title: An immunological basis for chronic histiocytic intervillositis in recurrent fetal loss.
abstract: OBJECTIVE
  Chronic histiocytic intervillositis (CHIV) is a rare type of placental pathology that is associated with reproductive loss at all gestational ages. The aim of the study was to investigate the relationship between the severity of CHIV and the outcome of pregnancy and to compare the immune response between CHIV patients and controls to explore an immunological origin of CHIV.
  
  
  METHODS
  Microscopic slides were reviewed and scored according to a previously published grading system in 30 pregnancies of 22 CHIV patients. Partner-specific mixed lymphocyte reactions, cytotoxic T-lymphocyte precursor frequencies (CTLpf), and anti-HLA antibodies were determined in four patients and seven controls.
  
  
  RESULTS
  Higher CHIV scores are associated with worse pregnancy outcome. CHIV patients demonstrated a higher CTLpf against their partner compared to non-complicated pregnancies (P = 0.03). The CTLpf was extremely high in 75% of the patients. Antipaternal HLA antibodies were only present in 75% of the CHIV patients compared to none of the controls (P = 0.02).
  
  
  CONCLUSIONS
  CHIV scores seem to be associated with the severity of adverse pregnancy outcome. High antipaternal cellular (T-cell) and humoral (B-cell) response to partner-specific CTLpf and the presence of anti-HLA antibodies directed to the partner suggest an immunologic origin of CHIV.
authors.affiliation: Division of Obstetrics and Prenatal Medicine, Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands. a.reus@erasmusmc.nl
authors.forename: Averil D
authors.initials: AD
authors.lastname: Reus
authors.forename: Nicole M
authors.initials: NM
authors.lastname: van Besouw
authors.forename: Nikki M
authors.initials: NM
authors.lastname: Molenaar
authors.forename: Eric A P
authors.initials: EA
authors.lastname: Steegers
authors.forename: Willy
authors.initials: W
authors.lastname: Visser
authors.forename: Ronella P
authors.initials: RP
authors.lastname: de Kuiper
authors.forename: Ronald R
authors.initials: RR
authors.lastname: de Krijger
authors.forename: Dave L
authors.initials: DL
authors.lastname: Roelen
authors.forename: Niek
authors.initials: N
authors.lastname: Exalto
mesh_terms: D000026:Abortion, Habitual / Q000276:immunology*; D000328:Adult; D001402:B-Lymphocytes / Q000276:immunology; D002824:Chorionic Villi / Q000276:immunology / Q000378:metabolism / Q000473:pathology; D002908:Chronic Disease; D005260:Female; D005865:Gestational Age; D006680:HLA Antigens; D006644:Histiocytes / Q000276:immunology / Q000473:pathology; D006801:Humans; D007959:Lymphocyte Culture Test, Mixed; D008875:Middle Aged; D010922:Placenta Diseases / Q000276:immunology / Q000473:pathology; D011247:Pregnancy; D011248:Pregnancy Complications / Q000276:immunology / Q000473:pathology; D011256:Pregnancy Outcome; D013602:T-Lymphocytes, Cytotoxic / Q000276:immunology; D055815:Young Adult
chemical_list: D006680:HLA Antigens
keywords: Adverse pregnancy outcome; chronic histiocytic intervillositis; immunology; miscarriage