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Assessment of Toxoplasma gondii Infection with Pro and Anti-inflammatory Cytokine along with sHLA-G Activity in Pregnant Rheumatoid Arthritis Women in Middle Euphrates Region

Wijdan Dhaidan Shnain Al-abbas
Journal of Progressive Medical Sciences, Vol. 1 No. 3 (2025): Journal of Progressive Medical Sciences
Published: 2026-05-05

Abstract

Background: Pregnancy is a period of profound immune modifications that are necessary for the development of maternal–fetal tolerance. soluble human leukocyte antigen-G (sHLA-G) is an important immunomodulatory molecule in this regard. rheumatoid arthritis, Toxoplasma gondii infection respectively affecting the balance of human immune system and sHLA-G expression during pregnancy, however, the effect of interplay rheumatoid arthritis and Toxoplasma gondii infection on sHLA-G expression during pregnancy are not well-known.


Objectives: This work was aimed to study the effect of Toxoplasma gondii infection on serum sHLA-G expression, Pro and Anti-inflammatory Cytokine Activity in pregnant women with rheumatoid arthritis in Middle Euphrates region-Iraq using serological, molecular and immunological tools.


Methods: A cross-sectional case–control study was performed in 112 pregnant women in Middle Euphrates region classified into four groups: Rheumatoid arthritis with T. gondii infection, Rheumatoid arthritis without infection, T. gondii infection with non-RA and healthy pregnant controls. Anti-Toxoplasma IgM and IgG antibodies were examined by ELISA, and T. gondii was confirmed using real-time PCR to detect the DNA of pathogens. sHLA-G and cytokines (IL-6,  IFN-γ, TNF-α, and IL-10) in the serum were evaluated by ELISA. Rheumatoid arthritis activity was measured by DAS28. Statistical analysis involved ANOVA, correlation analysis and multivariable regression.


Results: The serum sHLA-G concentrations were significantly different between the study groups (P < 0.001); the highest concentration of serum sHLA-G was detected in pregnant women with Rheumatoid arthritis and concurrent T. gondii infection.


Compared with chronic infection, acute toxoplasmosis was characterized by higher sHLA-G levels (P < 0.01). sHLA-G had a positive correlation with IL-10 and disease activity of Rheumatoid arthritis, and negative correlations with pro-inflammatory cytokines. After controlling for confounders, T. gondii infection remained an independent predictor of sHLA-G high concentrations.


Conclusions: The correlations reveal further clues about the mechanism of action of sHLA-G: positive correlations with the anti-inflammatory cytokine IL-10 (r = +0.62, P01) suggest a mixed pattern of pro-inflammatory/regulatory cytokine production in this context. Detailed multivariate regression analysis confirmed that Toxoplasma gondii infection is an independent risk factor for sHLA-G release (p < 0.001). Toxoplasma gondii infection in pregnant women with rheumatoid arthritis significantly inhibits sHLA-G secretion, suggesting a possible collaboration between autoimmunity and the parasite, and pregnancy-induced immune tolerance. The findings suggest that sHLA-G may become a key indicator of underlying immune regulation.

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Wijdan Dhaidan Shnain Al-abbas
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