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Chen J, Wu S, Wang M, Zhang H, Cui M. A review of autoimmunity and immune profiles in patients with primary ovarian insufficiency. Medicine (Baltimore) 2022; 101:e32500. [PMID: 36595863 PMCID: PMC9794221 DOI: 10.1097/md.0000000000032500] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Primary ovarian insufficiency (POI) is a complicated clinical syndrome characterized by progressive deterioration of ovarian function. Autoimmunity is one of the main pathogenic factors affecting approximately 10% to 55% of POI cases. This review mainly focuses on the role of autoimmunity in the pathophysiology of POI and the potential therapies for autoimmunity-related POI. This review concluded that various markers of ovarian reserve, principally anti-Müllerian hormone, could be negatively affected by autoimmune diseases. The presence of lymphocytic oophoritis, anti-ovarian autoantibodies, and concurrent autoimmune diseases, are the main characteristics of autoimmune POI. T lymphocytes play the most important role in the immune pathogenesis of POI, followed by disorders of other immune cells and the imbalance between pro-inflammatory and anti-inflammatory cytokines. A comprehensive understanding of immune characteristics of patients with autoimmune POI and the underlying mechanisms is essential for novel approaches of treatment and intervention for autoimmune POI.
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Affiliation(s)
- Junyu Chen
- Departments of Gynecology and Obstetrics, The Second Hospital of Jilin University, Changchun, China
| | - Shan Wu
- Departments of Gynecology and Obstetrics, The Second Hospital of Jilin University, Changchun, China
- Department of Reproductive Endocrinology, Women’s Hospital, Zhejiang University, School of Medicine, Hangzhou, China
| | - Mengqi Wang
- Departments of Gynecology and Obstetrics, The Second Hospital of Jilin University, Changchun, China
| | - Haoxian Zhang
- Department of Pharmacy, Xuchang Central Hospital, Xuchang, China
| | - Manhua Cui
- Departments of Gynecology and Obstetrics, The Second Hospital of Jilin University, Changchun, China
- * Correspondence: Manhua Cui, Department of Gynecology and Obstetrics, The Second Hospital of Jilin University, 218 Ziqiang Street, Changchun, Jilin 130022, China (e-mail: )
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Girbash EF, Abdelwahab SM, Fahmi DS, Abdeldayem HM, Ghonaim R, Atta DS. Preliminary study on Anti‐Müllerian hormone, Antral follicle count, menstruation and lymphocyte subsets in systemic lupus erythematosus patients. Int J Gynaecol Obstet 2022; 159:129-135. [DOI: 10.1002/ijgo.14109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 10/18/2021] [Accepted: 01/20/2022] [Indexed: 11/07/2022]
Affiliation(s)
- Ehab F. Girbash
- Obstetrics & Gynecology Department, Faculty of Medicine ‐ Zagazig University
| | - Shaimaa M Abdelwahab
- Rheumatology & Rehabilitation Department, Faculty of Medicine ‐Zagazig University
| | - Dalia S Fahmi
- Rheumatology & Rehabilitation Department, Faculty of Medicine ‐Zagazig University
| | | | - Rania Ghonaim
- Clinical Pathology Department, Faculty of Medicine ‐Zagazig University
| | - Doaa S Atta
- Rheumatology & Rehabilitation Department, Faculty of Medicine ‐Zagazig University
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3
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Giambalvo S, Garaffoni C, Silvagni E, Furini F, Rizzo R, Govoni M, Bortoluzzi A. Factors associated with fertility abnormalities in women with systemic lupus erythematosus: a systematic review and meta-analysis. Autoimmun Rev 2022; 21:103038. [PMID: 34995765 DOI: 10.1016/j.autrev.2022.103038] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 01/01/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Fertility is thought to be not affected in women with systemic lupus erythematosus (SLE), however disease-related factors, psychosocial effects of chronic disease, as well as medications exposure might impair gonadal function. OBJECTIVE This systematic literature review (SLR) aimed to explore clinical, hormonal, serological and treatment factors associated with fertility outcomes in women of childbearing age with SLE. METHODS This SLR was conducted following the Preferred Reporting Items for systematic reviews and Meta-analysis (PRISMA) statement. All articles available in English (1972 - 30th April 2021) in Pubmed, EMBASE, Scopus and Cochrane Library were screened. Study selection and data collection were performed by two independent reviewers. All data were extracted using a standardized template. The risk of bias of the included studies was assessed using the NIH risk-of-bias tool. RESULTS Of 789 abstracts evaluated, we included in this review 46 studies, of which 1 SLR, 16 cross-sectional studies, 18 cohort studies, 10 observational studies and 1 case-series, with data pertaining to 4704 patients (mean age 31.5 ± 3.7 years, disease duration 83.27 ± 38.3 months). Definitions of premature ovarian failure (POF) adopted in the studies varied in terms of the number of months of amenorrhea considered and the age of onset of amenorrhea. Clinical factors associated with the development of POF were older age at the time of initiation of therapy, and older age at the onset of SLE disease. Cyclophosphamide exposure (CYC) and its cumulative dose influenced gonadal function in SLE women, leading to amenorrhoea and POF, as reported in 19 studies. Mycophenolate, azathioprine, calcineurin inhibitors and steroids associated with a lower risk of POF compared to CYC. POF was less frequent in patients co-treated with CYC and gonadotropin-releasing hormone analogues (GnRH-a) compared with patients not receiving GnRH-a (risk ratio 0.798, 95%-CI [0.1417; 0.5525]). 11 studies evaluated the impact of damage accrual and disease activity on ovarian reserve with conflicting evidence. Finally, 18 studies investigated exposure to hormonal and serological factors and, among others, neither Anti-Müllerian Hormone nor anti-corpus luteum antibodies were associated with POF. CONCLUSION The strongest evidence regarding management factors associated with fertility in SLE women of childbearing age remains the treatment with CYC, as well as its cumulative dosage. Hormonal and serological factors appeared not to impact fertility outcomes, but they might be used as a surrogate of fertility, especially during the treatment with disease-specific drugs.
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Affiliation(s)
- S Giambalvo
- Unit of Rheumatology, Department of Medical Sciences, University of Ferrara, Azienda Ospedaliera-Universitaria Sant'Anna of Ferrara, Italy
| | - C Garaffoni
- Unit of Rheumatology, Department of Medical Sciences, University of Ferrara, Azienda Ospedaliera-Universitaria Sant'Anna of Ferrara, Italy
| | - E Silvagni
- Unit of Rheumatology, Department of Medical Sciences, University of Ferrara, Azienda Ospedaliera-Universitaria Sant'Anna of Ferrara, Italy
| | - F Furini
- Unit of Rheumatology, Ospedale Maggiore, Bologna, Italy
| | - R Rizzo
- Department of Chemical, Pharmaceutical and Agricultural Science, University of Ferrara, Italy
| | - M Govoni
- Unit of Rheumatology, Department of Medical Sciences, University of Ferrara, Azienda Ospedaliera-Universitaria Sant'Anna of Ferrara, Italy
| | - A Bortoluzzi
- Unit of Rheumatology, Department of Medical Sciences, University of Ferrara, Azienda Ospedaliera-Universitaria Sant'Anna of Ferrara, Italy.
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Karvonen-Gutierrez CA, Leis A. Impact of menopause on women with systemic lupus erythematosus. Maturitas 2021; 154:25-30. [PMID: 34736577 DOI: 10.1016/j.maturitas.2021.09.004] [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: 06/19/2021] [Revised: 09/05/2021] [Accepted: 09/08/2021] [Indexed: 10/20/2022]
Abstract
Systemic lupus erythematosus (SLE) is an autoimmune disease characterized by chronic and systemic inflammation affecting multiple organ systems, including an increased risk of cardiovascular disease due to the SLE-associated hyperinflammatory state. SLE shows a strong female predominance, suggesting a potential role of sex hormones in the pathogenesis of the disease. Evidence suggests an earlier age of menopause among women with SLE, despite mixed findings regarding other markers of ovarian aging. In healthy populations, the menopausal transition is associated with important physiologic changes resulting in increased cardiometabolic risk and risk of osteoporosis. Thus, women with SLE who experience the inflammatory effects of the autoimmune condition combined with the (potentially earlier) menopausal transition may represent a particularly vulnerable group of individuals during a particular window of time. Little is known, however, about strategies for cardiovascular risk or bone loss mitigation in women with SLE during the menopausal transition. Further, despite lack of knowledge regarding the burden of menopausal symptoms in women with SLE, existing recommendations provide only cautionary guidance for the use of hormone replacement therapy to address menopausal symptoms in this population. Importantly, the data regarding both SLE and menopause-associated cardiovascular and osteoporotic risk demonstrate the critical need for additional research to identify the type and timing of treatments or interventions needed to best mitigate this increased risk.
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Affiliation(s)
- Carrie A Karvonen-Gutierrez
- Department of Epidemiology, University of Michigan School of Public Health-I, 1415 Washington Heights, Room 6618, Ann Arbor, MI, United States.
| | - Aleda Leis
- Department of Epidemiology, University of Michigan School of Public Health-I, 1415 Washington Heights, Room 6618, Ann Arbor, MI, United States
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Morales-Martínez FA, Salas-Castro C, García-Garza MR, Valdés-Martínez O, García-Luna SM, Garza-Elizondo M, Vidal-Gutiérrez O, Saldívar-Rodríguez D, Sordia-Hernández LH. Evaluation of the Ovarian Reserve in Women With Systemic Lupus Erythematosus. J Family Reprod Health 2021; 15:38-44. [PMID: 34429735 PMCID: PMC8346742 DOI: 10.18502/jfrh.v15i1.6076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Objective: Systemic lupus erythematosus (SLE) is a chronic multisystem autoimmune disorder where the disease activity itself and the medications used for its treatment, may have adverse effects on ovarian function. This study aimed to assess the ovarian reserve (OR) in SLE patients. Materials and methods: The anti-müllerian hormone (AMH) and the antral follicle count (AFC), two markers to evaluate the OR was assessed in 64 SLE patients and compared to normal individuals. Additionally, we assessed whether the disease per se or the pharmacological treatments affect the OR. Results: Patients with SLE displayed alterations in the OR regardless of the presence of alterations of the menstrual cycle. The AFC and AMH were significantly lower in SLE patients with and without menstrual alterations when compared to control individuals (p<0.0001). However, the AFC and AMH levels were significantly correlated (p=0.006) in the SLE patients with menstrual alterations. Except for hydroxychloroquine that was statistically higher in SLE patients with menstrual alterations (p=0.04), the cumulative dose for cyclophosphamide, corticosteroid, and methotrexate was similar in SLE patients regardless of the occurrence of menstrual alterations. Conclusion: The monitoring of AMH and AFC in SLE patients should be used to detect the rapid and irreversible decline of the OR to provide a possibility of pregnancy to the SLE patients.
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Affiliation(s)
- Felipe Arturo Morales-Martínez
- University Center of Reproductive Medicine, Dr. José Eleuterio González Hospital, Free University of New León, Monterrey, Mexic
| | - Celina Salas-Castro
- University Center of Reproductive Medicine, Dr. José Eleuterio González Hospital, Free University of New León, Monterrey, Mexic
| | - Manuel Rolando García-Garza
- University Center of Reproductive Medicine, Dr. José Eleuterio González Hospital, Free University of New León, Monterrey, Mexic
| | - Otto Valdés-Martínez
- University Center of Reproductive Medicine, Dr. José Eleuterio González Hospital, Free University of New León, Monterrey, Mexic
| | - Selene Marysol García-Luna
- University Center of Reproductive Medicine, Dr. José Eleuterio González Hospital, Free University of New León, Monterrey, Mexic
| | - Mario Garza-Elizondo
- Reumatology ward, Dr. José Eleuterio González Hospital, Free University of New León, Monterrey, Mexic
| | - Oscar Vidal-Gutiérrez
- Departament of Gynecology and Obstetrics, Dr. José Eleuterio González Hospital, Free University of New León, Monterrey, Mexic
| | - Donato Saldívar-Rodríguez
- Departament of Gynecology and Obstetrics, Dr. José Eleuterio González Hospital, Free University of New León, Monterrey, Mexic
| | - Luis Humberto Sordia-Hernández
- University Center of Reproductive Medicine, Dr. José Eleuterio González Hospital, Free University of New León, Monterrey, Mexic
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Angley M, Spencer JB, Lim SS, Howards PP. Anti-Müllerian hormone in African-American women with systemic lupus erythematosus. Lupus Sci Med 2020; 7:e000439. [PMID: 33132225 PMCID: PMC7607611 DOI: 10.1136/lupus-2020-000439] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 09/18/2020] [Accepted: 10/01/2020] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Women with SLE may experience ovarian insufficiency or dysfunction due to treatment or disease effects. Anti-Müllerian hormone (AMH), a marker of ovarian reserve, has been examined in small populations of women with SLE with conflicting results. To date, these studies have included very few African-American women, the racial/ethnic group at greatest risk of SLE. METHODS We enrolled African-American women aged 22-40 years diagnosed with SLE after age 17 from the Atlanta Metropolitan area. Women without SLE from the same area were recruited from a marketing list for comparison. AMH was measured in serum using the Ansh Labs assay (Webster, Texas, USA). We considered AMH levels <1.0 ng/mL and AMH <25th percentile of comparison women as separate dichotomous outcomes. Log-binomial regression models estimating prevalence ratios were adjusted for age, body mass index and hormonal contraception use in the previous year. RESULTS Our sample included 83 comparison women without SLE, 68 women with SLE and no history of cyclophosphamide (SLE/CYC-) and 11 women with SLE and a history of cyclophosphamide treatment (SLE/CYC+). SLE/CYC+ women had a greater prevalence of AMH <1.0 ng/mL compared with women without SLE (prevalence ratio (PR): 2.90, 95% CI: 1.29 to 6.51). SLE/CYC- women were also slightly more likely to have AMH <1.0 ng/mL (PR: 1.62, 95% CI: 0.93 to 2.82) than comparison women. Results were similar when considering AMH <25th percentile by age of comparison women. CONCLUSIONS Treatment with CYC is associated with low AMH in African-American women with SLE. SLE itself may also be associated with reduced AMH, but to a lesser extent.
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Affiliation(s)
- Meghan Angley
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Jessica B Spencer
- Division of Reproductive Endocrinology and Infertility, Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - S Sam Lim
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
- Department of Medicine, Division of Rheumatology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Penelope P Howards
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
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Gao H, Ma J, Wang X, Lv T, Liu J, Ren Y, Li Y, Zhang Y. Preliminary study on the changes of ovarian reserve, menstruation, and lymphocyte subpopulation in systemic lupus erythematosus (SLE) patients of childbearing age. Lupus 2017; 27:445-453. [PMID: 28820360 DOI: 10.1177/0961203317726378] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Objective The main aim of this study was to investigate the ovarian reserve, menstruation, and lymphocyte subpopulation in systemic lupus erythematosus (SLE) patients of childbearing age. Methods We enrolled 40 SLE patients of childbearing age and 40 age-matched healthy controls. Anti-Müllerian hormone (AMH) was tested by electrochemiluminescence, and lymphocyte subsets were tested by flow cytometry. Menstruation situation was obtained by interview. Results The AMH level of the SLE group was significantly lower than that of the control group ( p < 0.001), which was negatively correlated with erythrocyte sedimentation rate (ESR ( r = −0.316, p = 0.047)) and disease activity (SLEDAI ( r = −0.338, p = 0.033)). The AMH concentration of SLE patients with normal menstruation was higher than those with abnormal menstruation ( p < 0.001). The percentages of CD4+ T lymphocytes and NK (natural killer) cells in the SLE group were significantly lower than those in the control group ( p < 0.001). However, the percentages of B cells and CD8+ T lymphocytes in the SLE group were higher than those in the control group ( p < 0.05). Conclusion Decreased AMH and high incidence of abnormal menstruation indicated that autoimmunity activities of SLE can impair the ovarian reserve of female patients. Lymphocytes in SLE patients were in a state of disorder.
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Affiliation(s)
- H Gao
- Department of Rheumatology and Immunology, Tangdu Hospital of The Fourth Military Medical University, Xi'an, China
| | - J Ma
- Department of Rheumatology and Immunology, Tangdu Hospital of The Fourth Military Medical University, Xi'an, China
| | - X Wang
- Department of Rheumatology and Immunology, Tangdu Hospital of The Fourth Military Medical University, Xi'an, China
| | - T Lv
- Department of Rheumatology and Immunology, Tangdu Hospital of The Fourth Military Medical University, Xi'an, China
| | - J Liu
- Department of Rheumatology and Immunology, Tangdu Hospital of The Fourth Military Medical University, Xi'an, China
| | - Y Ren
- Department of Rheumatology and Immunology, Tangdu Hospital of The Fourth Military Medical University, Xi'an, China
| | - Y Li
- Department of Rheumatology and Immunology, Tangdu Hospital of The Fourth Military Medical University, Xi'an, China
| | - Y Zhang
- Department of Rheumatology and Immunology, Tangdu Hospital of The Fourth Military Medical University, Xi'an, China
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Codacci-Pisanelli G, Del Pup L, Del Grande M, Peccatori FA. Mechanisms of chemotherapy-induced ovarian damage in breast cancer patients. Crit Rev Oncol Hematol 2017; 113:90-96. [PMID: 28427528 DOI: 10.1016/j.critrevonc.2017.03.009] [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: 07/11/2016] [Revised: 02/23/2017] [Accepted: 03/08/2017] [Indexed: 01/25/2023] Open
Abstract
Fertility preservation in breast cancer patients is an increasingly relevant topic. In the present paper we review available data on the mechanism of ovarian damage caused by anticancer agents currently used for the treatment of breast cancer. We also describe current methods to preserve fertility including oocytes or ovarian tissue freezing and administration of LH-RHa during chemotherapy. The aim of the paper is to provide clinical oncologists with an adequate knowledge of the subject to enable them to give a correct counselling to young women that must receive chemotherapy and want to increase their possibilities of maintaining fertility.
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Affiliation(s)
- Giovanni Codacci-Pisanelli
- University of Rome "la Sapienza", Department of Medical and Surgical Sciences and Biotechnology, Corso della Repubblica, 79 Latina, 04100, Italy.
| | - Lino Del Pup
- Department of Gynaecological Oncology, National Cancer Institute, Via Franco Gallini, 2, Aviano (Pordenone) 33170 Italy.
| | - Maria Del Grande
- Istituto Oncologico della Svizzera Italiana, Ente Ospedaliero Cantonale, Via Ospedale, Ospedale San Giovanni, 6500 Bellinzona, Switzerland.
| | - Fedro A Peccatori
- Department of Gynaecological Oncology, European Institute of Oncology, Via Ripamonti, 435 Milano 20141, Italy.
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