The TH 22-mediated IL-22 deficiency associated with premature ovarian insufficiency

IL-33 and soluble ST2 in follicular fluid are associated with premature ovarian insufficiency

Background

Premature ovarian insufficiency (POI) is a common reproductive disease that is associated with chronic inflammation in ovaries. Interleukin 33 (IL-33) is a pro-inflammatory IL-1 family cytokine, and functions as an alarmin reflecting inflammatory reaction. Our study aimed to investigate levels of IL-33 and its soluble receptor (sST2) in both follicular fluid (FF) and paired serum during different stages of POI, and evaluate their predictive potentials for POI. Furthermore, we attempted to determine whether IL-33 and sST2 were associated with embryo quality.

Methods

A total of 148 women, including 50 patients with biochemical POI (bPOI) (10 IU/L < follicle-stimulating hormone (FSH) ≤ 25 IU/L), 46 patients with POI (25 IU/L

Results

FF IL-33 levels were significantly increased in bPOI and POI patients compared to controls. They exhibited positive associations with FSH and luteinizing hormone (LH), whereas negative correlations with anti-Müllerian hormone (AMH), estradiol (E2), testosterone (T) and antral follicle count (AFC). Receiver operating characteristic (ROC) curve analysis showed that for POI prediction, FF IL-33 had a better predictive accuracy (AUC 0.901) with high sensitivity (82.61%) and good specificity (84.62%) than those for bPOI prediction. IL-33 levels in paired serum did not differ among three groups. Regarding sST2, its levels in FF declined with POI progression. Contrarily, they showed negative associations with FSH and LH, but positive correlations with AMH, E2, T and AFC. ROC analysis revealed that FF sST2 had comparatively weak potentials for both bPOI and POI prediction compared to those of FF IL-33. Similarly, there was no significant alteration of sST2 in paired serum among three groups. Additionally, Spearman's correlation analysis revealed that FF IL-33 levels were negatively associated with the rates of Day-3 good-quality embryos (r=-0.206, P=0.012), whereas FF sST2 did not.

Conclusion

Our study revealed an increased abundance of FF IL-33, whereas an sST2 deficiency with POI development. This implies that IL-33 and sST2 levels might be associated with the development of POI.

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Key Words

• IL-33
• embryo development
• embryo quality
• inflammation
• ovarian reserve
• predictor
• premature ovarian insufficiency
• soluble ST2

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MESH Headings

• Humans
• Female
• Interleukin-33/blood
• Interleukin-33/metabolism
• Interleukin-1 Receptor-Like 1 Protein/blood
• Interleukin-1 Receptor-Like 1 Protein/metabolism
• Follicular Fluid/metabolism
• Primary Ovarian Insufficiency/blood
• Primary Ovarian Insufficiency/metabolism
• Adult
• Biomarkers/blood
• Biomarkers/metabolism
• Biomarkers/analysis
• Follicle Stimulating Hormone/blood
• Follicle Stimulating Hormone/metabolism
• Case-Control Studies

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Affiliation(s)

Maoxing Tang Department of Reproductive Medicine, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
Xuedong Sun Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou, China
Ping Li Department of Reproductive Medicine, Women and Children’s Hospital, School of Medicine, Xiamen University, Xiamen, China
Weifen Deng Reproductive Medicine Centre, Shenzhen Hengsheng Hospital, Shenzhen, China
Xi Zhan Department of Reproductive Medicine, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
Peng Sun Department of Reproductive Medicine, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
Yuhua Shi Department of Obstetrics and Gynecology, Center for Reproductive Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, China

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IL-22, a vital cytokine in autoimmune diseases

Interleukin-22 (IL-22) is a vital cytokine that is dysregulated in various autoimmune conditions including rheumatoid arthritis (RA), multiple sclerosis (MS), and Alzheimer's disease (AD). As the starting point for the activation of numerous signaling pathways, IL-22 plays an important role in the initiation and development of autoimmune diseases. Specifically, imbalances in IL-22 signaling can interfere with other signaling pathways, causing cross-regulation of target genes which ultimately leads to the development of immune disorders. This review delineates the various connections between the IL-22 signaling pathway and autoimmune disease, focusing on the latest understanding of the cellular sources of IL-22 and its effects on various cell types. We further explore progress with pharmacological interventions related to targeting IL-22, describing how such therapeutic strategies promise to usher in a new era in the treatment of autoimmune disease.

[Immunological status in patients with amenorrhea (literature review)]

Amenorrhea is a common symptom of a whole range of nosologies among women of reproductive age, which can accompany any endocrinopathy in the stage of decompensation. In all the diversity of various links in the pathogenesis of reproductive disorders, the problem of immunopathology remains a little aside, however, the significance of these disorders is underestimated. This publication provides an overview of immune system abnormalities in a women with amenorrhea. As is known, in polycystic ovary syndrome (PCOS) and premature ovarian insufficiency (POI), one of the clinical manifestations is amenorrhea. On the one hand, these nosologies differ significantly from each other in etiology, pathogenesis and approaches to therapy, and on the other hand, they have a common similarity, manifested by immunological disorders. The article provides information about the immune status of patients with PCOS and POI. Works devoted to various disorders in the immune system, pathologies of humoral and cellular immunity, which in the future may serve as the key to the development of new and non-standard methods of treating such socially significant diseases, are analyzed. Literature search was carried out in national (eLibrary, CyberLeninka.ru) and international (PubMed, Cochrane Library) databases in Russian and English. The choice of sources was prioritized for the period from 2018 to 2024.

Troxerutin dampened hypothalamic neuroinflammation via microglial IL-22/IL-22R1/IRF3 activation in dihydrotestosterone-induced polycystic ovary syndrome rats

BACKGROUND

Polycystic ovary syndrome (PCOS) is the most common reproductive-endocrine condition in premenopausal women. Troxerutin, a common clinical anti-coagulant agent, was shown to work as a strong IL-22 boosting agent counteracting the hyperactivated gonadotrophin releasing hormone (GnRH) neurons and heightened GnRH release, the neuroendocrine origin of PCOS with unknown mechanism in rats. Exploring the off-label use of troxerutin medication for PCOS is thus sorely needed.

METHODS

Serum IL-22 content and hypothalamic IL-22 protein were detected. Inflammatory factor levels in hypothalamo-pituitary were evaluated. Immunofluorescence staining was employed to determine the activation and M1/M2-prone polarization of microglia in arcuate hypothalamus and median eminence. RNA-sequencing and transcriptome analysis were applied to explore the potential driver of microglia M2-polarization in response to IL-22 bolstering effect. The function of microglial IL-22/IL-22R1/IRF3 system was further verified using in vivo knockdown of IL-22R1 and a potent IRF3 inhibitor in BV2 microglial cell lines in vitro.

RESULTS

Troxerutin augmented serum IL-22 content, and its consequent spillover into the hypothalamus led to the direct activation of IL-22R1/IRF3 system on microglia, thereby promoted microglia M2 polarization in arcuate hypothalamus and median eminence, dampened hypothalamic neuroinflammation, inhibited hyperactive GnRH and rescued a breadth of PCOS-like traits in dihydrotestosterone (DHT) rats. The salutary effects of troxerutin treatment on hypothalamic neuroinflammation, microglial M1/2 polarization, GnRH secretion and numerous PCOS-like features were blocked by in vivo knockdown of IL-22R1. Moreover, evidence in vitro illustrated that IL-22 supplement to BV-2 microglia cell lines promoted M2 polarization, overproduction of anti-inflammatory marker and limitation of pro-inflammatory factors, whereas these IL-22 effects were blunted by geldanamycin, a potent IRF3 inhibitor.

CONCLUSION

Here, the present study reported the potential off-label use of troxerutin medication, a common clinical anti-coagulant agent and an endogenous IL-22 enhancer, for multiple purposes in PCOS. The rational underlying the application of troxerutin as a therapeutic choice in PCOS derived from its activity as an IL-22 memetic agent targeting the neuro-endocrine origin of PCOS, and its promotive impact on microglia M2 polarization via activating microglial IL-22R1/IRF3 system in the arcuate hypothalamus and median eminence of DHT female rats.