Diabetes drug ‘could lead to treatment for recurrent miscarriage’

A pilot clinical trial found that the treatment increases the amount of stem cells in the lining of the womb.

An existing diabetes drug could also be used as the first treatment to prevent miscarriage, new research suggests.

The treatment works by increasing the amount of stem cells in the lining of the womb, improving conditions to support pregnancy. Previous research by University of Warwick researchers revealed a lack of stem cells in the womb lining is causing thousands of women to suffer from recurrent miscarriages. This is defined as the loss of two or more consecutive pregnancies, with additional miscarriages decreasing the likelihood of a successful pregnancy.

The team also demonstrated that stem cells protect specialised cells, called decidual cells, from excessive stress and inflammation. These cells surround the implanting embryo and excessive stress can cause breakdown of the womb lining in pregnancy.

According to the study published in the EBioMedicine journal, a new class of diabetes drugs called gliptins targets an enzyme involved in the recruitment of circulating stem cells to the womb. Researchers analysed whether inhibiting this enzyme, called DPP4, using a particular drug – sitagliptin – would improve conditions in the womb for pregnancy.

In a pilot clinical trial, 38 women aged 18 to 42 who had experienced a large number of recurrent miscarriages – five on average – were given either an oral course of sitagliptin or a placebo for three menstrual cycles. Biopsies of the womb were taken at the start of the course of treatment, and afterwards, to determine the number of stem cells present before and after the course.

There was an average increase in stem cell count of 68% in those women who took the full course of sitagliptin, the study found. This compares to no significant increase in those in the control group receiving an identical placebo pill. They also saw a 50% decrease in the number of “stressed” cells present in the lining of the womb.

Researchers say there were minimal side effects for the participants. They now hope to take the treatment to a clinical trial, and if successful it would be the first targeted specifically at the lining of the womb to prevent miscarriage.

Professor Jan Brosens, of Warwick Medical School and consultant in reproductive health at University Hospitals Coventry and Warwickshire NHS Trust, said: “There are currently very few effective treatments for miscarriage and this is the first that aims at normalising the womb before pregnancy.

“Although miscarriages can be caused by genetic errors in the embryo, an abnormal womb lining causes the loss of chromosomal normal pregnancies.

“We hope that this new treatment will prevent such losses and reduce both the physical and psychological burden of recurrent miscarriage.”

The research was funded by and took place at Tommy’s National Miscarriage Research Centre.

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