Effects of TIMP1 rs4898 Gene Polymorphism on Early-Onset Preeclampsia Development and Placenta Weight

Introduction: Some evidence indicates that the improper trophoblast invasion of maternal spiral arteries could be caused by an imbalance between matrix metalloproteinases (MMPs) and tissue inhibitors of metalloproteinases (TIMPs), leading to preeclampsia (PE) development. This study aimed to assess the potential role of MMP1, MMP9, TIMP1 and TIMP2 gene polymorphisms in the pathogenesis of PE. Materials and methods: A total of 308 Polish women, 115 preeclamptic (55 with early-onset preeclampsia [EOPE], 60 with late-onset preeclampsia [LOPE]) and 193 healthy pregnant women, all of Caucasian origin, were recruited to the study. PE was diagnosed following the ACOG criteria. The polymorphic variants of the MMP-TIMP pathway (MMP1 rs1799750, MMP9 rs17576, MMP9 rs17577, TIMP1 rs4898, TIMP2 rs2277698, TIMP2 rs55743137) were genotyped by polymerase chain reaction and restriction fragment length polymorphism. Results: Analyzing all SNPs in the MMP-TIMP pathway, no significant differences in allele frequencies between preeclamptic women and controls were observed. However, comparing the EOPE and LOPE groups with each other, we observed a statistically significant difference between them for the TIMP1 rs4898 variant. In the whole group of 308 women, the mean placenta weight was the lowest in carriers of the rs4898 CC genotype. Post hoc analysis revealed significant differences between CC-CT (p = 0.0209) and CC-TT (p = 0.0469). Additionally, during allele analysis, a statistically significant difference in the mean placenta weight (for C allele 529.32 ± 157.11 g, for T allele 560.24 ± 162.24 g, p = 0.021) was also observed. Conclusion: Our findings suggest a relationship between TIMP1 rs4898 (372T > C) polymorphism and increased risk of early-onset preeclampsia in a population of pregnant Polish women. Our data suggest that the TIMP1 rs4898 C allele might be associated with increased risk for early-onset, but not for late-onset preeclampsia. To evaluate the role of the TIMP1 polymorphic variants in the etiopathology of preeclampsia, further studies with a larger sample size are needed.

FokI vitamin D receptor polymorphism as a protective factor in intrahepatic cholestasis of pregnancy

OBJECTIVES

Intrahepatic cholestasis in pregnancy (ICP) is a pregnancy-specific liver disorder. Its etiology is not fully understood. Increasing evidence indicates the important role of vitamin D and the vitamin D receptor (VDR) in this disorder. The presence of polymorphic variants in the VDR gene could influence its activity and susceptibility to ICP development. The goal of the study was to investigate the role of four genetic polymorphisms of the VDR gene - Fok (rs731236), Bsm (rs1544410), Apa (rs7975232), and Taq (rs731236) - in the etiology of ICP in Polish women.

MATERIAL AND METHODS

Ninety-eight women with confirmed ICP and 215 healthy pregnant women as a control group were recruited to the study. We examined four SNPs of the VDR gene: BsmI (rs7975232), TaqI (rs1544410), ApaI (rs228570), FokI (rs731236). Genotyping was performed using the PCR/RFLP method.

RESULTS

We observed higher frequency (borderline significant) of the Ff-ff genotypes containing at least one mutated allele of the VDR FokI polymorphism in the control group compared to the ICP group (p = 0.045, OR = 1.71, 95% CI 1.01-2.88). The frequency of the mutated f allele was slightly higher in controls (49.1%) than in the ICP group (43.4%) (OR = 1.26, 95% CI 0.90-1.77), but the difference was not statistically significant (p = 0.196).

CONCLUSIONS

Our results showed that the maternal VDR FokI polymorphism could play a protective role in ICP development and probably modulate the risk of ICP occurrence in pregnant women in the Polish population. In the future, to confirm these observations, research in larger, ethnically stratified and clinically analyzed groups is necessary.

The relevance of IL-1β and IL-1RN gene polymorphisms in the etiology of preterm delivery in the population of Polish women

OBJECTIVES

Preterm delivery (PTD) is one of the important challenges for perinatal medicine due to prematurity and associated complications. The mechanisms leading to the PTD occurrence are not fully clarified and it is assumed that PTD is a complex phenomenon caused by many different pathophysiological factors. Nowadays, an important role is attributed to genetic determinants of PTD, pointing to possible relevance of polymorphic variants of candidate genes to participate in the etiology of PTD. The aim of the study was to assess the relevance of +3953C > T IL-1β and 86 bp VNTR IL-1RN gene polymorphisms in the etiology of PTD in Polish women.

MATERIAL AND METHODS

Study group consisted of 150 women (mean age 29.2 ± 5.6 years, mean weeks of gestational age 33.7 ± 2.8 gw.) with preterm delivery (22 + 0 - 36 + 6 gw.). To the control group 150 healthy pregnant women (mean age 29.0 ± 3.7 years, mean weeks of gestational age 39.3 ± 1.2 gw.) who delivered > 37 gw. were enrolled. All investigated polymorphisms were analyzed by polymerase chain reaction (PCR) and restriction fragment length polymorphism (RFLP).

RESULTS

The interesting observation was the notice of overrepresentation of 2/2 genotype of IL-1RN gene in the control group (8.0 vs. 3.3%, p = 0.06) and 2 allele in the control group (25.0 vs. 20.0%, p = 0.07).

CONCLUSIONS

The +3953C > T polymorphism of IL-1β gene probably is not connected with the risk of preterm delivery. The study results points to the possible modulating effect of mutated IL-1RN* 2 allele (86 bp VNTR polymorphism) of IL-1RN gene in decreased risk of preterm delivery.

MTHFR genetic polymorphism and the risk of intrauterine fetal death in Polish women

OBJECTIVES

To evaluate the role of MTHFR genetic variants in the etiology of intrauterine fetal death in the second part of pregnancy at women from Polish population.

MATERIAL AND METHODS

A case-control study was performed on a 76 women with a positive history of at least one in- trauterine fetal death after 22 gestational week and 400 healthy controls. The MTHFR genotyping for polymorphic sites 667C > T, 1298A > C, 1793G > A was determined by polymerase chain reaction/restriction fragment length polymorphism (PCR/RFLP) method.

RESULTS

For 1298A > C polymorphism, no statistically significant higher frequency of AA vs. AC+CC genotype was observed in the IUFD group 67.1 % vs. 55.2% in the control group (OR = 0.61, p = 0.05, pcorr = 0.15). We observed overrepresentation of three-locus haplotype CCG (p = 0.20; pcorr = 0.56) and two-locus haplotype CC (p = 0.17; pcorr = 0.48) in the IUFD group compared to controls.

CONCLUSIONS

There was no observed relationships in genotype frequency of MTHFR 677C > T and 1793G > A variants, however 1298A > C showed a slightly higher but statistically insignificant prevalence in IUFD compared to the controls in Polish population. Further studies on a larger population are needed.

Importance of polymorphic variants of phosphatidylethanolamine N-methyltransferase (PEMT) gene in the etiology of intrauterine fetal death in the Polish population

OBJECTIVES

Intrauterine fetal death (IUFD) is a multifactorial disorder and one of the most severe obstetrical complications. Our primary aim was to study the possible associations between polymorphic variants of the PEMT gene and IUFD in the Polish population.

STUDY DESIGN

The case-control study involved 76 mothers with IUFD occurrence and 215 mothers of healthy children. Genetic analysis of the four single nucleotide polymorphisms in the PEMT gene (rs4646406, rs4244593, rs897453 and rs12325817) was performed with the PCR/RFLP method.

RESULTS

Three oef the analyzed PEMT polymorphisms (rs4646406, rs4244593, and rs8974) were significantly associated with IUFD in the Polish population. Among them, PEMT variant rs4244593 was associated with increased risk of IUFD in three genetic inheritance models. Results were statistically significant even after applying Bonferroni correction for multiple comparisons (p < 0.0125). The distribution of all haplotypes except TAGC was not different between cases and controls, however, after applying permutation test, none of the haplotypes showed a relation with IUFD.

CONCLUSIONS

The present findings indicate that PEMT polymorphisms may be associated with the susceptibility to IUFD in the Polish population.

Polymorphic variants of genes involved in choline pathway and the risk of intrauterine fetal death

OBJECTIVES

Choline and folate metabolism disturbances may be involved in the occurrence of intrauterine fetal death (IUFD). The proper activity of this metabolism could be determined by genetic variants involved in choline pathway e.g. CHKA (gene encoding choline kinase α), PCYT1A (gene encoding CCTα) and CHDH (gene encoding choline dehydrogenase). Our study aimed at determining the genotype and allele frequencies of CHKA rs7928739, PCYT1A rs712012, PCYT1A rs7639752, CHDH rs893363 and CHDH rs2289205 polymorphisms in mothers with IUFD occurrence.

MATERIAL AND METHODS

The study involved 76 mothers with IUFD occurrence and 215 mothers of healthy children. Genetic analysis was performed with the use of PCR/RFLP method.

RESULTS

The frequency of genotypes and alleles of studied polymorphisms was similar in both groups. The study revealed no association of PCYT1A, CHKA and CHDH polymorphisms in analysed groups of women. While evaluating the co-existence of analysed polymorphisms statistically significant correlation was revealed. Co-existence of CHKA rs7928739 AC/CHDH rs2289205 AA genotypes was observed statistically more frequently in the study group than in the control group (p = 0,031).

CONCLUSIONS

There is no correlation between single CHKA rs7928739, PCYT1A rs712012, PCYT1A rs7639752, CHDH rs893363 and CHDH rs2289205 polymorphisms and the incidence of intrauterine fetal death. However, revealed statistically significant difference between co-existence of CHKA rs7928739 AC/CHDH rs2289205 AA genotypes between study groups suggest the need of further analysis.

Coexistence of ACE (I/D) and PAI-1 (4G/5G) gene variants in recurrent miscarriage in Polish population

OBJECTIVES

Recurrent miscarriage (RM) is one of the most common obstetric complications. Numerous studies have suggested that genetic variants leading to an impaired balance between coagulation and fibrinolysis may contribute to elevated risk of pregnancy loss. The aim of the study was to investigate a possible association between angiotensin-converting enzyme (ACE, rs1799752) I/D and plasminogen activator inhibitor type 1 (PAI-1, rs1799768) 4G/5G polymorphisms with RM among Polish women.

MATERIAL AND METHODS

DNA was extracted from peripheral blood samples of 152 women with a history of ≥ 2 consecutive pregnancy losses before 22 weeks of gestation, and 180 healthy controls with at least 1 live birth at term and no history of pregnancy loss. Polymerase chain reaction (PCR) and restriction fragment length polymorphism (RFLP) were used to identify the polymorphisms.

RESULTS

No statistically significant differences were found in genotype and allele frequencies of the studied polymorphisms. The most relevant difference between the study group and controls was found for the ID genotype distribution of the ACE gene (52.6 vs. 46.7%, OR = 1.27, p = 0.28). The analysis of genotype coexistence revealed a higher incidence of the combination of the ACE II and the PAI-1 4G/4G genotypes in the control group (10.0 vs.5.9% in control group; p = 0.17).

CONCLUSIONS

The obtained results suggest no apparent association between the ACE I/D, PAI-1 4G/5G polymorphisms and increased RM susceptibility in the analyzed Polish population.

PEMT rs12325817 and PCYT1A rs7639752 polymorphisms are associated with betaine but not choline concentrations in pregnant women

Maternal metabolism during gestation may depend on nutrient intake but also on polymorphism of genes encoding enzymes involved in metabolism of different nutrients. Data on choline or carnitine metabolism in pregnant women are scarce. We hypothesized that (1) choline intake in Polish pregnant women is inadequate and (2) choline and carnitine metabolism would differ by genotype and nutritional status of pregnant women. One hundred three healthy Polish women aged 18 to 44 years in the third trimester of pregnancy were enrolled in the study. The average choline, folate, and carnitine intakes were 365 ± 14 mg/d, 1089 ± 859 μg, and 132 ± 8 mg/d, respectively. Most women did not achieve an adequate intake of choline. Average choline, betaine, trimethylamine oxide, l-carnitine, and acetylcarnitine concentrations were 10.64 ± 3.30 μmol/L, 14.43 ± 4.01 μmol/L, 2.01 ± 1.24 μmol/L, 12.73 ± 5.41 μmol/L, and 6.79 ± 3.82 μmol/L, respectively. Approximately 15% lower betaine concentrations were observed in the GG homozygotes of PEMT rs12325817 and in the GG homozygotes of PCYT1A rs7639752 than in the respective minor allele carriers. Birth weight was higher in the G allele homozygotes of the CHDH rs2289205 than in the minor allele carriers: GG: 3398 ± 64 g; GA+AA: 3193 ± 76 g. Our study shows that choline intake in Polish pregnant women is inadequate and that polymorphisms of PEMT rs12325817 and PCYT1A rs7639752 are associated with betaine but not choline concentrations.

The RANKL/RANK/OPG signal trail: significance of genetic polymorphisms in the etiology of postmenopausal osteoporosis

OBJECTIVES

Recent studies have demonstrated that disorders of bone metabolism, which is regulated by RANK/RANKL/OPG signaling pathway, are the cause of osteoporosis. The aim of the study was to investigate the distribution of genotypes of the RANK 575C>T and RANKL -643C>T polymorphisms and to analyze their relationship with bone parameters in postmenopausal women.

MATERIAL AND METHODS

A total of 310 postmenopausal Caucasian women (139 with osteoporosis, 107 with osteopenia, and 64 healthy postmenopausal controls) were included. Bone mineral density (BMD) at the lumbar region of the spine (L2-L4) was measured by dual energy X-ray absorptiometry (DXA). Genetic analysis was performed using the PCR-RFLP method.

RESULTS

Analysis of the frequency of genotypes and alleles of the RANK 575C>T and RANKL -643C>T polymorphisms did not show any statistically significant differences between the study groups (osteoporosis and osteopenia) and postmenopausal women with normal t-score value (ns). Notably, a significant association between the RANKL -643C>T polymorphism and body mass, such as BMI values in osteoporotic women (p<0.05), was observed.

CONCLUSIONS

Our results suggest lack of association between the 575C>T RANK polymorphism and the development of osteoporosis. The -643C>T RANKL polymorphism, through its significant influence on body weight and BMI value, may contribute to the development of osteoporosis in postmenopausal women.

Correlation between factor VII and PAI-1 genetic variants and recurrent miscarriage

BACKGROUND

Polymorphisms which are presented below may be the cause of inherited thrombophilia and may result in pregnancy loss. The hypothesis is based on a number of cardiology studies which have confirmed the involvement of these polymorphisms in thrombotic incidents.

OBJECTIVES

To evaluate the role of polymorphisms of factor VII gene (Arg353Gln, -122T > C) and PAI-1 gene (-675 4G/5G) in the etiology of recurrent miscarriage.

MATERIAL AND METHODS

The study group included 152 women with a positive history of ≥ 2 consecutive pregnancy losses (114 and 38 women with 2 and ≥ 3 miscarriages, respectively), while 180 healthy women were recruited as controls. Genetic analysis was performed with the use of PCR/RFLP.

RESULTS

Lower frequency of Arg353/Gln353 was observed in women with 2 and ≥ 3 miscarriages as compared to controls (21.1% vs. 23.9% and 13.2% vs. 23.9%, respectively). The frequency of Gln353 was lower in women with ≥ 3 miscarriages as compared to controls (6.6% vs. 11.9%, p = ns). The frequency of -122TT was higher in women with ≥ 3 miscarriages as compared to controls (86.84% vs. 76.67%, p = ns), whereas -122TC was more frequent in controls (13.16% vs. 22.78% in controls, p = ns). The frequency of -122T was higher in patients with ≥ 3 abortions as compared to controls (93.42% vs. 88.06%, p = ns), and -122C was observed more frequently in controls (6.58% vs. 11.94% in controls, p = ns). There were no significant differences as far as the -675 4G/5G polymorphism was concerned.

CONCLUSIONS

The obtained results suggest a possible protective role of Gln353 and -122C alleles in recurrent miscarriage.

Demographic factors determining folic acid supplementation in pregnant and childbearing age women

OBJECTIVES

Adequate folate intake constitutes a significant problem in the periconceptional period and early pregnancy but can be achieved by folic acid (FA) supplementation. Low intake of folate may cause numerous negative effects on the pregnancy outcome, including recurrent miscarriage, preeclampsia, fetal hypotrophy, premature delivery, premature placental abruption, and intrauterine fetal death. The aim of the study was to evaluate factors determining FA supplementation in the population of Polish women before and during pregnancy.

MATERIAL AND METHODS

The study group consisted of 257 women hospitalized postpartum at the Division of Perinatology and Women's Diseases, Poznan University of Medical Sciences, Poland. We evaluated folic acid intake considering selected demographic data. A structured questionnaire was used to evaluate folic acid intake before and during pregnancy of the investigated women.

RESULTS

The vast majority of the investigated women (89.1%) took FA during pregnancy. During the pre-pregnancy period, a statistically significantly higher supplementation of folic acid was observed among women with the monthly income level of > 5000 PLN (p = 0.03), and among women who planned their pregnancy as compared to women who did not plan their pregnancy (p < 0.001). During pregnancy, these differences disappeared. A statistically significantly higher number of secundi- and multiparas did not take FA during pregnancy as compared to primiparas (p = 0.008). No correlation between cigarette smoking and FA intake was observed.

CONCLUSIONS

Our analysis showed that FA intake increased (by 36.2%) during pregnancy as compared to the pre-pregnancy period, and depended on income, parity, and pregnancy planning.

Importance of polymorphic variants of Tumour Necrosis Factor - α gene in the etiology of Intrauterine Growth Restriction

OBJECTIVES

Intrauterine growth restriction (IUGR) is one of the main global causes of increased perinatal mortality and fetal and neonatal morbidity. It remains a key challenge for modern perinatal medicine. Negative effects of IUGR are manifested not only in the perinatal period but also at the later stages of life. Proinflammatory cytokines and their polymorphisms are hypothesized to play an important role in IUGR pathomechanisms. The aim of the study was to determine the role of selected polymorphisms (-238G >A, -308G >A and -376G >A) of tumor necrosis factor alpha (TNF-α) in the etiology of intrauterine growth restriction.

MATERIAL AND METHODS

The study included 120 patients with IUGR (mean age 30.32, mean gestational age 36.34 gestational weeks) and 135 healthy pregnant women (mean age 31.63, average week of delivery 38.76). The investigated polymorphisms were determined by PCR/RFLP methods.

RESULTS

Higher frequency of TNF-α mutated allele -308A was found in a subgroup of women whose pregnancy en-ded < 37 weeks (18.5 vs. 12.2% in control , OR = 1.63, p = 0.09) and in the subgroup of women with a score ≥ 3 UAS (20.6 vs. 12.2% in control , OR = 1.86, p = 0.06). Heterozygous genotype -308GA was associated with at least 3 times greater risk of three or four abnormalities in uterine arteries score (41.2 vs. 20.0 in control, OR = 2.80, p = 0.01).

CONCLUSIONS

The obtained results suggest that the -308G >A TNF-α gene variant may play a role in the etiology of IUGR in the Polish population, but further studies on larger groups are needed.

The importance of polymorphic variants of collagen 1A2 gene (COL1A2) in the development of osteopenia and osteoporosis in postmenopausal women

OBJECTIVES

Collagen type I plays an important role in the bone matrix and is encoded by COL1A2 (collagen type I alpha 2) gene that may be a potential candidate for osteoporotic fracture. The aim of this study is to determine whether EcoRI, Del38 and PvuII polymorphisms of COL1A2 are associated with the development of osteoporosis and osteopenia in post-menopausal Polish women. Moreover, analysis of relationship between frequency of COL1A2 gene polymorphic variants and clinical parameters of bone turnover and degree of osteoporosis was performed.

MATERIAL AND METHODS

The study group comprised of women with osteoporosis (n = 90), osteopenia (n = 56) and healthy individuals (n = 56). The EcoRI, Del38 and PvuII polymorphisms in COL1A2 gene were detected by PCR-RFLP method.

RESULTS

In women with osteoporosis the TT genotype of EcoRI polymorphism had the lowest Z-score value compared to other genotypes (p = 0.034). In case of Del28 polymorphism, there was a statistically significant correlation between lower BMI values and the DD genotype in women with osteopenia (p = 0.041). There was no statistically significant correlation between polymorphic variants of Del28 polymorphism and clinical parameters of women with osteoporosis. The analysis of PvuII polymorphism showed that in women with osteopenia the CC genotype had the lowest body weight compared to other genotypes (p = 0.039). PvuII polymorphism and clinical parameters in the group of women with osteoporosis had no statistically significant correlations.

CONCLUSIONS

The analyzed COL1A2 polymorphisms seem to be related to osteoporosis development and their particular clinical parameters. Hence, the COL1A2 polymorphism may be a genetic risk factor related to the development of osteoporosis.

Contribution of inherited thrombophilia to recurrent miscarriage in the Polish population

INTRODUCTION

The aim of the study was to evaluate the contribution of genetic variants determining inherited thrombophilia to recurrent miscarriage (RM) in the Polish population. The following polymorphisms were analyzed: 1691G>A, 1328T>C of coagulation factor V, 20210G>A of coagulation factor II, R353Q (11496G>A) of coagulation factor VII, 667C>T, 1298A>C, 1793G>A of MTHFR.

MATERIAL AND METHODS

A total of 359 women with ≥ 2 subsequent recurrent miscarriages (303 < 13 weeks of gestation (w.g.) and 56 between 13-22 w.g.) and 400 healthy controls were included in the study. Frequency of the genetic polymor-phisms was determined with the PCR/RFLP method.

RESULTS

Higher frequency of the 20210GA genotype was found in the RM < 13 w.g. (2.97 vs. 1.50% in controls, OR = 2.01, ns) and the RM 13-22 w.g. (5.36 vs. 1.50% in controls, OR = 3.72, p = 0.09) subgroups. Statistically significantly higher frequency of the 11496GA genotype was noted in controls as compared to the RM 13-22 w.g. subgroup (10.71 vs. 23.00% in controls, OR = 0.40, p = 0.02). Statistically significantly higher frequency of the 1793GA genotype was observed in the RM < 13 w.g. subgroup as compared to controls (12.21 vs. 7.75% in controls, OR = 1.66, p = 0.03). No significant correlations were found as far as the rest of the analyzed polymorphisms are concerned.

CONCLUSIONS

The obtained results suggest that the 1793G>A MTHFR, R353Q (11496G>A) factor VII gene and the 20210G>A factor II gene polymorphisms play a role in the etiology of RM in the Polish population.

DRD1 and DRD4 dopamine receptors in the etiology of preeclampsia

INTRODUCTION

Recent reports have suggested an association between genetic polymorphisms of dopamine receptors and the development of an increased risk of chronic hypertension, as well as preeclampsia (PE).

OBJECTIVES

The aim of the study was to evaluate the impact of the -48A>G DRD1 and -521C>T DRD4 polymorphisms in the etiology of PE among Polish women.

MATERIAL AND METHODS

Ninety-eight preeclamptic women and 120 healthy pregnant controls were enrolled in the study The investigated polymorphisms of the DRD 1 and DRD4 genes were identified using PCR/RFLP methods.

RESULTS

As far as the -48A>G DRD 1 polymorphism is concerned, the mutated -48GG genotype was more often found in controls (14.2%) than in the PE group (10.2%, ns), and the subgroup with severe PE (8.2%). Also, the frequency of the mutated -48G allele was higher in controls (39.6%) than in the PE group (33.2%, ns), and in the subgroup with severe PE (31.6%, ns). As for the -521C>TDRD4 polymorphism, a similar occurrence of the mutated -521 TTgenotype and the -521T allele in all of the investigate groups was observed. Lower serum concentrations of total protein (5.59 g/L and 5.57 g/L vs. 6.17 g/L in carriers of the -52100 genotype, p=0.02) were noted in patients with the mutated homozygous -521 TT genotype and heterozygous -521CT genotype of DRD4.

CONCLUSIONS

The obtained results suggest a possible protective role of the mutated -48G DRD1 allele in the etiology of preeclampsia, especially its severe form. The presence of the mutated -521 T DRD4 allele could influence the decrease of total blood protein in preeclamptic patients. The observed frequency of dopamine DRD1 and DRD4 polymorphisms is similar to the distribution of these variants in other Caucasian populations.

Coexistence of the 677C>T and 1298A>C MTHFR polymorphisms and its significance in the population of Polish women

OBJECTIVES

The aim of the study was to evaluate the frequency of the 677C>T and 1298A>C polymorphisms of the methylenetetrahydrofolate reductase (MTHFR) gene, as well as the coexistence of both these genetic variants in women from the Polish population.

MATERIAL AND METHODS

A total of 662 women from the Polish population were enrolled in the study group. The frequency of the investigated genotypes of the 677C>T and 1298A>C polymorphisms of the MTHFR gene was analyzed with the use of PCR/RFLP methods.

RESULTS

The frequency of the 677CC, 677CT and 677TT genotypes in the studied population of women was 50.60%, 39.88% and 9.52%, respectively As to the 1298AA, 1298AC and 1298CC genotypes, the obtained results were as follows: 42.75%, 47.88% and 9.37%, respectively (Tables II and III). Simultaneous analysis revealed the most frequent coexistence of 677CC/1298AC (28.85%), 677CT/1298AA (20.85%) and 677CT/1298AC (19.03%) genotypes. The coexistence of 677CC/1298AA (12.39%), 677CC/1298CC (9.37%) and 677TT/1298AA (9.51%) genotypes was observed less frequently In the studied population of Polish women, the coexistence of 677CT/1298CC, 677TT/1298AC and 677TT/1298CC genotypes has been not observed.

CONCLUSIONS

The frequency and coexistence of genotypes of the 677C>T and 1298A>C MTHFR gene polymorphisms in the studied population of Polish women is similar to other North-European populations. Women carriers of the mutated variants of both, 677C>T and 1298A>C polymorphisms of the MTHFR gene should receive special perinatal care in order to prevent fetal defects and thrombosis-related complications during pregnancy It is vital to emphasize the significance of proper education of folate supplementation, especially in pregnant patients and women of reproductive age.

The contribution of Hind III C>G PAI-1 gene polymorphism in etiology of recurrent miscarriages

OBJECTIVES

The goal of the study was to assess the relationship of HindIII C>G PAI-1 gene polymorphism with increased risk of recurrent miscarriages.

MATERIAL AND METHODS

A whole of 152 women with a history of at least two miscarriages were classified into analysis. The study group was divided twice (114 subjects with 2 miscarriages and 38 subjects with >3 miscarriages, 123 subjects with miscarriages at <13gw, and 29 subjects with miscarriages in <21 gw). The controls consisted of 180 women with a positive history of at least one pregnancy and birth of a healthy term newborn, and a negative history of miscarriage. The analysed polymorphisms were determined by PCR/RFLP methods.

RESULTS

The occurrence of HindIII GG genotype in the whole study group was 25.7% and 20.0% in controls (OR= 1.38, p=0. 14). HindIII G allele was also observed more frequently in the whole study group (45.7% vs. 42.2% in controls, OR=1. 15, p=0.20). The occurrence of HindIII GG genotype was higher in the subgroup of women with >3 miscarriages (31.6% vs. 20.0% in controls, OR= 1.85, p=0.09). HindIII G allele was also noted more frequently in the subgroup of women with >3 miscarriages (50.0% vs. 42.2% in controls, OR=1.37, p=0. 13). A tendency of higher frequency of HindIII GG genotype and HindIII G allele was also noted in the subgroup of patients with miscarriages in the first and second trimester (HindIII GG: 31.0% vs. 20.0% in controls, OR= 1.80, p=O. 14, HindIII G: 51.7% vs. 42.2% in controls, OR=1.4 7, p=0.11).

CONCLUSIONS

Mutated HindIII G allele and HindIII GG genotype of HindIII C>G polymorphism probably augment the risk of recurrent miscarriages.

The evaluation of the predictive value of TNF-alpha concentration in maternal serum in the prediction of neonatal and maternal infection

INTRODUCTION

The consequences of uncomplicated PPROM are serious, and the presence of overt intraamniotic infection (IAI) is associated with a significant increase in both, the maternal and fetal morbidity and mortality rate. TNF-alpha is a cytokine involved in systemic inflammation and plays an important role in modulating the acute phase reaction.

AIM

The aim of this study was to evaluate the predictive value of TNF-alpha levels in maternal serum within 6 hours after pprom and in the period of up to 12 hours after delivery in the prediction of neonatal and maternal infection.

MATERIAL AND METHODS

The investigation was conducted on a group of 56 women diagnosed with PPROM between 30+0 and 36+6 weeks gestational age. In the period of up to 6 hrs from pprom first sample of 10 ml of maternal venous blood for laboratory testing was taken and the level of TNF-alpha was measured. A second sample of venous blood was taken within 12 hrs from delivery to reassess the TNF-alpha levels. All the participants were divided retrospectively into four groups depending on the occurrence of adverse neonatal and maternal outcome. Measuring the concentration of TNF-alpha in maternal serum was performed using the elisa method (enzyme-linked immunosorbent assay).

RESULTS

A statistically significant difference in the second assay (up to 12 hours after delivery) between the patients with and without signs of maternal infection was observed concerning the TNF-alpha serum level. The concentration of this cytokine in maternal serum after delivery was 1.79 and 1.36 pg/ml (p < 0.05) respectively whereas within 6 hours from the PPROM in those two groups it was comparable (1.25 vs. 7.37 pg/ml - ns). Analogous observations were made in case of adverse neonatal outcome, where the TNF-alpha serum level within 12 hours after delivery was 1.70 and 1.45 pg/ml (p < 0.05) and in the period of up to 6 hours from pprom was 1.25 vs. 1.38 pg/ml (ns) respectively

CONCLUSIONS

1. In our investigation the maternal serum TNF-alpha concentration testing within 6 hours from PPROM between 30+0 and 36+6 weeks of gestation did not allow for the identification of patients who are more likely to develop signs of maternal infection and whose infant was at risk of neonatal infection after delivery 2. In case of pprom between 30+0 and 36+6 weeks of gestation maternal serum TNF-alpha concentration testing in the period of up to 12 hours after delivery may be a useful diagnostic tool for identification of patients with an increased risk of maternal and neonatal infection. 3. The lower the gestational age at PPROM and at delivery the risk of neonatal infection was greater.

The -323P0/P10 factor VII gene polymorphism and the risk of recurrent miscarriage

OBJECTIVES

Genetically determined disturbances in the activity of coagulation factor VII may lead to obstetric complications. The aim of the study was to evaluate the correlation between -323P0/P10 factor VII gene polymorphism and the risk of recurrent miscarriage.

MATERIAL AND METHODS

The study group consisted of 152 women with a history of > or = 2 miscarriages. The control group comprised 180 women with no history of miscarriage and > or = 1 pregnancy who gave birth to a healthy newborn at term. The study group was further subdivided twice into two subgroups: 1174 patients with a history of 2 miscarriages and 38 subjects with a history of > or = 3 miscarriages, and 123 patients with miscarriages < 13 gw. and 29 with miscarriages < 21 gw. Genetic analysis was performed with the use of PCR/RFLP.

RESULTS

Overrepresentation of P0/P0 genotype and lower frequency of P0/P10 genotype was noted in the study group as compared to controls (P0/P0: 80.26 vs. 76.67%, p = 0.25; P0/P10: 18.42 vs. 22.78%, p = 0.20). A higher presentation of P0/P0 genotype and P0 allele, lower frequency of P0/P10 genotype and P10 allele was observed in the subgroup of women with > or = 3 miscarriages as compared to controls (P0/P0: 8.84 vs. 76.67%, p = 0.12; P0: 93.42 vs. 88.06%, p = 0.12; P0/P10:13.16 vs. 22.78%, p = 0.13; P10: 11.94 vs. 6.58%, p = 0.12).

CONCLUSIONS

The obtained results suggest a probable protective role of -323P10 allele against the risk of miscarriage in women with > or = 3 recurrent pregnancy losses.

[Listeriosis in pregnancy--case report]

Listeriosis is a rather rare infectious disease but its incidence in pregnancy is over 20 times higher than in the general population. Pregnant women with listeriosis comprise one-third of all listeriosis cases. Listeriosis is a foodborne disease. Sporadic as well as epidemic cases of listeriosis are usually related to contaminated processed food, especially meat dishes served in fast-food restaurants and dairy products. Pregnant women are at an increased risk for listeriosis infection. Unfortunately the symptoms are not specific and the diagnosis presents a considerable challenge. Although the literature offers some case reports on a complicated course of listeriosis during pregnancy the infection usually runs a mild course in pregnant women. Regardless, fetal or neonatal infection is related to very high risk of lethal complications in the newborn, among others: sepsis, meningitis or pneumonia. In this paper we present a case of a 28-year-old gravida with listeriosis. We described the course of the infection, diagnostic process and treatment in both, the mother and the newborn.

[Fetal programming as a cause of chronic diseases in adult life]

Long-term adaptive changes occurring in a developing fetus in response to unstable in utero environmental conditions, which appear at a particular time (critical window), are called intrauterine or fetal programming. These adaptive changes are beneficial during the intrauterine period because they adapt the fetus to current needs, but may turn out to be harmful in the end and lead to development of chronic diseases in adult life. Fetal programming means the structural and functional changing of an organism, metabolism and function of some cells, tissues and systems, that occur even despite intrauterine limitations. Events of fetal life influence the determination of physiological patterns which may manifest as disease processes in the adulthood (Barker's hypothesis). Genetic and environmental factors (poor diet in pregnancy chronic intrauterine fetal hypoxia, the effects of xenobiotics and drugs, as well as hormonal disorders) influence the phenotype of a newborn and are involved in the intrauterine programming process. The effects of fetal programming may be passed along to the next generations via not fully understood pathways, which probably include epigenetic mechanisms. Most of the mechanisms underlying this process remain unclear and need to be elucidated.

Frequency of G2677T/A and C3435T polymorphisms of MDR1 gene in preeclamptic women

OBJECTIVE

Preeclampsia (PE) belongs to main causes of mortality rates of mothers, fetuses and new born children. Polymorphism of MDR1 gene is connected with reduction of P-glycoprotein expression in placenta and increased fetal exposure to xenobiotics. The aim of the study was to determine the frequency of C3435T and G2677T/A polymorphisms of MDR1 gene in pregnant women with preeclampsia.

MATERIALS AND METHODS

The study consisted of 180 Polish women including 60 women with PE and 120 healthy pregnant women. Determination of C3435T and G2677T/A polymorphisms of MDR1 gene was performed using PCR-RFLP method.

RESULTS

No significant association between genotypes of the examined polymorphisms and the clinical parameters of pregnant women with PE was observed However the interesting tendency to higher prevalence of mutated 2677A allele of G2677T/A MDR1 polymorphism in PE group has been shown (2,50 vs. 0,83% in controls, OR=3,05, ns).

CONCLUSIONS

The results of this study suggest no significant effect of examined C3435T and G2677T/A MDR1 polymorphisms in PE pathogenesis. However given the noteworthy results related to mutated 2677A allele of G2677T/A MDR1 polymorphism in preeclamptic women further studies seem to be needed. Nevertheless, the frequency of investigated polymorphisms was consistent with the distribution in other Caucasian populations.

[Analysis of factors influencing neonatal bacterial flora of the conjunctiva shortly after delivery]

OBJECTIVES

The aim of this study was the analysis of conjunctival flora in newborns within the first 72 hours of life, depending on the methods of delivery and other perinatal factors.

MATERIAL AND METHODS

The study group consisted of 192 mothers and 192 newborns. Culture samples were obtained before delivery from the cervicovaginal secretions of pregnant women and, in case of caesarean sections, additionally from the maternal surface of the fetal membranes. Conjunctival specimens were obtained twice from the inferior conjunctival fornix of the right eye in all the newborns: early sample--immediately after the delivery and late sample--on the third day of neonatal life. Perinatal factors influencing bacterial colonization were analyzed.

RESULTS

Statistically significant difference between the four clinical subgroups was found in the interval between the rupture of the membranes and delivery number of obstetrical examinations during delivery antibiotic use during the perinatal period and the presence of green amniotic fluid. Statistically significant difference was observed in the incidence of early sterile samples and method of delivery. The correlation between bacterial species obtained from conjunctival and cervicovaginal secretions samples was also found. The tendency for more frequent occurrence of early sterile samples was observed in newborns of mothers who received antibiotics in the perinatal period and if the interval between the rupture of the membranes and labor was shorter.

CONCLUSIONS

The obtained data expanded the knowledge about neonatal conjunctival bacterial flora and demonstrated influence of the perinatal factors on bacterial colonization of the infants' conjunctiva.

Inherited thrombotic thrombocytopenic purpura in pregnancy

OBJECTIVE

The primary pathologic reason for thrombotic thrombocytopenic purpura (TTP) lies in the systemic formation of platelet aggregations in association with endothelial cells damage. Endothelial damage is a result of an abnormal synthesis and metabolism of unusually large von Willebrand Factor (ULvWF) multimers. In normal conditions vWF cleaving metalloprotease, known as ADAMTS-13 (A Disintegrin And Metalloproteinase with Thrombospondin type-1 motif, member 13) prevents the ULvWF entrance in the circulation. It already has been proven that thrombotic thrombocytopenic purpura is strongly correlated with severe congenital or acquired deficiency of ADAMTS-13. Congenital ADAMTS-13 deficiency is known as Upshaw-Schulman Syndrome and it accounts for only 2-4% of all TTP cases. It is conditioned by genetic variants of the ADAMTS-13 gene causing reduced ADAMTS-13 synthesis and shows an autosomal recessive type of inheritance.

CASE PRESENTATION

We present an interesting case of a 20 year old patient, primigravida, nulliparous, in 28th gestational week of twin pregnancy with undiagnosed Upshaw-Schulman Syndrome. The patient was transferred from the district hospital to the Tertiary Perinatal Care Center because of thrombocytopenia and suspicion of hemolytic-uremic syndrome. Genetic analysis performed 5 years after patient's death (before 2008 that kind of genetic analysis had not been available in Poland) showed a homozygotic mutation in the ADMTS13 gene (4143insA) which confirmed the diagnosis of Upshaw-Schulman Syndrome.

CONCLUSIONS

1. TTP, especially hereditary Upshaw-Schulman Syndrome, is extremely rare and complicates the course of pregnancy. It is usually very sudden and dramatic; 2. Differential diagnosis of this disease is difficult and treatment strategy very burdensome for the patient. For this reason, diagnosis of micro-angiopathic disorders need to be simultaneously based on both clinical symptoms and laboratory findings; 3. Genetic diagnosis that confirms exact recognition of Upshaw-Schulman Syndrome is not commonly available; 4. The described case was a huge diagnostic challenge, and actually the final diagnosis was published until five years after the patient's death. Before 2008, that type of genetic analysis had not been available in Poland; 5. Despite the enormous progress in medical knowledge and experience, the exact diagnosis of TTP, including Upshaw-Schulman Syndrome, of this condition remains very difficult.

[Genetic variants of endothelial nitric synthase in gestational hypertension and preeclampsia]

INTRODUCTION

Decreased nitric oxide (NO) plasma concentration may be involved in the development of preeclampsia. It has been suggested that genetic variants of endothelial nitric oxide synthase (eNOS) gene may reduce NO plasma levels.

AIM OF THE STUDY

To evaluate the correlation of 894G>T (Glu298Asp) and -786T>C polymorphisms of NOS3 gene with the development of preeclampsia (PE) and gestational hypertension (GH).

MATERIAL AND METHODS

110 hypertensive pregnant women (mean age 29.46 +/- 4.54 years, mean gestational age 36.88 +/- 3.50 gw., mean systolic blood pressure 16782 +/- 16.87 mmHg, mean diastolic blood pressure 104.32 +/- 11.62 mmHg) were enrolled into the study group. The whole study group was further subdivided into two subgroups: women with gestational hypertension (GH, n = 69) and with preeclampsia (PE, n = 41). Gestational hypertension and preeclampsia were diagnosed according to the ACOG standards. All patients with multiple pregnancy diabetes, vascular changes and thrombotic complications were excluded from the study. The control group consisted of 150 healthy pregnant women (mean age 28.29 +/- 4.40 years, mean gestational age 39.06 +/- 1.28 gw., mean systolic blood pressure 12.07 +/- 10.75 mmHg, mean diastolic blood pressure 70.62 +/- 9.13 mm Hg). The frequency of investigated genotypes of NOS3 gene polymorphisms was examined by polymerase chain reaction and restriction fragment length polymorphism (PCR/RFLP) method.

RESULTS

As far as the 894G>T polymorphism was concerned, a higher frequency of 894TT genotype in the control group in comparison to the whole study group was observed (8.7 vs. 5.4%; WR = 0.61, p = ns). A similar observation was made about the 894T allele (25.4 vs. 30.0%, WR = 0.79, p = ns). The frequency of the 894T allele was also higher in controls in comparison to the PE group (30% vs. 26.8%, p = ns) and GH group (30% vs. 24.6%, p = ns). Analyzing the -786T>C polymorphism no statistically significant differences between the whole study and the control groups was found. The frequency of the mutated -786CC genotype was similar in the entire study group and controls (13.6 vs. 15.3%, p = ns). The frequency of the mutated -786C allele was also similar in both analyzed groups (37.3 vs. 38.0%, p = ns). A statistically significant difference in the frequency of coexistence of mutated homozygotic genotypes 894TT/-786CC between the investigated groups (0.9% in the whole study group vs. 6.7% in the control group, p = 0.019) was observed. Coexistence of 894GT/-786TC genotypes was noted more frequently in the control group (19.1% in the whole study group vs. 24.7% in the control group, p = ns). The frequency of other combinations of investigated genotypes coexistence did not significantly differ between the control group, the entire study group, and the PE and GH groups. In the PE group, a higher systolic blood pressure was noted in patients with -786CC genotype (205.0 +/- 21.2 mmHg) in comparison to patients with -786TT (177.0 +/- 17.8 mmHg) or -786TC (173.4 +/- 13.5 mmHg) genotypes (p = ns).

CONCLUSIONS

The presence of the 894TT genotype of the 894G>T (Glu298Asp) polymorphism may play a protective role in the development of preeclampsia. The presence of the -786CC genotype of the -786T>C polymorphism may correlate with the increase of the systolic blood pressure in pregnant women with preeclampsia.

Contribution of maternal-fetal adrenomedullin polymorphism to gestational hypertension and preedlampsia--gene-gene interaction pilot study

INTRODUCTION

Adrenomedullin (ADM), a peptide with vasodilatory natriuretic and diuretic properties, is secreted in many tissues and shows multidirectional activity ADM activity may play an important role in the pathophysiology of gestational hypertension (GH) and preeclampsia (PE) by involvement in compensation of failed utero-placental unit circulation.

AIM OF THE STUDY

The aim of the study was to evaluate the association of -1984A>G ADM gene polymorphism with the development of GH and PE in maternal-fetal dyads.

MATERIALS AND METHODS

The study group consisted of 46 hypertensive pregnant subjects (further divided into two subgroups: 20 pregnant women with GH and 26 women with PE). 43 healthy pregnant women constituted the control group. The study and the control groups as well as the newborns were genotyped for -1984A>G ADM gene polymorphism using PCR/RLFP procedures.

RESULTS

Minor--1984G allele was found to be higher in both, the GH (15.00%, OR = 3.62, p = 0.05), and the PE groups (9.62, OR = 2.18, p=ns) when compared with controls (4.65%). A tendency for higher frequency of minor -1984G allele (12.50 vs. 6.98% in controls, OR = 1.91, p=ns) was observed in the newborns from the GH group. It was also noteworthy that coexistence of both heterozygous genotypes of maternal-fetal dyads (-1984AG mother/1984AG fetus) was overrepresented in the GH group (15.00 vs. 6.98%, OR = 2.35, p=ns) and in the PE group (11.54 vs. 6.98%, OR = 1.74, p=ns) when compared to controls.

CONCLUSIONS

The observed tendency for overrepresentation of minor -1984G ADM allele in the GH and PE women and their newborns, despite lack of statistical significance, suggests participation of this genetic variant in the pathogenesis of the mentioned conditions. Additionally the obtained results could indicate that maternal-fetal gene-gene interaction may be a potential source of adverse perinatal outcomes.

[Conservative treatment of endometriosis]

Endometriosis is a common disease concerning 5-10% of women at reproductive age. It may cause sterility and decrease the quality of life. The best known symptoms are dysmenorrhea, dyspareunia, chronic pelvic pain and pain related to ovulation. Endometriosis is a chronic illness which, so far can not be completely cured. Clinical treatment is focused on decreasing symptoms, improving the quality of life, inhibition of endometrial focuses, sustaining sterility and preventing recurrences. Most of the time clinical treatment is not limited only to one possibility but usually joins a few therapeutic options. One of the possibilities is the surgical treatment, usually laparoscopic. Conservative treatment may be its completion. The main medical aim of conservative treatment is to decrease pain by inhibition of inflammation and to reduce or arrest the production of cyclic ovarian hormones, what usually leads to amenorrhea. Drugs used in conservative treatment of endometriosis are often connected with numerous side effects, constituting a serious limitation of a long-term therapy. That is the reason why much research concentrates on finding the optimal medical procedures for patients with endometriosis.

Importance of CYP1A1 polymorphism and its transcriptional regulation in ovarian and endometrial cancer

Human cytochrome P450 1A 1 is one of the most important enzymes participating in human carcinogenesis because it metabolites several procarcinogens to active carcinogenic metabolites. Additionally enzymes of CYP450 family play an important role in estrogenes catabolization (17-beta-estradiol and estron) to intermediate products (2-, 4-hydroxyestradiol and 2-, 4-hydroxyestrone) including CYP1A1 that catalyses hydroxylation to 2-hydroxyestrogens in the endometrium. Derivates of these compounds (4-hydroxyestrogens) are carcinogenic and could induce DNA damage leading to tumour transformation. The presence of CYP1A1 enzyme in genital tract tissues could induce chemical carcinogenesis initiating cancer development. Recent studies also confirmed the role of CYP1A1 in the development of ovarian and endometrial cancer in humans. The presence of mutated CYP1A1 polymorphic variants influencing the CYP1A 1 activity could be responsible for different interindividual susceptibility to genital cancers in women.

[Concentration of selected cytokines in women with premature rupture of membranes and preterm delivery--preliminary study]

INTRODUCTION

For years much attention has been paid to the possible role of cytokines in the etiology of preterm delivery (PTD) in relation to anticipation of delivery in women with premature rupture of membranes (PROM). There are no clear indications introducing this observation to clinical practice. The goal of this study was to evaluate interleukin-6 (IL-6), tumor necrosis factor alpha (TNF-alpha), G-colony stimulating factor (G-CSF) concentration in serum of women with PROM in connection with the occurrence of the delivery

MATERIAL AND METHODS

35 patients with PROM (average age 29.6 +/- 3.8 years, average time of gestation 35.2 +/- 1.5 weeks) were analyzed. The pregnant women were divided into 2 groups: 15 women delivered < 24 h and 20 women delivered > 24 h since the appearance of PROM. In both analyzed subgroups, the levels of IL-6, TNF-alpha, G-CSF CRP and leucocytosis have been compared. The concentration of IL-6, TNF-alpha and G-CSF in serum was measured by immunoenzymatic ELISA method, CRP concentration by immunoturbimetric method.

RESULTS

In the whole group of women with PROM, the differences in average serum concentration of IL-6 before and after delivery (6.01 +/- 3.71 pg/mL and 7.98 +/- 3.44 pg/mL p < 0.05) and G-CSF (130.92 +/- 110.32 pg/mL and 79.59 +/- 52, 13 pg/mL, p < 0,05) have been observed. Moreover, average TNF-alpha concentration before and after the delivery was 1.43 +/- 0.63 pg/mL and 1.72 +/- 1.06 pg/mL (p > 0.05), respectively. It is particularly interesting that the authors have observed higher concentration of G-CSF in women who delivered within 24 h since PROM (147.05 +/- 103.88 pg/mL), if compared to the women who delivered after 24 h since PROM (118.81 +/- 115.71 pg/mL, without statistically significant difference p > 0.05). The same remark was connected with difference of IL-6 concentration in analogical groups of women (6.42 +/- 4.14 pg/mL vs 5.71 +/- 3.42 pg/mL, p > 0.05). Equally interesting observation were statistically significant differences in G-CSF concentration before and after delivery (147.06 +/- 103,88 vs 74.67 +/- 46.84, p < 0.05) in the event of the delivery < 24 h since PROM, such as in IL-6 concentration (5.71 +/- 3.42 vs 8.11 +/- 3.41, p < 0.05) in case of the delivery > 24 h since PROM.

CONCLUSIONS

Statistically significant differences in IL-6, G-CSF, and CRP concentration before and after the delivery suggest the participation of these factors in the etiology of preterm delivery in women with PROM. The higher IL-6 and G-CSF concentration in women delivering within 24 h since the appearance of PROM suggest that these cytokines could be involved in the processes leading to delivery Statistically significant differences in IL-6 and G-CSF concentration before and after the delivery in a group of women delivering < 24 h or > 24 could indicate an important contribution of changes in proportions of these cytokines in PTD the etiology in PROM.

Adrenomedullin mRNA expression in placenta of preeclamptic women

INTRODUCTION

Adrenomedullin (ADM) is indicated to be a biologically active polypeptide released by endothelium with strong hypotensive, long-acting vasodilatator properties. It is suggested that development of preeclampsia is partly related to decreased ADM influence on blood vessels.

AIM

The purpose of this study was to evaluate the adrenomedullin mRNA expression in placenta of preeclamptic women and additionally to assess the correlation between ADM mRNA expression and -1984A > G ADM gene polymorphism.

MATERIAL AND METHODS

26 preeclamptic (PE), 20 with gestational hypertension (GH) and 43 normotensive healthy pregnant women have been involved into the study. The placenta samples were collected instantly after delivery from the central part of maternal side. The ADM gene expression was measured with the real-time polymerase chain reaction (rt-PCR). The results were standardized according to the reference glyceraldehyde-3-phosphate dehydrogenase (GAPDH) gene. The -1984A > G ADM gene polymorphism was determined by PCR/RFLP assay

RESULTS

Lower expression of ADM mRNA in PE group (0.881 +/- 0.254 vs. 1.039 +/- 0.391 in controls, ns) has been investigated. In PE group the placental ADM mRNA expression was slightly higher at women carrying AA genotype (0.890 +/- 0.263 vs. 0.842 +/- 0.231, ns). In the control group higher placental ADM mRNA expression in women with AG + GG genotype of -1984A > G ADM gene polymorphism (1.249 +/- 0.431) in comparison to women carrying AA genotype (1.036 +/- 0.356, ns) was observed. The study also revealed negative correlation between placental ADM mRNA expression and systolic blood pressure in hypertensive pregnant women (p = 0.020).

CONCLUSION

Reduced mRNA expression for ADM in the placenta connected with reverse correlation of systolic blood pressure in preeclamptic women suggests the significant role of disturbances in placental secretion of ADM in etiology of preeclampsia.

Genetic variability of endothelin-1 system in gestational hypertension and preeclampsia

INTRODUCTION

Recently much attention has been focused on endothelin-1 (ET-1) and endothelin-1 converting enzyme (ECE-1) gene polymorphisms and connected changes in ET-1 concentration. Additionally these processes have been shown to be possibly involved in preeclampsia susceptibility. The aim of this study was to evaluate the correlation between ET-1 (Lys198Asn) and ECE-1 (Thr341lle) gene polymorphisms and the risk of gestational hypertension and preeclampsia.

MATERIAL AND METHODS

The study group consisted of 110 hypertensive (69 with gestational hypertension and 41 preeclamptic) pregnant women. The control group included 150 healthy pregnant women. The frequency of investigated polymorphisms was examined by polymerase chain reaction and restriction fragment length polymorphism (PCR/RFLP) assay

RESULTS

There were no statistically significant differences in genotype frequencies of ET-1 Lys198Asn and ECE-1 Thr341lle gene polymorphic variants between hypertensive pregnant women and the control group. There were also no remarkable differences between GH and PE groups when compared to the controls. However parallel presence of both Thr341lle ECE-1 and Lys198Asn ET-1 variant localisation showed a higher occurrence rate of ECE-1 CT/ET-1 GT heterozygotic genotypes in the control group (5,3%) than in the whole study or GH and PE groups (0.9%, 1.4% and 0.0% respectively p = ns). In preeclamptic women, the higher systolic blood pressure value was observed in GG Lys198Asn ET-1 genotype carriers (180.7 mmHg) than in patients with at least one mutated T allele (GT and TT) (167.3 mmHg, p = ns). The lowest blood pressure level was connected with the mutated TT Lys198Asn ET- 1 genotype presence.

CONCLUSIONS

Results of this study suggest lack of direct correlation of Lys198Asn ET-1 and Thr341lle ECE-1 gene polymorphisms with risk of gestational hypertension and preeclampsia in the studied population of Polish women. High prevalence of ECE-1 CT/ET-1 GT heterozygote genotypes of both Thr341lle ECE-1 and Lys198Asn ET-1 polymorphisms in healthy pregnant subjects compared to GH and PE groups suggests the protective role of mutated alleles in the development of PE. The carrier of mutated TT genotype of Lys198Asn ET-1 polymorphism is probably connected with lower systolic blood pressure level in preeclamptic women. Future studies are needed to establish the role of analysed polymorphisms in the etiology of gestational hypertension and preeclampsia.

The possible role of adrenomedullin in the etiology of gestational hypertension and preeclampsia

INTRODUCTION

Nowadays the possible role of vasoactive peptide adrenomedullin (ADM) is considered in the etiology of preeclampsia (PE), where ADM is indicated to be a protective factor decreasing blood pressure. The aim of this study was to evaluate the role of -1984A>G ADM gene polymorphism and its connection with ADM plasma level in women with gestational hypertension (GH) and preeclampsia.

MATERIAL AND METHODS

63 hypertensive (30 with GH and 33 with PE) and 94 healthy pregnant women were included into the study The frequency of genotypes and alleles of -1984A>G ADM gene polymorphism was examined by PCR/RFLP method. ADM concentration was measured by ELISA method.

RESULTS

In GH subgroup higher frequency of heterozygous AG genotype (16.67% vs. 8.50%, O.R. = 2.68, p = ns) and G allele (11.67 vs. 4.30%, O.R. = 2.97, p = 0.043) was observed. In PE subgroup overrepresentation of heterozygous AG genotype (15.15% vs. 8.5%) and slightly higher frequency of G allele (p = ns) were noted. In AA genotype subgroup of hypertensive women in comparison to the AG+GG genotype group higher proteinuria value (212.1 vs. 90.9 mg/dl, p < 0.0001), lower systolic (171.1 vs. 177.3 mmHg), as well as lower diastolic blood pressure level (107.1 vs. 111.4 mmHg) were noted. The highest ADM plasma level was observed in the group of women with PE (1.817 vs. 1.692 ng/ml, p = ns). Moreover, higher ADM plasma concentration in patients with AA genotypes in comparison to the carriers of AG and GG genotypes (1.844 vs. 1.402 ng/ml, p = ns) was noted.

CONCLUSIONS

Higher ADM plasma concentration in women with PE suggests possible correlation between ADM level and pathological changes in cardiovascular system during pregnancy Overrepresentation of genotypes containing at least one mutated G allele of the -1984A>G ADM gene polymorphism in women with GH and PE suggests participation of this allele in pathogenesis of these conditions. Higher ADM concentration in carriers of homozygous AA genotype found in GH and PE groups indicates the possible important role of A allele in prevention of GH/PE appearance.

The significance of -786T > C polymorphism of endothelial NO synthase (eNOS) gene in severe preeclampsia

OBJECTIVE

Preeclampsia (PE) is believed to be induced by endothelial cell dysfunction in placenta. Highly polymorphic endothelial nitric oxide synthase (eNOS) activity belongs to the factors significantly influencing vaso-motor tone in placenta and PE susceptibility. The aim of this study was to evaluate prevalence of -786T/C polymorphism of eNOS gene in the groups of women with mild and severe PE.

STUDY DESIGN

The study was performed in the group of 218 preeclamptic (including 136 with severe PE) and of 400 normotensive healthy women delivered normally after a healthy gestation. The eNOS -786T/C polymorphism was determined using PCR/RFLP assay. Additionally, detailed correlation between eNOS genotypes and clinical/laboratory data in the PE group has been analyzed.

RESULTS

The higher frequency of mutated homozygous CC genotypes (17.4% vs. 11.5% in controls, OR 1.62, n.s.) and of C alleles (allelic frequency 44.1 vs. 36.6%; OR 1.36, p = 0.012) in the group of PE has been determined. Furthermore, in the group of severe PE the overrepresentation of mutated CC genotypes (23.5% vs. 11.5%, OR 2.37, p = 0.0014) and mutated C alleles (47.8 vs. 36.6%, OR 1.58, p = 0.0016) has been found.

CONCLUSIONS

The presence of mutated homozygous CC genotype and C allele of -786T/C polymorphism of eNOS gene influences the higher susceptibility to develop severe PE development.

[Is venous thrombembolism during pregnancy an indication for routine assay of antithrombin activity and antithrombin supplementation?]

During pregnancy the concentrations of many coagulation factors are increased what leads to a "physiological" hypercoagulability status and constitutes a natural protection against delivery hemorrhage. These changes may be conducive to venous thrombembolism. Antithrombin is one of the endogenous clotting inhibitors. As a serine protease, it inactivates thrombin and the efficiency of this reaction is intensified by heparin. Acquired antithrombin deficiency is caused by disseminated intravascular coagulation syndrome, deep vein thrombosis, neoplasms, nephritic syndrome, renal failure, liver diseases, long-term estrogen treatment, dialysis or extracorporeal circulation. There are also cases of inherited antithrombin deficiency which leads to thrombophilia. The following study presents a course of pregnancy and postpartum of a woman with deep vein thrombosis and acquired antithrombin deficiency as well as the applied treatment. The legitimacy of routine assay of antithrombin activity and antithrombin supplementation in pregnant women with thrombosis was considered. This procedure may be helpful when dealing with obese pregnant patients as it is difficulty to identify and establish a therapeutic dose of heparin in their cases. Therapy guidelines for pregnant patients with thrombosis and acquired antithrombin deficiency have not been established yet.

[Polymorphism in the genes of Toll-like receptors type 2 and type 4 (TLR-2 and TLR-4) and the risk of premature rupture of the membranes--preliminary study]

INTRODUCTION

Toll-like receptors (TLR) -2 and -4 are a part of basic defence mechanism protecting against bacterial infections. They recognize microbial products and increase immune response of the host organism. The relationship between the expression of TLR receptors and the occurrence of intraamniotic infection (IAI) as well as preterm labour was demonstrated. Therefore, a relationship between TLR-2 and -4 genes polymorphism, premature rupture of membranes (PROM), intraamniotic infection and preterm labour is claimed to exist.

AIM

The aim of the following study was to evaluate the frequency of two genetic polymorphisms: Arg753Gln (G20877A) in TLR-2 and Thr399lle (C8993T) in TLR-4 genes in a group of pregnant women with preterm rupture of membranes and preterm labour.

MATERIAL AND METHODS

33 pregnant women with the diagnosis of preterm--between 30 and 36 weeks of gestation--rupture of membranes (study group), and 60 healthy pregnant women (controls) were enrolled into the study. To analyse Arg753Gln polymorphism of TLR-2 gene and Thr399lle polymorphism of TLR-4 gene, polymerase chain reaction and restriction fragments length polymorphism (PCR/RFLP) were used.

RESULTS

For G20877A polymorphism in TLR-2 gene, the frequency of heterozygous GA genotype in the study group was 9.1% and was comparable with the control group (8.3%, p = ns). Moreover frequency mutated G allele was comparable in both examined groups (4.6% in the study group and 4.2% in the control group, p = ns). For C8993T polymorphism in TLR-4 gene, heterozygous CT genotype was less frequent in the study group in comparison with the control group (9.1 vs. 16.7%). The homozygous CC genotype was more frequent in the study group (90.0 vs 83.3%, p = ns), with relatively high value of the odds ratio (OR = 2,0). Similar observations were conducted by analysing the frequencies of the alleles in both examined groups.

CONCLUSION

Overrepresentation of heterozygous CT genotype and mutated T allele of C8993T polymorphism in TLR-4 gene in the control group may indicate that, possibly, it plays a protective role against PROM. However this hypothesis requires further investigation on a larger group of patients with premature rupture of membranes.

[Genetic conditioned changes in activity of 5,10-methylenetetrahydrofolate reductase (MTHFR) and recurrent miscarriages]

5,10-methylenetetrahydrofolate reductase (MTHFR) is the key enzyme in folate, methionine and homocysteine metabolism. The disturbances in MTHFR activity could be the cause of increased serum level of homocysteine. Hyperhomocysteinemia is a risk factor of changes in coagulation cascade through direct cytotoxic influence on endothelium, atherogenesis, activation of coagulation factor V and VII, increased level of thrombin and platelets aggregation. Genetic disturbances in MTHFR enzyme activity in the presence of polymorphic variants of its gene are responsible for homocysteine augmentation and could be the reason of several gestational complications such as recurrent miscarriages.

[Inherited thrombophilia as the reason of recurrent miscarriges in the first trimester of pregnancy]

INTRODUCTION

It is currently believed that disturbances of maternal clothing system leading to occurrence of thrombotic abnormalities, conditioned by the presence of acquired or inherited thrombophilias, may be an important reason for recurrent abortions. The aim of this study was to investigate frequency and significance of polymorphisms in genes coding for factor V (1691G>A) and factor II (20210G>A) of coagulation cascade in a group of women with two or more miscarriages in the first trimester of pregnancy.

MATERIAL AND METHODS

The investigations were conducted in a group of 104 women with anamese history of two or more miscarriages in the first trimester of pregnancy and in a group of 169 women with correct obstetrical anamnesis and confirmed presence of at least one pregnancy that resulted in a birth of a healthy child. The analysis was performed by polymerase chain reaction and restriction fragment length polymorphism (PCR/RFLP).

RESULTS

Investigation of 20210G>A polymorphism of prothrombin gene revealed high overrepresentation of genotype GA (8.33% and 1.18% in the control group, p = 0.07) and allele A (4.17% and 0.59% in the control group, p = 0.07) in the subgroup of women with three or more miscarriages. Investigation of 1691 G>A polymorphism showed preponderance of genotype GA (12.50% vs 6.51%, p = 0.31) and allele A (6.25% vs 3.25%, p = 0.31) in a group of women with miscarriages between 10 and 13 week of gestation in comparison to the control group. Investigation of 20210G>A polymorphism showed majority of genotype GA (8.70%) in women with miscarriages in the early as well as in the late period of the first trimester in comparison to the control group (1.18%, p = 0.07). The frequency of occurrance of mutated allele A was 4.35% and 0.59% in the control group (1.18%, p = 0.07).

CONCLUSIONS

The analysis of obtained results suggests the possible influence of both considered polymorphisms 1691G>A of factor V gene and 20210G>A prothrombin gene on mechanism of recurrent miscarriages in the first trimester of pregnancy and participation of 1691G>A polymorphism in the etiology of recurrent miscarriages during the late period of the first trimester of pregnancy (10-13 week of gestation).

[Polymorphism of osteoprotegerin gene and osteoporosis in postmenopausal women]

INTRODUCTION

Osteoprotegerin (OPG) plays a crucial role in the control of bone resorption through competitive inhibition of receptor activator of nuclear factor kappaB ligand (RANKL). This process leads to inhibition of osteoclasts differentiation and activity. The aim of the following study was to evaluate the distribution of genotypes of -163A>G and 1181G>C polymorphisms in OPG gene and analyze their relationship with bone mineral density (BMD) and other parameters of bone turnover in population of Polish postmenopausal women.

MATERIAL AND METHOD

The study included 310 postmenopausal Caucasian women (54.48+/-8.53 years); 139 women with osteoporosis, 107 with osteopenia and 64 healthy women. Genetic analysis was performed by PCR/RFLP reaction. BMD value was measured by dual energy X-ray absorptiometry (DXA).

RESULTS

For -163A>G polymorphism the higher frequency of heterozygotes AG (26.6 vs. 18.7%, ns) and slight overrepresentation of mutated G allel (14.1 vs. 10.9%, ns) in the osteoporosis group was observed. The frequency of recessive CC homozygotes and C alleles of 1187G>C polymorphism did not differ among the investigated groups. The distribution of particular haplotypes of -163A>G and 1181G>C polymorphisms in all subgroups was similar. Correlation between values of investigated parameters of bone turnover and frequency of genotypes of investigated polymorphisms has not been observed.

CONCLUSIONS

The overrepresentation of heterozygous AG genotype and mutated G allele of -163A>G polymorphism of OPG gene in the group of women with osteoporosis might suggest the significance of this variant in the development of osteoporosis. A more extensive analysis of genetic variants of RANKL/RANK/OPG signal pathways, joint with an investigation of modulated influence of estrogens, TNF-alpha or several interleukin influencing the development of osteoporosis is necessary.

[The course of pregnancy, delivery and puerperium in a woman with multifactorial thrombophilia--a case report]

Hereditary or acquired thrombophilia may induce many complications in pregnant women, the relationship between thrombophilia and recurrent miscarriages as well as intrauterine death in the second half of the pregnancy being identified as a particularly frequent one. The introduction of detailed diagnostic methods in women with pregnancy loss in anamnesis allow for more frequent recognition of multifactorial thrombophilia. However, uniform recommendations connected with pregnancy course in these cases, application of anticoagulation prophylaxis and optimal dosage are lacking. In this manuscript we have described the course of a pregnancy, delivery and puerperium of a pregnant woman with recurrent miscarriages in anamnesis, antiphospholipid syndrome, being simultaneously a carrier of both--Leiden (1691G>A) and 20210G>A prothrombin mutations--(multifactorial thrombophilia), in which anticoagulant prophylaxis has been successfully applied.

[The connection between Arg353Gln polymorphism of coagulation factor VII and recurrent miscarriages]

INTRODUCTION

In recent years much attention has been paid to the possibly significant role of the activity differences of factor VII (FVII) in the etiology of recurrent miscarriages.

OBJECTIVES

The aim of study was to evaluate the frequency of Arg353Gln genetic polymorphism of coagulation factor VII and the role of presence of Gln353 allele in the group of women with two or more spontaneous abortions in the first trimester of pregnancy.

MATERIAL AND METHODS

104 women (average age 30.15 +/- 4.07 years), with two or more spontaneous abortions in the first trimester (between 6 and 13 weeks of gestation) of pregnancy, and 163 healthy women (average age 29,40 +/- 3,56 years), with at least one pregnancy which had ended with the delivery of a healthy newborn, have been analyzed. The frequency of genotypes has been determined by means of polymerase chain reaction/restriction fragment length polymorphism (PCR/RFLP) methods.

RESULTS

In the group of recurrent miscarriages, higher frequency of homozygotic Arg353/Arg353 genotype (82.69 vs 74.85%) and lower frequency of heterozygotic Arg353/Gln353 (17.31 vs 25.15%) genotype have been noted, comparing to the control group. Frequency of mutated Gln353 allele was lower in the group of spontaneous abortions (8.65 vs. 12.58%, ns). Observed frequency of mutated Gln353 allele in the control group (12.58%) was compatible with th frequency for Caucasian observed by other authors. In the subgroup of women with two (80 women), three or more abortions (24 women), the frequency of heterozygous genotype Arg353/Gln353 was lower if compared to the controls (16.25% and 20.83%, respectively) (controls 25.15%, ns). Lower frequency of heterozygous genotype Arg353/Gln353 in the subgroup of women with abortions in the early (6-9 week of gestation) period of the first trimester (13.85 vs 25.15%, p=0.04) has been observed.

CONCLUSION

Research and investigation which have been carried out suggest a weak connection of Arg353Gln polymorphism of coagulation factor VII with the frequency of recurrent miscarriages. However, higher frequency of Gln353 allele in the control group of healthy women suggests its protective role in coagulation changes and recurrent miscarriages. A visibly lower frequency of heterozygous genotype Arg353/Gln353 in the miscarriages in the early period of the first trimester, which might suggest potentially great protective significance of Gln353 allele presence in this period of pregnancy, remains an interesting fact.

[The influence of interleukin-6 and tumor necrosis factor alpha gene polymorphisms on bone mineral density in postmenopausal women]

Proinflammatory cytokines, interleukin-6 (IL-6) and tumor necrosis factor alpha (TNF-alpha), involved into osteoclastogenesis and responsible for bone resorption process, participate in the pathogenesis of the osteoporosis. In vitro studies have shown that single nucleotide polymorphisms of IL-6 and TNF-alpha genes could influence the transcription process of the genes and the cytokines level.

AIM

Assessment of the influence of IL-6 and TNF-alpha gene polymorphisms on bone mineral density (BMD) and evaluation of their connection with osteoporosis prevalence in women from Wielkopolska region.

MATERIAL AND METHODS

In the group of 267 postmenopausal women (average age 58.5+/-5.9 years, average age of last period 49.8+/-3.9 years) bone mineral density in lumbar spine (L2-L4) was performed using dual energy X-ray absorptiometry (DXA). Genotypes frequencies were determined by polymerase chain reaction with restriction fragment length polymorphism (PCR/RFLP) using restriction enzymes Lwe I and Faq I, respectively. The connection between the polymorphisms of investigated genes and body mass index, age of menarche and menopause and length of reproductive age had been analyzed as well.

RESULTS

No statistically significant association was found between examined genetic factors and the value of bone mineral density in the investigated group of postmenopausal women. The frequencies of investigated genotypes were in compliance with Hardy-Weinberg equilibrium. The correspondence between evaluated clinical parameters and IL-6 i TNF-alpha genotypes frequencies has not been proven.

CONCLUSIONS

The -174G/C polymorphism in the IL-6 and -308G/A polymorphism in TNF-alpha genes have no influence on bone mineral density value (BMD) in the investigated population of women from Wielkopolska region.

[The (-2548G/A) polymorphism of leptin gene in women with gestational hypertension and preeclampsia]

INTRODUCTION

Leptin is a polypeptide hormone (167 amino acids, molecular weight of about 16kDa), synthesized mainly in white adipose tissue. The hormone plays an important role in regulation of hunger and satiety processes, in metabolism of carbohydrates and fats, development of cardio-vascular diseases and obesity. The occurrence of the increased level of leptin in pregnant women with hypertension, especially in women with preeclampsia, has also been brought to our attention. In recent years it has been suggested that the presence of different variants of leptin and leptin receptor genes may modify the leptin level in serum, and, in this way, influence an increased risk of obstetric complications, such as preeclampsia or eclampsia.

MATERIALS AND METHODS

We have analyzed a group of 103 hypertensive pregnant women--61 women with gestational hypertension (GH) and 42 women with preeclampsia (PE). The control group consisted of 113 healthy pregnant women who have been investigated. Gestational hypertension and preeclampsia were recognized with the help of and assessed according to the ACOG criteria. The (-2548G/A) polymorphism was determined using polymerase chain reaction/restriction fragment length polymorphism (PCR/RFLP).

RESULTS

In our study, a higher frequency of mutated AA genotype in GH group and PE groups (21.31% and 21.43% respectively vs. 16.81% in the controls) and the overrepresentation of mutated A allele in both analyzed groups (47.54% and 45.24% respectively vs. 41.59% in the controls) have been observed, without statistically significant differences.

CONCLUSIONS

The overrepresentation of AA genotypes and higher frequency of mutated A allele of (-2548G/A) polymorphism of leptin gene in GH and PE groups might indicate its possible contribution in gestational hypertension and preeclampsia.