Maternal autoimmune diseases and immunologically induced embryonic and fetoplacental damage

Abstract

BACKGROUND:Autoimmune diseases are a group of illnesses in which autoantibodies are produced against various organs, presenting with a variety of clinical symptoms. In this review, we discuss the different aspects of autoimmune diseases in pregnancy. We also describe experimental models that help to understand the etiology and pathogenesis of the effects of this maternal disease on the developing embryo, fetus and placenta. METHODS:The possible direct effects of sera or IgG obtained from women with systemic lupus erythematosus/antiphospholipid syndrome (SLE/APS) and recurrent pregnancy loss (RPL) were examined on cultured 10.5-and 11.5-day-old rat embryos and on cultured human placental explants, as compared to sera from healthy women or synthetic medium that were used as controls. In addition, we examined the effects of the sera obtained from these women after successful treatment that allowed the birth of normal infants. RESULTS: We observed increased embryonic death and anomalies in embryos cultured on sera and IgG from SLE/APS women. Similarly, when human placental explants were cultured on these sera, trophoblastic cell growth was reduced and apoptotic rate was increased. Successful treatment also reduced the damage caused by the sera from these women in the cultured embryos and placentas. CONCLUSIONS: Our results, and the cited studies, point to the important role of the placental damage in the etiology of RPL associated with SLE/APS. Animal models, both in vivo and in vitro, as well as cultured early human placental explants can be used successfully to understand some of the pathogenic aspects of SLE/APS and RPL.

First trimester combined screening in patients with systemic lupus erythematosus: impact of pre-analytical variables on risk assessment

“…However, pregnancy in patients with SLE and other autoimmune disorders is still a condition carrying some risks for both the mother and baby. These include miscarriage, prematurity, fetal growth disorders, and fetal death, which are thought to be the consequence of immunological changes in the placenta [19][20][21][22][23][24]. In our study, we did not have any cases of SLE-related miscarriages or fetal deaths but the median gestational age at delivery and birthweight in pregnancies of women with SLE were lower than in those without SLE.…”

Systemic lupus erythematosus, regulatory T cells and pregnancy

“…A few studies have investigated in vitro the effects of sera from women with SLE on embryo and placental tissue cultures. In this context, culture of rat embryos in the presence of human sera from women with SLE and recurrent pregnancy loss resulted in increased embryonic death and abnormality [118]. This same study investigated the effects on human placental tissue (trimester unspecified) and demonstrated reduced proliferation and increased apoptosis -an observation later confirmed on first trimester trophoblast [119].…”

Recurrent Pregnancy Loss and Infertility in an Apparently Healthy 23-Year-Old Woman

“…The risk factors associated with RPL include parental and fetal chromosome abnormalities, abnormal uterine pathology, endocrine dysfunction, immunologic disease, and thrombophilic disorders ( Table 2). [2][3][4][5][6][7][8][9][10][11][12][13][14][15] 3. The patient's difficulties with RPL and secondary infertility are most likely multifactorial.…”