A STUDY OF THE SECRETORY IMMUNE SYSTEM OF THE FEMALE GENITAL TRACT

The impact of aging on innate and adaptive immunity in the human female genital tract

Mucosal tissues in the human female reproductive tract (FRT) are primary sites for both gynecological cancers and infections by a spectrum of sexually transmitted pathogens, including human immunodeficiency virus (HIV), that compromise women's health. While the regulation of innate and adaptive immune protection in the FRT by hormonal cyclic changes across the menstrual cycle and pregnancy are being intensely studied, little to nothing is known about the alterations in mucosal immune protection that occur throughout the FRT as women age following menopause. The immune system in the FRT has two key functions: defense against pathogens and reproduction. After menopause, natural reproductive function ends, and therefore, two overlapping processes contribute to alterations in immune protection in aging women: menopause and immunosenescence. The goal of this review is to summarize the multiple immune changes that occur in the FRT with aging, including the impact on the function of epithelial cells, immune cells, and stromal fibroblasts. These studies indicate that major aspects of innate and adaptive immunity in the FRT are compromised in a site‐specific manner in the FRT as women age. Further, at some FRT sites, immunological compensation occurs. Overall, alterations in mucosal immune protection contribute to the increased risk of sexually transmitted infections (STI), urogenital infections, and gynecological cancers. Further studies are essential to provide a foundation for the development of novel therapeutic interventions to restore immune protection and reverse conditions that threaten women's lives as they age.

A review of the human vs. porcine female genital tract and associated immune system in the perspective of using minipigs as a model of human genital Chlamydia infection

Sexually transmitted diseases constitute major health issues and their prevention and treatment continue to challenge the health care systems worldwide. Animal models are essential for a deeper understanding of the diseases and the development of safe and protective vaccines. Currently a good predictive non-rodent model is needed for the study of genital chlamydia in women. The pig has become an increasingly popular model for human diseases due to its close similarities to humans. The aim of this review is to compare the porcine and human female genital tract and associated immune system in the perspective of genital Chlamydia infection. The comparison of women and sows has shown that despite some gross anatomical differences, the structures and proportion of layers undergoing cyclic alterations are very similar. Reproductive hormonal cycles are closely related, only showing a slight difference in cycle length and source of luteolysing hormone. The epithelium and functional layers of the endometrium show similar cyclic changes. The immune system in pigs is very similar to that of humans, even though pigs have a higher percentage of CD4(+)/CD8(+) double positive T cells. The genital immune system is also very similar in terms of the cyclic fluctuations in the mucosal antibody levels, but differs slightly regarding immune cell infiltration in the genital mucosa - predominantly due to the influx of neutrophils in the porcine endometrium during estrus. The vaginal flora in Göttingen Minipigs is not dominated by lactobacilli as in humans. The vaginal pH is around 7 in Göttingen Minipigs, compared to the more acidic vaginal pH around 3.5-5 in women. This review reveals important similarities between the human and porcine female reproductive tracts and proposes the pig as an advantageous supplementary model of human genital Chlamydia infection.

The relationship of infertility to antibody production in the uterovaginal sperm storage tubules of turkey breeder hens

Oviductal tissue from fertile and infertile turkey breeder hens was stained immuno-histochemically to test for the presence of antibody positive cells. Relatively infertile turkey hens (< 50% fertility) were found to have antibody positive cells within the uterovaginal sperm storage tubule epithelium, while fertile turkey hens (> 90% fertility) had no antibody positive cells. Data suggest a local immune response to spermatozoa exists in the uterovaginal sperm storage tubules of the turkey hen which may have a detrimental effect on fertility.

Immunoglobulin (Ig)-containing plasma cells in the Harderian gland in broiler and native chickens of Bangladesh

The distribution and frequency of immunoglobulin (Ig)-containing plasma cells, their variations due to sex, and the mode of secretion of Ig cells into the duct system of the Harderian gland was investigated in broiler and native chickens of both sexes in Bangladesh. The Harderian gland is covered by a capsule, and the connective tissue septa divide the gland into numerous unequal-sized numerous lobes and lobules. The Ig-containing plasma cells were located in the interstitial space, interacinar space, apical part of the lobule, and lumina of the lobules of the Harderian gland in both broiler and native chickens. The population of these Ig-containing plasma cells varied in between broiler and native chickens, and also between male and female broiler and native chickens. In the broiler, the number of IgM-containing plasma cells was higher; in contrast, in the native chickens, the population of IgA-containing plasma cells was larger. In the broiler, there were more IgA- and IgG-containing plasma cells in the male; in contrast, there were more IgM-containing plasma cells in female. In native chickens the frequency of IgA-containing plasma cells was greater in the female than male. When the data for broiler and native birds were compared, it was found that there were significantly more IgA- and IgG-containing plasma cells in the native male and female chickens than in the broiler males and females. The secretory Igs were located in the lumina of acini and the duct system of the Harderian gland. In the present study Ig-containing plasma cells were observed to be released in the lumina of the lobules of Harderian gland by the breakdown of acinar tissues in broilers, and by holocrine mode of secretion in the native chicken. These results suggested that the Harderian gland, even though it is not a lymphoid organ as a whole, but acts as an immunopotent organ in chickens, and that the gland in native chicken contains more Ig-containing plasma cells due to their scavenging.

Immunoglobulin levels and phagocytes in the cervical mucus plug at term of pregnancy

BACKGROUND

To characterize the potential for adaptive immune protection in cervical mucus plugs with respect to immunoglobulin isotypes and effector cells (phagocytes).

METHODS

Thirty-one cervical mucus plugs were collected from healthy women in labor at term. The cervical mucus plugs were allocated either to analysis of immunoglobulins by enzyme-linked immunosorbent assay (ELISA), gel chromatography and Western blotting (n = 20) or to microscopical, including immunocytochemical, analyses. The levels of immunoglobulin in the plugs were compared to the levels in 10 samples of ovulatory cervical mucus from nonpregnant women.

RESULTS

In the cervical mucus plugs, levels of immunoglobulin G (IgG) [median 3270 microg/mL (100-14 500)] and IgA [540 (22-2820)], but not IgM [30.5 (1.0-160)], were significantly elevated compared to cervical mucus from nonpregnant women (p < 0.02 for IgG and IgA). The IgG : IgA ratio in the plugs was also elevated (p < 0.02). The proportion of secretory immunoglobulin A (SIgA) relative to total IgA in the plugs ranged from 16 to 65% (n = 5). IgA and IgG were largely intact. Microscopically, the vagina-proximal part of the cervical mucus plugs contained bacteria and was rich in cells, mainly phagocytes. Conversely, the uterine part contained few cells.

CONCLUSION

The high immunoglobulin levels in combination with the presence of phagocytes suggest a potential for adaptive immune defense in the cervical mucus plug, which, together with innate immune factors, may act as an immunological gatekeeper protecting the fetomaternal unit against infection from the vagina.

Cervical immunoglobulin A and altered vaginal flora in pregnant women with threatened preterm delivery

The aim of our study was to investigate the cervical immunoglobulin A concentration in women with threatened preterm delivery. Immunoglobulin A concentration in the cervical mucus of 80 women with symptoms of preterm delivery was measured using radial immunodiffusion. The results were compared with those of 60 healthy pregnant women. Concentrations of immunoglobulins in maternal serum were also measured. There was no significant difference of cervical immunoglobulin A (IgA) concentration between women with threatened preterm delivery and controls: 53.98 (0.0-189.7) mg/l vs. 61.7 (1.4-400.9; p<0.4) mg/l (median, range). The median of cervical IgA levels in the group of threatened preterm delivery did not differ significantly between patients delivered preterm (n=34) or at term (n=46): 38.3 (0.0-187.9) vs. 65.7 (1.4-189.7; p<0.2) mg/l. Women with a normal vaginal flora showed a significantly higher cervical IgA concentration than those with a pathological colonization: 72.7 (0.0-187.9) vs. 42.5 (0.0-189.7) mg/l. Patients with a pathological vaginal smear and preterm delivery had the lowest IgA levels (35.0; 0.0-187.9 mg/l). Measurement of cervical IgA concentration does not differentiate between women who deliver before or at term.

[Effect of estrogens and antiestrogens on the endometrium]

Estrogens act through specific receptors located in the nuclei of epithelial and stromal cells of the endometrium. Estrogens stimulate the synthesis of these receptors and the progesterone inhibits their synthesis. Estrogens induce the proliferation of the mucosa during the proliferative phase. They also stimulate the synthesis of receptors for the progesterone, which is a prerequisite for progesterone activity. Hyperplasias most of the time do not contain cytological atypia and are developed under a hyperestrogenic background. They contain receptors for estrogen and progesterone, and are able to respond to progestogens. Hyperplasias with cytological atypia are precancerous lesions, associated with an hyperestrogenic or atrophic background. In the later case, they may be focal and are better diagnosed by hysteroscopy. They are best managed by simple hysterectomy. Progesterone may be used if the patient desires to conceive. Endometrial cancers are either associated with an hyperestrogenic or atrophic background. In the later case, they are often of serous or clear cell type. Endometrial effects of antiestrogens are known only for tamoxifene. Tamoxifene has an atrophic effect but sometimes may induce an estrogenic stimulation of the endometrial mucosa through the alpha and beta estrogenic receptors. Polyp is the most frequent abnormality diagnosed but endometrial cancer is significantly more frequently diagnosed than in a control population. It is well differentiated and does not modify the survival of the patient.

The development of contraceptive vaccines

The use of vaccination as a means of controlling fertility was established during the last decade with the publication of a successful Phase II trial demonstrating the efficacy of this approach to family planning. However, only this one Phase II trial has been completed despite a plethora of hormonal and gamete antigens that have been proposed as candidate vaccines. Improvements in the design and formulation of contraceptive vaccines are underway and will be a necessary prelude to further clinical trials.

Differential induction of mucosal and systemic antibody responses in women after nasal, rectal, or vaginal immunization: influence of the menstrual cycle

A cholera vaccine containing killed vibrios and cholera toxin B subunit (CTB) was used to compare mucosal immunization routes for induction of systemic and mucosal Ab. Four groups of women were given three monthly immunizations by the rectal immunization (R(imm)) route, nasal immunization (N(imm)) route, or vaginal immunization route during either the follicular (V-FP(imm)) or luteal (V-LP(imm)) menstrual cycle phase. N(imm) was performed with 10-fold less vaccine to determine if administration of less Ag by this route can, as in rodents, produce mucosal Ab responses comparable to those induced by higher dose R(imm) or vaginal immunization. Concentrations of Ab induced in sera and secretions were measured by ELISA. None of these routes produced durable salivary Ab responses. N(imm) induced greatest levels of CTB-specific IgG in sera. R(imm) failed to generate CTB-specific IgA in genital tract secretions. N(imm), V-FP(imm), and V-LP(imm) all produced cervical CTB-specific IgA responses comparable in magnitude and frequency. However, only V-FP(imm) induced cervical IgA2-restricted Ab to the bacterial LPS vaccine component. V-FP(imm), but not V-LP(imm), also induced CTB-specific IgA in rectal secretions. N(imm) was superior to V-FP(imm) for producing rectal CTB-specific IgA, but the greatest amounts of CTB-specific IgA and LPS-specific IgA, IgG, and IgM Ab were found in rectal secretions of R(imm) women. These data suggest that in women, N(imm) alone could induce specific Ab in serum, the genital tract, and rectum. However, induction of genital tract and rectal Ab responses of the magnitude generated by local V-FP(imm) or R(imm) will likely require administration of comparably high nasal vaccine dosages.

Immunity in the female lower genital tract and the impact of HIV infection

This study investigates the distribution of immunocompetent cells in the ectocervix, and cytokine and immunoglobulin (Ig) levels in cervicovaginal secretions to determine whether they are altered in asymptomatic human immunodeficiency virus (HIV) infection. Ectocervical biopsies from 10 HIV+ and 10 presumed HIV-ve women were studied by immunocytochemistry. Levels of Igs in cervicovaginal secretions were quantified by radial immunodiffusion (RID) and cytokine levels by ELISA. HIV+ women had significantly increased numbers of CD8+ lymphocytes resulting in reversal of the CD4:CD8 ratio. There was a significant increase in the proportion of activated CD8+ HLA-DR+ and CD4+ HLA-DR + lymphocytes, but not in CD8+ TIA-1+ cells. The epithelium of the cervix from HIV+ subjects showed a significant increase in both numbers of macrophages (CD68+) and proportions of activated macrophages (CD68+ HLA-DR+) compared to normal. The stroma contained increased proportions of inductive (D1+) and suppressive (D1+ D7+) macrophages but a decrease in effector phagocyte (D7+) proportions and Langerhans' cells. Significantly lower tumour necrosis factor (TNF)-alpha levels were observed in cervicovaginal secretions from HIV+ subjects. IgG levels were 4 times higher and IgM levels twice higher in cervicovaginal secretions from HIV+ women, compared to results from normal subjects. These results suggest a response within the CD8+ cells in HIV+ women, yet these cells may have a low cytolytic capacity. The raised proportions of HLA-DR+ and D1+ CD4+ macrophages could act as antigen-presenting cells (APC) for CD4+ CD45RO+ lymphocytes, and represent a local acquired response. However, the close juxtaposition of these cells offers the potential for them to act as a local reservoir of virus and promote its proliferation. The increase of IgG over sIgA in secretions of HIV+ subjects provides evidence suggesting a dysregulation of local humoral immunity.

Detection of cervical immunoglobulin A in normal pregnancy

The aim of our study was to evaluate a feasible method to quantify the immunoglobulin A concentration in the cervical mucus of women with a normal singleton pregnancy. In 60 immunologic healthy pregnant women cervical mucus samples were taken at a random time in pregnancy using an absorbing cylindrical cotton-swab stick. In this cervical mucus immunoglobulin A concentration was measured by radial immunodiffusion. A vaginal bacterial swab was taken from each woman. Concentration of immunoglobulins in maternal serum was estimated. There was no statistically significant difference of cervical immunoglobulin A concentration between the investigated groups (p = 0.952): 18-24 gestational weeks (gw): 52.8 (6.6-258.4) mg/l; 25-29 gw: 89.3 (4.8-193.8) mg/l; 30-34 gw: 55 (1.4-326) mg/l; 35-40 gw: 59.2 (4-400.9) mg/l. Women with a normal vaginal flora showed a significantly higher cervical immunoglobulin A concentration than those with a pathological colonization: 92.2 (6.6-400.9) mg/l vs. 42.5 (1.4-326) mg/l (p < 0.05). The serum levels of immunoglobulins A, A1, A2, M and G do not correlate to cervical immunoglobulin A levels nor to gestational age. In normal pregnancy, cervical immunoglobulin A concentration does not change with advancing gestational age, but a pathological vaginal colonization seems to be associated with decreased immunoglobulin A levels.

Vaccine for contraception targeting sperm

Development of a vaccine(s) based on sperm antigens represents a promising approach to contraception. The utility of a sperm antigen in immunocontraception is contingent upon its tissue specificity, involvement in fertility and on raising high antibody titer, especially locally in the genital tract, that is capable of inducing reversible infertility. Several sperm antigens, such as lactate dehydrogenase C4, PH-20, sperm protein (SP)-10, fertilization antigen (FA)-1, FA-2, cleavage signal (CS)-1, NZ-1, and NZ-2 have been proposed as potential candidates for the vaccine development. Spermzona pellucida (ZP) binding is a pivotal tissue- and mostly species-specific event in the fertilization process, and the molecules involved in this site constitute the most exciting candidates for immuno-contraception. FA-1 is a sperm-specific glycoprotein having receptor activity for ZP recognition and binding. Complementary DNA encoding for FA-1 antigen has been cloned and sequenced. Active immunization of animals with recombinant FA-1 antigen causes a long-lasting reversible inhibition in fertility by raising a sperm-specific immune response. This antigen is also involved in human immunoinfertility. The exciting findings from the recent trial in immunoinfertile couples indicate that the FA-1 antigen may have clinical application in the treatment of male infertility. A vaccine having most appropriate tissue-specific and effective recombinant and/or synthetic epitopes of various sperm antigens, such as the FA-1 antigen, in a single formulation may provide a highly immunogenic and efficacious antisperm vaccine for contraception. The advances made during the last 5 years suggest that it may be a realistic proposition.

Changes to the cytokine microenvironment in the genital tract mucosa of HIV+ women

As previous studies have indicated that genital tract mucosal T cell function may be impaired in HIV infection, we investigated the T cell cytokine mRNA in the genital tract mucosa of HIV-infected women to determine if there are alterations in the cytokine profile which may explain the T cell impairment. The in situ hybridization technique was used to investigate the T helper-1 (Th1: IL-2, interferon-gamma (IFN-gamma)) and Th2 cytokine (IL-4, IL-5, IL-10) mRNA profile in cervical biopsies from 10 HIV+ and 10 HIV- subjects. Cervical intraepithelial neoplasia (CIN) and genital infection had previously been excluded and the distribution of immunocompetent cells within the cervical mucosa was known for each subject. Non-parametric tests were used to compare the optical density (OD) of cytokine mRNA in the HIV+ and HIV- groups. Comparisons were also made between peripheral CD4 lymphocyte counts, cervical CD4/CD8 T lymphocyte ratios and cytokine mRNA OD in HIV+ subjects. The HIV+ women had significantly higher mRNA OD for the Th2 cytokines IL-4, IL-5 and IL-10 than HIV women. There was also significantly lower IL-2 mRNA OD in the former group. HIV+ women had lower IFN-gamma mRNA than HIV- women, but the difference was not statistically significant. There was no correlation between cytokine mRNA OD and peripheral CD4 count or cervical CD4/CD8 ratio. The predominance of Th2 cytokines, which are immuno-inhibitory, in the cervical mucosa of HIV+ women may underlie the impaired cytotoxic potential observed in the CD8+ T lymphocytes and may contribute to the susceptibility of HIV-infected women to recurrent genital tract infections and cervical neoplasia.

Immunohistochemical study of in vivo and in vitro IgA coating of candida species in vulvovaginal candidiasis

OBJECTIVE

To evaluate whether quantitative or qualitative IgA deficiencies in cervicovaginal secretions can be identified in patients with recurrent vulvovaginal candidiasis.

DESIGN

Prospective and controlled study.

SETTING

Department of Dermatology, University of Vienna.

SUBJECTS

30 patients with symptomatic and recurrent vulvovaginal candidiasis at the time of their presentation. 30 healthy women as a control group.

INTERVENTION

Blood samples were drawn for measurement of serum IgA levels. Smears of the cervix and vagina were taken for direct microscopy and microbiological culture. Lavage of the vagina and ectocervix was performed with sterile saline solution for measurement of cervicovaginal IgA levels.

MAIN OUTCOME MEASURES

IgA levels of serum and cervicovaginal secretion evaluated by Single Radial Immunodiffusion. IgA labelling was demonstrated on fungal elements in vaginal smears and subcultured blastospores after incubation with vaginal secretions by immunohistochemistry.

RESULTS

We could not find any significant difference of IgA levels in serum and cervicovaginal secretions between the symptomatic group and healthy controls (p value for serum = 0.5796, p value for secretion = 0.2381). In vaginal smears yeasts revealed IgA coating on their surfaces, whereas three of the 61 subcultures were negative. Negative subcultures were assigned to three patients with recurrent candidiasis. No correlation was found between IgA levels of cervicovaginal secretions and staining intensity of subcultured blastospores after incubation with vaginal secretions (r = -0.0578). IgA levels of serum and vaginal secretion showed no correlation (r = -0.00012).

CONCLUSION

Recurrent vulvovaginal candidiasis cannot be attributed to IgA deficiency. In some cases an IgA coating defect of yeasts might be involved. In addition inactivation of the IgA molecule by candida proteases might be of pathogenetic importance.

Secretory immunity in the female reproductive tract

PROBLEM

Antibodies and antibody-producing cells display a different and characteristic distribution in body fluids and tissues.

METHOD

We have investigated the tissues of the female reproductive tract to determine whether the distribution of immunoglobulin-producing cells and the contents of cervical secretions were similar to those found in tissues of the secretory immune system.

RESULTS

Immunohistochemical examinations of female genital tissues revealed the presence of plasma cells that secrete IgA (and in lower numbers IgM and IgG) especially in the subepithelial layers of the uterine endo- and ectocervix, fallopian tubes, and vagina. Both IgA1- and IgA2-producing plasma cells were found in approximately equal proportions. The presence of J-chain in the IgA-secreting cells suggests the synthesis of polymeric IgA (pIgA). Epithelial cells lining the fallopian tube and endocervix were positive for secretory component (SC), which is required for the transepithelial transport of pIgA into external secretions. Cervical mucus was collected and the molecular forms of IgA were separated using column chromatography. Approximately 80% of IgA in cervical mucus was polymeric compared with 55% in the vaginal fluid.

CONCLUSIONS

These data indicate that all effector components of the mucosal immune system are present in the female reproductive tract. The immunization routes that lead to a secretory IgA (S-IgA) response need to be further explored.

Genital secretory immune response to chronic simian immunodeficiency virus (SIV) infection: a comparison between intravenously and genitally inoculated rhesus macaques

The humoral and genital secretory immune response to chronic SIV infection was compared between female Rhesus macaques inoculated by i.v. or intravaginal routes. Total IgG levels in serum were 10-fold higher in SIV-infected animals when compared with uninfected controls. Vaginal washes from normal macaques contained predominantly IgA and IgG, while those from SIV-infected animals contained high levels of IgG. The SIV-infected animals had high titres of SIV-specific IgG in serum, with lower but detectable IgA and IgM responses. The genital secretory immune response to SIV was similar in intravenously and intravaginally inoculated animals. The anti-SIV response in the vaginal washes consisted mainly of IgG. Within the lamina propria of the reproductive tract of animals chronically infected with SIV there were essentially no IgA or IgG plasma cells and only a small number of IgM plasma cells, while two normal animals had large numbers of IgA plasma cells. These results suggest that the mucosal immune system of the female reproductive tract is impaired in chronic SIV infection.

Human vaginal leukocytes and the effects of vaginal fluid on lymphocyte and macrophage defense functions

OBJECTIVES

The purpose of this study was to quantify, characterize, and further define the role of vaginal white blood cells in defense mechanisms and human immunodeficiency virus infection.

STUDY DESIGN

Vaginal lavages were obtained from five healthy women throughout three menstrual cycles. Lymphocyte subpopulations, macrophages, and granulocytes were characterized and quantified by an immunohistologic technique. Vaginal lavage fluid was added to peripheral blood mononuclear cells, and effects on cell viability, lymphocyte proliferation, macrophage phagocytosis, and expression of various cell surface molecules critical to immunologic functions were assessed. Data were analyzed by Student's t test.

RESULTS

Few lymphocytes were found at any stage of the menstrual cycle; however, granulocytes and macrophages were abundant at menstruation and present at low levels through the proliferative phase. Vaginal lavage fluid collected during menses, at midcycle, and after coitus suppressed mitogen-induced lymphocyte proliferation but had no effect on surface expression of human leukocyte antigen or CD4 antigens, or on macrophage function. Likewise, low pH (less than 5.0) medium significantly inhibited lymphocyte proliferation but had no effect on macrophage phagocytosis. The spermicide nonoxynol 9 was toxic to both lymphocytes and macrophages.

CONCLUSION

White blood cells, including lymphocytes and macrophages, are infrequently present in cervicovaginal secretions of healthy women except during menses; the vaginal environment may effect their function.

Vaginal infections, cervical ripening and preterm delivery

A prospective study is presented which addresses the relative effect of cervicovaginal infection and precocious maturation of the uterine cervix on preterm delivery. From April 1981 through December 1983, a total of 5758 pregnant women were checked by means of a vaginal examination at every prenatal visit and a research for bacterial cervicovaginal infection whenever abnormal signs were observed. The study reveals that vaginal infection has no measurable effect when observed during the second trimester of pregnancy, and a small effect during the third trimester. This means that infection of the vagina or/and the cervix may be demonstrated as a risk factor only when the cervix is short before 28 weeks or open before 37 weeks.

Synthesis and secretion of proteins by postpartum human oviductal tissue in culture

An explant culture system that used labelled leucine and two-dimensional polyacrylamide gel electrophoresis (2D-PAGE) with fluorography was used to identify specific de novo synthesized and released polypeptides by the human postpartum oviduct. Both ampulla and isthmus tissue in culture exhibited de novo synthesis and release of a large number of polypeptide subunits. Immunoglobulins A and G appear to be the major proteins produced in the ampulla. In addition, two complexes of acidic (pI less than 5) polypeptide subunits are found primarily in ampulla culture medium. Two families of proteins (Mr 51,000 and 60,000) are released by the isthmus but appear to be minor in the ampulla cultures.

Secretory IgA against herpes simplex virus in cervical secretions

A recently developed method to recover proteins from cervical secretions was combined with methods to detect minute concentrations of herpes simplex virus (HSV) type specific antibodies to measure the concentrations of locally produced antibodies in women with genital infections. Forty nine women attending a sexually transmitted disease (STD) clinic were included. Cervical secretions were obtained by suction into a plastic catheter. Soluble proteins were recovered from the secretions by elution with hyperosmolar sodium chloride. A rabbit antibody to human secretory component, which was conjugated to horseradish peroxidase, was used to measure secretory IgA (S-IgA) that was HSV type specific. For comparison, HSV type specific IgG was measured in serum samples from the patients. Of the 49 women, 16 yielded detectable HSV type 2 (HSV 2) S-IgA in secretions. Twelve of them also reacted to the HSV type common antigen, but only five had HSV 2 IgG detectable in their serum. S-IgA against HSV was found in significantly more women with a clinical diagnosis of acute cervicitis than in others. This could be explained by a general increase in local antibody production and immunity triggered by previous contacts with HSV. It is concluded that local mucosal immunity to HSV 2 can be detected in women who do not have a specific humoral antibody response to the virus. For seroepidemiological studies of infection with HSV 2 this local immunity may be considered to be a factor that gives an underestimation of the true incidence of HSV 2 infection.

Expression of IgA and secretory component in the normal and in adenocarcinomas of Fallopian tube, endometrium and endocervix

The occurrence and localization of IgA and secretory components (SC) were examined in the normal and in adenocarcinomas of Fallopian tube, endometrium and endocervix. IgA-containing immunocytes were identified in the stroma of 90% of normal Fallopian tubes. It is suggested that the Fallopian tube may have an immunological function and may, together with the endocervix, constitute the local secretory immune system of the female genital tract. IgA and SC were frequently demonstrated in the cytoplasm and luminal secretion of adenocarcinomas of the endocervix, endometrium and Fallopian tube. This study has shown a decrease in immunoreactivity of SC among poorly differentiated adenocarcinomas but has failed to demonstrate any correlation between the expression of IgA and the degree of differentiation of the tumours. Secretory component appears, therefore, to be more useful than IgA as an indicator of secretory activity and differentiation of adenocarcinomas of the female genital tract.

Immunohistochemical characterization of stromal leucocytes in nonpregnant human endometrium

Stromal leucocytes in normal premenopausal human endometrium were characterised by an indirect immunoperoxidase technique employing a panel of monoclonal antibodies. T cells were scanty in proliferative endometrium but increased in frequency in the secretory phase of the menstrual cycle. An additional population of phenotypically unusual lymphocytes (CD2-positive, CD3-negative) was detected in the stratum functionalis in mid- and late secretory phase endometrium, particularly in areas exhibiting pseudodecidual change. The distribution of these unusual lymphocytes mirrored that of the so-called "endometrial stromal granulocytes," which have recently been shown to be granulated lymphocytes. Macrophages were common throughout the menstrual cycle. B lymphocytes were detected in lymphoid aggregates in the basalis but rarely in the functionalis.

Immunohistochemical evaluation of the equine endometrium during the oestrous cycle

Endometrial biopsies were obtained from four mares during consecutive oestrous cycles on the first day of oestrus, on the day when ovulation was detected, and four and eight days after ovulation. Cycle stages were confirmed by means of rectal palpation, ultrasonography and plasma progesterone determination. Immunohistochemical evaluation of the formalin fixed biopsy specimens was performed using a peroxidase anti-peroxidase technique. Immunoglobulin (Ig)A-, IgM-, IgG(Fc)- and IgG(T)-containing cells were detected in all biopsies; with IgA- and IgG(Fc)-containing cells generally predominating. There was no cyclical trend of Ig-containing cell numbers for any isotype. Free immunoglobulins of the four classes evaluated were frequently seen in luminal epithelium, glandular epithelium and secretions, and interstitium. This study of endometrial biopsies from a limited number of cycling mares suggests the presence in the equine endometrium of free and intracellular immunoglobulins of the classes A, M, G(Fc) and G(T) without any apparent cyclical trend.

Localization of immunoglobulin-containing cells in human endometrium in the first trimester of pregnancy and throughout the menstrual cycle

The distribution of immunoglobulins in normal human endometrium throughout the menstrual cycle and in early pregnancy has been studied with an immunoperoxidase technique. In first-trimester decidua, IgG was detected within many cells of differing morphology and size. Large IgG-containing cells were often binucleate and were believed to be decidual cells. Examination of serial sections showed no kappa or lambda light-chain restriction, suggesting absorption of the immunoglobulin content. Medium-sized, irregular, IgG-containing cells were macrophages. An additional substantial population of small hyperchromatic IgG-containing cells were prominent around arterioles and adjacent to endometrial glands. From examination of adjacent sections stained with phloxine tartrazine, it was concluded that these represented endometrial granulocytes. Labelling for light chains again suggested absorption of the immunoglobulin content. In contrast, in non-pregnant endometrium immunoglobulin-containing stromal cells were uncommon, although IgG and IgA were detected in gland epithelium and secretions and in the stromal interstitium particularly in the secretory phase. These results support the notion that human endometrium lacks a classical secretory immune system and highlight the requirement for correlation between studies of cell surface markers, morphology and cell surface receptors.

Recovery of microorganisms from the pelvic cavity after intracervical or intrauterine artificial insemination

To assess the risk of introducing microorganisms into the peritoneal cavity during intracervical or intrauterine insemination, we cultured the cervix and semen from 19 couples before insemination and the peritoneal fluid from the female partner after insemination. The peritoneal cultures taken before hydrotubation grew organisms in one of ten intracervical inseminations and five of the nine intrauterine inseminations (P less than 0.05). In four of the five positive peritoneal cultures from the intrauterine group, the organism was also cultured from the semen specimen obtained before insemination and not from the cervical sample. Therefore, intrauterine insemination appears to increase the risk of introducing microorganisms into the upper genital tract and the peritoneal cavity. The clinical significance of this finding remains to be established.

Estradiol regulation of the secretory immune system in the female reproductive tract: IgA in uterine and vaginal secretions of rats following portacaval anastomosis

The uterine immune system is under the control of estradiol which acts to increase the levels of both IgA and secretory component (SC) in uterine secretions. The objective of the present study was to determine whether serum is the primary source of the IgA which enters uterine secretions in response to estradiol. To examine this, serum IgA levels in rats were surgically elevated by portacaval anastomosis which prevents hepatic clearance of IgA. Under these conditions, IgA levels in serum were 2- to 4-fold higher than those of intact or sham-operated animals. Levels of IgA in uterine secretions of portacaval animals, however, were significantly lower than those measured in controls when animals were ovariectomized and treated with estradiol. IgA in vaginal secretions of portacaval animals was greater than that in sham-operated or intact rats. To determine whether IgA had leaked from the uterus into vaginal secretions, a second group of animals had their uteri ligated at the utero-cervical junction prior to hormone treatment. Following estradiol stimulation, uterine IgA levels in portacaval animals were the same as those measured in intact and sham-operated animals. When free SC was measured in uterine secretions of ligated rats, levels were the same in all three groups. These studies indicate that elevated levels of serum IgA did not lead to a rise in uterine IgA. Further, since SC, which is thought to be a receptor for transporting IgA into mucosal secretions, remained unchanged, it appears unlikely that IgA movement into the uterine lumen was transport limited. These studies suggest that the presence of IgA in uterine and vaginal secretions is not due exclusively to serum contributions but may involve local synthesis of IgA.

Immunoglobulin levels in the serum and cervical mucus of tailed copper IUD users

Immunoglobulin levels were measured by agar gel single radial immunodiffusion in the serum and cervical mucus of 50 tailed copper IUD users, 20 combined oral contraceptive users and 20 women not using contraception (controls). IgG, IgA and IgM levels were significantly higher in the copper IUD users compared to the other two groups. It is not known whether this was related to the small numbers of bacteria found in the uterine cavity of tailed IUD users or to the foreign body reaction of the device.

Effect of Copper T intrauterine device on cervico-vaginal flora

The effect of the Copper T intrauterine device (IUD) insertion on vaginal and cervical flora was studied in thirty cases. The vaginal and cervical cultures showed a significant increase (P less than 0.01) in some of the anaerobic bacteria. Some of the aerobic organisms showed a statistically significant increase in the cervical cultures (P less than 0.01). Strict asepsis during insertion of the device is recommended.

Antispermatozoal antibodies in human follicular fluid

The possibility of antispermatozoal antibodies in women having significant effects in the higher regions of the female reproductive tract has been investigated. Follicular fluids (FF) and sera taken at the time of oocyte recovery from women undergoing in vitro fertilisation and embryo transfer (IVF-ET) were tested for the presence of antispermatozoal antibodies, and the concentrations of IgM, IgG, IgA, and complement C3 were determined. The concentrations of immunoglobulins and C3 in FF were consistent with transudation from serum inversely proportional to molecular weight. Titres of agglutinating and immobilizing antibodies in FF were usually one or two dilution steps below those of serum except where immobilizing activity was associated with IgM. IgG:IgA ratios were lower in FF from women with antispermatozoal antibodies, suggesting local production or enhanced transudation of IgA; however, a secretory component could not be detected in any of the follicular fluids in this study. Two women with antispermatozoal antibodies and infertility in excess of 5 years had successful IVF-ET and have delivered healthy infants.

Study of precipitation reactions to Actinomyces israelii antigens in uterine secretions

Uterine secretions were obtained from 110 women and analysed by counterimmunoelectrophoresis for the occurrence of precipitation reactions against Actinomyces israelii antigens. Precipitation reactions were found in secretions from seven women and a correlation was found between these reactions and long term use of plastic intrauterine devices. The precipitating components could not be proved to be immunoglobulins; neither could identity be shown with IgG precipitins in reference serum. The nature and the importance of the precipitating components are discussed.

IUD-induced changes in cervical secretion content of albumin, IgG and complement C3c

Cervical secretion albumin, IgG, complement C3c, spinnbarkeit and amount of wet weight mucus recovered were analyzed in a group of 13 women using IUD as a contraceptive method and the results were compared to those obtained in a control group. Significant differences were obtained when concentrations and amounts of soluble proteins in the respective groups were compared, but spinnbarkeit and amount of wet weight mucus recovered were not affected by the presence of the IUDs.

Group B streptococcus amnionitis with intact membranes associated with quintuplet delivery

Chorioamnionitis is a frequent cause of premature labour and delivery, as well as of maternal and neonatal mortality. Group B streptococcus (GBS) has emerged over the past decade as a common pathogen in the etiology of neonatal sepsis. The case of chorioamnionitis reported here is unusual for three reasons: the premature labour was associated with intact membrane and amniotic fluid infected with GBS; all 5 infants were contaminated with GBS and all infants survived. Chorioamniotitis with intact membranes raises some questions regarding the antepartum use of steroids (potent anti-inflammatory agents), etc. The likelihood of chorioamnionitis in spite of cervical mucus, intact membranes, and the bacteriostatic activity of the amniotic fluid should alert the obstetrician to take special precautions, such as weekly vaginal cultures and appropriate vaginal antimicrobial treatment, in cases of imminent premature delivery.

Variations in the levels of secretory component in human uterine fluid during the menstrual cycle

To determine whether variations in the level of secretory component (SC) occur during the menstrual cycle, we compared the amounts of SC in human uterine secretions during the proliferative, secretory, and menstrual phases. Uterine washes were obtained from women (ages: 18-49) with histologically normal endometria by lavage with Gravlee jet wash device using isotonic glycine. SC was measured by a radioimmunoassay which recognizes primarily free SC. Levels of uterine luminal SC, when expressed as the percentage of total wash protein, were highest during the secretory phase, significantly reduced during the proliferative phase and lowest during menstruation. The mean protein concentration in uterine fluids did not vary significantly during the menstrual cycle. Total amounts of SC were also greatest during the secretory phase, averaging two times higher than SC levels in proliferative samples. These results demonstrate that fluctuations do occur in the SC content of human uterine secretions during the menstrual cycle and suggest that hormones play an important role in the secretory immune system of the human uterus.

Secretory component and IgA in endometrial adenocarcinomas. An immunohistochemical study

The localization of secretory component (SC) and IgA was immunohistochemically studied in 6 normal endometrium and 55 endometrial adenocarcinomas including 34 well, 11 moderately and 10 poorly differentiated ones. In normal endometrium, SC localization was found in the cytoplasm of epithelial cells and luminal contents of the gland. IgA showed similar localization of SC. Secretory phase endometrium contained proportionally larger numbers of positive cells for SC and IgA than proliferative phase endometrium. SC localization was found in all cases of well and moderately differentiated carcinomas, while it was found only in 4 cases out of 10 poorly differentiated carcinomas. IgA localization was similar to that of SC and this condition was thought to reveal the binding of IgA to SC existing in the tumor cells. The present immunohistochemical study revealed that the staining intensity of SC well correlated with the histological grade of differentiation of the tumors.

Gynecologic sepsis as a cause of covert infection in old age

Three cases of endometritis, which presented covertly in elderly women, are described. All three patients were in a poor state of nutrition, and two had serious intercurrent disease. It is believed that cyclical shedding of the endometrium and "normal" vaginal flora (under the influence of estrogen) are the major defenses against infection. These are lost after the menopause, and were therefore absent in the three patients described here. The waning of the immune response associated with aging, particularly the progesterone-stimulated uptake of polymeric IgA in the endometrium, may be important, as may the immunosuppressive effect of malnutrition. It is suggested that a nonspecific deterioration in an elderly woman or infection of uncertain site should prompt a careful re-examination, including a thorough pelvic examination.

Immunohistochemical studies of the local immune system in the reproductive tract of the sow

Tissues from the reproductive tract of sexually mature female pigs were examined histologically using antisera to porcine IgG, IgA and IgM coupled to horseradish peroxidase. Plasma cells synthesising all three immunoglobulins were found in all regions of the tract, with IgA-producing cells as the predominant type. Larger numbers of plasma cells were found in the lower region of the tract and the number of plasma cells was raised during oestrous. Intercellular staining of immunoglobulins was also observed and was also under hormonal influence. The results indicate the presence of a local mucosal immune system in the female reproductive tract of the pig.

Hormonal control of the secretory immune system of the human uterine cervix

A quantitative immunohistochemical study of IgA-containing plasma cells in the human uterine cervix has shown that the number of such cells increases during the late secretory phase of the menstrual cycle but decreases in the early secretory phase of the cycle, in pregnancy, in cystic glandular hyperplasia of the endometrium and after the menopause. These results are interpreted as indicating that progesterone causes an increased plasma cell localisation in the cervix whilst oestrogens cause a decrease: it is suggested that this reflects hormonal control of a receptor mechanism and that this receptor can also be blocked by high levels of LH or hCG. The number of cervical epithelial cells containing secretory component (SC) is increased in the late secretory phase of the menstrual cycle, in users of contraceptive pills and in pregnancy. It is suggested that progesterone acts to increase the intra-epithelial content of SC and that no other hormonal factor need be involved.

Effect of estradiol and progesterone on the secretory immune system in the female genital tract

The female genital tract is a part of the secretory immune system that functions to keep the body free from disease by working against bacterial invasion. In response to estradiol, the essential component in this system, IgA, accumulates in uterine secretions of ovariectomized rats. Evidence is presented that estradiol has an effect on at least three parameters of the uterine IgA response by increasing: 1) the amount of IgA and the infiltration of IgA-positive lymphocytes into the uterine endometrium and myometrium; 2) the movement of IgA from the tissue into the uterine lumen, and 3) the amount of secretory tissue component present in the uteri of proestrus, and ovariectomized rats treated with estradiol. These studies indicate that estradiol plays an important role in regulating the uterine immune system. Further, it suggests that estradiol may control lymphocyte migration into the uterus as well as IgA transport into the uterine lumen.