Immunopathology of the Implantation Site Utilizing Monoclonal Antibodies to Natural Killer Cells in Women with Recurrent Pregnancy Losses

• Published in: American journal of reproductive immunology (1989) 1999-01, Vol.41 (1), p.91-98
• Main Authors: Kwak, Joanne Y.H., Beer, Alan E., Kim, Sung Hee, Mantouvalos, Harris P.
• Format: Article
• Language: English
• Subjects: Abortion, Habitual - immunology; Abortion, Habitual - physiopathology; Abortion, Induced; Antibodies, Monoclonal - immunology; Biological and medical sciences; CD57; Diseases of mother, fetus and pregnancy; Embryo Implantation; Female; Gynecology. Andrology. Obstetrics; Humans; Immunohistochemistry; Keratins - analysis; Killer Cells, Natural - immunology; Leukocyte Common Antigens - immunology; Medical sciences; natural killer cells; pathology; placenta; Placenta - pathology; Pregnancy; Pregnancy. Fetus. Placenta; recurrent spontaneous abortions; Trophoblasts - immunology
• ISSN: 1046-7408; 8755-8920; 1600-0897
• DOI: 10.1111/j.1600-0897.1999.tb00080.x

PROBLEM: Placental lesions of 71 women with documented recurrent spontaneous abortions of unknown etiology were evaluated using immunohistochemical staining. METHOD OF STUDY: Placental tissue blocks (less than 12 weeks gestation) from prior pregnancy losses were obtained, recut, and analyzed utilizing monoclonal antibody to identify the trophoblast (cytokeratin 8/18) and natural killer (NK) cells (CD57) at the implantation site. The following features were evaluated: trophoblast invasion pattern; syncytium formation; vasculitis and thromboembolism of decidual vessels: decidual inflammation; decidual necrosis; fibrin deposition at the decidual necrosis site; mononuclear‐cell infiltration in villi and intervillous space; perivillous fibrin deposition; trophoblast morphology; and quantitation of CD57 + NK cells within the decidual tissue near the implantation site. Controls consisted of 20 healthy women with no history of recurrent pregnancy losses, who had their pregnancies electively terminated. RESULTS: Of the women studied, 29.6% demonstrated elevated CD57 + NK cells at the implantation site (P = 0.030), 54.1% had inadequate cytotrophoblast invasion depth (P = 0.000), 44.1% demonstrated inadequate syncytium formation (P = 0.004), and 33.9% presented thromboembolism in decidual vessels (P = 0.025). CONCLUSION: Some women with recurrrent spontaneous abortions demonstrate abnormal placental lesions at the implantation site. Immunopathologic evaluation of the placental implantation site that terminated in a spontaneous abortion may reveal the immunopathogenesis of previous pregnancy losses.