Immunological factors and placentation: Implications for pre-eclampsia
Redman CWG., Sargent IL.
© Cambridge University Press 2007 and Cambridge University Press, 2009.In this chapter what constitutes a systemic inflammatory response is described. Evidence is presented that normal pregnancy evokes such a response and that pre-eclampsia arises when the response becomes extreme and decompensates. The possible causes of systemic inflammation in pregnancy are reviewed, as is the relation between the inflammatory response and systemic oxidative stress. The interaction between systemic inflammation and changes in lipid and glucose metabolism are described and the relevance of long-term systemic inflammation as a predisposing risk factor is outlined. It is suggested that the metabolic results of systemic inflammation may endow a survival advantage for the fetus. Last, the systemic inflammation is related to other immune responses that are thought to be important for the success or failure of pregnancy. Immune and inflammatory responses In evolutionary terms, inflammatory responses are older than immune responses. The latter are superimposed on the former and cannot work without it. The primitive innate (inflammatory) system responds quickly and is relatively non-specific. The more sophisticated adaptive immune system is slow but precise, delivering antigen-specific responses with astonishing versatility and accuracy. The innate and adaptive systems are asymmetrically interdependent. The innate system does not need the adaptive system to function, whereas the adaptive system cannot function without signals from the innate system, nor need it provoke antibodies of antigen-specific cytotoxicity. This is a crucial consideration in relation to this chapter. A systemic inflammatory response is not necessarily generated by antigenic stimulation.