The functional competence of uterine-derived polymorphonuclear neutrophils (PMN) from mares resistant and susceptible to chronic uterine infection: a sequential migration analysis

The Effects of Treatment with N-Acetyl Cysteine on Clinical Signs in Persistent Breeding-Induced Endometritis Susceptible Mares

Persistent breeding-induced endometritis (PBIE) is a major cause of infertility in mares. Endometrial inflammation that persists until embryonic descent ultimately results in early embryonic death. A poor endometrial biopsy grade (IIb or III) has been identified as a risk factor for PBIE. Intrauterine fluid accumulation (>2 cm in depth), pathologic endometrial edema, and elevated intrauterine neutrophil levels are all clinical features of PBIE. Commonly applied treatment options include uterine lavage and oxytocin therapy. N-acetyl cysteine (NAC), a mucolytic used to treat bacterial endometritis in mares, has anti-inflammatory properties and was investigated as a potential treatment for PBIE. A randomized, blinded, cross-over design clinical trial used NAC before breeding in PBIE-susceptible mares (n = 9). Intrauterine infusion of 3.3% NAC was performed 12 hours before insemination, and endometrial cytology and endometrial biopsy samples were obtained at 12 and 60 hours after insemination. Endometrial biopsies were evaluated for the degree of inflammation present. Clinical signs of endometrial edema and intrauterine fluid volumes were assessed by transrectal ultrasound at 12 and then every 24 hours after breeding. Data were analyzed using repeated measures analysis of variance and a Mann Whitney Wilcoxon Test. Treatment with NAC did not improve clinical signs in PBIE-affected mares. However, endometrial biopsies from mares treated with NAC displayed more diffuse and severe neutrophil infiltration than control cycles. Further research using a larger population of mares is required to evaluate the effects of NAC treatment on the endometrium of PBIE-susceptible mares.

The contribution of complement to opsonic activity in the uterine secretions of mares free of endometritis

The aim of the present study was to investigate if complement contributes to opsonic activity in the uterine secretions of mares with normal reproductive functions. Five mares with a mean age of 9 years were used in the study. The mares were considered to be free of endometritis based upon clinical history, palpation per rectum and ultrasonogaraphy of the genital tract, videoendoscopic inspection of the uterus, electronmicroscopy of endometrial biopsies, and bacteriological and cytological examination of swabs from the endometrium. The hormonal status of the mares was also determined. Uterine secretions were collected by a tampon inserted into the uterus during estrus. Secretion and serum samples were divided in half, one half of which was subjected to heat treatment (56 degrees C in 30 minutes) in order to inactivate the complement. Opsonic activity in the samples was then determined in a chemiluminescence assay using zymosan as the target particle. Opsonic activity was expressed as peak chemiluminescence and the time to peak chemiluminescence. Heat treatment of the secretions reduced peak luminescence significantly (P<0.01), and it prolonged the time to peak luminescence significantly (P<0.05). These data show that complement contributes a considerably to opsonic activity in uterine secretions prior to an inflammatory response in the equine uterus.

Effect of adjunctive treatment with intravenously administeredPropionibacterium acneson reproductive performance in mares with persistent endometritis

OBJECTIVE

To determine whether treatment with a preparation of Propionibacterium acnes would improve pregnancy and live foal rates in mares with persistent endometritis.

DESIGN

Randomized placebo-controlled clinical trial.

ANIMALS

95 mares with a cytologic diagnosis of persistent endometritis.

PROCEDURES

Mares were treated with P acnes or placebo (both administered IV) on days 0, 2, and 6. No attempt was made to alter additional treatments administered by attending veterinarians. Information on breeding history, physical examination findings, results of cytologic examination and microbial culture of uterine samples, additional treatments administered, breeding dates, results of pregnancy examinations, whether a live foal was produced, and reactions to treatment was recorded.

RESULTS

In multivariate logistic regression models, mare age, year of entry into the study, and first breeding within 8 days after first treatment with P acnes or placebo were significantly associated with pregnancy. Fewer number of cycles bred and younger age were significantly associated with delivery of a live foal in a separate multivariate analysis. Results of multivariate logistic regression modeling indicated that mares treated with P acnes were more likely to become pregnant and to deliver a live foal, compared with placebo-treated controls.

CONCLUSIONS AND CLINICAL RELEVANCE

IV administration of P acnes as an adjunct to conventional treatments in mares with a cytologic diagnosis of persistent endometritis improved pregnancy and live foal rates. The optimal effect was detected in mares bred during the interval extending from 2 days before to 8 days after first treatment with P acnes.

Making sense of equine uterine infections: the many faces of physical clearance

Equine uterine infections inflict major losses on the equine industry. Persistent inflammation of the oviduct and uterus leads to loss of the conceptus and mares susceptible to infection have weakened uterine defences partly due to retention of inflammatory exudate. Bacteria may trigger inflammation, resist phagocytosis, or adhere to the endometrium and types of infection range from genital commensals in susceptible mares to reproductive pathogens in normal mares. Uterine infections are diagnosed by history, detection of uterine inflammation, and isolation of typical organisms and susceptible mares may be identified by detection of intrauterine fluid during oestrus, or at 6-48 h post-breeding. Therapy includes oxytocin, uterine lavage, antibiotics, and prostaglandin analogues and clinical studies indicate additive benefits of oxytocin and antibiotics. Improved conception rates have been associated with autologous, intrauterine plasma, despite controversy about its bactericidal efficacy. Because of the potential for endometrial damage, intrauterine antiseptics require caution.

Degenerative Endometrial Changes do not Change the Functional Capacity of Immigrating Uterine Neutrophils in Mares

An endometritis model was used to investigate the influence of degenerative endometrial changes (endometrosis) on functional parameters of uterine neutrophils in the horse. Six hours after intrauterine application of recombinant human interleukin-8 (rhIL-8), the uteri of 15 mares were flushed with phosphate-buffered saline. Quantitative and qualitative flow cytometric assays were then made to determine the absolute numbers, viability, phenotype, generation of reactive oxygen species (ROS), and phagocytic activity of immigrated polymorphonuclear neutrophilic granulocytes (PMN). Recombinant hIL-8 attracted similarly high numbers of similarly viable PMN into the uteri of mares with or without degenerative endometrial changes. Compared with blood PMN, immigrated uterine neutrophils displayed significantly upregulated expression of CD11a/CD18 (LFA-1) on uterine PMN whereas major histocompatibility complex class I molecules were expressed at lower densities. The ability to phagocytose opsonized streptococci did not differ between uterine and blood PMN. However, uterine PMN displayed a higher capacity to generate ROS. On average, uterine PMN of mares with degenerative endometrial changes showed phenotypical and functional characteristics similar to those of mares with a histologically healthy endometrium. Therefore, degenerative endometrial changes per se did not reduce the functional capacity of equine uterine neutrophils in mares.

Endometritis in she donkeys in Egypt

The endometrial necropsies of 165 she donkeys were examined and the endometria were classified into four grades according to histological features (I, IIa, IIb, III). Category I was observed in 86 cases (52.12%) and diagnosed as normal endometria. Category IIa was observed in 18 cases (10.91%) and diagnosed as slight endometritis. Category IIb was observed in 28 cases (16.97%) and diagnosed as moderate endometritis (two to four nests/field), while category III was observed in 33 cases (20%) and diagnosed as severe endometritis (eight nests/field). A bacteriological examination was carried out and oestrogen and progesterone were estimated. Our results indicate that endometritis and the prognosis of fertility in she donkeys were more or less parallel to mares.

Post-breeding endometritis in the mare

Post-breeding endometritis is a major cause of subfertility in the mare. Endometritis is a normal event in the immediate period after mating, but the presence of ultransonographically visible uterine fluid more than 12 h later is thought to be evidence of uterine pathology. In mares that are free of venerally transmitted endometritis, treatment is aimed at removing the intraluminal fluid. If the endometritis persists past day 5, when the embryo enters the uterine lumen, the cytotoxic environment will not be compatible with pregnancy. Reproductive anatomy, defective myometrial contractility, lowered immune defences, overproduction of mucus, inadequate lymphatic drainage, or a combination of these factors will predispose the mare to post-breeding endometritis.

Assessment of the effect of three treatments to remove intrauterine fluid on pregnancy rate in the mare

The effects on pregnancy rate of three different treatments to remove intrauterine fluid were assessed in 1267 mares. The mares were mated and allocated, in strict rotation, to four treatment groups: 1) untreated controls, 2) intrauterine infusion of broad spectrum antibiotics, 3) intravenous injection of oxytocin, 4) intravenous injection of oxytocin followed by intrauterine antibiotics. The pregnancy status of the mares was determined 13 to 15 days and 27 to 30 days after ovulation by transrectal ultrasonography. The pregnancy rate of group 4 (72 per cent) was higher than that of group 2 (64 per cent, P < 0.01) or group 3 (63 per cent, P < 0.01). The pregnancy rates of groups 2 and 3 were higher than that of group 1 (56 per cent, P < 0.01). The treatment with antibiotics and oxytocin appeared to have an additive beneficial effect which suggested two different modes of action of the combination treatment, namely antibacterial activity and fluid drainage. In the untreated mares more fluid accumulated in the uterine lumen after mating, and this was the most likely reason for their lower pregnancy rate.

Scintigraphic measurement of uterine clearance in normal mares and mares with recurrent endometritis

The percentage of Technetium 99m-albumin colloid (99mTc-microAA), a radiocolloid, cleared from the uterine lumen within 4 h of intrauterine infusion, was measured in 15 mares during 2 consecutive cycles, on Day 3 of oestrus and 48 h after ovulation. Four nulliparous (Group 1) and 4 multiparous (Group 2) mares were classified as resistant and the remaining 7 multiparous mares were classified as susceptible (Group 3) to endometritis. Mares in Groups 1 and 2 cleared more 99mTc-microAA from their uteri than did mares in Group 3 during oestrus (P < 0.01) and 48 h after ovulation (P < 0.001). In the Group 1 + 2 mares, > 50% of the colloid was cleared in 7 and none in the remaining mare, apparently related to lack of cervical relaxation. Mean percentage of 99mTc-microAA cleared by Group 3 mares was negligible (< 5%), but some 99mTc-microAA was cleared by 3 of the 7 mares during 4 of the 6 studies conducted. Clearance of radiocolloid infused into the uterus of 3 reproductively normal mares during dioestrus was negligible. 99mTc-microAA infused into the uterus did not adversely affect endometrial integrity as determined by endometrial biopsy. Mares tolerated the procedures well. We conclude that scintigraphy can be used to detect impaired mechanical clearance of the uterus: reproductively normal mares clear > 50% 99mTc-microAA within 2 h of infusion whereas those susceptible to endometritis or mares with poor cervical dilatation may exhibit delayed uterine clearance.

Effects of intrauterine infusion of endotoxin in normal cows and in cows with endometritis induced by experimental infection with

Two experiments were carried out to describe the effects of intrauterine infusion of Escherichia coli endotoxin on some aspects of nonspecific uterine defense mechanisms in healthy cyclic cows (Experiment 1) and in cows with induced endometritis by experimental infection with Streptococcus agalactiae (Experiment 2). In Experiments 1 and 2, the mean log(e) total white cell counts (>95% neutrophils) in the uterine flushing fluid of the endotoxin-treated group were significantly increased (P<0.01 and P<0.05, respectively). Streptococcus agalactiae was detected by the Latex Agglutination Test (LAT) in 47% of the samples from uteri experimentally infected with this organism; 12.5% were positive on culture, and only 10% were positive on both tests. With one exception, all the samples with a positive culture were positive to the LAT, but not all samples submitted to the LAT had positive culture. There was a significant (P<0.05) association between endotoxin treatment and the presence of infection detected by the LAT but not with that detected by culture (P>0.05) at 3 to 12 days post infection. Similar results were found at 8 to 16 days post infection. The infection disappeared from the endotoxin-treated group but not from the non-treated group 12 days after the induction of infection. It is concluded that intrauterine E. coli endotoxin infusion might provide an alternative treatment for those cows with endometritis that is refractory to conventional antimicrobial and hormonal therapy. It is also concluded that the LAT is an easier, quicker and more reliable method than bacterial culture for the detection of endometritis caused by Strep. agalactiae , and, possibly, such immunodiagnostic tests may be useful for the detection of other uterine infections.

Mononuclear cell infiltration of the equine endometrium: immunohistochemical studies

Endometrial sections from mares with varying degrees of mononuclear cell infiltration were examined for immunoglobulin (Ig)A-, IgM-, IgG(T)- and IgG(Fc)-containing cells, luminal and glandular epithelial cell Ig-staining and free interstitial Ig-staining, using a peroxidase anti-peroxidase technique. Mares with mild to moderate (Group 2) and mares with severe diffuse mononuclear cell infiltration, superimposed by acute endometritis (Group 3), had significantly higher numbers of Ig-containing cells than genitally-normal mares (Group 1). The differences between Groups 1 and 3 were significant for all four isotypes. In Groups 1 and 2, numbers of IgA-containing cells were significantly larger than numbers of IgM- and IgG(T)-containing cells. Generally, more glandular epithelial cells stained for IgA and IgM than for IgG(T) and IgG(Fc), and Ig-staining for all isotypes increased from Group 1 to Group 3. Free interstitial staining did not appear to differ among the three groups, but IgG(Fc)- and IgG(T)-staining generally was more intense than IgA- and IgM-staining. The efficiency of uterine defence in the mare does not seem to depend solely on humoral factors, and defects involving other components of the defence system may contribute to failure of the uterus to clear infection.

A method for the accurate measurement of opsonic activity in uterine secretions of the mare

This study was undertaken to develop a method for accurately measuring opsonic activity in the uterine secretions of the mare. Ten mares were used in the study. They ranged in ages from 6 to 19 years and were of various genital health status. Undiluted uterine secretions were collected by inserting a tampon into the uterus during estrus; serum samples were collected simultaneously Opsonic activity in the secretions and serum was analyzed in a chemiluminescence assay, in which zymosan particles were opsonized. Opsonic activity was determined as peak chemiluminescence, time to peak chemiluminescence, and total chemiluminescence (area under curve). The peak chemiluminescence was 16 to 17 times higher when uterine secretions were used for opsonization rather than when buffer was used. Compared to the opsonic activity in serum, the peak chemiluminescence was 21% (P</=0.05) lower, the time to peak chemiluminescence was 117% (P</=0.05) longer, and the total chemiluminescence over 60 minutes was 7% (P</=0.05) greater in the uterine secretions. These data show that opsonic activity in the uterus is approximately of the same magnitude as that in the circulation.

Inflammatory components in uterine fluid from mares with experimentally induced bacterial endometritis

Exudate and uterine flushings were collected at either 30, 60, 120 or 240 mins after intrauterine infusions of Streptococcus zooepidemicus in genitally normal mares during oestrus. Uteri were also flushed without prior induction of endometritis. Protein concentrations in exudate and flushings increased with time and exudate pH decreased with time; the pH of flushings did not alter. Lysozyme and lactate dehydrogenase were present in flushings from non-infected uteri, but concentrations increased with time after infection. Immunoreactive prostaglandin E2 was undetectable before infection, but concentrations rose after infection. No neutrophils were present in non-infected flushings but, by 30 mins, there were significant (P less than 0.01) neutrophil numbers in exudate and flushings; thereafter numbers increased, particularly in exudate. Acute endometritis resembled acute inflammation at other sites in the horse and a significant response had occurred by 30 mins after experimental infection.

Uterine defense mechanisms in the mare

Uterine defense against infection in the mare has been actively investigated over the past decade. Mechanisms of defense, including the role of immunoglobulins, polymorphonuclear neutrophils, and the physical ability of mares to eliminate bacteria from the uterus, are discussed.