Pengaruh Siklus Haid Terhadap Imunitas Mukosa Saluran Reproduksi
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Transcript of Pengaruh Siklus Haid Terhadap Imunitas Mukosa Saluran Reproduksi
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The Immune System inReproductive Tract Throughout
Menstrual Cycle
Budi Wiweko
Reproductive ImmunoendocrinologyDivisionDepartment of Obstetrics and Gynecology
Faculty of Medicine niversity ofIndonesia
Dr! "ipto Mangunkusumo General
#ospital
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Outline of this talk
%! Introduction
&! Immune system in female
reproductive tract
'! Menstrual cycle and femaleimmune system
(! )ake *ome messages
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Introduction
Immunesystem infemalereproductive
tract
Menstrualcycle andfemale
immunesystem
)ake *omemessages
Basic concept of mucosal immunity
+iyono et al! ,dv Drug Deliver Rev- %../
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)*e mucous membranes are one of t*elargest organs of t*e body
)*ey cover a surface area of more t*an
(00m&1e2uivalent to one and a *alf tenniscourts3
"omprise t*e linings of t*e gastrointestinal-
urogenital and respiratory tracts
Introduction
Immunesystem infemalereproductive
tract
Menstrualcycle andfemale
immunesystem
)ake *omemessages
Brandt4aeg! $ Reprod Immunol- %..5
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)*e mucous membranes produce a special type of
antibody called secretory Ig, or sIg,
)*is antibody is secreted as a dimer- 6oined at t*e non7
antigen binding end by a protein known as t*e $ c*ain
Introduction
Immunesystem infemalereproductive
tract
Menstrualcycle andfemale
immunesystem
)ake *omemessages
Brandt4aeg! $ Reprod Immunol- %..5
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)*e mucosal surfaces of t*e body are particularly
vulnerable to infection
)*ey are t*in and permeable barriers to t*einterior
of t*e body because of t*eir p*ysiological
activities gas e8c*ange 1t*e lungs3
food absorption 1t*e gut3
sensory activities 1eyes- nose- mout*- and t*roat3
reproduction 1uterus and vagina3
Introduction
Immunesystem infemalereproductive
tract
Menstrualcycle andfemale
immunesystem
)ake *omemessages
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Immune system of female reproductive tract ist*e 9rst line of defense against se8uallytransmitted
diseases 1:)Ds3
Introduction
Immunesystem infemalereproductive
tract
Menstrualcycle andfemale
immunesystem
)ake *omemessages
Bacteria
;iruses
:perm Fetus
,
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Introduction
Immunesystem infemalereproductive
tract
Menstrualcycle andfemale
immunesystem
)ake *omemessages
)*e female reproductive tract is a uni2ue
immunological site t*at is re2uired to protect t*e
mucosa from a variety of pat*ogens wit*out
compromising t*e development of an allogenically
distinct fetus
#ickey et al! $ Reprod Immunol- &0%%
There are more than 30 diferent types oparasites, bacteria and viruses that inect the emalereproductive tract
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Introduction
Immunesystem infemalereproductive
tract
Menstrualcycle andfemale
immunesystem
)ake *omemessages
"omponents of t*e *umoral and cellular immune
system are present t*roug*out t*e female genital
tract w*ic* is bot* an inductive and an e>ector site
for immune response
?*ongmin! "lin Immunol- &00%
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)*e mucosal immune system in genital tractconsist of
resident population of monocytes and ) cells in t*esubmucosa of t*e vagina and cervi8
)*ey are in
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Introduction
Immunesystem infemalereproductive
tract
Menstrualcycle andfemale
immunesystem
)ake *omemessages
)*e upper female reproductive tract- consisting of t*eFallopian tubes- uterine endometrium and endocervi8 islined by a single layer of columnar epit*elial cells linked bytig*t 6unctions
Overlying t*e cells is a protective mucus layer! :ecretion isgenerally preferential towards t*e apical@luminalcompartment wit* a gradient across t*e epit*elial layer
from lumen to tissue! nderlying t*e epit*elial cells areinnate and adaptive immune cells#ickey et al! $ Reprod Immunol- &0%%
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Introduction
Immunesystem infemalereproductive
tract
Menstrualcycle andfemale
immunesystem
)ake *omemessages
)*e lower female reproductive tract- consisting of t*eectocervi8 and vaginais covered by a layer of strati9ed
s2uamous epit*elial cells
:imilar to t*e upper female reproductive tract- epit*elialcells are protected by a mucus layer! )*e lower femalereproductive tract *as a resident commensal bacterialpopulation t*at produces lactic acid t*us lowering vaginal
p#! Below t*e epit*elial layer are innate and adaptiveimmune cells
#ickey et al! $ Reprod Immunol- &0%%
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Introduction
Immunesystem infemalereproductive
tract
Menstrualcycle andfemale
immunesystem
)ake *omemessages
)*e mucosa of vaginaand ectocervi8consist of keratini4ed- strati9ed s2uamousepit*elium and underlying vascularsubmucosa
Andocervi8consist of a simple columnarepit*elium covering a vascular submucosa
+iyono et al! ,dv Drug Deliver Rev- %../
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Introduction
Immunesystem infemalereproductive
tract
Menstrualcycle andfemale
immunesystem
)ake *omemessages
)*e innate immune responseof upper female reproductivetract epit*elial cells to an
invading pat*ogen! Apit*elialcells e8press a panel of)oll7likereceptors 1)Rs3 and RIG7likereceptors 1RRs3 t*at allowt*em to recogni4e and respondto bacteria or viruses
)*e )ype I interferon 1IFC3response 1green arrows- middlesection of panel "3 is a potentdefense system in femalereproductive tract cells!
,dditionally- in response topat*ogens and se8 *ormones-antimicrobials andcytokines@c*emokines aresecreted to confer broadspectrum protection#ickey et al! $ Reprod Immunol- &0%%
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Introduction
Immunesystem infemalereproductive
tract
Menstrualcycle andfemale
immunesystem
)ake *omemessages
Innate immune system competence is ofcritical importance in preventing microbial
penetration
In t*is conte8t- it is important to consider t*edi>erences in t*e microenvironments of t*e
sterileE upper and non7sterile
#orne et al! Reproduction- &00=
:I:ecretory leucocyte protease in*ibit
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TH !"#CTIO# $#% %ISTRIB"TIO# O! C&&S I# TH "''R!M$& R'RO%"CTI( TR$CT )!$&&O'I$# T"BS* "TRI#
$#% #%OCR(IC$& M"COS$+ $#% TH &O,R !M$&R'RO%"CTI( TR$CT )CTOCR(IC$& $#% ($-I#$&M"COS$+
#ickey et al! $ Reprod Immunol- &0%%
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Introduction
Immunesystem infemalereproductive
tract
Menstrualcycle andfemale
immunesystem
)ake *omemessages
Reproductive *ormones *ave been s*own to playkey
roles in t*e regulation of mucosal immunity of t*e
female genital tract
Astrogenincreasing selective transport of Ig,
into t*e cervical mucus
Franklin! $ Reprod Immunol- %...
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Introduction
Immunesystem infemalereproductive
tract
Menstrualcycle andfemale
immunesystem
)ake *omemessages
,dult women are moresusceptible to :)Isduring menses andt*e follicular p*ase-
and less likely to beinfected during t*eluteal p*ase
)*e concentration of genital tractimmunoglobulins in adult women are varyt*roug* t*e menstrual cycleand relatedto ovarian *ormone concentrations
:*rier et al! $ ,dolescent #ealt* Brief- &00'
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Introduction
Immunesystem infemalereproductive
tract
Menstrualcycle andfemale
immunesystem
)ake *omemessages
Mucosal Immunity of The
$dolescent!emale -enital Tract
ydia , :*rier- Frederick Bowman
$ournal of ,dolescent #ealt*- &00'
)*is study soug*t to c*aracteri4e mucosalimmunity of t*e adolescent genital tractsduring t*e cycle and determine ifadolescent *ave more suppressedimmunoglobulin level in t*e follicular p*aset*an adults
,dolescent *ad a greater drop in IgG in t*efollicular p*ase and may be more sensitive
to estradiol t*an adults
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Introduction
Immunesystem infemalereproductive
tract
Menstrualcycle andfemale
immunesystem
)ake *omemessages
:e8ually transmitted infections 1:)Is3
disproportionately a>ect female adolescents
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Introduction
Immunesystem infemalereproductive
tract
Menstrualcycle andfemale
immunesystem
)ake *omemessages
B cell numbers and activity mig*t increase in t*e peri7
ovulatory period!
Monocyte numbers increase during t*e luteal p*ase-
w*ile t*eir I7% and )CFH production develop in opposing
fas*ion
Results on C+ cell number and activity *ave been
con
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Introduction
Immunesystem infemalereproductive
tract
Menstrualcycle andfemale
immunesystem
)ake *omemessages
In t*e case of autoimmune conditions- :A and M:appear to worsen premenstrually- w*ile R, worsensduring menstruation
rigione! ,utoimmune reviews- &0%&
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Introduction
Immunesystem infemalereproductive
tract
Menstrualcycle andfemale
immunesystem
)ake *omemessages
Characteri.ation of
immunoglobulins and cytokinesin human cervical mucus/
in0uence of e1ogenous andendogenous hormone
RD Franklin- W# +utte*
$ournal of Reproductive Immunology- %...
)*is study soug*t to determine t*e e>ect ofe8ogenous *ormoneson reproductive tractimmunity in women on O" and tocompare t*e results wit* respects tonaturally cycling women
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Introduction
Immunesystem infemalereproductive
tract
Menstrualcycle andfemale
immunesystem
)ake *omemessages
)*e peak concentration of Ig, and IgG occurred
appro8imately one day before t*e estradiol peak6ust
before ovulation
Franklin! $ Reprod Immunol- %...
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Introduction
Immunesystem infemalereproductive
tract
Menstrualcycle andfemale
immunesystem
)ake *omemessages
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Introduction
Immunesystem infemalereproductive
tract
Menstrualcycle andfemale
immunesystem
)ake *omemessages
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Introduction
Immunesystem infemalereproductive
tract
Menstrualcycle andfemale
immunesystem
)ake *omemessages
Distribution of ) cells at di>erent sites of t*e lowerreproductive tract during various stages of menstrualcycle
Ma et al! "lin Immunol- &00%
Cormal
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Introduction
Immunesystem infemalereproductive
tract
Menstrualcycle andfemale
immunesystem
)ake *omemessages
%! Immune response in t*e female reproductivetract must deal wit* potential bacterial andviral pat*ogens- allogeneic spermato4oa andimmunologically distinct fetus
&! Immunoglobulins in t*e cervical mucusreac*ed peak levels before ovulation
'! "*anges in t*e concentration ofimmunoglobulin in cervicovaginal secretions
are not due to c*anges of t*e immune cellspopulation in t*e genital tract at di>erenttime of cycles
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TH$#2 3O"
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TH$#2 3O