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Xue X, Guo C, Fan C, Lei D. The causal role of circulating immunity-inflammation in preeclampsia: A Mendelian randomization. J Clin Hypertens (Greenwich) 2024; 26:474-482. [PMID: 38476059 PMCID: PMC11088432 DOI: 10.1111/jch.14775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 01/01/2024] [Accepted: 01/04/2024] [Indexed: 03/14/2024]
Abstract
Patients with systemic autoimmune diseases, such as systemic lupus erythematosus, were at a higher risk for preeclampsia. The causal relationship between immunological inflammation and preeclampsia (PE) remains uncertain. We aimed to investigate the causal relationship between circulating immune inflammation and PE. Genetically predicted blood immune cells and circulating inflammatory proteins were identified using two genome-wide association studies (GWAS). We used a two-sample Mendelian randomization (MR) method to determine whether circulating immunological inflammation causes PE. Our findings indicated that ten immunophenotypes were identified to be significantly associated with PE risk: CD62L- Dendritic Cell Absolute Count, CD86+ myeloid Dendritic Cell %Dendritic Cell, CD62L- myeloid Dendritic Cell Absolute Count, CD86+ myeloid Dendritic Cell Absolute Count, CD62L- myeloid Dendritic Cell %Dendritic Cell, CD62L- CD86+ myeloid Dendritic Cell %Dendritic Cell, CD62L- CD86+ myeloid Dendritic Cell Absolute Count, CD16 on CD14+ CD16+ monocyte, HLA DR+ Natural Killer Absolute Count, and T cell Absolute Count. Ninety-one inflammation-related proteins had no statistically significant effect on PE following false discovery rate (FDR) correction. Certain proteins exhibited unadjusted low p-values that merited mention. These proteins include interleukin-10 (OR = 0.76, 95%CI = 0.63-0.93, p = .006), fibroblast growth factor 21 (OR = 1.23, 95%CI = 1.01-1.47, p = .035), and Caspase 8 (OR = 0.65, 95%CI = 0.50-0.85, p = .001). The ELISA analysis demonstrated elevated levels of FGF-21 and decreased levels of IL-10 and Caspase-8 in the plasma of patients with PE. These findings reveal that immunophenotypes and circulating inflammatory proteins may induce PE, confirming the importance of peripheral Immunity-Inflammation in PE. The discovery has the potential to lead to earlier detection and more effective treatment techniques.
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Affiliation(s)
- Xiaolei Xue
- Department of ObstetricsThe Fifth Affiliated Hospital of Xinjiang Medical UniversityUrumqiChina
| | - Chuanhui Guo
- State Key Laboratory of Animal Biotech BreedingCollege of Biological SciencesChina Agricultural UniversityBeijingChina
| | - Cuifang Fan
- Department of ObstetricsRenmin Hospital of Wuhan UniversityWuhanChina
| | - Di Lei
- Department of ObstetricsRenmin Hospital of Wuhan UniversityWuhanChina
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2
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Wei XW, Zhang YC, Wu F, Tian FJ, Lin Y. The role of extravillous trophoblasts and uterine NK cells in vascular remodeling during pregnancy. Front Immunol 2022; 13:951482. [PMID: 37408837 PMCID: PMC10319396 DOI: 10.3389/fimmu.2022.951482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 07/01/2022] [Indexed: 07/07/2023] Open
Abstract
Successful embryo implantation requires both a receptive endometrium and competent blastocysts. After implantation, the maternal decidua undergoes a series of changes, including uterine spiral artery (SA) remodeling to accommodate the fetus and provide nutrients and oxygen for the fetus to survive. Uterine spiral arteries transform from small-diameter, high-resistance arteries to large-diameter and low-resistance arteries during pregnancy. This transformation includes many changes, such as increased permeability and dilation of vessels, phenotypic switching and migration of vascular smooth muscle cells (VSMCs), transient loss of endothelial cells (ECs), endovascular invasion of extravillous trophoblasts (EVTs), and presence of intramural EVT, which are regulated by uterine NK (uNK) cells and EVTs. In this review, we mainly focus on the separate and combined roles of uNK cells and EVTs in uterine SA remodeling in establishing and maintaining pregnancy. New insight into related mechanisms will help us better understand the pathogenesis of pregnancy complications such as recurrent pregnancy loss (RPL) and preeclampsia (PE).
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Affiliation(s)
- Xiao-Wei Wei
- The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Key Laboratory of Embryo Original Diseases, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Municipal Key Clinical Specialty, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Institute of Birth Defects and Rare Diseases, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yu-Chen Zhang
- Department of Obstetrics and Gynecology, Shanghai First Maternity and Infant Hospital, Tongji University of Medicine, Shanghai, China
| | - Fan Wu
- The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Fu-Ju Tian
- The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Key Laboratory of Embryo Original Diseases, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Municipal Key Clinical Specialty, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Institute of Birth Defects and Rare Diseases, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yi Lin
- Shanghai Sixth People’s Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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3
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Huang Q, Hao S, You J, Yao X, Li Z, Schilling J, Thyparambil S, Liao WL, Zhou X, Mo L, Ladella S, Davies-Balch SR, Zhao H, Fan D, Whitin JC, Cohen HJ, McElhinney DB, Wong RJ, Shaw GM, Stevenson DK, Sylvester KG, Ling XB. Early-pregnancy prediction of risk for pre-eclampsia using maternal blood leptin/ceramide ratio: discovery and confirmation. BMJ Open 2021; 11:e050963. [PMID: 34824115 PMCID: PMC8627403 DOI: 10.1136/bmjopen-2021-050963] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE This study aimed to develop a blood test for the prediction of pre-eclampsia (PE) early in gestation. We hypothesised that the longitudinal measurements of circulating adipokines and sphingolipids in maternal serum over the course of pregnancy could identify novel prognostic biomarkers that are predictive of impending event of PE early in gestation. STUDY DESIGN Retrospective discovery and longitudinal confirmation. SETTING Maternity units from two US hospitals. PARTICIPANTS Six previously published studies of placental tissue (78 PE and 95 non-PE) were compiled for genomic discovery, maternal sera from 15 women (7 non-PE and 8 PE) enrolled at ProMedDx were used for sphingolipidomic discovery, and maternal sera from 40 women (20 non-PE and 20 PE) enrolled at Stanford University were used for longitudinal observation. OUTCOME MEASURES Biomarker candidates from discovery were longitudinally confirmed and compared in parallel to the ratio of placental growth factor (PlGF) and soluble fms-like tyrosine kinase (sFlt-1) using the same cohort. The datasets were generated by enzyme-linked immunosorbent and liquid chromatography-tandem mass spectrometric assays. RESULTS Our discovery integrating genomic and sphingolipidomic analysis identified leptin (Lep) and ceramide (Cer) (d18:1/25:0) as novel biomarkers for early gestational assessment of PE. Our longitudinal observation revealed a marked elevation of Lep/Cer (d18:1/25:0) ratio in maternal serum at a median of 23 weeks' gestation among women with impending PE as compared with women with uncomplicated pregnancy. The Lep/Cer (d18:1/25:0) ratio significantly outperformed the established sFlt-1/PlGF ratio in predicting impending event of PE with superior sensitivity (85% vs 20%) and area under curve (0.92 vs 0.52) from 5 to 25 weeks of gestation. CONCLUSIONS Our study demonstrated the longitudinal measurement of maternal Lep/Cer (d18:1/25:0) ratio allows the non-invasive assessment of PE to identify pregnancy at high risk in early gestation, outperforming the established sFlt-1/PlGF ratio test.
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Affiliation(s)
| | - Shiying Hao
- Department of Cardiothoracic Surgery, Stanford University, Stanford, California, USA
- Clinical and Translational Research Program, Betty Irene Moore Children's Heart Center, Lucile Packard Children's Hospital, Palo Alto, California, USA
| | - Jin You
- Department of Bioengineering, University of California Riverside, Riverside, California, USA
| | | | - Zhen Li
- Department of Surgery, Stanford University, Stanford, California, USA
- Binhai Industrial Technology Research Institute, Zhejiang University, Tianjin, China
- School of Electrical Engineering, Southeast University, Nanjing, China
| | | | | | | | - Xin Zhou
- Tianjin Key Laboratory of Cardiovascular Remodeling and Target Organ Injury, Pingjin Hospital Heart Center, Tianjin, China
| | - Lihong Mo
- Department of Obstetrics and Gynecology, University of California San Francisco, Fresno, California, USA
| | - Subhashini Ladella
- Department of Obstetrics and Gynecology, University of California San Francisco, Fresno, California, USA
| | | | - Hangyi Zhao
- Department of Mathematics, Stanford University, Stanford, California, USA
| | - David Fan
- Department of Statistics and Applied Probability, University of California Santa Barbara, Santa Barbara, California, USA
| | - John C Whitin
- Department of Pediatrics, Stanford University, Stanford, California, USA
| | - Harvey J Cohen
- Department of Pediatrics, Stanford University, Stanford, California, USA
| | - Doff B McElhinney
- Department of Cardiothoracic Surgery, Stanford University, Stanford, California, USA
- Clinical and Translational Research Program, Betty Irene Moore Children's Heart Center, Lucile Packard Children's Hospital, Palo Alto, California, USA
| | - Ronald J Wong
- Department of Pediatrics, Stanford University, Stanford, California, USA
| | - Gary M Shaw
- Department of Pediatrics, Stanford University, Stanford, California, USA
| | - David K Stevenson
- Department of Pediatrics, Stanford University, Stanford, California, USA
| | - Karl G Sylvester
- Department of Surgery, Stanford University, Stanford, California, USA
| | - Xuefeng B Ling
- Department of Surgery, Stanford University, Stanford, California, USA
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Travis OK, Baik C, Tardo GA, Amaral L, Jackson C, Greer M, Giachelli C, Ibrahim T, Herrock OT, Williams JM, Cornelius DC. Adoptive transfer of placental ischemia-stimulated natural killer cells causes a preeclampsia-like phenotype in pregnant rats. Am J Reprod Immunol 2021; 85:e13386. [PMID: 33315281 PMCID: PMC8131208 DOI: 10.1111/aji.13386] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 10/21/2020] [Accepted: 12/09/2020] [Indexed: 12/14/2022] Open
Abstract
PROBLEM The Reduced Uterine Perfusion Pressure (RUPP) rat model of placental ischemia recapitulates many characteristics of preeclampsia including maternal hypertension, intrauterine growth restriction (IUGR), and increased cytolytic natural killer cells (cNKs). While we have previously shown a 5-fold higher cytotoxicity of RUPP NKs versus normal pregnant NKs, their role in RUPP pathophysiology remains unclear. In this study, we tested the hypotheses that (1) adoptive transfer of RUPP-stimulated NKs will induce maternal hypertension and IUGR in normal pregnant control (Sham) rats and (2) adoptive transfer of Sham NKs will attenuate maternal hypertension and IUGR in RUPP rats. METHOD OF STUDY On gestation day (GD)14, vehicle or 5 × 106 RUPP NKs were infused i.v. into a subset of Sham rats (Sham+RUPP NK), and vehicle or 5 × 106 Sham NKs were infused i.v. into a subset of RUPP rats (RUPP+Sham NK; n = 12/group). On GD18, Uterine Artery Resistance Index (UARI) was measured. On GD19, mean arterial pressure (MAP) was measured, animals were sacrificed, and blood and tissues were collected for analysis. RESULTS Adoptive transfer of RUPP NKs into Sham rats resulted in elevated NK activation, UARI, placental oxidative stress, and preproendothelin expression as well as reduced circulating nitrate/nitrite. This led to maternal hypertension and IUGR. RUPP recipients of Sham NKs demonstrated normalized NK activation, sFlt-1, circulating and placental VEGF, and UARI, which led to improved maternal blood pressure and normal fetal growth. CONCLUSION These data suggest a direct role for cNKs in causing preeclampsia pathophysiology and a role for normal NKs to improve maternal outcomes and IUGR during late gestation.
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Affiliation(s)
- Olivia K Travis
- Department of Pharmacology and Toxicology, University of Mississippi Medical Center
| | - Cedar Baik
- Department of Emergency Medicine University of Mississippi Medical Center
| | - Geilda A Tardo
- Department of Emergency Medicine University of Mississippi Medical Center
| | - Lorena Amaral
- Department of Pharmacology and Toxicology, University of Mississippi Medical Center
| | - Carmilya Jackson
- Department of Emergency Medicine University of Mississippi Medical Center
| | - Mallory Greer
- Department of Pharmacology and Toxicology, University of Mississippi Medical Center
| | - Chelsea Giachelli
- Department of Emergency Medicine University of Mississippi Medical Center
| | - Tarek Ibrahim
- Department of Pharmacology and Toxicology, University of Mississippi Medical Center
| | - Owen T. Herrock
- Department of Pharmacology and Toxicology, University of Mississippi Medical Center
| | - Jan M Williams
- Department of Pharmacology and Toxicology, University of Mississippi Medical Center
| | - Denise C Cornelius
- Department of Pharmacology and Toxicology, University of Mississippi Medical Center
- Department of Emergency Medicine University of Mississippi Medical Center
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5
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Sá CPND, Jiménez MF, Rosa MW, Arlindo EM, Ayub ACK, Cardoso RB, Kreitchmann R, El Beitune P. Evaluation of Angiogenic Factors (PlGF and sFlt-1) in Pre-eclampsia Diagnosis. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRÍCIA 2020; 42:697-704. [PMID: 33254263 PMCID: PMC10309227 DOI: 10.1055/s-0040-1713916] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVE Recent observations support the hypothesis that an imbalance between angiogenic factors has a fundamental role in the pathogenesis of pre-eclampsia and is responsible for the clinical manifestations of the disease. The goal of the present study was to evaluate the sensitivity, specificity, and the best accuracy level of Soluble fms-like tyrosine kinase-1 (sFlt-1), placental growth factor (PlGF), and sFlt-1/PlGF ratio in maternal serum and protein/creatinine ratio in urine sample to define the best cutoff point of these tests to discriminate between the patients with gestational hypertension and the patients with pre-eclampsia, to evaluate the possibility of using them as diagnostic methods. METHODS A prospective longitudinal study was performed, and blood samples were collected from 95 pregnant patients with hypertension to measure serum concentrations of biomarkers sFlt-1 and PlGF. Urine samples were collected for protein screening. Significance was set as p < 0.05. RESULTS The sFlt-1/PlGF ratio demonstrated a sensitivity of 57.5% and a specificity of 60% using 50.4 as a cutoff point. The test that showed the best accuracy in the diagnosis of pre-eclampsia was protein/creatinine ratio, with a sensitivity of 78.9% and a specificity of 70% using 0.4 as a cutoff point and showing an area under the receiver operating characteristic curve of 0.80 (p < 0.001). CONCLUSION No studied laboratory test proved to be fairly accurate for the diagnosis of pre-eclampsia, except for the protein/creatinine ratio. The evidence is insufficient to recommend biomarkers sFlt-1 and PlGF to be used for the diagnosis of pre-eclampsia.
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Affiliation(s)
- Catherine Primo Nogueira de Sá
- Department of Gynecology and Obstetrics, Universidade Federal de Ciências da Saúde, Porto Alegre, RS, Brazil.,Obstetrics Service, Santa Casa de Misericórdia, Porto Alegre, RS, Brazil.,Obstetrics Service, Hospital Moinhos de Vento, Porto Alegre, RS, Brazil
| | - Mirela Foresti Jiménez
- Department of Gynecology and Obstetrics, Universidade Federal de Ciências da Saúde, Porto Alegre, RS, Brazil.,Obstetrics Service, Santa Casa de Misericórdia, Porto Alegre, RS, Brazil
| | | | - Ellen Machado Arlindo
- Department of Gynecology and Obstetrics, Universidade Federal de Ciências da Saúde, Porto Alegre, RS, Brazil.,Obstetrics Service, Santa Casa de Misericórdia, Porto Alegre, RS, Brazil.,Obstetrics Service, Hospital Moinhos de Vento, Porto Alegre, RS, Brazil
| | - Antonio Celso Koehler Ayub
- Department of Gynecology and Obstetrics, Universidade Federal de Ciências da Saúde, Porto Alegre, RS, Brazil.,Obstetrics Service, Santa Casa de Misericórdia, Porto Alegre, RS, Brazil
| | - Rodrigo Bernardes Cardoso
- Department of Gynecology and Obstetrics, Universidade Federal de Ciências da Saúde, Porto Alegre, RS, Brazil.,Obstetrics Service, Santa Casa de Misericórdia, Porto Alegre, RS, Brazil
| | - Régis Kreitchmann
- Department of Gynecology and Obstetrics, Universidade Federal de Ciências da Saúde, Porto Alegre, RS, Brazil.,Obstetrics Service, Santa Casa de Misericórdia, Porto Alegre, RS, Brazil
| | - Patrícia El Beitune
- Department of Gynecology and Obstetrics, Universidade Federal de Ciências da Saúde, Porto Alegre, RS, Brazil.,Obstetrics Service, Santa Casa de Misericórdia, Porto Alegre, RS, Brazil
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6
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Mayoral Andrade G, Vásquez Martínez G, Pérez-Campos Mayoral L, Hernández-Huerta MT, Zenteno E, Pérez-Campos Mayoral E, Martínez Cruz M, Martínez Cruz R, Matias-Cervantes CA, Meraz Cruz N, Romero Díaz C, Cruz-Parada E, Pérez-Campos E. Molecules and Prostaglandins Related to Embryo Tolerance. Front Immunol 2020; 11:555414. [PMID: 33329514 PMCID: PMC7710691 DOI: 10.3389/fimmu.2020.555414] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 10/19/2020] [Indexed: 12/20/2022] Open
Abstract
It is generally understood that the entry of semen into the female reproductive tract provokes molecular and cellular changes facilitating conception and pregnancy. We show a broader picture of the participation of prostaglandins in the fertilization, implantation and maintenance of the embryo. A large number of cells and molecules are related to signaling networks, which regulate tolerance to implantation and maintenance of the embryo and fetus. In this work, many of those cells and molecules are analyzed. We focus on platelets, polymorphonuclear leukocytes, and group 2 innate lymphoid cells involved in embryo tolerance in order to have a wider view of how prostaglandins participate. The combination of platelets and neutrophil extracellular traps (Nets), uterine innate lymphoid cells (uILC), Treg cells, NK cells, and sex hormones have an important function in immunological tolerance. In both animals and humans, the functions of these cells can be regulated by prostaglandins and soluble factors in seminal plasma to achieve an immunological balance, which maintains fetal-maternal tolerance. Prostaglandins, such as PGI2 and PGE2, play an important role in the suppression of the previously mentioned cells. PGI2 inhibits platelet aggregation, in addition to IL-5 and IL-13 expression in ILC2, and PGE2 inhibits some neutrophil functions, such as chemotaxis and migration processes, leukotriene B4 (LTB4) biosynthesis, ROS production, and the formation of extracellular traps, which could help prevent trophoblast injury and fetal loss. The implications are related to fertility in female when seminal fluid is deposited in the vagina or uterus.
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Affiliation(s)
- Gabriel Mayoral Andrade
- Research Centre Medicine National Autonomous University of Mexico-Benito Juárez Autonomous University of Oaxaca (UNAM-UABJO), Faculty of Medicine, Benito Juárez Autonomous University of Oaxaca, Oaxaca, Mexico
| | | | - Laura Pérez-Campos Mayoral
- Research Centre Medicine National Autonomous University of Mexico-Benito Juárez Autonomous University of Oaxaca (UNAM-UABJO), Faculty of Medicine, Benito Juárez Autonomous University of Oaxaca, Oaxaca, Mexico
| | | | - Edgar Zenteno
- Department of Biochemistry, School of Medicine, UNAM, Mexico City, México
| | - Eduardo Pérez-Campos Mayoral
- Research Centre Medicine National Autonomous University of Mexico-Benito Juárez Autonomous University of Oaxaca (UNAM-UABJO), Faculty of Medicine, Benito Juárez Autonomous University of Oaxaca, Oaxaca, Mexico
| | | | - Ruth Martínez Cruz
- Research Centre Medicine National Autonomous University of Mexico-Benito Juárez Autonomous University of Oaxaca (UNAM-UABJO), Faculty of Medicine, Benito Juárez Autonomous University of Oaxaca, Oaxaca, Mexico
| | | | - Noemi Meraz Cruz
- School of Medicine, Branch at National Institute of Genomic Medicine, Mexico City, Mexico
| | - Carlos Romero Díaz
- Research Centre Medicine National Autonomous University of Mexico-Benito Juárez Autonomous University of Oaxaca (UNAM-UABJO), Faculty of Medicine, Benito Juárez Autonomous University of Oaxaca, Oaxaca, Mexico
| | - Eli Cruz-Parada
- Biochemistry and Immunology Unit, National Technological of Mexico/ITOaxaca, Oaxaca, Mexico
| | - Eduardo Pérez-Campos
- Biochemistry and Immunology Unit, National Technological of Mexico/ITOaxaca, Oaxaca, Mexico
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7
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PlGF Immunological Impact during Pregnancy. Int J Mol Sci 2020; 21:ijms21228714. [PMID: 33218096 PMCID: PMC7698813 DOI: 10.3390/ijms21228714] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 11/13/2020] [Accepted: 11/16/2020] [Indexed: 12/12/2022] Open
Abstract
During pregnancy, the mother’s immune system has to tolerate the persistence of paternal alloantigens without affecting the anti-infectious immune response. Consequently, several mechanisms aimed at preventing allograft rejection, occur during a pregnancy. In fact, the early stages of pregnancy are characterized by the correct balance between inflammation and immune tolerance, in which proinflammatory cytokines contribute to both the remodeling of tissues and to neo-angiogenesis, thus, favoring the correct embryo implantation. In addition to the creation of a microenvironment able to support both immunological privilege and angiogenesis, the trophoblast invades normal tissues by sharing the same behavior of invasive tumors. Next, the activation of an immunosuppressive phase, characterized by an increase in the number of regulatory T (Treg) cells prevents excessive inflammation and avoids fetal immuno-mediated rejection. When these changes do not occur or occur incompletely, early pregnancy failure follows. All these events are characterized by an increase in different growth factors and cytokines, among which one of the most important is the angiogenic growth factor, namely placental growth factor (PlGF). PlGF is initially isolated from the human placenta. It is upregulated during both pregnancy and inflammation. In this review, we summarize current knowledge on the immunomodulatory effects of PlGF during pregnancy, warranting that both innate and adaptive immune cells properly support the early events of implantation and placental development. Furthermore, we highlight how an alteration of the immune response, associated with PlGF imbalance, can induce a hypertensive state and lead to the pre-eclampsia (PE).
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8
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Pourmoghadam Z, Soltani-Zangbar MS, Sheikhansari G, Azizi R, Eghbal-Fard S, Mohammadi H, Siahmansouri H, Aghebati-Maleki L, Danaii S, Mehdizadeh A, Hojjat-Farsangi M, Motavalli R, Yousefi M. Intrauterine administration of autologous hCG- activated peripheral blood mononuclear cells improves pregnancy outcomes in patients with recurrent implantation failure; A double-blind, randomized control trial study. J Reprod Immunol 2020; 142:103182. [PMID: 32781360 DOI: 10.1016/j.jri.2020.103182] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 07/18/2020] [Accepted: 07/26/2020] [Indexed: 01/30/2023]
Abstract
We aimed to investigate the effect of intrauterine administration of autologous hCG-activated PBMCs in RIF women with low Th-17/Treg cell ratio. 248 women with a history of implantation failure volunteered to receive PBMC-therapy. After immunologic consultation and doing flow cytometry analysis, 100 women with at least three IVF/ET failure who had low Th-17/Treg ratio in comparison with healthy control were enrolled in this study. These 100 patients were randomly divided into two groups as PBMC receiving (n = 50) and controls (n = 50). Then PBMCs were obtained from patients and treated with hCG for 48 h. Afterward, PBMCs were administered into the uterine cavity of the patient in the study group, two days before ET. The concentration of inflammatory cytokines was examined in the supernatant of cultured PBMCs after 2, 24, and 48 h of incubation using the ELISA method. The frequency of Th-17, Treg, and the Th-17/Treg ratio was significantly lower in RIF women than the healthy controls (P < 0.0001). The secretion of inflammatory cytokines was significantly higher after 48 h compared to 2 and 24 h (P < 0.0001). The pregnancy and live birth rate were significantly increased in women undergoing the PBMC-therapy compared to control (PBS-injecting) group (P = 0.032 and P = 0.047, respectively). The miscarriage rate was considerably lower in PBMC-therapy group (P = 0.029). Our findings suggest that intrauterine administration of autologous in vitro hCG-activated PBMCs improves pregnancy outcomes in patients with at least three IVF/ET failures.
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Affiliation(s)
- Zahra Pourmoghadam
- Drug Applied Research Center, Tabriz University of Medical Sciences, Tabriz, Iran; Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Golshan Sheikhansari
- Drug Applied Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ramyar Azizi
- Drug Applied Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Shadi Eghbal-Fard
- Stem Cell Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hamed Mohammadi
- Non-Communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran
| | | | | | - Shahla Danaii
- Gynecology Department, Eastern Azerbaijan ACECR ART center, Eastern Azerbaijan branch of ACECR, Tabriz, Iran
| | - Amir Mehdizadeh
- Endocrine Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mohammad Hojjat-Farsangi
- Department of Oncology-Pathology, Immune and Gene Therapy Lab, Cancer Center Karolinska (CCK), Karolinska University Hospital Solna and Karolinska Institute, Stockholm, Sweden
| | - Roza Motavalli
- Stem Cell Research Center, Tabriz University of Medical Sciences, Tabriz, Iran; Kidney Disease Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mehdi Yousefi
- Stem Cell Research Center, Tabriz University of Medical Sciences, Tabriz, Iran; Kidney Disease Research Center, Tabriz University of Medical Sciences, Tabriz, Iran; Department of Immunology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran.
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9
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The Roles of Uterine Natural Killer (NK) Cells and KIR/HLA-C Combination in the Development of Preeclampsia: A Systematic Review. BIOMED RESEARCH INTERNATIONAL 2020; 2020:4808072. [PMID: 32309433 PMCID: PMC7149372 DOI: 10.1155/2020/4808072] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 02/18/2020] [Accepted: 03/20/2020] [Indexed: 12/21/2022]
Abstract
Preeclampsia (PE) is termed as a systemic disease that involves multiple organs; however, the exact etiology is still quite unclear. It is believed that the poor remodeling of uterine spiral arteries triggers PE, thereby causing failed placentation and producing inflammatory factors. The decline of blood flow results in lowering the nutrients and oxygen received by the fetus and augmenting the placental pressure in PE. Decidual immune cells, especially uterine natural killer (uNK) cells, are involved in the process of placentation. Decidual NK (dNK) cells significantly contribute to the vascular remodeling through the secretion of cytokines and angiogenic mediators in normal placental development. The abnormal activation of NK cells in both the peripheral blood and the decidua was counted among the causes leading to PE. The correlation existing between maternal killer cell immunoglobulin-like receptor (KIR) and HLA-C in trophoblast cells constitutes a robust evidence for the genetic etiology of PE. The combinations of the two kinds of gene systems, together with the KIR genotype in the mother and the HLA-C group in her fetus, are likely to exactly decide the pregnancy outcome. The women, who have the inappropriate match of KIR/HLA-C, are likely to be prone to the augmented risk of PE. However, the combinations of KIR/HLA-C in PE undergo ethnic changes. The extensive prospective research works in Europe, Asia, and Africa are required for providing more findings in PE patients.
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10
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Zhao S, Lv N, Li Y, Liu T, Sun Y, Chu X. Identification and characterization of methylation-mediated transcriptional dysregulation dictate methylation roles in preeclampsia. Hum Genomics 2020; 14:5. [PMID: 32000849 PMCID: PMC6993410 DOI: 10.1186/s40246-020-0256-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 01/20/2020] [Indexed: 12/15/2022] Open
Abstract
Background Preeclampsia (PE) is a heterogeneous, hypertensive disorder of pregnancy, with no robust biomarkers or effective treatments. PE increases the risk of poor outcomes for both the mother and the baby. Methylation-mediated transcriptional dysregulation motifs (methTDMs) could contribute the PE development. However, precise functional roles of methTDMs in PE have not been globally described. Methods Here, we develop a comprehensive and computational pipeline to identify PE-specific methTDMs following TF, gene, methylation expression profile, and experimentally verified TF-gene interactions. Results The regulation patterns of methTDMs are multiple and complex in PE and contain relax inhibition, intensify inhibition, relax activation, intensify activation, reverse activation, and reverse inhibition. A core module is extracted from global methTDM network to further depict the mechanism of methTDMs in PE. The common and specific features of any two kinds of regulation pattern are also analyzed in PE. Some key methylation sites, TFs, and genes such as IL2RG are identified in PE. Functional analysis shows that methTDMs are associated with immune-, insulin-, and NK cell-related functions. Drug-related network identifies some key drug repurposing candidates such as NADH. Conclusion Collectively, the study highlighted the effect of methylation on the transcription process in PE. MethTDMs could contribute to identify specific biomarkers and drug repurposing candidates for PE.
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Affiliation(s)
- Shuyu Zhao
- Third Ward of Obstetrics and Gynecology, The Second Affiliated Hospital of Harbin Medical University, 246 XueFu Road, Harbin, 150006, Heilongjiang, People's Republic of China
| | - Nan Lv
- Third Ward of Obstetrics and Gynecology, The Second Affiliated Hospital of Harbin Medical University, 246 XueFu Road, Harbin, 150006, Heilongjiang, People's Republic of China.
| | - Yan Li
- Third Ward of Obstetrics and Gynecology, The Second Affiliated Hospital of Harbin Medical University, 246 XueFu Road, Harbin, 150006, Heilongjiang, People's Republic of China
| | - Tianyi Liu
- Third Ward of Obstetrics and Gynecology, The Second Affiliated Hospital of Harbin Medical University, 246 XueFu Road, Harbin, 150006, Heilongjiang, People's Republic of China
| | - Yuhong Sun
- Third Ward of Obstetrics and Gynecology, The Second Affiliated Hospital of Harbin Medical University, 246 XueFu Road, Harbin, 150006, Heilongjiang, People's Republic of China
| | - Xiaodan Chu
- Third Ward of Obstetrics and Gynecology, The Second Affiliated Hospital of Harbin Medical University, 246 XueFu Road, Harbin, 150006, Heilongjiang, People's Republic of China
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Rambaldi MP, Weiner E, Mecacci F, Bar J, Petraglia F. Immunomodulation and preeclampsia. Best Pract Res Clin Obstet Gynaecol 2019; 60:87-96. [DOI: 10.1016/j.bpobgyn.2019.06.005] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 04/10/2019] [Accepted: 06/17/2019] [Indexed: 01/08/2023]
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12
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Cytotoxic Activity of Peripheral Blood NK Cells towards Trophoblast Cells during Pregnancy. Bull Exp Biol Med 2019; 166:567-573. [DOI: 10.1007/s10517-019-04393-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Indexed: 01/14/2023]
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13
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Shields CA, McCalmon M, Ibrahim T, White DL, Williams JM, LaMarca B, Cornelius DC. Placental ischemia-stimulated T-helper 17 cells induce preeclampsia-associated cytolytic natural killer cells during pregnancy. Am J Physiol Regul Integr Comp Physiol 2018; 315:R336-R343. [PMID: 29718698 DOI: 10.1152/ajpregu.00061.2018] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Previous studies have demonstrated that T-helper 17 (TH17) cells and cytolytic natural killer (cNK) cells are increased in women with preeclampsia. In this study we investigated the role of placental ischemia-stimulated TH17 cells in induction of cNK cells in pregnancy. We further assessed the role of TH17 cell-mediated oxidative stress in facilitation of cNK cell activation in pregnancy by treating rats with the SOD mimetic tempol. CD4+/CD25- cells were isolated from reduced uterine perfusion pressure (RUPP) rats and differentiated into TH17 cells in vitro. On day 12 of gestation ( GD12), 1 × 106 placental ischemia-stimulated TH17 cells were injected into normal pregnant (NP) rats (NP + RUPP TH17 rats), and a subset of rats were treated with tempol (30 mg·kg-1·day-1) from GD12 to GD19 (NP + RUPP TH17 + tempol rats). On GD19, cNK cells, mean arterial pressure, fetal weight, and cNK cell-associated cytokines and proteins were measured. Placental cNK cells were 2.9 ± 1, 14.9 ± 4, and 2.8 ± 1.0% gated in NP, NP + RUPP TH17, and NP + RUPP TH17 + tempol rats, respectively. Mean arterial pressure increased from 96 ± 5 mmHg in NP rats to 118 ± 2 mmHg in NP + RUPP TH17 rats and was 102 ± 3 mmHg in NP + RUPP TH17 + tempol rats. Fetal weight was 2.37 ± 0.04, 1.95 ± 0.14, and 2.3 ± 0.05 g in NP, NP + RUPP TH17, and NP + RUPP TH17 + tempol rats, respectively. Placental IFNγ increased from 1.1 ± 0.6 pg/mg in NP rats to 3.9 ± 0.6 pg/mg in NP + RUPP TH17 rats. Placental perforin increased from 0.18 ± 0.18 pg/mg in NP rats to 2.4 ± 0.6 pg/mg in NP + RUPP TH17 rats. Placental levels of granzymes A and B followed a similar pattern. Treatment with tempol did not lower placental cNK cytokines or proteins. The results of the present study identify TH17 cells as a mediator of aberrant NK cell activation that is associated with preeclampsia.
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Affiliation(s)
- Corbin A Shields
- Department of Pharmacology and Toxicology, University of Mississippi Medical Center , Jackson, Mississippi
| | - Maggie McCalmon
- Department of Emergency Medicine, University of Mississippi Medical Center , Jackson, Mississippi
| | - Tarek Ibrahim
- Department of Pharmacology and Toxicology, University of Mississippi Medical Center , Jackson, Mississippi
| | - Dakota L White
- Department of Emergency Medicine, University of Mississippi Medical Center , Jackson, Mississippi
| | - Jan M Williams
- Department of Pharmacology and Toxicology, University of Mississippi Medical Center , Jackson, Mississippi
| | - Babbette LaMarca
- Department of Pharmacology and Toxicology, University of Mississippi Medical Center , Jackson, Mississippi
| | - Denise C Cornelius
- Department of Pharmacology and Toxicology, University of Mississippi Medical Center , Jackson, Mississippi.,Department of Emergency Medicine, University of Mississippi Medical Center , Jackson, Mississippi
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Milosevic-Stevanovic J, Krstic M, Radovic-Janosevic D, Popovic J, Tasic M, Stojnev S. Number of decidual natural killer cells & macrophages in pre-eclampsia. Indian J Med Res 2018; 144:823-830. [PMID: 28474619 PMCID: PMC5433275 DOI: 10.4103/ijmr.ijmr_776_15] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Background & objectives: The process of human placentation is complex and still not well understood. This study was aimed to examine the relationship between clinical features of pre-eclampsia and degree of trophoblastic invasion after its immunohistochemical visualization in the context of possible alterations in the number of natural killer (NK) cells and macrophages in the decidua. Methods: This prospective study included a study group comprising 30 pregnant women with pre-eclampsia delivered by caesarean section and a control group comprising 20 healthy pregnant women also delivered by caesarean section. Samples of placental bed obtained during caesarean section were analyzed after immunohistochemical labelling CD56+ NK cells, CD68+ macrophages and cytokeratin 7 trophoblastic cells. Results: In pre-eclampsia, there was a significantly lower number of CD56+ NK cells in the decidua (P<0.001) and a higher number of CD68+ macrophages (P<0.001) compared to control group. In the subgroup of pre-eclampsia with intrauterine growth retardation (IUGR), a significantly greater number of NK cells (P<0.05) was recorded, as well as an increased number of macrophages, but not significantly compared to pre-eclampsia without IUGR. There was no significant difference in the distribution of these cells in the decidua in relation to the severity of pre-eclampsia. CD56+ NK cells were significantly less (P<0.05) and macrophages were more (P<0.05) in the group with poor trophoblastic invasion. Interpretation & conclusions: Alterations in the number of immune cells in relation to the degree of trophoblastic invasion indicated their role in aetiopathogenesis of pre-eclampsia, while the direct association between their number and severity of pre-eclampsia was not confirmed.
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Affiliation(s)
- Jelena Milosevic-Stevanovic
- Department of Gynecology & Obstetrics; Department of Clinic of Gynecology & Obstetrics, Clinical Center Nis, Nis, Serbia
| | - Miljan Krstic
- Department of Pathology, Faculty of Medicine, University of Nis; Department of Pathology & Pathological Anatomy Center, Clinical Center Nis, Nis, Serbia
| | - Dragana Radovic-Janosevic
- Department of Gynecology & Obstetrics; Department of Clinic of Gynecology & Obstetrics, Clinical Center Nis, Nis, Serbia
| | - Jasmina Popovic
- Department of Gynecology & Obstetrics; Department of Clinic of Gynecology & Obstetrics, Clinical Center Nis, Nis, Serbia
| | - Marija Tasic
- Department of Clinic of Gynecology & Obstetrics, Clinical Center Nis, Nis, Serbia
| | - Slavica Stojnev
- Department of Pathology, Faculty of Medicine, University of Nis, Nis, Serbia
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Natural killer cells and T lymphocytes in pregnancy and pre-eclampsia. Clin Sci (Lond) 2017; 131:2911-2917. [DOI: 10.1042/cs20171070] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Revised: 10/24/2017] [Accepted: 11/06/2017] [Indexed: 01/01/2023]
Abstract
Although pre-eclampsia (PE), a hypertensive disorder of pregnancy, has significant maternal and fetal morbidity and mortality worldwide, the mechanisms contributing to this disease have not been fully elucidated. Studies in patients and experimental models have shown that changes in the number or function of immune cells of both the adaptive and innate immune systems contribute to the development and pathogenesis of PE. This commentary summarizes our current understanding of the role of the immune system in the pathogenesis of PE, specifically focussing on dysfunction of natural killer (NK) cells and T lymphocyte populations.
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Gerard C. 10 workshops on Immunology of preeclampsia. J Reprod Immunol 2017; 123:94-99. [PMID: 28668208 DOI: 10.1016/j.jri.2017.06.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 06/07/2017] [Accepted: 06/20/2017] [Indexed: 02/02/2023]
Abstract
For the 10th issue of the « island workshops », now the Reunion Workshops, organised by Pierre Yves Robillard since the first one in Tahiti challenging the "vascular disease only" theory of pre eclampsia and introducing the primipaternity concept, we examined the reasons for considering an Immunological approach to the disease. This (brief) overview thus examines several important topics in an Immunological framework. I have chosen to present here the evolution of the main themes rather than a purely chronological vision.
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Affiliation(s)
- Chaouat Gerard
- 976 INSERM Hôpital Saint Louis, Pavillon Bazin, Avenue Claude Vellefaux 75010 Paris, France.
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Milosevic-Stevanovic J, Krstic M, Radovic-Janosevic D, Stefanovic M, Antic V, Djordjevic I. Preeclampsia with and without intrauterine growth restriction–Two pathogenetically different entities? Hypertens Pregnancy 2016; 35:573-582. [DOI: 10.1080/10641955.2016.1212872] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Affiliation(s)
- S. Ananth Karumanchi
- From the Center for Vascular Biology, Departments of Medicine, Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
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Schatz F, Guzeloglu-Kayisli O, Arlier S, Kayisli UA, Lockwood CJ. The role of decidual cells in uterine hemostasis, menstruation, inflammation, adverse pregnancy outcomes and abnormal uterine bleeding. Hum Reprod Update 2016; 22:497-515. [PMID: 26912000 DOI: 10.1093/humupd/dmw004] [Citation(s) in RCA: 130] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 02/01/2016] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Human pregnancy requires robust hemostasis to prevent hemorrhage during extravillous trophoblast (EVT) invasion of the decidualized endometrium, modification of spiral arteries and post-partum processes. However, decidual hemorrhage (abruption) can occur throughout pregnancy from poorly transformed spiral arteries, causing fetal death or spontaneous preterm birth (PTB), or it can promote the aberrant placentation observed in intrauterine growth restriction (IUGR) and pre-eclampsia; all leading causes of perinatal or maternal morbidity and mortality. In non-fertile cycles, the decidua undergoes controlled menstrual bleeding. Abnormal uterine bleeding (AUB) accompanying progestin-only, long-acting, reversible contraception (pLARC) accounts for most discontinuations of these safe and highly effective agents, thereby contributing to unwanted pregnancies and abortion. The aim of this study was to investigate the role of decidual cells in uterine hemostasis, menstruation, inflammation, adverse pregnancy outcomes and abnormal uterine bleeding. METHODS We conducted a critical review of the literature arising from PubMed searches up to December 2015, regarding in situ and in vitro expression and regulation of several specific proteins involved in uterine hemostasis in decidua and cycling endometrium. In addition, we discussed clinical and molecular mechanisms associated with pLARC-induced AUB and pregnancy complications with abruptions, chorioamnionitis or pre-eclampsia. RESULTS Progestin-induced decidualization of estradiol-primed human endometrial stromal cells (HESCs) increases in vivo and in vitro expression of tissue factor (TF) and type-1 plasminogen activator inhibitor (PAI-1) while inhibiting plasminogen activators (PAs), matrix metalloproteinases (MMPs), and the vasoconstrictor, endothelin-1 (ET-1). These changes in decidual cell-derived regulators of hemostasis, fibrinolysis, extracellular matrix (ECM) turnover, and vascular tone prevent hemorrhage during EVT invasion and vascular remodeling. In non-fertile cycles, progesterone withdrawal reduces TF and PAI-1 while increasing PA, MMPs and ET-1, causing menstrual-associated bleeding, fibrinolysis, ECM degradation and ischemia. First trimester decidual hemorrhage elicits later adverse outcomes including pregnancy loss, pre-eclampsia, abruption, IUGR and PTB. Decidual hemorrhage generates excess thrombin that binds to decidual cell-expressed protease-activated receptors (PARs) to induce chemokines promoting shallow placentation; such bleeding later in pregnancy generates thrombin to down-regulate decidual cell progesterone receptors and up-regulate cytokines and MMPs linked to PTB. Endometria of pLARC users display ischemia-induced excess vasculogenesis and progestin inhibition of spiral artery vascular smooth muscle cell proliferation and migration leading to dilated fragile vessels prone to bleeding. Moreover, aberrant TF-derived thrombin signaling also contributes to the pathogenesis of endometriosis via induction of angiogenesis, inflammation and cell survival. CONCLUSION Perivascular decidualized HESCs promote endometrial hemostasis during placentation yet facilitate menstruation through progestational regulation of hemostatic, proteolytic, and vasoactive proteins. Pathological endometrial hemorrhage elicits excess local thrombin generation, which contributes to pLARC associated AUB, endometriosis and adverse pregnancy outcomes through several biochemical mechanisms.
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Affiliation(s)
- Frederick Schatz
- Department of Obstetrics and Gynecology, Morsani College of Medicine, University of South Florida, Tampa, FL 33612, USA
| | - Ozlem Guzeloglu-Kayisli
- Department of Obstetrics and Gynecology, Morsani College of Medicine, University of South Florida, Tampa, FL 33612, USA
| | - Sefa Arlier
- Department of Obstetrics and Gynecology, Morsani College of Medicine, University of South Florida, Tampa, FL 33612, USA
| | - Umit A Kayisli
- Department of Obstetrics and Gynecology, Morsani College of Medicine, University of South Florida, Tampa, FL 33612, USA
| | - Charles J Lockwood
- Department of Obstetrics and Gynecology, Morsani College of Medicine, University of South Florida, Tampa, FL 33612, USA
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Amraoui F, Hassani Lahsinoui H, Boussata S, Keijser R, Veenboer G, Middeldorp S, van der Post J, Ris-Stalpers C, Afink G, van den Born B. Placental expression of heparan sulfate 3-O-sulfotransferase-3A1 in normotensive and pre-eclamptic pregnancies. Placenta 2015; 36:1218-24. [DOI: 10.1016/j.placenta.2015.09.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Revised: 09/13/2015] [Accepted: 09/14/2015] [Indexed: 01/30/2023]
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Gurnadi JI, Mose J, Handono B, Satari MH, Anwar AD, Fauziah PN, Yogi Pramatirta A, Rihibiha DD. Difference of concentration of placental soluble fms-like tyrosine kinase-1(sFlt-1), placental growth factor (PlGF), and sFlt-1/PlGF ratio in severe preeclampsia and normal pregnancy. BMC Res Notes 2015; 8:534. [PMID: 26434493 PMCID: PMC4593222 DOI: 10.1186/s13104-015-1506-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Accepted: 09/21/2015] [Indexed: 12/20/2022] Open
Abstract
Background Placental soluble fms-like tyrosine kinase-1 (sFlt-1) which is an antagonist of vascular endothelial growth factor and placental growth factor (PIGF), is considered as one of etiology factors cause endothelial damage in preeclampsia due to increase of sFlt-1 level that change vascular endothelial integrity. This study aims to analyze the difference of sFlt-1 and PlGF concentration in severe preeclampsia and normal pregnancy, and the correlation between both in occurrence of severe preeclampsia. Method This is case control study involving 18 subjects with severe preeclampsia and 19 subjects with normal pregnancy as controls who met inclusion and exclusion criteria. Concentration of sFlt-1 and PlGF are measured with ELISA. Statistical analysis is performed with Chi square test, Fisher’s exact test, T test, Mann–Whitney test, and Spearman’s rank correlation test. Results This study results in no significant difference in characteristics of gestational age, and parity in both study groups. Median concentration of sFlt-1 in severe preeclampsia is higher (20,524.75 pg/mL) compared with normal pregnancy (6820.4 pg/mL). Concentration of PlGF is lower in severe preeclampsia (47 pg/mL) compared with normal pregnancy (337 pg/mL). sFlt-1 concentration is higher in severe preeclampsia compared to normal pregnancy. PlGF concentration is lower in severe preeclampsia compared to normal pregnancy. Ratio of sFlt-1 and PlGF concentration is significantly correlated in both severe preeclampsia and normal pregnancy. Conclusions There is a significant negative correlation between the concentration of sFLt-1 and PlGF in normal pregnancy.
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Affiliation(s)
- Jeffry Iman Gurnadi
- Department of Obstetrics and Gynecology, Faculty of Medicine, Padjadjaran University, Bandung, Indonesia.
| | - Johannes Mose
- Department of Obstetrics and Gynecology, Faculty of Medicine, Padjadjaran University, Bandung, Indonesia.
| | - Budi Handono
- Department of Obstetrics and Gynecology, Faculty of Medicine, Padjadjaran University, Bandung, Indonesia.
| | - Mieke H Satari
- Department of Microbiology, Faculty of Dentistry, Padjadjaran University, Bandung, Indonesia.
| | - Anita Deborah Anwar
- Department of Obstetrics and Gynecology, Faculty of Medicine, Padjadjaran University, Bandung, Indonesia.
| | - Prima Nanda Fauziah
- Department of Biology, School of Life Sciences and Technology, Bandung Institute of Technology, Bandung, Indonesia.
| | - A Yogi Pramatirta
- Department of Obstetrics and Gynecology, Faculty of Medicine, Padjadjaran University, Bandung, Indonesia.
| | - Dwi Davidson Rihibiha
- Department of Biotechnology, School of Life Sciences and Technology, Bandung Institute of Technology, Bandung, Indonesia.
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Mardanian F, Kazeroonizadeh M, Rashidi B. Evaluation of CD56(dim) and CD56(bright) natural killer cells in peripheral blood of women with IVF failures. IRANIAN JOURNAL OF REPRODUCTIVE MEDICINE 2015; 13:577-82. [PMID: 26568763 PMCID: PMC4637126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Infertility is an increasing medical and social problem. In vitro fertilization (IVF) has become a common and accessible treatment for a wide variety of indications that have variable outcomes. Natural killer (NK) cells have been identified as relevant immunological factors involved in reproductive success or failure. OBJECTIVE The aim of this study was to compare the percentage of peripheral blood CD56(+) (CD56(dim) and CD56(bright)) cells and the level of NK cell in patients with IVF failure with those of successful IVF control women. MATERIALS AND METHODS We assessed the level of CD56(dim) CD16(+) and CD56(bright) CD16(-) cells in 50 women under IVF treatment and compared between successful IVF and IVF failure with the flowcytometry technique. RESULTS Of studied women, 68% did not response to IVF therapy and 32% had successful IVF, the level of CD56(dim) CD16(+) cells in women with IVF failure was significantly higher than successful IVF (p<0.0001) but the level of CD56(bright) CD16(-) cells was not significantly different between women with IVF failure and successful IVF (p=0.28). CONCLUSION The results of present study demonstrated that the level of NK cells as a risk factor is associated with pregnancy loss in women with IVF failure. However, number of sample in this study is low and further studies with more sample size are needed to be done. We suggest considering treatment option for women undergoing repeated IVF failure with increased percentage of CD56(dim) cells and the level of peripheral blood NK cell.
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Affiliation(s)
- Farahnaz Mardanian
- Department of Obstetrics and Gynecology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Moones Kazeroonizadeh
- Department of Obstetrics and Gynecology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Bahman Rashidi
- Department of Anatomy, School of Medicine, Isfahan University of Medical Sciences,Isfahan, Iran.
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Soares MJ, Chakraborty D, Kubota K, Renaud SJ, Rumi MAK. Adaptive mechanisms controlling uterine spiral artery remodeling during the establishment of pregnancy. THE INTERNATIONAL JOURNAL OF DEVELOPMENTAL BIOLOGY 2015; 58:247-59. [PMID: 25023691 DOI: 10.1387/ijdb.140083ms] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Implantation of the embryo into the uterus triggers the initiation of hemochorial placentation. The hemochorial placenta facilitates the acquisition of maternal resources required for embryo/fetal growth. Uterine spiral arteries form the nutrient supply line for the placenta and fetus. This vascular conduit undergoes gestation stage-specific remodeling directed by maternal natural killer cells and embryo-derived invasive trophoblast lineages. The placentation site, including remodeling of the uterine spiral arteries, is shaped by environmental challenges. In this review, we discuss the cellular participants controlling pregnancy-dependent uterine spiral artery remodeling and mechanisms responsible for their development and function.
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Affiliation(s)
- Michael J Soares
- Institute for Reproductive Health and Regenerative Medicine, Department of Pathology and Laboratory Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA.
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Bueno-Sánchez JC, Peña-Alzate S, Peña RB, Agudelo-Jaramillo B, Cadavid-Jaramillo AP, Chaouat G, Maldonado-Estrada JG. Sera from early-onset, severely preeclamptic women directly modulate HLA-E expression in the EA.hy296 endothelial cell line. J Reprod Immunol 2014; 104-105:68-79. [PMID: 24837231 DOI: 10.1016/j.jri.2014.03.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Revised: 03/14/2014] [Accepted: 03/17/2014] [Indexed: 11/18/2022]
Abstract
The expression of endothelial HLA-E in the context of the systemic inflammatory response observed in preeclampsia has not been established. An experimental study was designed to determine the effect of the sera of pregnant women on the expression of HLA-E in EA.hy296 endothelial cells. First, measurements of protein fractions were performed in sera from early-onset, severely preeclamptic women without HELLP syndrome, in which there was no significant difference in total proteins between the groups, but a reduced level of plasma albumin and an increase in α1-globulin were observed in both groups of pregnant women compared with non-pregnant women. Measurements of colloid osmotic pressure (COP) using a recalculated albumin/globulin ratio formula determined only a significant decrease in COP in all pregnant groups compared with non-pregnant women. The expression of membrane HLA-E was increased in EA.hy296 endothelial cells stimulated with sera of early-onset, severely preeclamptic women, while recombinant interferon-γ (IFN-γ) significantly reduced the expression of membrane HLA-E. Pro-inflammatory cytokines were measured by Luminex in the serum samples, and increased levels of tumor necrosis factor (TNF) and decreased levels of IFN-γ were observed in early-onset, severe preeclampsia compared with normal pregnancy. Moreover, soluble HLA-E was detected in these serum samples by Western blot and ELISA, but no significant difference was found. This raises the possibility that a systemic inflammatory response promotes a compensatory mechanism of COP balance in severe preeclampsia by release of inflammation-induced factors, including endothelial HLA-E. Evidence is now provided regarding HLA-E expression by EA.hy296 cells.
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Affiliation(s)
- J C Bueno-Sánchez
- Reproduction Group, Universidad de Antioquia, Calle 70 No. 52-21, Medellin, Colombia; Department of Physiology and Biochemistry, Universidad de Antioquia, Calle 70 No. 52-21, Medellin, Colombia.
| | - S Peña-Alzate
- Reproduction Group, Universidad de Antioquia, Calle 70 No. 52-21, Medellin, Colombia
| | - R B Peña
- Reproduction Group, Universidad de Antioquia, Calle 70 No. 52-21, Medellin, Colombia
| | - B Agudelo-Jaramillo
- NACER-SSR, Department of Obstetrics and Gynaecology, School of Medicine, Universidad de Antioquia, Calle 70 No. 52-21, Medellin, Colombia; Hospital Universitario San Vicente Fundación and Hospital General de Medellín, Obstetrics and Gynaecology Services, Medellín, Colombia
| | - A P Cadavid-Jaramillo
- Reproduction Group, Universidad de Antioquia, Calle 70 No. 52-21, Medellin, Colombia
| | - G Chaouat
- INSERM U 976, Pavillon Bazin, Hopital Saint Louis, 75010 Paris, France
| | - J G Maldonado-Estrada
- Reproduction Group, Universidad de Antioquia, Calle 70 No. 52-21, Medellin, Colombia; Centauro Group, School of Veterinary Medicine, Universidad de Antioquia, Calle 70 No. 52-21, Medellin, Colombia
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Long W, Shi Z, Fan S, Liu L, Lu Y, Guo X, Rong C, Cui X, Ding H. Association of maternal KIR and fetal HLA-C genes with the risk of preeclampsia in the Chinese Han population. Placenta 2014; 36:433-7. [PMID: 24951171 DOI: 10.1016/j.placenta.2014.05.008] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Revised: 05/21/2014] [Accepted: 05/24/2014] [Indexed: 01/05/2023]
Abstract
INTRODUCTION This study is to investigate the distribution of inhibitory and activating killer-cell immunoglobulin-like receptors (KIRs) and the combination of KIR/human leukocyte antigen (HLA)-C in women with preeclampsia in the Chinese Han population. METHODS A total of 271 patients and 295 controls were enrolled in our study. The inhibitory/activating KIR and HLA-C genes were detected using the PCR-SSP (polymerase chain reaction with sequence-specific primers) method. RESULTS Our result showed that decreased numbers of individual activating KIR genes (2DS2, 2DS3, and 2DS5) were observed in women with preeclampsia. Furthermore, the gene frequency of total activating KIRs was significantly lower in patients compared with that of the controls (P = 0.03). The frequency of the KIR2DL1 gene was increased in women with preeclampsia when a homozygous HLA-C2 allele appeared in the fetus. CONCLUSION The results suggest that a KIR genetic variation might influence the risk of preeclampsia. The lack of activating KIRs could possibly lower uterine natural killer (uNK) cell activation, thereby contributing to the pathogenesis of preeclampsia. Moreover, the imbalance of the inhibitory or activating signals at the maternal-fetal interface seems to play a regulatory role in the occurrence of preeclampsia.
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Affiliation(s)
- W Long
- Department of Obstetrics, Nanjing Medical University Affiliated Nanjing Maternal and Child Health Hospital, Nanjing 210004, China
| | - Z Shi
- Department of Obstetrics, Nanjing Medical University Affiliated Nanjing Maternal and Child Health Hospital, Nanjing 210004, China
| | - S Fan
- Department of Obstetrics, Nanjing Medical University Affiliated Nanjing Maternal and Child Health Hospital, Nanjing 210004, China
| | - L Liu
- Department of Obstetrics, Nanjing Medical University Affiliated Nanjing Maternal and Child Health Hospital, Nanjing 210004, China
| | - Y Lu
- Department of Obstetrics, Nanjing Medical University Affiliated Nanjing Maternal and Child Health Hospital, Nanjing 210004, China
| | - X Guo
- Maternal and Child Health Medical Institute, Nanjing Medical University Affiliated Nanjing Maternal and Child Health Hospital, Nanjing 210004, China
| | - C Rong
- Maternal and Child Health Medical Institute, Nanjing Medical University Affiliated Nanjing Maternal and Child Health Hospital, Nanjing 210004, China
| | - X Cui
- Department of Obstetrics, Nanjing Medical University Affiliated Nanjing Maternal and Child Health Hospital, Nanjing 210004, China.
| | - H Ding
- Department of Obstetrics, Nanjing Medical University Affiliated Nanjing Maternal and Child Health Hospital, Nanjing 210004, China.
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Lockwood CJ, Huang SJ, Chen CP, Huang Y, Xu J, Faramarzi S, Kayisli O, Kayisli U, Koopman L, Smedts D, Buchwalder LF, Schatz F. Decidual cell regulation of natural killer cell-recruiting chemokines: implications for the pathogenesis and prediction of preeclampsia. THE AMERICAN JOURNAL OF PATHOLOGY 2014; 183:841-56. [PMID: 23973270 DOI: 10.1016/j.ajpath.2013.05.029] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Revised: 04/17/2013] [Accepted: 05/28/2013] [Indexed: 10/26/2022]
Abstract
First trimester human decidua is composed of decidual cells, CD56(bright)CD16(-) decidual natural killer (dNK) cells, and macrophages. Decidual cells incubated with NK cell-derived IFN-γ and either macrophage-derived TNF-α or IL-1β synergistically enhanced mRNA and protein expression of IP-10 and I-TAC. Both chemokines recruit CXCR3-expressing NK cells. This synergy required IFN-γ receptor 1 and 2 mediation via JAK/STAT and NFκB signaling pathways. However, synergy was not observed on neutrophil, monocyte, and NK cell-recruiting chemokines. Immunostaining of first trimester decidua localized IP-10, I-TAC, IFN-γR1, and -R2 to vimentin-positive decidual cells versus cytokeratin-positive interstitial trophoblasts. Flow cytometry identified high CXCR3 levels on dNK cells and minority peripheral CD56(bright)CD16(-) pNK cells and intermediate CXCR3 levels on the majority of CD56(dim)CD16(+) pNK cells. Incubation of pNK cells with either IP-10 or I-TAC elicited concentration-dependent enhanced CXCR3 levels and migration of both pNK cell subsets that peaked at 10 ng/mL, whereas each chemokine at a concentration of 50 ng/mL inhibited CXCR3 expression and pNK cell migration. Deciduae from women with preeclampsia, a leading cause of maternal and fetal morbidity and mortality, displayed significantly lower dNK cell numbers and higher IP-10 and I-TAC levels versus gestational age-matched controls. Significantly elevated IP-10 levels in first trimester sera from women eventually developing preeclampsia compared with controls, identifying IP-10 as a novel, robust early predictor of preeclampsia.
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Affiliation(s)
- Charles J Lockwood
- Department of Obstetrics and Gynecology, Ohio State University College of Medicine, Columbus, Ohio, USA
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Role of invariant natural killer T cells in lipopolysaccharide-induced pregnancy loss. Cell Immunol 2013; 286:1-10. [DOI: 10.1016/j.cellimm.2013.10.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2012] [Revised: 05/27/2013] [Accepted: 10/25/2013] [Indexed: 11/18/2022]
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Cerdeira AS, Karumanchi SA. Angiogenic factors in preeclampsia and related disorders. Cold Spring Harb Perspect Med 2012; 2:cshperspect.a006585. [PMID: 23125198 DOI: 10.1101/cshperspect.a006585] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
During fetal development, the human placenta undergoes high levels of both angiogenesis and vasculogenesis. Additionally, the developing placenta undergoes a process of vascular mimicry (referred to as pseudovasculogenesis) as cytotrophoblasts convert from an epithelial to an endothelial phenotype. The initiation, maturation, and maintenance of the placental vasculature are of critical importance. Failure to do so can lead to adverse obstetric outcomes such as preeclampsia and/or intrauterine growth restriction (IUGR). Furthermore, the foundation of many aspects of adult health is laid in utero. In this context, normal placental function is not only critical for normal fetal development but can also permanently influence long-term health and disease. Understanding the mechanisms that regulate placental vasculogenesis and angiogenesis is therefore of critical importance. This chapter will focus on placental vascular development with a particular emphasis on the role of angiogenic factors in the pathogenesis of the maternal syndrome of preeclampsia and related disorders.
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Affiliation(s)
- Ana Sofia Cerdeira
- Department of Medicine, Obstetrics & Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts 02114, USA
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Mary S, Patil GV, Kulkarni AV, Kulkarni MJ, Joshi SR, Mehendale SS, Giri AP. Dynamic proteome in enigmatic preeclampsia: an account of molecular mechanisms and biomarker discovery. Proteomics Clin Appl 2012; 6:79-90. [PMID: 22447695 DOI: 10.1002/prca.201100089] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The coevolution of genomics and proteomics has led to advancements in the field of diagnosis and molecular mechanisms of disease. Proteomics is now stepping into the field of obstetrics, where early diagnosis of pregnancy complication such as preeclampsia (PE) is imperative. PE is a multifactorial disease characterized by hypertension with proteinuria, which is a leading cause of maternal and neonatal morbidity and mortality occurring in 5-7% of pregnancies worldwide. This review discusses the probable molecular mechanisms that lead to PE and summarizes the proteomics research carried out in understanding the pathogenicity of PE, and for identifying the candidate biomarker for diagnosis of the disease.
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Affiliation(s)
- Sheon Mary
- Division of Biochemical Sciences, National Chemical Laboratory (CSIR), Pune, Maharashtra, India
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Li LP, Fang YC, Dong GF, Lin Y, Saito S. Depletion of invariant NKT cells reduces inflammation-induced preterm delivery in mice. THE JOURNAL OF IMMUNOLOGY 2012; 188:4681-9. [PMID: 22467647 DOI: 10.4049/jimmunol.1102628] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
This study sought to determine whether invariant NKT (iNKT) cells play an essential role in inflammation-induced preterm delivery. Preterm delivery and fetal death rates were determined in wild-type (WT) C57BL/6 mice and iNKT cell-deficient Jα18(-/-) mice injected i.p. with LPS. The percentages of decidual immune cells, including activated subsets, and costimulatory molecule expression were analyzed by flow cytometry. Th1 and Th2 cytokine production in the culture supernatants of decidual mononuclear cells was measured by ELISA. To some extent, Jα18(-/-) mice were resistant to LPS-induced preterm delivery. The proportions of decidual CD3(+) and CD49b(+) cells were slightly lower in Jα18(-/-) mice than in WT Jα18(+/+) mice, whereas almost no CD3(+)CD49b(+) cells could be found in Jα18-null mice. The percentages of activated decidual DCs, T cells, and NK cells were significantly lower in LPS-treated Jα18(-/-) mice than in WT mice. The CD40, CD80, and CD86 expression levels on decidual CD11c(+) cells from Jα18(-/-) mice were also significantly lower than in WT mice. Mean concentrations of Th1 cytokines IFN-γ and IL-12p70 in the culture supernatants of decidual mononuclear cells from LPS-treated Jα18(-/-) mice were apparently lower than those of LPS-induced WT mice. Additionally, the proportions of activated CD11c(+) cells, CD3(+) cells, and CD49b(+) cells in LPS-induced preterm delivery mice were strikingly higher in both WT and null mice when compared with the control PBS group and LPS-injected but normally delivered mice. Our results suggest that iNKT cells may play an essential role in inflammation-induced preterm birth.
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Affiliation(s)
- Li-Ping Li
- Department of Obstetrics and Gynecology, Guangzhou Medical College Affiliated Guangzhou First Municipal People's Hospital, Guangzhou 510180, China
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Fainaru O, Hantisteanu S, Rotfarb N, Michaeli M, Hallak M, Ellenbogen A. Maturation of human ovarian follicles is accompanied by a decrease in the CD56+CD16+ natural killer cell population. Fertil Steril 2011; 95:2395-8. [DOI: 10.1016/j.fertnstert.2011.03.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2010] [Revised: 03/02/2011] [Accepted: 03/05/2011] [Indexed: 10/18/2022]
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Silasi M, Cohen B, Karumanchi SA, Rana S. Abnormal placentation, angiogenic factors, and the pathogenesis of preeclampsia. Obstet Gynecol Clin North Am 2010; 37:239-53. [PMID: 20685551 DOI: 10.1016/j.ogc.2010.02.013] [Citation(s) in RCA: 130] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Preeclampsia is a common complication of pregnancy with potentially devastating consequences to both the mother and the baby.It is the leading cause of maternal deaths in developing countries. In developed countries it is the major cause of iatrogenic premature delivery and contributes significantly to increasing health care cost associated with prematurity. There is currently no known treatment for preeclampsia; ultimate treatment involves delivery of the placenta. Although there are several risk factors (such as multiple gestation or chronic hypertension), most patients present with no obvious risk factors. The molecular pathogenesis of preeclampsia is just now being elucidated. It has been proposed that abnormal placentation and an imbalance in angiogenic factors lead to the clinical findings and complications seen in preeclampsia. Preeclampsia is characterized by high levels of circulating antiangiogenic factors such as soluble fms-like tyrosine kinase-1 and soluble endoglin, which induce maternal endothelial dysfunction. These soluble factors are altered not only at the time of clinical disease but also several weeks before the onset of clinical signs and symptoms. Many methods of prediction and surveillance have been proposed to identify women who will develop preeclampsia, but studies have been inconclusive. With the recent discovery of the role of angiogenic factors in preeclampsia, novel methods of prediction and diagnosis are being developed to aid obstetricians and midwives in clinical practice. This article discusses the role of angiogenic factors in the pathogenesis, prediction, diagnosis, and possible treatment of preeclampsia.
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Affiliation(s)
- Michelle Silasi
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Kirstein 3182, Boston, MA 02215, USA
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Decreased proportion of peripheral blood vascular endothelial growth factor-expressing T and natural killer cells in preeclampsia. Am J Obstet Gynecol 2010; 203:567.e1-8. [PMID: 20833383 DOI: 10.1016/j.ajog.2010.07.019] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2010] [Revised: 07/12/2010] [Accepted: 07/15/2010] [Indexed: 11/20/2022]
Abstract
OBJECTIVE The purpose of this study was to determine the proportion of circulating T and natural killer (NK) cells that express intracellular vascular endothelial growth factor (VEGF) in women with preeclampsia compared to those with a normal pregnancy. STUDY DESIGN In all, 24 preeclamptic patients and 30 healthy pregnant women were involved in this case-control study. Intracellular VEGF expression of unstimulated lymphocytes was determined with flow cytometric examination. RESULTS In healthy pregnant women, the majority of both T and NK cells expressed VEGF in their cytoplasma (median, 79.9%; 25-75 percentile, 73.7-87.0 and median, 78.3%; 25-75 percentile, 64.1-85.3, respectively). Furthermore, CD4(+) helper and CD8(+) cytotoxic T cells showed a similar pattern of VEGF expression in normal pregnancy. However, the proportion of VEGF-expressing peripheral blood T (both helper and cytotoxic) and NK cells was markedly decreased in preeclampsia (for T cells: median, 51.6%; 25-75 percentile, 40.1-60.0; P < .001; for NK cells: median, 45.2%; 25-75 percentile, 27.4-64.0; P < .001). CONCLUSION Our results suggest decreased production of VEGF by circulating T and NK cells in preeclampsia, which might contribute to the development of the generalized endothelial dysfunction characteristic of the maternal syndrome of the disease.
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CD56brightCD16− natural killer cells accumulate in the ovarian follicular fluid of patients undergoing in vitro fertilization. Fertil Steril 2010; 94:1918-21. [DOI: 10.1016/j.fertnstert.2009.12.067] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2009] [Revised: 12/17/2009] [Accepted: 12/23/2009] [Indexed: 11/21/2022]
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Ahn H, Park J, Gilman-Sachs A, Kwak-Kim J. Immunologic Characteristics of Preeclampsia, a Comprehensive Review. Am J Reprod Immunol 2010; 65:377-94. [DOI: 10.1111/j.1600-0897.2010.00913.x] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
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Zhou H, Chen L, You Y, Zou L, Zou P. Foxp3-transduced polyclonal regulatory T cells suppress NK cell functions in a TGF-beta dependent manner. Autoimmunity 2010; 43:299-307. [PMID: 20166879 DOI: 10.3109/08916930903405875] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
CD4(+)CD25(+) regulatory T cells (Treg) are a unique population of T cells that maintain immune tolerance and are essential in host suppression of autoimmune diseases. Natural killer (NK) cells are an important component of the innate immune system and respond to insults. Recent studies demonstrate that NK cells may play a vital role during the onset and progression of certain autoimmune diseases. The decreased or abolished regulation by Treg cells on NK cells may lead to the abnormal autoimmune response. The purpose of this study was to investigate the suppressive effect of Foxp3-transduced CD4(+) T cells on NK cell functions, and thus to present a possible method for managing NK cell-related autoimmune abnormalities. This study showed that forced Foxp3 expression in polyclonal CD4(+) T cells could obtain Treg cells phenotype, including specifically expressing CD25, transforming growth factor (TGF-beta) and CTLA-4. Since NK cells have two major immunological properties--cytotoxicity and cytokine production, we observed that transduction-induced Treg cells decreased NK cell cytotoxicity obviously, and dramatically downregulated the interferon-gamma secretion of NK cell responding to IL-12 stimulation. Moreover, it was found that cell-cell interaction was essential for suppression of NK cell functions, and TGF-beta played a vital role in the inhibition process. These results indicate that the forced Foxp3 expression in polyclonal CD4(+) T cells could induce Treg cells and potentially inhibit NK cell functions.
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Affiliation(s)
- Hao Zhou
- Institute of Hematology, Tongji Medical College, Union Hospital, Huazhong University of Science and Technology, 1277 Jiefang Road, Wuhan 430022, China
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Tskitishvili E, Sharentuya N, Temma-Asano K, Mimura K, Kinugasa-Taniguchi Y, Kanagawa T, Fukuda H, Kimura T, Tomimatsu T, Shimoya K. Oxidative stress-induced S100B protein from placenta and amnion affects soluble Endoglin release from endothelial cells. Mol Hum Reprod 2010; 16:188-199. [DOI: 10.1093/molehr/gap104] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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Biggar RJ, Poulsen G, Melbye M, Ng J, Boyd HA. Spontaneous labor onset: is it immunologically mediated? Am J Obstet Gynecol 2010; 202:268.e1-7. [PMID: 20045503 DOI: 10.1016/j.ajog.2009.10.875] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2009] [Revised: 08/17/2009] [Accepted: 10/27/2009] [Indexed: 12/31/2022]
Abstract
OBJECTIVE The investigators tested the hypothesis that maternal-fetal immune interactions could be important in initiating spontaneous labor onset by examining if labor was delayed when fetuses share maternal HLA antigen types. STUDY DESIGN HLA antigen types A, B, and DR in 200 Danish mother-infant pairs delivering in 42-44 weeks (postterm) were compared with 195 mother-infant pairs delivering in 37-40 weeks (term). RESULTS Sharing of HLA A and B antigens was more common than expected in postterm deliveries. Odds ratios were 1.54 (95% confidence interval [CI], 1.01-2.35) and 1.75 (95% CI, 0.87-3.52), respectively (risk per shared antigen: 1.40 [95% CI, 1.04-1.90] per unit increase). Adding stringent birth-length criteria for postmaturity (92 cases; 168 controls) strengthened risks associated with antigen sharing to 1.57 (95% CI, 0.90-2.74) and 2.60 (95% CI, 1.15-5.88), respectively (risk per shared antigen: 1.60 (95% CI, 1.10-2.32). CONCLUSION Postterm-delivered infants had more HLA A and B antigens in common with their mothers, suggesting that recognition of HLA antigen differences by adaptive immunity may have a role in triggering labor onset.
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Affiliation(s)
- Robert J Biggar
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
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Kopcow HD, Eriksson M, Mselle TF, Damrauer SM, Wira CR, Sentman CL, Strominger JL. Human decidual NK cells from gravid uteri and NK cells from cycling endometrium are distinct NK cell subsets. Placenta 2010; 31:334-8. [PMID: 20172608 DOI: 10.1016/j.placenta.2010.01.003] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2009] [Revised: 12/31/2009] [Accepted: 01/05/2010] [Indexed: 10/19/2022]
Abstract
Human NK cells from the decidua basalis of gravid uteri and from the cycling endometrium of women undergoing hysterectomy were isolated and compared by gene expression profiling using Affymetrix microarrays with probes representing approximately 47,400 transcripts. Substantial differences indicate that these two types of NK cells represent distinct subsets.
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Affiliation(s)
- H D Kopcow
- Department of Molecular and Cellular Biology, Harvard University, Cambridge, MA 02138, USA
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Biggar RJ, Poulsen G, Ng J, Melbye M, Boyd HA. HLA antigen sharing between mother and fetus as a risk factor for eclampsia and preeclampsia. Hum Immunol 2010; 71:263-7. [PMID: 20074602 DOI: 10.1016/j.humimm.2010.01.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2009] [Revised: 01/04/2010] [Accepted: 01/07/2010] [Indexed: 11/28/2022]
Abstract
Immune maladaption between mother and infant has been suggested to induce preeclampsia/eclampsia. When fetuses share more human leukocyte antigen (HLA) types with their mother, immune differences would be limited and thereby could affect this risk. Data from Danish women (1996-2002) with single live-birth pregnancies complicated by severe preeclampsia/eclampsia were compared to women with term pregnancies uncomplicated by hypertension. HLA A, B, and DR types were resolved at the intermediate-level typing (antigen). A total of 201 cases and 195 control mother-infant pairs had complete HLA types. The odds ratios of preeclampsia/eclampsia in mothers sharing both HLA antigens with their infants were 1.19 (95% confidence interval: 0.81-1.76) for HLA A, 0.91 (0.59-1.42) for HLA B, and 1.05 (0.5-1.59) for HLA DR antigens. No specific HLA antigens in either mother or infant appeared important after Bonferroni correction, except possibly DR01 in mothers (protective). Thus, maladaption mediated by adaptive immunity between mother and infant is not the basis for the mother developing preeclampsia/eclampsia.
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Affiliation(s)
- Robert J Biggar
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark.
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Li L, Kang J, Lei W. Role of Toll-like receptor 4 in inflammation-induced preterm delivery. Mol Hum Reprod 2009; 16:267-72. [DOI: 10.1093/molehr/gap106] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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Cudihy D, Lee RV. The pathophysiology of pre-eclampsia: Current clinical concepts. J OBSTET GYNAECOL 2009; 29:576-82. [DOI: 10.1080/01443610903061751] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Bachmayer N, Sohlberg E, Sundström Y, Hamad RR, Berg L, Bremme K, Sverremark-Ekström E. ORIGINAL ARTICLE: Women with Pre-Eclampsia Have an Altered NKG2A and NKG2C Receptor Expression on Peripheral Blood Natural Killer Cells. Am J Reprod Immunol 2009; 62:147-57. [DOI: 10.1111/j.1600-0897.2009.00724.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
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Effect of ovarian steroids on gene expression profile in human uterine microvascular endothelial cells. Fertil Steril 2009; 92:709-21. [DOI: 10.1016/j.fertnstert.2008.06.022] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2007] [Revised: 04/07/2008] [Accepted: 06/09/2008] [Indexed: 12/11/2022]
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Kitaya K, Yasuo T. Dermatan sulfate proteoglycan biglycan as a potential selectin L/CD44 ligand involved in selective recruitment of peripheral blood CD16(-) natural killer cells into human endometrium. J Leukoc Biol 2008; 85:391-400. [PMID: 19088176 DOI: 10.1189/jlb.0908535] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Unique CD16(-) NK cells acutely increase in the human uterine endometrium after ovulation. The origin of these NK cells remains unknown, but they may be recruited selectively from the circulation. Proteoglycans and their glycosaminoglycan side-chains expressed on endometrial microvascular endothelial cells play a key role in lymphocyte tethering/rolling, the initial step of lymphocyte extravasation. In this study, we sought for the potential proteoglycans involved in tethering/rolling of peripheral blood CD16(-) NK cells on endometrial microvascular endothelial cells. As compared with CD16(+) NK cells and non-NK cells, enriched peripheral blood CD16(-) NK cells bound preferably to immobilized glycosaminoglycans except for keratan sulfate. CD16(-) NK cells bound maximally to dermatan sulfate (DS), which was diminished by enzymatic pretreatment with dermatanase and chondroitinase ABC, but not with chondroitinase ACII. The binding capacity of CD16(-) NK cells to DS was attenuated by blocking antibodies against selectin L and CD44 or pretreatment of CD16(-) NK cells with IL-15. Of three known DS proteoglycans, biglycan and decorin but not epiphycan were expressed in the human cycling endometrium. In the endometrial microvessels, the immunoreactivity for biglycan was greater in the secretory phase than in the proliferative phase, and there was little, if any, immunoreactivity for decorin throughout the menstrual cycle. The ovarian steroid progesterone enhanced biglycan expression in cultured human uterine microvascular endothelial cells. These findings demonstrated that DS proteoglycan biglycan is a potential selectin L/CD44 ligand involved in tethering/rolling of peripheral blood CD16(-) NK cells on endometrial microvascular endothelial cells.
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Affiliation(s)
- Kotaro Kitaya
- Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, Japan.
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Kitaya K. Accumulation of uterine CD16(-) natural killer (NK) cells: friends, foes, or Jekyll-and-Hyde relationship for the conceptus? Immunol Invest 2008; 37:467-81. [PMID: 18716934 DOI: 10.1080/08820130802191292] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Human cycling endometrium and early pregnant decidua are infiltrated by a unique lymphocyte subset of CD16(-) natural killer (NK) cells, which are minor cells in circulating blood and other organs. The number of uterine (u) CD16(-) NK cells rises sharply after ovulation. If pregnancy occurs, uCD16(-) NK cells increase further in number, but are shed during the menstrual period. uCD16(-) NK cells have the potential to produce cytokines and growth factors that play important roles in embryo implantation and placentation, but they are armed with cytolytic cytoplasmic granules. In the mid-secretory phase endometrium of women with recurrent miscarriages, dense accumulations of uCD16(-) NK cells also occur, like those seen in first-trimester decidua of uncomplicated pregnancies. This finding complicates understanding the exact roles of these NK cells at implantation sites. uCD16(-) NK cells are likely to be a mixture of indigenous endometrial NK cells and immigrant NK cells from the circulation. However, it is not yet known if NK cells from these two different origins display similar or unique characteristics. In this review, the potential underlying mechanisms for accumulation of uCD16(-) NK cells in uncomplicated pregnancies and in pathological pregnancies, especially recurrent miscarriages, are discussed.
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Affiliation(s)
- Kotaro Kitaya
- Department of Obstetrics and Gynecology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan.
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Linton NF, Wessels JM, Cnossen SA, Croy BA, Tayade C. Immunological mechanisms affecting angiogenesis and their relation to porcine pregnancy success. Immunol Invest 2008; 37:611-29. [PMID: 18716940 DOI: 10.1080/08820130802191540] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Prenatal mortality due to loss of lymphocyte-promoted endometrial angiogenesis is being investigated as a major cause of litter reductions during pregnancy in pigs. This review discusses immune mechanisms influencing porcine endometrial angiogenesis as well as additional signalling molecules that may play important roles in the compromise of peri-implantation and mid-gestation fetal pig survival. These include dendritic cells, signalling molecules such as toll-like receptors, chemokines and ficolins. Together these cells and molecules regulate immune responses and, ideally, protect the mother and prevent immune-based conceptus losses. Dendritic cells were recently shown to be angiogenic. Their tolerogenic role at the maternal-fetal interface coupled with the ability to secrete and respond to angiogenic factors suggests that dendritic cells are the key coordinators of angiogenesis at the porcine maternal-fetal interface. Chemokines coordinate the localization of immune effector and endothelial cells. The balance between pro-angiogenic and anti-angiogenic chemokines is addressed in relation to conceptus viability. Ficolins, components of the lectin-mediated complement activation pathway, are used for self/non-self recognition. Together, these components of the immune system could regulate lymphocyte- and non-lymphocyte-promoted endometrial angiogenesis to determine conceptus survival.
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Affiliation(s)
- Nicola F Linton
- Department of Biomedical Sciences, University of Guelph, Guelph, Ontario, Canada
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