SOLUBLE TUMOR-NECROSIS-FACTOR RECEPTORS AND INTERLEUKIN-6 LEVELS IN PATIENTS WITH SEVERE PREECLAMPSIA

Objective: To investigate whether serum and amniotic fluid (AF) levels of soluble tumor necrosis factor receptors and interleukin-6, markers of immune activation and endothelial dysfunction, are altered in pati ents with severe preeclampsia. Methods: Plasma was collected before in duction of labor, at delivery, and postpartum from 19 patients with se vere preeclampsia. Amniotic fluid was also obtained in early labor fro m these patients. Similar samples were obtained from an antepartum con trol group matched for gestational age and a term control group withou t preeclampsia. All plasma and AF samples were assayed or p55 and p75 soluble tumor necrosis factor receptors and for interleukin-6 by speci fic enzyme-linked immunoassays. Levels in preeclamptic patients and th e control groups were compared. Results: Levels of both receptors were significantly elevated in AF and all maternal plasma samples except t hose collected 24 hours postpartum for patients with preeclampsia rela tive to levels in controls. Interleukin-6 was detected more frequently and in higher concentrations in the plasma collected before labor for preeclamptic patients compared with controls, but no difference was n oted in interleukin-6 detection rates or plasma concentrations at deli very. Conversely, AF concentrations of interleukin-6 were significantl y reduced in patients with preeclampsia. Conclusion: The increased lev els of soluble tumor necrosis factor receptors found in patients with severe preeclampsia may represent a protective response to increased t urner necrosis factor activity and be a marker for immune activation. Increased interleukin-6 concentrations in maternal plasma before labor suggest the involvement of this cytokine as well in the altered immun e response and its contribution to endothelial cell dysfunction.