Using proteomic analysis of the human amniotic fluid to identify histologic chorioamnionitis

Obstet Gynecol. 2008 Feb;111(2 Pt 1):403-12. doi: 10.1097/AOG.0b013e31816102aa.

Abstract

Objective: To estimate the relationship between histologic chorioamnionitis and four amniotic fluid proteomic biomarkers characteristic of inflammation (defensins 2 and 1, calgranulins C and A).

Methods: One hundred fifty-eight women with singleton pregnancies had a clinically indicated amniocentesis to rule out inflammation and infection in the context of preterm labor or preterm premature rupture of membranes. A proteomic fingerprint (Mass Restricted score) was generated from amniotic fluid using surface-enhanced laser desorption ionization time-of-flight mass spectrometry. The Mass Restricted score ranges from 0 to 4 (none to all four biomarkers present) in direct relationship with severity of intra-amniotic inflammation. Presence or absence of biomarkers was analyzed in relationship to placental pathology. Criteria for severity of histologic chorioamnionitis were 3 stages and 4 grades of inflammation of the amnion, choriodecidua and chorionic plate.

Results: The prevalence of histologic chorioamnionitis was 64% (stage I 12%, stage II 16%, and stage III 37%). The Mass Restricted score significantly correlated with stages of histologic chorioamnionitis (r=0.539, P<.001), grades of choriodeciduitis (r=0.465, P<.001), and amnionitis (r=0.536, P<.001). African-American women were overrepresented in the group with severe inflammation (Mass Restricted score 3-4, P=.022). Of the four biomarkers of the Mass Restricted score, calgranulin C had the strongest relationship with presence of stage III chorioamnionitis, independent of race, amniocentesis-to-delivery interval, and gestational age.

Conclusion: Proteomic analysis of amniotic fluid provides an opportunity for early recognition of histologic chorioamnionitis. This methodology may in the future identify candidates for antenatal therapeutic interventions.

Level of evidence: II.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adolescent
  • Adult
  • African Americans
  • Amniocentesis / methods
  • Amniotic Fluid / chemistry*
  • Biomarkers / analysis
  • Chorioamnionitis / diagnosis*
  • Chorioamnionitis / epidemiology
  • Chorioamnionitis / metabolism
  • European Continental Ancestry Group
  • Female
  • Humans
  • Inflammation
  • Pregnancy
  • Pregnancy Complications, Infectious / diagnosis*
  • Pregnancy Outcome
  • Prevalence
  • Proteome / analysis*
  • Proteomics / methods*
  • Reproducibility of Results
  • Sensitivity and Specificity
  • Severity of Illness Index
  • Spectrometry, Mass, Matrix-Assisted Laser Desorption-Ionization

Substances

  • Biomarkers
  • Proteome