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Phipps EA, Thadhani R, Benzing T, Karumanchi SA. Pre-eclampsia: pathogenesis, novel diagnostics and therapies. Nat Rev Nephrol 2019; 15:275-289. [PMID: 30792480 PMCID: PMC6472952 DOI: 10.1038/s41581-019-0119-6] [Citation(s) in RCA: 548] [Impact Index Per Article: 109.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Pre-eclampsia is a complication of pregnancy that is associated with substantial maternal and fetal morbidity and mortality. The disease presents with new-onset hypertension and often proteinuria in the mother, which can progress to multi-organ dysfunction, including hepatic, renal and cerebral disease, if the fetus and placenta are not delivered. Maternal endothelial dysfunction due to circulating factors of fetal origin from the placenta is a hallmark of pre-eclampsia. Risk factors for the disease include maternal comorbidities, such as chronic kidney disease, hypertension and obesity; a family history of pre-eclampsia, nulliparity or multiple pregnancies; and previous pre-eclampsia or intrauterine fetal growth restriction. In the past decade, the discovery and characterization of novel antiangiogenic pathways have been particularly impactful both in increasing understanding of the disease pathophysiology and in directing predictive and therapeutic efforts. In this Review, we discuss the pathogenic role of antiangiogenic proteins released by the placenta in the development of pre-eclampsia and review novel therapeutic strategies directed at restoring the angiogenic imbalance observed during pre-eclampsia. We also highlight other notable advances in the field, including the identification of long-term maternal and fetal risks conferred by pre-eclampsia.
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Affiliation(s)
- Elizabeth A Phipps
- Nephrology Division, Brigham and Women's Hospital, Boston, MA, USA
- Nephrology Division, Massachusetts General Hospital, Boston, MA, USA
| | - Ravi Thadhani
- Nephrology Division, Massachusetts General Hospital, Boston, MA, USA
- Departments of Medicine and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Thomas Benzing
- Department II of Internal Medicine and Center for Molecular Medicine Cologne, University of Cologne, Cologne, Germany
| | - S Ananth Karumanchi
- Departments of Medicine and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
- Nephrology Division, Departments of Medicine, Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA, USA.
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52
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Chen W, Chen J, Xu M, Zhong Z, Zhang Q, Yang W, Huang G. Electroacupuncture facilitates implantation by enhancing endometrial angiogenesis in a rat model of ovarian hyperstimulation. Biol Reprod 2019; 100:268-280. [PMID: 30084973 PMCID: PMC6335210 DOI: 10.1093/biolre/ioy176] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 07/06/2018] [Accepted: 07/31/2018] [Indexed: 01/31/2023] Open
Abstract
Controlled ovarian hyperstimulation (COH) impairs the synchronized development of endometrium and embryo, resulting in the failure of embryo implantation. Here, we investigated what effects electroacupuncture had on embryo implantation in COH rats. Female rats were randomly assigned to four groups: normal (N), model (M), electroacupuncture (EA), and electroacupuncture pretreatment (PEA). Rats in groups M, EA, PEA were injected with pregnant mare serum gonadotropin (PMSG) and human chorionic gonadotropin to establish the COH model. Rats in group EA received electroacupuncture treatment from the PMSG injection day to the 3rd day of pregnancy (D3), while those in group PEA received electroacupuncture treatment for 3 days before the PMSG day and continuing to D3. Furthermore, another 30 female rats who received the same treatment as the rats in group PEA were injected with siVEGFR2 into uterine lumen. The endometrial microvascular density (MVD) and the expression levels of vascular endothelial growth factor-A, angiopoietin-1, and fibroblast growth factor-2 were significantly lower in groups M than in groups N and PEA. The percentage of dolichos biflorus agglutinin positive uterine natural killer cells in groups N, EA and PEA was higher than that in group M. After the siVEGFR2 injection, the protein expression levels of vascular endothelial growth factor receptor 2 (VEGFR2), PI3K, p-AKT and p-ERK, the embryo number and the MVD were significantly reduced. In conclusion, electroacupuncture can facilitate embryo implantation in COH rats by activating the VEGFR2/PI3K/AKT and VEGFR2/ERK signaling pathways which have a positive relationship with endometrial angiogenesis.
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Affiliation(s)
- Wei Chen
- Institute of Integrated Traditional Chinese and Western Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Jie Chen
- Department of Biochemistry and Molecular Biology, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Menghao Xu
- School of Basic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Zhiyan Zhong
- Institute of Integrated Traditional Chinese and Western Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Qing Zhang
- Institute of Integrated Traditional Chinese and Western Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Wei Yang
- Reproductive Medicine Center, Tongji Hospital, Tongji Medicine College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Guangying Huang
- Institute of Integrated Traditional Chinese and Western Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
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53
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Borges M, Magalhães Silva T, Brito C, Teixeira N, Roberts CW. How does toxoplasmosis affect the maternal-foetal immune interface and pregnancy? Parasite Immunol 2018; 41:e12606. [PMID: 30471137 DOI: 10.1111/pim.12606] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Revised: 11/13/2018] [Accepted: 11/20/2018] [Indexed: 12/11/2022]
Abstract
Toxoplasma gondii is a zoonotic parasite which, depending on the geographical location, can infect between 10% and 90% of humans. Infection during pregnancy may result in congenital toxoplasmosis. The effects on the foetus vary depending on the stage of gestation in which primary maternal infection arises. A large body of research has focused on understanding immune response to toxoplasmosis, although few studies have addressed how it is affected by pregnancy or the pathological consequences of infection at the maternal-foetal interface. There is a lack of knowledge about how maternal immune cells, specifically macrophages, are modulated during infection and the resulting consequences for parasite control and pathology. Herein, we discuss the potential of T. gondii infection to affect the maternal-foetal interface and the potential of pregnancy to disrupt maternal immunity to T. gondii infection.
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Affiliation(s)
- Margarida Borges
- UCIBIO/REQUIMTE, Department of Biological Sciences, Faculty of Pharmacy, University of Porto, Porto, Portugal
| | - Tânia Magalhães Silva
- Instituto de Biologia Molecular e Celular (IBMC), University of Porto, Porto, Portugal.,Instituto de Investigação e Inovação em Saúde (i3S), University of Porto, Porto, Portugal
| | - Carina Brito
- UCIBIO/REQUIMTE, Department of Biological Sciences, Faculty of Pharmacy, University of Porto, Porto, Portugal
| | - Natércia Teixeira
- UCIBIO/REQUIMTE, Department of Biological Sciences, Faculty of Pharmacy, University of Porto, Porto, Portugal
| | - Craig W Roberts
- Strathclyde Institute for Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK
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54
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Ni X, Fu B, Zhang J, Sun R, Tian Z, Wei H. Cytokine-Based Generation of CD49a +Eomes -/+ Natural Killer Cell Subsets. Front Immunol 2018; 9:2126. [PMID: 30319610 PMCID: PMC6167425 DOI: 10.3389/fimmu.2018.02126] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 08/29/2018] [Indexed: 01/06/2023] Open
Abstract
Recent studies have identified CD49a+Eomes− and CD49a+Eomes+ subsets of tissue-resident NK (trNK) cells in different organs of the mouse. However, the characteristics of CD49a+Eomes−/+ NK cell development and the regulation of Eomes expression in NK cells remain unclear. Here, we established an in vitro cytokine-based feeder-free system in which bone marrow progenitor cells differentiate into CD49a+ NK cells. IL-15 was identified as being the key cytokine in this system that supported the development and maintenance of CD49a+ NK cells. The CD49a+ NK cells generated were Eomes−CD49b− and shared the same phenotype as hepatic trNK cells. IL-4 induced the expression of Eomes in generated NK cells and converted them into CD49a+Eomes+ cells, which were phenotypically and functionally similar to uterine trNK cells. Moreover, the IL-4/STAT6 axis was identified as being important in the generation of CD49a+Eomes+ induced NK cells. Collectively, these studies describe an approach to generate CD49a+Eomes−/+ subsets of NK cells and demonstrate important roles for IL-15 and IL-4 in the differentiation of these cells. These findings have potential for developmental research underlying the generation of different subsets of NK cells and the application of adoptive NK cell transfer therapies.
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Affiliation(s)
- Xiang Ni
- Institute of Immunology and the CAS Key Laboratory of Innate Immunity and Chronic Disease, School of Life Science and Medical Center, University of Science and Technology of China, Hefei, China.,Hefei National Laboratory for Physical Sciences at Microscale, University of Science and Technology of China, Hefei, China
| | - Binqing Fu
- Institute of Immunology and the CAS Key Laboratory of Innate Immunity and Chronic Disease, School of Life Science and Medical Center, University of Science and Technology of China, Hefei, China.,Hefei National Laboratory for Physical Sciences at Microscale, University of Science and Technology of China, Hefei, China
| | - Jinghe Zhang
- Institute of Immunology and the CAS Key Laboratory of Innate Immunity and Chronic Disease, School of Life Science and Medical Center, University of Science and Technology of China, Hefei, China.,Hefei National Laboratory for Physical Sciences at Microscale, University of Science and Technology of China, Hefei, China
| | - Rui Sun
- Institute of Immunology and the CAS Key Laboratory of Innate Immunity and Chronic Disease, School of Life Science and Medical Center, University of Science and Technology of China, Hefei, China.,Hefei National Laboratory for Physical Sciences at Microscale, University of Science and Technology of China, Hefei, China
| | - Zhigang Tian
- Institute of Immunology and the CAS Key Laboratory of Innate Immunity and Chronic Disease, School of Life Science and Medical Center, University of Science and Technology of China, Hefei, China.,Hefei National Laboratory for Physical Sciences at Microscale, University of Science and Technology of China, Hefei, China
| | - Haiming Wei
- Institute of Immunology and the CAS Key Laboratory of Innate Immunity and Chronic Disease, School of Life Science and Medical Center, University of Science and Technology of China, Hefei, China.,Hefei National Laboratory for Physical Sciences at Microscale, University of Science and Technology of China, Hefei, China
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55
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Ribatti D, Tamma R, Crivellato E. Cross talk between natural killer cells and mast cells in tumor angiogenesis. Inflamm Res 2018; 68:19-23. [PMID: 30132016 DOI: 10.1007/s00011-018-1181-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 08/13/2018] [Accepted: 08/16/2018] [Indexed: 12/13/2022] Open
Abstract
Natural killer (NK) cells are large granular lymphocytes of the innate immune system, responsible for direct targeting and killing of both virally infected and transformed cells. Under pathological conditions and during inflammation, NK cells extravasate into the lymph nodes and accumulate at inflammatory or tumor sites. The activation of NK cells depends on an intricate balance between activating and inhibitory signals that determines if a target will be susceptible to NK-mediated lysis. Many experimental evidences indicate that NK cells are also involved in several immunoregulatory processes and have the ability to modulate the adaptive immune responses. Many other important aspects about NK cell biology are emerging in these last years. The aim of this review is to elucidate the role of NK cells in tumor angiogenesis and their interaction with mast cells. In fact, it has been observed that NK cells produce pro-angiogenic factors and participate alone or in cooperation with mast cells to the regulation of angiogenesis in both physiological and pathological conditions including tumors.
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Affiliation(s)
- Domenico Ribatti
- Department of Basic Medical Sciences, Neurosciences and Sensory Organs, University of Bari Medical School, Policlinico, Piazza G. Cesare, 11, 70124, Bari, Italy.
| | - Roberto Tamma
- Department of Basic Medical Sciences, Neurosciences and Sensory Organs, University of Bari Medical School, Policlinico, Piazza G. Cesare, 11, 70124, Bari, Italy
| | - Enrico Crivellato
- Department of Medicine, Section of Human Anatomy, University of Udine, Udine, Italy
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56
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Aquaporin 1 gene deletion affects the amniotic fluid volume and composition as well as the expression of other aquaporin water channels in placenta and fetal membranes. Clin Chim Acta 2018; 482:161-165. [DOI: 10.1016/j.cca.2018.04.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 03/31/2018] [Accepted: 04/03/2018] [Indexed: 01/10/2023]
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57
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Castellana B, Perdu S, Kim Y, Chan K, Atif J, Marziali M, Beristain AG. Maternal obesity alters uterine NK activity through a functional KIR2DL1/S1 imbalance. Immunol Cell Biol 2018; 96:805-819. [PMID: 29569748 DOI: 10.1111/imcb.12041] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 03/09/2018] [Accepted: 03/13/2018] [Indexed: 12/28/2022]
Abstract
In pregnancy, uterine natural killer cells (uNK) play essential roles in coordinating uterine angiogenesis, blood vessel remodeling and promoting maternal tolerance to fetal tissue. Deviances from a normal uterine microenvironment are thought to modify uNK function(s) by limiting their ability to establish a healthy pregnancy. While maternal obesity has become a major health concern due to associations with adverse effects on fetal and maternal health, our understanding into how obesity contributes to poor pregnancy disorders is unknown. Given the importance of uNK in pregnancy, this study examines the impact of obesity on uNK function in women in early pregnancy. We identify that uNK from obese women show a greater propensity for cellular activation, but this difference does not translate into increased effector killing potential. Instead, uNK from obese women express an altered repertoire of natural killer receptors, including an imbalance in inhibitory KIR2DL1 and activating KIR2DS1 receptors that favors HLA-C2-directed uNK activation. Notably, we show that obesity-related KIR2DS1 skewing potentiates TNFα production upon receptor crosslinking. Together, these findings suggest that maternal obesity modifies uNK activity by altering the response toward HLA-C2 antigen and KIR2DL1/2DS1-controlled TNFα release. Furthermore, this work identifies alterations in uNK function resulting from maternal obesity that may impact early developmental processes important in pregnancy health.
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Affiliation(s)
- Barbara Castellana
- British Columbia Children's Hospital Research Institute, Vancouver, BC, Canada.,Department of Obstetrics & Gynecology, The University of British Columbia, Vancouver, BC, Canada
| | - Sofie Perdu
- British Columbia Children's Hospital Research Institute, Vancouver, BC, Canada.,Department of Obstetrics & Gynecology, The University of British Columbia, Vancouver, BC, Canada
| | - Yoona Kim
- British Columbia Children's Hospital Research Institute, Vancouver, BC, Canada
| | - Kathy Chan
- British Columbia Children's Hospital Research Institute, Vancouver, BC, Canada
| | - Jawairia Atif
- British Columbia Children's Hospital Research Institute, Vancouver, BC, Canada
| | - Megan Marziali
- British Columbia Children's Hospital Research Institute, Vancouver, BC, Canada
| | - Alexander G Beristain
- British Columbia Children's Hospital Research Institute, Vancouver, BC, Canada.,Department of Obstetrics & Gynecology, The University of British Columbia, Vancouver, BC, Canada
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58
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Hayder H, O'Brien J, Nadeem U, Peng C. MicroRNAs: crucial regulators of placental development. Reproduction 2018; 155:R259-R271. [PMID: 29615475 DOI: 10.1530/rep-17-0603] [Citation(s) in RCA: 95] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 04/03/2018] [Indexed: 12/25/2022]
Abstract
MicroRNAs (miRNAs) are small non-coding single-stranded RNAs that are integral to a wide range of cellular processes mainly through the regulation of translation and mRNA stability of their target genes. The placenta is a transient organ that exists throughout gestation in mammals, facilitating nutrient and gas exchange and waste removal between the mother and the fetus. miRNAs are expressed in the placenta, and many studies have shown that miRNAs play an important role in regulating trophoblast differentiation, migration, invasion, proliferation, apoptosis, vasculogenesis/angiogenesis and cellular metabolism. In this review, we provide a brief overview of canonical and non-canonical pathways of miRNA biogenesis and mechanisms of miRNA actions. We highlight the current knowledge of the role of miRNAs in placental development. Finally, we point out several limitations of the current research and suggest future directions.
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Affiliation(s)
- Heyam Hayder
- Department of BiologyYork University, Toronto, Ontario, Canada
| | - Jacob O'Brien
- Department of BiologyYork University, Toronto, Ontario, Canada
| | - Uzma Nadeem
- Department of BiologyYork University, Toronto, Ontario, Canada
| | - Chun Peng
- Department of BiologyYork University, Toronto, Ontario, Canada
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59
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Christensen KE, Bahous RH, Hou W, Deng L, Malysheva OV, Arning E, Bottiglieri T, Caudill MA, Jerome-Majewska LA, Rozen R. Low Dietary Folate Interacts with MTHFD1 Synthetase Deficiency in Mice, a Model for the R653Q Variant, to Increase Incidence of Developmental Delays and Defects. J Nutr 2018; 148:501-509. [PMID: 29659962 DOI: 10.1093/jn/nxy013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 01/09/2018] [Indexed: 11/15/2022] Open
Abstract
Background Suboptimal folate intake, a risk factor for birth defects, is common even in areas with folate fortification. A polymorphism in methylenetetrahydrofolate dehydrogenase 1 (MTHFD1), R653Q (MTHFD1 c.1958 G > A), has also been associated with increased birth defect risk, likely through reduced purine synthesis. Objective We aimed to determine if the interaction of MTHFD1 synthetase deficiency and low folate intake increases developmental abnormalities in a mouse model for MTHFD1 R653Q. Methods Female Mthfd1S+/+ and Mthfd1S+/- mice were fed control or low-folate diets (2 and 0.3 mg folic acid/kg diet, respectively) before mating and during pregnancy. Embryos and placentas were examined for anomalies at embryonic day 10.5. Maternal 1-carbon metabolites were measured in plasma and liver. Results Delays and defects doubled in litters of Mthfd1S+/- females fed low-folate diets compared to wild-type females fed either diet, or Mthfd1S+/- females fed control diets [P values (defects): diet 0.003, maternal genotype 0.012, diet × maternal genotype 0.014]. These adverse outcomes were associated with placental dysmorphology. Intrauterine growth restriction was increased by embryonic Mthfd1S+/- genotype, folate deficiency, and interaction of maternal Mthfd1S+/- genotype with folate deficiency (P values: embryonic genotype 0.045, diet 0.0081, diet × maternal genotype 0.0019). Despite a 50% increase in methylenetetrahydrofolate reductase expression in low-folate maternal liver (P diet = 0.0007), methyltetrahydrofolate concentration decreased 70% (P diet <0.0001) and homocysteine concentration doubled in plasma (P diet = 0.0001); S-adenosylmethionine decreased 40% and S-adenosylhomocysteine increased 20% in low-folate maternal liver (P diet = 0.002 and 0.0002, respectively). Conclusions MTHFD1 synthetase-deficient mice are more sensitive to low folate intake than wild-type mice during pregnancy. Reduced purine synthesis due to synthetase deficiency and altered methylation potential due to low folate may increase pregnancy complications. Further studies and individualized intake recommendations may be required for women homozygous for the MTHFD1 R653Q variant.
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Affiliation(s)
- Karen E Christensen
- Departments of Human Genetics and Pediatrics, McGill University, and the Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Renata H Bahous
- Departments of Human Genetics and Pediatrics, McGill University, and the Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Wenyang Hou
- Departments of Human Genetics and Pediatrics, McGill University, and the Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Liyuan Deng
- Departments of Human Genetics and Pediatrics, McGill University, and the Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Olga V Malysheva
- Division of Nutritional Sciences and Genomics, Cornell University, Ithaca, NY
| | - Erland Arning
- Institute of Metabolic Disease, Baylor Research Institute, Dallas, TX
| | | | - Marie A Caudill
- Division of Nutritional Sciences and Genomics, Cornell University, Ithaca, NY
| | - Loydie A Jerome-Majewska
- Departments of Human Genetics and Pediatrics, McGill University, and the Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Rima Rozen
- Departments of Human Genetics and Pediatrics, McGill University, and the Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
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60
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Ashary N, Tiwari A, Modi D. Embryo Implantation: War in Times of Love. Endocrinology 2018; 159:1188-1198. [PMID: 29319820 DOI: 10.1210/en.2017-03082] [Citation(s) in RCA: 105] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 12/29/2017] [Indexed: 12/22/2022]
Abstract
Contrary to widespread belief, the implantation of an embryo for the initiation of pregnancy is like a battle, in that the embryo uses a variety of coercive tactics to force its acceptance by the endometrium. We propose that embryo implantation involves a three-step process: (1) identification of a receptive endometrium; (2) superimposition of a blastocyst-derived signature onto the receptive endometrium before implantation; and finally (3) breaching by the embryo and trophoblast invasion, culminating in decidualization and placentation. We review here the story that is beginning to emerge, focusing primarily on the cells that are in "combat" during this process.
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Affiliation(s)
- Nancy Ashary
- Molecular and Cellular Biology Laboratory, National Institute for Research in Reproductive Health, Indian Council of Medical Research, Mumbai, India
| | - Abhishek Tiwari
- Molecular and Cellular Biology Laboratory, National Institute for Research in Reproductive Health, Indian Council of Medical Research, Mumbai, India
| | - Deepak Modi
- Molecular and Cellular Biology Laboratory, National Institute for Research in Reproductive Health, Indian Council of Medical Research, Mumbai, India
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61
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Quao ZC, Tong M, Bryce E, Guller S, Chamley LW, Abrahams VM. Low molecular weight heparin and aspirin exacerbate human endometrial endothelial cell responses to antiphospholipid antibodies. Am J Reprod Immunol 2018; 79:10.1111/aji.12785. [PMID: 29135051 PMCID: PMC5728699 DOI: 10.1111/aji.12785] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 10/26/2017] [Indexed: 12/25/2022] Open
Abstract
PROBLEM Women with antiphospholipid antibodies (aPL) are at risk for pregnancy complications despite treatment with low molecular weight heparin (LMWH) or aspirin (ASA). aPL recognizing beta2 glycoprotein I can target the uterine endothelium, however, little is known about its response to aPL. This study characterized the effect of aPL on human endometrial endothelial cells (HEECs), and the influence of LMWH and ASA. METHOD OF STUDY HEECs were exposed to aPL or control IgG, with or without low-dose LMWH and ASA, alone or in combination. Chemokine and angiogenic factor secretion were measured by ELISA. A tube formation assay was used to measure angiogenesis. RESULTS aPL increased HEEC secretion of pro-angiogenic VEGF and PlGF; increased anti-angiogenic sFlt-1; inhibited basal secretion of the chemokines MCP-1, G-CSF, and GRO-α; and impaired angiogenesis. LMWH and ASA, alone and in combination, exacerbated the aPL-induced changes in the HEEC angiogenic factor and chemokine profile. There was no reversal of the aPL inhibition of HEEC angiogenesis by either single or combination therapy. CONCLUSION By aPL inhibiting HEEC chemokine secretion and promoting sFlt-1 release, the uterine endothelium may contribute to impaired placentation and vascular transformation. LMWH and ASA may further contribute to endothelium dysfunction in women with obstetric APS.
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Affiliation(s)
- Zola Chihombori Quao
- Department of Obstetrics, Gynecology & Reproductive Sciences, Yale University, New Haven, CT, USA
| | - Mancy Tong
- Department of Obstetrics, Gynecology & Reproductive Sciences, Yale University, New Haven, CT, USA
| | - Elena Bryce
- Department of Obstetrics, Gynecology & Reproductive Sciences, Yale University, New Haven, CT, USA
- Albert Einstein College of Medicine, Bronx, NY
| | - Seth Guller
- Department of Obstetrics, Gynecology & Reproductive Sciences, Yale University, New Haven, CT, USA
| | - Lawrence W Chamley
- Department of Obstetrics & Gynecology, University of Auckland, Auckland, New Zealand
| | - Vikki M Abrahams
- Department of Obstetrics, Gynecology & Reproductive Sciences, Yale University, New Haven, CT, USA
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62
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Immunometabolism, pregnancy, and nutrition. Semin Immunopathol 2017; 40:157-174. [PMID: 29071391 DOI: 10.1007/s00281-017-0660-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 10/18/2017] [Indexed: 12/16/2022]
Abstract
The emerging field of immunometabolism has substantially progressed over the last years and provided pivotal insights into distinct metabolic regulators and reprogramming pathways of immune cell populations in various immunological settings. However, insights into immunometabolic reprogramming in the context of reproduction are still enigmatic. During pregnancy, the maternal immune system needs to actively adapt to the presence of the fetal antigens, i.e., by functional modifications of distinct innate immune cell subsets, the generation of regulatory T cells, and the suppression of an anti-fetal effector T cell response. Considering that metabolic pathways have been shown to affect the functional role of such immune cells in a number of settings, we here review the potential role of immunometabolism with regard to the molecular and cellular mechanisms necessary for successful reproduction. Since immunometabolism holds the potential for a therapeutic approach to alter the course of immune diseases, we further highlight how a targeted metabolic reprogramming of immune cells may be triggered by maternal anthropometric or nutritional aspects.
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63
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Nejabati HR, Latifi Z, Ghasemnejad T, Fattahi A, Nouri M. Placental growth factor (PlGF) as an angiogenic/inflammatory switcher: lesson from early pregnancy losses. Gynecol Endocrinol 2017; 33:668-674. [PMID: 28447504 DOI: 10.1080/09513590.2017.1318375] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Placental growth factor (PlGF) is an angiogenic factor which belongs to vascular endothelial growth factor (VEGF) family. In addition to the angiogenic function of PlGF, in some conditions such as preeclampsia and early pregnancy losses, it can induce inflammatory reactions which could be accompanied with reduced angiogenesis. Hence, it is crucial to investigate inflammatory and angiogenic switching states and understand underlying mechanisms. PlGF is expressed in endometrium, placenta and trophoblast cells and is involved in maturation of uterine NK cells. Up-regulation of PlGF directs VEGF to VEGFR-2 and reinforces angiogenesis. However, when VEGF/VEGFR-2 signaling pathway is impaired, PlGF may shift to severe inflammation and cause tissue damages which could lead to early pregnancy losses. Downregulation of PlGF has also been reported in pregnancy complications. In this review, we discussed the role of PlGF in embryo implantation failure and early pregnancy loss and also possible mechanisms regarding the role of PlGF in angiogenic/inflammatory switching in early pregnancy losses. Furthermore, we summarized the effects of various compounds on PlGF expression and briefly talked about its therapeutic potential that may be an opportunity for prevention of pregnancy loss.
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Affiliation(s)
- Hamid Reza Nejabati
- a Women's Reproductive Health Research Center
- b Department of Clinical Biochemistry , Faculty of Medicine , and
| | - Zeinab Latifi
- b Department of Clinical Biochemistry , Faculty of Medicine , and
| | | | - Amir Fattahi
- a Women's Reproductive Health Research Center
- c Department of Reproductive Biology , Faculty of Advanced Medical Sciences, Tabriz University of Medical Sciences , Tabriz , Iran
| | - Mohammad Nouri
- c Department of Reproductive Biology , Faculty of Advanced Medical Sciences, Tabriz University of Medical Sciences , Tabriz , Iran
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Activated NK cells cause placental dysfunction and miscarriages in fetal alloimmune thrombocytopenia. Nat Commun 2017; 8:224. [PMID: 28794456 PMCID: PMC5550461 DOI: 10.1038/s41467-017-00269-1] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Accepted: 06/16/2017] [Indexed: 01/29/2023] Open
Abstract
Miscarriage and intrauterine growth restriction (IUGR) are devastating complications in fetal/neonatal alloimmune thrombocytopenia (FNAIT). We previously reported the mechanisms for bleeding diatheses, but it is unknown whether placental, decidual immune cells or other abnormalities at the maternal-fetal interface contribute to FNAIT. Here we show that maternal immune responses to fetal platelet antigens cause miscarriage and IUGR that are associated with vascular and immune pathologies in murine FNAIT models. Uterine natural killer (uNK) cell recruitment and survival beyond mid-gestation lead to elevated NKp46 and CD107 expression, perforin release and trophoblast apoptosis. Depletion of NK cells restores normal spiral artery remodeling and placental function, prevents miscarriage, and rescues hemorrhage in neonates. Blockade of NK activation receptors (NKp46, FcɣRIIIa) also rescues pregnancy loss. These findings shed light on uNK antibody-dependent cell-mediated cytotoxicity of invasive trophoblasts as a pathological mechanism in FNAIT, and suggest that anti-NK cell therapies may prevent immune-mediated pregnancy loss and ameliorate FNAIT.Fetal/neonatal alloimmune thrombocytopenia (FNAIT) is a gestational disease caused by maternal immune responses against fetal platelets. Using a FNAIT mouse model and human trophoblast cell lines, here the authors show that uterine natural killer cell-mediated trophoblast apoptosis contributes to FNAIT pathogenesis.
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65
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Beards F, Jones LE, Charnock J, Forbes K, Harris LK. Placental Homing Peptide-microRNA Inhibitor Conjugates for Targeted Enhancement of Intrinsic Placental Growth Signaling. Am J Cancer Res 2017; 7:2940-2955. [PMID: 28824727 PMCID: PMC5562227 DOI: 10.7150/thno.18845] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 03/22/2017] [Indexed: 12/11/2022] Open
Abstract
Suboptimal placental growth and development are the underlying cause of many pregnancy complications. No treatments are available, primarily due to the risk of causing fetal teratogenicity. microRNAs (miRNAs) are short, non-coding RNA sequences that regulate multiple downstream genes; miR-145 and miR675 have previously been identified as negative regulators of placental growth. In this proof of principle study, we explored the feasibility of delivering miRNA inhibitors to the placentas of pregnant mice and developed novel placental homing peptide-microRNA inhibitor conjugates for targeted enhancement of intrinsic placental growth signalling. Scrambled-, miR-145- or miR-675 inhibitor sequences were synthesised from peptide nucleic acids and conjugated to the placental homing peptide CCGKRK. Intravenous administration of the miR-145- and miR-675 conjugates to pregnant C57BL/6J mice significantly increased fetal and placental weights compared to controls; the miR-675 conjugate significantly reduced placental miR-675 expression. When applied to human first trimester placental explants, the miR-145 conjugate significantly reduced placental miR-145 expression, and both conjugates induced significant enhancement of cytotrophoblast proliferation; no effect was observed in term placental explants. This study demonstrates that homing peptide-miRNA inhibitor conjugates can be exploited to promote placental growth; these novel therapeutics may represent an innovative strategy for targeted treatment of compromised placental development.
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66
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Winger EE, Reed JL, Ji X. Early first trimester peripheral blood cell microRNA predicts risk of preterm delivery in pregnant women: Proof of concept. PLoS One 2017; 12:e0180124. [PMID: 28692679 PMCID: PMC5503193 DOI: 10.1371/journal.pone.0180124] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 06/11/2017] [Indexed: 12/16/2022] Open
Abstract
Objective We investigated the capacity of first trimester peripheral blood mononuclear cell (PBMC) microRNA to determine risk of spontaneous preterm birth among pregnant women. Study design The study included 39 pregnant women with the following delivery outcomes: 25 with a full term delivery (38–42 weeks gestation) 14 with spontaneous preterm birth (<38 weeks gestation). Of the 14 women experiencing spontaneous preterm birth, 7 delivered at 34-<38 weeks gestation (late preterm) and 7 delivered at <34 weeks gestation (early preterm). Samples were collected at a mean of 7.9±3.0 weeks gestation. Quantitative rtPCR was performed on 30 selected microRNAs. MicroRNA Risk Scores were calculated and Area-Under the Curve-Receiver-Operational-Characteristic (AUC-ROC) curves derived. Results The AUC-ROC for the group delivering preterm (<38 weeks) was 0.95 (p>0.0001). The AUC-ROC for early preterm group (<34 weeks) was 0.98 (p<0.0001) and the AUC-ROC for the late preterm group (34-<38 weeks) was 0.92 (p<0.0001). Conclusion Quantification of first trimester peripheral blood PBMC MicroRNA may provide sensitive and specific prediction of spontaneous preterm birth in pregnant women. Larger studies are needed for confirmation.
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Affiliation(s)
- Edward E. Winger
- Laboratory for Reproductive Medicine and Immunology, San Francisco, CA, United States of America
- * E-mail:
| | - Jane L. Reed
- Laboratory for Reproductive Medicine and Immunology, San Francisco, CA, United States of America
| | - Xuhuai Ji
- Stanford University, Human Immune Monitoring Center, Stanford, CA, United States of America
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67
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Kofod L, Lindhard A, Bzorek M, Eriksen JO, Larsen LG, Hviid TVF. Endometrial immune markers are potential predictors of normal fertility and pregnancy after in vitro fertilization. Am J Reprod Immunol 2017; 78. [DOI: 10.1111/aji.12684] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Accepted: 03/20/2017] [Indexed: 01/15/2023] Open
Affiliation(s)
- Louise Kofod
- Department of Clinical Biochemistry, Centre for Immune Regulation and Reproductive Immunology (CIRRI)Zealand University Hospital Roskilde Denmark
- Department of Clinical MedicineUniversity of Copenhagen Copenhagen Denmark
| | - Anette Lindhard
- Department of Clinical MedicineUniversity of Copenhagen Copenhagen Denmark
- The Fertility Clinic, Department of Gynaecology and ObstetricsZealand University Hospital Roskilde Denmark
| | - Michael Bzorek
- Department of Clinical MedicineUniversity of Copenhagen Copenhagen Denmark
- Department of PathologyZealand University Hospital Roskilde Denmark
| | - Jens Ole Eriksen
- Department of Clinical MedicineUniversity of Copenhagen Copenhagen Denmark
- Department of PathologyZealand University Hospital Roskilde Denmark
| | - Lise Grupe Larsen
- Department of Clinical MedicineUniversity of Copenhagen Copenhagen Denmark
- Department of PathologyZealand University Hospital Roskilde Denmark
| | - Thomas Vauvert F. Hviid
- Department of Clinical Biochemistry, Centre for Immune Regulation and Reproductive Immunology (CIRRI)Zealand University Hospital Roskilde Denmark
- Department of Clinical MedicineUniversity of Copenhagen Copenhagen Denmark
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68
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Chymase-producing cells of the innate immune system are required for decidual vascular remodeling and fetal growth. Sci Rep 2017; 7:45106. [PMID: 28327604 PMCID: PMC5361184 DOI: 10.1038/srep45106] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 02/16/2017] [Indexed: 01/22/2023] Open
Abstract
Intrauterine growth restriction (IUGR) is caused by insufficient remodeling of spiral arteries (SAs). The mechanism underlying the relevance of natural killer cells (NKs) and mast cells (MCs) for SA remodeling and its effects on pregnancy outcome are not well understood. We show that NK depletion arrested SA remodeling without affecting pregnancy. MC depletion resulted in abnormally remodeled SAs and IUGR. Combined absence of NKs and MCs substantially affected SA remodeling and impaired fetal growth. We found that α-chymase mast cell protease (Mcpt) 5 mediates apoptosis of uterine smooth muscle cells, a key feature of SA remodeling. Additionally, we report a previously unknown source for Mcpt5: uterine (u) NKs. Mice with selective deletion of Mcpt5+ cells had un-remodeled SAs and growth-restricted progeny. The human α-chymase CMA1, phylogenetic homolog of Mcpt5, stimulated the ex vivo migration of human trophoblasts, a pre-requisite for SA remodeling. Our results show that chymases secreted by uMCs and uNKs are pivotal to the vascular changes required to support pregnancy. Understanding the mechanisms underlying pregnancy-induced vascular changes is essential for developing therapeutic options against pregnancy complications associated with poor vascular remodeling.
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69
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Zhao M, Zhang WQ, Liu JL. A study on regional differences in decidualization of the mouse uterus. Reproduction 2017; 153:645-653. [PMID: 28250238 DOI: 10.1530/rep-16-0486] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2016] [Revised: 02/06/2017] [Accepted: 02/28/2017] [Indexed: 01/01/2023]
Abstract
Although regional differences in mouse decidualization have been recognized for decades, the molecular mechanisms remain understudied. In the present study, by using RNA-seq, we compared transcriptomic differences between the anti-mesometrial (AM) region and the mesometrial (M) region of mouse uterus on day 8 of pregnancy. A total of 1423 differentially expressed genes were identified, of which 811 genes were upregulated and 612 genes were downregulated in the AM region compared to those in the M region. Gene ontology analysis showed that upregulated genes were generally involved in cell metabolism and differentiation, whereas downregulated genes were associated with lymphocyte themes and immune response. Through network analysis, we identified a total of 6 hub genes. These hub genes are likely more important than other genes due to their key positions in the network. We also examined the promoter regions of differentially expressed genes for the enrichment of transcription factor-binding sites. In the end, we demonstrated that a similar regional gene expression pattern can be observed in the artificial decidualization model. Our study contributes to an increase in the knowledge on the molecular mechanisms underlying regional decidualization in mice.
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Affiliation(s)
- Miao Zhao
- College of Veterinary MedicineSouth China Agricultural University, Guangzhou, China
| | - Wen-Qian Zhang
- College of Veterinary MedicineSouth China Agricultural University, Guangzhou, China
| | - Ji-Long Liu
- College of Veterinary MedicineSouth China Agricultural University, Guangzhou, China
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70
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Figueiró-Filho EA, Croy BA, Reynolds JN, Dang F, Piro D, Rätsep MT, Forkert ND, Paolozza A, Smith GN, Stroman PW. Diffusion Tensor Imaging of White Matter in Children Born from Preeclamptic Gestations. AJNR Am J Neuroradiol 2017; 38:801-806. [PMID: 28126749 DOI: 10.3174/ajnr.a5064] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 11/06/2016] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND PURPOSE Individuals born from pregnancies complicated by preeclampsia have an elevated risk for cognitive impairment. Deviations in maternal plasma angiokines occur for prolonged intervals before clinical signs of preeclampsia. We hypothesized that fetal brain vascular and nervous tissue development become deviated during maternal progression toward preeclampsia and that such deviations would be detectable by MR imaging. MATERIALS AND METHODS In this pilot study, 10 matched (gestational and current ages) pairs (5 boys/5 girls, 7-10 years of age) from preeclampsia or control pregnancies were examined by using diffusion tensor MR imaging. An unbiased voxel-based analysis was conducted on fractional anisotropy and mean diffusivity parametric maps. Six brain ROIs were identified for subsequent analysis by tractography (middle occipital gyrus, caudate nucleus and precuneus, cerebellum, superior longitudinal fasciculus, and cingulate gyrus). RESULTS Statistical differences were present between groups for fractional anisotropy in the caudate nucleus (offspring from preeclamptic gestation > controls), volume of the tract for the superior longitudinal fasciculus (offspring from preeclamptic gestation > controls) and the caudate nucleus (offspring from preeclamptic gestation > controls), and for parallel diffusivity of the cingulate gyrus (offspring from preeclamptic gestation > controls). CONCLUSIONS These novel preliminary results along with previous results from the same children that identified altered cerebral vessel calibers and increased regional brain volumes justify fully powered MR imaging studies to address the impact of preeclampsia on human fetal brain development.
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Affiliation(s)
- E A Figueiró-Filho
- From the Departments of Biomedical and Molecular Sciences (E.A.F.-F., B.A.C., J.N.R., F.D., D.P., N.D.F., G.N.S.) .,Centre for Neuroscience Studies (E.A.F.-F., J.N.R., P.W.S.), Queen's University, Kingston, Ontario, Canada.,Faculty of Medicine (E.A.F.-F.), Federal University of Mato Grosso do Sul, Campo Grande, Mato Grosso do Sul, Brazil
| | - B A Croy
- From the Departments of Biomedical and Molecular Sciences (E.A.F.-F., B.A.C., J.N.R., F.D., D.P., N.D.F., G.N.S.)
| | - J N Reynolds
- From the Departments of Biomedical and Molecular Sciences (E.A.F.-F., B.A.C., J.N.R., F.D., D.P., N.D.F., G.N.S.).,Centre for Neuroscience Studies (E.A.F.-F., J.N.R., P.W.S.), Queen's University, Kingston, Ontario, Canada
| | - F Dang
- From the Departments of Biomedical and Molecular Sciences (E.A.F.-F., B.A.C., J.N.R., F.D., D.P., N.D.F., G.N.S.)
| | - D Piro
- From the Departments of Biomedical and Molecular Sciences (E.A.F.-F., B.A.C., J.N.R., F.D., D.P., N.D.F., G.N.S.)
| | - M T Rätsep
- Obstetrics and Gynecology (M.T.R., G.N.S.)
| | - N D Forkert
- From the Departments of Biomedical and Molecular Sciences (E.A.F.-F., B.A.C., J.N.R., F.D., D.P., N.D.F., G.N.S.).,Department of Radiology and Hotchkiss Brain Institute (N.D.F.), University of Calgary, Calgary, Alberta, Canada
| | - A Paolozza
- Laboratory for Infant Studies (A.P.), University of Toronto Scarborough, Scarborough, Ontario, Canada
| | - G N Smith
- From the Departments of Biomedical and Molecular Sciences (E.A.F.-F., B.A.C., J.N.R., F.D., D.P., N.D.F., G.N.S.).,Obstetrics and Gynecology (M.T.R., G.N.S.)
| | - P W Stroman
- Centre for Neuroscience Studies (E.A.F.-F., J.N.R., P.W.S.), Queen's University, Kingston, Ontario, Canada
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71
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Novel Regulators of Hemodynamics in the Pregnant Uterus. PROGRESS IN MOLECULAR BIOLOGY AND TRANSLATIONAL SCIENCE 2017; 145:181-216. [DOI: 10.1016/bs.pmbts.2016.12.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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72
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da Anunciação ARA, Mess AM, Orechio D, Aguiar BA, Favaron PO, Miglino MA. Extracellular matrix in epitheliochorial, endotheliochorial and haemochorial placentation and its potential application for regenerative medicine. Reprod Domest Anim 2016; 52:3-15. [DOI: 10.1111/rda.12868] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 09/10/2016] [Indexed: 12/20/2022]
Affiliation(s)
- ARA da Anunciação
- School of Veterinary Medicine and Animal Science; University of Sao Paulo; Sao Paulo Brazil
| | - AM Mess
- School of Veterinary Medicine and Animal Science; University of Sao Paulo; Sao Paulo Brazil
| | - D Orechio
- School of Veterinary Medicine and Animal Science; University of Sao Paulo; Sao Paulo Brazil
| | - BA Aguiar
- School of Veterinary Medicine and Animal Science; University of Sao Paulo; Sao Paulo Brazil
| | - PO Favaron
- School of Veterinary Medicine and Animal Science; University of Sao Paulo; Sao Paulo Brazil
| | - MA Miglino
- School of Veterinary Medicine and Animal Science; University of Sao Paulo; Sao Paulo Brazil
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73
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Senthilnayagam B, Karthikeyan S, Sukumaran J, Srivalsan A, Rao R, Subbiah V. Decidual CD56+ Natural Killer Cells in Spontaneous Early Pregnancy Loss- An Immunohistochemical Study. J Clin Diagn Res 2016; 10:EC27-EC29. [PMID: 27891347 DOI: 10.7860/jcdr/2016/22902.8740] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Accepted: 09/01/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Natural killer cells are believed to promote placental and trophoblastic growth and provide immune- modulation at maternal-fetal interface in pregnancy and their role in reproductive failure has been a matter of discussion. AIM To study CD56+ Natural killer cells in spontaneous pregnancy loss. MATERIALS AND METHODS In this prospective observational study, formalin-fixed paraffin embedded sections from products of conception from twenty women each with spontaneous early pregnancy loss (test group) and elective pregnancy termination (control group). Immunohistochemical staining with CD 56 monoclonal antibody was done by avidin-biotin peroxidase technique. CD56+ cells in decidua were counted under light microscopy by two independent observers in ten high power fields (40X) and mean cell count taken. Student's paired 't'-test was used to statistically compare CD56+ NK cell population between the test and control groups. RESULTS The mean number of CD56+ NK cells was higher in the decidual tissue of women who had spontaneous early pregnancy loss (mean±SD, 57.55±1.79) as compared to the mean number of CD56+ NK cells in the decidual tissue from women who underwent elective termination (mean±SD, 50.9±3.46). The difference was statistically significant (difference of 6.65 with 95% confidence interval of 4.76 to 8.54, p-value <0.0001). CONCLUSION This could imply that CD56+ NK cells have a role in the pathogenesis of spontaneous early pregnancy loss and further large scale studies can throw more light on the mechanism and designing of appropriate therapy.
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Affiliation(s)
- Balamurugan Senthilnayagam
- Professor, Department of Pathology, Chettinad Hospital and Research Institute , Kancheepuram, Tamil Nadu, India
| | - Sridhar Karthikeyan
- Intern, Department of Pathology, Chettinad Hospital and Research Institute , Kancheepuram, Tamil Nadu, India
| | - Jayapriya Sukumaran
- Assistant Professor (Formerly), Department of Microbiology, Chettinad Hospital and Research Institute , Kancheepuram, Tami Nadu, India
| | - Anoop Srivalsan
- Professor, Department of Obstetrics and Gynaecology, Chettinad Hospital and Research Institute , Kancheepuram, Tamil Nadu, India
| | - Ramesh Rao
- Professor, Department of Pathology, Chettinad Hospital and Research Institute , Kancheepuram, Tamil Nadu, India
| | - Vasantha Subbiah
- Professor, Department of Obstetrics and Gynaecology, Chettinad Hospital and Research Institute , Kancheepuram, Tamil Nadu, India
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74
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Perdu S, Castellana B, Kim Y, Chan K, DeLuca L, Beristain AG. Maternal obesity drives functional alterations in uterine NK cells. JCI Insight 2016; 1:e85560. [PMID: 27699222 DOI: 10.1172/jci.insight.85560] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Over one-fifth of North American women of childbearing age are obese, putting these women at risk for a variety of detrimental chronic diseases. In addition, obesity increases the risk for developing major complications during pregnancy. The mechanisms by which obesity contributes to pregnancy complications and loss remain unknown. Increasing evidence indicates that obesity results in major changes to adipose tissue immune cell composition and function; whether or not obesity also affects immune function in the uterus has not been explored. Here we investigated the effect of obesity on uterine natural killer (uNK) cells, which are essential for uterine artery remodeling and placental development. Using a cohort of obese or lean women, we found that obesity led to a significant reduction in uNK cell numbers accompanied with impaired uterine artery remodeling. uNK cells isolated from obese women had altered expression of genes and pathways associated with extracellular matrix remodeling and growth factor signaling. Specifically, uNK cells were hyper-responsive to PDGF, resulting in overexpression of decorin. Functionally, decorin strongly inhibited placental development by limiting trophoblast survival. Together, these findings establish a potentially new link between obesity and poor pregnancy outcomes, and indicate that obesity-driven changes to uterine-resident immune cells critically impair placental development.
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Affiliation(s)
- Sofie Perdu
- The Child and Family Research Institute, Vancouver, Canada
| | - Barbara Castellana
- The Child and Family Research Institute, Vancouver, Canada.,Department of Obstetrics and Gynecology and the
| | - Yoona Kim
- The Child and Family Research Institute, Vancouver, Canada
| | - Kathy Chan
- The Child and Family Research Institute, Vancouver, Canada
| | - Lauren DeLuca
- The Child and Family Research Institute, Vancouver, Canada.,Experimental Medicine Graduate Program, The University of British Columbia, Vancouver, Canada
| | - Alexander G Beristain
- The Child and Family Research Institute, Vancouver, Canada.,Department of Obstetrics and Gynecology and the.,Experimental Medicine Graduate Program, The University of British Columbia, Vancouver, Canada
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75
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Menon R, Bonney EA, Condon J, Mesiano S, Taylor RN. Novel concepts on pregnancy clocks and alarms: redundancy and synergy in human parturition. Hum Reprod Update 2016; 22:535-60. [PMID: 27363410 DOI: 10.1093/humupd/dmw022] [Citation(s) in RCA: 169] [Impact Index Per Article: 21.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 05/16/2016] [Indexed: 12/19/2022] Open
Abstract
The signals and mechanisms that synchronize the timing of human parturition remain a mystery and a better understanding of these processes is essential to avert adverse pregnancy outcomes. Although our insights into human labor initiation have been informed by studies in animal models, the timing of parturition relative to fetal maturation varies among viviparous species, indicative of phylogenetically different clocks and alarms; but what is clear is that important common pathways must converge to control the birth process. For example, in all species, parturition involves the transition of the myometrium from a relaxed to a highly excitable state, where the muscle rhythmically and forcefully contracts, softening the cervical extracellular matrix to allow distensibility and dilatation and thus a shearing of the fetal membranes to facilitate their rupture. We review a number of theories promulgated to explain how a variety of different timing mechanisms, including fetal membrane cell senescence, circadian endocrine clocks, and inflammatory and mechanical factors, are coordinated as initiators and effectors of parturition. Many of these factors have been independently described with a focus on specific tissue compartments.In this review, we put forth the core hypothesis that fetal membrane (amnion and chorion) senescence is the initiator of a coordinated, redundant signal cascade leading to parturition. Whether modified by oxidative stress or other factors, this process constitutes a counting device, i.e. a clock, that measures maturation of the fetal organ systems and the production of hormones and other soluble mediators (including alarmins) and that promotes inflammation and orchestrates an immune cascade to propagate signals across different uterine compartments. This mechanism in turn sensitizes decidual responsiveness and eventually promotes functional progesterone withdrawal in the myometrium, leading to increased myometrial cell contraction and the triggering of parturition. Linkage of these processes allows convergence and integration of the gestational clocks and alarms, prompting a timely and safe birth. In summary, we provide a comprehensive synthesis of the mediators that contribute to the timing of human labor. Integrating these concepts will provide a better understanding of human parturition and ultimately improve pregnancy outcomes.
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Affiliation(s)
- Ramkumar Menon
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine and Perinatal Research, The University of Texas Medical Branch at Galveston, 301 University Blvd., MRB, Room 11.138, Galveston, TX 77555-1062, USA
| | - Elizabeth A Bonney
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Vermont College of Medicine, 792 College Parkway, Fanny Allen Campus, Suite 101, Colchester, Burlington, VT 05446, USA
| | - Jennifer Condon
- Department of Obstetrics and Gynecology, Wayne State University, Perinatal Research Branch, NICHD, Detroit, MI 48201, USA
| | - Sam Mesiano
- Department of Reproductive Biology and Obstetrics and Gynecology, Case Western Reserve University, 11100 Euclid Ave, Cleveland, OH 44106, USA
| | - Robert N Taylor
- Department of Obstetrics and Gynecology, Medical Center Boulevard, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA
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76
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Abstract
Innate lymphoid cells (ILCs) are innate immune cells that provide an early source of cytokines to initiate and tailor the immune response to the type of the encountered pathogen or insult. The group 1 ILCs are comprised of conventional natural killer (cNK) cells and subsets of "unconventional NK cells," termed ILC1s. Although cNK cells and ILC1s share many features, such as certain phenotypic markers and the ability to produce IFN-γ upon activation, it is now becoming apparent that these two subsets develop from different progenitors and show unique tissue distribution and functional characteristics. Recent studies have aimed at elucidating the individual contributions of cNK cells and ILC1s during protective host responses as well as during chronic inflammation. This review provides an overview of the current knowledge of the developmental origins as well as of the phenotypic and functional characteristics of ILC1s.
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Affiliation(s)
- Anja Fuchs
- Department of Surgery, Washington University School of Medicine , St. Louis, MO , USA
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77
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Zavan B, do Amarante-Paffaro AM, Paffaro VA. alpha-actin down regulation and perforin loss in uterine natural killer cells from LPS-treated pregnant mice. Physiol Res 2016; 64:427-32. [PMID: 26066976 DOI: 10.33549/physiolres.932923] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
One of the most abundant immunologic cell types in early decidua is the uterine natural killer (UNK) cell that despite the presence of cytoplasmic granules rich in perforin and granzymes does not degranulate in normal pregnancy. UNK cells are important producers of angiogenic factors that permit normal dilation of uterine arteries to provide increased blood flow for the growing feto-placental unit. Gram-negative bacteria lipopolysaccharide (LPS) administration can trigger an imbalance of pro-inflammatory and anti-inflammatory cytokines impairing the normal immune cells activity as well as uterine homeostasis. The present study aimed to evaluate by immunohistochemistry the reactivity of perforin and alpha-actin on UNK cell from LPS-treated pregnant mice. For the first time, we demonstrate that LPS injection in pregnant mice causes alpha-actin down regulation, concomitantly with perforin loss in UNK cells. This suggests that LPS alters UNK cell migration and activates cytotoxic granule release.
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Affiliation(s)
- B Zavan
- Biomedical Science Institute, Federal University of Alfenas, Alfenas, Minas Gerais, Brazil.
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78
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Giaglis S, Stoikou M, Grimolizzi F, Subramanian BY, van Breda SV, Hoesli I, Lapaire O, Hasler P, Than NG, Hahn S. Neutrophil migration into the placenta: Good, bad or deadly? Cell Adh Migr 2016; 10:208-25. [PMID: 26933824 PMCID: PMC4853040 DOI: 10.1080/19336918.2016.1148866] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Almost 2 decades have passed since the discovery that pregnancy is associated with a basal inflammatory state involving neutrophil activation, and that this is more overt in cases with preeclampsia, than in instances with sepsis. This pivotal observation paved the way for our report, made almost a decade ago, describing the first involvement of neutrophil extracellular traps (NETs) in a non-infectious human pathology, namely preeclampsia, where an abundance of these structures were detected directly in the placental intervillous space. Despite these remarkable findings, there remains a paucity of interest among reproductive biologists in further exploring the role or involvement of neutrophils in pregnancy and related pathologies. In this review we attempt to redress this deficit by highlighting novel recent findings including the discovery of a novel neutrophil subset in the decidua, the interaction of placental protein 13 (PP13) and neutrophils in modulating spiral artery modification, as well as the use of animal model systems to elucidate neutrophil function in implantation, gestation and parturition. These model systems have been particularly useful in identifying key components implicated in recurrent fetal loss, preeclampsia or new signaling molecules such as sphingolipids. Finally, the recent discovery that anti-phospolipid antibodies can trigger NETosis, supports our hypothesis that these structures may contribute to placental dysfunction in pertinent cases with recurrent fetal loss.
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Affiliation(s)
- Stavros Giaglis
- a Department of Biomedicine , University Hospital Basel , Basel , Switzerland.,b Department Rheumatology , Cantonal Hospital Aarau , Aarau , Switzerland
| | - Maria Stoikou
- a Department of Biomedicine , University Hospital Basel , Basel , Switzerland
| | - Franco Grimolizzi
- a Department of Biomedicine , University Hospital Basel , Basel , Switzerland.,c Polytechnic University Marche , Ancona , Italy
| | - Bibin Y Subramanian
- a Department of Biomedicine , University Hospital Basel , Basel , Switzerland
| | - Shane V van Breda
- a Department of Biomedicine , University Hospital Basel , Basel , Switzerland
| | - Irene Hoesli
- a Department of Biomedicine , University Hospital Basel , Basel , Switzerland
| | - Olav Lapaire
- d Department of Obstetrics , University Women's Hospital Basel , Basel , Switzerland
| | - Paul Hasler
- b Department Rheumatology , Cantonal Hospital Aarau , Aarau , Switzerland
| | - Nandor Gabor Than
- e Lendulet Reproduction Research Group, Institute of Enzymology , Research Center for Natural Sciences; Hungarian Academy of Sciences , Budapest , Hungary
| | - Sinuhe Hahn
- a Department of Biomedicine , University Hospital Basel , Basel , Switzerland
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Rätsep MT, Hickman AF, Croy BA. The Elsevier trophoblast research award lecture: Impacts of placental growth factor and preeclampsia on brain development, behaviour, and cognition. Placenta 2016; 48 Suppl 1:S40-S46. [PMID: 26880207 DOI: 10.1016/j.placenta.2016.02.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2015] [Revised: 01/19/2016] [Accepted: 02/03/2016] [Indexed: 12/17/2022]
Abstract
Preeclampsia (PE) is a significant gestational disorder affecting 3-5% of all human pregnancies. In many PE pregnancies, maternal plasma is deficient in placental growth factor (PGF), a placentally-produced angiokine. Beyond immediate fetal risks associated with acute termination of the pregnancy, offspring of PE pregnancies (PE-F1) have higher long-term risks for hypertension, stroke, and cognitive impairment compared to F1s from uncomplicated pregnancies. At present, mechanisms that explain PE-F1 gains in postpartum risks are poorly understood. Our laboratory found that mice genetically-deleted for Pgf have altered fetal and adult brain vascular development. This is accompanied by sexually dimorphic alterations in anatomic structure in the adult Pgf-/- brain and impaired cognitive functions. We hypothesize that cerebrovascular and neurological aberrations occur in fetuses exposed to the progressive development of PE and that these brain changes impair cognitive functioning, enhance risk for stroke, elevate severity of stroke, and lead to worse stroke outcomes. These brain and placental outcomes may be linked to down-regulated PGF gene expression in early pre-implantation embryos, prior to gastrulation. This review explores our hypothesis that there are mechanistic links between low PGF detection in maternal plasma prodromal to PE, PE, and altered brain vascular, structural, and functional development amongst PE-F1s. We also include a summary of preliminary outcomes from a pilot study of 7-10 year old children that is the first to report magnetic resonance imaging, magnetic resonance angiography, and functional brain region assessment by eye movement control studies in PE-F1s.
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Affiliation(s)
- Matthew T Rätsep
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, Ontario, Canada.
| | - Andrew F Hickman
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, Ontario, Canada
| | - B Anne Croy
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, Ontario, Canada
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80
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Luna RL, Kay VR, Rätsep MT, Khalaj K, Bidarimath M, Peterson N, Carmeliet P, Jin A, Croy BA. Placental growth factor deficiency is associated with impaired cerebral vascular development in mice. Mol Hum Reprod 2016; 22:130-42. [PMID: 26646502 PMCID: PMC4733225 DOI: 10.1093/molehr/gav069] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Revised: 11/23/2015] [Accepted: 11/27/2015] [Indexed: 12/23/2022] Open
Abstract
STUDY HYPOTHESIS Placental growth factor (PGF) is expressed in the developing mouse brain and contributes to vascularization and vessel patterning. STUDY FINDING PGF is dynamically expressed in fetal mouse brain, particularly forebrain, and is essential for normal cerebrovascular development. WHAT IS KNOWN ALREADY PGF rises in maternal plasma over normal human and mouse pregnancy but is low in many women with the acute onset hypertensive syndrome, pre-eclampsia (PE). Little is known about the expression of PGF in the fetus during PE. Pgf (-/-) mice appear normal but recently cerebral vascular defects were documented in adult Pgf (-/-) mice. STUDY DESIGN, SAMPLES/MATERIALS, METHODS Here, temporal-spatial expression of PGF is mapped in normal fetal mouse brains and cerebral vasculature development is compared between normal and congenic Pgf (-/-) fetuses to assess the actions of PGF during cerebrovascular development. Pgf/PGF, Vegfa/VEGF, Vegf receptor (Vegfr)1 and Vegfr2 expression were examined in the brains of embryonic day (E)12.5, 14.5, 16.5 and 18.5 C57BL/6 (B6) mice using quantitative PCR and immunohistochemistry. The cerebral vasculature was compared between Pgf (-/-) and B6 embryonic and adult brains using whole mount techniques. Vulnerability to cerebral ischemia was investigated using a left common carotid ligation assay. MAIN RESULTS AND THE ROLE OF CHANCE Pgf/PGF and Vegfr1 are highly expressed in E12.5-14.5 forebrain relative to VEGF and Vegfr2. Vegfa/VEGF is relatively more abundant in hindbrain (HB). PGF and VEGF expression were similar in midbrain. Delayed HB vascularization was seen at E10.5 and 11.5 in Pgf (-/-) brains. At E14.5, Pgf (-/-) circle of Willis showed unilateral hypoplasia and fewer collateral vessels, defects that persisted post-natally. Functionally, adult Pgf (-/-) mice experienced cerebral ischemia after left common carotid arterial occlusion while B6 mice did not. LIMITATIONS, REASONS FOR CAUTION Since Pgf (-/-) mice were used, consequences of complete absence of maternal and fetal PGF were defined. Therefore, the effects of maternal versus fetal PGF deficiency on cerebrovascular development cannot be separated. However, as PGF was strongly expressed in the developing brain at all timepoints, we suggest that local PGF has a more important role than distant maternal or placental sources. Full PGF loss is not expected in PE pregnancies, predicting that the effects of PGF deficiency identified in this model will be more severe than any effects in PE-offspring. WIDER IMPLICATIONS OF THE FINDINGS These studies provoke the question of whether PGF expression is decreased and cerebral vascular maldevelopment occurs in fetuses who experience a preeclamptic gestation. These individuals have already been reported to have elevated risk for stroke and cognitive impairments. LARGE SCALE DATA N/A. STUDY FUNDING AND COMPETING INTERESTS This work was supported by awards from the Natural Sciences and Engineering Research Council, the Canada Research Chairs Program and the Canadian Foundation for Innovation to B.A.C. and by training awards from the Universidade Federal de Pernambuco and Conselho Nacional de Desenvolvimento Cientifico e Tecnologico (CNPq), Brazil to R.L.L.; Queen's University to V.R.K. and the Canadian Institutes of Health Research to M.T.R. The work of P.C. is supported by the Belgian Science Policy BELSPO-IUAP7/03, Structural funding by the Flemish Government-Methusalem funding, and the Flemish Science Fund-FWO grants. There were no competing interests.
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Affiliation(s)
- Rayana Leal Luna
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, ON K7L 3N6, Canada Federal University of Pernambuco - UFPE, Recife, Pernambuco 50670-901, Brazil
| | - Vanessa R Kay
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, ON K7L 3N6, Canada
| | - Matthew T Rätsep
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, ON K7L 3N6, Canada
| | - Kasra Khalaj
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, ON K7L 3N6, Canada
| | - Mallikarjun Bidarimath
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, ON K7L 3N6, Canada
| | - Nichole Peterson
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, ON K7L 3N6, Canada
| | - Peter Carmeliet
- Laboratory of Angiogenesis and Neurovascular Link, Vesalius Research Center, Department of Oncology, University of Leuven, Leuven, Belgium
| | - Albert Jin
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, ON K7L 3N6, Canada
| | - B Anne Croy
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, ON K7L 3N6, Canada
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81
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Montaldo E, Vacca P, Chiossone L, Croxatto D, Loiacono F, Martini S, Ferrero S, Walzer T, Moretta L, Mingari MC. Unique Eomes(+) NK Cell Subsets Are Present in Uterus and Decidua During Early Pregnancy. Front Immunol 2016; 6:646. [PMID: 27004067 PMCID: PMC4794975 DOI: 10.3389/fimmu.2015.00646] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Accepted: 12/11/2015] [Indexed: 12/22/2022] Open
Abstract
Decidual and uterine natural killer (NK) cells have been shown to contribute to the successful pregnancy both in humans and mice. NK cells represent “cytotoxic” group 1 innate lymphoid cells (ILCs) and are distinct from the recently described “helper” ILC1. Here, we show that both in humans and mice the majority of group 1 ILC in endometrium/uterus and decidua express Eomesodermin (Eomes), thus suggesting that they are developmentally related to conventional NK cells. However, they differ from peripheral NK cells. In humans, Eomes+ decidual NK (dNK) cells express CD49a and other markers of tissue residency, including CD103, integrin β7, CD9, and CD69. The expression of CD103 allows the identification of different subsets of IFNγ-producing Eomes+ NK cells. We show that TGFβ can sustain/induce CD103 and CD9 expression in dNK cells and decidual CD34-derived NK cells, indicating that the decidual microenvironment can instruct the phenotype of Eomes+ NK cells. In murine decidua and uterus, Eomes+ cells include CD49a−CD49b+ conventional NK cells and CD49a+ cells. Notably, Eomes+CD49a+ cells are absent in spleen and liver. Decidual and uterine Eomes+CD49a+ cells can be dissected in two peculiar cell subsets according to CD49b expression. CD49a+CD49b− and CD49a+CD49b+ cells are enriched in immature CD11blowCD27high cells, while CD49a−CD49b+ cells contain higher percentages of mature CD11bhighCD27low cells, both in uterus and decidua. Moreover, Eomes+CD49a+CD49b− cells decrease during gestation, thus suggesting that this peculiar subset may be required in early pregnancy rather than on later phases. Conversely, a minor Eomes−CD49a+ ILC1 population present in decidua and uterus increases during pregnancy. CD49b−Eomes± cells produce mainly TNF, while CD49a−CD49b+ conventional NK cells and CD49a+CD49b+ cells produce both IFNγ and TNF. Thus, human and murine decidua contains unique subsets of group 1 ILCs, including Eomes+ and Eomes− cells, with peculiar phenotypic and functional features. Our study contributes to re-examination of the complexity of uterine and decidual ILC subsets in humans and mice and highlights the role of the decidual microenvironment in shaping the features of these cells.
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Affiliation(s)
| | - Paola Vacca
- Department of Experimental Medicine (DIMES), Università degli Studi di Genova , Genoa , Italy
| | | | - Daniele Croxatto
- Department of Experimental Medicine (DIMES), Università degli Studi di Genova , Genoa , Italy
| | | | | | - Simone Ferrero
- IRCCS AOU San Martino-IST, Genoa, Italy; Department of Neurosciences Rehabilitation Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), Università degli Studi di Genova, Genoa, Italy
| | - Thierry Walzer
- CIRI, Centre International de Recherche en Infectiologie - INSERM, Ecole Normale Supérieure de Lyon, Université Lyon 1 , CNRS, Lyon , France
| | - Lorenzo Moretta
- Department of Immunology, IRCCS Bambino Gesù Children's Hospital , Rome , Italy
| | - Maria Cristina Mingari
- Department of Experimental Medicine (DIMES), Università degli Studi di Genova, Genoa, Italy; IRCCS AOU San Martino-IST, Genoa, Italy
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82
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Fisher SJ. Why is placentation abnormal in preeclampsia? Am J Obstet Gynecol 2015; 213:S115-22. [PMID: 26428489 DOI: 10.1016/j.ajog.2015.08.042] [Citation(s) in RCA: 394] [Impact Index Per Article: 43.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Accepted: 08/16/2015] [Indexed: 02/02/2023]
Abstract
The causes of preeclampsia remain one of the great medical mysteries of our time. This syndrome is thought to occur in 2 stages with abnormal placentation leading to a maternal inflammatory response. Specific regions of the placenta have distinct pathologic features. During normal pregnancy, cytotrophoblasts emigrate from the chorionic villi and invade the uterus, reaching the inner third of the myometrium. This unusual process is made even more exceptional by the fact that the placental cells are hemiallogeneic, coexpressing maternal and paternal genomes. Within the uterine wall, cytotrophoblasts deeply invade the spiral arteries. Cytotrophoblasts migrate up these vessels and replace, in a retrograde fashion, the maternal endothelial lining. They also insert themselves among the smooth muscle cells that form the tunica media. As a result, the spiral arteries attain the physiologic properties that are required to perfuse the placenta adequately. In comparison, invasion of the venous side of the uterine circulation is minimal, sufficient to enable venous return. In preeclampsia, cytotrophoblast invasion of the interstitial uterine compartment is frequently shallow, although not consistently so. In many locations, spiral artery invasion is incomplete. There are many fewer endovascular cytotrophoblasts, and some vessels retain portions of their endothelial lining with relatively intact muscular coats, although others are not modified. Work from our group showed that these defects mirror deficits in the differentiation program that enables cytotrophoblast invasion of the uterine wall. During normal pregnancy, invasion is accompanied by the down-regulation of epithelial-like molecules that are indicative of their ectodermal origin and up-regulation of numerous receptors and ligands that typically are expressed by endothelial or vascular smooth muscle cells. For example, the expression of epithelial-cadherin (the cell-cell adhesion molecule that many ectodermal derivatives use to adhere to one another) becomes nearly undetectable, replaced by vascular-endothelial cadherin, which serves the same purpose in blood vessels. Invading cytotrophoblasts also modulate vascular endothelial growth factor ligands and receptors, at some point in the differentiation process expressing every (mammalian) family member. Molecules in this family play crucial roles in vascular and trophoblast biology, including the prevention of apoptosis. In preeclampsia, this process of vascular mimicry is incomplete, which we theorize hinders the cells interactions with spiral arterioles. What causes these aberrations? Given what is known from animal models and human risk factors, reduced placental perfusion and/or certain disease states (metabolic, immune and cardiovascular) lie upstream. Recent evidence suggests the surprising conclusion that isolation and culture of cytotrophoblasts from the placentas of pregnancies complicated by preeclampsia enables normalization of their gene expression. The affected molecules include SEMA3B, which down-regulates vascular endothelial growth factor signaling through the PI3K/AKT and GSK3 pathways. Thus, some aspects of the aberrant differentiation of cytotrophoblasts within the uterine wall that is observed in situ may be reversible. The next challenge is asking what the instigating causes are. There is added urgency to finding the answers, because these pathways could be valuable therapeutic targets for reversing abnormal placental function in patients.
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83
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Woidacki K, Meyer N, Schumacher A, Goldschmidt A, Maurer M, Zenclussen AC. Transfer of regulatory T cells into abortion-prone mice promotes the expansion of uterine mast cells and normalizes early pregnancy angiogenesis. Sci Rep 2015; 5:13938. [PMID: 26355667 PMCID: PMC4565045 DOI: 10.1038/srep13938] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Accepted: 08/03/2015] [Indexed: 12/21/2022] Open
Abstract
Implantation of the fertilized egg depends on the coordinated interplay of cells and
molecules that prepare the uterus for this important event. In particular,
regulatory T cells (Tregs) are key regulators as their ablation hinders implantation
by rendering the uterus hostile for the embryo. In addition, the adoptive transfer
of Tregs can avoid early abortion in mouse models. However, it is still not defined
which mechanisms underlie Treg function during this early period. Cells of the
innate immune system have been reported to support implantation, in part by
promoting angiogenesis. In particular, uterine mast cells (uMCs) emerge as novel
players at the fetal-maternal interface. Here, we studied whether the positive
action of Tregs is based on the expansion of uMCs and the promotion of angiogenesis.
We observed that abortion-prone mice have insufficient numbers of uMCs that could be
corrected by the adoptive transfer of Tregs. This in turn positively influenced the
remodeling of spiral arteries and placenta development as well as the levels of
soluble fms-like tyrosine kinase 1 (sFlt-1). Our data suggest an interplay between
Tregs and uMCs that is relevant for the changes required at the feto-maternal
interface for the normal development of pregnancy.
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Affiliation(s)
- Katja Woidacki
- Experimental Obstetrics and Gynecology, Medical Faculty, Otto-von-Guericke University, Magdeburg, Germany
| | - Nicole Meyer
- Experimental Obstetrics and Gynecology, Medical Faculty, Otto-von-Guericke University, Magdeburg, Germany
| | - Anne Schumacher
- Experimental Obstetrics and Gynecology, Medical Faculty, Otto-von-Guericke University, Magdeburg, Germany
| | - Alexandra Goldschmidt
- Experimental Obstetrics and Gynecology, Medical Faculty, Otto-von-Guericke University, Magdeburg, Germany
| | - Marcus Maurer
- Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Germany
| | - Ana Claudia Zenclussen
- Experimental Obstetrics and Gynecology, Medical Faculty, Otto-von-Guericke University, Magdeburg, Germany
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84
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Zenclussen AC, Hämmerling GJ. Cellular Regulation of the Uterine Microenvironment That Enables Embryo Implantation. Front Immunol 2015; 6:321. [PMID: 26136750 PMCID: PMC4470084 DOI: 10.3389/fimmu.2015.00321] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Accepted: 06/03/2015] [Indexed: 11/13/2022] Open
Abstract
Implantation of the fertilized egg into the maternal uterus is a crucial step in pregnancy establishment. Increasing evidence suggests that its success depends on various cell types of the innate immune system and on the fine balance between inflammatory and anti-inflammatory processes. In addition, it has recently been established that regulatory T cells play a superordinate role in dictating the quality of uterine environment required for successful pregnancy. Here, we discuss the cellular regulation of uterine receptivity with emphasis on the function and regulation of cells from the innate and adaptive immune system.
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Affiliation(s)
- Ana Claudia Zenclussen
- Experimental Obstetrics and Gynecology, Medical Faculty, Otto-von-Guericke University , Magdeburg , Germany
| | - Günter J Hämmerling
- Molecular Immunology, German Cancer Research Center (DKFZ) , Heidelberg , Germany
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85
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Hahn S, Lapaire O, Than NG. Biomarker development for presymptomatic molecular diagnosis of preeclampsia: feasible, useful or even unnecessary? Expert Rev Mol Diagn 2015; 15:617-29. [PMID: 25774007 PMCID: PMC4673513 DOI: 10.1586/14737159.2015.1025757] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The past decade saw the advent of a number of promising biomarkers to detect pregnancies at risk for preeclampsia (PE), the foremost being those associated with an imbalance of angiogenic factors. In late pregnancy, these are useful for the detection of imminent cases of PE, while earlier they were more predictive for early- than late-onset PE. This suggests that there may be fundamental differences between the underlying pathology of these two PE forms. Therefore, it is possible that such a biological premise may limit the development of biomarkers that will permit the efficacious detection of both early- and late-onset PE via an analysis of first-trimester maternal blood samples. Consequently, a significant increase in our understanding of the underlying pathology of PE, using a variety of approaches ranging from systems biology to animal models, will be necessary in order to overcome this obstacle.
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Affiliation(s)
- Sinuhe Hahn
- Laboratory for Prenatal Medicine, Department of Biomedicine, University Hospital Basel, Hebelstrasse 20, CH 4031 Basel, Switzerland
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86
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Aasa KL, Zavan B, Luna RL, Wong PG, Ventura NM, Tse MY, Carmeliet P, Adams MA, Pang SC, Croy BA. Placental growth factor influences maternal cardiovascular adaptation to pregnancy in mice. Biol Reprod 2014; 92:44. [PMID: 25537372 DOI: 10.1095/biolreprod.114.124677] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
In healthy human pregnancies, placental growth factor (PGF) concentrations rise in maternal plasma during early gestation, peak over Weeks 26-30, then decline. Because PGF in nongravid subjects participates in protection against and recovery from cardiac pathologies, we asked if PGF contributes to pregnancy-induced maternal cardiovascular adaptations. Cardiovascular function and structure were evaluated in virgin, pregnant, and postpartum C56BL/6-Pgf(-) (/) (-) (Pgf(-) (/) (-)) and C57BL/6-Pgf(+/+) (B6) mice using plethysmography, ultrasound, quantitative PCR, and cardiac and renal histology. Pgf(-/-) females had higher systolic blood pressure in early and late pregnancy but an extended, abnormal midpregnancy interval of depressed systolic pressure. Pgf(-/-) cardiac output was lower than gestation day (gd)-matched B6 after midpregnancy. While Pgf(-) (/) (-) left ventricular mass was greater than B6, only B6 showed the expected gestational gain in left ventricular mass. Expression of vasoactive genes in the left ventricle differed at gd8 with elevated Nos expression in Pgf(-) (/) (-) but not at gd14. By gd16, Pgf(-) (/) (-) kidneys were hypertrophic and had glomerular pathology. This study documents for the first time that PGF is associated with the systemic maternal cardiovascular adaptations to pregnancy.
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Affiliation(s)
- Kristiina L Aasa
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, Ontario Canada
| | - Bruno Zavan
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, Ontario Canada Department of Cell, Tissue and Developmental Biology, Federal University of Alfenas, Alfenas MG, Brazil
| | - Rayana L Luna
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, Ontario Canada Federal University of Pernambuco - UFPE, Recife, Brazil
| | - Philip G Wong
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, Ontario Canada
| | - Nicole M Ventura
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, Ontario Canada
| | - M Yat Tse
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, Ontario Canada
| | - Peter Carmeliet
- Laboratory of Angiogenesis and Neurovascular Link, Vesalius Research Center, VIB, Leuven, Belgium Laboratory of Angiogenesis and Neurovascular Biology, Vesalius Research Center, Department of Oncology, University of Leuven, Leuven, Belgium
| | - Michael A Adams
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, Ontario Canada
| | - Stephen C Pang
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, Ontario Canada
| | - B Anne Croy
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, Ontario Canada
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