Obstetrics and Gynaecology
Mohamed Abd El-Tawab Abd El-Aleem;
Abstract
SUMMARY AND CONCLUSION
U
terine NK cells are the most abundant leukocytes in preimplantation endometrium and early pregnancy deciduas. Maternal uterine NK cells are adjacent to, and have the ability to interact directly with the fetal trophoblasts. NK cells in both the uterus and the peripheral circulation are characterized by the presence of CD56 antigen. However, unlike the peripheral NK cells, the uterine NK cells can be divided by immunohistochemistry and flow cytometry into 2 subpopulations, the CD56dimCD16+ and the CD56bright CD16- . It is believed that the CD56bright CD16- population is the abundant population in the normal deciduas.
This study aimed at studying the role of uterine NK cells in recurrent miscarriage. The study was held in Ain Shams university Maternity hospital. It included 21 patients with history of recurrent miscarriage (3 or more abortions) and 21 healthy fertile women with no history of recurrent miscarriage.
All the patients and control group were less than 40 years old to decrease the risk of chromosomal abnormalities. All patients had neither history nor current evidence of abnormal glucose tolerance, abnormal thyroid function, hyperprola-ctinaemia or antiphospholipid antibody syndrome. All the patients had no history of hormonal contraception or intrauterine contraceptive device usage in the preceding 3 months. Mid-luteal endometrial biopsies were obtained and then subjected to immunohistochemical studies using monoclonal antibodies against the CD56 molecules on the uterine NK cells.
It was found that 10 of the 21 recruited patients had CD56% more than 10% representing 47.6 % of the cases while number of patients with CD56 % less than 10% was 11 representing 52.4% of cases, Of the 21 control healthy fertile women, 19 had CD56% less than 10% representing 90.5 % while only 2 women had CD56 % more than 10% representing 9.5 % of the control group.
The study showed that the CD 56% in the patient group ranged between (4% - 20%) with a mean of 11.3% ± 4.6 while this percentage in the control group ranged between (2.5%-12%) with a mean of 6.3% ± 2.6.
The study failed to find a significant relationship between the number of previous miscarriages and CD 56% in both patient and control groups, the study also found no significance between the number of live birth and CD 56% in both groups, also the study failed to find any significant relationship between the age of the woman and CD 56% in all recruited women and lastly the study found no significant relationship between duration since last miscarriage and CD56 % in both groups.
From the above, it is concluded that the subpopulation of uterine NK cells predominate in the deciduas of patients with recurrent miscarriage, and these cells are significantly related to the history of recurrent miscarriages, It is also concluded that there is no relationship between the number of previous miscarriages, the number of live birth, the age of the woman, duration since last miscarriage and the percentage of NK cells homing the endometrium.
Finally, it can be concluded that uNK cell population might be playing an important role in the pathophysiology of recurrent miscarriage. It is controversial whether immuno-therapy for RM is effective. However, immunomo-dulation of preimplantation endometrium or decidua opens new avenues for treatment of RM. So, we believe that randomized controlled studies are indicated to assess whether women with such high NK levels would benefit from immune therapy.
U
terine NK cells are the most abundant leukocytes in preimplantation endometrium and early pregnancy deciduas. Maternal uterine NK cells are adjacent to, and have the ability to interact directly with the fetal trophoblasts. NK cells in both the uterus and the peripheral circulation are characterized by the presence of CD56 antigen. However, unlike the peripheral NK cells, the uterine NK cells can be divided by immunohistochemistry and flow cytometry into 2 subpopulations, the CD56dimCD16+ and the CD56bright CD16- . It is believed that the CD56bright CD16- population is the abundant population in the normal deciduas.
This study aimed at studying the role of uterine NK cells in recurrent miscarriage. The study was held in Ain Shams university Maternity hospital. It included 21 patients with history of recurrent miscarriage (3 or more abortions) and 21 healthy fertile women with no history of recurrent miscarriage.
All the patients and control group were less than 40 years old to decrease the risk of chromosomal abnormalities. All patients had neither history nor current evidence of abnormal glucose tolerance, abnormal thyroid function, hyperprola-ctinaemia or antiphospholipid antibody syndrome. All the patients had no history of hormonal contraception or intrauterine contraceptive device usage in the preceding 3 months. Mid-luteal endometrial biopsies were obtained and then subjected to immunohistochemical studies using monoclonal antibodies against the CD56 molecules on the uterine NK cells.
It was found that 10 of the 21 recruited patients had CD56% more than 10% representing 47.6 % of the cases while number of patients with CD56 % less than 10% was 11 representing 52.4% of cases, Of the 21 control healthy fertile women, 19 had CD56% less than 10% representing 90.5 % while only 2 women had CD56 % more than 10% representing 9.5 % of the control group.
The study showed that the CD 56% in the patient group ranged between (4% - 20%) with a mean of 11.3% ± 4.6 while this percentage in the control group ranged between (2.5%-12%) with a mean of 6.3% ± 2.6.
The study failed to find a significant relationship between the number of previous miscarriages and CD 56% in both patient and control groups, the study also found no significance between the number of live birth and CD 56% in both groups, also the study failed to find any significant relationship between the age of the woman and CD 56% in all recruited women and lastly the study found no significant relationship between duration since last miscarriage and CD56 % in both groups.
From the above, it is concluded that the subpopulation of uterine NK cells predominate in the deciduas of patients with recurrent miscarriage, and these cells are significantly related to the history of recurrent miscarriages, It is also concluded that there is no relationship between the number of previous miscarriages, the number of live birth, the age of the woman, duration since last miscarriage and the percentage of NK cells homing the endometrium.
Finally, it can be concluded that uNK cell population might be playing an important role in the pathophysiology of recurrent miscarriage. It is controversial whether immuno-therapy for RM is effective. However, immunomo-dulation of preimplantation endometrium or decidua opens new avenues for treatment of RM. So, we believe that randomized controlled studies are indicated to assess whether women with such high NK levels would benefit from immune therapy.
Other data
| Title | Obstetrics and Gynaecology | Other Titles | الخلايا الرَحِمِيّة الطبيعية القاتلة بالنسبة لفقدان الحمل المتكرر غير المبرر | Authors | Mohamed Abd El-Tawab Abd El-Aleem | Issue Date | 2015 |
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