Chronic histiocytic intervillositis: A breakdown in immune tolerance comparable to allograft rejection?
Chronic histiocytic intervillositis: A breakdown in immune tolerance comparable to allograft rejection?
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DOI：
10.1111/aji.13373
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发表时间：
2021-03
期刊：
影响因子：
--
通讯作者：
Crocker IP
中科院分区：
文献类型：
--
作者：
Brady CA;Williams C;Sharps MC;Shelleh A;Batra G;Heazell AEP;Crocker IP
慢性组织细胞性绒毛间炎（CHI）是一种妊娠疾病，其特征是母体巨噬细胞浸润到人胎盘的绒毛间隙，通常伴有绒毛周围纤维蛋白沉积。CHI与胎儿生长受限以及流产和死产风险增加密切相关。虽然罕见，每10 000例妊娠中有6例超过12周妊娠，但复发率高达25%-100%。迄今为止，由于缺乏诊断性生物标志物，CHI的诊断只能在分娩后检查胎盘后进行，并且标准因出版物而异。没有治疗方案已被证明有效，CHI仍然是一个严重的产科难题。尽管其潜在病因尚不清楚，但由于母体巨噬细胞的存在以及报告的自身免疫性疾病女性的发病率增加，CHI被假设为对半同种异体胎儿的不适当免疫应答。由于缺乏了解，治疗方法仍然是实验性的，理由有限。然而，最近有证据表明，免疫抑制和抗血栓治疗可能是有效的，在预防复发的相关不良妊娠结局。由于CHI的病理特征与实体器官移植的急性排斥反应之间存在相似性，因此对这一假设的进一步研究可能为解决CHI和其他免疫相关的胎盘疾病提供基础。本文将探讨CHI和同种异体移植排斥反应之间的相似之处，并确定需要进一步确认和利用这种比较的领域。
Chronic histiocytic intervillositis (CHI) is a pregnancy disorder characterized by infiltration of maternal macrophages into the intervillous space of the human placenta, often with accompanying perivillous fibrin deposition. CHI is associated strongly with foetal growth restriction and increased risk of miscarriage and stillbirth. Although rare, affecting 6 in every 10 000 pregnancies beyond 12 weeks’ gestation, the rate of recurrence is high at 25%–100%. To date, diagnosis of CHI can only be made post‐delivery upon examination of the placenta due to a lack of diagnostic biomarkers, and criteria vary across publications. No treatment options have shown proven efficacy, and CHI remains a serious obstetric conundrum. Although its underlying aetiology is unclear, due to the presence of maternal macrophages and the reported increased incidence in women with autoimmune disease, CHI is hypothesized to be an inappropriate immune response to the semi‐allogeneic foetus. Given this lack of understanding, treatment approaches remain experimental with limited rationale. However, there is recent evidence that immunosuppression and antithrombotic therapies may be effective in preventing recurrence of associated adverse pregnancy outcomes. With similarities noted between the pathological features of CHI and acute rejection of solid organ transplants, further investigation of this hypothesis may provide a basis for tackling CHI and other immune‐related placental conditions. This review will explore parallels between CHI and allograft rejection and identify areas requiring further confirmation and exploitation of this comparison.
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DOI：
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发表时间：
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影响因子：
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