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Creisher PS, Parish MA, Lei J, Liu J, Perry JL, Campbell AD, Sherer ML, Burd I, Klein SL. Suppression of progesterone by influenza A virus mediates adverse maternal and fetal outcomes in mice. mBio 2024; 15:e0306523. [PMID: 38190129 PMCID: PMC10865978 DOI: 10.1128/mbio.03065-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 12/06/2023] [Indexed: 01/09/2024] Open
Abstract
Influenza A virus infection during pregnancy can cause adverse maternal and fetal outcomes but the mechanism responsible remains elusive. Infection of outbred mice with 2009 H1N1 at embryonic day (E) 10 resulted in significant maternal morbidity, placental tissue damage and inflammation, fetal growth restriction, and developmental delays that lasted through weaning. Restriction of pulmonary virus replication was not inhibited during pregnancy, but infected dams had suppressed circulating and placental progesterone (P4) concentrations that were caused by H1N1-induced upregulation of pulmonary cyclooxygenase (COX)-1-, but not COX-2-, dependent synthesis and secretion of prostaglandin (PG) F2α. Treatment with 17-α-hydroxyprogesterone caproate (17-OHPC), a synthetic progestin that is safe to use in pregnancy, ameliorated the adverse maternal and fetal outcomes from H1N1 infection and prevented placental cell death and inflammation. These findings highlight the therapeutic potential of progestin treatments for influenza during pregnancy.IMPORTANCEPregnant individuals are at risk of severe outcomes from both seasonal and pandemic influenza A viruses. Influenza infection during pregnancy is associated with adverse fetal outcomes at birth and adverse consequences for offspring into adulthood. When outbred dams, with semi-allogenic fetuses, were infected with 2009 H1N1, in addition to pulmonary virus replication, lung damage, and inflammation, the placenta showed evidence of transient cell death and inflammation that was mediated by increased activity along the arachidonic acid pathway leading to suppression of circulating progesterone. Placental damage and suppressed progesterone were associated with detrimental effects on perinatal growth and developmental delays in offspring. Treatment of H1N1-infected pregnant mice with 17-OHPC, a synthetic progestin treatment that is safe to use in pregnancy, prevented placental damage and inflammation and adverse fetal outcomes. This novel therapeutic option for the treatment of influenza during pregnancy should be explored clinically.
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Affiliation(s)
- Patrick S. Creisher
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Maclaine A. Parish
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Jun Lei
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Jin Liu
- Department of Gynecology and Obstetrics, Integrated Research Center for Fetal Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jamie L. Perry
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Ariana D. Campbell
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Morgan L. Sherer
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Irina Burd
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Sabra L. Klein
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Creisher PS, Parish MA, Lei J, Liu J, Perry JL, Campbell AD, Sherer ML, Burd I, Klein SL. Suppression of progesterone by influenza A virus mediates adverse maternal and fetal outcomes in mice. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.09.11.557146. [PMID: 37745453 PMCID: PMC10515826 DOI: 10.1101/2023.09.11.557146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/26/2023]
Abstract
Influenza A virus infection during pregnancy can cause adverse maternal and fetal outcomes, but the mechanism responsible remains elusive. Infection of outbred mice with 2009 H1N1 at embryonic day (E) 10 resulted in significant maternal morbidity, placental tissue damage and inflammation, fetal growth restriction, and developmental delays that lasted through weaning. Restriction of pulmonary virus replication was not inhibited during pregnancy, but infected dams had suppressed circulating and placental progesterone (P4) concentrations that were caused by H1N1-induced upregulation of pulmonary cyclooxygenase (COX)-1, but not COX-2-, dependent synthesis and secretion of prostaglandin (PG) F2α. Treatment with 17-α-hydroxyprogesterone caproate (17-OHPC), a synthetic progestin that is safe to use in pregnancy, ameliorated the adverse maternal and fetal outcomes from H1N1 infection and prevented placental cell death and inflammation. These findings highlight the therapeutic potential of progestin treatments for influenza during pregnancy.
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Bonney EA. A Framework for Understanding Maternal Immunity. Immunol Allergy Clin North Am 2023; 43:e1-e20. [PMID: 37179052 PMCID: PMC10484232 DOI: 10.1016/j.iac.2023.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
This is an alternative and controversial framing of the data relevant to maternal immunity. It argues for a departure from classical theory to view, interrogate and interpret existing data.
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Affiliation(s)
- Elizabeth A Bonney
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Vermont Robert Larner College of Medicine, Given Building, Room C246, 89 Beaumont Avenue, Burlington, VT 05405, USA.
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Sharma S, Rodrigues PR, Zaher S, Davies LC, Ghazal P. Immune-metabolic adaptations in pregnancy: A potential stepping-stone to sepsis. EBioMedicine 2022; 86:104337. [PMID: 36470829 PMCID: PMC9782817 DOI: 10.1016/j.ebiom.2022.104337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 09/30/2022] [Accepted: 10/17/2022] [Indexed: 12/04/2022] Open
Abstract
Physiological shifts during pregnancy predispose women to a higher risk of developing sepsis resulting from a maladapted host-response to infection. Insightful studies have delineated subtle point-changes to the immune system during pregnancy. Here, we present an overlay of these point-changes, asking what changes and when, at a physiological, cellular, and molecular systems-level in the context of sepsis. We identify distinct immune phases in pregnancy delineated by placental hormone-driven changes in homeostasis setpoints of the immune and metabolic systems that subtly mirrors changes observed in sepsis. We propose that pregnancy immune-metabolic setpoint changes impact feedback thresholds that increase risk for a maladapted host-response to infection and thus act as a stepping-stone to sepsis. Defining maternal immune-metabolic setpoint changes is not only vital for tailoring the right diagnostic tools for early management of maternal sepsis but will facilitate an unravelling of the pathophysiological pathways that predispose an individual to sepsis.
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Affiliation(s)
- Simran Sharma
- Project Sepsis, Systems Immunity Research Institute, Cardiff University, Cardiff, CF14 4XN, UK,Department of Obstetrics & Gynaecology, University Hospital of Wales, Cardiff, CF14 4XW, UK,Corresponding author. Department of Obstetrics & Gynaecology, University Hospital of Wales, Cardiff, CF14 4XW, UK.
| | - Patricia R.S. Rodrigues
- Project Sepsis, Systems Immunity Research Institute, Cardiff University, Cardiff, CF14 4XN, UK
| | - Summia Zaher
- Project Sepsis, Systems Immunity Research Institute, Cardiff University, Cardiff, CF14 4XN, UK,Department of Obstetrics & Gynaecology, University Hospital of Wales, Cardiff, CF14 4XW, UK
| | - Luke C. Davies
- Project Sepsis, Systems Immunity Research Institute, Cardiff University, Cardiff, CF14 4XN, UK,Biomedical Sciences Unit, Swansea University Medical School, Singleton Park, Swansea, SA2 8PP, UK
| | - Peter Ghazal
- Project Sepsis, Systems Immunity Research Institute, Cardiff University, Cardiff, CF14 4XN, UK,Corresponding author. Systems Immunity Research Institute, School of Medicine, Cardiff University, Heath Park, Cardiff, CF14 4XN, UK.
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Moldenhauer LM, Hull ML, Foyle KL, McCormack CD, Robertson SA. Immune–Metabolic Interactions and T Cell Tolerance in Pregnancy. THE JOURNAL OF IMMUNOLOGY 2022; 209:1426-1436. [DOI: 10.4049/jimmunol.2200362] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 08/01/2022] [Indexed: 01/04/2023]
Abstract
Abstract
Pregnancy depends on a state of maternal immune tolerance mediated by CD4+ regulatory T (Treg) cells. Uterine Treg cells release anti-inflammatory factors, inhibit effector immunity, and support adaptation of the uterine vasculature to facilitate placental development. Insufficient Treg cells or inadequate functional competence is implicated in infertility and recurrent miscarriage, as well as pregnancy complications preeclampsia, fetal growth restriction, and preterm birth, which stem from placental insufficiency. In this review we address an emerging area of interest in pregnancy immunology–the significance of metabolic status in regulating the Treg cell expansion required for maternal–fetal tolerance. We describe how hyperglycemia and insulin resistance affect T cell responses to suppress generation of Treg cells, summarize data that implicate a role for altered glucose metabolism in impaired maternal–fetal tolerance, and explore the prospect of targeting dysregulated metabolism to rebalance the adaptive immune response in women experiencing reproductive disorders.
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Affiliation(s)
- Lachlan M. Moldenhauer
- *Robinson Research Institute and School of Biomedicine, University of Adelaide, Adelaide, South Australia, Australia; and
| | - M. Louise Hull
- *Robinson Research Institute and School of Biomedicine, University of Adelaide, Adelaide, South Australia, Australia; and
| | - Kerrie L. Foyle
- *Robinson Research Institute and School of Biomedicine, University of Adelaide, Adelaide, South Australia, Australia; and
| | - Catherine D. McCormack
- *Robinson Research Institute and School of Biomedicine, University of Adelaide, Adelaide, South Australia, Australia; and
- †Women’s and Children’s Hospital, North Adelaide, Adelaide, South Australia, Australia
| | - Sarah A. Robertson
- *Robinson Research Institute and School of Biomedicine, University of Adelaide, Adelaide, South Australia, Australia; and
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Moldenhauer LM, Jin M, Wilson JJ, Green ES, Sharkey DJ, Salkeld MD, Bristow TC, Hull ML, Dekker GA, Robertson SA. Regulatory T Cell Proportion and Phenotype Are Altered in Women Using Oral Contraception. Endocrinology 2022; 163:6628694. [PMID: 35786711 PMCID: PMC9354970 DOI: 10.1210/endocr/bqac098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Indexed: 11/19/2022]
Abstract
Regulatory T (Treg) cells are a specialized CD4+ T cell subpopulation that are essential for immune homeostasis, immune tolerance, and protection against autoimmunity. There is evidence that sex-steroid hormones estrogen and progesterone modulate Treg cell abundance and phenotype in women. Since natural oscillations in these hormones are modified by hormonal contraceptives, we examined whether oral contraception (OC) use impacts Treg cells and related T cell populations. T cells were analyzed by multiparameter flow cytometry in peripheral blood collected across the menstrual cycle from healthy women either using OC or without hormonal contraception and from age-matched men. Compared to naturally cycling women, women using OC had fewer Treg cells and an altered Treg cell phenotype. Notably, Treg cells exhibiting a strongly suppressive phenotype, defined by high FOXP3, CD25, Helios, HLADR, CTLA4, and Ki67, comprised a lower proportion of total Treg cells, particularly in the early- and mid-cycle phases. The changes were moderate compared to more substantial differences in Treg cells between women and men, wherein women had fewer Treg cells-especially of the effector memory Treg cell subset-associated with more T helper type 1 (Th1) cells and CD8+ T cells and lower Treg:Th1 cell and Treg:CD8+ T cell ratios than men. These findings imply that OC can modulate the number and phenotype of peripheral blood Treg cells and raise the possibility that Treg cells contribute to the physiological changes and altered disease susceptibility linked with OC use.
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Affiliation(s)
| | | | - Jasmine J Wilson
- Robinson Research Institute and School of Biomedicine, University of Adelaide, Adelaide, Australia
| | - Ella S Green
- Robinson Research Institute and School of Biomedicine, University of Adelaide, Adelaide, Australia
| | - David J Sharkey
- Robinson Research Institute and School of Biomedicine, University of Adelaide, Adelaide, Australia
| | - Mark D Salkeld
- Robinson Research Institute and School of Biomedicine, University of Adelaide, Adelaide, Australia
| | - Thomas C Bristow
- Robinson Research Institute and School of Biomedicine, University of Adelaide, Adelaide, Australia
| | - M Louise Hull
- Robinson Research Institute and Adelaide Medical School, University of Adelaide, Adelaide, Australia
| | - Gustaaf A Dekker
- Robinson Research Institute and Adelaide Medical School, University of Adelaide, Adelaide, Australia
- Division of Women’s Health, Lyell McEwin Hospital, Elizabeth Vale, Australia
| | - Sarah A Robertson
- Correspondence: Sarah A. Robertson, PhD, Robinson Research Institute and the School of Biomedicine, University of Adelaide, Adelaide, SA 5005, Australia.
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