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Vascular cell adhesion molecule in pregnancy
Letters 279
Volume 179, Number 1 Am J Obstet Gynecol
use of high-resolution transducers and increased experience of sonographers had decreased the risk of vascular trauma, we think that nontransplacental amniocentesis is equally safe because this is the only case complicated in our series. Turgay Sener; MD, Sinan Ozalp, MD, Hikmet Hassa, MD, Omer T. Yalrin, MD, and Sakir Polay, MD Porsuk Bulvari, Bulvar Apt No 44-5,
Eski~ehir,
26130 Turkey
REFERENCES 1. Giorlandino C, Mobili L, Bilancioni E, D'Alessio P, Garcioppolo 0, Gentili P, et aI. Transplacental amniocentesis: is it really a higher-risk procedure? Prenat Diagn 1994;14:803-6. 2. Lenke RR, Ashwood ER, Cyr DR, Gavett M, Smith JR, Stenchever MA. Genetic amniocentesis: significance of intraamniotic bleeding and placental location. Obstet Gynecol 1985;65:798-801. 6/8/91204
concentrations rather than analysis of variance to analyze differences between age groups. Reanalysis of our data with use of similar gestational age categories and analysis of variance showed no significant differences. In any case, neither of our studies found the large increase in VCAM concentrations between 30 and 36 weeks noted in the study by Beckmann et al. B. Denise Raynor, MD, and Sampath Parthasarathy, PhD Department of Gynecology and Obstetrics, Emory University, 69 Butler St, Atlanta, GA 30303
REFERENCES 1. Raynor BD, Parthasarathy S. Maternal serum vascular cell adhesion molecule concentration during pregnancy. J Soc Gynecol Invest 1997;4:78-80. 2. Krauss T, Kuhn W, Lakoma C, Augustin HG. Circulating endothelial cell adhesion molecules as diagnostic markers for the early identification of pregnant women at risk for development of preeclampsia. AmJ Obstet GynecoI1997;177:443-9.
6/8/91196
Vascular cell adhesion molecule in pregnancy To the Editors: I read with interest the article by Beckmann et al. (Beckmann I, Visser W, Struijk PC, van Dooren M, Glavimans], Wallenburg HCS. Circulating bioactive tumor necrosis factor-a, tumor necrosis factor-a receptors, fibronectin, and tumor necrosis factor-a inducible cell adhesion molecule VCAM-l in uncomplicated pregnancy. Am] Obstet GynecoI1997;177:1247-52). The authors stated, "To the best of our knowledge, this study reports for the first time the course of sVCAM-l plasma concentrations during pregnancy." The authors overlooked our previous study, which found a weak negative linear correlation between gestational age and soluble vascular cell adhesion molecule-l (VCAM-l) (r= -0.24, P < .034).1 The cross-sectional study analyzed 78 maternal serum samples from normal singleton gestations between 5 and 39 weeks. The mean serum concentration was significantly higher before 20 weeks than after (P < .03). We have concluded that VCAM decreases rather than increases during normal pregnancy. We hypothesized that VCAM is important in trophoblast invasion and that the second wave of trophoblast invasion of the spiral arteries is near complete by the twentieth week of gestation, accounting for the decline in serum VCAM. We have found that plasma levels are higher than those in serum; perhaps some differences may relate to these different media. However, support for our conclusion comes from Krauss et a1. 2 In a longitudinal study of plasma from more than 200 women, the authors found no change in VCAM-l between 16 and 42 weeks. Although this observation would seem to contradict our data, the latter study did not include patients before 16 weeks, which accounts for the major portion of the gestational age-related difference in our sample. The graph of mean plasma VCAM from Krauss et al shows some decline between 16 to 21 weeks and 22 to 27 weeks, although it is not significant. However, it is not clear why these authors chose to use the Mann-Whitney U test, a nonparametric test for nonnormally distributed data, when they emphasize the normal distribution of VCAM
Reply To the Editors: We appreciate Raynor and Parthasarathy's interest in our article. Unfortunately, their work was published after our article had been submitted for publication and we are pleased to use this opportunity to respond to their comments. We and others 1 have shown that levels of circulating adhesion molecules demonstrate wide variation between individual pregnant women, which is supported by the results of Raynor and Parthasarathy's cross-sectional study. For that reason we feel that a longitudinal study design with an equal number of samples collected from each woman at predefined periods throughout pregnancy is to be preferred. The study by Krauss et al 2 cannot be considered truly longitudinal because these authors randomly collected two to five plasma samples from >200 (exact number not given) pregnant women. We agree that plasma levels ofVCAM-l tend to be higher than those in serum, and in addition various assays with different monoclonal antibodies may also produce disparate results. However, the results of a longitudinal study by Austgulen et aI,I with a study design similar to ours, support our finding that serum levels of VCAM-l show a significant increase in the last trimester of uncomplicated pregnancy. lise Beckmann, PhD, and Henk C.S. Wallenburg, MD, PhD 1nstitute of Obstetrics and Gynecology, Erasmus University School of Medicine and Health Sciences, EE 2283, PO Box 1738, 3000 DR Rotterdam, The Netherlands
REFERENCES 1. Austgulen R, Lien E, Vince G, Redman CWG. Increased maternal plasma levels of soluble adhesion molecules (ICAM-I, VCAM-I, E-selectin) in preeclampsia. Eur J Obstet Gynecol Reprod Bioi 1997;71:53-8. 2. Krauss T, Kuhn W, Lakoma C, Augustin HG. Circulating endothelial cell adhesion molecules as diagnostic markers for the early identification of pregnant women at risk for development of preeclampsia. Am] Obstet GynecoI1997;177:443-9.
6/8/91197
Volume 179, Number 1 Am J Obstet Gynecol
use of high-resolution transducers and increased experience of sonographers had decreased the risk of vascular trauma, we think that nontransplacental amniocentesis is equally safe because this is the only case complicated in our series. Turgay Sener; MD, Sinan Ozalp, MD, Hikmet Hassa, MD, Omer T. Yalrin, MD, and Sakir Polay, MD Porsuk Bulvari, Bulvar Apt No 44-5,
Eski~ehir,
26130 Turkey
REFERENCES 1. Giorlandino C, Mobili L, Bilancioni E, D'Alessio P, Garcioppolo 0, Gentili P, et aI. Transplacental amniocentesis: is it really a higher-risk procedure? Prenat Diagn 1994;14:803-6. 2. Lenke RR, Ashwood ER, Cyr DR, Gavett M, Smith JR, Stenchever MA. Genetic amniocentesis: significance of intraamniotic bleeding and placental location. Obstet Gynecol 1985;65:798-801. 6/8/91204
concentrations rather than analysis of variance to analyze differences between age groups. Reanalysis of our data with use of similar gestational age categories and analysis of variance showed no significant differences. In any case, neither of our studies found the large increase in VCAM concentrations between 30 and 36 weeks noted in the study by Beckmann et al. B. Denise Raynor, MD, and Sampath Parthasarathy, PhD Department of Gynecology and Obstetrics, Emory University, 69 Butler St, Atlanta, GA 30303
REFERENCES 1. Raynor BD, Parthasarathy S. Maternal serum vascular cell adhesion molecule concentration during pregnancy. J Soc Gynecol Invest 1997;4:78-80. 2. Krauss T, Kuhn W, Lakoma C, Augustin HG. Circulating endothelial cell adhesion molecules as diagnostic markers for the early identification of pregnant women at risk for development of preeclampsia. AmJ Obstet GynecoI1997;177:443-9.
6/8/91196
Vascular cell adhesion molecule in pregnancy To the Editors: I read with interest the article by Beckmann et al. (Beckmann I, Visser W, Struijk PC, van Dooren M, Glavimans], Wallenburg HCS. Circulating bioactive tumor necrosis factor-a, tumor necrosis factor-a receptors, fibronectin, and tumor necrosis factor-a inducible cell adhesion molecule VCAM-l in uncomplicated pregnancy. Am] Obstet GynecoI1997;177:1247-52). The authors stated, "To the best of our knowledge, this study reports for the first time the course of sVCAM-l plasma concentrations during pregnancy." The authors overlooked our previous study, which found a weak negative linear correlation between gestational age and soluble vascular cell adhesion molecule-l (VCAM-l) (r= -0.24, P < .034).1 The cross-sectional study analyzed 78 maternal serum samples from normal singleton gestations between 5 and 39 weeks. The mean serum concentration was significantly higher before 20 weeks than after (P < .03). We have concluded that VCAM decreases rather than increases during normal pregnancy. We hypothesized that VCAM is important in trophoblast invasion and that the second wave of trophoblast invasion of the spiral arteries is near complete by the twentieth week of gestation, accounting for the decline in serum VCAM. We have found that plasma levels are higher than those in serum; perhaps some differences may relate to these different media. However, support for our conclusion comes from Krauss et a1. 2 In a longitudinal study of plasma from more than 200 women, the authors found no change in VCAM-l between 16 and 42 weeks. Although this observation would seem to contradict our data, the latter study did not include patients before 16 weeks, which accounts for the major portion of the gestational age-related difference in our sample. The graph of mean plasma VCAM from Krauss et al shows some decline between 16 to 21 weeks and 22 to 27 weeks, although it is not significant. However, it is not clear why these authors chose to use the Mann-Whitney U test, a nonparametric test for nonnormally distributed data, when they emphasize the normal distribution of VCAM
Reply To the Editors: We appreciate Raynor and Parthasarathy's interest in our article. Unfortunately, their work was published after our article had been submitted for publication and we are pleased to use this opportunity to respond to their comments. We and others 1 have shown that levels of circulating adhesion molecules demonstrate wide variation between individual pregnant women, which is supported by the results of Raynor and Parthasarathy's cross-sectional study. For that reason we feel that a longitudinal study design with an equal number of samples collected from each woman at predefined periods throughout pregnancy is to be preferred. The study by Krauss et al 2 cannot be considered truly longitudinal because these authors randomly collected two to five plasma samples from >200 (exact number not given) pregnant women. We agree that plasma levels ofVCAM-l tend to be higher than those in serum, and in addition various assays with different monoclonal antibodies may also produce disparate results. However, the results of a longitudinal study by Austgulen et aI,I with a study design similar to ours, support our finding that serum levels of VCAM-l show a significant increase in the last trimester of uncomplicated pregnancy. lise Beckmann, PhD, and Henk C.S. Wallenburg, MD, PhD 1nstitute of Obstetrics and Gynecology, Erasmus University School of Medicine and Health Sciences, EE 2283, PO Box 1738, 3000 DR Rotterdam, The Netherlands
REFERENCES 1. Austgulen R, Lien E, Vince G, Redman CWG. Increased maternal plasma levels of soluble adhesion molecules (ICAM-I, VCAM-I, E-selectin) in preeclampsia. Eur J Obstet Gynecol Reprod Bioi 1997;71:53-8. 2. Krauss T, Kuhn W, Lakoma C, Augustin HG. Circulating endothelial cell adhesion molecules as diagnostic markers for the early identification of pregnant women at risk for development of preeclampsia. Am] Obstet GynecoI1997;177:443-9.
6/8/91197