#2-50E. Unraveling the Placental Pathway: Molecular Insights into Fetal and Neonatal Lupus (Int J Mol Sci, 2024)

How should clinicians approach the critical risks of congenital heart block (CHB) in pregnancies complicated by maternal autoimmune disease, especially Systemic Lupus Erythematosus (SLE)? This narrative review provides a detailed look at the molecular mechanisms of Neonatal Lupus Erythematosus (NLE). It explains how maternal autoantibodies, notably anti-Ro/SSA and anti-La/SSB, cross the placental barrier, leading to the formation of immune complexes that disrupt the physiological apoptosis of fetal cardiomyocytes and trigger inflammation and fibrosis, resulting in severe outcomes like CHB. The most crucial clinical takeaway emphasized is that early prophylactic treatment with hydroxychloroquine (HCQ) has been shown to reduce the recurrence risk of CHB by greater than 50% in subsequent pregnancies, offering a vital preventative tool. However, its application demands careful monitoring, as HCQ carries the risk of maternal QTc interval prolongation, requiring consideration of potential fetal effects. Physicians must recognize that managing NLE necessitates an interdisciplinary team approach involving rheumatologists, obstetricians, and pediatricians, integrating prenatal screening and ensuring comprehensive, long-term cardiovascular follow-up for affected offspring.

Citation: Di Ludovico, A.; Rinaldi, M.; Mainieri, F.; Di Michele, S.; Girlando, V.; Ciarelli, F.; La Bella, S.; Chiarelli, F.; Attanasi, M.; Mauro, A.; et al. Molecular Mechanisms of Fetal and Neonatal Lupus: A Narrative Review of an Autoimmune Disease Transferal across the Placenta. International Journal of Molecular Sciences. 2024. DOI: 10.3390/ijms25105224111.

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