1
|
Chen S, Li X, Guo Q, Wang B, Lan J, Qian H, Liu Y, Shi G. Association between antinuclear antibody and female infertility: A meta-analysis. Scand J Immunol 2023; 98:e13285. [PMID: 38441210 DOI: 10.1111/sji.13285] [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: 07/02/2022] [Revised: 01/07/2023] [Accepted: 05/01/2023] [Indexed: 03/07/2024]
Abstract
Autoimmunity is reported involving in reproductive failures, and antinuclear antibody (ANA) positivity has been regarded as a typical feature of autoimmunity. Published studies on the association of ANA with reproductive failures including infertility are controversial. The aim of this meta-analysis was to analyse whether the presence of ANA positivity increases the risk of infertility in women. We searched the PubMed and Embase databases for relevant literature without any restrictions prior to April 28, 2021. All analyses were performed using the RevMan 5.3 software. Twelve studies with 2734 participants, including 1482 patients with infertility, met the inclusion and exclusion criteria. The total positivity rate of ANA was 23.8% (353/1482) in all infertile patients and 8.5% (107/1252) in the control group. Infertile females had a significantly higher ANA positivity rate than the control group (odds ratio [OR] = 2.90, 95% confidence interval [CI]: 1.72-4.87, I2 = 65%, P < .0001). Several subgroup analyses were performed to reduce the heterogeneity. ANA positivity was associated with female infertility in studies either performed by indirect immunofluorescence (OR = 2.26, 95% CI:1.67-3.06, P < .00001) or by ELISA (OR = 10.76, 95% CI:1.82-63.64, P < .00001). ANA was significantly associated with increased risk of women infertility either after the definite exclusion of individuals with autoimmune diseases (AID) or without exclusion [(OR = 1.99, 95% CI:1.29-3.06, P = .002), (OR = 2.76, 95% CI:1.56-4.88, P = .0005), respectively]. This meta-analysis provides a comprehensive overview of the prevalence of antinuclear antibodies (ANA) in infertile women and suggests that ANA positivity increases the risk of infertility.
Collapse
Affiliation(s)
- Shiju Chen
- Department of Rheumatology and Clinical Immunology, The First Affiliated Hospital of Xiamen University, Xiamen, China
- School of Medicine, Xiamen University, Xiamen, China
| | - Xiaodong Li
- Department of Gynaecology and Obstetrics, The First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Qiwei Guo
- United Diagnostic and Research Center for Clinical Genetics, Women and Children's Hospital, School of Medicine & School of Public Health, Xiamen University, Xiamen, China
| | - Bin Wang
- Department of Rheumatology and Clinical Immunology, The First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Jingying Lan
- School of Medicine, Xiamen University, Xiamen, China
| | - Hongyan Qian
- Department of Rheumatology and Clinical Immunology, The First Affiliated Hospital of Xiamen University, Xiamen, China
- School of Medicine, Xiamen University, Xiamen, China
| | - Yuan Liu
- Department of Rheumatology and Clinical Immunology, The First Affiliated Hospital of Xiamen University, Xiamen, China
- School of Medicine, Xiamen University, Xiamen, China
| | - Guixiu Shi
- Department of Rheumatology and Clinical Immunology, The First Affiliated Hospital of Xiamen University, Xiamen, China
- School of Medicine, Xiamen University, Xiamen, China
| |
Collapse
|
2
|
Impact of Antithyroperoxidase Antibodies (Anti-TPO) on Ovarian Reserve and Early Embryo Development in Assisted Reproductive Technology Cycles. Int J Mol Sci 2023; 24:ijms24054705. [PMID: 36902134 PMCID: PMC10003042 DOI: 10.3390/ijms24054705] [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: 01/23/2023] [Revised: 02/17/2023] [Accepted: 02/21/2023] [Indexed: 03/05/2023] Open
Abstract
Autoimmune thyroid disease (AITD) is one of the most common endocrinopathies and is more prevalent in women. It becomes evident that the circulating antithyroid antibodies that often follow AITD have effects on many tissues, including ovaries, and therefore that this common morbidity might have an impact on female fertility, the investigation of which is the aim of the present research. Ovarian reserve, ovarian response to stimulation and early embryo development in infertile patients with thyroid autoimmunity were assessed in 45 women with thyroid autoimmunity and 45 age-matched control patients undergoing infertility treatment. It was demonstrated that the presence of anti-thyroid peroxidase antibodies is associated with lower serum anti-Müllerian hormone levels and antral follicle count. Further investigation revealed the higher prevalence of sub-optimal response to ovarian stimulation in TAI-positive women, lower fertilization rate and lower number of high-quality embryos in this group of patients. The cut-off value for follicular fluid anti-thyroid peroxidase antibody affecting the above-mentioned parameters was determined to be 105.0 IU/mL, highlighting the necessity of closer monitoring in couples seeking infertility treatment with ART.
Collapse
|
3
|
Mao R, Wang X, Long R, Wang M, Jin L, Zhu L. A new insight into the impact of systemic lupus erythematosus on oocyte and embryo development as well as female fertility. Front Immunol 2023; 14:1132045. [PMID: 37033965 PMCID: PMC10076658 DOI: 10.3389/fimmu.2023.1132045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Accepted: 03/14/2023] [Indexed: 04/11/2023] Open
Abstract
Background Systemic lupus erythematosus (SLE) is often associated with adverse reproductive outcomes. But it's currently unclear regarding the role of SLE in oocyte and embryonic development. Also, it's controversial whether SLE has an adverse effect on fertility. There is a lack of comprehensive understanding and assessment of fertility in patients with SLE. Objective This study was aim to investigate oocyte and embryonic development as well as ovarian reserve, and clinical outcomes in SLE patients during in vitro fertilization (IVF) treatment. By combining data on embryonic and gamete development in SLE patients, we hope to provide new insights into a comprehensive assessment of fertility in SLE patients. Methods In this study, we collected data from 34 SLE patients who were previously diagnosed and in remission for a total of 44 IVF cycles and matched 102 infertile women with a total of 148 IVF cycles by Propensity Score Matching (PSM) of 1:3 ratio. We then evaluated baseline characteristics, ovarian reserve, IVF laboratory outcomes, and clinical outcomes between the two groups. Results After PSM matching, baseline characteristics including age, infertility types, and duration, as well as infertility causes overall coincided between the two groups. Anti-müllerian hormone (AMH) was significantly lower in the SLE group vs comparison (1.9 vs. 3.3 ng/mL, P=0.001). The SLE group performed a significant reduction in available embryo rate (76.6% vs. 86.0%, P=0.001), good-quality blastocyst formation rate (35.1% vs. 47.0%, P=0.003), and blastocyst formation rate (51.0% vs. 67.7%, P=0.001) compared to the comparison. As for clinical outcomes, the implantation rate in the SLE group was notably lower (37.9% vs. 54.9%, P=0.022). The CLBR following every embryo-transfer procedure was distinctly lower (41.2% vs 64.7%, P=0.016) in the SLE group vs comparison. Also, the conservative and optimal CLBRs following every complete cycle procedure were significantly reduced in the SLE group vs the comparison (P=0.001, both). Conclusion Patients with SLE present worse outcomes in oocyte and embryonic development, thus yielding compromised female fertility and clinical pregnancy. Individualized fertility assessment and early fertility guidance are necessary for these special groups.
Collapse
Affiliation(s)
| | | | | | | | - Lei Jin
- *Correspondence: Lixia Zhu, ; Lei Jin,
| | - Lixia Zhu
- *Correspondence: Lixia Zhu, ; Lei Jin,
| |
Collapse
|
4
|
Liu T, Guo X, Liao Y, Liu Y, Zhu Y, Chen X. Correlation Between the Presence of Antinuclear Antibodies and Recurrent Pregnancy Loss: A Mini Review. Front Endocrinol (Lausanne) 2022; 13:873286. [PMID: 35600596 PMCID: PMC9114698 DOI: 10.3389/fendo.2022.873286] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 03/29/2022] [Indexed: 12/15/2022] Open
Abstract
In the past decade, the incidence of recurrent pregnancy loss (RPL) has increased significantly, and immunological disorders have been considered as one of the possible causes contributing to RPL. The presence of antinuclear antibodies (ANAs) is regarded as a typical antibody of autoimmunity. However, the relationship between the presence of ANAs and RPL, the underlying mechanism, and the possible role of immunotherapy is still controversial. The aim of this mini review is to assess the association between ANAs and RPL and the effects of immunotherapy on pregnancy outcomes in women with positive ANAs and a history of RPL from the available data and to provide a relevant reference basis for clinical application in this group of women.
Collapse
Affiliation(s)
- Ting Liu
- Department of Obstetrics and Gynaecology, Shenzhen Baoan Women’s and Children’s Hospital, Jinan University, Shenzhen, China
| | - Xi Guo
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Ying Liao
- Department of Obstetrics and Gynaecology, Shenzhen Baoan Women’s and Children’s Hospital, Jinan University, Shenzhen, China
| | - Yingyu Liu
- Department of Obstetrics and Gynaecology, Shenzhen Baoan Women’s and Children’s Hospital, Jinan University, Shenzhen, China
| | - Yuanfang Zhu
- Department of Obstetrics and Gynaecology, Shenzhen Baoan Women’s and Children’s Hospital, Jinan University, Shenzhen, China
- *Correspondence: Yuanfang Zhu, ; Xiaoyan Chen, ;
| | - Xiaoyan Chen
- Department of Obstetrics and Gynaecology, Shenzhen Baoan Women’s and Children’s Hospital, Jinan University, Shenzhen, China
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
- *Correspondence: Yuanfang Zhu, ; Xiaoyan Chen, ;
| |
Collapse
|
5
|
Liu H, Zhang Y, Liu H, Huang Q, Ying Y. Anticentromere antibody induced by immunization with centromere protein and Freund's complete adjuvant may interfere with mouse early-stage embryo. Reprod Biol Endocrinol 2021; 19:127. [PMID: 34416895 PMCID: PMC8377848 DOI: 10.1186/s12958-021-00813-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 07/27/2021] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Anticentromere antibody (ACA) is a member of the antinuclear antibody spectrum (ANAs) which has been speculated to be associated with subfertility. Thus, the present study aimed to investigate the induction of ACA production and its potential interference with early-stage embryos. METHODS Recombinant centromere protein-A (CENP-A) or centromere protein-B (CENP-B) and complete Freund's adjuvant (CFA) were used to immunize mice. Serum ACA level was then evaluated by using an indirect immunofluorescence test. Immunofluorescence assay was performed to detect IgG in follicles in ovarian tissues and early-stage embryos. RESULTS Following treatment, serum positive ACA was observed in mice treated with CENP and CFA. Furthermore, IgG were detected in follicular fluid and early-stage embryos from mice treated with CENP and CFA. CONCLUSIONS This study preliminarily indicated that ACA induced by CENP and CFA may penetrate into the living embryos of early-stage in mice.
Collapse
Affiliation(s)
- Hanyan Liu
- grid.417009.b0000 0004 1758 4591Department of Obstetrics and Gynecology, Center for Reproductive Medicine, Key Laboratory for Major Obstetric Diseases of Guangdong Province, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yufen Zhang
- grid.411634.50000 0004 0632 4559Department of Obstetrics and Gynecology, Fengshun County People’s Hospital, Fengshun county, Meizhou City, Guangdong Province China
| | - Haiying Liu
- grid.417009.b0000 0004 1758 4591Department of Obstetrics and Gynecology, Center for Reproductive Medicine, Key Laboratory for Major Obstetric Diseases of Guangdong Province, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Qing Huang
- grid.417009.b0000 0004 1758 4591Department of Obstetrics and Gynecology, Center for Reproductive Medicine, Key Laboratory for Major Obstetric Diseases of Guangdong Province, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Ying Ying
- grid.417009.b0000 0004 1758 4591Department of Obstetrics and Gynecology, Center for Reproductive Medicine, Key Laboratory for Major Obstetric Diseases of Guangdong Province, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| |
Collapse
|
6
|
Ying Y, Liu S, Wu Y, Li S, Huang Q. Anticentromere antibody induced by immunization with centromere protein a and Freund's complete adjuvant may interfere with mouse oocyte meiosis. Reprod Biol Endocrinol 2021; 19:50. [PMID: 33794912 PMCID: PMC8015055 DOI: 10.1186/s12958-021-00737-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 03/25/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Anticentromere antibody (ACA) is a member of the antinuclear antibody (ANA) family, and recent studies have found that ACA may be associated with oocyte maturation disorders; however, the possible mechanism behind this phenomenon remains unknown. We conducted this study to investigate whether ACA could penetrate into the living oocytes and interfere with oocyte meiosis in a mouse model. METHODS We divided mice into three groups: human recombinant centromere protein-A (human CENP-A, HA) and complete Freund's adjuvant (CFA) were used to immunize mice for the study group (HA + CFA), and mice injected with CFA (CFA group) or saline (Saline group), respectively, served as controls. After immunization, serum anti-CENP-A antibody was detected by indirect immunofluorescence assay (IIFT) and enzyme-linked immunosorbent assay (ELISA). Chromosome alignment and intracellular IgG localization in MI- and MII-stage oocytes were investigated by immunofluorescence analysis. RESULTS Positive ACAs were successfully induced by immunization with CENP-A and CFA, and results showed that the serum level of anti-CENP-A antibody was significantly higher in the HA + CFA group compared with the control groups. There was marked increase of chromosome misalignments in MI and MII oocytes in the HA + CFA group compared to the control groups. However, no oocytes from any of the three groups showed intracellular antibody immunofluorescence. CONCLUSIONS The development and maturation of oocytes were impaired in peripheral ACA positive mice, which exhibited severe chromosomal misalignments in metaphase meiosis; however, no evidence of ACAs entering the oocytes was observed, thus the underlying mechanism needs further exploration.
Collapse
Affiliation(s)
- Ying Ying
- grid.417009.b0000 0004 1758 4591Department of Obstetrics and Gynecology, Key Laboratory for Major Obstetric Diseases of Guangdong Province, Reproductive Medicine Center, The Third Affiliated Hospital of Guangzhou Medical University, 63 Duobao Road, Liwan District, Guangzhou, China
| | - Shuang Liu
- grid.417009.b0000 0004 1758 4591Department of Obstetrics and Gynecology, Key Laboratory for Major Obstetric Diseases of Guangdong Province, Reproductive Medicine Center, The Third Affiliated Hospital of Guangzhou Medical University, 63 Duobao Road, Liwan District, Guangzhou, China
| | - Yixuan Wu
- grid.417009.b0000 0004 1758 4591Department of Obstetrics and Gynecology, Key Laboratory for Major Obstetric Diseases of Guangdong Province, Reproductive Medicine Center, The Third Affiliated Hospital of Guangzhou Medical University, 63 Duobao Road, Liwan District, Guangzhou, China
| | - Sichen Li
- grid.417009.b0000 0004 1758 4591Department of Obstetrics and Gynecology, Key Laboratory for Major Obstetric Diseases of Guangdong Province, Reproductive Medicine Center, The Third Affiliated Hospital of Guangzhou Medical University, 63 Duobao Road, Liwan District, Guangzhou, China
| | - Qing Huang
- grid.417009.b0000 0004 1758 4591Department of Obstetrics and Gynecology, Key Laboratory for Major Obstetric Diseases of Guangdong Province, Reproductive Medicine Center, The Third Affiliated Hospital of Guangzhou Medical University, 63 Duobao Road, Liwan District, Guangzhou, China
| |
Collapse
|
7
|
Immunization with CENP-C Causes Aberrant Chromosome Segregation during Oocyte Meiosis in Mice. J Immunol Res 2021; 2021:4610494. [PMID: 33604391 PMCID: PMC7868151 DOI: 10.1155/2021/4610494] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 01/16/2021] [Accepted: 01/20/2021] [Indexed: 11/18/2022] Open
Abstract
Anticentromere antibodies (ACA) were associated with lower oocyte maturation rates and cleavage rates, while the mechanism was not clear. Aims of this study were to examine whether active immunization with centromere protein C could elicit the CENP-C autoantibody in mice and the impacts of the CENP-C autoantibody on oocyte meiosis. Mice were divided into two groups, one was the experimental group immunized with human centromere protein C and Freund's adjuvant (CFA), and the other was the control group injected with CFA only. Serum and oocytes of BALB/c mice immunized with human centromere protein C (CENP-C) in complete Freund's adjuvant (CFA) or injected with only CFA were studied for the development of the CENP-C antibody. Rates of germinal vesicle breakdown (GVBD), first polar body (Pb1) extrusion, abnormal spindle morphology, and chromosome misalignment were compared between the experimental group and the control group. The CENP-C antibody was only observed in serum and oocytes of mice immunized with the centromere protein C antigen. The first polar body (Pb1) extrusion rate was lower in the experimental group (P < 0.01). A higher percentage of spindle defects and chromosome congression failure were also detected in the experimental group (spindle defects: 64.67 ± 1.16% vs. 9.27 ± 2.28% control; chromosome misalignment: 50.80 ± 2.40% vs. 8.30 ± 1.16% control; P < 0.01 for both). Oocyte meiosis was severely impaired by the CENP-C antibody, which may be the main mechanism of adverse reproductive outcomes for ACA-positive women who have no clinical symptoms of any autoimmune diseases.
Collapse
|
8
|
Goodale LF, Hayrabedyan S, Todorova K, Roussev R, Ramu S, Stamatkin C, Coulam CB, Barnea ER, Gilbert RO. PreImplantation factor (PIF) protects cultured embryos against oxidative stress: relevance for recurrent pregnancy loss (RPL) therapy. Oncotarget 2018; 8:32419-32432. [PMID: 28423690 PMCID: PMC5464799 DOI: 10.18632/oncotarget.16028] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Accepted: 02/22/2017] [Indexed: 11/25/2022] Open
Abstract
Recurrent pregnancy loss (RPL) affects 2-3% of couples. Despite a detailed work-up, the etiology is frequently undefined, leading to non-targeted therapy. Viable embryos and placentae express PreImplantation Factor (PIF). Maternal circulating PIF regulates systemic immunity and reduces circulating natural killer cells cytotoxicity in RPL patients. PIF promotes singly cultured embryos' development while anti-PIF antibody abrogates it. RPL serum induced embryo toxicity is negated by PIF. We report that PIF rescues delayed embryo development caused by <3 kDa RPL serum fraction likely by reducing reactive oxygen species (ROS). We reveal that protein disulfide isomerase/thioredoxin (PDI/TRX) is a prime PIF target in the embryo, rendering it an important ROS scavenger. The 16F16-PDI/TRX inhibitor drastically reduced blastocyst development while exogenous PIF increased >2 fold the number of embryos reaching the blastocyst stage. Mechanistically, PDI-inhibitor preferentially binds covalently to oxidized PDI over its reduced form where PIF avidly binds. PIF by targeting PDI/TRX at a distinct site limits the inhibitor's pro-oxidative effects. The >3kDa RPL serum increased embryo demise by three-fold, an effect negated by PIF. However, embryo toxicity was not associated with the presence of putative anti-PIF antibodies. Collectively, PIF protects cultured embryos both against ROS, and higher molecular weight toxins. Using PIF for optimizing in vitro fertilization embryos development and reducing RPL is warranted.
Collapse
Affiliation(s)
- Lindsay F Goodale
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY, USA.,Department of Population Health and Reproduction, School of Veterinary Medicine, University of California-Davis, Davis, CA, USA
| | - Soren Hayrabedyan
- Institute of Biology and Immunology of Reproduction, Bulgarian Academy of Sciences, Sofia, Bulgaria
| | - Krassimira Todorova
- Institute of Biology and Immunology of Reproduction, Bulgarian Academy of Sciences, Sofia, Bulgaria
| | | | - Sivakumar Ramu
- CARI Reproductive Institute, Chicago, IL, USA.,Promigen Life Sciences, Downers Grove, IL, USA
| | - Christopher Stamatkin
- CARI Reproductive Institute, Chicago, IL, USA.,Therapeutic Validation Core, Indiana University Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN, USA
| | | | - Eytan R Barnea
- BioIncept, LLC, Cherry Hill, NJ, USA.,Society for the Investigation of Early Pregnancy (SIEP), Cherry Hill, NJ, USA
| | - Robert O Gilbert
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY, USA.,Ross University School of Veterinary Medicine, Basseterre, St. Kitts, West Indies
| |
Collapse
|
9
|
Cheloufi M, Wackenheim C, Dumestre-Pérard C, Gueniffey A, Equy V, Thong-Vanh C, Dunand-Faure C, Hoffmann P, Deroux A. [Use of hydroxychloroquine and prednisone in the presence of serum autoimmunity in female infertility]. ACTA ACUST UNITED AC 2018; 46:112-117. [PMID: 29398524 DOI: 10.1016/j.gofs.2017.12.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Presence of non-specific autoimmunity (antinuclear antibodies without antigenic specificities and/or antiphospholipid antibodies without criteria of antiphospholipid syndrome) seems to be associated with unexplained female infertility. The objective is to study the characteristics of patients who undergone treatment for non-specific antibodies in Medically Assisted Procreation (MAP). METHODS Ten patients were prospectively followed at MAP center of Grenoble University Hospital. Patient characteristics were collected and evaluated. All patients had a consultation in internal medicine unit as well as an autoimmune assessment (antinuclear antibodies, APL especially) in search of defined autoimmune disease (exclusion criterion). The treatments undertaken were at clinician' discretion. RESULTS One patient received quadritherapy (heparin, platelet antiaggregant, prednisone and hydroxychloroquine), 5 received triple therapy, 3 had dual therapy, and one patient had prednisone only. The 10 patients had a pregnancy under treatment, 8 of which were completed without complications. The control of autoimmunity under treatment appears to show a decrease in serum antibody levels. Tolerance was good (delayed hypersensitivity to hydrochloroquine resulted in discontinuation of therapy in only one patient). CONCLUSION The presence of non-specific serum autoimmunity in a context of infertility appears to be pathogenic and immunomodulatory treatments are clinically and/or biologically effective. A prospective and interventional study with a larger number of patients is needed to assess the efficacy of such treatments in patients with unexplained infertility.
Collapse
Affiliation(s)
- M Cheloufi
- Service de procréation médicalement assistée et de gynécologie obstétrique, centre hospitalier universitaire Grenoble-Alpes, avenue Maquis-du-Grésivaudan, 38700 La Tronche, France.
| | - C Wackenheim
- Service de médecine interne, centre hospitalier universitaire Grenoble-Alpes, boulevard de la Chantourne, 38700 La Tronche, France
| | - C Dumestre-Pérard
- Laboratoire d'immunologie, pole de biologie, centre hospitalier universitaire Grenoble-Alpes, boulevard de la Chantourne, 38700 La Tronche, France
| | - A Gueniffey
- Service de procréation médicalement assistée et de gynécologie obstétrique, centre hospitalier universitaire Grenoble-Alpes, avenue Maquis-du-Grésivaudan, 38700 La Tronche, France
| | - V Equy
- Service de procréation médicalement assistée et de gynécologie obstétrique, centre hospitalier universitaire Grenoble-Alpes, avenue Maquis-du-Grésivaudan, 38700 La Tronche, France
| | - C Thong-Vanh
- Service de procréation médicalement assistée et de gynécologie obstétrique, centre hospitalier universitaire Grenoble-Alpes, avenue Maquis-du-Grésivaudan, 38700 La Tronche, France
| | - C Dunand-Faure
- Service de procréation médicalement assistée et de gynécologie obstétrique, centre hospitalier universitaire Grenoble-Alpes, avenue Maquis-du-Grésivaudan, 38700 La Tronche, France
| | - P Hoffmann
- Service de procréation médicalement assistée et de gynécologie obstétrique, centre hospitalier universitaire Grenoble-Alpes, avenue Maquis-du-Grésivaudan, 38700 La Tronche, France
| | - A Deroux
- Service de médecine interne, centre hospitalier universitaire Grenoble-Alpes, boulevard de la Chantourne, 38700 La Tronche, France
| |
Collapse
|
10
|
An Exploration of the Impact of Anticentromere Antibody on Early-Stage Embryo. J Immunol Res 2017; 2017:4809294. [PMID: 29119119 PMCID: PMC5651102 DOI: 10.1155/2017/4809294] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2017] [Accepted: 07/16/2017] [Indexed: 11/18/2022] Open
Abstract
Background Previously, we found women with positive anticentromere antibody showed impaired potential of oocyte maturation and embryo cleavage; the possible mechanism behind this phenomenon was still unknown. Objective Thus, the present study aimed to preliminarily explore whether ACA could penetrate into the living embryos and impair their developmental potential via in vitro coculture with mouse embryos. Methods Mouse embryos were collected and used for in vitro culture with polyclonal anticentromere protein A (CENP-A) antibody; then, immunofluorescence assay was performed to determine the penetration of antibody into embryos, and embryo development potential was observed. Results All embryos cultured with anti-CENP-A antibody exhibited immunofluorescence on the nucleus, while none of the embryos from the control groups showed immunofluorescence. Additionally, embryos cultured with anti-CENP-A antibody experienced significant growth impairment compared with controls. Conclusion Mouse embryos may be a direct target for ACA in vitro prior to implantation. However, the precise mechanism needs further clarification.
Collapse
|
11
|
|
12
|
Ticconi C, Pietropolli A, Borelli B, Bruno V, Piccione E, Bernardini S, Di Simone N. Antinuclear autoantibodies and pregnancy outcome in women with unexplained recurrent miscarriage. Am J Reprod Immunol 2016; 76:396-399. [DOI: 10.1111/aji.12560] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Accepted: 08/09/2016] [Indexed: 12/24/2022] Open
Affiliation(s)
- Carlo Ticconi
- Section of Gynecology and Obstetrics; Academic Department of Biomedicine and Prevention; University Tor Vergata; Rome Italy
| | - Adalgisa Pietropolli
- Section of Gynecology and Obstetrics; Academic Department of Biomedicine and Prevention; University Tor Vergata; Rome Italy
| | - Barbara Borelli
- Section of Gynecology and Obstetrics; Academic Department of Biomedicine and Prevention; University Tor Vergata; Rome Italy
| | - Valentina Bruno
- Section of Gynecology and Obstetrics; Academic Department of Biomedicine and Prevention; University Tor Vergata; Rome Italy
| | - Emilio Piccione
- Section of Gynecology and Obstetrics; Academic Department of Biomedicine and Prevention; University Tor Vergata; Rome Italy
| | - Sergio Bernardini
- Department of Experimental Medicine and Surgery; University Tor Vergata; Rome Italy
| | - Nicoletta Di Simone
- Department of Obstetrics and Gynecology; Catholic University of Sacred Heart; Rome Italy
| |
Collapse
|
13
|
Moindjie H, Santos ED, Loeuillet L, Gronier H, de Mazancourt P, Barnea ER, Vialard F, Dieudonne MN. Preimplantation Factor (PIF) Promotes Human Trophoblast Invasion1. Biol Reprod 2014; 91:118. [DOI: 10.1095/biolreprod.114.119156] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
|
14
|
Obstetric antiphospholipid syndrome: a recent classification for an old defined disorder. Autoimmun Rev 2014; 13:901-8. [PMID: 24820522 DOI: 10.1016/j.autrev.2014.05.004] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2014] [Accepted: 04/18/2014] [Indexed: 12/11/2022]
Abstract
Obstetric antiphospholipid syndrome (APS) is now being recognized as a distinct entity from vascular APS. Pregnancy morbidity includes >3 consecutive and spontaneous early miscarriages before 10weeks of gestation; at least one unexplained fetal death after the 10th week of gestation of a morphologically normal fetus; a premature birth before the 34th week of gestation of a normal neonate due to eclampsia or severe pre-eclampsia or placental insufficiency. It is not well understood how antiphospholipid antibodies (aPLs), beyond their diagnostic and prognostic role, contribute to pregnancy manifestations. Indeed aPL-mediated thrombotic events cannot explain the obstetric manifestations and additional pathogenic mechanisms, such as a placental aPL mediated complement activation and a direct effect of aPLs on placental development, have been reported. Still debated is the possible association between aPLs and infertility and the effect of maternal autoantibodies on non-vascular manifestations in the babies. Combination of low dose aspirin and unfractionated or low molecular weight heparin is the effective treatment in most of the cases. However, pregnancy complications, in spite of this therapy, can occur in up to 20% of the patients. Novel alternative therapies able to abrogate the aPL pathogenic action either by interfering with aPL binding at the placental level or by inhibiting the aPL-mediated detrimental effect are under active investigation.
Collapse
|
15
|
Zhu Q, Wu L, Xu B, Hu MH, Tong XH, Ji JJ, Liu YS. A retrospective study on IVF/ICSI outcome in patients with anti-nuclear antibodies: the effects of prednisone plus low-dose aspirin adjuvant treatment. Reprod Biol Endocrinol 2013; 11:98. [PMID: 24093222 PMCID: PMC3852712 DOI: 10.1186/1477-7827-11-98] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2013] [Accepted: 10/03/2013] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Anti-nuclear antibodies (ANA) are suspected of having relevance to adverse reproductive events. METHODS This study aims to investigate the potential effect of ANA on IVF/ICSI outcome and the therapeutic role of prednisone plus low-dose aspirin (P + A) adjuvant treatment in ANA + patients. The first IVF/ICSI cycles without P + A of sixty-six ANA + women were enrolled as the ANA + group, and the 233 first IVF/ICSI cycles of matched ANA- women served as the ANA- group. The ANA + group was divided into the Titre < =1:320 subgroup and the Titre > 1:320 subgroup. Twenty-one ANA + women with adverse outcomes in their first cycles (ANA + cycles without P + A) received P + A adjuvant treatment for three months before the second IVF/ICSI cycle (ANA + cycles with P + A). The clinical characteristics and the IVF/ICSI outcomes were compared, respectively, between 1) the ANA + group and the ANA- group, 2) the Titre < =1:320 subgroup and the Titre > 1:320 subgroup, and 3) the ANA + cycles without P + A and the ANA + cycles with P + A. RESULTS No significant differences were observed between each of the two-group pairs in the clinical characteristics. The ANA + group exhibited significantly lower MII oocytes rate, normal fertilisation, pregnancy and implantation rates, as well as remarkably higher abnormal fertilisation and early miscarriage rates. The Titre < =1:320 subgroup's IVF/ICSI outcomes were as poor as those of the Titre > 1:320 subgroup. After the P + A adjuvant treatment, the number of two pro-nuclei, perfect embryos and available embryos, and the implantation rate increased significantly. CONCLUSIONS These observations suggest that ANA could exert a detrimental effect on IVF/ICSI outcome that might not be titre-dependent, and P + A adjuvant treatment could be useful for ANA + patients. This hypothesis should be verified in further prospective randomised studies.
Collapse
Affiliation(s)
- Qing Zhu
- Centre for Reproductive Medicine, Department of Obstetrics and Gynecology, Anhui Provincial Hospital affiliated with Anhui Medical University, Hefei, Anhui 230000, China
| | - Li Wu
- Centre for Reproductive Medicine, Department of Obstetrics and Gynecology, Anhui Provincial Hospital affiliated with Anhui Medical University, Hefei, Anhui 230000, China
| | - Bo Xu
- Centre for Reproductive Medicine, Department of Obstetrics and Gynecology, Anhui Provincial Hospital affiliated with Anhui Medical University, Hefei, Anhui 230000, China
| | - Mei-Hong Hu
- Centre for Reproductive Medicine, Department of Obstetrics and Gynecology, Anhui Provincial Hospital affiliated with Anhui Medical University, Hefei, Anhui 230000, China
| | - Xian-Hong Tong
- Centre for Reproductive Medicine, Department of Obstetrics and Gynecology, Anhui Provincial Hospital affiliated with Anhui Medical University, Hefei, Anhui 230000, China
| | - Jing-Juan Ji
- Centre for Reproductive Medicine, Department of Obstetrics and Gynecology, Anhui Provincial Hospital affiliated with Anhui Medical University, Hefei, Anhui 230000, China
| | - Yu-Sheng Liu
- Centre for Reproductive Medicine, Department of Obstetrics and Gynecology, Anhui Provincial Hospital affiliated with Anhui Medical University, Hefei, Anhui 230000, China
| |
Collapse
|
16
|
Ying Y, Zhong YP, Zhou CQ, Xu YW, Miao BY, Wang Q, Li J. Preliminary investigation of the impact of anticentromere antibody on oocyte maturation and embryo cleavage. Fertil Steril 2013; 100:1585-9. [PMID: 24044934 DOI: 10.1016/j.fertnstert.2013.07.1998] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2013] [Revised: 07/24/2013] [Accepted: 07/29/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To explore whether anticentromere antibody (ACA) is the most significant antibody among antinuclear antibodies (ANA), which adversely affect oocyte maturation, embryo cleavage, and pregnancy outcome in women undergoing an intracytoplasmic sperm injection program. DESIGN Retrospective, nested case-control study. SETTING Center for reproductive medicine, university hospital. PATIENT(S) A total of 187 women receiving the first intracytoplasmic sperm injection cycle were enrolled in this study, including 20 women with positive ACA and ANA (ACA[+]/ANA[+] group), 51 women with negative ACA and positive ANA(ACA[-]/ANA[+] group), and 116 patients with negative ACA and ANA (ACA[-]/ANA[-] group). Patients in the three groups were age-matched. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Percentages of germinal vesicle, metaphase I, and metaphase II oocytes, embryo cleavage rate, number of high-quality embryos, and rates of pregnancy and implantation. RESULT(S) The metaphase I oocyte percentage was markedly higher and the metaphase II oocyte percentage and the normal cleavage rate were significantly lower in the ACA[+]/ANA[+] group as compared with the ACA[-]/ANA[+] group. Furthermore, statistically significant differences were found in rates of pregnancy and implantation among the three groups. However, no significant difference was found between any two groups owing to the small sample size, except for a significantly lower implantation rate being found in the ACA[+]/ANA[+] group when compared with the ACA[-]/ANA[-] group. CONCLUSION(S) Our data suggest that ACA may be the essential marker for defective oocytes or embryos in infertile women with any type of ANA.
Collapse
Affiliation(s)
- Ying Ying
- Reproductive Medicine Center for The First Affiliated Hospital of Sun Yat-sen University, Key Laboratory of Reproductive Medicine of Guangdong Province, Guangzhou, People's Republic of China
| | | | | | | | | | | | | |
Collapse
|
17
|
Ying Y, Zhong YP, Zhou CQ, Xu YW, Ding CH, Wang Q, Li J, Shen XT. A Further Exploration of the Impact of Antinuclear Antibodies onIn VitroFertilization-Embryo Transfer Outcome. Am J Reprod Immunol 2013; 70:221-9. [PMID: 23480310 DOI: 10.1111/aji.12111] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2012] [Accepted: 02/07/2013] [Indexed: 11/30/2022] Open
Affiliation(s)
- Ying Ying
- Reproductive Medicine Center; for The First Affiliated Hospital of Sun Yat-sen University, Key Laboratory of Reproductive Medicine of Guangdong Province; Sun Yat-sen University; Guangzhou China
| | - Yi-Ping Zhong
- Reproductive Medicine Center; for The First Affiliated Hospital of Sun Yat-sen University, Key Laboratory of Reproductive Medicine of Guangdong Province; Sun Yat-sen University; Guangzhou China
| | - Can-Quan Zhou
- Reproductive Medicine Center; for The First Affiliated Hospital of Sun Yat-sen University, Key Laboratory of Reproductive Medicine of Guangdong Province; Sun Yat-sen University; Guangzhou China
| | - Yan-Wen Xu
- Reproductive Medicine Center; for The First Affiliated Hospital of Sun Yat-sen University, Key Laboratory of Reproductive Medicine of Guangdong Province; Sun Yat-sen University; Guangzhou China
| | - Chen-Hui Ding
- Reproductive Medicine Center; for The First Affiliated Hospital of Sun Yat-sen University, Key Laboratory of Reproductive Medicine of Guangdong Province; Sun Yat-sen University; Guangzhou China
| | - Qiong Wang
- Reproductive Medicine Center; for The First Affiliated Hospital of Sun Yat-sen University, Key Laboratory of Reproductive Medicine of Guangdong Province; Sun Yat-sen University; Guangzhou China
| | - Jie Li
- Reproductive Medicine Center; for The First Affiliated Hospital of Sun Yat-sen University, Key Laboratory of Reproductive Medicine of Guangdong Province; Sun Yat-sen University; Guangzhou China
| | - Xiao-Ting Shen
- Reproductive Medicine Center; for The First Affiliated Hospital of Sun Yat-sen University, Key Laboratory of Reproductive Medicine of Guangdong Province; Sun Yat-sen University; Guangzhou China
| |
Collapse
|
18
|
Velayuthaprabhu S, Matsubayashi H, Sugi T, Nakamura M, Ohnishi Y, Ogura T, Archunan G. Expression of Apoptosis in Placenta of Experimental Antiphospholipid Syndrome Mouse. Am J Reprod Immunol 2013; 69:486-94. [DOI: 10.1111/aji.12084] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2012] [Accepted: 01/03/2013] [Indexed: 01/06/2023] Open
Affiliation(s)
| | | | | | | | - Yasuyuki Ohnishi
- Central Institute for Experimental Animals; Kawasaki; Kanagawa; Japan
| | - Tomoyuki Ogura
- Central Institute for Experimental Animals; Kawasaki; Kanagawa; Japan
| | - Govindaraju Archunan
- Department of Aniaml Science; Bharathidasan University; Tiruchirappalli; Tamil nadu; India
| |
Collapse
|
19
|
Preimplantation factor inhibits circulating natural killer cell cytotoxicity and reduces CD69 expression: implications for recurrent pregnancy loss therapy. Reprod Biomed Online 2013. [DOI: 10.1016/j.rbmo.2012.09.017] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
|
20
|
Ying Y, Zhong YP, Zhou CQ, Xu YW, Wang Q, Li J, Shen XT, Wu HT. Antinuclear Antibodies Predicts a Poor IVF-ET Outcome: Impaired Egg and Embryo Development and Reduced Pregnancy Rate. Immunol Invest 2012; 41:458-68. [DOI: 10.3109/08820139.2012.660266] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
21
|
Coulam CB, Acacio B. Does Immunotherapy for Treatment of Reproductive Failure Enhance Live Births? Am J Reprod Immunol 2012; 67:296-304. [DOI: 10.1111/j.1600-0897.2012.01111.x] [Citation(s) in RCA: 100] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2012] [Accepted: 01/23/2012] [Indexed: 02/03/2023] Open
|
22
|
Preimplantation factor negates embryo toxicity and promotes embryo development in culture. Reprod Biomed Online 2011; 23:517-24. [DOI: 10.1016/j.rbmo.2011.06.009] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2011] [Revised: 06/10/2011] [Accepted: 06/15/2011] [Indexed: 01/24/2023]
|
23
|
Zhong YP, Ying Y, Wu HT, Zhou CQ, Xu YW, Wang Q, Li J, Sheng XT, Li J. Impact of anticardiolipin antibody on the outcome of in vitro fertilization and embryo transfer. Am J Reprod Immunol 2011; 66:504-9. [PMID: 21762406 DOI: 10.1111/j.1600-0897.2011.01058.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PROBLEM To investigate the impact of anticardiolipin antibody (ACA) on the outcome of in vitro fertilization and embryo transfer (IVF-ET). METHODS A total of 76 infertile women positive for anticardiolipin antibody (ACA+ group) and 819 controls negative for anticardiolipin antibody (ACA- group) undergoing IVF-ET in the First Affiliated Hospital, to Sun Yat-Sen University, were retrospectively analyzed. Women were diagnosed as having pure tubal factor infertility. RESULTS The proportion of patients with a history of spontaneous abortion in the ACA+ group was significantly higher than that in ACA- group (19.7% versus 8.9%). The IVF rate, pregnancy rate and implantation rate in the ACA+ group were markedly lower than those in the ACA- group (75.5% versus 78.9%, 31.3% versus 48.6% and 16.1% versus 28.1%, respectively). Furthermore, the incidence of pregnancy loss in the ACA+ group was higher than that in the ACA- group (32.0% versus 15.1%). CONCLUSION ACA-positive patients had significantly decreased IVF rate, pregnancy rate and implantation rate and high risk of abortion. Therefore, ACA positivity predicts poor outcome of IVF-ET, and pre-treatment to lower ACA level may be clinically beneficial for patients receiving IVF-ET.
Collapse
Affiliation(s)
- Yi-Ping Zhong
- Reproductive Medicine Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | | | | | | | | | | | | | | | | |
Collapse
|
24
|
Olexikova L, Makarevich A, Pivko J, Chrenek P. Antibody to Hsp70 alters response of rabbit preimplantation embryos to hyperthermia in vitro. Anim Reprod Sci 2010; 119:130-6. [DOI: 10.1016/j.anireprosci.2009.12.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2009] [Revised: 11/30/2009] [Accepted: 12/07/2009] [Indexed: 10/20/2022]
|
25
|
Prevalence of antiphospholipid antibodies among women experiencing unexplained infertility and recurrent implantation failure. Fertil Steril 2009; 93:2441-3. [PMID: 19962695 DOI: 10.1016/j.fertnstert.2009.08.062] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2009] [Revised: 08/28/2009] [Accepted: 08/29/2009] [Indexed: 11/22/2022]
Abstract
The prevalences of antiphospholipid antibodies (APAs) among 1,325 women with a history of unexplained infertility and 676 women experiencing recurrent implantation failure were compared with 789 women experiencing recurrent pregnancy loss and 205 fertile control women. Eight percent and 9% of women with a history of unexplained infertility and recurrent implantation failure had more than one positive APA compared with 1.5% of fertile negative control women and 11% of positive control women experiencing recurrent pregnancy loss.
Collapse
|
26
|
Matsubayashi H. Autoantibodies and coagulation in reproductive medicine. Reprod Med Biol 2009; 8:131-140. [PMID: 29662422 DOI: 10.1007/s12522-009-0026-9] [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: 05/29/2009] [Accepted: 06/29/2009] [Indexed: 10/20/2022] Open
Abstract
Management of recurrent pregnancy loss (RPL) is considered to be difficult, in part because of cunfusion between autoantibodies and coagulation disorders. Autoantibodies and coagulation are related; two groups of multicenter studies concerning autoantibodies and coagulation reported that factor XII deficiency, hypofibrinolysis, anti-phosphatidylethanolamine (aPE), anti-beta2-glycoprotein I, anti-annexin A5, and lupus anticoagulant (LA) were found to be frequent risk factors in RPL women. Therefore, discrimination of autoantibodies and coagulation is important in understanding RPL well. We propose three types of pathways regarding reproduction, which are different and independent: (1) Negatively charged-phospholipid related antibodies (anti-phosphatidylserine; aPS, anti-cardiolipin; aCL, lupus anticoagulant; LA, anti-annexin A5; aANX), (2) factor XII-aPE-fibrinolysis: suppression of fibrinolysis, (3) protein C-protein S-factor V: loss of inactivation against activated factor V. Women with RPL and infertility showed similar findings in terms of the above clinical tests. Available data, however, is not enough to conclude whether these are pathogenic to infertile women.
Collapse
Affiliation(s)
- Hidehiko Matsubayashi
- Tokai University School of Medicine 143 Shimokasuya, Isehara 259-1193 Kanagawa Japan.,Osaka New ART Clinic Pacificmarks Nishiumeda 10F, 2-6-20 Umeda, Kita-ku 530-0001 Osaka Japan
| |
Collapse
|
27
|
Buckingham K, Chamley L. A critical assessment of the role of antiphospholipid antibodies in infertility. J Reprod Immunol 2009; 80:132-45. [DOI: 10.1016/j.jri.2008.11.005] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2008] [Accepted: 11/07/2008] [Indexed: 10/21/2022]
|
28
|
Matsubayashi H, Sugi T, Arai T, Shida M, Kondo A, Suzuki T, Izumi SI, McIntyre JA. IgG-antiphospholipid antibodies in follicular fluid of IVF-ET patients are related to low fertilization rate of their oocytes. ACTA ACUST UNITED AC 2006; 55:341-8. [PMID: 16635208 DOI: 10.1111/j.1600-0897.2006.00374.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
PROBLEM Patients undergoing in vitro fertilization and embryo transfer (IVF-ET) failures show an increased incidence of antiphospholipid antibodies (aPL) in their blood. The physiological manifestations of aPL in this patient group are nonetheless controversial. Pathological effects of aPL on embryos in vitro have been documented. We questioned whether aPL if found in follicular fluids (FFs) could result in embryonic damage. METHOD OF STUDY Blood from 44 patients with three or more IVF-ET failures were tested by enzyme-linked immunosorbent assays (ELISA) for the presence of immunoglobulin (Ig)G, IgM and IgA aPL. Both the 29 aPL-positive and 15 aPL-negative patients gave permission for FF collection during their next IVF-ET attempt for additional aPL determinations. RESULTS Patients with no aPL in their blood, had no aPL in their FFs. Patients with IgG and/or IgM aPL in their blood had IgG but not IgM in their respective FFs. CONCLUSIONS The presence of IgG aPL in FFs and increased infertility length were significantly related to lower fertilization rates, independently. Follicular fluid IgG aPL appears as a risk factor in association with successful IVF-ET outcomes.
Collapse
Affiliation(s)
- Hidehiko Matsubayashi
- Department of Obstetrics and Gynecology, Specialized Clinical Science, Tokai University School of Medicine, Kanagawa, Japan.
| | | | | | | | | | | | | | | |
Collapse
|
29
|
Halperin R, Shinnar N, Kronfeld-Schor N, Hadas E. Human decidua-associated protein 200 neutralizes the detrimental effect of serum containing antiphospholipid antibodies on fetal survival in the rat. Am J Reprod Immunol 2006; 55:246-50. [PMID: 16533335 DOI: 10.1111/j.1600-0897.2005.00355.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
PROBLEM We wanted to examine whether the detrimental effect of serum containing antiphospholipid (APL) antibodies on rat pregnancy outcome can be neutralized by addition of human decidua-associated protein (hDP) 200, a kind of rheumatoid factor, extracted from decidual tissue. METHODS Fifty microliters of pooled serum, obtained from women having anticardiolipin antibody and lupus anticoagulant and presenting with APL antibody syndrome, added with 100 microL of immunoaffinity purified hDP200 was injected into unilateral uterine horn of each rat on day L5 of rat pregnancy. The contralateral uterine horn was used for injection of 50 microL APL positive serum added with physiologic saline as a control. The rats were killed on day L14, and the uterus of each rat was inspected for the presence of live and resorbed fetuses. RESULTS The addition of hDP200 to APL positive serum before the intrauterine injection neutralized the detrimental effect of APL serum on fetal resorption rate. Although the neutralizing effect was demonstrated following the addition of hDP200 and immediate intrauterine injection (a decrease in fetal resorption rate, P = 0.004), still the effect was more impressive following the addition of hDP200 and incubation period of 24 hr before the injection, thus causing a significant increase in the number of normal embryos and a significant decrease in fetal resorption rate (P < 0.001). CONCLUSION Human decidua-associated protein 200, extracted from human decidual tissue neutralizes the detrimental effect of serum containing APL antibodies in an experimental rat model. Further studies are needed to prove this finding.
Collapse
Affiliation(s)
- Reuvit Halperin
- Department of Obstetrics and Gynecology, Assaf Harofeh Medical Center, Zerifin, affiliated with Sackler School of Medicine, Tel-Aviv University, Israel.
| | | | | | | |
Collapse
|
30
|
Stern C, Chamley L. Antiphospholipid antibodies and coagulation defects in women with implantation failure after IVF and recurrent miscarriage. Reprod Biomed Online 2006; 13:29-37. [PMID: 16820106 DOI: 10.1016/s1472-6483(10)62013-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Evaluation of patients with IVF implantation failure or recurrent miscarriage often frustratingly fails to elicit any particular cause for their problem. Testing for antiphospholipid antibodies or thrombophilia is commonly carried out, and interpretation of results in the light of the current evidence is extremely difficult. This paper reviews the purported pathogenetic mechanisms and clinical associations between both antiphospholipid antibodies and inherited thrombophilias, and reproductive failure. The current management strategies are also critically evaluated and recommendations are made for optimal, evidence-based clinical practice.
Collapse
Affiliation(s)
- Catharyn Stern
- Royal Women's Hospital and Melbourne IVF, Melbourne, Australia.
| | | |
Collapse
|
31
|
Buckingham KL, Stone PR, Smith JF, Chamley LW. Antiphospholipid antibodies in serum and follicular fluid--is there a correlation with IVF implantation failure? Hum Reprod 2005; 21:728-34. [PMID: 16253967 DOI: 10.1093/humrep/dei369] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Antiphospholipid antibodies (aPLs) are associated with infertility, but the mechanism underlying this statistical association is currently obscure. We aimed to investigate the finding that aPLs are concentrated in follicular fluid and to establish if this is associated with a poorer outcome from IVF. METHODS AND RESULTS In 19.2% of 99 women undergoing IVF, at least one aPL was detected in their serum and/or follicular fluids, but the antibody levels in follicular fluid were not higher than in serum. Women with aPLs had a lower implantation rate (14%) than women without these antibodies (24.1%), but this difference was not significant (P=0.127). There was also a non-significant reduction in the live birth rate for women with aPLs. In a parallel investigation, 10 sheep immunized with beta2 glycoprotein I (beta2GPI) or irrelevant control antigens showed strong immune responses, but there were no significant differences between the levels of antibodies in the follicular fluid or serum from beta2GPI or control immunized sheep. CONCLUSION aPLs do not appear to be selectively concentrated in follicular fluids and, when present, do not adversely affect the reproductive outcome of women undergoing IVF.
Collapse
Affiliation(s)
- K L Buckingham
- Department of Obstetrics and Gynaecology, University of Auckland, and Fertility Plus, Greenlane Clinical Centre, Private Bag 92189, Auckland 1003, New Zealand.
| | | | | | | |
Collapse
|
32
|
Kuo PL, Guo HR. Mechanism of recurrent spontaneous abortions in women with mosaicism of X-chromosome aneuploidies. Fertil Steril 2005; 82:1594-601. [PMID: 15589865 DOI: 10.1016/j.fertnstert.2004.06.042] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2003] [Revised: 06/01/2004] [Accepted: 06/01/2004] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To investigate the mechanism of recurrent miscarriages in women with mosaicism of X-chromosome aneuploidies. DESIGN Prospective case-control study. SETTING University-based reproductive clinic housed in a medical center with genetic laboratories. PATIENT(S) Eighteen women who experienced recurrent miscarriages and had mosaicism of X-chromosome aneuploidies; two control groups, one with a balanced structural autosomal rearrangement and the other without chromosomal abnormalities. INTERVENTION(S) Criteria were established for the diagnosis of low-grade X-chromosome mosaicism by using peripheral blood lymphocytes. Patients were evaluated for the pathogenesis of recurrent miscarriages. Their abortion rate was assessed, and each abortus was karyotyped. MAIN OUTCOME MEASURE(S) Abortion rate and karyotype of the abortus. RESULT(S) In comparison with patients with X-chromosome mosaicism with a balanced structural autosomal rearrangement, patients with X-chromosome mosaicism without a balanced autosomal structural rearrangement had a significantly higher incidence of diminished ovarian reserve (DOR) and had a somewhat higher prevalence of uterine anomalies. In comparison with controls without chromosomal abnormalities, the patients with a balanced autosomal structural rearrangement also had higher incidence of both conditions, but the differences were not statistically significant. At least two factors are implicated in recurrent miscarriages in women with X-chromosome mosaicism. Among them, DOR is the most prevalent (occurring in 44.4% of cases), followed by uterine anomalies (16.7% of cases). Cases with DOR had a higher abortion rate than did those without (68.6% vs. 44.1%). Cases with DOR also had a slightly higher rate of abnormal karyotypes in the abortus than did those without (73.7% vs. 42.9%). CONCLUSION(S) The oocytes of women with X-chromosome mosaicism are in a suboptimal state of development and are prone to embryonic lethality.
Collapse
Affiliation(s)
- Pao-Lin Kuo
- Department of Obstetrics and Gynecology, National Cheng-Kung University Medical College, Tainan, Taiwan, Republic of China.
| | | |
Collapse
|
33
|
Clark DA. Shall We properly Re-examine the Status of Allogeneic Lymphocyte Therapy for Recurrent early Pregnancy Failure? Am J Reprod Immunol 2004; 51:7-15. [PMID: 14725561 DOI: 10.1046/j.8755-8920.2003.00133.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PROBLEM How to evaluate immunological therapy advocated for recurrent spontaneous abortion and implantation failure. I was invited to comment on the opinion article of Chaouat (AJRI December 2003). METHODS A critical examination of key beliefs and application of the principles of evidence and logic utilizing current data. RESULTS AND CONCLUSIONS Although rationale has no bearing on efficacy of proposed treatments and is not sufficient justification for routine practice, insufficient attention to data concerning patient selection, insufficient attention to treatment methodology, and lack of full disclosure in some clinical trials needs to be corrected. A more systematic collection of follow-up data is needed.
Collapse
Affiliation(s)
- David A Clark
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
| |
Collapse
|
34
|
Abstract
PROBLEM The amino phospholipids (PL), phosphatidylserine (PS) and phosphatidylethanolamine (PE) are distributed asymmetrically in the plasma membranes of eucaryotic cells. This arrangement involves active transport of PS and PE from the outer to inner membrane leaflet by an aminophospholipid translocase (flipase). Cell activation, injury and programmed cell death (apoptosis) cause collapse of the PS/PE asymmetry by activation of another enzyme system, scramblase. Unlike other cells, the developing trophoblast exteriorizes PS during its differentiation. METHODS OF STUDY An analysis of published and unpublished data. RESULTS The trophoblast is targeted by antiphospholipid antibodies (aPL), especially to PS (aPS). Cardiolipin is not present in the trophoblast plasma membrane, nonetheless, anticardiolipin (aCL) has been implicated in trophoblast pathology. The aPS and aCL are often crossreactive. Both animal and in vitro experimental models have shown monoclonal and polyclonal aPS and aCL to specifically destroy trophoblast, inhibit syncytium formation, halt human chorionic gonadatropin (hCG) production, and limit trophoblast invasion. Antibodies to PE (aPE) have not been well characterized, however, recent reports from several independent laboratories document that aPE are associated significantly with very early (embryonic) recurrent pregnancy loss (RPL). Umeda and coworkers have shown that during cytokinesis (late telophase) of Chinese hamster ovary (CHO) cells, formation of PE rafts in cleavage furrows is required for completion of cell division and formation of daughter cells. This raises the question whether aPE might interfere with implantation and cell division during embryogenesis. CONCLUSIONS A role for aPL in implantation failure and occult pregnancy loss constitutes the basis of this overview.
Collapse
Affiliation(s)
- J A McIntyre
- HLA-Vascular Biology Laboratory, St Francis Hospital and Health Centers, Indiana/Purdue Universities at Indianapolis, Indianapolis, IN 46107, USA.
| |
Collapse
|
35
|
Abstract
PROBLEM Implantation of the embryo determines successful from unsuccessful cycles after in vitro fertilization (IVF) and embryo transfer (ET). The purpose of this study was to compare immunologic risk factors among women experiencing implanation failure characterized by a negative pregnancy test after IVF/ET and those experiencing chemical pregnancies. In addition ultrasonographic measurement of gestational sac size from 24 to 35 days from last menstrual period (LMP) were compared between chemical pregnancies and other pregnancy outcomes. METHODS OF STUDY Blood samples from 122 women experiencing IVF implantation failure with a negative pregnancy test after ET and 20 women with chemical pregnancies were evaluated for the presence of antiphospholipid antibodies (APA), antinuclear antibodies (ANA), circulating embryotoxins (ETA) and elevated levels of natural killer (NK) cells. Gestational sac size measured from 24 to 35 days form LMP were compared according to pregnancy outcome: term birth (n = 46), ectopic pregnancy (n = 49), spontaneous abortion (n = 56) and chemical pregnancy (n = 20). RESULTS Women experiencing chemical pregnancies had a higher frequency of APA than women with implantation failure associated with a negative pregnancy test (80% versus 28%, P < 0.0001). The prevalence of ANA, elevated NK cells and ETA was not different between the two groups. The mean gestational sac size from 24 to 35 days from LMP did not differ when chemical pregnancies were compared with pregnancies progressing longer than 35 days. The maximal gestational sac diameter among chemical pregnancies was 3.8 mm. CONCLUSION Mechanisms involved in implantation failure associated with a negative pregnancy test may be different from those involved in chemical pregnancies. Chemical pregnancies may be the result of defective angiogenesis.
Collapse
Affiliation(s)
- Carolyn B Coulam
- Sher Institute for Reproductive Medicine and Millenova Immunology Laboratories, Chicago, IL 60610, USA.
| | | |
Collapse
|
36
|
Matalon ST, Shoenfeld Y, Blank M, Yacobi S, Blumenfeld Z, Ornoy A. The effects of IgG purified from women with SLE and associated pregnancy loss on rat embryos in culture. Am J Reprod Immunol 2002; 48:296-304. [PMID: 12516651 DOI: 10.1034/j.1600-0897.2002.01084.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PROBLEM Recurrent fetal loss occurs in approximately 1% of women. Autoimmune causes have been suggested as a factor in some of these cases. High rates of intrauterine fetal growth retardation and increased incidence of prematurity is associated with systemic lupus erythematosus (SLE) and the anti-phospholipid syndrome (APS). Autoantibodies from sera of SLE/APS patients affect reproductive outcome in pregnant mice, as was studied in vivo, where injection of immunoglobulin (Ig)G purified from patients with APS to mice caused fetal resorptions and growth retardation. METHODS In order to investigate the direct effect of IgG purified from women with SLE or APS on the growth and viability of embryos, we cultured 11.5-day old-rat embryos in their yolk sacs in the presence of IgG purified from SLE and APS patients. RESULTS IgG purified from SLE and recurrent pregnancy loss (RPL) patients affected directly the embryo and yolk sac reducing their growth. The purified IgG positive for anti-cardiolipin/anti-DNA antibodies reduced yolk sac and embryonic growth more than sera negative for these antibodies. CONCLUSION Various antiphospholipid antibodies affect differently the growth and development of the embryo and the placenta.
Collapse
Affiliation(s)
- S T Matalon
- Laboratory of Teratology, Department of Anatomy and Cell Biology, Hebrew University Hadassah Medical School, Jerusalem, Israel
| | | | | | | | | | | |
Collapse
|
37
|
Halperin R, Hadas E, Shinnar N, Bukovsky I, Schneider D. Fetal survival in the rat as affected by intrauterine injection of serum containing antiphospholipid antibodies. Am J Reprod Immunol 2002; 48:291-5. [PMID: 12516650 DOI: 10.1034/j.1600-0897.2002.01083.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PROBLEM We wanted to study and examine whether the detrimental effect of antiphospholipid antibodies on gestation is locally derived. Therefore, we established an experimental rat model, enabling to study the intrauterine effect of serum, containing antiphospholipid antibodies, in vivo. METHODS Sera were obtained from five women, having anticardiolipin antibody and lupus anticoagulant, and presenting with antiphospholipid antibody syndrome. Pooled serum of 150 microL was injected into unilateral uterine horn of each rat on days L2-L7 of rat pregnancy. The contralateral uterine horn was used for injection of 150 microL normal serum or physiologic saline as a control. The rats were sacrificed on day L14, and the uterus of each rat was inspected for the presence of live and resorbed fetuses. RESULTS A significant effect on fetal resorption and viability was observed following the intrauterine injection of antiphospholipid positive serum (APL positive serum), as compared with the intrauterine injection of normal serum or saline. A significant increase in fetal resorption rate and decrease in fetal viability was noted following the injection of APL positive serum on day L6 (P = 0.005 and 0.004, respectively) and day L7 (P = 0.003 and 0.003, respectively) as compared with normal serum. A comparison with the contralateral injection of saline demonstrated a significant effect of the APL positive serum also following the intrauterine injection on days L3 and L5. CONCLUSIONS The current study provides an experimental rat model, which can be employed to study the local intrauterine effect of APL positive serum on pregnancy outcome and to further assess the efficacy of various treatment modalities.
Collapse
Affiliation(s)
- Reuvit Halperin
- Department of Obstetrics and Gynecology, Assaf Harofeh Medical Center, Zerifin, Isreal.
| | | | | | | | | |
Collapse
|
38
|
Affiliation(s)
- Carolyn B Coulam
- Sher Institute for Reproductive Medicine, Millenova Immunology Laboratories, Chicago, IL, USA.
| |
Collapse
|
39
|
Abstract
Antiphospholipid antibodies (aPL) are an established cause of recurrent pregnancy loss. As defective embryonic implantation is a common link between unexplained infertility and recurrent miscarriage, interest has focused on the potential relationship between aPL and implantation failure after in vitro fertilization and embryo transfer (IVF-ET). This review critically examines the published data to determine whether women undergoing IVF-ET should be routinely screened for aPL. Although most studies have reported an increased prevalence of aPL among women undergoing IVF-ET, prospective studies examining the effect of aPL on the outcome of IVF-ET demonstrate that these antibodies do not significantly affect either the implantation or ongoing pregnancy rates. The increased prevalence of aPL among women with infertility is therefore likely to be part of a generalized autoimmune disturbance associated with infertility. Hence routine screening for aPL among women undergoing IVF-ET is not warranted and therapeutic interventions should be used only in well designed randomized controlled trials.
Collapse
Affiliation(s)
- May Backos
- Department of Reproductive Science and Medicine, Imperial College School of Medicine at St Mary's Hospital, London W2 1NY, UK
| | | | | |
Collapse
|
40
|
A rational basis for antiphospholipid antibody testing and selective immunotherapy in assisted reproduction: a rebuttal to the American Society for Reproductive Medicine Practice Committee opinion11The opinions and commentary expressed in this article are solely those of the author. Publication does not imply endorsement by the Editor or the American Society for Reproductive Medicine. Fertil Steril 2000. [DOI: 10.1016/s0015-0282(00)01525-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
41
|
Abstract
Animal models of the relatively new antiphospholipid syndrome (APS) enabled researchers to understand disease pathogenesis and to test novel experimental therapeutic modalities. Animal models of APS include spontaneous genetic models and experimental induced models. The latter test more reliably the pathogenicity of antiphospholipid antibodies because the syndrome is induced in normal mice rather than being secondary to a preexisting autoimmune disease. Reports about animal models of APS in the recent year provide new insights into the pathogenesis of antiphospholipid antibodies and beta2-glycoprotein-I in reproductive failure, neurologic manifestations, thrombosis, and atherosclerosis. In addition, novel therapies that were successful in experimental APS included anti-idiotypes, oral tolerance, and specific peptides that bind to beta2-glycoprotein-I. Animal models provide the first step in development of novel therapies for patients with APS.
Collapse
Affiliation(s)
- Y Sherer
- Department of Medicine B, Sheba Medical Center, Tel-Hashomer, Israel
| | | |
Collapse
|