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Franklin AD, Freedman A, Wylie K, Mangold KA, Wang V, Price E, Ernst LM. Molecular detection of bacteria, placental inflammation, and neonatal sepsis risk. J Perinatol 2024; 44:46-54. [PMID: 37700009 DOI: 10.1038/s41372-023-01775-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 08/21/2023] [Accepted: 09/01/2023] [Indexed: 09/14/2023]
Abstract
OBJECTIVE To identify bacteria in umbilical cord tissue and investigate the association with placental inflammation and neonatal sepsis risk score. STUDY DESIGN Retrospective cohort study from 2017-2019. RNA was extracted from umbilical cord tissue and NanoString nCounter used to identify seven bacteria genera. Sepsis risk score was calculated using the Kaiser sepsis calculator. Placental histopathology was abstracted from medical records. RESULTS Detection of bacterial RNA in the umbilical cord (n = 96/287) was associated with high-stage maternal and fetal acute placental inflammation (maternal 35.4% vs 22.5%, p = 0.03 and fetal 34.4% vs 19.4%, p < 0.01) and maternal vascular malperfusion (36.5% vs 23.0%, p = 0.02). Detection of Ureaplasma spp. was also associated with increased sepsis risk score (1.5/1000 [0.6, 8.6] vs 0.9/1000 [0.2, 2.9], p = 0.04). CONCLUSION Umbilical cord bacterial pathogens are linked to fetal and maternal placental inflammation and maternal vascular malperfusion during gestation and associated with increased sepsis risk score in the neonate.
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Affiliation(s)
- Andrew D Franklin
- Department of Pediatrics, Division of Neonatology, NorthShore University HealthSystem, Evanston, IL, USA
- Department of Pediatrics, University of Chicago Pritzker School of Medicine, Chicago, IL, USA
| | - Alexa Freedman
- Department of Obstetrics and Gynecology, NorthShore University HealthSystem, Evanston, IL, USA
| | - Kristine Wylie
- Department of Pediatrics, Department of Obstetrics and Gynecology, and Department of Molecular Microbiology, Washington University, St. Louis, MO, USA
| | - Kathy A Mangold
- Department of Pathology and Laboratory Medicine, NorthShore University HealthSystem, Evanston, IL, USA
- Department of Pathology, University of Chicago Pritzker School of Medicine, Chicago, IL, USA
| | - Vivien Wang
- Department of Pathology and Laboratory Medicine, NorthShore University HealthSystem, Evanston, IL, USA
| | - Erica Price
- Department of Pathology and Laboratory Medicine, NorthShore University HealthSystem, Evanston, IL, USA
| | - Linda M Ernst
- Department of Pathology and Laboratory Medicine, NorthShore University HealthSystem, Evanston, IL, USA.
- Department of Pathology, University of Chicago Pritzker School of Medicine, Chicago, IL, USA.
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Van Mechelen K, van Westering-Kroon E, Hütten M, Mahieu L, Villamor E. Placing Ureaplasma within the Context of Bronchopulmonary Dysplasia Endotypes and Phenotypes. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10020256. [PMID: 36832386 PMCID: PMC9955705 DOI: 10.3390/children10020256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 01/17/2023] [Accepted: 01/29/2023] [Indexed: 02/03/2023]
Abstract
Different pathophysiological pathways (endotypes), leading to very preterm birth may result in distinct clinical phenotypes of bronchopulmonary dysplasia (BPD). Ureaplasma is a unique player in the pathogenesis of BPD. The interaction between factors inherent to Ureaplasma (virulence, bacterial load, duration of exposure), and to the host (immune response, infection clearance, degree of prematurity, respiratory support, concomitant infections) may contribute to BPD development in a variable manner. The data reviewed herein support the hypothesis that Ureaplasma, as a representative of the infectious/inflammatory endotype, may produce pulmonary damage predominantly in parenchyma, interstitium, and small airways. In contrast, Ureaplasma may have a very limited role in the pathogenesis of the vascular phenotype of BPD. In addition, if Ureaplasma is a key factor in BPD pathogenesis, its eradication by macrolides should prevent BPD. However, various meta-analyses do not show consistent evidence that this is the case. The limitations of current definitions and classifications of BPD, based on respiratory support needs instead of pathophysiology and phenotypes, may explain this and other failures in strategies aimed to prevent BPD. The precise mechanisms through which Ureaplasma infection leads to altered lung development and how these pathways can result in different BPD phenotypes warrant further investigation.
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Affiliation(s)
- Karen Van Mechelen
- Department of Pediatrics, Maastricht University Medical Center, School for Oncology and Reproduction (GROW), Maastricht University, 6229 HX Maastricht, The Netherlands
| | - Elke van Westering-Kroon
- Department of Pediatrics, Maastricht University Medical Center, School for Oncology and Reproduction (GROW), Maastricht University, 6229 HX Maastricht, The Netherlands
| | - Matthias Hütten
- Department of Pediatrics, Maastricht University Medical Center, School for Oncology and Reproduction (GROW), Maastricht University, 6229 HX Maastricht, The Netherlands
| | - Ludo Mahieu
- Department of Neonatology, Antwerp University Hospital, 2650 Edegem, Belgium
| | - Eduardo Villamor
- Department of Pediatrics, Maastricht University Medical Center, School for Oncology and Reproduction (GROW), Maastricht University, 6229 HX Maastricht, The Netherlands
- Correspondence:
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Ureaplasma-Driven Neonatal Neuroinflammation: Novel Insights from an Ovine Model. Cell Mol Neurobiol 2023; 43:785-795. [PMID: 35334011 PMCID: PMC9957905 DOI: 10.1007/s10571-022-01213-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 03/14/2022] [Indexed: 11/03/2022]
Abstract
Ureaplasma species (spp.) are considered commensals of the adult genitourinary tract, but have been associated with chorioamnionitis, preterm birth, and invasive infections in neonates, including meningitis. Data on mechanisms involved in Ureaplasma-driven neuroinflammation are scarce. The present study addressed brain inflammatory responses in preterm lambs exposed to Ureaplasma parvum (UP) in utero. 7 days after intra-amniotic injection of UP (n = 10) or saline (n = 11), lambs were surgically delivered at gestational day 128-129. Expression of inflammatory markers was assessed in different brain regions using qRT-PCR and in cerebrospinal fluid (CSF) by multiplex immunoassay. CSF was analyzed for UP presence using ureB-based real-time PCR, and MRI scans documented cerebral white matter area and cortical folding. Cerebral tissue levels of atypical chemokine receptor (ACKR) 3, caspases 1-like, 2, 7, and C-X-C chemokine receptor (CXCR) 4 mRNA, as well as CSF interleukin-8 protein concentrations were significantly increased in UP-exposed lambs. UP presence in CSF was confirmed in one animal. Cortical folding and white matter area did not differ among groups. The present study confirms a role of caspases and the transmembrane receptors ACKR3 and CXCR4 in Ureaplasma-driven neuroinflammation. Enhanced caspase 1-like, 2, and 7 expression may reflect cell death. Increased ACKR3 and CXCR4 expression has been associated with inflammatory central nervous system (CNS) diseases and impaired blood-brain barrier function. According to these data and previous in vitro findings from our group, we speculate that Ureaplasma-induced caspase and receptor responses affect CNS barrier properties and thus facilitate neuroinflammation.
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Jonduo ME, Vallely LM, Wand H, Sweeney EL, Egli-Gany D, Kaldor J, Vallely AJ, Low N. Adverse pregnancy and birth outcomes associated with Mycoplasma hominis, Ureaplasma urealyticum and Ureaplasma parvum: a systematic review and meta-analysis. BMJ Open 2022; 12:e062990. [PMID: 36028274 PMCID: PMC9422885 DOI: 10.1136/bmjopen-2022-062990] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 06/16/2022] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES Mycoplasma hominis, Ureaplasma urealyticum and Ureaplasma parvum (genital mycoplasmas) commonly colonise the urogenital tract in pregnant women. This systematic review aims to investigate their role in adverse pregnancy and birth outcomes, alone or in combination with bacterial vaginosis (BV). METHODS We searched Embase, Medline and CINAHL databases from January 1971 to February 2021. Eligible studies tested for any of the three genital mycoplasmas during pregnancy and reported on the primary outcome, preterm birth (PTB) and/or secondary outcomes low birth weight (LBW), premature rupture of membranes (PROM), spontaneous abortion (SA) and/or perinatal or neonatal death (PND).Two reviewers independently screened titles and abstracts, read potentially eligible full texts and extracted data. Two reviewers independently assessed risks of bias using published checklists. Random effects meta-analysis was used to estimate summary ORs (with 95% CIs and prediction intervals). Multivariable and stratified analyses were synthesised descriptively. RESULTS Of 57/1194 included studies, 39 were from high-income countries. In meta-analysis of unadjusted ORs, M. hominis was associated with PTB (OR 1.87, 95% CI 1.49 to 2.34), PROM, LBW and PND but not SA. U. urealyticum was associated with PTB (OR 1.84, 95% CI 1.34 to 2.55), PROM, LBW, SA and PND. U. parvum was associated with PTB (1.60, 95% CI 1.12 to 2.30), PROM and SA. Nine of 57 studies reported any multivariable analysis. In two studies, analyses stratified by BV status showed that M. hominis and U. parvum were more strongly associated with PTB in the presence than in the absence of BV. The most frequent source of bias was a failure to control for confounding. CONCLUSIONS The currently available literature does not allow conclusions about the role of mycoplasmas in adverse pregnancy and birth outcomes, alone or with coexisting BV. Future studies that consider genital mycoplasmas in the context of the vaginal microbiome are needed. PROSPERO REGISTRATION NUMBER CRD42016050962.
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Affiliation(s)
- Marinjho Emely Jonduo
- Global Health Program, The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
- Sexual and Reproductive Health Unit, Papua New Guinea Institute of Medical Research, Goroka, Eastern Highlands Province, Papua New Guinea
| | - Lisa Michelle Vallely
- Global Health Program, The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Handan Wand
- Biostatistics and Databases Program, The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Emma Louise Sweeney
- Infectious Diseases Unit, The University of Queensland Centre for Clinical Research, Herston, Queensland, Australia
| | - Dianne Egli-Gany
- Institute of Social and Preventive Medicine, University of Bern, Bern, Bern, Switzerland
| | - John Kaldor
- Global Health Program, The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Andrew John Vallely
- Global Health Program, The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
- Sexual and Reproductive Health Unit, Papua New Guinea Institute of Medical Research, Goroka, Eastern Highlands Province, Papua New Guinea
| | - Nicola Low
- Institute of Social and Preventive Medicine, University of Bern, Bern, Bern, Switzerland
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5
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Lee SM, Park KH, Joo E, Jeong DE, Lee JE, Lee KN, Shin S. High-throughput analysis of amniotic fluid proteins associated with histological chorioamnionitis in preterm premature rupture of membranes using an antibody-based microarray. Am J Reprod Immunol 2022; 88:e13595. [PMID: 35792516 DOI: 10.1111/aji.13595] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 05/30/2022] [Accepted: 06/30/2022] [Indexed: 11/28/2022] Open
Abstract
PROBLEM To identify potential proteins in the amniotic fluid (AF) that may be associated with histologic chorioamnionitis (HCA) in patients with preterm premature rupture of membranes (PPROM) using antibody-based microarray analysis. METHOD OF STUDY This was a retrospective cohort study involving 100 singleton pregnant women with PPROM at 24-34 weeks who underwent amniocentesis and delivered within 120 h of amniocentesis. First, the AF proteomes of 15 patients with PPROM and HCA were compared with those of 15 gestational age-matched patients without HCA using a protein microarray. Next, 12 candidate proteins associated with HCA were further validated in 100 consecutive patients with PPROM by ELISA. RESULTS Of 507 proteins assessed in the microarray analysis, 46 showed significant intergroup differences. Further quantification confirmed that the levels of EN-RAGE, IL-6, MMP-9, TNFR2, SPARC, TSP2, and uPA were higher in the AF of PPROM patients with HCA than in those without. Multivariate analyses also showed that elevated AF EN-RAGE, IL-6, MMP-9, and TNFR2 levels were independently associated with HCA when adjusted for baseline variables. The frequency of the highest quartile of the aforementioned proteins significantly increased as the total grade of HCA increased; the risk of HCA significantly increased with increasing AF levels of each protein (P for trend < .001). CONCLUSIONS Using protein-antibody microarray technology, we discovered several potential AF proteins (EN-RAGE, IL-6, MMP-9, and TNFR2) independently associated with HCA in patients with PPROM. Furthermore, we demonstrated a direct correlation between the gradation of the intra-amniotic inflammatory response and HCA severity.
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Affiliation(s)
- Seung Mi Lee
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Kyo Hoon Park
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Eunwook Joo
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Da Eun Jeong
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Ji Eun Lee
- Center for Theragnosis, Biomedical Research Institute, Korea Institute of Science and Technology, Seoul, South Korea
| | - Kyong-No Lee
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Sue Shin
- Department of Laboratory Medicine, Seoul National University Boramae Hospital, Seoul, South Korea
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6
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Noda-Nicolau NM, Tantengco OAG, Polettini J, Silva MC, Bento GFC, Cursino GC, Marconi C, Lamont RF, Taylor BD, Silva MG, Jupiter D, Menon R. Genital Mycoplasmas and Biomarkers of Inflammation and Their Association With Spontaneous Preterm Birth and Preterm Prelabor Rupture of Membranes: A Systematic Review and Meta-Analysis. Front Microbiol 2022; 13:859732. [PMID: 35432251 PMCID: PMC9006060 DOI: 10.3389/fmicb.2022.859732] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 03/07/2022] [Indexed: 12/20/2022] Open
Abstract
Genital mycoplasmas (GM), such as Mycoplasma hominis, Mycoplasma genitalium, Ureaplasma parvum, and Ureaplasma urealyticum are commonly associated with spontaneous preterm labor (SPTL), spontaneous preterm birth (PTB), and preterm prelabor rupture of membranes (PPROM). This study determined the association between GM and such adverse pregnancy outcomes. We searched for studies published 1980–2019 in MEDLINE, EMBASE, and Web of Science. Studies were eligible when GM was detected during pregnancy. We included 93 and 51 studies in determining the prevalence and the inflammatory biomarkers associated with GM, respectively, using the “metafor” package within R. The protocol was registered with PROSPERO (registration no. CRD42016047297). Women with the studied adverse pregnancy outcomes had significantly higher odds of presence with GM compared to women who delivered at term. For PTB, the odds ratios were: M. hominis (OR: 2.25; CI: 1.35–3.75; I2: 44%), M. genitalium (OR: 2.04; CIL 1.18–3.53; I2: 20%), U. parvum (OR: 1.75; CI: 1.47–2.07; I2: 0%), U. urealyticum (OR: 1.50; CI: 1.08–2.07; I2: 58%). SPTL had significantly higher odds with M. hominis (OR: 1.96; CI: 1.19–3.23; I2: 1%) or U. urealyticum (OR: 2.37; CI: 1.20–4.70; I2: 76%) compared to women without SPTL. Women with PPROM had significantly higher odds with M. hominis (OR: 2.09; CI: 1.42–3.08; I2: 0%) than women without PPROM. However, our subgroup analysis based on the diagnostic test and the sample used for detecting GM showed a higher prevalence of GM in maternal samples than in fetal samples. GM presence of the cervix and vagina was associated with lower odds of PTB and preterm labor (PTL). In contrast, GM presence in the AF, fetal membrane, and placenta was associated with increased odds of PTB and PTL. However, genital mycoplasmas may not elicit the massive inflammation required to trigger PTB. In conclusion, GM presence in the fetal tissues was associated with significantly increased odds of PTB and PTL.
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Affiliation(s)
- Nathalia M Noda-Nicolau
- Department of Pathology, Botucatu Medical School, Universidade Estadual Paulista, Botucatu, Brazil
| | - Ourlad Alzeus G Tantengco
- Division of Basic and Translational Research, Department of Obstetrics and Gynecology, The University of Texas Medical Branch at Galveston, Galveston, TX, United States.,Department of Biochemistry and Molecular Biology, College of Medicine, University of the Philippines Manila, Manila, Philippines
| | - Jossimara Polettini
- Graduate Program in Biomedical Sciences, Universidade Federal da Fronteira Sul, Passo Fundo, Brazil
| | - Mariana C Silva
- Department of Pathology, Botucatu Medical School, Universidade Estadual Paulista, Botucatu, Brazil
| | - Giovana F C Bento
- Department of Pathology, Botucatu Medical School, Universidade Estadual Paulista, Botucatu, Brazil
| | - Geovanna C Cursino
- Department of Pathology, Botucatu Medical School, Universidade Estadual Paulista, Botucatu, Brazil
| | - Camila Marconi
- Department of Basic Pathology, Setor de Ciências Biológicas, Universidade Federal do Paraná, Curitiba, Brazil
| | - Ronald F Lamont
- Research Unit of Gynaecology and Obstetrics, Department of Gynecology and Obstetrics, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark.,Division of Surgery, Northwick Park Institute for Medical Research, University College London, London, United Kingdom
| | - Brandie D Taylor
- Division of Basic and Translational Research, Department of Obstetrics and Gynecology, The University of Texas Medical Branch at Galveston, Galveston, TX, United States
| | - Márcia G Silva
- Department of Pathology, Botucatu Medical School, Universidade Estadual Paulista, Botucatu, Brazil
| | - Daniel Jupiter
- Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, TX, United States
| | - Ramkumar Menon
- Division of Basic and Translational Research, Department of Obstetrics and Gynecology, The University of Texas Medical Branch at Galveston, Galveston, TX, United States
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Maternal Ureaplasma exposure during pregnancy and the risk of preterm birth and BPD: a meta-analysis. Arch Gynecol Obstet 2022; 306:1863-1872. [DOI: 10.1007/s00404-022-06491-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 02/22/2022] [Indexed: 01/03/2023]
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8
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Gallini F, De Rose DU, Coppola M, Pelosi MS, Cota F, Bottoni A, Ricci D, Romeo DM, Spanu T, Maggio L, Mercuri E, Vento G. Maternal Ureaplasma/Mycoplasma colonization during pregnancy and neurodevelopmental outcomes for preterm infants. Front Pediatr 2022; 10:893812. [PMID: 36046478 PMCID: PMC9420904 DOI: 10.3389/fped.2022.893812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 07/19/2022] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Ureaplasma (U.) and Mycoplasma (M.) species have been related to pregnancy complications (including preterm birth) and worse neonatal outcomes. The aim of our work is to evaluate neurodevelopmental outcomes in preterm infants born to mothers with Ureaplasma/Mycoplasma colonization during pregnancy. METHODS Preterm infants with gestational age (GA) of ≤ 30 weeks were included in a retrospective follow-up study. To evaluate the effects of maternal vaginal colonization, we divided preterm infants into two groups: exposed and unexposed infants. All infants were assessed at 24 ± 3 months of age using Griffith's Mental Developmental Scales (GMDS). RESULTS Among 254 preterm infants, only 32 infants (12.6%) were exposed to U. /M. colonization during pregnancy. Exposed infants and unexposed ones had a similar Griffith's Developmental Quotient (106 ± 27.2 vs. 108.9 ± 19.5, respectively), without significant differences (p = 0.46). However, exposed infants had a significantly poorer outcome than their unexposed peers in terms of locomotor abilities (100.7 ± 28.3 exposed vs. 111.5 ± 26.1 unexposed, p = 0.03). CONCLUSION For visual and hearing impairment, exposed and unexposed infants had similar incidences of cognitive and motor impairment. However, exposed infants had significantly lower locomotor scores than unexposed peers.
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Affiliation(s)
- Francesca Gallini
- Neonatology Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario "Agostino Gemelli" Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy.,Università Cattolica del Sacro Cuore, Milan, Italy
| | - Domenico Umberto De Rose
- Neonatology Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario "Agostino Gemelli" Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy.,Neonatal Intensive Care Unit, Medical and Surgical Department of Fetus-Newborn-Infant, "Bambino Gesù" Children's Hospital Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy
| | - Maria Coppola
- Neonatology Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario "Agostino Gemelli" Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy
| | - Maria Sofia Pelosi
- Neonatology Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario "Agostino Gemelli" Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy
| | - Francesco Cota
- Neonatology Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario "Agostino Gemelli" Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy.,Università Cattolica del Sacro Cuore, Milan, Italy
| | - Anthea Bottoni
- Neonatology Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario "Agostino Gemelli" Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy
| | - Daniela Ricci
- National Centre of Services and Research for the Prevention of Blindness and Rehabilitation of Low Vision Patients-International Agency for the Prevention of Blindness (IAPB) Italia Onlus, Rome, Italy.,Pediatric Neurology Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario "Agostino Gemelli" Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy
| | - Domenico Marco Romeo
- Università Cattolica del Sacro Cuore, Milan, Italy.,Pediatric Neurology Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario "Agostino Gemelli" Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy
| | - Teresa Spanu
- Università Cattolica del Sacro Cuore, Milan, Italy.,Department of Laboratory and Infectious Sciences, Fondazione Policlinico Universitario "Agostino Gemelli" Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy
| | - Luca Maggio
- Università Cattolica del Sacro Cuore, Milan, Italy.,Neonatology Unit, S. Camillo-Forlanini Hospital, Rome, Italy
| | - Eugenio Mercuri
- Università Cattolica del Sacro Cuore, Milan, Italy.,Pediatric Neurology Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario "Agostino Gemelli" Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy
| | - Giovanni Vento
- Neonatology Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario "Agostino Gemelli" Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy.,Università Cattolica del Sacro Cuore, Milan, Italy
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9
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Holali Ameyapoh A, Katawa G, Ritter M, Tchopba CN, Tchadié PE, Arndts K, Kamassa HE, Mazou B, Amessoudji OM, N'djao A, Agoro S, Vogelbusch C, Omondi MA, Kolou M, Karou SD, Horsnell W, Hoerauf A, Ameyapoh Y, Layland LE. Hookworm Infections and Sociodemographic Factors Associated With Female Reproductive Tract Infections in Rural Areas of the Central Region of Togo. Front Microbiol 2021; 12:738894. [PMID: 34803955 PMCID: PMC8595254 DOI: 10.3389/fmicb.2021.738894] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 10/04/2021] [Indexed: 11/26/2022] Open
Abstract
Female reproductive tract infections (FRTIs) have a huge impact on women’s health including their reproductive health in rural areas. Immunomodulation by helminth infections could influence the occurrence of FRTIs. This study aimed to investigate the association between FRTIs, hookworm infections, and sociodemographic factors in six rural areas of the central region of Togo. A semi-structured questionnaire was used to collect sociodemographical information, and parasitological assessments were used to diagnose helminth infections. Moreover, cytobacteriological examination of vaginal swabs was performed for the diagnosis of candidiasis and bacterial vaginosis (BV), and real-time PCR method was used to determine sexually transmitted infections (STIs). Finally, a logistic regression analysis was performed to assess the relationship and association of these factors to FRTIs. The prevalence of FRTIs was 82.3% including STIs (74.38%), BV (31.79%), and vulvovaginal candidiasis (9.85%). In detail, FRTIs were caused by bacteria such as Ureaplasma parvum (50%), Ureaplasma urealyticum (26.5%), and Mycoplasma hominis (17.5%) and viruses such us cytomegalovirus (5%) and human papilloma virus (HPV) (20%). No cases of Haemophilus ducreyi, Treponema pallidum, or varicella-zoster virus (VZV) were observed. Interestingly, women who had hookworm infections were at high risk of HPV. The use of condoms was a protective factor [adjusted odds ratio (aOR) = 0.23; 95% CI [0.11–0.51)], while the use of contraceptive methods was a risk factor [aOR = 2.49; 95% CI (1.19–5.19)] for STIs. The risk of BV was lower among participants who had more than four pregnancies [aOR = 0.27; 95% CI (0.11–0.65)]. Furthermore, women who had ever been paid for sexual intercourse were at high probability risk of vulvovaginal candidiasis [aOR = 16.92; 95% CI (1.46–196.48)]. This study highlighted risk factors associated with FRTIs, the control of which would help to reduce the incidence of these diseases. Health-care professionals could develop education and sensitization strategies based on these risk factors, and anti-hookworm treatment concepts may be taken into consideration to minimize the risk of HPV infections.
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Affiliation(s)
- Adjoa Holali Ameyapoh
- Laboratoire de Microbiologie et de Contrôle de Qualité des Denrées Alimentaires, Unité de Recherche en Immunologie et Immunomodulation (UR2IM), Ecole Supérieure des Techniques Biologiques et Alimentaires (ESTBA), Université de Lomé, Lomé, Togo
| | - Gnatoulma Katawa
- Laboratoire de Microbiologie et de Contrôle de Qualité des Denrées Alimentaires, Unité de Recherche en Immunologie et Immunomodulation (UR2IM), Ecole Supérieure des Techniques Biologiques et Alimentaires (ESTBA), Université de Lomé, Lomé, Togo
| | - Manuel Ritter
- Institute for Medical Microbiology, Immunology and Parasitology (IMMIP), University Hospital Bonn (UKB), Bonn, Germany
| | - Christèle Nguepou Tchopba
- Laboratoire de Microbiologie et de Contrôle de Qualité des Denrées Alimentaires, Unité de Recherche en Immunologie et Immunomodulation (UR2IM), Ecole Supérieure des Techniques Biologiques et Alimentaires (ESTBA), Université de Lomé, Lomé, Togo
| | - Pélagie Edlom Tchadié
- Laboratoire de Microbiologie et de Contrôle de Qualité des Denrées Alimentaires, Unité de Recherche en Immunologie et Immunomodulation (UR2IM), Ecole Supérieure des Techniques Biologiques et Alimentaires (ESTBA), Université de Lomé, Lomé, Togo
| | - Kathrin Arndts
- Institute for Medical Microbiology, Immunology and Parasitology (IMMIP), University Hospital Bonn (UKB), Bonn, Germany
| | - Hélène E Kamassa
- Laboratoire de Microbiologie et de Contrôle de Qualité des Denrées Alimentaires, Unité de Recherche en Immunologie et Immunomodulation (UR2IM), Ecole Supérieure des Techniques Biologiques et Alimentaires (ESTBA), Université de Lomé, Lomé, Togo
| | - Bassimtou Mazou
- Laboratoire de Microbiologie et de Contrôle de Qualité des Denrées Alimentaires, Unité de Recherche en Immunologie et Immunomodulation (UR2IM), Ecole Supérieure des Techniques Biologiques et Alimentaires (ESTBA), Université de Lomé, Lomé, Togo
| | - Oukoe M Amessoudji
- Laboratoire de Microbiologie et de Contrôle de Qualité des Denrées Alimentaires, Unité de Recherche en Immunologie et Immunomodulation (UR2IM), Ecole Supérieure des Techniques Biologiques et Alimentaires (ESTBA), Université de Lomé, Lomé, Togo
| | - Akawulu N'djao
- Hôpital du District de Tchaoudjo, Direction Préfectorale de la Santé, Sokodé, Togo
| | - Sibabe Agoro
- Direction Régionale de la Santé, Région la Kara, Kara, Togo
| | - Celina Vogelbusch
- Institute for Medical Microbiology, Immunology and Parasitology (IMMIP), University Hospital Bonn (UKB), Bonn, Germany
| | - Millicent A Omondi
- Division of Immunology, Faculty of Health Science, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | - Malewe Kolou
- Faculté des Sciences de la Santé, Université de Lomé, Lomé, Togo
| | - Simplice D Karou
- Laboratoire de Microbiologie et de Contrôle de Qualité des Denrées Alimentaires, Unité de Recherche en Immunologie et Immunomodulation (UR2IM), Ecole Supérieure des Techniques Biologiques et Alimentaires (ESTBA), Université de Lomé, Lomé, Togo
| | - William Horsnell
- Division of Immunology, Faculty of Health Science, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa.,Wellcome Centre for Infectious Diseases Research in Africa (CIDRI), University of Cape Town, Cape Town, South Africa.,Institute of Microbiology and Infection, University of Birmingham, Birmingham, United Kingdom
| | - Achim Hoerauf
- Institute for Medical Microbiology, Immunology and Parasitology (IMMIP), University Hospital Bonn (UKB), Bonn, Germany.,German Center for Infection Research (DZIF), Partner Site Bonn-Cologne, Bonn, Germany.,German-West African Centre for Global Health and Pandemic Prevention (G-WAC), Partner Site, Bonn, Bonn, Germany
| | - Yaovi Ameyapoh
- Laboratoire de Microbiologie et de Contrôle de Qualité des Denrées Alimentaires, Unité de Recherche en Immunologie et Immunomodulation (UR2IM), Ecole Supérieure des Techniques Biologiques et Alimentaires (ESTBA), Université de Lomé, Lomé, Togo
| | - Laura E Layland
- Institute for Medical Microbiology, Immunology and Parasitology (IMMIP), University Hospital Bonn (UKB), Bonn, Germany.,German Center for Infection Research (DZIF), Partner Site Bonn-Cologne, Bonn, Germany
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10
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Šket T, Ramuta TŽ, Starčič Erjavec M, Kreft ME. The Role of Innate Immune System in the Human Amniotic Membrane and Human Amniotic Fluid in Protection Against Intra-Amniotic Infections and Inflammation. Front Immunol 2021; 12:735324. [PMID: 34745106 PMCID: PMC8566738 DOI: 10.3389/fimmu.2021.735324] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 09/23/2021] [Indexed: 01/18/2023] Open
Abstract
Intra-amniotic infection and inflammation (IAI) affect fetal development and are highly associated with preterm labor and premature rupture of membranes, which often lead to adverse neonatal outcomes. Human amniotic membrane (hAM), the inner part of the amnio-chorionic membrane, protects the embryo/fetus from environmental dangers, including microbial infection. However, weakened amnio-chorionic membrane may be breached or pathogens may enter through a different route, leading to IAI. The hAM and human amniotic fluid (hAF) respond by activation of all components of the innate immune system. This includes changes in 1) hAM structure, 2) presence of immune cells, 3) pattern recognition receptors, 4) cytokines, 5) antimicrobial peptides, 6) lipid derivatives, and 7) complement system. Herein we provide a comprehensive and integrative review of the current understanding of the innate immune response in the hAM and hAF, which will aid in design of novel studies that may lead to breakthroughs in how we perceive the IAI.
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Affiliation(s)
- Tina Šket
- Department of Synthetic Biology and Immunology, National Institute of Chemistry, Ljubljana, Slovenia
| | - Taja Železnik Ramuta
- Institute of Cell Biology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | | | - Mateja Erdani Kreft
- Institute of Cell Biology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
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11
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Venturelli N, Zeis A, De Beritto T, Hageman JR. Ureasplasma and Its Role in Adverse Perinatal Outcomes: A Review. Neoreviews 2021; 22:e574-e584. [PMID: 34470759 DOI: 10.1542/neo.22-9-e574] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Human Ureaplasma species are the most common microbes found in amniotic fluid and in the placenta after preterm birth, and have previously been correlated with chorioamnionitis, preterm labor, and bronchopulmonary dysplasia, among other adverse birth and neonatal outcomes. Although these correlations exist, there still remains little explanation as to whether Ureaplasma plays a pathogenic role in the development of neonatal disease. In addition, Ureaplasma species are not usually identified on routine culture as they require special culture methods because of their fastidious growth requirements. Treatment of Ureaplasma with macrolides has been shown to effectively eradicate the bacteria in pregnant women and infants. However, it is unclear whether this leads to improved neonatal morbidity and mortality, or whether these generally represent commensal organisms. This review will synthesize the current perspectives about the proposed mechanisms of pathogenicity of Ureaplasma bacteria, its links to poor neonatal outcomes, and the role of screening and treatment in current clinical practice.
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Affiliation(s)
| | | | - Theodore De Beritto
- Division of Neonatology, Department of Pediatrics, Mattel Children's Hospital, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Joseph R Hageman
- NICU Quality Improvement, Comer Children's Hospital, The University of Chicago, Chicago, IL
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12
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Ureaplasma parvum alters the immune tolerogenic state in placental tissue and could cause miscarriage. Fertil Steril 2021; 116:1030-1039. [PMID: 34325918 DOI: 10.1016/j.fertnstert.2021.05.108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 05/25/2021] [Accepted: 05/26/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To study the inflammatory profile and genes involved in the response to bacterial infections in women who developed spontaneous abortion in the presence of Ureaplasma parvum. DESIGN Cross-sectional study. SETTING A maternal and child referral center. PATIENT(S) Eighty-nine women with spontaneous abortion and 20 women with normal vaginal delivery (control group) were studied. INTERVENTION(S) Samples of biopsied placental tissue were collected for Mollicutes detection. MAIN OUTCOME MEASURE(S) The samples were subjected to histologic analysis, immunohistochemical evaluation for macrophages and lymphocytes, cytokine quantification, and quantitative polymerase chain reaction array to evaluate the expression of 84 genes related to the innate and adaptive immune responses. RESULT(S) The presence of U. parvum in the abortion group was positively associated with the influx of polymorphonuclear cells in the placental tissue and increased concentrations of interleukin-6 and interleukin-12p70. U. parvum caused downregulation of genes involved in the immune response, such as attraction of immune cells, activation of an inflammatory response, T-helper cell 17 response activation, and activation of the complement system at the beginning and end of pregnancy. CONCLUSION The direct action of U. parvum on placental tissue altered the gestational tolerogenic state, reducing the immune response against pathogens and activating the extrinsic apoptotic pathway, causing spontaneous abortion.
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13
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Abstract
Ureaplasma species are increasingly recognized as relevant pathogens in prenatal, perinatal and postnatal morbidity. They are commonly found as commensals on the mucous membranes of the lower urogenital tract of pregnant women, but when ascending, they can cause bacterial vaginosis, chorioamnionitis, premature birth and postnatal morbidities such as bronchopulmonary dysplasia, and early-onset neonatal sepsis and meningitis. The detection of Ureaplasma species is challenging and is not covered by routine diagnostics, and current empiric antibiotic treatment in neonates suspected of infection is not directed against Ureaplasma species. The aim of this review is to discuss the pathophysiology of Ureaplasma infections, the clinical consequences and the current difficulties in diagnosis and treatment by providing an overview of the current literature.
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Affiliation(s)
- Kim Stol
- From the Division of Pediatric Infectious Diseases, Immunology and Rheumatology, Department of Pediatrics
| | - Jop Jans
- Department of Pediatrics, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Lisa Ott de Bruin
- Department of Pediatrics, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Wendy Unger
- Laboratory of Pediatrics, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Annemarie van Rossum
- From the Division of Pediatric Infectious Diseases, Immunology and Rheumatology, Department of Pediatrics
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14
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Chen X, Guo DY, Yin TL, Yang J. Non-Coding RNAs Regulate Placental Trophoblast Function and Participate in Recurrent Abortion. Front Pharmacol 2021; 12:646521. [PMID: 33967782 PMCID: PMC8100504 DOI: 10.3389/fphar.2021.646521] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Accepted: 03/15/2021] [Indexed: 12/12/2022] Open
Abstract
Recurrent spontaneous abortion (RSA) is a serious pregnancy complication with an increasing clinical incidence. The various causes of recurrent abortion are complicated. Developments in genetics, immunology, and cell biology have identified important roles of non-coding RNAs (ncRNAs) in the occurrence and progress of recurrent abortion. NcRNAs can affect the growth, migration, and invasion of placental trophoblasts by regulating cell processes such as the cell cycle, apoptosis, and epithelial-mesenchymal transformation. Therefore, their abnormal expression might lead to the occurrence and development of RSA. NcRNAs include small nuclear RNA (snRNA), small nucleolar RNA (snoRNA), ribosomal RNA (rRNA), transfer, RNA (tRNA), circular RNA (cRNA), and Piwi-interacting RNA (piRNA). In this review, we discuss recent research that focused on the function and mechanism of microRNAs (miRNAs), long non-coding RNAs (lncRNAs), and circular RNA (circRNA) in regulating placental trophoblasts. The use of ncRNAs as potential diagnostic and predictive biomarkers in RSA is also discussed to provide future research insights.
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Affiliation(s)
- Xin Chen
- Reproductive Medical Center, Renmin Hospital of Wuhan University and Hubei Clinic Research Center for Assisted Reproductive Technology and Embryonic Development, Wuhan, China
| | - Duan-Ying Guo
- Department of Gynecology, Longgang District People's Hospital of Shenzhen, Shenzhen, China
| | - Tai-Lang Yin
- Reproductive Medical Center, Renmin Hospital of Wuhan University and Hubei Clinic Research Center for Assisted Reproductive Technology and Embryonic Development, Wuhan, China
| | - Jing Yang
- Reproductive Medical Center, Renmin Hospital of Wuhan University and Hubei Clinic Research Center for Assisted Reproductive Technology and Embryonic Development, Wuhan, China
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15
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Plummer EL, Vodstrcil LA, Bodiyabadu K, Murray GL, Doyle M, Latimer RL, Fairley CK, Payne M, Chow EPF, Garland SM, Bradshaw CS. Are Mycoplasma hominis, Ureaplasma urealyticum and Ureaplasma parvum associated with specific genital symptoms and clinical signs in non-pregnant women? Clin Infect Dis 2021; 73:659-668. [PMID: 33502501 DOI: 10.1093/cid/ciab061] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND There is limited evidence supporting an association between Mycoplasma hominis, Ureaplasma urealyticum and Ureaplasma parvum and symptoms or disease in non-pregnant women. However, testing and reporting of these organisms frequently occurs, in-part due to their inclusion in multiplex-PCR assays for sexually transmitted infection (STI) detection. We investigated if M. hominis, U. urealyticum and U. parvum were associated with symptoms and/or signs in non-pregnant women attending a sexual health service. METHODS Eligible women attending Melbourne Sexual Health Centre completed a questionnaire regarding sexual practices and symptoms. Symptomatic women underwent examination. Women were assessed for bacterial vaginosis (BV) and vulvovaginal candidiasis (VVC), and tested for M. hominis, U. urealyticum and U. parvum, and four non-viral STIs using a commercial multiplex-PCR. RESULTS 1,272 women were analysed. After adjusting for STIs and VVC, M. hominis was associated with abnormal vaginal discharge (aOR=2.70, 95%CI:1.92-3.79), vaginal malodour (aOR=4.27, 95%CI:3.08-5.91), vaginal pH>4.5 (aOR=4.27, 95%CI:3.22-5.66) and presence of clue cells (aOR=8.08, 95%CI:5.68-11.48). Ureaplasma spp. were not associated with symptoms/signs. BV was strongly associated with M. hominis (aOR=8.01, 95%CI:5.99-10.71), but was not associated with either Ureaplasma spp. In stratified analyses, M. hominis was associated with self-reported vaginal malodour and clinician-recorded vaginal discharge in women with BV, but not with symptoms/signs in women without BV. CONCLUSION Only M. hominis was associated with symptoms/signs, and these were manifestations of BV. Importantly, M. hominis was not associated with symptoms/signs in women without BV. These findings do not support routine testing for M. hominis, U. urealyticum and U. parvum in non-pregnant women.
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Affiliation(s)
- Erica L Plummer
- Central Clinical School, Monash University, Melbourne, Australia
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia
| | - Lenka A Vodstrcil
- Central Clinical School, Monash University, Melbourne, Australia
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia
| | - Kaveesha Bodiyabadu
- Murdoch Children's Research Institute, Parkville, Australia
- Women's Centre for Infectious Diseases, The Royal Women's Hospital, Parkville, Australia
- SpeeDx Pty Ltd, Sydney, Australia
| | - Gerald L Murray
- Murdoch Children's Research Institute, Parkville, Australia
- Women's Centre for Infectious Diseases, The Royal Women's Hospital, Parkville, Australia
- Department of Obstetrics and Gynaecology, The University of Melbourne, Parkville, Australia
| | - Michelle Doyle
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia
| | - Rosie L Latimer
- Central Clinical School, Monash University, Melbourne, Australia
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia
| | - Christopher K Fairley
- Central Clinical School, Monash University, Melbourne, Australia
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia
| | - Matthew Payne
- Division of Obstetrics and Gynaecology, The University of Western Australia, Perth, Australia
| | - Eric P F Chow
- Central Clinical School, Monash University, Melbourne, Australia
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Suzanne M Garland
- Murdoch Children's Research Institute, Parkville, Australia
- Women's Centre for Infectious Diseases, The Royal Women's Hospital, Parkville, Australia
- Department of Obstetrics and Gynaecology, The University of Melbourne, Parkville, Australia
| | - Catriona S Bradshaw
- Central Clinical School, Monash University, Melbourne, Australia
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
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16
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The Associations of Genital Mycoplasmas with Female Infertility and Adverse Pregnancy Outcomes: a Systematic Review and Meta-analysis. Reprod Sci 2021; 28:3013-3031. [PMID: 33398853 DOI: 10.1007/s43032-020-00399-w] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 11/16/2020] [Indexed: 01/11/2023]
Abstract
The roles of genital mycoplasmas including Mycoplasma genitalium (M. genitalium), Mycoplasma hominis (M. hominis), Ureaplasma urealyticum (U. urealyticum), and Ureaplasma parvum (U. parvum) in reproductive diseases are equivocal. To investigate whether genital mycoplasmas are risk factors of female infertility and adverse pregnancy outcomes, we performed a systematic review and meta-analysis. Electronic databases were searched for related studies. A random-effects model or fixed-effects model was employed to generate forest plots. Pooled odd ratios (ORs) with 95% confidence intervals (CIs) were applied to measure the strength of associations. Meanwhile, heterogeneity was evaluated by H statistic and I2 statistic, and publication bias was explored by funnel plots based on Egger's test and Begg's test. The search yielded 2054 relevant records, and 35 articles were ultimately included for meta-analysis. M. genitalium was a significant risk factor for female infertility (OR, 13.03 [95% CI, 3.46-48.98]) and preterm birth (PTB) (OR, 1.81 [95% CI, 1.17-2.80]), but not for spontaneous abortion (SA) (OR, 0.58 [95% CI, 0.25-1.35]). M. hominis can significantly increase the potential risk of female infertility (OR, 1.56 [95% CI, 1.02-2.38]), SA (OR, 9.14 [95% CI, 4.14-20.18]), stillbirth (OR, 3.98 [95% CI, 1.39-11.36]), and premature rupture of membranes (PROM) (OR, 1.79 [95% CI, 1.26-2.55]), but was not associated with PTB (OR, 1.29 [95% CI, 0.78-2.15]). U. urealyticum had no significant risk effect on female infertility (OR, 0.68 [95% CI, 0.42-1.11]). Coinfections of M. hominis and Ureaplasma were significantly associated with female infertility, SA, and stillbirth, but not with PROM. On the basis of current evidences, this meta-analysis supports that M. genitalium is a risk factor for female infertility and PTB; M. hominis is a potential risk factor for female infertility, SA, stillbirth, and PROM; U. urealyticum has no significant association with female infertility; and the relationship of U. parvum with female infertility and adverse pregnancy outcomes needs to be paid more attention to and remains to be further revealed.
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17
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Kacerovsky M, Romero R, Stepan M, Stranik J, Maly J, Pliskova L, Bolehovska R, Palicka V, Zemlickova H, Hornychova H, Spacek J, Jacobsson B, Pacora P, Musilova I. Antibiotic administration reduces the rate of intraamniotic inflammation in preterm prelabor rupture of the membranes. Am J Obstet Gynecol 2020; 223:114.e1-114.e20. [PMID: 32591087 DOI: 10.1016/j.ajog.2020.01.043] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 01/22/2020] [Accepted: 01/24/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Preterm prelabor rupture of the membranes (PPROM) is frequently complicated by intraamniotic inflammatory processes such as intraamniotic infection and sterile intraamniotic inflammation. Antibiotic therapy is recommended to patients with PPROM to prolong the interval between this complication and delivery (latency period), reduce the risk of clinical chorioamnionitis, and improve neonatal outcome. However, there is a lack of information regarding whether the administration of antibiotics can reduce the intensity of the intraamniotic inflammatory response or eradicate microorganisms in patients with PPROM. OBJECTIVE The first aim of the study was to determine whether antimicrobial agents can reduce the magnitude of the intraamniotic inflammatory response in patients with PPROM by assessing the concentrations of interleukin-6 in amniotic fluid before and after antibiotic treatment. The second aim was to determine whether treatment with intravenous clarithromycin changes the microbial load of Ureaplasma spp DNA in amniotic fluid. STUDY DESIGN A retrospective cohort study included patients who had (1) a singleton gestation, (2) PPROM between 24+0 and 33+6 weeks, (3) a transabdominal amniocentesis at the time of admission, and (4) intravenous antibiotic treatment (clarithromycin for patients with intraamniotic inflammation and benzylpenicillin/clindamycin in the cases of allergy in patients without intraamniotic inflammation) for 7 days. Follow-up amniocenteses (7th day after admission) were performed in the subset of patients with a latency period lasting longer than 7 days. Concentrations of interleukin-6 were measured in the samples of amniotic fluid with a bedside test, and the presence of microbial invasion of the amniotic cavity was assessed with culture and molecular microbiological methods. Intraamniotic inflammation was defined as a bedside interleukin-6 concentration ≥745 pg/mL in the samples of amniotic fluid. Intraamniotic infection was defined as the presence of both microbial invasion of the amniotic cavity and intraamniotic inflammation; sterile intraamniotic inflammation was defined as the presence of intraamniotic inflammation without microbial invasion of the amniotic cavity. RESULTS A total of 270 patients with PPROM were included in this study: 207 patients delivered within 7 days and 63 patients delivered after 7 days of admission. Of the 63 patients who delivered after 7 days following the initial amniocentesis, 40 underwent a follow-up amniocentesis. Patients with intraamniotic infection (n = 7) and sterile intraamniotic inflammation (n = 7) were treated with intravenous clarithromycin. Patients without either microbial invasion of the amniotic cavity or intraamniotic inflammation (n = 26) were treated with benzylpenicillin or clindamycin. Treatment with clarithromycin decreased the interleukin-6 concentration in amniotic fluid at the follow-up amniocentesis compared to the initial amniocentesis in patients with intraamniotic infection (follow-up: median, 295 pg/mL, interquartile range [IQR], 72-673 vs initial: median, 2973 pg/mL, IQR, 1750-6296; P = .02) and in those with sterile intraamniotic inflammation (follow-up: median, 221 pg/mL, IQR 118-366 pg/mL vs initial: median, 1446 pg/mL, IQR, 1300-2941; P = .02). Samples of amniotic fluid with Ureaplasma spp DNA had a lower microbial load at the time of follow-up amniocentesis compared to the initial amniocentesis (follow-up: median, 1.8 × 104 copies DNA/mL, 2.9 × 104 to 6.7 × 108 vs initial: median, 4.7 × 107 copies DNA/mL, interquartile range, 2.9 × 103 to 3.6 × 107; P = .03). CONCLUSION Intravenous therapy with clarithromycin was associated with a reduction in the intensity of the intraamniotic inflammatory response in patients with PPROM with either intraamniotic infection or sterile intraamniotic inflammation. Moreover, treatment with clarithromycin was related to a reduction in the load of Ureaplasma spp DNA in the amniotic fluid of patients with PPROM <34 weeks of gestation.
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18
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Abstract
Spontaneous abortion is considered a public health problem having several causes, including infections. Among the infectious agents, bacteria of the vaginal microbiota and Ureaplasma parvum have been associated with abortion, but their participation needs to be further elucidated. This study aims to evaluate the influence of Mollicutes on the development of spontaneous abortion. Women who underwent spontaneous abortion and those with normal birth (control) were studied. Samples of cervical mucus (CM) and placental tissue were collected to identify Mollicutes using the quantitative polymerase chain reaction methodology. Eighty-nine women who had a miscarriage and 20 women with normal pregnancies were studied. The presence of Mollicutes in placental tissue increased the chance of developing miscarriage sevenfold. The prevalence of U. parvum in women who experienced spontaneous abortion was 66.3% in placental tissue. A positive association was observed between the detection of U. parvum in samples of placental tissue and abortion. There was a significant increase in microbial load in placental tissue for M. hominis, U. urealyticum and U. parvum compared to the control group. Detection of U. parvum in CM in pregnant women can ascend to the region of the placental tissue and trigger a spontaneous abortion.
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19
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Fisher AL, Sangkhae V, Presicce P, Chougnet CA, Jobe AH, Kallapur SG, Tabbah S, Buhimschi CS, Buhimschi IA, Ganz T, Nemeth E. Fetal and amniotic fluid iron homeostasis in healthy and complicated murine, macaque, and human pregnancy. JCI Insight 2020; 5:135321. [PMID: 31990688 DOI: 10.1172/jci.insight.135321] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 01/22/2020] [Indexed: 12/21/2022] Open
Abstract
Adequate iron supply during pregnancy is essential for fetal development. However, how fetal or amniotic fluid iron levels are regulated during healthy pregnancy, or pregnancies complicated by intraamniotic infection or inflammation (IAI), is unknown. We evaluated amniotic fluid and fetal iron homeostasis in normal and complicated murine, macaque, and human pregnancy. In mice, fetal iron endowment was affected by maternal iron status, but amniotic fluid iron concentrations changed little during maternal iron deficiency or excess. In murine and macaque models of inflamed pregnancy, the fetus responded to maternal systemic inflammation or IAI by rapidly upregulating hepcidin and lowering iron in fetal blood, without altering amniotic fluid iron. In humans, elevated cord blood hepcidin with accompanying hypoferremia was observed in pregnancies with antenatal exposure to IAI compared with those that were nonexposed. Hepcidin was also elevated in human amniotic fluid from pregnancies with IAI compared with those without IAI, but amniotic fluid iron levels did not differ between the groups. Our studies in mice, macaques, and humans demonstrate that amniotic fluid iron is largely unregulated but that the rapid induction of fetal hepcidin by inflammation and consequent fetal hypoferremia are conserved mechanisms that may be important in fetal host defense.
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Affiliation(s)
- Allison L Fisher
- Molecular, Cellular and Integrative Physiology Graduate Program, Graduate Programs in Bioscience.,Center for Iron Disorders, and
| | | | - Pietro Presicce
- Neonatal-Perinatal Medicine, Department of Pediatrics, Department of Medicine, David Geffen School of Medicine, UCLA, Los Angeles, California, USA
| | - Claire A Chougnet
- Division of Immunobiology, Cincinnati Children's Hospital Research Foundation.,University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Alan H Jobe
- University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.,Division of Neonatology/Pulmonary Biology, Cincinnati Children's Hospital Research Foundation, Cincinnati, Ohio, USA
| | - Suhas G Kallapur
- Neonatal-Perinatal Medicine, Department of Pediatrics, Department of Medicine, David Geffen School of Medicine, UCLA, Los Angeles, California, USA
| | - Sammy Tabbah
- Cincinnati Fetal Center, Cincinnati Children's Hospital Medical Center and Department of Obstetrics and Gynecology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Catalin S Buhimschi
- Department of Obstetrics and Gynecology, University of Illinois at Chicago College of Medicine, Chicago, Illinois, USA
| | - Irina A Buhimschi
- Department of Obstetrics and Gynecology, University of Illinois at Chicago College of Medicine, Chicago, Illinois, USA
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20
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Fetal membrane bacterial load is increased in histologically confirmed inflammatory chorioamnionitis: A retrospective cohort study. Placenta 2020; 91:43-51. [PMID: 32174306 DOI: 10.1016/j.placenta.2020.01.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 01/14/2020] [Accepted: 01/18/2020] [Indexed: 12/16/2022]
Abstract
INTRODUCTION It is widely debated whether fetal membranes possess a genuine microbiome, and if bacterial presence and load is linked to inflammation. Chorioamnionitis is an inflammation of the fetal membranes. This research focussed on inflammatory diagnosed histological chorioamnionitis (HCA) and aimed to determine whether the bacterial load in fetal membranes correlates to inflammatory response, including histological staging and inflammatory markers in HCA. METHODS Fetal membrane samples were collected from patients with preterm spontaneous labour and histologically phenotyped chorioamnionitis (HCA; n = 12), or preterm (n = 6) and term labour without HCA (n = 6). The bacterial profile of fetal membranes was analysed by sequencing the V4 region of the 16S rRNA gene. Bacterial load was determined using qPCR copy number/mg of tissue. The association between bacterial load and bacterial profile composition was assessed using correlation analysis. RESULTS Bacterial load was significantly greater within HCA amnion (p = 0.002) and chorion (p = 0.042), compared to preterm birth without HCA. Increased bacterial load was positively correlated with increased histological staging (p = 0.001) and the expression of five inflammatory markers; IL8, TLR1, TLR2, LY96 and IRAK2 (p=<0.050). Bacterial profiles were significantly different between membranes with and without HCA in amnion (p = 0.012) and chorion (p = 0.001), but no differences between specific genera were detected. DISCUSSION Inflammatory HCA is associated with infection and increased bacterial load in a dose response relationship. Bacterial load is positively correlated with HCA severity and the TLR signalling pathway. Further research should investigate the bacterial load threshold required to generate an inflammatory response in HCA.
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Rittenschober-Böhm J, Waldhoer T, Schulz SM, Pimpel B, Goeral K, Kasper DC, Witt A, Berger A. Vaginal Ureaplasma parvum serovars and spontaneous preterm birth. Am J Obstet Gynecol 2019; 220:594.e1-594.e9. [PMID: 30735669 DOI: 10.1016/j.ajog.2019.01.237] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Revised: 01/25/2019] [Accepted: 01/30/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Ureaplasma species (spp) are the bacteria most often isolated from the amniotic cavity of women with preterm labor or preterm premature rupture of membranes; thus, the link between intrauterine Ureaplasma spp infection and adverse pregnancy outcome clearly is established. However, because vaginal Ureaplasma spp colonization is very common in pregnant women, the reason that these microorganisms cause ascending infections in some cases but remain asymptomatic in most pregnancies is not clear. Previous studies suggested an association between vaginal colonization with Ureaplasma parvum as opposed to U urealyticum and preterm delivery. However, because of the high frequency of vaginal Ureaplasma spp colonization during pregnancy, additional risk factors are needed to select a group of women who might benefit from treatment. OBJECTIVE To further identify pregnant women who are at increased risk for preterm delivery, the aim of the present study was to investigate U parvum serovar-specific pathogenicity in a large clinical cohort. STUDY DESIGN We serotyped 1316 samples that were positive for U parvum using a high-resolution melt polymerase chain reaction assay, and results were correlated with pregnancy outcome. RESULTS Within U parvum positive samples, serovar 3 was the most common isolate (43.3%), followed by serovar 6 (31.4%) and serovar 1 (25.2%). There was a significantly increased risk for spontaneous preterm birth at very low (<32 weeks gestation; P<.005) and extremely low (<28 weeks gestation; P<.005) gestational age in the group with vaginal U parvum serovar 3 colonization compared with the control group of pregnant women who tested negative for vaginal Ureaplasma spp colonization. This association was found for neither serovar 1 nor serovar 6. The combination of vaginal U parvum serovar 3 colonization and diagnosis of bacterial vaginosis in early pregnancy or a history of preterm birth further increased the risk for adverse pregnancy outcome. CONCLUSION Colonization with U parvum serovar 3, but not serovar 1 or serovar 6, in early pregnancy is associated with preterm delivery at very and extremely low gestational age. The combination of U parvum serovar 3 colonization and a history of preterm birth or bacterial vaginosis further increases the risk for spontaneous preterm birth at low gestational age and may define a target group for therapeutic intervention studies.
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Affiliation(s)
- Judith Rittenschober-Böhm
- Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria.
| | - Thomas Waldhoer
- Department of Epidemiology, Center of Public Health, Medical University of Vienna, Vienna, Austria
| | - Stefan M Schulz
- Research Core Unit for Pediatric Biochemistry and Analytics, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Birgit Pimpel
- Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Katharina Goeral
- Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - David C Kasper
- Research Core Unit for Pediatric Biochemistry and Analytics, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Armin Witt
- Division of Obstetrics and Feto-Maternal Medicine, Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
| | - Angelika Berger
- Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
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Zanotta N, Campisciano G, Morassut S, Castro-Silva E, Luksa V, Zito G, Luppi S, Martinelli M, Colli C, De Seta F, Ricci G, Suligoi B, Comar M. Emerging role for Ureaplasma parvum serovar 3: Active infection in women with silent high-risk human papillomavirus and in women with idiopathic infertility. J Cell Physiol 2019; 234:17905-17911. [PMID: 30883747 DOI: 10.1002/jcp.28423] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 01/28/2019] [Accepted: 01/30/2019] [Indexed: 12/17/2022]
Abstract
Recently, there are controversial opinions on the presence of Mycoplasmas/Ureaplasmas as colonizers or pathogens, and on the use of a targeted therapy. This study aimed to characterize Mycoplasmas/Ureaplasmas infections in reproductive age women, including the acquisition of sexually transmitted (ST) pathogens and poor birth outcomes. A total of 646 healthy Italian women fulfilled the inclusion criteria including 521 infertile women, 65 pregnant women, and 60 fertile women with identified risk factors and symptomatic for vaginitis/cervicitis. Multiplex and quantitative molecular techniques and direct automatic DNA sequencing were performed to assess the genome structure of Mycoplasma/Ureaplasma species and ST infected pathogens. Ureaplasma parvum serovar 3 represented the predominant colonizer of the urogenital tract of this series and the unique species significantly associated with ST pathogens coinfection (p < 0.01). U. parvum load >104 bacteria/ml, suggestive of active infection, has been measured only in asymptomatic high-risk human papillomavirus infected women (24.3%) and in 40% of women with idiopathic infertility. To note, 16% of the follicular fluid from these idiopathic women resulted infected with U. parvum. In conclusion, the present study focused the attention on U. parvum serovar 3 as emerging microorganism in sexually active women that may have the benefit of targeted therapy.
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Affiliation(s)
- Nunzia Zanotta
- Institute for Maternal and Child Health-IRCCS "Burlo Garofolo", Trieste, Italy
| | | | - Sara Morassut
- Institute for Maternal and Child Health-IRCCS "Burlo Garofolo", Trieste, Italy
| | | | - Viviana Luksa
- Department of Medical Sciences, University of Trieste, Trieste, Italy
| | - Gabriella Zito
- Institute for Maternal and Child Health-IRCCS "Burlo Garofolo", Trieste, Italy
| | - Stefania Luppi
- Institute for Maternal and Child Health-IRCCS "Burlo Garofolo", Trieste, Italy
| | - Monica Martinelli
- Institute for Maternal and Child Health-IRCCS "Burlo Garofolo", Trieste, Italy
| | | | - Francesco De Seta
- Institute for Maternal and Child Health-IRCCS "Burlo Garofolo", Trieste, Italy.,Department of Medical Sciences, University of Trieste, Trieste, Italy
| | - Giuseppe Ricci
- Institute for Maternal and Child Health-IRCCS "Burlo Garofolo", Trieste, Italy.,Department of Medical Sciences, University of Trieste, Trieste, Italy
| | | | - Manola Comar
- Institute for Maternal and Child Health-IRCCS "Burlo Garofolo", Trieste, Italy.,Department of Medical Sciences, University of Trieste, Trieste, Italy
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Kong Y, Yang T, Yang T, Ruan Z, Song T, Ding H, Xie X, Zhang J. Correlation between Ureaplasma spp. sub-group 1 and preterm pre-labour rupture of membranes revealed by an eMLST scheme. INFECTION GENETICS AND EVOLUTION 2018; 68:172-176. [PMID: 30582987 DOI: 10.1016/j.meegid.2018.12.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 12/20/2018] [Accepted: 12/20/2018] [Indexed: 11/16/2022]
Abstract
Ureaplasma spp. is gaining recognition as an important pathogen associated with preterm birth (PTB) and preterm pre-labour rupture of membranes (PPROM). The aim of this study was to investigate the clonality of this organism in maternal/neonatal pairs with PTB or pre-labour rupture of membranes (PROM) or PPROM and the association between sub-groups and PPROM. In total, 50 of 93 maternal/neonatal pairs that were diagnosed with PTB, PROM or PPROM were identified with Ureaplasma spp. colonized in the amniotic fluid or umbilical cord or placenta. All 104 clinical Ureaplasma spp. samples (50, 30, and 24 cultured from amniotic fluid, umbilical cord, and placenta, respectively) were included for analysis of the genetic lineages using the eMLST scheme. A total of 34 eSTs were revealed, with two predominant eSTs (eST16 and eST41). Interestingly, six maternal/neonatal pairs displayed eST differences in the above three specimen sources. In addition, phylogenetic analysis showed two genetically significant distant clusters, and cluster I included the most clinical strains. Interestingly, there was a significant difference in the prevalence of sub-group 1 of cluster II between women with PPROM and those with PROM. In conclusion, the distribution of cluster I was predominately higher than that of cluster II in maternal/neonatal pairs. In addition, sub-group 1 was prone to associated PPROM through the specific epidemic clonal lineages.
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Affiliation(s)
- Yingying Kong
- Clinical Laboratory, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310016, China; Biomedical Research Center, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310016, China
| | - Tingting Yang
- Clinical Laboratory, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310016, China
| | - Ting Yang
- Clinical Laboratory, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310016, China
| | - Zhi Ruan
- Clinical Laboratory, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310016, China; Biomedical Research Center, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310016, China
| | - Tiejun Song
- Clinical Laboratory, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310016, China; Biomedical Research Center, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310016, China
| | - Honghui Ding
- Yiwu Maternity and Child Care Hospital, Jinhua, Zhejiang 322000, China
| | - Xinyou Xie
- Clinical Laboratory, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310016, China; Biomedical Research Center, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310016, China.
| | - Jun Zhang
- Clinical Laboratory, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310016, China; Biomedical Research Center, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310016, China.
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Gastric fluid used to assess changes during the latency period in preterm prelabor rupture of membranes. Pediatr Res 2018; 84:240-247. [PMID: 29892034 DOI: 10.1038/s41390-018-0073-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Revised: 05/07/2018] [Accepted: 05/11/2018] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To determine changes in the intraamniotic environment during the latency period using paired amniotic and gastric fluid samples in pregnancies complicated by preterm prelabor rupture of membranes (PPROM). METHODS A total of 34 women with singleton pregnancies complicated by PPROM prior to 34 weeks were included in the study. Amniotic fluid was obtained by transabdominal amniocentesis at the time of admission. Immediately after delivery, umbilical cord blood and gastric fluid were obtained. RESULT Microorganisms in amniotic and gastric fluid samples were found in 38% and 59% of women, respectively. Bedside IL-6 levels were higher in amniotic than in gastric fluid in pregnancies without fetal inflammatory response syndrome (FIRS) (263 pg/mL vs. 50 pg/mL; p < 0.0001), but not in pregnancies with FIRS (318 pg/mL vs. 444 pg/mL; p = 0.91). Funisitis and FIRS was associated with the highest bedside IL-6 levels in gastric fluid. A gastric fluid bedside IL-6 level of 275 pg/mL was found to be the ideal cutoff value to predict funisitis and FIRS. CONCLUSIONS The microbial and inflammatory status of the intraamniotic compartment changes during the latency period in PPROM. Bedside IL-6 assessment of gastric fluid may be useful in the rapid diagnosis of funisitis and FIRS.
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Glaser K, Silwedel C, Fehrholz M, Henrich B, Waaga-Gasser AM, Claus H, Speer CP. Ureaplasma isolates stimulate pro-inflammatory CC chemokines and matrix metalloproteinase-9 in neonatal and adult monocytes. PLoS One 2018; 13:e0194514. [PMID: 29558521 PMCID: PMC5860755 DOI: 10.1371/journal.pone.0194514] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 03/05/2018] [Indexed: 11/25/2022] Open
Abstract
Being generally regarded as commensal bacteria, the pro-inflammatory capacity of Ureaplasma species has long been debated. Recently, we confirmed Ureaplasma–driven pro-inflammatory cytokine responses and a disturbance of cytokine equilibrium in primary human monocytes in vitro. The present study addressed the expression of CC chemokines and matrix metalloproteinase-9 (MMP-9) in purified term neonatal and adult monocytes stimulated with serovar 8 of Ureaplasma urealyticum (Uu) and serovar 3 of U. parvum (Up). Using qRT-PCR and multi-analyte immunoassay, we assessed mRNA and protein expression of the monocyte chemotactic proteins 1 and 3 (MCP-1/3), the macrophage inflammatory proteins 1α and 1β (MIP-1α/β) as well as MMP-9. For the most part, both isolates stimulated mRNA expression of all given chemokines and MMP-9 in cord blood and adult monocytes (p<0.05 and p<0.01). These results were paralleled by Uu and Up-induced secretion of MCP-1 protein in both cells (neonatal: p<0.01, adult: p<0.05 and p<0.01). Release of MCP-3, MIP-1α, MIP-1β and MMP-9 was enhanced upon exposure to Up (neonatal: p<0.05, p<0.01 and p<0.001, respectively; adult: p<0.05). Co-stimulation of LPS-primed monocytes with Up increased LPS-induced MCP-1 release in neonatal cells (p<0.05) and aggravated LPS-induced MMP-9 mRNA in both cell subsets (neonatal: p<0.05, adult: p<0.01). Our results document considerable expression of pro-inflammatory CC chemokines and MMP-9 in human monocytes in response to Ureaplasma isolates in vitro, adding to our previous data. Findings from co-stimulated cells indicate that Ureaplasma may modulate monocyte immune responses to a second stimulus.
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Affiliation(s)
- Kirsten Glaser
- University Children´s Hospital, University of Würzburg, Würzburg, Germany
- * E-mail:
| | - Christine Silwedel
- University Children´s Hospital, University of Würzburg, Würzburg, Germany
| | - Markus Fehrholz
- University Children´s Hospital, University of Würzburg, Würzburg, Germany
| | - Birgit Henrich
- Institute of Medical Microbiology and Hospital Hygiene, University Clinic of Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | - Ana Maria Waaga-Gasser
- Department of Surgery I, Molecular Oncology & Immunology, University of Würzburg, Würzburg, Germany
| | - Heike Claus
- Institute for Hygiene and Microbiology, University of Würzburg, Würzburg, Germany
| | - Christian P. Speer
- University Children´s Hospital, University of Würzburg, Würzburg, Germany
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Musilova I, Andrys C, Drahosova M, Zednikova B, Hornychova H, Pliskova L, Zemlickova H, Jacobsson B, Kacerovsky M. Late preterm prelabor rupture of fetal membranes: fetal inflammatory response and neonatal outcome. Pediatr Res 2018; 83:630-637. [PMID: 29186106 DOI: 10.1038/pr.2017.300] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2017] [Accepted: 10/14/2017] [Indexed: 12/29/2022]
Abstract
BackgroundTo characterize the influence of microbial invasion of the amniotic cavity (MIAC) and/or intra-amniotic inflammation (IAI) on the intensity of the fetal inflammatory response and the association between the presence of the fetal inflammatory response syndrome (FIRS) and short-term neonatal morbidity in the preterm prelabor rupture of membranes (PPROM) between the gestational ages of 34 and 37 weeks.MethodsOne hundred and fifty-nine women were included in the study. The umbilical cord blood interleukin (IL)-6 concentrations were determined using enzyme-linked immunosorbent assay kits. FIRS was defined based on the umbilical cord blood IL-6 concentration and the presence of funisitis and/or chorionic plate vasculitis.ResultsWomen with both MIAC and IAI had the highest median umbilical cord blood IL-6 concentrations and highest rates of FIRS. Women with FIRS had the higher rates of early-onset sepsis and intraventricular hemorrhage grades I and II when FIRS was characterized based on the umbilical cord blood IL-6 concentrations and the histopathological findings.ConclusionThe presence of both MIAC and IAI was associated with a higher fetal inflammatory response and a higher rate of FIRS. Different aspects of short-term neonatal morbidity were related to FIRS when defined by umbilical cord blood IL-6 concentrations and the histopathology of the placenta.
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Affiliation(s)
- Ivana Musilova
- Department of Clinical Immunology and Allergy, University Hospital in Hradec Kralove, Charles University, Faculty of Medicine Hradec Kralove, Hradec Kralove, Czech Republic
| | - Ctirad Andrys
- Department of Clinical Immunology and Allergy, University Hospital in Hradec Kralove, Charles University, Faculty of Medicine Hradec Kralove, Hradec Kralove, Czech Republic
| | - Marcela Drahosova
- Department of Clinical Immunology and Allergy, University Hospital in Hradec Kralove, Charles University, Faculty of Medicine Hradec Kralove, Hradec Kralove, Czech Republic
| | - Barbora Zednikova
- Department of Clinical Immunology and Allergy, University Hospital in Hradec Kralove, Charles University, Faculty of Medicine Hradec Kralove, Hradec Kralove, Czech Republic
| | - Helena Hornychova
- Fingerland's Department of Pathology, University Hospital in Hradec Kralove, Charles University, Faculty of Medicine Hradec Kralove, Hradec Kralove, Czech Republic
| | - Lenka Pliskova
- Institute of Clinical Biochemistry and Diagnostics, University Hospital in Hradec Kralove, Charles University, Faculty of Medicine Hradec Kralove, Hradec Kralove, Czech Republic
| | - Helena Zemlickova
- Institute of Clinical Microbiology, University Hospital in Hradec Kralove, Charles University, Faculty of Medicine Hradec Kralove, Hradec Kralove, Czech Republic
| | - Bo Jacobsson
- Department of Obstetrics and Gynecology, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Marian Kacerovsky
- Department of Obstetrics and Gynecology, University Hospital in Hradec Kralove, Charles University, Faculty of Medicine Hradec Kralove, Hradec Kralove, Czech Republic
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Musilova I, Pliskova L, Gerychova R, Janku P, Simetka O, Matlak P, Jacobsson B, Kacerovsky M. Maternal white blood cell count cannot identify the presence of microbial invasion of the amniotic cavity or intra-amniotic inflammation in women with preterm prelabor rupture of membranes. PLoS One 2017; 12:e0189394. [PMID: 29232399 PMCID: PMC5726631 DOI: 10.1371/journal.pone.0189394] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Accepted: 11/26/2017] [Indexed: 02/07/2023] Open
Abstract
Objective The main aim of this study was to determine the relationship between the maternal white blood cell (WBC) count at the time of hospital admission in pregnancies complicated by preterm prelabor rupture of membranes (PPROM) and the presence of microbial invasion of the amniotic cavity (MIAC) and/or intra-amniotic inflammation (IAI). The second aim was to test WBC diagnostic indices with respect to the presence of MIAC and/or IAI. Methods Four hundred and seventy-nine women with singleton pregnancies complicated by PPROM, between February 2012 and June 2017, were included in this study. Maternal blood and amniotic fluid samples were collected at the time of admission. Maternal WBC count was assessed. Amniotic fluid interleukin-6 (IL-6) concentration was measured using a point-of-care test, and IAI was characterized by an IL-6 concentration of ≥ 745 pg/mL. MIAC was diagnosed based on a positive polymerase chain reaction result for the Ureaplasma species, Mycoplasma hominis, and/or Chlamydia trachomatis and/or for the 16S rRNA gene. Results Women with MIAC or IAI had higher WBC counts than those without (with MIAC: median, 12.8 × 109/L vs. without MIAC: median, 11.9 × 109/L; p = 0.0006; with IAI: median, 13.7 × 109/L vs. without IAI: median, 11.9 × 109/L; p < 0.0001). When the women were divided into four subgroups based on the presence of MIAC and/or IAI, the women with both MIAC and IAI had a higher WBC count than those with either IAI or MIAC alone, and those without MIAC and IAI [both MIAC and IAI: median, 14.0 × 109/L; IAI alone: 12.1 × 109/L (p = 0.03); MIAC alone: 12.1 × 109/L (p = 0.0001); and without MIAC and IAI: median, 11.8 × 109/L (p < 0.0001)]. No differences in the WBC counts were found among the women with IAI alone, MIAC alone, and without MIAC and IAI. Conclusion The women with both MIAC and IAI had a higher maternal WBC count at the time of hospital admission than the remaining women with PPROM. The maternal WBC count at the time of admission showed poor diagnostic indices for the identification of the presence of both MIAC and IAI. Maternal WBC count at the time of admission cannot serve as a non-invasive screening tool for identifying these complications in women with PPROM.
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Affiliation(s)
- Ivana Musilova
- Department of Obstetrics and Gynecology, Charles University Faculty of Medicine in Hradec Kralove, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
| | - Lenka Pliskova
- Institute of Clinical Biochemistry and Diagnostics, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
| | - Romana Gerychova
- Department of Obstetrics and Gynecology, University Hospital Brno, Faculty of Medicine Masaryk University, Brno, Czech Republic
| | - Petr Janku
- Department of Obstetrics and Gynecology, University Hospital Brno, Faculty of Medicine Masaryk University, Brno, Czech Republic
| | - Ondrej Simetka
- Department of Gynecology and Obstetrics, University Hospital Ostrava, Ostrava, Czech Republic
| | - Petr Matlak
- Department of Gynecology and Obstetrics, University Hospital Ostrava, Ostrava, Czech Republic
| | - Bo Jacobsson
- Department of Obstetrics and Gynecology, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.,Domain of Health Data and Digitalization, Norwegian Institute of Public Health, Oslo, Norway
| | - Marian Kacerovsky
- Department of Obstetrics and Gynecology, Charles University Faculty of Medicine in Hradec Kralove, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic.,Biomedical Research Center, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
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Glaser K, Silwedel C, Fehrholz M, Waaga-Gasser AM, Henrich B, Claus H, Speer CP. Ureaplasma Species Differentially Modulate Pro- and Anti-Inflammatory Cytokine Responses in Newborn and Adult Human Monocytes Pushing the State Toward Pro-Inflammation. Front Cell Infect Microbiol 2017; 7:484. [PMID: 29234642 PMCID: PMC5712342 DOI: 10.3389/fcimb.2017.00484] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Accepted: 11/13/2017] [Indexed: 12/22/2022] Open
Abstract
Background:Ureaplasma species have been associated with chorioamnionitis and preterm birth and have been implicated in the pathogenesis of neonatal short and long-term morbidity. However, being mostly commensal bacteria, controversy remains on the pro-inflammatory capacity of Ureaplasma. Discussions are ongoing on the incidence and impact of prenatal, perinatal, and postnatal infection. The present study addressed the impact of Ureaplasma isolates on monocyte-driven inflammation. Methods: Cord blood monocytes of term neonates and adult monocytes, either native or LPS-primed, were cultured with Ureaplasma urealyticum (U. urealyticum) serovar 8 (Uu8) and Ureaplasma parvum serovar 3 (Up3). Using qRT-PCR, cytokine flow cytometry, and multi-analyte immunoassay, we assessed mRNA and protein expression of tumor necrosis factor (TNF)-α, interleukin (IL)-1β, IL-8, IL-12p40, IL-10, and IL-1 receptor antagonist (IL-1ra) as well as Toll-like receptor (TLR) 2 and TLR4. Results: Uu8 and Up3 induced mRNA expression and protein release of TNF-α, IL-1β and IL-8 in term neonatal and adult monocytes (p < 0.01 and p < 0.05). Intracellular protein expression of TNF-α, IL-1β and IL-8 in Ureaplasma-stimulated cells paralleled those results. Ureaplasma-induced cytokine levels did not significantly differ from LPS-mediated levels except for lower intracellular IL-1β in adult monocytes (Uu8: p < 0.05). Remarkably, ureaplasmas did not induce IL-12p40 response and promoted lower amounts of anti-inflammatory IL-10 and IL-1ra than LPS, provoking a cytokine imbalance more in favor of pro-inflammation (IL-1β/IL-10, IL-8/IL-10 and IL-8/IL-1ra: p < 0.01, vs. LPS). In contrast to LPS, both isolates induced TLR2 mRNA in neonatal and adult cells (p < 0.001 and p < 0.05) and suppressed TLR4 mRNA in adult monocytes (p < 0.05). Upon co-stimulation, Uu8 and Up3 inhibited LPS-induced intracellular IL-1β (p < 0.001 and p < 0.05) and IL-8 in adult monocytes (p < 0.01), while LPS-induced neonatal cytokines were maintained or aggravated (p < 0.05). Conclusion: Our data demonstrate a considerable pro-inflammatory capacity of Ureaplasma isolates in human monocytes. Stimulating pro-inflammatory cytokine responses while hardly inducing immunomodulatory and anti-inflammatory cytokines, ureaplasmas might push monocyte immune responses toward pro-inflammation. Inhibition of LPS-induced cytokines in adult monocytes in contrast to sustained inflammation in term neonatal monocytes indicates a differential modulation of host immune responses to a second stimulus. Modification of TLR2 and TLR4 expression may shape host susceptibility to inflammation.
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Affiliation(s)
- Kirsten Glaser
- University Children's Hospital, University of Wuerzburg, Wuerzburg, Germany
| | - Christine Silwedel
- University Children's Hospital, University of Wuerzburg, Wuerzburg, Germany
| | - Markus Fehrholz
- University Children's Hospital, University of Wuerzburg, Wuerzburg, Germany
| | - Ana M Waaga-Gasser
- Department of Surgery I, Molecular Oncology and Immunology, University of Wuerzburg, Wuerzburg, Germany
| | - Birgit Henrich
- Institute of Medical Microbiology and Hospital Hygiene, University Clinic of Heinrich-Heine University Duesseldorf, Duesseldorf, Germany
| | - Heike Claus
- Institute for Hygiene and Microbiology, University of Wuerzburg, Wuerzburg, Germany
| | - Christian P Speer
- University Children's Hospital, University of Wuerzburg, Wuerzburg, Germany
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29
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Musilova I, Andrys C, Krejsek J, Drahosova M, Zednikova B, Pliskova L, Zemlickova H, Jacobsson B, Kacerovsky M. Amniotic fluid pentraxins: Potential early markers for identifying intra-amniotic inflammatory complications in preterm pre-labor rupture of membranes. Am J Reprod Immunol 2017; 79:e12789. [PMID: 29193454 DOI: 10.1111/aji.12789] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Accepted: 10/31/2017] [Indexed: 12/22/2022] Open
Abstract
In this study, pentraxin 3 (PTX3), C-reactive protein (CRP), and serum amyloid P component (SAP) concentrations in the amniotic fluid of women with preterm pre-labor rupture of membranes (PPROM) were evaluated based on evidence of microbial invasion of the amniotic cavity (MIAC), intra-amniotic inflammation (IAI), and microbial-associated IAI. A total of 149 women with PPROM were included in this study. Amniotic fluid samples were obtained by transabdominal amniocentesis. Amniotic fluid PTX3, SAP, and CRP concentrations were assessed using enzyme-linked immunosorbent assay. PTX3 and CRP concentrations were higher in women with MIAC, IAI, and microbial-associated IAI than in women without these conditions. SAP concentrations were only higher in the presence of IAI and microbial-associated IAI. Amniotic fluid PTX3 concentrations of 11 ng/mL were found to be the best value for identifying the presence of microbial-associated IAI and IAI in women with PPROM. To conclude, amniotic fluid pentraxins are involved in intra-amniotic inflammatory responses in pregnancies complicated by PPROM.
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Affiliation(s)
- Ivana Musilova
- Department of Obstetrics and Gynecology, Faculty of Medicine Hradec Kralove, University Hospital Hradec Kralove, Charles University in Prague, Hradec Kralove, Czech Republic
| | - Ctirad Andrys
- Department of Clinical Immunology and Allergy, Faculty of Medicine Hradec Kralove, University Hospital Hradec Kralove, Charles University in Prague, Hradec Kralove, Czech Republic
| | - Jan Krejsek
- Department of Clinical Immunology and Allergy, Faculty of Medicine Hradec Kralove, University Hospital Hradec Kralove, Charles University in Prague, Hradec Kralove, Czech Republic
| | - Marcela Drahosova
- Department of Clinical Immunology and Allergy, Faculty of Medicine Hradec Kralove, University Hospital Hradec Kralove, Charles University in Prague, Hradec Kralove, Czech Republic
| | - Barbora Zednikova
- Department of Clinical Immunology and Allergy, Faculty of Medicine Hradec Kralove, University Hospital Hradec Kralove, Charles University in Prague, Hradec Kralove, Czech Republic
| | - Lenka Pliskova
- Institute of Clinical Biochemistry and Diagnostics, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
| | - Helena Zemlickova
- Institute of Clinical Microbiology, Faculty of Medicine Hradec Kralove, University Hospital in Hradec Kralove, Charles University, Hradec Kralove, Czech Republic
| | - Bo Jacobsson
- Department of Obstetrics and Gynecology, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.,Division of Health Data and Digitalisation, Department of Genetics and Bioinformatics, Norwegian Institute of Public Health, Oslo, Norway
| | - Marian Kacerovsky
- Department of Obstetrics and Gynecology, Faculty of Medicine Hradec Kralove, University Hospital Hradec Kralove, Charles University in Prague, Hradec Kralove, Czech Republic.,Biomedical Research Center, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
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30
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Silwedel C, Speer CP, Glaser K. Ureaplasma-associated prenatal, perinatal, and neonatal morbidities. Expert Rev Clin Immunol 2017; 13:1073-1087. [DOI: 10.1080/1744666x.2017.1381559] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Christine Silwedel
- University Children’s Hospital, University of Wuerzburg, Wuerzburg, Germany
| | - Christian P. Speer
- University Children’s Hospital, University of Wuerzburg, Wuerzburg, Germany
| | - Kirsten Glaser
- University Children’s Hospital, University of Wuerzburg, Wuerzburg, Germany
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31
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Abstract
Preterm birth (PTB) remains a major obstetric healthcare problem and a significant contributor to perinatal morbidity, mortality, and long-term disability. Over the past few decades, the perinatal outcomes of preterm neonates have improved markedly through research and advances in neonatal care, whereas rates of spontaneous PTB have essentially remained static. However, research into causal pathways and new diagnostic and treatment modalities is now bearing fruit and translational initiatives are beginning to impact upon PTB rates. Successful PTB prevention requires a multifaceted approach, combining public health and educational programs, lifestyle modification, access to/optimisation of obstetric healthcare, effective prediction and diagnostic modalities, and the application of effective, targeted interventions. Progress has been made in some of these areas, although there remain areas of controversy and uncertainty. Attention is now being directed to areas where greater gains can be achieved. In this mini-review, we will briefly and selectively review a range of PTB prevention strategies and initiatives where progress has been made and where exciting opportunities await exploitation, evaluation, and implementation.
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Affiliation(s)
- Jeff A Keelan
- Division of Obstetrics & Gynaecology, School of Medicine, University of Western Australia King Edward Memorial Hospital, Perth, Australia
| | - John P Newnham
- Division of Obstetrics & Gynaecology, School of Medicine, University of Western Australia King Edward Memorial Hospital, Perth, Australia
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32
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Sweeney EL, Kallapur SG, Meawad S, Gisslen T, Stephenson SA, Jobe AH, Knox CL. Ureaplasma Species Multiple Banded Antigen (MBA) Variation Is Associated with the Severity of Inflammation In vivo and In vitro in Human Placentae. Front Cell Infect Microbiol 2017; 7:123. [PMID: 28451522 PMCID: PMC5390016 DOI: 10.3389/fcimb.2017.00123] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Accepted: 03/27/2017] [Indexed: 02/06/2023] Open
Abstract
Background: The multiple banded antigen (MBA), a surface-exposed lipoprotein, is a proposed virulence factor of Ureaplasma spp. We previously demonstrated that the number of Ureaplasma parvum MBA size variants in amniotic fluid was inversely proportional to the severity of chorioamnionitis in experimentally infected pregnant sheep. However, the effect of ureaplasma MBA size variation on inflammation in human pregnancies has not been reported. Methods: Ureaplasmas isolated from the chorioamnion of pregnant women from a previous study (n = 42) were speciated/serotyped and MBA size variation was demonstrated by PCR and western blot. Results were correlated with the severity of chorioamnionitis and cord blood cytokines. In vitro, THP-1-derived macrophages were exposed to recombinant-MBA proteins of differing sizes and NF-κB activation and cytokine responses were determined. Results: MBA size variation was identified in 21/32 (65.6%) clinical isolates (in 10 clinical isolates MBA size variation was unable to be determined). Any size variation (increase/decrease) of the MBA (regardless of Ureaplasma species or serovar) was associated with mild or absent chorioamnionitis (P = 0.023) and lower concentrations of cord blood cytokines IL-8 (P = 0.04) and G-CSF (P = 0.008). In vitro, recombinant-MBA variants elicited different cytokine responses and altered expression of NF-κB p65. Conclusion: This study demonstrates that size variation of the ureaplasma MBA protein modulates the host immune response in vivo and in vitro.
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Affiliation(s)
- Emma L Sweeney
- Faculty of Health, School of Biomedical Sciences, Institute of Health and Biomedical Innovation, Queensland University of TechnologyBrisbane, QLD, Australia
| | - Suhas G Kallapur
- Division of Neonatology, Cincinnati Children's Hospital Medical CentreCincinnati, OH, USA
| | - Simone Meawad
- Faculty of Health, School of Biomedical Sciences, Institute of Health and Biomedical Innovation, Queensland University of TechnologyBrisbane, QLD, Australia
| | - Tate Gisslen
- Division of Neonatology, Cincinnati Children's Hospital Medical CentreCincinnati, OH, USA.,Division of Neonatology, Department of Paediatrics, University of MinnesotaMinneapolis, MN, USA
| | - Sally-Anne Stephenson
- Faculty of Health, School of Biomedical Sciences, Institute of Health and Biomedical Innovation, Queensland University of TechnologyBrisbane, QLD, Australia
| | - Alan H Jobe
- Division of Neonatology, Cincinnati Children's Hospital Medical CentreCincinnati, OH, USA
| | - Christine L Knox
- Faculty of Health, School of Biomedical Sciences, Institute of Health and Biomedical Innovation, Queensland University of TechnologyBrisbane, QLD, Australia
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33
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Musilova I, Andrys C, Drahosova M, Soucek O, Pliskova L, Jacobsson B, Kacerovsky M. Cervical fluid interleukin 6 and intra-amniotic complications of preterm prelabor rupture of membranes. J Matern Fetal Neonatal Med 2017; 31:827-836. [DOI: 10.1080/14767058.2017.1297792] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Ivana Musilova
- Department of Obstetrics and Gynecology, Charles University in Prague, Faculty of Medicine Hradec Kralove, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
| | - Ctirad Andrys
- Department of Clinical Immunology and Allergy, Charles University in Prague, Faculty of Medicine Hradec Kralove, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
| | - Marcela Drahosova
- Department of Clinical Immunology and Allergy, Charles University in Prague, Faculty of Medicine Hradec Kralove, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
| | - Ondrej Soucek
- Department of Clinical Immunology and Allergy, Charles University in Prague, Faculty of Medicine Hradec Kralove, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
| | - Lenka Pliskova
- Institute of Clinical Biochemistry and Diagnostics, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
| | - Bo Jacobsson
- Department of Obstetrics and Gynecology, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
- Domain of Health Data and Digitalization, Norwegian Institute of Public Health, Oslo, Norway
| | - Marian Kacerovsky
- Department of Obstetrics and Gynecology, Charles University in Prague, Faculty of Medicine Hradec Kralove, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
- Biomedical Research Center, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
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34
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Sweeney EL, Dando SJ, Kallapur SG, Knox CL. The Human Ureaplasma Species as Causative Agents of Chorioamnionitis. Clin Microbiol Rev 2017; 30:349-379. [PMID: 27974410 PMCID: PMC5217797 DOI: 10.1128/cmr.00091-16] [Citation(s) in RCA: 93] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The human Ureaplasma species are the most frequently isolated microorganisms from the amniotic fluid and placentae of women who deliver preterm and are also associated with spontaneous abortions or miscarriages, neonatal respiratory diseases, and chorioamnionitis. Despite the fact that these microorganisms have been habitually found within placentae of pregnancies with chorioamnionitis, the role of Ureaplasma species as a causative agent has not been satisfactorily explained. There is also controversy surrounding their role in disease, particularly as not all women infected with Ureaplasma spp. develop chorioamnionitis. In this review, we provide evidence that Ureaplasma spp. are associated with diseases of pregnancy and discuss recent findings which demonstrate that Ureaplasma spp. are associated with chorioamnionitis, regardless of gestational age at the time of delivery. Here, we also discuss the proposed major virulence factors of Ureaplasma spp., with a focus on the multiple-banded antigen (MBA), which may facilitate modulation/alteration of the host immune response and potentially explain why only subpopulations of infected women experience adverse pregnancy outcomes. The information presented within this review confirms that Ureaplasma spp. are not simply "innocent bystanders" in disease and highlights that these microorganisms are an often underestimated pathogen of pregnancy.
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Affiliation(s)
- Emma L Sweeney
- Institute of Health and Biomedical Innovation, Faculty of Health, School of Biomedical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Samantha J Dando
- Monash Biomedicine Discovery Institute, Department of Anatomy and Developmental Biology, Monash University, Clayton, Victoria, Australia
| | - Suhas G Kallapur
- Division of Neonatology, the Perinatal Institute, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio, USA
| | - Christine L Knox
- Institute of Health and Biomedical Innovation, Faculty of Health, School of Biomedical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
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35
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Feng L, Ransom CE, Nazzal MK, Allen TK, Li YJ, Truong T, Potts LC, Seed PC, Murtha AP. The Role of Progesterone and a Novel Progesterone Receptor, Progesterone Receptor Membrane Component 1, in the Inflammatory Response of Fetal Membranes to Ureaplasma parvum Infection. PLoS One 2016; 11:e0168102. [PMID: 27977732 PMCID: PMC5158007 DOI: 10.1371/journal.pone.0168102] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 11/24/2016] [Indexed: 01/02/2023] Open
Abstract
Ureaplasma parvum (U. parvum) is gaining recognition as an important pathogen for chorioamnionitis and preterm premature rupture of membranes. We aimed to investigate the roles of progesterone (P4) and a novel progesterone receptor, progesterone receptor membrane component 1 (PGRMC1), in the response of fetal membranes to U. parvum. Fetal membrane cells (amnion, chorion and decidua) were isolated and confirmed to be free of Mycoplasmataceae. Cells were treated with U. parvum (5x106 CFU), and adherence was quantified by qPCR. Amnion and chorion cells were transfected with scrambled siRNA or validated PGRMC1 siRNA for 72h. Cells were then treated with U. parvum for 4h with or without pretreatment with P4 (10−7 M) or ethanol for 1h. Interleukin-8 (IL-8), matrix metalloproteinase 9 (MMP9) and cyclooxygenase (COX-2) mRNA expression were quantified by qRT-PCR. Culture medium was harvested and analyzed for IL-8 and prostaglandin (PGE2) secretion by ELISA and MMP9 activity by zymography. U. parvum had a mean adherence of 15.0±0.6%, 16.9± 3.7% and 4.7±0.3% in cultured amnion, chorion and decidua cells, respectively. Exposure to U. parvum elicited significant inflammatory responses including induction of IL-8, COX-2, PGE2 and MMP9. A possible role of PGRMC1 was identified in the inhibition of U. parvum-stimulated COX-2 and MMP9 mRNA expression in chorion cells and MMP9 activity in amnion cells. On the other hand, it might enhance the U. parvum-stimulated IL-8 protein secretion in amnion cells. P4, mediated through PGRMC1, significantly inhibited U. Parvum-induced MMP9 mRNA and COX-2 mRNA expression in chorion cells. P4 appeared to attenuate U. parvum induced IL-8 mRNA expression in chorion cells, but this P4 effect might not mediated through PGRMC1. In summary, U. parvum preferentially adheres to and induces inflammatory responses in chorion and amnion cells. P4 and PGRMC1 appear to differentially modulate the inflammatory responses induced by U. parvum among amnion and chorion cells.
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Affiliation(s)
- Liping Feng
- Department of Obstetrics and Gynecology, Duke University, Durham, North Carolina, United States of America
- * E-mail:
| | - Carla E. Ransom
- Department of Obstetrics and Gynecology, Duke University, Durham, North Carolina, United States of America
| | - Matthew K. Nazzal
- Department of Obstetrics and Gynecology, Duke University, Durham, North Carolina, United States of America
| | - Terrence K. Allen
- Department of Anesthesiology, Duke University, Durham, North Carolina, United States of America
| | - Yi-Ju Li
- Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina, United States of America
| | - Tracy Truong
- Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina, United States of America
| | - Lauren C. Potts
- Department of Obstetrics and Gynecology, Duke University, Durham, North Carolina, United States of America
| | - Patrick C. Seed
- Department of Pediatrics, Duke University, Durham, North Carolina, United States of America
| | - Amy P. Murtha
- Department of Obstetrics and Gynecology, Duke University, Durham, North Carolina, United States of America
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36
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Cox C, Watt AP, McKenna JP, Coyle PV. Gardnerella vaginalis and Mollicute detection in rectal swabs from men who have sex with men. Int J STD AIDS 2016; 28:708-714. [PMID: 27542698 DOI: 10.1177/0956462416665060] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The numbers of rectal sexually transmitted infections are on the rise especially among men who have sex with men. Males from men who have sex with men population are encouraged to send a rectal swab to the laboratory for sexually transmitted infection screening at their visit to the Genitourinary Medicine Clinic. In healthy asymptomatic males, the range of pathogens tested is limited therefore other pathogens may be left untreated allowing infections to persist among sexual partners. Molecular techniques have revolutionarised sexually transmitted infection testing enabling the detection of previously difficult-to-culture pathogens in extra-genital sites and have increased the evidence base for their clinical significance. The present study tests 107 rectal swabs from men who have sex with men negative for Chlamydia trachomatis and Neisseria gonorrhoeae against quantitative polymerase chain reaction (qPCR) assays targeting five common sexually transmitted bacteria which include Mycoplasma genitalium, Mycoplasma hominis, Ureaplasma urealyticum, Ureaplasma parvum and Gardnerella vaginalis. The pathogenic role of these five bacteria in men who have sex with men is currently unknown. Amongst the 107 patients, a positive qPCR was obtained respectively for G. vaginalis 89 (83.2%); U. urealyticum 26 (24.3%); M. hominis 26 (24.3%); M. genitalium 10 (9.3%) and U. parvum 5 (4.7%). Bacterial loads in single and co-infections were compared for each organism. G. vaginalis and M. hominis loads were significantly ( p = 0.007 and p = 0.005, respectively) higher when co-infecting with at least one other organism. Amongst co-infections, the loads of each organism were assessed to determine possible synergies. G. vaginalis and M. hominis displayed a synergistic pattern ( r = 0.51; p = 0.02) which is in keeping with a similar synergy detected previously in the vagina of women with bacterial vaginosis. This study outlines that potential significant infections are being missed in men who have sex with men population; however, further research is warranted to confirm a pathogenesis in the rectal mucosa before routine screening can be introduced to clinical settings.
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Affiliation(s)
- Ciara Cox
- Regional Virus Laboratory, Belfast Health and Social Care Trust, Northern Ireland and Centre for Infection and Immunity, Queens University Belfast, Belfast, Northern Ireland
| | - Alison P Watt
- Regional Virus Laboratory, Belfast Health and Social Care Trust, Northern Ireland and Centre for Infection and Immunity, Queens University Belfast, Belfast, Northern Ireland
| | - James P McKenna
- Regional Virus Laboratory, Belfast Health and Social Care Trust, Northern Ireland and Centre for Infection and Immunity, Queens University Belfast, Belfast, Northern Ireland
| | - Peter V Coyle
- Regional Virus Laboratory, Belfast Health and Social Care Trust, Northern Ireland and Centre for Infection and Immunity, Queens University Belfast, Belfast, Northern Ireland
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37
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Musilova I, Andrys C, Drahosova M, Soucek O, Stepan M, Bestvina T, Spacek R, Jacobsson B, Cobo T, Kacerovsky M. Intraamniotic inflammation and umbilical cord blood interleukin-6 concentrations in pregnancies complicated by preterm prelabor rupture of membranes. J Matern Fetal Neonatal Med 2016; 30:900-910. [PMID: 27265200 DOI: 10.1080/14767058.2016.1197900] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To evaluate umbilical cord blood interleukin (IL)-6 concentrations and the occurrence of fetal inflammatory response syndrome (FIRS) with respect to microbial invasion of the amniotic cavity (MIAC) and/or intraamniotic inflammation (IAI) in pregnancies complicated by preterm prelabor rupture of membranes (PPROM). METHODS One-hundred-eighty-eight women with singleton pregnancies complicated by PPROM between gestational ages of 24 + 0 and 36 + 6 weeks were included in the study. Blood samples were obtained by venipuncture from the umbilical cord after the delivery of the newborn. The umbilical cord blood IL-6 concentrations were evaluated using ELISA kits. FIRS was defined as umbilical cord blood IL-6 > 11 pg/mL. RESULT Women with MIAC and IAI had higher IL-6 concentrations than women without these complications (with MIAC: median 18.1 pg/mL versus without MIAC: median 5.8; p < 0.0001; with IAI: median 32.9 pg/mL, versus without IAI: median 5.8; p < 0.0001). Women with IAI with MIAC and women with IAI without MIAC had the highest umbilical cord blood IL-6 concentrations (medians: 32.6 and 39.4 pg/mL) and rates of FIRS (78% and 67%). CONCLUSIONS IAI was associated with the highest umbilical cord blood IL-6 concentrations and rate of FIRS independent of the presence or absence of MIAC.
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Affiliation(s)
- Ivana Musilova
- a Department of Obstetrics and Gynecology , Faculty of Medicine, Charles University in Prague, Hradec Kralove, University Hospital Hradec Kralove , Hradec Kralove , Czech Republic
| | - Ctirad Andrys
- b Department of Clinical Immunology and Allergy , Faculty of Medicine, Charles University in Prague, Hradec Kralove, University Hospital Hradec Kralove , Hradec Kralove , Czech Republic
| | - Marcela Drahosova
- b Department of Clinical Immunology and Allergy , Faculty of Medicine, Charles University in Prague, Hradec Kralove, University Hospital Hradec Kralove , Hradec Kralove , Czech Republic
| | - Ondrej Soucek
- b Department of Clinical Immunology and Allergy , Faculty of Medicine, Charles University in Prague, Hradec Kralove, University Hospital Hradec Kralove , Hradec Kralove , Czech Republic
| | - Martin Stepan
- a Department of Obstetrics and Gynecology , Faculty of Medicine, Charles University in Prague, Hradec Kralove, University Hospital Hradec Kralove , Hradec Kralove , Czech Republic
| | - Tomas Bestvina
- a Department of Obstetrics and Gynecology , Faculty of Medicine, Charles University in Prague, Hradec Kralove, University Hospital Hradec Kralove , Hradec Kralove , Czech Republic
| | - Richard Spacek
- c Department of Obstetrics and Gynecology , Faculty of Medicine, Ostrava University , Ostrava , Czech Republic
| | - Bo Jacobsson
- d Department of Obstetrics and Gynecology , Sahlgrenska Academy, Gothenburg University , Gothenburg , Sweden.,e Department of Genetics and Bioinformatics Area of Health Data and Digitalisation , Institute of Public Health , Oslo , Norway
| | - Teresa Cobo
- d Department of Obstetrics and Gynecology , Sahlgrenska Academy, Gothenburg University , Gothenburg , Sweden.,f BCNatal-Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan De Deu), Fetal I + D Fetal Medicine Research Center, IDIBAPS, University of Barcelona , Barcelona , Spain.,g Center for Biomedical Research on Rare Diseases (CIBER-ER) , Barcelona , Spain , and
| | - Marian Kacerovsky
- a Department of Obstetrics and Gynecology , Faculty of Medicine, Charles University in Prague, Hradec Kralove, University Hospital Hradec Kralove , Hradec Kralove , Czech Republic.,h Biomedical Research Center, University Hospital Hradec Kralove , Hradec Kralove , Czech Republic
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38
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Glaser K, Speer CP. Neonatal CNS infection and inflammation caused by Ureaplasma species: rare or relevant? Expert Rev Anti Infect Ther 2016; 13:233-48. [PMID: 25578885 DOI: 10.1586/14787210.2015.999670] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Colonization with Ureaplasma species has been associated with adverse pregnancy outcome, and perinatal transmission has been implicated in the development of bronchopulmonary dysplasia in preterm neonates. Little is known about Ureaplasma-mediated infection and inflammation of the CNS in neonates. Controversy remains concerning its incidence and implication in the pathogenesis of neonatal brain injury. In vivo and in vitro data are limited. Despite improving care options for extremely immature preterm infants, relevant complications remain. Systematic knowledge of ureaplasmal infection may be of great benefit. This review aims to summarize pathogenic mechanisms, clinical data and diagnostic pitfalls. Studies in preterm and term neonates are critically discussed with regard to their limitations. Clinical questions concerning therapy or prophylaxis are posed. We conclude that ureaplasmas may be true pathogens, especially in preterm neonates, and may cause CNS inflammation in a complex interplay of host susceptibility, serovar pathogenicity and gestational age-dependent CNS vulnerability.
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Affiliation(s)
- Kirsten Glaser
- University Children's Hospital, University of Würzburg, Josef-Schneider-Str. 2, D-97080 Würzburg, Germany
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39
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Keelan JA, Payne MS, Kemp MW, Ireland DJ, Newnham JP. A New, Potent, and Placenta-Permeable Macrolide Antibiotic, Solithromycin, for the Prevention and Treatment of Bacterial Infections in Pregnancy. Front Immunol 2016; 7:111. [PMID: 27066004 PMCID: PMC4817400 DOI: 10.3389/fimmu.2016.00111] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2015] [Accepted: 03/14/2016] [Indexed: 01/24/2023] Open
Abstract
Intrauterine infection–inflammation is a major cause of early preterm birth and subsequent neonatal mortality and acute or long-term morbidity. Antibiotics can be administered in pregnancy to prevent preterm birth either prophylactically to women at high risk for preterm delivery, or to women with diagnosed intrauterine infection, prelabor rupture of membranes, or in suspected preterm labor. The therapeutic goals of each of these scenarios are different, with different pharmacological considerations, although effective antimicrobial therapy is an essential requirement. An ideal antibiotic for these clinical indications would be (a) one that is easily administered and orally bioactive, (b) has a favorable adverse effect profile (devoid of reproductive toxicity or teratogenicity), (c) is effective against the wide range of microorganisms known to be commonly associated with intra-amniotic infection, (d) provides effective antimicrobial protection within both the fetal and amniotic compartments after maternal delivery, (e) has anti-inflammatory properties, and (f) is effective against antibiotic-resistant microorganisms. Here, we review the evidence from clinical, animal, and ex vivo/in vitro studies that demonstrate that a new macrolide-derived antibiotic – solithromycin – has all of these properties and, hence, may be an ideal antibiotic for the treatment and prevention of intrauterine infection-related pregnancy complications. While this evidence is extremely encouraging, it is still preliminary. A number of key studies need to be completed before solithromycin’s true potential for use in pregnancy can be ascertained.
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Affiliation(s)
- Jeffrey A Keelan
- King Edward Memorial Hospital, School of Women's and Infants' Health, University of Western Australia , Perth, WA , Australia
| | - Matthew S Payne
- King Edward Memorial Hospital, School of Women's and Infants' Health, University of Western Australia , Perth, WA , Australia
| | - Matthew W Kemp
- King Edward Memorial Hospital, School of Women's and Infants' Health, University of Western Australia , Perth, WA , Australia
| | - Demelza J Ireland
- King Edward Memorial Hospital, School of Women's and Infants' Health, University of Western Australia , Perth, WA , Australia
| | - John P Newnham
- King Edward Memorial Hospital, School of Women's and Infants' Health, University of Western Australia , Perth, WA , Australia
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40
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Potts LC, Feng L, Seed PC, Jayes FL, Kuchibhatla M, Antczak B, Nazzal MK, Murtha AP. Inflammatory Response of Human Gestational Membranes to Ureaplasma parvum Using a Novel Dual-Chamber Tissue Explant System. Biol Reprod 2016; 94:119. [PMID: 27009041 DOI: 10.1095/biolreprod.115.137596] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2015] [Accepted: 03/14/2016] [Indexed: 11/01/2022] Open
Abstract
Preterm premature rupture of membranes (PPROM) is often associated with intra-amniotic inflammation and infection. Current understanding of the pathogenesis of PPROM includes activation of pro-inflammatory cytokines and proteolytic enzymes leading to compromise of membrane integrity. The impact of exposure to bacterial pathogens, including Ureaplasma parvum, on gestational membranes is poorly understood. Our objective was to develop a dual-chamber system to characterize the inflammatory response of gestational membranes to U. parvum in a directional nature. Full-thickness human gestational membrane explants, with either choriodecidua or amnion oriented superiorly, were suspended between two washers in a cylindrical device, creating two distinct compartments. Brilliant green dye was introduced into the top chamber to assess the integrity of the system. Tissue viability was evaluated after 72 h using a colorimetric cell proliferation assay. Choriodecidua or amnion was exposed to three doses of U. parvum and incubated for 24 h. Following treatment, media from each compartment were used for quantification of U. parvum (quantitative PCR), interleukin (IL)-8 (enzyme-linked immunosorbent assay), and matrix metalloproteinase (MMP)-2 and MMP-9 activity (zymography). We observed that system integrity and explant viability were maintained over 72 h. Dose-dependent increases in recovered U. parvum, IL-8 concentration, and MMP-2 activity were detected in both compartments. Significant differences in IL-8 concentration and MMP-9 activity were found between the choriodecidua and amnion. This tissue explant system can be used to investigate the inflammatory consequences of directional bacterial exposure for gestational membranes and provides insight into the pathogenesis of PPROM and infectious complications of pregnancy.
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Affiliation(s)
- Lauren C Potts
- Department of Obstetrics and Gynecology, Duke University, Durham, North Carolina
| | - Liping Feng
- Department of Obstetrics and Gynecology, Duke University, Durham, North Carolina
| | - Patrick C Seed
- Department of Pediatrics, Duke University, Durham, North Carolina
| | - Friederike L Jayes
- Department of Obstetrics and Gynecology, Duke University, Durham, North Carolina Department of Pathology, Duke University, Durham, North Carolina
| | - Maragatha Kuchibhatla
- Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina
| | - Brian Antczak
- Department of Obstetrics and Gynecology, Duke University, Durham, North Carolina
| | - Matthew K Nazzal
- Department of Obstetrics and Gynecology, Duke University, Durham, North Carolina
| | - Amy P Murtha
- Department of Obstetrics and Gynecology, Duke University, Durham, North Carolina Department of Pediatrics, Duke University, Durham, North Carolina
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Cox C, Saxena N, Watt AP, Gannon C, McKenna JP, Fairley DJ, Sweet D, Shields MD, L Cosby S, Coyle PV. The common vaginal commensal bacterium Ureaplasma parvum is associated with chorioamnionitis in extreme preterm labor. J Matern Fetal Neonatal Med 2016; 29:3646-51. [PMID: 26795404 DOI: 10.3109/14767058.2016.1140734] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To assess the association of vaginal commensal and low-grade pathogenic bacteria including Ureaplasma parvum, Ureaplasma urealyticum, Mycoplasma hominis, Mycoplasma genitalium, Group B streptococcus (GBS), and Gardnerella vaginalis, in women who delivered preterm at less than 37-week gestation in the presence or absence of inflammation of the chorioamnionitic membranes. METHODS A case control study involving women who delivered before 37-week gestation with and without inflammation of chorioamnionitic membranes. A total of 57 placental samples were histologically examined for polymorphonuclear leukocyte infiltration of placental tissue for evidence of chorioamnionitis, and by type-specific nucleic acid amplification for evidence of infection with one or more of the target bacteria. Demographic data were collected for each mother. RESULTS Among the 57 placental samples, 42.1% had chorioamnionitis and 24.6% delivered in the second trimester of pregnancy; U. parvum, U. urealyticum, G. vaginalis, and GBS were all detected in the study with respective prevalence of 19.3%, 3.5%, 17.5%, and 15.8%; M. genitalium and M. hominis were not detected. U. parvum was significantly associated with chorioamnionitis (p = 0.02; OR 5.0; (95% CI 1.2-21.5) and was more common in women who delivered in the second (35.7%) compared to the third trimester of pregnancy (13.9%). None of the other bacteria were associated with chorioamnionitis or earlier delivery, and all G. vaginalis-positive women delivered in the third trimester of pregnancy (p = 0.04). CONCLUSIONS The detection of U. parvum in placental tissue was significantly associated with acute chorioamnionitis in women presenting in extreme preterm labor.
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Affiliation(s)
- Ciara Cox
- a Department of Microbiology , Belfast Health and Social Care Trust , Belfast , Northern Ireland , UK .,b Centre for Infection and Immunity, Queen's University Belfast , Northern Ireland , UK
| | - Nita Saxena
- c Royal Belfast Hospital for Sick Children, Royal Hospitals Group , Belfast , UK , and
| | - Alison P Watt
- a Department of Microbiology , Belfast Health and Social Care Trust , Belfast , Northern Ireland , UK
| | - Caroline Gannon
- d Department of Pathology , Belfast Health and Social Care Trust , Belfast , Northern Ireland , UK
| | - James P McKenna
- a Department of Microbiology , Belfast Health and Social Care Trust , Belfast , Northern Ireland , UK
| | - Derek J Fairley
- a Department of Microbiology , Belfast Health and Social Care Trust , Belfast , Northern Ireland , UK .,b Centre for Infection and Immunity, Queen's University Belfast , Northern Ireland , UK
| | - David Sweet
- c Royal Belfast Hospital for Sick Children, Royal Hospitals Group , Belfast , UK , and
| | - Michael D Shields
- b Centre for Infection and Immunity, Queen's University Belfast , Northern Ireland , UK .,c Royal Belfast Hospital for Sick Children, Royal Hospitals Group , Belfast , UK , and
| | - Sara L Cosby
- b Centre for Infection and Immunity, Queen's University Belfast , Northern Ireland , UK
| | - Peter V Coyle
- a Department of Microbiology , Belfast Health and Social Care Trust , Belfast , Northern Ireland , UK
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42
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Sweeney EL, Kallapur SG, Gisslen T, Lambers DS, Chougnet CA, Stephenson SA, Jobe AH, Knox CL. Placental Infection With Ureaplasma species Is Associated With Histologic Chorioamnionitis and Adverse Outcomes in Moderately Preterm and Late-Preterm Infants. J Infect Dis 2015; 213:1340-7. [PMID: 26671889 DOI: 10.1093/infdis/jiv587] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Accepted: 11/19/2015] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVE The human Ureaplasma species are the microbes most frequently isolated from placentae of women who deliver preterm. The role of Ureaplasma species has been investigated in pregnancies at <32 weeks of gestation, but currently no studies have determined the prevalence of ureaplasmas in moderately preterm and late-preterm (hereafter, "moderate/late preterm") infants, the largest cohort of preterm infants. METHODS Women delivering moderate/late preterm infants (n = 477) and their infants/placentae (n = 535) were recruited, and swab specimens of chorioamnion tissue, chorioamnion tissue specimens, and cord blood specimens were obtained at delivery. Swab and tissue specimens were cultured and analyzed by 16S ribosomal RNA polymerase chain reaction (PCR) for the presence of microorganisms, while cord blood specimens were analyzed for the presence of cytokines, chemokines, and growth factors. RESULTS We detected microorganisms in 10.6% of 535 placentae (443 were delivered late preterm and 92 were delivered at term). Significantly, Ureaplasma species were the most prevalent microorganisms, and their presence alone was associated with histologically confirmed chorioamnionitis in moderate/late preterm and term placentae (P < .001). The presence of ureaplasmas in the chorioamnion was also associated with elevated levels of granulocyte colony-stimulating factor (P = .02). CONCLUSIONS These findings have important implications for infection and adverse pregnancy outcomes throughout gestation and should be of major consideration for obstetricians and neonatologists.
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Affiliation(s)
- Emma L Sweeney
- Institute of Health and Biomedical Innovation, Biomedical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | | | | | | | - Claire A Chougnet
- Division of Immunobiology, Cincinnati Children's Hospital Medical Centre, Ohio
| | - Sally-Anne Stephenson
- Institute of Health and Biomedical Innovation, Biomedical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | | | - Christine L Knox
- Institute of Health and Biomedical Innovation, Biomedical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, Australia
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43
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Cox C, McKenna JP, Watt AP, Coyle PV. Ureaplasma parvum and Mycoplasma genitalium are found to be significantly associated with microscopy-confirmed urethritis in a routine genitourinary medicine setting. Int J STD AIDS 2015; 27:861-7. [PMID: 26378187 DOI: 10.1177/0956462415597620] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Accepted: 06/29/2015] [Indexed: 11/17/2022]
Abstract
Inflammation of the urethra defined by an excess of polymorphonuclear leukocytes in the absence of sexually transmitted Chlamydia trachomatis and Neisseria gonorrhoeae is called non-chlamydial non-gonococcal urethritis (NCNGU). Although Mycoplasma genitalium is now recognised as causing a sexually transmitted infection, the clinical significance of the other Mollicute species is less clear. This study used specific real-time quantitative polymerase chain reaction assays to detect and quantify four Mollicute species, M. genitalium, M. hominis, Ureaplasma urealyticum and U. parvum, in urine specimens from men with and without NCNGU. A total of 165 urine specimens from male patients attending a genitourinary medicine clinic were eligible for the study, with microscopy-confirmed (≥5 polymorphonuclear leukocytes in urethral swab) NCNGU in 75 (45.5%) and non-confirmed NCNGU in 90 (54.5%). Chi-squared statistical analysis indicated a significantly higher prevalence of U. parvum (17.3% vs. 5.6%; p = 0.03) and M. genitalium (12% vs. 0%; p < 0.001) in NCNGU. In a subset analysis, M. genitalium was also significantly (p = 0.03) higher in men who have sex with men (MSM; 13.5%) compared to non-MSM (3.1%). No significant associations were reported for U. urealyticum and M. hominis In conclusion, this study supports a clinically significant role in NGNCU for both U. parvum and M. genitalium.
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Affiliation(s)
- Ciara Cox
- Regional Virus Laboratory, Belfast Health and Social Care Trust, Belfast, UK
| | - James P McKenna
- Regional Virus Laboratory, Belfast Health and Social Care Trust, Belfast, UK
| | - Alison P Watt
- Regional Virus Laboratory, Belfast Health and Social Care Trust, Belfast, UK
| | - Peter V Coyle
- Regional Virus Laboratory, Belfast Health and Social Care Trust, Belfast, UK
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Prevalence of early-onset neonatal infection among newborns of mothers with bacterial infection or colonization: a systematic review and meta-analysis. BMC Infect Dis 2015; 15:118. [PMID: 25886298 PMCID: PMC4364328 DOI: 10.1186/s12879-015-0813-3] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Accepted: 02/09/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although neonatal infections cause a significant proportion of deaths in the first week of life, little is known about the burden of neonatal disease originating from maternal infection or colonization globally. This paper describes the prevalence of vertical transmission--the percentage of newborns with neonatal infection among newborns exposed to maternal infection. METHODS We searched Pubmed, Embase, Scopus, Web of Science, Cochrane Library, and WHO Regional Databases for studies of maternal infection, vertical transmission, and neonatal infection. Studies that measured prevalence of bacterial vertical transmission were included. Random effects meta-analyses were used to pool data to calculate prevalence estimates of vertical transmission. RESULTS 122 studies met the inclusion criteria. Only seven studies (5.7%) were from very high neonatal mortality settings. Considerable heterogeneity existed between studies given the various definitions of infection (lab-confirmed, clinical signs), colonization, and risk factors of infection. The prevalence of early onset neonatal lab-confirmed infection among newborns of mothers with lab-confirmed infection was 17.2% (95%CI 6.5-27.9). The prevalence of neonatal lab-confirmed infection among newborns of colonized mothers was 0% (95% CI 0.0-0.0). The prevalence of neonatal surface colonization among newborns of colonized mothers ranged from 30.9-45.5% depending on the organism. The prevalence of neonatal lab-confirmed infection among newborns of mothers with risk factors (premature rupture of membranes, preterm premature rupture of membranes, prolonged rupture of membranes) ranged from 2.9-19.2% depending on the risk factor. CONCLUSIONS The prevalence of early-onset neonatal infection is high among newborns of mothers with infection or risk factors for infection. More high quality studies are needed particularly in high neonatal mortality settings to accurately estimate the prevalence of early-onset infection among newborns at risk.
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45
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Khosropour CM, Manhart LE, Gillespie CW, Lowens MS, Golden MR, Jensen NL, Kenny GE, Totten PA. Efficacy of standard therapies against Ureaplasma species and persistence among men with non-gonococcal urethritis enrolled in a randomised controlled trial. Sex Transm Infect 2015; 91:308-13. [PMID: 25616607 DOI: 10.1136/sextrans-2014-051859] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Accepted: 12/29/2014] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVE Ureaplasma urealyticum biovar 2 (UU-2), but not Ureaplasma parvum (UP), has been associated with non-gonococcal urethritis (NGU), but little is known about species-specific responses to standard therapies. We examined species-specific treatment outcomes and followed men with treatment failure for 9 weeks. METHODS From May 2007 to July 2011, men aged ≥16 attending a sexually transmitted disease (STD) clinic in Seattle, Washington, with NGU (urethral discharge or urethral symptoms plus ≥5 polymorphonuclear leucocytes /high-powered field) enrolled in a double-blind, randomised trial. Participants received active azithromycin (1 g) + placebo doxycycline or active doxycycline (100 mg twice a day ×7 days) + placebo azithromycin. Ureaplasma were detected in culture followed by species-specific PCR. Outcomes were assessed at 3, 6 and 9 weeks. At 3 weeks, men with persistent Ureaplasma detection received 'reverse therapy' (e.g., active doxycycline if they first received active azithromycin). At 6 weeks, persistently positive men received moxifloxacin (400 mg×7 days). RESULTS Of 490 men, 107 (22%) and 60 (12%) were infected with UU-2 and UP, respectively, and returned at 3 weeks. Persistent detection was similar for UU-2-infected men initially treated with azithromycin or doxycycline (25% vs. 31%; p=0.53), but differed somewhat for men with UP (45% vs. 24%; p=0.11). At 6 weeks, 57% of UU-2-infected and 63% of UP-infected men who received both drugs had persistent detection. Failure after moxifloxacin occurred in 30% and 36%, respectively. Persistent detection of UU-2 or UP was not associated with signs/symptoms of NGU. CONCLUSIONS Persistent detection after treatment with doxycycline, azithromycin and moxifloxacin was common for UU and UP, but not associated with persistent urethritis. TRIAL REGISTRATION NUMBER NCT00358462.
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Affiliation(s)
| | - Lisa E Manhart
- Department of Epidemiology, University of Washington, Seattle, WA, USA Department of Global Health, University of Washington, Seattle, WA, USA
| | - Catherine W Gillespie
- Department of Epidemiology, University of Washington, Seattle, WA, USA Children's National Health System, Washington, DC, USA
| | - M Sylvan Lowens
- Public Health - Seattle and King County HIV/STD Program, Seattle, WA, USA
| | - Matthew R Golden
- Department of Epidemiology, University of Washington, Seattle, WA, USA Public Health - Seattle and King County HIV/STD Program, Seattle, WA, USA Department of Medicine, University of Washington, Seattle, WA, USA
| | - Nicole L Jensen
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - George E Kenny
- Department of Medicine, University of Washington, Seattle, WA, USA
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46
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Maternal Genital Tract Infection. Mucosal Immunol 2015. [DOI: 10.1016/b978-0-12-415847-4.00113-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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47
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Chlamydia trachomatis and Genital Mycoplasmas: Pathogens with an Impact on Human Reproductive Health. J Pathog 2014; 2014:183167. [PMID: 25614838 PMCID: PMC4295611 DOI: 10.1155/2014/183167] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Revised: 12/09/2014] [Accepted: 12/11/2014] [Indexed: 11/30/2022] Open
Abstract
The most prevalent, curable sexually important diseases are those caused by Chlamydia trachomatis (C. trachomatis) and genital mycoplasmas. An important characteristic of these infections is their ability to cause long-term sequels in upper genital tract, thus potentially affecting the reproductive health in both sexes. Pelvic inflammatory disease (PID), tubal factor infertility (TFI), and ectopic pregnancy (EP) are well documented complications of C. trachomatis infection in women. The role of genital mycoplasmas in development of PID, TFI, and EP requires further evaluation, but growing evidence supports a significant role for these in the pathogenesis of chorioamnionitis, premature membrane rupture, and preterm labor in pregnant woman. Both C. trachomatis and genital mycoplasmas can affect the quality of sperm and possibly influence the fertility of men. For the purpose of this paper, basic, epidemiologic, clinical, therapeutic, and public health issue of these infections were reviewed and discussed, focusing on their impact on human reproductive health.
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48
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Musilova I, Pliskova L, Kutova R, Hornychova H, Jacobsson B, Kacerovsky M. Ureaplasma species and Mycoplasma hominis in cervical fluid of pregnancies complicated by preterm prelabor rupture of membranes. J Matern Fetal Neonatal Med 2014; 29:1-7. [PMID: 25369771 DOI: 10.3109/14767058.2014.984606] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To evaluate Ureaplasma species and Mycoplasma hominis DNA in the cervical fluid and their association with microbial invasion of the amniotic cavity (MIAC) and/or histological chorioamnionitis (HCA) in pregnancies complicated by preterm prelabor rupture of membranes (PPROM). STUDY DESIGN A prospective study of 68 women with singleton pregnancies complicated by PPROM between 24(0/7) and 36(6/7) weeks was conducted. Cervical fluid and amniotic fluid were collected from all women at the time of admission. The Ureaplasma species and Mycoplasma hominis DNA in the cervical fluid were identified using specific real-time PCR. RESULTS Ureaplasma species and Mycoplasma hominis DNA were identified in 59% (40/69) of the cervical fluid samples. Women with the presence of Ureaplasma species DNA with and without Mycoplasma hominis DNA in the cervical fluid had a higher rate of MIAC alone [35% (14/40) versus 11% (3/28); p = 0.02] and a higher rate of the presence of both MIAC and HCA [30% (12/40) versus 4% (1/28); p = 0.01] than women without Ureaplasma species and Mycoplasma hominis DNA in the cervical fluid. CONCLUSIONS The presence of Ureaplasma species DNA with and without Mycoplasma hominis DNA in the cervical fluid is associated with a higher risk of MIAC or MIAC and HCA together in pregnancies complicated by PPROM.
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Affiliation(s)
- Ivana Musilova
- a Department of Obstetrics and Gynecology, Faculty of Medicine , Charles University in Prague , Hradec Kralove , Czech Republic
| | - Lenka Pliskova
- b Institute of Clinical Biochemistry and Diagnostics, Charles University in Prague, Faculty of Medicine Hradec Kralove, University Hospital Hradec Kralove , Czech Republic
| | - Radka Kutova
- b Institute of Clinical Biochemistry and Diagnostics, Charles University in Prague, Faculty of Medicine Hradec Kralove, University Hospital Hradec Kralove , Czech Republic
| | - Helena Hornychova
- c Fingerland's Department of Pathology , Charles University in Prague, Faculty of Medicine Hradec Kralove, University Hospital Hradec Kralove , Czech Republic
| | - Bo Jacobsson
- d Department of Obstetrics and Gynecology , Sahlgrenska Academy , Gothenburg , Sweden .,e Department of Genes and Environment, Division of Epidemiology , Norwegian Institute of Public Health , Oslo , Norway , and
| | - Marian Kacerovsky
- a Department of Obstetrics and Gynecology, Faculty of Medicine , Charles University in Prague , Hradec Kralove , Czech Republic .,f Biomedical Research Center, University Hospital Hradec Kralove , Czech Republic
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Agger WA, Siddiqui D, Lovrich SD, Callister SM, Borgert AJ, Merkitch KW, Mason TC, Baumgardner DJ, Burmester JK, Shukla SK, Welter JD, Stewart KS, Washburn M, Bailey HH. Epidemiologic factors and urogenital infections associated with preterm birth in a midwestern U.S. population. Obstet Gynecol 2014; 124:969-977. [PMID: 25437726 PMCID: PMC4251709 DOI: 10.1097/aog.0000000000000470] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To correlate epidemiologic factors with urogenital infections associated with preterm birth. METHODS Pregnant women were sequentially included from four Wisconsin cohorts: large urban, midsize urban, small city, and rural city. Demographic, clinical, and current pregnancy data were collected. Cervical and urine specimens were analyzed by microscopy, culture, and polymerase chain reaction for potential pathogens. RESULTS Six hundred seventy-six women were evaluated. Fifty-four (8.0%) had preterm birth: 12.1% (19/157) large urban, 8.8% (15/170) midsize urban, 9.4% (16/171) small city, and 2.3% (4/178) rural city. Associated host factors and infections varied significantly among sites. Urogenital infection rates, especially Mycoplasma hominis and Ureaplasma parvum, were highest at the large urban site. Large urban site, minority ethnicity, multiple infections, and certain historical factors were associated with preterm birth by univariable analysis. By multivariable analysis, preterm birth was associated with prior preterm birth (adjusted odds ratio [aOR] 2.76, 95% confidence interval [CI] 1.27-6.02) and urinary tract infection (aOR 2.62, 95% CI 1.32-519), and negatively associated with provider-assessed good health (aOR 0.42, 95% CI 0.23-0.76) and group B streptococcal infection treatment (surrogate for health care use) (aOR 0.38, 95% CI 0.15-.99). Risk and protective factors were similar for women with birth at less than 35 weeks, and additionally associated with M hominis (aOR 3.6, 95% CI 1.4-9.7). CONCLUSION These measured differences among sites are consistent with observations that link epidemiologic factors, both environmental and genetic, with minimally pathogenic vaginal bacteria, inducing preterm birth, especially at less than 35 weeks of gestation.
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Affiliation(s)
- William A. Agger
- Gundersen Health System, La Crosse
- Gundersen Medical Foundation, La Crosse
| | | | | | | | | | | | | | | | | | | | | | | | - M.J. Washburn
- Wisconsin Network for Health Research Central Administration, Madison
| | - Howard H. Bailey
- University of Wisconsin, Madison
- Wisconsin Network for Health Research Central Administration, Madison
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50
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Murtha AP, Edwards JM. The role of Mycoplasma and Ureaplasma in adverse pregnancy outcomes. Obstet Gynecol Clin North Am 2014; 41:615-27. [PMID: 25454994 DOI: 10.1016/j.ogc.2014.08.010] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Genital mycoplasmas are frequently found in the vaginal flora across socioeconomic and ethnic groups and have been demonstrated to be involved in adverse perinatal outcomes. Both Mycoplasma and Ureaplasma spp cause inflammation potentially leading to spontaneous preterm birth and PPROM as well as postdelivery infectious complications and neonatal infections. Herein we have provided an overview of the existing literature and supportive evidence for genital mycoplasma's role in perinatal complications. Future research will need to focus on clearly delineating the species, allowing for discrimination of their effects.
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Affiliation(s)
- Amy P Murtha
- Department of Obstetrics and Gynecology, Duke University Medical Center, 2608 Erwin Road, Suite 200, Durham, NC 27705, USA; Division of Maternal Fetal Medicine, Duke University Medical Center, 2608 Erwin Road, Suite 200, Durham, NC 27705, USA; Department of Pediatrics, Duke University Medical Center, 2608 Erwin Road, Suite 200, Durham, NC 27705, USA.
| | - James M Edwards
- Department of Obstetrics and Gynecology, Duke University Medical Center, 2608 Erwin Road, Suite 200, Durham, NC 27705, USA
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