Tedesco F, Pausa M, Bulla R, Melazzini S, Guaschino S
Dipartimento di Fisiologia e Patologia, Università, Trieste.
Recenti Prog Med. 1997 Sep;88(9):406-14.
The mother establishes with the fetus a special interaction in pregnancy allowing his normal survival in spite of the different HLA antigens. The main factors contributing to these favourable conditions for the fetus are an efficient local immunosuppression and the formation of a protective barrier between the mother and the fetus. A number of substances are responsible for the local immunosuppression and include cytokines, prostaglandins, hormones as well as various other proteins of pregnancy. In addition, cytokines produced by TH2 lymphocytes seem to be predominant with respect to those of TH1 cells. An effective protection is provided by the trophoblast layer, which not only forms a physical barrier between the mother and the fetus but evades the immune attack of the mother by expressing inhibitory molecules of the complement system and by down regulating the expression of HLA antigens. Data obtained from murine models and clinical observation in pathological pregnancies suggest that an abnormal immune response of the mother against the feto-placental unit may be responsible for the occurrence of recurrent spontaneous abortions. This is proved by the ability of the partner's lymphocytes administered to females in the mouse model prior to mating to reduce the incidence of abortions. Unfortunately, similar treatment in women with recurrent abortion does not appear to be very effective.
在孕期，母亲与胎儿建立了一种特殊的相互作用，使得胎儿尽管具有不同的人类白细胞抗原（HLA）仍能正常存活。促成胎儿处于这些有利条件的主要因素是有效的局部免疫抑制以及母亲与胎儿之间保护性屏障的形成。多种物质参与局部免疫抑制，包括细胞因子、前列腺素、激素以及妊娠过程中的各种其他蛋白质。此外，TH2淋巴细胞产生的细胞因子相对于TH1细胞产生的细胞因子似乎占主导地位。滋养层提供了有效的保护，它不仅在母亲与胎儿之间形成了物理屏障，还通过表达补体系统的抑制分子以及下调HLA抗原的表达来逃避母亲的免疫攻击。从小鼠模型和病理性妊娠的临床观察中获得的数据表明，母亲对胎儿 - 胎盘单位的异常免疫反应可能是复发性自然流产发生的原因。这在小鼠模型中通过在交配前给雌性小鼠注射配偶的淋巴细胞来降低流产发生率的实验得到了证实。不幸的是，类似的治疗方法在复发性流产的女性中似乎效果不佳。
