Immunologic and rheumatologic causes and treatment of recurrent pregnancy loss: what is the evidence?

Odendaal, Joshua; Quenby, Siobhán; Sammaritano, Lisa R.; Macklon, Nick S.; Branch, D. Ware; Rosenwaks, Zev

doi:10.1016/j.fertnstert.2019.10.002

Cited by 19 publications

(18 citation statements)

References 91 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Vast studies on unexplained RSA (URSA) suggested potential immunologic modification, containing underlying autoimmune inflammation [ 154 ]. Aspirin, low molecular weight heparin (LMWH), and an association of them have been applicated in research for URSA as treatments.…”

Section: Treatment Of Recurrent Spontaneous Abortionmentioning

confidence: 99%

“…There is an evident case of an autoimmune progress result in RSA that combination therapy with low-dose aspirin and prophylactic heparin or LMWH could bring better pregnancy outcomes in patients with antiphospholipid syndrome, which has been taken as a standard therapeutic method for female meeting standard for obstetric antiphospholipid syndrome [ 157 ]. Furthermore, an existing evidence suggested that immunological therapeutic method had a positive role in RSA [ 154 ]. A variety of immunotherapies have become available, covering intravenous immune globulin (IVIG), immunosuppressant, and granulocyte colony-stimulating factor [ 158 , 159 ].…”

Section: Treatment Of Recurrent Spontaneous Abortionmentioning

confidence: 99%

See 1 more Smart Citation

The Role of Immune Cells in Recurrent Spontaneous Abortion

Zheng

Zhao

et al. 2021

Reprod. Sci.

View full text Add to dashboard Cite

Recurrent spontaneous abortion affects approximately 1–2% of women of childbearing, and describes a condition in which women suffer from three or more continuous spontaneous miscarriages. However, the origin of recurrent spontaneous abortion (RSA) remains unknown, preventing effective treatment and placing stress upon patients. It has been acknowledged that successful pregnancy necessitates balanced immune responses. Therefore, immunological aberrancy may be considered a root cause of poor pregnancy outcomes. Considerable published studies have investigated the relationship between various immune cells and RSA. Here, we review current knowledge on this area, and discuss the five main categories of immune cells involved in RSA; these include innate lymphocytes (ILC), macrophages, decidual dendritic cells (DCs), and T cells. Furthermore, we sought to summarize the impact of the multiple interactions of various immune cells on the emergence of RSA. A good understanding of pregnancy-induced immunological alterations could reveal new therapeutic strategies for favorable pregnancy outcomes.

show abstract

Section: Treatment Of Recurrent Spontaneous Abortionmentioning

confidence: 99%

Section: Treatment Of Recurrent Spontaneous Abortionmentioning

confidence: 99%

The Role of Immune Cells in Recurrent Spontaneous Abortion

Zheng

Zhao

et al. 2021

Reprod. Sci.

View full text Add to dashboard Cite

show abstract

“…Частота НВ складає від 15 до 23%, причому в половині випадків відзначають звичне НВ. Окрім цього, переривання вагітності в 75-80% випадків настає на ранніх строках (до 12 тижнів гестації) [1][2][3]21]. Основні труднощі, пов'язані з вивченням НВ, обумовлені поліетіологічністю цієї патології, в розвитку та реалізації якої беруть участь важливі системи організму матері й плода.…”

Section: вступunclassified

New aspects in the pathogenesis of miscarriage in women with extragenital pathology

Loskutova

Bichevska²,

Корнієць

2021

View full text Add to dashboard Cite

Study objective: to determine the dynamics of type 9 metalloproteinase (MMP-9) and its tissue inhibitor-1 (TIMP-1) in the pathogenesis of early miscarriage in women with chronic diseases of the hepatobiliary system.Materials and methods. The study included 39 women with a history of early pregnancy miscarriage, who were diagnosed with chronic liver diseases as a result of clinical, instrumental and laboratory studies (17 persons with steatosis and 22 persons with non-alcoholic steatohepatitis). The control group consisted of 8 women without somatic pathology and 8 pregnant women at the first trimester of gestation. MMP-9 and TIMP-1 value in the blood serum was determined by the enzyme immunoassay.Results. MMP-9 and TIMP-1 growth in the blood serum of women with a history of miscarriage was established in the pre-gravidar period. The most significant increase in the parameters of the intercellular matrix was found in patients with non-alcoholic steatohepatitis. MMP-9 and TIMP-1 increased in in blood serum in the first trimester in women with liver diseases. MMP-9 increased against the background of a decrease in the TIMP-1 activity in patients with the threat of premature pregnancy termination. Miscarriage was diagnosed in patients with a minimum value of a tissue inhibitor. Conclusions. There is an imbalance between MMP-9 and TIMP-1 in the blood serum in women with early miscarriage and chronic diseases of the hepatobiliary system. MMP-9 and TIMP-1 level in patients with hepatic steatosis is lower than in patients with non-alcoholic steatohepatitis. MMP-9 increased during physiological pregnancy, and the TIMP-1 activity practically did not change, which indicates the role of MMP-9 in the initial stages of placentation. MMP-9 value in women with a burdened premorbid background with a physiological course of pregnancy and threatening early spontaneous miscarriage was significantly different. The highest activity of MMP-9 was in women with the threat of spontaneous miscarriage in the early stages. TIMP-1 in the first trimester in women with chronic liver disease increased in those with a favorable course of pregnancy and decreased in the threat of spontaneous miscarriage. Such changes in MMP-9 and TIMP-1 in patients with miscarriage indicate the accumulation of intercellular matrix and sclerotic changes in the vessels that provide blood to the uterus.

show abstract

“…This topic remains controversial in the literature and at scientific events, such as the one that occurred in the “Fertile Battles” section of the recent edition of Fertility and Sterility, the official journal of American Society for Reproductive Medicine (ASRM). The key point of the debate was to understand the immunological mechanisms involved in the embryonic implantation and thus propose therapeutic options based on the clinical evidence of improvement in pregnancy results 1,2 …”

Section: Introductionmentioning

confidence: 99%

“…In this scenario, clinicians and patients expect that immunotherapies, with strong scientific evidence, can help a considerable percentage of couples with RM and recurrent implantation failure (RIF). However, the diagnosis of RM and RIF remains unclear and inconsistent, when evaluated established protocols 1 …”

Section: Introductionmentioning

confidence: 99%

Lymphocyte immunotherapy in recurrent miscarriage and recurrent implantation failure

Cavalcante

Sarno

Barini

2021

American J Rep Immunol

View full text Add to dashboard Cite

Problem Lymphocyte immunotherapy (LIT) emerged in the early 1980s as a new therapeutic proposal for couples with a history of recurrent miscarriages (RM). However, in the early 2000s, the effectiveness of LIT was questioned. Recently, meta‐analyses have observed the effectiveness and safety of LIT in treating couples with RM. Some studies evaluated the use of LIT in recurrent implantation failure (RIF) in in vitro fertilization cycles. Methods This systematic and narrative review evaluated the data available in the literature regarding the efficacy and safety of the use of LIT. Searches in PubMed/Medline, Embase, and Cochrane Library databases were conducted, using the following keywords: "recurrent miscarriage," "lymphocyte immunotherapy," and "recurrent implantation failure". Results This review describes the historical aspects of LIT and discusses its protocols, mechanisms of action, side effects, complications, and current evidence of the effectiveness in cases of reproductive failure. It also discusses the use of LIT during the COVID‐19 pandemic and new immunological therapies. Conclusion In the vast majority of studies, the use of LIT for RM couples has shown an improvement in pregnancy outcomes. The most of the current studies that support the evidence are quasi‐experimental, with few randomized, double‐blind studies (Level of evidence III). However, the current evidence are not convincing for the use of LIT in RIF patients.

show abstract

Immunologic and rheumatologic causes and treatment of recurrent pregnancy loss: what is the evidence?

Abstract: Disclaimer: Authors for ''fertile battles'' are chosen to represent the full breadth of opinions. Individual authors, even within one side of the debate, do not necessarily agree with all viewpoints expressed.

Cited by 19 publications

References 91 publications

The Role of Immune Cells in Recurrent Spontaneous Abortion

The Role of Immune Cells in Recurrent Spontaneous Abortion

New aspects in the pathogenesis of miscarriage in women with extragenital pathology

Lymphocyte immunotherapy in recurrent miscarriage and recurrent implantation failure

Contact Info

Product

Resources

About