There is a high risk of clinical or subclinical reproductive tract disease in the postpartum period in dairy cows. An integrated process of adaptive events should occur synchronously, including a robust but well-regulated immune response in the uterus. Failure of this process may result in reproductive tract inflammatory disease.
Neutrophils are the most abundant type of inflammatory cell and the main line of defence against infection in the uterus. Avoidance of clinical disease (metritis and purulent vaginal discharge) depends in large part on how effective the immune response is at limiting the burden and effects of bacterial pathogens, while the occurrence of subclinical endometritis is more a function of avoiding excessive or persistent inflammation.
Glucose supply, hypocalcemia, lipid mobilization from body fat, ketosis, and the flux of proinflammatory cytokines influence immune response and change rapidly and variably among individual cows. It is clear that hypocalcaemia is associated with reproductive tract disease, but the mechanisms remain unclear (i.e., direct effects of calcium on innate immune cell function vs. indirect effects of hypocalcemia through shared pathways related to feed intake or behaviour). Therefore, the importance of prevention or early treatment of subclinical hypocalcemia as a means to improve immune function and prevent reproductive tract disease is also unclear. Effective but well-regulated inflammatory response will be favoured by best management practices for transition cows, but specific interventions to modulate immune response to prevent uterine disease remain developmental.
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