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Recurrent Spontaneous Abortion of Immune Origin and HLA Sensitization Immunotherapy

Advances in Reproductive Sciences 2022年第1期10卷 12-18页

作者： Isabela Mansur Bandeira Juliana Vasconcelos Thiago Luiz Bandeira Jorge Oliveira Carla Goulart Aderbal Sabra Luiz Werber-Bandeira Clinical and Experimental Immunology and Allergy Service Santa Casa da Misericordia do Rio de Janeiro Rio de Janeiro Brazil Food Allergy and Autism Unit of the Clinical Immunology Service Santa Casa da Misericordia do Rio de Janeiro Rio de Janeiro Brazil

Introduction: Spontaneous abortion is defined as pregnancy loss before the twentieth week and Recurrent Spontaneous Abortion (RSA) is defined as at least three spontaneous and successive pregnancy losses in the same period. Among the different types of immunological causes, this study refers specifically to the alloimmune cause. Women with RSA of alloimmune cause share a greater number of Human Leukocyte Antigen (HLA) with their husbands, leading to the inhibition of the production of anti-paternal asymmetric blocking antibodies, which would protect embryonic cells. Objectives: To evaluate the effect of immunotherapy with paternal HLA-sensitizing mononuclear cells in cases of RSA through the positivity of the cross-match test and its efficacy in pregnancy success. Patients and Methods: Written consent was obtained, 12 couples with a history of RSA presenting negative cross-match were included in the study. Blood samples were collected from the couple for cross-matching and the separation of paternal mononuclear cells. Immunotherapy was performed with paternal mononuclear cells intradermally in the wives’ arms on day (D) 0, D15 and D30. After the third dose, a second evaluation of the cross- match tests was performed. Results and Discussion: The age of the wives ranged from 28 to 41 years, with a mean of 34.5 years. The twelve couples had a negative cross-match test (100%). Eleven couples (96.6%) tested positive in the cross- match test after immunotherapy. Of these, 10 (90.9%) had successful pregnancies. Immunotherapy with paternal mononuclear cells showed an excellent ability to sensitize the maternal immune system, with positive cross-match, resulting in a successful pregnancy.

关键词： Spontaneous Abortion Immunotherapy Pregnancy maternal-fetal relationships

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