Liaison between natural killer cells and dendritic cells in human gestation

A successful pregnancy relies on immunological adaptations that allow the fetus to grow and develop in the uterus, despite being recognized by maternal immune cells. Among several immunocompetent cell types present within the human maternal/fetal interface, DC-SIGN~ dendritic cells （DCs） and CD56＋ natural killer （NK） cells are of major importance for early pregnancy maintenance, not only generating maternal immunological tolerance but also regulating stromal cell differentiation. Previous reports show the presence of NK-DC cell conjugates in first trimester human decidua, suggesting that these cells may play a role in the modulation of the local immune response within the uterus. While effective immunity is necessary to protect the mother from harmful pathogens, some form of tolerance must be activated to avoid an immune response against fetal antigens. This review article discusses current evidence concerning the functions of DC and NK cells in pregnancy and their liaison in human decidua.     

Immune cells in term and preterm labor

Labor resembles an inflammatory response that includes secretion of cytokines/chemokines by resident and infiltrating immune cells into reproductive tissues and the maternal/fetal interface. Untimely activation of these inflammatory pathways leads to preterm labor, which can result in preterm birth. Preterm birth is a major determinant of neonatal mortality and morbidity; therefore, the elucidation of the process of labor at a cellular and molecular level is essential for understanding the pathophysiology of preterm labor. Here, we summarize the role of innate and adaptive immune cells in the physiological or pathological activation of labor. We review published literature regarding the role of innate and adaptive immune cells in the cervix, myometrium, fetal membranes, decidua and the fetus in late pregnancy and labor at term and preterm. Accumulating evidence suggests that innate immune cells （neutrophils, macrophages and mast cells） mediate the process of labor by releasing pro-inflammatory factors such as cytokines, chemokines and matrix metalloproteinases. Adaptive immune cells （T-cell subsets and B cells） participate in the maintenance of fetomaternal tolerance during pregnancy, and an alteration in their function or abundance may lead to labor at term or preterm. Also, immune cells that bridge the innate and adaptive immune systems （natural killer T （NKT） cells and dendritic cells （DCs）） seem to participate in the pathophysiology of preterm labor. In conclusion, a balance between innate and adaptive immune cells is required in order to sustain pregnancy; an alteration of this balance will lead to labor at term or preterm.     

Maternal-fetal tolerance is maintained despite transgene-driven trophoblast expression of MHC class I,and defects in Fas and its ligand

During mammalian pregnancy, one or more semiallogeneic fetuses gestate in direct contact with the maternal circulation and uterine tissue. However, a damaging maternal immune response is not normally provoked. We studied two possible mechanisms for this maternal-fetal tolerance, alone and in combination. First, we directly tested the hypothesis that the striking absence of MHC class I molecules on most placenta trophoblasts protects the fetus from maternal immune attack, by creating transgenic mice which express L^d in giant cell trophoblasts. Second, because Fas ligand (FasL) may contribute to immune privilege, we tested whether functional FasL expression by the fetus, or Fas expression by the mother, contributes to successful reproduction in a fully allogeneic breeding. Our data indicate that neither abnormal expression of MHC class I in giant cells, nor disruption of the Fas-FasL system, nor a combination of these two defects, has an adverse effect on pregnancy outcome. These results suggest that during healthy allogeneic pregnancy, down-regulation of MHC class I and expression of FasL on placenta are not critical events, and other factors must prevent a harmful maternal immune response.     

Maternal asthma during pregnancy and fetal outcomes: potential mechanisms and possible solutions

PURPOSE OF REVIEW: Asthma exacerbations during pregnancy can be a serious complication that have detrimental consequences for both mother and fetus. The pathophysiological mechanisms that cause worsening asthma during pregnancy are only just starting to be examined. This review will examine the recent literature on immune function in pregnant women, immune function in nonpregnant asthma patients and studies conducted on asthma during pregnancy. RECENT FINDINGS: Fifty-five percent of women with asthma will experience at least one exacerbation during pregnancy. This has significant effects on fetal growth and survival, especially if the fetus is male. A number of factors that may contribute to the development of worsening asthma during pregnancy include pregnancy-induced changes in maternal immune function, increased maternal susceptibility to infection, female fetal sex, noncompliance with medication and prepregnancy asthma severity. Interestingly, the immune changes in the maternal system in response to the presence of the fetus and placenta are very similar to the immune changes described in nonpregnant asthma patients with noneosinophilic asthma. SUMMARY: These studies highlight that worsening asthma during pregnancy cannot be attributed to pregnancy alone or asthma alone and may be a complex combination of factors and events.     

Trophoblast Immune Receptors in Maternal-Fetal Tolerance

During pregnancy, interactions between maternal immune cells and fetal trophoblast cells of the placenta would seemingly lead to disaster, as the trophoblast cells are semi-allogeneic and should trigger rejection by the maternal immune response. A fundamental immunologic question of pregnancy as posed by Sir Peter Medawar centers on how immunologic disaster is averted. It is becoming clear that many different mechanisms act during gestation to render the maternal immune system tolerant of the fetus. These include, among others, restricted major histocompatibility complex (MHC) protein expression, the presence of immunosuppressive B7 family members, immunomodulatory adhesion molecules, the expression of apoptosis-inducing proteins, and complement regulatory proteins. Understanding of maternal-fetal tolerance has clinically important implications for the fields of reproduction, autoimmunity and transplantation. Herein are discussed mechanisms by which trophoblast cells are protected from maternal immune cell attack. Specifically the role of trophoblast cell surface proteins at the maternal-fetal interface is considered.     

NK Cell Tolerance and the Maternal–Fetal Interface

Natural killer (NK) cells play a fundamental role in the innate immune response through their ability to secrete cytokines and kill target cells without prior sensitization. These effector functions are central to NK cell anti-viral and anti-tumor abilities. Due to their cytotoxic nature, it is vital that NK cells have the capacity to recognize normal self-tissue and thus prevent their destruction. In addition to their role in host defense, NK cells accumulate at the maternal-fetal interface and are thought to play a critical role during pregnancy. The close proximity of uterine NK (uNK) cells to fetal trophoblast cells of the placenta would seemingly lead to catastrophic consequences, as the trophoblast cells are semi-allogeneic. A fundamental enigma of pregnancy is that the fetal cells constitute an allograft but, in normal pregnancies, they are in effect not perceived as foreign and are not rejected by the maternal immune system. Although the mechanisms involved in achieving NK cell tolerance are becoming increasingly well-defined, further clarification is required, given the clinical implications of this work in the areas of infection, transplantation, cancer and pregnancy. Herein, we discuss several mechanisms of NK cell tolerance and speculate as to how they may apply to uNK cells at the maternal–fetal interface.     

NK cell tolerance and the maternal-fetal interface.

Natural killer (NK) cells play a fundamental role in the innate immune response through their ability to secrete cytokines and kill target cells without prior sensitization. These effector functions are central to NK cell anti-viral and anti-tumor abilities. Due to their cytotoxic nature, it is vital that NK cells have the capacity to recognize normal self-tissue and thus prevent their destruction. In addition to their role in host defense, NK cells accumulate at the maternal-fetal interface and are thought to play a critical role during pregnancy. The close proximity of uterine NK (uNK) cells to fetal trophoblast cells of the placenta would seemingly lead to catastrophic consequences, as the trophoblast cells are semi-allogeneic. A fundamental enigma of pregnancy is that the fetal cells constitute an allograft but, in normal pregnancies, they are in effect not perceived as foreign and are not rejected by the maternal immune system. Although the mechanisms involved in achieving NK cell tolerance are becoming increasingly well-defined, further clarification is required, given the clinical implications of this work in the areas of infection, transplantation, cancer and pregnancy. Herein, we discuss several mechanisms of NK cell tolerance and speculate as to how they may apply to uNK cells at the maternal-fetal interface.     

Trophoblast immune receptors in maternal-fetal tolerance

During pregnancy, interactions between maternal immune cells and fetal trophoblast cells of the placenta would seemingly lead to disaster, as the trophoblast cells are semi-allogeneic and should trigger rejection by the maternal immune response. A fundamental immunologic question of pregnancy as posed by Sir Peter Medawar centers on how immunologic disaster is averted. It is becoming clear that many different mechanisms act during gestation to render the maternal immune system tolerant of the fetus. These include, among others, restricted major histocompatibility complex (MHC) protein expression, the presence of immunosuppressive B7 family members, immunomodulatory adhesion molecules, the expression of apoptosis-inducing proteins, and complement regulatory proteins. Understanding of maternal-fetal tolerance has clinically important implications for the fields of reproduction, autoimmunity and transplantation. Herein are discussed mechanisms by which trophoblast cells are protected from maternal immune cell attack. Specifically the role of trophoblast cell surface proteins at the maternal-fetal interface is considered.     

Imitating a stress response: A new hypothesis about the innate immune system’s role in pregnancy

Recent research challenges long-held hypotheses about mechanisms through which pregnancy induces maternal immune suppression or tolerance of the embryo/fetus. It is now understood that normal pregnancy engages the immune system and that the immune milieu changes with advancing gestation. We suggest that pregnancy mimics the innate immune system’s response to stress, causing a sterile inflammatory response that is necessary for successful reproduction. The relationship between external stressors and immunomodulation in pregnancy has been acknowledged, but the specific mechanisms are still being explicated.Implantation and the first trimester are times of immune activation and intensive inflammation in the uterine environment. A period of immune quiescence during the second trimester allows for the growth and development of the maturing fetus. Labor is also an inflammatory event. The length of gestation and timing of parturition can be influenced by environmental stressors. These stressors affect pregnancy through neuroendocrine interaction with the immune system, specifically through the hypothalamic–pituitary–adrenal (HPA) axis and the hypothalamic–pituitary–ovarian axis. Trophoblastic cells that constitute the maternal–fetal interface appear to harness the maternal immune system to promote and maximize the reproductive success of the mother and fetus. Pregnancy is a time of upregulated innate immune responses and decreased adaptive, cell-mediated responses. The inflammatory processes of pregnancy resemble an immune response to brief naturalistic stressors: there is a shift from T helper (Th) 1 to T helper (Th) 2 dominant adaptive immunity with a concomitant shift in cytokine production, decreased proliferation of T cells, and decreased cytotoxicity of natural killer (NK) cells.Inclusion of both murine and human studies, allows an exploration of insights into how trophoblasts influence the activity of the maternal innate immune system during gestation.     

Immune responsiveness in the neonatal period

The maintenance of pregnancy requires suppression of the maternal immune system which would naturally recognize the developing fetus as an allograft and seek to destroy it by mounting a Th1 regulated cytotoxic immune response. During pregnancy a range of soluble factors are produced by the placenta which switch maternal immune regulation towards a protective Th2 phenotype. These factors also influence the developing fetal immune system and all newborns initially have an immunological milieu skewed towards Th2 immunity. Vaccination during the neonatal period must therefore overcome the dual challenge of the inhibitory effect of maternally derived antibody and this natural Th2 regulatory environment. One means of overcoming these obstacles is by the use of adjuvant systems that can redirect the neonatal immune response towards an appropriate Th1 regulated reaction that affords protection from infectious disease. In this overview, experiments are described in which viral antigens incorporated into immune stimulatory complexes (ISCOMs) are able to induce immune responses with balanced Th1 and Th2 regulation in neonatal mice, as evidenced by the nature of the IgG subclass response and cytokine profile, and the induction of cytotoxic lymphocytes. ISCOM adjuvanted vaccines are able to induce similar protective immunity in the newborn of larger animal species including cattle, horses and dogs.     

Review of the immune mechanisms of preeclampsia and the potential of immune modulating therapy

Successful pregnancy relies on maternal immunologic tolerance mechanisms limit maladaptive immune responses against the semi-allogeneic fetus and placenta and support fetal growth. Preeclampsia is a common disorder of pregnancy that affects 4–10% of pregnancies and is a leading cause of maternal and neonatal morbidity and mortality. Preeclampsia clinically manifests as maternal hypertension, proteinuria, and progressive multi-organ injury likely triggered by hypoxic injury to the placenta, resulting in local and systemic anti-angiogenic and inflammatory factor production. Despite the steady rising rates of preeclampsia in the United States, effective treatment options are limited to delivery, which improves maternal status often at the cost of prematurity in the newborn. Preeclampsia also increases the lifelong risk of cardiovascular disease for both mother and infant. Thus, identifying new therapeutic targets is a high priority area to improve maternal, fetal, and infant health outcomes. Immune abnormalities in the placenta and in the maternal circulation have been reported to precede the clinical onset of disease. In particular, excessive systemic and placental complement activation and impaired adaptive T cell tolerance with Th1/Th2/Th17/Treg imbalance has been reported in humans and in animal models of preeclampsia. In this review, we focus on the evidence for the immune origins of preeclampsia, discuss the promise of immune modulating therapy for prevention or treatment, and highlight key areas for future research.     

A new era in reproductive medicine: consequences of third-party oocyte donation for maternal and fetal health

The fetus is a semi-allograft for the maternal host in natural pregnancy, but the fetus is a complete allograft after oocyte donation (OD), and there is greater antigenic dissimilarity with the mother. Thus, OD pregnancy is a good model for understanding how the fetus is protected by the maternal immune system. Recent clinical data have revealed a higher risk of miscarriage, gestational hypertension, preterm birth, and low birth weight with OD pregnancy. There is also a higher incidence of chorionic deciduitis, dense fibrinoid deposits in the chorionic basal plate, inflammatory lesions in the chorionic plate, and C4d deposition on syncytiotrophoblasts in OD pregnancy. Impaired accumulation of T cells, regulatory T (Treg) cells, natural killer (NK) cells, and monocytes in the decidua basalis and poor remodeling of spiral arteries are observed in OD pregnancy irrespective of whether preeclampsia occurs. These findings may partly explain why OD pregnancy is associated with a high risk of gestational hypertension and preeclampsia. We need to clarify the immunological and pathological differences between uncomplicated and complicated OD pregnancy. In uncomplicated OD pregnancy, the level of HLA match between mother and baby is significantly higher than would be expected by chance, suggesting that miscarriage may be frequent with marked HLA mismatch. This review discusses the relationship between various aspects of the immune system and complications of OD pregnancy.     

Contribution of macrophages to fetomaternal immunological tolerance

The semi-allogeneic fetus develops in a uniquely immune tolerant environment within the uterus. For successful pregnancy, both the innate and adaptive immune systems must favor acceptance of the fetal allograft. Macrophages are the second most abundant immune cells after natural killer (NK) cells in the decidua. In coordination with decidual NK cells and dendritic cells, macrophages aid in implantation, vascular remodeling, placental development, immune tolerance to placental cells, and maintenance of tissue homeostasis at the maternal-fetal interface. Decidual macrophages show the classical activated (M1) and alternatively activated (M2) phenotypes under the influence of the local milieu of growth factors and cytokines, and appropriate temporal regulation of the M1/M2 switch is vital for successful pregnancy. Disturbances in the mechanisms that control the M1/M2 balance and associated functions during pregnancy can trigger a spectrum of pregnancy complications ranging from preeclampsia and fetal growth restriction to preterm delivery. This review addresses various mechanisms of tolerance, focusing on the basic biology of macrophages, their plasticity and polarization, and their protective roles at the immune-privileged maternal-fetal interface, including direct and indirect roles in promoting fetomaternal immune tolerance.     

Attitudes toward presymptomatic testing and prenatal diagnosis for adrenoleukodystrophy among affected families

One hundred and thirty-six individuals with a family history of X-linked adrenoleukodystrophy (ALD) or adrenomyeloneuropathy (AMN) were given a questionnaire surveying their sociodemographic characteristics, knowledge of X-linked inheritance, and attitudes toward prenatal, presymptomatic, and carrier testing. Of the respondents, 68% indicated that they would use prenatal testing. Of these, 57.1% would terminate a pregnancy of a male fetus hemizygous for the ALD gene and 13.5% would reportedly choose to terminate a heterozygote female fetus. Presymptomatic testing would be used by 88.7% of respondents to test at-risk sons and carrier testing would reportedly be used by 95.4% of respondents to test their at-risk daughters. Respondents correctly answered an average of 61% of the questions testing understanding of X-linked inheritance. This indicates a strong interest in prenatal, presymptomatic, and carrier testing and a need for genetic counselors to provide information about these available tests and X-linked inheritance.     

Attitudes toward presymptomatic testing and prenatal diagnosis for adrenoleukodystrophy among affected families.

One hundred and thirty-six individuals with a family history of X-linked adrenoleukodystrophy (ALD) or adrenomyeloneuropathy (AMN) were given a questionnaire surveying their sociodemographic characteristics, knowledge of X-linked inheritance, and attitudes toward prenatal, presymptomatic, and carrier testing. Of the respondents, 68% indicated that they would use prenatal testing. Of these, 57.1% would terminate a pregnancy of a male fetus hemizygous for the ALD gene and 13.5% would reportedly choose to terminate a heterozygote female fetus. Presymptomatic testing would be used by 88.7% of respondents to test at-risk sons and carrier testing would reportedly be used by 95.4% of respondents to test their at-risk daughters. Respondents correctly answered an average of 61% of the questions testing understanding of X-linked inheritance. This indicates a strong interest in prenatal, presymptomatic, and carrier testing and a need for genetic counselors to provide information about these available tests and X-linked inheritance.     

胎盘在妊娠免疫耐受作用中的研究进展

胎儿携带二分之一父方基因和二分之一母方基因在母体宫内,可视为移入母体内的半异体移植物,但成功妊娠的胎儿却不被母体排斥,这是由于妊娠期的母体存在免疫耐受。其中胎盘的滋养层和底蜕膜上有许多免疫因子可使胎儿得以逃避母体的免疫攻击：胎盘自身的机械性屏障作用也起重要作用；HLA-G，E可抑制妊娠时T细胞及NK细胞的表达；补体调节蛋白可通过干扰膜攻击复合物的形成而利于母胎免疫；母体Treg细胞在正常妊娠时的表达量高于非妊娠时的表达量，也参与了母胎免疫耐受。     

Immunological Role of the Placenta, Blocking Factors and NK Cells in Post-implantation Pregnancy

The unexpected failure of the mother to immunologically reject the foetus is partly thought to result from immunological properties of the placenta. The placental trophoblast produces immunosuppressive factors including progesterone and blocking antibodies which together down-regulate maternal immune responses to the foetoplacental unit. This article reviews the post implantation immunology of pregnancy emphasizing the roles of placenta, blocking factors and natural killer (NK) cells.     

Th1 cytokines are essential for placental immunity to Listeria monocytogenes

The fetal allograft poses an immunological challenge: how is it protected while immunity to pathogens, particularly those that replicate in the placenta, is maintained? Several theories have been proposed to explain this fetal protection, including a pregnancy-based bias towards a Th2 rather than Th1 cytokine profile in order to avoid generating cytotoxic T cells that could threaten the fetus. Listeria monocytogenes preferentially replicates in the placenta and systemically requires a Th1 response for sterile eradication. In the placenta, the Th1 cytokines tumor necrosis factor alpha (TNF-alpha) and gamma interferon (IFN-gamma) are also synthesized in response to this pathogen, without fetal loss. Here we show, by using mice homozygous for null mutations in either the cytokine or cytokine receptor genes, a requirement for both TNF-alpha and IFN-gamma signaling for an effective placental immune response to L. monocytogenes. However, T cells were not recruited to the placenta. Genetic studies in which the fetal component of the placenta was genetically different from the mother indicated that both the production of and response to these cytokines were maternal. Despite the requirement for these cytokines, the early recruitment of neutrophils to the placenta was normal. Consequently, the bacterium appeared to be delayed in its colonization of this organ and did not fully gain hold until 72 h postinfection. These data show a requirement for Th1 cytokines during pregnancy for effective immunity and indicate that a bias away from Th1 cytokine synthesis is not a necessary prerequisite of pregnancy.     

Mother's little helpers: mechanisms of maternal-fetal tolerance

The evolutionary adaptation in mammals that allows implantation of their embryos in the mother's womb creates an immunological problem. Although it ensures optimal nourishment and protection of the fetus throughout its early development, intimate contact with the mother's uterine tissue makes the fetus a potential target for her immune system. As half the fetal genes are derived from the father, the developing embryo and placenta must be considered a 'semi-allograft'. Such a mismatched organ transplant would be readily rejected without powerful immune suppression. During pregnancy, however, the semi-allogeneic fetus is protected from assault by the maternal immune system over an extended period of time. The mother's immune system seems to recognize the fetus as 'temporary self'. How this feat is managed is key to understanding immunological tolerance and intervention in treating disease.