Binding of human secretory leukocyte protease inhibitor in uterine cervical mucus to immunoglobulins: pathophysiology in immunologic infertility and local immune defense

Alginate/Chitosan Particle-Based Drug Delivery Systems for Pulmonary Applications

Cystic fibrosis (CF) is a complex, potentially life-threatening disease that is most effectively treated through the administration of antibiotics (e.g., colistimethate sodium). Chronic infection with Pseudomonas aeruginosa is one of the most significant events in the pathogenesis of cystic fibrosis, and tobramycin is the treatment of choice for those patients with chronic P. aeruginosa infection who are deteriorating despite regular administration of colistimethate sodium. Effective treatment can be challenging due to the accumulation of thickened mucus in the pulmonary environment, and here we describe the results of our investigation into the development of alginate/chitosan particles prepared via precipitation for such environments. Tobramycin loading and release from the alginate/chitosan particles was investigated, with evidence of both uptake and release of sufficient tobramycin to inhibit P. aeruginosa in vitro. Functionalisation of the alginate/chitosan particles with secretory leukocyte protease inhibitor (SLPI) was shown to help inhibit the inflammatory response associated with lung infections (via inhibition of neutrophil elastase activity) and enhance their interaction with cystic fibrosis mucus (assayed via reduction of the depth of particle penetration into the mucus) in vitro, which have prospects to enhance their efficacy in vivo.

WAP domain proteins as modulators of mucosal immunity

WAP (whey acidic protein) is an important whey protein present in milk of mammals. This protein has characteristic domains, rich in cysteine residues, called 4-DSC (four-disulfide core domain). Other proteins, mainly present at mucosal surfaces, have been shown to also possess these characteristic WAP-4-DSC domains. The present review will focus on two WAP-4-DSC containing proteins, namely SLPI (secretory leucocyte protease inhibitor) and trappin-2/elafin. Although first described as antiproteases able to inhibit in particular host neutrophil proteases [NE (neutrophil elastase), cathepsin-G and proteinase-3] and as such, able to limit maladaptive tissue damage during inflammation, it has become apparent that these molecules have a variety of other functions (direct antimicrobial activity, bacterial opsonization, induction of adaptive immune responses, promotion of tissue repair, etc.). After providing information about the 'classical' antiproteasic role of these molecules, we will discuss the evidence pertaining to their pleiotropic functions in inflammation and immunity.

Antisperm antibodies and conception

Sperm have been known to be antigenic for more than a century. There is a strong body of evidence that in humans and in other species at least some antibodies that bind to sperm antigens can cause infertility. Therefore, these antibodies are of interest today for two practical reasons. Firstly, the association of the antibodies with infertility means that they must be detected and then the couples treated appropriately. Secondly, because these antibodies can induce infertility they have the potential to be developed for contraceptive purposes in humans and also for the control of feral animal populations.

Cervical occlusion in women with cervical insufficiency: protocol for a randomised, controlled trial with cerclage, with and without cervical occlusion*

OBJECTIVE

To evaluate the effect of double cerclage compared with a single cerclage.

DESIGN

Randomised, controlled multicentre trial.

SETTING

Ten different countries are participating with both secondary and tertiary centres. The countries participating are Denmark, Sweden, Germany, United Kingdom, Spain, South Africa, Australia and India. This gives both a broad spectrum of diversity global and local. We expect a total of 242 women enrolled per year.

POPULATION

Prophylactic study: 1. History of cervical incompetence/insufficiency. (Delivery 15 to <36 weeks.) 2. Congenital short cervix (secondary to maternal administration of diethyl stilbestrol) or traumatic/surgical damage rendering the vaginal approach difficult (e.g. conisation). 3. Cervical suture applied in previous pregnancy, successful outcome. 4. Previous failed cerclage. Therapeutic study: 5. Secondary cerclage: Short cervix, without the membranes being exposed to the vagina. 6. Tertiary cerclage: Short cervix, membranes exposed to the vagina. Observational study: Eligible women who refuse to be randomised will participate in an observational study. 7. Repeat/requested cervical occlusion.

METHODS

The women will be randomised between a single (vaginal or abdominal) and a double cerclage. The cervical cerclage (McDonald or Shirodkar) as well as the abdominal suture will be performed with the same material and technique normally used by the participating department. Those randomised to the double cerclage will have their external os closed with a continuous nylon 2-0/3-0 suture, in addition to the standard single cerclage. Local guidelines concerning antibiotics, Heparin, bed rest, tocolytics etc. are followed and recorded in the follow-up form.

MAIN OUTCOME MEASURES

Primary endpoint is take home baby rate. The secondary endpoints are gestational age at delivery, incidence of preterm birth (<34+0 days) and number of days in neonatal unit.

Biological Functions of IgA

Immunoglobulin A (IgA) is the most enigmatic of immunoglobulins. It is by far the most abundant of human Igs, being present in the blood plasma at concentrations approximating 2–3mg/mL, as well as the dominant isotype in most secretions where its output amounts to some 5–8g/day in adults. Furthermore, its evolutionary origins appear to precede the synapsid– diapsid divergence in tetrapod phylogeny (>300 million years ago) because it is present in both mammals and birds and therefore possibly also in reptiles (reviewed in Peppard et al., 2005); an IgA-like molecule has now been identified in a lizard (Deza et al., 2007).

Clinical associations and mechanisms of action of antisperm antibodies

OBJECTIVE

To review and critique the current English literature describing the effects of antisperm antibodies (ASA) on mammalian fertility.

DESIGN

A comprehensive English language literature was searched using Medline and by hand-searching. Emphasis was placed on clinically relevant articles.

RESULT(S)

Results from the studies were extrapolated and the effects of ASA on fertility described.

CONCLUSION(S)

Antisperm antibodies may interfere with fertility. Not all ASA cause infertility. Current tests cannot differentiate the infertility-related ASA from those that do not interfere with infertility, because the antigenic specificities of these ASA are not known. The antigens which the infertility-related ASA must be characterized to allow an accurate detection and proper treatment for couples with ASA.

Sperm immobilizing antibodies in the sera of infertile women cause low fertilization rates and poor embryo quality in vitro

PROBLEM

The effects of sperm immobilizing antibodies in the sera of infertile women on fertilization and embryo quality in vitro were investigated.

METHOD OF STUDY

Before the introduction of sperm immobilization test (SIT) as a routine test for female infertility, 85 oocytes were collected in nine in vitro fertilization (IVF) cycles from four infertile women who were afterward found having had sperm immobilizing antibodies in their sera and the oocytes were inseminated with swim-up sperm in a medium containing the patient's serum. Fifty oocytes were collected in five IVF cycles from five infertile women possessing the antibodies in their sera and the oocytes were inseminated with swim-up sperm in a medium supplemented with human serum albumin (HSA).

RESULTS

In the former group, 41 of 85 oocytes were fertilized, giving a fertilization rate of 48.2%. In the latter group, 43 of 50 oocytes were fertilized, giving a fertilization rate of 86.0%. There was a significant difference of the fertilization rate between the groups (P < 0.0001). Embryo quality was assessed by the Veeck's classification. The grade 1 and grade 2 embryos were considered good quality. Using this classification, 16 (39.0%) of 41 embryos incubated in the medium containing the patient's serum were good quality, while 34 (79.1%) of 43 embryos incubated in the medium supplemented with HSA were good quality. There was also a significant difference between the groups (P = 0.0003).

CONCLUSIONS

These findings might indicate that sperm immobilizing antibodies in the sera of infertile women cause low fertilization rates and poor embryo quality in vitro. It is suggested that SIT in the sera of infertile women should be performed at least before proceeding IVF. The manipulation of gametes and embryos from patients having sperm immobilizing antibodies should be carefully carried out especially to avoid contaminating patient's serum and follicular fluid in the culture medium in order to have a better IVF result.

An immune hypothesis of sexual orientation

Sexual orientation is encoded within immune-cell subsets (ICS) of mucosal and epithelial tissues. Gender orientation may be encoded within other ICS. Many immune cells: recognize and react to H-Y and H-X antigens; and enact these perceptions and reactions in accord with the perceiver's and the perceived's MHC haplotype, XX or XY status, and immune-self recognition. Non-heterosexual orientations derive from excessive cross-priming, accompanied by clonal deletions, clonal expansions, anergy and tolerance. For at least some tissues, cross-priming sufficient to induce altered orientations may occur during critical periods of immunological development and can occur during fetal and infant development via maternal-fetal transfusion, placental pathology, and impaired maternal nutrient-status or via excessive peripheral apoptosis during postnatal illness. Mast cell interactions with neurons illustrate how mucosal perceptions can be transduced into neuronal signals that modulate CNS events. This hypothesis is testable by mixed-lymphocyte reactions in appropriate cell subsets. Dendritic-cell immunizations are a potential therapy.

Sperm-immobilizing antibodies block capacitation in human spermatozoa

Sperm-immobilizing antibodies block human fertilization by interfering with the acrosome reaction (AR). To clarify the mechanism of blockage of AR by sperm-immobilizing antibodies, the authors examined their effects on the increase of intracellular free Ca2+ concentration induced by follicular fluids (Ca2+ influx) in spermatozoa and on their capacitation. Sperm-immobilizing antibodies did not suppress Ca2+ influx induced by follicular fluid, but they inhibited capacitation of human spermatozoa. Namely delta%AR (%AR after addition of an AR inducer--%AR before treatment) induced by progesterone was significantly (p < .0001) lower when spermatozoa were incubated in human tubal fluid medium cotaining antibody-positive serum (1.2%), compared to that when incubated in control medium (19.2%). Furthermore, the proportion of both spermatozoa that became capacitated and ones that had become capacitated decreased significantly (p < .0001) after 2, 4, and 6 h of incubation in medium containing antisperm antibody-positive serum, compared to those of spermatozoa incubated in control medium. In conclusion, sperm-immobilizing antibodies may be closely related to their blockage of capacitation.