P-398 HLA expression profile - the picture of successful pregnancy

Study question

Which the difference of HLA profile expression among normal and abnormal karyotype?

Summary answer

In missed abortion groups, a significant decrease in HLA-G expression is observed in the chorionic villus structures in comparison with normal karyotype group.

What is known already

The study of pregnant alloimmunity confirms the relationship of recurrent miscarriage with the individual characteristics of the HLA I and II class system (Human leukocyte antigen), which can lead to impaired production of the mixed lymphocyte reaction blocking antibodies (MLR-Bf), anti-paternalcyto-toxicantibodies (APCA) and anti-idiotypic antibodies, Ab2, which are necessary for successful implantation and pregnancy development. For example, HLA-G is mainly restricted to the fetal–maternal interface on the extravillous cytotrophoblast, to placenta, amnion when HLA II class system mostly determinates in dNK, T-cells, macrophages.

Study design, size, duration

It was a prospective complex cohort study from 2016-2020 years with cytogenetics and pathomorphological investigations. The purpose of this study is to investigate HLA-DR expression in gravid endometrium, HLA-G and KIR2DL4 expression in chorionic villous among 3 groups (study included 115 cases of abortion material): group 1 – 36 cases after missed abortion with normal karyotype, group 2–35 cases after missed abortion with polyploidy and group 3–44 cases after induced abortion group (normal pregnancy).

Participants/materials, setting, methods

Criteria of inclusion: abortive material from 3 groups of women with missed or after induced abortion; 6-12 weeks, singleton pregnancy, cytogenetic of chorionic villous was obligatorily - normal fetal karyotype and polyploidy of fetus. In this work, we used: cytogenetic method and morphological study (histological-H&E stain, immunohistochemical, morphometric method). Immunohistochemical examination included quantitative and qualitative assessment of the expression of Anti-HLA-DR (mouse monoclonal), Anti-HLA-G (mouse monoclonal) and AntiKIR2DL1+KIR2DL3 + KIR2DL4 + KIR2DS4 (rabbit polyclonal).

Main results and the role of chance

By IHC the expression of HLA-G in extravillous trophoblast cells but the expression of HLA-DR and KIR2DL4 were detected in stroma, glands, the endometrial epithelium, both in groups.The HLA-G expression area in both groups with missed abortion didn’t differ statistically. But the expression of HLA-G in 3 group was strictly higher (in group 1 with a normal karyotype 37.7, in group 2-36.4, in the control group 67.09, p < 0.001). When divided into subgroups depending on the karyotype, the following data were obtained: in the group with a non-developing pregnancy with a normal karyotype of male fetuses, there is a tendency to lower expression of HLA-G molecules compared to female fetuses (32.96 (10.22) and 41 .45(9.36), respectively). Expression of the KIR2DL4 receptor was verified in chorionic villi (in the cytotrophoblast and syncytiotrophoblast), as well as in the structures of the endometrium, both in the glands, stroma, and in the surface epithelium, regardless of the karyotype. The expression area of the KIR2DL4 receptor did not differ statistically between the three groups (29.6, 33.1 and 27.55, p = 0.75). The expression area of the HLA-DR was detected in each group in gravid endometrium, but it hadn’t statistically differences (44.1, 38.2 and 42.5, p = 0.82).

Limitations, reasons for caution

No reasons for cautions

Wider implications of the findings

In missed abortion groups,a significant decrease in HLA-G expression is observed in the chorionic villus structures in comparison with the control group.The mechanism of abortion in groups with missed abortion with both normal karyotype and pathological karyotype of the fetus is identical.HLA-G molecule has a leading role in successful implantation.

Trial registration number

АААА-А20-120041390025-9

P–414 HLA-G expression as a new prognostic marker of successful implantation

Study question

Is the low HLA-G expression a determinant of early reproductive loss?

Summary answer

Low expression of HLA-G is associated with pregnancy complications and can be one of the reasons of spontaneous abortion (such as RPL).

What is known already

The dysregulated maternal immune responses to invading embryos may play role in RIF, RPL, and second- and third-trimester obstetrical conditions. HLA-G is a molecule that was first known to confer protection to the fetus from destruction by the immune system of its mother, thus critically contributing to fetal–maternal tolerance due to inducing displacement of pro-inflammatory to Th1 cell-mediated response of Th2, has a positive influence on the process of implantation. HLA-G is mainly restricted to the fetal–maternal interface on the extravillous cytotrophoblast, to placenta, amnion.

Study design, size, duration

It was a prospective complex cohort study from 2016–2020 years with pathomorphological investigations. The purpose of this study is to investigate the HLA-G and KIR2DL4 expression in chorionic villous among 3 groups (study included 118 cases of abortion material): group 1 – 36 cases after missed abortion with normal karyotype, group 2 – 36 cases after missed abortion with polyploidy and group 3 – 46 cases after induced abortion group (normal pregnancy).

Participants/materials, setting, methods

Criteria of inclusion: abortive material from 3 groups of women with missed or after induced abortion; 6–12 weeks, singleton pregnancy, cytogenetic of chorionic villous was obligatorily - normal fetal karyotype and polyploidy of fetus. Pathomorophological investigation included H&E stain, IHC and confocal laser scanning microscopy. Immunohistochemical examination included quantitative and qualitative assessment of the expression of Anti-HLA-G (mouse monoclonal) in an extra villous trophoblast and Anti-KIR2DL1+KIR2DL3 + KIR2DL4 + KIR2DS4 (rabbit polyclonal) in chorionic villi.

Main results and the role of chance

The immunohistochemical study showed homogenous distribution HLA-G expression in extravillous trophoblast cells (EVT) and KIR2DL4 expression in chorion villous both in missed abortion groups and in induced abortion group. HLA-G expression average relative area in 1 and 2 groups was not statistically different (in 1 group with normal karyotype 33,9±3,5 and in 2 group 38,6±2,8). But the expression of HLA-G in 3 group was strictly higher (55,6 ±2,4). The average relative area of KIR2DL4 receptor wasn’t statistically different among 3 groups. However, the histological picture both missed abortion groups (for the genetic\immunological reasons for rejection) is the only one - this is a missed abortion of an early terms of gestation. In a histological study of missed abortion, as our study shows, the histological picture is similar in 1 and 2 groups. Thus, in 1 group with a normal karyotype of the fetus (before conducting the chorion cytogenetic study in the genetics laboratory) in 59.2% the histological examination determined a picture of an impaired early pregnancy with signs of trophoblast chromosomal pathology. Thus, without a cytogenetic study of the chorion, it is impossible to clearly determine whether the chromosomal pathology of the fetus is the cause of missed abortion.

Limitations, reasons for caution

There is no limitations, reasons for caution.

Wider implications of the findings: Thus, HLA-G molecule has a leading role in the onset and successful prolongation of pregnancy, implantation, placentation and fetal development.

Trial registration number

98–2019

Vitamin D significance in pathogenesis of endometriosis

Genital endometriosis (GE) is a widespread multifactorial disease thus making it necessary to carry on studying its pathogeny in order to work out target therapy techniques. Studying vitamin D role in GE pathogeny is a new promising research trend.

PATIENTS AND TECHNIQUE

25(ОН)D level was determined in peripheral blood (PB) of 440 patients with GE and in peritoneal fluid (PF) - in 49 GE patients; the same test in PB was performed in 30 patients of the control group with the ovulatory menstrual cycle and no gynecologic pathology. 129 patients with GE, as well as 82 women of the control, underwent examination of vitamin D receptor (VDR) polymorphism gene in BsmI, FokI, and TaqI polymorphic locus. We examined vitamin D receptor expression in the eutopic and ectopic endometrium in 32 women with GE and in the endometrium of 20 women from the control group. We also compared the efficacy of combined therapy involving colecalciferol to the standard hormone modulating therapy.

RESULTS

It was established that the prevalent GE forms are characterized by lower 25(ОН)D levels both in PB and in PF. It was also found that G/G genotype of VDR BsmI gene polymorphic variant 1.9 times increases GE occurrence risk. VDR expression was authentically lower in the ectopic endometrium compared to the eutopic endometrium. Patients with GE show no VDR expression cyclic variations in the endometrium which is contrary to the control. Therapy in combination with colecalciferol promotes a more expressed decrease of endometriosis-associated pain syndrome and psycho-emotional stabilization of GE patients compared to the standard hormone modulating therapy.

CONCLUSION

Vitamin D deficiency plays a significant role in the pathogenesis of GE and Vit D may be applied as its targeted therapy.

The effectiveness of resveratrol in treatment of PCOS on the basis of experimental model in rats

PURPOSE OF THE STUDY

Polycystic ovary syndrome (PCOS) is a widespread endocrine disorder in women of reproductive age. Further research is required to justify new directions of effective targeted therapy of this condition. Resveratrol possesses anti-inflammatory, antioxidant and antidiabetic properties. The purpose of this study was to evaluate the potential effectiveness of resveratrol in PCOS based on the created model of this disease in Wistar rats.

MATERIALS AND METHODS

The PCOS model was created by oral administration of letrozole to female Wistar rats.. The animals received resveratrol at a dosage of 20 mg/kg and 30 mg/kg for the next 30 days. Then ovariectomy was performed for histological confirmation of the effectiveness of resveratrol in the treatment of PCOS. Regularity of estrous cycle, animal's body mass and the level of soluble receptors for advanced glycation end products (sRAGE) in the blood of rats were also evaluated in dynamics.

RESULTS

The study revealed that administration of resveratrol leads to dose-dependent restoration of normal morphology of ovarian tissue, normalizes regularity of estrous cycle and decreases body weight of rats with PCOS.

CONCLUSION

The results obtained in rats suggest that resveratrol may be a promising agent for the treatment of PCOS in women.

The potentialities of oxytocin receptor inhibitors for endometriosis therapy

OBJECTIVE

Genital endometriosis (GE) is a widespread gynecological disease which requires its further pathogenesis investigation and search for new effective treatments. The known data of oxytocin receptor presence in endometrioid heterotopy smooth muscle cells give some grounds to assume oxytocin participation in the pathogenesis of endometriosis. The present study objective was to evaluate oxytocin level in peripheral blood (PB) in patients with endometriosis associated pain syndrome and to estimate the efficacy of oxytocin receptor inhibitors (IOXTR) administration based on animal endometriosis model.

MATERIALS AND METHODS

The basic group comprised 61 patients with endometriosis associated pain syndrome, while 21 patients formed the control group. VAS, MPQ, and BBS objective tests were applied for pain syndrome evaluation. Oxytocin level in PB was measured by immunoenzyme method. After confirmation of endometriosis experimental model formation in rats and further randomization, a daily IOXTR intra-abdominal injection was performed in a dose of 0.35 mg/kg/24 h in the basic group (n = 12) or saline solution administration in the control (n = 12). On the final stage, endometrioid heterotopy size measuring was performed along with histological examination.

RESULTS

Oxytocin level in PB was authentically higher in patients with GE compared to the control: 51.45 (35.54-62.76) pg/mL and 27.64 (23.23-34.12) pg/mL, respectively (p<.001). Positive correlation between oxytocin PB level and pain syndrome expression was established in patients with GE: VAS (r = 0.76; p<.001), MPQ (r = 0.52; p<.001), and BBS (r = 0.57; p<.001). Based on the experimental disease model authentical decrease of endometrioid heterotopy average area was observed after IOXTR therapy compared to the control (7.3 ± 1.8 mm² and 22.2 ± 1.2 mm², respectively, p<.05).

CONCLUSIONS

The obtained results confirm the oxytocin role in the pathogenesis of endometrioid associated pain syndrome. The high efficacy of IOXTR administration based on animal model of surgically induced endometriosis allows viewing this method as a perspective therapy.