The Effects of Hormones and Vaginal Microflora on the Glycome of the Female Genital Tract: Cervical-Vaginal Fluid

In this study, we characterized the glycome of cervical-vaginal fluid, collected with a Catamenial cup. We quantified: glycosidase levels; sialic acid and high mannose specific lectin binding; mucins, MUC1, MUC4, MUC5AC, MUC7; and albumin in the samples collected. These data were analyzed in the context of hormonal status (day of menstrual cycle, hormonal contraception use) and role, if any, of the type of the vaginal microflora present. When the Nugent score was used to stratify the subjects by microflora as normal, intermediate, or bacterial vaginosis, several important differences were observed. The activities of four of six glycosidases in the samples from women with bacterial vaginosis were significantly increased when compared to normal or intermediate women: sialidase, P = <0.001; α-galactosidase, P = 0.006; β-galactosidase, P = 0.005; α-glucosidase, P = 0.056. Sialic acid binding sites as measured by two lectins, Maackia amurensis and Sambucus nigra binding, were significantly lower in women with BV compared to women with normal and intermediate scores (P = <0.0001 and 0.008 respectively). High mannose binding sites, a measure of innate immunity were also significantly lower in women with BV (P = <0.001). Additionally, we observed significant increases in MUC1, MUC4, MUC5AC, and MUC7 concentrations in women with BV (P = <0.001, 0.001, <0.001, 0.02 respectively). Among normal women we found that the membrane bound mucin MUC4 and the secreted MUC5AC were decreased in postmenopausal women (P = 0.02 and 0.07 respectively), while MUC7 (secreted) was decreased in women using levonorgestrel-containing IUDs (P = 0.02). The number of sialic acid binding sites was lower in the postmenopausal group (P = 0.04), but the number of high mannose binding sites, measured with Griffithsin, was not significantly different among the 6 hormonal groups. The glycosidase levels in the cervical-vaginal mucus were rather low in the groups, with exception of α-glucosidase activity that was much lower in the postmenopausal group (P<0.001). These studies present compelling evidence that the vaginal ecosystem responds to the presence of different vaginal microorganisms. These effects were so influential that it required us to remove subjects with BV for data interpretation of the impact of hormones. We also suggest that certain changes occurring in vaginal/cervical proteins are due to bacteria or their products. Therefore, the quantitation of vaginal mucins and lectin binding offers a new method to monitor bacteria-host interactions in the female reproductive tract. The data suggest that some of the changes in these components are the result of host processing, such as the increases in mucin content, while the microflora is responsible for the increases in glycosidases and the decreases in lectin binding. The methods should be considered a valid marker for insult to the female genital tract.

Matrix metalloproteinases in the cervical mucus plug in relation to gestational age, plug compartment, and preterm labor

BACKGROUND

High concentrations of matrix metalloproteinases (MMPs) and tissue inhibitors of metalloproteinases (TIMPs) have been identified in the cervical mucus plug (CMP) at term of pregnancy. Their physiological and pathophysiological implications, however, remain to be elucidated, and CMPs from preterm labor have never been examined. This study was therefore conducted to describe the concentrations of MMP-2, TIMP-1, MMP-8 and MMP-9 in the CMP in relation to gestational age, IL-8 as an indicator of inflammation, compartment of the CMP, and preterm labor.

METHODS

An aliquot of the distal plug compartment facing the vaginal microflora (CMP-dist) was collected from non-pregnant (n = 15), early pregnant (n = 15) and term pregnant women (n = 15). Whole CMPs shed during active vaginal term (n = 15) and preterm (n = 4) labor were also included. Protein concentrations were determined by enzyme-linked immunosorbent assay (ELISA).

RESULTS

MMP-2 was not detectable in the non-pregnant CMP-dists whereas high concentrations were found in early pregnancy followed by an 85% decline at term. High concentrations of TIMP-1 were found in both the non-pregnant and early pregnant CMP-dists with a 90% decline at term. Consequently, the molar TIMP/MMP ratio was 40 in the non-pregnant state and 0.2 at term. The MMP-2 and TIMP-1 concentrations were alike in the CMP-dists and the whole CMPs.MMP-8, MMP-9, and IL-8 were mainly found in the distal CMP compartment. MMP-8 and MMP-9 concentrations were several fold increased in this compartment during pregnancy compared to the non-pregnant state. In the preterm whole CMPs, MMP-8, MMP-9 and IL-8 were 2 to 5 fold increased compared to term whole CMPs.

CONCLUSIONS

These results suggest that CMP MMP-2 reflects the non-leukocyte dependent cervical remodeling that occurs in early pregnancy, whereas MMP-8 and MMP-9 are involved in the defense against ascending infections primarily located to the distal compartment of the CMP. The upregulation of MMP-8, MMP-9 and IL-8 in whole CMPs from preterm labor may indicate the involvement of an intrauterine infection.

Increased expression of alpha-enolase in cervico-vaginal fluid during labour

OBJECTIVES

The aim of this study was (i) to characterise differentially expressed proteins in cervico-vaginal fluid (CVF) at the time of preterm labour onset and (ii) to confirm these studies in human CVF samples taken from women before and during spontaneous labour.

STUDY DESIGN

Preterm labour was induced in sheep (n = 5) via fetal dexamethasone infusion (1 mg/24 h). CVF samples were taken prior to dexamethasone infusion (0 h), 28 h after the start of dexamethasone infusion, and immediately prior to delivery. Two-dimensional gel electrophoresis (2-DE) and mass spectrometry (MS) were used to identify differentially expressed proteins. For the human studies, paired CVF samples were taken 5-9 days before labour and during spontaneous labour onset (n = 7).

RESULTS

There was a 4.2-fold increase in α-enolase protein expression in sheep CVF during labour. Likewise, α-enolase protein expression was significantly increased during spontaneous human labour at term.

CONCLUSIONS

Alpha-enolase is known to be bound to neutrophils and interact in the immune response, and thus may play a role in inflammation associated with human labour.

Two esterases common to seminal plasma, other external secretions and leucocytes in man

Two esterases previously identified in seminal plasma, on the basis of their electrophoretic mobility, immunogenicity and sensitivity to organophosphorus esters were detected in various human external secretions and leucocyte extracts. alpha-Esterase was found to be abundant in urine and milk whereas this enzyme occurred in a low concentration in seminal plasma, leucocyte extract, cervical mucus and sweat. The concentration of betagamma-esterase was high in seminal plasma and leucocyte extract. The enzyme was present in small amounts in urine, milk, gastric juice, saliva, sputum, tears, cervical mucus and sweat.

Balance between matrix metalloproteinases (MMP) and tissue inhibitors of metalloproteinases (TIMP) in the cervical mucus plug estimated by determination of free non-complexed TIMP

BACKGROUND

The cervical mucus plug (CMP) is a semi-solid structure with antibacterial properties positioned in the cervical canal during pregnancy. The CMP contains high concentrations of matrix metalloproteinase 8 and 9 (MMP-8, MMP-9) and tissue inhibitor of metalloproteinase 1 (TIMP-1). This indicates a potential to degrade extracellular matrix components depending on the balance between free non-complexed inhibitors and active enzymes.

METHODS

Thirty-two CMPs collected during active labor at term were analyzed. Twelve CMPs were separated into a cellular and an extracellular/fluid phase and analyzed by gelatin and reverse zymography to reveal MMP and TIMP location. Twenty samples were homogenized, extracted and studied by the TIMP activity assay based on gelatin zymography. Enzyme-linked immunosorbent assay (ELISA) was used to determine TIMP-1, MMP-8 and MMP-9 protein concentrations, and gelatin and reverse zymography used to identify gelatinases and TIMPs, respectively. The Western blotting technique was applied for semi-quantification of alpha2-macroglobulin. An ELISA activity assay was used to detect MMP-8 and MMP-9 activity.

RESULTS

ProMMP-2, proMMP-9, TIMP-1 and TIMP-2 were almost exclusively located in the fluid phase compared to the cellular phase of the CMP. All the extracted samples contained MMP-8, MMP-9, TIMP-1, TIMP-2 and alpha2-macroglobulin. Free non-complexed TIMP was detected in all the samples analyzed by the TIMP activity assay and was associated with TIMP-1 protein (R = 0.71, p < 0.001) and with the TIMP/MMP molar ratio (1.7 (1.1-2.5) (mean (95% confidence interval)) (R = 0.65, p = 0.002). The ELISA activity assay showed no activity from MMP-8 or MMP-9.

CONCLUSION

Due to their extracellular location, potential proteolytic activity from neutrophil-derived MMPs in the CMP could exert a biological impact on cervical dilatation and fetal membrane rupture at term. The functional TIMP activity assay, revealing excess non-complexed TIMP, and a molar inhibitor/enzyme ratio above unity, indicate that refined MMP control prevents CMP-originated proteolytic activity in the surrounding tissue.

Menstrual cycle–related sialidase activity of the female cervical mucus is associated with exosome-like vesicles

OBJECTIVE

To study endogenous sialidase activity in genital tract secretions of pregnant and nonpregnant women.

DESIGN

Laboratory study.

SETTING

Department of Evolutionary Biology and Department of Obstetrics and Reproductive Medicine, University of Siena, Siena, Italy.

INTERVENTION(S)

Vaginal and cervical mucus samples were obtained from pregnant and nonpregnant women in different phases of the menstrual cycle and in different weeks of pregnancy.

MAIN OUTCOME MEASURE(S)

Sialidase activity was assessed by fluorimetric assay and localized by transmission electron microscopy and differential centrifugation.

RESULT(S)

Sialidase activity in cervical mucus of healthy women reaches a maximum in the ovulatory phase. Cervical mucus from pregnant and nonpregnant women had significant sialidase activity that was associated with membranous vesicles having an exosome-like structure.

CONCLUSION(S)

Female cervical mucus contains an endogenous menstrual cycle-related sialidase that could be involved in modifying the rheologic properties of mucus to favor sperm progression at fertilization. Its association with exosome-like vesicles also suggests a role in intercellular communication before and after fertilization.

Increased Risk of Intrauterine Transmission of HIV-1 Associated With Granulocyte Elastase in Endocervical Mucus

BACKGROUND

One of the remaining challenges in the prevention of mother-to-child transmission of HIV is to reduce the risk of the transmission during pregnancy. It remains to be investigated which factors affect intrauterine HIV transmission and how they can be identified and addressed during pregnancy.

METHODS

Granulocyte elastase in the endocervical mucus of HIV-positive pregnant women in Zambia was measured, and its association with intrauterine transmission of HIV-1 from the mother to the fetus was investigated.

RESULTS

The intrauterine transmission rate determined by polymerase chain reaction assay of DNA from neonates at birth was 15.3%. The risk for intrauterine transmission was 8.65-fold higher in women who were positive for granulocyte elastase than in those who were negative.

CONCLUSION

We suggest that the women showing positive granulocyte elastase at delivery be strongly suspected of having and if having had chorioamnionitis during pregnancy, which could affect the intrauterine transmission of HIV.

Cervical inflammatory cytokines and other markers in the cervical mucus of pregnant women with lower genital tract infection

OBJECTIVE

To evaluate concentrations of interleukin (IL)-6, IL-8, lactoferrin (LF), and alpha defencine (alpha-DF) in the cervical mucus of pregnant women and analyze their relation to cervicitis and bacterial vaginosis (BV).

METHODS

Cervical mucus samples were obtained from August 2003 through May 2004 from 157 women who were between the 6th and 36th week of an uncomplicated singleton pregnancy. All women were delivered at term, 69 without BV or cervicitis, 9 with BV, and 79 with cervicitis.

RESULTS

Interleukin 8, LF, and mu-DF concentrations were higher in women with cervicitis (0.81 +/- 0.36 pg/mL, 14.8+/-12.3 microg/mL, and 0.60 +/- 0.49 microg/mL) than in women without BV or cervicitis (0.35 +/- 0.34 pg/mL, 8.0 +/- 11.0 microg/mL, and 0.15 +/- 0.12 microg/mL). Interleukin 6 concentration was higher in women with BV (0.26 +/- 0.32 pg/mL) than in women without BV or cervicitis (0.09 +/- 0.15 pg/mL) or in women with cervicitis (0.12 +/- 0.18 pg/mL).

CONCLUSIONS

Higher levels of inflammatory cytokines in the cervical mucus of pregnant women may lead to early detection of lower genital tract infection.

Increased Level of Granulocyte Elastase in Cervical Secretion Is an Independent Predictive Factor for Preterm Delivery

OBJECTIVE

The objective of this study was to explore whether increased levels of granulocyte elastase in cervical secretion is an independent predictive factor for preterm delivery before 34 weeks of gestation in the patient with preterm labor.

METHODS

One hundred and sixty-one women with preterm labor at 22-28 weeks of gestation were enrolled prospectively. The level of granulocyte elastase in cervical secretions was measured by immunoassay, vaginal secretions were collected for the microscopic evaluation of Gram-stained smears, and the uterine cervix was assessed by transvaginal ultrasonography.

RESULTS

Nineteen of 161 patients (12%) delivered before 34 weeks of gestation. Granulocyte elastase assessment had a sensitivity, specificity, positive predictive value, and negative predictive value for preterm delivery of 53, 75, 22 and 92%, respectively. A positive elastase assessment was associated with a relative risk for preterm delivery of 2.9 (95% CI 1.3-6.6), whereas a positive bacterial vaginosis assessment and shorter cervical length less than 25 mm demonstrated a relative risk of 1.9 (95% CI 0.8-4.6) and 1.5 (95% CI 0.6-5.0), respectively.

CONCLUSION

The present study demonstrates that the risk of spontaneous preterm delivery before 34 weeks of gestation is increased in the women with preterm labor who are found to have an increased level of granulocyte elastase in cervical secretions.

Enzyme activity in bovine cervical mucus during spontaneous and induced estrus

The purpose of the present research was to compare the enzyme activity of alkaline phosphatase (ALP), lactate dehydrogenase (LDH), alpha-amylase, alpha-manosidase, beta-N-acetyloglucosaminidase, beta-glucuronidase, and beta-galactosidase in the cervical mucus of cows during spontaneous and induced estrus. Friesian cows (n = 106) were assigned to 4 groups: 1) no treatment; 2) progesterone releasing intervaginal device (PRID) for 12 days plus pregnant mare serum gonadotrophin (PMSG) at the removal of the PRID; 3) PGF2alpha 2 doses 11 days apart; and 4) PRID for 7 days plus PGF2alpha 1 dose, 24 hours before removal of the PRID. Fourteen cows were excluded from the trial because of an inadequate quantity of cervical mucus collected or a lost PRID. The cows from the 3 induced estrus groups were artificially inseminated (AI) twice, while those with spontaneous estrus received only a single AI. Cervical mucus samples were collected from all cows 5 to 30 min before the first AI. The results are summarized as follows: 1) ALP and alpha-amylase activity for spontaneous estrus were similar to those for induced estrus; 2) LDH activity levels during spontaneous estrus were significantly lower (P < 0.001) than that in the P4 and P4+PGF2alpha induced estrus groups; and 3) glycosidases' activity was significantly lower (P < 0.001) in the spontaneous estrus group than that in the induced estrous groups. In conclusion, the activity of most enzymes in the cervical mucus of cows, in the present study, was significantly different between the spontaneous and the induced estrus groups.

Application of a novel human cervical mucin-based assay demonstrates the absence of increased mucinase activity in bacterial vaginosis

Enzymes produced in bacterial vaginosis (BV) have been proposed as possible mediators of pre-term birth. Most studies have concentrated on mid-trimester measurements of enzyme activity, and utilize synthetic substrates to measure enzyme activity, which may not accurately represent mucinase activity in vivo. We have developed a novel ELISA mucinase assay using biotinylated human cervical mucin as a substrate. The assay is rapid, sensitive and can be used to screen large numbers of samples. The new assay has been used to assess vaginal mucinase activities in 92 women <14 weeks gestational age with and without BV. No differences in mucinase activity were detected between normal and BV groups while significant elevation of sialidase and other glycosidases was confirmed as reported before. This study shows that significant mucinase activity is a normal event in the mucus barrier, but does not reflect changes identified for individual enzyme activities associated with BV.

[Pro- and antioxidant system activity in cervical mucosa]

The aim of the study was to evaluate the activity of the pro- and antioxidant systems in cervical mucus of healthy women and women with pathological of disorders cervical. After cervical mucus liquefaction, the activity of superoxide dismutase, catalase and xanthine oxidase was determined by means of chemiluminescence assays. The activity of the antioxidant system in cervical mucus of healthy women was higher as compared to the group with pathological cervical disorders. Moreover, in mucus samples obtained from women with dysplasia, the significantly heightened activity of xanthine oxidase (strong pro-oxidant) was observed. The antioxidant system present in cervical mucus may protect both the cells of the uterine cervix and the viable sperm.

Cervical intraepithelial neoplasia is associated with increased polyamine oxidase and diamine oxidase concentrations in cervical mucus

OBJECTIVE

The aim of this study was to establish whether reactive oxygen species, generated during oxidation of amines, catalyzed by polyamine oxidase (PAO) and diamine oxidase (DAO) in cervical secretions may play a role in the etiology of cervical cancer.

METHODS

Cervical mucus was obtained from women attending the gynecological outpatient department: 139 with and 154 without cytological evidence of cervical intraepithelial neoplasia were recruited. The mucus was freeze dried in liquid nitrogen, weighed, and later resuspended for assay of PAO and DAO concentrations using a chemiluminescence method. The two groups were compared by group sequential analysis using PEST3 software.

RESULTS

Patients with a colposcopic diagnosis of a high-grade squamous intraepithelial lesion (SIL) had significantly higher enzyme activities than control cases (L(N)PAO 1.37 (0.37) versus 1.18 (0.35): Student t test: P < 0.001; L(N)DAO 1.37 (0.36) versus 1.15 (0.37): Student t test: P < 0.001).

CONCLUSION

It is probable that this rise in enzyme activity precedes cytological changes and plays some part in the etiology of cervical cancer, as the cells that undergo premalignant change are normally squamous in origin, whereas mucus is a product of columnar epithelium. Higher enzyme activity in patients with SIL than in controls may be a reflection of higher risk of exposure to amine substrates in semen through multiple sexual partners.

Changes in molecular weight of hyaluronan and hyaluronidase activity in uterine cervical mucus in cervical ripening

BACKGROUND

This study was undertaken to investigate changes in the forms of hyaluronan and hyaluronidase activity in cervical mucus during cervical ripening.

METHODS

Uterine cervical mucus was obtained from 57 pregnant women (25 at preterm gestation, ten at term gestation, 11 within 1 week before labor, and 11 during the first stage of labor). We determined 1) concentration of hyaluronan, 2) hyaluronidase activity, and 3) molecular weight of hyaluronan in cervical mucus. Data are presented as mean and range.

RESULTS

The hyaluronan concentration in mucus in the 1st stage of labor (1.58 microg/ml, 0.46-23.96) was significantly (p<0.05) higher than that in all other groups (preterm: 0.29, 0.10-0.88; term: 0.24, 0.11-0.80; within 1 week before labor: 0.30, 0.18-0.62). Hyaluronidase activity both within 1 week before labor group (3.03 min., 1.12-3.95) and in 1st stage of labor group (3.52, 0.43-5.15) was significantly (p<0.05) higher than that in preterm group (1.70, 0.00-5.47). The molecular weight of hyaluronan in cervical mucus in the 1st stage of labor (0.97x106, 0.86-1.41) was significantly (p<0.05) lower than in the preterm and term groups (preterm: 1.60, 1.21-2.20, term: 1.41, 1.21-2.20). There was a significant correlation between hyaluronidase activity and molecular weight of hyaluronan (p<0.05, r=-0.41, n=23).

CONCLUSION

These findings suggest that either hyaluronidase or low-molecular weight hyaluronan could be one of the most important regulators in the process of cervical ripening.

Does chondroitin sulfate defend the human uterine cervix against ripening in threatened premature labor?

OBJECTIVE

This study was undertaken to investigate changes in chondroitin sulfate levels in the cervix and the physiologic role of chondroitin sulfate isomers in the process of cervical ripening.

STUDY DESIGN

Uterine cervical mucus samples were obtained from 57 women (7 nonpregnant women, 19 at preterm gestation, 9 at term gestation, 16 during the first stage of term labor, and 6 with threatened premature labor). Chondroitin sulfate isomer (chondroitin 0-sulfate, 4-sulfate, and 6-sulfate) concentrations in cervical mucus were measured by high-performance liquid chromatography. The effect of exogenous chondroitin sulfate on hyaluronidase activity in cervical mucus was evaluated by gel permeation chromatography of fluorolabeled hyaluronic acid.

RESULTS

Chondroitin sulfate concentrations in cervical mucus were increased significantly (P <. 05) in the threatened premature labor group compared with the preterm and term groups. However, the same finding was not observed in the first stage of term labor. Exogenous chondroitin sulfate inhibited hyaluronidase activity in mucus.

CONCLUSION

Chondroitin sulfate may defend against cervical ripening in threatened premature labor.

Binding of a bovine oviductal fluid catalase to mammalian spermatozoa

Hydrogen peroxide (H2O2) is a reactive oxygen species that at low concentration is toxic to sperm. H2O2 inhibits not only sperm viability but also the acrosome reaction, sperm-egg binding, and oocyte penetration. Catalase activates the decomposition of H2O2 into water and oxygen, thus removing an initiator of free radical chain reactions leading to lipid peroxidation. Since the oviduct is known to enhance sperm survival, we hypothesized that it might secrete catalase. We found that oviductal fluid, harvested from washed cells collected at the slaughterhouse, possessed catalase-specific activity that varied during the estrous cycle. Catalase activity increased during the cycle and reached its maximal level just before ovulation (Days 18-20). No significant difference in activity was seen between fluid from the isthmus and that from the ampulla. Indirect immuno-staining of spermatozoa incubated in the oviductal fluid revealed the association of catalase in the region of the acrosomal cap. Addition of a commercial antibody directed against bovine liver catalase completely inhibited catalase activities from the oviductal fluid. Catalase activity was also detected in porcine oviductal fluid, human oviductal fluid, and cervical mucus. Western blots of oviductal fluid probed with the anti-catalase antibody revealed two major bands at 60 and 40 kDa. An immunoaffinity column was used to purify oviductal catalase, showing a unique band at about 60 kDa when analyzed by SDS-PAGE. The purified protein was incubated with bovine, boar, and human sperm, and Western blots of these sperm after several washes detected a band at 60 kDa, indicating that the protein was bound to sperm membranes. However, bovine liver catalase did not bind to sperm. Since H2O2 is one of the key reactants in the chain reaction of free radical production, this enzyme may play an important role in sperm survival within the female tract.

The usefulness of screening for chlamydial trachomatis infection with cervical mucus leukocyte esterase

OBJECTIVE

To evaluate the ability of leukocyte esterase dipstick test (LET) performed in cervical mucus to predict direct immunofluorescent (DIF)-verified Chlamydia trachomatis (Ct) cervical infection.

METHOD

Eighty women with inflammatory cervico-vaginal smear were submitted to both an endocervical smear, to verify Ct cervicitis by DIF technique; and a cervical mucus sample to perform LET. Results of LET and DIF were matched.

RESULTS

Among 30 Chlamydial positive subjects, cervical mucus esterase test was positive in 28 (93.3%); while among 50 Chlamydial negative controls, esterase test was negative in 43 subject (86%). The sensitivity, specificity, positive and negative predictive values for LET were 93.3%, 86%, 80% and 95% respectively.

CONCLUSION

Cervical mucus LET is a simple, cost effective screening test, with promising accuracy, for Ct cervical infection among women with inflammatory cervico-vaginal smears.

Biochemical changes in the cervical mucus after application of laminaria tent

BACKGROUND

This research was aimed to study the biochemical changes in cervical mucus after application of laminaria tent.

MATERIAL AND METHODS

Cervical mucus was collected before and after insertion of laminaria tent from 20 normal pregnant women in the first and second trimesters. Interleukin-1 beta, IL-8, collagenase activity, elastase activity, PGE2 and PGF2 alpha were measured in the collected samples. Laminaria tent was also inserted in one vaginal cervix of five non-pregnant rabbits and the clinical and histological changes were compared with five non-treated rabbits. Collagen contents were assessed histologically and Leukocyte number was counted.

RESULTS

IL-1 beta and IL-8 and elastase activity were significantly increased after insertion of laminaria (p<0.0001 and 0.001 respectively). Collagenase activity was not significantly changed. Whereas concentration of PGE2 and PGF2 alpha in the mucus were markedly increased (p<0.0001 and 0.001 respectively). Collagen contents were significantly decreased in laminaria and opposite side cervices (p<0.0001). No significant changes in leukocyte count could be observed in treated and non treated cervices.

CONCLUSIONS

Insertion of laminaria leads to increase concentration of IL-1 beta, IL-8, PGE2, PGF2 alpha and elastase activity. Mechanical stretching of the cervix and biochemical changes in cervical mucus may explain the mechanism of cervical ripening induced by laminaria.

Evaluation of the significance of polyamines and their oxidases in the aetiology of human cervical carcinoma

The risk of cancer of the cervix is linked with sexual behaviour. Although infectious agents such as human papillomaviruses (HPVs) are implicated, these alone may be insufficient to induce the disease. We have investigated the potential role of oxidation products of the polyamines spermine and spermidine and the diamine putrescine in seminal plasma (SP) as co-factors in the development of cervical cancer. These amines are oxidised by polyamine oxidase (PAO) and diamine oxidase (DAO) to generate oxygen radicals and hydrogen peroxide, reactive aldehydes and acrolein, which are likely to exert local mutagenic, cytotoxic and immunosuppressive effects in vivo. Using a chemiluminescence assay, we determined the levels of these amines in 187 samples of SP. Spermine plus spermidine, as substrates for PAO, were present in a range equivalent to 0-4.8 mg ml-1 spermine. Putrescine, as a substrate for DAO, was detectable in only 4 of 40 samples assayed (range 0-168 micrograms ml-1) and constitutes a minor component of the oxidisable content of SP. Cervical mucus (126 samples) was assayed for the presence of PAO and DAO. Both enzymes were present in 14.3% of the samples, PAO only in 21.4%, DAO only in 15.1% and neither enzyme in 49.2%. PAO levels ranged from 0 to 0.828 pmol peroxide generated min-1 mg-1 mucus and DAO levels ranged from 0 to 7.0 pmol peroxide generated min-1 mg-1 mucus. These results suggest that sexual activity in the absence of physical barrier contraception may lead to the generation of mutagenic and immunosuppressive polyamine oxidation products within the female genital tract. We thus propose that women with high levels of PAO and/or DAO in their cervical mucus may be at increased risk of cervical cancer, especially if the male partner's SP shows high polyamine levels. HPV infection may synergise with the effects of polyamine oxidation by suppressing apoptosis in keratinocytes carrying potentially oncogenic mutations, leading to the survival and proliferation of transformed cells in the cervix.

Secretory leukocyte protease inhibitor in the cervical mucus and in the fetal membranes

OBJECTIVE

The purpose was to determine the concentration of leukocyte elastase and SLPI in the cervical mucus plug, cervical tissue, fetal membranes, amniotic fluid and serum from pregnant women.

STUDY DESIGN

Samples were analysed using radioimmunoassay, immunodiffusion, immunohistological and enzyme assay techniques. Statistical comparisons were performed by the Mann-Whitney two-sample rank sum test.

RESULTS

Concentrations of SLPI and elastase in cervical tissue are significantly increased during pregnancy and after delivery. Very high concentrations of SLPI and elastase were found in the cervical mucus plug. The concentrations of SLPI and elastase in human fetal membranes are highest at the rupture site. The concentration of elastase in amnion from preterm delivery was significantly higher than in amnion from term deliveries.

CONCLUSION

The high molar ratio of SLPI/elastase in the cervical mucus plug suggests that inhibition of elastase is important during normal pregnancy. The role of SLPI may be protection of the fetal membranes and cervical tissue.

Fluctuations in elastase of cervical mucus and clinical efficacy of cefodizime in obstetric and gynecologic infections

Clinical efficacy of cefodizime (CDZM) in obstetric and gynecologic infections and in their prevention, and fluctuations in cervical mucus elastase in gynecologic infections and during pregnancy were studied, and the following results were obtained: 1. Cervical mucus elastase showed high values of > or = 5,001 micrograms/L in 68.2% of non-pregnant patients and in 25.9% of pregnant patients (gestational age of 24-42 weeks). Patients with concomitant chorioamnionitis showed a significantly higher rate of elastase elevation than those without this complication (63.2% vs. 25.9%, P < 0.005). 2. Cervical mucus elastase in uterine and pelvic infections showed high values before administration of CDZM but tended to decline with the progress of cure (15/19 cases, 78.9%). 3. The efficacy rate of 2-4 g/day of CDZM drip infusion against infections was 53/56 (94.6%) while the bacterial eradication rate was 36/38 (94.7%). The efficacy rate of 2 g/day of CDZM drip infusion for the prevention of postoperative infections was 429/431 (99.8%). Diarrhea occurred in 3/489 (0.6%) as subjective and objective side effects. Slight rises in GOT and GPT were noted in 13/486 (2.7%) as abnormal laboratory values. These results suggested the usefulness of CDZM in the obstetric and gynecologic fields.

Lysozyme in cervical mucus of patients with chorioamnionitis

Lysozyme and lactoferrin, antimicrobial substances present in cervical mucus, play an important role in defense mechanisms against ascending infections in development of chorioamnionitis (CAM). In this study, we measured the concentration of lysozyme in cervical mucus, and studied its relationship with other factors, and obtained following results. The concentration of lysozyme in cervical mucus decreased more significantly in positive CAM in preterm labor than in negative CAM and control subjects (P < 0.001). A direct correlation between the concentrations of lysozyme and lactoferrin was observed (r = 0.709). In positive CAM, the concentration of elastase in cervical mucus reached a significantly high level (more than 8,000 micrograms/L), and a no correlation between the concentrations of elastase and lysozyme was observed. These findings suggest a reduction of the defense mechanism occurred because the concentrations of both lysozyme and lactoferrin in cervical mucus during preterm labor (positive CAM) decreased.

Elastase activity of endocervical mucus in normal pregnancy

Elastase activity of 294 samples of endocervical mucus taken from 125 normal pregnant women during the visits to antenatal clinic were measured. Activity of the enzyme increased gradually with the advance of gestational age. Steep rising of the enzyme was seen between 34-35 weeks of gestation and the peak was achieved at 37 week since then the enzyme activity sustained at relatively high level until deliveries. Average activity of the enzyme after 34 weeks of gestation showed significant difference over that of earlier period. To use delivery date as a referent point, the peak was reached in the last fourth week of pregnancies and then sustained until deliveries. Significantly higher average activity was also seen in these last 4 weeks of gestation. These correlated very well to the fact that cervical maturation progresses most rapidly during last month of pregnancy. Immunohistochemical staining for elastase demonstrated elastase-containing granules in polymorphonuclear leukocytes. These cells found in cervical tissue taken from immediately postpartal women were much more than in those of early pregnant women. These findings may be the evidences support roles of granulocyte elastase in the process of cervical maturation preceding spontaneous labors in normal pregnancies.

[The effect of granulocyte elastase inhibitor (urinastatin) vaginal suppository on patients with imminent premature delivery]

Cervical maturation, dilatation and uterine contraction in imminent premature delivery are closely related to chemical mediators from activated granulocytes which infiltrate into the cervix. It is known that urinastatin (urinary trypsin inhibitor, UTI) inhibits many kinds of chemical mediators from granulocytes and macrophages such as granulocyte elastase (elastase) and interleukin 1. We examined the effect of a UTI suppository on uterine contraction and the elastase level in cervical mucus in cases of imminent premature delivery. We treated 43 cases of imminent premature delivery with tocolysis index 3 or 4 with 4 kinds of therapy: Group A (N = 12): ritodorine drop infusion therapy; Group B (N = 9): daily UTI suppository (1,000U) therapy; Group C (N = 14): daily UTI suppository + ritodorine drop infusion therapy; Group D: daily UTI suppository + ritodorine drop infusion + antibiotics (oral cepharosporine) therapy. The elastase level of cervical mucus before treatment was 0.76 +/- 0.40 micrograms/ml in group A, 0.93 +/- 0.43 micrograms/ml in group B, 0.85 +/- 0.40 micrograms/ml in group C and 0.90 +/- 0.41 micrograms/ml in group D. There was no significant difference between these groups. The elastase level in cervical mucus was 0.75 +/- 0.47 micrograms/ml in group A, 0.27 +/- 0.35 micrograms/ml in group B, 0.27 +/- 0.33 micrograms/ml in group C and 0.30 +/- 0.19 micrograms/ml in group D, respectively. The elastase level was decreased significantly in groups B, C and D. The time taken to depress uterine contraction was 65 +/- 66 min in group A, 375 +/- 336 min in group B, 70 +/- 64 min in group C and 58 +/- 53 min in group D, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Diamine oxidase activity in amniotic fluid for diagnosis of ruptured membranes

Diamine oxidase in vaginal effluent is used as a parameter for ascertaining the state of fetal membranes. A new method using tritiated putrescine as a substrate is described for the determination of diamine oxidase in amniotic fluid and vaginal effluents. A number of tests are used for the diagnosis of premature rupture of fetal membranes. The described procedure for diamine oxidase activity determination can be used in general hospitals and has advantages over other parameters such as pH, glucose or fructose concentration, and the amniotic fluid crystallization test.

[Preliminary study of cervicovaginal peroxidase as indicator for ovulation]

The study was designed to determine whether the change in the pattern of cervicovaginal peroxidase activity in the fertile period of women can serve as a basis for the development of a technique to predict ovulation time in natural family planning. Eight healthy women volunteered for this study in Chengdu area. The samples of cervical mucus and vaginal secretion were collected. The specific G-Px activity was measured with reference to the procedure of Tsibris, et al., on days 6, 8, 10, 12 through 16, 18, 20, 22, 24 of each menstrual cycle; at the same time an antecubital venous blood sample was drawn to be analyzed for levels of LH, FSH, E2, and P by RIA. The data showed that in 7 ovulatory cycles the G-Px activity did not vary regularly in vaginal secretion but it did drop rapidly in cervical mucus 2 or 3 days before ovulation time and it rose again one day after ovulation. The results suggest that the measurement of the G-Px activity in cervical mucus can be used to predict ovulation by two to three days before the time.

The relationship between granulocyte elastase-like activity of cervical mucus and cervical maturation

Granulocyte elastase (elastase)-like activity in 119 samples of cervical mucus from pregnant women was measured. Though elastase-like activity in normal pregnant women was low in 2nd and 3rd trimesters (less than 20 units), it increased during labor (1st stage of labor: 70 +/- 50 U/l; 2nd stage: 72 +/- 56). Elastase-like activity in pregnant women with imminent premature delivery (24-30 gestational weeks) was also high (78 +/- 57). Elastase-like activity of cervical mucus correlated with Bishop score in both normal term and preterm labor. Elastase-containing granulocytes were identified by immunohistochemistry in ripened cervix in normal and preterm labor. Some granulocytes degranulate and release elastase into the cervical stroma. Others migrate through the basement membrane of the endocervix to reach the cervical canal. Elastase could not be demonstrated in immature cervix as assessed by Bishop score. The staining intensity of elastase in the cervix correlated closely with elastase-like activity in cervical mucus. Thus elastase-like activity in cervical mucus reflects the degree of cervical maturation. These results lead one to speculate that elastase is one of the neutral proteases which depolymerize and degrade collagen in the ripening cervix.

Enzymes of human cervical mucus: a comparative study on fertile and infertile mucus and on the endocervical epithelium

We report a comparative study on protein and enzyme content of human periovulatory cervical mucus and endocervical epithelium. The salient results of our investigation are summarized in the following three points: 1) The method of taking of cervical mucus samples may markedly affect the results of protein and enzyme assays. It is warmly advisable to collect mucus samples from the endocervical canal. 2) Cervical mucus from women diagnosed as having cervical-factor infertility is oligoproteic and lacks some enzyme activities always present in normal cases. 3) Human cervical mucus and endocervical epithelium are very similar as for the enzyme distribution, but show quite different LDH-isoenzyme patterns. In the latter tissue, the H subunits constitute about 77 per cent of the whole LDH, suggesting that this enzyme here is functioning to produce pyruvate rather than lactate.

Alterations in protein, sialic acid and some enzymes in cervical mucus of female rats during NET-EN treatment

The effect of norethisterone enanthate (NET-EN) on cervical mucus protein, sialic acid and some enzymes (e.g. peroxidase, alkaline phosphatase and alpha-amylase) were studied in adult female rats. One mg NET-EN every 12 days was found to be an effective contraceptive dose of this drug in this species, acting primarily through the cervical mucus. NET-EN produced a highly significant increase in protein content and peroxidase and alkaline phosphatase activities. However, sialic acid content and amylase activity did not exhibit any definite pattern after NET-EN therapy. The increased protein content together with persistent elevated levels of peroxidase and alkaline phosphatase corroborates the hypothesis that NET-EN creates a progestogenic phase which prevents sperm penetration and thus conception.

Placental-type alkaline phosphatase in cervical neoplasia

Monoclonal antibodies reactive with placental-type alkaline phosphatase have formed the basis of methods for detection of this oncodevelopmental antigen in patients with pre-invasive and invasive cervical neoplasia, with or without evidence of papilloma virus infection. Disease-related elevations of placental-type alkaline phosphatase were not observed in patients' sera. Solubilised cervical smears or biopsy material, and cervical mucus swabs, often contained substantial amounts of this isoenzyme; however, there was no significant difference between any of the patient and control groups. Thus, serological and smear test assays for placental-type alkaline phosphatase were not useful in differential diagnosis of cervical lesions. However, its presence in most biopsy specimens, often at high levels, indicated possible application for in vivo radioimmunoimaging studies of invasive or metastatic cervical cancer.

Cervicovaginal peroxidases: markers of the fertile period

The specific activity of guaiacol peroxidase was measured daily in human cervical mucus, vaginal fluids, and saliva during 45 cycles in 31 women. Also determined were basal body temperatures and serum hormones (luteinizing hormone [LH], estradiol, progesterone). The guaiacol peroxidase was extracted with 0.5 M CaCl2 and thus may be a different peroxidase from that obtained by noncalcium extraction procedures. The guaiacol peroxidase specific activity did not vary in the saliva during the cycle but fell sharply in the cervical mucus and vaginal fluid four to five days before the ovulation time, estimated by the LH peak, and rose again one to two days after ovulation. Anovulatory cycles did not show the midcycle drop in guaiacol peroxidase. Growth curve analysis gave excellent fitting of the guaiacol peroxidase data to a polynominal model. These data suggest that cervicovaginal guaiacol peroxidase may be clinically useful in detecting the fertile period for population control and for infertility treatment.

Changes in enzyme levels in human cervical mucus during the menstrual cycle

Cervical mucus is a complex secretion produced by the endocervical epithelium. A comparative analysis of 30 enzymes was carried out on 15 women during their periovulatory period (days 10 to 16 of the menstrual cycle). Nine different enzymes were always found to be present in the cervical mucus. Changes in enzymatic activity were further studied in two of the women, one with a normal (27-day) and the other with a short (20-day) menstrual cycle. The data were compared with those for the same enzymes in the saliva of these two women. Each woman's ovulation time was determined through hormone measurements in urine and blood, as well as by recording basal body temperature and by Billing's method. Our results indicate that a maximum peak occurs for several enzymes during the periovulatory period.

Some molecular features of human cervical mucus

1) The time preservation effect of the enzymatic activities present in human cervical mucus has been studied. 2) In order to protect the enzymatic activities of the mucus from bacterial impurities, the enzymes studied were assayed in presence of NaN3. 3) The effect of an acid pH likes present in the vagina was also studied: a low pH exerts a marked inhibition on mucus enzymes. 4) the use of nonionic detergents for mucus solubilization does not produce a marked increase of the enzymatic activities studied. 5) A NADP-dependent malate dehydrogenase in peri- and post-ovulatory period has been identified. 6) The presence in mucus of at least four lactate dehydrogenase isoenzymes has been demonstrated and their absolute values determined.

[Diagnostic value of increased lactate dehydrogenase activity in vaginal secretions for the early detection of diseases requiring treatment of the female genitals and breast]

The Diagnostic Validity of Enhanced Lactate Dehydrogenase Activity in the Vaginal Secretion for Early Diagnosis of Diseases of the Female Genitals and the Mamma in Need of Treatment. An impregnated hygiene tampon (Gynaegnost) was used, which by a colour reaction permits the determination of augmented activity of lactate dehydrogenase (LDH) in vaginal secretion. The diagnostic validity of the results of the findings by this method in the detection of diseases of the female genitals and the mamma needing treatment was examined in two clinical diagnostic studies. The first study including 486 patients chiefly suffering from manifest carcinoma was aimed at solving a deliberately limited question. In patients with carcinoma stages I to IV of the most important genital locations augmented LDH-activity (correct positive results) was found in about 90%. A second study comprised 1955 women entering into outpatient gynaecological services for preventive examination; the definition of this series was difficult. Three categories of diagnostic groups can be determined by the results of this study. In the first category with the most important subgroup "routine examination without specification of a pathological finding" less than 20% "false" positive test results by the indicator were observed. A second category with inflammatory diseases (colpitis, endometritis) showed positive results in about one-third of the examinations. The third category comprised a minor number of malignant tumors roughly with a percentage of positive results corresponding to that of the first study. Augmented LDH activity in vaginal secretion is a diagnostic criterion which detects not only cancer; it is similar to the test of occult blood in faeces.(ABSTRACT TRUNCATED AT 250 WORDS)

[The effect of prolonged whole-body gamma irradiation of 6,7 Gy and 4,8 Gy (700 and 500 R) on the trypsin inhibiting activity (TIA) of blood, the cervical mucus and the morphological structure of the cervix in ewes]

The pattern of changes in the trypsin-inhibition activities (TIA) of blood plasma, cervical mucus and in the morphological structure of cervix was studied in ewes exposed to 60Co radiation for seven and five days, the radiation doses being 6.7 Gy and 4.8 Gy (700 and 500 R). During exposure, the group of ewes irradiated with 4.8 Gy was given the Roboran vitamin premix in addition to standard feed. After termination of irradiation the animals in this trial were given the ampicillin antibiotic (5250 mg). TIA was determined from the retardation of the hydrolysis of the synthetic substrate N-alpha-tosyl-p-nitroanilide (TAPA) by bovine trypsin; the TIA was expressed as the percentage of inhibited trypsin. As found on the day of the termination of irradiation, almost all the studied TIA values of blood plasma and cervical mucus were increased in the irradiated animals, the range being from 103.1 to 155.0% of the levels for non-irradiated ewes. A reduction was recorded only in total TIA of blood plasma in the group irradiated with the dose of 6.7 Gy (83.1% of the values for non-irradiated animals). In the group of animals irradiated with 4.8 Gy and fed no Roboran, the TIA of cervical mucus was observed to decrease to 92.4%. When evaluating the average TIA of different test groups throughout the experiment it was found that all the studied TIA values of the irradiated animals increased within a range from 104.1 to 184.0% of the values for untreated ewes. It was only in the average values of total TIA in blood plasma that, after irradiation with 6.7 Gy, a decrease to 92.7% of the level without irradiation was recorded. It was found during the study of changes in the proportions of glands in the stroma and changes in epithelium thickness in the mucous membrane of cervix uteri that the irradiated ewes had the epithelium thickness reduced to 95.3%-65.5% and that their stromal gland number decreased to 75.4%-79.7% of that recorded in non-irradiated animals. It was only in the group given a Roboran supplement that an increase to 123.7% of the gland number for untreated ewes was recorded on the tenth day after the termination of irradiation.

Cervical mucus peroxidase is a reliable indicator for ovulation in humans

This study was designed to establish whether fluctuation in cervical mucus peroxidase concentration correlates with the cyclic pattern of the menstrual cycle hormones in the human female. Forty healthy, normal-cycling women between the ages of 19 and 29 years were chosen for the study. Blood samples and cervical mucus were collected on days 6, 9 through 15, and 17 through 19 of the menstrual cycle for three consecutive cycles in each volunteer. Blood estrogen, progesterone, follicle-stimulating hormone, and luteinizing hormone levels were quantitated by radioimmunoassay, and cervical mucus peroxidase concentrations were measured spectrophotometrically. The data showed that in the typical menstrual cycle the mucus peroxidase peak was reached immediately prior to the luteinizing hormone/follicle-stimulating hormone surge and coincided with the estrogen peak. Consistent data in three consecutive menstrual cycles in each volunteer led us to postulate that the mucus peroxidase peak during the menstrual cycle precedes the ovulatory period in the normal healthy woman.

Cyclic changes of sialidase in human cervical mucus

1. Sialidase activity is detectable in whole cervical mucus of normal women throughout the menstrual cycle and presents cyclic variations toward endogenous and exogenous substrates. 2. The level of sialic acid bound to the mucus increases progressively till mid-cycle and declines in the post-ovulatory phase. 3. The sialidase of the mucus probably derives from different sources and its role remains speculative.

Lactate dehydrogenase in human cervical mucus: correlation with ovulation, influence of ovarian steroid hormones, and isozyme pattern

The glycolytic enzymes, lactate dehydrogenase (LDH), glucose-6-phosphate dehydrogenase, and hexokinase in cervical mucus of 96 ovulatory women were serially measured daily during the menstrual cycle. Among all of the enzymes, the cyclic changes in LDH activity were the most significant, being high during the proliferative phase, gradually decreasing to the lowest level around ovulation, and then increasing markedly again. Estrogen inhibited cervical mucus LDH activity; progestrone accelerated it. Examination of the LDH isozyme pattern showed that H-LDH (H-subunit of LDH), being predominant throughout the cycle, apparently carries some responsibility for the cyclic change in LDH activity. In a comparison of LDH activity with the serum luteinizing hormone (LH) peak, the activity level nadir of LDH usually appeared between 1 day before and 1 day after the serum LH peak, pointing to the advantage of daily measurement of cervical mucus LDH activity for predicting the potential day of conception.

The fractional postcoital test: a reappraisal

Postcoital tests (PCTs) were conducted following artificial insemination with either live or dead spermatozoa. The cervical mucus samples were analyzed for sperm counts and acid phosphatase activity. The results indicate that the final distribution of mucus and sperm in the PCT sampling catheter is not truly representative of their original distribution within the cervix. Moreover, PCTs done after insemination with semen containing only dead sperm yield unrealistically high sperm counts and high cervical mucus acid phosphatase levels. This is apparently due to the translocation of semen from the area of the external os into the mucus sample by the sampling catheter. This problem can be largely prevented by removing a plug of mucus from the external os prior to the catheter sampling procedure.

Enzyme activities and protein and carbohydrate concentrations in cervical secretions at dioestrus in normal ewes and ewes with permanent phytooestrogenic infertility

Cervical secretions of clover-affected and control ewes in the luteal phase of the ovarian cycle were obtained by flushing the anterior vagina. The flushings were analysed for proteins, carbohydrates and enzyme activities, and were found to be similar to the secretions of the normal ovine uterus. There was significantly more protein, carbohydrate and acid-soluble glycoprotein but less alkaline phosphatase, N-acetylglycosidases (EC 3.2.1.30 and 3.2.1.53) and ribonuclease I in the vaginal flushings of clover-affected ewes. The observed changes were not due to more inflammation in the cervix of clover-affected ewes as there were fewer bacteria, leukocytes and epithelial cells and no elevation of lysozomal enzyme activities in their flushings. It is suggested that the cervix of the clover-affected ewe behaves as though under a stronger than normal oestrogenic stimulation during dioestrus.