Abstract
Intra-amniotic infection and inflammation (IAI) affect fetal development and are highly associated with preterm labor and premature rupture of membranes, which often lead to adverse neonatal outcomes. Human amniotic membrane (hAM), the inner part of the amnio-chorionic membrane, protects the embryo/fetus from environmental dangers, including microbial infection. However, weakened amnio-chorionic membrane may be breached or pathogens may enter through a different route, leading to IAI. The hAM and human amniotic fluid (hAF) respond by activation of all components of the innate immune system. This includes changes in 1) hAM structure, 2) presence of immune cells, 3) pattern recognition receptors, 4) cytokines, 5) antimicrobial peptides, 6) lipid derivatives, and 7) complement system. Herein we provide a comprehensive and integrative review of the current understanding of the innate immune response in the hAM and hAF, which will aid in design of novel studies that may lead to breakthroughs in how we perceive the IAI.
Highlights
Amniotic membrane (AM) serves as a wall of an embryo/fetal annex, and is the innermost component of the fetal membrane that envelops the amniotic fluid (AF) with the developing embryo/fetus [1]
Besides the nourishment and homeostatic functions, the cells of the Human AM (hAM) provide an extensive immune defense against the potential pathogens. hAM cells and cells involved in the immune response secrete a vast array of protective molecules including lipids, peptides, and proteins that comprise up to 25% of all identified proteins found in the Human AF (hAF) [22]
The pathogens are recognized by the pattern recognition receptors (PRRs), a component of the innate immune system, which activates the synthesis of cytokines, chemoattractant cytokines, prostaglandins, proteases, antimicrobial peptides, and other mechanisms of the innate immune system, some of which are mediated by neutrophils, monocytes and lymphocytes [51, 67, 68]
Summary
Amniotic membrane (AM) serves as a wall of an embryo/fetal annex, and is the innermost component of the fetal membrane (i.e. amnio-chorionic membrane) that envelops the amniotic fluid (AF) with the developing embryo/fetus [1]. The membrane of the socalled amniotic egg provided protection from dryer environment, while allowing the necessary gas exchange [3]. These egg-laying animals are ancestors to today’s clade Amniotes, which comprises of reptiles, birds and mammals. Though there are significant differences between the AM and AF of these animals, its main functions remain the same: to provide nourishment, homeostatic environment and protection from physical, chemical and biological stress to the fetus [4,5,6,7]
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