Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, USA; Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA.
Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, USA; Department of Global Health, University of Washington, Seattle, WA, USA.
Placenta. 2023 Sep 26;141:2-9. doi: 10.1016/j.placenta.2022.10.002. Epub 2022 Oct 14.
Viral hemorrhagic fevers (VHF) are endemic to Africa, South America and Asia and contribute to significant maternal and fetal morbidity and mortality. Viruses causing VHFs are typically zoonotic, spreading to humans through livestock, wildlife, or mosquito vectors. Some of the most lethal VHF viruses also impart a high-risk of stillbirth including ebolaviruses, Marburg virus (MARV), Lassa virus (LASV), and Rift Valley Fever Virus (RVFV). Large outbreaks and epidemics are common, though the impact on the mother, fetus and placenta is understudied from a public health, clinical and basic science perspective. Notably, these viruses utilize ubiquitous cellular surface entry receptors critical for normal placental function to enable viral invasion into multiple key cell types of the placenta and set the stage for maternal-fetal transmission and stillbirth. We employ insights from molecular virology and viral immunology to discuss how trophoblast expression of viral entry receptors for VHF viruses may increase the risk for viral transmission to the fetus and stillbirth. As the frequency of VHF outbreaks is expected to increase with worsening climate change, understanding the pathogenesis of VHF-related diseases in the placenta is paramount to predicting the impact of emerging viruses on the placenta and perinatal outcomes.
病毒性出血热（VHF）在非洲、南美洲和亚洲流行，导致产妇和胎儿发病率和死亡率显著增加。引起 VHF 的病毒通常是动物源性的，通过牲畜、野生动物或蚊子媒介传播给人类。一些最致命的 VHF 病毒也会导致高风险的死产，包括埃博拉病毒、马尔堡病毒（MARV）、拉萨病毒（LASV）和裂谷热病毒（RVFV）。尽管从公共卫生、临床和基础科学的角度来看，这些病毒对母亲、胎儿和胎盘的影响尚未得到充分研究，但大规模暴发和流行很常见。值得注意的是，这些病毒利用普遍存在的细胞表面进入受体，这些受体对正常胎盘功能至关重要，使病毒能够侵入胎盘的多个关键细胞类型，并为母婴传播和死产奠定基础。我们利用分子病毒学和病毒免疫学的见解来讨论 VHF 病毒的病毒进入受体在滋养细胞中的表达如何增加病毒向胎儿传播和死产的风险。随着气候变化的恶化，预计 VHF 暴发的频率将会增加，因此了解胎盘与 VHF 相关疾病的发病机制对于预测新出现的病毒对胎盘和围产期结局的影响至关重要。
