Background Inflammatory Rheumatic diseases (IRD) frequently affect women of fertile age. Adverse pregnancy outcomes and recurrent pregnancy complications are increased. The profound immunologic adaptions necessary for maternal tolerance toward the foetus and the immunological reset to a non-pregnant state thereafter, influence maternal IRD in several ways. Also lactation affects immune functions and might modulate activity of autoimmune diseases(1). Women with IRD are often in need of medication during their pregnancy, and it is of vital importance to understand how this can affect both the mother and the foetus. The advancement in knowledge regarding pathogenetic mechanisms is closely related to the accessibility of biological material for research studies. The National Service for Pregnancy and Rheumatic Diseases (NKSR), Norway has therefore recognized the importance of establishing a biobank with material from this patient group.
Objectives The objective of this project is to develop and implement a biobank based on biological material from patients with rheumatic disease before, during and after pregnancy.
Methods This biobank is a part of the Regional Biobank of Central Norway, a research facility established to provide an organizational framework for all research which involves biological material from patients in any of the public hospitals of the region. Collection, storage and use of the biological material follow their infrastructure and rules. Serum, buffy coat, Tempus Blood RNA Tubes, urine, breast milk, umbilical cord blood and placenta are the target materials. Blood samples are taken before pregnancy, in pregnancy week 10-12, week 23-25, week 30-32, and 6 weeks, 6 months and 12 months post partum. Our strategy is to retain samples for analysis at different levels in the biological process from genetic make-up (DNA) through gene expression (RNA) and to executive proteins (serum samples). DNA for genetic and epigenetic analyses will be extracted from buffy coat. RNA will be extracted from Tempus Blood RNA Tubes for gene expression and qualitative analyses, whereas serum/plasma enables analysis of a wide range of proteins, cytokines, nutrients and metabolites. The biobank database will be linked with Revnatus, a national database developed by NKSR, with comprehensive clinical data collected before, during and after pregnancy on women with IRD. The biobank project has been approved by the regional committees for medical and health research ethics.
Results 70 patients are so far included in the biobank. This includes the diagnoses Systemic Lupus Erythematosus (12), Rheumatoid Arthritis (13), Juvenile Idiopathic Arthritis (13), Psoriatic Arthritis (7), Ankylosing Spondylitis (10), Sjögren's Syndrome (3) Mixed Connective Tissue Disease (2) and other (7). One expects to include approximately 50 new patients per year.
Conclusions This collection of biological material will create a foundation for numerous research projects in the future, with possibilities to investigate biological correlations to clinical findings, in order to increase understanding of the underlying patophysiology and possibly contribute to medical advancement of great clinical significance.
Østensen, M., Villiger, P. M., & Forger, F. (2012) Interaction of pregnancy and autoimmune disease. Autoimmunity Reviews. 11, 437-446.
Disclosure of Interest None declared
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