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Uterine natürliche Killerzellen: Freund oder Feind?

Uterine natural killer cells: friend or foe?

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Gynäkologische Endokrinologie Aims and scope

Zusammenfassung

Hintergrund

Natürliche Killerzellen (NK-Zellen) spielen eine entscheidende Rolle bei der Etablierung einer erfolgreichen Schwangerschaft. Sie sind sowohl im peripheren Blut als auch im Endometrium nachweisbar.

Zielsetzung/Material und Methoden

Im Rahmen dieser Arbeit werden Informationen zu uterinen NK-Zellen zusammengetragen mit dem Ziel, einen umfassenden Überblick über ihre Herkunft, Eigenschaften und Funktionen sowie über diagnostische Verfahren zu vermitteln. Gleichzeitig sollen potenzielle Therapieoptionen aufgezeigt werden.

Ergebnisse

NK-Zellen weisen signifikante Unterschiede hinsichtlich ihrer immunmodulatorischen Aktivitäten auf. Etwa 90 % der uterinen NK-Zellen zeigen eine geringe Zytotoxizität, sind jedoch hoch aktiv in der Produktion von Zytokinen. Uterine NK-Zellen nehmen eine entscheidende Rolle ein bei der Kontrolle der Zellinvasion des extravillösen Trophoblasten und dem Umbau der uterinen Spiralarterien. Ein vermehrtes Auftreten uteriner NK-Zellen jedoch wird mit Implantationsstörungen und verschiedenen Schwangerschaftskomplikationen wie Fehlgeburten, Hypertonie, Präeklampsie und fetaler Wachstumsrestriktion assoziiert.

Schlussfolgerung

Ein tief greifendes Verständnis der Implantation und der (Früh‑)Schwangerschaft trägt dazu bei, die Erfolgsraten von Fortpflanzungsmaßnahmen zu erhöhen und Schwangerschaftskomplikationen zu minimieren. Immunmodulatorische Therapien, beispielsweise mit Kortikosteroiden, Lipidinfusionen und Immunglobulinen, werden derzeit bei NK-Zell-Veränderungen angewendet. Die Vergleichbarkeit internationaler Studien gestaltet sich jedoch aufgrund von Unterschieden im Studiendesign, der angewendeten Methodik, der Interventionen sowie der untersuchten Studienpopulation als herausfordernd. Dies erschwert nicht nur die Interpretation der Ergebnisse, sondern auch die Entwicklung evidenzbasierter Therapieansätze.

Abstract

Background

In the context of establishing a successful pregnancy, natural killer (NK) cells play a crucial role. These cells are found in both peripheral blood and the endometrium.

Objective, material and methods

The objective of this study is to provide a comprehensive overview of the origin, characteristics, functions and diagnostic methods concerning uterine NK cells. In addition, potential treatment options are discussed.

Results

Notable variations in cytotoxicity profiles exist among NK cells. Approximately 90% of uterine NK cells demonstrate low cytotoxicity; however, they are highly active in cytokine production. Uterine NK cells play a crucial role in controlling the invasion of extravillous trophoblasts and the remodeling of uterine spiral arteries. An increased concentration of uterine NK cells, however, is associated with implantation disorders and various pregnancy complications, such as miscarriage, hypertension, pre-eclampsia, and fetal growth restriction.

Conclusion

A profound understanding of implantation and (early) pregnancy contributes to increasing the success rates of reproductive interventions and minimizing pregnancy complications. Immunomodulatory therapies, such as corticosteroids, lipid infusions, and immunoglobulins, are currently being employed for NK cell-related alterations; however, the comparability of international studies is challenging due to differences in design, methodology, intervention and study populations. This not only complicates the interpretation of results but also hinders the development of evidence-based treatment approaches.

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Authors and Affiliations

  1. Abteilung für Gynäkologische Endokrinologie und Fertilitätsstörungen, Frauenklinik, Universitätsfrauenklinik Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Deutschland

    R.-J. Kuon & C. Zhang

  2. Gynäkologische Endokrinologie und Reproduktionsmedizin, Medizinische Universität Innsbruck, Innsbruck, Österreich

    E. Reiser & B. Toth

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  1. R.-J. Kuon
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  2. E. Reiser
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Correspondence to R.-J. Kuon.

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Interessenkonflikt

R.-J. Kuon und B. Toth sind Gesellschafter der Reprognostics GbR Mannheim. E. Reiser und C. Zhang geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autor/-innen keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Ruben Kuon, Heidelberg

Bettina Toth, Innsbruck

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Kuon, RJ., Reiser, E., Zhang, C. et al. Uterine natürliche Killerzellen: Freund oder Feind?. Gynäkologische Endokrinologie 21, 254–260 (2023). https://doi.org/10.1007/s10304-023-00533-2

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  • DOI: https://doi.org/10.1007/s10304-023-00533-2

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