Disturbances in placental immunology: ready for therapeutic interventions?
Recent studies have provided new insight into aberrations in the immunological interplay between mother and fetus and their potential role in the development of recurrent fetal loss and preeclampsia. The action of anti-phospholipid antibodies in recurrent fetal loss is now proposed to involve the complement system, neutrophil activation and the production of TNFalpha by immune bystander cells. A clear involvement of the immune system is emerging in preeclampsia, involving mainly the innate arm, especially neutrophils. The activation of peripheral neutrophils by placentally released inflammatory debris triggers the induction of neutrophil extracellular traps (NETs), which may lead to an occlusion of the intervillous space, thereby further promoting a condition of placental hypoxia. It has, hence, been suggested that new therapeutic strategies be developed, including the possible use of TNFalpha antagonists in cases of recurrent miscarriage. These strategies need to be addressed with caution due to the possible induction of fetal congenital abnormalities.
Hahn
Sinuhe
S
Laboratory for Prenatal Medicine, University Women's Hospital, Department of Research, University of Basel, Spitalstrasse 21, 4031 Basel, Switzerland. shahn@uhbs.ch
Gupta
Anurag Kumar
AK
Troeger
Carolyn
C
Rusterholz
Corinne
C
Holzgreve
Wolfgang
W
D000026:Abortion, Habitual / Q000276:immunology*; D016736:Antiphospholipid Syndrome / Q000150:complications / Q000276:immunology; D005260:Female; D006801:Humans; D010920:Placenta / Q000276:immunology*; D011225:Pre-Eclampsia / Q000276:immunology*; D011247:Pregnancy