Cargando…
Immunomodulatory Therapy Reduces the Severity of Placental Lesions in Chronic Histiocytic Intervillositis
Chronic histiocytic intervillositis (CHI) is a rare, but highly recurrent inflammatory placental lesion wherein maternal macrophages infiltrate the intervillous space. Pregnancies with CHI are at high risk of fetal growth restriction, miscarriage or stillbirth. Presently, the diagnosis can only be m...
Autores principales: | , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Frontiers Media S.A.
2021
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8558526/ https://www.ncbi.nlm.nih.gov/pubmed/34733868 http://dx.doi.org/10.3389/fmed.2021.753220 |
_version_ | 1784592582524796928 |
---|---|
author | Brady, Chloe A. Williams, Charlotte Batra, Gauri Church, Elaine Tower, Clare L. Crocker, Ian P. Heazell, Alexander E. P. |
author_facet | Brady, Chloe A. Williams, Charlotte Batra, Gauri Church, Elaine Tower, Clare L. Crocker, Ian P. Heazell, Alexander E. P. |
author_sort | Brady, Chloe A. |
collection | PubMed |
description | Chronic histiocytic intervillositis (CHI) is a rare, but highly recurrent inflammatory placental lesion wherein maternal macrophages infiltrate the intervillous space. Pregnancies with CHI are at high risk of fetal growth restriction, miscarriage or stillbirth. Presently, the diagnosis can only be made after histopathological examination of the placenta. Given its proposed immunological etiology, current treatments include aspirin, heparin, and immunomodulatory agents. However, the rationale for these medications is largely based upon small case series and reports as there is a lack of larger studies investigating treatment efficacy. Therefore, this study sought to determine whether inclusion of immunomodulatory medications was effective at reducing the severity of lesions and improving pregnancy outcomes in subsequent pregnancies. Thirty-three women with a history of CHI in at least one pregnancy (index case) were identified retrospectively through medical records. Twenty-eight participants presented with a first subsequent pregnancy and a further 11 with a second subsequent pregnancy at a specialist clinic for pregnancy after loss. Data on maternal demographics, medical history, medication, pregnancy outcome, and placental pathology was collected and compared between pregnancies. Twenty-seven (69%) subsequent pregnancies were treated with at least one or both of prednisolone and hydroxychloroquine. Inclusion of at least one immunomodulatory agent in treatment regimen resulted in an almost 25% increase in overall livebirth rate (61.5 vs. 86.2%). In women treated with immunomodulatory medication a greater proportion of placentas had reduced severity of lesions compared to those treated without (86.7 vs. 33.3%, respectively). A reduction in CHI severity was associated with a 62.3% improvement in livebirth rate compared to those where severity remained unchanged in relation to the index case. These data provide preliminary evidence that the use of immunomodulatory medication in the management of CHI improves histopathological lesions and the chance of livebirth in subsequent pregnancies. Due to CHI's rarity and ethical and feasibility issues, randomized controlled trials in affected women are challenging to conduct. As a result, collaboration between centers is required in future to increase study sample sizes and elucidate the mechanisms of hydroxychloroquine and prednisolone in reducing pathology. |
format | Online Article Text |
id | pubmed-8558526 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Frontiers Media S.A. |
record_format | MEDLINE/PubMed |
spelling | pubmed-85585262021-11-02 Immunomodulatory Therapy Reduces the Severity of Placental Lesions in Chronic Histiocytic Intervillositis Brady, Chloe A. Williams, Charlotte Batra, Gauri Church, Elaine Tower, Clare L. Crocker, Ian P. Heazell, Alexander E. P. Front Med (Lausanne) Medicine Chronic histiocytic intervillositis (CHI) is a rare, but highly recurrent inflammatory placental lesion wherein maternal macrophages infiltrate the intervillous space. Pregnancies with CHI are at high risk of fetal growth restriction, miscarriage or stillbirth. Presently, the diagnosis can only be made after histopathological examination of the placenta. Given its proposed immunological etiology, current treatments include aspirin, heparin, and immunomodulatory agents. However, the rationale for these medications is largely based upon small case series and reports as there is a lack of larger studies investigating treatment efficacy. Therefore, this study sought to determine whether inclusion of immunomodulatory medications was effective at reducing the severity of lesions and improving pregnancy outcomes in subsequent pregnancies. Thirty-three women with a history of CHI in at least one pregnancy (index case) were identified retrospectively through medical records. Twenty-eight participants presented with a first subsequent pregnancy and a further 11 with a second subsequent pregnancy at a specialist clinic for pregnancy after loss. Data on maternal demographics, medical history, medication, pregnancy outcome, and placental pathology was collected and compared between pregnancies. Twenty-seven (69%) subsequent pregnancies were treated with at least one or both of prednisolone and hydroxychloroquine. Inclusion of at least one immunomodulatory agent in treatment regimen resulted in an almost 25% increase in overall livebirth rate (61.5 vs. 86.2%). In women treated with immunomodulatory medication a greater proportion of placentas had reduced severity of lesions compared to those treated without (86.7 vs. 33.3%, respectively). A reduction in CHI severity was associated with a 62.3% improvement in livebirth rate compared to those where severity remained unchanged in relation to the index case. These data provide preliminary evidence that the use of immunomodulatory medication in the management of CHI improves histopathological lesions and the chance of livebirth in subsequent pregnancies. Due to CHI's rarity and ethical and feasibility issues, randomized controlled trials in affected women are challenging to conduct. As a result, collaboration between centers is required in future to increase study sample sizes and elucidate the mechanisms of hydroxychloroquine and prednisolone in reducing pathology. Frontiers Media S.A. 2021-10-18 /pmc/articles/PMC8558526/ /pubmed/34733868 http://dx.doi.org/10.3389/fmed.2021.753220 Text en Copyright © 2021 Brady, Williams, Batra, Church, Tower, Crocker and Heazell. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. |
spellingShingle | Medicine Brady, Chloe A. Williams, Charlotte Batra, Gauri Church, Elaine Tower, Clare L. Crocker, Ian P. Heazell, Alexander E. P. Immunomodulatory Therapy Reduces the Severity of Placental Lesions in Chronic Histiocytic Intervillositis |
title | Immunomodulatory Therapy Reduces the Severity of Placental Lesions in Chronic Histiocytic Intervillositis |
title_full | Immunomodulatory Therapy Reduces the Severity of Placental Lesions in Chronic Histiocytic Intervillositis |
title_fullStr | Immunomodulatory Therapy Reduces the Severity of Placental Lesions in Chronic Histiocytic Intervillositis |
title_full_unstemmed | Immunomodulatory Therapy Reduces the Severity of Placental Lesions in Chronic Histiocytic Intervillositis |
title_short | Immunomodulatory Therapy Reduces the Severity of Placental Lesions in Chronic Histiocytic Intervillositis |
title_sort | immunomodulatory therapy reduces the severity of placental lesions in chronic histiocytic intervillositis |
topic | Medicine |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8558526/ https://www.ncbi.nlm.nih.gov/pubmed/34733868 http://dx.doi.org/10.3389/fmed.2021.753220 |
work_keys_str_mv | AT bradychloea immunomodulatorytherapyreducestheseverityofplacentallesionsinchronichistiocyticintervillositis AT williamscharlotte immunomodulatorytherapyreducestheseverityofplacentallesionsinchronichistiocyticintervillositis AT batragauri immunomodulatorytherapyreducestheseverityofplacentallesionsinchronichistiocyticintervillositis AT churchelaine immunomodulatorytherapyreducestheseverityofplacentallesionsinchronichistiocyticintervillositis AT towerclarel immunomodulatorytherapyreducestheseverityofplacentallesionsinchronichistiocyticintervillositis AT crockerianp immunomodulatorytherapyreducestheseverityofplacentallesionsinchronichistiocyticintervillositis AT heazellalexanderep immunomodulatorytherapyreducestheseverityofplacentallesionsinchronichistiocyticintervillositis |