Mangili G, Illeni M T, Spolti N, Lombardo C, Bruno L, Maggi R
I Clinica Ostetrica e Ginecologica, Università di Milano.
Ann Ostet Ginecol Med Perinat. 1990 Sep-Oct;111(5):326-31.
Molar tissue expresses HLA antigens evidenced in the father. These antigens are present on the trophoblastic extravillous tissue, not on the syncytium and cytotrophoblast. These antigens show some characteristics of Qa murine antigens mapped in the HLA system linked to class I antigens. Antibodies anti HLA against the partner antigens and lymphocytotoxic antibodies have been evidenced in the serum of patients with vesicular mole. In vesicular mole the production of antibodies should be determined by the immunogenicity of cells that infiltrate the decidua, expressing paternal HLA antigens. It has been demonstrated that the recognition of "not self" antigens in the mother should stimulate a cellular immune response. We do not know why the tumor grows. Maybe the woman is not able to produce anti HLA antibodies although recognizes them as "not self", or the patients is not antigenically stimulated because there is immunocompatibility between the two partners. The literature shows that the development and progression of the disease are stimulated by histocompatibility, although this factors does not seem fundamental. If the two partners are histocompatible the tumor can be less immunogenic, so the mother shows a lower response and the growth of the tumor appears to be favoured.
葡萄胎组织表达在父亲体内证实存在的HLA抗原。这些抗原存在于滋养层的绒毛外组织上,而不存在于合体滋养层和细胞滋养层上。这些抗原显示出一些在与I类抗原相关的HLA系统中定位的Qa鼠抗原的特征。在水泡状胎块患者的血清中已证实存在针对配偶抗原的抗HLA抗体和淋巴细胞毒性抗体。在水泡状胎块中,抗体的产生应由浸润蜕膜、表达父系HLA抗原的细胞的免疫原性决定。已经证明,母亲体内对“非自身”抗原的识别应刺激细胞免疫反应。我们不知道肿瘤为何生长。也许该女性虽然将它们识别为“非自身”,却无法产生抗HLA抗体,或者由于两个配偶之间存在免疫相容性,患者未受到抗原刺激。文献表明,组织相容性会刺激该疾病的发展和进展,尽管这一因素似乎并非至关重要。如果两个配偶组织相容性良好,肿瘤的免疫原性可能较低,因此母亲的反应较低,肿瘤的生长似乎会受到促进。