EFFECTS OF MATERNAL CYTOMEGALOVIRUS INFECTION ON FETAL IMMUNE ORGANS DEVELOPMENT. CLINICAL CASE
Introduction: Cytomegalovirus (CMV), a ubiquitous herpesvirus, causes congenital infection in 0.5–2% of live births, leading to severe manifestations like hepatosplenomegaly, microcephaly, and neurological damage. CMV evades immunity by manipulating apoptosis via Bcl-2 upregulation and p53 suppression, disrupting thymic and splenic development critical for T-cell education and peripheral immunity. This case report examines morphological changes and expression of apoptosis (Bcl-2, p53) and proliferation (Ki-67) markers in fetal thymus and spleen from a 23-week miscarriage due to maternal CMV infection.
Materials and Methods: Autopsy of fetus from a 28-year-old woman’s fourth pregnancy (late miscarriage at 23 weeks) provided thymus and spleen samples. Macroscopic and microscopic assessments followed standardized algorithms. Immunohistochemistry used monoclonal antibodies (Bcl-2 Clone 124, p53 Clone DO-7, Ki-67 Clone MIB-1; DAKO) with LSAB2®-HRP and diaminobenzidine chromogen. Results were quantified via Histo score (McCarthy et al., 1985).
Results: Thymus showed enlargement, large lobules (cortex:medulla 2:1), preserved lymphocytes, and moderate Hassall's corpuscles. Spleen exhibited splenomegaly, white:red pulp 1:2, activated white pulp, and marginal zone clusters. Bcl-2 stained cytoplasmically in thymic medulla and splenic marginal zone; p53 was weakly positive in thymic cortex/medulla; Ki-67 was pronounced in thymic subcapsular cortex and splenic periarteriolar lymphoid sheaths.
Discussion: Thymic hyperplasia and preserved lymphocytes indicate CMV-driven proliferation over atrophy, with Bcl-2 medullary dominance suggesting impaired negative selection and autoreactive T-cell survival. Splenic white pulp expansion reflects immune activation, but disorganization and Bcl-2/Ki-67 upregulation imply exhaustion and dysregulation. A decrease in p53 levels may indicate a disruption of the apoptotic process.
Conclusion: CMV profoundly alters fetal thymus/spleen morphology and apoptosis/proliferation, disrupting T-cell repertoire and self-tolerance, contributing to long-term immunological sequelae.
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Milyushina Ya.A., Yesbolatova G.M. Effects of maternal cytomegalovirus infection on fetal immune organs development. Clinical case // Nauka i Zdravookhranenie [Science & Healthcare]. 2025. Vol.27 (6), pp. 263-270. doi 10.34689/SH.2025.27.6.030Related publications:
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