Are amniotic fluid neutrophils in women with intraamniotic infection and/or inflammation of fetal or maternal origin?
Are amniotic fluid neutrophils in women with intraamniotic infection and/or inflammation of fetal or maternal origin?
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DOI：
10.1016/j.ajog.2017.09.013
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发表时间：
2017-12-01
影响因子：
9.8
通讯作者：
Maymon, Eli
中科院分区：
文献类型：
--
作者：
Gomez-Lopez, Nardhy;Romero, Roberto;Maymon, Eli
背景技术背景：中性粒细胞是在患有羊膜内感染和/或炎症的妇女的羊膜腔内发现的最丰富的白色血细胞。目前认为这些中性粒细胞是胎儿来源的。然而，在有严重急性母体炎症反应但胎盘中没有严重胎儿炎症反应的妇女的羊水中发现了丰富的中性粒细胞，这表明这些先天性免疫细胞也可以来自母体或胎儿和母体中性粒细胞的混合物。目的：我们试图研究羊水内感染和/或感染的妇女羊水中性粒细胞的来源。或炎症，并将这些发现与胎盘中的急性组织学母体和胎儿炎症反应相关联。收集了15名疑似羊膜内感染和/或炎症的妇女的羊水（阳性微生物培养物和/或白细胞介素-6浓度>= 2.6 ng/mL）。通过荧光激活细胞分选法纯化羊水中性粒细胞，提取DNA，并进行DNA指纹分析。还在脐带和母体血液DNA中进行DNA指纹分析。荧光原位杂交法检测女性与男性新生儿。Blinded胎盘组织病理学评价carried.RESULTS：第一，DNA指纹图谱显示，43%（6/14）的妇女谁经历了一个单一的羊水穿刺术主要是胎儿中性粒细胞在羊水中。第二，DNA指纹图谱显示，36%（5/14）的妇女谁经历了一个单一的羊水穿刺术有主要是母亲的中性粒细胞在羊水。第三，DNA指纹分析表明，21%（3/14）的妇女谁经历了一个单一的羊水穿刺有明显的混合物的胎儿和母亲的中性粒细胞在羊水。第四，DNA指纹分析显示，一名接受2次羊膜穿刺术的妇女（患者15）首先有胎儿中性粒细胞，随着感染的进展，大量的母体中性粒细胞侵入羊膜腔。第五，荧光原位杂交证实了DNA指纹结果，显示胎儿和母亲的中性粒细胞存在于羊水中。第六，大多数在采集时主要具有胎儿来源的羊水中性粒细胞的女性分娩了极早产儿（71% [5/7]）。第七，所有在采集时主要含有母体来源的羊水中性粒细胞的女性均分娩了足月或晚期早产儿（100% [6/6]）。第八，在羊水中有明显的胎儿和母体中性粒细胞混合物的2名妇女在收集时分娩了极早产儿（67% [2/3]），第三名妇女分娩了足月新生儿（33% [1/3]）。最后，大多数妇女在这项研究中提出了急性母胎胎盘炎性反应（87% [13/15]）。结论：羊水中性粒细胞可以主要是胎儿或母体来源，或胎儿和母体来源的混合物，在妇女羊膜内感染和/或炎症。本文的研究结果提供了证据表明胎儿和母体中性粒细胞都可以侵入羊水腔，这表明胎儿和母亲都参与了宿主针对羊水内感染的防御机制。
BACKGROUND: Neutrophils are the most abundant white blood cells found in the amniotic cavity of women with intraamniotic 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 severe 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.OBJECTIVE: We sought to investigate the origin of amniotic fluid neutrophils from women with intraamniotic 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 intraamniotic infection and/or inflammation (positive microbiological cultures and/or interleukin-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 was assayed in women with male neonates. Blinded placental histopathological evaluations were conducted.RESULTS: First, DNA fingerprinting revealed that 43% (6/14) of women who underwent a single amniocentesis had mostly fetal neutrophils in the amniotic fluid. Second, DNA fingerprinting showed that 36% (5/14) of the women who underwent a single amniocentesis had predominantly maternal neutrophils in the amniotic fluid. Third, 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. Fourth, DNA fingerprinting revealed that a woman who underwent 2 amniocenteses (patient 15) had fetal neutrophils first, and as infection progressed, abundant maternal neutrophils invaded the amniotic cavity. Fifth, fluorescence in situ hybridization confirmed DNA fingerprinting results by showing that both fetal and maternal neutrophils were present in the amniotic fluid. Sixth, 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]). Seventh, 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]). Eighth, 2 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]). Finally, 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 intraamniotic infection and/or inflammation. The findings herein provide evidence that both fetal and maternal neutrophils can invade the amniotic cavity, suggesting that both the fetus and the mother participate in the host defense mechanisms against intraamniotic infection.