Advances in understanding the physiological mechanism of maternal immune tolerance to the embryo.

The results of immunological studies, especially research conducted in the last decade, have shown that free (not bound to protein) progesterone molecules (fP(4)) can block the ability of dendritic cells, monocytes and macrophages to present antigens to Th cells and thereby reduce maternal immune activity and increase the maternal tolerance to the semiallogenic embryo. Endocrine studies have shown that fP(4) in the female reproductive organs are transferred at high concentrations into the arterial blood that supplies the oviduct and uterus due to the special adaptations of the blood circulation and lymph flow. Here, the authors present the results of numerous studies documenting their thesis that an important element of maternal tolerance of the semiallogenic embryo in the uterus is conditioned by the close interaction of two processes that occur in the reproductive organs: (1) the local decrease of maternal immune system activity, in which the ability of dendritic cells, macrophages and monocytes to present embryonic antigens to Th cells is blocked by fP(4); and (2) the proper function of the system governing the local retrograde and destination transfer of hormones, which increases the concentration of fP(4) that are able to immediately bind to their receptors in dendritic cells and in the monocytes and macrophages present in the blood supplying the oviduct and uterus. The authors believe that the local interaction of the immune and endocrine systems in the female reproductive tract reduces local maternal immunoreactivity and thus fulfils a critical physiological role; this mechanism protects the embryo but does not change the general immunological resistance of the mother.