Microchimerism and HLA-compatible relationships of pregnancy in scleroderma

Summary Background Fetal cells can be found in the maternal circulation in most pregnancies. Fetal progenitor cells have been found to persist in the circulation of women many years after childbirth. We tested the hypothesis that microchimerism is involved in the pathogenesis of scleroderma. Scleroderma is of interest because of a strong female predilection, an increased incidence in the years after childbearing, and clinical similarities between scleroderma and chronic graft-versus-host disease after allogeneic bone-marrow transplantation. We also investigated whether HLA-compatibility of a child was associated with later development of scleroderma in the mother. Methods We enrolled 40 women who had previously given birth to at least one son—16 healthy controls, 17 scleroderma patients, and seven healthy sisters of patients. We used quantitative PCR to amplify a Y-chromosome-specific sequence in whole peripheral blood from these women. Also 32 controls with 58 children, and 21 scleroderma patients with 47 children were HLA genotyped. Findings The mean number of male cell DMA equivalents among controls was 0·38 cells per 16 ml whole blood (median 0 [range 0–2]) and 11·1 (6·0 [0–61]) among scleroderma patients (p=0-0007). Controls' youngest sons were born a mean of 15-4 years previously, and scleroderma patients' sons 18·5 years previously. Some scleroderma patients had concentrations of male DMA higher than those found in most pregnant women. HLA-class II compatibility of a child from the mother's perspective was more common among scleroderma patients than among controls, but was not essential for persistence of male DMA in maternal peripheral blood. Interpretation Low concentrations of male DMA can be detected in healthy women decades after the birth of a son. Microchimerism in scleroderma patients could be secondary to the underlying disease. However, the finding that HLA class II compatibility of a child was more common for scleroderma patients than for controls, supports the possibility that microchimerism may be involved in the pathogenesis of scleroderma.