A multiparametric study of the action of mifepristone used in emergency contraception using the Rhesus monkey as a primate model

Does Enoxaparin treatment have any effects on the placenta in women with unexplained histories of habitual abortion? A case control study

BACKGROUND

It is very common to offer low molecular weight heparin (LMWH) medications to women with unexplained habitual abortion, to increase the livebirth rate. Although no benefit from LMWH has been clearly demonstrated, examination of the effects of enoxaparin on placental structure is lacking.

OBJECTIVE

To assess placental structural changes in pregnancies treated with enoxaparin, compared with controls.

DESIGN AND SETTING

Case-control study in an obstetrics and gynecology unit of a tertiary-level university hospital in Turkey.

METHODS

Forty patients who had had term pregnancies and live births but also histories of habitual abortion were recruited for this study. Placentas were sampled using a systematic random sampling method. Tissue samples were obtained, embedded and sectioned for routine histological analyses. Hematoxylin and eosin staining was used. Surface area and length estimates from placental components were evaluated by using Image J. Cell proliferation and apoptosis were also assessed via immunohistochemistry.

RESULTS

There were no significant differences between the groups regarding maternal age, abortion rate, birth weight or gestational age. Comparison of the enoxaparin and control groups showed that there were no significant differences in terms of surface area and ratios of placental components. We found that Bcl-2 was generally expressed at high levels in the enoxaparin group, while there was no difference in terms of Ki-67 between the groups.

CONCLUSIONS

This study demonstrates that enoxaparin did not show any significant effect on the placental structure of cases that had histories of habitual abortion.

Effects of ulipristal acetate on human embryo attachment and endometrial cell gene expression in an in vitro co-culture system

STUDY QUESTION

Does ulipristal acetate (UPA) used for emergency contraception (EC) interfere with the human embryo implantation process?

SUMMARY ANSWER

UPA, at the dosage used for EC, does not affect human embryo implantation process, in vitro.

WHAT IS KNOWN ALREADY

A single pre-ovulatory dose of UPA (30 mg) acts by delaying or inhibiting ovulation and is recommended as first choice among emergency contraceptive pills due to its efficacy. The compound has also been demonstrated to have a dose-dependent effect on the endometrium, which theoretically could impair endometrial receptivity but its direct action on human embryo implantation has not yet been studied.

STUDY DESIGN, SIZE, DURATION

Effect of UPA on embryo implantation process was studied in an in vitro endometrial construct. Human embryos were randomly added to the cultures and cultured for 5 more days with UPA (n = 10) or with vehicle alone (n = 10) to record the attachment of embryos.

PARTICIPANTS/MATERIALS, SETTING, METHODS

Endometrial biopsies were obtained from healthy, fertile women on cycle day LH+4 and stromal and epithelial cells were isolated. A three-dimensional in vitro endometrial co-culture system was constructed by mixing stromal cells with collagen covered with a layer of epithelial cells and cultured in progesterone containing medium until confluence. The treatment group received 200 ng/ml of UPA. Healthy, viable human embryos were placed on both control and treatment cultures. Five days later the cultures were tested for the attachment of embryos and the 3D endometrial constructs were analysed for endometrial receptivity markers by real-time PCR.

MAIN RESULTS AND THE ROLE OF CHANCE

There was no significant difference in the embryo attachment rate between the UPA treated group and the control group as 5 out of 10 human embryos exposed to UPA and 7 out of 10 embryos in the control group attached to the endometrial cell surface (P = 0.650). Out of 17 known receptivity genes studied here, only 2 genes, HBEGF (P = 0.009) and IL6 (P = 0.025) had a significant up-regulation and 4 genes, namely HAND2 (P = 0.003), OPN (P = 0.003), CALCR (P = 0.016) and FGF2 (P = 0.023) were down-regulated with the exposure of UPA, compared with control group.

LIMITATIONS, REASONS FOR CAUTION

This proof of concept study was conducted with a few human embryos, as their availability was limited. Although the 3D model used for this study is well established and the artificial endometrial luminal epithelium shown to express progesterone regulated markers of endometrial receptivity it is still an in vitro model, lacking all cell types that constitute the receptive endometrium in vivo.

WIDER IMPLICATIONS OF THE FINDINGS

This study provides new insights on the mechanism of action of UPA on human embryo implantation, demonstrating that UPA in a dosage used for EC does not affect embryo viability and the implantation process of embryo. Progesterone receptor modulators (PRMs) hold the potential to be attractive estrogen- and gestagen-free contraceptives and thus may be made available to a larger proportion of women globally due to these findings.

STUDY FUNDING/COMPETING INTERESTS

Swedish Research Council (K2010-54X-14212-09-3) and support provided through the regional agreement on medical training and clinical research (ALF) between Stockholm County Council and Karolinska University Hospital.

The effect of mifepristone on apoptosis and caspase-3 activation in human ovarian luteinized granulosa cells

OBJECTIVE

To investigate the effect of mifepristone, an oral contraceptive, on apoptosis in human ovarian luteinized granulosa cells.

STUDY DESIGN

Human ovarian luteinized granulosa cells were treated in vitro with 1.25, 2.5, 5.0, 10.0, or 20.0 microM of mifepristone. Nuclear morphology, apoptosis ratio, and level of caspase-3 expression were determined with immunofluorescence microscopy, the terminal deoxynucleotidyl transferase mediated nick end labeling (TUNEL) assay, and flow cytometry.

RESULTS

We found that mifepristone-treated cells contained single condensed chromatin with multiple nuclear fragments, which is morphologic evidence of apoptosis. A significant difference was observed in the TUNEL assay between mifepristone-treated cells and control cells (P<0.05). Consistent with the results of the TUNEL assay, the fluorescence intensity of caspase-3 in drug-treated cells was also significantly different (P<0.05) from control cells; specifically, the difference between cells treated with different doses of drugs was much smaller and negligible.

CONCLUSION

From these results, we propose that mifepristone induces human ovarian luteinized granulosa cells to undergo apoptosis by activating caspase-3.

Progesterone, but not luteal estrogen, is required for the establishment of pregnancy in the new world monkey Cebus apella

The aim of this study was to examine the requirement of luteal progesterone or luteal estrogen for the establishment of pregnancy in the Cebus monkey and to test in a primate species the synergism between RU 486 and letrozole (LTZ) found in rodents for inhibiting implantation. Exposure of target tissues to either hormone was suppressed during the mid-luteal phase of mating cycles by subcutaneous administration of the antiprogestin (RU 486), the aromatase inhibitor LTZ or the antiestrogen (ICI 182780) on days 4-7 of the luteal phase. Administration of 0.1 or 0.5 mg/kg of LTZ on days 5-7 of the luteal phase caused a profound drop in the levels of E(2) in all animals, whereas administration of ICI 182780 0.2 mg/kg on days 4-6 of the luteal phase had the opposite effect. The pregnancy rate in vehicle treated cycles of the same females was (58.3%). Treatment with RU 486, 0.8 mg/kg/day on days 5-7 of the luteal phase-induced endometrial bleeding in 3/5 mated females none of which became pregnant, whereas pregnancy was confirmed in one of the two animals that did not bled. Treatment with RU 486, 0.4 mg/kg/day alone or with LTZ on days 5-7 or ICI 182780 alone, on days 4-6 of the luteal phase failed to induce bleeding, allowing the establishment of pregnancy in 50.0-66.6% of the animals in these groups. We conclude that in Cebus monkeys, progesterone but not luteal estradiol is required for the establishment of pregnancy and that RU 486 and LTZ do not exhibit in this species the synergism found in rodents.

Isolating with physical restraint low status female monkeys during luteal phase might make an appropriate premenstrual depression syndrome model

BACKGROUND

Rhesus monkeys (Macaca mulatta) have a close phylogenetic relationship to humans, and have a similar 28-day menstrual cycle with similar hormonal fluctuations. In this study, we attempt to establish the premenstrual depression syndrome of rhesus monkey (M. mulatta) models by isolation with physical restraint of low social status young female monkeys during their luteal phase.

METHODS

Low social status young female rhesus monkeys (M. mulatta) were isolated with physical restraint during their luteal phase by using a specifically designed isolating-cage. During the entire menses cycle, serum levels of 5-hydroxytrypamine, noradrenalin and adrenalin were detected by capillary zone electrophoresis, and the changes in the serum levels of progesterone, estradiol and prolactin were investigated by radioimmunoassay. At the same time, the pharmaceutical interference effect of Jingqianshu granule, a traditional Chinese medicine specifically used to cure premenstrual depression patients, was tested using this premenstrual depression syndrome monkey model.

RESULTS

After being immured in two consecutive menstrual cycles, monkeys presented depressive symptoms during the premenstrual phase of three consecutive menstrual cycles. The serum contents of the three kinds of monoamine neurotransmitters in depressive monkeys were significantly higher than the normal ones. The serum levels of progesterone and prolactin increased obviously, and a marked change in the pattern of progesterone secretion could be observed. Moreover, the premenstrual depressive symptoms of model group monkeys could not only be cured by Jingqianshu granule, but the higher serum levels of prolactin and monoamine neurotransmitters in these monkeys could be reduced by this herbal medicine. These data were well in line with clinical observations of women with premenstrual depression syndrome.

CONCLUSION

Our results in this study for the first time indicate that isolation with physical restraint of low status young female monkeys during their luteal phase makes an appropriate premenstrual depression syndrome model. This model might potentially facilitate studies on the etiology of premenstrual depression syndrome and the development of better methods for the therapy of this disease.

Target-oriented anti-implantation approaches for pregnancy interception: Experiences in the rhesus monkey model

Blastocyst implantation is a critical process in the establishment of pregnancy in eutherian mammals and requires a harmonious symbiosis between the developing conceptus and the differentiating maternal uterus. A better understanding of this symbiotic relationship will provide novel approaches and interventions for realizing anti-implantation strategies for effective fertility regulation and reproductive health care management. We have been using the rhesus monkey (Macaca mulatta) as a nonhuman primate model to this end. In the present study, the process of progesterone-mediated regulation of endometrial receptivity for blastocyst implantation has been targeted by the use of mifepristone as an emergency contraceptive agent. Furthermore, based on cell-specific, temporal and spatial distribution of vasotropic cytokines and mediators in the "receptive" and periimplantation periods, the pregnancy interceptive potentials of (a) monoclonal antibody (MAb) to leukemia inhibitory factor (LIF); (b) inhibitors of nitric oxide synthase [e.g., N6-nitro-l-arginine (l-NAME) and aminoguanidine]; and (c) MAb to vascular endothelial growth factor (VEGF) were examined. LIF is a progesterone-responsive pleiotropic cytokine that functions as a proinflammatory cytokine, together with interleukins 1 and 6, during the process of implantation-placentation in primates, and its immunoneutralization with MAb resulted in inhibition (p<.04) of pregnancy establishment in the rhesus monkey. However, timed administration of l-NAME or aminoguanidine failed to inhibit blastocyst implantation in a significant manner. Also, no synergistic antinidatory action of antiprogestin combined with l-NAME was detected in the rhesus monkey. The application of MAb to VEGF during the periimplantation period, on the other hand, led to significant (p<.04) prevention of pregnancy without influencing steroid hormone levels in the circulation. Our data lend support to the hypothesis that VEGF is essential for pregnancy establishment and that trophoblast-derived VEGF, acting via its specific receptors Flt-1 and KDR, is necessary for blastocyst implantation. The use of cDNA-based expression arrays followed by differential display analysis has provided preliminary understanding of the nature of gene cluster networks operative in the receptive endometrium of potential conception cycles in the rhesus monkey. This knowledge may, in the future, lead to further innovative anti-implantation strategies for targeted pregnancy interception.

Menstrual-like breakdown and apoptosis in human endometrial explants

BACKGROUND

Apoptosis occurs in late secretory and menstrual human endometrium and is thought to play an important role in endometrial physiology. Menstrual-like breakdown has been observed in vitro in endometrial explants. The purpose of this study was to assess the role of apoptosis in menstrual-like breakdown in human endometrial explants.

METHODS

Human endometrial tissue was obtained during the mid-secretory phase and cultured with or without estrogen and progesterone. The occurrence of breakdown was assessed by histology. Apoptosis was determined by gel electrophoresis for the detection of DNA fragmentation and by immunohistochemistry using the M30 CytoDEATH and anti-cleaved caspase-3 (CASP3) antibodies for the detection of caspase activity. Expression of BCL2 and BAX was quantified using real-time PCR analysis.

RESULTS

Apoptosis occurred in human endometrial explants at all time-points studied. Cleaved CASP3 and M30 antigen expression increased in all explants, suggesting the involvement of CASP3 in the apoptosis. Low BCL2:BAX ratios were observed in all samples when compared with pre-culture controls. Estradiol and progesterone supplementation of the culture media reduced or eliminated menstrual-like breakdown but did not affect the degree of apoptosis observed.

CONCLUSIONS

The apoptosis observed in endometrium during the late secretory phase and menstrual phase does not appear to be mechanistically related to the tissue breakdown but rather may be involved in the impending remodelling that occurs in the endometrium in the transition from secretory to proliferative phase following the menses.