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Authors
Abstract(s)
Introdução: A Perturbação do Espetro do Autismo (PEA) é uma doença do
neurodesenvolvimento de etiologia multifatorial e regista uma prevalência de 1 em 100
pessoas, segundo a Organização Mundial de Saúde. Nas últimas décadas observou-se um
aumento do número de grávidas com algum tipo de doença crónica, estando as doenças
autoimunes entre as doenças preexistentes mais comuns na gravidez. Os mecanismos de
inflamação crónica sistémica, associados às doenças autoimunes, podem resultar no
aumento de doenças inflamatórias na geração seguinte, com possíveis consequências no
neurodesenvolvimento da descendência.
Objetivos: Nesta dissertação pretende-se explorar a associação entre as doenças
autoimunes maternas e o risco de desenvolvimento de PEA, sendo ainda relevante
compreender os mecanismos envolvidos nesta associação e quais as terapêuticas futuras,
de forma a reduzir a PEA na descendência, de mães portadoras de doenças autoimunes.
Métodos: Procedeu-se à pesquisa, entre junho e novembro de 2022, de artigos
científicos, utilizando como motor de pesquisa, a Pubmed e as seguintes palavras-chave:
“autism”, “autoimmune diseases”, “maternal immune activation”, “pregnancy”,
“maternal autoantibodies”. Foram também usados como complemento websites, livros de
referência médica e guidelines nacionais e internacionais.
Resultados: A teoria de ativação imune materna (AIM) é uma hipótese que procura
explicar a relação entre um estado inflamatório crónico durante a gravidez e o
desenvolvimento de perturbações do neurodesenvolvimento na descendência. Segundo
esta, triggers durante a gravidez, como, as doenças autoimunes, têm a capacidade de
desencadear uma resposta inflamatória, envolvendo citocinas como a IL-17A e IL-6, o que
pode levar a uma resposta imunológica materna exacerbada e prejudicial para o feto.
Embora ainda não sejam conhecidos os mecanismos exatos, acredita-se que a AIM seja
responsável por provocar alterações na microglia e desencadear nesta uma possível
resposta inflamatória excessiva, o que pode resultar em danos no desenvolvimento
cerebral do feto. No que diz respeito à terapêutica disponível, é necessário o
desenvolvimento de estratégias terapêuticas eficazes preventivas da PEA.
Conclusão: Após análise de diversos artigos, foi constatado que existe uma forte
associação entre doenças autoimunes maternas e o desenvolvimento de perturbações do
neurodesenvolvimento na descendência, em especial a PEA.
Introduction: Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder of multifactorial etiology with a prevalence of 1 in 100 people, according to the World Health Organization. In recent decades, an increase in the number of pregnant women with some type of chronic disease has been observed, with autoimmune diseases being among the most common pre-existing diseases in pregnancy. The mechanisms of chronic systemic inflammation, associated with autoimmune diseases, may result in increased inflammatory diseases in the next generation, with possible consequences on neurodevelopment of the offspring. Objectives: This dissertation aims to explore the association between maternal autoimmune diseases and the risk of developing ASD, as well as to understand the mechanisms involved in this association and future therapies to reduce ASD in the offspring of mothers with autoimmune diseases. Methods: Between June and November 2022, scientific articles were searched using Pubmed as a search engine and the following keywords: "autism", "autoimmune diseases", "maternal immune activation", "pregnancy", "maternal autoantibodies". Websites, medical reference books, and national and international guidelines were also used as a complement. Results: The maternal immune activation theory (MIA) is a hypothesis that seeks to explain the relationship between a chronic inflammatory state during pregnancy and the development of neurodevelopmental disorders in the offspring. According to this, triggers during pregnancy, such as autoimmune diseases, can trigger an inflammatory response, involving cytokines such as IL-17A and IL-6, which can lead to an exacerbated maternal immune response that is harmful to the fetus. Although the exact mechanisms are not yet known, it is believed that MIA is responsible for causing changes in microglia and triggering in them a possible excessive inflammatory response, which may result in damage to the developing brain of the fetus. As far as available therapeutics are concerned, the development of effective preventive therapeutic strategies for ASD is needed. Conclusion: After reviewing several articles, it was found that there is a strong association between maternal autoimmune diseases and the development of neurodevelopmental disorders in the offspring, especially ASD.
Introduction: Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder of multifactorial etiology with a prevalence of 1 in 100 people, according to the World Health Organization. In recent decades, an increase in the number of pregnant women with some type of chronic disease has been observed, with autoimmune diseases being among the most common pre-existing diseases in pregnancy. The mechanisms of chronic systemic inflammation, associated with autoimmune diseases, may result in increased inflammatory diseases in the next generation, with possible consequences on neurodevelopment of the offspring. Objectives: This dissertation aims to explore the association between maternal autoimmune diseases and the risk of developing ASD, as well as to understand the mechanisms involved in this association and future therapies to reduce ASD in the offspring of mothers with autoimmune diseases. Methods: Between June and November 2022, scientific articles were searched using Pubmed as a search engine and the following keywords: "autism", "autoimmune diseases", "maternal immune activation", "pregnancy", "maternal autoantibodies". Websites, medical reference books, and national and international guidelines were also used as a complement. Results: The maternal immune activation theory (MIA) is a hypothesis that seeks to explain the relationship between a chronic inflammatory state during pregnancy and the development of neurodevelopmental disorders in the offspring. According to this, triggers during pregnancy, such as autoimmune diseases, can trigger an inflammatory response, involving cytokines such as IL-17A and IL-6, which can lead to an exacerbated maternal immune response that is harmful to the fetus. Although the exact mechanisms are not yet known, it is believed that MIA is responsible for causing changes in microglia and triggering in them a possible excessive inflammatory response, which may result in damage to the developing brain of the fetus. As far as available therapeutics are concerned, the development of effective preventive therapeutic strategies for ASD is needed. Conclusion: After reviewing several articles, it was found that there is a strong association between maternal autoimmune diseases and the development of neurodevelopmental disorders in the offspring, especially ASD.
Description
Keywords
Ativação Imune Materna Autismo Descendência Doenças Autoimunes Gravidez