New immune horizons in therapeutics and diagnostic approaches to Preeclampsia

Interleukin 17 RA and RC gene polymorphisms and increased preeclampsia risk: Single and combined genetic analysis

BACKGROUND

Preeclampsia is a major pregnancy complication characterized by hypertension and systemic dysfunction, significantly impacting maternal health. The study highlights the complex immune responses triggered during pregnancy, particularly focusing on the interleukin 17 signaling pathway in PE pathogenesis. This study examines the association between two genetic variants-IL-17RA rs4819554 and IL-17RC rs708567-and the risk of preeclampsia.

METHODS

In this case-control study, a cohort of 470 women including 240 diagnosed with PE and 230 control women were examined utilizing polymerase chain reaction-restriction fragment length polymorphism techniques (PCR-RFLP). Additionally, a new computational study was conducted to prediction the possible roles of these polymorphisms.

RESULTS

The research found significant correlations between the AG and GG genotypes of IL-17 RA rs4819554 and the TT genotype of IL-17RC rs708567 with increased preeclampsia risk, particularly severe cases. Notably, combining these polymorphisms further elevated the risk, with the IL-17 RA rs4819554 GG/ IL-17RC rs708567 CC genotype associated with a six-fold increase in late-onset PE risk. These findings underscore the potential of IL-17 receptor gene variants as biomarkers for preeclampsia susceptibility and suggest a complex interplay of genetic factors influencing inflammation during pregnancy. The IL-17RA rs4819554 gene polymorphism may result in differential allelic expression, according to in-silico study. Additionally, bioinformatics study revealed that the IL-17RC rs708567 SNP will result in a notable change to its secondary structure and physicochemical characteristics.

CONCLUSIONS

This study provides significant insights into the genetic mechanisms underlying preeclampsia, highlighting the necessity for further investigation into these genetic variants and their implications for pregnancy outcomes.

Cytokine modulation and immunoregulation of uterine NK cells in pregnancy disorders

Uterine natural killer (uNK) cells play a pivotal role in promoting placental development and supporting maternal-fetal immune tolerance, primarily through cytokine regulation and growth factor production. While the importance of uNK cells in pregnancy is well-established, the mechanisms of their interactions with trophoblasts and contributions to various pregnancy complications remain incompletely understood. This review highlights recent advancements in understanding uNK cell functions, with a focus on cytokine production, growth factor secretion, and receptor-ligand interactions, particularly involving killer immunoglobulin-like receptors (KIR) and human leukocyte antigen-C (HLA-C). We explore how uNK cell dysfunction contributes to pregnancy complications, including preeclampsia, recurrent pregnancy loss, and placenta accreta spectrum (PAS) disorders, emphasizing their roles in immune tolerance and placental health. By detailing the distinct cytokine signaling pathways and functional subtypes of uNK cells, this review provides insights into their regulatory mechanisms essential for pregnancy maintenance. Additionally, we discuss emerging therapeutic strategies targeting uNK-trophoblast interactions and propose future research directions, including the development of non-invasive biomarkers and personalized interventions. This comprehensive review addresses critical knowledge gaps, aiming to advance research in reproductive immunology and guide therapeutic innovations in maternal health.

Exploring gene expression signatures in preeclampsia and identifying hub genes through bioinformatic analysis

INTRODUCTION

Preeclampsia (PE) is a multisystem disease that affects women during the pregnancy. Its pathogenicity remains unclear, and no definitive screening test can predict its occurrence so far. The aim of this study is to identify the critical genes that are involved in the pathogenicity of PE by applying integrated bioinformatic methods and to investigate the genes' diagnostic capability.

METHODS

Datasets that investigated PE have been downloaded from Gene Expression Omnibus (GEO) datasets. Differential gene expression, weighted gene co-expression analysis (WGCNA), protein-protein interaction (PPI) network construction, and finally, the calculation of area under the curve and Receiver operating characteristic curve (ROC) analysis were done for the potential hub genes. The results generated from the GSE186257 dataset (discovery cohort) were validated in the GSE75010 dataset (validation cohort). Following validation of the hub-genes, a multilayer regulatory network was constructed to include the up-stream regulatory elements (transcription factors and miRNAs) of the validated hub-genes.

RESULTS

WGCNA revealed six modules that were significantly correlated with PE. A total of 231 differentially expressed genes (DEGs) were identified. DEGs were intersected with the WGCNA modules' genes, totalling 55 genes. These shared genes were used to construct the PPI network; subsequently, four genes, namely FLT1, HTRA4, LEP and PAPPA2, were identified as hub-genes for PE in the discovery cohort. The expressional of these four hub genes were validated in the validation cohort and found to be highly expressed. ROC analysis in both datasets revealed that all these genes had a significant PE diagnostic ability. The regulatory network showed that FLT1 gene is the most connected and regulated gene among the validated hub-genes.

DISCUSSION

This integrated analysis revealed that FLT1, LEP, HTRA4 and PAPPA2 may be strongly involved in the pathogenicity of PE and act as promising biomarkers and potential therapeutic targets for PE.

The effectiveness of low-dose aspirin for the prevention of hypertensive disorders of pregnancy in a sub-Saharan Africa Country: A randomized clinical trial

OBJECTIVE

To evaluate whether a daily dose of low-dose aspirin (LDA) can prevent hypertensive disorders of pregnancy (HDP), including preeclampsia, among pregnant women in a South African cohort, and to assess its impact on related maternal and fetal outcomes, such as preterm birth and neonatal complications.

STUDY DESIGN

This single-center, open-label, parallel-group randomized controlled trial (RCT) was conducted at a regional hospital in Durban, KwaZulu-Natal, South Africa, from May 2021 to March 2024. A total of 423 pregnant women, aged 18 years or older with singleton pregnancies between 12 and 20 weeks of gestation, were randomized to receive either 162 mg of LDA daily or standard care. The primary outcome was the incidence of HDP, while secondary outcomes included early-onset preeclampsia (EOPE), preterm birth, low birth weight (LBW), and neonatal death. Data analysis used relative risk (RR) and 95 % confidence intervals (CIs).

RESULTS

Of the 423 women, 209 were in the LDA group and 214 in the control group. The incidence of HDP was significantly lower in the LDA group (6.2 % vs. 25.2 %; RR = 0.25, 95 % CI [0.14-0.44], p < 0.001), corresponding to a 75 % reduction in HDP risk, with an absolute risk reduction (ARR) of 19 % and a number needed to treat (NNT) of 5.3. EOPE was reduced (2.4 % vs. 14.0 %; RR = 0.17, 95 % CI [0.07-0.41], p < 0.001), as was preterm birth (6.7 % vs. 26.2 %; RR = 0.26, 95 % CI [0.15-0.45], p < 0.001). There were no significant differences for LBW or neonatal death. Sensitivity analysis confirmed the importance of initiating LDA before 16 weeks, showing continued reductions in HDP incidence with early initiation.

CONCLUSION

LDA significantly reduces the risk of HDP, EOPE, and preterm birth, particularly when initiated before 16 weeks of gestation. These findings support the use of LDA for preventing hypertensive disorders of pregnancy in low-resource settings and underscore the value of early intervention for improved maternal and fetal outcomes.

The rebalancing of the immune system at the maternal-fetal interface ameliorates autism-like behavior in adult offspring

Maternal immune activation (MIA) is critical for imparting neuropathology and altered behaviors in offspring; however, maternal-fetal immune cell populations have not been thoroughly investigated in MIA-induced autism spectrum disorders (ASDs). Here, we report the single-cell transcriptional landscape of placental cells in both PBS- and poly(I:C)-induced MIA dams. We observed a decrease in regulatory T (Treg) cells but an increase in the M1 macrophage population at the maternal-fetal interface in MIA dams. Based on the Treg-targeting approach, we investigate an immunoregulatory protein, the helminth-derived heat shock protein 90α (Sjp90α), that induces maternal Treg cells and subsequently rescues the autism-like behaviors in adult offspring. Furthermore, in vivo depletion of maternal macrophages attenuates placental inflammatory reaction and reverses behavioral abnormalities in adult offspring. Notably, Sjp90α induces CD4+ T cell differentiation via scavenger receptor A (SR-A) on the macrophage in vitro. Our findings suggest a maternal Treg-targeted approach to alleviate MIA-induced autism-like behavior in adult offspring.

The Enigmatic Interplay of Interleukin-10 in the Synergy of HIV Infection Comorbid with Preeclampsia

Cytokines coordinate the intricate choreography of the immune system, directing cellular activities that mediate inflammation, pathogen defense, pathology and tissue repair. Within this spectrum, the anti-inflammatory prowess of interleukin-10 (IL-10) predominates in immune homeostasis. In normal pregnancy, the dynamic shift of IL-10 across trimesters maintains maternal immune tolerance ensuring fetal development and pregnancy success. Unravelling the dysregulation of IL-10 in pregnancy complications is vital, particularly in the heightened inflammatory condition of preeclampsia. Of note, a reduction in IL-10 levels contributes to endothelial dysfunction. In human immunodeficiency virus (HIV) infection, a complex interplay of IL-10 occurs, displaying a paradoxical paradigm of being immune-protective yet aiding viral persistence. Genetic variations in the IL-10 gene further modulate susceptibility to HIV infection and preeclampsia, albeit with nuanced effects across populations. This review outlines the conceptual framework underlying the role of IL-10 in the duality of normal pregnancy and preeclampsia together with HIV infection, thus highlighting its regulatory mechanisms and genetic influences. Synthesizing these findings in immune modulation presents avenues for therapeutic interventions in pregnancy complications comorbid with HIV infection.

Combined maternal KIR2DL4 and fetal HLA-G polymorphisms were associated with preeclampsia in a Han Chinese population

Preeclampsia is the main cause of maternal and infant mortality and morbidity during pregnancy. Killer cell immunoglobulin-like receptor 2DL4 (KIR2DL4) and human leukocyte antigen G (HLA-G) play crucial roles in immune tolerance at the maternal-fetal interface. In this case‒control study, 154 maternal-fetal pairs were recruited, including 74 pairs with preeclampsia (56 of 74 pairs from family triads) and 80 pairs with a normal pregnancy (78 of 80 pairs from family triads). SNaPshot technology was used to detect genetic polymorphisms for 7 TagSNPs in the KIR2DL4 and HLA-G genes. Among the fetal HLA-G gene polymorphisms, rs9380142 (A vs. G: OR = 2.802, 95% CI = 1.761-4.458) and rs1063320 (G vs. C: OR = 1.807, 95% CI = 1.144-2.852) differed between the preeclampsia group and the control group. The transmission disequilibrium test (TDT) suggested that the differences in the rs9380142G/A polymorphism in foetuses between preeclampsia triads and control triads were due to differences in transmission from the parents (P = 0.001). There was no significant difference in the distribution of maternal KIR2DL4 alleles or genotype frequency between the preeclampsia group and the control group. Gene‒gene interaction analysis revealed that the combined genotypes of maternal rs649216-CC and fetal rs9380142-GG, maternal rs1051456-CG/GG and fetal rs9380142-GG, maternal rs34785252-CC and fetal rs9380142-AA/GA, and maternal rs34785252-CC/AA and fetal rs9380142-GG were associated with a significantly lower risk of preeclampsia. Therefore, this study suggested that the combination of maternal KIR2DL4 and fetal HLA-G polymorphisms was associated with preeclampsia in a Han Chinese population.

Evaluating Hematological Inflammatory Markers as Predictors of Preeclampsia

Background: Preeclampsia, affecting 2–8% of pregnancies, is characterized by new-onset hypertension, proteinuria, and edema, stemming from placental dysfunction and subsequent inflammatory cascade activation. This study aimed to test the predictive ability of hematological indices in predicting preeclampsia. Therefore, predicting the diagnosis of preeclampsia earlier with higher accuracy could potentially preserve the lives of both the mother and the fetus, while also reducing the rates of complications. Methods: This retrospective study included two groups: patients with preeclampsia and a matched control group without additional medical conditions, both having undergone childbirth in the same gestational week. The primary difference between the groups was the preeclampsia diagnosis. Hematological parameters and inflammatory indices were compared for analysis. Results: Statistical significance was observed between derived neutrophil-lymphocyte ratio (dNLR), systemic immune-inflammation index (SIRI) and pan-immune inflammation value (PIV) between groups. The dNLR and PIV showed predictive relevance for preeclampsia (p < 0.05). However, their predictive performance was weak (under the curve (AUC) <0.5). A composite index (CoI) combining these indices achieved a higher AUC of 0.62, indicating limited better predictive performance capability. Conclusions: These findings affirm the correlation between preeclampsia and increased inflammation. Inflammatory markers like the dNLR, SIRI, and PIV showed statistical significance but were not practically useful in clinical settings due to their low sensitivity and specificity. The results highlight the necessity of exploring a CoI, which combines these markers, to enhance predictive accuracy and clinical utility.

Unveiling immune tolerance pathways in preeclampsia placenta: implications for molecular targets and discovery of potential biomarkers

During pregnancy, there is a link between disruption of maternal immune tolerance and preeclampsia, but the molecular mechanisms that regulate maternal and fetal immune tolerance remain unclear. This study employs bioinformatics to identify new markers related to placental immune tolerance and explore their potential role in predicting preeclampsia. Analyzing preeclampsia-related gene expression profiles in the Gene Expression Omnibus (GEO) dataset reveals 211 differentially expressed genes (DEGs) in the placenta, mainly influencing immune cell differentiation and response pathways. Employing weighted gene co-expression network analysis (WGCNA) and lasso regression, four potential target genes (ANKRD37, CRH, LEP, SIGLEC6) are identified for potential prediction of preeclampsia. Validation using the GSE4707 dataset confirmed the diagnostic and predictive potential of these candidate genes. RT-qPCR verified up-regulation in the placenta, while ELISA showed their correlation with immune tolerance factors associated with placental immune tolerance. As a result of this study, identifies potential biomarkers associated with placental immunity and contributes to understanding the molecular mechanism of preeclampsia.

Bridging the divide: unveiling mutual immunological pathways of cancer and pregnancy

The juxtaposition of two seemingly disparate physiological phenomena within the human body-namely, cancer and pregnancy-may offer profound insights into the intricate interplay between malignancies and the immune system. Recent investigations have unveiled striking similarities between the pivotal processes underpinning fetal implantation and successful gestation and those governing tumor initiation and progression. Notably, a confluence of features has emerged, underscoring parallels between the microenvironment of tumors and the maternal-fetal interface. These shared attributes encompass establishing vascular networks, cellular mobilization, recruitment of auxiliary tissue components to facilitate continued growth, and, most significantly, the orchestration of immune-suppressive mechanisms.Our particular focus herein centers on the phenomenon of immune suppression and its protective utility in both of these contexts. In the context of pregnancy, immune suppression assumes a paramount role in shielding the semi-allogeneic fetus from the potentially hostile immune responses of the maternal host. In stark contrast, in the milieu of cancer, this very same immunological suppression fosters the transformation of the tumor microenvironment into a sanctuary personalized for the neoplastic cells.Thus, the striking parallels between the immunosuppressive strategies deployed during pregnancy and those co-opted by malignancies offer a tantalizing reservoir of insights. These insights promise to inform novel avenues in the realm of cancer immunotherapy. By harnessing our understanding of the immunological events that detrimentally impact fetal development, a knowledge grounded in the context of conditions such as preeclampsia or miscarriage, we may uncover innovative immunotherapeutic strategies to combat cancer.

Comparison of immune-related gene signatures and immune infiltration features in early- and late-onset preeclampsia

BACKGROUND

Preeclampsia, a severe pregnancy syndrome, is widely accepted divided into early- and late-onset preeclampsia (EOPE and LOPE) based on the onset time of preeclampsia, with distinct pathophysiological origins. However, the molecular mechanism especially immune-related mechanisms for EOPE and LOPE is currently obscure. In the present study, we focused on placental immune alterations between EOPE and LOPE and search for immune-related biomarkers that could potentially serve as potential therapeutic targets through bioinformatic analysis.

METHODS

The gene expression profiling data was obtained from the Gene Expression Omnibus database. ESTIMATE algorithm and Gene Set Enrichment Analysis were employed to evaluate the immune status. The intersection of differentially expressed genes in GSE74341 series and immune-related genes set screened differentially expressed immune-related genes. Protein-protein interaction network and random forest were used to identify hub genes with a validation by a quantitative real-time PCR. Kyoto Encyclopedia of Genes and Genomes pathways, Gene Ontology and gene set variation analysis were utilized to conduct biological function and pathway enrichment analyses. Single-sample gene set enrichment analysis and CIBERSORTx tools were employed to calculate the immune cell infiltration score. Correlation analyses were evaluated by Pearson correlation analysis. Hub genes-miRNA network was performed by the NetworkAnalyst online tool.

RESULTS

Immune score and stromal score were all lower in EOPE samples. The immune system-related gene set was significantly downregulated in EOPE compared to LOPE samples. Four hub differentially expressed immune-related genes (IL15, GZMB, IL1B and CXCL12) were identified based on a protein-protein interaction network and random forest. Quantitative real-time polymerase chain reaction validated the lower expression levels of four hub genes in EOPE compared to LOPE samples. Immune cell infiltration analysis found that innate and adaptive immune cells were apparent lacking in EOPE samples compared to LOPE samples. Cytokine-cytokine receptor, para-inflammation, major histocompatibility complex class I and T cell co-stimulation pathways were significantly deficient and highly correlated with hub genes. We constructed a hub genes-miRNA regulatory network, revealing the correlation between hub genes and hsa-miR-374a-5p, hsa-miR-203a-3p, hsa-miR-128-3p, hsa-miR-155-3p, hsa-miR-129-2-3p and hsa-miR-7-5p.

CONCLUSIONS

The innate and adaptive immune systems were severely impaired in placentas of EOPE. Four immune-related genes (IL15, GZMB, IL1B and CXCL12) were closely correlated with immune-related pathogenesis of EOPE. The result of our study may provide a new basis for discriminating between EOPE and LOPE and acknowledging the role of the immune landscape in the eventual interference and tailored treatment of EOPE.