: 05/03/2019] [Indexed: 01/05/2023]
Abstract
In recent years, advances in sensitive analytical techniques have encouraged the analysis of various compounds in biological fluids. While blood serum, blood plasma and urine still remain the golden standards in clinical, toxicological and forensic science, analyses of other body fluids, such as breast milk, exhaled breath condensate, sweat, saliva, amniotic fluid, cerebrospinal fluid, or capillary blood in form of dried blood spots are becoming more popular. This review article focuses on capillary electrophoresis and microchip electrophoresis of small ions and molecules (e.g. inorganic cations/anions, basic/acidic drugs, small acids/bases, amino acids, peptides and other low molecular weight analytes) in various less conventional human body fluids and hopes to stimulate further interest in the field.
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Affiliation(s)
- Petr Kubáň
- Institute of Analytical Chemistry of the Czech Academy of Sciences, Veveří 97, CZ-60200, Brno, Czech Republic
| | - Miloš Dvořák
- Institute of Analytical Chemistry of the Czech Academy of Sciences, Veveří 97, CZ-60200, Brno, Czech Republic
| | - Pavel Kubáň
- Institute of Analytical Chemistry of the Czech Academy of Sciences, Veveří 97, CZ-60200, Brno, Czech Republic.
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Pleskacova A, Bartakova V, Chalasova K, Pacal L, Kankova K, Tomandl J. Uric Acid and Xanthine Levels in Pregnancy Complicated by Gestational Diabetes Mellitus-The Effect on Adverse Pregnancy Outcomes. Int J Mol Sci 2018; 19:ijms19113696. [PMID: 30469427 PMCID: PMC6274971 DOI: 10.3390/ijms19113696] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 11/17/2018] [Accepted: 11/19/2018] [Indexed: 11/16/2022] Open
Abstract
Uric acid (UA) levels are associated with many diseases including those related to lifestyle. The aim of this study was to evaluate the influence of clinical and anthropometric parameters on UA and xanthine (X) levels during pregnancy and postpartum in women with physiological pregnancy and pregnancy complicated by gestational diabetes mellitus (GDM), and to evaluate their impact on adverse perinatal outcomes. A total of 143 participants were included. Analyte levels were determined by HPLC with ultraviolet detection (HPLC-UV). Several single-nucleotide polymorphisms (SNPs) in UA transporters were genotyped using commercial assays. UA levels were higher within GDM women with pre-gestational obesity, those in high-risk groups, and those who required insulin during pregnancy. X levels were higher in the GDM group during pregnancy and also postpartum. Positive correlations between UA and X levels with body mass index (BMI) and glycemia levels were found. Gestational age at delivery was negatively correlated with UA and X levels postpartum. Postpartum X levels were significantly higher in women who underwent caesarean sections. Our data support a possible link between increased UA levels and a high-risk GDM subtype. UA levels were higher among women whose glucose tolerance was severely disturbed. Mid-gestational UA and X levels were not linked to adverse perinatal outcomes.
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Affiliation(s)
- Anna Pleskacova
- Department of Pathophysiology, Faculty of Medicine, Masaryk University, 625 00 Brno, Czech Republic.
- Department of Biochemistry, Faculty of Medicine, Masaryk University, 625 00 Brno, Czech Republic.
| | - Vendula Bartakova
- Department of Pathophysiology, Faculty of Medicine, Masaryk University, 625 00 Brno, Czech Republic.
| | - Katarina Chalasova
- Department of Pathophysiology, Faculty of Medicine, Masaryk University, 625 00 Brno, Czech Republic.
| | - Lukas Pacal
- Department of Pathophysiology, Faculty of Medicine, Masaryk University, 625 00 Brno, Czech Republic.
| | - Katerina Kankova
- Department of Pathophysiology, Faculty of Medicine, Masaryk University, 625 00 Brno, Czech Republic.
| | - Josef Tomandl
- Department of Pathophysiology, Faculty of Medicine, Masaryk University, 625 00 Brno, Czech Republic.
- Department of Biochemistry, Faculty of Medicine, Masaryk University, 625 00 Brno, Czech Republic.
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Brien ME, Duval C, Palacios J, Boufaied I, Hudon-Thibeault AA, Nadeau-Vallée M, Vaillancourt C, Sibley CP, Abrahams VM, Jones RL, Girard S. Uric Acid Crystals Induce Placental Inflammation and Alter Trophoblast Function via an IL-1-Dependent Pathway: Implications for Fetal Growth Restriction. THE JOURNAL OF IMMUNOLOGY 2016; 198:443-451. [PMID: 27903743 DOI: 10.4049/jimmunol.1601179] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 10/24/2016] [Indexed: 12/21/2022]
Abstract
Excessive placental inflammation is associated with several pathological conditions, including stillbirth and fetal growth restriction. Although infection is a known cause of inflammation, a significant proportion of pregnancies have evidence of inflammation without any detectable infection. Inflammation can also be triggered by endogenous mediators, called damage associated molecular patterns or alarmins. One of these damage-associated molecular patterns, uric acid, is increased in the maternal circulation in pathological pregnancies and is a known agonist of the Nlrp3 inflammasome and inducer of inflammation. However, its effects within the placenta and on pregnancy outcomes remain largely unknown. We found that uric acid (monosodium urate [MSU]) crystals induce a proinflammatory profile in isolated human term cytotrophoblast cells, with a predominant secretion of IL-1β and IL-6, a result confirmed in human term placental explants. The proinflammatory effects of MSU crystals were shown to be IL-1-dependent using a caspase-1 inhibitor (inhibits IL-1 maturation) and IL-1Ra (inhibits IL-1 signaling). The proinflammatory effect of MSU crystals was accompanied by trophoblast apoptosis and decreased syncytialization. Correspondingly, administration of MSU crystals to rats during late gestation induced placental inflammation and was associated with fetal growth restriction. These results make a strong case for an active proinflammatory role of MSU crystals at the maternal-fetal interface in pathological pregnancies, and highlight a key mediating role of IL-1. Furthermore, our study describes a novel in vivo animal model of noninfectious inflammation during pregnancy, which is triggered by MSU crystals and leads to reduced fetal growth.
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Affiliation(s)
- Marie-Eve Brien
- Ste-Justine Hospital Research Centre, Feto-Maternal and Neonatal Pathologies Research Axis, University of Montreal, Montreal, Quebec H3T 1C5, Canada.,Department of Obstetrics and Gynecology, University of Montreal, Montreal, Quebec H3T 1C5, Canada.,Department of Microbiology, Virology and Immunology, University of Montreal, Montreal, Quebec H3T 1C5, Canada
| | - Cyntia Duval
- Ste-Justine Hospital Research Centre, Feto-Maternal and Neonatal Pathologies Research Axis, University of Montreal, Montreal, Quebec H3T 1C5, Canada.,Department of Obstetrics and Gynecology, University of Montreal, Montreal, Quebec H3T 1C5, Canada
| | - Julia Palacios
- Ste-Justine Hospital Research Centre, Feto-Maternal and Neonatal Pathologies Research Axis, University of Montreal, Montreal, Quebec H3T 1C5, Canada.,Department of Obstetrics and Gynecology, University of Montreal, Montreal, Quebec H3T 1C5, Canada
| | - Ines Boufaied
- Ste-Justine Hospital Research Centre, Feto-Maternal and Neonatal Pathologies Research Axis, University of Montreal, Montreal, Quebec H3T 1C5, Canada.,Department of Obstetrics and Gynecology, University of Montreal, Montreal, Quebec H3T 1C5, Canada
| | | | - Mathieu Nadeau-Vallée
- Ste-Justine Hospital Research Centre, Feto-Maternal and Neonatal Pathologies Research Axis, University of Montreal, Montreal, Quebec H3T 1C5, Canada.,Department of Pharmacology, University de Montreal, Montreal H3T 1C5, Canada
| | - Cathy Vaillancourt
- Institut de la Recherche Scientifique, Centre Institut Armand-Frappier, Laval, Quebec H7V 1B7, Canada
| | - Colin P Sibley
- Maternal and Fetal Health Research Centre, University of Manchester, Manchester, M13 9WL, United Kingdom.,St. Mary's Hospital, Central Manchester University Hospital National Health Service Foundation Trust, Manchester Academic Health Science Centre, Manchester, M13 9WL, United Kingdom; and
| | - Vikki M Abrahams
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, CT 06510
| | - Rebecca L Jones
- Maternal and Fetal Health Research Centre, University of Manchester, Manchester, M13 9WL, United Kingdom.,St. Mary's Hospital, Central Manchester University Hospital National Health Service Foundation Trust, Manchester Academic Health Science Centre, Manchester, M13 9WL, United Kingdom; and
| | - Sylvie Girard
- Ste-Justine Hospital Research Centre, Feto-Maternal and Neonatal Pathologies Research Axis, University of Montreal, Montreal, Quebec H3T 1C5, Canada; .,Department of Obstetrics and Gynecology, University of Montreal, Montreal, Quebec H3T 1C5, Canada.,Department of Microbiology, Virology and Immunology, University of Montreal, Montreal, Quebec H3T 1C5, Canada.,Department of Pharmacology, University de Montreal, Montreal H3T 1C5, Canada
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Literature-Informed Analysis of a Genome-Wide Association Study of Gestational Age in Norwegian Women and Children Suggests Involvement of Inflammatory Pathways. PLoS One 2016; 11:e0160335. [PMID: 27490719 PMCID: PMC4973994 DOI: 10.1371/journal.pone.0160335] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 07/18/2016] [Indexed: 12/16/2022] Open
Abstract
Background Five-to-eighteen percent of pregnancies worldwide end in preterm birth, which is the major cause of neonatal death and morbidity. Approximately 30% of the variation in gestational age at birth can be attributed to genetic factors. Genome-wide association studies (GWAS) have not shown robust evidence of association with genomic loci yet. Methods We separately investigated 1921 Norwegian mothers and 1199 children from pregnancies with spontaneous onset of delivery. Individuals were further divided based on the onset of delivery: initiated by labor or prelabor rupture of membranes. Genetic association with ultrasound-dated gestational age was evaluated using three genetic models and adaptive permutations. The top-ranked loci were tested for enrichment in 12 candidate gene-sets generated by text-mining PubMed abstracts containing pregnancy-related keywords. Results The six GWAS did not reveal significant associations, with the most extreme empirical p = 5.1 × 10−7. The top loci from maternal GWAS with deliveries initiated by labor showed significant enrichment in 10 PubMed gene-sets, e.g., p = 0.001 and 0.005 for keywords "uterus" and "preterm" respectively. Enrichment signals were mainly caused by infection/inflammation-related genes TLR4, NFKB1, ABCA1, MMP9. Literature-informed analysis of top loci revealed further immunity genes: IL1A, IL1B, CAMP, TREM1, TFRC, NFKBIA, MEFV, IRF8, WNT5A. Conclusion Our analyses support the role of inflammatory pathways in determining pregnancy duration and provide a list of 32 candidate genes for a follow-up work. We observed that the top regions from GWAS in mothers with labor-initiated deliveries significantly more often overlap with pregnancy-related genes than would be expected by chance, suggesting that increased sample size would benefit similar studies.
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Skinner CD. Fiber optic illumination of a poly(dimethylsiloxane) sheath flow cuvette for diode laser induced fluorescence detection in capillary electrophoresis. Electrophoresis 2015; 36:502-8. [DOI: 10.1002/elps.201400437] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Revised: 10/15/2014] [Accepted: 10/16/2014] [Indexed: 11/06/2022]
Affiliation(s)
- Cameron D. Skinner
- Department of Chemistry and Biochemistry; Concordia University; Montréal QC Canada
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10
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Second trimester amniotic fluid retinol in patients developing preeclampsia. Arch Gynecol Obstet 2014; 291:831-6. [DOI: 10.1007/s00404-014-3477-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2014] [Accepted: 09/12/2014] [Indexed: 10/24/2022]
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11
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Fotiou M, Michaelidou AM, Athanasiadis AP, Menexes G, Symeonidou M, Koulourida V, Ganidou M, Theodoridis TD, Tarlatzis BC. Second trimester amniotic fluid glucose, uric acid, phosphate, potassium, and sodium concentrations in relation to maternal pre-pregnancy BMI and birth weight centiles. J Matern Fetal Neonatal Med 2014; 28:910-5. [PMID: 25046579 DOI: 10.3109/14767058.2014.937692] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To study the evolution profile of amniotic fluid (AF) glucose, uric acid, phosphate, potassium, and sodium, in the second trimester of pregnancy, and explore the possible relations between the concentration of these components and maternal, as well as neonatal characteristics. METHODS AF of 52 pregnant women was analyzed using an automatic multichannel analyzer. Maternal age, pre-pregnancy Body Mass Index (BMI), inter-pregnancy intervals, and smoking status were derived from questionnaires. Information on pregnancy and delivery was collected from medical records. RESULTS Uric acid increased (r = 0.423, p < 0.01), while phosphate and glucose concentrations decreased during the period of 16-26th week of pregnancy (r = -0.590, p < 0.001 and r = -0.314, p < 0.05, respectively). Maternal pre-pregnancy BMI was significantly correlated with AF uric acid concentration (r = 0.460, p < 0.01) and marginally with AF glucose (r = 0.274, p = 0.052) and sodium (r = 0.254, p = 0.070) levels. Multiple linear regression indicated that mid-trimester AF uric acid and phosphate levels were significantly related to birth weight centiles (R(2)( )= 0.345, p < 0.05). CONCLUSIONS Our results suggest that: (a) AF phosphate levels reflect gestational age to a satisfactory extent, (b) maternal pre-pregnancy BMI is significantly correlated with AF uric acid concentration, and (c) in appropriate for gestational age infants, AF phosphate and uric acid levels may serve as potential biomarkers of birth weight centiles. Further studies on AF composition may help to unravel the biochemical pathways underlying fetal development and could offer insight on the potential impact of maternal nutritional management on fetal growth regulation.
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Affiliation(s)
- Maria Fotiou
- Department of Food Science and Technology, School of Agriculture, Faculty of Agriculture, Forestry and Natural Environment, Aristotle University of Thessaloniki , Thessaloniki , Greece
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Feig DI, Madero M, Jalal DI, Gabriela Sanchez-Lozada L, Johnson RJ. Uric acid and the origins of hypertension. J Pediatr 2013; 162:896-902. [PMID: 23403249 PMCID: PMC7556347 DOI: 10.1016/j.jpeds.2012.12.078] [Citation(s) in RCA: 80] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2012] [Revised: 11/19/2012] [Accepted: 12/21/2012] [Indexed: 12/29/2022]
Affiliation(s)
- Daniel I. Feig
- Division of Pediatric Nephrology, University of Alabama, Birmingham
| | - Magdalena Madero
- Division of Nephrology, National Heart Institute, INC Ignacio Chavez, Mexico City Mexico City
| | - Diana I. Jalal
- Division of Renal Diseases and Hypertension, University of Colorado, Aurora
| | | | - Richard J Johnson
- Division of Renal Diseases and Hypertension, University of Colorado, Aurora
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Boisvert MR, Koski KG, Burns DH, Skinner CD. Early prediction of macrosomia based on an analysis of second trimester amniotic fluid by capillary electrophoresis. Biomark Med 2013; 6:655-62. [PMID: 23075245 DOI: 10.2217/bmm.12.54] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
AIM To identify, using capillary electrophoresis and chemometrics, early biomarkers in human amniotic fluid of large-for-gestational-age (LGA) infants. MATERIALS & METHODS Second trimester amniotic fluid samples, obtained from mothers undergoing age-related amniocentesis, were analyzed by capillary electrophoresis. Electropherogram data were aligned using correlation-optimized warping. A genetic algorithm using a Bayesian evaluation function and a leave-one-out cross-validation strategy for two birth outcomes: appropriate-for-gestational-age (AGA) versus LGA infants. RESULTS LGA (n = 23) was differentiated from AGA (n = 86) with a sensitivity of 100% and a specificity of 98% using only two wavelets. The first wavelet is associated with albumin and the second wavelet with an unknown small molecule. CONCLUSION The approach developed herein allows LGA fetuses to be metabolically distinguished from AGA fetuses early in pregnancy and indicates that the birth of a LGA infant is already associated with an altered biochemical profile by the second trimester.
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Affiliation(s)
- Michel R Boisvert
- Department of Chemistry & Biochemistry, Concordia University, Montreal, QC, H4B 1R6, Canada
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Mid-infrared (MIR) metabolic fingerprinting of amniotic fluid: A possible avenue for early diagnosis of prenatal disorders? Anal Chim Acta 2013; 764:24-31. [DOI: 10.1016/j.aca.2012.12.023] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2012] [Revised: 12/12/2012] [Accepted: 12/14/2012] [Indexed: 11/19/2022]
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15
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Elverson CA, Wilson ME, Hertzog MA, French JA. Social regulation of the stress response in the transitional newborn: a pilot study. J Pediatr Nurs 2012; 27:214-24. [PMID: 22525809 DOI: 10.1016/j.pedn.2011.01.029] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2009] [Revised: 01/15/2011] [Accepted: 01/16/2011] [Indexed: 12/28/2022]
Abstract
The purpose of the study was to explore relationships between caregiver holding and feeding behaviors and the transitional newborn infant's cortisol response. Behaviors of 46 mothers, fathers, and their term transitional newborn infants were measured with the Index of Mother-Infant Separation (IMIS). Repeated measures of infant salivary cortisol were used to calculate area under the curve. A higher percentage of observations in which mother was holding infant was related to lower infant total cortisol during the first 6 hours after birth (r = -.24, p = .05, one-tailed).
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Abstract
ATP-binding cassette (ABC) transporters form a large family of transmembrane proteins that facilitate the transport of specific substrates across membranes in an ATP-dependent manner. Transported substrates include lipids, lipopolysaccharides, amino acids, peptides, proteins, inorganic ions, sugars and xenobiotics. Despite this broad array of substrates, the physiological substrate of many ABC transporters has remained elusive. ABC transporters are divided into seven subfamilies, A-G, based on sequence similarity and domain organization. Here we review the role of members of the ABCG subfamily in human disease and how the identification of disease genes helped to determine physiological substrates for specific ABC transporters. We focus on the recent discovery of mutations in ABCG2 causing hyperuricemia and gout, which has led to the identification of urate as a physiological substrate for ABCG2.
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Affiliation(s)
- Owen M Woodward
- Department of Physiology, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
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Amorini AM, Giorlandino C, Longo S, D’Urso S, Mesoraca A, Santoro ML, Picardi M, Gullotta S, Cignini P, Lazzarino D, Lazzarino G, Tavazzi B. Metabolic profile of amniotic fluid as a biochemical tool to screen for inborn errors of metabolism and fetal anomalies. Mol Cell Biochem 2011; 359:205-16. [DOI: 10.1007/s11010-011-1015-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2011] [Accepted: 07/27/2011] [Indexed: 01/28/2023]
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18
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Athanasiadis AP, Michaelidou AM, Fotiou M, Menexes G, Theodoridis TD, Ganidou M, Tzevelekis B, Assimakopoulos E, Tarlatzis BC. Correlation of 2nd trimester amniotic fluid amino acid profile with gestational age and estimated fetal weight. J Matern Fetal Neonatal Med 2011; 24:1033-8. [PMID: 21271782 DOI: 10.3109/14767058.2010.545909] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES Our aim was to identify and quantitate free amino acids in human amniotic fluid (AF) specimens collected during 2nd trimester amniocentesis and determine the correlation between amino acid concentrations, gestational age, and estimated fetal weight. METHODS Seventy-eight AF samples were retrieved between 18 and 22 weeks of gestation. Fetal weight estimation was based on fetal biometric measurements. RESULTS Twenty-one amino acids were quantified. The concentration of glutamine exhibited the greatest correlation with gestational age (r = 0.477, p < 0.01). Additionally, significant negative correlations were recorded between gestational age and levels of alanine, proline, lysine, valine, taurine, leucine, glutamic acid, tyrosine, phenylalanine, isoleucine, ornithine, methionine, and tryptophane (p < 0.05). After adjusting for maternal age, fetal gender, intervals between consecutive pregnancies, pre-pregnancy body mass index, and smoking during pregnancy the strength of the correlation for proline and lysine decreased. A stepwise multiple linear regression model including gestational age as a first level predictor of fetal weight indicated that lysine and cysteine concentrations were additional predictors. CONCLUSIONS Our results suggest that AF amino acids are crucial for fetal growth. Our purpose was not to establish an immediate diagnostic application. However, further exploration is likely to be fruitful, especially in high-risk pregnancies.
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Affiliation(s)
- Apostolos P Athanasiadis
- 1st Department of Obstetrics & Gynecology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece.
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Gao T, Zablith N, Burns DH, Koski KG, Skinner CD. Identification and quantitation of human amniotic fluid components using capillary zone electrophoresis. Anal Biochem 2009; 388:155-7. [DOI: 10.1016/j.ab.2009.02.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2008] [Revised: 02/09/2009] [Accepted: 02/09/2009] [Indexed: 10/21/2022]
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