Selection of patients with habitual abortion for paternal leucocyte immunization

Abstract

After potentiation of the immune response in habitual aborters 75-85% of subsequent pregnancies are claimed to result in healthy term infants. However, all publications to date have either been based on the authors concept of the immune processes involved or an attempt to demonstrate the efficacy of treatment either empirically or by matched trials. As immunization is coming into wider clinical use, it is necessary to determine which patients will benefit from this form of treatment. This paper presents our experience with paternal leucocyte immunization over the period 1985-1988. 207 patients were classified on a clinical basis and by immunological testing. 143 patients have been immunised, 129 pregnancies have occurred in 108 patients. The vast majority of our patients have recurrent missed abortions. Only six women habitually aborted live fetuses. Two had subsequent live births. Secondary aborters seem to do well in subsequent pregnancies, whether immunized or not. The patient most likely to benefit from immunization is the Primary missed aborter who does not possess antipaternal antibody (APCA), but is induced to produce APCA by immunization. Using these criteria, 75% success rates are observed in the subsequent pregnancy. This success rate is irrespective of HLA antigen sharing or in-vitro mixed lymphocyte reactivity.

Ciprofloxacin Affects Pregnancy Loss in CBA/JxDBA/2J Mice Possibly via Elevation of Interleukin‐3 and Granulocyte Macrophage‐Colony Stimulating Factor Production

“…Immunization of women suffering from recurrent pregnancy loss by diverse means such as paternal or third party leukocytes or immunoglobulins was found to be successful in preventing fetal demise. 3,10,11 Similar results were obtained in the resorption-prone CBA/JxDBA/2J mouse model, which mimics human fetal loss, where immunization with paternal or third party leukocytes carrying the pater-nal MHC haplotype resulted in a decreased resorption rate. 1,12 -14 Also, nonspecific immunomodulation with CFA was shown by us to decrease fetal loss in the CBA/JxDBA/2J model, an effect that was associated with an increased number of Mac-1-positive cells in the spleen and placenta and an increased production of IL-1.…”

Congenital Malformations after Immunotherapy for Habitual Abortion: Is there an Increase?

“…Its underlying causes remain unknown in the majority of cases [1][2][3]. We have recently defined a subgroup of habitual aborters who are most likely to bene fit from paternal leucocyte immunization [4], These pa tients lack antipatemal complement-dependent anti bodies (APCA), are primary aborters (who had no viable pregnancy prior to the abortions) and previously had only anembryonic pregnancies (blighted ova).…”

“…The ring of cells at the Ficoll serum interface was washed and resuspended in 5 ml of Hart man's solution. The suspension was injected in 0.5-ml aliquots sub cutaneously and intradermally as previously described [4]. Patients were considered immune when the cytotoxic cross-match converted to positive, indicating the production of APCA.…”