Secretion of the Shiga toxin B subunit (Stx1B) via an autotransporter protein optimizes the protective immune response to the antigen expressed in an attenuated E. coli (rEPEC E22Δler) vaccine strain

We previously developed attenuated rabbit enteropathogenic E. coli (rEPEC) strains which are effective oral vaccines against their parent pathogens by deleting ler, a global regulator of virulence genes. To use these strains as orally administered vectors to deliver other antigens we incorporated the B subunit of shiga-like toxin 1(Stx1) into the passenger domain of the autotransporter EspP expressed on a plasmid. Native EspP enters the periplasm where its passenger domain is exported to the bacterial surface through an outer membrane channel formed by its translocator domain, then cleaved and secreted. Since antigen localization may determine immunogenicity, we engineered derivatives of EspP expressing Stx1B- passenger domain fusions: 1. in cytoplasm 2. in periplasm, 3. surface-attached or 4. secreted. To determine which construct was most immunogenic, rabbits were immunized with attenuated O103 E. coli strain (E22 Δler) alone or expressing Stx1B in each of the above four cellular locations. IgG responses to Stx1B, and toxin-neutralizing antibodies were measured. Animals were challenged with a virulent rabbit Enterohemorrhagic E. coli (EHEC) strain of a different serogroup (O15) than the vaccine strain expressing Stx1 (RDEC-H19) and their clinical course observed. IgG responses to Stx1B subunit were induced in all animals vaccinated with the strain secreting Stx1B, in some vaccinated with surface-expressed Stx1B, but in not animals immunized with periplasmic or cytoplasmic Stx1B. Robust protection was observed only in the group immunized with the vaccine secreting Stx1B. Taken together, our data suggest that secretion of Stx1B, or other antigens, via an autotransporter, may maximize the protective response to live attenuated oral vaccine strains.

Long-term systemic and mucosal antibody responses measured in BALB/c mice following intranasal challenge with viable enterotoxigenic Escherichia coli

The immunogenicity induced in BALB/c mice following intranasal challenge with a viable nonlethal dose (1.2 x 10(8) CFU) of enterotoxigenic Escherichia coli (ETEC) strain E23477A (O139:H28:CS1:CS3:LT+:ST+) was studied over a 140-day period. Serum IgG and IgM antibodies against coli surface antigen 3 (CS3), O139 lipopolysaccharide and heat-labile enterotoxin were measured by day 14 and remained at elevated levels out to day 140. The serum IgG response to the somatic antigens (CS3 and O139 lipopolysaccharide) was significantly greater (P < 0.05) than the IgG response to heat-labile enterotoxin, and the serum IgG response to CS3 was significantly greater (P < 0.05) than the IgG response to O139 lipopolysaccharide. The predominant serum IgG subclasses to CS3 were IgG1 and IgG2a, and they were significantly greater (P < 0.05) than IgG2b and IgG3. The predominant serum IgG subclass response to O139 lipopolysaccharide was initially IgG3 until day 56, after which IgG1 was predominant. The serum subclass response to CS3 indicated a mixed T helper 1/2 (Th1/Th2) profile, whereas the response to O139 lipopolysaccharide was primarily that of a Th2-type, at least over time. Fecal IgG and IgA responses to CS3 and O139 lipopolysaccharide were detected by day 14 and were measured out to day 140, with the CS3 fecal antibody responses being significantly greater (P < 0.05) than the O139 lipopolysaccharide and heat-labile enterotoxin fecal antibody responses. The aim of this study is the development of the intranasal mouse model that can aid in better understanding the immunopathology of ETEC infection and in screening of vaccine candidates prior to volunteer trials.

The encapsulation of enterotoxigenic Escherichia coli colonization factor CS3 in biodegradable microspheres enhances the murine antibody response following intranasal administration

The aim of this study was to measure serum and mucosal antibody responses following intranasal administration of biodegradable poly(dl-lactide-co-glycolide) (PLGA) microspheres loaded with the CS3 colonization factor isolated from enterotoxigenic Escherichia coli (ETEC). The response was compared against that measured in mice similarly administered the native CS3 antigen and in mice co-administered, along with the CS3 antigen, a known mucosal adjuvant, the R192G mutant heat-labile enterotoxin (mLT). The integrity of the CS3 antigen released from the microspheres was maintained as determined by SDS-PAGE and immunoblotting. Native CS3 induced serum and mucosal (bronchoalveolar, small intestinal and faecal) IgG and IgA responses. The co-administration of the mLT mucosal adjuvant significantly enhanced (P<0·001) serum and mucosal antibody responses to the CS3 protein. Likewise, the CS3-loaded PLGA microspheres induced significantly greater (P<0·001) serum and mucosal antibody responses than native CS3, as well as inducing antibody responses superior to those of the CS3 plus mLT formulation. Following administration of CS3 plus mLT, the mice became distressed (loss of activity, increased huddling, ruffled fur), a situation not seen following administration of the CS3-loaded PLGA microspheres. The results in this trial show that the CS3-loaded PLGA microspheres when administered intranasally to mice caused no observable distress to the mice and significantly (P<0·001) enhanced the immunogenicity of the CS3 protein.

Intranasal immunization of BALB/c mice with enterotoxigenic Escherichia coli colonization factor CS6 encapsulated in biodegradable poly(dl-lactide-co-glycolide) microspheres

Mice were intranasally administered enterotoxigenic Escherichia coli colonization factor CS6 encapsulated in poly(DL-lactide-co-glycolide) microspheres (CS6-PLG), with immune response measured and compared to that of similarly administered native CS6 and CS6 plus mutant heat-labile enterotoxin mucosal adjuvant (CS6+mLT). Native CS6 and the CS6-PLG microspheres administered intranasally to mice induced serum IgG responses, with the CS6-PLG microspheres inducing a significantly greater (P<0.001) response than native CS6. Following intranasal administration of native CS6, no fecal IgG and IgA responses were measured; however, the CS6-PLG microspheres induced significantly greater (P<0.001) fecal IgG and IgA responses than native CS6. The coadministration of the mLT mucosal adjuvant with CS6 induced significantly greater serum (P<0.001) and fecal (P<0.01) responses than the CS6-PLG microspheres. However, following intranasal administration of the mLT adjuvant, the mice showed definite signs of distress, indicating an adverse reaction to the mLT. Thus, this brings into question the safety of the mLT and its use as an intranasal adjuvant. In contrast, the PLG-microspheres administered intranasally caused no noticeable distress to the mice. The results obtained in this study indicate that the encapsulation of CS6 in PLG-microspheres administered intranasally to mice acted in an adjuvant capacity to enhance the CS6 immune response.

Microencapsulated subunit vaccine approach to enterotoxigenic Escherichia coli and other mucosal pathogens

Infections of the intestinal, urogenital, and respiratory tracts are serious health problems worldwide from both a morbidity and mortality perspective. Mucosal pathogens attach to surfaces of mucosa as a prerequisite for colonization and subsequent pathogenesis. By expressing various surface adhesins (colonization factors, CF) they are able to bind to specific mucosal receptors. Enterotoxigenic Escherichia coli (ETEC) can express numerous CF that allow them to attach to a variety of hosts. Mucosal immunity directed against pathogenic microorganisms is critical in host protection with secretory IgA being particularly important in preventing microoganisms from colonizing host cells. M cells likewise have an important immunological function in the small intestines by binding and transporting antigens to lymphocytes and macrophages thus enhancing the immune response. The use of subunit vaccines, such as antigen encapsulated microspheres, can act to effectively deliver specific antigens so as to optimize their immunological response. With the threat of bioterrorism becoming a reality in recent years, the miroencapsulation of antigens from potential bioterrorist agents may be an effective method of delivery so as to induce a level of protection in at risk individuals. The encapsulation of ETEC colonization factors in microspheres and their subsequent administration in small animals and humans has been conducted for many years. Evidence suggests that this type of delivery system for ETEC antigens may enhance their immunogenicity and provide protection against this microorganism.

Murine antibody response to intranasally administered enterotoxigenic Escherichia coli colonization factor CS6

Enterotoxigenic Escherichia coli (ETEC) is the most common cause of bacterial diarrhea worldwide and is an important cause of infant morbidity and mortality in developing nations. ETEC colonization factors (CF) are virulence determinants that appear to be protective antigens in humans and are the major target of vaccine efforts. One of the most prevalent CF, CS6, is expressed by about 30% of ETEC worldwide. This study was designed to compare the immunogenicity between encapsulated CS6 (CS6-PLG) and unencapsulated CS6. Recombinant CS6 was purified and encapsulated in biodegradable poly(DL-lactide-co-glycolide) (PLG) microspheres using current Good Manufacturing Practices (cGMP). CS6-PLG and CS6 were administered intranasally (IN) to BALB/c mice in three vaccinations 4 weeks apart. Enzyme linked immunosorbent assay (ELISA) was used to measure the anti-CS6 response in serum and mucosal secretions following each of the three inoculations. Mice vaccinated with two or three doses of CS6-PLG demonstrated a significantly greater rise in serum anti-CS6 IgG and mucosal IgA titer values than those immunized with two or three doses of CS6 alone. Three doses of CS6-PLG led to anti-CS6 serum IgG and mucosal IgA titer values 14-fold and 4.4-fold greater, respectively, than three doses of CS6 (P<0.02). IN administered CS6 to mice is safe and highly immunogenic either alone or when encapsulated in microspheres. PLG microsphere encapsulation of CS6 significantly augments the antibody response to that antigen when administered to a mucosal surface.

Mucosal immunization of BALB/c mice using enterotoxigenic Escherichia coli colonization factors CFA/I and CS6 administered with and without a mutant heat-labile enterotoxin

Mice (BALB/c) were intranasally (IN) and intragastrically (IG) administered the ETEC colonization factors (CF), CFA/I and CS6, with and without the R192G mutant heat-labile enterotoxin (mLT), and immunogenicity and efficacy measured. The IN administration of CFA/I to mice induced strong serum and fecal IgG and IgA responses. The IG administration of CFA/I to mice induced serum IgG and fecal IgA responses, but only when mLT was co-administered with CFA/I were serum IgA titers detected. The IN administration of CS6 to mice induced serum IgG antibodies, and mLT, when co-administered with CS6, enhanced the serum IgG response. Only when the mLT was co-administered with CS6, were serum and fecal IgA responses detected. The IG administration of CS6 plus mLT induced serum IgG and fecal IgA responses. Partial protection against lethal challenge with ETEC strain H10407 was seen in the mice IN administered the CFA/I plus mLT (P<0.01), and H10407 was cleared from the lungs of CFA/I plus mLT-immunized mice at a significantly greater rate than from the control mice (P<0.05). CFA/I and CS6 administered IN and IG induced mixed Th1/Th2 immune responses with the Th2 type being predominant as evidenced by IgG1>IgG2a. The administration of colonization factors to mice, particularly by the IN route, potentially serves as a useful way to measure the serum and mucosal immune responses to these antigens prior to their use in volunteers.

Pathogenicity and immune response measured in mice following intranasal challenge with enterotoxigenic Escherichia coli strains H10407 and B7A

The pathogenicity and immunogenicity induced in BALB/c mice by intranasal (i.n.) inoculation of enterotoxigenic Escherichia coli (ETEC) strains H10407 (O78:H11:CFA/I:LT(+):ST(+)) and B7A (O148:H28:CS6:LT(+):ST(+)) (two ETEC strains previously used in human challenge trials) were studied. The i.n. inoculation of BALB/c mice with large doses of ETEC strains H10407 and B7A caused illness and death. The H10407 strain was found to be consistently more virulent than the B7A strain. Following i.n. challenge with nonlethal doses of H10407 and B7A, the bacteria were cleared from the lungs of the mice at a steady rate over a 2-week period. Macrophages and neutrophils were observed in the alveoli and bronchioles, and lymphocytes were observed in the septa, around vessels, and in the pleura of the lungs in mice challenged with H10407 and B7A. In mice i.n. challenged with H10407, serum immunoglobulin G (IgG) and IgM antibodies were measured at high titers to the CFA/I and O78 lipopolysaccharide (LPS) antigens. In mice i.n. challenged with B7A, low serum IgG antibody titers were detected against CS6, and low serum IgG and IgM antibody titers were detected against O148 LPS. The serum IgG and IgM antibody titers against the heat-labile enterotoxin were equivalent in the H10407- and B7A-challenged mice. The CFA/I and O78 LPS antigens gave mixed T-helper cell 1-T-helper cell 2 (Th1-Th2) responses in which the Th2 response was greater than the Th1 response (i.e., stimulated primarily an antibody response). These studies indicate that the i.n. challenge of BALB/c mice with ETEC strains may provide a useful animal model to better understand the immunogenicity and pathogenicity of ETEC and its virulence determinants. This model may also be useful in providing selection criteria for vaccine candidates for use in primate and human trials.

Application of an enzyme immunoassay for urinary follicle-stimulating hormone to describe the effects of an acute stressor at different stages of the menstrual cycle in female laboratory macaques

An enzyme-linked immunosorbent assay (ELISA) for human urinary beta follicle-stimulating hormone (FSH) subunit was validated for use in the laboratory macaque (Macaca mulatta and Macaca fasicularis). This ELISA is based on the dissociation of the FSH heterodimer in urine and the subsequent measurement of the beta subunit as a representation of total urinary FSH. This assay was then used to describe the gonadotropin escape following ovarian senescence in post-menopausal macaques. In addition, the assay was used to observe the impact of an acute stressor on the pituitary-gonadal axis and how the impact of this stressor varies when experienced at different stages of the menstrual cycle. The study design involved the measurement of ovarian steroids and FSH in urine collected daily during a period of time when animals experienced a well-defined event on two occasions consisting of capture, restraint, and anesthesia. This unique study design was made possible by the ability to monitor both ovarian and pituitary function in the absence of confounding daily captures and restraint for blood collection. There was a high correlation between urinary FSH measured in macaques with the beta FSH subunit ELISA and serum FSH measured in paired blood samples by radioimmunoassay (n=39, r2=0.878, P<0.001) and the composite urinary FSH profile obtained from normal, premenopausal macaques exhibited the expected dynamics with a transient rise of FSH during the luteal-follicular transition as well as an acute rise of FSH at mid-cycle. This pattern was lost in castrate and post-menopausal monkeys in which FSH levels were significantly increased (P<0.0001) above those of intact males and young females, respectively. In the stress study, we found that stressors occurring during the luteal-follicular transition not only resulted in acute perturbations of FSH but also led to abnormalities in the subsequent menstrual cycle in 50% of the cases.

Sildenafil for psychotropic-induced sexual dysfunction in 31 women and 61 men

Ninety-two outpatients (31 women, 61 men) who were treated with oral sildenafil for psychotropic-induced sexual dysfunction (PISD) completed ratings of their sexual functioning pre- and posttreatment. Both women and men reported significant improvements (p = .001) in all domains of sexual functioning, with 88% reporting improvement in overall sexual satisfaction. Significant improvements were reported regardless of psychotropic medication type. However, patients taking selective serotonin re-uptake inhibitors reported less improvement in arousal, libido, and overall sexual satisfaction than did other patients, whereas patients taking benzodiazepines reported significantly more improvement in libido and overall sexual satisfaction. Oral sildenafil may be an effective treatment for PISD.

Regulation of biologically active dimeric inhibin A and B from infancy to adulthood in the male

Inhibins are glycoprotein members of the transforming growth factor-beta family that have been implicated in the control of spermatogenesis by exerting a negative feedback on FSH secretion. In addition, locally produced inhibins may play a role in paracrine regulation of testicular function. Immunoassays were used to measure the two biologically active dimeric forms of inhibin (inhibin A and B) in serum, seminal plasma, and urine. To better define their actions, inhibins were measured in the male during infancy, sexual maturation, and senescence. Inhibin B but not A was measurable in the serum of male newborns, infants, children, and adults. In adult males, measurable levels of inhibin B were detected in the seminal plasma but not the urine. The circulating levels of inhibin B increased shortly after birth and peaked at 4-12 months of age (210 +/- 31 pg/mL). The concentration measured in the serum then decreased to a low of 81 +/- 12 pg/mL of inhibin B from 3-9 yr of age followed by a gradual increase beginning with the onset of puberty and reaching another peak of 167 +/- 20 pg/mL in males who were 20-30 yr of age. Inhibin B levels then gradually declined with increasing age up through 90 yr of age. Serum levels of gonadotropins and total testosterone production were also measured in these same males. There was a brief increase in the gonadotropins (FSH and LH) during the few months of postnatal development, followed by a decrease to basal levels until the onset of puberty at 10-14 yr of age. Testosterone was also increased in the serum of infants from day 1 through 12 months of age, which decreased in young children but increased again following the elevation of gonadotropins during puberty. In adults aged 20-90 yr, serum levels of inhibin B were inversely proportional to levels of FSH but not LH or testosterone. In males in which a semen analysis was performed, those males with normal semen analysis had a significantly higher inhibin B levels, sperm production, and lower FSH levels than males with either oligospermia or nonobstructive azoospermia. The levels of Inhibin B found in circulation were a good marker for testicular function and could be useful in the diagnosis of patients with semen abnormalities or a complete absence of spermatogenesis. Because this glycoprotein is secreted in high amounts in the prepubertal testis up to 3 yr of age, inhibin B could potentially be used as a marker in the diagnosis of cryptorchidism and precocious puberty.

Temperature-sensitive mutants of Actinobacillus pleuropneumoniae induce protection in mice

Temperature-sensitive mutants of Actinobacillus pleuropneumoniae 4074, serotype 1, were isolated after treatment with nitrosoguanidine and enrichment with penicillin and D-cycloserine. Of the four temperature-sensitive mutants evaluated in mice, one (A-1) had a tight phenotype (i.e., it ceased replication immediately after transfer to the nonpermissive temperature [37 degrees C]) and three (1-2, 4-1, and 12-1) were coasters that continued replication for up to three generations after transfer to 37 degrees C. The reversion frequencies ranged from 10(-6) to 10(-9), and cutoff temperatures ranged from 33 to 35 degrees C. No major changes were detected in the biochemical profiles; agglutination reactions; electrophoretic profiles of the lipopolysaccharides, outer membrane proteins, and hemolysin proteins; hemolytic titers; or CAMP factor reactions of the mutants and the wild-type bacteria. Groups of 3- to 5-week-old, female ICR mice were immunized intranasally with three doses of 3.5 x 10(6) CFU of the mutants over 3 weeks and subsequently challenged intranasally with 5 50% lethal doses of the parental wild-type. Protection was induced by both the tight and the coaster mutants, with the 4-1 and 12-1 coasters eliciting greater protection (67 and 82%, respectively) than that induced by the A-1 tight mutant (57%). Intranasal immunization with both phenotypes induced serum antibody responses against the surface antigens and the hemolysin protein.

Immunization with temperature-sensitive mutants of Actinobacillus pleuropneumoniae induces protective hemolysin-neutralizing antibodies in mice

The immunogenicity and protective potential of three temperature-sensitive mutants of Actinobacillus pleuropneumoniae were evaluated in mice with respect to antibodies against the capsular polysaccharide, lipopolysaccharide, outer membrane proteins, and hemolysin protein. Antibodies to the capsular polysaccharide and lipopolysaccharide could not be correlated with protection in the mice; there were no significant differences among the anti-capsular and anti-lipopolysaccharide antibody titers regardless of the severity of infection. Sera from mice immunized with the mutants and challenged with the wild type contained antibodies that reacted in immunoblots to four major outer membrane proteins(66, 39, 29, and 16 kDa) regardless of the severity of infection after challenge. Both the tight and coaster mutants synthesized and secreted the 105-kDa hemolysin protein exotoxin in vitro and in vivo; hemolysin protein neutralization titers and the blotting intensity of the sera, however, varied inversely with the severity of infection. Sera from mice surviving challenge with little to no lung involvement stained the hemolysin band more intensely and had significantly higher neutralization titers (P < 0.05) than sera from mice that either died or survived with severe pulmonary hemorrhage. These results confirm the importance of the hemolysin in pathogenesis and the need for including it in any vaccine preparation.

Vaginal lubricants for the infertile couple: effect on sperm activity

OBJECTIVE

To determine the effects of natural vegetable oils and vaginal lubricants on sperm motion and viability.

DESIGN

Four widely used vaginal lubricants (K-Y Jelly, Astroglide, Replens, and Touch) and two vegetable oil products that have been used as vaginal lubricants were purchased through local vendors. Sperm was obtained by masturbation without lubrication from normal, healthy donors. Lubricants were mixed with sperm from individual donors and the effects on sperm motility were determined at 1, 15, 30, and 60 minutes.

SETTING

Southwestern Fertility Associates of The University of Texas Southwestern Medical Center at Dallas.

MAIN OUTCOME MEASURES

Sperm motility was evaluated by manual motility counts and by computer-assisted semen analysis. Sperm viability was evaluated with Hoechst 33258 dye. The effects of the various lubricants were compared with those of a spermicidal agent, Gynol II (negative control) and Ham's F-10 (positive control).

RESULTS

Commercial lubricants inhibited sperm motility by 60-100% after 60 minutes of incubation. Sperm exposed to Replens or Astroglide were nonmotile and nonviable after incubation for 60 minutes, similar to the control, nonoxynol-9 containing product Gynol II. Canola oil had no detrimental effects and was indistinguishable from Ham's F-10 in terms of sperm viability and motility.

CONCLUSIONS

For couples with infertility, the use of vaginal lubricants during intercourse is not recommended. In cases where a lubricant is required, careful selection can maximize sperm motility and viability.

Inhibin-B: a likely candidate for the physiologically important form of inhibin in men

Inhibin is a glycoprotein hormone that is defined on the basis of inhibition of pituitary FSH production, However, previous data have not shown any correlation between RIA measurements of inhibin and FSH in men. New enzyme-linked immunosorbent assays, specific for inhibin A, inhibin B, and inhibin pro-alphaC-related immunoreactivity, were applied to the measurement of inhibin in 32 healthy men. Further measurements of inhibin B and pro-alphaC-RI were carried out on groups of men exhibiting a wide range of FSH concentrations, including semen donors, infertile men, and men with elevated FSH concentrations. Inhibin A was undetectable (<2 pg/mL) in all men studied. The healthy men studied all had measurable concentrations of inhibin B (135.6 pg/mL; confidence interval, 108.4-169.4) and pro-alphaC-RI (426.3 pg/mL; confidence interval, 378.4-480.2). A close negative correlation was found between the inhibin B and FSH concentrations in the semen donors (r = -0.69; P < 0.001), the infertile men (r = -0.81; P < 0.001), and the men with elevated FSH concentrations (r = -0.54; P < 0.01), but not in a group of healthy volunteers (r = -0.08; P = NS). No correlation was observed between concentrations of pro-alphaC-RI and FSH in any of the groups studied. These results strongly suggest that the physiologically important form of inhibin in men is inhibin B, which has a critical effect on FSH release. Inhibin B may offer a clinically useful serum marker of testicular function.

Cervical mucus anti-sperm antibodies: treatment with intrauterine insemination

PROBLEM

To determine (1) the incidence of cervical mucus anti-sperm antibodies in infertile women, and (2) the results of treatment by intrauterine insemination.

METHOD

Cervical mucus was collected the morning after urinary LH surge occurred from 153 consecutive women being treated for unexplained infertility with intrauterine insemination. Immunobead testing for IgG, IgA, IgA1, and IgA2 was performed with only actively motile sperm being counted.

RESULTS

Overall, 23/153 (15.0%) of cervical mucus samples were positive for anti-sperm antibodies: 9/23 (39.1%) were only IgA-positive (62% IgA1-positive, 38% IgA2-positive), 11/23 (47.8%) were only IgG-positive, and 3/23 (13.0%) were positive for both IgA and IgG. Insemination resulted in a pregnancy in 6/23 (26.1%) of women with cervical mucus anti-sperm antibodies after 1-3 cycles.

CONCLUSIONS

Testing for cervical mucus anti-sperm antibodies should be performed in cases of "unexplained" infertility, and intrauterine insemination may be an effective treatment, resulting in pregnancies in over one-fourth of couples.

Telomerase activity in human germline and embryonic tissues and cells

Telomerase is a ribonucleoprotein that synthesizes telomere repeats onto chromosome ends and is involved in maintaining telomere length in germline tissues and in immortal and cancer cells. In the present study, the temporal regulation of expression of telomerase activity was examined in human germline and somatic tissues and cells during development. Telomerase activity was detected in fetal, newborn, and adult testes and ovaries, but not in mature spermatozoa or oocytes. Blastocysts expressed high levels of telomerase activity as did most human somatic tissues at 16-20 weeks of development with the exception of human brain tissue. This activity could no longer be detected in the somatic tissues examined from the neonatal period onward. Neither placenta nor cultured fetal amniocytes contained detectable telomerase activity. Fetal tissues explanted into primary cell culture showed a dramatic decline in telomerase activity which became undetectable after the first passage in vitro. Elucidation of the regulatory pathways involved in the repression of telomerase activity during development may lead to the ability to manipulate telomerase levels and explore the consequences both for cellular aging and for the survival of cancer cells.

Oral contraceptive pills, gonadotropin-releasing hormone agonists, or use in combination for treatment of hirsutism: a clinical research center study

The effectiveness of oral contraceptive pills (OCPs), GnRH agonist (GnRH-a), and a combination of OCPs and GnRH-a in the treatment of hirsute women was compared and the impact of these treatments on hormonal and Ca metabolism was investigated. Thirty-three women were prospectively enrolled and randomized into three treatment groups (11 in each group). The serum levels of LH, estradiol, testosterone, free testosterone, androstenedione, and 17-hydroxyprogesterone declined in all 3 treatment groups, whereas the inclusion of GnRH-a treatment tended to promote a more rapid decrease in these hormone levels. Total cholesterol, low density lipoprotein, and high density lipoprotein levels remained unchanged. The assessment of hirsutism by the Ferriman-Gallwey score revealed a similar 25% reduction in score by all three treatment groups by 6 months. In addition, no difference was detected between groups with respect to hair diameters and the vellus index. Clinical assessment of hirsutism at 3 months by the patients revealed that the GnRH-a and the OCPs-plus-GnRH-a groups had better responses than the group on OCPs alone, but by 6 months all three groups were similar. The symptoms of hot flashes and vaginal dryness were greatest in subjects treated with GnRH-a alone. Serum Ca, phosphorus, alkaline phosphatase, osteocalcin, and 2-h fasting and 24-h urinary Ca excretion levels all increased significantly in subjects treated with the GnRH-a alone, whereas a decrement or no changes occurred for these measurement in the other two groups. The estimated Ca balance was unchanged in the OCPs and the OCPs-plus-GnRH-a groups but declined by 90 mg/day from baseline in the GnRH-a-treated women (p < or = 0.001). Bone density significantly decreased in the lumber spine in women treated with GnRH-a alone, with a less marked decline in the femoral neck. In contrast, women receiving OCPs plus GnRH had increased bone density in the lumbar spine. It is concluded that: 1) clinical measures of hirsutism are not different after 6 months of treatment with OCPs alone, GnRH-a alone, or a combination of the two; 2) the decline in gonadotropins and steroid hormones and improvement in clinical response were more rapid and pronounced when GnRH-a treatment was added to OCP administration; and 3) the negative impact of GnRH-a alone on Ca balance and bone loss limits its usefulness as a single agent for long-term therapy of hirsutism.

Intrauterine insemination with frozen donor sperm: a prospective randomized trial comparing three different sperm preparation techniques

OBJECTIVE

To compare the pregnancy rates (PRs) after intrauterine insemination (IUI) with frozen-thawed donor sperm. Sperm were isolated after thawing using three different sperm preparation techniques: simple washing, Percoll density gradient, and Sephadex columns (SpermPrep Column; Fertility Technologies, Natick, MA).

DESIGN

Women (n = 98) were randomized upon entry into the program into one of three different sperm preparation methods. The same sperm preparation technique was used for the woman during subsequent cycles, if pregnancy did not occur. The study was stopped when > or = 75 treatment cycles for each group were completed for analysis of PRs per treatment cycle.

SETTING

All patients were treated at our private care center at the University of Texas Southwestern Medical Center.

PATIENTS

Patients entering this study were spontaneously ovulating women undergoing IUI with frozen donor sperm.

MAIN OUTCOME MEASURE

Pregnancy rate per cycle of timed IUI.

RESULTS

After 260 cycles of insemination, the PR per cycle was 19.1% with simple washing, 16.9% with Sephadex columns, and 11.4% with Percoll density gradient. Although these results were not statistically different, Percoll density gradient had a 40% lower PR per treatment cycle compared with simple washing. However, Percoll density gradient preparation of sperm resulted in a statistically significant increase in the motility, curvilinear velocity, straight line velocity, and the number of normal heads compared with the other two treatments.

CONCLUSION

Although Percoll density gradient separation of sperm results in a population of cells that is more motile and morphologically normal, this did not result in subsequent cycle fecundity. These data suggest that the reliance on the averaged values of motility, curvilinear velocity, straight line velocity and morphology may have little predictive value of the potential fertility of frozen-thawed sperm.

The effects of growth factors and phorbol esters on steroid biosynthesis in isolated human theca interna and granulosa-lutein cells in long term culture

In this report we examined the effects of growth factors and phorbol esters on steroid hydroxylase activity in cultured human thecal and granulosa-lutein cells. Treatment of thecal cells with epidermal growth factor (EGF), fibroblast growth factor (FGF), transforming growth factor-beta (TGF beta), and tetradecanoyl phorbol acetate (TPA) resulted in the inhibition of forskolin- and dibutyryl cAMP-stimulated 17 alpha-hydroxylase activity and 17 alpha-hydroxyprogesterone and dehydroepiandrosterone production. In contrast, cAMP-stimulated 3 beta-hydroxysteroid dehydrogenase (3 beta HSD) activity was enhanced by FGF and TGF beta, and treatment with EGF enhanced cAMP-stimulated progesterone production. cAMP stimulated 3 beta HSD activity was unaffected by TPA (10 nmol/L) treatment, yet TPA inhibited cAMP-stimulated progesterone production. Basal 3 beta HSD activity and progesterone production were inhibited by TPA. In contrast to the inhibitory actions of EGF, FGF, and TGF beta on 17 alpha-hydroxylase expression, insulin and insulin-like growth factor-I enhanced forskolin-stimulated 17 alpha-hydroxylase activity. In granulosa-lutein cells, forskolin-stimulated aromatase activity was suppressed by EGF, FGF, and TPA. TGF beta had no effect on forskolin-stimulated aromatase activity. EGF, FGF, and TGF beta did not affect forskolin-stimulated progesterone production, whereas treatment with TPA inhibited cAMP-stimulated progesterone secretion. These data suggest that growth factors may differentially regulate cAMP-dependent processes in human thecal and granulosa cells of the developing follicle.

Treatment of antibody-associated sperm with media containing high serum content: a prospective trial of fertility involving men with high antisperm antibodies following intrauterine insemination

PROBLEM

Antisperm antibodies (ASAs) associated with the sperm surface can significantly influence oocyte fertilization. We initiated a prospective trial comparing the effect of serum-medium dilution on ASA binding and/or distribution following ejaculation and on subsequent pregnancy rates following intrauterine insemination (IUI).

METHOD

Infertile couples (N = 16) were entered into this prospective randomized protocol where the husband's sperm was at least 50% positive for both IgA and IgG ASAs using the immunobead assay. Couples underwent IUI with washed sperm collected during ejaculation into (a) 10 ml of serum medium made up of 50% maternal serum (antibody negative) in Hepes-buffered medium (SM) or (b) in a sterile cup (DRY). For the following cycle, each couple received the alternate sperm treatment. All patients underwent at least two DRY and two SM collections prior to beginning IUI. Sperm from these collections were analyzed by manual semen analysis, computer-aided semen analysis (CASA), and immunobead testing. All sperm preparations for IUI were analyzed by manual analysis and CASA before IUI. Outcome measures were changes in the distribution and amount of sperm antibody binding, sperm motion parameters, and pregnancy rates following IUI. Statistical analysis was performed using Fisher's exact test.

RESULTS

Collection of sperm into SM significantly reduces (P < 0.01) the percentage of antibody-bound sperm (54.8% IgA, 60.0% IgG) versus 83.5% IgA and 87.7% IgG with DRY collection. The distribution or pattern of antibody binding to the sperm also was altered by SM. There was no significant difference between the motility of the sperm following collection with SM or DRY sperm as determined by manual and CASA methods. More importantly, there was no statistically significant difference in the pregnancy rates/treatment cycle following SM (3.1% 32 cycles) or DRY (6.7%, 30 cycles).

CONCLUSION

Our data suggests that SM collection alters immunobead detectable ASA binding. Localization of ASA binding sites suggests that head-bound antibodies are influenced by SM treatment with little effect on tail-bound antibodies. In spite of the significant reduction of ASAs present on the sperm following SM treatment, there was no influence on pregnancy rates.

Transformation of human granulosa cells with the E6 and E7 regions of human papillomavirus

Ovarian granulosa cells are the primary site of estrogen and progesterone synthesis and play an essential role in the maturation of the developing ovum. Freshly isolated granulosa cells are often used to study the regulation of steroid and protein biosynthesis, but the small number of cells available for these cultures has proven inadequate for many detailed gene regulatory studies. The goal of this study was to develop human granulosa (HG) cell lines that maintain differentiated function. The E6 and E7 open reading frames of high risk strains of human papillomavirus have been used to produce immortalized cell lines. Primary cultures of human luteinized granulosa cells were infected with defective retroviruses containing the E6 and E7 regions of human papillomavirus 16 and with the neomycin phosphotransferase gene to confer G418 resistance. Three of eight clones that were isolated after selection in medium containing G418 were found to produce progesterone following treatment with forskolin or dibutyryl cAMP for 48 h. Forskolin caused these cells to retract in the characteristic rounding response, as described in primary HG cultures. One clone, HGL5, was used for a detailed characterization of differentiated function. HGL5 cells retained the ability to increase progesterone production and convert exogenously added androstenedione to estradiol in response to agonists of the protein kinase-A pathway (forskolin and dibutyryl cAMP), but were not responsive to FSH or LH treatment. A key enzyme in the production of estradiol, cytochrome P450 aromatase, has proven difficult to maintain in long term cultures of granulosa cells. For that reason, we examined the expression of aromatase in the transformed HGL5 clone by monitoring mRNA levels. Aromatase mRNA increased by 4- to 5-fold after forskolin treatment, as determined by Northern analysis. This human granulosa cell culture line maintains many of the functions of normal cells and should provide an important model to study the molecular events controlling granulosa cell differentiation and function.

Evaluation of clomiphene citrate and human chorionic gonadotropin treatment: a prospective, randomized, crossover study during intrauterine insemination cycles

OBJECTIVE

To test the hypothesis that in couples undergoing IUI, actively managed cycles using clomiphene citrate (CC) stimulation, ultrasound monitoring, and hCG timing will result in increased pregnancy rate (PR) per cycle compared with unstimulated urinary LH-timed cycles.

PATIENTS

Fifty-six couples with unexplained infertility (n = 26) or male factor infertility (n = 30) participated in the study.

SETTING

Tertiary academic medical center.

DESIGN

Prospective, randomized, crossover. Couples were randomized initially to one of the two study groups (treatment A: LH-timed IUI; treatment B: CC-stimulated, hCG-timed IUI). If no pregnancy occurred, each couple alternated between the two regimens during subsequent cycles, up to a total of four cycles.

RESULTS

Twenty-nine couples completed the study and the analysis of 95 cycles revealed that among the male factor infertility group, one pregnancy occurred during the 26 cycles of each treatment group (PR per cycle of 3.9% for both treatment groups). In contrast, among the unexplained infertility group, there was a marked difference in the effect of treatments. During treatment A only one pregnancy occurred in 20 cycles (PR of 5% per cycle) whereas during treatment B, six pregnancies occurred in 23 cycles (PR of 26.1% per cycle).

CONCLUSIONS

If IUI is chosen as the treatment modality in unexplained infertility, the addition of active ovulation management that includes CC stimulation, ultrasound monitoring of folliculogenesis, and hCG timing of ovulation increases the PR per cycle. In couples with male infertility, PR per cycle is low and is apparently not affected by the addition of active ovulation management.

An evaluation of the effect of gonadotropin-releasing hormone analogs and medroxyprogesterone acetate on uterine leiomyomata volume by magnetic resonance imaging: a prospective, randomized, double blind, placebo-controlled, crossover trial

The purpose of this study was to prospectively compare the effectiveness of administering medroxyprogesterone acetate (MPA; 20 mg/day) in either the first (protocol A) or last (protocol B) 12-week period along with a 6-month course of the GnRH analog (GnRH-a; leuprolide acetate; 1 mg/day, sc) on uterine and leiomyomata volumes and hormone (estradiol, LH, and FSH) and serum lipid (total cholesterol, triglycerides, and high and low density lipoprotein) levels. Sixteen women were randomized into protocol A or B, received either MPA or placebo along with GnRH-a, respectively, and were then crossed over at 12 weeks to placebo or MPA, respectively, for the final 12-week interval of GnRH-a therapy. Total, myoma, and nonmyoma uterine volumes were determined by magnetic resonance imaging, and serum studies were performed at the beginning of the study and at 12 and 24 weeks. In both protocols, LH and estradiol levels declined by 80-90% (P < 0.03) and 55-72% (P < 0.02) of the baseline, respectively, at 12 weeks and remained at this level at 24 weeks. There were no significant changes in the other laboratory tests between protocols or longitudinally over time. Total uterine volume decreased to 73% of the baseline at 12 weeks in protocol B (P < 0.04), but did not change in protocol A. After crossover at 12 weeks, the total uterine volume of women in protocol A decreased to 74% of the baseline (P < 0.02) at 24 weeks. Between-protocol comparisons demonstrated a greater decline in total uterine volume in protocol B than A at 12 weeks, but after cross-over, MPA addition was associated with a significant increase in total uterine volume (protocol B) compared to a decrease in protocol A at 24 weeks (P < 0.005). In contrast, although myoma volume declined in both protocols, no significant changes in myoma volume were detected within or between groups over the treatment period. Nonmyoma volume changes in protocols A and B roughly paralleled total uterine volume changes, with MPA coadministration showing a correlation with a reversal in the GnRH-a-associated decrease in nonmyomatous tissue volume.(ABSTRACT TRUNCATED AT 400 WORDS)

The effect of gonadotropin-releasing hormone agonists on adrenocorticotropin and cortisol secretion in adult premenopausal women

GnRH agonists are known to suppress LH, FSH, and subsequent ovarian estradiol production by down-regulation of pituitary gonadotropin receptors. Previous investigations have demonstrated that GnRH agonists also suppress GHRH-stimulated GH release in normal men and women and PRL levels in subjects with hyperprolactinemia. Little is known about the effects of GnRH agonists on the hypothalamic-pituitary-adrenal axis. The purpose of the present investigation was to determine the secretion of ACTH and cortisol after an iv infusion of hCRH in control women (n = 11) and in women undergoing treatment with GnRH agonists (n = 10). The plasma and serum levels of ACTH and cortisol increased after infusion of CRH in all women. The basal and CRH-stimulated plasma levels of ACTH and cortisol at each time point were not statistically different between GnRH agonist-treated women and controls. Thus, the chronic use of GnRH agonists is known to suppress the hypothalamic-pituitary-ovarian axis and is associated with GH and PRL suppression as well, but does not apparently alter the hypothalamic-pituitary-adrenal axis.

Effect of angiotensin II on human luteinized granulosa cells

OBJECTIVE

To determine if human luteinized granulosa cells (GCs) exhibit angiotensin II (AII) receptors and if AII affects GC steroidogenesis.

DESIGN

Luteinized GCs were either treated immediately or maintained in culture for up to 6 days before use. The presence of functional AII receptors was evaluated using the following criteria: [1] receptor binding of 125I-labeled AII; [2] changes in inositol phosphate production; [3] effects on progesterone (P) production; and [4] effects on cyclic adenosine 3':5' monophosphate (cAMP) production.

RESULTS

No specific binding of 125I-labeled AII was observed using human luteinized GCs in culture. Angiotensin II did not alter the formation of [3H] inositol phosphates, nor did it alter the release of P from freshly isolated cells or cells that had been in culture for 5 days. Angiotensin II was also unable to alter basal or gonadotropin-stimulated cAMP production. These data suggest that human luteinized GCs exhibit little or no type 1 or type 2 AII receptors.

CONCLUSION

This observation is in contrast to reports in rat granulosa that exhibit AII receptors. The reason for a lack of AII receptor expression on human luteinized GCs is unknown but could be because of luteal phase down regulation with gonadotropin-releasing hormone agonist or the subsequent stimulation with gonadotropins in these women before follicular stimulation.

Protective efficacy of conjugate vaccines against experimental challenge with porcine Actinobacillus pleuropneumoniae

In an attempt to protect pigs against swine pleuropneumonia induced by Actinobacillus pleuropneumoniae (SPAP) by neutralizing the effects of three virulence factors of A. pleuropneumoniae--the capsular polysaccharide (CP), the lipopolysaccharide (LPS), and the hemolysin protein (HP)--two subunit conjugate vaccines were prepared by covalently coupling the CP to the HP and the LPS to the HP. The CP, LPS, and HP were isolated from A. pleuropneumoniae, strain 4074, serotype 1, and the protective efficacy of the conjugate vaccines in swine experimentally infected with A. pleuropneumoniae was evaluated. Following a booster vaccination, a significant (P < 0.05) IgG antibody response to the CP, LPS, and HP was detected in the vaccinated pigs. The pigs vaccinated with the CP-HP and LPS-HP conjugates exhibited significantly less mortality (P < 0.05) and significantly greater weight gain (P < 0.001) than unvaccinated pigs. Vaccinated pigs exhibited significantly fewer and less extensive gross pulmonary lesions (P < 0.001) when compared with unvaccinated pigs. Thus, on the basis of mortality, weight gains, and pulmonary lesion formation, the two conjugate vaccines used in conjunction with one another provide noticeable protective efficacy against SPAP.

Preparation, characterization, and immunogenicity of conjugate vaccines directed against Actinobacillus pleuropneumoniae virulence determinants

Conjugate vaccines were prepared in an attempt to protect pigs against swine pleuropneumonia induced by Actinobacillus pleuropneumoniae (SPAP). Two subunit conjugates were prepared by coupling the A. pleuropneumoniae 4074 serotype 1 capsular polysaccharide (CP) to the hemolysin protein (HP) and the lipopolysaccharide (LPS) to the HP. Adipic acid dihydrazide was used as a spacer to facilitate the conjugation in a carbodiimide-mediated reaction. The CP and the LPS were found to be covalently coupled to the HP in the conjugates as determined by sodium dodecyl sulfate-polyacrylamide gel electrophoresis and detergent gel chromatography analyses. Following a booster vaccination, pigs exhibited significantly high (P less than 0.05) immunoglobulin G antibodies against CP, LPS, and HP. The anti-CP and anti-LPS immunoglobulin G antibodies were found to function as opsonins in the phagocytosis of A. pleuropneumoniae by polymorphonuclear leukocytes, whereas antibodies to the HP neutralized the cytotoxic effect of the HP on polymorphonuclear leukocytes. No killing of A. pleuropneumoniae was observed when the effects of the antibodies were tested in the presence of complement. Thus, polysaccharide-protein A. pleuropneumoniae conjugates elicit significant antibody responses against each component of each conjugate, which could be instrumental in protecting swine against SPAP.

Spermatozoal characteristics from fresh and frozen donor semen and their correlation with fertility outcome after intrauterine insemination

OBJECTIVE

To determine if conventional sperm parameters, specific characteristics of sperm motion determined by computer-aided semen analysis (CASA), sperm penetration assay (SPA), and/or spontaneous acrosome reaction assay could best predict fertility outcome after intrauterine insemination (IUI) from frozen donor sperm.

DESIGN

A retrospective analysis of 2,245 cycles of therapeutic donor IUIs were initially studied; 1,147 cycles that met selection criteria were used in this report.

SETTING

A university-based assisted reproductive technology center.

PATIENTS, PARTICIPANTS

All IUIs were performed on women with documented patency of at least one fallopian tube, ovulatory cycles, and who did not receive human menopausal gonadotropins. Sperm donors had to be used for at least four different recipients (mean of 15) and at least 14 different cycles of insemination (mean of 41).

INTERVENTIONS

None.

MAIN OUTCOME MEASURE

Pregnancy.

RESULTS

Statistical comparisons were made between donors of different relative fertility by using the Mann-Whitney test, Spearman's rank correlation, and multiple regression analysis. These analyses demonstrated that the most significant predictors of the fertility of frozen-thawed donor sperm were curvilinear velocity, straight line velocity, and the total number of motile sperm inseminated. The number of sperm with spontaneous acrosome reactions negatively correlated with fertility outcome, and SPA provided no predictive value.

CONCLUSIONS

Our study supports the hypothesis that the study of sperm motion characteristics using CASA after thawing and washing of cryopreserved sperm is a better predictor of fertile outcome after IUI than analysis of fresh semen.

Characterization of lipopolysaccharides from four Pasteurella haemolytica serotype strains: evidence for presence of sialic acid in serotypes 1 and 5

Highly purified lipopolysaccharides (LPS) obtained from four strains of Pasteurella haemolytica representative of four different serotypes were studied to ascertain their overall structural elements and sugar and fatty acid compositions. SDS-PAGE analysis revealed that each LPS was of the smooth-type although they differed in migration patterns. Somewhat unusual features of these LPS included the presence of: (a) rhamnose in the core oligosaccharides of serotypes 2 and 3; and (b) sialic acid in the LPS of serotypes 1 and 5. The fatty acids, myristic, hydroxymyristic and palmitic occur in essentially equivalent amounts in each of these LPS. In addition, stearic acid was present in small amounts of serotypes 1 and 5.

Quality assurance in the reproductive biology laboratory

The goal of the clinical laboratory is to produce analytical results that are free of errors and useful in the diagnoses of patients' conditions and in the treatment of patients. Every laboratory assay contains a certain amount of errors. This can be due to random error, which is unpredictable, or to systematic error, which is the result of the difference between the control analysis and the expected target value. The purpose of a good quality assurance-quality control program is to detect errors when they become clinically significant and to ensure that all laboratory procedures, including analytical procedures, are designed to deliver as good a test result as possible. Reproductive biology laboratories that deal in human in vitro fertilization or andrology will have to develop quality assurance-quality control programs, much like those of anatomical pathology laboratories, due to the unique type of services that they offer.

Massive amounts of immunoreactive endothelin in human seminal fluid

We found that immunoreactive endothelin (ET) is present in seminal fluid in very large amounts (500-5000 ng/L; quantification based on ET-1 standard). This immunoreactive ET was detected by use of a radioimmunoassay system in which the N-terminal portion of ET-1 and ET-2 (and big ET-1 and big ET-2) are recognized. Thus, the immunoreactive ET in seminal fluid may include the precursors of ET-1 or ET-2 (i.e., big ET) as well as metabolites of ET-1 or ET-2 in which the N-terminal region is intact. The levels of immunoreactive ET in seminal fluid from men with normal semen analyses and that in seminal fluid of vasectomized men were within the same range. Using a different radioimmunoassay system in which the C-terminal portion of ET-1, ET-2, and ET-3 is recognized, we found that the levels of immunoreactive ET were much lower (or undetectable). We speculate that bioactive ET may be produced and act to promote sperm transport in the male reproductive tract; thereafter, bioactive ET may be metabolized by membrane metalloendopeptidase (which is present in male reproductive tissues and semen) to immunoreactive, inactive products. Alternatively, big ET in seminal fluid may be processed in tissues of the female internal genitalia to bioactive ET, which could act to promote sperm transport through the uterine cavity by stimulating myometrial contractions.

The hormonal regulation of platelet-activating factor acetylhydrolase activity in plasma

We have previously reported that certain fetal tissues including the lung and kidney have an increased platelet-activating factor (PAF) content and enzymatic mechanism for its elevated biosynthesis during the latter stages of pregnancy. In contrast, in the maternal plasma compartment of both the rabbit and human, a decreased capacity to inactivate PAF has been demonstrated. The PAF acetylhydrolase in the fetal plasma is also suppressed. The present study was undertaken to determine the mechanism(s) involved in the regulation of PAF acetylhydrolase. The 17 alpha-ethynylestradiol was administered (intraperitoneal [i.p.] 2.5 mg/kg body wt 5 days) to female and male rats. The plasma PAF acetylhydrolase activity decreased 5-fold. A decrease was observed when a concentration of the estrogen as low as 50 micrograms/kg was employed. The injection of dexamethasone (i.p., 1.3 mg/kg body wt, 5 days) to male and female rats resulted in a 3-fold increase in the plasma PAF acetylhydrolase activity. The activity returned to the values prior to hormone treatment 4 days after cessation of treatment. Testosterone and progesterone were without effect on plasma acetylhydrolase activity. The change in PAF acetylhydrolase activity caused by estrogen and the glucocorticoid was reflected by a change in the activity in the HDL fraction and not due to the presence of an inhibitor or activator in the plasma of the hormone-treated animals. Human serum obtained from a group of women, in which the 17 beta-estradiol concentration was elevated in preparation for an in vitro fertilization procedure, showed an inverse relationship between the plasma estrogen concentration and the PAF acetylhydrolase activity.(ABSTRACT TRUNCATED AT 250 WORDS)

Effect of superovulation with human menopausal gonadotropins on growth hormone levels in women

GH synthesis and secretion are influenced by several factors, including age, body weight, and sex steroid hormones. Endogenous and exogenous estrogens influence the circulating levels of GH. The purpose of the present investigation was to define the relationship between serum GH and estradiol levels during the follicular phase in women with normal ovulatory menstrual cycles compared with that in women undergoing superovulation with human menopausal gonadotropins (hMG) alone or hMG plus GnRH agonists during treatment for infertility. Serum GH and estradiol levels were determined by immunoassay in eight women during the follicular phase of a spontaneous natural cycle (group I). Thirty women underwent ovulation induction with hMG alone (group II), and 30 women received GnRH agonists followed by hMG (group III). During the follicular phase estradiol levels increased gradually in group I and reached a peak estradiol level of 1.19 +/- 0.2 nmol/L (mean +/- SEM). As expected, estradiol levels rose faster and reached higher levels in groups II and III (5.44 +/- 0.62 and 8.73 +/- 0.91 nmol/L, respectively). Whereas serum GH levels increased minimally in group I, reaching a peak level of 2.54 +/- 1.15 nmol/L, serum GH concentrations increased markedly after day 8 in groups II and III, reaching peak levels of 8.70 +/- 1.58 and 7.54 +/- 1.12 nmol/L, respectively (P less than 0.01). Basal to peak GH levels were higher in groups II and III than in group I. In summary, there are modest increases in GH levels during the follicular phase of the normal menstrual cycle, but the levels are markedly increased during superovulation with hMG or hMG plus GnRH agonists, and parallel increases in estradiol levels.

Comparison of bicarbonate and HEPES-buffered media on pregnancy rates after intrauterine insemination with cryopreserved donor sperm

OBJECTIVE

We compared the pregnancy rates (PRs) after intrauterine insemination (IUI) with frozen donor sperm prepared in Ham's F-10 medium (Irvine Scientific, Santa Ana, CA) with bicarbonate buffer and synthetic human tubal fluid with HEPES buffer (Irvine Scientific).

DESIGN

Women (n = 101) were randomized upon entry into the program, receiving sperm prepared in either Ham's F-10 or human tubal fluid medium their first treatment cycle. If pregnancy did not occur, the alternate medium was used to prepared sperm for the following cycle.

SETTING

All patients were treated in our private care center.

PATIENTS

Patients entering this study were normally ovulating women undergoing IUI with frozen donor sperm.

MAIN OUTCOME MEASURE

Pregnancy was used as our main outcome measure of success.

RESULTS

After 324 cycles of treatment, the PR per cycle of IUI was 17.5% with sperm prepared in human tubal fluid which was significantly different (P = 0.05) from the PR (9.8%) after insemination with sperm prepared in Ham's F-10. There was no statistical difference in the number of motile cells inseminated in each of these groups.

CONCLUSIONS

Transitory exposure of the sperm in Ham's F-10 medium to the environment during preparation for insemination may result in an alkalinization of the medium that has a lasting influence on sperm fertility.

Identification and localization of surface sialylated glycoconjugates in Actinobacillus pleuropneumoniae by direct enzyme-colloidal gold cytochemistry

Electron microscopic examination of ultrathin sections of 5 strains of Actinobacillus pleuropneumoniae stained for polysaccharides with ruthenium red revealed considerable variability in the amounts of preserved capsular material among the 5 serotypes studied. The amount of capsule was inversely related to the extent of outer membrane-associated sialylated glycoconjugate as evidenced by the degree of binding by colloidal gold-labelled neuraminidase at the cell surface. Serotypes 1, 3, and 5 possessed a well-developed and continuous capsular layer. In serotypes 2 and 7, the capsule consisted of a broken patchy layer that left much of the underlying outer membrane exposed. Morphometric analyses of the mean frequencies of neuraminidase-conjugated gold particles over the perimeters of the A. pleuropneumoniae cells showed that the lowest mean frequencies were observed in serotypes 1, 3, and 5, whereas the second highest and highest mean frequencies were observed in serotypes 7 and 2, respectively. Evidence suggested a serotypic difference in the amount of capsule present and this correlated inversely with the number of sialylated glycoconjugates, which appear to be localized in the outer membranes of the A. pleuropneumoniae cells.

Transforming growth factor-beta inhibits steroid 17 alpha-hydroxylase cytochrome P-450 expression in ovine adrenocortical cells

The maintenance of optimal steroidogenesis in adrenocortical cells primarily depends on the chronic action of ACTH to promote the synthesis of the various steroid-metabolizing cytochrome P-450 enzymes. In the steroidogenic pathway, 17 alpha-hydroxylase cytochrome P-450 (P-450(17) alpha) is a key enzyme controlling the formation of cortisol and androgens. Recently, we demonstrated that transforming growth factor-beta (TGF beta) is a potent inhibitor of steroid production in ovine adrenocortical cells. In the present study we used a polyclonal antibody to P450(17) alpha to determine adrenal cell P-450(17) alpha enzyme content by Western analysis. In addition, we used a cDNA probe encoding for bovine P-450(17) alpha mRNA to determine levels of P-450(17) alpha mRNA in sheep ovarian adrenocortical cells in primary culture. When cells were cultured in a serum-free medium in the presence of ACTH for 48 h, P-450(17) alpha activity, enzyme content, and mRNA levels for P-450(17) alpha increased by 3- to more than 10-fold. TGF beta decreased the basal level and completely blocked the stimulatory action of ACTH on P-450(17) alpha enzyme activity. The effects of TGF beta on P-450(17) alpha enzyme content and mRNA levels were manifested in a dose-dependent manner, with maximal inhibition observed using 1 ng/ml TGF beta. Importantly, the inhibitory effects of TGF beta on P-450(17) alpha were not overcome by (Bu)2cAMP. These findings indicate that TGF beta is a potent negative regulator of P-450, and the inhibitory action appears to be at the level of P-450(17) alpha gene expression. The ability of TGF beta to suppress the positive stimulatory action of ACTH suggests that TGF beta could play a role in determining the pathway of steroidogenesis and, thereby, the specific steroids secreted by adrenocortical cells.

Pharmacy intervention and the anesthesia drug exchange drawer

We implemented an ED drug system for anesthesia carts at no net cost. Cooperation by the departments of pharmacy and anesthesia permitted the establishment of services without additional funds for new personnel or equipment. The system offers a number of important advantages over individual-cart drug stocking. Benefits include reduced costs, improved patient safety, improved drug handling, and better communication between anesthesia and pharmacy personnel. We conclude that when a satellite pharmacy is not feasible, or as an interim measure, an ED system can provide substantial benefits over individual anesthesia carts. We further observed that anesthetists' drug-handling behaviors improved when carts were common and standardized.

Proliferating human granulosa-lutein cells in long term monolayer culture: expression of aromatase, cholesterol side-chain cleavage, and 3 beta-hydroxysteroid dehydrogenase

The development of long term culture conditions with which to study the regulation of expression of aromatase, cholesterol side-chain cleavage enzyme, and 3 beta-hydroxysteroid dehydrogenase (3 beta HSD) in human granulosa-lutein cells is described in this report. Conditions have been established for the dispersal, growth, freezing, and storage of functional human granulosa cells isolated from preovulatory follicles of women undergoing laparoscopy for gamete intrafallopian tube transfer and in vitro fertilization procedures. Optimal growth conditions for human granulosa-lutein cells were determined by plating cells at a low density and testing the capacity of a variety of culture conditions to support growth. A combination of fetal bovine serum (FBS), horse serum, and the serum substitute UltroSer G was found to increase cell number to maximal levels, 8- to 10-fold higher than with sera alone. Human granulosa-lutein cells grown under these conditions had a doubling rate of 36-40 h and were morphologically distinct from human theca interna cells grown under similar conditions. Human granulosa-lutein cells treated with forskolin retracted and rounded up, whereas cultures of human ovarian theca interna cells or human fibroblasts treated similarly did not retract. Human granulosa-lutein cells were grown for successive passages and transferred to serum-free medium containing forskolin, LH, hCG, or cholera toxin. Addition of these agents resulted in a time- and dose-dependent increase in aromatase activity and progesterone secretion. In these studies FSH treatment was found not to increase aromatase activity. In a study of the time course of 3 beta HSD activity in the absence of forskolin under serum-free conditions, it was found that 3 beta HSD activity increased 3-fold during the 72-h treatment period. Forskolin-stimulated 3 beta HSD activity also increased in a time-dependent manner, with levels in treated cells 3-fold higher than those in control cells. Northern analysis performed on total RNA obtained from forskolin- or hCG-stimulated granulosa-lutein cells confirmed that the increase in aromatase activity was associated with a corresponding increase in levels of mRNA specific for aromatase cytochrome P-450. Levels of mRNA encoding cholesterol side-chain cleavage cytochrome P-450 were similarly increased in cells treated with forskolin compared with unstimulated values at each of the time points investigated. Under serum-free conditions in the absence of stimulation, the 3.4-kilobase band of aromatase cytochrome P-450 mRNA was detectable.(ABSTRACT TRUNCATED AT 400 WORDS)

The effect of gonadotropin-releasing hormone agonists on growth hormone secretion in adult premenopausal women

Suppression of the pituitary-gonadal axis by the administration of gonadotropin-releasing hormone agonists (GnRH-a) has been used for a variety of endocrinological and gynecological disorders. The suppressive effect of GnRH-a on luteinizing hormone, follicle-stimulating hormone, and sex steroid production is well documented. However, little is known regarding the effect of GnRH-a on other aspects of pituitary function. The purpose of the present study was to determine the effect of GnRH-a treatment on growth hormone-releasing hormone (GH-RH)-stimulated GH release in premenopausal women. Eight control women and seven women, who were receiving a GnRH-a, were recruited. Before and after a bolus infusion of human GH-RH, blood samples were obtained over 3 hours and analyzed for GH by immunoassay. Basal GH and insulin-like growth factor levels were not statistically different between the two groups. However, basal levels of estradiol and the integrated GH response after GH-RH were significantly lower in the GnRH-a treated women. The reduction in GH-RH-stimulated GH release in GnRH-a treated women may be attributed to diminished endogenous estrogen secretion, or to direct pituitary suppression by GnRH-a, or both.

3 beta-hydroxysteroid dehydrogenase/isomerase in the fetal zone and neocortex of the human fetal adrenal gland

The fetal zone of the human fetal adrenal (HFA) gland is established to have decreased 3 beta-hydroxysteroid dehydrogenase/delta 4-5 isomerase (3 beta HSD) activity compared to the neocortex or definitive zone. 3 beta HSD activity, however, can be induced in primary cell culture through treatment with ACTH. Therefore, the HFA with two distinct steroidogenic zones with differences in 3 beta HSD activity as well as the capacity to increase 3 beta HSD activity in response to ACTH provides an excellent model to study the regulation of this enzyme. The presence of 3 beta HSD in the fetal and neocortex zones of the HFA was examined using a polyclonal antibody raised against purified human placental microsomal 3 beta HSD. After homogenates of the fetal and neocortical zones of the HFA were electrophoresed on a sodium dodecyl sulfate-polyacrylamide gel and immunoblotted, the presence of the 3 beta HSD protein with a molecular size of 45 kDa could be demonstrated only in the neocortical zone. ACTH treatment (greater than 2 days) of fetal and neocortical zone explant cultures produced increases in cortisol secretion associated with the respective levels of immunodetectable 3 beta HSD protein. Cortisol and dehydroepiandrosterone sulfate were the respective principal steroid products of neocortical and fetal zone explants. After ACTH treatment, immunodetectable 3 beta HSD was induced to a greater magnitude in the neocortex. These findings provide evidence that the lack of 3 beta HSD activity in the fetal zone, previously considered to be the result of the presence of an endogenous inhibitor, is due to an absence of the protein in this portion of the gland. The lack or minimal expression of 3 beta HSD in the fetal zone of HFA may be due to the action (or lack thereof) of a tissue-specific factor regulating the synthesis of 3 beta HSD.

A prospective randomized study of pregnancy rates following intrauterine and intracervical insemination using frozen donor sperm

Cryopreserved sperm have lowered fertility when compared with fresh sperm in artificial insemination by donor programs. The purpose of this study was to compare pregnancy rates following intrauterine insemination (IUI) and intracervical insemination (ICI) with cryopreserved sperm in a prospective trial using the patient as her own control. A total of 154 patients were randomized into alternating treatment cycles and underwent 238 cycles of IUI and 229 cycles of ICI. The pregnancy rate per treatment cycle was 9.7% following IUI and 3.9% following ICI. Treatment outcome was influenced by patient age, ovulatory status, and endometriosis. Pregnancy success correlated well with the post-thaw survival of sperm and the number of motile cells inseminated. In spite of having normal semen parameters, some donors were found to have markedly reduced sperm fecundity. We conclude that IUI with cryopreserved sperm can be an effective treatment for couples with infertility, genetic indications, or other reasons.

Structures and sugar compositions of lipopolysaccharides isolated from seven Actinobacillus pleuropneumoniae serotypes

Highly purified lipopolysaccharide (LPS) preparations obtained from seven Actinobacillus pleuropneumoniae strains representative of seven different serotypes were used to determine the structure and monosaccharide composition of the polysaccharide components of each lipopolysaccharide. An indication of the structure of each LPS was obtained by procedures that included sodium dodecyl sulfate-polyacrylamide gel electrophoresis followed by silver staining and gel chromatographic fractionation of acetic acid-hydrolyzed LPS. The polysaccharide components of the LPSs were analyzed by gas-liquid chromatography. The LPSs of the strains of serotypes 2, 4, and 7 were of the smooth type, and those of the strains of serotypes 3 and 6 were of the rough type; the LPSs of the strains of serotypes 1 and 5 could be considered semirough. Rhamnose was present only in the O polysaccharide of the smooth-type and semirough-type LPSs, whereas galactose was present only in the O polysaccharide of the smooth-type LPS and in the core oligosaccharides of the rough-type and semirough-type LPSs. Glucoheptose and mannoheptose were present in the core oligosaccharides of all the LPSs except for the strain of serotype 3, in which only mannoheptose was detected. N-Acetylglucosamine was detected only in the O polysaccharides of the strains of serotypes 1 and 5.