Severity of COVID-19 in pregnant women: a review on the potential role of regulatory T cells

Nafiseh Saghafi; Mahmoud Mahmoudi; Amir Abbas Momtazi-Borojeni; Sara Mirzaeian; Fataneh Tavasolian; Thozhukat Sathyapalan; Elham Abdollahi; Amirhossein Sahebkar

doi:10.2174/0929867330666230619114508

Severity of COVID-19 in pregnant women: a review on the potential role of regulatory T cells

Curr Med Chem. 2023 Jun 19. doi: 10.2174/0929867330666230619114508. Online ahead of print.

Authors

Nafiseh Saghafi¹, Mahmoud Mahmoudi², Amir Abbas Momtazi-Borojeni³, Sara Mirzaeian¹, Fataneh Tavasolian⁴, Thozhukat Sathyapalan⁵, Elham Abdollahi^{1

2}, Amirhossein Sahebkar^{6

7}

Affiliations

¹ Department of Obstetrics and Gynecology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
² Department of Immunology and Allergy, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
³ Department of Advanced Technologies in Medicine, School of Medicine, Neyshabur University of Medical Sciences, Neyshabur, Iran.
⁴ Toronto Western Hospital, Toronto, Canada.
⁵ Academic Diabetes, Endocrinology and Metabolism, Hull York Medical School, University of Hull, UK.
⁶ Biotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran.
⁷ Applied Biomedical Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.

PMID: 37340747
DOI: 10.2174/0929867330666230619114508

Abstract

As a physiological condition, pregnancy may cause temporary alterations in the hematological, cardiopulmonary, and immune responses, affecting the maternal susceptibility to viral infections. Pregnant women are vulnerable to infection with the influenza A virus, hepatitis E virus, MERS CoV, and SARS CoV. The agent of Coronavirus disease (COVID-19) is the SARS coronavirus (SARS CoV-2), which affects the cells upon binding to the angiotensin-converting enzyme-2 (ACE2). However, ACE2 expression is elevated in the placental tissue. However, surprisingly, COVID-19 infection in pregnant women tends to have a lower severity and mortality. Therefore, it is interesting to find the immunological mechanisms related to the severity of COVID-19 in pregnancy. Regulatory T cells (Tregs) are a subset of CD4+T cells that may play a central role in maintaining maternal tolerance by regulating immune responses. Pregnancy-induced Tregs are developed to control immune responses against paternal antigens expressed by the semi-allograft fetus. The role of uncontrolled immune responses in COVID-19 pathogenesis has already been identified. This review provides insight into whether pregnancy-induced regulatory T-cell functions could influence the severity of COVID-19 infection during pregnancy.

Keywords: COVID-19; SARS CoV; infection; pregnancy; pregnant; regulatory T cells.