Recurrent implantation failure and inflammatory markers in serum and follicle fluid of women undergoing assisted reproduction

It has been shown previously that the immune system plays a role in implantation and embryo development. The objective was therefore to evaluate cytokine levels and Th1/Th2 ratio in women with recurrent implantation failure in this nested case-control study. Women with no implantation after ≥ 3 embryo transfers were included in the recurrent implantation failure group (n = 29) and were compared with women with successful pregnancy after the first embryo transfer, with an indication of male factor (n = 26). Cytokines analyzed with the Meso scale discovery (MSD) technology Proinflammatory Human Kit 1 and calculated Th1/Th2 ratios were the main outcome measures. In serum there was a difference between the recurrent implantation failure group and the control group in ratios for IFN-γ/IL-10 (p = 0.01), IL-1β/IL-10 (p = 0.04), IL-2/IL-10 (p = 0.00), TNF-α/IL-10 (p = 0.02), IFN-γ/IL-13 (p = 0.01), IL-12/IL-13 (p = 0.02), IL-2/IL-13 (p = 0.00), and TNF-α/IL-13 (p = 0.00), where the control group had higher ratios, i.e. a shift towards a Th1 pro-inflammatory profile before treatment start. In follicular fluid there were differences in ratios between IL-2/IL-10 (p = 0.02), IL-8/IL-10 (p = 0.02), TNF-α/IL-10 (p = 0.02), IFN-γ/IL-13 (p = 0.01), and TNF-α/IL-13 (p = 0.03). The recurrent implantation failure group had higher ratios except for IFN-γ/IL-13, indicating a shift towards a Th1 pro-inflammatory profile in their follicular fluid. Pro-inflammatory activity in both serum and follicle fluid differs in recurrent implantation failure patients and patients with successful assisted reproduction treatment. Women at risk of immune-related recurrent implantation failure could be identified proactively. Because it is taken at a timepoint closer to implantation, ratios in follicular fluid are specifically interesting as risk markers.

P-410 Repeated unsuccessful embryo transfers and inflammatory parameters in serum before IVF start and in follicle fluid at OPU

Study question

Is there a difference in cytokine Th1/Th2 ratio in women with repeated implantation failure (RIF) compared to women with a successful IVF treatment?

Summary answer

Proinflammatory activity in both serum and follicle fluid (FF) differs in RIF patients and patients with successful IVF treatment.

What is known already

Unexplained recurrent implantation failure (RIF) is generally used to describe patients who have not become pregnant after repeated embryo transfers (ETs) of good quality embryos (GQE) during IVF treatment. There is no unison definition. Implantation requires a receptive endometrium. Receptivity is modulated by cytokines amongst other factors. Cytokines are signaling molecules mainly produced by T-helper lymphocytes (Th; CD3+/CD4+) and macrophages. The guiding of the blastocyst to the endometrial lining, the trophoblast cell invasion and the subsequent remodeling of the damaged endometrial tissue all require proinflammatory cytokines (Th1 dominant), whereas the sustainment of pregnancy requires an anti-inflammatory state (Th2 dominant).

Study design, size, duration

Retrospective study based on material collected during a larger study including 384 women enrolled during 2007-2016. Inclusion criteria were: <40 years of age, body mass index <30kg/m2, non-smoking, regular menstruation cycle of 21-35 days and bilateral ovaries. Serum was obtained before treatment and FF was collected during OPU in the first IVF cycle.

Participants/materials, setting, methods

Patients with no implantation after ≥3 ETs with fresh or frozen GQEs and any indication were included in the RIF group (n = 29). Women with achieved pregnancy after ≤3 ETs, with an indication of male factor, were selected as controls (n = 26).

Cytokines were analysed with the MSD Proinflammatory Human Kit 1 (MSD, USA; IFN-γ, IL-1β, IL-2, IL-4, IL-6, IL-8, IL-10, IL-12p70, IL-13 and TNF-α). Th1/Th2 ratios were calculated and compared with the Mann-Whitney U test.

Main results and the role of chance

In serum there was a difference between RIF and non RIF in ratios for IFN-γ/IL10 (p = 0,01), IL-1β/IL10 (p = 0,04), IL2/IL10 (p = 0,00), TNF-α/IL10(p = 0,02), IFNγ/IL13(p = 0,01), IL12/IL13 (p = 0,02), IL2/IL13 (p = 0,00) and TNF-α/IL13 (p = 0,00) (p < 0,05 for all), where the control group all had higher ratios, eg. a shift towards a Th1 profile before treatment start.

In FF there were differences in ratios between IL2/IL10 (p = 0,02), IL-8/IL-10 (0,02), TNF-α/IL10 (p = 0,02), IFNγ/IL13 (p = 0,01) and TNF-α/IL13 (p = 0,03). The RIF group had higher ratios of all these except for IFNγ/IL13, indicating that they had a shift towards a Th1 profile in their FF.

The RIF patients had a median age of 33 years, whilst the median age in the controls was 30 years (p = 0.01), there was no difference in BMI or cycle length.

Using inclusion and exclusion criteria regarding lifestyle factors and a strict definition of RIF and controls brings strength to the results and minimizes the role of chance. Also, there were no participants with chronic inflammatory disease.

Limitations, reasons for caution

The FF was pooled so the cytokine concentrations in the follicle containing the oocyte used for fertilization and ET was not determined. The age difference between the groups could have an effect. Yet, the median was below 35 years, where a decline in implantation and pregnancy rates are found.

Wider implications of the findings

Women at risk of immune related RIF could be identified proactively. Because it is taken at a timepoint closer to implantation, ratios in FF are specifically interesting as risk markers. Women with RIF and a Th1 shift in FF could be offered immune modulating therapy within a research setting.

Trial registration number

not applicable

Gonadotropin receptor variants are linked to cumulative live birth rate after in vitro fertilization

Purpose

The objective was to investigate if the gonadotropin receptor variants N680S (N: asparagine, S: serine, rs6166) in the follicle-stimulating hormone receptor (FSHR) and N312S (rs2293275) in the luteinizing hormone/human chorionic gonadotropin receptor (LHCGR) predicted cumulative live birth rate after in vitro fertilization (IVF).

Methods

A total of 665 women were consecutively enrolled for IVF during the period 2007–2016. Inclusion criteria were < 40 years of age, body mass index < 30 kg/m², non-smoking, regular menstruation cycle of 21–35 days, and bilateral ovaries. A blood sample was drawn for endocrine hormonal analysis and for DNA extraction with subsequent genotyping of the FSHR N680S and LHCGR N312S polymorphisms. Statistical analyses were done on all completed IVF cycles.

Results

Women homozygous for S in both receptors combined (4S) had significantly higher live birth rate compared to those with other receptor variants when combining the first three IVF cycles (OR = 2.00, 95% CI [1.02, 3.92], p = 0.043). Cumulatively higher chance of live birth rate, during all IVF cycles, was also evident (HR = 1.89, 95% CI [1.00, 3.57], p = 0.049).

Conclusions

Gonadotropin receptor variants are promising candidates for the prediction of the possibility to have a baby to take home after IVF treatment.

Thrombin stimulates insulin secretion via protease-activated receptor-3

The disease mechanisms underlying type 2 diabetes (T2D) remain poorly defined. Here we aimed to explore the pathophysiology of T2D by analyzing gene co-expression networks in human islets. Using partial correlation networks we identified a group of co-expressed genes ('module') including F2RL2 that was associated with glycated hemoglobin. F2Rl2 is a G-protein-coupled receptor (GPCR) that encodes protease-activated receptor-3 (PAR3). PAR3 is cleaved by thrombin, which exposes a 6-amino acid sequence that acts as a 'tethered ligand' to regulate cellular signaling. We have characterized the effect of PAR3 activation on insulin secretion by static insulin secretion measurements, capacitance measurements, studies of diabetic animal models and patient samples. We demonstrate that thrombin stimulates insulin secretion, an effect that was prevented by an antibody that blocks the thrombin cleavage site of PAR3. Treatment with a peptide corresponding to the PAR3 tethered ligand stimulated islet insulin secretion and single β-cell exocytosis by a mechanism that involves activation of phospholipase C and Ca(2+) release from intracellular stores. Moreover, we observed that the expression of tissue factor, which regulates thrombin generation, was increased in human islets from T2D donors and associated with enhanced β-cell exocytosis. Finally, we demonstrate that thrombin generation potential in patients with T2D was associated with increased fasting insulin and insulinogenic index. The findings provide a previously unrecognized link between hypercoagulability and hyperinsulinemia and suggest that reducing thrombin activity or blocking PAR3 cleavage could potentially counteract the exaggerated insulin secretion that drives insulin resistance and β-cell exhaustion in T2D.

High-dose vitamin D supplementation in children with cerebral palsy or neuromuscular disorder

Adequate vitamin D levels are essential for normal skeletal development and mineralization. This is particularly important in children with cerebral palsy or other neuromuscular disorders who are at an increased risk of osteoporosis. The aim of this study was to evaluate the effect of high-dose vitamin D3 supplementation on vitamin D status in 44 disabled children. Vitamin D was administered during school days (1000 IU vitamin D3 per orally five days per week for 10 weeks) to half of the children (N=21) while the others (N=23) continued without supplementation. At baseline the median serum 25-hydroxyvitamin D was 44 nmol/L (range 26-82 nmol/L). The concentration increased significantly during the 10 weeks intervention in the supplemented group (median 56 nmol/L, range 39-88 nmol/L; p=0.012 for the difference from baseline) and decreased in the control group (median 37 nmol/L, range 24-74 nmol/L; p=0.038). No significant changes in any of the other measured parameters were observed. Hypovitaminosis D is prevalent in disabled children. Supplementation with 1000 IU vitamin D3 perorally five days per week results in a significant increase in vitamin D level and is not associated with hypercalcemia or other adverse effects.

Molecular basis for resistance of herpes simplex virus type 1 mutants to the sulfated oligosaccharide inhibitor PI-88

Herpes simplex virus type 1 variants selected by virus propagation in cultured cells in the presence of the sulfated oligosaccharide PI-88 were analyzed. Many of these variants were substantially resistant to the presence of PI-88 during their initial infection of cells and/or their cell-to-cell spread. Nucleotide sequence analysis revealed that the deletion of amino acids 33-116 of gC but not lack of gC expression provided the virus with selective advantage to infect cells in the presence of PI-88. Purified gC (Delta33-116) was more resistant to PI-88 than unaltered protein in its binding to cells. Alterations that partly contributed to the virus resistance to PI-88 in its cell-to-cell spread activity were amino acid substitutions Q27R in gD and R770W in gB. These results suggest that PI-88 targets several distinct viral glycoproteins during the course of initial virus infection and cell-to-cell spread.