Immunopathology of the Implantation Site Utilizing Monoclonal Antibodies to Natural Killer Cells in Women with Recurrent Pregnancy Losses

Authors

  • Joanne Y.H. Kwak M.D,

    Corresponding author
    1. Departments of Obstetrics and Gynecology, Microbiology and Immunology, FUHS/The Chicago Medical School, North Chicago, IL 60064
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  • Alan E. Beer,

    1. Departments of Obstetrics and Gynecology, Microbiology and Immunology, FUHS/The Chicago Medical School, North Chicago, IL 60064
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  • Sung Hee Kim,

    1. Bioleda Association, Los Alamitos, CA 90720
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  • Harris P. Mantouvalos

    1. Departments of Obstetrics and Gynecology, Microbiology and Immunology, FUHS/The Chicago Medical School, North Chicago, IL 60064
    2. Center for the Immunological Study of Recurrent Spontaneous Abortions, University of Athens, Athens, Greece
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Reproductive Medicine, Department of Obstetrics and Gynecology, Department of Microbiology and Immunology, FUHS/The Chicago Medical School, 3333 Green Bay Road, North Chicago, IL 60064, USA.

Abstract

PROBLEM: Placental lesions of 71 women with documented recurrent spontaneous abortions of unknown etiology were evaluated using immunohistochemical staining.

METHOD OF STUDY: Placental tissue blocks (less than 12 weeks gestation) from prior pregnancy losses were obtained, recut, and analyzed utilizing monoclonal antibody to identify the trophoblast (cytokeratin 8/18) and natural killer (NK) cells (CD57) at the implantation site. The following features were evaluated: trophoblast invasion pattern; syncytium formation; vasculitis and thromboembolism of decidual vessels: decidual inflammation; decidual necrosis; fibrin deposition at the decidual necrosis site; mononuclear-cell infiltration in villi and intervillous space; perivillous fibrin deposition; trophoblast morphology; and quantitation of CD57 + NK cells within the decidual tissue near the implantation site. Controls consisted of 20 healthy women with no history of recurrent pregnancy losses, who had their pregnancies electively terminated.

RESULTS: Of the women studied, 29.6% demonstrated elevated CD57 + NK cells at the implantation site (P = 0.030), 54.1% had inadequate cytotrophoblast invasion depth (P = 0.000), 44.1% demonstrated inadequate syncytium formation (P = 0.004), and 33.9% presented thromboembolism in decidual vessels (P = 0.025).

CONCLUSION: Some women with recurrrent spontaneous abortions demonstrate abnormal placental lesions at the implantation site. Immunopathologic evaluation of the placental implantation site that terminated in a spontaneous abortion may reveal the immunopathogenesis of previous pregnancy losses.

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