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Farkas B, Boldizsar F, Bohonyi N, Farkas N, Marczi S, Kovacs GL, Bodis J, Koppan M. Comparative analysis of abdominal fluid cytokine levels in ovarian hyperstimulation syndrome (OHSS). J Ovarian Res 2020; 13:25. [PMID: 32138790 PMCID: PMC7057507 DOI: 10.1186/s13048-020-00624-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 02/17/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Ovarian hyperstimulation syndrome (OHSS) is a rare, yet severe, iatrogenic complication of ovulation induction therapy during assisted reproductive procedures. Our group previously detected atypical cells in the ascitic fluid of OHSS patients, although no malignancy developed during follow up. Here, the aim was to perform a comparative analysis of the cytokines present in the abdominal fluid of patients affected by OHSS versus patients with advanced ovarian cancer, a benign adnexal mass, or ovarian endometriosis. METHODS This prospective, non-randomized study was conducted at the Clinical Center of the University of Pecs Department of Obstetrics and Gynecology/Reproductive Center between October 2016 and March 2018. Abdominal fluid samples were obtained from 76 patients and subjected to Luminex analysis. The samples were collected from patients with OHSS (OHSS; n = 16), advanced ovarian cancer (OC; n = 22), a benign adnexal mass (BAM; n = 21), or ovarian endometriosis (EM; n = 17). Data were subjected to the non-parametric Kruskal-Wallis test and Spearman's rank correlation coefficient to identify statistical differences between the four study groups. RESULTS Leukocytosis and hemoconcentration were detected in the peripheral blood of OHSS patients. Abdominal fluid analysis further revealed significantly higher levels of interleukin (IL)-6, IL-8, IL-10, and transforming growth factor (TGF)-β in both the OHSS and OC groups compared to the BAM and EM groups. The highest concentration of vascular endothelial growth factor (VEGF) was detected in the OC group, while a significantly lower level was detected in the OHSS group. Moreover, VEGF levels in OC and OHSS groups were significantly elevated compared to the levels in the BAM and EM groups. CONCLUSIONS Vasoactive and hematogenic cytokines were present at higher levels in both the OHSS and OC abdominal fluid samples compared to the fluid samples obtained from the peritoneal cavity of the BAM patients. It is possible that these cytokines play an important role in the formation of ascites.
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Affiliation(s)
- Balint Farkas
- Department of Obstetrics and Gynecology, University of Pecs, School of Medicine, 17 Edesanyak Str., Pecs, Hungary. .,Member of the HAS-UP Human Reproduction Scientific Research Group, Hungarian Academy of Sciences (HAS), Pecs, Hungary.
| | - Ferenc Boldizsar
- Department of Immunology and Biotechnology, University of Pecs, School of Medicine, Pecs, Hungary
| | - Noemi Bohonyi
- Department of Obstetrics and Gynecology, University of Pecs, School of Medicine, 17 Edesanyak Str., Pecs, Hungary
| | - Nelli Farkas
- School of Medicine, Institute of Bioanalysis, University of Pecs, Pecs, Hungary
| | - Saska Marczi
- Laboratory of Molecular and HLA Diagnostics, University Hospital Osijek, Clinical Institute of Transfusion Medicine, Osijek, Croatia.,Department of Medical, Chemistry, Biochemistry and Clinical Chemistry, University of Osijek, Faculty of Medicine, Osijek, Croatia
| | - Gabor L Kovacs
- Member of the HAS-UP Human Reproduction Scientific Research Group, Hungarian Academy of Sciences (HAS), Pecs, Hungary.,Szentágothai Research Center, University of Pecs, Pecs, Hungary.,Department of Laboratory Medicine, Faculty of Medicine, University of Pecs, Pecs, Hungary
| | - Jozsef Bodis
- Department of Obstetrics and Gynecology, University of Pecs, School of Medicine, 17 Edesanyak Str., Pecs, Hungary.,Member of the HAS-UP Human Reproduction Scientific Research Group, Hungarian Academy of Sciences (HAS), Pecs, Hungary
| | - Miklos Koppan
- Department of Obstetrics and Gynecology, University of Pecs, School of Medicine, 17 Edesanyak Str., Pecs, Hungary
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Pepe G, Locati M, Della Torre S, Mornata F, Cignarella A, Maggi A, Vegeto E. The estrogen-macrophage interplay in the homeostasis of the female reproductive tract. Hum Reprod Update 2019; 24:652-672. [PMID: 30256960 DOI: 10.1093/humupd/dmy026] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 08/10/2018] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Estrogens are known to orchestrate reproductive events and to regulate the immune system during infections and following tissue damage. Recent findings suggest that, in the absence of any danger signal, estrogens trigger the physiological expansion and functional specialization of macrophages, which are immune cells that populate the female reproductive tract (FRT) and are increasingly being recognized to participate in tissue homeostasis beyond their immune activity against infections. Although estrogens are the only female gonadal hormones that directly target macrophages, a comprehensive view of this endocrine-immune communication and its involvement in the FRT is still missing. OBJECTIVE AND RATIONALE Recent accomplishments encourage a revision of the literature on the ability of macrophages to respond to estrogens and induce tissue-specific functions required for reproductive events, with the aim to envision macrophages as key players in FRT homeostasis and mediators of the regenerative and trophic actions of estrogens. SEARCH METHODS We conducted a systematic search using PubMed and Ovid for human, animal (rodents) and cellular studies published until 2018 on estrogen action in macrophages and the activity of these cells in the FRT. OUTCOMES Our search identified the remarkable ability of macrophages to activate biochemical processes in response to estrogens in cell culture experiments. The distribution at specific locations, interaction with selected cells and acquisition of distinct phenotypes of macrophages in the FRT, as well as the cyclic renewal of these properties at each ovarian cycle, demonstrate the involvement of these cells in the homeostasis of reproductive events. Moreover, current evidence suggests an association between estrogen-macrophage signaling and the generation of a tolerant and regenerative environment in the FRT, although a causative link is still missing. WIDER IMPLICATIONS Dysregulation of the functions and estrogen responsiveness of FRT macrophages may be involved in infertility and estrogen- and macrophage-dependent gynecological diseases, such as ovarian cancer and endometriosis. Thus, more research is needed on the physiology and pharmacological control of this endocrine-immune interplay.
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Affiliation(s)
- Giovanna Pepe
- Department of Pharmacological and Biomolecular Sciences, Center of Excellence on Neurodegenerative Diseases, University of Milan, via Balzaretti, 9 Milan, Italy
| | - Massimo Locati
- Humanitas Clinical and Research Center, Segrate, Italy
- Department of Medical Biotechnologies and Translational Medicine, University of Milan, via fratelli Cervi, Segrate, Italy
| | - Sara Della Torre
- Department of Pharmacological and Biomolecular Sciences, Center of Excellence on Neurodegenerative Diseases, University of Milan, via Balzaretti, 9 Milan, Italy
| | - Federica Mornata
- Department of Pharmacological and Biomolecular Sciences, Center of Excellence on Neurodegenerative Diseases, University of Milan, via Balzaretti, 9 Milan, Italy
| | - Andrea Cignarella
- Department of Medicine, University of Padua, Largo Meneghetti 2, Padua, Italy
| | - Adriana Maggi
- Department of Pharmacological and Biomolecular Sciences, Center of Excellence on Neurodegenerative Diseases, University of Milan, via Balzaretti, 9 Milan, Italy
| | - Elisabetta Vegeto
- Department of Pharmacological and Biomolecular Sciences, Center of Excellence on Neurodegenerative Diseases, University of Milan, via Balzaretti, 9 Milan, Italy
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Atilgan R, Pala Ş, Yavuzkır Ş, Başpınar M, Yılmaz M, Ilhan N. What is the impact of short- and long-term supplementation of either cabergoline or clarithromycin on resolving rat ovarian hyperstimulation syndrome (OHSS) model? J OBSTET GYNAECOL 2019; 39:687-694. [PMID: 30892121 DOI: 10.1080/01443615.2018.1563774] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
This study aimed to evaluate the effects of coasting, cabergoline and clarithromycin in a rat ovarian hyperstimulation syndrome (OHSS) model. The 42 female Wistar rats were divided into seven groups: control, OHSS (was given 10 IU of pregnant mare serum gonadotropin for 4 consecutive days from day 22 and 30 IU hCG on the fifth day to induce OHSS ), coasting (hCG was applied on the 27th day after gonadotropin injections and the rats were decapitated on the 28th day), Cabergoline (100 mg/kg/d) and clarithromycin (100 mg/kg/d) were given (on the 26th day) with a short-term supplementation (on the 26th day) and long-term supplementation (from the 22nd to the 26th day) groups. The rats were decapitated on the 27th day. Cabergoline and clarithromycin significantly lowered VEGF-2 levels. Clarithromycin significantly reduced IL-1b and TNF-a and significantly increased IL-10 levels. Clarithromycin may be an effective drug for the treatment of OHSS. Impact statement What is already known on this subject? Ovarian hyper-stimulation syndrome (OHSS) is a self-limited disease, in which vascular endothelial growth factor (VEGF) plays the most important role and has a large clinical spectrum related with increased capillary permeability and fluid retention. Some treatment methods that block VEGF over-expression are used in treatment of OHSS. Clarithromycin is known to suppress the production of some pro-inflammatory molecules such as VEGF, IL-8, IL-1, IL-6 and TNF-a. In our study, we compared the efficacy of coasting, short- and long-term supplementation of clarithromycin and cabergoline on correcting OHSS parameters in an experimental study. What do the results of this study add? As a result of our study, we found that OHSS parameters improved better in early prophylactic treatment regimens. We have shown that clarithromycin may be a more effective treatment agent than coasting and cabergoline. What are the implications of these findings for clinical practice and/or further research? Although our study is important in that it is the first pilot study to show that clarithromycin is effective in the treatment of OHSS, there is a need for larger clinical trials.
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Affiliation(s)
- Remzi Atilgan
- a Department of Obstetrics and Gynecology , Firat University School of Medicine , Elazig , Turkey
| | - Şehmus Pala
- a Department of Obstetrics and Gynecology , Firat University School of Medicine , Elazig , Turkey
| | - Şeyda Yavuzkır
- a Department of Obstetrics and Gynecology , Firat University School of Medicine , Elazig , Turkey
| | - Melike Başpınar
- a Department of Obstetrics and Gynecology , Firat University School of Medicine , Elazig , Turkey
| | - Mustafa Yılmaz
- b Department of Emergency Medicine , Firat University School of Medicine , Elazig , Turkey
| | - Nevin Ilhan
- c Department of Biochemistry , Firat University School of Medicine , Elazig , Turkey
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Chistyakova GN, Remizova II, Gazieva IA, Chermyaninova OV. Immunological and hemostasiological disorders in women with ovarian hyperstimulation syndrome. Gynecol Endocrinol 2014; 30 Suppl 1:39-42. [PMID: 25200828 DOI: 10.3109/09513590.2014.945787] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
To assess the markers of destabilization of homeostasis in women with ovarian hyperstimulation syndrome (OHSS), the investigation of the levels of cortisol, markers of renin-angiotensin-aldosterone system, endothelin, proinflammatory cytokines, acute phase proteins, and parameters of hemostasis was performed. Our survey involved 105 women who became pregnant after IVF: 21 women with symptoms of the early moderate and severe OHSS, 28 women with the late moderate and severe OHSS, and 56 pregnant women undergoing IVF without symptoms of OHSS. It was found significant increase of levels of cortisol, interleukins, the number of leucocytes, concentration of fibrinogen and D-dimers in patients with early and late OHSS. The development of late OHSS is associated with the lower level of IL-8 and ceruloplasmin. The OHSS is characterized by leukocytosis, higher level of IL-6, TNF-α, fibrinogen, D-dimers, thus reflecting the homeostasis imbalance. The determination of the level of fibrinogen, D-dimers, leukocytes can be an important screening test of the intensity of the inflammatory process in patients with OHSS.
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Affiliation(s)
- G N Chistyakova
- Department of Immunology and Microbiology, Mother and Child Care Ural Research Institution of Ministry of Health Care of the Russian Federation , Ekaterinburg , Russian Federation
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Xu CK, Tang SB. Alteration of endometrial receptivity in rats with ovarian hyperstimulation syndrome. J OBSTET GYNAECOL 2014; 34:146-52. [DOI: 10.3109/01443615.2013.832735] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Correlation of IL-1, IL-6, IL-10 Concentrations to Ovarian Hyperstimulation Syndrome and Effect of Intravenous Immunoglobulin on Ovarian Hyperstimulated Rats. ACTA ACUST UNITED AC 2008. [DOI: 10.1016/s1001-7844(08)60018-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Bauersachs RM, Manolopoulos K, Hoppe I, Arin MJ, Schleussner E. More on: the 'ART' behind the clot: solving the mystery. J Thromb Haemost 2007; 5:438-9. [PMID: 17269941 DOI: 10.1111/j.1538-7836.2007.02339.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Fernandez S, Jose P, Avdiushko MG, Kaplan AM, Cohen DA. Inhibition of IL-10 receptor function in alveolar macrophages by Toll-like receptor agonists. THE JOURNAL OF IMMUNOLOGY 2004; 172:2613-20. [PMID: 14764735 DOI: 10.4049/jimmunol.172.4.2613] [Citation(s) in RCA: 75] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Despite an immunosuppressive lung environment, alveolar macrophages (AM) retain the capacity to respond to microorganisms. This report demonstrates that IL-10, constitutively produced by normal alveolar epithelium, stimulates signal transduction through the IL-10R on AM and that IL-10R function can be inhibited by stimulation of Toll-like receptor (TLR) on AM. IL-10 mRNA and protein were constitutively expressed in normal alveolar epithelium of mice, and IL-10R were constitutively expressed on normal murine AM. Stimulation of AM through TLR2, TLR4, or TLR9 was sufficient to inhibit IL-10R signal transduction, including phosphorylation and nuclear translocation of STAT3 transcription factor. Inhibition of IL-10R function by TLRs was not associated with a decrease in IL-10R expression, but did require expression of the myeloid differentiation factor 88 adaptor protein. Continuous exposure of macrophages to IL-10 caused sustained expression of the chemokine receptors CCR1 and CCR5. However, the addition of TLR ligands inhibited IL-10-induced expression of CCR1 and CCR5. Finally, exposure of macrophages to TLR ligands blocked the ability of IL-10 to inhibit the induction of TNF-alpha by C2-ceramide. These findings demonstrate a novel regulatory mechanism that may allow AM to overcome inhibitory effects of constitutive IL-10 in the lungs that may permit a more effective response to pulmonary infections.
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MESH Headings
- Adaptor Proteins, Signal Transducing
- Animals
- Antigens, Differentiation/genetics
- Antigens, Differentiation/physiology
- Bronchoalveolar Lavage Fluid/chemistry
- Bronchoalveolar Lavage Fluid/immunology
- CpG Islands/immunology
- DNA-Binding Proteins/antagonists & inhibitors
- DNA-Binding Proteins/metabolism
- Dose-Response Relationship, Immunologic
- Down-Regulation/genetics
- Down-Regulation/immunology
- Immunosuppressive Agents/antagonists & inhibitors
- Immunosuppressive Agents/pharmacology
- Interleukin-10/antagonists & inhibitors
- Interleukin-10/metabolism
- Interleukin-10/pharmacology
- Ligands
- Lipopolysaccharides/metabolism
- Lipopolysaccharides/pharmacology
- Macrophage Activation/drug effects
- Macrophage Activation/immunology
- Macrophages, Alveolar/drug effects
- Macrophages, Alveolar/immunology
- Macrophages, Alveolar/metabolism
- Membrane Glycoproteins/agonists
- Membrane Glycoproteins/metabolism
- Membrane Glycoproteins/physiology
- Mice
- Mice, Inbred C57BL
- Mice, Knockout
- Myeloid Differentiation Factor 88
- Oligodeoxyribonucleotides/metabolism
- Oligodeoxyribonucleotides/pharmacology
- Receptors, Cell Surface/agonists
- Receptors, Cell Surface/metabolism
- Receptors, Cell Surface/physiology
- Receptors, Immunologic/deficiency
- Receptors, Immunologic/genetics
- Receptors, Immunologic/physiology
- Receptors, Interleukin/antagonists & inhibitors
- Receptors, Interleukin/biosynthesis
- Receptors, Interleukin/physiology
- Receptors, Interleukin-10
- STAT3 Transcription Factor
- Signal Transduction/genetics
- Signal Transduction/immunology
- Sphingosine/analogs & derivatives
- Sphingosine/antagonists & inhibitors
- Sphingosine/pharmacology
- Teichoic Acids/metabolism
- Teichoic Acids/pharmacology
- Toll-Like Receptor 2
- Toll-Like Receptor 4
- Toll-Like Receptors
- Trans-Activators/antagonists & inhibitors
- Trans-Activators/metabolism
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Affiliation(s)
- Stefan Fernandez
- Department of Microbiology, University of Kentucky Medical Center, Lexington, KY 40536, USA
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Katayama M, Matsuda Y, Shimokawa KI, Kaneko S. Simultaneous determination of 16 estrogens, dehydroepiandrosterone and their glucuronide and sulfate conjugates in serum using sodium cholate micelle capillary electrophoresis. Biomed Chromatogr 2003; 17:263-7. [PMID: 12833391 DOI: 10.1002/bmc.236] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The simultaneous determination of 16 estrogens, dehydroepiandrosterone (DHEA) and their glucuronide and sulfate conjugates by micellar electrokinetic chromatography (MEKC) with sodium cholate micelle is reported. Sodium cholate, sodium dodecylsulfate (SDS) and alpha-, beta-, gamma-cyclodextrins were studied as micelle reagents in the pH range of 7.0-10.0. Estrogens, DHEA and their glucuronide and sulfate conjugates were separated using a 50 cm x 50 microm capillary with 10 mM borate-phosphate buffer (pH 8.0) containing 50 mM sodium cholate as carrier. The method could simultaneously determine 1.0-1000 microg/mL of steroids and metabolites in 100 microL of serum by photometric detection at 214 nm within 14 min and 80 ng/mL steroids could be determined by using 2.0 mL of serum. The relative standards deviations were 6.7-7.7% at 10 microg/mL in serum. The recoveries were 89.1-92.0% with 10 microg/mL serum samples.
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Affiliation(s)
- Masatoki Katayama
- Department of Functional Bioanalysis, Meiji Pharmaceutical University, 2-522-1 Noshio, Kiyose, Tokyo 204-8588, Japan
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Mouihate A, Pittman QJ. Neuroimmune response to endogenous and exogenous pyrogens is differently modulated by sex steroids. Endocrinology 2003; 144:2454-60. [PMID: 12746307 DOI: 10.1210/en.2002-0093] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The objective of this study was to explore whether and how ovarian hormones interact with the febrile response to pyrogens. Estrogen and progesterone treatment of ovariectomized rats was associated with a reduction in lipopolysaccharide (LPS)-induced fever, compared with ovariectomized controls. LPS-fever reduction was accompanied by reduced levels of the inducible cyclooxygenase-2 (COX-2) protein expression in the hypothalamus as well as reduced plasma levels of IL-1beta. The amount of LPS-induced IL-6 in the plasma was not affected by ovarian hormone replacement. In contrast, hypothalamic COX-2 expression in response to intraperitoneal injection of IL-1beta was potentiated by the ovarian hormone replacement. IL-1beta induced a moderate increase in plasma levels of IL-6 that was suppressed by ovarian hormone replacement. These data suggest that ovarian hormone replacement attenuated the proinflammatory response to LPS by suppressing the LPS-induced IL-1beta production and COX-2 expression in the hypothalamus. The markedly different action of ovarian hormones on IL-1beta and LPS effects suggests that this sex hormone modulation of the immune response is a function of the nature of infection and provides further evidence that LPS actions are different from those of IL-1beta.
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Affiliation(s)
- A Mouihate
- Neuroscience Research Group, Department of Physiology and Biophysics, Faculty of Medicine, University of Calgary, Alberta, Canada T2N 4N1.
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Yamada H, Morikawa M, Furuta I, Kato EH, Shimada S, Iwabuchi K, Minakami H. Intravenous immunoglobulin treatment in women with recurrent abortions: increased cytokine levels and reduced Th1/Th2 lymphocyte ratio in peripheral blood. Am J Reprod Immunol 2003; 49:84-9. [PMID: 12765346 DOI: 10.1034/j.1600-0897.2003.01184.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PROBLEM The aim of this study was to investigate changes in peripheral blood Th1/Th2 cytokine levels and lymphocyte ratios after massive intravenous immunoglobulin (MIVIg) treatment for women with recurrent spontaneous abortion (RSA) of unexplained etiology. METHOD OF STUDY Serum Th1 (IFN-gamma, TNF-alpha) and Th2 cytokine (IL-4, IL-10) levels were assessed by ELISA methods (n = 9) and peripheral blood Th1/Th2 lymphocyte ratios (n = 4) by flow cytometry before and after MIVIg treatments in women with four or more consecutive RSA. RESULTS Pre-treatment serum IFN-gamma (0.06 +/- 0.09 pg/mL, mean +/- SD), TNF-alpha (0.21 +/- 0.45 pg/mL), IL-4 (0.70 +/- 1.16 pg/mL), and IL-10 (1.12 +/- 1.67 pg/mL) increased to 0.17 +/- 0.16 pg/mL, 0.77 +/- 0.28 pg/mL, 1.82 +/- 0.89 pg/mL, and 3.44 +/- 0.48 pg/mL, respectively, after MIVIg treatments (P < 0.05). CD4-positive IFN-gamma/IL-4 lymphocyte ratios (17.3 +/- 9.1) were reduced to 11.5 +/- 7.1 after treatment (P < 0.05). CONCLUSIONS Massive intravenous immunoglobulin treatments increased peripheral blood cytokine levels and decreased Th1/Th2 lymphocyte ratios; thus, MIVIg treatments modify the peripheral Th1/Th2 balance.
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Affiliation(s)
- Hideto Yamada
- Department of Obstetrics and Gynecology, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
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