Immunomodulation and preeclampsia. (October 2019) - Rambaldi, Marianna Pina
Abstract: Preeclampsia (PE) is an enigmatic syndrome, still with unknown aetiology and multi-factorial pathogenesis. Our understanding of the role of the immune system in PE development has undergone a transformation over the years. From a model based on the alterations in cell-mediated immunity, research moved on to a vision centred on the alteration of the humoural immunity and on the systemic involvement of the inflammatory system. The first hypothesis was classically derived from the evidence that an adequate maternal immunological response is necessary in pregnancy to allow the survival of the foetus. An abnormal response of the maternal immune system against the placenta may be the first pathogenetic step of PE, followed by a systemic inflammatory reaction. Currently available treatments for PE are mainly preventative with aspirin. Treatment aims to modulate inflammation and the immune system before their changes become established. Highlights: Activation of maternal immune system against the placenta may be at the origin of PE, followed by systemic inflammation. Aberrant activation of innate immune cells, leukocyte and T-helper cell subsets induce a cytotoxic environment in utero. TNF-α and IL-6 increase in PE, whereas IL-10 and IL-4 decrease. The resulting imbalance play a role in the onset of PE. Assessment of the immune system in early pregnancy can be useful in predicting the risk of PE in asymptomatic pregnant women.