Maisonneuve Émeline, Panchaud Alice, Baud David, Gavillet Mathilde
Service d'obstétrique, Département femme-mère-enfant, Centre hospitalier universitaire vaudois et Université de Lausanne, 1011 Lausanne.
Institut bernois de médecine de famille, Université de Berne, 3012 Berne.
Rev Med Suisse. 2024 Oct 16;20(891):1869-1873. doi: 10.53738/REVMED.2024.20.891.1869.
During pregnancy, the mother's IgG immunoglobulins cross the -placenta via the neonatal Fc receptor (FcRn), enabling the fetus to acquire passive immunity. In the presence of maternal allo- or auto-antibodies, placental transfer of these pathogenic antibodies mediated by FcRn can cause diseases in the fetus and/or the newborn. FcRn blockade therefore appears to be a therapeutic strategy in these high-risk pregnancies, firstly by reducing IgG recycling, -thereby reducing its concentration in the maternal circulation, and secondly by blocking placental transfer. The promising results of a recent trial testing nipocalimab, a monoclonal antibody targeting FcRn, in very severe erythrocyte alloimmunisation, has opened the way to new targeted therapeutic approaches for perinatal diseases mediated by maternal IgG.
在怀孕期间，母亲的IgG免疫球蛋白通过新生儿Fc受体（FcRn）穿过胎盘，使胎儿获得被动免疫。在存在母体同种或自身抗体的情况下，由FcRn介导的这些致病性抗体的胎盘转移可导致胎儿和/或新生儿患病。因此，FcRn阻断似乎是这些高危妊娠中的一种治疗策略，首先是通过减少IgG的再循环，从而降低其在母体循环中的浓度，其次是通过阻断胎盘转移。最近一项针对靶向FcRn的单克隆抗体尼泊卡利单抗在非常严重的红细胞同种免疫中的试验取得了令人鼓舞的结果，为治疗由母体IgG介导的围产期疾病开辟了新的靶向治疗方法。
