Peripartum cardiomyopathy, an autoimmune manifestation of allograft rejection?
The timing of peripartum cardiomyopathy (PPCM) in association with pregnancy is typical of autoimmune conditions. This review addresses this fact by presenting PPCM as an organ specific autoimmune response (though not necessarily as an outright autoimmune condition), akin to autoimmune responses seen with complications of allogeneic organ transplantations. Since pregnancy represents a semi-allograft (representing paternal alloantigens), pregnancy and allogeneic organ transplants can be expected to be subject to similar allograft tolerance mechanisms, and also to share potential complications of normal allograft tolerance. This review suggests that PPCM represents a cardio-toxic autoimmune component within a more general immunological malfunction of tolerance of the fetal allograft by the maternal immune system. Treatment of PPCM with therapies, proven successful in graft versus host disease and organ rejection, may, therefore, be successful. Their success would also be confirmatory of such a concept.
Gleicher
Norbert
N
Center for Human Reproduction and the Foundation for Reproductive Medicine, New York, NY, USA. ngleicher@thechr.com
Elkayam
Uri
U
D017152:Antibodies, Antiphospholipid / Q000276:immunology; D001324:Autoantigens / Q000276:immunology; D015551:Autoimmunity / Q000276:immunology*; D024722:Cardiac Myosins / Q000276:immunology; D009202:Cardiomyopathies / Q000276:immunology* / Q000503:physiopathology; D005260:Female; D006084:Graft Rejection / Q000276:immunology* / Q000503:physiopathology; D006648:Histocompatibility / Q000235:genetics / Q000276:immunology; D006801:Humans; D009928:Organ Specificity; D021041:Placental Circulation / Q000276:immunology; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000276:immunology* / Q000503:physiopathology; D023001:Transplantation Tolerance; D014184:Transplantation, Homologous
D017152:Antibodies, Antiphospholipid; D001324:Autoantigens; D024722:Cardiac Myosins