37 results on '"Zeynep Alpay Savasan"'
Search Results
2. P805: Rare clinical gene variant of GBE1: Glycogen storage disease IV
- Author
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Megan Miller, Elana Perry, Anne Heuerman, Hyunyoung Ahn, and Zeynep Alpay Savasan
- Subjects
Genetics ,QH426-470 ,Medicine - Published
- 2024
- Full Text
- View/download PDF
3. Metabolomic Profiling of Cerebral Palsy Brain Tissue Reveals Novel Central Biomarkers and Biochemical Pathways Associated with the Disease: A Pilot Study
- Author
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Zeynep Alpay Savasan, Ali Yilmaz, Zafer Ugur, Buket Aydas, Ray O. Bahado-Singh, and Stewart F. Graham
- Subjects
cerebral palsy ,metabolomics ,1H NMR ,targeted mass spectrometry ,metabolic pathways ,Microbiology ,QR1-502 - Abstract
Cerebral palsy (CP) is one of the most common causes of motor disability in childhood, with complex and heterogeneous etiopathophysiology and clinical presentation. Understanding the metabolic processes associated with the disease may aid in the discovery of preventive measures and therapy. Tissue samples (caudate nucleus) were obtained from post-mortem CP cases (n = 9) and age- and gender-matched control subjects (n = 11). We employed a targeted metabolomics approach using both 1H NMR and direct injection liquid chromatography-tandem mass spectrometry (DI/LC-MS/MS). We accurately identified and quantified 55 metabolites using 1H NMR and 186 using DI/LC-MS/MS. Among the 222 detected metabolites, 27 showed significant concentration changes between CP cases and controls. Glycerophospholipids and urea were the most commonly selected metabolites used to develop predictive models capable of discriminating between CP and controls. Metabolomics enrichment analysis identified folate, propanoate, and androgen/estrogen metabolism as the top three significantly perturbed pathways. We report for the first time the metabolomic profiling of post-mortem brain tissue from patients who died from cerebral palsy. These findings could help to further investigate the complex etiopathophysiology of CP while identifying predictive, central biomarkers of CP.
- Published
- 2019
- Full Text
- View/download PDF
4. Genome-Wide DNA Methylation Analysis and Epigenetic Variations Associated with Congenital Aortic Valve Stenosis (AVS).
- Author
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Uppala Radhakrishna, Samet Albayrak, Zeynep Alpay-Savasan, Amna Zeb, Onur Turkoglu, Paul Sobolewski, and Ray O Bahado-Singh
- Subjects
Medicine ,Science - Abstract
Congenital heart defect (CHD) is the most common cause of death from congenital anomaly. Among several candidate epigenetic mechanisms, DNA methylation may play an important role in the etiology of CHDs. We conducted a genome-wide DNA methylation analysis using an Illumina Infinium 450k human methylation assay in a cohort of 24 newborns who had aortic valve stenosis (AVS), with gestational-age matched controls. The study identified significantly-altered CpG methylation at 59 sites in 52 genes in AVS subjects as compared to controls (either hypermethylated or demethylated). Gene Ontology analysis identified biological processes and functions for these genes including positive regulation of receptor-mediated endocytosis. Consistent with prior clinical data, the molecular function categories as determined using DAVID identified low-density lipoprotein receptor binding, lipoprotein receptor binding and identical protein binding to be over-represented in the AVS group. A significant epigenetic change in the APOA5 and PCSK9 genes known to be involved in AVS was also observed. A large number CpG methylation sites individually demonstrated good to excellent diagnostic accuracy for the prediction of AVS status, thus raising possibility of molecular screening markers for this disorder. Using epigenetic analysis we were able to identify genes significantly involved in the pathogenesis of AVS.
- Published
- 2016
- Full Text
- View/download PDF
5. Comparison of four risk assessment tools for postpartum pharmacologic thromboprophylaxis
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Sonia Sajja and Zeynep Alpay Savasan
- Subjects
Obstetrics and Gynecology - Published
- 2023
6. Advances in cerebral palsy biomarkers
- Author
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Zeynep, Alpay Savasan, Sun Kwon, Kim, Kyung Joon, Oh, and Stewart F, Graham
- Subjects
Cerebral Palsy ,Animals ,Humans ,Biomarkers - Abstract
Cerebral palsy (CP), defined as a group of nonprogressive disorders of movement and posture, is the most common cause of severe neurodisability in children. The prevalence of CP is the same across the globe, affecting approximately 17 million people worldwide. Cerebral Palsy is an umbrella term used to describe the disease due to its inherent heterogeneity. For instance, CP has multiple (1) causes; (2) clinical types; (3) patterns of neuropathology on brain imaging and (4) it's associated with several developmental pathologies such as intellectual disability, autism, epilepsy, and visual impairment. Understanding its physiopathology is crucial to developing protective strategies. Despite its importance, there is still insufficient progress in the areas of CP prediction, early diagnosis, treatment, and prevention. Herein we describe the current risk factors and biomarkers used for the diagnosis and prediction of CP. With the advancement in biomarker discovery, we predict that our understanding of the etiopathophysiology of CP will also increase, lending to more opportunities for developing novel treatments and prognosis.
- Published
- 2021
7. Advances in cerebral palsy biomarkers
- Author
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Zeynep Alpay Savasan, Sun Kwon Kim, Kyung Joon Oh, and Stewart F. Graham
- Subjects
medicine.medical_specialty ,business.industry ,Visual impairment ,Disease ,Neuropathology ,medicine.disease ,Cerebral palsy ,Epilepsy ,Intellectual disability ,medicine ,Neurodisability ,Autism ,medicine.symptom ,Intensive care medicine ,business - Abstract
Cerebral palsy (CP), defined as a group of nonprogressive disorders of movement and posture, is the most common cause of severe neurodisability in children. The prevalence of CP is the same across the globe, affecting approximately 17 million people worldwide. Cerebral Palsy is an umbrella term used to describe the disease due to its inherent heterogeneity. For instance, CP has multiple (1) causes; (2) clinical types; (3) patterns of neuropathology on brain imaging and (4) it's associated with several developmental pathologies such as intellectual disability, autism, epilepsy, and visual impairment. Understanding its physiopathology is crucial to developing protective strategies. Despite its importance, there is still insufficient progress in the areas of CP prediction, early diagnosis, treatment, and prevention. Herein we describe the current risk factors and biomarkers used for the diagnosis and prediction of CP. With the advancement in biomarker discovery, we predict that our understanding of the etiopathophysiology of CP will also increase, lending to more opportunities for developing novel treatments and prognosis.
- Published
- 2021
8. Diagnosis of neonatal neuroblastoma with postmortem magnetic resonance imaging
- Author
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Nathan M. Novotny, Zeynep Alpay-Savasan, Jacqueline K. Macknis, James Davis, and Luis Goncalves
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lcsh:Medical physics. Medical radiology. Nuclear medicine ,medicine.medical_specialty ,Hepatoblastoma ,Abdominal compartment syndrome ,lcsh:R895-920 ,Case Report ,Autopsy ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,Postmortem imaging ,0302 clinical medicine ,Obstetrics and gynaecology ,Neuroblastoma ,medicine ,Radiology, Nuclear Medicine and imaging ,medicine.diagnostic_test ,Virtual autopsy ,business.industry ,Ultrasound ,Magnetic resonance imaging ,medicine.disease ,Abdominal mass ,Surgery ,Metastatic neuroblastoma ,030220 oncology & carcinogenesis ,Fetal imaging ,Radiology ,medicine.symptom ,business ,MRI - Abstract
Postmortem magnetic resonance imaging (MRI) is emerging as a valuable tool to accompany traditional autopsy and has potential for use in cases when traditional autopsy is not possible. This case report will review the use of postmortem MRI with limited tissue sampling to differentiate between metastatic neuroblastoma and hepatoblastoma which could not be clearly differentiated with prenatal ultrasound, prenatal MRI, or emergent postnatal ultrasound. The mother presented to our institution at 27 weeks gestation after an obstetric ultrasound at her obstetrician's office identified a large abdominal mass. Fetal ultrasonography and MRI confirmed the mass but were unable to differentiate between neuroblastoma and multifocal hepatoblastoma. The baby was delivered by cesarean section after nonreassuring heart tones led to an emergent cesarean section. The baby underwent decompressive laparotomy to relieve an abdominal compartment syndrome; however, the family eventually decided to withdraw life support. At this time, we performed a whole body postmortem MRI which further characterized the mass as an adrenal neuroblastoma which was confirmed with limited tissue sampling. Postmortem MRI was especially helpful in this case, as the patient’s family declined traditional autopsy.
- Published
- 2017
9. 425: Does pulse pressure help to determine the effectiveness of labetalol in severe hypertension?
- Author
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James H. Liu, Zeynep Alpay Savasan, and Perry Friedman
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medicine.medical_specialty ,business.industry ,Internal medicine ,medicine ,Cardiology ,Obstetrics and Gynecology ,Labetalol ,business ,Pulse pressure ,medicine.drug - Published
- 2020
10. Metabolomic Profiling of Cerebral Palsy Brain Tissue Reveals Novel Central Biomarkers and Biochemical Pathways Associated with the Disease: A Pilot Study
- Author
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Ali Yilmaz, Zeynep Alpay Savasan, Stewart F. Graham, Zafer Ugur, Ray O. Bahado-Singh, and Buket Aydas
- Subjects
0301 basic medicine ,medicine.drug_class ,Endocrinology, Diabetes and Metabolism ,Caudate nucleus ,lcsh:QR1-502 ,Disease ,Brain tissue ,Pharmacology ,Biochemistry ,Article ,lcsh:Microbiology ,Cerebral palsy ,03 medical and health sciences ,1H NMR ,0302 clinical medicine ,Metabolomics ,targeted mass spectrometry ,medicine ,metabolic pathways ,Molecular Biology ,cerebral palsy ,business.industry ,medicine.disease ,Androgen ,metabolomics ,Metabolic pathway ,030104 developmental biology ,Targeted mass spectrometry ,J0101 ,business ,030217 neurology & neurosurgery - Abstract
Cerebral palsy (CP) is one of the most common causes of motor disability in childhood, with complex and heterogeneous etiopathophysiology and clinical presentation. Understanding the metabolic processes associated with the disease may aid in the discovery of preventive measures and therapy. Tissue samples (caudate nucleus) were obtained from post-mortem CP cases (n = 9) and age- and gender-matched control subjects (n = 11). We employed a targeted metabolomics approach using both 1H NMR and direct injection liquid chromatography-tandem mass spectrometry (DI/LC-MS/MS). We accurately identified and quantified 55 metabolites using 1H NMR and 186 using DI/LC-MS/MS. Among the 222 detected metabolites, 27 showed significant concentration changes between CP cases and controls. Glycerophospholipids and urea were the most commonly selected metabolites used to develop predictive models capable of discriminating between CP and controls. Metabolomics enrichment analysis identified folate, propanoate, and androgen/estrogen metabolism as the top three significantly perturbed pathways. We report for the first time the metabolomic profiling of post-mortem brain tissue from patients who died from cerebral palsy. These findings could help to further investigate the complex etiopathophysiology of CP while identifying predictive, central biomarkers of CP.
- Published
- 2019
- Full Text
- View/download PDF
11. Metabolomic determination of pathogenesis of late-onset preeclampsia
- Author
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David S. Wishart, Zeynep Alpay-Savasan, Argyro Syngelaki, Beomsoo Han, R. Mandal, Edison Dong, Ranjit Akolekar, Stewart F. Graham, Onur Turkoglu, Samuel Bauer, Liona C. Poon, Ray O. Bahado-Singh, Trent C. Bjondahl, Dotun Ogunyemi, and Kypros H. Nicolaides
- Subjects
Adult ,0301 basic medicine ,medicine.medical_specialty ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Insulin resistance ,Metabolomics ,Pre-Eclampsia ,Leucine ,Pregnancy ,Valine ,Internal medicine ,medicine ,Humans ,Glycolysis ,Prospective Studies ,Isoleucine ,030219 obstetrics & reproductive medicine ,business.industry ,Reproducibility of Results ,Obstetrics and Gynecology ,medicine.disease ,Pregnancy Trimester, First ,Metabolic pathway ,030104 developmental biology ,Endocrinology ,Case-Control Studies ,Pediatrics, Perinatology and Child Health ,Ketone bodies ,Female ,Metabolic syndrome ,business ,Algorithms ,Biomarkers ,Metabolic Networks and Pathways - Abstract
Our primary objective was to apply metabolomic pathway analysis of first trimester maternal serum to provide an insight into the pathogenesis of late-onset preeclampsia (late-PE) and thereby identify plausible therapeutic targets for PE.NMR-based metabolomics analysis was performed on 29 cases of late-PE and 55 unaffected controls. In order to achieve sufficient statistical power to perform the pathway analysis, these cases were combined with a group of previously analyzed specimens, 30 late-PE cases and 60 unaffected controls. Specimens from both groups of cases and controls were collected in the same clinical centers during the same time period. In addition, NMR analyses were performed in the same lab and using the same techniques.We identified abnormalities in branch chain amino acids (valine, leucine and isoleucine) and propanoate, glycolysis, gluconeogenesis and ketone body metabolic pathways. The results suggest insulin resistance and metabolic syndrome, mitochondrial dysfunction and disturbance of energy metabolism, oxidative stress and lipid dysfunction in the pathogenesis of late PE and suggest a potential role for agents that reduce insulin resistance in PE.Branched chain amino acids are known markers of insulin resistance and strongly predict future diabetes development. The analysis provides independent evidence linking insulin resistance and late-PE and suggests a potentially important therapeutic role for pharmacologic agents that reduce insulin resistance for late-PE.
- Published
- 2016
12. Second- and third-trimester biochemical and ultrasound markers predictive of ischemic placental disease
- Author
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Ray O. Bahado-Singh, Zeynep Alpay Savasan, and Luis F. Goncalves
- Subjects
Pathology ,medicine.medical_specialty ,Placenta Diseases ,Placenta ,Pregnancy Trimester, Third ,Preeclampsia ,Pre-Eclampsia ,Ischemia ,Predictive Value of Tests ,Pregnancy ,medicine ,Humans ,Placental Circulation ,Ultrasonography, Doppler, Color ,Abruptio Placentae ,Fetus ,Fetal Growth Retardation ,Placental abruption ,business.industry ,Obstetrics ,Ultrasound ,Pregnancy Outcome ,Obstetrics and Gynecology ,medicine.disease ,Placental disease ,Pregnancy Complications ,Regional Blood Flow ,Pregnancy Trimester, Second ,Predictive value of tests ,Pediatrics, Perinatology and Child Health ,Female ,business ,Biomarkers - Abstract
Ischemic placental disease is a recently coined term that describes the vascular insufficiency now believed to be an important etiologic factor in preeclampsia, intrauterine fetal growth restriction, and placental abruption. Given the increased risk for poor maternal and fetal outcomes, early prediction and prevention of this disorder is of significant clinical interest for many. In this article, we review the second- and third-trimester serum and ultrasound markers predictive of ischemic placental disease. Limited first-trimester data is also presented. While current studies report a statistical association between marker levels and various adverse perinatal outcomes, the observed diagnostic accuracy is below the threshold required for clinical utility. An exception to this generalization is uterine artery Doppler for the prediction of early-onset preeclampsia. Metabolomics is a relatively new analytic platform that holds promise as a first-trimester marker for the prediction of both early- and late-onset preeclampsia.
- Published
- 2014
13. Metabolomic Prediction of Fetal Congenital Heart Defect in the First Trimester
- Author
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Philip B. Liu, David S. Wishart, Rupasri Mandal, Argyro Syngelaki, Rebecca Ertl, Edison Dong, Trent C. Bjorndahl, Ray O. Bahado-Singh, Kypros H. Nicolaides, Zeynep Alpay-Savasan, and Beomsoo Han
- Subjects
Adult ,Heart Defects, Congenital ,medicine.medical_specialty ,Magnetic Resonance Spectroscopy ,Metabolite ,Tandem mass spectrometry ,Gastroenterology ,chemistry.chemical_compound ,Metabolomics ,Pregnancy ,Tandem Mass Spectrometry ,Internal medicine ,medicine ,Humans ,Fetus ,Univariate analysis ,business.industry ,Area under the curve ,Obstetrics and Gynecology ,General Medicine ,Confidence interval ,Pregnancy Trimester, First ,Endocrinology ,Logistic Models ,chemistry ,Gestation ,Female ,business ,Chromatography, Liquid - Abstract
Objective The objective of the study was to identify metabolomic markers in maternal first-trimester serum for the detection of fetal congenital heart defects (CHDs). Study Design Mass spectrometry (direct injection/liquid chromatography and tandem mass spectrometry) and nuclear magnetic resonance spectrometry–based metabolomic analyses were performed between 11 weeks' and 13 weeks 6 days' gestation on maternal serum. A total of 27 CHD cases and 59 controls were compared. There were no known or suspected chromosomal or syndromic abnormalities indicated. Results A total of 174 metabolites were identified and quantified using the 2 analytical methods. There were 14 overlapping metabolites between platforms. We identified 123 metabolites that demonstrated significant differences on a univariate analysis in maternal first-trimester serum in CHD vs normal cases. There was a significant disturbance in acylcarnitine, sphingomyelin, and other metabolite levels in CHD pregnancies. Predictive algorithms were developed for CHD detection. High sensitivity (0.929; 95% confidence interval [CI], 0.92–1.00) and specificity (0.932; 95% CI, 0.78–1.00) for CHD detection were achieved (area under the curve, 0.992; 95% CI, 0.973–1.0). Conclusion In the first such report, we demonstrated the feasibility of the use of metabolomic developing biomarkers for the first-trimester prediction of CHD. Abnormal lipid metabolism appeared to be a significant feature of CHD pregnancies.
- Published
- 2015
14. Management of Pregnant Patients with Diabetes with Ischemic Heart Disease
- Author
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Theodore B. Jones, Ray O. Bahado-Singh, Quinetta Johnson, and Zeynep Alpay Savasan
- Subjects
medicine.medical_specialty ,Pregnancy ,business.industry ,Biochemistry (medical) ,Clinical Biochemistry ,Myocardial Ischemia ,Pregnancy in Diabetics ,Disease Management ,Disease ,Hypoglycemia ,medicine.disease ,Angina ,Diabetes mellitus ,Internal medicine ,medicine ,Cardiology ,Humans ,Female ,cardiovascular diseases ,Myocardial infarction ,Intensive care medicine ,Ischemic heart ,business ,Glycemic - Abstract
Management of pregnant patients with diabetes who have ischemic heart disease (IHD) remains a challenging clinical dilemma for obstetricians and maternal fetal specialist alike. The diagnosis of women with IHD is difficult, primarily because of a lack of awareness of the atypical characteristics at presentation by both patient and provider. Counseling of women regarding pregnancy when they are diabetic with IHD is best done before conception. Management by trimester should focus on careful monitoring of maternal cardiac status and stabilization of glycemic control without hypoglycemia. Delivery and postpartum care remain critical in the avoidance of complications and mortality.
- Published
- 2013
15. Endoglin in Amniotic Fluid as a Risk Factor for the Subsequent Development of Bronchopulmonary Dysplasia
- Author
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Yi Xu, Roberto Romero, Sun K. Kim, Sonia S. Hassan, Deug Chan Lee, Zeynep Alpay Savasan, Zhong Dong, Tinnakorn Chaiworapongsa, and Lami Yeo
- Subjects
Adult ,Fetal Membranes, Premature Rupture ,medicine.medical_specialty ,Amniotic fluid ,Immunology ,Fluorescent Antibody Technique ,Enzyme-Linked Immunosorbent Assay ,Receptors, Cell Surface ,Inflammation ,Infections ,Gastroenterology ,Umbilical cord ,Article ,Young Adult ,Obstetric Labor, Premature ,Antigens, CD ,Pregnancy ,Risk Factors ,Internal medicine ,medicine ,Humans ,Immunology and Allergy ,Rupture of membranes ,Risk factor ,Bronchopulmonary Dysplasia ,business.industry ,Obstetrics ,Endoglin ,Infant, Newborn ,Obstetrics and Gynecology ,Amniotic Fluid ,Flow Cytometry ,medicine.disease ,female genital diseases and pregnancy complications ,Cross-Sectional Studies ,medicine.anatomical_structure ,Reproductive Medicine ,Bronchopulmonary dysplasia ,embryonic structures ,Female ,medicine.symptom ,business - Abstract
Objective Cross-talk between inflammation and angiogenesis pathways has been recently reported. The objectives of this study were to: (i) examine whether amniotic fluid (AF) concentrations of soluble endoglin (sEng), a protein with anti-angiogenic properties, change during pregnancy, parturition, or intra-amniotic infection and/or inflammation (IAI); (ii) determine whether an increase in sEng in the AF of patients with preterm labor (PTL) and preterm prelabor rupture of membranes (PROM) is associated with adverse neonatal outcomes; and (iii) investigate potential sources of sEng in AF. Study design A cross-sectional study was conducted to include patients in the following groups: (i) mid-trimester (n = 20); (ii) PTL with term delivery (n = 95); (iii) PTL leading to preterm delivery with (n = 40) and without IAI (n = 46); (iv) preterm PROM with (n = 37) and without IAI (n = 37); (v) term in labor (n = 48) and not in labor (n = 44). AF concentrations of sEng were determined by enzyme-linked immunosorbent assay. Chorioamniotic membranes, umbilical cord blood, and AF macrophages were examined for the expression of endoglin. Results (i) Patients with IAI had a higher median AF concentration of sEng than those without IAI (P = 0.02 for PTL and 0.06 for preterm PROM); (ii) AF concentrations of sEng in the 3rd and 4th quartiles were associated with IAI (OR 2.5 and 7.9, respectively); (iii) an AF sEng concentration ≥779.5 pg/mL was associated with bronchopulmonary dysplasia (BPD) (OR 7.9); (iv) endoglin was co-localized with CD14+ macrophages in AF pellets of patients with IAI by immunofluorescence and flow cytometry; and (v) the concentration of sEng in the supernatant was significantly increased after the treatment of macrophages with endotoxin or TNF-α. Conclusions Soluble endoglin participates in the host response against IAI. Activated macrophages may be a source of sEng concentrations in the AF of patients with IAI. An increase of sEng in the AF is associated with BPD and adverse neonatal outcomes.
- Published
- 2012
16. Genome-Wide DNA Methylation Analysis and Epigenetic Variations Associated with Congenital Aortic Valve Stenosis (AVS)
- Author
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Ray O. Bahado-Singh, Samet Albayrak, Uppala Radhakrishna, Zeynep Alpay-Savasan, Amna Zeb, Paul S Sobolewski, and Onur Turkoglu
- Subjects
Male ,0301 basic medicine ,lcsh:Medicine ,030204 cardiovascular system & hematology ,Pathology and Laboratory Medicine ,Bioinformatics ,Biochemistry ,Genome ,Epigenesis, Genetic ,0302 clinical medicine ,Medicine and Health Sciences ,lcsh:Science ,Lipoprotein Receptors ,Stenosis ,Genetics ,DNA methylation ,Multidisciplinary ,Gene Ontologies ,Heart ,Genomics ,Methylation ,Chromatin ,Nucleic acids ,CpG site ,Aortic Valve ,Epigenetics ,Female ,Anatomy ,DNA modification ,Chromatin modification ,Research Article ,Chromosome biology ,Signal Transduction ,Cell biology ,Lipoproteins ,Biology ,Chromosomes ,03 medical and health sciences ,Signs and Symptoms ,Genomic Medicine ,Diagnostic Medicine ,Humans ,Gene ,Identical protein binding ,Biology and life sciences ,PCSK9 ,lcsh:R ,Computational Biology ,Proteins ,DNA ,Aortic Valve Stenosis ,Genome Analysis ,030104 developmental biology ,Case-Control Studies ,Cardiovascular Anatomy ,CpG Islands ,lcsh:Q ,Gene expression - Abstract
Congenital heart defect (CHD) is the most common cause of death from congenital anomaly. Among several candidate epigenetic mechanisms, DNA methylation may play an important role in the etiology of CHDs. We conducted a genome-wide DNA methylation analysis using an Illumina Infinium 450k human methylation assay in a cohort of 24 newborns who had aortic valve stenosis (AVS), with gestational-age matched controls. The study identified significantly-altered CpG methylation at 59 sites in 52 genes in AVS subjects as compared to controls (either hypermethylated or demethylated). Gene Ontology analysis identified biological processes and functions for these genes including positive regulation of receptor-mediated endocytosis. Consistent with prior clinical data, the molecular function categories as determined using DAVID identified low-density lipoprotein receptor binding, lipoprotein receptor binding and identical protein binding to be over-represented in the AVS group. A significant epigenetic change in the APOA5 and PCSK9 genes known to be involved in AVS was also observed. A large number CpG methylation sites individually demonstrated good to excellent diagnostic accuracy for the prediction of AVS status, thus raising possibility of molecular screening markers for this disorder. Using epigenetic analysis we were able to identify genes significantly involved in the pathogenesis of AVS.
- Published
- 2016
17. Clinical chorioamnionitis is characterized by changes in the expression of the alarmin HMGB1 and one of its receptors, sRAGE
- Author
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Roberto Romero, Juan Pedro Kusanovic, Chong Jai Kim, Youssef Hussein, Tinnakorn Chaiworapongsa, Zeynep Alpay Savasan, Zhong Dong, and Sonia S. Hassan
- Subjects
Amniotic fluid ,biology ,business.industry ,Obstetrics and Gynecology ,Inflammation ,HMGB1 ,RAGE (receptor) ,Glycation ,Pediatrics, Perinatology and Child Health ,Immunology ,biology.protein ,Extracellular ,Medicine ,medicine.symptom ,business ,Receptor ,Neuroinflammation - Abstract
Objective: High mobility group box-1 (HMGB1) protein is an alarmin, a normal cell constituent, which is released into the extracellular environment upon cellular stress/damage and capable of activating inflammation and tissue repair. The receptor for advanced glycation end products (RAGE) can bind HMGB1. RAGE, in turn, can induce the production of pro-inflammatory cytokines; this may be modulated by the soluble truncated forms of RAGE, including soluble RAGE (sRAGE) and endogenous secretory RAGE (esRAGE). The objectives of this study were to determine whether: 1) clinical chorioamnionitis at term is associated with changes in amniotic fluid concentrations of HMGB1, sRAGE and esRAGE; and 2) the amniotic fluid concentration of HMGB1 changes with labor or as a function of gestational age. Methods: Amniotic fluid samples were collected from the following groups: 1) mid-trimester (n = 45); 2) term with (n = 48) and without labor (n = 22) without intra-amniotic infection; and 3) term with clinical chorioamnioni...
- Published
- 2012
18. Damage-associated molecular patterns (DAMPs) in preterm labor with intact membranes and preterm PROM: a study of the alarmin HMGB1
- Author
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Zeynep Alpay Savasan, Roberto Romero, Youssef Hussein, Tinnakorn Chaiworapongsa, Chong Jai Kim, Yi Xu, Juan Pedro Kusanovic, Zhong Dong, and Sonia S. Hassan
- Subjects
Adult ,Fetal Membranes, Premature Rupture ,Amniotic fluid ,Adolescent ,Inflammation ,Pregnancy Proteins ,HMGB1 ,Chorioamnionitis ,Article ,Sepsis ,Young Adult ,Obstetric Labor, Premature ,Mediator ,Pregnancy ,Stress, Physiological ,Extracellular ,Humans ,Medicine ,Amnion ,HMGB1 Protein ,Pregnancy Complications, Infectious ,Retrospective Studies ,biology ,business.industry ,Infant, Newborn ,Obstetrics and Gynecology ,medicine.disease ,Blockade ,Cross-Sectional Studies ,Pediatrics, Perinatology and Child Health ,Immunology ,Metabolome ,biology.protein ,Female ,medicine.symptom ,business ,DNA Damage - Abstract
Preterm parturition is a syndrome caused by multiple etiologies. Although intra-amniotic infection is causally linked with intrauterine inflammation and the onset of preterm labor, other patients have preterm labor in the absence of demonstrable infection. It is now clear that inflammation may be elicited by activation of the Damage-Associated Molecular Patterns (DAMPs), which include pathogen-associated molecular patterns (PAMPs) as well as "alarmins" (endogenous molecules that signal tissue and cellular damage). A prototypic alarmin is high-mobility group box 1 (HMGB1) protein, capable of inducing inflammation and tissue repair when it reaches the extracellular environment. HMGB1 is a late mediator of sepsis, and blockade of HMGB1 activity reduces mortality in an animal model of endotoxemia, even if administered late during the course of the disorder. The objectives of this study were to: (1) determine whether intra-amniotic infection/inflammation (IAI) is associated with changes in amniotic fluid concentrations of HMGB1; and (2) localize immunoreactivity of HMGB1 in the fetal membranes and umbilical cord of patients with chorioamnionitis.Amniotic fluid samples were collected from the following groups: (1) preterm labor with intact membranes (PTL) with (n=42) and without IAI (n=84); and (2) preterm prelabor rupture of membranes (PROM) with (n=38) and without IAI (n=35). IAI was defined as either a positive amniotic fluid culture or amniotic fluid concentration of interleukin-6 (IL-6) ≥ 2.6ng/mL. HMGB1 concentrations in amniotic fluid were determined by ELISA. Immunofluorescence staining for HMGB1 was performed in the fetal membranes and umbilical cord of pregnancies with acute chorioamnionitis.(1) Amniotic fluid HMGB1 concentrations were higher in patients with IAI than in those without IAI in both the PTL and preterm PROM groups (PTL IAI: median 3.1 ng/mL vs. without IAI; median 0.98 ng/mL; p0.001; and preterm PROM with IAI median 7.3 ng/mL vs. without IAI median 2.6 ng/mL; p=0.002); (2) patients with preterm PROM without IAI had a higher median amniotic fluid HMGB1 concentration than those with PTL and intact membranes without IAI (p0.001); and (3) HMGB1 was immunolocalized to amnion epithelial cells and stromal cells in the Wharton's jelly (prominent in the nuclei and cytoplasm). Myofibroblasts and macrophages of the chorioamniotic connective tissue layer and infiltrating neutrophils showed diffuse cytoplasmic HMGB1 immunoreactivity.(1) intra-amniotic infection/inflammation is associated with elevated amniotic fluid HMGB1 concentrations regardless of membrane status; (2) preterm PROM was associated with a higher amniotic fluid HMGB1 concentration than PTL with intact membranes, suggesting that rupture of membranes is associated with an elevation of alarmins; (3) immunoreactive HMGB1 was localized to amnion epithelial cells, Wharton's jelly and cells involved in the innate immune response; and (4) we propose that HMGB1 released from stress or injured cells into amniotic fluid may be responsible, in part, for intra-amniotic inflammation due to non-microbial insults.
- Published
- 2011
19. Maternal plasma concentrations of angiogenic/anti-angiogenic factors are of prognostic value in patients presenting to the obstetrical triage area with the suspicion of preeclampsia
- Author
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Zeynep Alpay Savasan, Roberto Romero, Zhong Dong, Juan Pedro Kusanovic, Eleazar Soto, Sonia S. Hassan, Tinnakorn Chaiworapongsa, Adi L. Tarca, Bhatti Gaurav, and Giovanna Ogge
- Subjects
Adult ,Placental growth factor ,Gestational hypertension ,medicine.medical_specialty ,Receptors, Cell Surface ,Pregnancy Proteins ,Article ,Preeclampsia ,Young Adult ,Pre-Eclampsia ,Antigens, CD ,Pregnancy ,medicine ,Humans ,Young adult ,Obstetrics and Gynecology Department, Hospital ,Placenta Growth Factor ,Retrospective Studies ,Vascular Endothelial Growth Factor Receptor-1 ,business.industry ,Obstetrics ,Endoglin ,Obstetrics and Gynecology ,Retrospective cohort study ,Prognosis ,medicine.disease ,Vascular Endothelial Growth Factor Receptor-2 ,Pediatrics, Perinatology and Child Health ,Gestation ,Female ,Triage ,business ,Biomarkers - Abstract
To determine whether maternal plasma concentrations of placental growth factor (PlGF), soluble endoglin (sEng), soluble vascular endothelial growth factor receptor-1 (sVEGFR-1) and -2 could identify patients at risk for developing preeclampsia (PE) requiring preterm delivery.Patients presenting with the diagnosis "rule out PE" to the obstetrical triage area of our hospital at37 weeks of gestation (n = 87) were included in this study. Delivery outcomes were used to classify patients into four groups: I) patients without PE or those with gestational hypertension (GHTN) or chronic hypertension (CHTN) who subsequently developed PE at term (n = 19); II): mild PE who delivered at term (n = 15); III): mild disease (mild PE, GHTN, CHTN) who subsequently developed severe PE requiring preterm delivery (n = 26); and IV): diagnosis of severe PE (n = 27). Plasma concentrations of PlGF, sEng, sVEGFR-1 and -2 were determined at the time of presentation by ELISA. Reference ranges for analytes were constructed by quantile regression in our laboratory (n = 180; 1046 samples). Comparisons among groups were performed using multiples of the median (MoM) and parametric statistics after log transformation. Receiver operating characteristic curves, logistic regression and survival analysis were employed for analysis.The mean MoM plasma concentration of PlGF/sVEGFR-1, PlGF/sEng, PlGF, sVEGFR-1 and -2, and sEng in Group III was significantly different from Group II (all p0.05). A plasma concentration of PlGF/sVEGFR-1 ≤ 0.05 MoM or PlGF/sEng ≤0.07 MoM had the highest likelihood ratio of a positive test (8.3, 95% CI 2.8-25 and 8.6, 95% CI 2.9-25, respectively), while that of PlGF ≤0.396 MoM had the lowest likelihood ratio of a negative test (0.08, 95% CI 0.03-0.25). The association between low plasma concentrations of PlGF/sVEGFR-1 (≤0.05 MoM) as well as that of PlGF/sEng (≤0.07 MoM) and the development of severe PE remained significant after adjusting for gestational age at presentation, average systolic and diastolic blood pressure, and a history of chronic hypertension [adjusted odds ratio (OR) = 27 (95% CI 6.4-109) and adjusted OR 30 (95% CI 6.9-126), respectively]. Among patients who presented34 weeks gestation (n = 59), a plasma concentration of PlGF/sVEGFR-10.033 MoM identified patients who delivered within 2 weeks because of PE with a sensitivity of 93% (25/27) and a specificity of 78% (25/32). This cut-off was associated with a shorter interval-to-delivery due to PE [hazard ratio = 6 (95% CI 2.5-14.6)].Plasma concentrations of angiogenic/anti-angiogenic factors are of prognostic value in the obstetrical triage area. These observations support the value of these biomarkers in the clinical setting for the identification of the patient at risk for disease progression requiring preterm delivery.
- Published
- 2011
20. Maternal and Neonatal Outcomes in Pregnancies With Invasive Cancer [33L]
- Author
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Zeynep Alpay Savasan and Amna Zeb
- Subjects
medicine.medical_specialty ,Invasive carcinoma ,business.industry ,Neonatal outcomes ,Obstetrics ,Obstetrics and Gynecology ,Medicine ,business - Published
- 2018
21. Validation of metabolomic models for prediction of early-onset preeclampsia
- Author
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Edison Dong, Onur Turkoglu, Zeynep Alpay-Savasan, Argyro Syngelaki, Trent C. Bjondahl, R. Mandal, Samuel Bauer, Stewart F. Graham, Ray O. Bahado-Singh, Ranjit Akolekar, Kypros H. Nicolaides, Beomsoo Han, and David S. Wishart
- Subjects
Oncology ,Adult ,medicine.medical_specialty ,Magnetic Resonance Spectroscopy ,Bioinformatics ,Preeclampsia ,Young Adult ,Insulin resistance ,Metabolomics ,Pre-Eclampsia ,Pregnancy ,Internal medicine ,medicine ,Humans ,Receiver operating characteristic ,business.industry ,Early onset preeclampsia ,Obstetrics and Gynecology ,Ultrasonography, Doppler ,medicine.disease ,Confidence interval ,Pregnancy Trimester, First ,Uterine Artery ,Area Under Curve ,Case-Control Studies ,Pulsatile Flow ,Biomarker (medicine) ,Blood sugar regulation ,Female ,business ,Algorithms ,Biomarkers - Abstract
Objective We sought to perform validation studies of previously published and newly derived first-trimester metabolomic algorithms for prediction of early preeclampsia (PE). Study Design Nuclear magnetic resonance–based metabolomic analysis was performed on first-trimester serum in 50 women who subsequently developed early PE and in 108 first-trimester controls. Random stratification and allocation was used to divide cases into a discovery group (30 early PE and 65 controls) for generation of the biomarker model(s) and a validation group (20 early PE and 43 controls) to ensure an unbiased assessment of the predictive algorithms. Cross-validation testing on the different algorithms was performed to confirm their robustness before use. Metabolites, demographic features, clinical characteristics, and uterine Doppler pulsatility index data were evaluated. Area under the receiver operator characteristic curve (AUC), 95% confidence interval (CI), sensitivity, and specificity of the biomarker models were derived. Results Validation testing found that the metabolite-only model had an AUC of 0.835 (95% CI, 0.769–0.941) with a 75% sensitivity and 74.4% specificity and for the metabolites plus uterine Doppler pulsatility index model it was 0.916 (95% CI, 0.836–0.996), 90%, and 88.4%, respectively. Predictive metabolites included arginine and 2-hydroxybutyrate, which are known to be involved in vascular dilation, and insulin resistance and impaired glucose regulation, respectively. Conclusion We found confirmatory evidence that first-trimester metabolomic biomarkers can predict future development of early PE.
- Published
- 2015
22. Does IVF Treatment (Autologous and Donor Oocyte) Improve Pregnancy Outcomes in Women 40 Years and Older? [24K]
- Author
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Amna Zeb, Emily Heasley, Zeynep Alpay Savasan, and Aseel Abdulahad
- Subjects
Ivf treatment ,Pregnancy ,medicine.medical_specialty ,business.industry ,Obstetrics ,Obstetrics and Gynecology ,Medicine ,Donor oocyte ,business ,medicine.disease ,Pregnancy outcomes - Published
- 2017
23. Optimal Management and Delivery Time for Intrahepatic Cholestasis of Pregnancy: Meta-analysis [37D]
- Author
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Zeynep Alpay Savasan and Amna Zeb
- Subjects
medicine.medical_specialty ,business.industry ,Treatment modality ,Obstetrics ,Meta-analysis ,Obstetrics and Gynecology ,Medicine ,Gestation ,business ,medicine.disease ,Cholestasis of pregnancy ,Optimal management - Published
- 2017
24. Twin Anemia Polycythemia Sequence: A Complication of Monochorionic Diamniotic Twin Gestation [16P]
- Author
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Lauren Scott, Amna Zeb, and Zeynep Alpay Savasan
- Subjects
Monochorionic diamniotic twin ,medicine.medical_specialty ,genetic structures ,business.industry ,Obstetrics ,Obstetrics and Gynecology ,medicine.disease ,Prenatal ultrasound ,hemic and lymphatic diseases ,Twin gestation ,Vascular anastomosis ,Medicine ,Gestation ,Twin Anemia-Polycythemia Sequence ,business ,Complication - Abstract
INTRODUCTION:Twin anemia polycythemia sequence (TAPS) is an important prenatal complication of monochorionic twin gestations due to abnormal placental vascular anastomosis. Prenatal ultrasound is the only screening modality. Our objective was to evaluate the prediction potential of current prenatal
- Published
- 2017
25. Female Infertility and Free Radicals: Potential Role in Endometriosis and Adhesions
- Author
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Zeynep Alpay Savasan
- Subjects
Peritoneal surface ,business.industry ,Female infertility ,Endometriosis ,Inflammation ,Postoperative adhesion ,medicine.disease_cause ,medicine.disease ,Bioinformatics ,Pathophysiology ,Andrology ,medicine ,Tissue healing ,medicine.symptom ,business ,Oxidative stress - Abstract
Oxidative stress is widely implicated in various forms of reproduction failure. Postoperative adhesions and endometriosis are the two common conditions associated with female infertility with several similarities in their development and clinical behavior. The pathophysiology of both conditions involves peritoneal surface inflammation, tissue healing, and fibrogenesis, in which alterations in oxidative metabolism appear to be operational. Enhanced free radical generation and/or decreased scavenging have been shown in the endometriosis and postoperative adhesion tissues. Interventions targeting oxidative metabolism for the prevention and treatment of either condition have given mixed results. Studies utilizing contemporary methods may shed further light on the involvement of oxidative stress leading to development of more targeted therapies in these conditions.
- Published
- 2012
26. Hematologic profile of the fetus with systemic inflammatory response syndrome
- Author
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Samuel S. Edwin, Sonia S. Hassan, Roberto Romero, Stanley M. Berry, Zeynep Alpay Savasan, Juan Pedro Kusanovic, Tinnakorn Chaiworapongsa, Bo Hyun Yoon, and Moshe Mazor
- Subjects
Adult ,medicine.medical_specialty ,Adolescent ,Leukocytosis ,Neutrophils ,Neutropenia ,Gastroenterology ,Article ,Leukocyte Count ,Young Adult ,Pregnancy ,White blood cell ,Internal medicine ,Humans ,Medicine ,Rupture of membranes ,Erythropoiesis ,Retrospective Studies ,Fetus ,Interleukin-6 ,business.industry ,Obstetrics and Gynecology ,Gestational age ,Fetal Blood ,medicine.disease ,Systemic Inflammatory Response Syndrome ,Neutrophilia ,Fetal Diseases ,Cross-Sectional Studies ,medicine.anatomical_structure ,Pediatrics, Perinatology and Child Health ,Immunology ,Absolute neutrophil count ,Female ,medicine.symptom ,business ,Biomarkers - Abstract
The fetal inflammatory response syndrome (FIRS) is associated with impending onset of preterm labor/delivery, microbial invasion of the amniotic cavity and increased perinatal morbidity. FIRS has been defined by an elevated fetal plasma interleukin (IL)-6, a cytokine with potent effects on the differentiation and proliferation of hematopoietic precursors. The objective of this study was to characterize the hematologic profile of fetuses with FIRS.Fetal blood sampling was performed in patients with preterm prelabor rupture of membranes and preterm labor with intact membranes (n=152). A fetal plasma IL-6 concentration ≥ 11 pg/mL was used to define FIRS. Hemoglobin concentration, platelet count, total white blood cell (WBC) count, differential count, and nucleated red blood cell (NRBC) count were obtained. Since blood cell count varies with gestational age, the observed values were corrected for fetal age by calculating a ratio between the observed and expected mean value for gestational age.1) The prevalence of FIRS was 28.9% (44/152); 2) fetuses with FIRS had a higher median corrected WBC and corrected neutrophil count than those without FIRS (WBC: median 1.4, range 0.3-5.6, vs. median 1.1, range 0.4-2.9, P=0.001; neutrophils: median 3.6, range 0.1-57.5, vs. median 1.8, range 0.2-13.9, P0.001); 3) neutrophilia (defined as a neutrophil count95th centile of gestational age) was significantly more common in fetuses with FIRS than in those without FIRS (71%, 30/42, vs. 35%, 37/105; P0.001); 4) more than two-thirds of fetuses with FIRS had neutrophilia, whereas neutropenia was present in only 4.8% (2/42); 5) FIRS was not associated with detectable changes in hemoglobin concentration, platelet, lymphocyte, monocyte, basophil or eosinophil counts; and 6) fetuses with FIRS had a median corrected NRBC count higher than those without FIRS. However, the difference did not reach statistical significance (NRBC median 0.07, range 0-1.3, vs. median 0.04, range 0-2.3, P=0.06).The hematologic profile of the human fetus with FIRS is characterized by significant changes in the total WBC and neutrophil counts. The NRBC count in fetuses with FIRS tends to be higher than fetuses without FIRS.
- Published
- 2012
27. Interleukin-19 in fetal systemic inflammation
- Author
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Roberto Romero, Zeynep Alpay Savasan, Yi Xu, Juan Pedro Kusanovic, Sonia S. Hassan, Youssef Hussein, Tinnakorn Chaiworapongsa, Chong Jai Kim, and Zhong Dong
- Subjects
Adult ,Adolescent ,Systemic inflammation ,Chorioamnionitis ,Article ,Young Adult ,Pregnancy ,Funisitis ,medicine ,Humans ,Fetus ,business.industry ,Interleukins ,Infant, Newborn ,Obstetrics and Gynecology ,Interleukin ,medicine.disease ,Fetal Blood ,Systemic Inflammatory Response Syndrome ,Interleukin-10 ,Systemic inflammatory response syndrome ,Interleukin 10 ,Case-Control Studies ,Pediatrics, Perinatology and Child Health ,Immunology ,Interleukin 19 ,Female ,medicine.symptom ,business - Abstract
The fetal inflammatory response syndrome (FIRS) is considered the fetal counterpart of the systemic inflammatory response syndrome (SIRS), which can be caused by infection and non-infection-related insults. Although the initial response is mediated by pro-inflammatory signals, the control of this response is achieved by anti-inflammatory mediators which are essential for the successful outcome of the affected individual. Interleukin (IL)-19 is capable of stimulating the production of IL-10, a major anti-inflammatory cytokine, and is a potent inducer of the T-helper 2 (Th2) response. The aim of this study was to determine if there is a change in umbilical cord plasma IL-19 and IL-10 concentrations in preterm neonates with and without acute funisitis, the histologic counterpart of FIRS.A case-control study was conducted including 80 preterm neonates born after spontaneous labor. Neonates were classified according to the presence (n = 40) or absence of funisitis (n = 40), which is the pathologic hallmark of FIRS. Neonates in each group were also matched for gestational age. Umbilical cord plasma IL-19 and IL-10 concentrations were determined by ELISA.1) The median umbilical cord plasma IL-19 concentration was 2.5-fold higher in neonates with funisitis than in those without funisitis (median 87 pg/mL; range 20.6-412.6 pg/mL vs. median 37 pg/mL; range 0-101.7 pg/mL; p0.001); 2) newborns with funisitis had a significantly higher median umbilical cord plasma IL-10 concentration than those without funisitis (median 4 pg/mL; range 0-33.5 pg/mL vs. median 2 pg/mL; range 0-13.8 pg/mL; p0.001); and 3) the results were similar when we included only patients with funisitis who met the definition of FIRS by umbilical cord plasma IL-6 concentrations ≥ 17.5 pg/mL (p0.001).IL-19 and IL-10 are parts of the immunologic response of FIRS. A subset of fetuses with FIRS had high umbilical cord plasma IL-19 concentrations. In utero exposure to high systemic concentrations of IL-19 may reprogram the immune response.
- Published
- 2011
28. Unexplained Fetal Death is Associated with Increased Concentrations of Anti-Angiogenic Factors in Amniotic Fluid
- Author
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Roberto Romero, Zhong Dong, Sonia S. Hassan, Juan Pedro Kusanovic, Pooja Mittal, Giovanna Ogge, Shali Mazaki-Tovi, Edi Vaisbuch, Sun Kwon Kim, Zeynep Alpay Savasan, Tinnakorn Chaiworapongsa, Ichchha Madan, and Lami Yeo
- Subjects
Adult ,medicine.medical_specialty ,Amniotic fluid ,Adolescent ,Receptors, Cell Surface ,Article ,Preeclampsia ,Andrology ,Young Adult ,Antigens, CD ,Pregnancy ,Medicine ,Humans ,Soluble endoglin ,Young adult ,Fetal Death ,Vascular Endothelial Growth Factor Receptor-1 ,Fetal death ,Placental abruption ,business.industry ,Obstetrics ,Endoglin ,Obstetrics and Gynecology ,Middle Aged ,medicine.disease ,Amniotic Fluid ,Cross-Sectional Studies ,embryonic structures ,Pediatrics, Perinatology and Child Health ,Female ,business - Abstract
Angiogenesis is critical for successful pregnancy. An anti-angiogenic state has been implicated in preeclampsia, fetal growth restriction and fetal death. Increased maternal plasma concentrations of the anti-angiogenic factor, soluble vascular endothelial growth factor receptor (sVEGFR)-1, have been reported in women with preeclampsia and in those with fetal death. Recent observations indicate that an excess of sVEGFR-1 and soluble endoglin (sEng) is also present in the amniotic fluid of patients with preeclampsia. The aim of this study was to determine whether fetal death is associated with changes in amniotic fluid concentrations of sVEGFR-1 and sEng, two powerful anti-angiogenic factors. Study design. This cross-sectional study included patients with fetal death (n = 35) and controls (n = 129). Fetal death was subdivided according to clinical circumstances into: (1) unexplained (n = 25); (2) preeclampsia and/or placental abruption (n = 5); and (3) chromosomal/congenital anomalies (n = 5). The control group consisted of patients with preterm labor (PTL) who delivered at term (n = 92) and women at term not in labor (n = 37). AF concentrations of sVEGFR-1 and sEng were determined by ELISA. Non-parametric statistics and logistic regression analysis were applied. Results. (1) Patients with a fetal death had higher median amniotic fluid concentrations of sVEGFR-1 and sEng than women in the control group (p0.001 for each); (2) these results remained significant among different subgroups of stillbirth (p0.05 for each); and (3) amniotic fluid concentrations of sVEGFR-1 and those of sEng above the third quartile were associated with a significant risk of unexplained preterm fetal death (adjusted OR = 10.8; 95%CI 1.3-89.2 and adjusted OR 87; 95% CI 2.3-3323, respectively). Conclusion. Patients with an unexplained fetal death at diagnosis are characterized by an increase in the amniotic fluid concentrations of sVEGFR-1 and sEng. These observations indicate that an excess of anti-angiogenic factors in the amniotic cavity is associated with unexplained fetal death especially in preterm gestations.
- Published
- 2010
29. Evidence in support of a role for anti-angiogenic factors in preterm prelabor rupture of membranes
- Author
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Zeynep Alpay Savasan, Edi Vaisbuch, Sonia S. Hassan, Roberto Romero, Lami Yeo, Tinnakorn Chaiworapongsa, Zhong Dong, Juan Pedro Kusanovic, Pooja Mittal, Ichchha Madan, Shali Mazaki-Tovi, Sun Kwon Kim, and Giovanna Ogge
- Subjects
Adult ,medicine.medical_specialty ,Fetal Membranes, Premature Rupture ,Amniotic fluid ,Adolescent ,Term Birth ,Gestational Age ,Prom ,Chorioamnionitis ,Article ,chemistry.chemical_compound ,Young Adult ,Pregnancy ,medicine ,Rupture of membranes ,Humans ,Vascular Endothelial Growth Factor Receptor-1 ,Placental abruption ,Obstetrics ,business.industry ,Obstetrics and Gynecology ,Gestational age ,medicine.disease ,Amniotic Fluid ,Vascular Endothelial Growth Factor Receptor-2 ,female genital diseases and pregnancy complications ,Vascular endothelial growth factor ,Cross-Sectional Studies ,chemistry ,Premature birth ,embryonic structures ,Pediatrics, Perinatology and Child Health ,Premature Birth ,Female ,business - Abstract
Vaginal bleeding, placental abruption, and defective placentation are frequently observed in patients with preterm prelabor rupture of membranes (PROM). Recently, a role of vascular endothelial growth factor (VEGF) and its receptor, VEGF receptor (VEGFR)- 1 has been implicated in the mechanisms of membrane rupture. The purpose of this study was to determine whether the soluble form of VEGFR-1 and -2 concentrations in amniotic fluid (AF) change with preterm PROM, intra-amniotic infection/inflammation (IAI), or parturition.This cross-sectional study included 544 patients in the following groups: (1) midtrimester (MT) (n = 48); (2) preterm labor (PTL) leading to term delivery (n = 143); (3) PTL resulting in preterm delivery with (n = 72) and without IAI (n = 100); (4) preterm PROM with (n = 46) and without IAI (n = 42); (5) term in labor (n = 48); and (6) term not in labor (n = 45). The concentrations of sVEGFR-1 and sVEGFR-2 were determined by ELISA. Non-parametric statistics and logistic regression analysis were applied.(1) Preterm PROM (with and without IAI) had a lower median AF concentration of sVEGFR-1 than patients with PTL who delivered at term (p0.001 for each comparison); (2) A decrease in AFsVEGFR-1 concentrations per each quartile was associated with PROM after adjusting for confounders (OR 1.8; 95%CI 1.4-2.3); (3) IAI, regardless of the membrane status, was not associated with a change in the median AF concentrations of sVEGFR-1 and sVEGFR-2 (p0.05 for each comparison); and (4) Spontaneous term and PTL did not change the median sVEGFR-1 and sVEGFR-2 concentrations (p0.05 for each comparison).(1) This is the first evidence that preterm PROM is associated with a lower AF concentration of sVEGFR-1 than patients with PTL intact membranes. These findings cannot be attributed to gestational age, labor, or IAI; and (2) AF concentrations of sVEGFR-2 did not change with preterm PROM, IAI, or labor at term and preterm.
- Published
- 2010
30. The frequency and clinical significance of intra-amniotic infection and/or inflammation in women with placenta previa and vaginal bleeding: an unexpected observation
- Author
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Edi Vaisbuch, Chong Jai Kim, Roberto Romero, Ichchha Madan, Sonia S. Hassan, Lami Yeo, Juan Pedro Kusanovic, Pooja Mittal, Tinnakorn Chaiworapongsa, Zeynep Alpay Savasan, Shali Mazaki-Tovi, and Zhong Dong
- Subjects
Adult ,medicine.medical_specialty ,Amniotic fluid ,Placenta Previa ,Gestational Age ,Chorioamnionitis ,Article ,Cohort Studies ,Pregnancy ,Risk Factors ,medicine ,Humans ,Vaginal bleeding ,Retrospective Studies ,Gynecology ,medicine.diagnostic_test ,business.industry ,Obstetrics ,Interleukin-6 ,Pregnancy Outcome ,Obstetrics and Gynecology ,Gestational age ,Bacterial Infections ,medicine.disease ,Amniotic Fluid ,Placenta previa ,Premature birth ,embryonic structures ,Pediatrics, Perinatology and Child Health ,Amniocentesis ,Premature Birth ,Female ,Uterine Hemorrhage ,medicine.symptom ,business - Abstract
OBJECTIVE Idiopathic vaginal bleeding, a common complication of pregnancy, increases the risk of small-for-gestational age (SGA) neonate, preeclampsia and preterm delivery and can be the only clinical manifestation of intra-amniotic infection and/or inflammation (IAI). Placenta previa is thought to be protective against ascending intrauterine infection, yet an excess of histologic chorioamnionitis has been reported in this condition. The aim of this study was to determine the frequency and clinical significance of IAI in women with placenta previa and vaginal bleeding in the absence of preterm labor. STUDY DESIGN A retrospective cohort study including 35 women with placenta previa and vaginal bleeding
- Published
- 2010
31. Maternal and neonatal circulating visfatin concentrations in patients with pre-eclampsia and a small-for-gestational age neonate
- Author
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Chia Ling Nhan-Chang, Ichchha Madan, Bo Hyun Yoon, Sonia S. Hassan, Roberto Romero, Edi Vaisbuch, Juan Pedro Kusanovic, Pooja Mittal, Lami Yeo, Zeynep Alpay Savasan, Ricardo Gomez, Sun Kwon Kim, Tinnakorn Chaiworapongsa, Juan M. Gonzalez, Giovanna Ogge, and Shali Mazaki-Tovi
- Subjects
Adult ,medicine.medical_specialty ,Nicotinamide phosphoribosyltransferase ,Adipokine ,Article ,chemistry.chemical_compound ,Young Adult ,Pre-Eclampsia ,Pregnancy ,medicine ,Humans ,Young adult ,Nicotinamide Phosphoribosyltransferase ,reproductive and urinary physiology ,Retrospective Studies ,Eclampsia ,business.industry ,Obstetrics ,Infant, Newborn ,Obstetrics and Gynecology ,Retrospective cohort study ,medicine.disease ,female genital diseases and pregnancy complications ,chemistry ,Cord blood ,Pediatrics, Perinatology and Child Health ,Infant, Small for Gestational Age ,Small for gestational age ,Cytokines ,Female ,business ,Infant, Premature - Abstract
Maternal circulating visfatin concentrations are higher in patients with a small-for-gestational-age (SGA) neonate than in those who delivered an appropriate-for-gestational age (AGA) neonate or in those with pre-eclampsia. It has been proposed that enhanced transfer of visfatin from the foetal to maternal circulation may account for the high concentrations of maternal visfatin observed in patients with an SGA neonate. The aims of this study were: (1) to determine whether cord blood visfatin concentrations differ between normal neonates, SGA neonates and newborns of pre-eclamptic mothers; and (2) to assess the relationship between maternal and foetal circulating visfatin concentrations in patients with an SGA neonate and those with pre-eclampsia.This cross-sectional study included 88 pregnant women and their neonates, as well as 22 preterm neonates in the following groups: (1) 44 normal pregnant women at term and their AGA neonates; (2) 22 normotensive pregnant women and their SGA neonates; (3) 22 women with pre-eclampsia and their neonates; and (4) 22 preterm neonates delivered following spontaneous preterm labour without funisitis or histologic chorioamnionitis, matched for gestational age with infants of pre-eclamptic mothers. Maternal plasma and cord blood visfatin concentrations were determined by ELISA. Non-parametric statistics were used for analyses.(1) The median visfatin concentration was lower in umbilical cord blood than in maternal circulation, in normal pregnancy, SGA and pre-eclampsia groups (p0.001 for all comparisons); (2) the median cord blood visfatin concentrations did not differ significantly between term AGA or SGA neonates, infants of mothers with pre-eclampsia and their gestational-age-matched preterm AGA neonates; (3) maternal and cord blood visfatin concentrations correlated only in the normal term group (r=0.48, p=0.04).Circulating visfatin concentrations are lower in the foetal than in the maternal circulation and did not significantly differ between the study groups. Thus, it is unlikely that the foetal circulation is the source of the high maternal visfatin concentrations reported in patients with an SGA neonate.
- Published
- 2010
32. 73: Evidence for intersection between the angiogenic and inflammatory pathways in preterm labor and preterm PROM
- Author
-
Ichchha Madan, Roberto Romero, Zhong Dong, Shali Mazaki-Tovi, Lami Yeo, Sonia S. Hassan, Edi Vaisbuch, Juan Pedro Kusanovic, Pooja Mittal, Giovanna Ogge, Sun Kwon Kim, Tinnakorn Chaiworapongsa, and Zeynep Alpay-Savasan
- Subjects
Preterm labor ,Intersection ,business.industry ,Obstetrics and Gynecology ,Medicine ,Inflammatory pathways ,Prom ,business ,Bioinformatics - Published
- 2009
33. 792: Fetal death: a condition with a disparity in SVEGFR-2 between the maternal and fetal compartments
- Author
-
Roberto Romero, Adi L. Tarca, Tinnakorn Chaiworapongsa, Zhong Dong, Sun Kwon Kim, Juan Pedro Kusanovic, Pooja Mittal, Giovanna Ogge, Zeynep Alpay Savasan, Ichchha Madan, Lami Yeo, Shali Mazaki-Tovi, Edi Vaisbuch, and Sonia S. Hassan
- Subjects
Fetus ,medicine.medical_specialty ,Fetal death ,Obstetrics ,business.industry ,medicine ,Obstetrics and Gynecology ,business - Published
- 2009
34. 171: The frequency and clinical significance of intra-amniotic infection in women with placenta previa and vaginal bleeding: an unexpected observation
- Author
-
Zhong Dong, Sonia S. Hassan, Roberto Romero, Tinnakorn Chaiworapongsa, Ichchha Madan, Lami Yeo, Zeynep Alpay Savasan, Edi Vaisbuch, Juan Pedro Kusanovic, Shali Mazaki-Tovi, and Pooja Mittal
- Subjects
Gynecology ,medicine.medical_specialty ,Intra-amniotic infection ,business.industry ,medicine ,Obstetrics and Gynecology ,Clinical significance ,Vaginal bleeding ,medicine.symptom ,medicine.disease ,business ,Placenta previa - Published
- 2009
35. 534: Evidence in support for a role of anti-angiogenic factors in preterm prelabor rupture of membranes (PPROM)
- Author
-
Lami Yeo, Roberto Romero, Ichchha Madan, Sonia S. Hassan, Juan Pedro Kusanovic, Pooja Mittal, Giovanna Ogge, Tinnakorn Chaiworapongsa, Edi Vaisbuch, Sun Kwon Kim, Zeynep Alpay Savasan, Shali Mazaki-Tovi, and Zhong Dong
- Subjects
business.industry ,Anti angiogenic ,Cancer research ,Obstetrics and Gynecology ,Medicine ,Rupture of membranes ,business - Published
- 2009
36. 791: Fetal death is associated with increased concentration of anti-angiogenic factors
- Author
-
Juan Pedro Kusanovic, Pooja Mittal, Roberto Romero, Shali Mazaki-Tovi, Edi Vaibuch, Lami Yeo, Ichchha Madan, Zhong Dong, Sun Kwon Kim, Zeynep Alpay Savasan, Sonia S. Hassan, Giovanna Ogge, and Tinnakorn Chaiworapongsa
- Subjects
Fetal death ,business.industry ,Anti angiogenic ,Cancer research ,Obstetrics and Gynecology ,Medicine ,business - Published
- 2009
37. Diagnosis of neonatal neuroblastoma with postmortem magnetic resonance imaging
- Author
-
James Davis, MD, Nathan Novotny, MD, Jacqueline Macknis, MD, Zeynep Alpay-Savasan, MD, and Luis F. Goncalves, MD
- Subjects
Fetal imaging ,Postmortem imaging ,MRI ,Metastatic neuroblastoma ,Virtual autopsy ,Medical physics. Medical radiology. Nuclear medicine ,R895-920 - Abstract
Postmortem magnetic resonance imaging (MRI) is emerging as a valuable tool to accompany traditional autopsy and has potential for use in cases when traditional autopsy is not possible. This case report will review the use of postmortem MRI with limited tissue sampling to differentiate between metastatic neuroblastoma and hepatoblastoma which could not be clearly differentiated with prenatal ultrasound, prenatal MRI, or emergent postnatal ultrasound. The mother presented to our institution at 27 weeks gestation after an obstetric ultrasound at her obstetrician's office identified a large abdominal mass. Fetal ultrasonography and MRI confirmed the mass but were unable to differentiate between neuroblastoma and multifocal hepatoblastoma. The baby was delivered by cesarean section after nonreassuring heart tones led to an emergent cesarean section. The baby underwent decompressive laparotomy to relieve an abdominal compartment syndrome; however, the family eventually decided to withdraw life support. At this time, we performed a whole body postmortem MRI which further characterized the mass as an adrenal neuroblastoma which was confirmed with limited tissue sampling. Postmortem MRI was especially helpful in this case, as the patient’s family declined traditional autopsy.
- Published
- 2017
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