Analysis of CD138+ Uterine Plasma Cells in Patients with Recurrent Miscarriage

Kilian Vomstein 1 Ruben Kuon 1 Tamara Goeggl 1 Maja Weber 2 Udo Markert 2 Thomas Strowitzki 1 Bettina Toth 3
1Department of Gynecological Endocrinology and Fertility Disorders, Ruprecht-Karls University Heidelberg, INF 440, 69120 Heidelberg, Germany
2Placenta-Lab, Department of Obstetrics, University Hospital Jena, Bachstrasse 18, 07743 Jena, Germany
3Department of Gynecological Endocrinology and Reproductive Medicine, University of Innsbruck, Austria, Germany

Background

Chronic endometritis (CE) has been associated with recurrent miscarriage (RM). However diagnosis is challenging and data on successful treatment still lacking. Detection of Syndecan-1 (CD138) via immunohistochemistry on endometrial plasma cells has been shown to provide an accurate diagnosis of CE.

Objective

The aim of this study was to identify CD138+ uterine plasma cells in RM patients in order to determine the prevalence of CE. Further a correlation to uterine natural killer (uNK) cells as well as the success of CE treatment was analyzed.

Methods

In n=125 non-pregnant patients with ≥3 consecutive miscarriages an endometrial biopsy was performed in the mid-luteal phase. The biopsy was taken to evaluate CD138+ uterine plasma cells and CD56+ uNK cells by immunohistochemistry. Patients showing elevated CD138+ plasma cells (>5/mm2) were treated with doxycycline (200mg day 1, 100mg for the next 20 days). To control success of treatment, a second biopsy and analysis of CD138+ plasma cells was performed after treatment.

Results

Out of 125 patients, n=12 (9.6%) showed elevated CD138+ plasma cells and were diagnosed with CE. Out of these, n=8 patients showed >10 CD138+ plasma cells indicating a high elevation. There was no correlation between CD56+ uNK and CD138+ plasma cells (p=0.68). All RM patients (n=12) diagnosed with CE received antibiotic treatment and success of treatment was confirmed in 92% of the cases with post-treatment CD138+ plasma cells <5/mm2.

Conclusion

In our cohort of RM patients a high prevalence of CE was detected. Endometrial biopsies might be implemented in RM diagnostics to detect and treat CE.









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