“I had a problem of recurrent miscarriages, I had six and they were more and more precocious, testifies Lucile Hatzismalis, a former patient of the University Hospital of Bordeaux. With great luck, my path crossed that of Professor Estibaliz Lazaro (who works in the internal medicine and infectious diseases department) and we were able to set up a treatment, in preconception and during my pregnancy, which allowed the birth of my little girl. This happy mother of a little girl, now 18 months old, suffers from intervillitis, a malformation of the placenta, which prevented her from carrying her pregnancies to term.
Reduce uncertainty
Even after a check-up, in 50% of cases after a miscarriage (less than 20 weeks of gestation) we do not know how to give an explanation to the families about its cause. What if six out of 1,000 pregnancies are affected by fetal death? in utero (more than 20 weeks of gestation), in 20% of cases, we don’t know how to explain it either. The “In utero care” project, carried out by the hospital-university teams (obstetrics gynecology, internal medicine and immunology) of the CHU and the University of Bordeaux, in collaboration with the CHU of Limoges and Poitiers, aims precisely to reduce this level of uncertainty, by learning more about the pathologies of pregnancy, in order to prevent them.
“Intervillitis is an inflammation (which can be diagnosed on the anatomy of the placenta) which develops without any explanation. It has been proposed [à Lucile Hatzismalis] a powerful anti-inflammatory treatment, combined with immunomodulatory treatments, points out Professor Estibaliz Lazaro. We confirmed on a second patient and this was the starting point for a project with a broader spectrum. She and her colleague Professor Patrick Blanco, head of the immunology and immunogenetics department, start from the observation of their patients whom they see in consultation. “Women crumble when left in limbo [après ces événements de fausses couches ou de mort fœtale in utero], because they yearn for an explanation. If we do not qualify these women as “sick”, it is because we are not yet able to detect an anomaly which explains their miscarriages.
Different fields of investigation
The project is based on ten years of work already carried out on intervillite. The idea is not to develop new drugs, “in the field of inflammation we already have quite a few”, comments Professor Patrick Blanco, but to apply existing therapies to the field of pregnancy. already. “For some of the treatments that already exist, we wonder if we can give them to pregnant women,” he says. We know that those who have the disease took the treatment before becoming pregnant and, if it has been continued, we can give it to our patients who do not have the disease, but who are thought to have the same pathophysiological mechanisms. Other patients will benefit from the same protocol successfully offered to the first two patients, including Lucile Hatzismalis.
The research project investigates at several levels (genetic, environmental and immunological). Helped by the teamArtémis, an environmental health prevention platform dedicated to reproductionthe research project will, for example, focus on the possible role of fine particles on the occurrence of miscarriages and fetal losses.
It is currently the only research project of this type in France and it is tackling a major task in a sensitive area. “It’s not easy to carry out clinical trials on pregnant women. The Dépakine affair sadly reminded us how much we had to be careful, comments Professor Patrick Blanco. And, the corollary is that the pharmaceutical industry does not invest, and also perhaps that we have not taken the measure of the extent of perinatal deaths. »