The role of cytokines in immune regulation of female reproductive physiology

Cytokines act as protein mediators of the immune system and exert pleiotropic effects on the source cells and/or on target cells. Cytokines are formed in a cascade, bind to specific receptors, and influence the activity, differentiation, proliferation, and survival of immune cells of both T helper 1 (Th1) type (which has proinflammatory properties) and Th2 type (with an anti-inflammatory function). The female reproductive system is regulated by the immune system via cytokines at various physiological stages: during the ovarian cycle, maternal recognition, embryo implantation, gestation, and birth, participating in homeostasis and protection from pathogens. These processes interact under the hormonal influence of the hypothalamic­pituitary­gonadal axis. This review is aimed at addressing the involvement of some cytokines in female reproductive physiology, highlighting the maternal recognition of the embryo and implantation as immunologically important steps for fetal survival. The scientific knowledge on the role of cytokines in female reproduction processes, such as the Th1/Th2 balance and immune tolerance should advance the research in various fields of assisted reproduction in humans and animals, such as artificial insemination, embryo transfer, and in vitro fertilization. The same is true for the development of contraceptive methods and understanding of pathological processes such as uterine infections and autoimmune diseases.

Primeiro escore de risco inflamatório das endopróteses de aorta / First inflammatory risk score for aortic endoprostheses

OBJETIVO: Propor um escore de risco inflamatório para tratamento endovascular dos aneurismas da aorta. MÉTODOS: Vinte e cinco pacientes foram seguidos do período pré-operatório até 3º mês de pós-operatório (1 hora, 6 horas, 24 horas, 48 horas, 7 dias, 1 mês, 2 meses e 3 meses). Variáveis inflamatórias avaliadas foram proteína C reativa, velocidade de hemossedimentação, interleucinas (IL-6, IL8), fator de necrose tumoral alfa, L-selectina, molécula de adesão intercelular (ICAM-1), transfusão de hemáceas, volume de cristalóide, volume de contraste, material da prótese, número de próteses, contagem total de leucócitos e linfócitos. O teste de Spearman apontou as variáveis candidatas ao maior risco inflamatório, segundo P < 20 por cento. A regressão logística apontou variáveis selecionáveis para escore final segundo P < 10 por cento. A análise da curva ROC revelou valores de corte para variáveis selecionadas pela regressão logística. RESULTADOS: Variáveis apresentadas pelo teste de Spearman foram: volume de cristalóide (P = 0,04), material da prótese (P = 0,04), volume de contraste (P=0,02), IL-8 préoperatória (P= 0,10), ICAM-1 1 mês (P=0,03) e L-selectina 1 mês (P = 0,06). A regressão logística revelou que os valores do volume de cristalóide e IL-8 pré-operatória são primordiais para constituição do escore de risco inflamatório para tratamento endovascular dos aneurismas da aorta. O escore de risco seria dividido em três categorias (leve, moderado e grave), com base em intervalos numéricos das duas variáveis selecionadas e as categorias seriam correlacionadas com achados clínicos CONCLUSÃ: Volume de cristalóide e IL-8 pré-operatória são variáveis que poderiam contribuir para categorizar risco inflamatório e, desse modo, ter um papel prognóstico no tratamento endovascular dos aneurismas da aorta.

OBJECTIVE: To purpose an inflammatory risk score for aortic aneurysm endovascular treatment. METHODS: Twenty-five patients were followed-up from preoperative period to third month postoperatively (1-hour, 6-hour, 24-hour, 48-hour, 7-day, 1-month, 2- month and 3month). Inflammatory variables were C-reactive protein, hemosedimentation velocity, interleukins (IL-6, IL-8), tumor necrosis factor-Alpha, L-selectin, intercellular adhesion molecule (ICAM-1), red blood cells transfusion, volume of crystalloid, volume of contrast, type of endoprosthesis, number of endoprostheses, total count of leukocytes and lymphocytes. Spearman test defined the variables considered as candidates to higher inflammatory risk based on P < 20 percent. Logistic regression defined the variables considered as selected for final score based on P < 10 percent. ROC curve analysis revealed the cut-off values for variables selected by logistic regression. RESULTS: Variables defined by Spearman test were: volume of crystalloid (P=0.04), type of endoprosthesis (P=0.04), volume of contrast (P=0.02), preoperative IL-8 (P = 0.10), 1 - month ICAM-1 (P=0.03) and 1-month L-selectin (P=0.06). Logistic regression revealed that volume of crystalloid and preoperative IL-8 values are relevant for composition of inflammatory risk score for aortic aneurysm endovascular treatment. Risk score would be divided into three categories (mild, moderate and severe) based on numeric intervals of these two variables and the categories would be correlated to clinical findings. CONCLUSION: Volume of crystalloid and preoperative IL-8 are variables that might contribute to categorize inflammatory risk and thereby might play a prognostic role for aortic aneurysm endovascular treatment.