Electronic Letters to:

Endocrine Research: A. W. Horne, S. van den Driesche, A. E. King, S. Burgess, M. Myers, H. Ludlow, P. Lourenco, P. Ghazal, A. R. Williams, H. O. D. Critchley, and W. C. Duncan Endometrial Inhibin/Activin β-B Subunit Expression Is Related to Decidualization and Is Reduced in Tubal Ectopic Pregnancy J Clin Endocrinol Metab 2008; 93: 2375-2382 [Abstract] [Full text] [PDF]

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Response to E-Letter

Andrew W Horne   (5 August 2008)

Confounding factors?

Ricardo F Savaris   (22 June 2008)

Response to E-Letter 5 August 2008
Andrew W Horne, Clinical Lecturer in Obstetrics and Gynaecology University of Edinburgh Send letter to journal: Re: Response to E-Letter andrew.horne{at}ed.ac.uk Andrew W Horne	We thank Dr. Savaris for his interest in our paper (1). We used a 2-3 hr pre-treatment of prostaglandins (400 mcg Misoprostol per vagina), but not anti-progestins to prepare the cervix in the women undergoing surgical management of miscarriage and surgical termination of pregnancy. We appreciate that there has been one study that has suggested that this could alter the expression of steroid receptors (2), but are unaware of any studies that demonstrate changes in secreted genes that can be detected in the circulation after such a short time. Dr. Savaris also states that there is a discrepancy between our study and that of Florio et al., who demonstrated differences in circulating activin A in women with ectopic pregnancies (3). Although we did not detect a difference in beta A subunit expression in our decidual samples, we believe, as discussed, that it is likely that the source of beta A is from the corpus luteum, or the ectopic pregnancy, rather than the endometrium, and thus, providing an explanation for this finding. Of note, the recent abstract from Kirk et al. (4) that was presented at ESHRE on 8 July 2008, suggests that activin A concentrations may not be helpful in detecting ectopic pregnancies. References 1. Horne AW, van den Driesche S, King AE, Burgess S, Myers M, Ludlow H, Lourenco P, Ghazal P, Williams AR, Critchley HO, Duncan WC. Endometrial inhibin/activin beta-B subunit expression is related to decidualization and is reduced in tubal ectopic pregnancy. J Clin Endocrinol Metab. 2008 93:2375-2382 2. Milne SA, Henderson TA, Kelly RW, Saunders PT, Baird DT, Critchley HO. Leukocyte populations and steroid receptor expression in human first- trimester decidua; regulation by antiprogestin and prostaglandin E analog. J Clin Endocrinol Metab. 2005 90:4315-4321 3. Florio P, Severi FM, Bocchi C, Luisi S, Mazzini M, Danero S, Torricelli M, Petraglia F. Single serum activin a testing to predict ectopic pregnancy. J Clin Endocrinol Metab. 2007 92(5):1748-1753 4. Kirk E, Papageorghiou B, Van Calster B, Condous G, Bottomley C, Timmerman D, Spencer K, Bourne T. Can serial measurements of inhibin A and activin A be used to predict the outcome of pregnancies of unknown location? 24th Annual Meeting of the ESHRE, Barcelona, Spain 7-9 July, 2008. Hum Reprod 2008 23 (Suppl 1)
Confounding factors? 22 June 2008
Ricardo F Savaris, Professor Universidade Federal do Rio Grande do Sul Send letter to journal: Re: Confounding factors? rsavaris{at}hcpa.ufrgs.br Ricardo F Savaris	I read with great interest the article published by Dr. Horne et al. (1). The search for a single marker to discriminate ectopic from eutopic pregnancy is crucial in clinical practice. The authors performed a well-designed study, but some questions cannot be answered due to lack of information. The authors do not state whether they used prostaglandins and/or anti-progesterones to prepare the cervix before termination of pregnancy, as is recommended by the Royal College of Obstetricians and Gynaecologists (2). If so, these medications could alter gene expression in the endometrium and may explain the discrepancies between their findings and Dr. Florio et al. (3) References 1. Horne AW, van den Driesche S, King AE, Burgess S, Myers M, Ludlow H, Lourenco P, Ghazal P, Williams AR, Critchley HO, Duncan WC. 2008. Endometrial Inhibin/Activin β-B Subunit Expression Is Related to Decidualization and Is Reduced in Tubal Ectopic Pregnancy. J Clin Endocrinol Metab 93:2375-2382 2. RCOG. 2004. The Care of Women Requesting Induced Abortion, Evidence-based clinical guideline. 3. Florio P, Severi FM, Bocchi C, Luisi S, Mazzini M, Danero S, Torricelli M, Petraglia F. 2007. Single serum activin a testing to predict ectopic pregnancy. J Clin Endocrinol Metab 92:1748-1753