Unexplained fetal death has a biological signature of maternal anti-fetal rejection

Chronic chorioamnionitis and alloimmune anti-human leucocyte antigen antibodies

Joonho Lee, Roberto Romero, Zhong Dong, Yi Xu, Faisal Qureshi, Suzanne Jacques, Wonsuk Yoo, Tinnakorn Chaiworapongsa, Pooja Mittal, Sonia S. Hassan, Chong Jai Kim

Research output: Contribution to journalArticle

35 Citations (Scopus)

Abstract

Aims: Chronic chorioamnionitis is a histological manifestation of maternal anti-fetal cellular rejection. As failure of graft survival is the most catastrophic event in organ transplantation, we hypothesized that fetal death could be a consequence of maternal rejection. The aim of this study was to assess whether there is evidence of cellular and antibody-mediated rejection in fetal death. Methods and results: Placental histology was reviewed for the presence of chronic chorioamnionitis in unexplained preterm fetal death (n=30) and preterm live birth (n=103). Amniotic fluid CXCL10 concentrations were measured with a specific immunoassay. Chronic chorioamnionitis was more frequent in fetal death than in live birth (60.0% versus 37.9%; P<0.05) and fetal death had a higher median amniotic fluid CXCL10 concentration than live birth (2.0 versus 1.8ng/ml, P<0.05), after adjusting for gestational age at amniocentesis. Maternal anti-human leucocyte antigen class II panel-reactive seropositivity determined by flow cytometry was higher in fetal death compared to live birth (35.7% versus 10.9%; P<0.05). Conclusions: Chronic chorioamnionitis is a common pathologic feature in unexplained preterm fetal death. This novel finding suggests that cellular and antibody-mediated anti-fetal rejection of the mother is associated with fetal death (graft failure) in human pregnancy.

Original languageEnglish (US)
Pages (from-to)928-938
Number of pages11
JournalHistopathology
Volume59
Issue number5
DOIs
StatePublished - Nov 1 2011

Fingerprint

Chorioamnionitis
Fetal Death
HLA Antigens
Mothers
Antibodies
Live Birth
Amniotic Fluid
Amniocentesis
Premature Birth
Organ Transplantation
Graft Survival
Immunoassay
Gestational Age
Anti-Idiotypic Antibodies
Histology
Flow Cytometry
Transplants
Pregnancy

Keywords

  • Amniotic fluid
  • CXCL10
  • Panel-reactive antibody
  • Placenta
  • Pregnancy

ASJC Scopus subject areas

  • Pathology and Forensic Medicine
  • Histology

Cite this

Unexplained fetal death has a biological signature of maternal anti-fetal rejection : Chronic chorioamnionitis and alloimmune anti-human leucocyte antigen antibodies. / Lee, Joonho; Romero, Roberto; Dong, Zhong; Xu, Yi; Qureshi, Faisal; Jacques, Suzanne; Yoo, Wonsuk; Chaiworapongsa, Tinnakorn; Mittal, Pooja; Hassan, Sonia S.; Kim, Chong Jai.

In: Histopathology, Vol. 59, No. 5, 01.11.2011, p. 928-938.

Research output: Contribution to journalArticle

Lee, J, Romero, R, Dong, Z, Xu, Y, Qureshi, F, Jacques, S, Yoo, W, Chaiworapongsa, T, Mittal, P, Hassan, SS & Kim, CJ 2011, 'Unexplained fetal death has a biological signature of maternal anti-fetal rejection: Chronic chorioamnionitis and alloimmune anti-human leucocyte antigen antibodies', Histopathology, vol. 59, no. 5, pp. 928-938. https://doi.org/10.1111/j.1365-2559.2011.04038.x
Lee, Joonho ; Romero, Roberto ; Dong, Zhong ; Xu, Yi ; Qureshi, Faisal ; Jacques, Suzanne ; Yoo, Wonsuk ; Chaiworapongsa, Tinnakorn ; Mittal, Pooja ; Hassan, Sonia S. ; Kim, Chong Jai. / Unexplained fetal death has a biological signature of maternal anti-fetal rejection : Chronic chorioamnionitis and alloimmune anti-human leucocyte antigen antibodies. In: Histopathology. 2011 ; Vol. 59, No. 5. pp. 928-938.
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abstract = "Aims: Chronic chorioamnionitis is a histological manifestation of maternal anti-fetal cellular rejection. As failure of graft survival is the most catastrophic event in organ transplantation, we hypothesized that fetal death could be a consequence of maternal rejection. The aim of this study was to assess whether there is evidence of cellular and antibody-mediated rejection in fetal death. Methods and results: Placental histology was reviewed for the presence of chronic chorioamnionitis in unexplained preterm fetal death (n=30) and preterm live birth (n=103). Amniotic fluid CXCL10 concentrations were measured with a specific immunoassay. Chronic chorioamnionitis was more frequent in fetal death than in live birth (60.0{\%} versus 37.9{\%}; P<0.05) and fetal death had a higher median amniotic fluid CXCL10 concentration than live birth (2.0 versus 1.8ng/ml, P<0.05), after adjusting for gestational age at amniocentesis. Maternal anti-human leucocyte antigen class II panel-reactive seropositivity determined by flow cytometry was higher in fetal death compared to live birth (35.7{\%} versus 10.9{\%}; P<0.05). Conclusions: Chronic chorioamnionitis is a common pathologic feature in unexplained preterm fetal death. This novel finding suggests that cellular and antibody-mediated anti-fetal rejection of the mother is associated with fetal death (graft failure) in human pregnancy.",
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