Department of Pathology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands.
Department of Pathology, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands.
Int J Mol Sci. 2021 Apr 30;22(9):4786. doi: 10.3390/ijms22094786.
Chronic intervillositis of unknown etiology (CIUE) is a rare, poorly understood, histopathological diagnosis of the placenta that is frequently accompanied by adverse pregnancy outcomes including miscarriage, fetal growth restriction, and intrauterine fetal death. CIUE is thought to have an immunologically driven pathophysiology and may be related to human leukocyte antigen mismatches between the mother and the fetus. Dizygotic twins with one-sided CIUE provide an interesting context to study the influence of immunogenetic differences in such cases. The main immune-cell subsets were investigated using immunohistochemistry. We identified three dizygotic twin pregnancies in which CIUE was present in only one of the two placentas. Two of the pregnancies ended in term delivery and one ended in preterm delivery. Presence of CIUE was correlated with lower placental weight and lower birthweight. Relative number of CD68, CD56, CD20, and CD3 positive cells were comparable between co-twins. The presence of one-sided CIUE in dizygotic twin pregnancy was associated with selective growth restriction in the affected twin. This suggests a unique fetal immunogenetic contribution to the pathogenesis of CIUE. Further study of dizygotic and monozygotic placentas affected by CIUE could identify new insights into its pathophysiology and into the field of reproductive immunology.
不明病因的慢性绒毛膜炎（CIUE）是一种罕见且尚未被充分认识的胎盘组织病理学诊断，常伴有不良妊娠结局，包括流产、胎儿生长受限和宫内胎儿死亡。CIUE 被认为具有免疫驱动的病理生理学机制，可能与母亲和胎儿之间的人类白细胞抗原不匹配有关。具有单侧 CIUE 的双卵双胞胎为研究此类病例中免疫遗传差异的影响提供了一个有趣的背景。我们使用免疫组织化学方法研究了主要的免疫细胞亚群。我们确定了三例存在单侧 CIUE 的双卵双胞胎妊娠，其中仅一个胎盘存在 CIUE。其中两例妊娠足月分娩，一例早产。CIUE 的存在与胎盘重量降低和出生体重降低相关。CD68、CD56、CD20 和 CD3 阳性细胞的相对数量在同卵双胞胎之间相似。在双卵双胞胎妊娠中，单侧 CIUE 的存在与受影响的双胞胎选择性生长受限相关。这表明胎儿免疫遗传因素在 CIUE 的发病机制中具有独特的作用。进一步研究受 CIUE 影响的双卵和单卵胎盘，可以为其病理生理学和生殖免疫学领域提供新的见解。
