Department of Biophysics and Human Physiology, Faculty of Health Sciences, Warsaw Medical University, 02-091 Warsaw, Poland.
Department of Connective Tissue Diseases, National Institute of Geriatrics, Rheumatology and Rehabilitation, 02-637 Warsaw, Poland.
Int J Mol Sci. 2021 Mar 13;22(6):2922. doi: 10.3390/ijms22062922.
Tumor necrosis factor-alpha (TNF-α) is a multifunctional Th1 cytokine and one of the most important inflammatory cytokines. In pregnancy, TNF-α influences hormone synthesis, placental architecture, and embryonic development. It was also shown that increased levels of TNF-α are associated with pregnancy loss and preeclampsia. Increased TNF-α levels in complicated pregnancy draw attention to trophoblast biology, especially migratory activity, syncytialisation, and endocrine function. Additionally, elevated TNF-α levels may affect the maternal-fetal relationship by altering the secretory profile of placental immunomodulatory factors, which in turn affects maternal immune cells. There is growing evidence that metabolic/pro-inflammatory cytokines can program early placental functions and growth in the first trimester of pregnancy. Furthermore, early pregnancy placenta has a direct impact on fetal development and maternal immune system diseases that release inflammatory (e.g., TNF-α) and immunomodulatory factors, such as chronic inflammatory rheumatic, gastroenterological, or dermatological diseases, and may result in an abnormal release of cytokines and chemokines in syncytiotrophoblasts. Pregnancy poses a challenge in the treatment of chronic disease in patients who plan to have children. The activity of the disease, the impact of pregnancy on the course of the disease, and the safety of pharmacotherapy, including anti-rheumatic agents, in pregnancy should be considered.
肿瘤坏死因子-α（TNF-α）是一种多功能 Th1 细胞因子，也是最重要的炎症细胞因子之一。在妊娠期间，TNF-α 影响激素合成、胎盘结构和胚胎发育。研究还表明，TNF-α 水平升高与流产和子痫前期有关。复杂妊娠中 TNF-α 水平的升高引起了对滋养层生物学的关注，特别是迁移活性、合胞体形成和内分泌功能。此外，升高的 TNF-α 水平可能通过改变胎盘免疫调节因子的分泌谱来影响母婴关系，进而影响母体免疫细胞。越来越多的证据表明，代谢/促炎细胞因子可以在妊娠早期编程胎盘的功能和生长。此外，早期妊娠胎盘直接影响胎儿发育和母体免疫系统疾病，这些疾病会释放炎症（例如 TNF-α）和免疫调节因子，如慢性炎症性风湿、胃肠病学或皮肤病学疾病，并且可能导致合胞滋养层中细胞因子和趋化因子的异常释放。对于计划怀孕的患有慢性疾病的患者，妊娠对治疗提出了挑战。应考虑疾病的活动度、妊娠对疾病进程的影响以及妊娠期间包括抗风湿药物在内的药物治疗的安全性。
