The significance of human leukocyte antigen profiles in human infertility, recurrent abortion, and pregnancy disorders

The role of immunization treatment in preventing recurrent abortion

Published reports of controlled studies of immunization treatment in recurrent abortion have not shown any ability of either third-party cells or the husband's cells to prevent further abortions, whereas preliminary results of ongoing studies speak in favor of a beneficial effect of third-party cells. However, the lack of significant differences so far does not prove that immunotherapy in habitual abortion is ineffective, because all of these studies include too few patients in each group to give any conclusive results. Only a mega-trial could evaluate the efficacy and side effects of leukocyte immunotherapy. Such controlled studies are needed to clarify the true benefits, risks, and limitations of immunization treatment in recurrent abortion. Factors such as appropriate inclusion criteria, the time relationship between immunization and the next pregnancy, the number of immunizations required, the cell source and cell doses need to be established. Until this additional information is available this treatment should not be considered routinely indicated. This approach should be restricted to a few centers in order to provide maximal possibilities for collection and evaluation of the data.

Selection of patients with habitual abortion for paternal leucocyte immunization

After potentiation of the immune response in habitual aborters 75-85% of subsequent pregnancies are claimed to result in healthy term infants. However, all publications to date have either been based on the authors concept of the immune processes involved or an attempt to demonstrate the efficacy of treatment either empirically or by matched trials. As immunization is coming into wider clinical use, it is necessary to determine which patients will benefit from this form of treatment. This paper presents our experience with paternal leucocyte immunization over the period 1985-1988. 207 patients were classified on a clinical basis and by immunological testing. 143 patients have been immunised, 129 pregnancies have occurred in 108 patients. The vast majority of our patients have recurrent missed abortions. Only six women habitually aborted live fetuses. Two had subsequent live births. Secondary aborters seem to do well in subsequent pregnancies, whether immunized or not. The patient most likely to benefit from immunization is the Primary missed aborter who does not possess antipaternal antibody (APCA), but is induced to produce APCA by immunization. Using these criteria, 75% success rates are observed in the subsequent pregnancy. This success rate is irrespective of HLA antigen sharing or in-vitro mixed lymphocyte reactivity.

White cell subpopulations in autoimmune infertile men and their wives with cytotoxic sperm antibodies

Sixty six infertile men with cytotoxic sperm antibodies had fewer and lower percentages of OKT4-positive helper/inducer T lymphocytes p = 0.004 and 0.003, respectively), than the fertile (n = 14) and infertile (n = 12) antibody-negative controls. Ratio of OKT4/OKT8 was decreased (p less than 0.01), while numbers of OKDR and BD-Leu12 positive predominantly B lymphocytes were increased (p less than 0.0001) in infertile men with sperm antibodies. T lymphocytes positive for OKT3, OKT11 and OKT4 and the OKT4/OKT8 ratio were decreased in infertile women with sperm antibodies, while B lymphocytes positive for OKDR and BD-Leu12 were increased in infertile women with or without sperm antibodies (p less than 0.0001, versus fertile controls). Lymphocyte responses to phytohemagglutinin (PHA), concanavalin A (ConA) and pokeweed mitogen (PWM), however, were similar in 20 fertile and 136 infertile couples. Lymphocytes from infertile men with sperm antibodies had an enhanced stimulatory response to autologous sperm and seminal plasma. It is concluded that sperm antigens from autoimmune infertile men stimulate heightened immune responses to sperm antigens and altered distribution of white cell populations in both partners.

T and B lymphocyte populations in uterus draining lymph nodes at estrus and diestrus in Wistar rats

In this paper, data are presented on the characterization of uterus draining lymph nodes (UDLN) B and T lymphocytes of virgin rats at estrus (E) and diestrus (D). We established that the T/B lymphocyte relationship in the UDLN is less than one at estrus and more than one at diestrus. This is due to a decrease in the percentage and in the total number of mature T cell population in association with a decrease in the percentage of the OX8 subset in the UDLN at estrus. This situation may be related to an increase in estrogens known to produce thymic involution. These changes were not observed when we studied peripheral (popliteal) lymph nodes. The changes observed in the UDLN T cell population at estrus could be under hormonal control and we think that this condition may be important to prepare the immune system for an eventual pregnancy.