Introdução: O objetivo foi avaliar a expressão de algumas proteínas no endométrio durante a fase lútea do ciclo menstrual de mulheres férteis e inférteis, por meio imunoistoquímica de micro-arranjos teciduais (TMA). Métodos: Analisou-se a expressão de dez proteínas em 52 amostras de endométrio obtidas nas fases lútea inicial, intermediária (janela de implantação) e final. Resultados: As proteínas, fator inibidor de leucemia (LIF), fator de crescimento insulinóide tipo 1 (IGF-1), receptor de progesterona (PR), claudina-4, receptor de fator de crescimento vascular endotelial 3 (VEGFR-3) e citoqueratina 7 (CK-7) mostraram-se expressas no endométrio nas fases lútea inicial, intermediária e final. A proteína morfogenética óssea 4 (BMP-4) expressou-se no endométrio nas fases lútea inicial e intermediária. As proteínas citoqueratina 17 (CK-17), substância solúvel 100 (S100) e calretinina não se expressaram no endométrio durante os três períodos avaliados. Houve correlação entre as expressões protéicas de LIF, IGF-1 e PR. As proteínas LIF e BMP-4 foram diferencialmente expressos no endométrio nas fases lútea inicial, intermediária e final. As proteínas claudina-4 e PR não se expressam simultâneamente no endométrio durante a fase lútea. Conclusão: Baseados nos resultados deste estudo podemos sugerir que a presença das proteínas LIF, IGF-1 e PR durante a janela implantacional teria relevância como preditor do adequado desenvolvimento do endométrio. / Introduction: The objective of this study was to evaluate endometrial protein expressions from fertile and infertile women during the luteal phase of the menstrual cycle by immunohistochemistry in tissue microarrays (TMA). Method: The expression of ten proteins obtained from 52 endometrial samples in the initial, mid (window of implantation) and late (premenstrual) phases of the menstrual cycle were evaluated. Results: The proteins leukemia inhibitory factor (LIF), insulin like growth factor 1 (IGF-1), progesterone receptor (PR), claudin-4, vascular endothelial growth factor receptor 3 (VEGFR-3), and cytokeratin 7 (CK-7) were expressed in the endometrium in the three intervals of the luteal phase. Endometrial expression of the morphogenetic bone protein 4 (BMP-4) occurred during the initial and mid luteal phases. Cytokeratin 17, substance 100 and calretinin were not expressed in the luteal phase. There were positive correlations among endometrial expressions of LIF, IGF- 1, and PR. LIF and BMP-4 were differently expressed in the initial, mid and late phases of the luteal phase. Claudin-4 and PR did not express simultaneously during the different intervals of the luteal phase. Conclusion: These findings suggest that positively correlated endometrial expressions of LIF, IGF-1 and PR at the window of implantation could characterize an adequately developed and receptive endometrium.

Introdução: O objetivo foi avaliar a expressão de algumas proteínas no endométrio durante a fase lútea do ciclo menstrual de mulheres férteis e inférteis, por meio imunoistoquímica de micro-arranjos teciduais (TMA). Métodos: Analisou-se a expressão de dez proteínas em 52 amostras de endométrio obtidas nas fases lútea inicial, intermediária (janela de implantação) e final. Resultados: As proteínas, fator inibidor de leucemia (LIF), fator de crescimento insulinóide tipo 1 (IGF-1), receptor de progesterona (PR), claudina-4, receptor de fator de crescimento vascular endotelial 3 (VEGFR-3) e citoqueratina 7 (CK-7) mostraram-se expressas no endométrio nas fases lútea inicial, intermediária e final. A proteína morfogenética óssea 4 (BMP-4) expressou-se no endométrio nas fases lútea inicial e intermediária. As proteínas citoqueratina 17 (CK-17), substância solúvel 100 (S100) e calretinina não se expressaram no endométrio durante os três períodos avaliados. Houve correlação entre as expressões protéicas de LIF, IGF-1 e PR. As proteínas LIF e BMP-4 foram diferencialmente expressos no endométrio nas fases lútea inicial, intermediária e final. As proteínas claudina-4 e PR não se expressam simultâneamente no endométrio durante a fase lútea. Conclusão: Baseados nos resultados deste estudo podemos sugerir que a presença das proteínas LIF, IGF-1 e PR durante a janela implantacional teria relevância como preditor do adequado desenvolvimento do endométrio. / Introduction: The objective of this study was to evaluate endometrial protein expressions from fertile and infertile women during the luteal phase of the menstrual cycle by immunohistochemistry in tissue microarrays (TMA). Method: The expression of ten proteins obtained from 52 endometrial samples in the initial, mid (window of implantation) and late (premenstrual) phases of the menstrual cycle were evaluated. Results: The proteins leukemia inhibitory factor (LIF), insulin like growth factor 1 (IGF-1), progesterone receptor (PR), claudin-4, vascular endothelial growth factor receptor 3 (VEGFR-3), and cytokeratin 7 (CK-7) were expressed in the endometrium in the three intervals of the luteal phase. Endometrial expression of the morphogenetic bone protein 4 (BMP-4) occurred during the initial and mid luteal phases. Cytokeratin 17, substance 100 and calretinin were not expressed in the luteal phase. There were positive correlations among endometrial expressions of LIF, IGF- 1, and PR. LIF and BMP-4 were differently expressed in the initial, mid and late phases of the luteal phase. Claudin-4 and PR did not express simultaneously during the different intervals of the luteal phase. Conclusion: These findings suggest that positively correlated endometrial expressions of LIF, IGF-1 and PR at the window of implantation could characterize an adequately developed and receptive endometrium.

L’immunologie de la reproduction englobe les principes de l’immunologie générale et les aspects spécifiques de la reproduction et du développement. Les Colony Stimulating Factors (CSFs) sont une illustration de l'application médicale de ce domaine. Dans la famille des CSFs, le Granulocyte-Colony Stimulating Factor (G-CSF) apparaît aujourd'hui comme une thérapie innovante dans divers cas d'échec de la reproduction, bien que ses cibles et ses effets ne soient pas encore clairement établis. Dans ce travail, à travers une revue sur les CSFs dans la reproduction, une étude consacrée aux gènes cibles du G-CSF dans l'endomètre humain, et une étude consacrée aux effets de la supplémentation systémique en G-CSF sur l’implantation embryonnaire murine, nous avons essayé d'approcher certains mécanismes d'action possibles pour cette cytokine. Dans les modèles murins fertiles et pro-abortifs, la supplémentation systémique en G-CSF, ciblant spécifiquement l’endomètre préimplantatoire, modifie les taux d’implantation embryonnaire. Dans l’endomètre humain, certaines dérégulations préimplantatoires de gènes cibles du G-CSF ont également été observées chez les patients infertiles. L'influence du G-CSF sur ces gènes cibles a été également illustrée dans un modèle ex-vivo de culture endométriale. Ces cibles dont l’expression est influencée par le G-CSF sont décrites comme des molécules clés dans le processus implantatoire, intervenant sur l’adhésion embryonnaire, la migration cellulaire, le remodelage des tissus et l'angiogenèse locale. Ces données suggèrent des possibilités de diagnostic préventif et pré-conceptionnel de certains échecs de reproduction, considérés jusqu’à maintenant comme idiopathiques, et de thérapies innovantes orientées, afin d’optimiser la réceptivité du biosenseur endométrial afin de permettre une implantation embryonnaire harmonieuse et une grossesse évolutive. / Reproductive Immunology involves general immunology principles and special aspects of reproduction and development. Colony Stimulating Factors (CSFs) are an illustration of the medical application of this domain. In the CSF family, Granulocyte-Colony Stimulating Factor (G-CSF) appears today as a promising therapy in various cases of reproductive failure although its targets and effects are not clearly established. In this work, through a review on CSFs in reproduction, a study dedicated to human endometrial targets of G-CSF, and a study dedicated to systemic G-CSF supplementation effects on murine embryo implantation, we tried to approach some possible mechanisms of action of this cytokine. In the considered non-abortive and abortion-prone murine models, the timed systemic G-CSF supplementation, targeting specifically the pre implantation endometrium, influenced the embryo implantation process. Some pre conceptual human endometrial dysregulations of G-CSF target genes were also observed in infertile patients. The endometrial influence of G-CSF on these target genes was also illustrated in an ex-vivo model. These molecules under G-CSF influence are described as critically involved in embryo implantation process, by influencing embryo adhesion, cell migration, tissue remodelling and angiogenesis. These data suggest possible pre-conceptual preventive diagnosis of such reproductive failures and future orientated therapies to optimise the endometrial biosensor and the further embryo implantation and ongoing pregnancy.

Evidências epidemiológicas associam diferentes fatores ambientais, tais como poluição e ingestão de alimentos contaminados, com desfechos gestacionais negativos e fertilidade diminuída em humanos. Não há duvidas de que a poluição do ar nos grandes centros urbanos é capaz de provocar desfechos negativos sobre a gestação: baixo peso ao nascer, prematuridade, perda gestacional, entre outros. Entretanto, poucos estudos foram conduzidos para avaliar um possível efeito da exposição à poluição ambiental particulada do ar sobre a saúde reprodutiva feminina. O objetivo deste trabalho foi avaliar se a exposição subcrônica a poluição atmosférica particulada da cidade de São Paulo é capaz de alterar a receptividade uterina à implantação embrionária. Para tanto, foram avaliados 3 grupos de fêmeas de camundongos (n=10), expostas cronicamente desde o período de desmame (PND21) até atingirem a idade reprodutiva (PND60) à duas concentrações de MP2,5 (600?g/m3 ou 1200ug/m3) ou ar filtrado. Diferentes parâmetros relacionados à fertilidade e a receptividade uterina foram avaliados. Nossos achados mostram que a exposição ao material particulado de origem veicular provoca alterações na ciclicidade estral prévia ao acasalamento, bem como um aumento no peso dos ovários. Avaliação da reserva folicular indica que há um aumento na quantidade de folículos médios associado à exposição a menor concentração de MP (p=0,04). A avaliação histopatológica do tecido uterino revelou que há aumentos na fração de volume das glândulas uterinas (600ug/m3; p=0,01); o epitélio glandular (p=0,001) e luminal (p=0,03) estão espessados e o diâmetro médio das glândulas uterinas foi maior nos grupos expostos ao MP (p=0,004). A análise qualitativa da distribuição de pinopódios no epitélio luminal por microscopia eletrônica de varredura e transmissão indica que há uma redução na presença destas estruturas. A avaliação da expressão de LIF por imunomarcação mostrou-se reduzida no epitélio luminal (p<0,001), nas glândulas (p<0,001) e estroma (p=0,004) nas fêmeas expostas ao MP, porém nenhuma diferença foi observada na expressão de MUC-1 (mucina). Entretanto quando avaliadas a expressão gênica de MUC-1 e LIF no tecido uterino e os níveis de IL-1beta e IL-6 no fluído uterino nenhuma diferença foi observada entre os grupos. Com base em nossos achados conclui-se que a exposição à poluição particulada do ar de origem veicular pode estar envolvida no aumento das perdas gestacionais e/ou implantacionais pelo comprometimento da receptividade uterina provavelmente pelo prejuízo do remodelamento uterino necessário a implantação / Epidemiological evidences have shown that environmental factors, such as environmental pollution and ingestion of contaminated food, are associated with negative gestational outcomes and decreased fertility in human. There is no doubt that exposure to air pollution in large urban areas are capable of impairing health (e.g. hypertension) and of aggravating preexisting diseases (e.g asthma). However, the effects of air pollution exposures on female reproductive health are lesser known. Previous experimental studies have shown that low birth weights are reduced and embryonic implantational index are reduced in animals exposed to ambient levels of air pollution. The aim of this study was to evaluate if sub chronic exposures to particulate air pollution before pregnancy and during the initial stages is capable to alter the uterine receptivity of mice. To test this, 3 groups of female mice were continually exposed from 21st to 60th postnatal day to either filtered or two different doses of concentrated ambient particles (MP2,5 - 600ug/m3 or 1200ug/m3) with the aid of a Ambient Particle Concentrator and different parameters associated with fertility and uterine receptivity were evaluated. Or data have shown that exposures to particulate air pollution from vehicular origin are associated to changes in estrous ciclicity, cycles are shorter and the number of days in estrous reduced. Evaluation of the follicular reserve also indicates that animals exposed to MP present an increased number of ovarian medium follicles (p=0.04). Histopathological evaluation of the uterine tissue revealed increases in the volume fraction of uterine glands (p= 0.01) of those animals exposed to 600ug/m3. The luminal (p= 0.03) and glandular epithelium (p= 0,001) are thicker and the uterine glands diameters (p=0,004) were greater in exposed animals. Qualitative analysis by transmission and scanning electron microscopy indicates that there is a reduction in the presence of pinopódios in the luminal epithelium of PM exposed females. The expressions of LIF assessed by immunohistochemistry in those females exposed to PM were reduced in the luminal epithelium (p<0,001), and in the glandular (p<0,001) and stromal compartments as well. However no differences in the expression of MUC-1 were seen. Gene expression of LIF and MUC-1 in the whole endometrium (qPCR) and the expression of IL-6 and IL-1beta in the uterine fluid did not show significant difference between the groups tested. In conclusion, our data have shown that exposures to ambient air particulate pollution can be associated with increased rates of implantational losses due to changes in the uterine receptivity related to factors involved in uterine remodeling for pregnancy

<p>The human endometrium undergoes dramatic changes in morphology and function during the menstrual cycle. Recurrent angiogenesis (the formation of new blood vessels) is of utmost importance for oxygen supply and nourishment of the rapidly growing endometrial tissue. </p><p>The importance of some growth factors known to stimulate new blood vessel formation both in vivo and in vitro in non-uterine tissues, for endometrial angiogenesis, was studied. Further, the possible relationship between the patterns of expression of some angiogenic growth factors and bleeding disturbances during the use of a progestin-only intrauterine contraceptive device was analyzed. Different ways of determining changes in the endometrial vascular density during the menstrual cycle were also evaluated. </p><p>The expression of the angiogenic growth factors vascular endothelial growth factors (VEGF) A, B, C, and D, fibroblast growth factor 2 (FGF-2), and epidermal growth factor (EGF) and their receptors was analyzed using immunohistochemistry.</p><p>VEGF-A, -B and -C, FGF-2 and EGF and their receptors were all found to be expressed in normal human endometrium, especially in and/or around blood vessels, supporting the hypothesis that these peptides most probably contribute to the regulation of angiogenesis and blood vessel function in normal human endometrium.</p><p>There were differences in expression of some of the studied ligands and receptors in endometrium from users of an LNG-IUS with and without bleeding disturbances. We conclude that changes in the expression of these growth factors and receptors might be involved in the formation of fragile and dysfunctional blood vessels that subsequently give rise to bleeding disturbances.</p><p>The three different methods that were applied for calculating endometrial blood vessel density showed similar results and none of them indicated any significant changes during the menstrual cycle. Angiogenesis thus seems to occur mainly by blood vessel elongation and the angiogenic activity is probably related to changes in endometrial thickness and coiling of the spiral arteries.</p>

The human endometrium undergoes dramatic changes in morphology and function during the menstrual cycle. Recurrent angiogenesis (the formation of new blood vessels) is of utmost importance for oxygen supply and nourishment of the rapidly growing endometrial tissue. The importance of some growth factors known to stimulate new blood vessel formation both in vivo and in vitro in non-uterine tissues, for endometrial angiogenesis, was studied. Further, the possible relationship between the patterns of expression of some angiogenic growth factors and bleeding disturbances during the use of a progestin-only intrauterine contraceptive device was analyzed. Different ways of determining changes in the endometrial vascular density during the menstrual cycle were also evaluated. The expression of the angiogenic growth factors vascular endothelial growth factors (VEGF) A, B, C, and D, fibroblast growth factor 2 (FGF-2), and epidermal growth factor (EGF) and their receptors was analyzed using immunohistochemistry. VEGF-A, -B and -C, FGF-2 and EGF and their receptors were all found to be expressed in normal human endometrium, especially in and/or around blood vessels, supporting the hypothesis that these peptides most probably contribute to the regulation of angiogenesis and blood vessel function in normal human endometrium. There were differences in expression of some of the studied ligands and receptors in endometrium from users of an LNG-IUS with and without bleeding disturbances. We conclude that changes in the expression of these growth factors and receptors might be involved in the formation of fragile and dysfunctional blood vessels that subsequently give rise to bleeding disturbances. The three different methods that were applied for calculating endometrial blood vessel density showed similar results and none of them indicated any significant changes during the menstrual cycle. Angiogenesis thus seems to occur mainly by blood vessel elongation and the angiogenic activity is probably related to changes in endometrial thickness and coiling of the spiral arteries.

CAPES - Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Contaminação bacteriana que normalmente infecta o endométrio bovino no pós-parto prejudica a defesa imunológica quando há estresse metabólico, levando a endometrite e infertilidade. A resposta do endométrio contra bactérias depende da imunidade inata, com o reconhecimento de padrões moleculares associados a patógenos, estimulando a inflamação, caracterizadas por secreção de interleucinas (IL)-1p, IL-6 e IL-8. Entretanto, animais frequentemente falham em eliminar a infecção microbiana quando apresentam reduzidas concentrações de glicose e glutamina, que são fontes de energia para o endométrio no conhecido balanço energético negativo. A contínua inflamação e resposta imune inata contra infecção bacteriana no útero após o parto compromete o bem-estar animal. Neste estudo testou-se a hipótese de que as vias homeostáticas conferidas pela glicose, glutamina e biotina integram o metabolismo energético e a imunidade inata no tecido endometrial bovino. A ausência de glicose reduziu a secreção de IL-1P, IL-6 e IL-8 em culturas de órgãos endometriais desafiadas com a endotoxina lipopolissacarídeo (LPS). Depleção de glutamina também reduziu a atividade inflamatória do endométrio contra LPS. Entretanto, as atividades de glicose e glutamina dependem da presença de glicólise. A vitamina biotina demonstrou ter caráter anti- inflamatório, reduzindo a produção de citocinas pró-inflamatórias no endométrio. Em conclusão, o estresse energético metabólico afetou as respostas inflamatórias à infecções bacterianas no endométrio. Providenciamos dados que demonstram como o balanço energético negativo pode estar ligado a doença uterina no pós-parto. / Bacteria that usually infect the bovine endometrium at postpartum impairs immune defense when exist metabolic stress, leading to endometritis and infertility. The response of the endometrium to bacteria depends on innate immunity, with the recognition of pathogen-associated molecular patterns by stimulating inflammation, characterized by secretion of interleukins (IL) -1p, IL-6 and IL-8. However, animals often fail to eliminate the microbial infection when they have reduced levels of glucose and glutamine, which are sources of energy to the endometrium in the negative energy balance. Continuous inflammation and innate immune response to bacterial infection in the uterus after calving compromise animal welfare. In this study we tested the hypothesis that homeostatic pathways conferred by glucose , glutamine and biotin, link the energy metabolism and innate immunity in the bovine endometrial tissue. The deprivation of glucose reduced the secretion of IL-1P, IL-6 and IL-8 in cultures of endometrial organs challenged with the endotoxin lipopolysaccharide (LPS). Glutamine depletion also reduces the inflammatory activity of the endometrium to LPS. However, glucose and glutamine activities depend on the presence of glycolysis. The vitamin biotin demonstrates anti-inflammatory nature, reducing the production of proinflammatory cytokines in the endometrium. In conclusion, the energy metabolic stress disrupts inflammatory responses to bacterial infections in the endometrium. We provide data on how negative energy balance may be linked to postpartum uterine disease. / Tese (Doutorado)

Evidências epidemiológicas associam diferentes fatores ambientais, tais como poluição e ingestão de alimentos contaminados, com desfechos gestacionais negativos e fertilidade diminuída em humanos. Não há duvidas de que a poluição do ar nos grandes centros urbanos é capaz de provocar desfechos negativos sobre a gestação: baixo peso ao nascer, prematuridade, perda gestacional, entre outros. Entretanto, poucos estudos foram conduzidos para avaliar um possível efeito da exposição à poluição ambiental particulada do ar sobre a saúde reprodutiva feminina. O objetivo deste trabalho foi avaliar se a exposição subcrônica a poluição atmosférica particulada da cidade de São Paulo é capaz de alterar a receptividade uterina à implantação embrionária. Para tanto, foram avaliados 3 grupos de fêmeas de camundongos (n=10), expostas cronicamente desde o período de desmame (PND21) até atingirem a idade reprodutiva (PND60) à duas concentrações de MP2,5 (600?g/m3 ou 1200ug/m3) ou ar filtrado. Diferentes parâmetros relacionados à fertilidade e a receptividade uterina foram avaliados. Nossos achados mostram que a exposição ao material particulado de origem veicular provoca alterações na ciclicidade estral prévia ao acasalamento, bem como um aumento no peso dos ovários. Avaliação da reserva folicular indica que há um aumento na quantidade de folículos médios associado à exposição a menor concentração de MP (p=0,04). A avaliação histopatológica do tecido uterino revelou que há aumentos na fração de volume das glândulas uterinas (600ug/m3; p=0,01); o epitélio glandular (p=0,001) e luminal (p=0,03) estão espessados e o diâmetro médio das glândulas uterinas foi maior nos grupos expostos ao MP (p=0,004). A análise qualitativa da distribuição de pinopódios no epitélio luminal por microscopia eletrônica de varredura e transmissão indica que há uma redução na presença destas estruturas. A avaliação da expressão de LIF por imunomarcação mostrou-se reduzida no epitélio luminal (p<0,001), nas glândulas (p<0,001) e estroma (p=0,004) nas fêmeas expostas ao MP, porém nenhuma diferença foi observada na expressão de MUC-1 (mucina). Entretanto quando avaliadas a expressão gênica de MUC-1 e LIF no tecido uterino e os níveis de IL-1beta e IL-6 no fluído uterino nenhuma diferença foi observada entre os grupos. Com base em nossos achados conclui-se que a exposição à poluição particulada do ar de origem veicular pode estar envolvida no aumento das perdas gestacionais e/ou implantacionais pelo comprometimento da receptividade uterina provavelmente pelo prejuízo do remodelamento uterino necessário a implantação / Epidemiological evidences have shown that environmental factors, such as environmental pollution and ingestion of contaminated food, are associated with negative gestational outcomes and decreased fertility in human. There is no doubt that exposure to air pollution in large urban areas are capable of impairing health (e.g. hypertension) and of aggravating preexisting diseases (e.g asthma). However, the effects of air pollution exposures on female reproductive health are lesser known. Previous experimental studies have shown that low birth weights are reduced and embryonic implantational index are reduced in animals exposed to ambient levels of air pollution. The aim of this study was to evaluate if sub chronic exposures to particulate air pollution before pregnancy and during the initial stages is capable to alter the uterine receptivity of mice. To test this, 3 groups of female mice were continually exposed from 21st to 60th postnatal day to either filtered or two different doses of concentrated ambient particles (MP2,5 - 600ug/m3 or 1200ug/m3) with the aid of a Ambient Particle Concentrator and different parameters associated with fertility and uterine receptivity were evaluated. Or data have shown that exposures to particulate air pollution from vehicular origin are associated to changes in estrous ciclicity, cycles are shorter and the number of days in estrous reduced. Evaluation of the follicular reserve also indicates that animals exposed to MP present an increased number of ovarian medium follicles (p=0.04). Histopathological evaluation of the uterine tissue revealed increases in the volume fraction of uterine glands (p= 0.01) of those animals exposed to 600ug/m3. The luminal (p= 0.03) and glandular epithelium (p= 0,001) are thicker and the uterine glands diameters (p=0,004) were greater in exposed animals. Qualitative analysis by transmission and scanning electron microscopy indicates that there is a reduction in the presence of pinopódios in the luminal epithelium of PM exposed females. The expressions of LIF assessed by immunohistochemistry in those females exposed to PM were reduced in the luminal epithelium (p<0,001), and in the glandular (p<0,001) and stromal compartments as well. However no differences in the expression of MUC-1 were seen. Gene expression of LIF and MUC-1 in the whole endometrium (qPCR) and the expression of IL-6 and IL-1beta in the uterine fluid did not show significant difference between the groups tested. In conclusion, our data have shown that exposures to ambient air particulate pollution can be associated with increased rates of implantational losses due to changes in the uterine receptivity related to factors involved in uterine remodeling for pregnancy

Infertility affects 15% of reproductive-aged couples. The milieu surrounding the growing embryo is of outmost importance, and should be optimised during in vitro fertilisation (IVF). Many biological processes, such as angiogenesis, coagulation, and immune processes need to be well regulated for a pregnancy to occur and progress normally. Histidine-rich glycoprotein (HRG) is a plasma protein that regulates components of these systems by building complexes with various ligands. A single nucleotide polymorphism (SNP) in HRG, denoted HRG C633T, seem to be of importance for IVF treatment outcomes. The aim of this thesis was to further investigate the proposed human fertility effects of the HRG C633T SNP. According to the findings of this thesis, the HRG C633T genotype is associated with primary recurrent miscarriage. Male HRG C633T genotype is associated with semen characteristics in infertile men, and pregnancy rates following IVF. However, the distribution of the HRG C633T SNP does not differ between infertile and fertile couples. We further examined the role of the region surrounding the HRG C633T SNP for regulation of endometrial angiogenesis and human embryo development. The region affects primary endometrial endothelial cell migration, proliferation and tube-formation in vitro but does not appear to affect human embryo development. No effect of the HRG peptide was noted on the secretome of human embryos. However, early embryos secrete proteins into the surrounding culture media and the level of secretion of VEGF-A, IL-6, EMMPRIN and PlGF is greater in embryos of higher developmental stages. In conclusion, the HRG C633T genotype appears to play a role only if infertility is established. The region surrounding HRG C633T SNP is of relevance in vitro for regulation of human endometrial endothelial cell angiogenesis. To predict which embryos to transfer in IVF, we have highlighted a number of proteins of interest for further investigation.

Chlamydiae growing in target mucosal human epithelial cells in vitro can transition from their normal developmental cycle progression, alternating between infectious but metabolically inactive elementary bodies to metabolically active but noninfectious reticulate bodies (RBs) and back to elementary bodies, into a state of persistence. Persistence in vitro is defined as viable but noncultivable chlamydiae involving morphologically enlarged, aberrant, and nondividing RBs. The condition is reversible, yielding infectious elementary bodies after removal of the inducers, including penicillin, interferon-gamma, iron or nutrient starvation, concomitant herpes infection, or maturation of the host cell into its physiologically differentiated state. All aberrant RB phenotypes are not the same, owing to differing up- or down-regulated chlamydial gene sets and subsequent host responses. Although all persistence-inducing conditions exist in vivo, key questions include (1) whether or not aberrant chlamydial RBs occur in vivo during the alternating acute-silent chronic-acute chlamydial infection scenario that exists in infected patients and animals and (2) whether such aberrant RBs can contribute to prolonged, chronic inflammation, fibrosis, and scarring.