Recurrent abortions and lymphocyte transfusions.
Normal pregnancies depend on successful implantation of the placenta in the uterus. The trophoblast which forms the ultimate interface between the fetal and maternal tissue seems to lack the foreign (allo) antigens (namely HLA/TLX) required to induce immunological rejection reactions in the mother. It was previously believed that the trophoblast expressed paternal allo antigens and that successful pregnancies were dependent on so called 'kind' (non-cytotoxic or non-complement binding) blocking antibodies in order to protect the fetal unit from maternal cytotoxic T-cells and -antibodies. Blocking antibodies attached to paternal antigens on the trophoblast were assumed to prevent maternal cytotoxic T cell and cytotoxic antibodies from recognising the trophoblast as foreign tissue. On this assumption it was reasoned that transfusions of paternal HLA-expressing lymphocytes would increase maternal antipaternal HLA (TLX) blocking antibodies and thus be beneficial to women who experienced multiple miscarriages. There is, however, no scientific evidence for a specific immune response after lymphocyte transfusions that fulfil this function. Immunological tests, as for example mixed lymphocyte culture (MLC), on peripheral blood lymphocytes do not seem to reflect the local immune state in the uterus, either in the pregnant or the non-pregnant state. Since the trophoblast forms the ultimate interface between fetal and maternal tissue, its structure, secretions, and interaction with the decidua must be of definite importance for implantation of the blastocyst and growth of the embryo.
Bjercke
S
S
Department of Obstetrics and Gynecology, Rikshospitalet, Oslo, Norway.
D000026:Abortion, Habitual / Q000097:blood / Q000276:immunology* / Q000628:therapy*; D005260:Female; D006680:HLA Antigens / Q000276:immunology*; D006801:Humans; D007519:Isoantigens / Q000276:immunology*; D007959:Lymphocyte Culture Test, Mixed; D017710:Lymphocyte Transfusion / Q000379:methods*; D008297:Male; D011247:Pregnancy; D011257:Pregnancy Proteins / Q000276:immunology*; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome
D006680:HLA Antigens; D007519:Isoantigens; D011257:Pregnancy Proteins; C055067:trophoblast-lymphocyte cross-reactive antigens