Intravenous immunoglobulin (IVIG) modulates Th17 cells and improves live birth rate in patients with recurrent spontaneous abortion

Eghbal-Fard SP1P, Ahmadi MP1P, Dolati SP1P, Nouri MP2P, Babaloo
ZP1P, Farzadi LP3P, Jadidi Niaragh FP1P, Yousefi M P1P.
۱٫ Stem Cell and Regenerative Medicine Institute, Tabriz
University of Medical Sciences, Tabriz, Iran.
۲٫ Department of Biochemistry, Tabriz University of Medical
Sciences, Tabriz, Iran.
۳٫ Department of Gynecology, Tabriz University of Medical
Sciences, Tabriz, Iran.

Introduction: Recurrent spontaneous abortion (RSA) isa growing problem in the Iran, particularly among women over 30 years of age. In these women, RSAoccurs with both natural and artificial fertilization techniques. There is increasing evidence thatimmunologic factors play an important role in RSA.Th17 cells are recently proposed as new risk factors in RSA. Higher level of IL-17 has been reported in women with unexplained RSA compared with women with normal pregnancies Intravenous Immunoglobulin G (IVIG) was shown to cause immunomodulation in RSA patients.

Materials and Methods: 38 RSA subjects with cellular immune abnormalities were included and peripheral bloods was drawn upon positive pregnancy test. On the same date, IVIG, 400 mg/kg, was administrated intravenously and continue every 4 wk through 28-30 wk of gestation. 12 RSA patients with abnormal cellular immune profile were included as IVIG untreated group. We investigated IVIG effect on Th17 cells frequencies and cytokine secretions and pregnancy outcome in RSA patients before and after treatment.

Results: IVIG treatment significantly reduced the frequency of Th17 cells from 3.94±۱٫۱۲% to 1.83±۰٫۵۶%. Moreover, significant reduction in RORγt and IL-17 mRNAs and cytokine secretions (IL-17 and IL-23) were observed in IVIG treated patients. Pregnancy outcome in IVIG treated subjects (87.5%) was significantly higher than untreated group (41.6%). Conclusion: Our findings shed more light on the mechanisms of IVIG immunomdulatory effects and introduced IVIG as a promising therapeutic approach in RSA patients with cellular immune system abnormalities.

Key words: Recurrent spontaneous abortion, Intravenous immunoglobulin G, Treatment, Th17.

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