Alloimmune mechanisms of recurrent miscarriage


Cite item

Full Text

Open Access Open Access
Restricted Access Access granted
Restricted Access Subscription or Fee Access

Abstract

The review outlines current ideas on the alloimmune mechanism of sporadic recurrent miscarriage. It considers immunological parameters, the changes of which are associated with the impaired mechanisms of immune recognition and response in this obstetric disease. The reasons that have no unique response to the questions of what immune mechanisms ensure fetal tolerance to paternal antigens and what mechanisms cause impaired gestational processes, as well as prospects for the areas of further investigations are discussed.

Full Text

Restricted Access

About the authors

A. M Khachatryan

Academician V.I. Kulakov Research Center of Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia

Email: nelly1986@mail.ru
Graduate student, Department of Pregnancy Loss Prevention and Therapy

L. V Krechetova

Academician V.I. Kulakov Research Center of Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia

Email: k_l_v_@mail.ru
PhD in medical sciences, Head of Laboratory of Clinical Immunology

N. K Tetruashvili

Academician V.I. Kulakov Research Center of Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia

Email: tetrauly@mail.ru
Doctor of Medicine, Head of the Department of Pregnancy Loss Prevention and Therapy

References

  1. Thornton C.A. Immunology of pregnancy. Proc. Nutr. Soc. 2010; 69(3): 357-65.
  2. Сухих Г.Т., Ванько Л.В. Иммунология беременности. М.: Изд-во РАМН; 2003. 400 с.
  3. Сотникова Н.Ю., ред. Иммунологическая загадка беременности. Иваново: Изд-во МИК; 2005. 276 с.
  4. Leber A., Zenclussen M.L., Teles A., Brachwitz N., Casalis P., El-Mousleh T. et al. Pregnancy: tolerance and suppression of immune responses. Methods Mol. Biol. 2011; 677: 397-417.
  5. Carp Howard J.A., ed. Reccurent pregnancy loss: causes, controversies and treatment. Informa UK Ltd.; 2007. 290 p.
  6. Farquharson R.G., Stephenson M.D., eds. Early pregnancy. Cambridge University Press; 2012. doi: http://dx.doi.org/10.1017/CB09780511777851.
  7. Wilczynski J.R. Immunological analogy between allograft rejection, recurrent abortion and pre-eclampsia - the same basic mechanism? Hum. Immunol. 2006; 67(7): 492-511.
  8. Erlebacher A. Mechanisms of T cell tolerance towards the allogenic fetus. Nat. Rev. Immunol. 2013; 13(1): 23-33.
  9. Matthiesen L., Kalkunte S., Sharma S. Multiple pregnancy failures: an immunological paradigm. Am. J. Reprod. Immunol. 2012; 67(4): 334-40.
  10. Raghupathy R. The immune system in pregnancy: Friend or foe? Kuwait Med. J. 2009; 41(2): 93-102.
  11. Ярилин А.А. Иммунология: учебник. М.: ГЭОТАР-Медиа; 2010. 752 с.
  12. Mitchell P., Azfali B., Lombardi G., Lechler R.I. The T-helper 17-regulatory T-cell axis in transplantant rejection and tolerance. Curr. Opin. Organ. Transplant. 2009; 14(4): 326-31.
  13. Fietta P., Delsante G. The effector T-helper cell triade. Riv. Biol. 2009; 102(1): 61-74.
  14. Wegmann T.G., Lin H., Guilbert L., Mosmann T.R. Bidirectional cytokine interactions in the maternal-fetal relationship: is successful pregnancy a TH2 phenomenon? Immunol. Today. 1993; 14(7): 353-6.
  15. Romero R., Gotsch F., Pineles B., Kusanovic J.P. Inflammation in pregnancy: its roles in reproductive physiology, obstetrical complications, and fetal injury. Nutr. Rev. 2007; 65(12, Pt 2): S194-202.
  16. Mor G., Cardenas I., Abrahams V., Guller S. Inflammation and pregnancy: the role of the immune system at the implantation site. Ann. N.Y. Acad. Sci. 2011; 1221: 80-7.
  17. Zeldovich V., Bakardjiev A. Host defence and tolerance: unique challenges in the placenta. PLoS Pathog. 2012; 8(8): e1002804.
  18. Munoz-Suano A., Hamilton A.B., Betz A.G. Gimme shelter: the immune system during pregnancy. Immunol. Rev. 2011; 241(1): 20-38.
  19. Petroff M.G. Review: Fetal antigens-identity, origins, and influences on the maternal immune system. Placenta. 2011; 32(Suppl. 2): S176-81.
  20. Saito S., Nakashima A., Shima T. Future directions of studies for recurrent miscarriage associated with immune etiologies. J. Reprod. Immunol. 2011; 90(1): 91-5.
  21. Ernerudh J., Berg G., Mjösberg J. Regulatory T helper cells in pregnancy and their roles in systemic versus local immune tolerance. Am. J. Reprod. Immunol. 2011; 66(Suppl. 1): 31-43.
  22. Williams Z. Inducing tolerance to pregnancy. N. Engl. J. Med. 2012; 367(12): 1159-61.
  23. Saito S., Shima T., Nakashima A., Shiozaki A., Ito M., Sasaki Y. What is the role of regulatory T cells in the success of implantation and early pregnancy? J. Assist. Reprod. Genet. 2007; 24(9): 379-86.
  24. Wang W.J., Hao C.F., Yi-Lin, Yin G.J., Bao S.H., Qiu L.H., Lin Q.D. Increased prevalence of T helper 17 (Th17) cells in peripheral blood and decidua in unexplained recurrent spontaneous abortion patients. J. Reprod. Immunol. 2010; 84(2): 164-70.
  25. Ziegler S.F., Buckner J.H. FOXP3 and the regulation of Treg/Th17 differentiation. Microbes Infect. 2009; 11(5): 594-8.
  26. Saito S., Sasaki Y., Sakai M. CD4+CD25+high regulatory T-cells in human pregnancy. J. Reprod. Immunol. 2005; 65(2): 111-20.
  27. Chaouat G., Petitbarat M., Dubanchet S., Rahmati M., Ledee N. Tolerance to the foetal allograft? Am. J. Reprod. Immunol. 2010; 63: 624-36.
  28. Ширшев С.В. Иммунология материнско-фетальных взаимодействий. Екатеринбург: РАН УО Ин-т экологии и генетики микроорганизмов; 2009. 582 с.
  29. Сидельникова В.М. Привычная потеря беременности. М.: Триада-Х; 2005. 303 с.
  30. Regan L., Braude P.R., Hill D.P. A prospective study of the incidence, time of appearance and significance of anti-paternal lymphocytotoxic antibodies in human pregnancy. Hum. Reprod. 1991; 6(2): 294-8.
  31. Maruyama T., Makino T., Sugi T., Iwasaki K., Ozawa N., Matsubayashi H., Nozawa S. Flow cytometric crossmatch and early pregnancy loss in women with a history of recurrent spontaneous abortions who underwent paternal leukocyte immunotherapy. Am. J. Obstet. Gynecol. 1993; 168(5): 1528-36.
  32. Nielsen H.S., Witvliet M.D., Steffensen R., Haasnoot G.W., Goulmy E., Christiansen O.B., Claas F. The presence of HLA-antibodies in recurrent miscarriage patients is associated with a reduced chance of a live birth. J. Reprod. Immunol. 2010; 87(1-2): 67-73.
  33. Bartel G., Walch K., Wahrmann M., Pils S., Küssel L., Polterauer S. et al. Prevalence and qualitative properties of circulating anti-human leukocyte antigen alloantibodies after pregnancy: no association with unexplained recurrent miscarriage. Hum. Immunol. 2011; 72(2): 187-92.
  34. Pandey M.K., Thakur S., Agrawal S. Lymphocyte immunotherapy and its probable mechanism in the maintenance of pregnancy in women with recurrent spontaneous abortion. Arch. Gynecol. Obstet. 2004; 269(3): 161-72.
  35. Agrawal S., Pandey M.K., Mandai S., Mishra L., Agarwal S. Humoral immune response to an allogenic foetus in normal fertile women and recurrent aborters. BMC Pregnancy Childbirth. 2002; 2(1): 6.
  36. Koelsch U., Weber C., Ritter C., Viehbahn A., Brune T. Immune reactivity between mother and fetus is independent of MHC haplotype. Am. J. Reprod. Immunol. 2007; 58(3): 179. doi: 10.1111/j.1600-0897.2007.00519_8.x
  37. Lashley E.E., Meuleman T., Claas F.H. Beneficial or harmful effect of antipaternal human leukocyte antibodies on pregnancy outcome? A systematic review and meta-analysis. Am. J. Reprod. Immunol. 2013; 70(2): 87-103.
  38. Gutierrez G., Gentile T., Miranda S., Margni R.A. Asymmetric antibodies: a protective arm in pregnancy. Chem. Immunol. Allergy. 2005; 89: 158-68.
  39. Agrawal S., Pandey M.K., Pandey A. Prevalence of MLR blocking antibodies before and after immunotherapy. Hematother. Stem Cell Res. 2000; 9(2): 257-62.
  40. Agrawal S., Sharma R.K., Kishore R., Agarwal S.S. Development of antiidiotypic antibodies to HLA antigens during pregnancy. Indian J. Med. Res. 1994; 99: 42-6.
  41. Pandey M.K., Saxena V., Agrawal S. Characterization of mixed lymphocyte reaction blocking antibodies (MLR-Bf) in human pregnancy. BMC Pregnancy Childbirth. 2003; 3: 2.
  42. Pandey M.K., Agrawal S. Induction of MLR-Bf and protection of fetal loss: a current double blind randomized trial of paternal lymphocyte immunization for women with recurrent spontaneous abortion. Int. Immunopharmacol. 2004; 4(2): 289-98.
  43. Nonaka T., Takakuwa K., Ooki I., Akashi M., Yokoo T., Kikuchi A., Tanaka K. Results of immunotherapy for patients with unexplained primary recurrent abortions-prospective non-randomized cohort study. Am. J. Reprod. Immunol. 2007; 58(6): 530-6.
  44. Porter T.F., La Coursiere Y., Scott J.R. Immunotherapy for recurrent miscarriage. Cochrane Database Syst. Rev. 2006; (2): CD000112.
  45. Khonina N.A., Broitman E.V., Shevela E.Y., Pasman N.M., Chernykh E.R. Mixed lymphocyte reaction blocking factors (MLR-Bf) as potential biomarker for indication and efficacy of paternal lymphocyte immunization in recurrent spontaneous abortion. Arch. Gynecol. Obstet. 2013; 288(4): 933-7.
  46. Bozorgmehr M., Zarnani A.H., Nikoo S., Moazzeni S.M. Suppressive effect of pregnant serum on murine dendritic cell function. J. Obstet. Gynaecol. Res. 2012; 38(5): 797-803.
  47. Clark D.A., Wong K., Banwatt D., Chen Z., Liu J., Lee L., Gorczynski R.M., Blajchman M.A. CD200-dependent and nonCD200-dependent pathways of NK cell suppression by human IVIG. J. Assist. Reprod. Genet. 2008; 25(2-3): 67-72.
  48. Le Bouteiller P., Siewiera J., Casart Y., Aguerre-Girr M., El Costa H., Berrebi A. et al. The human decidual NK-cell response to virus infection: what can we learn from circulating NK lymphocytes? J. Reprod. Immunol. 2011; 88(2): 170-5.
  49. Lash G.E., Bulmer J.N. Do uterine natural killer (uNK) cells contribute to female reproductive disorders? J. Reprod. Immunol. 2011; 88(2): 156-64.
  50. Blois S.M., Klapp B.F., Barrientos G. Decidualization and angiogenesis in early pregnancy: unravelling the functions of DC and NK cells. J. Reprod. Immunol. 2011; 88(2): 86-92.
  51. Fu B., Li X., Sun R., Tong X., Ling B., Tian Z., Wei H. Natural killer cells promote immune tolerance by regulating inflammatory TH17 cells at the human maternal-fetal interface. Proc. Natl. Acad. Sci. USA. 2013; 110(3): E231-40.
  52. Bao S.H., Shuai W., Tong J., Wang L., Chen P., Sun J. Increased expression of Toll-like receptor 3 in decidual natural killer cells of patients with unexplained recurrent spontaneous miscarriage. Eur. J. Obstet. Gynecol. Reprod. Biol. 2012; 165(2): 326-30.
  53. Vacca P., Cantoni C., Vitale M., Prato C., Canegallo F., Fenoglio D. et al. Crosstalk between decidual NK and CD14+ myelomonocytic cells results in induction of Tregs and immunosuppression. Proc. Natl. Acad. Sci. USA. 2010; 107(26): 11918-23.
  54. Clark D.A. Cell-surface CD200 may predict efficacy of paternal mononuclear leukocyte immunotherapy in treatment of human recurrent pregnancy loss. Am. J. Reprod. Immunol. 2009; 61(1): 75-84.
  55. Lee S.K., Na B.J., Kim J.Y., Hur S.E., Lee M., Gilman-Sachs A., Kwak-Kim. Determination of clinical Ccellular immune markers in women with recurrent pregnancy loss. Am. J. Reprod. Immunol. 2013; 70(5): 398-411.
  56. Fukui A., Funamizu A., Yokota M., Yamada K., Nakamua R., Fukuhara R. et al. Uterine and circulating natural killer cells and their roles in women with recurrent pregnancy loss, implantation failure and preeclampsia. J. Reprod. Immunol. 2011; 90(1): 105-10.
  57. Chaouat G. Inflammation, NK cells and implantation: friend and foe (the good, the bad and the ugly?): replacing placental viviparity in an evolutionary perspective. J. Reprod. Immunol. 2013; 97(1): 2-13.

Supplementary files

Supplementary Files
Action
1. JATS XML
Download

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies