Depressed lymphocyte response to P.H.A. in women taking oral contraceptives

Prevalence and Risk Factors of Vulvovaginal Candidosis during Pregnancy: A Review

Vulvovaginal candidosis (VVC) is a symptomatic vaginal yeast infection, especially caused by Candida spp. Although VVC is common among reproductive-age women, prevalence studies notice the uprise of vaginal Candida colonization to 30% during pregnancy by culture, especially in the last trimester. Recent studies have considered it a severe problem due to the emerging evidence showing the association of VVC with a higher chance of pregnancy-related complexities (e.g., preterm labor, premature rupture of membranes, congenital cutaneous candidosis, and chorioamnionitis). In this review, we have reassessed and summarized the prevalence rate of VVC in expecting mothers and analyzed the association of several factors to the increased risk of VVC during pregnancy in different regions of the world. Altogether, these data collected from various studies showed the highest prevalence of VVC during pregnancy, mostly in Asian and African countries (90.38%, 62.2%, and 61.5% in Kenya, Nigeria, and Yemen, respectively). The prevalence rate of VVC during pregnancy was also found to differ with age, gestation period, parity, educational status, and socioeconomic level. Some pregnancy-related factors (e.g., weakened immunity; elevated level of sex hormones, glycogen deposition; low vaginal pH; decreased cell-mediated immunity) and several clinical and behavioral factors can be suggested as potential risk factors of candidosis during pregnancy.

Influence of low-dose oral contraception on peripheral blood lymphocyte subsets at particular phases of the hormonal cycle

OBJECTIVE

To investigate the effects of low-dose oral hormonal contraception on the immune system during certain phases of the hormonal cycle.

DESIGN

Prospective, nonrandomized, controlled study.

SETTING

Academic research setting.

PATIENT(S)

Women with regular menstrual cycle using hormonal oral contraception (OC; Cileste, 250 microg of norgestimat and 35 microg of ethinylestradiol, or Marvelon, 150 microg of desogestrel and 30 microg of ethinylestradiol) and women not using hormonal or other forms of contraception.

INTERVENTION(S)

Peripheral blood lymphocyte subsets were determined by flow cytometry on the first day of menstruation (day 1), in the follicular phase (day 8), midcycle (day 15), and in the luteal phase (day 22).

MAIN OUTCOME MEASURE(S)

Levels of lymphocyte subpopulations.

RESULT(S)

Women using OC had significantly higher levels of CD3+ CD8+ cells throughout their pill cycle compared to controls. Furthermore, women taking Cileste had lower levels of natural killer (NK) cells during their cycle and also women taking Marvelon but only from days 8-15. Within the pill cycle of Cileste we observed an increase in CD20+ and CD20+ CD5+ cells from days 1-8.

CONCLUSION(S)

Cytotoxic lymphocytes, which are responsible for first-line immune defense, and B cells, which are involved in autoimmune disorders, are affected by OC.

Active lifestyle offsets HRT-induced suppression of T cell reactivity to mitogens

OBJECTIVE

The purpose of the study was to investigate the combined impact of hormone replacement therapy (HRT) and active lifestyle on the phenotypic profile and in vitro activities of specific immune cells in postmenopausal women.

METHODS

Healthy postmenopausal women aged 45-70 were assigned to one of four groups: (a) HRT/sedentary (n = 9); (b) HRT/active (n = 12); (c) no HRT/sedentary (n = 10); and (d) no HRT/active (n = 9). Blood samples were collected from each subject on 3 days within 1 week. The mean value of three samples was used to assess the in vitro response of T lymphocytes to the mitogens phytohemagglutinin and concanavalin A and natural killer cell activity. One of three blood samples was utilized for phenotypic analysis of circulating leukocytes.

RESULTS

The mitogenic reactivity of T lymphocytes in whole blood cultures for the groups receiving HRT was lower than from the groups not receiving HRT. There also was a trend for T lymphocyte reactivity to be higher in the active women when compared to the sedentary women. In contrast, the phenotypic profile of leukocytes and natural killer cell activity were not significantly different for samples collected from the four groups.

CONCLUSIONS

These data suggest that the suppressive effect of HRT on T cell function in postmenopausal women may be attenuated by a physically active lifestyle.

Early pregnancy factor: an extracellular chaperonin 10 homologue

Early pregnancy factor (EPF) has been identified as a homologue of chaperonin 10 (cpn10) with immunosuppressive and growth factor properties. As a homologue of cpn10, it belongs to the heat shock family of proteins (hsp) but, unlike other members of this family, EPF is detected extracellularly. Early pregnancy factor was first discovered in pregnancy serum by the rosette inhibition test, and the novelty of its discovery was that its presence could diagnose pregnancy within 6-24 h of a fertile mating. As well as being a monitor of the presence of a viable embryo, it is necessary for embryonic survival. In this capacity it acts as both an immunosuppressant and growth factor. Early pregnancy factor is also a product of proliferating primary and neoplastic cells and functions as an autocrine growth factor both in vivo and in vitro. It has a modifying effect on the outcome of experimental autoimmune encephalomyelitis, an animal model of multiple sclerosis. Early pregnancy factor is considered to be one of the major factors involved in the modification of multiple sclerosis observed during pregnancy.

Cytokine Levels in Whole Blood Cell Cultures of Oral Contraceptive Users and Pregnant Women

The production of the cytokines IFN-gamma, IL-2, IL-1-alpha and TNF-alpha was investigated in the supernatants of mitogen-stimulated whole blood cell cultures from 52 oral contraceptive users, 33 pregnant women and 75 female controls. Cells from women taking oral contraceptives produced significantly less IFN-gamma (p≤0.05) and TNF-alpha (p≤0.05) compared to the controls. In the cultures of the pregnant women significantly lower levels of IFN-gamma (p≤0.01), IL-2 (p ≤0.001) and TNF-alpha (p≤0.01) were found than in those of the controls. Total and differential leukocyte counts were almost identical in all three groups of women. It is suggested, that lymphocyte and monocyte function as measured by cytokine production is altered in women taking oral contraceptives and in pregnant women.

Hormonal regulation of soluble immune response suppressor (SIRS): a possible role of SIRS in the maintenance of pregnancy

This study was conducted to investigate the effects of sex hormones upon the nature of soluble immune response suppressor (SIRS) produced by concanavalin A-stimulated Lyt-2+ T cells. Conventional SIRS affected IgM PFC only. However, SIRS made with progesterone (20-400 ng/ml or Prog-SIRS) suppressed IgM PFC, one-way MLR, and generation CTL; and SIRS made with estrogen (0.2-50 ng/ml or Est-SIRS) enhanced these responses. The factor(s) (MW 40,000-55,000) to stimulate macrophages to produce the second soluble factor (M phi-SF) was isolated from all preparations by gel filtration. Furthermore, Est-SIRS contained a factor(s) (MW 10,000-30,000) to enhance IgM PFC, MLR, and mitogen-induced blastogenesis of both T and B cells; and Prog-SIRS possessed the suppressive factor(s) to IgM PFC, MLR, and mitogen-induced T-cell proliferation. These activities were not impaired by 2-mercaptoethanol. Moreover, the suppressive activity of Prog-SIRS was completely absorbed by T cells only, but the enhancing activity of Est-SIRS was not completely absorbed by a single-cell population. These data suggest that progesterone can contribute to the suppression of allograft rejection through soluble factors, and estrogen can enhance host responses which may be affected by several soluble factors during pregnancy.

Amenorrhea after immunosuppressive treatment of multiple sclerosis

Interviews on changes in the menstrual cycle were taken from 38 women of fertile age, several years after immunosuppressive treatment (IS) with prednisone and cyclophosphamide (CP) for definite multiple sclerosis (MS). Serum FSH, LH and 17-beta-oestradiol levels were determined at the time of interview. MS in itself did not change the experience of menstrual cycles; 17 patients developed hypergonadotrophic amenorrhea during or after IS. Symptoms related to climacterium (c. q. flushing) were present in 15 of these patients. The onset of amenorrhea depended on the age at the time of IS and on the cumulative dose of CP. Older patients developed amenorrhea at a lower cumulative dose of CP than did younger patients. High estrogen oral contraceptives are advocated in oncology to prevent disturbance of ovarian function by anti-mitotic treatment. This policy is advisable in female MS patients treated with drugs like CP or azathioprine.

Increased prevalence of human papillomaviruses in the lower genital tract of pregnant women

In order to evaluate the influence of pregnancy on the presence of human papillomavirus (HPV) in the lower female genital tract, cervical smears of 92 pregnant and 96 non-pregnant women, matched by age, were examined for the presence of HPV-DNA by means of Southern blot hybridization. All patients had negative PAP smears. Twenty-six (28%) of the pregnant women and 12 (12.5%) of the non-pregnant women were positive for HPV. HPV 16 accounted for 42% of all positive pregnant cases and only 25% of the positive non-pregnant cases. Smears of pregnant patients contained more than 10 pg viral DNA in 45% of the cases against 20% in the non-pregnant group. HPV 16 showed the most active replication in both groups. This study demonstrates an increased prevalence of HPV (preferentially of HPV 16) and a higher replication rate of viral DNA during pregnancy.

Rat pregnancy immunoregulatory circuits are progestation hormonal status, decidual tissue, embryo-trophoblast and late pregnancy changes dependent

We have tested the spleen cells of rats for their reactivity to mating and unrelated (third party) strain alloantigens during pregnancy, pseudopregnancy, and traumatic deciduoma installation. By cytotoxic T-lymphocyte assays, after 7-day one-way mixed lymphocyte cultures (MLC), we detected the presence of many immunoregulatory circuits among rat pregnancy and postpartum. They are progestation hormonal status, decidual tissue, embryo-trophoblast, late-pregnancy-parturition-associated changes, and lactation-hormonal-status dependent.

Rat pregnancy induces two suppressor cell activities

Pregnancy in rat is able to stimulate two suppressor cell activities. One is specific to the paternal histocompatibility antigens and it resides in the T-lymphocyte population. The second is nonspecific and is of non-T nature. The use of various methods for pseudopregnancy and deciduoma installation has allowed the demonstration of two inducing circuits: (a) the presence of fertilized ova in the female genital tract and (b) the progestation hormonal status.

Effect of pregnancy on stimulation of alphavirus immunity in mice

The state of pregnancy was associated with a marked enhancement of both proliferative and cytotoxic T cell antiviral immune responses after infection of mice with avirulent Semliki Forest virus. Strong responses were obtained from the spleen and the para-aortic lymph nodes that drain the uterus. This immune enhancement seemed to be in response to the increased antigenic challenge that originated from infected placental and fetal tissue and was released during the process of abortion. Immune enhancement was not observed in pregnant mice similarly infected with Ross River virus, which also established an intrauterine infection but does not cause abortion.

Estrogen replacement therapy and the mixed lymphocyte reaction

Alterations in immune reactivity may occur in postmenopausal women during estrogen replacement therapy. Fifty-eight women were followed during 6 months of treatment with various synthetic and natural estrogens. Samples of serum showed a dose-dependent inhibitory influence on the mixed lymphocyte reaction. Mean levels of two immunosuppressive serum factors, total cortisol and pregnancy zone protein, were increased during treatment, but individual values were not correlated to depressed lymphocyte reactivity. A direct effect of estrogen on immunoreactive cells is suggested.

Immune reactivity of women on hormonal contraceptives. Phytohemagglutinin and concanavalin-A induced lymphocyte response

To investigate the influence of sex-steroids on the in vitro correlate of cell-mediated immunity (CMI), blood samples from 49 women on hormonal contraceptives were tested on the lymphocyte response to the mitogens phytohemagglutinin (PHA) and concanavalin A (Con-A). Sixteen women were taking oral contraceptives of combined oestrogen/progestogen of the same brand (low oestrogenic and middle range progestogenic activity); 15 had received intramuscular injections of medroxyprogesterone acetate and 18 women were using a sequential pill. The results were compared with those of 18 women not taking contraceptive steroids and matched for age. No significant changes were observed between the different groups. Considering the previously found alterations in dinitrochlorobenzene (DNCB) skin test reactivity by sex steroids, it is hypothesized that sex-steroids have little or no influence on the central proliferative phase of the immune response, but have a profound effect on the efferent phase.

Immune studies in oral contraceptive users

Some of the parameters of immune status-percentage of B and T lymphocyte subpopulation, PHA-induced lymphocyte transformation measured by 3H-thymidine incorporation (PILT) and levels of total haemolytic complement (CH5O) were studied in Indian women from low income group who were using estrogen-progestogen combination pills. There were no differences in percentage of B and T lymphocyte subpopulation or PILT between OC users and the control group. However, CH5O levels were significantly lower in OC users. The depression in circulating complement levels in OC users is intriguing and suggests the possibility that complement system and circulating immune complexes may be altered in OC users.

Determination of pregnancy zone protein in serum using an automated immunoprecipitin reaction method

Determination of pregnancy zone protein in serum by means of an automated immunoprecipitin reaction method and pretreatment with polyethylene glycol for reducing the serum blanks is described. Using this procedure the sensitivity of the method was greatly improved, from originally 100 mg/l to 1 mg/l. The precision "between days" was 9.9%. A positive and significant correlation to electroimmuno assay is demonstrated. In apparently healthy controls the median serum pregnancy zone protein in females was 38 mg/l (2--91 mg/l) and in males 2 mg/l (0--20 mg/l). No correlation between serum pregnancy zone protein and age could be demonstrated. In malignant diseases our results seem to confirm a relationship between increased pregnancy zone protein and spreading of the tumours. Serum pregnancy zone protein in disseminated malignancies are increased significantly compared to controls. In males 75% with disseminated tumours have elevated serum pregnancy zone protein.

Cell-mediated immunity in pregnant patients with and without a previous history of spontaneous abortions

The percentage of T-cells was studied in pregnant patients with a previous history of spontaneous abortions, in patients without such a history and in nonpregnant controls. The percentage of T-cells remained unaltered during the three trimesters of normal pregnancy. In patients with a previous history of spontaneous abortions, the T-cell percentages were lower in the second and third trimesters than in non-pregnant controls, but the values did not differ statistically from corresponding values in those patients with no previous history of spontaneous abortion (normal pregnancy). The phytohaemagglutinin (PHA)-induced transformation of lymphocytes was depressed in the second and third trimesters of both patients with a normal pregnancy and those with a previous history of spontaneous abortions. Thus, while the percentage of T-cells remained unaltered during pregnancy, their response to PHA falls in the second and third trimesters.

Erythema nodosum associated with pregnancy and oral contraceptives

Erythema nodosum recurred in a woman during each of her four pregnancies and every time she was started on oral contraceptives. The lesions always disappeared in the fifth month of gestation or when contraceptives were withdrawn. Erythema nodosum is mediated by immune mechanisms, and both pregnancy and oral contraceptive use can interfere with the immune system. The concentrations of oestrogen and progesterone or the ratio between them may be critical to the development of erythema nodosum. The observation that the lesions spontaneously resolved in the fifth month of pregnancy supports this hypothesis.

The effect of prolactin on the response of human lymphocytes to phytohaemagglutinin

Lymphocytes were collected from ten normal human males and incubated with or without phytohaemagglutinin (PHA) in the absence or presence of ovine prolactin in concentrations found in normal individuals and in human pregnancy. Prolactin consistently inhibited lymphocyte transformations. The degree of inhibition became progressively less as PHA concentrations were increased.

A quantitative study of the pregnancy zone protein in sera of woman taking oral contraceptives

By means of a single radial immunodiffusion the concentration of "the pregnancy zone protein" (PZ) was measured in sera from women taking oral contraceptive drugs. Woman taking only 0.3 mg. of norethisterone were found not to induce measurable amounts of PZ, whereas women taking combined contraceptive drugs showed a significant rise in concentration of PZ. After six months' treatment, 1 mg. of norethisterone and 0.1 mg. of meastranol daily were found to give an average concentration of PZ amounting to 59 mg. per 100 ml., that is, approximately half of the concentration of PZ in sera from women during the last trimester of pregnancy. Different combined contraceptive pills gave rise to different concentrations of PZ.

[Immunochemical investigations on the protein of the "pregnancy zone". X. Demonstration of immunosuppressive activities of the pregnancy-associated alpha2-glycoprotein (pregnancy zone protein) by means of the macrophage electrophoretic mobility test (author's transl)]

By means of the macrophage electrophoretic mobility (MEM) test the supposed immunosuppressive activity of the pregnancy-associated alpha2-glycoprotein (pregnancy zone protein) could be demonstrated significantly. Pregnancy sera and sera of nonpregnant women with hormonal contraception containing this pregnancy protein showed an immunosuppresive activity, too. On the contrary, serum of male donors with the blood group AB and human serum albumin had no inhibitory effects. The results suggest that the pregnancy-associated alpha2-glycoprotein rather influences the afferent limb of the immune response and does not interfere with the activity of the mediator (migration inhibiting factor).

Dinitrochlorobenzene sensitisation test in women on hormonal contraceptives

Cell-mediated immunity was measured in women on hormonal contraceptives using the 2,4-dinitrochlorobenzene (D.N.C.B.) sensitisation test. Three groups of women were studied: forty-eight women were taking oral contraceptives of combined oestrogen/progestogen (thirty-seven of them had used oral contraceptives for a year or longer); twelve women were using a sequential pill (ethinyloestradiol and megestrolacetate); and sixteen women had received intramuscular injections of medroxyprogesterone acetate. The results were compared with those of a control group of twenty-nine age-matched women not taking contraceptive steroids. In women on the combined contraceptive pill and those who had received intramuscular progesterone, mean D.N.C.B. reactivity was significantly increased. The results were even more striking in women who had used combined contraceptive pills for more than one year. These results do not accord with the previously reported decrease in cell-mediated immunity in women on hormonal contraceptives.

Phytohemagglutinin-induced lymphocyte transformation in newly presenting patients with primary carcinoma of the lung

The transformation of peripheral blood lymphocytes in response to PHA was studied in 37 newly presenting patients who were subsequently proven to have carcinoma of the lung. When compared with healthy age- and sex-matched normal controls, no differences were noted in the thymidine uptake of the unstimulated lymphocytes in culture or in the response to any of the three dose levels of PHA used. Neither the extent of the spread of the carcinoma nor the type of its histology showed any correlation with the PHA response, but the PHA response was significantly depressed within 14 days of death in 7 patients. No evidence for serum inhibitory factors was found.

Oestrogen therapy and serum cortisol in carcinoma of the prostate

Patients with prostatic cancer, receiving oestrogen therapy were found to have elevated serum cortisol levels and lymphopenia. Oestrogens are known to have a profound effect on the immune system; the possibility that this effect is mediated through the adrenal cortex is discussed. The significance of these findings, however, remains to be determined.

Lymphocyte reactivity in pregnant women and newborn infants

The mitotic response to phytohaemagglutinin (PHA) was determined in lymphocytes of mothers and their newborn infants obtained at delivery and seven days later by measuring the rate of 125 I-idoxuridine uptake into DNA in lymphocytes cultured in their own plasma and after washing and resuspension in fetal bovine serum. There was no difference in the unstimulated counts of maternal lymphocytes taken at delivery, whether unwashed or washed, compared with those from nonpregnant controls. With PHA stimulation the mitotic response of the maternal lymphocytes cultured in their own plasma was reduced compared with that of the control lymphocytes but washed maternal cells showed a similar response to the controls. These findings suggest that the reduced lymphocyte mitotic response to PHA in pregnancy is due to a plasma inhibitory factor This inhibition was not evident in maternal blood taken seven days after delivery. DNA synthesis in unstimulated cultures from newborn infants at birth and seven days after birth was greater than that in adult control cultures. With PHA stimulation the mitotic response of cord-blood lymphocytes cultured in their own plasma paralleled that of control lymphocytes but washed newborn cells showed a greater response. Thus plasma suppression similar to that observed in the mother seems also to affect infants at birth. This inhibition was not demonstrable in blood taken from infants of 7 days.

Inhibitory effect of progesterone on the phytohaemagglutinin- induced transformation of human peripheral lymphocytes

Effect of sex steroids, progesterone and estradiol-17beta, on transformation of human lymphocytes induced by PHA was investigated. Responses of peripheral lymphocytes from non-pregnant women to PHA was markedly reduced in the presence of progesterone at a concentration of 10(3) or 10(4) ng/ml. Estradiol-17beta, on the other hand, had no effects on the PHA-induced transformation under the present experimental conditions. The immunosuppressive property of progesterone may contribute to depression of maternal cell-mediated immunity against fetus during pregnancy.

Depression of cellular immunity in pregnancy due to a serum factor

Lymphocytes from pregnant women and non-pregnant individuals were cultured under the stimulus of phytohaemagglutinin in the presence of their own and heterologous (allogeneic) sera. The results indicate that heterologous sera have an inhibitory effect on the lymphocyte transformation rate and suggest that the inhibitory property is more powerful in pregnant and fetal sera. Conversely, the addition of heterologous non-pregnant sera to cultures of pregnant lymphocytes increases their transformation rate. These findings suggest that there is a serum inhibitor in pregnancy and this finding may be relevant to the survival of the fetal allograft.