Peripheral and uterine NK cells in patients with repeated spontaneous abortions

Abstract

We investigated eighteen selected patients, aged 23–39 (mean age: 28) years who suffered from repeated spontaneous abortions (3–9). Women had basic education in 2/18, high school 12/18, and university finished 4/18. Detailed examinations showed genetic trombophilic factors in five (5/18), antiphospholipid syndrom in six (6/18) of them, normal spermiogramme in nine of their partners, moderate pathology in acrosomal enzymeswas found in nine men. All couples have been treated according to accepted rules of the therapy in previously acquired pathologies (LWHM, aspirin, vitamins, gestagens). Despite this targeted treatment, our patients miscarried again. We went on examination of their peripheral natural killer cells (pNK) such as CD16+ CD56, and CD4, CD8, CD19 by flow cytometry, and uterine natural killer cells (unNK) during timed hysteroscopy (22–24 day of their menstrual cycle). UnNK were identified by immunohistochemistry. We did not find any correlation of pNK and unNK cells in all investigated patients. But in six 6/18 of them extremely high number of endometrial CD56+, and in four 4/18 CD16+, and in one patient both CD56+ CD16+ was found. Wedecided to treat our infertilepatientswithhighpositivefindings of the uterine NK cells CD56+ CD16+ by IVIG. We suppose that criterium of unNK cells is much better than criterium of pNK cells only. Diagnostic hysteroscopy has its advantages (vizualization of the endometrium, uterine anatomy, etc.). Imunohistochemical evidence of high number of uNK cells seems to be much better for decision of IVIG therapy in context of clinical conditions of both partners.