5.2 The Effect of Buy-and-Builds on Portfolio Companies
6.1.2 Data Treatment
Embora esteja muito bem estabelecido na literatura que o sucesso da gestação depende de uma complexa regulação do sistema imune inato, a PTX3, proteína que corresponde a um importante componente do braço humoral da imunidade inata, ainda não teve seu papel elucidado nas gestações normais e nas complicações gestacionais.
Poucos estudos avaliaram a expressão de PTX3 na interface materno-fetal de gestações normais e os resultados apresentados são conflitantes. Aumento nos níveis de PTX3 com o avanço da idade gestacional foram observados por diversos autores122,166,167. Rovere-Querini et al.122 e
Cruciani et al.166
observaram um aumento progressivo dos níveis séricos de PTX3 ao longo da gestação normal, com elevação substancial no momento do parto a termo. No mesmo sentido, Larsson et al.167 demonstram um aumento contínuo discreto dos níveis séricos de PTX3 até a 31ª
semana, sendo que o aumentos dos níveis após esse período foram mais evidentes, culminando em um pico imediatamente antes do parto e um rápido decréscimo no pós-parto, reforçando a ideia de que o trabalho de parto em si é caracterizado por um ambiente pró-inflamatório. Divergindo desses resultados, Cetin et al.160 não observaram alterações nos níveis plasmáticos de
PTX3 ao longo da gestação.
Com relação à associação entre PTX3 e prematuridade, Cruciani et al.166
observaram associação entre níveis plasmáticos elevados de PTX3 e TPP e RPM-PT. No mesmo sentido, Assi et al.163
demonstraram que o parto prematuro espontâneo está associado a um aumento significativo dos níveis plasmáticos de PTX3 entretanto, essa alteração não foi observada em níveis vaginais.
Além disso, Cruciani et al.165 demonstraram que PTX3 é um constituinte fisiológico do LA.
A origem da PTX3 presente no LA ainda permanece incerta, porém diversas fontes têm sido sugeridas, entre elas a produção de PTX3 pelas membranas corioamnióticas122
. Os mesmos
inflamação/infecção intra-amniótica (IAI), achado que sugere que essa proteína desempenha um papel importante na resposta imune inata contra invasão microbiana da cavidade amniótica. Corroborando essa ideia, Kacerovsky et al.164
em estudo recente com gestantes com RPM-PT, demonstraram associação entre corioamninite histológica e níveis aumentados de PTX3 no LA.
Tendo em vista a escassez de estudos que avaliam a atuação da PTX3 na interface materno-fetal, além da divergência dos resultados obtidos, a investigação da expressão e da localização de PTX3 na cavidade amniótica é de grande importância para o entendimento da participação da imunidade inata em gestações normais e em adversidades gestacionais.
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