Maternal Schistosomiasis Japonica Is Associated with Maternal, Placental, and Fetal Inflammation
Maternal Schistosomiasis Japonica Is Associated with Maternal, Placental, and Fetal Inflammation
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DOI：
10.1128/iai.01072-10
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发表时间：
2011-03-01
影响因子：
3.1
通讯作者：
Friedman, Jennifer F.
中科院分区：
文献类型：
--
作者：
Kurtis, Jonathan D.;Higashi, Ashley;Friedman, Jennifer F.
血吸虫感染了大约4000万育龄妇女，并导致促炎细胞因子的产生，这与胎儿生长受限有关。在小鼠模型和两项人类观察性研究中，怀孕期间血吸虫感染与出生体重减轻有关，尽管最近的一项针对曼氏血吸虫的治疗试验并未发现这种关联。我们对生活在菲律宾日本血吸虫疫区的99名孕妇进行了一项观察性研究。我们招募了孕32周的妇女，并测量了日本血吸虫和地蠕虫的感染强度。我们收集了孕32周时的母体外周血和分娩时的胎盘和脐带血来评估炎症状态。分娩时，我们采集胎盘组织样本并测量出生体重。在针对地蠕虫调整的多变量模型中，母体血吸虫病与母体外周血（肿瘤坏死因子α [tnf - α]和白细胞介素10 [IL-10]）、胎盘（tnf - α、IL-6、tnf - α受体II [RII]和IL-1 β）和脐血（IL-1 β和tnf - α RII）炎症细胞因子水平升高以及急性绒毛膜下炎和免疫组化评估的合胞滋养细胞tnf - α产量增加有关（均P < 0.05）。在调整混杂因素后，胎盘IL-1 β和合体滋养细胞产生tnf - α与出生体重下降独立相关（均P < 0.05）。我们的数据表明，母体血吸虫病导致在母体、胎盘和胎儿室中可检测到的促炎特征，这些反应的一部分与出生体重下降有关。产妇血吸虫病与不良分娩结果之间的这种潜在机制联系将有助于关于产妇血吸虫感染治疗的辩论。
Schistosomes infect similar to 40 million women of childbearing age and result in the elaboration of proinflammatory cytokines that have been implicated in fetal growth restriction. In murine models and two observational studies in humans, schistosome infection during pregnancy was associated with reduced birth weight, although a recent treatment trial in Schistosoma mansoni did not detect this association. We conducted an observational study among 99 pregnant women living in an area of Schistosoma japonicum endemicity in the Philippines. We enrolled women at 32 weeks gestation and measured S. japonicum and geohelminth infection intensity. We collected maternal peripheral blood at 32 weeks gestation and placental and cord blood at delivery to assess inflammatory status. At delivery, we collected a placental-tissue sample and measured birth weight. In multivariate models adjusted for geohelminths, maternal schistosomiasis was associated with increased levels of inflammatory cytokines in maternal peripheral (tumor necrosis factor alpha [TNF-alpha] and interleukin 10 [IL-10]), placental (TNF-alpha, IL-6, TNF-alpha receptor II [RII], and IL-1 beta), and cord (IL-1 beta and TNF-alpha RII) blood, as well as acute subchorionitis and increased TNF-alpha production by syncytiotrophoblasts assessed by immunohistochemistry (all P < 0.05). After adjusting for confounders, placental IL-1 beta, and TNF-alpha production by syncytiotrophoblasts was independently associated with decreased birth weight (both P < 0.05). Our data indicate that maternal schistosomiasis results in a proinflammatory signature that is detectable in maternal, placental, and fetal compartments, and a subset of these responses are associated with decreased birth weight. This potential mechanistic link between maternal schistosomiasis and poor birth outcomes will contribute to the debate regarding treatment of maternal schistosome infections.