Alhajjat Amir, Shaaban Aimen
Division of Pediatric Surgery, Phoenix Children's Hospital, 1919 E Thomas Rd, Phoenix, Arizona.
The Chicago Institute for Fetal Health, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.
Curr Stem Cell Rep. 2018 Jun;4(2):182-187. doi: 10.1007/s40778-018-0129-5. Epub 2018 May 3.
In Utero Hematopoietic Cellular Transplantation (IUHCT) is a promising intervention for the non-toxic treatment of congenital disease that hinges on the assumption of fetal immunologic immaturity and an inability to reject a hematopoietic allograft. However, clinical IUCHT has failed except in cases where the fetus is severely immunocompromised. The current review examines recent studies of engraftment barriers stemming from either the fetal or maternal immune system.
New reports have illuminated roles for maternal humoral and cellular immunity and fetal innate cellular immunity in the resistance to allogeneic IUHCT. These experimental findings have inspired new approaches to overcome these barriers. Despite these advances, postulates regarding a maternal immune barrier to IUHCT provide an inadequate explanation for the well-documented clinical success only in the treatment of fetal immunodeficiency with normal maternal immunity.
Characterization of the maternal and fetal immune response to allogeneic IUHCT provides new insight into the complexity of prenatal tolerance. Future work in this area should aim to provide a unifying explanation for the observed patterns of success and failure with clinical IUHCT.
宫内造血细胞移植（IUHCT）是一种有前景的先天性疾病无毒治疗干预措施，其基于胎儿免疫不成熟以及无法排斥造血同种异体移植物的假设。然而，除了胎儿严重免疫受损的情况外，临床IUCHT均告失败。本综述探讨了近期关于胎儿或母体免疫系统导致植入障碍的研究。
新报告揭示了母体体液和细胞免疫以及胎儿固有细胞免疫在抵抗异体IUHCT中的作用。这些实验结果激发了克服这些障碍的新方法。尽管取得了这些进展，但关于母体对IUHCT免疫屏障的假设，对于仅在母体免疫正常的情况下治疗胎儿免疫缺陷所取得的临床成功记录，提供的解释并不充分。
对母体和胎儿对异体IUHCT免疫反应的特征分析，为产前耐受性的复杂性提供了新的见解。该领域未来的工作应旨在为临床IUHCT观察到的成功和失败模式提供统一的解释。
