Oxytocin - the new wonder drug for treatment of endometritis?

Markers of the uterine innate immune response of the mare

Reproductive efficiency in mares is low and persistent mating-induced endometritis (PMIE) is an important cause of subfertility. Mating-induced endometritis (MIE) an obligate precursor to PMIE, is a ubiquitous, transient inflammatory response to the presence of sperm, seminal components and pathogens. However, the specific inflammatory pathways that derive from MIE and that may also be precursors to PMIE are not clear. The ability to identify and measure robust, repeatable markers of inflammation integral to MIE may be key to understanding the progression to PMIE. The aim of the study was to (i) refine a protocol for inducing MIE and in doing so test a range of cellular and molecular parameters as valid markers of MIE to facilitate future studies of mares susceptible to PMIE (ii) concurrently identify those parameters with potential as inflammatory indicators during MIE to inform and enhance early treatment regimens in practice. Mating-induced endometritis was induced in pony mares using a stringent protocol; mares were treated intrauterine with frozen/thawed semen (n = 5; FTS) or frozen/thawed extender (n = 6: FTEx). The parameters tested were measured before treatment were compared to samples collected at strategic time points after treatment: uterine cytology using cytological (at 8, 16, 24, 48 and 72 h after treatment) or histological analysis (at 24 and 72 h); uterine bacteriology (at 24 and 72 h); secretion of prostaglandin F(2alpha) (PGF(2alpha); at 8, 16, 24, 48 and 72 h); peripheral concentrations of serum amyloid A (SAA; at 24h); endometrial mRNA gene expression, focussing upon IL8 and TLR4, as examples of genes pertinent to inflammation (at 24 h). Uterine neutrophil cell numbers in both treatment groups increased at 8 (P < 0.001), 16 (P < 0.01) and 24 (P < 0.01) h after insemination, indicative of MIE and distinguished between different treatments because neutrophil numbers were greater from FTS mares than FTEx mares 8h after challenge. Uterine neutrophil cell numbers, assessed by histology, increased (P < 0.001) 24 and 72 h after treatment. Prostaglandin F(2alpha) concentrations increased (P < 0.05) 16 h after treatments, while SAA concentrations and bacterial growth scores were not significantly different after treatment. Endometrium from pony mares expressed mRNA for IL8 and TLR4 but expression was not altered after insemination. The protocol induced MIE, as confirmed by uterine cytology and maybe used hereafter as a repeatable and robust method for studying immune mechanisms that underlie MIE and so may aid the understanding of progression to persistent inflammation. It can be concluded that of the range of parameters tested, neutrophil cell numbers by cytological analysis and PGF(2alpha) were regarded as the most accurate markers of inflammation during MIE and important for use in practice.

Breeding-induced endometritis in mares

Endometritis is a common cause of infertility in broodmares. In the past, the condition was believed to be exclusively the result of bacterial contamination of the uterus. Treatment strategies were focused on preventing bacteria from entering the uterus and on treating mares with signs of endometritis with antibiotics. More recent research on uterine defense mechanisms has increased our understanding of the pathophysiology of equine endometritis. Additional causative agents have been identified, and we have learned to separate uterine infections and a physiologic breeding-induced endometritis resulting from uterine exposure to semen.vi

Day of cycle affects changes in equine intrauterine pressure in response to teasing

Oxytocin is released in response to teasing during both estrus and diestrus in mares, and at least during estrus, teasing results in an increase in electromyographic activity in the uterus. Exogenous oxytocin causes an increase in intrauterine pressure and prior studies have shown that this response is correlated to the day of the estrous cycle. To determine if teasing causes an increase in intrauterine pressure and if this response varies by day of the cycle, intrauterine pressure was measured while mares were teased with a stallion 2 days before ovulation, on the day ovulation was detected and 2 days after ovulation. A significant increase in intrauterine pressure was observed in response to teasing both 2 days before ovulation and on the day of ovulation, when plasma concentrations of progesterone were low. No significant increase in intrauterine pressure was observed in response to teasing 2 days after ovulation when progesterone concentrations were elevated. Management practices that include teasing or stallion exposure may be beneficial in stimulating uterine clearance mechanisms in mares during the preovulatory period.

Isolation and cryopreservation of functionally competent equine leucocytes

Sufficient numbers of functionally competent polymorphonuclear neutrophil granulocytes (PMN) seem to be of major importance during the course of equine endometritis. In this study, we wanted to establish a method for cryopreservation of functionally competent neutrophils for an intended local endometritis therapy in mares. The separation of leucocytes by hypotonic lysis of whole blood from clinically healthy mares was superior to the separation by dextrose sedimentation. After suspension of the cells in the cryoprotective solution [equine plasma with 5% (v/v) dimethyl sulphoxide (DMSO)], the leucocytes were frozen in liquid nitrogen. A temperature gradient with low cooling velocity (1 degree C/min between 4 and -70 degrees C) resulted in highest numbers of viable cells after thawing. Thawed PMN had a high phagocytic capacity for opsonized streptococci. Their ability to generate reactive oxygen species (ROS) after stimulation with a phorbol ester was even higher than that of freshly isolated PMN and was preserved up to 6 h after thawing. The results of this study indicate that cryopreservation of PMN may provide viable and functionally competent neutrophils for therapeutic use in mares susceptible to endometritis.

Effect on fertility of uterine lavage performed immediately prior to insemination in mares

OBJECTIVE

To determine the effect on fertility of large-volume uterine lavage with lactated Ringer's solution (LRS) performed immediately prior to insemination in mares.

DESIGN

Prospective randomized controlled study.

ANIMALS

20 mares.

PROCEDURE

Control mares (n = 10) were inseminated with 1 billion (estimated before cooling) progressively motile spermatozoa that had been cooled in a passive cooling unit for 24 hours. Mares (n = 10) in the treatment group were inseminated with 1 billion progressively motile spermatozoa (cooled as described for control mares) immediately after uterine lavage with 4 L of sterile LRS.

RESULTS

There were no significant differences in pregnancy rates or size of the embryonic vesicle on days 12, 13, and 14 after ovulation between control and treated mares.

CONCLUSIONS AND CLINICAL RELEVANCE

Results indicate that uterine lavage with LRS can be performed immediately prior to insemination without adversely affecting fertility in mares. This is clinically important, because insemination may be necessary when a mare has inflammation-associated fluid (detectable ultrasonographically) in the uterus; removal of the fluid is desirable, because it adversely affects spermatozoal motility and fertility. This situation typically arises when mares require rebreeding after they have developed persistent mating-induced endometritis or are inseminated multiple times in a 24-hour period (during the period of physiologic mating-induced inflammation), which is a common practice when using cooled or frozen-thawed semen.

Effect of dose and day of treatment on uterine response to oxytocin in mares

To determine the effect of dose and day of oxytocin treatment on intrauterine pressure, 6 normal mares were treated with 10 or 25 IU oxytocin 2 days before ovulation, on the day of ovulation and 2 days after ovulation. Intrauterine pressure (IUP) was measured using micro-tip-catheters (one placed intrauterine, a second and third serving as reference sensors in the vagina and external to the mare) and transmitted by telemetry for 30 min to establish a baseline before saline was administered, iv, and for an additional 30 min after saline administration. Oxytocin was then given, iv, and IUP was recorded for 60 min. No change in IUP was observed after saline injection. The administration of both 10 (n=16) and 25 (n=10) IU oxytocin induced a response (P<0.01). The intensity of response depended on the day of administration (P<0.01) and the dose of oxytocin (P<0.001). The variation of response was significantly greater after 10 IU oxytocin (CV 15.78%) compared with 25 IU oxytocin (CV 6.42%). The uterine response was greatest on Day 2 prior to ovulation and lowest on Day 2 after ovulation. The response was negatively correlated to increasing plasma progesterone (10 IU oxytocin: r = -0.435, 25 IU oxytocin: r = -0.265). There was no correlation between the uterine response and plasma estradiol-17beta concentration (P<0.01). In conclusion the results of this study show that oxytocin administration to mares before ovulation provides a greater response than after ovulation. A decline in the intensity of response after ovulation can be compensated for with a higher dose of oxytocin. Furthermore, the use of the multiple catheter technique is an effective method for assessing changes in uterine pressure.

Uterine contractility is necessary for the clearance of intrauterine fluid but not bacteria after bacterial infusion in the mare

Bacteria were infused into the uteri of 5 estrous mares resistant to persistent mating-induced endometritis, first during a control cycle, and then during treatment with clenbuterol, a beta 2 agonist. Uterine cellular response was evaluated 48 h later by transrectal ultrasonography, followed by uterine lavage. During clenbuterol treatment all mares accumulated intrauterine fluid, whereas in the control cycle none of the mares retained fluid. There was no significant difference between the 2 cycles in the cloudiness of the lavage fluid, number of cells per milliliter, percentage of neutrophils and frequency of bacterial growth from the recovered fluid. We conclude that uterine contractility is important in the clearance of uterine fluid, but not necessarily for the elimination of bacteria, thus supporting the published evidence that impaired uterine contractility contributes to the pathogenesis of persistent mating-induced endometritis.

Changes in intrauterine pressure after oxytocin administration in reproductively normal mares and in those with a delay in uterine clearance

Intrauterine pressure was measured in 4 reproductively normal mares and 4 mares with delay in uterine clearance after administration of oxytocin to determine if intrauterine pressure varied between dosage and group. Changes in intrauterine pressure were measured during estrus, when a follicle was > or =35 mm, using a Millar "Mikro-tip" catheter that had 3 discrete pressure sensors/channels. Mares received 4 different treatments of 10, 5, 2.5 or 0 IU (vehicle) of oxytocin. The protocol for each treatment consisted of a 10-min baseline recording, administration of treatment and measurement of changes in intrauterine pressure for 65 min. After administration of the first two treatments, mares were rested for 2 h and the protocol repeated for the remaining 2 treatments. Changes in intrauterine pressure were measured on a physiograph and stored in a computer. The results were analyzed by 4x4 Latin Square Design analysis of variance (ANOVA) using the GLM procedure of the Statistical Analysis System. The ANOVA detected a main effect of treatment (P<0.01) and mare (nested within group; P<0.01) but no effect of channels, group or treatment-by-group interaction. There was a dose-dependent increase in uterine activity in both normal mares and those with delayed uterine clearance. A dose of 10 IU of oxytocin induced a larger number of uterine contractions (5.67+/-0.06) for a longer time (24.09+/-1.18 min) than the 5 IU (4.16+/-0.06 contractions and 16.31+/-1.18; P<0.01 min) or 2.5 IU dose (4.08+/-0.06 contractions and 17.61+/-1.18 min). The first intrauterine wave occurred most often near the tip of the horn in 10 of 12 recordings in normal mares and in 8 of 12 recordings in mares with delayed uterine clearance. It was then propagated from the middle of the horn to the uterine body just cranial to the cervix. There was no pattern of propagation for subsequent intrauterine pressure waves. We conclude that the difference in spontaneous clearance of the uterus between the 2 groups is not reflected in their response to exogenous oxytocin as determined by changes in intrauterine pressure.

Histomorphological endometrial status and influence of oxytocin on the uterine drainage and pregnancy rate in mares

The aim of this field study was to examine the influence of the uterotonic substance oxytocin in 2 different therapeutic dosages of 15 and 25 i.u., respectively on the uterine drainage of oestrous mares and on their fertility. In addition endometrial biopsies of mares with and without intrauterine fluid accumulations around the time of ovulation were evaluated histomorphologically regarding the aetiology of susceptibility to uterine infection. A population of 59 Hanoverian Warmblood mares was used in this study. The mares were divided into Group A (mares with intrauterine fluid accumulations [n = 49]) and Group B (controls [n = 10]). Group A was further subdivided into 3 groups according to varying oxytocin administrations (none, 15 i.u., 25 i.u.). Prior to insemination, all mares were examined by rectal palpation, ultrasonography and vaginal inspection. In addition, hormone plasma concentrations were evaluated at the time of ovulation, namely oestradiol and progesterone concentrations. Endometrial biopsies were obtained from all mares. Endometrial samples for microbiological and cytological evaluation were taken from mares of Group A only. All mares were inseminated close to ovulation during the first cycle. This study shows that intravenous oxytocin treatment of mares with intrauterine fluid accumulations results in better pregnancy rates than no treatment.

Assessment of the effect of three treatments to remove intrauterine fluid on pregnancy rate in the mare

The effects on pregnancy rate of three different treatments to remove intrauterine fluid were assessed in 1267 mares. The mares were mated and allocated, in strict rotation, to four treatment groups: 1) untreated controls, 2) intrauterine infusion of broad spectrum antibiotics, 3) intravenous injection of oxytocin, 4) intravenous injection of oxytocin followed by intrauterine antibiotics. The pregnancy status of the mares was determined 13 to 15 days and 27 to 30 days after ovulation by transrectal ultrasonography. The pregnancy rate of group 4 (72 per cent) was higher than that of group 2 (64 per cent, P < 0.01) or group 3 (63 per cent, P < 0.01). The pregnancy rates of groups 2 and 3 were higher than that of group 1 (56 per cent, P < 0.01). The treatment with antibiotics and oxytocin appeared to have an additive beneficial effect which suggested two different modes of action of the combination treatment, namely antibacterial activity and fluid drainage. In the untreated mares more fluid accumulated in the uterine lumen after mating, and this was the most likely reason for their lower pregnancy rate.