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"ABSTRAKLatar Belakang. Infertilitas merupakan sumber keluhan dan kecemasan pada pasangan suami istri. Infertilitas dialami oleh sekitar 50 ndash; 80 juta pasangan di dunia. Di Indonesia terdapat kurang lebih 12 pasangan infertil. Salah satu penyebab gangguan kesuburan atau infertilitas yang dialami pasangan suami istri adalah yang penyebabnya tidak terjelaskan unexplainned . Dikatakan infertil tidak terjelaskan karena pada semua pemeriksaan standar pasangan suami istri termasuk tes ovulasi, patensi tuba dan analisis sperma berada dalam keadaan normal. Sebagian besar masalah infertil tidak terjelaskan dikaitkan dengan gangguan imunologi yang terjadi antara suami istri, dengan adanya perubahan peningkatan indeks proliferasi limfosit sebagai indikator.Metode. Dilakukan pengambilan sampel darah tepi dan pemisahan SMDT pasangan infertil tidak terjelaskan. Sebelum dilakukan kultur MLR Mixed Lymphocyte Reaction , SMDT suami diinkubasi dengan Mitomycin C. Kultur MLR SMDT suami dan istri selama 72 jam. Dilakukan labelling sel dengan BrdU untuk mengetahui indeks proliferasi yang menunjukkan nilai proliferasi sel limfosit. Hasilnya dibandingkan dengan istri pasangan fertil.Hasil. Dari 11 pasangan Infertil tidak terjelaskan dan 4 pasangan fertil, terdapat perbedaan yang bermakna antara indeks prolifersi sel limfosit istri dengan medium standar pasangan infertil tidak terjelaskan dibandingkan indeks prolifersi sel limfosit istri pasangan fertil p = 0,01 . Terdapat perbedaan yang bermakna antara indeks proliferasi sel limfosit istri yang diberi stimulan IL2 pasangan infertil tidak terjelaskan dengan sel limfosit istri pasangan fertil setelah kultur 72 jam p = 0,049 . Terdapat perbedaan yang bermakna antara indeks proliferasi sel limfosit istri pasangan infertil tidak terjelaskan dengan sel limfosit istri pasangan fertil yang di stimulasi oleh sel limfosit suami setelah kultur MLR 72 jam p = 0,014 . Tidak terdapat perbedaan yang bermakna antara indeks proliferasi sel limfosit istri pasangan infertil tidak terjelaskan yang diberi stimulan IL2 dengan sel limfosit istri pasangan fertil yang di stimulasi oleh sel limfosit suami setelah kultur MLR 72 jam p = 0,115 . Tidak terdapat perbedaan antara proliferasi sel limfosit pasangan infertil tidak terjelaskan dengan metode MLR pada pasangan infertil tidak terjelaskan setelah menikah lebih dari 5 tahun dan kurang dari 5 tahun p=0,202 . Hasil penelitian ini menguatkan dugaan adanya peran imunologi sebagaian dalam terjadinya infertil tidak terjelaskan.

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ABSTRACTInfertility is a source of worry of the couple. Infertility is occured in 50 80 millions couple in the world. There is almost 12 infertile couple in Indonesia. One of the reason of this infertility problem is unexplainned. Diagnosis of unexplainned infertility is made when all of the basic evaluation including ovulation test, tubal patency and normal sperm analysis are established. The potential cause of unexplainned infertility has been described mostly as an immunology problem, where as there is a change of lymphocyte proliferation as an indicator.Method. Peripheral blood and lymphocyte isolation were collected from unexplainned infertile couples and fertile couples. Before MLR the husband rsquo s lymphocytes were incubated with mitomycin C. The MLR between husband and wife rsquo s lymphocytes were cultured for 72 hours. The cell were labelled with BrdU to measure proliferation index that show lymphocyte proliferation assay. The result were compared between unexplainned infertile couples and controls. Result. From 11 unexplainned infertile couples and 4 fertile couples, There was a significant difference between wife rsquo s lymphocyte proliferation index with the standard medium of unexplained infertile couples compared to the fertile wife 39 s lymphocyte proliferation index p 0.01 . There was a significant difference between the proliferation index of wife rsquo s lymphocyte cells induced by IL2 stimulant of unexplained infertile couples with fertile lymphocyte cell after culture 72 hours p 0.049 . There was a significant difference between unexplainned infertile couples lymphocyte cell proliferation index indices with the fertile wife lymphocyte cell were stimulated by husband 39 s lymphocyte cells after culture of MLR 72 hours p 0.014 . There was no significant difference between unexplained infertile couples lymphocyte cell proliferation index induced by IL2 stimulant with fertile lymphocyte cells stimulated by husband lymphocyte cells after culture of MLR 72 hours p 0.115 . There was no difference between unexplained infertile lymphocyte cell proliferation with MLR method in unexplained infertile couples after marriage of more than 5 years and less than 5 years p 0.202 . The results of this study reinforce the alleged existence of immunological role in the occurrence of infertile unexplained. Keywords unexplainned infertility, MLR culture, cell proliferation, index proliferation"

"ABSTRAKLatar Belakang. Gangguan kesuburan merupakan masalah kesehatan reproduksi di dunia yang terjadi pada 10-15% pasangan suami istri. Salah satu penyebab gangguan kesuburan atau infertilitas yang dialami pasangan suami istri adalah yang penyebabnya tidak terjelaskan (unexplained). Dikatakan infertil tidak terjelaskan karena pada semua pemeriksaan standar pasangan suami istri termasuk tes ovulasi, patensi tuba dan analisis sperma berada dalam keadaan normal. Sebagian besar masalah infertil tidak terjelaskan dikaitkan dengan gangguan imunologi yang terjadi antara suami istri, dengan adanya perubahan atau pergeseran proporsi subpopulasi limfosit sebagai indikator.Metode. Dilakukan pengambilan sampel darah tepi dan pemisahan sel mononukleus pasangan infertil tidak terjelaskan. Sebelum dilakukan MLR (Mixed Lymphocyte Reaction) sel mononukleus suami istri, dilakukan pemeriksaan typing sel T CD4+, CD8+ dan sel B CD19+ sel mononukleus istri. Sebelum kultur MLR, sel mononukleus suami diinkubasi dengan Mitomycin C. Kultur MLR sel mononukleus suami dan istri selama 72 jam. Dilakukan typing sel T CD4+, CD8+ dan sel B CD19+ sel mononukleus istri setelah kultur. Hasilnya dibandingkan dengan istri pasangan fertil.Hasil. Dari 15 pasangan infertil tidak terjelaskan dan 6 pasangan fertil, tidak terdapat perbedaan bermakna pada rentang usia istri kedua kelompok (p = 0,078). Peningkatan nilai rerata populasi sel T CD4+, CD8+ dan sel B CD19+ sesudah kultur MLR lebih tinggi pada istri pasangan infertil tidak terjelaskan dibandingkan istri pasangan fertil, meskipun secara statistik tidak terdapat perbedaan bermakna (p = 0,223, p = 0,126, p = 0,462). Proporsi peningkatan proliferasi sel T CD4+, CD8+ sesudah kultur MLR pada istri pasangan infertil tidak terjelaskan berbeda bermakna dibandingkan dengan istri pasangan fertil (p = 0,044 dan p = 0,003). Hasil penelitian ini menguatkan dugaan adanya peran imunologi pada sebagian pasangan infertil tidak terjelaskan.

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ABSTRACTBackground. Infertility is a world reproductive health problem which is occured in 10-15% of the couples. One of the reason of this infertility problem is unexplained. Diagnosis of unexplained infertility is made when all of the basic evaluation including ovulation test, tubal patency and normal sperm analysis are established. The potential cause of unexplained infertility has been described mostly as an immunology problem, whereas there is a change or modulation of lymphocyte subpopulation proportion as an indicator.Method. Peripheral blood and lymphocyte isolation were collected from unexplained infertile couples and fertile couples. Immunotyping of CD4+, CD8+ T cells and CD19+ B cell from wife?s lymphocyte of both group were measured before the mixed lymphocyte reaction (MLR). Before MLR, the husband?s lymphocytes were incubated with Mitomycin C. The MLR between husband and wife?s lymphocytes were cultured for 72 hours. Immunotyping of CD4+, CD8+ T cells and CD19+ B cell after cultured and compared between unexplained infertile couples and controls.Results. From 15 unexplained infertile couples and 6 fertile couples, there were no statistical different in the age ranges between the wife of both group (p = 0,078). The mean number population of CD4+, CD8+ T cells and CD19+ B cell after MLR cultured were higher from the wife of unexplained infertile group compared to the wife of fertile group, but there were no statistical different between them (p = 0,223, p = 0,126, p = 0,462). Increased proportion of CD4+, CD8+ T cells proliferation after MLR cultured from the wife of unexplained infertile couple were significantly different compared to the wife of fertile group (p = 0,044 and p = 0,003). This results suggested that there is a tendency for immunological factor involvement in the pathogenesis of partially unexplained infertility couples"

"Diabetes melitus (DM) tipe 2 adalah penyakit yang berhubungan dengan kondisi inflamasi ringan kronis. Selain terjadi peningkatan kadar sitokin proinflamasi, diduga terjadi gangguan pada mediator antiinflamasi, yaitu enzim indoleamine 2,3-dioxygenase (IDO). Tujuan dari penelitian ini adalah menganalisis produksi IDO dari kultur peripheral blood mononuclear cells (PBMC) pada penderita DM tipe 2 dan meneliti hubungan IDO dengan kadar sitokin proinflamasi seperti TNF-α, IL-6, dan IFN-γ; serta sitokin antiinflamasi, IL-10. Sampel PBMC diambil dari 21 pasien DM tipe 2 dan 17 subjek kontrol sehat kemudian dilakukan kultur dengan stimulasi phytohemagglutinin (PHA). Setelah kultur selama 3 hari, produksi TNF-α, IL-6, IFN-γ, dan IL-10 diukur menggunakan multiplex immunoassay, sedangkan kadar IDO diukur menggunakan ELISA. Kadar IDO dari kultur PBMC tanpa stimulasi dan dengan stimulasi PHA secara signifikan lebih tinggi pada pasien DM tipe 2 dengan p<0,001 dan p=0,012. Sebanyak 52,8% pasien DM tipe 2 mengalami penurunan produksi IDO setelah distimulasi PHA dan hal tersebut berhubungan dengan kadar IFN-γ yang rendah dengan p=0,005. Di lain pihak, 42,8% pasien DM tipe 2 mengalami peningkatan produksi IDO setelah stimulasi PHA dan hal ini berhubungan dengan rasio TNF-α/IL-10 (r=0,513 p=0,079), IL-6/IL-10 (r=0,446 p=0,114) dan IFN-γ/IL-10 (r=0,422 p=0,129). Pada DM tipe 2, terjadi perubahan produksi IDO. IFN-γ yang rendah berkontribusi pada penurunan produksi IDO. Sementara itu, respon proinflamasi berhubungan dengan peningkatan produksi IDO.

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Type 2 diabetes mellitus (T2DM) is associated with chronic low-grade inflammatory condition. Besides the increased of proinflammatory cytokines level, it was found that anti-inflammatory mediators were disturbed. So, we would analyse the production of indoleamine 2,3-dioxygenase (IDO) in PHA-stimulated PBMC from type 2 DM patients and investigate its association to pro and anti-inflammatory cytokines. PBMC samples were collected from 21 patients with T2DM and 17 healthy subjects, then followed by 3-day PHA stimulation. In vitro production of TNF-α, IL-6, IFN-γ and IL-10 were measured using multiplex immunoassay; meanwhile, IDO level was assessed using ELISA. IDO concentration from unstimulated and PHA-stimulated PBMC were significantly higher in T2DM patients with p<0,001 and p=0.012 respectively. Reduced IDO production occurred in 52,8% of T2DM and it was associated with low interferon γ with p=0.005; whereas 42,8% of T2DM had higher IDO production and had moderate positive correlations with ratio of TNF-α/IL-10 (r=0,513 p=0,079), IL-6/IL-10 (r=0,446 p=0,114) and IFN-γ/IL-10 (r=0,422 p=0,129). We could conclude that there is an alteration of IDO production after PHA stimulation in T2DM. Low interferon γ level seems to contribute in reducing IDO production. In T2DM with higher IDO production, proinflammatory responses are more influential in increasing IDO production."