Premature Ovarian Failure and Ovarian Autoimmunity

Hoek, Annemieke

doi:10.1210/er.18.1.107

Cited by 212 publications

(246 citation statements)

References 103 publications

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“…31 Lymphocytic infiltration seems to occur only in women with serum ACA and SC antibodies. 21,32 Additionally, it is reported that primordial follicles are spared, while growing preantral and antral follicles are either destroyed and/or undergo cystic luteinization of granulosa cells. 7,19,20,31,33 (see Figures 1 and 4 for histological features of the ovary).…”

Section: Autoimmune Oophoritis As a Cause For Primary Ovarian Insuffimentioning

confidence: 99%

Ovarian autoimmune disease: clinical concepts and animal models

et al. 2014

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The ovary is not an immunologically privileged organ, but a breakdown in tolerogenic mechanisms for ovary-specific antigens has disastrous consequences on fertility in women, and this is replicated in murine models of autoimmune disease. Isolated ovarian autoimmune disease is rare in women, likely due to the severity of the disease and the inability to transmit genetic information conferring the ovarian disease across generations. Nonetheless, autoimmune oophoritis is often observed in association with other autoimmune diseases, particularly autoimmune adrenal disease, and takes a toll on both society and individual health. Studies in mice have revealed at least two mechanisms that protect the ovary from autoimmune attack. These mechanisms include control of autoreactive T cells by thymus-derived regulatory T cells, as well as a role for the autoimmune regulator (AIRE), a transcriptional regulator that induces expression of tissue-restricted antigens in medullary thymic epithelial cells during development of T cells. Although the latter mechanism is incompletely defined, it is well established that failure of either results in autoimmune-mediated targeting and depletion of ovarian follicles. In this review, we will address the clinical features and consequences of autoimmune-mediated ovarian infertility in women, as well as the possible mechanisms of disease as revealed by animal models.

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Section: Autoimmune Oophoritis As a Cause For Primary Ovarian Insuffimentioning

confidence: 99%

Ovarian autoimmune disease: clinical concepts and animal models

et al. 2014

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“…Idiopathic POF not associated with autoimmune diseases is often referred to as isolated POF. The majority of patients with POF associated with autoimmune AD have steroid-producing cell Abs (StCA) (6). In contrast, StCA are found in 1-10% of patients with POF associated with other autoimmune diseases or patients with isolated POF (5,6).…”

Section: Introductionmentioning

confidence: 99%

“…The major autoantigen targets of StCA are steroid 17a-hydroxylase (17a-OH) and cytochrome P450 side-chain cleavage enzyme (P450scc) (8,9). The presence of StCA in sera from patients with POF is associated with lymphocytic oophoritis (5,6,10).…”

Section: Introductionmentioning

confidence: 99%

Autoantibodies to steroidogenic enzymes in patients with premature ovarian failure with and without Addison's disease

Prà

Chen²,

Furmaniak³

et al. 2003

European Journal of Endocrinology

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Design: Adrenal cortex autoantibodies (ACA), steroid-producing cell autoantibodies (StCA) and autoantibodies (Abs) to steroidogenic enzymes in three groups of patients with premature ovarian failure (POF), 15 with autoimmune Addison's disease (AD), 26 with non-adrenal autoimmune diseases and 31 with isolated POF, have been assessed. Methods: ACA and StCA were measured using an immunofluorescence technique. Abs to 21-hydroxylase (21-OH), to 17a-hydroxylase (17a-OH) and to cytochrome P450 side-chain cleavage (P450scc) were measured using an immunoprecipitation assay. Results: Seventy-three percent of patients with POF and AD were positive for StCA, 93% for 17a-OH and/or P450scc Abs, 93% for ACA and 100% for 21-OH Abs. Among patients with POF and nonadrenal autoimmune diseases, 8% were positive for StCA, 12% for 17a-OH and/or P450scc Abs, and 8% and 12% for ACA and 21-OH Abs respectively. StCA, 17a-OH and/or P450scc Abs were all found in 10% of patients with isolated POF, and 13% had ACA and 21-OH Abs. All StCA-, 17a-OH-and/or P450scc Abs-positive patients were also positive for ACA and 21-OH Abs. Two patients with isolated POF who were ACA and 21-OH Ab positive developed AD 3 and 5 years after the onset of POF. Conclusion: This study has shown that, when POF is associated with AD, StCA, 17a-OH and/or P450scc Abs are present in the majority of patients, while in the other two groups these Abs are detectable in a much lower proportion of patients. Measurement of ACA/21-OH Abs in some patients with POF may be important in identifying patients at risk of developing overt AD.

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“…Corticosteroids are shown to stimulate estradiol and progesterone productions, which are immunoregulating biomolecules, during pregnancy, as it's well known that progesterone is needed to maintain pregnancy [19]. There are numerous anecdotal reports of successful treatment of POF/POI and infertility with low-dose corticosteroid immunosuppression [20]. Women with POF/POI were treated with immunosuppression without screening for ovarian autoimmunity and two pregnancies occurred in 11 women [21].…”

Section: Discussionmentioning

confidence: 99%

Can anti-ovarian antibody testing be useful in an IVF-ET clinic?

Pires

Parikh

Mande

et al. 2010

J Assist Reprod Genet

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Objective To establish importance of anti-ovarian antibodies (AOA) testing in infertile women. Design A clinical reproductive outcome comparative study between two groups of women undergoing IVF-ET. Group 1 consists of women tested positive for AOA, put on corticosteroid therapy, reverted to AOA negative and then taken up for IVF-ET. Group 2 were seronegative for AOA. Setting Major urban infertility reference centre and National research institute. Results AOA positive serum samples were sent periodically to re-investigate presence of AOA after corticosteroid therapy and women turned AOA negative were taken up for IVF-ET. Of the 70/138 women in group 1 who were treated with corticosteroids and turned seronegative for AOA, 22/70 were poor responders and needed donor oocyte-recipient cycles. Results demonstrated that fertilization and clinical pregnancy rates between both groups are comparable. Nevertheless, it is also observed that there is poor response to stimulation protocol, smaller number of oocytes retrieved and more spontaneous abortions in group 1 women. Hence not all outcomes following the treatment are comparable between the two groups. Usefulness of the test was established in two case studies. Conclusions AOA testing could be included in the battery of tests investigating and treating infertility.

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Premature Ovarian Failure and Ovarian Autoimmunity

Cited by 212 publications

References 103 publications

Ovarian autoimmune disease: clinical concepts and animal models

Ovarian autoimmune disease: clinical concepts and animal models

Autoantibodies to steroidogenic enzymes in patients with premature ovarian failure with and without Addison's disease

Can anti-ovarian antibody testing be useful in an IVF-ET clinic?

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