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      Fetomaternal alloimmunity as a cause of liver disease

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          Abstract

          Fetomaternal alloimmune disease has traditionally been associated with haematological disease such as fetomaternal alloimmune thrombocytopaenia and Rh haemolytic anaemia, but is now known to also be organ specific. Alloimmune membranous glomerulonephritis (AMG) is one of the most well understood organ-specific alloimmune diseases. Neonatal haemochromatosis (NH) is a rare condition characterised by early liver failure in infants, with evidence suggesting that it is also alloimmune. Both AMG and NH appear to involve the passive transfer of alloantibodies to the fetus, which bind a specific alloantigen, fix complement and activate the terminal complement cascade. Although differences between AMG and NH are known, and evidence of the presence of antigen-specific alloantibodies in NH is still missing, we will use AMG as an example of fetomaternal organ specific alloimmune disease, and critically compare this to other emerging evidence that indicates that NH is also alloimmune.

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          Most cited references77

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          Primary biliary cirrhosis.

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            Placental transport of immunoglobulin G

            Maternal antibodies transported across the placenta protect the newborn. Maternal immunoglobulin G (IgG) concentrations in fetal blood increase from early in the second trimester through term, most antibodies being acquired during the third trimester. IgG1 is the most efficiently transported subclass and IgG2 the least. Transfer across the syncytiotrophoblast of the chorionic villi is mediated by the neonatal Fc receptor, FcRn. Immune complexes are absorbed in the stroma of the villi, probably by FcgammaRI, FcgammaRII, and FcgammaRIII on placental macrophages. The mechanism of IgG transport across the endothelium of fetal capillaries is not understood. Endothelial cells in terminal villi express FcgammaRIIb. However, it is not known whether this receptor transports IgG or prevents transport of immune complexes to the fetus.
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              Antenatal membranous glomerulonephritis due to anti-neutral endopeptidase antibodies.

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                Author and article information

                Contributors
                +44-020-32993397 , +44-020-32993397 , dimitrios.bogdanos@kcl.ac.uk , http://www.bogdanoslab.com
                Journal
                Auto Immun Highlights
                Auto Immun Highlights
                Auto-Immunity Highlights
                Springer International Publishing (Cham )
                2038-0305
                2038-3274
                23 March 2011
                May 2011
                : 2
                : 1
                : 21-28
                Affiliations
                [ ]Liver Immunopathology and Immunodiagnostics, Institute of Liver Studies and Liver Unit, King’s College London School of Medicine at King’s College Hospital, Denmark Hill Campus, London, SE5 9RS UK
                [ ]Paediatric Liver, GI and Nutrition Centre, King’s College London School of Medicine at King’s College Hospital, London, SE5 9RS UK
                [ ]Department of Obstetrics and Gynaecology, University of Thessaly Medical School, 41222 Larissa, Thessaly Greece
                [ ]Department of Medicine and Research Laboratory of Internal Medicine, University of Thessaly Medical School, 41222 Larissa, Thessaly Greece
                Article
                19
                10.1007/s13317-011-0019-7
                4389071
                26000116
                73c29c6b-c492-48f6-a9e4-ed30fd2fcf4f
                © Springer-Verlag 2011
                History
                : 1 February 2011
                : 14 February 2011
                Categories
                Review Article
                Custom metadata
                © The Author(s) 2011

                alloimmune,autoimmunity,immunisation,intravenous immunoglobulin,placenta

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