Modulação da resposta inflamatória no útero de éguas tratadas com plasma rico em plaquetas
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Data
2021-04-15
Autores
Segabinazzi, Lorenzo Garrido Teixeira Martini [UNESP]
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Editor
Universidade Estadual Paulista (Unesp)
Resumo
A endometrite é a causa mais comum de subfertilidade em éguas. Todas as éguas apresentam uma inflamação endometrial fisiológica pós-cobertura; entretanto, 15-20% das éguas têm endometrite persistente pós-cobertura (EPPC). Recentemente, o plasma rico em plaquetas (PRP) vêm se tornando popular no manejo reprodutivo de éguas susceptíveis a EPPC. Atualmente, não existe uma padronização dos métodos de preparação do PRP para uso intrauterino em éguas. Desta forma, este estudo teve como objetivo comparar três métodos de preparação de PRP para infusão intrauterina em éguas e avaliar a resposta inflamatória pós-cobertura, cultura endometrial e recuperação embrionária em éguas suscetíveis a EPPC tratadas com PRP. No primeiro estudo, o PRP foi produzido por três métodos. Método 1, o sangue foi coletado em bolsa de transfusão, transferido para tubos Falcon e duplamente centrifugadas; Método 2, sangue foi coletado em tubos vacutainer e centrifugado uma única vez; Método 3 sangue foi coletado em uma seringa de 60 mL contendo anticoagulante, a qual foi mantida em posição vertical para sedimentar por 4h. Após o processamento, a contagem de células e a viabilidade plaquetária foram avaliadas. Em um subgrupo de éguas (n = 6), o PRP foi avaliado 6 e 24h pós-refrigeração a 5 °C. No estudo 2, éguas (n = 12) suscetíveis a EPPC tiveram três ciclos atribuídos aleatoriamente para receber infusões intrauterinas de LRS (controle), ou PRP autólogo ou plasma pobre em plaquetas (PPP) antes (48 e 24h) e após a inseminação artificial (IA) (6 e 24h). Tanto o PRP quanto o PPP foram obtidos pelo Método 1 no experimento 2. As éguas foram inseminadas com sêmen fresco de um garanhão com fertilidade conhecida. O acúmulo de líquido intrauterino (IUF) e as células polimorfonucleares endometriais (PMNs) foram avaliados a cada 24h até 96h pós-inseminação. Citocinas uterinas (Ilβ, IL6, CXCL8 e IL10) foram avaliadas antes (0h), 6 e 24h após IA, e cultura endometrial três e nove dias após IA. A lavagem do embrião foi realizada 8 dias após a ovulação. Os dados foram analisados com modelo misto, teste post-hoc de Tukey’s e regressão multivariada. No estudo 1, o Método 1 resultou no maior e o método 3 nas menores concentrações de plaquetas, e o último teve maior concentração de leucócitos que os outros (P<0,05). A viabilidade das plaquetas foi semelhante entre os tratamentos. O resfriamento por 24h não afetou a contagem de plaquetas. No entanto, a viabilidade plaquetária foi reduzida após o resfriamento do PRP produzido pelo método 3. Estudo 2, o tratamento com PRP reduziu os PMNs endometriais, IUF pós-reprodução e citocinas pró-inflamatórias quando comparados aos ciclos atribuídos pelo controle, mas não significativamente diferente do PPP. Os controles tiveram uma porcentagem significativamente maior de culturas bacterianas positivas (33%) em comparação com os ciclos atribuídos a PRP (0%), enquanto os ciclos tratados com PPP não foram significativamente diferentes dos outros grupos (25%). Os ciclos atribuídos ao PRP tiveram taxas de recuperação embrionária significativamente maiores (83%) do que o controle (33%), embora não significativamente diferente do PPP (60%). Em conclusão, o Método 1 resultou nas maiores concentrações de plaquetas, enquanto o método 3 resultou em maiores contagens de leucócitos. O resfriamento afetou a viabilidade das plaquetas no PRP obtido com o método 3. Resta determinar se os diferentes métodos e o resfriamento afetariam a eficácia clínica do PRP. A infusão de plasma reduziu a duração e intensidade da resposta inflamatória pós-IA e melhorou a recuperação embrionária em éguas suscetíveis a EPPC. As plaquetas parecem ter uma propriedade antimicrobiana e anti-inflamatória dependente da dose.
Endometritis is the most common cause of subfertility in mares. All mares display a physiological post-breeding endometrial inflammation; however, 15-20% of mares have persistent breeding-induced endometritis (PBIE). Recently, platelet-rich plasma (PRP) is becoming popular in mare practice to mitigate post-breeding induced endometritis and improve fertility. Currently, there is no standardization of methods to prepare PRP for intrauterine use in mares. This study aimed to compare three methods to prepare PRP for intrauterine infusion in mares and to assess the post-breeding inflammatory response, endometrial culture and embryo recovery in mares susceptible to PBIE treated with PRP. In the first study, PRP was produce by three methods. Method 1, blood was collected in blood transfusion bag, transferred to Falcon tubes and double centrifuged; Method 2, blood was collected in vacutainer tubes and centrifuged once; Method 3, blood was collected in a syringe containing anticoagulant, which was kept in an upright-position to sediment for 4h. After processing, cell counts and platelet viability were assessed. In a subset of mares (n=6), PRP was evaluated at 6 and 24h post-cooling at 5°C. In study 2, mares (n=12) susceptible to PBIE had three cycles randomly assigned in a crossover design to receive intrauterine infusions of LRS (control), or autologous PRP or platelet-poor plasma (PPP) pre- (48 and 24h) and post-breeding (6 and 24h). Both PRP and PPP were obtained by Method 1. Mares were bred with fresh semen from one stallion. Intrauterine fluid accumulation (IUF) and endometrial polymorphonuclear cells (PMNs) were assessed every 24h up to 96h post-breeding. Uterine cytokines (Ilβ, IL6, CXCL8 and IL10) were evaluated before (0h), 6 and 24h post-breeding, and endometrial culture three and nine-days after breed. Embryo flushing was performed 8d post-ovulation. Data were analyzed with mixed model, Tukey’s post-hoc test, and multivariate regression. In study 1, Method 1 resulted in the greatest and method 3 in the fewest platelet concentrations, and the latter had greater WBC than the others (P<0.05). Platelet viability was similar across treatments. Cooling for 24h did not affect platelet counts. However, platelet viability was reduced after cooling PRP produced by method 3. Study 2, PRP treatment reduced endometrial PMNs, post-breeding IUF and pro-inflammatory cytokines when compared to control-assigned cycles, but not significantly different than PPP. Controls had a significantly higher percentage of positive bacterial cultures (33%) in comparison to PRP-assigned cycles (0%), whereas cycles treated with PPP were not significantly different from the other groups (25%). The PRP-assigned cycles had significantly higher embryo recovery rates (83%) than the control (33%), though not significantly different than PPP (60%). In conclusion, Method 1 resulted in the greatest platelet concentrations, while method 3 resulted had greater WBC counts. Cooling affected platelet viability in PRP obtained with method 3. It remains to be determined whether the different methods and cooling would affect PRP's clinical efficacy. Plasma infusion reduced the duration and intensity of the post-breeding inflammatory response and improved embryo recovery in mares susceptible to PBIE. Platelets incrementally downregulate PBIE and appear to have a dose-dependent antimicrobial property.
Endometritis is the most common cause of subfertility in mares. All mares display a physiological post-breeding endometrial inflammation; however, 15-20% of mares have persistent breeding-induced endometritis (PBIE). Recently, platelet-rich plasma (PRP) is becoming popular in mare practice to mitigate post-breeding induced endometritis and improve fertility. Currently, there is no standardization of methods to prepare PRP for intrauterine use in mares. This study aimed to compare three methods to prepare PRP for intrauterine infusion in mares and to assess the post-breeding inflammatory response, endometrial culture and embryo recovery in mares susceptible to PBIE treated with PRP. In the first study, PRP was produce by three methods. Method 1, blood was collected in blood transfusion bag, transferred to Falcon tubes and double centrifuged; Method 2, blood was collected in vacutainer tubes and centrifuged once; Method 3, blood was collected in a syringe containing anticoagulant, which was kept in an upright-position to sediment for 4h. After processing, cell counts and platelet viability were assessed. In a subset of mares (n=6), PRP was evaluated at 6 and 24h post-cooling at 5°C. In study 2, mares (n=12) susceptible to PBIE had three cycles randomly assigned in a crossover design to receive intrauterine infusions of LRS (control), or autologous PRP or platelet-poor plasma (PPP) pre- (48 and 24h) and post-breeding (6 and 24h). Both PRP and PPP were obtained by Method 1. Mares were bred with fresh semen from one stallion. Intrauterine fluid accumulation (IUF) and endometrial polymorphonuclear cells (PMNs) were assessed every 24h up to 96h post-breeding. Uterine cytokines (Ilβ, IL6, CXCL8 and IL10) were evaluated before (0h), 6 and 24h post-breeding, and endometrial culture three and nine-days after breed. Embryo flushing was performed 8d post-ovulation. Data were analyzed with mixed model, Tukey’s post-hoc test, and multivariate regression. In study 1, Method 1 resulted in the greatest and method 3 in the fewest platelet concentrations, and the latter had greater WBC than the others (P<0.05). Platelet viability was similar across treatments. Cooling for 24h did not affect platelet counts. However, platelet viability was reduced after cooling PRP produced by method 3. Study 2, PRP treatment reduced endometrial PMNs, post-breeding IUF and pro-inflammatory cytokines when compared to control-assigned cycles, but not significantly different than PPP. Controls had a significantly higher percentage of positive bacterial cultures (33%) in comparison to PRP-assigned cycles (0%), whereas cycles treated with PPP were not significantly different from the other groups (25%). The PRP-assigned cycles had significantly higher embryo recovery rates (83%) than the control (33%), though not significantly different than PPP (60%). In conclusion, Method 1 resulted in the greatest platelet concentrations, while method 3 resulted had greater WBC counts. Cooling affected platelet viability in PRP obtained with method 3. It remains to be determined whether the different methods and cooling would affect PRP's clinical efficacy. Plasma infusion reduced the duration and intensity of the post-breeding inflammatory response and improved embryo recovery in mares susceptible to PBIE. Platelets incrementally downregulate PBIE and appear to have a dose-dependent antimicrobial property.
Descrição
Palavras-chave
PRP, Endometrite infecciosa, Bactéria, Inflamação uterina, Imunomodulação, Equino, Infectious endometritis, Uterine inflammation, Immunomodulators, Equine