Intradermal lymphocyte therapy: A promising treatment for recurrent pregnancy loss in patients without anti-TPO antibodies.

BACKGROUND

Recurrent pregnancy loss (RPL) remains a complex and challenging reproductive issue often associated with immunological abnormalities. This study investigates the immunomodulatory effects of intradermal lymphocyte therapy in RPL patients, exploring cellular, molecular, and cytokine changes, with specific attention to individuals with positive anti-thyroid peroxidase antibodies (Anti-TPO).

METHODS

The study included 105 patients with RPL, divided into Anti-TPO positive RPL patients (n = 25), Anti-TPO negative RPL patients (n = 38), and RPL patients without lymphocyte immunotherapy (LIT) (n = 42). LIT was administered according to a standardized protocol, and various immune parameters including flow cytometry analysis of Th1/Th2, Th17, Treg, and NK cells, real-time PCR analysis of gene expression levels, and ELISA analysis of cytokine levels were assessed before and after LIT. Clinical outcomes including clinical miscarriage rates, delivery or pregnancy rates, and live birth rates were also evaluated.

RESULTS

Flow cytometry analysis revealed significant decreases in Th1/Th2 and NK cell percentages post-LIT in both Anti-TPO positive and negative RPL patients. Real-time PCR analysis showed significant alterations in gene expression levels of FoxP3, T-bet, GATA3, RORγt, IL-17, TGF-β, IFNγ, and IL-4 post-LIT in both groups. ELISA analysis demonstrated significant changes in levels of IL-17, TGF-β, IFNγ, and IL-4 post-LIT in both groups. Anti-TPO negative RPL patients with LIT had a lower miscarriage rate (10.53 %) compared to Anti-TPO positive RPL patients with LIT (40 %). Also, the pregnancy rate and the live birth rate were higher (89.47 %) in Anti-TPO negative RPL patients with LIT compared to Anti-TPO positive RPL patients with LIT (60 % and 56 % respectively). Moreover, the average pregnancy rate and live birth rate were significantly higher in RPL patients with LIT than in those without LIT (30.95 %).

CONCLUSION

These findings suggest that while LIT may confer benefits in improving pregnancy outcomes, its efficacy may be influenced by the presence of Anti-TPO Abs. These findings highlight the complex interplay between immune dysregulation and pregnancy outcomes in RPL patients and underscore the need for personalized treatment approaches.