Fourteen years of debate and workshops on the immunology of preeclampsia. Where are we now after the 2012 workshop?

This paper depicts an overview of debates that have taken place during the 14 years of the International Workshops on Reproductive Immunology/Immunological Tolerance and Immunology of Preeclampsia. This 8th event in 2012 (Reunion island, overseas department of France in the Indian Ocean) witnessed a consensus among immunologists on the key role of regulatory T-cells in the orchestration of trophoblastic invasion at the maternal-fetal interface, while they represent some 10% of the immunological cellular repertoire at the site of implantation (NK cells representing 70%). On the vascular side, the upregulation of carbon monoxide CO, metabolite of heme oxygenase-1 (HO-1; by inhibiting soluble Flt-1, SFlt-1, and soluble endoglin, SEng, release), explains the very promising protective and potentially therapeutic effect of pravastatin in preeclampsia and the paradoxical strong protective effect of cigarette smoking on preeclampsia. Finally, there was, through a study performed on Mauritius island a great interest in the inositol phosphoglycans P-type (IPG-P) as a reliable, cheap, and predictive urinary test in preeclamptic women (a few weeks before the clinical onset of the disease). Besides the interest of a specific test, IPG-P may also partially explain the global endothelial cell disease encountered in preeclampsia. Furthermore, the Appendix of this paper lists the programs of all the workshops that have taken place since 1998.