Patent Application: US-72649307-A

Abstract:
the invention relates to markers which find use in the diagnosis of labour or pre - term labour , to assays comprising such markers , to methods of identifying therapeutic agents which can prolong pregnancy , using these markers and to methods of treatment of pre - term labour , methods of prolonging gestation , or methods of suppressing labour contractility based on the markers .

Description:
patient recruitment took place in the department of obstetrics and gynaecology , university college hospital galway ( uchg ), ireland . biopsies of myometrium were excised from the midline of the upper lip of the uterine incision , during elective ( pregnant at term - pregnant non - labouring , pnl ) and intrapartum ( pregnant labouring , pl ) caesarean section . women who had received prostaglandins or oxytocin were excluded from the study . the criteria for inclusion in the intrapartum group were regular spontaneous uterine contractions , effacement of the cervix , and cervical dilatation & gt ; 3 cm prior to caesarean section . women with malignant conditions , and those receiving exogenous hormone therapy ( e . g . progestagens ), were excluded from the study . immediately upon removal , biopsies were rinsed in sterile saline and used directly for primary cell preparation or snap frozen in liquid nitrogen and stored at − 80 ° c . until rna isolation . total rna was isolated from human myometrium using trizol reagent ( life technologies ltd ., uk ) ( chomczynski , 1993 ). total rna was isolated from the uterine smooth muscle cells using the rneasy mini rna isolation kit ( qiagen , crawley , west sussex , uk ). all rna samples were dnase i treated using the dna - free ™ kit ( ambion , spitfire close , huntingdon , cambridgeshire , uk ) rna ( 500 ng - dnase i treated ) was reverse transcribed into complementary dna ( cdna ) for use as a template for polymerase chain reaction ( pcr ). the rna samples were then denatured at 65 ° c . for 10 minutes . reverse transcription was performed at 42 ° c . for 60 minutes in a reaction volume of 20 μl containing the following : oligo dt primer ( 500 ng ), moloney murine leukaemia virus ( m - mlv ) reverse transcription buffer ( 50 mmol / l tris - hci ph 8 . 3 , 75 mm kcl , 3 mmol / l mgcl 2 , 10 mmol / l dithiothreitol ( dtt ) ( promega , southampton science park , southampton , uk ), diethylpyrocarbonate ( depc ) treated water ( sigma aldrich , dublin , ireland ), deoxyribonucleotide triphosphates ( dntps ) ( 0 . 2 mmol / l ) ( promega , uk ) and 200 u m - mlv reverse transcriptase ( promega , uk ). reverse transcriptase activity was stopped by heating samples at 65 ° c . for 10 minutes . control rna samples , in which no reverse transcriptase was added , were included to confirm that no genomic dna contamination was present . 1 μl of the 20 μl rt reaction was then used in the subsequent pcr . pcr was performed in a final volume of 50 μl containing 1 . 5 mmol / l mgcl 2 , 20 mmol / l tris - hcl , 50 mmol / l kcl ph8 . 3 , 1 . 25 u taq dna polymerase ( bioline ltd . london , uk ), 0 . 2 mm dntps and 0 . 2 μm of each sense and antisense primer . cdna amplification was carried out by an initial denaturation step of 5 minutes at 95 ° c . followed by 28 - 40 cycles of denaturation at 94 ° c . for 1 min , annealing at 55 - 60 ° c . for 1 min and elongation at 72 ° c . for 30 s - 1 min , followed by a final extension step at 72 ° c . for 10 minutes . 10 μl of each pcr product was then separated by gel electrophoresis on 1 - 1 . 5 % agarose gels . products were separated alongside a 100 bp dna molecular weight ladder ( promega , uk ) for sizing . the concentration and quality of the total rna were assessed by spectrophotometry ( nanodrop , nanodrop technologies , wilmington , usa ) and bioanalyser ( agilent , santa clara , calif ., usa ). reverse transcription - in vitro transcription ( rt - ivt ) digoxigenin ( dig ) labelling was performed on 0 . 5 μg total rna in accordance to the applied biosystems chemiluminescent rt - ivt labelling protocol ( foster city , usa ). qc procedures ( nanodrop and agilent bioanalyser ) were carried out on the crna samples to confirm the quality and quantity of the crna . the 6 dig labelled crna samples were fragmented and subsequently prepared for hybridisation to applied biosystems genome survey microarray ( version 2 ) 32 , 878 probes for 29 , 098 genes , for 16 hours . following hybridisation the arrays were stained using the applied biosystems chemiluminescence detection kit , with an anti - dig antibody - alkaline phosphatase conjugate . interaction of alkaline phosphatase , enhancer and chemiluminescent substrate produced light with an emission maxima of 458 nm . the arrays were then scanned using the applied biosystems 1700 chemiluminescent microarray ananlyser . ( abi ) ( geneservice , cambridge uk ). spotfire decisionsite for functional genomics ( goteborg , sweden ), bioconductor ( www . bioconductor . org ), panther ( abi , usa ), genomatix bibliosphere pathway ( genomatix software gmbh , munich , germany ) were utilised for data analysis . a student t - test was performed on the microarray data and a p value of & lt ; 0 . 05 was considered to be statistically significant . real - time pcr was performed on a 1 / 125 dilution of each the 7 pnl and 6 pl myometrial cdna in triplicate for each transcript , using the applied biosystems abi prism 7000 sequence detection system ( abi , usa ). the pcr reactions were performed in a final volume of 25 μl containing 12 . 5 μl sybr green pcr master mix ( abi , usa ), 5 μl diluted cdna and 0 . 4 μm of each sense and antisense primer . the final volume of 25 μl was achieved using pcr grade water ( sigma , ireland ). cdna amplification was performed by an initial step of 50 ° c . for 2 minutes an initial denaturation step at 95 ° c . for 10 minutes , followed by 40 cycles of denaturation at 95 ° c . for 15 seconds , annealing at 60 ° c . and elongation at 72 ° c . for 30 seconds each . the sequences of the oligonucleotide primers are indicated in tables 4 and 5 . the probe ids and the gene / cdna sequence ids relate to sequences deposited at the national centre for biotechnological information , bethesda , md ., usa and are available at www . ncbi . nlm . nih . gov . fluorescence data was acquired at the end of each pcr cycle . melting curve analysis was performed by an initial denaturation step of 95 ° c . for 15 seconds , cooling to 60 ° c . for 10 seconds , and 95 ° c . for 15 seconds . fluorescence was measured continually during the melting curve cycle . crossing temperatures for the respective reactions from their standard curves were averaged and normalized to the housekeeping gene , β - actin . the average normalised crossing temperatures ( ct ) of the 7 pnl and the 6 pl myometrial tissue types ( pnl v pl ) were compared using a student t test . results were expressed as normalised mean ct units ± the standard error of the mean ( sem ). a p value of & lt ; 0 . 05 was considered to be statistically significant . relative fold changes were then calculated using the difference in the ct values ( x ) between the pregnant at - term and the labouring myometrium for each transcript , relative fold change = 2 x . all statistical analysis was performed using the spss statistical package ( statistical package for the social sciences , v . 11 , spss inc ., chicago , ill ., usa ). myometrial tissue samples were minced ( finely and any fibrous tissue removed ) and digested in sterile filtered dmem ( minus calf serum ) containing 1 mg / ml collagenase type ia and 1 mg / ml collagenase type xi and 0 . 1 % bsa ( sigma ) for 45 minutes . the resulting suspension was vortexed and the nondispersed tissue fragments were separated by filtration of the mixture through sterile gauze layers and individual cells were then collected by centrifugation at 400 g for 10 minutes . cells were then washed and centrifuged 2 to 3 times in sterile pbs . after washing cells were cultured in sgm - 2 medium ( cambrex , biowhittaker uk ltd ., wokingham , berkshire , uk ) at 37 ° c . and 5 % co 2 . cells were subcultivated with trypsin / edta at a 1 : 2 or 1 : 3 split after reaching confluence . primary uterine smooth muscle cells were obtained from cambrex , biowhittaker , uk uk and cultured in sgm - 2 medium ( cambrex , uk ) or medium 231 ( cascade biologics , inc . mansfield , nottinghamshire , ng12 5br , uk ). uterine / myometrial smooth muscle cells were characterised for mrna expression of calponin , and estrogen receptor a and for sma actin mrna and protein expression . primary myometrial cells or primary uterine smooth muscle cells ( to passage 8 ) were cultivated on labtekii 8 well chamber slides ( nalge nunc int ., naperville , ill ., usa ) overnight . the samples were fixed in 4 % paraformaldehyde for 30 minutes at room temperature . cells were subsequently incubated with primary antibody , either a 1 : 25 or 1 : 50 dilution of cybr ( pscdbp ) ( ab2247 ) goat polyclonal igg anti - human primary antibody ( abcam cambridge , uk ), tlr2 ( n - 17 sc8689 ) goat polyclonal igg anti - human primary antibody or rgs12 ( a - 14 sc17740 ) goat polyclonal igg anti - human primary antibody ( santa cruz biotechnology inc ., heidelberg , germany ) in pbs / 1 % bsa overnight at 4 ° c . samples were rinsed in 1 × pbs 3 times and incubated with a 1 : 400 dilution of alexa fluor 488 donkey anti - goat igg ( a11055 ) ( molecular probes , eugene , oreg ., usa ) for 1 hour at room temperature and then rinsed in pbs . control cells were incubated with the secondary antibody alone . the coverslips were then mounted on glass slides with vectashield mounting medium with dapi ( vector laboratories , burlingame calif ., usa ). fluorescent images were obtained using the laser scanning microscope lsm 510 ( confocal microscope ) ( carl zeiss ag , strasse 22 , oberkocken , germany ) and / or the dp70 fluorescence microscope ( olympus , tokyo , japan ). fresh myometrial biopsy from an elective caesarean section underwent primary fixation in 2 . 5 % glutaraldehyde / 2 % paraformaldehyde , were sectioned into smaller segments and secondary fixation was in osmium tetroxide . the samples were dehydrated in alcohol and then placed in epoxypropane and gradually introduced to 100 % taab resin . the samples in resin were poured into beam capsule moulds and placed in a 60 ° c . oven overnight to polymerise . ultrathin section ( 60 - 90 nm ) were cut from them on the leica em fc6 ultramicrotome ( leica , 2345 bannockburn , ill ., usa ). the ultrathin sections were then mounted on nickel grids and incubated with goat polyclonal igg anti - human primary antibody , rgs12 ( a - 14 sc17740 ) overnight . grids were washed and then incubated in em rabbit anti - goat igg ( h + l ) 10 nm gold particle conjugated secondary antibody ( em - rgha10 - agar scientific , cambridge road , essex , uk ) for 1 hour . the negative control was incubated without primary antibody . they were stained with uranyl acetate and lead citrate . visualisation was performed using a hitachi transmission electron microscope ( hitachi high technology , minato - ku , tokyo , japan ). for the microarray experiment , biopsies of myometrium were obtained at the time of elective ( n = 3 ) and intrapartum ( n = 3 ) caesarean section . the reason for elective caesarean section included previous caesarean section ( n = 3 ). the reasons for emergency caesarean section were face presentation ( n = 1 ), previous classical caesarean section ( n = 1 ) and suspected fetal distress ( n = 1 ). the mean age of the women was 35 . 8 years ( range , 31 - 41 ). all women were multigravida and delivered between 38 and 41 weeks &# 39 ; gestation . for real - time rt - pcr confirmation analysis , biopsies of myometrium were obtained at the time of elective ( n = 7 ) and intrapartum ( n = 6 ) caesarean section . the reasons for elective caesarean section included previous caesarean section ( n = 6 ) and placenta praevia ( n = 1 ). the reasons for emergency caesarean section were face presentation ( n = 4 ), suspected fetal distress ( n = 1 ) and previous classical caesarean section ( n = 1 ). the mean age of the women was 34 . 83 years ( range , 29 - 41 ) of whom 2 were primagravida and 11 were multigravida . all women were delivered between 37 and 42 weeks &# 39 ; gestation . there was no significant difference between those undergoing elective or emergency caesarean section in terms of age , gestation or parity . microarray analysis of the total rna from 3 pregnant non - labouring myometrial biopsies and 3 labouring myometrial biopsies resulted in the differential expression of 698 genes , p & lt ; 0 . 05 and 105 genes , p & lt ; 0 . 01 . table 2 shows some of the upregulated genes at labour , in descending order of fold change . among the genes chosen for further analysis were cybr ( pscdbp ), etb ( ednrb ), tlr2 , flj35382 , twist 1 and rgs12 . all of the sequences found to be upregulated in pre - term labour in the study are shown in table 4 while the sequences found to be down - regulated in pre - term labour in the study are shown in table 5 . rt - pcr analysis using dna - freetm treated rna demonstrated expression of cybr ( pscdbp ), etb ( ednrb ), tlr2 , flj35382 , twist 1 and rgs12 and β - actin both in non - labouring and labouring human myometrium ( data not shown ). the absence of transcripts in reverse transcriptase negative reactions ( rt -) confirmed that all products were rna derived and not generated from contaminating genomic dna . in order to determine cellular expression , rt - pcr analysis was also performed using dna - free ™ treated rna from primary human myometrial smooth muscle cells ( passage 6 ) ( fig1 ). subsequently , quantitative real - time fluorescence rt - pcr was performed . relative quantitative expression analysis was performed by real - time rt - pcr . in order to minimise any undue experimental error from sources such as pipetting inaccuracies , analyses of each gene was performed in triplicate . all non - labouring . and labouring myometrial biopsies demonstrated expression of cybr ( pscdbp ), etb ( ednrb ), tlr2 , flj35382 , twist 1 and rgs12 and β - actin mrna . rt - pcr product specificity was confirmed using melting curve analysis . amplification curve crossing points were determined for each gene generated within the initial phase of exponential amplification , per 0 . 5 μg total rna in the tissues studied . β - actin expression showed no significant difference between the different tissue types . the averaged crossing temperature ( ct ) values for each candidate gene were compared to those for the corresponding β - actin values . individual gene expression levels showed significant difference between pregnant labouring and non - labouring human myometrium ( p & lt ; 0 . 05 ). ct values for each transcript normalised to β - actin ( per 0 . 5 μg total rna ) were plotted for labouring and non - labouring myometrium , in fig2 . relative fold changes were then calculated using the difference in the ct values ( x ) between the pregnant labouring and non - labouring myometrium for each transcript , relative fold change = 2 ×. a representation of these results is shown in table 2 . the hypothetical protein flj35382 showed the greatest relative fold change by real time rt - pcr at labour , 11 . 3 fold upregulated at labour in comparison to the non - labouring at - term myometrium . cybr ( pscdbp ), tlr2 , twist 1 , etb ( ednrb ) and rgs 12 showed a 9 . 89 , 7 . 59 , 5 . 74 , 5 . 67 and 5 . 18 fold , respectively , relative increase in mrna expression at labour ( table 3 ). a summary of the fold changes observed using real - time rt - pcr is shown in fig3 . immunolabelling confocal microscopy was used to determine the localisation of cybr ( pscdbp ) and tlr2 on human primary uterine smooth muscle cells , passage number 5 . cybr ( pscdbp ) localised to the cytoplasm of the cell surrounding the nucleus . tlr2 was expressed on uterine smooth muscle cell membrane ( fig4 ). electron micrographs of pregnant non - labouring human uterine smooth muscle are indicated in fig5 where rgs 12 was immunologically detected in human myometrium isolated from pregnant non - labouring myometrium by immunogold transmission electron microscopy , where it localised to the cell nucleus of smooth muscle cell and the cytosol near vacuoles but seemingly not associated with them ( fig5 b ). the expression of certain genes within the human myometrium and also the up - regulation or down - regulation of these genes in the myometrium at labour has been shown for the first time . data generated from the microarray experiment is in agreement with previously published reports on expression of certain genes in the human myometrium i . e .. the up - regulation of human il - 6 ( osman et al ., 2003 ), phospholipase a2 ( slater et al ., 2004 ), mcp - 1 ( esplin et al ., 2005 ) tnfr 11b , and egr1 ( havelock et al ., 2005 ). inflammation associated genes were prominent amongst the differentially expressed genes identified in the labouring myometrium . within this subset of genes , the up - regulation of tlr - 2 , twist 1 and cybr ( pscdbp ) were studied further . twist - 1 and flj35382 have previously been associated with pre - term labour . cybr ( also known as cbp , cytip , or casp ) is an intracellular scaffold protein that has been implicated in intercellular adhesion of lymphoid cells by regulating integrin deactivation and cytoskeletal rearrangements ( tang et al ., 2002 ; boehm et al ., 2003 ). although cybr has been shown to be upregulated in mouse uterine leiomyosarcoma ( ryschich et al ., 2006 ), no information regarding the expression or function of cybr in the human reproductive system is currently available . most cybr functions have been attributed to its interaction with the guanine nucleotide exchange factor ( gef ), cytohesin - 1 ( geiger et al ., 2000 ). through this interaction , cybr regulates cytohesin - 1 activation of the adp - ribosylation factors including arfl ( tang et al ., 2002 ). adp - ribosylation factors are small gtp binding proteins that regulate vesicular transport pathways and organization of the actin cytoskeleton during cell migration ( randazzo et al ., 2000 ). cybr transcription is up - regulated by cytokines , including il - 2 and il - 12 , in cultured lymphocytes , ( tang et al ., 2002 ) and a role in leukocyte trafficking , especially in response to proinflammatory cytokines in stress conditions has been proposed ( coppola et al ., 2006 ). the recent observation that increased cybr expression results in nfat - ap - 1 activation through regulation of the vav - jnk / p38 mapks signalling pathways has implicated cybr in . t cell receptor mediated signalling ( chen et al ., 2006 ). the data showed a 10 - fold up - regulation of cybr mrna expression in the human myometrium at labour . cybr expression was localised to uterine smooth muscle cells for the first time , using rt - pcr and confocal microscopy . in uterine smooth muscle cells , cybr appears to localise in a vesicular manner within the cytoplasm and about the nuclear periphery . while the exact function of cybr in the myometrium remains to be elucidated , our findings suggest the possible involvement of cybr in the signal transduction mechanisms associated with labour . mammalian toll - like receptors ( tlrs ) consist of a family of 11 receptor subtypes that recognize the molecular patterns of pathogens ( akira , 2001 ). after engaging the pathogenic patterned ligands , the cytosolic portion of the tlrs recruits adaptor proteins , via a receptor - driven signalling cascade , thus activating the transcription factor nf - κb , leading to the expression of proinflammatory cytokines and chemokines , triggering inflammation ( akira and takeda , 2004 ). in addition to their expression on immune cells , tlrs are also expressed on vascular endothelial cells , lung and intestinal epithelial cells , cardiac myocytes , and adipocytes ( akira , 2001 ). increasing evidence suggests that tlrs also play an important role in non - infection mediated inflammation via recognition of host - derived , endogenous ‘ damage signals ’ such as heat shock proteins ( panjwani et al ., 2002 ) and ‘ alarmins ’ such as the nuclear protein high - mobility group box protein 1 ( park et al ., 2004 ), which are presented as a result of tissue trauma . ten tlrs are expressed in human endometrial tissue ( aflatoonian et al ., 2006 ). the tlr2 subtype is found in vaginal epithelium , stromal muscle cells , ectocervix epithelium and blood vessel endothelial cells ( fazeli et al ., 2005 ). spontaneous labour at term and pre - term delivery with histological chorioamnionitis , regardless of membrane status , is associated with an increased mrna expression of tlr - 2 and tlr - 4 in the chorioamniotic membranes ( kim et al ., 2004 ). interestingly , maternal and fetal polymorphisms of the human tlr - 4 gene are associated with spontaneous pre - term labour ( v amer and esplin , 2005 ). murine models of inflammation - induced pre - term birth have demonstrated an up - regulation of tlr - 2 in the uterus ( elovitz and mrinalini , 2005 ) and have implicated tlr4 in mediating the induction of preterm labour ( wang and hirsch , 2003 ). tlrs are responsive to multiple endogenous ligands including fibronectin ( okamura et al ., 2001 ), fibrinogen ( smiley et al ., 2001 ) and surfactant protein a ( sp - a ) ( guillot et al ., 2002 ). sp - a has been shown to interact with tlr - 2 resulting in an alteration of tlr - 2 mediated signalling ( murakami et al ., 2002 ). recently , murine sp - a secreted by the maturing fetal lung has been proposed to act as a trigger for parturition onset by inducing the migration of macrophages to the maternal uterus , where they activate nf - κb resulting in the stimulation of uterine contractility ( condon et al ., 2004 ). natural soluble forms of tlr2 ( stlr2 ) exist , which are shown to be capable of modulating cell activation to bacterial lipopeptides ( lebouder et al ., 2003 ). although tlr4 expression has been observed in human pregnant myometrial cells ( dallot et al ., 2005 ) no such findings have been reported regarding tlr2 . our findings have demonstrated a 7 . 59 fold up - regulation of tlr2 in the human myometrium at labour . we have also shown tlr2 expression in uterine smooth muscle cells where it appears to be localised on the plasma membrane and within the cytoplasm . as all the patients included in this study delivered at term , these findings provide evidence for a role for tlr2 in the process of non - infection related normal labour . many genes were identified to be differentially expressed during this microarray experiment . among the other genes targeted for further investigation were endothelin - β receptor , regulator of g - protein signalling - 12 and the hypothetical protein flj35382 . endothelin - 1 ( et - 1 ) is a known mediator of human myometrial contraction in - vitro ( word et al ., 1990 ). it belongs to a family of three 21 - amino acid isopeptides ( inoue et al ., 1989 ). eta and etb ( ednrb ) are two distinct g - protein coupled heptahelical endothelin receptors , eta is selective for et - 1 ( arai et al ., 1990 ), whereas etb exhibits similar affinities for all three et isopeptides ( sakurai et al ., 1990 ). although both endothelin receptors have been identified in the human myometrium ( breuiller - fouche et al ., 1994 ), it is thought that only the eta receptor mediates the contractile effect of et - 1 both in - vivo and in - vitro ( bacon et al ., 1995 ; heluy et al ., 1995 ; dallot et al ., 2003 ). the physiological role of the etb receptor in myometrial tissue remains to be determined . under inflammatory conditions the major endothelin receptor subtype expressed in myometrial cells shifts from eta to etb ( ednrb ), with a concomitant decrease in et - 1 release leading to a loss of et - 1 induced myometrial cell contraction ( breuiller - fouche et al ., 2005 ). interestingly , we found for the first time a significant up - regulation of etb during normal labour , which suggests a role for etb in non - infectious human labour . elucidating the functional role of etb in the normal myometrium should provide a greater insight into endothelin function in pregnancy . the group of proteins known as regulators of g - protein signaling ( rgs ) are a large and diverse family initially identified as gtpase activating proteins ( gaps ) of the gα - subunit of heterotrimeric g - proteins . at least some rgs proteins can also influence gα activity through either effector antagonism or by acting as guanine nucleotide dissociation inhibitors ( gdis ) ( arshavsky and pugh , 1998 ; hepler , 1999 ). there are now over 25 mammalian rgss containing proteins that are reported to carry out a variety of functions , many of which are unrelated to gpcr signaling ( jean - baptiste et al ., 2006 ). such diversity of function is enabled by the variety of rgs protein structure and their ability to interact with other cellular molecules including phospholipids , receptors , effectors and scaffolds . the activity , sub - cellular distribution and expression levels of rgs proteins are dynamically regulated , providing a layer of complexity that has yet to be fully elucidated ( willars , 2006 ). rgs12 has gap activity against gα i - and gα 0 - subunits , and also acts as a gdi of gα i via a c - terminal goloco motif ( kimple et al ., 2001 ). the presence of both a goloco and rgs domain within rgs 12 proteins allows for interaction with two gα - subunits ( hepler et al ., 2005 ). rgs12 interacts with both n - type and ca ( v ) 2 . 2 ca 2 + channels ( schiff et al ., 2000 ; richman et al ., 2005 ). pdz - containing rgs12 binds a c - terminal motif found in proteins such as the il - 8 receptor ( snow et al ., 1998 ) and a role for rgs12 in asymmetric cell division has been proposed where it directs cell polarity , mitotic spindle organization and chromosomal segregation ( willard et al ., 2004 ). human rgs12 splice variants exhibit differential spatiotemporal patterns of expression during postimplantation embryogenesis ( martin - mccaffrey et al ., 2005 ). there was a & gt ; 5 - fold change in rgs12 mrna expression between non - labouring and labouring myometrium . transmission electron microscopy was used to investigate the localisation of rgs12 within myometrial tissue sections . rgs12 appeared to localise to the nucleus and the cytosol of smooth muscle cells within the tissue . this is the first study to identify rgs12 in the human myometrium and to demonstrate the upregulation of an rgs protein during labour . the diversity of rgs protein structure clearly underlies a complex and broad range of physiological roles for this family in the normal myometrium and in labour . this is the first investigation of these novel 133 genes of which 65 are up - regulated and 68 down - regulated in human myometrium during labour . many of these genes have not been previously investigated , this is the first study to report their expression in human uterus , more specifically the myometrium . the words “ comprises / comprising ” and the words “ having / including ” when used herein with reference to the present invention are used to specify the presence of stated features , integers , steps or components but does not preclude the presence or addition of one or more other features , integers , steps , components or groups thereof . it is appreciated that certain features of the invention , which are , for clarity , described in the context of separate embodiments , may also be provided in combination in a single embodiment . conversely , various features of the invention which are , for brevity , described in the context of a single embodiment , may also be provided separately or in any suitable sub - 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