Immunotherapy for recurrent spontaneous abortion and its analogies to treatment for cancer

Education Case: Hereditary Thrombophilia With Double Heterozygous Factor V Leiden and Factor II c.*97G>A Mutations

The following fictional case is intended as a learning tool within the Pathology Competencies for Medical Education (PCME), a set of national standards for teaching pathology. These are divided into three basic competencies: Disease Mechanisms and Processes, Organ System Pathology, and Diagnostic Medicine and Therapeutic Pathology. For additional information, and a full list of learning objectives for all three competencies, see http://journals.sagepub.com/doi/10.1177/2374289517715040.¹.

Circulating cell-derived microparticles in women with pregnancy loss

PROBLEM

To analyze cell-derived microparticles (cMP) in pregnancy loss (PL), both recurrent miscarriages (RM) and unexplained fetal loss (UFL).

METHOD OF STUDY

Non-matched case-control study was performed at Vall d'Hebron Hospital. Cell-derived microparticles of 53 PL cases, 30 with RM, 16 with UFL, and 7 (RM + UFL), were compared to 38 healthy pregnant women. Twenty healthy non-pregnant women act as controls. Cell-derived microparticles were analyzed through flow cytometry. Results are given as total annexin (A5+), endothelial-(CD144+/CD31+ CD41-), platelet-(CD41+), leukocyte-(CD45+) and CD41- c-MP/μL of plasma. Antiphospholipid antibodies (aPLA) were analyzed according to established methods.

RESULTS

Comparing PL versus healthy pregnant, we observed a significant endothelial cMP decrease in PL. When comparing RM subgroup with controls, we observed significant decreases in endothelial cMP. When comparing the PL positive for aPLA versus PL-aPLA-negative, no cMP numbering differences were seen.

CONCLUSION

Pregnancy loss seems to be related to endothelial cell activation and/or consumption. A relationship between aPLA and cMP could not be demonstrated.

Circulating microparticles, lupus anticoagulant and recurrent miscarriages

Pregnancy is a pro-inflammatory/hypercoagulable state. Impairment of trophoblastic invasion and placental microthrombi are involved mechanisms in the pathogenesis of recurrent miscarriages (RM). Although in RM related to antiphospholipid antibodies (aPL) non-thrombotic mechanism seems to play an important role as well, we focused this review on the thrombotic mechanisms of RM related to aPL. Thus, in cases of RM related to aPL, placental injury produces inflammatory changes in endothelial cells. Endothelial dysfunction has been shown by increased plasma levels of ICAM-1/VCAM-1 and E-selectin. In RM associated with aPL, the thrombogenic mechanisms included different pathways: protein C inhibition, annexin-5 displacement, blocking of beta(2)GP1 anticoagulant activity and tissue factor upregulation. A new marker/causative agent of RM by itself or in relation to lupus anticoagulant (LA) has risen: circulating microparticles. Microparticles are a heterogeneous group of small, membrane-coated vesicles with a diameter of 0.1-1 microm. Microparticles are released from the cellular membrane during cell activation/apoptosis. Exposition of phospholipids in the outer membrane leaflet could explain the role of microparticles in the thrombotic events. Microparticles have been associated with RM. Microparticles are increased in women with RM when compared with healthy pregnant women. A relationship between aPL and activated endothelial cells (EC) occurs, as well as between EC and circulating microparticles. Interestingly, microparticles induced coagulation in vitro via tissue factor, especially in plasmas with LA. Finally, the relationship between EC, microparticles, LA and RM is revised.

Review: analogies between trophoblastic and malignant cells

PROBLEM

The question of how trophoblastic and malignant cells evade immunologic recognition and rejection by their host was studied.

METHOD OF STUDY

A literature review was conducted.

RESULTS

Trophoblastic and malignant cells share a number of similarities. These include a lack of major histocompatibility complex antigen expression, resistance to lysis by natural killer cells, T-helper cell-2 (TH2)-biased response, prostaglandin E production, and response to transforming growth factor beta. In addition, the analogies between trophoblastic and malignant cells extend into immunotherapy in which anti-idiotype therapy has a viable role in the prevention of pregnancy loss and the treatment of cancer.

CONCLUSIONS

Trophoblastic and malignant cells use a number of similar mechanisms to resist rejection by their host. By using similar strategies these cells are able to successfully co-exist in an immunologically hostile environment.

Effects of the whole extract and the chromatographic fractions of the pig placenta on lymphocyte proliferation and humoral immune response

The immunoregulatory properties of pig fetal placenta extracts (PE) from 1 st, 2nd and 3rd month of pregnancy and five fractions (F1 to F5), isolated on Sephadex G-200 and additionally characterized by fast performance liquid chromatography, FPLC (Superose 12 HR) were studied in order to clarify the local immune regulation in diffuse epitheliochorial placentation. The obtained substances were added at 6.25 to 100 microg in cultures of Concanavalin A-stimulated mouse splenocytes and Phytohemagglutinin-stimulated pig and human PBL to monitor their influence on [(3)H]Thimidine uptake in proliferating lymphocytes. Their effects on the number of plaque-forming cells in spleen cell suspensions from mice treated ip simultaneously with sheep red blood cells and with 100 microg protein of PE, respectively, of each fraction were also investigated: PE and F1 had no effect while F4 and F5 suppressed the mitogen-induced lymphocyte proliferation in all studied species. F2 and F3 stimulated mouse and pig lymphocyte proliferation. The effects were dose-dependent and the suppression was not due to cytotoxic effects. The FPLC data allowed the suggestion that 110 kD protein(s) were involved in stimulation and 7 kD substance(s) - in suppression of cell proliferation. The PE from the 3 studied periods as well as the 5 fractions increased significantly the primary humoral immune response against T-dependent antigen. The results revealed that trophoblast of epitheliochorial placenta produces simultaneously immuno-stimulatory and -suppressive factors acting across the species barrier. Their presence at the feto-maternal interface may contribute to the regulation of local immune reactions and survival of the allogenic fetuses despite the morphological specificities of this type of placentation.

Complement in human reproduction: activation and control

The behaviour of the complement system during human reproduction is now the focus of much scientific attention. The presence of antisperm antibodies in the reproductive tracts of some infertile individuals, and of complement in cervical and ovarian follicular fluid, suggests that complement-mediated damage of spermatozoa is involved in some cases of infertility. Further, deposition of maternal IgG and of complement in the extrafetal tissues indicates that complement activation occurs within the fetoplacental unit. Recently, three complement-regulatory proteins--decay-accelerating factor, membrane cofactor protein and CD59--have been detected on spermatozoa and in the extrafetal tissues. It is likely that these inhibitors are essential for normal reproductive function. This article reviews current understanding of the interaction of the complement system with cells and tissues involved in reproduction, with emphasis on the nature and function of the controlling proteins.