Prolactin and autoimmunity

Prolactin as a novel biomarker in malignancy

Apart from lactation, prolactin is engaged in a wide range of physiological activities and mostly generated by lactotroph cells in the anterior pituitary. Among these actions are metabolic, immunological, and reproductive ones. Prolactin acts through the binding of the hormone to its receptor, PRLR. Among organs in which this receptor is found include the liver, adipose tissue, immunological cells, and the central nervous system. Because of its control of glucose and lipid metabolism, adipogenesis, and leptin production, prolactin is a fundamental component in the control of metabolism. It is responsible for maintaining energy homeostasis during critical physiological states such as increasing immune cell diversity and proliferation. However, elevated levels of prolactin have been linked to exacerbated autoimmune diseases. An association has been established between the hormone prolactin and the development and progression of a number of malignancies, including breast, ovarian, prostate, and hepatic cancers. Investigations are now being conducted to determine the diagnostic and therapeutic potential of prolactin. The objective of this review is to investigate the various functions that prolactin serves, as well as the ways in which high or low amounts of the hormone influence certain cancers.

Impact of Laboratory-Measured Euthyroid Hashimoto's Thyroiditis on Reproductive Hormone Profile in Women with Obesity

Introduction: Hashimoto's thyroiditis is a common endocrinological disorder that often coexists with obesity. Thyroid hormones interact with the regulation of sex steroids, and thyroid autoimmunity has a negative impact on female fertility. There are studies showing when euthyroid state is achieved with hormone replacement therapy (HRT), the reproductive hormone profile is improved but they usually compare the reproductive hormones before and after HRT in the same individuals. Studies comparing patients with Hashimoto's thyroiditis in an euthyroid state receiving HRT with individuals having normal thyroid function are limited. Here, it was aimed to search the impact of euthyroid Hashimoto's thyroiditis on reproductive hormone profile in women living with obesity. Materials and Methods: Sixty-one randomly selected female patients with Hashimoto's thyroiditis were included as the case group and 60 patients without Hashimoto's thyroiditis were included as the control group, from our obesity center. The case group included patients who had menstrual cycles and were euthyroid under l-thyroxine treatment for at least 6 months. Data on weight, height, body mass index (BMI), waist circumference (WC), free thyroxine (fT4), thyroid stimulating hormone (TSH), thyroid peroxidase antibody (anti-TPO), cortisol, insulin, prolactin (PRL), follicular stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2), progesterone (prog), testosterone (T), and dehydroepiandrosterone sulfate (DHEAS) levels, l-thyroxine treatment dosage (for case group), and accompanying diseases were recorded. The results were evaluated using SPSS. Results: A total of 121 patients were included in the study. Mean age was 41.8 ± 8.5 years in case and 38.6 ± 8.9 years in control group. There was no significant difference in weight, height, BMI, WC, or accompanying diseases between Hashimoto's thyroiditis and control group. fT4, anti-TPO, cortisol levels were higher in Hashimoto's thyroiditis group when compared with control group, but there was no significant difference for TSH, insulin, FSH, LH, E2, prog, T, DHEAS, or PRL. Conclusion: In women living with obesity, it is important to screen for Hashimoto's thyroiditis and achieve euthyroidism through effective LT4 treatment to promote a healthy reproductive system and improve fertility rates.

Re-embarking in ART while still breastfeeding: an unresolved question

Infertile women may request to embark on a new course of Assisted Reproductive Technologies (ART) in pursuit of a second child while still breastfeeding their first child. Breastfeeding is a time of profound hormonal changes that may interfere with ovarian physiology and uterine receptivity. Prolactin and oxytocin can mediate a plethora of potential detrimental effects. However, robust evidence to advise in favor or against ART during breastfeeding is lacking. In this narrative review, we reviewed the literature with the intent to shed light on this neglected issue. Possible adverse effects on ART success emerged for ovulatory mechanisms, folliculogenesis, uterine contractions, uterine peristalsis, and early embryo development. A negative impact of exogeneous hormones on infant health might be considered only for stimulation cycles. Overall, most concerns can be claimed for the clinical setting of ovarian stimulation, followed by the one of embryo transfer in a natural cycle and, finally, by the embryo transfer in a hormone replacement treatment preparation. However, in general, it seems wise to wait for breastfeeding to be discontinue before re-embarking on IVF, also considering that a too short interpregnancy interval may be deleterious to pregnancy outcomes. On the other hand, one must also recognize that available evidence is insufficient to deny access to treatments for women requesting earlier access. These women must be informed regarding the non-fully reassuring evidence.

Molecular and cellular morphology of placenta unveils new mechanisms of reproductive immunology

INTRODUCTION

Despite of numerous studies of the placenta, some molecular and cellular characteristics, particularly the relationship among different cell types, have not been well understood. We aim to investigate the basic and intricate details of cellular and molecular elements in early and late phase placentas to gain better understanding of the immune regulation of human reproductive process.

METHODS

A novel combination of techniques of spatial transcriptomics(ST), multiple immunohistochemistry, and a dual labeling combining immunohistochemistry and (fluorescence in situ hybridization) FISH on normal and ectopic pregnancy and animal models was employed to investigate the placenta at tissue, cell, protein and molecular levels and to trace the fetal and maternal origin of every cell in early and late placentas.

RESULTS

Original discoveries include early expression of immune checkpoint proteins in embryo trophoblasts even before implantation. The detailed distributional relationships among different cell types of fetal and maternal origins in placenta and decidua indicate an immune rejection of the mother towards the fetus and this was counterbalanced by immune inhibitory proteins and blocking antibody Immunoglobulin G4 (IgG4) at the junction between the fetus and the mother. In contrary to common believe, we found that vascular endothelial and glandular epithelial cells in the decidua remain maternal in origin and were not replaced by fetal cells. At term placenta, fetal immune cells infiltrated into the maternal side of the decidus and vice versa indicating a possible immune reaction between fetal and maternal immune systems and suggesting a possible immune mechanism for trigger of parturition. The ability of trophoblasts to create an immune suppressed environment was also supported by findings in ectopic pregnancy and the animal models.

CONCLUSION

The findings indicate a fetus-driven mechanism of immune balance involving both cellular and humoral immunity in human reproduction.

Circulating T Cell Subsets in Type 1 Diabetes

Type 1 diabetes (T1D) is a complex disease driven by the immune system attacking the insulin-producing beta cells in the pancreas. Understanding the role of different T cell subpopulations in the development and progression of T1D is crucial. By employing flow cytometry to compare the characteristics of T cells, we can pinpoint potential indicators of treatment response or therapeutic inefficacy. Our study reveals elevated prolactin (PRL) levels in T1D patients, along with a decreased production of key cytokines. Additionally, PD1 appears to play a significant role in T1D. Notably, PRL levels correlate with an earlier disease onset and a specific T cell phenotype, hinting at the potential influence of PRL. These findings highlight the need for further research to identify promising cellular targets for more effective and tailored therapies.

Prolactin Role in COVID-19 and Its Association with the Underlying Inflammatory Response

The COVID-19 pandemic has prompted interest in identifying reliable biomarkers to predict disease severity and guide clinical decisions. Prolactin (PRL), a hormone traditionally associated with lactation, has gained attention for its role in immune modulation. This study aimed to assess PRL as a biomarker for disease severity in COVID-19. A prospective cohort of 142 patients with moderate to severe COVID-19, defined as a WHO-CPS 5 or 6, was recruited from the University General Hospital of Patras. Baseline PRL levels were measured using an electrochemiluminescence immunoassay, and serum cytokines, including IL-1β, IL-6, IL-8, IL-10, IL-12p70, and TNF-α, were quantified through flow cytometry. Clinical outcomes, including mortality and the need for invasive mechanical ventilation (IMV), were recorded. Results indicated that PRL levels were significantly higher in female patients (12.95 ng/mL vs. 9.40 ng/mL, p < 0.001) but they did not correlate with key severity indices such as CCI, SOFA score upon admission or inflammatory markers. No significant associations between baseline PRL levels, cytokine concentrations, and clinical outcomes in COVID-19 were noted. Our findings suggest that PRL may lack prognostic reliability for disease severity compared to more established predictive markers and that its role in the immune response remains uncertain.

The influence of sex on neuroimmune communication, pain, and physiology

With the National Institutes of Health's mandate to consider sex as a biological variable (SABV), there has been a significant increase of studies utilizing both sexes. Historically, we have known that biological sex and hormones influence immunological processes and now studies focusing on interactions between the immune, endocrine, and nervous systems are revealing sex differences that influence pain behavior and various molecular and biochemical processes. Neuroendocrine-immune interactions represent a key integrative discipline that will reveal critical processes in each field as it pertains to novel mechanisms in sex differences and necessary therapeutics. Here we appraise preclinical and clinical literature to discuss these interactions and key pathways that drive cell- and sex-specific differences in immunity, pain, and physiology.

Effects of Acremonium terricola Culture on Lactation Performance, Immune Function, Antioxidant Capacity, and Intestinal Flora of Sows

This study aimed to determine the effects of different doses of Acremonium terricola culture (ATC) on lactation performance, immune function, antioxidant capacity, and intestinal flora of sows. Forty-five Landrace sows (3-6 parity) were randomly assigned to the following three treatments from 85 days of gestation to 21 days after farrowing: a control diet (CON, basal diet), a low-dose Acremonium terricola culture diet (0.2% ATC, basal diet + 0.2% ATC), and a high-dose Acremonium terricola culture diet (0.4% ATC, basal diet + 0.4% ATC). Compared with the CON group, the supplementation of 0.2% ATC increased the average daily milk yield of sows by 4.98%, increased milk fat, total solids, and freezing point depression on day 1 postpartum (p < 0.05), increased serum concentration of Triiodothyronine, Thyroxin, and Estradiol on day 21 postpartum (p < 0.05). Compared with the CON group, the supplementation of 0.4% ATC increased the average daily milk yield of sows by 9.38% (p < 0.05). Furthermore, the supplementation of 0.2% ATC increased serum concentration of IgG, IgM, and IFN-γ, CD4 on day 1 postpartum (p < 0.05) and increased serum concentration of immunoglobulin A ( IgA), immunoglobulin G (IgG), immunoglobulin M ( IgM), complement 3 (C3), cluster of differentiation 4 (CD4), cluster of differentiation 8 (CD8), interferon-γ (IFN-γ) on day 21 postpartum (p < 0.05), while the supplementation of 0.4% ATC reduced serum concentration of IL-2 on day 21 postpartum (p < 0.05). Moreover, the supplementation of 0.4% ATC significantly increased serum concentration of catalase (CAT) (p < 0.05). Additionally, the supplementation of ATC affected the relative abundance of the intestinal flora at different taxonomic levels in sows and increased the abundance of beneficial bacteria such as in the norank_f__Eubacterium_coprostanoligenes group, Eubacterium_coprostanoligenes group, and Lachnospiraceae_XPB1014 group of sows, while reducing the abundance of harmful bacteria such as Phascolarctobacterium and Clostridium_sensu_stricto_1. These data revealed that the supplementation of ATC during late gestation and lactation can improve lactation performance, immune function, antioxidant capacity, and the gut microbiota. Compared with supplementation of 0.4% ATC, 0.2% ATC enhances the levels of thyroid-related hormones, specific antibodies, and cytokines in serum, promotes the diversity of beneficial gut microbiota, beneficial bacteria in the intestine, reduces the population of harmful bacteria, and thereby bolsters the immunity of sows. Hence, 0.2% ATC is deemed a more optimal concentration.

Bisphenol A-What Do We Know? A Global or Local Approach at the Public Health Risk Level

BPA has demonstrated enormous multisystem and multi-organ toxicity shown mainly in animal models. Meanwhile, the effects of its exposure in humans still require years of observation, research, and answers to many questions. Even minimal and short-term exposure contributes to disorders or various types of dysfunction. It is released directly or indirectly into the environment at every stage of the product life cycle, demonstrating its ease of penetration into the body. The ubiquity and general prevalence of BPA influenced the main objective of the study, which was to assess the toxicity and health effects of BPA and its derivatives based on the available literature. In addition, the guidelines of various international institutions or regions of the world in terms of its reduction in individual products were checked. Bisphenol A is the most widely known chemical and perhaps even the most studied by virtually all international or national organizations, but nonetheless, it is still controversial. In general, the level of BPA biomonitoring is still too high and poses a potential threat to public health. It is beginning to be widely argued that future toxicity studies should focus on molecular biology and the assessment of human exposure to BPA, as well as its substitutes. The effects of its exposure still require years of observation, extensive research, and answers to many questions. It is necessary to continue to deepen the knowledge and interest of many organizations, companies, and consumers around the world in order to make rational purchases as well as future choices, not only consumer ones.

The relationship between plasma prolactin levels and clinical manifestations with neuromyelitis optica spectrum disorders

INTRODUCTION

Systemic prolactin levels have been found to increase in 19 patients diagnosed with neuromyelitis optica spectrum disorders (NMOSD). However, the relationship between plasma prolactin levels and clinical manifestations in NMOSD patients remains unclear.

METHODS

This cross-sectional study was conducted as part of a Registered Cohort Study of Inflammatory Demyelination Disease (NCT04386018). A total of 95 patients diagnosed with central nervous system demyelinating diseases and 43 healthy controls were recruited between May 2020 and February 2022 at the First Affiliated Hospital of Fujian Medical University. Plasma samples were collected from all participants and analyzed for prolactin levels using electrochemiluminescence immunoassay. The study aimed to investigate the correlation between plasma prolactin levels and clinical features in patients with central nervous system demyelinating diseases.

RESULTS

Plasma prolactin levels in NMOSD patients were significantly higher than those in multiple sclerosis/myelin oligodendrocyte glycoprotein antibody-associated diseases patients and controls (p<0.05, respectively), and were found to be correlated with disease activity, sensory abnormalities, thoracic spinal cord lesions, and MR lesion enhancement (p<0.05). A total of 16.28% of NMOSD patients exhibited macroprolactinemia. However, there was no correlation found between macroprolactin levels and disease activity (p>0.05).

CONCLUSION

Prolactin may play a role in the pro-inflammatory regulation mechanism of NMOSD.

A randomized, double-blind study on the efficacy of oral domperidone versus placebo for reducing SARS-CoV-2 viral load in mild-to-moderate COVID-19 patients in primary health care

INTRODUCTION

The clinical effect of domperidone against COVID-19 has been investigated in a double-blind phase III clinical trial (EudraCT number 2021-001228-17). Domperidone has shown in vitro antiviral activity against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and potential immudolatory properties through the stimulation of prolactin secretion.

PATIENTS AND METHODS

The efficacy of oral domperidone plus standard of care (SOC; n = 87) versus placebo plus SOC (n = 86) was evaluated in a 28-day randomized double-blind multicentre study in primary health care centres. A total of 173 outpatients with mild-to-moderate COVID-19 were included. Three daily doses of 10 mg (30 mg/day) of domperidone or placebo were administered for 7 days. Reduction of viral load on day 4 was the primary efficay endpoint. It was estimated in saliva samples by reverse transcription-quantitative polymerase chain reaction (RT-qPCR), as the cycle thresholds detected ORF1ab, N Protein and S Protein genes.

RESULTS

A significant reduction in the viral load was observed (p < 0.001) from baseline to days 4, 7 and 14 of the three genes studied with non-significant differences between domperidone and placebo groups. Twenty-three patients (13.3%) experienced adverse events, 14 patients in the domperidone group (16.1%) and 9 patients in the placebo group (10.5%). No patients needed to be hospitalized.

CONCLUSION

Results do not prove the use of domperidone as antiviral in patients with COVID-19.

The effects of prolactin on the immune system, its relationship with the severity of COVID-19, and its potential immunomodulatory therapeutic effect

Prolactin (PRL) is an endocrine hormone secreted by the anterior pituitary gland that has a variety of physiological effects, including milk production, immune system regulation, and anti-inflammatory effects. Elevated levels of PRL have been found in several viral infections, including 2019 coronavirus disease (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV2), a viral pathogen that has recently spread worldwide. PRL production is increased in SARS-CoV2 infection. While PRL can trigger the production of proinflammatory cytokines, it also has several anti-inflammatory effects that can reduce hyperinflammation. The exact mechanism of PRL's contribution to the severity of COVID-19 is unknown. The purpose of this review is to discuss the interaction between PRL and SARS-CoV2 infection and its possible association with the severity of COVID-19.

Reduced Health Related Quality of Life, Increased Fatigue, and Daytime Sleepiness in Women with Hyperprolactinemia

Prolactin has many physiological effects and seems to be involved in the human quality of life and well-being. The aim of this study was to describe health related quality of life, fatigue and daytime sleepiness in women with untreated hyperprolactinemia. In total 32 women (mean age 37.0±10.9 years) with verified hyperprolactinemia completed a questionnaire including questions on fatigue, measured with the Swedish version of the Fatigue Impact Scale (FIS), propensity to fall in sleep, measured with the Swedish version of the Epworth Sleepiness Scale (ESS), and Health related quality of life (HRQoL), measured by the Short-Form-36 scale (SF-36). For comparison Swedish normative data were used. The women were also interviewed regarding different symptoms related to hyperprolactinemia and the answers were analyzed using qualitative content analysis. HRQoL, as measured with SF-36, was significantly lower in all dimensions, except in physical function, compared to the Swedish reference population. Total FIS was 54.3 (41.1) and mean score on the ESS was 8.7 (4.2) indicating increased fatigue and deterioration in night sleep. The women felt very tired, and several of them rarely felt rested in the morning. The restless night sleep and the fatigue during the daytime got them to feel feeble and sometimes to find it difficult to concentrate, which affected both their mood and life in general. Women diagnosed with hyperprolactinemia reported deterioration in night sleep, increased rate of fatigue, and a reduced health related quality of life in comparison with the reference population.

Modulatory role of prolactin in type 1 diabetes

OBJECTIVES

Patients with type 1 diabetes mellitus have been reported to have elevated prolactin levels and a possible relationship between prolactin levels and the development of the disease has been proposed. However, some studies show that prolactin mediates beneficial functions in beta cells. Therefore, we review information on the roles of prolactin in type 1 diabetes mellitus.

CONTENT

Here we summarize the functions of prolactin in the immune system and in pancreatic beta cells, in addition, we describe studies related to PRL levels, its regulation and alterations of secretion in patients with type 1 diabetes mellitus.

SUMMARY

Studies in murine models have shown that prolactin protects beta cells from apoptosis, stimulates their proliferation and promotes pancreatic islet revascularization. In addition, some studies in patients with type 1 diabetes mellitus have shown that elevated prolactin levels correlate with better disease control.

OUTLOOK

Prolactin treatment appears to be a promising strategy to improve beta-cell vascularization and proliferation in transplantation and immunotherapies.

The Involvement of Prolactin in Stress-Related Disorders

The most important and widely studied role of prolactin (PRL) is its modulation of stress responses during pregnancy and lactation. PRL acts as a neuropeptide to support physiological reproductive responses. The effects of PRL on the nervous system contribute to a wide range of changes in the female brain during pregnancy and the inhibition of the hypothalamic-pituitary axis. All these changes contribute to the behavioral and physiological adaptations of a young mother to enable reproductive success. PRL-driven brain adaptations are also crucial for regulating maternal emotionality and well-being. Hyperprolactinemia (elevated PRL levels) is a natural and beneficial phenomenon during pregnancy and lactation. However, in other situations, it is often associated with serious endocrine disorders, such as ovulation suppression, which results in a lack of offspring. This introductory example shows how complex this hormone is. In this review, we focus on the different roles of PRL in the body and emphasize the results obtained from animal models of neuropsychiatric disorders.

Prolactin Relationship with Fertility and In Vitro Fertilization Outcomes-A Review of the Literature

Hyperprolactinemia is a known cause of amenorrhea and infertility. However, there is an increasing body of evidence suggesting that prolactin is involved in multiple physiological aspects of normal reproduction. Thus, the present paper aims to review the current literature regarding the relationship between serum prolactin level and in vitro fertilization (IVF)/intracytoplasmic sperm injection outcome and the role of dopamine agonists treatment in IVF success. Moreover, the mechanisms by which prolactin may exert its role in fertility and infertility were summarized. Although not all studies agree, the available evidence suggests that higher prolactin levels in follicular fluid are associated with increased oocytes competence, but also with positive effects on corpus luteum formation and survival, endometrial receptivity, blastocyst implantation potential and survival of low-motile sperm. Transient hyperprolactinemia found in IVF cycles was reported in most of the studies not to be related to IVF outcome, although a few reports suggested that it may be associated with higher implantation and pregnancy rates, and better-cumulated pregnancy outcomes. Administration of dopamine agonists for hyperprolactinemia preceding IVF treatment does not seem to negatively impact the IVF results, while treatment of transient hyperprolactinemia during IVF might be beneficial in terms of fertilization rates and conception rates. Due to limited available evidence, future studies are necessary to clarify the optimal level of circulating prolactin in patients performing IVF and the role of dopamine agonist treatment.

The emerging role of noncoding RNAs in systemic lupus erythematosus: new insights into the master regulators of disease pathogenesis

Auto-immune diseases are a form of chronic disorders in which the immune system destroys the body's cells due to a loss of tolerance to self-antigens. Systemic lupus erythematosus (SLE), identified by the production of autoantibodies in different body parts, is one of the most well-known examples of these diseases. Although the etiology of SLE is unclear, the disease's progression may be affected by genetic and environmental factors. As studies in twins provide adequate evidence for genetic involvement in the SLE, other phenomena such as metallization, histone modifications, and alterations in the expression of noncoding RNAs (ncRNAs) also indicate the involvement of epigenetic factors in this disease. Among all the epigenetic alterations, ncRNAs appear to have the most crucial contribution to the pathogenesis of SLE. The ncRNAs' length and size are divided into three main classes: micro RNAs, long noncoding RNAs (LncRNA), and circular RNAs (circRNAs). Accumulating evidence suggests that dysregulations in these ncRNAs contributed to the pathogenesis of SLE. Hence, clarifying the function of these groups of ncRNAs in the pathophysiology of SLE provides a deeper understanding of the disease. It also opens up new opportunities to develop targeted therapies for this disease.

Evaluation of the relationship between the morphometric structure of the pituitary gland and fatigue in patients with multiple sclerosis

BACKGROUND

The correlation between fatigue and disability in multiple sclerosis (MS) with the hypothalamus-pituitary-adrenal axis is known. This study aimed to investigate the relationship between the morphometric dimensions of the pituitary gland with fatigue and disability.

METHOD

This research, designed as a prospective and case-control study, included 85 MS patients and 45 healthy controls. The disability was evaluated using the expanded disability rating scale (EDSS), while fatigue was determined using the fatigue severity scale (FSS) and the neurological fatigue index (NFI-MS). The morphometric structure of the pituitary gland was measured using a coronal, T2-weighted, turbo-spin-echo sequence of magnetic resonance imaging.

RESULTS

FSS and NFI-MS scores were higher in MS patients than in the control group (p = 0.001). Patients with a progressive and moderate-to-severe disability had a higher FSS score (p = 0.015; p = 0.002, respectively). A positive correlation was determined between disease duration, attack frequency, and EDSS and physical fatigue subscale score (p = 0.001; r = 0.383; 0.373; 0.545, respectively). The height and width of the pituitary gland were higher in MS patients (p = 0.021; p = 0.001, respectively). Pituitary gland height was higher in fatigued patients (p = 0.041). A low-positive correlation was determined between the number of attacks and the height of the pituitary gland (p = 0.027, r = 0.231).

CONCLUSION

The difference in the dimensions of the pituitary gland in MS patients, especially in the fatigued group, supports the relationship of fatigue with morphometric features as well as the hypothalamus-pituitary-adrenal axis.

Urticaria in Pregnancy and Lactation

Chronic urticaria (CU) is a mast cell-driven chronic inflammatory disease with a female predominance. Since CU affects mostly females in reproductive age, pregnancy is an important aspect to consider in the context of this disease. Sex hormones affect mast cell (MC) biology, and the hormonal changes that come with pregnancy can modulate the course of chronic inflammatory conditions, and they often do. Also, pregnancy-associated changes in the immune system, including local adaptation of innate and adaptive immune responses and skewing of adaptive immunity toward a Th2/Treg profile have been linked to changes in the course of inflammatory diseases. As of now, little is known about the effects of pregnancy on CU and the outcomes of pregnancy in CU patients. Also, there are no real-life studies to show the safety of urticaria medications during pregnancy. The recent PREG-CU study provided the first insights on this and showed that CU improves during pregnancy in half of the patients, whereas it worsens in one-third; and two of five CU patients experience flare-ups of their CU during pregnancy. The international EAACI/GA2LEN/EuroGuiDerm/APAAACI guideline for urticaria recommends adopting the same management strategy in pregnant and lactating CU patients; starting treatment with standard doses of second-generation (non-sedative) H1 antihistamines, to increase the dose up to 4-folds in case of no response, and to add omalizumab in antihistamine-refractory patients; but also emphasizes the lack of evidence-based information on the safety and efficacy of urticaria treatments during pregnancy. The PREG-CU study assessed treatments and their outcomes during pregnancy. Here, we review the reported effects of sex hormones and pregnancy-specific immunological changes on urticaria, we discuss the impact of pregnancy on urticaria, and we provide information and guidance on the management of urticaria during pregnancy and lactation.

Modified techniques versus Hadfield's procedure in patients with periductal mastitis

BACKGROUND

Periductal mastitis (PM) is a rare disease characterized by chronic inflammation of the terminal mammary ducts. Complete removal of terminal lactiferous ducts with Hadfield procedure is a previously defined technique in treatment but carries various complications risks. This study aims to evaluate the effectiveness of modified techniques in the treatment of PM.

METHODS

Twenty women who underwent surgery due to PM between January 2012 and December 2019 were retrospectively analyzed. Types of PM were determined. All patients were operated on with three different incisions [Hadfield's operation with periareolar incision (n:11), periareolar combined radial incision (n:7), and round block incision (n:2)].

RESULTS

The mean age was 37.5 ± 6.5 years (range: 24-49). Sixty percent of patients had type 3 PM. In Hadfield's procedure, NAC retraction (n:2), seroma (n:1), and hematoma (n:1) were seen. In the periareolar incision combined radial incision group only one patient had complications (seroma) and none in the round block method. Follow-up was 12 ± 1.5 months and disease relapse occurred in two patients in the Hadfield group. Patients who underwent round block were more satisfied with the appearance of the nipple.

CONCLUSIONS

In the treatment of PM, the main principle of surgical treatment is the excision of the affected canal with a clear margin. Apart from the classical Hadfield procedure, the round block method and periareolar combined radial incision techniques can be performed in the treatment of PM.

A bibliometric review of peripartum cardiomyopathy compared to other cardiomyopathies using artificial intelligence and machine learning

As developments in artificial intelligence and machine learning become more widespread in healthcare, their potential to transform clinical outcomes also increases. Peripartum cardiomyopathy is a rare and poorly-characterised condition that presents as heart failure in the last trimester prior to delivery or within 5-6 months postpartum. The lack of a definitive understanding of the molecular causes and clinical progress of this condition suggests that bibliometrics will be well-suited to creating new insights into this serious clinical problem. We examine similarities and differences between peripartum and its closely related familial dilated cardiomyopathy and idiopathic dilated cardiomyopathy. Using PubMed as the source of bibliometric data, we apply artificial intelligence-supported natural language processing to compare extracted data and genes association with these cardiomyopathies. Gene data were enhanced with additional metadata from third-party datasets and then analysed for their impact and specificity for peripartum cardiomyopathy. Artificial intelligence identified 14 genes that distinguished peripartum from both dilated and familial dilated cardiomyopathy. They are as follows: CTSD, RLN2, MMP23B*, SLC17A5, ST2*, PTHLH, CFH*, CFI, GPT, MR1, Rln1, SRI, STAT5A* and THBD. We then used the Human Protein Atlas website that uses affinity-purified rabbit polyclonal antibodies to identify genes that are expressed at the protein level (bold), or as RNA transcripts (*) in healthy human left ventricles. Additional analysis focussed on the full set of peripartum genes on linkage and specificity to cardiomyopathy yielded a different set of thirteen genes (bold font indicates those expressed in cardiomyocytes: PRL, RLN2, PLN, ST2, CTSD, F2, ACE, STAT3, TTN, SPP1, LGALS3, miR-146a, GNB3, SRI). This type of analysis can highlight new avenues for research, aimed at improving genomics-driven peripartum cardiomyopathy diagnosis as well as potential pathological and clinical sub-classification. We expect that this will allow for future improvements in identification, treatment and management of this condition. The first step in the application of these bibliometric-based artificial intelligence methods is to understand the current knowledge, and it is the aim of this paper to show how this might be achieved.

Association between Serum Prolactin Levels and Neurodegenerative Diseases: Systematic Review and Meta-Analysis

INTRODUCTION

Prolactin (PRL) exerts inflammatory and anti-inflammatory properties and is also thought to play an important role in the pathogenesis of neurodegenerative diseases (NDs). However, serum PRL levels in patients with NDs were inconsistent in the research literature.

OBJECTIVE

We aimed to assess the serum PRL levels in patients with NDs.

METHODS

Electronic databases, including MEDLINE, Embase, Cochrane Library database, clinicaltrials.gov, Web of Science, and Google Scholar, and reference lists of articles were searched up to December 31, 2020. Pooled standard mean difference (SMD) with 95% confidence interval (CI) was calculated by fixed-effect or random-effect model analysis.

RESULTS

A total of 36 comparisons out of 29 studies (3 RCTs and 26 case controls) focusing on NDs (including Parkinson's disease, Alzheimer's disease, Huntington's disease [HD], multiple sclerosis [MS], and epilepsy) were reported. The meta-analysis showed that there was no statistically significant difference in serum PRL levels between patients with NDs and healthy controls (SMD = 0.40, 95% CI: -0.16 to 0.96, p = 0.16). Subgroup analysis showed that serum PRL levels in patients with HD and MS were higher than those of healthy controls. Furthermore, patients with NDs aged <45 years had higher serum PRL levels (SMD = 0.97, 95% CI: 0.16-1.78, p = 0.018) than healthy controls. High serum PRL levels were found in subgroups such as the microenzymatic method, Asia, and the Americas.

CONCLUSIONS

Our meta-analysis showed serum PRL levels in patients with HD and MS were significantly higher than those in healthy controls. Serum PRL levels were associated with age, region, and detection method. Other larger sample studies using more uniform detection methods are necessary to confirm our results.

Prolactin and Its Altered Action in Alzheimer's Disease and Parkinson's Disease

BACKGROUND

Prolactin (PRL) is one of the most diverse pituitary hormones and is known to modulate normal neuronal function and neurodegenerative conditions. Many studies have described the influence that PRL has on the central nervous system and addressed its contribution to neurodegeneration, but little is known about the mechanisms responsible for the effects of PRL on neurodegenerative disorders, especially on Alzheimer's disease (AD) and Parkinson's disease (PD).

SUMMARY

We review and summarize the existing literature and current understanding of the roles of PRL on various PRL aspects of AD and PD.

KEY MESSAGES

In general, PRL is viewed as a promising molecule for the treatment of AD and PD. Modulation of PRL functions and targeting of immune mechanisms are needed to devise preventive or therapeutic strategies.

Sex Differences in Otolaryngology: Focus on the Emerging Role of Estrogens in Inflammatory and Pro-Resolving Responses

Otolaryngology (also known as ear, nose, and throat (ENT)) diseases can be significantly affected by the level of sex hormones, which indicates that sex differences affect the manifestation, pathophysiology, and outcomes of these diseases. Recently, increasing evidence has suggested that proinflammatory responses in ENT diseases are linked to the level of sex hormones. The sex hormone receptors are present on a wide variety of immune cells; therefore, it is evident that they play crucial roles in regulating the immune system and hence affect the disease progression of ENT diseases. In this review, we focus on how sex hormones, particularly estrogens, regulate ENT diseases, such as chronic rhinosinusitis, vocal fold polyps, thyroid cancer, Sjögren’s syndrome, and head and neck cancers, from the perspectives of inflammatory responses and specialized proresolving mediator-driven resolution. This paper aims to clarify why considering sex differences in the field of basic and medical research on otolaryngology is a key component to successful therapy for both males and females in the future.

Is Adjunct Aripiprazole Effective in Treating Hyperprolactinemia Induced by Psychotropic Medication? A Narrative Review

Psychotropic medication treatment can cause elevated serum prolactin levels and hyperprolactinaemia (HPRL). Reports have suggested that aripiprazole may decrease elevated prolactin. The aim of this review was to assess evidence for the efficacy of adjunct aripiprazole in the treatment of psychotropic-induced HPRL. PubMed and Google Scholar were searched to identify randomised placebo-controlled trials (RCTs) of adjunct aripiprazole in patients with HPRL attributed to primary psychotropic medications. Data for individual patients from case studies, chart reviews and open-label studies were also identified and assessed. Six RCTs, with a total of 609 patients, met inclusion criteria. Primary psychotropics included risperidone, haloperidol, paliperidone, fluphenazine and loxapine. Reductions in prolactin from baseline, before the introduction of aripiprazole, were significantly greater for adjunct aripiprazole than for adjunct placebo in all the studies (p = 0.04 to p < 0.0001). Normalisation of serum prolactin levels was significantly more likely with adjunct aripiprazole than adjunct placebo (p = 0.028 to p < 0.001, data from three studies). Improvement or resolution of HPRL-related symptoms (galactorrhoea, oligomenorrhoea, amenorrhoea and sexual dysfunction) were reported in three studies. Prolactin levels decreased in all case reports and in both of two open-label studies; they normalised in 30/41 patients (73.2%) in case studies and 12/29 (41.4%) in the open-label studies. Adjunct aripiprazole was statistically significantly effective in treating elevated serum prolactin levels in six RCTs. Evidence from case reports and open-label studies suggests a degree of effectiveness in most patients.

Prolactin-Releasing Peptide Differentially Regulates Gene Transcriptomic Profiles in Mouse Bone Marrow-Derived Macrophages

Prolactin-releasing Peptide (PrRP) is a neuropeptide whose receptor is GPR10. Recently, the regulatory role of PrRP in the neuroendocrine field has attracted increasing attention. However, the influence of PrRP on macrophages, the critical housekeeper in the neuroendocrine field, has not yet been fully elucidated. Here, we investigated the effect of PrRP on the transcriptome of mouse bone marrow-derived macrophages (BMDMs) with RNA sequencing, bioinformatics, and molecular simulation. BMDMs were exposed to PrRP (18 h) and were subjected to RNA sequencing. Differentially expressed genes (DEGs) were acquired, followed by GO, KEGG, and PPI analysis. Eight qPCR-validated DEGs were chosen as hub genes. Next, the three-dimensional structures of the proteins encoded by these hub genes were modeled by Rosetta and Modeller, followed by molecular dynamics simulation by the Gromacs program. Finally, the binding modes between PrRP and hub proteins were investigated with the Rosetta program. PrRP showed no noticeable effect on the morphology of macrophages. A total of 410 DEGs were acquired, and PrRP regulated multiple BMDM-mediated functional pathways. Besides, the possible docking modes between PrRP and hub proteins were investigated. Moreover, GPR10 was expressed on the cell membrane of BMDMs, which increased after PrRP exposure. Collectively, PrRP significantly changed the transcriptome profile of BMDMs, implying that PrRP may be involved in various physiological activities mastered by macrophages.

SARS-CoV-2 Pneumonia Affects Male Reproductive Hormone Levels: A Prospective, Cohort Study

BACKGROUND

SARS-CoV-2 which causes coronavirus disease 2019 (COVID-19) binds to angiotensin-converting enyzme 2 (ACE2) and enters the host cell. ACE2 protein is expressed highly in the testis.

AIM

The aim of this study was to compare male reproductive hormones such as total testosterone (TT), luteinizing hormone (LH), follicular stimulant hormone (FSH), and prolactin between patients with COVID-19, age-matched cases with non-COVID-19 respiratory tract infection, and age-matched controls.

METHODS

This was a prospective cohort study and included 262 men aged between 20 and 65 years. The study comprised 3 groups including patients with COVID-19 (n = 89), cases with non-COVID-19 respiratory tract infection (n = 30), and age-matched controls (n = 143). All cases were evaluated using TT, LH, FSH, and prolactin. Correlations between TT and clinical parameters of patient groups were investigated using Pearson's correlation test.

OUTCOMES

The primary outcome of the study was detection of the difference of TT, FSH, LH, and prolactin levels between the groups. Secondary outcome was to correlate TT and hospitalization time and oxygen saturation on hospital admission (SpO2) of patients.

RESULTS

The mean age of study groups was 49.9 ± 12.5 years, 52.7 ± 9.6 years, and 50 ± 7.8 years, respectively (P = .06). Serum TT levels was median 185.52 ng/dL in patients with COVID-19, median 288.67 ng/dL in patients with non-COVID-19 respiratory tract infection and median 332 ng/dL in control cases, (P < .0001). The proportion of patients with testosterone deficiency in group 1, group 2, and group 3 was 74.2%, 53.3%, and 37.8%, respectively (P < .0001). Serum LH levels (P = 0.0003) and serum prolactin levels (P = .0007) were higher in patients with COVID-19 and patients with non-COVID-19 respiratory tract infection than control cases. Correlation analysis revealed significant negative correlation between serum TT levels and hospitalization time of patients with COVID-19 (r = -0.45, P < .0001). In addition, a significant positive correlation was observed between SpO2 and serum TT levels in patients with COVID-19 ( r = 0.32, P = .0028).

CLINICAL IMPLICATIONS

Physicians may consider to evaluate male patients with COVID-19 for concomitant androgen deficiency.

STRENGTHS & LIMITATIONS

Strengths include the evidence about the alteration of male reproductive hormones under COVID-19. Limitations include the analysis limited to one general hospital, only a single measurement of TT was available, free and bioavailable testosterone levels were not evaluated.

CONCLUSION

This study demonstrates COVID-19 is associated with decreased level of TT and increased level of LH and prolactin. More serious COVID-19 causes more reduction in TT levels and prolongs hospitalization period. Kadihasanoglu M, Aktas S, Yardimci E, et al. SARS-CoV-2 Pneumonia Affects Male Reproductive Hormone Levels: A Prospective, Cohort Study. J Sex Med 2021;18:256-264.

Serum prolactin in patients with relapsing remitting multiple sclerosis

Background

Multiple sclerosis (MS) is an inflammatory demyelinating disorder that affects the central nervous system (CNS) of females more than males. The objective of the current study was to assess serum level of prolactin (PRL) and tumor necrosis factor alpha (TNFα) in patients with relapsing remitting multiple sclerosis (RRMS) and to explore their role in disease activity.

Subjects and methods

Fifty females were included in this study, 40 patients with RRMS were evaluated during relapse and remission and 10 age-matched healthy subjects who served as controls. All patients were subjected to neurological evaluation including Expanded Disability Status Scale (EDSS), brain, and spine magnetic resonance image (MRI); serum PRL and TNFα levels were measured for all patients (during relapse and remission) and controls.

Results

Median serum PRL level was significantly higher in MS patients during relapse than remission and control subjects (P = 0.041). TNFα level was significantly higher in MS patients in relapse than remission (P = 0.026) as well as the healthy controls (P = 0.001). The area under the receiver operating characteristic curve (AUROC) was analyzed for prediction of MS relapse, AUROC of serum TNFα was 0.811 and that of serum PRL was 0.678. Both serum PRL and TNFα were positively correlated in MS patients in relapse with each other (r = 0.672, P < 0.001) and also with age, EDSS, number of relapses, and MRI lesion number (P value = 0.001).

Conclusion

Elevated serum PRL and TNFα levels are associated with relapse in MS patients. Moreover, they are positively correlated with EDSS, disease duration, and MRI lesion number.

Impact of oral contraceptives and breastfeeding on disease activity in a sample of Egyptian rheumatoid arthritis patients

Background

Women are more affected by rheumatoid arthritis (RA) than men and the incidence of RA in women increases around the age of menopause indicating that hormonal factors may have a role in disease pathogenesis and progression. Despite several studies on the role of sex hormones and oral contraceptives (OCs) in RA patients, the effect of combined oral contraceptives on RA disease activity is still controversial, and since few studies have been performed in Egypt on this issue so we aimed to study the effect of OCs, breastfeeding, and prolactin on disease activity and their relation to the titer of autoantibodies in female Egyptian RA patients.

Results

One hundred twenty married female RA patients were classified into three groups based on the OCs use (n = 40 each); current, past and non-users and according to lactation into three groups; lactating using OCs (n = 22), lactating not using OCs (n = 30), and non-lactating (n = 68). Our patients were using combined estrogen-progestin oral contraceptives. Clinical manifestations, disease activity, and laboratory findings were determined. The clinical manifestations including arthritis, and morning stiffness were significantly reduced in current users in comparison to past and non-users. Mean DAS28 was reduced significantly (p < 0.05) in current and past users of OCs. Also, using OCs during lactation reduced the clinical manifestations significantly. Lactating women who were not using OCs had significantly high DAS28 and ESR (p < 0.05) in comparison to lactating using OCs and non-lactating. On the other hand, using OCs reduced serum prolactin significantly. Lactating women not using OCs had significantly high serum prolactin (p < 0.05) and (p < 0.001) in comparison to lactating using OCs and non-lactating respectively which was correlated with DAS28 score.

Conclusion

Oral contraceptives may be considered in RA female patients not only as a suitable birth control method but also it has a controlling effect on disease activity even during lactation.

Message

Oral contraceptives ameliorate disease activity in RA patients

Repurposing prolactin as a promising immunomodulator for the treatment of COVID-19: Are common Antiemetics the wonder drug to fight coronavirus?

Prolactin (PRL), the well-known lactogenic hormone, plays a crucial role in immune function given the fact that long term hypoprolactinemia (serum prolactin level below normal) can even lead to death from opportunistic infection. High blood PRL level is known to provide an immunological advantage in many pathological conditions (with some exceptions like autoimmune diseases) and women, because of their higher blood PRL level, get an advantage in this regard. It has been reported that by controlled enhancement of blood PRL level (within the physiological limit and in some cases a little elevated above the normal to induce mild hyperprolactinemia) using dopamine antagonists such immune-stimulatory advantage can led to survival of the patients in many critical conditions. Here it is hypothesized that through controlled augmentation of blood PRL level using dopamine antagonists like domperidone/metoclopramide, which are commonly used drugs for the treatment of nausea and vomiting, both innate and adaptive immunity can be boosted to evade or tone down COVID-19. The hypothesis is strengthened from the fact that at least seven little-understood salient observations in coronavirus patients can apparently be explained by considering the role of enhanced PRL in line with the proposed hypothesis and hence, clinical trials (both therapeutic and prophylactic) on the role of enhanced PRL on the course and outcome of coronavirus patients should be conducted accordingly.

Prolactin, a potential biomarker for chronic GVHD activity

INTRODUCTION

The polypeptide prolactin (PRL) is a peptide hormone and a cytokine mostly secreted from the anterior pituitary gland. PRL is also synthesized in extra pituitary tissues including thymocytes and T lymphocytes. Considering the need for chronic GVHD (cGVHD) biomarkers, we explored the relationship between hyperprolactinemia and active cGVHD in a cohort of long-term post-alloHCT survivors.

METHODS

Three-hundred sixteen adults underwent alloHCT between 2010 and 2016, survived more than 1 year and were included. All patients underwent a regular annual assessment that includes a hormone profile with serum PRL levels.

RESULTS

Overall, 236 (74.7%) patients had cGVHD, and in 199 (63%), the grade was moderate or severe. Sixty-five (21%) recipients had active cGVHD at the time of the annual evaluation, and hyperprolactinemia was documented in 63 (19.9%) patients. Hyperprolactinemia correlated with cGVHD activity (Odds Ratio 6.9 (95% CI; 3.6-13.1); P < .001) in the multivariate analysis. In conclusion, patients with hyperprolactinemia were 6.4 times more likely to have active cGVHD in comparison with those patients with normal levels of PRL (P < .001).

CONCLUSION

Prolactin may serve as a biomarker for cGVHD activity. Further studies are required to confirm these findings, and to explore if hyperprolactinemia has an impact on cGVHD severity and prognosis.

Hypothesis: Rheumatoid arthritis and periodontitis: A new possible link via prolactin hormone

Rheumatoid arthritis and periodontitis are two common chronic inflammatory diseases affecting human population worldwide. The association between the two conditions have been the focus of many researches, trying to explore the possible mechanisms underlying this association. Prolactin hormone, besides its known lactogenic effects acts as a cytokine secreted from various tissues other than the pituitary gland with multiple pleotropic actions in immunity and inflammation. Several data showed that prolactin levels are increased significantly in the synovial and periodontal tissues, and this increase is correlated with disease activity and tissue destruction. Our hypothesis suggests that local prolactin can represent a link between the two conditions. In this work, we suggest a possible mechanistic interactions, hypothesized to form a common path linking between rheumatoid arthritis, periodontitis and prolactin. This is because of the need to develop new treatment strategies for the most effective long term control of inflammation in both conditions.

The Influence of Pregnancy on the Clinical Evolution and Prognosis of Pre-Existing Inflammatory and Autoimmune Skin Disorders and Their Management

BACKGROUND

Although the possible occurrence of typical dermatoses during pregnancy is well recognized, little is known about the influence of pregnancy on the clinical evolution and prognosis of different pre-existing chronic dermatological disorders.

SUMMARY

In this study a comprehensive search of the available literature and reviews has been undertaken in order to collect and analyze articles reporting pre-existing chronic skin disorders in pregnant women and report current knowledge on their particular clinical and therapeutic aspects.

Dolichosin A, a coumestan isolated from Glycine tabacina, inhibits IL-1β-induced inflammation in SW982 human synovial cells and suppresses RANKL-induced osteoclastogenesis: From network pharmacology to experimental pharmacology

ETHNOPHARMACOLOGICAL RELEVANCE

Glycine tabacina (Labill.) Benth has been used as a traditional Chinese herbal medicine for the treatment of rheumatoid arthritis (RA) and joint infection. It is also one of the sources of the renowned native herbal medicine 'I-Tiao-Gung' in Taiwan.

AIM OF THE STUDY

This study aimed to investigate anti-arthritic effects and underlying mechanisms of dolichosin A (DoA), a coumestan compound isolated from G. tabacina, by the integration of network pharmacology and experimental pharmacology.

MATERIALS AND METHODS

Putative therapeutic targets and potential pharmacological mechanisms of DoA for RA treatment were predicted by network pharmacology approach. The regulated network of DoA acting on RA was constructed using Cytoscape 3.7.1. Anti-arthritic effects of DoA and predicted mechanisms were further validated using IL-1β-induced SW982 human synovial cell model and RANKL-induced osteoclastogenesis model.

RESULTS

A regulatory network of DoA-targets-pathways-RA was successfully constructed using network pharmacology approach. In this network, 65 candidate targets of DoA related to its therapeutic effect on RA were identified and the functional enrichment analysis revealed that these candidate targets were significantly involved in 12 central signaling pathways such as PI3K/AKT pathway, MAPK pathway and osteoclast differentiation. Furthermore, we found that DoA could significantly inhibit IL-1β-induced inflammation in SW982 human synovial cells, as evidenced by the decreased levels of pro-inflammatory mediators (TNF-α, IL-6 and COX-2) and MMP-3. DoA also suppressed RANKL-induced osteoclastogenesis in vitro, as evidenced by decreased number of TRAP-positive multinucleated osteoclasts and reduced TRAP activity. Further experimental mechanism evidence confirmed the predicted results of network pharmacology that the blockade of PI3K/AKT and MAPK pathways activation was closely associated with these regulated processes of DoA.

CONCLUSIONS

Our results demonstrated that DoA exhibited strong anti-arthritic activity through suppressing PI3K/AKT and MAPK pathways activation in activated synovial cells and osteoclasts, suggesting its potential as a hopeful candidate for the development of novel agents for the prevention and treatment of RA.

Hyperprolactinaemia

Hyperprolactinaemia is one of the most common problems in clinical endocrinology. It relates with various aetiologies (physiological, pharmacological, pathological), the clarification of which requires careful history taking and clinical assessment. Analytical issues (presence of macroprolactin or of the hook effect) need to be taken into account when interpreting the prolactin values. Medications and sellar/parasellar masses (prolactin secreting or acting through “stalk effect”) are the most common causes of pathological hyperprolactinaemia. Hypogonadism and galactorrhoea are well-recognized manifestations of prolactin excess, although its implications on bone health, metabolism and immune system are also expanding. Treatment mainly aims at restoration and maintenance of normal gonadal function/fertility, and prevention of osteoporosis; further specific management strategies depend on the underlying cause. In this review, we provide an update on the diagnostic and management approaches for the patient with hyperprolactinaemia and on the current data looking at the impact of high prolactin on metabolism, cardiovascular and immune systems.

Prolactin and autoimmunity: The hormone as an inflammatory cytokine

Nowadays, more than 80 autoimmune disorders are recognized, in which an aberrant immune response against different organs and tissues plays a crucial role. Hormonal homeostasis has great influence in achieving competent and healthy immune system function. Prolactin has a bioactive function acting as a hormone and a cytokine. It influences the immune system modulation, mainly inhibiting the negative selection of autoreactive B lymphocytes. Hyperprolactinemia has been detected in many patients with different autoimmune diseases, such as rheumatoid arthritis, systemic lupus erythematosus, Sjögren syndrome, multiple sclerosis, autoimmune thyroid disease, systemic sclerosis, among others, and its believed to play a crucial role in disease pathogenesis. A direct correlation between prolactin levels and disease activity was not clear. Genetic factors may have a role in humans as in animal models. Dopamine agonists have proven to offer clinical benefits among autoimmune patients and represent a promising therapy to be explored. In this review, the authors attempt to provide a critical overview on the role of prolactin in the immune system, exploring its contribution to the development of autoimmune diseases.

Exacerbations of autoimmune diseases during pregnancy and postpartum

Autoimmune diseases represent a complex heterogeneous group of disorders that occur as a results of immune homeostasis dysregulation and loss of self-tolerance. Interestingly, more than 80% of the cases are found among women at reproductive age. Normal pregnancy is associated with remarkable changes in the immune and endocrine signaling required to tolerate and support the development and survival of the placenta and the semi-allogenic fetus in the hostile maternal immune system environment. Gravidity and postpartum represent an extremely challenge period, and likewise the general population, women suffering from autoimmune disorders attempt pregnancy. Effective preconception counseling and subsequent gestation and postpartum follow-up are crucial for improving mother and child outcomes. This comprehensive review provides information about the different pathways modulating autoimmune diseases activity and severity, such as the influence hormones, microbiome, infections, vaccines, among others, as well as updated recommendations were needed, in order to offer those women better medical care and life quality.

Autoimmune phenomena involving the pituitary gland in children: New developing data about diagnosis and treatment

The contribution of autoimmune phenomena to dysfunction of hypophysis or hypothalamus is far to be unraveled and also the specific pathways of hypophysitis are poorly understood until now, mostly for the pediatric population. Primary hypophysitis is rare in children and often regarded as an autoimmune disorder, following the evidence of lymphoplasmacytic infiltration in the pituitary gland, detection of anti-pituitary antibodies (APA) and anti-hypotalamus antibodies (AHA) by indirect immunofluorescence on cryostatic sections of human or primate hypophysis and hypothalamus, and coexistence with other autoimmune disorders. The rarity of this condition and the lack of ad hoc studies make hard any assessment of the real incidence of hypophysitis in pediatric patients, and also the role of APA and AHA has been poorly investigated in children with idiopathic hypopituitarism. Potential target autoantigens studied in autoimmune hypophysitis have been various pituitary-specific factors, chaperone proteins, alpha-enolase, secretogranins, chorionic somatomammotropin and intracellular transcription factors. Many clinical features both endocrine and neurologic or systemic can herald the onset of autoimmune hypophysitis. Antidiuretic hormone deficiency with central diabetes insipidus and growth retardation are the most significant presenting symptoms in children with hypophysitis, requiring a careful differential diagnosis with other causes of hypopituitarism, including tumors of the sellar region, differently from adults in whom adrenal insufficiency, hypogonadism, headache or diplopia might be the leading manifestations. Growth hormone deficiency is found in 3/4 of pediatric cases. Five histologic variants of primary hypophysitis have been described: lymphocytic, granulomatous, xanthomatous, IgG4-related and necrotizing: lymphocytic hypophysitis is the most frequent variant in the pediatric sceneries. Children with diagnosis of hypophysitis are also at risk of developing germinomas later in life, and require an extended follow-up in the long-term. Therapeutic options should be differentiated according to the rapidity of disease progression and modality of clinical onset, as acute pictures might require corticosteroids or immunosuppressant agents, while chronic forms may need a conservative management or appropriate hormone replacement therapies. This review updates and summarizes the most recent information related to the autoimmune involvement of hypophysis and hypothalamus in children, discusses the correlations between APA, AHA and disease activity, as well as the recommendations for treatment of primary hypophysitis from the pediatric perspective.

Updated advances of linking psychosocial factors and sex hormones with systemic lupus erythematosus susceptibility and development

Systemic lupus erythematosus (SLE) is a systemic autoimmune disease that primarily affects women, especially those of reproductive age. Genetics, environment, and gene-environment interactions play key roles in the development of SLE. Despite the numerous susceptibility genes of SLE identified to date, gene therapy is far from a clinical reality. Thus, more attention should be paid to the risk factors and underlying mechanisms of SLE. Currently, it is reported that psychosocial factors and sex hormones play vital roles in patients with SLE, which still need further investigated. The purpose of this review is to update the roles and mechanisms of psychosocial factors and sex hormones in the susceptibility and development of SLE. Based on review articles and reports in reputable peer-reviewed journals and government websites, this paper summarized psychosocial factors (e.g., alexithymia, depression, anxiety, negative emotions, and perceived stress) and sex hormones (e.g., estrogens, progesterone, androgens, and prolactin) involved in SLE. We further explore the mechanisms linking these factors with SLE susceptibility and development, which can guide the establishment of practical measures to benefit SLE patients and offer new ideas for therapeutic strategies.

Hyperprolactinemia is associated with a high prevalence of serum autoantibodies, high levels of inflammatory cytokines and an abnormal distribution of peripheral B-cell subsets

PURPOSE

Hyperprolactinemia (HPRL) has been reported in many autoimmune diseases. However, the serum autoantibody profile and peripheral B-cell subset distribution in women with HPRL are largely unknown. The current study aimed to investigate the autoantibody prevalence and cytokine levels as well as to further explore the B-cell subset distribution in women with HPRL.

METHODS

Sera from 202 women with HPRL and 97 healthy women were included in this study. All sera were examined for prolactin (PRL), anti-nuclear antibody (ANA), rheumatoid factor, anticardiolipin (ACL), immunoglobulin G, immunoglobulin M, complement 3, complement 4, interleukin 4 (IL-4) and interleukin 6 (IL-6). Peripheral blood was collected from 22 women with HPRL and 19 healthy women, and B-cell subsets were measured by flow cytometry.

RESULTS

At least one autoantibody was found in 47 out of 202 women with HPRL compared with 9 of 97 healthy women (p < 0.001). The levels of IL-4 (p < 0.0001) and IL-6 (p < 0.0001) were significantly higher in women with HPRL than in healthy women. The percentages of naive IgD⁺IgM^- B cells (B_ND cells, p < 0.0001), antibody-secreting cells (p = 0.007) and unswitched memory B cells (p = 0.004) among the total B cells from HPRL women were significantly higher than those from healthy women.

CONCLUSIONS

Women with HPRL had a higher prevalence of autoantibodies, higher serum levels of IL-4 and IL-6, and more B_ND cells, antibody-secreting B cells and unswitched memory B cells than healthy women. These data imply that a high level of PRL is associated with autoimmune diseases.

Autoimmune thyroid diseases are more common in patients with prolactinomas: a retrospective case-control study in an Italian cohort

BACKGROUND

Prolactin may exert immunological effects. Over the years, a higher prevalence of autoimmune thyroid diseases (ATD) has been reported in patients with prolactinomas (PRLs) in areas with sufficient iodine intake.

PURPOSE

The aim of our study was to evaluate the prevalence of ATD [Graves' disease (GD) and chronic autoimmune thyroiditis (AIT)] in a retrospective cohort of Italian patients with PRLs compared to a sex-matched control group, represented by subjects with non-functioning pituitary adenoma (NFPA) or empty sella (ES).

MATERIALS AND METHODS

We enrolled 149 patients (108 F/41 M) with PRLs (110 micro/39 macro) and 143 subjects (100 F/43 M) with NFPA (n = 96, 56 micro/40 macro) or ES (n = 47), with normal serum prolactin. Neck ultrasound and thyroid function tests (anti-thyroid antibodies, TSH, FT3 and FT4) were performed in all patients.

RESULTS

In PRLs, median serum prolactin was significantly higher (98.3 vs. 8.9 ng/ml, p ≤ 0.0001), while age was lower (34 vs. 46 years, p ≤ 0.001) compared to controls. The prevalence of ATD was 13.4% (20/149) in PRLs (1 GD and 19 AIT) compared to 6.3% (9/143) in the controls (p = 0.042). At the multivariate analysis, serum prolactin was the only independent factor predicting ATD. Thyroid volume (12.5 ± 5.9 ml vs. 12.8 ± 10 ml, p = 0.47) and the presence of uni- or multinodular goiter (29.5% vs. 35%, p = 0.35) did not differ between PRLs and control groups.

CONCLUSIONS

Our data in an area with mild iodine deficiency confirm a higher prevalence of ATD in patients with prolactinomas.

Does Prolactin treatment trigger imunoendocrine alterations during experimental T. cruzi infection?

Prolactin (PRL) is a pleiotropic polypeptide hormone produced by the anterior pituitary gland and negatively controlled by dopamine. Some researchers have associated the immune regulatory functions of PRL with some infectious diseases like Toxoplasma gondii and T. cruzi. This work aimed to analyze the possible immuno-modulatory effects of this hormone through the subcutaneous administration of PRL during the experimental Chagas disease. On the 14th day post-infection (dpi), PRL triggered increased percentages of NK cells in treated infected animals as compared to the infected and untreated ones. For early and late apoptosis, our results showed that in chronically infected groups, PRL counteracted splenocyte apoptosis as revealed by the reduced percentages of both, early and late apoptosis. Reduced percentages of spleen CD4⁺ and CD8⁺ T cells were detected in infected PRL treated rats (60 days post-infection). Concerning to B cells, a significant increased percentage of these cells was found for all PRL treated infected animals (14th dpi), but no statistically significant alteration was observed on the 60th days post-infection. Furthermore, PRL treatment triggered a significant increase in the percentage of CD4⁺ T lymphocytes IFN-γ producers, while on the 60th dpi, a reduced percentage of IFN-γ in these cells was observed in prolactin-treated rats compared to infected and untreated ones. Enhanced serum IL-12 levels were detected in infected and PRL treated subjects (60th dpi). Only on 7th day post-infection, the flow cytometric analysis of CFSE-stained CD3⁺ T cells showed an enhanced proliferation of polyclonal stimulated T cells in PRL-treated and infected animals. In this study, we demonstrated that PRL can influence many aspects of the immune response during the experimental Chagas' disease, and this substance could be used as a supporting trial along with the conventional drug treatment.

Autoimmune Disease in Women: Endocrine Transition and Risk Across the Lifespan

Women have a higher incidence and prevalence of autoimmune diseases than men, and 85% or more patients of multiple autoimmune diseases are female. Women undergo sweeping endocrinological changes at least twice during their lifetime, puberty and menopause, with many women undergoing an additional transition: pregnancy, which may or may not be accompanied by breastfeeding. These endocrinological transitions exert significant effects on the immune system due to interactions between the hormonal milieu, innate, and adaptive immune systems as well as pro- and anti-inflammatory cytokines, and thereby modulate the susceptibility of women to autoimmune diseases. Conversely, pre-existing autoimmune diseases themselves impact endocrine transitions. Concentration-dependent effects of estrogen on the immune system; the role of progesterone, androgens, leptin, oxytocin, and prolactin; and the interplay between Th1 and Th2 immune responses together maintain a delicate balance between host defense, immunological tolerance and autoimmunity. In this review, multiple autoimmune diseases have been analyzed in the context of each of the three endocrinological transitions in women. We provide evidence from human epidemiological data and animal studies that endocrine transitions exert profound impact on the development of autoimmune diseases in women through complex mechanisms. Greater understanding of endocrine transitions and their role in autoimmune diseases could aid in prediction, prevention, and cures of these debilitating diseases in women.

No impact of treated hyperprolactinemia on cumulative live birth rate and perinatal outcomes in in vitro fertilization-embryo transfer

AIM

To investigate whether treated hyperprolactinemia has an impact on pregnancy outcomes in in vitro fertilization/intracytoplasmic sperm injection-embryo transfer (IVF/ICSI-ET).

METHODS

A retrospective cohort study was conducted on 535 women who underwent IVF/ICSI-ET between January 2012 and December 2016, of which 123 had treated hyperprolactinemia (case group), 369 were matched controls. Besides, 43 remained hyperprolactinemic after treatment consisted of abnormal group. Cumulative live birth rate (CLBR) after one oocyte retrieval cycle was taken as the primary outcome. A time-to-event analysis using Fine and Gray's test was used to compare CLBR between case and control groups.

RESULTS

The median prolactin level was 80.00 ng/mL before dopamine agonist treatment in case group, and it reduced to 14.80 ng/mL after the treatment, similar to the level of control group (15.17 ng/mL, P = 0.316). No significant differences in baseline characteristics were found between case and control groups. The CLBR after one oocyte retrieval cycle were 69.1% (85/123) and 66.4% (245/369) in the case group and control group, respectively (P = 0.580). No significant differences were found between case and control groups in perinatal outcomes. Pregnancy and perinatal outcomes of abnormal group were similar to those of case and control groups.

CONCLUSION

Impact of treated hyperprolactinemia on CLBR and perinatal outcomes in IVF-ET was not evident.

To reflect human autoimmune thyroiditis, thyroid peroxidase (not thyroglobulin) antibodies should be measured in female (not sex-independent) NOD.H2h4 mice

NOD.H2^h4 mice are the most commonly used model for human autoimmune thyroiditis. Because thyroid autoimmunity develops slowly (over months), NOD.H2^h4 mice are usually exposed to excess dietary iodide to accelerate and amplify the process. However, unlike the female bias in human thyroid autoimmunity, autoantibodies to thyroglobulin (TgAb) are reported to be similar in male and female NOD.H2^h4 . We sought evidence for sexual dimorphism in other parameters in this strain maintained on regular or iodized water. Without iodide, TgAb levels are higher in males than in females, the reverse of human disease. In humans, autoantibodies to thyroid peroxidase (TPOAb) are a better marker of disease than TgAb. In NOD.H2^h4 mice TPOAb develop more slowly than TgAb, being detectable at 6 months of age versus 4 months for the latter. Remarkably, unlike TgAb, TPOAb levels are higher in female than male NOD.H2^h4 mice on both regular and iodized water. As previously observed, serum T4 levels are similar in both sexes. However, thyroid-stimulating hormone (TSH) levels are significantly higher in males than females with or without iodide exposure. TSH levels correlate with TgAb levels in male NOD.H2^h4 mice, suggesting a possible role for TSH in TgAb development. However, there is no correlation between TSH and TPOAb levels, the latter more important than TgAb in human disease. In conclusion, if the goal of an animal model is to closely reflect human disease, TPOAb rather than TgAb should be measured in older female NOD.H2^h4 mice, an approach requiring patience and the use of mouse TPO protein.