Detection of prespecified CE-associated pathogen targets by quantitative polymerase chain reaction is associated with CD138-positive endometrium: a retrospective cohort study
- 1Department of Reproductive Medicine, Kameda IVF Clinic Makuhari
- 2Department of Reproductive Medicine, Kamiya Ladies Clinic
Abstract
Introduction: We examined whether endometrial quantitative polymerase chain reaction (qPCR) detection of DNA from prespecified pathogen targets classically implicated in chronic endometritis (CE), from other reproductive-tract bacterial targets, or from Lactobacillus is associated with CD138-defined CE, independent of incidental endometrial polyps.
Methods: We included 126 infertile women who underwent concurrent CD138 immunostaining and endometrial qPCR and who had also undergone hysteroscopy. Women with antibiotic use within 1 month before sampling, Lactobacillus probiotic use, insufficient samples for CD138 assessment, or no hysteroscopy were excluded. Robustness was evaluated by two prespecified polyp-exclusion analyses, by exclusion of women with endometriosis or adenomyosis, and by multivariable logistic regression.
Results: CD138-positive endometrium was detected in 57 of 126 women (45.2%). Detection of CE-associated pathogen targets was associated with CD138 positivity (odds ratio 8.01, 95% confidence interval 1.70–37.85, P = 0.003; exact conditional odds ratio 7.89, 1.61–76.56), with specificity 97.1%, positive predictive value 84.6%, and sensitivity 19.3%, but this rested on only 13 target-positive women, of whom 11 were CD138-positive, so the estimate is imprecise. Other reproductive-tract bacterial targets were not associated with CD138 positivity (odds ratio 0.55, 0.25–1.22, P = 0.171). Lactobacillus detection was not significantly associated with CD138 positivity (odds ratio 0.54, 0.27–1.11, P = 0.107), although several analyses were directionally consistent with lower reported Lactobacillus values in CD138-positive women; this was suggestive rather than confirmatory. Conversely, 80.7% (46/57) of CD138-positive women had no detectable pathogen target. After polyp exclusion, the association was maintained (odds ratios 17.44 and 18.79), whereas the other categories remained nonsignificant. The association persisted after exclusion of women with endometriosis or adenomyosis (odds ratio 8.32, 1.75–39.60) and in the parsimonious multivariable model (adjusted odds ratio 8.94, 1.85–43.24; Firth penalized adjusted odds ratio 7.40, 1.67–32.90).
Discussion: Detection of prespecified CE-associated pathogen targets, but not detection of other reproductive-tract bacterial targets, was associated with CD138-positive CE, independent of incidental polyps; the Lactobacillus findings were suggestive but not confirmatory. Because the panel provides no universal bacterial quantification, these data cannot evaluate non- Lactobacillus -dominant microbiota as a community state. qPCR may help identify a high-specificity, DNA-defined pathogen-associated subset, while CD138-positive CE appears etiologically heterogeneous and still requires histologic diagnosis.
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BibTeX
@article{nishii2026detection,
title = {{Detection of prespecified CE-associated pathogen targets by quantitative polymerase chain reaction is associated with CD138-positive endometrium: a retrospective cohort study}},
author = {Shogo Nishii and Nanako Iwami and Hirobumi Kamiya and Kiyotaka Kawai},
journal = {Frontiers in Immunology},
year = {2026},
month = oct,
doi = {10.3389/fimmu.2026.1928249},
url = {https://www.frontiersin.org/articles/10.3389/fimmu.2026.1928249/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Detection of prespecified CE-associated pathogen targets by quantitative polymerase chain reaction is associated with CD138-positive endometrium: a retrospective cohort study
AU - Shogo Nishii
AU - Nanako Iwami
AU - Hirobumi Kamiya
AU - Kiyotaka Kawai
PY - 2026
DA - 2026/10/13
JO - Frontiers in Immunology
DO - 10.3389/fimmu.2026.1928249
UR - https://www.frontiersin.org/articles/10.3389/fimmu.2026.1928249/full
AB - Introduction: We examined whether endometrial quantitative polymerase chain reaction (qPCR) detection of DNA from prespecified pathogen targets classically implicated in chronic endometritis (CE), from other reproductive-tract bacterial targets, or from Lactobacillus is associated with CD138-defined CE, independent of incidental endometrial polyps. Methods: We included 126 infertile women who underwent concurrent CD138 immunostaining and endometrial qPCR and who had also undergone hysteroscopy. Women with antibiotic use within 1 month before sampling, Lactobacillus probiotic use, insufficient samples for CD138 assessment, or no hysteroscopy were excluded. Robustness was evaluated by two prespecified polyp-exclusion analyses, by exclusion of women with endometriosis or adenomyosis, and by multivariable logistic regression. Results: CD138-positive endometrium was detected in 57 of 126 women (45.2%). Detection of CE-associated pathogen targets was associated with CD138 positivity (odds ratio 8.01, 95% confidence interval 1.70–37.85, P = 0.003; exact conditional odds ratio 7.89, 1.61–76.56), with specificity 97.1%, positive predictive value 84.6%, and sensitivity 19.3%, but this rested on only 13 target-positive women, of whom 11 were CD138-positive, so the estimate is imprecise. Other reproductive-tract bacterial targets were not associated with CD138 positivity (odds ratio 0.55, 0.25–1.22, P = 0.171). Lactobacillus detection was not significantly associated with CD138 positivity (odds ratio 0.54, 0.27–1.11, P = 0.107), although several analyses were directionally consistent with lower reported Lactobacillus values in CD138-positive women; this was suggestive rather than confirmatory. Conversely, 80.7% (46/57) of CD138-positive women had no detectable pathogen target. After polyp exclusion, the association was maintained (odds ratios 17.44 and 18.79), whereas the other categories remained nonsignificant. The association persisted after exclusion of women with endometriosis or adenomyosis (odds ratio 8.32, 1.75–39.60) and in the parsimonious multivariable model (adjusted odds ratio 8.94, 1.85–43.24; Firth penalized adjusted odds ratio 7.40, 1.67–32.90). Discussion: Detection of prespecified CE-associated pathogen targets, but not detection of other reproductive-tract bacterial targets, was associated with CD138-positive CE, independent of incidental polyps; the Lactobacillus findings were suggestive but not confirmatory. Because the panel provides no universal bacterial quantification, these data cannot evaluate non- Lactobacillus -dominant microbiota as a community state. qPCR may help identify a high-specificity, DNA-defined pathogen-associated subset, while CD138-positive CE appears etiologically heterogeneous and still requires histologic diagnosis.
SN - 1664-3224
ER -