The immunosuppressive cytokines influence the fetal survival in patients with pregnancy-induced hypertension

Roles of TGF-β1 in Viral Infection during Pregnancy: Research Update and Perspectives

Transforming growth factor-beta 1 (TGF-β1) is a pleiotropic growth factor playing various roles in the human body including cell growth and development. More functions of TGF-β1 have been discovered, especially its roles in viral infection. TGF-β1 is abundant at the maternal-fetal interface during pregnancy and plays an important function in immune tolerance, an essential key factor for pregnancy success. It plays some critical roles in viral infection in pregnancy, such as its effects on the infection and replication of human cytomegalovirus in syncytiotrophoblasts. Interestingly, its role in the enhancement of Zika virus (ZIKV) infection and replication in first-trimester trophoblasts has recently been reported. The above up-to-date findings have opened one of the promising approaches to studying the mechanisms of viral infection during pregnancy with links to corresponding congenital syndromes. In this article, we review our current and recent advances in understanding the roles of TGF-β1 in viral infection. Our discussion focuses on viral infection during pregnancy, especially in the first trimester. We highlight the mutual roles of viral infection and TGF-β1 in specific contexts and possible functions of the Smad pathway in viral infection, with a special note on ZIKV infection. In addition, we discuss promising approaches to performing further studies on this topic.

Distinct cytokine profiles in patients with preeclampsia

OBJECTIVE

Preeclampsia (PE) is a common but serious pregnancy complication that adversely affects both maternal and fetal health. However, the mechanisms of its pathogenesis remain unclear, and effective biomarkers for early diagnosis are still lacking.

METHODS

In this retrospective study, comprehensive bioinformatic analysis and logistic regression analysis were used to compare profiles of 48 serum cytokines in 27 PE patients with those in 41 normotensive pregnant subjects.

RESULTS

The results revealed that serum cytokine profiles accumulated to different levels between the two groups, which had significant correlations with the clinical features of PE. Nine cytokines with high discriminatory capacity for diagnosising PE (AUC ≥ 0.7) were selected for inclusion in a multivariate logistic regression model for PE and calculated as a probability diagnostic formula. This model constructed from the panel of nine cytokines had better diagnostic performance than any individual cytokine (AUC = 0.97, 95% CI 0.94-1.00, P < 0.0001), with a sensitivity of 96.30% and a specificity of 90.24%.

CONCLUSIONS

The set of cytokine profiles and risk assessment model described here can serve as a basis for developing early clinical diagnostic and therapeutic strategies for PE.

Macrophage M1/M2 polarization in patients with pregnancy-induced hypertension

This study aimed to validate whether macrophage polarization imbalance and abnormal cytokines production occurred in pregnancy-induced hypertension (PIH) patients. PIH women (n = 26) were enrolled and the level of biochemical parameters were determined. The percentage of CD86- and CD163-positive cells, representing M1 and M2 macrophages, were determined by flow cytometry. The concentrations of cytokines (TNF-α, IL-1β, IL-4, IL-13, and IL-10) were determined using enzyme-linked immunosorbent assay kit. THP-1 cells were incubated with 10% serum from PIH and control groups, and then macrophage polarization and cytokines production were analyzed. The levels of high-density lipoprotein cholesterol and apolipoprotein A1 were significantly lower, and the levels of fasting blood glucose, total cholesterol, triacylglycerol, low-density lipoprotein cholesterol, apolipoprotein B, and lipoprotein a were significantly higher in the PIH group than that in the control group. The PIH group contained a significant higher percentage of CD86-positive cells (M1) and a significant lower percentage of CD163-positive cells (M2), representing higher M1/M2 ratio, than the control group. The PIH group expressed higher concentrations of TNF-α and IL-1β, and expressed lower concentrations of IL-4, IL-10, and IL-13 than the control group. The in vitro experiment also showed macrophage polarization imbalance and abnormal cytokines production in THP-1 cells treated with PIH serum as compared with that treated with control serum. Macrophage polarization imbalance and abnormal cytokines production occurred in PIH patients and in THP-1 cells treated with PIH serum.

The Role of Interleukin-10 in the Pathophysiology of Preeclampsia

PURPOSE OF REVIEW

The pathophysiology of preeclampsia is complex and not entirely understood. A key feature in preeclampsia development is an immunological imbalance that shifts the maternal immune response from one of tolerance towards one promoting chronic inflammation and endothelial dysfunction. As a key regulator of immunity, IL-10 not only has immunomodulatory activity, but also directly benefits vasculature and promotes successful cellular interactions at the maternal-fetal interface. Here we focus on the mechanisms by which the dysregulation of IL-10 may contribute to the pathophysiology of preeclampsia.

RECENT FINDINGS

Dysregulation of IL-10 has been demonstrated in various animal models of preeclampsia. Decreased IL-10 production in both placenta and peripheral blood mononuclear cells has been reported in human studies, but with inconsistent results. The significance of IL-10 in preeclampsia has shifted from a key biomarker to one with therapeutic potential. As such, a better understanding of the role of this cytokine in the pathophysiology of preeclampsia is of paramount importance.

Distinct First Trimester Cytokine Profiles for Gestational Hypertension and Preeclampsia

OBJECTIVE

Gestational hypertension and preeclampsia involve dysregulated maternal inflammatory responses to pregnancy, but whether such responses differ between the disorders has not been determined. We aimed to investigate disease-specific early pregnancy serum cytokine profiles of women subsequently developing gestational hypertension or preeclampsia for new insight into the underlying pathogeneses and differences between the disorders.

APPROACH AND RESULTS

The study cohort consisted of 548 pregnant Norwegian women who were either multiparous with previous gestational hypertension or preeclampsia or were nulliparous. Maternal sera at gestational weeks 11(0)-13(6) were assayed for 27 cytokines, C-reactive protein, total cholesterol, high-density lipoprotein, triglyceride, creatinine, calcium, uric acid, and placental growth factor. Compared with normotensive women, women with both hypertensive conditions presented an atherogenic lipid profile at early gestation, but only those later developing gestational hypertension had significantly higher serum levels of interleukin (IL)-5 and IL-12. Comparing the 2 hypertensive pregnancy disorders, women subsequently developing gestational hypertension had higher serum levels of IL-1β, IL-5, IL-7, IL-8, IL-13, basic fibroblast growth factor, and vascular endothelial growth factor than the women subsequently developing preeclampsia.

CONCLUSIONS

This study identifies early pregnancy differences in serum cytokine profiles for gestational hypertension and preeclampsia.

Microenvironment of the feto–maternal interface protects the semiallogenic fetus through its immunomodulatory activity on dendritic cells

OBJECTIVE

To investigate the immunomodulatory activity of decidual culture supernatant on dendritic cell (DC) functions.

DESIGN

In vivo and in vitro experimental study using mice.

SETTING

Academic research laboratory.

ANIMAL(S)

C57BL/6-mated female Balb/c mice.

INTERVENTION(S)

Culture supernatants of decidual cells obtained from the uteri of allogenic pregnant mice (Balb/c x C57BL/6) were collected. Dendritic cells were purified from Balb/c mice spleens and pulsed with antigen during overnight culture. In some cultures, decidual supernatant was added at 5%, 10%, or 20% final concentration. Endometrial culture supernatant-treated DCs served as a control. Antigen-pulsed DCs were injected into the front footpads of syngeneic mice.

MAIN OUTCOME MEASURE(S)

Lymph nodes of primed mice were removed 5 days after DC injection. Antigen-specific proliferation and interleukin-10 and interferon gamma production by lymphocytes were measured by (3)H-Thymidine incorporation and ELISA, respectively.

RESULT(S)

The results showed that decidual culture supernatant markedly blocked in vivo antigen presentation by DCs and inhibited their capacity to induce interferon gamma (but not interleukin-10) production by primed lymphocytes.

CONCLUSION(S)

It seems that soluble factors produced by decidual cells are important mediators of immunoregulation at the feto-maternal interface, which provide the two fundamental requirements for protection of the semiallogenic fetus, namely immunologic tolerance and predominance of T helper 2 immunity, through modulation of DCs function.

Maternal Serum Interleukin-10, Interleukin-2 and Interleukin-6 in Pre-Eclampsia and Eclampsia

PROBLEM

The aim of the study was to investigate and compare the concentrations of interleukin (IL)-2, IL-6, and IL-10 in serum of women with mild pre-eclampsia, severe pre-eclampsia, eclampsia, and normotensive pregnancy.

METHOD OF STUDY

A total of 69 consecutive cases, 38 mild pre-eclampsia, 20 severe pre-eclampsia, 11 eclampsia, and 20 normotensive controls were included in this study. Serum IL-2, IL-6, and IL-10 levels were determined using enzyme-linked immunosorbent assay method.

RESULTS

Gestational age (P = 0.210) and body mass index (P = 0.214) between the groups were similar. The mean concentration of serum IL-2 and IL-6 were not different between the groups (P = 0.261, P = 0.141 respectively). The median concentrations of serum IL-10 in patients with mild and severe pre-eclampsia were similar (P < 0.282) and was significantly lower than those of controls (P < 0.001) and patients with eclampsia (P < 0.001). In patients with eclampsia, the median concentration of IL-10 was significantly higher than that of all other groups (P < 0.001 for each comparison).

CONCLUSION

Pre-eclampsia is associated with a deficiency serum IL-10. High serum IL-10 is correlated with the presence of eclampsia.

Elevated serum levels of interleukin-15 and interleukin-16 in preeclampsia

A generalized inflammatory response has been considered to be the main pathology and has an important role in the pathogenesis of preeclampsia. The immune aberrations per se and immunomodulatory milieu present in serum need to be elucidated. The purpose of the current investigation was to characterize changes in serum levels of interleukin (IL)-15 and IL-16 in preeclampsia. Thirty-seven women with preeclampsia were recruited and 36 age- and gestational age-matched women with normal pregnancy served as control. Levels of IL-15 and IL-16 were detected with immune assays in all serum samples. We found that serum levels of IL-15 and IL-16 were significantly higher in preeclampsia than in normal pregnancy (p<0.001 for both). There were significant differences in serum IL-15 and IL-16 between mild and severe preeclampsia (p<0.01 for both). Our data corroborate the hypothesis of an increased inflammatory response in preeclampsia, as illustrated by the elevated serum levels of IL-15 and IL-16, suggesting their possible role in the pathogenesis of preeclampsia. These associations may offer insight into the pathophysiology of preeclampsia.

IGF-I Overexpression causes fetal loss during placentation in mice

To understand the role of IGF-I in murine pregnancy, we studied the reproductive performance of IGF-I overexpressed mice. Fetal loss occurred only in the transfected uterine horn during day 10-15 of pregnancy. The placenta appeared healthy until Day 10 of pregnancy. From day 12, the decidua basalis of the transfected horn increased in thickness. The vascular lumen was expanded, and most of embryos were dead. Uterine natural killer cells did not undergo apoptosis from day 10 to day 15 when they usually go through apoptosis. Thus, it is likely that IGF-I plays a role in the decidual formation through regulation of uNK cells. This is the first report to demonstrate that IGF-I overexpression can cause fetal loss during murine placentation.

Expression of TGF-betal in placenta of the patients with pregnancy-induced hypertension and its relationship with serum VCAM-1

The expression of transforming growth factor-beta1 (TGF-beta1) in placental tissue of pregnancy-induced hypertension (PIH) and the relationship between the level of expression of TGF-beta1 and the amount of vascular cell adhesion molecule-1 (VCAM-1) in serum was studied. Immunohistochemistry ABC was used to detect the expression and distribution of TGF-beta1 in placental tissues in 40 PIH women and 20 normal pregnancy women. High resolution pathological image analysis system was used to determine the quality of TGF-beta1. The VCAM-1 in serum was examined by enzyme linked immunoabsorbent assay (ELISA). The results showed that TGF-beta1 could be express in syncytiotrophoblast. The levels of TGF-beta1 expression in placental tissues of the patients with moderate and severe PIH were significantly higher (P < 0.05), while the serum VCAM-1 was significantly lower than in normal group (P < 0.01). There was a significant positive correlation between the expression of TGF-beta1 in placental tissues and the serum VCAM-1 (r = 0.969, P < 0.01). It was concluded that the level of TGF-beta1 expression in PIH was increased and was positively correlated with the amount of serum VCAM-1, indicating that they might be involved in the pathogenesis of PIH.

Frequencies of dendritic cells (myeloid DC and plasmacytoid DC) and their ratio reduced in pregnant women: comparison with umbilical cord blood and normal healthy adults

CD11c(+) peripheral blood myeloid dendritic cells (MDC), and CD123(bright) plasmacytoid cells (PDC), are two human dendritic cell (DC) populations. In the present study, the percentages of MDC [lin(-)/HLA-DR(+)/CD123(-)/CD11c(+)] and PDC [lin(-)/HLA-DR(+)/CD123(bright)] in a peripheral blood (PB) sample obtained from women at the time of delivery and in their umbilical cord blood (UCB) were compared with those in the PB of healthy volunteers. The percentages of MDC and PDC were determined by four-color flow cytometry. The percentages of MDC and PDC were significantly lower in the PB obtained at delivery (MDC, 0.11% +/- 0.08%; PDC, 0.06% +/- 0.06%) and in the UCB (MDC, 0.15% +/- 0.03%; PDC, 0.05% +/- 0.05%) than in the PB of the controls (males, 0.28% +/- 0.12%, 0.11% +/- 0.06%; females, 0.32% +/- 0.13%, 0.11% +/- 0.07%). Among the pregnant women at delivery, there were significant correlations between the percentage of MDC or percentage of PDC in the PB at delivery and the respective parameter in the UCB. The PB of other pregnant women, at 20-35 weeks of gestational age, also indicated significantly low percentages of MDC and PDC (0.1% +/- 0.1%, 0.06% +/- 0.07%). The ratio of MDC/PDC was not reduced in the UCB (4.25 +/- 2.74), but was reduced in the PB obtained at delivery and the PB obtained during pregnancy (0.79 +/- 0.91) in comparison with that in age-matched, nonpregnant females (3.96 +/- 2.95). It was assumed that reduction of MDC during pregnancy plays an important role in maintaining immune tolerance against the embryo.

Expression of intracellular Th1 and Th2 cytokines in women with recurrent spontaneous abortion, implantation failures after IVF/ET or normal pregnancy

PROBLEM

We aimed to investigate absolute counts of intracellular T helper 1 (Th1) and Th2 cytokine expressing T-cell subpopulations in women with three or more recurrent spontaneous abortions (RSA), multiple implantation failures after in-vitro fertilization and embryo transfer (IVF/ET) (three or more) or during normal pregnancy.

METHOD OF STUDY

Absolute cell counts and percentages of CD3+, CD3+/CD4+, and CD3+/CD8+ T-cell populations expressing intracellular cytokines [interferon-gamma (IFN-gamma), tumor necrosis factor-alpha (TNF-alpha), interleukin (IL)-4 and IL-10] was studied by four-color flow cytometry in 15 RSA and 13 implantation failure patients. Eighteen fertile non-pregnant and 47 normal pregnant women were also compared with regard to intracellular cytokine expression.

RESULTS

Interleukin-10 producing CD3+/CD8+ T-cell counts were significantly lower in women with RSA (P < 0.05) and implantation failures (P < 0.05), and TNF-alpha producing CD3+/CD4+ T-cell counts were higher in women with RSA (P < 0.05) and implantation failures (P < 0.005) than those of non-pregnant fertile controls. During normal pregnancies, first trimester IL-4 expressing CD3+, CD3+/CD4+ T-cell counts (P < 0.05) and IFN-gamma expressing CD3+ T-cell counts (P < 0.05) were significantly higher than those of third trimester (P < 0.05). First trimester TNF-alpha expressing CD3+/CD8+ T-cell counts were significantly higher than those of second and third trimester women (P < 0.05). However, there are no differences in cytokine expression between non-pregnant and first trimester pregnant women.

CONCLUSION

Absolute counts of IFN-gamma, IL-4, and TNF-alpha expressing T cells decrease with the progress of gestation (third trimester) during normal pregnancies. In women with implantation failures, absolute cell counts of TNF-alpha expressing CD3+/ 4- cells reflects the presence of dominant Th1 immune response. A significantly increased Th1 cytokine expression may be the underlying immune etiology for reproductive failures.