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Schwangerschaft und maternales Immunsystem

Pregnancy and the maternal immune system

  • Leitthema
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Der Gynäkologe Aims and scope

Zusammenfassung

Die Schwangerschaft ist ein natürliches, erfolgreiches Modell immunologischer Toleranz. Der Fetus wird vom mütterlichen Immunsystem nicht nur passiv toleriert, sondern offenbar partiell in seiner Entwicklung aktiv unterstützt (Immunotrophismus), was den vordergründigen Mechanismen der Transplantationsimmunologie (Selbst-Fremd-Erkennung) widerspricht. Das geregelte invasive Wachstum wird ermöglicht durch ein immunologisches Milieu, dessen Charakteristika in den letzen Jahren zunehmend verstanden werden. Unterbrechungen dieses feinen Netzwerkes können zu Störungen von Implantation und Plazentation führen mit der Folge von intrauteriner Wachstumsretardierung und Spontanabort. Das Verständnis der immunologischen Kommunikation an der trophoblastären Invasionsfront kann helfen, andere invasive Prozesse (z. B. im Rahmen maligner Entartung) besser zu verstehen und eröffnet therapeutische Möglichkeiten. Wir stellen exemplarisch drei Hauptakteure des Immunsystems an der fetomaternalen Grenzzone vor: den Trophoblasten und seine immunkompetente Funktion sowie das Zusammenspiel der Zytokine, die dezidualen Immunzellen am Beispiel der uterinen natürlichen Killerzellen und das vom aufnehmenden Endometrium sezernierte Glykoprotein Glycodelin. Die aktuellen Empfehlungen zu einer Immuntherapie bei rezidivierenden Spontanaborten werden diskutiert.

Abstract

Pregnancy is a successful natural model of immune tolerance. The fetus is not only passively tolerated by the maternal immune system – it is actively supported in its development (immunotrophism), which is in apparent conflict with the primary mechanism of transplantation immunology (recognition of foreign bodies). Its ‘invasive’ growth is made possible by an immunologic situation whose characteristics are being more and more understood. However, disbalance in this fine network can lead to disturbances in implantation and placentation and result in intrauterine growth retardation or spontaneous miscarriage. Understanding immunologic communication at the trophoblastic level can improve understanding of other invasive processes, for example those of malignant degeneration, and open new therapeutic possibilities. We describe three main functions of the immune system that apply in the fetomaternal interphase: (1) trophoblast immune function and the cytokine network, (2) uterine natural killer cells, and (3) the function of the immunosuppressive glycoprotein glycodelin. Current recommendations for immunotherapy in case of recurrent miscarriage are discussed.

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Authors and Affiliations

  1. Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, Klinikum der Universität München-Campus Innenstadt, München, Deutschland

    C. Scholz & U. Jeschke

  2. Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, Klinikum der Universität München-Campus Großhadern, Marchioninistr. 15, 81377, München, Deutschland

    N. Rogenhofer, CJ. Thaler &  B. Toth

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  1. C. Scholz
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  2. N. Rogenhofer
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Correspondence to B. Toth.

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Scholz, C., Rogenhofer, N., Jeschke, U. et al. Schwangerschaft und maternales Immunsystem. Gynäkologe 42, 25–30 (2009). https://doi.org/10.1007/s00129-008-2228-3

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