Laboratory of Multidisciplinary Research, São Francisco University, USF, Bragança Paulista, Brazil.
Department of Obstetrics and Gynecology, Campinas University (UNICAMP), Campinas, Brazil.
J Cell Mol Med. 2021 Mar;25(5):2290-2296. doi: 10.1111/jcmm.16257. Epub 2021 Feb 5.
Altered immune and/or inflammatory response plays an important role in cases of recurrent pregnancy loss (RPL) and repeated implantation failure (RIF). Exacerbation of the maternal immune response through increased NK cell activity and inflammatory cytokines can cause embryo rejection leading to abortion or embryo implantation failure. Immunosuppressors or immunomodulators can help or prevent this condition. Currently, lipid emulsion therapy (LET) has emerged as a treatment for RPL and RIF in women with abnormal NK cell activity, by decreasing the exacerbated immune response of the maternal uterus and providing a more receptive environment for the embryo. However, the mechanisms by which the intralipid acts to reduce NK cell activity are still unclear. In this review, we focus on the studies that conducted LET to treat patients with RPL and RIF with abnormal NK cell activity. We find that although some authors recommend LET as an effective intervention, more studies are necessary to confirm its effectiveness in restoring NK cell activity to normal levels and to comprehend the underlying mechanisms of the lipids action in ameliorating the maternal environment and improving the pregnancy rate.
改变的免疫和/或炎症反应在反复性流产(RPL)和反复着床失败(RIF)病例中起着重要作用。通过增加 NK 细胞活性和炎症细胞因子来加剧母体免疫反应会导致胚胎排斥,从而导致流产或胚胎着床失败。免疫抑制剂或免疫调节剂可以帮助或预防这种情况。目前,脂乳剂疗法(LET)已成为治疗异常 NK 细胞活性的 RPL 和 RIF 的一种方法,通过降低母体子宫过度的免疫反应,为胚胎提供更易接受的环境。然而,脂乳剂降低 NK 细胞活性的作用机制仍不清楚。在这篇综述中,我们重点关注了使用 LET 治疗异常 NK 细胞活性的 RPL 和 RIF 患者的研究。我们发现,尽管一些作者推荐 LET 作为一种有效的干预措施,但仍需要更多的研究来证实其有效性,以恢复 NK 细胞活性至正常水平,并理解脂质在改善母体环境和提高妊娠率方面的作用机制。