title: Further observations on the fetal inflammatory response syndrome: a potential homeostatic role for the soluble receptors of tumor necrosis factor alpha.
abstract: OBJECTIVE
  The fetal inflammatory response syndrome is a subclinical condition frequently present in preterm labor and preterm premature rupture of the membranes and is associated with increased perinatal morbidity and mortality. Tumor necrosis factor alpha is a mediator of septic shock and death, and it exerts its biologic effects by interacting with 2 receptors, TNF-R1 and TNF-R2. Soluble tumor necrosis factor receptors can buffer the biologic activity and protect against the deleterious effects of tumor necrosis factor alpha. The purpose of this study was to determine the behavior of soluble tumor necrosis factor receptors in fetuses with and without fetal inflammatory response syndrome.
  
  
  METHODS
  Fetal blood sampling was performed in patients with preterm labor (n = 95) and preterm premature rupture of the membranes (n = 39). Control samples were obtained from fetuses who were undergoing blood sampling for clinical indications and had normal outcomes (n = 21). Fetal inflammatory response syndrome was defined as a fetal plasma interleukin 6 concentration >11 pg/mL. Concentrations of interleukin 6 and TNF-R1 and TNF-R2 were determined by use of sensitive and specific immunoassays. Analysis of covariance was used for statistical analysis.
  
  
  RESULTS
  (1) TNF-R1 and TNF-R2 were detectable in all samples, and their concentrations decreased with advancing gestational age (r = -0.8 and r = -0.7; P<.0001 and P<.001, respectively). (2) The mean fetal plasma concentrations of TNF-R1 and TNF-R2 were significantly higher in fetuses with fetal inflammatory response syndrome than in those without the syndrome after adjustment for gestational age and fetal membrane status (TNF-R1: no fetal inflammatory response syndrome, mean +/- SE, 3473.7+/-128.8 pg/mL; vs fetal inflammatory response syndrome, mean +/- SE, 4079.9+/-190.7 pg/mL; P<.005; TNF-R2: no fetal inflammatory response syndrome, mean +/- SE, 6033.2+/-235.4 pg/mL; vs. fetal inflammatory response syndrome, mean +/- SE, 7783.1+/-342.8 pg/mL; P<.0001). (3) Fetuses of patients who delivered within 72 hours of cordocentesis had significantly higher concentrations of TNF-R1 and TNF-R2 receptors than those with longer latency periods (P<.05 for each).
  
  
  CONCLUSIONS
  The fetal inflammatory response syndrome is associated with increased availability of the soluble receptors of tumor necrosis factor alpha in fetal plasma. These factors may attenuate the deleterious effects of tumor necrosis factor alpha.
authors.affiliation: Perinatology Research Branch, National Institute of Child Health and Human Development, Wayne State University/Hutzel Hospital, Detroit, MI 48201, USA.
authors.forename: R
authors.initials: R
authors.lastname: Romero
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: Gomez
authors.forename: M
authors.initials: M
authors.lastname: Mazor
authors.forename: B H
authors.initials: BH
authors.lastname: Yoon
authors.forename: S M
authors.initials: SM
authors.lastname: Berry
mesh_terms: D000328:Adult; D015703:Antigens, CD / Q000097:blood / Q000502:physiology*; D005260:Female; D005312:Fetal Blood; D005315:Fetal Diseases / Q000097:blood / Q000503:physiopathology*; D006706:Homeostasis; D006801:Humans; D007249:Inflammation / Q000097:blood / Q000503:physiopathology*; D011247:Pregnancy; D018124:Receptors, Tumor Necrosis Factor / Q000097:blood / Q000502:physiology*; D047888:Receptors, Tumor Necrosis Factor, Type I; D047889:Receptors, Tumor Necrosis Factor, Type II; D012016:Reference Values; D012995:Solubility; D014409:Tumor Necrosis Factor-alpha / Q000378:metabolism*
chemical_list: D015703:Antigens, CD; D018124:Receptors, Tumor Necrosis Factor; D047888:Receptors, Tumor Necrosis Factor, Type I; D047889:Receptors, Tumor Necrosis Factor, Type II; D014409:Tumor Necrosis Factor-alpha