Kovacevic Dalibor, Velikic Gordana, Maric Dusan M, Maric Dusica L, Puletic Miljan, Gvozdenovic Ljiljana, Vojvodic Danilo, Supic Gordana
"Genesis" Hospital, 21000 Novi Sad, Serbia.
Department for Research and Development, Clinic Orto MD-Parks Dr Dragi Hospital, 21000 Novi Sad, Serbia.
Int J Mol Sci. 2025 Apr 3;26(7):3348. doi: 10.3390/ijms26073348.
Multiple System Atrophy (MSA) is a rare, rapidly progressive neurodegenerative disorder marked by autonomic dysfunction, parkinsonism, and cerebellar ataxia. While predominantly affecting individuals in their fifth or sixth decade, advancements in assisted reproductive technologies (ART) have created new clinical scenarios involving pregnancies in women within MSA's typical onset range. Given the scarcity of documented MSA pregnancies, this review leverages insights from related Parkinson's spectrum mechanisms to explore hypothetical scenarios for how pregnancy-induced physiological changes might influence MSA progression. Pregnancy-induced hormonal fluctuations, including elevated estrogen and progesterone levels, may modulate α-synuclein aggregation and neuroinflammatory pathways. Immune adaptations, such as fetal microchimerism and Th2-biased immune profiles, introduce additional complexities, particularly in donor embryo pregnancies involving complex microchimerism. Metabolic demands and oxidative stress further intersect with these mechanisms, potentially accelerating disease progression. We analyze existing literature and theoretical models, emphasizing the need for interdisciplinary research. Clinical implications are discussed to propose evidence-based strategies for optimizing maternal-fetal outcomes. This paper identifies critical knowledge gaps and proposes avenues for future investigation to optimize maternal-fetal outcomes in this unique and underexplored clinical intersection.
多系统萎缩（MSA）是一种罕见的、快速进展的神经退行性疾病，其特征为自主神经功能障碍、帕金森综合征和小脑共济失调。虽然主要影响五、六十岁的个体，但辅助生殖技术（ART）的进步创造了新的临床情况，涉及处于MSA典型发病年龄范围内的女性怀孕。鉴于记录在案的MSA妊娠案例稀少，本综述利用帕金森病谱系机制的相关见解，探讨妊娠引起的生理变化可能如何影响MSA进展的假设情况。妊娠引起的激素波动，包括雌激素和孕激素水平升高，可能会调节α-突触核蛋白的聚集和神经炎症途径。免疫适应，如胎儿微嵌合体和Th2偏向的免疫谱，带来了更多复杂性，特别是在涉及复杂微嵌合体的供体胚胎妊娠中。代谢需求和氧化应激进一步与这些机制相互作用，可能加速疾病进展。我们分析现有文献和理论模型，强调跨学科研究的必要性。讨论了临床意义，以提出优化母婴结局的循证策略。本文确定了关键的知识空白，并提出了未来研究的途径，以优化这一独特且未被充分探索的临床交叉领域中的母婴结局。
