T lymphocyte subpopulations and lymphocyte proliferative activity in normal and pre-eclamptic pregnancy

Total Th1/Th2 cytokines profile from peripheral blood lymphocytes in normal pregnancy and preeclampsia syndrome

To evaluate total Th1/Th2 cytokines in CD3⁺ cells (immunocompetent T-lymphocytes) and peripheral blood lymphocytes, mostly CD4+ (T helper cells) and CD8+ (T-cytotoxic cells) subpopulations in preeclampsia. Total blood leukocytes and lymphocytes counts, percent cells: CD3⁺, INF-g⁺/CD3⁺, IL-4⁺/CD3⁺, and IL-10⁺/CD3⁺, CD4⁺/CD8⁺ were determined by flow-cytometry. Preeclampsia (n= 26) and normal pregnancy (n= 25) participants were age and gestational age matched. CD4⁺ lymphocytes count was higher in preeclampsia, compared with normal pregnancy (43.6 ± 5.8 vs 37.6 ± 5.6%; P< 0.001). CD3⁺ cells Th1/Th2 shift was not detected in preeclampsia, yet may be present in other cell types, such as CD4⁺ and CD3 - lymphocytes.

Advances in Hepatitis E Virus Biology and Pathogenesis

Hepatitis E virus (HEV) is one of the causative agents for liver inflammation across the world. HEV is a positive-sense single-stranded RNA virus. Human HEV strains mainly belong to four major genotypes in the genus Orthohepevirus A, family Hepeviridae. Among the four genotypes, genotype 1 and 2 are obligate human pathogens, and genotype 3 and 4 cause zoonotic infections. HEV infection with genotype 1 and 2 mainly presents as acute and self-limiting hepatitis in young adults. However, HEV infection of pregnant women with genotype 1 strains can be exacerbated to fulminant hepatitis, resulting in a high rate of case fatality. As pregnant women maintain the balance of maternal-fetal tolerance and effective immunity against invading pathogens, HEV infection with genotype 1 might dysregulate the balance and cause the adverse outcome. Furthermore, HEV infection with genotype 3 can be chronic in immunocompromised patients, with rapid progression, which has been a challenge since it was reported years ago. The virus has a complex interaction with the host cells in downregulating antiviral factors and recruiting elements to generate a conducive environment of replication. The virus-cell interactions at an early stage might determine the consequence of the infection. In this review, advances in HEV virology, viral life cycle, viral interference with the immune response, and the pathogenesis in pregnant women are discussed, and perspectives on these aspects are presented.

Lymphocyte calcium influx characteristics and their modulation by Kv1.3 and IKCa1 channel inhibitors in healthy pregnancy and preeclampsia

PROBLEM

Calcium handling of T lymphocytes is altered in healthy pregnancy (HP) and preeclampsia (PE) compared to non-pregnant (non-P) women. We compared the activation-elicited calcium influx in T lymphocytes in HP, PE and non-P women and tested its alteration upon inhibition of Kv1.3 and IKCa1 potassium channels.

METHOD OF STUDY

The alteration of calcium influx was measured in major T-lymphocyte subsets of 9 non-P, HP and PE women with flow cytometry with or without treatment of cells with potassium channel inhibitors.

RESULTS

The elicited calcium response was lower in HP compared to non-P. In HP, calcium influx was sensitive to potassium channel inhibition in CD8 and Th1, but not in Th2 cells. In PE, calcium influx and its sensitivity to inhibition were comparable to non-P.

CONCLUSION

There is a characteristic pattern of calcium influx in T lymphocytes and its sensitivity to potassium channel inhibition in HP that is missing in PE, raising the notion that T-lymphocyte calcium handling may have a role in the characteristic immune status of HP.

Longitudinal study of CD4+ cell counts in HIV-negative pregnant patients

OBJECTIVE

To evaluate the absolute CD4+, CD8+, and lymphocyte cell counts and percentages from the first trimester through 6-12 weeks post-delivery in normal human immunodeficiency virus (HIV)-negative pregnant patients.

METHODS

A longitudinal laboratory analysis was performed during pregnancy that involved 51 HIV-negative subjects with blood analysis obtained in all trimesters, at delivery, and 6-12 weeks post-delivery. Twenty-five HIV-negative non-pregnant controls were also evaluated. Blood was analysed for absolute CD4+, CD8+, and lymphocyte cell counts and percentages. Means, standard deviations, trends, and differences were examined.

RESULTS

The mean white blood cell (WBC) count is elevated above the non-pregnant state and this parameter increases through the pregnancy up to and including parturition. The mean absolute lymphocyte cell count, lymphocyte percentage, and absolute CD4+ cell count are significantly lower during pregnancy and the progression through pregnancy appears U-shaped. The mean absolute CD8+ cell count is not significantly different. The CD4+ and CD8+ percentages are higher during pregnancy and this elevation persists into the 6-12 week post-delivery time period. A 3-digit drop in CD4+ percentage is common during pregnancy between blood draws; whereas, a 30% decrease or more in absolute CD4+ cell count is rare.

CONCLUSIONS

By longitudinal analysis, pregnancy appears to significantly elevate the mean values of the WBC count, CD4+ percentage, and CD8+ percentage, but significantly decreases the absolute lymphocyte count, lymphocyte percentage, and absolute CD4+ cell count when compared to non-pregnant controls. The mean absolute CD8+ cell count appears to be unaffected.

Functional changes of human peripheral B-lymphocytes in pre-eclampsia

PROBLEM

The aim of our study was to investigate the functional changes of human peripheral B-lymphocytes in healthy and pre-eclamptic pregnancies.

METHOD OF STUDY

Twenty patients with pre-eclampsia and 15 healthy third-trimester pregnant women were recruited in this study. Peripheral blood mononuclear cells (PBMCs) were isolated and directly stained with fluorescein isothiocyanate (FITC)-labeled anti-CD27 monoclonal antibody (mAb) and phycoerythrin (PE)-labeled anti-CD38 mAb. The percentages of the individual B-cell subsets were estimated out of total lymphocytes by flow cytometric analysis. Additionally, the enriched PBMCs were cultured with or without the stimulation of pokeweed mitogen (PWM) for 5 days. Then morphologic observation of plasma cells was analysed by Wright-Giemsa stain, and antibody-producing cells were detected by enzyme-linked immunospot assay.

RESULTS

The percentage of CD27(-)CD38(-) naïve B-cells and CD27(-)CD38(+) plasma cells did not differ between study groups (P > 0.05). The percentage of CD27(+)CD38(-) memory B-cells and CD27(+)CD38(+) plasma cell precursors increased in pre-eclamptic women compared with the controls (P < 0.05). Irrespective of whether the PBMCs were stimulated with or w/o PWM in vitro, the mean percentages of generated plasma cells were significantly higher in pre-eclamptic group than in the controls (P < 0.05). There were more antibody-producing cells in pre-eclamptic women following the activation of PWM than those in the controls (P < 0.01).

CONCLUSION

Our findings implicate that the functional changes of human circulating B-cells might contribute to the etiology of pre-eclampsia.

Hepatitis E and pregnancy: understanding the pathogenesis

Hepatitis E virus (HEV) is a single-stranded RNA virus that causes large-scale epidemics of acute viral hepatitis, particularly in developing countries. In men and non-pregnant women, the disease is usually self-limited and has a case-fatality rate of less than <0.1%. However, in pregnant women, particularly from certain geographical areas in India, HEV infection is more severe, often leading to fulminant hepatic failure and death in a significant proportion of patients. In contrast, reports from Egypt, Europe and the USA have shown that the course and severity of viral hepatitis during pregnancy is not different from that in non-pregnant women. The reasons for this geographical difference are not clear. The high mortality rate in pregnancy has been thought to be secondary to the associated hormonal (oestrogen and progesterone) changes during pregnancy and consequent immunological changes. These immunological changes include downregulation of the p65 component of nuclear factor (NF-kappaB) with a predominant T-helper type 2 (Th2) bias in the T-cell response along with host susceptibility factors, mediated by human leucocyte antigen expression. Thus far, researchers were unable to explain the high HEV morbidity in pregnancy, why it is different from other hepatitis viruses such as hepatitis A with similar epidemiological features and the reason behind the difference in HEV morbidity in pregnant women in different geographical regions. The recent developments in understanding the immune response to HEV have encouraged us to review the possible mechanisms for these differences. Further research in the immunology of HEV and pregnancy is required to conquer this disease in the near future.

Hepatitis E and pregnancy: understanding the pathogenesis

Hepatitis E virus (HEV) is a single-stranded RNA virus that causes large-scale epidemics of acute viral hepatitis, particularly in developing countries. In men and non-pregnant women, the disease is usually self-limited and has a case-fatality rate of less than <0.1%. However, in pregnant women, particularly from certain geographical areas in India, HEV infection is more severe, often leading to fulminant hepatic failure and death in a significant proportion of patients. In contrast, reports from Egypt, Europe and the USA have shown that the course and severity of viral hepatitis during pregnancy is not different from that in non-pregnant women. The reasons for this geographical difference are not clear. The high mortality rate in pregnancy has been thought to be secondary to the associated hormonal (oestrogen and progesterone) changes during pregnancy and consequent immunological changes. These immunological changes include downregulation of the p65 component of nuclear factor (NF-kappaB) with a predominant T-helper type 2 (Th2) bias in the T-cell response along with host susceptibility factors, mediated by human leucocyte antigen expression. Thus far, researchers were unable to explain the high HEV morbidity in pregnancy, why it is different from other hepatitis viruses such as hepatitis A with similar epidemiological features and the reason behind the difference in HEV morbidity in pregnant women in different geographical regions. The recent developments in understanding the immune response to HEV have encouraged us to review the possible mechanisms for these differences. Further research in the immunology of HEV and pregnancy is required to conquer this disease in the near future.

HIV-1: maternal prognosis

Profound modifications in the profile of patients are currently being observed within the epidemic context of AIDS, especially with respect to pauperization and feminization of the disease. The population most frequently affected is in the reproductive age, and among adults aged 18 to 24 years, the ratio is 1 man to 1 woman, a phenomenon occurring uniformly all over the world. One of the main challenges for HIV-1-infected pregnant women and their doctors is the effect of the interaction between HIV infection and pregnancy. The present article is a review of the literature; and its objective is to assess the influence of HIV-1 infection seen from the maternal perspective, with a discussion of immunologic function, maternal prognosis, and the HIV-abortion interface. At present, we cannot conclude that pregnancy has a short-term effect on the evolution of HIV infection, but the concomitance of HIV and pregnancy may adversely affect the prognosis of gestation, especially in view of its frequent association with increased abortion and puerperal morbidity rates.

Impact of high flaxseed diet on mitogen-induced proliferation, IL-2 production, cell subsets and fatty acid composition of spleen cells from pregnant and F1 generation Sprague-Dawley rats

Flaxseed (FS) being rich in alpha-linolenic acid may alter the immune parameters. Therefore, we assessed the impact of FS and defatted flaxseed meal (FLM) on fatty acid composition, cell subsets, proliferation and IL-2 production by splenic lymphocytes. Pregnant female Sprague-Dawley rats were fed diets containing 0% FS and FLM, 20 or 40% FS, 13 or 26% FLM during gestation or gestation, lactation and 8 week post-weaning period. FS and FLM resulted in up to 8.3 fold and 4.6 fold increase in splenic ALA among pregnant rats, 4.5 fold and 1.2 fold increase in splenic ALA among F(1) generation rats. Splenic linoleic acid (LA) and arachidonic acid (AA) were 18 and 40% lower in 40% FS fed pregnant rats, and AA was 15% lower in all the other groups. Among F(1) rats, splenic LA and AA were 16 and 48% lower in 40% FS group, and AA was 18% lower in 20% FS and 26% FLM groups. Concanavalin A and phytohemagglutinin mediated proliferation of spleen cells were 60 and 52% lower in 40% FS fed pregnant and F(1) generation rats, respectively. No significant changes were observed in the cell subsets or IL-2 production by splenic cells from different groups.

The changes of circulating lymphocyte sub-populations in women with preterm labour: a case-controlled study

OBJECTIVE

The aim of this study was to determine the changes in circulating T-cell subpopulations, B cells and natural killer cells in patients with imminent preterm labour.

METHODS

Thirty-five pregnant patients with imminent preterm labour and 35 women with uncomplicated pregnancies were included in the study. The gestational ages of the patients ranged from 28 to 36 weeks in both groups. The specific lymphocyte antigens were detected using direct staining with monoclonal antibodies, and analysed by flow cytometry.

RESULTS

We observed no significant difference in the mean percentage of T cell subpopulations, natural killer cells and active T cells in the group of patients with preterm labor when compared to controls. The mean percentage of T CD3+ lymphocytes was significantly lower and that of B CD19+ cells higher in the study group when compared to controls.

CONCLUSION

The alterations in maternal circulating lymphocyte subpopulations could be associated with the mechanisms mediating preterm labour.

Effects of trophoblast invasion on the distribution of leukocytes in uterine and tubal implantation sites

OBJECTIVE

To distinguish endocrine and paracrine influences on leukocyte subpopulations at uterine and tubal implantation sites.

DESIGN

Retrospective immunohistochemical study.

SETTING

Departments of Anatomy, and Obstetrics and Gynecology, School of Medicine, RWTH University of Aachen, Aachen, Germany.

PATIENT(S)

Ten women with a viable ectopic pregnancy (EP), 25 women who had undergone elective first-trimester termination of pregnancy, and 4 women who had undergone hysterectomy with adnexectomy.

INTERVENTION(S)

None.

MAIN OUTCOME MEASURE(S)

Quantitative analysis of leukocyte subpopulations at the implantation sites and their corresponding noninvaded tissues, decidual tissue from patients with EP, and tubal mucosa from normal menstrual cycle.

RESULT(S)

Similar numbers and characteristic distribution patterns of macrophages, T cells, and B cells were found at both normal intrauterine and tubal implantation sites. Natural killer (NK) cells were always absent from tubal mucosa. The number and distribution of leukocytes within decidual tissue from women with EP corresponded to those in the noninvaded decidual compartment in intrauterine pregnancy (IUP).

CONCLUSION(S)

Leukocyte populations present in the tubal and uterine mucosa are an intrinsic characteristic of these tissues. The distinct leukocyte distribution pattern at the implantation sites suggests that the invading trophoblast exerts a paracrine influence on endometrial and endosalpingeal leukocytes. The absence of natural killer cells from the tubal wall may be one reason for the higher degree of invasiveness of the trophoblast at the tubal implantation site.

Changes in lymphocyte subsets during pregnancy and post-partum in cases of beginning eclampsia

AIMS

The goal of the present retrospective study was to examine the peripheral blood lymphocytes for expression of phenotypic and activation markers concerning the development of hypertension in pregnancy.

METHODS

16 women (aged 25-43 years; mean 35.1) developing hypertension in the third trimester (week 25-34) have had blood samples taken in the first (< 14 weeks), the second (week 14-23), the third trimester (week 24-35), in late pregnancy (week 36-termination of pregnancy) and within 1 week post-partum, The control group consisted of 16 age-matched pregnant healthy women, who underwent the same regime. All blood samples were taken in the morning, stored at room temperature and stained within 6 hours and measured within 24 hours. Kruskal-Wallis analysis of variance between both groups was done with multiple comparison according to Dunn.

RESULTS

Comparing both groups, the total white cell count was significantly increased in all pregnancies and post-partum. In case of hypertension in pregnancy the cell numbers of suppressor/cytotoxic (CD 8+) and CD 56(+)-activated T cells showed a significant increase in the first trimester (< 14 weeks) [p < 0.05] and decreased thereafter to normal values. In the second trimester (week 14-23) helper/inducer lymphocytes and CD 56+/CD 3+ lymphocytes decreased in case of pre-ecclampsia and cytotoxic lymphocytes elevated [p < 0.05]. In the third trimester (week 24-35) there was no difference in both study groups and in late pregnancy (week 36-termination) there were only small differences without statistical significance. Within 1 week postnatal the value of Il-2 receptor T lymphocytes decreased in the group of pre-eclampsia in comparison to normal pregnancies [p < 0.05].

CONCLUSIONS

Regarding the major changes in activated T cells in both study groups no specific pattern of lymphocyte subsets in case of pre-eclampsia could be found in comparison to healthy pregnant women. Further investigations should focus on functional activation and/or suppression of the cellular immune system. Perhaps this could lead to a screening test for pre-eclampsia in future, which is non-invasive for the patient and economic for our social community because it might reduce medical costs.

The expression and concentrations of Fas/APO-1 (CD95) antigen in patients with severe pre-eclampsia

PROBLEM

Apoptosis has been proposed as a mechanism for maintaining homeostasis in the immune system. Activated lymphocytes are removed by a Fas/FasL-mediated programmed cell death process called activation induced cell death (AICD). The aim of the study was to investigate surface Fas antigen (APO-1, CD95) expression on T lymphocytes and NK cells and also soluble Fas antigen concentrations in pre-eclamptic patients and healthy pregnant women.

MATERIALS AND METHODS

Sixteen pre-eclamptic patients and 18 healthy pregnant women were studied. Peripheral blood lymphocytes were isolated, labeled by direct staining with anti-CD95 monoclonal antibodies and analyzed using the flow cytometric method. Furthermore, the concentrations of soluble CD95 molecule in serum of patients with severe pre-eclampsia and women with uncomplicated pregnancy were measured using ELISA method.

RESULTS

We found that Fas antigen expression and fluorescence intensity on T CD8+ lymphocytes were higher in patients with severe pre-eclampsia in comparison with healthy pregnant women (P<0.05). Furthermore, the concentrations of soluble CD95 molecule were higher in the group of pre-eclamptic patients when compared to controls (P<0.001).

CONCLUSIONS

These findings suggest that T CD8+ lymphocytes in patients with severe pre-eclampsia can be activated. Moreover, higher concentrations of soluble CD95 antigen can suggest altered possibilities to undergo Fas/FasL-mediated activation induced cell death process of lymphocytes in severe pre-eclampsia.

Immune activation in the early puerperium is related to postpartum anxiety and depressive symptoms

The pathophysiology of the postpartum blues, common transient mood disorders in the first week postpartum, has remained elusive. Recently, however, it has been shown that depression and anxiety disorders are accompanied by activation of the inflammatory response system (IRS). This study was developed to determine whether the postnatal blues is associated with IRS activation. Serum concentrations of interleukin-6 (IL-6), IL-6 receptor (IL-6R), gp130 (the IL-6 signaling protein), IL-1R antagonist (IL-1RA) and leukemia inhibitory factor receptor (LIFR) were assayed in 22 nonpregnant women and in 91 pregnant women before delivery and 1 and 3 days after delivery. On each occasion the parturient women completed the State version of the Spielberger State-Trait-Anxiety-Inventory (STAI) and the Zung Depression Rating Scale (ZDS). Serum IL-6, IL-1RA and LIFR were significantly higher in pregnant women at the end of term than in nonpregnant women.

Effects of pregnancy and delivery on serum concentrations of Clara Cell Protein (CC16), an endogenous anticytokine: lower serum CC16 is related to postpartum depression

There is now some evidence that lower serum concentrations of Clara Cell Protein (CC16) are related to stress-induced anxiety, psychoses and major depression. This study was developed to determine whether serum CC16 is lowered in the early puerperium and whether Postnatal Depression and Postnatal Blues are associated with lower levels of serum CC16. Serum concentrations of CC16 were assayed in 17 non-pregnant women and in 98 pregnant women before delivery and 1 and 3 days after delivery. On each occasion the parturients completed the State version of the Spielberger State-Trait Anxiety Inventory (STAI) and the Zung Depression Rating Scale (ZDS). Serum CC16 was significantly lower in pregnant women, at the end of pregnancy as well as 1 and 3 days after delivery, than in the non-pregnant women. Serum CC16 was somewhat, although significantly, higher 1 and 3 days after delivery than before delivery. Parturients who developed a postpartum depression had significantly lower serum CC16 concentrations than women who did not. There were no significant differences in serum CC16 between the puerperal women whose STAI or ZDS scores increased in the puerperium and those whose scores did not. It is concluded that in puerperal women there is a decreased anti-inflammatory capacity in the serum, in part caused by lowered serum CC16, and that the latter may be related to the development of postpartum depression.

Lymphocyte subsets and mitogen stimulation of blood lymphocytes in preeclampsia

PROBLEM

The question of whether there are differences in systemic immune reactivity in severe preeclampsia compared with normal pregnancy was addressed.

METHOD OF STUDY

During the third trimester, blood samples were taken from 12 pregnant women with severe preeclampsia. Five of the preeclamptic pregnancies were analyzed separately because they were treated with dexamethasone before the blood samples were taken. The seven dexamethasone-treated preeclamptic pregnant women were analyzed and compared with six uncomplicated pregnancies. A control group consisted of 15 nonpregnant females. Lymphocyte subsets were identified by flow cytometry. The function of peripheral blood mononuclear cells (PBMCs) was studied as proliferative responses to mitogens alone and in combination with immunomodulating drugs.

RESULTS

An increased number of B lymphocytes (CD19+) (P < 0.05) and natural killer (NK) cells (P < 0.05) was noticed in severe preeclampsia compared with normal pregnancy. The proliferative response of PBMCs in phytohemagglutinin (PHA)-stimulated cultures in autologous serum from patients with severe preeclampsia was reduced (P < 0.05) compared with normal pregnancy. The addition of indomethacin and cimetidine significantly stimulated (P < 0.05) the proliferative responses. The enhancing effect of cimetidine was not found in dexamethasone-treated preeclamptic patients.

CONCLUSIONS

The presence of systemic immunosuppression in severe preeclampsia is demonstrated as a reduced proliferative response of PBMCs to PHA, which could be partly restituted by indomethacin or cimetidine, indicating immunosuppressor activity that is mediated by prostaglandin and histamine. Increased levels of B lymphocytes and NK cells were also noticed.

Lymphocyte subpopulations in intrauterine growth retardation in women with or without previous pregnancies

OBJECTIVE

To evaluate lymphocyte subpopulations in pregnant women with intrauterine growth retardation (IUGR).

STUDY DESIGN

Forty-two normotensive and healthy women with singleton pregnancies and intrauterine growth retardation were studied in the third trimester of pregnancy and compared with 42 normal pregnant women. Peripheral blood lymphocytes were studied using murine monoclonal antibodies and flow cytometry.

RESULTS

B-lymphocytes in both total number (312.54 vs. 163.19 cells/mm3; P = 0.000003) and percentage (11.04% vs. 7.07%; P = 0.000002) were significantly increased in patients with IUGR in comparison to normal pregnant women. Significant correlations were found between birthweight and both total number and percentage of lymphocytes B. In primigravid women, we found that women with IUGR had a higher total lymphocyte count (2749.09 vs. 2130 cells/mm3; P = 0.006), higher T-lymphocyte count (2053.77 vs. 1676.40 cells/mm3; P = 0.02), higher B-lymphocyte count and percentage (309.13 vs. 145.36 cells/mm3; P = 0.000001) (11.45 vs. 6.81%); P = 0.00001), higher CD4 lymphocyte count and percentage (1342.68 vs. 972.22 cells/mm3, P = 0.001) (49.18 vs. 44.04%; P = 0.04), lower CD8-lymphocytes percentage (28.27 vs. 32.9%; P = 0.04), and higher CD4/CD ratio (1.83 vs. 1.46; P = 0.02) than the normal control group.

CONCLUSIONS

B-lymphocytes are increased in women with IUGR in comparison to women with normal pregnancies and there was a significant negative correlation between maternal B-lymphocytes and birthweight. With respect to T-lymphocytes, the immunological profile is different according to the presence or absence of a previous pregnancy. Fetal immunological rejection could be involved in the pathogenesis of IUGR in primigravid women, but in multigravid women there were no differences between women with IUGR and those with normal fetal growth.

Changes in lymphocyte subsets during normal pregnancy

Peripheral blood lymphocytes from healthy women were studied during pregnancy and postnatally, and were compared with lymphocytes from an age-matched non-pregnant control group. Compared with non-pregnant women, the total white cell count was significantly increased at all pregnancies and also post-partum. In pregnancy the absolute number and percentage of T lymphocytes was slightly elevated while almost no changes in B cells were found. No significant changes were found in the percentage of suppressor/cytotoxic (CD8+), of helper/inducer (CD4+) T lymphocytes, nor of CD4+/CD8+ ratio at any stage of pregnancy and puerperium. The most remarkable changes of the immune system occurred in the group of HLA-DR+ and CD56+ activated T cells. The cell numbers showed a significant increase in the first trimester (< 14 weeks) and decreased slightly from stage to stage. Lower values in NK (natural killer) cells and higher levels of IL-2 receptor positive T lymphocytes did not reach significant levels of change.

The prevalence of serum antineutrophil cytoplasmic autoantibodies in preeclampsia and eclampsia

OBJECTIVES

The purpose of this study was to evaluate the prevalence of antineutrophil cytoplasmic autoantibodies (ANCAs) in preeclampsia and eclampsia.

METHODS

Blood samples were obtained from 26 mildly preeclamptic, 26 severely preeclamptic, and 20 eclamptic, and 20 normal pregnant women (controls) in the late third trimester for the determination of serum cytoplasmic pattern ANCA (cANCA) and perinuclear pattern ANCA (pANCA) by the corresponding enzyme immunoassay.

RESULTS

Significant elevations of serum cANCA and pANCA were found in mild and severe preeclampsia and eclampsia. The extent of rise correlated well with the severity of the disease. Both ANCAs were detected in 80% of eclamptic cases versus 38.5 and 69.3% of mild and severe preeclampsia, respectively. Marked elevations of serum ANCAs were associated with poor fetal outcome.

CONCLUSION

ANCAs may be involved in the pathogenesis of glomerulonephritis in preeclampsia and eclampsia and their presence may be attributed to an autoimmune mechanism initiated by autoantibody-mediated activation of neutrophils.