Immunological Study of Unexplained Recurrent Spontaneous Abortion

Alaa Saddallah Ahmad; Alaa Zanzal Raad

Alaa Saddallah Ahmad Medical Microbiology Student, College of Medicine, Tikrit University, Tikrit, Iraq
Alaa Zanzal Raad Medical Microbiology, College of Medicine, Tikrit University, Tikrit, Iraq

Keywords: RSA, T helper, IL-37, Vaginitis

Abstract

Miscarriage poses a significant health concern, with a substantial proportion attributed to immunological factors, particularly maternal immune responses towards the fetus. This study aimed to identify immunological biomarkers associated with unexplained recurrent abortions. Vaginal swabs and blood samples were collected from 100 women with recurrent abortions and 80 control women with previous normal pregnancies. Analysis revealed significantly higher T-helper 1 cytokine levels and lower T-helper 2 cytokine levels in women with recurrent abortions compared to controls. The imbalance in T-helper cell responses, indicated by elevated Th1:Th2 ratios and IFN-γ:IL-4 and IFN-γ:IL-10 ratios, suggests a potential mechanism underlying pregnancy loss. These findings underscore the importance of immune modulation in pregnancy outcomes and highlight the need for further research to elucidate underlying mechanisms and develop targeted interventions for optimizing maternal-fetal tolerance.

References

[1] R. Arora, A. Rathee, M. Sachdeva, and U. Agrawal, "Unexplained repeated pregnancy loss and T helper cells," European Journal of Obstetrics & Gynecology and Reproductive Biology, vol. 254, pp. 277-283, Nov. 2020.
[2] M. Jain, Z. Hassan, and S. Jain, "Study of Th 1 and Th 2 activity in women with threatened miscarriages," International Journal of Reproduction, Contraception, Obstetrics and Gynecology, vol. 4, no. 6, pp. 1918-1922, Nov. 2015.
[3] G. A. Abdullah and N. K. Mahdi, "The role of cytokines among women with spontaneous miscarriage," Medical Journal of Islamic World Academy of Sciences, vol. 21, no. 3, pp. 119-124, 2013.
[4] R. Raghupathy and J. Kalinka, "Cytokine imbalance in pregnancy complications and its modulation," Front Biosci., vol. 13, no. 1, pp. 985-994, Jan. 2008.
[5] M. P. Piccinni, R. Raghupathy, S. Saito, and J. Szekeres-Bartho, "Cytokines, hormones and cellular regulatory mechanisms favoring successful reproduction," Frontiers in Immunology, vol. 12, article 717808, Jul. 2021.
[6] M. Hisano, K. Nakagawa, J. Kwak-Kim, R. Sugiyama, H. Sago, and K. Yamaguchi, "Changes in the T-helper 1 and 2 cell populations during pregnancy in tacrolimus-treated women with repeated implantation failure and recurrent pregnancy loss," Human Fertility, vol. 25, no. 5, pp. 975-982, Oct. 2022.
[7] G. Cavalli et al., "The anti-inflammatory cytokine interleukin-37 is an inhibitor of trained immunity," Cell Rep., vol. 35, no. 1, article 108955, Apr. 2021.
[8] M. Kwiatek, T. Gęca, and A. Kwaśniewska, "Pro- and Anti-Inflammatory Cytokines in the First Trimester-Comparison of Missed Miscarriage and Normal Pregnancy," Int J Environ Res Public Health, vol. 18, no. 16, article 8538, Aug. 2021.
[9] F. Cunningham et al., "Williams Obstetrics," 23rd ed., McGrraw-Hill Companies, 2010.
[10] J. J. Oats and J. Boyle, "Llewellyn-Jones Fundamentals of Obstetrics and Gynaecology, E-Book," Elsevier Health Sciences, Nov. 4, 2022.
[11] M. Makhseed et al., "Th1 and Th2 cytokine profiles in recurrent aborters with successful pregnancy and with subsequent abortions," Human Reproduction, vol. 16, no. 10, pp. 2219-2226, Oct. 2001.
[12] M. D. Salazar Garcia et al., "Early Pregnancy Immune Biomarkers in Peripheral Blood may Predict Preeclampsia," J Reprod Immunol, vol. 125, pp. 25-31, 2018.
[13] I. C. Weel et al., "Association Between Placental Lesions, Cytokines and Angiogenic Factors in Pregnant Women With Preeclampsia," PLoS One, vol. 11, article e0157584, 2016.
[14] L. M. T. Stokkeland et al., "Serum Cytokine Patterns in First Half of Pregnancy," Cytokine, vol. 119, pp. 188-196, 2019.
[15] T. Spence et al., "Maternal Serum Cytokine Concentrations in Healthy Pregnancy and Preeclampsia," J Pregnancy, vol. 2021, article 6649608.
[16] Y. Peng and M. Wang, "Significance to investigate the TH1/TH2 cytokines and their proportions in peripheral blood of women with unexplained recurrent spontaneous abortion and normal women based on pregnancy status."
[17] Y. Gao and P. L. Wang, "Increased CD56(+) NK cells and enhanced Th1 responses in human unexplained recurrent spontaneous abortion," Genet Mol Res, vol. 14, no. 4, pp. 18103-18109, 2015.
[18] L. Y. Zhu, "Changes and clinical significance of peripheral blood helper T lymphocyte and natural killer (NK) cells in unexplained recurrent spontaneous abortion (URSA) patients after abortion and successful pregnancy," Clin Exp Obstet Gynecol, vol. 42, no. 1, pp. 62-XX.