Cyclin-dependent Kinase Inhibitor 2A (Placental Senescence Marker) on Labor-related Signals

Preterm Labor Clinical Trial

Official title:

The Role of Cyclin-dependent Kinase Inhibitor 2A (P16 INK4a) (Placental Senescence Marker) on Labor-related Signals Through Progesterone Receptors Expression in Human Placenta

Clinical Trial Details — Status: Not yet recruiting

Administrative data

• NCT number: NCT05864066
• Other study ID #: P16 INK4a and PR
• Status: Not yet recruiting
• Start date: September 2023
• Est. completion date: February 2025

Study information

• Verified date: May 2023
• Source: Assiut University
• Contact: Fatma El-Sayed Moustafa, Assistant lecturer
• Phone: 01094045199
• Email: fatma.taha.elsayed[@]gmail.com
• Is FDA regulated: No
• Study type: Observational

Clinical Trial Summary

Onset of labor in human is initiated by progesterone withdrawal. Over many decades researchers had proposed hypotheses to explain the functional withdrawal of progesterone. These hypotheses were through the sequestration of active progesterone by corticosteroid-binding globulin, a decrease in active progesterone metabolite levels and changes in the ratio of progesterone receptor (PR) isoforms (nuclear progesterone receptors A (nPRA) and nuclear progesterone receptors B (nPRB)). Progesterone performs its action non-genomically through binding to membrane receptors and genomically via binding to nPRs. PRA is the less active or inactive form of progesterone receptors and shorter in amino acid sequence than PRB, the active form of the receptors.

Description:

Another mechanism was done through transcriptional co-activators, repressors inflammation resulting in nuclear factor kappa-light-chain-enhancer of activated B cells (NF-kB) mediated PR suppression. Previous study had explored that the uterine myometrium as the site of this functional withdrawal. There is also a clock that can determine the length of human pregnancy resides in the placenta and functional progesterone withdrawal likely occurs in this organ as well.

Ageing is a process that causes deterioration in function at the cellular, tissue and organ levels. Telomeres are protective caps made of nucleoprotein molecules located at the end of chromosomes and are necessary for protection against breaks at DNA ends, fusion of chromosome ends and chromosome degradation.

Telomeres are shortened with each cell division. The rate at which this occurs is accelerated by certain stressors such as oxidative stress. When telomeres reach a dangerously short length the process of cellular senescence initiates through which cells irreversibly stop growing and dividing by arresting their cell cycle and gradually ageing (becoming senescent).

Cellular senescence is a state of irreversible cell cycle arrest resulting from high levels of P16 INK4a as well as tumour 15 suppressors p53 and retinoblastoma tumour suppressor protein. Senescent cells markedly have an ability to change gene expression patterns with overexpression of anti-apoptotic Bcl-2 leading to resistance to apoptosis and in parallel increase NFκB activity results in the expression of proinflammatory cytokines and chemokines. As pregnancy comes to term, decidual cells show many features of senescence including secretion of senescence-associated secretory phenotype (SASP) factors such as interleukin-6 (IL-6). A gradual process of decidual senescence may be critical for driving the cellular and tissue changes that contribute to labor onset at term. If ageing of the placenta normally determines pregnancy duration, this means that premature placental ageing will lead to preterm labor onset.

According to World Health Organization (WHO), the American Academy of Pediatrics (AAP), and the American College of Obstetricians and Gynecologists (ACOG), preterm birth is defend as babies born alive before 37 weeks of pregnancy are completed. Each year, 15million babies are born preterm in the world. The National Center for Health Statistics of the Centers for Disease Control and Prevention generally reports data on three categories of preterm birth: overall preterm (< 37 weeks 'gestation), moderately preterm (between 32 and 36 weeks' gestation) and very preterm births (< 32 weeks' gestation). Late preterm infants are born at a gestational age between 34 weeks and less than37 weeks.

Recruitment information / eligibility

• Status: Not yet recruiting
• Enrollment: 81
• Est. completion date: February 2025
• Est. primary completion date: September 2024
• Accepts healthy volunteers: No
• Gender: Female
• Age group: 18 Years to 40 Years

Eligibility

Inclusion Criteria:

• Pregnant women who will come for termination of pregnancy by caesarean section or vaginal delivery.

• Gestational age is between 28 to < 37 weeks for preterm labor and 37 to 40 weeks for term labor.

• The age range of women is between18- 40 years.

Exclusion Criteria:

• Acute or chronic infectious diseases or other chronic illness

• Autoimmune diseases

• PE complicated with Eclampsia, DIC or HELP syndrome

• Congenital anomaly of the uterus

• History of trauma

• Twins pregnancy

• Congenital anomalies of the fetus

• Fetal growth restriction

Related Conditions & MeSH terms

• Obstetric Labor, Premature
• Preterm Labor

Locations

Country	Name	City	State
n/a

Sponsors (1)

Lead Sponsor	Collaborator
Assiut University

References & Publications (8)

Faul F, Erdfelder E, Lang AG, Buchner A. G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods. 2007 May;39(2):175-91. doi: 10.3758/bf03193146. — View Citation

Grazul-Bilska AT, Thammasiri J, Kraisoon A, Reyaz A, Bass CS, Kaminski SL, Navanukraw C, Redmer DA. Expression of progesterone receptor protein in the ovine uterus during the estrous cycle: Effects of nutrition, arginine and FSH. Theriogenology. 2018 Mar 1;108:7-15. doi: 10.1016/j.theriogenology.2017.11.008. Epub 2017 Nov 20. — View Citation

Jacobsen BM, Horwitz KB. Progesterone receptors, their isoforms and progesterone regulated transcription. Mol Cell Endocrinol. 2012 Jun 24;357(1-2):18-29. doi: 10.1016/j.mce.2011.09.016. Epub 2011 Sep 17. — View Citation

Kidus F, Woldemichael K, Hiko D. Predictors of neonatal mortality in Assosa zone, Western Ethiopia: a matched case control study. BMC Pregnancy Childbirth. 2019 Mar 29;19(1):108. doi: 10.1186/s12884-019-2243-5. — View Citation

Kowalik MK, Rekawiecki R, Kotwica J. Expression of membrane progestin receptors (mPRs) in the bovine corpus luteum during the estrous cycle and first trimester of pregnancy. Domest Anim Endocrinol. 2018 Apr;63:69-76. doi: 10.1016/j.domaniend.2017.12.004. Epub 2018 Jan 11. — View Citation

Kumari R, Jat P. Mechanisms of Cellular Senescence: Cell Cycle Arrest and Senescence Associated Secretory Phenotype. Front Cell Dev Biol. 2021 Mar 29;9:645593. doi: 10.3389/fcell.2021.645593. eCollection 2021. — View Citation

Martin JA, Hamilton BE, Osterman MJK, Driscoll AK. Births: Final Data for 2018. Natl Vital Stat Rep. 2019 Nov;68(13):1-47. — View Citation

Menon R, Bonney EA, Condon J, Mesiano S, Taylor RN. Novel concepts on pregnancy clocks and alarms: redundancy and synergy in human parturition. Hum Reprod Update. 2016 Sep;22(5):535-60. doi: 10.1093/humupd/dmw022. Epub 2016 Jun 30. — View Citation

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	P16 INK4a	1.Evaluating the role of cyclin-dependent kinase inhibitor 2A (P16 INK4a) placental senescence marker to predict time of labor.	one year
Secondary	PR	2.Local effect of cyclin-dependent kinase inhibitor 2A (P16 INK4a) placental senescence marker on progesterone receptors expression in human placenta.	one year