Moffett, Regan & Braude [329:1283-5] review the associations
between natural killer (NK) cells, miscarriage and infertility. My
interest is in recurrent miscarriage and my work is cited in the article
in, I think, a way that might mislead the reader. I will not comment on
either blood NK cells or infertility.
I agree that there is a lack of understanding of the biological mechanisms
that link endometrial NK cells and miscarriage, but there is an undoubted
link, demonstrated in three separate studies, including an un-cited report
by one of the review authors [1]. Women with high numbers of endometrial
NK cells, pre-pregnancy, are more likely to have recurring miscarriage.
Whether that association is causal or casual is, at present, not known.
Further research work (in progress) has shown that steroid treatment
usually reduces the number of endometrial NK cells in women with high
concentrations. Whether or not that improves outcome in substantive terms
? the birth of live babies ? is also unknown. I agree that there is no
basis for recommending steroid treatment for women with high
concentrations of endometrial NK cells unless a randomised trial shows
this to be effective and safe. I am trying to find funding for such a
study at present. In the meantime, I have gone to some lengths to engage
with the public about the often neglected problem of recurrent early
pregnancy, including appearing on Women?s Hour on BBC Radio 4. At all
times, I have stressed that steroid treatment is experimental and
unproven, and that it is not appropriate to extrapolate from a single, and
unusual, case history.
I also agree with the review authors that couples afflicted by infertility
and recurrent miscarriage are vulnerable to exploitation. I therefore
attach the following:
Competing interests: SQ has no private clinical practice, and therefore
receives no remuneration from couples with recurrent miscarriage.
1. Clifford K., Flanagan A.M., Regan L. (1999) Endometrial CD56+
natural killer cells in
women with recurrent miscarriage: a histomorphometric study. Hum. Reprod.,
14:2727-30
Rapid Response:
Re: A Timely Defence Against Exploitation
Moffett, Regan & Braude [329:1283-5] review the associations
between natural killer (NK) cells, miscarriage and infertility. My
interest is in recurrent miscarriage and my work is cited in the article
in, I think, a way that might mislead the reader. I will not comment on
either blood NK cells or infertility.
I agree that there is a lack of understanding of the biological mechanisms
that link endometrial NK cells and miscarriage, but there is an undoubted
link, demonstrated in three separate studies, including an un-cited report
by one of the review authors [1]. Women with high numbers of endometrial
NK cells, pre-pregnancy, are more likely to have recurring miscarriage.
Whether that association is causal or casual is, at present, not known.
Further research work (in progress) has shown that steroid treatment
usually reduces the number of endometrial NK cells in women with high
concentrations. Whether or not that improves outcome in substantive terms
? the birth of live babies ? is also unknown. I agree that there is no
basis for recommending steroid treatment for women with high
concentrations of endometrial NK cells unless a randomised trial shows
this to be effective and safe. I am trying to find funding for such a
study at present. In the meantime, I have gone to some lengths to engage
with the public about the often neglected problem of recurrent early
pregnancy, including appearing on Women?s Hour on BBC Radio 4. At all
times, I have stressed that steroid treatment is experimental and
unproven, and that it is not appropriate to extrapolate from a single, and
unusual, case history.
I also agree with the review authors that couples afflicted by infertility
and recurrent miscarriage are vulnerable to exploitation. I therefore
attach the following:
Competing interests: SQ has no private clinical practice, and therefore
receives no remuneration from couples with recurrent miscarriage.
1. Clifford K., Flanagan A.M., Regan L. (1999) Endometrial CD56+
natural killer cells in
women with recurrent miscarriage: a histomorphometric study. Hum. Reprod.,
14:2727-30
Competing interests:
None declared
Competing interests: No competing interests