A diabetes drug could lead to new treatment for recurrent miscarriage as a study led by the University of Warwick has found that an existing drug designed to treat diabetes can also be used to improve the womb for pregnancy.
The study found that sitagliptin could be repurposed as the first treatment to prevent miscarriage by targeting the lining of the womb itself, according to a clinical trial led by the University.
Sitagliptin is first drug of its kind shown to increase stem cells in the lining of the womb, improving the conditions to support pregnancy.
Recurrent miscarriage is defined as the loss of two or more consecutive pregnancies, with additional miscarriages decreasing the likelihood of a successful pregnancy. Previous research by the Warwick team revealed that a lack of stem cells in the womb lining is causing thousands of women to suffer from recurrent miscarriages.
The team also demonstrated that stem cells protect specialised cells, called decidual cells, from excessive stress and inflammation. Decidual cells surround the implanting embryo and excessive stress can cause breakdown of the womb lining in pregnancy.
A new class of diabetes drugs called gliptins targets an enzyme involved in the recruitment of circulating stem cells to the womb. The researchers investigated 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 (an average of five) 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.
They found an average increase in stem cell count of 68% in those women who took the full course of sitagliptin. 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. There were minimal side effects for the participants.
The research by Warwick Medical School is reported in the journal EBioMedicine, from research conducted with University Hospitals Coventry and Warwickshire and supported by the NIHR Coventry and Warwickshire Clinical Research Facility. The research was funded by and took place at Tommy’s National Miscarriage Research Centre.
The researchers now hope to take the treatment to clinical trial and, if successful, it would be the first targeted specifically at the lining of the womb to prevent miscarriage.
Professor Siobhan Quenby, from Warwick Clinical Trials Unit and an Honorary Consultant at University Hospital Coventry and Warwickshire NHS Trust, said: “We have improved the environment that an embryo develops in and in doing so we hope to improve the chances of a successful pregnancy. These are very early results and the treatment now needs to be further tested in a large-scale clinical trial.”
Jane Brewin, Chief Executive at Tommy’s said: “This breakthrough research by the world leading team at Warwick shows great promise for an effective treatment which will reduce miscarriage and possibly later pregnancy loss too. A large-scale trial is needed to verify the findings and we hope that this will get underway quickly.”