The uterine secretome initiates growth of gynecologic tissues in ectopic locations

Endosalpingiosis (ES) and endometriosis (EM) refer to the growth of tubal and endometrial epithelium respectively, outside of their site of origin. We hypothesize that uterine secretome factors drive ectopic growth. To test this, we developed a mouse model of ES and EM using tdTomato (tdT) transgenic fluorescent mice as donors. To block implantation factors, progesterone knockout (PKO) tdT mice were created. Fluorescent lesions were present after oviduct implantation with and without WT endometrium. Implantation was increased (p<0.05) when tdt oviductal tissue was implanted with endometrium compared to oviductal tissue alone. Implantation was reduced (p<0.0005) in animals implanted with minced tdT oviductal tissue with PKO tdT endometrium compared to WT endometrium. Finally, oviductal tissues was incubated with and without a known implantation factor, leukemia inhibitory factor (LIF) prior to and during implantation. LIF promoted lesion implantation. In conclusion, endometrial derived implantation factors, such as LIF, are necessary to initiate ectopic tissue growth. We have developed an animal model of ectopic growth of gynecologic tissues in a WT mouse which will potentially allow for development of new prevention and treatment modalities.

Rapid cold sterilization of 3D printed surgical instruments for the austere environment

INTRODUCTION

Medical operations are vulnerable to global supply chain fluctuations. The ability to locally produce and reliably sterilize medical equipment may mitigate this risk. This project developed a reliable high-level disinfection process for 3D printed surgical tools.

METHODS

Surgical instruments and consumables were designed and printed from various materials. Devices contaminated with known and unknown bacteria underwent one of three cleaning methods followed by high-level disinfection using submersion in a Cidex OPA Solution. Devices were then cultured on blood agar plates and incubated for 48 h. Positive and negative controls were performed.

RESULTS

The results of control experiments showed no growth on negative controls and significant growth on all positive control plates. Of the three cleaning methods tested, one showed no growth: cleaning with isopropyl alcohol and chlorhexidine followed by Cidex bath.

DISCUSSION

This project successfully developed a rapid high-level disinfection process for 3D printed surgical instruments made from two different types of 3D printing material.

Impact of Precision Nutrition Counseling for Active Duty Service Members at Risk for Metabolic Syndrome

Objectives

Metabolic Syndrome (MetS) is characterized by abdominal obesity, dyslipidemia, elevated fasting blood glucose (FBG), and hypertension; personalized nutrition counseling and wellness applications have demonstrated positive results for weight management when coupled with high levels of participant engagement and motivation.

Methods

In a prospective RCT RDs conducted personalized nutrition counseling using results of targeted sequencing, biomarkers, and expert recommendations to reduce risk for MetS. Treatment Group (TG) received six weekly sessions; Control Group (CG) received a pamphlet of expert recommendations upon randomization. A digital application provided real-time health data capture. Anthropometrics and BP were evaluated at baseline, 6, & 12 wks; biomarkers at baseline & 12 wks. Primary outcome was change in weight at 12 wks. Statistical analyses included descriptives and t-test or ANOVA; significance set at P < .05.

Results

138 subjects enrolled from Nov 2019 - Feb 2021 between 2 sites [Northwest (NW) in WA; Southwest (SW) in TX]; 107 completed the study with n = 70 in the TG. Demographics: 66% male, mean age 31 yrs, 66% married, 49% Caucasian, non-Hispanic. There were no differences between TG and CG at baseline. High deleterious variant prevalence found for genes/SNPs associated with obesity (40%), cholesterol (38%), and BP (58%). 65% of subjects had 25(OH) D less than 30 ng/mL upon enrollment. In NW cohort primary outcome of change in weight at 12 wks was not significant p = .34. Significant difference at 6 wks noted for TG change in weight p = 0.02; fat mass p = .01; BMI p = 0.02; and % body fat p = 0.01. BP significant at 12 wks, both systolic (p = .04) and diastolic (p = .04). Change in 25(OH)D favored TG, p = 0.01. SW TG had greater reduction in waist circ p = .04 at 6 wks. Digital app had low adherence and poor correlation with ASA24 reference.

Conclusions

Significant progress was achieved in the TG at 6 weeks although not sustained at 12 weeks. The concept of nutrigenomics was well-received in this cohort.

Funding Sources

TriService Nursing Research Program.

Precision Nutrition Assessment of Risk for Metabolic Syndrome in Active Duty Service Members

Objectives

Precision nutrition leverages the specificity of molecular and phenotypic differences in personalizing diet and lifestyle interventions.Objective for this phase of the study: 1) examine the effectiveness of gene-based nutrition counseling on behavior change measured by weight, body mass index (BMI), blood glucose, lipids, 25-hydroxyvitamin (OH) D, %body fat (BF), waist circumference, and blood pressure.

Methods

In this prospective multisite RCT, a baseline genomic profile from 70 diet-responsive genes/80 variants, is augmented by biomarkers specific to metabolic syndrome (MetS) risk for each subject. Treatment group (TG) receives gene-based nutrition counseling for six weekly sessions; Control group (CG) receives evidence-based nutrition content in pamphlets directed at preventing metabolic syndrome. A digital app provides real-time health data capture with continuous feedback and is validated by in-person interviews. Primary outcome is weight loss at 12 weeks.

Results

Army NW cohort has enrolled 90 subjects to date; 49 are assigned to the TG. Sample demographics: males (70%), mean age 32 yrs, 58% married, 75% Caucasian, non-Hispanic, and 78% report some college education. In females, mean BMI 28.3, %BF 34.2, waist circumference 32.2 in; males mean BMI 30.1, %BF 29, waist circumference 40 in. For MetS components, 27/90 subjects show no abnormal components yet 41/90 have 2 or 3 alterations. Elevations noted as follows: fasting blood glucose in 47%, blood pressure in 38%, and waist circumference in 30%. High variant presence is noteworthy for genes with a role in obesity and hypertension. In 71% of subjects baseline 25(OH) D ≤ 30 ng/mL. Preliminary results for primary outcome of weight loss at 12 weeks reveal no change in TG (n = 21), an average loss of 5 lbs in CG (n = 21) within groups, and a significant difference between groups; TG 197.4 (39.3) vs CG 192.6 (40.3), p &lt; .001.

Conclusions

Digital health integration, along with genomic data and family history, can reveal early signals of risk in a young, generally healthy, military population. Health promotion efforts must drive behavior change at both the individual and population level.

Funding Sources

The TriService Nursing Research Program

An intrauterine genomic classifier reliably delineates the location of nonviable pregnancies

OBJECTIVE

To compare the intrauterine gene expression signatures of women with surgically confirmed ectopic pregnancy (ECT) and those of women with miscarriage to inform the development of a genomic classifier for the reliable delineation of pregnancy location in women with clinically nonviable pregnancies of unknown location (NV-PULs).

DESIGN

Discovery-based prospective cohort study.

SETTING

Academic medical center.

PATIENT(S)

Women with clinically nonviable early pregnancy to include abnormal intrauterine pregnancy (AIUP), ECT, or NV-PUL.

INTERVENTION(S)

Endometrial (EM) pipelle sampling of the uterus was conducted at the time of scheduled surgery for clinically nonviable early pregnancy (dilation and curettage, manual vacuum aspiration, or laparoscopy). All pregnancy locations were surgically and/or histologically confirmed as intrauterine or ectopic.

MAIN OUTCOME MEASURE(S)

Gene expression profiles as determined by array hybridization, quantitative real-time polymerase chain reaction, and nCounter technology.

RESULT(S)

Intrauterine samples were obtained by EM pipelle from 27 women undergoing surgery for a clinically nonviable early pregnancy. Comparison of array-based global gene expression signatures from women with histologically confirmed ECT versus AIUP revealed 61 differentially expressed genes from which the 5 most informative were included in the pregnancy location classifier. All 5 genes (C20orf85, LRRC46, RSPH4A, WDR49, and ZBBX) were cilia-associated and showed increased expression in pipelle samples from women with ECT relative to expression in samples from women with AIUP. The 5-gene classifier demonstrated an average area under the receiver operator characteristic curve of 0.97 for the detection of ECT. In an external test set composed of publicly available EM pipelle-based gene expression data from a study with similar ECT and AIUP cohorts (n = 19), the classifier revealed an average area under the receiver operator characteristic curve of 0.84.

CONCLUSION(S)

Consistently increased expression of cilia-associated genes in the uterine cavity of women with ECT provides a reliable molecular signal for the delineation of pregnancy location in women with clinically assessed NV-PUL. A classifier consisting of the 5 most informative cilia-associated genes demonstrated 91% (42/46) accuracy in predicting the pregnancy location.

The proteome of human Fallopian tube lavages during the phase of embryo transit reveals candidate proteins for the optimization of preimplantation embryo culture

STUDY QUESTION

Are there phase-specific changes in the early secretory (ES) phase human tubal lavage proteome that can inform and potentially optimize IVF culture media?

SUMMARY ANSWER

The human tubal lavage proteome during the ES phase relative to the menstrual phase reveals substantial differential protein abundance in pathways such as glycolysis, redox homeostasis and activation of 14-3-3 zeta-mediated signaling.

WHAT IS KNOWN ALREADY

The Fallopian tube is uniquely suited to the development of the preimplantation embryo as it transits the tube during the ES phase of the menstrual cycle. Euploid cleavage-stage embryo arrest may reflect incomplete recapitulation of in-vivo conditions by current media formulations.

STUDY DESIGN, SIZE, DURATION

Proteome-wide analysis of distal tubal lavage specimens collected from 26 healthy women undergoing open microtubal anastomosis surgery from January 2013 to January 2018 was performed. Specimens were grouped by menstrual cycle phase in order to analyze phase-specific differences in protein abundance. For the murine embryo assay, single-cell embryos (N = 482) were collected from superovulated wild type C57BL/6 female mice and cultured in microdrops over 5 days for the assessment of blastocyst development.

PARTICIPANTS/MATERIALS, SETTING, METHODS

Human tubal lavage specimens were processed for label-free mass spectrometry. Reported menstrual cycle day was confirmed by measuring serum hormones. Key protein targets in the ES phase were validated via immunoblot. The ES phase-specific increase in 14-3-3 zeta protein was confirmed via ELISA of conditioned media obtained from primary human Fallopian tube epithelial cell culture. A murine embryo assay was performed to investigate the impact of graduated concentrations of 14-3-3 zeta on the blastocyst development rate.

MAIN RESULTS AND THE ROLE OF CHANCE

Comparison of the ES and menstrual phase human tubal lavage proteomes revealed 74 differentially expressed proteins with enrichment of pathways and biological processes involved in the regulation of carbohydrate metabolism, oxidative stress and cell survival. The adapter-regulator protein 14-3-3 zeta was among the most significantly increased in the ES phase. Supplementation of embryo culture media with 14-3-3 zeta at concentrations tested did not significantly improve the murine blastocyst development.

LIMITATIONS, REASONS FOR CAUTION

Although select associations were recapitulated in the conditioned media from sex steroid exposed primary human tubal epithelial cells, cell culture represents an in-vitro approximation. Changes to embryo culture media, such as protein supplementation, must undergo rigorous preclinical safety testing prior to adoption for human use.

WIDER IMPLICATIONS OF THE FINDINGS

This study represents the first description of the human Fallopian tube lavage proteome across the menstrual cycle, revealing a unique proteomic signature during the ES phase. Although supplementation of culture media with 14-3-3 zeta at appropriate concentrations showed no significant impact on the murine blastocyst development rate, other biologically plausible candidate proteins for individual or high throughput testing strategies are identified.

STUDY FUNDING/COMPETING INTEREST(S)

This work was funded in part by an Army Medical Department Advanced Medical Technology Initiative grant from the United States Army Medical Research and Materiel Command's Telemedicine and Advanced Technology Research Center. There are no competing interests.

TRIAL REGISTRATION NUMBER

N/A.

DRB4*01:01 Has a Distinct Motif and Presents a Proinsulin Epitope That Is Recognized in Subjects with Type 1 Diabetes

DRB4*01:01 (DRB4) is a secondary HLA-DR product that is part of the high-risk DR4/DQ8 haplotype that is associated with type 1 diabetes (T1D). DRB4 shares considerable homology with HLA-DR4 alleles that predispose to autoimmunity, including DRB1*04:01 and DRB1*04:04. However, the DRB4 protein sequence includes distinct residues that would be expected to alter the characteristics of its binding pockets. To identify high-affinity peptides that are recognized in the context of DRB4, we used an HLA class II tetramer-based approach to identify epitopes within multiple viral Ags. We applied a similar approach to identify antigenic sequences within glutamic acid decarboxylase 65 and pre-proinsulin that are recognized in the context of DRB4. Seven sequences were immunogenic, eliciting high-affinity T cell responses in DRB4⁺ subjects. DRB1*04:01-restricted responses toward many of these peptides have been previously described, but responses to a novel pre-proinsulin 9-28 peptide were commonly observed in subjects with T1D. Furthermore, T cells that recognized this peptide in the context of DRB4 were present at significantly higher frequencies in patients with T1D than in healthy controls, implicating this as a disease-relevant specificity that may contribute to the breakdown of β cell tolerance in genetically susceptible individuals. We then deduced a DRB4 motif and confirmed its key features through structural modeling. This modeling suggested that the core epitope within the pre-proinsulin 9-28 peptide has a somewhat unusual binding motif, with tryptophan in the fourth binding pocket of DRB4, perhaps influencing the availability of this complex for T cell selection.