Analysis of the concentrations of interleukin 18 in amniotic fluid in the second and the third trimesters of pregnancy.

BACKGROUND: Interleukin 18 (IL-18) is a glycoprotein produced by macrophages. IL-18 influences different populations of T lymphocytes and NK cells and stimulates the production of INF-gamma by these cells. IL-18 induces both Th1 and Th2 response. That is why IL-18 is a unique cytokine. OBJECTIVES: The aim of work was to examine the concentration of interleukin 18 in amniotic fluid in the 2nd and the 3rd trimesters of physiological pregnancies. MATERIAL AND METHODS: 74 pregnant women were qualified to take part in the studies. The amniotic fluid samples by amniocentesis were taken from the patients. Two groups were distinguished among the examined patients: group I - 45 pregnant women qualified for genetic amniocentesis between the 15th and 19th week of pregnancy. All findings of the cytogenetic tests were normal. Group II: 29 pregnant women in their 3rd trimester were qualified for diagnostic amniocentesis in order to determine the biological maturity of the fetuses. The concentration of IL-18 was marked with the immunoenzymatic method ELISA with the use of the kit produced by the MBL company. Method sensitivity was < 12.5 pg/mL. RESULTS: In the 2nd trimester of pregnancy the average concentration of IL-18 in the amniotic fluid was 454.69 pg/mL and in the 3rd trimester was 71.73 pg/mL. The obtained data proved that the average concentration of IL-18 in the 2nd trimester was significantly higher than in the 3rd trimester. The obtained differences in the findings were statistically significant (p < 0.05). CONCLUSIONS: The presence and high levels of IL-18 in the amniotic fluid in the 2nd trimester of pregnancy indicate an early process of initiation of immunological mechanisms by the fetus. An average concentration of IL-18 in the amniotic fluid was significantly higher in the 2nd trimester of pregnancy than in the 3rd trimester, which may indicate the influential role of IL-18 on the development of the immune response in the fetus in this period of gestation.

The role of ductus venosus Doppler flow in the diagnosis of chromosomal abnormalities during the first trimester of pregnancy.

BACKGROUND: The ductus venosus (DV) is an intrahepatic end-part of the umbilical vein. Inappropriate first trimester DV Doppler blood flow patterns correspond to a higher risk of chromosomal abnormalities. OBJECTIVES: The aim of the study was to assess the usefulness of ductus venosus Doppler flow in a first trimester screening for aneuploidies. MATERIAL AND METHODS: A prospective study included 1526 singleton pregnancies with increased risk of chromosomal abnormalities who underwent prenatal first trimester screening between the years 2006-2009. All ultrasound scans were performed by experienced sonographers and included an assessment of fetal growth, nuchal translucency (NT), nasal bone assessment (NB) and ductus venosus (DV) blood flow. Reversed a-wave (atrial diastole) in the ductus venosus flow pattern was recognized as abnormal. In addition to DV blood flow, the levels of pregnancy-associated plasma protein-A (PAPP-A) and free ß - human chorionic gonadotropin (ß-hCG) in maternal serum were measured. The risk of chromosomal abnormalities was calculated using the Fetal Medicine Foundation software. The following risk levels were assumed: high risk results - 1:100 or lower, intermediate risk 1:100 - 1:1000, and low risk above 1:1000. In 523 pregnancies, patients underwent amniocentesis and karyotyping. RESULTS: The authors diagnosed 46 cases with chromosomal abnormalities (using amniocentesis and karyotyping). 29 patients had spontaneous miscarriage, in 21 cases they reported fetuses with congenital malformations (mostly heart defects). Abnormal DV blood flow was recognized in 113 pregnant women (7.4%). The majority of cases affected by abnormal DV blood flow were classified as intermediate and high disorder risk groups - 100 (6.5%). The comparison between a combined test with and without DV assessment revealed that the addition of DV flow pattern results increased sensitivity from 84% to 92% in screening for aneuploidies. The false-positive ratio was between 0.4% and 2.4%. CONCLUSIONS: Ductus venosus Doppler blood flow examination is useful in the first trimester prenatal diagnostic since it increases the sensitivity of the combined test in the assessment of risk for chromosomal abnormalities. The authors recommend assessing DV blood flow during the first trimester screening in all pregnancies, irrespectively of the chromosomal abnormalities background risk. This procedure in clinical practice seems to be favorable and less complicated.

Second-trimester IL-15 and IL-18 levels in the amniotic fluid of fetuses with normal karyotypes and with chromosome abnormalities.

BACKGROUND: Little is known about the behavior of interleukin 15 (IL-15) and 18 (IL-18) in the amniotic fluid in the second trimester of gestations complicated by chromosomal defects in the fetus. Likewise, it has not yet been established whether a fetus with chromosome abnormalities creates its immunity mechanisms in the same way as a fetus with a normal karyotype. OBJECTIVES: The aim of this work was to assess the concentration of IL-15 and IL-18 in the amniotic fluid in the second trimester of gestation in fetuses with normal karyotypes and with chromosome abnormalities. MATERIAL AND METHODS: The material consisted of 51 samples of amniotic fluid obtained from genetic amniocenteses carried out between the 15th and the 19th weeks of gestation. On the basis of cytogenetic screening, two groups were singled out: Group I--45 fetuses with normal karyotypes, and Group II--6 fetuses with abnormal karyotypes. The concentrations of IL-15 and IL-18 in the amniotic fluid were assessed with ready-made assays and analyzed, and the results from both groups were compared. RESULTS: The differences between the IL-15 levels in the amniotic fluid from Groups I and II proved to be statistically insignificant (p = 0.054). However, the average IL-18 levels in the amniotic fluid of the fetuses with normal karyotypes were significantly higher than in the amniotic fluid of the fetuses with chromosome abnormalities (p = 0.032). CONCLUSIONS: Some defense mechanisms in the second trimester of gestation in fetuses with chromosome abnormalities may develop in a different way than in fetuses with normal karyotypes.

Analysis of the concentrations of interleukin 15 in amniotic fluid in the second and the third trimesters of pregnancy.

BACKGROUND: Cytokines play an essential role in the regulation of immunological responses. Interleukin 15 (IL-15) is a glycoprotein secreted primarily by macrophages and monocytes. IL-15 plays a key role in the immunological response of the cellular type. OBJECTIVES: The objective of this study was to evaluate changes in the concentration of interleukin 15 in amniotic fluid in the second and the third trimesters ofa normal pregnancy. MATERIAL AND METHODS: The study included 74 pregnant women who were subjected to a diagnostic amniocentesis in order to extract amniotic fluid samples. The patients were divided into two groups: group I - 45 pregnant women in the 2nd trimester, subjected to genetic amniocentesis during the 15th through 19th weeks. The results of the cytogenetic tests were found to be normal in all the fetuses. Group II: 29 pregnant women in their 3rd trimester, were subjected to amniocentesis in order to determine the biological maturity of the fetuses. The concentration of IL-15 was marked with the ELISA method using a kit made by the R&D company. Method sensitivity was > 2 pg/ml. RESULTS: The average concentration of IL-15 in the amniotic fluid of 2nd trimester pregnancies was 6.54 pg/ ml, whereas in the 3rd trimester it rose to 18.62 pg/ml. Discrepancies were found to be statistically significant (p < 0.05). CONCLUSIONS: The presence of IL-15 in the amniotic fluid in the second trimester of gestation indicates an early activation of the fetus's defensive mechanisms. An average concentration of IL-15 in the amniotic fluid is significantly higher in the third trimester of pregnancy than in the second trimester, which can mean about the development of the immune response in the fetus.