Immunomodulation and preeclampsia

Preeclampsia (PE) is an enigmatic syndrome, still with unknown aetiology and multi-factorial pathogenesis. Our understanding of the role of the immune system in PE development has undergone a transformation over the years. From a model based on the alterations in cell-mediated immunity, research moved on to a vision centred on the alteration of the humoural immunity and on the systemic involvement of the inflammatory system. The first hypothesis was classically derived from the evidence that an adequate maternal immunological response is necessary in pregnancy to allow the survival of the foetus. An abnormal response of the maternal immune system against the placenta may be the first pathogenetic step of PE, followed by a systemic inflammatory reaction. Currently available treatments for PE are mainly preventative with aspirin. Treatment aims to modulate inflammation and the immune system before their changes become established. (C) 2019 Elsevier Ltd. All rights reserved.