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Suker A, Li Y, Robson D, Marren A. Australasian recurrent pregnancy loss clinical management guideline 2024, part II. Aust N Z J Obstet Gynaecol 2024. [PMID: 38934293 DOI: 10.1111/ajo.13820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 04/03/2024] [Indexed: 06/28/2024]
Abstract
Part II of the Australasian guideline for the investigation and management of recurrent pregnancy loss (RPL) provides evidence-based guidance on the management of RPL provided. The implications of inherited and acquired thrombophilia with respect to RPL and suggestions for clinical management are provided. Autoimmune factors, including human leukocyte antigen, cytokines, antinuclear antibodies and coeliac antibodies, and guidance for management are discussed. Infective, inflammatory and endometrial causes of RPL are discussed in detail. Environmental and lifestyle factors, male factor and unexplained causes are outlined. Levels of evidence and grades of consensus are provided for all evidence-based statements.
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Affiliation(s)
- Adriana Suker
- Department of Obstetrics and Gynaecology, Liverpool Hospital, Sydney, New South Wales, Australia
| | - Ying Li
- Department of Reproductive Endocrinology and Infertility, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Danielle Robson
- Department of Reproductive Endocrinology and Infertility, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Anthony Marren
- Department of Reproductive Endocrinology and Infertility, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
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Zhao Y, Zhao X, Feng X. Alpha-lipoic acid upregulates the PPARγ/NRF2/GPX4 signal pathway to inhibit ferroptosis in the pathogenesis of unexplained recurrent pregnancy loss. Open Med (Wars) 2024; 19:20240963. [PMID: 38859880 PMCID: PMC11163161 DOI: 10.1515/med-2024-0963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 03/16/2024] [Accepted: 04/07/2024] [Indexed: 06/12/2024] Open
Abstract
Aim With unknown etiology and limited treatment options, unexplained recurrent pregnancy loss (URPL) remains a thorny problem. Ferroptosis, a newly identified type of cell death, has been shown to be crucial in the development in reproductive disorders. This study aims to explore the specific mechanism of ferroptosis in URPL and to uncover whether alpha-lipoic acid (ALA) can inhibit ferroptosis, and then exert a protective effect in URPL. Method The decidua tissues of URPL and control patients who actively terminated pregnancy were collected. The CBA/J × DBA/2 murine models of URPL were established, and were randomly treated with peroxisome proliferator activated receptor γ (PPARγ) agonists (Rosiglitazone) and ALA. The CBA/J × BALB/c murine models of normal pregnancy were intraperitoneally injected with PPARγ inhibitors (T0070907). Here, we used reactive oxygen species (ROS), malondialdehyde (MDA), glutathione (GSH)/GSSG, and FeRhoNox-1 analysis to detect the level of ferroptosis. We used quantitative real-time reverse transcription polymerase chain reaction (qRT-PCR) analysis to evaluate the mRNA level of PPARγ. Besides, western blot and immunofluorescence were utilized to test the expression profile of PPARγ/nuclear factor erythroid 2-related factor 2 (NRF2)/glutathione peroxidase 4 (GPX4). Results In this study, we found that iron deposition was increased in the decidual tissue of patients with URPL. Additionally, the changes in cell morphology, the level of ROS, MDA, GSH, and the expression of ferroptosis marker proteins NRF2/GPX4 confirmed activated ferroptosis in URPL. Besides, bioinformatics analysis combined with experiments confirmed that PPARγ was critical in triggering NRF2/GPX4 pathway in URPL. Furthermore, URPL mouse models were established, and the results showed that PPARγ/NRF2/GPX4-mediated ferroptosis was also significantly increased, which could be mitigated by ALA treatment. Conclusion Overall, these findings suggest that ferroptosis may play an important role in URPL, and ALA might be a promising therapeutic drug for improving pregnancy outcomes in URPL via targeting the PPARγ/NRF2/GPX4 pathway.
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Affiliation(s)
- Yan Zhao
- Department of Gynecology, The First Affiliated Hospital of Heilongjiang University of Chinese Medicine, Harbin, 150040, China
| | - Xiaoxuan Zhao
- Department of Traditional Chinese Medicine (TCM) Gynecology, Hangzhou Hospital of Traditional Chinese Medicine Affiliated to Zhejiang Chinese Medical University, Hangzhou, 310007, China
| | - Xiaoling Feng
- Department of Gynecology, The First Affiliated Hospital of Heilongjiang University of Chinese Medicine, Harbin, 150040, China
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Yao Y, Ye Y, Chen J, Zhang M, Cai X, Zheng C. Maternal-fetal immunity and recurrent spontaneous abortion. Am J Reprod Immunol 2024; 91:e13859. [PMID: 38722063 DOI: 10.1111/aji.13859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 04/15/2024] [Accepted: 04/18/2024] [Indexed: 06/26/2024] Open
Abstract
Recurrent Spontaneous Abortion (RSA) is a common pregnancy complication, that has multifactorial causes, and currently, 40%-50% of cases remain unexplained, referred to as Unexplained RSA (URSA). Due to the elusive etiology and mechanisms, clinical management is exceedingly challenging. In recent years, with the progress in reproductive immunology, a growing body of evidence suggests a relationship between URSA and maternal-fetal immunology, offering hope for the development of tailored treatment strategies. This article provides an immunological perspective on the pathogenesis, diagnosis, and treatment of RSA. On one hand, it comprehensively reviews the immunological mechanisms underlying RSA, including abnormalities in maternal-fetal interface immune tolerance, maternal-fetal interface immune cell function, gut microbiota-mediated immune dysregulation, and vaginal microbiota-mediated immune anomalies. On the other hand, it presents the diagnosis and existing treatment modalities for RSA. This article offers a clear knowledge framework for understanding RSA from an immunological standpoint. In conclusion, while the "layers of the veil" regarding immunological factors in RSA are gradually being unveiled, our current research may only scratch the surface. In terms of immunological etiology, effective diagnostic tools for RSA are currently lacking, and the efficacy and safety of immunotherapies, primarily based on lymphocyte immunotherapy and intravenous immunoglobulin, remain contentious.
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Affiliation(s)
- Yao Yao
- Department of Pharmacy, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Zhejiang Provincial Clinical Research Center for Obstetrics and Gynecology, Hangzhou, China
| | - Yiqing Ye
- Department of Pharmacy, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Zhejiang Provincial Clinical Research Center for Obstetrics and Gynecology, Hangzhou, China
| | - Jia Chen
- School of Pharmacy, Hangzhou Medical College, Hangzhou, China
| | - Meng Zhang
- Department of Pharmacy, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Zhejiang Provincial Clinical Research Center for Obstetrics and Gynecology, Hangzhou, China
| | - Xiaoyu Cai
- Department of Pharmacy, Hangzhou First People's Hospital, Hangzhou, China
| | - Caihong Zheng
- Department of Pharmacy, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Zhejiang Provincial Clinical Research Center for Obstetrics and Gynecology, Hangzhou, China
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de Assis V, Giugni CS, Ros ST. Evaluation of Recurrent Pregnancy Loss. Obstet Gynecol 2024; 143:645-659. [PMID: 38176012 DOI: 10.1097/aog.0000000000005498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 11/02/2023] [Indexed: 01/06/2024]
Abstract
Recurrent pregnancy loss (RPL) affects approximately 5% of couples. Although RPL definitions vary across professional societies, an evaluation after a second clinically recognized first-trimester pregnancy loss is recommended. Good quality evidence links parental chromosomal rearrangements, uterine anomalies, and antiphospholipid syndrome (APS) to RPL. In contrast, the relationship between RPL and other endocrine, hematologic, and immunologic disorders or environmental exposures is less clear. Anticoagulant therapy and low-dose aspirin are recommended for patients with RPL who have also been diagnosed with APS. Vaginal progesterone supplementation may be considered in patients experiencing vaginal bleeding during the first trimester. Surgical correction may be considered for patients with RPL in whom a uterine anomaly is identified. Evaluation and management of additional comorbidities should be guided by the patient's history rather than solely based on the diagnosis of RPL, with the goal of improving overall health to reduce complications in the event of pregnancy. Most people with RPL, including those without identifiable risk factors, are expected to achieve a live birth within 5 years from the initial evaluation. Nevertheless, clinicians should be sensitive to the psychological needs of individuals with this condition and provide compassionate and supportive care across all stages.
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Affiliation(s)
- Viviana de Assis
- Department of Obstetrics and Gynecology, University of South Florida Morsani College of Medicine, Tampa, Florida
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Huang Y, Dai F, Chen L, Li Z, Liu H, Cheng Y. BMP4 in Human Endometrial Stromal Cells Can Affect Decidualization by Regulating FOXO1 Expression. Endocrinology 2024; 165:bqae049. [PMID: 38679470 DOI: 10.1210/endocr/bqae049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 04/06/2024] [Accepted: 04/15/2024] [Indexed: 05/01/2024]
Abstract
CONTEXT Recurrent spontaneous abortion (RSA) is defined as the loss of 2 or more consecutive intrauterine pregnancies with the same sexual partner in the first trimester. Despite its significance, the etiology and underlying mechanisms of RSA remain elusive. Defective decidualization is proposed as one of the potential causes of RSA, with abnormal decidualization leading to disturbances in trophoblast invasion function. OBJECTIVE To assess the role of bone morphogenetic protein 4 (BMP4) in decidualization and RSA. METHODS Decidual samples were collected from both RSA patients and healthy controls to assess BMP4 expression. In vitro cell experiments utilized the hESC cell line to investigate the impact of BMP4 on decidualization and associated aging, as well as its role in the maternal-fetal interface communication. Subsequently, a spontaneous abortion mouse model was established to evaluate embryo resorption rates and BMP4 expression levels. RESULTS Our study identified a significant downregulation of BMP4 expression in the decidua of RSA patients compared to the normal control group. In vitro, BMP4 knockdown resulted in inadequate decidualization and inhibited associated aging processes. Mechanistically, BMP4 was implicated in the regulation of FOXO1 expression, thereby influencing decidualization and aging. Furthermore, loss of BMP4 hindered trophoblast migration and invasion via FOXO1 modulation. Additionally, BMP4 downregulation was observed in RSA mice. CONCLUSION Our findings highlighted the downregulation of BMP4 in both RSA patients and mice. BMP4 in human endometrial stromal cells was shown to modulate decidualization by regulating FOXO1 expression. Loss of BMP4 may contribute to the pathogenesis of RSA, suggesting potential avenues for abortion prevention strategies.
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Affiliation(s)
- Yanjie Huang
- Department of Obstetrics and Gynecology, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, People's Republic of China
| | - Fangfang Dai
- Department of Obstetrics and Gynecology, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, People's Republic of China
| | - Liping Chen
- Department of Obstetrics and Gynecology, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, People's Republic of China
| | - Zhidian Li
- Department of Obstetrics and Gynecology, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, People's Republic of China
| | - Hua Liu
- Department of Obstetrics and Gynecology, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, People's Republic of China
| | - Yanxiang Cheng
- Department of Obstetrics and Gynecology, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, People's Republic of China
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Tang C, Hu W. Non-coding RNA regulates the immune microenvironment in recurrent spontaneous abortion (RSA): new insights into immune mechanisms†. Biol Reprod 2024; 110:220-229. [PMID: 37956412 PMCID: PMC10873270 DOI: 10.1093/biolre/ioad157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 11/01/2023] [Accepted: 11/09/2023] [Indexed: 11/15/2023] Open
Abstract
Recurrent spontaneous abortion (RSA) has various causes, including chromosomal abnormalities, prethrombotic state, and abnormal uterine anatomical factors. However, the pathogenesis of RSA is still unclear. Surprisingly, non-coding RNA can stably express at the maternal-fetal interface and regulate immune cells' proliferation, apoptosis, invasion, metastasis, and angiogenesis. Accumulating evidence suggests that the competing endogenous RNA (ceRNA) regulatory network between non-coding RNAs complicates RSA's pathological process and maybe a new starting point for exploring RSA. In this review, we mainly discuss the regulatory network and potential significance of non-coding RNA in the immune microenvironment of RSA patients. In addition, the cellular interactions of non-coding RNA transported through vesicles were introduced from aspects of trophoblast function and immune regulation. Finally, we analyze previous studies and further discuss that the stable expression of non-coding RNA may be used as a biomarker of some disease states and a prediction target of RSA.
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Affiliation(s)
- Cen Tang
- Obstetrics Department, Kunming Medical University Second Affiliated Hospital, Kunming, Yunnan, China
| | - Wanqin Hu
- Obstetrics Department, Kunming Medical University Second Affiliated Hospital, Kunming, Yunnan, China
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Tisato V, Silva JA, Scarpellini F, Capucci R, Marci R, Gallo I, Salvatori F, D'Aversa E, Secchiero P, Serino ML, Zauli G, Singh AV, Gemmati D. Epigenetic role of LINE-1 methylation and key genes in pregnancy maintenance. Sci Rep 2024; 14:3275. [PMID: 38332006 PMCID: PMC10853191 DOI: 10.1038/s41598-024-53737-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 02/04/2024] [Indexed: 02/10/2024] Open
Abstract
Spontaneous abortion is a pregnancy complication characterized by complex and multifactorial etiology. About 5% of childbearing women are globally affected by early pregnancy loss (EPL) and most of them experience recurrence (RPL). Epigenetic mechanisms and controlled inflammation are crucial for pregnancy maintenance and genetic predispositions may increase the risk affecting the maternal-fetal crosstalk. Combined analyses of global methylation, inflammation and inherited predispositions may contribute to define pregnancy loss etiopathogenesis. LINE-1 epigenetic regulation plays crucial roles during embryo implantation, and its hypomethylation has been associated with senescence and several complex diseases. By analysing a group of 230 women who have gone through pregnancy interruption and comparing those experiencing spontaneous EPL (n = 123; RPL, 54.5%) with a group of normal pregnant who underwent to voluntary interruption (VPI, n = 107), the single statistical analysis revealed significant lower (P < 0.00001) LINE-1 methylation and higher (P < 0.0001) mean cytokine levels (CKs: IL6, IL10, IL17A, IL23) in EPL. Genotyping of the following SNPs accounted for different EPL/RPL risk odds ratio: F13A1 rs5985 (OR = 0.24; 0.06-0.90); F13B rs6003 (OR = 0.23; 0.047-1.1); FGA rs6050 (OR = 0.58; 0.33-1.0); CRP rs2808635/rs876538 (OR = 0.15; 0.014-0.81); ABO rs657152 (OR = 0.48; 0.22-1.08); TP53 rs1042522 (OR = 0.54; 0.32-0.92); MTHFR rs1801133/rs1801131 (OR = 2.03; 1.2-3.47) and FGB rs1800790 (OR = 1.97; 1.01-3.87), although Bonferroni correction did not reach significant outputs. Principal Component Analysis (PCA) and logistic regression disclosed further SNPs positive/negative associations (e.g. APOE rs7412/rs429358; FGB rs1800790; CFH rs1061170) differently arranged and sorted in four significant PCs: PC1 (F13A, methylation, CKs); PC3 (CRP, MTHFR, age, methylation); PC4 (F13B, FGA, FGB, APOE, TP53, age, methylation); PC6 (F13A, CFH, ABO, MTHFR, TP53, age), yielding further statistical power to the association models. In detail, positive EPL risk association was with PC1 (OR = 1.81; 1.33-2.45; P < 0.0001) and negative associations with PC3 (OR = 0.489; 0.37-0.66; P < 0.0001); PC4 (OR = 0.72; 0.55-0.94; P = 0.018) and PC6 (OR = 0.61; 0.46-0.81; P = 0.001). Moreover, significant inverse associations were detected between methylation and CKs levels in the whole group (rIL10 = - 0.22; rIL17A = - 0.25; rIL23 = - 0.19; rIL6 = - 0.22), and methylation with age in the whole group, EPL and RPL subgroups (r2TOT = 0.147; r2EPL = 0.136; r2 RPL = 0.248), while VPI controls lost significance (r2VPI = 0.011). This study provides a valuable multilayer approach for investigating epigenetic abnormalities in pregnancy loss suggesting genetic-driven dysregulations and anomalous epigenetic mechanisms potentially mediated by LINE-1 hypomethylation. Women with unexplained EPL might benefit of such investigations, providing new insights for predicting the pregnancy outcome and for treating at risk women with novel targeted epidrugs.
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Affiliation(s)
- Veronica Tisato
- Department of Translational Medicine, University of Ferrara, 44121, Ferrara, Italy.
- University Strategic Centre for Studies On Gender Medicine, University of Ferrara, 44121, Ferrara, Italy.
- Centre Haemostasis & Thrombosis, University of Ferrara, 44121, Ferrara, Italy.
- LTTA Centre, University of Ferrara, 44121, Ferrara, Italy.
| | - Juliana A Silva
- Department of Translational Medicine, University of Ferrara, 44121, Ferrara, Italy
| | | | - Roberta Capucci
- Department of Medical Sciences, University of Ferrara, 44121, Ferrara, Italy
| | - Roberto Marci
- Department of Translational Medicine, University of Ferrara, 44121, Ferrara, Italy
| | - Ines Gallo
- Department of Translational Medicine, University of Ferrara, 44121, Ferrara, Italy
| | - Francesca Salvatori
- Department of Translational Medicine, University of Ferrara, 44121, Ferrara, Italy
| | - Elisabetta D'Aversa
- Department of Translational Medicine, University of Ferrara, 44121, Ferrara, Italy
| | - Paola Secchiero
- Department of Translational Medicine, University of Ferrara, 44121, Ferrara, Italy
| | - Maria L Serino
- Centre Haemostasis & Thrombosis, University of Ferrara, 44121, Ferrara, Italy
| | - Giorgio Zauli
- Department of Environmental Sciences and Prevention, University of Ferrara, 44121, Ferrara, Italy
| | - Ajay V Singh
- Department of Chemical and Product Safety, German Federal Institute for Risk Assessment (BfR), 10589, Berlin, Germany
| | - Donato Gemmati
- Department of Translational Medicine, University of Ferrara, 44121, Ferrara, Italy.
- University Strategic Centre for Studies On Gender Medicine, University of Ferrara, 44121, Ferrara, Italy.
- Centre Haemostasis & Thrombosis, University of Ferrara, 44121, Ferrara, Italy.
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Wang H, Liu Z, Meng L, Zhang X. Comprehensive bioinformation analysis of differentially expressed genes in recurrent pregnancy loss. HUM FERTIL 2023; 26:1015-1022. [PMID: 35306956 DOI: 10.1080/14647273.2022.2045636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 01/25/2022] [Indexed: 11/04/2022]
Abstract
Recurrent pregnancy loss (RPL) occurs frequently, and its causes are complex. The aetiology of nearly 50% of RPL cases is still unknown. This study aimed to ascertain differentially expressed genes (DEGs) and pathways by comprehensive bioinformatics analysis. We downloaded the gene expression microarray of GSE165004 from the Gene Expression Omnibus (GEO). Gene ontology (GO) analysis and Kyoto Encyclopaedia of Gene and Genome (KEGG) pathway enrichment analyses were performed on selected genes by using the R Programming Language. A protein-protein interaction (PPI) network was constructed with the Retrieval of Interacting Genes (STRING). Our analysis revealed that 1,869 genes were differentially expressed in RPL and control groups. GO analysis revealed that the interferon type 1 and the glycoprotein-related biological processes played irreplaceable roles, meanwhile KEGG enrichment analysis also revealed that the cAMP signalling pathway and the prolactin signalling pathway played important roles. In the following study, we found that there were many DEGs in the RPL group that were closely related to endometrial decidualization, such as IL17RD, IL16, SOX4, CREBBP, and POFUT1 as well as Notch1 and RBPJ in the Notch signalling pathway family were down-regulated in the RPL group. The results provided valuable information on the pathogenesis of RPL.
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Affiliation(s)
- Huaibin Wang
- School of Public Health, North China University of Science and Technology, Tangshan, P.R. China
| | - Zhao Liu
- School of Public Health, North China University of Science and Technology, Tangshan, P.R. China
| | - Lijun Meng
- Department of Environmental and Chemical Engineering, Tangshan University, Tangshan, P.R. China
| | - Xiujun Zhang
- School of Public Health, North China University of Science and Technology, Tangshan, P.R. China
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Zhao X, Hu Y, Xiao W, Ma Y, Shen D, Jiang Y, Shen Y, Wang S, Ma J. Efficacy of mesenchymal stromal cells in the treatment of unexplained recurrent spontaneous abortion in mice: An analytical and systematic review of meta-analyses. PLoS One 2023; 18:e0294855. [PMID: 38011163 PMCID: PMC10681256 DOI: 10.1371/journal.pone.0294855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 11/08/2023] [Indexed: 11/29/2023] Open
Abstract
OBJECTIVES Unexplained recurrent spontaneous abortion (URSA) remains an intractable reproductive dilemma due to the lack of understanding of the pathogenesis. This study aimed to evaluate the preclinical evidence for the mesenchymal stromal cell (MSC) treatment for URSA. METHODS A meticulous literature search was independently performed by two authors across the Cochrane Library, EMBASE, and PubMed databases from inception to April 9, 2023. Each study incorporated was assessed using the Systematic Review Centre for Laboratory Animal Experimentation (SYRCLE) risk of bias tool. The amalgamated standardized mean difference (SMD) accompanied by 95% confidence interval (CI) were deduced through a fixed-effects or random-effects model analysis. RESULTS A total of ten studies incorporating 140 mice were subjected to data analysis. The MSC treatment yielded a significant reduction in the abortion rate within the URSA model (OR = 0.23, 95%CI [0.17, 0.3], P<0.00001). Moreover, it elicited a positive modulatory impact on the expression profiles of several inflammatory cytokines in the decidual tissue of URSA murine models, inclusive of IL4 (SMD 1.63, 95% CI [0.39, 2.86], P = 0.01), IL10 (SMD 1.60, 95% CI [0.58, 2.61], P = 0.002), IFN-γ (SMD -1.66, 95%CI [-2.79, -0.52], P = 0.004), and TNF-α (SMD -1.98, 95% CI [-2.93, -1.04], P< 0.0001). Subgroup analyses underscored that the administration mode of intraperitoneal and uterine horn injections, and sources of bone MSCs and adipose-derived MSCs contributed positively to the expression of IL4, IL10, and decreased the expression of IFN-γ in decidual tissue of URSA (P<0.05). Conversely, the tail vein injections subgroup was observed with no statistical significance (P>0.05). CONCLUSIONS The findings underscore the considerable potential of MSCs in URSA therapy. Nonetheless, the demand for enhanced transparency in research design and direct comparisons between various MSC sources and administration routes in URSA is paramount to engendering robust evidence that could pave the way for successful clinical translation.
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Affiliation(s)
- Xiaoxuan Zhao
- Department of Traditional Chinese Medicine (TCM) Gynecology, Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University, Zhejiang Province, Hangzhou, 310007, China
| | - Yijie Hu
- The Third Clinical Medical College, Zhejiang Chinese Medical University, Zhejiang Province, Hangzhou, 310053, China
| | - Wenjun Xiao
- The Third Clinical Medical College, Zhejiang Chinese Medical University, Zhejiang Province, Hangzhou, 310053, China
| | - Yiming Ma
- The Third Clinical Medical College, Zhejiang Chinese Medical University, Zhejiang Province, Hangzhou, 310053, China
| | - Dan Shen
- Department of Traditional Chinese Medicine (TCM) Gynecology, Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University, Zhejiang Province, Hangzhou, 310007, China
| | - Yuepeng Jiang
- The Third Clinical Medical College, Zhejiang Chinese Medical University, Zhejiang Province, Hangzhou, 310053, China
| | - Yi Shen
- Department of Traditional Chinese Medicine (TCM) Gynecology, Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University, Zhejiang Province, Hangzhou, 310007, China
| | - Suxia Wang
- Department of Traditional Chinese Medicine (TCM) Gynecology, Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University, Zhejiang Province, Hangzhou, 310007, China
| | - Jing Ma
- Department of Traditional Chinese Medicine (TCM) Gynecology, Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University, Zhejiang Province, Hangzhou, 310007, China
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Quan X, Lan Y, Yang X. Thyroid autoimmunity and future pregnancy outcome in women of recurrent pregnancy loss: a meta-analysis. J Assist Reprod Genet 2023; 40:2523-2537. [PMID: 37770816 PMCID: PMC10643810 DOI: 10.1007/s10815-023-02933-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 09/06/2023] [Indexed: 09/30/2023] Open
Abstract
BACKGROUND Thyroid autoimmunity (TAI) has been associated with the risk of recurrent pregnancy loss (RPL). This systematic review and meta-analysis was conducted to evaluate the influence of TAI on subsequent pregnancy outcome of women with RPL. METHODS A systematic search of Medline, Web of Science, and Embase was conducted to identify studies evaluating the influence of TAI on subsequent risk of pregnancy loss (PL) in women with RPL. Study quality was evaluated via the Newcastle-Ottawa Scale. A random-effects model was utilized to pool the results, accounting for heterogeneity. RESULTS Ten observational studies were included. Compared to women without thyroid autoantibodies, RPL women with TAI had a higher risk of PL in their subsequent pregnancy (risk ratio [RR]: 1.46. 95% confidence interval [CI]: 1.20 to 1.78, p < 0.001; I2 = 35%). Sensitivity analyses showed consistent results in studies with thyroid peroxidase antibody positivity (RR: 1.50, 95% CI: 1.23 to 1.82) and in studies with TAI assessed before pregnancy (RR: 1.28, 95% CI: 1.07 to 1.53). Subgroup analyses showed that the results were not significantly different in prospective and retrospective studies, in RPL defined as at least two or three PL, in euthyroid women and women with euthyroidism or subclinical hypothyroidism, in women with and without levothyroxine treatment, in studies reporting first-trimester or overall PL, and in studies with different quality scores (p for subgroup difference all > 0.05). CONCLUSIONS In women with RPL, positive for TAI may be related to a higher risk of PL in subsequent pregnancy.
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Affiliation(s)
- Xiaozhen Quan
- Department of Reproductive Center, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Hubei Province, No. 136, Jingzhou Street, Xiangcheng District, Xiangyang City, 441021, China
| | - Yanli Lan
- Department of Reproductive Center, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Hubei Province, No. 136, Jingzhou Street, Xiangcheng District, Xiangyang City, 441021, China
| | - Xuezhou Yang
- Department of Reproductive Center, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Hubei Province, No. 136, Jingzhou Street, Xiangcheng District, Xiangyang City, 441021, China.
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Gonçalves CCRA, Feitosa BM, Cavalcante BV, Lima ALGDSB, de Souza CM, Joventino LB, Cavalcante MB. Obesity and recurrent miscarriage: The interconnections between adipose tissue and the immune system. Am J Reprod Immunol 2023; 90:e13757. [PMID: 37641378 DOI: 10.1111/aji.13757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 07/16/2023] [Accepted: 07/17/2023] [Indexed: 08/31/2023] Open
Abstract
Currently, obesity is considered a global public health problem. It is the main risk factor for noncommunicable diseases and reproductive complications, such as recurrent miscarriage (RM). RM affects approximately 1% of couples of reproductive age, and recent studies suggest that its prevalence is increasing. Immunological abnormalities may be responsible for a significant number of cases of unexplained RM. Obesity is recognized as a chronic low-grade inflammatory condition. The accumulation of fat in obese adipose tissue promotes changes in the local and systemic immune response. Adipokines, exosomes, micro-RNAs, lipids, and other factors released or secreted by adipose tissue are responsible for the interconnection between obesity and the immune system. Obesity-induced dysregulation of the innate and acquired immune response is also involved in the immunopathology of pregnancy loss in patients with unexplained RM. Therefore, understanding the communication pathways between maternal adipose tissue and the immune response in women living with obesity and RM is an important objective. Thus, diagnostic tools and new immunomodulatory therapies may be proposed for the management of patients with concurrent obesity and RM.
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Affiliation(s)
| | | | | | | | | | | | - Marcelo Borges Cavalcante
- Medical School, Universidade de Fortaleza (UNIFOR), Fortaleza, CE, Brazil
- Postgraduate Program in Medical Sciences, Universidade de Fortaleza (UNIFOR), Fortaleza, CE, Brazil
- CONCEPTUS - Reproductive Medicine, Fortaleza, Brazil
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12
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Wu J, Fang S, Feng P, Cai C, Zhang L, Yang L. Changes in expression levels of Nod-like receptors in the spleen of ewes. Anim Reprod 2023; 20:e20220093. [PMID: 37228386 PMCID: PMC10205055 DOI: 10.1590/1984-3143-ar2022-0093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 03/07/2023] [Indexed: 05/27/2023] Open
Abstract
Nucleotide-binding oligomerization domain receptors (NOD-like receptors, NLRs) have critical effects on interfaces of the immune and reproductive systems, and the spleen plays a key role in both innate and adaptive immune functions. It is hypothesized that NLR family participates in maternal splenic immune regulation during early pregnancy in sheep. In this study, maternal spleens were collected on day 16 of the estrous cycle, and days 13, 16 and 25 of gestation (n = 6 for each group) in ewes. Expression of NLR family, including NOD1, NOD2, class II transactivator (CIITA), NLR family apoptosis inhibitory protein (NAIP), nucleotide-binding oligomerization domain, Leucine rich repeat and Pyrin domain containing 1 (NLRP1), NLRP3 and NLRP7, was analyzed using quantitative real-time PCR, Western blot and immunohistochemistry analysis. The results revealed that expression levels of NOD1, NOD2, CIITA and NLRP3 were downregulated at days 13 and 16 of pregnancy, but expression of NLRP3 was increased at day 25 of pregnancy. In addition, expression values of NAIP and NLRP7 mRNA and proteins were improved at days 16 and 25 of pregnancy, and NLRP1 was peaked at days 13 and 16 of pregnancy in the maternal spleen. Furthermore, NOD2 and NLRP7 proteins were limited to the capsule, trabeculae and splenic cords. In summary, early pregnancy changes expression of NLR family in the maternal spleen, which may be related with the maternal splenic immunomodulation during early pregnancy in sheep.
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Affiliation(s)
- Jiaxuan Wu
- Department of Animal Science, School of Life Sciences and Food Engineering, Hebei University of Engineering, Handan, China
| | - Shengya Fang
- Department of Animal Science, School of Life Sciences and Food Engineering, Hebei University of Engineering, Handan, China
| | - Pengfei Feng
- Department of Animal Science, School of Life Sciences and Food Engineering, Hebei University of Engineering, Handan, China
| | - Chunjiang Cai
- Department of Animal Science, School of Life Sciences and Food Engineering, Hebei University of Engineering, Handan, China
| | - Leying Zhang
- Department of Animal Science, School of Life Sciences and Food Engineering, Hebei University of Engineering, Handan, China
| | - Ling Yang
- Department of Animal Science, School of Life Sciences and Food Engineering, Hebei University of Engineering, Handan, China
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13
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Ren J, Jin H, Zhu Y. The Role of Placental Non-Coding RNAs in Adverse Pregnancy Outcomes. Int J Mol Sci 2023; 24:ijms24055030. [PMID: 36902459 PMCID: PMC10003511 DOI: 10.3390/ijms24055030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 02/16/2023] [Accepted: 02/23/2023] [Indexed: 03/08/2023] Open
Abstract
Non-coding RNAs (ncRNAs) are transcribed from the genome and do not encode proteins. In recent years, ncRNAs have attracted increasing attention as critical participants in gene regulation and disease pathogenesis. Different categories of ncRNAs, which mainly include microRNAs (miRNAs), long non-coding RNAs (lncRNAs), and circular RNAs (circRNAs), are involved in the progression of pregnancy, while abnormal expression of placental ncRNAs impacts the onset and development of adverse pregnancy outcomes (APOs). Therefore, we reviewed the current status of research on placental ncRNAs and APOs to further understand the regulatory mechanisms of placental ncRNAs, which provides a new perspective for treating and preventing related diseases.
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Affiliation(s)
- Jiawen Ren
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No 81 Meishan Road, Hefei 230032, China
- MOE Key Laboratory of Population Health Across Life Cycle, School of Public Health, Anhui Medical University, No 81 Meishan Road, Hefei 230032, China
- Anhui Provincial Key Laboratory of Population Health and Aristogenics, Anhui Medical University, No 81 Meishan Road, Hefei 230032, China
- NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Anhui Medical University, Hefei 230032, China
| | - Heyue Jin
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No 81 Meishan Road, Hefei 230032, China
- MOE Key Laboratory of Population Health Across Life Cycle, School of Public Health, Anhui Medical University, No 81 Meishan Road, Hefei 230032, China
- Anhui Provincial Key Laboratory of Population Health and Aristogenics, Anhui Medical University, No 81 Meishan Road, Hefei 230032, China
- NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Anhui Medical University, Hefei 230032, China
| | - Yumin Zhu
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No 81 Meishan Road, Hefei 230032, China
- MOE Key Laboratory of Population Health Across Life Cycle, School of Public Health, Anhui Medical University, No 81 Meishan Road, Hefei 230032, China
- Anhui Provincial Key Laboratory of Population Health and Aristogenics, Anhui Medical University, No 81 Meishan Road, Hefei 230032, China
- NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Anhui Medical University, Hefei 230032, China
- Correspondence:
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14
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Lebedeva OP, Popov VN, Syromyatnikov MY, Starkova NN, Maslov AY, Kozarenko ON, Gryaznova MV. Female reproductive tract microbiome and early miscarriages. APMIS 2023; 131:61-76. [PMID: 36511842 PMCID: PMC10107729 DOI: 10.1111/apm.13288] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 12/08/2022] [Indexed: 12/15/2022]
Abstract
Miscarriage is one of the main causes of reproductive loss, which can lead to a number of physical and psychological complications and other long-term consequences. However, the role of vaginal and uterine microbiome in such complications is poorly understood. To review the published data on the function of the female reproductive tract microbiome in the pathogenesis of early miscarriages. The articles published over the past 20 years and deposited in PubMed, Google Academy, Scopus, Elibrary, ResearchGate, and EBSCO databases were analyzed. The review presents new data on the impact of the vaginal and uterine microbiome on the local immunity, including defense against sexually transmitted infections, and its association with other factors of miscarriages. The studies on the microbiome of non-pregnant women with recurrent miscarriages in the anamnesis, patients undergoing IVF, and pregnant women with miscarriages, as well as new directions in the microbiome research are discussed. The majority of studies have demonstrated that the dominant species of the vaginal and uterine microbiome in patients with early miscarriages are non-Lactobacillus bacteria. As many of these bacteria have not previously been detected by cultural studies and their role in obstetric complications is not well defined, further research on the female reproductive tract microbiome, including the microbiome of the cervix uteri, is needed to develop new approaches for the prognosis and prevention of miscarriages.
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Affiliation(s)
- Olga P Lebedeva
- Department of Obstetrics and Gynecology, Belgorod National Research University, Belgorod, Russia.,Laboratory of Metagenomics and Food Biotechnology, Voronezh State University of Engineering Technologies, Voronezh, Russia
| | - Vasily N Popov
- Laboratory of Metagenomics and Food Biotechnology, Voronezh State University of Engineering Technologies, Voronezh, Russia.,Department of Genetics, Cytology, and Bioengineering, Voronezh State University, Voronezh, Russia
| | - Mikhail Y Syromyatnikov
- Laboratory of Metagenomics and Food Biotechnology, Voronezh State University of Engineering Technologies, Voronezh, Russia.,Department of Genetics, Cytology, and Bioengineering, Voronezh State University, Voronezh, Russia
| | | | - Alexander Y Maslov
- Department of Genetics, Albert Einstein College, New York City, NY, USA.,Laboratory of Applied Genomic Technologies, Voronezh State University of Engineering Technologies, Voronezh, Russia
| | - Olesya N Kozarenko
- Laboratory of Metagenomics and Food Biotechnology, Voronezh State University of Engineering Technologies, Voronezh, Russia.,Female Health Department, Yakovlevo Central District Hospital, Belgorod Region, Russia
| | - Mariya V Gryaznova
- Laboratory of Metagenomics and Food Biotechnology, Voronezh State University of Engineering Technologies, Voronezh, Russia.,Department of Genetics, Cytology, and Bioengineering, Voronezh State University, Voronezh, Russia
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15
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Rezayat F, Esmaeil N, Rezaei A. Potential Therapeutic Effects of Human Amniotic Epithelial Cells on Gynecological Disorders Leading to Infertility or Abortion. Stem Cell Rev Rep 2023; 19:368-381. [PMID: 36331801 DOI: 10.1007/s12015-022-10464-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/09/2022] [Indexed: 11/06/2022]
Abstract
The induction of feto-maternal tolerance, fetal non-immunogenicity, and the regulation of mother's immune system are essential variables in a successful pregnancy. Fetal membranes have been used as a source of stem cells and biological components in recent decades. Human amniotic epithelial cells (hAEC) have stem/progenitor characteristics like those found in the amniotic membrane. Based on their immunomodulatory capabilities, recent studies have focused on the experimental and therapeutic applications of hAECs in allograft transplantation, autoimmune disorders, and gynecological problems such as recurrent spontaneous abortion (RSA), recurrent implantation failure (RIF), and premature ovarian failure (POF). This review discusses some of the immunomodulatory features and therapeutic potential of hAECs in preventing infertility, miscarriage, and implantation failure by controlling the maternal immune system.
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Affiliation(s)
- Fatemeh Rezayat
- Department of Immunology, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Nafiseh Esmaeil
- Department of Immunology, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran. .,Research Institute for Primordial Prevention of Non-Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran. .,Department of Immunology, School of Medicine, Environment Research Center, Research Institute for Primordial Prevention of Non-Communicable Disease, Isfahan University of Medical Sciences, 81744-176, Isfahan, Iran.
| | - Abbas Rezaei
- Department of Immunology, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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16
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Zhao QY, Li QH, Fu YY, Ren CE, Jiang AF, Meng YH. Decidual macrophages in recurrent spontaneous abortion. Front Immunol 2022; 13:994888. [PMID: 36569856 PMCID: PMC9781943 DOI: 10.3389/fimmu.2022.994888] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 11/22/2022] [Indexed: 12/13/2022] Open
Abstract
Recurrent spontaneous abortion (RSA) is defined as two or more pregnancy loss, affecting the happiness index of fertility couples. The mechanisms involved in the occurrence of RSA are not clear to date. The primary problem for the maternal immune system is how to establish and maintain the immune tolerance to the semi-allogeneic fetuses. During the pregnancy, decidual macrophages mainly play an important role in the immunologic dialogue. The purpose of this study is to explore decidual macrophages, and to understand whether there is a connection between these cells and RSA by analyzing their phenotypes and functions. Pubmed, Web of Science and Embase were searched. The eligibility criterion for this review was evaluating the literature about the pregnancy and macrophages. Any disagreement between the authors was resolved upon discussion and if required by the judgment of the corresponding author. We summarized the latest views on the phenotype, function and dysfunction of decidual macrophages to illuminate its relationship with RSA.
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Affiliation(s)
| | | | | | | | | | - Yu-Han Meng
- Center of Reproductive Medicine, Affiliated Hospital of Weifang Medical University, Weifang, Shandong, China
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17
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Cao C, Bai S, Zhang J, Sun X, Meng A, Chen H. Understanding recurrent pregnancy loss: recent advances on its etiology, clinical diagnosis, and management. MEDICAL REVIEW (BERLIN, GERMANY) 2022; 2:570-589. [PMID: 37724255 PMCID: PMC10471095 DOI: 10.1515/mr-2022-0030] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 11/14/2022] [Indexed: 09/20/2023]
Abstract
Recurrent pregnancy loss (RPL) has become an important reproductive health issue worldwide. RPL affects about 2%-3% of reproductive-aged women, and makes serious threats to women's physical and mental health. However, the etiology of approximately 50% of RPL cases remains unknown (unexplained RPL), which poses a big challenge for clinical management of these patients. RPL has been widely regarded as a complex disease where its etiology has been attributed to numerous factors. Heretofore, various risk factors for RPL have been identified, such as maternal ages, genetic factors, anatomical structural abnormalities, endocrine dysfunction, prethrombotic state, immunological factors, and infection. More importantly, development and applications of next generation sequencing technology have significantly expanded opportunities to discover chromosomal aberrations and single gene variants responsible for RPL, which provides new insight into its pathogenic mechanisms. Furthermore, based upon patients' diagnostic evaluation and etiologic diagnosis, specific therapeutic recommendations have been established. This review will highlight current understanding and recent advances on RPL, with a special focus on the immunological and genetic etiologies, clinical diagnosis and therapeutic management.
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Affiliation(s)
- Chunwei Cao
- Medical Research Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangdong Province, China
- Guangzhou laboratory, Guangzhou, Guangdong Province, China
- Center for Reproductive Genetics and Reproductive Medicine, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong Province, China
| | - Shiyu Bai
- Reproductive Medicine Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong Province, China
| | - Jing Zhang
- Medical Research Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangdong Province, China
- Center for Reproductive Genetics and Reproductive Medicine, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong Province, China
| | - Xiaoyue Sun
- Medical Research Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangdong Province, China
- Center for Reproductive Genetics and Reproductive Medicine, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong Province, China
| | - Anming Meng
- Guangzhou laboratory, Guangzhou, Guangdong Province, China
| | - Hui Chen
- Reproductive Medicine Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong Province, China
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18
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Toth B, Bohlmann M, Hancke K, Kuon R, Nawroth F, von Otte S, Rogenhofer N, Rudnik-Schöneborn S, Schleußner E, Tempfer C, Vomstein K, Wischmann T, von Wolff M, Würfel W, Zschocke J. Recurrent Miscarriage: Diagnostic and Therapeutic Procedures. Guideline of the DGGG, OEGGG and SGGG (S2k-Level, AWMF Registry No. 015/050, May 2022). Geburtshilfe Frauenheilkd 2022. [DOI: 10.1055/a-1895-9940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Abstract
Purpose The aim of this guideline is to standardize the diagnosis and therapy of recurrent miscarriage (RM) using evidence from the recent literature. This is done by using
consistent definitions, objective evaluations and standardized treatment protocols.
Methods When this guideline was compiled, special consideration was given to previous recommendations in prior versions of this guideline and the recommendations of the European
Society of Human Reproduction and Embryology, the Royal College of Obstetricians and Gynecologists, the American College of Obstetricians and Gynecologists and the American Society for
Reproductive Medicine, and a detailed individual search of the literature about the different topics was carried out.
Recommendations Recommendations about the diagnostic and therapeutic procedures offered to couples with RM were developed based on the international literature. Special attention was
paid to known risk factors such as chromosomal, anatomical, endocrinological, physiological coagulation, psychological, infectious and immune disorders. Recommendations were also developed
for those cases where investigations are unable to find any abnormality (idiopathic RM).
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Affiliation(s)
- Bettina Toth
- Klinik für Gynäkologische Endokrinologie und Reproduktionsmedizin, Universität Innsbruck, Innsbruck, Austria
| | - Michael Bohlmann
- Zentrum für Gynäkologie und Geburtshilfe, St. Elisabeth Krankenhaus Lörrach, Lörrach, Germany
| | - Katharina Hancke
- Klinik für Frauenheilkunde, Universitätsklinikum Ulm, Ulm, Germany
| | - Ruben Kuon
- Universitäts-Frauenklinik Heidelberg, Heidelberg, Germany
| | | | - Sören von Otte
- Kinderwunschzentrum, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
| | - Nina Rogenhofer
- Klinikum der Universität München – Frauenklinik Maistraße, München, Germany
| | | | | | - Clemens Tempfer
- Universitätsfrauenklinik, Ruhr-Universität Bochum, Bochum, Germany
| | - Kilian Vomstein
- Klinik für Gynäkologische Endokrinologie und Reproduktionsmedizin, Universität Innsbruck, Innsbruck, Austria
| | - Tewes Wischmann
- Institut für Medizinische Psychologie, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Michael von Wolff
- Universitätsklinik für Frauenheilkunde, Inselspital Bern, Bern, Switzerland
| | | | - Johannes Zschocke
- Zentrum für Medizinische Genetik, Universität Innsbruck, Innsbruck, Austria
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19
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Yang L, Zhang X, Gu Y, Shi Y, Wang LB, Shi JX, Zhen XX, Xin YW, Gu WW, Wang J. SEC5 is involved in M2 polarization of macrophages via the STAT6 pathway, and its dysfunction in decidual macrophages is associated with recurrent spontaneous abortion. Front Cell Dev Biol 2022; 10:891748. [PMID: 36313547 PMCID: PMC9614079 DOI: 10.3389/fcell.2022.891748] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 10/04/2022] [Indexed: 11/13/2022] Open
Abstract
Decidual macrophages (dMϕs) play critical roles in the establishment of microhomeostasis at the maternal-fetal interface during pregnancy. Impaired macrophage polarization during early pregnancy is associated with recurrent spontaneous abortion (RSA). In the present study, the SEC5 expression level was found to be significantly decreased in primary dMϕs of patients with RSA, and downregulation of SEC5 expression inhibited M2 polarization and STAT6 phosphorylation, whereas SEC5 overexpression in the Mϕs promoted M2 polarization and STAT6 phosphorylation in vitro. We subsequently found that SEC5 interacted with STAT6 in THP-1-derived Mϕs. The abundance of phosphorylated STAT6 (pSTAT6) protein was obviously increased, with a predominant distribution in the nucleus, after M2 polarization of Mϕs, and SEC5 protein was colocalized with pSTAT6. Moreover, a significantly reduced pSTAT6 expression level was observed in the dMϕs of patients with RSA. M2 polarization of Mϕs showed a stimulatory effect on the proliferation and invasion of human extravillous trophoblasts (EVTs) in vitro, and downregulation of SEC5 expression in Mϕs effectively reversed this effect. In a mouse model of LPS-induced early pregnancy loss, the uterine SEC5 expression level and the number of M2-Mϕs at the maternal-fetal interface were significantly reduced. More interestingly, heterozygous SEC5-deficient (SEC5−/+) pregnant mice were more sensitive to LPS-induced pregnancy loss. Taken together, these data indicate that SEC5 participates in the regulation of M2 polarization of Mϕs by interacting with STAT6 and that decreased SEC5 expression inhibits the M2 polarization of dMϕs and results in early pregnancy loss by interfering with the physical activities of EVTs and immunotolerance at the maternal-fetal interface.
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Affiliation(s)
- Long Yang
- NHC Key Lab of Reproduction Regulation (Shanghai Institute for Biomedical and Pharmaceutical Technologies), Fudan University, Shanghai, China
| | - Xuan Zhang
- NHC Key Lab of Reproduction Regulation (Shanghai Institute for Biomedical and Pharmaceutical Technologies), Fudan University, Shanghai, China
| | - Yan Gu
- The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Yan Shi
- NHC Key Lab of Reproduction Regulation (Shanghai Institute for Biomedical and Pharmaceutical Technologies), Fudan University, Shanghai, China
| | - Long-Bin Wang
- The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Jia-Xin Shi
- NHC Key Lab of Reproduction Regulation (Shanghai Institute for Biomedical and Pharmaceutical Technologies), Fudan University, Shanghai, China
| | - Xing-Xing Zhen
- NHC Key Lab of Reproduction Regulation (Shanghai Institute for Biomedical and Pharmaceutical Technologies), Fudan University, Shanghai, China
| | - Ya-Wei Xin
- The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Wen-Wen Gu
- NHC Key Lab of Reproduction Regulation (Shanghai Institute for Biomedical and Pharmaceutical Technologies), Fudan University, Shanghai, China
- *Correspondence: Wen-Wen Gu, ; Jian Wang,
| | - Jian Wang
- NHC Key Lab of Reproduction Regulation (Shanghai Institute for Biomedical and Pharmaceutical Technologies), Fudan University, Shanghai, China
- *Correspondence: Wen-Wen Gu, ; Jian Wang,
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20
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Zhang X, Yan J, Dai Z, Long X, Jin J, Yang Q, Lin C, Yang Y, Chen Y, Zhu J. Long non-coding RNA LINC01347 suppresses trophoblast cell migration, invasion and EMT by regulating miR-101-3p/PTEN/AKT axis. Reprod Biol 2022; 22:100670. [PMID: 35810709 DOI: 10.1016/j.repbio.2022.100670] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 06/11/2022] [Accepted: 06/27/2022] [Indexed: 10/17/2022]
Abstract
Recurrent miscarriage (RM) is one of the common complications of pregnancy, which is closely related to gene mutation. The profiling of non-coding RNAs showed that the expression level of long non-coding RNA LINC01347 (LINC01347) in the serum of patients with recurrent abortion was significantly increased, which could serve as a potential marker for early diagnosis. However, the biological functions of LINC01347 in the miscarriage remain to be elucidated. In this study, LINC01347 expression levels in HTR-8/SVneo cells and placenta samples were measured by RT-qPCR. The migration ability of HTR-8/SVneo cells was detected by wound-healing assay. Western blotting (WB) assay was conducted to measure E-cadherin, Vimentin, N-cadherin, PTEN, phospho-AKT(S473), phospho-AKT(T308) and AKT levels. Dual luciferase reporter assay and RNA pull-down analysis were performed to validate the molecular interactions. The results showed an upregulation of LINC01347 in the placenta samples of RM patients and HTR-8/SVneo cells. LINC01347 overexpression impaired the invasion and migration of trophoblast cells, while LINC01347 silencing promoted cell migration and invasion. LINC01347 level was also negatively correlated with the changes of epithelial-mesenchymal transition (EMT) markers in trophoblasts. We further demonstrated that miR-101-3p/PTEN/AKT axis played an important role in mediating the biological roles of LINC01347 in the invasion and migration of trophoblasts. In conclusion, our results revealed that LINC01347 suppresses the migratory ability and regulates the EMT processes in trophoblasts by regulating miR-101-3p/PTEN/AKT axis, suggesting that targeting LINC01347 may serve as a strategy to ameliorate RM.
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Affiliation(s)
- Xiahui Zhang
- Department of Obstetrics and Gynecology, The First People's Hospital of Wenling, 317500, China
| | - Jinyu Yan
- Department of Obstetrics and Gynecology, The First People's Hospital of Wenling, 317500, China
| | - Zhenzhen Dai
- Department of Obstetrics and Gynecology, The First People's Hospital of Wenling, 317500, China
| | - Xiaoxi Long
- Department of Obstetrics and Gynecology, The First People's Hospital of Wenling, 317500, China
| | - Jiaxi Jin
- Department of Obstetrics and Gynecology, The First People's Hospital of Wenling, 317500, China
| | - Qian Yang
- Department of Obstetrics and Gynecology, The First People's Hospital of Wenling, 317500, China
| | - Chenxiao Lin
- Department of Obstetrics and Gynecology, The First People's Hospital of Wenling, 317500, China
| | - Youlin Yang
- Department of Obstetrics and Gynecology, The First People's Hospital of Wenling, 317500, China
| | - Yi Chen
- Department of Obstetrics and Gynecology, The First People's Hospital of Wenling, 317500, China.
| | - Jun Zhu
- Department of Obstetrics and Gynecology, The First People's Hospital of Wenling, 317500, China.
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21
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Bagkou Dimakou D, Tamblyn J, Justin C, Coomarasamy A, Richter A. Diagnosis and management of idiopathic recurrent pregnancy loss (RPL): Current immune testing and immunomodulatory treatment practice in the United Kingdom. J Reprod Immunol 2022; 153:103662. [PMID: 35872373 DOI: 10.1016/j.jri.2022.103662] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 06/01/2022] [Accepted: 07/07/2022] [Indexed: 11/28/2022]
Abstract
Recurrent pregnancy loss (RPL) affects 1.9 % of couples. Despite the severe physical, psychological, and economic impact of RPL, miscarriage care provision remains highly heterogeneous. Due to the absence of strong scientific evidence, national and international guidelines on the diagnosis and treatment of this condition remain unclear and often contradictory. In the absence of identifiable RPL-associated risk factors, when the condition is termed "idiopathic", immunological tests and immunomodulatory treatments are sometimes suggested even though the contribution of aberrant immune activity to this condition remains undetermined. Through an online survey, distributed across the UK (37.7% response rate), a high variation in clinical practice was detected, with multiple RPL definitions utilized and different tests employed for potential risk factor identification. Immunological testing was found to be provided in 7.9 %(N = 3) of the included clinics. Moreover, multiple therapies, including immunomodulatory ones were utilized for the management of idiopathic RPL. These findings highlight a need for additional research on the implication of immune activity in this condition. The high variation between clinics regarding the tests employed for the diagnosis and management of idiopathic RPL also underlines the need for guidelines to direct clinical practice, taking into consideration both the patients' needs but also the strength of the available scientific evidence.
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Affiliation(s)
- Danai Bagkou Dimakou
- University of Birmingham, Institute of Immunology and Immunotherapy, United Kingdom; Tommy's National Centre for Miscarriage Research, United Kingdom.
| | - Jennifer Tamblyn
- Tommy's National Centre for Miscarriage Research, United Kingdom; Leeds General Teaching Hospital Trust, United Kingdom
| | - Chu Justin
- Tommy's National Centre for Miscarriage Research, United Kingdom; University of Birmingham, Institute of Metabolism and Systems Research, United Kingdom
| | - Arri Coomarasamy
- Tommy's National Centre for Miscarriage Research, United Kingdom; University of Birmingham, Institute of Metabolism and Systems Research, United Kingdom
| | - Alex Richter
- University of Birmingham, Institute of Immunology and Immunotherapy, United Kingdom
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22
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Zhu RH, Dai FF, Yang DY, Liu SY, Zheng YJ, Wu ML, Deng ZM, Wang ZT, Zhang YW, Tan W, Li ZD, He J, Yang X, Hu M, Cheng YX. The Mechanism of Insulin-Like Growth Factor II mRNA-Binging Protein 3 Induce Decidualization and Maternal-Fetal Interface Cross Talk by TGF-β1 in Recurrent Spontaneous Abortion. Front Cell Dev Biol 2022; 10:862180. [PMID: 35465321 PMCID: PMC9023862 DOI: 10.3389/fcell.2022.862180] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 03/09/2022] [Indexed: 12/20/2022] Open
Abstract
Recurrent spontaneous abortion (RSA) is defined as the loss of two or more consecutive intrauterine pregnancies that are clinically established early in pregnancy. To date, the etiology and underlying mechanisms of RSA remain unclear. It is widely thought that the impairment of decidualization is inclined to induce subsequent pregnancy failure and leads to the dysregulation of extra-villous trophoblast invasion and proliferation through maternal–fetal cross talk. However, the mechanism of decidualization in RSA has yet to be understood. In our study, we demonstrate that decidual samples from RSA patients have significantly higher insulin-like growth factor 2 mRNA-binding protein 3 (IGF2BP3) and lower TGF-β1 levels compared to healthy controls. In addition, the overexpression of IGF2BP3 in human endometrial stromal cells (hESCs) can lead to the impairment of decidualization in vitro-induced model and the abnormal cell cycle regulation. Furthermore, TGF-β1 and MMP9 levels were greatly increased after decidualization, whereas IGF2BP3 overexpression inhibited endometrial mesenchymal decidualization by downregulating TGF-β1, impeding maternal–fetal interface cytokine cross talk, and limiting the ability of trophoblast invasion. In conclusion, our investigation first demonstrates that abnormal elevation of IGF2BP3 in the pregnant endometrium leads to the impairment of decidualization and abnormal trophoblast invasion, thereby predisposing individuals to RSA.
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Affiliation(s)
- Rong-hui Zhu
- Department of Obstetrics and Gynecology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Fang-fang Dai
- Department of Obstetrics and Gynecology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Dong-yong Yang
- Department of Obstetrics and Gynecology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Shi-yi Liu
- Department of Obstetrics and Gynecology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Ya-jing Zheng
- Department of Obstetrics and Gynecology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Ma-li Wu
- Department of Obstetrics and Gynecology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Zhi-min Deng
- Department of Obstetrics and Gynecology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Zi-tao Wang
- Department of Obstetrics and Gynecology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Yu-wei Zhang
- Department of Obstetrics and Gynecology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Wei Tan
- Department of Obstetrics and Gynecology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Zhi-dian Li
- Department of Obstetrics and Gynecology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Juan He
- Department of Obstetrics and Gynecology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Xiao Yang
- Department of Obstetrics and Gynecology, Renmin Hospital of Wuhan University, Wuhan, China
- Department of Obstetrics and Gynecology, Peking University People’s Hospital, Beijing, China
- *Correspondence: Xiao Yang, ; Min Hu, ; Yan-xiang Cheng,
| | - Min Hu
- Department of Obstetrics and Gynecology, Renmin Hospital of Wuhan University, Wuhan, China
- *Correspondence: Xiao Yang, ; Min Hu, ; Yan-xiang Cheng,
| | - Yan-xiang Cheng
- Department of Obstetrics and Gynecology, Renmin Hospital of Wuhan University, Wuhan, China
- *Correspondence: Xiao Yang, ; Min Hu, ; Yan-xiang Cheng,
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23
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Progesterone: A Unique Hormone with Immunomodulatory Roles in Pregnancy. Int J Mol Sci 2022; 23:ijms23031333. [PMID: 35163255 PMCID: PMC8835837 DOI: 10.3390/ijms23031333] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 01/10/2022] [Accepted: 01/13/2022] [Indexed: 12/11/2022] Open
Abstract
Progesterone is well known for its numerous endocrinologic roles in pregnancy but is also endowed with fascinating immunomodulatory capabilities. It can downregulate the induction of inflammatory reactions, the activation of immune cells and the production of cytokines, which are critical mediators of immune responses. These features appear to be critical to the success of pregnancy, given the ability of maternal immune reactivity to interfere with pregnancy and to contribute to several pregnancy complications. This review summarizes the contribution of maternal immune effectors in general, and cytokines in particular, to pregnancy complications such as recurrent miscarriage, pre-eclampsia and preterm labor; it describes the promise offered by supplementation with progesterone and the oral progestogen dydrogesterone, as well as the progesterone-induced blocking factor in the prevention and/or treatment of these serious complications.
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24
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Fan Y, Wang Y, Luo Z, Xu Y, Zhang J, Wang W, Cui N, Hao G. Effects of Anticoagulants and Immune Agents on Pregnancy Outcomes and Offspring Safety in Frozen-Thawed Embryo Transfer Cycles-A Retrospective Cohort Study. Front Endocrinol (Lausanne) 2022; 13:884972. [PMID: 35800429 PMCID: PMC9255591 DOI: 10.3389/fendo.2022.884972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 05/09/2022] [Indexed: 11/13/2022] Open
Abstract
The application of anticoagulants and immune agents in assisted reproduction technology has been in a chaotic state, and no clear conclusion has been reached regarding the effectiveness and safety of this treatment. We aimed to explore the potential association between adjuvant medication and pregnancy outcomes and offspring safety in a retrospective cohort study including 8,873 frozen-thawed embryo transfer cycles. The included cycles were divided into three groups according to the drugs used, namely, the routine treatment group (without anticoagulant agents and immune agents), the anticoagulant agent group, and the immunotherapy group. Among normal ovulatory patients, those who used immune agents had a 1.4-fold increased risk of miscarriage (≤13 weeks), but a 0.8-fold decreased chance of birth (≥28 weeks) compared with the routine treatment group. Among patients with more than 1 embryo transferred, those who used anticoagulant agents showed a 1.2-fold higher risk of multiple birth than those undergoing routine treatment. Among patients without pregnancy complications, anticoagulant treatment was associated with a 2.1-fold increased risk of congenital anomalies. Among young patients (<26 years) with a singleton pregnancy, the neonatal birth weight of the immunotherapy group and the anticoagulant treatment group was 305.4 g and 175.9 g heavier than the routine treatment group, respectively. In conclusion, adjuvant anticoagulants or immune agent treatment in assisted reproductive technology should be used under strict supervision, and the principle of individualized treatment should be followed.
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Rogenhofer N, Mahner S, von Hasselbach YL, Thaler CJ. Effects of intralipid infusions on anti-trophoblast antibody (ATAb)-activities in patients with recurrent pregnancy loss: An observational report. Am J Reprod Immunol 2021; 87:e13506. [PMID: 34935238 DOI: 10.1111/aji.13506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 10/18/2021] [Accepted: 10/26/2021] [Indexed: 11/30/2022] Open
Abstract
PROBLEM Some studies suggest intravenous intralipid infusions (IVIL) to be effective in the treatment of immune-mediated pregnancy failure. To this date it remains to be established, how IVIL might protect pregnancy and therefore a specific subgroup of RPL patients that might benefit from IVIL has not been defined. Anti-trophoblast antibodies (ATAb) have been associated with RPL and appear to mediate immune pathology. We have shown, that ATAb in vitro decrease HCG- and progesterone production pointing to a mechanism how ATAb interfere with normal pregnancies. We have measured ATAb-activities in patients undergoing off label IVIL-treatment. METHOD OF STUDY Ten RPL-patients with positive ATAb, determined by using the choriocarcinoma cellline JEG-3 and flow cytometry as described before, and otherwise unexplained RPL, received off-label IVIL during pregnancy. Two ATAb-positive RPL patients preferred expectant management. In addition, ATAb-activity was studied in pregnancies of two healthy ATAb-negative volunteers without miscarriages. RESULTS In RPL patients receiving IVIL, relative ATAb-activity decreased from an average of 56.8±17.0% to 20.8±11.0% (P < .001). The two RPL-patients without IVIL, aborted at 6+3gw and 7+4gw and embryonic genetic testing revealed euploid karyotypes. During pregnancies of the two healthy ATAb-negative individuals, ATAb-activities remained negative (16±9.8%) without significant changes (P = .22). Nine of the 10 pregnancies receiving IVIL proceeded uneventful with healthy newborns ≥37gw. One patient receiving IVIL aborted at 7+6gw and embryonic genetic-testing revealed a trisomy 16. No specific side effects concerning IVIL were noted. CONCLUSIONS Intralipid preparations during pregnancies of ATAb-positive RPL-patients significantly reduce ATAb-activities and this may indicate a therapeutic mechanism of IVIL.
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Affiliation(s)
- Nina Rogenhofer
- Division of Gynecological Endocrinology and Reproductive Medicine, Department of Obstetrics and Gynecology, University Hospital LMU Munich - Großhadern, Munich, Germany
| | - Sven Mahner
- Division of Gynecological Endocrinology and Reproductive Medicine, Department of Obstetrics and Gynecology, University Hospital LMU Munich - Großhadern, Munich, Germany
| | | | - Christian J Thaler
- Division of Gynecological Endocrinology and Reproductive Medicine, Department of Obstetrics and Gynecology, University Hospital LMU Munich - Großhadern, Munich, Germany
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26
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Li WX, Xu XH, Jin LP. Regulation of the innate immune cells during pregnancy: An immune checkpoint perspective. J Cell Mol Med 2021; 25:10362-10375. [PMID: 34708495 PMCID: PMC8581333 DOI: 10.1111/jcmm.17022] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Revised: 09/03/2021] [Accepted: 10/04/2021] [Indexed: 12/17/2022] Open
Abstract
The foetus can be regarded as a half‐allograft implanted into the maternal body. In a successful pregnancy, the mother does not reject the foetus because of the immune tolerance mechanism at the maternal‐foetal interface. The innate immune cells are a large part of the decidual leukocytes contributing significantly to a successful pregnancy. Although the contributions have been recognized, their role in human pregnancy has not been completely elucidated. Additionally, the accumulated evidence demonstrates that the immune checkpoint molecules expressed on the immune cells are co‐inhibitory receptors regulating their activation and biological function. Therefore, it is critical to understand the immune microenvironment and explore the function of the innate immune cells during pregnancy. This review summarizes the classic immune checkpoints such as PD‐1, CTLA‐4 and some novel molecules recently identified, including TIM‐3, CD200, TIGIT and the Siglecs family on the decidual and peripheral innate immune cells during pregnancy. Furthermore, it emphasizes the role of the immune checkpoint molecules in pregnancy‐associated complications and reproductive immunotherapy.
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Affiliation(s)
- Wen-Xuan Li
- Shanghai Key Laboratory of Maternal-Fetal Medicine, Clinical and Translational Research Center, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Xiang-Hong Xu
- Shanghai Key Laboratory of Maternal-Fetal Medicine, Clinical and Translational Research Center, Department of Biobank, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Li-Ping Jin
- Shanghai Key Laboratory of Maternal-Fetal Medicine, Clinical and Translational Research Center, Department of Biobank, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
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27
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Wang P, Jiang G, Ju W, Cai Y, Wang J, Wu F. Influence of Bushen Tiaochong Cycle Therapy on Th1/Th2 Deviation, Sex Hormone Level, and Pregnancy Outcome of Alloimmune Recurrent Spontaneous Abortion. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2021; 2021:8624414. [PMID: 34594392 PMCID: PMC8478574 DOI: 10.1155/2021/8624414] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 09/07/2021] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To analyze the influence of Bushen Tiaochong cycle therapy on Th1/Th2 deviation, sex hormone level, and pregnancy outcome of alloimmune recurrent spontaneous abortion (RSA). METHODS From August 2018 to April 2020, 130 patients with alloimmune RSA who met the inclusion criteria were randomly divided into the control group (n = 65) and the study group (n = 65). The former received lymphocyte immunotherapy (LIT), and the latter received Bushen Tiaochong cycle therapy on the basis of LIT. The treatment ended at 12 w of pregnancy. The total score of traditional Chinese medicine (TCM) syndromes, Th1 cytokine (IL-2), Th2 cytokine (IL-10), and related hormones (chorionic gonadotropin (hCG) and progesterone (P)) were compared between the two groups before and after treatment. The positive rate of blocking antibody (BA), pregnancy success rate, and preterm birth rate were counted. RESULT After treatment, the total score of TCM syndromes, IL-2 level, and Th1/Th2 ratio in the two groups decreased significantly, while the levels of IL-10, hCG, and P increased significantly, and the study group improved significantly compared with the control group (P < 0.05). The positive rate of BA and pregnancy success rate in the study group were higher than those in the control group (P < 0.05). There was no significant difference in the preterm birth rate between the two groups (P > 0.05). CONCLUSION On the basis of routine western medicine treatment, a combined application of Bushen Tiaochong cycle therapy can significantly improve the Th1/Th2 deviation, serum sex hormone level, and pregnancy outcome in patients with alloimmune RSA.
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Affiliation(s)
- Peng Wang
- Department of Gynecology, Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine, Nanchang, Jiangxi 330000, China
| | - Guilin Jiang
- Department of Gynecology, Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine, Nanchang, Jiangxi 330000, China
| | - Wenjuan Ju
- Department of Gynecology, Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine, Nanchang, Jiangxi 330000, China
| | - Yaping Cai
- Jiangxi University of Traditional Chinese Medicine, Nanchang, Jiangxi 330000, China
| | - Jinrong Wang
- Jiangxi University of Traditional Chinese Medicine, Nanchang, Jiangxi 330000, China
| | - Feihua Wu
- Department of Gynecology, Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine, Nanchang, Jiangxi 330000, China
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28
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Parhizkar F, Motavalli-Khiavi R, Aghebati-Maleki L, Parhizkar Z, Pourakbari R, Kafil HS, Danaii S, Yousefi M. The Impact of New Immunological Therapeutic Strategies on Recurrent Miscarriage and Recurrent Implantation Failure. Immunol Lett 2021; 236:20-30. [PMID: 34090942 DOI: 10.1016/j.imlet.2021.05.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 05/12/2021] [Accepted: 05/25/2021] [Indexed: 12/16/2022]
Abstract
Maternal-fetal immune dysregulation is one of the risk factors that increases the probability of embryo rejection and reproductive failure. The stimulation of immunological tolerance and suppression of immunological rejection are prerequisites for protecting embryos and preventing immunological attacks. Hence, it appears that immunomodulatory and immunosuppressive therapies can manage reproductive failures by controlling immune cells. The current medical literature has shown that immunotherapy approaches and cell therapy have promising results in improving pregnancy outcomes and live birth rates. These outcomes are obtained by regulating maternal immune responses, and exerting positive effects on human reproductive processes.
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Affiliation(s)
- Forough Parhizkar
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran; Stem Cell Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Roza Motavalli-Khiavi
- Department of Molecular Medicine, Faculty of Advanced Medical Sciences, Tabriz University of Medical Sciences, Tabriz, Iran; Stem Cell Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Zahra Parhizkar
- Student Research Committee, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Ramin Pourakbari
- Department of Immunology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Shahla Danaii
- Gynecology Department, Eastern Azerbaijan ACECR ART Centre, Eastern Azerbaijan branch of ACECR, Tabriz, Iran
| | - Mehdi Yousefi
- Stem Cell Research Center, Tabriz University of Medical Sciences, Tabriz, Iran; Department of Immunology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran.
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29
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Dahdouh EM, Kutteh WH. Genetic testing of products of conception in recurrent pregnancy loss evaluation. Reprod Biomed Online 2021; 43:120-126. [PMID: 33926784 DOI: 10.1016/j.rbmo.2021.03.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Revised: 03/04/2021] [Accepted: 03/17/2021] [Indexed: 10/21/2022]
Abstract
Genetic testing of products of conception (POC) has been proposed as a tool to be used in the evaluation of patients with recurrent pregnancy loss (RPL). Following a complete RPL evaluation, POC results may reveal an aneuploidy and provide an explanation for the miscarriage in more than 55% of cases. When the cytogenetic result of the pregnancy loss reveals a euploid pregnancy, management should be directed towards the identification of treatable abnormalities. Furthermore, the results of POC testing might better define a subgroup of patients with unexplained RPL who may benefit from expectant management versus preimplantation genetics (aneuploid unexplained RPL) or investigational therapy (euploid unexplained RPL).
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Affiliation(s)
- Elias M Dahdouh
- Assisted Reproduction Technology Centre, Department of Obstetrics and Gynecology, CHU Sainte-Justine, Montreal QC, Canada; Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Montreal, Montreal QC, Canada.
| | - William H Kutteh
- Division of Reproductive Endocrinology, Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville TN, USA; Recurrent Pregnancy Loss Center, Fertility Associates of Memphis, Memphis TN, USA
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30
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Canella PRBC, Barini R, Carvalho PDO, Razolli DS. Lipid emulsion therapy in women with recurrent pregnancy loss and repeated implantation failure: The role of abnormal natural killer cell activity. J Cell Mol Med 2021; 25:2290-2296. [PMID: 33544456 PMCID: PMC7933936 DOI: 10.1111/jcmm.16257] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 12/09/2020] [Accepted: 12/14/2020] [Indexed: 12/18/2022] Open
Abstract
Altered immune and/or inflammatory response plays an important role in cases of recurrent pregnancy loss (RPL) and repeated implantation failure (RIF). Exacerbation of the maternal immune response through increased NK cell activity and inflammatory cytokines can cause embryo rejection leading to abortion or embryo implantation failure. Immunosuppressors or immunomodulators can help or prevent this condition. Currently, lipid emulsion therapy (LET) has emerged as a treatment for RPL and RIF in women with abnormal NK cell activity, by decreasing the exacerbated immune response of the maternal uterus and providing a more receptive environment for the embryo. However, the mechanisms by which the intralipid acts to reduce NK cell activity are still unclear. In this review, we focus on the studies that conducted LET to treat patients with RPL and RIF with abnormal NK cell activity. We find that although some authors recommend LET as an effective intervention, more studies are necessary to confirm its effectiveness in restoring NK cell activity to normal levels and to comprehend the underlying mechanisms of the lipids action in ameliorating the maternal environment and improving the pregnancy rate.
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Affiliation(s)
| | - Ricardo Barini
- Department of Obstetrics and Gynecology, Campinas University (UNICAMP), Campinas, Brazil
| | | | - Daniela Soares Razolli
- Postgraduate Program in Health Sciences, São Francisco University, Bragança Paulista, Brazil
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31
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Abstract
Recurrent pregnancy loss is a distressing pregnancy disorder experienced by ~2.5% of women trying to conceive. Recurrent pregnancy loss is defined as the failure of two or more clinically recognized pregnancies before 20-24 weeks of gestation and includes embryonic and fetal losses. The diagnosis of an early pregnancy loss is relatively straightforward, although progress in predicting and preventing recurrent pregnancy loss has been hampered by a lack of standardized definitions, the uncertainties surrounding the pathogenesis and the highly variable clinical presentation. The prognosis for couples with recurrent pregnancy loss is generally good, although the likelihood of a successful pregnancy depends on maternal age and the number of previous losses. Recurrent pregnancy loss can be caused by chromosomal errors, anatomical uterine defects, autoimmune disorders and endometrial dysfunction. Available treatments target the putative risk factors of pregnancy loss, although the effectiveness of many medical interventions is controversial. Regardless of the underlying aetiology, couples require accurate information on their chances of having a baby and appropriate support should be offered to reduce the psychological burden associated with multiple miscarriages. Future research must investigate the pathogenesis of recurrent pregnancy loss and evaluate novel diagnostic tests and treatments in adequately powered clinical trials.
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32
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Sadeghpour S, Ghasemnejad Berenji M, Nazarian H, Ghasemnejad T, Nematollahi MH, Abroon S, Paktinat S, Heidari Khoei H, Ghasemnejad Berenji H, Ghaffari Novin M. Effects of treatment with hydroxychloroquine on the modulation of Th17/Treg ratio and pregnancy outcomes in women with recurrent implantation failure: clinical trial. Immunopharmacol Immunotoxicol 2020; 42:632-642. [PMID: 33081532 DOI: 10.1080/08923973.2020.1835951] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
AIM The imbalance of Th17/Treg cells has been recently suggested as a new risk factors for recurrent implantation failure (RIF). Furthermore Th17/Treg cells are involved in immune regulation in peripheral blood and endometrial tissue of patients with RIF. In this research, we investigated the effects of Hydroxychloroquine (HCQ) on the level and function of Th17 and Treg cells in women with RIF. It may be possible to improve pregnancy outcomes by modulating high cytokine levels. METHODS Women with RIF received oral HCQ (n = 60) on day 4 of the menstrual cycle and continued until day 20 of the menstrual cycle and 2 days before embryo transfer and continued until the day of the pregnancy test, for a total of 16 days in another cycle. The serum levels of IL-17 and IL-10, the expression of transcription factors related to Th17 and Treg cells and the immune-reactivity of IL-17, IL-21 as Th17 related cytokines and IL-10, TGF- β as Treg related cytokines in endometrial tissues were evaluated by ELISA, real-time PCR, and fluorescent immunohistochemistry respectively. Results: Treatment with HCQ down-regulated Th17 related cytokines and function and up-regulated Treg related cytokines and function significantly (p < .001). RORγt, the Th17 transcription factor, expression was down-regulated and FOXP-3, the T-reg transcription factor, expression was up-regulated. The biochemical pregnancy rate was not significantly different in RIF patients before and after treatment. CONCLUSION Our results demonstrated that the administration of HCQ in RIF women with immune cell disorders during pregnancy could affect the Th17/Treg ratio and enhance Treg and diminish Th17 responses which may be associated with successful pregnancy outcomes. However, significant difference in pregnancy outcomes was not observed in the present study.
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Affiliation(s)
- Sonia Sadeghpour
- Department of Obstetrics and Gynecology, School of Medicine, Urmia University of Medical Sciences, Urmia, Iran
| | - Morteza Ghasemnejad Berenji
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Urmia University of Medical Sciences, Urmia, Iran
| | - Hamid Nazarian
- Department of Biology and Anatomical Sciences, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Tohid Ghasemnejad
- Department of Medical Genetics, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mohammad Hadi Nematollahi
- Department of Biochemistry, Faculty of Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Sina Abroon
- Department of Clinical Biochemistry, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Shahrokh Paktinat
- Department of Biology and Anatomical Sciences, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Heidar Heidari Khoei
- Department of Biology and Anatomical Sciences, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hojjat Ghasemnejad Berenji
- Department of Biology and Anatomical Sciences, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Marefat Ghaffari Novin
- Department of Biology and Anatomical Sciences, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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33
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Guzman-Genuino RM, Hayball JD, Diener KR. Regulatory B Cells: Dark Horse in Pregnancy Immunotherapy? J Mol Biol 2020; 433:166596. [PMID: 32693108 DOI: 10.1016/j.jmb.2020.07.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 07/13/2020] [Accepted: 07/15/2020] [Indexed: 12/20/2022]
Abstract
There are many unanswered questions surrounding the function of immune cells and how they interact with the reproductive system to support successful pregnancy or contribute to pregnancy pathologies. While the role of immune cells such as uterine natural killer and dendritic cells, and more recently regulatory T cells has been established, the role of another major immune cell population, the B cell, and particularly the regulatory B cells, is relatively poorly understood. This review outlines what is known about B-cell subsets in the context of pregnancy, what constitutes a regulatory B cell and what role they may play, particularly during early pregnancy. Lastly, we discuss why immunotherapies for the treatment of pregnancy disorders is not widely progressed clinically and speculate on the potential of functional regulatory B cells as the basis of novel immunotherapeutic approaches for the treatment of immune-based pregnancy pathologies.
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Affiliation(s)
- Ruth Marian Guzman-Genuino
- Experimental Therapeutics Laboratory, University of South Australia Cancer Research Institute, Clinical and Health Sciences, University of South Australia, Adelaide, SA, Australia
| | - John D Hayball
- Experimental Therapeutics Laboratory, University of South Australia Cancer Research Institute, Clinical and Health Sciences, University of South Australia, Adelaide, SA, Australia; Robinson Research Institute and Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia
| | - Kerrilyn R Diener
- Experimental Therapeutics Laboratory, University of South Australia Cancer Research Institute, Clinical and Health Sciences, University of South Australia, Adelaide, SA, Australia; Robinson Research Institute and Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia.
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