Human sperm antigens corresponding to sperm-immobilizing antibodies in the sera of women with infertility of unknown cause: personal review of our recent studies.
Human sperm antigens corresponding to sperm-immobilizing antibodies in the sera of women with infertility of unknown cause: personal review of our recent studies.
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与不明原因不孕妇女血清中精子固定抗体相对应的人类精子抗原：对我们最近研究的个人回顾。
DOI：
10.1093/oxfordjournals.humrep.a136951
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发表时间：
1989
影响因子：
6.1
通讯作者：
S. Isojima
中科院分区：
文献类型：
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作者：
S. Isojima
1964年，富兰克林和杜克斯（1964 a，B）报道了某些不孕妇女血清中存在精子凝集抗体（SA-Ab），它能通过使精子在女性生殖道内凝集而导致不孕。然而，作者对他们的观点表示怀疑，因为在射出的精液中有许多非特异性精子凝集。出于这个原因，我提出了精子固定试验（SI-T）来检测针对精子的抗体（Isojima et al.，1968年，1972年）。与精子凝集试验（SA-T）相比，SI-T需要对精子进行补体补充，反映了更多的抗体反应。当同时应用SI和SA试验检测不明原因不孕妇女血清时，SI阳性血清的发生率与不明原因不孕的相关性比SA阳性血清的发生率更密切。报道了几种检测抗精子抗体的其他测定方法，例如被动血凝试验（Mathur等人，1979）、放射免疫测定（Moyes，1969）、酶联免疫吸附测定（ELISA）（Lynch等，1986）和检测结合的免疫球蛋白抗体（Bronson等，1986年）。所有方法都检测到抗体与精子的结合，但其中只有几种结合抗体可能对精子产生生物学效应，如SI和SA活性和阻止受精。因此，抗精子抗体的检测方法在临床上只能作为免疫性不孕症的第一步筛选试验，其次是生物学试验。最近我们门诊的不明原因不孕妇女血清中精子动员抗体（SI-Ab）阳性的结果见表1。从这些结果可以清楚地看出，在许多不明原因不孕症妇女的血清中可以发现SI-Ab，但在对照组中没有发现。当定量SI-Ab测定（Isojima和Koyama，1976 a; Koyama等人，1988）用于检查几年内患者中SI-Ab的滴度，发现几个月内抗体滴度的变化（Koyama等人，1988年）。事实上，具有高滴度SI-Ab的女性发现很难怀孕。在此，必须再次强调，如果通过证明抗体与精子结合的方法检测抗体，则可能无法实现抗精子抗体与女性不明原因不孕症之间的临床良好相关性。我们不应该忘记，在所有的精子结合抗体中，只有具有生物活性的精子抗体，如SI-Abs，SA-Abs和受精阻断抗体与不育有关。细胞介导的精子免疫可能存在于不孕妇女和不明原因的习惯性流产患者中。在动物不育中，有几个关于细胞介导的免疫的报道（Marcus et al.，1976; Tumboh-Oeri和Roberts，1978; Tinneberg等人，1980年）。我们检测患者淋巴细胞对人精浆（HSP）或洗涤精子的混合白细胞反应（MLR）的结果见表II。一些具有SI-Ab的患者也表明对HSP或人类精子的高敏感性指数，并且具有高敏感性指数的一名患者在妊娠5周时流产两次。Mettler和Schirwani（1975）也报道了一些不孕妇女对精子的细胞介导免疫，安德森和Hill（1988）最近撰写了一篇关于不孕症中细胞介导免疫的综述。然而，是否精子或HSP的细胞介导的免疫与不育症尚未得到最终证明。
In 1964, Franklin and Dukes (1964a, b) reported the presence of sperm-agglutinating antibodies (SA-Abs) in the sera of some infertile women which could induce sterility by agglutinating sperm in the female genital tract. However, the author was doubtful of their opinion, because there were many non-specific sperm agglutinations in ejaculated semen. For this reason, I proposed a sperm immobilization test (SI-T) to detect antibodies against spermatozoa (Isojima et al., 1968, 1972). The SI-T required a complement to immobilize sperm and reflected more antibody reaction than the sperm agglutination test (SA-T). When both SI and SA tests were applied to examine the sera of women with unexplained infertility, the incidence of Si-positive sera was more closely correlated with sterility of unknown cause than that of SA-positive sera. Several other assay methods to detect anti-sperm antibodies were reported, eg passive haemagglutination tests (Mathur et al., 1979), radioimmunoassays (Moyes, 1969), enzyme-linked immunosorbent assay (ELISA)(Lynch et al., 1986) and detection of bound immunoglobulin antibodies (Bronson et al., 1986). All methods detected the binding of antibodies to sperm; however, only several binding antibodies among them might exert biological effects on sperm, eg SI and SA activities and preventing fertilization. Therefore, the assay methods to detect anti-sperm antibodies could be clinically used as only the first screening test to examine for immunological infertility and these should be followed by biological tests as the second step. The recent results from our clinic of positive spermimmobilizing antibodies (SI-Abs) in the sera of women with unexplained infertility are shown in Table I. From these results, it is clear that SI-Abs could be found in the sera of many women with unexplained infertility, but not in the control groups. When the quantitative SI-Ab assay (Isojima and Koyama, 1976a; Koyama et al., 1988) was applied to examine the titres of SI-Abs in patients over several years, variations of antibody titres were found over several months (Koyama et al., 1988). It was a fact that women possessing high titres of SI-Abs found it very difficult to conceive. Here, it must be stressed again that clinically good correlations between anti-sperm antibodies and unexplained infertility in women may not be achieved if antibodies are detected by methods which prove binding of antibodies to sperm. We should not forget that only the biologically active antibodies to sperm, eg SI-Abs, SA-Abs and antibodies blocking fertilization among all sperm-binding antibodies are relevant to sterility. Cell-mediated immunity to sperm may be present in infertile women and patients suffering habitual abortions for unknown reasons. In animal infertility, there are several reports concerning cell-mediated immunity (Marcus et al., 1976; Tumboh-Oeri and Roberts, 1978; Tinneberg et al., 1980). Our results examining mixed leukocyte reaction (MLR) of patients' lymphocytes to human seminal plasma (HSP) or washed sperm are presented in Table II. Some patients possessing SI-Abs also indicated high sensitivity indices to HSP or human sperm and one patient with a high sensitivity index aborted twice when she was at 5 weeks of gestation. Mettler and Schirwani (1975) also reported cell-mediated immunity to sperm in some sterile women, and Anderson and Hill (1988) recently wrote a review concerning cell-mediated immunity in infertility. However, whether cellmediated immunity to sperm or HSP is relevant to sterility has not been conclusively proven yet.