IMPACT OF PREVENTIVE THERAPY ON REGULATING MECHANISMS OF DECIDUAL MACROPHAGE POLARIZATION IN PREGNANT WOMEN WITH HIGH RISK OF PREECLAMPLSIA

The aim: This study was aimed at analyzing the impact of preventive therapy for pregnant women at a high risk to develop preeclampsia on the normalization of the mechanisms of decidual macrophage polarization. Materials and methods: The methodology was designed to obtain data on the content of pro- and anti-inflammatory cytokines and indicators of nitric oxide and arginase metabolism in cervical mucus. The ration between M1 / M2 decidual macrophages in the placenta was determined by applying immunohistochemical methods. The effectiveness of the proposed therapy for the secondary prevention of preeclampsia (metformin, vitamin D3 and corvitin) was evaluated. Results: Pregnant women with preeclampsia showed the imbalance between pro- and anti-inflammatory cytokines in favour of TNF-α and INF-γ under the decrease in IL-10 that results in an imbalance in the activity of enzymes regulating L-arginine metabolism, with increased iNOS activity and decreased arginine activity. In the placentas of the pregnant women with preeclampsia, in contrast to the healthy pregnant women, M1 decidual macrophages are found as predominant. The women, who received the course of the preventive therapy with metformin, vitamin D3 and corvitin, showed a decrease in the concentration of pro-inflammatory cytokines and an increase in anti-inflammatory cytokine IL-10, normalization of the balance between iNOS and arginase activity, and the normalization of the M1 / M2 macrophages ratio. Conclusions: Normalization of the balance between pro- and anti-inflammatory cytokines, iNOS and arginase activity in cervical mucus, the ratio between decidual M1 and M2 macrophages as results of the therapy proposed reduce the incidence of preeclampsia and associated complications.