Dexamethasone attenuates the embryotoxic effect of endometriotic peritoneal fluid in a murine model

Female reproductive disease, endometriosis: From inflammation to infertility

Despite the fact that endometriosis is a common gynecological disease that occurs in 10% of women of reproductive age, the pathogenesis and treatment strategy are not clear to date. Endometriosis patients are commonly characterized by adhesions in the pelvis or ovaries, which leads to prolonged inflammation in the abdominal cavity. To handle the chronic inflammation, changes of immune cells, including T cells, NK cells, and macrophage, are accompanied. Therefore, diverse cytokines and adhesions of the abdominal cavity lead to poor quality of ovarian follicles, inappropriate response to the hormone, and infertility. This review will guide researchers to summarize the molecular changes and identify new treatment strategies for endometriosis-mediated inflammation and pregnancy failure.

The proteome of human Fallopian tube lavages during the phase of embryo transit reveals candidate proteins for the optimization of preimplantation embryo culture

STUDY QUESTION

Are there phase-specific changes in the early secretory (ES) phase human tubal lavage proteome that can inform and potentially optimize IVF culture media?

SUMMARY ANSWER

The human tubal lavage proteome during the ES phase relative to the menstrual phase reveals substantial differential protein abundance in pathways such as glycolysis, redox homeostasis and activation of 14-3-3 zeta-mediated signaling.

WHAT IS KNOWN ALREADY

The Fallopian tube is uniquely suited to the development of the preimplantation embryo as it transits the tube during the ES phase of the menstrual cycle. Euploid cleavage-stage embryo arrest may reflect incomplete recapitulation of in-vivo conditions by current media formulations.

STUDY DESIGN, SIZE, DURATION

Proteome-wide analysis of distal tubal lavage specimens collected from 26 healthy women undergoing open microtubal anastomosis surgery from January 2013 to January 2018 was performed. Specimens were grouped by menstrual cycle phase in order to analyze phase-specific differences in protein abundance. For the murine embryo assay, single-cell embryos (N = 482) were collected from superovulated wild type C57BL/6 female mice and cultured in microdrops over 5 days for the assessment of blastocyst development.

PARTICIPANTS/MATERIALS, SETTING, METHODS

Human tubal lavage specimens were processed for label-free mass spectrometry. Reported menstrual cycle day was confirmed by measuring serum hormones. Key protein targets in the ES phase were validated via immunoblot. The ES phase-specific increase in 14-3-3 zeta protein was confirmed via ELISA of conditioned media obtained from primary human Fallopian tube epithelial cell culture. A murine embryo assay was performed to investigate the impact of graduated concentrations of 14-3-3 zeta on the blastocyst development rate.

MAIN RESULTS AND THE ROLE OF CHANCE

Comparison of the ES and menstrual phase human tubal lavage proteomes revealed 74 differentially expressed proteins with enrichment of pathways and biological processes involved in the regulation of carbohydrate metabolism, oxidative stress and cell survival. The adapter-regulator protein 14-3-3 zeta was among the most significantly increased in the ES phase. Supplementation of embryo culture media with 14-3-3 zeta at concentrations tested did not significantly improve the murine blastocyst development.

LIMITATIONS, REASONS FOR CAUTION

Although select associations were recapitulated in the conditioned media from sex steroid exposed primary human tubal epithelial cells, cell culture represents an in-vitro approximation. Changes to embryo culture media, such as protein supplementation, must undergo rigorous preclinical safety testing prior to adoption for human use.

WIDER IMPLICATIONS OF THE FINDINGS

This study represents the first description of the human Fallopian tube lavage proteome across the menstrual cycle, revealing a unique proteomic signature during the ES phase. Although supplementation of culture media with 14-3-3 zeta at appropriate concentrations showed no significant impact on the murine blastocyst development rate, other biologically plausible candidate proteins for individual or high throughput testing strategies are identified.

STUDY FUNDING/COMPETING INTEREST(S)

This work was funded in part by an Army Medical Department Advanced Medical Technology Initiative grant from the United States Army Medical Research and Materiel Command's Telemedicine and Advanced Technology Research Center. There are no competing interests.

TRIAL REGISTRATION NUMBER

N/A.

Endometriosis with infertility: A comprehensive review on the role of immune deregulation and immunomodulation therapy

BACKGROUND

Endometriosis is a multifactorial pathology dependent on intrinsic and extrinsic factors, but the immune deregulation seems to play a pivotal role. In endometriosis-associated infertility, this could raise the benefit of immunomodulatory strategies to improve the results of ART. In this review, we will describe (1) sera and peritoneal fluid cytokines and immune markers; (2) autoantibodies; and (3) immunomodulatory treatments in endometriosis with infertility.

METHODS

The literature research was conducted in MEDLINE, Embase, and Cochrane Library with the following keywords: "endometriosis", "unexplained miscarriage", "implantation failure", "recurrent implantation failure » and « IVF-ICSI », « biomarkers of autoimmunity", "TNF-α", "TNF-α antagonists", "infliximab", "adalimumab", "etanercept", "immunomodulatory treatment", "steroids", "intralipids", "intravenous immunoglobulins", "G-CSF", "pentoxyfylline".

RESULTS

Several studies analyzed the levels of pro-inflammatory cytokines in sera and peritoneal fluid of endometriosis-associated infertility, in particular TNF-α. Various autoantibodies have been found in peritoneal fluid and sera of infertile endometriosis women even in the absence of clinically defined autoimmune disease, as antinuclear, anti-SSA, and antiphospholipid autoantibodies. In few uncontrolled studies, steroids and TNF-α antagonists could increase the pregnancy rates in endometriosis-associated infertility, but well-designed trials are lacking.

CONCLUSION

Endometriosis is characterized by increased levels of cytokines and autoantibodies. This suggests the role of inflammation and immune cell deregulation in infertility associated with endometriosis. The strategies of immunomodulation to regulate these immune deregulations are poorly studied, and well-designed studies are necessary.

Sham surgical embryo transfer affects offspring neurodevelopment and manifestation of hypertensive phenotype in ISIAH rats

The study investigates how surgery during pregnancy, i.e., sham operation associated with embryo transfer, affects hypertensive phenotype in ISIAH rats genetically predisposed to hypertension. ISIAH rats born after maternal surgery at fourth day of pregnancy were compared with naturally conceived controls. Surgery during pregnancy in ISIAH rats caused acceleration of neurodevelopment in young offspring, as well as aggravating hypertension, suppressing exploratory activity, reducing hippocampal BDNF expression, and compensatory increasing of hippocampal neuronal density in adult ISIAH offspring. Maternal surgery during early pregnancy caused alterations in offspring phenotype in hypertensive ISIAH rat model.

Effect of low-dose dexamethasone on patients with elevated early follicular phase progesterone level and pregnancy outcomes in IVF-ET treatment: A randomized controlled clinical trial

OBJECTIVE

To evaluate the effect of low-dose dexamethasone on patients with elevated early follicular progesterone levels in IVF-ET treatment.

DESIGN

Randomized controlled trial.

SETTING

In vitro fertilization (IVF) centre.

PATIENT(S)

A total of 459 patients undergoing a first IVF/ICSI cycle.

INTERVENTION(S)

If progesterone concentration exceeded 1.9 nmol/L on days 3-4 of ovarian stimulation, the patients in dexamethasone (DEX) group were treated with oral dexamethasone 0.75 mg/d, and the patients in control group received no extra treatment.

MAIN OUTCOME MEASURE

The cumulative live-birth rate (per cycle started) in 2 years.

RESULTS

The total dose of gonadotropins (1987 ± 536 IU in DEX group vs 2135 ± 701 IU in control group, P = 0.009) and the serum concentrations of progesterone on human chorionic gonadotropin (HCG) day (3.1 ± 1.4 nmol/L in DEX group vs 4.0 ± 1.3 nmol/L in control group, P < 0.001) were both significantly lower in DEX group than that in control. No significant differences between the two groups were observed in the number of oocytes, two pronuclear (2PN) embryos and clinical pregnancy rate. In addition, the cumulative live-birth rate was significantly higher in the DEX group than that in controls (70.0% vs 61.1%, P = 0.029, 95% confidence interval: 1.01-2.19).

CONCLUSION(S)

Progesterone secretion can be suppressed by dexamethasone, and dexamethasone may sensitize the ovary to gonadotropin stimulation in IVF treatment. In addition, the cumulative live-birth rate was significantly higher in the DEX group than in controls, and the obstetric and neonatal outcomes support the safety of DEX treatment in IVF.

Implications of immune dysfunction on endometriosis associated infertility

Endometriosis is a complex, inflammatory disease that affects 6-10% of reproductive-aged women. Almost half of the women with endometriosis experience infertility. Despite the excessive prevalence, the pathogenesis of endometriosis and its associated infertility is unknown and a cure is not available. While many theories have been suggested to link endometriosis and infertility, a consensus among investigators has not emerged. In this extensive review of the literature as well as research from our laboratory, we provide potential insights into the role of immune dysfunction in endometriosis associated infertility. We discuss the implication of the peritoneal inflammatory microenvironment on various factors that contribute to infertility such as hormonal imbalance, oxidative stress and how these could further lead to poor oocyte, sperm and embryo quality, impaired receptivity of the endometrium and implantation failure.