Decline in number of elevated blood CD3(+) XXXX (+) NKT cells in response to intravenous immunoglobulin treatment correlates with successful pregnancy.

@entity1 @entity2208 @entity2940 @entity19 @entity117 @entity4071 @entity393 @entity792
PROBLEM: @entity1 with elevated blood natural killer (NK) cells may be offered intravenous immunoglobulin (IVIG) treatment, but there is controversy about the utility of blood NK cell testing. @entity1 @entity2940 (+) NK cells include several subpopulations that include the putatively cytotoxic @entity2940 (+) @entity4071 (+) subset. In @entity19 models of pregnant failure, NKT cells appear to be important. However, a @entity19 model may only be pertinent to a subset of @entity1 , as recurrent pregnancy failure is a heterogenous group. METHOD OF STUDY: An ethics-approved observational study was done to observe the effect of treatment on total blood lymphoid cells, and subsets of @entity2940 (+) blood lymphocytes including @entity2940 (+) CD3(+) NKT cells determined by flow cytometry, and to correlate with pregnancy outcome. Fifteen fertile @entity1 with a history of successful pregnancy and thirty-one @entity1 suffering from repeated implantation failure or recurrent @entity2208 provided serial blood samples during one menstrual cycle or prior to and during treatment. IVIG was administered to the latter group with or without heparin/ @entity117 . RESULTS: Eight of thirty infertile @entity1 presented with high numbers of @entity2940 (+) CD3(+) NKT cells, which declined after treatment with IVIG. The elevated NKT cell group with or without concomitant @entity792 achieved a significantly higher successful pregnancy rate over the course of the study, as compared to @entity1 with average numbers of NKT cells and no evidence of @entity792 (P = 0.018). Elevated NKT levels alone was an independent predictor of success on treatment (P = 0.003). CONCLUSION: Elevated NKT cells in recurrent @entity393 or implantation failure can be ameliorated with IVIG treatment, and result in successful pregnancy. Assay of NKT cell numbers may identify @entity1 who are more likely to benefit from IVIG therapy and merits further examination in randomized phase II studies.
