title: A role for matrix metalloproteinase-9 in spontaneous rupture of the fetal membranes.
abstract: OBJECTIVE
  Preterm premature rupture of fetal membranes is responsible for 30% to 40% of preterm deliveries. Fetal membranes are composed primarily of collagen. Matrix metalloproteinases are enzymes capable of degrading extracellular matrix macromolecules, including collagens. Expression of matrix metalloproteinase-9 (gelatinase B, 92 kd) and its tissue inhibitor (tissue inhibitor of metalloproteinase-1) has been localized in amnion and chorion. The objective of this study was to determine whether rupture of fetal membranes and intrauterine infection are associated with changes in the expression of matrix metalloproteinase-9 and tissue inhibitor of metalloproteinase-1.
  
  
  METHODS
  Two hundred one women in the following categories had amniotic fluid retrieved: (1) preterm labor and intact membranes in the presence (n = 42) or absence (n = 21) of microbial invasion of the amniotic cavity, (2) preterm premature rupture of the membranes with (n = 29) or without (n = 23) microbial invasion of the amniotic cavity, and (3) term gestation with intact membranes (n = 50) or with premature rupture of the membranes (n = 40). Women in groups 1 and 2 were matched for gestational age at amniocentesis. Microbial invasion of the amniotic cavity was defined by a positive amniotic fluid culture for micro-organisms. Matrix metalloproteinase-9 and tissue inhibitor of metalloproteinase-1 were measured with use of sensitive and specific immunoassays that were validated for amniotic fluid.
  
  
  RESULTS
  Spontaneous rupture of membranes at term is associated with a significant increase in the amniotic fluid concentrations of matrix metalloproteinase-9 (premature rupture of membranes, no labor: median 3.9 ng/mL, range 2. 7 to 11.1 ng/mL vs no premature rupture of membranes, no labor: median <0.4 ng/mL, range <0.4 to 22.4 ng/mL; P <.001). Patients with preterm premature rupture of the membranes had higher median matrix metalloproteinase-9 concentrations than those with preterm labor and intact membranes who were delivered at term (7.6 ng/mL, range <0.4 to 230.81 ng/mL vs <0.4 ng/mL, range <0.4 to 1650 ng/mL; P =.06). Women with microbial invasion of the amniotic cavity had higher median matrix metalloproteinase-9 concentrations than did those without microbial invasion regardless of membrane status (preterm labor: 54.5 ng/mL, range <0.4 to 3910 ng/mL vs <0.4 ng/mL, range <0. 4 to 1650 ng/mL; P <.01; preterm premature rupture of membranes: 179. 8 ng/mL, range <0.4 to 611 ng/mL vs 7.6 ng/mL, range <0.4 to 230.81; P <.001).
  
  
  CONCLUSIONS
  Our data support a role for matrix metalloproteinase-9 in the mechanisms responsible for membrane rupture in term and preterm gestations.
authors.affiliation: Perinatology Research Branch, National Institute of Child Health and Human Development, The National Institutes of Health, Bethesda, MD, USA.
authors.forename: N
authors.initials: N
authors.lastname: Athayde
authors.forename: S S
authors.initials: SS
authors.lastname: Edwin
authors.forename: R
authors.initials: R
authors.lastname: Romero
authors.forename: R
authors.initials: R
authors.lastname: Gomez
authors.forename: E
authors.initials: E
authors.lastname: Maymon
authors.forename: P
authors.initials: P
authors.lastname: Pacora
authors.forename: R
authors.initials: R
authors.lastname: Menon
mesh_terms: D000650:Amnion / Q000382:microbiology; D000653:Amniotic Fluid / Q000201:enzymology; D001424:Bacterial Infections / Q000201:enzymology; D017364:Collagenases / Q000378:metabolism / Q000502:physiology*; D003430:Cross-Sectional Studies; D005260:Female; D005322:Premature Rupture of Fetal Membranes / Q000503:physiopathology*; D006801:Humans; D020780:Matrix Metalloproteinase 9; D009994:Osmolar Concentration; D011247:Pregnancy; D019715:Tissue Inhibitor of Metalloproteinase-1 / Q000378:metabolism; D014591:Uterine Diseases / Q000201:enzymology
chemical_list: D019715:Tissue Inhibitor of Metalloproteinase-1; D017364:Collagenases; D020780:Matrix Metalloproteinase 9