[Immunotherapy as an effective treatment of recurrent spontaneous abortion--own experience]

Recent data emphasize relationship between antiphospholipid antibodies (APA) and increased natural killer cell activity in women with recurrent spontaneous abortion (RSA). Therefore, it has been proposed that final common mechanism involved in the pathogenesis of RSA is associated with auto- and alloimmunity.

The aim of this study was to present our data concerning diagnosis and treatment of women with RSA.

Sixty nonpregnant women with the history of RSA were studied, among them 41 were screened at the beginning of their next pregnancy. We investigated the existence of inherited (deficiencies of protein C, protein S, antithrombin III, a resistance to the activated protein C-including Leiden V mutation) or acquired thrombophilia (APA-anticardiolipin antibodies, antiphosphatidylserine antibodies, lupus anticoagulant). Natural killer cell activity was measured using flow cytometry. In addition, the following lymphocytes surface antigens: CD3, CD4, CD8, CD16, CD56 were studied using flow cytometry. We also studied the existence of autoimmunity: antinuclear antibodies (ANA), antithyroid antibodies (ATA). According to presence of auto- or alloimmunity, we introduce immunotherapy: intravenous immunoglobulin, alloimmunization, heparin/aspirin, aspirin alone, steroids or combine therapy.

We determined the existence of thrombophilia in 17 women, ANA in 5 women, ATA in 5 women, increased number of NK cells in 16 women and increased NK cell activity in 14 women. Forty-one women were pregnant and followed up during pregnancy, among them 33/41 delivered normal healthy baby, 7/41 experienced the next abortion and 1/41 had ectopic pregnancy. Therefore, overall success of immunotherapy was 80.5%.

Immunotherapy seems to be effective treatment for women with the history of RSA and combined immune abnormalities. Regulation of immune system activity may underlie possible effect of such therapy.