Disorders of the Immune System in Pregnancy

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Obstetrics & Gynecology".

Deadline for manuscript submissions: 20 June 2024 | Viewed by 1786

Special Issue Editors


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Guest Editor
Obstetrics & Gynecology Unit, Department of Medicine and Surgery, University of Parma, 43121 Parma, Italy
Interests: fetal growth restriction; intrapartum ultrasound; parental diagnosis; maternal–fetal medicine; placenta accreta spectrum; fetal cardiac function

E-Mail Website
Guest Editor
Obstetrics & Gynecology Unit, Department of Medicine and Surgery, University of Parma, 43121 Parma, Italy
Interests: intrapartum ultrasound; maternal–fetal medicine; prenatal diagnosis; fetal growth restriction; placenta accreta spectrum; fetal cardiac function; intrapartum fetal monitoring

Special Issue Information

Dear Colleagues,

Pregnancy is characterized by a unique immunological environment characterized by the suppression of a variety of cell- and antibody-mediated mechanisms to accommodate the fetus and allow pregnancy continuation. This may explain the remission of some autoimmune disorders during pregnancy and also the increased incidence of complications in women with active disease at the time of conception or disease upturn at any point of gestation. Almost all organs and systems can be affected, and several pregnancy-specific complications can occur in pregnant women with autoimmune disease. The fetus is not exempt given that the transplacental passage of maternal auto- and alloantibodies may be responsible for the damage of fetal tissues and cells such as erythrocytes and platelets.

The aim of this Special Issue is to present novel and high-quality research in the field and highlight the most up-to-date evidence in the context of diagnosis, management, and prognosis of various disorders of the immune system, potentially leading to maternal and fetal complications during pregnancy.

Prof. Dr. Andrea Dall'Asta
Prof. Dr. Tullio Ghi
Guest Editors

Manuscript Submission Information

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Keywords

  • fetal alloimmunization
  • antiplatelet alloantibodies
  • congenital heart block
  • celiac disease in pregnancy
  • anti-cardiolipin antibodies in pregnancy
  • anti-beta2 microglobulin antibodies in pregnancy
  • renal autoimmunity in pregnancy
  • IBD in pregnancy

Published Papers (2 papers)

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Research

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12 pages, 2920 KiB  
Article
Autophagy Inhibition in Trophoblasts Induces Aberrant Shift in CXCR4+ Decidual NK Cell Phenotype Leading to Pregnancy Loss
by Nan Liu, Huihui Shen, Zehua Wang, Xueyun Qin, Mingqing Li and Xinyan Zhang
J. Clin. Med. 2023, 12(23), 7491; https://doi.org/10.3390/jcm12237491 - 04 Dec 2023
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Abstract
Background: Pregnancy, a complex biological phenomenon, relies on intricate maternal–fetal interactions for success. Decidual natural killer (dNK) cells and trophoblasts are pivotal in establishing immune tolerance at the maternal–fetal interface. The chemokine receptor CXCR4 plays a crucial role in NK cell development and [...] Read more.
Background: Pregnancy, a complex biological phenomenon, relies on intricate maternal–fetal interactions for success. Decidual natural killer (dNK) cells and trophoblasts are pivotal in establishing immune tolerance at the maternal–fetal interface. The chemokine receptor CXCR4 plays a crucial role in NK cell development and immune tolerance during early placental development. Methods: Primary decidual immune cells from 42 women with normal pregnancies and 20 patients experiencing recurrent spontaneous abortions (RSAs) were studied. Gene transcription in NK cells was assessed using real-time polymerase chain reaction. In a co-culture system, we examined the influence of trophoblasts on CXCR4 expression in dNK cells, with subsequent analysis conducted via flow cytometry. The proportion of CXCR4+ NK cells was assessed using flow cytometry after co-culture with trophoblasts pre-treated with 3-MA or a p53 activator. Results: Our study confirmed a diminished presence of decidual CXCR4+ NK cells in RSA patients during early pregnancy. Co-culturing with a trophoblast-derived supernatant increased CXCR4 expression in dNK cells. In addition, trophoblast autophagy plays an educative role in regulating the dNK landscape via the IGF2-TP53-CXCR4 axis. Conclusion: Autophagy inhibition in trophoblasts induces an aberrant shift in the CXCR4+ dNK phenotype, potentially contributing to pregnancy loss. This sheds light on the nuanced behavior of dNK cells during pregnancy, offering promising therapeutic avenues to mitigate pregnancy complications. Full article
(This article belongs to the Special Issue Disorders of the Immune System in Pregnancy)
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Review

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19 pages, 911 KiB  
Review
Pregnancy in Glomerular Disease: From Risk Identification to Counseling and Management
by Veronica Maressa, Elisa Longhitano, Chiara Casuscelli, Silvia Di Carlo, Luigi Peritore and Domenico Santoro
J. Clin. Med. 2024, 13(6), 1693; https://doi.org/10.3390/jcm13061693 - 15 Mar 2024
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Abstract
Background: Pregnancy involves complex hemodynamic and immune adaptations to support the developing fetus. The kidney assumes a pivotal role in orchestrating these mechanisms. However, renal disease poses a potential risk for adverse maternal–fetal outcomes. While kidney function, hypertension, and proteinuria are recognized [...] Read more.
Background: Pregnancy involves complex hemodynamic and immune adaptations to support the developing fetus. The kidney assumes a pivotal role in orchestrating these mechanisms. However, renal disease poses a potential risk for adverse maternal–fetal outcomes. While kidney function, hypertension, and proteinuria are recognized as key influencers of risk, the mere presence of glomerular disease, independent of these factors, may wield significant impact. Methods: A brief review of the existing literature was conducted to synthesize current knowledge regarding the interplay between glomerulonephritis and pregnancy. Results: The review underscores the centrality of the kidney in the context of pregnancy and highlights the role of glomerular disease, particularly when active. It emphasizes multifaceted risk modulators, including kidney function, hypertension, and proteinuria. Conclusion: Understanding the dynamics between pregnancy and glomerulonephritis is crucial for optimizing maternal and fetal outcomes. Preconception counseling and collaborative nephro-gynecological management emerge as pivotal components in addressing the unique challenges posed by this medical interplay. Full article
(This article belongs to the Special Issue Disorders of the Immune System in Pregnancy)
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Planned Papers

The below list represents only planned manuscripts. Some of these manuscripts have not been received by the Editorial Office yet. Papers submitted to MDPI journals are subject to peer-review.

Title: Pre-conceptional counselling in women with autoimmune inflammatory rheumatic diseases

Abstract:

Rheumatic diseases in pregnancy represent a complex challenge for both patients and healthcare providers. Timely and interdisciplinary preparation for pregnancy focusing on adequate disease control may reduce the risk of disease flare and the overall risk of maternal and fetal pregnancy complications. This review provides a comprehensive overview of the essential components of pre-pregnancy counselling in rheumatic disease, including medication management strategies tailored to pregnant individuals, disease activity monitoring throughout pregnancy, maternal and fetal pregnancy monitoring in rheumatic disease and the promotion of shared decision-making between healthcare providers and patients. Guidelines from key international organizations will be critically assessed and discussed, highlighting the quintessential discussion points of care in this special group of patients. 

Keywords: pre-pregnancy counselling; rheumatic diseases; interdisciplinary care; disease control; fetal and maternal obstetric complications

 

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