DIFFERENTIATED APPROACH TO TREATMENT OF MISCARRIAGE (LITERATURE REVIEW)

Mukharamova T. M.

LITERATURE REVIEWS

Scentific article

Miscarriage is a polyetiological complication of pregnancy, significant factors in the occurrence and implementation of which are violations of immune and endocrine regulation, which are often realized in the framework of progesterone deficiency and imbalance of biologically active mediators of immune and intercellular relationshipscytokines. It is established that the cytokine system plays an important role in the regulation of intercellular interactions in the endometrium, in the implementation of endocrine effects, and also largely determines the process of trophoblast invasion. As one of the reasons leading to the development of pathology of the early gestational period, which consists in violation of the processes of implantation and placentation, weak allogeneic stimulation of the mother’s immune system by antigens of the fetus of paternal origin is considered. In particular, the presence in spouses of matching alleles of the human histocompatibility system HLA genes, which reduces mutual allogeneic stimulation, has been discussed as an alloimmune factor leading to disruption of the normal course of pregnancy. Currently, the development of an immune response to paternal alloantigens is recognized as a necessary condition for the normal relationship between the mother and the developing fetus. To enhance the specific response of ymphocytes women alloantigen partner in the pregestational period of training in couples with recurrent miscarriage is used immunochemotherapy (ICT) – immunization by lymphocytes of women sexual partner. This procedure is performed in couples with habitual miscarriage of unclear Genesis, that is, with idiopathic habitual miscarriage. This diagnosis is made with the exception of genetic, anatomical, endocrine, infectious and autoimmune causes of miscarriage. In the presence of alloimmune factors of violation of the gestational process, such as compatibility of spouses on HLA-antigens or a high level of natural killer cells with the CD56 + phenotype in a woman, an idiopathic habitual miscarriage of alloimmune Genesis is diagnosed. One of the indicators of the formation of the response of the immune system of a woman to the introduction of allogeneic cells is the appearance in the serum of antibodies to HLA-antigens of the partner’s leukocytes, or anti-paternal antibodies (AOAT). It is known that the production of antibodies in successive immunizations is a dynamic process that develops over several months, and the choice of the optimal testing period also becomes a key factor in assessing the effects of immunization by detecting the level of AOAT. Detection of allogeneic antibodies in the recipient’s serum that can bind to the surface antigens of donor lymphocytes using flow cytofluorometry (PCM) is widely used in transplantation to identify pre-existing antibodies that are a risk factor in organ transplantation. Unlike Transplantology, the appearance of a certain level of antibodies to fetal alloantigens during immunization can be a sign of normalization of the mother’s immune response, which after immunization will contribute to the prolongation of pregnancy. From this point of view, the absence of AOAT in primates does not mean that the maternal body systems sensitive to the appearance of paternal antigens, responsible for normal interaction with the developing fetus, are not stimulated. This means that AOATS recorded in this way do not reflect the nature of maternal immune system stimulation by fetal alloantigens in a normally developing pregnancy. The method of determining AOAT using PCM is to determine the binding of fluorescent-labeled antibodies to immunoglobulin G (IgG) of a woman with IgG-class antibodies on the surface of the partner’s lymphocytes. The development of multicolored fluorometry led to the improvement of the method and determined the possibility of detecting antibodies on certain subpopulations of immunocompetent cells. According to recent studies, lymphoimmunotherapy is indicated for couples with miscarriage, in which there are two or more matches on the alleles of the HLA class II system.

cytokines, limfomonotsitoza, miscarriage.

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«Bulletin of problems biology and medicine» Issue 4 Part 2 (154), 2019 year, 33-37 pages, index UDK 618.39-097

10.29254/2077-4214-2019-4-2-154-33-37