Is there an association between Chlamydia trachomatis load and in situ expression of cyclooxygenase/inflammatory cytokines in first trimester aborters

Abstract

Background: Colonization of Chlamydia trachomatis genital tract infection during pregnancy is associated with adverse obstetric outcomes in women; however, despite clear association between C. trachomatis and spontaneous abortion (SA), study on C. trachomatis load in first trimester abortion remains meagre. The reported occurrence of sporadic/recurrent SA (SSA/RSA) in C. trachomatis-positive women emphasize the need to identify chlamydial load and possible immunomolecular pathway in early SSA/RSA. The study aims to find whether there is association between C. trachomatis load and in situ expression of cyclooxygenase (cox)-2/pro-inflammatory cytokines in C. trachomatis-positive SSA/RSA. Methods and materials: 150 women experiencing SA, viz.: SSA (n = 70) and RSA (n = 80) during first trimester were enrolled from Gynecology Receiving Room (GRR), Department of Obstetrics and Gynecology, Safdarjung hospital, New Delhi (India) after obtaining hospital ethical permission and prior informed written consent from each patient. Endometrial curettage tissue (ECT) was collected for detection of C. trachomatis load and in situ expression of cox-2 and pro-inflammatory cytokines, viz.: IFN-γ/TGF-b1 in each patient by quantitative real time (qRT) PCR. Data was statistically analyzed. Results: C. trachomatis plasmid gene (200 bp) was found in 12.8% and 15% of SSA and RSA respectively; while 1–4/4–12 copies of C. trachomatis were detected in SSA/RSA respectively. Significant upregulation of cox-2/IFN-γ/TGF-b1 gene was found in C. trachomatis-positive RSA versus SSA (‘p’ < 0.0001). After controlling for confounding variables, linear regression analysis showed that C. trachomatis copy load in SSA/RSA was significantly associated with cox-2/IFN-γ/TGF-b1. Significant positive correlation was observed between C. trachomatis copy load and cox-2/IFN-γ/TGF-b1 gene (‘p’ < 0.0001) in SSA/RSA. Conclusion: Findings delineated that C. trachomatis load during early pregnancy is clearly associated with elevated cytokines and cox-2 in SSA/RSA, thereby accelerating endometrial contractions and ultimately resulting in SA. Hence, it is suggested that investigation of C. trachomatis load in SSA/RSA should be undertaken in first trimester of pregnancy for better clinical management of SA.