Recurrent Miscarriage Treatment Options and Reproductive Immunology

References:
LIT: see LIT video for lots of sources
🎥 • Lymphocyte Immunizatio...
Anti-TNF (Humira and Enbrel) : “A randomized controlled trial enrolling patients with RSA with innate immune disorders reported that etanercept [Enbrel] significantly reduced TNF-α and NK cell activity at weeks 4-10 of gestation and female patients treated with etanercept had higher live birth rates compared with those treated with placebo “
📚 Fu, JinhuaLai, Zin-Ti, et al. "A Randomized Controlled Trial of Etanercept in the Treatment of Refractory Recurrent Spontaneous Abortion with Innate Immune Disorders." Taiwanese Journal of Obstetrics and Gynecology, vol. 58, no. 5, 2019, pp. 621-625.
🔗 doi.org/10.1016/j.tjog.2019.0...
Intralipids: “the fatty acids present in the lipid emulsions can act as ligands to activate peroxisome proliferator‐activated receptors (PPARs) expressed by NK cells, reducing their activity. Activation of PPARs has been shown to decrease the cytotoxic activity of NK cells, so it is possible that the intralipid modulates the immune system favoring embryo implantation and pregnancy maintenance”
📚Canella, Paula Renata Bueno Campos et al. “Lipid emulsion therapy in women with recurrent pregnancy loss and repeated implantation failure: The role of abnormal natural killer cell activity.” Journal of cellular and molecular medicine vol. 25,5 (2021): 2290-2296.
🔗 doi.org/10.1111/jcmm.16257
Intralipid vs IVIG: "Seventy-six patients in the intralipid group and 78 in the IVIG group completed the trial. There were no statistically significant differences in successful pregnancy rates between the two groups (92.1 vs 88.2 %, P = 0.415). "
📚 Meng, Lili et al. “Effectiveness and potential mechanisms of intralipid in treating unexplained recurrent spontaneous abortion.” Archives of gynecology and obstetrics vol. 294,1 (2016): 29-39
🔗 doi.org/10.1007/s00404-015-39...
IVIG: “The percentage of CD56dim NK cells expressing CD94 was also increased after IVIG, and this occurred specifically in autoimmune/inflammatory patients. This has been demonstrated also following IVIG treatment in women with recurrent spontaneous abortions”
📚McAlpine, Sarah M et al. “High Dose Intravenous IgG Therapy Modulates Multiple NK Cell and T Cell Functions in Patients With Immune Dysregulation.” Frontiers in immunology vol. 12 660506. 19 May. 2021
🔗 doi.org/10.3389/immu.2021.660506
Prednisone: "Women with RM had significantly more uNK than the controls. Prednisolone treatment significantly reduced the number of CD56 cells in the endometrium, from a median of 14% (before) to 9% (after)"
*I had wrong value in the video. Prednisone reduces cytotoxic NK cells by 5% (14-9=5%). sorry!!*
📚Quenby, S et al. "Prednisolone reduces preconceptual endometrial
natural killer cells in women with recurrent miscarriage" Fertility and Sterility vol. 84, No 4 , 2005, pp. 980-984
🔗 www.fertstert.org/article/S00...
HCQ (Hydroxychloroquine, plaquinel): "HCQ decreases the circulating levels of interleukin 1, 2,6, TNF and interferon-γ, promoting the TH2 processes that prevail in a “normal pregnancy". Otherwise, HCQ decreases APL plasma levels and interferes with both endothelial cell activation and TNF-α production, two major key pathways involved in APS."
📚Pasquier, Elisabeth et al. “Hydroxychloroquine for prevention of recurrent miscarriage: study protocol for a multicentre randomised placebo-controlled trial BBQ study.” BMJ open vol. 9,3 e025649. 20 Mar. 2019
🔗 doi.org/10.1136/bmjopen-2018-...
Neupogen (or Filgrastim): “Our study showed that G-CSF treatment increased the number of decidual Treg cells in RPL patients “
📚Scarpellini, Fabio et al. “Immunohistochemical Study on the Expression of G-CSF, G-CSFR, VEGF, VEGFR-1, Foxp3 in First Trimester Trophoblast of Recurrent Pregnancy Loss in Pregnancies Treated with G-CSF and Controls.” International journal of molecular sciences vol. 21,1 285. 31 Dec. 2019
🔗 doi.org/10.3390/ijms21010285
🤓 I highly recommend Dr Beer's Book: amzn.to/3t58Hga
#RepeatPregnancyLoss #ReproductiveImmunology
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