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Re: RPLFrom: Terrence.Jones@ncal.kaiperm.orgThu Aug 15 15:16:14 1996
-If TLX (trophoblast-lymphocyte cross-reactive antibody) disrupts implantation -If blocking antibodies inhibit this activity -If INSUFFICIENT AMOUNT of blocking antibodies fails to inhibit TLX -if recognition of certain antigenic determinants are important to recognize fetal/placental tissue as different from maternal -if the absence of such recognition leads to insufficient blocking antibody THEN - it is possible that SOME pts with similar HLA patterns may conceive a fetus not-sufficiently-antigenically-different enuf to inhibit local cell- mediated immune response(s). Initial studies suggested improved outcome with paternal leukocyte trans- fusion to help augment the maternal sensitization to subtle antigenic differ- ences in their otherwise closely-matched HLA partners. Subsequent studies failed to demonstrate this, the most recent, comparison, study by Grimes - revealing no sig difference between leukocyte transfusion and simply giving emotional support thru psychotherapy. (As an aside, there is a somewhat lower risk of graft-vs-host rxn, and minor blood group sensitization, with psycho- therapy.) Unfortunately, this has cast skepticism upon the scientific nature of immunologic RPL, when instead it was aimed at inappropriate clinical entrepreneurialism around the LA area. For instance, one reason why paternal leukocyte transfusion may not work is that the maternal immune system is producing sufficient amounts of blocking AB, they just don't function that well. Perhaps someday we'll be able to measure some of these immuno-reactive mediators, and events. Meantime, serum IgG from parous pts, a good source of TLX blocking AB, may prove useful in the select centers where this is being tested. Sounds like your pt. needs a few late luteal endo biopsies. Should these reveal an endometrial lag, then you get to decide wheteher you believe LPD (luteal phase defect) (1) exists, (2) is a follicular-mediated event, (3) is a steroid biosynthetic defect, (4) originates from dysfunctional oocyte(s)... Would like to follow along with this discussion, but I'm signing off for the week to visit the Grand Canyon. If anyone's in the neighborhood, please "drop in". :) tj.
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