Морфофункциональные, молекулярные и иммунологические изменения в плаценте и периферической крови при патологическом прикреплении плаценты

Abstract

Introduction. Placenta accreta spectrum is an abnormal invasion of villous trophoblast into the myometrium and one of the most severe complications of pregnancy. We aimed to study morphofunctional, molecular, and immunological changes in the placenta and peripheral blood in various types of placenta accreta spectrum.Materials and methods. The study involved 45 pregnant women who underwent ultrasound examination at weeks 35–38. According to the ultrasound data, 15 women had placenta accreta and 15 women developed placenta increta. The comparison group included 15 pregnant women without placenta accreta spectrum with a uterine scar after cesarean section. Histological and immunohistochemical studies were performed on paraffin sections of the placentas. We used mouse antibodies to insulin-like growth factor-binding protein-1, pregnancy-specific β-1 glycoprotein, and human placental lactogen, proteinase 3 and measured them using ELISA. We also studied tumor necrosis factor. Immunophenotyping of peripheral blood lymphocytes was performed using flow cytometry. Results. Рlacenta accreta spectrum is accompanied by increased intensity of IHC staining of placental villi for all the studied markers, in contrast to those in the comparison group. The maximum intensity of insulin-like growth factor-binding protein-1 staining was found in placenta increta. Increased serum concentration of proteinase 3 and placental lactogen (placenta increta) and decreased level of insulin-like growth factor-binding protein-1 were found in placenta accreta spectrum.Conclusion. In placenta accreta spectrum, there is a functional redundancy of placental proteins and an increased pro-inflammatory status. An imbalance between aggressive factors are likely to contribute to pathological villous invasion. Keywords: placenta accreta spectrum, immune status, placental proteins, proteinase 3