title: Decreased placental and maternal serum TRAIL-R2 levels are associated with placenta accreta.
abstract: OBJECTIVE
  TNF-related apoptosis-inducing ligand receptor-2 (TRAIL-R2) is produced both by decidual and trophoblast cells during pregnancy and known to participate in apoptosis. In this study, we aimed to determine and to compare maternal serum and placental TRAIL-R2 levels in patients with placenta accreta, non-adherent placenta previa and in healthy pregnancies. We also aimed to analyze the association of placenta accreta with the occurrence of previous C-sections.
  
  
  METHODS
  A total of 82 pregnant women were enrolled in this case-control study (27 placenta accreta patients, 26 non-adherent placenta previa patients and 29 age-, and BMI-matched healthy, uncomplicated pregnant controls). TRAIL-R2 levels were studied in both maternal serum and placental tissue homogenates. Determining the best predictor(s) which discriminate placenta accreta was analyzed by multiple logistic regression analyses. Adjusted odds ratios and 95% confidence intervals were also calculated.
  
  
  RESULTS
  Both placental and serum TRAIL-R2 levels were significantly lower in placenta accreta group (median 34.82 pg/mg and 19.85 pg/mL, respectively) when compared with both non-adherent placenta previa (median 39.24 pg/mg and 25.99 pg/mL, respectively) and the control groups (median 41.62 pg/mg and 25.87 pg/mL, respectively) (p < 0.05). Placental TRAIL-R2 levels and previous cesarean section were found to be significantly associated with placenta accreta (OR: 0.934 95% CI 0.883-0.987, p = 0.016 and OR:7.725 95% CI: 2.717-21.965, p < 0.001, respectively). Placental and serum TRAIL-R2 levels were positively correlated.
  
  
  CONCLUSIONS
  Decreased levels of placental TRAIL-R2 and previous history of cesarean section were found to be significantly associated with placenta accreta, suggesting a possible role of apoptosis in abnormal trophoblast invasion.
authors.affiliation: Zekai Tahir Burak Women's Health Education and Training Hospital, Department of Perinatology, Ankara, Turkey. Electronic address: efseroztas@gmail.com.
authors.forename: Efser
authors.initials: E
authors.lastname: Oztas
authors.affiliation: Zekai Tahir Burak Women's Health Education and Training Hospital, Department of Perinatology, Ankara, Turkey.
authors.forename: Sibel
authors.initials: S
authors.lastname: Ozler
authors.affiliation: Zekai Tahir Burak Women's Health Education and Training Hospital, Department of Perinatology, Ankara, Turkey.
authors.forename: Ali Ozgur
authors.initials: AO
authors.lastname: Ersoy
authors.affiliation: Zekai Tahir Burak Women's Health Education and Training Hospital, Department of Perinatology, Ankara, Turkey.
authors.forename: Ebru
authors.initials: E
authors.lastname: Ersoy
authors.affiliation: Zekai Tahir Burak Women's Health Education and Training Hospital, Department of Perinatology, Ankara, Turkey.
authors.forename: Ali Turhan
authors.initials: AT
authors.lastname: Caglar
authors.affiliation: Zekai Tahir Burak Women's Health Education and Training Hospital, Department of Perinatology, Ankara, Turkey.
authors.forename: Dilek
authors.initials: D
authors.lastname: Uygur
authors.affiliation: Zekai Tahir Burak Women's Health Education and Training Hospital, Department of Perinatology, Ankara, Turkey.
authors.forename: Aykan
authors.initials: A
authors.lastname: Yucel
authors.affiliation: Yildirim Beyazit University Faculty of Medicine, Department of Clinical Biochemistry, Ankara, Turkey.
authors.forename: Merve
authors.initials: M
authors.lastname: Ergin
authors.affiliation: Zekai Tahir Burak Women's Health Education and Training Hospital, Department of Perinatology, Ankara, Turkey.
authors.forename: Nuri
authors.initials: N
authors.lastname: Danisman
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D002585:Cesarean Section; D015536:Down-Regulation; D005260:Female; D006801:Humans; D062145:Maternal Serum Screening Tests; D009035:Mothers; D010920:Placenta / Q000378:metabolism*; D010921:Placenta Accreta / Q000097:blood* / Q000378:metabolism*; D010923:Placenta Previa / Q000097:blood / Q000378:metabolism; D011247:Pregnancy; D053220:Receptors, TNF-Related Apoptosis-Inducing Ligand / Q000097:blood* / Q000378:metabolism*
chemical_list: D053220:Receptors, TNF-Related Apoptosis-Inducing Ligand
keywords: Apoptosis; Placenta accreta; TRAIL-R2