Lymphocyte subsets in the endometrium of genitally normal mares and mares susceptible to endometritis

MicroRNAs in equine Endometritis: A review of pathophysiology and molecular insights for diagnostic and therapeutic strategies

Endometritis plays an important role in mare infertility. Certain infectious agents interfere with the innate immune system of endometrium, causing a systemic inflammatory response that lasts for a long time and circulates via the blood or cellular degeneration, leading to endometritis due to bacterial endotoxins. Different small, non-coding RNA molecules are involved in many biological functions. For instance, microRNAs (miRNAs) are involved in the post-transcriptional regulation of gene expression. These miRNAs are important regulators of gene expression, primarily via inhibiting transcription and translation processes. This manuscript reviews: (1) pathomorphological findings in equine endometritis, (2) the expression and effects of eca-miR-17, eca-miR-223, eca-miR-200a, eca-miR-155, and eca-miR-205 in endometritis and (3) the therapeutic role of miRNA in equine endometritis. The miRNAs have a vital regulatory role in a wide range of inflammatory diseases by regulating the molecular mechanism of cytokines that cause inflammation through signal pathways. This review emphasizes the demand for cutting-edge genetic technologies and the development of novel pharmaceutical preparations to improve our understanding of the genes encoding by these miRNAs. It also focuses on the efficacy of miRNAs for control, early diagnosis, and prevention of endometritis.

Populations of NK Cells and Regulatory T Cells in the Endometrium of Cycling Mares-A Preliminary Study

Endometrial immune cells are essential to support uterine functions across the estrous cycle and in preparation for pregnancy. It has been acknowledged that changes in phenotype and/or numbers of lymphocytes, such as regulatory T cells (Tregs) and NK cells, might result in lower fertility in women and mice. Little is known about equine endometrial immune cells across the estrous cycle. Here, we compared the populations of endometrial Tregs and NK cells in estrus and diestrus in mares. Endometrial biopsy and blood samples were taken in estrus and diestrus from 11 mares ages 4-12 years. Flow cytometry with anti-CD4, -CD25 and -FOXP3 and anti-NKp46 and -CD3 antibodies was used to determine the populations of Tregs and NK cells, respectively. The concentration of progesterone was measured with chemiluminescence immunoassay. The results were analyzed with paired Student t tests. The mean percentage of endometrial CD4⁺FOXP3⁺ Tregs was 13.7 ± 6.2% in diestrus and 14.5 ± 5.9% in estrus, while the mean percentage of endometrial CD4⁺FOXP3⁺CD25⁺ Tregs changed from 3.6 ± 2.1% in diestrus to 2 ± 2% in estrus (p = 0.0947). The mean proportion of CD3^-NKp46⁺ lymphocytes in the endometrium was not significantly different, with 6 ± 1% in estrus and 6.5 ± 1.4% in diestrus. There was a large variation in the percentage of NK cells between mares of 2.1-12.7%. This study showed, for the first time, the presence of CD4⁺FOXP3⁺CD25⁺ Tregs and CD3^-NKp46⁺ NK cells in the endometrium of non-pregnant cycling mares. The percentage of Tregs, and to a greater extent NK cells, showed large fluctuations between mares. Both Tregs and NK cells might be important for the preparation of the endometrium for semen deposition and pregnancy; however, further research is required.

The NF-κB signaling pathway in mare's endometrium infiltrated with the inflammatory cells

Endometritis is an important issue decreasing mares' fertility. In the case of endometritis both, inflammatory cells infiltration and proinflammatory molecules production are regulated by various cellular and gene-regulatory mechanisms, including the nuclear factor-κB (NF-κB) dependent pathway. NF-κB signaling pathway has been recently studied in the equine endometrium in the context of endometrosis. Thus, this study aimed to determine gene transcription of NF-κB subunits (RelA; NF-κB1; NF-κB2), proinflammatory molecules (MCP-1; IL-6), and hyaluronan synthases (HAS 1; HAS 2; HAS 3) in endometritis and compare them with the intensity and type of inflammatory cell infiltration. Endometrial samples, collected post-mortem from cyclic mares in estrus or diestrus, were classified histologically and examined using quantitative PCR. Transcription NF-κB subunits genes did not differ with either inflammatory intensity or type of inflammatory cell infiltration. Transcription of MCP-1 and IL-6 genes increased with the severity of inflammation, with the involvement of HAS 3 and HAS 2 genes, as opposed to HAS 1 genes. These proinflammatory molecules and hyaluronan synthases in the equine inflamed endometrium do not seem to be regulated by the NF-κB pathway. Hence, separate signaling pathways for the development and progression of equine endometritis and endometrosis may be suggested.

Effects of Hysteroscopic and Uterine Body Insemination on the Presence of Selected Immune Cells in the Equine Endometrium

The effects of standard uterine body and hysteroscopic insemination on endometrial health were investigated. For this purpose, 33 mares were assigned to five different protocols: control (no insemination; n = 7), sham AI (sham uterine body insemination; n = 6), sham HysAI (sham hysteroscopic insemination; n = 7), standard AI (standard uterine body insemination, 300 × 10⁶ progressively motile sperms (PMS); n = 7) and HysAI (hysteroscopic insemination, 100 × 10⁶ PMS; n = 6). Sampling included uterine swabbing for microbiological examination, cytology for determination of polymorphonuclear neutrophils (PMNs) in the uterus, and endometrial biopsy collection for histology and characterization of endometrial immune cells on day 18 after ovulation (B1) as well as 8-10 hours (B2, day 20) and 72 hours after insemination (B3, day 23). Microbial contamination increased throughout the experiment in the sham insemination groups. Significant effects (P < .05) over time were detected for PMNs (cytology: sham HysAI, standard AI, and HysAI; histology: standard AI and HysAI), macrophages (immunohistochemistry: standard AI and HysAI) and T cells (immunohistochemistry: standard AI), showing an increase at B2 and a subsequent decrease toward baseline levels at B3. At B2, significant differences (P < .05) existed for PMNs (mean ± SEM) between control (1.3 ± 1.9%) and sham AI (2.2 ± 2.7%) versus standard AI (12.2 ± 4.7%) and for macrophages between control (4.1 ± 3.5%) and sham AI (2.5 ± 1.3%) versus standard AI (25.4 ± 15.8%). Thus, the cellular immune response of the endometrium depends on sperm deposition in the uterus and does not differ between hysteroscopic and standard uterine body insemination.

The Healthy and Diseased Equine Endometrium: A Review of Morphological Features and Molecular Analyses

Simple Summary

Diseases of the endometrium are a frequent cause of subfertility in mares and have an economic impact on the horse breeding industry. These include periglandular fibrosis of endometrial glands (endometrosis), degenerative diseases of vessels (angiosis), inflammation (endometritis), as well as altered differentiation of endometrial glands. Some mares are susceptible towards persistent endometritis. The etiology and pathogenesis of endometrosis are still unclear. This review describes morphological hallmarks and molecular features associated with endometrial health and different types of diseases. The presented literature data reveal characteristic differences in the expression of several extra- and intracellular molecules between the healthy and diseased equine endometrium. Some of these molecules can be detected directly within the tissue and thus have the potential to serve as excellent diagnostic markers for the presence of endometrial diseases. The knowledge of disease-associated changes in cellular differentiation, secretory functions, and immune mechanisms will help to decipher pathogenesis and will contribute to the development of novel treatments. In addition, the quantification of molecular alterations may contribute to a fertility prognosis for an individual mare. Reproductive health increases the well-being of mares and reduces financial loss for the horse breeding industry.

Abstract

Mares are seasonally polyestric. The breeding season in spring and summer and the winter anestrus are flanked by transitional periods. Endometrial diseases are a frequent cause of subfertility and have an economic impact on the horse breeding industry. They include different forms of endometrosis, endometritis, glandular maldifferentiation, and angiosis. Except for suppurative endometritis, these are subclinical and can only be diagnosed by the microscopic examination of an endometrial biopsy. Endometrosis is characterized by periglandular fibrosis and nonsuppurative endometritis by stromal infiltration with lymphocytes and plasma cells. The pathogenesis of endometrosis and nonsuppurative endometritis is still undetermined. Some mares are predisposed to persistent endometritis; this has likely a multifactorial etiology. Glandular differentiation has to be interpreted under consideration of the season. The presence of endometrial diseases is associated with alterations in the expression of several intra- and extracellular molecular markers. Some of them may have potential to be used as diagnostic biomarkers for equine endometrial health and disease. The aim of this review is to provide an overview on pathomorphological findings of equine endometrial diseases, to outline data on analyses of cellular and molecular mechanisms, and to discuss the impact of these data on reproduction and treatment.

Ultrastructural and histological characteristics of the equine endometrium at day 5 post ovulation

Rapid endometrial adaptations occur with the embryo entering the uterus to create a receptive uterine environment, which is essential for the conceptus' development. The aim of this study was to demonstrate ultrastructural and histological changes of the endometrium at day 5 after ovulation in cyclic and inseminated mares. Mares were daily examined by transrectal palpation and ultrasonographic examination of the reproductive tract until ovulation was detected. In the first cycle, endometrial biopsies from 10 cyclic mares (Cyclic group) were collected on day 5 post-ovulation. In the second cycle, the same mares were inseminated with fresh semen from a fertile stallion (Inseminated group). Intrauterine biopsies were collected on day 5 post-ovulation, and according to sampling moment, inseminated mares were subdivided into two subgroups, those sampled at day 5-5.5 (n = 5) and those sampled at day 5.5-6 (n = 5). Biopsy samples were analyzed through scanning electron microscopy and light microscopy. Inseminated group presented an increase in glandular diameter, decrease in ciliated cell population, and an increase in lymphocyte population, compared to Cyclic group. No differences were observed between both experimental groups in number of micro-ciliated polygonal cells, percentage of flat or protruded cells in the epithelium, amount of secretion over the epithelium, glandular density, glandular luminal diameter, height of the glandular epithelium, amount of intraglandular secretion, blood vessel diameter and number of eosinophils and neutrophils. No differences in any of the variables were detected between subgroups from inseminated mares. These facts lead to the hypothesis that there is some sort of signaling to prepare and adapt the uterus to maintain pregnancy even before embryo arrival. There is also evidence to support an alternative hypothesis suggesting that all of the above mentioned are inflammatory events, resulting from a previous inflammation due to residual seminal effects. The results here presented lead to the conclusion that significant ultrastructural and histological changes of the endometrium occur on day 5 post ovulation in inseminated mares.

Tissue distribution of some immune cells in bovine reproductive tract during follicular and luteal phase

More recent studies indicate that immune cells which secrete their secretory products or cytokines play an important role in reproductive system. In our study, immune cell populations (CD8⁺ T lymphocytes, CD68⁺ macrophages, plasma cells, siderophages, eosinophils) and expression of major histocompatibility complex (MHC) class I and class II were examined in female reproductive tract during follicular (n = 13) and luteal phase (n = 10). Plasma cells and eosinophil granulocytes are present in few numbers in luminal epithelium, but abundant in longitudinal muscle layer of uterus, whereas siderophages are the dominant cell type in stroma. Moreover, MHC-I and -II⁺ cells are expressed by individual cells in organ layers, while CD8⁺ T cells and CD68⁺ macrophages are dominant in epithelium and muscle layer, respectively. In conclusion, we did not found significant changes in immune cells according to follicular and luteal phases, but localization and numbers in each organ have changed according to both organ and layers. These results indicate that these factors may play a crucial role not only to generate an immune response but also to have a role in regulation of physiological functions in female reproductive organs.

The effect of select seminal plasma proteins on endometrial mRNA cytokine expression in mares susceptible to persistent mating-induced endometritis

In the horse, breeding induces a transient endometrial inflammation. A subset of mares are unable to resolve this inflammation, and they are considered susceptible to persistent mating-induced endometritis PMIE Select seminal plasma proteins cysteine-rich secretory protein-3 (CRISP-3) and lactoferrin have been shown to affect the innate immune response to sperm in vitro. The objective of this study was to determine whether the addition of CRISP-3 and lactoferrin at the time of insemination had an effect on the mRNA expression of endometrial cytokines in susceptible mares after breeding. Six mares classified as susceptible to PMIE were inseminated during four consecutive oestrous cycles with treatments in randomized order of: 1 mg/ml CRISP-3, 150 μg/ml lactoferrin, seminal plasma (positive control) or lactated Ringer's solution (LRS; negative control) to a total volume of 10 ml combined with 1 × 10⁹ spermatozoa pooled from two stallions. Six hours after treatment, an endometrial biopsy was obtained for qPCR analysis of selected genes associated with inflammation (pro-inflammatory cytokines interleukin (IL)-1β, IL-8, tumour necrosis factor (TNF)-α, interferon (INF)-γ, anti-inflammatory cytokines IL-1RN and IL-10, and inflammatory-modulating cytokine IL-6). Seminal plasma treatment increased the mRNA expression of IL-1β (p = .019) and IL-8 (p = .0068), while suppressing the mRNA expression of TNF (p = .0013). Lactoferrin also suppressed the mRNA expression of TNF (p = .0013). In conclusion, exogenous lactoferrin may be considered as one modulator of the complex series of events resulting in the poorly regulated pro-inflammatory response seen in susceptible mares.

Characterisation of lymphocyte subsets in the equine oviduct

REASONS FOR PERFORMING STUDY

The equine oviduct is the site of fertilisation and location of embryonic development during the first 5 or 6 days. It therefore has an important influence on mare fertility. Although histopathological changes have been described previously, there is limited information regarding lymphocyte subtypes present in the mucosa of the normal equine oviduct.

OBJECTIVES

To characterise the distribution of CD3+, CD4+, CD8+ and B lymphocytes in the equine oviduct from inseminated mares during oestrus and dioestrus, and from noninseminated mares during the immediate post ovulatory period.

METHODS

Oviductal tissues were collected from noninseminated mares at oestrus (> 30 mm follicle, n = 4), at Day 1 post ovulation (n = 3) and at dioestrus (Day 7 post ovulation; n = 4). Oviducts were also collected from inseminated mares at Days 1, 2, and 3 post ovulation (n = 4 for each period). Cross-sections of tissues from the ampullar-isthmic junction from each oviduct were snap frozen and cryostat sections stained by the immunoperoxidase technique with monoclonal antibodies directed against equine lymphocyte surface markers for B cells as well as CD3+, CD4+ and CD8+ cells.

RESULTS

In all oviductal sections examined, B cells were rare whereas T cells were relatively abundant. The predominant cell type found was the CD8+ phenotype, with a lesser number of CD4+ cells. Among mares, individual variation was large; therefore, although breeding status and stage of oestrous cycle appeared to alter lymphocyte populations, these differences were not significant.

CONCLUSIONS AND POTENTIAL RELEVANCE

A population of CD3+, CD4+ and CD8+ cells exists within the mucosal region of the equine oviduct. The density of these cells is similar to that described in the human oviduct. Their function is not currently known, but they may be involved with modulation of the maternal response to the presence of spermatozoa or the early conceptus within the equine oviduct. As our capacity to differentiate these cell types improves, along with the ability to identify the specific cytokines they produce, their functional significance will become more apparent.

Immune parameters in mares resistant and susceptible to persistent post-breeding endometritis: Effects of immunomodulation

Our objective was to characterize immune parameters in susceptible (SM) and resistant (RM) mares, with and without artificial insemination (AI) and immunomodulation. Eight RM and eight SM were selected based on their reproductive history and functional tests. Both groups of mares were evaluated during three consecutive cycles: Cycle 1, untreated cycle (control); Cycle 2, AI with dead semen; Cycle 3, AI with dead semen and immunomodulation. Endometrial biopsies were taken during the three cycles as follows: Cycle 1--at estrus, when follicles > or =35mm and at diestrus (7+/-1 days after ovulation); Cycle 2--at estrus 24h post-AI, and at diestrus; Cycle 3--at estrus 24h after treatment with a Mycobacterium phlei cell-wall extract (MCWE) and AI, and at diestrus. The mRNA transcription (mRNAT) of IL-8 and IL-10 were determined by real-time PCR. Image analysis of immunohistochemistry slides was performed using digital software (Image-Pro Plus v 5.0; Media Cybernetics); the percentage of stained area was determined for Major Histocompatibility Complex II (MHC-II), polymorphonuclear leukocytes (PMN) and T lymphocytes (TL) on each tissue section. In Cycle 1, SM had significantly higher MHC-II, TL, PMN and IL-8 than RM during estrus (P<0.006, P<0.0005, P<0.05, respectively), while transcription of IL-10 was significantly lower than in RM (P<0.0001). During diestrus, SM had higher levels of TL, PMN and IL-8 than RM (P<0.0001). After AI (Cycle 2), SM had higher levels of IL-8 and lower levels of IL-10 than RM at estrus and no differences were detected for MHC-II, TL and PMN positive cells. During diestrus in the same cycle, all the immune parameters were higher in SM mares (P<0.005, P<0.0004, P<0.0001, P<0.02, respectively). When MCWE was applied at the time of AI (Cycle 3), SM expressed significant higher levels of IL-10 24h after treatment (P<0.005), which were also higher than in the control Cycle 2 or after AI (Cycle 2). However, no significant differences were detected for MHC-II, lymphocytes-PMN or IL-8 between SM and RM during diestrus in Cycle 3. This study showed that SM had higher levels of all immune parameters except IL-10 than RM during Cycle 1. After AI (Cycle 2), the inflammatory condition persisted in SM but not RM mares until day 7 post-ovulation. Following treatment with MCWE at the time of AI (Cycle 3) uterine immunological changes in SM resulted in an endometrial immune environment similar to that found in normal RM.

Lactoferrin expression in the horse endometrium: Relevance in persisting mating-induced endometritis

Lactoferrin (LF) is an estrogen-regulated glycoprotein with well-described antibacterial and immunomodulatory properties. The present study is the first report on LF expression in horse endometrial specimens. Mares chosen for the study were either resistant or susceptible for persisting mating-induced endometritis (PMIE) during the natural ovulatory cycle and in early pregnancy. Our investigations included immunostaining for LF protein and CD18, a leukocyte marker, as neutrophils are a possible source for LF in the endometrium. Quantification of LF mRNA was performed by use of real-time RT-PCR. This study demonstrated that LF protein in equine endometrium was expressed in glandular and luminal epithelium and in neutrophils. Similar to other mammalian species, the level of endometrial LF transcription in the mare was modulated according to the stage of the estrus cycle and was 5500-fold higher during estrus compared with diestrus and early pregnancy. The endometria from mares susceptible for PMIE and delayed uterine clearance exhibited an increased LF transcription during all stages of the estrus cycle that reached statistical significance in proestrus. In the endometria of mares susceptible for PMIE the upregulated LF mRNA expression was not associated with a higher number of CD18 positive leukocytes but correlated with the number of uterine glands. Enhanced LF transcription within the endometrial epithelium might therefore be a response to recurrent persisting inflammation following insemination in mares with delayed uterine clearance.

Lymphocytes and T lymphocyte subsets are regionally distributed in the female goat reproductive tract: influence of the stage of the oestrous cycle

The reproductive tract of the female is a part of the mucosal system which protects from pathogens invasion. We have analysed the presence and distribution of total lymphocytes, plasma cells (antibody secreting B cells) and T lymphocytes subsets in the reproductive tract of the female goat. The influence of the oestrous cycle on the densities of lymphocytes and plasma cells of the cervix and uterus horn was evaluated in sections prepared for conventional histology. Immunocytochemistry was used for the study of lymphocyte subsets by confocal microscopy and immunoperoxidase techniques. Present results show that the reproductive tract of the goat is a site rich in lymphocytes. These cells were found mingled with the epithelial cells of the endometrium and distributed throughout the stroma. Lymphocyte aggregates were observed in the stroma. Lymphocyte but not plasma cell number changed depending on the reproductive stage of the goats. The impact of the hormonal environment was different for the cervix and uterine horn. Immunocytochemistry studies evidenced the presence of cells displaying immunoreactivity for both CD 4+ and CD 8+ antibodies in the epithelial layer and stroma of the cervix and uterine horn. These cells were more numerous in the cervix and were also found infiltrating the luminal epithelia of endometrial glands. Overall, our results indicate that lymphocyte distribution is different in the cervix and the horn, and is influenced by the stage of the reproductive cycle. In summary, CD 4+ and CD 8+ T lymphocytes subsets could be found in the endometrium of both the cervix and uterine horn of the goat reproductive tract.

T-cell distribution in two different segments of the equine endometrium 6 and 48 hours after insemination

The T-cell response after the introduction of semen into the uterine cavity in the mare was studied by examining, immunohistochemically, the distribution of helper T-cells (CD4+) and cytotoxic T-cells (CD8+) in endometrial biopsy specimens. Endometrial tissue samples were obtained from twenty-five gynecologically healthy mares during estrus before and 6 or 48 h after deposition of a single dose of stallion semen. An increase (P=0.04) in the number of helper T-cells (CD4+) compared to pre-insemination values was observed in the uterine body in both groups, 6 and 48 h, after insemination. No significant variations in numbers of CD8+ cells were recorded either 6 or 48 h after insemination. There seems to be an early (6 h) recruitment of helper T-cells to the equine endometrium after semen deposition, which might be related to the activation of the endometritis-like reaction seen as part of the equine uterine immune defense during estrus.

Post-breeding endometritis in the mare

Post-breeding endometritis is a major cause of subfertility in the mare. Endometritis is a normal event in the immediate period after mating, but the presence of ultransonographically visible uterine fluid more than 12 h later is thought to be evidence of uterine pathology. In mares that are free of venerally transmitted endometritis, treatment is aimed at removing the intraluminal fluid. If the endometritis persists past day 5, when the embryo enters the uterine lumen, the cytotoxic environment will not be compatible with pregnancy. Reproductive anatomy, defective myometrial contractility, lowered immune defences, overproduction of mucus, inadequate lymphatic drainage, or a combination of these factors will predispose the mare to post-breeding endometritis.

Compartmentalization of steroidogen esis by the equine corpus luteum

The presence of cytochrome P450C17 within equine follicles and corpora lutea (CL) was detected by immunostaining. Two different antibodies were used which had previously been shown by immunoblotting to cross-react with equine P450C17. Strong positive immunostaining was present in the theca-derived cells of the CL during the estrous cycle and pregnancy. In the CL from mares after Day 40 of pregnancy there were also occasional bands of positively stained cells which resembled the polyhedral-shaped theca cells seen in preovulatory follicles. The pattern of immunostaining suggested compartmentalization of steroidogenesis within the equine CL with small cells possessing the potential to produce androgen which could then be aromatized to estrogen by the large luteal cells.

Oxytocin in the semen and gonads of the stallion

It has been suggested that oxytocin is involved in sperm transport and motility in domestic animals. Immunoreactive oxytocin was measured in seminal fractions (pre-ejaculatory fluid, seminal plasma, gel and sperm) and in extracts of testis and epididymis from stallions. In addition, sections of gonadal tissue from stallions were immunostained for the presence of oxytocin and its neurophysin. Oxytocin was detected in all of the seminal fractions, being highest in the gel. It was also present in washed, lysed sperm and in extracts from the testis and epididymis. Immunostaining for oxytocin was present in occasional interstitial cells in the testis and in the epididymal epithelium and smooth muscle. However, immunostaining for neurophysin was detected in a few interstitial cells in the testis of only 1 of 8 stallions and was absent from all areas of the epididymis. These data demonstrate for the first time the presence of oxytocin in stallion semen and gonadal tissue; however, lack of immunostaining for neurophysin indicated that it was unlikely that there was local synthesis within the gonads.

Does artificial insemination with chilled, extended semen reduce the antigenic challenge to the mare's uterus compared with natural service?

Uterine response in infection-resistant mares (n = 5) at 48 h after AI was compared with that following natural service in these same mares, and after AI in infection-susceptible mares (n = 6). In the resistant mares, small amounts of uterine fluid were detected and bacteria were isolated infrequently at 48 h after breeding, but cytological examination of uterine flushes revealed that a significant degree of endometritis was present. There was no difference in the degree of inflammatory response by 48 h after AI or natural mating. In 4 of the 6 susceptible mares moderate to large accumulations of intrauterine fluid were detected at 48 h after AI, and massive uterine neutrophilia was present in all 6 mares. It was concluded that there was no evidence that using conventional AI techniques limited the inflammatory response of the mare's uterus.