Maternal-fetal immunity and recurrent spontaneous abortion

IF 2.5 3区 医学 Q3 IMMUNOLOGY American Journal of Reproductive Immunology Pub Date : 2024-05-09 DOI:10.1111/aji.13859
Yao Yao, Yiqing Ye, Jia Chen, Meng Zhang, Xiaoyu Cai, Caihong Zheng
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Abstract

Recurrent Spontaneous Abortion (RSA) is a common pregnancy complication, that has multifactorial causes, and currently, 40%–50% of cases remain unexplained, referred to as Unexplained RSA (URSA). Due to the elusive etiology and mechanisms, clinical management is exceedingly challenging. In recent years, with the progress in reproductive immunology, a growing body of evidence suggests a relationship between URSA and maternal-fetal immunology, offering hope for the development of tailored treatment strategies. This article provides an immunological perspective on the pathogenesis, diagnosis, and treatment of RSA. On one hand, it comprehensively reviews the immunological mechanisms underlying RSA, including abnormalities in maternal-fetal interface immune tolerance, maternal-fetal interface immune cell function, gut microbiota-mediated immune dysregulation, and vaginal microbiota-mediated immune anomalies. On the other hand, it presents the diagnosis and existing treatment modalities for RSA. This article offers a clear knowledge framework for understanding RSA from an immunological standpoint. In conclusion, while the “layers of the veil” regarding immunological factors in RSA are gradually being unveiled, our current research may only scratch the surface. In terms of immunological etiology, effective diagnostic tools for RSA are currently lacking, and the efficacy and safety of immunotherapies, primarily based on lymphocyte immunotherapy and intravenous immunoglobulin, remain contentious.

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母胎免疫与复发性自然流产
复发性自然流产(RSA)是一种常见的妊娠并发症,其病因是多方面的,目前,40%-50%的病例仍无法解释,被称为原因不明的自然流产(URSA)。由于病因和机制难以捉摸,临床治疗极具挑战性。近年来,随着生殖免疫学的发展,越来越多的证据表明URSA与母胎免疫学之间存在关系,为制定有针对性的治疗策略带来了希望。本文从免疫学的角度阐述了 RSA 的发病机制、诊断和治疗。一方面,文章全面回顾了 RSA 的免疫学机制,包括母胎界面免疫耐受异常、母胎界面免疫细胞功能异常、肠道微生物群介导的免疫失调以及阴道微生物群介导的免疫异常。另一方面,文章还介绍了 RSA 的诊断和现有治疗方法。本文为从免疫学角度理解 RSA 提供了一个清晰的知识框架。总之,尽管有关 RSA 免疫学因素的 "层层面纱 "正逐渐被揭开,但我们目前的研究可能只是触及了皮毛。就免疫学病因学而言,目前尚缺乏有效的 RSA 诊断工具,而以淋巴细胞免疫疗法和静脉注射免疫球蛋白为主的免疫疗法的有效性和安全性仍存在争议。
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来源期刊
CiteScore
6.20
自引率
5.60%
发文量
314
审稿时长
2 months
期刊介绍: The American Journal of Reproductive Immunology is an international journal devoted to the presentation of current information in all areas relating to Reproductive Immunology. The journal is directed toward both the basic scientist and the clinician, covering the whole process of reproduction as affected by immunological processes. The journal covers a variety of subspecialty topics, including fertility immunology, pregnancy immunology, immunogenetics, mucosal immunology, immunocontraception, endometriosis, abortion, tumor immunology of the reproductive tract, autoantibodies, infectious disease of the reproductive tract, and technical news.
期刊最新文献
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