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Exacoustos C, Ticconi C, Colombi I, Iorio GG, Vaquero E, Selntigia A, Chiaramonte B, Soreca G, Rizzo G. Type and Location of Adenomyosis in Women with Recurrent Pregnancy Loss: A Transvaginal Ultrasonographic Assessment. Reprod Sci 2024:10.1007/s43032-024-01541-8. [PMID: 38619796 DOI: 10.1007/s43032-024-01541-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 04/02/2024] [Indexed: 04/16/2024]
Abstract
The current knowledge on adenomyosis as a risk factor for RPL is very scant. Overall 120 women were included in this retrospective observational study. They were divided in three groups each of which consisted of 40 subjects: Group 1: women with RPL who were diagnosed to have adenomyosis on transvaginal ultrasound (TVS); Group 2: patients with RPL without ultrasonographic findings of adenomyosis; Group 3: patients with ultrasound diagnosis of adenomyosis without RPL and at least one live birth pregnancy. The copresence of endometriosis was also investigated. Among women with RPL, patients with adenomyosis (Group 1) had higher number of pregnancy losses (p = 0.03) and lower age at first pregnancy loss (p = 0.03) than women without adenomyosis (Group 2). Moreover, they had more frequently primary RPL (p = 0.008). Adenomyosis of the inner myometrium was found more frequently (p = 0.04) in patients of Group 1 than in patients of Group 3 in which adenomyosis was mainly in the outer myometrium (p= 0.02). No differences were found in the severity of adenomyosis between these two groups of women. TVS findings for endometriosis were observed more frequently in women with adenomyosis without RPL (Group 3) than in the other two groups of patients. Adenomyosis can be a factor involved in RPL. Differences in adenomyosis localization are associated with different risks for RPL. Patients with RPL should be investigated for the presence of adenomyosis and also for the type and localization of the disease in the different myometrial layers.
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Affiliation(s)
- Caterina Exacoustos
- Department of Surgical Sciences, Obstetrics and Gynecological Unit, University of Rome 'Tor Vergata', Rome, Italy
| | - Carlo Ticconi
- Department of Surgical Sciences, Obstetrics and Gynecological Unit, University of Rome 'Tor Vergata', Rome, Italy.
| | - Irene Colombi
- Department of Molecular and Developmental Medicine, Obstetrics and Gynecological Clinic University of Siena, Siena, Italy
| | - Giuseppe Gabriele Iorio
- Department of Neuroscience, Reproductive Science and Odontostomatology, University of Naples 'Federico II', Naples, Italy
| | - Elena Vaquero
- Department of Biomedicine and Prevention, Obstetrics and Gynecological Unit, University of Rome 'Tor Vergata', Rome, Italy
| | - Aikaterini Selntigia
- Department of Surgical Sciences, Obstetrics and Gynecological Unit, University of Rome 'Tor Vergata', Rome, Italy
| | - Barbara Chiaramonte
- Department of Biomedicine and Prevention, Obstetrics and Gynecological Unit, University of Rome 'Tor Vergata', Rome, Italy
| | - Giorgia Soreca
- Department of Surgical Sciences, Obstetrics and Gynecological Unit, University of Rome 'Tor Vergata', Rome, Italy
| | - Giuseppe Rizzo
- Department of Biomedicine and Prevention, Obstetrics and Gynecological Unit, University of Rome 'Tor Vergata', Rome, Italy
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Gil Laborda R, de Frías ER, Subhi-Issa N, de Albornoz EC, Meliá E, Órdenes M, Verdú V, Vidal J, Suárez E, Santillán I, Ordóñez D, Pintado-Vera D, González Villafáñez V, Lorenzo Á, Fariñas M, Rodríguez-Paíno M, Núñez Beltrán M, García Segovia Á, Del Olmo A, Martín Cañadas F, Daurelio R, de la Fuente A, González Casbas JM, Cabezuelo V, Ros Berruezo F, Moreno Hidalgo MÁ, Iniesta S, Bueno B, Martínez Acera Á, Izquierdo A, Vicario JL, Fernández-Arquero M, Sánchez-Ramón S. Centromeric AA motif in KIR as an optimal surrogate marker for precision definition of alloimmune reproductive failure. Sci Rep 2024; 14:3354. [PMID: 38336826 PMCID: PMC10858137 DOI: 10.1038/s41598-024-53766-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Accepted: 02/05/2024] [Indexed: 02/12/2024] Open
Abstract
Throughout pregnancy, the decidua is predominantly populated by NK lymphocytes expressing Killer immunoglobulin-like receptors (KIR) that recognize human leukocyte antigen-C (HLA-C) ligands from trophoblast cells. This study aims to investigate the association of KIR-HLA-C phenotypes in couples facing infertility, particularly recurrent pregnancy loss (RPL) and recurrent implantation failure (RIF), in comparison to a reference population and fertile controls. This observational, non-interventional retrospective case-control study included patients consecutively referred to our Reproductive Immunology Unit from 2015 to 2019. We analyzed the frequencies of KIR and HLA-C genes. As control groups, we analyzed a reference Spanish population for KIR analysis and 29 fertile controls and their male partners for KIR and HLA-C combinations. We studied 397 consecutively referred women with infertility and their male partners. Among women with unexplained RPL (133 women) and RIF (176 women), the centromeric (cen)AA KIR genotype was significantly more prevalent compared to the reference Spanish population (p = 0.001 and 0.02, respectively). Furthermore, cenAA was associated with a 1.51-fold risk of RPL and a 1.2-fold risk of RIF. Conversely, the presence of BB KIR showed a lower risk of reproductive failure compared to non-BB KIR (OR: 0.12, p < 0.001). Women and their partners with HLA-C1C1/C1C1 were significantly less common in the RPL-Group (p < 0.001) and RIF-Group (p = 0.002) compared to the control group. Moreover, the combination of cenAA/C1C1 in women with C1C1 partners was significantly higher in the control group than in the RPL (p = 0.009) and RIF (p = 0.04) groups, associated with a 5-fold increase in successful pregnancy outcomes. In our cohort, the cenAA KIR haplotype proved to be a more accurate biomarker than the classic AA KIR haplotype for assessing the risk of RPL and RIF, and might be particularly useful to identify women at increased risk among the heterogeneous KIR AB or Bx population. The classification of centromeric KIR haplotypes outperforms classical KIR haplotypes, making it a better indicator of potential maternal-fetal KIR-HLA-C mismatch in patients.
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Affiliation(s)
- Raquel Gil Laborda
- Department of Immunology, IML and IdISSC, Hospital Clínico San Carlos, Madrid, Spain
| | | | - Nabil Subhi-Issa
- Department of Immunology, IML and IdISSC, Hospital Clínico San Carlos, Madrid, Spain
| | - Elena Carrillo de Albornoz
- Woman Unit, Hospital Ruber Internacional, Madrid, Spain
- Assisted Reproductive Unit, Hospital Ruber Internacional, Madrid, Spain
| | - Elena Meliá
- Woman Unit, Hospital Ruber Internacional, Madrid, Spain
| | - Marcos Órdenes
- Assisted Reproductive Unit, Hospital Ruber Internacional, Madrid, Spain
| | - Victoria Verdú
- Clínica GINEFIV, Madrid, Spain
- Clínica IVF, Madrid, Spain
| | - Juan Vidal
- Woman Unit, Hospital Ruber Internacional, Madrid, Spain
| | - Esther Suárez
- Woman Unit, Hospital Ruber Internacional, Madrid, Spain
| | - Isabel Santillán
- Clínica GINEFIV, Madrid, Spain
- Instituto Europeo de Fertilidad (IEF), Madrid, Spain
| | - Daniel Ordóñez
- Woman Unit, Hospital Ruber Internacional, Madrid, Spain
- Assisted Reproductive Unit, Hospital Ruber Internacional, Madrid, Spain
| | | | | | - Ángel Lorenzo
- Woman Unit, Hospital Ruber Internacional, Madrid, Spain
- Assisted Reproductive Unit, Hospital Ruber Internacional, Madrid, Spain
| | | | | | - María Núñez Beltrán
- Department of Immunology, IML and IdISSC, Hospital Clínico San Carlos, Madrid, Spain
| | - Áurea García Segovia
- Sanitas Assisted Reproduction Unit, Clínica Sanitas Millenium Alcobendas, Madrid, Spain
| | - Ainhoa Del Olmo
- Department of Immunology, IML and IdISSC, Hospital Clínico San Carlos, Madrid, Spain
| | | | | | | | | | | | | | | | - Silvia Iniesta
- Assisted Reproductive Unit, Hospital Ruber Internacional, Madrid, Spain
| | - Beatriz Bueno
- Assisted Reproductive Unit, Hospital Ruber Internacional, Madrid, Spain
| | - Álvaro Martínez Acera
- Woman Unit, Hospital Ruber Internacional, Madrid, Spain
- Assisted Reproductive Unit, Hospital Ruber Internacional, Madrid, Spain
| | - Alexandra Izquierdo
- Department of Immunology, IML and IdISSC, Hospital Clínico San Carlos, Madrid, Spain
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Sadeghi Jam Z, Tahmasebi Fard Z. Gene Expression Levels of CSF-1 and CSF-1R Endometrial under The Influence of Prolactin Level in Unexplained Miscarriage: A Case-Control Study. Int J Fertil Steril 2023; 17:236-241. [PMID: 37577905 PMCID: PMC10439994 DOI: 10.22074/ijfs.2023.555588.1316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 09/15/2022] [Accepted: 06/11/2023] [Indexed: 08/15/2023]
Abstract
BACKGROUND Hormones such as prolactin, by influencing expression of the endometrial genes, play a pivotal role in embryo implantation and development. The present study aimed to evaluate serum level of prolactin and its effect on altering expression level of colony-stimulating factor-1 (CSF-1) and colony-stimulating factor-1 receptor (CSF-1R) genes in endometrial tissue during in vitro fertilization (IVF) pregnancy in the infertile women and recurrent pregnancy loss (RPL), compared to fertile women, who lost their pregnancies at gestational age <20 weeks. MATERIALS AND METHODS In this case-control study, 40 infertile women, 40 IVF pregnant women with RPL and 40 fertile women who lost their pregnancies at <20 weeks of gestation for unknown reasons were selected. Prolactin serum level was assessed using ELISA technique and expression of CSF-1 and CSF-1R genes was determined in endometrial tissue, using quantitative reverse transcription polymerase chain reaction (qRT-PCR). RESULTS Mean prolactin level of the infertile group was 24.38 ± 1.43 ng/mL and it had statistically significant relationship with the fertile group (P<0.001). Expression level of the CSF-1 and CSF-1R genes were higher in the fertile than infertile groups by 2.88 times (P<0.0001) and 2.64 times (P<0.0001), while it was respectively 2.28 (P<0.0001) and 1.69 (P<0.0001) times higher compared to the RPL group. Risk factors for pregnancy loss, such as aging, increased body mass index (BMI), smoking and diabetes caused decreasing changes in gene expression (CSF-1 and CSF-1R ) and the differences were statistically significant, except in the infertile group. CONCLUSION The present study showed a significant relationship of CSF-1 and CSF-1R expression levels with pregnancy loss. Risk factors such as aging, obesity, smoking and diabetes decreased both genes expression levels.
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Affiliation(s)
- Zahra Sadeghi Jam
- Department of Biology, Roudehen Branch, Islamic Azad University, Roudehen, Iran
| | - Zahra Tahmasebi Fard
- Department of Biology, Roudehen Branch, Islamic Azad University, Roudehen, Iran.
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Ringel F, Lewandofski F, Kiesewetter H, Sehouli J, Hoppe B, Kiesewetter A, Hannen R, Stoll CF, Maas S, Salama A. Polyclonal Anti-D Antibodies Significantly Reduce the Rate of Miscarriages in Rh(D) positive Women with Recurrent Pregnancy loss. Obstet Gynecol Res 2023; 6:107-114. [PMID: 37168076 PMCID: PMC10167743 DOI: 10.26502/ogr0119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Background Macrophages play a key role in all environmental conditions surrounding pregnancy. Coating of autologous red blood cells (RBCs) with polyclonal antibodies to Rh(D) antigen may result in an immunomodulation and improved outcome in Rh(D) positive women with recurrent pregnancy loss (RPL). Methods A total of 60 Rh(D) positive women (age 23 to 45 years) with a history of RPL and ineffective treatment with low molecular weight heparin (LMWH) and/or aspirin were included in this retrospective study. In addition to this treatment, Anti-D (300 μg) was given subcutaneously to each woman either prior to pregnancy and/or two times within 12 weeks of gestation. Results Treatment with Anti-D in non-responders to heparin/aspirin resulted in successful pregnancies in 67% of all cases. The remaining women had only aborts (23%) or did not become pregnant (10%). None of the treated women has developed anemia due to this treatment or any other significant adverse reaction. The rate of successful pregnancies does not appear to be influenced by the administration of: Anti-D prior to pregnancy, age, thrombophilia or previous alive births. Conclusion The improved outcome following the administration of Anti-D in women with RPL might be explained by immune modulations induced by different immune reactions including polarization of decidual macrophages. The results obtained in this study clearly indicate that Anti-D is safe and highly effective in treatment of Rh(D) positive women with RPL. However, further studies are required to support our results and to find out the optimal dose and timing of Anti-D administration.
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Affiliation(s)
| | | | | | - Jalid Sehouli
- Berlin, Germany, Charite, Universitaetsmedizin Berlin, Klinik fuer Gynaekologie mit Zentrum für onkologische Chirurgie, Campus Virchow-Klinikum
| | - Berthold Hoppe
- Berlin, Germany, Medicover, Hemostaseologicum Mitte, and Institute of Laboratory Medicine, BG Klinikum Unfallkrankenhaus Berlin, and MSH Medical School Hamburg, Germany
| | | | | | | | | | - Abdulgabar Salama
- Berlin, Germany, Medicover, Hemostaseologicum Mitte, and Charite, Universitaetsmedizin Berlin, Klinik fuer Gynaekologie mit Zentrum für onkologische Chirurgie, Campus Virchow-Klinikum
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Mitchell JM, Cullen S, McEvoy A, Crosby D, Allen C. Can Anti-Müllerian Hormone levels predict future pregnancy outcomes in recurrent pregnancy loss? Eur J Obstet Gynecol Reprod Biol 2023; 284:20-23. [PMID: 36924658 DOI: 10.1016/j.ejogrb.2023.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 03/02/2023] [Accepted: 03/08/2023] [Indexed: 03/17/2023]
Abstract
OBJECTIVE Serum Anti-Müllerian Hormone (AMH) levels have been shown to be lower among women who have experienced recurrent pregnancy loss (RPL) compared with the general population. However, it is unclear whether it can predict livebirth. This study aims to determine whether AMH can predict the likelihood of a livebirth in women with RPL. STUDY DESIGN Prospective analysis of a consecutive cohort of women undergoing investigation for RPL in a tertiary referral centre over a seven year period (August 2014 -December 2021). Analysis was performed using descriptive statistics, chi-square models and logistic regression models adjusting for maternal age and previous livebirth. Exclusion criteria for the regression analysis included abnormal parental karyotype and abnormal pelvic ultrasound scan. Pregnancy outcome was defined as livebirth or further pregnancy loss. RESULTS There were 488 women who underwent investigation of RPL during the study period. Of these, 65.2% (n = 318) conceived following attendance at the clinic. The majority of these women (69.4%, n = 221) proceeded to have a livebirth. There were no differences in median AMH levels between the livebirth group and the further pregnancy loss group (11 pmol/L vs 9 pmol/L respectively (p = 0.083). AMH did not affect clinical pregnancy rates (p = 0.77, 95% CI = 0.99 [0.98, 1.01]) or pregnancy outcome (p = 0.30, 95% CI = 1.01 [0.99, 1.04]). Abnormal pelvic ultrasonography (p = 0.04) and an abnormal parental karyotype (p = 0.04) were associated with an increased likelihood of a subsequent pregnancy loss. CONCLUSION Although AMH levels may have some utility in counselling of some couples with RPL, these contemporaneous data indicate that low AMH does not negatively influence subsequent pregnancy outcome in women with recurrent pregnancy loss.
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Affiliation(s)
- J M Mitchell
- National Maternity Hospital, Holles Street, Dublin 2, Ireland.
| | - S Cullen
- National Maternity Hospital, Holles Street, Dublin 2, Ireland
| | - A McEvoy
- National Maternity Hospital, Holles Street, Dublin 2, Ireland
| | - D Crosby
- National Maternity Hospital, Holles Street, Dublin 2, Ireland; Merrion Fertility Clinic, 60 Lower Mount Street, Dublin 2, Ireland
| | - C Allen
- National Maternity Hospital, Holles Street, Dublin 2, Ireland; Merrion Fertility Clinic, 60 Lower Mount Street, Dublin 2, Ireland
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Habibi M, Fakhari Zavareh Z, Abbasi B, Esmaeili V, Shahverdi A, Sadighi Gilani MA, Tavalaee M, Nasr-Esfahani MH. Alpha-Lipoic Acid Supplementation for Male Partner of Couples with Recurrent Pregnancy Loss: A Post hoc analysis in Clinical Trial. Int J Fertil Steril 2023; 17:67-74. [PMID: 36617206 PMCID: PMC9807888 DOI: 10.22074/ijfs.2022.543027.1222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Indexed: 01/09/2023]
Abstract
BACKGROUND Increased sperm DNA damage is known as one of the causes of recurrent pregnancy loss (RPL) which can be due to increased levels of oxidative stress. Therefore, the aim of this study was to assess the effect of alpha-lipoic acid (ALA) on sperm parameters and sperm functions in couples with a history of RPL. MATERIALS AND METHODS In this post hoc analysis in clinical trial study, a total of 37 couples with RPL (n=12 and n=25 for placebo and ALA groups, respectively) were considered. Men were treated with ALA (600 mg/day) or placebo for 80 days. Semen samples were acquired from the participants before initiation and after completion of the medication course and assessed regarding conventional sperm parameters, chromatin damage/integrity, intracellular oxidative stress, lipid peroxidation, and seminal antioxidant characteristics. Individuals were further followed up for twelve months for pregnancy occurrence and outcomes. Finally, after excluding patients with no history of RPL, the data was analyzed. RESULTS No significant differences were observed between the baseline measures of the aforementioned parameters except for seminal volume. After the intervention, the mean sperm DNA damage, protamine deficiency, and persisted histones were significantly lower in the ALA group than in placebo receivers (P<0.05). A decrease in the mean of seminal total antioxidant capacity (P=0.03), malondialdehyde (P=0.02), and sperm DNA damage (P=0.004) as well as an increase in sperm total motility (P=0.04) after treatment with ALA was noticed. In addition, the mean of protamine deficiency and persisted histones were declined post-ALA therapy (P=0.003 and 0.002, respectively). The percentage of spontaneous pregnancy in the ALA group (4 of 25 cases; 16%) was higher than in the placebo group (1 of 12, 8.3%). CONCLUSION ALA-therapy attenuates sperm DNA damage and lipid peroxidation while enhancing sperm total motility and chromatin compaction in the male partner of couples with PRL (registration number: IRCT20190406043177N1).
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Affiliation(s)
- Masoud Habibi
- Department of Embryology, Reproductive Biomedicine Research Center, Royan Institute for Reproductive
Biomedicine, ACECR, Tehran, Iran
| | - Zohreh Fakhari Zavareh
- Department of Embryology, Reproductive Biomedicine Research Center, Royan Institute for Reproductive
Biomedicine, ACECR, Tehran, Iran
| | - Behzad Abbasi
- Department of Animal Biotechnology, Reproductive Biomedicine Research Center, Royan Institute for Biotechnology,
ACECR, Isfahan, Iran,Isfahan Fertility and Infertility Center, Isfahan, Iran
| | - Vahid Esmaeili
- Department of Embryology, Reproductive Biomedicine Research Center, Royan Institute for Reproductive
Biomedicine, ACECR, Tehran, Iran
| | - Abdolhossein Shahverdi
- Department of Embryology, Reproductive Biomedicine Research Center, Royan Institute for Reproductive
Biomedicine, ACECR, Tehran, Iran
| | - Mohammad Ali Sadighi Gilani
- Department of Andrology, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine,
ACECR, Tehran, Iran
| | - Marziyeh Tavalaee
- Department of Animal Biotechnology, Reproductive Biomedicine Research Center, Royan Institute for Biotechnology,
ACECR, Isfahan, Iran,P.O.Box: 8165131378Department of Animal BiotechnologyReproductive Biomedicine Research CenterRoyan Institute for BiotechnologyACECRIsfahanIran
Emails:,
| | - Mohammad Hossein Nasr-Esfahani
- Department of Animal Biotechnology, Reproductive Biomedicine Research Center, Royan Institute for Biotechnology,
ACECR, Isfahan, Iran,Isfahan Fertility and Infertility Center, Isfahan, Iran,P.O.Box: 8165131378Department of Animal BiotechnologyReproductive Biomedicine Research CenterRoyan Institute for BiotechnologyACECRIsfahanIran
Emails:,
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7
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Comins-Boo A, Valdeolivas L, Pérez-Pla F, Cristóbal I, Subhi-Issa N, Domínguez-Soto Á, Pilar-Suárez L, Gasca-Escorial P, Calvo-Urrutia M, Fernández-Arquero M, Herráiz MÁ, Corbí Á, Sánchez-Ramón S. Immunophenotyping of peripheral blood monocytes could help identify a baseline pro-inflammatory profile in women with recurrent reproductive failure. J Reprod Immunol 2022; 154:103735. [PMID: 36063657 DOI: 10.1016/j.jri.2022.103735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 07/23/2022] [Accepted: 08/19/2022] [Indexed: 12/14/2022]
Abstract
Recurrent pregnancy loss (RPL) and recurrent implantation failure (RIF) are two well-defined clinical entities, but the role of the monocytes in their pathophysiology needs to be clarified. This study aimed to evaluate the role of the three monocyte subsets (classical, intermediate, and non-classical) and relevant cytokines/chemokines in a cohort of RPL and RIF women to better characterize a baseline proinflammatory profile that could define inflammatory pathophysiology in these two different conditions. We evaluated 108 non-pregnant women: 53 RPL, 24 RIF, and 31 fertile healthy controls (HC). Multiparametric flow cytometry was used to quantify the frequency of surface chemokine receptors (CCR2, CCR5, and CX3CR1) on the monocyte subsets. Cytokines were assessed in plasma samples using a multiplex assay. The CX3CR1+ and CCR5+ intermediate monocytes were significantly higher in RPL and RIF compared to HC. A significant positive correlation was observed between CX3CR1+ intermediate monocytes and IL-17A (P = .03, r = 0.43). The Boruta algorithm followed by a multivariate logistic regression model was used to select the most relevant variables that could help define RPL and RIF: in RPL were CX3CR1 non-classical monocytes, TGF-β1, and CCR5 intermediate monocytes; in RIF: CCR5 intermediate monocytes and TGF-β3. The combination of these variables could predict RPL and RIF with 90 % and 82 %, respectively. Our study suggests that a combination of specific blood monocyte subsets and cytokines could aid in identifying RPL and RIF women with a pro-inflammatory profile. These findings could provide a more integrated understanding of these pathologies. Further investigation and validation in independent cohorts are warranted.
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Affiliation(s)
- Alejandra Comins-Boo
- Department of Immunology, IML, and IdSSC, Hospital Clínico San Carlos, Madrid, Spain; Department of Immunology, Ophthalmology, and ENT, School of Medicine, Complutense University School of Medicine, Madrid, Spain
| | - Lorena Valdeolivas
- Department of Immunology, IML, and IdSSC, Hospital Clínico San Carlos, Madrid, Spain; Department of Immunology, Ophthalmology, and ENT, School of Medicine, Complutense University School of Medicine, Madrid, Spain
| | - Fernando Pérez-Pla
- Department of Applied Mathematics and Computational Science, University of Cantabria, Spain
| | - Ignacio Cristóbal
- Department of Obstetrics and Gynecology, Hospital Clínico San Carlos, Madrid, Spain
| | - Nabil Subhi-Issa
- Department of Immunology, IML, and IdSSC, Hospital Clínico San Carlos, Madrid, Spain; Department of Immunology, Ophthalmology, and ENT, School of Medicine, Complutense University School of Medicine, Madrid, Spain
| | - Ángeles Domínguez-Soto
- Molecular Microbiology and Infection Biology Department, Centro de Investigaciones Biológicas, CSIC, Madrid, Spain
| | - Lydia Pilar-Suárez
- Department of Obstetrics and Gynecology, Hospital Clínico San Carlos, Madrid, Spain
| | - Pilar Gasca-Escorial
- Department of Obstetrics and Gynecology, Hospital Clínico San Carlos, Madrid, Spain
| | - Marta Calvo-Urrutia
- Department of Obstetrics and Gynecology, Hospital Clínico San Carlos, Madrid, Spain
| | - Miguel Fernández-Arquero
- Department of Immunology, IML, and IdSSC, Hospital Clínico San Carlos, Madrid, Spain; Department of Immunology, Ophthalmology, and ENT, School of Medicine, Complutense University School of Medicine, Madrid, Spain
| | - Miguel Ángel Herráiz
- Department of Obstetrics and Gynecology, Hospital Clínico San Carlos, Madrid, Spain
| | - Ángel Corbí
- Molecular Microbiology and Infection Biology Department, Centro de Investigaciones Biológicas, CSIC, Madrid, Spain
| | - Silvia Sánchez-Ramón
- Department of Immunology, IML, and IdSSC, Hospital Clínico San Carlos, Madrid, Spain; Department of Immunology, Ophthalmology, and ENT, School of Medicine, Complutense University School of Medicine, Madrid, Spain.
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Kim HI, Choi EA, Paik EC, Park S, Hwang YI, Lee JH, Seo SK, Cho S, Choi YS, Lee BS, Park J, Lee S, Lee KR, Yun BH. Identification of Single Nucleotide Polymorphisms as Biomarkers for Recurrent Pregnancy Loss in Korean Women. J Korean Med Sci 2022; 37:e336. [PMID: 36631028 PMCID: PMC9705206 DOI: 10.3346/jkms.2022.37.e336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 10/12/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Single nucleotide polymorphisms (SNPs) are reportedly associated with repeated abortion. Thus, genetic analysis based on race is the key to developing accurate diagnostic tests. This study analyzed the genetic polymorphisms of recurrent pregnancy loss (RPL) patients among Korean women compared to the controls. METHODS In 53 women of RPL group and 50 controls, the genetic analysis was performed. The genotype distribution and allele frequency were analyzed statistically for the difference between the two groups. The association between each SNP marker and RPL risk was analyzed. RESULTS The genotypes of LEPR, endothelial nitric oxide synthase (eNOS), KDR, miR-27a, miR-449b, and tumor necrosis factor-alpha (TNF-α) were analyzed using odds ratio (OR) with 95% confidence intervals (CIs). Only the AG genotype of miR-449b (A>G) polymorphism showed significant association with the risk of RPL when compared to the AA genotype (OR, 2.39). The combination of GG/AG+GG/CA+AA genotypes for eNOS/miR-449b/TNF-α was associated with 7.36-fold higher risk of RPL (OR, 7.36). The GG/AG+GG combination for eNOS/miR-449b showed 2.43-fold higher risk for RPL (OR, 2.43). The combination of AG+GG/CA+AA genotypes for miR-449b/TNF-α showed a significant association with the risk of RPL (OR, 7.60). From the haplotype-based analysis, the G-G-A haplotype of eNOS/miR-449b/TNF-α and the G-A haplotype of miR-449b/TNF-α were associated with increased risk of RPL (OR, 19.31; OR, 22.08, respectively). CONCLUSION There is a significant association between the risk of RPL and miR-449b/TNF-α combination, and therefore, genetic analysis for specific combined genotypes can be an important screening method for RPL in Korean women.
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Affiliation(s)
- Hye In Kim
- Department of Obstetrics and Gynecology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Eun A Choi
- Department of Obstetrics and Gynecology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | | | | | - Yu Im Hwang
- Bundang Cheil Women's Hospital, Seongnam, Korea
| | - Jae Hoon Lee
- Institute of Women's Life Medical Science, Yonsei University College of Medicine, Seoul, Korea
- Department of Obstetrics and Gynecology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Seok Kyo Seo
- Department of Obstetrics and Gynecology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
- Institute of Women's Life Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - SiHyun Cho
- Institute of Women's Life Medical Science, Yonsei University College of Medicine, Seoul, Korea
- Department of Obstetrics and Gynecology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Young Sik Choi
- Department of Obstetrics and Gynecology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
- Institute of Women's Life Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Byung Seok Lee
- Department of Obstetrics and Gynecology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
- Institute of Women's Life Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Jimyeong Park
- Seoul Clinical Laboratories Healthcare Co., Ltd., Yongin, Korea
| | - Sanghoo Lee
- Seoul Clinical Laboratories Healthcare Co., Ltd., Yongin, Korea.
| | - Kyoung-Ryul Lee
- Seoul Clinical Laboratories Healthcare Co., Ltd., Yongin, Korea
| | - Bo Hyon Yun
- Department of Obstetrics and Gynecology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
- Bundang Cheil Women's Hospital, Seongnam, Korea.
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Jalilvand A, Yari K, Heydarpour F. Role of polymorphisms on the Recurrent Pregnancy Loss: A systematic review, Meta-analysis and bioinformatic analysis. Gene 2022; 844:146804. [PMID: 35998845 DOI: 10.1016/j.gene.2022.146804] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 07/16/2022] [Accepted: 08/06/2022] [Indexed: 02/08/2023]
Abstract
Recurrent miscarriage (RM) is a major reproductive health issue. RM is a multi-factorial disease, and is affected by environmental, genetic, and epigenetic factors. Genetics has a common role in recurrent miscarriage occurrence. It seems that molecular genetics has a great role in RSA incidence. So, in these years, RM has become for a major subject of genetics research. There are many genes that are involved in each phase for successful reproduction. This research aimed to evaluate the effect of all studied polymorphisms in studies on RSA that have not been included in any meta-analysis. PubMed, Scopus, and Web of Science databases were recruited to investigate the related articles. The systematic review results identified 143 studies worldwide. Thirteen genes have been included in assessing the case-control studies. Sixty-four SNPs were recruited to assess the association between genetic factors and RSA susceptibility. Ninety-two studies containing twenty two SNPs (from 10 genes) were included in the quantitative analysis. Bioinformatic analysis indicated that rs12722482 showed "Damaging Status" by double servers, and rs315952 and rs854560 had "Possibly damaging" status in the PolyPhen-2 server. MethPrimer server indicated that there is "CpG Island" in the rs10895068, rs1130355, and rs41557518 variants, and rs10895068-G allele makes a CpG dinucleotide which can change the gene methylation and result in altering the gene expression. So, further studies on rs12722482 and rs10895068 can demonstrate valuable results. To the best of our knowledge, this systematic review has covered the all studied polymorphisms of HLA-C, HLA-G, PON1, AGTR1, TAFI, FAS, FAS-L, ESR1, PGR, CTLA-4, MMP-2, MMP-3, MMP-9, and IL1RN for the first time. Also, we did a novel meta-analysis for AGTR1 rs5186, TAFI rs1926447, rs3742264, HLA-G rs1063320, rs1233334, rs1736936, rs2249863, PON1 rs662, rs854560, FAS rs2234767, rs1800682, FAS-L rs763110, ESR1, rs9340799, rs3798759, PGR rs1042838, CTLA4 rs4553808, rs5742909, rs231775, rs3087243, and MMP-2 rs243865 and updated statistical finding for rs2234693 and rs371194629. Rs2234693, rs9340799, rs231775, and rs371194629 demonstrated a significant association with RSA risk. Some variations showed significant association, while further studies are suggested to confirm the results. Finally, Rs4553808 and rs5742909 revealed no significant deviation in the results. It is suggested that these SNPs may be excluded from subsequent case-control studies or other analyses.
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Affiliation(s)
- Amin Jalilvand
- Researcher in Molecular Genetics, Kermanshah ACECR Institute of Higher Education, Kermanshah, Iran
| | - Kheirollah Yari
- Medical Biology Research Center, Health Technology Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran.
| | - Fatemeh Heydarpour
- Social Development and Health Promotion Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
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10
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Krop J, Van Der Keur C, Kapsenberg JM, Den Hollander F, Van Der Hoorn MLP, Heidt S, Claas FHJ, Eikmans M. Soluble HLA-G blood levels are not increased during ongoing pregnancy in women with a history of recurrent pregnancy loss. J Reprod Immunol 2022; 153:103665. [PMID: 35905658 DOI: 10.1016/j.jri.2022.103665] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 05/30/2022] [Accepted: 07/11/2022] [Indexed: 11/30/2022]
Abstract
Recurrent pregnancy loss (RPL) affects 1-2 % of couples who are trying to conceive. At some point, some couples do maintain a healthy pregnancy to term, but the underlying mechanism of RPL remains elusive. Human leukocyte antigen (HLA)-G is an immune modulatory molecule. Our group previously showed increased HLA-G levels in the decidua of term pregnancies after RPL, while other studies showed reduced soluble HLA-G (sHLA-G) blood levels in women with RPL. This led us to investigate sHLA-G levels in blood of women with RPL who had either a subsequent pregnancy loss (RPL-pregnancy loss) or a healthy term pregnancy (RPL-live birth), and compare these to healthy control pregnancies and non-pregnant controls. Soluble HLA-G concentrations were quantified by ELISA. Women with healthy term pregnancy had increased sHLA-G levels compared to non-pregnant controls. In contrast, RPL-live birth women at term did not have increased blood sHLA-G levels. Soluble HLA-G levels remained stable between first and third trimester. Interestingly, when comparing first trimester samples of RPL-live birth to RPL-pregnancy loss, sHLA-G levels also did not significantly differ. High sHLA-G levels in blood seem not to be crucial for an ongoing healthy pregnancy after RPL. However, since it was previously shown that women with RPL-live birth have increased HLA-G levels in term decidua compared to control pregnancies, the current data suggest that local and systemic immune regulation are not necessarily in concert. Further study of the contribution of fetus-derived HLA-G and HLA-G of maternal origin may provide more insight in the pathophysiology of RPL.
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Affiliation(s)
- J Krop
- Department of Immunology, Leiden University Medical Centre, Leiden, the Netherlands
| | - C Van Der Keur
- Department of Immunology, Leiden University Medical Centre, Leiden, the Netherlands
| | - J M Kapsenberg
- Department of Immunology, Leiden University Medical Centre, Leiden, the Netherlands
| | - F Den Hollander
- Department of Immunology, Leiden University Medical Centre, Leiden, the Netherlands
| | - M L P Van Der Hoorn
- Department of Obstetrics, Leiden University Medical Centre, Leiden, the Netherlands
| | - S Heidt
- Department of Immunology, Leiden University Medical Centre, Leiden, the Netherlands
| | - F H J Claas
- Department of Immunology, Leiden University Medical Centre, Leiden, the Netherlands
| | - M Eikmans
- Department of Immunology, Leiden University Medical Centre, Leiden, the Netherlands.
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11
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Kim JH, Kim SH, Yang N, Ko Y, Lee SR, Chae HD. Outcomes of Empirical Treatment With Intravenous Immunoglobulin G Combined With Low-Dose Aspirin in Women With Unexplained Recurrent Pregnancy Loss. J Korean Med Sci 2022; 37:e200. [PMID: 35762143 PMCID: PMC9239843 DOI: 10.3346/jkms.2022.37.e200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 05/20/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND To assess the clinical efficacy of intravenous immunoglobulin G (IVIG) administration combined with low-dose aspirin in women with unexplained recurrent pregnancy loss (RPL). METHODS We retrospectively analyzed the medical records of patients who had been diagnosed with unexplained RPL and treated with IVIG and low-dose aspirin between January 2000 and March 2020 at Asan Medical Center. We analyzed pregnancy outcomes and their association with the percentage of natural killer (NK) cells. RESULTS The study analyzed a total of 93 patients and 113 natural and assisted reproductive technology pregnancy cycles. The live birth rate per cycle was 73.5% (83/113), and the term delivery rate was 86.7% (72/83). The live birth rate was high regardless of the type of RPL, method of pregnancy, timing of IVIG treatment, and presence or absence of autoantibodies. In addition, the live birth rate was significantly higher in patients who received IVIG more than once, compared with patients who received IVIG only once (77.8% vs. 42.9%, P = 0.006). There was no significant association between the NK cell counts and live birth rate (65.5% in the group with NK cell < 12%, and 69.7% in that with NK cell ≥ 12%, P = 0.725). Among all patients, 87.6% had no complications, and there were no congenital malformation among newborn babies. CONCLUSION IVIG combined with low-dose aspirin treatment showed favorable pregnancy outcomes regardless of the patient's NK cell counts (%).
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Affiliation(s)
- Ju Hee Kim
- Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Sung Hoon Kim
- Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
| | - Nuri Yang
- Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Yuri Ko
- Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Sa Ra Lee
- Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Hee Dong Chae
- Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
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Shahidi M, Nazari F, Ghanbarian H, Taheripanah R, Hajivalili M, Amani D. miR-146b-5p and miR-520h Expressions Are Upregulated in Serum of Women with Recurrent Spontaneous Abortion. Biochem Genet 2022. [PMID: 35083607 DOI: 10.1007/s10528-021-10173-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 12/06/2021] [Indexed: 12/12/2022]
Abstract
Unexplained recurrent spontaneous abortion (URSA) is characterized by two or more consecutive pregnancy losses before the 20th week of gestation with unknown etiology. Dysregulation of microRNAs (miRNAs) expression has been reported in reproductive diseases. This study aimed to compare differentially expressed miRNAs in the serum samples between URSA patients and healthy individuals. URSA cases were confirmed by a gynecologist. Peripheral blood sample was gathered from 9 URSA patients, 15 normal pregnant, and 10 non-pregnant women without abortion history. After separating serum, the expression levels of the miR-101-3p, miR-517c-3p, miR-146b-5p, miR-221-3p, and miR-520 h were measured by qRT-PCR assay. The circulating level of miR-520 h in URSA patients was significantly up-regulated compared with healthy pregnant (P < 0.01) and healthy non-pregnant (P = 0.002) women. Furthermore, miR-520 h expression was significantly different between healthy non-pregnant and pregnant women (P = 0.002). Statistical analysis indicated miR-146b-5p expression was significantly up-regulated in URSA patients compared to normal pregnant women (P = 0.018). However, the transcription level of miR-146b-5p was insignificantly different between normal non-pregnant women and the other two groups. Also, circulating levels of miR-101-3p, miR-221-3p, and miR-517c-3p were not significantly different in the studied groups. Statistical analysis showed significant correlations between both miR-221-3p and miR-517c-3p and other miRNAs (P < 0.05). The circulating levels of miR-520 h and miR-146b-5p could be considered biomarkers for URSA diagnosis. Also, miR-517c-3p and miR-221-3p might play a regulatory role in other miRNAs expressions during pregnancy. Previous work, in contrary to our findings, claims that the expression levels of miR-221-3p, miR-101-3p, and miR-517c-3p increased in plasma and tissue samples of patients with URSA. However, our research for the first time indicates that the expression level of miR-520 h and miR-146b-5p in the serum of these patients has increased. Future investigations are necessary to confirm these findings.
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Fatemi N, Varkiani M, Ramezanali F, Babaabasi B, Ghaheri A, Biglari A, Totonchi M. Risk Factors Associated with Recurrent Pregnancy Loss and Outcome of Pre-Implantation Genetic Screening of Affected Couples. Int J Fertil Steril 2021; 15:269-274. [PMID: 34913295 PMCID: PMC8530214 DOI: 10.22074/ijfs.2021.137626.1027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 01/30/2021] [Indexed: 12/14/2022]
Abstract
Background: Recurrent pregnancy loss (RPL) is a multifactorial disorder which affects up to 5% of couples around
the world. Several factors are considered to be involved in RPL; but, the etiology remains unexplained in 35-60% of
cases. The aim of this study was to assess the frequency of risk factors associated with RPL in a group of our clinic
clients, and their pre-implantation genetic screening (PGS) outcome.
Materials and Methods: We designed a retrospective descriptive study among, 602 Iranian couples referred to the
Royan Reproductive Clinic (Tehran-Iran) from 2006 to 2018. Their karyotyping test and PGS outcomes were analyzed. PGS had been applied by array comparative genomic hybridization (array-CGH) on embryos from these patients. Also, karyotyping test had been performed using standard cytogenetic techniques.
Results: G-banding analysis revealed a frequency of 15.61% chromosomal abnormalities in RPL couples. Also, the reciprocal translocations were more frequent (33/1204 cases) compared to the other structural abnormalities. Pregnancy rate per
embryo transferred were 50% with array-CGH approach. Conclusion: Our findings could confirm a positive correlation between chromosomal abnormalities and RPL rate. Applying PGS for the RPL couples, leads to improvement of pregnancy success rate.
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Affiliation(s)
- Nayeralsadat Fatemi
- Department of Genetics and Molecular Medicine, School of Medicine, Zanjan University of Medical Sciences (ZUMS), Zanjan, Iran.,Department of Genetics, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Maryam Varkiani
- Department of Genetics, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran.,Department of Molecular Genetics, Faculty of Basic Sciences and Advanced Technologies in Biology, University of Science and Culture, Tehran, Iran
| | - Fariba Ramezanali
- Department of Endocrinology and Female Infertility, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Babak Babaabasi
- Department of Genetics, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Azadeh Ghaheri
- Reproductive Epidemiology Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Alireza Biglari
- Department of Genetics and Molecular Medicine, School of Medicine, Zanjan University of Medical Sciences (ZUMS), Zanjan, Iran.
| | - Mehdi Totonchi
- Department of Genetics, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran. .,Department of Stem Cells and Developmental Biology, Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology, ACECR, Tehran, Iran
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14
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Abdollahi E, Rezaee SA, Saghafi N, Rastin M, Clifton V, Sahebkar A, Rafatpanah H. Evaluation of the Effects of 1,25 Vitamin D3 on Regulatory T Cells and T Helper 17 Cells in Vitamin D-deficient Women with Unexplained Recurrent Pregnancy Loss. Curr Mol Pharmacol 2021; 13:306-317. [PMID: 32124705 DOI: 10.2174/1874467213666200303130153] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 11/27/2019] [Accepted: 12/31/2019] [Indexed: 01/02/2023]
Abstract
BACKGROUND Vitamin D insufficiency and deficiency can be associated with adverse effects on pregnancy outcomes, which may include recurrent pregnancy loss through the mechanisms that are yet unknown. The aim of this study was to evaluate the effect of 1,25VitD3 on regulatory T cells (Tregs) and T helper17 (Th17) cell populations In vitro in unexplained recurrent pregnancy loss (URPL) patients and healthy women. METHODS Samples from 20 non-pregnant women with a history of URPL were compared to 20 normal non-pregnant women. Peripheral blood mononuclear cells (PBMC) were divided into 3 wells for each subject: in the presence of 1, 25 VitD3 (50 nM, for 16 hours), PHA (positive control) (10μM), and without any treatment (as a baseline or negative control). The percentage of regulatory T cells and Th17 cells was measured by flow cytometry at baseline and then after cell culture experiments. RESULTS Our study indicated that the percentage of Tregs in patients with URPL was significantly lower than the control group (2.42 ± 0.27 vs. 3.41 ± 0.29, P= 0.01). The percentage of Th17 cells was significantly greater in URPL patients compared to the control group (2.91 ± 0.33 vs. 1.18± 0.15, P=0.001). 1, 25VitD3 treatment significantly increased the percentage of Tregs from the baseline in the URPL group compared to that in the control group (1.23 ± 0.03 vs. 1.00 ± 0.03, P= 0.01). CONCLUSION Vitamin D deficiency may be a contributor to recurrent pregnancy loss and suggests supplementation of women with Vit D pre-pregnancy may be protective against URPL.
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Affiliation(s)
- Elham Abdollahi
- Department of Medical Immunology and Allergy, Student Research Committee, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran,Graduate Research Trainee in Mater Research Institute-University of Queensland, Translational Research Institute, South Brisbane, Australia
| | - Seyed Abdolrahim Rezaee
- Research Center for HIV/AIDS, HTLV and Viral Hepatitis, Iranian Academic Center for Education, Culture & Research (ACECR), Mashhad Branch, Mashhad, Iran,Inflammation and Inflammatory Diseases Research Centre, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Nafiseh Saghafi
- Department of Gynecology Oncology, Woman Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Maryam Rastin
- Immunology Research Center, BuAli Research Institute, Department of Immunology and Allergy, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Vicki Clifton
- Pregnancy and Development, Mater Research Institute-University of Queensland, Translational Research Institute, South Brisbane, Australia
| | - Amirhossein Sahebkar
- Halal Research Center of IRI, FDA, Tehran, Iran,Biotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran,Neurogenic Inflammation Research Center, Mashhad University of Medical Sciences, Mashhad, Iran,Polish Mother's Memorial Hospital Research Institute (PMMHRI), Lodz, Poland
| | - Houshang Rafatpanah
- Research Center for HIV/AIDS, HTLV and Viral Hepatitis, Iranian Academic Center for Education, Culture & Research (ACECR), Mashhad Branch, Mashhad, Iran,Inflammation and Inflammatory Diseases Research Centre, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
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15
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Tasadduq R, Ajmal L, Batool F, Zafar T, Babar A, Riasat A, Shakoori AR. Interplay of immune components and their association with recurrent pregnancy loss. Hum Immunol 2021; 82:162-169. [PMID: 33581927 DOI: 10.1016/j.humimm.2021.01.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 01/18/2021] [Accepted: 01/21/2021] [Indexed: 11/28/2022]
Abstract
Maintenance and progression of pregnancy is an intricate process governed by a variety of developmental cues. Recurrent pregnancy loss (RPL) is a complication experienced by expecting mothers that is defined as three or more consecutive pregnancy losses. This review focuses on the dysfunctions of the immune system as one of the key contributors towards RPL. The current data suggests that the alloimmune and autoimmune factors contribute to the loss of fetus. Such causes despite being recognized as a definitive reason for recurrent pregnancy loss, are still under extensive investigation with new parameters being discovered and scrutinized for their association with RPLs. More in-depth and high throughput studies are required for devising better diagnostic tools and management strategies for the affected female so that they can carry their pregnancy to term.
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Affiliation(s)
- Raazia Tasadduq
- Department of Biochemistry, Kinnaird College for Women, 93 Jail Road, G.O.R-1, Lahore, Pakistan.
| | - Laiba Ajmal
- Department of Biochemistry, Kinnaird College for Women, 93 Jail Road, G.O.R-1, Lahore, Pakistan
| | - Farhat Batool
- Department of Biochemistry, Kinnaird College for Women, 93 Jail Road, G.O.R-1, Lahore, Pakistan
| | - Tehniyat Zafar
- Department of Biochemistry, Kinnaird College for Women, 93 Jail Road, G.O.R-1, Lahore, Pakistan
| | - Aleena Babar
- Department of Biochemistry, Kinnaird College for Women, 93 Jail Road, G.O.R-1, Lahore, Pakistan
| | - Amna Riasat
- Department of Biochemistry, Kinnaird College for Women, 93 Jail Road, G.O.R-1, Lahore, Pakistan
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16
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Gay C, Hamdaoui N, Pauly V, Rojat Habib MC, Djemli A, Carmassi M, Chau C, Bretelle F. Impact of antibiotic treatment for chronic endometritis on unexplained recurrent pregnancy loss. J Gynecol Obstet Hum Reprod 2021; 50:102034. [PMID: 33307243 DOI: 10.1016/j.jogoh.2020.102034] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 12/02/2020] [Accepted: 12/06/2020] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Recurrent Pregnancy Loss (RPL) affects about 1% of all couples and is likely to cause therapeutic vagrancy and psychological distress. Multiple origins can explain RPL, and recent studies suggest the influence of chronic endometritis. The aim of our study is to evaluate the impact of antibiotic treatment on obstetrical prognosis among patients consulting for RPL with isolated chronic endometritis. MATERIAL AND METHODS We conducted a monocentric retrospective comparative study. Patients consulting for RPL, with normal etiologic examinations (except for chronic endometritis), were included. In the case of chronic endometritis, patients could receive antibiotic treatment (14 days of doxycycline and metronidazole). Pregnancy outcomes, collected one year after inclusion, were compared between 3 groups: patients without chronic endometritis, patients with treated chronic endometritis, patients with untreated chronic endometritis. Univariate and multivariate analyses were performed. RESULTS 42 patients were included. 22 patients had chronic endometritis. Groups were comparable in terms of age, BMI, the number of miscarriages, tobacco consumption, AMH, and FSH levels on day 2. In multivariate analysis, a significant improvement of live birth rate was observed among patients treated for chronic endometritis, compared to the no endometritis group (OR 21.4 [1.93-236.70] p = 0.013) and the untreated endometritis group (OR 24.90 [1.64-376.93] p = 0.020). CONCLUSION In our patients examined for RPL, the live birth rate was improved after treatment of chronic endometritis with 14-day antibiotic treatment in comparison to patients with untreated chronic endometritis.
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Nezhat C, Rambhatla A, Miranda-Silva C, Asiaii A, Nguyen K, Eyvazzadeh A, Tazuke S, Agarwal S, Jun S, Nezhat A, Roman RA. BCL-6 Overexpression as a Predictor for Endometriosis in Patients Undergoing In Vitro Fertilization. JSLS 2020; 24:e2020.00064. [PMID: 33414614 PMCID: PMC7757768 DOI: 10.4293/jsls.2020.00064] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To evaluate the positive predictive value (PPV) of endometrial BCL-6 overexpression as a noninvasive screening test endometriosis in patients undergoing in vitro fertilization (IVF). METHODS Retrospective cohort study at a university-affiliated private practice. Inclusion criteria were reproductive age females currently undergoing IVF with a diagnosis of unexplained infertility or unexplained recurrent pregnancy loss. Those with endometrial BCL-6 overexpression underwent laparoscopic surgery with an indication for treatment of suspected endometriosis. The primary outcome was the PPV of endometrial BCL-6 testing to surgically diagnose endometriosis. Statistical analysis was performed using SPSS v.25.0. RESULTS Seventy-five patients met inclusion criteria for our study. The PPV of BCL-6 testing for endometriosis was 96%. Of those patients without endometriosis, 100% had other inflammatory pelvic pathologies, which were diagnosed and treated at the time of laparoscopy. CONCLUSIONS Endometrial BCL-6 overexpression has a high PPV for diagnosing endometriosis and can help identify a patient population that may require surgical treatment before embryo transfer.
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Affiliation(s)
- Camran Nezhat
- Camran Nezhat Institute, Center for Special Minimally Invasive and Robotic Surgery, Palo Alto, CA
| | - Anupama Rambhatla
- Camran Nezhat Institute, Center for Special Minimally Invasive and Robotic Surgery, Palo Alto, CA
| | - Catarina Miranda-Silva
- Camran Nezhat Institute, Center for Special Minimally Invasive and Robotic Surgery, Palo Alto, CA
| | - Atena Asiaii
- Camran Nezhat Institute, Center for Special Minimally Invasive and Robotic Surgery, Palo Alto, CA
| | - Kimsa Nguyen
- Camran Nezhat Institute, Center for Special Minimally Invasive and Robotic Surgery, Palo Alto, CA
| | | | - Salli Tazuke
- The Colorado Center for Reproductive Medicine - San Francisco. Menlo Park, CA
| | - Shruti Agarwal
- Camran Nezhat Institute, Center for Special Minimally Invasive and Robotic Surgery, Palo Alto, CA
| | - Sunny Jun
- The Colorado Center for Reproductive Medicine - San Francisco. Menlo Park, CA
| | - Azadeh Nezhat
- Camran Nezhat Institute, Center for Special Minimally Invasive and Robotic Surgery, Palo Alto, CA
| | - Robert A Roman
- Camran Nezhat Institute, Center for Special Minimally Invasive and Robotic Surgery, Palo Alto, CA
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Abstract
OBJECTIVE To review the current understanding of the role the uterus plays in recurrent pregnancy loss. FINDINGS Congenital and acquired uterine abnormalities are associated with recurrent pregnancy loss in the first and second trimester. Relevant congenital Mullerian tract anomalies include unicornuate, didelphys, bicornuate and septate uteri. Pregnancy loss has also been associated with acquired uterine abnormalities that distort the uterine cavity such as intrauterine adhesions and submucosal myomas. Initial evaluation of women with recurrent pregnancy loss should include a uterine assessment such as a pelvic ultrasound or sonohysterography. Uterine abnormalities such as uterine septum, intrauterine adhesions and submucosal myomas may be managed surgically with operative hysteroscopy. CONCLUSION Uterine abnormalities, both congenital and acquired, can be responsible for recurrent pregnancy loss.
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Affiliation(s)
- Jenna M Turocy
- Department of Obstetrics & Gynecology, Columbia University Medical Center, Fertility Center, 5 Columbus Circle, PH, New York, New York, USA.
| | - Beth W Rackow
- Department of Obstetrics & Gynecology, Columbia University Medical Center, Fertility Center, 5 Columbus Circle, PH, New York, New York, USA
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Abstract
Rapid advances in genomics have expanded the use of chromosome testing following miscarriage. In addition to conventional cytogenetics, the availability of single nucleotide polymorphism microarray technology and array comparative geneomic hybridization have provided further options for clinicians. This review will cover the indications for testing and the advantages/disadvantages of the various methodologies available.
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Affiliation(s)
- Dana B McQueen
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Northwestern University, Chicago, IL, United States.
| | - Ruth B Lathi
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Northwestern University, Chicago, IL, United States; Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Stanford University, Palo Alto, United States
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20
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Alhalabi N, Al-Achkar W, Wafa A, Kenj M, Alhalabi M. De novo Balanced Robertsonian Translocation rob(22;22)(q10;q10) in a Woman with Recurrent Pregnancy Loss: A Rare Case. J Reprod Infertil 2018; 19:61-66. [PMID: 29850449 PMCID: PMC5960054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND Recurrent pregnancy loss (RPL), one of the most common complications of pregnancy, is responsible for significant emotional distress to the couple desiring to conceive. In almost 50% of the cases, the etiology remains unknown. The frequency of chromosomal structural rearrangements associated with a history of RPL in couples varies between 2% to 8%. Robertsonian translocations (ROBs) have an estimated incidence rate of 1/1000 births, making this type of rearrangement the most common structural chromosomal abnormalities seen in the general population. According to the literature, there are few RPL cases with rob (22;22). CASE PRESENTATION This case is a Syrian female offered to the Orient Hospital (Damascus, Syria), having RPL in the first trimester, no fetal malformations, and/or no neonatal death. She had a balanced chromosomal translocation involved the both short arms of chromosome 22. Banding cytogenetics, refined by array-proven multicolor banding (aMCB) revealed a rob (22; 22)(q10;q10). Her husband had a normal karyotype. Interestingly, chromosomal analysis was performed for her other family members and it revealed normal karyotype for all people, which indicates that translocation is of de novo origin. However, the couple did not have any living offspring after seven years of marriage. CONCLUSION The present case was a case of RPL occurring due to rob (22;22). However, the rob(22;22)(q10;10) is the cause of recurrent abortions. Couples with the history of RPL should be suggested to do cytogenetic analysis in order to estimate whether they have chromosomal rearrangement. This diagnostic approach is of great significance to figure out what causes RPL.
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Affiliation(s)
- Nawras Alhalabi
- Faculty of Medicine, Syrian Private University, Damascus, Syria,Corresponding Author: Nawras Alhalabi, Faculty of Medicine, Syrian Private University, Damascus, Syria, E-mail:
| | - Walid Al-Achkar
- Department of Molecular Biology and Biotechnology, Human Genetics Division, Atomic Energy Commission of Syria, Damascus, Syria
| | - Abdulsamad Wafa
- Department of Molecular Biology and Biotechnology, Human Genetics Division, Atomic Energy Commission of Syria, Damascus, Syria
| | - Mazen Kenj
- Assisted Reproduction Unit, Orient Hospital, Damascus, Syria,Kenj Cytogenetics Laboratory, Damascus, Syria
| | - Marwan Alhalabi
- Assisted Reproduction Unit, Orient Hospital, Damascus, Syria,Department of Reproductive Medicine, Genetics and Embryology, Faculty of Medicine of Damascus University, Damascus, Syria
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21
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Hwang KR, Choi YM, Kim JJ, Lee SK, Yang KM, Paik EC, Jeong HJ, Jun JK, Yoon SH, Hong MA. Methylenetetrahydrofolate Reductase Polymorphisms and Risk of Recurrent Pregnancy Loss: a Case-Control Study. J Korean Med Sci 2017; 32:2029-2034. [PMID: 29115087 PMCID: PMC5680504 DOI: 10.3346/jkms.2017.32.12.2029] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Accepted: 09/09/2017] [Indexed: 12/02/2022] Open
Abstract
The balance between coagulation and fibrinolysis is an essential part in early pregnancy. Mutations in methylenetetrahydrofolate reductase (MTHFR) gene lead to decreased activity of the enzyme and hyperhomocysteinemia, which then induces platelet aggregation by promoting endothelial oxidative damage, possibly resulting in adverse effect on maintenance of pregnancy. We investigated the role of MTHFR single nucleotide polymorphisms (SNPs), C677T and A1298C, in Korean patients with recurrent pregnancy loss (RPL). We conducted a prospective case-control study in the Korean population. Subjects included 302 women with 2 or more consecutive, unexplained, spontaneous miscarriages before 20 weeks of gestation and 315 control women without a history of recurrent miscarriages. The genotyping for C677T and A1298C polymorphisms was performed using the TaqMan assay. Continuous variables were compared using Student's t-test, and χ² test was used to evaluate differences in the genotype distributions between the RPL and the controls. The genotype distribution of both polymorphisms in the RPL group did not differ from those of the controls. For further analysis, if RPL patients were divided according to the numbers of pregnancy losses (≥ 2 and ≥ 3) neither group was significantly different compared with controls. MTHFR gene C677T and A1298C polymorphisms are not associated with idiopathic RPL in Korean women, suggesting that those may not be susceptible allelic variants or be deficient to cause RPL.
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Affiliation(s)
- Kyu Ri Hwang
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
- Department of Obstetrics and Gynecology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
| | - Young Min Choi
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
- The Institute of Reproductive Medicine and Population, Medical Research Centre, Seoul National University College of Medicine, Seoul, Korea.
| | - Jin Ju Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
- Department of Obstetrics and Gynecology, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Korea
| | - Sung Ki Lee
- Department of Obstetrics and Gynecology, Konyang University College of Medicine, Daejeon, Korea
| | - Kwang Moon Yang
- Department of Obstetrics and Gynecology, Cheil General Hospital and Women's Healthcare Center, Dankook University, College of Medicine, Seoul, Korea
| | - Eun Chan Paik
- Department of Obstetrics and Gynecology, Bundang Cheil Women's Hospital, Sungnam, Korea
| | - Hyeon Jeong Jeong
- Department of Obstetrics and Gynecology, Seoul Rachel Fertility Center, Seoul, Korea
| | - Jong Kwan Jun
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
| | - Sang Ho Yoon
- Department of Obstetrics and Gynecology, Graduate School of Medicine, Dongguk University, Seoul, Korea
| | - Min A Hong
- The Institute of Reproductive Medicine and Population, Medical Research Centre, Seoul National University College of Medicine, Seoul, Korea
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