Department of Obstetrics and Gynecology, Changhai Hospital, Naval Medical University, Shanghai, China.
Department of Neurology, Naval Specialty Medical Center, Naval Medical University, Shanghai, China.
Am J Reprod Immunol. 2022 Aug;88(2):e13541. doi: 10.1111/aji.13541. Epub 2022 Apr 5.
Progesterone supplementation is recommended to prevent spontaneous preterm birth (sPTB) in clinical practice. However, the exact mechanism is still unclear. This study aims to better understand the mechanisms that progesterone can prevent PTB.
Late pregnant mice were given various doses of progesterone receptor antagonist mifepristone, and pregnancy outcomes were observed. Then, non-pregnant and pregnant mice were given a subcutaneous injection of 40 mg/kg progesterone and 5 mg/kg mifepristone, respectively. CD4 CD25 FoxP3 Treg cells in peripheral blood and decidua basalis were detected by FACS. Expressions of FoxP3 and TGF-β1 in the decidua basalis were detected.
Mifepristone induced preterm birth, and an obvious dose-response was found. Proportions of CD4 CD25 FoxP3 Treg cells in the peripheral blood of non-pregnant mice increased significantly after progesterone injection. CD4 CD25 FoxP3 Treg cells in the peripheral blood of pregnant mice increased significantly compared with those of non-pregnant mice. In pregnant mice, mifepristone significantly decreased the proportions of CD4 CD25 FoxP3 Treg cells in peripheral blood, and reduced proportions of Treg cells at the maternal-fetal interface and expressions of FoxP3 and TGF-β1 in the maternal-fetal interface. Total 40 mg/kg of progesterone did not increase CD4 CD25 FoxP3 Treg in the peripheral blood of pregnant mice, but increased proportions of Treg cells at the maternal-fetal interface and up-regulated FoxP3 and TGF-β1 expressions in the maternal-fetal interface.
Progesterone promotes pregnancy immune homeostasis by up-regulating Treg cells and TGF-β1 expression in the maternal-fetal interface. It may be one of the mechanisms of progesterone in preventing sPTB.
临床推荐孕激素补充治疗以预防自发性早产(sPTB)。然而,确切的机制仍不清楚。本研究旨在更好地理解孕激素预防早产的机制。
给孕晚期小鼠给予不同剂量的孕激素受体拮抗剂米非司酮,观察妊娠结局。然后,给非孕和孕鼠分别皮下注射 40mg/kg 孕激素和 5mg/kg 米非司酮,流式细胞术检测外周血和蜕膜组织中 CD4 CD25 FoxP3 Treg 细胞。检测蜕膜组织中 FoxP3 和 TGF-β1 的表达。
米非司酮诱导早产,且存在明显的剂量反应关系。孕激素注射后,非孕鼠外周血中 CD4 CD25 FoxP3 Treg 细胞比例明显增加。与非孕鼠相比,孕鼠外周血中 CD4 CD25 FoxP3 Treg 细胞比例明显增加。在孕鼠中,米非司酮明显降低外周血中 CD4 CD25 FoxP3 Treg 细胞的比例,并减少母胎界面 Treg 细胞的比例,降低母胎界面 FoxP3 和 TGF-β1 的表达。总剂量 40mg/kg 的孕激素并未增加孕鼠外周血中 CD4 CD25 FoxP3 Treg 细胞的比例,但增加了母胎界面 Treg 细胞的比例,并上调母胎界面 FoxP3 和 TGF-β1 的表达。
孕激素通过上调母胎界面 Treg 细胞和 TGF-β1 的表达促进妊娠免疫耐受。这可能是孕激素预防 sPTB 的机制之一。