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Köstlin N, Hofstädter K, Ostermeir AL, Spring B, Leiber A, Haen S, Abele H, Bauer P, Pollheimer J, Hartl D, Poets CF, Gille C. Granulocytic Myeloid-Derived Suppressor Cells Accumulate in Human Placenta and Polarize toward a Th2 Phenotype. THE JOURNAL OF IMMUNOLOGY 2015; 196:1132-45. [PMID: 26712947 DOI: 10.4049/jimmunol.1500340] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Accepted: 11/23/2015] [Indexed: 12/11/2022]
Abstract
Tolerance induction toward the semiallogeneic fetus is crucial to enable a successful pregnancy; its failure is associated with abortion or preterm delivery. Skewing T cell differentiation toward a Th2-dominated phenotype seems to be pivotal in maternal immune adaption, yet underlying mechanisms are incompletely understood. Myeloid-derived suppressor cells (MDSCs) are innate immune cells that mediate T cell suppression and are increased in cord blood of healthy newborns and in peripheral blood of pregnant women. In this study, we demonstrate that granulocytic MDSCs (GR-MDSCs) accumulate in human placenta of healthy pregnancies but are diminished in patients with spontaneous abortions. Placental GR-MDSCs effectively suppressed T cell responses by expression of arginase I and production of reactive oxygen species and were activated at the maternal-fetal interface through interaction with trophoblast cells. Furthermore, GR-MDSCs isolated from placenta polarized CD4(+) T cells toward a Th2 cytokine response. These results highlight a potential role of GR-MDSCs in inducing and maintaining maternal-fetal tolerance and suggest them as a promising target for therapeutic manipulation of pregnancy complications.
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Affiliation(s)
- Natascha Köstlin
- Department of Neonatology, University Children's Hospital Tuebingen, 72076 Tuebingen, Germany
| | - Kathrin Hofstädter
- Department of Neonatology, University Children's Hospital Tuebingen, 72076 Tuebingen, Germany
| | - Anna-Lena Ostermeir
- Department of Neonatology, University Children's Hospital Tuebingen, 72076 Tuebingen, Germany
| | - Bärbel Spring
- Department of Neonatology, University Children's Hospital Tuebingen, 72076 Tuebingen, Germany
| | - Anja Leiber
- Department of Neonatology, University Children's Hospital Tuebingen, 72076 Tuebingen, Germany
| | - Susanne Haen
- Department of Pathology, University Hospital Tuebingen, 72076 Tuebingen, Germany
| | - Harald Abele
- Department of Obstetrics and Gynecology, University Hospital Tuebingen, 72076 Tuebingen, Germany
| | - Peter Bauer
- Institute of Medical Genetics and Applied Genomics, University Hospital Tuebingen, 72076 Tuebingen, Germany
| | - Jürgen Pollheimer
- Department of Obstetrics and Fetal-Maternal Medicine, Medical University of Vienna, 1090 Vienna, Austria; and
| | - Dominik Hartl
- Department of Pediatrics I, University Children's Hospital Tuebingen, 72076 Tuebingen, Germany
| | - Christian F Poets
- Department of Neonatology, University Children's Hospital Tuebingen, 72076 Tuebingen, Germany
| | - Christian Gille
- Department of Neonatology, University Children's Hospital Tuebingen, 72076 Tuebingen, Germany;
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2
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Aringer M, Fischer-Betz R, Hiepe F. [Statement on the use of mycophenolate mofetil for systemic lupus erythematosus]. Z Rheumatol 2014; 72:575-80. [PMID: 23756593 DOI: 10.1007/s00393-013-1213-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Mycophenolate mofetil (MMF) is among the few immunosuppressive drugs with sufficient data from controlled studies on the therapy of systemic lupus erythematosus (SLE). In the light of results from recently published randomized controlled trials on the effectiveness of MMF in the treatment of lupus nephritis, it has become necessary to revise the statement of the Germany Society of Rheumatology on the use of MMF for SLE. In the induction therapy of lupus nephritis MMF has been shown to be equivalent in effectiveness to i.v. cyclophosphamide and superior to azathioprine in the maintenance phase. Cyclophosphamide is inferior to MMF and probably also to azathioprine as maintenance therapy and should therefore, not be considered for this purpose and also because of its toxicity. For other organ manifestations MMF also constitutes an alternative when approved immunosuppressants are not able to control the disease and glucocorticoids cannot be reduced to 7.5 mg prednisolone daily equivalents or less.
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Affiliation(s)
- M Aringer
- Medizinische Klinik und Poliklinik III, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland.
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Feldtkeller E, Lind-Albrecht G, Rudwaleit M. Core set of recommendations for patients with ankylosing spondylitis concerning behaviour and environmental adaptations. Rheumatol Int 2013; 33:2343-9. [DOI: 10.1007/s00296-013-2727-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2012] [Accepted: 03/18/2013] [Indexed: 01/12/2023]
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Abstract
The treatment of inflammatory rheumatic diseases, such as rheumatoid arthritis, spondylitis ankylosans and systemic lupus erythematosus, is improving continuously. This has lead to an increasing number of young patients with a wish to have children. Greater insight into the course of rheumatic diseases during pregnancy and post partum has enabled optimized support for women with rheumatic diseases wishing to have children. To ensure a favorable outcome, pregnancy should be started during a period of disease stability and should be monitored closely. A careful assessment of possible risks and the justified use of antirheumatic drugs before, during and after pregnancy are key issues for success.
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