Immune recognition of endometrial tumor antigens induced by multiparity

Systemic Immune-Inflammation Indices Could Be Additional Predictive Markers for Cesarean Scar Pregnancy

PROBLEM

Cesarean scar pregnancy (CSP) is characterized by a gestational sac fully or partially implanted in the scar from a previous cesarean section. Systemic immune-inflammation indices (SIIs) have recently been discussed as additional diagnostic markers in placenta accreta and preeclampsia. CSP shares a similar pathogenesis with these diseases, suggesting that assessing the SIIs and neutrophil-to-lymphocyte ratio (NLR) could enhance additional predictability in diagnosing CSP.

METHOD OF STUDY

In this study, we analyzed the complete blood counts between 264 women who were confirmed with CSP by ultrasound and 295 women who underwent elective termination.

RESULTS

The mean counts of total white cells and neutrophils were significantly higher, whereas the counts of monocytes, lymphocytes, and platelets were significantly lower in the CSP group compared to the control group (p < 0.001). Additionally, the SII, systemic inflammation response index (SIRI), or NLR was significantly higher in the CSP group compared to the control group (p < 0.0001). Given the limited effect of SII and SIRI on the increased risk of developing CSP, the optimal cut-off value for NLR in predicting CSP was 2.87 (area under the curve [AUC] 0.656, 68% sensitivity). The optimal cut-off value for NLR in predicting type 2 CSP was 2.91 (AUC 0.690, 71% sensitivity).

CONCLUSIONS

Although ultrasound or magnetic resonance imaging images are a gold standard for visualizing the gestational sac's location in the diagnosis of CSP, assessing peripheral blood tests is cost-effective, and NLR may provide additional diagnosis value for CSP.

Pregnancy, abortion, and birth control methods' complicity with breast cancer occurrence

Reproductive factors play significantly important roles in determining the breast cancer (BC) risk. The impact of pregnancy, abortion, and birth control methods on tumor development remains unclear. It has been found that early full-term pregnancies in young women can lower their lifetime risk of developing the type of cancer in question. However, having a first full-term pregnancy at an older age can increase this risk. The relationship between pregnancy and breast cancer (BC) is, however, much more complicated. Both induced and spontaneous abortions lead to sudden changes in hormonal balance, which could cause different effects on sensitive breast epithelial cells, making abortion a potential risk factor for breast cancer. The influence of hormonal contraception on carcinogenesis is not comprehensively understood, and therefore, more exhaustive analysis of existing data and further investigation is needed. This review explores how the mentioned reproductive factors affect the risk of breast cancer (BC), focusing on the molecular mechanisms that contribute to its complexity. By comprehending this intricate network of relationships, we can develop new strategies for predicting and treating the disease.

Understanding How Pregnancy Protects Against Ovarian and Endometrial Cancer Development: Fetal Antigens May Be Involved

It is well known that many factors, including infertility, obesity, type 2 diabetes, and family history of cancer, increase the risk of developing endometrial and ovarian cancer. However, multiparous women are known to have a lower risk of developing either ovarian or endometrial cancer than nonparous women. The lack of ovulation and shifting of sex hormonal balance, with decreased estrogen levels and increased progesterone levels during pregnancy, has traditionally been thought to be the major contributor to this decreased risk. However, in reality, the mechanisms underlying this phenomenon are relatively unknown. Increasing evidence suggests that endocrine factors are unlikely to completely explain the protective effect of pregnancies, and that multiple other nonendocrine mechanisms including fetal antigens and the newly proposed dormant cells hypothesis may also be involved. In this review, we summarize recent evidence and describe the potential underlying mechanisms that may explain how pregnancy protects against the development of ovarian and endometrial cancers in women's later life.

Breast cancer, placenta and pregnancy

BACKGROUND

Breast cancer is one of the most frequently diagnosed malignancies during pregnancy. Tumours often present characteristics of high malignancy and are hormone receptor negative/HER2 positive or triple negative. In general, pregnancy, including the postpartum period, is associated with a transiently increased risk of developing breast cancer but followed by a long-lasting protective period. Placental metastases are very rare and, thus far, breast cancer metastases in the foetal compartment have not been described. To discuss these apparently contradictory observations, this narrative review resumes immunological and hormonal alterations during pregnancy potentially affecting breast cancer risk as well as tumour growth and behaviour.

OBSERVATIONS

Upregulation of breast cancer-associated genes involved in immunological and reproductive processes has been observed in parous women and is potentially responsible for a transiently increased risk in pregnancy. In contrast, maternal immunisation and immunoglobulin production against antigens expressed on trophoblast cells, such as specific glycosylation patterns of mucin-1 or RCAS1-associated truncated glycans, seem to prevent breast cancer development in later years. Animal and human studies indicate that T cells are involved in these processes. Several placenta-derived factors, especially kisspeptin, have direct anti-tumour effects. The pregnancy-related increase of estrogen, progesterone, and other hormones influence growth and characteristics of breast cancer while the role of further placenta-secreted factors is still controversially discussed.

CONCLUSION

Several factors and cells are involved in altered breast cancer risk during and after pregnancy and have potential for developing novel treatment strategies in future.

Reproductive factors and postmenopausal hormone use in relation to endometrial cancer risk in the Nurses' Health Study cohort 1976-2004

Endometrial cancer is a disease primarily driven by cumulative exposure to estrogen unopposed by progesterone. Reproductive factors associated with changes in endogenous hormone levels and use of exogenous hormones such as postmenopausal hormones influence the risk of disease. The authors used the Nurses' Health Study, comprised of 121,700 nurses, to assess the above associations. Over 28 years of follow-up, 778 adenocarcinoma cases were diagnosed and 1,850,078 person-years were accumulated. Cox proportional hazards models were used to estimate relative risks (RR) and 95% confidence intervals (CI). A late age at menarche decreased the risk independent of body mass index (BMI) (P-trend = 0.02). A late age at menopause increased cancer risk (P-trend = 0.0003). An advanced age at last birth reduced the risk (P-trend < 0.0001), however, an inverse association with age at first birth and parity diminished after adjustment for age at last birth. Compared with never users, an increased risk was observed among long-term (> or =5 years) users of both estrogen (E) (RR = 7.67, 95% CI: 5.57, 10.57) and combined estrogen plus progesterone (E+P) (RR = 1.52, 95% CI: 1.03, 2.23). Normal-weight (BMI < 25) women had the highest risk following E or E+P use (P-interaction-E = 0.0008, P-interaction-E+P = 0.02). The findings from this study underscore the importance of hormonal mechanisms in endometrial carcinogenesis.

Immunoplacental therapy, a potential multi-epitope cancer vaccine

The field of tumor immunology has made great advancements in recent years. A retrospective analysis of previous vaccine strategies combined with present knowledge may provide additional insight in this treatment modality. This article provides a review of immunoplacental therapy (IPT), a cancer vaccine consisting of chorionic villi extractions from the human placenta after a live full-term delivery. This therapy was first introduced in the 1970s by Valentin I. Govallo, M.D., Ph.D., who noted the immunological similarities between pregnancy and cancer. The goal of cancer immunotherapy, according to Govallo, is to view the fetal allograft as an "impregnating tumor" and create an immunological state in the oncological patient analogous to a spontaneous abortion in a pregnant women. The placenta shares identical growth mechanisms, antigenic determinants, and immune-escape properties with cancer cells; this includes numerous tumor-associated antigens, angiogenic growth factors, complement regulatory proteins, and defective apoptotic mechanisms which aid in their survival. Placental vaccination may function as a multi-epitope vaccine; the body recognizes the placental antigens of this vaccine as foreign, and thus stimulates a cross reactive humoral and cell-mediated immune response targeting cancer tumor-associated antigens as well as proteins that aid in cancer angiogenesis, complement regulation, and apoptotic resistance. With recent advancements in molecular and cellular cancer immunology, the model introduced by Govallo may provide an important strategic approach to cancer immunotherapy.

Tumour-derived exosomes and their role in cancer-associated T-cell signalling defects

Dendritic and lymphoid ‘exosomes’ regulate immune activation. Tumours release membranous material mimicking these ‘exosomes,’ resulting in deletion of reactive lymphocytes. Tumour-derived ‘exosomes’ have recently been explored as vaccines, without analysis of their immunologic consequences. This investigation examines the composition of tumour-derived ‘exosomes’ and their effects on T lymphocytes. Membranous materials were isolated from ascites of ovarian cancer patients (n=6) and Western immunoblotting was performed for markers associated with ‘exosomes.’ Using cultured T cells, ‘exosomes’ were evaluated for suppression of CD3-ζ and JAK 3 expressions and induction of apoptosis, measured by DNA fragmentation. ‘Exosome’ components mediating suppression of CD3-ζ were isolated by continuous eluting electrophoresis and examined by Western immunoblotting. ‘Exosomes’ were shown to be identical with previously characterised shed membrane vesicles by protein staining and TSG101 expression. ‘Exosomes’ expressed class I MHC, placental alkaline phosphatase, B23/nucleophosmin, and FasL. ‘Exosomes’ suppressed expression of T-cell activation signalling components, CD3-ζ and JAK 3 and induced apoptosis. CD3-ζ suppression was mediated by two components: 26 and 42 kDa. Only the 42 kDa component reacted with anti-FasL antibody. These results indicate that, while ‘exosomes’ express tumour antigens, leading to their proposed utility as tumour vaccines, they also can suppress T-cell signalling molecules and induce apoptosis.

Epithelial ovarian carcinoma and fertility of parents

We studied the fertility of the parents of 163 women with epithelial ovarian carcinoma in two hospitals in New York City, compared with the parents of 159 controls from similar neighborhoods. We used unconditional logistic regression to control for covariates, including parity, oral contraceptive use, age at menarche, and Jewish ancestry. Compared with women with zero or one sibling, those with two, three or four or more siblings had adjusted odds ratios (95% confidence intervals) of 0.91 (0.47-1.77), 0.61 (0.28-1.37), and 0.50 (0.26-0.98). On average, each additional sibling was associated with a risk reduction to 0.80 (0.66-0.98). These findings support the hypothesis that heritable conditions associated with reduced fertility of the subjects' parents may contribute to risk and may explain some of the effects of parity on the risk of this carcinoma. Alternatively, they may reflect some unidentified aspect of the environment experienced by girls growing up in small families. If confirmed in other data sets, these findings imply that sibship size might have confounded previous estimates of risk associated with a family history of cancer or with Jewish ethnicity.

The fetal antigen hypothesis: cancers and beyond

Twenty years ago the fetal antigen hypothesis was proposed as a potential mechanism by which women are naturally immunized against cancer antigens by antigens from their fetus. Evidence from recent clinical studies shows that a high percentage of parous woman, but not nulliparous women, show evidence of immunization to antigens found on breast, ovarian and endometrial cancer cells. I suggest that this maternal immunization also affects the fetus, causing early immune rejection of fertilized ova that express cancer-related genotypes. Additional cancers, and perhaps even other types of genetic diseases, may be involved in this mechanism.

Alterations in humoral immune responses associated with recurrent pregnancy loss

OBJECTIVE

To investigate the reactivity of maternal antibodies with endometrium-derived antigens and to correlate their association with recurrent pregnancy loss (RPL).

DESIGN

Prevalence study.

SETTING

Academic research center.

PATIENT(S)

Nulliparous women (n = 10), women with RPL (n = 15), pregnant women (n = 8), and multiparous women with a normal obstetric history (n = 20).

INTERVENTION(S)

None.

MAIN OUTCOME MEASURE(S)

Reactive antibodies were analyzed by Western immunoblot techniques and quantitated by densitometry.

RESULT(S)

Antibodies from women with RPL and multiparous women recognized antigens ranging from 10-120 kd on normal endometrium and endometrial tumors. Antibodies from most women with RPL (10/15) and from multiparous women (15/20) recognized 65-kd and 80-kd proteins in normal endometrium. Antibodies from women with RPL recognized 21-kd and 28-kd antigens (12/15 and 13/15, respectively) in endometrial tumors at a significantly greater rate (than did antibodies from multiparous women (5/20 and 8/20, respectively). Women with RPL had significantly lower levels of asymmetric IgG compared with controls.

CONCLUSION(S)

Recurrent pregnancy loss may be linked with the failure to elicit asymmetric IgG and a unique immunologic recognition of endometrial antigens.