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Gil Laborda R, de Frías ER, Subhi-Issa N, de Albornoz EC, Meliá E, Órdenes M, Verdú V, Vidal J, Suárez E, Santillán I, Ordóñez D, Pintado-Vera D, González Villafáñez V, Lorenzo Á, Fariñas M, Rodríguez-Paíno M, Núñez Beltrán M, García Segovia Á, Del Olmo A, Martín Cañadas F, Daurelio R, de la Fuente A, González Casbas JM, Cabezuelo V, Ros Berruezo F, Moreno Hidalgo MÁ, Iniesta S, Bueno B, Martínez Acera Á, Izquierdo A, Vicario JL, Fernández-Arquero M, Sánchez-Ramón S. Centromeric AA motif in KIR as an optimal surrogate marker for precision definition of alloimmune reproductive failure. Sci Rep 2024; 14:3354. [PMID: 38336826 PMCID: PMC10858137 DOI: 10.1038/s41598-024-53766-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Accepted: 02/05/2024] [Indexed: 02/12/2024] Open
Abstract
Throughout pregnancy, the decidua is predominantly populated by NK lymphocytes expressing Killer immunoglobulin-like receptors (KIR) that recognize human leukocyte antigen-C (HLA-C) ligands from trophoblast cells. This study aims to investigate the association of KIR-HLA-C phenotypes in couples facing infertility, particularly recurrent pregnancy loss (RPL) and recurrent implantation failure (RIF), in comparison to a reference population and fertile controls. This observational, non-interventional retrospective case-control study included patients consecutively referred to our Reproductive Immunology Unit from 2015 to 2019. We analyzed the frequencies of KIR and HLA-C genes. As control groups, we analyzed a reference Spanish population for KIR analysis and 29 fertile controls and their male partners for KIR and HLA-C combinations. We studied 397 consecutively referred women with infertility and their male partners. Among women with unexplained RPL (133 women) and RIF (176 women), the centromeric (cen)AA KIR genotype was significantly more prevalent compared to the reference Spanish population (p = 0.001 and 0.02, respectively). Furthermore, cenAA was associated with a 1.51-fold risk of RPL and a 1.2-fold risk of RIF. Conversely, the presence of BB KIR showed a lower risk of reproductive failure compared to non-BB KIR (OR: 0.12, p < 0.001). Women and their partners with HLA-C1C1/C1C1 were significantly less common in the RPL-Group (p < 0.001) and RIF-Group (p = 0.002) compared to the control group. Moreover, the combination of cenAA/C1C1 in women with C1C1 partners was significantly higher in the control group than in the RPL (p = 0.009) and RIF (p = 0.04) groups, associated with a 5-fold increase in successful pregnancy outcomes. In our cohort, the cenAA KIR haplotype proved to be a more accurate biomarker than the classic AA KIR haplotype for assessing the risk of RPL and RIF, and might be particularly useful to identify women at increased risk among the heterogeneous KIR AB or Bx population. The classification of centromeric KIR haplotypes outperforms classical KIR haplotypes, making it a better indicator of potential maternal-fetal KIR-HLA-C mismatch in patients.
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Affiliation(s)
- Raquel Gil Laborda
- Department of Immunology, IML and IdISSC, Hospital Clínico San Carlos, Madrid, Spain
| | | | - Nabil Subhi-Issa
- Department of Immunology, IML and IdISSC, Hospital Clínico San Carlos, Madrid, Spain
| | - Elena Carrillo de Albornoz
- Woman Unit, Hospital Ruber Internacional, Madrid, Spain
- Assisted Reproductive Unit, Hospital Ruber Internacional, Madrid, Spain
| | - Elena Meliá
- Woman Unit, Hospital Ruber Internacional, Madrid, Spain
| | - Marcos Órdenes
- Assisted Reproductive Unit, Hospital Ruber Internacional, Madrid, Spain
| | - Victoria Verdú
- Clínica GINEFIV, Madrid, Spain
- Clínica IVF, Madrid, Spain
| | - Juan Vidal
- Woman Unit, Hospital Ruber Internacional, Madrid, Spain
| | - Esther Suárez
- Woman Unit, Hospital Ruber Internacional, Madrid, Spain
| | - Isabel Santillán
- Clínica GINEFIV, Madrid, Spain
- Instituto Europeo de Fertilidad (IEF), Madrid, Spain
| | - Daniel Ordóñez
- Woman Unit, Hospital Ruber Internacional, Madrid, Spain
- Assisted Reproductive Unit, Hospital Ruber Internacional, Madrid, Spain
| | | | | | - Ángel Lorenzo
- Woman Unit, Hospital Ruber Internacional, Madrid, Spain
- Assisted Reproductive Unit, Hospital Ruber Internacional, Madrid, Spain
| | | | | | - María Núñez Beltrán
- Department of Immunology, IML and IdISSC, Hospital Clínico San Carlos, Madrid, Spain
| | - Áurea García Segovia
- Sanitas Assisted Reproduction Unit, Clínica Sanitas Millenium Alcobendas, Madrid, Spain
| | - Ainhoa Del Olmo
- Department of Immunology, IML and IdISSC, Hospital Clínico San Carlos, Madrid, Spain
| | | | | | | | | | | | | | | | - Silvia Iniesta
- Assisted Reproductive Unit, Hospital Ruber Internacional, Madrid, Spain
| | - Beatriz Bueno
- Assisted Reproductive Unit, Hospital Ruber Internacional, Madrid, Spain
| | - Álvaro Martínez Acera
- Woman Unit, Hospital Ruber Internacional, Madrid, Spain
- Assisted Reproductive Unit, Hospital Ruber Internacional, Madrid, Spain
| | - Alexandra Izquierdo
- Department of Immunology, IML and IdISSC, Hospital Clínico San Carlos, Madrid, Spain
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