Department of Medical Physiology, Texas A&M Health Science Center , Temple, TX , USA.
Department of Surgery, Texas A&M Health Science Center , Temple, TX , USA.
Front Cardiovasc Med. 2015 Apr 28;2:20. doi: 10.3389/fcvm.2015.00020. eCollection 2015.
The maternal innate immune system plays an important role both in normal pregnancy as well as hypertensive disorders of pregnancy including preeclampsia (PE). We propose four pathways that involve excessive innate immunity that lead to most forms of PE. Pre-existing endothelial dysfunction plus pregnancy leads to an excessive innate immune response resulting in widespread inflammation, placental and renal dysfunction, vasoconstriction, and PE. Placental dysfunction due to shallow trophoblast invasion, inadequate spiral artery remodeling, and/or low placental perfusion initiates an innate immune response leading to excessive inflammation, endothelial and renal dysfunction, and PE. A heightened innate immune system due to pre-existing or acquired infections plus the presence of a paternally derived placenta and semi-allogeneic fetus cause an excessive innate immune response which manifests as PE. Lastly, an abnormal and excessive maternal immune response to pregnancy leads to widespread inflammation, organ dysfunction, and PE. We discuss the potential role of innate immunity in each of these scenarios, as well as the overlap, and how targeting the innate immune system might lead to therapies for the treatment of PE.
母体固有免疫系统在正常妊娠以及包括子痫前期（PE）在内的妊娠高血压疾病中起着重要作用。我们提出了四条途径，涉及导致大多数形式的 PE 的过度固有免疫。预先存在的内皮功能障碍加上妊娠导致过度的固有免疫反应，导致广泛的炎症、胎盘和肾功能障碍、血管收缩和 PE。由于绒毛细胞滋养层侵袭浅、螺旋动脉重塑不足和/或胎盘灌注不足导致的胎盘功能障碍引发固有免疫反应，导致过度炎症、内皮和肾功能障碍以及 PE。由于先前存在或获得性感染以及父系胎盘和半同种异体胎儿的存在而导致固有免疫系统升高，导致过度固有免疫反应，表现为 PE。最后，母体对妊娠的异常和过度免疫反应导致广泛的炎症、器官功能障碍和 PE。我们讨论了固有免疫在这些情况下的潜在作用，以及重叠情况，以及如何针对固有免疫系统可能为治疗 PE 带来治疗方法。
