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Stope MB, Mustea A, Sänger N, Einenkel R. Immune Cell Functionality during Decidualization and Potential Clinical Application. Life (Basel) 2023; 13:life13051097. [PMID: 37240742 DOI: 10.3390/life13051097] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 04/20/2023] [Accepted: 04/26/2023] [Indexed: 05/28/2023] Open
Abstract
Due to a vast influx in the secretory phase of the menstrual cycle, leukocytes represent 40-50% of the decidua at the time of implantation. Their importance for the implantation, maintenance of pregnancy, and parturition are known yet not fully understood. Thus, in idiopathic infertility, decidual immune-related factors are speculated to be the cause. In this review, the immune cell functions in the decidua were summarized, and clinical diagnostics, as well as interventions, were discussed. There is a rising number of commercially available diagnostic tools. However, the intervention options are still limited and/or poorly studied. In order for us to make big steps towards the proper use of reproductive immunology findings, we need to understand the mechanisms and especially support translational research.
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Affiliation(s)
- Matthias B Stope
- Department of Gynecology and Gynecological Oncology, University Hospital Bonn, 53127 Bonn, Germany
| | - Alexander Mustea
- Department of Gynecology and Gynecological Oncology, University Hospital Bonn, 53127 Bonn, Germany
| | - Nicole Sänger
- Department of Gynecological Endocrinology and Reproductive Medicine, University Hospital Bonn, 53127 Bonn, Germany
| | - Rebekka Einenkel
- Department of Gynecological Endocrinology and Reproductive Medicine, University Hospital Bonn, 53127 Bonn, Germany
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2
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Corrigendum. Am J Reprod Immunol 2019; 82:e13161. [DOI: 10.1111/aji.13161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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3
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Chin TH, Hsu YC, Soong YK, Lee CL, Wang HS, Huang HY, Wu HM, Yu HT, Huang SY, Chang CL. Obstetric and perinatal outcomes of pregnancy in patients with repeated implantation failure. Taiwan J Obstet Gynecol 2019; 58:487-491. [DOI: 10.1016/j.tjog.2019.05.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2019] [Indexed: 01/08/2023] Open
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4
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Soh MC, Moretto M. The use of biologics for autoimmune rheumatic diseases in fertility and pregnancy. Obstet Med 2019; 13:5-13. [PMID: 32284726 DOI: 10.1177/1753495x19841799] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 03/10/2019] [Indexed: 12/18/2022] Open
Abstract
In an age where autoimmune rheumatic diseases are successfully managed with biologics, their discontinuation in pregnancy is inadvisable without careful forethought; maternal disease activity is associated with adverse pregnancy outcomes, which has long-term implications for both mother and offspring. We aim to provide clinicians with the necessary tools to facilitate decision-making - when a biologic should be used, when it can be discontinued in pregnancy if appropriate. The pathophysiology of these biologic molecules and their effect on fertility, pregnancy and parturition are discussed. A summary of the 2016 international guidelines (European League Against Rheumatism and British Society in Rheumatology) on biologics in pregnancy has been tabulated; more recent publications are discussed in depth. Data on transplacental-transfer ratios and breastmilk excretion rates are also included. Biologic effects on organogenesis, their implications for the exposed infant in terms of infection risks and vaccination requirements are included, and future directions for research proposed.
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Affiliation(s)
- May Ching Soh
- Department of Rheumatology, Tauranga Hospital, Bay of Plenty District Health Board, Tauranga, New Zealand.,Department of Obstetrics and Gynaecology, Elizabeth Rothwell Building, Waikato Hospital, Waikato District Health Board, Hamilton, New Zealand.,Women's Health Academic Centre, King's College London, London, UK
| | - Marcelo Moretto
- Department of Gynaecology, Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil.,Clínica Generar-Human Reproduction, Porto Alegre, Brazil
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5
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The role of immunotherapy in in vitro fertilization: a guideline. Fertil Steril 2019; 110:387-400. [PMID: 30098685 DOI: 10.1016/j.fertnstert.2018.05.009] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 05/10/2018] [Indexed: 12/22/2022]
Abstract
Adjuvant immunotherapy treatments in in vitro fertilization (IVF) aim to improve the outcome of assisted reproductive technology (ART) in both the general ART population as well as subgroups such as patients with recurrent miscarriage or implantation failure. The purpose of this guideline is to evaluate the role of immunomodulating therapy in ART. Unfortunately, many of the evaluated therapies lack robust evidence from well-designed adequately powered randomized controlled trials to support their use. Immunotherapies reviewed in the present document are either not associated with improved live-birth outcome in IVF or have been insufficiently studied to make definitive recommendations.
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Affiliation(s)
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- American Society for Reproductive Medicine, Birmingham, Alabama
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6
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Inal ZO, Inal HA, Erdem S. The effect of serum and follicular fluid secreted frizzle-related protein-5 on in vitro fertilization outcomes in patients with polycystic ovary syndrome. Mol Biol Rep 2018; 45:2037-2044. [PMID: 30194556 DOI: 10.1007/s11033-018-4360-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Accepted: 09/03/2018] [Indexed: 10/28/2022]
Abstract
In this study, we aimed to investigate serum and follicular fluid (FF) secreted frizzle-related protein-5 (Sfrp-5) levels in nonobese, nonhyperandrogenic patients with polycystic ovary syndrome (PCOS) undergoing in vitro fertilization (IVF), in addition to IVF outcomes. In total, 160 patients undergoing IVF treatment were included in the study: 80 patients diagnosed with PCOS according to the Rotterdam criteria (group I, study) and 80 patients with the etiology of male factor infertility (group II, control). There were statistically significant between-group differences in serum estradiol (E2) levels on the day of hCG administration (2377.00 ± 733.23 vs. 1931.3 ± 1,010.69), the total gonadotropin dose required (2000.63 ± 1,051.87 vs. 1.134.69 ± 286.45), and the total number of retrieved oocytes (8.60 ± 2.06 vs. 11.05 ± 4.39) (p < 0.05). There was also a statistically significant between-group difference in serum and FF Sfrp-5 levels on the day of oocyte retrieval (11.40 ± 2.88 vs. 8.87 ± 1.85, p < 0.001; 11.06 ± 2.30 vs. 9.71 ± 2.15, p = 0.008; respectively). However, there were no between-group differences in fertilization rates, clinical pregnancy rates, and live birth rates (p > 0.05). A correlation analysis showed that serum and FF Sfrp-5 levels were associated with insulin and inflammatory markers (p < 0.05). In a selected population of nonobese, nonhyperandrogenic PCOS patients, there was a significant difference in Sfrp-5 levels of the PCOS group versus those of the control group. Further studies are needed to determine the effects of Sfrp-5 in women with PCOS.
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Affiliation(s)
- Zeynep Ozturk Inal
- Department of Reproductive Endocrinology, Konya Education and Research Hospital, Meram Yeni Yol, 42090, Konya, Turkey
| | - Hasan Ali Inal
- Department of Reproductive Endocrinology, Konya Education and Research Hospital, Meram Yeni Yol, 42090, Konya, Turkey.
| | - Sami Erdem
- Department of Biochemistry, Konya Education and Research Hospital, Konya, Turkey
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7
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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: 29] [Impact Index Per Article: 4.8] [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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8
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Hviid MM, Macklon N. Immune modulation treatments—where is the evidence? Fertil Steril 2017; 107:1284-1293. [DOI: 10.1016/j.fertnstert.2017.04.009] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2017] [Accepted: 04/18/2017] [Indexed: 12/11/2022]
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9
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The Efficacy of Assisted Reproduction in Women with Inflammatory Bowel Disease and the Impact of Surgery-A Nationwide Cohort Study. Inflamm Bowel Dis 2017; 23:208-217. [PMID: 27997432 DOI: 10.1097/mib.0000000000000996] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND In this study, we analyze the chance of a live birth and the impact of inflammatory bowel disease surgery in women with Crohn's disease (CD) or ulcerative colitis (UC) who have undergone assisted reproductive technology (ART) treatments. METHODS This is a nationwide cohort study based on the Danish health registries. We compare all women with and without CD or UC who received a first time ART treatment from January 1, 1994 to June 30, 2012 with follow-up until December 31, 2013. Our outcome was live birth per woman within 18 months after the first ART treatment. We adjusted for multiple covariates and looked specifically at CD and UC surgeries before ART. RESULTS In all, 381 women with UC, 158 women with CD, and 50,321 women without inflammatory bowel disease received first time ART treatments. In women with UC, the adjusted odds ratio (OR) of a live birth was 0.82 (95% confidence interval [CI], 0.57-1.17). In women with CD, the adjusted OR of a live birth was 0.58 (95% CI, 0.32-1.03). In women with CD having previous CD surgery versus no CD surgery, the adjusted OR of a live birth was significantly decreased (0.29, 95% CI, 0.13-0.65). In women with UC with previous UC surgery, the similar OR was 0.81 (95% CI, 0.47-1.40). CONCLUSIONS In women with CD surgery, the chance of a live birth within 18 months after initiation of ART treatment was significantly decreased. This knowledge should help patients make decisions regarding pregnancy planning.
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10
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Nørgård BM, Larsen PV, Fedder J, de Silva PS, Larsen MD, Friedman S. Live birth and adverse birth outcomes in women with ulcerative colitis and Crohn's disease receiving assisted reproduction: a 20-year nationwide cohort study. Gut 2016; 65:767-76. [PMID: 26921349 DOI: 10.1136/gutjnl-2015-311246] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Accepted: 02/08/2016] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To examine the chance of live births and adverse birth outcomes in women with ulcerative colitis (UC) and Crohn's disease (CD) compared with women without inflammatory bowel disease (IBD) who have undergone assisted reproductive technology (ART) treatments. METHODS This was a nationwide cohort study based on Danish health registries, comprising all women with an embryo transfer during 1 January 1994 through 2013. The cohorts comprised 1360 ART treatments in 432 women with UC, 554 ART treatments in 182 women with CD and 148,540 treatments in 52,489 women without IBD. Our primary outcome was live births per ART treatment cycle. We controlled for multiple covariates in the analyses. Our secondary outcomes were adverse birth outcomes. RESULTS The chance of a live birth for each embryo transfer was significantly reduced in ART treatments in women with UC (OR=0.73, 95% CI 0.58 to 0.92), but not significantly reduced in the full model of ART treatments in women with CD (OR=0.77, 95% CI 0.52 to 1.14). Surgery for CD before ART treatment significantly reduced the chance of live birth for each embryo transfer (OR=0.51, 95% CI 0.29 to 0.91). In children conceived through ART treatment by women with UC, the OR of preterm birth was 5.29 (95% CI 2.41 to 11.63) in analyses including singletons and multiple births; restricted to singletons the OR was 1.80, 95% CI 0.49 to 6.62. CONCLUSIONS Our results suggest that women with UC and CD receiving ART treatments cannot expect the same success for each embryo transfer as other infertile women. Women with CD may seek to initiate ART treatment before needing CD surgery. Increased prenatal observation in UC pregnancies after ART should be considered.
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Affiliation(s)
- B M Nørgård
- Center for Clinical Epidemiology, Odense University Hospital and Research Unit of Clinical Epidemiology, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark Crohn's and Colitis Center, Brigham and Women's Hospital, Boston, Massachusetts, USA Harvard Medical School, Harvard University, Boston, Massachusetts, USA
| | - P V Larsen
- Center for Clinical Epidemiology, Odense University Hospital and Research Unit of Clinical Epidemiology, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - J Fedder
- Department D, Centre of Andrology and Fertility Clinic, Odense University Hospital, Odense, Denmark Research Unit of Human Reproduction, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - P S de Silva
- Crohn's and Colitis Center, Brigham and Women's Hospital, Boston, Massachusetts, USA Harvard Medical School, Harvard University, Boston, Massachusetts, USA
| | - M D Larsen
- Center for Clinical Epidemiology, Odense University Hospital and Research Unit of Clinical Epidemiology, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - S Friedman
- Center for Clinical Epidemiology, Odense University Hospital and Research Unit of Clinical Epidemiology, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark Crohn's and Colitis Center, Brigham and Women's Hospital, Boston, Massachusetts, USA Harvard Medical School, Harvard University, Boston, Massachusetts, USA
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11
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Mekinian A, Cohen J, Alijotas-Reig J, Carbillon L, Nicaise-Roland P, Kayem G, Daraï E, Fain O, Bornes M. Unexplained Recurrent Miscarriage and Recurrent Implantation Failure: Is There a Place for Immunomodulation? Am J Reprod Immunol 2016; 76:8-28. [DOI: 10.1111/aji.12493] [Citation(s) in RCA: 84] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Accepted: 01/02/2016] [Indexed: 12/16/2022] Open
Affiliation(s)
- Arsène Mekinian
- AP-HP; Hôpital Saint-Antoine; Service de Médecine Interne and Inflammation-(DHU i2B); Paris France
| | - Jonathan Cohen
- AP-HP; Hôpital Tenon; Service d'Obstétrique et de Procréation Médicalement Assistée; Paris France
| | - Jaume Alijotas-Reig
- Systemic Autoimmune Disease Unit; Department of Internal Medicine I; Vall d'Hebrón University Hospital; Universitat Autonoma de Barcelona; Barcelona Spain
| | - Lionel Carbillon
- AP-HP; Hôpital Jean Verdier; Service d'Obstétrique; Bondy France
| | | | - Gilles Kayem
- AP-HP; Hôpital Trousseau; Service d'Obstétrique; Paris France
| | - Emile Daraï
- AP-HP; Hôpital Tenon; Service d'Obstétrique et de Procréation Médicalement Assistée; Paris France
| | - Olivier Fain
- AP-HP; Hôpital Saint-Antoine; Service de Médecine Interne and Inflammation-(DHU i2B); Paris France
| | - Marie Bornes
- AP-HP; Hôpital Tenon; Service d'Obstétrique et de Procréation Médicalement Assistée; Paris France
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Yildizfer F, Donma O, Yen M, Ekmekci O, Karatas Kul ZA, Keser Z, Esat Imal A, Cagil E, Mengi M, Ekmekci H, Sahmay S, Nalbantoglu B, Donma MM. In Vitro Fertilization, Levels of Pro-Inflammatory Factors and Lipid Peroxidation. INTERNATIONAL JOURNAL OF FERTILITY & STERILITY 2015; 9:277-84. [PMID: 26644849 PMCID: PMC4671383 DOI: 10.22074/ijfs.2015.4541] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Accepted: 05/04/2014] [Indexed: 01/18/2023]
Abstract
BACKGROUND Infertility is a problem concerning 10-15% of the individuals in the fertile period. This study investigated effects of proinflammatory factors as well as lipid hydroperoxides (LPO) levels upon in vitro fertilization (IVF) success. MATERIALS AND METHODS In this prospective, non-randomized, controlled clinical study, sera obtained from 26 fertile (group-1), 26 infertile women before (group-2) and after (group-3) IVF treatment were analyzed. Leptin, leptin receptor, resistin, tumor necrosis factor-alpha (TNF-α), and C-reactive protein (CRP) were analyzed using enzyme-linked immunosorbent assay (ELISA). LPO was determined spectrophotometrically. Mann- Whitney U test, paired samples t test, Wilcoxon signed-rank test as well as Pearson correlation analysis by SPSS were performed for statistical analysis. RESULTS TNF-α, resistin and LPO levels increased (P=0.020, P=0.003, P=0.001, respectively) in group-3 compared to group-2. A significant increase in LPO was noted both in group-2 and -3 compared to controls (P=0.000). LPO were higher in non-pregnants than pregnants in group-2. For pregnants, significant correlations were observed between leptin and resistin in group-2 and TNF-α and leptin in group-3. None of these correlations were found for the women, who could not conceive. CONCLUSION LPO, leptin-resistin correlation, associations with TNF-α may be helpful during the interpretation of IVF success rates.
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Affiliation(s)
- Ferdag Yildizfer
- Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Orkide Donma
- Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Mustafa Yen
- Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Ozlem Ekmekci
- Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | | | - Zafer Keser
- University of Texas, Health Science Center at Houston, Houston, USA
| | - Ahmet Esat Imal
- Tufts Medical Center, Molecular Oncology Research Institute, Boston, USA
| | - Emin Cagil
- Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Murat Mengi
- Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Hakan Ekmekci
- Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Sezai Sahmay
- Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
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The effect of serum and follicular fluid amyloid-associated protein levels on in vitro fertilization outcome in patients with polycystic ovary syndrome. J Assist Reprod Genet 2015; 32:1637-42. [PMID: 26463878 DOI: 10.1007/s10815-015-0582-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2015] [Accepted: 09/23/2015] [Indexed: 10/22/2022] Open
Abstract
PURPOSE In this study, we aimed to investigate serum and follicular fluid amyloid A protein levels in non-obese non-hyperandrogenic patients with polycystic ovary syndrome (PCOS) undergoing in vitro fertilization (IVF) and IVF outcome. METHODS A total of 81 patients undergoing IVF treatment, 41 patients diagnosed as PCOS according to the Rotterdam criteria (group I) and 40 patients with the etiology of male factor infertility (group II), were included in the study. On the day of oocyte pickup, serum and follicular fluid samples were collected from all patients. RESULTS Serum E2 level on the day of hCG (2849.93 ± 541.54 vs. 2494.28 ± 712.98) and total number of retrieved oocytes (13.73 ± 3.57 vs. 10.53 ± 4.07) were significantly higher in group I when compared to group II (p < 0.05). However, number of mature oocytes, fertilization rate, and clinical pregnancy rate did not differ (p > 0.05). No significant difference was found between two groups regarding the serum and follicular fluid amyloid A protein levels on the day of oocyte retrieval (p > 0.05).
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Winger EE, Reed JL, Ji X. First-trimester maternal cell microRNA is a superior pregnancy marker to immunological testing for predicting adverse pregnancy outcome. J Reprod Immunol 2015; 110:22-35. [PMID: 25965838 DOI: 10.1016/j.jri.2015.03.005] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Accepted: 03/16/2015] [Indexed: 12/22/2022]
Abstract
Patients at risk of immune-mediated pregnancy complications have historically relied on the use of peripheral blood immunological assays for diagnosis and pregnancy monitoring. However, these tests often fail to identify many at-risk patients, achieving moderately predictive receiver operating characteristic (ROC) curve AUCs of 0.60-0.70. We previously demonstrated that a microRNA panel comprising 30 microRNAs successfully predicts pregnancy outcome in the first trimester. In our current study we constructed a smaller, more clinically useful seven-microRNA panel from the original panel of 30 microRNAs with equivalent sensitivity and specificity. To select optimal microRNAs for a smaller panel, quantitative RT-PCR on 30 microRNAs was first performed on 48 patients (191 samples) with concurrent immunological testing: TNFα/Il-10 ratio, IFNγ/Il-10, CD56+16+%, NK 50:1 cytotoxicity and T regulatory cells. MicroRNAs were separated into clusters associated with: Th1/Th2 response; T regulatory cell percent; pregnancy risk; treatment response. Seven most differentially expressed microRNAs were selected. The seven microRNA scoring system was then applied to 39 patient samples in the first trimester of pregnancy (19 healthy deliveries, 8 miscarriages, 12 preeclampsia [7 late-onset and 5 early-onset]) and 20 samples in the preconception period (2-10 weeks before conception). Predictive value was assessed. ROC curves for the seven-microRNA panel achieved AUC 0.92 for miscarriage and 0.90 for preeclampsia (blood drawn 34.9±19.2 days post-implantation). For samples measured preconception, ROC curve analysis demonstrated AUC 0.81 for adverse pregnancy outcome. Maternal PBMC microRNA can identify high-risk patients likely to benefit from immunotherapy with improved sensitivity and specificity compared with standard immune assays.
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Affiliation(s)
- Edward E Winger
- Laboratory for Reproductive Medicine and Immunology, 7013 Realm Dr, Ste A, San Jose, CA, USA.
| | - Jane L Reed
- Laboratory for Reproductive Medicine and Immunology, 7013 Realm Dr, Ste A, San Jose, CA, USA.
| | - Xuhuai Ji
- Stanford University, Human Immune Monitoring Center, CCSR 0128, 1291 Welch Road, Stanford, CA, USA.
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Nardo LG, El-Toukhy T, Stewart J, Balen AH, Potdar N. British Fertility Society Policy and Practice Committee: Adjuvants in IVF: Evidence for good clinical practice. HUM FERTIL 2014; 18:2-15. [DOI: 10.3109/14647273.2015.985454] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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16
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Additive Verfahren in der Reproduktionsmedizin. GYNAKOLOGISCHE ENDOKRINOLOGIE 2014. [DOI: 10.1007/s10304-013-0606-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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17
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Mekinian A, Costedoat-Chalumeau N, Masseau A, Tincani A, De Caroli S, Alijotas-Reig J, Ruffatti A, Ambrozic A, Botta A, Le Guern V, Fritsch-Stork R, Nicaise-Roland P, Carbonne B, Carbillon L, Fain O. Obstetrical APS: is there a place for hydroxychloroquine to improve the pregnancy outcome? Autoimmun Rev 2014; 14:23-9. [PMID: 25179813 DOI: 10.1016/j.autrev.2014.08.040] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Accepted: 08/25/2014] [Indexed: 01/12/2023]
Abstract
The use of the conventional APS treatment (the combination of low-dose aspirin and LMWH) dramatically improved the obstetrical prognosis in primary obstetrical APS (OAPS). The persistence of adverse pregnancy outcome raises the need to find other drugs to improve obstetrical outcome. Hydroxychloroquine is widely used in patients with various autoimmune diseases, particularly SLE. Antimalarials have many anti-inflammatory, anti-aggregant and immune-regulatory properties: they inhibit phospholipase activity, stabilize lysosomal membranes, block the production of several pro-inflammatory cytokines and, in addition, impair complement-dependent antigen-antibody reactions. There is ample evidence of protective effects of hydroxychloroquine in OAPS similar to the situation in SLE arising from in vitro studies of pathophysiological working mechanism of hydroxychloroquine. However, the clinical data on the use of hydroxychloroquine in primary APS are lacking and prospective studies are necessary.
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Affiliation(s)
- Arsene Mekinian
- AP-HP, Hôpital Saint-Antoine, Service de médecine interne, Inflammation-Immunopathology-Biotherapy Department (DHU i2B), Sorbonne Universités, UPMC Univ Paris 06, F-75012 Paris, France.
| | - Nathalie Costedoat-Chalumeau
- Université René Descartes, Paris, France; APHP, Centre de reference malades auto-immunes et systemiques rares, Service de médecine interne, Hopital Cochin, Paris, France
| | - Agathe Masseau
- Université Nantes, Nantes, France; Service de médecine interne, Hopital Nantes, Nantes, France
| | - Angela Tincani
- Rheumatology and Clinical Immunology, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Sara De Caroli
- Department of Obstetrics, Gynaecology, and Pediatrics, Catholic University of Sacred Heart, Rome, Italy
| | - Jaume Alijotas-Reig
- Systemic Autoimmune Disease Unit, Department of Internal Medicine I, Vall d'Hebrón University Hospital, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Amelia Ruffatti
- Rheumatology Unit, Department of Medicine, University of Padua, Padua, Italy
| | - Ales Ambrozic
- Department of Rheumatology, University Medical Centre Ljubljana, Slovenia
| | - Angela Botta
- Department of Obstetrics, Gynaecology, and Pediatrics, Catholic University of Sacred Heart, Rome, Italy
| | - Véronique Le Guern
- Université René Descartes, Paris, France; APHP, Centre de reference malades auto-immunes et systemiques rares, Service de médecine interne, Hopital Cochin, Paris, France
| | - Ruth Fritsch-Stork
- Department of Rheumatology and Clinical Immunology, University Medical Center, Utrecht, Netherlands
| | - Pascale Nicaise-Roland
- Université Paris 7, Paris, France; AP-HP, Unité Fonctionnelles d'Immunologie «Auto-immunité et Hypersensibilités», Hôpital Bichat-Claude Bernard, Paris, France
| | - Bruno Carbonne
- Université Paris 7, Paris, France; AP-HP, Service de gynécologie obstétrique, Hôpital Trousseau Paris, France
| | - Lionel Carbillon
- Université Paris 13, Bondy, France; AP-HP, Service de gynécologie-obstétrique, Hôpital Jean Verdier, 93140 Bondy, France
| | - Olivier Fain
- AP-HP, Hôpital Saint-Antoine, Service de médecine interne, Inflammation-Immunopathology-Biotherapy Department (DHU i2B), Sorbonne Universités, UPMC Univ Paris 06, F-75012 Paris, France
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18
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Aspirin and heparin to improve live birth rate in IVF for unexplained implantation failure? Reprod Biomed Online 2013; 26:538-41. [PMID: 23602681 DOI: 10.1016/j.rbmo.2013.03.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Accepted: 03/05/2013] [Indexed: 12/19/2022]
Abstract
The data concerning use of aspirin and/or heparin in IVF failure patients is reviewed. A number of methodological and biological problems are identified. A strategy to achieve reliable conclusions is explained.
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