醫(yī)學免疫學復習資料：Immune status during pregnancy

ImmunestatusduringpregnancySessioncontentInfectionandvaccinationduringpregnancyHowpregnancyaffectsautoimmunediseaseTransferofmaternalantibodytothefetusImmunologicalfactorsinfluencingpregnancyoutcomesTolerancetothesemi-allogeneicfetusImmunesystemcellsdevelopduringhaematopoiesisLymphocytes=acquired(adaptive)responseTheimmunesystemAcquired(adaptive)Immunity-Twokindsoflymphocytes:TandBBothexhibit:1.antigen-specificity

2.immunologicalmemoryAcquiredimmunityLymphocytesneedtoproliferatetoprovideenoughspecificcellstofighttheinfectionSessioncontentInfectionandvaccinationduringpregnancyHowpregnancyaffectsautoimmunediseaseTransferofmaternalantibodytothefetusImmunologicalfactorsinfluencingpregnancyoutcomesTolerancetothesemi-allogeneicfetusPregnancyisnotanimmunodeficiencydiseaseMostnormalpregnantwomen: 1)Respondadequatelytomostinfections 2)Respondadequatelytomostvaccines‘Immunodeficiency’islargelyfocussedatthematernal-fetalinterfaceHowever….Pregnantwomendohaveanincreasedincidenceorseverityofinfectionwith:

ToxoplasmaInfluenzaHepatitisListeriaVaricellaMalariaWorseningofleprosyin3rdtrimesterDisseminatedcoccidiodomycosisReactivationofEpstein-BarrvirusReactivationofcytomegalovirusSevereAcuteRespiratorySyndrome(SARS)SARSCoronovirusLamCMetal.Br.J.Obs.Gyn.2004;111:771-4ComplicationsandoutcomesbetweenpregnantandnonpregnantSevereAcuteRespiratorySyndrome(SARS)patientsVaccinationandpregnancyInactivatedvirusseasonalflujabadvised,irrespectiveofstageofpregnancy.

Noevidenceexistsofriskfromvaccinatingpregnantwomenwithinactivatedvirusorbacterialvaccinesortoxoids.VaccinationofPregnantWomenLivevaccinesposetheoreticalrisktofetusBenefitsoutweighpotentialriskswhenlikelihoodofdiseaseexposurehigh,wheninfectionwouldposearisktomotherorfetus,andwhenvaccineunlikelytocauseharm.

Nolive-virusvaccinesbecauseoftheoreticalriskoftransmissionofvaccinevirustofetus. CDCCDCVaccinestobeconsideredandcontraindicatedinpregnantwomenSessioncontentInfectionandvaccinationduringpregnancyHowpregnancyaffectsautoimmunediseaseTransferofmaternalantibodytothefetusImmunologicalfactorsinfluencingpregnancyoutcomesTolerancetothesemi-allogeneicfetusAllergyInappropriateimmunitygivingrisetoimmunopathologyAutoimmunediseasesTypeIdiabetesSLE:SystemiclupuserythematosusGraves’diseaseAutoimmunediseaseisgenerallymorecommoninfemalesClinicalevidenceforimmunologicalchangesinpregnancy–autoimmunediseasemodulation70%ofwomenwithrheumatoidarthritisshowsomeremissionduringpregnancy.Womenwithsystemiclupuserythematosustendtohavediseaseflaresduringpregnancyandpost-partum.Thsubsets?TcellsIL-4IL-5IL-10IL-13IL-17IL-22TGFbIL-10IL-35PerforinGranzymesFasLCytokinesabT-cellHelpB-cellsInhibitTh1Promoteinflamm-ationHelpCTL¯o-phages(&someB-cells)InhibitTh2Produce/expressPrimaryfunctionSuppressimmuneresponsesKillinfectedcellsIFNgIL-2TNFbCD4Th1CD4Th2CD4Th17CD4TfhCD4TregCD8TcIL-21ICOSHelpgerminalcenterB-cellsDifferenttypesofT-celleffectorfunctionThyroidAutoimmunityinPregnancyGaber??ekS&ZaletelK(2011)Exp.Rev.Clin.Immunol.7:697-707RegulatoryTcellsThyroidautoantibodiesSessioncontentInfectionandvaccinationduringpregnancyHowpregnancyaffectsautoimmunediseaseTransferofmaternalantibodytothefetusImmunologicalfactorsinfluencingpregnancyoutcomesTolerancetothesemi-allogeneicfetusTransportofIgGfrommothertofetusandnewbornPalmeiraPetal.(2012)ClinicalandDevelopmentalImmunologydoi:10.1155/2012/985646MaternalIgGtransferacrossthesyncytiotrophoblastLysosomalenzymesDevelopmentofserumimmunoglobulinlevelsinthehumanPalmeiraPetal.(2012)ClinicalandDevelopmentalImmunologydoi:10.1155/2012/985646Correlationofmaternal&termcordbloodanti-tetanusIgGFcRntransferof‘badantibodies’I.HemolyticdiseaseofthenewbornHaemolyticdiseaseofthenewborn(HDN)duetorhesusincompatibilityFcRntransferof‘badantibodies’I.HemolyticdiseaseofthenewbornFcRntransferof‘badantibodies’2.NeonatalthyrotoxicosisSessioncontentInfectionandvaccinationduringpregnancyHowpregnancyaffectsautoimmunediseaseTransferofmaternalantibodytothefetusImmunologicalfactorsinfluencingpregnancyoutcomesTolerancetothesemi-allogeneicfetusAntiphospholipidsyndromeAutoimmunediseaseinwhichantiphopholipidantibodiesarepresentIncreasedriskofbloodclottingAssociatedwithanincreasedriskofrecurrentmiscarriageAntiphopholipidantibodiesarepresentin>10%ofwomenwithrecurrentmiscarriageRuiz-IrastorzaG.etal.(2010)Lancet;376:1498.LivedoreticularisinantiphospholipidsyndromeAntiphospholipidsyndromeEffectsofantiphospholipidantibodiesontheplacentaAntiphospholipidantibodiesinducethrombosisAntiphospholipidantibodiesreactwithtrophoblastAntiphospholipidantibodiesreactwithdecidualcellsRuiz-IrastorzaG.etal.(2010)Lancet;376:1498.PathogenesisofthrombosisinantiphospholipidsyndromeSessioncontentInfectionandvaccinationduringpregnancyHowpregnancyaffectsautoimmunediseaseTransferofmaternalantibodytothefetusImmunologicalfactorsinfluencingpregnancyoutcomesTolerancetothesemi-allogeneicfetusAllergyInappropriateimmunitygivingrisetoimmunopathologyDuringpregnancy:Mothershouldnotrejectsemi-allogeneicfetusMustprotectmotherandfetusfrominfectionsOnlypartialseparationofmaternalandfetalcirculationsFetalcellspresentinmaternalcirculationandmaternalcellspresentinthefetusMicrochimerismestablishedinmaternalcirculationSignificance?OnlypartialseparationofmaternalandfetalcirculationsSomemechanismspostulatedtoaccountforthesurvivalofthefetusSomemechanismspostulatedtoaccountforthesurvivalofthefetusNaturalkiller(NK)cellsMHCClassIInfectedorcancercellActivatorInfectedorcancercellKillKillNKcellNormalcellMHCClassIActivatorActivatingreceptorInhibitoryreceptor‘Missingself’LackofMHCclassI.Canoccurin…Tumours:e.g.LymphomaMelanomaInfection:e.g.AdenovirusCytomegalovirus

RoleofMHCclassIinCytotoxicT-cellandNK-cellfunctionSomemechanismspostulatedtoaccountforthesurvivalofthefetusDistinctpopulationfromperipheralNKcellsOriginsunclear,developfromaresidenthematopoietic..stemcellorrecruitedfromblood?IncreasedintheendometriumduringpregnancyCytotoxicfunction↓duetopresenceofHLA-GProducepro-angiogenic(e.g.VEGF)andvasoactive..mediatorsUterine/DecidualNK(uNK/dNK)cellsBloisSMetal.JReprodImmunol.2011:88:86-92.RoleofdendriticcellsanduNKcellsindecidualizationandangiogenesisPeripheralNK(CD56dim)uNK(CD56bright)CD2++CD7++CD18(inte