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Experience in IVIg therapy for selected women with recurrent reproductive failure and NK cell expansion.

AbstractPROBLEM:
Recurrent reproductive failure (RRF) has been associated with expansion of circulating NK cells, key cells for maternal tolerance, decidual vasculogenesis and embryo growth. This study reports our experience in intravenous immunoglobulin (IVIg) therapy of a large cohort of women with RRF with expanded circulating NK and/or NKT-like cells (blood NKT cells are a heterogeneous subset of T cells that share properties of both T cells and NK cells).
METHOD OF STUDY:
Observational study of RRF women with NK or NKT-like expansion (>12% or 10% cutoff levels of total lymphocytes, respectively), treated with IVIg for the next gestation.
RESULTS:
By multivariant logistic regression analysis after adjusting for age, NK cells subsets and other therapies, IVIg significantly improved the live birth rate to 96.3% in women with recurrent miscarriage (RM) compared with 30.6% in case not receiving IVIg (P < 0.0001). In women with recurrent implantation failure (RIF), in comparison with women not receiving IVIg, treatment increased the pregnancy rate from 26.2 to 93.8% (P ≤ 0.0001) and the live birth rate from 17.9 to 80.0% in RIF (P ≤ 0.0001).
CONCLUSIONS:
Immunomodulation with IVIg in our selected group of RRF patients with immunologic alterations enhanced clinical pregnancy and live birth rates. Our results may facilitate the design of future clinical trials of IVIg in this pathology.
AuthorsRocio Ramos-Medina, Aurea García-Segovia, Juana Gil, Javier Carbone, Angel Aguarón de la Cruz, Ansgar Seyfferth, Bárbara Alonso, Jorge Alonso, Juan A León, Diana Alecsandru, Elena Meliá, Elena Carrillo de Albornoz, Daniel Ordoñez, Isabel Santillán, Victoria Verdú, Jose Maria Garcia Ruiz de Morales, Marcos López-Hoyos, Arturo López Larios, Almudena Sampalo, Pedro Caballero, Luis Ortiz Quintana, Eduardo Fernández-Cruz, Silvia Sánchez-Ramón
JournalAmerican journal of reproductive immunology (New York, N.Y. : 1989) (Am J Reprod Immunol) Vol. 71 Issue 5 Pg. 458-66 (May 2014) ISSN: 1600-0897 [Electronic] Denmark
PMID24612159 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
Copyright© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
Chemical References
  • Immunoglobulins, Intravenous
  • Immunologic Factors
Topics
  • Abortion, Habitual (drug therapy, immunology, pathology)
  • Adult
  • Female
  • Fertilization in Vitro
  • Humans
  • Immunoglobulins, Intravenous (therapeutic use)
  • Immunologic Factors (therapeutic use)
  • Killer Cells, Natural (drug effects, immunology, pathology)
  • Live Birth
  • Logistic Models
  • Lymphocyte Count
  • Natural Killer T-Cells (drug effects, immunology, pathology)
  • Pregnancy
  • Treatment Failure

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