Cytokine network at the feto-maternal interface.

In early pregnancy invading fetal trophoblasts encounter abundant maternal decidual natural killer cells (dNK). dNK express perforin, granzymes A and B and the activating receptors NKp30, NKp44, NKp46, NKG2D, and 2B4 as well as LFA-1. Even though they are granular and express the essential molecules required for lysis, fresh dNK displayed very reduced lytic activity on classical MHC I negative targets K562 and 721.221, ≈15% of that of peripheral NK cells. dNK formed conjugates and activating immune synapses with 721.221 and K562 cells in which CD2, LFA-1 and actin were polarized toward the contact site. However, in contrast to peripheral NK cells, they failed to polarize their microtubule organizing centers and perforin-containing granules to the synapse, accounting for their lack of cytotoxicity.

https://www.pnas.org/content/pnas/102/43/15563.full.pdf

Human decidual NK cells form immature activating synapses and are not cytotoxic

Pregnancy presents an immunological conundrum because two genetically different individuals coexist. The maternal lymphocytes at the uterine maternal-fetal interface that can recognize mismatched placental cells are T cells and abundant distinctive uterine NK (uNK) cells. Multiple mechanisms exist that avoid damaging T cell responses to the fetus, whereas activation of uNK cells is probably physiological. Indeed, genetic epidemiological data suggest that the variability of NK cell receptors and their MHC ligands define pregnancy success; however, exactly how uNK cells function in normal and pathological pregnancy is still unclear, and any therapies aimed at suppressing NK cells must be viewed with caution. Allorecognition of fetal placental cells by uNK cells is emerging as the key maternal-fetal immune mechanism that regulates placentation.

/pdf/uterine-nk-cells-active-regulators-at-the-maternal-fetal-2a913qdunl.pdf

Uterine NK cells: active regulators at the maternal-fetal interface

This review examines evidence supporting the concept that menstruation occurs as a result of an inflammatory process. In the endometrium, leukocyte numbers rise in the late secretory phase following the fall in serum progesterone concentrations. It is postulated that products released following activation of these leukocytes are critically important for menstruation. Mast cells, eosinophils, neutrophils and macrophages in particular are involved. Endometrial granular lymphocytes may also play a role, although their increase in numbers is somewhat earlier during the menstrual cycle than that of the others, suggesting perhaps a primary role in embryo implantation. Leukocyte products include a range of proteases, chemokines and cytokines which in concert result in focal production and activation of matrix metalloproteinases by endometrial cells and the subsequent breakdown of tissue that characterizes menstruation. Regulation of leukocyte entry, proliferation, differentiation and activation within the endometrium is not yet well understood, although both chemokines and cytokines produced locally by endometrial cells are clearly implicated. The role of progesterone in regulating these events is still not understood although the lack of progesterone receptors on endometrial leukocytes suggests indirect actions.

Endometrial leukocytes and menstruation

The immunological relationship between the mother and the fetus is a bi-directional communication determined on the one hand by fetal antigen presentation and on the other hand by recognition of and reaction to these antigens by the maternal immune system. There is evidence now that immunological recognition of pregnancy is important for the maintenance of gestation, and that inadequate recognition of fetal antigens might result in failed pregnancy. In contrast to HLA-A and -B Class I genes that are downregulated in human trophoblast cells, nonpolymorphic Class I molecules, e.g., HLA-G Class Ib, are expressed in extravillous cytotrophoblast and also in endothelial cells of fetal vessels in the chorionic villi as well as in amnion cells and amniotic fluid. The trophoblast does not induce transplantation immunity and resists NK- and CTL-mediated lysis in vitro. According to our present knowledge, HLA-G presents antigens for gamma/delta T cells and at the same time defends the trophoblast from cytotoxic effector mechanisms. Since polymorphic MHC is absent from the trophoblast, presentation of fetally derived antigens is unlikely to be MHC restricted. gamma/delta T cells recognize a distinct group of ligands with a smaller receptor repertoire than alpha/beta T cells. Most gamma/delta T cells recognize unprocessed foreign antigens without MHC. In the decidua gamma/delta TCR-positive cells significantly increase in number and the majority of decidual gamma/delta T cells are in an activated form due to recognition of conserved mammalian molecules on the trophoblast. Following recognition of fetally derived antigens, the immune system reacts with the setting in of a wide range of protective mechanisms. Many observations suggest that pregnancy is associated with an altered TH1/TH2 balance. Maternal immune response is biased toward humoral immunity and away from cell-mediated immunity that could be harmful to the fetus. Cytokines of maternal origin act on placental development. On the other hand, antigen expression on the placenta determines maternal cytokine pattern. Normal human pregnancy is characterized by low peripheral NK activity, and increased NK activity seems to play a role in spontaneous abortions of unknown etiology. In early human pregnancy the majority of uterine lymphocytes are CD56(bright) granulated NK cells, which do not express CD16 or CD3. In rodents and humans, uterine NK cells are under hormonal control. In early pregnancy they are enriched at sites where fetal trophoblast infiltrates the decidua. The dynamics of the appearance of uterine NK cells suggest that one of the functions of these cells is control of placentation. Another protective mechanism operating in favor of pregnancy is progesterone-dependent immunomodulation. Due to stimulation by fetally derived antigens, pregnancy lymphocytes develop progesterone receptors and in the presence of progesterone produce a mediator (PIBF) that, through altering the cytokine balance, inhibits NK activity and exerts an antiabortive effect in mice.

Immunological relationship between the mother and the fetus.

At the time the human placenta is established, the uterine mucosal lining (decidua) is infiltrated by abundant CD3- CD56bright natural killer (NK) cells. NK cells circulating in blood are known to contain perforin and granzyme A in their cytoplasmic granules. TIA-1, an RNA-binding protein capable of inducing DNA fragmentation, has also been found in the granules of cytolytic cells. In this paper, we demonstrate the presence of perforin, granzyme A and TIA-1 in the granules of uterine NK cells. Sixteen sections of non-pregnant endometrium throughout the menstrual cycle and six sections of early decidua, together with cytospins of four preparations of isolated decidual leukocytes were stained by both immunohistology and immuno-electron microscopy to localize perforin, granzyme A and TIA-1 to the cytoplasmic granules of CD56+ cells. The presence in vivo of these cytolytic molecules in a normal physiological situation implies that these uterine NK cells may have effector functions in the control of normal placentation.

Peter Wooding

Papers

Expression of perforin, granzyme A and TIA-1 by human uterine CD56+ NK cells implies they are activated and capable of effector functions.