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Hum. Reprod. Advance Access published online on February 8, 2008
Human Reproduction, doi:10.1093/humrep/den011
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© The Author 2008. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Association of maternal killer-cell immunoglobulin-like receptors and parental HLA-C genotypes with recurrent miscarriage

S.E. Hiby1, L. Regan2, W. Lo2, L. Farrell1, M. Carrington3 and A. Moffett1,4

1 Department of Pathology, University of Cambridge, Tennis Court Road, Cambridge CB2 1QP, UK 2 Department of Obstetrics and Gynaecology, St Mary's Hospital Medical School, Norfolk Place, London W2 1PG, UK 3 Laboratory of Genomic Diversity, SAIC-Frederick, Inc., NCI-Frederick, Frederick, MD 21702, USA

4 Correspondence address. E-mail: am485{at}cam.ac.uk

BACKGROUND: The natural killer (NK) cells at the site of placentation express killer-cell immunoglobulin-like receptors (KIR) that can bind to human leukocyte antigen (HLA)-C molecules on trophoblast cells. Both these gene systems are polymorphic and an association of particular maternal KIR/fetal HLA-C genotypes has been shown in pre-eclampsia. Pre-eclampsia and recurrent miscarriage (RM) share the pathogenesis of defective placentation and therefore we have now genotyped couples with RM.

METHODS AND RESULTS: DNA was obtained from the male (n = 67) and female (n = 95) partners of couples with three or more spontaneous miscarriages and genotyped for HLA-C groups and 11 KIR genes using the PCR-sequence-specific primer method (SSP). The frequency of the HLA-C2 group was increased in both parents (reaching significance only in the male partners, P = 0.018) compared with a parous control population. The KIR gene frequencies of the male partners were similar to controls, but the women had a high frequency of KIR AA haplotypes that lack activating KIR. In particular, the activating KIR for HLA-C2 groups (KIR2DS1) was significantly lower in these women (P = 0.00035, odds ratio 2.63, confidence interval 1.54–4.49).

CONCLUSIONS: This is the first report to identify a genetic male factor that confers risk in RM. These findings support the idea that successful placentation depends on the correct balance of NK cell inhibition and activation in response to trophoblast.

Key words: recurrent miscarriage/natural killer cells/HLA-C/trophoblast/killer-immunoglobulin-like receptor

Submitted on October 9, 2007; resubmitted on December 18, 2007; accepted on January 9, 2008.


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