Abstract
Recurrent spontaneous miscarriage (RSM) and idiopathic infertility (IIF) are partially caused by immunologic disturbances. Paternal lymphocyte immunization (PLI) is proposed for restoration of the proper Th1/Th2 balance in these patients, but still there are controversies on PLI mechanism, its efficacy and identification of patients who may benefit from this therapy. The study group consisted of n = 34 RSM and n = 42 IIF women with unexplained miscarriage or IIF. PLI was offered as a treatment in both groups. Peripheral blood lymphocyte (PBL) populations (CD3+, CD3−/CD19+, CD3+/CD4+, CD3+/CD8+, CD3−/CD16+CD56+) were studied before immunization, while PBL cytokine secretion (IFN-γ, TNF-α, IL-10, IL-5, IL-4, IL-2), before and after immunization, pre-conceptionally in both groups. The reference PBL ratio and cytokine levels were adopted from previously studied normal fertile women. PBL populations, concentration and ratio of Th1/Th2 cytokines did not differ between RSM and IIF patients. Compared to the results observed in normal fertile women the levels of IFN-γ, TNF-α and IL-2 were higher, while IL-10 lower in both RSM and IIF patients (p < 0.01). After immunization a decrease of IFN-γ (RSM and IIF groups) and IL-4 and IL-10 (RSM group) were observed, as well as an increase in TNF-α/IL-4 ratio (RSM group) (p < 0.05). No differences in Th1/Th2 concentration and ratio between patients with successful and unsuccessful pregnancy were observed. No significant correlations between success and particular cytokine concentration were observed. Concentrations of Th1/Th2 cytokines and PBL populations did not differ between RSM and IIF women. Th1 shift in both RSM and IIF patients was observed in comparison to fertile women. Treatment with PLI-induced pre-conceptionally cytokine changes which neither indicated Th2 shift nor correlated with subsequent pregnancy success.
Similar content being viewed by others
Abbreviations
- RSM:
-
Recurrent spontaneous miscarriage
- IL:
-
Interleukin
- TNF-α:
-
Tumor necrosis factor-alpha
- IFN-γ:
-
Interferon-gamma
- IIF:
-
Idiopathic infertility
- ART:
-
Artificial reproductive techniques
- RIF:
-
Recurrent implantation failures
- PLI:
-
Paternal lymphocyte immunization
- IUI:
-
Intrauterine insemination
- IVF-ET:
-
In vitro fertilization-embryo transfer
- PBL:
-
Peripheral blood lymphocyte
- BV:
-
Bacterial vaginosis
- ACA:
-
Anticardiolipin antibody
- ANA:
-
Antinuclear antibody
- ASA:
-
Antisperm antibody
- ATA:
-
Antithyroid antibody
- TPOa:
-
Peroxidase antibody
- TGa:
-
Thyroglobulin antibody
- LA:
-
Lupus anticoagulant
- LCT:
-
Lymphocytotoxic test
- PE:
-
Phycoerythrin
References
Aboul Enien WM, El Metwally HA (2005) Association of abnormal vaginal flora with increased cervical tumour necrosis factor-alpha and interferon-gamma levels in idiopathic infertility. Egypt J Immunol 12:53–59
Amani D, Samsami A, Zolghadri J et al (2003) TGF-b1 gene polymorphism (position/509 C/T) in repeated spontaneous abortion (RSA). J Reprod Immunol 58(10):2
Ashkar AA, Croy BA (2001) Functions of uterine natural killer cells are mediated by interferon gamma production during murine pregnancy. Semin Immunol 13:235–241
Ashkar AA, Di Santo J, Croy A (2000) Interferon gamma contributes to initiation of uterine vascular modification, decidual integrity and uterine natural killer cell maturation during normal murine pregnancy. J Exp Med 192:259–270
Banasik M (2007) Monitorowanie równowagi cytokin Th1/Th2 u pacjentek z nawykowymi poronieniami o nieustalonej etiologii. Habilitation thesis
Beer AE (2003) Th-1/Th-2 natural killer cell activation systemically and locally in the endometrium and therapeutic options and outcome. J Reprod Immunol 58:I.27
Chaouat G, Menu E, Clark DA et al (1990) Control of fetal survival in CBA × DBA/2 mice by lymphokine therapy. J Reprod Fertil 89:447–458
Chaouat G, Ledee-Bataille N, Dubanchet S et al (2004) Reproductive immunology 2003: reassessing the Th1/Th2 paradigm? Immunol Lett 92:207–214
Check JH (2010) A practical approach to the prevention of miscarriage: part 2-active immunotherapy. Clin Exp Obstet Gynecol 37:5–9
Chegini N, Ma C, Roberts M et al (2002) Differential expression of interleukins (IL) IL-13 and IL-15 throughout the menstrual cycle in endometrium of normal fertile women and women with recurrent spontaneous abortion. J Reprod Immunol 56:93–110
Chernyshov VP, Sudoma IO, Don’skoi BV et al (2010) Elevated NK cell cytotoxicity, CD158a expression in NK cells and activated T lymphocytes in peripheral blood of women with IVF failures. Am J Reprod Immunol 64:58–67
Christiansen OB, Nielsen HS, Pedersen B (2004) Active or passive immunization in unexplained recurrent miscarriage. J Reprod Immunol 62:41–52
Clark DA (2010) Anti-TNFalpha therapy in immune-mediated subfertility: atate of the art. J Reprod Immunol 85:15–24
Clark DA, Chaouat G (2005) Loss of surface CD200 on stored allogeneic leukocytes may impair anti-abortive effect in vivo. Am J Reprod Immunol 53:13–20
Clark DA, Blois S, Kandil J et al (2005) Reduced uterine indoleamine 2,3-dioxygenase versus increased Th1/Th2 cytokine ratios as a basis for occult and clinical pregnancy failure in mice and humans. Am J Reprod Immunol 54:203–216
Coulam CB, Goodman C, Roussev RG et al (1995) Systemic CD56 + cells can predict pregnancy outcome. Am J Reprod Immunol 33:40–46
Croy BA, Esadeg S, Chantakru S et al (2003) Update on pathways regulating the activation of uterine natural killer cells, their interactions with decidual spiral arteries and homing of their precursors o the uterus. J Reprod Immunol 59:175–191
Daher S, de Arruda Geraldes Denardi K, de Arruda Geraldes Denardi K, Blotta MH et al (2004) Cytokines in recurrent pregnancy loss. J Reprod Immunol 62:151–157
Drakakis P, Loutradis D, Makrigiannakis A et al (2003) Alloimmunization in patients with multiple pregnancy failures in IVF-ET. J Reprod Immunol 58(5):3
Fasouliotis SJ, Spandorfer SD, Witkin SS et al (2004) Maternal serum levels of interferon-gamma and interleukin-2 soluble receptor-alpha predict the outcome of early IVF pregnancies. Hum Reprod 19:1357–1363
Gharesi-Fard B, Zolghadri J, Kamali-Sarvestani E (2008) Effect of leukocyte therapy on tumor necrosis factor-alpha and interferon-gamma production in patients with recurrent spontaneous abortion. Am J Reprod Immunol 59:242–250
Guerin LR, Prins JR, Robertson SA (2009) Regulatory T-cells and immune tolerance in pregnancy: a new target for infertility treatment? Hum Reprod Update 15:517–535
Hanzlikova J, Ulcova-Gallova Z, Malkusova I et al (2009) TH1-TH2 response and the atopy risk in patients with reproduction failure. Am J Reprod Immunol 61:213–220
Hayakawa S, Karasaki-Suzuki M, Itoh T et al (2000) Effects of paternal lymphocyte immunization on peripheral Th1/Th2 balance and TCR V beta and V gamma repertoire usage of patients with recurrent spontaneous abortions. Am J Reprod Immunol 43:107–115
Hill JA, Polgar K, Anderson DJ (1995) T helper 1-type cellular immunity to trophoblast in women with recurrent spontaneous abortions. JAMA 273:1933–1936
Inagaki N, Stern C, McBain J et al (2003) Analysis of intra-uterine cytokine concentration and matrix-metalloproteinase activity in women with recurrent failed embryo transfer. Hum Reprod 18:608–615
Kang HJ, Feng Z, Sun Y et al (2009) Single-nucleotide polymorphisms in the p53 pathway regulate fertility in humans. Proc Natl Acad Sci USA 106:9761–9766
Kwak JY, Gilman-Sachs A, Moretti M et al (1998) Natural killer cell cytotoxicity and paternal lymphocyte immunization in women with recurrent spontaneous abortions. Am J Reprod Immunol 40:352–358
Kwak-Kim JY, Chung-Bang HS, Ng SC et al (2003) Increased T helper 1 cytokine responses by circulating T cells are present in women with recurrent pregnancy losses and in infertile women with multiple implantation failures after IVF. Hum Reprod 18:767–773
Ledee-Bataille N, Olivennes F, Kadoch J et al (2004) Detectable levels of interleukin-18 in uterine luminal secretions at oocyte retrieval predict failure of the embryo transfer. Hum Reprod 19:1968–1973
Liu C, Wang J, Zhou S et al (2010) Association between -238 but not -308 polymorphism of tumor necrosis factor alpha (TNF-alpha) and unexplained recurrent spontaneous abortion (URSA) in Chinese population. Reprod Biol Endocrinol 8:114
Makhseed M, Raghupathy R, Azizieh F et al (2001) Th1 and Th2 cytokine profiles in recurrent aborters with successful pregnancy and with subsequent abortions. Hum Reprod 16:2219–2226
Malinowski A, Zeman K, Banasik M et al (1997) Efficiency of lymphocyte immunization by the partner in prevention of unexplained recurrent spontaneous abortion. II. Immunologic prognostic factors. Ginekol Pol 68:173–180
Marzi M, Vigano A, Trabattoni D et al (1996) Characterization of type 1 and type 2 cytokine production profile in physiologic and pathologic human pregnancy. Clin Exp Immunol 106:127–133
Mellor AM, Munn DH (2004) IDO expression by dendritic cells: tolerance and tryptophan catabolism. Nat Rev Immunol 4:762–774
Michelon T, Michelon J, Badalotti M et al (2003) Pregnancy and birth rate following immunotherapy in infertile women. J Reprod Immunol 58(5):1
Michou VI, Kanavaros P, Athanassiou V et al (2003) Fraction of the peripheral blood concentration of CD56+/CD16-/CD3- cells in total natural killer cells as an indication of fertility and infertility. Fertil Steril 80(suppl 2):691–697
Murphy SP, Tayade C, Ashkar AA et al (2009) Interferon gamma in successful pregnancies. Biol Reprod 80:848–859
Ober C, Karrison T, Odem RR et al (1999) Mononuclear-cell immunisation in prevention of recurrent miscarriages: a randomised trial. Lancet 354:365–369
Pandey MK, Agrawal S (2004) Induction of MLR-Bf and protection of fetal loss: a current double blind randomized trial of paternal lymphocyte immunization for women with recurrent spontaneous abortion. Int Immunopharmacol 4:289–298
Pandey MK, Thakur S, Agrawal S (2004) Lymphocyte immunotherapy and its probable mechanism in the maintenance of pregnancy in women with recurrent spontaneous abortion. Arch Gynecol Obstet 269:161–172
Parr EL, Chen HL, Parr MB et al (1995) Synthesis and granular localization of tumor necrosis factor-alpha in activated NK cells in the pregnant mouse uterus. J Reprod Immunol 28:31–40
Plaks V, Birnberg T, Berkutzki T et al (2008) Uterine DCs are crucial for decidua formation during embryo implantation in mice. J Clin Invest 118:3954–3965
Porter TF, LaCoursiere Y, Scott JR (2006) Immunotherapy for recurrent miscarriage. Cochrane Database Syst Rev 19:CD000112
Practice Committee of the American Society for Reproductive Medicine (2008) Definitions of infertility and recurrent pregnancy loss. Fertil Steril 90(5 suppl):S60
Raghupathy R, Makhseed M, Azizieh F et al (2000) Cytokine production by maternal lymphocytes during normal pregnancy and in unexplained recurrent spontaneous abortion. Hum Reprod 15:713–718
Ramhorst R, Agriello E, Zittermann S et al (2000) Is the paternal mononuclear cells’ immunization a successful treatment for recurrent spontaneous abortion? Am J Reprod Immunol 44:129–135
Ramhorst R, Garcia V, Agriello E et al (2003) Intracellular expression of CD69 in endometrial and peripheral T cells represents a useful marker in women with recurrent miscarriage: modulation after allogeneic leukocyte immunotherapy. Am J Reprod Immunol 49:149–158
Robertson SA, Seamark RF, Guilbert LJ et al (1994) The role of cytokines in gestation. Crit Rev Immunol 14:239–292
Sacks GP, Redman CW, Sargent IL (2003) Monocytes are primed to produce the Th1 type cytokine IL-12 in normal human pregnancy: an intracellular flow cytometric analysis of peripheral blood mononuclear cells. Clin Exp Immunol 131:490–497
Saito S, Sasaki Y, Sakai M (2005) CD4 + CD25 high regulatory T cells in human pregnancy. J Reprod Immunol 65:111–120
Salker M, Teklenburg G, Molokhia M et al (2010) Natural selection of human embryos: impaired decidualization of endometrium disables embryo-maternal interactions and causes recurrent pregnancy loss. PLoS One 5:e10287
Srivastava P, Jha R, Bas S et al (2008) In infertile women, cells from Chlamydia trachomatis infected site release higher levels of interferon-gamma, interleukin-10 and tumor necrosis factor-alpha upon heat shock protein stimulation than fertile women. Reprod Biol Endocrinol 6:20
Sugi T, Makino T, Maruyama T et al (1991) A possible mechanism of immunotherapy for patients with recurrent spontaneous abortions. Am J Reprod Immunol 25:185–189
Svensson L, Arvola M, Sallstrom RH et al (2001) The Th2 cytokines IL-4 and IL-10 are not crucial for the completion of allogeneic pregnancy in mice. J Reprod Immunol 51:3–7
Szpakowski A, Malinowski A, Zeman K et al (2001) The influence of paternal lymphocytes immunization on percentage of peripheral blood CD16+/CD56+ cells in women with primary recurrent spontaneous abortion. Ginekol Pol 72:1063–1068
Takeshita T (2004) Diagnosis and treatment of recurrent miscarriage associated with immunologic disorders: is paternal lymphocyte immunization the relic of the past? J Nihon Med Sch 71:308–313
Thum MY, Abdalla HI, Bhaskaran S et al (2007) The relationship of systemic TNF-alpha and IFN-gamma with IVF treatment outcome and peripheral blood NK cells. Am J Reprod Immunol 57:210–217
Toth B, Jeschke U, Rogenhofer N et al (2010) Recurrent miscarriage: current concepts in diagnosis and treatment. J Reprod Immunol 85:25–32
Wegmann TG, Lin H, Guilbert L et al (1993) Bidirectional cytokine interactions in the maternal-fetal relationship: is successful pregnancy a Th2 phenomenon? Immunol Today 14:353–356
Winger EE, Reed JL, Ashoush S et al (2009) Treatment with adalimumab (Humira) and intravenous immunoglobulin improves pregnancy rates in women undergoing IVF. Am J Reprod Immunol 61:113–120
Yang H, Qiu L, Di W et al (2008) Proportional change of CD4+CD25+ regulatory T cells after lymphocyte therapy in unexplained recurrent spontaneous abortion patients. Fertil Steril 92:301–305
Yokoo T, Takakuwa K, Ooki I et al (2006) Alteration of TH1 and TH2 cells by intracellular cytokine detection in patients with unexplained recurrent abortion before and after immunotherapy with the husband’s mononuclear cells. Fertil Steril 85:1452–1457
Zenclussen AC, Fest S, Busse P et al (2002) Questioning the Th1/Th2 paradigm in reproduction: peripheral levels of IL-12 are down-regulated in miscarriage patients. Am J Reprod Immunol 48:245–251
Zenclussen AC, Gerlof K, Zenclussen ML et al (2005) Abnormal T-cell reactivity against paternal antigens in spontaneous abortion: adoptive transfer of pregnancy-induced CD4+CD25+ T regulatory cells prevents fetal rejection in a murine abortion model. Am J Pathol 166:811–822
Acknowledgments
The study was co-financed by the Medical University of Lodz Grant no. 502-15-800.
Author information
Authors and Affiliations
Corresponding author
About this article
Cite this article
Wilczyński, J.R., Radwan, P., Tchórzewski, H. et al. Immunotherapy of Patients with Recurrent Spontaneous Miscarriage and Idiopathic Infertility: Does the Immunization-Dependent Th2 Cytokine Overbalance Really Matter?. Arch. Immunol. Ther. Exp. 60, 151–160 (2012). https://doi.org/10.1007/s00005-012-0161-6
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00005-012-0161-6