1
|
Collin-Bund V, Poindron V, Van Quyen PL, Boudier É, Minella C, Langer B, Akladios C, Weingertner AS. Controversies in chronic histiocytic intervillositis. J Gynecol Obstet Hum Reprod 2025; 54:102931. [PMID: 40015626 DOI: 10.1016/j.jogoh.2025.102931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2025] [Revised: 02/23/2025] [Accepted: 02/24/2025] [Indexed: 03/01/2025]
Abstract
Understanding the"paradox" of pregnancy remains a challenging field of investigation especially when immunological dysregulation is suspected in pathological pregnancies. Chronic histiocytic intervillositis (CHI) is an example of a rare placental inflammatory disease that can occur during any trimester of pregnancy. The pathogenesis of CHI involves an abnormal immune response characterized by an inflammatory infiltrate of maternal CD68+ mononuclear immune cells in the intervillous space. CHI may be associated with villous and intervillous fibrinoid deposits. The precise immunological mechanism is not yet fully understood; it probably relies on an allo-immune of graft rejection rather than an auto-immune mechanism, although it has been described in several autoimmune diseases. CHI has also been described in COVID19 infected pregnant women. The recurrence rate is high and complications are severe: CHI is strongly associated with fetal growth restriction, miscarriage and stillbirth. The management of these patients remains an issue lacking of -standardized guidelines. The aim of this narrative review is to focus on the knowledge, pathogenesis, diagnosis and treatment of CHI over the last 5 years.
Collapse
Affiliation(s)
- Virginie Collin-Bund
- Department of Gynecology and Obstetrics, Hôpitaux Universitaires de Strasbourg, Strasbourg, France; Laboratoire d'ImmunoRhumatologie Moléculaire, Institut National de la Santé et de la Recherche Médicale (INSERM) UMR_S 1109, Institut thématique interdisciplinaire (ITI) de Médecine de Précision de Strasbourg, Transplantex NG, Faculté de Médecine, Fédération Hospitalo-Universitaire OMICARE, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, Strasbourg, France; Department of Maternal Fetal Medicine, Strasbourg University Hospital, Strasbourg, France.
| | - Vincent Poindron
- Department of Clinical Immunology and Internal Medicine, Strasbourg University Hospital, Strasbourg, France
| | | | - Éric Boudier
- Department of Gynecology and Obstetrics, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Chris Minella
- Department of Gynecology and Obstetrics, Hôpitaux Universitaires de Strasbourg, Strasbourg, France; Department of Maternal Fetal Medicine, Strasbourg University Hospital, Strasbourg, France
| | - Bruno Langer
- Department of Gynecology and Obstetrics, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Chérif Akladios
- Department of Gynecology and Obstetrics, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Anne-Sophie Weingertner
- Department of Gynecology and Obstetrics, Hôpitaux Universitaires de Strasbourg, Strasbourg, France; Department of Maternal Fetal Medicine, Strasbourg University Hospital, Strasbourg, France
| |
Collapse
|
2
|
Mattuizzi A, Sauvestre F, Fargeix T, White E, Leibler C, Cargou M, Dugot-Senant N, Douchet I, Duluc D, Bordes C, Truchetet MÉ, Richez C, Forcade É, Duffau P, Viallard JF, Sentilhes L, Blanco P, Lazaro E. Inflammasome-targeted therapy might prevent adverse perinatal outcomes of recurrent chronic intervillositis of unknown etiology. Nat Commun 2024; 15:9396. [PMID: 39477918 PMCID: PMC11525837 DOI: 10.1038/s41467-024-53591-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 10/14/2024] [Indexed: 11/02/2024] Open
Abstract
Chronic histiocytic intervillositis of unknown origin (CHI) is a rare placental disorder associated with adverse pregnancy outcomes, frequent recurrence, and a lack of effective preventive strategies. Recent insights indicate a potential link between CHI-associated inflammatory lesions and the inflammasome pathway, suggesting innovative therapeutic avenues. Here we show a potential role of the inflammasome pathway in CHI through comprehensive transcriptomic analysis of grade 2 or 3 histopathologic CHI samples, paired with placental controls. Additionally, we present case studies of three individuals with recurrent CHI, who have undergone treatment with anakinra and colchicine throughout pregnancy, resulting in improved perinatal outcomes. Notably, all cases are characterized by the birth of healthy, full-term infants, with reduced or absent intervillositis recurrence. Placental assessment unveils heightened activation of the NLRP3-PYCARD inflammasome pathway and IL-1β processing in CHI samples, with downregulation observed in treated pregnancy samples, devoid of intervillositis. Collectively, these findings suggest a potential therapeutic role for targeting the inflammasome pathway in preventing recurrent CHI in pregnant individuals.
Collapse
Affiliation(s)
- Aurélien Mattuizzi
- The Obstetrics and Gynecology Department, Groupe Hospitalier Pellegrin, Bordeaux University Hospital, Bordeaux, France
| | - Fanny Sauvestre
- Fœtopathology Unit, Pathology Department, Groupe Hospitalier Pellegrin, Bordeaux University Hospital, Bordeaux, France
| | - Tiphaine Fargeix
- The Internal Medicine Department, Groupe Hospitalier Sud, Bordeaux University Hospital, Bordeaux, France
- Unité Mixte de Recherche-Centre National de la Recherche Scientifique 5164, ImmunoConcEpT, Bordeaux University, Bordeaux, France
| | - Eoghann White
- Unité Mixte de Recherche-Centre National de la Recherche Scientifique 5164, ImmunoConcEpT, Bordeaux University, Bordeaux, France
| | - Claire Leibler
- Unité Mixte de Recherche-Centre National de la Recherche Scientifique 5164, ImmunoConcEpT, Bordeaux University, Bordeaux, France
- The Immunology and Immunogenetic Department, Groupe Hospitalier Pellegrin, Bordeaux University Hospital, Bordeaux, France
| | - Marine Cargou
- The Immunology and Immunogenetic Department, Groupe Hospitalier Pellegrin, Bordeaux University Hospital, Bordeaux, France
| | | | - Isabelle Douchet
- Unité Mixte de Recherche-Centre National de la Recherche Scientifique 5164, ImmunoConcEpT, Bordeaux University, Bordeaux, France
| | - Dorothée Duluc
- Unité Mixte de Recherche-Centre National de la Recherche Scientifique 5164, ImmunoConcEpT, Bordeaux University, Bordeaux, France
| | - Cécile Bordes
- Unité Mixte de Recherche-Centre National de la Recherche Scientifique 5164, ImmunoConcEpT, Bordeaux University, Bordeaux, France
- The Immunology and Immunogenetic Department, Groupe Hospitalier Pellegrin, Bordeaux University Hospital, Bordeaux, France
| | - Marie-Élise Truchetet
- Unité Mixte de Recherche-Centre National de la Recherche Scientifique 5164, ImmunoConcEpT, Bordeaux University, Bordeaux, France
- The Rheumatology Department, Groupe Hospitalier Pellegrin, Bordeaux University Hospital, Bordeaux, France
| | - Christophe Richez
- Unité Mixte de Recherche-Centre National de la Recherche Scientifique 5164, ImmunoConcEpT, Bordeaux University, Bordeaux, France
- The Rheumatology Department, Groupe Hospitalier Pellegrin, Bordeaux University Hospital, Bordeaux, France
| | - Édouard Forcade
- Unité Mixte de Recherche-Centre National de la Recherche Scientifique 5164, ImmunoConcEpT, Bordeaux University, Bordeaux, France
- The Hematology Department, Groupe Hospitalier Sud, Bordeaux University Hospital, Bordeaux, France
| | - Pierre Duffau
- Unité Mixte de Recherche-Centre National de la Recherche Scientifique 5164, ImmunoConcEpT, Bordeaux University, Bordeaux, France
- The Internal Medicine Department, Groupe Hospitalier Saint-André, Bordeaux University Hospital, Bordeaux, France
| | - Jean-François Viallard
- The Internal Medicine Department, Groupe Hospitalier Sud, Bordeaux University Hospital, Bordeaux, France
| | - Loïc Sentilhes
- The Obstetrics and Gynecology Department, Groupe Hospitalier Pellegrin, Bordeaux University Hospital, Bordeaux, France
- Unité Mixte de Recherche-Centre National de la Recherche Scientifique 5164, ImmunoConcEpT, Bordeaux University, Bordeaux, France
| | - Patrick Blanco
- Unité Mixte de Recherche-Centre National de la Recherche Scientifique 5164, ImmunoConcEpT, Bordeaux University, Bordeaux, France
- The Immunology and Immunogenetic Department, Groupe Hospitalier Pellegrin, Bordeaux University Hospital, Bordeaux, France
| | - Estibaliz Lazaro
- The Internal Medicine Department, Groupe Hospitalier Sud, Bordeaux University Hospital, Bordeaux, France.
- Unité Mixte de Recherche-Centre National de la Recherche Scientifique 5164, ImmunoConcEpT, Bordeaux University, Bordeaux, France.
| |
Collapse
|
3
|
Nori W, Akram NN, Al-Ani RM. Update on hydroxychloroquine use in pregnancy. World J Exp Med 2023; 13:99-101. [PMID: 37767540 PMCID: PMC10520759 DOI: 10.5493/wjem.v13.i4.99] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 07/05/2023] [Accepted: 07/24/2023] [Indexed: 09/15/2023] Open
Abstract
It is well-known that hydroxychloroquine (HCQ) treats malaria, systemic lupus erythematosus, and rheumatoid arthritis in women for its immunomodulatory and anti-inflammatory action. Additionally, HCQ was used in cases with refractory antiphospholipid syndrome. HCQ safety was reinforced in pregnant women owing to insignificant reports of adverse pregnancy outcomes and major congenital malformation. Recently, HCQ was tested in cases with chronic placental inflammation with a promising result of increased life birth; however, its benefit needs further validation. We aimed to highlight the recent updates for HCQ use in various conditions in pregnancy.
Collapse
Affiliation(s)
- Wassan Nori
- Department of Obstetrics and Gynecology, Mustansiriyah University, Baghdad 10052, Iraq
| | | | - Raid M Al-Ani
- Department of Surgery/Otolaryngology, University of Anbar, Anbar 31001, Iraq
| |
Collapse
|
4
|
Immunopathological insights into villitis of unknown etiology on the basis of transplant immunology. Placenta 2023; 131:49-57. [PMID: 36473393 DOI: 10.1016/j.placenta.2022.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 11/15/2022] [Indexed: 11/27/2022]
Abstract
Villitis of unknown etiology (VUE) is an inflammatory disease characterized by the infiltration of maternal CD8 +T cells into the placental villi. Although the pathogenesis of VUE is still debated, dysregulation of the immune system appears to be an important factor in the development of the disease. Interaction of maternal T cells with the fetal antigens seems to be the trigger for the VUE onset. In this context, graft vs host disease (GVHD) and allographic rejection seem to share similarities in the VUE immunopathological mechanism, especially those related to immunoregulation. In this review, we compared the immunological characteristics of VUE with allograft rejection, and GVHD favoring a better knowledge of VUE pathogenesis that may contribute to VUE therapeutics strategies in the future.
Collapse
|
5
|
Luo M, Xie D, Lin Z, Sun H, Liu Y. Toxicology evaluation of overdose hydroxychloroquine on zebrafish (Danio rerio) embryos. Sci Rep 2022; 12:18259. [PMID: 36309536 PMCID: PMC9617536 DOI: 10.1038/s41598-022-23187-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 10/26/2022] [Indexed: 12/31/2022] Open
Abstract
Potential risks of treatment with hydroxychloroquine (HCQ) include QT interval prolongation, hypoglycemia, a wide range of neuropsychiatric manifestations, hematotoxicity, and potential genetic defects. HCQ is extremely toxic when used in overdose and can lead to tachycardia, hypotension, known central nervous system, transmission defects, hypokalemia and other manifestations in individuals. The mechanism of excessive HCQ leading to these manifestations is still unclear. In this paper, overdose HCQ at different concentrations was used to treat zebrafish embryos, and the phenomena like human beings were obtained, such as increased heart rate and nervous system inhibition. With the increase of concentration to 100 μM, embryo mortality and malformation rate increased and hatching rate decreased, in situ hybridization showed abnormal differentiation of embryo germ layers and formation of vital organs. We selected embryos treated with 50 μM HCQ, in which concentration the mortality rate, hatching rate and malformation rate of the embryos were like those of the control group, for transcriptome analysis. Although the above indexes did not change significantly, the molecular changes related to the development of the heart, eye, nerve and other important organs were significant. This study provides useful information for further research on the toxicity mechanism of HCQ overdose, and provides some insight that can guide future studies in humans.
Collapse
Affiliation(s)
- Min Luo
- grid.13291.380000 0001 0807 1581Prenatal Diagnosis Center, Department of Obstetrics & Gynecologic, Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, 610041 People’s Republic of China
| | - Dan Xie
- grid.13291.380000 0001 0807 1581Prenatal Diagnosis Center, Department of Obstetrics & Gynecologic, Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, 610041 People’s Republic of China
| | - Ziyuan Lin
- grid.13291.380000 0001 0807 1581SCU-CUHK Joint Laboratory for Reproductive Medicine, Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, 610041 People’s Republic of China
| | - Huaqin Sun
- grid.13291.380000 0001 0807 1581SCU-CUHK Joint Laboratory for Reproductive Medicine, Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, 610041 People’s Republic of China
| | - Yanyan Liu
- grid.13291.380000 0001 0807 1581Prenatal Diagnosis Center, Department of Obstetrics & Gynecologic, Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, 610041 People’s Republic of China
| |
Collapse
|
6
|
Preparing for Pregnancy in Women with Systemic Lupus Erythematosus—A Multidisciplinary Approach. Medicina (B Aires) 2022; 58:medicina58101371. [DOI: 10.3390/medicina58101371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 09/22/2022] [Accepted: 09/23/2022] [Indexed: 11/17/2022] Open
Abstract
Pregnancy is one of the most challenging processes the human body is exposed to: the healthy mother can carry to term a genetically different new-born, while her immune system adapts to tolerate this new status and avoids rejection. In autoimmune disorders, motherhood is even more challenging, with additional medical counselling, mother care, and foetus development checks being necessary. While the aspects of supplementary mother care and pregnancy progress tracking are associated with well-established medical procedures and protocols, counselling, be it pre- or post-conception, is still underestimated and scarcely applied. Indeed, over the past decades, medical counselling for this particular population has changed significantly, but from a healthcare’s provider point of view, more is required to ensure a smooth, controllable pregnancy evolution. One of the most frequent autoimmune diseases affecting young females during their fertile years is Systemic Lupus Erythematosus (SLE). Like other heterogenous diseases, it exposes the mother to severe, organ-threatening complications and unpredictable evolution. Both the disease and its treatment can significantly affect the mother’s willingness to engage in a potentially risky pregnancy, as well as the likeliness to carry it to term without any impairments. A good collaboration between the patient’s rheumatologist and obstetrician is therefore mandatory in order to: (a) allow the mother to make an informed decision on pursuing with the pregnancy; (b) ensure a perfect synchronization between pregnancy terms and treatment; and (c) avoid or minimize potential complications. The best approach to achieve these outcomes is pregnancy planning. Moreover, knowing one desired prerequisite for a successful pregnancy evolution in SLE mothers is a stable, inactive, quiescent disease for at least six months prior to conception, planning becomes more than a recommended procedure. One particular aspect that requires attention before conception is the treatment scheme applied before delivery as autoantibodies can influence significantly the course of pregnancy. In this view, future SLE mothers should ideally benefit from preconception counselling within their agreed care pathway. A multidisciplinary team including at least the rheumatologist and obstetrician should be employed throughout the pregnancy, to decide on the appropriate timing of conception and compatible medication with respect to disease activity, as well as to monitor organ involvement and foetus development progress.
Collapse
|
7
|
Moar L, Simela C, Nanda S, Marnerides A, Al-Adnani M, Nelson-Piercy C, Nicolaides KH, Shangaris P. Chronic histiocytic intervillositis (CHI): current treatments and perinatal outcomes, a systematic review and a meta-analysis. Front Endocrinol (Lausanne) 2022; 13:945543. [PMID: 35937841 PMCID: PMC9355722 DOI: 10.3389/fendo.2022.945543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 06/29/2022] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Chronic histiocytic intervillositis (CHI) is a rare placental lesion with a high recurrence rate and poor perinatal outcomes. There are currently limited guidelines regarding the diagnosis of this condition in the index pregnancy and treatment where recurrence is suspected. OBJECTIVE The primary objective of this systematic review and meta-analysis was to determine the perinatal outcomes of pregnancies affected by chronic histiocytic intervillositis and to what extent they can be improved with treatment. The secondary objective was to assess the relationship between CHI lesion severity and pregnancy loss. METHODS A systematic search of Ovid Embase, Web of Science, Science Direct, PubMed, Ovid Medline, Google Scholar and CINAHL was carried out. Case reports, cohort, case-control and randomised controlled trials (RCT) detailing the perinatal outcomes of CHI pregnancies, both treated and untreated, were included. RESULTS No RCTs were identified. However, in a review population of 659 pregnancies, with additional 7 in case reports, CHI treatments included aspirin, prednisone, prednisolone, low molecular weight heparin (LMWH), hydroxychloroquine and adalimumab. A descriptive synthesis of data found mixed results for treatments in relation to live birth, miscarriage and fetal growth restriction outcomes. Furthermore, quantitative synthesis of 38 pregnancies revealed a non-significant improvement in live birth rate with CHI targeted treatment (OR 1.79 [95% CI 0.33-9.61] (p=0.50), while meta-analysis of CHI severity in line with pregnancy loss, in a sample of 231 pregnancies, revealed lower odds of pregnancy loss with less severe lesions (OR: 0.17 [0.03-0.80], p=0.03). CONCLUSIONS This systematic review and meta-analysis reinforce notions surrounding the insufficient evidence for CHI treatment. It also strengthens previous hypotheses detailing the positive association between CHI lesion severity and odds of pregnancy loss. Aspirin, LMWH, prednisolone, hydroxychloroquine and adalimumab are candidates with varying levels of weak to moderate evidence supporting their use. Further prospective research is required to obtain robust evidence pertaining to treatment safety and efficacy and optimal drug regimes. SYSTEMATIC REVIEW REGISTRATION [website], identifier CRD42021237604.
Collapse
Affiliation(s)
- Laurel Moar
- School of Life Course and Population Sciences, King’s College London, London, United Kingdom
| | - Chloe Simela
- School of Life Course and Population Sciences, King’s College London, London, United Kingdom
| | - Surabhi Nanda
- School of Life Course and Population Sciences, King’s College London, London, United Kingdom
- Department of Women and Children, Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Andreas Marnerides
- Department of Histopathology, St. Thomas Hospital, Westminster Bridge Road, London, United Kingdom
| | - Mudher Al-Adnani
- Department of Histopathology, St. Thomas Hospital, Westminster Bridge Road, London, United Kingdom
| | - Catherine Nelson-Piercy
- School of Life Course and Population Sciences, King’s College London, London, United Kingdom
- Department of Women and Children, Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Kypros H. Nicolaides
- School of Life Course and Population Sciences, King’s College London, London, United Kingdom
- Harris Birthright Research Centre for Fetal Medicine, King’s College London, London, United Kingdom
| | - Panicos Shangaris
- School of Life Course and Population Sciences, King’s College London, London, United Kingdom
- Department of Women and Children, Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom
- Peter Gorer Department of Immunobiology, School of Immunology and Microbial Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, United Kingdom
- *Correspondence: Panicos Shangaris,
| |
Collapse
|