Publication: Plasenta Akreata Spektrumu Hastalarında Bcl-2 ve Esr1 İfade Düzeylerinin İncelenmesi
Abstract
Amaç: Bu çalışmada plasenta akreata spektrumundaki (PAS) gebelerin plasental doku BCL-2 ve ESR1 gen ifade düzeylerinin yaş, gebelik haftası ve parite açısından eşlenmiş kontrol grubuyla kıyaslanarak değerlendirilmesi amaçlanmıştır. Hasta ve Yöntem: Prospektif, tek merkezli vaka-kontrol dizaynına sahip bu çalışmaya Ondokuz Mayıs Üniversitesi Tıp Fakültesi Hastanesi Kadın Hastalıkları ve Doğum kliniğinde plasenta invazyon anomalisi tanısıyla sezaryen ile doğum yapmış hastalar ile kontrol grubu olarak yaş, gestasyonel hafta ve parametreleri açısından eşleştirilmiş ve aynı bölümde sezaryen ile doğum yapmış kadınlar dahil edilmiştir. Katılımcıların detaylı obstetrik öykülerinin alınmasının ardından sezaryen doğumu takiben plasenta dokularının maternal yüzeyinden sistematik rastgele örnekleme ile tüm kalınlık boyunca doku parçaları alındı. Plasenta örnekleri gen ifade düzeyi analizi için serum fizyolojik içerisine alınarak çalışma gününe kadar -80°C'lik derin dondurucuda saklandı. TRIzol yöntemi olarak adlandırılan guanidinyum tiyosiyanat-fenol-kloroform ekstraksiyon yöntemini kullanarak plasenta dokusundan yüksek kaliteli total RNA izole edilmiştir. cDNA sentezi kit protokolüne uygun olarak gerçekleştirildi. Kantitatif Gerçek Zamanlı PCR (qRT-PCR) tekniği ile RNA'dan sentezlenen cDNA'yı kantitatif bir şekilde amplifiye eden gen ekspresyon seviyeleri hassas bir şekilde ölçüldü. Değişkenler iki grup arasında istatistiksel olarak karşılaştırılmıştır. Bulgular: Çalışmaya PAS tanısıyla sezaryen doğum yapmış 10 hasta ile, yaş, parite ve gebelik yaşı açısından benzer kontrol grubunda 10 gebe alınmıştır. BCL-2 gen ifade düzeyi açısından plasenta örnekleri analiz edildiğinde, plasenta akreata grubunda kontrol grubuna kıyasla BCL-2 gen ifade düzeyinin 0,28 kat daha az görülürken, bu fark istatiksel olarak ileri düzeyde anlamlı bulunmuştur (p<0,001). ESR1 gen ifade düzeyi açısından plasenta örnekleri analiz edildiğinde, plasenta akreata grubunda kontrol grubuna kıyasla ESR1 gen ifade düzeyi 0,37 kat daha az görülürken, bu fark istatiksel olarak ileri düzeyde anlamlı bulunmuştur (p<0,001). Sonuç: Bu çalışma PAS vakalarında plasental ESR1 ekspresyonunun PAS olmayan gebelerden anlamlı düzeyde düşük olduğunu gösteren ilk çalışmadır. Normal plasentaya kıyasla anlamlı farklılık bulunması, BCL-2 ve ESR'in PAS patogenezinde kritik rolüne ışık tutabilir. PAS' nu erken tanımak ve yönetmek için yeni çalışmalar yapılması gerekmektedir. Anahtar Kelimeler: BCL-2 geni, ESR1 geni , invazyon, plasenta akreata spektrumu
Aim: The aim of this study was to evaluate the gene expression levels of BCL-2 and ESR1 in placental tissue of pregnant women with placenta acreata spectrum (PAS) compared with age, gestational age and parity matched control group. Patients and Methods: In this prospective, single-center, case-control study, patients who underwent cesarean delivery in Ondokuz Mayıs University Faculty of Medicine Hospital, Gynecology and Obstetrics Clinic with the diagnosis of abnormal placental invasion and women who were matched in terms of age, gestational week and parameters and who underwent cesarean delivery in the same department were included as the control group. After detailed obstetric history of the participants, tissue pieces were taken from the maternal surface of the placenta tissues following cesarean delivery by systematic random sampling through the entire thickness. Placenta samples were placed in saline for gene expression level analysis and stored in a deep freezer at -80°C until the study day. High quality total RNA was isolated from placenta tissue using the guanidinium thiocyanate-phenol-chloroform extraction method called TRIzol method. cDNA synthesis was performed according to the kit protocol. Gene expression levels were precisely measured by Quantitative Real-Time PCR (qRT-PCR) technique, which quantitatively amplified cDNA synthesized from RNA. Variables were statistically compared between the two groups. Results: The study included 10 patients who underwent cesarean delivery with a diagnosis of PAS and 10 pregnant women in the control group who were similar in terms of age, parity and gestational age. BCL-2 gene expression level was analyzed in placenta samples and BCL-2 gene expression level was 0.28 times lower in the placenta acreata group compared to the control group, and this difference was statistically highly significant (p<0.001). ESR1 gene expression level was found to be 0.37 times lower in the placenta acreata group compared to the control group, and this difference was statistically highly significant (p<0.001). Conclusion: This is the first study to show that placental ESR1 expression is significantly lower in PAS cases than in non-PAS pregnant women. The significant difference compared to normal placenta may shed light on the critical role of BCL-2 and ESR in the pathogenesis of PAS. Further studies are needed to recognize and manage PAS in the early stages. Keywords: BCL-2 gene, ESR1 gene , invasion, placenta acreata spectrum
Aim: The aim of this study was to evaluate the gene expression levels of BCL-2 and ESR1 in placental tissue of pregnant women with placenta acreata spectrum (PAS) compared with age, gestational age and parity matched control group. Patients and Methods: In this prospective, single-center, case-control study, patients who underwent cesarean delivery in Ondokuz Mayıs University Faculty of Medicine Hospital, Gynecology and Obstetrics Clinic with the diagnosis of abnormal placental invasion and women who were matched in terms of age, gestational week and parameters and who underwent cesarean delivery in the same department were included as the control group. After detailed obstetric history of the participants, tissue pieces were taken from the maternal surface of the placenta tissues following cesarean delivery by systematic random sampling through the entire thickness. Placenta samples were placed in saline for gene expression level analysis and stored in a deep freezer at -80°C until the study day. High quality total RNA was isolated from placenta tissue using the guanidinium thiocyanate-phenol-chloroform extraction method called TRIzol method. cDNA synthesis was performed according to the kit protocol. Gene expression levels were precisely measured by Quantitative Real-Time PCR (qRT-PCR) technique, which quantitatively amplified cDNA synthesized from RNA. Variables were statistically compared between the two groups. Results: The study included 10 patients who underwent cesarean delivery with a diagnosis of PAS and 10 pregnant women in the control group who were similar in terms of age, parity and gestational age. BCL-2 gene expression level was analyzed in placenta samples and BCL-2 gene expression level was 0.28 times lower in the placenta acreata group compared to the control group, and this difference was statistically highly significant (p<0.001). ESR1 gene expression level was found to be 0.37 times lower in the placenta acreata group compared to the control group, and this difference was statistically highly significant (p<0.001). Conclusion: This is the first study to show that placental ESR1 expression is significantly lower in PAS cases than in non-PAS pregnant women. The significant difference compared to normal placenta may shed light on the critical role of BCL-2 and ESR in the pathogenesis of PAS. Further studies are needed to recognize and manage PAS in the early stages. Keywords: BCL-2 gene, ESR1 gene , invasion, placenta acreata spectrum
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