Restoration of mRNA expression level of endometrial MEIS1, as a co-factor of HOXA10, after laparoscopic salpingectomy of women with hydrosalpinx

Abstract Study question Do salpingectomy could restore HOXA10 co-factor MEIS1 expression in endometrial tissues of hydrosalpinx patients? Summary answer Laparoscopic salpingectomy could restore endometrial HOXA10-cofactor- MEIS1 expression level, in addition to HOXA10, in hydrosalpinx women. What is known already Hydrosalpinx is defined as a distally blocked and dilated fallopian tube which has been filled with serous fluid. Evidence suggests that hydrosalpinx is associated with adverse effect on endometrial receptivity by abnormal expression of key molecules such as HOXA10 in the pre-implantation endometrium. Previous data showed salpingectomy results in statistically significant increase in endometrial HOXA10 expression. MEIS1 is a three-amino-acid loop extension (TALE) family homeobox gene which has been proven to be a novel coactivator of HOXA10 during human and mouse endometrial decidualization. MEIS1-HOXA10 complex binds to the promoters of the target genes which are beneficial for human stromal cell decidualization. Study design, size, duration This prospective study was conducted from January 2021 to January 2022 to determine whether salpingectomy would reverse HOXA10-cofactor- MEIS1 expression levels after salpingectomy. All women signed the informed consent and did not receive any hormonal medication during the last three months. In this study 10 infertile women with moderate to severe hydrosalpinx proven by hysterosalpingography or laparoscopy undergoing salpingectomy were recruited. Ten healthy fertile age-matched women considered as control group. Participants/materials, setting, methods Ten infertile women, aged 20-40, with sonovisible hydrosalpinx (diameter >10mm), AMH>1.2 ng/dL, BMI (18–28 kg/m2) and regular menstrual cycle indicated by mid-luteal progesterone levels of > 10 ng/mL were included. Ten healthy fertile age-matched women with a history of successful pregnancy considered as control group. Mid–luteal-phase endometrial sampling (by pipelle) was performed at the time of surgery and second sampling was obtained forth-post treatment cycle. RNA extraction and cDNA synthesis were done. Main results and the role of chance Quantitative mRNA expression of MEIS1 was determined by real-time PCR technique. Gene expression data were analyzed based on 2 –ΔΔCT to estimate the relative fold change value. The non-parametric Wilcoxon signed rank test was used for data analysis. P value less than 0.05 was considered statistically significant.There was a significant reduction in the expression levels of MEIS1 gene in the endometrial samples of hydrosalpinx group before surgical removal. The obtained data showed that salpingectomy resulted in a statistically significant increase (about 6-fold) in endometrial MEIS1 expression (P = 0.02). Moreover, there was not significant difference in MEIS1 mRNA expression of hydrosalpinx group after salpingectomy and the control group (P > 0.05). Limitations, reasons for caution Larger sample size for the confirmation of these data is needed. Epigenetic evaluation of hydrosalpinx endometrial tissues especially in HOXA10 promoter is recommended. Wider implications of the findings This study suggests that the restoration of MEIS1 gene expression observed in hydrosalpinx women after salpingectomy can be considered as a molecular mechanism by which salpingectomy results in improvement of pregnancy rate in IVF cycle. Trial registration number not applicable