A leading role for the immune system in the pathophysiology of preeclampsia

[摘要] Preeclampsiasyndromeischaracterizedbyinadequateplacentation,becauseofdeficienttrophoblasticinvasionoftheuterinespiralarteries,leadingtoplacentalhypoxia,secretionofproinflammatorycytokines,thereleaseofangiogenicandantiangiogenicfactorsandmiRNAs.Althoughimmune‐systemalterationsareassociatedwiththeoriginofpreeclampsia,otherfactors,includingproinflammatorycytokines,neutrophilactivation,andendothelialdysfunction,arealsorelatedtothepathophysiologyofthissyndrome.Thepathophysiologyofpreeclampsiamayinvolveseveralfactors,includingpersistenthypoxiaattheplacentallevelandthereleaseofhighamountsofSTBMs.DAMPmoleculesreleasedunderhypoxicconditionsandSTBMs,whichbindTLRs,mayactivatemonocytes,DCs,NKcells,andneutrophils,promotingpersistentinflammatoryconditionsinthissyndrome.Thedevelopmentofhypertensioninpreeclampticwomenisalsoassociatedwithendothelialdysfunction,whichmaybemediatedbyvariousmechanisms,includingneutrophilactivationandNETformation.Furthermore,preeclampticwomenhavehigherlevelsofnonclassicandintermediatemonocytesandlowerlevelsoflymphoidBDCA‐2+DCs.Thecytokinessecretedbythesecellsmaycontributetotheinflammatoryprocessandtochangesinadaptive‐immunesystemcells,whicharealsomodulatedinpreeclampsia.ThechangesinTcellsubsetsthatmaybeseeninpreeclampsiaincludelowTregactivity,ashifttowardTh1responses,andthepresenceofTh17lymphocytes.BcellscanparticipateinthepathophysiologyofpreeclampsiabyproducingautoantibodiesagainstadrenoreceptorsandautoantibodiesthatbindtheAT1‐R...

[学科分类] 生理学

[关键词] preeclampsia;STBM;neutrophil;dendritic cell;lymphocyte;monocyte;TLR;B cell