For example, chlamydial heat shock protein\60 (HSP60) and CPAF have been found to be more prevalent in women with TFI as compared to fertile women

For example, chlamydial heat shock protein\60 (HSP60) and CPAF have been found to be more prevalent in women with TFI as compared to fertile women.6, 11, 12 Therefore, analysing the presence and composition of individual antibodies in infertile women is of great importance. The Mikrogen immunoblot detects IgG antibodies directed against MOMP, TARP, CPAF, cHSP60 and outer membrane protein 2 (OMP2), which are immunodominant proteins. antibody titres. Serum was tested with the Mikrogen recomLine immunoblot and quantified with the recomScan. A greedy algorithm that explores all possible antibody combinations was developed. Results Significant differences in the distributions of antigen titres between cases and controls were observed Rabbit Polyclonal to EIF2B3 for CPAF ((infections is high due to its asymptomatic course in up to 80% of women and 50% of men.2, 3 In women, unnoticed and thus untreated urogenital infections can lead to severe complications such as pelvic inflammatory disease (PID), ectopic pregnancy and tubal factor infertility (TFI). infections are most prevalent in young adolescents, but complications such as TFI can become evident more than 10?years later when these women fail to conceive and present with infertility. By that time, the bacterium has been cleared by the immune system, and DNA is not detectable any more by PCR. Serum IgG antibodies however may remain detectable for many years after infection, even after antibiotic treatment.4 In Dutch fertility clinics, serological chlamydia antibody tests (CAT) are used in infertile women as markers of a previous infection and to estimate the risk of TFI. Based on CAT, high\risk patients for TFI might be referred for invasive diagnostic testing (eg laparoscopy), whereas in low\risk patients, less\invasive procedures (eg hysterosalpingography) might be preferred or it may be decided to refrain from further testing. The predictive value for TFI of the currently most frequently used CAT is poor, with a negative predictive value (NPV) of 74%\90% and a positive predictive value (PPV) for TFI of 32%\63%.5, 6, 7 These poor predictive values of the CAT are due to the fact that CATs are designed to detect antibodies and not TFI. In clinical practice, false\positive CAT results may lead to unnecessary laparoscopies in women without TFI, and false\negative CAT results may cause delay in diagnosis and treatment in women with TFI. The CAT that is most Echinomycin frequently used in Dutch fertility clinics is the mono\target Medac IgG ELISA plus, which is a MOMP\peptide\based assay. This enzyme\linked immunosorbent assay (ELISA) detects antibodies against het major outer membrane protein (MOMP) on the cell surface and is considered as species specific with a minimal cross\reactivity with antibodies.5 MOMP is an immunodominant protein that is involved in maintaining rigidity of the chlamydial membrane, attachment to the human epithelial cell and functions as a pore to provide the bacterium with nutrients once Echinomycin it has Echinomycin invaded the human cell.8, 9, 10 A previous study compared the predictive value for TFI of the Medac ELISA (Medac GmbH, Wedel, Germany) with a multi\target Mikrogen ELISA and immunoblot.7 This multi\target ELISA detects antibodies directed against MOMP, translocated actin\recruiting phosphoprotein (TARP; involved in the internalization of into the host cell) and chlamydial protease\like activity factor (CPAF; involved in host and bacterial protein regulation and bacterial survival), all immunodominant epitopes. Even though the multi\target ELISA detects a broader spectrum of IgG antibodies, no significant improvement of the predictive value for TFI was Echinomycin found.7 The disadvantage of a multi\target ELISA is that it does not allow differentiation of IgG antibodies against different antigens, and thus, it remains unclear which antibodies are positive in one well. It is hypothesized that certain IgG antibodies are more predictive for TFI than others. For example, chlamydial heat shock protein\60 (HSP60) and CPAF have been found to be more prevalent in women with TFI as compared to fertile women.6, 11, 12 Therefore, analysing the presence and composition of individual antibodies in infertile women is of great importance. The Mikrogen immunoblot detects IgG antibodies directed against MOMP, TARP, CPAF, cHSP60 and outer membrane protein 2 (OMP2), which are immunodominant proteins. The benefit of an immunoblot is that it allows differentiation between the IgG antibodies in the serum. Although previous research showed that ELISAs have a higher sensitivity than immunoblots, the specificity of the immunoblot is higher than the ELISA.13, 14 However, there is no significant difference in the NPV and PPV of the Mikrogen IgG ELISA and immunoblot.15 Therefore, it is interesting to analyse the predictive value for TFI of the separate antibodies in the Mikrogen immunoblot and of different antibody titre cut\off values and to adjust the algorithm of the immunoblot analysing software in order to improve the prediction of TFI. There is a clinical unmet need for improvement of the clinical predictive value.