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Immunomodulation in Recurrent Miscarriage

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Abstract

There are many etiological factors responsible for recurrent abortions. However, no explanation can be identified in approximately 40–50 % of women with recurrent miscarriage (RM). Several studies demonstrated that successful pregnancy is dependant on shifting of maternal immune response from (proinflammatory) Th1 toward (anti-inflammatory) Th2 phenotypes. It was suggested that unexplained RM might be due to immunologic factors. Recently, there is improved understanding regarding the role of the different immune cells and proteins that are important at each stage of a normal pregnancy. Various immune-based therapies with variable clinical evidences have been reported in women with RM with variable efficacy. Still there is lack of information about the mode of action and possible adverse effects of the treatment and a reliable marker for patient selection for immunopotentiation. Adequately powered placebo-controlled studies are required to study and treat couples with the so-called idiopathic recurrent miscarriage.

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References

  1. Stirrat GM. Recurrent miscarriage: definition and epidemiology. Lancet. 1990;336(673–67):5.

    Google Scholar 

  2. Shormila R, Knapp LA. Human reproductive failure I: immunological factors. Hum Reprod Update. 2000;7:113–34.

    Google Scholar 

  3. Moff ett-King A. Natural killer cells and pregnancy. Nat Rev Immunol. 2002;2:656–63.

    Article  CAS  Google Scholar 

  4. Raghupathy R, Makhseed M, Azizieh F, et al. Cytokine production by maternal lymphocytes during normal human pregnancy and in unexplained recurrent spontaneous abortion. Hum Reprod. 2000;15:713–8.

    Article  CAS  PubMed  Google Scholar 

  5. Raghupathy R, Makhseed M, Azizieh F, et al. Maternal Th1- and Th2-type reactivity to placental antigens in normal human pregnancy and unexplained recurrent spontaneous abortions. Cell Immunol. 1999;196:122–30.

    Article  CAS  PubMed  Google Scholar 

  6. Eblen AC, Gercel-Taylor C, Shields LB, et al. Alterations in humoral immune responses associated with recurrent pregnancy loss. Fertil Steril. 2000;73:305–13.

    Article  CAS  PubMed  Google Scholar 

  7. Faust Z, Laskarin G, Rukavina D, et al. Progesterone-induced blocking factor inhibits degranulation of natural killer cells. Am J Reprod Immunol. 1999;42:71–5.

    CAS  PubMed  Google Scholar 

  8. Arck PC, Rücke M, Rose M, et al. Early risk factors for miscarriage: a prospective cohort study in pregnant women. Reprod Biomed Online. 2008;17:101–13.

    Article  PubMed  Google Scholar 

  9. Blois SM, Joachim R, Kandil J, et al. Depletion of CD8+ cells abolishes the pregnancy protective effect of progesterone substitution with dydrogesterone in mice by altering the Th1/Th2 cytokine profile. J Immunol. 2004;172:5893–9.

    Article  CAS  PubMed  Google Scholar 

  10. Hidalgo A, Suzano RC, Revuelta MP, et al. Calcium and depolarization-dependent effect of pregnenolone derivatives on uterine smooth muscle. Gen Pharmacol. 1996;27:879–85.

    Article  CAS  PubMed  Google Scholar 

  11. Kalinka J, Szekeres-Bartho J. The impact of dydrogesterone supplementation on hormonal profile and progesterone-induced blocking factor concentrations in women with threatened abortion. Am J Reprod Immunol. 2005;53:166–71.

    Article  CAS  PubMed  Google Scholar 

  12. Robertson SA. GM-CSF regulation of embryo development and pregnancy. Cytokine Growth Factor Rev. 2007;18(3–4):287–98.

    Article  CAS  PubMed  Google Scholar 

  13. Tsampalas M, Gridelet V, Berndt S, et al. Human chorionic gonadotropin: a hormone with immunological and angiogenic properties. J Reprod Immunol. 2010;85(1):93–8.

    Article  CAS  PubMed  Google Scholar 

  14. Quenby S, Kalumbi C, Bates M, et al. Prednisolone reduces preconceptual endometrial natural killer cells in women with recurrent miscarriage. Fertil Steril. 2005;84(4):980–4.

    Article  CAS  PubMed  Google Scholar 

  15. Laskin CA, Bombardier C, Hannah ME, et al. Prednisone and aspirin in women with autoantibodies and unexplained recurrent fetal loss. N Engl J Med. 1997;337:148–53.

    Article  CAS  PubMed  Google Scholar 

  16. Reznikoff-Etievant MF, Cayol V, Zou GM, et al. Habitual abortions in 678 healthy patients: investigation and prevention. Hum Reprod. 1999;14(8):2106–9.

    Article  CAS  PubMed  Google Scholar 

  17. Empson M, Lassere M, Craig J, et al. Prevention of recurrent miscarriage for women with antiphospholipid antibody or lupus anticoagulant. Cochrane Database Syst Rev. 2005;18(2):CD002859.

    Google Scholar 

  18. Bansal AS. Joining the immunological dots in recurrent miscarriage. Am J Reprod Immunol. 2010;64:307–15.

    CAS  PubMed  Google Scholar 

  19. Ata A, Tan SL, Shehata F, et al. A systematic review of intravenous immunoglobulin for treatment of unexplained recurrent miscarriage. Fert Steril. 2011;95(3):1080–5.

    Article  CAS  Google Scholar 

  20. Sherer Y, Levy Y, Langevitz P, et al. Adverse effects of intravenous immunoglobulin therapy in 56 patients with autoimmune diseases. Pharmacology. 2001;62:133–7.

    Article  CAS  PubMed  Google Scholar 

  21. Porter TF, LaCoursiere Y, Scott JR. Immunotherapy for recurrent miscarriage. Rev: Cochrane Database Syst; 2006.

    Google Scholar 

  22. Winger EE, Reed JL. Treatment with tumor necrosis factor inhibitors and intravenous immunoglobulin improves live birth rates in women with recurrent spontaneous abortion. Am J Reprod Immunol. 2008;60(1):8–16.

    Article  CAS  PubMed  Google Scholar 

  23. Fleischmann RM, Iqbal I, Stern RL. Considerations with the use of biological therapy in the treatment of rheumatoid arthritis. Expert Opin Drug Saf. 2004;3:391–403.

    Article  CAS  PubMed  Google Scholar 

  24. Raghupathy R. Manipulation of cytokine production profiles as a therapeutic approach for immunologic pregnancy loss. Indian J Biochem Biophys. 2008;45(4):229–36.

    CAS  PubMed  Google Scholar 

  25. El-Zibdeh MY. Dydrogesterone in the reduction of recurrent spontaneous abortion. J Steroid Biochem Mol Biol. 2005;97(5):431–4.

    Article  CAS  PubMed  Google Scholar 

  26. Hung CH, Chu YT, Hua YM, et al. Effects of formoterol and salmeterol on the production of Th1- and Th2-related chemokines by monocytes and bronchial epithelial cells. Eur Respir J. 2008;31(6):1313–21.

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Obstetrics & Gynecology, Maulana Azad Medical College & Lok Nayak Hospital, 13 B, DDA Flats, Ber Sarai, New Delhi, 110016, India

    Ashok Kumar (Director Professor)

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  1. Ashok Kumar
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Correspondence to Ashok Kumar.

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Kumar, A. Immunomodulation in Recurrent Miscarriage. J Obstet Gynecol India 64, 165–168 (2014). https://doi.org/10.1007/s13224-014-0541-4

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  • DOI: https://doi.org/10.1007/s13224-014-0541-4

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