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Relation between Chlamydia trachomatis, the trophoblast and preterm delivery

Emil Kovachev, Stephan Ivanov, Blagovest Belchev, Nikolay Kolev, Stephan Kisyov, Simona Anzhel


There is a connection between preterm labor and intrauterie infections which is well established in up to 40% of cases. Success of the interaction between the invading trophoblast at the maternal-fetal interface and the maternal immune system is an immunologically unique fact. In this process the trophoblast participates in both the immune suppression which is necessary for tolerance to the semialogenic fetus and the immune activation against damaging factors such as infections. Alterations in this type of cross-talk, as in the cases of infection-triggered inflammation by Chlamydia species, could result in pregnancy complications such as prematurity or spontaneous abortion.

Related articles and clinical cases have been gathered and reviewed to establish the main mechanisms and to confirm the relationship between preterm labor and Chlamydia trachomatis infection.


genital chlamydiosis; Toll - like receptors; heat shock protein; pregnancy

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Abrahams VM, Romero R, Mor G. TLR-3 and TLR-4 mediate differential chemokine production and immune cell recruitment by first trimester trophoblast cells. Am J Reprod Immunol 2005; 53: 279. ASRI205-202.

Abrahams VM, Visintin I, Aldo PB, Guller S, Romero R, Mor G. A role for TLRs in the regulation of immune cell migration by first trimester trophoblast cells. J Immunol 2005; 175: 8096-8104.

Abrahams VM, Mor G. Toll-like receptors and their role in the trophoblast. Placenta. 2005;26:540-547

Baud D, Regan L, Greub G. Emerging role of Chlamydia and Chlamydia-like organisms in adverse pregnancy outcomes. Curr Opin Infect Dis. 2008;21:70-76.

Baboonian C, Smith DA, Shapland D, Arno G, Zal B, Akiyu J, Kaski JC. Placental infection with Chlamydia pneumoniae and intrauterine growth restriction. Cardiovasc Res. 2003;60:165-169.

Beagley KW, Timms P. Chlamydia trachomatis infection: incidence, health costs and prospects for vaccine development. J Reprod Immunol. 2000;48:47-68.

Bulut, Y., E. Faure, L. Thomas, H. Karahashi, K. S. Michelson, O. Equils, S. G. Morrison, R. P. Morrison, and M. Arditi. 2002. Chlamydial heat shock protein 60 activates macrophages and endothelial cells through Toll-like receptor 4 and MD2 in a MyD88-dependent pathway. J. Immunol. 168:1435-1440.

Cassell G, Andrews W, Hauth J, et al. Isolation of microorganisms from the chorioamnion is twice that from amniotic fluid at cesarean delivery in women with intact membranes. Am J Obstet Gynecol 1993;168:424-424 abstract.

Dudley DJ. Pre-term labor: an intra-uterine inflammatory response syndrome? J Reprod Immunol 1997;36:93-109

Dong ZW, Li Y, Zhang LY, Liu RM. Detection of Chlamydia trachomatis intrauterine infection using polymerase chain reaction on chorionic villi. Int J Gynaecol Obstet.1998;61:29-32

Goncalves, L. F., T. Chaiworapongsa, R. Romero. 2002. Intrauterine infection and prematurity. Ment. Retard. Dev. Disabil. Res. Rev. 8:3.

Goldenberg, R. L., J. C. Hauth, W. W. Andrews. 2000. Intrauterine infection and preterm delivery. N. Engl. J. Med. 342:1500.

Gomez R, Romero R, Edwin SS, David C. Pathogenesis of preterm labor and preterm premature rupture of membranes associated with intraamniotic infection. Infect Dis Clin North Am1997;11:135-176

Hossain A, Arif M, Ramia S, Bakir TF. Chlamydia trachomatis as a cause of abortion. J Hyg Epidemiol Microbiol Immunol. 1990;34:53-55.

Jain A, Nag VL, Goel MM, Chandrawati, Chaturvedi UC. Adverse foetal outcome in specific IgM positive Chlamydia trachomatis infection in pregnancy. Indian J Med Res. 1991;94:420-423

Lien, E., T. J. Sellati, A. Yoshimura, T. H. Flo, G. Rawadi, R. W. Finberg, J. D. Carroll, T. Espevik, R. R. Ingalls, J. D. Radolf, D. T. Golenbock. 1999. Toll-like receptor 2 functions as a pattern recognition receptor for diverse bacterial products. J. Biol. Chem. 274:33419.

Manavi K. A review on infection with Chlamydia trachomatis. Best Pract Res Clin Obstet Gynaecol.2006;20:941-951

Mitsunari M, Yoshida S, Shoji T et al. Macrophage-activating lipopeptide-2 induces cyclooxygenase-2 and prostaglandin E(2) via toll-like receptor 2 in human placental trophoblast cells. J Reprod Immunol 2006; 72: 46-48

Mor G, Romero R, Aldo PB, Abrahams VM. Is the trophoblast an immune regulator? The role of Toll-like receptors during pregnancy. Crit Rev Immunol. 2005;25:375-388.

Ohashi, K., Burkart, V., Flohe, S., and Kolb, H. (2000) J. Immunol. 164, 558-561

About The Authors

Emil Kovachev
Department of Obstetrics and Gynecology, Medical University of Varna

Stephan Ivanov
Department of Obstetrics and Gynecology, Medical University of Varna

Blagovest Belchev
Department of Obstetrics and Gynecology, Medical University of Varna

Nikolay Kolev
Department of Obstetrics and Gynecology, Medical University of Varna

Stephan Kisyov
Department of Obstetrics and Gynecology, Medical University of Varna

Simona Anzhel
Medical University of Varna

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