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Jin F, Liu W, Cheng G, Cai S, Yin T, Diao L. The function of decidua natural killer cells in physiology and pathology of pregnancy. Am J Reprod Immunol 2023; 90:e13755. [PMID: 37641369 DOI: 10.1111/aji.13755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 06/22/2023] [Accepted: 07/10/2023] [Indexed: 08/31/2023] Open
Abstract
The role of decidual natural killer (dNK) cells in maintaining immune tolerance at the maternal-fetal interface during pregnancy is a significant topic in reproductive health. Immune tolerance is essential for a successful pregnancy and involves a complex immune response involving various immune cells and molecules. DNK cells comprise the largest population of lymphocyte subsets found in the decidua and play important roles in maintaining immune tolerance. These cells exert multiple functions to maintain homeostasis of the decidual microenvironment, including modulation of trophoblast invasion, promotion of fetal development, regulation of endometrial decidualization and spiral artery remodeling. DNK cells can also be divided into different subsets based on their functions as NKtolerant , NKcytotoxic , and NKregulatory cells. However, the relationship between dNK cells function and pregnancy outcomes is complex and poorly understood. In this review, we will focus on the physiological role of dNK cells during pregnancy and highlight the potential role in pathological pregnancies and therapeutic approaches.
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Affiliation(s)
- Fangfang Jin
- Reproductive Medicine Center, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Wei Liu
- Shenzhen Key Laboratory for Reproductive Immunology of Peri-implantation, Shenzhen Zhongshan Institute for Reproduction and Genetics, Shenzhen Zhongshan Urology Hospital, Shenzhen, Guangdong, China
- Guangdong Engineering Technology Research Center of Reproductive Immunology for Peri-implantation, Shenzhen, Guangdong, China
| | - Guan Cheng
- Department of Clinical Laboratory, Institute of translational medicine, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Songchen Cai
- Shenzhen Key Laboratory for Reproductive Immunology of Peri-implantation, Shenzhen Zhongshan Institute for Reproduction and Genetics, Shenzhen Zhongshan Urology Hospital, Shenzhen, Guangdong, China
- Guangdong Engineering Technology Research Center of Reproductive Immunology for Peri-implantation, Shenzhen, Guangdong, China
| | - Tailang Yin
- Reproductive Medicine Center, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Lianghui Diao
- Shenzhen Key Laboratory for Reproductive Immunology of Peri-implantation, Shenzhen Zhongshan Institute for Reproduction and Genetics, Shenzhen Zhongshan Urology Hospital, Shenzhen, Guangdong, China
- Guangdong Engineering Technology Research Center of Reproductive Immunology for Peri-implantation, Shenzhen, Guangdong, China
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Cavalcante MB, Alcântara da Silva PH, Sampaio OGM, Câmara FEA, de Melo Bezerra Cavalcante CT, Barini R. The use of immunotherapies for recurrent miscarriage: An overview of systematic reviews and meta-analysis. J Reprod Immunol 2023; 158:103986. [PMID: 37413775 DOI: 10.1016/j.jri.2023.103986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 05/12/2023] [Accepted: 06/27/2023] [Indexed: 07/08/2023]
Abstract
Immunotherapies have been a treatment proposed for recurrent miscarriages (RMs). The use of immunotherapies remains not recommended in the management of couples with RM. This overview of systematic reviews and meta-analysis (SRs-MAs) aims to identify and evaluate the quality of SRs-MAs that studied the effectiveness of immunotherapies in the treatment of RM patients. SRs-MAs were searched in PubMed/Medline, Embase, and Web of Science. SRs-MAs were analyzed using AMSTAR-2, PRISMA 2020, Risk of Bias in Systematic (ROBIS), and Grading of Recommendations Assessment, Development, and Evaluation (GRADE) tools to evaluate the methodological quality, reporting quality, risk of bias, and evidence quality of included SRs-MAs, respectively. This review included 20 SRs-MAs that evaluated the following immunotherapies: intravenous immunoglobulin (13 publications), lymphocyte immunotherapy (6 publications), corticosteroids (3 publications), and lipid emulsion (1 publication). SRs-MAs were rated as high methodological, moderate, and critically low quality in 14 (70 %), 1 (5 %), and 5 (25 %) SRs-MAs and high reporting, moderate, and low quality in 13 (65 %), 4 (20 %), and 3 (5 %) SRs-MAs, respectively. The overall risk of bias revealed a low risk of bias for three-quarters of the SRs-MAs. Grading of Recommendations Assessment, Development, and Evaluation (GRADE) analysis resulted in 23 outcomes, of which 4, 3, 5, and 11 results were of high, moderate, low, and very low quality, respectively. An improvement has been observed over the past few years in the quality of systematic reviews (SR)-MAs that have investigated the efficacy of intravenous immunoglobulin, lymphocyte immunotherapy, lipid emulsion therapy, and corticosteroids as a therapy for RM.
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Affiliation(s)
- Marcelo Borges Cavalcante
- Post Graduate Program in Medical Sciences, Universidade de Fortaleza (UNIFOR), Fortaleza, CE 60.811-905, Brazil; CONCEPTUS - Reproductive Medicine, Fortaleza, CE 60.170-240, Brazil.
| | | | - Olga Goiana Martins Sampaio
- Post Graduate Program in Medical Sciences, Universidade de Fortaleza (UNIFOR), Fortaleza, CE 60.811-905, Brazil
| | | | | | - Ricardo Barini
- Department of Obstetrics and Gynecology, Campinas University (UNICAMP), Campinas, SP 13.083-887, Brazil
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Lédée N, Petitbarat M, Prat-Ellenberg L, Dray G, Vaucoret V, Kazhalawi A, Rodriguez-Pozo A, Habeichi N, Ruoso L, Cassuto NG, Rahmati M. The Next Frontier in ART: Harnessing the Uterine Immune Profile for Improved Performance. Int J Mol Sci 2023; 24:11322. [PMID: 37511080 PMCID: PMC10379072 DOI: 10.3390/ijms241411322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 06/23/2023] [Accepted: 06/24/2023] [Indexed: 07/30/2023] Open
Abstract
Assisted reproduction techniques have improved considerably in recent decades, but despite these advances, success rates remain relatively low. Endometrial immune profiling involves the analysis of cytokine biomarkers in the endometrium during the mid-luteal phase. This profiling aims to provide insights into the immune environment of the uterus. The aim is to identify immune disturbances and thus guide the development of personalized therapeutic approaches. The first part of the review looks back at the emergence of innovative concepts, highlighting the specificity of the human uterine environment at the time of implantation. Based on this new knowledge, biomarkers have been selected for endometrial immune profiling. The second part details the results of clinical studies conducted over the last ten years. These clinical results suggest that this approach can increase the rate of live births in patients suffering from repeated implantation failures or repeated pregnancy loss. Uterine immune profiling represents a clinical innovation that can significantly improve the performance of medically assisted reproduction treatments through personalized strategies tailored to the local immune profile. Innovation in personalized medicine for assisted reproduction is crucial to improving the success rates of fertility treatments, while reducing the risks and costs associated with ineffective or unnecessary interventions.
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Affiliation(s)
- Nathalie Lédée
- MatriceLab Innove Laboratory, Immeuble Les Gemeaux, 2 Rue Antoine Etex, 94000 Creteil, France
- Centre d'Assistance Médicale à la Procréation, Hôpital des Bluets, 4 Rue Lasson, 75012 Paris, France
| | - Marie Petitbarat
- MatriceLab Innove Laboratory, Immeuble Les Gemeaux, 2 Rue Antoine Etex, 94000 Creteil, France
| | - Laura Prat-Ellenberg
- Centre d'Assistance Médicale à la Procréation, Hôpital des Bluets, 4 Rue Lasson, 75012 Paris, France
| | - Géraldine Dray
- Centre d'Assistance Médicale à la Procréation, Hôpital des Bluets, 4 Rue Lasson, 75012 Paris, France
| | - Virginie Vaucoret
- Centre d'Assistance Médicale à la Procréation, Hôpital des Bluets, 4 Rue Lasson, 75012 Paris, France
| | - Alaa Kazhalawi
- MatriceLab Innove Laboratory, Immeuble Les Gemeaux, 2 Rue Antoine Etex, 94000 Creteil, France
| | - André Rodriguez-Pozo
- MatriceLab Innove Laboratory, Immeuble Les Gemeaux, 2 Rue Antoine Etex, 94000 Creteil, France
| | - Nada Habeichi
- MatriceLab Innove Laboratory, Immeuble Les Gemeaux, 2 Rue Antoine Etex, 94000 Creteil, France
| | - Lea Ruoso
- Laboratoire Drouot, 21 Rue Drouot, 75010 Paris, France
| | | | - Mona Rahmati
- London Women's Clinic, 113-115 Harley Street, London W1G 6AP, UK
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Cimadomo D, de los Santos MJ, Griesinger G, Lainas G, Le Clef N, McLernon DJ, Montjean D, Toth B, Vermeulen N, Macklon N. ESHRE good practice recommendations on recurrent implantation failure. Hum Reprod Open 2023; 2023:hoad023. [PMID: 37332387 PMCID: PMC10270320 DOI: 10.1093/hropen/hoad023] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Indexed: 06/20/2023] Open
Abstract
STUDY QUESTION How should recurrent implantation failure (RIF) in patients undergoing ART be defined and managed? SUMMARY ANSWER This is the first ESHRE good practice recommendations paper providing a definition for RIF together with recommendations on how to investigate causes and contributing factors, and how to improve the chances of a pregnancy. WHAT IS KNOWN ALREADY RIF is a challenge in the ART clinic, with a multitude of investigations and interventions offered and applied in clinical practice, often without biological rationale or with unequivocal evidence of benefit. STUDY DESIGN SIZE DURATION This document was developed according to a predefined methodology for ESHRE good practice recommendations. Recommendations are supported by data from the literature, if available, and the results of a previously published survey on clinical practice in RIF and the expertise of the working group. A literature search was performed in PubMed and Cochrane focussing on 'recurrent reproductive failure', 'recurrent implantation failure', and 'repeated implantation failure'. PARTICIPANTS/MATERIALS SETTING METHODS The ESHRE Working Group on Recurrent Implantation Failure included eight members representing the ESHRE Special Interest Groups for Implantation and Early Pregnancy, Reproductive Endocrinology, and Embryology, with an independent chair and an expert in statistics. The recommendations for clinical practice were formulated based on the expert opinion of the working group, while taking into consideration the published data and results of the survey on uptake in clinical practice. The draft document was then open to ESHRE members for online peer review and was revised in light of the comments received. MAIN RESULTS AND THE ROLE OF CHANCE The working group recommends considering RIF as a secondary phenomenon of ART, as it can only be observed in patients undergoing IVF, and that the following description of RIF be adopted: 'RIF describes the scenario in which the transfer of embryos considered to be viable has failed to result in a positive pregnancy test sufficiently often in a specific patient to warrant consideration of further investigations and/or interventions'. It was agreed that the recommended threshold for the cumulative predicted chance of implantation to identify RIF for the purposes of initiating further investigation is 60%. When a couple have not had a successful implantation by a certain number of embryo transfers and the cumulative predicted chance of implantation associated with that number is greater than 60%, then they should be counselled on further investigation and/or treatment options. This term defines clinical RIF for which further actions should be considered. Nineteen recommendations were formulated on investigations when RIF is suspected, and 13 on interventions. Recommendations were colour-coded based on whether the investigations/interventions were recommended (green), to be considered (orange), or not recommended, i.e. not to be offered routinely (red). LIMITATIONS REASONS FOR CAUTION While awaiting the results of further studies and trials, the ESHRE Working Group on Recurrent Implantation Failure recommends identifying RIF based on the chance of successful implantation for the individual patient or couple and to restrict investigations and treatments to those supported by a clear rationale and data indicating their likely benefit. WIDER IMPLICATIONS OF THE FINDINGS This article provides not only good practice advice but also highlights the investigations and interventions that need further research. This research, when well-conducted, will be key to making progress in the clinical management of RIF. STUDY FUNDING/COMPETING INTERESTS The meetings and technical support for this project were funded by ESHRE. N.M. declared consulting fees from ArtPRED (The Netherlands) and Freya Biosciences (Denmark); Honoraria for lectures from Gedeon Richter, Merck, Abbott, and IBSA; being co-founder of Verso Biosense. He is Co-Chief Editor of Reproductive Biomedicine Online (RBMO). D.C. declared being an Associate Editor of Human Reproduction Update, and declared honoraria for lectures from Merck, Organon, IBSA, and Fairtility; support for attending meetings from Cooper Surgical, Fujifilm Irvine Scientific. G.G. declared that he or his institution received financial or non-financial support for research, lectures, workshops, advisory roles, or travelling from Ferring, Merck, Gedeon-Richter, PregLem, Abbott, Vifor, Organon, MSD, Coopersurgical, ObsEVA, and ReprodWissen. He is an Editor of the journals Archives of Obstetrics and Gynecology and Reproductive Biomedicine Online, and Editor in Chief of Journal Gynäkologische Endokrinologie. He is involved in guideline developments and quality control on national and international level. G.L. declared he or his institution received honoraria for lectures from Merck, Ferring, Vianex/Organon, and MSD. He is an Associate Editor of Human Reproduction Update, immediate past Coordinator of Special Interest Group for Reproductive Endocrinology of ESHRE and has been involved in Guideline Development Groups of ESHRE and national fertility authorities. D.J.M. declared being an Associate Editor for Human Reproduction Open and statistical Advisor for Reproductive Biomedicine Online. B.T. declared being shareholder of Reprognostics and she or her institution received financial or non-financial support for research, clinical trials, lectures, workshops, advisory roles or travelling from support for attending meetings from Ferring, MSD, Exeltis, Merck Serono, Bayer, Teva, Theramex and Novartis, Astropharm, Ferring. The other authors had nothing to disclose. DISCLAIMER This Good Practice Recommendations (GPR) document represents the views of ESHRE, which are the result of consensus between the relevant ESHRE stakeholders and are based on the scientific evidence available at the time of preparation. ESHRE GPRs should be used for information and educational purposes. They should not be interpreted as setting a standard of care or be deemed inclusive of all proper methods of care, or be exclusive of other methods of care reasonably directed to obtaining the same results. They do not replace the need for application of clinical judgement to each individual presentation, or variations based on locality and facility type. Furthermore, ESHRE GPRs do not constitute or imply the endorsement, or favouring, of any of the included technologies by ESHRE.
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Affiliation(s)
| | - D Cimadomo
- IVIRMA Global Research Alliance, GENERA, Clinica Valle Giulia, Rome, Italy
| | | | - G Griesinger
- Department of Reproductive Medicine and Gynecological Endocrinology, University Hospital of Schleswig-Holstein, Campus Luebeck, Luebeck, Germany
- University of Luebeck, Luebeck, Germany
| | - G Lainas
- Eugonia IVF, Unit of Human Reproduction, Athens, Greece
| | - N Le Clef
- ESHRE Central Office, Strombeek-Bever, Belgium
| | - D J McLernon
- School of Medicine Medical Sciences and Nutrition, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - D Montjean
- Fertilys Fertility Centers, Laval & Brossard, Canada
| | - B Toth
- Gynecological Endocrinology and Reproductive Medicine, Medical University Innsbruck, Innsbruck, Austria
| | - N Vermeulen
- ESHRE Central Office, Strombeek-Bever, Belgium
| | - N Macklon
- Correspondence address. ESHRE Central Office, BXL7—Building 1, Nijverheidslaan 3, B-1853 Strombeek-Bever, Belgium. E-mail:
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5
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Stope MB, Mustea A, Sänger N, Einenkel R. Immune Cell Functionality during Decidualization and Potential Clinical Application. Life (Basel) 2023; 13:life13051097. [PMID: 37240742 DOI: 10.3390/life13051097] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 04/20/2023] [Accepted: 04/26/2023] [Indexed: 05/28/2023] Open
Abstract
Due to a vast influx in the secretory phase of the menstrual cycle, leukocytes represent 40-50% of the decidua at the time of implantation. Their importance for the implantation, maintenance of pregnancy, and parturition are known yet not fully understood. Thus, in idiopathic infertility, decidual immune-related factors are speculated to be the cause. In this review, the immune cell functions in the decidua were summarized, and clinical diagnostics, as well as interventions, were discussed. There is a rising number of commercially available diagnostic tools. However, the intervention options are still limited and/or poorly studied. In order for us to make big steps towards the proper use of reproductive immunology findings, we need to understand the mechanisms and especially support translational research.
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Affiliation(s)
- Matthias B Stope
- Department of Gynecology and Gynecological Oncology, University Hospital Bonn, 53127 Bonn, Germany
| | - Alexander Mustea
- Department of Gynecology and Gynecological Oncology, University Hospital Bonn, 53127 Bonn, Germany
| | - Nicole Sänger
- Department of Gynecological Endocrinology and Reproductive Medicine, University Hospital Bonn, 53127 Bonn, Germany
| | - Rebekka Einenkel
- Department of Gynecological Endocrinology and Reproductive Medicine, University Hospital Bonn, 53127 Bonn, Germany
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Genest G, Banjar S, Almasri W, Beauchamp C, Benoit J, Buckett W, Dzineku F, Gold P, Dahan MH, Jamal W, Jacques Kadoch I, Kadour-Peero E, Lapensée L, Miron P, Shaulov T, Sylvestre C, Tulandi T, Mazer BD, Laskin CA, Mahutte N. Immunomodulation for unexplained recurrent implantation failure: where are we now? Reproduction 2023; 165:R39-R60. [PMID: 36322478 DOI: 10.1530/rep-22-0150] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 11/02/2022] [Indexed: 11/05/2022]
Abstract
In brief Immune dysfunction may contribute to or cause recurrent implantation failure. This article summarizes normal and pathologic immune responses at implantation and critically appraises currently used immunomodulatory therapies. Abstract Recurrent implantation failure (RIF) may be defined as the absence of pregnancy despite the transfer of ≥3 good-quality blastocysts and is unexplained in up to 50% of cases. There are currently no effective treatments for patients with unexplained RIF. Since the maternal immune system is intricately involved in mediating endometrial receptivity and embryo implantation, both insufficient and excessive endometrial inflammatory responses during the window of implantation are proposed to lead to implantation failure. Recent strategies to improve conception rates in RIF patients have focused on modulating maternal immune responses at implantation, through either promoting or suppressing inflammation. Unfortunately, there are no validated, readily available diagnostic tests to confirm immune-mediated RIF. As such, immune therapies are often started empirically without robust evidence as to their efficacy. Like other chronic diseases, patient selection for immunomodulatory therapy is crucial, and personalized medicine for RIF patients is emerging. As the literature on the subject is heterogenous and rapidly evolving, we aim to summarize the potential efficacy, mechanisms of actions and side effects of select therapies for the practicing clinician.
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Affiliation(s)
- Geneviève Genest
- Department of Allergy and Immunology, McGill University, Montreal Quebec, Canada
| | - Shorooq Banjar
- Department of Allergy and Immunology, McGill University, Montreal Quebec, Canada
| | - Walaa Almasri
- Department of Allergy and Immunology, McGill University, Montreal Quebec, Canada
| | - Coralie Beauchamp
- Department of Gynaecology, University of Montreal, Montreal, Quebec, Canada
| | - Joanne Benoit
- Department of Gynaecology, University of Montreal, Montreal, Quebec, Canada
| | - William Buckett
- McGill University Health Centre Reproductive Centre, Montreal, Quebec, Canada
| | | | - Phil Gold
- Department of Allergy and Immunology, McGill University, Montreal Quebec, Canada
| | - Michael H Dahan
- Department of Obstetrics and Gynecology, McGill University, McGill University Health Centre, Montreal, Quebec, Canada
| | - Wael Jamal
- Department of Gynaecology, University of Montreal, Montreal, Quebec, Canada
| | | | - Einav Kadour-Peero
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, McGill University, Montréal, Quebec, Canada
| | - Louise Lapensée
- Department of Gynaecology, University of Montreal, Montreal, Quebec, Canada
| | - Pierre Miron
- Fertilys Reproductive Center, Laval, Quebec, Canada
| | - Talya Shaulov
- Department of Obstetrics and Gynecology, McGill University, McGill University Health Centre, Montreal, Quebec, Canada
| | - Camille Sylvestre
- Division of Reproductive Endocrinology and Infertility, University of Montreal, Montreal, Quebec, Canada
| | - Togas Tulandi
- Department of Obstetrics and Gynecology, McGill University, McGill University Health Centre, Montreal, Quebec, Canada
| | - Bruce D Mazer
- Department of Pediatrics, McGill University, Division of Allergy Immunology and Clinical Dermatology, Montreal Children's Hospital, McGill University, Montréal, Quebec, Canada
| | - Carl A Laskin
- Deptartments of Medicine and Obstetrics & Gynecology University of Toronto, Toronto, Ontario, Canada
| | - Neal Mahutte
- The Montreal Fertility Centre, Montreal, Quebec, Canada
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Ma J, Gao W, Li D. Recurrent implantation failure: A comprehensive summary from etiology to treatment. Front Endocrinol (Lausanne) 2023; 13:1061766. [PMID: 36686483 PMCID: PMC9849692 DOI: 10.3389/fendo.2022.1061766] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 12/13/2022] [Indexed: 01/06/2023] Open
Abstract
Implantation is the first step in human reproduction. Successful implantation depends on the crosstalk between embryo and endometrium. Recurrent implantation failure (RIF) is a clinical phenomenon characterized by a lack of implantation after the transfer of several embryos and disturbs approximately 10% couples undergoing in vitro fertilization and embryo transfer. Despite increasing literature on RIF, there is still no widely accepted definition or standard protocol for the diagnosis and treatment of RIF. Progress in predicting and preventing RIF has been hampered by a lack of widely accepted definitions. Most couples with RIF can become pregnant after clinical intervention. The prognosis for couples with RIF is related to maternal age. RIF can be caused by immunology, thrombophilias, endometrial receptivity, microbiome, anatomical abnormalities, male factors, and embryo aneuploidy. It is important to determine the most possible etiologies, and individualized treatment aimed at the primary cause seems to be an effective method for increasing the implantation rate. Couples with RIF require psychological support and appropriate clinical intervention. Further studies are required to evaluate diagnostic method and he effectiveness of each therapy, and guide clinical treatment.
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Affiliation(s)
- Junying Ma
- Center of Reproductive Medicine, Shengjing Hospital of China Medical University, Shenyang, China
- Key Laboratory of Reproductive and Genetic Medicine, China Medical University, National Health Commission, Shenyang, China
- Shengjing Hospital of China Medical University, Key Laboratory of Reproductive Dysfunction Diseases and Fertility Remodeling of Liaoning Province, Shenyang, China
| | - Wenyan Gao
- Department of Obstetrics, the First Affiliated Hospital of China Medical University, Shenyang, China
| | - Da Li
- Center of Reproductive Medicine, Shengjing Hospital of China Medical University, Shenyang, China
- Key Laboratory of Reproductive and Genetic Medicine, China Medical University, National Health Commission, Shenyang, China
- Shengjing Hospital of China Medical University, Key Laboratory of Reproductive Dysfunction Diseases and Fertility Remodeling of Liaoning Province, Shenyang, China
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8
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Henshaw J, Tremellen K. Intralipid infusion therapy as an adjunct treatment in women experiencing adenomyosis-related infertility. Ther Adv Reprod Health 2023; 17:26334941231181258. [PMID: 37362235 PMCID: PMC10288412 DOI: 10.1177/26334941231181258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 05/19/2023] [Indexed: 06/28/2023] Open
Abstract
Background Currently, there is some evidence that adenomyosis patients using gonadotropin-releasing hormone (GnRH) agonist long downregulation (LDR) prior to embryo transfer may improve in vitro fertilization (IVF) success rate, but not to the baseline expected success where there is no adenomyosis. Given the association between adenomyosis and an aberrant endometrial immune environment, many physicians also use prednisolone or Intralipid adjuvant treatments in combination with GnRH agonist therapy, despite neither being of proven benefit. Objective The purpose of this study was to investigate whether the addition of prednisolone or Intralipid immune therapy to GnRH agonist LDR improves fertility outcomes in patients with adenomyosis. Methods This is a retrospective cohort study of 116 consecutive adenomyosis patients who underwent their first transfer of a genetically screened euploid embryo between January 2019 and December 2020 at a private IVF clinic. Results There was no difference in maternal age, body mass index, number of embryo's transferred and gravidity or parity among the three treatment groups. Patients who received Intralipid had a poorer prognosis with a longer duration of infertility (4 years) and a higher number of previous embryo transfers (ETs, 5 previous ETs) compared to the comparison groups. Logistic regression analysis adjustment for all covariates revealed that LDR plus Intralipid therapy produced significantly higher live birth rates (LBRs; 60%) compared to LDR alone (40% LBR); yet, the addition of prednisolone to GnRH agonist LDR (30% LBR) provided no additional live birth benefit. Conclusion In this retrospective analysis, we showed Intralipid adjuvant treatment in combination with GnRH agonist therapy in adenomyosis patients undergoing IVF resulted in a LBR expected in women without adenomyosis using preimplantation genetic testing screened embryos. This benefit was not seen when using prednisolone as an adjuvant to GnRH agonist LDR. Future randomized clinical trials will be required to confirm the therapeutic benefit of Intralipid in combination with GnRH agonist therapy.
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Affiliation(s)
- James Henshaw
- Department of Obstetrics and Gynaecology, Royal Hospital for Women, Randwick, NSW, Australia
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9
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Kumar P, Marron K, Harrity C. Intralipid therapy and adverse reproductive outcome: is there any evidence? REPRODUCTION AND FERTILITY 2022; 2:173-186. [PMID: 35118388 PMCID: PMC8788620 DOI: 10.1530/raf-20-0052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 06/03/2021] [Indexed: 12/21/2022] Open
Abstract
Controversy exists regarding the benefits of intravenous intralipid therapy in patients with a poor reproductive history. It is frequently reported that there is no evidence to support the effectiveness, utility or safety for this treatment. While individual studies may be perceived as weak, a systematic review and meta-analysis were performed to determine if there is any advantage to patients. PubMed, Embase and Scopus searches were performed with the target populations being either recurrent pregnancy loss (RPL), or recurrent implantation failure (RIF) undergoing assisted reproductive technology (ART) and receiving intralipid infusions. These cohorts were compared with either placebo, no intervention or alternative treatments. The most relevant outcome measures were considered to be clinical pregnancy rate (CPR), live birth rate (LBR), implantation rate (IR) and miscarriage rate (MR). Twelve studies encompassing 2676 participants met the criteria for selection and were included and reviewed. Treatment of the target population with intralipid led to an improvement in IR (Odds Ratio (OR): 2.97, 2.05–4.29), pregnancy rate (OR: 1.64, 1.31–2.04), and LBR (OR: 2.36, 1.75–3.17), with a reduction in MR (OR: 0.2, 0.14–0.30). Although intravenous intralipid is not recommended as a routine treatment for recurrent miscarriage or implantation failure, there is enough data to suggest consideration in selected patients where routine testing is unremarkable, standard treatments have failed and immunological risk factors are present. The presence of abnormal uterine natural killer (uNK) cells needs more study as a target marker to determine those who could benefit.
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Affiliation(s)
- Parijot Kumar
- Beaumont Hospital, Dublin, Ireland.,RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Kevin Marron
- RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Conor Harrity
- Beaumont Hospital, Dublin, Ireland.,RCSI University of Medicine and Health Sciences, Dublin, Ireland.,ReproMed, Dublin, Ireland
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10
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A Brief Analysis of Tissue-Resident NK Cells in Pregnancy and Endometrial Diseases: The Importance of Pharmacologic Modulation. IMMUNO 2021. [DOI: 10.3390/immuno1030011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
NK cells are lymphocytes involved in the innate and adaptative immune response. These cells are located in peripheral blood and tissues with ample functions, from immune vigilant to tolerogenic reactions. In the endometrium, NK cell populations vary depending on age, hormones, and inflammation. When pregnancy occurs, tissue-resident NK cells and conventional NK cells are recruited to protect the fetus, a tolerogenic response. On the contrary, in the inflamed endometrium, various inflammatory cells down-regulate NK tolerance and impair embryo implantation. Therefore, NK cells’ pharmacological modulation is difficult to achieve. Several strategies have been used, from progesterone, lipid emulsions to steroids; the success has not been as expected. However, new therapeutic approaches have been proposed to decrease the endometrial inflammatory burden and increase pregnancy success based on understanding NK cell physiology.
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Li D, Zheng L, Zhao D, Xu Y, Wang Y. The Role of Immune Cells in Recurrent Spontaneous Abortion. Reprod Sci 2021; 28:3303-3315. [PMID: 34101149 PMCID: PMC8186021 DOI: 10.1007/s43032-021-00599-y] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 04/22/2021] [Indexed: 02/06/2023]
Abstract
Recurrent spontaneous abortion affects approximately 1–2% of women of childbearing, and describes a condition in which women suffer from three or more continuous spontaneous miscarriages. However, the origin of recurrent spontaneous abortion (RSA) remains unknown, preventing effective treatment and placing stress upon patients. It has been acknowledged that successful pregnancy necessitates balanced immune responses. Therefore, immunological aberrancy may be considered a root cause of poor pregnancy outcomes. Considerable published studies have investigated the relationship between various immune cells and RSA. Here, we review current knowledge on this area, and discuss the five main categories of immune cells involved in RSA; these include innate lymphocytes (ILC), macrophages, decidual dendritic cells (DCs), and T cells. Furthermore, we sought to summarize the impact of the multiple interactions of various immune cells on the emergence of RSA. A good understanding of pregnancy-induced immunological alterations could reveal new therapeutic strategies for favorable pregnancy outcomes.
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Affiliation(s)
- Dan Li
- Reproductive Medical Center, The Second Hospital of Jilin University, Changchun, China
| | - Lianwen Zheng
- Reproductive Medical Center, The Second Hospital of Jilin University, Changchun, China
| | | | - Ying Xu
- Reproductive Medical Center, The Second Hospital of Jilin University, Changchun, China
| | - Yeling Wang
- Departments of Cardiovascular Medicine, First Hospital, Jilin University, Changchun, 130000, China.
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Parhizkar F, Motavalli-Khiavi R, Aghebati-Maleki L, Parhizkar Z, Pourakbari R, Kafil HS, Danaii S, Yousefi M. The Impact of New Immunological Therapeutic Strategies on Recurrent Miscarriage and Recurrent Implantation Failure. Immunol Lett 2021; 236:20-30. [PMID: 34090942 DOI: 10.1016/j.imlet.2021.05.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 05/12/2021] [Accepted: 05/25/2021] [Indexed: 12/16/2022]
Abstract
Maternal-fetal immune dysregulation is one of the risk factors that increases the probability of embryo rejection and reproductive failure. The stimulation of immunological tolerance and suppression of immunological rejection are prerequisites for protecting embryos and preventing immunological attacks. Hence, it appears that immunomodulatory and immunosuppressive therapies can manage reproductive failures by controlling immune cells. The current medical literature has shown that immunotherapy approaches and cell therapy have promising results in improving pregnancy outcomes and live birth rates. These outcomes are obtained by regulating maternal immune responses, and exerting positive effects on human reproductive processes.
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Affiliation(s)
- Forough Parhizkar
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran; Stem Cell Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Roza Motavalli-Khiavi
- Department of Molecular Medicine, Faculty of Advanced Medical Sciences, Tabriz University of Medical Sciences, Tabriz, Iran; Stem Cell Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Zahra Parhizkar
- Student Research Committee, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Ramin Pourakbari
- Department of Immunology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Shahla Danaii
- Gynecology Department, Eastern Azerbaijan ACECR ART Centre, Eastern Azerbaijan branch of ACECR, Tabriz, Iran
| | - Mehdi Yousefi
- Stem Cell Research Center, Tabriz University of Medical Sciences, Tabriz, Iran; Department of Immunology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran.
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Fu YY, Ren CE, Qiao PY, Meng YH. Uterine natural killer cells and recurrent spontaneous abortion. Am J Reprod Immunol 2021; 86:e13433. [PMID: 33896061 DOI: 10.1111/aji.13433] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 04/07/2021] [Indexed: 01/07/2023] Open
Abstract
Recurrent spontaneous abortion (RSA), termed as two or more consecutive pregnancy loss is a great problem for some women of childbearing age. A large number of evidence confirm that there may be an immune background of RSA. As a member of the innate immune system, uterine natural killer (uNK) cells account for about 70% of total lymphocytes during pregnancy and play a critical role in the establishment and maintenance of pregnancy. This review mainly introduces the phenotype, origin, receptor, and function of uNK cells to illuminate its relationship with RSA.
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Affiliation(s)
- Yao-Yao Fu
- Clinical Medical Colleges, Weifang Medical University, Weifang, China
| | - Chun-E Ren
- Center of Reproductive Medicine, Affiliated Hospital of Weifang Medical University, Weifang, China
| | - Peng-Yun Qiao
- Center of Reproductive Medicine, Affiliated Hospital of Weifang Medical University, Weifang, China
| | - Yu-Han Meng
- Center of Reproductive Medicine, Affiliated Hospital of Weifang Medical University, Weifang, China
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Cheloufi M, Kazhalawi A, Pinton A, Rahmati M, Chevrier L, Prat-Ellenberg L, Michel AS, Dray G, Mekinian A, Kayem G, Lédée N. The Endometrial Immune Profiling May Positively Affect the Management of Recurrent Pregnancy Loss. Front Immunol 2021; 12:656701. [PMID: 33841443 PMCID: PMC8024694 DOI: 10.3389/fimmu.2021.656701] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 03/04/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction The endometrial immune profiling is an innovative approach based on the analysis of the local immune reaction occurring in the endometrium at the time of the embryo implantation. By documenting the local immune activation during the period of uterine receptivity, we aim to detect and correct potential imbalances before and at the very beginning of placentation. The main objective of the study was to analyze in women with a history of repeated pregnancy loss (RPL) the association of personalized strategies based on immune dysregulations with live birth rates. The secondary objective was to highlight the main prognostic factors for live births. Methods This is an observational retrospective analysis of 104 patients with RPL, included between January 2012 and December 2019. Inclusion criteria included a spontaneous fertility with at least three miscarriages, an assessment including a three-dimension ultrasound scan, an endometrial biopsy for uterine immune profiling and a follow-up over at least 6 months with personalized care if indicated after the complete assessment. We defined as a success if the patients had a live birth after the suggested plan, as a failure if the patient either did not get pregnant or experienced a new miscarriage after the targeted therapies. Results Uterine immune profiling was the only exploration to be significantly associated with a higher live birth rate (LBR) if a dysregulation was identified and treated accordingly (55% vs 45%, p=0.01). On the contrary, an absence of local dysregulation (resulting in an apparently balanced immune environment) was associated with a higher risk of a new miscarriage, suggesting that the cause inducing RPL still needed to be identified. Independently of age and AMH level, dysregulated immune profile is significatively associated with 3 times higher LBR than a non-deregulated profile (OR=3.4 CI 95%1.27-9.84) or five times in case of an overactive profile treated by immunotherapy (OR=5 CI 95% 1.65-16.5). The usage of ART was significantly associated with lower LBR regardless of the presence of a subfertility factor (p=0.012). Personalization of medical care using natural cycle or simple hormonal stimulation is associated with a significantly higher LBR than personalization including ART treatments regardless of maternal age and AMH level (OR= 2.9 CI 95% 1.03-8.88). Conclusion Our study suggests that some endometrial immune profiles with targeted management of RPL are associated with a higher rate of LBR. ART may be negatively associated with LBR.
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Affiliation(s)
- Meryam Cheloufi
- Department of Obstetrics and Gynecology, Trousseau Hospital, APHP, Sorbonne Université, FHU PREMA, Paris, France
| | - Alaa Kazhalawi
- MatriceLAB Innove SARL, Pépinière Paris Santé Cochin, Paris, France
| | - Anne Pinton
- Department of Obstetrics and Gynecology, Trousseau Hospital, APHP, Sorbonne Université, FHU PREMA, Paris, France
| | | | - Lucie Chevrier
- MatriceLAB Innove SARL, Pépinière Paris Santé Cochin, Paris, France
| | - Laura Prat-Ellenberg
- Centre d'Assistance Médical á la Procréation Bluets-Drouot, Hôpital Les Bluets, Paris, France
| | - Anne-Sophie Michel
- Department of Obstetrics and Gynecology, Trousseau Hospital, APHP, Sorbonne Université, FHU PREMA, Paris, France.,Centre d'Assistance Médical á la Procréation Bluets-Drouot, Hôpital Les Bluets, Paris, France
| | - Geraldine Dray
- Centre d'Assistance Médical á la Procréation Bluets-Drouot, Hôpital Les Bluets, Paris, France
| | - Arsène Mekinian
- Hôpital Saint-Antoine Groupe Hospitalier AP-HP, Sorbonne Université (Paris), Paris, France
| | - Gilles Kayem
- Department of Obstetrics and Gynecology, Trousseau Hospital, APHP, Sorbonne Université, FHU PREMA, Paris, France
| | - Nathalie Lédée
- MatriceLAB Innove SARL, Pépinière Paris Santé Cochin, Paris, France.,Centre d'Assistance Médical á la Procréation Bluets-Drouot, Hôpital Les Bluets, Paris, France
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Canella PRBC, Barini R, Carvalho PDO, Razolli DS. Lipid emulsion therapy in women with recurrent pregnancy loss and repeated implantation failure: The role of abnormal natural killer cell activity. J Cell Mol Med 2021; 25:2290-2296. [PMID: 33544456 PMCID: PMC7933936 DOI: 10.1111/jcmm.16257] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 12/09/2020] [Accepted: 12/14/2020] [Indexed: 12/18/2022] Open
Abstract
Altered immune and/or inflammatory response plays an important role in cases of recurrent pregnancy loss (RPL) and repeated implantation failure (RIF). Exacerbation of the maternal immune response through increased NK cell activity and inflammatory cytokines can cause embryo rejection leading to abortion or embryo implantation failure. Immunosuppressors or immunomodulators can help or prevent this condition. Currently, lipid emulsion therapy (LET) has emerged as a treatment for RPL and RIF in women with abnormal NK cell activity, by decreasing the exacerbated immune response of the maternal uterus and providing a more receptive environment for the embryo. However, the mechanisms by which the intralipid acts to reduce NK cell activity are still unclear. In this review, we focus on the studies that conducted LET to treat patients with RPL and RIF with abnormal NK cell activity. We find that although some authors recommend LET as an effective intervention, more studies are necessary to confirm its effectiveness in restoring NK cell activity to normal levels and to comprehend the underlying mechanisms of the lipids action in ameliorating the maternal environment and improving the pregnancy rate.
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Affiliation(s)
| | - Ricardo Barini
- Department of Obstetrics and Gynecology, Campinas University (UNICAMP), Campinas, Brazil
| | | | - Daniela Soares Razolli
- Postgraduate Program in Health Sciences, São Francisco University, Bragança Paulista, Brazil
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16
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Lédée N, Petitbarat M, Prat-Ellenberg L, Dray G, Cassuto GN, Chevrier L, Kazhalawi A, Vezmar K, Chaouat G. The uterine immune profile: A method for individualizing the management of women who have failed to implant an embryo after IVF/ICSI. J Reprod Immunol 2020; 142:103207. [DOI: 10.1016/j.jri.2020.103207] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 03/06/2020] [Accepted: 09/08/2020] [Indexed: 11/28/2022]
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Kwak-Kim J, Ota K, Sung N, Huang C, Alsubki L, Lee S, Han JW, Han A, Yang X, Saab W, Derbala Y, Wang WJ, He Q, Liao A, Takahashi T, Cavalcante MB, Barini R, Bao S, Fukui A, Lédée N, Coulam C. COVID-19 and immunomodulation treatment for women with reproductive failures. J Reprod Immunol 2020; 141:103168. [PMID: 32603991 PMCID: PMC7291967 DOI: 10.1016/j.jri.2020.103168] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 06/11/2020] [Indexed: 12/19/2022]
Abstract
COVID-19 pandemic is affecting various areas of health care, including human reproduction. Many women with reproductive failures, during the peri-implantation period and pregnancy, are on the immunotherapy using immune modulators and immunosuppressant due to underlying autoimmune diseases, cellular immune dysfunction, and rheumatic conditions. Many questions have been raised for women with immunotherapy during the COVID-19 pandemic, including infection susceptibility, how to manage women with an increased risk of and active COVID-19 infection. SARS-CoV-2 is a novel virus, and not enough information exists. Yet, we aim to review the data from previous coronavirus outbreaks and current COVID-19 and provide interim guidelines for immunotherapy in women with reproductive failures.
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Affiliation(s)
- Joanne Kwak-Kim
- Reproductive Medicine and Immunology, Obstetrics and Gynecology, Clinical Sciences Department, Center for Cancer Cell Biology, Immunology and Infection, Chicago Medical School, Rosalind Franklin University of Medicine and Science, 830 West End Court, Vernon Hills, IL, 60061, USA.
| | - Kuniaki Ota
- Fukushima Medical Center for Children and Women, Fukushima Medical University, 1 Hikarigaoka, Fukushima City, Fukushima 960-1295, Japan
| | - Nayoung Sung
- Reproductive Medicine and Immunology, Obstetrics and Gynecology, Clinical Sciences Department, Center for Cancer Cell Biology, Immunology and Infection, Chicago Medical School, Rosalind Franklin University of Medicine and Science, 830 West End Court, Vernon Hills, IL, 60061, USA
| | - Changsheng Huang
- Reproductive Medicine and Immunology, Obstetrics and Gynecology, Clinical Sciences Department, Center for Cancer Cell Biology, Immunology and Infection, Chicago Medical School, Rosalind Franklin University of Medicine and Science, 830 West End Court, Vernon Hills, IL, 60061, USA; Traditional Chinese Medicine Department of Rheumatism, Huazhong University of Science and Technology Union Shenzhen Hospital, China
| | - Lujain Alsubki
- Reproductive Medicine and Immunology, Obstetrics and Gynecology, Clinical Sciences Department, Center for Cancer Cell Biology, Immunology and Infection, Chicago Medical School, Rosalind Franklin University of Medicine and Science, 830 West End Court, Vernon Hills, IL, 60061, USA; Department of Obstetrics and Gynecology, King Faisal Specialist Hospital and Research Center, Riyadh. Saudi Arabia
| | - Sungki Lee
- Department of Obstetrics and Gynecology, Myuonggok Medical Research Center, Konyang University College of Medicine, Daejeon, South Korea
| | - Jae Won Han
- Department of Obstetrics and Gynecology, Myuonggok Medical Research Center, Konyang University College of Medicine, Daejeon, South Korea
| | - Aera Han
- Department of Obstetrics and Gynecology, MizMedi Hospital, Seoul, South Korea
| | - Xiuhua Yang
- Department of Obstetrics, The First Hospital of China Medical University, Shenyang, China
| | - Wael Saab
- The Centre for Reproductive & Genetic Health, 230-232 Great Portland St, Fitzrovia, London W1W 5QS, UK
| | - Youssef Derbala
- Obstetrics and Gynecology, Beaumont Hospital, Dearborn, Grosse Pointe, MI, USA
| | - Wen-Juan Wang
- Reproduction Medical Center, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, 264000, China
| | - Qiaohua He
- Department of Reproductive Medicine Center, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Henan Provincial People's Hospital of Henan University, Zhengzhou, Henan, 450003, China
| | - Aihua Liao
- Institute of Reproductive Health, Center for Reproductive Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Toshifumi Takahashi
- Fukushima Medical Center for Children and Women, Fukushima Medical University, 1 Hikarigaoka, Fukushima City, Fukushima 960-1295, Japan
| | - Marcelo Borges Cavalcante
- Department of Obstetrics and Gynecology, Fortaleza University (UNIFOR), Fortaleza, CE, Brazil; CONCEPTUS - Reproductive Medicine, Fortaleza, CE, Brazil
| | - Ricardo Barini
- Department of Obstetrics and Gynecology, Campinas University (UNICAMP), Campinas, SP, Brazil
| | - Shihua Bao
- Department of Reproductive Immunology, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, 201204, China
| | - Atsushi Fukui
- Department of Obstetrics and Gynecology, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo 663-8501, Japan
| | - Nathalie Lédée
- MatriceLAB Innove, Pépinière Paris Santé Cochin, Hôpital Cochin, 29 rue du faubourg St Jacques, 75014 Paris, France; Centre d'assistance médicale à la procréation, Hôpital des Bluets, 4 rue Lasson, 75012, Paris, France
| | - Carolyn Coulam
- Clinical Immunology Laboratory, Rosalind Franklin University of Medicine and Science, North Chicago, 60064, IL, USA
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Baron C, Haouzi D, Gala A, Ferrieres-Hoa A, Vintejoux E, Brouillet S, Hamamah S. [Endometrial receptivity in assisted reproductive techniques: An aspect to investigate in embryo implantation failure]. ACTA ACUST UNITED AC 2020; 49:128-136. [PMID: 32721539 DOI: 10.1016/j.gofs.2020.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Indexed: 10/23/2022]
Abstract
Infertility affects between 8 and 12% of reproductive-age couples worldwide. Despite improvements in assisted reproductive techniques (ART), live birth rates are still limited. In clinical practice, imaging and microscopy are currently widely used, but their diagnostic effectiveness remains limited. In research, the emergence of innovative techniques named OMICS would improve the identification of the implantation window, while progressing in the understanding of the pathophysiological mechanisms involved in embryo implantation failures. To date, transcriptomic analysis seems to be the most promising approach in clinical research. The objective of this review is to present the results obtained with the different approaches available in clinical practice and in research to assess endometrial receptivity in patients undergoing ART.
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Affiliation(s)
- C Baron
- Inserm U1203, développement embryonnaire précoce humain et pluripotence, université Montpellier, Montpellier, France
| | - D Haouzi
- Inserm U1203, développement embryonnaire précoce humain et pluripotence, université Montpellier, Montpellier, France
| | - A Gala
- Département de biologie de la reproduction, biologie de la reproduction et diagnostic pre-implantatoire, université Montpellier, CHU Montpellier, Montpellier, France
| | - A Ferrieres-Hoa
- Département de biologie de la reproduction, biologie de la reproduction et diagnostic pre-implantatoire, université Montpellier, CHU Montpellier, Montpellier, France
| | - E Vintejoux
- Département de médecine de la reproduction, CHU de Montpellier, 34000 Montpellier, France
| | - S Brouillet
- Inserm U1203, développement embryonnaire précoce humain et pluripotence, université Montpellier, Montpellier, France; Département de biologie de la reproduction, biologie de la reproduction et diagnostic pre-implantatoire, université Montpellier, CHU Montpellier, Montpellier, France; Inserm 1036, laboratoire biologie du cancer et de l'infection (BCI), Commissariat à l'énergie atomique et aux énergies alternatives (CEA), institut de biosciences et biotechnologies de Grenoble (BIG), université Grenoble-Alpes, 38000 Grenoble, France; Centre clinique et biologique d'assistance médicale à la procréation - centre d'étude et de conservation des œufs et du sperme humains (CECOS), hôpital Couple-Enfant, centre hospitalier universitaire de Grenoble, La Tronche, France.
| | - S Hamamah
- Inserm U1203, développement embryonnaire précoce humain et pluripotence, université Montpellier, Montpellier, France; Département de biologie de la reproduction, biologie de la reproduction et diagnostic pre-implantatoire, université Montpellier, CHU Montpellier, Montpellier, France.
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Coulam CB. Intralipid treatment for women with reproductive failures. Am J Reprod Immunol 2020; 85:e13290. [DOI: 10.1111/aji.13290] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 06/15/2020] [Indexed: 11/29/2022] Open
Affiliation(s)
- Carolyn B. Coulam
- Clinical Immunology Laboratory Rosalind Franklin University of Medicine and Science North Chicago IL USA
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20
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Sacks G, Finkelstein E. Natural killer cells and reproductive success. Am J Reprod Immunol 2020; 85:e13291. [DOI: 10.1111/aji.13291] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 06/15/2020] [Indexed: 12/30/2022] Open
Affiliation(s)
- Gavin Sacks
- IVFAustralia Sydney Australia
- University of New South Wales Sydney Australia
- St George hospital and Royal Hospital for Women Sydney Australia
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21
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Zhou P, Wu H, Lin X, Wang S, Zhang S. The effect of intralipid on pregnancy outcomes in women with previous implantation failure in in vitro fertilization/intracytoplasmic sperm injection cycles: A systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol 2020; 252:187-192. [PMID: 32622103 DOI: 10.1016/j.ejogrb.2020.06.057] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 06/23/2020] [Accepted: 06/25/2020] [Indexed: 11/19/2022]
Abstract
Several recent studies have investigated the relationship between intravenous intralipid and in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) outcomes in women with previous implantation failure. We conducted a systematic review and meta-analysis to evaluate the effects of intravenous intralipid on pregnancy outcomes in women with previous implantation failure. Ovid MEDLINE, the Cochrane Library, Embase and ClinicalTrials.gov were searched up to August 5th, 2019. Randomized controlled trials comparing intravenous intralipid with placebo or no treatment during IVF/ICSI cycles in women with at least one implantation failure were included. Results were presented as risk ratio (RR) with 95 % confidence intervals (CIs). Four studies with 544 participants were included. Live birth rate was statistically higher among the groups of women who received intravenous intralipid (RR 1.98, 95 % CI 1.39-2.80, quality of evidence: low). Intralipid infusion could significantly improve clinical pregnancy rate (RR 1.74, 95 % CI 1.27-2.40, quality of evidence: low). When excluding two studies only published as conference abstracts, there were no significant differences in terms of live birth (RR 1.78, 95 % CI 0.95-3.34, heterogeneity: I² = 25.5 %, quality of evidence: low, Fig. 4A) and clinical pregnancy (RR 1.66, 95 % CI 0.90-3.08, heterogeneity: I² = 47.7 %, quality of evidence: low, Fig. 4B). Adverse events were reported to be rare, but three congenital anomalies were observed in women receiving intravenous intralipid. Administering intravenous intralipid during IVF/ICSI cycles may improve live birth and clinical pregnancy in women with previous implantation failure, such benefit is not significant excluding studies with high risk of bias in the analysis, more studies are needed to evaluate its efficacy and safety especially congenital malformations.
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Affiliation(s)
- Ping Zhou
- Assisted Reproduction Unit, Department of Obstetrics and Gynecology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, Zhejiang, China
| | - Hanglin Wu
- Department of Obstetrics and Gynaecology, Hangzhou Women's Hospital, No. 369 Kun Peng Road, Hangzhou 310008, Zhejiang, China
| | - Xiaona Lin
- Assisted Reproduction Unit, Department of Obstetrics and Gynecology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, Zhejiang, China
| | - Shasha Wang
- Assisted Reproduction Unit, Department of Obstetrics and Gynecology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, Zhejiang, China
| | - Songying Zhang
- Assisted Reproduction Unit, Department of Obstetrics and Gynecology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, Zhejiang, China.
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Plaçais L, Kolanska K, Kraiem YB, Cohen J, Suner L, Bornes M, Sedille L, Rosefort A, D'Argent EM, Selleret L, Abisror N, Johanet C, Buffet NC, Darai E, Antoine JM, Fain O, Kayem G, Mekinian A. Intralipid therapy for unexplained recurrent miscarriage and implantation failure: Case-series and literature review. Eur J Obstet Gynecol Reprod Biol 2020; 252:100-104. [PMID: 32592916 DOI: 10.1016/j.ejogrb.2020.06.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 06/04/2020] [Accepted: 06/08/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION In retrospective cohort study of women with unexplained recurrent implantation failure (RIF) and miscarriage (RM), we analyzed the efficacy and safety of intralipid therapy to obtain a live birth. PATIENTS AND METHODS Women with unexplained RM and/or RIF were included from 2015 to 2018 from three French university hospitals. RESULTS Among 187 women treated for unexplained recurrent miscarriages and implantation failures, 26 women with median age of 36 years (29-43) received intralipid therapy. Among these 26 women, 10 women with a median age of 33 years (31-40) had a history of spontaneous recurrent miscarriages, with a median of 5 (4-8) previous miscarriages. Live births occurred in 7 (70 %) pregnancies under intralipids and were significantly more frequent than in women with recurrent miscarriages who did not receive intralipid therapy (n = 20, p = 0.02). Age, number of previous miscarriages, and additional therapies did not significantly differ between the two groups. Among the 26 included women, 16 had a history of recurrent implantation failures, with median age of 37 years (29-43) and median 9.5 (3-19) embryo transfers. Clinical pregnancy occurred in 9 (56 %) women receiving intralipids after embryo transfers under intralipids among which 5 (55 %) resulted in a live birth. Comparing successful pregnancies under intralipids with those with fetal loss, no significant differences have been noted. CONCLUSION Intralipids could be an effective and safe therapy in women with unexplained recurrent miscarriages and infertility.
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Affiliation(s)
- Léo Plaçais
- AP-HP, Hôpital Saint Antoine, service de médecine interne et Inflammation-Immunopathology-Biotherapy Department (DHU i2B), Faculté de Médecine Sorbonne Université, F-75012, Paris, France; Sorbonne Universités, UPMC Université Paris 06, UMR 7211, F-75005, Paris, France
| | - Kamilla Kolanska
- Sorbonne Universités, UPMC Université Paris 06, UMR 7211, F-75005, Paris, France; AP-HP, Hôpital Tenon, service de gynécologie, obstétrique et PMA, Faculté de Médecine Sorbonne Université, F-75020, Paris, France
| | - Yasmine Ben Kraiem
- Sorbonne Universités, UPMC Université Paris 06, UMR 7211, F-75005, Paris, France; AP-HP, Hôpital Tenon, service de gynécologie, obstétrique et PMA, Faculté de Médecine Sorbonne Université, F-75020, Paris, France
| | - Jonathan Cohen
- Sorbonne Universités, UPMC Université Paris 06, UMR 7211, F-75005, Paris, France; AP-HP, Hôpital Tenon, service de gynécologie, obstétrique et PMA, Faculté de Médecine Sorbonne Université, F-75020, Paris, France
| | - Ludovic Suner
- Sorbonne Universités, UPMC Université Paris 06, UMR 7211, F-75005, Paris, France; AP-HP, Hôpital Saint Antoine, service d'hématologie biologique, Faculté de Médecine Sorbonne Université, F-75012, Paris, France
| | - Marie Bornes
- Sorbonne Universités, UPMC Université Paris 06, UMR 7211, F-75005, Paris, France; AP-HP, Hôpital Tenon, service de gynécologie, obstétrique et PMA, Faculté de Médecine Sorbonne Université, F-75020, Paris, France
| | - Lucie Sedille
- Sorbonne Universités, UPMC Université Paris 06, UMR 7211, F-75005, Paris, France; AP-HP, Hôpital Trousseau, service de gynécologie, obstétrique, Faculté de Médecine Sorbonne Université, F-75012, Paris, France
| | - Audrey Rosefort
- AP-HP, Hôpital Saint Antoine, service de médecine interne et Inflammation-Immunopathology-Biotherapy Department (DHU i2B), Faculté de Médecine Sorbonne Université, F-75012, Paris, France
| | - Emmanuel Mathieu D'Argent
- Sorbonne Universités, UPMC Université Paris 06, UMR 7211, F-75005, Paris, France; AP-HP, Hôpital Tenon, service de gynécologie, obstétrique et PMA, Faculté de Médecine Sorbonne Université, F-75020, Paris, France
| | - Lise Selleret
- Sorbonne Universités, UPMC Université Paris 06, UMR 7211, F-75005, Paris, France; AP-HP, Hôpital Tenon, service de gynécologie, obstétrique et PMA, Faculté de Médecine Sorbonne Université, F-75020, Paris, France
| | - Noémie Abisror
- AP-HP, Hôpital Saint Antoine, service de médecine interne et Inflammation-Immunopathology-Biotherapy Department (DHU i2B), Faculté de Médecine Sorbonne Université, F-75012, Paris, France; Sorbonne Universités, UPMC Université Paris 06, UMR 7211, F-75005, Paris, France
| | - Catherine Johanet
- AP-HP, Hôpital Trousseau, service de gynécologie, obstétrique, Faculté de Médecine Sorbonne Université, F-75012, Paris, France
| | - Nathalie Chabbert Buffet
- Sorbonne Universités, UPMC Université Paris 06, UMR 7211, F-75005, Paris, France; AP-HP, Hôpital Tenon, service de gynécologie, obstétrique et PMA, Faculté de Médecine Sorbonne Université, F-75020, Paris, France
| | - Emile Darai
- Sorbonne Universités, UPMC Université Paris 06, UMR 7211, F-75005, Paris, France; AP-HP, Hôpital Tenon, service de gynécologie, obstétrique et PMA, Faculté de Médecine Sorbonne Université, F-75020, Paris, France
| | - Jean Marie Antoine
- Sorbonne Universités, UPMC Université Paris 06, UMR 7211, F-75005, Paris, France; AP-HP, Hôpital Tenon, service de gynécologie, obstétrique et PMA, Faculté de Médecine Sorbonne Université, F-75020, Paris, France
| | - Olivier Fain
- AP-HP, Hôpital Saint Antoine, service de médecine interne et Inflammation-Immunopathology-Biotherapy Department (DHU i2B), Faculté de Médecine Sorbonne Université, F-75012, Paris, France; Sorbonne Universités, UPMC Université Paris 06, UMR 7211, F-75005, Paris, France
| | - Gilles Kayem
- Sorbonne Universités, UPMC Université Paris 06, UMR 7211, F-75005, Paris, France; AP-HP, Hôpital Trousseau, service de gynécologie, obstétrique, Faculté de Médecine Sorbonne Université, F-75012, Paris, France
| | - Arsène Mekinian
- AP-HP, Hôpital Saint Antoine, service de médecine interne et Inflammation-Immunopathology-Biotherapy Department (DHU i2B), Faculté de Médecine Sorbonne Université, F-75012, Paris, France; Sorbonne Universités, UPMC Université Paris 06, UMR 7211, F-75005, Paris, France.
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Lédée N, Petitbarat M, Prat-Ellenberg L, Dray G, Cassuto GN, Chevrier L, Kazhalawi A, Vezmar K, Chaouat G. Endometrial Immune Profiling: A Method to Design Personalized Care in Assisted Reproductive Medicine. Front Immunol 2020; 11:1032. [PMID: 32582163 PMCID: PMC7287127 DOI: 10.3389/fimmu.2020.01032] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 04/29/2020] [Indexed: 11/20/2022] Open
Abstract
Objective: To assess the efficiency of the endometrial immune profiling as a method to design personalized care to enhance the pregnancy rate in a large heterogeneous infertile population. We hypothesized that some reproductive failures could be induced by a uterine immune dysregulation which could be identified and corrected with a targeted plan. Design: Prospective cohort study. Setting: Multicentric study. Intervention(s) and Main outcome measure(s): One thousand and seven hundred thirty-eight infertile patients had an immune profiling on a timed endometrial biopsy between 2012 and 2018. This test documented the absence or the presence of an endometrial immune dysregulation and identified its type. In case of dysregulation, a targeted personalized plan was suggested to the treating clinician aiming to supply the anomaly. One year after the test, the clinician was contacted to provide the outcome of the subsequent embryo transfer with the applied suggested plan. Result(s): After testing, 16.5% of the patients showed no endometrial immune dysregulation, 28% had a local immune under-activation, 45% had a local immune over-activation, and 10.5% had a mixed endometrial immune profile. In patients with a history of repeated implantation failures (RIF) or recurrent miscarriages (RM), the pregnancy rate was significantly higher if an endometrial dysregulation was found and the personalized plan applied, compared to the patients with an apparent balanced immune profile (respectively 37.7 and 56% vs. 26.9 and 24%, p < 0.001). In contrast, in good prognosis IVF (in vitro fertilization) subgroup and patients using donor eggs, this difference was not significant between dysregulated and balanced subgroups, but higher pregnancy rates were observed in absence of dysregulation. For patients with immune over-activation, pregnancy rates were significantly higher for patients who had a test of sensitivity, regarding the type of immunotherapy introduced, when compared to the ones who did not (51 vs. 39.9%, p = 0.012). Conclusion(s): Local endometrial immunity appears to be a new and important parameter able to influence the prognosis of pregnancy. Targeted medical care in case of local immune dysregulation resulted in significantly higher pregnancy rates in RIF and RM patients.
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Affiliation(s)
- Nathalie Lédée
- MatriceLAB Innove, Pépinière Paris Santé Cochin, Hôpital Cochin, Paris, France.,Centre d'Assistance Médicale à la Procréation, Hôpital des Bluets, Paris, France
| | - Marie Petitbarat
- MatriceLAB Innove, Pépinière Paris Santé Cochin, Hôpital Cochin, Paris, France
| | - Laura Prat-Ellenberg
- Centre d'Assistance Médicale à la Procréation, Hôpital des Bluets, Paris, France
| | - Géraldine Dray
- Centre d'Assistance Médicale à la Procréation, Hôpital des Bluets, Paris, France
| | - Guy N Cassuto
- Centre d'Assistance Médicale à la Procréation, Hôpital des Bluets, Paris, France.,Laboratoire Drouot, Paris, France
| | - Lucie Chevrier
- MatriceLAB Innove, Pépinière Paris Santé Cochin, Hôpital Cochin, Paris, France
| | - Alaa Kazhalawi
- MatriceLAB Innove, Pépinière Paris Santé Cochin, Hôpital Cochin, Paris, France
| | - Katia Vezmar
- MatriceLAB Innove, Pépinière Paris Santé Cochin, Hôpital Cochin, Paris, France
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24
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Testing the endometrium: is there enough evidence to justify clinical use? Curr Opin Obstet Gynecol 2020; 32:185-190. [DOI: 10.1097/gco.0000000000000627] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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25
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Ali S, Majid S, Niamat Ali M, Taing S. Evaluation of T cell cytokines and their role in recurrent miscarriage. Int Immunopharmacol 2020; 82:106347. [PMID: 32143004 DOI: 10.1016/j.intimp.2020.106347] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 02/08/2020] [Accepted: 02/23/2020] [Indexed: 01/03/2023]
Abstract
Recurrent miscarriage (RM) is defined as two or more consecutive pregnancy losses that affect approximately 5% of conceived women worldwide. RM is a multi-factorial reproductive problem and has been associated with parental chromosomal abnormalities, embryonic chromosomal rearrangements, uterine anomalies, autoimmune disorders, endocrine dysfunction, thrombophilia, life style factors, and maternal infections. However, the exact cause is still undecided in remaining 50% of cases. Immunological rejection of the embryo due to exacerbated maternal immune reaction against paternal embryonic antigens has been set forth as one of the significant reason for RM. The accurate means that shield the embryo during normal pregnancy from the attack of maternal immune network and dismissal are inadequately implicit. However, it is suggested that the genetically irreconcilable embryo escapes maternal immune rejection due to communication among many vital cytokines exuded at maternal-embryonic interface both by maternal and embryonic cells. Previous investigations suggested the Th1/Th2 dominance in altered immunity of RM patients, according to which the allogenic embryo flees maternal T cell reaction by inclining the Th0 differentiation toward Th2 pathway resulting into diminished pro-inflammatory Th1 immunity. However, recently pro-inflammatory Th17 cells and immunoregulatory Treg cells have been discovered as essential immune players in RM besides Th1/Th2 components. Cytokines are believed to develop a complicated regulatory network so as to establish a state of homeostasis between the semi-allogenic embryo and the maternal immune system. However, an adverse imbalance among cytokines at maternal-embryonic interface perhaps due to their gene polymorphisms may render immunoregulatory means not enough to re-establish homeostasis and thus may collapse pregnancy.
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Affiliation(s)
- Shafat Ali
- Cytogenetics and Molecular Biology Laboratory, Centre of Research for Development, University of Kashmir, 190006 Srinagar, J&K, India
| | - Sabhiya Majid
- Department of Biochemistry, Government Medical College, Srinagar, J&K, India
| | - Md Niamat Ali
- Cytogenetics and Molecular Biology Laboratory, Centre of Research for Development, University of Kashmir, 190006 Srinagar, J&K, India.
| | - Shahnaz Taing
- Department of Obstetrics and Gynaecology, Government Medical College Associated Lalla Ded Hospital, Srinagar, J&K, India
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26
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Liu J, Dong P, Wang S, Li J. Natural killer, natural killer T, helper and cytotoxic T cells in the decidua from recurrent spontaneous abortion with normal and abnormal chromosome karyotypes. Biochem Biophys Res Commun 2018; 508:354-360. [PMID: 30503343 DOI: 10.1016/j.bbrc.2018.11.156] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 11/23/2018] [Indexed: 02/06/2023]
Abstract
PROBLEM Recurrent spontaneous abortion (RSA) is associated with immune imbalance at the maternal-fetal interface. Decidual immune cells and cytokines expressed at this interface regulate the response of the maternal immune system to the fetus. However, the populations and cytokine expression levels of these lymphocytes in miscarriage with normal and abnormal chromosome karyotypes remain unclear. METHODS We assessed the populations and cytokine expression levels of Natural Killer (NK), Natural Killer T (NKT), Helper T (Th) and Cytotoxic T (Tc) cells in the decidua of RSA by flow cytometry and simultaneously analyzed the fetal chromosome karyotypes of these miscarriages. RESULTS Flow cytometry showed no significant difference between RSA and normal pregnancy in the percentages of Th, Tc, NK, and NKT cells. Type-1 cells decreased significantly in the decidua of normal pregnancy, and NK2 and NKT2 cells increased significantly in the normal pregnancy group. We also found no difference in the lymphocyte composition and the proportion of types 1 and 2 subsets of the four lymphocytes in the decidua between RSA with abnormal chromosome karyotypes of villous trophoblasts (RSA-A) and RSA with normal chromosome karyotypes of villous trophoblasts (RSA-N), but the proportion of type-1 cells in both groups was significantly higher than that in normal pregnancy. CONCLUSION No difference existed between the type-1 immune response of RSA in normal and abnormal chromosome karyotypes of villous trophoblasts.
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Affiliation(s)
- Jia Liu
- Department of Obstetrics and Gynecology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Peng Dong
- Department of Obstetrics and Gynecology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Shijun Wang
- Department of Obstetrics and Gynecology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jian Li
- Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China.
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