Preeclampsia: a view through the danger model.
Classical thinking suggests that the immune system undergoes activation on the basis of discrimination between 'self' and 'non-self'. Accordingly, the fetus activates the mother's immune system because the fetus is in part 'non-self'. Thus, successful pregnancy depends on constraint of maternal immunity. Preeclampsia is an outcome of lost constraint. Instead, the danger model suggests that normal pregnancy, regardless of the expression of 'non-self' antigens, does not activate the maternal immune system unless that pregnancy expresses danger signals. Thus, preeclampsia stems from stress or abnormal cell death in pregnancy-related tissues. This compels expression of specific danger signals and potential activation of anti-fetal immunity, which secondarily feeds the syndrome. Study of preeclampsia from this perspective may bring forth novel mechanisms and indicators of vascular and metabolic dysfunction during pregnancy.
Bonney
Elizabeth A
EA
Department of Obstetrics and Gynecology, University of Vermont College of Medicine, Given Building, Room C-244, 89 Beaumont Avenue, Burlington, VT 05405, USA. ebonney@uvm.edu
D005260:Female; D005313:Fetal Death; D005333:Fetus / Q000276:immunology / Q000502:physiology; D017359:HELLP Syndrome / Q000276:immunology* / Q000503:physiopathology; D006801:Humans; D007108:Immune Tolerance; D008431:Maternal-Fetal Exchange; D008954:Models, Biological; D010920:Placenta / Q000276:immunology*; D011225:Pre-Eclampsia / Q000276:immunology* / Q000503:physiopathology; D011247:Pregnancy