Circulating matrix metalloproteinase MMP-9 and MMP-2/TIMP-2 complex are associated with spontaneous early pregnancy failure.

BACKGROUND: Trophoblast cell (CTB) invasion into the maternal endometrium plays a crucial role during human embryo implantation and placentation. This invasion is facilitated by the activity of matrix metalloproteinases, which are regulated by tissue inhibitors of MMPs (TIMPs). METHODS: This study compares the serum levels of MMP-9, MMP-2/TIMP-2 complex, TIMP-1 and TIMP-2 in 129 patients with ongoing pregnancy (n = 40) or spontaneous early pregnancy failure (n = 89). RESULTS: MMP-9 was markedly (p < 0.0001) elevated in missed abortions, as was MMP-2/TIMP-2 complex (p < 0.0005). However, the serum levels of TIMP-1 and TIMP-2 were markedly elevated (p < 0.0001) in ongoing pregnancies. CONCLUSIONS: Human placentation is mediated by fetal trophoblastic cells that invade the maternal uterine endometrium. Trophoblast invasion requires a precisely regulated secretion of specific proteolytic enzymes able to degrade the endometrial basement membrane and extracellular matrix. The elevated levels of MMP-9 and MMP-2/TIMP-2 complex may play a role in spontaneous termination of pregnancy.

[Expression of aspartyl-(asparaginyl) beta-hydroxylase in villi in patients with missed abortion].

OBJECTIVE: To determine the difference in aspartyl-(asparaginyl) beta-hydroxylase (AAH) expression level in villi between patients with missed abortion and normal women with early pregnancy, and to confirm the expression loci of AAH in villi. METHODS: A total of 50 patients of missed abortion were collected and categorized into a test group, which was subdivided into Group 1 and Group 2. Patients in Group 1 (n=20) were of confirmed etiological disorders while those in Group 2 (n=30) showed no obviously etiological clues. In addition, 20 women of early pregnancy with artificial abortion were categorized into a control group, whose embryos were sonographically confirmed alive before surgery. The 50 patients of missed abortion were also subdivided into a group within 4 weeks and a group over 4 weeks according to the time that the embryo stayed in utrine after death. Immunohistochemical technique and computer image analysis were used to detect the expression loci and the level of AAH in villi. RESULTS: AAH was expressed in the endochylema and nucleus of trephocyte both in missed abortion and normal early pregnancy. The expression level of AAH in villi of missed abortion was much lower than that of in villi of normal early pregnancy (P<0.05). The expression level had no difference between different groups of patients with missed abortion(P>0.05). CONCLUSION: Low expression of AAH in the endochylema and nucleus of trephocyte may play a role in patients with missed abortion.

Adenosine deaminase activity in serum and placenta of patients with anembryonic pregnancies and missed abortions.

AIM: The aim of this study is to assess adenosine deaminase (ADA) activity in the serum and placenta of patients with missed abortions, anembryonic pregnancies, and voluntary abortions. METHODS: Nine cases of anembryonic pregnancies and 21 cases of missed abortions (group I, n=30), and voluntary dilatation and curettage cases (group II, n=30) were included in this prospective study. Adenosine deaminase activity in serum and placental tissue was measured according to the Giusti method. The t-test was applied for statistical evaluation with the help of SPSS 9.0. RESULTS: The mean serum ADA level in the abortion cases (group I) was 9.13+/-1.59 U/l, while it was 17.06+/-6.5 U/l in the control group (group II; p<0.05). Also, the mean placental ADA levels in abortion cases and in the control group were 11.8+/-4.7 nmol/mg protein/min and 25.8+/-6.6 nmol/mg protein/min respectively (p<0.05). CONCLUSIONS: These results suggest that ADA may have a modulatory role in the implantation and duration of pregnancy. Low levels of ADA in early pregnancy may lead to an accumulation of products toxic to DNA and to the subsequent loss of the pregnancy.

Is maternal serum creatine kinase actually a marker for early diagnosis of ectopic pregnancy?

OBJECTIVE: Our purpose was to investigate whether serum creatine kinase (CK) levels could be used as an early marker of ectopic pregnancy. Student's t-test was used for statistical analysis. STUDY DESIGN: In a prospective study we therefore measured serum progesterone, beta hCG and CK levels in 30 women with ectopic pregnancies, 30 women with ongoing pregnancies and 30 women with missed abortion. RESULTS: The mean serum CK concentration for patients with an ectopic pregnancy, ongoing pregnancy, and the women with missed abortion was 81.4 +/- 66.2, 81.5 +/- 40.3, 84.8 +/- 49.3, respectively. No relationship was found between CK level and the location of the pregnancy. CONCLUSION: Conversely to the first report of Lavie et al. (Am J Obstet Gynecol 1993; 169: 1149), our data suggest that serum CK level is not discriminative in the early diagnosis of tubal pregnancy.

Maternal serum creatine kinase as a biochemical marker of tubal pregnancy.

OBJECTIVE: To evaluate the role of serum creatine kinase as a possible marker for diagnosis of tubal pregnancy. METHODS: Five groups of patients were included in this prospective study: group A, 20 patients with tubal pregnancies; group B, 20 patients with missed abortions; group C, 20 patients with pelvic inflammatory disease; group D, 10 patients with acute appendicitis; group E (controls), 20 patients with normal pregnancies matched for age and gestation. Total creatine kinase levels were measured in the serum of all five groups. RESULTS: Creatine kinase levels were found to be > or =75 IU/l in all patients with tubal pregnancies, which was significantly higher than in the other four groups (P < 0.0001). CONCLUSION: Our results indicate that maternal serum creatine kinase can be an important biochemical marker in suspected tubal pregnancy.