3 Macrophages and migratory cells in endometrium relevant to implantation
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The implantation of an appropriately developed embryo into a suitably conditioned uterine lining depends on the synchronous maturation of the preimplantation embryo and uterine lining. The pre- and postimplantation embryo also requires protection from immunocompetent maternal immune effectors. Preimplantation embryo development is affected by genotype, intercellular communication and autocrine growth factors (polyamines, TGF-alpha, TGF-beta 1, PAF). Factors of maternal origin may also enhance embryo development (EGF, TGF-alpha, TGF-beta 1, IGF, polyamines). The preimplantation embryo signals its presence to the mother by release of factor(s) such as IFN-alpha-II and a PAF-like factor. PAF may induce EPF in the mother and enhances vascular permeability at the implantation site. Uterine or peritoneal leukocytosis may inhibit development via toxic effects of lymphokines/monokines (IL-2, IL-1?, IFN-gamma, TNF-alpha). Immunoprotection of the preimplantation embryo is conferred by embryo derived maternal factors (EPF, T-cell suppressor factors). The uterus is receptive during a limited period of time (implantation window) and the substrate adhesion molecules produced by uterine and embryonic trophectoderm cells are crucial for the initial stages of implantation. At implantation, trophoblast expression of MHC and non-MHC antigens is shut off and both immunocompetent maternal cells (macrophages, dendritic cells, granulocytes, IELs, immunocytes) and lymphatics become sparse at implantation sites. Peri-implantation cytokines of maternal origin, such as CSF-1, GM-CSF and IGF-1 binding protein, are probably important for trophoblast growth and development. Immuno-protection of the embryo at this stage may be mediated by embryo derived factors that inactivate macrophages and by a population of large, hormone dependent Lyt 2+ (CD8+) suppressor cells. It is possible that these CD8+ cells respond to progesterone and secrete molecules that inactivate natural effector (NK-type) cells against trophoblast. Prostaglandins (PGE2) may play a brief role in immunosuppression at the time of implantation but its role is probably more important with respect to the decidual response. Defects in the pre- and peri-implantation stages of pregnancy may lead to delayed failure in the form of clinical miscarriage.