ВИЖ И ТОВА :
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Abstract
Objective: The present study was conducted to evaluate the efficacy of immunotherapy with husband's lymphocytes in women with recurrent spontaneous abortion (RSA).
Methods: A total of 205 women with three or more consecutive abortions were screened for known causes of recurrent spontaneous abortion. Only 105 women were registered for immunotherapy after excluding the women who had one or the other known cause of abortion. 73 women were registered for immunotherapy against husband's lymphocytes. 32 women were registered under double blind randomized trial. These women were negative for antipaternal cytotoxic antibodies against their husband's cells.
Success rate of immunotherapy was same in both the groups.
Results: Immunotherapy with husband cells in 73 RSA women was carried out in non-randomized trial. Our results show that the success rate was significantly higher (86%) when compared to other groups of the present study i.e. RSA women who declined to enter the trial (33%), dropouts (50%) and antipaternal cytotoxicity negative RSA women (30%). Antipaternal cytotoxic antibodies (APCA) were taken as the measure of immuno-potentiation. Our results indicate that APCA can be taken as a good indicator for selecting patients for immunotherapy and also to measure whether the RSA women is adequately immunized or not. We have also seen the effect of husband's cells in double blind randomized trial group (32 RSA women). The success rate was 85%, which is comparable to non-randomized trial group.
Conclusions: Our results indicate the importance of immunotherapy with husband's lymphocytes in RSA women and also show that APCA can be considered as one of the important immuno-potentiating factor.
Recurrent spontaneous abortion (RSA) can be defined as occurrence of three or more clinically detectable pregnancy lose before 20th weeks of gestation from the last menstrual period or less than 500 grams of foetal body weight ( 5 , 6 ). It occurs approximately 1 in 300 pregnant women ( 7 ).
RSA can be classified into primary RSA aborters and secondary RSA aborters. Primary RSA aborters are those women who have lost all previous pregnancies and no live birth. Secondary RSA aborters are those who have at least one successful pregnancy irrespective of the number of pregnancy loss.
In most women who experience recurrent miscarriage, no cause can be identified. Alloimmune mechanisms that prevent mothers from developing immunological responses essential for the survival of the semiallogeneic pregnancy have been proposed as the cause of fifty percent of all these losses. Embryo rejection in animal models appears to depend upon activated natural killer (NK) cells rather then on antigen specific effector cells. It has been shown in animal model that granulocyte macrophage colony stimulating factor (GM-CSF) may prevent spontaneous abortion by prevention of NK cells and in humans CD56+ lymphoid cells secrete a novel transforming growth factor, 2, which has been shown to be immunosuppressive in nature ( 8 , 9 , 10 ). Activation of the maternal immune system suppresses NK cells (9, 11 , 12 ). It has been reported that alloimmunization may modify the maternal immune response therefore immunization have been used to prevent further miscarriages ( 13 , 14 , 15 , 16 , 17 , 18 ).
For immunotherapy with husband's cells
A closer examination of the immunotherapy group revealed that the success rate of pregnancy in the adequately immunized group was 86% in the present study, which is in accord to the other reported studies
The exact mechanism, which may play a role in the maintenance of pregnancy, is the participation of suppressor cells (26, 30 ). It was reported that lymphocyte immunization cause an increase in progesterone induced blocking factor (PIBf) in RSA women, which may play a role in the maintenance of pregnancy by balancing the production of cytokines (21).Further it was suggested that paternal lymphocytes immunization is responsible for modulation of immunity in women with unexplained recurrent spontaneous abortion as a result of which there is a shift in the balance for cytokine profiles away from Th1 type reactivity to Th2 type reactivity. This shift of cytokines is essential for the maintenance and continuation of successful pregnancy ( 31 ).
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