Loss of Endometrial Plasticity in Recurrent Pregnancy Loss.

Menstruation drives cyclic activation of endometrial progenitor cells, tissue regeneration, and maturation of stromal cells, which differentiate into specialized decidual cells prior to and during pregnancy. Aberrant responsiveness of human endometrial stromal cells (HESCs) to deciduogenic cues is strongly associated with recurrent pregnancy loss (RPL), suggesting a defect in cellular maturation. MeDIP-seq analysis of HESCs did not reveal gross perturbations in CpG methylation in RPL cultures, although quantitative differences were observed in or near genes that are frequently deregulated in vivo. However, RPL was associated with a marked reduction in methylation of defined CA-rich motifs located throughout the genome but enriched near telomeres. Non-CpG methylation is a hallmark of cellular multipotency. Congruently, we demonstrate that RPL is associated with a deficiency in endometrial clonogenic cell populations. Loss of epigenetic stemness features also correlated with intragenic CpG hypomethylation and reduced expression of HMGB2, coding high mobility group protein 2. We show that knockdown of this sequence-independent chromatin protein in HESCs promotes senescence and impairs decidualization, exemplified by blunted time-dependent secretome changes. Our findings indicate that stem cell deficiency and accelerated stromal senescence limit the differentiation capacity of the endometrium and predispose for pregnancy failure.

An evaluation of luminol formulations and their effect on DNA profiling.

Luminol is a presumptive test reagent used for the location of latent bloodstains. Various formulations are used by different forensic practitioners and commercial products are also widely available. There is little concurrence between authors with regards to the sensitivity limits of luminol which can vary significantly depending upon the substrate. We evaluated the sensitivity and stability of five different luminol formulations on a range of blood dilutions. All formulations showed an overall decrease in performance over 24 h though the effect was more gradual on a non-porous surface compared to porous. We found that BlueStar® Magnum showed the greatest sensitivity compared to other formulations and detected 50 µl of 1/100,000 blood dilutions on both porous and non-porous surfaces. Two formulations of luminol were selected based on the result of the sensitivity and stability study and were assessed for their impact on the DNA profiling process. There was a statistically significant improvement in DNA profile peak area from luminol-treated samples when compared to control samples of neat blood stains. However, at the weaker blood dilution of 1/1,000, the difference between control and luminol-treated samples was dependent on the substrate type with porous (fabric) samples showing a significant difference and non-porous (tile) swabbed samples requiring further work to conclusively ascertain the effect.

Standardisation of uterine natural killer (uNK) cell measurements in the endometrium of women with recurrent reproductive failure.

Considerable work is being carried out on endometrial NK cells to determine whether they play a role in successful pregnancy outcome. In addition there is debate about whether measurements of uNK should be included in the clinical assessment for women with recurrent implantation failure or recurrent miscarriage. A hindrance to taking this forward is the fact that the density of uNK cells reported by different centres is very different. The aim of this study was to determine the reason for these differences and to develop a standardised method. Three centres participated in the study. Each centre exchanged five formalin fixed, wax embedded sections of endometrium from five women. Sections were immunostained for CD56. Images were taken of 10 random fields at ×400 magnification; total stromal and uNK cells were counted using Image J. Results were expressed as % positive uNK cells and the variation in counts obtained in each centre was compared. After initial analysis a standardised protocol was agreed and the process repeated. Significant variation was seen in the counts obtained after initial analysis (Centre A vs.B, mean difference=-0.72 P<0.001; A vs.C mean difference=-0.47 P<0.001; B vs.C, mean difference=0.25 P=0.085). Analysis suggested that differences may be due to duration of tissue fixation, the embedding and sectioning processes, selection of areas for assessment, definition of immunopositive cells and inclusion or exclusion of blood vessels. Adoption of a standardised protocol reduced the variation (Centre A vs.B mean difference=-0.105 P=0.744; A vs.C mean difference=0.219 P=0.150; B vs.C mean difference=0.32 P=0.031). Use of a standardised method is needed to establish a normal range for uNK cells and to develop a meaningful clinical test for uNK cell measurements.

Localisation of luminal epithelium edge in digital histopathology images of IHC stained slides of endometrial biopsies.

Diagnosis of recurrent miscarriage due to abnormally high number of uterine natural killer (uNK) cells has recently been made possible by a protocol devised by Quenby et al. Hum Reprod 2009;24(1):45-54. The diagnosis involves detection and counting of stromal and uNK cell nuclei in endometrial biopsy slides immunohistochemically stained with haematoxylin for staining cell nuclei and CD56 as a marker for the uNK cells. However, manual diagnosis is a laborious process, fraught with subjective errors. In this paper, we present a novel method for detection of uterine natural killer (uNK) cells in the human female uterus lining and localisation of the luminal epithelium edge in endometrial biopsies. Specifically, we employ a local phase symmetry based method to detect stromal cell nuclei and propose an adaptive background removal method that significantly eases the segmentation of uNK cell nuclei regions. We also propose a novel method using alpha shapes for the identification of epithelial cell nuclei and B-Spline curve fitting on identified cell nuclei to localise the luminal epithelium edge. The objective of edge localisation is to avoid cell nuclei near the luminal epithelium edge being counted in the diagnosis process due to their non-relevance to the calculation of stromal to uNK cell ratio that determines the diagnosis of recurrent miscarriages in the end. The resulting algorithm offers a promising potential for computer-assisted diagnosis of recurrent miscarriage due to its high accuracy.