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The American College of Obstetricians and Gynecologists (ACOG) identifies four categories of HDP, namely gestational hypertension (GH), Preeclampsia (PE), chronic hypertension (CH), and CH with superimposed PE. PE is a multisystem, heterogeneous disorder that encompasses 2%\u20138% of all pregnancy\u2010related complications, contributing to about 9% to 26% of maternal deaths in low\u2010income countries and 16% in high\u2010income countries. These translate to\u00a050\u00a0000 maternal deaths and over 500\u00a0000 fetal deaths worldwide, therefore demanding high priority in understanding clinical presentation, screening, diagnostic criteria, and effective management. PE is accompanied by uteroplacental insufficiency leading to vascular and metabolic changes, vasoconstriction, and end\u2010organ ischemia. PE is diagnosed after 20\u00a0weeks of pregnancy in women who were previously normotensive or hypertensive. Besides shallow trophoblast invasion and inadequate remodeling of uterine arteries, dysregulation of the nonimmune system has been the focal point in PE. This results from aberrant immune system activation and imbalanced differentiation of T cells. Further, a failure of tolerance toward the semi\u2010allogenic fetus results due to altered distribution of Tregs such as CD4+FoxP3+ or CD4+CD25+CD127(low) FoxP3+ cells, thereby creating a cytotoxic environment by suboptimal production of immunosuppressive cytokines like IL\u201010, IL\u20104, and IL\u201013. Also, intracellular production of complement protein C5a may result in decreased FoxP3+ regulatory T cells. With immune system dysfunction as a major driver in PE pathogenesis, it is logical that therapeutic targeting of components of the immune system with pharmacologic agents like anti\u2010inflammatory and immune\u2010modulating molecules are either being used or under clinical trial. Cholesterol synthesis inhibitors like Pravastatin may improve placental perfusion in PE, while Eculizumab (monoclonal antibody inhibiting C5)\u00a0and small molecular inhibitor of C5a, Zilucoplan are under investigation. Monoclonal antibody against IL\u201017(Secukinumab) has been proposed to alter the Th imbalance\u00a0in PE. Autologous Treg therapy\u00a0and immune checkpoint inhibitors like anti\u2010CTLA\u20104 are emerging as new candidates in immune horizons for PE management in the future.<\/jats:p>","DOI":"10.1111\/aji.13670","type":"journal-article","created":{"date-parts":[[2022,12,24]],"date-time":"2022-12-24T07:25:46Z","timestamp":1671866746000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":26,"title":["New immune horizons in therapeutics and diagnostic approaches to Preeclampsia"],"prefix":"10.1111","volume":"89","author":[{"given":"Indrani","family":"Mukherjee","sequence":"first","affiliation":[{"name":"Department of Biochemistry All India Institute of Medical Sciences  New Delhi India"},{"name":"Amity Institute of Biotechnology (AIB) Amity University  Noida India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sunil","family":"Singh","sequence":"additional","affiliation":[{"name":"Department of Biochemistry All India 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