IMUNSKI SISTEM U TRUDNOĆI
Ključne reči:
imunski sistem, trudnoća, proinflamtorno i antiinflamatorno stanje, imunološki satApstrakt
Uvod: Trudnice se smatraju posebnom populacijskom grupom usled promene statusa imunološkog sistema uzrokovanog trudnoćom. Imunski sistem majke igra ključnu ulogu u razvoju deteta tokom trudnoće, ali promene u cirkulišućim imunološkim medijatorima kod majke i novorođenčeta mogu biti povezane sa komplikacijama trudnoće i podložnošću autoimunim i neurorazvojnim stanjima deteta. Bitno je istražiti ovu oblast koja predstavlja izazov za donošenje odluka o pristupu, sprečavanju i lečenju infektivnih i inflamatornih oboljenja kod trudnica, kako bi se izbegli neželjeni ishodi po majku i plod.
Pregled: U literaturi ne postoji konsenzus o shvatanju imunskog sistema trudnice kao proimflamatornog ili antiinflamatornog stanja. Međutim, većina autora se slaže da se trudnoća ne može posmatrati kao pojedinačni događaj i da zapravo ima tri različite faze, koje karakterišu različiti biološki i imunski procesi, koji odgovaraju aktuelnom stanju trudnice.
Svrha ovog rada je prikaz sistematskog pregleda dostupne literature zasnovane na dokazima, koja se odnosi na promene adaptivnog i stečenog imuniteta u trudnoći kao i postojanje “imunološkog sata” koji se smatra ključnim za traženje hronoloških odstupanja povezanih sa patološkim stanjima kod žena tokom trudnoće.
Zaključak: Ova analiza pruža informacije o imunskim promenama i disregulaciji tokom trudnoće, koja potencijalno može dovesti do neželjenih ishoda poput preeklampsije, usporavanja rasta fetusa i pobačaja.
Reference
Lyall K, Schmidt RJ, Hertz-Picciotto I. Environmental factors in the preconception and prenatal periods in relation to risk for ASD. In: Volkmar FR, Paul R, Rogers SJ, Pelphrey KA, editors. Handbook of autism and pervasive developmental disorders, fourth edition: assessment, interventions, policy, the future. Fourth ed. Hoboken: Wiley; 2014; 424–56.
Hsu P, Nanan RK. Innate and adaptive immune interactions at the fetal maternal interface in healthy human pregnancy and preeclampsia. Front Immunol. 2014;5:125.
Laloraya M, Padmanabhan AR. Forbearance of the Immune System during Pregnancy: Fetal Parasite Takes an Estrogenic Way Reproductive Immunol Open Acc 2016; 1:21.
Khan D, Ansar AS. The Immune System Is a Natural Target for Estrogen Action: Opposing Effects of Estrogen in Two Prototypical Autoimmune Diseases. Front Immunol 2016; 6: 635.
Aluvihare VR, Kallikourdis M, Betz AG: Regulatory T cells mediate maternal tolerance to the fetus. Nat Immunol 2004; 5:266–271.
Mor G, Straszewski-Chavez SL, Abrahams VM: Macrophage–trophoblast interactions. Methods Mol Med 2006; 122:149–163.
Wicherek L, Basta P, Pitynski K, Marianowski P, Kijowski J, Wiatr J, Majka M: The characterization of the subpopulation of suppressive B7H4(+) macrophages and the subpopulation of CD25(+) CD4(+) and FOXP3(+) regulatory T-cells in decidua during the secretory cycle phase, Arias Stella reaction, and spontaneous abortion – a preliminary report. Am J ReprodImmunol 2009; 61:303–312.
Greenwood JD, Minhas K, di Santo JP, Makita M, Kiso Y, Croy BA: Ultrastructural studies of implantation sites from mice deficient in uterine natural killer cells. Placenta 2000; 21:693–702.
Le Bouteiller P, Piccinni MP: Human NK cells in pregnant uterus: why there? Am J Reprod Immunol 2008; 59:401–406.
Wegmann T: Fetal protection against abortion: is it immunosupression or immunostimulation? Ann Immunol 1984; 135D:309–312.
11.Szekeres-Bartho J, Wegmann TG: A progesterone dependent immunomodulatory protein alters the Th1 ⁄ Th2 balance. J ReprodImmunol 1996; 31:81–95.
Wegmann TG, Lin H, Guilbert L, Mosmann TR: Bidirectional cytokine interactions in the maternalfetal relationship: is successful pregnancy a TH2 phenomenon? Immunol Today 1993; 14:353–356.
Saito S, Miyazaki S, Sasaki Y: Th1 ⁄ Th2 Balance of the Implantation Site in Humans. Georgetown, TX, Landes Bioscience ⁄ Springer Science, 2006.
Mor G: Pregnancy reconceived. Nat Hist 2007; 116:36–41.
Mor G, Koga K: Macrophages and pregnancy. Reprod Sci 2008; 15:435–436.
16 Mor G, Abrahams V: Immunology of implantation. In Immunology and Allergy Clinics, A Arici (ed). Philadelphia, W.B. Saunders Company, 2002, pp 545– 565.
Romero R, Espinoza J, Kusanovic JP, Gotsch F, Hassan S, Erez O, Chaiworapongsa T, Mazor M: The preterm parturition syndrome. BJOG 2006; 113(Suppl. 3):17–42.
Romero R, Espinoza J, Goncalves LF, Kusanovic JP, Friel LA, Nien JK: Inflammation in preterm and term labour and delivery. Semin Fetal Neonatal Med 2006; 11:317–326.
Romero R: Novel aspects of neutrophil biology in human pregnancy. Am J Reprod Immunol 2005; 53:275.
Mor G: Inflammation and pregnancy: the role of toll like receptors in trophoblast-immune interaction. Ann N Y Acad Sci 2008; 1127:121–128.
Laresgoiti-Servitje E. A leading role for the immune system in the pathophysiology of preeclampsia. J Leukoc Biol. 2013; 94(2):247-57.
Robertson SA. Seminal plasma and male factor signalling in the female reproductive tract. Cell Tissue Res 2005; 322:43–52.
Filipović, I., Filipović, Đ. 2010, "Fetus kao alograft", Naučni časopis urgentne medicine - Halo 94, vol. 16, no. 3, pp. 126-130.
Prabhu Das M, Bonney E, Caron K, Dey S, Erlebacher A, Fazleabas A, Fisher S, et al. Immune mechanisms at the maternal-fetal interface: Perspectives and challenges. Nat. Immunol 2015; 16, 328–334.
.Romero R, Dey SK, Fisher SJ. Preterm labor: One syndrome, many causes. Science 2014; 345, 760–765.
Arck PC,Hecher K. Fetomaternal immune cross-talk and its consequences for maternal and off spring’s health. Nat. Med 2013; 99, 548–556.
Aghaeepour, N. et al. An immune clock of human pregnancy. Sci. Immunol 2017; 2: 2946.
Kay AW, Fukuyama J, Aziz N, Dekker CL, Mackey S, Swan GE,Davis MM, Holmes S, Blish CA. Enhanced natural killer-cell and T-cell responses to influenza A virus during pregnancy. Proc Natl Acad Sci U.S.A.2014; 111:14506–14511.
Le Gars M, Kay AW, Bayless NL, Aziz N, Dekker CL, Swan GE, Davis MM, Blish CA. Increased proinflammatory responses of monocytes and plasmacytoid dendritic cells to influenza A virus infection during pregnancy. J Infect Dis 2016; 214, 1666–1671.
