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Radwan P, Tarnowska A, Piekarska K, Wiśniewski A, Krasiński R, Radwan M, Nowak I. The impact of soluble HLA-G in IVF/ICSI embryo culture medium on implantation success. Front Immunol 2022; 13:982518. [PMID: 36505440 PMCID: PMC9730522 DOI: 10.3389/fimmu.2022.982518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 11/04/2022] [Indexed: 11/25/2022] Open
Abstract
The HLA-G molecule is widely accepted as an important factor for pregnancy success. Its expression has been detected in the extravillous trophoblasts. Soluble HLA-G (sHLA-G) was found in the genital tract, pre-implanted embryos as well as in seminal fluid. In this study, we investigated the concentration of sHLA-G (sHLA-G1 and sHLA-G5) in media from 344 single cultured embryos following in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI). The level of sHLA-G (U/ml) was tested with a sandwich enzyme-linked immunosorbent assay (ELISA) kit. We correlated sHLA-G secretion with ovarian stimulation protocols, the type of embryo transfer (fresh or frozen cycle) and the quality of the embryos. The ovarian stimulation protocol affects the secretion of sHLA-G by the embryo. Embryos obtained from the long agonist protocol secreted more sHLA-G than those originating from the short antagonist protocol (p = 0.0001). Embryos whose transfer resulted in a clinical pregnancy and/or live birth secreted more sHLA-G compared to those whose transfer ended without pregnancy. This was particularly observable in embryos following the long ovarian stimulation protocol and from a frozen embryo cycle. In conclusion, sHLA-G secreted by the embryo has an impact on implantation and live birth and could be a developmental potential marker of the embryo. Its concentration depends on the ovarian stimulation protocol used.
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Affiliation(s)
- Paweł Radwan
- Gameta Hospital, Department of Reproductive Medicine, Rzgów, Poland
| | - Agnieszka Tarnowska
- Laboratory of Immunogenetics and Tissue Immunology, Ludwik Hirszfeld Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, Department of Clinical Immunology, Wrocław, Poland
| | - Karolina Piekarska
- Laboratory of Immunogenetics and Tissue Immunology, Ludwik Hirszfeld Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, Department of Clinical Immunology, Wrocław, Poland
| | - Andrzej Wiśniewski
- Laboratory of Immunogenetics and Tissue Immunology, Ludwik Hirszfeld Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, Department of Clinical Immunology, Wrocław, Poland
| | - Rafał Krasiński
- Gameta Hospital, Department of Reproductive Medicine, Rzgów, Poland
| | - Michał Radwan
- Gameta Hospital, Department of Reproductive Medicine, Rzgów, Poland
| | - Izabela Nowak
- Laboratory of Immunogenetics and Tissue Immunology, Ludwik Hirszfeld Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, Department of Clinical Immunology, Wrocław, Poland,*Correspondence: Izabela Nowak,
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Vani V, Vasan SS, Adiga SK, Varsha SR, Sachdeva G, Kumar P, Seshagiri PB. Soluble human leukocyte antigen-G is a potential embryo viability biomarker and a positive predictor of live-births in humans. Am J Reprod Immunol 2021; 86:e13499. [PMID: 34766406 DOI: 10.1111/aji.13499] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 08/18/2021] [Accepted: 09/20/2021] [Indexed: 11/27/2022] Open
Abstract
PROBLEM Human infertility affects 15-20% of reproductive-age couples and it is mitigated by assisted reproductive technology (ART) approaches. Poor biological viability of embryos contributes to implantation failure and live birth rate (LBR). This study is aimed to examine whether or not embryo-secreted soluble human leukocyte antigen-G (sHLA-G) is (i) associated with developing embryos and (ii) able to predict successful pregnancy outcome. METHOD OF STUDY A retrospective, multicentric study using 539 human embryo spent medium samples (E-SMs), analysed for sHLA-G levels by ELISA. Correlation analysis was performed on sHLA-G levels with developing embryonic stages, their quality scores and pregnancy outcome in terms of LBR. RESULTS Of 539 E-SMs analysed, 445 had detectable sHLA-G (83%) with levels varying within and across clinics and, between stages of embryonic development. Levels of sHLA-G (ng/mL) were significantly (P < .05) different in E-SMs of cleavage-stage embryos versus blastocysts. There was an insignificant correlation between the sHLA-G levels and morphology scores of embryos. But, sHLA-G levels showed a positive correlation with grades of blastocysts and importantly, its levels were significantly (P < .05) higher in live-birth vis-a-vis no-birth cases. Also, levels were higher in live-births out of blastocysts-ETs versus cleavage-stage-embryo transfers. Altered levels were observed with embryos, which resulted in miscarriages. Overall, a significant (P < .0001) association of sHLA-G with live births was observed. CONCLUSION Embryo-derived sHLA-G can be a valuable embryo viability, independent, biomarker, which can predict live-birth outcome and it could be useful as an adjunct to existing criteria for elective single embryo transfer.
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Affiliation(s)
- Venkatappa Vani
- Department of Molecular Reproduction, Development and Genetics, Indian Institute of Science, Sir C.V. Raman Road, Bangalore, India
| | - Satya S Vasan
- Manipal Ankur Andrology & Reproductive Services, Bangalore, India
| | - Satish K Adiga
- Department of Clinical Embryology, Kasturba Medical College, Manipal, India
| | | | | | - Pratap Kumar
- Department of Reproductive Medicine & Surgery, Kasturba Medical College, Manipal, India
| | - Polani B Seshagiri
- Department of Molecular Reproduction, Development and Genetics, Indian Institute of Science, Sir C.V. Raman Road, Bangalore, India
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Bahrami-Asl Z, Farzadi L, Fattahi A, Yousefi M, Quinonero A, Hakimi P, Latifi Z, Nejabati HR, Ghasemnejad T, Sadigh AR, Heidari MH, Nouri M, Novin MG, Dominguez F. Tacrolimus Improves the Implantation Rate in Patients with Elevated Th1/2 Helper Cell Ratio and Repeated Implantation Failure (RIF). Geburtshilfe Frauenheilkd 2020; 80:851-862. [PMID: 32817992 PMCID: PMC7428373 DOI: 10.1055/a-1056-3148] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 11/09/2019] [Indexed: 12/21/2022] Open
Abstract
Introduction
An abnormal endometrial immune response is involved in the pathogenesis of repeated implantation failure (RIF), so we investigated the effectiveness of tacrolimus treatment on the endometrium of RIF patients.
Materials and Methods
Ten RIF patients with elevated T-helper 1/T-helper 2 (Th1/Th2) cell ratios were recruited into a clinical study. The expression of p53, leukemia inhibitory factor (LIF), interleukin (IL)-4, IL-10, IL-17, and interferon gamma (IFN-γ) in the endometrium of patients with and without tacrolimus treatment and the association of these factors with assisted reproductive technology (ART) outcomes were investigated.
Results
Tacrolimus significantly increased the expression of LIF, IL-10, and IL-17 and decreased the expression of IL-4, IFN-γ, and the IFN-γ/IL-10 ratio in RIF patients. Tacrolimus treatment resulted in an implantation rate of 40%, a clinical pregnancy rate of 50%, and a live birth rate of 35% in RIF patients with elevated Th1/Th2 ratios who had previously failed to become pregnant despite at least three transfers of embryos. We also found a significant positive correlation between IL-10 levels and the implantation rate.
Conclusions
Our findings suggest that RIF patients with a higher Th1/Th2 ratio could be candidates for tacrolimus therapy and that this immunosuppressive drug could be acting through upregulation of LIF, IL-10, and IL-17.
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Affiliation(s)
- Zahra Bahrami-Asl
- Department of Biology and Anatomical Sciences, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Fundacion Instituto Valenciano de Infertilidad (FIVI), Instituto Universitario IVI (IUIVI), ISS LaFe, Valencia, Spain
| | - Laya Farzadi
- Department of Reproductive Biology, School of Advanced Medical Sciences, Tabriz University of Medical Sciences, Tabriz, Iran.,Women's Reproductive Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Amir Fattahi
- Department of Reproductive Biology, School of Advanced Medical Sciences, Tabriz University of Medical Sciences, Tabriz, Iran.,Women's Reproductive Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mehdi Yousefi
- Department of Immunology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Alicia Quinonero
- Fundacion Instituto Valenciano de Infertilidad (FIVI), Instituto Universitario IVI (IUIVI), ISS LaFe, Valencia, Spain
| | - Parvin Hakimi
- Women's Reproductive Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Zeinab Latifi
- Department of Biochemistry and Clinical Laboratories, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hamid Reza Nejabati
- Department of Biochemistry and Clinical Laboratories, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Tohid Ghasemnejad
- Department of Medical Genetics, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Aydin Raei Sadigh
- Department of Biochemistry and Clinical Laboratories, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mohammad Hassan Heidari
- Department of Biology and Anatomical Sciences, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Nouri
- Department of Reproductive Biology, School of Advanced Medical Sciences, Tabriz University of Medical Sciences, Tabriz, Iran.,Institute for Stem Cell and Regenerative Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Marefat Ghaffari Novin
- Department of Biology and Anatomical Sciences, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Francisco Dominguez
- Fundacion Instituto Valenciano de Infertilidad (FIVI), Instituto Universitario IVI (IUIVI), ISS LaFe, Valencia, Spain
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Niu Z, Wang L, Pang RT, Guo Y, Yeung WS, Yao Y. A meta-analysis of the impact of human leukocyte antigen-G on the outcomes of IVF/ICSI. Reprod Biomed Online 2017; 34:611-618. [DOI: 10.1016/j.rbmo.2017.03.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2016] [Revised: 03/03/2017] [Accepted: 03/03/2017] [Indexed: 01/22/2023]
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Barnea E, Almogi-Hazan O, Or R, Mueller M, Ria F, Weiss L, Paidas M. Immune regulatory and neuroprotective properties of preimplantation factor: From newborn to adult. Pharmacol Ther 2015; 156:10-25. [DOI: 10.1016/j.pharmthera.2015.10.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Rizzo R. HLA-G molecules in pregnancy and their possible role in assisted reproductive technology. ACTA ACUST UNITED AC 2014. [DOI: 10.1586/eog.09.21] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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7
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Focus on the importance of soluble human leukocyte antigen G as a marker for embryo selection in assisted reproductive technology. Fertil Steril 2013; 100:e43. [PMID: 24188880 DOI: 10.1016/j.fertnstert.2013.10.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Accepted: 10/08/2013] [Indexed: 11/23/2022]
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Kotze D, Kruger TF, Lombard C, Padayachee T, Keskintepe L, Sher G. The effect of the biochemical marker soluble human leukocyte antigen G on pregnancy outcome in assisted reproductive technology--a multicenter study. Fertil Steril 2013; 100:1303-9. [PMID: 23993930 DOI: 10.1016/j.fertnstert.2013.07.1977] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Revised: 07/19/2013] [Accepted: 07/19/2013] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To determine whether the presence of soluble human leukocyte antigen G (sHLA-G) affects implantation and pregnancy outcomes in vitro. DESIGN A multicenter retrospective study. SETTING Six certified in vitro fertilization (IVF) units. PATIENT(S) Embryos obtained from 2,040 patients from six different IVF clinics. INTERVENTION(S) Soluble HLA-G determination on day-2 embryos after intracytoplasmic sperm injection, with embryos transferred on day 3 using the sHLA-G data. MAIN OUTCOME MEASURE(S) Ongoing pregnancy rate (10- to 12-week ultrasound finding). RESULT(S) All embryos were individually cultured, and a chemiluminescence enzyme-linked immunosorbent assay was used to detect the presence of sHLA-G in the culture medium surrounding the embryos. Embryos were selected based on a positive sHLA-G result and a graduated embryo scoring (GES) score >70, or on embryo morphology if the test was negative. In all centers, a positive sHLA-G result was associated with an increase in the odds of an ongoing pregnancy. The incidence of an ongoing pregnancy was 2.52 times greater in embryos transferred on day 3 with a positive sHLA-G test result than the incidence of an ongoing pregnancy in embryos with a negative sHLA-G test result. CONCLUSION(S) Data from this multicenter study confirm that sHLA-G expression is a valuable noninvasive embryo marker to assist in improving pregnancy outcomes, with the theoretical potential to reduce multiple pregnancies.
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González A, Rebmann V, LeMaoult J, Horn PA, Carosella ED, Alegre E. The immunosuppressive molecule HLA-G and its clinical implications. Crit Rev Clin Lab Sci 2012; 49:63-84. [PMID: 22537084 DOI: 10.3109/10408363.2012.677947] [Citation(s) in RCA: 130] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Human leukocyte antigen G (HLA-G) is a non-classical major histocompatibility complex (MHC) class I molecule that, through interaction with its receptors, exerts important tolerogenic functions. Its main physiological expression occurs in placenta where it seems to participate in the maternal tolerance toward the fetus. HLA-G has been studied as a marker of pregnancy complications such as abortion or pre-eclapmsia. Although HLA-G is not expressed in most adult tissues, its ectopic expression has been observed in some diseases such as viral infections, autoimmune disorders, and especially cancer. HLA-G neo-expression in cancer is associated with the capability of tumor cells to evade the immune control. In this review, we will summarize HLA-G biology and how it participates in these physiopathological processes. Special attention will be paid to its role as a diagnostic tool and also as a therapeutic target.
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Affiliation(s)
- Alvaro González
- Department of Biochemistry, University Clinic of Navarra, Pamplona, Spain.
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Rizzo R, Vercammen M, van de Velde H, Horn PA, Rebmann V. The importance of HLA-G expression in embryos, trophoblast cells, and embryonic stem cells. Cell Mol Life Sci 2011; 68:341-52. [PMID: 21080028 PMCID: PMC11114702 DOI: 10.1007/s00018-010-0578-1] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2010] [Accepted: 10/22/2010] [Indexed: 10/18/2022]
Abstract
The nonclassical HLA-G molecule is a trophoblast-specific molecule present in almost every pregnancy. It differs from classical HLA class I molecules by the low degree of allelic variants and the high diversity of protein structures. HLA-G is reported to be a tolerogenic molecule that acts on cells of both innate and adaptive immunity. At the maternal-fetal interface HLA-G seems to be responsible largely for the reprogramming of local maternal immune response. This review will focus on the HLA-G gene expression profile in pregnancy, in preimplantation embryos, and in human embryonic stem cells with emphasis on the structural diversity of the HLA-G protein and its potential functional and diagnostic implications.
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Affiliation(s)
- Roberta Rizzo
- Department of Experimental and Diagnostic Medicine, Section of Medical Genetics, University of Ferrara, Ferrara, Italy
| | - Martine Vercammen
- Department of Hematology, Universitair Ziekenhuis (UZ) Brussel, Brussels, Belgium
| | - Hilde van de Velde
- Centre for Reproductive Medicine, Universitair Ziekenhuis (UZ) Brussel, Brussels, Belgium
- Department of Reproduction and Genetics, Universitair Ziekenhuis (UZ) Brussel, Brussels, Belgium
| | - Peter A. Horn
- Institute for Transfusion Medicine, University Hospital of Essen, Virchowstr. 179, 45122 Essen, Germany
| | - Vera Rebmann
- Institute for Transfusion Medicine, University Hospital of Essen, Virchowstr. 179, 45122 Essen, Germany
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Rebmann V, Switala M, Eue I, Grosse-Wilde H. Soluble HLA-G is an independent factor for the prediction of pregnancy outcome after ART: a German multi-centre study. Hum Reprod 2010; 25:1691-8. [DOI: 10.1093/humrep/deq120] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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12
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Possible role of human leukocyte antigen–G molecules in human oocyte/embryo secretome. Hum Immunol 2009; 70:970-5. [DOI: 10.1016/j.humimm.2009.07.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2009] [Revised: 07/28/2009] [Accepted: 07/29/2009] [Indexed: 11/21/2022]
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13
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Can soluble human leucocyte antigen-G predict successful pregnancy in assisted reproductive technology? Curr Opin Obstet Gynecol 2009; 21:285-90. [DOI: 10.1097/gco.0b013e32832924cd] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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14
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Tabiasco J, Perrier d'Hauterive S, Thonon F, Parinaud J, Léandri R, Foidart JM, Chaouat G, Munaut C, Lombroso R, Selva J, Bergère M, Hammoud I, Kozma N, Aguerre-Girr M, Swales AKE, Sargent IL, Le Bouteiller P, Lédée N. Soluble HLA-G in IVF/ICSI embryo culture supernatants does not always predict implantation success: a multicentre study. Reprod Biomed Online 2009; 18:374-81. [PMID: 19298737 DOI: 10.1016/s1472-6483(10)60096-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Several reports have described an association between the presence of soluble human leukocyte antigen G (sHLA-G) in human embryo culture supernatants (ES) and implantation success. However, not all studies agree with these findings. To further document this debate, a multicentre blinded study was performed to investigate, on a large number of IVF ES and ICSI ES, whether sHLA-G is a useful criterion for embryo selection before transfer. A total of 1405 ES from 355 patients were collected from three assisted reproductive technique (ART) centres and evaluated for their sHLA-G content in a single laboratory, using a chemiluminescence enzyme-linked immunosorbent assay. In only one centre was a significant association between sHLA-G-positive ES and successful implantation established (P = 0.0379), whereas no such association was observed in the other centres. It was found that the percentages and concentrations of sHLA-G-positive ES varied between centres, depending on culture media and ART conditions. The percentage of sHLA-G-positive ES was significantly higher in IVF ES than ICSI ES (P < 0.001 and P < 0.01 for two centres). These data demonstrate that substantial variations of sHLA-G content in ES occur between different ART centres, highlighting the influence of several technical parameters that differ from one centre to another.
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Affiliation(s)
- Julie Tabiasco
- INSERM, U563, Centre de Physiopathologie de Toulouse Purpan, Toulouse, F-31300 France
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15
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Symposium: innovative techniques in human embryo viability assessment. Soluble human leukocyte antigen-G and pregnancy success. Reprod Biomed Online 2009; 17:470-85. [PMID: 18854100 DOI: 10.1016/s1472-6483(10)60233-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Non-invasive methods of assessing embryo quality are critical for pregnancy success following IVF or intracytoplasmic sperm injection (ICSI). The addition of new non-invasive morphological and biochemical analyses may further improve pregnancy success, allowing the transfer of a single embryo, thereby reducing the risks involved in multiple births following IVF/ICSI. The presence of a protein, soluble human leukocyte antigen-G (sHLA-G), in embryo cultures has been suggested as a way to non-invasively predict embryo quality and pregnancy success, especially when used in conjunction with current embryo quality assessment methods. Detection of sHLA-G in embryo culture medium has been correlated with pregnancy success in 12 studies, but three studies were not able to detect sHLA-G. This is a review of the literature on sHLA-G detection in IVF/ICSI, and reasons are proposed for the reported discrepancies, as well as guidelines for reporting of data in future studies. Furthermore, it is suggested that the use of an HLA-G transgenic mouse model would advance understanding of the mechanism of action of sHLA-G in preimplantation embryos and its correlation to embryo health and viability. Research on a mouse model, combined with clinical studies, should enable the development of a fast and reliable method for utilizing sHLA-G detection to improve pregnancy success after IVF/ICSI.
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Vercammen MJ, Verloes A, Van de Velde H, Haentjens P. Accuracy of soluble human leukocyte antigen-G for predicting pregnancy among women undergoing infertility treatment: meta-analysis. Hum Reprod Update 2008; 14:209-18. [PMID: 18390888 DOI: 10.1093/humupd/dmn007] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND There have been concerns about validity and accuracy of the measurement of sHLA-G in embryo culture supernatants. In this systematic review, we quantified the diagnostic accuracy of sHLA-G for predicting the ability to achieve clinical pregnancy in women who are undergoing infertility treatment. METHODS Medline and Embase were searched up to 7 September 2007, for full English and non-English articles concerning cohort studies evaluating sHLA-G in embryo culture for predicting clinical pregnancy in women undergoing IVF and ICSI. RESULTS Eleven studies including 1813 patients met our inclusion criteria. In the individual studies, sensitivity ranged from 0.01 to 0.97, specificity from 0.18 to 0.98, the positive likelihood ratio from 0.34 to 3.21 and the negative likelihood ratio from 0.08 to 1.01. These values were highly heterogeneous with, in each case, I(2) values of >75%, and P-values for the Q statistic of <0.001, arguing against generating a pooled estimate for these diagnostic test properties. The diagnostic odds ratios (DORs) ranged from 0.92 to 24.82 in the individual studies with an I(2) value of 49% indicating moderate heterogeneity. Therefore, the meta-analysis combined the logs of the DORs, which are derived from sensitivity and specificity. A random-effects model yielded a summary DOR of 4.38 (95% CI, 2.93-6.55), consistent with modest diagnostic accuracy. Interestingly, an a priori defined subgroup analysis restricted to six studies with good quality embryos showed a better diagnostic performance with a DOR of 12.67 (95% CI, 3.66-43.80) to predict the ability to achieve clinical pregnancy in women undergoing infertility treatment. CONCLUSIONS Further research is needed with single-embryo culture, single-embryo transfer and highly sensitive detection techniques to determine the potential application of measuring sHLA-G in culture supernatant.
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Affiliation(s)
- M J Vercammen
- Laboratory of Haematology, Universitair Ziekenhuis Brussel (UZ Brussel), Laarbeeklaan 101, B-1090, Brussels, Belgium
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Shaikly VR, Morrison IEG, Taranissi M, Noble CV, Withey AD, Cherry RJ, Blois SM, Fernández N. Analysis of HLA-G in Maternal Plasma, Follicular Fluid, and Preimplantation Embryos Reveal an Asymmetric Pattern of Expression. THE JOURNAL OF IMMUNOLOGY 2008; 180:4330-7. [DOI: 10.4049/jimmunol.180.6.4330] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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18
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Barnea ER. Signaling between embryo and mother in early pregnancy: Basis for development of tolerance. RECURRENT PREGNANCY LOSS 2007. [DOI: 10.3109/9780203931677.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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Sageshima N, Shobu T, Awai K, Hashimoto H, Yamashita M, Takeda N, Odawara Y, Nakanishi M, Hatake K, Ishitani A. Soluble HLA-G is absent from human embryo cultures: a reassessment of sHLA-G detection methods. J Reprod Immunol 2007; 75:11-22. [PMID: 17485119 DOI: 10.1016/j.jri.2007.02.010] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2006] [Revised: 02/15/2007] [Accepted: 02/21/2007] [Indexed: 10/23/2022]
Abstract
In recent years, the number of patients receiving in vitro fertilization (IVF) has been increasing, though the rate of successful implantations has remained at 10-20%. A major goal of this procedure is to afford the ability to select embryos with the most potential for implantation and development. Previous studies claimed to have detected soluble HLA-G (sHLA-G) protein in culture supernatant from 2 to 3-day embryos using ELISA methods, and concluded that sHLA-G protein levels were associated with successful implantation. This result, if substantiated could provide an important tool for IVF. In this study, we have re-examined these experiments by attempting to detect sHLA-G in the medium from 2 to 3-day embryos (84 samples) and 4 to 6-day embryos (25 samples) in which a part of blastocyst has started to differentiate into trophoblasts. Using a highly specific and sensitive ELISA, no sHLA-G protein was detectable in any sample, despite the fact that 27 of the 109 samples were from successfully implanted embryos. These results indicate that 2-6-day embryos do not secrete sHLA-G detectable by ELISA, and therefore that sHLA-G in culture medium is not a useful for successful implantation at this stage of development.
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Affiliation(s)
- Noriko Sageshima
- Department of Legal Medicine, Nara Medical University, 840, Shijocho, Kashihara, Nara 634-8521, Japan
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20
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Fanchin R, Gallot V, Rouas-Freiss N, Frydman R, Carosella ED. Implication of HLA-G in Human Embryo Implantation. Hum Immunol 2007; 68:259-63. [PMID: 17400061 DOI: 10.1016/j.humimm.2006.11.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2006] [Revised: 11/10/2006] [Accepted: 11/20/2006] [Indexed: 11/27/2022]
Abstract
The mechanisms underlying the processes of human embryo implantation and maternal immunotolerance to the fetus remain incompletely understood. Growing evidence indicates that one of the nonclassic human leukocyte antigen (HLA) genes, HLA-G, is expressed selectively on the surface of the extravillous throphoblast and plays an important role in the adaptations of the maternal immune system to pregnancy; however the implication of this molecule in the process of human embryo implantation is also plausible. Therefore the aim of the present article is to review the available literature specifically focused on the possible relationship between HLA-G and human embryo implantation. In particular, studies investigating HLA-G expression on human preimplantation embryos and in the endometrium, as well as its levels in embryo culture supernatants and circulating maternal blood, are discussed.
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Affiliation(s)
- Renato Fanchin
- Department of Obstetrics and Gynecology, Hôpital Antoine Béclère, Clamart, France.
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