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Milosevic Stevanovic J, Krstic M, Vukomanovic P, Kutlesic R, Trajkovic SP, Simic D. Failure of placentation and pregnancy complications: The role of feto-maternal immune balance. Eur J Obstet Gynecol Reprod Biol 2024; 295:126-135. [PMID: 38354605 DOI: 10.1016/j.ejogrb.2024.02.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 02/05/2024] [Accepted: 02/10/2024] [Indexed: 02/16/2024]
Affiliation(s)
- Jelena Milosevic Stevanovic
- Department of Gynecology and Obstetrics, Faculty of Medicine, University of Nis, Nis, Serbia; Clinic of Gynecology and Obstetrics, Clinical Center Nis, Nis, Serbia.
| | - Miljan Krstic
- Department of Pathology, Faculty of Medicine, University of Nis, Nis, Serbia; Center for Pathology, Clinical Center Nis, Nis, Serbia
| | - Predrag Vukomanovic
- Department of Gynecology and Obstetrics, Faculty of Medicine, University of Nis, Nis, Serbia; Clinic of Gynecology and Obstetrics, Clinical Center Nis, Nis, Serbia
| | - Ranko Kutlesic
- Department of Gynecology and Obstetrics, Faculty of Medicine, University of Nis, Nis, Serbia; Clinic of Gynecology and Obstetrics, Clinical Center Nis, Nis, Serbia
| | - Sonja Pop Trajkovic
- Department of Gynecology and Obstetrics, Faculty of Medicine, University of Nis, Nis, Serbia; Clinic of Gynecology and Obstetrics, Clinical Center Nis, Nis, Serbia
| | - Dusan Simic
- Department of Gynecology and Obstetrics, Faculty of Medicine, University of Nis, Nis, Serbia
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Tomkiewicz J, Darmochwał-Kolarz D. The Diagnostics and Treatment of Recurrent Pregnancy Loss. J Clin Med 2023; 12:4768. [PMID: 37510883 PMCID: PMC10380966 DOI: 10.3390/jcm12144768] [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: 06/01/2023] [Revised: 06/21/2023] [Accepted: 07/17/2023] [Indexed: 07/30/2023] Open
Abstract
Recurrent pregnancy loss is a common problem in the reproductive age population of women. It can be caused by many different conditions. This problem is addressed in international guidelines that take a slightly different approach to its diagnosis and treatment. The guidelines used in this review mainly use the guidelines of the Royal College of Obstetricians and Gynaecologists (RCOG), American Society of Reproductive Medicine (ASRM) and European Society of Human Reproduction and Embryology (ESHRE). This review shows how much the approach to miscarriages has changed and how much more needs to be explored and refined. The review also addresses the topic of unexplained pregnancy loss, which continues to be a challenge for clinicians.
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Affiliation(s)
- Julia Tomkiewicz
- Fryderyk Chopin University Hospital No 1, 35-055 Rzeszow, Poland
| | - Dorota Darmochwał-Kolarz
- Department of Obstetrics & Gynecology, Medical College, University of Rzeszow, 35-959 Rzeszow, Poland
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Horiuchi Y, Yanaihara A, Hatakeyama S, Taga Y, Kondou T, Kuramoto G, Ohgi S. Efficacy of Hyaluronan-Enriched Transfer Medium for Low-Grade Frozen Embryo Transfer. Cureus 2023; 15:e39210. [PMID: 37337498 PMCID: PMC10276893 DOI: 10.7759/cureus.39210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2023] [Indexed: 06/21/2023] Open
Abstract
RESEARCH QUESTION This study aimed to retrospectively evaluate the efficacy of a hyaluronan-enriched transfer medium (HETM) for transfer failures and transfer of frozen embryos that have been graded as C at the time of transfer according to the Gardner classification of trophectoderm (TE). DESIGN This study included 365 cycles of unsuccessful frozen-thawed embryo transfers in hormone replacement cycles graded C according to the Gardner classification of TE at the time of transfer. Clinical pregnancy rates were compared using the χ2 test, with the patients divided into two groups: one whose transfers did include HETM (HETM group) and one whose transfers did not include HETM (control group). As a subgroup analysis, patients with a TE grade of C at the time of transplantation were divided into two groups: those aged 39 years or younger and those aged 40 years or older at the time of transplantation. The clinical pregnancy rates of the groups with and without HETM were then compared. RESULTS No difference in the clinical pregnancy rates between the HETM and control groups was observed. CONCLUSIONS Hyaluronic acid is believed to favor implantation by promoting adhesion between the embryo and the endometrium, and there are reports of improved implantation and pregnancy rates as a result of HETM. However, the present results suggest limited effectiveness for HETM. Further case series should be conducted, and the suitability of its use as a treatment should be investigated.
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Affiliation(s)
- Yoriko Horiuchi
- Obstetrics and Gynecology, Yanaihara Women's Clinic, Kamakura, JPN
| | | | - Shota Hatakeyama
- Obstetrics and Gynecology, Yanaihara Women's Clinic, Kamakura, JPN
| | - Yukino Taga
- Obstetrics and Gynecology, Yanaihara Women's Clinic, Kamakura, JPN
| | - Tetsurou Kondou
- Obstetrics and Gynecology, Showa University Koto Toyosu Hospital, Tokyo, JPN
| | - Goro Kuramoto
- Obstetrics and Gynecology, Tokyo Women's Medical University, Tokyo, JPN
| | - Shirei Ohgi
- Obstetrics and Gynecology, Yanaihara Women's Clinic, Kamakura, JPN
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Placental Syndromes-A New Paradigm in Perinatology. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19127392. [PMID: 35742640 PMCID: PMC9224387 DOI: 10.3390/ijerph19127392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 06/08/2022] [Accepted: 06/13/2022] [Indexed: 12/10/2022]
Abstract
Placental syndromes include pregnancy loss, fetal growth restriction, preeclampsia, preterm delivery, premature rupture of membranes, placental abruption and intrauterine fetal demise. This paper discusses the common etiopathogenesis of those syndromes and the role of angiogenic biomarkers in their development. Pregnancy implantation, placental development and maternal adaptation are complex processes in which fetal and maternal cells interact. The syncytiotrophoblast, trophoblast, uterine natural killer cells and regulatory T cells interfere and interact in all the above-mentioned processes. The proper angioneogenesis and vasculogenesis of the placenta, as well as maternal circulatory adaptation, are dependent on angiogenic factor expression. Insufficient maternal immunotolerance, dysregulation in uterine natural killer or regulatory T cell function, syncytiotrophoblast and trophoblast ischemia and hypoxia or impaired balance in angiogenic factors are all related to the occurrence of placental syndromes. Differences in the time of impairment onset and its intensity and correlation with other dysfunctions result in the development of a specific syndrome. The clinical manifestations in the form of a combination of specific symptoms determine the diagnosis. However, they are just symptoms of an underlying complex trophoblast disorder.
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Benner M, Feyaerts D, Lopez-Rincon A, van der Heijden OWH, van der Hoorn ML, Joosten I, Ferwerda G, van der Molen RG. A combination of immune cell types identified through ensemble machine learning strategy detects altered profile in recurrent pregnancy loss: a pilot study. F&S SCIENCE 2022; 3:166-173. [PMID: 35560014 DOI: 10.1016/j.xfss.2022.02.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 02/03/2022] [Accepted: 02/03/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To compare the immunologic profiles of peripheral and menstrual blood (MB) of women who experience recurrent pregnancy loss and women without pregnancy complications. DESIGN Explorative case-control study. Cross-sectional assessment of flow cytometry-derived immunologic profiles. SETTING Academic medical center. PATIENT(S) Women who experienced more than 2 consecutive miscarriages. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Flow cytometry-based immune profiles of uterine and systemic immunity (recurrent pregnancy loss, n = 18; control, n = 14) assessed by machine learning classifiers in an ensemble strategy, followed by recursive feature selection. RESULT(S) In peripheral blood, the combination of 4 cell types (nonswitched memory B cells, CD8+ T cells, CD56bright CD16- natural killer [NKbright] cells, and CD4+ effector T cells) classified samples correctly to their respective cohort. The identified classifying cell types in peripheral blood differed from the results observed in MB, where a combination of 6 cell types (Ki67+CD8+ T cells, (Human leukocyte antigen-DR+) regulatory T cells, CD27+ B cells, NKbright cells, regulatory T cells, and CD24HiCD38Hi B cells) plus age allowed for assigning samples correctly to their respective cohort. Based on the combination of these features, the average area under the curve of a receiver operating characteristic curve and the associated accuracy were >0.8 for both sample sources. CONCLUSION(S) A combination of immune subsets for cohort classification allows for robust identification of immune parameters with possible diagnostic value. The noninvasive source of MB holds several opportunities to assess and monitor reproductive health.
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Affiliation(s)
- Marilen Benner
- Radboud Institute of Molecular Life Sciences, Department of Laboratory Medicine, Laboratory of Medical Immunology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Dorien Feyaerts
- Radboud Institute of Molecular Life Sciences, Department of Laboratory Medicine, Laboratory of Medical Immunology, Radboud University Medical Center, Nijmegen, the Netherlands
| | | | | | | | - Irma Joosten
- Radboud Institute of Molecular Life Sciences, Department of Laboratory Medicine, Laboratory of Medical Immunology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Gerben Ferwerda
- Radboud Institute of Molecular Life Sciences, Department of Laboratory Medicine, Laboratory of Medical Immunology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Renate G van der Molen
- Radboud Institute of Molecular Life Sciences, Department of Laboratory Medicine, Laboratory of Medical Immunology, Radboud University Medical Center, Nijmegen, the Netherlands.
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6
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Understanding human immunity in idiopathic recurrent pregnancy loss. Eur J Obstet Gynecol Reprod Biol 2021; 270:17-29. [PMID: 35007974 DOI: 10.1016/j.ejogrb.2021.12.024] [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: 03/11/2021] [Revised: 12/12/2021] [Accepted: 12/21/2021] [Indexed: 01/03/2023]
Abstract
Miscarriage, defined as the loss of a pregnancy before a viable gestation, affects 1 in 6 couples. Recurrent pregnancy loss (RPL), defined as two or more miscarriages, affects up to 1.9% of couples. The physical, psychological, and financial impact of miscarriage can be substantial. However, despite its multifactorial etiology, for up to 50% of couples a reason behind this condition cannot be identified, termed 'idiopathic RPL'. Much recent research has strived to understand this, with immune dysregulation being a source of particular interest. In this short review we summarize the current evidence on the complex role of the immune system both pre- and early post-conception in RPL. A key question is whether systemic peripheral blood markers, in particular natural killer cell and T cells, may be utilized to accurately predict and/ or diagnose those pregnancies at high risk of loss. Given the invasive nature of endometrial testing, identification of reliable peripheral immune biomarkers is particularly appealing. Clinical trials using potent immunomodulatory agents, including intravenous immunoglobulin, donor leukocyte immunization, and tumor necrosis factor (TNF)-α inhibitors, have been undertaken with the primary objective of preventing miscarriage in women with RPL. Standardisation of both diagnostic and prognostic immune cell testing assays is required to permit accurate identification of those women who may benefit from immunomodulation. Prompt clarification is required to meet the increasing expectation from couples and clinicians, as without these advancements women are at risk of exposure to potent immune-therapies and subsequent studies are at risk of failure, generating further controversy regarding the role of immune dysregulation in women with RPL. Through this review we highlight clear gaps in our current knowledge on immune activity in RPL.
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KIECKA ANETA, MACURA BARBARA, SZCZEPANIK MARIAN. Can Lactobacillus spp. Be a Factor Reducing the Risk of Miscarriage? Pol J Microbiol 2021; 70:431-446. [PMID: 35003275 PMCID: PMC8702604 DOI: 10.33073/pjm-2021-043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 10/30/2021] [Indexed: 11/30/2022] Open
Abstract
Pregnancy loss is a common obstetric problem. Significant causes of miscarriage include genetic and epigenetic disorders of the embryo, immunological and endocrine factors, uterine malformations, improper embryo selection, and lifestyle. Perhaps a hitherto underappreciated cause of miscarriage may be an abnormal microbiota composition of the female reproductive system. Lactobacillus spp. is the most common bacteria within the reproductive tract. However, the protective role of Lactobacilli in the vagina has been well described in the literature, while it is still unknown what function Lactobacilli may have in the uterus. Moreover, new research shows that Lactobacillus spp. can have a role in miscarriage. However, both molecular and immunological mechanisms of host-Lactobacillus spp. interactions are not fully understood. Understanding these relationships will help address the importance and extent of the protective role of Lactobacillus spp. in miscarriage.
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Affiliation(s)
- ANETA KIECKA
- Jagiellonian University Medical College, Faculty of Health Sciences, Institute of Physiotherapy, Chair of Biomedical Sciences, Cracow, Poland
| | - BARBARA MACURA
- Jagiellonian University Medical College, Faculty of Health Sciences, Institute of Physiotherapy, Chair of Biomedical Sciences, Cracow, Poland
| | - MARIAN SZCZEPANIK
- Jagiellonian University Medical College, Faculty of Health Sciences, Institute of Physiotherapy, Chair of Biomedical Sciences, Cracow, Poland
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Kolanska K, Uddin J, Dabi Y, Mathieu d'Argent E, Dupont C, Selleret L, Touboul C, Antoine JM, Chabbert-Buffet N, Daraï E. Secondary infertility with a history of vaginal childbirth: Ready to have another one? J Gynecol Obstet Hum Reprod 2021; 51:102271. [PMID: 34785399 DOI: 10.1016/j.jogoh.2021.102271] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 10/25/2021] [Accepted: 11/10/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Up to 30% of couples may face secondary infertility. The impact of ectopic pregnancy, spontaneous abortion, pregnancy termination or live birth with caesarean section may impair further fertility in different ways. However, secondary infertility after physiological vaginal life childbirth has been little studied. The aim of this study was to describe the population and the fertility issues and analyze the predictive factors of success in in vitro fertilization in women presenting secondary infertility after a physiological vaginal childbirth. MATERIAL AND METHODS This single-centre retrospective study included women aged 18-43 years consulting between 2013 and 2020 for secondary infertility in a couple having already had previous vaginal life childbirth. Couples' characteristics, management decision after the first consultation and IVF outcomes were analyzed. RESULTS Secondary infertility was found in 286 couples, out of whom 138 had a history of vaginal life childbirth. Population was characterized by an advanced female age and overweight. After the first consultation, IVF was performed in only 40% of couples. No predictive factor of live birth was found. CONCLUSION Our study shows that in couples with secondary infertility after prior physiological delivery cigarette smoking is frequent in male partners, and ovarian reserve markers are altered. However, no statistically significant predictive factor of live birth after IVF treatment has been identified. Further large prospective studies are necessary.
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Affiliation(s)
- Kamila Kolanska
- Service de gynécologie obstétrique et médecine de la reproduction, Hôpital Tenon, AP-HP, Sorbonne Université, 4 rue de la Chine, 75020 Paris, France; INSERM UMRS 938, Centre de Recherche Saint-Antoine, 27 rue Chaligny, 75571 PARIS cedex 12, France.
| | - Jennifer Uddin
- Service de gynécologie obstétrique et médecine de la reproduction, Hôpital Tenon, AP-HP, Sorbonne Université, 4 rue de la Chine, 75020 Paris, France
| | - Yohann Dabi
- Service de gynécologie obstétrique et médecine de la reproduction, Hôpital Tenon, AP-HP, Sorbonne Université, 4 rue de la Chine, 75020 Paris, France
| | - Emmanuelle Mathieu d'Argent
- Service de gynécologie obstétrique et médecine de la reproduction, Hôpital Tenon, AP-HP, Sorbonne Université, 4 rue de la Chine, 75020 Paris, France
| | - Charlotte Dupont
- INSERM UMRS 938, Centre de Recherche Saint-Antoine, 27 rue Chaligny, 75571 PARIS cedex 12, France; Service de biologie de la reproduction-CECOS, Hôpital Tenon, AP-HP, Sorbonne Université, 4 rue de la Chine, 75020 Paris, France
| | - Lise Selleret
- Service de gynécologie obstétrique et médecine de la reproduction, Hôpital Tenon, AP-HP, Sorbonne Université, 4 rue de la Chine, 75020 Paris, France
| | - Cyril Touboul
- Service de gynécologie obstétrique et médecine de la reproduction, Hôpital Tenon, AP-HP, Sorbonne Université, 4 rue de la Chine, 75020 Paris, France; INSERM UMRS 938, Centre de Recherche Saint-Antoine, 27 rue Chaligny, 75571 PARIS cedex 12, France
| | - Jean-Marie Antoine
- Service de gynécologie obstétrique et médecine de la reproduction, Hôpital Tenon, AP-HP, Sorbonne Université, 4 rue de la Chine, 75020 Paris, France
| | - Nathalie Chabbert-Buffet
- Service de gynécologie obstétrique et médecine de la reproduction, Hôpital Tenon, AP-HP, Sorbonne Université, 4 rue de la Chine, 75020 Paris, France; INSERM UMRS 938, Centre de Recherche Saint-Antoine, 27 rue Chaligny, 75571 PARIS cedex 12, France
| | - Emile Daraï
- Service de gynécologie obstétrique et médecine de la reproduction, Hôpital Tenon, AP-HP, Sorbonne Université, 4 rue de la Chine, 75020 Paris, France; INSERM UMRS 938, Centre de Recherche Saint-Antoine, 27 rue Chaligny, 75571 PARIS cedex 12, France
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9
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Jiang L, Fei H, Jin X, Liu X, Yang C, Li C, Chen J, Yang A, Zhu J, Wang H, Fei X, Zhang S. Extracellular Vesicle-Mediated Secretion of HLA-E by Trophoblasts Maintains Pregnancy by Regulating the Metabolism of Decidual NK Cells. Int J Biol Sci 2021; 17:4377-4395. [PMID: 34803505 PMCID: PMC8579460 DOI: 10.7150/ijbs.63390] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 09/24/2021] [Indexed: 01/08/2023] Open
Abstract
Extracellular vesicles derived from trophoblasts (T-EVs) play an important role in pregnancy, but the mechanism is not entirely clear. In this study, we found that HLA-E, which is mostly confined to the cytoplasm of trophoblast cells, was secreted by T-EVs. The level of HLA-E in T-EVs from unexplained recurrent spontaneous abortion (URSA) patients was lower than that in normal pregnancy (NP) and RSA patients who had an abnormal embryo karyotype (AK-RSA). T-EVs promoted secretion of IFN-γ and VEGFα by decidual NK (dNK) cells from URSA patients via HLA-E, VEGFα was necessary for angiogenesis and trophoblast growth, and IFN-γ inhibited Th17 induction. Glycolysis and oxidative phosphorylation (OxPhos) were involved in this process. Glycolysis but not OxPhos of dNK cells facilitated by T-EVs was dependent on mTORC1 activation. Inhibition of T-EV production in vivo increased the susceptibility of mice to embryo absorption, which was reversed by transferring exogenous T-EVs. T-EVs promoted secretion of IFN-γ and VEGFα by dNK cells to maintain pregnancy via Qa-1 in abortion-prone mouse models. This study reveals a new mechanism of pregnancy maintenance mediated by HLA-E via T-EVs.
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Affiliation(s)
- Lingling Jiang
- Assisted Reproduction Unit, Department of Obstetrics and Gynecology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, 310016, Hangzhou, China
- Department of Obstetrics and Gynecology, Key Laboratory of Reproductive Dysfunction, Management of Zhejiang Province, 310016, Hangzhou, China
| | - Haiyi Fei
- Assisted Reproduction Unit, Department of Obstetrics and Gynecology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, 310016, Hangzhou, China
- Department of Obstetrics and Gynecology, Key Laboratory of Reproductive Dysfunction, Management of Zhejiang Province, 310016, Hangzhou, China
| | - Xiaoying Jin
- Assisted Reproduction Unit, Department of Obstetrics and Gynecology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, 310016, Hangzhou, China
- Department of Obstetrics and Gynecology, Key Laboratory of Reproductive Dysfunction, Management of Zhejiang Province, 310016, Hangzhou, China
| | - Xiu Liu
- Assisted Reproduction Unit, Department of Obstetrics and Gynecology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, 310016, Hangzhou, China
- Department of Obstetrics and Gynecology, Key Laboratory of Reproductive Dysfunction, Management of Zhejiang Province, 310016, Hangzhou, China
| | - Cuiyu Yang
- Assisted Reproduction Unit, Department of Obstetrics and Gynecology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, 310016, Hangzhou, China
- Department of Obstetrics and Gynecology, Key Laboratory of Reproductive Dysfunction, Management of Zhejiang Province, 310016, Hangzhou, China
| | - Chao Li
- Assisted Reproduction Unit, Department of Obstetrics and Gynecology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, 310016, Hangzhou, China
- Department of Obstetrics and Gynecology, Key Laboratory of Reproductive Dysfunction, Management of Zhejiang Province, 310016, Hangzhou, China
| | - Jianmin Chen
- Assisted Reproduction Unit, Department of Obstetrics and Gynecology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, 310016, Hangzhou, China
- Department of Obstetrics and Gynecology, Key Laboratory of Reproductive Dysfunction, Management of Zhejiang Province, 310016, Hangzhou, China
| | - Anran Yang
- Assisted Reproduction Unit, Department of Obstetrics and Gynecology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, 310016, Hangzhou, China
- Department of Obstetrics and Gynecology, Key Laboratory of Reproductive Dysfunction, Management of Zhejiang Province, 310016, Hangzhou, China
| | - Jiajuan Zhu
- Assisted Reproduction Unit, Department of Obstetrics and Gynecology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, 310016, Hangzhou, China
- Department of Medical, Jiaxing University Affiliated Women and Children Hospital, 314051, Jiaxing, China
| | - Huihong Wang
- Department of Obstetrics and Gynecology, Hangzhou Women's Hospital, 310008, Hangzhou, China
| | - Xiaoyang Fei
- Department of Obstetrics and Gynecology, Hangzhou Women's Hospital, 310008, Hangzhou, China
| | - Songying Zhang
- Assisted Reproduction Unit, Department of Obstetrics and Gynecology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, 310016, Hangzhou, China
- Department of Obstetrics and Gynecology, Key Laboratory of Reproductive Dysfunction, Management of Zhejiang Province, 310016, Hangzhou, China
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10
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Biology and pathology of the uterine microenvironment and its natural killer cells. Cell Mol Immunol 2021; 18:2101-2113. [PMID: 34426671 PMCID: PMC8429689 DOI: 10.1038/s41423-021-00739-z] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 07/12/2021] [Indexed: 02/07/2023] Open
Abstract
Tissues are the new frontier of discoveries in immunology. Cells of the immune system are an integral part of tissue physiology and immunity. Determining how immune cells inhabit, housekeep, and defend gut, lung, brain, liver, uterus, and other organs helps revealing the intimate details of tissue physiology and may offer new therapeutic targets to treat pathologies. The uterine microenvironment modulates the development and function of innate lymphoid cells [ILC, largely represented by natural killer (NK) cells], macrophages, T cells, and dendritic cells. These immune cells, in turn, contribute to tissue homeostasis. Regulated by ovarian hormones, the human uterine mucosa (endometrium) undergoes ~400 monthly cycles of breakdown and regeneration from menarche to menopause, with its fibroblasts, glands, blood vessels, and immune cells remodeling the tissue into the transient decidua. Even more transformative changes occur upon blastocyst implantation. Before the placenta is formed, the endometrial glands feed the embryo by histiotrophic nutrition while the uterine spiral arteries are stripped of their endothelial layer and smooth muscle actin. This arterial remodeling is carried out by invading fetal trophoblast and maternal immune cells, chiefly uterine NK (uNK) cells, which also assist fetal growth. The transformed arteries no longer respond to maternal stimuli and meet the increasing demands of the growing fetus. This review focuses on how the everchanging uterine microenvironment affects uNK cells and how uNK cells regulate homeostasis of the decidua, placenta development, and fetal growth. Determining these pathways will help understand the causes of major pregnancy complications.
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11
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Hao F, Zhou X, Jin L. Natural killer cells: functional differences in recurrent spontaneous abortion†. Biol Reprod 2021; 102:524-531. [PMID: 31742319 DOI: 10.1093/biolre/ioz203] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 03/13/2019] [Accepted: 10/21/2019] [Indexed: 12/15/2022] Open
Abstract
Recurrent spontaneous abortion (RSA) is one of the major pregnancy disorders and poses a serious risk to both the mother and the fetus. Although a number of research efforts have been conducted, therapeutic advances for treating RSA have not lived up to their expectations. Hence, other treatments should be explored. The important role of natural killer (NK) cells in immunotherapy is attracting increasing attention, both as a pharmaceutical target and for cell therapies. NK cells are abundant in the endometrium and play a role in implantation and placentation in normal pregnancy. As research progresses, NK cells are increasingly regarded as playing essential roles in the emergence and development of RSA. In this article, I review recent findings on the role of uterine NK cells in the pathophysiology of RSA. These cells may become therapeutic NK cell-related targets. In conclusion, although several issues regarding NK cells in RSA remain unresolved and require further investigation, extensive evidence is available for the treatment of RSA.
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Affiliation(s)
- Fan Hao
- Clinical and Translational Research Center, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xiangyu Zhou
- Clinical and Translational Research Center, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China
| | - Liping Jin
- Clinical and Translational Research Center, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China
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12
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Kniotek M, Roszczyk A, Zych M, Szafarowska M, Jerzak M. Differences in the Expression of KIR, ILT Inhibitory Receptors, and VEGF Production in the Induced Decidual NK Cell Cultures of Fertile and RPL Women. BIOMED RESEARCH INTERNATIONAL 2021; 2021:6673427. [PMID: 33997038 PMCID: PMC8112925 DOI: 10.1155/2021/6673427] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 04/09/2021] [Accepted: 04/22/2021] [Indexed: 12/28/2022]
Abstract
RESULTS KIR2DL1 and ILT-2 expression on idNK cells was higher in healthy women than in RPL patients. Sildenafil enhanced NKG2A expression in RPL patients. VEGF concentration was higher in fertile woman idNK cell cultures. idNK cells were more sensitive for necrosis in RPL than in fertile women. SC did not influence VEGF production or idNK cell apoptosis. CONCLUSIONS A combination of hypoxia, IL-15, and AZA promotes the conversion of pbNK into idNK cells CD56+CD16--expressing KIR receptors and produces VEGF. Alterations in KIR2DL1 and ILT-2 expression as well as impaired VEGF production were associated with RPL. SC affects NKG2A expression on RPL idNK cells. SC had no effect on VEGF release or idNK cell apoptosis.
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Affiliation(s)
- Monika Kniotek
- Department of Clinical Immunology, Transplantation Institute, Medical University of Warsaw, Nowogrodzka 59, Warsaw, 02-006 Mazovian Voivodeship, Poland
| | - Aleksander Roszczyk
- Department of Clinical Immunology, Transplantation Institute, Medical University of Warsaw, Nowogrodzka 59, Warsaw, 02-006 Mazovian Voivodeship, Poland
| | - Michał Zych
- Department of Clinical Immunology, Transplantation Institute, Medical University of Warsaw, Nowogrodzka 59, Warsaw, 02-006 Mazovian Voivodeship, Poland
| | - Monika Szafarowska
- Department of Gynecology and Gynecologic Oncology, Military Institute of Health Sciences, Szaserów 128, Warsaw, 04-141 Mazovian Voivodeship, Poland
| | - Małgorzata Jerzak
- Department of Gynecology and Gynecologic Oncology, Military Institute of Health Sciences, Szaserów 128, Warsaw, 04-141 Mazovian Voivodeship, Poland
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Takeyama R, Fukui A, Mai C, Yamamoto M, Saeki S, Yamaya A, Shibahara H. Co-expression of NKp46 with activating or inhibitory receptors on, and cytokine production by, uterine endometrial NK cells in recurrent pregnancy loss. J Reprod Immunol 2021; 145:103324. [PMID: 33930666 DOI: 10.1016/j.jri.2021.103324] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 03/28/2021] [Accepted: 04/13/2021] [Indexed: 11/24/2022]
Abstract
NKp46 (CD335) is one of the activating receptors expressed on NK cells and its expression is decreased in patients with reproductive failure. However, the reasons remain unknown. In this study, we aimed to clarify the significance of decreased NKp46 expression in reproductive failure. Uterine endometrial samples collected from 39 patients with recurrent pregnancy loss (RPL) were assigned to high- or low-risk groups based on an 18 % ratio of CD16+/CD56dim NK cells in uterine endometrial NK (uNK) cells. We analyzed the expression of NKp46 and other activating or inhibitory receptors on, and intracellular cytokine production by NK cells using multicolor flow cytometry. The numbers of NKp46+/CD16- NK, NKp46+/NKG2C- NK, IL-4+/CD56+ NK, and IL-10+/CD56+ NK cells were significantly decreased, whereas that TNF-α+/CD56+ NK cells was significantly increased in the high-risk group, when compared with the low-risk group (P < 0.05 for all). The ratios of TNF-α/IL-4, IFN-γ/IL4, TNF-α/IL-10, and IFN-γ/IL10 cytokine production in uNK cells were significantly increased in the high-risk when compared with the low-risk group (P < 0.05, for all). It is suggested that low expression of activating receptors on NKp46 uNK cells is more prevalent in high-risk women.
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Affiliation(s)
- Ryu Takeyama
- Department of Obstetrics and Gynecology, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Atsushi Fukui
- Department of Obstetrics and Gynecology, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan.
| | - Chuxian Mai
- Department of Obstetrics and Gynecology, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Mayu Yamamoto
- Department of Obstetrics and Gynecology, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Shinichiro Saeki
- Department of Obstetrics and Gynecology, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Ayano Yamaya
- Department of Obstetrics and Gynecology, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Hiroaki Shibahara
- Department of Obstetrics and Gynecology, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
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14
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The immune potential of decidua-resident CD16 +CD56 + NK cells in human pregnancy. Hum Immunol 2021; 82:332-339. [PMID: 33583640 DOI: 10.1016/j.humimm.2021.01.014] [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: 11/05/2020] [Revised: 01/05/2021] [Accepted: 01/21/2021] [Indexed: 12/22/2022]
Abstract
Human CD56+CD3- NK cells can be subdivided into two different subsets according to the expression pattern of CD56 and CD16. CD56+/brightCD16- (CD16-) NK cells are prominently cytokine producers with little cytotoxicity whereas CD56+/dimCD16+ (CD16+) NK cells are efficient killers with poorer cytokine production potential. In human pregnancy, CD56+ decidual (d)NK cells accumulate in the maternal fetal interface to regulate placental immunity and development. Unlike peripheral blood (pb)NK cells, the majority of dNK cells are CD56 positive with limited CD16 reactivity. Our results demonstrated that in normal and pathological pregnancies, CD16+ dNK cells are a unique population in comparison to CD16- dNK subset. The expression of NK activation receptors CD335, CD336, CD244 and CD314 on CD16+ dNK subpopulation was lower than that on CD16- dNK cells. Upon cytokine stimulation with rhIL-12/15/18 or TGFβ blockade, the CD16+ dNK subset exhibited more robust response on the expression of IFNG, IL-8 and CD107a, compared to that of the CD16- dNK subpopulation. Functions of the CD16+ dNK subset were shown to be independent of cellular interaction with trophoblast cells. Studies of preeclamptic patients revealed lower proportions of CD16+ dNK cells, suggesting potential protective roles of these cells during normal gestations.. Therefore, we suggest that the CD16+ dNK subset, through compensating CD16- dNK cell function, is an indispensable componentto regulate decidual immune response and to support placentation.
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15
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Tersoglio AE, Salatino DR, Tersoglio S, Castro M, Gonzalez A. Normalization of endometrial histopathology and endometrial NK cells concentration predict successful pregnancy in repeated implantation failure. JBRA Assist Reprod 2021; 25:59-70. [PMID: 33094607 PMCID: PMC7863109 DOI: 10.5935/1518-0557.20200049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 06/02/2020] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE The primary objective was to establish the endometrial predictors of clinical pregnancy in a population of repeated implantation failure with oocyte donation after specific endometrial treatment. The secondary one was to evaluate reproduction outcomes in terms of Implantation rate (IR), Clinical pregnancy (CP), Live birth delivery rate (LBDR) and Prematurity, in relation to normalization or no-normalization of the predictors. METHODS 66 patients were assigned to the study. We ran a Pipelle endometrial biopsy to investigate the endometrium lymphocyte population by Flow Cytometry and abnormal/normal patterns by histopathology in pre/post-treatment. We employed the binary logistic regression model to identify the predictors for CP. For the secondary objective, we assessed the clinical outcomes in function to the normalization or no normalization in post-treatment. RESULTS Endometrial histopathology and endometrial NK cell counts resulted in CP predictors (Wald chi2 test (p=0.044 and 0.001)), respectively. We had a higher IR, CP and LBDR when both predictors were normalized in comparison with no normalization (p<0.001). There was a high percentage of prematurity in both normalized vs. non-normalized groups (34.4% (11/32) and 71.43% (5/7), respectively) without significant differences. CONCLUSION Endometrial histopathology and endometrial NK cell counts showed that they are valid predictors of pregnancy outcome in repeated implantation failure after treatment. In post-treatment, the pregnancy outcomes were significantly higher in the presence of both normalized predictors. Pregnancy rates were zero in the no-normalization of both predictors. There was a high percentage of prematurity in both groups.
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Affiliation(s)
- Alberto E. Tersoglio
- Private setting, International Center for Assisted Reproduction, Mendoza, Argentina
| | - Dante R. Salatino
- Private setting, International Center for Assisted Reproduction, Mendoza, Argentina
| | - Sebastian Tersoglio
- Private setting, International Center for Assisted Reproduction, Mendoza, Argentina
| | - Matías Castro
- Private setting, International Center for Assisted Reproduction, Mendoza, Argentina
| | - Adriana Gonzalez
- Immunology Laboratory, Academics Units, National University of Cuyo, Mendoza, Argentina
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16
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Marinić M, Mika K, Chigurupati S, Lynch VJ. Evolutionary transcriptomics implicates HAND2 in the origins of implantation and regulation of gestation length. eLife 2021; 10:61257. [PMID: 33522483 PMCID: PMC7943190 DOI: 10.7554/elife.61257] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 01/29/2021] [Indexed: 12/19/2022] Open
Abstract
The developmental origins and evolutionary histories of cell types, tissues, and organs contribute to the ways in which their dysfunction produces disease. In mammals, the nature, development and evolution of maternal-fetal interactions likely influence diseases of pregnancy. Here we show genes that evolved expression at the maternal-fetal interface in Eutherian mammals play essential roles in the evolution of pregnancy and are associated with immunological disorders and preterm birth. Among these genes is HAND2, a transcription factor that suppresses estrogen signaling, a Eutherian innovation allowing blastocyst implantation. We found dynamic HAND2 expression in the decidua throughout the menstrual cycle and pregnancy, gradually decreasing to a low at term. HAND2 regulates a distinct set of genes in endometrial stromal fibroblasts including IL15, a cytokine also exhibiting dynamic expression throughout the menstrual cycle and gestation, promoting migration of natural killer cells and extravillous cytotrophoblasts. We demonstrate that HAND2 promoter loops to an enhancer containing SNPs implicated in birth weight and gestation length regulation. Collectively, these data connect HAND2 expression at the maternal-fetal interface with evolution of implantation and gestational regulation, and preterm birth.
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Affiliation(s)
- Mirna Marinić
- Department of Human Genetics, University of Chicago, Chicago, United States
| | - Katelyn Mika
- Department of Human Genetics, University of Chicago, Chicago, United States
| | | | - Vincent J Lynch
- Department of Biological Sciences, University at Buffalo, Buffalo, United States
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17
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Mansour L, Alkhuriji A, Babay ZA, Alqadheeb S, Al-Khulaifi F, Al-Talhi R, Alomar S. Association of Killer Immunoglobulin-Like Receptor and Human Leukocyte Antigen Class I Ligand with Recurrent Abortion in Saudi Women. Genet Test Mol Biomarkers 2020; 24:78-84. [PMID: 31999488 DOI: 10.1089/gtmb.2019.0224] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Aims: This study was designed to determine whether genetic polymorphisms of the killer immunoglobulin-like receptor (KIR) and human leukocyte antigen class I (HLA-C) genes are associated with recurrent spontaneous abortion (RSA) in Saudi women. Materials and Methods: Sixty-five healthy women with a history of RSA (three or more spontaneous abortions) and 65 healthy controls (with two or more healthy-born children) living in Riyadh were typed for 17 KIR genes and the HLA-C1 and HLA-C2 allotypes using polymerase chain reaction-sequence-specific primer methodology. Results: The frequencies of KIR2DS2 and KIR2DL5A were significantly lower among RSA women compared to healthy controls (odds ratio [OR] = 0.17; p < 0.001; OR = 0.16; p < 0.001, respectively). No association with maternal HLA-C genotypes was observed. Analysis of KIR-HLA-C combinations indicated a protective effect of KIR2DS2 with its cognate HLA-C1 ligand in both homozygote or heterozygote combinations. Conclusion: Our results demonstrate that the KIR genes of the B haplotype may play an important role in ensuring the success of pregnancy.
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Affiliation(s)
- Lamjed Mansour
- Doping Research Chair, Zoology Department, College of Science, King Saud University, Riyadh, Saudi Arabia
| | - Afrah Alkhuriji
- Zoology Department, College of Science, King Saud University, Riyadh, Saudi Arabia
| | - Zeneb Ahmed Babay
- College of Medicine, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Sarah Alqadheeb
- Zoology Department, College of Science, King Saud University, Riyadh, Saudi Arabia
| | - Fadwa Al-Khulaifi
- Zoology Department, College of Science, King Saud University, Riyadh, Saudi Arabia.,Biology Department, College of Science, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Razan Al-Talhi
- Zoology Department, College of Science, King Saud University, Riyadh, Saudi Arabia
| | - Suliman Alomar
- Doping Research Chair, Zoology Department, College of Science, King Saud University, Riyadh, Saudi Arabia
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18
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CD49a +CD49b + NK cells induced by viral infection reflect an activated state of conventional NK cells. SCIENCE CHINA-LIFE SCIENCES 2020; 63:1725-1733. [PMID: 32335843 DOI: 10.1007/s11427-019-1665-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 01/26/2020] [Indexed: 02/07/2023]
Abstract
Natural killer (NK) cells are important innate effectors that play a pivotal role in the defense against tumors and infections and participate in regulating adaptive immunity. Recent studies have revealed phenotypic and functional heterogeneity of NK cells. Here, using murine models of acute and chronic lymphocytic choriomeningitis virus infection, we observed that a CD49a+ CD49b+ NK cell subset emerged in the liver and other tissues, and underwent vigorous expansion following viral infection, before progressively decreasing in cell number. These viral infection-induced CD49a+CD49b+ NK cells displayed an activated and mature phenotype. Moreover, compared with liver-resident NK cells and conventional NK (cNK) cells, CD49a+CD49b+ NK cells showed increased functional competence, as evidenced by higher amounts of IFN-γ production and stronger cytotoxic capabilities during viral infection. Generation of these CD49a+CD49b+ NK cells was shown to be independent of the T-bet transcription factor. Adoptive transfer experiments revealed that cNK cells could convert into CD49a+CD49b+ NK cells following viral infection. Collectively, these results suggest that viral infection-induced CD49a+CD49b+ NK cells represent a transiently activated state of cNK cells.
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19
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Ehrlich R, Hull ML, Walkley J, Sacks G. Intralipid Immunotherapy for Repeated IVF Failure. FERTILITY & REPRODUCTION 2019. [DOI: 10.1142/s2661318219500178] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
The intravenous fat emulsion, intralipid, has been hypothesised to be an effective and safe treatment for repeated in vitro fertilisation (IVF), implantation failure and pregnancy loss. This exploratory, retrospective cohort study determined pregnancy outcomes and documented adverse events associated with intralipid use. Ninety-three women were identified as having received intralipid for a history of repeated unsuccessful IVF cycles and pre-viable pregnancy loss in two Australian IVF units that independently recruited between October 2014 and July 2016. Pregnancy outcomes and adverse events were recorded in fresh and frozen embryo transfer cycles in which the infusion was administered. The 93 women who received intralipid had a clinical pregnancy rate of 40.0%, compared with 35.0% in 651 age-matched controls undergoing IVF, which was not significantly different. The intralipid group had a livebirth rate of 35.7%. Apart from flushing, which was experienced by one individual, there were no adverse events associated with intralipid use. As a prelude to definitive evidence of benefit, we did not identify a safety concern or reduced pregnancy rates in intralipid users compared to controls. Indeed, these outcomes were better than expected in a poor prognosis group. This data supports an argument for large, randomised controlled trials to determine the benefit of intralipid in the treatment of recurrent implantation failure or miscarriage.
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Affiliation(s)
- Romy Ehrlich
- University of New South Wales, Sydney, Australia
| | - M. Louise Hull
- Robinson Research Institute, University of Adelaide, Frome Road, Adelaide, South Australia, Australia
- FertilitySA, Adelaide, South Australia, Australia
- Embrace Fertility, Adelaide, South Australia, Australia
| | - Jane Walkley
- FertilitySA, Adelaide, South Australia, Australia
- Embrace Fertility, Adelaide, South Australia, Australia
| | - Gavin Sacks
- University of New South Wales, Sydney, Australia
- IVFAustralia, Bondi, Sydney, Australia
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20
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Comparison of T and NK lymphocyte subsets between human endometrial tissue and peripheral blood. Cent Eur J Immunol 2019; 44:316-321. [PMID: 31871420 PMCID: PMC6925561 DOI: 10.5114/ceji.2019.89610] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 10/31/2017] [Indexed: 12/21/2022] Open
Abstract
Immune profiles in endometrium may be changed in patients with IVF failure and its possible correlations with immune parameters in peripheral blood are important for the diagnostic approach. Such correlations in healthy women are unknown and have been studied in the present research. The expression of CD56, CD158a, HLA DR, CD69 in T lymphocytes, CD4 T lymphocytes, CD8+ T lymphocytes and NK cells were studied by flow-cytometry in endometrium and peripheral blood in healthy 24 donors of oocytes aged 25-32 years. Levels of T lymphocyte and T helper cells were lower in endometrium and no differences in CD8 T lymphocytes were registered between endometrium and peripheral blood. The expression of HLA DR and especially CD69 was higher in CD3, CD4, CD8 T cells in endometrium in comparison with peripheral blood. The endometrium lymphocyte population was enriched by NK cells that were generally CD56++ with a higher expression of HLA DR and almost in total were CD69 positive. Strong positive correlations of CD8 expression in NK cells (r = 0.6478, p < 0.001) and HLA DR expression in CD8 T cells (r = 0.6107, p < 0.01) between peripheral blood and endometrium were registered in fertile women. The endometrial CD56 expression in CD8+ T cells negatively correlated with endometrial CD8 expression in NK cells (r = -0.5252, p < 0.01) which possibly reflected a suppressive and regulating mechanism in the endometrium. CD8+ NK cells and HLA DR+ CD8 T cells in endometrium were related to the same subsets in peripheral blood.
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21
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Meuleman T, Baden N, Haasnoot GW, Wagner MM, Dekkers OM, le Cessie S, Picavet C, van Lith JMM, Claas FHJ, Bloemenkamp KWM. Oral sex is associated with reduced incidence of recurrent miscarriage. J Reprod Immunol 2019; 133:1-6. [PMID: 30980918 DOI: 10.1016/j.jri.2019.03.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 03/07/2019] [Accepted: 03/25/2019] [Indexed: 12/13/2022]
Abstract
A possible way of immunomodulation of the maternal immune system before pregnancy would be exposure to paternal antigens via seminal fluid to oral mucosa. We hypothesized that women with recurrent miscarriage have had less oral sex compared to women with uneventful pregnancy. In a matched case control study, 97 women with at least three unexplained consecutive miscarriages prior to the 20th week of gestation with the same partner were included. Cases were younger than 36 years at time of the third miscarriage. The control group included 137 matched women with an uneventful pregnancy. The association between oral sex and recurrent miscarriage was assessed with conditional logistic regression, odds ratios (ORs) were estimated. Missing data were imputed using Imputation by Chained Equations. In the matched analysis, 41 out of 72 women with recurrent miscarriage had have oral sex, whereas 70 out of 96 matched controls answered positive to this question (56.9% vs. 72.9%, OR 0.50 95%CI 0.25-0.97, p = 0.04). After imputation of missing exposure data (51.7%), the association became weaker (OR 0.67, 95%CI 0.36-1.24, p = 0.21). In conclusion, this study suggests a possible protective role of oral sex in the occurrence of recurrent miscarriage in a proportion of the cases. Future studies in women with recurrent miscarriage explained by immune abnormalities should reveal whether oral exposure to seminal plasma indeed modifies the maternal immune system, resulting in more live births.
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Affiliation(s)
- T Meuleman
- Department of Obstetrics, Leiden University Medical Centre, Leiden, the Netherlands.
| | - N Baden
- Department of Obstetrics, Leiden University Medical Centre, Leiden, the Netherlands
| | - G W Haasnoot
- Department of Immunohematology and Blood transfusion, Leiden University Medical Centre, Leiden, the Netherlands
| | - M M Wagner
- Department of Obstetrics, Leiden University Medical Centre, Leiden, the Netherlands
| | - O M Dekkers
- Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, the Netherlands
| | - S le Cessie
- Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, the Netherlands; Medical Statistics, Department of Biomedical Datasciences, Leiden University Medical Centre, Leiden, the Netherlands
| | - C Picavet
- AllthatChas Research Consultancy, Amsterdam, the Netherlands
| | - J M M van Lith
- Department of Obstetrics, Leiden University Medical Centre, Leiden, the Netherlands
| | - F H J Claas
- Department of Immunohematology and Blood transfusion, Leiden University Medical Centre, Leiden, the Netherlands
| | - K W M Bloemenkamp
- Department of Obstetrics, Leiden University Medical Centre, Leiden, the Netherlands; Department of Obstetrics, Wilhelmina Children Hospital Birth Centre, Division Woman and Baby, University Medical Centre Utrecht, Utrecht, the Netherlands
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22
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Yamaguchi K. Tacrolimus treatment for infertility related to maternal-fetal immune interactions. Am J Reprod Immunol 2019; 81:e13097. [PMID: 30689243 DOI: 10.1111/aji.13097] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 01/15/2019] [Accepted: 01/16/2019] [Indexed: 12/29/2022] Open
Abstract
Many approaches have been used to achieve successful pregnancies in patients with infertility, though existing treatments remain unsatisfactory in patients with infertility caused by abnormal maternal-fetal immunity. However, our understanding of the immunological aspects of infertility has steadily progressed, aided by recent research into organ transplantation and cancer. The results of these recent analyses have led to the development and evaluation of several candidate immunological treatments, but the use of immunological treatments remains a novel approach. The current paper presents the hypothesis that tacrolimus may have potential as a candidate agent for the treatment of maternal-fetal immunity-related infertility.
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Affiliation(s)
- Koushi Yamaguchi
- Center of Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan
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23
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Benner M, Ferwerda G, Joosten I, van der Molen RG. How uterine microbiota might be responsible for a receptive, fertile endometrium. Hum Reprod Update 2019; 24:393-415. [PMID: 29668899 DOI: 10.1093/humupd/dmy012] [Citation(s) in RCA: 145] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Accepted: 03/27/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Fertility depends on a receptive state of the endometrium, influenced by hormonal and anatomical adaptations, as well as the immune system. Local and systemic immunity is greatly influenced by microbiota. Recent discoveries of 16S rRNA in the endometrium and the ability to detect low-biomass microbiota fueled the notion that the uterus may be indeed a non-sterile compartment. To date, the concept of the 'sterile womb' focuses on in utero effects of microbiota on offspring and neonatal immunity. However, little awareness has been raised regarding the importance of uterine microbiota for endometrial physiology in reproductive health; manifested in fertility and placentation. OBJECTIVE AND RATIONALE Commensal colonization of the uterus has been widely discussed in the literature. The objective of this review is to outline the possible importance of this uterine colonization for a healthy, fertile uterus. We present the available evidence regarding uterine microbiota, focusing on recent findings based on 16S rRNA, and depict the possible importance of uterine colonization for a receptive endometrium. We highlight a possible role of uterine microbiota for host immunity and tissue adaptation, as well as conferring protection against pathogens. Based on knowledge of the interaction of the mucosal immune cells of the gut with the local microbiome, we want to investigate the potential implications of commensal colonization for uterine health. SEARCH METHODS PubMed and Google Scholar were searched for articles in English indexed from 1 January 2008 to 1 March 2018 for '16S rRNA', 'uterus' and related search terms to assess available evidence on uterine microbiome analysis. A manual search of the references within the resulting articles was performed. To investigate possible functional contributions of uterine microbiota to health, studies on microbiota of other body sites were additionally assessed. OUTCOMES Challenging the view of a sterile uterus is in its infancy and, to date, no conclusions on a 'core uterine microbiome' can be drawn. Nevertheless, evidence for certain microbiota and/or associated compounds in the uterus accumulates. The presence of microbiota or their constituent molecules, such as polysaccharide A of the Bacteroides fragilis capsule, go together with healthy physiological function. Lessons learned from the gut microbiome suggest that the microbiota of the uterus may potentially modulate immune cell subsets needed for implantation and have implications for tissue morphology. Microbiota can also be crucial in protection against uterine infections by defending their niche and competing with pathogens. Our review highlights the need for well-designed studies on a 'baseline' microbial state of the uterus representing the optimal starting point for implantation and subsequent placenta formation. WIDER IMPLICATIONS The complex interplay of processes and cells involved in healthy pregnancy is still poorly understood. The correct receptive endometrial state, including the local immune environment, is crucial not only for fertility but also placenta formation since initiation of placentation highly depends on interaction with immune cells. Implantation failure, recurrent pregnancy loss, and other pathologies of endometrium and placenta, such as pre-eclampsia, represent an increasing societal burden. More robust studies are needed to investigate uterine colonization. Based on current data, future research needs to include the uterine microbiome as a relevant factor in order to understand the players needed for healthy pregnancy.
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Affiliation(s)
- Marilen Benner
- Department of Laboratory Medicine, Laboratory of Medical Immunology, Radboud University Medical Center, Geert Grooteplein 10, PO Box 9101, Internal mail 469, 6500 HB Nijmegen, The Netherlands
| | - Gerben Ferwerda
- Department of Laboratory Medicine, Laboratory of Medical Immunology, Radboud University Medical Center, Geert Grooteplein 10, PO Box 9101, Internal mail 469, 6500 HB Nijmegen, The Netherlands
| | - Irma Joosten
- Department of Laboratory Medicine, Laboratory of Medical Immunology, Radboud University Medical Center, Geert Grooteplein 10, PO Box 9101, Internal mail 469, 6500 HB Nijmegen, The Netherlands
| | - Renate G van der Molen
- Department of Laboratory Medicine, Laboratory of Medical Immunology, Radboud University Medical Center, Geert Grooteplein 10, PO Box 9101, Internal mail 469, 6500 HB Nijmegen, The Netherlands
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24
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Azargoon A, Mirrasouli Y, Shokrollahi Barough M, Barati M, Kokhaei P. The State of Peripheral Blood Natural Killer Cells and Cytotoxicity in Women with Recurrent Pregnancy Loss and Unexplained Infertility. INTERNATIONAL JOURNAL OF FERTILITY & STERILITY 2019; 13:12-17. [PMID: 30644239 PMCID: PMC6334012 DOI: 10.22074/ijfs.2019.5503] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Accepted: 07/02/2018] [Indexed: 12/04/2022]
Abstract
Background The prognostic value of peripheral natural killer (pNK) cells, as a screening test in women with recur-
rent pregnancy loss (RPL) and unexplained infertility, is still a matter for discussion. The purpose of this study was to
compare the percentage of circulating CD56+NK cells, CD69 and perforin markers between women with unexplained
infertility and RPL with the healthy control group. Materials and Methods In this case-control study, the percentage of CD56+NK cells and activation markers (CD69
and perforin levels) in the peripheral blood were measured in 25 women with unexplained infertility, 24 women with
idiopathic RPL and 26 women from the healthy control group, using specific monoclonal antibodies by flow cytometry. Results The percentage of CD56+NK cells was significantly higher in patients with infertility in comparison with
the healthy control group (P=0.007). There were not significant differences either in the total number of CD56+cells
between the RPL group and the control group (P=0.2) or between the RPL group and the infertile group (P=0.36).
The percentage of CD69+lymphocytes in RPL group was significantly higher than in the infertility group (P=0.004).
There was a statistically significant difference in Perforin levels between RLP and control (P=0.001) as well as RPL
and infertile (P=0.002) groups. Conclusion An increased percentage of CD56+NK cells in patients with unexplained infertility, an elevated expression
of CD69 on NK cells in patients with RPL and infertility and a high level of perforin on CD56+cells in the RPL group
might be considered as immunological risk factors in these women.
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Affiliation(s)
- Azam Azargoon
- Abnormal Uterine Bleeding Research Center, Semnan University of Medical Sciences, Semnan, Iran.,Department of Infertility, Amir-AL-Momenin Hospital, Semnan University of Medical Sciences, Semnan, Iran
| | - Yasaman Mirrasouli
- Department of Infertility, Amir-AL-Momenin Hospital, Semnan University of Medical Sciences, Semnan, Iran.,Student Research Committee, Semnan University of Medical Sciences, Semnan, Iran
| | - Mahdieh Shokrollahi Barough
- Student Research Committee, Semnan University of Medical Sciences, Semnan, Iran.,Cancer Immunotherapy and Regenerative Medicine Department, Breast Cancer Research Center, Motamed Cancer Institute, ACECR, Tehran, Iran
| | - Mehdi Barati
- Student Research Committee, Semnan University of Medical Sciences, Semnan, Iran.,Department of Immunology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Parviz Kokhaei
- Cancer Research Center, Semnan University of Medical Sciences, Semnan, Iran. Electronic Address: .,Immune and Gene therapy Lab, CCK, Karolinska University Hospital Solna, Stockholm, Sweden
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25
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Renaud SJ, Scott RL, Chakraborty D, Rumi MAK, Soares MJ. Natural killer-cell deficiency alters placental development in rats. Biol Reprod 2017; 96:145-158. [PMID: 28395334 DOI: 10.1095/biolreprod.116.142752] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 12/06/2016] [Indexed: 12/18/2022] Open
Abstract
Natural killer (NK) cells are the most prevalent leukocyte population in the uterus during early pregnancy. Natural killer cells contribute to uterine vascular (spiral artery) remodeling in preparation for the increased demand on these vessels later in pregnancy. A second wave of spiral artery modification is directed by invasive trophoblast cells. The significance of the initial wave of NK-cell-mediated vascular remodeling in species exhibiting deep trophoblast invasion such as humans and rats is not known. The purpose of this study was to generate a genetic model of NK-cell deficiency in rats, and determine the consequences of NK-cell deficiency on spiral artery remodeling and reproductive outcomes. To accomplish this task, we utilized zinc finger nuclease-mediated genome editing of the rat interleukin-15 (Il15) gene. Il15 encodes a cytokine required for NK-cell lineage development. Using this strategy, a founder rat was generated containing a frameshift deletion in Il15. Uteri of females harboring a homozygous mutation at the Il15 locus contained no detectable NK cells. NK-cell deficiency did not impact fetal growth or viability. However, NK-cell deficiency caused major structural changes to the placenta, including expansion of the junctional zone and robust, early-onset activation of invasive trophoblast-guided spiral artery remodeling. In summary, we successfully generated an NK-cell-deficient rat and showed, using this model, that NK cells dampen the extent of trophoblast invasion and delay trophoblast-directed spiral artery remodeling. This study furthers our understanding of the role of NK cells on uterine vascular remodeling, trophoblast invasion, and placental development.
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Affiliation(s)
- Stephen J Renaud
- Institute for Reproductive Health and Regenerative Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA.,Department of Pathology and Laboratory Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Regan L Scott
- Institute for Reproductive Health and Regenerative Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA.,Department of Pathology and Laboratory Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Damayanti Chakraborty
- Institute for Reproductive Health and Regenerative Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA.,Department of Pathology and Laboratory Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Mohammad A K Rumi
- Institute for Reproductive Health and Regenerative Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA.,Department of Pathology and Laboratory Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Michael J Soares
- Institute for Reproductive Health and Regenerative Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA.,Department of Pathology and Laboratory Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA.,Department of Obstetrics and Gynecology, University of Kansas Medical Center, Kansas City, Kansas, USA
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26
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Peng H, Tian Z. Diversity of tissue-resident NK cells. Semin Immunol 2017; 31:3-10. [PMID: 28802693 DOI: 10.1016/j.smim.2017.07.006] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Accepted: 07/19/2017] [Indexed: 02/07/2023]
Abstract
Although natural killer (NK) cells were initially named for their spontaneous tumor-killing capacity, their concept has been greatly expanded with more than 40 years of extensive investigation. Currently, NK cells are known as a heterogeneous population of innate lymphoid cell (ILC) family, consisting of different subsets with unique phenotypic and functional features. Recent studies have shown that tissue-resident NK (trNK) cells, which are distinct from conventional NK (cNK) cells, preferentially distribute in non-lymphoid tissues, such as the liver, uterus, salivary gland, and adipose. In this review, we provide a comprehensive overview of the current knowledge about the phenotype, function and development of trNK cells across different tissues and describe the similarities and differences between diverse trNK cells and cNK cells, with a particular focus on the tissue-specific characteristics of different trNK cells.
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Affiliation(s)
- Hui Peng
- Institute of Immunology and The CAS Key Laboratory of Innate Immunity and Chronic Disease, School of Life Sciences and Medical Center, University of Science and Technology of China, Hefei, Anhui 230027, China.
| | - Zhigang Tian
- Institute of Immunology and The CAS Key Laboratory of Innate Immunity and Chronic Disease, School of Life Sciences and Medical Center, University of Science and Technology of China, Hefei, Anhui 230027, China; Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310003, China.
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27
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Winger EE, Reed JL, Ji X. Early first trimester peripheral blood cell microRNA predicts risk of preterm delivery in pregnant women: Proof of concept. PLoS One 2017; 12:e0180124. [PMID: 28692679 PMCID: PMC5503193 DOI: 10.1371/journal.pone.0180124] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 06/11/2017] [Indexed: 12/16/2022] Open
Abstract
Objective We investigated the capacity of first trimester peripheral blood mononuclear cell (PBMC) microRNA to determine risk of spontaneous preterm birth among pregnant women. Study design The study included 39 pregnant women with the following delivery outcomes: 25 with a full term delivery (38–42 weeks gestation) 14 with spontaneous preterm birth (<38 weeks gestation). Of the 14 women experiencing spontaneous preterm birth, 7 delivered at 34-<38 weeks gestation (late preterm) and 7 delivered at <34 weeks gestation (early preterm). Samples were collected at a mean of 7.9±3.0 weeks gestation. Quantitative rtPCR was performed on 30 selected microRNAs. MicroRNA Risk Scores were calculated and Area-Under the Curve-Receiver-Operational-Characteristic (AUC-ROC) curves derived. Results The AUC-ROC for the group delivering preterm (<38 weeks) was 0.95 (p>0.0001). The AUC-ROC for early preterm group (<34 weeks) was 0.98 (p<0.0001) and the AUC-ROC for the late preterm group (34-<38 weeks) was 0.92 (p<0.0001). Conclusion Quantification of first trimester peripheral blood PBMC MicroRNA may provide sensitive and specific prediction of spontaneous preterm birth in pregnant women. Larger studies are needed for confirmation.
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Affiliation(s)
- Edward E. Winger
- Laboratory for Reproductive Medicine and Immunology, San Francisco, CA, United States of America
- * E-mail:
| | - Jane L. Reed
- Laboratory for Reproductive Medicine and Immunology, San Francisco, CA, United States of America
| | - Xuhuai Ji
- Stanford University, Human Immune Monitoring Center, Stanford, CA, United States of America
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28
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Jiang R, Yan G, Xing J, Wang Z, Liu Y, Wu H, Fan X, Zhou J, Ding L, Sun H. Abnormal ratio of CD57+
cells to CD56+
cells in women with recurrent implantation failure. Am J Reprod Immunol 2017; 78. [PMID: 28543977 DOI: 10.1111/aji.12708] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2017] [Accepted: 04/18/2017] [Indexed: 12/19/2022] Open
Affiliation(s)
- Ruiwei Jiang
- Department of Obstetrics and Gynecology; Center for Reproductive Medicine; The Affiliated Drum Tower Hospital of Nanjing University Medical School; Nanjing China
| | - Guijun Yan
- Department of Obstetrics and Gynecology; Center for Reproductive Medicine; The Affiliated Drum Tower Hospital of Nanjing University Medical School; Nanjing China
| | - Jun Xing
- Department of Obstetrics and Gynecology; Center for Reproductive Medicine; The Affiliated Drum Tower Hospital of Nanjing University Medical School; Nanjing China
| | - Zhilong Wang
- Department of Obstetrics and Gynecology; Center for Reproductive Medicine; The Affiliated Drum Tower Hospital of Nanjing University Medical School; Nanjing China
| | - Yong Liu
- Central Research Lab; The Affiliated Drum Tower Hospital of Nanjing University Medical School; Nanjing China
| | - Hongyan Wu
- Department of Pathology; The Affiliated Drum Tower Hospital of Nanjing University Medical School; Nanjing China
| | - Xiangshan Fan
- Department of Pathology; The Affiliated Drum Tower Hospital of Nanjing University Medical School; Nanjing China
| | - Jianjun Zhou
- Department of Obstetrics and Gynecology; Center for Reproductive Medicine; The Affiliated Drum Tower Hospital of Nanjing University Medical School; Nanjing China
| | - Lijun Ding
- Department of Obstetrics and Gynecology; Center for Reproductive Medicine; The Affiliated Drum Tower Hospital of Nanjing University Medical School; Nanjing China
| | - Haixiang Sun
- Department of Obstetrics and Gynecology; Center for Reproductive Medicine; The Affiliated Drum Tower Hospital of Nanjing University Medical School; Nanjing China
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29
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Fuchinoue K, Fukui A, Chiba H, Kamoi M, Funamizu A, Taima A, Fukuhara R, Mizunuma H. Expression of retinoid-related orphan receptor (ROR)γt on NK22 cells in the peripheral blood and uterine endometrium of women with unexplained recurrent pregnancy loss and unexplained infertility. J Obstet Gynaecol Res 2016; 42:1541-1552. [PMID: 27374797 DOI: 10.1111/jog.13075] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2015] [Accepted: 05/07/2016] [Indexed: 01/23/2023]
Abstract
AIM Recently, NK22 cells, a subset of interleukin (IL)-22-producing natural killer (NK) cells, were identified. We have previously reported the higher percentage of NK22 cells in women suffering recurrent pregnancy loss (RPL). Moreover, we have also reported lower expression of NKp46, a kind of natural cytotoxicity receptor (NCR), on NK cells and the changes of NK cell producing cytokines in women who experience RPL. NK22 cells express NCRs, such as NKp44 or NKp46. Retinoid-related orphan receptor γt (RORγt) is known as a regulator of NK22 cells; however, in NK22 cells of peripheral blood (PB) and the uterine endometrium (UE), the relationship between NCRs and RORγt is unclear. We investigate RORγt expression NK22 cells in the PB and UE of women with unexplained infertility (uI) or unexplained RPL (uRPL). METHODS Lymphocytes were extracted from PB and UE, derived from women with uI or uRPL. Expression of RORγt and NCRs in NK cells and NK cell-produced cytokines were analyzed by flow cytometry. RESULTS CD56+ /NKp46+ /RORγt+ cells were positively correlated with CD56+ /IL-22+ cells in both PB and UE. CD56bright /NKp46bright /RORγt+ cells were significantly higher in uRPL than in uI, and endometrial CD56bright /NKp46bright /RORγt+ cells were positively correlated with PB. In UE, CD56bright /RORγt+ cells were negatively correlated with CD56bright /interferon-γ+ and CD56bright /tumor necrosis factor-α+ cells of uRPL. CONCLUSION RORγt may be associated with NK22 cells in reproduction. Particularly, higher expression of RORγt may be associated with elevated NK22 cells in uRPL.
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MESH Headings
- Abortion, Habitual/blood
- Abortion, Habitual/metabolism
- Adult
- Cytokines/metabolism
- Endometrium/metabolism
- Female
- Humans
- Infertility, Female/blood
- Infertility, Female/metabolism
- Interleukins/metabolism
- Killer Cells, Natural/metabolism
- Lymphocytes/metabolism
- Nuclear Receptor Subfamily 1, Group F, Member 3/blood
- Nuclear Receptor Subfamily 1, Group F, Member 3/metabolism
- Pregnancy
- Receptors, Natural Cytotoxicity Triggering/metabolism
- Interleukin-22
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Affiliation(s)
- Kohei Fuchinoue
- Department of Obstetrics and Gynecology, Hirosaki University Graduate School of Medicine, Aomori, Japan
| | - Atsushi Fukui
- Department of Obstetrics and Gynecology, Hirosaki University Graduate School of Medicine, Aomori, Japan.
| | - Hitomi Chiba
- Department of Obstetrics and Gynecology, Hirosaki University Graduate School of Medicine, Aomori, Japan
| | - Mai Kamoi
- Department of Obstetrics and Gynecology, Hirosaki University Graduate School of Medicine, Aomori, Japan
| | - Ayano Funamizu
- Department of Obstetrics and Gynecology, Hirosaki University Graduate School of Medicine, Aomori, Japan
| | - Ayako Taima
- Department of Obstetrics and Gynecology, Hirosaki University Graduate School of Medicine, Aomori, Japan
| | - Rie Fukuhara
- Department of Obstetrics and Gynecology, Hirosaki University Graduate School of Medicine, Aomori, Japan
| | - Hideki Mizunuma
- Department of Obstetrics and Gynecology, Hirosaki University Graduate School of Medicine, Aomori, Japan
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30
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Small HY, Nosalski R, Morgan H, Beattie E, Guzik TJ, Graham D, Delles C. Role of Tumor Necrosis Factor-α and Natural Killer Cells in Uterine Artery Function and Pregnancy Outcome in the Stroke-Prone Spontaneously Hypertensive Rat. Hypertension 2016; 68:1298-1307. [PMID: 27733586 PMCID: PMC5058643 DOI: 10.1161/hypertensionaha.116.07933] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 09/07/2016] [Indexed: 12/17/2022]
Abstract
Women with chronic hypertension are at increased risk of maternal and fetal morbidity and mortality. We have previously characterized the stroke-prone spontaneously hypertensive rat (SHRSP) as a model of deficient uterine artery function and adverse pregnancy outcome compared with the control Wistar-Kyoto. The activation of the immune system plays a role in hypertension and adverse pregnancy outcome. Therefore, we investigated the role of tumor necrosis factor-α in the SHRSP phenotype in an intervention study using etanercept (0.8 mg/kg SC) at gestational days 0, 6, 12, and 18 in pregnant SHRSP compared with vehicle-treated controls (n=6). Etanercept treatment significantly lowered systolic blood pressure after gestational day 12 and increased litter size in SHRSP. At gestational day 18, etanercept improved the function of uterine arteries from pregnant SHRSP normalizing the contractile response and increasing endothelium-dependent relaxation, resulting in increased pregnancy-dependent diastolic blood flow in the uterine arteries. We identified that the source of excess tumor necrosis factor-α in the SHRSP was a pregnancy-dependent increase in peripheral and placental CD3- CD161+ natural killer cells. Etanercept treatment also had effects on placental CD161+ cells by reducing the expression of CD161 receptor, which was associated with a decrease in cytotoxic granzyme B expression. Etanercept treatment improves maternal blood pressure, pregnancy outcome, and uterine artery function in SHRSP by antagonizing signaling from excess tumor necrosis factor-α production and the reduction of granzyme B expression in CD161+ natural killer cells in SHRSP.
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Affiliation(s)
- Heather Yvonne Small
- From the BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Scotland (H.Y.S., R.N., H.M., E.B., T.J.G., D.G., C.D.); and Department of Internal Medicine, Jagiellonian University Medical College, Kraców, Poland (R.N.).
| | - Ryszard Nosalski
- From the BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Scotland (H.Y.S., R.N., H.M., E.B., T.J.G., D.G., C.D.); and Department of Internal Medicine, Jagiellonian University Medical College, Kraców, Poland (R.N.)
| | - Hannah Morgan
- From the BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Scotland (H.Y.S., R.N., H.M., E.B., T.J.G., D.G., C.D.); and Department of Internal Medicine, Jagiellonian University Medical College, Kraców, Poland (R.N.)
| | - Elisabeth Beattie
- From the BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Scotland (H.Y.S., R.N., H.M., E.B., T.J.G., D.G., C.D.); and Department of Internal Medicine, Jagiellonian University Medical College, Kraców, Poland (R.N.)
| | - Tomasz J Guzik
- From the BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Scotland (H.Y.S., R.N., H.M., E.B., T.J.G., D.G., C.D.); and Department of Internal Medicine, Jagiellonian University Medical College, Kraców, Poland (R.N.)
| | - Delyth Graham
- From the BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Scotland (H.Y.S., R.N., H.M., E.B., T.J.G., D.G., C.D.); and Department of Internal Medicine, Jagiellonian University Medical College, Kraców, Poland (R.N.)
| | - Christian Delles
- From the BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Scotland (H.Y.S., R.N., H.M., E.B., T.J.G., D.G., C.D.); and Department of Internal Medicine, Jagiellonian University Medical College, Kraców, Poland (R.N.)
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31
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Chernyshov VP, Dons’koi BV, Sudoma IO, Goncharova YO. Multiple immune deviations predictive for IVF failure as possible markers for IVIG therapy. Immunol Lett 2016; 176:44-50. [DOI: 10.1016/j.imlet.2015.12.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Revised: 12/21/2015] [Accepted: 12/29/2015] [Indexed: 11/25/2022]
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32
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Grimstad F, Krieg S. Immunogenetic contributions to recurrent pregnancy loss. J Assist Reprod Genet 2016; 33:833-47. [PMID: 27169601 DOI: 10.1007/s10815-016-0720-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 04/25/2016] [Indexed: 12/13/2022] Open
Abstract
While sporadic pregnancy loss is common, occurring in 15 % of pregnancies, recurrent pregnancy loss (RPL) impacts approximately 5 % of couples. Though multiple causes are known (including structural, hormonal, infectious, autoimmune, and thrombophilic causes), after evaluation, roughly half of all cases remain unexplained. The idiopathic RPL cases pose a challenging therapeutic dilemma in addition to incurring much physical and emotional morbidity. Immunogenetic causes have been postulated to contribute to these cases of RPL. Natural Killer cell, T cell expression pattern changes in the endometrium have both been shown in patients with RPL. Human leukocyte antigen (HLA) and cytokine allelic variations have also been studied as etiologies for RPL. Some of the results have been promising, however the studies are small and have not yet put forth outcomes that would change our current diagnosis and management of RPL. Larger database studies are needed with stricter control criteria before reasonable conclusions can be drawn.
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Affiliation(s)
- Frances Grimstad
- Department of Obstetrics and Gynecology, University of Kansas, 3901 Rainbow Blvd MS 2028, Kansas City, KS, 66160, USA.
| | - Sacha Krieg
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Oregon Health Sciences University, Portland, OR, USA
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33
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Hosseini S, Shokri F, Tokhmechy R, Savadi-Shiraz E, Jeddi-Tehrani M, Rahbari M, Zarnani AH. Menstrual blood contains immune cells with inflammatory and anti-inflammatory properties. J Obstet Gynaecol Res 2015; 41:1803-12. [DOI: 10.1111/jog.12801] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2015] [Accepted: 06/09/2015] [Indexed: 12/30/2022]
Affiliation(s)
- Samira Hosseini
- Department of Immunology, School of Public Health; Tehran University of Medical Sciences; Tehran Iran
| | - Fazel Shokri
- Department of Immunology, School of Public Health; Tehran University of Medical Sciences; Tehran Iran
| | - Reihaneh Tokhmechy
- Reproductive Biotechnology Research Center; Avicenna Research Institute, ACECR; Tehran Iran
| | - Elham Savadi-Shiraz
- Reproductive Biotechnology Research Center; Avicenna Research Institute, ACECR; Tehran Iran
| | - Mahmood Jeddi-Tehrani
- Monoclonal Antibody Research Center; Avicenna Research Institute, ACECR; Tehran Iran
| | - Marjaneh Rahbari
- Reproductive Biotechnology Research Center; Avicenna Research Institute, ACECR; Tehran Iran
| | - Amir-Hassan Zarnani
- Reproductive Immunology Research Center, Avicenna Research Institute; ACECR; Tehran Iran
- Immunology Research Center; Iran University of Medical Sciences; Tehran Iran
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34
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Rahiminejad ME, Moaddab A, Ebrahimi M, Rabiee S, Zamani A, Ezzati M, Abdollah Shamshirsaz A. The relationship between some endometrial secretion cytokines and in vitro fertilization. IRANIAN JOURNAL OF REPRODUCTIVE MEDICINE 2015; 13:557-562. [PMID: 26568760 PMCID: PMC4637123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Revised: 02/05/2015] [Accepted: 06/21/2015] [Indexed: 06/05/2023]
Abstract
BACKGROUND Endometrial secretion analysis is a non-invasive and promising method in evaluation of endometrial receptivity. OBJECTIVE The aim of the present study was to assess the relationship between the success rate of IVF procedures and some endometrial secretion cytokines, including interleukin-1β (IL-1β), tumor necrosis factor (TNF-α), interferon gamma-induced protein 10 (IP-10), and monocyte chemoattractant protein (MCP). MATERIALS AND METHODS In a prospective cohort study, 50 women selected for IVF met the study inclusion criteria. All the patients underwent endometrial secretion aspiration prior to embryo transfer. The level of IL-1β, TNF-α, IP-10 and MCP were analyzed by enzyme-linked immunosorbent assay method using special standard kits. To detect successful implantation and pregnancy patients underwent serum human chorionic gonadotropin measurements and ultrasound evaluation. RESULTS Five samples were excluded. Nine women (20%) had successful clinical pregnancies, which resulted in live birth. Other 36 women (80%) were classified as failed pregnancy. Comparison of cytokine levels showed lower concentrations of TNF-α, IP-10, and MCP in the group with successful clinical pregnancy compared to the group with failed pregnancy (p=0.007, 0.005 and 0.001, respectively). However, no significant difference was revealed in IL-1β levels between two groups (p=0.614). CONCLUSION The current study suggested that lower concentrations of TNF-α, IP-10, and MCP in endometrial secretions might be associated with improved endometrial receptivity and IVF outcome. Regarding IL-1β, no statistically significant differences were seen between the groups with and without successful pregnancy.
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Affiliation(s)
- Mohammad Ehsan Rahiminejad
- Department of Obstetrics & Gynecology, Hamadan University of Medical Sciences and Health Services, Hamadan, Iran.
| | - Amirhossein Moaddab
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas, USA.
| | - Mehrnoosh Ebrahimi
- Department of Obstetrics & Gynecology, Hamadan University of Medical Sciences and Health Services, Hamadan, Iran.
| | - Soghra Rabiee
- Department of Obstetrics & Gynecology, Hamadan University of Medical Sciences and Health Services, Hamadan, Iran.
| | - Alireza Zamani
- Department of Immunology and Hematology, Hamadan University of Medical Sciences and Health Services, Hamadan, Iran.
| | - Mohammad Ezzati
- Department of Obstetrics and Gynecology, UT Southwestern Medical Center, Dallas, TX, USA.
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35
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Zhang J, Dunk CE, Kwan M, Jones RL, Harris LK, Keating S, Lye SJ. Human dNK cell function is differentially regulated by extrinsic cellular engagement and intrinsic activating receptors in first and second trimester pregnancy. Cell Mol Immunol 2015; 14:203-213. [PMID: 26277900 DOI: 10.1038/cmi.2015.66] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Revised: 06/11/2015] [Accepted: 06/11/2015] [Indexed: 01/28/2023] Open
Abstract
Decidual natural killer (dNK) cells express an array of activation receptors to regulate placental immunity and development during early pregnancy. We investigated the functional character of human dNK cells during the first and second trimester of gestation and the interaction between dNK and trophoblast cells. Although the frequency of CD56+CD16- dNK among the total CD45+ leukocytes did not change over this period, the expression of the activating receptors, NKp80 and NKG2D, was greatly upregulated. We observed a significantly higher number of extravillous trophoblast cells in proximity to the dNK cells in the first trimester in comparison with the second trimester decidua. NKG2D expression by first trimester dNK cells was decreased when co-cultured with the HTR-8 trophoblast cell line. In the second trimester, functional markers of dNK activation, i.e., angiogenic factor production (e.g., vascular endothelial growth factor, interleukin-8, interferon-gamma), remained stable despite an increase in NKp80 or NKG2D surface expression. Furthermore, the degranulation capacity of dNK cells, as assessed by CD107a, was decreased in the second trimester. We suggest that in the first trimester, trophoblast-dNK interactions generate a population of dNK cells with a suppressed activating phenotype. In the second trimester, the loss of trophoblast-dNK interactions led to the inhibition of dNK cell function, although their activating receptor expression was increased. We speculate that during pregnancy, two mechanisms operate to modulate the dNK cell activation:suppression of activating receptor levels in the first trimester by trophoblasts and disengagement of receptor-ligand coupling in the second trimester.
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Affiliation(s)
- Jianhong Zhang
- Research Centre for Women's and Infants' Health, Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, ON M5T 3H7, Canada
| | - Caroline E Dunk
- Research Centre for Women's and Infants' Health, Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, ON M5T 3H7, Canada.,Department of Obstetrics & Gynaecology, University of Toronto, Toronto, ON M5G 1L4, Canada
| | - Melissa Kwan
- Research Centre for Women's and Infants' Health, Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, ON M5T 3H7, Canada.,Department of Physiology, University of Toronto, Toronto, ON M5G 1L4, Canada
| | - Rebecca L Jones
- Institute of Human Development, University of Manchester, Manchester, M13 9WL, UK.,St. Mary's Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, M13 9WL, UK
| | - Lynda K Harris
- Institute of Human Development, University of Manchester, Manchester, M13 9WL, UK.,St. Mary's Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, M13 9WL, UK
| | - Sarah Keating
- Department of Pathology, University of Toronto, Toronto, ON M5G 1L4, Canada
| | - Stephen J Lye
- Research Centre for Women's and Infants' Health, Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, ON M5T 3H7, Canada.,Department of Obstetrics & Gynaecology, University of Toronto, Toronto, ON M5G 1L4, Canada.,Department of Physiology, University of Toronto, Toronto, ON M5G 1L4, Canada
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36
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Sacks G. Enough! Stop the arguments and get on with the science of natural killer cell testing. Hum Reprod 2015; 30:1526-1531. [DOI: 10.1093/humrep/dev096] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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37
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Fukui A, Kamoi M, Funamizu A, Fuchinoue K, Chiba H, Yokota M, Fukuhara R, Mizunuma H. NK cell abnormality and its treatment in women with reproductive failures such as recurrent pregnancy loss, implantation failures, preeclampsia, and pelvic endometriosis. Reprod Med Biol 2015; 14:151-157. [PMID: 29259412 DOI: 10.1007/s12522-015-0207-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2014] [Accepted: 03/31/2015] [Indexed: 12/20/2022] Open
Abstract
The regulation of uterine and peripheral blood natural killer (NK) cells has been associated with problems related to reproductive immunology such as recurrent pregnancy loss (RPL), implantation failure or preeclampsia. NKp46, one of the natural cytotoxicity receptors (NCRs), is a unique marker that functions in NK cell cytotoxicity and cytokine production. Expression of NKp46 on NK cells is lower in women with recurrent pregnancy loss and pregnancy-induced hypertension. Moreover, expression of NKp46 on peritoneal fluid NK cells is lower in women with pelvic endometriosis. Therefore, evaluation of NKp46 on peripheral blood NK cells may provide a means of screening for reproductive abnormalities. Recently, a new type of NK cell, the NK22 cell, has been reported. This cell may be a regulator not only of the mucosal barrier but also of reproduction. For women with RPL showing abnormal uterine and/or peripheral blood NK cells, both intravenous immunoglobulin treatment and intralipid treatment have been reported. The effects of these treatments are still controversial, and further studies are needed in order to clarify their true impact. The present review examines variations in the expression of NCRs on NK cells, the participation of NK22 cells in reproduction, and the possible use of intravenous immunoglobulin or intralipid treatment for women with recurrent pregnancy loss and NK cell abnormality.
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Affiliation(s)
- Atsushi Fukui
- Department of Obstetrics and Gynecology Hirosaki University Graduate School of Medicine 5 Zaifu-cho 036-8562 Hirosaki Aomori Japan
| | - Mai Kamoi
- Department of Obstetrics and Gynecology Hirosaki University Graduate School of Medicine 5 Zaifu-cho 036-8562 Hirosaki Aomori Japan
| | - Ayano Funamizu
- Department of Obstetrics and Gynecology Hirosaki University Graduate School of Medicine 5 Zaifu-cho 036-8562 Hirosaki Aomori Japan
| | - Kohei Fuchinoue
- Department of Obstetrics and Gynecology Hirosaki University Graduate School of Medicine 5 Zaifu-cho 036-8562 Hirosaki Aomori Japan
| | - Hitomi Chiba
- Department of Obstetrics and Gynecology Hirosaki University Graduate School of Medicine 5 Zaifu-cho 036-8562 Hirosaki Aomori Japan
| | - Megumi Yokota
- Department of Obstetrics and Gynecology Hirosaki University Graduate School of Medicine 5 Zaifu-cho 036-8562 Hirosaki Aomori Japan
| | - Rie Fukuhara
- Department of Obstetrics and Gynecology Hirosaki University Graduate School of Medicine 5 Zaifu-cho 036-8562 Hirosaki Aomori Japan
| | - Hideki Mizunuma
- Department of Obstetrics and Gynecology Hirosaki University Graduate School of Medicine 5 Zaifu-cho 036-8562 Hirosaki Aomori Japan
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Dan S, Wei W, Yichao S, Hongbo C, Shenmin Y, Jiaxiong W, Hong L. Effect of Prednisolone Administration on Patients with Unexplained Recurrent Miscarriage and in Routine Intracytoplasmic Sperm Injection: A Meta-Analysis. Am J Reprod Immunol 2015; 74:89-97. [PMID: 25753479 DOI: 10.1111/aji.12373] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Accepted: 02/06/2015] [Indexed: 01/23/2023] Open
Affiliation(s)
- Song Dan
- Center for Reproduction and Genetics; Suzhou Municipal Hospital; Affiliated Hospital of Nanjing Medical University; Suzhou China
| | - Wang Wei
- Center for Reproduction and Genetics; Suzhou Municipal Hospital; Affiliated Hospital of Nanjing Medical University; Suzhou China
| | - Shi Yichao
- Center for Reproduction and Genetics; Suzhou Municipal Hospital; Affiliated Hospital of Nanjing Medical University; Suzhou China
| | - Cheng Hongbo
- Center for Reproduction and Genetics; Suzhou Municipal Hospital; Affiliated Hospital of Nanjing Medical University; Suzhou China
| | - Yang Shenmin
- Center for Reproduction and Genetics; Suzhou Municipal Hospital; Affiliated Hospital of Nanjing Medical University; Suzhou China
| | - Wang Jiaxiong
- Center for Reproduction and Genetics; Suzhou Municipal Hospital; Affiliated Hospital of Nanjing Medical University; Suzhou China
| | - Li Hong
- Center for Reproduction and Genetics; Suzhou Municipal Hospital; Affiliated Hospital of Nanjing Medical University; Suzhou China
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Lee SK, Kim CJ, Kim DJ, Kang JH. Immune cells in the female reproductive tract. Immune Netw 2015; 15:16-26. [PMID: 25713505 PMCID: PMC4338264 DOI: 10.4110/in.2015.15.1.16] [Citation(s) in RCA: 149] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2014] [Revised: 01/28/2015] [Accepted: 01/28/2015] [Indexed: 02/07/2023] Open
Abstract
The female reproductive tract has two main functions: protection against microbial challenge and maintenance of pregnancy to term. The upper reproductive tract comprises the fallopian tubes and the uterus, including the endocervix, and the lower tract consists of the ectocervix and the vagina. Immune cells residing in the reproductive tract play contradictory roles: they maintain immunity against vaginal pathogens in the lower tract and establish immune tolerance for sperm and an embryo/fetus in the upper tract. The immune system is significantly influenced by sex steroid hormones, although leukocytes in the reproductive tract lack receptors for estrogen and progesterone. The leukocytes in the reproductive tract are distributed in either an aggregated or a dispersed form in the epithelial layer, lamina propria, and stroma. Even though immune cells are differentially distributed in each organ of the reproductive tract, the predominant immune cells are T cells, macrophages/dendritic cells, natural killer (NK) cells, neutrophils, and mast cells. B cells are rare in the female reproductive tract. NK cells in the endometrium significantly expand in the late secretory phase and further increase their number during early pregnancy. It is evident that NK cells and regulatory T (Treg) cells are extremely important in decidual angiogenesis, trophoblast migration, and immune tolerance during pregnancy. Dysregulation of endometrial/decidual immune cells is strongly related to infertility, miscarriage, and other obstetric complications. Understanding the immune system of the female reproductive tract will significantly contribute to women's health and to success in pregnancy.
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Affiliation(s)
- Sung Ki Lee
- Department of Obstetrics and Gynecology, College of Medicine, Konyang University, Daejeon 302-718, Korea
| | - Chul Jung Kim
- Department of Obstetrics and Gynecology, College of Medicine, Konyang University, Daejeon 302-718, Korea
| | - Dong-Jae Kim
- Department of Obstetrics and Gynecology, College of Medicine, Konyang University, Daejeon 302-718, Korea
| | - Jee-Hyun Kang
- Department of Family Medicine, College of Medicine, Konyang University, Daejeon 302-718, Korea
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Kamoi M, Fukui A, Kwak-Kim J, Fuchinoue K, Funamizu A, Chiba H, Yokota M, Fukuhara R, Mizunuma H. NK22 Cells in the Uterine Mid-Secretory Endometrium and Peripheral Blood of Women with Recurrent Pregnancy Loss and Unexplained Infertility. Am J Reprod Immunol 2015; 73:557-67. [PMID: 25559361 DOI: 10.1111/aji.12356] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Accepted: 12/12/2014] [Indexed: 12/30/2022] Open
Abstract
PROBLEM We aimed to investigate natural killer 22 (NK22) cells in the peripheral blood and the uterine endometrium of women with unexplained recurrent pregnancy loss (URPL) and unexplained infertility (UI). METHOD OF STUDY Peripheral blood and endometrial samples were collected from women with URPL (n = 43) and UI (n = 38). Intracellular cytokine production, such as IL-22, IFN-γ and TNF-α, and the expression of NKp46 on NK cells were analyzed by three-color flow cytometry. RESULTS The percentages of endometrial CD56(+) /IL-22(+) and CD56(dim) /IL-22(+) cells in women with URPL were significantly higher than those of UI (P < 0.05, respectively). In addition, the percentage of CD56(bright) /IL-22(+) cells in women with RPL was negatively correlated with those of CD56(bright) /IFN-γ(+) and CD56(bright) /TNF-α(+) in both peripheral blood and endometrial NK cells. This was not seen in women with UI. The percentage of CD56(bright) /IL-22(+) cells was negatively correlated with CD56(bright) /NKp46 expressing NK cells in peripheral blood. CONCLUSION Endometrial NK22 cells are differently regulated in women with URPL and UI. Women with URPL have higher level of NK22 cells with a potential to induce NK2 shift than women with UI.
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Affiliation(s)
- Mai Kamoi
- Department of Obstetrics and Gynecology, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, Japan
| | - Atsushi Fukui
- Department of Obstetrics and Gynecology, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, Japan
| | - Joanne Kwak-Kim
- Reproductive Medicine Program, Department of Obstetrics and Gynecology, Chicago Medical School at Rosalind Franklin University of Medicine and Science, Vernon Hills, IL, USA
| | - Kohei Fuchinoue
- Department of Obstetrics and Gynecology, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, Japan
| | - Ayano Funamizu
- Department of Obstetrics and Gynecology, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, Japan
| | - Hitomi Chiba
- Department of Obstetrics and Gynecology, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, Japan
| | - Megumi Yokota
- Department of Obstetrics and Gynecology, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, Japan
| | - Rie Fukuhara
- Department of Obstetrics and Gynecology, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, Japan
| | - Hideki Mizunuma
- Department of Obstetrics and Gynecology, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, Japan
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Sacks G. Reproductive immunology: the relevance of laboratory research to clinical practice (and vice versa). Hum Reprod 2014; 30:253-5. [DOI: 10.1093/humrep/deu325] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
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Favorable immune phenotype predicts successful implantation and pregnancy. Immunol Lett 2014; 162:217-21. [DOI: 10.1016/j.imlet.2014.10.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2014] [Revised: 10/16/2014] [Accepted: 10/21/2014] [Indexed: 01/07/2023]
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Diejomaoh MF. Recurrent spontaneous miscarriage is still a challenging diagnostic and therapeutic quagmire. Med Princ Pract 2014; 24 Suppl 1:38-55. [PMID: 25428171 PMCID: PMC6489083 DOI: 10.1159/000365973] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Accepted: 07/17/2014] [Indexed: 01/12/2023] Open
Abstract
Recurrent spontaneous miscarriage (RSM), affecting 1-2% of women of reproductive age seeking pregnancy, has been a clinical quagmire and a formidable challenge for the treating physician. There are many areas of controversy in the definition, aetiology, investigations and treatment of RSM. This review will address the many factors involved in the aetiology of RSM which is multifactorial in many patients, with antiphospholipid syndrome (APS) being the most recognized aetiological factor. There is no identifiable cause in about 40-60% of these patients, in which case the condition is classified as idiopathic or unexplained RSM. The RSM investigations are extensive and should be undertaken in dedicated, specialized, well-equipped clinics/centres where services are provided by trained specialists. The challenges faced by the treating physician are even more overwhelming regarding the decision of what should be the most appropriate therapy offered to patients with RSM. Our review will cover the diverse modalities of therapy available including the role of preimplantation genetic testing using recent microarray technology, such as single nucleotide polymorphism and comparative genomic hybridization, as well as preimplantation genetic diagnosis; the greatest emphasis will be on the treatment of APS, and there will be important comments on the management of patients presenting with idiopathic RSM. The controversial areas of the role of natural killer cells in RSM, the varied modalities in the management of idiopathic RSM and the need for better-planned studies will be covered as well.
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Affiliation(s)
- Michael F.E. Diejomaoh
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Kuwait University, and Maternity Hospital, Kuwait City, Kuwait
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Moffett A, Colucci F. Uterine NK cells: active regulators at the maternal-fetal interface. J Clin Invest 2014; 124:1872-9. [PMID: 24789879 PMCID: PMC4001528 DOI: 10.1172/jci68107] [Citation(s) in RCA: 269] [Impact Index Per Article: 26.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Pregnancy presents an immunological conundrum because two genetically different individuals coexist. The maternal lymphocytes at the uterine maternal-fetal interface that can recognize mismatched placental cells are T cells and abundant distinctive uterine NK (uNK) cells. Multiple mechanisms exist that avoid damaging T cell responses to the fetus, whereas activation of uNK cells is probably physiological. Indeed, genetic epidemiological data suggest that the variability of NK cell receptors and their MHC ligands define pregnancy success; however, exactly how uNK cells function in normal and pathological pregnancy is still unclear, and any therapies aimed at suppressing NK cells must be viewed with caution. Allorecognition of fetal placental cells by uNK cells is emerging as the key maternal-fetal immune mechanism that regulates placentation.
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Affiliation(s)
- Ashley Moffett
- Department of Pathology and
Centre for Trophoblast Research, Physiology Building, University of Cambridge, Cambridge, United Kingdom.
Department of Obstetrics and Gynaecology, University of Cambridge School of Clinical Medicine, NIHR Cambridge Biomedical Research Centre, Addenbrooke’s Hospital, Cambridge,United Kingdom
| | - Francesco Colucci
- Department of Pathology and
Centre for Trophoblast Research, Physiology Building, University of Cambridge, Cambridge, United Kingdom.
Department of Obstetrics and Gynaecology, University of Cambridge School of Clinical Medicine, NIHR Cambridge Biomedical Research Centre, Addenbrooke’s Hospital, Cambridge,United Kingdom
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Hosseini S, Zarnani AH, Asgarian-Omran H, Vahedian-Dargahi Z, Eshraghian MR, Akbarzadeh-Pasha Z, Arefi S, Jeddi-Tehrani M, Shokri F. Comparative analysis of NK cell subsets in menstrual and peripheral blood of patients with unexplained recurrent spontaneous abortion and fertile subjects. J Reprod Immunol 2014; 103:9-17. [PMID: 24725996 DOI: 10.1016/j.jri.2014.03.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Accepted: 03/04/2014] [Indexed: 10/25/2022]
Abstract
Natural killer (NK) cells play a fundamental role in maintaining pregnancy. Based on the availability and non-invasive method of collection of menstrual blood (MB), here we investigated for the first time a comparative analysis of NK cell subsets in MB and peripheral blood (PB) of women with recurrent spontaneous abortion (RSA) and fertile women. PB and MB of healthy fertile (n=15) and RSA women (n=15) were sampled simultaneously on the second day of the menstrual cycle. Proportions of CD56+CD3-CD16+/-, CD56+CD3-CCR7+/-, and CD56+CD3-CD45RO+/- cells were analyzed using flow cytometry. In the MB of both groups, proportions of CD16+ and CD45RO- NK cells were significantly lower than in the PB. In parallel, CD56+CD16+CCR7- and CCR7+ cells were present in significantly smaller amounts in MB than in PB. However, the amounts of CD56+CD16-CCR7- and CCR7+ cells were greater in MB. In comparison to the fertile group, the percentage of MB CD45RO+ NK cells was significantly lower and frequencies of PB CD16-, CD45RO- and CD56+CD16+CCR7+ subsets were significantly higher in RSA patients. Different subsets of NK cells are differentially distributed in MB in comparison with PB in women with RSA and fertile subjects. Population differences of NK cell subsets in RSA patients and normal controls were more clearly reflected at the systemic level.
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Affiliation(s)
- Samira Hosseini
- Department of Immunology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir-Hassan Zarnani
- Reproductive Immunology Research Center, Avicenna Research Institute, ACECR, Tehran, Iran; Immunology Research Center, Iran University of Medical Sciences, Tehran, Iran; Nanobiotechnology Research Center, Avicenna Research Institute, ACECR, Tehran, Iran.
| | - Hossein Asgarian-Omran
- Department of Immunology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | | | | | - Zahra Akbarzadeh-Pasha
- Reproductive Immunology Research Center, Avicenna Research Institute, ACECR, Tehran, Iran
| | - Soheila Arefi
- Reproductive Immunology Research Center, Avicenna Research Institute, ACECR, Tehran, Iran
| | - Mahmood Jeddi-Tehrani
- Monoclonal Antibody Research Center, Avicenna Research Institute, ACECR, Tehran, Iran
| | - Fazel Shokri
- Department of Immunology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran; Monoclonal Antibody Research Center, Avicenna Research Institute, ACECR, Tehran, Iran.
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Lee SB, Cha J, Kim IK, Yoon JC, Lee HJ, Park SW, Cho S, Youn DY, Lee H, Lee CH, Lee JM, Lee KY, Kim J. A high-throughput assay of NK cell activity in whole blood and its clinical application. Biochem Biophys Res Commun 2014; 445:584-90. [PMID: 24561245 DOI: 10.1016/j.bbrc.2014.02.040] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Accepted: 02/10/2014] [Indexed: 01/29/2023]
Abstract
Natural killer (NK) cells are lymphocytes of the innate immune system and have the ability to kill tumor cells and virus-infected cells without prior sensitization. Malignant tumors and viruses have developed, however, strategies to suppress NK cells to escape from their responses. Thus, the evaluation of NK cell activity (NKA) could be invaluable to estimate the status and the outcome of cancers, viral infections, and immune-mediated diseases. Established methods that measure NKA, such as (51)Cr release assay and CD107a degranulation assay, may be used to determine NK cell function, but they are complicated and time-consuming because they require isolation of peripheral blood mononuclear cells (PBMC) or NK cells. In some cases these assays require hazardous material such as radioactive isotopes. To overcome these difficulties, we developed a simple assay that uses whole blood instead of PBMC or isolated NK cells. This novel assay is suitable for high-throughput screening and the monitoring of diseases, because it employs serum of ex vivo stimulated whole blood to detect interferon (IFN)-γ secreted from NK cells as an indicator of NKA. After the stimulation of NK cells, the determination of IFNγ concentration in serum samples by enzyme-linked immunosorbent assay (ELISA) provided a swift, uncomplicated, and high-throughput assay of NKA ex vivo. The NKA results microsatellite stable (MSS) colorectal cancer patients was showed significantly lower NKA, 263.6 ± 54.5 pg/mL compared with healthy subjects, 867.5 ± 50.2 pg/mL (p value <0.0001). Therefore, the NKA could be utilized as a supportive diagnostic marker for microsatellite stable (MSS) colorectal cancer.
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Affiliation(s)
- Saet-byul Lee
- Department of Microbiology and Brain Korea 21 Project for Medical Sciences, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Junhoe Cha
- ATGen Co. Ltd., Sungnam, Republic of Korea
| | - Im-kyung Kim
- Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Joo Chun Yoon
- Department of Microbiology, Ewha Womans University School of Medicine, Seoul, Republic of Korea
| | - Hyo Joon Lee
- Department of Microbiology and Brain Korea 21 Project for Medical Sciences, Yonsei University College of Medicine, Seoul, Republic of Korea
| | | | | | | | - Heyja Lee
- ATGen Co. Ltd., Sungnam, Republic of Korea
| | | | - Jae Myun Lee
- Department of Microbiology and Brain Korea 21 Project for Medical Sciences, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kang Young Lee
- Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
| | - Jongsun Kim
- Department of Microbiology and Brain Korea 21 Project for Medical Sciences, Yonsei University College of Medicine, Seoul, Republic of Korea.
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Sharma S. Natural killer cells and regulatory T cells in early pregnancy loss. THE INTERNATIONAL JOURNAL OF DEVELOPMENTAL BIOLOGY 2014; 58:219-29. [PMID: 25023688 PMCID: PMC4306453 DOI: 10.1387/ijdb.140109ss] [Citation(s) in RCA: 94] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Survival of the allogeneic embryo in the uterus depends on the maintenance of immune tolerance at the maternal-fetal interface. The pregnant uterus is replete with activated maternal immune cells. How this immune tolerance is acquired and maintained has been a topic of intense investigation. The key immune cells that predominantly populate the pregnant uterus are natural killer (NK) cells. In normal pregnancy, these cells are not killers, but rather provide a microenvironment that is pregnancy compatible and supports healthy placentation. In placental mammals, an array of highly orchestrated immune elements to support successful pregnancy outcome has been incorporated. This includes active cooperation between maternal immune cells, particularly NK cells, and trophoblast cells. This intricate process is required for placentation, immune regulation and to remodel the blood supply to the fetus. During the past decade, various types of maternal immune cells have been thought to be involved in cross-talk with trophoblasts and in programming immune tolerance. Regulatory T cells (Tregs) have attracted a great deal of attention in promoting implantation and immune tolerance beyond implantation. However, what has not been fully addressed is how this immune-trophoblast axis breaks down during adverse pregnancy outcomes, particularly early pregnancy loss, and in response to unscheduled inflammation. Intense research efforts have begun to shed light on the roles of NK cells and Tregs in early pregnancy loss, although much remains to be unraveled in order to fully characterize the mechanisms underlying their detrimental activity. An increased understanding of host-environment interactions that lead to the cytotoxic phenotype of these otherwise pregnancy compatible maternal immune cells is important for prediction, prevention and treatment of pregnancy maladies, particularly recurrent pregnancy loss. In this review, we discuss relevant information from experimental and human models that may explain the pregnancy disrupting roles of these pivotal sentinel cells at the maternal-fetal interface.
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Affiliation(s)
- Surendra Sharma
- Women and Infants Hospital of Rhode Island, Warren Alpert Medical School of Brown University, Department of Pediatrics, Providence, Rhode Island, USA.
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Seshadri S, Sunkara SK. Natural killer cells in female infertility and recurrent miscarriage: a systematic review and meta-analysis. Hum Reprod Update 2013; 20:429-38. [PMID: 24285824 DOI: 10.1093/humupd/dmt056] [Citation(s) in RCA: 175] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
INTRODUCTION Embryo implantation is a complex process involving maternal hormonal changes, immune responses and maturational events in the embryo. A pregnancy could fail when these events are not synchronized. It is speculated that in women, an elevation of natural killer (NK) cells may have an effect on reproductive performance, and NK cell levels in blood are currently being used as a diagnostic test to guide the initiation of therapies in patients with infertility. METHODS We conducted a systematic review to evaluate the (i) levels of NK cells in blood and endometrium in infertile versus fertile women, (ii) association between NK cells and IVF outcome, (iii) levels of NK cells in blood and endometrium in women with recurrent miscarriage (RM) versus controls. The following electronic databases were searched: Medline, EMBASE, Cochrane Library, Web of Science and National Research Register. RESULTS A total of 22 studies were included. Meta-analysis of studies that evaluated peripheral and uterine NK (uNK) cell percentages in infertile versus fertile women showed no significant difference between the two groups [standardized mean difference (SMD) -0.33; 95% confidence intervals (CI) -1.06, 0.4; P = 0.37; SMD -1.82; 95% CI -4.80, 1.17; P = 0.23 respectively]. Pooling of studies that reported peripheral NK cells as numbers showed significantly higher NK cell numbers in infertile women compared with fertile controls (SMD 3.16; 95% CI 1.07, 5.24; P = 0.003). Meta-analysis of studies that evaluated the role of NK cells in IVF outcome showed no significant difference in live birth rates in women with elevated NK cells or NK cell activity compared with women without elevated peripheral NK cells or NK cell activity (NK activity assessed using a cytotoxicity assay) (relative risk 0.57; 95% CI 0.06, 5.22; P = 0.62). Meta-analysis of studies that evaluated peripheral NK cell percentages in women with RM versus controls showed significantly higher NK cell percentages in women with RM (SMD 1.36; 95% CI 0.04, 2.69; P = 0.04). Meta-analysis of studies that evaluated peripheral NK cell numbers showed significantly higher NK cell numbers in women with RM compared with controls (SMD 0.81; 95% CI 0.47, 1.16; P < 0.00001). Meta-analysis of studies that evaluated uNK cells showed no significant difference in women with RM compared with controls (SMD 0.40; 95% CI -1.24, 2.04; P = 0.63). CONCLUSIONS Further research is needed before NK cell assessment can be recommended as a diagnostic tool in the context of female infertility or RM. There is no clear explanation as to why the results differ when data for NK cells are expressed as numbers or a percentage. On the basis of current evidence, NK cell analysis and immune therapy should be offered only in the context of clinical research.
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Zhang Y, Kwak-Kim J, Huang D, Hu L, Liao A. Cyclic Changes and Relationship between Peripheral and Endometrial NK Cells from Women with Repeated Failure after Artificial Insemination by Donor Sperm. Am J Reprod Immunol 2013; 71:44-54. [DOI: 10.1111/aji.12159] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2013] [Accepted: 08/15/2013] [Indexed: 11/29/2022] Open
Affiliation(s)
- Yang Zhang
- Family Planning Research Institute; Center for Reproductive Medicine; Tongji Medical College; Huazhong University of Science and Technology; Wuhan China
- Hospital for Reproductive Medicine; Affiliated to Shandong University; Jinan China
| | - Joanne Kwak-Kim
- Reproductive Medicine; Department of Obstetrics and Gynecology; Chicago Medical School at Rosalind Franklin University of Medicine and Science; Vernon Hills IL USA
- Department of Microbiology and Immunology; Chicago Medical School at Rosalind Franklin University of Medicine and Science; North Chicago IL USA
| | - Donghui Huang
- Family Planning Research Institute; Center for Reproductive Medicine; Tongji Medical College; Huazhong University of Science and Technology; Wuhan China
| | - Lian Hu
- Family Planning Research Institute; Center for Reproductive Medicine; Tongji Medical College; Huazhong University of Science and Technology; Wuhan China
| | - Aihua Liao
- Family Planning Research Institute; Center for Reproductive Medicine; Tongji Medical College; Huazhong University of Science and Technology; Wuhan China
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Li MQ, Jin LP. Ovarian stimulation for in vitro fertilization alters the protein profile expression in endometrial secretion. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2013; 6:1964-71. [PMID: 24133574 PMCID: PMC3796218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Accepted: 08/29/2013] [Indexed: 06/02/2023]
Abstract
Failure of the embryo to implant now constitutes the major limiting step in IVF treatment. Successful implantation requires a vital embryo and an effective molecular dialogue with a 'receptive' endometrium. However, what precisely constitutes a receptive human endometrium remains poorly defined. Several observations have indicated that ovarian stimulation for IVF may impair endometrial receptivity. The histological approach to monitor endometrial maturation requires an invasive biopsy that excludes its use during the luteal phase of cycles in which implantation is the end-point objective as in IVF. In recent years, several studies have been reported that the removal of endometrial secretions immediately prior to embryo transfer provides sufficient material for analysis of markers of receptivity without disrupting embryo implantation. Therefore, analysis of protein patterns in endometrial secretion fluid may offer a relatively non-invasive means of assessing endometrial receptivity during fertility treatment cycles. Several studies have shown that protein profile expression in endometrial secretions undergo cyclical changes, and demonstrated significant differences between the natural cycle and stimulated cycle. These findings suggest that endometrial secretion analysis provide a novel means of investigating the effect of ovarian stimulation on the intrauterine environment at the time of embryo transfer, which may help to develop less disruptive ovarian stimulation protocols for IVF in the future.
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Affiliation(s)
- Ming-Qing Li
- Laboratory for Reproductive Immunology, Hospital and Institute of Obstetrics and Gynecology, Fudan University Shanghai Medical CollegeShanghai 200011, People’s Republic of China
- Shanghai Key Laboratory of Female Reproductive Endocrine Related DiseasesShanghai 200011, People’s Republic of China
| | - Li-Ping Jin
- Laboratory for Reproductive Immunology, Hospital and Institute of Obstetrics and Gynecology, Fudan University Shanghai Medical CollegeShanghai 200011, People’s Republic of China
- Shanghai Key Laboratory of Female Reproductive Endocrine Related DiseasesShanghai 200011, People’s Republic of China
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