Lactoferrin administration prior to genetic amniocentesis dampens the intraamniotic inflammatory response

Introduction: Increased active Matrix Metalloprotease (MMP) - 9 and decreased active MMP-2 have been associated with premature rupture of membranes and increased risk of preterm delivery. Administration of Lactoferrin (LF), a glycoprotein with anti-inflammatory properties, is able to decrease the amniotic fluid (AF) concentration of IL-6, with protective role against abortion secondary to amniocentesis (1). Therefore, we aimed to verify the efficacy of LF to modulate the production of active MMP-9 and MMP-2 and their tissue inhibitors (TIMP-1 and TIMP-2, respectively) following amniocentesis. Methods: One-hundred and six women were divided into two groups: 61 patients were controls; 45 patients were treated with vaginal LF, 4 hours before amniocentesis. Amniotic fluid was collected and stored at -80°C until assay. Active MMP-9 and MMP-2, TIMP-1 and TIMP-2 were determined by commercially available activity assays and ELISAs. The values were normalized by AF creatinine concentration. The Mann-Whitney U test was used to compare untreated and treated patients. A p<0.05 was considered significant. Results: Active MMP-9 and its inhibitor TIMP-1 were significantly lower in the AF of patients treated with LF than the controls (p<0.05 and p<0.005, respectively). However, the MMP-9/TIMP-1 molar ratio was not different between the two groups. On the contrary, we observed an increase in the levels of both active MMP- 2 and TIMP-2 in the patients treated with LF compared to the controls (p<0.0001 and p<0.05, respectively), with a simultaneous increase in the MMP-2/TIMP-2 molar ratio (p<0.005). Conclusions: As previously demonstrated, transvaginal LF administration is able to decrease the inflammation by decreasing AF IL-6 levels. To check the modulation of production of MMP-9 and MMP-2 and their tissue inhibitors, might be an adjunctive and useful tool against the increased risk of abortion that the procedure entails.