Imbalance of immunoregulatory molecular cellular mechanisms as a cause of recurrent miscarriage

Abstract

Introduction. Recurrent pregnancy loss (RPL) is an early spontaneous termination of pregnancy before 20 weeks, which is defined as two or more miscarriages. Most of the known causes associated with the pathophysiology of RPL include endocrine disorders, antiphospholipid syndrome, intrauterine infection, anatomical defects of the uterus, etc. However, in approximately 50% of cases, the cause of the pathogenesis of RPL remains unclear and may be associated with a violation of immune mechanisms, such as maternal tolerance to fetal alloantigens and controlled inflammation, which play a decisive role in successful pregnancy. Purpose of the review. To summarize current knowledge about the molecular cellular immune mechanisms that ensure the induction and maintenance of maternal-fetal tolerance and highlight the association between impaired immunoregulation and the development of RPL. Methods. The materials were the results of research on the topic over the past 23 years. Publications included in the Pubmed and eLibrary.ru databases were analyzed. Results. This review provides information about the immune regulation of pregnancy, which is carried out through the interaction of molecular mediators and effector cells of the innate and adaptive immunity. Current evidence points to a key role of the immune system in the pathophysiology of RPL. Successful pregnancy requires a finely regulated and tightly controlled balance between immune activation and tolerance to fetal antigens. Conclusion. The main events occur in the uteroplacental zone, where trophoblast cells and maternal lymphocytes come into close contact. The search for biomarkers for pregnancy complications is the focus of scientists.