Association between endometrial senescent cells and immune cells in women with repeated implantation failure

PURPOSE

The aim of this study was to compare women with recurrent implantation failure (RIF) and control group in terms of the associations between p16-positive senescent cells and certain types of immune cells in human endometrium during the mid-luteal phase METHODS: Immunohistochemical staining was performed in 116 endometrial biopsies taken from 57 women presenting RIF, and control group of 59 women who became pregnant after the first intracytoplasmic sperm injection. Endometrial tissue sections were stained immunohistochemically for p16 (Senescent cells), CD4 (T-helpers), CD8 (T-killers), CD14 (Monocytes), CD68 (Macrophages), CD56 (Natural killers), and CD79α (B-cells). The percentage of positively stained cells for each marker was calculated by HALO image analysis software. The quantity and the relationship between senescent cells and immune cells were assessed and compared between the two groups.

RESULTS

The correlation coefficient was highest between senescent cells and CD4+ cells and was lowest between senescent cells and CD14+ cells in RIF women, similarly to the control group. However, most of the observed correlations among senescent and immune cells weaken notably or disappear in the RIF group. When comparing senescent cell-to-immune cell quantitative ratios, only p16+/CD4+ cell ratio was significantly higher in RIF women as compared with patients from the control group.

CONCLUSION

Our study indicates that the quantity of senescent cells in human endometrium during the mid-luteal phase has the strongest association with the amount of T helpers. Moreover, the specificity of this association might have an important impact on the occurrence of RIF.

Pathomorphological Diagnostic Criteria for Focal Cortical Dysplasias and Other Common Epileptogenic Lesions—Review of the Literature

Focal cortical dysplasia (FCD) represents a heterogeneous group of morphological changes in the brain tissue that can predispose the development of pharmacoresistant epilepsy (recurring, unprovoked seizures which cannot be managed with medications). This group of neurological disorders affects not only the cerebral cortex but also the subjacent white matter. This work reviews the literature describing the morphological substrate of pharmacoresistant epilepsy. All illustrations presented in this study are obtained from brain biopsies from refractory epilepsy patients investigated by the authors. Regarding classification, there are three main FCD types, all of which involve cortical dyslamination. The 2022 revision of the International League Against Epilepsy (ILAE) FCD classification includes new histologically defined pathological entities: mild malformation of cortical development (mMCD), mild malformation of cortical development with oligodendroglial hyperplasia in frontal lobe epilepsy (MOGHE), and “no FCD on histopathology”. Although the pathomorphological characteristics of the various forms of focal cortical dysplasias are well known, their aetiologic and pathogenetic features remain elusive. The identification of genetic variants in FCD opens an avenue for novel treatment strategies, which are of particular utility in cases where total resection of the epileptogenic area is impossible.

Endometrial immune cell ratios and implantation success in patients with recurrent implantation failure

The objective of this study was to compare the endometrial immune cells quantities and ratios during the mid-luteal phase between women with recurrent implantation failure (RIF) with successful and unsuccessful embryo implantation. For this purpose, endometrial biopsies from 116 women aged between 29 and 46 with history of RIF undergoing Assisted Reproductive Technology (ART) without endometrial pathologies were immunohistochemically stained for CD3 + T-cells, CD4 + T-helpers, CD8 + T-killers, CD14 + monocytes, CD68 + macrophages, CD56 + NK cells and CD79α+ B-cells. Endometrial immune cells quantities and ratios were compared based on the embryo implantation outcome in the subsequent embryo transfer cycle. Spearman correlation analysis and Mann-Whitney U test were used to analyse the obtained data. Patients who experienced successful implantation at the subsequent cycle had significantly lower percentage of CD3 + T cells, and higher ratios of CD4 + /CD8 + , CD4 + /CD3 + and CD68 + /CD3 + than the patients who experienced another failure in implantation. In addition, the ratios of CD3 + /CD14 + , CD79α+ /CD14 + and CD56 + /CD14 + were significantly lower in the successful implantation group than that in the unsuccessful one. A cut off value of CD68 + /CD3 + ratio higher than 0.85 (AUC 0.67, 95% CI 0.56-0.79), CD4 + /CD3 + ratio higher than 0.19 (AUC 0.67, 95% CI 0.56-0.79) and CD4 + /CD8 + ratio higher than 0.43 (AUC 0.62, 95% CI 0.50-0.73) could be predictive factors for successful implantation in RIF patients. Knowledge on the immune cell composition could assist in the evaluation of the endometrial receptivity in RIF patients.

NOTCH1- and CD117-positive stem cells in human endometrium and their implications for successful implantation

OBJECTIVE

To investigate the quantity of 2 stem cell types in the endometrial stroma of women undergoing in vitro fertilization and their association with steroid hormone signaling and implantation success after embryo transfer.

DESIGN

Prospective cohort study.

SETTING

Private hospital.

PATIENT(S)

A total of 109 patients undergoing in vitro fertilization.

INTERVENTION(S)

Not applicable.

MAIN OUTCOME MEASURE(S)

Immunohistochemistry staining of endometrial biopsies taken during the midluteal phase using antibodies against NOTCH1 and CD117 was performed. The percentage of endometrial stromal cells positive for these markers was determined. The link of these stem cell percentages with the serum progesterone and estradiol levels and the endometrial expression of their respective receptors were assessed. After embryo transfer, the quantity of stained cells for each marker was also compared according to implantation outcome.

RESULT(S)

The percentage of NOTCH1+ stromal cells ranged from 0.003%-2.112% (median, 0.062%) and was significantly higher than that of CD117+ cells, which ranged from 0.000%-0.210% (median, 0.020%) (Z = -7.035). The percentage of NOTCH1+ stem cells showed no difference between the studied serum hormone level groups and no relationship with the expression of their receptors in the endometrium. In contrast, the number of CD117+ cells significantly differed between patients with high and low levels of serum progesterone (cutoff, 14.9 ng/mL) and estradiol (cutoff, 135.6 pg/mL). Furthermore, the quantity of CD117+ stem cells was positively correlated with the progesterone receptor (R = 0.277) and estradiol receptor (R= 0.318) expression levels in the endometrium. Although the quantity of NOTCH1+ cells did not differ between the 2 implantation groups, the median percentage of CD117+ cells was significantly higher in patients with successful implantation than in those with unsuccessful implantation (0.03% vs. 0.01%, respectively). The cutoff value for the percentage of CD117+ cells predicting successful implantation was 0.018% (area under the curve, 0.66; 95% confidence interval, 0.56-0.77; sensitivity, 63.1%; specificity, 61.4%).

CONCLUSION(S)

This study indicates that the quantity of certain stem cell types (CD117+), but not others (NOTCH1+), in the functional endometrium is associated with implantation success and sex hormone signaling during the midluteal phase. These findings highlight the role of CD117+ cells in preparing the endometrium for embryo implantation, and their quantity may be an indirect indicator of endometrial receptivity.

Vertical Transmission of SARS-CoV-2 Infection and Miscarriage in the Second Trimester: Report of an Immunohistochemically Proven Case

It is an acknowledged fact that SARS-CoV-2 exhibits tropism for the human placenta. A possible mechanism of SARS-CoV-2 entry into host cells is via angiotensin-converting enzyme 2 (ACE2) receptors, which are expressed in trophoblasts, endothelial cells, and macrophages. The present study describes a case of spontaneous miscarriage in the 20th gestational week after maternal SARS-CoV-2 infection. The placenta and various fetal organs were examined for structural alterations and expression of the viral nucleocapsid protein and several immune cell markers via immunohistochemistry (IHC). Histopathological examination of the placenta revealed acute chorioamnionitis, acute subamnionic placentitis, multiple intervillous thrombi, increased fibrinoid deposition, and necrotic changes of the chorionic villi. Immunohistochemistry confirmed the presence of SARS-CoV-2 nucleocapsid protein regions predominantly in the syncytiotrophoblast. Staining of the placental tissue for different markers helped elucidate the distribution of immune cells. Pathomorphological examination of the fetal organs demonstrated changes in microcirculation with the presence of sludge phenomenon and diapedesis haemorrhages, mostly in the lungs, brain, and myocardium. IHC staining of fetal organs revealed expression of SARS-CoV-2 nucleocapsid protein, which was detected to the highest extent in the brain, lungs, and liver. The findings of the present report support the hypothesis of possible vertical transmission of SARS-CoV-2 from mother to fetus.

P-296 Relationship between the percentage of stem cells and implantation success in women with in-vitro fertilization

Study question

Is there a relationship between the percentage of stem cells in human endometrial stroma during the mid-luteal phase of the menstrual cycle and implantation success?

Summary answer

Women with successful implantation have significantly higher percentage of endometrial stromal CD117-positive stem cells during the mid-luteal phase of the menstrual cycle.

What is known already

Human endometrium as a highly regenerative dynamic tissue has a population of certain types of adult stem cells localized in the stroma and epithelium. These cells, including mesenchymal and hematopoietic stromal stem cells, participate in the immense cellular turnover in the human endometrium before and during the implantation process. General adult stem cell markers such as CD117 and NOTCH1 have been identified in human endometrium. However, there is a scarce data about the quantity of these endometrial stromal stem cells and their influence on the process of implantation.

Study design, size, duration

This is a cohort study of 109 women who had an endometrial biopsy during the mid-lutheal phase (LH + 7) in a natural cycle and positive or negative hCG test after in-vitro fertilization (IVF) with euploid embryos within 6 months of biopsy. We used immunohistochemical biomarkers NOTCH1 (E-AB-12815, Elabscience), CD117 (CD117/c-Kit/SCF-Receptor) (RB-9038-RQ, Epredia), to identify stem cells in endometrial stroma. The study was conducted between March 2020 and January 2022.

Participants/materials, setting, methods

The percentages of NOTCH1-positive and CD117-positive stem cells in the stroma were calculated after enumeration by two independent investigators in multiple endometrial sections. After embryo transfer women were divided into the following groups: unsuccessful embryo implantation (negative hCG test) ( n = 45) and successful implantation (positive hCG test) ( n = 64). The percentage of NOTCH1-positive and CD117-positive cells in the endometrial stroma were compared between these groups through Wilcoxon signed-rank test.

Main results and the role of chance

The percentage of CD117-positive stem cells in the endometrial stroma ranged between 0% and 0.21%, with a median of 0.02%. The percentage of NOTCH1-positive stem cells in the endometrial stroma ranged between 0.003% and 2.11%, with a median of 0.06%. There was no significant difference in female age (years), BMI (kg/m2) and blastocyst quality between the studied patient groups (P < 0.05). The quantity of NOTCH1-positive cells also did not differ significantly between the two groups (P = 0.18). However, the mean percentage of CD117-positive stromal cells was significantly higher in women with successful implantation compared to patients with unsuccessful implantation (0.04% vs. 0.02%, respectively, P = 0.004). The optimal successful implantation cut-off value for the percentage of CD117-positive stromal cells, was 0.018% (AUC 0.67, 95% CI 0.56-0.77). Therefore, a percentage of 0.018% of CD117-positive stem cells in the endometrial stroma was associated with 63.1% sensitivity and 61.4% specificity for predicting successful implantation after IVF.

Limitations, reasons for caution

The study cohort was limited in sample size. Not all confounding factors such as potential immunological and genetic reasons for unsuccessful implantation have been taken into account. In addition, the endometrial biopsy could also have an effect on endometrial receptivity and pregnancy outcome.

Wider implications of the findings

The results of this study revealed that the quantity of certain types of stem cells is associated with successful embryo implantation. These findings emphasize the essential impact of stem cells in human endometrium on the process of implantation.

Trial registration number

not applicable

P-792 Stem cells association to the immune cell populations of the human endometrium during the window of implantation

Study question

Are endometrial stem cells associated with endometrial immune cell populations during the window of implantation?

Summary answer

Endometrial stem cells are associated with the presence of macrophages and B-cells, but do not correlate to T-cells and natural killer (NK) cells.

What is known already

The endometrial stem cells are essential for the periodic uterine regeneration. Besides their role in tissue remodeling it has been recently shown that they exert immunomodulatory and anti-inflammatory effect on the components of the immune system. A well known fact is that the immune cell composition of the endometrium during the window of implantation is pivotal for the successful embryo implantation. There are only a few publications that study the association of the endometrial stem cells with the immune cells with regard to the window of implantation.

Study design, size, duration

Single center prospective study analyzing the cell composition of endometrial samples from women undergoing IVF. A total of 109 patients without endometrial pathologies were recruited for endometrial biopsy between March 2020 and January 2022. Endometrial samples were obtained on day 7 after LH peak in the presumed window of implantation and processed to formalin-fixed, paraffin-embedded slices for immunohistochemical analysis. This study received the approval of the hospital’s medical ethics committee.

Participants/materials, setting, methods

Tissue sections were immunohistochemically stained for CD117 and NOTCH1 as stem cell markers as well as for immune cells with CD3 (T-cells), CD8 (T-killers), CD4 (T-helpers), CD56 (NK cells), CD68 (Macrophages), CD14 (Macrophages) and CD79α (B-cells) antibodies. The percentage of positively stained stromal cells was evaluated by Image-J software in the same tissue area for each sample. Statistical analysis: Spearman correlation, p < 0.05 was considered significant.

Main results and the role of chance

Immunohistochemical analysis showed that NOTCH1 and CD117 positive stem cells are present in all samples with mean 0.133±0.029% and 0.034±0.004%, respectively, and they were significantly correlated (R = 0.397, p < 0.001). The presence of CD3+ T-cells, CD4+ T-helpers, CD8+ T-killers, CD56+ NK cells, CD79α+ B cells, CD68+ macrophages, CD14+ macrophages was also confirmed with mean 1.133±0.259%, 0.374±0.058%, 0.074±0.013%, 0.883±0.184%, 0.188±0.060%, 1.018±0.202% and 1.309±0.257%, respectively.

Spearman analysis revealed significant positive correlation between NOTCH1 positive stem cells and CD79α+ B-cells (R = 0.211, p = 0.029), CD14+ macrophages (R = 0.231, p = 0.017), but no relation to the other studied immune cell types was observed (p > 0.05).

Significant positive correlation between CD117 positive stem cells and CD14+ macrophages (R = 0.262, p = 0.007), CD68+ macrophages (R = 0.216, p = 0.025) and no relation to the other studied immune cell types was observed (p > 0.05).

When the immune cells ratios were evaluated and analysed for correlation with stem cells, it turned out that only CD117 positive stem cells are significantly correlated to CD8+ T-killers/CD68+ macrophages ratio (R=-0.274, p = 0.007).

Limitations, reasons for caution

In this study only immunohistochemical analysis was used. In future studies flowcytometrical quantification of the studied cells will be used. Also more immune cell subtypes should be included in the analysis to further characterise the stem cells association to the immune cell populations.

Wider implications of the findings

During the window of implantation the endometrial stem cells are associated to the macrophages distribution. In contrast to NOTCH1+, CD117+ stem cells relate to the endometrial B-cells. These findings confirm the role of the endometrial stem cells in the fine tuning of the immune behavior during the window of implantation.

Trial registration number

Not Applicable

O-217 Associations between endometrial stem cells quantities, serum levels of progesterone and estradiol and expression of their respective receptors in endometrial tissue during the mid-luteal phase

Study question

Is the percentage of endometrial stem cells linked to serum progesterone, serum estradiol, and their receptors expression in human endometrium during the mid-luteal phase?

Summary answer

We found an association between CD117+ endometrial stem cells and serum progesterone, estradiol, as well as with the expression of their receptors in the endometrium.

What is known already

Various types of stem cells including NOTCH1+ and CD117+ stromal cells have been found in the endometrium. Their quantities have been hypothesised to fluctuate with the menstrual cycle and to have a link with endometrial receptivity. It has been well established that progesterone and estradiol play a crucial role in the preparation of the endometrium for implantation and the expression of their receptors also varies with the menstrual cycle. Nonetheless, the relationship between stem cells and other established markers of endometrial receptivity, such as the sex hormones signaling system, constitutes a novel field of research.

Study design, size, duration

The present observational study included 87 women aged 26-56 (mean 39.5 years old) undergoing in-vitro fertilisation and for whom a peripheral blood sample and an endometrial biopsy were obtained during the mid-luteal phase (LH + 7) of a natural cycle. Immunohistochemical (IHC) markers for NOTCH1 (E-AB-12815, Elabscience), CD117 (CD117/c-Kit/SCF-Receptor RB-9038-RQ, Epredia), progesterone (PR) and estrogen receptors (ER) (1-PR026-07, 1-ES006-07, Quartett) were used to stain endometrial tissue. The investigation was carried out between March 2020 and January 2022.

Participants/materials, setting, methods

Serum progesterone and estradiol were measured via electrochemiluminescence using Cobas e411 analyser (Roche Diagnostics, Germany) on the day of obtaining the endometrial biopsy. Stem cells (count and percentage) and the expression of hormone receptors (6-point scale) were determined using ImageJ. Stem cells percentage was compared between groups with high and low progesterone (analogously for estradiol) using Wilcoxon signed-rank test. To assess the link between stem cell percentages and receptor expression, Spearman correlation was used.

Main results and the role of chance

The mean percentage of positively stained NOTCH1 endometrial stromal stem cells was 0.13 ± 0.29% and CD117+ cells was 0.034 ± 0.039%. The hormone serum levels ranged from 0.2 to 60 ng/mL (median of 14.9 ng/mL) for progesterone and from 12 to 1985 pg/mL (median of 135.6 pg/mL) for estradiol.

While the quantities of the two stem cell types demonstrated a positive correlation with each other (R = 0.379, p < 0.001), the percentage of NOTCH1+ stem cells showed no difference between the studied serum hormone levels (p > 0.05), nor revealed a relationship with the expression of their receptors (p > 0.05). In contrast, the amount of CD117+ cells differed significantly between patients with high and low serum progesterone (cutoff 14.9 ng/mL, p = 0.001) and estradiol levels (cutoff 135.6 pg/mL, p = 0.019). Furthermore, the quantity of stem cells positive for CD117 correlated positively with the two hormone receptor levels in the endometrium – PR (R = 0.277, p = 0.019) and ER (R = 0.318, p = 0.007).

Limitations, reasons for caution

A limitation of the study was the sample size. These findings should be confirmed using a larger population. In addition, confounding variables such as the immunological profile of the tissue should also be taken into account.

Wider implications of the findings

This study shows that certain endometrial stem cell types (CD117+) but not others (NOTCH1+) are associated with sex hormone signaling during the mid-luteal phase. This relationship highlights the role these cells play in preparing the endometrium for embryo implantation and their quantity might be an indirect indicator of endometrial receptivity.

Trial registration number

not applicable

A case of human papillomavirus infection and vulvar cancer in a young patient - "hit and run" theory

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Squamous vulvar cancer is often associated with human papillomavirus infection.

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Vulvar cancer located in the Bartholini gland area should be distinguished from Bartholini gland carcinoma.

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The “hit and run” theory states that the viral genome may disappear after the host cell accumulates numerous mutations.

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The “hit and run” theory suggests that viruses might cause more cancers than previously thought.

Vulvar cancer (VC) is a rare disease, of which the squamous vulvar carcinomas (SVCs) are the most common histological subtype. SVC is often associated with human papillomavirus (HPV) infection. HPV- positive SVCs are multifocal, typically have non-keratinizing morphology, presence of koilocytes and tend to arise in younger women (<50 years), which are often smokers. The “hit and run” theory has been a subject of longstanding curiosity in tumor virology. The “hit and run” scenario suggests that viruses have an activating role in the cancer development and the viral genome may disappear after the host cell accumulates numerous mutations.

Herein, a case of HPV- positive SVC in a 22-year-old patient with a possible “hit and run” scenario, is presented. Gynecological examination revealed a vulvar mass (3 cm) with ulcerated surface, located at the left Bartholini gland area. Punch biopsies of the lesion were performed. The histopathological examination revealed non-keratinizing squamous cell carcinoma (Grade 2) of the vulva and presence of koilocytes. P16 immunostaining was block-positive. HPV-testing of the specimen was negative.

In the majority of cases, VC arising in young patients is associated with HPV. VC located in the BG area should be distinguished from BG carcinoma. Future studies should reconsider the third diagnostic (histological areas of apparent transition from normal elements to malignant ones) criteria for defining BG carcinoma. The “hit and run” theory is rarely mentioned in oncology, but should be considered in cancer- associated viruses. The “hit and run” affair suggests that viruses may cause more cancers than previously thought.

[OVARIAN ANASTOMOSING HEMANGIOMA WITH STROMAL LUTEINIZATION: A CASE REPORT]

In 2009, Montgomery and Epstein coined the term "anastomosing hemangioma" for a newly described variant of capillary hemangioma with an unusual sinusoidal pattern, histologically mimicking angiosarcoma. The lesion was considered unique for genitourinary system with predilection to kidney but we found in the literature only 4 cases of this entity in ovaries. A 70-year-old woman presented with ultrasound visualized myometrial nodules and cystic formation of the right ovary, intraoperatively diagnosed as serous cystadenoma. Hysterectomy with bilateral adnexectomy was performed. The section of the ovary revealed a fortuitous finding in the cortex: circumscribed lesion, 7 mm in diameter, with mahogany brown, spongy appearance. Microscopic examination of H&E-stained slides manifested well-demarcated but un-encapsulated vascular proliferation, composed of tightly packed capillary-sized blood vessels with an anastomosing sinusoidal-like architecture and tortuous "feeding" and "draining" vessels of medium caliber. Endothelial lining featured only mild cytologic atypia and lack of mitotic figures. The lesion was surrounded by luteinized ovarian stroma. Immunohistochemical examination with CD34 highlighted endothelial cells; SMA--supporting stromal cells. The anastomosing hemangioma of the ovary with stromal luteinisation was diagnosed as accidental finding. The authors discuss morphological characteristics of anastomosing hemangioma and the unusual for menopausal women but quite often combination between this lesion in the ovary and stromal luteinisation.