- AMNIOTIC INFECTION SHALI MAZAKI-TOVI, ROBERTO ROMERO, JUAN PEDRO KUSANOVIC, OFFER EREZ, FRANCESCA GOTSCH, POOJA MITTAL, NANDOR GABOR THAN, CHIA-LING NHAN-CHANG, NEIL HAMILL, EDI VAISBUCH, SAMUEL S EDWIN, JYH KAE NIEN, JIMMY ESPINOZA, SONIA HASSAN, GILLIAN BRYANT-GREENWOOD, Wayne State University School of Medicine, Department of Obstetrics and Gynecology, Detroit, Michigan, Perinatology Research Branch, NICHD, NIH, DHHS, Detroit, Michigan, CEDIP, Hospital Sotero del Rio, Dept. Ob-Gin, P.Universidad Catolica de Chile, Puente Alto, Chile, University of Hawaii, Department of Cell & Molecular Biology, Honolulu, Hawaii OBJECTIVE: Visfatin is a novel adipokine originally described as a pre-B-cell colony enhancing factor. Visfatin is produced by amniotic epithelium, cytotrophoblast, and decidua and is differentially expressed when fetal membranes are exposed to mechanical stress and/or proinflammatory stimuli. Similarly, visfatin expression is dramatic up-regulated during labor. The aims of this study were to determine whether visfatin is detectable in amniotic fluid and if its concentration changes in gestational age, intra-amniotic inflammation (IAI), and labor. STUDY DESIGN: In this cross-sectional study, visfatin concentration in amniotic fluid (AF) was determined by sensitive immunoassay in patients from the following groups: 1) Midtrimester (n 84); 2) Term not in labor (n 27) and in labor (n 51); 3)Preterm labor (PTL) who delivered at term (n 35), 4) PTL without IAI who delivered preterm (n 52); 5)PTL with IAI (n 25); 6) Preterm PROM with (n 26) and without (n 26) IAI. Non-parametric statistics were used for analysis. RESULTS: 1) The median visfatin AF concentration was significantly lower in the midtrimester than at term (median: 9.2 ng/ml range: 4.9-85.7 vs. 89.6 ng/ml, 12.7-250.4, p 0.0001); 2) The median visfatin concentration was significantly higher in women with PTL and IAI than those with PTL and term delivery (83.4 ng/ml, 18.3-316.8 vs. 47.1 ng/ml, 4.9-118.8, respectively; p 0.001) or preterm (52.9 ng/ml, 5.3-316.8; p 0.006); 3) Among women with preterm PROM, the median visfatin concentration was significantly higher in those with IAI than in those without IAI (60.5 ng/ml, 10.2-289.9 vs. 31.7 ng/ml, 4.9-124.3, respectively; p 0.01); 4) AF concentrations of visfatin were correlated with glucose concentrations (p 0.002, r 0.21) and with AF WBC count (p 0.001, r 0.48). CONCLUSION: 1)Visfatin is a physiologic constituent of AF; 2) The concentrations of AF visfatin increase with advancing gestational age; 3) AF visfatin concentration is elevated in IAI, regardless of membrane status, suggesting that visfatin participates in the host response against infection.