The Implication of Aquaporin-9 in the Pathogenesis of Preterm
                    Premature Rupture of Membranes

Fatma Ölmez; Süleyman Cemil Oğlak; Esra Can

doi:10.1055/a-1808-1614

Zeitschrift für Geburtshilfe und Neonatologie, Table of Contents

Z Geburtshilfe Neonatol 2022; 226(04): 233-239
DOI: 10.1055/a-1808-1614

Original Article

The Implication of Aquaporin-9 in the Pathogenesis of Preterm Premature Rupture of Membranes

Fatma Ölmez

¹Obstetrics and Gynecology, Istanbul Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, Turkey

,

Süleyman Cemil Oğlak

²Obstetrics and Gynecology, Diyarbakir Gazi Yasargil Training and Research Hospital, Diyarbakır, Turkey

,

Esra Can

¹Obstetrics and Gynecology, Istanbul Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, Turkey

› Author Affiliations

Abstract

Objective This study aimed to detect aquaporin-9 (AQP9) concentrations in the serum of patients with preterm premature rupture of membranes (PPROM) and compare them with the healthy control group with intact membranes.

Material and methods We conducted this prospective case-control study from March 2021 to August 2021. Of the 80 pregnant patients included in the study, we enrolled 42 singleton pregnant patients with PPROM as the study group and 43 healthy gestational age-, and body mass index (BMI)-matched healthy pregnant women with intact fetal membranes as the control group. We compared demographic and clinical characteristics, complete blood count and biochemical parameters, and serum AQP9 concentrations of the participants. We constructed an ROC curve to illustrate the sensitivity and specificity performance characteristics of AQP9 and calculated a cutoff value by using the Youden index.

Results Maternal serum AQP-9 concentrations were significantly higher in patients with PPROM (804.46±195.63 pg/mL) compared to the healthy pregnant women in the control group (505.97±68.89 pg/mL, p<0.001). When we examine the area under the ROC curve (AUC), the AQP-9 value can be reflected as a statistically significant parameter for diagnosing PPROM. According to the Youden index, a 654.78 pg/mL cut-off value of AQP-9 can be utilized to diagnose PPROM with 80.5% sensitivity and 100% specificity.

Conclusion Maternal serum AQP9 concentrations were significantly higher in PPROM patients than healthy pregnant women with an intact membrane. We suggest that AQP9 might be an essential biomarker of the inflammatory process and energy homeostasis in PPROM.

Keywords

Water channel proteins - Aquaporin-9 - inflammation - energy homeostasis

Full Text

References

References
1 Behram M, Oğlak SC, Başkıran Y. et al. Maternal serum IL-22 concentrations are significantly upregulated in patients with preterm premature rupture of membranes. Ginekol Pol 2021; 92: 631-636
2 Sae-Lin P, Wanitpongpan P. Incidence and risk factors of preterm premature rupture of membranes in singleton pregnancies at Siriraj Hospital. J Obstet Gynaecol Res 2019; 45: 573-577
3 Mercer BM, Crouse DT, Goldenberg RL. et al. Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. The antibiotic treatment of PPROM study: systemic maternal and fetal markers and perinatal outcomes. Am J Obstet Gynecol 2012; 206: 145.e1-9
4 Chackowicz A, Czuzoj-Shulman N, Abenhaim HA. The effects of tocolysis on neonatal septic death in women with PPROM: a retrospective cohort study. Arch Gynecol Obstet 2018; 298: 897-902
5 Yılmaz Baran Ş, Törer B, Kalaycı H. et al. The effect of the cause of delivery on neonatal outcomes in early preterm deliveries. J Fetal Med 2019; 6: 139-145
6 Gilman-Sachs A, Dambaeva S, Salazar Garcia MD. et al. Inflammation induced preterm labor and birth. J Reprod Immunol 2018; 129: 53-58
7 Chang HH, Larson J, Blencowe H. et al. Preventing preterm births: analysis of trends and potential reductions with interventions in 39 countries with very high human development index. Lancet 2013; 381: 223-234
8 Menon R, Richardson LS. Preterm prelabor rupture of the membranes: a disease of the fetal membranes. Semin Perinatol 2017; 41: 409-419
9 Oğlak SC, Obut M. Expression of ADAMTS13 and PCNA in the placentas of gestational diabetic mothers. Int J Morphol 2021; 39: 38-44
10 Behram M, Oğlak SC, Doğan Y. Evaluation of BRD4 levels in patients with early-onset preeclampsia. J Gynecol Obstet Hum Reprod 2021; 50: 101963
11 Behram M, Oğlak SC, Dağ İ. Circulating levels of Elabela in pregnant women complicated with intrauterine growth restriction. J Gynecol Obstet Hum Reprod 2021; 50: 102127
12 Oğlak SC, Tunç Ş, Ölmez F. First trimester mean platelet volume, neutrophil to lymphocyte ratio, and platelet to lymphocyte ratio values are useful markers for predicting preeclampsia. Ochsner J 2021; 21: 364-370
13 O’Brien JM, Santolaya JL, Palomares K. et al. Association of histological chorioamnionitis and magnesium sulfate treatment in singleton and dichorionic twin pregnancies with preterm premature rupture of membranes: preliminary observations. J Perinat Med 2018; 46: 839-844
14 Martinez-Portilla RJ, Hawkins-Villarreal A, Alvarez-Ponce P. et al. Maternal serum ınterleukin-6: a non-ınvasive predictor of histological chorioamnionitis in women with preterm-prelabor rupture of membranes. Fetal Diagn Ther 2019; 45: 168-175
15 Mikołajczyk M, Wirstlein P, Adamczyk M. et al. Value of cervicovaginal fluid cytokines in prediction of fetal inflammatory response syndrome in pregnancies complicated with preterm premature rupture of membranes (pPROM). J Perinat Med 2020; 48: 249-255
16 Bersani I, De Carolis MP, Foell D. et al. Interleukin-22: biomarker of maternal and fetal inflammation?. Immunol Res 2015; 61: 4-10
17 Liu H, Zheng Z, Wintour EM. Aquaporins and fetal fluid balance. Placenta 2008; 29: 840-847
18 Ölmez F, Oğlak SC, Gedik Özköse Z. Increased maternal serum aquaporin-9 expression in pregnancies complicated with early-onset preeclampsia. J Obstet Gynaecol Res 2022; 48: 647-653
19 Marino GI, Castro-Parodi M, Dietrich V. et al. High levels of human chorionic gonadotropin (hCG) correlate with increased aquaporin-9 (AQP9) expression in explants from human preeclamptic placenta. Reprod Sci 2010; 17: 444-453
20 Damiano AE. Aquaporins during pregnancy. Vitam Horm 2020; 112: 327-355
21 Kitchen P, Day RE, Salman MM. et al. Beyond water homeostasis: diverse functional roles of mammalian aquaporins. Biochim Biophys Acta 2015; 1850: 2410-2421
22 Committee on Practice Bulletins-Obstetrics. ACOG Practice Bulletin No. 188: Prelabor Rupture of Membranes. Obstet Gynecol 2018; 131: e1-e14
23 Thumm B, Walsh G, Heyborne KD. Diagnosis of rupture of membranes: AmniSure, clinical assessment, and the Food and Drug Administration warning. Am J Obstet Gynecol MFM 2020; 2: 100200
24 Asadi N, Faraji A, Keshavarzi A. et al. Predictive value of procalcitonin, C-reactive protein, and white blood cells for chorioamnionitis among women with preterm premature rupture of membranes. Int J Gynaecol Obstet 2019; 147: 83-88
25 Cahill AG, Spain J. Intrapartum fetal monitoring. Clin Obstet Gynecol 2015; 58: 263-268
26 Oğlak SC, Bademkıran MH, Obut M. Predictor variables in the success of slow-release dinoprostone used for cervical ripening in intrauterine growth restriction pregnancies. J Gynecol Obstet Hum Reprod 2020; 49: 101739
27 Loitto VM, Forslund T, Sundqvist T. et al. Neutrophil leukocyte motility requires directed water influx. J Leukoc Biol 2002; 71: 212-222
28 Hayashi M, Zhu K, Sagesaka T. et al. Amniotic fluid levels of tumor necrosis factor-alpha and soluble tumor necrosis factor receptor 1 before and after the onset of labor in normal pregnancies. Horm Metab Res 2008; 40: 251-256
29 Presicce P, Cappelletti M, Senthamaraikannan P. et al. TNF-signaling modulates neutrophil-mediated ımmunity at the feto-maternal ınterface during LPS-ınduced ıntrauterine ınflammation. Front Immunol 2020; 11: 558
30 Kobayashi K, Yasui M. Cellular and subcellular localization of aquaporins 1, 3, 8, and 9 in amniotic membranes during pregnancy in mice. Cell Tissue Res 2010; 342: 307-316
31 Damiano AE. Review: Water channel proteins in the human placenta and fetal membranes. Placenta 2011; 32: S207-S211
32 Gena P, Buono ND, D’Abbicco M. et al. Dynamical modeling of liver Aquaporin-9 expression and glycerol permeability in hepatic glucose metabolism. Eur J Cell Biol 2017; 96: 61-69
33 Carbrey JM, Gorelick-Feldman DA, Kozono D. et al. Aquaglyceroporin AQP9: solute permeation and metabolic control of expression in liver. Proc Natl Acad Sci U S A 2003; 100: 2945-2950
34 Rojek AM, Skowronski MT, Füchtbauer EM. et al. Defective glycerol metabolism in aquaporin 9 (AQP9) knockout mice. Proc Natl Acad Sci U S A 2007; 104: 3609-3614
35 Liu H, Yang M, Qiu GP. et al. Aquaporin 9 in rat brain after severe traumatic brain injury. Arq Neuropsiquiatr 2012; 70: 214-220
36 Mittal P, Romero R, Mazaki-Tovi S. et al. Fetal membranes as an interface between inflammation and metabolism: increased aquaporin 9 expression in the presence of spontaneous labor at term and chorioamnionitis. J Matern Fetal Neonatal Med 2009; 22: 1167-1175
37 Sorokin Y, Romero R, Mele L. et al. Maternal serum interleukin-6, C-reactive protein, and matrix metalloproteinase-9 concentrations as risk factors for preterm birth<32 weeks and adverse neonatal outcomes. Am J Perinatol 2010; 27: 631-640
38 Aris IM, Logan S, Lim C. et al. Preterm prelabour rupture of membranes: a retrospective cohort study of association with adverse outcome in subsequent pregnancy. BJOG 2017; 124: 1698-1707