Demishev, Michael, MD

Hanna, Nazeeh, MD

Keeler, Sean M, MD

Kiefer, Daniel G, MD

Muscat, Jolene C, MD

English

Lehigh Valley Health Network: LVHN Scholarly Works

Lehigh Valley Health NetworkLVHN Scholarly WorksDepartment of Obstetrics & GynecologyExamining the Relationship of InflammatoryMediators Among Fetal CompartmentsDaniel G. Kiefer MDLehigh Valley Health Network, Daniel_G.Kiefer@lvhn.orgSean M. Keeler MDLehigh Valley Health NetworkJolene C. Muscat MDMichael Demishev MDNazeeh Hanna MDFollow this and additional works at: https://scholarlyworks.lvhn.org/obstetrics-gynecologyPart of the Obstetrics and Gynecology CommonsThis Poster is brought to you for free and open access by LVHN Scholarly Works. It has been accepted for inclusion in LVHN Scholarly Works by anauthorized administrator. For more information, please contact LibraryServices@lvhn.org.Published In/Presented AtKiefer, D., Keeler, S., Muscat, J., Demishev, M., & Hanna, N. (2011, February 7-12). Examining the relationship of inflammatorymediators among fetal compartments. Poster presented at: The 31st Annual Meeting of the Society for Materna-Fetal Medicine, SanFrancisco, CA.Examining the Relationship of Inflammatory Mediators Among Fetal Compartments1Lehigh Valley Health Network, Obstetrics and Gynecology, Allentown, PA, 2Naval Medical Center Portsmouth, Obstetrics and Gynecology, Portsmouth, VA, 3Stony Brook-Winthrop University Hospitals, Obstetrics and Gynecology, Long Island, NY, 4Winthrop University Hospital, Pediatrics, Mineola, NYDaniel Kiefer1, LCDR Sean Keeler2, Jolene Muscat3, Michael Demishev3, Nazeeh Hanna4Conclusions:CompartmentAmniotic FluidUmbilical VeinUmbilical ArteryPlacental CultureAmniotic fluid  1 1 2Umbilical Vein  19 5Umbilical Artery    4Placental Culture     •  There is significant correlation of inflammatory mediators between the umbilical artery and vein, but not between the fetal circulation and amniotic fluid. •  The contribution of the placenta to the in-utero inflammatory milieu remains unclear as few cytokine levels were correlated with other compartments and there was little change in mediator levels between the umbilical artery and vein.•  It is possible that the culture methods altered placental mediator expression.  Future studies will attempt to perform direct analysis of placental tissue.Table 1.  Inflammatory Mediator Correlation Among CompartmentsTable 2.  Median Inflammatory Mediator Levels by Compartment (pg/ml)OBJECTIVE: Although cytokines have been shown to be important in both term and preterm labor, the source (ie, fetal or placental) of many cytokines is uncertain. Therefore, we evaluate the relationship of inflammatory mediators between the umbilical artery, umbilical vein, placenta, and amniotic fluid.STUDY DESIGN: Twenty term, non-laboring patients without major maternal or fetal complications undergoing cesarean delivery were asked to provide samples during the immediate pre-operative and intra-operative period. Amniotic fluid was obtained intra-operatively via needle aspiration of the intact amniotic sac after hysterotomy. Fetal plasma from the umbilical artery and vein were sampled from a section of cord after delivery. A portion of the placenta was cultured under standard conditions for 24 hours. The supernatant was then collected. All fluids were analyzed for 27 inflammatory mediators using the Bio-Plex Array. We the compared the inflammatory mediator profile between compartments using Spearman correlation with P <0.05 required for significance. Mediator levels in the umbilical artery and vein were compared using the t-test.RESULTS: Table 1 shows the number of cytokines (out of 27) that reached a significant correlation between the various fetal compartment combinations. There was a high degree of correlation between the umbilical artery and vein with 19 of the 27 reaching a significant correlation. When comparing median cytokine levels, only monocyte chemotactic protein-1 (MCP-1) was significantly different in the artery (196 pg/ml) when compared to the vein (123 pg/ml, P=0.01).CONCLUSION: There is significant correlation of inflammatory mediators between the umbilical artery and vein, but not between the fetal circulation and amniotic fluid. The contribution of the placenta to the in-utero inflammatory milieu remains unclear as few cytokine levels were correlated with other compartments.KEY: Table indicates the number of inflammatory mediators (out of 27) that reached a significant correlation between the indicated compartments.KEY: Interleukin (IL), platelet derived growth factor (PDGF), fibroblast growth factor (FGF), granulocyte colony stimulating factor (G-CSF), granulocyte macrophage stimulating factor (GM-CSF), interferon gamma (IFN-γ), inducible protein-10 (IP-10), monocyte chemotactic protein-1 (MCP-1), macrophage inflammatory protein (MIP), tumor necrosis factor alpha (TNF-α), vascular endothelial growth factor (VEGF), regulated on activation normal T cell expressed and secreted (RANTES); *Out of range, greater than the limit of the assay.CompartmentAmniotic FluidUmbilical VeinUmbilical VeinPlacental CultureIL-1β 2.1 1.2 0.9 239.7IL-1ra 930.3 167.6 104 5836.0IL-2 Not detected Not detected Not detected Not detectedIL-4 1.8 1.1 0.7 4.1IL-5 3.4 0.9 0.6 0.9IL-6 25.3 3.0 3.6 00R>*IL-7 12.6 2.7 3.7 4.2IL-8 40.0 4.7 4.4 29855.7IL-9 21.3 7.6 4.5 48.9IL-10 1.9 1.9 1.7 239.5IL-12 13.0 6.1 4.6 5.9IL-13 5.1 2.4 2.2 53.6IL-15 Not detected 8.0 7.5 21.6IL-17 9.9 27.5 23.1 56.1PDGF 37.1 241.8 257.4 93.8Eotaxin Not detected 45.6 51.8 20.3FGF 13.7 46.0 26.3 181.2G-CSF 99.4 43.7 42.9 OOR>*GM-CSF Not detected 100.2 100.2 263.7IFN-γ 167.2 74.2 68.5 281.4IP-10 390.4 187.6 273.8 16308.8MCP-1 28.2 190.2 97.7 12803.9MIP-1A Not detected Not detected Not detected 5451.3MIP-1B 6.2 81.4 84.1 13838.1RANTES 22.5 1001.7 943.8 1178.5TNA-α Not detected 18.0 16.1 4044.5VEGF 8.11 30.3 25.4 22.7Background and Objective:Methods:•  Term, non-laboring patients without major maternal or fetal complications undergoing cesarean delivery were asked to provide samples during the immediate pre-operative and intra-operative period. •  Amniotic fluid was obtained intra-operatively via needle aspiration of the intact amniotic sac after hysterotomy. •  Fetal plasma from the umbilical artery and vein were sampled from a section of cord after delivery.•  A portion of the placenta was cultured under standard conditions for 24 hours. The supernatant was then collected. •  All fluids were analyzed for 27 inflammatory mediators using the Bio-Plex™ Array. •  We the compared the inflammatory mediator profile between compartments using Spearman correlation with P <0.05 required for significance. •  Mediator levels in the umbilical artery and vein were compared using the non-parametric t-test.•  Although cytokines and other inflammatory mediators have been shown to be important in both term and preterm labor, the source (ie, fetal or placental) of many cytokines is uncertain. •  We evaluate the relationship of inflammatory mediators between the umbilical artery, umbilical vein, placenta, and amniotic fluid.Results:•  Table 1 shows the number of cytokines (out of 27) that reached a significant correlation between various fetal compartment combinations. •  There was a high degree of correlation between the umbilical artery and vein with 19 of the 27 reaching a significant correlation. •  Table 2 contains the median cytokine levels for each compartment.•  When comparing median cytokine levels, only monocyte chemotactic protein-1 (MCP-1) was significantly different in the artery (196 pg/ml) when compared to the vein (123 pg/ml, P=0.01).Disclaimer: The views expressed on this poster are those of the author and do not necessarily reflect the official policy or position of the Department of the Navy, Department of Defense, or the U.S. Government.

Examining the Relationship of Inflammatory Mediators Among Fetal Compartments

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Examining the Relationship of Inflammatory Mediators Among Fetal Compartments

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