Saito Shigeru
University of Toyama Toyama Japan.
Reprod Med Biol. 2024 Aug 1;23(1):e12600. doi: 10.1002/rmb2.12600. eCollection 2024 Jan-Dec.
Immune cells play an important role in the establishment of pregnancy, and abnormalities in the immune system can cause implantation failure and miscarriage.
Previous papers have been summarized and the role of immune cells in reproduction is reviewed.
The immune environment in the uterus changes drastically from before implantation to after pregnancy to maintain pregnancy. In allogeneic pregnancies, immature dendritic cells (DCs) that induce immune tolerance from outside the uterus flow into the uterus, and mature DCs that remain in the uterus express programmed cell death ligand 2, which suppresses the immune response. Macrophages are classified into M1-macrophages, which induce inflammation, and M2-macrophages, which suppress inflammation; M1-macrophages are required for luteinization, and M2-macrophages induce the differentiation of endometrial epithelial cells to enable implantation. Regulatory T cells, which suppress rejection, are essential for the implantation and maintenance of allogeneic pregnancies. Implantation failure and fetal loss are associated with decreased numbers or qualitative abnormalities of DCs, macrophages, and regulatory T cells. The clinical usefulness of immunomodulatory therapies in patients with repeated implantation failure and recurrent pregnancy loss has been reported.
The provision of individualized medical care in cases of implantation failure or miscarriage may improve clinical outcomes.
免疫细胞在妊娠建立过程中发挥重要作用，免疫系统异常可导致着床失败和流产。
总结以往文献并综述免疫细胞在生殖中的作用。
从着床前到妊娠后，子宫内的免疫环境会发生巨大变化以维持妊娠。在同种异体妊娠中，诱导子宫外免疫耐受的未成熟树突状细胞（DCs）流入子宫，而留在子宫内的成熟DCs表达程序性细胞死亡配体2，从而抑制免疫反应。巨噬细胞分为诱导炎症的M1巨噬细胞和抑制炎症的M2巨噬细胞；黄体化需要M1巨噬细胞，M2巨噬细胞诱导子宫内膜上皮细胞分化以实现着床。抑制排斥反应的调节性T细胞对于同种异体妊娠的着床和维持至关重要。着床失败和胎儿丢失与DCs、巨噬细胞和调节性T细胞数量减少或质量异常有关。免疫调节疗法在反复着床失败和复发性流产患者中的临床应用价值已有报道。
针对着床失败或流产病例提供个体化医疗护理可能会改善临床结局。
