Endometrial immune profiling: a new perspective for pregnancy morbidity risk assessment in systemic lupus erythematosus - a pilot study

Systemic lupus erythematosus (SLE) affect predominantly women of childbearing
age. SLE is a heterogeneous autoimmune disease characterized by interferon
upregulation and production of autoantibodies (1). SLE have been associated
with a higher risk of adverse pregnancy outcomes (APO) like intrauterine fetal
death, fetal growth restriction (FGR), preterm birth, low birth weight, and
preeclampsia (2). Type I interferon signature and complement activation in
peripheral blood have been linked to APO risk in SLE.
The menstrual cycle is governed by a sophisticated interaction involving
endometrial cells, immune cells, cytokines and sex hormones. It is known that
the endometrial immune environment prepares its immune balance to accept the
embryo and facilitates implantation (5). Receptive endometrium is characterized
by a slightly pro-inflammatory response, complement cascade pathway activation,
and an adequate interaction between extracellular vesicles, endometrial
epithelial cells and the blastocyst (6). Therefore, an optimal balance between
pro-inflammatory factors and the tolerogenic adaptive immune response in the
endometrial tissue is pivotal for subsequent modifications of the luminal
epithelium of the endometrium and proper embryo implantation.
It has been shown that preconceptional disease activity can predict APO in
patients with SLE, which stress the importance of remission of the underlying
disease. However, not all APO are explained with these preconceptional,
disease-related factors. There could be local immune changes in the endometrial
environment in patients with SLE that increase the risk for pregnancy
complications. Endometrial immune profiling is a new method to analyze the
immune cell distribution and cytokine production in endometrial tissue samples
or menstrual blood by different techniques such as multiparameter flow
cytometry or gene expression analysis. It has already been suggested as a new
screening strategy for personalized care for couples with repeated embryo
implantation failures using assisted-reproductive therapy (ART).

to characterize the endometrial immune environment in patients with SLE

cross-sectional, observational pilot study in patients with SLE.

All patients will receive standard care and treatment during follow up.
Procedures that will be solely done for research purposes are: extra blood
withdrawal and collection of menstrual blood during one period. The knowledge
generated in this project will be useful to propose innovative and personalized
interventions to achieve better pregnancy outcomes in patients with SLE.