1
|
Herrera Choque AG, Cuna WR, Gabrielli S, Mattiucci S, Passera R, Rodriguez C. Parasitic Effects on the Congenital Transmission of Trypanosoma cruzi in Mother-Newborn Pairs. Microorganisms 2024; 12:1243. [PMID: 38930625 PMCID: PMC11206037 DOI: 10.3390/microorganisms12061243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2024] [Revised: 06/11/2024] [Accepted: 06/13/2024] [Indexed: 06/28/2024] Open
Abstract
Maternal parasitemia and placental parasite load were examined in mother-newborn pairs to determine their effect on the congenital transmission of Trypanosoma cruzi. Parasitemia was qualitatively assessed in mothers and newborns by the microhematocrit test; parasite load was determined in the placental tissues of transmitting and non-transmitting mothers by the detection of T. cruzi DNA and by histology. Compared to transmitter mothers, the frequency and prevalence of parasitemia were found to be increased in non-transmitter mothers; however, the frequency and prevalence of parasite load were higher among the transmitter mothers than among their non-transmitter counterparts. Additionally, serum levels of interferon (IFN)-γ were measured by an enzyme-linked immunosorbent assay (ELISA) in peripheral, placental, and cord blood samples. Median values of IFN-γ were significantly increased in the cord blood of uninfected newborns. The median IFN-γ values of transmitter and non-transmitter mothers were not significantly different; however, non-transmitter mothers had the highest total IFN-γ production among the group of mothers. Collectively, the results of this study suggest that the anti-T. cruzi immune response occurring in the placenta and cord is under the influence of the cytokines from the mother's blood and results in the control of parasitemia in uninfected newborns.
Collapse
Affiliation(s)
- Ana Gabriela Herrera Choque
- Unidad de Inmunología Parasitaria, Facultad de Medicina, Universidad Mayor de San Andrés, La Paz, Bolivia; (A.G.H.C.); (W.R.C.)
| | - Washington R. Cuna
- Unidad de Inmunología Parasitaria, Facultad de Medicina, Universidad Mayor de San Andrés, La Paz, Bolivia; (A.G.H.C.); (W.R.C.)
| | - Simona Gabrielli
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy; (S.G.); (S.M.)
| | - Simonetta Mattiucci
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy; (S.G.); (S.M.)
| | - Roberto Passera
- Department of Medical Sciences, University of Torino, 10126 Torino, Italy;
| | - Celeste Rodriguez
- Unidad de Inmunología Parasitaria, Facultad de Medicina, Universidad Mayor de San Andrés, La Paz, Bolivia; (A.G.H.C.); (W.R.C.)
| |
Collapse
|
2
|
Benizio E, Moreira-Espinoza MJ, Triquell MF, Mezzano L, Díaz-Luján CM, Fretes RE. Pro-inflammatory cytokines are modified during the multiplication of Trypanosoma cruzi within the placental chorionic villi and are associated with the level of infection via the signaling pathway NF-κB. Am J Reprod Immunol 2023; 90:e13777. [PMID: 37766400 DOI: 10.1111/aji.13777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 08/20/2023] [Accepted: 08/29/2023] [Indexed: 09/29/2023] Open
Abstract
PROBLEM Congenital Trypanosoma cruzi (T. cruzi) infection has been associated with changes in the levels of TNF-α and IFN-γ during the pregnancy. Therefore, we propose to study the participation and dynamics of proinflammatory cytokines in the infection process of placental explants infected by T. cruzi in vitro. METHOD OF STUDY Chorionic villous explants (CVE) obtained of human term placentas (n = 8) from normal pregnancies were cultured with 105 trypomastigotes/mL of Tulahuen strain DTU VI for 0, 2, 4, 16, 24, 48 and 72 h. Explants were treated with sulfasalazine (SULF) (5 mM) and N-acetyl-cysteine (NAC) (15 mM), as inhibitors molecules of NF-κB pathway, or LPS (1 μg/mL) for 24 and 72 h p.i. Motile trypomastigotes were counted in culture supernatants. Immunohistochemistry and ELISA for TNF-α, IFN-γ, IL-1β, IL-4, and IL-10 were performed in CVE and culture supernatants respectively. The parasite load was measured by RT-qPCR. RESULTS T. cruzi invades the chorionic villi from 4 h p.i. increasing significantly its DNA at 48 and 72 h p.i. of culture (parasite multiplication phase). They were detected in stromal cells, which was related to elevation of TNF-α, IL-1β, IFN-γ, and IL-10. The inhibition of NF-κB activity in the explants decreased the production of the analyzed cytokines, showing elevated levels of T. cruzi DNA during the multiplication phase of the parasite. CONCLUSIONS Placental tissue modifies the secretion of pro-inflammatory cytokines during the phase of parasite multiplication, but not during the invasion phase, which in turns modifies the level of infection via the signaling pathway NF-κB.
Collapse
Affiliation(s)
- Evangelina Benizio
- Institute and Cathedra of Cell Biology, Histology and Embryology, Health Science Faculty, Universidad Nacional de Córdoba - INICSA (CONICET), Ciudad Universitaria Córdoba, Córdoba, Argentina
- Instituto Académico Pedagógico de Ciencias Humanas (IAPCH), Universidad Nacional de Villa María (UNVM), Villa María, Córdoba, Argentina
| | - María José Moreira-Espinoza
- Institute and Cathedra of Cell Biology, Histology and Embryology, Health Science Faculty, Universidad Nacional de Córdoba - INICSA (CONICET), Ciudad Universitaria Córdoba, Córdoba, Argentina
| | - María Fernanda Triquell
- Institute and Cathedra of Cell Biology, Histology and Embryology, Health Science Faculty, Universidad Nacional de Córdoba - INICSA (CONICET), Ciudad Universitaria Córdoba, Córdoba, Argentina
- Instituto Académico Pedagógico de Ciencias Humanas (IAPCH), Universidad Nacional de Villa María (UNVM), Villa María, Córdoba, Argentina
| | - Luciana Mezzano
- Institute and Cathedra of Cell Biology, Histology and Embryology, Health Science Faculty, Universidad Nacional de Córdoba - INICSA (CONICET), Ciudad Universitaria Córdoba, Córdoba, Argentina
| | - Cintia M Díaz-Luján
- Institute and Cathedra of Cell Biology, Histology and Embryology, Health Science Faculty, Universidad Nacional de Córdoba - INICSA (CONICET), Ciudad Universitaria Córdoba, Córdoba, Argentina
- Instituto Académico Pedagógico de Ciencias Humanas (IAPCH), Universidad Nacional de Villa María (UNVM), Villa María, Córdoba, Argentina
| | - Ricardo E Fretes
- Institute and Cathedra of Cell Biology, Histology and Embryology, Health Science Faculty, Universidad Nacional de Córdoba - INICSA (CONICET), Ciudad Universitaria Córdoba, Córdoba, Argentina
- Instituto Académico Pedagógico de Ciencias Humanas (IAPCH), Universidad Nacional de Villa María (UNVM), Villa María, Córdoba, Argentina
| |
Collapse
|
3
|
Mezzano L, Morán JP, Moreira-Espinoza MJ, Triquell MF, Mezzano J, Díaz-Luján CM, Fretes RE. Chagas disease affects the human placental barrier's turnover dynamics during pregnancy. Mem Inst Oswaldo Cruz 2022; 117:e210304. [PMID: 35766782 PMCID: PMC9239690 DOI: 10.1590/0074-02760210304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 04/11/2022] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Trypanosoma cruzi crosses the placental barrier and produces the congenital transmission of Chagas disease (CD). Structural alterations of the chorionic villi by this parasite have been described in vitro, but little is known about trophoblast turnover in placentas from women with CD. OBJECTIVE To analyze the proliferation and fusion processes in placentas from women with CD. METHODS Archived human term placenta paraffin-embedded blocks were used, from women with CD (CDP), and no pathology (NP). Immunohistochemistry tests were performed for Ki67 to calculate the proliferation index (PI) of cytotrophoblast (CTB) and Syncytin-1, a fusion marker of syncytiotrophoblast (STB). Hematoxylin/Eosin stained sections were employed to analyze STB percentages, STB detachment areas and syncytial knots quantity. Non parametric Student's t-tests were performed (p < 0.05). RESULTS Syncytial knots and STB detachment significantly increased in placental villi from the CDP group. STB percentage was significantly lower in the CDP group as well as the PI and Syncytin-1 expression significantly decreased in these placentas, compared with control (NP). CONCLUSION Dynamic of trophoblast turnover is altered in placentas from women with CD. These changes may lead into a gap in the placental barrier possibly allowing the parasite entry into the chorionic villi.
Collapse
Affiliation(s)
- Luciana Mezzano
- National University of Córdoba, Institute of Research in Health Sciences (CONICET), Medicine School, Cellular Biology Institute, Cathedra of Cellular Biology, Histology and Embryology, Córdoba, Argentina,+ Corresponding authors: /
| | - Joana Paola Morán
- National University of Córdoba, Institute of Research in Health Sciences (CONICET), Medicine School, Cellular Biology Institute, Cathedra of Cellular Biology, Histology and Embryology, Córdoba, Argentina
| | - María José Moreira-Espinoza
- National University of Córdoba, Institute of Research in Health Sciences (CONICET), Medicine School, Cellular Biology Institute, Cathedra of Cellular Biology, Histology and Embryology, Córdoba, Argentina
| | - María Fernanda Triquell
- National University of Córdoba, Institute of Research in Health Sciences (CONICET), Medicine School, Cellular Biology Institute, Cathedra of Cellular Biology, Histology and Embryology, Córdoba, Argentina,National University of Villa María, Institute of Human Sciences, Histology, Cytology and Embryology Department, Córdoba, Argentina
| | - Julieta Mezzano
- Tufts University, Friedman School of Nutrition Science and Policy, Boston, MA, USA
| | - Cintia María Díaz-Luján
- National University of Córdoba, Institute of Research in Health Sciences (CONICET), Medicine School, Cellular Biology Institute, Cathedra of Cellular Biology, Histology and Embryology, Córdoba, Argentina,National University of Villa María, Institute of Human Sciences, Histology, Cytology and Embryology Department, Córdoba, Argentina
| | - Ricardo Emilio Fretes
- National University of Córdoba, Institute of Research in Health Sciences (CONICET), Medicine School, Cellular Biology Institute, Cathedra of Cellular Biology, Histology and Embryology, Córdoba, Argentina,National University of Villa María, Institute of Human Sciences, Histology, Cytology and Embryology Department, Córdoba, Argentina,+ Corresponding authors: /
| |
Collapse
|
4
|
|
5
|
Liempi A, Castillo C, Medina L, Galanti N, Maya JD, Parraguez VH, Kemmerling U. Comparative ex vivo infection with Trypanosoma cruzi and Toxoplasma gondii of human, canine and ovine placenta: Analysis of tissue damage and infection efficiency. Parasitol Int 2020; 76:102065. [PMID: 32001348 DOI: 10.1016/j.parint.2020.102065] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 01/07/2020] [Accepted: 01/24/2020] [Indexed: 11/24/2022]
Abstract
Trypanosoma cruzi, the causative agent of Chagas disease, and Toxoplasma gondii, which is responsible for Toxoplasmosis, are two parasites that cause significant protozoan zoonoses and consequently important economic losses in human, companion animals and livestock. For the congenital transmission to occur, both parasites must cross the barrier present in the mammalian placenta, which differs between species. Particularly, hemochorial, endotheliochorial and epitheliochorial placental barriers are present, respectively, in human, dog and sheep. The type of placental barrier has been associated with the probability of transmission of pathogens. In this study, we used experimental placental ex vivo infection models of T. cruzi and T. gondii in the above-mentioned mammals in order to study tissue alterations and to compare infection efficiency. Here, we infected placental term explants from human, dog and sheep and analyzed tissue damage by standard histological and histochemical methods. Comparative infection efficiency was determined by quantitative PCR. Both parasites are able to infect the different placental explants; however, more T. gondii parasites were detected, and T. gondii causes a more severe tissue damage in human and canine explants than T. cruzi. The histopathological changes observed in ovine placenta explants were similar in presence of both parasites. We conclude that the infection efficiency of T. gondii is higher, compared to T. cruzi, during the ex vivo infection of human, canine and ovine placental explants. In addition, the ex vivo infection of mammalian placental explants constitutes an interesting experimental approach to study part of the infection mechanisms as well as host responses during congenital infection of both parasites.
Collapse
Affiliation(s)
- Ana Liempi
- Programa de Anatomía y Biología del Desarrollo, Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Christian Castillo
- Programa de Anatomía y Biología del Desarrollo, Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Lisvaneth Medina
- Programa de Anatomía y Biología del Desarrollo, Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Norbel Galanti
- Programa de Biología Celular y Molecular, Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Juan Diego Maya
- Programa de Farmacología Molecular y Clínica, Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Victor Hugo Parraguez
- Departamento de Ciencias Biológicas Animales, Facultad de Ciencias Veterinarias y Pecuarias, Universidad de Chile, Santiago, Chile
| | - Ulrike Kemmerling
- Programa de Anatomía y Biología del Desarrollo, Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de Chile, Santiago, Chile.
| |
Collapse
|
6
|
Triquell MF, Díaz-Luján C, Romanini MC, Ramirez JC, Paglini-Oliva P, Schijman AG, Fretes RE. Nitric oxide synthase and oxidative-nitrosative stress play a key role in placental infection by Trypanosoma cruzi. Am J Reprod Immunol 2018; 80:e12852. [PMID: 29577492 DOI: 10.1111/aji.12852] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2017] [Accepted: 03/02/2018] [Indexed: 12/28/2022] Open
Abstract
PROBLEM The innate immune response of the placenta may participate in the congenital transmission of Chagas disease through releasing reactive oxygen and nitrogen intermediates. METHOD OF STUDY Placental explants were cultured with 1 × 106 and 1 × 105 trypomastigotes of Tulahuen and Lucky strains and controls without parasites, and with the addition of nitric oxide synthase inhibitor Nω-Nitro-l-arginine methyl ester (l-NAME) and N-acetyl cysteine (NAC) as the reactive oxygen species (ROS) scavenger. Detachment of the syncytiotrophoblast (STB) was examined by histological analysis, and the nitric oxide synthase, endothelial (eNOS), and nitrotyrosine expressions were analyzed by immunohistochemistry, as well as the human chorionic gonadotrophin (hCG) levels in the culture supernatant through ELISA assays. Parasite load with qPCR using Taqman primers was quantified. RESULTS The higher number of T. cruzi (106 ) increased placental infection, eNOS expression, nitrosative stress, and STB detachment, with the placental barrier being injured by oxidative stress. CONCLUSION The higher number of parasites caused deleterious consequences to the placental barrier, and the inhibitors (l-NAME and NAC) prevented the damage caused by trypomastigotes in placental villi but not that of the infection. Moreover, trophoblast eNOS played a key role in placental infection with the highest inoculum of Lucky, demonstrating the importance of the enzyme and nitrosative-oxidative stress in Chagas congenital transmission.
Collapse
Affiliation(s)
- María Fernanda Triquell
- Biología Celular, Histología y Embriología, Fac. Cs. Médicas, Universidad Nacional de Córdoba-INICSA (CONICET), Córdoba, Argentina.,Histología y Citología, Instituto de Ciencias Humanas, Universidad Nacional de Villa María, Córdoba, Argentina
| | - Cintia Díaz-Luján
- Biología Celular, Histología y Embriología, Fac. Cs. Médicas, Universidad Nacional de Córdoba-INICSA (CONICET), Córdoba, Argentina.,Histología y Citología, Instituto de Ciencias Humanas, Universidad Nacional de Villa María, Córdoba, Argentina
| | - María Cristina Romanini
- Departamento de Anatomía-Facultad de Agronomía y Veterinaria, Universidad Nacional Río Cuarto, Córdoba, Argentina
| | - Juan Carlos Ramirez
- Laboratorio de Biología Molecular de la Enfermedad de Chagas, Instituto de Investigaciones en Ingeniería Genética y Biología Molecular "Dr Hector Torres" (INGEBI-CONICET), Buenos Aires, Argentina
| | - Patricia Paglini-Oliva
- Cátedra de Física Biomédica, Facultad Cs. Médicas, Universidad Nacional Córdoba, Córdoba-INICSA (CONICET), Córdoba, Argentina
| | - Alejandro Gabriel Schijman
- Laboratorio de Biología Molecular de la Enfermedad de Chagas, Instituto de Investigaciones en Ingeniería Genética y Biología Molecular "Dr Hector Torres" (INGEBI-CONICET), Buenos Aires, Argentina
| | - Ricardo Emilio Fretes
- Biología Celular, Histología y Embriología, Fac. Cs. Médicas, Universidad Nacional de Córdoba-INICSA (CONICET), Córdoba, Argentina.,Histología y Citología, Instituto de Ciencias Humanas, Universidad Nacional de Villa María, Córdoba, Argentina.,IICSHUM-Histología y Embriología, Universidad Nacional de La Rioja, La Rioja, Argentina
| |
Collapse
|
7
|
Díaz-Luján C, Triquell MF, Castillo C, Hardisson D, Kemmerling U, Fretes RE. Role of placental barrier integrity in infection by Trypanosoma cruzi. Acta Trop 2016; 164:360-368. [PMID: 27686961 DOI: 10.1016/j.actatropica.2016.09.021] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Revised: 09/10/2016] [Accepted: 09/24/2016] [Indexed: 11/17/2022]
Abstract
American trypanosomiasis has long been a neglected disease endemic in LatinAmerica, but congenital transmission has now spread Chagas disease to cause a global health problem. As the early stages of the infection of placental tissue and the vertical transmission by Trypanosoma cruzi are still not well understood, it is important to investigate the relevance of the first structure of the placental barrier in chorionic villi infection by T. cruzi during the initial stage of the infection. Explants of human chorionic villi from healthy pregnant women at term were denuded of their syncytiotrophoblast and co-cultured for 3h, 24h and 96h with 800,000 trypomastigotes (simulating acute infection). T. cruzi infected cells were identified by immunohistochemistry for cytokeratin-7 (+cytotrophoblast) and CD68 (+macrophages), and the infection was quantified. In placental tissue, the parasite load was analyzed by qPCR and microscopy, and the motile trypomastigotes were quantified in culture supernatant. In denuded chorionic villous, the total area occupied by the parasite (451.23μm2, 1.33%) and parasite load (RQ: 87) was significantly higher (p<0.05) than in the entire villous (control) (5.98μm2, 0.016%) (RQ:1) and with smaller concentration of nitric oxide. Stromal non-macrophage cells were infected as well as cytotrophoblasts and some macrophages, but with significant differences being observed. The parasite quantity in the culture supernatant was significantly higher (p<0.05) in denuded culture explants from 96h of culture. Although the human complete chorionic villi limited the infection, the detachment of the first structure of the placenta barrier (syncytiotrophoblast) increased both the infection of the villous stroma and the living trypomastigotes in the culture supernatant. Therefore structural and functional alterations to chorionic villi placental barrier reduce placental defenses and may contribute to the vertical transmission of Chagas.
Collapse
Affiliation(s)
- C Díaz-Luján
- Cell Biology, Histology and Embryology Department, Facultad Cs. Médicas. Instituto de Biología Celular, Universidad Nacional de Córdoba-INICSA (CONICET), Argentina; Histology and Cytology, Medicine, Universidad Nacional de Villa María, Córdoba, Argentina.
| | - M F Triquell
- Cell Biology, Histology and Embryology Department, Facultad Cs. Médicas. Instituto de Biología Celular, Universidad Nacional de Córdoba-INICSA (CONICET), Argentina
| | - C Castillo
- Programa de Anatomía del Desarrollo, Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de Chile, Chile
| | - D Hardisson
- Hospital La Paz, Universidad Autónoma de Madrid, Spain
| | - U Kemmerling
- Programa de Anatomía del Desarrollo, Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de Chile, Chile
| | - R E Fretes
- Cell Biology, Histology and Embryology Department, Facultad Cs. Médicas. Instituto de Biología Celular, Universidad Nacional de Córdoba-INICSA (CONICET), Argentina; Histology, Embryology and Genetic-IICSHUM, Health Department, Universidad Nacional de La Rioja, Argentina; Histology and Cytology, Medicine, Universidad Nacional de Villa María, Córdoba, Argentina.
| |
Collapse
|
8
|
Liempi A, Castillo C, Carrillo I, Muñoz L, Droguett D, Galanti N, Maya JD, Kemmerling U. A local innate immune response against Trypanosoma cruzi in the human placenta: The epithelial turnover of the trophoblast. Microb Pathog 2016; 99:123-129. [PMID: 27554274 DOI: 10.1016/j.micpath.2016.08.022] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 08/18/2016] [Accepted: 08/19/2016] [Indexed: 12/29/2022]
Abstract
Congenital Chagas disease, caused by Trypanosoma cruzi, is partially responsible for the progressive globalization of Chagas disease despite of its low transmission rate. The probability of congenital transmission depends on complex interactions between the parasite, the maternal and fetus/newborn immune responses and placental factors, being the latter the least studied one. During transplacental transmission, the parasite must cross the placental barrier where the trophoblast, a continuous renewing epithelium, is the first tissue to have contact with the parasite. Importantly, the epithelial turnover is considered part of the innate immune system since pathogens, prior to cell invasion, must attach to the surface of cells. The trophoblast turnover involves cellular processes such as proliferation, differentiation and apoptotic cell death, all of them are induced by the parasite. In the present review, we analyze the current evidence about the trophoblast epithelial turnover as a local placental innate immune response.
Collapse
Affiliation(s)
- Ana Liempi
- Programa de Anatomía y Biología del Desarrollo, Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de Chile, Chile
| | - Christian Castillo
- Programa de Anatomía y Biología del Desarrollo, Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de Chile, Chile
| | - Ileana Carrillo
- Programa de Anatomía y Biología del Desarrollo, Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de Chile, Chile
| | - Lorena Muñoz
- Programa de Anatomía y Biología del Desarrollo, Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de Chile, Chile
| | - Daniel Droguett
- Programa de Anatomía y Biología del Desarrollo, Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de Chile, Chile; Departamento de Estomatología, Facultad de Ciencias de la Salud, Universidad de Talca, Chile
| | - Norbel Galanti
- Programa de Biología Celular y Molecular, Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de Chile, Chile
| | - Juan Diego Maya
- Programa de Farmacología Molecular y Clínica, Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de Chile, Chile
| | - Ulrike Kemmerling
- Programa de Anatomía y Biología del Desarrollo, Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de Chile, Chile.
| |
Collapse
|
9
|
Carlier Y, Truyens C. Congenital Chagas disease as an ecological model of interactions between Trypanosoma cruzi parasites, pregnant women, placenta and fetuses. Acta Trop 2015; 151:103-15. [PMID: 26293886 DOI: 10.1016/j.actatropica.2015.07.016] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Revised: 07/13/2015] [Accepted: 07/15/2015] [Indexed: 12/31/2022]
Abstract
The aim of this paper is to discuss the main ecological interactions between the parasite Trypanosoma cruzi and its hosts, the mother and the fetus, leading to the transmission and development of congenital Chagas disease. One or several infecting strains of T. cruzi (with specific features) interact with: (i) the immune system of a pregnant woman whom responses depend on genetic and environmental factors, (ii) the placenta harboring its own defenses, and, finally, (iii) the fetal immune system displaying responses also susceptible to be modulated by maternal and environmental factors, as well as his own genetic background which is different from her mother. The severity of congenital Chagas disease depends on the magnitude of such final responses. The paper is mainly based on human data, but integrates also complementary observations obtained in experimental infections. It also focuses on important gaps in our knowledge of this congenital infection, such as the role of parasite diversity vs host genetic factors, as well as that of the maternal and placental microbiomes and the microbiome acquisition by infant in the control of infection. Investigations on these topics are needed in order to improve the programs aiming to diagnose, manage and control congenital Chagas disease.
Collapse
Affiliation(s)
- Yves Carlier
- Laboratoire de Parasitologie, Faculté de Médecine, Université Libre de Bruxelles (ULB), CP 616, Route de Lennik 808, 1070 Bruxelles, Belgium; Department of Tropical Medicine, School of Public Health and Tropical Medicine, Tulane University, Suite 2210, 1440 Canal Street, New Orleans, LA 70112-2797, USA.
| | - Carine Truyens
- Laboratoire de Parasitologie, Faculté de Médecine, Université Libre de Bruxelles (ULB), CP 616, Route de Lennik 808, 1070 Bruxelles, Belgium.
| |
Collapse
|
10
|
Li L, Schust DJ. Isolation, purification and in vitro differentiation of cytotrophoblast cells from human term placenta. Reprod Biol Endocrinol 2015; 13:71. [PMID: 26156160 PMCID: PMC4497497 DOI: 10.1186/s12958-015-0070-8] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Accepted: 06/26/2015] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The syncytialization of cytotrophoblast cells to syncytiotrophoblast is central to human placental transport and hormone production. Many techniques for in vitro study of this process have been proposed and new investigators to the field may find the literature in the field daunting. Here, we present a straightforward and reliable method to establish this important model using modern but readily available tools and reagents. METHODS Villous cytotrophoblast cells are obtained from term placenta using mild enzymatic degradation, Percoll gradient centrifugation, negative magnetic cell sorting using an antibody against classical major histocompatibility complex molecules and in vitro culture on a matrix-coated growth surface. RESULTS The purity of isolated cytotrophoblast cells exceeds 98 % as assessed by cytokeratin-7 expression using flow cytometry. Contamination by mesenchymal cells, extravillous trophoblast cells, leukocytes, Hofbauer and endothelial cells is minimized (less than 2 % when analyzed for vimentin, HLA-G, CD45, CD163 and CD31 using flow cytometry). Isolated cytotrophoblast cells began to aggregate into monolayers of mononucleated cells within about 12 h of plating. By 72 h in culture, most cytotrophoblast cells have differentiated into syncytiotrophoblast as demonstrated by a loss of intercellular E-cadherin expression upon fusion into multinucleated syncytia. After 72 h in culture, nearly every cultured cell expresses syncytiotrophoblast markers, including cytokeratin-7, human chorionic gonadotropin-β (β-hCG) and the fusion-related proteins glial cell missing-1 (GCM-1) and syncytin. CONCLUSIONS We present an efficient and reliable method for isolating of cytotrophoblast cells with high purity and complete differentiation into syncytiotrophoblast in vitro.
Collapse
Affiliation(s)
- Liping Li
- Department of Obstetrics, Gynecology and Women's Health, University of Missouri School of Medicine, 500 N. Keene Street, Columbia, MO, USA.
- Department of Obstetrics and Gynecology, Guangzhou Medical University Affiliated Guangzhou First People's Hospital, 1 Panfu Road, Guangzhou, China.
| | - Danny J Schust
- Department of Obstetrics, Gynecology and Women's Health, University of Missouri School of Medicine, 500 N. Keene Street, Columbia, MO, USA.
| |
Collapse
|
11
|
Lee JS, Romero R, Han YM, Kim HC, Kim CJ, Hong JS, Huh D. Placenta-on-a-chip: a novel platform to study the biology of the human placenta. J Matern Fetal Neonatal Med 2015; 29:1046-54. [PMID: 26075842 DOI: 10.3109/14767058.2015.1038518] [Citation(s) in RCA: 175] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Studying the biology of the human placenta represents a major experimental challenge. Although conventional cell culture techniques have been used to study different types of placenta-derived cells, current in vitro models have limitations in recapitulating organ-specific structure and key physiological functions of the placenta. Here we demonstrate that it is possible to leverage microfluidic and microfabrication technologies to develop a microengineered biomimetic model that replicates the architecture and function of the placenta. MATERIALS AND METHODS A "Placenta-on-a-Chip" microdevice was created by using a set of soft elastomer-based microfabrication techniques known as soft lithography. This microsystem consisted of two polydimethylsiloxane (PDMS) microfluidic channels separated by a thin extracellular matrix (ECM) membrane. To reproduce the placental barrier in this model, human trophoblasts (JEG-3) and human umbilical vein endothelial cells (HUVECs) were seeded onto the opposite sides of the ECM membrane and cultured under dynamic flow conditions to form confluent epithelial and endothelial layers in close apposition. We tested the physiological function of the microengineered placental barrier by measuring glucose transport across the trophoblast-endothelial interface over time. The permeability of the barrier study was analyzed and compared to that obtained from acellular devices and additional control groups that contained epithelial or endothelial layers alone. RESULTS Our microfluidic cell culture system provided a tightly controlled fluidic environment conducive to the proliferation and maintenance of JEG-3 trophoblasts and HUVECs on the ECM scaffold. Prolonged culture in this model produced confluent cellular monolayers on the intervening membrane that together formed the placental barrier. This in vivo-like microarchitecture was also critical for creating a physiologically relevant effective barrier to glucose transport. Quantitative investigation of barrier function was conducted by calculating permeability coefficients and metabolic rates in varying conditions of barrier structure. The rates of glucose transport and metabolism were consistent with previously reported in vivo observations. CONCLUSION The "Placenta-on-a-Chip" microdevice described herein provides new opportunities to simulate and analyze critical physiological responses of the placental barrier. This system may be used to address the major limitations of existing placenta model systems and serve to enable research platforms for reproductive biology and medicine.
Collapse
Affiliation(s)
- Ji Soo Lee
- a Interdisciplinary Program of Bioengineering, Seoul National University Graduate School , Seoul , Republic of Korea
| | - Roberto Romero
- b Perinatology Research Branch, Program for Perinatal Research and Obstetrics, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development , NIH, Bethesda, MD and Detroit, MI , USA .,c Department of Obstetrics and Gynecology , University of Michigan , Ann Arbor , MI , USA .,d Department of Epidemiology and Biostatistics , Michigan State University , East Lansing , MI , USA .,e Department of Molecular Obstetrics and Genetics , Wayne State University , Detroit , MI , USA
| | - Yu Mi Han
- f Department of Obstetrics and Gynecology , Seoul National University Bundang Hospital , Gyeonggi-do , Republic of Korea
| | - Hee Chan Kim
- g Institute of Medical and Biological Engineering, Medical Research Center, Seoul National University , Seoul , Republic of Korea .,h Department of Biomedical Engineering , Seoul National University College of Medicine , Seoul , Republic of Korea .,i Department of Biomedical Engineering , Seoul National University Hospital , Seoul , Republic of Korea
| | - Chong Jai Kim
- j Department of Pathology , Asan Medical Center, University of Ulsan College of Medicine , Seoul , Republic of Korea , and
| | - Joon-Seok Hong
- f Department of Obstetrics and Gynecology , Seoul National University Bundang Hospital , Gyeonggi-do , Republic of Korea
| | - Dongeun Huh
- k Department of Bioengineering , University of Pennsylvania , Philadelphia , PA , USA
| |
Collapse
|
12
|
Carlier Y, Sosa-Estani S, Luquetti AO, Buekens P. Congenital Chagas disease: an update. Mem Inst Oswaldo Cruz 2015; 110:363-8. [PMID: 25760448 PMCID: PMC4489473 DOI: 10.1590/0074-02760140405] [Citation(s) in RCA: 97] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Accepted: 02/10/2015] [Indexed: 12/17/2022] Open
Abstract
Congenital infection with Trypanosoma cruzi is a global problem, occurring on average
in 5% of children born from chronically infected mothers in endemic areas, with
variations depending on the region. This presentation aims to focus on and update
epidemiological data, research methods, involved factors, control strategy and
possible prevention of congenital infection with T. cruzi. Considering that
etiological treatment of the child is always effective if performed before one year
of age, the diagnosis of infection in pregnant women and their newborns has to become
the standard of care and integrated into the surveillance programs of syphilis and
human immunodeficiency virus. In addition to the standard tests, polymerase chain
reaction performed on blood of neonates of infected mothers one month after birth
might improve the diagnosis of congenital infection. Recent data bring out that its
transmission can be prevented through treatment of infected women before they become
pregnant. The role of parasite genotypes and host genetic factors in parasite
transmission and development of infection in foetuses/neonates has to be more
investigated in order to better estimate the risk factors and impact on health of
congenital infection with T. cruzi.
Collapse
Affiliation(s)
- Yves Carlier
- Faculté de Médecine, Université Libre de Bruxelles, Bruxelles, Belgique
| | - Sergio Sosa-Estani
- Instituto Nacional de Parasitología Dr Mario Fatala Chaben, Ministry of Health, Buenos Aires, Argentina
| | | | - Pierre Buekens
- School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
| |
Collapse
|
13
|
Liempi A, Castillo C, Cerda M, Droguett D, Duaso J, Barahona K, Hernández A, Díaz-Luján C, Fretes R, Härtel S, Kemmerling U. Trypanosoma cruzi infectivity assessment in "in vitro" culture systems by automated cell counting. Acta Trop 2015; 143:47-50. [PMID: 25553972 DOI: 10.1016/j.actatropica.2014.12.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Revised: 11/04/2014] [Accepted: 12/09/2014] [Indexed: 10/24/2022]
Abstract
Chagas disease is an endemic, neglected tropical disease in Latin America that is caused by the protozoan parasite Trypanosoma cruzi. In vitro models constitute the first experimental approach to study the physiopathology of the disease and to assay potential new trypanocidal agents. Here, we report and describe clearly the use of commercial software (MATLAB(®)) to quantify T. cruzi amastigotes and infected mammalian cells (BeWo) and compared this analysis with the manual one. There was no statistically significant difference between the manual and the automatic quantification of the parasite; the two methods showed a correlation analysis r(2) value of 0.9159. The most significant advantage of the automatic quantification was the efficiency of the analysis. The drawback of this automated cell counting method was that some parasites were assigned to the wrong BeWo cell, however this data did not exceed 5% when adequate experimental conditions were chosen. We conclude that this quantification method constitutes an excellent tool for evaluating the parasite load in cells and therefore constitutes an easy and reliable ways to study parasite infectivity.
Collapse
|
14
|
Krishnan L, Nguyen T, McComb S. From mice to women: the conundrum of immunity to infection during pregnancy. J Reprod Immunol 2013; 97:62-73. [PMID: 23432873 PMCID: PMC3748615 DOI: 10.1016/j.jri.2012.10.015] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2012] [Revised: 10/29/2012] [Accepted: 10/30/2012] [Indexed: 12/20/2022]
Abstract
Resistance to infection is the ability of the host to evoke a strong immune response sufficient to eliminate the infectious agent. In contrast, maternal tolerance to the fetus necessitates careful regulation of immune responses. Successful pregnancy requires the maternal host to effectively balance the opposing processes of maternal immune reactivity and tolerance to the fetus. However, this balance can be perturbed by infections which are recognized as the major cause of adverse pregnancy outcome including pre-term labor. Select pathogens also pose a serious threat of severe maternal illness. These include intracellular and chronic pathogens that have evolved immune evasive strategies. Murine models of intracellular bacteria and parasites that mimic pathogenesis of infection in humans have been developed. While human epidemiological studies provide insight into maternal immunity to infection, experimental infection in pregnant mice is a vital tool to unravel the complex molecular mechanisms of placental infection, congenital transmission and maternal illness. We will provide a comprehensive review of the pathogenesis of several infection models in pregnant mice and their clinical relevance. These models have revealed the immunological function of the placenta in responding to, and resisting infection. Murine feto-placental infection provides an effective way to evaluate new intervention strategies for managing infections during pregnancy, adverse fetal outcome and long-term effects on the offspring and mother.
Collapse
Affiliation(s)
- Lakshmi Krishnan
- Human Health Therapeutics, Division of Life Sciences, National Research Council, Ottawa, ON, Canada.
| | | | | |
Collapse
|
15
|
Castillo C, Ramírez G, Valck C, Aguilar L, Maldonado I, Rosas C, Galanti N, Kemmerling U, Ferreira A. The interaction of classical complement component C1 with parasite and host calreticulin mediates Trypanosoma cruzi infection of human placenta. PLoS Negl Trop Dis 2013; 7:e2376. [PMID: 23991234 PMCID: PMC3749977 DOI: 10.1371/journal.pntd.0002376] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Accepted: 07/03/2013] [Indexed: 01/28/2023] Open
Abstract
Background 9 million people are infected with Trypanosoma cruzi in Latin America, plus more than 300,000 in the United States, Canada, Europe, Australia, and Japan. Approximately 30% of infected individuals develop circulatory or digestive pathology. While in underdeveloped countries transmission is mainly through hematophagous arthropods, transplacental infection prevails in developed ones. Methodology/Principal Findings During infection, T. cruzi calreticulin (TcCRT) translocates from the endoplasmic reticulum to the area of flagellum emergence. There, TcCRT acts as virulence factor since it binds maternal classical complement component C1q that recognizes human calreticulin (HuCRT) in placenta, with increased parasite infectivity. As measured ex vivo by quantitative PCR in human placenta chorionic villi explants (HPCVE) (the closest available correlate of human congenital T. cruzi infection), C1q mediated up to a 3–5-fold increase in parasite load. Because anti-TcCRT and anti-HuCRT F(ab′)2 antibody fragments are devoid of their Fc-dependent capacity to recruit C1q, they reverted the C1q-mediated increase in parasite load by respectively preventing its interaction with cell-bound CRTs from both parasite and HPCVE origins. The use of competing fluid-phase recombinant HuCRT and F(ab′)2 antibody fragments anti-TcCRT corroborated this. These results are consistent with a high expression of fetal CRT on placental free chorionic villi. Increased C1q-mediated infection is paralleled by placental tissue damage, as evidenced by histopathology, a damage that is ameliorated by anti-TcCRT F(ab′)2 antibody fragments or fluid-phase HuCRT. Conclusions/Significance T. cruzi infection of HPCVE is importantly mediated by human and parasite CRTs and C1q. Most likely, C1q bridges CRT on the parasite surface with its receptor orthologue on human placental cells, thus facilitating the first encounter between the parasite and the fetal derived placental tissue. The results presented here have several potential translational medicine aspects, specifically related with the capacity of antibody fragments to inhibit the C1q/CRT interactions and thus T. cruzi infectivity. The Trypanosoma cruzi protozoan infects 9 million people in Latin America and increasing numbers in North America, Europe, Australia, and Japan. It is an important neglected parasitic disease in the Americas with no safe treatment available. One third of those infected develops incapacitating pathology. While in poor countries transmission of the parasite is mainly through blood feeding insects, transplacental infection is increasingly important in developed regions. Herein we show that T. cruzi calreticulin (TcCRT), a multifunctional protein, exteriorized by the parasite, mediates infection of human placenta, since it binds human complement component C1, a “danger signal” detector. (Complement is an innate immune defense system, with more than 40 plasma or membrane-bound proteins). However, in a parasite strategy, maternal C1 is utilized to infect placenta. Fetal calreticulin (HuCRT) is also easily detectable in placental tissues that are in direct contact with maternal blood. Thus, C1q by bridging parasite and HuCRT mediates high increases in cultured placental tissue infection with damaging consequences. Complete reversion of C1-mediated infection and a decreased placental damage, is observed in the presence of anti-TcCRT and anti-HuCRT antibody fragments, or fluid-phase competing HuCRT. It remains to be determined whether these mechanisms also operate in other intracellular protozoa.
Collapse
Affiliation(s)
- Christian Castillo
- Institute of Biomedical Sciences, Faculty of Medicine, University of Chile, Santiago, Chile
| | | | | | | | | | | | | | | | | |
Collapse
|
16
|
Cencig S, Coltel N, Truyens C, Carlier Y. Fertility, gestation outcome and parasite congenital transmissibility in mice infected with TcI, TcII and TcVI genotypes of Trypanosoma cruzi. PLoS Negl Trop Dis 2013; 7:e2271. [PMID: 23785533 PMCID: PMC3681732 DOI: 10.1371/journal.pntd.0002271] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2012] [Accepted: 05/03/2013] [Indexed: 12/21/2022] Open
Abstract
This work aims to compare the effects of acute or chronic infections with the T. cruzi genotypes TcI (X10 strain), TcII (Y strain) and TcVI (Tulahuen strain) on fertility, gestation, pup growth and the possible vertical transmission of parasites in BALB/c mice. The occurrence of congenital infection was evaluated by microscopic examination of blood and/or qPCR on blood and heart in newborn pups and/or older offspring submitted to cyclophosphamide-induced immunosuppression in order to detect possible cryptic congenital infection. Altogether, the results show that: i) for the three strains tested, acute infection occurring after the embryo implantation in the uterus (parasite inoculation 4 days before mating), or close to delivery (parasite inoculation on day 13 of gestation), prevents or severely jeopardizes gestation outcome (inducing pup mortality and intra-uterine growth retardation); ii) for the three strains tested, gestation during chronic infection results in intra-uterine growth retardation, whereas re-inoculation of TcVI parasites during gestation in such chronically infected mice, in addition, strongly increases pup mortality; iii) congenital infection remains a rare consequence of infection (occurring in approximately 4% of living pups born to acutely infected dams); iv) PCR, detecting parasitic DNA and not living parasites, is not convenient to detect congenial infection close to delivery; v) transmission of parasites by breast milk is unlikely. This study should encourage further investigations using other parasite strains and genotypes to explore the role of virulence and other factors, as well as the mechanisms of such effects on gestation and on the establishment of congenital infection.
Collapse
Affiliation(s)
- Sabrina Cencig
- Laboratoire de Parasitologie, Faculté de Médecine, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Nicolas Coltel
- Laboratoire de Parasitologie, Faculté de Médecine, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Carine Truyens
- Laboratoire de Parasitologie, Faculté de Médecine, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Yves Carlier
- Laboratoire de Parasitologie, Faculté de Médecine, Université Libre de Bruxelles (ULB), Brussels, Belgium
| |
Collapse
|
17
|
Castillo C, Villarroel A, Duaso J, Galanti N, Cabrera G, Maya JD, Kemmerling U. Phospholipase C gamma and ERK1/2 Mitogen Activated Kinase Pathways are differentially modulated by Trypanosoma cruzi during tissue invasion in human placenta. Exp Parasitol 2013; 133:12-7. [DOI: 10.1016/j.exppara.2012.10.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2012] [Revised: 10/08/2012] [Accepted: 10/19/2012] [Indexed: 02/07/2023]
|
18
|
Affiliation(s)
- Varvara B Zeldovich
- Department of Pediatrics, University of California, San Francisco, San Francisco, California, United States of America
| | | |
Collapse
|
19
|
Fretes RE, Kemmerling U. Mechanism of Trypanosoma cruzi Placenta Invasion and Infection: The Use of Human Chorionic Villi Explants. J Trop Med 2012; 2012:614820. [PMID: 22701129 PMCID: PMC3369486 DOI: 10.1155/2012/614820] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2011] [Revised: 02/06/2012] [Accepted: 02/14/2012] [Indexed: 11/28/2022] Open
Abstract
Congenital Chagas disease, a neglected tropical disease, endemic in Latin America, is associated with premature labor and miscarriage. During vertical transmission the parasite Trypanosoma cruzi (T. cruzi) crosses the placental barrier. However, the exact mechanism of the placental infection remains unclear. We review the congenital transmission of T. cruzi, particularly the role of possible local placental factors that contribute to the vertical transmission of the parasite. Additionally, we analyze the different methods available for studying the congenital transmission of the parasite. In that context, the ex vivo infection with T. cruzi trypomastigotes of human placental chorionic villi constitutes an excellent tool for studying parasite infection strategies as well as possible local antiparasitic mechanisms.
Collapse
Affiliation(s)
- Ricardo E. Fretes
- Department of Histology and Embryology, Faculty of Medicine, Universidad Nacional Córdoba, 5000 Cordoba, Argentina
- IICSHUM and Cathedra of Histology, Embryology and Genetic, Health Department, Universidad Nacional La Rioja, 5300 La Rioja, Argentina
| | - Ulrike Kemmerling
- Program of Anatomy and Developmental Biology, Institute for Biomedical Sciences, Faculty of Medicine, University of Chile, 8380453 Santiago, Chile
| |
Collapse
|