title: Experience in IVIg therapy for selected women with recurrent reproductive failure and NK cell expansion.
abstract: OBJECTIVE
  Recurrent reproductive failure (RRF) has been associated with expansion of circulating NK cells, key cells for maternal tolerance, decidual vasculogenesis and embryo growth. This study reports our experience in intravenous immunoglobulin (IVIg) therapy of a large cohort of women with RRF with expanded circulating NK and/or NKT-like cells (blood NKT cells are a heterogeneous subset of T cells that share properties of both T cells and NK cells).
  
  
  METHODS
  Observational study of RRF women with NK or NKT-like expansion (>12% or 10% cutoff levels of total lymphocytes, respectively), treated with IVIg for the next gestation.
  
  
  RESULTS
  By multivariant logistic regression analysis after adjusting for age, NK cells subsets and other therapies, IVIg significantly improved the live birth rate to 96.3% in women with recurrent miscarriage (RM) compared with 30.6% in case not receiving IVIg (P < 0.0001). In women with recurrent implantation failure (RIF), in comparison with women not receiving IVIg, treatment increased the pregnancy rate from 26.2 to 93.8% (P ≤ 0.0001) and the live birth rate from 17.9 to 80.0% in RIF (P ≤ 0.0001).
  
  
  CONCLUSIONS
  Immunomodulation with IVIg in our selected group of RRF patients with immunologic alterations enhanced clinical pregnancy and live birth rates. Our results may facilitate the design of future clinical trials of IVIg in this pathology.
authors.affiliation: Unit of Clinical Immunology, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
authors.forename: Rocio
authors.initials: R
authors.lastname: Ramos-Medina
authors.forename: Aurea
authors.initials: A
authors.lastname: García-Segovia
authors.forename: Juana
authors.initials: J
authors.lastname: Gil
authors.forename: Javier
authors.initials: J
authors.lastname: Carbone
authors.forename: Angel
authors.initials: A
authors.lastname: Aguarón de la Cruz
authors.forename: Ansgar
authors.initials: A
authors.lastname: Seyfferth
authors.forename: Bárbara
authors.initials: B
authors.lastname: Alonso
authors.forename: Jorge
authors.initials: J
authors.lastname: Alonso
authors.forename: Juan A
authors.initials: JA
authors.lastname: León
authors.forename: Diana
authors.initials: D
authors.lastname: Alecsandru
authors.forename: Elena
authors.initials: E
authors.lastname: Meliá
authors.forename: Elena
authors.initials: E
authors.lastname: Carrillo de Albornoz
authors.forename: Daniel
authors.initials: D
authors.lastname: Ordoñez
authors.forename: Isabel
authors.initials: I
authors.lastname: Santillán
authors.forename: Victoria
authors.initials: V
authors.lastname: Verdú
authors.forename: Jose Maria
authors.initials: JM
authors.lastname: Garcia Ruiz de Morales
authors.forename: Marcos
authors.initials: M
authors.lastname: López-Hoyos
authors.forename: Arturo
authors.initials: A
authors.lastname: López Larios
authors.forename: Almudena
authors.initials: A
authors.lastname: Sampalo
authors.forename: Pedro
authors.initials: P
authors.lastname: Caballero
authors.forename: Luis
authors.initials: L
authors.lastname: Ortiz Quintana
authors.forename: Eduardo
authors.initials: E
authors.lastname: Fernández-Cruz
authors.forename: Silvia
authors.initials: S
authors.lastname: Sánchez-Ramón
mesh_terms: D000026:Abortion, Habitual / Q000188:drug therapy* / Q000276:immunology / Q000473:pathology; D000328:Adult; D005260:Female; D005307:Fertilization in Vitro; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use*; D007155:Immunologic Factors / Q000627:therapeutic use*; D007694:Killer Cells, Natural / Q000187:drug effects* / Q000276:immunology / Q000473:pathology; D050498:Live Birth; D016015:Logistic Models; D018655:Lymphocyte Count; D055611:Natural Killer T-Cells / Q000187:drug effects* / Q000276:immunology / Q000473:pathology; D011247:Pregnancy; D017211:Treatment Failure
chemical_list: D016756:Immunoglobulins, Intravenous; D007155:Immunologic Factors
keywords: IVIg therapy; natural killer cells; observational study; recurrent reproductive failure