nach oben

Erschienen in:

2017 | OriginalPaper | Buchkapitel

18. Immunologie: Diagnostik und Therapie

verfasst von : Ruben J. Kuon, Bettina Toth

Erschienen in: Fehlgeburten Totgeburten Frühgeburten

Verlag: Springer Berlin Heidelberg

Einloggen, um Zugang zu erhalten

Zusammenfassung

Immunologische Veränderungen können bei Frauen mit Fehlgeburten identifiziert werden. Es ist jedoch unklar, ob diese Ursache oder Folge der Fehlgeburt sind. Bei der immunologischen Diagnostik werden verschiedene autoimmune und allogene Faktoren betrachtet. Zur immunmodulierenden Therapie werden u.a. Glucocorticoide, Immunglobuline, Granulocyte-Colony Stimulating Factor, Intralipide und TNF-Inhibitoren eingesetzt. Es fehlt bislang eine eindeutige Zuordnung eines diagnostischen Markers zu einer gezielten immunmodulatorischen Therapie.

Akhter A, Faridi RM, Das V, Pandey A, Naik S, Agrawal S (2012) In vitro up-regulation of HLA-G using dexamethasone and hydrocortisone in first-trimester trophoblast cells of women experiencing recurrent miscarriage. Tissue Antigens 80: 126–135CrossRefPubMed

Ata B, Tan SL, Shehata F, Holzer H, Buckett W (2011) A systematic review of intravenous immunoglobulin for treatment of unexplained recurrent miscarriage. Fertility and Sterility 95: 1080–5.e1–2

Beaman KD, Ntrivalas E, Mallers TM, Jaiswal MK, Kwak-Kim J, Gilman-Sachs A (2012) Immune etiology of recurrent pregnancy loss and its diagnosis. Am J Reprod Immunol 67: 319–325CrossRefPubMed

Beta J, Szekeres-Bartho J, Skyfta E, Akolekar R, Nicolaides KH (2011) Maternal serum progesterone-induced blocking factor at 11–13 weeks’ gestation in spontaneous early preterm delivery. Fetal Diagn Ther 29: 197–200CrossRefPubMed

Beydoun H, Saftlas AF (2005) Association of human leucocyte antigen sharing with recurrent spontaneous abortions. Tissue Antigens 65: 123–135CrossRefPubMed

Bingley PJ, Williams AJK, Norcross AJ, Unsworth DJ, Lock RJ, Ness AR, Jones RW, Avon Longitudinal Study of Parents and Children Study Team (2004) Undiagnosed coeliac disease at age seven: population based prospective birth cohort study. BMJ 328: 322–323CrossRefPubMedPubMedCentral

Bustos D, Moret A, Tambutti M, Gogorza S, Testa R, Ascione A, Prigoshin N (2006) Autoantibodies in Argentine women with recurrent pregnancy loss. Am J Reprod Immunol 55: 201–207CrossRefPubMed

Carp HJA, Shoenfeld Y (2007) Recurrent spontaneous abortions in antiphospholipid syndrome: natural killer cells - an additional mechanism in a multi factorial process. Rheumatology 46: 1517–1519CrossRefPubMed

Choi BC, Polgar K, Xiao L, Hill JA (2000) Progesterone inhibits in-vitro embryotoxic Th1 cytokine production to trophoblast in women with recurrent pregnancy loss. Hum Reprod 15 (suppl 1): 46–59CrossRefPubMed

Christiansen OB, Pedersen B, Rosgaard A, Husth M (2002) A randomized, double-blind, Placebo-controlled trial of intravenous immunoglobulin in the prevention of recurrent miscarriage: evidence for a therapeutic effect in women with secondary recurrent miscarriage. Hum Reprod 17: 809–816CrossRefPubMed

Christiansen OB, Larsen EC, Egerup P, Lunoee L, Egestad L, Nielsen HS (2015) Intravenous immunoglobulin treatment for secondary recurrent miscarriage: a randomised, double-blind, Placebo-controlled trial. BJOG 122: 500–508CrossRefPubMed

Coomarasamy A, Williams H, Truchanowicz E, Seed PT, Small R, Quenby S, Gupta P, Dawood F, Koot YEM, Bender Atik R, et al. (2015) A randomized trial of progesterone in women with recurrent miscarriages. N Engl J Med 373: 2141–2148CrossRefPubMed

Coulam CB, Acacio B (2012) Does immunotherapy for treatment of reproductive failure enhance live births? Am J Reprod Immunol 67: 296–304CrossRefPubMed

Croy BA, van den Heuvel MJ, Borzychowski AM, Tayade C (2006) Uterine natural killer cells: a specialized differentiation regulated by ovarian hormones. Immunol Rev 214: 161–185CrossRefPubMed

Druckmann R, Druckmann MA (2005) Progesterone and the immunology of pregnancy. J Steroid Biochem Mol Biol 97: 389–396CrossRefPubMed

Eblen AC, Gercel-Taylor C, Shields LB, Sanfilippo JS, Nakajima ST, Taylor DD (2000) Alterations in humoral immune responses associated with recurrent pregnancy loss. Fertility and Sterility 73: 305–313CrossRefPubMed

Empson M, Lassere M, Craig J, Scott J (2005) Prevention of recurrent miscarriage for women with antiphospholipid antibody or lupus anticoagulant. Cochrane Database Syst Rev CD002859

Ensom MHH, Stephenson MD (2011) A two-center study on the pharmacokinetics of intravenous immunoglobulin before and during pregnancy in healthy women with poor obstetrical histories. Human Reproduction 26: 2283–2288CrossRefPubMedPubMedCentral

Fawzy M, Shokeir T, El-Tatongy M, Warda O, El-Refaiey A, Mosbah A (2008) Treatment options and pregnancy outcome in women with idiopathic recurrent miscarriage: a randomized Placebo-controlled study. Arch Gynecol Obstet 278: 33–38CrossRefPubMed

Fukui A, Kwak-Kim J, Ntrivalas E, Gilman-Sachs A, Lee SK, Beaman K (2008) Intracellular cytokine expression of peripheral blood natural killer cell subsets in women with recurrent spontaneous abortions and implantation failures. Fertility and Sterility 89: 157–165CrossRefPubMed

Gomaa MF, Elkholy AG, El-Said MM, Abdel-Salam NE (2014) Combined oral prednisolone and heparin versus heparin: the effect on peripheral NK cells and clinical outcome in patients with unexplained recurrent miscarriage. A double-blind Placebo randomized controlled trial. Arch Gynecol Obstet 290: 757–762CrossRefPubMedPubMedCentral

Granato D, Blum S, Rössle C, Le Boucher J, Malnoë A, Dutot G (2000) Effects of parenteral lipid emulsions with different fatty acid composition on immune cell functions in vitro. J Parenter Enteral Nutr 24: 113–118CrossRef

Haas DM, Ramsey PS (2013) Progestogen for preventing miscarriage. Cochrane Database Syst Rev 10: CD003511

Hadziselimovic F, Geneto R, Buser M (2007) Celiac disease, pregnancy, small for gestational age: role of extravillous trophoblast. Fetal Pediatr Pathol 26: 125–134CrossRefPubMed

Hiby SE, Regan L, Lo W, Farrell L, Carrington M, Moffett A (2008) Association of maternal killer-cell immunoglobulin-like receptors and parental HLA-C genotypes with recurrent miscarriage. Human Reproduction 23: 972–976CrossRefPubMed

Hiby SE, Walker JJ, O’shaughnessy KM, Redman CWG, Carrington M, Trowsdale J, Moffett A (2004) Combinations of maternal KIR and fetal HLA-C genes influence the risk of preeclampsia and reproductive success. J Exp Med 200: 957–965CrossRefPubMedPubMedCentral

Hughes GRV (2011) Hughes syndrome (the antiphospholipid syndrome): a disease of our time. Inflammopharmacology 19: 69–73CrossRefPubMed

Huong DL, Wechsler B, Bletry O, Vauthier-Brouzes D, Lefebvre G, Piette JC (2001) A study of 75 pregnancies in patients with antiphospholipid syndrome. J Rheumatol 28: 2025–2030PubMed

Jauniaux E, Farquharson RG, Christiansen OB, Exalto N (2006) Evidence-based guidelines for the investigation and medical treatment of recurrent miscarriage. Hum Reprod 21: 2216–2222CrossRefPubMed

de Jong PG, Kaandorp S, Di Nisio M, Goddijn M, Middeldorp S (2014) Aspirin and/or heparin for women with unexplained recurrent miscarriage with or without inherited thrombophilia. Cochrane Database Syst Rev 7: CD004734

Kaandorp SP, Goddijn M, van der Post JAM, Hutten BA, Verhoeve HR, Hamulyák K, Mol BW, Folkeringa N, Nahuis M, Papatsonis DNM et al. (2010) Aspirin plus heparin or aspirin alone in women with recurrent miscarriage. N Engl J Med 362: 1586–1596CrossRefPubMed

Kitaya K, Yamaguchi T, Yasuo T, Okubo T, Honjo H (2007) Post-ovulatory rise of endometrial CD16(−) natural killer cells: in situ proliferation of residual cells or selective recruitment from circulating peripheral blood? Journal of Reproductive Immunology 76: 45–53

Kolho KL, Tiitinen A, Tulppala M, Unkila-Kallio L, Savilahti E (1999) Screening for coeliac disease in women with a history of recurrent miscarriage or infertility. Br J Obstet Gynaecol 106: 171–173CrossRefPubMed

Kumar A, Meena M, Begum N, Kumar N, Gupta RK, Aggarwal S, Prasad S, Batra S (2011) Latent celiac disease in reproductive performance of women. Fertility and Sterility 95: 922–927CrossRefPubMed

Kurien BT, Scofield RH (2006) Autoantibody determination in the diagnosis of systemic lupus erythematosus. Scand J Immunol 64: 227–235CrossRefPubMed

Kwak-Kim J, Agcaoili MSL, Aleta L, Liao A, Ota K, Dambaeva S, Beaman K, Kim JW, Gilman-Sachs A (2013) Management of women with recurrent pregnancy losses and antiphospholipid antibody syndrome. Am J Reprod Immunol 69: 596–607CrossRefPubMed

Lash GE, Bulmer JN (2011) Do uterine natural killer (uNK) cells contribute to female reproductive disorders? Journal of Reproductive Immunology 88: 156–164PubMed

Lee SK, Kim JY, Lee M, Gilman-Sachs A, Kwak-Kim J (2012) Th17 and regulatory T cells in women with recurrent pregnancy loss. Am J Reprod Immunol 67: 311–318CrossRefPubMed

McCracken SA, Grant KE, MacKenzie IZ, Redman CW, Mardon HJ (1999) Gestational regulation of granulocyte-colony stimulating factor receptor expression in the human placenta. Biol Reprod 60: 790–796CrossRefPubMed

Miyakis S, Lockshin MD, Atsumi T, Branch DW, Brey RL, Cervera R, Derksen RH, De Groot PG, Koike T, Meroni PL et al. (2006) International consensus statement on an update of the classification criteria for definite antiphospholipid syndrome (APS). J Thromb Haemost 4(2): 295–306CrossRefPubMed

Moffett A, Shreeve N (2015) First do no harm: uterine natural killer (NK) cells in assisted reproduction. Human Reproduction 30: 1519–1525CrossRefPubMedPubMedCentral

Moraru M, Carbone J, Alecsandru D, Castillo-Rama M, García-Segovia A, Gil J, Alonso B, Aguarón A, Ramos-Medina R, Martínez de María J et al. (2012) Intravenous immunoglobulin treatment increased live birth rate in a Spanish cohort of women with recurrent reproductive failure and expanded CD56(+) cells. Am J Reprod Immunol 68: 75–84CrossRefPubMed

Ober C, Elias S, Kostyu DD, Hauck WW (1992) Decreased fecundability in Hutterite couples sharing HLA-DR. Am J Hum Genet 50: 6–14PubMedPubMedCentral

Park-Wyllie L, Mazzotta P, Pastuszak A (2000) Birth defects after maternal exposure to corticosteroids: prospective cohort study and meta-analysis of epidemiological studies. Teratology 62(6): 385–392CrossRefPubMed

Pasquier E, de Saint Martin L, Bohec C, Chauleur C, Bretelle F, Marhic G, Le Gal G, Debarge V, Lecomte F, Denoual-Ziad C et al. (2015) Enoxaparin for prevention of unexplained recurrent miscarriage: a multicenter randomized double-blind Placebo-controlled trial. Blood 125: 2200–2205CrossRefPubMedPubMedCentral

Perricone C, de Carolis C, Perricone R (2012) Pregnancy and autoimmunity: a common problem. Best Practice and Research Clinical Rheumatology 26: 47–60CrossRefPubMed

Porter TF, LaCoursiere Y, Scott JR (2012) Immunotherapy for recurrent miscarriage. Cochrane Database Syst Rev 2: CD000112

Quaranta M, Erez O, Mastrolia SA, Koifman A, Leron E, Eshkoli T, Mazor M, Holcberg G (2015) The physiologic and therapeutic role of heparin in implantation and placentation. Peer J 3: e691CrossRef

Quenby S, Kalumbi C, Bates M, Farquharson R, Vince G (2005) Prednisolone reduces preconceptual endometrial natural killer cells in women with recurrent miscarriage. Fertility and Sterility 84: 980–984CrossRefPubMed

Rai RS, Clifford K, Cohen H, Regan L (1995) High prospective fetal loss rate in untreated pregnancies of women with recurrent miscarriage and antiphospholipid antibodies. Hum Reprod 10: 3301–3304PubMed

Robertson MJ, Ritz J (1990) Biology and clinical relevance of human natural killer cells. Blood 76: 2421–2438PubMed

Robson A, Harris LK, Innes BA, Lash GE, Aljunaidy MM, Aplin JD, Baker PN, Robson SC, Bulmer JN (2012) Uterine natural killer cells initiate spiral artery remodeling in human pregnancy. Faseb J 26: 4876–4885CrossRefPubMed

Roussev RG, Acacio B, Ng SC, Coulam CB (2008) Duration of intralipid“s suppressive effect on NK cells functional activity. Am J Reprod Immunol 60: 258–263CrossRefPubMed

Rychly DJ, DiPiro JT (2005) Infections associated with tumor necrosis factor-alpha antagonists. Pharmacotherapy 25: 1181–1192CrossRefPubMed

Sacks G (2015) Enough! Stop the arguments and get on with the science of natural killer cell testing. Hum Reprod 30(7): 1526–1531CrossRefPubMed

Santjohanser C, Knieper C, Franz C, Hirv K, Meri O, Schleyer M, Würfel W, Toth B (2013) Granulocyte-colony stimulating factor as treatment option in patients with recurrent miscarriage. Arch Immunol Ther Exp 61: 159–164CrossRef

Sasaki Y, Sakai M, Miyazaki S, Higuma S, Shiozaki A, Saito S (2004) Decidual and peripheral blood CD4+CD25+ regulatory T cells in early pregnancy subjects and spontaneous abortion cases. Mol Hum Reprod 10: 347–353CrossRefPubMed

Scarpellini F, Sbracia M (2009) Use of granulocyte colony-stimulating factor for the treatment of unexplained recurrent miscarriage: a randomised controlled trial. Human Reproduction 24: 2703–2708CrossRefPubMed

Schleussner E, Kamin G, Seliger G, Rogenhofer N, Ebner S, Toth B, Schenk M, Henes M, Bohlmann MK, Fischer T et al. (2015) Low-molecular-weight heparin for women with unexplained recurrent pregnancy loss: a multicenter trial with a minimization randomization scheme. Ann Intern Med 162: 601–609CrossRefPubMed

Seshadri S, Sunkara SK (2014) Natural killer cells in female infertility and recurrent miscarriage: a systematic review and meta-analysis. Human Reproduction Update 20: 429–438CrossRefPubMed

Shoenfeld Y, Carp HJA, Molina V, Blank M, Cervera R, Balasch J, Tincani A, Faden D, Lojacono A, Doria A et al. (2006) Autoantibodies and prediction of reproductive failure. Am J Reprod Immunol 56: 337–344CrossRefPubMed

Stephenson MD, Kutteh WH, Purkiss S, Librach C, Schultz P, Houlihan E, Liao C (2010) Intravenous immunoglobulin and idiopathic secondary recurrent miscarriage: a multicentered randomized Placebo-controlled trial. Human Reproduction 25: 2203–2209CrossRefPubMedPubMedCentral

Tang AW, Alfirevic Z, Quenby S (2011) Natural killer cells and pregnancy outcomes in women with recurrent miscarriage and infertility: a systematic review. Human Reproduction 26: 1971–1980CrossRefPubMed

Tang AW, Alfirevic Z, Turner MA, Drury JA, Small R, Quenby S (2013) A feasibility trial of screening women with idiopathic recurrent miscarriage for high uterine natural killer cell density and randomizing to prednisolone or Placebo when pregnant. Human Reproduction 28: 1743–1752CrossRefPubMed

Tatar G, Elsurer R, Simsek H, Balaban YH, Hascelik G, Ozcebe OI, Buyukasik Y, Sokmensuer C (2004) Screening of tissue transglutaminase antibody in healthy blood donors for celiac disease screening in the Turkish population. Dig Dis Sci 49: 1479–1484CrossRefPubMed

Tempfer CB, Kurz C, Bentz EK, Unfried G, Walch K, Czizek U, Huber JC (2006) A combination treatment of prednisone, aspirin, folate, and progesterone in women with idiopathic recurrent miscarriage: a matched-pair study. Fertility and Sterility 86: 145–148CrossRefPubMed

Tersigni C, Castellani R, de Waure C, Fattorossi A, De Spirito M, Gasbarrini A, Scambia G, Di Simone N (2014) Celiac disease and reproductive disorders: meta-analysis of epidemiologic associations and potential pathogenic mechanisms. Human Reproduction Update 20: 582–593CrossRefPubMed

Thum MY, Bhaskaran S, Abdalla HI, Ford B, Sumar N, Bansal A (2008) Prednisolone suppresses NK cell cytotoxicity in vitro in women with a history of infertility and elevated NK cell cytotoxicity. Am J Reprod Immunol 59: 259–265CrossRefPubMed

Toth B, Jeschke U, Rogenhofer N, Scholz C, Würfel W, Thaler CJ, Makrigiannakis A (2010) Recurrent miscarriage: current concepts in diagnosis and treatment. Journal of Reproductive Immunology 85: 25–32CrossRefPubMed

Trowsdale J, Moffett A (2008) NK receptor interactions with MHC class I molecules in pregnancy. Semin. Immunol 20: 317–320CrossRefPubMed

Vaquero E, Lazzarin N, De Carolis C, Valensise H, Moretti C, Ramanini C (2000) Mild thyroid abnormalities and recurrent spontaneous abortion: diagnostic and therapeutical approach. Am J Reprod Immunol 43: 204–208CrossRefPubMed

Wang WJ, Hao CF, Yi-Lin, Yin GJ, Bao SH, Qiu LH, Lin QD (2010) Increased prevalence of T helper 17 (Th17) cells in peripheral blood and decidua in unexplained recurrent spontaneous abortion patients. Journal of Reproductive Immunology 84: 164–170CrossRefPubMed

Winger EE, Reed JL (2008) Treatment with tumor necrosis factor inhibitors and intravenous immunoglobulin improves live birth rates in women with recurrent spontaneous abortion. Am J Reprod Immunol 60(1): 8–16CrossRefPubMed

Titel: Immunologie: Diagnostik und Therapie
verfasst von: Ruben J. Kuon
Bettina Toth
Verlag: Springer Berlin Heidelberg
Buch: Fehlgeburten Totgeburten Frühgeburten
Print ISBN: 978-3-662-50423-9

Electronic ISBN: 978-3-662-50424-6

Copyright-Jahr: 2017
DOI: https://doi.org/10.1007/978-3-662-50424-6_18

Neu im Fachgebiet Gynäkologie und Geburtshilfe

23.04.2024 | Medikamente in Schwangerschaft und Stillzeit | Nachrichten

Update Gynäkologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert – ganz bequem per eMail.

Newsletter bestellen

Live-Webinar: Aktuelle Leitlinien bei Herz-Kreislauf-Erkrankungen

Springer Medizin

18. Immunologie: Diagnostik und Therapie

Zusammenfassung

Neu im Fachgebiet Gynäkologie und Geburtshilfe

ICI-Therapie in der Schwangerschaft wird gut toleriert

Weniger postpartale Depressionen nach Esketamin-Einmalgabe

Bei RSV-Impfung vor 60. Lebensjahr über Off-Label-Gebrauch aufklären!

Harnwegsinfektprophylaxe: Es geht auch ohne Antibiotika

Update Gynäkologie

Live-Webinar: Aktuelle Leitlinien bei Herz-Kreislauf-Erkrankungen

Springer Medizin

Zusammenfassung

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Neu im Fachgebiet Gynäkologie und Geburtshilfe

ICI-Therapie in der Schwangerschaft wird gut toleriert

Weniger postpartale Depressionen nach Esketamin-Einmalgabe

Bei RSV-Impfung vor 60. Lebensjahr über Off-Label-Gebrauch aufklären!

Harnwegsinfektprophylaxe: Es geht auch ohne Antibiotika

Update Gynäkologie