[Frontiers in Bioscience 13, 1981-1990, January 1, 2008]
Role of progesterone and progestin therapy in threatened abortion and preterm labour
Julia Szekeres-Bartho1, Jacek R. Wilczynski2, Pawel Basta 3, Jaroslaw Kalinka4
1Department of Medical Microbiology and Immunology,Medical School, Pecs University, H-7643 Pecs, Hungary, 2 Dept. of Gynecological Surgery, Polish Mother's Health Center Research Institute, Lodz, Poland, 3rd Chair and Dept. of Obstetrics and Gynecology, Medical University, Lodz, Poland, 3 Department of Gynecology, Obstetrics and Oncology of the Jagiellonian University, 23 Kopernika Str, 31- 501 Krakow, Poland, 4 Medical and Environmental Pregnancy Health Hazards Unit, Department of Perinatology, 1st Chair of Gynecology and Obstetrics, Medical University of Lodz, Poland, Wilenska 37, 94-029 Lodz, Poland
TABLE OF CONTENTS
Progesterone (P) has been widely used in an attempt to prevent threatened miscarriage, recurrent miscarriage and pre-term labour. Successful pregnancy depends on maternal tolerance of the fetal "semi-allograft". Along with its endocrine effects, P also acts as an "immunosteroid", by controlling the bias towards a pregnancy protective immune milieu. A protein called progesterone-induced blocking factor (PIBF), by inducing a Th2 dominant cytokine production mediates the immunological effects of progesterone. Progesterone plays a role in uterine homing of NK cells and up-regulates HLA-G gene expression, the ligand for various NK inhibitory receptors. At high concentrations, progesterone is a potent inducer of Th2-type cytokines as well as of LIF and M-CSF production by T cells. The possible mechanisms by which progesterone contributes to the maintenance of early and late pregnancy are discussed.