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Huang C, Alsubki L, Sung N, Kwak-Kim J. P–363 Poor Ovarian Response is Associated with Anti-ovarian Antibody, and Pro-inflammatory Immune Responses in Women Underwent Assisted Reproductive Technology Cycles. Hum Reprod 2021. [DOI: 10.1093/humrep/deab130.362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Study question
To investigate if the anti-ovarian antibody (AOA) is associated with poor ovarian response (POR) and pro-inflammatory immune responses in women undergoing assisted reproductive technology (ART) cycles.
Summary answer
The POR patients have a higher prevalence of AOAs. Women with autoimmune POR (POR(+)/AOA(+)) have dysregulated pro-inflammatory immune responses and metabolic factors.
What is known already
It has been proved that AOAs play important role in diseases that related to human reproduction such as premature ovarian failure (POF) which also termed as premature ovarian insufficiency (POI), infertility, polycystic ovary syndrome (PCOS), in vitro fertilization (IVF) implantation failure, and in poor ovarian response in IVF stimulation. The POR women had elevated inflammatory immune responses: increased NK cell count and cytotoxicity, B cell counts, Th1/Th2 ratio and elevated metabolic factors such as higher homocysteine and plasminogen activator inhibitor–1 (PAI–1) level.
Study design, size, duration
This study is a retrospective cohort study between December 2015 and February 2019. 248 women who underwent ART cycles were included. Study patients were divided into four groups based on AOA test and POR diagnose defined by the European Society of Human Reproduction and Embryology consensus: POR(-)/AOA (-) group (N = 148), POR(+)/AOA(-) group (N = 34), POR (-)/AOA (+) group (N = 44), POR(+)/AOA(+) group (N = 22). Peripheral blood was collected during the early follicular phase when they enter the program.
Participants/materials, setting, methods
The natural killer (NK) cell levels and cytotoxicity, T helper (Th) 1/Th2 cell ratios were measured by flowcytometry. Anti-phospholipid Antibodies (APA) was tested by enzyme linked immunosorbent assay (ELISA). AOA, 25 (OH) vitamin D level, homocysteine, PAI–1 level was tested by Immunofluorescence Assay.One way ANOVA was applied to compare the continuous variables among study groups. Chi-squared analysis or Fisher’s exact test were performed to compare the categorical variables.
Main results and the role of chance
The POR patients have a significantly higher prevalence of AOA than non-POR patients (39.3% vs. 22.9%, P = 0.017, OR 2.176 95% CI 1.156–4.099). Peripheral blood CD56+ NK cell level (%), NK cytotoxicity, CD19+CD5+ B–1 cell level (%) and IFN-g/IL–10 producing Th1/Th2 cell ratios were significantly higher in POR(+)/AOA(+) group than those of other groups (P < 0.05, P < 0.05, P < 0.05, P < 0.05, respectively). TNF-a/IL–10 producing Th1/Th2 cell ratio of POR(+)/AOA (+) group was significantly higher than those of POR(+)/AOA(-) and POR(-)/AOA(-) groups (P < 0.05, respectively). Peripheral blood homocysteine and vitamin D levels of the POR(+)/AOA (+) group were significantly lower than those of other groups (P < 0.005, respectively). Peripheral blood PAI–1 level of POR(+)/AOA(+) group was significantly higher than that of POR(-)/AOA(-) group (P < 0.05). In POR(+)/AOA(+) group, the prevalence of antiphospholipid antibody was significantly higher than that of POR(+)/AOA(-) group (54.5% vs 20.5%, P = 0.005, OR 4.667, 95% CI 1.532–14.216).
Limitations, reasons for caution
This was a single center study, results need to be validated across different center and study population.
Wider implications of the findings: The diagnostic and therapeutic approaches for AOA (+) autoimmune POR patients should be differentiated from those for non-autoimmune POR.
Trial registration number
Not applicable
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Affiliation(s)
- C Huang
- Chicago Medical School- Rosalind Franklin University of Medicine and Science, Reproductive Medicine and Immunology- Obstetrics and Gynecology- Clinical Sciences Department., Vernon Hills, U.S.A
- Shenzhen Nanshan People’s Hospital and The 6th Affiliated Hospital of Shenzhen University Health Science Center, Department of Rheumatology of Traditional Chinese Medicine, Shenzhen, China
| | - L Alsubki
- Chicago Medical School- Rosalind Franklin University of Medicine and Science, Reproductive Medicine and Immunology- Obstetrics and Gynecology- Clinical Sciences Department., Vernon Hills, U.S.A
| | - N Sung
- Chicago Medical School- Rosalind Franklin University of Medicine and Science, Reproductive Medicine and Immunology- Obstetrics and Gynecology- Clinical Sciences Department., Vernon Hills, U.S.A
| | - J Kwak-Kim
- Chicago Medical School- Rosalind Franklin University of Medicine and Science, Reproductive Medicine and Immunology- Obstetrics and Gynecology- Clinical Sciences Department., Vernon Hills, U.S.A
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Saab W, Seshadri S, Huang C, Alsubki L, Sung N, Kwak-Kim J. A systemic review of intravenous immunoglobulin G treatment in women with recurrent implantation failures and recurrent pregnancy losses. Am J Reprod Immunol 2021; 85:e13395. [PMID: 33511656 DOI: 10.1111/aji.13395] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 01/22/2021] [Accepted: 01/23/2021] [Indexed: 11/28/2022] Open
Abstract
Over the last few decades, the advancement in reproductive technologies and protocols to improve embryo quality through culture techniques and genetic testing to eliminate chromosomally abnormal embryos resulted in better pregnancy rates and outcomes after fertility treatments. Unfortunately, some patients still struggle with recurrent implantation failures (RIFs) and recurrent pregnancy losses (RPLs). Immune etiologies have been attributed to play an important role in some of those patients. Maintaining a pre-conceptional anti-inflammatory environment for implantation and pregnancy continuation yields superior results. Intravenous immunoglobulin G (IVIG) treatment has been reported to enhance reproductive outcome in patients with RIF and RPL with immune dysregulations. In this systemic review, we analyzed outcomes of IVIG trials for RIF and RPL, its mechanism of action, dosing, administration, side-effects, and evidence for its use in women with RIF and RPL.
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Affiliation(s)
- Wael Saab
- Assisted Conception unit, The Centre for Reproductive and Genetic Health, London, UK
| | - Srividya Seshadri
- Assisted Conception unit, The Centre for Reproductive and Genetic Health, London, UK
| | - Changsheng Huang
- Reproductive Medicine and Immunology, Obstetrics and Gynecology, Clinical Sciences Department, Chicago Medical School, Rosalind Franklin University of Medicine and Science, Vernon Hills, IL, USA.,Department of Traditional Chinese Medicine Rheumatology, Shenzhen Nanshan People's Hospital and The 6th Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, Guangdong, China
| | - Lujain Alsubki
- Reproductive Medicine and Immunology, Obstetrics and Gynecology, Clinical Sciences Department, Chicago Medical School, Rosalind Franklin University of Medicine and Science, Vernon Hills, IL, USA.,Department of Obstetrics and Gynecology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Nayoung Sung
- Reproductive Medicine and Immunology, Obstetrics and Gynecology, Clinical Sciences Department, Chicago Medical School, Rosalind Franklin University of Medicine and Science, Vernon Hills, IL, USA
| | - Joanne Kwak-Kim
- Reproductive Medicine and Immunology, Obstetrics and Gynecology, Clinical Sciences Department, Chicago Medical School, Rosalind Franklin University of Medicine and Science, Vernon Hills, IL, USA
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Kwak-Kim J, Ota K, Sung N, Huang C, Alsubki L, Lee S, Han JW, Han A, Yang X, Saab W, Derbala Y, Wang WJ, He Q, Liao A, Takahashi T, Cavalcante MB, Barini R, Bao S, Fukui A, Lédée N, Coulam C. COVID-19 and immunomodulation treatment for women with reproductive failures. J Reprod Immunol 2020; 141:103168. [PMID: 32603991 PMCID: PMC7291967 DOI: 10.1016/j.jri.2020.103168] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 06/11/2020] [Indexed: 12/19/2022]
Abstract
COVID-19 pandemic is affecting various areas of health care, including human reproduction. Many women with reproductive failures, during the peri-implantation period and pregnancy, are on the immunotherapy using immune modulators and immunosuppressant due to underlying autoimmune diseases, cellular immune dysfunction, and rheumatic conditions. Many questions have been raised for women with immunotherapy during the COVID-19 pandemic, including infection susceptibility, how to manage women with an increased risk of and active COVID-19 infection. SARS-CoV-2 is a novel virus, and not enough information exists. Yet, we aim to review the data from previous coronavirus outbreaks and current COVID-19 and provide interim guidelines for immunotherapy in women with reproductive failures.
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Affiliation(s)
- Joanne Kwak-Kim
- Reproductive Medicine and Immunology, Obstetrics and Gynecology, Clinical Sciences Department, Center for Cancer Cell Biology, Immunology and Infection, Chicago Medical School, Rosalind Franklin University of Medicine and Science, 830 West End Court, Vernon Hills, IL, 60061, USA.
| | - Kuniaki Ota
- Fukushima Medical Center for Children and Women, Fukushima Medical University, 1 Hikarigaoka, Fukushima City, Fukushima 960-1295, Japan
| | - Nayoung Sung
- Reproductive Medicine and Immunology, Obstetrics and Gynecology, Clinical Sciences Department, Center for Cancer Cell Biology, Immunology and Infection, Chicago Medical School, Rosalind Franklin University of Medicine and Science, 830 West End Court, Vernon Hills, IL, 60061, USA
| | - Changsheng Huang
- Reproductive Medicine and Immunology, Obstetrics and Gynecology, Clinical Sciences Department, Center for Cancer Cell Biology, Immunology and Infection, Chicago Medical School, Rosalind Franklin University of Medicine and Science, 830 West End Court, Vernon Hills, IL, 60061, USA; Traditional Chinese Medicine Department of Rheumatism, Huazhong University of Science and Technology Union Shenzhen Hospital, China
| | - Lujain Alsubki
- Reproductive Medicine and Immunology, Obstetrics and Gynecology, Clinical Sciences Department, Center for Cancer Cell Biology, Immunology and Infection, Chicago Medical School, Rosalind Franklin University of Medicine and Science, 830 West End Court, Vernon Hills, IL, 60061, USA; Department of Obstetrics and Gynecology, King Faisal Specialist Hospital and Research Center, Riyadh. Saudi Arabia
| | - Sungki Lee
- Department of Obstetrics and Gynecology, Myuonggok Medical Research Center, Konyang University College of Medicine, Daejeon, South Korea
| | - Jae Won Han
- Department of Obstetrics and Gynecology, Myuonggok Medical Research Center, Konyang University College of Medicine, Daejeon, South Korea
| | - Aera Han
- Department of Obstetrics and Gynecology, MizMedi Hospital, Seoul, South Korea
| | - Xiuhua Yang
- Department of Obstetrics, The First Hospital of China Medical University, Shenyang, China
| | - Wael Saab
- The Centre for Reproductive & Genetic Health, 230-232 Great Portland St, Fitzrovia, London W1W 5QS, UK
| | - Youssef Derbala
- Obstetrics and Gynecology, Beaumont Hospital, Dearborn, Grosse Pointe, MI, USA
| | - Wen-Juan Wang
- Reproduction Medical Center, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, 264000, China
| | - Qiaohua He
- Department of Reproductive Medicine Center, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Henan Provincial People's Hospital of Henan University, Zhengzhou, Henan, 450003, China
| | - Aihua Liao
- Institute of Reproductive Health, Center for Reproductive Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Toshifumi Takahashi
- Fukushima Medical Center for Children and Women, Fukushima Medical University, 1 Hikarigaoka, Fukushima City, Fukushima 960-1295, Japan
| | - Marcelo Borges Cavalcante
- Department of Obstetrics and Gynecology, Fortaleza University (UNIFOR), Fortaleza, CE, Brazil; CONCEPTUS - Reproductive Medicine, Fortaleza, CE, Brazil
| | - Ricardo Barini
- Department of Obstetrics and Gynecology, Campinas University (UNICAMP), Campinas, SP, Brazil
| | - Shihua Bao
- Department of Reproductive Immunology, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, 201204, China
| | - Atsushi Fukui
- Department of Obstetrics and Gynecology, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo 663-8501, Japan
| | - Nathalie Lédée
- MatriceLAB Innove, Pépinière Paris Santé Cochin, Hôpital Cochin, 29 rue du faubourg St Jacques, 75014 Paris, France; Centre d'assistance médicale à la procréation, Hôpital des Bluets, 4 rue Lasson, 75012, Paris, France
| | - Carolyn Coulam
- Clinical Immunology Laboratory, Rosalind Franklin University of Medicine and Science, North Chicago, 60064, IL, USA
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