The Expression And Significance Of Calreticulin Integrin-associated Protein And Thrombospondin-1in Human Decidual Tissue Of Missed Abortion

BackgroundAfter more than30years’development, assisted reproductive technology has become an important means for the infertile patients to have their own offspring. The clinical pregnancy rate was kept stable at about50%. But According to the literature, the early miscarriage rate is high as18%-30%, which seriously affects the ongoing pregnancy rate, while early miscarriage rate of natural pregnancy is only about12%-15%.Missed abortion is a common type of pathological pregnancy in clinical obstetrics and gynecology. In most cases, it happens within12weeks of pregnancy. Many complicated factors may trigger it, including embryonic chromosomal abnormalities, maternal reproductive tract infections, endocrine abnormalities, immune imbalance of maternal-fetal, abnormal apoptosis, uterine placental circulation disorders, environmental factors, etc. The current studies on early pregnancy loss mainly focus on the early embryonic abnormality and immune imbalance of maternal-fetal. Early studies suggest that the embryonic chromosomal abnormalities rates of missed abortion between ART and natural pregnancy show no significant differences. Then, are there any factors causing the higher rate of missed abortion of ART? Therefore, the research on the decidua growth, degradation and regulation mechanisms for clear embryo implantation has great significance.Calreticulin is one of the calcium-binding chaperones of endoplasmic reticulum and can have according biological effects through subcellular localization. Calreticulin participates in antigen presentation, Inhibition of angiogenesis and apoptosis. Integrin-associated protein (IAP) can regulate protein binding through inhibiting the expression signals and reduce the phagocytic activity of macrophages by the expression of the inhibitory-regulatory signals. Thrombospondin-1(TSP-1) can mediate cell adhesion, activate TGF-3, inhibit cell proliferation of vascular endothelial. Then, is there a similar protein expression in the decidua? The effects of the expressions of calreticulin, Integrin-associated protein and Thrombospondin-1on the process of pregnancy establishing and maintaining are rarely mentioned.ObjectiveThe thesis aims to contrast the expression differences of CRT, IAP and TSP-1in the decidua between the normal early pregnancy and early missed abortion patients though checking their decidual tissue expressions of CRT, IAP and TSP-1after excluding the factor of embryonic chromosomal abnormalities; so as to analyze the relations between the abnormal expressions of the CRT, IAP and TSP-1and missed abortion. Therefore, the author is trying to provide a new perspective for the study of the pathogenesis of missed abortion and to provide a new theoretical basis in clinical and scientific research to increase the pregnancy rate of ART.Materials and methodsThis study collected the data of54patients who accepted abortion during the period from July2012to January2013at the First Affiliated Hospital of Zhengzhou University. The research involves two research groups:missed abortions of ART:27patients with missed abortion after accepted ART; missed abortions of natural pregnancy:27patients with missed abortions after natural pregnancy. Both of the Research groups were excluded from the embryonic chromosomal abnormalities. The control group includes30patients accepted the voluntary abortions for personal reasons. The electrochemical luminescence method is used to detect injection take lining, serum human choronic gonadotrophin-beta (β-HCG) and to measure the gestational sac and crown-rump length with the vagina two-dimensional ultrasound before surgical abortions. Isolated decidua tissue was divided into two parts after irrigation with physiological saline. One part of the tissue was detected the content of CRT, LAP and TSP-1by immunohistochemical method after4%paraformaldehyde-flxed, embedded in paraffin and sliced. The other part was sent to pathological examination. The SPSS12.0was used to analyze the experiment data.Results1. There were no significant differences among study groups and control group in the aspects of age, body mass index, the number of days of pregnancy (P>0.05). The gestational sac the average diameters and serum beta-hCG levels of missed abortions were below the level of the control group on the day of surgery (F=32.312, P=0.000; F=56.606, P=0.000).2. CRT IAP and TSP-1positively expressed in the cytoplasm and membrane of decidua. The CRT and TSP-1expressions of missed abortions of ART and missed abortions of natural pregnancy were significant higher than the control group. The LAP expressions of missed abortions of ART and missed abortions of natural pregnancy were lower than the control group (F=115.580, P=0.000; F=1255.696, P=0.000; F=604.99, P=0.000).(P<0.05). The expressions of three proteins in decidua of missed abortions of ART and missed abortions of natural pregnancy showed no significant difference (P>0.05).3. CRT and IAP expressed significant inverse correlation of the two missed abortion groups (r=-0.647, P=0.000; r=-0.474,P=0.013). CRT and IAP expressed significant positive correlation of normal pregnancy (r=0.328, P=0.028).Conclusion1. Patients with missed abortions could terminate their pregnancy through early pregnancy serum β-hCG and gestational sac average diameter line.2. The expression of CRT and of TSP-1in the decidua of patients with missed abortions were higher than that of normal pregnancy, The expression of IAP the decidua of patients with missed abortions is lower than that of normal pregnancy, which suggests that abnormal levels of the three protein may be involved in the incidence of missed abortion.3. The expressions of CRT and IAP in the decidua of patients with missed abortions have a negative correlation. Besides, there may be some mechanisms regulating their expressions in the decidua and remain stable of the maternal cells in maternal-fetal.