Immunologic aspects of preeclampsiaAJOG Global Reports at a Glance
Preeclampsia is a syndrome with multiple etiologies. The diagnosis can be made without proteinuria in the presence of dysfunction of at least 1 organ associated with hypertension. The common pathophysiological pathway includes endothelial cell activation, intravascular inflammation, and syncytiotrop...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2024-02-01
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| Series: | AJOG Global Reports |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666577824000157 |
| _version_ | 1797237979319631872 |
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| author | Henri Boulanger, MD Stéphane Bounan, MD Amel Mahdhi, MD Dominique Drouin, MD Salima Ahriz-Saksi, MD Fabien Guimiot, PhD Nathalie Rouas-Freiss, PD, PhD |
| author_facet | Henri Boulanger, MD Stéphane Bounan, MD Amel Mahdhi, MD Dominique Drouin, MD Salima Ahriz-Saksi, MD Fabien Guimiot, PhD Nathalie Rouas-Freiss, PD, PhD |
| author_sort | Henri Boulanger, MD |
| collection | DOAJ |
| description | Preeclampsia is a syndrome with multiple etiologies. The diagnosis can be made without proteinuria in the presence of dysfunction of at least 1 organ associated with hypertension. The common pathophysiological pathway includes endothelial cell activation, intravascular inflammation, and syncytiotrophoblast stress. There is evidence to support, among others, immunologic causes of preeclampsia. Unlike defense immunology, reproductive immunology is not based on immunologic recognition systems of self/non-self and missing-self but on immunotolerance and maternal–fetal cellular interactions. The main mechanisms of immune escape from fetal to maternal immunity at the maternal–fetal interface are a reduction in the expression of major histocompatibility complex molecules by trophoblast cells, the presence of complement regulators, increased production of indoleamine 2,3-dioxygenase, activation of regulatory T cells, and an increase in immune checkpoints. These immune protections are more similar to the immune responses observed in tumor biology than in allograft biology. The role of immune and nonimmune decidual cells is critical for the regulation of trophoblast invasion and vascular remodeling of the uterine spiral arteries. Regulatory T cells have been found to play an important role in suppressing the effectiveness of other T cells and contributing to local immunotolerance. Decidual natural killer cells have a cytokine profile that is favored by the presence of HLA-G and HLA-E and contributes to vascular remodeling. Studies on the evolution of mammals show that HLA-E, HLA-G, and HLA-C1/C2, which are expressed by trophoblasts and their cognate receptors on decidual natural killer cells, are necessary for the development of a hemochorial placenta with vascular remodeling. The activation or inhibition of decidual natural killer cells depends on the different possible combinations between killer cell immunoglobulin-like receptors, expressed by uterine natural killer cells, and the HLA-C1/C2 antigens, expressed by trophoblasts. Polarization of decidual macrophages in phenotype 2 and decidualization of stromal cells are also essential for high-quality vascular remodeling. Knowledge of the various immunologic mechanisms required for adequate vascular remodeling and their dysfunction in case of preeclampsia opens new avenues of research to identify novel biological markers or therapeutic targets to predict or prevent the onset of preeclampsia. |
| first_indexed | 2024-04-24T17:28:21Z |
| format | Article |
| id | doaj.art-922948ed5815403f8ef167526f5e5233 |
| institution | Directory Open Access Journal |
| issn | 2666-5778 |
| language | English |
| last_indexed | 2024-04-24T17:28:21Z |
| publishDate | 2024-02-01 |
| publisher | Elsevier |
| record_format | Article |
| series | AJOG Global Reports |
| spelling | doaj.art-922948ed5815403f8ef167526f5e52332024-03-28T06:38:56ZengElsevierAJOG Global Reports2666-57782024-02-0141100321Immunologic aspects of preeclampsiaAJOG Global Reports at a GlanceHenri Boulanger, MD0Stéphane Bounan, MD1Amel Mahdhi, MD2Dominique Drouin, MD3Salima Ahriz-Saksi, MD4Fabien Guimiot, PhD5Nathalie Rouas-Freiss, PD, PhD6Department of Nephrology and Dialysis, Clinique de l'Estrée, Stains, France (Drs Boulanger and Ahriz-Saksi); Corresponding author: Henri Boulanger, MD.Department of Obstetrics and Gynecology, Saint-Denis Hospital Center, Saint-Denis, France (Drs Bounan and Mahdhi)Department of Obstetrics and Gynecology, Saint-Denis Hospital Center, Saint-Denis, France (Drs Bounan and Mahdhi)Department of Obstetrics and Gynecology, Clinique de l'Estrée, Stains, France (Dr Drouin)Department of Nephrology and Dialysis, Clinique de l'Estrée, Stains, France (Drs Boulanger and Ahriz-Saksi)Fetoplacental Unit, Robert-Debré Hospital, Assistance Publique – Hôpitaux de Paris, Paris, France (Dr Guimiot)Fundamental Research Division, CEA, Institut de biologie François Jacob, Hemato-Immunology Research Unit, Inserm UMR-S 976, Institut de Recherche Saint-Louis, Paris University, Saint-Louis Hospital, Paris, France (Dr Rouas-Freiss)Preeclampsia is a syndrome with multiple etiologies. The diagnosis can be made without proteinuria in the presence of dysfunction of at least 1 organ associated with hypertension. The common pathophysiological pathway includes endothelial cell activation, intravascular inflammation, and syncytiotrophoblast stress. There is evidence to support, among others, immunologic causes of preeclampsia. Unlike defense immunology, reproductive immunology is not based on immunologic recognition systems of self/non-self and missing-self but on immunotolerance and maternal–fetal cellular interactions. The main mechanisms of immune escape from fetal to maternal immunity at the maternal–fetal interface are a reduction in the expression of major histocompatibility complex molecules by trophoblast cells, the presence of complement regulators, increased production of indoleamine 2,3-dioxygenase, activation of regulatory T cells, and an increase in immune checkpoints. These immune protections are more similar to the immune responses observed in tumor biology than in allograft biology. The role of immune and nonimmune decidual cells is critical for the regulation of trophoblast invasion and vascular remodeling of the uterine spiral arteries. Regulatory T cells have been found to play an important role in suppressing the effectiveness of other T cells and contributing to local immunotolerance. Decidual natural killer cells have a cytokine profile that is favored by the presence of HLA-G and HLA-E and contributes to vascular remodeling. Studies on the evolution of mammals show that HLA-E, HLA-G, and HLA-C1/C2, which are expressed by trophoblasts and their cognate receptors on decidual natural killer cells, are necessary for the development of a hemochorial placenta with vascular remodeling. The activation or inhibition of decidual natural killer cells depends on the different possible combinations between killer cell immunoglobulin-like receptors, expressed by uterine natural killer cells, and the HLA-C1/C2 antigens, expressed by trophoblasts. Polarization of decidual macrophages in phenotype 2 and decidualization of stromal cells are also essential for high-quality vascular remodeling. Knowledge of the various immunologic mechanisms required for adequate vascular remodeling and their dysfunction in case of preeclampsia opens new avenues of research to identify novel biological markers or therapeutic targets to predict or prevent the onset of preeclampsia.http://www.sciencedirect.com/science/article/pii/S2666577824000157coevolution of the KIR receptors and their cognate antigensdecidual cellsdecidual macrophagedecidual natural killer cellsdefense immunologyendometrial stromal cells |
| spellingShingle | Henri Boulanger, MD Stéphane Bounan, MD Amel Mahdhi, MD Dominique Drouin, MD Salima Ahriz-Saksi, MD Fabien Guimiot, PhD Nathalie Rouas-Freiss, PD, PhD Immunologic aspects of preeclampsiaAJOG Global Reports at a Glance AJOG Global Reports coevolution of the KIR receptors and their cognate antigens decidual cells decidual macrophage decidual natural killer cells defense immunology endometrial stromal cells |
| title | Immunologic aspects of preeclampsiaAJOG Global Reports at a Glance |
| title_full | Immunologic aspects of preeclampsiaAJOG Global Reports at a Glance |
| title_fullStr | Immunologic aspects of preeclampsiaAJOG Global Reports at a Glance |
| title_full_unstemmed | Immunologic aspects of preeclampsiaAJOG Global Reports at a Glance |
| title_short | Immunologic aspects of preeclampsiaAJOG Global Reports at a Glance |
| title_sort | immunologic aspects of preeclampsiaajog global reports at a glance |
| topic | coevolution of the KIR receptors and their cognate antigens decidual cells decidual macrophage decidual natural killer cells defense immunology endometrial stromal cells |
| url | http://www.sciencedirect.com/science/article/pii/S2666577824000157 |
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