Efficacy of Intrauterine Perfusion of Cyclosporin A for Intractable Recurrent Spontaneous Abortion Patients With Endometrial Alloimmune Disorders: A Randomized Controlled Trial

Zhao, Liang; Qi, Lijuan; Fu, Jianhua; Bi, Shuqin; Liu, Lin; Fu, Ying‐Hui

doi:10.3389/fphys.2021.737878

Cited by 5 publications

(6 citation statements)

References 34 publications

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“…Specific targeted treatment at the particular time of conception or pregnancy can be offered to control the NK cells mediated pathology. Intravenous immunoglobulin G, glucocorticoids, cyclosporin A, and vitamin D have been utilized to control NK cells for women with RPL [94,196,197]. In conclusion, women with RPL have pro-inflammatory type 1 shift in pNK and dNK cells and increased NKC in pNK.…”

Section: Discussionmentioning

confidence: 99%

Natural killer cell-mediated immunopathology in recurrent pregnancy losses

et al. 2022

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Natural killer (NK) cells have a dual role in human reproduction for maternal-fetal tolerance and protection from infection. During the ovarian cycle and pregnancy, peripheral NK (pNK) and uterine NK (uNK) cells dynamically change their proportions and cytotoxicities to prepare and accommodate invading trophoblast and maintain pregnancy. However, dysregulated pNK and uNK cell proportions and cytotoxic activities have been associated with aberrant spiral artery remodeling and trophoblast invasion, leading to implantation failures and recurrent pregnancy losses (RPLs). This review will focus on the role of NK cells in RPLs reviewing the ontogeny of NK cells, changes in pNK and uNK cell levels, and activities during the ovarian cycle, normal pregnancy, and RPL. In addition, the immunopathological role of NK cells in endometrial/decidual vascular development and killer immunoglobin-like receptor (KIR) and human leukocyte antigen (HLA)-C interactions are discussed.

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Section: Discussionmentioning

confidence: 99%

Natural killer cell-mediated immunopathology in recurrent pregnancy losses

et al. 2022

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“…Intrauterine infusion of CsA is a new study. In the study of Zhao et al [15], it was used to treat refractory recurrent spontaneous abortion patients with endometrial alloimmune disorder. Participants were randomly divided into two groups: the CsA group received 250mgCsA intrauterine infusion on the 3rd and 7th day after menstruation for 2 menstrual cycles, and the placebo group received placebo.…”

Section: Intrauterine Infusion Of Cyclosporine Amentioning

confidence: 99%

Application of Intrauterine Perfusion in Patients with Recurrent Spontaneous

2024

AJMHS

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Recurrent abortion (Recurrent Spontaneous Abortion, RSA) is a common disease in obstetrics and gynecology, which refers to three or more times of spontaneous abortion in the same woman, which can be characterized by vaginal bleeding and abdominal pain after menopause. Most of RSA are early abortion and a few are late abortion, which are related to genetic and endocrine factors. Due to the development of assisted reproductive technology, endometrial damage has been found to be an important factor leading to recurrent abortion. Intrauterine infusion of drugs or biological agents can directly contact the endometrial gland and act directly on the endometrium to improve and repair the endometrium. The treatment process has the characteristics of less trauma, no pain, simple operation and good patient compliance. This article will review the application of intrauterine infusion of different drugs in patients with recurrent abortion.

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“…However, it is worth noting that the lack of consensus on the normal reference range of uNK cells is still a key constraint to the development of this field, with data from various laboratories and analytical platforms being quite inconsistent. While some centers employed the cutoff value of 5%, 8,20,21 others used 13.9% as the cutoff value, 37 and our center had utilized the thresholds of 18.06% and 8.71% sequentially. 24,26 Differences in experimental methods and strategies for defining reference ranges are two major aspects that contribute to the lack of reliable reference values.…”

Section: Dxm-response (Nmentioning

confidence: 99%

“…The number of uNK cells increases dramatically during the mid-luteal phase, the implantation window, and reaches up to 70% in the first trimester. 8 It plays important roles in maintaining immune tolerance at the maternal-fetal interface, regulating trophoblast invasion, promoting decidualization, spiral artery remodeling and fetal development. [9][10][11][12][13][14][15] Nevertheless, pathological alterations to uNK cell numbers and/or functions can lead to an array of unfavorable pregnancy outcomes.…”

Section: Introductionmentioning

confidence: 99%

“…Uterine natural killer cells (uNK) are the most abundant group of immune cells at the maternal‐fetal interface. The number of uNK cells increases dramatically during the mid‐luteal phase, the implantation window, and reaches up to 70% in the first trimester 8 . It plays important roles in maintaining immune tolerance at the maternal‐fetal interface, regulating trophoblast invasion, promoting decidualization, spiral artery remodeling and fetal development 9–15 .…”

Section: Introductionmentioning

confidence: 99%

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Intrauterine perfusion of dexamethasone improves pregnancy outcomes in recurrent reproductive failure patients with elevated uterine natural killer cells. A retrospective cohort study

Zhang,

Wang,

Lian

et al. 2023

American J Rep Immunol

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ObjectiveTo determine the effect of intrauterine perfusion of dexamethasone (DXM) on pregnancy outcomes in recurrent reproductive failure (RRF) patients with elevated uNK cells.MethodsThis retrospective cohort study included 132 RRF patients with elevated uNK cells: 56 patients received DXM treatment and 76 patients refused it in the frozen‐thawed embryo transfer cycles. To determine the efficacy of intrauterine perfusion of DXM, multivariate logistic regression models and diagnosis‐based subgroup analysis were performed. We also compared the pregnancy outcomes of patients with different responsiveness to DXM treatment.ResultsIntrauterine perfusion of DXM significantly improved clinical pregnancy rate (aOR: 3.188, 95% CI: 1.395–7.282, P = .006) and live birth rate (aOR: 3.176, 95% CI: 1.318–7.656, P = .010) in RRF patients with elevated uNK cells, but there was no significant association with miscarriage rate. Subgroup analysis revealed that intrauterine perfusion of DXM in patients with recurrent implantation failure (RIF) showed significant improvement in clinical pregnancy rate (aOR: 6.110, 95% CI: 1.511–24.713, P = .011) and live birth rate (aOR: 9.904, 95% CI: 1.963–49.968, P = .005), but there was insufficient evidence of benefit in recurrent pregnancy loss (RPL) patients. Additionally, uNK cell levels dropped to normal range was achieved in only 35.90% of RRF patients after DXM treatment, no significant difference was found in pregnancy outcomes among patients with different responsiveness to DXM treatment (all P > .05).ConclusionIntrauterine perfusion of DXM was a promising and effective treatment to enhance clinical pregnancy rate and live birth rate in RRF women with abnormally elevated uNK cells, and RIF patients are more likely to benefit than RPL patients.

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Efficacy of Intrauterine Perfusion of Cyclosporin A for Intractable Recurrent Spontaneous Abortion Patients With Endometrial Alloimmune Disorders: A Randomized Controlled Trial

Cited by 5 publications

References 34 publications

Natural killer cell-mediated immunopathology in recurrent pregnancy losses

Natural killer cell-mediated immunopathology in recurrent pregnancy losses

Application of Intrauterine Perfusion in Patients with Recurrent Spontaneous

Intrauterine perfusion of dexamethasone improves pregnancy outcomes in recurrent reproductive failure patients with elevated uterine natural killer cells. A retrospective cohort study

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