Mechanism of Human Chorionic Gonadotrophinmediated Immunomodulation in Pregnancy

Amolak S Bansal; Shabana A Bora; Srdjan Saso; J Richard Smith; Mark R Johnson; Meen-Yau Thum


Expert Rev Clin Immunol. 2012;8(8):747-753. 

In This Article

Five-year View

The precise mechanism by which hCG mediates recruitment and stimulation of Tregs at the fetal–maternal interface will be clarified over the next few years. While we have some understanding of how Tregs modulate Th17, Th1 and Th2 cells, the precise molecular mechanisms require delineation. Equally important will be the dissection of the pathways that allow Tregs to influence NK-cell activity. Although regulatory NK cells have been proposed by a few groups, further work is required to confirm their existence and role in impaired fertility and miscarriage. With an increased understanding of the role of hCG in the immunomodulation of the early pregnancy, it is extremely likely that factors such as autoimmunity to this hormone and receptor will be investigated in detail. At a practical level, the precise timing, dose and duration of hCG use needs to be determined that will encourage optimal angiogenesis and maternal tolerance mechanisms. Clarification will also be required to define how this hormone should be used in conjunction with established hormone therapies, particularly progesterone.