Department of Immunology, St Helier Hospital, Carshalton, Surrey, England.
Am J Reprod Immunol. 2010 Nov;64(5):307-15. doi: 10.1111/j.1600-0897.2010.00864.x.
While raised cellular immunity mediated by T helper (Th) 1 type cells may be harmful for the developing embryo/foetus, it is likely that Th2 type immunity may be helpful. The role of natural killer (NK) cells is presently underestimated, although they are clearly important in angiogenesis and the coordinated invasion of the decidua by the trophoblast. Deficient T regulatory cell (Treg) function is evident in women with recurrent miscarriage particularly when this occurs in early pregnancy. The role of the pro-inflammatory Th17 cells is presently unclear. However, early evidence suggests that excessive Th17 activity may promote miscarriage and preterm delivery. This may relate to the ability of these cells to produce those cytokines that encourage Th1 and NK cell activity. As such recurrent miscarriage may be caused not only by chromosomal abnormalities, autoimmunity and uterine abnormalities but also by subclinical uterine infection and inflammation which by stimulating interleukin 6 favours Th17 development over Tregs. This review examines the role of these different cells in early pregnancy and suggests a schema that may join the dots of the immunological puzzle called pregnancy. Finally, suggestions are made as to how inappropriate immunity in recurrent miscarriage may be down-regulated using currently available therapies.
虽然由辅助性 T 细胞 (Th) 1 型细胞介导的升高的细胞免疫可能对发育中的胚胎/胎儿有害，但 Th2 型免疫可能是有益的。自然杀伤 (NK) 细胞的作用目前被低估了，尽管它们在血管生成和滋养层对蜕膜的协调入侵中显然很重要。反复流产的妇女中 T 调节细胞 (Treg) 功能明显不足，尤其是在早期妊娠时。促炎 Th17 细胞的作用目前尚不清楚。然而，早期证据表明，过度的 Th17 活性可能会导致流产和早产。这可能与这些细胞产生那些促进 Th1 和 NK 细胞活性的细胞因子的能力有关。因此，反复流产不仅可能由染色体异常、自身免疫和子宫异常引起，还可能由亚临床子宫感染和炎症引起，因为炎症刺激白细胞介素 6 有利于 Th17 发展而不是 Treg。这篇综述探讨了这些不同细胞在早期妊娠中的作用，并提出了一个可能将称为妊娠的免疫学难题联系起来的方案。最后，就如何使用现有疗法下调反复流产中不合适的免疫提出了建议。
