Case Of Xanthogranulomatous Oophoritis

Xanthogranulomatous inflammation is characterized by destruction of the tissues of the organ involved and replacement by chronic inflammatory cells such as lymphocytes, plasma cells, occasional neutrophils with or without multinucleated or Touton giant cells. Exact aetiology is not known but the theory of infection with organisms like Proteus, E coli, and Bacteroides fragilis is most popular. Xanthogranulomatous inflammation of the female genital tract is not common and usually involves the endometrium; however, xanthogranulomatous inflammation of the ovaries is a rare entity.

Metabolic endotoxaemia--a potential novel link between ovarian inflammation and impaired progesterone production

INTRODUCTION

Medical conditions such as obesity and inflammatory bowel disease are associated with impaired luteal function, menstrual disturbance and infertility. It is proposed that the disturbance in gut wall integrity ("leaky gut") seen in these conditions may result in the passage of bacterial endotoxin (LPS) from the colonic lumen into the circulation that may initiate inflammation in the ovary and subsequently impair hormone production.

METHODS

Quantify the association between systemic levels of LBP, a marker of endotoxin exposure, and levels of inflammation in the ovary (follicular fluid IL-6), plus steroid hormone production in 45 women undergoing IVF treatment.

RESULTS

Endotoxaemia (LBP) were positively correlated with plasma CRP and inflammation within the ovary (follicular fluid IL-6). Furthermore, endotoxaemia was negatively correlated with progesterone production.

CONCLUSION

The observed correlations, together with previously published animal studies linking endotoxin exposure to impaired luteal function, suggest that the translocation of bacterial endotoxin from the gut lumen into the circulation has the potential to interfere with progesterone production and result in luteal deficiency.

Pathophysiology of white-tailed deer vaccinated with porcine zona pellucida immunocontraceptive

White-tailed deer (n=14 treated, n=7 control) were examined postmortem to identify any possible pathophysiology resulting from PZP immunocontraception vaccination. Deer were treated twice in 1997; given a booster in 1998, with six being revaccinated in September 2000. Granulomas were found at injection sites of most deer, even 2 years post-treatment. Eosinophilic oophoritis occurred in 6 of 8 (75%) deer vaccinated in 1998, and 3 of 6 (50%) revaccinated in 2000. The 2000 revaccinates without oophoritis, had significantly fewer normal secondary follicles than control females (P=0.03), and deer in the 1998 treatment group (P=0.04). PZP immunocontraceptive vaccine elicited ovarian pathologies in deer similar to those observed in other species.

Reduction in hospitalized women with pelvic inflammatory disease in Oslo over the past decade

BACKGROUND

A tuboovarian abscess (TOA) is a common complication of pelvic inflammatory disease (PID), occurring world-wide in 15-30% of women with PID. The aim of the study was to identify changes during the last 10 years in the number of women hospitalized with PID in Oslo, as well as a change regarding the frequencies of the subdiagnoses salpingitis and tuboovarian abscess.

METHODS

We performed a review of computerized diagnosis lists and manual check of the medical records of women hospitalized with PID in Oslo. The years 1990-92 and 2000-02 were included, resulting in information from two time periods 10 years apart. Cases were registered as salpingitis, oophoritis or tuboovarian abscess. Medical and demographic variables from the medical records of women diagnosed during 4 out of the 6 years were described in detail.

RESULTS

We identified 523 women with the diagnosis of PID hospitalized during 1990-92 and 2000-02. There was a 35% reduction in hospitalized cases of salpingitis over the period of 10 years, but the number of cases of tuboovarian abscesses among women admitted for PID remained unchanged from 1990-92 to 2000-02. We found low frequencies of Chlamydia trachomatis and Neisseria gonorrhoea infections, although documented bacteriological sampling was insufficient.

CONCLUSIONS

Fewer patients were hospitalized in Oslo for PID during the time period of 2000-02 compared with 10 years earlier, but a higher percentage of patients had developed TOA compared with the first time period (43% compared with 26%, p = 0.013), indicating a changing clinical panorama of PID.

Tubo-ovarian abscess occurring 16 years after supracervical hysterectomy

BACKGROUND

Supracervical hysterectomy is seldom performed and there are few reports of tubo-ovarian abscess (TOA) after supracervical hysterectomy.

CASE

The case of a 49-year-old woman with a right TOA is reported. This patient had received a supracervical hysterectomy 16 years earlier due to rupture of the uterus. At this admission, she presented with complaints of, lower abdominal pain and fever. Bimanual and transvaginal ultrasound examinations demonstrated a tender mass in the right adnexal region. Laparotomy, pathologic examination and microbiologic study confirmed the diagnosis of right TOA.

CONCLUSION

After supracervical hysterectomy, patients may develop endocervicitis, parametritis and/or TOA. This series may be a subtype of ascending infections in the female genital tract.

A case of ovarian actinomycosis

Background: Pelvic actinomycosis is uncommon and often presents as a complication of an intrauterine device (IUD). A diagnosis of actinomycosis can be made from the finding of sulfur granules within inflammatory exudate on histologic examination after surgery. However, it may be possible to diagnose actinomycosis before surgery by finding Actinomyces-like organisms on Papanicolaou smears.

Case: A 41-year-old woman had been diagnosed as having a pelvic abscess, and bilateral salpingo-oophorectomy was performed. She had been an IUD user for 6 years. Actinomyces-like organisms were detected in her previous Papanicolaou cervical smears. If the patient had been treated when the Actinomyces-like organisms were detected by Papanicolaou smears, the serious ovarian actinomycosis might have been avoided.

Conclusion: We suggest that routine cervical examinations are important for women who are IUD users.

A case of pregnancy complicated by the development of a tubo-ovarian abscess following in vitro fertilization and embryo transfer

Tubo-ovarian abscess is an uncommon complication in pregnant women. In this report, we present a patient who developed a tubo-ovarian abscess during pregnancy following in vitro fertilization and embryo transfer (IVF-ET). Despite treatment with intravenous antibiotics she delivered at 22 weeks of gestation. After delivery, she underwent a left salpingo-oophorectomy. Review of the literature revealed only 26 reported cases of tubo-ovarian or pelvic abscess during pregnancy. Pelvic inflammatory disease, previous laparotomy, and structural genital anomalies are known risk factors for pelvic abscess during pregnancy. Pelvic abscess resulting as a complication of vaginal oocyte retrieval has been reported. Therefore, although enabling women with organic pelvic disease such as endometriosis and hydrosalpinx to achieve pregnancy, assisted reproductive techniques may potentially result in pelvic infection during pregnancy. This case suggests that a preconception evaluation and treatment for such conditions should be considered for women undergoing treatment for infertility.

Xanthogranulomatous oophoritis and salpingitis: late sequelae of inadequately treated staphylococcal PID

We describe the case of a 42-year-old woman who was a follow-up case of incompletely treated pelvic inflammatory disease, and presented with menorrhagia and bilateral ovarian masses. Subtotal hysterectomy with bilateral salpingo-oophorectomy was performed. Purulent material was obtained from the cystic masses, which grew Staphylococcus aureus. Histological examination of right-sided cystic mass revealed a simple cyst of the ovary. Left sided tuboovarian mass revealed the presence of lipid filled macrophages with lymphocytes, plasma cells and neutrophils; this established the diagnosis of xanthogranulomatous salpingitis and oophoritis. The case is of interest in view of the rarity of this condition; five cases of xanthogranulomatous salpingitis and oophoritis have been reported in the world literature till date.

Tubo-ovarian abscess after colonic vaginoplasty for high cloacal anomaly in a 13-year-old girl

Recently a few articles have been published concerning the long-term follow-up of vaginoplasty of cloaca. However, no postoperative evaluation has been fully described and, in particular, the late complications are still unknown. We report a case of tuboovarian abscess after colonic vaginoplasty for high cloacal anomaly in a 13-year-old girl. She required a left salpingo-oophorectomy and postoperatively showed regular menstruation. Therefore we stress that tubo-ovarian abscess is one of the important late complications after colonic vaginoplasty for high cloacal anomaly.

Endogenous oocyte antigens are required for rapid induction and progression of autoimmune ovarian disease following day-3 thymectomy

Female (C57BL/6xA/J)F(1) mice undergoing thymectomy on day 3 after birth (d3tx) developed autoimmune ovarian disease (AOD) and autoimmune disease of the lacrimal gland. As both were prevented by normal adult CD25(+) T cells, regulatory T cell depletion is responsible for d3tx diseases. AOD began as oophoritis at 3 wk. By 4 wk, AOD progressed to ovarian atrophy with autoantibody response against multiple oocyte Ag of early ontogeny. The requirement for immunogenic endogenous ovarian Ag was investigated in d3tx female mice, d3tx male mice, and d3tx neonatally ovariectomized (OX) females. At 8 wk, all mice had comparable lacrimalitis but only those with endogenous ovaries developed AOD in ovarian grafts. The duration of Ag exposure required to initiate AOD was evaluated in d3tx mice OX at 2, 3, or 4 wk and engrafted with an ovary at 4, 5, or 6 wk, respectively. The mice OX at 2 wk did not have oophoritis whereas approximately 80% of mice OX at 3 or 4 wk had maximal AOD, thus Ag stimulus for 2.5 wk following d3tx is sufficient. AOD progression requires additional endogenous Ag stimulation from the ovarian graft. In mice OX at 3 wk, ovaries engrafted at 5 wk had more severe oophoritis than ovaries engrafted at 6 or 12 wk; moreover, only mice engrafted at 5 wk developed ovarian atrophy and oocyte autoantibodies. Similar results were obtained in mice OX at 4 wk. Thus endogenous tissue Ag are critical in autoimmune disease induction and progression that occur spontaneously upon regulatory T cell depletion.

Retargeting T cell-mediated inflammation: a new perspective on autoantibody action

To understand the pathogenesis of organ-specific autoimmune disease requires an appreciation of how the T cell-mediated inflammation is targeted, and how the organ function is compromised. In this study, autoantibody was documented to influence both of these parameters by modulating the distribution of T cell-mediated inflammation. The murine autoimmune ovarian disease is induced by immunization with the ZP3330-342 peptide of the ovarian zona pellucida 3 glycoprotein, ZP3. Passively transferred or actively induced Ab to ZP3335-342 bound to the zona pellucida in the functional and degenerative ovarian follicles, and the ovaries remained histologically normal. Transfer of ZP3330-342 peptide-specific T cells targeted the degenerative follicles and spared the functional follicles, and the resultant interstitial oophoritis was associated with unimpaired ovarian function. Unexpectedly, the coexistence of ZP3330-342 peptide-specific T cells and zona-bound autoantibody led to a dramatic translocation of the ovarian inflammation to the growing and mature ovarian follicles, with destruction of the ovarian functional unit. Ab retargeted both Th1-induced mononuclear inflammation and Th2-induced eosinophilic inflammation, and retargeting was induced by murine and rat polyclonal Abs to multiple distinct native B cell determinants of the zona pellucida. Therefore, by reacting with the native determinants in tissue Ag, Ab alters the distribution of T cell-mediated inflammation, and results in destruction of the functional units of the target organ. We propose that this is a clinically important and previously unappreciated element of Ab action in autoimmune disease.

Post-mortem incidental finding of cytomegalovirus oophoritis after an allogeneic stem cell transplant

Cytomegalovirus (CMV) disease is a common and serious complication of allogeneic stem cell transplantation (SCT). Its two most frequent manifestations are interstitial pneumonitis and gastroenteritis. We describe here the first reported case of CMV ovarian infection in an allo-SCT recipient. This patient was included in a clinical trial of high-dose chemotherapy (HDCT) with HLA-matched peripheral SCT for metastatic breast cancer. She expired 53 days after transplantation from organ failure unrelated to her CMV oophoritis.

Autoimmune premature ovarian failure: of mice and women

Autoimmunity is a well-established mechanism of premature ovarian failure and may be the dominant cause of reversible premature ovarian failure. Because of its strong analogy with the human disease, murine experimental post-thymectomy autoimmune oophoritis may provide insight into the pathogenesis of autoimmune premature ovarian failure in women and might open new avenues to specific diagnostic and therapeutic methods. We reviewed the literature on murine experimental post-thymectomy autoimmune oophoritis in order to compare and contrast it with human autoimmune premature ovarian failure, to which it is similar in several ways. The histologic distribution of the ovarian lymphocytic infiltration is similar, and both have reduced natural killer cell activity. Susceptibility appears to be associated with genes outside the major histocompatibility complex in both the mouse and the human. Finally, the mouse model disorder is associated with a persistent neonatal-like Th2 response, which suggests possible similarities with autoimmune polyglandular failure type 1 in humans. In this condition autoimmunity develops despite an impaired cellular immune response.

Mechanism of ovarian autoimmunity: induction of T cell and antibody responses by T cell epitope mimicry and epitope spreading

Autoimmune diseases are often manifested as organ inflammation with loss of function, and detectable autoreactive T cell and autoantibody responses. In the proper genetic context, we have shown that these parameters of autoimmunity can result from a single pivotal event: the induction of a strong and persistent T cell response for a foreign or unrelated self peptide that mimics the target self peptide. This may apply to organ-specific and systemic autoimmunity, independent of whether the tissue inflammation results from T cell immune mechanism or antibodies. T cell peptide mimicry, through sharing of critical residues or by a less defined mechanism, can result in autoimmune disease. Once triggered, the helper T cell response leads rapidly to a concomitant autoantibody response spreading to distant B cell determinants of the self protein antigen. Evidently, with T cell help, endogenous antigens can stimulate B cells to provoke a functional autoantibody response against conformational antigenic determinants. These findings are based on recent studies on a novel autoimmune ovarian disease model induced by a self peptide with well-defined T and B cell epitopes. However, studies reported on systemic lupus erythematosus models have shown that similar events may result in autoantibody response in systemic autoimmunity.

[Secondary infection of the ovarian endometriotic cysts]

OBJECTIVE

To explore the clinic manifestations, diagnostic methods and principles of management in the secondary infection of the endometriotic cysts of ovary.

METHODS

Thirteen cases of the infected ovarian endometriotic cysts were analysed retrospectively in our hospital from Jan. 1990 to Dec. 1996. The diagnosis was confirmed by the operation and pathologic findings.

RESULTS

The clinic manifestations were divided into five types, namely acute, subacute, chronic, occult and stabile types. The definitive diagnosis can be made by abdominal pain, fever and adnexal mass combined with B-scan findings and chocolate-brown purulent fluid which was punctured from the adnexal mass. Operation was the main method for treatment.

CONCLUSIONS

Secondary infection of the endometriotic cyst is one of the gynecologic emergency. Correct diagnosis and prompt management are of vital importance.

Post-thymectomy murine experimental autoimmune oophoritis is associated with reduced natural killer cell activity

PROBLEM

Natural killer (NK) cells can influence the immune response by secreting potent lymphokines. It has been suggested that NK cells have a suppressive action on B cells, and that impaired NK cell activity may play a role in some types of autoimmunity. NK cell abnormalities have been reported in women with premature ovarian failure. We therefore examined NK cell activity during the development of murine experimental autoimmune oophoritis, which serves as a model for autoimmune ovarian failure in women.

METHOD OF STUDY

Neonatally thymectomized and sham-operated C57B1/6 x A/J (B6A) mice were prepared and sacrificed at 4, 6, 8, and 10 weeks after surgery. Splenic NK cell activity was determined in groups of five or more mice by measuring the percent specific lysis of target YAC-1 lymphoma cells using a standard 4-hr chromium release cytotoxicity assay. The number of splenic NK cells in neonatally thymectomized and sham-operated animals was also compared using flow cytometry. In a subsequent experiment, interleukin 12 (IL-12; NK cell-stimulating factor) was administered to neonatal mice before neonatal thymectomy.

RESULTS

Neonatally thymectomized mice with associated autoimmune oophoritis had a 75% reduction in the number of splenic NK cells, and 50% or greater reduction in splenic NK cell activity at 4, 6, and 8 weeks after surgery. IL-12 treatment before neonatal thymectomy maintained NK cell activity and was shown to ameliorate the associated autoimmune oophoritis.

CONCLUSION

Murine post-thymectomy autoimmune oophoritis is associated with reduced NK cell number and impaired NK cell activity, and in these respects the model is similar to premature ovarian failure in women. Research to define the relationship between NK cell abnormalities and the mechanism of ovarian failure in this model might lend insight into the pathogenesis of premature ovarian failure in women.

Kallikreins and kinins in inflammatory-like events in the reproductive tract

The normal reproductive events of proliferation of the endometrial lining of the uterus during the menstrual cycle and ovulation have been likened to inflammatory-like events. The kallikrein-kinin system is involved in inflammatory processes in many tissues. In this review, we identify which components of the kallikrein-kinin system--the enzyme, tissue kallikrein; the substrate, low molecular weight kininogen and the effector receptor for the generated bradykinin peptide, the B2 receptor--have been identified in the uterus and ovary and their known involvement in the function of these organs. All three components have been localized to the glandular epithelial cells of the human endometrium. Tissue kallikrein gene expression is elevated midcycle when estrogens levels are also rising. This is also a time of extensive endometrial proliferation and tissue remodelling in preparation for embryo implantation, an event which is likened to other inflammatory processes. Similarly, tissue kallikrein gene expression was elevated following the estrogen surge at proestrous in the rat uterus, suggesting tissue kallikrein gene expression may be regulated by estrogens. Tissue kallikrein enzyme activity and gene expression has been demonstrated in the rat ovary and shown to be variously altered at the time of ovulation. Bradykinin has also been implicated in the expulsion of the ovum at the time of ovulation. These findings show that various components of the kallikrein-kinin system are present in the uterus and ovary. Further studies are required to more fully delineate their role in reproductive function.

Murine postthymectomy autoimmune oophoritis develops in association with a persistent neonatal-like Th2 response

Autoimmune oophoritis develops in some patients despite evidence of impaired cellular immunity. Here, using the murine postthymectomy model of autoimmune oophoritis, we investigate the hypothesis that neonatal thymectomy induces autoimmune oophoritis by disrupting the normal postnatal balance of T helper cell regulation. Stimulated CD4+ splenic lymphocytes from adult mice sham-operated as neonates produced the expected T helper type 1 (Th1) predominant response normally seen in adult mice (low levels of interleukin-4 and high levels of interferon gamma). In contrast, cells from adult mice thymectomized as neonates produced an inappropriate neonatal-like Th2-predominant response (high levels of interleukin-4 and low levels of interferon-gamma). Manipulations that restored the postnatal shift to an adult Th1-dominant pattern ameliorated the autoimmune oophoritis. Thus, neonatal thymectomy abrogates the postnatal shift to a Th1-dominant pattern, and the resulting persistent neonatal-like Th2-dominant response is tightly associated with the development of postthymectomy autoimmune oophoritis. These results (i) suggest that the postnatal shift to the normal adult Th1/Th2 balance is established by a thymus-dependent process and (ii) raise the possibility that specific genetic defects, as yet to be determined, might mimic the effect of neonatal thymectomy in this model, impair the development of normal Th1/Th2 balance, and be a cause autoimmunity. These results hold implications for the pathogenesis and possibly for the therapy of autoimmune polyglandular failure in humans.

[Ileus in late pregnancy--sequela of follicle puncture within the scope of in vitro fertilization?]

Complications in connection with the puncture in in-vitro fertilisation (IVF) occur normally relatively soon after the operation. This is a report on a patient in her 28th week of gestation, operated on by laparotomy for ileus. Retrospectively this acute event must be seen as a very rare late complication connected with the puncture. It must be stressed that patients should be informed about this eventually.

Rapid induction of autoantibodies by endogenous ovarian antigens and activated T cells: implication in autoimmune disease pathogenesis and B cell tolerance

Animals immunized with nuclear antigenic peptides produce autoantibodies to distant antigenic sites and neighboring Ags within a multimolecular complex. This has led to the hypothesis that induction of autoantibodies in systemic autoimmune diseases might be triggered by a T cell epitope. We have investigated the T to B epitope spreading phenomenon based on the murine autoimmune oophoritis model. Mice immunized with a ZP3 T cell peptide spontaneously produced amplified autoantibodies (amAb) against linear ZP3 B cell epitopes outside the peptide immunogen. Each ZP3 B cell peptide, chimerized to a foreign promiscuous T cell epitope, elicited Ab to the peptide within the native ZP3 molecule. Mice with amAb often had no oophoritis; but more importantly, bilateral ovariectomy 1 day before ZP3 T epitope injection inhibited the induction of the amAb response, whereas ovariectomy 2 to 4 days after immunization was not inhibitory. Because endogenous ovarian Ag depletion before detectable ZP3 T cell response (day 5) and oophoritis (day 7) failed to prevent the amAb response, the autoantibodies are likely stimulated by endogenous ZP3 Ags present outside the normal ovaries. AmAb, of only the IgG class, appeared on day 7; this was 2 to 3 days after detectable T cell response, and 5 to 6 days before A response to the T cell peptide immunogen. The rapid, class-switched amAb response indicates that B cells in female mice are not tolerant to self ovarian Ag and they may normally be primed by ZP3. As evidence for their pathogenic potentials, amAb were produced in response to oophoritogenic, nonovarian T cell peptides that mimic ZP3; moreover, an excellent correlation existed between amAb titers and fertility reduction.

Frequency of molecular mimicry among T cell peptides as the basis for autoimmune disease and autoantibody induction

Experimental ovarian autoimmune disease is inducible by immunization with an ovarian peptide from zona pellucida (ZP) 3, a glycoprotein of the zona pellucida on mouse oocyte. The murine ZP3 peptide contains two nested T cell epitopes with slightly different critical residue motifs. To investigate the frequency of cross-reaction between nonovarian and ovarian peptides, we have chosen arbitrarily 16 nonovarian peptides with complete or partial homology to the critical residue motifs of the two T cell epitopes. Based on peptide induction of autoimmune oophoritis and T cell-dependent amplified autoantibody response to ovarian ZP, cross-reaction was documented for 7 (or 44%) of the 16 nonovarian peptides studied. Thus, molecular mimicry as a pathogenetic mechanism of autoimmunity should not be limited by the frequency of cross-reaction among self and nonself peptides. On the other hand, the sharing of critical residue motif per se is not sufficient for mimicry to occur, nor does it predict peptide cross-reaction.

Elucidation of autoimmune disease mechanism based on testicular and ovarian autoimmune disease models

This paper describes several selected models of autoimmune disease of the gonads. Based on these findings, I have reviewed current knowledge concerning the tolerance mechanisms that normally prevent gonadal autoimmunity, the potential events that can overcome such mechanism to trigger autoimmune diseases. In addition we also summarize the immunopathology of orchitis and our understanding of the mechanisms responsible for the immunopathology of the disease. Recent studies indicate that pathogenic T cells capable of eliciting autoimmune diseases in these organs develop in both the neonatal and adult thymuses and they persist in the normal peripheral immune system. However, the function of the pathogenic T cells in adult mice is normally under the control of regulatory T cells which maintain peripheral tolerance, and important phenotypic differences are being defined between these two functional CD4+ T cell subsets. When the clonal balance of these T cell subsets is tipped in favor of pathogenic T cells, autoimmune diseases of the gonads could ensue. Pathogenic T cells responsible for autoimmune oophoritis can be activated through stimulation by non-ovarian peptides that cross-react with self ovarian peptides at the level of the T cell receptor. This novel form of antigen mimicry depends in part on the sharing, between unrelated peptides, the few critical amino acids required for activation of pathogenic T cells. Antibodies can bind to the ovarian target antigens during the development of autoimmune orchitis and autoimmune oophoritis. However, the precise role of antibody in these autoimmune diseases has not been critically explored. In this study, I have described a novel mechanism of autoantibody induction. Immunization of female mice with a pure T cell peptide from ZP3 can lead to the production of antibodies against ZP3 domains outside the immunogenic ZP3 peptide. Evidently, endogenous antigens from normal and pathologic ovaries may reach peripheral immune tissues, and provide the antigenic stimulus to trigger an autoantibody response. This occurs at the same time when activation of ZP3 specific T cells is detected, and it is not simply a consequence of tissue injury. Importantly, the autoantibodies react with native antigenic determinants, and are potentially important in autoimmune disease pathogenesis.

Murine experimental autoimmune oophoritis develops independently of gonadotropin stimulation and is primarily localized in the stroma and theca

PROBLEM

Neonatal thymectomy performed on day 3 of life (NTX3) induces experimental autoimmune oophoritis in certain strains of mice. The disease has its onset around the time of the first estrous, suggesting the process may be gonadotropin dependent. Furthermore, one study reported that gonadotropin stimulation exacerbated the ovarian lymphocytic infiltration in NTX3 mice. Here we examine the possibility that gonadotropin stimulation of the ovary plays a role in the development of post-thymectomy autoimmune oophoritis.

METHOD

Using immunohistochemistry we defined the time course and histologic distribution of the post-thymectomy ovarian lymphocytic infiltration that develops in B6A mice ([C57BL6 X A/J]F1). We detected ovarian leukocytes using a monoclonal antibody against mouse CD45/T200 and counted those positive staining cells that had the morphologic appearance of lymphocytes. We then treated NTX3 mice to determine if gonadotropin stimulation could exacerbate the disease or cause the disease to appear earlier. We also treated NTX3 mice to determine if gonadotropin suppression could reduce the severity of the disease.

RESULTS

Ovarian lymphocytic infiltration was observed as early as 3 weeks after thymectomy, and, during the course of the disease, was primarily located in the stroma and theca. Gonadotropin stimulation did not exacerbate existing disease or induce an earlier onset of severe disease. Furthermore, gonadotropin suppression did not reduce the degree of lymphocytic infiltration or oocyte destruction.

CONCLUSIONS

Our findings suggest that murine experimental autoimmune oophoritis develops independently of gonadotropin stimulation of the ovary.

[Autoimmune ovarian inflammation]

Autoimmune oophoritis, which is frequently associated with other autoimmune diseases including other endocrine organs (autoimmune polyglandular syndrome), may precede the associated diseases by several years. The clinical significance of this association has increasingly been emphasized. And, this should facilitate early diagnosis since early initiation of replacement therapy can be life-saving. Thus, a review article on this subject apparently is of interest not only for gynaecologists but for internists, general practitioners and others.

Antigen mimicry in autoimmune disease sharing of amino acid residues critical for pathogenic T cell activation

A nonamer peptide from murine nicotinic acetylcholine receptor delta chain (ACR delta), which shared four amino acid residues with a nonamer peptide of murine ovarian zona pellucida glycoprotein ZP3, induced murine autoimmune oophoritis and IgG autoantibody to the zona pellucida. Crossreaction between the ACR delta and ZP3 peptides was established by the response of a ZP3 peptide-specific, oophoritogenic T cell clone to both peptides in association with IA (alpha k beta b). By substituting the ZP3 peptides with a single alanine, four amino acids within the ZP3 peptide were found to be important for ovarian autoimmune disease, autoantibody response, and stimulation of the ZP3-specific T cell clone. Substitution with conservative amino acids of three residues also ablated activity, whereas the fourth, a phenylalanine, was replaceable by tyrosine without loss of activity. Of the four critical amino acids, three were shared between the ZP3 peptide and the ACR delta peptide. Moreover, polyalanine peptides with the four critical ZP3 amino acids or the four amino acids common to the ZP3 and ACR delta peptides induced immune response to ZP3 and elicited severe ovarian autoimmune disease. Thus, organ-specific autoimmune disease can occur through immune response against unrelated self (or foreign) peptides that share with a self-peptide sufficient common amino acid residues critical for activation of pathogenic, autoreactive T cells.

Interspecies-specific ovarian autoantigens involved in neonatal thymectomy-induced murine autoimmune oophoritis

PROBLEM

Thymectomy of mice on day 3 after birth (3d-Tx) gives rise to the appearance of a particular type of ovarian lesion known as experimental autoimmune oophoritis (AIO).

METHOD

In the present study, the spleen cells from BALB/c mice having undergone 3 day-Tx AIO were fused with X63-Ag8-6.5.3 myeloma cells, and a number of hybridoma clones producing autoantibodies against ovarian tissue were established.

RESULTS

On the basis of immunohistochemical and protein-chemical analysis, two independent clones, designated at T2.2 and S1.6, were found to react with interstitial tissues surrounding the follicles. These monoclonal antibodies showed broad cross-species reactivity, in that they recognized similar antigenic macromolecules in the rat, pig, human, and mouse. The antigenic determinants were strongly resistant to heat and acid, especially to the treatment of periodic acid, indicating that the antigenic determinants had no relation with carbohydrate components.

CONCLUSIONS

By antibody affinity chromatography, two kinds of autoantigens were identified. SDS-PAGE, under reduced or nonreduced conditions, revealed an 80/85 kDa protein for T2.2, and an 82 kDa for S1.6, respectively.

Effector and regulatory cells in autoimmune oophoritis elicited by neonatal thymectomy

(C57BL/6 x A/J)F1 (B6AF1) mice thymectomized between days 1 and 4 of age develop autoimmune oophoritis (D3TX oophoritis) 4 to 6 wk later. Oophoritis can be adoptively transferred to young recipients, and the disease in D3TX mice is prevented by reconstitution with normal adult spleen cells. The present study was further defined the nature of the effector and suppressor cells. Contrary to an earlier report, oophoritis is transferred to syngeneic and not allogeneic recipients. The spleen cells from D3TX mice when stimulated in vitro with Con A, also transfer oophoritis to adult recipients. The effector cells are CD4+: oophoritis transfer is abrogated by CD4 antibody and not by CD8 antibody and C. Spleen cells from D3TX male mice transfer disease less efficiently than female cells, thus endogenous ovarian Ag may be required for activation of effector T cells. T cells from normal adult spleen that suppress D3TX oophoritis also appear to be of CD4+ phenotype. These cells are likely to be derived from adult thymus because adult thymocytes also suppress D3TX disease. We were unable to substantiate the earlier claim that suppressor cells in normal mice are ovarian Ag specific. Thus male and female spleen cells suppress disease with comparable efficiency, and deprivation of endogenous ovarian Ag by neonatal ovariectomy of cell donors had no observable effect on disease suppression.

Necrotic oophoritis in heifers vaccinated intravenously with infectious bovine rhinotracheitis virus vaccine during estrus

Twenty-two Hereford heifers were injected IM with prostaglandin F2 alpha a, 11 days apart to synchronize estrous cycles. Twelve of 14 heifers that had signs of estrus were inoculated IV with 1 of 3 modified-live infectious bovine rhinotracheitis virus vaccines, and 2 were assigned to a nonvaccinated control group. Also, 6 of the 8 anestrous heifers were inoculated IV with 1 of the 3 vaccines on the fourth day after the last prostaglandin injection and the other 2 were assigned to the nonvaccinated group. Vaccine virus was isolated from the blood and nasal and vaginal secretions from the vaccinated heifers on postvaccination days 4, 7, and 9. On postvaccination day 9, all heifers were ovariectomized and ovarian tissues were processed for virus isolation and histologic examination. Vaccine virus was isolation and histologic examination. Vaccine virus was isolated from ovarian tissues of some heifers in each of the vaccine groups. Necrotic oophoritis characterized by multifocal areas of ovarian tissue necrosis, hemorrhage, and mononuclear lymphocytic infiltration was observed. The corpora lutea and surrounding ovarian tissues taken from vaccinated heifers in each group had varying amounts of necrotic and inflammatory change, but the changes appeared to be more severe in 1 group than in the other 2. Virus also was isolated from 2 of the controls; these heifers apparently became infected with vaccine virus that had been excreted from the vaccinated animals.

Induction of class II major histocompatibility complex antigen expression in human granulosa cells by interferon gamma: a potential mechanism contributing to autoimmune ovarian failure

We investigated the possibility that major histocompatibility complex (MHC) class II antigens and interferon gamma, a product of activated T lymphocytes, play a role in human autoimmune oophoritis. MHC class II molecules initiate immune responses by presenting antigens to T-helper lymphocytes; interferon gamma can induce class II antigen expression at ectopic sites and has been implicated in the cause of various autoimmune disorders. We studied the expression of class II MHC antigens in ovaries from normal women of reproductive-age and from women with premature autoimmune ovarian failure. Immunoperoxidase technique applied to tissue sections of nine normal human ovaries revealed class II MHC antigen expression only on occasional cells of macrophage morphology; granulosa cells were negative regardless of stage of follicular maturation. In contrast, extensive and intense class II antigen expression was observed in granulosa cells in ovarian biopsy sections from four patients with premature autoimmune ovarian failure. Immunofluorescence and radioimmunoassay techniques used to detect and quantitate MHC antigens revealed that class II antigen expression could be induced and class I MHC antigen expression was enhanced in granulosa cell cultures after the addition of interferon gamma. These data provide evidence that autoimmune oophoritis is associated with ectopic expression of MHC class II antigens by ovarian granulosa cells, and that this phenomenon can be induced by the immunologic cytokine interferon gamma.

Plasma protein and hormone profiles associated with autoimmune oophoritis and ovarian tumorigenesis in neonatally thymectomized mice

Interactions between the immune and endocrine systems may have an important role in ovarian tumorigenesis. Neonatal thymectomy at 3 days of age (Tx-3) in (C3H/HeMs x 129/J)F1 (C31) female mice results in an autoimmune ovarian dysgenesis then subsequent tumor formation. At 3 months of age the histology of the ovaries showed that approximately 60% of the Tx-3 mice (Tx-3 DO) had completely lost their oocytes and follicles so that a preponderance of interstitial-like cells remained. The remainder of the Tx-3 mice had atypical ovaries (Tx-3 AO). The vaginal cytology showed that both groups of Tx-3 mice became acyclic at an early age compared to the intact mice. Around 12 months of age, a high percentage of the dysgenic ovaries developed trabecular tumors. Plasma protein-related indicators of systemic inflammatory responses showed little change during the course of the autoimmune oophoritis or ovarian tumorigenesis. Levels of estradiol 17 beta (E2) and testosterone (T) did not vary in the Tx-3 mice compared to those of the intact mice through 21 months of age but progesterone levels were lower during the exacerbation of the autoimmune oophoritis and tumor development. By 24 months of age levels of P increased while E2 decreased. Apparently, the premature reproductive failure in these mice at a young-adult stage results from the early loss of the oocytes by the localized autoimmune insult to the ovaries. The autoimmune oophoritis may then be the primary trigger for the subsequent ovarian tumor formation and the tumors succeed in association with the altered hormonal milieu.

Aromatase activity in cultured ovaries from neonatally thymectomized mice with ovarian dysgenesis

The autoimmune oophoritis resulting from thymectomy at 3 days of age (Tx-3) in B6A female mice is characterized by dysgenic ovaries and circulating auto-antibodies against the oocyte (AOA). Dysgenesis of the ovaries starts around 24 days of age with a decline in numbers of the oocytes and follicles and is accompanied by lymphocytic infiltration. By 60 days of age the ovarian dysgenesis (OD) is complete with a preponderance of interstitial cells associated with elevated levels of testosterone (T). From 60-120 days of age the ovaries become progressively smaller in size and T levels rise. Since ovarian interstitial cells can produce T, assessment of aromatase activity was determined using cultured ovaries from 20-, 30-, 60-, 90- and 120-day-old mice. Similar or enhanced ability in aromatizing T to estradiol-17 beta (E2) was demonstrated by the ovaries from all Tx-3 mice compared with those from intact mice. At 30 and 60 days of age Tx-3 mice had increased circulating levels of E2 then the levels of E2 returned to those of intact mice at 90 and 120 days of age. The results indicate that the ovaries in Tx-3 mice may have an ability to aromatize T to E2 in culture, but apparently are not doing so at 90 and 120 days of age in situ. Further, ovaries of Tx-3 animals are able to aromatize T to E2 in the absence of organized follicular cells. These abnormal responses of ovarian hormones clearly demonstrate that the presence of AOA have a damaging effect on the endocrine activity as well as the morphology of the ovary.

[Pathogenetic therapy of chronic salpingo-oophoritis]

The practicability of using neurotropic agents as part of combined rehabilitation program in patients with residual chronic salpingo-oophoritis and reproductive disorders is discussed. The results of the assessment of sympatho-adrenal and endocrine status by radioimmune assays in 87 patients are reported. The treatment normalized catecholamine levels, which was accompanied by a tendency to normalization at different levels of the reproductive system. Pregnancy resulted in 33.2% of the patients.

[Criteria of the severity of the course of acute nonspecific salpingo-oophoritis]

Differential-diagnostic value of various clinical and laboratory tests was assessed in 105 patients with acute nonspecific salpingo-oophoritis. Auxiliary methods, such as cytochemical studies of neutrophil alkaline phosphatase, lymphocyte acid phosphatase, lymphocyte glycogen and lymphocyte succinate dehydrogenase, as well as the identification of auto-organic antibodies to the enosalpinx and ovarian tissue, were used to assess the severity of the condition. Their diagnostic value is stated with reference to the severity of adnexal inflammation.

Cytomegalovirus oophoritis with cortical necrosis during remission of acute lymphocytic leukemia

Ovarian involvement of cytomegalovirus (CMV) is rarely observed in autopsy and biopsy materials. Cortical necrosis of the ovaries was found in an autopsy case with generalized CMV infection. The patient was an 11-year-old girl in a remission state of acute lymphocytic leukemia. Autopsy revealed several areas showing necrotic change up to 2 mm in size in the cortex of both ovaries. Many cytomegalic cells were found in both the necrotic and intact areas of the cortex. CMV had infected the granulosa, thecal and stromal cells as well as vascular endothelial cells. Oocytes of neither primary nor graafian follicles showed cytomegalic changes, although they were destroyed due to the necrosis. CMV antigen was immunohistologically detected in these cytomegalic cells. Ultrastructurally, herpesvirus-type particles were revealed in the nuclei and cytoplasm of the cytomegalic cells. This case demonstrated that ovarian infection with CMV can potentially induce cortical necrosis and decrease the number of oocytes.

[Necrotic oophoritis due to cytomegalovirus]

In a 54-year-old woman with malignant lymphoma, cytomegalovirus oophoritis was disclosed at autopsy. The virus, which is recognized by its typical nuclear inclusions, reaches the cortical stroma of the ovaries and causes zones of necrosis there. Its presence is confirmed by ultrastructural and immunohistochemical examination. The real frequency of ovarian involvement is difficult to evaluate since histological examination of ovaries is not routinely performed at autopsy. As far as we know the present case is the seventh detailed observation of cytomegalovirus oophoritis published in the literature.

Cellular events associated with autoimmune oophoritis and ovarian tumorigenesis in neonatally thymectomized mice

Thymectomy at 3 days of age (Tx-3) in (C3H/HeMs x 129/J)F1 (C31) female mice results in post-pubertal ovarian dysgenesis associated with high levels of circulating auto-oocyte antibodies (AOA) prior to ovarian tumor formation. Evidence suggests that the etiology for the ovarian dysgenesis resulting from Tx-3 is autoimmune and involves helper T cell abnormalities. The present study characterized circulating leukocytes and mitogenic activity using concanavalin A (ConA) with serologically selected spleen T cells. We observed no sustained abnormalities in either number of circulating leukocytes or percentages of granulocytes or lymphocytes. Circulating mononuclear cells with positive immunofluorescence for Thy 1.2 and Lyt 1.1+Lyt 1.2 cell markers were similar in all mice. However, the spleen cells from Tx-3 mice with ovarian dysgenesis remaining after adsorption with antisera to the Lyt 2.1+Lyt 2.2 antigens (helper T cells remaining) showed increased incorporation of [3H]thymidine compared to the intact mice. This stimulated activity occurred during the periods of early ovarian dysgenesis and active tumor growth. Apparently, the autoimmune oophoritis results from an imbalance within the Lyt 1 cells which may represent a primary insult to the ovary that results in later ovarian tumor development.

The effect of antisera to thymosin alpha 1 on the course of autoimmune ovarian dysgenesis in neonatally thymectomized mice

Thymectomy at 3 days of age (Tx-3) in B6A female mice results in an autoimmune oophoritis that has only been successfully overcome by the transplant of an intact thymus or an injection of T cells. In Tx-3 mice levels of thymosin alpha 1 (TSN alpha 1), a potent thymic hormone involved in the development of helper T cells, was previously shown to be high after 7 days. By 60 days levels of TSN alpha 1 returned to levels found in intact mice. By this age ovarian dysgenesis was also complete and accompanied by high circulating levels of auto-oocyte antibody (AOA), estradiol-17 beta (E2) and testosterone (T). In the present study injections of antisera to TSN alpha 1 were given to Tx-3 mice in an attempt to decrease circulating TSN alpha 1 levels. We reasoned that this treatment should inhibit lymphocyte differentiation, and possibly in turn aid in overcoming the ovarian dysgenesis. After treatment of the Tx-3 mice, dysgenic ovaries persisted and high levels of AOA remained similar to the untreated Tx-3 mice. Levels of E2 and T, however, were returned to those found in intact mice. These results suggest that there is a sensitive balance between the thymus and the ovary that may not be related to changes in only a single thymic hormone.

Bilateral salmonella salpingo-oophoritis

A previously healthy nulliparous caucasian female presented with lower abdominal pain and a history of diarrhoea and vomiting for 2 weeks. Repeated stool examinations and blood culture were negative. A lump in the lower abdomen became more apparent over the next 2 weeks and a subsequent laparotomy revealed bilateral tubo-ovarian abscess formation. One ovary which was endometriotic and both the tubes were excised and the pus yielded a heavy growth of Salmonella stanley.

Secondary amenorrhoea associated with Chlamydia trachomatis infection

Chlamydia trachomatis was isolated from the ovaries of a 39-year-old married woman who presented with secondary amenorrhoea. Treatment with doxycycline was given and menstruation resumed spontaneously.

Study on cellular events in post-thymectomy autoimmune oophoritis in mice. II. Requirement of Lyt-1 cells in normal female mice for the prevention of oophoritis

Autoimmune oophoritis that develops in A/J mice after neonatally thymectomy (NTx) was prevented by a single intraperitoneal injection of spleen cells or thymocytes from normal adult female mice. Prevention of oophoritis was achieved when spleen cells were given within 2 wk after Tx. When spleen cells were obtained from neonatally oophorectomized mice, four times more cells were required for the prevention of oophoritis, but those from the mice oophorectomized on day 7 after birth had equivalent capacity to prevent oophoritis to those from normal female mice. The spleen cells from normal A/J mice that prevented the development of oophoritis in NTx A/J mice were Thy-1+, Lyt-1+,23-, Ia-, Qa-1-, sensitive to in vitro irradiation with 400 rad, resistant to administration of cyclophosphamide or anti-thymocyte serum, and were not eliminated by adult thymectomy. Thymocytes with oophoritis-preventing capacity were also found to be Lyt-1+,23- and TL-1,2,3-. These results seem to correlate well with the finding that the Lyt-1 subpopulation is substantially decreased in NTx mice. The results suggest that, in this post-thymectomy autoimmune oophoritis, NTx abrogates the Lyt-1 T cell subpopulation that serves as suppressive or regulatory cells over developing self-reactive cells directed toward ovarian antigens, and eventually may cause autoimmune oophoritis.

Study on cellular events in postthymectomy autoimmune oophoritis in mice. I. Requirement of Lyt-1 effector cells for oocytes damage after adoptive transfer

Neonatal thymectomy during the critical period, 2-4 d after birth, can induce various organ-specific autoimmune diseases including oophoritis in A/J mice. The oophoritis thus induced was passively transferred into neonatal mice by injection of spleen cells obtained from syngeneic donors with the disease. Recipient ovaries were rapidly damaged with remarkable mononuclear cell infiltration and destruction of follicular structures. The phenotype of effector cells responsible for successful adoptive transfer was found to be Thy-1+, Lyt-1+,23-, Ia-, Qa-1-, and was sensitive to antithymocyte serum treatment but resistant to cyclophosphamide treatment or in vitro X-ray irradiation. The compatibility between donor and recipient at the major histocompatibility complex was not required for the effector phase of transfer. The oophoritis induced in BALB/c (nu/+ or +/+) was also shown to be transferred into athymic BALB/c nude mice with resulting ovarian lesion and circulating autoantibodies against oocytes. In this transfer system, the effector cells were also demonstrated to be T cells with the Lyt-1+,23- phenotype. Adoptive transfer experiments in both systems revealed that the destruction of ovaries in postthymectomy autoimmune oophoritis was mediated by Lyt-1 T cells. Whether these T cells can be distinguished from other Lyt-1 cells, such as T helper cells and effector T cells in delayed-type hypersensitivity (DTH), is not clear at present, but the results suggest that the effector mechanisms may be closely related to a DTH reaction.