Comparison of Expression of Chemokine Receptor 4 in Maternal Decidua and Chorionic Villi in Women with Spontaneous Miscarriages and Women Opting for Termination of Viable Pregnancies

BACKGROUND: Early pregnancy losses can be a distressing experience both for the parents and the treating clinician. We aim to explore the role of chemokine receptor 4 (CXCR4) in early pregnancy losses by comparing its expression among patients with spontaneous miscarriages and patients undergoing termination of viable pregnancies for unwanted pregnancies. AIM: The aim of the study was to investigate the expression of CXCR4 in early pregnancy losses and correlate the various clinical parameters with differential expression of the above receptor in the chorionic villi and maternal decidua. STUDY AND SETTING: The present study is a case-“control study done in a tertiary care center. METHODOLOGY: Fifty patients attending outdoor and antenatal clinic of the hospital aged 18-40 years with spontaneous miscarriage under 20 weeks of gestational age were included as cases and compared with fifty females of comparable age group (18-40 years) seeking medical termination of pregnancy as controls. Chorionic villi and decidua obtained from the cases and controls were analyzed for CXCR4 expression. STATISTICAL ANALYSIS: The results were analyzed using mean ± standard deviation, percentiles values, Chi-square test, and P value to determine the association of CXCR4 expression in decidua and chorionic villi of cases versus controls. RESULTS: CXCR4 expression was significantly downregulated in cases as compared to the controls with P < 0.001. The mean normalized ratio of CXCR4 expression to housekeeping gene (β Actin) expression in the case group was 1.607 ± 1.108 and in the control group, it was 2.506 ± 1.457. There was a strong correlation between the expression of CXCR4 and maternal age. With increasing age, the expression of CXCR4 was more downregulated in both the cases and control groups (P < 0.001). The expression of CXCR4 was elevated in controls as compared to cases in <30 years age group (P = 0.009). CXCR4 expression was higher in primigravida than in multigravida (P = 0.001), and as the number of previous miscarriages increased, the expression of CXCR4 was found to be decreased (P = 0.021). CONCLUSION: CXCR4 expression is significantly reduced in women with spontaneous miscarriages in comparison with viable pregnancies. and possibly, therapies targeted at increasing the expression of CXCR4 can be used as a treatment modality for management of spontaneous miscarriages.