Scripties UMCG - Rijksuniversiteit Groningen
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Altered levels of decidual macrophages, mast cells and regulatory T cells in pregnancy pathology

(2019) Bezemer, R.E.

The maternal immune system is involved in implantation of the conceptus and placental development. Inadequate adaptation of the maternal immune system, especially at the fetal maternal interface, is associated with placental lesions and pregnancy complications likefetal growth restriction and stillbirth. Altered levels of several immune cell subsets have been associated with these complications. This study aims to analyze the levels of decidual macrophages, regulatory T cells and mast cells in placental tissue of pregnancies complicated with placental lesions (maternal vascular malperfusion, fetal vascular malperfusion, delayed villous maturation, chorioamnionitis, and villitis of unknown etiology), adverse pregnancy outcomes (fetal growth restriction and stillbirth), and different clinical strategies for fetal growth restriction (induction of labor and expectant management).
Placental tissue and histology reports were available from fetal growth restriction (n= 250), stillbirth (n=64) and healthy pregnancy (n=18) cohorts. Using immunohistochemistry, placental tissue slides were stained for CD68 (macrophages), FOXP3 (regulatory T cells) and tryptase (mast cells). Slides were scanned and cell numbers were analyzed using Visiopharm version 2018.4.
Placentas of pregnancies with fetal growth restriction and stillbirth showed higher numbers of decidual CD68+ macrophages compared to healthy controls. Numbers of decidual regulatory T cells were higher in placentas with villitis of unknown origin compared to placentas without lesions in the fetal growth restriction cohort. Higher numbers of mast cells were found in placentas after expectant management compared to induction of labor.
Numbers of macrophages, mast cells and regulatory T cells are altered in placental lesions, adverse pregnancy outcomes and different management strategies for fetal growth restriction and are likely associated with inflammation and hypoxia in the later phases of pregnancy. Elucidating the exact mechanisms through which these immune cells exert their functions could identify new targets for the treatment of pregnancy pathologies.

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