Aberrant autophagy and proinflammatory cytokines may reduce endometrial decidualization: a essential role of obesity on infertility

Background: Obesity is associated with reproductive disorders and infertility. Autophagy is upregulated during decidualization, but is diminished in obesity models with impaired decidualization. Defects in autophagy are related to the occurrence of inflammatory diseases, but its role in endometrial decidualization with obese patients is unknown.Methods: The levels of autophagy-related factors (LC3B-II and Beclin 1), and autophagy-related proteins which have a correlation with endometrial decidualization (ATG3, ATG5, ATG7 and foxo1), as well as autophagy-related inflammatory cytokines in endometrium of lean and obese patients was assessed. We then investigated the the role of autophagic flux during decidualization in ‘obese’- vs ‘lean’- treated cells from matched patients.Results: Alteration in autophagic flux and the expression of autophagy-related genes revealed impaired autophagy in obese patients compared with lean. Autophagy-related proinflammatory cytokines were upregulated in the uterine cavity of obese patients, who also showed impaired decidualization.Conclusions: Obesity downregulates the expression of autophagy-related genes and impairs endometrial stromal cell autophagic flux, and induces inflammation. These alterations in autophagy are associated with increased activation of autophagy-related proinflammatory cytokines might decrease basic uterine receptivity.