To B or not to B cells-mediate a healthy start to life — The Association Specialists
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To B or not to B cells-mediate a healthy start to life (322)

Tommie Nguyen 1 2 , Julia Warning 2 , Vanessa Yenson 2 , Christopher Ward 3 , Jonathan Morris 2 4
  1. Autoimmunity and Immunotherapy Research, Kolling Institute of Medical Research, Sydney, NSW, Australia
  2. Division of Perinatal Research, Kolling Institute of Medical Research, Sydney, NSW, Australia
  3. Northern Blood Research Center, Kolling Institute of Medical Research, Sydney, NSW, Australia
  4. Northern Clinical School, University of Sydney, Sydney, NSW, Australia

Background: The long term health of a new borne is significantly programmed during pregnancy. Maternal immune responses play a critical role in this process. The maternal immune system is programmed to accommodate fetal tolerance as well as to provide a protection against infections for the immune-compromised mother and her baby during gestation and lactation. Antibody productions by maternal B cells play a significant role in providing such immuno-protection. However, aberrant B cells and autoantibody production as a consequence of maternal autoimmunity can pose serious risks to both the mother and her baby. Despite their implications in pregnancy, the role of B cells in human pregnancy outcomes has been poorly studied.
Aim: This study examined the implications of B cells and B-cell depletion therapy (Rituximab) in human pregnancy outcomes.
Methods: Our study utilised human and mouse samples to examine the evidence of aberrant activation of B cells in adverse pregnancies. A systematic review was also performed to examine the evidence of aberrant B cells and the use of B cell depletion therapy in high-risk pregnancies.
Results: Our research data highlighted the evidence of an association between aberrant activation of B-cell compartment and adverse pregnancies. Evidence suggests that this aberration leads to the exacerbation of the maternal autoimmunity and autoantibody productions during pregnancy that directly contribute to the pathologies of pregnancy and neonatal complications. The evidence of clinical benefits and safety of B-cell depletion therapy during pregnancy was reviewed and a strong argument was mounted for further clinical evaluation of B-cell-targeted therapies in adverse pregnancies with an emphasis on improving neonatal outcomes and prevention of neonatal conditions such as congenital heart block and fetal/neonatal alloimmune thrombocytopenia.
Conclusion: Aberrant B cells contribute to pregnancy complications. The clinical benefits of B cell depletion therapy for maternal and neonatal outcomes should be further investigated.