Features of Structure and Functions of Decidual Macrophages in Healthy Pregnancy and Preeclampsia

Abstract

According to modern scholarly data, decidual macrophages play a significant role both in the physiological and pathological course of pregnancy due to their plasticity and immunosuppressive properties, participation in the remodeling of tissues and vessels, and the ability to form a local adaptive immunity. The normal course of pregnancy is characterized as a condition of moderate systemic inflammatory process because of activation of the immune system components, in the first place, the innate immunity and vascular endothelium. The development of preeclampsia is characterized by the impairment of placental processes and production of pathologically altered placenta, an excess of proinflammatory cytokines that contribute to the development of a systemic inflammatory response. However, there is still not enough data on the peculiarities of cytokine levels, the nature of phenotypic and morphofunctional macrophage changes, the ratio of subpopulations of decidual macrophages in the physiological and pathological course of pregnancy, which limits the understanding of the pathogenetic role of M1 and M2 decidual macrophages in preeclampsia. It is only probable, but not proven, that the development of preeclampsia is associated with an imbalance of decidual macrophages during the late phase of the first trimester and the early phase of the second trimester of pregnancy, with the predominance of macrophages of the M1 phenotype and subsequent inadequate remodeling of the uterine spiral arteries. The effectiveness of preventing preeclampsia by stimulating the differentiation of decidual macrophages in the direction of the M2 phenotype has not been studied. The obtained results determine the expediency and relevance of further studying the etiopathogenesis of preeclampsia, improving the knowledge of the immunological mechanisms of this obstetric pathology development (taking into account the peculiarities of differentiation in subpopulations of decidual macrophages with the formation of M1 and M2 phenotypes) and determine the need for the development of new methods for the early formation of high-risk groups for preeclampsia, ways of secondary prevention of the disease, which would enable us to develop effective tactics for the management of pregnant women with preeclampsia, specifically aimed at reducing maternal and perinatal morbidity and mortality.