High levels of HtrA4 detected in preeclamptic circulation may disrupt endothelial cell function by cleaving the main VEGFA receptor KDR

Systemic endothelial dysfunction is a key characteristic of preeclampsia (PE), which is a serious disorder of human pregnancy. We have previously reported that high-temperature requirement factor (Htr)A4 is a placenta-specific protease that is secreted into the maternal circulation and significantly up-regulated in PE, especially early-onset PE. We have also demonstrated that high levels of HtrA4 detected in the early onset PE circulation induce endothelial dysfunction in HUVECs. In the current study, we investigated whether HtrA4 could cleave the main receptor of VEGFA, the kinase domain receptor (KDR), thereby inhibiting VEGFA signaling. We first demonstrated that HtrA4 cleaved recombinant KDR in vitro. We then confirmed that HtrA4 reduced the level of KDR in HUVECs and inhibited the VEGFA-induced phosphorylation of Akt kinase, which is essential for downstream signaling. Further functional studies demonstrated that HtrA4 prevented the VEGFA-induced tube formation in HUVECs and dose-dependently inhibited the VEGFA-induced angiogenesis in explants of mouse aortic rings. These data strongly suggest that high levels of HtrA4 in the maternal circulation could cleave the main receptor of VEGFA in endothelial cells to induce a wide-spread impairment of angiogenesis. Our studies therefore suggest that HtrA4 is a potential causal factor of early onset PE.-Wang, Y., La, M., Pham, T., Lovrecz, G. O., Nie, G. High levels of HtrA4 detected in preeclamptic circulation may disrupt endothelial cell function by cleaving the main VEGFA receptor KDR.

Hypoxia is involved in the reduction of HtrA3 in patients with endometrial hyperplasia and cancer

Endometrial cancer (EC) has recently become a major gynecological cancer and endometrial hyperplasia increases the risk for developing EC. Previous studies have reported that human high temperature requirement factor A3 (HtrA3), a member of ATP independent serine proteases family, is involved in endometrial carcinogenesis. However, the underlying mechanism of HtrA3 function is unclear in endometrial hyperplasia and cancer. In this study, we investigated that HtrA3 expression was reduced in endometrial hyperplasia as well as EC. The circulating levels of HtrA3 were also significantly reduced in both atypical hyperplasia and EC. Whether hypoxia is involved in the reduction of HtrA3 in EC was further investigated. Immunohistochemistry (IHC) scores of Glut1 and HtrA3 in type 1 and type 2 EC tissues showed the inverse correlation. And hypoxic condition reduced the expression of HtrA3. Furthermore, silencing HtrA3 promoted EC cell migration. Our study demonstrated the reduced levels of HtrA3 in endometrial hyperplasia including atypical hyperplasia which is a premalignant condition; and as the degree of hypoxia increases in EC, HtrA3 eventually loses its expression. Hypoxia is responsible for the reduction of HtrA3 which in turn promotes EC progression. These findings suggested that HtrA3 is an important adaptor in hypoxic regions that drives endometrial cancer development.

Measuring PC activity in endocervical swab may provide a simple and non-invasive method to detect endometrial cancer in post-menopausal women

Endometrial cancer is one of the most common gynecological malignancies in post-menopausal women. If detected at early stages, endometrial cancer can be effectively treated by abdominal hysterectomy. However, to date, there is no biochemical test available for early and easy detection of endometrial cancer. Our previous study has established that the total proprotein convertase (PC) activity is significantly increased in the uterine lavage of post-menopausal women with endometrial cancer. Uterine lavage can be obtained relatively non-invasively compared to uterine tissues, however, blood contamination and other factors limit the wide clinical use of uterine lavage. The aim of this study was to determine whether endocervical swab is a viable alternative to uterine lavage for the detection of endometrial cancer. We determined the correlation in PC activity between paired endocervical swabs and uterine lavages from individual post-menopausal women (control as well as endometrial cancer patients), and also compared the total PC activity in endocervical swabs between control and endometrial cancer patients. Our data demonstrated that the total PC activity in swab and lavage was highly correlative in post-menopausal women, and that the PC activity in endocervical swab was significantly increased in endometrial cancer patients compared to controls. These results strongly suggest that determining PC activity in endocervical swabs may provide a simple, non-invasive and novel method to detect endometrial cancer in post-menopausal women.

MicroRNA-509-5p functions as an anti-oncogene in breast cancer via targeting SOD2

OBJECTIVE

Breast cancer is one of the most common malignant tumors in women worldwide. Considering the poor therapeutic effect of breast cancer, we are supposed to dissect the functioning mode of miR-509-5p on breast cancer cell growth and metastasis, providing therapeutic targets for breast cancer.

PATIENTS AND METHODS

Quantitative Real-time PCR (qRT-PCR) assay was employed to detect miR-509-5p expression level. CCK8 assay and colony formation assay were incorporated to assess cell viability and proliferation capacities. Cell migration and invasion assay were performed to investigate metastasis capacity of breast cancer cells. Flow cytometry was used to identify cell apoptosis and cell cycle distribution. Protein levels were assessed by Western blotting assay. The target gene was predicted and verified by bioinformatics analysis and luciferase assay.

RESULTS

MiR-509-5p was obviously downregulated in breast cancer tissues when compared with pericarcinomatous tissues (n=76). Overexpressed miR-509-5p could attenuate breast cancer cell viability, proliferation, migration and invasion capacities, as well as promote cell apoptosis and induce cell cycle arrest at G0/G1 phase. Superoxide dismutase 2 (SOD2) was chosen as the target gene of miR-509-5p by bioinformatic analysis and Luciferase reporter assay. Moreover, restoration of SOD2 could rescue tumor suppression role of miR-509-5p on breast cancer tumorigenesis.

CONCLUSIONS

MiR-509-5p exerted tumor-suppressive effects on breast cancer progression and metastasis via targeting SOD2 in vitro, which provided an innovative and candidate target for diagnose and treatment of breast cancer.

Multiple Soluble TGF-β Receptors in Addition to Soluble Endoglin Are Elevated in Preeclamptic Serum and They Synergistically Inhibit TGF-β Signaling

CONTEXT

Preeclampsia (PE) can be classified into early-onset (<34 weeks of gestation) and late-onset (>34 weeks of gestation) subtypes. Soluble endoglin, an auxiliary receptor for transforming growth factor (TGF)-β ligands, is increased in PE circulation and believed to inhibit TGF-β action by sequestering the ligands. However, soluble endoglin, with a low affinity to TGF-β ligands, has been demonstrated to have little effect by itself on TGF-β action.

OBJECTIVES

We examined whether multiple soluble TGF-β receptors are elevated in PE circulation and whether they synergistically block TGF-β signaling.

DESIGN

TGF-β receptors were measured using enzyme-linked immunosorbent assay in sera collected from preeclamptic pregnancies and gestation-age-matched controls. TGF-β signaling was assessed using an in vitro bioassay and a tube formation assay.

RESULTS

TGF-β type I, II, and III receptors were all identified in pregnant serum; all were substantially elevated in early-onset but not late-onset PE. Endoglin was increased in both subtypes. At the greatest concentrations detected in PE, none of these soluble TGF-β receptors alone, including endoglin, inhibited TGF-β signaling. However, when all four soluble receptors were present, signaling of both TGF-β1 and TGF-β2 was substantially reduced. Removal of any one of these soluble receptors alleviated TGF-β1 inhibition; however, removal of soluble TGFβRIII was necessary to relieve TGF-β2 inhibition.

CONCLUSIONS

Multiple soluble TGF-β receptors are present in pregnant circulation and elevated in early-onset PE; they synergistically inhibit TGF-β signaling, which might be more likely to occur in early-onset than late-onset PE. Reducing soluble TGFβRIII, rather than endoglin, would be more effective in alleviating the inhibition of both TGF-β1 and TGF-β2 signaling in PE.

The significance of post-translational removal of α-DG-N in early stage endometrial cancer development

Endometrial cancer is one of the most common gynecological malignancies affecting post-menopausal women, yet the underlying mechanisms are not well understood. Dystroglycan (DG) is a large glycoprotein, consisting of α- and β-subunits that are non-covalently associated with each other. Modifications to α-DG have been linked to a variety of cancers, where the N-terminus of α-DG (α-DG-N) is post-translationally removed by a furin-like enzyme. However, the functional significance of α-DG-N removal is unknown. Our previous studies have established that the α-DG cleavage enzyme furin is significantly up-regulated in endometrial cancer. This study aimed to investigate the importance of α-DG-N removal in post-menopausal endometrial cancer. We demonstrated that α-DG-N removal predominantly occurred in early stage endometrial cancer tissues, and that the cleaved α-DG-N was significantly elevated in the uterine lavage of early grade endometrial cancer patients. Furthermore, α-DG-N removal significantly decreased the tight junction integrity and polarity of the endometrial epithelial cells, promoting the loss of polarity markers scribble and atypical protein kinase C (aPKC) and reducing the trans-epithelial electrical resistance. The removal of α-DG-N also sensitized the cells for estrogen-dependent proliferation. These results strongly suggest that α-DG-N removal plays an important role in early stage development of endometrial cancer, and that the elevated levels of α-DG-N in uterine fluid may provide a biomarker for early detection of endometrial cancer.

HtrA3 Isoform-Specific ELISAs for Early Detection of Preeclampsia

Preeclampsia is a serious disorder of human pregnancy occurring after 20 weeks of gestation. It can be divided into subtypes of early onset (<34 weeks of gestation) and late onset (>34 weeks). Presymptomatic detection to identify those at high risk is important for managing this disease. HtrA3, a serine protease with high expression in the developing placenta, exists in long (HtrA3-L) and short (HtrA3-S) isoforms. They are identical, except HtrA3-S lacks the C-terminal PDZ domain. We have previously shown by Western blot analysis that serum HtrA3 levels at the end of the first trimester are significantly higher in women who later develop preeclampsia than in controls. In this study, using highly specific HtrA3 monoclonal antibodies, we established and fully validated two enzyme-linked immunosorbent assays to detect both HtrA3 isoforms together (HtrA3-T) and HtrA3-L alone in the human serum. We then determined serum HtrA3 at 11 to 13 weeks of gestation in a cohort of singleton pregnancies that proceeded without complications or developed preeclampsia in the third trimester. Compared with controls, those who developed late-onset preeclampsia had significantly higher levels of HtrA3-L, whereas those who developed early-onset preeclampsia had significantly lower ratios of HtrA3-L/HtrA3-T. These data support a potential utility of these HtrA3 ELISAs for early detection of preeclampsia.

Fertile ground: human endometrial programming and lessons in health and disease

The human endometrium is a highly dynamic tissue that is cyclically shed, repaired, regenerated and remodelled, primarily under the orchestration of oestrogen and progesterone, in preparation for embryo implantation. Humans are among the very few species that menstruate and that, consequently, are equipped with unique cellular and molecular mechanisms controlling these cyclic processes. Many reproductive pathologies are specific to menstruating species, and studies in animal models rarely translate to humans. Abnormal remodelling and regeneration of the human endometrium leads to a range of reproductive complications. Furthermore, the processes regulating endometrial remodelling and implantation, including those controlling hormonal impact, breakdown and repair, stem/progenitor cell activation, inflammation and cell invasion have broad applications to other fields. This Review presents current knowledge regarding the normal and abnormal function of the human endometrium. The development of biomarkers for prediction of uterine diseases and pregnancy disorders and future avenues of investigation to improve fertility and enhance endometrial function are also discussed.

High levels of HtrA4 observed in preeclamptic circulation drastically alter endothelial gene expression and induce inflammation in human umbilical vein endothelial cells

Introduction

Preeclampsia (PE) is a life-threatening pregnancy disorder characterized by wide-spread endothelial dysfunction. Placental factors circulating in the maternal blood are believed to cause endothelial dysfunction. Our previous study identified HtrA4 as a placenta-specific serine protease that is released into the maternal circulation and significantly increased in early-onset PE. In this study, we examined the impact of HtrA4 on expression of endothelial genes related to vessel biology, using human umbilical vein endothelial cells (HUVECs) as a model.

Methods

HUVECs were treated with 0 or 3 μg/ml HtrA4 (highest concentration seen in PE circulation) for 24 h and analysed by an endothelial cell biology PCR array containing 84 genes. HtrA4-induced changes were then validated by real-time RT-PCR and ELISA for time and dose dependency.

Results

High levels of HtrA4 significantly altered the expression of a range of genes related to inflammation, vaso-activity, angiogenesis, cell adhesion, platelet activation and coagulation. In particular, pro-inflammatory genes IL6, PTGS2 (COX2) and IL1B were significantly increased by HtrA4. IL6 protein in HUVEC media was also drastically increased. THBD, an anticoagulant factor reported to be increased in PE, was significantly up-regulated by HtrA4. In contrast, THBS1, which is involved in many regulatory processes of endothelial cell biology, was severely down-regulated by HtrA4.

Discussion

HtrA4 significantly increased the inflammatory responses of HUVECs, and altered their expression of a number of genes important for vessel biology. These data suggest that placenta-derived HtrA4 that is increased in PE circulation is a potential causal factor of endothelial dysfunction.

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HtrA4 altered expression of endothelial genes involved in vessel biology.

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HtrA4 significantly induced inflammation in endothelial cells.

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Placental-derived HtrA4 is a potential causal factor of endothelial dysfunction.

Total PC Activity Is Increased in Uterine Lavage of Post-Menopausal Endometrial but Not Ovarian Cancer Patients

Endometrial and ovarian cancers are two most common cancers affecting women in their post-menopausal years. To date, there are no simple biochemical tests to detect these cancers at early stages. Our previous study has demonstrated that the activity of total proprotein convertases (PCs) is significantly increased in uterine lavage at all stages of endometrial cancer, suggesting uterine lavage which can be obtained relatively non-invasively may provide a simple tool for the detection of endometrial cancer. However, uterine lavage may also contain ovarian-derived factors, and PCs are also reported to be up-regulated in ovarian cancer. In this study we determined whether increases in uterine lavage PC activity are specific to endometrial cancer or are also associated with ovarian cancer. PC activity was detected in all uterine lavages examined but no difference was found between women with and without ovarian cancer. On the other hand, the PC activity was significantly higher in post-menopausal endometrial cancer patients, consistent with our previous report. These results suggest that measuring total PC activity in uterine lavage is a useful tool to detect endometrial cancer specifically.

Meta-analysis of IL-6 -174G/C polymorphism and psoriasis risk

Previous studies examining the association between interleukin-6 (IL-6) -174G/C polymorphism and psoriasis risk have produced inconsistent results. The aim of this study was to offer a comprehensive review of the association between IL-6 -174G/C polymorphism and psoriasis risk through a meta-analysis. Literature search of PubMed and Embase databases was conducted to identify all eligible studies published before October 29, 2015. Four case-control studies involving 651 psoriasis cases and 552 controls were included in this meta-analysis. Data were extracted, and pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated to assess the associations. Combined analysis revealed a significant association between this polymorphism and psoriasis risk under the recessive model (OR = 1.69, 95%CI = 1.12-2.55, P = 0.013 for GG vs GC + CC), and the heterozygous comparison model (OR = 1.70, 95%CI = 1.29-2.23, P < 0.001 for GG vs GC). However, no significant association was observed under the allelic model (OR = 1.37, 95%CI = 0.99-1.89, P = 0.060 for G vs C), the dominant model (OR = 1.25, 95%CI = 0.92-1.71, P = 0.152 for GG + GC vs CC), and the homozygote comparison model (OR = 1.62, 95%CI = 0.79-3.32, P = 0.186 for GG vs CC). We conclude that the IL-6 -174G/C polymorphism contributes to psoriasis risk. However, further studies should be performed to validate our results.

Risk factors of node metastasis in cervical carcinoma

Purpose ofinvestigation: To investigate the metastatic risk factors of pelvic lymph nodes in patients with cervical carcinoma in Stage Ia2 and IIa2.

MATERIALS AND METHODS

The clinic pathologic parameters in 337 patients with Stage Ia2-IIa2 cervical carcinoma were retrospectively analyzed. The risk factors for pelvic lymph node metastasis were evaluated by the way of univariate X2 statistic analysis and binary logistic regression analysis.

RESULTS

The lymph nodes metastasis rate was 11.87% (40/337). Single variable analysis showed that age, clinical stage, the size of tumor ≥ four cm, depth of stromal invasion 2/3, lymph-vascular space involvement (LVSI), and parametrial extension were related to the metastasis of lymph nodes. Multivariate analysis showed that the size of tumor, depth of stromal invasion, LVSI, and parametrial extension were independent risk factors.

CONCLUSION

Patients with tumor size ≥ four cm, stromal invasion ≥ 2/3, LVSI, and parametrial extension were at high risk of lymph node metastasis.

A High-Throughput Assay for the Detection of α-Dystroglycan N-Terminus in Human Uterine Fluid to Determine Uterine Receptivity

Embryo implantation requires a healthy embryo and a receptive uterus. In women, the uterus remains a hostile environment and must undergo functional changes to convert to a receptive state for embryo implantation. Determining uterine receptivity is vital in IVF treatment, as the timing of embryo transfer needs to be synchronized with uterine receptivity. However, to date, no reliable biochemical tests are available to determine uterine receptivity. We recently established that removal of α-dystroglycan N-terminus (α-DG-N) from the uterine surface plays an important role in the establishment of uterine receptivity. Importantly, the α-DG-N removed from the uterine tissue enters into the uterine fluid, and the levels correlate with the tissue status of receptivity. Detection of α-DG-N in uterine fluid may therefore provide a nonsurgical approach to assess uterine receptivity. In this study, we first validated three monoclonal antibodies raised against α-DG-N in our system, and then established a sandwich ELISA suitable for the detection of α-DG-N in human uterine fluid. This ELISA detected significantly higher concentrations of α-DG-N in uterine fluid of women in the receptive phase. We believe this newly established α-DG-N ELISA may provide an important tool in the development of noninvasive strategies to detect uterine receptivity in women.

Serum HtrA1 is differentially regulated between early-onset and late-onset preeclampsia

INTRODUCTION

HtrA1 (high temperature requirement A1) is a serine protease of the HtrA family. We have previously shown that the placenta expresses the highest level of HtrA1 mRNA compared to other tissues in the human. Others have reported that placental HtrA1 is significantly up-regulated in preeclampsia (PE), a pregnancy-specific multi-systemic disorder associated with new onset hypertension and proteinuria. However, it is unclear how serum HtrA1 changes in a normal pregnancy and whether it is altered in PE pregnancies.

METHODS

A sandwich ELISA highly specific to human HtrA1 and suitable for serum detection was developed and thoroughly validated. This assay was then applied to serum samples from different stages of normal pregnancy, as well as early-onset (<34 weeks) and late-onset (>34 weeks) PE pregnancies.

RESULTS

Serum HtrA1 increased progressively with increasing gestation in normal pregnancies. However, this trend was perturbed in women with PE. Compared to respective gestation-age-matched normal pregnancies, HtrA1 serum levels were significantly increased in early-onset PE, but significantly reduced in late-onset PE.

DISCUSSION

This is the first report to show a clear increase of HtrA1 in the maternal circulation during normal pregnancy, consistent with HtrA1 being highly expressed in the placenta. Importantly, this study identified that serum HtrA1 was altered differently in early-onset and late-onset PE pregnancies, highlighting the complex regulation of HtrA1 in the different subtypes. The significant increase of serum HtrA1 in early-onset PE suggests that it may be a potential biomarker for the diagnosis of early-onset PE at disease presentation.

Association between IL-21 polymorphism and systemic lupus erythematosus: a meta-analysis

Several case-control studies have been conducted to investigate the association between Interleukin-21 (IL-21) polymorphisms and systemic lupus erythematosus (SLE) susceptibility, and most of the studies focused on IL-21 rs907715 and rs2221903 polymorphisms. Given the inconsistent results from these studies, the present meta-analysis aimed to obtain a more precise estimate of the association between IL-21 rs907715 and rs2221903 polymorphisms and SLE. Studies regarding these specific polymorphisms and SLE were retrieved from PubMed, Embase, Web of Science, CNKI, and CBM. Data were extracted and meta-analysis was performed using the STATA 12.0 software. For the IL-21 rs907715 polymorphism, seven sets of comparisons involving 7977 SLE cases and 8097 healthy controls were considered. Results showed that there were significant differences in the IL-21 rs907715 genotype distribution between SLE patients and healthy controls in the comparisons of all genetic models. Upon stratified analysis by ethnicity, a similar result was found in the Caucasian and African-American population. For the IL-21 rs2221903 polymorphism, seven sets of comparisons involving 7990 SLE cases and 8098 healthy controls were considered. Results showed that there were significant differences in the IL-21 rs2221903 genotype distribution between SLE patients and healthy controls in the comparisons of GG versus AA and GG versus GA+AA. Upon stratified analysis by ethnicity, a similar result was found in the Caucasian population. This meta-analysis suggests that the both IL-21 rs907715 and rs2221903 polymorphisms may be associated with SLE susceptibility. As current evidence remains limited, further studies are needed to warrant the association between IL-21 rs907715 and rs2221903 polymorphisms and SLE susceptibility.

Human HtrA4 Expression Is Restricted to the Placenta, Is Significantly Up-Regulated in Early-Onset Preeclampsia, and High Levels of HtrA4 Cause Endothelial Dysfunction

CONTEXT

Preeclampsia (PE), a pregnancy-specific disorder closely associated with endothelial dysfunction and capillary leakage, is responsible for substantial maternal/fetal morbidity and mortality. PE can be classified as early-onset (<34 wk) and late-onset (>34 wk); the two subsets differ in presentation and pathogenesis.

OBJECTIVES

The objectives of the study were to examine serine protease high-temperature requirement factor A4 (HtrA4) expression in the placenta and other human tissues and in early-onset vs late-onset PE, to determine serum HtrA4 levels in normal pregnancy and in PE subtypes, and to investigate the effect of high levels of HtrA4 on endothelial integrity and function.

METHODS

Microarray data analysis and RT-PCR determined HtrA4 expression in the human placenta, various tissues, and cell lines. The serum HtrA4 protein levels were analyzed by an ELISA. The potential impact of excessive circulating HtrA4 on the maternal vasculature was determined by in vitro endothelial tube and permeability assays.

RESULTS

Human HtrA4 expression was restricted to the placenta and significantly up-regulated in early-onset but not late-onset PE. The serum HtrA4 levels in normal pregnancy increased significantly between the first and second trimesters and then remained constant. Women with early-onset but not late-onset PE showed significantly higher HtrA4 levels in serum compared with gestational age-matched controls. In cell models, high levels of HtrA4 disturbed endothelial cell tube formation and permeability in a dose-dependent manner, and this was linked to alterations in junctional proteins and microtubule organization.

CONCLUSIONS

HtrA4 represents a novel placenta-specific serine protease that is altered specifically in early-onset PE with potential causal roles in endothelial dysfunction and disease development.

Endometrial CRISP3 is regulated throughout the mouse estrous and human menstrual cycle and facilitates adhesion and proliferation of endometrial epithelial cells

The endometrium (the mucosal lining of the uterus) is a dynamic tissue that undergoes extensive remodeling, secretory transformation in preparation for implantation of an embryo, inflammatory and proteolytic activity during menstruation, and rapid postmenstrual repair. A plethora of local factors influence these processes. Recently, a cysteine-rich protein, CRISP3, a clade of the CRISP, antigen 5, pathogenesis-related (CAP) protein superfamily, has been implicated in uterine function. The localization, regulation, and potential function of CRISP3 in both the human and mouse endometrium is described. CRISP3 localizes to the luminal and glandular epithelium of the endometrium within both species, with increased immunoreactivity during the proliferative phase of the human cycle. CRISP3 also localizes to neutrophils, particularly within the premenstrual human endometrium and during the postbreakdown repair phase of a mouse model of endometrial breakdown and repair. Endometrial CRISP3 is produced by primary human endometrial epithelial cells and secreted in vivo to accumulate in the uterine cavity. Secreted CRISP3 is more abundant in uterine lavage fluid during the proliferative phase of the menstrual cycle. Human endometrial epithelial CRISP3 is present in both a glycosylated and a nonglycosylated form in vitro and in vivo. Treatment of endometrial epithelial cells in vitro with recombinant CRISP3 enhances both adhesion and proliferation. These data suggest roles for epithelial and neutrophil-derived CRISP3 in postmenstrual endometrial repair and regeneration.