REVIEW ARTICLE: Immunological Modes of Pregnancy Loss

Authors

  • Joanne Kwak-Kim,

    1. Reproductive Medicine Program, Department of Obstetrics and Gynecology, The Chicago Medical School at Rosalind Franklin University of Medicine and Science, Vernon Hills, IL, USA
    2. Department of Microbiology and Immunology, The Chicago Medical School at Rosalind Franklin University of Medicine and Science, Vernon Hills, IL, USA
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  • Joon Cheol Park,

    1. Reproductive Medicine Program, Department of Obstetrics and Gynecology, The Chicago Medical School at Rosalind Franklin University of Medicine and Science, Vernon Hills, IL, USA
    2. Department of Obstetrics and Gynecology, School of Medicine, Keimyung University, Daegu, Korea
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  • Hyun Kyong Ahn,

    1. Reproductive Medicine Program, Department of Obstetrics and Gynecology, The Chicago Medical School at Rosalind Franklin University of Medicine and Science, Vernon Hills, IL, USA
    2. Department of Obstetrics and Gynecology, Cheil General Hospital & Women’s Healthcare Center, Kwandong University, College of Medicine, Seoul, Korea
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  • Joon Woo Kim,

    1. Divison of Rheumatology, Department of Medicine, Feinberg School of Medicine, North Western University, Chicago, IL, USA
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  • Alice Gilman-Sachs

    1. Department of Microbiology and Immunology, The Chicago Medical School at Rosalind Franklin University of Medicine and Science, Vernon Hills, IL, USA
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Joanne Kwak-Kim, MD, Director, Reproductive Medicine, Associate Prof. Department of Obstetrics and Gynecology Associate Prof. Department of Microbiology and Immunology, The Chicago Medical School at Rosalind Franklin University of Medicine and Sciences 830 West End Court, Suite 400, Vernon Hills, IL 60061, USA.
E-mail: joanne.kwakkim@rosalindfranklin.edu

Abstract

Citation Kwak-Kim J, Park JC, Ahn HK, Kim JW, Gilman-Sachs A. Immunological modes of pregnancy loss. Am J Reprod Immunol 2010

During the implantation period, a significant portion of embryos are lost and eventually less than half of clinically established pregnancies end as full-term pregnancies without obstetrical complications. A significant portion of these pregnancy losses is associated with immune etiologies, including autoimmune and cellular immune abnormalities. Although an autoimmune etiology such as anti-phospholipid antibodies (APAs) has been reported to induce placental infarct and thrombosis at maternal–fetal interface, APAs induce inflammatory immune responses as well. Inflammatory immune responses, such as increased proportions of NK cells and Th1/Th2 cell ratios in peripheral blood are related to recurrent pregnancy losses and multiple implantation failures. Systemic and local inflammatory immune responses seem to be induced by activation of Toll-like receptors with infectious agents, fetal cell debris, or gonadotropin-releasing hormone agonist, etc. Cellular activation of T and NK cells leads to pro-inflammatory cytokine storm and consequently, placental infarction and thrombosis. Potential application of anti-inflammatory therapeutic agents for the prevention of pregnancy losses should be explored further.

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