妊娠免疫调节以和孕激素在辅助生殖医疗中应用新进展课件.ppt

The diagram shows a pre-implantation-stage blastocyst (approximately 6 -7 days after conception) and the tightly networked processes thought to be necessary for uterine receptivity and blastocyst apposition and adhesion. COX-2 = cyclooxygenase-2 EGF = epidermal growth factor LIF = leukemia inhibiting factor Progesterone (bended arrow) plays a crucial role not only in preparing the endometrial stroma for the successful blastocyst adhesion But also in pathways involving cytokines prostaglandin Source Norwitz et al., N Engl J Med, 2001 The fetal and the maternal tissues are in close harmony on day 7. 母亲血循环标记为“m”，胎儿循环成蓝色，标志为“f”。 请注意途中母亲和胎儿循环紧密相连的地方。母亲所有免疫物质都已出现，准备开始产生保护或排斥反应。 The maternal blood circulation is marked with ‘m’ and the foetal circulation, coloured in blue, marked with ‘f’. Notice the close proximity between the maternal and foetal circulations. Now all the mother’s immunological armamentarium are in place, and ready to either protect or reject. Clark 等 1999年在《美国生殖免疫杂志》发表了里程碑性的文章。文章题目很有趣：“为什么你的母亲排斥你？”，这篇文章讨论了母亲对胎儿排斥的免疫基础。 The landmark article by, Clark et al, published in, in the American Journal of Reproductive Immunology. With its catchy title “Why did your mother reject you?” the article discusses the immunological basis of rejection of the foetus by the mother. Pregnancy is a semi-graft – 50% of the fetal antigens are foreign to the mother. In some pregnancies, the mother recognizes these foreign paternal antigens and sets up an immune rejection reaction to them, which causes abortion. In habitual abortion, this reaction is repeated in every subsequent pregnancy. In healthy pregnancy, however, the fetus is not compromised by an allogenic immune response. In these pregnancies, a cross talk between the pre-embryo and the mother-to-be starts early after fertilization, and results in a protective immune response in the mother. There are quite a number of different pathways involved in the rejection of a fetus by its mother, but three, in partic