Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Digestive Diseases and Sciences
Published in: Digestive Diseases and Sciences 9/2015

01-09-2015 | Review

Pregnancy and the Immune System: General Overview and the Gastroenterological Perspective

Authors: Tomer Adar, Sorina Grisaru-Granovsky, Ami Ben Ya’acov, Eran Goldin, Ariella Bar-Gil Shitrit

Published in: Digestive Diseases and Sciences | Issue 9/2015

Login to get access

Abstract

Pregnancy represents a unique immune tolerant condition that cannot be attributed merely to generalized immunosuppression. A variety of mechanisms have been described, ranging from the non-self recognition, immunomodulation of specific inflammatory cell populations and a Th2-directed shift of the immune response, which are mediated by both localized and systemic mediators. Furthermore, an inflammatory response directed toward the conceptus is no longer considered an obligatory deleterious response; instead, it is considered an important factor that is necessary for normal growth and development. These immunomodulatory changes during pregnancy may also affect concurrent conditions and alter the course of inflammatory diseases. Herein, we review the main immunomodulatory changes that occur during pregnancy and their effect on coexisting inflammatory conditions, with a specific focus on gastrointestinal disorders.
Literature
1.
Aagaard-Tillery KM, Silver R, Dalton J. Immunology of normal pregnancy. Semin Fetal Neonatal Med. 2006;11:279–295.CrossRefPubMed
2.
3.
Sprent J, Kishimoto H. The thymus and negative selection. Immunol Rev. 2002;185:126–135.
4.
Sebille F, Vanhove B, Soulillou JP. Mechanisms of tolerance induction: Blockade of co-stimulation. Philos Trans R Soc Lond. 2001;356:649–657.CrossRef
5.
Dodson MG, Kerman RH, Lange CF, Stefani SS, O’Leary JA. T and b cells in pregnancy. Obstet Gynecol. 1977;49:299–302.PubMed
6.
Tallon DF, Corcoran DJ, O’Dwyer EM, Greally JF. Circulating lymphocyte subpopulations in pregnancy: a longitudinal study. J Immunol. 1984;132:1784–1787.PubMed
7.
8.
Marolis GB, Buckley RH, Younger JB. Serum immunogbulin concentrations during normal pregnancy. Am J Obstet Gynecol. 1971;109:971–976.PubMed
9.
Gehrz RC, Christianson WR, Linner KM, Conroy MM, McCue SA, Balfour HH Jr. A longitudinal analysis of lymphocyte proliferative responses to mitogens and antigens during human pregnancy. Am J Obstet Gynecol. 1981;140:665–670.PubMed
10.
Gill TJ 3rd, Repetti CF. Immunologic and genetic factors influencing reproduction. A review. Am J Pathol. 1979;95:465–570.PubMedCentralPubMed
11.
Sunderland CA, Redman CW, Stirrat GM. Hla a, b, c antigens are expressed on nonvillous trophoblast of the early human placenta. J Immunol. 1981;127:2614–2615.PubMed
12.
Bulmer JN, Johnson PM. Antigen expression by trophoblast populations in the human placenta and their possible immunobiological relevance. Placenta. 1985;6:127–140.CrossRefPubMed
13.
Faulk WP, Temple A. Distribution of beta2 microglobulin and hla in chorionic villi of human placentae. Nature. 1976;262:799–802.CrossRefPubMed
14.
Hviid TV. Hla-g in human reproduction: Aspects of genetics, function and pregnancy complications. Human Reprod Update. 2006;12:209–232.CrossRef
15.
Rizzo R, Vercammen M, van de Velde H, Horn PA, Rebmann V. The importance of hla-g expression in embryos, trophoblast cells, and embryonic stem cells. Cell Mol Life Sci. 2011;68:341–352.CrossRefPubMed
16.
Zuckermann FA, Head JR. Possible mechanism of non-rejection of the feto-placental allograft: Trophoblast resistance to lysis by cellular immune effectors. Transpl Proc. 1987;19:554–556.
17.
Gonen-Gross T, Goldman-Wohl D, Huppertz B, et al. Inhibitory nk receptor recognition of hla-g: Regulation by contact residues and by cell specific expression at the fetal-maternal interface. PLoS ONE. 2010;5:e8941.PubMedCentralCrossRefPubMed
18.
Houlihan JM, Biro PA, Fergar-Payne A, Simpson KL, Holmes CH. Evidence for the expression of non-hla-a,-b,-c class i genes in the human fetal liver. J Immunol. 1992;149:668–675.PubMed
19.
Shukla H, Swaroop A, Srivastava R, Weissman SM. The mrna of a human class i gene hla g/hla 6.0 exhibits a restricted pattern of expression. Nucleic Acids Res. 1990;18:2189.PubMedCentralCrossRefPubMed
20.
Kirszenbaum M, Moreau P, Gluckman E, Dausset J, Carosella E. An alternatively spliced form of hla-g mrna in human trophoblasts and evidence for the presence of hla-g transcript in adult lymphocytes. Proc Natl Acad Sci USA. 1994;91:4209–4213.PubMedCentralCrossRefPubMed
21.
22.
Gonzalez IT, Barrientos G, Freitag N, et al. Uterine nk cells are critical in shaping dc immunogenic functions compatible with pregnancy progression. PLoS ONE. 2012;7:e46755.PubMedCentralCrossRefPubMed
23.
Hanna J, Goldman-Wohl D, Hamani Y, et al. Decidual nk cells regulate key developmental processes at the human fetal-maternal interface. Nat Med. 2006;12:1065–1074.CrossRefPubMed
24.
Leber A, Teles A, Zenclussen AC. Regulatory t cells and their role in pregnancy. Am J Reprod Immunol. 2010;63:445–459.CrossRefPubMed
25.
Aluvihare VR, Kallikourdis M, Betz AG. Regulatory t cells mediate maternal tolerance to the fetus. Nat Immunol. 2004;5:266–271.CrossRefPubMed
26.
Heikkinen J, Mottonen M, Alanen A, Lassila O. Phenotypic characterization of regulatory t cells in the human decidua. Clin Exp Immunol. 2004;136:373–378.PubMedCentralCrossRefPubMed
27.
Sasaki Y, Sakai M, Miyazaki S, Higuma S, Shiozaki A, Saito S. Decidual and peripheral blood cd4+ cd25+ regulatory t cells in early pregnancy subjects and spontaneous abortion cases. Mol Hum Reprod. 2004;10:347–353.CrossRefPubMed
28.
Somerset DA, Zheng Y, Kilby MD, Sansom DM, Drayson MT. Normal human pregnancy is associated with an elevation in the immune suppressive cd25+ cd4+ regulatory t-cell subset. Immunology. 2004;112:38–43.PubMedCentralCrossRefPubMed
29.
Zenclussen AC, Gerlof K, Zenclussen ML, et al. Abnormal t-cell reactivity against paternal antigens in spontaneous abortion: Adoptive transfer of pregnancy-induced cd4+ cd25+ t regulatory cells prevents fetal rejection in a murine abortion model. Am J Pathol. 2005;166:811–822.PubMedCentralCrossRefPubMed
30.
Holmes CH, Simpson KL, Wainwright SD, et al. Preferential expression of the complement regulatory protein decay accelerating factor at the fetomaternal interface during human pregnancy. J Immunol. 1990;144:3099–3105.PubMed
31.
Thellin O, Heinen E. Pregnancy and the immune system: between tolerance and rejection. Toxicology. 2003;185:179–184.CrossRefPubMed
32.
Bamberger AM, Schulte HM, Thuneke I, Erdmann I, Bamberger CM, Asa SL. Expression of the apoptosis-inducing fas ligand (fasl) in human first and third trimester placenta and choriocarcinoma cells. J Clin Endocrinol Metab. 1997;82:3173–3175.CrossRefPubMed
33.
Runic R, Lockwood CJ, Ma Y, Dipasquale B, Guller S. Expression of fas ligand by human cytotrophoblasts: implications in placentation and fetal survival. J Clin Endocrinol Metab. 1996;81:3119–3122.PubMed
34.
Polgar B, Barakonyi A, Xynos I, Szekeres-Bartho J. The role of gamma/delta t cell receptor positive cells in pregnancy. Am J Reprod Immunol. 1999;41:239–244.CrossRefPubMed
35.
Barakonyi A, Polgar B, Szekeres-Bartho J. The role of gamma/delta t-cell receptor-positive cells in pregnancy: part II. Am J Reprod Immunol. 1999;42:83–87.PubMed
36.
Raghupathy R. Th1-type immunity is incompatible with successful pregnancy. Immunol Today. 1997;18:478–482.CrossRefPubMed
37.
Raghupathy R, Makhseed M, Azizieh F, Hassan N, Al-Azemi M, Al-Shamali E. Maternal th1- and th2-type reactivity to placental antigens in normal human pregnancy and unexplained recurrent spontaneous abortions. Cell Immunol. 1999;196:122–130.CrossRefPubMed
38.
Makhseed M, Raghupathy R, Azizieh F, Omu A, Al-Shamali E, Ashkanani L. Th1 and th2 cytokine profiles in recurrent aborters with successful pregnancy and with subsequent abortions. Hum Reprod. 2001;16:2219–2226.CrossRefPubMed
39.
Jaattela M, Kuusela P, Saksela E. Demonstration of tumor necrosis factor in human amniotic fluids and supernatants of placental and decidual tissues. Lab Invest. 1988;58:48–52.PubMed
40.
41.
Chen HL, Yang YP, Hu XL, Yelavarthi KK, Fishback JL, Hunt JS. Tumor necrosis factor alpha mrna and protein are present in human placental and uterine cells at early and late stages of gestation. Am J Pathol. 1991;139:327–335.PubMedCentralPubMed
42.
Witkin SS, Liu HC, Davis OK, Rosenwaks Z. Tumor necrosis factor is present in maternal sera and embryo culture fluids during in vitro fertilization. J Reprod Immunol. 1991;19:85–93.CrossRefPubMed
43.
Caniggia I, Mostachfi H, Winter J, et al. Hypoxia-inducible factor-1 mediates the biological effects of oxygen on human trophoblast differentiation through tgfbeta(3). J Clin Investig. 2000;105:577–587.PubMedCentralCrossRefPubMed
44.
Caniggia I, Taylor CV, Ritchie JW, Lye SJ, Letarte M. Endoglin regulates trophoblast differentiation along the invasive pathway in human placental villous explants. Endocrinology. 1997;138:4977–4988.PubMed
45.
Uzumcu M, Coskun S, Jaroudi K, Hollanders JM. Effect of human chorionic gonadotropin on cytokine production from human endometrial cells in vitro. Am J Reprod Immunol. 1998;40:83–88.CrossRefPubMed
46.
Kang J, Akoum A, Chapdelaine P, Laberge P, Poubelle PE, Fortier MA. Independent regulation of prostaglandins and monocyte chemoattractant protein-1 by interleukin-1beta and hcg in human endometrial cells. Hum Reprod. 2004;19:2465–2473.CrossRefPubMed
47.
Bourdiec A, Bedard D, Rao CV, Akoum A. Human chorionic gonadotropin regulates endothelial cell responsiveness to interleukin 1 and amplifies the cytokine-mediated effect on cell proliferation, migration and the release of angiogenic factors. Am J Reprod Immunol. 2013;70:127–138.CrossRefPubMed
48.
Bourdiec A, Calvo E, Rao CV, Akoum A. Transcriptome analysis reveals new insights into the modulation of endometrial stromal cell receptive phenotype by embryo-derived signals interleukin-1 and human chorionic gonadotropin: Possible involvement in early embryo implantation. PLoS ONE. 2013;8:e64829.PubMedCentralCrossRefPubMed
49.
Dosiou C, Lathi RB, Tulac S, Huang ST, Giudice LC. Interferon-related and other immune genes are downregulated in peripheral blood leukocytes in the luteal phase of the menstrual cycle. J Clin Endocrinol Metab. 2004;89:2501–2504.CrossRefPubMed
50.
Zen M, Ghirardello A, Iaccarino L, et al. Hormones, immune response, and pregnancy in healthy women and sle patients. Swiss Med Weekly. 2010;140:187–201.
51.
Kyurkchiev D, Ivanova-Todorova E, Kyurkchiev SD. New target cells of the immunomodulatory effects of progesterone. Reprod Biomed Online. 2010;21:304–311.CrossRefPubMed
52.
Szekeres-Bartho J, Halasz M, Palkovics T. Progesterone in pregnancy; receptor-ligand interaction and signaling pathways. J Reprod Immunol. 2009;83:60–64.CrossRefPubMed
53.
Szekeres-Bartho J, Polgar B, Kozma N, et al. Progesterone-dependent immunomodulation. Chem Immunol Allergy. 2005;89:118–125.
54.
Lee JH, Ulrich B, Cho J, Park J, Kim CH. Progesterone promotes differentiation of human cord blood fetal t cells into t regulatory cells but suppresses their differentiation into th17 cells. J Immunol. 2011;187:1778–1787.PubMedCentralCrossRefPubMed
55.
Tanriverdi F, Silveira LF, MacColl GS, Bouloux PM. The hypothalamic-pituitary-gonadal axis: immune function and autoimmunity. J Endocrinol. 2003;176:293–304.CrossRefPubMed
56.
Matera L, Mori M, Galetto A. Effect of prolactin on the antigen presenting function of monocyte-derived dendritic cells. Lupus. 2001;10:728–734.CrossRefPubMed
57.
58.
Doria A, Ghirardello A, Iaccarino L, et al. Pregnancy, cytokines, and disease activity in systemic lupus erythematosus. Arthritis Rheum. 2004;51:989–995.CrossRefPubMed
59.
Athanassakis I, Bleackley RC, Paetkau V, Guilbert L, Barr PJ, Wegmann TG. The immunostimulatory effect of t cells and t cell lymphokines on murine fetally derived placental cells. J Immunol. 1987;138:37–44.PubMed
60.
Armstrong DT, Chaouat G. Effects of lymphokines and immune complexes on murine placental cell growth in vitro. Biol Reprod. 1989;40:466–474.CrossRefPubMed
61.
Tangri S, Wegmann TG, Lin H, Raghupathy R. Maternal anti-placental reactivity in natural, immunologically mediated fetal resorptions. J Immunol. 1994;152:4903–4911.PubMed
62.
Aggarwal R, Jameel S. Hepatitis E. Hepatology (Baltimore, Md). 2011;54:2218–2226.
63.
Hazes JM, Coulie PG, Geenen V, et al. Rheumatoid arthritis and pregnancy: evolution of disease activity and pathophysiological considerations for drug use. Rheumatology (Oxford, England). 2011;50:1955–1968.
64.
Petri M. The hopkins lupus pregnancy center: ten key issues in management. Rheum Dis Clin N Am. 2007;33:227–235, v.
65.
Confavreux C, Hutchinson M, Hours MM, Cortinovis-Tourniaire P, Moreau T. Rate of pregnancy-related relapse in multiple sclerosis. Pregnancy in multiple sclerosis group. New Engl J Med. 1998;339:285–291.CrossRefPubMed
66.
Fiocchi C. Inflammatory bowel disease: etiology and pathogenesis. Gastroenterology. 1998;115:182–205.CrossRefPubMed
67.
Niessner M, Volk BA. Altered th1/th2 cytokine profiles in the intestinal mucosa of patients with inflammatory bowel disease as assessed by quantitative reversed transcribed polymerase chain reaction (rt-pcr). Clin Exp Immunol. 1995;101:428–435.PubMedCentralCrossRefPubMed
68.
Habal FM, Kapila V. Inflammatory bowel disease and pregnancy: Evidence, uncertainty and patient decision-making. Can J Gastroenterol. 2009;23:49–53.PubMedCentralPubMed
69.
Agret F, Cosnes J, Hassani Z, et al. Impact of pregnancy on the clinical activity of crohn’s disease. Aliment Pharmacol Ther. 2005;21:509–513.CrossRefPubMed
70.
Andres PG, Friedman LS. Epidemiology and the natural course of inflammatory bowel disease. Gastroenterol Clin N Am. 1999;28:255–281, vii.
71.
Ferguson CB, Mahsud-Dornan S, Patterson RN. Inflammatory bowel disease in pregnancy. BMJ. 2008;337:a427.
72.
Subhani JM, Hamiliton MI. Review article: The management of inflammatory bowel disease during pregnancy. Aliment Pharmacol Ther. 1998;12:1039–1053.CrossRefPubMed
73.
Bush MC, Patel S, Lapinski RH, Stone JL. Perinatal outcomes in inflammatory bowel disease. J Matern Fetal Neonatal Med. 2004;15:237–241.CrossRefPubMed
74.
Riis L, Vind I, Politi P, et al. Does pregnancy change the disease course? A study in a european cohort of patients with inflammatory bowel disease. Am J Gastroenterol 2006;101:1539–1545.
75.
Clark DA. Should anti-tnf-alpha therapy be offered to patients with infertility and recurrent spontaneous abortion? Am J Reprod Immunol. 2009;61:107–112.CrossRefPubMed
76.
Daher S, Fonseca F, Ribeiro OG, Musatti CC, Gerbase-DeLima M. Tumor necrosis factor during pregnancy and at the onset of labor and spontaneous abortion. Eur J Obstet Gynecol Reprod Biol. 1999;83:77–79.CrossRefPubMed
77.
Chaparro M, Gisbert JP. Transplacental transfer of immunosuppressants and biologics used for the treatment of inflammatory bowel disease. Curr Pharm Biotechnol. 2011;12:765–773.CrossRefPubMed
78.
Chambers CD, Johnson DL. Emerging data on the use of anti-tumor necrosis factor-alpha medications in pregnancy. Birth Defects Res A. 2012;94:607–611.CrossRef
79.
Simister NE, Story CM, Chen HL, Hunt JS. An igg-transporting fc receptor expressed in the syncytiotrophoblast of human placenta. Eur J Immunol. 1996;26:1527–1531.CrossRefPubMed
80.
Takizawa T, Anderson CL, Robinson JM. A novel fc gamma r-defined, igg-containing organelle in placental endothelium. J Immunol. 2005;175:2331–2339.CrossRefPubMed
81.
Hou JK, Mahadevan U. A 24-year-old pregnant woman with inflammatory bowel disease. Clinical gastroenterology and hepatology : the official clinical practice. J Am Gastroenterol Assoc. 2009;7:944–947.
82.
Gisbert JP, Chaparro M. Safety of anti-tnf agents during pregnancy and breastfeeding in women with inflammatory bowel disease. Am J Gastroenterol. 2013;108:1426–1438.CrossRefPubMed
83.
Casanova MJ, Chaparro M, Domenech E, et al. Safety of thiopurines and anti-tnf-alpha drugs during pregnancy in patients with inflammatory bowel disease. Am J Gastroenterol. 2013;108:433–440.
84.
Katz JA, Antoni C, Keenan GF, Smith DE, Jacobs SJ, Lichtenstein GR. Outcome of pregnancy in women receiving infliximab for the treatment of crohn’s disease and rheumatoid arthritis. Am J Gastroenterol. 2004;99:2385–2392.CrossRefPubMed
85.
Mahadevan U, Kane S, Sandborn WJ, et al. Intentional infliximab use during pregnancy for induction or maintenance of remission in crohn’s disease. Aliment Pharmacol Ther. 2005;21:733–738.CrossRefPubMed
86.
Skomsvoll JF, Wallenius M, Koksvik HS, et al. Drug insight: anti-tumor necrosis factor therapy for inflammatory arthropathies during reproduction, pregnancy and lactation. Nat Clin Pract Rheumatol. 2007;3:156–164.CrossRefPubMed
87.
Schnitzler F, Fidder H, Ferrante M, et al. Outcome of pregnancy in women with inflammatory bowel disease treated with antitumor necrosis factor therapy. Inflamm Bowel Dis. 2011;17:1846–1854.CrossRefPubMed
88.
Turnbaugh PJ, Ley RE, Mahowald MA, Magrini V, Mardis ER, Gordon JI. An obesity-associated gut microbiome with increased capacity for energy harvest. Nature. 2006;444:1027–1031.CrossRefPubMed
89.
Rettew JA, Huet YM, Marriott I. Estrogens augment cell surface tlr4 expression on murine macrophages and regulate sepsis susceptibility in vivo. Endocrinology. 2009;150:3877–3884.CrossRefPubMed
90.
Newnham JP, Dickinson JE, Hart RJ, Pennell CE, Arrese CA, Keelan JA. Strategies to prevent preterm birth. Front Immunol. 2014;5:584.
91.
Areia A, Vale-Pereira S, Alves V, Rodrigues-Santos P, Moura P, Mota-Pinto A. Membrane progesterone receptors in human regulatory T cells: a reality in pregnancy. Bjog. 2015. doi:10.​1111/​1471-0528.​13294
92.
Wilcken B, Leung KC, Hammond J, Kamath R, Leonard JV. Pregnancy and fetal long-chain 3-hydroxyacyl coenzyme a dehydrogenase deficiency. Lancet. 1993;341:407–408.CrossRefPubMed
93.
Brites D. Intrahepatic cholestasis of pregnancy: changes in maternal-fetal bile acid balance and improvement by ursodeoxycholic acid. Ann Hepatol. 2002;1:20–28.PubMed
94.
Reyes H, Simon FR. Intrahepatic cholestasis of pregnancy: An estrogen-related disease. Semin Liver Dis. 1993;13:289–301.CrossRefPubMed
95.
Stone JH. Hellp syndrome: hemolysis, elevated liver enzymes, and low platelets. JAMA. 1998;280:559–562.CrossRefPubMed
96.
Vigil-De Gracia P, Ortega-Paz L. Pre-eclampsia/eclampsia and hepatic rupture. Int J Gynaecol Obstet. 2012;118:186–189.
97.
Kinthala S, Fakoory M, Greaves T, Kandamaran L, Thomas H, Moe S. Subcapsular liver hematoma causing cardiac tamponade in hellp syndrome. Int J Obstet Anesth. 2012;21:276–279.CrossRefPubMed
98.
Rawal BK, Parida S, Watkins RP, Ghosh P, Smith H. Symptomatic reactivation of hepatitis b in pregnancy. Lancet. 1991;337:364.CrossRefPubMed
99.
Fontaine H, Nalpas B, Carnot F, Brechot C, Pol S. Effect of pregnancy on chronic hepatitis c: a case-control study. Lancet. 2000;356:1328–1329.CrossRefPubMed
100.
Uribe M, Chavez-Tapia NC, Mendez-Sanchez N. Pregnancy and autoimmune hepatitis. Ann Hepatol. 2006;5:187–189.PubMed
101.
Steven MM, Buckley JD, Mackay IR. Pregnancy in chronic active hepatitis. Q J Med. 1979;48:519–531.PubMed
102.
Courtemanche C, Elson-Schwab I, Mashiyama ST, Kerry N, Ames BN. Folate deficiency inhibits the proliferation of primary human cd8+ t lymphocytes in vitro. J Immunol. 2004;173:3186–3192.CrossRefPubMed
103.
Tamura J, Kubota K, Murakami H, et al. Immunomodulation by vitamin b12: Augmentation of cd8 + t lymphocytes and natural killer (nk) cell activity in vitamin b12-deficient patients by methyl-b12 treatment. Clin Exp Immunol. 1999;116:28–32.PubMedCentralCrossRefPubMed
Metadata
Title
Pregnancy and the Immune System: General Overview and the Gastroenterological Perspective
Authors
Tomer Adar
Sorina Grisaru-Granovsky
Ami Ben Ya’acov
Eran Goldin
Ariella Bar-Gil Shitrit
Publication date
01-09-2015
Publisher
Springer US
Published in
Digestive Diseases and Sciences / Issue 9/2015
Print ISSN: 0163-2116
Electronic ISSN: 1573-2568
DOI
https://doi.org/10.1007/s10620-015-3683-z

Other articles of this Issue 9/2015

Digestive Diseases and Sciences 9/2015 Go to the issue

Editorial

Small Intestinal Multifocal Stenosing Ulceration

Original Article

Extended Ischemia Times Promote Risk of HCC Recurrence in Liver Transplant Patients

Original Article

Oral Lichen Planus in IBD Patients: A Paradoxical Adverse Effect of Anti-TNF-α Therapy

Original Article

Nucleoside–Nucleotide Analog Combination Therapy Is Effective in Preventing Recurrent Hepatitis B After Liver Transplantation

UNM Clinical Case Conferences

Hard to Swallow: A Rare Cause

Erratum

Erratum to: Prevalence of Helicobacter pylori Infection Worldwide: A Systematic Review of Studies with National Coverage
Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Reserve your place

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin
Prof. Florian Limbourg
Prof. Anoop Chauhan
Developed by: Springer Medicine
Obesity Clinical Trial Summary

At a glance: The STEP trials

Read more

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

Pediatric Cardiology Video

Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.

Year in Review: Pulmonary vascular disease

Cardiopulmonary Comorbidity Video

The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Valvular Heart Disease Video

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.

Watch now

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

16-04-2024 Type 2 Diabetes News

Incentivised to exercise

11-04-2024 Lifestyle Modifications News

New intervention for STEMI-related cardiogenic shock

10-04-2024 Myocardial Infarction News

» View more highlights on the ACC 2024 congress hub page

Image Credits