Cytokine levels in follicular fluid of polycystic ovaries in patients treated with dexamethasone

A review of nitric oxide and oxidative stress in typical ovulatory women and in the pathogenesis of ovulatory dysfunction in PCOS

Polycystic ovary syndrome (PCOS) is a heterogeneous functional endocrine disorder associated with a low-grade, chronic inflammatory state. Patients with PCOS present an increased risk of metabolic comorbidities and often menstrual dysregulation and infertility due to anovulation and/or poor oocyte quality. Multiple mechanisms including oxidative stress and low-grade inflammation are believed to be responsible for oocyte deterioration; however, the influence of nitric oxide (NO) insufficiency in oocyte quality and ovulatory dysfunction in PCOS is still a matter for debate. Higher production of superoxide (O2•-) mediated DNA damage and impaired antioxidant defense have been implicated as contributory factors for the development of PCOS, with reported alteration in superoxide dismutase (SOD) function, an imbalanced zinc/copper ratio, and increased catalase activity. These events may result in decreased hydrogen peroxide (H2O2) accumulation with increased lipid peroxidation events. A decrease in NO, potentially due to increased activity of NO synthase (NOS) inhibitors such as asymmetric dimethylarginine (ADMA), and imbalance in the distribution of reactive oxygen species (ROS), such as decreased H2O2 and increased O2•-, may offset the physiological processes surrounding follicular development, oocyte maturation, and ovulation contributing to the reproductive dysfunction in patients with PCOS. Thus, this proposal aims to evaluate the specific roles of NO, oxidative stress, ROS, and enzymatic and nonenzymatic elements in the pathogenesis of PCOS ovarian dysfunction, including oligo- anovulation and oocyte quality, with the intent to inspire better application of therapeutic options. The authors believe more consideration into the specific roles of oxidative stress, ROS, and enzymatic and nonenzymatic elements may allow for a more thorough understanding of PCOS. Future efforts elaborating on the role of NO in the preoptic nucleus to determine its influence on GnRH firing and follicle-stimulating hormone/Luteinizing hormone (FSH/LH) production with ovulation would be of benefit in PCOS. Consequently, treatment with an ADMA inhibitor or NO donor may prove beneficial to PCOS patients experiencing reproductive dysfunction and infertility.

Influence of interleukin 1 beta and tumour necrosis factor alpha on the in vitro growth, maturation and mitochondrial distribution of bovine oocytes from small antral follicles

SummaryThis study aimed to investigate the effects of IL1β and TNFα on growth and maturation of oocytes from small follicles (1-3 mm) during in vitro culture. To this end, cumulus-oocyte complexes (COCs) with diameters of ~110 µm were cultured in TCM-199 medium alone or supplemented with IL1β (10 ng/ml), TNFα (10 ng/ml) or both for 48 h. The oocytes were measured at the beginning and at the end of the culture period. COCs were cultured for 20 h in pre-maturation medium and then half of the COCs of each group was destined for in vitro maturation and the remaining COCs were used to evaluate meiotic progression, mitochondrial distribution and the expression of mRNAs for GDF-9, c-Mos, Cyclin-B1 and H1foo. The results showed that COCs cultured with TNFα alone or together with IL1β had higher diameters than those cultured in control medium alone or supplemented with IL1β. Control oocytes isolated from large antral follicles (>5 mm) had heterogeneous distribution of mitochondria. Oocytes isolated from small antral follicles, that had been grown in vitro in TCM-199 alone or supplemented with TNFα had similar heterogeneous mitochondrial distribution before in vitro maturation (IVM). After IVM, mitochondria were heterogeneously distribution when cultured in TCM-199. However, when cultured with TNFα and/or IL1β, mitochondria were homogeneously distributed. Presence of TNFα and/or IL1β in TCM-199 culture medium did not influence the expression of mRNAs for GDF-9, c-Mos, Cyclin-B1 and H1foo. In conclusion, TNFα and a mixture of TNFα and IL1β both stimulated the growth of bovine oocytes during their in vitro culture, but do not influence gene expression in grown oocytes.

Gonadotrophin stimulation in IVF alters the immune cell profile in follicular fluid and the cytokine concentrations in follicular fluid and serum

Study question

Are the immune cell profiles and the cytokine concentrations in follicular fluid (FF) and serum at the preovulatory stage different in conventional exogenous gonadotrophin stimulated IVF (c-IVF) compared with natural cycle IVF (NC-IVF)?

Summary answer

The cell counts of CD45+ leucocytes and T cell subpopulations and the cytokine concentrations in FF and serum are different in c-IVF compared to NC-IVF.

What is known already

FF-derived cells are heterogeneous. Immune cells are involved in intra-ovarian processes and cytokines are required for normal follicular development. Gonadotrophins stimulate the regulatory intrafollicular system and influence the local distribution of immune cells and the intrafollicular release of cytokines. Administration of exogenous gonadotrophins may have a significant effect on this local regulatory system, which then in turn could influence oocyte quality.

Study design, size, duration

The study included 105 patients, 69 undergoing c-IVF and 36 undergoing NC-IVF. c-IVF was performed by exogenous ovarian stimulation with hMG and GnRH antagonists.

Participants/materials, setting, methods

FF samples were collected from the first dominant follicle in c-IVF without pooling and from single leading preovulatory follicles in NC-IVF. Three different approaches were used to analyze FF samples: (i) microscopic investigation of CD45+ leucocytes, (ii) fluorescence-activated cell sorting to determine CD19+ B cells and CD3+ T cells including T cell subpopulations (CD4+, CD8+), and (iii) evaluation of tumour necrosis factor-alpha (TNF-α), interferon-gamma (INF-γ), interleukins (IL)-2, -6, -8, -10 and vascular endothelial growth factor (VEGF) levels in matched FF and serum samples using the Bio-Plex® platform.

Main results and the role of chance

FF obtained from c-IVF contained proportionally more CD45+ leucocytes (P = 0.0384), but fewer CD8+ cytotoxic T cells than FF from NC-IVF. CD3+ T lymphocytes were the most common type of lymphocytes, and the number thereof was comparable in the two study groups. In c-IVF, serum VEGF levels were higher (P = 0.007) than in NC-IVF while FF contained marginally decreased concentrations of IL-8 in c-IVF in comparison to NC-IVF. The cytokine concentration gradient between FF and serum in c-IVF was 10-fold for IL-8 and 8-fold for VEGF and thereby markedly lower than in NC-IVF, where the differences were 32-fold and 30-fold, respectively. Strong positive correlations were determined between FF- IL-10 and FF- VEGF in c-IVF (r = 0.85, P < 0.0001) and in NC-IVF (r = 0.81, P < 0.0001).

Large scale data

N/A.

Limitations, reasons for caution

The ovulation of NC-IVF follicles was induced by the exogenous administration of hCG, which means that the environment did not fully correspond to the physiological situation.

Wider implications of the findings

The differences in the immune profile and the cytokine concentrations in c-IVF and NC-IVF follicles support the hypothesis that conventional ovarian stimulation affects indirectly and heterogeneously the intrafollicular milieu, and thereby possibly affects the oocyte quality and the IVF outcome. However, further studies are needed to confirm our findings and to refine stimulation protocols in the context of optimizing the intrafollicular environment during oocyte maturation.

Study funding/competing interest(s)

The study was supported by a research grant from IBSA Institut Biochimique SA and MSD Merck Sharp & Dohme GmbH. The authors are clinically involved in low dose mono-follicular stimulation and IVF-therapies, using gonadotrophins from all gonadotrophins distributors on the Swiss market, including Institut Biochimique SA and MSD Merck Sharp & Dohme GmbH.

The promoter -1031(T/C) polymorphism in tumor necrosis factor-alpha associated with polycystic ovary syndrome

BACKGROUND

A tumor necrosis factor-alpha is a multifunctional pro-inflammation cytokine, which has been considered as one of pathogenic factors for various diseases. The promoter -1031(T/C) polymorphism in the tumor necrosis factor-alpha gene was reported that it plays a part in reproduction-related diseases. Among these, polycystic ovary syndrome (PCOS) is known to be a common gynecological disease of women in reproductive age women. Here, we performed a comparative study of -1031(T/C) polymorphism of TNF-alpha gene with PCOS in a Korean population.

METHODS

The -1031(T/C) polymorphism of TNF-alpha gene was analyzed by polymerase chain reaction restriction fragment length polymorphism (PCR-RFLP) in a total of 217 PCOS patients and 144 matched female controls of healthy women. And statistical analysis was performed using HapAnalyzer. X2 test and logistic regression were utilized analyze the association between two groups. A p-value under 0.05 was considered statistically significant.

RESULTS

The genotype and allelic frequencies were in Hardy-Weinberg equilibrium (HWE). There was strong association between the -1031(T/C) polymorphism in the promoter region of TNF-alpha gene and PCOS (p-value = 0.0003, odd ratio (OR) = 2.53). In addition, the frequency of C allele was significantly higher in PCOS patients compared with controls. Sequence analyses also showed the -1031(T/C) polymorphism of TNF-alpha gene.

CONCLUSION

This is the first study on the -1031(T/C) polymorphism of TNF-alpha gene in PCOS. We concluded that the -1031(T/C) polymorphism of TNF-alpha gene is associated with PCOS in a Korean population. Therefore, it is possible that it may be considered as a clinical biomarker to diagnose for PCOS, and is helpful in understanding the etiology for the pathogenesis of PCOS.

Extra- and intra-ovarian factors in polycystic ovary syndrome: impact on oocyte maturation and embryo developmental competence

BACKGROUND

Polycystic ovary syndrome (PCOS) is a common metabolic dysfunction and heterogeneous endocrine disorder in women of reproductive age. Although patients with PCOS are typically characterized by increased numbers of oocytes retrieved during IVF, they are often of poor quality, leading to lower fertilization, cleavage and implantation rates, and a higher miscarriage rate.

METHODS

For this review, we searched the database MEDLINE (1950 to January 2010) and Google for all full texts and/or abstract articles published in English with content related to oocyte maturation and embryo developmental competence.

RESULTS

The search showed that alteration of many factors may directly or indirectly impair the competence of maturating oocytes through endocrine and local paracrine/autocrine actions, resulting in a lower pregnancy rate in patients with PCOS. The extra-ovarian factors identified included gonadotrophins, hyperandrogenemia and hyperinsulinemia, although intra-ovarian factors included members of the epidermal, fibroblast, insulin-like and neurotrophin families of growth factors, as well as the cytokines.

CONCLUSIONS

Any abnormality in the extra- and/or intra-ovarian factors may negatively affect the granulosa cell-oocyte interaction, oocyte maturation and potential embryonic developmental competence, contributing to unsuccessful outcomes for patients with PCOS who are undergoing assisted reproduction.

Circulating inflammatory markers in polycystic ovary syndrome: a systematic review and metaanalysis

OBJECTIVE

To perform a review and metaanalysis of the studies evaluating the status of serum inflammatory markers in women with polycystic ovary syndrome (PCOS).

DESIGN

Systematic review and metaanalysis of articles published in English before January 2010 and identified using the PubMed search engine.

SETTING

Academic hospital.

PATIENT(S)

Women with PCOS and appropriate controls.

INTERVENTION(S)

Measurement of serum concentrations of inflammatory markers by high-sensitivity techniques.

MAIN OUTCOME MEASURE(S)

Metaanalyses of the mean difference in serum C-reactive protein (CRP), interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) concentrations among patients with PCOS and appropriate controls, applying random-effects models to limit interstudy variability, and using appropriate estimates of evidence dissemination bias.

RESULT(S)

Metaanalysis of the 31 articles meeting inclusion criteria showed that circulating CRP was 96% higher in women with PCOS compared to controls (95% confidence interval, 71%-122%; z = 7.32) without evidence of dissemination bias (Egger's regression intercept, 0.45; 95% confidence interval, -2.30 to 3.21). These findings persisted after excluding five studies with mismatches in body mass, frequency of obesity, or both, between women with PCOS and controls. Metaanalyses involving 10 studies of IL-6, and nine studies of TNF-α revealed no statistically significant differences between PCOS and controls.

CONCLUSION(S)

Women with PCOS exhibit an elevation in circulating CRP that is independent of obesity. This finding corroborates existing molecular evidence of the chronic low-grade inflammation that may underpin the pathogenesis of this disorder.

The role of interleukins in the ovary

A brief look at the history of cytokine research shows that the term ‘lymphokine’ was first described in 1969 as the product of sensitized lymphocytes exposed to specific antigens. To eliminate the incorrect notion that such proteins can be produced only by lymphocytes, Cohenet al.(1974) proposed the term ‘cytokines’ to indicate their production also by nonlymphoid cells.2After a long-persisting reluctance, it seems that ‘cytokine’ is becoming the prevalent term for these proteins. Meanwhile, a group of participants at the Second International Lymphokine Workshop held in 1979 proposed the term ‘interleukin’ in order to develop, ‘a system of nomenclature based on the protein's ability to act as communication signals between different populations of leukocytes’.3They introduced the names IL-I and IL-2 for two important cytokines. Since then the number of described interleukins reached 16 and this number may increase. Furthermore, notwithstanding this previous notion, interleukins are now known to be produced in a variety of tissues other than leucocytes and affect the functions of many and diverse somatic cell types (e.g. IL-1 or IL-6). Therefore, while many cytokines are now termed as interleukins, others continue to be known by their old names [e.g. tumour necrosis factor-alpha (TNF-α)], suggesting that they had been recognized earlier, but all of them are included under the generic name of cytokines.

Leukocytes: essential cells in ovarian function and ovulation

The disciplines of reproduction and immunology, once quite discrete, are now closely associated, with compelling evidence to suggest that immune mechanisms play important roles in the cervix, uterus, fallopian tubes and ovary. Cells and mediators classically described as part of the immune system are found throughout the reproductive tract. Disorders of reproduction, including pre-eclampsia, unexplained infertility, endometriosis, recurrent miscarriage and disturbed fetal growth almost certainly have some of their origins in the dysfunction of immune regulation. There appears to be some evidence that immune disorders, such as rheumatoid arthritis and scleroderma, can manifest as infertility, before clinical disease becomes apparent.

Serum levels of soluble vascular cell adhesion molecule-1, tumor necrosis factor-alpha, and interleukin-6 in in vitro fertilization cycles

OBJECTIVE

To assess whether gonadotropin-induced changes in E(2) alter serum levels of soluble vascular cell adhesion molecule-1 (sVCAM-1) and proinflammatory cytokines.

DESIGN

Prospective collection of serum in patients undergoing IVF.

SETTING

University hospital.

PATIENT(S)

Twenty-four infertile women.

INTERVENTION(S)

Serum collection at baseline, in the mid and late follicular phases, at oocyte retrieval, and in the mid and late luteal phases.

MAIN OUTCOME MEASURE(S)

Samples were assayed for sVCAM-1, tumor necrosis factor-alpha (TNF-alpha), interleukin-6 (IL-6), and E(2).

RESULT(S)

The VCAM-1 was maximally suppressed in the luteal phase. Luteal sVCAM-1 levels correlated [1] positively with the patient's age, units of gonadotropins, day 3 FSH levels and [2] negatively with [a] the follicular, retrieval, and luteal E(2) levels and [b] the number of preovulatory follicles and oocytes retrieved. Similar correlations were noted in the late luteal phase. Serum TNF-alpha reached a peak in the mid-follicular phase and a nadir in the luteal phase. The TNF-alpha levels at retrieval correlated [1] positively with the patient's age and [2] negatively with E(2) and number of preovulatory follicles and retrieved oocytes. The IL-6 levels were suppressed in the follicular phase and correlated negatively with E(2) levels.

CONCLUSION(S)

Changes in E(2) levels seen during gonadotropin stimulation significantly alter VCAM-1 expression and induce changes in serum IL-6 and TNF-alpha levels.

Novel follicular fluid factors influencing oocyte developmental potential in IVF: a review

The aim of IVF centres today is to obtain high quality, developmentally competent embryos, and thus increase live birth rates. Apoptosis in the patient's follicles in among the factors that will determine IVF outcome. Follicular fluid constitutes an important microenvironment, containing apoptotic factors and others, which influence oocyte growth. The sFas-sFas ligand system is present in the follicular fluid and may play a role in preventing oocyte aresia during folliculogenesis. Levels of the anti-apoptotic molecule sFas may be related positively to oocyte maturation and negatively to fertilization and embryo quality. Reactive oxygen species exert a toxic effect when found in high concentrations in the follicular fluid, whereas in low concentrations they might be indispensable for pregnancy and therefore serve as a potential marker for successful IVF outcome. Nitric oxide plays a dual role; in some cells promoting and in others inhibiting apoptosis. Nitric oxide production is stimulated by TNF-alpha, so the latter is also implicated in the apoptotic process. Hyaluronan, a disaccharide, whose functions have not been fully elucidated, is a valuable predictor of oocyte fertilization. Gelatinases are responsible for remodelling during follicular atresia. In conclusion, a number of factors found in the follicular fluid, some involved in apoptosis, can infulence assisted reproduction.

Follicular fluid concentration of leukaemia inhibitory factor is decreased among women with polycystic ovarian syndrome during assisted reproduction cycles

BACKGROUND

The possibility that a specific cytokine profile could be detected in the ovaries of patients with polycystic ovarian syndrome (PCOS) was investigated.

METHOD

Enzyme-linked immunosorbent assay (ELISA) or bioassays were used to assess the concentrations of leukaemia inhibitory factor (LIF), tumour necrosis factor, interleukin 11, gamma interferon, progesterone and oestradiol in follicular fluids from preovulatory follicles collected after ovarian stimulation from 15 PCOS patients, 15 infertile control patients with regular cycles, and 8 oocyte donors.

RESULTS

LIF and progesterone concentrations were significantly lower in the follicular fluid of PCOS patients (LIF median: 265 pg/ml) compared with controls (LIF median: 816 pg/ml); LIF and progesterone follicular fluid concentrations were correlated (r = 0.720, P = 0.0001). The LH/FSH ratio was negatively correlated with LIF concentrations (r = - 0.714, P = 0.0075). Although the PCOS and control patients did not differ significantly in age, ovarian reserve or IVF indication, the implantation rate was significantly lower among the women with PCOS (IR = 9 versus 21%, P = < 0.01).

CONCLUSION

The specific cytokine profile of the PCOS patients is probably related to the lower implantation rate since follicular fluid LIF appears to function as an embryotrophic agent.

Elevated expression of tumour necrosis factor alpha in cultured granulosa cells from women with endometriosis

Fertilization and oocyte cleavage rates have previously been demonstrated to be lower for women with endometriosis undergoing IVF compared with controls. This might be related to impaired oocyte function, possibly due to an inflammatory milieu in the pelvis of these women, where an elevated concentration of many cytokines is documented. The aim of this study was to examine whether granulosa cells from women with endometriosis deviated with respect to production of the inflammatory cytokines interleukin-1beta, interleukin-6, interleukin-8 and tumour necrosis factor alpha (TNFalpha) compared with granulosa cells from healthy women, undergoing IVF for male infertility. The effect of human chorionic gonadotrophin on cytokine production was also investigated. Granulosa cells in follicular fluid were obtained at oocyte retrieval for IVF. Incubated cell culture media were analysed by enzyme-linked immunosorbent assay. The basal production of all four cytokines was higher in cells from women with endometriosis when compared to controls, although the increase was only significant for TNFalpha. Chorionic gonadotrophin had no significant effect, although it had a tendency to suppress cytokine release in both patient categories. Whether aberrant cytokine production in granulosa cells from women with endometriosis may disturb fertilizing capacity of oocytes requires study.

Relationships between concentrations of tumor necrosis factor-alpha and nitric oxide in follicular fluid and oocyte quality

PURPOSE

Our objective was to explain a relationship between concentrations of tumor necrosis factor-alpha (TNF-alpha) and nitric oxide (NO) in follicular fluid, oocyte quality, and outcomes of in vitro fertilization--embryo transfer (IVF-ET).

METHODS

The concentrations of TNF-alpha and NO were measured in 115 follicular fluid samples collected from 43 patients undergoing IVF-ET program, due to tubal obstruction, some with endometriosis (8 patients) or hydrosalpinx (5 patients). A correlation of these factors concentrations and the oocyte quality, the oocyte maturity, and infertility-associated diseases was analyzed.

RESULTS

No correlation was found between concentrations of NO and TNF-alpha in follicular fluid. NO concentrations in follicular fluids were significantly higher in patients with endometriosis (P < 0.001) or hydrosalpinx (P < 0.01) compared to the patients with just tubal obstruction. Follicular NO concentration differences according to oocyte maturity and oocyte quality were not found. In contrast, TNF-alpha concentrations in follicular fluids were significantly higher in poor quality oocytes (P < 0.05) but were not associated with infertility-associated diseases, such as hydrosalphinx or endometriosis,and the oocyte maturity. No significant differences in follicular levels of NO and TNF-alpha as well as IVF-ET parameters of pregnant and nonpregnant groups were revealed.

CONCLUSIONS

There is no significant correlation between the concentrations of NO and TNF-alpha in follicular fluid. NO levels in follicular fluid are altered in infertility-associated diseases. However, TNF-alpha levels but not NO levels influence oocyte quality. These results suggest that the production of NO and TNF-alpha in follicular fluid may be regulated via different pathways and can be tempered with infertility-associated diseases, thereby influencing oocyte quality locally.

Gonadotropins induce the release of interleukin-1 beta, interleukin-6 and tumor necrosis factor-alpha from the human preovulatory follicle

PROBLEM

The effects of exogenous gonadotropin administration and steroid levels on the release of various cytokines into the human follicular fluid (FF) were studied.

METHOD OF STUDY

Forty patients were included in two groups, those undergoing controlled ovarian hyperstimulation (COH) (n = 33) and natural cycles (n = 7). FF transvaginal aspirations were performed 36 hr after administration of human chorionic gonadotropin or a spontaneous surge of luteinizing hormone, respectively. FF cytokine measurements were performed with sensitive immunoassays.

RESULTS

FF cytokine levels were higher after COH [interleukin (IL)-1 beta, 6.6 +/- 0.32 pg/ml; IL-6, 18.7 +/- 2.1 pg/ml; and tumor necrosis factor (TNF)-alpha, 32.5 +/- 4.9 pg/ml] than in natural unstimulated cycles (0.52 +/- 0.1 pg/ml, P < 0.001; 8.9 +/- 1.2 pg/ml, P < 0.01; and 13.2 +/- 2.6 pg/ml, P < 0.001, respectively). FF estradiol (E2) and progesterone levels were not statistically different between groups, despite the higher serum E2 levels observed in patients after COH.

CONCLUSIONS

Gonadotropins might regulate ovarian secretion of cytokines, because FF IL-1 beta, IL-6, and TNF-alpha levels after COH were higher than during natural cycles.

Tumor necrosis factor-alpha (TNF-alpha) inhibits steroidogenesis of bovine ovarian granulosa and thecal cells in vitro. Involvement of TNF-alpha receptors

The effect of recombinant bovine tumor necrosis factor-alpha (TNF-alpha) on steroidogenesis and numbers of bovine ovarian granulosa and thecal cells has been studied, and specific binding sites for 125I-TNF-alpha on ovarian cells have been determined. Granulosa cells have been examined from small (surface diameter 1-5 mm) follicles, whereas thecal cells from large (> or = 8 mm) follicles were utilized. Increasing doses of TNF-alpha significantly attenuated insulin- and IGF-I-induced estradiol production by granulosa cells from small follicles, but had no effect on basal estradiol production. Moreover, TNF-alpha significantly attenuated insulin- and LH-induced androstenedione production by thecal cells from large follicles. TNF-alpha had little or no effect on the numbers of granulosa and thecal cells in these same studies. Specific high-affinity, low-capacity binding of 125I-TNF-alpha was also demonstrable in granulosa and thecal cells. Thus, it appears that TNF-alpha inhibits insulin- and IGF-I-induced estradiol production by granulosa cells and androstenedione production by thecal cells via TNF-alpha binding to its own receptor.

Cytokines in the human ovary: presence in follicular fluid and correlation with leukotriene B4

PURPOSE

This study was undertaken to correlate the follicular levels of interleukin (IL)-1 alpha, IL-2, tumor necrosis factor-alpha (TNF-alpha), and leukotriene (LT) B4 with oocyte maturity, fertilization, and achievement of pregnancy.

METHODS

The material was obtained from 22 women undergoing IVF, 8 of whom became pregnant and 14 of whom did not.

RESULTS

All of the studied cytokines and LT B4 were found in follicular fluids, but there were no significant differences according to oocyte maturity, fertilization, embryo quality, and achievement of pregnancy. On the other hand, a significant positive correlation was found between IL-1 alpha and TNF-alpha, IL-1 alpha, and LT B4 as well as between TNF-alpha and LT B4 in follicular fluids with subsequently fertilized oocytes.

CONCLUSIONS

It seems that IL-1 alpha, TNF-alpha and LT B4 may take part in the process of follicle wall degradation, and their follicular correlations may suggest more optimal follicular and oocyte development and maturation.

Review: cytokine involvement in ovarian processes

PROBLEM

Expression of tumor necrosis factor-alpha (TNF) and interleukins 1 alpha and 1 beta (IL-1) have been reported in ovaries of several species and humans and are implicated in ovarian follicular development and atresia, ovulation, steroidogenesis, and corpus luteum function (including formation, development, and regression). The principal abnormal processes affected by these cytokines are ovarian cancer and reduction of ovarian function during sepsis.

METHODS

A literature review.

RESULTS

Numerous studies indicate that TNF and IL-1 inhibit gonadotropin-stimulated steroidogenesis of undifferentiated ovarian cells due to inhibition of adenylyl cyclase and post-cAMP sites. In differentiated ovarian cells, these cytokines either stimulate progesterone synthesis or have little to no effect on steroidogenesis. Both cytokines participate in ovulation and levels of these cytokines increase during the preovulatory period. Endotoxin inhibits gonadotropin-stimulated ovarian steroidogenesis and follicular development and these effects are mediated, in part, by TNF and by direct effects of endotoxin on ovarian cells. IN newly formed corpora lutea, progesterone secretion is inhibited by TNF and IL-1, although each has proliferative effects. TNF also has been implicated in regression of corpora lutea because TNF stimulates prostaglandin synthesis and luteal TNF increases after initiation of the decline in progesterone secretion. TNF and IL-1 are secreted by some ovarian cancer cells and stimulate growth of these cells.

CONCLUSIONS

Thus, TNF and IL-1 are multifunctional factors affecting various ovarian processes.

Cytokines in the ovary: pathophysiology and potential for pharmacological intervention

The ovary and testis are sites for interaction between the endocrine and immune system via leukocytes and their secreted products, the cytokines. There are convincing data available to show that the gonads are sites of cytokine action and production. In the ovary, cytokines and leukocytes are intimately involved in follicular development, ovulation, and luteal function. A variety of clinical situations may be due to cytokine action in the gonads, and therapeutic manipulation of the immune system may affect reproductive function.

Interleukin-1 beta (IL-1 beta) is increased in the follicular fluids of patients with premature luteinization

PROBLEM

Most, but not all, studies indicate that premature luteinization correlates with poor pregnancy outcome in in-vitro fertilization (IVF) programs. It remains unclear whether cytokines (IL-1 beta, TNF alpha), the established immune mediators, play a role in regulation or initiation of an abnormal follicular or embryo development in patients with premature luteinization.

METHODS

Levels of cytokines (IL-1 beta, TNF alpha), estradiol (E2) progesterone (P4), and androstenedione (A'ione) were examined in 18 preovulatory follicular fluid (FF) samples from patients with premature luteinization (group 1) and 3 FF samples from patients without premature luteinization (group 2). The number of oocytes recovered, fertilization rate, and pregnancy outcome were evaluated in these two groups.

RESULT

IL-1 beta (25.4 +/ 11.9 pg/ml, mean +/ SD) and TNF alpha (13.4 +/ 10.7 pg/ml) were present in these FF samples. The mean level of IL-1 beta in group 1 was significantly higher than that in group 2 (37.3 +/ 12.3 vs. 20.0 +/ 7.6 pg/ml; P < 0.00001) and the mean level of E2 was significantly lower in group 1 than that in group 2 (1064 +/ 686 vs. 1570 +/ 641 ng/ml; P = 0.02). The levels of TNF alpha, P4, and A'ione showed no distinction between these two groups. There was no correlation between the levels of either IL-1 beta or TNF alpha and P4, E2 or A'ione. The fertilization rate in group 1 (62/77; 80%) was similar to that in group 2 (124/160; 78%). Five of 7 patients in group 1 and seven of 20 patients in group 2 achieved pregnancy following embryo transfer. One of five pregnancies in group 1 aborted.

CONCLUSION

The exaggerated levels of IL-1 beta in patients with premature luteinization may arise from accumulation of this cytokine owing to sustained high LH stimulation, and this may be a protective response to the abnormal LH surge and function to inhibit prematurely increased secretion of P4. These data indicate the important role of LH in the induction of IL-1 beta secretion and the possible regulatory action of IL-1 beta in luteinization. According to the diminution of E2 in group 1, there may be a subtle atretic process progressing in follicles primed with prematurely elevated LH. However, the detrimental effect of premature luteinization, if it exists, may work at the stage ¿during or after implantation.

Immunological aspects of ovarian function: role of the cytokines

Interaction between the immune system and reproduction is multiple. Either directly or indirectly through their products, immune cells are associated with the regulation of every level of the hypothalamus-pituitary-ovarian axis. Immune cells are present in the ovaries and their numbers increase during the cycle. During the follicular development cytokines assist granulosa cell growth while inhibiting their differentiation. During the LH peak, an influx of immune cells occurs and several cytokines are released. The rupture of the follicle is considered as an inflammatory reaction. IL-1, TNF-alpha are the main cytokines involved in this process. During the luteal phase, the installation of the corpus luteum needs the setting up of neovascularization. Cytokines are probable candidates for this function, but they also promote cellular differentiation resulting in steroid synthesis. In the absence of pregnancy T lymphocytes and eosinophils are involved in corpus luteum regression. Their products are directly cytotoxic for the luteal cells. They attract macrophages which are locally activated to phagocytose the damaged luteal cells. They can induce apoptosis of endothelial and luteal cells through gene expression. Cytokines are members of a larger regulatory network residing in the ovary and involving hormones and growth factors. The various stages of ovarian cycle will be shown from an immunological point of view. Understanding the role of the cytokines should enable us to go beyond a purely descriptive stage, and allow us to envisage new ovulation induction therapy and treatment in certain cases of premature menopause.

In vivo CD3+CD25+ lymphocyte subpopulation is down-regulated without increased serum-soluble interleukin-2 receptor (sIL-2R) by gonadotropin releasing hormone agonist (GnRH-a)

PROBLEM

To test further whether the suppression of the CD3+CD25+ lymphocyte subpopulation by gonadotropin-releasing hormone agonist (GnRH-a) is related to the change in levels of cytokines and soluble interleukin-2 receptor (sIL-2R).

METHOD

Twenty-seven infertile patients were enrolled under the long protocol of GnRH-a agonist (buserelin acetate) and superovulation with gonadotropin from our IVF-ET program. Peripheral B cells, NK cells, CD4+ and CD8+ T cells and the expression of CD69, CD25, HLA-DR, and CD71 antigens on the T cells were serially examined by dual-color flow cytometry. Serum levels of cytokines and sIL-2R were measured.

RESULTS

The B cells, NK cells, T cells, CD4+, CD8+ T cells, CD3+DR+, and CD3+CD71+ lymphocyte subpopulations were not changed after the use of GnRH-a. The CD25+ T cell subpopulation was significantly down-regulated, but the CD69+ T cell subpopulation was increased when the GnRH-a was used for approximately 2 wk. The serum levels of interleukin-1 beta (IL-1 beta), interleukin-2 (IL-2), interleukin-4 (IL-4), interferon-gamma (IFN-gamma), and sIL-2R were not changed.

CONCLUSION

The GnRH-a had a transiently suppressive effect on CD25+ T cells, but a stimulatory effect on CD69+ T cells. However, the serum level of cytokines or sIL-2R did not change. These immunological modulations seems to be the result of interaction between GnRH-a and estrogen.

Effects of cytokines on FSH-induced estradiol production by bovine granulosa cells in vitro: dependence on size of follicle

The objective of the present studies was to determine the effect of cytokines on FSH-induced estrogen production by granulosa cells from small (1-5 mm) and large (> or = 8 mm) bovine follicles. FSH-induced estradiol production by granulosa cells from large follicles (expressed as pg estradiol/10(5) cells/24 hr) was not affected (P > .05) by 10 or 100 ng/ml of interleukin (IL)-1 beta, 10 or 100 ng/ml of tumor necrosis factor-alpha (TNF alpha) or 100 ng/ml of IL-2. In contrast, 100 ng/ml of IL-1 beta, IL-2 or TNF alpha inhibited (P < .05) FSH-induced estradiol production by 31%, 55% or 72%, respectively in cells from small follicles. Interferon-alpha (IFN alpha; 100 U/ml) inhibited (P < .05) FSH-induced estradiol production by 61% and 20% in cultures of cells from small and large follicles, respectively. Interferon-beta (IFN beta; 100 U/ml), interferon gamma (IFN gamma; 100 U/ml) and bovine trophoblast protein-1 (bTP-1; 100 U/ml) inhibited (P < .05) estradiol production by 47%, 71% and 28%, respectively in cells from small follicles, but had no effect (P > .05) on FSH-induced estradiol production in cells from large follicles. TNF alpha binding protein-I blocked (P < .05) the inhibitory effect of TNF alpha on FSH-induced estradiol production by cells from small follicles. Viability of granulosa cells was not affected (P > .05) by the various cytokines. In summary, cytokines have little or no effect on FSH-induced estradiol production by bovine granulosa cells collected from large follicles, whereas cytokines (bTP-1 < or = IL-1 beta < IL-2 = IFN beta < IFN alpha < TNF alpha) have potent inhibitory effects on FSH-induced estradiol production by granulosa cells collected from small follicles. Thus, it appears that less differentiated granulosa cells (small follicles) are more responsive to cytokines than are highly differentiated granulosa cells (large follicles).