Intercellular communication by exosomes in placenta: A possible role in cell fusion?

Exosomes are nanovesicles released from viable cells and have attracted increasing interest due to their role in intercellular communication and biological functions. More recently exosomes have been shown to be released by trophoblasts and to carry molecules involved in placental physiology. This involves proteins such as fibronectin, syncytin, Wnt/βcatenin-related molecules, galectin-3, and HLA-G, but also bioactive lipids such as the immunosuppressive PGE2, the PPARγ ligand 15d-PGJ2, or microRNAs that appear as immunomodulators in pregnancy and are able to confer viral resistance.     

Review: Embryo- and endometrium-derived exosomes and their potential role in assisted reproductive treatments–liquid biopsies for endometrial receptivity

Multiple pregnancies resulting from the transfer of more than one embryo pose a significant threat to offspring born through Assisted Reproductive Treatments (ART). Transferring one embryo at a time would eliminate this risk. However, current approaches of identifying the highest quality embryo to transfer are either unreliable (e.g. morphology assessment) or highly invasive and potentially detrimental to embryos (e.g. PGD). Approaches for non-invasive embryo selection would be a major advancement that would increase efficiency and reduce both the costs and the risks associated with ART. Exosomes are a particular subtype of extracellular vesicles (EVs) that are secreted from a wide range of cells, including placental and endometrium cells. Exosomes are very stable vesicles that contain a broad spectrum of molecules, including proteins, mRNAs and miRNAs. Very little is known about this form of cell-to-cell communication in the context of ovarian follicular biology and implantation, but emerging data suggest that exosomes secreted by the blastocyst could influence gene expression and receptivity of endometrial cells thereby controlling its own implantation. Here we review emerging findings regarding exosomal signalling in reproductive biology and the prospects for mapping blastocyst-derived exosomal profiles as a means for supporting single embryo transfer policies.     

Does leukocytospermia associate with poor semen parameters and sperm functions in male infertility? The role of different seminal leukocyte concentrations

To investigate the effect of leukocytospermia on standard semen analysis and sperm function tests such as acrosome reaction, hypoosmotic swelling, antisperm antibody binding and cervical mucus penetration, a prospective clinical study was performed. Two hundred and nineteen male infertility patients undergoing investigation and treatment were included in the study. There was a significant association between acrosome reaction positivity and leukocytospermia according to WHO (World Health Organization) criteria. Increased hypoosmotic swelling test score, higher sperm concentration and enhanced acrosome reaction were closely related to leukocytospermia. When the patients were divided into subgroups according to seminal leukocyte concentrations, acrosome reaction and hypoosmotic swelling were observed to be higher in semen samples with higher leukocyte concentrations compared to those with low seminal leukocyte concentration. In addition, higher sperm concentrations were observed in semen samples with increased leukocyte levels compared to semen samples with low leukocyte levels. These results suggest that leukocytospermia may have a favorable effect on some sperm functions at seminal leukocyte concentrations between 1 and 3x10(6)/ml.     

Inside–out: the role of anger experience and expression in the development of postpartum mood disorders

Purpose: Among negative emotions, anger has not been studied in as much depth in her connection to postpartum mood disorders. The study aimed to investigate the role of anger as a potential vulnerability factor increasing the risk of Maternity Blues (MB) and Postpartum Depression (PPD).

Materials and methods: Pregnant women in their third trimester of pregnancy underwent the following tests: the State Trait Anger Expression Inventory 2 – STAXI-2 (baseline visit), the Blues Questionnaire -BQ (3 and 5 days after delivery), and the Edinburgh Postnatal Depression Scale (EPDS) (3 and 6 months following delivery).

Results: One hundred ten subjects were included in this study. The prevalence rate of mothers with MB was about 35%, whereas about 4% of women developed a PPD. Significant positive correlations were found among State anger (SANG), Trait anger (TANG), anger expression out (AXO) and in (AXI) and postpartum depressive disorders, as measured by blues questionnaire (BQ) and EPDS.

Conclusions: Anger experience and expression can be considered as vulnerability factors for postpartum mood disorders onset. Particularly, the expression of angry feelings toward other persons or objects in the environment (AXO) predicts the onset of MB, whereas holding in or suppressing angry feelings (AXI) could be a risk factor for subsequent PPD.     

The role of veno-venous anastomoses in twin–twin transfusion syndrome

The aim of this study was to investigate the independent role of veno-venous (VV) anastomoses in the development of twin–twin transfusion syndrome (TTTS). Thirty TTTS placentas and 41 non-TTTS placentas, routinely injected with colored dye, were enrolled in this study. We excluded all cases with arterio-arterial (AA) anastomoses and TTTS cases treated with laser surgery. The prevalence of VV anastomoses was significantly higher in TTTS cases compared to non-TTTS cases, 37% (11/30) and 7% (3/41), respectively (P < .01; odds ratio 7.3; 95% confidence interval: 1.8–37.1). Our findings suggest that, in the absence of AA anastomoses, VV anastomoses may enhance the development of TTTS.     

Does granulosa cell apoptosis have a role in the etiology of unexplained infertility?

OBJECTIVE(S): To compare granulosa cell apoptosis in patients with unexplained infertility and tubal factor. Accelerated granulosa cell apoptosis may be the cause of unexplained infertility. STUDY DESIGN: Setting was IVF-ET Unit of Cerrahpasa Medical Faculty, Istanbul University. GnRH analogs and gonadotropins were used for ovulation induction in patients with unexplained infertility (n=15) and tubal factor (n=15) undergoing in vitro fertilization and embryo transfer (IVF-ET) procedures. Following HCG injection and follicular aspiration, apoptosis of granulosa cells was assessed using the in situ DNA nick end labelling method and apoptosis rate was further determined by flow cytometry. Apoptosis rates were compared between two groups. Mann-Whitney's U-test and Student's t-test were used for statistics. RESULTS: Apoptosis rate was significantly higher in the unexplained infertility group (33.20 +/- 35.62% versus 10.10 +/- 17.23%). CONCLUSION(S): Granulosa cell apoptosis seems to have a role in the etiology of unexplained infertility.     

The role of shear wave elastography in the assessment of placenta previa–accreta

Objective: To evaluate the value of shear wave elastography (SWE) in the prediction of morbidly adherent placenta.

Methods: Forty-three women with normal placental location and 26 women with anteriorly localized placenta previa were recruited for this case-control study. Placental elasticity values in both the groups were determined by SWE imaging.

Results: SWE values were higher in the placenta previa group in all regions than in normal localized placentas (p?p?>?.05).

Conclusions: Placental stiffness is significantly higher in placenta previa than normal localized placentas. However, we could not demonstrate any statistically significant difference in the elasticity values between the placenta previa with and without accreta.     

Contamination of ART culture Media–The role of semen and strategies for prevention

ObjectiveMicrobial contamination of ART culture media is rare but serious. We examined our own experience and conducted a review of the literature with a view to preventing its occurrence and recurrence.Case reportA total of 12 cases were recorded during January 2006 to March 2019. The contaminations were caused by semen and were shown to be bacteria that were resistant to the prophylactic antibiotics used in the medium. After the procedures were cancelled due to contaminations, nine husbands received antibiotic treatment, while nine couples changed over to the ICSI program. Eventually, eight couples concluded the study with live birth deliveries, and there was no recurrence of contamination.ConclusionART laboratories should preserve all sperm suspension samples until embryo transfer has been completed for the purpose of checking whether contamination has occurred. In addition to antibiotic treatment, implementation of the ICSI procedure during the next ART cycle has already been proven to be effective. In the future, the zona-removal technique may be considered as another potential option.     

Flow-cytometric analysis of membrane integrity of stallion sperm in the face of agglutination: the “zombie sperm” dilemma

Purpose

To define the effect of sperm agglutination, associated with incubation under capacitating conditions, on accuracy of membrane assessment via flow cytometry and to develop methods to mitigate that effect.

Methods

Sperm motility was measured by CASA. Sperm were stained with PI-PSA or a novel method, LD-PSA, using fixable live/dead stain and cell dissociation treatment, before flow-cytometric analysis. Using LD-PSA, acrosome reaction and plasma membrane status were determined in equine sperm treated with 10 μm A23187 for 10 min, followed by 0, 1, or 2 h incubation in capacitating conditions.

Results

Using PI-PSA, measured membrane integrity (MI; live sperm) was dramatically lower than was total motility (TMOT), indicating spurious results (“zombie sperm”). Sperm aggregates were largely of motile sperm. Loss of motility after A23187 treatment was associated with disaggregation and increased MI. On disaggregation using LD-PSA, MI rose, and MI then corresponded with TMOT. In equine sperm incubated after A23187 treatment, as the percentage of live acrosome-reacted sperm increased, TMOT decreased to near 0.

Conclusion

Flow cytometry assesses only individualized sperm; thus, agglutination of viable sperm alters recorded membrane integrity. As viable sperm become immotile, they individualize; therefore, factors that decrease motility, such as A23187, result in increased measured MI. Disaggregation before assessment allows more accurate determination of sperm membrane status; in this case we documented a mismatch between motility and live acrosome-reacted equine sperm that may relate to the poor repeatability of A23187 treatment for equine IVF. These findings are of profound value to future studies on sperm capacitation.

     

The role of blood in early endometrial–peritoneal interactions in a syngeneic mouse model of endometriosis

Purpose

The aim of this study was to clarify the role of blood in the early stage of development of endometriotic lesions by developing a syngeneic transplantation model using immunocompetent mice.

Methods

Endometriotic lesions were induced in C57BL/6 mice by an intraperitoneal injection of endometrial fragments plus saline or endometrial fragments plus blood. Some endometrial fragments plus blood were injected with heparin, hirudin or tissue plasminogen activator (tPA). Endometriotic lesions on days 1, 3 and 5 were evaluated by gross and microscopic findings.

Results

The areas of endometriotic lesions in the blood group (6.4 ± 1.7 mm²) were significantly larger than those in the saline group (0.5 ± 0.3 mm²). The areas of endometriotic lesions were significantly reduced by the addition of heparin, hirudin or tPA. On day 1, endometriotic lesions in the blood group were observed on the peritoneum in five of the six mice. Endometriotic lesions on days 3 and 5 were significantly larger than those on day 1. On day 5, endometriotic lesions appeared cystic in all the mice.

Conclusions

Blood accelerates the early stage of development of endometriotic lesions when endometrial fragments plus blood are injected. Blood property might be involved in early endometrial–peritoneal interactions.     

Progesterone-enhanced sperm hyperactivation through IP3–PKC and PKA signals

Propose

The present study examined whether regulation of progesterone-enhanced hyperactivation of spermatozoa is associated with the production of inositol 1,4,5-trisphosphate (IP₃) and diacylglycerol (DAG) by phospholipase C (PLC) and cyclic adenosine monophosphate (cAMP) by adenylate cyclase (AC), as well as activation of protein kinase C (PKC) and protein kinase A (PKA).

Methods

Hamster spermatozoa were hyperactivated by incubation for 4 h in modified Tyrode’s albumin lactate pyruvate (mTALP) medium. In order to examine the effects of IP₃ receptor (IP₃R), PKC and PKA on progesterone-enhanced hyperactivation, their inhibitors (xestospongin C, bisindolylmaleimide 1 and H-89) were used.

Results

Progesterone-enhanced hyperactivation was significantly suppressed by the inhibitors of IP₃R, PKC and PKA.

Conclusions

The results suggest that progesterone-enhanced sperm hyperactivation occurs through two signal pathways. One is an intracellular Ca²⁺ signal through production of IP₃ and DAG by PLC, binding of IP₃ to IP₃R and activation of PKC by DAG and Ca²⁺. The other is a cAMP–PKA signal through production of cAMP by AC and activation of PKA by cAMP.     

Postpartum hemorrhage: The role of the Maternal–Fetal Medicine specialist in enhancing quality and patient safety

Postpartum hemorrhage in excess of 1000 mL affects 2.9–4.3% of deliveries in North America and the prevalence is increasing (Calvert et al., 2012¹; Callaghan et al., 2010²). Given the unpredictable nature of most postpartum hemorrhages, all obstetric providers must understand the initial steps in the assessment and management of this emergency. In this monograph we will review the potential role of the Maternal–Fetal Medicine (MFM) specialist in managing this acute obstetric emergency. MFMs are uniquely positioned to develop hospital protocols, advocate for investment in resources to optimize outcomes, and utilize novel educational models, such as simulation, to educate other providers on the recognition and management of this condition. MFMs can also aid in the antepartum diagnosis of abnormal placentation, which is an increasingly common risk factor for severe hemorrhage.     

Evaluation of neutrophil–lymphocyte ratio,platelet–lymphocyte ratio and red blood cell distribution width–platelet ratio as early predictor of acute pancreatitis in pregnancy

Objective: Acute pancreatitis (AP) is a state of inflammation. It has been widely known that neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR) and red blood cell distribution width (RDW) to platelet ratio (RPR) reflect systemic inflammation. The aim of this study is to investigate whether these inflammatory markers could be used as reliable markers in early prediction of AP in pregnancy and if there is a relationship between disease severity and these markers.

Methods: The study group consisted of 14 patients, who developed AP in ongoing pregnancy, and the control group consisted of 30 healthy pregnant women. NLR, PLR and RPR were calculated for both the groups.

Results: NLR was significantly elevated in the AP group when compared with the controls (p?=?0.00), but there was no statistically significant difference in terms of PLR and RPR (p?>?0.05). ROC curve analysis results for NLR showed that there was a significant prediction power of NLR for AP (R²?=?0.842; p?<?0.001). For NLR parameter, if cut-off value is chosen to be 4.1030, then sensitivity is 71.4% and specificity is 100.0%. There was statistically significant and positive correlation between C-reactive protein (CRP) and glucose with NLR (p?=?0.001, p?=?0.043). It was seen that Ranson was close to be significant (p?=?0.051).

Conclusion: NLR might be used as an early marker of AP and may have a role in prediction of disease severity.     

Comparison of maternal–and paternal–fetal attachment in Turkish couples

Objective

to compare maternal–fetal attachment (MFA) and paternal–fetal attachment (PFA) in terms of selected variables.

Design

cross-sectional study.

Setting

three training hospitals in Ankara, Turkey. The study was performed between December 2005 and March 2006.

Participants

a total of 144 pregnant women and 144 partners participated in the study; the response rate was 98%.

Findings

there was a statistically significant difference between MFA and PFA scores (p<0.001). A comparison of MFA and PFA scores according to the selected variables (education, employment status, planning of pregnancy, pregnancy risk status) revealed that the MFA scores for pregnant women were significantly higher than the PFA scores of their partners, except for unemployed partners. The MFA (ρ=−0.24, p<0.004) and PFA (ρ=−0.32, p<0.001) scores decreased with increasing age of both pregnant women and their partners.

Key conclusions and implications for practice

although partners have lower fetal attachment scores than pregnant women, it is important to recognise factors influencing the attachment of the mother and father towards their fetus. Prenatal midwives and nurses are in a unique position to assess attachment and to intervene to promote attachment behaviours.     

The role and significance of endomorphin-1 and μ-opioid receptor in rats with endometriosis

Endomorphin-1 (EM-1) was reported to have very high affinity and selectivity for μ-opioid receptor (MOR). However, it remained unclear whether EM-1 and MOR were involved in the pathologies of endometriosis resulting in reduced fertility. In this study, RT-PCR, radioimmunoassay, immunohistochemistry, and Western blot were used, respectively. The results showed that the immune positive cells of EM-1 in hypothalamus, pituitary, and ovaries were significantly increased in endometriosis model rats, accompanied by the increase of plasma level of EM-1 and the decrease of follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2), and progesterone (P). Interestingly, EM-1 was negatively correlated with FSH and LH (p?相似文献