Change Of Dendritic Cells Subsets After Active Immunotherapy In Unexpained Recurrent Spontaneous Abortion

ObjectiveTo investigate the fuction of dendritic cells( DC) in activeImmunotherapy of the alloimmune URSA patients and to make up forthe deficiency of blocking antibody(BA).MethodsPartⅠ:38 URSA patients and 31 normal non-pregnanct women(NNP) were included in this study. Before and after active immunotherapy, peripheral blood plasmacytoid dendritic cells(PDC)and myeloid dendritic cells(MDC) were both tested by the flow cytometric method.PartⅡ: The study object was from the URSA group of PartⅠ.According to pregnancy outcome after active immunotherapy, theURSA patients were divided into successful group( n=27) andunsuccessful group(n=11). According to posttreatment BA, the URSApatients were divided into BA- positive group( n=28) and BA-negative group(n=10).ResultsPartⅠ There were no difference in the percentage of PDC betweenURSA group and NNP group(P>0.05). The percentage of MDC, theMDC/PDC ratio in URSA group were significantly higher than that inNNP group(P<0.05).PartⅡ Change of DC subsets after active immunotherapy in URSA patients1.URSA patients accepted active immunotherapy. The successful rate of pregnancy in BA-positive patients was significantly higher than that in BA-negative patients(P<0.05).2.The DC subsets data of 38 URSA patients were included in this study.There were no difference in the percentage of PDC, MDC and the MDC/PDC ratio between pre-immunotherapy and posttreatment(P>0.05).3.In the BA-positive URSA patients group, there were no difference in the percentage of PDC and the MDC/PDC ratio after treatment(P>0.05). The percentage of MDC after treatment was significantly lower than that pre-immunotherapy(P<0.01).4.In the BA-negative URSA patients group,there were no difference in the percentage of PDC, MDC and the MDC/PDC ratio after treatment(P>0.05).5.There were no difference in the percentage of PDC, MDC andthe MDC/PDC ratio before treatment and in the percentage of PDC,MDC/PDC ratio after treatment between the BA-negative and BA-positive URSA patients group(P>0.05). The percentage of MDC in the BA-positive URSA patients group was significantly lower than that in the BA-negative URSA patients group after treatment(P<0.05).6.In the successful pregnancy group, there were no difference in the percentage of PDC after active immunotherapy(P>0.05), the percentage of MDC and the MDC/PDC ratio after treatment were significantly lower than that before treatment(P<0.001 and P<0.01, respectively).7.In the unsuccessful pregnancy group, there were no difference in the percentage of PDC, MDC and the MDC/PDC ratio after active immunotherapy(P>0.05).8.There were no difference in the percentage of PDC, MDC,MDC/PDC ratio before treatment and in the percentage of PDC between the successful and unsuccessful pregnancy group(P>0.05). The percentage of MDC, MDC/PDC ratio in the successful pregnancy group were significantly lower than that in the unsuccessful pregnancy group after treatment(P<0.01 and P<0.05, respectively).Conclusion1.The percentage of MDC, MDC/PDC ratio in URSA group were significantly higher than that in NNP group. The systemic circulation of URSA patients may tend to immune function disorder.2.The successful rate of pregnancy in BA-positive patients was higher than that in BA-negative patients after active immunotherapy. So to some extent, BA may evaluate the effectiveness of activeimmunotherapy.3.The percentage of MDC in BA-positive patients may be reduced after active immunotherapy.The percentage of MDC in BA-positive patients may be lower than that in BA-negative patients after active immunotherapy. BA-positive patients may form the tolerance microenvironment after active immunotherapy. BA is the production of Th2 type immunoreaction by DC subsets. These results suggest the decrease of MDC after immunotherapy may be the immunological mechanisms of tolerance microenvironment and the generation of BA.4.The percentage of MDC, MDC/PDC ratio in the successful pregnancy group may be reduced after active immunotherapy.The percentage of MDC、MDC/PDC ratio in the successful pregnancy group may be lower than that in the unsuccessful pregnancy group after treatment. successful active immunotherapy can reduce the level of MDC and MDC/PDC ratio and may form the tolerance microenvironment.5.DC may make up for the deficiency of BA. DC may be the immunological mechanism of tolerance microenvironment after active immunotherapy and may serve as a novel biomarker for monitoring active immunotherapy in URSA patients.