Most metabolomic research has focused on preeclampsia
and a number of researchers have found
differences between women with pre-eclampsia
and women with uncomplicated pregnancies using
a number of different analytical techniques,38–42 but
these used time-of-disease blood samples or
placentas at delivery and further work needs to
concentrate on early pregnancy if predictive
markers are to be found.
Not only are omic strategies of value in potential
biomarker discovery, they also help to elucidate the
molecular mechanisms involved in both normal
and diseased states. Hypoxia plays a role in the
pathophysiology of pre-eclampsia and fetal growth
restriction and Hoang et al.43 have detected distinct
changes in the protein expression of first-trimester
cytotrophoblasts under hypoxic conditions.
Metabolomic differences have also been
demonstrated on placental explants under different
oxygen conditions42 and from women with
pre-eclampsia.44 This demonstrates the systems
biology approach to experimental models.
Preterm birth
Romero et al
.
45 have extensively reviewed the
application of high-dimensional biology to the
preterm parturition syndrome incorporating
spontaneous preterm birth and preterm prelabour
rupture of membranes. Numerous genetic
polymorphisms have been reported that confer
increased risk of preterm birth or preterm
prelabour rupture of membranes, in particular
those coding for matrix metalloproteinases
(MMPs) and interleukins.
In preterm birth, differential expression of proteins
has been found in placental membranes,46
cervicovaginal fluid,47,48 amniotic fluid49 and
maternal serum.50
The metabolic profiling of amniotic fluid has been
reported to identify women at risk of preterm
delivery and intra-amniotic infection with a
precision of 96%.51
Oncology
Profiling of gynaecological cancers has provided
insight into the origin of these tumours as well as
attempting to find diagnostic markers and potential
therapies and to predict response to treatment.
Predictive markers or early diagnostic markers may
be of great benefit, particularly in ovarian cancers, as
most cases are detected at an advanced stage and
5-year survival is poor. The literature in this area is
vast; for example, various genes have been
implicated in epithelial ovarian cancer, such as p53
,
BCL-2
,BAX,EGFR and c-erB2. Numerous studies
have reported multigene signatures of prognosis
and response to chemotherapy in epithelial ovarian
cancer. Gene expression profiling is also used for the