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Helmo FR, Lopes AMM, Carneiro ACDM, Campos CG, Silva PB, Dos Reis Monteiro MLG, Rocha LP, Dos Reis MA, Etchebehere RM, Machado JR, Corrêa RRM. Angiogenic and antiangiogenic factors in preeclampsia. Pathol Res Pract 2017; 214:7-14. [PMID: 29174227 DOI: 10.1016/j.prp.2017.10.021] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 10/23/2017] [Accepted: 10/25/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND Pre-eclampsia is a multifactorial hypertensive disorder that is triggered by placental insufficiency and that accounts for up to 15% of maternal deaths. In normal pregnancies, this process depends on the balance between the expression of angiogenic factors and antiangiogenic factors, which are responsible for remodeling the spiral arteries, as well as for neoangiogenesis and fetal development. PURPOSE The aim of this review is to discuss the main scientific findings regarding the role of angiogenic and antiangiogenic factors in the etiopathogenesis of preeclampsia. METHODS An extensive research was conducted in the Pubmed database in search of scientific manuscripts discussing potential associations between angiogenic and antiangiogenic factors and preeclampsia. Ninety-one papers were included in this review. RESULTS There is an increased expression of soluble fms-like tyrosine kinase receptor and soluble endoglin in pre-eclampsia, as well as reduced placental expression of vascular endothelial growth factor and placental growth factor. Systemic hypertension, proteinuria and kidney injury - such as enlargement and glomerular fibrin deposit, capillary occlusion due to edema, and hypertrophy of endocapillary cells - are some of these changes. The complex etiopathogenesis of preeclampsia instigates research of different biomarkers that allow for the early diagnosis of this entity, such as vascular endothelial growth factor, placental growth factor, soluble fms-like tyrosine kinase receptor, soluble endoglin, placental glycoprotein pregnancy-associated plasma protein-A and protein 13. CONCLUSION Even though it is possible to establish an efficient and effective diagnostic tool, three key principles must be observed in the management of preeclampsia: prevention, early screening and treatment.
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Affiliation(s)
- Fernanda Rodrigues Helmo
- Discipline of General Pathology, Institute of Biological and Natural Sciences, Federal University of Triângulo Mineiro, Uberaba, Minas Gerais, Brazil
| | - Angela Maria Moed Lopes
- Oncology Research Institute, Federal University of Triângulo Mineiro, Uberaba, Minas Gerais, Brazil
| | - Anna Cecília Dias Maciel Carneiro
- Discipline of Histology, Institute of Biological and Natural Sciences, Federal University of Triângulo Mineiro. Uberaba, Minas Gerais, Brazil
| | - Carolina Guissoni Campos
- Oncology Research Institute, Federal University of Triângulo Mineiro, Uberaba, Minas Gerais, Brazil
| | - Polyana Barbosa Silva
- Oncology Research Institute, Federal University of Triângulo Mineiro, Uberaba, Minas Gerais, Brazil
| | | | - Laura Penna Rocha
- Discipline of General Pathology, Institute of Biological and Natural Sciences, Federal University of Triângulo Mineiro, Uberaba, Minas Gerais, Brazil
| | - Marlene Antônia Dos Reis
- Discipline of General Pathology, Institute of Biological and Natural Sciences, Federal University of Triângulo Mineiro, Uberaba, Minas Gerais, Brazil
| | - Renata Margarida Etchebehere
- Surgical Pathology Service, Clinical Hospital, Federal University of Triângulo Mineiro, Uberaba, Minas Gerais, Brazil
| | - Juliana Reis Machado
- Discipline of General Pathology, Institute of Biological and Natural Sciences, Federal University of Triângulo Mineiro, Uberaba, Minas Gerais, Brazil; Department of General Pathology, Institute of Tropical Pathology and Public Health, Federal University of Goiás, Goiânia, Goiás, Brazil
| | - Rosana Rosa Miranda Corrêa
- Discipline of General Pathology, Institute of Biological and Natural Sciences, Federal University of Triângulo Mineiro, Uberaba, Minas Gerais, Brazil.
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Colucci F. The role of KIR and HLA interactions in pregnancy complications. Immunogenetics 2017; 69:557-565. [PMID: 28695287 PMCID: PMC5537332 DOI: 10.1007/s00251-017-1003-9] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2017] [Accepted: 05/15/2017] [Indexed: 11/26/2022]
Abstract
Combinations of KIR and HLA genes associate with pregnancy complications as well as with many other clinical scenarios. Understanding how certain KIR and HLA genes influence the biology of a disease is, however, a formidable challenge. These are the two most variable gene families in the human genome. Moreover, the biology of a disease is best understood by studying the cells of the affected tissue. Natural Killer (NK) cells express KIR and are the most abundant leukocytes in the uterus. Most of our knowledge of NK cells is based on what we have learned from cells isolated from blood, but these are different from their tissue resident counterparts, including uterine NK (uNK) cells. Reproductive immunology faces an additional challenge: Two genotypes must be considered because both maternal and foetal HLA class I molecules may influence the outcome of pregnancy, most likely through interactions with maternal KIR expressed on uNK cells. Maternal uNK cells are not spontaneously cytotoxic and instead engage in interactions with trophoblast. We hypothesise that these interactions regulate allocation of resources between the foetus and the mother and may go wrong in diseases of pregnancy.
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Affiliation(s)
- Francesco Colucci
- Department of Obstetrics and Gynaecology, NIHR Cambridge Biomedical Research Centre, Addenbrooke's Hospital, University of Cambridge School of Clinical Medicine, Box 111, Hills Road, Cambridge, CB2 0SP, UK.
- Centre for Trophoblast Research, University of Cambridge, Physiology Building, Downing Street, Cambridge, CB2 3EG, UK.
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The role of decidual NK cells in pregnancies with impaired vascular remodelling. J Reprod Immunol 2016; 119:81-84. [PMID: 27680579 DOI: 10.1016/j.jri.2016.09.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Revised: 09/08/2016] [Accepted: 09/16/2016] [Indexed: 12/22/2022]
Abstract
The pathologies of the dangerous pregnancy complications pre-eclampsia (PE) and fetal growth restriction (FGR) are established in the first trimester of human pregnancy yet we know little of how this happens. Finely tuned interactions between maternal and placental cells are essential for pregnancy to progress without complications; however, the precise nature of this cross-talk and how it can go wrong are crucial questions that remain to be answered. This review summarises recent studies examining the role played by natural killer cells in regulating normal placentation and remodelling. Their involvement when it is impaired in PE/FGR pregnancies will additionally be discussed.
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Moffett A, Chazara O, Colucci F, Johnson MH. Variation of maternal KIR and fetal HLA-C genes in reproductive failure: too early for clinical intervention. Reprod Biomed Online 2016; 33:763-769. [PMID: 27751789 DOI: 10.1016/j.rbmo.2016.08.019] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Revised: 08/19/2016] [Accepted: 08/23/2016] [Indexed: 01/15/2023]
Abstract
A distinctive type of (uterine) natural killer (NK) cell is present in the uterine decidua during the period of placental formation. Uterine NK cells express members of the killer immunoglobulin-like receptor (KIR) family that bind to parental HLA-C molecules on the invading placental trophoblast cells. The maternal KIR genes and their fetal ligands are highly variable, so different KIR/HLA-C genetic combinations occur in each pregnancy. Some women only possess inhibitory KIR genes, whereas other women also express activating KIR genes. The overall signal that NK cells receive from paternal HLA-C on trophoblast depends on the ratio of activating and inhibitory KIR genes expressed by them. Therefore, NK cells provide a balance during placentation to ensure maternal survival and an adequately nourished fetus. Because inhibitory KIRs are found more frequently in women with defective placentation, e.g. pre-eclampsia, fetal growth restriction or recurrent spontaneous abortion, some fertility clinics suggest that women should be 'tissue typed' for their KIR genotypes. We explain why, presently, it is premature to introduce KIR and HLA-C typing to predict pregnancy outcome. In future, however, selecting for certain combinations of KIR and HLA-C variants in surrogacy, egg or sperm donation may prove useful to reduce disorders of pregnancy.
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Affiliation(s)
- Ashley Moffett
- Dept of Pathology, University of Cambridge, Tennis Court Road, Cambridge CB2 1QP, UK; Centre for Trophoblast Research, University of Cambridge, Tennis Court Road, Cambridge CB2 1QP, UK.
| | - Olympe Chazara
- Dept of Pathology, University of Cambridge, Tennis Court Road, Cambridge CB2 1QP, UK; Centre for Trophoblast Research, University of Cambridge, Tennis Court Road, Cambridge CB2 1QP, UK
| | - Francesco Colucci
- Centre for Trophoblast Research, University of Cambridge, Tennis Court Road, Cambridge CB2 1QP, UK; Department of Obstetrics and Gynaecology, University of Cambridge, Tennis Court Road, Cambridge CB2 1QP, UK
| | - Martin H Johnson
- Centre for Trophoblast Research, University of Cambridge, Tennis Court Road, Cambridge CB2 1QP, UK; Department of Physiology, Development and Neuroscience, University of Cambridge, Tennis Court Road, Cambridge CB2 1QP, UK
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Are animal models useful or confusing in understanding the human feto-maternal relationship? A debate. J Reprod Immunol 2015; 108:56-64. [DOI: 10.1016/j.jri.2014.10.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Revised: 10/24/2014] [Accepted: 10/29/2014] [Indexed: 11/18/2022]
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Moffett A, Colucci F. Uterine NK cells: active regulators at the maternal-fetal interface. J Clin Invest 2014; 124:1872-9. [PMID: 24789879 PMCID: PMC4001528 DOI: 10.1172/jci68107] [Citation(s) in RCA: 270] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Pregnancy presents an immunological conundrum because two genetically different individuals coexist. The maternal lymphocytes at the uterine maternal-fetal interface that can recognize mismatched placental cells are T cells and abundant distinctive uterine NK (uNK) cells. Multiple mechanisms exist that avoid damaging T cell responses to the fetus, whereas activation of uNK cells is probably physiological. Indeed, genetic epidemiological data suggest that the variability of NK cell receptors and their MHC ligands define pregnancy success; however, exactly how uNK cells function in normal and pathological pregnancy is still unclear, and any therapies aimed at suppressing NK cells must be viewed with caution. Allorecognition of fetal placental cells by uNK cells is emerging as the key maternal-fetal immune mechanism that regulates placentation.
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Affiliation(s)
- Ashley Moffett
- Department of Pathology and
Centre for Trophoblast Research, Physiology Building, University of Cambridge, Cambridge, United Kingdom.
Department of Obstetrics and Gynaecology, University of Cambridge School of Clinical Medicine, NIHR Cambridge Biomedical Research Centre, Addenbrooke’s Hospital, Cambridge,United Kingdom
| | - Francesco Colucci
- Department of Pathology and
Centre for Trophoblast Research, Physiology Building, University of Cambridge, Cambridge, United Kingdom.
Department of Obstetrics and Gynaecology, University of Cambridge School of Clinical Medicine, NIHR Cambridge Biomedical Research Centre, Addenbrooke’s Hospital, Cambridge,United Kingdom
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Houser BL. Decidual macrophages and their roles at the maternal-fetal interface. THE YALE JOURNAL OF BIOLOGY AND MEDICINE 2012; 85:105-18. [PMID: 22461749 PMCID: PMC3313525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The semi-allogeneic fetus, whose genome consists of maternally and paternally inherited alleles, must coexist with an active maternal immune system during its 9 months in utero. Macrophages are the second most abundant immune cell at the maternal-fetal interface, although populations and functions for these populations remain ill defined. We have previously reported two distinct subsets of CD14(+) decidual macrophages found to be present in first trimester decidual tissue, 20 percent CD11c(HI) and 68 percent CD11c(LO). Interestingly, CD11c(HI) decidual macrophages express genes associated with lipid metabolism, inflammation, and antigen presentation function and specifically upregulate CD1 molecules. Conversely, CD11c(LO) decidual macrophages express genes associated with extracellular matrix formation, muscle regulation, and tissue growth. The large abundance of CD11c(HI) decidual macrophages and their ability to process antigens more efficiently than CD11c(LO) macrophages suggests that CD11c(HI) macrophages may be important antigen processing and presenting cells at the maternal-fetal interface, while CD11c(LO) macrophages may perform necessary homeostatic functions during placental construction. Thus, macrophage heterogeneity may be an important and necessary division of labor that leads to both an induction of maternal immune cell tolerance to fetal antigens as well as basic homeostatic functions in human pregnancy.
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Zhu BF, Wang HD, Shen CM, Deng YJ, Yang G, Wu QJ, Xu P, Qin HX, Fan SL, Huang P, Deng LB, Lucas R, Wang ZY. Killer cell immunoglobulin-like receptor gene diversity in the Tibetan ethnic minority group of China. Hum Immunol 2010; 71:1116-23. [DOI: 10.1016/j.humimm.2010.07.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2010] [Revised: 06/24/2010] [Accepted: 07/12/2010] [Indexed: 11/30/2022]
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Parham P, Abi-Rached L, Matevosyan L, Moesta AK, Norman PJ, Older Aguilar AM, Guethlein LA. Primate-specific regulation of natural killer cells. J Med Primatol 2010; 39:194-212. [PMID: 20618586 DOI: 10.1111/j.1600-0684.2010.00432.x] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Natural killer (NK) cells are circulating lymphocytes that function in innate immunity and placental reproduction. Regulating both development and function of NK cells is an array of variable and conserved receptors that interact with major histocompatibility complex (MHC) class I molecules. Families of lectin-like and immunoglobulin-like receptors are determined by genes in the natural killer complex (NKC) and leukocyte receptor complex (LRC), respectively. As a consequence of the strong, varying pressures on the immune and reproductive systems, NK cell receptors and their MHC class I ligands evolve rapidly, are highly diverse and exhibit dramatic species-specific differences. The variable, polymorphic family of killer cell immunoglobulin-like receptors (KIR) that regulate human NK cell development and function arose recently, from a single-copy gene during the evolution of simian primates. Our studies of KIR and MHC class I genes in representative species show how these two unlinked but functionally intertwined genetic complexes have co-evolved. In humans, combinations of KIR and HLA class I factors are associated with infectious diseases, including HIV/AIDS, autoimmunity, reproductive success and the outcome of therapeutic transplantation. The extraordinary, and unanticipated, divergence of human NK cell receptors and MHC class I ligands from their mouse counterparts can in part explain the difficulties experienced in finding informative mouse models for human diseases. Non-human primate models have far greater potential, but to realize their promise will first require more complete definition of the genetics and function of KIR and MHC variation in non-human primate species, at a level comparable to that achieved for the human species.
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Affiliation(s)
- Peter Parham
- Department of Structural Biology, Stanford University School of Medicine, Stanford, CA, USA.
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Chaouat G, Petitbarat M, Dubanchet S, Rahmati M, Ledée N. Tolerance to the foetal allograft? Am J Reprod Immunol 2010; 63:624-36. [PMID: 20367624 DOI: 10.1111/j.1600-0897.2010.00832.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
In this review, we will detail the concept of tolerance and its history in reproductive immunology. We will then consider whether it applies to the foetal-maternal relationship and discuss the mechanisms involved in non-rejection of the foeto-placental unit.
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Affiliation(s)
- Gérard Chaouat
- U 782 INSERM, Université Paris Sud, and Hôpital Antoine Béclère, Clamart, France.
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Toth B, Jeschke U, Rogenhofer N, Scholz C, Würfel W, Thaler CJ, Makrigiannakis A. Recurrent miscarriage: current concepts in diagnosis and treatment. J Reprod Immunol 2010; 85:25-32. [PMID: 20185181 DOI: 10.1016/j.jri.2009.12.006] [Citation(s) in RCA: 119] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2009] [Revised: 12/01/2009] [Accepted: 12/13/2009] [Indexed: 11/24/2022]
Abstract
Although recurrent miscarriage (RM) affects only 1-3% of couples, it has a major influence on the wellbeing and psychosocial status of patients. Therefore, research into improved diagnosis and development of new treatment strategies is essential. In this review, we summarize current concepts on diagnosis and treatment in RM, drawing upon research reports and international guidelines to provide insights into the pathophysiology of pregnancy disrupted by repeated miscarriage. Anatomical malformations, infectious diseases, endocrine disorders, autoimmune defects as well as acquired and inherited thrombophilia are established risk factors in RM. In addition, our recent findings indicate an impact on miscarriage incidence of glycoproteins such as glycodelin, and nuclear hormone receptors such as the peroxisome proliferator-activated receptors (PPARs). Significantly reduced glycodelin expression is associated with miscarriage, whereas up-regulation of PPARs appears to compensate for either the activated immune response or the disturbed cytotrophoblast differentiation in RM patients. There is also evidence that circulating placental microparticles are increased in a subgroup of RM patients, indicating an acquired procoagulant state even outside pregnancy. Treatment strategies like aspirin and low molecular weight heparin (LMWH) are standard medications in RM, although only a few placebo-controlled trials have proven their benefit in respect to live birth rate. There is emerging evidence that new treatment options, including drugs like TNFalpha inhibitors and granulocyte colony-stimulating factor (G-CSF) might be beneficial in some cases of RM. However, larger clinical trials must be completed to further prove or disprove benefits of these drugs in the treatment of RM patients.
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Affiliation(s)
- Bettina Toth
- Department of Gynecological Endocrinology and Fertility Disorders, Ruprecht-Karl University Heidelberg, Vossstr 9, 69115 Heidelberg, Germany.
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