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Aktive und passive Immunisierung

Active and passive immunization

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Gynäkologische Endokrinologie Aims and scope

Zusammenfassung

Das Geheimnis der Immuntoleranz des semiallogenen Embryos in der erfolgreich etablierten Gravidität beruht auf Immunmodulationen in verschiedenen Ebenen wie der embryomaternalen Interphase, dem peripheren und angeborenen Immunsystem. Diese Immunmodulation weist Analogien zum Tumorwachstum auf, allerdings mit dem entscheidenden Unterschied, dass Limitierungen und Kontrollmechanismen Platz greifen. Wesentliche Pfeiler der Immuntoleranz sind einerseits die Bevorzugung förderlicher T-Helfer-Lymphozyten, die mit ihrer Zytokinexpression die Implantation favorisieren, und andererseits die fehlende Expression von MHC-Ia-Antigenen. Aus diesen Erkenntnissen resultiert aber bislang kein geeignetes Konzept für eine Immuntestung bei rezidivierenden Implantationsfehlern. Diese Situation und eine nicht auf Evidenz basierte Datenlage lässt jegliche Immuntherapie empirisch erscheinen. Sowohl der aktiven Immunisierung mit allogenen Lymphozyten als auch der passiven Immunisierung mit intravenösen Immunglobulinen haftet die nicht existente Validisierung der Effektivität an. Sie ist die Voraussetzung dafür, dass die Immunisierung Bestandteil der adjunktiven Maßnahmen im ART werden kann.

Abstract

The immune tolerance of successfully implanted semi-allogenic embryos depends on immune modulation on different levels: the embryo-maternal interface, the peripheral immune system, and the innate immune system. This immune modulation shows similarities with how tumors grow, but with an important difference: there are limitations and control mechanisms during placentation. Critical components of immune tolerance are the environment conducive to T-helper lymphocytes, whose cytokine expression favors implantation, and the lack of expression of major histocompatibility complex (MHC) Ia antigens. Despite this, no immunological testing has yet been developed for repeated implantation failure (RIF). This, along with non-evidence-based data, makes any immune therapy appear empirical. The effectiveness of active immunization using allogenic lymphocytes and of passive immunization using intravenous immunoglobulin has not been validated. This is necessary for immunization to be considered as an adjunctive therapy to assisted reproduction.

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  1. Universitätsklinik für Reproduktionsmedizin und Gynäkologische Endokrinologie, Medizinische Fakultät der Otto-von-Guericke-Universität Magdeburg, Universitätsklinikum Magdeburg, Gerhart-Hauptmann-Straße 35, 39108, Magdeburg, Deutschland

    J. Kleinstein

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Kleinstein, J. Aktive und passive Immunisierung. Gynäkologische Endokrinologie 7, 87–92 (2009). https://doi.org/10.1007/s10304-008-0296-z

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