Association between mannan binding protein deficiency and recurrent miscarriage.

The distribution of mannan binding protein (MBP) in blood donor sera was determined by enzyme-linked immunosorbent assay to establish normal concentrations. Abnormally low MBP concentrations were found in 16% (21 out of 135) of female partners and 14% (15 out of 108) of male partners of couples experiencing recurrent miscarriage, compared with < 5% of obstetrically normal controls (P < 0.005). This relationship was even stronger (9.5 versus 1.0%) and more significant (P < 0.002) when only subjects presumed to be homozygous for the mutant allele responsible for MBP deficiency were considered. By immunohistochemistry, MBP could be demonstrated in first trimester placenta. We suggest that low concentrations of MBP within the feto-placental unit increase susceptibility to fetal loss, possibly via an infection-induced placental cytokine imbalance.

Endothelial cell ultrastructure after aortic aneurysm rupture: an electron microscopy study.

Endothelial cell activation as an early response to hypovolaemic shock may be important in the pathogenesis of coagulopathy and multiple organ failure after aortic aneurysm rupture. The aim of this study was to determine whether any evidence could be found of changes in endothelial cell ultrastructure in patients undergoing operation for ruptured aneurysm and to establish a model for future studies of endothelial cells in these patients. At the start of operation, fat samples from the anterior abdominal wall were taken from five patients with ruptured abdominal aortic aneurysms and in an identical fashion from five control patients undergoing elective surgery. Endothelial cells lining capillaries were examined by transmission electron microscopy. Photomicrographs were taken of all capillaries present and these were assessed blindly by three independent observers. When compared with controls it was found that the luminal surface of the endothelial cells in patients with aneurysm rupture was more convoluted, with more frequent processes projecting into the lumen of the capillary. Budding of the luminal surface of the endothelial cell was seen in 11 of 45 capillaries in the rupture group and in none of 44 capillaries in the control group (P < 0.005). Budding was seen in at least one capillary of all five patients presenting with rupture but in none of the control group (P < 0.05). In conclusion, at the ultrastructural level there are changes within endothelial cells in capillaries at an early stage after ruptured abdominal aortic aneurysm.

Immunohistochemical localization of a beta-D-galactoside-binding lectin at the human maternofetal interface.

The 14 kD S-type lectin from human placenta may have a role in regulating the maternal immune response to fetal antigens. In this study, an immunoperoxidase technique was used to determine the distribution of the lectin at the human maternofetal interface. Tissue obtained during the first trimester of pregnancy and at term was used. The lectin was not detectable in either the villous syncytiotrophoblast or the underlying cytotrophoblast in first-trimester tissue, although some cells of the cytotrophoblast columns were reactive. It was also not detectable in villous or extravillous trophoblast populations at term. In contrast, strong reactivity was found in decidual stromal cells throughout gestation, and endometrial stromal cells were also positive. The lectin is, therefore, not a component of the immunosuppressive factors associated with syncytiotrophoblast membranes, but may have a role in either the decidual control of trophoblast migration or some functions unrelated to pregnancy, or both.