Immune cells in the placental bed

Leukocytes are an important component of the human uterine decidua in normal pregnancy. The focus of research has been on the more abundant populations such as the uterine natural killer (uNK) cells and macrophages, but more recently interest has also extended to less abundant, but functionally significant populations. Investigation of function in human pregnancy is limited by the scope of in vitro studies and the inability to perform in vivo manipulation of cell populations. Investigation of pathological pregnancy may provide clues to function, although acquisition of samples is limited until after clinical presentation. Investigation of animal models may provide clues to function in humans and this has certainly been the case for the uNK cells. However, human placentation differs substantially from the usual laboratory animal models and any extrapolation to humans from animal studies should be made with this in mind. Considerable advances have been made over the last 25 years but many questions still remain; the next 25 years may provide more answers to the role of the endometrial leukocytes in normal pregnancy, so that further advances can be made in investigation of their role, if any, in pregnancy pathology.