title: Characterizing Villitis of Unknown Etiology and Inflammation in Stillbirth.
abstract: Villitis of unknown etiology (VUE) is an enigmatic inflammatory condition of the placenta associated with fetal growth restriction and stillbirth. Greater understanding of this condition is essential to understand its contribution to adverse outcomes. Our aim was to identify and quantify the cells in VUE in cases of stillbirth and to characterize immune responses specific to this condition. Immunohistochemistry was performed on placentas from stillborn infants whose cause of death was recorded as VUE to identify CD45(+) leukocytes, CD163(+) macrophages, CD4(+) and CD8(+) T cells, neutrophils, and proinflammatory and anti-inflammatory cytokines. Images were quantified with HistoQuest software. CD45(+) leukocytes comprised 25% of cells in VUE lesions: macrophages (12%) and CD4 T cells (11%) being predominant cell types; CD8 T cells were observed in all lesions. Leukocytes and macrophages were increased throughout the placenta in stillbirths; pan-placental CD4(+) and CD8(+) T cells outside VUE lesions were increased in stillbirth with VUE. There was increased IL-2 and IL-12 and reduced IL-4 immunostaining in VUE lesions. Our results suggest VUE in stillbirth has a similar immune cell profile to live birth. Pan-placental macrophages, CD4 and CD8 T cells indicate a wider inflammatory response unrestricted to VUE lesions. The cytokine profile observed suggests a skew towards inappropriate Th1 immune responses. Full characterisation VUE lesion phenotype confirms its immunological origins and provides foundations to develop novel investigations.
authors: Maternal and Fetal Health Research Centre, Institute of Human Development, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom. Electronic address: hayleyderricott@live.co.uk.
authors: Hayley
authors: H
authors: Derricott
authors: Maternal and Fetal Health Research Centre, Institute of Human Development, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom.
authors: Rebecca L
authors: RL
authors: Jones
authors: Maternal and Fetal Health Research Centre, Institute of Human Development, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom.
authors: Susan L
authors: SL
authors: Greenwood
authors: Department of Paediatric Histopathology, Royal Manchester Children's Hospital, Manchester, United Kingdom.
authors: Gauri
authors: G
authors: Batra
authors: Department of Paediatric Histopathology, Edinburgh Royal Infirmary, Edinburgh, United Kingdom.
authors: Margaret J
authors: MJ
authors: Evans
authors: Maternal and Fetal Health Research Centre, Institute of Human Development, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom.
authors: Alexander E P
authors: AE
authors: Heazell
mesh_terms: D000293:Adolescent; D000328:Adult; D018414:CD8-Positive T-Lymphocytes / Q000276:immunology*; D002824:Chorionic Villi / Q000276:immunology / Q000378:metabolism*; D005260:Female; D006801:Humans; D007249:Inflammation / Q000150:complications / Q000276:immunology / Q000473:pathology*; D008264:Macrophages / Q000378:metabolism; D010920:Placenta / Q000378:metabolism / Q000473:pathology*; D010922:Placenta Diseases / Q000276:immunology / Q000473:pathology*; D011247:Pregnancy; D050497:Stillbirth / Q000453:epidemiology*; D055815:Young Adult