Chlamydial antibodies and deoxyribonucleic acid in patients with ectopic pregnancy

Serum interleukin-1β, interleukin-8 and anti-heat shock 60 Chlamydia trachomatis antibodies as markers of ectopic pregnancy

Anti-Chlamydial trachomatis (anti-CT) responses, particularly anti-heat shock 60 (Hsp60), antibodies confer a higher risk of ectopic pregnancy. With emerging evidence supporting the pivotal role of interleukin-1β (IL-1β) and IL-8 in the immunopathogenesis of CT-specific tubal obstruction, we determined anti-CT Hsp60 antibody reactivity and serum concentrations of IL-1β and IL-8 in failed pregnancies consisting of 30 consecutive ectopic pregnancies and 30 missed abortions, with 32 viable intrauterine pregnancies tested as normal controls. ELISAs were utilised to measure IgA or IgG anti-CT major outer membrane outer protein (MOMP) antibodies, IgG anti-CT Hsp60 antibodies and IL-1β and IL-8. IgG anti-CT Hsp60 antibodies were more prevalent in ectopic pregnancy cases (43.3%, 13/30) than in intrauterine pregnancies (16%, 5/32, p=0.016). All 13 ectopic pregnancy anti-CT Hsp60-positive cases had anti-CT MOMP antibodies. CT-specific antibodies were more frequent in merged ectopic pregnancy and missed abortions cases (35%, 21/60) than in intrauterine pregnancies (16%, p=0.049). The median (range) levels of IL-1β in ectopic pregnancy, missed abortions and normal intrauterine pregnancies were 1.74 (0.2-8.7), 1.14 (0.2-16) and 1.22 (0.2-16.2) pg/ml, respectively (p>0.05, for all). Serum IL-8 levels were comparable amongst groups: ectopic pregnancy (median [range]: 25.1 [18.3-1000]); missed abortions (32.9 [15.39-1000]); and intrauterine pregnancies (25.11 [18.3-1000] pg/ml). Anti-CT antibody-positive ectopic pregnancy had significantly lower IL-1β levels (1.29 [0.2-2.93]) pg/ml than sero-negative ectopic pregnancy cases (2.09 [1.10-8.70]) pg/ml, (p=0.022), but IL-8 did not differ. Our data demonstrate that anti-CT Hsp60 immunity is a predominant feature of ectopic pregnancy. We conclude that neither IL-1β nor IL-8 can be considered markers of failed pregnancy, although lower levels of the former cytokine are associated with CT-related ectopic pregnancy.

Role of activins and inducible nitric oxide in the pathogenesis of ectopic pregnancy in patients with or without Chlamydia trachomatis infection

Chlamydia trachomatis infection can lead to pelvic inflammatory disease, ectopic pregnancy (EP), infertility, and chronic pelvic pain in women. Activins and inducible nitric oxide synthase (iNOS) are produced by the human fallopian tube, and we speculate that tubal activins and iNOS may be involved in the immune response to C. trachomatis in humans and their pathological alteration may result in tubal pathology and the development of EP. Blood and fallopian tubes were collected from 14 women with EP. Sera were analyzed by enzyme-linked immunosorbent assay to detect antibodies against chlamydial heat shock protein 60 (chsp60) and the major outer membrane protein of C. trachomatis. Confirmation of C. trachomatis serology was made using the microimmunofluorescence test. The patients were classified into three groups according to their serological results, and immunohistochemistry and quantitative reverse transcription-PCR were performed to investigate the expression of candidate molecules by tubal epithelial cells among the three groups. This is the first study to show an increase in the expression of activin betaA subunit, type II receptors, follistatin, and iNOS within the human fallopian tube of EP patients who were serologically positive for C. trachomatis. A similar expression profile was observed in the fallopian tubes with detectable antibodies only against chsp60. These results were shown at the mRNA and protein levels. We suggest that tubal activin A, its type II receptors, follistatin, and NO could be involved in the microbial-mediated immune response within the fallopian tube, and their pathological expression may lead to tubal damage and the development of EP.

Births and Ectopic Pregnancies in a Large Cohort of Women Tested for Chlamydia trachomatis

BACKGROUND

Recent studies show divergent results concerning the risk of ectopic pregnancy following Chlamydia trachomatis (CT) infection.

GOAL

Our goal was to investigate future reproductive health outcomes (births and ectopic pregnancies) among women tested for CT.

METHODS

Our cohort consisted of 20,762 women born during 1970-1984 who were tested for CT during 1990-2003. We linked CT data to data on ectopic pregnancies and births during 1990-2004. Cox regression with time-dependent covariates was used to assess the association between CT history and births/ectopic pregnancies adjusted for age at first test. Analyses with ectopic pregnancy as outcome were also adjusted for parity.

RESULTS

We observed 9.6 births per 100 person-years of observation among women with negative tests only and 10.2 per 100 person-years among women with at least 1 positive test (hazard ratio adjusted for age at first test, 1.07; 95% CI, 1.01-1.12). Ectopic pregnancy incidence rates were higher for women with positive test(s) compared with women with negative test only (0.24 vs. 0.13 per 100 person-years; hazard ratio adjusted for age at first test and parity, 1.82; 95% CI, 1.27-2.60). Among women with at least 1 registered pregnancy, the adjusted hazard ratio was 2.03; 95% CI, 1.28-3.22).

CONCLUSION

Although women diagnosed with CT were at higher risk for ectopic pregnancy than women with negative test results only, our study suggest that their fertility prospects were better than they would have been had CT screening not been implemented in this population. Opportunistic CT screening is an appropriate method for maintaining female reproductive health.

Chlamydia trachomatis infections increase the risk for ectopic pregnancy: a population-based, nested case-control study

BACKGROUND

Chlamydia trachomatis (CT) as a risk factor for ectopic pregnancy (EP) has mainly been established through seroepidemiologic cross-sectional studies.

GOAL

The goal of this study was to obtain EP risk estimates for women diagnosed with CT using women with negative tests as the reference group.

METHODS

We linked prospectively collected CT laboratory data (1990-2003) to EP hospital data (discharge and outpatient registries) in a nested case-control study. Six hundred sixteen women with CT test(s) before first EP were eligible as cases. Three controls were matched to each case for year of birth, age at first test, and number of prior tests.

RESULTS

Previous CT infection was associated with elevated EP risk (odds ratio [OR], 1.4; 95% confidence interval [CI], 1.0-2.0). In stratified analysis, the association was only significant for the youngest women (born 1970-1984) who had a nearly complete CT testing history (OR, 2.1; 95% CI, 1.3-3.2).

CONCLUSION

A history of diagnosed CT infection is associated with a 2-fold increased EP risk.

Deoxyribonucleic acid of Chlamydia trachomatis in fresh tissue from the Fallopian tubes of patients with ectopic pregnancy

OBJECTIVES

The role of persistent chlamydial infection of the Fallopian tubes in ectopic pregnancy is still unresolved. Therefore, we examined tissue of the Fallopian tubes from patients with ectopic pregnancy for the presence of Chlamydia trachomatis. In addition, other markers of C. trachomatis infection implicated in the pathogenesis of tubal damage were studied including antibodies to heat shock protein 60 of chlamydial and human origin.

STUDY DESIGN

Fresh frozen tubal tissue from 55 patients with ectopic pregnancy in a hospital setting were examined for the presence of C. trachomatis DNA by polymerase chain reaction (PCR) and blood sample were analysed for antibodies to C. trachomatis including heat shock protein 60 (hsp60).

RESULTS

Chlamydial DNA was not detected in any of the 55 tubal specimens using a commercial test, Cobas Amplicor, Roche, and an in-house real time PCR able to detect a few copies of the organism. Logistic regression showed that chlamydial IgG antibodies were more common in a subgroup of patients with previous PID than in controls (OR=7.84, CI 1.78-34.6). Specific antibodies to hsp60 of chlamydial (OR=7.00, CI 1.50-32.6) but not of human origin (OR=2.13, CI 0.14-31.6) were associated with ectopic pregnancy in this group.

CONCLUSIONS

No evidence of persistent infection of C. trachomatis in the fallopian tubes at the time of ectopic pregnancy was found in this study.

Genital Chlamydia trachomatis infection in Egyptian women: incidence among different clinical risk groups

OBJECTIVE

To investigate genital Chlamydial infection incidence among high risk clinical conditions in Egyptian women.

METHODS

A case control study in Ain Shams University Hospital involving 501 patients with cervicitis (n = 58), abnormal cervical smear (n = 256), tubal infertility (n = 85), ectopic pregnancy (n = 22), preterm labour (n = 80) and 192 controls. Active cervical Chlamydial infection was diagnosed using direct immunofluorescent technique. Data were analyzed by Chi-square (chi 2) and Z tests.

RESULTS

Significant increase of Chlamydial infection among different clinical conditions compared to controls. The percentage of positive chlamydial infection was 79.3% among cervicitis group, 33.3% among subjects with inflammatory smear, 75.2% among those with cervical condyloma, 82.6% among those with cervical intraepithelial neoplasia, 51.8% among tubal infertility subjects, 77.2% among ectopic patients and 56.3% among subjects with preterm labour.

CONCLUSION

The incidence of Chlamydial infection in these high risk Egyptian patients is relatively high. Emperical treatment is recommended as the diagnosis is costly and usually not available.

Chlamydial antibodies in women who suffer miscarriage

OBJECTIVE

To ascertain the relation between previous chlamydial infection and miscarriage.

DESIGN

A prospective study of 349 women who had a miscarriage.

PARTICIPANTS

Women surgically treated for spontaneous pregnancy loss on an outpatient basis at a hospital.

SUBJECTS

Three hundred and forty-nine women who miscarried, of whom 91 had at least one previous miscarriage and 33 had had two or more miscarriages previously. Age-matched women who had a normal pregnancy served as controls.

INTERVENTIONS

Blood samples were drawn from patients and controls for antibody determination.

MAIN OUTCOME MEASURES

Patients and controls were compared regarding the frequency of Chlamydia trachomatis IgG antibodies (titre > or = 1/32). Antibodies to C. pneumoniae were also analysed to study cross reactivity.

RESULTS

The frequency of IgG antibodies among the patients was 137/349 (39.3%) which was not statistically different from that among controls (116/349; 33.2%). Even among those who had miscarried previously the antibody frequencies did not differ significantly between patients and controls. The rate of C. trachomatis antibodies was about the same whether or not antibodies to C. pneumoniae were present in both patients and controls.

CONCLUSION

No association was found serologically between previous chlamydial infection and miscarriage and no significant cross reactivity between C. pneumoniae and C. trachomatis could be detected.