The research objectives of the Division of Immunology and Infectious Diseases are to: a) define the immunologic, infectious, and genetic factors that influence the occurrence, severity, frequency and consequences of disorders affecting women, b) to utilize this knowledge to develop improved diagnostic and prognostic criteria for these disorders, and c) to devise unique protocols to prevent or treat these disorders or to limit their recurrence.

Current research projects:

1. Preterm birth remains the number one health problem in obstetrics. Over the last 10 years the rate of preterm birth in the United States has actually increased. We are studying the influence of polymorphisms in fetal and maternal genes encoding cytokines or components of the innate immune system on pregnancy outcome: preterm premature rupture of fetal membranes, preterm birth, preeclampsia, intrauterine growth restriction, neonatal morbidities. The relation between genotype and concentrations of the specific gene product in amniotic fluid, vaginal secretions and cord blood is also being evaluated. Both singleton gestations and multifetal pregnancies are being examined.

2. Detection of microorganisms and pro-inflammatory mediators in mid-trimester amniotic fluids from healthy asymptomatic women and their relationship to previous and subsequent pregnancy outcome is also being evaluated.

3. Recurrent vulvovaginal candidiasis (RVVC) is a common condition affecting reproductive age women. The etiology is unknown and current treatments bring only temporary relief at best. We are examining the immune basis for RVVC in women by a comparative analysis of genes and their products known to be involved in immune defense against this microorganism.

4. Vulvar vestibulitis syndrome (VVS) is a chronic inflammation of the vaginal vestibule of unknown etiology. Vaginal penetration is painful or impossible for women with VVS. Our studies are evaluating differences between patients and control women in gene sequences and their products involved in initiation and termination of pro-inflammatory immunity. A systematic search for microorganisms that might contribute to VVS initiation or persistence is also being undertaken.

5. There is a great need to identify early markers for ovarian and endometrial cancer. Early detection correlations with high cure rates for these malignancies. Heat shock proteins are produced when cells are under stress and serve as an early warning signal that "danger" is present. Heat shock proteins also bind to intracellular components that trigger cell death (apoptosis) and prevent this occurrence. We are evaluating in women being evaluated for a possible gynecologic malignancy, whether detection in vaginal secretions of heat shock proteins or complexes composed of heat shock proteins and proteins involved in apoptosis will be predictive of a subsequent diagnosis of ovarian or endometrial cancer.

6. Infections are a major cause of infertility in some women but not in others. We are examining the influence of possession of specific genotypes of genes involved in immune defense mechanisms on the consequences of genital tract infections by specific microorganisms. The consequences of infection may vary depending on the genetic makeup of individual.