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CORD BLOOD CALPROTECTIN
CONCENTRATIONS IN FULLTERM PREGNANCIES WITH
NORMAL AND RESTRICTED
FETAL GROWTH
Sofia Liosi 1 , Des...
Calprotectin
• a 36-kDa calcium and zinc binding
protein

• comprises two heavy chains of 14 kDa
and one light chain of 8 ...
Calprotectin
• a marker of neutrophil turnover
• immunomodulatory and antimicrobial
effects

• antiproliferative effects (...
Intrauterine growth
restriction
(IUGR)
• Failure of the fetus to achieve his/her
intrinsic growth potential

• Consequence...
Neutrophil activation
is present in preeclampsia and isolated
intrauterine growth restriction

•
•
•

Possible mechanisms ...
IUGR
• associated with an increased

incidence of apoptosis in
IUGR-affected fetal membranes
Hypothesis
• Umbilical cord blood concentrations of
calprotectin in IUGR cases may differ
from respective concentrations i...
Aim
•

Investigate cord blood calprotectin
concentrations in IUGR, and AGA
pregnancies at birth

•

Correlate determined c...
Subjects
• 160 healthy, singleton full-term

pregnancies
- 1 10 AGA (placental weight: 480-621 g)
- 50 asymmetric IUGR ( p...
Gestation Related Optimal
Weight (GROW) computergenerated programme
www.gestation.net

d
6
5
P
p
E
x
S
c
l
M
n
k
o
G
)
h
g...
Causes of IUGR
•
•
•
•

Preeclampsia ( n=6 )
Pregnancy induced hypertension (n=5 )
Various diseases : severe type I DM
( n...
Demographic data

•
•
•
•
•
•

IUGR
Gestational age (weeks)
38 .36 ±1 .27 *
BW (g)
25 07 ± 264.5 *
BW centile
3 .0 (0-5)
G...
Methods
•
•

•

Blood collected from:
Doubly-clamped umbilical cords (m ixed
arteriovenous blood ) – reflecting fetal
stat...
CALPROTECTIN LEVELS (ng/ml)

Figure 1. Error bars of the concentrations of
Calprotectin in IUGR cases and AGA controls.

3...
Results (1)

• No statistically significant differences in
cord blood calprotectin concentrations
between IUGR and AGA gro...
Results (2)
•
•

In a combined group
Cord blood calprotectin concentrations
were significantly decreased in cases of
caesa...
Results (3)
• In the IUGR group
• Calprotectin was significantly elevated
for every week increase in gestational
age.

• C...
Conclusions (1)
• Cord blood calprotectin concentrations at
term are independent of intrauterine
growth and probably do no...
Conclusions (2)
• Calprotectin may have a limited role

during fetal life, possibly due to the
lower degree of neutrophil ...
Conclusions (3)
• Excessive inflammatory response

associated with vaginal delivery may
account for the higher calprotecti...
Calprotectin europaediatrics 2009
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Calprotectin europaediatrics 2009

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Calprotectin europaediatrics 2009

  1. 1. CORD BLOOD CALPROTECTIN CONCENTRATIONS IN FULLTERM PREGNANCIES WITH NORMAL AND RESTRICTED FETAL GROWTH Sofia Liosi 1 , Despina D. Briana 1 Dimitrios Gourgiotis 2 , , Maria Boutsikou 1 , Stavroula Baka 1 , Antonios Marmarinos , Dimitrios Hassiakos 1 , Ariadne Malamitsi-Puchner 1 . 1.Neonatal Division, 2nd Department of Obstetrics and Gynecology, Athens University Medical School, Athens, Greece 2.Research Laboratories, 2nd Department of Pediatrics, Athens University Medical School, Athens, Greece
  2. 2. Calprotectin • a 36-kDa calcium and zinc binding protein • comprises two heavy chains of 14 kDa and one light chain of 8 kDa • constitutes approximately 60% of soluble cytosol proteins in human neutrophil granulocytes
  3. 3. Calprotectin • a marker of neutrophil turnover • immunomodulatory and antimicrobial effects • antiproliferative effects (inducing apoptosis)
  4. 4. Intrauterine growth 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 mortality in intra- and extra-uterine life
  5. 5. Neutrophil activation is present in preeclampsia and isolated intrauterine growth restriction • • • Possible mechanisms may be: hypoxia the presence of soluble mediators of inflammation endothelial stimulation
  6. 6. IUGR • associated with an increased incidence of apoptosis in IUGR-affected fetal membranes
  7. 7. Hypothesis • Umbilical cord blood concentrations of calprotectin in IUGR cases may differ from respective concentrations in appropriate-for-gestational-age (AGA) controls since the former present increased neutrophil activation and excessive apoptosis .
  8. 8. Aim • Investigate cord blood calprotectin concentrations in IUGR, and AGA pregnancies at birth • Correlate determined concentrations with gestational age, gender and mode of delivery .
  9. 9. Subjects • 160 healthy, singleton full-term pregnancies - 1 10 AGA (placental weight: 480-621 g) - 50 asymmetric IUGR ( placental weight 230 -400g) • Apgar scores: > 8 in 1 st and 5 th minute
  10. 10. Gestation Related Optimal Weight (GROW) computergenerated programme www.gestation.net d 6 5 P p E x S c l M n k o G ) h g w r i B y D e a m t s u C ( b : = W
  11. 11. Causes of IUGR • • • • Preeclampsia ( n=6 ) Pregnancy induced hypertension (n=5 ) Various diseases : severe type I DM ( n=5),iron deficiency anemia (n=3), hypothyroidism (n=7) Maternal smoking ( n=24 )
  12. 12. Demographic data • • • • • • IUGR Gestational age (weeks) 38 .36 ±1 .27 * BW (g) 25 07 ± 264.5 * BW centile 3 .0 (0-5) Gender (male/female) 21/29 Mode of delivery (VD/ECS)** 22/28 Parity (1st /other) 31 / 19 * values are mean ± SD **VD: vaginal delivery/ ECS: elective cesarian section AGA 3 8.98 ± 1.07 * 3 310 ± 310.5* 44.5 (20-99) 66/44 77/33 76/34
  13. 13. Methods • • • Blood collected from: Doubly-clamped umbilical cords (m ixed arteriovenous blood ) – reflecting fetal state Determination of plasma calprotectin concentrations by enzyme immunoassay ( Human Calprotectin ELISA, HBT Hycult Biotechnology b.v , Uden, The Netherlands) Statistical analysis (parametric tests)
  14. 14. CALPROTECTIN LEVELS (ng/ml) Figure 1. Error bars of the concentrations of Calprotectin in IUGR cases and AGA controls. 320 300 280 260 240 220 0 AGA GROUP (N=110) IUGR GROUP (N=50)
  15. 15. Results (1) • No statistically significant differences in cord blood calprotectin concentrations between IUGR and AGA groups .
  16. 16. Results (2) • • In a combined group Cord blood calprotectin concentrations were significantly decreased in cases of caesarean section . • The effect of birthweight, customized centile, gestational age, gender and parity on calprotectin concentrations was not significant .
  17. 17. Results (3) • In the IUGR group • Calprotectin was significantly elevated for every week increase in gestational age. • Calprotectin was positively correlated with birthweight.
  18. 18. Conclusions (1) • Cord blood calprotectin concentrations at term are independent of intrauterine growth and probably do not reflect the increased neutrophil activation and excessive apoptosis expected in IUGR • P arity, gender and maternal age do not seem to have any impact on umbilical cord blood calprotectin concentrations
  19. 19. Conclusions (2) • Calprotectin may have a limited role during fetal life, possibly due to the lower degree of neutrophil activation in the fetus. • Neutrophil activation and apoptosis seem to increase with advancing gestational age in the IUGR group, as indicated by the increasing calprotectin concentrations with progressing pregnancy
  20. 20. Conclusions (3) • Excessive inflammatory response associated with vaginal delivery may account for the higher calprotectin concentrations in the latter

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