Proteomics, part II: the emerging role of proteomics over genomics in spontaneous preterm labor/birth.
Conventional wisdom holds that complications of immature organ systems such as respiratory distress syndrome, intraventricular hemorrhage, necrotizing enterocolitis, and bronchopulmonary dysplasia are the primary causes of the high neonatal morbidity and mortality attendant preterm delivery. However, recent evidence suggests that a major cause of prematurity-associated neonatal pathology is the fetal and neonatal response to inflammation/infection. Although functional genomics offered the promise of providing answers to many of these questions, the identification of the genes intrinsic to human parturition proved to be a difficult task. Proteomic profiling of the amniotic fluid (AF) provides a precise means for detection of inflammation by revealing the presence of 4 biomarkers (defensins-2 and -1, calgranulin-C, and calgranulin-A) that are highly predictive of intrauterine inflammation (MR score). The MR score is especially useful as it presents a gradient of disease activity progressing from "absent" to "mild" to "severe" inflammation. Thus, it provides the ability to identify patients who may benefit from interventions in utero in a modern diagnostic-therapeutic framework.


BACKGROUND
Obstetricians & Gynecologists, Family Physicians.


OBJECTIVE
After completion of this article, the reader should be able to explain that the cause or causes of preterm delivery are still unknown, recall that functional genomics has not given the answer to these causes, and state that proteomic profiling of amniotic fluid, through mass-restricted (MR) scoring, may be predictive of intrauterine inflammation and allow for potential diagnosis and potential therapy.
Buhimschi
Catalin S
CS
Department of Obstetrics, Gynecology and Reproductive Science, Yale University School of Medicine, New Haven, Connecticut 06520-8063, USA. catalin.buhimschi@yale.edu
Weiner
Carl P
CP
Buhimschi
Irina A
IA
D000818:Animals; D016207:Cytokines / Q000378:metabolism / Q000502:physiology; D005260:Female; D005322:Premature Rupture of Fetal Membranes / Q000209:etiology; D023281:Genomics; D006801:Humans; D007752:Obstetric Labor, Premature / Q000209:etiology*; D009774:Obstetrics / Q000379:methods; D010449:Peptide Mapping; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000276:immunology; D040081:Protein Array Analysis; D040901:Proteomics
D016207:Cytokines