CORD BLOOD CALPROTECTIN CORD BLOOD CALPROTECTIN CONCENTRATIONS IN FULL- CONCENTRATIONS IN FULL- TERM PREGNANCIES WITH TERM PREGNANCIES WITH NORMAL AND RESTRICTED NORMAL AND RESTRICTED FETAL GROWTH FETAL GROWTH Sofia Liosi Sofia Liosi 1 1 , Despina D. Briana , Despina D. Briana 1 1 Dimitrios Gourgiotis Dimitrios Gourgiotis 2 2 , , Maria Boutsikou , , Maria Boutsikou 1 1 , Stavroula , Stavroula Baka Baka 1 1 , Antonios Marmarinos , Dimitrios Hassiakos , Antonios Marmarinos , Dimitrios Hassiakos 1 1 , , Ariadne Malamitsi-Puchner Ariadne Malamitsi-Puchner 1 1 . . 1. 1. Neonatal Division, 2nd Department of Obstetrics and Gynecology, Athens Neonatal Division, 2nd Department of Obstetrics and Gynecology, Athens University Medical School, Athens, Greece University Medical School, Athens, Greece 2.Research Laboratories, 2nd Department of Pediatrics, Athens University 2.Research Laboratories, 2nd Department of Pediatrics, Athens University Medical School, Athens, Greece Medical School, Athens, Greece
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CORD BLOOD CALPROTECTIN CORD BLOOD CALPROTECTIN CONCENTRATIONS IN FULL-CONCENTRATIONS IN FULL-TERM PREGNANCIES WITH TERM PREGNANCIES WITH NORMAL AND RESTRICTED NORMAL AND RESTRICTED
FETAL GROWTHFETAL GROWTH
Sofia LiosiSofia Liosi 11 , Despina D. Briana, Despina D. Briana 11
1.1.Neonatal Division, 2nd Department of Obstetrics and Gynecology, Athens Neonatal Division, 2nd Department of Obstetrics and Gynecology, Athens University Medical School, Athens, GreeceUniversity Medical School, Athens, Greece
2.Research Laboratories, 2nd Department of Pediatrics, Athens University 2.Research Laboratories, 2nd Department of Pediatrics, Athens University Medical School, Athens, GreeceMedical School, Athens, Greece
CalprotectinCalprotectin
• a 36-kDa calcium and zinc binding a 36-kDa calcium and zinc binding protein protein
• comprises two heavy chains of 14 kDa comprises two heavy chains of 14 kDa and one l ight chain of 8 kDaand one l ight chain of 8 kDa
• constitutes approximately 60% of soluble constitutes approximately 60% of soluble cytosol proteins in human neutrophil cytosol proteins in human neutrophil granulocytesgranulocytes
CalprotectinCalprotectin
• a marker of neutrophil turnover
• immunomodulatory and antimicrobial effects
• antiproliferative effects (inducing apoptosis)
Intrauterine growth Intrauterine growth restriction (IUGR)restriction (IUGR)• Failure of the fetus to achieve his/her
intrinsic growth potential
• Consequence of anatomical and/or functional disorders and diseases in the feto-placental-maternal unit
• Results to increased morbidity and mortali ty in intra- and extra-uterine l i fe
Neutrophil activationNeutrophil activation
is present in preeclampsia and isolated intrauterine growth restriction
Possible mechanisms may be: • hypoxia• the presence of soluble mediators of inflammation• endothelial stimulation
IUGRIUGR
• associated with an increased incidence of apoptosis in IUGR-affected fetal membranes
HypothesisHypothesis
• Umbilical cord blood Umbilical cord blood concentrations of concentrations of calprotectin in IUGR cases may differ calprotectin in IUGR cases may differ from respective concentrations in from respective concentrations in appropriate-for-gestational-age (AGA) appropriate-for-gestational-age (AGA) controls since the former present controls since the former present increased neutrophil activation and increased neutrophil activation and
excessive apoptosisexcessive apoptosis ..
AimAim
• Investigate cord blood calprotectin concentrations in IUGR, and AGA pregnancies at birth
• Correlate determined concentrations with gestational age, gender and mode of delivery ..
• Preeclampsia (Preeclampsia ( n=6 )n=6 ) • Pregnancy induced hypertension (n=5Pregnancy induced hypertension (n=5 ))• Various diseases : Various diseases : severe type I DMsevere type I DM
Figure 1. Error bars Figure 1. Error bars of the concentrations of of the concentrations of Calprotectin in IUGR cases and AGA controls.Calprotectin in IUGR cases and AGA controls.
IUGR GROUP (N=50)
AGA GROUP (N=110)
C
AL
PR
OT
EC
TIN
LE
VE
LS
(n
g/m
l)
320
300
280
260
240
220
0
Results (1)Results (1)
• NoNo statistically signif icant differences in statistically signif icant differences in cord blood calprotectin concentrations cord blood calprotectin concentrations between IUGR and AGA groupsbetween IUGR and AGA groups ..
Results (2)Results (2)
• In a combined groupIn a combined group
• Cord blood calprotectin concentrations Cord blood calprotectin concentrations were signif icantly decreased in cases of were signif icantly decreased in cases of caesarean sectioncaesarean section ..
• The effect of birthweight, customized The effect of birthweight, customized centi le, gestational age, gender and centi le, gestational age, gender and parity on calprotectin concentrations was parity on calprotectin concentrations was not signif icantnot signif icant ..
Results (3)
• In the IUGR groupIn the IUGR group
• Calprotectin was significantly elevated Calprotectin was significantly elevated for every week increase in gestational for every week increase in gestational age.age.
• Calprotectin was posit ively correlated Calprotectin was posit ively correlated
with birthweight.with birthweight.
Conclusions (1)Conclusions (1)
• Cord blood calprotectin concentrations at Cord blood calprotectin concentrations at term are independent of intrauterine term are independent of intrauterine growth and probably do not reflect the growth and probably do not reflect the increased neutrophil activation and increased neutrophil activation and excessive apoptosis expected in IUGRexcessive apoptosis expected in IUGR
• PParity, gender and maternal age do not arity, gender and maternal age do not seem to have any impact on umbil ical seem to have any impact on umbil ical cord blood calprotectin concentrationscord blood calprotectin concentrations
Conclusions (2)Conclusions (2)
• Calprotectin may have a l imited role Calprotectin may have a l imited role during fetal l i fe, possibly due to the during fetal l i fe, possibly due to the lower degree of neutrophil activation in lower degree of neutrophil activation in the fetus.the fetus.
• Neutrophil activation and apoptosis seem Neutrophil activation and apoptosis seem to increase with advancing gestational to increase with advancing gestational age in the IUGR group, as indicated by age in the IUGR group, as indicated by the increasing calprotectin the increasing calprotectin concentrations with progressing concentrations with progressing pregnancypregnancy
Conclusions (3)
• Excessive inflammatory response associated with vaginal delivery may account for the higher calprotectin concentrations in the latter