Adenosine Deaminase And Pregnancy: A Possible Prognostic Marker For Recurrent/Threatened Abortion In Women Ppt Powerpoint Presentation slides PURSHOTTAM KISHORE Medical Slideshow Adenosine Deaminase Deficiency: Genotype Phenotype Correlations Based .

Adenosine Deaminase And Pregnancy: A Possible Prognostic Marker For Recurrent/Threatened Abortion In Women

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Slide 1 :

Adenosine Deaminase And Pregnancy: A Possible Prognostic Marker For Recurrent/Threatened Abortion In Women P. K. Mehrotra Div of Endocrinology, Central Drug Research Institute, Lucknow, India

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Introduction ADA is a nucleic acid enzyme, localized at the foeto-maternal interface, the hemochorial placenta as well as in the peripheral blood around pregnancy. It catalyses the hydrolytic deamination of adenosine and 2'-deoxyadenosine to inosine and 2'-deoxyinosine, respectively. Since the adenosine and 2'-deoxyadenosine are known growth inhibitors they interfere with the embryogenesis as well as endometrial decidualization, the prerequisite phenomena for pregnancy sustenance.

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Spontaneous or risk of threatened abortion in women is a common complication of pregnancy of which no cure is known. One of the recent concepts on the genesis of spontaneous abortion has involved the principal enzyme ADA, whose level becomes very low in the placental tissue as well as in the peripheral blood in human (Nicotra et al 1998). Adequate information is available in lower animals to support this contention. (Farheen,2000; Mehrotra et al, 2001, 2002, 2005)

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The level of this enzyme is markedly regulated by the endogenous hormones, the estrogen and progesterone, whose level is reported to go down in patients of habitual abortions (Liu et al, 1996). Human endometrium consists of , besides epithelial and stromal, the cells of lymphopoietic origin including large granular lymphocyte (LGL) that express NK cell antigens(CD56+). In women facing recurrent spontaneous abortions (RSA) the percentage of CD56+ cells also goes down in the decidua (Hill et al, 1995;Takashahi et al,1999). As the expression of ADA is linked to the differentiation of functional 'T' and 'B' lymphocytes, the progenitors of NK cells, the enzyme level may be linked to the influx of these cells also.

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The present study was carried out to determine the level of enzyme adenosine deaminase in the peripheral blood of human females visiting antenatal clinic of Queen Mary’s Hospital (Qm.H), King George Medical University, Lucknow, India. The subjects were classified in two phases of menstrual cycle, first and second trimester pregnancy as well as the subjects undergoing recurrent spontaneous and threatened abortions in order to analyze the order of difference.

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EXPERIMENTAL DESIGN/ SUBJECTS SELECTION Blood (10.0 ml) of selected subjects collected during first and subsequent visits is divided in four groups: • Gr. I. Control non pregnant group: Normal healthy fertile women (age:20-35). In proliferative or secretory phase. • Gr. II. Control pregnant group: First and second trimester. No history of bleeding/ abortion. • Three subgroups: • Primi gravida- First pregnancy: with no risk factor.

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• Multi gravida- Previous pregnancies: with no risk factor. • Primi/Multi gravida- Single or multiple pregnancy but with some other risk factors (Diagnosed at antenatal clinic.) • Gr. III. Study group: • First and second trimester : With H/O recurrent abortions earlier (at least 2 ): this pregnancy normal. • Gr. 1V. Study group: • First and second trimester :Pregnant but having bleeding; diagnosed as threatened abortion.

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RISK FACTORS RESPONSIBLE FOR ABORTIONS Anatomical abnormalities of reproductive tract. Endocrinological disorders e.g. diabetes, hypothyroidism. H/O Operation of lower genital tract especially cervix, leading to incompetent cervical os. H/O Infertility, especially polycystic ovarian diseases (PCOD).. H/O Hypertension. H/O Radiation exposure. H/O Drug intake in 1st trimester (Besides multivitamin or folic acid) H/O Fever and Rashes H/O Systemic lupus erythematous (SLE), rheumatoid arthritis or other collagen disorder. H/O Renal disease.

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OTHER PARAMETERS Level of estrogen and progesterone (RIA). (Normal vs. Study group) Blood group and Rh factor Haematological analysis-'T' and 'B' lymphocytes (Number and nucleus/nucleolus: size/ratio) DNA gene amplification studies – Leucocytes (Normal vs. study group)

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CONCLUSION LEVEL OF ENZYME ADA IN PERIPHERAL BLOOD OF WOMEN MAY BE CONSIDERED AS A SPECIFIC MARKER TO DENOTE NORMAL/ RISK PREGNANCY WHILE THE LEVEL OF HORMONES PARTICULARLY PROGESTERONE SUPPORTS THE NOTION OTHER BLOOD PARAMETERS DO NOT OFFER ANY CLUE

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