Recurrent Pregnancy Loss
Conditions
Keywords
Natural Killer cells
Brief summary
In 50% of women with recurrent pregnancy loss (RPL) miscarriages are unexplained, therefore no therapeutic intervention is possible. In a pilot study, women with unexplained RPL showed less endometrial NK cells (eNK) compared to women with a previously uncomplicated pregnancy. It is known that eNK cells are important for embryo implantation during early pregnancy. Investigators presume that high sympathetic activity in these women is related to eNK cell number, function and phenotype and that exercise is an effective intervention to lower sympathetic activity and to influence the immune system, as especially peripheral NK cells have been assumed to be responsive to physical training. The investigators hypothesize that moderate exercise can lower the adrenergic tone of the sympathetic nervous system hereby influencing endometrial NK cells in women with RPL and eventually pregnancy outcome.
Interventions
OTHERExercise
Aerobe cycling training consisting of 12-weeks of HR-controlled training at 50-60% of VO2max (maximal oxygen uptake) for 1 hour, for 2 times (week: 1-6) to 3 times (week: 7-12) per week
Sponsors
Maastricht University Medical Center
Radboud University Medical Center
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
BASIC_SCIENCE
Masking
NONE
Eligibility
Sex/Gender
FEMALE
Age
No minimum to 40 Years
Healthy volunteers
No
Inclusion criteria
* RPL defined as 2 or more unexplained pregnancy losses from the time of conception until 24 weeks of gestation, known cause for the miscarriages are the presence of thyroid abnormalities, anti-phospholipid syndrome, uterine malformation, and abnormal parental karyotype according to international guideline. * Couples should not be aiming to conceive during the time course of the exercise intervention.
Exclusion criteria
* Age above 40 years * BMI above 40 * Current use of immunosuppressive or biological drugs * Current use of hormone conceptive * HIV positivity * Current or recent (\<2 weeks) symptomatic genital infection such as chlamydia, gonorroa, or pelvic inflammatory disease * Pre-existent diabetes mellitus, autoimmune disease or overt cardiovascular disease * Vaccination (i.e Covid) within 1 month prior to or during sampling and intervention * New pregnancy at time of measurements, breastfeeding * Current or recent (\<2-3 months ago) pregnancy * (Physical) inabilities to follow moderate aerobe cycling training * Participants who are not capable of signing the informed consent
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| CD56 endometrial NK cell frequency | 3 months | Change in CD56 eNK cell frequency measured as percentage of total lymphocyte or total CD56 population by flowcytometry. |
| CD56 endometrial NK cell function | 3 months | Change in CD56 eNK cell function measured as percentage of CD56 degranulation by flowcytometry. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| CD56 peripheral NK cell function | 3 months | Change in CD56 pNK cell function measured as percentage of CD56 degranulation by flowcytometry. |
| CD56 peripheral NK cell phenotype | 3 months | Change in CD56 pNK cell phenotype measured as percentage of (sub)population or mean fluorescent intensity respectively by flowcytometry. |
| Vaginal microbiome | 3 months | Change in taxonomic classification of vaginal microbiota of different subtypes but also classified in clustering of different subtypes. |
| Metabolic syndrome parameters I | 3 months | Change in cm waist circumference. |
| Metabolic syndrome parameters II | 3 months | Chance in mmHg blood pressure, both systolic as diastolic. |
| Metabolic syndrome parameters III | 3 months | Change in concentration (mg/dL) triglyceride. |
| CD56 endometrial NK cell phenotype | 3 months | Change in CD56 eNK cell phenotype measured as percentage of (sub)population or mean fluorescent intensity respectively by flowcytometry. |
| Metabolic syndrome parameters V | 3 months | Change in concentration (mg/dL) blood sugar levels. |
| Sympathetic activity | 3 months | Change in baroreceptor sensitivity in ms/mmHg. |
| Uterine blood flow | 3 months | Change in pulsatility index, lower indicates better outcome. |
| Physical fitness | 3 months | Change in VO2max. |
| Pregnancy rate and live birth rate after one year of intervention, higher rater indicate better outcome. | 3 months | Questionnaire. |
| Metabolic syndrome parameters IV | 3 months | Change in concentration (mg/dL) cholesterol levels. |
| CD56 peripheral NK cell frequency | 3 months | Change in CD56 pNK cell frequency measured as percentage of total lymphocyte or CD56 population by flowcytometry. |
Countries
Netherlands
Outcome results
None listed