У женщин с астмой и без нее одинаковое количество воспалительных клеток в эндометрии

Endometrial inflammatory cell counts similar in infertile women with, without asthma Key takeaways: - Women undergoing fertility treatment made up this study population. - Those with asthma did not significantly differ from those without asthma in plasma cell, mast cell and eosinophil number in the endometrium. Among women undergoing fertility treatment, those with asthma had similar numbers of local inflammatory markers in the endometrium to those without asthma, according to results published in Respiratory Medicine. “Our findings do not support the idea that infertility in women with asthma is explained by obvious inflammatory-cell changes or chronic endometritis in the endometrium,” Anne Vejen Hansen, MD, PhD, of the department of respiratory medicine at Copenhagen University Hospital Hvidovre, told Healio. “While the study was exploratory and relatively small, it suggests that clinicians should continue focusing on optimal asthma management while recognizing that the biological link between asthma and reduced fertility remains to be clarified,” she said. In an explorative, observational, nonrandomized pilot study, Vejen Hansen and colleagues evaluated 13 women with asthma (mean age, 31.9 years; mean BMI, 23.1 kg/m2) and 15 women without asthma (mean age, 33 years; mean BMI, 24.3 kg/m2), all undergoing fertility treatment (intrauterine insemination or in vitro fertilization), to determine if levels of inflammatory cells in the endometrium differ between the two groups. “For several years, research has shown that women with asthma are more likely to experience a longer time to pregnancy, require fertility treatment and have an increased risk of pregnancy loss,” Vejen Hansen said. “However, we still don’t understand why. “We wanted to investigate whether asthma-related inflammation might also be present in the uterus and potentially affect the endometrium, which plays a crucial role in implantation and early pregnancy,” she said. “This study was our first step toward exploring that possible mechanism.” At baseline, significantly more women with vs. without asthma had a positive allergy skin test (70% vs. 13%; P = .006). Of the four assessed blood biomarkers, two were significantly higher in the group with vs. without asthma: IgE (median, 62 IU/L vs. 15 IU/L; P = .018) and eosinophils (median, 0.17 109/L vs. 0.07 109/L; P = .02). In contrast, infertility diagnosis types and fertility history did not significantly differ between the groups. In terms of pulmonary characteristics, measures that were significantly different in women with vs. without asthma included FeNO (median, 17 ppb vs. 11 ppb; P = .034), response dose ratio to methacholine (median, 0.02 vs. 0.01; P < .001), Asthma Control Questionnaire-5 median score (0.6 vs. 0; P = .001) and mini Asthma Quality of Life Questionnaire mean score (5.7 vs. 6.77; P = .001). In contrast, the two groups did not significantly differ in FEV1 percent predicted, FEV1/FVC ratio or sputum cell count (data available for 12 women in each group). During analysis of endometrial biopsies near ovulation from both populations, researchers found that inflammatory cell types in those with asthma did not significantly differ from the ones in those without asthma. The number of plasma cells, mast cells, CD3/T-lymphocytes, CD20/B-lymphocytes and eosinophils did not significantly differ between the two sets of women. “However, a consistent, though nonsignificant, trend towards lower cell counts was observed in the asthma group across several markers,” Vejen Hansen and colleagues wrote. “Given the small sample size, this finding should be interpreted with caution and may reflect random variation or underlying differences between groups.” Vejen Hansen told Healio that the lack of evidence of increased inflammatory cells in the endometrium of women with asthma was “somewhat unexpected.” “Although this was somewhat unexpected, it is an important finding because it suggests that the explanation for reduced fertility in women with asthma is likely more complex than simply increased inflammation in the uterine lining,” she told Healio. “It also helps guide future research toward other potential mechanisms.” Both groups also had similar endometrium thickness and dominant follicle size, and every woman had a normal 3D scan of the uterine endometrium. Further, researchers tested 141 associations between asthma and 47 biomarkers across tissue types, none of which were significant following multiple comparison adjustment. “This was a pilot study, so the next step is to investigate a larger cohort to confirm these findings,” Vejen Hansen told Healio. “Future studies should also look beyond inflammatory cell counts and explore how asthma may influence endometrial function, immune signaling, vascular biology and implantation. Ultimately, we hope this work will help identify the mechanisms underlying asthma-related infertility and pave the way for more targeted interventions.” For more information: Anne Vejen Hansen, MD, PhD, can be reached at [email protected].