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Activins and inducible nitric oxide synthase (iNOS) are produced by the human fallopian tube, and we speculate that tubal activins and iNOS may be involved in the immune response to<jats:italic>C. trachomatis<\/jats:italic>in humans and their pathological alteration may result in tubal pathology and the development of EP. Blood and fallopian tubes were collected from 14 women with EP. Sera were analyzed by enzyme-linked immunosorbent assay to detect antibodies against chlamydial heat shock protein 60 (chsp60) and the major outer membrane protein of<jats:italic>C. trachomatis.<\/jats:italic>Confirmation of<jats:italic>C. trachomatis<\/jats:italic>serology was made using the microimmunofluorescence test. The patients were classified into three groups according to their serological results, and immunohistochemistry and quantitative reverse transcription-PCR were performed to investigate the expression of candidate molecules by tubal epithelial cells among the three groups. This is the first study to show an increase in the expression of activin \u03b2A subunit, type II receptors, follistatin, and iNOS within the human fallopian tube of EP patients who were serologically positive for<jats:italic>C. trachomatis<\/jats:italic>. A similar expression profile was observed in the fallopian tubes with detectable antibodies only against chsp60. These results were shown at the mRNA and protein levels. We suggest that tubal activin A, its type II receptors, follistatin, and NO could be involved in the microbial-mediated immune response within the fallopian tube, and their pathological expression may lead to tubal damage and the development of EP.<\/jats:p>","DOI":"10.1128\/cvi.00221-09","type":"journal-article","created":{"date-parts":[[2009,8,20]],"date-time":"2009-08-20T02:09:03Z","timestamp":1250734143000},"page":"1493-1503","update-policy":"https:\/\/doi.org\/10.1128\/asmj-crossmark-policy-page","source":"Crossref","is-referenced-by-count":27,"title":["Role of Activins and Inducible Nitric Oxide in the Pathogenesis of Ectopic Pregnancy in Patients with or without<i>Chlamydia trachomatis<\/i>Infection"],"prefix":"10.1128","volume":"16","author":[{"given":"Bassem","family":"Refaat","sequence":"first","affiliation":[{"name":"Academic Unit of Reproductive and Developmental Medicine, Level 4, The Jessop Wing, Royal Hallamshire Hospital, Sheffield S10 2SF, United Kingdom"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Majedah","family":"Al-Azemi","sequence":"additional","affiliation":[{"name":"Academic Unit of Reproductive and Developmental Medicine, Level 4, The Jessop Wing, Royal Hallamshire Hospital, Sheffield S10 2SF, United Kingdom"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ian","family":"Geary","sequence":"additional","affiliation":[{"name":"Infection and Immunity Department, School of Medicine and Biomedical Sciences, University of Sheffield, Sheffield S10 2RX, United Kingdom"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adrian","family":"Eley","sequence":"additional","affiliation":[{"name":"Infection and Immunity Department, School of Medicine and Biomedical Sciences, University of Sheffield, Sheffield S10 2RX, United Kingdom"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"William","family":"Ledger","sequence":"additional","affiliation":[{"name":"Academic Unit of Reproductive and Developmental Medicine, Level 4, The Jessop Wing, Royal Hallamshire Hospital, Sheffield S10 2SF, United Kingdom"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"235","reference":[{"key":"e_1_3_1_2_2","doi-asserted-by":"crossref","first-page":"453","DOI":"10.1038\/eye.1998.104","volume":"12","year":"1998","unstructured":"Abu el-Asrar, A. 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