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Geisler HC, Ghalsasi AA, Safford HC, Swingle KL, Thatte AS, Mukalel AJ, Gong N, Hamilton AG, Han EL, Nachod BE, Padilla MS, Mitchell MJ. EGFR-targeted ionizable lipid nanoparticles enhance in vivo mRNA delivery to the placenta. J Control Release 2024; 371:455-469. [PMID: 38789090 PMCID: PMC11259947 DOI: 10.1016/j.jconrel.2024.05.036] [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: 11/30/2023] [Revised: 05/15/2024] [Accepted: 05/19/2024] [Indexed: 05/26/2024]
Abstract
The full potential of ionizable lipid nanoparticles (LNPs) as an in vivo nucleic acid delivery platform has not yet been realized given that LNPs primarily accumulate in the liver following systemic administration, limiting their success to liver-centric conditions. The engineering of LNPs with antibody targeting moieties can enable extrahepatic tropism by facilitating site-specific LNP tethering and driving preferential LNP uptake into receptor-expressing cell types via receptor-mediated endocytosis. Obstetric conditions stemming from placental dysfunction, such as preeclampsia, are characterized by overexpression of cellular receptors, including the epidermal growth factor receptor (EGFR), making targeted LNP platforms an exciting potential treatment strategy for placental dysfunction during pregnancy. Herein, an EGFR antibody-conjugated LNP (aEGFR-LNP) platform was developed by engineering LNPs with increasing densities of antibody functionalization. aEGFR-LNPs were screened in vitro in immortalized placental trophoblasts and in vivo in non-pregnant and pregnant mice and compared to non-targeted formulations for extrahepatic, antibody-targeted mRNA LNP delivery to the placenta. Our top performing LNP with an intermediate density of antibody functionalization (1:5 aEGFR-LNP) mediated a ∼twofold increase in mRNA delivery in murine placentas and a ∼twofold increase in LNP uptake in EGFR-expressing trophoblasts compared to non-targeted counterparts. These results demonstrate the potential of antibody-conjugated LNPs for achieving extrahepatic tropism, and the ability of aEGFR-LNPs in promoting mRNA delivery to EGFR-expressing cell types in the placenta.
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Affiliation(s)
- Hannah C Geisler
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, United States
| | - Aditi A Ghalsasi
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, United States
| | - Hannah C Safford
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, United States
| | - Kelsey L Swingle
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, United States
| | - Ajay S Thatte
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, United States
| | - Alvin J Mukalel
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, United States
| | - Ningqiang Gong
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, United States
| | - Alex G Hamilton
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, United States
| | - Emily L Han
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, United States
| | - Benjamin E Nachod
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, United States
| | - Marshall S Padilla
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, United States
| | - Michael J Mitchell
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, United States; Penn Institute for RNA Innovation, Perelman School of Medicine, Philadelphia, PA, United States; Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States; Institute for Immunology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States; Cardiovascular Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States; Institute for Regenerative Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States.
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2
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Kamijo K. Shift in Dominance from Blocking to Stimulating Type of Thyrotropin Receptor Antibodies, Resulting in Conversion from Hypothyroidism to Hyperthyroidism during Late Pregnancy. Intern Med 2024; 63:521-526. [PMID: 37380454 PMCID: PMC10937123 DOI: 10.2169/internalmedicine.1929-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 05/18/2023] [Indexed: 06/30/2023] Open
Abstract
A 20-year-old woman with a 10-month history of treatment for Graves' disease (GD), developed hypothyroidism with a high level of thyrotropin (TSH) receptor-blocking antibodies (TBAbs). She conceived at 28 years old and was clinically euthyroid in the first and second trimester, while taking L-thyroxine. However, at 28 weeks she became hyperthyroid with an unexpected rise in TSH receptor-stimulating antibody (TSAb) levels. She was diagnosed with GD, and methimazole was initiated. Her thyroid function normalized, but the neonate became hyperthyroid. We herein report the first case of a shift in dominance from TBAbs to TSAbs in late pregnancy.
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Affiliation(s)
- Keiichi Kamijo
- Department of Internal Medicine, Kamijo Thyroid Clinic, Japan
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3
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Bogović Crnčić T, Girotto N, Ilić Tomaš M, Krištofić I, Klobučar S, Batičić L, Ćurko-Cofek B, Sotošek V. Innate Immunity in Autoimmune Thyroid Disease during Pregnancy. Int J Mol Sci 2023; 24:15442. [PMID: 37895126 PMCID: PMC10607674 DOI: 10.3390/ijms242015442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 10/17/2023] [Accepted: 10/20/2023] [Indexed: 10/29/2023] Open
Abstract
Autoimmune thyroid disease (AITD) is the most common organ-specific autoimmune disorder clinically presented as Hashimoto thyroiditis (HT) and Graves' disease (GD). The pathogenesis of AITD is caused by an inappropriate immune response related to genetic, non-genetic, and environmental factors. Pregnancy is one of the factors that have a great influence on the function of the thyroid gland because of the increased metabolic demand and the effects of hormones related to pregnancy. During pregnancy, an adaptation of the maternal immune system occurs, especially of the innate immune system engaged in maintaining adaptive immunity in the tolerant state, preventing the rejection of the fetus. Pregnancy-related hormonal changes (estrogen, progesterone, hCG) may modulate the activity of innate immune cells, potentially worsening the course of AITD during pregnancy. This especially applies to NK cells, which are associated with exacerbation of HD and GD. On the other hand, previous thyroid disorders can affect fertility and cause adverse outcomes of pregnancy, such as placental abruption, spontaneous abortion, and premature delivery. Additionally, it can cause fetal growth retardation and may contribute to impaired neuropsychological development of the fetus. Therefore, maintaining the thyroid equilibrium in women of reproductive age and in pregnant women is of the highest importance.
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Affiliation(s)
- Tatjana Bogović Crnčić
- Department of Nuclear Medicine, Faculty of Medicine, University of Rijeka, Braće Branchetta 20, 51000 Rijeka, Croatia; (T.B.C.); (M.I.T.)
| | - Neva Girotto
- Department of Nuclear Medicine, Faculty of Medicine, University of Rijeka, Braće Branchetta 20, 51000 Rijeka, Croatia; (T.B.C.); (M.I.T.)
| | - Maja Ilić Tomaš
- Department of Nuclear Medicine, Faculty of Medicine, University of Rijeka, Braće Branchetta 20, 51000 Rijeka, Croatia; (T.B.C.); (M.I.T.)
| | - Ines Krištofić
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Rijeka, Braće Branchetta 20, 51000 Rijeka, Croatia;
| | - Sanja Klobučar
- Department of Internal Medicine, Faculty of Medicine, University of Rijeka, Braće Branchetta 20, 51000 Rijeka, Croatia;
| | - Lara Batičić
- Department of Medical Chemistry, Biochemistry and Clinical Chemistry, Faculty of Medicine, University of Rijeka, Braće Branchetta 20, 51000 Rijeka, Croatia;
| | - Božena Ćurko-Cofek
- Department of Physiology, Immunology and Pathophysiology, Faculty of Medicine, University of Rijeka, Braće Branchetta 20, 51000 Rijeka, Croatia;
| | - Vlatka Sotošek
- Department of Anesthesiology, Reanimatology, Emergency and Intensive Care Medicine, University of Rijeka, Braće Branchetta 20, 51000 Rijeka, Croatia;
- Department of Clinical Medical Sciences II, Faculty of Health Studies, University of Rijeka, Viktora Cara Emina 2, 51000 Rijeka, Croatia
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4
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Kazakou P, Tzanetakos D, Vakrakou AG, Tzartos JS, Evangelopoulos ΜE, Anagnostouli M, Stathopoulos P, Kassi GN, Stefanis L, Kilidireas C, Zapanti E. Thyroid autoimmunity following alemtuzumab treatment in multiple sclerosis patients: a prospective study. Clin Exp Med 2023; 23:2885-2894. [PMID: 36641771 PMCID: PMC10543528 DOI: 10.1007/s10238-022-00981-3] [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: 10/04/2022] [Accepted: 12/20/2022] [Indexed: 01/16/2023]
Abstract
Autoimmune thyroid disease (AITD) is the most common adverse effect in alemtuzumab (ALZ) treated relapsing-remitting (RR) multiple sclerosis (MS) patients. The objective of this prospective study was to analyze the occurrence, timing of onset, clinical course, and laboratory characteristics of AITD post-ALZ. We evaluated 35 RRMS patients treated with ALZ at a single academic MS center; clinical and laboratory data were collected before ALZ initiation and thereafter quarterly on follow-up with a median of 43.5 months. Seventeen out of 31 patients (54.8%) with no prior history of thyroid dysfunction developed AITD with a mean onset of 19.4 months ± 10.2 (SD) after the first ALZ cycle; Graves' disease (GD) (n = 9); hypothyroidism with positive stimulating thyrotropin receptor antibodies (TRAb) (n = 1); Hashimoto thyroiditis (HT) (n = 6); HT with hypothyroidism (n = 1). Interestingly, seven of nine (77.7%) GD patients showed a fluctuating course. Three out of four patients with preexisting thyroid disease remained stable, whereas one with prior HT and hypothyroidism developed fluctuating GD. All patients with GD commenced antithyroid drugs (ATDs); five continued on "block and replace" treatment; one required radioactive iodine, and one total thyroidectomy. Our analysis showed earlier onset of ALZ-induced AITD in comparison to most other ALZ cohorts; overall, these patients required complex therapeutic approaches of the AITD. We observed a higher rate of fluctuating GD, with earlier onset and lower remission rate than previously reported, which in the majority of patients required prolonged "block and replace" therapy in the minimum dose of each therapeutic agent or more definitive interventions.
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Affiliation(s)
- Paraskevi Kazakou
- Endocrine Unit and Diabetes Centre, Department of Clinical Therapeutics, Alexandra Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
| | - Dimitrios Tzanetakos
- Multiple Sclerosis & Demyelinating Diseases Unit, 1st Department of Neurology, Eginition Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
- Second Department of Neurology, School of Medicine, National and Kapodistrian University of Athens, "Attikon" University Hospital, Athens, Greece.
| | - Aigli G Vakrakou
- Multiple Sclerosis & Demyelinating Diseases Unit, 1st Department of Neurology, Eginition Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - John S Tzartos
- Second Department of Neurology, School of Medicine, National and Kapodistrian University of Athens, "Attikon" University Hospital, Athens, Greece
| | - Μaria-Eleptheria Evangelopoulos
- Multiple Sclerosis & Demyelinating Diseases Unit, 1st Department of Neurology, Eginition Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria Anagnostouli
- Multiple Sclerosis & Demyelinating Diseases Unit, 1st Department of Neurology, Eginition Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Panos Stathopoulos
- Multiple Sclerosis & Demyelinating Diseases Unit, 1st Department of Neurology, Eginition Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Georgia N Kassi
- Department of Endocrinology, Alexandra Hospital, Athens, Greece
| | - Leonidas Stefanis
- 1st Department of Neurology, Eginition Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Constantinos Kilidireas
- Multiple Sclerosis & Demyelinating Diseases Unit, 1st Department of Neurology, Eginition Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
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Jiang H, Chen L, Huang N, Shi H, Chi H, Yang R, Long X, Qiao J. Maternal preconception thyroid autoimmunity is associated with neonatal birth weight conceived by PCOS women undergoing their first in vitro fertilization/intracytoplasmic sperm injection. J Ovarian Res 2023; 16:140. [PMID: 37452360 PMCID: PMC10347740 DOI: 10.1186/s13048-023-01208-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 06/16/2023] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND Thyroid autoimmunity and polycystic ovary syndrome (PCOS) are the most common endocrinopathies and have close relationships based on common etiology and pathogenesis, including genetic susceptibility, metabolic disorders, hormonal dysregulation, immune response, and inflammatory activation. The co-occurrence of both diseases is associated with adverse reproductive outcomes, but its effect on neonatal outcomes remains largely unknown. We aim to explore the effect of thyroid autoimmunity on neonatal birth weight in PCOS women undergoing IVF/ICSI. METHODS This is a retrospective analysis of 486 PCOS women who underwent the first IVF/ICSI cycles and gave birth to 361 singletons and 125 twins during 2018 - 2020 at a reproductive center. The associations between maternal preconception serum thyroid function and autoimmunity indicators and birth weights of the singleton and twin groups were evaluated using generalized linear models (GLMs) and generalized estimate equations (GEEs), respectively. Analyses were further stratified by neonatal sex, maternal age, and maternal preconception BMI to assess the possible interaction effects. RESULTS Maternal preconception serum TPOAb had a significant negative association with singleton birth weight (P for trends = 0.03). Compared with women in the first tertile of TPOAb, women in the third tertile had a change in singleton birth weight of - 119.72 g (95% CI: - 222.68 g, - 16.70 g). Maternal preconception serum TPOAb had a significant positive association with twin birth weight (P for trends = 0.01). Compared with women in the first tertile of TPOAb, women in the third tertile had a change in twin birth weight of 138.62 g (95% CI: 33.96 g, 243.30 g). Besides, maternal preconception serum TPOAb had a specific association with increased twin birth weight for female neonates, a specific association with decreased singleton birth weight for PCOS women under 35 years, and a specific association with decreased twin birth weight for overweight PCOS women (all P for interactions < 0.05). CONCLUSIONS Maternal preconception thyroid autoimmunity may affect the birth weights of both singleton and twin neonates. Further large cohorts and experimental studies are required to confirm these findings and explore the underlying mechanisms.
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Affiliation(s)
- Huahua Jiang
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, 100191, China
- National Clinical Research Center for Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- Key Laboratory of Assisted Reproduction, Peking University, Ministry of Education, Beijing, China
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing, China
| | - Lixue Chen
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, 100191, China
- National Clinical Research Center for Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- Key Laboratory of Assisted Reproduction, Peking University, Ministry of Education, Beijing, China
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing, China
| | - Ning Huang
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, 100191, China
- National Clinical Research Center for Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- Key Laboratory of Assisted Reproduction, Peking University, Ministry of Education, Beijing, China
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing, China
| | - Huifeng Shi
- National Clinical Research Center for Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- National Centre for Healthcare Quality Management in Obstetrics, Beijing, China
| | - Hongbin Chi
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, 100191, China
- National Clinical Research Center for Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- Key Laboratory of Assisted Reproduction, Peking University, Ministry of Education, Beijing, China
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing, China
| | - Rui Yang
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, 100191, China
- National Clinical Research Center for Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- Key Laboratory of Assisted Reproduction, Peking University, Ministry of Education, Beijing, China
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing, China
| | - Xiaoyu Long
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, 100191, China.
- National Clinical Research Center for Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China.
- Key Laboratory of Assisted Reproduction, Peking University, Ministry of Education, Beijing, China.
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing, China.
| | - Jie Qiao
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, 100191, China.
- National Clinical Research Center for Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China.
- Key Laboratory of Assisted Reproduction, Peking University, Ministry of Education, Beijing, China.
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing, China.
- Beijing Advanced Innovation Center for Genomics, Peking University, Beijing, China.
- Peking-Tsinghua Center for Life Sciences, Peking University, Beijing, China.
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6
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Terezia H, Zuzana K, Petr N. Evaluation of SARS-CoV-2 vaccination in pregnant and breastfeeding women. IJID REGIONS 2023; 8:S2772-7076(23)00066-8. [PMID: 37363194 PMCID: PMC10265926 DOI: 10.1016/j.ijregi.2023.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 06/05/2023] [Accepted: 06/08/2023] [Indexed: 06/28/2023]
Abstract
Background : The SARS-CoV-2 virus can lead to adverse pregnancy outcomes; pregnant women also experience immune suppression, increasing vulnerability. Vaccination can confer lasting protection, but most clinical trials exclude pregnant and breastfeeding women, leading to paucity of safety data. Methods : Via an online questionnaire, we have inquired about the safety experience of 2192 pregnant or breastfeeding women vaccinated against SARS-CoV-2, including the incidence of adverse events, pregnancy outcomes, and confirmed infection with SARS-CoV-2. Results : The incidence of other adverse events was higher in women vaccinated during breastfeeding. Significant differences were observed for fatigue (relative risk 1.230, 95%CI 1.051 to 1.444, p=0.0098), headache (RR 1.822, 95%CI 1.379 to 2.418, p<0.0001), myalgia (RR 1.633, 95%CI 1.269 to 2.110, p<0.0001), chills (RR 2.027, 95%CI, p<0.0001), subfebrile temperature ≤ 38°C (RR 1.697, 95%CI 1.240 to 2.335, p=0.0007), arthralgia (RR 1.924, 95%CI 1.340 to 2.776, p=0.0002), fever > 38°C (R 6.410, 95%CI 2.890 to 14.30, p<0.0001), and shivers (RR 2.204, 95%CI 1.264 to 3.863, p=0.0049). No pattern of SAEs emerged. Menstrual cycle bleeding disorders occurred in 0.7% of breastfeeding women after the first dose and 0.5% after the second dose. One spontaneous abortion occurred; 93.1% of pregnancies were carried to term, 5.6% late preterm, 0.9% moderate preterm, and 0.3% very preterm. Two children had congenital defects. Vaccine efficacy was 96.3%. Conclusions : The safety profile of SARS-CoV-2 vaccines in pregnant and breastfeeding women was similar to the general population. Breastfeeding women experienced higher adverse event rates than pregnant women, presumably due to immune suppression in pregnancy.
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Affiliation(s)
- Harvanova Terezia
- Faculty of Pharmacy, Comenius University, Department of Organisation and Management in Pharmacy, Bratislava, Slovakia
| | - Kobliskova Zuzana
- Faculty of Pharmacy, Comenius University, Department of Organisation and Management in Pharmacy, Bratislava, Slovakia
| | - Novak Petr
- Institute of Neuroimmunology, Slovak Academy of Sciences, Bratislava, Slovakia
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7
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van Hulsteijn LT, Prins JR, Scheffer-Rath MEA, van Trotsenburg ASP, Links TP, Dullaart RPF. Fetal Thyrotoxicosis due to Maternal TSH Receptor Stimulating Antibodies Causes Infant Central Hypothyroidism. Horm Res Paediatr 2023; 97:180-186. [PMID: 37231969 DOI: 10.1159/000530725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 04/11/2023] [Indexed: 05/27/2023] Open
Abstract
INTRODUCTION Women with a current diagnosis or past history of Graves' disease (GD) are at risk of developing fetal thyrotoxicosis (FT) during pregnancy when they are inadequately treated, or because of placental passage of TSH receptor antibodies (TRAb). It is known that FT induced by high maternal thyroid hormone concentrations may result in infant (central) hypothyroidism. CASE PRESENTATION In a euthyroid woman with a history of GD treated with radioactive iodide (I131), persistently high levels of maternal TRAb resulted in recurrent FT during two separate pregnancies, followed by neonatal hyperthyroidism and infant central hypothyroidism. DISCUSSION This case demonstrates the novel insight that FT due to high fetal thyroid hormone concentrations stimulated by high maternal TRAb levels might also result in (central) hypothyroidism, requiring long-term evaluation of the hypothalamus-pituitary-thyroid axis in these children.
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Affiliation(s)
- Leonie T van Hulsteijn
- Department of Endocrinology, University Medical Center Groningen, Groningen, The Netherlands
| | - Jelmer R Prins
- Department of Obstetrics and Gynecology, University Medical Center Groningen, Groningen, The Netherlands
| | - Mirjam E A Scheffer-Rath
- Department of Pediatric Endocrinology, Beatrix Children's Hospital, University Medical Center Groningen, Groningen, The Netherlands
| | - A S Paul van Trotsenburg
- Department of Pediatric Endocrinology, Emma Children's Hospital, Amsterdam University Medical Center, Groningen, The Netherlands
| | - Thera P Links
- Department of Endocrinology, University Medical Center Groningen, Groningen, The Netherlands
| | - Robin P F Dullaart
- Department of Endocrinology, University Medical Center Groningen, Groningen, The Netherlands
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8
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Meyyazhagan A, Kuchi Bhotla H, Pappuswamy M, Tsibizova V, Al Qasem M, Di Renzo GC. Cytokine see-saw across pregnancy, its related complexities and consequences. Int J Gynaecol Obstet 2023; 160:516-525. [PMID: 35810391 DOI: 10.1002/ijgo.14333] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 06/17/2022] [Accepted: 07/07/2022] [Indexed: 01/20/2023]
Abstract
During pregnancy, a woman's immune system adapts to the changing hormonal concentrations, causing immunologic transition. These immunologic changes are required for a full-term pregnancy, preserving the fetus' innate and adaptive immunity. Preterm labor, miscarriage, gestational diabetes mellitus, and pre-eclampsia are all caused by abnormal cytokine expression during pregnancy and childbirth. A disruption in the cytokine balance can lead to autoimmune diseases or microbiologic infections, or to autoimmune illness remission during pregnancy with postpartum recurrence. The cytokine treatments are essential and damaging to the developing fetus. The current review summarizes the known research on cytokine changes during pregnancy and their possible consequences for pregnant women. Studies suggest that customizing medication for each woman and her progesterone levels should be based on the cytokine profile of each pregnant woman. Immune cells and chemicals play an important function in development of the placenta and embryo. During pregnancy, T cells divide and move, and a careful balance between proinflammatory and anti-inflammatory cytokines is necessary. The present review focuses on the mother's endurance in generating fetal cells and the immunologic mechanism involved.
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Affiliation(s)
- Arun Meyyazhagan
- Center for Perinatal and Reproductive Medicine, University of Perugia, Perugia, Italy.,PREIS International and European School of Perinatal, Neonatal and Reproductive Medicine, Florence, Italy
| | - Haripriya Kuchi Bhotla
- Department of Life Sciences, CHRIST (Deemed to be University), Bengaluru, Karnataka, India
| | - Manikantan Pappuswamy
- Department of Life Sciences, CHRIST (Deemed to be University), Bengaluru, Karnataka, India
| | - Valentina Tsibizova
- PREIS International and European School of Perinatal, Neonatal and Reproductive Medicine, Florence, Italy.,Institute of Perinatology and Pediatrics, Almazov National Medical Research Center, Saint-Petersburg, Russia
| | - Malek Al Qasem
- PREIS International and European School of Perinatal, Neonatal and Reproductive Medicine, Florence, Italy.,Department of Obstetrics and Gynecology, Faculty of Medicine, Mutah University, Al-Karak, Jordan
| | - Gian Carlo Di Renzo
- Center for Perinatal and Reproductive Medicine, University of Perugia, Perugia, Italy.,PREIS International and European School of Perinatal, Neonatal and Reproductive Medicine, Florence, Italy.,Department of Obstetrics and Gynecology, I.M. Sechenov First State University of Moscow, Moscow, Russia
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9
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Guo Y, Fang Z, Yu L, Sun X, Li F, Jin L. Which endometrial preparation protocol provides better pregnancy and perinatal outcomes for endometriosis patients in frozen-thawed embryo transfer cycles? A retrospective study on 1413 patients. J Ovarian Res 2023; 16:7. [PMID: 36624470 PMCID: PMC9830850 DOI: 10.1186/s13048-023-01095-4] [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: 11/02/2022] [Accepted: 01/03/2023] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVE To determine the optimal endometrial preparation protocol for a frozen embryo transfer in patients with endometriosis. DESIGN Retrospective cohort study. SETTING Tertiary care academic medical center. PATIENT(S) One thousand four hundred thirteen patients with endometriosis who underwent oocyte aspiration from 2015 to 2020 and frozen embryo transfer from 2016 to 2020 and received natural cycle, hormone replacement treatment with or without GnRHa pretreatment endometrial preparation. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Clinical pregnancy rate, live birth rate, miscarriage rate, multiple pregnancy rate, biochemical pregnancy rate and ectopic pregnancy rate. Singleton live births were assessed for perinatal outcomes and obstetric complications. RESULT(S) There were no differences in clinical pregnancy outcomes or prenatal outcomes among the three commonly used endometrial preparation protocols for frozen embryo transfer cycles in patients with endometriosis. Results remained after screening variables using univariate logistic regression into multivariate logistic regression. No advantages or disadvantages were found among the three endometrial preparation protocols in patients with endometriosis. CONCLUSION(S) Natural cycle, hormone replacement cycle, or hormone replacement treatment with GnRHa pretreatment showed no superiority or inferiority in pregnancy and perinatal outcomes in patients with endometriosis.
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Affiliation(s)
- Yaxin Guo
- grid.412793.a0000 0004 1799 5032Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 JieFang Avenue, Wuhan, 430030 People’s Republic of China
| | - Zishui Fang
- grid.412793.a0000 0004 1799 5032Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 JieFang Avenue, Wuhan, 430030 People’s Republic of China
| | - Lin Yu
- Department of Artificial Intelligence, NanPeng Artificial Intelligence Research Institute Ltd, Chongqing, People’s Republic of China
| | - Xin Sun
- Department of Artificial Intelligence, NanPeng Artificial Intelligence Research Institute Ltd, Chongqing, People’s Republic of China
| | - Fei Li
- grid.412793.a0000 0004 1799 5032Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 JieFang Avenue, Wuhan, 430030 People’s Republic of China
| | - Lei Jin
- grid.412793.a0000 0004 1799 5032Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 JieFang Avenue, Wuhan, 430030 People’s Republic of China
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10
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Serény-Litvai T, Bajnok A, Temesfoi V, Nörenberg J, Pham-Dobor G, Kaposi A, Varnagy A, Kovacs K, Pentek S, Koszegi T, Mezosi E, Berki T. B cells from anti-thyroid antibody positive, infertile women show hyper-reactivity to BCR stimulation. Front Immunol 2022; 13:1039166. [DOI: 10.3389/fimmu.2022.1039166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 10/10/2022] [Indexed: 11/13/2022] Open
Abstract
Anti-thyroid antibody (ATA) positivity affects 1 out of 9 women in childbearing age and presents a significant risk for infertility. Emerging evidence indicates that alterations in the B cell receptor induced calcium (Ca2+) signaling could be key in the development of autoimmunity. We aimed to investigate the Ca2+ flux response of B lymphocyte subsets to BCR stimulation in Hashimoto’s thyroiditis and related infertility. We collected peripheral blood samples from ATA+, infertile, euthyroid patients (HIE), hypothyroid, ATA+ patients before (H1) and after levothyroxine treatment (H2), and age-matched healthy controls (HC). All B cell subsets of ATA+, infertile, euthyroid patients showed elevated basal Ca2+ level and hyper-responsivity to BCR ligation compared to the other groups, which could reflect altered systemic immune function. The Ca2+ flux of hypothyroid patients was similar to healthy controls. The levothyroxine-treated patients had decreased prevalence of CD25+ B cells and lower basal Ca2+ level compared to pre-treatment. Our results support the role of altered Ca2+ flux of B cells in the early phase of thyroid autoimmunity and infertility.
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11
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Świątkowska-Stodulska R, Berlińska A, Stefańska K, Zieliński M, Kwiatkowski S, Połom J, Andrysiak-Mamos E, Wydra P, Sworczak K. Endocrine Autoimmunity in Pregnancy. Front Immunol 2022; 13:907561. [PMID: 35844617 PMCID: PMC9277138 DOI: 10.3389/fimmu.2022.907561] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 05/06/2022] [Indexed: 11/20/2022] Open
Abstract
Human gestation leads to a number of physiological alterations which peak at the development of placentta known for, among many other functions, being a transient but highly potent endocrine organ. Hormonal activity of placenta is marked by its ability to continuously produce and secrete high levels of progesterone. Progesterone guards the well-being of the fetoplacental unit throughout the gestation and one of the proposed mechanisms of this principle involves the development of local and systemic immune tolerance mainly due to impediment of CD4+ lymphocyte activation. However, though these alterations are present and well-established, autoimmunity is not entirely rare and a wide spectrum of diseases can continue, or develop de novo, throughout the gestation or even after the delivery. Up-to-date data supports the existence of a relationship between the clinical course of chosen autoimmune diseases and levels of circulating sex steroids. The most common autoimmune endocrinopathies in pregnant women are Hashimoto’s disease, Graves’ disease, and, more rarely, primary adrenal insufficiency in the form of Addison’s disease. Gestation can influence the clinical course of these endocrinopathies in patients who were diagnosed before conception. Multiple particles, like TSH-receptor stimulating antibodies, thyroid hormones, glucocorticoids, and anti-thyroid medications, can cross the placental barrier and evoke biological action in fetal tissues. Thyroid pathology in the form of postpartum thyroiditis is particularly prevalent in patients with positive anti-thyroperoxidase and anti-thyroglobulin antibodies. Certain populations are more at risk of developing numerous gestational complications and require regular follow-up. In our paper, we would like to address physiological, physiopathological, and clinical aspects of endocrine autoimmunity throughout human gestation, as well as special circumstances to consider in pregnant women.
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Affiliation(s)
- Renata Świątkowska-Stodulska
- Department of Endocrinology and Internal Medicine, Faculty of Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | - Agata Berlińska
- Department of Endocrinology and Internal Medicine, Faculty of Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | - Katarzyna Stefańska
- Division of Gynecology and Obstetrics, Faculty of Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | - Maciej Zieliński
- Department of Medical Immunology, Faculty of Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | - Sebastian Kwiatkowski
- Department of Obstetrics and Gynecology, Pomeranian Medical University of Szczecin, Szczecin, Poland
| | - Joanna Połom
- Department of Internal Medicine, Connective Tissue Diseases and Geriatrics, Faculty of Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | - Elżbieta Andrysiak-Mamos
- Department of Endocrinology, Metabolic Diseases and Internal Diseases Pomeranian Medical University, Szczecin, Poland
| | - Piotr Wydra
- Department of Medical Immunology, Faculty of Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | - Krzysztof Sworczak
- Department of Endocrinology and Internal Medicine, Faculty of Medicine, Medical University of Gdańsk, Gdańsk, Poland
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12
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Bliddal S, Derakhshan A, Xiao Y, Chen LM, Männistö T, Ashoor G, Tao F, Brown SJ, Vafeiadi M, Itoh S, Grineva EN, Taylor P, Ghafoor F, Vaidya B, Hattersley A, Mosso L, Oken E, Kishi R, Alexander EK, Maraka S, Huang K, Chaker L, Bassols J, Pirzada A, López-Bermejo A, Boucai L, Peeters RP, Pearce EN, Nelson SM, Chatzi L, Vrijkotte TG, Popova PV, Walsh JP, Nicolaides KH, Suvanto E, Lu X, Pop VJM, Forman JL, Korevaar TIM, Feldt-Rasmussen U. Association of Thyroid Peroxidase Antibodies and Thyroglobulin Antibodies with Thyroid Function in Pregnancy: An Individual Participant Data Meta-Analysis. Thyroid 2022; 32:828-840. [PMID: 35596568 DOI: 10.1089/thy.2022.0083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Objectives: Thyroid autoimmunity is common in pregnant women and associated with thyroid dysfunction and adverse obstetric outcomes. Most studies focus on thyroid peroxidase antibodies (TPOAbs) assessed by a negative-positive dichotomy and rarely take into account thyroglobulin antibodies (TgAbs). This study aimed at determining the association of TPOAbs and TgAbs, respectively, and interdependently, with maternal thyroid function. Methods: This was a meta-analysis of individual participant cross-sectional data from 20 cohorts in the Consortium on Thyroid and Pregnancy. Women with multiple pregnancy, pregnancy by assisted reproductive technology, history of thyroid disease, or use of thyroid interfering medication were excluded. Associations of (log2) TPOAbs and TgAbs (with/without mutual adjustment) with cohort-specific z-scores of (log2) thyrotropin (TSH), free triiodothyronine (fT3), total triiodothyronine (TT3), free thyroxine (fT4), total thyroxine (TT4), or triiodothyronine:thyroxine (T3:T4) ratio were evaluated in a linear mixed model. Results: In total, 51,138 women participated (51,094 had TPOAb-data and 27,874 had TgAb-data). Isolated TPOAb positivity was present in 4.1% [95% confidence interval, CI: 3.0 to 5.2], isolated TgAb positivity in 4.8% [CI: 2.9 to 6.6], and positivity for both antibodies in 4.7% [CI: 3.1 to 6.3]. Compared with antibody-negative women, TSH was higher in women with isolated TPOAb positivity (z-score increment 0.40, CI: 0.16 to 0.64) and TgAb positivity (0.21, CI: 0.10 to 0.32), but highest in those positive for both antibodies (0.54, CI: 0.36 to 0.71). There was a dose-response effect of higher TPOAb and TgAb concentrations with higher TSH (TSH z-score increment for TPOAbs 0.12, CI: 0.09 to 0.15, TgAbs 0.08, CI: 0.02 to 0.15). When adjusting analyses for the other antibody, only the association of TPOAbs remained statistically significant. A higher TPOAb concentration was associated with lower fT4 (p < 0.001) and higher T3:T4 ratio (0.09, CI: 0.03 to 0.14), however, the association with fT4 was not significant when adjusting for TgAbs (p = 0.16). Conclusions: This individual participant data meta-analysis demonstrated an increase in TSH with isolated TPOAb positivity and TgAb positivity, respectively, which was amplified for individuals positive for both antibodies. There was a dose-dependent association of TPOAbs, but not TgAbs, with TSH when adjusting for the other antibody. This supports current practice of using TPOAbs in initial laboratory testing of pregnant women suspected of autoimmune thyroid disease. However, studies on the differences between TPOAb- and TgAb-positive women are needed to fully understand the spectrum of phenotypes.
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Affiliation(s)
- Sofie Bliddal
- Department of Medical Endocrinology and Metabolism, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Arash Derakhshan
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
- Academic Center for Thyroid Diseases, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Yi Xiao
- Section of Biostatistics, Department of Public Health, Copenhagen University, Copenhagen, Denmark
| | - Liang-Miao Chen
- Department of Endocrinology and Rui'an Center of the Chinese-American Research Institute for Diabetic Complications, Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Tuija Männistö
- Northern Finland Laboratory Center Nordlab and Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Ghalia Ashoor
- Harris Birthright Research Center for Fetal Medicine, King's College Hospital, London, United Kingdom
| | - Fangbiao Tao
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China
- Anhui Provincial Key Laboratory of Population Health & Aristogenics, Hefei, China
| | - Suzanne J Brown
- Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Nedlands, Australia
| | - Marina Vafeiadi
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Sachiko Itoh
- Center for Environmental and Health Sciences, Hokkaido University, Sapporo, Japan
| | | | - Peter Taylor
- Thyroid Research Group, Institute of Molecular and Experimental Medicine, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Farkhanda Ghafoor
- Research & Innovation, Shalamar Institute of Health Sciences, Lahore, Pakistan
| | - Bijay Vaidya
- Department of Endocrinology, Royal Devon and Exeter Hospital NHS Foundation Trust, University of Exeter Medical School, Exeter, United Kingdom
| | - Andrew Hattersley
- University of Exeter Medical School, Royal Devon & Exeter Hospital, Exeter, United Kingdom
| | - Lorena Mosso
- Endocrinology Department and Center of Translational Endocrinology (CETREN), Department of Endocrinology, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Emily Oken
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Hypertension and Diabetes, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Reiko Kishi
- Center for Environmental and Health Sciences, Hokkaido University, Sapporo, Japan
| | - Erik K Alexander
- Division of Endocrinology, Hypertension and Diabetes, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Spyridoula Maraka
- Division of Endocrinology and Metabolism, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
- Knowledge and Evaluation Research Unit, Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Central Arkansas Veterans Healthcare System, Little Rock, Arkansas, USA
| | - Kun Huang
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China
| | - Layal Chaker
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
- Academic Center for Thyroid Diseases, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Judit Bassols
- Maternal-Fetal Metabolic Research Group, Girona Biomedical Research Institute (IDIBGI), Dr. Josep Trueta Hospital, Girona, Spain
| | - Amna Pirzada
- Shifa Institute of Medical Technology, Shifa International Hospital, Islamabad, Pakistan
| | - Abel López-Bermejo
- Pediatric Endocrinology Research Group, Girona Biomedical Research Institute (IDIBGI), Dr. Josep Trueta Hospital, Girona, Spain
| | - Laura Boucai
- Division of Endocrinology, Department of Medicine, Memorial Sloan-Kettering Cancer Center, Weill Cornell University, New York, New York, USA
| | - Robin P Peeters
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
- Academic Center for Thyroid Diseases, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Elizabeth N Pearce
- Section of Endocrinology, Diabetes, and Nutrition, Boston University School of Medicine, Boston, Massachusetts, USA
| | | | - Leda Chatzi
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Tanja G Vrijkotte
- Department of Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Polina V Popova
- Institute of Endocrinology, Almazov National Medical Research Centre, St. Petersburg, Russia
- Department of Internal Diseases and Endocrinology, St. Petersburg Pavlov State Medical University, St. Petersburg, Russia
- World-Class Research Center for Personalized Medicine, Almazov National Medical Research Centre, St. Petersburg, Russia
| | - John P Walsh
- Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Nedlands, Australia
- Medical School, University of Western Australia, Crawley, Australia
| | - Kypros H Nicolaides
- Department of Women and Children's Health, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
| | - Eila Suvanto
- Department of Obstetrics and Gynecology and Medical Research Center Oulu, University of Oulu, Oulu, Finland
| | - Xuemian Lu
- Department of Endocrinology and Rui'an Center of the Chinese-American Research Institute for Diabetic Complications, Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Victor J M Pop
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, the Netherlands
| | - Julie Lyng Forman
- Section of Biostatistics, Department of Public Health, Copenhagen University, Copenhagen, Denmark
| | - Tim I M Korevaar
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
- Academic Center for Thyroid Diseases, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Ulla Feldt-Rasmussen
- Department of Medical Endocrinology and Metabolism, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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13
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Brown HK, Barrett K, Scime NV. Perinatal mental illness and maternal autoimmune disease: A review of current evidence and avenues for future research. Front Neuroendocrinol 2022; 65:100975. [PMID: 34968632 DOI: 10.1016/j.yfrne.2021.100975] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 11/30/2021] [Accepted: 12/21/2021] [Indexed: 11/28/2022]
Abstract
This review summarizes evidence on the association between perinatal mental illness and maternal autoimmune disease and identifies avenues for future research. Perinatal mental illness has several characteristics in common with autoimmune disease, including increased incidence in the early postpartum period, recurrence across pregnancies, evidence of elevated immune-mediated cytokines, and familial risk, as well as the general predominance of mental illness in females versus males. Several studies have demonstrated elevated risk of maternal autoimmune disease in women with perinatal mental illness, and of perinatal mental illness in those with autoimmune dysfunction, suggesting a bi-directional relationship. Further research is needed to elucidate the importance of the specific diagnosis, severity, and timing of perinatal mental illness and specific diagnosis of autoimmune disease, as well as the relative importance of perinatal versus non-perinatal mental illness. Such research could have implications for prevention, treatment, and follow-up of perinatal mental illness.
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Affiliation(s)
- Hilary K Brown
- Department of Health and Society, University of Toronto Scarborough, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
| | - Kathryn Barrett
- Library, University of Toronto Scarborough, Toronto, Ontario, Canada
| | - Natalie V Scime
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
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14
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Shi Q, Wu M, Chen P, Wei B, Tan H, Huang P, Chang S. Criminal of Adverse Pregnant Outcomes: A Perspective From Thyroid Hormone Disturbance Caused by SARS-CoV-2. Front Cell Infect Microbiol 2022; 11:791654. [PMID: 35047419 PMCID: PMC8761741 DOI: 10.3389/fcimb.2021.791654] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 12/06/2021] [Indexed: 01/11/2023] Open
Abstract
Nowadays, emerging evidence has shown adverse pregnancy outcomes, including preterm birth, preeclampsia, cesarean, and perinatal death, occurring in pregnant women after getting infected by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), but the underlying mechanisms remain elusive. Thyroid hormone disturbance has been unveiled consistently in various studies. As commonly known, thyroid hormone is vital for promoting pregnancy and optimal fetal growth and development. Even mild thyroid dysfunction can cause adverse pregnancy outcomes. We explored and summarized possible mechanisms of thyroid hormone abnormality in pregnant women after coronavirus disease 2019 (COVID-19) infection and made a scientific thypothesis that adverse pregnancy outcomes can be the result of thyroid hormone disorder during COVID-19. In which case, we accentuate the importance of thyroid hormone surveillance for COVID-19-infected pregnant women.
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Affiliation(s)
- Qiman Shi
- Department of General Surgery, Xiangya Hospital Central South University, Changsha, China
| | - Min Wu
- Department of General Surgery, Xiangya Hospital Central South University, Changsha, China
| | - Pei Chen
- Department of General Surgery, Xiangya Hospital Central South University, Changsha, China
| | - Bo Wei
- Department of General Surgery, Xiangya Hospital Central South University, Changsha, China
| | - Hailong Tan
- Department of General Surgery, Xiangya Hospital Central South University, Changsha, China
| | - Peng Huang
- Department of General Surgery, Xiangya Hospital Central South University, Changsha, China
| | - Shi Chang
- Department of General Surgery, Xiangya Hospital Central South University, Changsha, China.,Clinical Research Center for Thyroid Disease in Hunan Province, Changsha, China.,Hunan Provincial Engineering Research Center for Thyroid and Related Diseases Treatment Technology, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, China
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15
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Gilden J, Poels EMP, Lambrichts S, Vreeker A, Boks MPM, Ophoff RA, Kahn RS, Kamperman AM, Bergink V. Bipolar episodes after reproductive events in women with bipolar I disorder, A study of 919 pregnancies. J Affect Disord 2021; 295:72-79. [PMID: 34416620 DOI: 10.1016/j.jad.2021.08.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Revised: 08/01/2021] [Accepted: 08/03/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Women with bipolar I disorder are at high risk for severe episodes after childbirth, but there is no study that provides an overview on bipolar episode risk both during pregnancy and after childbirth, miscarriage and induced abortion. The aim of this study was to determine the episode risk during all pregnancy outcomes subdivided by first and subsequent pregnancies. METHODS Participants were 436 women with bipolar I disorder from the Dutch Bipolar Cohort, having 919 pregnancies of which 762 resulted in a live childbirth, 118 ended in a miscarriage and 39 ended in induced abortion. Women reported on the occurrence of manic or depressed episodes during the perinatal period. Information about medication use was obtained by questionnaires. RESULTS Episode risk was 5.2% during pregnancy, and 30.1% in the postpartum period, with a peak in the early postpartum period. Risk of an episode was highest after live birth (34.4%), and lower after miscarriage (15.2%) and induced abortion (27.8%). Women with an episode during pregnancy or postpartum were less likely to have a second child compared to women with an uneventful first pregnancy (cOR=0.34; 95%CI: 0.22-0.51; p<0.001); if they had a second child their risk of an episode was significantly elevated with a subsequent pregnancy (cOR=6.17; 95%CI: 3.64-10.45; p<0.001). LIMITATIONS Retrospective cross-sectional design with assessment (partial) through self-report in a homogeneous population. CONCLUSIONS Women with bipolar I disorder have a six times higher risk of an episode after delivery compared to during pregnancy, therefore preventive strategies are particularly important immediately after delivery.
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Affiliation(s)
- Janneke Gilden
- Department of Psychiatry, Erasmus University Medical Center, 3000 CA Rotterdam, the Netherlands.
| | - Eline M P Poels
- Department of Psychiatry, Erasmus University Medical Center, 3000 CA Rotterdam, the Netherlands
| | - Simon Lambrichts
- Academic Center for ECT and Neuromodulation (AcCENT), KU Leuven - University of Leuven, University Psychiatric Center KU Leuven, Kortenberg, Belgium
| | - Annabel Vreeker
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Center, 3000 CA Rotterdam, the Netherlands
| | - Marco P M Boks
- Department of Psychiatry, Utrecht Medical Center, 3508 GA Utrecht, the Netherlands
| | - Roel A Ophoff
- Department of Psychiatry, Erasmus University Medical Center, 3000 CA Rotterdam, the Netherlands
| | - René S Kahn
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Astrid M Kamperman
- Department of Psychiatry, Erasmus University Medical Center, 3000 CA Rotterdam, the Netherlands; Epidemiological and Social Psychiatric Research Institute, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Veerle Bergink
- Department of Psychiatry, Erasmus University Medical Center, 3000 CA Rotterdam, the Netherlands; Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; Department of obstetrics, gynecology and reproductive science, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
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16
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Wang Z, Shen J, Song Q, Cui X, Shi Z, Su J, Zang J. Effects of animal protein intake during pregnancy on autoimmune thyroiditis in pregnant women with mild iodine deficiency. J Hum Nutr Diet 2021; 35:542-553. [PMID: 34800315 DOI: 10.1111/jhn.12954] [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: 07/27/2021] [Accepted: 09/27/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Iodine and animal protein may affect thyroid function. In the present study, we explored the association between animal protein intake and thyroid antibody status in pregnant women following universal salt iodisation. METHODS Pregnant women were enrolled using a multistage, stratified random sampling method in Shanghai. In total, 4646 eligible women were interviewed in person. We used a validated food frequency questionnaire and food composition tables to calculate the daily intakes of protein and iodine. We collected urine samples and performed thyroid antibody tests. RESULTS Positive thyrotropin receptor antibody (TR-Ab) rates were different among animal protein intake groups (p < 0.05). Median urinary iodine concentration (UIC) was higher in the thyroid peroxidase antibody (TPO-Ab) positive group than in the negative group (p < 0.05). The median of total protein intake, animal protein intake and UIC was higher in the TR-Ab positive group than in the negative group (p < 0.05). The median of total protein intake and UIC was higher in the TPO-Ab/TG-Ab/TR-Ab positive group than in the negative group (p < 0.05). Multivariable logistic regression results showed that insufficient iodine had a negative correlation with positive TPO-Ab and positive TR-Ab (p < 0.05). The middle third and top third animal protein intakes served as protective factors for TR-Ab (coefficient = 0.559, 95% confidence interval [CI] = 0.415-0.752, p < 0.001; coefficient = 0.0.406, 95% CI = 0.266-0.621, p < 0.001) and positive TPO-Ab/TR-Ab/TG-Ab (coefficient = 0.817, 95% CI = 0.687-0.971, p = 0.022; coefficient = 0.805, 95% CI = 0.672-0.964, p = 0.018). CONCLUSIONS Adequate animal protein intake protects against elevated anti-thyroid antibody levels in pregnant women with mild iodine deficiency.
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Affiliation(s)
- Zhengyuan Wang
- Division of Health Risk Factors Monitoring and Control, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Jiaying Shen
- Tongji University School of Medicine, Tongji University, Shanghai, China
| | - Qi Song
- Division of Health Risk Factors Monitoring and Control, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Xueying Cui
- Division of Health Risk Factors Monitoring and Control, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Zehuan Shi
- Division of Health Risk Factors Monitoring and Control, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Jin Su
- Division of Health Risk Factors Monitoring and Control, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Jiajie Zang
- Division of Health Risk Factors Monitoring and Control, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
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17
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Ross KM, Dunkel Schetter C, Carroll JE, Mancuso RA, Breen EC, Okun ML, Hobel C, Coussons-Read M. Inflammatory and immune marker trajectories from pregnancy to one-year post-birth. Cytokine 2021; 149:155758. [PMID: 34773858 DOI: 10.1016/j.cyto.2021.155758] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 09/10/2021] [Accepted: 10/27/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND Pregnancy is an immunomodulatory state, with reported systematic changes in inflammatory and immune activity by pregnancy stage. Published data are inconsistent as to how inflammatory and immune markers change and recover across pregnancy and the postpartum period, or the sociodemographic, health and pregnancy-related factors that could affect biomarker trajectories. The purpose of this study is to describe inflammatory and immune marker trajectories from pregnancy to a year post-birth, and to test associations with sociodemographic, health and pregnancy-related variables. METHODS A sample of 179 pregnant women were assessed three times during pregnancy (between 8 and 36 weeks gestation) and three times during the postpartum period (between 1 and 12 months). Maternal sociodemographic characteristics, health, and pregnancy factors were obtained at study entry. Blood samples from each assessment were assayed for interleukin(IL)-6, tumor necrosis factor(TNF)α, IL-8, IL-10, and interferon(IFN)γ. Multilevel modelling was used to characterize biomarker trajectories and associations with sociodemographic and health variables. RESULTS Distinct trajectories over time emerged for each biomarker. Male pregnancies were associated with higher TNFα, IL-10, and IFNγ; higher pre-pregnancy BMI was associated with higher IL-6 and IFNγ. Nulliparity was associated with greater increases in IL-6 and TNFα. CONCLUSIONS Patterns observed for inflammatory and immune markers from pregnancy to a year postpartum support the hypothesis that the maternal immune system changes systematically across pregnancy and through an extended postpartum period. Parity, pre-pregnancy BMI and child sex are associated with inflammatory marker patterns over time. These results contribute to our understanding of how immune system activity changes from pregnancy to the post-birth period, and the factors that could affect those changes.
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Affiliation(s)
- Kharah M Ross
- Centre for Social Sciences, Athabasca University, Athabasca, AB, Canada.
| | | | - Judith E Carroll
- Cousins Center for Psychoneuroimmunology, Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Roberta A Mancuso
- Department of Psychology and Neuroscience, Regis University, Denver, CO, USA
| | - Elizabeth C Breen
- Cousins Center for Psychoneuroimmunology, Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Michele L Okun
- University of Colorado - Colorado Springs, Colorado Springs, CO, USA
| | - Calvin Hobel
- Cedars-Sinai Medical Centre, Los Angeles, CA, USA
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18
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Yu Y, Liu QQ, Liu DY, Wang DD, Yang LQ, Ye SM. Antibodies against thyroid-stimulating hormone receptor cause maternal-neonatal transmission of Graves' Disease. Exp Ther Med 2021; 22:1253. [PMID: 34603521 PMCID: PMC8453324 DOI: 10.3892/etm.2021.10688] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 03/15/2021] [Indexed: 11/25/2022] Open
Abstract
The present study aimed to investigate whether the thyroid-stimulating hormone receptor (TSHR) autoantibodies (Ab) from mothers with Graves' disease (GD) could cause neonatal thyroid disease and the underlying mechanisms of this. An adenovirus expressing the TSHR A-subunit and a control adenovirus expressing β-galactosidase was constructed by Beijing Sino Geno Max Co., Ltd. The sequences were subsequently verified and amplified via PCR. A GD model was established in female BALB/c mice (n=90) by three intramuscular injections of a TSHR-expressing adenovirus (Ad-TSHR). Mice injected with Ad-β-galactosidase served as a sham immunization group. The immunized females were paired with unimmunized males to generate offspring. The serum levels of TSHR-Ab and thyroxine (T4) of mothers and neonates were measured after delivery. Breast milk was collected from the stomachs of neonatal mice to determine the TSHR-Ab levels. The positive rate of serum TSHR-Ab (>0.3 IU/l) in the TSHR group was 99% (89/90) and 0% in the sham group. The mother mice in the TSHR group had elevated serum T4 levels and the thyroid pathological features of Graves' hyperthyroidism.GD mice gave birth to smaller newborns with thyroid pathological changes and higher serum levels of TSHR-Ab and T4, compared to the offspring in the sham group. The TSHR-Ab levels in breast milk from the GD mice declined with time. Mice immunized with Ad-TSHR exhibited the clinicopathological features of human GD and give birth to neonates with thyroid disease at birth.
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Affiliation(s)
- Yue Yu
- Department of Pediatrics, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230601, P.R. China
| | - Qian-Qi Liu
- Nanjing Children's Hospital Affiliated to Nanjing Medical University, Nanjing, Jiangsu 210008, P.R. China
| | - De-Yun Liu
- Department of Pediatrics, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230601, P.R. China
| | - Dan-Dan Wang
- Nanjing Children's Hospital Affiliated to Nanjing Medical University, Nanjing, Jiangsu 210008, P.R. China
| | - Li-Qi Yang
- Department of Pediatrics, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230601, P.R. China
| | - Shu-Ming Ye
- Department of Orthopedic Surgery, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230601, P.R. China
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19
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Krupa A, Kowalska I. The Kynurenine Pathway-New Linkage between Innate and Adaptive Immunity in Autoimmune Endocrinopathies. Int J Mol Sci 2021; 22:9879. [PMID: 34576041 PMCID: PMC8469440 DOI: 10.3390/ijms22189879] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 09/09/2021] [Accepted: 09/10/2021] [Indexed: 12/18/2022] Open
Abstract
The kynurenine pathway (KP) is highly regulated in the immune system, where it promotes immunosuppression in response to infection or inflammation. Indoleamine 2,3-dioxygenase 1 (IDO1), the main enzyme of KP, has a broad spectrum of activity on immune cells regulation, controlling the balance between stimulation and suppression of the immune system at sites of local inflammation, relevant to a wide range of autoimmune and inflammatory diseases. Various autoimmune diseases, among them endocrinopathies, have been identified to date, but despite significant progress in their diagnosis and treatment, they are still associated with significant complications, morbidity, and mortality. The precise cellular and molecular mechanisms leading to the onset and development of autoimmune disease remain poorly clarified so far. In breaking of tolerance, the cells of the innate immunity provide a decisive microenvironment that regulates immune cells' differentiation, leading to activation of adaptive immunity. The current review provided a comprehensive presentation of the known role of IDO1 and KP activation in the regulation of the innate and adaptive arms of the immune system. Significant attention has been paid to the immunoregulatory role of IDO1 in the most prevalent, organ-specific autoimmune endocrinopathies-type 1 diabetes mellitus (T1DM) and autoimmune thyroiditis.
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Affiliation(s)
- Anna Krupa
- Department of Internal Medicine and Metabolic Diseases, Medical University of Bialystok, M. Sklodowskiej-Curie 24A, 15-276 Bialystok, Poland
| | - Irina Kowalska
- Department of Internal Medicine and Metabolic Diseases, Medical University of Bialystok, M. Sklodowskiej-Curie 24A, 15-276 Bialystok, Poland
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20
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Guo F, Yang X. A Comprehensive Review of the Management of Pregnant Women with COVID-19: Useful Information for Obstetricians. Infect Drug Resist 2021; 14:3363-3378. [PMID: 34466003 PMCID: PMC8402981 DOI: 10.2147/idr.s325496] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 08/18/2021] [Indexed: 12/22/2022] Open
Abstract
Due to the physiological changes of the cardiovascular system and respiratory system in pregnancy, pregnant women are vulnerable to pathogen infection and severe pneumonia. With the increasing incidence of COVID-19 pneumonia, its influence on pregnant women and neonates has attracted more attention. In this review, we collected all relevant articles published in English from September 1, 2019 to June 10, 2021, regarding the epidemiology, clinical presentations, chemical examinations, imaging findings, the timing of delivery and delivery mode, maternal and neonatal complications, medication, and vertical transmission of COVID-19 in pregnancy. It has been reported that compared with non-pregnant females, pregnant women with COVID-19 are more likely to develop into severe type. In particular, the risk of entering the intensive care unit and endotracheal intubation was higher. Chest computed tomography and blood routine examination are useful for the diagnosis of COVID-19 in a short period of time. COVID-19 pneumonia is not an independent indication for terminating the pregnancy, and it is not contraindicated for vaginal delivery. Compared to normal pregnant females, patients with COVID-19 showed an elevated susceptibility of preterm delivery. Multidisciplinary consultation was suggested in the treatment policy of COVID-19 in pregnancy. Currently, there is no evaluation on the safety, efficacy, and immunity of the approved vaccines for mothers and infants. In human placental tissues, the COVID-19 virus has been found by different detection methods. The mechanism by which the virus enters the placental tissue is unclear, which may be related to placental inflammation. The long-term prognosis of pregnant women with COVID-19 remains unclear and requires further detailed investigation.
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Affiliation(s)
- Feng Guo
- Department of Emergency Medicine, Shengjing Hospital of China Medical University, Shenyang, Liaoning, People’s Republic of China
| | - Xiuhua Yang
- Department of Obstetrics, The First Hospital of China Medical University, Shenyang, Liaoning, People’s Republic of China
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21
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Ahlers NE, Weiss SJ. Exposure to particulate matter, prenatal depressive symptoms and HPA axis dysregulation. Heliyon 2021; 7:e07166. [PMID: 34141927 PMCID: PMC8187961 DOI: 10.1016/j.heliyon.2021.e07166] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Revised: 01/07/2021] [Accepted: 05/26/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The prevalence of depression during pregnancy is on the rise, affecting women's well-being and their children's health outcomes. Preliminary studies suggest that exposure to air pollution during pregnancy may play a role in development of depressive symptoms. In addition, pollution has been linked to dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis, our brain's primary stress response system. The purpose of this study was to examine the association of air pollution exposure during pregnancy to prenatal depressive symptoms. We also evaluated whether cortisol, the hormonal endpoint of HPA activation, mediated the relationship between exposure to pollution and prenatal depression. METHODS Women were recruited in obstetric clinics during their third trimester of pregnancy. They completed the Patient Health Questionnaire-9 to assess depression and provided salivary samples at 4 times during the day for 2 days. Four measures of cortisol were calculated from salivary assays: average cortisol level, cortisol awakening response (CAR), diurnal cortisol slope (DCS), and area under the curve (AUCG). We acquired data on particulate matter with a diameter of 2.5 μm (PM2.5) or less within each woman's residential area from public records of the air quality control district. Structural equation modeling was used to analyze the aims. RESULTS Increased prenatal exposure to PM2.5 across pregnancy was associated with more severe depressive symptoms during the 3rd trimester (β = 0.14, p = 0.02). Greater PM2.5 exposure also had significant relationships with both higher cortisol AUCG (β = 15.933, p = 0.005) and average cortisol levels (β = 0.018, p = 0.023) among women. However, no cortisol parameter appeared to mediate the relationship between PM2.5 exposure and depressive symptoms. CONCLUSIONS Findings suggest pregnancy may be a critical window of sensitivity to PM2.5 exposure that escalates depression risk and induces activation of the HPA axis, evidenced in greater overall cortisol concentration. Further research is needed to identify mechanisms underlying the effects of particulate matter, especially potential methylation of glucocorticoid or serotonin transporter genes that may elicit changes in both depression and the stress response system. In addition, assessment of depression appears warranted for pregnant women in regions known for high pollution.
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Affiliation(s)
- Nina E. Ahlers
- Department of Community Health Systems, University of California, San Francisco, CA, USA
| | - Sandra J. Weiss
- Department of Community Health Systems, University of California, San Francisco, CA, USA
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22
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Hammerstad SS, Celius EG, Husby H, Sørensen IM, Norheim IE. Management of Severe Graves' Hyperthyroidism in Pregnancy Following Immune Reconstitution Therapy in Multiple Sclerosis. J Endocr Soc 2021; 5:bvab044. [PMID: 34017934 PMCID: PMC8122367 DOI: 10.1210/jendso/bvab044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Indexed: 12/03/2022] Open
Abstract
CONTEXT Alemtuzumab (ALZ), a CD52 monoclonal antibody, is highly efficacious in multiple sclerosis; however, side effects are common. Autoimmune thyroid disease (Graves' disease and Hashimoto thyroiditis) is a well-known complication of ALZ. Treatment of ALZ-induced Graves' disease can be challenging, and even more difficult during pregnancy. CASE DESCRIPTION We present a case of severe ALZ-induced Graves' disease with a rapid increase in thyrotropin receptor antibodies (TRAb 240 IU/L) and thyrotoxicosis in early pregnancy. Treatment with high doses of antithyroid medication was needed. There was high risk of both fetal and neonatal thyrotoxicosis. Serial fetal sonography showed normal development. The newborn baby presented high levels of TRAb (240 IU/L) and developed neonatal thyrotoxicosis on day 8. Adequate monitoring, treatment, and follow-up of the newborn baby ensured normal thyroid function until disappearance of TRAb 6 weeks after birth. CONCLUSION Multiple sclerosis patients treated with ALZ may develop severe Graves' disease with an increased risk of both fetal and neonatal thyrotoxicosis. Close follow-up with a multidisciplinary approach is needed to ensure a healthy outcome.
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Affiliation(s)
- Sara Salehi Hammerstad
- Division of Peadiatric and Adolescent Medicine, Oslo University Hospital, Ullevål, Oslo, Norway
- Specialist Center Pilestredet Park, OsloNorway
| | - Elisabeth G Celius
- Department of Neurology, Oslo University Hospital, Ullevål, Oslo; Norway and University of Oslo
| | - Henrik Husby
- Department of Fetal Medicine, Oslo University Hospital, Ullevål, OsloNorway
| | - Ingvild M Sørensen
- Division of Peadiatric and Adolescent Medicine, Oslo University Hospital, Ullevål, Oslo, Norway
| | - Ingrid E Norheim
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Aker, Oslo, Norway
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23
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Andersen SL, Nielsen KK, Kristensen SR. The interrelationship between pregnancy, venous thromboembolism, and thyroid disease: a hypothesis-generating review. Thyroid Res 2021; 14:12. [PMID: 34034778 PMCID: PMC8146627 DOI: 10.1186/s13044-021-00102-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 04/26/2021] [Indexed: 11/28/2022] Open
Abstract
Pregnancy induces physiological changes that affect the risk of thrombosis and thyroid disease. In this hypothesis-generating review, the physiological changes in the coagulation system and in thyroid function during a normal pregnancy are described, and the incidence of venous thromboembolism (VTE) and thyroid disease in and after a pregnancy are compared and discussed. Furthermore, evidence regarding the association between thyroid disease and VTE in non-pregnant individuals is scrutinized. In conclusion, a normal pregnancy entails hormonal changes, which influence the onset of VTE and thyroid disease. Current evidence suggests an association between thyroid disease and VTE in non-pregnant individuals. This review proposes the hypothesis that maternal thyroid disease associates with VTE in pregnant women and call for future research studies on this subject. If an association exists in pregnant women specifically, such findings may have clinical implications regarding strategies for thyroid function testing and potential thromboprophylaxis in selected individuals.
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Affiliation(s)
- Stine Linding Andersen
- Department of Clinical Biochemistry, Aalborg University Hospital, Hobrovej 18-22, 9000, Aalborg, Denmark. .,Department of Clinical Medicine, Aalborg University, Sdr. Skovvej 15, 9000 Aalborg, 9000, Aalborg, Denmark.
| | - Kasper Krogh Nielsen
- Department of Clinical Biochemistry, Aalborg University Hospital, Hobrovej 18-22, 9000, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Sdr. Skovvej 15, 9000 Aalborg, 9000, Aalborg, Denmark
| | - Søren Risom Kristensen
- Department of Clinical Biochemistry, Aalborg University Hospital, Hobrovej 18-22, 9000, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Sdr. Skovvej 15, 9000 Aalborg, 9000, Aalborg, Denmark
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24
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Naveed M, Naeem M, ur Rahman M, Gul Hilal M, Kakakhel M, Ali G, Hassan A. Review of potential risk groups for coronavirus disease 2019 (COVID-19). New Microbes New Infect 2021; 41:100849. [PMID: 33614041 PMCID: PMC7879740 DOI: 10.1016/j.nmni.2021.100849] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 01/17/2021] [Accepted: 02/01/2021] [Indexed: 01/08/2023] Open
Abstract
The current pandemic of coronavirus disease 19 (COVID-19) is a global issue caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Studies have revealed that this virus results in poorer consequences and a higher rate of mortality in older adults and those with comorbidities such as cardiovascular disease, hypertension, diabetes and prolonged respiratory illness. In this review, we discuss in detail the potential groups at risk of COVID-19 and outline future recommendations to mitigate community transmission of COVID-19. The rate of COVID-19 was high in healthcare workers, smokers, older adults, travellers and pregnant women. Furthermore, patients with severe medical complications such as heart disease, hypertension, respiratory illness, diabetes mellitus and cancer are at higher risk of disease severity and mortality. Therefore, special effort and devotion are needed to diminish the threat of SARS-CoV-2 infection. Proper vaccination, use of sanitizers for handwashing and complete lockdown are recommended to mitigate the chain of COVID-19 transmission.
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Affiliation(s)
- M. Naveed
- Institute of Microbiology, School of Life Sciences, Lanzhou University, Tianshui Road No. 222, Lanzhou, 730000, China
| | - M. Naeem
- Department of Microbiology, University of Swabi, Khyber PakhtunKhwa, Pakistan
| | - M. ur Rahman
- College of Life Sciences, Northwest University, Xian, Shaanxi Province, 710069, China
| | - M. Gul Hilal
- Institute of Occupational and Environmental Health, School of Public Health, Lanzhou University, Lanzhou, 730000, China
| | - M.A. Kakakhel
- MOE Key Laboratory of Cell Activities and Stress Adaptations, School of Life Sciences, Lanzhou University, Lanzhou, 730000, China
| | - G. Ali
- MOE Key Laboratory of Cell Activities and Stress Adaptations, School of Life Sciences, Lanzhou University, Lanzhou, 730000, China
| | - A. Hassan
- Bioengineering College of Chongqing University, Chongqing, China
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25
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Keestra SM, Male V, Salali GD. Out of balance: the role of evolutionary mismatches in the sex disparity in autoimmune disease. Med Hypotheses 2021; 151:110558. [PMID: 33964604 DOI: 10.1016/j.mehy.2021.110558] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 02/07/2021] [Accepted: 03/02/2021] [Indexed: 12/28/2022]
Abstract
Over the past century autoimmune disease incidence has increased rapidly in (post-) industrialised, affluent societies, suggesting that changes in ecology and lifestyle are driving this development. Epidemiological studies show that (i) 80% of autoimmune disease patients are female, (ii) autoimmune diseases co-occur more often in women, and (iii) the incidence of some autoimmune diseases is increasing faster in women than in men. The female preponderance in autoimmunity is most pronounced between puberty and menopause, suggesting that diverging sex hormone levels during the reproductive years are implicated in autoimmune disease development. Using an evolutionary perspective, we build on the hypotheses that female immunity is cyclical in menstruating species and that natural selection shaped the female immune system to optimise the implantation and gestation of a semi-allogeneic foetus. We propose that cyclical immunomodulation and female immune tolerance mechanisms are currently out of balance because of a mismatch between the conditions under which they evolved and (post-)industrialised, affluent lifestyles. We suggest that current changes in autoimmune disease prevalence may be caused by increases in lifetime exposure to cyclical immunomodulation and ovarian hormone exposure, reduced immune challenges, increased reproductive lifespan, changed reproductive patterns, and enhanced positive energy balance associated with (post-)industrialised, affluent lifestyles. We discuss proximate mechanisms by which oestrogen and progesterone influence tolerance induction and immunomodulation, and review the effect of the menstrual cycle, pregnancy, and contraceptive use on autoimmune disease incidence and symptoms.
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Affiliation(s)
- Sarai M Keestra
- Amsterdam UMC, University of Amsterdam, the Netherlands; Department of Global Health & Development, London School of Hygiene and Tropical Medicine, UK.
| | - Victoria Male
- Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, UK
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26
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Affiliation(s)
- Riley Epp
- Department of Medicine University of Ottawa, Ottawa, Ontario, Canada
- Division of Endocrinology and Metabolism, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Janine Malcolm
- Department of Medicine University of Ottawa, Ottawa, Ontario, Canada
- Division of Endocrinology and Metabolism, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Khiera Jolin-Dahel
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Erin Keely
- Department of Medicine University of Ottawa, Ottawa, Ontario, Canada
- Division of Endocrinology and Metabolism, The Ottawa Hospital, Ottawa, Ontario, Canada
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27
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Li C, Zhang N, Zhou J, Leung W, Gober HJ, Huang Z, Pan X, Chen L, Guan L, Wang L. Variations in the Antithyroid Antibody Titre During Pregnancy and After Delivery. Risk Manag Healthc Policy 2021; 14:847-859. [PMID: 33688281 PMCID: PMC7935493 DOI: 10.2147/rmhp.s279975] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 02/01/2021] [Indexed: 01/01/2023] Open
Abstract
Background Immunosuppression occurs during pregnancy, and the antithyroid antibody titre drops, rebounding after delivery. We aimed to determine variations in antithyroid antibody titres during pregnancy and after delivery. Methods This retrospective study was conducted in a single centre. Antibody titres of 142 patients were measured to assess variations in the levels of thyroid-stimulating hormone receptor antibodies (TRAbs), thyroid peroxidase antibodies (TPOAbs), and thyroid globulin antibodies (TgAbs). We compared the titres of each antibody between adjacent time periods (eg, first trimester (T1) vs second trimester (T2), T2 vs third trimester (T3), T3 vs the postpartum period (PP)) by paired t-test or the Wilcoxon test. Then, we analysed data from patients with complete laboratory examination results in all four periods with the Friedman test, performing comparisons among groups. Results In the TgAb group, significant differences existed between T1 and T2 and between T2 and T3 in the LT4 subgroup and between T1 and T2 in the no-medication subgroup. In the TRAb group, significant differences existed between T1 and T2 in the LT4 subgroup. In the TPOAb group, significant differences existed among each group in the LT4 subgroup, and there were significant differences between T1 and T2 and between T2 and T3 in the no-medication subgroup. The Friedman test showed that the P-values were 0.013 and 0.004 in the LT4 and no-medication subgroups of the TgAb group, respectively; 0.122 in the LT4 subgroup of the TRAb group; and <0.001 and 0.272 in the LT4 and no-medication subgroups of the TPOAb group, respectively. In the LT4 subgroup of the TgAb group, the P-values for comparisons of time periods were 0.602 between T1 and T2, 0.602 between T2 and T3, 0.006 between T1 and T3, and 0.602 between T3 and PP. In the no-medication subgroup of the TgAb group, the P-values were 0.078 between T1 and T2, 1.000 between T2 and T3, 0.011 between T1 and T3, and 0.078 between T3 and PP. In the LT4 subgroup of the TPOAb group, the P-values were 0.09 between T1 and T2, 0.014 between T2 and T3, <0.001 between T1 and T3, and 0.772 between T3 and PP. Conclusion We can conclude that the TgAb and TPOAb titres dropped during pregnancy.
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Affiliation(s)
- Chuyu Li
- Laboratory for Reproductive Immunology, Hospital & Institute of Obstetrics and Gynecology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China.,The Academy of Integrative Medicine of Fudan University, Shanghai, People's Republic of China.,Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, Shanghai, People's Republic of China
| | - Na Zhang
- Laboratory for Reproductive Immunology, Hospital & Institute of Obstetrics and Gynecology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China.,The Academy of Integrative Medicine of Fudan University, Shanghai, People's Republic of China.,Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, Shanghai, People's Republic of China
| | - Jing Zhou
- Laboratory for Reproductive Immunology, Hospital & Institute of Obstetrics and Gynecology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China.,The Academy of Integrative Medicine of Fudan University, Shanghai, People's Republic of China.,Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, Shanghai, People's Republic of China
| | - Wingting Leung
- Laboratory for Reproductive Immunology, Hospital & Institute of Obstetrics and Gynecology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China.,The Academy of Integrative Medicine of Fudan University, Shanghai, People's Republic of China.,Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, Shanghai, People's Republic of China
| | - Hans-Jürgen Gober
- Department of Pharmacy, Neuromed Campus, Kepler University Hospital, Linz, 4020, Austria
| | - Zengshu Huang
- Laboratory for Reproductive Immunology, Hospital & Institute of Obstetrics and Gynecology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China.,The Academy of Integrative Medicine of Fudan University, Shanghai, People's Republic of China.,Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, Shanghai, People's Republic of China
| | - Xinyao Pan
- Laboratory for Reproductive Immunology, Hospital & Institute of Obstetrics and Gynecology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China.,The Academy of Integrative Medicine of Fudan University, Shanghai, People's Republic of China.,Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, Shanghai, People's Republic of China
| | - Lijia Chen
- Laboratory for Reproductive Immunology, Hospital & Institute of Obstetrics and Gynecology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China.,The Academy of Integrative Medicine of Fudan University, Shanghai, People's Republic of China.,Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, Shanghai, People's Republic of China
| | - Liang Guan
- Department of Nuclear Medicine, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, People's Republic of China.,Department of Nuclear Medicine, Ruijin Hospital North, School of Medicine, Shanghai Jiaotong University, Shanghai, People's Republic of China
| | - Ling Wang
- Laboratory for Reproductive Immunology, Hospital & Institute of Obstetrics and Gynecology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China.,The Academy of Integrative Medicine of Fudan University, Shanghai, People's Republic of China.,Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, Shanghai, People's Republic of China
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28
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Moshkelgosha S, Verhasselt HL, Masetti G, Covelli D, Biscarini F, Horstmann M, Daser A, Westendorf AM, Jesenek C, Philipp S, Diaz-Cano S, Banga JP, Michael D, Plummer S, Marchesi JR, Eckstein A, Ludgate M, Berchner-Pfannschmidt U. Modulating gut microbiota in a mouse model of Graves' orbitopathy and its impact on induced disease. MICROBIOME 2021; 9:45. [PMID: 33593429 PMCID: PMC7888139 DOI: 10.1186/s40168-020-00952-4] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 12/06/2020] [Indexed: 05/15/2023]
Abstract
BACKGROUND Graves' disease (GD) is an autoimmune condition in which autoantibodies to the thyrotropin receptor (TSHR) cause hyperthyroidism. About 50% of GD patients also have Graves' orbitopathy (GO), an intractable disease in which expansion of the orbital contents causes diplopia, proptosis and even blindness. Murine models of GD/GO, developed in different centres, demonstrated significant variation in gut microbiota composition which correlated with TSHR-induced disease heterogeneity. To investigate whether correlation indicates causation, we modified the gut microbiota to determine whether it has a role in thyroid autoimmunity. Female BALB/c mice were treated with either vancomycin, probiotic bacteria, human fecal material transfer (hFMT) from patients with severe GO or ddH2O from birth to immunization with TSHR-A subunit or beta-galactosidase (βgal; age ~ 6 weeks). Incidence and severity of GD (TSHR autoantibodies, thyroid histology, thyroxine level) and GO (orbital fat and muscle histology), lymphocyte phenotype, cytokine profile and gut microbiota were analysed at sacrifice (~ 22 weeks). RESULTS In ddH2O-TSHR mice, 84% had pathological autoantibodies, 67% elevated thyroxine, 77% hyperplastic thyroids and 70% orbital pathology. Firmicutes were increased, and Bacteroidetes reduced relative to ddH2O-βgal; CCL5 was increased. The random forest algorithm at the genus level predicted vancomycin treatment with 100% accuracy but 74% and 70% for hFMT and probiotic, respectively. Vancomycin significantly reduced gut microbiota richness and diversity compared with all other groups; the incidence and severity of both GD and GO also decreased; reduced orbital pathology correlated positively with Akkermansia spp. whilst IL-4 levels increased. Mice receiving hFMT initially inherited their GO donors' microbiota, and the severity of induced GD increased, as did the orbital brown adipose tissue volume in TSHR mice. Furthermore, genus Bacteroides, which is reduced in GD patients, was significantly increased by vancomycin but reduced in hFMT-treated mice. Probiotic treatment significantly increased CD25+ Treg cells in orbital draining lymph nodes but exacerbated induced autoimmune hyperthyroidism and GO. CONCLUSIONS These results strongly support a role for the gut microbiota in TSHR-induced disease. Whilst changes to the gut microbiota have a profound effect on quantifiable GD endocrine and immune factors, the impact on GO cellular changes is more nuanced. The findings have translational potential for novel, improved treatments. Video abstract.
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Affiliation(s)
- Sajad Moshkelgosha
- Molecular Ophthalmology, Department of Ophthalmology, University Hospital Essen, University of Duisburg-Essen, 45147, Essen, Germany
- Current address: Latner Thoracic Surgery Laboratories, Toronto General Research Institute, University Health Network and University of Toronto, Toronto, Canada
| | - Hedda Luise Verhasselt
- Institute of Medical Microbiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Cultech Ltd., Baglan, Port Talbot, UK
| | - Giulia Masetti
- Division of Infection & Immunity, School of Medicine, Cardiff University, UHW main building, Heath Park, Cardiff, CF14 4XW, UK
- Department of Bioinformatics, PTP Science Park Srl, Lodi, Italy
- Current address: Computational metagenomics, Department CIBIO, University of Trento, Trento, Italy
| | - Danila Covelli
- Cultech Ltd., Baglan, Port Talbot, UK
- Graves' Orbitopathy Center, Endocrinology, Department of Clinical Sciences and Community Health, Fondazione Ca'Granda IRCCS, University of Milan, Milan, Italy
| | - Filippo Biscarini
- Department of Bioinformatics, PTP Science Park Srl, Lodi, Italy
- Italian National Research Council (CNR), Milano, Italy
| | - Mareike Horstmann
- Molecular Ophthalmology, Department of Ophthalmology, University Hospital Essen, University of Duisburg-Essen, 45147, Essen, Germany
| | - Anke Daser
- Department of Ophthalmology, University Hospital Essen, University of Duisburg-Essen, 45147, Essen, Germany
| | - Astrid M Westendorf
- Institute of Medical Microbiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Christoph Jesenek
- Molecular Ophthalmology, Department of Ophthalmology, University Hospital Essen, University of Duisburg-Essen, 45147, Essen, Germany
| | - Svenja Philipp
- Molecular Ophthalmology, Department of Ophthalmology, University Hospital Essen, University of Duisburg-Essen, 45147, Essen, Germany
| | - Salvador Diaz-Cano
- Department of Histopathology, King's College Hospital, King's College, London, UK
| | - J Paul Banga
- Molecular Ophthalmology, Department of Ophthalmology, University Hospital Essen, University of Duisburg-Essen, 45147, Essen, Germany
| | | | | | - Julian R Marchesi
- School of Biosciences, Cardiff University, Cardiff, UK
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Anja Eckstein
- Department of Ophthalmology, University Hospital Essen, University of Duisburg-Essen, 45147, Essen, Germany.
| | - Marian Ludgate
- Division of Infection & Immunity, School of Medicine, Cardiff University, UHW main building, Heath Park, Cardiff, CF14 4XW, UK.
| | - Utta Berchner-Pfannschmidt
- Molecular Ophthalmology, Department of Ophthalmology, University Hospital Essen, University of Duisburg-Essen, 45147, Essen, Germany.
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Govender R, Moodley J, Naicker T. The COVID-19 Pandemic: an Appraisal of its Impact on Human Immunodeficiency Virus Infection and Pre-Eclampsia. Curr Hypertens Rep 2021; 23:9. [PMID: 33570681 PMCID: PMC7877335 DOI: 10.1007/s11906-021-01126-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2020] [Indexed: 12/22/2022]
Abstract
PURPOSE OF REVIEW The impact of the coronavirus disease 2019 (COVID-19) pandemic is profound, with distressing consequences on many individuals, especially those with co-morbidities. Pregnant women are one such group of individuals who are at in increased risk of contracting COVID-19, due to their immunocompromised state. In South Africa, HIV infection and pre-eclampsia are the leading causes of maternal morbidity and mortality, with South Africa being the HIV epicentre of the world. The relationship between COVID-19 superimposed on HIV infection and preeclampsia is complex and uncertain due to their different immune responses, and therefore requires further research. RECENT FINDINGS Notably evidence suggests that pregnant women with chronic comorbidities (HIV and pre-eclampsia) may be at a greater risk of contracting or encountering complications from COVID-19. Maternal stress, during a pandemic, as well as home delivery have become potential options for pregnant woman. Nonetheless there is currently a paucity of information on the combined effect of COVID-19 in HIV-associated preeclampsia. Understanding the pathogenesis of COVID-19 could potentially aid in developing effective treatment strategies for COVID-19 in HIV associated preeclampsia. This review article presents a comprehensive analysis of the current data in relation to COVID-19 and its effect on pregnant women, including symptoms, pathogenesis and the possible risk of vertical transmission. This paper also reviews its' interactions and effects on preeclamptic and HIV positive pregnant women with suspected or confirmed COVID-19.
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Affiliation(s)
- Rowen Govender
- Optics & Imaging Centre, Doris Duke Medical Research Institute, College of Health Sciences, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Private Bag 7, Congella, Durban, KwaZulu-Natal, 4013, South Africa.
| | - Jagidesa Moodley
- Women's Health and HIV Research Group, Department of Obstetrics & Gynaecology, School of Clinical Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Thajasvarie Naicker
- Optics & Imaging Centre, Doris Duke Medical Research Institute, College of Health Sciences, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Private Bag 7, Congella, Durban, KwaZulu-Natal, 4013, South Africa
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30
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Shepherd R, Cheung AS, Pang K, Saffery R, Novakovic B. Sexual Dimorphism in Innate Immunity: The Role of Sex Hormones and Epigenetics. Front Immunol 2021; 11:604000. [PMID: 33584674 PMCID: PMC7873844 DOI: 10.3389/fimmu.2020.604000] [Citation(s) in RCA: 118] [Impact Index Per Article: 39.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 12/04/2020] [Indexed: 12/17/2022] Open
Abstract
Sexual dimorphism refers to differences between biological sexes that extend beyond sexual characteristics. In humans, sexual dimorphism in the immune response has been well demonstrated, with females exhibiting lower infection rates than males for a variety of bacterial, viral, and parasitic pathogens. There is also a substantially increased incidence of autoimmune disease in females compared to males. Together, these trends indicate that females have a heightened immune reactogenicity to both self and non-self-molecular patterns. However, the molecular mechanisms driving the sexually dimorphic immune response are not fully understood. The female sex hormones estrogen and progesterone, as well as the male androgens, such as testosterone, elicit direct effects on the function and inflammatory capacity of immune cells. Several studies have identified a sex-specific transcriptome and methylome, independent of the well-described phenomenon of X-chromosome inactivation, suggesting that sexual dimorphism also occurs at the epigenetic level. Moreover, distinct alterations to the transcriptome and epigenetic landscape occur in synchrony with periods of hormonal change, such as puberty, pregnancy, menopause, and exogenous hormone therapy. These changes are also mirrored by changes in immune cell function. This review will outline the evidence for sex hormones and pregnancy-associated hormones as drivers of epigenetic change, and how this may contribute to the sexual dimorphism. Determining the effects of sex hormones on innate immune function is important for understanding sexually dimorphic autoimmune diseases, sex-specific responses to pathogens and vaccines, and how innate immunity is altered during periods of hormonal change (endogenous or exogenous).
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Affiliation(s)
- Rebecca Shepherd
- Epigenetics Group, Infection and Immunity Theme, Murdoch Children’s Research Institute, Royal Children’s Hospital, Parkville, VIC, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, VIC, Australia
| | - Ada S. Cheung
- Department of Medicine (Austin Health), The University of Melbourne, Parkville, VIC, Australia
- Department of Endocrinology, Austin Health, Heidelberg, VIC, Australia
| | - Ken Pang
- Department of Paediatrics, The University of Melbourne, Parkville, VIC, Australia
- Brain and Mitochondrial Research, Murdoch Children’s Research Institute, Royal Children’s Hospital, Parkville, VIC, Australia
- Inflammation Division, The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia
- Department of Adolescent Medicine, Royal Children’s Hospital, Parkville, VIC, Australia
| | - Richard Saffery
- Epigenetics Group, Infection and Immunity Theme, Murdoch Children’s Research Institute, Royal Children’s Hospital, Parkville, VIC, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, VIC, Australia
| | - Boris Novakovic
- Epigenetics Group, Infection and Immunity Theme, Murdoch Children’s Research Institute, Royal Children’s Hospital, Parkville, VIC, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, VIC, Australia
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31
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Recent insights into the impact of immune dysfunction on reproduction in autoimmune thyroiditis. Clin Immunol 2021; 224:108663. [PMID: 33401032 DOI: 10.1016/j.clim.2020.108663] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 10/22/2020] [Accepted: 12/30/2020] [Indexed: 02/06/2023]
Abstract
Autoimmune thyroiditis (AIT) is a common organ-specific autoimmune disease with a high incidence among women of childbearing age. Recent studies have reported that women with AIT are more susceptible to infertility, miscarriage and preterm birth. It has been investigated that abnormal changes in maternal immune system and maternal-fetal interface can dampen the immune tolerance between mother and fetus, which underlie the pathogenesis of adverse pregnancy outcomes. Hence, we summarize the immunological changes related to adverse reproductive outcomes in AIT and highlight the respective contributions of both humoral and cellular immune dysfunctions to pregnancy failures. Moreover, the direct impacts of AIT on maternal-fetal immune activation and biological influences to trophoblasts are discussed as well. All these associations require confirmation in larger studies, and the pathogenic mechanisms need to be better understood, which might provide useful information for clinical diagnosis and therapy of AIT.
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32
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Ejtahed HS, Angoorani P, Soroush AR, Siadat SD, Shirzad N, Hasani-Ranjbar S, Larijani B. Our Little Friends with Big Roles: Alterations of the Gut Microbiota in Thyroid Disorders. Endocr Metab Immune Disord Drug Targets 2021; 20:344-350. [PMID: 31566142 DOI: 10.2174/1871530319666190930110605] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 07/13/2019] [Accepted: 08/08/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND The thyroid gland influences the metabolic processes in our body by producing thyroid hormones, and thyroid disorders can range from a harmless goiter to life-threatening cancer. A growing number of evidence support the link between gut microbiota composition and thyroid homeostasis. Gut dysbiosis can disrupt the normal gut barrier function, leading to immunologic and metabolic disorders. OBJECTIVE The aim of this review was to discuss the main features of gut dysbiosis associated with different thyroid disorders. RESULTS Gut microbiota contributes to thyroid hormone synthesis and hydrolysis of thyroid hormones conjugates. It has been shown that microbial metabolites may play a role in autoimmune thyroid diseases via modulating the immune system. Intestinal microbiota can contribute to the thyroid malignancies via controlling DNA damage and apoptosis and influencing inflammatory reactions by the microbiota- derived metabolites. However, the pathogenic role of altered gut microbiota in different thyroid disorders has not yet fully elucidated. CONCLUSION Further research is needed to assess the role of alterations of the gut microbiota in disease onset and development in order to achieve novel strategies for the prevention and treatment of these diseases.
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Affiliation(s)
- Hanieh-Sadat Ejtahed
- Obesity and Eating Habits Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.,Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Pooneh Angoorani
- Obesity and Eating Habits Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Ahmad-Reza Soroush
- Obesity and Eating Habits Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed-Davar Siadat
- Department of Mycobacteriology and Pulmonary Research, Microbiology Research Center, Pasteur Institute of Iran, Tehran, Iran
| | - Nooshin Shirzad
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Shirin Hasani-Ranjbar
- Obesity and Eating Habits Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.,Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Bagher Larijani
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
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33
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Susac Syndrome and Pregnancy. Case Rep Neurol Med 2020; 2020:6049126. [PMID: 33425410 PMCID: PMC7775175 DOI: 10.1155/2020/6049126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 12/04/2020] [Accepted: 12/15/2020] [Indexed: 11/17/2022] Open
Abstract
Susac syndrome (SuS) is a rare poorly characterised disorder that affects the brain, retina, and cochlea. Here, we present a case of a 31-year-old pregnant female with a new diagnosis of SuS that was successfully managed to 36 weeks of gestation with minimal disease burden to both the mother and newborn. She was treated initially using intravenous methylprednisolone followed by oral prednisone, and intravenous immunoglobulin (IVIg). We stress the importance of a multidisciplinary approach, involving both neurology and maternal-fetal medicine, and provide guidance in navigating the various options for immunosuppressive therapy during pregnancy.
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Aranyosi JK, Deli T, Erdei A, Toth G, Jakab A, Fodor M, Nagy EV, Ujhelyi B. Unusual onset of thyroid associated orbitopathy during pregnancy: case report and review of literature. BMC Endocr Disord 2020; 20:183. [PMID: 33317492 PMCID: PMC7737351 DOI: 10.1186/s12902-020-00663-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 12/09/2020] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Thyroid associated orbitopathy (TAO) is the most common extrathyroidal complication of Graves' disease. The disease course ranges from mild, where symptomatic therapy is sufficient, to severe, where high dose steroid administration or orbital decompression surgery is required. Women of their reproductive age are more likely to be affected. Although pregnancy is a state of enhanced immune tolerance, TAO may develop or worsen in 0.2-0.4% of pregnant women. CASE PRESENTATION We present the case of a 19-year-old woman who has developed hyperthyroidism and progressive TAO during the second trimester of her third pregnancy, which has improved postpartum. The possible mechanisms and the importance of follow up in pregnancy is discussed. CONCLUSIONS Expectant mothers with Graves' disease require follow up of eye signs throughout pregnancy, preferably in the setting of a thyroid-eye clinic.
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Affiliation(s)
- Janos K Aranyosi
- Department of Ophthalmology, Faculty of Medicine, University of Debrecen, Nagyerdei krt 98, Debrecen, H-4032, Hungary
| | - Tamas Deli
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Annamaria Erdei
- Division of Endocrinology Department of Internal Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Geza Toth
- Department of Internal Medicine, Szent Lázár Hospital, Salgótarján, Hungary
| | - Attila Jakab
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Mariann Fodor
- Department of Ophthalmology, Faculty of Medicine, University of Debrecen, Nagyerdei krt 98, Debrecen, H-4032, Hungary
| | - Endre V Nagy
- Division of Endocrinology Department of Internal Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Bernadett Ujhelyi
- Department of Ophthalmology, Faculty of Medicine, University of Debrecen, Nagyerdei krt 98, Debrecen, H-4032, Hungary.
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Suzuki N, Yoshihara A, Yoshimura Noh J, Kinoshita K, Ohnishi J, Saito M, Sugino K, Ito K. TRAb elevations occurred even in the third trimester; a case of a mother of a child with neonatal thyroid dysfunction, who received radioactive iodine therapy for Graves' disease. Endocr J 2020; 67:1019-1022. [PMID: 32522908 DOI: 10.1507/endocrj.ej20-0039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Activity of Graves' disease (GD) is known to improve during gestation, as values of thyrotropin (TSH) receptor antibody (TRAb) also improve. However, the risk of neonatal hyperthyroidism increases when maternal TRAb values are high in the second to third trimester. A 29-year-old woman who had undergone radioactive iodine (RAI) therapy for GD 10 years earlier visited our hospital at 17 weeks of gestation, showing subclinical hypothyroidism and a positive TRAb value of 2.6 IU/L (reference range, <2.0 IU/L). Thyroid hormone replacement therapy was commenced and thyroid function normalized within 4 weeks, although TRAb was elevated at the time (3.8 IU/L). Prenatal check-up showed normal growth development and no irregularities. At 29 weeks of gestation, serum TRAb was extremely elevated, up to 16.8 IU/L. Since the risk of neonatal hyperthyroidism was of great concern, delivery was planned at an advanced-care medical center. At 38 weeks 5 days of gestation, she delivered a female neonate without any complications, although blood testing of the neonate showed subclinical hyperthyroidism with positive TRAb and TSH receptor stimulating antibody (TSAb). According to the American Thyroid Association guidelines, the TRAb value should be checked in the third trimester if mothers show a TRAb elevation between the initial visit after pregnancy and 18-22 weeks of gestation. However, if the mother has a history of RAI therapy for GD, regardless of thyroid function during gestation, the possibility of TRAb values elevating over time even years after the definitive therapy must be considered.
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Affiliation(s)
- Nami Suzuki
- Department of Internal Medicine, Ito Hospital, Tokyo 150-8308, Japan
| | - Ai Yoshihara
- Department of Internal Medicine, Ito Hospital, Tokyo 150-8308, Japan
| | | | - Kazuya Kinoshita
- Kinoshita Obstetrics and Gynecology Clinic, Tokyo 124-0004, Japan
| | - Junki Ohnishi
- Department of Obstetrics and Gynecology, The Jikei University Katsushika Medical Center, Tokyo 125-8506, Japan
| | - Maki Saito
- Department of Pediatrics, The Jikei University Katsushika Medical Center, Tokyo 125-8506, Japan
| | | | - Kochi Ito
- Department of Surgery, Ito Hospital, Tokyo 150-8308, Japan
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36
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Gut microbiota: a perspective of precision medicine in endocrine disorders. J Diabetes Metab Disord 2020; 19:1827-1834. [PMID: 33520863 DOI: 10.1007/s40200-020-00593-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 06/29/2020] [Accepted: 07/23/2020] [Indexed: 02/06/2023]
Abstract
Gut microbiota composition is unique in every individual, it impacts on organ functions that produce hormones. Gut microbiota composition balance is directly related to our general health status. This continual interaction between gut microbiota and endocrine organs sometimes can be considered as the etiology of diseases such as type 2 diabetes mellitus (T2DM), obesity, osteoporosis, polycystic ovary syndrome (PCOS), and thyroid diseases. Microbiota is introduced for a total collection of microbial organisms in our bodies and microbiome referred for their genome and their collective functions. Near 100 trillion microorganisms live in our body and almost all of them occupy the human gut gastrointestinal tract. Precision medicine can play a crucial role in health maintenance by affecting gut microbiota composition in every individual. It can also develop special treatments specifically for every individual. In this review, we addressed any correlation between gut microbiota and endocrine disorders including T2DM, obesity, PCOS, thyroid disorders and osteoporosis.
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37
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Ferrari SM, Fallahi P, Elia G, Ragusa F, Ruffilli I, Paparo SR, Antonelli A. Thyroid autoimmune disorders and cancer. Semin Cancer Biol 2020; 64:135-146. [DOI: 10.1016/j.semcancer.2019.05.019] [Citation(s) in RCA: 93] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 05/24/2019] [Accepted: 05/29/2019] [Indexed: 12/18/2022]
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Osborne LM, Gilden J, Kamperman AM, Hoogendijk WJ, Spicer J, Drexhage HA, Bergink V. T-cell defects and postpartum depression. Brain Behav Immun 2020; 87:397-403. [PMID: 31926288 PMCID: PMC7316619 DOI: 10.1016/j.bbi.2020.01.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 12/20/2019] [Accepted: 01/07/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Most studies of immune dysregulation in perinatal mood and anxiety disorders have focused on peripheral cytokines, but literature from non-perinatal mood disorders also implicates T-cell defects. We sought to characterize proportions of T-cell subtypes in women with postpartum depression. MATERIALS AND METHODS We enrolled 21 women with postpartum depression (PPD), 39 healthy postpartum controls, and 114 healthy non-postpartum women. Blood was collected in sodium-heparin EDTA tubes and was analyzed using flow cytometry. We conducted statistical tests including linear regression analysis that were aimed at determining differences in proportions of T cell populations among groups. RESULTS Mean counts of T-cells (all CD3+ T cells), T-helper cells, (CD3+CD4+ T cells), and T-cytotoxic cells (CD3+CD8+ T cells) were significantly increased in healthy postpartum women compared to healthy non-postpartum controls (p < 0.001, p = 0.007, and p = 0.002, respectively), but not in women with PPD. The increases in healthy postpartum women were driven by increases in TH1 cells and T regulatory cells, increases that were nonexistent or attenuated in women with postpartum depression. Mean counts of CD4+ T-helper memory cells were also increased in healthy postpartum women (p = 0.009), but slightly decreased in women with PPD (p = 0.066), when compared to healthy non-postpartum controls. CONCLUSIONS Our study confirms that the postpartum period in healthy women is a time of enhanced T cell activity. Women with postpartum depression failed to show physiological enhanced T-cell activity postpartum, and future research is needed to elucidate etiological mechanisms and consequences.
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Affiliation(s)
- Lauren M. Osborne
- Department of Psychiatry & Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA,Department of Gynecology & Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA,Corresponding author: Lauren M. Osborne, MD, Women’s Mood Disorders Center, Johns Hopkins University School of Medicine, 550 N. Broadway, Suite 305, Baltimore, MD 21205, 410-955-9986 (phone),
| | - Janneke Gilden
- Department of Psychiatry, Erasmus Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Astrid M Kamperman
- Department of Psychiatry, Erasmus Medical Center Rotterdam, Rotterdam, the Netherlands
| | | | - Julie Spicer
- Department of Psychiatry, Icahn School of Medicine at Mt. Sinai
| | - Hemmo A. Drexhage
- Department of Immunology, Erasmus Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Veerle Bergink
- Department of Psychiatry, Erasmus Medical Center Rotterdam, Rotterdam, the Netherlands,Department of Psychiatry, Icahn School of Medicine at Mt. Sinai,Department of Obstetrics & Gynecology, Icahn School of Medicine at Mt. Sinai
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39
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Qiancheng X, Jian S, Lingling P, Lei H, Xiaogan J, Weihua L, Gang Y, Shirong L, Zhen W, GuoPing X, Lei Z. Coronavirus disease 2019 in pregnancy. Int J Infect Dis 2020; 95:376-383. [PMID: 32353549 PMCID: PMC7185021 DOI: 10.1016/j.ijid.2020.04.065] [Citation(s) in RCA: 131] [Impact Index Per Article: 32.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 04/21/2020] [Accepted: 04/22/2020] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES This study aimed to compare clinical courses and outcomes between pregnant and reproductive-aged non-pregnant women with COVID-19, and to assess the vertical transmission potential of COVID-19 in pregnancy. METHODS Medical records of pregnant and reproductive-aged non-pregnant women hospitalized with COVID-19 from January 15 to March 15, 2020 were retrospectively reviewed. The severity of disease, virus clearance time, and length of hospital stay were measured as the primary objective, while the vertical transmission potential of COVID-19 was also assessed. RESULTS Eighty-two patients (28 pregnant women, 54 reproductive-aged non-pregnant women) with laboratory-confirmed COVID-19 were enrolled in this study. Univariate regression indicated no association between pregnancy and severity of disease (OR 0.73, 95% CI 0.08-5.15; p=0.76), virus clearance time (HR 1.16, 95% CI 0.65-2.01; p=0.62), and length of hospital stay (HR 1.10, 95% CI 0.66-1.84; p=0.71). Of the pregnant women, 22 delivered 23 live births, either by cesarean section (17, 60.7%) or vaginal delivery (5, 17.9%), and no neonate was infected with SARS-CoV-2. CONCLUSIONS Pregnant women have comparable clinical courses and outcomes with reproductive-aged non-pregnant women when infected with SARS-CoV-2. No evidence supported vertical transmission of COVID-19 in the late stage of pregnancy, including vaginal delivery.
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Affiliation(s)
- Xu Qiancheng
- Department of Critical Care Medicine, The First Affiliated Hospital of Wannan Medical College (Yijishan Hospital of Wannan Medical College), No. 2, West Road of Zheshan, Jinghu District, Wuhu, Anhui, 241000 China
| | - Shen Jian
- Department of Obstetrics and Gynecology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, 26 Shengli Street, Jiang,an District, Wuhan, Hubei, 430014 China
| | - Pan Lingling
- Department of Cardiology, The First Affiliated Hospital of Wannan Medical College (Yijishan Hospital of Wannan Medical College), No. 2, West Road of Zheshan, Jinghu District, Wuhu, Anhui, 241000 China
| | - Huang Lei
- Department of Obstetrics and Gynecology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, 26 Shengli Street, Jiang,an District, Wuhan, Hubei, 430014 China
| | - Jiang Xiaogan
- Department of Critical Care Medicine, The First Affiliated Hospital of Wannan Medical College (Yijishan Hospital of Wannan Medical College), No. 2, West Road of Zheshan, Jinghu District, Wuhu, Anhui, 241000 China
| | - Lu Weihua
- Department of Critical Care Medicine, The First Affiliated Hospital of Wannan Medical College (Yijishan Hospital of Wannan Medical College), No. 2, West Road of Zheshan, Jinghu District, Wuhu, Anhui, 241000 China
| | - Yang Gang
- Department of Respiratory and Critical Care Medicine, The Second People's Hospital of Wuhu, No. 265, Jiuhua Road, Jinghu District, Wuhu, Anhui, 241000 China
| | - Li Shirong
- Department of Respiratory and Critical Care Medicine, The Second People's Hospital of Wuhu, No. 265, Jiuhua Road, Jinghu District, Wuhu, Anhui, 241000 China
| | - Wang Zhen
- Department of Critical Care Medicine, The First Affiliated Hospital of Wannan Medical College (Yijishan Hospital of Wannan Medical College), No. 2, West Road of Zheshan, Jinghu District, Wuhu, Anhui, 241000 China
| | - Xiong GuoPing
- Department of Obstetrics and Gynecology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, 26 Shengli Street, Jiang,an District, Wuhan, Hubei, 430014 China.
| | - Zha Lei
- Department of Biological Sciences, Xi'an Jiaotong-Liverpool University, No. 111, Ren'ai Road, Dushu Lake Higher Education Town, Suzhou Industrial Park, Suzhou, 215123 China; Emergency and Critical Care Unit, Conch Hospital, Wuhu, Anhui, 241000 China.
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40
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Lind CM, Agugliaro J, Farrell TM. The metabolic response to an immune challenge in a viviparous snake, Sistrurus miliarius. J Exp Biol 2020; 223:jeb225185. [PMID: 32321747 DOI: 10.1242/jeb.225185] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 04/15/2020] [Indexed: 08/26/2023]
Abstract
Mounting an immune response may be energetically costly and require the diversion of resources away from other physiological processes. Yet, both the metabolic cost of immune responses and the factors that impact investment priorities remain poorly described in many vertebrate groups. For example, although viviparity has evolved many times in vertebrates, the relationship between immune function and pregnancy has been disproportionately studied in placental mammals. To examine the energetic costs of immune activation and the modulation of immune function during pregnancy in a non-mammalian vertebrate, we elicited an immune response in pregnant and non-pregnant pygmy rattlesnakes, Sistrurus miliarius, using lipopolysaccharide (LPS). Resting metabolic rate (RMR) was measured using flow-through respirometry. Immune function was examined using bactericidal assays and leukocyte counts. The RMR of pygmy rattlesnakes increased significantly in response to LPS injection. There was no statistically significant difference in the metabolic response of non-reproductive and pregnant snakes to LPS. Mean metabolic increments for pregnant females, non-reproductive females, and males were 13%, 18% and 26%, respectively. The ratio of heterophils to lymphocytes was elevated in response to LPS across reproductive categories; however, LPS did not impact plasma bactericidal ability in non-reproductive snakes. Although pregnant females had significantly higher plasma bactericidal ability compared with non-reproductive snakes prior to manipulation, their bactericidal ability declined in response to LPS. LPS administration also significantly reduced several litter characteristics, particularly when administrated relatively early in pregnancy. Our results indicate that immune performance is energetically costly and is altered during pregnancy, and that immune activation during pregnancy may result in tradeoffs that affect offspring in a viviparous reptile.
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Affiliation(s)
- Craig M Lind
- School of Natural Science and Mathematics, Stockton University, Galloway, NJ 08205, USA
| | - Joseph Agugliaro
- Department of Biological Sciences, Fairleigh Dickinson University, Madison, NJ 07940, USA
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41
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The correlation of thyroid autoimmunity and peripheral and uterine immune status in women with recurrent miscarriage. J Reprod Immunol 2020; 139:103118. [PMID: 32193011 DOI: 10.1016/j.jri.2020.103118] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 02/22/2020] [Accepted: 03/09/2020] [Indexed: 01/23/2023]
Abstract
PROBLEM Thyroid autoimmunity (TAI), which is the most prevalent cause of thyroid dysfunction in women of reproductive age, is associated with increased risk of miscarriages and adverse pregnancy outcomes. However, the exact pathophysiology of TAI is still unknown. We aim at investigating the relationship between TAI and the peripheral and uterine immune markers in women with recurrent miscarriage (RM). METHOD OF STUDY Peripheral blood and endometrial tissue samples were collected during mid-luteal phase of 242 RM women to evaluate the prevalence of TAI, the thyroid function, the percentages of peripheral blood and endometrial lymphocytes, the levels of peripheral blood T helper 1 (Th1) cytokine and natural killer (NK) cell cytotoxicity. RESULTS There was no relationship between TAI and peripheral immune parameters. However, the percentage of endometrial Regulatory T (Treg) cells was significantly higher in RM women who were thyroid antibody positive than in those who were antibody negative (p < 0.05). CONCLUSION Thyroid antibody positivity seems to be part of a more generalized immune dysfunction. The increased endometrial Treg cells in RM patients with TAI may ameliorate coincidental TAI during pregnancy by linked suppression and prevent the over-reactive status of the immune system.
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Minaldi E, D'Andrea S, Castellini C, Martorella A, Francavilla F, Francavilla S, Barbonetti A. Thyroid autoimmunity and risk of post-partum depression: a systematic review and meta-analysis of longitudinal studies. J Endocrinol Invest 2020; 43:271-277. [PMID: 31552596 DOI: 10.1007/s40618-019-01120-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 09/16/2019] [Indexed: 12/16/2022]
Abstract
PURPOSE The aim of this study was to systematically investigate whether, and to what extent, the detection of thyroid autoimmunity during pregnancy and in the weeks after childbirth is associated with an increased risk of developing post-partum depression (PPD), a condition associated with possible adverse outcomes for both mother and offspring. We performed a systematic review and meta-analysis of longitudinal studies, assessing the incidence of PPD in women with and without anti-thyroperoxidase antibody (TPOAb) positivity. METHODS We searched MEDLINE, EMBASE, Web of Science, Cochrane Library, and CINAHL. Methodological quality of the studies was assessed by the Newcastle-Ottawa Scale. In the presence of even modest between-studies heterogeneity, assessed by Cochrane Q and I2 tests, risk ratios (RRs) for PPD were combined using a random effects model. Funnel plot and trim-and-fill analysis were used to assess publication bias. RESULTS Five included studies provided information on 449 women with TPOAb-positive and 2483 TPOAb-negative women. Pooled RR indicated a significantly increased risk to develop PPD in TPOAb-positive group (RR 1.49, 95% CI 1.11-2.00; P = 0.008; I2 = 47%, Pfor heterogeneity = 0.11). Consistent with a possible publication bias, the trim-and-fill test detected two putative missing studies in the funnel plot. Nevertheless, the adjustment for publication bias produced a negligible effect on the pooled estimate (adjusted RR 1.41, 95% CI 1.18-1.68, P = 0.0002). CONCLUSIONS Thyroid autoimmunity during pregnancy and in the weeks after childbirth is associated with an increased risk of developing PPD. Further well-designed studies are warranted to confirm this association and elucidate underlying pathophysiological mechanisms. PROSPERO REGISTRATION CRD42019129643.
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Affiliation(s)
- E Minaldi
- Department of Life, Health and Environment Sciences, University of L'Aquila, Via Vetoio, 67100, L'Aquila, Italy
| | - S D'Andrea
- Department of Life, Health and Environment Sciences, University of L'Aquila, Via Vetoio, 67100, L'Aquila, Italy
| | - C Castellini
- Department of Life, Health and Environment Sciences, University of L'Aquila, Via Vetoio, 67100, L'Aquila, Italy
| | - A Martorella
- Department of Life, Health and Environment Sciences, University of L'Aquila, Via Vetoio, 67100, L'Aquila, Italy
| | - F Francavilla
- Department of Life, Health and Environment Sciences, University of L'Aquila, Via Vetoio, 67100, L'Aquila, Italy
| | - S Francavilla
- Department of Life, Health and Environment Sciences, University of L'Aquila, Via Vetoio, 67100, L'Aquila, Italy
| | - A Barbonetti
- Department of Life, Health and Environment Sciences, University of L'Aquila, Via Vetoio, 67100, L'Aquila, Italy.
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Cellini M, Santaguida MG, Stramazzo I, Capriello S, Brusca N, Antonelli A, Fallahi P, Gargano L, Centanni M, Virili C. Recurrent Pregnancy Loss in Women with Hashimoto's Thyroiditis with Concurrent Non-Endocrine Autoimmune Disorders. Thyroid 2020; 30:457-462. [PMID: 31910128 DOI: 10.1089/thy.2019.0456] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Background: An increased rate of recurrent miscarriage has been described in patients with autoimmune thyroid disease. However, there is a lack of studies that assess the rate of recurrent pregnancy loss (RPL) in patients with Hashimoto's thyroiditis (HT) isolated or with concurrent non-endocrine autoimmune disorders (NEAD). The objective of the study was to assess the rate of RPL in patients with HT isolated or accompanied with non-endocrine autoimmune diseases. Methods: This is a retrospective observational cohort study with a systematic review of the NEAD with concurrent HT in an outpatient Endocrinology Unit at a University Hospital. Among the 3480 consecutively examined women with HT, 87 patients met the criteria of RPL and represented the study group. Sixty-five of them had isolated HT and 22 women had HT+NEAD. Results: The rate of RPL in women with HT was 2.1% versus 5.64% observed in women with HT+NEAD (odds ratio = 2.78 [95% confidence interval 1.70-4.57]; p < 0.0001). On subdivision, this difference was still evident in euthyroid patients (p < 0.0001), while it disappeared in hypothyroid women (p = 0.21). The RPL did not correlate with the autoantibody concentrations nor in women with isolated HT nor in those with HT+NEAD. The presence of antiphospholipid syndrome (APS) explained RPL in 3 out of 22 (14%) patients with HT+NEAD, the remaining being related to different autoimmune disorders. Interestingly, even subtracting the patients with APS, RPL was more frequent in patients with poly-autoimmunity than in patients with isolated HT (p = 0.0013). Conclusions: The co-presence of NEAD is correlated with a higher risk of RPL in women with HT. The association with APS may explain only a fraction of RPL rate in patients with poly-autoimmunity.
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Affiliation(s)
- Miriam Cellini
- Department of Medico-Surgical Sciences and Biotechnologies, "Sapienza" University of Rome, Latina, Italy
| | | | - Ilaria Stramazzo
- Department of Medico-Surgical Sciences and Biotechnologies, "Sapienza" University of Rome, Latina, Italy
| | - Silvia Capriello
- Department of Medico-Surgical Sciences and Biotechnologies, "Sapienza" University of Rome, Latina, Italy
| | - Nunzia Brusca
- Department of Medico-Surgical Sciences and Biotechnologies, "Sapienza" University of Rome, Latina, Italy
| | - Alessandro Antonelli
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Poupak Fallahi
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Lucilla Gargano
- Endocrinology Unit, Santa Maria Goretti Hospital, AUSL Latina, Latina, Italy
| | - Marco Centanni
- Department of Medico-Surgical Sciences and Biotechnologies, "Sapienza" University of Rome, Latina, Italy
- Endocrinology Unit, Santa Maria Goretti Hospital, AUSL Latina, Latina, Italy
| | - Camilla Virili
- Department of Medico-Surgical Sciences and Biotechnologies, "Sapienza" University of Rome, Latina, Italy
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Moll M, Regan EA, Hokanson JE, Lutz SM, Silverman EK, Crapo JD, Make BJ, DeMeo DL. The Association of Multiparity with Lung Function and Chronic Obstructive Pulmonary Disease-Related Phenotypes. CHRONIC OBSTRUCTIVE PULMONARY DISEASES (MIAMI, FLA.) 2020; 7:86-98. [PMID: 32324980 PMCID: PMC7454017 DOI: 10.15326/jcopdf.7.2.2019.0166] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Apparent increased female susceptibility to chronic obstructive pulmonary disease (COPD) suggests sex hormones modulate disease pathogenesis. Little is known about associations between multiparity and lung function in smokers. RESEARCH QUESTION We hypothesized that multiparity is associated with lung function and measures of emphysema and airway disease. STUDY DESIGN AND METHODS Utilizing female participants from the 5-year follow up of the COPD Genetic Epidemiology (COPDGene®) study we performed multivariable linear regressions to assess the effect of multiparity and number of pregnancies on forced expiratory volume in 1 second (FEV1) percentage of predicted (% predicted), FEV1/forced vital capacity (FVC), percent emphysema on computed tomography (CT) scans, and Pi10, a measure of airway thickening. We sampled never smokers and those with lower smoking exposure from the National Health and Nutrition Examination Survey (NHANES) 2011-2012 dataset. RESULTS We included 1820 participants from COPDGene® and 418 participants from NHANES (321 never smokers, 97 ever smokers). In COPDGene®, multiparity (beta coefficient [β] = -3.8, 95% confidence interval [CI]: [-6.5, -1.1], p = 0.005) and higher number of pregnancies were associated with lower FEV1 % predicted. Multiparity was not associated with percent emphysema or Pi10. In individuals with no or mild obstruction, multiparity was associated with lower FEV1 % predicted. There was an interaction with multiparity and age on FEV1 % predicted (p = 0.025). In NHANES, there was no association between multiparity and FEV1 % predicted in never smokers or the lower smoking exposure group. INTERPRETATION Multiparity was associated with lower FEV1 % predicted in current and former smokers in COPDGene® study participants. These preliminary results emphasize the importance of smoking abstinence in women of child-bearing age.
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Affiliation(s)
- Matthew Moll
- Channing Division of Network Medicine, Brigham and Women’s Hospital, Boston, Massachusetts,Division of Pulmonary and Critical Care Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | | | - John E. Hokanson
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora
| | - Sharon M. Lutz
- PRecisiOn Medicine Translational Research (PROMoTeR) Center, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care, Boston, Massachusetts
| | - Edwin K. Silverman
- Channing Division of Network Medicine, Brigham and Women’s Hospital, Boston, Massachusetts,Division of Pulmonary and Critical Care Medicine, Brigham and Women’s Hospital, Boston, Massachusetts,Harvard Medical School, Boston, Massachusetts
| | - James D. Crapo
- Division of Pulmonary, Critical Care and Sleep Medicine, National Jewish Health, Denver, Colorado
| | - Barry J. Make
- Division of Pulmonary, Critical Care and Sleep Medicine, National Jewish Health, Denver, Colorado
| | - Dawn L. DeMeo
- Channing Division of Network Medicine, Brigham and Women’s Hospital, Boston, Massachusetts,Division of Pulmonary and Critical Care Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
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He L, Zhu X, Yang Q, Li X, Huang X, Shen C, Liu J, Zha B. Low Serum IL-17A in Pregnancy During Second Trimester Is Associated With an Increased Risk of Subclinical Hypothyroidism. Front Endocrinol (Lausanne) 2020; 11:298. [PMID: 32477272 PMCID: PMC7239996 DOI: 10.3389/fendo.2020.00298] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 04/20/2020] [Indexed: 12/17/2022] Open
Abstract
Problem: Interleukin-17A (IL-17A) has a role in sustaining normal pregnancy. IL-17A is also associated with thyroid autoimmunity during pregnancy. This study sought to investigate whether IL-17A is a risk factor for thyroid dysfunction during pregnancy in women negative for thyroid autoantibodies. Methods of Study: The study comprised 216 pregnant women with negative thyroid peroxidase antibody (TPOAb) and thyroglobulin antibody (TGAb) during the second trimester who provided blood samples for serum IL-17A, thyroid autoantibodies and thyroid function tests. To further evaluate the ratio of CD4+IL-17A+ Th17 cells, we collected peripheral blood from 26 women with thyroid-stimulating hormone (TSH) levels ≤ 2.5 mIU/L and 26 pregnancy-week matched women with TSH levels >2.5 mIU/L, along with samples from 20 women with TSH levels ≤ 4 mIU/L and 20 pregnancy-week matched women with TSH levels >4 mIU/L. Results: The serum IL-17A levels and ratios of CD4+IL-17A+ cells were significantly lower in women with TSH > 2.5 mIU/L than in those with TSH ≤ 2.5 mIU/L (both P < 0.01). Similar lower differences were noted in women with TSH > 4 mIU/L than in those with TSH ≤ 4 mIU/L (both P < 0.01). Moreover, serum TSH correlated negatively with IL-17A levels (β = -0.195, P = 0.004), but positively with the week of gestation (β = 0.284, P < 0.001). Logistic regression indicated that a lower serum IL-17A level was a risk factor for TSH > 2.5 mIU/L [OR = 0.453 (0.298-0.689), P = 0.000] and TSH > 4.0 mIU/L [OR = 0.588 (0.385-0.899), P = 0.013]. Conclusion: A low serum IL-17A level during the second trimester is associated with an increased risk of TSH > 2.5 mIU/L and subclinical hypothyroidism.
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Affiliation(s)
- Leqi He
- Department of Clinical Laboratory Medicine, Shanghai Fifth People's Hospital, Fudan University, Shanghai, China
| | - Xiuju Zhu
- Department of Clinical Laboratory Medicine, Shanghai Fifth People's Hospital, Fudan University, Shanghai, China
| | - Qian Yang
- Department of Endocrinology, Shanghai Fifth People's Hospital, Fudan University, Shanghai, China
| | - Xiaoying Li
- Department of Endocrinology, Shanghai Fifth People's Hospital, Fudan University, Shanghai, China
| | - Xinmei Huang
- Department of Endocrinology, Shanghai Fifth People's Hospital, Fudan University, Shanghai, China
| | - Chunmei Shen
- Department of Clinical Laboratory Medicine, Shanghai Fifth People's Hospital, Fudan University, Shanghai, China
| | - Jun Liu
- Department of Endocrinology, Shanghai Fifth People's Hospital, Fudan University, Shanghai, China
| | - Bingbing Zha
- Department of Endocrinology, Shanghai Fifth People's Hospital, Fudan University, Shanghai, China
- *Correspondence: Bingbing Zha
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Borba VV, Zandman-Goddard G, Shoenfeld Y. Exacerbations of autoimmune diseases during pregnancy and postpartum. Best Pract Res Clin Endocrinol Metab 2019; 33:101321. [PMID: 31564626 DOI: 10.1016/j.beem.2019.101321] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Autoimmune diseases represent a complex heterogeneous group of disorders that occur as a results of immune homeostasis dysregulation and loss of self-tolerance. Interestingly, more than 80% of the cases are found among women at reproductive age. Normal pregnancy is associated with remarkable changes in the immune and endocrine signaling required to tolerate and support the development and survival of the placenta and the semi-allogenic fetus in the hostile maternal immune system environment. Gravidity and postpartum represent an extremely challenge period, and likewise the general population, women suffering from autoimmune disorders attempt pregnancy. Effective preconception counseling and subsequent gestation and postpartum follow-up are crucial for improving mother and child outcomes. This comprehensive review provides information about the different pathways modulating autoimmune diseases activity and severity, such as the influence hormones, microbiome, infections, vaccines, among others, as well as updated recommendations were needed, in order to offer those women better medical care and life quality.
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Affiliation(s)
- Vânia Vieira Borba
- Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel
| | - Gisele Zandman-Goddard
- Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel; Department of Medicine C, Wolfson Medical Center, Tel Aviv, Israel
| | - Yehuda Shoenfeld
- Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel; I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Russia.
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47
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Fan J, Zhang Y, Zhang C, Barjaktarovic M, Yang X, Peeters RP, Huang HF, Korevaar TIM. Persistency of Thyroid Dysfunction from Early to Late Pregnancy. Thyroid 2019; 29:1475-1484. [PMID: 31347461 DOI: 10.1089/thy.2019.0115] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Background: Subclinical thyroid disease occurs in approximately 5-8% of all pregnancies and is associated with a higher risk of adverse outcomes such as miscarriage, preterm birth, and suboptimal child neurodevelopment. It is generally assumed that subclinical thyroid disease that persists from early to late pregnancy is associated with a higher risk of adverse outcomes than transient disease. However, it is unknown as to what percentage of women with subclinical disease during early pregnancy have persistent disease in the third trimester. Methods: This study comprised 42,492 mothers for whom early and late pregnancy thyrotropin (TSH), free thyroxine (fT4), triiodothyronine (T3), or TPOAbs were available and who did not receive thyroid treatment before or during pregnancy. We adjusted for potential confounders, including maternal age, parity, anthropometrics, and β-hCG concentrations. Results: Subclinical hypothyroidism and hypothyroxinemia persisted in 24.8% and 17.7% of cases. Overt hyperthyroidism persisted in 8.4% of cases while subclinical hyperthyroidism persisted in 20.9% of cases. Low T3 persisted in 43.4% of cases while elevated T3 persisted in 15.7% of cases. TPOAb positivity persisted in 84.0% of cases. In women with subclinical hypothyroidism, a TSH below ∼5 mU/L at the time of diagnosis was associated with an up to 50% lower risk of persistency. The fT4 concentration at diagnosis predicted hyperthyroidism persistency and TPOAb positivity predicted persistency of all disease entities. Conclusions: Early pregnancy thyroid disease only persists until the third trimester in 8.4-24.8% of cases when left untreated. The main predictor for persistency is TPOAb positivity, with TPOAb-positive women having a lower risk that subclinical hypothyroidism or hypothyroxinemia persists, but a higher risk that (subclinical) hyperthyroidism persists.
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Affiliation(s)
- Jianxia Fan
- International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China
- Shanghai Municipal Key Clinical Speciality, Shanghai, China
| | - Yong Zhang
- International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China
- Shanghai Municipal Key Clinical Speciality, Shanghai, China
| | - Chen Zhang
- International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Mirjana Barjaktarovic
- Department of Internal Medicine, Academic Center for Thyroid Diseases, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Xi Yang
- International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Robin P Peeters
- Department of Internal Medicine, Academic Center for Thyroid Diseases, Erasmus Medical Center, Rotterdam, the Netherlands
| | - He-Feng Huang
- International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China
- Shanghai Municipal Key Clinical Speciality, Shanghai, China
| | - Tim I M Korevaar
- Department of Internal Medicine, Academic Center for Thyroid Diseases, Erasmus Medical Center, Rotterdam, the Netherlands
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Abstract
PURPOSE OF REVIEW Graves' hyperthyroidism is associated with significant obstetric, maternal, fetal, and neonatal complications. Early diagnosis and an understanding of the management of Graves' hyperthyroidism in pregnancy can help to prevent these complications. Antithyroid drugs (ATD) should be avoided in early pregnancy, given their association with congenital malformations. RECENT FINDINGS TSH-receptor antibodies (TRAb) are integral in the management of Graves' hyperthyroidism in pregnancy and in the preconception period. TRAb are indicative of the current activity of Graves' hyperthyroidism and the likelihood of relapse. Furthermore, TRAb predicts the risk of fetal and neonatal hyperthyroidism.The incidence of congenital malformations is roughly the same for propylthiouracil (PTU) and methimazole (MMZ). Exposure to both ATDs in early pregnancy has been associated with increased incidence of congenital malformations compared with exposure to either ATD alone. SUMMARY The goal of the physician is maintaining euthyroidism throughout pregnancy and delivery of a healthy, euthyroid baby. An understanding of the natural progression of Graves' hyperthyroidism in pregnancy and the proper utilization of TRAb enables the physician to minimize the risks associated with Graves' hyperthyroidism and side effects of ATDs unique to pregnancy. The physician should prioritize preconception counseling in women with Graves' hyperthyroidism in order to avoid hyperthyroidism and having to use ATDs in pregnancy.
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Affiliation(s)
- Caroline T Nguyen
- Division of Endocrinology, Diabetes, & Metabolism, Department of Medicine and Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
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Nazarpour S, Ramezani Tehrani F, Amiri M, Bidhendi Yarandi R, Azizi F. Levothyroxine treatment and pregnancy outcomes in women with subclinical hypothyroidism: a systematic review and meta-analysis. Arch Gynecol Obstet 2019; 300:805-819. [PMID: 31399840 DOI: 10.1007/s00404-019-05245-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 07/10/2019] [Indexed: 12/12/2022]
Abstract
PURPOSE To evaluate the benefits of LT4 treatment on pregnancy outcomes in SCH women. STUDY DESIGN PubMed [including Medline], Web of Science, Wiley, Google Scholar, Science direct and Scopus were searched for identifying and retrieving all English articles published up to May 2018 on the effects of levothyroxine treatment on pregnancy outcomes in pregnant women with SCH compared to untreated or healthy controls. In this systematic review and meta-analysis, both fixed and random effect models were applied to estimate the pooled effect size. Heterogeneity and publication bias were evaluated using the I-squared (I2) and Begg's statistics, respectively. We also explored heterogeneity sources using meta-regression models and sensitivity analysis. RESULTS Data of 13 cohort studies and randomized controlled trials with a total of 11,503 participants were analyzed. This meta-analysis showed that pregnant women with SCH treated with levothyroxine had lower chances of pregnancy loss (OR 0.78, 95% CI 0.66-0.94; I2 = 0%) and higher chances for live birth rates (OR 2.72, 95% CI 1.44-5.11; I2 = 25%) than the placebo group. Compared to euthyroid women, SCH patients treated with levothyroxine had higher odds ratio for preterm labor (OR 1.82, 95% CI 1.14-2.91; I2 = 0%). CONCLUSIONS Results of this study showed that the effects of treatment with levothyroxine in SCH pregnant women are not the same for all pregnancy outcomes. Levothyroxine treatment in these patients can reduce pregnancy loss. Considering the limited number of studies available, further studies are warranted to document more precise data on other consequences.
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Affiliation(s)
- Sima Nazarpour
- Department of Midwifery, Islamic Azad University, Varamin-Pishva Branch, Tehran, Iran.,Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, No. 24 Parvaneh, Yaman Street, Velenjak, P.O. Box: 19395-4763, Tehran, 1985717413, Iran
| | - Fahimeh Ramezani Tehrani
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, No. 24 Parvaneh, Yaman Street, Velenjak, P.O. Box: 19395-4763, Tehran, 1985717413, Iran.
| | - Mina Amiri
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, No. 24 Parvaneh, Yaman Street, Velenjak, P.O. Box: 19395-4763, Tehran, 1985717413, Iran
| | - Razieh Bidhendi Yarandi
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, No. 24 Parvaneh, Yaman Street, Velenjak, P.O. Box: 19395-4763, Tehran, 1985717413, Iran.,Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Desai MK, Brinton RD. Autoimmune Disease in Women: Endocrine Transition and Risk Across the Lifespan. Front Endocrinol (Lausanne) 2019; 10:265. [PMID: 31110493 PMCID: PMC6501433 DOI: 10.3389/fendo.2019.00265] [Citation(s) in RCA: 91] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 04/10/2019] [Indexed: 12/12/2022] Open
Abstract
Women have a higher incidence and prevalence of autoimmune diseases than men, and 85% or more patients of multiple autoimmune diseases are female. Women undergo sweeping endocrinological changes at least twice during their lifetime, puberty and menopause, with many women undergoing an additional transition: pregnancy, which may or may not be accompanied by breastfeeding. These endocrinological transitions exert significant effects on the immune system due to interactions between the hormonal milieu, innate, and adaptive immune systems as well as pro- and anti-inflammatory cytokines, and thereby modulate the susceptibility of women to autoimmune diseases. Conversely, pre-existing autoimmune diseases themselves impact endocrine transitions. Concentration-dependent effects of estrogen on the immune system; the role of progesterone, androgens, leptin, oxytocin, and prolactin; and the interplay between Th1 and Th2 immune responses together maintain a delicate balance between host defense, immunological tolerance and autoimmunity. In this review, multiple autoimmune diseases have been analyzed in the context of each of the three endocrinological transitions in women. We provide evidence from human epidemiological data and animal studies that endocrine transitions exert profound impact on the development of autoimmune diseases in women through complex mechanisms. Greater understanding of endocrine transitions and their role in autoimmune diseases could aid in prediction, prevention, and cures of these debilitating diseases in women.
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Affiliation(s)
- Maunil K. Desai
- School of Pharmacy, University of Southern California, Los Angeles, CA, United States
| | - Roberta Diaz Brinton
- Center for Innovation in Brain Science, University of Arizona, Tucson, AZ, United States
- Departments of Pharmacology and Neurology, College of Medicine, University of Arizona, Tucson, AZ, United States
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