Mecanismos de modulación de la respuesta inmune por Chlamydia trachomatis asociados a infertilidad

Autores/as

  • Tatiana Marcela López-Castro
  • Ever Leonardo Rojas-Díaz
  • Fabio Noriel Rojas-rojas
  • Ivonne J. Díaz-Yamal
  • Jairo Muñoz-Cerón

DOI:

https://doi.org/10.18597/rcog.139

Palabras clave:

Chlamydia trachomatis, infertilidad, inmunidad innata, inmunidad adquirida, infección

Resumen

Introducción: la infertilidad, problema clínico y social que afecta del 13 al 15% de las parejas en el mundo, es causada, entre otros, por la enfermedad pélvica inflamatoria ocasionada por varios agentes infecciosos entre los cuales se destaca la Chlamydia trachomatis. Este agente infeccioso posee mecanismos moleculares con los cuales modula la respuesta inmune del huésped y produce cambios en la célula infectada para permitir su supervivencia, ocasionando que la respuesta del sistema inmunológico se establezca en forma crónica, con la consecuente inflamación permanente y con ello secuelas como cicatrices y obstrucción de la trompa de Falopio. El objetivo de esta revisión es ofrecer una actualización de conocimiento en inmunobiología de la infección por Chlamydia trachomatis y su relación con la infertilidad.

Materiales y métodos: se realizó una revisión de la literatura en diferentes bases de datos: PubMed/ Medline, Science Direct, Ovid, desde enero del año 1995 a enero del 2012, incluyendo artículos de revisión y estudios clínicos.

Resultados: en la actualidad se sostiene que la inmunomodulación que caracteriza la infección por Chlamydia trachomatis, los mediadores inflamatorios implicados en la respuesta inmune, y la posible aunque poco estudiada susceptibilidad genética del huésped, se relacionan estrechamente con la génesis de la infertilidad por factor tubárico.

Conclusión: la infertilidad causada por Chlamydia trachomatis tiene su origen en la respuesta inmunológica del huésped y en la modulación por parte de este agente infeccioso, lo que lleva a inflamación crónica, cicatrización y obstrucción de la trompa de Falopio.

Biografía del autor/a

Tatiana Marcela López-Castro

Fellowship en salud reproductiva y humana, Fundación Universitaria Sanitas. Bogotá, Colombia.

Ever Leonardo Rojas-Díaz

Estudiante X semestre, Facultad de Medicina, Fundación Universitaria Sanitas. Bogotá, Colombia.

Fabio Noriel Rojas-rojas

Residente de Ginecología y Obstetricia I año, Fundación Universitaria Sanitas. Bogotá, Colombia.

Ivonne J. Díaz-Yamal

Coordinadora Fellow en Salud Reproductiva y Humana, Fundación Universitaria Sanitas. Bogotá, Colombia.

Jairo Muñoz-Cerón

Inmunólogo y microbiólogo. Docente, Fundación Universitaria Sanitas. Bogotá, Colombia.

Referencias bibliográficas

Abdel Rahman YM, Belland RJ. The chlamydial developmental cycle FEMS Microbiol Rev 2005;29:949-59.

Centers for Disease Control, Division of Sexually transmitted Diseases: STD treatment guidelines. MMWR 1995;34(4S).

Raulston JE. Chlamydial envelope components and pathogen - host cell interactions. Mol Microbiol 1995;15:607-16.

Nichols BA, Setzer PY, Pang F, Dawson CR. New view of the surface projections of Chlamydia trachomatis. J Bacteriol 1998;164:344-9.

Ghuysen JM, Goffin C. Lack of cell wall peptidoglycan versus penicillin sensitivity: new insights into the chlamydial anomaly. Antimicrob Agents Chemother 1999;43:2339-44.

Schachter J. Infection and disease epidemiology. En: Stephens RS. Editor. Chlamydia: intracellular biology, pathogenesis and immunity. Washington, DC: American Society of Microbiology; 1999. p. 139-69.

Capmany A, Leiva N, Damiani MT. Golgi-associated Rab14, a new regulator for Chlamydia trachomatis infection outcome. Commun Integr Biol 2011;4:590-3.

Linhares IM, Witkin SS. Immunopathogenic consequences of Chlamydia trachomatis 60 kDa heat shock protein expression in the female reproductive tract. Cell Stress and Chaperones 2010;15:467-73.

Morré SA, van den Brule AJ, Rozendaal L, Boeke AJ, Voorhorst FJ, de Blok S, et al. The natural course of asymptomatic Chlamydia trachomatis infections: 45% clearance and no development of clinical PID after one-year follow-up. Int J STD AIDS 2002;13:12-8.

Kamel RM. Management of the infertile couple: an evidence-based protocol. Reprod Biol Endocrinol 2010;8:21.

Irvine S. Guidelines in the treatment of male infertility. Int Cong Series 2004;1266:202-7.

Jose-Miller AB, Boyden JW, Frey KA. Infertility. Am Fam Physician 2007;75;849-56.

Wilkes S, Chinn DJ, Murdoch A, Rubin G. Epidemiology and management of infertility: a population-based study in UK primary care. Fam Pract 2009; 26:269-74.

Vásquez RA. Infertilidad de origen tubárico: diagnóstico y manejo. Rev Ces Med 2008;22:45-55.

Kodaman PH, Arici A, Seli E. Evidence-based diagnosis and management of tubal factor infertility. Curr Opin Obstet Gynecol 2004;16:221-9.

Oakley L, Doyle P, Maconochie N. Lifetime prevalence of infertility and infertility treatment in the UK: results from a population-based survey of reproduction. Hum Reprod 2008;23:447-50.

World Health Organization. Global Prevalence and Incidence of Selected Sexually Transmitted Diseases: Overviews and Estimates, Geneva: WHO; 1996.

Cohen CR, Brunham RC. Pathogenesis of chlamydia induced pelvic inflammatory disease. Sex Transm Infect 1999;75:21-4.

Muzzi L, Sereni MI, Battista C, Zullo MA, Tambone V, Angioli R. Tubo-peritoneal factor of infertility: diagnosis and treatment. Clin Ter 2010;161:77-8.

Ruiz AI, Sánchez R, Ostos O, Ángel E, Bonilla H, Cifuentes C, et al. Estudio piloto de prevalencia de infección por chlamydia trachomatis detectada por PCR en mujeres con parto prematuro en el Instituto Materno Infantil de Bogotá. Rev Colomb Obstet Ginecol 2005;56:225-30.

Carey AJ, Beagley KW. Chlamydia trachomatis, a hidden epidemic: effects on the female reproduction and options for treatment. Am J Reprod Immunol 2010;63:576-86.

Brunham RC, Rekart ML. Considerations on Chlamydia trachomatis disease expression. FEMS Immunol Med Microbiol 2009;55:162-6.

Morrison SG, Morrison RP. In situ analysis of the evolution of the primary immune response in murine Chlamydia trachomatis genital tract infection. Infect Immun 2000;68:2870-9.

Kelly KA. Cellular immunity and Chlamydia genital infection: induction, recruitment, and effector mechanisms. Int Rev Immunol 2003;22:3-41.

Paavonen J, Weggert K. Chlamydia trachomatis: impact on reproduction human. Hum Reprod Update 1999;5:433-47.

Reddy B, Rastogi S, Das B, Salhan S, Verma S, Mittal A. Cytokine expression pattern in the genital tract of Chlamydia trachomatis positive infertile women - implication for t-cell responses. Clin exp immunol 2004; 137:552-8.

Tavares BM, De Resende AD, Cunha FQ, Murta EF. Local profile of cytokines and nitric oxide in patients with bacterial vaginosis and cervical intraephitelial neoplasia. Eur J Obstet Gynecol Reprod Biol 2008;138:93-9.

Mei B, Luo Q, Du K, Huo Z, Wang F, Yu P. Association of mica gene polymorphisms with Chlamydia trachomatis infection and related tubal pathology in infertile women. Hum Reprod 2009;24:3090-5.

Carey AJ, Beagley KW. Chlamydia trachomatis, a hidden epidemic: effects on the female reproduction and options for treatment. Am J Reprod Immunol 2010;63:576-86.

Vigil P, Morales P, Tapia A, Riquelme R, Salgado AM. Chlamydia trachomatis infection in male partners of infertile couples: incidence and sperm function. Andrologia 2002;34:155-61.

Buckner LR, Schust DJ, Ding J, Nagamatsu T, Beatty W, Chang TL, et al. Innate immune mediator profiles and their regulation in a novel polarized immortalized epithelial cell model derived from human endocervix. J Reprod Immunol 2011;92:8-20.

Da Costa CU, Wantia N, Kirschning CJ, Busch DH, Rodriguez N, Wagner H, et al. Heat shock protein 60 from Chlamydia pneumoniae elicits an unusual set of inflammatory responses via Toll-like receptor 2 and 4 in vivo. Eur J Immunol 2004;34:2874-84.

Sasu S, LaVerda D, Qureshi N, Golenbock DT, Beasley D. Chlamydia pneumoniae and chlamydial heat shock protein 60 stimulate proliferation of human vascular smooth muscle cells via Toll-like receptor 4 and p44/ p42 mitogen-activated protein kinase activation. Circ Res 2001;89:244-50.

O'Connell CM, Ionova IA, Quayle AJ, Visintin A, Ingalls RR. Localization of TLR2 and MyD88 to Chlamydia trachomatis inclusions: evidence for signaling by intracellular TLR2 during infection with an obligate intracellular pathogen. J Biol Chem 2006;281:1652-9.

Agrawal T, Bhengraj AR, Vats V, Salhan S, Mittal A. Expression of TLR 2, TLR 4 and iNOS in cervical monocytes of Chlamydiatrachomatis-infected women and their role in host immune response. Am J Reprod Immunol 2011;66:534-43.

Prebeck S, Kirschning C, Dürr S, da Costa C, Donath B, Brand K, et al. Predominant Role of Toll-Like Receptor 2 Versus 4 in Chlamydia pneumoniae-Induced Activation of Dendritic Cells. J Immunol 2001;167;3316-23.

Matsumoto A, Izutsu H, Miyashita N, Ohuchi M. Plaque formation by and plaque cloning of Chlamydia trachomatis Biovar trachoma. J Clin Microbiol 1998;36:3013-9.

O'Connell CM, AbdelRahman YM, Green E, Darville HK, Saira K, Smith B, et al. Toll-Like Receptor 2 Activation by Chlamydia trachomatis Is Plasmid Dependent, and Plasmid-Responsive Chromosomal Loci Are Coordinately Regulated in Response to Glucose Limitation by C. trachomatis but not by C. muridarum. Infect Immun 2011;79:1044-52.

Farencena AM, Comanducci M, Donati G, Ratti G, Cevenini R. Characterization of a new isolate of Chlamydia trachomatis which lacks the common plasmid and has properties of biovar trachoma. Infect Immun 1997;65:2965-9.

Peterson EM, Markoff BA, Schachter J, de la Maza LM. The 7.5-kb plasmid present in Chlamydia trachomatis is not essential for the growth of this microorganism. Plasmid 1990;23:144-8.

Stothard DR, Williams JA, van der Pol B, Jones RB. Identification of a Chlamydia trachomatis serovar E urogenital isolate which lacks the cryptic plasmid. Infect Immun 1998;66:6010-3.

Taylor BD,Darville T,Ferrell RE,Kammerer CM,Ness RB, Haggerty CL. Variants in toll-like receptor 1 and 4 genes are associated with Chlamydia trachomatis among women with pelvic inflammatory disease. J Infect Dis 2012;205:603-9.

Agrawal T, Vats V, Salhan S, Mittal A. The mucosal immune response to chlamydia trachomatis infection of the reproductive tract in women. J Reprod Immunol 2009;83:173-8.

Stephens RS. The cellular paradigm of chlamydial pathogenesis. Trends Microbiol 2003;11:45-9.

Rasmussen SJ, Eckmann L, Quayle AJ, Shen L, Zhang YX, Anderson DJ, et al. Secretion of proinflammatory cytokines by epithelial cells in response to Chlamydia infection suggests a central role for epithelial cells in chlamydial pathogenesis. J Clin Invest 1997;99:77-87.

, Agrawal T, Vats V, Wallace PK, Singh A, Salhan S, Mittal A. Recruitment of myeloid and plasmacytoid dendritic cells in cervical mucosa during chlamydia trachomatis infection. Clin Microbiol Infect 2009;15:50-9.

Marks E, Tam MA, Lycke NY. The Female Lower Genital Tract Is a Privileged Compartment with IL-10 Producing Dendritic Cells and Poor Th1 Immunity following Chlamydia trachomatis Infection. PLoS Pathog 2010;6:e1001179.

Leonhardt RM, Lee SJ, Kavathas PB, Cresswell P. Severe tryptophan starvation blocks onset of conventional persistence and reduces reactivation of Chlamydia trachomatis. Infect Immun 2007;75:5105-17.

Agrawal T, Vats V, Salhan S, Mittal A. Mucosal and peripheral immune responses to chlamydial heat shock proteins in women infected with Chlamydia trachomatis. Clin Exp Immunol 2007;148:461-7.

AgrawalT, VatsV, SalhanS, MittalA.Primary and secondary immune response of mucosal and peripheral lymphocytes during Chlamydia trachomatis infection. FEMS Immunol Med Microbiol 2007;49:280-7.

LaVerda D, Albanese LN, Ruther PE, Morrison SG, Morrison RP, Ault KA, et al. Seroreactivity to chlamydia trachomatis hsp10 correlates with severity of human genital tract disease. Infect Immun 2000;68:303-9.

Wyrick PB. Chlamydia trachomatis persistence in vitro: an overview. J Infect Dis 2010;15;201-16.

Kinnunen A, Paavonen J, Surcel HM. Heat shock protein 60 specific T-cell response in chlamydial infections. Scand J Immunol 2001;54:76-81.

Darville T, Hiltke TJ. Pathogenesis of genital tract disease due to Chlamydia trachomatis. J Infect Dis 2010;201:S114-25.

Belland RJ, Scidmore MA, Crane DD, Hogan DM, Whitmire W, McClarty G, et al. Chlamydia trachomatis cytotoxicity associated with complete and partial cytotoxin genes. Proc Natl Acad Sci USA 2001;98:13984-9.

Crowley-Nowick PA, Ellenberg JH, Vermund SH, Douglas SD, Holland CA, Moscicki AB. Cytokine profile in genital tract secretions from female adolescents: impact of human immunodeficiency virus, human papillomavirus, and other sexually transmitted pathogens. J Infect Dis 2000; 181:939-45.

Rodgers AK, Wang J, Zhang Y, Holden A, Berryhill B, Budrys NM, et al. Association of tubal factor infertility with elevated antibodies to Chlamydia trachomatiscaseinolytic protease P. Am J Obstet Gynecol 2010;203:494.e7-494.e14.

Stephens AJ, Aubuchon M, Schust DJ. Antichlamydial Antibodies, Human Fertility, and Pregnancy Wastage. Infect Dis Obstet Gynecol 2011; 2011:525182.

Fan T, Lu H, Hu H, Shi L, McClarty GA, Nance DM, et al. Inhibition of apoptosis in chlamydia-infected cells: blockade of mitochondrial cytochrome C release and caspase activation. J Exp Med 1998;187:487-96.

Fischer SF, Vier J, Kirschnek S, Klos A, Hess S, Ying S, et al. Chlamydia inhibit host cell apoptosis by degradation of proapoptotic bh3-only proteins. J Exp Med 2004;200:905-16.

Rudel T, Kepp O, Kozjak-Pavlovic V. Interactions between bacterial pathogens and mitochondrial cell death pathways. Nat Rev Microbiol 2008;8: 693-705.

Pennini ME, Perrinet S, Dautry-Varsat A, Subtil A. Histone methylation by NUE A novel nuclear effector of the intracellular pathogen chlamydia trachomatis. Plos Pathog 2010;6:e1000995.

Rahman M, Mcfadden G. Modulation of NF-KB signalling by microbial pathogens. Nature Rev Microbiol 2011;9:291-306.

Hirschfeld M, Kirschning CJ, Schwandner R, Wesche H, Weis JH, Wooten RM, et al. Inflammatory signaling by Borrelia burgdorferi lipoproteins is mediated by Toll-like receptor 2. J Immunol 1999;163:2382-6.

Frazer L, O’Connell C, Dar ville T. Chlamydialinduced TLR2 signaling leads to increased neutrophil production of proinflammatory molecules and delayed spontaneous apoptosis. J Immunol 2009;182:135-9.

Agrawal T, Gupta R, Dutta R, Srivastava P, Bhengraj AR, Salhan S, et al. Protective or pathogenic immune response to genital chlamydial infection in women–a possible role of cytokine secretion profile of cervical mucosal cells. Clin Immunol 2009;130:347-54.

Cómo citar

1.
López-Castro TM, Rojas-Díaz EL, Rojas-rojas FN, Díaz-Yamal IJ, Muñoz-Cerón J. Mecanismos de modulación de la respuesta inmune por Chlamydia trachomatis asociados a infertilidad. Rev. colomb. obstet. ginecol. [Internet]. 20 de diciembre de 2012 [citado 28 de marzo de 2024];63(4):346-55. Disponible en: https://revista.fecolsog.org/index.php/rcog/article/view/139

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2012-12-20

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