Distribution of Th1 and Th2 cell populations in human peripheral and decidual T cells from normal and anembryonic pregnancies

Immunological regulation and the role of autophagy in preeclampsia

Autophagy is a bulk degradation system that maintains cellular homeostasis by producing energy and/or recycling excess proteins. During early placentation, extravillous trophoblasts invade the decidua and uterine myometrium, facing maternal immune cells, which participate in the immune suppression of paternal and fetal antigens. Regulatory T cells will likely increase in response to a specific antigen before and during early pregnancy. Insufficient expansion of antigen-specific Treg cells, which possess the same T cell receptor, is associated with the pathophysiology of preeclampsia, suggesting sterile systemic inflammation. Autophagy is involved in reducing inflammation through the degradation of inflammasomes and in the differentiation and function of regulatory T cells. Autophagy dysregulation induces protein aggregation in trophoblasts, resulting in placental dysfunction. In this review, we discuss the role of regulatory T cells in normal pregnancies. In addition, we discuss the association between autophagy and regulatory T cells in the development of preeclampsia based on reports on the role of autophagy in autoimmune diseases.

Pregnancy-Related Immune Changes and Demyelinating Diseases of the Central Nervous System

Demyelinating diseases of the central nervous system comprise a heterogeneous group of autoimmune disorders characterized by myelin loss with relative sparing of axons occurring on a background of inflammation. Some of the most common demyelinating diseases are multiple sclerosis, acute disseminated encephalomyelitis, and neuromyelitis optica spectrum disorders. Besides showing clinical, radiological, and histopathological features that complicate their diagnosis, demyelinating diseases often involve different immunological processes that produce distinct inflammatory patterns. Evidence of demyelination diseases derives mostly from animal studies of experimental autoimmune encephalomyelitis (EAE), a model that relies on direct antibody–antigen interactions induced by encephalitogenic T cells. Pregnancy is characterized by non-self-recognition, immunomodulatory changes and an altered Th1/Th2 balance, generally considered a Th2-type immunological state that protects the mother from infections. During pregnancy, the immune response of patients with autoimmune disease complicated with pregnancy is different. Immune tolerance in pregnancy may affect the course of some diseases, which may reach remission or be exacerbated. In this review, we summarize current knowledge on the immune status during pregnancy and discuss the relationship between pregnancy-related immune changes and demyelinating diseases of the central nervous system.

Human embryo immune escape mechanisms rediscovered by the tumor

Towards the end of the 1990s, the two opposing theories on immunosurveillance and immunostimulation were extensively studied by researchers in an attempt to understand the complex mechanisms that regulate the relation between tumors and the host's immune system. Both theories probably have elements that would help us to comprehend how the host can induce anti-tumor clinical responses through stimulation of the immune system and which could also give us a deeper insight into the mechanisms of tumor immunosuppression. The model that most resembles the behavior of tumor cells in terms of growth, infiltration and suppression of the immune system of the environment in which they live is undoubtedly that of the embryonic cell. The fetus behaves like an allogenic transplant within the mother's body, using every means it has to escape from and defend itself against the mother's immune system. The majority of these mechanisms are the same as those found in tumor cells: antigenic loss, lack of expression of classic HLA-I molecules, production of immunosuppressive cytokines, induction of lack of expression of co-stimulatory molecules in antigen presenting cells, and induction of apoptosis in infiltrating lymphocytes, with activation of a type Th2 regulatory lymphocyte response. A careful and comparative study of key mechanisms capable of triggering tolerance or cytotoxicity in both embryonic and tumor cells could prove immensely valuable in designing new strategies for anti-tumor immunotherapy.

Excessive ovarian response is associated with increased expression of interleukin-2 in the periimplantation endometrium

OBJECTIVE

To evaluate and compare in vivo expression of T helper type 1 (Th1) cytokines in the peri-implantation endometrium of infertile patients between natural and stimulated cycles.

DESIGN

An observational study.

SETTING

A tertiary assisted reproduction center.

PATIENT(S)

Infertile patients.

INTERVENTION(S)

Uterine flushings and endometrial biopsies were collected 7 days after LH surge in natural cycles or after hCG injection in stimulated cycles.

MAIN OUTCOME MEASURE(S)

T helper type 1 cytokines were determined by immunolocalization and by ELISA.

RESULT(S)

Natural cycles were classified as group A (n = 17), whereas stimulated cycles with peak serum E(2) of <or=20,000 pmol/L (moderate responders) and with peak serum E(2) of >20,000 pmol/L (excessive responders) were classified as group B (n = 32) and group C (n = 32), respectively. Higher serum E(2) concentration was associated with increased expressions of interleukin (IL)-2 in the endometrium and uterine flushing. Group C demonstrated a statistically significantly higher IL-2 expression in endometrial biopsies by glandular and stromal immunostaining and by ELISA, compared with group A and group B. There was no difference in IL-2 concentration between group A and group B. Interferon-gamma protein concentration was comparable for the three groups.

CONCLUSION(S)

Increased expression of IL-2 in the peri-implantation endometrium may account for the lower implantation rate in excessive responders.

Suppression of IL-2 and IFN-gamma production in women with spontaneous preterm labor

AIMS

To determine the TH-1/TH-2 cytokine pattern in peripheral blood leukocytes (PBL) in late second- and third trimester in normal pregnancies, in comparison to patients with spontaneous preterm delivery (PTD; < 37 completed weeks' gestation).

METHODS

A cross-sectional retrospective study was performed in a tertiary care obstetric unit with healthy non-pregnant women (n=7); healthy pregnant women (n=25); patients (n=25) with preterm labor (defined as uterine contractions or changes in cervical length). The phenotypic analysis of TH-1/TH-2 immune deviation was examined in PBL.

RESULTS

26% PTD (n=13) were recorded. Patients delivering at term (n=37, 74%) were characterized by an upregulation of IL-2, IFN-gamma and IL-4 production during weeks 20-25, followed by a strong suppression in cytokine production, except for TGF-beta. Towards the end of pregnancy cytokine levels returned to normal as observed in non-pregnant women. In contrast, PTD showed an inverse pattern for IL-2 and IFN-gamma with marked suppression in IL-2 and IFN-gamma production between weeks 20-25, followed by a strong stimulation of these cytokines. No differences were observed in IL-4 and TGF-beta production.

CONCLUSION

An inverse pattern in IL-2 and IFN-gamma production in PBLs between weeks 20-30 is seen in PTD as compared to patients delivering at term.

Decreased expression of CD25 on decidual activated T lymphocytes is not mediated by reduced CD25 messenger ribonucleic acid

OBJECTIVE

To clarify whether the down-regulation of CD25 on decidual T cells occurred at the activated T cells and was governed through reduced CD25 messenger RNA (mRNA) production.

DESIGN

Retrospective analysis and prospective study.

SETTING

University hospital and medical college.

PATIENT(S)

A total of 12 women receiving hysterectomies and 20 pregnant women having elective abortions were included.

INTERVENTION(S)

The amount of CD25 mRNA in isolated T cells from peripheral blood, endometrium, and decidua was analyzed with real-time polymerase chain reaction and was compared after coculture with autologous cytotrophoblast cells.

MAIN OUTCOME MEASURE(S)

Expression levels of CD25 and CD25 mRNA before and after coculture.

RESULT(S)

The percentage of activated T cells expressing CD25 is lower in decidua than in peripheral blood but the opposite in regulatory T cells. Nevertheless, the amount of CD25 mRNA in decidual T cells did not decrease, instead of approaching that in corresponding fully activated T cells. In the coculture model, we found that the cytotrophoblast cells could induce the decreased expression of CD25 on T lymphocytes. However, there was no change in the amount of CD25 mRNA in T cells after coculture.

CONCLUSION(S)

This study demonstrates the effectiveness of the coculture model to study fetomaternal interactions and provides evidence that fetal cells may contribute to the control of maternal local immunity and that the decreased expression of CD25 on decidual T lymphocytes is not through the reduced CD25 mRNA level.

Role of sympathetic nerves on early embryonic development and immune modulation of uterus in pregnant mice

To determine the role of sympathetic nerves in the early embryonic development and the immune modulation of maternal uterus during pregnancy, a model of chemical sympathectomy in mice was established by intraperitoneal injection of 6-hydroxydopamine (6-OHDA). The embryonic development and the distribution of maternal uterine immunocytes were investigated during early pregnancy (E1-E9) with methods of histology, immunohistochemistry and ELISA. Our data showed that in the 6-OHDA-treated group, the number of implanted embryos was only 64.4% of that in the control group at E7, and the development of uterine glands and vessels was poor in pregnant mice. In addition, in uterine tissues of 6-OHDA-treated mice, the number of CD8+ T cells increased ten-fold and the concentration of IL-2 increased 3.6-fold at E5. However, no obvious changes to the number of CD4+ T cells and IL-4 were observed. Thus, the CD4+/CD8+ T cells ratio significantly decreased, while the IL-2/IL-4 ratio significantly increased. These findings indicated that the activation of sympathetic nerves might be favorable to fetal survival and development during early pregnancy through influencing on immune function and decidua formation of uterus.

Reduced expression of interleukin-11 and interleukin-6 in the periimplantation endometrium of excessive ovarian responders during in vitro fertilization treatment

CONTEXT

Impaired implantation in assisted reproduction cycles with high serum estradiol (E2) concentrations may be related to abnormal endometrial functions.

OBJECTIVE

The in vivo expression of T helper type 2 (Th2) cytokines in the periimplantation endometrium of infertile patients was compared between natural and stimulated cycles.

INTERVENTIONS AND MAIN OUTCOME MEASURES

Uterine flushings and endometrial biopsies were collected 7 d after the LH surge in natural cycles or after human chorionic gonadotropin injection in stimulated cycles. Th2 cytokines were determined by immunolocalization and by ELISA. Natural cycles were in group A, whereas stimulated cycles with peak serum E2 of no more than 20,000 pmol/liter (moderate responders) and more than 20,000 pmol/liter (excessive responders) were classified as group B and group C, respectively.

RESULTS

Higher E2 had a negative effect on IL-11 and IL-6 expression in the endometrium and IL-11 concentration in the uterine flushing. In endometrial biopsies, a significantly lower immunostaining of stromal IL-11 (P < 0.001) and glandular IL-6 (P < 0.05) was detected in group C compared with that of groups A and B. IL-11 concentration by ELISA was significantly lower in group C (P < 0.05). Endometrial leukemia inhibitory factor and IL-4 expression was similar in the three groups. In uterine flushings, a significantly higher percentage of women in group C had undetectable IL-11 and a lower IL-11 concentration (P < 0.01) compared with group A, whereas no difference in IL-6 concentration was noted in the three groups.

CONCLUSION

Reduced expression of IL-11 and IL-6 in periimplantation endometrium may account for lower implantation in excessive responders.

Stress and substance P but not the substance P-metabolite SP5-11 trigger murine abortion by augmenting TNF-alpha levels at the feto-maternal interface

In a well-established murine abortion model, stress is thought to trigger fetal rejection by inducing a proinflammatory immune response via substance P (SP), being tumour necrosis factor (TNF)-alpha-producing CD8+ T cells involved. Interestingly, the SP metabolite SP5-11 also binds to SP receptors and mediates SP-like effects on immune cells at sites of inflammation. No data were available regarding the effects of SP5-11 on pregnancy outcome in the CBA/J x DBA/2J abortion-prone combination. We investigated the influence of SP5-11 in contrast to stress or SP on the abortion rate and the cytokine production by lymphocytes as well as on the levels of CD8+ T cells. Stress and SP boosted the abortion rate and increased the percentage of type 1 [TNF-alpha, interferon-gamma, interleukin (IL)-12] and type 2 (IL-4 and IL-10) cytokine-producing lymphocytes in blood and decidua, predominantly CD8+ T cells. Interestingly, SP5-11 did not significantly affect the abortion rate or cytokine production in the decidua, while increasing the Th1 and Th2 cytokine production systemically. Our data suggest that stress and SP induce abortion by augmenting the local levels of TNF-alpha, which seems therefore to be a potent trigger of miscarriage. On the contrary, the SP metabolite SP5-11 only affects the systemic cytokine production without boosting the abortion rate in this experimental model.

Th1/Th2 cytokines balance--yin and yang of reproductive immunology

For years conception of Th2 overbalance during pregnancy has been a paradigm for immunology of reproduction, while Th1 activity has been presented as unwanted component. Studies concerning Th1/Th2 balance in physiological and complicated pregnancy have been reviewed. Th1 activity during early peri-implantation period, premature and term labour not only accompanies but even predominates over Th2 activity. Th1 activity plays important role in promotion of Th2 response, regulation of placentation process, defense against infections and initiation of delivery. Together with Th2 activity it is necessary component of immunological reactions during pregnancy, both activities being inseparable like yin and yang. So paradigm of "Th1-Th2 cooperation" is much closer to reality than "Th2 phenomenon".

Current concepts of tumor-infiltrating lymphocytes in human malignancies

Tumor-infiltrating lymphocytes (TILs) develop as manifestations of the recognition and defense against malignant cells by the host immune system. TILs were literally defined as "tumor-infiltrating lymphocytes", which a posteriori locate within the tumor tissues. Although such cells can be found, they fail to control the growth of tumor. Many have proposed diverse mechanisms for dysfunction of TILs with regard to the roles of immunosurveillance against cancer. However, only a few cancer types, e.g. melanoma, have seen the benefits brought by activating these cells for immunotherapy. Functional defects of TILs have been linked to abnormalities of signaling molecules; however, there is conflicting data. The death of TILs was attributed to expression of cancer-derived FasL, PD-1 and RCAS1, and cancer-induced activation-induced cell death (AICD). Confirmed by studies using TILs and animal models, the compromise of tumor-specific immune responses was thought to result from not only mechanisms of clonal anergy but also exhaustion and/or deletion. Furthermore, functional cytotoxic CD8(+) TILs might be rendered incompetent by cancer-induced up-regulation of inhibitory NK receptors or proximal signaling abnormalities. Additionally, immune privilege was partly attributed to recruitment of regulatory T cells to the tumor sites. The failure of IL-2 signaling, which stands at the center of T cell functionalities, had been linked to the enzymatic activity of cancer-derived matrix metalloproteinases (MMPs). Finally, the exploitation of IDO expression, an important enzyme in pregnancy-related immunosuppression, by cancer cells might play a role in tumor immunity. The disparity of cancer types, origin, developmental stages and individual genetic backgrounds likely account for differences, or even contradictions, which might be the reason why immunotherapy works only on a few cancer types. Delineating the mechanisms behind functional defects of TILs can help not only boost chances of the development of a successful cure but understand the not fully identified roles played by immune system in the face of malignancies.

Endometrial expression of immunomodulatory cytokines and their regulators during early pregnancy in bonnet monkeys (Macaca radiata)

BACKGROUND

It is well established that endometrium undergoes extensive histological changes during implantation and subsequent stages of pregnancy in rodents as well as primates. Our previous investigation using a non-human primate model has demonstrated that morphological alterations are initiated even before the embryo invades the endometrium. The present study was undertaken to determine whether the embryo-induced morphological changes are accompanied by any alteration in the protein levels of the immunomodulatory cytokines and their regulators in the preimplantation stage endometrium.

METHODS

The endometrial expression of immunosuppressive factors such as transforming growth factor beta2 (TGFbeta2), glycodelin (PP14), leukaemia inhibitory factor (LIF) and interleukin-6 (IL-6) were analysed on day 6 post-ovulation in pregnant and non-pregnant bonnet monkeys (Macaca radiata) using immunohistochemical methods.

RESULTS

The endometrial expression of TGFbeta2, TGFbeta2 receptor, PP14 and IL-6 were significantly up-regulated (p < 0.05) in pregnant animals as compared to non-pregnant animals, whereas the expression of LIF and its receptor remained unaltered in pregnant animals.

CONCLUSIONS

Expression levels of some immunomodulatory cytokines in endometrium are significantly increased even before the embryo invades the endometrium. The altered cytokine expression profile in endometrium probably contributes towards generating a conducive environment for the embryo survival, growth and development in the uterus.

Cytokine secretion patterns of NK cells and macrophages in early human pregnancy decidua and blood: implications for suppressor macrophages in decidua

PROBLEM

Local immune modulation has been shown to be of considerable importance for the maintenance of successful pregnancy. We have previously reported the secretion of interferon-gamma (IFN-gamma), interleukin-4 (IL-4) and IL-10 in human decidua from early normal pregnancy. The aim of this study was to investigate the cellular source of cytokine secretion in the decidua, and compare this to secretion patterns in peripheral blood.

METHOD OF STUDY

Decidual tissue and peripheral blood was collected from 20 women undergoing surgical abortion during first trimester pregnancy. Monocytes/macrophages and NK cells were enriched by immunomagnetic cell separation and cytokine secretion was detected by enzyme-linked immunosorbent spot-forming cell assay.

RESULTS

Decidual and peripheral monocytes/macrophages and NK cells spontaneously secrete IFN-gamma, IL-4 and IL-10. The number of IL-10 secreting cells was significantly higher in decidual macrophages compared with decidual non-monocytic cells as well as compared with blood monocytes/macrophages. These differences were not seen for IFN-gamma or IL-4.

CONCLUSIONS

Our results indicate that decidual macrophages subserve important suppressive functions in the pregnant uterus.

Porphyromonas gingivalis infection in pregnant mice is associated with placental dissemination, an increase in the placental Th1/Th2 cytokine ratio, and fetal growth restriction

Our previous animal studies showed that maternal Porphyromonas gingivalis infection in a subcutaneous chamber is associated with hepatic and uterine translocation, as well as systemic induction of maternal inflammatory responses, both of which were associated with fetal growth restriction (FGR). However, P. gingivalis-challenged dams had fetuses with either FGR (2 standard deviations below mean weight of nonchallenged dams) or normal weight. Therefore, the objective of this study was to determine whether maternal infection with P. gingivalis compromises normal fetal development via direct placental invasion and induction of fetus-specific placental immune responses characterized by a proinflammatory Th1-type cytokine profile. P. gingivalis-specific DNA was detected in placentas and fetuses of FGR and normal littermates from P. gingivalis-infected dams. Th1- and Th2-type cytokine mRNA as well as tumor necrosis factor alpha and transforming growth factor beta 2 mRNA were examined in placental tissue by using reverse transcription-PCR to determine Th1/Th2 ratios. For eight litters containing both normal-weight and FGR fetuses, P. gingivalis DNA was detected only in the placentas of FGR fetuses. All fetuses and all amniotic fluid samples from infected and control dams were negative for P. gingivalis DNA. mRNA levels of gamma interferon and interleukin-2 (IL-2) were significantly increased in placentas of FGR fetuses, while expression of IL-10 was significantly decreased in the same group. These data indicate that, in P. gingivalis-challenged dams, within each litter there is placenta-specific translocation of P. gingivalis that results in growth restriction of the targeted fetus, which is associated with a shift in the placental Th1/Th2 cytokine balance.

Analyses of dendritic cell subsets in pregnancy

PROBLEM

Changes in the frequency of dendritic cell (DC) subsets in the peripheral blood were analyzed as pregnancy progressed, and the effects of human chorionic gonadotropin (hCG) on myeloid and lymphoid DC subsets were phenotypically and functionally examined.

METHOD OF STUDY

Two major subsets of DCs were prepared from the peripheral blood by flow cytometry. Major histocompatibility complex class II molecules and adhesion/costimulatory molecules were examined before and after culture with hCG. hCG receptors on both DC subsets were analyzed by reverse transcriptase-polymerase chain reaction (RT-PCR).

RESULTS

The frequency of myeloid DCs increased in the late stage of pregnancy, while that of lymphoid DCs gradually decreased. The addition of hCG (physiological concentrations in pregnancy) to cultures induced the maturation of both DC subsets in conjunction with increases in the expression of adhesion/costimulatory molecules, their stimulatory activities in allogeneic mixed lymphocyte/leukocyte reaction, and cytokine secretion (interleukin-12 and interferon-gamma). hCG receptors were found in both DC subsets by RT-PCR, suggesting that these stimulatory activities of hCG are mediated by hCG receptors on the DCs.

CONCLUSIONS

hCG can modulate immune responses through the activation of myeloid and lymphoid DCs.