dNK cell defect role in Placenta

Accreta
Budi Wicaksono
Agung Sunarko
Ana Puji Rahayu
 Normal placenta implantation

Invasion extravillous
trophoblast

interstitial trophoblast HLA endovascular trophoblast

Invade endometrium convert to

uNK invades and remodels the
syncytial placental bed giant cel
(symplasmic fusion) maternal spiral arterioles
DECIDUA
uNK

uNK
vascular
uNK remodelling transformation

involves loss of the smooth muscle in the arterial wall,

resulting in vessels with dilated lumina with a hyalinized
wall containing endovascular trophoblast
(Sayar et all , 2015)
 Types of uNK cells

uNK cells

dNK 1 dNK 2 dNK 3

- more cytoplas- mic - express CCL5

- activating NKG2C and
granules - regulation of EVT
NKG2E
- higher cytoplasmic invasion via C-C motif
- inhibitory NKG2A
granule proteins chemokine receptor 1
receptors for HLA-E
- higher expression of (CCR1)
molecules
KIR genes able to bind
to HLA-C; LILRB1,
which has high affinity
for HLA-G
- interacts particularly Uterine natural killer cells: Time for a re-appraisal?
with EVT Judith, 2019
 Adaptor Protein of uNK cells

uNK cells

Gab 1 Gab 2 Gab 3

Expressed ubiquitously Expressed ubiquitously - Respon to cytokine

stimulation
- regulation of EVT
invasion

Placentation and antitumor immunity

regulated by a scaffolding protein in NK
cells Colucci F, 2019
 DECIDUAL DEVELOPMENT

dNK cell

Trophoblas
BALANCE

EVT

GROWTH FACTOR
ANGIOGENESIS
INVASION
 advanced
maternal Smoking
previous age Grande
curettage multi
paritas

chronic
Asherman’s
syndrome
ETIOLOGY ?????? hypertension

submucous
fibroids
Endometritis or myotonic
manual dystrophy
removal of Chemotherapy adenomyosis
the placenta or radiation
UNKNOWN
• The causes of placenta accreta are
previous
caesarean section or other surgical
procedure for the uterus, increase growth
factors, imbalance angiogenesis and anti angiogenesis,
the process of trophoblast invasion and etc.

• Trophoblast invasion is influenced by decidua NK cells,

where the function of dNK cells is to directing and
limiting trophoblast invasion.
dNK

dNK
dNK dNK

dNK
dNK dNK
 DECIDUAL DEFECT
GROWTH FACTOR
ANGIOGENESIS
EXCESSIVE INVASION