1
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Nishi K, Modi D. Placental exosomes in pregnancy and preeclampsia. Am J Reprod Immunol 2024; 91:e13857. [PMID: 38716824 DOI: 10.1111/aji.13857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 03/30/2024] [Accepted: 04/15/2024] [Indexed: 05/24/2024] Open
Abstract
Preeclampsia, poses significant risks to both maternal and fetal well-being. Exosomes released by the placenta play a crucial role in intercellular communication and are recognized as potential carriers of essential information for placental development. These exosomes transport a payload of proteins, nucleic acids, and lipids that mirror the placental microenvironment. This review delves into the functional roles of placental exosomes and its contents shedding light on their involvement in vascular regulation and immune modulation in normal pregnancy. Discernible changes are reported in the composition and quantity of placental exosome contents in pregnancies affected by preeclampsia. The exosomes from preeclamptic mothers affect vascularization and fetal kidney development. The discussion also explores the implications of utilizing placental exosomes as biomarkers and the prospects of translating these findings into clinical applications. In conclusion, placental exosomes hold promise as a valuable avenue for deciphering the complexities of preeclampsia, providing crucial diagnostic and prognostic insights. As the field progresses, a more profound comprehension of the distinct molecular signatures carried by placental exosomes may open doors to innovative strategies for managing and offering personalized care to pregnancies affected by preeclampsia.
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Affiliation(s)
- Kumari Nishi
- Department of Neuroendocrinology, ICMR-National Institute for Research in Reproductive and Child Health, Mumbai, Maharashtra, India
| | - Deepak Modi
- Molecular and Cellular Biology Laboratory, ICMR-National Institute for Research in Reproductive and Child Health, Mumbai, Maharashtra, India
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2
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Burton GJ, Moffett A. Trophoblast remodeling of the uterine veins and maternal placental blood flow. Am J Obstet Gynecol 2023; 229:704-705. [PMID: 37506752 DOI: 10.1016/j.ajog.2023.07.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 07/24/2023] [Indexed: 07/30/2023]
Affiliation(s)
- Graham J Burton
- Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, United Kingdom.
| | - Ashley Moffett
- Department of Pathology, University of Cambridge, Cambridge, United Kingdom
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3
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Kang M, Blenkiron C, Chamley L. The biodistribution of placental and fetal extracellular vesicles during pregnancy following placentation. Clin Sci (Lond) 2023; 137:385-399. [PMID: 36920079 PMCID: PMC10017278 DOI: 10.1042/cs20220301] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 02/15/2023] [Accepted: 02/20/2023] [Indexed: 03/16/2023]
Abstract
Human pregnancy is a highly orchestrated process requiring extensive cross-talk between the mother and the fetus. Extracellular vesicles released by the fetal tissue, particularly the placenta, are recognized as important mediators of this process. More recently, the importance of placental extracellular vesicle biodistribution studies in animal models has received increasing attention as identifying the organs to which extracellular vesicles are targeted to helps us understand more about this communication system. Placental extracellular vesicles are categorized based on their size into macro-, large-, and small-extracellular vesicles, and their biodistribution is dependent on the extracellular vesicle's particle size, the direction of blood flow, the recirculation of blood, as well as the retention capacity in organs. Macro-extracellular vesicles are exclusively localized to the lungs, while large- and small-extracellular vesicles show high levels of distribution to the lungs and liver, while there is inconsistency in the reporting of distribution to the spleen and kidneys. This inconsistency may be due to the differences in the methodologies employed between studies and their limitations. Future studies should incorporate analysis of placental extracellular vesicle biodistribution at the macroscopic level on whole animals and organs/tissues, as well as the microscopic cellular level.
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Affiliation(s)
- Matthew Kang
- Department of Obstetrics and Gynaecology, University of Auckland, 1023, Auckland, New Zealand
- Correspondence: Matt Kang ()
| | - Cherie Blenkiron
- Department of Obstetrics and Gynaecology, University of Auckland, 1023, Auckland, New Zealand
- Hub for Extracellular Vesicle Investigations (HEVI), University of Auckland, 1023, Auckland, New Zealand
- Auckland Cancer Society Research Center (ACSRC), University of Auckland, 1023, Auckland, New Zealand
- Molecular Medicine and Pathology, University of Auckland, 1023, Auckland, New Zealand
| | - Lawrence W. Chamley
- Department of Obstetrics and Gynaecology, University of Auckland, 1023, Auckland, New Zealand
- Hub for Extracellular Vesicle Investigations (HEVI), University of Auckland, 1023, Auckland, New Zealand
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4
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Koltsova EM, Martyanov AA, Podoplelova NA. Procoagulant Properties of Extracellular Vesicles in Normal and Pathological Pregnancy. BIOCHEMISTRY (MOSCOW), SUPPLEMENT SERIES A: MEMBRANE AND CELL BIOLOGY 2023. [DOI: 10.1134/s1990747822060071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
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5
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Gao P, Zha Y, Wei L, Zhou X, Zhu S, Zhang H, Gao X, Jiang Y, Chen Y, Li J, Zhang J, Yu J, Wang S, Liu H, Feng L. G-CSF: A vehicle for communication between trophoblasts and macrophages which may cause problems in recurrent spontaneous abortion. Placenta 2022; 121:164-172. [DOI: 10.1016/j.placenta.2022.03.125] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 02/26/2022] [Accepted: 03/25/2022] [Indexed: 12/20/2022]
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6
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Redman CW, Staff AC, Roberts JM. Syncytiotrophoblast stress in preeclampsia: the convergence point for multiple pathways. Am J Obstet Gynecol 2022; 226:S907-S927. [PMID: 33546842 DOI: 10.1016/j.ajog.2020.09.047] [Citation(s) in RCA: 119] [Impact Index Per Article: 59.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 09/14/2020] [Accepted: 09/19/2020] [Indexed: 12/29/2022]
Abstract
Preeclampsia evolves in 2 stages: a placental problem that generates signals to the mother to cause a range of responses that comprise the second stage (preeclampsia syndrome). The first stage of early-onset preeclampsia is poor placentation, which we here call malplacentation. The spiral arteries are incompletely remodeled, leading to later placental malperfusion, relatively early in the second half of pregnancy. The long duration of the first stage (several months) is unsurprisingly associated with fetal growth restriction. The first stage of late-onset preeclampsia, approximately 80% of total cases, is shorter (several weeks) and part of a process that is common to all pregnancies. Placental function declines as it outgrows uterine capacity, with increasing chorionic villous packing, compression of the intervillous space, and fetal hypoxia, and causes late-onset clinical presentations such as "unexplained" stillbirths, late-onset fetal growth restriction, or preeclampsia. The second stages of early- and late-onset preeclampsia share syncytiotrophoblast stress as the most relevant feature that causes the maternal syndrome. Syncytiotrophoblast stress signals in the maternal circulation are probably the most specific biomarkers for preeclampsia. In addition, soluble fms-like tyrosine kinase-1 (mainly produced by syncytiotrophoblast) is the best-known biomarker and is routinely used in clinical practice in many locations. How the stress signals change over time in normal pregnancies indicates that syncytiotrophoblast stress begins on average at 30 to 32 weeks' gestation and progresses to term. At term, syncytiotrophoblast shows increasing markers of stress, including apoptosis, pyroptosis, autophagy, syncytial knots, and necrosis. We label this phenotype the "twilight placenta" and argue that it accounts for the clinical problems of postmature pregnancies. Senescence as a stress response differs in multinuclear syncytiotrophoblast from that of mononuclear cells. Syncytiotrophoblast irreversibly acquires part of the senescence phenotype (cell cycle arrest) when it is formed by cell fusion. The 2 pathways converge on the common pathologic endpoint, syncytiotrophoblast stress, and contribute to preeclampsia subtypes. We highlight that the well-known heterogeneity of the preeclampsia syndrome arises from different pathways to this common endpoint, influenced by maternal genetics, epigenetics, lifestyle, and environmental factors with different fetal and maternal responses to the ensuing insults. This complexity mandates a reassessment of our approach to predicting and preventing preeclampsia, and we summarize research priorities to maximize what we can learn about these important issues.
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Fatal massive pulmonary thromboembolism and concomitant pulmonary trophoblastic embolism associated with exaggerated placental site reaction: a case study. Int J Legal Med 2021; 135:2357-2361. [PMID: 34596774 PMCID: PMC8484293 DOI: 10.1007/s00414-021-02710-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 09/22/2021] [Indexed: 10/25/2022]
Abstract
Pulmonary embolism is a major cause of maternal morbidity during pregnancy. Beside the frequently encountered thromboembolism, trophoblastic cell embolism has also been reported in a few case reports. This phenomenon may be symptomless in physiological gestational process but is more pronounced in contexts of preeclampsia or gestational trophoblastic disease. It was exceptionally reported to be associated with death. Here, we report the case of a 15-year-old girl, who experienced dyspnea followed by cardiac arrests and disseminated intravascular coagulation. Echocardiography showed a massive proximal pulmonary embolism. Abdominal sonography revealed that she was 11 weeks pregnant. Autopsy confirmed the presence of multiple clot emboli in the proximal pulmonary arteries. Additionally, the histopathological examination showed a massive syncytiotrophoblastic embolism in the lung microcirculation. Microscopic examination of the uterus revealed an exaggerated placental site reaction. In conclusion, this exhaustive post-mortem study describes a previously unreported association between exaggerated placental site reaction and pulmonary trophoblastic embolism, with fatal issue. Forensic pathologists should be aware that a large sampling of the lungs and uterus and examination of both placenta and fetus are needed to achieve this diagnosis. This case study emphasizes the need for further work elucidating pathways of trophoblast deportation.
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8
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Aplin JD, Jones CJP. Cell dynamics in human villous trophoblast. Hum Reprod Update 2021; 27:904-922. [PMID: 34125187 DOI: 10.1093/humupd/dmab015] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 04/22/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Villous cytotrophoblast (vCTB) is a precursor cell population that supports the development of syncytiotrophoblast (vSTB), the high surface area barrier epithelium of the placental villus, and the primary interface between maternal and fetal tissue. In light of increasing evidence that the placenta can adapt to changing maternal environments or, under stress, can trigger maternal disease, we consider what properties of these cells empower them to exert a controlling influence on pregnancy progression and outcome. OBJECTIVE AND RATIONALE How are cytotrophoblast proliferation and differentiation regulated in the human placental villus to allow for the increasing demands of the fetal and environmental challenges and stresses that may arise during pregnancy? SEARCH METHODS PubMed was interrogated using relevant keywords and word roots combining trophoblast, villus/villous, syncytio/syncytium, placenta, stem, transcription factor (and the individual genes), signalling, apoptosis, autophagy (and the respective genes) from 1960 to the present. Since removal of trophoblast from its tissue environment is known to fundamentally change cell growth and differentiation kinetics, research that relied exclusively on cell culture has not been the main focus of this review, though it is mentioned where appropriate. Work on non-human placenta is not systematically covered, though mention is made where relevant hypotheses have emerged. OUTCOMES The synthesis of data from the literature has led to a new hypothesis for vCTB dynamics. We propose that a reversible transition can occur from a reserve population in G0 to a mitotically active state. Cells from the in-cycle population can then differentiate irreversibly to intermediate cells that leave the cycle and turn on genes that confer the capacity to fuse with the overlying vSTB as well as other functions associated with syncytial barrier and transport function. We speculate that alterations in the rate of entry to the cell cycle, or return of cells in the mitotic fraction to G0, can occur in response to environmental challenge. We also review evidence on the life cycle of trophoblast from the time that fusion occurs, and point to gaps in knowledge of how large quantities of fetal DNA arrive in maternal circulation. We critique historical methodology and make a case for research to re-address questions about trophoblast lifecycle and dynamics in normal pregnancy and the common diseases of pre-eclampsia and fetal growth restriction, where altered trophoblast kinetics have long been postulated. WIDER IMPLICATIONS The hypothesis requires experimental testing, moving research away from currently accepted methodology towards a new standard that includes representative cell and tissue sampling, assessment of cell cycle and differentiation parameters, and robust classification of cell subpopulations in villous trophoblast, with due attention to gestational age, maternal and fetal phenotype, disease and outcome.
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Affiliation(s)
- John D Aplin
- Maternal and Fetal Health, University of Manchester, Manchester Academic Health Sciences Centre, St Mary's Hospital, Manchester, UK
| | - Carolyn J P Jones
- Maternal and Fetal Health, University of Manchester, Manchester Academic Health Sciences Centre, St Mary's Hospital, Manchester, UK
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9
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Güralp O, Gök K, Tüten N, Hamzaoglu K, Makul M, Oner YO, Bulut H, Schild-Suhren M, Malik E, Tüten A. Serum survivin is decreased in women with preeclampsia. Hypertens Pregnancy 2021; 40:144-151. [PMID: 34014801 DOI: 10.1080/10641955.2021.1917601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Objective: To evaluate the serum survivin level in preeclampsia.Methods: Eighty-eight pregnancies complicated with preeclampsia and 88 gestational-age (GA)-matched uncomplicated pregnancies were evaluated.Results: Mean serum survivin was detected to be significantly decreased in the early- (EOPE) and late-onset (LOPE) preeclampsia subgroups than the GA-matched control-groups; and were comparable in EOPE- and LOPE-groups after correction for GA. Serum survivin had weak negative correlations with systolic and diastolic arterial blood pressure.Conclusion: The serum survivin level was decreased in preeclamptic patients than the GA-matched controls. More comprehensive studies are needed to clarify the timing and extent of placental apoptosis in preeclampsia.
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Affiliation(s)
- Onur Güralp
- Klinikum Oldenburg Aör, Carl Von Ossietzky Oldenburg University, University Hospital for Gynecology and Obstetrics, Oldenburg, Germany
| | - Koray Gök
- Obstetrics and Gynecology, Sakarya University, Education and Research Hospital, Sakarya, Turkey
| | - Nevin Tüten
- Obstetrics and Gynecology, Kanuni Sultan Suleyman Education and Research Hospital, Istanbul, Turkey
| | - Kübra Hamzaoglu
- Department of Obstetrics and Gynecology, Istanbul Cerrahpasa University, Istanbul, Turkey
| | - Melike Makul
- Department of Obstetrics and Gynecology, Istanbul Cerrahpasa University, Istanbul, Turkey
| | - Yahya Ozgun Oner
- Department of Obstetrics and Gynecology, Istanbul Cerrahpasa University, Istanbul, Turkey
| | - Huri Bulut
- Faculty of Medicine, Medical Biochemistry Department, Istinye University, Istanbul, Turkey
| | - Meike Schild-Suhren
- Klinikum Oldenburg Aör, Carl Von Ossietzky Oldenburg University, University Hospital for Gynecology and Obstetrics, Oldenburg, Germany
| | - Eduard Malik
- Klinikum Oldenburg Aör, Carl Von Ossietzky Oldenburg University, University Hospital for Gynecology and Obstetrics, Oldenburg, Germany
| | - Abdullah Tüten
- Department of Obstetrics and Gynecology, Istanbul Cerrahpasa University, Istanbul, Turkey
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10
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Liu Chung Ming C, Sesperez K, Ben-Sefer E, Arpon D, McGrath K, McClements L, Gentile C. Considerations to Model Heart Disease in Women with Preeclampsia and Cardiovascular Disease. Cells 2021; 10:899. [PMID: 33919808 PMCID: PMC8070848 DOI: 10.3390/cells10040899] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 04/11/2021] [Accepted: 04/12/2021] [Indexed: 12/12/2022] Open
Abstract
Preeclampsia is a multifactorial cardiovascular disorder diagnosed after 20 weeks of gestation, and is the leading cause of death for both mothers and babies in pregnancy. The pathophysiology remains poorly understood due to the variability and unpredictability of disease manifestation when studied in animal models. After preeclampsia, both mothers and offspring have a higher risk of cardiovascular disease (CVD), including myocardial infarction or heart attack and heart failure (HF). Myocardial infarction is an acute myocardial damage that can be treated through reperfusion; however, this therapeutic approach leads to ischemic/reperfusion injury (IRI), often leading to HF. In this review, we compared the current in vivo, in vitro and ex vivo model systems used to study preeclampsia, IRI and HF. Future studies aiming at evaluating CVD in preeclampsia patients could benefit from novel models that better mimic the complex scenario described in this article.
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Affiliation(s)
- Clara Liu Chung Ming
- School of Biomedical Engineering/FEIT, University of Technology Sydney, Sydney, NSW 2007, Australia; (C.L.C.M.); (E.B.-S.); (D.A.)
| | - Kimberly Sesperez
- School of Life Sciences, Faculty of Science, University of Technology Sydney, Sydney, NSW 2007, Australia; (K.S.); (K.M.); (L.M.)
| | - Eitan Ben-Sefer
- School of Biomedical Engineering/FEIT, University of Technology Sydney, Sydney, NSW 2007, Australia; (C.L.C.M.); (E.B.-S.); (D.A.)
| | - David Arpon
- School of Biomedical Engineering/FEIT, University of Technology Sydney, Sydney, NSW 2007, Australia; (C.L.C.M.); (E.B.-S.); (D.A.)
| | - Kristine McGrath
- School of Life Sciences, Faculty of Science, University of Technology Sydney, Sydney, NSW 2007, Australia; (K.S.); (K.M.); (L.M.)
| | - Lana McClements
- School of Life Sciences, Faculty of Science, University of Technology Sydney, Sydney, NSW 2007, Australia; (K.S.); (K.M.); (L.M.)
| | - Carmine Gentile
- School of Biomedical Engineering/FEIT, University of Technology Sydney, Sydney, NSW 2007, Australia; (C.L.C.M.); (E.B.-S.); (D.A.)
- Sydney Medical School, The University of Sydney, Sydney, NSW 2000, Australia
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02115, USA
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11
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Alekar A. The outcomes of fetal cell microchimerism in the mother. BIOMEDICAL RESEARCH JOURNAL 2021. [DOI: 10.4103/bmrj.bmrj_9_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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12
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Tong M, Tsai BW, Chamley LW. Antiphospholipid antibodies and extracellular vesicles in pregnancy. Am J Reprod Immunol 2020; 85:e13312. [PMID: 32715546 DOI: 10.1111/aji.13312] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 07/20/2020] [Indexed: 12/28/2022] Open
Abstract
Antiphospholipid antibodies (aPL) are autoantibodies that target phospholipid-binding proteins, such as β2 glycoprotein I (β2GPI), and can induce thrombosis systemically, as well as increase the risk of obstetric complications such as recurrent miscarriage and preeclampsia. Due to the expression of β2GPI by placental trophoblasts, aPL readily target the maternal-fetal interface during pregnancy and many studies have investigated the deleterious effects of aPL on placental trophoblast function. This review will focus on studies that have examined the effects of aPL on the production and modification of extracellular vesicles (EVs) from trophoblasts, as EVs are a key mode of feto-maternal communication in both normal and pathological pregnancy. A more comprehensive understanding of the effects of aPL on the quantity and cargo of EVs extruded by the human placenta may contribute to our current knowledge of how aPL induce both systemic and obstetric disease.
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Affiliation(s)
- Mancy Tong
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Bridget W Tsai
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, NZ, USA
| | - Lawrence W Chamley
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, NZ, USA
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13
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Degrelle SA, Chissey A, Stepanian A, Fournier T, Guibourdenche J, Mandelbrot L, Tsatsaris V. Placental Overexpression of Soluble CORIN in Preeclampsia. THE AMERICAN JOURNAL OF PATHOLOGY 2020; 190:970-976. [PMID: 32084366 DOI: 10.1016/j.ajpath.2019.12.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 12/10/2019] [Accepted: 12/30/2019] [Indexed: 01/30/2023]
Abstract
Preeclampsia (PE) is a hypertensive disease of pregnancy associated with substantial maternal and fetal morbidity and mortality. CORIN is a transmembrane type II serine protease expressed in cardiomyocytes that converts pro-atrial natriuretic peptide into atrial natriuretic peptide, a cardiac hormone that regulates blood pressure. High levels of soluble CORIN have been reported in PE and are supposed to be cardiac in origin. We hypothesized that during pregnancy soluble CORIN is released by the syncytiotrophoblast and that increased levels of soluble CORIN in preeclampsia originate from placenta. A total of 375 patients (181 PE patients and 194 controls) were analyzed. High levels of soluble CORIN were confirmed in maternal blood from preeclamptic pregnancies compared with controls. Differentiated primary villous cytotrophoblasts showed that CORIN was expressed (mRNA and protein levels) and secreted by trophoblastic cells, mostly by the syncytiotrophoblast. Finally, placental explants showed a significant increase in CORIN production and secretion in PE cases compared with controls. This study showed that CORIN is secreted by trophoblastic cells and that high levels of soluble CORIN in preeclampsia have a placental origin.
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Affiliation(s)
- Séverine A Degrelle
- Université de Paris, National Institute of Health and Medical Research (INSERM), UMR-S1139, 3PHM, Paris, France; PremUp Foundation, Paris, France; Inovarion, Paris, France.
| | - Audrey Chissey
- Université de Paris, National Institute of Health and Medical Research (INSERM), UMR-S1139, 3PHM, Paris, France; PremUp Foundation, Paris, France
| | - Alain Stepanian
- Department of Biological Haematology, Lariboisière Hospital, Public Assistance-Paris Hospitals (AP-HP), Paris, France; University Institute of Hematology, Saint Louis Hospital, University of Paris Diderot, EA3518, Paris, France
| | - Thierry Fournier
- Université de Paris, National Institute of Health and Medical Research (INSERM), UMR-S1139, 3PHM, Paris, France; PremUp Foundation, Paris, France
| | - Jean Guibourdenche
- Université de Paris, National Institute of Health and Medical Research (INSERM), UMR-S1139, 3PHM, Paris, France; PremUp Foundation, Paris, France; Department of Biological Endocrinology, Cochin University Hospital Center, Louis Mourier Hospital, AP-HP, Paris, France
| | - Laurent Mandelbrot
- Department of Gynaecology-Obstetrics, Louis Mourier Hospital, AP-HP, Colombes, France; Université Paris Diderot, Sorbonne Paris Cité, Paris, France; University Hospital Federations (FHU) PREMA, Paris, France
| | - Vassilis Tsatsaris
- Université de Paris, National Institute of Health and Medical Research (INSERM), UMR-S1139, 3PHM, Paris, France; PremUp Foundation, Paris, France; University Hospital Federations (FHU) PREMA, Paris, France; Department of Gynaecology-Obstetrics, Port-Royal Hospital, AP-HP, Paris, France
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14
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Vangrieken P, Vanterpool SF, van Schooten FJ, Al-Nasiry S, Andriessen P, Degreef E, Alfer J, Kramer BW, von Rango U. Histological villous maturation in placentas of complicated pregnancies. Histol Histopathol 2020; 35:849-862. [PMID: 31985030 DOI: 10.14670/hh-18-205] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Chorioamnionitis and preeclampsia account for the majority of preterm births worldwide. Thus far, adequate methods for early detection or prevention of these diseases are lacking. In preeclampsia, accelerated villous maturation is believed to compensate placental insufficiency. However, little is known about the effects of placental inflammation in chorioamnionitis on villous maturation. Therefore, we established a set of morphological parameters to evaluate histological villous maturity in pregnancies complicated by chorioamnionitis and preeclampsia. Preterm placentas complicated by chorioamnionitis or preeclampsia were compared to idiopathic preterm placentas and term controls. Histological villous maturation was analyzed by means of 17 histological markers. Fourteen of these markers provided information on absolute and relative numbers of the terminal villi (TV), the extent of their vascularization (using CD31-stained sections) and their exchange capacities. In addition, the numbers of syncytial bridges, syncytial apoptotic knots and shed syncytiotrophoblasts were counted. Accelerated villous maturation in preeclampsia was demonstrated by means of histological villous remodeling and confirmed by 11 relevant markers. Chorioamnionitis, however, only showed increased area of fetal capillaries. In preeclampsia, placentas may transition from growth to maturation earlier than placentas in normal pregnancies, whereas in chorioamnionitis placental changes are more acute and therefore less elaborated at a structural level. Regression analysis suggests the number of all villi and the number of terminal villi as a percentage of all villi as parameters to evaluate histological villous maturity in preeclamptic placentas and to assist diagnosis. However, we would recommend to analyze all 11 relevant parameters to judge placental maturity in detail.
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Affiliation(s)
- Philippe Vangrieken
- School of Nutrition and Translational Research in Metabolism (NUTRIM), Department of Pharmacology and Toxicology, Maastricht University Medical Center+, Maastricht, the Netherlands.
| | - Sizzle F Vanterpool
- Department of Reproductive Medicine, University Hospital Ghent, Ghent, Belgium.,School for Mental Health and Neurosciences (MHeNS), Department of Pediatrics, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Frederik J van Schooten
- School of Nutrition and Translational Research in Metabolism (NUTRIM), Department of Pharmacology and Toxicology, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Salwan Al-Nasiry
- School for Oncology and Developmental Biology (GROW), Department of Obstetrics and Gynaecology, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Peter Andriessen
- Department of Pediatrics, Máxima Medical Center, Veldhoven, the Netherlands
| | - Ellen Degreef
- Foundation Laboratory for Pathology and Medical Microbiology (PAMM), Eindhoven, The Netherlands
| | - Joachim Alfer
- Department of Pathology, Kaufbeuren-Ravensburg, Ravensburg, Germany
| | - Boris W Kramer
- School for Mental Health and Neurosciences (MHeNS), Department of Pediatrics, Maastricht University Medical Center+, Maastricht, the Netherlands.,School for Oncology and Developmental Biology (GROW), Department of Obstetrics and Gynaecology, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Ulrike von Rango
- Department of Anatomy and Embryology, Maastricht University Medical Center+, Maastricht, the Netherlands
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15
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Fodor P, White B, Khan R. Inflammation-The role of ATP in pre-eclampsia. Microcirculation 2019; 27:e12585. [PMID: 31424615 DOI: 10.1111/micc.12585] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 02/23/2019] [Accepted: 08/15/2019] [Indexed: 12/20/2022]
Abstract
Sterile inflammation may be initiated by molecules in the host organism that signal "damage" or "danger" also known as danger-associated molecular pattern (DAMPs). In pre-eclampsia (PE), a variety of DAMPs may be involved in the etiology or exacerbation of the disorder. Adenosine 5'-triphosphate (ATP) is a key intracellular energy molecule as well as a ligand for purinergic receptors. In humans, under physiological conditions, extracellular ATP (eATP) levels are distinctly low, but can rise to several hundred fold when cells become injured, stressed, or even necrotic. This often initiates a sterile inflammatory response with eATP acting as a DAMP. Extracellular ATP and its derivative nucleotides synthetized by endonucleotidases exhibit many of their effects through purinergic receptors, via inflammatory cascades and the production of proinflammatory molecules. This is clearly seen in the P2X7 gated receptor, which is linked to release of cytokines of the interleukin-1 family. Considering its fundamental role in innate immunity, an imbalance of P2X7 receptor activation may lead to deleterious effects in the coordination of placental vessel tone via the synthesis of various proinflammatory cytokines. This review explores the implication of DAMPs, specifically ATP and uric acid in the inflammation associated with PE.
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Affiliation(s)
- Paul Fodor
- Division of Medical Science and Graduate Entry Medicine, School of Medicine, University of Nottingham, Medical School, Royal Derby Hospital Centre, Derby, UK
| | - Benjamin White
- Division of Medical Science and Graduate Entry Medicine, School of Medicine, University of Nottingham, Medical School, Royal Derby Hospital Centre, Derby, UK
| | - Raheela Khan
- Division of Medical Science and Graduate Entry Medicine, School of Medicine, University of Nottingham, Medical School, Royal Derby Hospital Centre, Derby, UK
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16
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Hendrix MLE, Bons JAP, Alers NO, Severens-Rijvers CAH, Spaanderman MEA, Al-Nasiry S. Maternal vascular malformation in the placenta is an indicator for fetal growth restriction irrespective of neonatal birthweight. Placenta 2019; 87:8-15. [PMID: 31520871 DOI: 10.1016/j.placenta.2019.09.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 08/12/2019] [Accepted: 09/04/2019] [Indexed: 11/30/2022]
Abstract
INTRODUCTION To study the association between placental pathology and neonatal birthweight and outcomes, and whether a combination of first trimester biomarkers and fetal growth velocity can predict placental lesions. METHODS The presence of maternal vascular malperfusion (MVM) lesions (Amsterdam criteria) was recorded in a retrospective cohort of singleton pregnancies in the Maastricht University Medical Centre, 2011-2018. First trimester maternal characteristics and PAPP-A, PlGF and sFlt-1 levels were collected. Fetal growth velocities were calculated (mm/week) from 20 to 32 weeks for abdominal circumference, biparietal diameter, head circumference and femur length. Data were compared between neonates with 'small for gestational age' (SGA < p10) and different categories of 'appropriate for gestational age (AGA)': AGAp10-30, AGAp30-50 and AGA > p50 (reference), using one-way ANOVA and post hoc test. RESULTS There were significantly more MVM lesions in the SGA group (94.6% p < .0001), but also in the AGAp10-30 (67.3% p < .0001) and AGAp30-50 (41.6% p = 0.002), compared to the reference AGA group (19.3%). The prediction of MVM for a 20% false-positive rate, with maternal characteristics was25.2%. The addition of birthweight percentile gave a prediction of 51.7% for MVM. However adding placental biomarkers and fetal growth velocities (instead of birthweight percentile) to the maternal characteristics, gave a prediction of 81.8% (PPV 49.5%, NPV 53.7%). DISCUSSION Placental MVM lesions correlated inversely with birthweight even in AGA neonates, and was associated with slower fetal growth and more adverse outcome in SGA neonates. A combination of first trimester biomarkers and fetal growth velocity had good prediction of placental MVM lesions, as an indicator of fetal growth restriction irrespective of neonatal weight.
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Affiliation(s)
- M L E Hendrix
- Department of Obstetrics & Gynecology, GROW School of Oncology and Developmental Biology, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands.
| | - J A P Bons
- Central Diagnostic Laboratory, Maastricht University Medical Centre, Maastricht (MUMC+), The Netherlands
| | - N O Alers
- Department of Obstetrics & Gynecology, GROW School of Oncology and Developmental Biology, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
| | - C A H Severens-Rijvers
- Department of Pathology, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
| | - M E A Spaanderman
- Department of Obstetrics & Gynecology, GROW School of Oncology and Developmental Biology, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
| | - S Al-Nasiry
- Department of Obstetrics & Gynecology, GROW School of Oncology and Developmental Biology, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
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17
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Romero R. Giants in Obstetrics and Gynecology Series: a profile of Christopher Redman, MB, BChir, MRCP, FRCP. Am J Obstet Gynecol 2019; 220:420-427.e1. [PMID: 31076040 PMCID: PMC6655553 DOI: 10.1016/j.ajog.2019.03.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 03/21/2019] [Indexed: 11/21/2022]
Affiliation(s)
- Roberto Romero
- Perinatology Research Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, MD and Detroit, MI.
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18
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Hahn S, Hasler P, Vokalova L, van Breda SV, Than NG, Hoesli IM, Lapaire O, Rossi SW. Feto-Maternal Microchimerism: The Pre-eclampsia Conundrum. Front Immunol 2019; 10:659. [PMID: 31001268 PMCID: PMC6455070 DOI: 10.3389/fimmu.2019.00659] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 03/11/2019] [Indexed: 12/15/2022] Open
Abstract
Feto-maternal microchimerism (FMM) involves bidirectional cross-placental trafficking during pregnancy, leading to a micro-chimeric state that can persist for decades. In this manner a pregnant woman will harbor cells from her mother, as well as, cells from her child. Historically, eclampsia, a severe disorder of pregnancy provided the basis for FMM following the detection of trophoblast cells in the lungs of deceased women. Bi-directional cell trafficking between mother and fetus is also altered in pre-eclampsia and has been suggested to contribute to the underlying etiology. FMM has been implicated in tolerance promotion, remission of auto-inflammatory disorders during pregnancy, or the development of autoimmune conditions post-partum. The underlying mechanism whereby the host immune system is modulated is unclear but appears to involve HLA class II molecules, in that incompatibility between mother and fetus promotes remission of rheumatoid arthritis, whereas feto-maternal HLA compatibility may assist in the post-partum initiation of scleroderma. Couples having a high degree of HLA class II compatibility have an increased risk for pre-eclampsia, while the occurrence of scleroderma and rheumatoid arthritis is greater in pre-eclamptic cases than in women with normal pregnancies, suggesting a long term autoimmune predisposition. Since pregnant women with pre-eclampsia exhibit significantly lower levels of maternally-derived micro-chimerism, the question arises whether pre-eclampsia and post-partum development of autoimmune conditions occur due to the failure of the grandmothers cells to adequately regulate an inappropriate micro-chimeric constellation.
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Affiliation(s)
- Sinuhe Hahn
- Department of Biomedicine, University Hospital Basel, Basel, Switzerland
| | - Paul Hasler
- Division of Rheumatology, Medical University Department, Kantonsspital Aarau, Aarau, Switzerland
| | - Lenka Vokalova
- Department of Biomedicine, University Hospital Basel, Basel, Switzerland
| | - Shane Vontelin van Breda
- Department of Biomedicine, University Hospital Basel, Basel, Switzerland.,Division of Rheumatology, Medical University Department, Kantonsspital Aarau, Aarau, Switzerland
| | - Nandor Gabor Than
- Systems Biology of Reproduction Lendulet Research Group, Institute of Enzymology, Research Centre for Natural Sciences, Hungarian Academy of Sciences, Budapest, Hungary
| | | | - Olav Lapaire
- Department of Obstetrics, University Women's Hospital Basel, Basel, Switzerland
| | - Simona W Rossi
- Department of Biomedicine, University Hospital Basel, Basel, Switzerland
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19
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Huppertz B. The Critical Role of Abnormal Trophoblast Development in the Etiology of Preeclampsia. Curr Pharm Biotechnol 2019; 19:771-780. [PMID: 29701150 PMCID: PMC6463401 DOI: 10.2174/1389201019666180427110547] [Citation(s) in RCA: 93] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 03/06/2018] [Accepted: 04/08/2018] [Indexed: 11/22/2022]
Abstract
Background: The pregnancy pathology preeclampsia is still among the leading causes of ma-ternal and perinatal morbidity and mortality. At the same time, its etiology is far from being identified and remains obscure in a number of facets. A number of hypotheses have been developed to explain the altered interplay between placenta and mother leading to the clinical symptoms of preeclampsia. However, none of them offers the opportunity to explain the variability of cases with late-onset versus early-onset, mild versus severe and with or with-out additional fetal growth restriction. Conclusion: This paper identifies the weaknesses of the most important current hypothesis and at the same time offers a set of new elucidations including maternal susceptibility, and villous/extravillous trophoblast differentiation to explain the development of preeclampsia. Such elucidations allow following new scientific routes and pathways to untangle the etiology of preeclampsia.
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Affiliation(s)
- Berthold Huppertz
- Department of Cell Biology, Histology and Embryology, Gottfried Schatz Research Center, Medical University of Graz, Graz, Austria
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20
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Moser G, Windsperger K, Pollheimer J, de Sousa Lopes SC, Huppertz B. Human trophoblast invasion: new and unexpected routes and functions. Histochem Cell Biol 2018; 150:361-370. [PMID: 30046889 PMCID: PMC6153604 DOI: 10.1007/s00418-018-1699-0] [Citation(s) in RCA: 94] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2018] [Indexed: 01/08/2023]
Abstract
Until recently, trophoblast invasion during human placentation was characterized by and restricted to invasion into uterine connective tissues and the uterine spiral arteries. The latter was explained to connect the arteries to the intervillous space of the placenta and to guarantee the blood supply of the mother to the placenta. Today, this picture has dramatically changed. Invasion of endoglandular trophoblast into uterine glands, already starting at the time of implantation, enables histiotrophic nutrition of the embryo prior to perfusion of the placenta with maternal blood. This is followed by invasion of endovenous trophoblasts into uterine veins to guarantee the drainage of fluids from the placenta back into the maternal circulation throughout pregnancy. In addition, invasion of endolymphatic trophoblasts into the lymph vessels of the uterus has been described. Only then, invasion of endoarterial trophoblasts into spiral arteries takes place, enabling hemotrophic nutrition of the fetus starting with the second trimester of pregnancy. This new knowledge paves the way to identify changes that may occur in pathological pregnancies, from tubal pregnancies to recurrent spontaneous abortions.
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Affiliation(s)
- Gerit Moser
- Department of Cell Biology, Histology and Embryology, Gottfried Schatz Research Center, Medical University of Graz, Neue Stiftingtalstrasse 6/II, 8010, Graz, Austria
| | - Karin Windsperger
- Division of Obstetrics and Feto-maternal Medicine, Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria.,Reproductive Biology Unit, Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
| | - Jürgen Pollheimer
- Reproductive Biology Unit, Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
| | - Susana Chuva de Sousa Lopes
- Department of Anatomy and Embryology, Leiden University Medical Center, Leiden, The Netherlands.,Department for Reproductive Medicine, Ghent University Hospital, Ghent, Belgium
| | - Berthold Huppertz
- Department of Cell Biology, Histology and Embryology, Gottfried Schatz Research Center, Medical University of Graz, Neue Stiftingtalstrasse 6/II, 8010, Graz, Austria.
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21
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Schoots MH, Gordijn SJ, Scherjon SA, van Goor H, Hillebrands JL. Oxidative stress in placental pathology. Placenta 2018; 69:153-161. [PMID: 29622278 DOI: 10.1016/j.placenta.2018.03.003] [Citation(s) in RCA: 231] [Impact Index Per Article: 38.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2018] [Revised: 03/14/2018] [Accepted: 03/15/2018] [Indexed: 02/08/2023]
Abstract
The most important function of the placenta is the exchange of nutrients and oxygen between a mother and her fetus. To establish a healthy functioning placenta, placentation needs to occur with adequate remodelling of spiral arteries by extravillous trophoblasts. When this process is impaired, the resulting suboptimal and inadequate placenta function results in the manifestation of pregnancy complications. Impaired placenta function can cause preeclampsia and leads to fetal growth restriction due to hypoxia. Presence of hypoxia leads to oxidative stress due to an imbalance between reactive oxygen species and antioxidants, thereby causing damage to proteins, lipids and DNA. In the placenta, signs of morphological adaptation in response to hypoxia can be found. Different placental lesions like maternal or fetal vascular malperfusion or chronic villitis lead to a decreased exchange of oxygen between the mother and the fetus. Clinically, several biomarkers indicative for oxidative stress, e.g. malondialdehyde and reduced levels of free thiols are found. This review aims to give an overview of the causes and (potential) role of placental oxidative stress in the development of placental parenchymal pathology and its clinical consequences. Also, therapeutic options aiming at prevention or treatment of hypoxia of the placenta and fetus are described.
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Affiliation(s)
- Mirthe H Schoots
- Department of Pathology and Medical Biology, Pathology Section, University of Groningen, University Medical Center Groningen, The Netherlands.
| | - Sanne J Gordijn
- Department of Obstetrics and Gynaecology, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Sicco A Scherjon
- Department of Obstetrics and Gynaecology, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Harry van Goor
- Department of Pathology and Medical Biology, Pathology Section, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Jan-Luuk Hillebrands
- Department of Pathology and Medical Biology, Pathology Section, University of Groningen, University Medical Center Groningen, The Netherlands
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22
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Nystad M, Sitras V, Nordbakken CV, Pedersen MI, Acharya G. Laeverin protein expression in normal and preeclamptic placentas using tissue microarray analysis. Acta Obstet Gynecol Scand 2018; 97:536-544. [DOI: 10.1111/aogs.13304] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Accepted: 01/16/2018] [Indexed: 12/21/2022]
Affiliation(s)
- Mona Nystad
- Women's Health and Perinatology Research Group; Department of Clinical Medicine; Faculty of Health Sciences UiT - The Arctic University of Norway; Tromsø Norway
- Department of Obstetrics and Gynecology; University Hospital of North Norway; Tromsø Norway
| | - Vasilis Sitras
- Institute of Clinical Medicine; University of Oslo; Oslo Norway
- Department of Obstetrics; Fetal Medicine; Oslo University Hospital - Rikshospitalet; Oslo Norway
| | | | - Mona Irene Pedersen
- Translational Cancer Research Group; Department of Clinical Medicine; Faculty of Health Sciences UiT - The Arctic University of Norway; Tromsø Norway
| | - Ganesh Acharya
- Women's Health and Perinatology Research Group; Department of Clinical Medicine; Faculty of Health Sciences UiT - The Arctic University of Norway; Tromsø Norway
- Department of Obstetrics and Gynecology; University Hospital of North Norway; Tromsø Norway
- Department of Clinical Sciences, Intervention and Technology; Karolinska Institute; Stockholm Sweden
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23
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Washington K, Ghosh S, Reeves IV. A Review: Molecular Concepts and Common Pathways Involving Vitamin D in the Pathophysiology of Preeclampsia. ACTA ACUST UNITED AC 2018. [DOI: 10.4236/ojog.2018.83023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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24
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Pantham P, Chamley LW. Harvesting and Characterization of Syncytial Nuclear Aggregates Following Culture of First Trimester Human Placental Explants. Methods Mol Biol 2018; 1710:155-163. [PMID: 29197001 DOI: 10.1007/978-1-4939-7498-6_12] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
There is currently no effective method to study multinucleated trophoblast debris extruded from the syncytiotrophoblast into the maternal circulation. In Chapter 9 , an in vitro placental explant culture model to generate trophoblast debris was described. Here, we detail the method utilized to isolate individual large multinucleated syncytial nuclear aggregates (SNAs) that are extruded from the syncytiotrophoblast following the culture of first trimester human placental explants. Syncytial nuclear aggregates have been observed in the peripheral maternal circulation as early as 6 weeks' gestation and may play a role in tolerating the maternal immune system during pregnancy. Conversely, aberrant cell death processes in the syncytiotrophoblast due to various maternal factors leading to the extrusion of SNAs that are altered in nature have been implicated in the development of preeclampsia. The methods described herein allow for the isolation and harvest of SNAs without other types of extruded trophoblast debris and can be used to investigate the effect of various maternal factors on the nature of SNAs extruded from the placenta in vitro.
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Affiliation(s)
- Priyadarshini Pantham
- Carl R. Woese Institute for Genomic Biology, University of Illinois at Urbana-Champaign, 1206 W Gregory Dr., Urbana, IL, 61801, USA.
| | - Lawrence W Chamley
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
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25
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Zhao M, Li Y, Xu L, Hickey A, Groom K, Stone PR, Chamley LW, Chen Q. Melatonin prevents preeclamptic sera and antiphospholipid antibodies inducing the production of reactive nitrogen species and extrusion of toxic trophoblastic debris from first trimester placentae. Placenta 2017; 58:17-24. [PMID: 28962691 DOI: 10.1016/j.placenta.2017.08.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Revised: 07/11/2017] [Accepted: 08/01/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND The exact cause of preeclampsia is unknown. However a "toxin" from the placenta triggers the condition via activation of the maternal endothelium. Extracellular vesicles (EVs) from the syncytiotrophoblast, may be an endothelial-activating toxin. Antiphospholipid antibodies (aPL) and preeclamptic sera both induce the production of endothelial cell-activating EVs by mechanisms which may produce excess free-radicals in the placenta. Melatonin is produced by the human placenta and has both direct and indirect anti-free-radical properties and may therefore counter the effects of aPL and preeclamptic sera. METHODS First trimester placental explants were exposed to preeclamptic sera or aPL in the presence or absence of melatonin. Nitrosylative damage was assessed in the explants by immunohistochemistry and the effect of EVs from these explants on endothelial cell activation determined by ICAM-1. Release of nitrosylated proteins from the explants was also measured. RESULTS Placental explants showed reduced secretion of melatonin after treatment with preeclamptic sera. Nitrosylated proteins were more abundant in placentae that had been treated with aPL or preeclamptic sera and EVs from such placentae induced endothelial cell activation. Adding melatonin to the aPL or preeclamptic sera reversed the protein nitrosylation and production of endothelial-activating EVs. DISCUSSION Our data are consistent with reports that the levels of circulating melatonin are reduced in preeclampsia and suggest that aPL and factors in preeclamptic sera induce free-radical-mediated damage in the placenta leading to the production of endothelial-activating EVs. Melatonin reversing production of endothelial-activating EVs indicates that melatonin may have therapeutic benefits in women with preeclampsia and/or aPL.
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Affiliation(s)
- Mingzhi Zhao
- The Hospital of Obstetrics & Gynaecology, Fudan University, Shanghai, China; Department of Obstetrics & Gynaecology, The University of Auckland, New Zealand
| | - Yanyun Li
- The Hospital of Obstetrics & Gynaecology, Fudan University, Shanghai, China; Department of Obstetrics & Gynaecology, The University of Auckland, New Zealand
| | - Lance Xu
- Department of Obstetrics & Gynaecology, The University of Auckland, New Zealand
| | - Anthony Hickey
- School of Biological Science, The University of Auckland, New Zealand
| | - Katie Groom
- Department of Obstetrics & Gynaecology, The University of Auckland, New Zealand
| | - Peter R Stone
- Department of Obstetrics & Gynaecology, The University of Auckland, New Zealand
| | - Lawrence W Chamley
- Department of Obstetrics & Gynaecology, The University of Auckland, New Zealand
| | - Qi Chen
- The Hospital of Obstetrics & Gynaecology, Fudan University, Shanghai, China; Department of Obstetrics & Gynaecology, The University of Auckland, New Zealand.
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26
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Milovanov AP, Voloshchuk IN. [Deported syncytiotrophoblast and placental microparticles in the mother's body during normal pregnancy and preeclampsia (28 years later)]. Arkh Patol 2017; 79:61-67. [PMID: 28295010 DOI: 10.17116/patol201779161-67] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Over the last 25 years, there has been new evidence for the need to systematize deported placental cells, by identifying 3 groups according to their size, blocking or passing the pulmonary capillaries. In group 1, deported syncytiotrophoblast is a viable multinucleated complexes 100 to 20 µm in diameter. Their common cytoplasm displays β-hCG immunoexpression. After apoptosis of these cells in the lung capillaries, placental bioproducts directly interact with endothelial cell receptors, by contributing to the gestational rearrangement of the woman's body. In Group 2, placental microparticles are necrotized parts of syncytiotrophoblast microvilli and organelles 1000 to 100 nm in size: they freely pass the lung capillaries, activate the production of proinflammatory cytokines by maternal macrophages, and cause a systemic inflammatory response. In excess they become triggers of extensive endotheliosis and vasospasm. In Group 3, placental nanoparticles (or exosomes) are the smallest structures 120 to 20 nm in size; their numbers in the blood are increased in preeclampsia. The given materials call for further investigation of deported placental cells by standardized studies.
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Affiliation(s)
- A P Milovanov
- Research Institute of Human Morphology, Moscow, Russia
| | - I N Voloshchuk
- Moscow Regional Institute of Obstetrics and Gynecology, Ministry of Health of the Moscow Region, Moscow, Russia
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27
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Senagore PK, Holzman CB, Parks WT, Catov JM. Working Towards a Reproducible Method for Quantifying Placental Syncytial Knots. Pediatr Dev Pathol 2017; 19:389-400. [PMID: 26529304 DOI: 10.2350/15-08-1701-oa.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Prominent syncytial knots (SK) in placentas signal advanced gestation or placental malperfusion, reflecting exposures that adversely affect placental development and pregnancy outcomes. Molecular-level interrogations of syncytiotrophoblast have altered perceptions of and raised questions about the function and disposition of SK. Quantifying SK and achieving acceptable levels of interrater reliability have been challenging. Our objective was to develop a simple, reproducible protocol for counting SK and demonstrate interrater reliability overall and within 3 parameters, ie, preterm vs term delivery, presence vs absence of diffuse prominent SK (DPSK), and SK relationship with a lesion, all of which could influence measurement reproducibility and interpretation. Criteria for defining SK and a grid system drawn on glass slides were developed for counting percentage of villi with SK. One disc section each from 151 placentas, sampled from 8 groups defined by the 3 parameters, was assessed by 2 pretrained pathologists. The resulting weighted kappa statistic for overall interrater agreement was 0.60 (very good) and Spearman correlation coefficient for ranking quartiles was >0.70. Agreement was best for preterm placentas, kappa = 0.61, and those only showing DPSK associated with a lesion, kappa = 0.67. Agreement was low in the absence of DPSK, kappa = 0.22, or when DPSK was present in a placenta not associated with a lesion, kappa = 0.32. The proposed method offers a potentially reliable approach for categorizing SK counts as normal vs abnormal or providing continuous measure counts. More extensive pretraining, focused on placentas with few SK and those without an associated lesion, is recommended to improve agreement.
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Affiliation(s)
- Patricia K Senagore
- 1 Department of Epidemiology and Biostatistics, Michigan State University College of Human Medicine, West Fee Hall, 909 Fee Road, Room B601, East Lansing, MI 48824, USA
| | - Claudia B Holzman
- 1 Department of Epidemiology and Biostatistics, Michigan State University College of Human Medicine, West Fee Hall, 909 Fee Road, Room B601, East Lansing, MI 48824, USA
| | - W Tony Parks
- 2 Department of Pathology, University of Pittsburgh, Magee-Women's Hospital of UPMC, 300 Halket Street, Room 4436, Pittsburgh, PA 15213, USA.,3 Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, 300 Halket Street, Pittsburgh, PA 15213, USA
| | - Janet M Catov
- 4 Magee Women's Research Institute; Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, 300 Halket Street, Suite 2315, Pittsburgh, PA, USA.,5 Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, 300 Halket Street, Pittsburgh, PA 15213, USA
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28
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Göhner C, Plösch T, Faas MM. Immune-modulatory effects of syncytiotrophoblast extracellular vesicles in pregnancy and preeclampsia. Placenta 2017. [PMID: 28647398 DOI: 10.1016/j.placenta.2017.06.004] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Unique immunologic adaptations exist to successfully establish and maintain pregnancy and to avoid an immune attack against the semi allogenic fetus. These adaptations occur both locally at the maternofetal interface and in the peripheral circulation and affect the innate as well as the adaptive immune system. Pregnancy is characterized by a general inflammatory state with activation of monocytes and granulocytes, but also with suppressive lymphocytes (regulatory T cells), and skewing towards T helper 2 immunity. The pregnancy complication preeclampsia is associated with an exaggerated inflammatory state and predominance of T helper 1 and 17 immunity. The syncytiotrophoblast has been found to secrete extracellular vesicles as communication factors into the maternal circulation. Syncytiotrophoblast extracellular vesicles from normal pregnancy have been shown to interact with monocytes, granulocytes, T cells and natural killer cells and influence the function of these cells. In doing so, they may support the inflammatory state of normal pregnancy as well as the suppressive lymphocyte phenotype. During preeclampsia, syncytiotrophoblast extracellular vesicles are not only increased in numbers but also showed an altered molecular load. Based on data from in vitro studies, it can be suggested that syncytiotrophoblast extracellular vesicles from preeclamptic pregnancies may support the exaggerated inflammatory state during preeclampsia. In this review, we discuss the immunological functions of syncytiotrophoblast extracellular vesicles and their involvement in adapting the maternal peripheral immunological adaptations to pregnancy.
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Affiliation(s)
- Claudia Göhner
- Placenta-Labor, Department of Obstetrics, Jena University Hospital, Friedrich Schiller University, Bachstraße 18, 07743 Jena, Germany; Department of Obstetrics and Gynecology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713GZ Groningen, The Netherlands.
| | - Torsten Plösch
- Department of Obstetrics and Gynecology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713GZ Groningen, The Netherlands
| | - Marijke M Faas
- Department of Obstetrics and Gynecology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713GZ Groningen, The Netherlands; Immunoendocrinology, Division of Medical Biology, Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713GZ Groningen, The Netherlands
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Xiao X, Xiao F, Zhao M, Tong M, Wise MR, Stone PR, Chamley LW, Chen Q. Treating normal early gestation placentae with preeclamptic sera produces extracellular micro and nano vesicles that activate endothelial cells. J Reprod Immunol 2017; 120:34-41. [PMID: 28441551 DOI: 10.1016/j.jri.2017.04.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 03/09/2017] [Accepted: 04/11/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVES Preeclampsia is characterised by systemic endothelial cell dysfunction thought to be triggered by toxic/dangerous factors from the placenta, including placental extracellular vesicles (EVs). Why placental EVs become toxic is unknown. We previously reported that preeclamptic sera produced toxic/dangerous placental macrovesicles but whether small EVs are also toxic/dangerous in preeclampsia is unknown. STUDY DESIGN First trimester placental explants were treated with 10% preeclamptic or control sera (n=10) for 24h. Micro- and nano-vesicles were harvested by sequential centrifugation. Micro- or nano-vesicles were also exposed to monolayers of endothelial cells in the presence or absence of nifedipine (50μg/ml) or labetalol (0.5μg/ml) which are well-known anti-hypertensives in clinical practices. MAIN OUTCOMES MEASURES The number and size of micro- and nano-vesicles were counted. Endothelial cell-surface intercellular adhesion molecule 1 (ICAM-1) and high mobility group box 1 (HMGB1) levels in micro- or nano-vesicles were measured by immunoassays. RESULTS Neither the amount nor size of both micro- and nano-vesicles was different after treating placental explants with preeclamptic or control sera. The levels of HMGB1 were significantly increased in both micro- and nano-vesicles from preeclamptic sera treated placental explants (p<0.03). Exposing endothelial cells to micro- or nano-vesicles from preeclamptic sera-treated placental explants induced endothelial activation, but it was reversed by co-incubation with nifedipine (p=0.004) or labetalol (p=0.002). CONCLUSION Our data demonstrate that preeclamptic sera produce toxic/dangerous micro- and nano-placental EVs which activated endothelial cells. This effect was reversed by antihypertensives. The increased levels of HMGB1 in EVs may contribute to endothelial cell activation.
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Affiliation(s)
- Xirong Xiao
- The Hospital of Obstetrics & Gynaecology, Fudan University, China; Department of Obstetrics & Gynaecology, The University of Auckland, New Zealand
| | - Fengyi Xiao
- The Hospital of Obstetrics & Gynaecology, Fudan University, China; Department of Obstetrics & Gynaecology, The University of Auckland, New Zealand
| | - Mingzhi Zhao
- The Hospital of Obstetrics & Gynaecology, Fudan University, China; Department of Obstetrics & Gynaecology, The University of Auckland, New Zealand
| | - Mancy Tong
- Department of Obstetrics & Gynaecology, The University of Auckland, New Zealand
| | - Michelle R Wise
- Department of Obstetrics & Gynaecology, The University of Auckland, New Zealand
| | - Peter R Stone
- Department of Obstetrics & Gynaecology, The University of Auckland, New Zealand
| | - Lawrence W Chamley
- Department of Obstetrics & Gynaecology, The University of Auckland, New Zealand
| | - Qi Chen
- The Hospital of Obstetrics & Gynaecology, Fudan University, China; Department of Obstetrics & Gynaecology, The University of Auckland, New Zealand.
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Tong M, Chen Q, James JL, Wise MR, Stone PR, Chamley LW. In vivo targets of human placental micro-vesicles vary with exposure time and pregnancy. Reproduction 2017; 153:835-845. [PMID: 28356498 DOI: 10.1530/rep-16-0615] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 03/27/2017] [Accepted: 03/29/2017] [Indexed: 01/15/2023]
Abstract
Throughout human gestation, the placenta extrudes vast quantities of extracellular vesicles (EVs) of different sizes into the maternal circulation. Although multinucleated macro-vesicles are known to become trapped in the maternal lungs and do not enter the peripheral circulation, the maternal organs and cells that smaller placental micro-vesicles interact with in vivo remain unknown. This study aimed to characterise the interaction between placental micro-vesicles and endothelial cells in vitro and to elucidate which organs placental micro-vesicles localise to in vivo Placental macro- and micro-vesicles were isolated from cultured human first trimester placental explants by sequential centrifugation and exposed to human microvascular endothelial cells for up to 72 h. In vivo, placental macro- and micro-vesicles were administered to both non-pregnant and pregnant CD1 mice, and after two or 30 min or 24 h, organs were imaged on an IVIS Kinetic Imager. Placental EVs rapidly interacted with endothelial cells via phagocytic and clathrin-mediated endocytic processes in vitro, with over 60% of maximal interaction being achieved by 30 min of exposure. In vivo, placental macro-vesicles were localised exclusively to the lungs regardless of time of exposure, whereas micro-vesicles were localised to the lungs, liver and kidneys, with different distribution patterns depending on the length of exposure and whether the mouse was pregnant or not. The fact that placental EVs can rapidly interact with endothelial cells and localise to different organs in vivo supports that different size fractions of placental EVs are likely to have different downstream effects on foeto-maternal communication.
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Affiliation(s)
- Mancy Tong
- Department of Obstetrics and GynaecologyThe University of Auckland, Auckland, New Zealand
| | - Qi Chen
- Department of Obstetrics and GynaecologyThe University of Auckland, Auckland, New Zealand
| | - Joanna L James
- Department of Obstetrics and GynaecologyThe University of Auckland, Auckland, New Zealand
| | - Michelle R Wise
- Department of Obstetrics and GynaecologyThe University of Auckland, Auckland, New Zealand.,Maternal Fetal MedicineAuckland City Hospital, Auckland, New Zealand
| | - Peter R Stone
- Department of Obstetrics and GynaecologyThe University of Auckland, Auckland, New Zealand.,Maternal Fetal MedicineAuckland City Hospital, Auckland, New Zealand
| | - Lawrence W Chamley
- Department of Obstetrics and GynaecologyThe University of Auckland, Auckland, New Zealand
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Tong M, Chen Q, James JL, Stone PR, Chamley LW. Micro- and Nano-vesicles from First Trimester Human Placentae Carry Flt-1 and Levels Are Increased in Severe Preeclampsia. Front Endocrinol (Lausanne) 2017; 8:174. [PMID: 28790977 PMCID: PMC5522845 DOI: 10.3389/fendo.2017.00174] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2017] [Accepted: 07/05/2017] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND/OBJECTIVES Preeclampsia is a life-threatening hypertensive disease affecting 3-5% of pregnancies. While the pathogenesis of preeclampsia remains unclear, it is known that placenta-derived factors trigger the disease by activating maternal endothelial cells prior to the onset of clinical symptoms. Extracellular vesicles (EVs) of different sizes extruded by the placenta may be one factor. The truncated/secreted form of Flt-1 (sFlt-1) has also been implicated in the pathogenesis of preeclampsia. We investigated whether placental EV production is altered in preeclampsia such that they induce endothelial cell activation, and whether (s)Flt-1 is involved. METHODS Macro-, micro-, and nano-vesicles were collected from normal and preeclamptic (PE) placental explants, and separated by differential centrifugation. The number and size of micro- and nano-vesicles was measured by nanoparticle tracking analysis and their ability to activate endothelial cells was quantified by endothelial cell intercellular adhesion molecule 1 expression and monocyte adhesion. The levels of Flt-1 were measured by western blots and ELISA. RESULTS PE placentae extruded significantly more micro- and nano-vesicles than control placentae and the extruded micro-vesicles were larger than those from control placentae. Micro- and nano-vesicles from both first trimester and term human placentae carried Flt-1 and levels were significantly increased in EVs from severe, but not mild, PE compared to normotensive placentae. All fractions of EVs from PE placentae activated endothelial cells, and for micro- and nano-vesicles, activation was reduced in the presence of exogenous vascular endothelial growth factor (VEGF), a Flt-1 neutralizing antibody, or by pre-treatment with VEGF. While EV-bound VEGF constituted over 20% of the total detected VEGF secreted by PE and normotensive placentae, EV-bound Flt-1 did not significantly contribute to the total level of sFlt-1/Flt-1 released by human third trimester placentae. DISCUSSION Micro- and nano-vesicles extruded by human placentae carry Flt-1 across gestation and in severe preeclampsia, the levels of vesicle-bound Flt-1 are upregulated. All fractions of PE placental EVs activated endothelial cells and for micro- and nano-vesicles, this was in part due to the ability of EV-bound Flt-1 to sequester VEGF. That placental EVs can activate endothelial cells supports the contention that EVs are one placental toxin contributing to the pathogenesis of preeclampsia.
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Affiliation(s)
- Mancy Tong
- Department of Obstetrics and Gynaecology, School of Medicine, The University of Auckland, Auckland, New Zealand
- *Correspondence: Mancy Tong,
| | - Qi Chen
- Department of Obstetrics and Gynaecology, School of Medicine, The University of Auckland, Auckland, New Zealand
| | - Joanna L. James
- Department of Obstetrics and Gynaecology, School of Medicine, The University of Auckland, Auckland, New Zealand
| | - Peter R. Stone
- Department of Obstetrics and Gynaecology, School of Medicine, The University of Auckland, Auckland, New Zealand
| | - Lawrence W. Chamley
- Department of Obstetrics and Gynaecology, School of Medicine, The University of Auckland, Auckland, New Zealand
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Nadeau-Vallée M, Obari D, Palacios J, Brien MÈ, Duval C, Chemtob S, Girard S. Sterile inflammation and pregnancy complications: a review. Reproduction 2016; 152:R277-R292. [PMID: 27679863 DOI: 10.1530/rep-16-0453] [Citation(s) in RCA: 181] [Impact Index Per Article: 22.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Accepted: 09/27/2016] [Indexed: 02/06/2023]
Abstract
Inflammation is essential for successful embryo implantation, pregnancy maintenance and delivery. In the last decade, important advances have been made in regard to endogenous, and therefore non-infectious, initiators of inflammation, which can act through the same receptors as pathogens. These molecules are referred to as damage-associated molecular patterns (DAMPs), and their involvement in reproduction has only recently been unraveled. Even though inflammation is necessary for successful reproduction, untimely activation of inflammatory processes can have devastating effect on pregnancy outcomes. Many DAMPs, such as uric acid, high-mobility group box 1 (HMGB1), interleukin (IL)-1 and cell-free fetal DNA, have been associated with pregnancy complications, such as miscarriages, preeclampsia and preterm birth in preclinical models and in humans. However, the specific contribution of alarmins to these conditions is still under debate, as currently there is lack of information on their mechanism of action. In this review, we discuss the role of sterile inflammation in reproduction, including early implantation and pregnancy complications. Particularly, we focus on major alarmins vastly implicated in numerous sterile inflammatory processes, such as uric acid, HMGB1, IL-1α and cell-free DNA (especially that of fetal origin) while giving an overview of the potential role of other candidate alarmins.
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Affiliation(s)
- Mathieu Nadeau-Vallée
- Departments of PediatricsOphthalmology and Pharmacology, CHU Sainte-Justine Research Center, Montreal, Quebec, Canada.,Department of PharmacologyUniversité de Montréal, Montreal, Quebec, Canada
| | - Dima Obari
- Department of PharmacologyUniversité de Montréal, Montreal, Quebec, Canada
| | - Julia Palacios
- Department of Obstetrics & GynecologyCHU Sainte-Justine Research Center, Montreal, Quebec, Canada
| | - Marie-Ève Brien
- Department of Obstetrics & GynecologyCHU Sainte-Justine Research Center, Montreal, Quebec, Canada.,Department of MicrobiologyVirology and Immunology, Université de Montréal, Montreal, Quebec, Canada
| | - Cyntia Duval
- Department of Obstetrics & GynecologyCHU Sainte-Justine Research Center, Montreal, Quebec, Canada
| | - Sylvain Chemtob
- Departments of PediatricsOphthalmology and Pharmacology, CHU Sainte-Justine Research Center, Montreal, Quebec, Canada .,Department of PharmacologyUniversité de Montréal, Montreal, Quebec, Canada
| | - Sylvie Girard
- Department of PharmacologyUniversité de Montréal, Montreal, Quebec, Canada .,Department of Obstetrics & GynecologyCHU Sainte-Justine Research Center, Montreal, Quebec, Canada.,Department of MicrobiologyVirology and Immunology, Université de Montréal, Montreal, Quebec, Canada
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Arriaga-Pizano L, Jimenez-Zamudio L, Vadillo-Ortega F, Martinez-Flores A, Herrerias-Canedo T, Hernandez-Guerrero C. The Predominant Th1 Cytokine Profile in Maternal Plasma of Preeclamptic Women Is Not Reflected in the Choriodecidual and Fetal Compartments. ACTA ACUST UNITED AC 2016; 12:335-42. [PMID: 15979545 DOI: 10.1016/j.jsgi.2005.02.005] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2004] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Human pregnancy disorders such as preeclampsia are thought to involve variations in cytokine levels. It has been proposed that, in preeclamptic women, a balance favoring the Th1-type over the Th2-type cytokine profile determines local or systemic immunologic responses to pregnancy and that this may cause defective placental implantation and placental ischemia, which activate systemic endothelial cells. The purpose of this study was to determine whether cytokine expression differs in the maternal, choriodecidual, and fetal compartments, and between women with or without preeclampsia. METHODS Plasma concentrations of interferon gamma (IFNgamma), interleukin (IL)-2, IL-4, and IL-10 were measured by enzyme-linked immunosorbent assay (ELISA) in samples obtained from maternal peripheral blood (MPB), choriodecidual (CD), and fetal cord (FC) blood compartments of 17 women with preeclampsia and in 15 normotensive women. Intracellular concentrations of IFNgamma and IL-2 in T lymphocytes were assessed by flow cytometry. RESULTS Plasma IFNgamma concentrations in both MPB and CD compartments were significantly higher in preeclamptic than in normotensive women. Maternal plasma IL-4 concentration was significantly lower in preeclamptic than in normotensive women. Intracellular IFNgamma and IL-2 concentrations did not differ significantly between preeclamptic and normotensive women. CONCLUSIONS The dominant Th1-type over Th2-type cytokine profile is evident in MPB, but not in the CD and FC blood compartments. This might reflect the complex cytokine networks in the fetal-placental interface and might involve trophoblasts or decidual and endothelial cells, which could account for the increased plasma IFNgamma concentration and T-helper cell number.
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Affiliation(s)
- Lourdes Arriaga-Pizano
- Department of Ultrastructure, Instituto Nacional de Perinatologia, Lomas Virreyes, Mexico City, Mexico
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Huppertz B, Kingdom JCP. Apoptosis in the Trophoblast—Role of Apoptosis in Placental Morphogenesis. ACTA ACUST UNITED AC 2016; 11:353-62. [PMID: 15350247 DOI: 10.1016/j.jsgi.2004.06.002] [Citation(s) in RCA: 187] [Impact Index Per Article: 23.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Villous trophoblast is the epithelial cover of the placental villous tree and comes in direct contact with maternal blood. The turnover of villous trophoblast includes proliferation and differentiation of cytotrophoblast, syncytial fusion of cytotrophoblast with the overlying syncytiotrophoblast, differentiation in the syncytiotrophoblast, and finally extrusion of apoptotic material into the maternal circulation. In recent years, it has become clear that apoptosis is a normal constituent of trophoblast turnover and the release of apoptotic material does not lead to an inflammatory response of the mother. During preeclampsia there seems to be an altered balance between proliferation and apoptosis of villous trophoblast leading to a dysregulation of the release from the syncytiotrophoblast. The normal apoptotic release may be reduced in favor of a necrotic release. Since apoptosis is still ongoing in the syncytiotrophoblast, a necrotic release of intrasyncytial and partly apoptotic material lead us to call this type of release "aponecrotic shedding." In this situation, cell-free components such as G-actin and DNA freely floating in maternal blood may trigger damage to the maternal endothelium, thereby triggering preeclampsia. This review highlights the importance of the apoptosis cascade in permitting normal physiologic turnover of villous trophoblast. It will demonstrate the participation of initial stages of this cascade within the cytotrophoblast and of the execution stages within the syncytiotrophoblast. Moreover, this review presents hypotheses of how dysregulation of the apoptosis cascade may be linked to endothelial dysfunction of the maternal vasculature in preeclampsia.
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Affiliation(s)
- Berthold Huppertz
- Department of Anatomy II, University Hospital RWTH, Aachen, Germany.
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Tannetta D, Masliukaite I, Vatish M, Redman C, Sargent I. Update of syncytiotrophoblast derived extracellular vesicles in normal pregnancy and preeclampsia. J Reprod Immunol 2016; 119:98-106. [PMID: 27613663 DOI: 10.1016/j.jri.2016.08.008] [Citation(s) in RCA: 137] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Revised: 08/12/2016] [Accepted: 08/23/2016] [Indexed: 11/24/2022]
Abstract
The release of extracellular vesicles (EV) by the syncytiotrophoblast (STB) may be an important mechanism by which the placenta signals to the mother. STB derived EV (STBEV) are comprised predominantly of exosomes (50-150nm) and microvesicles (100-1000nm) that contain bioactive mediators such as proteins, nucleic acids and lipids. They, along with larger syncytial nuclear aggregates are released by the STB into the maternal circulation throughout gestation in normal pregnancy where they appear to have an immunoregulatory role, inhibiting T cell and NK cell responses. In pre-eclampsia (PE) STBEV are released in significantly increased numbers and have pro-inflammatory, anti-angiogenic and procoagulant activity, implicating them in the maternal systemic inflammation, endothelial dysfunction and activation of the clotting system which typifies the disorder. Research has focused on understanding the biological significance of STBEV by measuring their size and repertoire of molecules carried and how they differ in normal pregnancy and PE, using techniques such as Nanoparticle Tracking Analysis, flow cytometry and mass spectrometry. We have also found alterations in STBEV surface glycans associated with PE. The goal is to better understand the role STBEV play in normal pregnancy and PE and whether they are potential biomarkers of placental pathology and therapeutic targets in PE.
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Affiliation(s)
- Dionne Tannetta
- Department of Food and Nutritional Sciences, PO Box 226, Whiteknights, Reading RG6 6AP, UK.
| | - Ieva Masliukaite
- Center for Reproductive Medicine, TKsO-266, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
| | - Manu Vatish
- Nuffield Department of Obstetrics & Gynaecology, University of Oxford, John Radcliffe Hospital, Oxford, OX3 9DU, UK.
| | - Christopher Redman
- Nuffield Department of Obstetrics & Gynaecology, University of Oxford, John Radcliffe Hospital, Oxford, OX3 9DU, UK.
| | - Ian Sargent
- Nuffield Department of Obstetrics & Gynaecology, University of Oxford, John Radcliffe Hospital, Oxford, OX3 9DU, UK.
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Zhao M, Yin Y, Wei J, Wu M, Yang C, Chen Q. Trophoblastic debris extruded from hydatidiform molar placentae activates endothelial cells: Possible relevance to the pathogenesis of preeclampsia. Placenta 2016; 45:42-9. [PMID: 27577709 DOI: 10.1016/j.placenta.2016.07.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2016] [Revised: 06/28/2016] [Accepted: 07/25/2016] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Preeclampsia is currently thought to be induced by a placental factor that triggers maternal endothelial activation. It is now well known that trophoblastic debris shed from the placenta into the maternal blood is associated with this disease. Hydatidiform mole is a pathological pregnancy characterised by hyperplastic trophoblast with little or no fetal development. Women with molar pregnancies may exhibit symptoms resembling preeclampsia. Deportation of trophoblastic debris occurs in molar pregnancies but, whether trophoblastic debris from molar pregnancies expresses pathogenic signals or activates endothelial cells is unknown. METHODS Trophoblastic debris were collected from either hydatidiform molar or normal first trimester placental explants and then exposed to monolayers of endothelial cell for 24 h. Endothelial cell activation was measured by quantifying cell-surface ICAM-1using ELISA. In addition, the expressions of High mobility group box 1(HMGB1) and heat shock protein 70 (HSP70) on molar placenta were examined by immunohistochemistry and western blotting. Circulating levels of sEndoglin in molar pregnancy was also measured. RESULTS Exposing trophoblastic debris from molar placentae increased endothelial cell surface ICAM-1 expression compared to endothelial cells exposed to trophoblastic debris from controls. Expression of HSP70 but not HMGB1 was significantly increased in hydatidiform molar placentae. The circulating levels of sEndoglin in hydatidiform molar pregnancy were not increased compared to controls. DISCUSSION Our results suggest that trophoblastic debris from molar pregnancies induces endothelial cell activation. HSP70 but not HMGB1 expressed on hydatidiform molar placenta may be a pathogenic signal to endothelial cells.
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Affiliation(s)
- Min Zhao
- Wuxi Maternity and Children Hospital, Nanjing Medical University, China
| | - Yongxiang Yin
- Wuxi Maternity and Children Hospital, Nanjing Medical University, China
| | - Jia Wei
- Department of Obstetrics & Gynaecology, The University of Auckland, New Zealand
| | - Man Wu
- Wuxi Maternity and Children Hospital, Nanjing Medical University, China
| | - Chaokuan Yang
- Department of Internal Medicine, Henan Medical College, China.
| | - Qi Chen
- Department of Obstetrics & Gynaecology, The University of Auckland, New Zealand; The Hospital of Obstetrics & Gynaecology, Fudan University, China.
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Kuessel L, Kasimir-Bauer S, Zeillinger R, Pateisky P, Ott J, Zeisler H, Birdir C. Detection of circulating trophoblast particles in maternal blood using density gradient centrifugation in preeclampsia and in normotensive pregnancies. Hypertens Pregnancy 2016; 35:323-9. [PMID: 26930176 DOI: 10.3109/10641955.2016.1143487] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVE Preeclampsia (PE) is a frequent pregnancy-related disease and a major cause of maternal and fetal morbidity and mortality. Despite that, exact mechanisms of its pathophysiology remain largely unknown. In pregnancies complicated by PE, changes in the regulation of apoptosis seem to result in increased apoptotic shedding of trophoblast particles (TPs) into maternal circulation. Since the number of TP in peripheral blood is low, their detection necessitates pre-analytical enrichment. METHODS In this prospective multicenter pilot study we aimed to analyze TP in peripheral blood of 29 women with PE and of 13 unaffected controls using the OncoQuick®plus system for cell enrichment. Using immunocytochemistry, slides were evaluated microscopically for TP. Statistical analyses were performed using Welch's t-test or Fisher's exact test. RESULTS TP were detected in 10 (34.5%) women with PE and in two (15.4%) of unaffected controls. More than one TP were only found in PE. Comparing the mean counts of TP between groups, we detected significantly more TP in PE (p = 0.046). CONCLUSIONS The OncoQuick®plus system can be applied to detect TP in both women with PE and in normotensive pregnancies. Longitudinal studies investigating the role of TP as a screening method for patients at risk for PE are warranted.
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Affiliation(s)
- Lorenz Kuessel
- a Department of Obstetrics and Gynecology , Medical University of Vienna , Vienna , Austria
| | - Sabine Kasimir-Bauer
- b Department of Obstetrics and Gynecology , University of Duisburg-Essen , Essen , Germany
| | - Robert Zeillinger
- a Department of Obstetrics and Gynecology , Medical University of Vienna , Vienna , Austria
| | - Petra Pateisky
- a Department of Obstetrics and Gynecology , Medical University of Vienna , Vienna , Austria
| | - Johannes Ott
- a Department of Obstetrics and Gynecology , Medical University of Vienna , Vienna , Austria
| | - Harald Zeisler
- a Department of Obstetrics and Gynecology , Medical University of Vienna , Vienna , Austria
| | - Cahit Birdir
- b Department of Obstetrics and Gynecology , University of Duisburg-Essen , Essen , Germany
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Chen Q, Sousa JD, Snowise S, Chamley L, Stone P. Reduction in the severity of early onset severe preeclampsia during gestation may be associated with changes in endothelial cell activation: A pathological case report. Hypertens Pregnancy 2016; 35:32-41. [PMID: 26852788 DOI: 10.3109/10641955.2015.1100309] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Early severe preeclampsia with changes consistent with the Hemolysis elevated liver enzymes low platelet count (HELLP) variant and severe fetal growth restriction rarely resolves prior to delivery. Established clinical disease is preceded by endothelial dysfunction and inflammation. Endothelial activation is reported in vitro to be raised in the presence of necrotic trophoblastic debris which is deported into the maternal circulation in preeclampsia. We report on an early severe preeclamptic patient admitted at 24 weeks gestation. Maternal serum was taken at day 2, 16, 30 of admission and 45 days postpartum. 20% maternal serum or trophoblastic debris from first trimester placental explants that had been cultured with 10% maternal serum was exposed to endothelial cells. Endothelial cell activation was quantified by the cell surface ICAM-1 expression and U937 monocyte adhesion assay. The clinical condition of this patient improved including the blood pressure, liver function, and platelet count by the 3rd day after antihypertensive treatment and remained normal until delivery at 37 weeks. ICAM-1 expression and U937 moncyte adhesion assay of endothelial cells was significantly increased following exposure of the endothelial cells to the maternal serum or trophoblastic debris from placentae treated with maternal serum drawn on day 2. However, ICAM-1 expression and the monocyte adhesion assay were significantly reduced following exposure of endothelial cells to maternal serum or trophoblastic debris from placenta treated with maternal serum drawn on day 16 or 30. Our data suggest unknown factor(s) in the maternal serum triggered endothelial cell activation when the clinical symptoms were present. The improvement in the clinical condition occurred along with the changes in endothelial cell activation.
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Affiliation(s)
- Q Chen
- a Department of Obstetrics & Gynaecology , The University of Auckland , Auckland , New Zealand.,b The Hospital of Obstetrics & Gynaecology , Fudan University , Shanghai , China
| | - J De Sousa
- c Maternal Fetal Medicine, Auckland City Hospital , Auckland , New Zealand
| | - S Snowise
- c Maternal Fetal Medicine, Auckland City Hospital , Auckland , New Zealand
| | - L Chamley
- a Department of Obstetrics & Gynaecology , The University of Auckland , Auckland , New Zealand
| | - P Stone
- a Department of Obstetrics & Gynaecology , The University of Auckland , Auckland , New Zealand.,c Maternal Fetal Medicine, Auckland City Hospital , Auckland , New Zealand
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Pantham P, Viall CA, Chen Q, Kleffmann T, Print CG, Chamley LW. Antiphospholipid antibodies bind syncytiotrophoblast mitochondria and alter the proteome of extruded syncytial nuclear aggregates. Placenta 2015; 36:1463-73. [PMID: 26506561 DOI: 10.1016/j.placenta.2015.10.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Revised: 08/28/2015] [Accepted: 10/11/2015] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Antiphospholipid antibodies (aPL) are autoantibodies that increase the risk of women developing the hypertensive disorder pre-eclampsia. aPL are internalised by the syncytiotrophoblast and increase extrusion of necrotic multinucleated syncytial nuclear aggregates (SNAs), which may trigger endothelial dysfunction in pre-eclampsia. The mechanisms by which aPL alter death processes in the syncytiotrophoblast leading to extrusion of SNAs are unknown. METHODS First trimester human placentae (n = 10) were dissected into explants and cultured either with aPL (50 μg/mL), isotype-matched control antibody (50 μg/mL), or media for 24 h. Harvested SNAs underwent iTRAQ proteomic analysis. Mitochondria in syncytiotrophoblast treated with aPL labelled with FluoroNanogold were visualised using transmission electron microscopy (TEM). RESULTS aPL altered the expression of 72 proteins in SNAs. Thirteen proteins were involved in mitochondrial function. TEM demonstrated that aPL bind to mitochondria in the syncytiotrophoblast and may cause mitochondrial swelling. DISCUSSION aPL disrupt mitochondria increasing the extrusion of SNAs with an altered proteome from the syncytiotrophoblast. These altered SNAs may trigger endothelial dysfunction and pre-eclampsia in these pregnancies.
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Affiliation(s)
- Priyadarshini Pantham
- Department of Obstetrics & Gynaecology, The University of Auckland, Auckland, New Zealand; Department of Pediatrics, Section of Neonatology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
| | - Chez A Viall
- Department of Obstetrics & Gynaecology, The University of Auckland, Auckland, New Zealand
| | - Qi Chen
- Department of Obstetrics & Gynaecology, The University of Auckland, Auckland, New Zealand
| | - Torsten Kleffmann
- Centre for Protein Research, University of Otago, Dunedin, New Zealand
| | - Cristin G Print
- Department of Molecular Medicine and Pathology, The University of Auckland, Auckland, New Zealand; Bioinformatics Institute, The University of Auckland, Auckland, New Zealand
| | - Lawrence W Chamley
- Department of Obstetrics & Gynaecology, The University of Auckland, Auckland, New Zealand
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Huppertz B. Maternal–fetal interactions, predictive markers for preeclampsia, and programming. J Reprod Immunol 2015; 108:26-32. [DOI: 10.1016/j.jri.2014.11.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Revised: 11/04/2014] [Accepted: 11/18/2014] [Indexed: 11/30/2022]
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Bouter A, Carmeille R, Gounou C, Bouvet F, Degrelle SA, Evain-Brion D, Brisson AR. Review: Annexin-A5 and cell membrane repair. Placenta 2015; 36 Suppl 1:S43-9. [PMID: 25701430 DOI: 10.1016/j.placenta.2015.01.193] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Revised: 01/21/2015] [Accepted: 01/26/2015] [Indexed: 11/16/2022]
Abstract
Annexins are soluble proteins that bind to biological membranes containing negatively charged phospholipids, principally phosphatidylserine, in a Ca(2+)-dependent manner. Annexin-A5 (AnxA5), the smallest member of the annexin family, presents unique properties of membrane binding and self-assembly into ordered two-dimensional (2D) arrays on membrane surfaces. We have previously reported that AnxA5 plays a central role in the machinery of membrane repair by enabling rapid resealing of plasma membrane disruption in murine perivascular cells. AnxA5 promotes membrane repair via the formation of a protective 2D bandage at membrane damaged site. Here, we review current knowledge on cell membrane repair and present recent findings on the role of AnxA5 in membrane resealing of human trophoblasts.
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Affiliation(s)
- A Bouter
- Molecular Imaging and NanoBioTechnology, UMR-5248-CBMN CNRS-University of Bordeaux-IPB, Allée Geoffroy Saint-Hilaire, F-33600 Pessac, France.
| | - R Carmeille
- Molecular Imaging and NanoBioTechnology, UMR-5248-CBMN CNRS-University of Bordeaux-IPB, Allée Geoffroy Saint-Hilaire, F-33600 Pessac, France
| | - C Gounou
- Molecular Imaging and NanoBioTechnology, UMR-5248-CBMN CNRS-University of Bordeaux-IPB, Allée Geoffroy Saint-Hilaire, F-33600 Pessac, France
| | - F Bouvet
- Molecular Imaging and NanoBioTechnology, UMR-5248-CBMN CNRS-University of Bordeaux-IPB, Allée Geoffroy Saint-Hilaire, F-33600 Pessac, France
| | - S A Degrelle
- Fondation PremUP, Paris F-75006, France; INSERM, U1139, Paris F-75006, France; Université Paris Descartes, UMR-S1139 Sorbonne Paris Cité, Paris F-75006, France
| | - D Evain-Brion
- Fondation PremUP, Paris F-75006, France; INSERM, U1139, Paris F-75006, France; Université Paris Descartes, UMR-S1139 Sorbonne Paris Cité, Paris F-75006, France
| | - A R Brisson
- Molecular Imaging and NanoBioTechnology, UMR-5248-CBMN CNRS-University of Bordeaux-IPB, Allée Geoffroy Saint-Hilaire, F-33600 Pessac, France
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Viall CA, Chamley LW. Histopathology in the placentae of women with antiphospholipid antibodies: A systematic review of the literature. Autoimmun Rev 2015; 14:446-71. [PMID: 25620498 DOI: 10.1016/j.autrev.2015.01.008] [Citation(s) in RCA: 104] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Accepted: 01/15/2015] [Indexed: 12/20/2022]
Abstract
BACKGROUND Antiphospholipid antibodies (aPLs) are a heterogenous group of autoantibodies associated with recurrent miscarriage, stillbirth, foetal growth restriction and premature birth. The cause of obstetric morbidity in women with aPLs is not completely understood. Workers have attempted to understand the role of aPLs in obstetric morbidity by investigating the histopathology of placentae from aPL-positive women. However, it is unclear from these diverse, and at times contradictory reports what histopathological lesions are common in the placentae of women with aPLs. This systematic review was undertaken to generate a complete picture of the placental features associated with aPLs in an attempt to understand the pathological processes that occur in pregnancies affected by aPLs. METHODS Pubmed, Scopus, Web of Science and Embase were searched on the 27th November 2014 using the keywords "placenta" OR "trophoblast" AND "antiphospholipid antibody" OR "antiphospholipid antibody syndrome". Records that were relevant and eligible were qualitatively assessed and given a score out of 24. RESULTS Of the 1112 records that were retrieved from the systematic search, 34 records were eligible for review, and were qualitatively scored. Of the 44 histopathological features that were reported in 580 placentae from aPL-positive women, six features appeared to be more common in the placentae of aPL-positive women compared to control women, including: placental infarction, impaired spiral artery remodelling, decidual inflammation, increased syncytial knots, decreased vasculosyncytial membranes and the deposition of complement split product C4d. CONCLUSION Based on the evidence in this systematic review, a human placental aPL fingerprint has been proposed. The diversity of the human placental aPL fingerprint suggests that multiple pathological processes may occur in pregnancies affected by aPL.
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Affiliation(s)
- Chez A Viall
- Department of Obstetrics and Gynaecology, The University of Auckland, Auckland, New Zealand.
| | - Lawrence W Chamley
- Department of Obstetrics and Gynaecology, The University of Auckland, Auckland, New Zealand; Gravida: National Centre for Growth and Development, New Zealand
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Carmeille R, Degrelle SA, Plawinski L, Bouvet F, Gounou C, Evain-Brion D, Brisson AR, Bouter A. Annexin-A5 promotes membrane resealing in human trophoblasts. BIOCHIMICA ET BIOPHYSICA ACTA-MOLECULAR CELL RESEARCH 2015; 1853:2033-44. [PMID: 25595530 DOI: 10.1016/j.bbamcr.2014.12.038] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Revised: 11/25/2014] [Accepted: 12/27/2014] [Indexed: 01/12/2023]
Abstract
Annexin-A5 (AnxA5) is the smallest member of the annexins, a group of soluble proteins that bind to membranes containing negatively-charged phospholipids, principally phosphatidylserine, in a Ca(2+)-dependent manner. AnxA5 presents unique properties of binding and self-assembling on membrane surfaces, forming highly ordered two-dimensional (2D) arrays. We showed previously that AnxA5 plays a central role in the machinery of cell membrane repair of murine perivascular cells, promoting the resealing of membrane damages via the formation of 2D protein arrays at membrane disrupted sites and preventing the extension of membrane ruptures. As the placenta is one of the richest source of AnxA5 in humans, we investigated whether AnxA5 was involved in membrane repair in this organ. We addressed this question at the level of human trophoblasts, either mononucleated cytotrophoblasts or multinucleated syncytiotrophoblasts, in choriocarcinoma cells and primary trophoblasts. Using established procedure of laser irradiation and fluorescence microscopy, we observed that both human cytotrophoblasts and syncytiotrophoblasts repair efficiently a μm²-size disruption. Compared to wild-type cells, AnxA5-deficient trophoblasts exhibit severe defect of membrane repair. Through specifically binding to the disrupted site as early as a few seconds after membrane wounding, AnxA5 promotes membrane resealing of injured human trophoblasts. In addition, we observed that a large membrane area containing the disrupted site was released in the extracellular milieu. We propose mechanisms ensuring membrane resealing and subsequent lesion removal in human trophoblasts. This article is part of a Special Issue entitled: 13th European Symposium on Calcium.
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Affiliation(s)
- Romain Carmeille
- Institute of Chemistry and Biology of Membranes and Nano-objects, UMR 5248, CNRS, University of Bordeaux, IPB, F-33600 Pessac, France
| | - Séverine A Degrelle
- Fondation PremUP, Paris, F-75006, France; INSERM, U1139, Paris, F-75006, France; Université Paris Descartes, UMR-S1139 Sorbonne Pris Cité, Paris, F-75006, France
| | - Laurent Plawinski
- Institute of Chemistry and Biology of Membranes and Nano-objects, UMR 5248, CNRS, University of Bordeaux, IPB, F-33600 Pessac, France
| | - Flora Bouvet
- Institute of Chemistry and Biology of Membranes and Nano-objects, UMR 5248, CNRS, University of Bordeaux, IPB, F-33600 Pessac, France
| | - Céline Gounou
- Institute of Chemistry and Biology of Membranes and Nano-objects, UMR 5248, CNRS, University of Bordeaux, IPB, F-33600 Pessac, France
| | - Danièle Evain-Brion
- Fondation PremUP, Paris, F-75006, France; INSERM, U1139, Paris, F-75006, France; Université Paris Descartes, UMR-S1139 Sorbonne Pris Cité, Paris, F-75006, France
| | - Alain R Brisson
- Institute of Chemistry and Biology of Membranes and Nano-objects, UMR 5248, CNRS, University of Bordeaux, IPB, F-33600 Pessac, France
| | - Anthony Bouter
- Institute of Chemistry and Biology of Membranes and Nano-objects, UMR 5248, CNRS, University of Bordeaux, IPB, F-33600 Pessac, France.
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Trophoblast debris extruded from preeclamptic placentae activates endothelial cells: a mechanism by which the placenta communicates with the maternal endothelium. Placenta 2014; 35:839-47. [PMID: 25096950 DOI: 10.1016/j.placenta.2014.07.009] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Revised: 06/25/2014] [Accepted: 07/15/2014] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Preeclampsia is characterized by maternal endothelial dysfunction. While the mechanisms leading to preeclampsia are unclear, a factor(s) from the placenta is responsible for triggering the disease. One placental factor implicated in triggering preeclampsia is trophoblast debris which may transmit pathogenic signals from the placenta to endothelial cells. In this study, we investigated whether trophoblast debris from preeclamptic placentae triggered endothelial cell activation. METHODS Trophoblast debris from preeclamptic or normotensive placentae, or trophoblast debris from normal placental explants that had been cultured with preeclamptic (n = 14) or normotensive sera (n = 14) was exposed to endothelial cells. Activation of the endothelial cells was quantified by cell surface ICAM-1 and U937 adhesion to endothelial cells. The levels of IL-1β, pro-caspase-1 and active caspase-1 in the trophoblast debris were measured. RESULTS Compared to controls, the levels of ICAM-1 and U937 adhesion to endothelial cells were significantly increased following exposure of the endothelial cells to trophoblast debris from preeclamptic placentae or placentae treated with preeclamptic sera. The levels IL-1β, pro-caspase-1 and active caspase-1 were significantly increased in both trophoblast debris from preeclamptic placentae and placentae treated with preeclamptic sera. DISCUSSION These results provide the first direct evidence that trophoblast debris produced from preeclamptic placentae or placentae treated with preeclamptic sera can activate the endothelium. CONCLUSIONS Trophoblast debris from preeclamptic but not normotensive placentae can induce endothelial cell activation. This may be one mechanism by which the preeclamptic placenta communicates with the maternal endothelium to induce activation of the endothelium.
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Tannetta D, Dragovic R, Alyahyaei Z, Southcombe J. Extracellular vesicles and reproduction-promotion of successful pregnancy. Cell Mol Immunol 2014; 11:548-63. [PMID: 24954226 PMCID: PMC4220835 DOI: 10.1038/cmi.2014.42] [Citation(s) in RCA: 138] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Accepted: 05/11/2014] [Indexed: 12/11/2022] Open
Abstract
Extracellular vesicles (EVs) are membrane-bound complexes secreted from cells under both physiological and pathological conditions. They contain proteins, nucleic acids and lipids and act as messengers for cell–cell communication and signalling, particularly between immune cells. EV research is a rapidly evolving and expanding field, and it appears that all biological fluids contain very large numbers of EVs; they are produced from all cells that have been studied to date, and are known to have roles in several reproductive processes. This review analyses the evidence for the role of EVs throughout human reproduction, starting with the paternal and maternal gametes, followed by the establishment and continuation of successful pregnancies, with specific focus, where possible, on the interaction of EVs with the maternal immune system. Importantly, variations within the EV populations are identified in various reproductive disorders, such as pre-term labour and pre-eclampsia.
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Calcium supplementation prevents endothelial cell activation: possible relevance to preeclampsia. J Hypertens 2014; 31:1828-36. [PMID: 23822977 DOI: 10.1097/hjh.0b013e328362ba1a] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Preeclampsia is a leading cause of maternal and fetal mortality and morbidity. A hallmark of preeclampsia is endothelial cell dysfunction/activation in response to 'toxins' from the placenta. Necrotic trophoblastic debris (NTD) is one possible placental toxin and other activators of endothelial cells include inflammatory cytokines. Calcium supplementation appears to protect 'at-risk' women from developing preeclampsia but how is unclear. METHODS Placental explants were cultured with interleukin-6 (IL-6) in varied concentrations of calcium. The resultant trophoblastic debris was exposed to endothelial cells. Endothelial cells were exposed to activators including NTD, IL-6, and preeclamptic sera in the presence of varied concentrations of calcium and activation monitored by quantifying cell surface markers by ELISA. RESULTS Raising the levels of calcium did not prevent the IL-6-induced shedding of NTD from placental explants but did prevent the activation of endothelial cells in response to IL-6, preeclamptic sera, or NTD. Reducing the level of calcium directly induced the activation of endothelial cells. Inhibiting nitric oxide synthetase ablated the ability of high calcium levels to protect endothelial cell activation. The activity of endothelial cell nitric oxide synthetase was blocked with L-N-nitroarginine methyl ester. CONCLUSION Our results demonstrate calcium levels do not affect the shedding of trophoblastic debris but are important to endothelial cell activation and supplemental calcium may reverse the activation of the endothelium in preeclamptic women. These results may in part explain the benefits of calcium supplementation in the reduction of risk for developing preeclampsia and provide in-vitro mechanistic support for the use of calcium supplementation in at-risk women.
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Leclerc F, Dubois MF, Aris A. Maternal, placental and fetal exposure to bisphenol A in women with and without preeclampsia. Hypertens Pregnancy 2014; 33:341-8. [PMID: 24724919 DOI: 10.3109/10641955.2014.892607] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES We aimed to investigate potential association between the exposure of bisphenol A (BPA) and preeclampsia. METHODS Concentrations of BPA were assessed in 58 pregnancies including 35 normotensive and 23 preeclamptic women, using a highly sensitive gas chromatography-mass spectrometry (GC-MS) method. RESULTS BPA was detected in maternal blood, fetal blood and placental tissue; and actual concentrations of BPA were determined. Interestingly, significant accumulation of BPA in the placentas of women with preeclampsia compared to normotensive women has been shown. CONCLUSIONS This is the first study to highlight a significant correlation between preeclampsia and a high accumulation of BPA in the placenta.
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Mayhew TM. Turnover of human villous trophoblast in normal pregnancy: what do we know and what do we need to know? Placenta 2014; 35:229-40. [PMID: 24529666 DOI: 10.1016/j.placenta.2014.01.011] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Revised: 01/22/2014] [Accepted: 01/23/2014] [Indexed: 12/16/2022]
Abstract
How the turnover of villous trophoblast is regulated is important for understanding normal and complicated pregnancies. There is considerable accord that syncytiotrophoblast (STB) grows and is refreshed by recruiting post-mitotic cells from the deeper cytotrophoblast (CTB). Nuclei in STB exhibit a spectrum of morphologies and packing densities and, until recently, there seemed to be a consensus that this variation reflected a transition from an early undifferentiated CTB-like phenotype to a long pre-apoptotic and brief apoptotic phase. In these later phases, nuclei are sequestered in clusters (syncytial knots) prior to extrusion as part of normal epithelial turnover. Early in gestation, nuclear clustering and formation of protrusions (syncytial sprouts) also occurs as a preliminary to villous sprouting. Nuclei in these clusters have a CTB-like phenotype and some sprouts may also detach from STB and pass into the uteroplacental circulation. However, this apparent consensus has been challenged and new interpretations of events in the proliferative (CTB), terminal differentiation (STB) and deportation compartments have emerged. Several different types of STB fragment are deported in normal pregnancy: larger multinucleate STB fragments, smaller uninucleate elements with CTB-like morphology, anucleate cytoplasmic fragments, microparticles and nanovesicles. This review identifies points of agreement and disagreement and offers possible avenues of future research. An obvious need is to standardise best practice in several areas including choosing appropriate references for cell cycle phase labelling indices and combining immunolabeling of cell cycle and apoptosis markers (at LM or TEM levels) with design-based stereological estimates of absolute numbers of cells and nuclei in different compartments throughout normal gestation. This would also provide a surer foundation for interpreting results from different research groups and changes in normal and complicated pregnancies.
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Affiliation(s)
- T M Mayhew
- School of Life Sciences, Queen's Medical Centre, University of Nottingham, Nottingham NG7 2UH, UK.
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Review: Where is the maternofetal interface? Placenta 2014; 35 Suppl:S74-80. [DOI: 10.1016/j.placenta.2013.10.014] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Revised: 10/24/2013] [Accepted: 10/24/2013] [Indexed: 11/22/2022]
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Antiphospholipid antibodies internalised by human syncytiotrophoblast cause aberrant cell death and the release of necrotic trophoblast debris. J Autoimmun 2013; 47:45-57. [PMID: 24035196 DOI: 10.1016/j.jaut.2013.08.005] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2013] [Revised: 08/13/2013] [Accepted: 08/14/2013] [Indexed: 11/21/2022]
Abstract
Antiphospholipid antibodies (aPL) are the strongest maternal risk factor for pre-eclampsia, a hypertensive disease of human pregnancy. Pre-eclampsia is triggered by a toxic factor released from the placenta that activates the maternal endothelium. Antiphospholipid antibodies cause the release of necrotic trophoblast debris from the placental syncytiotrophoblast and this debris can activate endothelial cells. In this study, we investigated how aPL affects syncytiotrophoblast death and production of necrotic trophoblast debris by examining the interaction between aPL and human first trimester placental explants. Human polyclonal and murine monoclonal aPL, but not control antibodies, were rapidly internalised by the syncytiotrophoblast. Inhibitors of endocytosis or the low-density lipoprotein receptor (LDLR) family, but not toll-like receptors, decreased the internalisation of aPL and prevented the release of necrotic trophoblast debris from the syncytiotrophoblast. Once internalised, aPL increased inner mitochondrial membrane leak and Cytochrome c release while depressing oxidative flux through Complex IV of the electron transport system in syncytiotrophoblast mitochondria. These data suggest that the human syncytiotrophoblast internalises aPL by antigen-dependent endocytosis involving LDLR family members. Once internalised by the syncytiotrophoblast, aPL affects the death-regulating mitochondria, causing extrusion of necrotic trophoblast debris which can activate maternal endothelial cells thereby contributing to the pathogenesis of pre-eclampsia.
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