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Shen HH, Zhang YY, Wang XY, Wang CJ, Wang Y, Ye JF, Li MQ. Potential Causal Association between Plasma Metabolites, Immunophenotypes, and Female Reproductive Disorders: A Two-Sample Mendelian Randomization Analysis. Biomolecules 2024; 14:116. [PMID: 38254716 PMCID: PMC10813709 DOI: 10.3390/biom14010116] [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: 12/06/2023] [Revised: 01/08/2024] [Accepted: 01/11/2024] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND While extensive research highlighted the involvement of metabolism and immune cells in female reproductive diseases, causality remains unestablished. METHODS Instrumental variables for 486 circulating metabolites (N = 7824) and 731 immunophenotypes (N = 3757) were derived from a genome-wide association study (GWAS) meta-analysis. FinnGen contributed data on 14 female reproductive disorders. A bidirectional two-sample Mendelian randomization study was performed to determine the relationships between exposures and outcomes. The robustness of results, potential heterogeneity, and horizontal pleiotropy were examined through sensitivity analysis. RESULTS High levels of mannose were found to be causally associated with increased risks of gestational diabetes (GDM) (OR [95% CI], 6.02 [2.85-12.73], p = 2.55 × 10-6). A genetically predicted elevation in the relative count of circulating CD28-CD25++CD8+ T cells was causally related to increased female infertility risk (OR [95% CI], 1.26 [1.14-1.40], p = 1.07 × 10-5), whereas a high absolute count of NKT cells reduced the risk of ectopic pregnancy (OR [95% CI], 0.87 [0.82-0.93], p = 5.94 × 10-6). These results remained consistent in sensitivity analyses. CONCLUSIONS Our study supports mannose as a promising GDM biomarker and intervention target by integrating metabolomics and genomics.
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Affiliation(s)
- Hui-Hui Shen
- Laboratory for Reproductive Immunology, Hospital of Obstetrics and Gynecology, Fudan University, Shanghai 200080, China
| | - Yang-Yang Zhang
- Laboratory for Reproductive Immunology, Hospital of Obstetrics and Gynecology, Fudan University, Shanghai 200080, China
- Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Xuan-Yu Wang
- College of Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, No. 10, Poyang Lake Road, Tuanpo Xinchengxi District, Jinghai District, Tianjin 301617, China
| | - Cheng-Jie Wang
- Department of Obstetrics and Gynecology, Hospital of Obstetrics and Gynecology, Fudan University, Shanghai 200011, China
| | - Ying Wang
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Qilu Hospital, Shandong University, Ji’nan 250012, China
| | - Jiang-Feng Ye
- Institute for Molecular and Cell Biology, Agency for Science, Technology and Research, Singapore 138632, Singapore
| | - Ming-Qing Li
- Laboratory for Reproductive Immunology, Hospital of Obstetrics and Gynecology, Fudan University, Shanghai 200080, China
- Shanghai Medical College, Fudan University, Shanghai 200032, China
- Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Hospital of Obstetrics and Gynecology, Fudan University, Shanghai 200080, China
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Yıldız Ş, Karakaş S, Kaya C, Kural A, Gedikbaşı A, Ekin D, Serhanoğlu Z, Çaypınar SS, Ekin M. Evaluation of HSP70 levels in ectopic pregnancy, abortus imminens and intrauterine pregnancy. Biomark Med 2022; 16:1251-1258. [PMID: 36820610 DOI: 10.2217/bmm-2022-0550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023] Open
Abstract
Aim: To assess the serum levels of HSP70 concentrations in ectopic pregnancy (EP) patients compared with abortus imminens (AI) patients and healthy controls. Materials & methods: Age-matched patients were divided into three groups, with 30 patients in each group: EP, AI and healthy intrauterine pregnancy groups. Blood samples were taken from the antecubital vein and kept for HSP70 analysis. Results: The HSP70 levels were higher in the EP group than in AI patients and healthy controls (p < 0.05). The area under the curve for the serum HSP70 assay reached a value of 0.81 for a cutoff point of 11.12 pg/ml, which identified women with EP. Conclusion: Serum HSP70 levels increased in women with EP compared with healthy controls and women with AI.
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Affiliation(s)
- Şükrü Yıldız
- University of Health Sciences Istanbul, Bakirkoy Dr. Sadi Konuk Training & Research Hospital, Department of Obstetrics & Gynecology, Istanbul, 34180, Turkey
| | - Sema Karakaş
- University of Health Sciences Istanbul, Bakirkoy Dr. Sadi Konuk Training & Research Hospital, Department of Obstetrics & Gynecology, Istanbul, 34180, Turkey
| | - Cihan Kaya
- Acıbadem Mehmet Ali Aydınlar University, Department of Obstetrics & Gynecology, Acıbadem Bakirkoy Hospital, Istanbul, 34200, Turkey
| | - Alev Kural
- University of Health Sciences Istanbul, Bakirkoy Dr. Sadi Konuk Training & Research Hospital, Department of Biochemistry, Istanbul, 34180, Turkey
| | - Asuman Gedikbaşı
- Institute of Child Health, Istanbul University Faculty of Medicine, Istanbul, 34200, Turkey
| | - Deniz Ekin
- University of Bristol, Faculty of Life Sciences, Bristol, BS8 1TH, United Kingdom
| | - Zınar Serhanoğlu
- University of Health Sciences Istanbul, Bakirkoy Dr. Sadi Konuk Training & Research Hospital, Department of Obstetrics & Gynecology, Istanbul, 34180, Turkey
| | - Sema S Çaypınar
- University of Health Sciences Istanbul, Başakşehir Çam ve Sakura Training & Research Hospital, Department of Perinatology, Istanbul, 34280, Turkey
| | - Murat Ekin
- University of Health Sciences Istanbul, Bakirkoy Dr. Sadi Konuk Training & Research Hospital, Department of Obstetrics & Gynecology, Istanbul, 34180, Turkey
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3
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Approbato FC, Approbato MS, Maia MCS, Lima YARD, Barbosa MA, Benetti BBDC. Bilateral but not unilateral tubal obstruction is associated with positive chlamydia serology. JBRA Assist Reprod 2020; 24:20-23. [PMID: 31397549 PMCID: PMC6993167 DOI: 10.5935/1518-0557.20190049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Objective: To assess the association between positive Chlamydia trachomatis (C. trachomatis) serology and unilateral or bilateral tubal obstruction. Methods: This was a cross sectional study that evaluated the association of positive C. trachomatis serology (Immunofluorescence Indirect Serology, IIF or Enzyme Immune Essay, EIE), in two infertile groups: A. 243 patients (27 with unilateral obstruction and 216 without it). B. 247 patients (31 with bilateral obstruction and 216 without it). The exclusion criteria were tubal ligation (tubectomy) and tubal surgery. The statistical test (SPSS 17.0) was the Chi-Square with a p=5%. Tubal obstruction was diagnosed through hysterosalpingography (HSG). Results: The mean age of the patients without obstruction was 33.6 years, SD 4.9. The mean age of the patients with unilateral obstruction was 33.7 years SD 4.9. The mean age of the patients with bilateral obstruction was 33.6 years, SD 4.9. There was no statistically significant difference between the age groups. In group A (unilateral obstruction versus serology) the Chi-Square was 0.02 (p=n.s.) and the Attributable Risk (AR) = 0.7%. In Group B (bilateral obstruction versus serology) the Chi-Square test was 9.87 (p<0.005) and the AR = 14.8%. Conclusion: This study found a strong and statistically significant association between bilateral tubal obstruction and C. trachomatis positive serology. The power of the test was 86%. There was no association between unilateral obstruction and positive serology.
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Affiliation(s)
- Fabiana C Approbato
- Brazil Human Reproduction Laboratory. Obstetric and Gynecology Dept. Federal University of Goias State, Brazil
| | - Mário S Approbato
- Brazil Human Reproduction Laboratory. Obstetric and Gynecology Dept. Federal University of Goias State, Brazil
| | - Mônica C S Maia
- Brazil Human Reproduction Laboratory. Obstetric and Gynecology Dept. Federal University of Goias State, Brazil
| | - Yanna A R de Lima
- Brazil Human Reproduction Laboratory. Obstetric and Gynecology Dept. Federal University of Goias State, Brazil
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Xia Q, Wang T, Xian J, Song J, Qiao Y, Mu Z, Liu H, Sun Z. Relation of Chlamydia trachomatis infections to ectopic pregnancy: A meta-analysis and systematic review. Medicine (Baltimore) 2020; 99:e18489. [PMID: 31895782 PMCID: PMC6946389 DOI: 10.1097/md.0000000000018489] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND In a multitude of previous studies, Chlamydia trachomatis (CT) plays an important role in the occurrence of ectopic pregnancy (EP). However, the predictive value of CT infections in the occurrence of EP has not been estimated worldwide. We thus evaluated, by means of a meta-analysis, the current status of the association between CT infections with EP and the potential predictive value of CT infections in EP. METHODS We evaluated studies performed between the database construction time and August 2018 published in PubMed, the Cochrane Library, EMBASE, and the Web of Science (SCI). The relationship between CT and EP was calculated based upon the predetermined entry criteria for control group selection and the original data. The related articles were analyzed using a random-effects model, and the heterogeneity of the studies was assessed using the I index. Data were analyzed with the STATA 12.0 software. RESULTS Twenty-five studies that recruited 11960 patients were included in the present meta-analysis, and the relation of CT infections with EP were assessed. The association between CT infections and EP risk showed an odds ratio (OR) of 3.03, with a 95% confidence interval (CI) of 2.37 to 3.89. Our results showed that there was a statistically significant difference between the intervention and control groups. The prevalence of CT infections in EP was then calculated by a subgroup analysis: African (OR, 2.22; 95% CI, 1.14-4.31), European (OR, 3.16; 95% CI, 2.10-4.47), North American (OR, 3.07; 95% CI, 1.78-5.31), and Asian (OR, 3.39; 95% CI, 1.95-5.90). CONCLUSIONS From the results of numerous studies conducted on different continents, this meta-analysis showed a clear association between EP and prior CT infections, that is, CT infections increase the risk of EP occurrence.
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Affiliation(s)
- Qingchang Xia
- Master of Gynecology in Traditional Chinese Medicine, First College of Clinical Medicine, Shandong University of Traditional Chinese Medicine
| | - Tianqi Wang
- Medical history of Chinese medicine, Institute for Literature and Culture of Chinese Medicine Shandong University of Traditional Chinese Medicine
| | - Jin Xian
- Affiliated Hospital of Shandong University of Traditional Chinese Medicine
| | - Jingyan Song
- Department of Gynecology of Traditional Chinese Medicine, College of Traditional Chinese Medicine
| | - Yan Qiao
- Master of Gynecology in Traditional Chinese Medicine, First College of Clinical Medicine
| | - Zhenni Mu
- Master of Gynecology in Traditional Chinese Medicine, College of Traditional Chinese Medicine
| | - Honggen Liu
- Master of Gynecology in Traditional Chinese Medicine, College of Traditional Chinese Medicine, Shandong University of Traditional Chinese Medicine
| | - Zhengao Sun
- Reproductive Medicine Center of Integration of Traditional and Western Medicine, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
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5
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Wang X, Lee CL, Li RHW, Vijayan M, Duan YG, Yeung WSB, Zhang Y, Chiu PCN. Alteration of the immune cell profiles in the pathophysiology of tubal ectopic pregnancy. Am J Reprod Immunol 2019; 81:e13093. [PMID: 30672642 DOI: 10.1111/aji.13093] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 01/14/2019] [Accepted: 01/14/2019] [Indexed: 12/31/2022] Open
Abstract
Tubal ectopic pregnancy (TEP) refers to implantation of conceptus in the fallopian tube. It makes up over 98% of ectopic pregnancy (EP), which is the leading cause of maternal morbidity and mortality in the first trimester of pregnancy. Immune cells at the maternal-fetal interface play important roles in the process of embryo implantation, stroma decidualization, and early placental development. Alterations in the composition, phenotype, and activity of the immune cells in the fallopian tubes contribute toward the onset of TEP. In this review, we compare the leukocytic proportions in decidua of normal pregnancy, and in decidua and fallopian tubes of TEP. The possible functions of these immune cells in the pathophysiology of TEP are also discussed.
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Affiliation(s)
- Xia Wang
- Department of Obstetrics & Gynaecology, The University of Hong Kong, Hong Kong, SAR, China
| | - Cheuk-Lun Lee
- Department of Obstetrics & Gynaecology, The University of Hong Kong, Hong Kong, SAR, China.,Department of Obstetrics and Gynaecology, Shenzhen Key Laboratory of Fertility Regulation, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Raymond H W Li
- Department of Obstetrics & Gynaecology, The University of Hong Kong, Hong Kong, SAR, China.,Department of Obstetrics and Gynaecology, Shenzhen Key Laboratory of Fertility Regulation, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Madhavi Vijayan
- Department of Obstetrics & Gynaecology, The University of Hong Kong, Hong Kong, SAR, China
| | - Yong-Gang Duan
- Department of Obstetrics and Gynaecology, Shenzhen Key Laboratory of Fertility Regulation, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - William S B Yeung
- Department of Obstetrics and Gynaecology, Shenzhen Key Laboratory of Fertility Regulation, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Yuanzhen Zhang
- Department of Obstetrics and Gynecology, Reproductive Medicine Center, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Philip C N Chiu
- Department of Obstetrics & Gynaecology, The University of Hong Kong, Hong Kong, SAR, China.,Department of Obstetrics and Gynaecology, Shenzhen Key Laboratory of Fertility Regulation, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
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6
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Ozyurek ES, Karacan T, Ozdalgicoglu C, Yilmaz S, Isik S, San M, Kaya E. Seropositivity for the human heat shock protein (Hsp)60 accompanying seropositivity for Chlamydia trachomatis is less prevalent among tubal ectopic pregnancy cases than individuals with normal reproductive history. Eur J Obstet Gynecol Reprod Biol 2018. [PMID: 29518642 DOI: 10.1016/j.ejogrb.2018.02.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To investigate the role of anti-human heat shock protein 60 (hHsp60) antibody positivity in the pathogenesis of ectopic pregnancy, following Chlamydia trachomatis (CT) infection. STUDY DESIGN In a case-control study, serological tests for anti-hHsp60 were performed in ectopic pregnancies (study group) and parturients with normal reproductive histories (control group). All participants in both groups were CT IgG(+). hHsp60 IgG(+) prevalences were compared between the two groups, by semiquantitative ELISA. Data were evaluated using nonparametric and parametric tests and multivariable regression. RESULTS After an initial pilot study, two groups were formed: 63 ectopic gestations (study group) and 95 normal parturients (control group), all CT IgG(+). Blood samples from all cases were tested for anti-hHsp60 IgG. Age, gravidity, and practising contraception were higher in the control group, while a history of pelvic infections were more common in the study group. Hsp60 IgG(+) was found to be significantly higher in the control group (63/95, 66.3%) compared to study group (30/63, 47.6%). Regression analysis revealed anti-hHsp60 positivity was an independent factor delineating the two groups. CONCLUSION Immunity to hHsp60 is less common in CT IgG(+) ectopic pregnancies than CT IgG(+) fertile subjects without a history of ectopic pregnancies. Hence, our findings suggest that hHsp60 seropositivity may decrease the probability of an ectopic gestation in subjects with previous CT infections.
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Affiliation(s)
- Eser S Ozyurek
- Bagcilar Research and Training Hospital, Department of Obstetrics and Gynecology, Istanbul, Turkey.
| | - Tolga Karacan
- Bagcilar Research and Training Hospital, Department of Obstetrics and Gynecology, Istanbul, Turkey
| | - Cenk Ozdalgicoglu
- Istanbul, Bagcilar Research and Training Hospital, Department of Medical Microbiology, Turkey
| | - Salih Yilmaz
- Bagcilar Research and Training Hospital, Department of Obstetrics and Gynecology, Istanbul, Turkey
| | - Salman Isik
- Bagcilar Research and Training Hospital, Department of Obstetrics and Gynecology, Istanbul, Turkey
| | - Mevlide San
- Bagcilar Research and Training Hospital, Department of Obstetrics and Gynecology, Istanbul, Turkey
| | - Erdal Kaya
- Bagcilar Research and Training Hospital, Department of Obstetrics and Gynecology, Istanbul, Turkey
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7
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Chlamydia trachomatis: the Persistent Pathogen. CLINICAL AND VACCINE IMMUNOLOGY : CVI 2017; 24:CVI.00203-17. [PMID: 28835360 DOI: 10.1128/cvi.00203-17] [Citation(s) in RCA: 103] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Chlamydia trachomatis is an obligate intracellular bacterium whose only natural host is humans. Although presenting as asymptomatic in most women, genital tract chlamydial infections are a leading cause of pelvic inflammatory disease, tubal factor infertility, and ectopic pregnancy. C. trachomatis has evolved successful mechanisms to avoid destruction by autophagy and the host immune system and persist within host epithelial cells. The intracellular form of this organism, the reticulate body, can enter into a persistent nonreplicative but viable state under unfavorable conditions. The infectious form of the organism, the elementary body, is again generated when the immune attack subsides. In its persistent form, C. trachomatis ceases to produce its major structural and membrane components, but synthesis of its 60-kDa heat shock protein (hsp60) is greatly upregulated and released from the cell. The immune response to hsp60, perhaps exacerbated by repeated cycles of productive infection and persistence, may promote damage to fallopian tube epithelial cells, scar formation, and tubal occlusion. The chlamydial and human hsp60 proteins are very similar, and hsp60 is one of the first proteins produced by newly formed embryos. Thus, the development of immunity to epitopes in the chlamydial hsp60 that are also present in the corresponding human hsp60 may increase susceptibility to pregnancy failure in infected women. Delineation of host factors that increase the likelihood that C. trachomatis will avoid immune destruction and survive within host epithelial cells and utilization of this knowledge to design individualized preventative and treatment protocols are needed to more effectively combat infections by this persistent pathogen.
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8
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Efthymiou G, Dardiotis E, Liaskos C, Marou E, Tsimourtou V, Rigopoulou EI, Scheper T, Daponte A, Meyer W, Sakkas LI, Hadjigeorgiou G, Bogdanos DP. Immune responses against Helicobacter pylori-specific antigens differentiate relapsing remitting from secondary progressive multiple sclerosis. Sci Rep 2017; 7:7929. [PMID: 28801580 PMCID: PMC5554191 DOI: 10.1038/s41598-017-07801-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 06/29/2017] [Indexed: 01/12/2023] Open
Abstract
To assess whether Helicobacter pylori (Hp) antibody (ab) reactivity against individual Hp antigens is pathogenetically relevant to multiple sclerosis (MS), we systematically investigated prevalence and clinical significance of abs against 14 immunodominant and subdominant Hp antigens by ELISA and immunoblotting in 139 consecutive MS patients with relapsing-remitting (RRMS, n = 102) or secondary progressive (SPMS, n = 37). Sera from 39 patients with Parkinson’s disease (PD), 21 with Alzheimer’s disease (ALZ) and 68 healthy controls (HCs), were also tested. Anti-flagellin (18.3%) and anti-p41 (25.0%) abs in MS were less frequent than in HCs (39.4%, 48.5%, respectively). Abs against 5 of the 14 antigens were less frequent in RRMS than HCs, including p41, p54-flagellin, p29-UreA, p67-FSH, and p120-CagA. Anti-VacA abs were more frequent in SPMS than in HCs (42.1 vs 12.1%, p = 0.019). Anti-p54, anti-p29-UreA and anti-p26 correlated with extended disability status scale (EDSS) (p = 0.017, p = 0.005, p = 0.002, respectively). Anti-p26 and anti-p17 correlated with the number of relapses (p = 0.037 and p = 0.047, respectively). This is the first comprehensive analysis of ab reactivities against most Hp antigens in MS patients. Ab responses differ between MS and HCs and between RRMS and SPMS, being more prevalent in SPMS than RRMS, thus suggesting an association between anti-Hp and the former type of MS.
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Affiliation(s)
- Georgios Efthymiou
- Department of Rheumatology and Clinical Immunology, University General Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Viopolis, 40500, Larissa, Greece.,Department of Neurology, University General Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, 40500, Larissa, Greece.,Cellular Immunotherapy & Molecular Immunodiagnostics, Biomedical Section, Centre for Research and Technology-Hellas (CERTH) - Institute for Research and Technology-Thessaly (IRETETH), 41222, Larissa, Greece
| | - Efthymios Dardiotis
- Department of Neurology, University General Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, 40500, Larissa, Greece
| | - Christos Liaskos
- Department of Rheumatology and Clinical Immunology, University General Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Viopolis, 40500, Larissa, Greece.,Cellular Immunotherapy & Molecular Immunodiagnostics, Biomedical Section, Centre for Research and Technology-Hellas (CERTH) - Institute for Research and Technology-Thessaly (IRETETH), 41222, Larissa, Greece
| | - Emmanouela Marou
- Department of Rheumatology and Clinical Immunology, University General Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Viopolis, 40500, Larissa, Greece.,Cellular Immunotherapy & Molecular Immunodiagnostics, Biomedical Section, Centre for Research and Technology-Hellas (CERTH) - Institute for Research and Technology-Thessaly (IRETETH), 41222, Larissa, Greece
| | - Vana Tsimourtou
- Department of Neurology, University General Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, 40500, Larissa, Greece
| | - Eirini I Rigopoulou
- Department of Internal Medicine, University General Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, 40500, Larissa, Greece
| | - Thomas Scheper
- Institute of Experimental Immunology, affiliated to EUROIMMUN AG, Lubeck, Germany
| | - Alexandros Daponte
- Department of Obstetrics and Gynecology, University General Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Viopolis, 40500, Larissa, Greece
| | - Wolfgang Meyer
- Institute of Experimental Immunology, affiliated to EUROIMMUN AG, Lubeck, Germany
| | - Lazaros I Sakkas
- Cellular Immunotherapy & Molecular Immunodiagnostics, Biomedical Section, Centre for Research and Technology-Hellas (CERTH) - Institute for Research and Technology-Thessaly (IRETETH), 41222, Larissa, Greece
| | - Georgios Hadjigeorgiou
- Department of Neurology, University General Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, 40500, Larissa, Greece
| | - Dimitrios P Bogdanos
- Department of Rheumatology and Clinical Immunology, University General Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Viopolis, 40500, Larissa, Greece. .,Cellular Immunotherapy & Molecular Immunodiagnostics, Biomedical Section, Centre for Research and Technology-Hellas (CERTH) - Institute for Research and Technology-Thessaly (IRETETH), 41222, Larissa, Greece.
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9
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Lu J, Zhu L, Zhang L, Jiang J, Xie F, Huang Q, Li X, Yi C. Abnormal Expression of TRAIL Receptors in Decidual Tissue of Chlamydia trachomatis-Infected Rats During Early Pregnancy Loss. Reprod Sci 2016; 24:1041-1052. [PMID: 27852922 DOI: 10.1177/1933719116676393] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Chlamydia trachomatis is the scientific name of pathogenic bacteria causing infection that has been linked to spontaneous abortion. In this study, the expression pattern of tumor necrosis factor-related apoptosis-inducing ligand (TRAIL; a cytokine related to cell apoptosis) and its receptors was monitored in the decidua of C trachomatis-infected pregnant rats during early gestation to investigate the potential role of this molecular system in C trachomatis-induced spontaneous abortion. The data showed that C trachomatis infection significantly altered the messenger RNA (mRNA) expression of the receptors; death receptor (DR) 4 and DR5 increased, but decoy receptor (DcR) 1 and DcR2 decreased. Consistent with mRNA data, immunohistochemical staining of TRAIL and its receptors indicated that both DR4 and DR5 protein levels were elevated in infected tissues, primarily, decidual cells, decidual vessel wall, and uterine glands, whereas DcR1 and DcR2 showed lower levels compared to the noninfected group. Although receptor expression was altered, there was no difference detected in TRAIL expression. The observed altered expression of TRAIL receptors in C trachomatis-infected rats compared to noninfected rats during the embryo implantation phase suggests a possible mechanism for spontaneous abortion due to apoptosis and therefore failed embryo implantation. In addition, the observed increase in caspase-3 levels in infected cells further supports this finding. Taken together, the data presented in this study suggests C trachomatis infection altered the expression of TRAIL receptors, thus representing a general mechanism for C trachomatis-induced spontaneous abortion in C trachomatis-infected rats during early pregnancy loss.
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Affiliation(s)
- Jinzhi Lu
- 1 Department of Laboratory Medicine, The First Affiliated Hospital of Yangtze University, Jingzhou, Hubei, People's Republic of China
| | - Liya Zhu
- 2 Department of Obstetrics and Gynecology, The First Affiliated Hospital of Yangtze University, Jingzhou, Hubei, People's Republic of China
| | - Lei Zhang
- 2 Department of Obstetrics and Gynecology, The First Affiliated Hospital of Yangtze University, Jingzhou, Hubei, People's Republic of China
| | - Jinpeng Jiang
- 2 Department of Obstetrics and Gynecology, The First Affiliated Hospital of Yangtze University, Jingzhou, Hubei, People's Republic of China
| | - Fang Xie
- 2 Department of Obstetrics and Gynecology, The First Affiliated Hospital of Yangtze University, Jingzhou, Hubei, People's Republic of China
| | - Qing Huang
- 2 Department of Obstetrics and Gynecology, The First Affiliated Hospital of Yangtze University, Jingzhou, Hubei, People's Republic of China
| | - Xiaolan Li
- 3 Department of Obstetrics and Gynecology, Yichang second People's Hospital, Yichang, Hubei, People's Republic of China
| | - Cunjian Yi
- 2 Department of Obstetrics and Gynecology, The First Affiliated Hospital of Yangtze University, Jingzhou, Hubei, People's Republic of China
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10
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Abstract
PURPOSE To investigate latent conjunctival Chlamydia trachomatis (CT) and Bacteroides fragilis (BF) infections as potential risk factors for posttrabeculectomy bleb failure. PATIENTS AND METHODS This retrospective observational study included 50 primary open-angle glaucoma eyes of 50 patients who were submitted to trabeculectomy without cytostatics from September 2010 to June 2011 and were followed up for at least a year. Preoperatively, conjunctival scrapings were taken and their specimens subjected to polymerase chain reaction, direct fluorescent assay and cell culture testing for CT, and culture for BF on blood agar medium. Serum CT-specific IgG and IgA and tear interleukin (IL)-1β and IL-8 concentrations were measured with enzyme-linked immunosorbent assay. We defined bleb failure as intraocular pressure >21 mm Hg with antiglaucoma medications, resulting from reduced bleb filtration capacity due to bleb fibrosis, fistula obstruction, flattened bleb, or encapsulated bleb, and no earlier than 2 weeks after surgery. At the time of the reintervention, a scleroconjunctival biopsy was obtained for histopathology (including direct fluorescent assay testing for CT). Eyes were divided into a failure group and a nonfailure group, depending on whether they developed bleb failure (required reintervention) or not within a follow-up year. RESULTS In the failure group (n=18), the frequencies of detection of CT and BF in conjunctival specimens were 27.8% and 66.7%, respectively, versus 0% and 9.4% in the nonfailure group (n=32). CT and BF were detected in 11.1% and 11.1%, respectively, of scleroconjunctival biopsies. IgG and IgA seropositivity to CT was found in 66.7% and 33.3%, respectively, of the failure group patients, versus 9.4% and 0% of the nonfailure group patients. Tear IL-1β and IL-8 levels were markedly elevated in the failure group (468.83±80.43 and 107.89±15.11 pg/mL, respectively) versus the nonfailure group (22.34±5.43 and 9.34±2.83 pg/mL, respectively). CONCLUSION Being a contributor to low-grade conjunctival inflammation, latent conjunctival CT, and BF infections in primary open-angle glaucoma patients represent risk factors for posttrabeculectomy bleb failure.
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Arsić D, Milovanović DR, Ferati AB, Prokić Z, Vlajković V, Ferati K, Arsić J. Monitoring of Chlamydia Trachomatis Genitourinary Infection in Women - Analytical Comparative Study Using Public Health Records from Two Balkan Countries. Cent Eur J Public Health 2016; 24:16-21. [PMID: 27070965 DOI: 10.21101/cejph.a4088] [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: 09/03/2014] [Accepted: 11/11/2015] [Indexed: 11/15/2022]
Abstract
AIM This study investigated the cumulative incidence of Chlamydia trachomatis infection in women treated in gynaecology departments of healthcare facilities in two towns in Serbia and one town in the Former Yugoslav Republic (FYR) of Macedonia, including their medical records in public health reports. METHODS A cross-sectional observational research design with retrospective data collection during a five-year period (2008-2012) originated from women treated as in- and out-patients. The data included the results of cervical and urethral swab testing on Chlamydia trachomatis infection and women's gynaecological diagnoses in Pomoravlje County (the Institute of Public Health Cuprija "Pomoravlje" in Cuprija, Alba outpatient clinic, Paracin) and in Skopje (Clinic for Obstetrics and Gynaecology, "Mikrolab" laboratory). RESULTS The incidence of positive ELISA assay from samples from the Institute of Public Health "Pomoravlje" Cuprija and polyclinic Alba was 6.5% and 12.5%, respectively (p<0.01). The incidence of positive DFA test from samples from the Clinic for Obstetrics and Gynaecology, Skopje and "Mikrolab" laboratory was 18.8% and 15.2%, respectively (p=0.20). In Pomoravlje County and in Skopje 7.5% and 17.6% of urethral swab samples were positive for Chlamydia trachomatis, respectively (p<0.01). The rate of microbiological samples tested for Chlamydia trachomatis in Pomoravlje County and Skopje was 48.4% and 21.2%, respectively (p<0.01). One-year incidences of Infectio sexuales chlamydiales (A56) from 2007-2011 were significantly different among three data settings relating to Serbia, the FYR of Macedonia and Pomoravlje County (p<0.001). CONCLUSIONS The incidence of Chlamydia trachomatis positive cervical and urethral swabs in our study were highly variable between countries and within individual hospitals and caused by many factors.
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Affiliation(s)
- Dragutin Arsić
- Institute for Public Health Ćuprija Pomoravlje, Ćuprija, Serbia
| | - Dragan R Milovanović
- Clinical Centre Kragujevac, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | | | | | | | - Kenan Ferati
- Faculty of Medicine, University of Tetovo, Tetovo, FYR of Macedonia
| | - Jovana Arsić
- Faculty of Business-Civil Security, International University of Brčko District, Brčko, Bosnia and Herzegovina
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Efthymiou G, Dardiotis E, Liaskos C, Marou E, Tsimourtou V, Scheper T, Meyer W, Daponte A, Sakkas LI, Hadjigeorgiou G, Bogdanos DP. Anti-hsp60 antibody responses based on Helicobacter pylori in patients with multiple sclerosis: (ir)Relevance to disease pathogenesis. J Neuroimmunol 2016; 298:19-23. [PMID: 27609271 DOI: 10.1016/j.jneuroim.2016.06.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 06/10/2016] [Accepted: 06/22/2016] [Indexed: 12/30/2022]
Abstract
In view of published data suggesting that Helicobacter pylori (Hp) is a trigger of multiple sclerosis (MS), we assessed anti-heat shock protein 60 (hsp60)Hp antibody reactivity in 129 MS patients and 48 demograpically-matched healthy controls (HCs). Anti-Hp antibodies by ELISA were more elevated in MS than HCs but did not differ between different MS phenotypes. All anti-Hp-positive MS sera, irrespectively of their clinical phenotype, were anti-anti-hsp60 positive. Anti-hsp60 Hp seropositivity correlated with age at disease onset. In conclusion, anti-hsp60 Hp antibodies are present in all anti-Hp positive MS patients, and their relevance to disease pathogenesis is questionable.
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Affiliation(s)
- Georgios Efthymiou
- Cellular Immunotherapy & Molecular Immunodiagnostics, Biomedical Section, Centre for Research and Technology-Hellas (CERTH), Institute for Research and Technology-Thessaly (IRETETH), 41222 Larissa, Greece; Department of Neurology, Faculty of Medicine, School of Health Sciences, University of Thessaly, 40500 Larissa, Greece; Department of Rheumatology, University General Hospital, Faculty of Medicine, School of Health Sciences, University of Thessaly, Viopolis, 41110 Larissa, Greece
| | - Efthymios Dardiotis
- Department of Neurology, Faculty of Medicine, School of Health Sciences, University of Thessaly, 40500 Larissa, Greece
| | - Christos Liaskos
- Cellular Immunotherapy & Molecular Immunodiagnostics, Biomedical Section, Centre for Research and Technology-Hellas (CERTH), Institute for Research and Technology-Thessaly (IRETETH), 41222 Larissa, Greece; Department of Rheumatology, University General Hospital, Faculty of Medicine, School of Health Sciences, University of Thessaly, Viopolis, 41110 Larissa, Greece
| | - Emmanouela Marou
- Cellular Immunotherapy & Molecular Immunodiagnostics, Biomedical Section, Centre for Research and Technology-Hellas (CERTH), Institute for Research and Technology-Thessaly (IRETETH), 41222 Larissa, Greece; Department of Rheumatology, University General Hospital, Faculty of Medicine, School of Health Sciences, University of Thessaly, Viopolis, 41110 Larissa, Greece
| | - Vana Tsimourtou
- Department of Neurology, Faculty of Medicine, School of Health Sciences, University of Thessaly, 40500 Larissa, Greece
| | - Thomas Scheper
- Institute of Immunology, EUROIMMUN, 23560 Lubeck, Germany
| | - Wolfgang Meyer
- Institute of Immunology, EUROIMMUN, 23560 Lubeck, Germany
| | - Alexandros Daponte
- Department of Obstetrics and Gyneocology, Faculty of Medicine, School of Health Sciences, University of Thessaly, 40500 Larissa, Greece
| | - Lazaros I Sakkas
- Department of Rheumatology, University General Hospital, Faculty of Medicine, School of Health Sciences, University of Thessaly, Viopolis, 41110 Larissa, Greece
| | - Georgios Hadjigeorgiou
- Department of Neurology, Faculty of Medicine, School of Health Sciences, University of Thessaly, 40500 Larissa, Greece
| | - Dimitrios P Bogdanos
- Cellular Immunotherapy & Molecular Immunodiagnostics, Biomedical Section, Centre for Research and Technology-Hellas (CERTH), Institute for Research and Technology-Thessaly (IRETETH), 41222 Larissa, Greece; Department of Rheumatology, University General Hospital, Faculty of Medicine, School of Health Sciences, University of Thessaly, Viopolis, 41110 Larissa, Greece.
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Jacquier N, Frandi A, Viollier PH, Greub G. Disassembly of a Medial Transenvelope Structure by Antibiotics during Intracellular Division. ACTA ACUST UNITED AC 2015; 22:1217-27. [PMID: 26364930 DOI: 10.1016/j.chembiol.2015.08.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Revised: 07/28/2015] [Accepted: 08/01/2015] [Indexed: 10/23/2022]
Abstract
Chlamydiales possess a minimal but functional peptidoglycan precursor biosynthetic and remodeling pathway involved in the assembly of the division septum by an atypical cytokinetic machine and cryptic or modified peptidoglycan-like structure (PGLS). How this reduced cytokinetic machine collectively coordinates the invagination of the envelope has not yet been explored in Chlamydiales. In other Gram-negative bacteria, peptidoglycan provides anchor points that connect the outer membrane to the peptidoglycan during constriction using the Pal-Tol complex. Purifying PGLS and associated proteins from the chlamydial pathogen Waddlia chondrophila, we unearthed the Pal protein as a peptidoglycan-binding protein that localizes to the chlamydial division septum along with other components of the Pal-Tol complex. Together, our PGLS characterization and peptidoglycan-binding assays support the notion that diaminopimelic acid is an important determinant recruiting Pal to the division plane to coordinate the invagination of all envelope layers with the conserved Pal-Tol complex, even during osmotically protected intracellular growth.
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Affiliation(s)
- Nicolas Jacquier
- Department of Laboratories, Institute of Microbiology, University Hospital Center and University of Lausanne, Lausanne 1011, Switzerland
| | - Antonio Frandi
- Department of Microbiology & Molecular Medicine, Institute of Genetics & Genomics in Geneva (iGE3), Faculty of Medicine/CMU, University of Geneva, Geneva 1211, Switzerland
| | - Patrick H Viollier
- Department of Microbiology & Molecular Medicine, Institute of Genetics & Genomics in Geneva (iGE3), Faculty of Medicine/CMU, University of Geneva, Geneva 1211, Switzerland.
| | - Gilbert Greub
- Department of Laboratories, Institute of Microbiology, University Hospital Center and University of Lausanne, Lausanne 1011, Switzerland.
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Lekovich J, Witkin SS, Doulaveris G, Orfanelli T, Shulman B, Pereira N, Rosenwaks Z, Spandorfer SD. Elevated serum interleukin-1β levels and interleukin-1β-to-interleukin-1 receptor antagonist ratio 1 week after embryo transfer are associated with ectopic pregnancy. Fertil Steril 2015; 104:1190-4. [PMID: 26279136 DOI: 10.1016/j.fertnstert.2015.07.1145] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Revised: 07/02/2015] [Accepted: 07/08/2015] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To investigate whether interleukin-1β (IL-1β) and interleukin-1 receptor antagonist (IL-1RA) serum levels in the early luteal phase differ in IVF cycles that result in an ectopic pregnancy (EP) when compared with other outcomes. DESIGN Retrospective cohort. SETTING Not applicable. PATIENT(S) A total of 307 women whose serum samples were available, with the following IVF outcomes: 103 live births, 80 negative pregnancy tests, 52 biochemical pregnancies, 47 EPs, and 25 miscarriages. INTERVENTION(S) Serum samples were obtained on cycle days 24 and 28 (cycle day 14 = day of egg retrieval). Levels of IL-1β and IL-1RA were determined by quantitative ELISA performed by blinded personnel. MAIN OUTCOME MEASURE(S) IL-1β and IL-1RA levels, IL-1β-to-IL-1RA ratio versus cycle outcome. RESULT(S) The IL-1β levels were predictive of an EP. At cycle days 24 and 28 the mean IL-1β levels were higher in patients with an EP (127.1 pg/mL and 166.9 pg/mL, respectively) than in women with any other IVF outcome (15.8-55.3 pg/mL and 14.8-75.5 pg/mL, respectively). At cycle day 24 the IL-1β-to-IL-1RA ratio was 0.18 in the ectopic group versus 0.01-0.09 in the other groups. CONCLUSION(S) Elevated IL-1β levels and IL-1β-to-IL-1RA ratio as early as 4 days before the first pregnancy test are associated with an EP. If confirmed by prospective studies, clinical application of these findings could potentially improve EP detection.
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Affiliation(s)
- Jovana Lekovich
- The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medical College, New York, New York.
| | - Steven S Witkin
- Division of Immunology and Infectious Diseases, Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, New York
| | - Georgios Doulaveris
- Division of Immunology and Infectious Diseases, Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, New York
| | - Theofano Orfanelli
- Division of Immunology and Infectious Diseases, Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, New York
| | - Brittney Shulman
- The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medical College, New York, New York
| | - Nigel Pereira
- The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medical College, New York, New York
| | - Zev Rosenwaks
- The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medical College, New York, New York
| | - Steven D Spandorfer
- The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medical College, New York, New York
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Prevalence and diagnostic significance of specific IgA and anti-heat shock protein 60 Chlamydia trachomatis antibodies in subfertile women. Eur J Clin Microbiol Infect Dis 2014; 33:761-6. [PMID: 24413970 DOI: 10.1007/s10096-013-2008-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Accepted: 10/21/2013] [Indexed: 10/25/2022]
Abstract
The objective of the present study was to evaluate the clinical usefulness of the simultaneous measurement of three serological markers of chlamydial infection in women with tubal factor infertility (TFI) and spontaneous miscarriage. Serum was collected from 87 patients (33 with TFI and 54 with spontaneous miscarriage) and analyzed for the presence of IgG and IgA antibodies against Chlamydia trachomatis MOMP antigen (Dia.Pro) and IgG antibodies to chlamydial heat shock protein 60 (cHSP60) antigen (Medac). We determined a high degree (64.5 %) of seropositivity against chlamydial antigens in our study population. The prevalence of persistent chlamydial infection has tended to be higher in the group of patients with TFI (41.4 %) than in patients with spontaneous miscarriage (21.3 %). The serum level of IgA, as a marker of active infection, was statistically higher in the TFI group with persistent infection than in the corresponding spontaneous miscarriage group (p = 0.008), while the serum level of IgG showed no statistically significant differences compared with the spontaneous miscarriage group with persistent infection (p = 0.227). Also, using the receiver operating characteristic (ROC) curve, we found that the serum level of IgA has the ability to discriminate patients with persistent chlamydial infection between the TFI and miscarriage groups, with a sensitivity and specificity of 74.3 % and 71.4 %, respectively. To the best of our knowledge, the present study is the first study which, besides the already confirmed linkage between serologic evidence of persistent chlamydial infection and TFI, also confirmed associations between spontaneous miscarriage and serologic evidence of persistent chlamydial infection.
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Current World Literature. Curr Opin Rheumatol 2013; 25:275-83. [DOI: 10.1097/bor.0b013e32835eb755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Shao R, Wang X, Wang W, Stener-Victorin E, Mallard C, Brännström M, Billig H. From mice to women and back again: causalities and clues for Chlamydia-induced tubal ectopic pregnancy. Fertil Steril 2012; 98:1175-85. [PMID: 22884019 DOI: 10.1016/j.fertnstert.2012.07.1113] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2012] [Revised: 07/12/2012] [Accepted: 07/12/2012] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To provide an overview of knockout mouse models that have pathological tubal phenotypes after Chlamydia muridarum infection, discuss factors and pathological processes that contribute to inflammation, summarize data on tubal transport and progression of tubal implantation from studies in humans and animal models, and highlight research questions in the field. DESIGN A search of the relevant literature using PubMed and other online tools. SETTING University-based preclinical and clinical research laboratories. PATIENT(S) Women with tubal ectopic pregnancy after Chlamydia trachomatis infection. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Critical review of the literature. RESULT(S) Chlamydia trachomatis infection poses a major threat to human reproduction. Biological and epidemiological evidence suggests that progression of Chlamydia infection causes intense and persistent inflammation, injury, and scarring in the fallopian tube, leading to a substantially increased risk of ectopic pregnancy and infertility. The main targets of Chlamydia infection are epithelial cells lining the mucosal surface, which play a central role in host immune responses and pathophysiology. Tubal phenotypes at the cellular level in mutant mice appear to reflect alterations in the balance between inflammatory mediator and factor deficiency. While studies in mice infected with Chlamydia muridarum have provided insight into potential inflammatory mediators linked to fallopian tube pathology, it is unclear how inflammation induced by Chlamydia infection prevents or retards normal tubal transport and causes embryo implantation in the fallopian tube. CONCLUSION(S) Given the similarities in the tubal physiology of humans and rodents, knockout mouse models can be used to study certain aspects of tubal functions, such as gamete transport and early embryo implantation. Elucidation of the exact molecular mechanisms of immune and inflammatory responses caused by Chlamydia infection in human fallopian tubal cells in vitro and understanding how Chlamydia infection affects tubal transport and implantation in animal studies in vivo may explain how Chlamydia trachomatis infection drives inflammation and develops the tubal pathology in women with tubal ectopic pregnancy.
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Affiliation(s)
- Ruijin Shao
- Department of Physiology/Endocrinology, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
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