Abstract
There are several open questions to be answered regarding the pathophysiology of the development of preeclampsia (PE). Numerous factors are involved in its genesis, such as defective placentation, vascular impairment, and an altered immune response. The activation of the adaptive and innate immune system represents an immunologic, particularity during PE. Proinflammatory cytokines are predominantly produced, whereas immune regulatory and immune suppressive factors are diminished in PE. In the present study, we focused on the recruitment of regulatory T cells (Tregs) which are key players in processes mediating immune tolerance. To identify Tregs in the decidua, an immunohistochemical staining of FoxP3 of 32 PE and 34 control placentas was performed. A clearly reduced number of FoxP3-positive cells in the decidua of preeclamptic women could be shown in our analysis (p = 0.036). Furthermore, CCL22, a well-known Treg chemoattractant, was immunohistochemically evaluated. Interestingly, CCL22 expression was increased at the maternal-fetal interface in PE-affected pregnancies (psyncytiotrophoblast = 0.035, pdecidua = 0.004). Therefore, the hypothesis that Tregs undergo apoptosis at the materno-fetal interface during PE was generated, and verified by FoxP3/TUNEL (TdT-mediated dUTP-biotin nick end labeling) staining. Galectin-2 (Gal-2), a member of the family of carbohydrate-binding proteins, which is known to be downregulated during PE, seems to play a pivotal role in T cell apoptosis. By performing a cell culture experiment with isolated Tregs, we could identify Gal-2 as a factor that seems to prevent the apoptosis of Tregs. Our findings point to a cascade of apoptosis of Tregs at the materno-fetal interface during PE. Gal-2 might be a potential therapeutic target in PE to regulate immune tolerance.
Highlights
Hypertensive disorders are a common complication in pregnancy, resulting in an increased risk of further complications, as well as long-term consequences for women and their fetuses [1,2,3]
Numerous factors are involved in its genesis, such as defective placentation, vascular impairment, and an altered immune response
We focused on the recruitment of regulatory T cells (Tregs) which are key players in processes mediating immune tolerance
Summary
Hypertensive disorders are a common complication in pregnancy, resulting in an increased risk of further complications, as well as long-term consequences for women and their fetuses [1,2,3]. The main diagnostic criteria of PE are based on the following symptoms: a new onset hypertonia (>140/90 mmHg), combined with proteinuria (>300 mg/24 h) or other organ dysfunction in the second half of pregnancy [5]. It is known that the pathogenesis of PE progresses in two stages, beginning with a defective trophoblast invasion and spiral artery remodeling, as well as immunological alterations in the early materno-fetal environment. An impaired trophoblast invasion [16,17]—resulting, among other complications, as a general vascular dysfunction and a deficient remodeling of the spiral arteries [5,18,19]—as well as defective placentation [15,20,21,22] appear to lead to placental insufficiency [23] and the release of vasoactive and pro-inflammatory substances that seem to cause the clinical symptoms
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