The H9N2 avian influenza virus increases APEC adhesion to oviduct epithelia by viral NS1 protein-mediated activation of the TGF-β pathway

H9N2 avian influenza is a low-pathogenic avian influenza circulating in poultry and wild birds worldwide and frequently contributes to chicken salpingitis that is caused by avian pathogenic Escherichia coli (APEC), leading to huge economic losses and risks for food safety. Currently, how the H9N2 virus contributes to APEC infection and facilitates salpingitis remains elusive. In this study, in vitro chicken oviduct epithelial cell (COEC) model and in vivo studies were performed to investigate the role of H9N2 viruses on secondary APEC infection, and we identified that H9N2 virus enhances APEC infection both in vitro and in vivo. To understand the mechanisms behind this phenomenon, adhesive molecules on the cell surface facilitating APEC adhesion were checked, and we found that H9N2 virus could upregulate the expression of fibronectin, which promotes APEC adhesion onto COECs. We further investigated how fibronectin expression is regulated by H9N2 virus infection and revealed that transforming growth factor beta (TGF-β) signaling pathway is activated by the NS1 protein of the virus, thus regulating the expression of adhesive molecules. These new findings revealed the role of H9N2 virus in salpingitis co-infected with APEC and discovered the molecular mechanisms by which the H9N2 virus facilitates APEC infection, offering new insights to the etiology of salpingitis with viral-bacterial co-infections.IMPORTANCEH9N2 avian influenza virus (AIV) widely infects poultry and is sporadically reported in human infections. The infection in birds frequently causes secondary bacterial infections, resulting in severe symptoms like pneumonia and salpingitis. Currently, the mechanism that influenza A virus contributes to secondary bacterial infection remains elusive. Here we discovered that H9N2 virus infection promotes APEC infection and further explored the underlying molecular mechanisms. We found that fibronectin protein on the cell surface is vital for APEC adhesion and also showed that H9N2 viral protein NS1 increased the expression of fibronectin by activating the TGF-β signaling pathway. Our findings offer new information on how AIV infection promotes APEC secondary infection, providing potential targets for mitigating severe APEC infections induced by H9N2 avian influenza, and also give new insights on the mechanisms on how viruses promote secondary bacterial infections in animal and human diseases.

The Treatment of Tubal Inflammatory Infertility using Yinjia Tablets through EGFR/MEK/ERK Signaling Pathway based on Network Pharmacology

Background: Salpingitis obstructive infertility (SOI) refers to infertility caused by abnormal conditions such as tubal adhesion and blockage caused by acute and chronic salpingitis. SOI has a serious impact on women's physical and mental health and family harmony, and it is a clinical problem that needs to be solved urgently.

Objective: The purpose of the present study was to explore the potential pharmacological mechanisms of the Yinjia tablets (Yin Jia Pian, YJP) on tubal inflammation.

Methods: Networks of YJP-associated targets and tubal inflammation-related genes were constructed through the STRING database. Potential targets and pathway enrichment analysis related to the therapeutic efficacy of YJP were identified using Cytoscape and Database for Annotation, Visualization, and Integrated Discovery (metascape). E. coli was used to establish a rat model of tubal inflammation and to validate the predictions of network pharmacology and the therapeutic efficacy of YJP. H&E staining was used to observe the pathological changes in fallopian tubes. TEM observation of the ultrastructure of the fallopian tubes. ELISA was used to detect the changes of IL-6 and TNF-α in fallopian tubes. Immunohistochemistry was used to detect the expression of ESR1. The changes of Bcl-2, ERK1/2, p-ERK1/2, MEK, p-MEK, EGFR, and p-EGFR were detected by western blot.

Results: Through database analysis, it was found that YJP shared 105 identical targets with the disease. Network pharmacology analysis showed that IL-6, TNF, and EGFR belong to the top 5 core proteins associated with salpingitis, and EGFR/MEK/ERK may be the main pathway involved. The E. coli-induced disease rat model of fallopian tube tissue showed damage, mitochondrial disruption, and increased levels of the inflammatory factors IL-6 and TNF-α. Tubal inflammatory infertility rats have increased expression of Bcl-2, p-ERK1/2, p-MEK, and p-EGFR, and decreased expression of ESR1. In vivo, experiments showed that YJP improved damage of tissue, inhibited shedding of tubal cilia, and suppressed the inflammatory response of the body. Furthermore, YJP inhibited EGFR/MEK/ERK signaling, inhibited the apoptotic protein Bcl-2, and upregulated ESR1.

Conclusion: This study revealed that YJP Reducing tubal inflammation and promoting tissue repair may be associated with inhibition of the EGFR/MEK/ERK signaling pathway.

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[THE ROLE OF NO AND MEXIDOL IN CONTRACTILITY OF OVARIAN AND CERVICAL PARTS OF UTERUS UNDER THE CONDITION OF IMMUNE-MEDIATED INJURY IN MICE]

Contractility of ovarian (OP) and cervical parts (CP) of uterus under the condition of immune-mediated injury which was induced by immunization with bovine serum albumin (BSA) was investigated. It was shown that under the activation of energy-synthesizing function of mitochondria with Mexidol the frequency of reductions in both uterine parts decreased, the amplitude and contractility index in the OP and CP as well as the duration of the active state in CP increased. Mexidol under the condition of immunization with BSA leads to the decrease in amplitude in 2,6 time and contractility index in 2,2 time in OP and to the increase of them in CP. It was shown that contractility features of ovarian and cervical parts of uterine under the condition of BSA- induced immunization were caused by changes of mitochondria functional state and were associated with nitric oxide.

NF κB expression increases and CFTR and MUC1 expression decreases in the endometrium of infertile patients with hydrosalpinx: a comparative study

BACKGROUND

Hydrosalpinx are associated with infertility, due to reduced rates of implantation and increased abortion rates. The aims of this study were to investigate the expression of cystic fibrosis transmembrane conductance regulator (CFTR), nuclear factor kappa B (NF KappaB) and mucin-1 (MUC-1), and analyze the correlation between the expression of CFTR and NF KappaB or MUC1, in the endometrium of infertile women with and without hydrosalpinx.

METHODS

Thirty-one infertile women with laparoscopy-confirmed unilateral or bilateral hydrosalpinx and 20 infertile women without hydrosalpinx or pelvic inflammatory disease (control group) were recruited. Endometrial biopsy samples were collected and the expression of CFTR, NF KappaB and MUC1 were analyzed using immunohistochemistry and quantitative real-time PCR.

RESULTS

CFTR, NF KappaB and MUC1 mRNA and protein expression tended to increase in the secretory phase compared to the proliferative phase in both groups; however, these differences were not significantly different. The endometrium of infertile patients with hydrosalpinx had significantly higher NF KappaB mRNA and protein expression, and significantly lower CFTR and MUC1 mRNA and protein expression, compared to control infertile patients. A positive correlation was observed between CFTR and MUC1 mRNA expression (r = 0.65, P < 0.05); a negative correlation was observed between CFTR mRNA and NF KappaB mRNA expression (r = -0.59, P < 0.05).

CONCLUSIONS

Increased NF KappaB expression and decreased CFTR and MUC1 expression in the endometrium of infertile patients with hydrosalpinx reinforce the involvement of a molecular mechanism in the regulation of endometrial receptivity.

[The relationship between HalphaD-5 and HbetaD-2 in infertile women's fimbriae tubes with adhesions and atresias]

OBJECTIVE

To investigate the expression and relationship of human alpha defensin-5 (HalphaD-5) and human beta defensin-2 (HbetaD-2) in human fimbriae tubes with adhesions and atresias.

METHODS

The tissue samples were collected from 30 human fimbriae tubes with adhesions and atresias, and 30 cases without adhesions and atresias. The expression of HalphaD-5 and HbetaD-2 in fimbriae tube tissue were measured by immunohistochemical SP methods. Image pro-plus 6.0 software was used to test the average IOD value of positive staining. Differences of HalphaD-5 and HbetaD-2 expressions were analyzed by independent-samples T test. The relationship between HalphaD-5 and HbetaD-2 was analyzed by Pearson correlation.

RESULTS

We found that HalphaD-5 and HbetaD-2 mainly expressed in the epithelial cells which face to lumen, mostly in the cytochylema. Both two groups expressed HalphaD-5 and HbetaD-2, but the degrees were different. Compared with human fimbriae tubes without adhesions or atresias, the expressions of HalphaD-5 and HbetaD-2 increased significantly in adhesion cases (P(HalphaD--5) = 0.000, P(HbetaD--2) = 0.02). In the group without adhesion, there was a positive correlation between HalphaD-5 and HbetaD-2 (r = 0.404, P = 0.027), while in the adhesion group, there was no correlation between HalphaD-5 and HbetaD-2 (P = 0.089).

CONCLUSION

HalphaD-5 and HbetaD-2 may protect fimbriae tubes during the pathological process of microorganisms attack.

Positive staining for p53 and expression of c-erbB-2 in endosalpinx hyperplasia: analysis of 48 cases and review of literature

To establish the diagnostic value of p53 and c-erbB-2 expression, forty-eight cases of endosalpinx hyperplasia were analyzed. p53 protein and c-erbB-2 oncoprotein expression was examined using an avidin-biotin peroxidase complex method. The accumulation of p53 protein and c-erbB-2 oncoprotein was used as objective evidence to support morphologic differential diagnosis of endosalpinx hyperplasia and early cancer. In all cases various forms of endosalpinx hyperplasia were seen. Only in 4 cases staining for p53 showed positive reaction without staining for c-erbB-2. In one case positive reaction for c-erbB-2 was showed and no expression of p53 protein was detected. It is concluded that immunohistochemical detection of the mutant p53 protein and c-erbB-2 oncoprotein might be useful tools in differential diagnosis among various forms of hyperplastic changes of endosalpinx. The presence of these markers may be associated with the risk of malignant transformation in various forms of the tubal hyperplasia.

Gonococcal infection of human fallopian tube mucosa in organ culture: relationship of mucosal tissue TNF-alpha concentration to sloughing of ciliated cells

BACKGROUND AND OBJECTIVES

An experimental model consisting of gonococcal infection of human fallopian tube mucosa in organ culture has proven useful in studying the molecular pathogenesis of acute gonococcal salpingitis and postsalpingitis sequelae. Gonococcal infection of human fallopian tube mucosa in organ culture results in the sloughing of ciliated epithelial cells from the mucosa. This damage to the mucosa can be quantified on fallopian tube pieces by an assay of the percent of the periphery that has ciliary activity (PPCA) remaining at specific time points after infection. Although assay of the PPCA has been quite valuable, it is labor-intensive, somewhat subjective, and requires that the observers have training and experience. A more practical assay for genital mucosal damage is desirable for further investigations that employ the fallopian tube experimental model. Gonococcal infection of fallopian tube mucosa in organ culture also results in the production of easily quantified tumor necrosis factor-alpha (TNF-alpha) by the mucosa. Furthermore, treatment of the organ cultures with recombinant human TNF-alpha (rHuTNFalpha) alone also causes sloughing of ciliated cells from the mucosa. These findings strongly suggest that TNF-alpha is a mediator of the mucosal damage that attends gonococcal infection.

GOALS OF THE STUDY

To determine: (1) whether the PPCA values and the TNF-alpha concentrations in fallopian tube mucosal tissues correlate closely enough to allow prediction of the PPCA from a measurement of the mucosal tissue TNF-alpha concentration; and (2) whether the correlation of the TNF-alpha mucosal tissue concentration with the sloughing of ciliated cells (measured by the PPCA) supports the hypothesis that induction of TNF-alpha by gonococcal infection, with resultant sloughing of ciliated cells, is likely to be a major pathogenic mechanism of gonococcal salpingitis and might mediate postsalpingitis infertility and ectopic pregnancy.

STUDY DESIGN

A metaanalysis was performed on studies from three research groups (two laboratories in the United States and one in the United Kingdom, using identical techniques for quantifying the PPCA, TNF-alpha, or both.

RESULTS

There was a close and statistically significant correlation between the TNF-alpha mucosal tissue concentration and the proportion of ciliated cells lost from the mucosa as measured by the PPCA (r = 0.95, p < 0.001). Therefore, as the mucosal tissue concentration of endogenous TNF-alpha increased, the loss of ciliated cells from the epithelium increased proportionately.

CONCLUSIONS

During gonococcal infection of human fallopian tube mucosa in organ culture, the mucosal tissue concentration of TNF-alpha can be used to predict the PPCA, and therefore, the extent of mucosal damage. This finding should facilitate studies of the molecular pathogenesis of infectious diseases involving human genital mucosa. Further, the close correlation of mucosal TNF-alpha concentration with genital mucosal damage, evaluated by the PPCA, supports the hypothesis that induction of the proinflammatory cytokine, TNF-alpha, by gonococcal infection, with resultant inflammation and sloughing of ciliated cells, is an important pathogenic mechanism of gonococcal salpingitis and may mediate postsalpingitis infertility and ectopic pregnancy as well.

C-reactive protein and the treatment of pelvic inflammatory disease

OBJECTIVE

The significance of C-reactive protein (CRP) in assessing the treatment of pelvic inflammatory disease (PID) was established and compared with body temperature (BT), erythrocyte sedimentation rate (ESR) and serum leukocyte concentration (L).

METHOD

In 51 patients with PID, 20 (39%) of them with tubo-ovarial abscess (TOA), measurement of BT and laboratory investigations were carried out on admission and during treatment on days 3-4, 6-8 and 18-21. The changes in these values were compared with the changes in clinical condition.

RESULT

Prior to treatment, the majority--49 patients or 96.1%--had increased CRP values. In successful treatment, the CRP values decreased significantly in PID patients without TOA on day 3-4, in patients with TOA on day 6-8 and reached normal values in both groups on day 18-21. Changes in clinical condition were most concurrent with changes in CRP.

CONCLUSION

In assessing PID treatment, the determination of CRP has precedence over L, ESR and BT as the percentage of patients with increased CRP is higher and because the changes in value follow the changes in clinical condition more reliably.

[Enterobius vermicularis localized to the internal female genitalia]

Enterobius vermicularis is one of the most common helminthic infections in humans. It normally inhabits the large intestine and is of low pathogenecity. The ova are, however, occasionally found in ectopic sites in the peritoneal cavity, usually as asymptomatic granulomas, though in rare cases they may cause chronic lower abdominal pain. Two cases of ectopic enterobius vermicularis are presented in this paper.

Increased inducibility of inflammatory mediators from peripheral blood mononuclear cells of women with salpingitis

To investigate whether immune system activation may contribute to the tissue damage observed in salpingitis, we isolated peripheral blood mononuclear cells and quantitated production of the monocyte activation products tumor necrosis factor-alpha, interleukin-1, and interleukin-6. Unstimulated cells from 7 of 20 women with salpingitis spontaneously released tumor necrosis factor at a concentration greater than 2 SD above the mean value produced by cells from 29 healthy donors. Interferon gamma (200 U/ml) further induced production of tumor necrosis factor from mononuclear cells of 11 women with salpingitis. In contrast, production of tumor necrosis factor by each of 23 other patients who lacked laparoscopic or clinical evidence of salpingitis was similar to that of the controls. In a subset of women whose cells were tested for production of other monokines, three of nine women with salpingitis spontaneously released interleukin-1 but none of the others did so. Four of nine patients with salpingitis also produced interleukin-6, but none of the others did so. None of the monokines were detected in serum from any subject. The results suggest that monocytes from women with salpingitis are primed in vivo and produce inflammatory mediators under conditions where monocytes from other women are poorly responsive. This increased monokine inducibility may contribute to the tubal damage that is the hallmark of salpingitis.

Collagen metabolism in gynecologic patients: changes in the concentration of the aminoterminal propeptide of type III procollagen in serum

We have previously found the serum concentration of the aminoterminal propeptide of type III procollagen, an indicator of collagen metabolism, to be increased in advanced ovarian cancer. In this study we measured the serum aminoterminal propeptide of type III procollagen concentration in healthy women during the menstrual cycle and in patients with salpingo-oophoritis, leiomyomas, endometriosis, and benign ovarian tumors. The concentration was higher in the luteal phase than that in the follicular phase, suggesting an association of collagen metabolism with ovarian steroid hormones. Severe salpingo-oophoritis increased the serum level of the aminoterminal propeptide of type III procollagen with a decrease to normal during recovery. Elevated values were occasionally seen in endometriosis and leiomyomas. These findings indicate that the aminoterminal propeptide of type III procollagen is a relatively unspecific indicator of ovarian carcinoma.

Peritoneal fluid leukotriene B4 and prostaglandin E2 in acute salpingitis

Concentrations of leukotriene B4 (LTB4) and prostaglandin E2 (PGE2) in peritoneal fluid were measured in 19 women with suspected acute pelvic inflammatory disease. Acute salpingitis was verified by laparoscopy in 16 cases; 11 of them had isolation of microbes from the peritoneal cavity. Means (+/- SD) levels of peritoneal fluid LTB4 and PGE2 in acute salpingitis were 506 +/- 288 and 378 +/- 330 pg/ml, respectively, and higher (p less than 0.001) than the levels in the peritoneal fluid of 20 healthy controls: LTB4 44 +/- 57, PGE2 11 +/- 2 pg/ml, respectively. An inflammatory cytologic pattern was found in the peritoneal fluid in all the cases with acute salpingitis, neutrophils being the prominent cells. These chemical mediators of inflammation in peritoneal fluid may have a role in the development of scarring and peritubal adhesions found after acute salpingitis.

[Prostanoids of the peritoneal fluid and sterility with or without pelvic lesions (endometriosis, postinfectious adhesions)]

Peritoneal fluid levels of 6-keto-PGF1 alpha, TxB2, PGE2 and PGF2 alpha were measured in 62 infertile women undergoing coelioscopy. In 10 patients with mild endometriosis, the levels of all prostanoids were significantly enhanced as compared to control group (15 infertile patients without pelvic lesion). In 5 patients with moderate endometriosis, only PGF2 alpha exhibited a significant enhancement. The results confirmed the prostanoid component alteration of peritoneal fluid in infertile women with mild or moderate endometriosis, which however not has been found by all authors. In 6 patients with chronic salpingitis, no difference was found in prostanoid levels as compared to control group. The 26 patients with pelvic adhesions were distributed in 3 groups on the criterion of easy lysed or not adhesions. In group I (not lysed adhesions, 7 patients), no difference was found in prostanoid levels as compared to control group. In group II (mixed adhesions, 13 patients), the levels of all prostanoids, particularly 6-keto-PGF1 alpha, were significantly higher than that found in control group. In group III (easy lysed adhesions, 6 patients), the levels of 6-keto-PGF1 alpha, TxB2 and particularly PGF2 alpha were significantly enhanced as compared to control group. The results of this study suggest that prostanoids are implicated in physiopathology of endometriosis and pelvic adhesions and perhaps in mechanism of the associated infertility.

Nodular salpingitis and tubal endometriosis. I. Comparative clinical study

Nodular salpingitis and tubal endometriosis have been referred to in succession as salpingiosis, diverticulosis, adenomyosis of the oviduct, endometrioid conditions, etc. This varied terminology underscores their etiopathogenetic and morphological substratum which is different from that of non specific tubal inflammation, but at the same time this variety of terms has always created confusion in interpretation and diagnosis. We have considered it necessary to carry out a comparative study of nodular salpingitis and tubal endometriosis in 42 cases of sterility operated during the last two years for tubal obstruction and in which histological examination has yielded evidence for the lesions of nodular salpingitis (NS) or endometriosis (EM) in at least one of the oviducts. As for the etiology of the two diseases, we have discussed the role plaid by inflammatory conditions, uterine trauma (curettage) and dystrophic disorders, as well as the importance of hyperandrogenism in NS. Taking into account the diffuse sclerogenic tendency of the tubal wall in NS and the concomitant inflammatory and dystrophic lesions in the peritubal tissues in EM, the postoperative outlook depends on early surgery, to be performed before tubal anatomy has been completely altered.