女性激素状态与生殖道支原体寄居的关系

本文调查了959名不同性激素状态妇女生殖道溶脲支原体(Uu)和人型支原体(Mh)的寄居情况。结果表明新生女婴、产后妇女和绝经妇女Uu和Mh寄居率较低,妊娠妇女Uu和Mh寄居率则相当高;已婚非孕妇女Uu和Mh寄居率高于未婚者。提示了女性激素水平与生殖道支原体寄居状态有密切联系。     

New Candidate Biomarkers in the Female Genital Tract to Evaluate Microbicide Toxicity

Vaginal microbicides hold great promise for the prevention of viral diseases like HIV, but the failure of several microbicide candidates in clinical trials has raised important questions regarding the parameters to be evaluated to determine in vivo efficacy in humans. Clinical trials of the candidate microbicides nonoxynol-9 (N9) and cellulose sulfate revealed an increase in HIV infection, vaginal inflammation, and recruitment of HIV susceptible lymphocytes, highlighting the need to identify biomarkers that can accurately predict microbicide toxicity early in preclinical development and in human trials. We used quantitative proteomics and RT-PCR approaches in mice and rabbits to identify protein changes in vaginal fluid and tissue in response to treatment with N9 or benzalkonium chloride (BZK). We compared changes generated with N9 and BZK treatment to the changes generated in response to tenofovir gel, a candidate microbicide that holds promise as a safe and effective microbicide. Both compounds down regulated mucin 5 subtype B, and peptidoglycan recognition protein 1 in vaginal tissue; however, mucosal brush samples also showed upregulation of plasma proteins fibrinogen, plasminogen, apolipoprotein A-1, and apolipoprotein C-1, which may be a response to the erosive nature of N9 and BZK. Additional proteins down-regulated in vaginal tissue by N9 or BZK treatment include CD166 antigen, olfactomedin-4, and anterior gradient protein 2 homolog. We also observed increases in the expression of C-C chemokines CCL3, CCL5, and CCL7 in response to treatment. There was concordance in expression level changes for several of these proteins using both the mouse and rabbit models. Using a human vaginal epithelial cell line, the expression of mucin 5 subtype B and olfactomedin-4 were down-regulated in response to N9, suggesting these markers could apply to humans. These data identifies new proteins that after further validation could become part of a panel of biomarkers to effectively evaluate microbicide toxicity.     

Microbiome Composition and Function Drives Wound-Healing Impairment in the Female Genital Tract

The mechanism(s) by which bacterial communities impact susceptibility to infectious diseases, such as HIV, and maintain female genital tract (FGT) health are poorly understood. Evaluation of FGT bacteria has predominantly been limited to studies of species abundance, but not bacterial function. We therefore sought to examine the relationship of bacterial community composition and function with mucosal epithelial barrier health in the context of bacterial vaginosis (BV) using metaproteomic, metagenomic, and in vitro approaches. We found highly diverse bacterial communities dominated by Gardnerella vaginalis associated with host epithelial barrier disruption and enhanced immune activation, and low diversity communities dominated by Lactobacillus species that associated with lower Nugent scores, reduced pH, and expression of host mucosal proteins important for maintaining epithelial integrity. Importantly, proteomic signatures of disrupted epithelial integrity associated with G. vaginalis-dominated communities in the absence of clinical BV diagnosis. Because traditional clinical assessments did not capture this, it likely represents a larger underrepresented phenomenon in populations with high prevalence of G. vaginalis. We finally demonstrated that soluble products derived from G. vaginalis inhibited wound healing, while those derived from L. iners did not, providing insight into functional mechanisms by which FGT bacterial communities affect epithelial barrier integrity.     

Folate Receptors in Malignant and Benign Tissues of Human Female Genital Tract

We have characterized the folate receptor in malignant and benign tissues of human female genital tract (Fallopian tube and benign and malignant tissues of uterus). Radioligand binding displayed characteristics similar to those of other folate binding proteins. Those include a high-affinity type of binding (K=10¹⁰M^–1), apparent positive cooperativity, a slow dissociation at pH 7.4 becoming rapid at pH 3.5, and inhibition of binding by folate analogues. The gel filtration profile of Triton X-100 solubilized tissue contained two large peaks of ³H-folate labelled protein (>=130 and 100kDa) as well as a 25 kDa peak. Only a single band of 70 kDa was seen on SDS-PAGE immunoblotting. The large molecular size forms on gel filtration appear to represent folate receptors having a hydrophobic membrane anchor inserted into Triton X-100 micelles. The folate receptor of female genital tract showed cross-reactivity in ELISA and positive immunostaining with rabbit antibodies against human milk folate binding protein. Variations in the ratio of immunoresponse to total high affinity folic acid binding suggests the presence of multiple isoforms of the receptor in different types of malignant and benign tissues.     

Ultrastructure of the Z-organ and Parts of the Female Genital Tract in Xiphinema coxi coxi

Ultrastructure of the Z-organ and associated apophyses in Xiphinema coxi coxi was studied by transmission electron microscopy to determine their structural origin and relationship with other parts of the genital tract. The Z-organ of X. coxi coxi is oval-shaped, ca. 30 µm long and 16 µm wide. It is clearly distinguished from the other parts of the female genital tract by its thick muscular outer wall, epithelium-lined lumen, and 4-5 centrally located apophyses. Each apophysis is continuous with the epithelial lining of the Z-organ, suggesting that it originated from epithelium. The apophyses appear as thickened and densely folded masses forming numerous interlaced pores and (or) chambers containing mucous-like materials and electron-dense crystals. These apophyses are characteristic of a typical Z-organ; no globular structures characteristics of the pseudo-Z-organ were observed. The thickness of the muscular layer of the oviduct and uterus varied with position. The overall Z-organ ultrastructure of this study, including body wall and internal apophyses, was comparable to the typical Z-organ of X. ifacolum. This suggests that X. coxi coxi should be classified as a Xiphinema species that contains the typical Z-organ.     

Immune Activation in the Female Genital Tract: Expression Profiles of Soluble Proteins in Women at High Risk for HIV Infection

Soluble cervicovaginal biomarkers of inflammation, immune activation and risk of HIV acquisition are needed to reliably assess the safety of new biomedical prevention strategies including vaccines and microbicides. However, a fuller understanding of expression profiles in women at high risk for HIV infection is crucial to the effective use of these potential biomarkers in Phase 3 trial settings. We have measured 45 soluble proteins and peptides in cervicovaginal lavage samples from 100 HIV negative women at high risk for HIV infection. Women were followed over one menstrual cycle to investigate modulation by hormonal contraception, menstrual cycle phase, recent sexual exposure and intravaginal practices. Women using injectable DMPA had increased concentration of several soluble proteins of the innate and adaptive immune system, including IL-1α, IL-1β, IL-2, MIP-1β, IP-10, IL-8, TGF-β, HBD4, IgA, IgG1, and IgG2. Women using combined oral contraceptives had a similar signature. There were differences in concentrations among samples from post-ovulation compared to pre-ovulation, notably increased immunoglobulins. Increased prostate-specific antigen, indicative of recent sexual exposure, was correlated with increased IL-6, MCP-1, and SLPI, and decreased GM-CSF and HBD3. The identified signature profiles may prove critical in evaluating the potential safety and impact on risk of HIV acquisition of different biomedical intervention strategies.     

Cleavage/Alteration of Interleukin-8 by Matrix Metalloproteinase-9 in the Female Lower Genital Tract

Objective

Interleukin-8 (IL-8, CXCL8) plays important roles in immune responses at mucosal sites including in the lower genital tract. Since several types of bacteria produce proteases that cleave IL-8 and many types of bacteria can be present in lower genital tract microbiota, we assessed genital fluids for IL-8 cleavage/alteration.

Study Design

Genital fluids collected by lavage from 200 women (23 HIV-seronegative and 177 HIV-seropositive) were tested for IL-8 cleavage/alteration by ELISA.

Results

IL-8 cleaving/altering activity was observed in fluids from both HIV-positive (28%) and HIV-negative women (35%). There was no clear relationship between the activity and the types of bacteria present in the lower genital tract as determined by high-throughput sequencing of the 16S rRNA gene. Protease inhibitors specific for matrix metalloproteinases (MMPs) reduced the activity and a multiplex assay that detects both inactive and active MMPs showed the presence of multiple MMPs, including MMP-1, -3, -7, -8, -9, -10 and -12 in genital secretions from many of the women. The IL-8-cleaving/altering activity significantly correlated with active MMP-9 as well as with cleavage of a substrate that is acted on by several active MMPs.

Conclusions

These studies show that multiple MMPs are present in the genital tract of women and strongly suggest that MMP-9 in genital secretions can cleave IL-8 at this mucosal site. These studies suggest that MMP-mediated cleavage of IL-8 can modulate inflammatory responses in the lower genital tract.     

Infertility as a Consequence of Spermagglutinating Staphylococcus aureus Colonization in Genital Tract of Female Mice

Various studies have shown Staphylococcus aureus to be one of the most prevalent organism in male and female genital tract but most practitioners dismiss it as mere contamination which is assumed to be of no significance. However, it is now suggested that the presence of this organism should not be ignored, as incubation of spermatozoa with S. aureus results in reduced sperm motility. Although S. aureus has been reported to cause immobilization of spermatozoa, however, its role in infertility has yet to be elucidated. The present study was designed to establish a spermagglutinating strain of S. aureus isolated from the cervix of a woman with unexplained infertility, in mouse and evaluate its effect on fertility outcome. Female Balb/c mice were inoculated intravaginally with different doses of S. aureus (10⁴, 10⁶ or 10⁸cfu/20 µl) for 10 consecutive days. Microbial colonization monitored every 3^rd day by vaginal cultures, revealed that strain could efficiently colonize mouse vagina. Mating on day 12, with proven breeder males led to 100% decrease in fertility as compared to control. Even a single dose of 10⁶ or 10⁸cfu could lead to vaginal colonization which persisted for 10 days followed by gradual clearing till 21 days, vaginal cultures were negative thereafter. Female mice mated on day 7 (culture positive), were rendered infertile, however, the mice mated on day 22 (culture negative), retained fertility and delivered pups indicating its role in provoking infertility. Further, except infertility, no other clinical manifestation could be seen apparently or histologically. However, when a non-spermagglutinating/immobilizing standard strain of S. aureus MTCC6625 was inoculated intravaginally at 10⁸cfu for 10 days followed by mating on day 12, fertility was observed in all the female mice. This supports the hypothesis that infertility observed in the former groups was as a result of colonization with spermagglutinating strain of S. aureus.     

Role of Heparan Sulfate in Attachment to and Infection of the Murine Female Genital Tract by Human Papillomavirus

The host factors required for in vivo infection have not been investigated for any papillomavirus. Using a recently developed murine cervicovaginal challenge model, we evaluated the importance of heparan sulfate proteoglycans (HSPGs) in human papillomavirus (HPV) infection of the murine female genital tract. We examined HPV type 16 (HPV16) as well as HPV31 and HPV5, for which some evidence suggests that they may differ from HPV16 in their utilization of HSPGs as their primary attachment factor in vitro. Luciferase-expressing pseudovirus of all three types infected the mouse genital tract, although HPV5, which normally infects nongenital epidermis, was less efficient. Heparinase III treatment of the genital tract significantly inhibited infection of all three types by greater than 90% and clearly inhibited virion attachment to the basement membrane and cell surfaces, establishing that HSPGs are the primary attachment factors for these three viruses in vivo. However, the pseudoviruses differed in their responses to treatment with various forms of heparin, a soluble analog of heparan sulfate. HPV16 and HPV31 infections were effectively inhibited by a highly sulfated form of heparin, but HPV5 was not, although it bound the compound. In contrast, a N-desulfated and N-acylated variant preferentially inhibited HPV5. Inhibition of infection paralleled the relative ability of the variants to inhibit basement membrane and cell surface binding. We speculate that cutaneous HPVs, such as HPV5, and genital mucosal HPVs, such as HPV16 and -31, may have evolved to recognize different forms of HSPGs to enable them to preferentially infect keratinocytes at different anatomical sites.Papillomaviruses (PVs) are icosahedral DNA viruses that have evolved into numerous genotypes that productively infect diverse vertebrates in a species-specific manner. These viruses also display strict tissue specificity, productively infecting only epithelial cells in the skin and mucosa. These features have inhibited viral propagation in vitro and retarded the development of in vivo models for infection. The human PVs (HPVs) belonging to the alpha genus preferentially infect the genital mucosa, and a subset of this genus include the types (e.g., HPV16, -18, -31, -33, and -45) that are the causative agents of cervical carcinoma. HPV types belonging to the beta genus generally cause asymptomatic skin infections, but certain beta types (e.g., HPV5 and -8) are associated with cutaneous squamous cell carcinomas in individuals with the rare genetic disorder epidermodysplasia verruciformis.As with other viruses, virion attachment to the host cell is required for successful PV infection. In vitro studies have implicated cell surface heparan sulfate (HS) proteoglycans (HSPGs) as the primary attachment factors for most HPV types (13, 15). HSPGs are composed of a core protein with covalently attached repeating disaccharide units known as glycosaminoglycans. Posttranslational modification of the glycosaminoglycans by acetylation and sulfation leads to substantial heterogeneity that varies across cell type and growth conditions (20, 23). HSPGs are nearly ubiquitously expressed on mammalian cell surfaces, where they are involved in diverse biological processes, including organogenesis, growth factor and cytokine binding, and wound healing. They are also integral components of the basement membrane (BM), the specialized extracellular matrix (ECM) that surrounds most tissues. In this locale, their putative functions include regulation of BM permeability, binding of growth factors, and a role in cellular adhesion (reviewed in reference 10).HSPGs can also help mediate infection by acting as receptors/coreceptors for some bacterial and viral pathogens (reviewed in reference 12). It is well established that HPV16 utilizes attachment to HSPGs for efficient infection in vitro. However, in vitro studies investigating other HPV types, such as HPV31 and HPV5, have described possible differences. Infection with HPV31 has been reported to be HSPG independent in keratinocyte lines such as HaCaT, although not in other, more transformed lines (17). Also, heparin, which shares the same disaccharide units with HS but is more homogeneous and has a higher level of sulfation, did not inhibit HPV5 infection at doses that efficiently blocked HPV16 infection in vitro (3).In addition to binding cell surfaces, PVs also bind strongly to the ECM deposited by epithelial cells in vitro and onto the BM in vivo (5, 9, 18). Laminin 5 appears to be the primary molecule mediating in vitro ECM binding (6). However, interaction with an HS moiety on the ECM may be critical for transfer of infectious virions to the cell surface (21). PV cell surface binding in vitro may arise independently of ECM binding; however, the kinetics of in vivo infection suggest that virion binding to the BM may be essential. It is therefore possible that this aspect of in vivo infection could differ from what has been seen in vitro.It is unclear if HSPGs play any role in PV infection in vivo, as the cellular factors and processes involved in PV infection of epithelial tissues in vivo have not been examined previously. There is a clear precedent of in vitro HSPG dependence for infection of cell lines that does not reflect an in vivo function. For instance, HSPGs facilitate human immunodeficiency virus infection of certain permissive lymphoid cell lines in vitro, yet they play no role in the infection of primary blood lymphocytes (14).In this study, we utilized our recently developed murine cervicovaginal challenge model (18), which is useful to examine establishment of HPV infection in vivo, to investigate the HSPG dependency of HPV infection, examining both binding and infection of HPV16 pseudovirions in the presence of agents that either compete for HS binding or remove HS from cell surfaces. Because of the published data suggesting possible differences from HPV16 in HSPG dependency for in vitro infection, we also evaluated HPV5 and HPV31 pseudovirions.     

Optimizing Viable Leukocyte Sampling from the Female Genital Tract for Clinical Trials: An International Multi-Site Study

Background

Functional analysis of mononuclear leukocytes in the female genital mucosa is essential for understanding the immunologic effects of HIV vaccines and microbicides at the site of HIV exposure. However, the best female genital tract sampling technique is unclear.

Methods and Findings

We enrolled women from four sites in Africa and the US to compare three genital leukocyte sampling methods: cervicovaginal lavages (CVL), endocervical cytobrushes, and ectocervical biopsies. Absolute yields of mononuclear leukocyte subpopulations were determined by flow cytometric bead-based cell counting. Of the non-invasive sampling types, two combined sequential cytobrushes yielded significantly more viable mononuclear leukocytes than a CVL (p<0.0001). In a subsequent comparison, two cytobrushes yielded as many leukocytes (∼10,000) as one biopsy, with macrophages/monocytes being more prominent in cytobrushes and T lymphocytes in biopsies. Sample yields were consistent between sites. In a subgroup analysis, we observed significant reproducibility between replicate same-day biopsies (r = 0.89, p = 0.0123). Visible red blood cells in cytobrushes increased leukocyte yields more than three-fold (p = 0.0078), but did not change their subpopulation profile, indicating that these leukocytes were still largely derived from the mucosa and not peripheral blood. We also confirmed that many CD4⁺ T cells in the female genital tract express the α4β7 integrin, an HIV envelope-binding mucosal homing receptor.

Conclusions

CVL sampling recovered the lowest number of viable mononuclear leukocytes. Two cervical cytobrushes yielded comparable total numbers of viable leukocytes to one biopsy, but cytobrushes and biopsies were biased toward macrophages and T lymphocytes, respectively. Our study also established the feasibility of obtaining consistent flow cytometric analyses of isolated genital cells from four study sites in the US and Africa. These data represent an important step towards implementing mucosal cell sampling in international clinical trials of HIV prevention.     

Review of the Comparative In vitro Susceptibilities of Lower Female Genital Tract Pathogens to Older and Newer Fluoroquinolones

Appraising and rearranging a variety of susceptibility studies that used the same methodology performed in our laboratory, we reviewed and compared the in vitro activities of the newer fluoroquinolones (gatifloxacin, grepafloxacin, moxifloxacin, sitafloxacin and trovafloxacin) to those of the older fluoroquinolones (ciprofloxacin, ofloxacin, sparfloxacin, and levofloxacin) against potentially pathogenic, anaerobic bacterial species of the lower female genital tract. At a concentration of 2 μg/ml, moxifloxacin (89% inhibition) and gatifloxacin (83% inhibition) had comparable anti-anaerobic activity to trovafloxacin (88% inhibition). Sitafloxacin, which is under clinical development in Japan, was also highly active against the anaerobes tested. Comparatively, the older fluoroquinolones and grepafloxacin demonstrated less anti-anaerobe activity. Sitafloxacin, moxifloxacin and trovafloxacin were the most active agents tested with 237/243 (97%), 217/243 (89%) and 319/367 (88%), of the strains inhibited at 2 μg/ml, respectively. While the older fluoroquinolones required the addition of a second drug to be useful in mixed gynaecological infections, the newer fluoroquinolones have improved anti-anaerobic activity and could potentially be useful as monotherapy.     

川金丝猴雌性生殖器官的观察

对3只川金丝猴(Rhinopithecus roxellanae)的雌性生殖器官进行了观察。结果表明,卵巢通常呈椭圆形,两端稍尖,长1．0～1．8cm,宽0．4、0．6cm,厚0．2～0．4cm。有一个体呈一端大、一端小,中间缩细类似亚铃的形状。输卵管两侧均有系膜固定,输卵管上系膜仅0．1～0．2cm宽。子宫略呈长简形,子宫底正中沟不明显,子宫颈管较长,子宫轴与阴道轴在一直线上,子宫颈阴道部明显突出,前唇尤为明显,而阴道后穹比前穹深得多。阴道下半部前壁处皱襞密而高,形成三角形隆起,尖端向尿道外口：阴道前庭内前庭球明显,长约0．5cm,宽约0．2cm,位于尿道外口两侧的椭圆形窝内。