The Placenta and its Underestimated Role in Clinical Practice and Research - Revista Brasileira de Ginecologia e Obstetrícia

A few years ago, when I was on my post-doctoral training abroad, on placental biology and immunology, I started to understand the amazing potential within studying the placenta. At the time, my 5-year-old daughter was asked to share with her classmate’s information regarding her family and when talking about my background, she said I was a medical doctor. The kids asked: “what kind of doctor?” and without a doubt she answered: “My mom is a placenta doctor.” They further asked what that was, and she finished the subject saying: “something very important.” I believe she was correct. This editorial aims to explain the relevance of the placenta for clinical practice and its research potential. All obstetricians should value the placenta.

It is only fare to start by acknowledging that one of the most significant researchers on the maternal-fetal interface was a Brazilian-British biologist, called Peter Medawar, with special interest in understanding graft rejection and immune tolerance that brilliantly used the placenta as a model for such theories. For his scientific work he was rewarded the 1960 Nobel Prize in Physiology “for discovery of acquired immunological tolerance.” Medawar was born and lived in Brazil during his childhood but decided to move to United Kingdom (UK) and renounced his Brazilian citizenship at the age of 18, when he was obligated to serve in the Brazilian army. Therefore, his academic accomplishments happened in UK, with theories that lasted for long and were essentially: (a) anatomical separation between mother and fetus by the placenta, (b) immaturity of fetal antigens, impairing their ability to produce a maternal immune response, and (c) immunological inertness of the maternal immune system during pregnancy. Nevertheless, we have much evolved and these theories, that guided research in reproductive immunology for decades, have not withstood. For a successful pregnancy, immune function is a complex series of tightly controlled immune modulations, with intense cellular communication in the maternal-fetal interface.

[…]