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Jia Y, Huang Y, Ai ZH, Dong YJ, Guo YH, Yang Y, Zhang D, Ye HX, Yang J. Exploring the effectiveness of endometrial receptivity array and immune profiling in patients with multiple implantation failure:A retrospective cohort study based on propensity score matching. J Reprod Immunol 2024; 163:104218. [PMID: 38422808 DOI: 10.1016/j.jri.2024.104218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 02/12/2024] [Accepted: 02/14/2024] [Indexed: 03/02/2024]
Abstract
This study aimed to evaluate the effectiveness of the endometrial receptivity array (ERA), endometrial immune profiling, and a combination of both in improving the pregnancy outcomes for multiple implantation failure patients. According to patients' willingness, 1429 women who incurred at least two or more consecutive implantation failures in IVF/ICSI treatment opted for frozen embryo transfer and were divided into four groups: 'No test', 'Immune Profiling', 'ERA' and 'ERA+ Immune Profiling'. Women in three test groups underwent timed endometrial biopsy for ERA, immune profiling, a combination of both. We observed the overall incidence rates of the displaced window of implantation (WOI) and endometrial immune dysregulation were 75.14% and 79.29%, respectively. After 1:1 propensity score matching (PSM), our data revealed that the 'ERA' and 'ERA + Immune Profiling' groups demonstrated significantly higher rates of biochemical, clinical, ongoing pregnancy, and implantation compared to the 'No test' group (p < 0.01). The 'Immune Profiling' group showed a higher implantation rate compared to 'No test' group (p < 0.05). Furthermore, when comparing three test groups, the 'ERA + Immune Profiling' group exhibited notably higher rates of clinical and ongoing pregnancy compared to the 'Immune Profiling' group (p < 0.017). However, there was no association between endometrial immune profiling and ERA phases, and their results did not differ between embryo implantation and non-implantation in these patients. Our findings underline the increased implantation rates by use of ERA and endometrial immune profiling in patients with multiple implantation failure, either individually or corporately. Moreover, a combination of both could improve their pregnancy outcomes significantly.
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Affiliation(s)
- Yan Jia
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, PR China; Department of Reproductive Immunology, Sichuan Jinxin Xi'nan Women's and Children's Hospital, Chengdu, Sichuan, PR China
| | - Yan Huang
- Department of Reproductive Immunology, Sichuan Jinxin Xi'nan Women's and Children's Hospital, Chengdu, Sichuan, PR China
| | - Zhong-Hua Ai
- Institute of Health Studies, School of Public Health, Kunming Medical University, Kunming, Yunnan, PR China
| | - Ya-Jun Dong
- Department of Reproductive Immunology, Sichuan Jinxin Xi'nan Women's and Children's Hospital, Chengdu, Sichuan, PR China
| | - Yan-Hua Guo
- Department of Reproductive Immunology, Sichuan Jinxin Xi'nan Women's and Children's Hospital, Chengdu, Sichuan, PR China
| | - Yue Yang
- Department of Reproductive Immunology, Sichuan Jinxin Xi'nan Women's and Children's Hospital, Chengdu, Sichuan, PR China
| | - Dan Zhang
- Department of Reproductive Immunology, Sichuan Jinxin Xi'nan Women's and Children's Hospital, Chengdu, Sichuan, PR China
| | - Hong-Xia Ye
- Department of Reproductive Immunology, Sichuan Jinxin Xi'nan Women's and Children's Hospital, Chengdu, Sichuan, PR China; Jinxin Research Institute for Reproductive Medicine and Genetics, Chengdu, Sichuan, PR China.
| | - Jie Yang
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, PR China; Department of Reproductive Immunology, Sichuan Jinxin Xi'nan Women's and Children's Hospital, Chengdu, Sichuan, PR China.
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Liu X, Wang Y, Wen X, Hao C, Ma J, Yan L. Platelet rich plasma alleviates endometritis induced by lipopolysaccharide in mice via inhibiting TLR4/NF-κB signaling pathway. Am J Reprod Immunol 2024; 91:e13833. [PMID: 38467595 DOI: 10.1111/aji.13833] [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: 12/06/2023] [Revised: 01/30/2024] [Accepted: 02/21/2024] [Indexed: 03/13/2024] Open
Abstract
BACKGROUND Endometritis is an inflammatory reaction of the lining of uterus, leading to the occurrence of infertility. Platelet rich plasma (PRP) has been proven to exhibit extremely effective for the treatment of endometrium-associated infertility, but the mechanism of its prevention for endometritis remains unclear. OBJECTIVE The present study aimed to investigate the protective effect of PRP against endometritis induced by lipopolysaccharide (LPS) and elucidate the mechanism underlying these effects. METHODS Mouse model of endometritis was established by intrauterine perfusion of LPS. PRP intrauterine infusion was administered at 24 h after LPS induction. After another 24 h, the uterine tissues were harvested to observe histopathological changes, production of proinflammatory cytokines, variation of the Toll-like receptor 4/nuclear factor κB (TLR4/NF-κB) signaling pathways, and validated the anti-inflammatory effect of PRP. The myeloperoxidase (MPO) activity and concentration of nitric oxide (NO) were determined using assay kit. Proinflammatory chemokines (tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β), and interleukin-6 (IL-6)) were measured by ELISA and Real-Time PCR. The activity of TLR4/NF-κB pathway in uterine tissues was measured by Western blotting. RESULTS Hematoxylin-eosin staining (H&E) appeared that PRP remarkably relieved the impairment of uterine tissues. Detection of MPO activity and concentration of NO revealed that PRP treatment distinctly mitigated infiltration of inflammatory cells in mice with endometritis induced by LPS. PRP treatment significantly affected the expression of TNF-α, IL-1β, and IL-6. PRP was also found to suppress LPS-induced activation of TLR4/NF-κB pathway. CONCLUSION PRP effectively alleviates LPS-induced endometritis via restraining the signal pathway of TLR4/NF-κB. These findings provide a solid foundation for PRP as a potential therapeutic agent for endometritis.
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Affiliation(s)
- Xiaoqiang Liu
- Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
- Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, Shandong, China
- Reproductive Medicine Center, Qingdao Women and Children's Hospital, Qingdao, Shandong, China
| | - Yuqing Wang
- Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
- Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, Shandong, China
| | - Xiaoyang Wen
- Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
- Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, Shandong, China
| | - Cuifang Hao
- Reproductive Medicine Center, Qingdao Women and Children's Hospital, Qingdao, Shandong, China
| | - Jinlong Ma
- Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
- Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, Shandong, China
| | - Lei Yan
- Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
- Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, Shandong, China
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Zhang F, Wang Z, Lian R, Diao L, Li Y, Wu Y, Yin T, Huang C. Intrauterine perfusion of dexamethasone improves pregnancy outcomes in recurrent reproductive failure patients with elevated uterine natural killer cells. A retrospective cohort study. Am J Reprod Immunol 2023; 90:e13796. [PMID: 38009055 DOI: 10.1111/aji.13796] [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: 05/23/2023] [Revised: 07/25/2023] [Accepted: 10/30/2023] [Indexed: 11/28/2023] Open
Abstract
OBJECTIVE To determine the effect of intrauterine perfusion of dexamethasone (DXM) on pregnancy outcomes in recurrent reproductive failure (RRF) patients with elevated uNK cells. METHODS This retrospective cohort study included 132 RRF patients with elevated uNK cells: 56 patients received DXM treatment and 76 patients refused it in the frozen-thawed embryo transfer cycles. To determine the efficacy of intrauterine perfusion of DXM, multivariate logistic regression models and diagnosis-based subgroup analysis were performed. We also compared the pregnancy outcomes of patients with different responsiveness to DXM treatment. RESULTS Intrauterine perfusion of DXM significantly improved clinical pregnancy rate (aOR: 3.188, 95% CI: 1.395-7.282, P = .006) and live birth rate (aOR: 3.176, 95% CI: 1.318-7.656, P = .010) in RRF patients with elevated uNK cells, but there was no significant association with miscarriage rate. Subgroup analysis revealed that intrauterine perfusion of DXM in patients with recurrent implantation failure (RIF) showed significant improvement in clinical pregnancy rate (aOR: 6.110, 95% CI: 1.511-24.713, P = .011) and live birth rate (aOR: 9.904, 95% CI: 1.963-49.968, P = .005), but there was insufficient evidence of benefit in recurrent pregnancy loss (RPL) patients. Additionally, uNK cell levels dropped to normal range was achieved in only 35.90% of RRF patients after DXM treatment, no significant difference was found in pregnancy outcomes among patients with different responsiveness to DXM treatment (all P > .05). CONCLUSION Intrauterine perfusion of DXM was a promising and effective treatment to enhance clinical pregnancy rate and live birth rate in RRF women with abnormally elevated uNK cells, and RIF patients are more likely to benefit than RPL patients.
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Affiliation(s)
- Feng Zhang
- Reproductive Medical Center, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Zhuran Wang
- Second School of Clinical Medicine, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Ruochun Lian
- Shenzhen Key Laboratory for Reproductive Immunology of Peri-implantation, Shenzhen Zhongshan Institute for Reproduction and Genetics, Shenzhen Zhongshan Urology Hospital, Shenzhen, Guangdong, China
| | - Lianghui Diao
- Shenzhen Key Laboratory for Reproductive Immunology of Peri-implantation, Shenzhen Zhongshan Institute for Reproduction and Genetics, Shenzhen Zhongshan Urology Hospital, Shenzhen, Guangdong, China
| | - Yuye Li
- Shenzhen Key Laboratory for Reproductive Immunology of Peri-implantation, Shenzhen Zhongshan Institute for Reproduction and Genetics, Shenzhen Zhongshan Urology Hospital, Shenzhen, Guangdong, China
| | - Yaya Wu
- Shenzhen Key Laboratory for Reproductive Immunology of Peri-implantation, Shenzhen Zhongshan Institute for Reproduction and Genetics, Shenzhen Zhongshan Urology Hospital, Shenzhen, Guangdong, China
| | - Tailang Yin
- Reproductive Medical Center, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
- Wuhan University Shenzhen Research Institute, Wuhan University, Shenzhen, Guangdong, China
| | - Chunyu Huang
- Shenzhen Key Laboratory for Reproductive Immunology of Peri-implantation, Shenzhen Zhongshan Institute for Reproduction and Genetics, Shenzhen Zhongshan Urology Hospital, Shenzhen, Guangdong, China
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Cai S, Dai S, Lin R, Huang C, Zeng Y, Diao L, Lian R, Tu W. The effectiveness and safety of intrauterine infusion of autologous regulatory T cells (Tregs) in patients with recurrent pregnancy loss and low levels of endometrial FoxP3 + cells: A retrospective cohort study. Am J Reprod Immunol 2023; 90:e13735. [PMID: 37491931 DOI: 10.1111/aji.13735] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 05/25/2023] [Accepted: 06/02/2023] [Indexed: 07/27/2023] Open
Abstract
PROBLEM Regulatory T cells (Tregs) are a specialized type of T cells that help maintain immune tolerance and homeostasis. The potential of Tregs cell-based therapies in treating diseases has been demonstrated in several clinical trials, which have shown promising outcomes and high safety in autoimmune diseases, transplant rejection, and graft-versus-host disease. However, their effectiveness and safety in improving endometrial receptivity and reducing pregnancy loss in human reproduction are unknown. METHOD OF STUDY The study used a retrospective design and included patients with recurrent pregnancy loss (RPL) and lower levels of endometrial FoxP3+ Tregs. Patients in the Tregs group (n = 33) received intrauterine Tregs infusion three times during the follicular phase, while the control group (n = 28) did not receive any intrauterine infusion. RESULTS The intrauterine infusion of autologous Tregs increased the levels of FoxP3+ Tregs and CD56+ NK cells. Patients in the Treg group had higher live birth rates and lower miscarriage rates, especially early miscarriage rates. However, the two groups had no differences in the implantation rate, clinical pregnancy rate, and percentage of preterm delivery. CONCLUSIONS The findings suggest that intrauterine Tregs infusion may be a potential therapeutic approach for RPL. Further research in larger clinical trials is needed to confirm these findings.
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Affiliation(s)
- Songchen Cai
- Shenzhen Key Laboratory of Reproductive Immunology for Peri-implantation, Shenzhen Zhongshan Institute for Reproduction and Genetics, Fertility Center, Shenzhen Zhongshan Urology Hospital, Shenzhen, China
| | - Su Dai
- Shenzhen Key Laboratory of Reproductive Immunology for Peri-implantation, Shenzhen Zhongshan Institute for Reproduction and Genetics, Fertility Center, Shenzhen Zhongshan Urology Hospital, Shenzhen, China
| | - Rong Lin
- Shenzhen Key Laboratory of Reproductive Immunology for Peri-implantation, Shenzhen Zhongshan Institute for Reproduction and Genetics, Fertility Center, Shenzhen Zhongshan Urology Hospital, Shenzhen, China
| | - Chunyu Huang
- Shenzhen Key Laboratory of Reproductive Immunology for Peri-implantation, Shenzhen Zhongshan Institute for Reproduction and Genetics, Fertility Center, Shenzhen Zhongshan Urology Hospital, Shenzhen, China
| | - Yong Zeng
- Shenzhen Key Laboratory of Reproductive Immunology for Peri-implantation, Shenzhen Zhongshan Institute for Reproduction and Genetics, Fertility Center, Shenzhen Zhongshan Urology Hospital, Shenzhen, China
| | - Lianghui Diao
- Shenzhen Key Laboratory of Reproductive Immunology for Peri-implantation, Shenzhen Zhongshan Institute for Reproduction and Genetics, Fertility Center, Shenzhen Zhongshan Urology Hospital, Shenzhen, China
| | - Ruochun Lian
- Shenzhen Key Laboratory of Reproductive Immunology for Peri-implantation, Shenzhen Zhongshan Institute for Reproduction and Genetics, Fertility Center, Shenzhen Zhongshan Urology Hospital, Shenzhen, China
| | - Wenwei Tu
- Department of Paediatrics and Adolescent Medicine, School of Clinical Medicine, The University of Hong Kong, Hong Kong, China
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Lv Y, Chen Y, Hu L, Ding H, Liu M, Li H, Hou Y, Xing Q. Is glucocorticoid use associated with a higher clinical pregnancy rate of in vitro fertilization and embryo transfer? A meta-analysis. Heliyon 2023; 9:e15833. [PMID: 37215803 PMCID: PMC10196514 DOI: 10.1016/j.heliyon.2023.e15833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 04/12/2023] [Accepted: 04/25/2023] [Indexed: 05/24/2023] Open
Abstract
Background It has been reported that the use of glucocorticoids may be able to improve clinical pregnancy rates in patients receiving in vitro fertilization and embryo transfer (IVF-ET). The purpose of this study was to investigate the association between glucocorticoid use and clinical pregnancy rate in IVF-ET patients. Methods This study has been registered on the International Register of Prospective Systems Evaluation (PROSPERO) (ID: CRD42022375427). A thorough and detailed search of databases including PubMed, Web of Science, Embase, and Cochrane Library was conducted to identify eligible studies up to October 2022. Quality assessment was conducted on the modified Jadad Scoring Scale and Newcastle-Ottawa Scale, and the inter-study heterogeneity was estimated by Q test and I2 test. Combined hazard ratios with 95% CI were calculated using random effects or fixed effects models based on heterogeneity. Meanwhile, Begg's and Egger's tests were used to detect the existence of publication bias, the leave-one-out method was used for sensitivity analysis and multiple subgroup analyses were conducted. Results Seventeen studies involving 3056 IVF-ET cycles were included. We found that glucocorticoid use was associated with a higher IVF-ET pregnancy rate (OR = 1.86, 95% CI = 1.27-2.74, P = 0.002). In the subgroup analysis, studies of different regions and different study types all showed similar results that glucocorticoid is beneficial to improve the clinical pregnancy rate of patients with IVF-ET, and patients with positive autoantibodies and patients receiving IVF-ET multiple times also showed the same results. However, there was no significant change in clinical pregnancy rates in the seven studies with negative autoantibodies and in the seven studies with initial IVF-ET treatment. The results of the 12 medium-acting glucocorticoids and 4 long-acting glucocorticoids were also generally consistent with each other. There was no statistical difference in subgroup analysis of whether patients had endometriosis or not. Conclusion Appropriate use of glucocorticoids is beneficial for improving the clinical pregnancy rate in women receiving IVF-ET, but this result still needs to be verified by more high-quality and large sample size randomized controlled trials (RCTs).
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Affiliation(s)
- Yaxuan Lv
- Department of Clinical Medicine, School of the First Clinical Medicine, Anhui Medical University, Hefei, China
| | - Yue Chen
- Department of Clinical Medicine, School of the First Clinical Medicine, Anhui Medical University, Hefei, China
| | - Lei Hu
- Department of Clinical Medicine, School of the First Clinical Medicine, Anhui Medical University, Hefei, China
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Haitian Ding
- Department of Clinical Medicine, School of the First Clinical Medicine, Anhui Medical University, Hefei, China
| | - Mengqing Liu
- Department of Clinical Medicine, School of the Chaohu Clinical Medicine, Anhui Medical University, Hefei, China
| | - Hailong Li
- Sun Yat-sen University, No.74 Nonglin Road, Guangzhou, 510030, Guangdong, China
| | - Yuyang Hou
- Department of Clinical Medicine, School of the First Clinical Medicine, Anhui Medical University, Hefei, China
| | - Qiong Xing
- Reproductive Medicine Center, Department of Obstetrics and Gynecology, First Affiliated Hospital of Anhui Medical University, No 218 Jixi Road, Hefei, 230022, Anhui, China
- Anhui Province Key Laboratory of Reproductive Health and Genetics, Anhui Medical University, No 81 Meishan Road, Hefei, 230032, Anhui, China
- NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract (Anhui Medical University), No 81 Meishan Road, Hefei, 230032, Anhui, China
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Discovery of immune-related diagnostic biomarkers and construction of diagnostic model in varies polycystic ovary syndrome. Arch Gynecol Obstet 2022; 306:1607-1615. [PMID: 35904610 DOI: 10.1007/s00404-022-06686-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 06/21/2022] [Indexed: 11/02/2022]
Abstract
AIMS The various diagnostic criteria for polycystic ovary syndrome (PCOS) raised problem for PCOS research worldwide. PCOS has been demonstrated to be significantly associated with immune response. We aimed to identify several immune-related biomarkers and construct a nomogram model for diagnosis in PCOS. METHODS The mRNA expression data were downloaded from Gene Expression Omnibus (GEO) database. Significant immune-related genes were identified to be the biomarkers for the diagnosis of PCOS using random forest model (RF), support vector machine model (SVM) and generalized linear model (GLM). The key biomarkers were selected from the optimal model and were utilized to construct a diagnostic nomogram. Receiver operating characteristic (ROC) curves was used to evaluate diagnostic ability of nomogram. Moreover, the relative proportion of 22 immune cell types was calculated by CIBERSORT algorithm. RESULTS Four immune-related biomarkers (cAMP, S100A9, TLR8 and IL6R) were demonstrated to be highly expressed in PCOS. The nomogram constructed on the ground of the four key biomarkers showed perfect performance in diagnosis of PCOS, whose AUC were greater than 0.7. Higher infiltrating abundance of neutrophils, resting NK cells and activated dendritic cells were observed in PCOS and were tightly associated with the four key biomarkers. CONCLUSIONS This study identified several immune-related diagnostic biomarkers for PCOS patients. The diagnostic nomogram constructed based the biomarkers provide a theory foundation for clinical application. Multiple immune cells were associated with the expression of these four biomarkers and might played a vital role in the procession of PCOS.
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Jia Y, Dong YJ, Sha YL, Cai SC, Diao LH, Qiu Z, Guo YH, Huang Y, Ye HX, Liu S. Effectiveness comparison between Endometrial Receptivity Array, Immune Profiling and the combination in treating patients with multiple implantation failure. Am J Reprod Immunol 2021; 87:e13513. [PMID: 34766396 DOI: 10.1111/aji.13513] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 10/28/2021] [Accepted: 11/05/2021] [Indexed: 11/29/2022] Open
Abstract
PROBLEM The clinical value of endometrial receptivity array (ERA), endometrial immune profiling, or a combination of both for multiple implantation failure patients is unclear. METHOD OF STUDY One hundred and seventy-two women with a history of at least two or more consecutive implantation failures in IVF/ICSI treatment were included. According to patients' willingness, they were divided into four groups, 'no treatment', 'Immune Profiling', 'ERA' and 'ERA + Immune Profiling'. Endometrial biopsy was examined by ERA, immune profiling alone, or combination, and intention was adopted accordingly. Pregnancy outcomes were compared, and the association between ERA phases and endometrial immune profiling was also assessed. RESULTS The overall incidence rate of the displaced window of implantation (WOI) and endometrial immune dysregulations were 84.9% and 75.3%, respectively. Implantation rate was significantly higher in the 'ERA + Immune Profiling' group than the 'no treatment' group (P = 0.007). Clinical pregnancy rate was somewhat improved in the three treatment groups but with a borderline significance (P = 0.071). After controlling for other confounders, 'ERA + Immune Profiling' treatment was associated with a higher pregnancy rate [aOR (95%CI) = 3.412 (1.387-8.395), P = 0.008]. There was no association between endometrial immune profiling and ERA phases. CONCLUSIONS Our findings highlight the high incidence of displaced WOI and endometrial immune dysregulation in multiple implantation failure patients. The combination of ERA and endometrial immune profiling is more likely to have clinical value than ERA or immune profiling alone. These data suggested the unsubstitutability of ERA and endometrial immune profiling on the treatment outcome for multiple implantation failure patients. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Yan Jia
- Department of Reproductive Immunology, Chengdu Xi'nan Gynecology Hospital, No. 66 Bisheng Road, Chengdu, Sichuan, PR China
| | - Ya-Jun Dong
- Department of Reproductive Immunology, Chengdu Xi'nan Gynecology Hospital, No. 66 Bisheng Road, Chengdu, Sichuan, PR China
| | - Yu-Lin Sha
- Department of Reproductive Immunology, Chengdu Xi'nan Gynecology Hospital, No. 66 Bisheng Road, Chengdu, Sichuan, PR China.,Chengdu Jinxin Research Institute of Reproductive Medicine and Genetics, No. 66 Bisheng Road, Chengdu, Sichuan, PR China
| | - Song-Chen Cai
- Shenzhen Key Laboratory of Reproductive Immunology for Peri-implantation, Shenzhen Zhongshan Institute for Reproduction and Genetics, Shenzhen Zhongshan Urology Hospital, Shenzhen, Guangdong, PR China
| | - Liang-Hui Diao
- Shenzhen Key Laboratory of Reproductive Immunology for Peri-implantation, Shenzhen Zhongshan Institute for Reproduction and Genetics, Shenzhen Zhongshan Urology Hospital, Shenzhen, Guangdong, PR China
| | - Zhu Qiu
- Department of Reproductive Immunology, Chengdu Xi'nan Gynecology Hospital, No. 66 Bisheng Road, Chengdu, Sichuan, PR China
| | - Yan-Hua Guo
- Department of Reproductive Immunology, Chengdu Xi'nan Gynecology Hospital, No. 66 Bisheng Road, Chengdu, Sichuan, PR China
| | - Yan Huang
- Department of Reproductive Immunology, Chengdu Xi'nan Gynecology Hospital, No. 66 Bisheng Road, Chengdu, Sichuan, PR China
| | - Hong-Xia Ye
- Department of Reproductive Immunology, Chengdu Xi'nan Gynecology Hospital, No. 66 Bisheng Road, Chengdu, Sichuan, PR China
| | - Su Liu
- Shenzhen Key Laboratory of Reproductive Immunology for Peri-implantation, Shenzhen Zhongshan Institute for Reproduction and Genetics, Shenzhen Zhongshan Urology Hospital, Shenzhen, Guangdong, PR China
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Qi L, Bi S, Fu J, Fu Y, Li L, Zhao L. Efficacy of Intrauterine Perfusion of Cyclosporin A for Intractable Recurrent Spontaneous Abortion Patients With Endometrial Alloimmune Disorders: A Randomized Controlled Trial. Front Physiol 2021; 12:737878. [PMID: 34552510 PMCID: PMC8450415 DOI: 10.3389/fphys.2021.737878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 08/13/2021] [Indexed: 11/13/2022] Open
Abstract
Objective To explore the therapeutic efficacy of intrauterine perfusion of cyclosporin A (CsA) in intractable recurrent spontaneous abortion (RSA) patients with endometrial alloimmune dysfunction. Methods This is a randomized controlled trial (RCT) of patients with intractable RSA with endometrial alloimmune disorders. A total of 201 women were enrolled, all of whom had at least 3 serial abortions and endometrial alloimmune dysfunction. Participants were randomly assigned to two groups. The CsA group (n = 101) received intrauterine infusion of 250 mg CsA on the 3rd and 7th days after menstruation for 2 menstrual cycles, while the placebo group (n = 100) received placebo. The birth of healthy, deformity-free babies was the main study outcome. Results In total, 75 (74.26%) women in the CsA group and 59 (59.00%) women in the placebo group gave birth to healthy babies [P = 0.01, OR = 2.01; 95% CI (1.10∼3.65)]. Compared to the placebo group, the CsA group had dramatically lower endometrial CD56+ cell and CD57+ cell concentrations at the luteal phase of the second menstrual cycle (P < 0.05). Conclusion Intrauterine perfusion of CsA was confirmed to be a promising approach for the treatment of intractable alloimmune RSA.
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Affiliation(s)
- Lijuan Qi
- Department of Obstetrics, Qingdao Jinhua Hospital, Qingdao, China
| | - Shuqin Bi
- Department of Obstetrics, Qingdao Jinhua Hospital, Qingdao, China
| | - Jinhua Fu
- Department of Obstetrics, Qingdao Jinhua Hospital, Qingdao, China
| | - Yinghui Fu
- Department of Obstetrics, Qingdao Jinhua Hospital, Qingdao, China
| | - Lin Li
- Department of Nephrology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Long Zhao
- Department of Nephrology, The Affiliated Hospital of Qingdao University, Qingdao, China
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Odendaal J, Quenby S. Immunological Testing in Assisted Reproductive Technology. Semin Reprod Med 2021; 39:13-23. [PMID: 34161996 DOI: 10.1055/s-0041-1730908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Fetal implantation requires carefully orchestrated involvement of the maternal immune system. Aberrant function within implantation has been suggested as a cause of implantation failure. The emergence of immunological theories of miscarriage has led to immunological testing as an adjuvant treatment in assisted reproductive technology; however, it remains controversial, with mixed evidence both for immunological cause and the benefits of immunological testing. Literature on common methods of immunological testing within assisted reproductive technology is reviewed including those of peripheral and uterine natural killer cells, chronic endometritis, and T-helper cells cytokine ratio. There is little consensus in the evidence on immunological testing in the context of recurrent implantation failure. The field is limited by a lack of uniformity in approach to testing and heterogeneity of the pathophysiological cause. Nevertheless, the maternal immune system is heavily involved in implantation and the new era of personalized medicine ensures that a more defined approach to immunological testing will be achieved.
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Affiliation(s)
- Joshua Odendaal
- Division of Biomedical Sciences, Clinical Sciences Research Laboratories, Warwick Medical School, University of Warwick, Coventry, United Kingdom.,Tommy's National Centre for Miscarriage Research, University Hospitals Coventry and Warwickshire, Coventry, United Kingdom
| | - Siobhan Quenby
- Division of Biomedical Sciences, Clinical Sciences Research Laboratories, Warwick Medical School, University of Warwick, Coventry, United Kingdom.,Tommy's National Centre for Miscarriage Research, University Hospitals Coventry and Warwickshire, Coventry, United Kingdom
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Role of anti-allergic agents on attenuating transfusion reactions in adults: A systematic review and meta-analysis. Transfus Apher Sci 2021; 60:103041. [PMID: 33455877 DOI: 10.1016/j.transci.2020.103041] [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: 02/27/2020] [Revised: 12/07/2020] [Accepted: 12/10/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND Anti-allergic agents (e.g. dexamethasone, chlorpheniramine or promethazine) are commonly administered to patients prior to blood product transfusions. However, the use of these agents is largely experience-based instead of evidence-based. This meta-analysis aimed to explore the evidence behind using anti-allergic agents to attenuate transfusion reactions. MATERIALS AND METHODS The Pubmed, EMBASE, Cochrane Library, Wanfang, Chinese National Knowledge Infrastructure (CNKI), and Chinese Biomedical literature (CMB) databases were all queried for related articles. Data from groups treated with and without anti-allergic agents were collected for meta-analysis using RevMan 5.3. Baseline characteristics and univariate statistics between groups were compared using SPSS 19.0. RESULTS Eight eligible articles (six case control studies and two randomized controlled trials, all with high risks of bias) were identified (22060 total cases). Administered anti-allergic agents in these studies only included dexamethasone, chlorpheniramine or promethazine. Baseline characteristics showed no significant age or gender differences between treatment or control groups. There were no significant differences between the pooled experimental or control groups (for each of the three medications) in terms of fever, pruritis, rash, airway spasm or overall transfusion reaction rates. CONCLUSION There is no evidence that dexamethasone, chlorpheniramine or promethazine can prevent transfusion reactions. Avoiding the arbitrary use of such anti-allergic agents before blood transfusions may potentially avoid needless adverse drug reactions.
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He S, Mao X, Lei H, Dong B, Guo D, Zheng B, Sun P. Peripheral Blood Inflammatory-Immune Cells as a Predictor of Infertility in Women with Polycystic Ovary Syndrome. J Inflamm Res 2020; 13:441-450. [PMID: 32884325 PMCID: PMC7443446 DOI: 10.2147/jir.s260770] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 07/29/2020] [Indexed: 12/19/2022] Open
Abstract
Purpose This study aimed to investigate the inflammatory-immune cells in the peripheral blood of women with polycystic ovary syndrome (PCOS) and assessed the potential correlation between inflammatory-immune cells and infertility in PCOS women. Materials and Methods In this case-control study, the profiles of lymphocyte subsets were analyzed by flow cytometry. White blood cells (WBC), neutrophils (Neu), lymphocytes, Ferriman-Gallwey (F-G) score, testosterone, prolactin, follicle-stimulating hormone, luteinizing hormone, fasting blood glucose, and fasting plasma insulin were measured, together with body mass index. Association between inflammatory-immune cells and PCOS was evaluated. Moreover, inflammatory-immune cells of the PCOS women with infertility were evaluated, and the relative operating characteristic (ROC) curve and cutoff values were calculated. Results The number of WBC, Neu, and lymphocytes was higher in PCOS women than controls (P<0.05). The percentages of total T lymphocytes, CD4+T, and NK were significantly increased in the PCOS group (P<0.001). The CD4/CD8 ratio was obviously elevated for increasing CD4+T (P<0.05). Consequently, T%, CD4+T%, and NK% were found to be the independent risk factors of PCOS by ROC curve and multivariate logistic regression analysis. Furthermore, only NK% was significantly higher in PCOS women with infertility than those who had PCOS without infertility (P<0.001). To diagnose infertility in PCOS, the cutoff value of NK% was calculated as 16.43%. Conclusion These findings suggest that the pathogenesis of PCOS is related to immune cells including T, CD4+T, and NK cells. NK cells are likely to be a potential predictive factor for PCOS women with infertility.
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Affiliation(s)
- ShuQiong He
- Department of Prenatal Diagnosis, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, 350001, People's Republic of China
| | - XiaoDan Mao
- Laboratory of Gynecologic Oncology, Department of Gynecology, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, 350001, People's Republic of China.,Fujian Key Laboratory of Women and Children's Critical Diseases Research, Fujian Maternity and Child Health Hospital, Fuzhou, 350001, People's Republic of China
| | - HuiFang Lei
- Laboratory of Gynecologic Oncology, Department of Gynecology, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, 350001, People's Republic of China.,Fujian Key Laboratory of Women and Children's Critical Diseases Research, Fujian Maternity and Child Health Hospital, Fuzhou, 350001, People's Republic of China
| | - BinHua Dong
- Laboratory of Gynecologic Oncology, Department of Gynecology, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, 350001, People's Republic of China.,Fujian Key Laboratory of Women and Children's Critical Diseases Research, Fujian Maternity and Child Health Hospital, Fuzhou, 350001, People's Republic of China
| | - DanHua Guo
- Department of Prenatal Diagnosis, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, 350001, People's Republic of China
| | - BeiHong Zheng
- Department of Reproduction, Fujian, Affiliated Hospital of Fujian Medical University, Fuzhou, 350001, People's Republic of China
| | - PengMing Sun
- Laboratory of Gynecologic Oncology, Department of Gynecology, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, 350001, People's Republic of China.,Fujian Key Laboratory of Women and Children's Critical Diseases Research, Fujian Maternity and Child Health Hospital, Fuzhou, 350001, People's Republic of China
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12
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Jiang Y, Zhao Q, Zhang Y, Zhou L, Lin J, Chen Y, Qian X. Treatment of G-CSF in unexplained, repeated implantation failure: A systematic review and meta-analysis. J Gynecol Obstet Hum Reprod 2020; 49:101866. [PMID: 32663652 DOI: 10.1016/j.jogoh.2020.101866] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 07/08/2020] [Accepted: 07/08/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUD Repeated implantation failure (RIF) is a stressful situation for subfertile women undergoing in vitro fertilisation (IVF) treatment and caregivers. Granulocyte-colony stimulating factor (G-CSF) seems to play an important role in assisted reproductive techniques. However, it is currently unknown whether G-CSF is effective in improving results for patients with RIF. OBJECTIVE To describe and summarize current evidence of the effect of the granulocyte colony stimulating factor (G-CSF) in treating RIF. METHOD Relevant scientific literature was thoroughly searched by computer in domestic and foreign database from the inceptions to November 2019. And relevant randomized controlled trials (RCTs) assessing the efficacy of G-CSF in unexplained RIF were included. The meta-analysis was conducted by Stata 12. 0 software, and we estimated relative risks (RRs) and associated 95 % confidence intervals (CIs) of G-CSF on implantation rate (IR), the clinical pregnancy rate (CPR), the abortion rate (AR) in patients with unexplained RIF using fixed-effect model. Besides, Subgroup analysis was performed according to the different administration methods. RESULT A total of eleven articles were included for the final meta-analysis with sample sizes ranging from 13 to 107 patients. The G-CSF was associated with an increased IR [RR = 2.346, 95 %CI (1.615-3.409), I2 = 0. 0%] and CPR [RR = 1.910, 95 %CI (1.562-2.337), I2 = 0.0 %] in patients with unexplained RIF. When further stratified by the method of administration, the subgroup analysis revealed that both intrauterine injection and subcutaneous injection are capable of improving IR[subcutaneous injection:RR = 2.400, 95 %CI (1. 268-4. 542), I2 = 0.0 %; intrauterine injection:RR = 2.317, 95 %CI (1.462-3.673), I2 = 0.0 %] and CPR[subcutaneous injection: RR = 2. 022, 95 %CI (1.443-2.832), I2 = 0. 0%; intrauterine injeciton: RR = 1.848, 95 %CI (1.438-2.376), I2 = 0. 0%]. G-CSF was not associated with AR in patients with unexplained RIF [RR = 2.092, 95 %CI (0.815-5.369), I2 = 0.0 %]. CONCLUSION The current evidence support G-CSF's positive effect on the implantation rate and clinical pregnancy rate of patients with unexplained RIF, especially when administrated by subcutaneous injection. There is no conclusive evidence for the association between G-CSF and the abortion rate. Moreover, few of the included articles reported side effects of G-CSF, so its safety remains to be investigated.Thus, future research should evaluate.
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Affiliation(s)
- Ying Jiang
- Department of Gynecology, Ningbo Municipal Hospital of Traditional Chinese Medicine, Ningbo, 315010, China
| | - Qi Zhao
- Department of Gynecology, Ningbo Municipal Hospital of Traditional Chinese Medicine, Ningbo, 315010, China
| | - Yuling Zhang
- Department of Gynecology, Ningbo Municipal Hospital of Traditional Chinese Medicine, Ningbo, 315010, China
| | - Lu Zhou
- Department of Gynecology, Ningbo Municipal Hospital of Traditional Chinese Medicine, Ningbo, 315010, China
| | - Jing Lin
- Department of Gynecology, Ningbo Municipal Hospital of Traditional Chinese Medicine, Ningbo, 315010, China
| | - Yan Chen
- Department of Gynecology, Ningbo Municipal Hospital of Traditional Chinese Medicine, Ningbo, 315010, China
| | - Xvwu Qian
- College of Traditional Chinese Medicine, Zhejiang Pharmaceutical College, Ningbo, 315503, China.
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13
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Reed BG, Babayev SN, Chen LX, Carr BR, Word RA, Jimenez PT. Estrogen-regulated miRNA-27b is altered by bisphenol A in human endometrial stromal cells. Reproduction 2020; 156:559-567. [PMID: 30328349 PMCID: PMC6215928 DOI: 10.1530/rep-18-0041] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2018] [Accepted: 09/28/2018] [Indexed: 12/25/2022]
Abstract
MicroRNAs (miRs) are small molecules important for regulation of transcription and translation. The objective was to identify hormonally regulated miRs in human endometrial stromal cells and to determine the impact of the endocrine disruptor, bisphenol A (BPA), on those miRs. miR microarray analysis and multiple confirmatory cell preparations treated with 17β-estradiol (E2) and BPA altered miR-27b, let-7c, let-7e and miR-181b. Further, decidualization downregulated miR-27b. VEGFB and VEGFC were validated as targets of miR-27b. Identification of miR-27b target genes suggests that BPA and E2 downregulate miR-27b thereby leading to upregulation of genes important for vascularization and angiogenesis of the endometrium during the menstrual cycle and decidualization.
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Affiliation(s)
- Beverly G Reed
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Green Center for Reproductive Biological Sciences, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Samir N Babayev
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Green Center for Reproductive Biological Sciences, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Lucy X Chen
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Green Center for Reproductive Biological Sciences, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Bruce R Carr
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Green Center for Reproductive Biological Sciences, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - R Ann Word
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Green Center for Reproductive Biological Sciences, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Patricia T Jimenez
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Green Center for Reproductive Biological Sciences, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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14
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Solano ME, Arck PC. Steroids, Pregnancy and Fetal Development. Front Immunol 2020; 10:3017. [PMID: 32038609 PMCID: PMC6987319 DOI: 10.3389/fimmu.2019.03017] [Citation(s) in RCA: 77] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 12/09/2019] [Indexed: 12/21/2022] Open
Abstract
Maternal glucocorticoids critically rise during pregnancy reaching up to a 20-fold increase of mid-pregnancy concentrations. Concurrently, another steroid hormone, progesterone, increases. Progesterone, which shows structural similarities to glucocorticoids, can bind the intracellular glucocorticoid receptor, although with lower affinity. Progesterone is essential for the establishment and continuation of pregnancy and it is generally acknowledged to promote maternal immune tolerance to fetal alloantigens through a wealth of immunomodulatory mechanisms. Despite the potent immunomodulatory capacity of glucocorticoids, little is known about their role during pregnancy. Here we aim to compare general aspects of glucocorticoids and progesterone during pregnancy, including shared common steroidogenic pathways, plasma transporters, regulatory pathways, expression of receptors, and mechanisms of action in immune cells. It was recently acknowledged that progesterone receptors are not ubiquitously expressed on immune cells and that pivotal features of progesterone induced- maternal immune adaptations to pregnancy are mediated via the glucocorticoid receptor, including e.g., T regulatory cells expansion. We hypothesize that a tight equilibrium between progesterone and glucocorticoids is critically required and recapitulate evidence supporting that their disequilibrium underlie pregnancy complications. Such a disequilibrium can occur, e.g., after maternal stress perception, which triggers the release of glucocorticoids and impair progesterone secretion, resulting in intrauterine inflammation. These endocrine misbalance might be interconnected, as increase in glucocorticoid synthesis, e.g., upon stress, may occur in detriment of progesterone steroidogenesis, by depleting the common precursor pregnenolone. Abundant literature supports that progesterone deficiency underlies pregnancy complications in which immune tolerance is challenged. In these settings, it is largely yet undefined if and how glucocorticoids are affected. However, although progesterone immunomodulation during pregnancy appear to be chiefly mediated glucocorticoid receptors, excess glucocorticoids cannot compensate by progesterone deficiency, indicating that additional und still undercover mechanisms are at play.
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Affiliation(s)
- Maria Emilia Solano
- Department for Obstetrics and Fetal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Petra Clara Arck
- Department for Obstetrics and Fetal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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15
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Zhang Y, Xu H, Liu Y, Zheng S, Zhao W, Wu D, Lei L, Chen G. Confirmation of chronic endometritis in repeated implantation failure and success outcome in IVF‐ET after intrauterine delivery of the combined administration of antibiotic and dexamethasone. Am J Reprod Immunol 2019. [DOI: 10.111/aji.1317710.1111/aji.13177] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023] Open
Affiliation(s)
- Yu Zhang
- Division of Life Sciences and Medicine Department of Reproductive Medicine Center The First Affiliated Hospital of USTC University of Science and Technology of China Hefei China
- Department of Obstetrics and Gynecology Anhui Women and Child Health Care Hospital Anhui Medical University Hefei China
| | - Hanjie Xu
- Division of Life Sciences and Medicine Department of Obstetrics and Gynecology The First Affiliated Hospital of USTC University of Science and Technology of China Hefei China
| | - Yusheng Liu
- Division of Life Sciences and Medicine Department of Reproductive Medicine Center The First Affiliated Hospital of USTC University of Science and Technology of China Hefei China
| | - Shengxia Zheng
- Division of Life Sciences and Medicine Department of Reproductive Medicine Center The First Affiliated Hospital of USTC University of Science and Technology of China Hefei China
| | - Weidong Zhao
- Division of Life Sciences and Medicine Department of Obstetrics and Gynecology The First Affiliated Hospital of USTC University of Science and Technology of China Hefei China
| | - Dabao Wu
- Division of Life Sciences and Medicine Department of Obstetrics and Gynecology The First Affiliated Hospital of USTC University of Science and Technology of China Hefei China
| | - Lei Lei
- Division of Life Sciences and Medicine Department of Obstetrics and Gynecology The First Affiliated Hospital of USTC University of Science and Technology of China Hefei China
| | - Gang Chen
- Division of Life Sciences and Medicine Department of Obstetrics and Gynecology The First Affiliated Hospital of USTC University of Science and Technology of China Hefei China
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16
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Placental bed research: II. Functional and immunological investigations of the placental bed. Am J Obstet Gynecol 2019; 221:457-469. [PMID: 31288009 DOI: 10.1016/j.ajog.2019.07.010] [Citation(s) in RCA: 72] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 06/01/2019] [Accepted: 07/02/2019] [Indexed: 01/14/2023]
Abstract
Research on the placenta as the interface between the mother and the fetus has been undertaken for some 150 years, and in 2 subsequent reviews, we attempted to summarize the situation. In the first part, we described the discovery of unique physiological modifications of the uteroplacental spiral arteries, enabling them to cope with a major increase in blood flow necessary to ensure proper growth of the fetus. These consist of an invasion of the arterial walls by trophoblast and a progressive disappearance of its normal structure. Researchers then turned to the pathophysiology of the placental bed and in particular to its maternal vascular tree. This yielded vital information for a better understanding of the so-called great obstetrical syndromes (preeclampsia, fetal growth restriction, premature labor and delivery, placenta accreta). Systematic morphological investigations of the uteroplacental vasculature showed that preeclampsia is associated with decreased or failed transformation of spiral arteries and the persistence of endothelial and smooth muscle cells in segments of their myometrial portion. Here we report on recent functional investigations of the placental bed, including in situ biophysical studies of uteroplacental blood flow and vascular resistance, and manipulation of uteroplacental perfusion. These new methodologies have provided a novel way of identifying pregnancies in which remodeling is impaired. In animals it is now possible to manipulate uteroplacental blood flow, leading to an enhancement of fetal growth; this opens the way to trials in abnormal human pregnancies. In this second part, we explored a new, extremely important area of research that deals with the role of specific subsets of leukocytes and macrophages in the placental bed. The human first-trimester decidua is rich in leukocytes called uterine natural killer cells. Both macrophages and uterine natural killer cells increase in number from the secretory endometrium to early pregnancy and play a critical role in mediating the process of spiral artery transformation by inducing initial structural changes. It seems therefore that vascular remodeling of spiral arteries is initiated independently of trophoblast invasion. Dysregulation of the immune system may lead to reproductive failure or pregnancy complications, and in this respect, recent studies have advanced our understanding of the mechanisms regulating immunological tolerance during pregnancy, with several mechanisms being proposed for the development of tolerance to the semiallogeneic fetus. In particular, these include several strategies by which the trophoblast avoids maternal recognition. Finally, an important new dimension is being explored: the likelihood that pregnancy syndromes and impaired uteroplacental vascular remodeling may be linked to future maternal and even the child's cardiovascular disease risk. The functional evidence underlying these observations will be discussed.
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17
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Zhang Y, Xu H, Liu Y, Zheng S, Zhao W, Wu D, Lei L, Chen G. Confirmation of chronic endometritis in repeated implantation failure and success outcome in IVF-ET after intrauterine delivery of the combined administration of antibiotic and dexamethasone. Am J Reprod Immunol 2019; 82:e13177. [PMID: 31373128 DOI: 10.1111/aji.13177] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 06/28/2019] [Accepted: 07/22/2019] [Indexed: 12/20/2022] Open
Abstract
PROBLEM The aim of this prospective study was to investigate the prevalence of chronic endometritis (CE) in repeated implantation failure (RIF) patients and to determine whether intrauterine delivery of the combined administration of antibiotic and dexamethasone improves the clinical pregnancy outcome. METHOD OF STUDY The combination of hysteroscopy and histology was used to diagnose CE in the patients with RIF, and the diagnosed patients were treated with the intrauterine delivery of the combined antibiotic and dexamethasone therapy. The prevalence of CE in the RIF patients was recorded, and the therapeutic effect was also evaluated in the first IVF-ET cycle. RESULTS In a total number of 298 patients with RIF, 109 cases (36.58%) were diagnosed as CE. Intrauterine infusion treatment resulted in CE resolution in 77.98% of patients. After the treatment, 85 cases with no signs of CE (Group 2) had a significantly higher implantation rate (31.33%) and clinical pregnancy rate (51.76%) as compared with both 126 cases without CE diagnosis (Group 1; 16.30% and 30.15%, respectively) and 24 cases with persistence of CE (Group 3; 14.89% and 25.00%, respectively). The live birth rate in the first IVF-ET cycle following treatment in Group 2 was significantly higher than that of both Group 1 and Group 3 (all P < .05). CONCLUSION Chronic endometritis is highly prevalent in patients with RIF. To the best of our knowledge, we for the first time reported that intrauterine delivery of the combined administration of antibiotic and dexamethasone as a treatment option of CE could achieve expected therapeutic effects and successful pregnancy outcomes.
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Affiliation(s)
- Yu Zhang
- Division of Life Sciences and Medicine, Department of Reproductive Medicine Center, The First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, China.,Department of Obstetrics and Gynecology, Anhui Women and Child Health Care Hospital, Anhui Medical University, Hefei, China
| | - Hanjie Xu
- Division of Life Sciences and Medicine, Department of Obstetrics and Gynecology, The First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, China
| | - Yusheng Liu
- Division of Life Sciences and Medicine, Department of Reproductive Medicine Center, The First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, China
| | - Shengxia Zheng
- Division of Life Sciences and Medicine, Department of Reproductive Medicine Center, The First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, China
| | - Weidong Zhao
- Division of Life Sciences and Medicine, Department of Obstetrics and Gynecology, The First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, China
| | - Dabao Wu
- Division of Life Sciences and Medicine, Department of Obstetrics and Gynecology, The First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, China
| | - Lei Lei
- Division of Life Sciences and Medicine, Department of Obstetrics and Gynecology, The First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, China
| | - Gang Chen
- Division of Life Sciences and Medicine, Department of Obstetrics and Gynecology, The First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, China
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Nazari L, Salehpour S, Hosseini MS, Hashemi Moghanjoughi P. The effects of autologous platelet-rich plasma in repeated implantation failure: a randomized controlled trial. HUM FERTIL 2019; 23:209-213. [DOI: 10.1080/14647273.2019.1569268] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Leila Nazari
- Department of Obstetrics and Gynecology, Preventative Gynecology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Saghar Salehpour
- Department of Obstetrics and Gynecology, Preventative Gynecology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maryam Sadat Hosseini
- Department of Obstetrics and Gynecology, Preventative Gynecology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Parisa Hashemi Moghanjoughi
- Department of Obstetrics and Gynecology, Preventative Gynecology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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19
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Zhang T, Chen X, Wang CC, Li TC, Kwak-Kim J. Intrauterine infusion of human chorionic gonadotropin before embryo transfer in IVF/ET cycle: The critical review. Am J Reprod Immunol 2019; 81:e13077. [PMID: 30589989 DOI: 10.1111/aji.13077] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 12/07/2018] [Accepted: 12/10/2018] [Indexed: 12/16/2022] Open
Abstract
Intrauterine infusion of human chorionic gonadotropin (IUI-hCG) has been proposed to improve the outcome of in vitro fertilization-embryo transfer (IVF-ET), since it plays a critical role in synchronizing endometrial and fetal development. As the early mediator from embryo, hCG promotes the decidualization, angiogenesis, maternal immune tolerance, and trophoblast invasion, favoring successful implantation of embryo. Although multiple clinical trials have been conducted to verify the efficacy of IUI-hCG on IVF-ET outcome in recent years, the findings remained controversial. The difference in study design and population might be the cause to the different consequences after administration of hCG. More importantly, the endometrial receptivity, which might affect the efficacy of IUI-hCG, has not been assessed in women receiving this intervention. Selecting the right population suitable for IUI-hCG based on known etiology would be crucial in enhancing its efficacy and minimize any possible complications. Investigation of optimal indications for IUI-hCG should be highlighted in the future.
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Affiliation(s)
- Tao Zhang
- Department of Obstetrics and Gynaecology, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR.,Shenzhen Youshare Biotechnology Co. Ltd, Shenzhen, China
| | - Xiaoyan Chen
- Department of Obstetrics and Gynaecology, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR
| | - Chi-Chiu Wang
- Department of Obstetrics and Gynaecology, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR.,Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong City, Hong Kong.,School of Biomedical Sciences, The Chinese University of Hong Kong, Hong Kong City, Hong Kong
| | - Tin Chiu Li
- Department of Obstetrics and Gynaecology, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR
| | - Joanne Kwak-Kim
- Department of Microbiology and Immunology, Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois.,Reproductive Medicine, Department of Obstetrics and Gynecology, Chicago Medical School, Rosalind Franklin University of Medicine and Science, Vernon Hills, Illinois
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20
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Vomstein K, Toth B, Kuon RJ. Implantationsversagen: Embryo, Endometrium oder beides? GYNAKOLOGISCHE ENDOKRINOLOGIE 2018. [DOI: 10.1007/s10304-018-0200-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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21
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Immunomodulatory effects of hydroxychloroquine on Th1/Th2 balance in women with repeated implantation failure. Biomed Pharmacother 2018; 107:1277-1285. [PMID: 30257342 DOI: 10.1016/j.biopha.2018.08.027] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Revised: 07/19/2018] [Accepted: 08/06/2018] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Cellular immune abnormalities such as the imbalance between T-helper (Th) 1 and Th2 cytokines have been implicated as potentially modifiable causes of idiopathic repeated implantation failures (RIF). The purpose of this study was to investigate the effects of hydroxychloroquine on IL-10 and TNF-α secretion, expression of T-bet and GATA-3 transcription factors and cellular localization of TNF-α, IFN-γ, IL-10 and IL-4 in endometrial cells in women with RIF. MATERIALS AND METHODS A total of 17 women with a history of RIF and elevated TNFα/IL-10 ratio (TNFα/IL-10> = 30.6) were included in the study. The serum levels of TNFα and IL-10, the expression of transcription factors related to Th1 and Th2 cells and the immune-reactivity of TNFα, IFN-γ as Th1 related cytokines and IL-10, IL-4 as Th2 related cytokines in endometrial tissues were evaluated by ELISA, real-time PCR, and fluorescent immunohistochemistry respectively. All, evaluations were done both before and after treatment with hydroxychloroquine (400 mg/orally per day). RESULTS Hydroxychloroquine treatment significantly decreased (p < 0.0001) serum level of TNF-α and significantly increased serum level of IL-10 (p < 0.0001). T-bet, the Th1 transcription factor, expression was down-regulated and GATA-3, the Th2 transcription factor, expression was up-regulated. IL-10 and IL-4 fluorescent immunoreactivities significantly increased (p < 0.05 and p < 0.001 respectively) and TNFα and IFN-γ fluorescent immunoreactivities significantly decreased (p < 0.05) in endometrial tissue in women with RIF after treatment in comparison with before treatment. CONCLUSION Hydroxychloroquine administration in women with RIF With a high TNF-α/IL-10 ratio during the implantation window can decrease this ratio and seems to be an effective therapeutic strategy in RIF caused by cellular immune abnormalities through a shift in Th2 responses.
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Vitagliano A, Saccardi C, Noventa M, Di Spiezio Sardo A, Saccone G, Cicinelli E, Pizzi S, Andrisani A, Litta PS. Effects of chronic endometritis therapy on in vitro fertilization outcome in women with repeated implantation failure: a systematic review and meta-analysis. Fertil Steril 2018; 110:103-112.e1. [DOI: 10.1016/j.fertnstert.2018.03.017] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 02/19/2018] [Accepted: 03/09/2018] [Indexed: 12/28/2022]
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