mRNA expression of VEGF and its receptors in fallopian tubes of women with ectopic pregnancies

The Association of Soluble VEGFR-1 Serum Level and Genetic (rs7993418) Polymorphism with In Vitro Fertilization and Embryo Transfer Outcome in the Population of Northern Iran

Background

Vascular endothelial growth factor receptors (VEGFRS) play an important role in embryo implantation. The aim of the present study was to examine the association of VEGFR1 circulating level and gene polymorphism with in vitro fertilization and embryo transfer (IVF-ET) outcome.

Methods

In this case-control study, 120 women who had unsuccessful IVF (IVF-) history and 120 women who had successful IVF outcome (IVF+) as controls were included. Genomic DNA was extracted from blood samples. Genotyping was performed using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). The serum levels of soluble VEGFR1 (sVEGFR1) were measured by ELISA. ANOVA test was used for statistical analysis.

Results

The frequency of T and C alleles in IVF+ individuals were 87.5%, 12.5% and among IVF- were 75.5%, 24.5%, respectively (p=0.0006). The minor allele (C) was associated with an increased risk of IVF failure based on results from co-dominant (OR=3.86, 95%CI 1.19-12.47), dominant (OR=2.32, 95%CI 1.31-4.10), recessive (OR=3.22, 95%CI 1.00-10.29), and allele models (OR=2.28, 95%CI 1.40-3.69). We also showed that there is a significant decrease in serum sVEGFR1 levels in IVF as compared to IVF+ (p=0.006) groups. Moreover, TT genotype is significantly associated with increased serum sVEGFR1 concentration in IVF group (TT, CT, and CC serum levels were 106.55±11.04, 94.33±10.75, and 83.33±9.13 ng/ml, and in IVF+ group were 156.11±18.08, 120.66±16.51, and 84.66±20.31 ng/ml, respectively).

Conclusion

The results of this study indicate that VEGFR1 polymorphism and sVEGFR1 circulating levels are associated with IVF-ET outcome. Moreover, CC genotype is associated with decreased sVEGFR-1 serum concentration and IVF-ET failure.

Tissue concentration of vascular endothelial growth factor is not related to the depth of trophoblastic invasion in ampullary pregnancies—A pilot study

Introduction: The factors that modulate trophoblastic invasion into the tubal wall remain uncertain. Moreover, it is known that the concentration of vascular endothelial growth factor (VEGF) is increased in cases of deeper trophoblastic invasion in the fallopian tubes.

Objective: This study aimed to assess if there is a correlation between VEGF tissue expression and the depth of trophoblastic infiltration into the tubal wall in patients with ampullary pregnancy.

Methods: A cross-sectional study was conducted in patients with a diagnosis of tubal pregnancy in the ampullary region who underwent salpingectomy. Inclusion criteria were spontaneously conceived singleton pregnancies, diagnosis of tubal pregnancy in the ampullary region, and radical surgical treatment. A lack of agreement regarding the location of the tubal pregnancy and impossibility of either anatomopathological or tissue VEGF analysis were the exclusion criteria. Histologically, trophoblastic invasion into the tubal wall was classified as grade I when limited to the tubal mucosa, grade II when it reached the muscle layer, and grade III when it comprised the full thickness of the tubal wall. A total of 42 patients fulfilled the inclusion criteria and were selected to participate in the study. Eight patients were excluded. After surgery, tissue VEGF expression was measured by immunohistochemistry and the point counting technique.

Results: Histological analysis revealed that eight patients had stage I tubal infiltration, seven had stage II, and 19 had stage III. The difference between the percentage of VEGF expression in the trophoblastic tissue was not significant in relation to the degree of trophoblastic invasion (p = 0.621) (ANOVA). Trophoblastic tissue VEGF showed no statistical difference for prediction of both degrees of trophoblastic invasion (univariate multinomial regression).

Conclusion: The depth of trophoblastic penetration into the tubal wall in ampullary pregnancies is not associated with tissue VEGF expression.

Exposure of human fallopian tube epithelium to elevated testosterone results in alteration of cilia gene expression and beating

STUDY QUESTION

How does exposure to a testosterone rich environment affect the function and gene expression of human fallopian tube epithelium (hFTE)?

SUMMARY ANSWER

Elevated testosterone level alters several gene transcripts that regulate cilia expression and negatively impacts the rate of cilia beating.

WHAT IS KNOWN ALREADY

The presence of estrogen in the follicular phase of the menstrual cycle increases the human fallopian tube ciliary beating frequency. The luteal phase, triggered by ovulation and increasing progesterone, is marked by a decrease in ciliary beating. Women with polycystic ovarian syndrome (PCOS) may have twice the serum level of testosterone than ovulatory women. To date, the effect of elevated androgens on the function of the human fallopian tube is not well-understood. We chose to examine the impact of elevated testosterone on hFTE.

STUDY DESIGN, SIZE, DURATION

A prospective basic science study of human fallopian tube specimens from reproductive-aged women undergoing benign gynecologic surgery was performed. Fallopian tube removal at a large US academic center was collected and provided to us to continue with epithelium isolation and culturing. A total of 12 patients were analyzed in the study.

PARTICIPANTS/MATERIALS, SETTING, METHODS

Fallopian tube epithelium was isolated and exposed to two different conditions: normal with low testosterone concentration of 0.8 nM and PCOS-like, with high testosterone concentration of 2 nM. The study was conducted in both static and dynamic conditions in microfluidic devices for a total of 14 days, after which the tissue was collected for processing including RNA extraction, quantitative PCR and immunohistochemistry. After the first 7 days of each experiment, a sample of tissue from each condition was imaged to quantify cilia beating frequency.

MAIN RESULTS AND THE ROLE OF CHANCE

hFTE exposed to the 2 nM testosterone displayed slower cilia beating, inhibited estrogen signaling and decreased expression of the ciliary marker FOXJ1 when compared to stimulation with 0.8 nM testosterone.

LARGE SCALE DATA

N/A.

LIMITATIONS, REASONS FOR CAUTION

The in vivo response to elevated testosterone may differ from in vitro studies. RNA amount was limited from tissue cultured in the microfluidic devices as compared to static culture.

WIDER IMPLICATIONS OF THE FINDINGS

Understanding elevated testosterone in tubal function may explain an additional contribution to subfertility in women with PCOS and other hyper-androgen disorders, aside from oligo-ovulation. Furthermore, this adds to the body of literature of fallopian tube function using a microfluidic device.

STUDY FUNDING/COMPETING INTEREST(S)

NIH grants: UH3 ES029073 and R01 CA240301. There are no competing interests.

Serum soluble FMS-like tyrosine kinase-1 in ectopic pregnancy

CONTEXT

The diagnosis of an ectopic pregnancy (EP) requires the usage of serial beta-human chorionic gonadotropin (hCG) measurements and ultrasonography to locate the gestational sac. With the rising trends in its incidence, a rapid, noninvasive biomarker to detect this condition at the earliest can aid in decreasing the morbidity and mortality linked with EP.

AIMS

This study was performed to determine the serum level of soluble FMS-like tyrosine kinase-1 (sFLT-1) at 4-10-week gestation in EP and normal pregnancy and to identify whether it can be used as a biomarker to distinguish an EP from a normal intrauterine pregnancy.

SETTINGS AND DESIGN

This was a prospective case-control study conducted over 2 years from 2015 to 2017 in 280 women between the age groups of 19 and 38 years at a tertiary level hospital.

SUBJECTS AND METHODS

Levels of sFLT-1 in sera of 140 women with EP and 140 women with normal pregnancy were assayed by a sandwich enzyme-linked immunosorbent assay at Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India.

STATISTICAL ANALYSIS USED

Statistical analyses were performed with SPSS software version 16.0, and P ≤ 0.05 was considered statistically significant.

RESULTS

The median sFLT-1 level in EP was 419 pg/ml. This was significantly lower than the value of 898 pg/ml in normal pregnancy. Receiver operating characteristic curve analysis showed that at a cutoff of 623 pg/ml, sFLT-1 was able to distinguish an EP from a normal intrauterine pregnancy with a sensitivity of 98.6% and a specificity of 90.7%.

CONCLUSIONS

The present study showed the significant early lowering of sFLT-1 in EP and may be considered as an effective biomarker compared to beta-hCG.