Talk:Reproductive immunology

Wiki Education Foundation-supported course assignment

This article was the subject of a Wiki Education Foundation-supported course assignment, between 29 June 2020 and 21 August 2020. Further details are available on the course page. Student editor(s): Gmackey18, M.Ocampo, Future UCSF Pharm.D., Ekocharyan, Alansfeld.

Above undated message substituted from Template:Dashboard.wikiedu.org assignment by PrimeBOT (talk) 08:03, 17 January 2022 (UTC)

Wiki Education Foundation-supported course assignment

This article was the subject of a Wiki Education Foundation-supported course assignment, between 7 June 2021 and 27 August 2021. Further details are available on the course page. Student editor(s): Skimucsf, S. de Jesus, Future UCSF Pharm.D., Ghovhanessian, AGhajar. Peer reviewers: BDeLosReyes1.

Above undated message substituted from Template:Dashboard.wikiedu.org assignment by PrimeBOT (talk) 08:03, 17 January 2022 (UTC)

Sections out of scope

I think the following two sections are out of scope, so I moved them to here until we can come to a conclusion about where to merge the text. I don't think it's practically possible to describe the immunology related to every sexually transmitted disease in this article, and I don't see why HPV specifically should be so extensively described.Mikael Häggström (talk) 10:01, 31 December 2010 (UTC)

Human Papilloma Virus (HPV)

The human papilloma virus, one of the most common sexually transmitted diseases, causes warts on the skin and mucous membranes, and can lead to infections in the mouth, hands, feet, anus and genital cavities. More than 60 subtypes of human papilloma virus exist; some of them are associated with cancerous cells.

A healthy immune system attacks foreign bodies such as the human papilloma virus, but proteins in the outer surface of the virus can evade the immune response. Studies have shown that molecules of the immune system such as TGF-β, TNF, IL-1, type I interferons and IFN- γ affect the growth of HPV infected cells but some viral transformations and progression can inhibit the response of these molecules making it difficult for the immune system to eliminate the virus. In some cases the virus can affect some other cells turning it into cancerous cells.

Studies have shown that HPV decreases sperm motility and sperm counts in men, and women have a higher risk of infertility if they develop cervical cancer due to the virus. Biopsy of the cervix during diagnosis and treatment of cervical dysplasia can weaken the cervix, causing premature delivery or miscarriage. These treatments also can narrow the cervical canal making it difficult for the delivery.

Immunology of Human Papilloma Virus

HPV 16 and HPV 18 are high-risk strains associated with cervical cancer. HPV 16 contains, within its DNA, protein encoding regions that encode for oncoproteins (proteins involved in the growth of tumor cells). The oncoproteins E6 and E7 play an important role in the replication and immortalization of the virus, and in the transformation of the host’s cells13. The E6 protein also binds to and inactivates the tumor suppressor p53 and the E7 protein degrades the tumor suppressor pRb promoting the development of tumor cells13.

HPV infects keratinocytes (epidermal cells that synthesize keratin) that are in the skin and affects its differentiation. Once the virus infects the cells, there is an immune response mediated by the Langerhans cells part of the epithelial immune system. The Langerhans cells capture the antigen (HPV virus infecting the host’s cells) and present it to the T lymphocytes found in the lymph nodes. The migration of the Langerhans cells to the lymph nodes is promoted by the cytokines IL-1α (Interleukin 1α), Tumor Necrosis Factor, and Interleukin 1β. After that, T lymphocytes help in the production of antibodies mediated by the B lymphocytes against the virus and aid in the development of cytotoxic lymphocytes. The cytotoxic lymphocyte CD8+ is responsible for recognizing and killing the virus infected host's cell. Therefore, the administration of the vaccine would allow the immune system to establish memory cells that would respond more rapidly to a second encounter with this antigen.

Nevertheless, studies show that HPV has mechanism to evade the cellular immune responses14. Some authors proposed that the virus can evade the immunological recognition. One of the mechanisms proposed consist in the delay of the expression of the viral proteins E6 and E7. These proteins are expressed in low levels at the basal epithelium of the skin but in higher levels at the superficial layer where the epithelial cell are differentiating and where immunocompetent cells have less access to them. Another mechanism proposes that the virus affect the keratinocytes in such a way that these cells are less susceptible to the action of cytotoxic lymphocytes. The escape of the virus from the action of the immune system can lead to a persistent infection and this can result in the development of cancerous cells.

References

Areas of improvement

There is room for improvement in the "Research in reproductive immunology and its challenges" section. This is a great place for PhD students and experts researching reproductive immunology to add more valuable information about recent findings. AGhajar (talk) 01:15, 5 August 2021 (UTC)

Section whose reference is not sufficiently medically reliable

I think the following section should be substantiated by medically reliable sources, especially as it deals with medication given to pregnant women. Those from rialab.com appear to be rather commercial and those pages do not appear to have been scientifically peer-reviewed. Aspirin, claimed to decrease miscarriage risk, has no evidence of beneficial effects in studies (pmid:20335572). Mikael Häggström (talk) 10:12, 31 December 2010 (UTC)

Medication Regime to Reduce Risk of Miscarriage

Although many women feel uncomfortable taking medication throughout their pregnancy, there are some medications that suppress the immune response and decrease the chances of an early miscarriage. These drugs include aspirin, heparin, prednisone, immunoglobulin G injected intravenously, and Enbrel. These medications are suggested for women who have been experiencing miscarriages. It is believed that 50% of women who have recurrent miscarriages are due to an immunological mechanism. Therefore, these medications are not recommended for all women who are trying to conceive.

==Adding this paragraph. Need to confirm the information in the rest of this section.Ghovhanessian (talk) 21:41, 27 July 2021 (UTC)

Progesterone is a medication often used to prevent threatened miscarriage. A threatened miscarriage is signs or symptoms of miscarriage, usually bleeding that occurs in the first 20-weeks of a pregnancy. Supplementation of progesterone can lower the rate of miscarriage, however, it did not have an effect on lowering the rate of pre-term births and live births.Ghovhanessian (talk) 21:41, 27 July 2021 (UTC)

Two medications that work against anti-phospholipids are aspirin and heparin. Aspirin is given in a small dosage, 80 mg, which is equivalent to the dosage of baby aspirin because it is able to cross the placenta but does not affect the fetus because of the small dosage. Aspirin is an anti-inflammatory that suppress the innate immune response to the presence of a foreign body such as a sperm or embryo. Aspirin is also an anti-platelet agent which is another method of fighting the inflammatory response. Aspirin is given prior to conception and continued throughout the pregnancy. Heparin, an anti-coagulant, constricts blood vessels to is effective in treating a female who has anti-phospholipids because they cause . If a female has both a blood clot and decreased blood flow due to the anti-phospholipid antibodies then the baby will be deprived of blood and could result in death of the fetus. Therefore, heparin can reduce the formation of a blood clot.[1]

Prednisone, an anti-inflammatory corticosteroid, is used to treat women who have antinuclear antibodies prior to conception. Many are concerned with the effects of taking prednisone during pregnancy, but studies have shown that the fetus is protected. Prednisone binds to a protein while in the vascular circulation that makes it more difficult to pass the placenta. The placenta also has enzymes that degrade the prednisone to an inactive form. Another protective mechanism is that the fetal liver can not activate prednisone until the second trimester.

Immunoglobulin G infusion is a preparation of antibodies that are derived from human and injected intravenously, used to treat women with elevated NK levels. It is given for three consecutive days monthly. Immunoglobulin G infusion is also administered in treatment of those women with antithyroid antibodies. Enbrel, also known as Etanercept, is a medication that inhibits tumor necrosis factor. Normally, tumor necrosis factor is secreted by natural killer cells and in the situation of pregnancy attacks the placenta. This medication prevents the attachment of tumor necrosis factor to the placental membrane. Enbrel is given twice weekly via subcutaneous injection.

References

References with missing target

I moved the following "references" to here, because they must be connected with their claims, respectively, using inline citations, before reinsertion: Mikael Häggström (talk) 10:21, 31 December 2010 (UTC)

3. Sheynkin YR. Immunology of male infertility. [Internet]. Stony Brook, State University of New York [rev. 23 Mar 2000, cited 4 May 2009]. <http://www.uhmc.sunysb.edu/urology/male_infertility/Immunology_of_male_infertility.html>

4. Beer AE. Consequences of recurrent pregnancy loss: an introduction to categories 1 - 5 immune problems. [Internet]. Center for reproductive immunology & genetics. Los Gatos, CA; 2003 [rev. 3 May 2009, cited 4 May 2009]. <http://repro-med.net/info/cat1-5.php>.

5. Miscarriages and Immunotherapy. Reproductive Immunology Associates. http://www.rialab.com/miscarriages_immunotherapy.php#aspirin. 1997. Updated 2009. Accessed May 2, 2009. (1)

7. Handbook of Clinical Laboratory Testing During Pregnancy

8. Glickman J. HPV Infertility. Health Science Report Web site. http://www.health-science-report.com/hpv/picture-of-hpv/hpv-infertility.html. Accessed April 30, 2009. Genital HPV infection-CDC fact sheet. Centers for Disease Control and Prevention Web site. http://www.cdc.gov/std/HPV/STDFact-HPV.htm. Published 2008. Accessed April 30, 2009.

14. Stanley M. The immunology of genital human papilloma virus infection. European journal of dermatology. 1998:8(7):8-12. http://www.john-libbey-eurotext.fr/en/revues/medecine/ejd/e-docs/00/00/67/E6/resume.phtml.

16. Beer AE, Kantecki JJ, Reed JL: Is Your Body Baby Friendly? USA: AJR Publishing; 2006. http://www.babyfriendlybook.com/

Foundations II 2021 Proposed Edits

• Add/update sections with missing citations
• Find additional topics to add
• May want to review the 'Section out of scope' and 'Section whose reference is not sufficiently medically reliable' for reusable resources

Skimucsf (talk) 20:44, 27 July 2021 (UTC)

AGhajar reviewed references #1-7, 11-13 S. de Jesus, Future UCSF Pharm.D. reviewed references #8-10, 14-19 Skimucsf reviewed references #20-25 Ghovhanessian reviewed references #26-32

Peer Review Foundations II 2021

Part I:

Do the group's edits substantially improve the article as described in the Wikipedia Guiding Framework?

BC: Yes. Their edits are neutral, have a clear structure, easy to read, as well as cited from reliable sources.

Brittany: Yes, the group's edits substantially improve the article as described in the WikiPedia Guiding Framework. When discussing Medications to reduce risk of miscarriage, it does not seem like the information presented is biased. However, I believe that this drug section might not be as of a strong addition to the Reproductive Immunology Wiki Page. While Reproductive Immunology may play a large effect in miscarriage, I believe that perhaps if if the drugs listed somehow intervene with the immune system's response towards miscarriage, it would be better. However, I really thought the immunocontraceptive vaccine section was very interesting!

CC: Yes because the article does a good job of explaining what reproductive immunology is as an introduction and later expanding on the different diseases and issues that can arise from it. The article is also easy to read, has a neutral tone, and good structure overall. However, the Drugs section seems a bit off-topic - in particular the part about sulfonamides and medications to increase live birth rate does not seem to be related to the immune system.

BD: The recent edits did a great job adding on to the topic by clarifying specific disease states related to reproductive immunology and explaining the immune system components that are relevant. Different sub-topics are well-organized into different sections and has a neutral tone throughout. Although the sections “Medication exposure during pregnancy” and “Drugs” are very informative, these sections can be further improved to show how these medications are related specifically to reproductive immunology. For example, the article can elaborate on the treatment guidelines for Rh disease, preeclampsia, etc instead for these sections.

Has the group achieved its overall goals for improvement?

BC: Yes. Their group added topics such as diseases related to insufficient immune tolerance, microbiology, and medication exposure during pregnancy, which further elaborated on the previous versions. These sections precisely explain the details of pharmacologic consideration during pregnancy.

Brittany: I believe the group has achieved its overall goals for improvement. When it comes to reviewing the "Section out of scope," I agree with how the contents might not necessarily be the best to include within the Wiki Page itself. In regards to See Also, I feel like "Sexually Transmitted Diseases" could be taken out as well.

CC: Yes they achieved their goal since they added the appropriate citations and expanded the ideas and information on the sections that were previously there.

BD: The group achieved their goals as they added several new sections to the article. I agree that the topics under “section out of scope” may not be relevant to the article. In terms of adding on to existing paragraphs, the paragraph regarding Immunocontraceptive vaccine has a "clarification needed" note that should be addressed.

Part II

Does the draft submission reflect a neutral point of view?

BC: The draft submission reflects a neutral point of view because I am not persuade into a particular idea or position. The wording that they use is not biased and does not make claims on behalf of others.

Are the points included verifiable with cited secondary sources that are freely available?

CC: Yes, the sources provided are verifiable and can be easily found. They are also secondary sources that are found on reliable sites.

Are the edits formatted consistent with Wikipedia's manual of style?

BD: The article has proper article titles, headings and sections that help with organizing the information. One way to improve the article is to consider combining the “Medication exposure during pregnancy” and “Drugs” sections since they both cover medications for pregnancy. Some strengths are that the links to other Wiki pages were listed under relevant sections, and the abbreviations were also first introduced along with the full description. However, there were a few grammar issues under the section “Medication exposure during pregnancy” so I suggest reviewing this section. For citations, the group formatted the date as “Month YYYY” or “YYYY-MM-DD” but wikipedia references should include only the year. Wiki:MOS also states to avoid “scare-quoting" so I recommend checking if "unexplained infertility” and "non-self" (found in lead paragraph and microbiology section respectively) have to be quoted.

Do the edits reflect language that supports diversity, equity, and inclusion?

Brittany: Yes, I believe the edits reflect language that support diversity, equity and inclusion. The article was well-written in the sense that it did not shame prospective patients on the immune system coming into play with miscarriage nor did this article aim to convince people to obtain the immunocontraceptive vaccine, but rather provided thorough information on it.

Cchung725 (talk) 21:56, 2 August 2021 (UTC) Group 6

Reference review

1. Verify that all references are all appropriately formatted according to the Manual of Style
2. Check for references drawn from predatory publishers (see sources linked above for identification strategies). If you there are any in the reference list, you should either replace them with a reliable source or remove the text citing them
3. Consolidate any duplicate references

Skimucsf reviewed #20-25; #24-25 updated with correct date format Skimucsf (talk) 21:21, 4 August 2021 (UTC) Ghovhanessian reviewed #24-32 Ghovhanessian (talk) 21:28, 4 August 2021 (UTC) S. de Jesus, Future UCSF Pharm.D. reviewed #8-10, 14-19; #14-19 updated with correct date format, #10 removed - primary source S. de Jesus, Future UCSF Pharm.D. (talk) 21:30, 4 August 2021 (UTC)

Restructure the article?

We should discuss if this article should be restructured and whether parts of it should be merged with or moved to the page on immune tolerance in pregnancy. Since both pages are rather short, they may both gain from a merge?

At the moment, the article focuses on reroductive immunology in humans. Perhaps it would be useful to start out more generally from viviparous animals or mammals? Should we try to make a proper disposition? --2A05:9CC3:7A:A30C:FD33:6569:141C:CBB6 (talk) 21:56, 17 October 2021 (UTC)