Department of Diagnostic Pathology, Faculty of Medicine, Miyazaki University Hospital, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki, 889-1692, Japan.
Department of Pathology, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan.
Virchows Arch. 2019 Sep;475(3):357-364. doi: 10.1007/s00428-019-02598-6. Epub 2019 Jun 19.
Chronic intervillositis of unknown etiology (CIUE) is a rare placental lesion associated with infiltration of mononuclear inflammatory cells into the intervillous space, poor perinatal outcomes (intrauterine fetal demise or fetal growth restriction), and high rates of recurrence. CD39 is the ectonucleotidase that protects tissues from inflammatory stress and cell injury, which is localized on the surface of villi in normal placentas; however, its expression and role in CIUE are unknown. The aims of this retrospective study were to determine the expression of CD39 in CIUE and its significance in pregnancy outcomes. We compared the number of CD68- and CD3-positive cells, CD39 expression, and complement 4d (C4d) and fibrin deposition in placental tissues from patients with CIUE (n = 22) and gestational age-matched controls (n = 20), and between CIUE pregnancies with poor and good outcomes. The numbers of CD68- or CD3-positive cells were significantly higher (P < 0.0001), whereas CD39 expression on the surface of villi and endothelial cells of the stem villi was significantly lower in the CIUE group than that in controls (45% vs. 95%, P < 0.0001 and 77% vs. 96%, P < 0.001, respectively). C4d and fibrin deposition were also significantly increased in CIUE compared with those of controls. Furthermore, CD39 downregulation and the number of CD68 cells were strongly associated with poor pregnancy outcomes (P < 0.01 and P < 0.05, respectively), but other histological parameters (CD3, C4d, and fibrin) did not show this association. Our study suggests that CD39 downregulation is a useful marker of CIUE and is associated with poor pregnancy outcomes in patients with CIUE.
原因不明的慢性绒毛膜炎（CIUE）是一种罕见的胎盘病变，其特征为绒毛间质内单核炎性细胞浸润，围产儿结局不良（宫内胎儿死亡或胎儿生长受限），且复发率高。CD39 是一种能够保护组织免受炎症应激和细胞损伤的细胞外核苷酸酶，其在正常胎盘的绒毛表面表达；然而，其在 CIUE 中的表达和作用尚不清楚。本回顾性研究旨在确定 CD39 在 CIUE 中的表达及其与妊娠结局的关系。我们比较了 CIUE 患者（n=22）和胎龄匹配对照组（n=20）胎盘组织中 CD68-和 CD3 阳性细胞的数量、CD39 表达以及补体 4d（C4d）和纤维蛋白沉积，并比较了 CIUE 妊娠中不良结局和良好结局组之间的差异。CIUE 组的 CD68-或 CD3 阳性细胞数量明显更高（P<0.0001），而绒毛和主绒毛的血管内皮细胞表面的 CD39 表达明显低于对照组（45%比 95%，P<0.0001 和 77%比 96%，P<0.001）。CIUE 组的 C4d 和纤维蛋白沉积也明显高于对照组。此外，CD39 下调和 CD68 细胞数量与不良妊娠结局密切相关（P<0.01 和 P<0.05），但其他组织学参数（CD3、C4d 和纤维蛋白）与不良妊娠结局无关。本研究表明，CD39 下调是 CIUE 的一个有用标志物，与 CIUE 患者的不良妊娠结局相关。
