The Experts below are selected from a list of 240 Experts worldwide ranked by ideXlab platform
A Stagnaro-green - One of the best experts on this subject based on the ideXlab platform.
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Post-miscarriage thyroid dysfunction.
Obstetrics & Gynecology, 1992Co-Authors: A Stagnaro-greenAbstract:BACKGROUND: Thyroid dysfunction is a common postpartum event affecting as many as 16.7% of women. The purpose of this paper was to report the first known case of post-miscarriage thyroid dysfunction. CASE: A 32-year-old woman with a 9-year history of infertility underwent in vitro fertilization. After two spontaneous miscarriages, she delivered a full-term healthy child. Spontaneous menses did not return following delivery, and hormonal evaluation revealed severe postpartum thyroid disease associated with hyperprolactinemia. Retrospective analysis of frozen sera revealed thyroid dysfunction and hyperprolactinemia after the first miscarriage, even though the gestation lasted only 47 days. CONCLUSION: The present case of thyroid dysfunction following a first-trimester miscarriage raises issues concerning the Immunology of Pregnancy and thyroid dysfunction after Pregnancy. The incidence of post-miscarriage thyroid dysfunction and severe postpartum thyroid disease resulting in amenorrhea requires further study.
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Post-miscarriage thyroid dysfunction.
Obstetrics and gynecology, 1992Co-Authors: A Stagnaro-greenAbstract:Thyroid dysfunction is a common postpartum event affecting as many as 16.7% of women. The purpose of this paper was to report the first known case of post-miscarriage thyroid dysfunction. A 32-year-old woman with a 9-year history of infertility underwent in vitro fertilization. After two spontaneous miscarriages, she delivered a full-term healthy child. Spontaneous menses did not return following delivery, and hormonal evaluation revealed severe postpartum thyroid disease associated with hyperprolactinemia. Retrospective analysis of frozen sera revealed thyroid dysfunction and hyperprolactinemia after the first miscarriage, even though the gestation lasted only 47 days. The present case of thyroid dysfunction following a first-trimester miscarriage raises issues concerning the Immunology of Pregnancy and thyroid dysfunction after Pregnancy. The incidence of post-miscarriage thyroid dysfunction and severe postpartum thyroid disease resulting in amenorrhea requires further study.
Anthony P. Weetman - One of the best experts on this subject based on the ideXlab platform.
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Immunity, thyroid function and Pregnancy: molecular mechanisms
Nature Reviews Endocrinology, 2010Co-Authors: Anthony P. WeetmanAbstract:Pregnancy is an immunological balancing act in which major changes in the mother's immune system occur that prevent rejection of the fetus that bears paternal antigens. This Review discusses the immunological mechanisms involved in such tolerance of the fetus, and highlights how these mechanisms may explain the clinical changes in autoimmune thyroid disease during and after Pregnancy. Women are exposed to fetal alloantigens during Pregnancy and must establish immunological tolerance to these antigens to prevent rejection of the fetus A generalized reduction of maternal immune responsiveness occurs during Pregnancy, which is caused by increased levels of progesterone The trophoblast synthesizes a number of immunologically active molecules that suppress immune responses at the interface between mother and placenta Most importantly, the mother generates regulatory T (T_REG) cells early in Pregnancy that maintain a state of tolerance to fetal alloantigens as long as the Pregnancy continues These T_REG cells may ameliorate coincidental autoimmune thyroid diseases during Pregnancy by linked suppression; worsening of these diseases postpartum may result from changes in the T_REG cell and cytokine milieu Pregnancy and the postpartum period have a profound effect on autoimmune thyroid disease. Graves disease ameliorates during Pregnancy, only to relapse postpartum, whereas postpartum thyroiditis is caused by destructive thyroiditis during the first few months after delivery. The Immunology of Pregnancy underlies these changes: the mother must maintain tolerance of the fetal semi-allograft while not suppressing her own immune system and exposing herself and the fetus to infection. Nonspecific factors, including hormonal changes, trophoblast expression of key immunomodulatory molecules and a switch to a predominantly T-helper-2-type pattern of cytokines, play some part in the maintenance of transient tolerance to paternal antigens in Pregnancy; however, the generation of specific regulatory T (T_REG) cells is key to this maintenance. T_REG cells preferentially accumulate in the decidua but may also be present in the mother's circulation and are thus capable of regulating coincidental autoimmune responses through the phenomenon of linked suppression. In turn, this suppression may explain why thyroid autoantibody levels decline during Pregnancy, which leads to remission of Graves disease. Postpartum exacerbation of autoimmunity may reflect an imbalance in T_REG cells, which is caused by the rapid fall in the numbers of these cells after delivery.
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Immunity, thyroid function and Pregnancy: molecular mechanisms
Nature reviews. Endocrinology, 2010Co-Authors: Anthony P. WeetmanAbstract:Pregnancy and the postpartum period have a profound effect on autoimmune thyroid disease. Graves disease ameliorates during Pregnancy, only to relapse postpartum, whereas postpartum thyroiditis is caused by destructive thyroiditis during the first few months after delivery. The Immunology of Pregnancy underlies these changes: the mother must maintain tolerance of the fetal semi-allograft while not suppressing her own immune system and exposing herself and the fetus to infection. Nonspecific factors, including hormonal changes, trophoblast expression of key immunomodulatory molecules and a switch to a predominantly T-helper-2-type pattern of cytokines, play some part in the maintenance of transient tolerance to paternal antigens in Pregnancy; however, the generation of specific regulatory T (T(REG)) cells is key to this maintenance. T(REG) cells preferentially accumulate in the decidua but may also be present in the mother's circulation and are thus capable of regulating coincidental autoimmune responses through the phenomenon of linked suppression. In turn, this suppression may explain why thyroid autoantibody levels decline during Pregnancy, which leads to remission of Graves disease. Postpartum exacerbation of autoimmunity may reflect an imbalance in T(REG) cells, which is caused by the rapid fall in the numbers of these cells after delivery.
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The Immunology of Pregnancy.
Thyroid : official journal of the American Thyroid Association, 1999Co-Authors: Anthony P. WeetmanAbstract:Pregnancy is an immunological balancing act in which the mother's immune system has to remain tolerant of paternal major histocompatibility (MHC) antigens and yet maintain normal immune competence ...
Henry N. Claman - One of the best experts on this subject based on the ideXlab platform.
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Immunology of Pregnancy
Clinical Reviews in Allergy & Immunology, 2004Co-Authors: Jill A. Poole, Henry N. ClamanAbstract:Pregnancy is a unique event in which a genetically and immunologically foreign fetus usually survives to full term without apparent rejection by the mother's immune system. Over the past decade, more information has been gathered to provide insight into the complex immunological mechanisms that allow the fetus to grow and survive in most cases. Whereas the maternal-fetal interface was once felt to be an immunologically privileged site with complete separation between the fetus and the mother, it is now known that recognition of the foreign fetus does occur. However, despite this immunological recognition, several mechanisms have been discovered which may explain why the mother does not reject the foreign fetus. These mechanisms include fetal factors such as trophoblast cell properties and altered MHC Class I expression as well as local maternal factors such as specialized uterine natural killer cells and a shifting of the T-helper cell cytokine profile from a type 1 to a type II array. Other novel immunomodulators are found to be expressed in the local uterine environment to aid in fetal survival. Furthermore, the persistence of fetal cells in the maternal circulation long after Pregnancy is over (termed chronic microchimerism) and may have implications for autoimmune diseases. This review presents investigations and developments relevant to an understanding as to why the fetus is not rejected by the maternal immune system.
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Immunology of Pregnancy. Implications for the mother.
Clinical reviews in allergy & immunology, 2004Co-Authors: Jill A. Poole, Henry N. ClamanAbstract:Pregnancy is a unique event in which a genetically and immunologically foreign fetus usually survives to full term without apparent rejection by the mother's immune system. Over the past decade, more information has been gathered to provide insight into the complex immunological mechanisms that allow the fetus to grow and survive in most cases. Whereas the maternal-fetal interface was once felt to be an immunologically privileged site with complete separation between the fetus and the mother, it is now known that recognition of the foreign fetus does occur. However, despite this immunological recognition, several mechanisms have been discovered which may explain why the mother does not reject the foreign fetus. These mechanisms include fetal factors such as trophoblast cell properties and altered MHC Class I expression as well as local maternal factors such as specialized uterine natural killer cells and a shifting of the T-helper cell cytokine profile from a type 1 to a type II array. Other novel immunomodulators are found to be expressed in the local uterine environment to aid in fetal survival. Furthermore, the persistence of fetal cells in the maternal circulation long after Pregnancy is over (termed chronic microchimerism) and may have implications for autoimmune diseases. This review presents investigations and developments relevant to an understanding as to why the fetus is not rejected by the maternal immune system.
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Pregnancy and Immunology: selected aspects.
Annals of allergy asthma & immunology : official publication of the American College of Allergy Asthma & Immunology, 2002Co-Authors: G. William Palmer, Henry N. ClamanAbstract:Learning Objectives This article reviews current concepts of the Immunology of Pregnancy and of the diagnosis and management of certain allergic conditions in the pregnant woman: asthma, rhinitis, immunotherapy, and hereditary angioedema (HAE). Data Sources Current texts, reviews, and individual studies were picked from the National Library of Medicine database. Results and Conclusions Knowledge concerning the immunologic paradox of Pregnancy continues to evolve. Although the answer is not definitive, attention is being paid to the role of a Th-2 shift in the pregnant uterus. Extensive studies, both epidemiologic and therapeutic, are clarifying the influence of Pregnancy on asthma and rhinitis (and vice versa) and the best methods for treatment of these conditions in the pregnant woman. A brief guideline to the handling of hereditary angioedema in Pregnancy is presented.
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Recurrent Pregnancy Loss
The Immunology of Human Pregnancy, 1993Co-Authors: Henry N. ClamanAbstract:No aspect of the Immunology of Pregnancy is more controversial than the subject of recurrent Pregnancy loss, or, as it will be called here, recurrent spontaneous abortion (RSAb). Nor is there any subject in this book more laden with emotion because the immunologic facts, as perceived, have a very strong influence on therapy decisions for RSAb and thus, potentially, on the ability of the childless to have children. Indeed, it is the question of the relevance of Immunology to RSAb that prompted the writing of this book. Because of these two factors—the controversial nature of the data and the emotional implications of the interpretation of the data—there will be few general statements in this chapter that will not be questioned by someone.
Charlie Loke - One of the best experts on this subject based on the ideXlab platform.
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Immunology of placentation in eutherian mammals
Nature Reviews Immunology, 2006Co-Authors: Ashley Moffett, Charlie LokeAbstract:A new way to view the Immunology of Pregnancy is discussed, which takes into account the differing placental strategies used by eutherian mammals. Why some human pregnancies fail might depend on the degree of invasion of the uterus by placental trophoblast cells. The traditional way to study the Immunology of Pregnancy follows the classical transplantation model, which views the fetus as an allograft. A more recent approach, which is the subject of this Review, focuses on the unique, local uterine immune response to the implanting placenta. This approach requires knowledge of placental structure and its variations in different species, as this greatly affects the type of immune response that is generated by the mother. At the implantation site, cells from the mother and the fetus intermingle during Pregnancy. Unravelling what happens here is crucial to our understanding of why some human pregnancies are successful whereas others are not.
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Immunology of placentation in eutherian mammals
Nature Reviews Immunology, 2006Co-Authors: Ashley Moffett, Charlie LokeAbstract:The traditional way to study the Immunology of Pregnancy follows the classical transplantation model, which views the fetus as an allograft. A more recent approach, which is the subject of this Review, focuses on the unique, local uterine immune response to the implanting placenta. This approach requires knowledge of placental structure and its variations in different species, as this greatly affects the type of immune response that is generated by the mother. At the implantation site, cells from the mother and the fetus intermingle during Pregnancy. Unravelling what happens here is crucial to our understanding of why some human pregnancies are successful whereas others are not.
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Immunology of placentation in eutherian mammals
Nature Reviews Immunology, 2006Co-Authors: Ashley Moffett, Charlie LokeAbstract:A new way to view the Immunology of Pregnancy is discussed, which takes into account the differing placental strategies used by eutherian mammals. Why some human pregnancies fail might depend on the degree of invasion of the uterus by placental trophoblast cells. The traditional way to study the Immunology of Pregnancy follows the classical transplantation model, which views the fetus as an allograft. A more recent approach, which is the subject of this Review, focuses on the unique, local uterine immune response to the implanting placenta. This approach requires knowledge of placental structure and its variations in different species, as this greatly affects the type of immune response that is generated by the mother. At the implantation site, cells from the mother and the fetus intermingle during Pregnancy. Unravelling what happens here is crucial to our understanding of why some human pregnancies are successful whereas others are not. The anatomical relationship between the placenta and the uterus holds the key to our understanding of the 'immunological paradox' of Pregnancy because this is where direct tissue contact occurs. There is great diversity in placental structures in eutherian mammals. For immunologists, the most important feature is the extent to which the placental trophoblast cells invade the uterus. This ranges from no invasion at all (epitheliochorial placentation) to very extensive invasion (haemochorial placentation). The human placenta is the most invasive of all. During Pregnancy, in invasive forms of placentation, the uterine lining is transformed into decidual tissue. The most obvious feature of the decidua is the influx of a distinctive population of uterine natural killer (NK) cells. Trophoblast cells express an array of MHC molecules some of which might be potential ligands for receptors expressed by the NK cells (CD94–NKG2A and KIRs (killer-cell immunoglobulin-like receptors)) and expressed by myelomonocytic cells (LILRB1 (leukocyte immunoglobulin-like receptor B1) and LILRB2) in the uterus. Interaction between HLA-C expressed by trophoblast cells and KIRs on maternal NK cells influences reproductive performance. Binding of HLA-G to LILRB molecules might induce tolerance in maternal T cells, thereby allowing cooperation between the innate and adaptive immune systems in mammalian reproduction. It is proposed that the function of uterine NK cells is to alter the structure of the uterine spiral arteries that supply the feto-placental unit. This effect could be mediated directly by affecting the structure or function of the vessel wall (as in mice) or indirectly through the influence on trophoblast-cell infiltration. The arterial modification is necessary to allow sufficient blood flow to the placenta and fetus. Inadequate arterial transformation results in Pregnancy disorders (such as fetal growth restriction or pre-eclampsia).
Catherine A. Thornton - One of the best experts on this subject based on the ideXlab platform.
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Immunology of Pregnancy.
The Proceedings of the Nutrition Society, 2010Co-Authors: Catherine A. ThorntonAbstract:The conceptual framework for reproductive Immunology was put in place over 50 years ago when the survival of the fetal semi-allograft within an immunocompetent mother was first considered. During this time, a number of paradigms have emerged and the mechanisms receiving current attention are those related to immune tolerance, such as regulatory T-cells and indoleamine 2,3,-dioxygenase, and innate immunity, such as natural killer cells, trophoblast debris and inflammation. A key consideration is the temporal and spatial variation in any of these pathways (e.g. implantation v. parturition). As fetally derived trophoblasts are the semi-allogeneic cells with which the maternal immune system comes into contact, understanding the immune response to these cells is critical. There is much interest in the immunological pathways that support a healthy Pregnancy and how they might be perturbed in adverse Pregnancy outcomes. Additionally, there is increasing awareness that antenatal determinants of the immune function of pregnant women and their offspring have consequences for health and disease in childhood and beyond. Changes in maternal diet over recent decades coincide with the increasing prevalence of allergic and other immune-mediated diseases, and the modification of maternal diet has emerged as a strategy for disease prevention. Approaches undergoing trial at numerous sites around the world include dietary supplementation with fish oil and/or probiotics. Understanding the underlying mechanisms of any positive effect on disease outcomes should reveal further novel strategies for disease prevention.
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Session 5: Early programming of the immune system and the role of nutrition Immunology of Pregnancy
2010Co-Authors: Catherine A. ThorntonAbstract:The conceptual framework for reproductive Immunology was put in place over 50 years ago when the survival of the fetal semi-allograft within an immunocompetent mother was first considered. During this time, a number of paradigms have emerged and the mechanisms receiving current attention are those related to immune tolerance, such as regulatory T-cells and indoleamine 2,3,-dioxygenase, and innate immunity, such as natural killer cells, trophoblast debris and inflammation. A key consideration is the temporal and spatial variation in any of these pathways (e.g. implantation v. parturition). As fetally derived trophoblasts are the semi-allogeneic cells with which the maternal immune system comes into contact, understanding the immune response to these cells is critical. There is much interest in the immunological pathways that support a healthy Pregnancy and how they might be perturbed in adverse Pregnancy outcomes. Additionally, there is increasing awareness that antenatal determinants of the immune function of pregnant women and their offspring have consequences for health and disease in childhood and beyond. Changes in maternal diet over recent decades coincide with the increasing prevalence of allergic and other immune-mediated diseases, and the modification of maternal diet has emerged as a strategy for disease prevention. Approaches undergoing trial at numerous sites around the world include dietary supplementation with fish oil and/or probiotics. Understanding the underlying mechanisms of any positive effect on disease outcomes should reveal further novel strategies for disease prevention.
