Abstract
The immune changes that accompany pregnancy are in several ways similar to those required for solid organ transplantation. Successful pregnancy involves controlled downregulation of the maternal immune system with increased tolerance of foetal cells expressing paternal HLA antigens. This is mediated principally by human chorionic gonadotrophin which has a documented ability to alter the action of T cells, dendritic cells and natural killer cells as well as increasing vascularisation. Chronic graft rejection is now the leading cause of graft dysfunction and failure. Long term anti-rejection therapy is accompanied by immune deficiency and an adverse cardiovascular profile. In contrast, overall immune function is preserved in pregnancy and pregnant women generally feel well. As such hCG initially added to conventional therapy may reduce or prevent chronic rejection in transplantation. In the future hCG may even replace long term anti-rejection therapy.
Highlights
The immune changes that accompany pregnancy are in several ways similar to those required for solid organ transplantation
Successful pregnancy involves controlled downregulation of the maternal immune system with increased tolerance of foetal cells expressing paternal HLA antigens. This is mediated principally by human chorionic gonadotrophin which has a documented ability to alter the action of T cells, dendritic cells and natural killer cells as well as increasing vascularisation
Pregnancy represents nature’s best model of solid organ transplantation; a complex graft mismatched at half of all HLA antigens
Summary
The importance of hCG in promoting tolerance and reducing the activation of those cells that are involved in rejection was investigated in the 1970s to see if the human hCG could lengthen the survival of skin allografts in mice and rats [7,8]. The improvement in the symptoms of rheumatoid arthritis during pregnancy is due in part to the hCG induced shift of Th1 mediated cellular immunity to a pro-pregnancy Th2 immunity and an increase in T regulatory cell function. These changes are favourable for both pregnancy [10] and for a reduction in pathogenic RA immune activity [11]. HCG has been used successfully in the management of paraneoplastic neuropathy mediated by anti-Hu antibodies [12]
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