Twenty-four percent of patients with clinical chorioamnionitis in preterm gestations have no evidence of either culture-proven intraamniotic infection or intraamniotic inflammation

Oh, Kyung Joon; Kim, Sun Min; Hong, Joon Seok; Maymon, Eli; Erez, Offer; Panaitescu, Bogdan; Gomez‐Lopez, Nardhy; Romero, Roberto; Yoon, Bo Hyun

doi:10.1016/j.ajog.2017.02.035

Cited by 90 publications

(62 citation statements)

References 111 publications

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“…Herein, we showed that women who underwent spontaneous preterm labor with IAI had the highest amniotic fluid concentrations of extracellular ASC, which coincides with most elevated concentrations of IL-6 (ie, intra-amniotic inflammation). These results are consistent with previous studies, which demonstrated that amniotic fluid concentrations of caspase-1 33 (the predominant inflammasomeactivated caspase 46 ), IL-1β, 26 and IL-18 106 35,37,117 and that Ureaplasma species (genital mycoplasmas are the most common microorganisms found in women with IAI 12,16,[118][119][120][121][122][123] ) are capable of activating the inflammasome pathway in murine macrophages. 124 Together, these findings indicate that the inflammasome is involved in the mechanisms that lead to microbialassociated preterm labor and birth.…”

Section: Inflammasome Activation In Spontaneous Preterm Labor With supporting

confidence: 93%

Inflammasome activation during spontaneous preterm labor with intra‐amniotic infection or sterile intra‐amniotic inflammation

Gomez‐Lopez

Romero

Panaitescu

et al. 2018

American J Rep Immunol

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Section: Inflammasome Activation In Spontaneous Preterm Labor With supporting

confidence: 93%

Inflammasome activation during spontaneous preterm labor with intra‐amniotic infection or sterile intra‐amniotic inflammation

Gomez‐Lopez

Romero

Panaitescu

et al. 2018

American J Rep Immunol

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“…Interestingly, in all of the cases, Ureaplasma urealyticum was found in the amniotic cavity by conventional microbiological techniques or live/dead staining. This genital mycoplasma was either found to be alone or associated with Mycoplasma hominis , both of which are associated with spontaneous preterm labor and birth 32, 62, 63, 78, 79, 99-104 and/or clinical chorioamnionitis 73, 104 , both regarded as major clinical pregnancy complications 105-115 . Genital mycoplasmas can induce severe inflammatory responses in the amniotic cavity and surrounding tissues 116-120 , which may be characterized by the migration of maternal neutrophils into this compartment, as demonstrated herein.…”

Section: Discussionmentioning

confidence: 99%

Are amniotic fluid neutrophils in women with intraamniotic infection and/or inflammation of fetal or maternal origin?

Gomez‐Lopez

Romero

et al. 2017

American Journal of Obstetrics and Gynecology

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101

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Background Neutrophils are the most abundant white blood cells found in the amniotic cavity of women with intra-amniotic infection and/or inflammation. The current belief is that these neutrophils are of fetal origin. However, abundant neutrophils have been found in the amniotic fluid of women with a severe acute maternal inflammatory response but without a fetal inflammatory response in the placenta, suggesting that these innate immune cells can also be of maternal origin or a mixture of both fetal and maternal neutrophils. Objectives To investigate the origin of amniotic fluid neutrophils from women with intra-amniotic infection and/or inflammation, and to correlate these findings with acute histologic maternal and fetal inflammatory responses in the placenta. Study Design Amniotic fluid was collected from 15 women with suspected intra-amniotic infection and/or inflammation (positive microbiological cultures and/or interleukin (IL)-6 concentrations≥2.6 ng/mL). Amniotic fluid neutrophils were purified by fluorescence-activated cell sorting, DNA was extracted, and DNA fingerprinting was performed. DNA fingerprinting was also performed in the umbilical cord and maternal blood DNA. Fluorescence in situ hybridization (FISH) was assayed in women with male neonates. Blinded placental histopathological evaluations were conducted. Results 1) DNA fingerprinting revealed that 43% (6/14) of the women who underwent a single amniocentesis had mostly fetal neutrophils in the amniotic fluid; 2) DNA fingerprinting showed that 36% (5/14) of the women who underwent a single amniocentesis had predominantly maternal neutrophils in the amniotic fluid; 3) DNA fingerprinting indicated that 21% (3/14) of the women who underwent a single amniocentesis had an evident mixture of fetal and maternal neutrophils in the amniotic fluid; 4) DNA fingerprinting revealed that a woman who underwent two amniocenteses (patient #15) had fetal neutrophils first, and as infection progressed, abundant maternal neutrophils invaded the amniotic cavity ; 5) FISH confirmed DNA fingerprinting results by showing that both fetal and maternal neutrophils are present in the amniotic fluid; 6) Most of the women who had predominantly amniotic fluid neutrophils of fetal origin at the time of collection delivered extremely preterm neonates [71% (5/7)]; 7) All of the women who had predominantly amniotic fluid neutrophils of maternal origin at the time of collection delivered term or late preterm neonates [100% (6/6)]; 8) Two of the women who had an evident mixture of fetal and maternal neutrophils in the amniotic fluid at the time of collection delivered extremely preterm neonates [67% (2/3)], and the third woman delivered a term neonate [33% (1/3)]; and 9) Most of the women included in this study presented acute maternal and fetal inflammatory responses in the placenta [87 % (13/15)]. Conclusion Amniotic fluid neutrophils can be either predominantly of fetal or maternal origin, or a mixture of both fetal and maternal origin, in women with intra-amniotic inf...

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“…Among the known mechanisms, pathological inflammation is the best‐characterized causal link to preterm labor and birth . To date, the most studied causes of pathological inflammation leading to preterm labor have been (a) intra‐amniotic infection/inflammation resulting from microbial invasion of the amniotic cavity and (b) intra‐amniotic inflammation without detectable microorganisms (ie, sterile intra‐amniotic inflammation) identified by using both molecular and conventional microbiological techniques, proposed to be due to endogenous danger signals, or alarmins . Most research concerning inflammation‐induced preterm labor has therefore focused on the innate limb of immunity .…”

Section: Introductionmentioning

confidence: 99%

Are B cells altered in the decidua of women with preterm or term labor?

Leng

Romero²,

et al. 2019

American J Rep Immunol

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Problem The immunophenotype of B cells at the maternal‐fetal interface (decidua) in labor at term and preterm labor is poorly understood. Method of study Decidual tissues were obtained from women with preterm or term labor and from non‐labor gestational age‐matched controls. Immunophenotyping of decidual B cells was performed using multicolor flow cytometry. Results (a) In the absence of acute or chronic chorioamnionitis, total B cells were more abundant in the decidua parietalis of women who delivered preterm than in those who delivered at term, regardless of the presence of labor; (b) decidual transitional and naïve B cells were the most abundant B‐cell subsets; (c) decidual B1 B cells were increased in women with either labor at term or preterm labor and chronic chorioamnionitis compared to those without this placental lesion; (d) decidual transitional B cells were reduced in women with preterm labor compared to those without labor; (e) naïve, class‐switched, and non–class‐switched B cells in the decidual tissues underwent mild alterations with the process of preterm labor; (f) decidual plasmablasts seemed to increase in women with either labor at term or preterm labor with chronic chorioamnionitis; and (g) decidual B cells expressed high levels of interleukin (IL)‐12, IL‐6, and/or IL‐35. Conclusion Total B cells are not increased with the presence of preterm or term labor; yet, specific subsets (B1 and plasmablasts) undergo alterations in women with chronic chorioamnionitis. Therefore, B cells are solely implicated in the pathological process of preterm labor in a subset of women with chronic inflammation of the placenta. These findings provide insight into the immunology of the maternal‐fetal interface in preterm and term labor.

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Twenty-four percent of patients with clinical chorioamnionitis in preterm gestations have no evidence of either culture-proven intraamniotic infection or intraamniotic inflammation

Cited by 90 publications

References 111 publications

Inflammasome activation during spontaneous preterm labor with intra‐amniotic infection or sterile intra‐amniotic inflammation

Inflammasome activation during spontaneous preterm labor with intra‐amniotic infection or sterile intra‐amniotic inflammation

Are amniotic fluid neutrophils in women with intraamniotic infection and/or inflammation of fetal or maternal origin?

Are B cells altered in the decidua of women with preterm or term labor?

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