This concurs with the following findings in previous reports on amniotic fluid levels of serine proteases (which can inactivate progranulin): (a) if either PTL or PPROM is complicated by microbial invasion of the amniotic cavity, higher neutrophil elastase levels are found than in cases with no microorganisms in amniotic fluid15; and (b) regardless of whether microbial invasion of the amniotic cavity is detected, amniotic fluid cathepsin-G levels are higher in cases with PPROM and intra-amniotic inflammation than in those with PPROM but no intra-amniotic inflammation22. Here, ELANE is linked to preterm premature rupture of the membranes.