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Aljassim F, Georgopoulou N, Rigby CH, Powell SG, Wyatt JNR, Hapangama DK, Hill CJ. Exploring the presence of markers of decidualization in the fallopian tubes: a systematic review. Biol Reprod 2023; 109:125-136. [PMID: 37265359 PMCID: PMC10427808 DOI: 10.1093/biolre/ioad062] [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: 03/19/2023] [Revised: 05/26/2023] [Accepted: 05/26/2023] [Indexed: 06/03/2023] Open
Abstract
The fallopian tubes (FTs) are part of the female upper genital tract. The healthy FT provides the biological environment for successful fertilization and facilitates the subsequent movement of the conceptus to the endometrial cavity. However, when the FT is damaged, as with salpingitis, pyosalpinx, and hydrosalpinx, it may increase the risk of an ectopic pregnancy, a life-threatening condition. Decidualization refers to a multifactorial process by which the endometrium changes to permit blastocyst implantation. The decidualization reaction is vital for endometrial receptivity during the window of implantation. To date, no comprehensive review that collates evidence on decidualization in the human FT has been conducted. Therefore, the aim of this review is to compile the current evidence on cellular decidualization occurring in the healthy and pathological FT in women of reproductive age. A literature search was conducted using five databases and identified 746 articles, 24 of which were analyzed based on inclusion and exclusion criteria. The available evidence indicates that the FT are able to undergo decidual changes under specific circumstances; however, the exact mechanism by which this occurs is poorly understood. Further research is needed to elucidate the mechanism by which decidualization can occur in the FT.
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Affiliation(s)
- F Aljassim
- Department of Women’s and Children’s Health, Institute of Life Course and Medical Sciences, University of Liverpool, member of Liverpool Health Partners, Liverpool, UK
| | - N Georgopoulou
- Department of Women’s and Children’s Health, Institute of Life Course and Medical Sciences, University of Liverpool, member of Liverpool Health Partners, Liverpool, UK
| | - C H Rigby
- Department of Women’s and Children’s Health, Institute of Life Course and Medical Sciences, University of Liverpool, member of Liverpool Health Partners, Liverpool, UK
| | - S G Powell
- Department of Women’s and Children’s Health, Institute of Life Course and Medical Sciences, University of Liverpool, member of Liverpool Health Partners, Liverpool, UK
| | - J N R Wyatt
- Department of Women’s and Children’s Health, Institute of Life Course and Medical Sciences, University of Liverpool, member of Liverpool Health Partners, Liverpool, UK
| | - D K Hapangama
- Department of Women’s and Children’s Health, Institute of Life Course and Medical Sciences, University of Liverpool, member of Liverpool Health Partners, Liverpool, UK
- Liverpool Women’s Hospital NHS Foundation Trust, Member of Liverpool Health Partners, Liverpool, UK
| | - C J Hill
- Department of Women’s and Children’s Health, Institute of Life Course and Medical Sciences, University of Liverpool, member of Liverpool Health Partners, Liverpool, UK
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Rigby CH, Aljassim F, Powell SG, Wyatt JN, Hill CJ, Hapangama DK. The immune cell profile of human fallopian tubes in health and benign pathology: a systematic review. J Reprod Immunol 2022; 152:103646. [DOI: 10.1016/j.jri.2022.103646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 05/12/2022] [Accepted: 05/17/2022] [Indexed: 10/18/2022]
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Kanter JR, Mani S, Gordon SM, Mainigi M. Uterine natural killer cell biology and role in early pregnancy establishment and outcomes. F&S REVIEWS 2021; 2:265-286. [PMID: 35756138 PMCID: PMC9232176 DOI: 10.1016/j.xfnr.2021.06.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Objective While immune cells were originally thought to only play a role in maternal tolerance of the semiallogenic fetus, an active role in pregnancy establishment is becoming increasingly apparent. Uterine natural killer (uNK) cells are of specific interest because of their cyclic increase in number during the window of implantation. As a distinct entity from their peripheral blood counterparts, understanding the biology and function of uNK cells will provide the framework for understanding their role in early pregnancy establishment and adverse pregnancy outcomes. Evidence Review This review discusses unique uNK cell characteristics and presents clinical implications resulting from their dysfunction. We also systematically present existing knowledge about uNK cell function in three processes critical for successful human embryo implantation and placentation: stromal cell decidualization, spiral artery remodeling, and extravillous trophoblast invasion. Finally, we review the features of uNK cells that could help guide future investigations. Results It is clear the uNK cells are intimately involved in multiple facets of early pregnancy. This is accomplished directly, through the secretion of factors that regulate stromal cells and trophoblast function; and indirectly, via interaction with other maternal cell types present at the maternal-fetal interface. Current work also suggests that uNK cells are a heterogenous population, with subsets that potentially accomplish different functions. Conclusion Establishment of pregnancy through successful embryo implantation and placentation requires crosstalk between multiple maternal cell types and invading fetal trophoblast cells. Defects in this process have been associated with multiple adverse perinatal outcomes including hypertensive disorders of pregnancy, placenta accreta, and recurrent miscarriage though the mechanism underlying development of these defects remain unclear. Abnormalities in NK cell number and function which would disrupt physiological maternal-fetal crosstalk, could play a critical role in abnormal implantation and placentation. It is therefore imperative to dissect the unique physiological role of uNK cells in pregnancy and use this knowledge to inform clinical practice by determining how uNK cell dysfunction could lead to reproductive failure.
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Affiliation(s)
- Jessica R. Kanter
- Division of Reproductive Endocrinology and Infertility, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Sneha Mani
- Division of Reproductive Endocrinology and Infertility, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Scott M. Gordon
- Division of Neonatology, Children’s Hospital of Philadelphia, Pennsylvania
| | - Monica Mainigi
- Division of Reproductive Endocrinology and Infertility, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
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Díaz-Hernández I, Alecsandru D, García-Velasco JA, Domínguez F. Uterine natural killer cells: from foe to friend in reproduction. Hum Reprod Update 2021; 27:720-746. [PMID: 33528013 DOI: 10.1093/humupd/dmaa062] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 12/15/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Recurrent miscarriage and pre-eclampsia are common reproductive disorders, but their causes are often unknown. Recent evidence has provided new insight into immune system influences in reproductive disorders. A subset of lymphocytes of the innate immune system known as uterine natural killer (uNK) cells are now recognized as fundamental to achieving embryo implantation and successful pregnancy, but were initially attributed a bad reputation. Indeed, immune therapies have been developed to treat the 'exaggerated' immune response from uNK cells. These treatments have been based on studies of peripheral blood natural killer (pbNK) cells. However, uNK cells and pbNK cells have different phenotypic and functional characteristics. The functions of uNK cells are closely related to their interactions with the extravillous trophoblast cells (EVTs) and spiral arteries, which underlie an essential role in regulating vascular function, controlling trophoblast invasion and promoting placental development. EVTs express MHC molecules of class I HLA-C/E/G/F, while uNK cells express, among other receptors, killer cell immunoglobulin-like receptors (KIRs) that bind to HLA-C or CD94/NKG2A inhibitory receptors, and then bind HLA-E. Associations of certain KIR/HLA-C combinations with recurrent miscarriage, pre-eclampsia, and foetal growth restriction and the interactions between uNK cells, trophoblasts and vascular cells have led to the hypothesis that uNK cells may play a role in embryo implantation. OBJECTIVE AND RATIONALE Our objective was to review the evolution of our understanding of uNK cells, their functions, and their increasingly relevant role in reproduction. SEARCH METHODS Relevant literature through June 2020 was retrieved using Google Scholar and PubMed. Search terms comprised uNK cells, human pregnancy, reproductive failure, maternal KIR and HLA-C, HLA-E/G/F in EVT cells, angiogenic cytokines, CD56+ NK cells, spiral artery, oestrogen and progesterone receptors, KIR haplotype and paternal HLA-C2. OUTCOMES This review provides key insights into the evolving conceptualization of uNK cells, from their not-so-promising beginnings to now, when they are considered allies in reproduction. We synthesized current knowledge about uNK cells, their involvement in reproduction and their main functions in placental vascular remodeling and trophoblast invasion. One of the issues that this review presents is the enormous complexity involved in studying the immune system in reproduction. The complexity in the immunology of the maternal-foetal interface lies in the great variety of participating molecules, the processes and interactions that occur at different levels (molecular, cellular, tissue, etc.) and the great diversity of genetic combinations that are translated into different types of responses. WIDER IMPLICATIONS Insights into uNK cells could offer an important breakthrough for ART outcomes, since each patient could be assessed based on the combination of HLA and its receptors in their uNK cells, evaluating the critical interactions at the materno-foetal interface. However, owing to the technical challenges in studying uNK cells in vivo, there is still much knowledge to gain, particularly regarding their exact origin and functions. New studies using novel molecular and genetic approaches can facilitate the identification of mechanisms by which uNK cells interact with other cells at the materno-foetal interface, perhaps translating this knowledge into clinical applicability.
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Affiliation(s)
| | - Diana Alecsandru
- Department of Immunology and Department of Reproductive Endocrinology and Infertility, Instituto Valenciano de Infertilidad-Madrid, Rey Juan Carlos University (IVI), Madrid 28023, Spain
| | - Juan Antonio García-Velasco
- Department of Immunology and Department of Reproductive Endocrinology and Infertility, Instituto Valenciano de Infertilidad-Madrid, Rey Juan Carlos University (IVI), Madrid 28023, Spain
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Lu H, Jin LP, Huang HL, Ha SY, Yang HL, Chang RQ, Li DJ, Li MQ. Trophoblast-derived CXCL12 promotes CD56 bright CD82 - CD29 + NK cell enrichment in the decidua. Am J Reprod Immunol 2019; 83. [PMID: 31650642 DOI: 10.1111/aji.13203] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 09/22/2019] [Accepted: 10/22/2019] [Indexed: 01/04/2023] Open
Abstract
PROBLEM Decidual natural killer (dNK) cells play key roles in maternal-fetal immune regulation, trophoblast invasion, and vascular remodeling, and most dNK cell populations are CD56bright CD16- NK cells. However, the enrichment and redistribution of dNK cells in the local decidua have not been clarified yet. METHOD OF STUDY A total of 45 women with normal pregnancies and 8 unexplained recurrent spontaneous abortion (RSA) patients were included. We isolated primary human dNK (n = 53) and peripheral blood NK (pNK) cells (n = 5) from specimen and analyzed CD56, CD82, and CD29 by flow cytometry (FCM). We assessed their adhesion ability by cell counts of NK cells adhered to decidual stromal cells (DSCs) in a co-culture system. RESULTS We found that RSA patients had more CD56dim dNK cells with lower CD82 and higher CD29 than women with normal pregnancies. There were negative correlations of CD82 to CD29 on CD56dim and CD56+ dNK cells. In normal pregnancies, dNK cells had lower CD82 and higher CD29 expression with a stronger adhesion ability than pNK cells. Blocking CD82 on dNK cells increased the adhesive ability and CD29 expression, while blocking CD29 decreased the adhesive ability. Co-culturing dNK cells with trophoblast cells decreased CD82 expression and increased the adhesive ability of dNK cells and the percentage of CD56bright NK cells, while blocking trophoblast-derived CXCL12 increased CD82 expression, decreased CD29 expression, and impaired the adhesive ability of NK cells. CONCLUSION Trophoblast cells enhance the adhesive ability of NK cells to DSCs via the CXCL12/CD82/CD29 signaling pathway and contribute to CD56bright NK cell enrichment in the uterus.
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Affiliation(s)
- Han Lu
- NHC Key Lab of Reproduction Regulation (Shanghai Institute of Planned Parenthood Research), Hospital of Obstetrics and Gynecology, Fudan University, Shanghai, China.,Institute of Obstetrics and Gynecology, Hospital of Obstetrics and Gynecology, Fudan University, Shanghai, China
| | - Li-Ping Jin
- Clinical and Translational Research Center, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China
| | - Hong-Lan Huang
- Institute of Obstetrics and Gynecology, Hospital of Obstetrics and Gynecology, Fudan University, Shanghai, China
| | - Si-Yao Ha
- Institute of Obstetrics and Gynecology, Hospital of Obstetrics and Gynecology, Fudan University, Shanghai, China
| | - Hui-Li Yang
- Institute of Obstetrics and Gynecology, Hospital of Obstetrics and Gynecology, Fudan University, Shanghai, China
| | - Rui-Qi Chang
- Institute of Obstetrics and Gynecology, Hospital of Obstetrics and Gynecology, Fudan University, Shanghai, China
| | - Da-Jin Li
- NHC Key Lab of Reproduction Regulation (Shanghai Institute of Planned Parenthood Research), Hospital of Obstetrics and Gynecology, Fudan University, Shanghai, China.,Institute of Obstetrics and Gynecology, Hospital of Obstetrics and Gynecology, Fudan University, Shanghai, China
| | - Ming-Qing Li
- NHC Key Lab of Reproduction Regulation (Shanghai Institute of Planned Parenthood Research), Hospital of Obstetrics and Gynecology, Fudan University, Shanghai, China.,Institute of Obstetrics and Gynecology, Hospital of Obstetrics and Gynecology, Fudan University, Shanghai, China.,Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Hospital of Obstetrics and Gynecology, Fudan University, Shanghai, China
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Jiang R, Yan G, Xing J, Wang Z, Liu Y, Wu H, Fan X, Zhou J, Ding L, Sun H. Abnormal ratio of CD57+
cells to CD56+
cells in women with recurrent implantation failure. Am J Reprod Immunol 2017; 78. [PMID: 28543977 DOI: 10.1111/aji.12708] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2017] [Accepted: 04/18/2017] [Indexed: 12/19/2022] Open
Affiliation(s)
- Ruiwei Jiang
- Department of Obstetrics and Gynecology; Center for Reproductive Medicine; The Affiliated Drum Tower Hospital of Nanjing University Medical School; Nanjing China
| | - Guijun Yan
- Department of Obstetrics and Gynecology; Center for Reproductive Medicine; The Affiliated Drum Tower Hospital of Nanjing University Medical School; Nanjing China
| | - Jun Xing
- Department of Obstetrics and Gynecology; Center for Reproductive Medicine; The Affiliated Drum Tower Hospital of Nanjing University Medical School; Nanjing China
| | - Zhilong Wang
- Department of Obstetrics and Gynecology; Center for Reproductive Medicine; The Affiliated Drum Tower Hospital of Nanjing University Medical School; Nanjing China
| | - Yong Liu
- Central Research Lab; The Affiliated Drum Tower Hospital of Nanjing University Medical School; Nanjing China
| | - Hongyan Wu
- Department of Pathology; The Affiliated Drum Tower Hospital of Nanjing University Medical School; Nanjing China
| | - Xiangshan Fan
- Department of Pathology; The Affiliated Drum Tower Hospital of Nanjing University Medical School; Nanjing China
| | - Jianjun Zhou
- Department of Obstetrics and Gynecology; Center for Reproductive Medicine; The Affiliated Drum Tower Hospital of Nanjing University Medical School; Nanjing China
| | - Lijun Ding
- Department of Obstetrics and Gynecology; Center for Reproductive Medicine; The Affiliated Drum Tower Hospital of Nanjing University Medical School; Nanjing China
| | - Haixiang Sun
- Department of Obstetrics and Gynecology; Center for Reproductive Medicine; The Affiliated Drum Tower Hospital of Nanjing University Medical School; Nanjing China
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Fonseca BM, Correia-da-Silva G, Teixeira NA. The rat as an animal model for fetoplacental development: a reappraisal of the post-implantation period. Reprod Biol 2012; 12:97-118. [DOI: 10.1016/s1642-431x(12)60080-1] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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8
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Low-dose mifepristone increases uterine natural killer cell cytotoxicity and perforin expression during the receptive phase. Fertil Steril 2011; 96:649-53. [DOI: 10.1016/j.fertnstert.2011.06.074] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2011] [Revised: 05/28/2011] [Accepted: 06/28/2011] [Indexed: 11/17/2022]
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Laskarin G, Redzovic A, Vukelic P, Veljkovic D, Gulic T, Haller H, Rukavina D. Phenotype of NK cells and cytotoxic/apoptotic mediators expression in ectopic pregnancy. Am J Reprod Immunol 2011; 64:347-58. [PMID: 20408833 DOI: 10.1111/j.1600-0897.2010.00844.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
PROBLEM The expression of cytotoxic/apoptotic mediators and the phenotype characteristics of uterine NK cells (uNK) in tubal ectopic pregnancy (EP) were investigated. METHOD OF STUDY Samples of uterine decidua and tubal mucosa as well as peripheral blood (PB) of the same women with EP were used for phenotype characterization of NK cells and detection of cytotoxic/apoptotic mediators and IL-15. RESULTS In tubal mucosa, perforin, FasL, granulysin and IL-15 were almost completely absent, but they were present in normal and EP uterine deciduas. TRAIL was present on trophoblast and tubal mucosa, contrary to its lack in normal and EP uterine decidua. CD16⁻ CD56(dim) NK cells, mostly CD94⁻ and NKG2A⁻, predominate in tubal mucosa, whereas CD16⁻ CD56(bright) NK cells, predominantly CD94(+) and NKG2A(+) prevail in EP uterine decidua. NK cells at the EP implantation site express lower percentages of perforin and granulysin, but they express a higher percentage of TRAIL than do EP uterine decidual and PB NK cells. Lower percentage of TNF-α-expressing and IL-4-expressing NK cells were found at the implantation site compared to EP uterine decidua. CONCLUSIONS Authentic uNK cell population seems to be insufficient to restrict trophoblast invasion because of low expression of cytotoxic/apoptotic mediators.
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Affiliation(s)
- Gordana Laskarin
- Department of Physiology and Immunology, University of Rijeka, Croatia
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Acar N, Ustunel I, Demir R. Uterine natural killer (uNK) cells and their missions during pregnancy: a review. Acta Histochem 2011; 113:82-91. [PMID: 20047753 DOI: 10.1016/j.acthis.2009.12.001] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2009] [Revised: 11/23/2009] [Accepted: 11/27/2009] [Indexed: 11/18/2022]
Abstract
Natural killer (NK) cells are lymphocytes of the innate immune system. The aim of this review is to describe the properties and roles of NK cells in the human uterus during pregnancy. Uterine natural killer cells (uNK) constitute a major lymphocyte population during early gestation in the uterus. The uterine natural killer cells are recognized owing to their CD56(bright), CD16(-), CD3(-) phenotype. Their number increases in the first trimester with a subsequent decline as pregnancy progresses. They have been shown to be closely associated with cells of the extravillous trophoblast (EVT) and spiral arteries. They play important roles in remodeling of the spiral arteries, control of trophoblast invasion and in the development of the placenta. Some studies have shown the number and repertoire of receptors of uNK differ between women with healthy pregnancies and those with pathologic pregnancies, such as pre-eclampsia or intrauterine growth retardation. During pregnancy, the cytotoxic characteristics of the uterine killer cells are not directed towards the fetus, and scientists continue to question and explore this phenomenon with increasing evidence that these cells may perform differing beneficial roles during pregnancy. Contrary to their previously suspected "hostile" characteristics, the uterine killer cells are considered to be "friendly" and appear to be essential and very important regulators of successful implantation and pregnancy.
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Affiliation(s)
- Nuray Acar
- Department of Histology and Embryology, Faculty of Medicine, Akdeniz University, Antalya, Turkey
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Radovic-Janosevic D, Lilic V, Basic H, Tubic-Pavlovic A, Stefanovic M, Milosevic J. Decidual natural killer cells in recurrent spontaneous abortions. VOJNOSANIT PREGL 2011; 68:41-5. [DOI: 10.2298/vsp1101041r] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background/Aim. A repeated or habitual miscarriage (PSP) is defined as three
or more consecutive losses of pregnancy. In the first three months of
pregnancy, habitual miscarriages occur in about 1% of pregnant women, out of
which 50% are of an unknown etiology. It is believed that among them, the
greatest number is the consequence of an inadequate alloimmune response of a
women to the pregnancy. The endocrine and immune systems are in a close
interaction during the implantation and maintaining of pregnancy. This
communication is the most obvious on endometrium of pregnancy decidua. The
aim of the study was to identify the number and the subpopulation
distribution of the decidual NK cells in the decidua by using an
immunohistochemical method. Methods. The research included a group of 30
women who had had two spontaneous miscarriages consecutively in the first
three months of their pregnancy, while the curettage after the third
spontaneous abortion was histopathologically and immunohistochemically
analyzed. The control group consisted of 20 women without a problematic
reproductive anamnesis, who had had their pregnancy terminated for social
reasons. The criteria for the eliminating from the research were the
diagnosed uterus anomalies, positive screening on thrombophilia, as well as
women suffering from diabetes melitus and the ones with the thyroid gland
function disorder. Results. The number and the phenotype structure of the
uterus NK cells were significantly different between the decidua of a normal
pregnancy and that in PSP. In the decidua in PSP, there were much more NK
cells with the phenotype of the peripheral circulation CD57 and CD56dim,
while in the decidua of the control group the dominant cells were the typical
uNK cell subpopulation CD56bright. Conclusion. The above mentioned results
show that the disregulation of the immunocompetent cells of the decidua, by
creating an inadequate cytokine milieu, is one of the mechanism of rejecting
the semiallogeneic blastocyst.
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Affiliation(s)
| | - Vekoslav Lilic
- Klinički Centar Niš, Klinika za ginekologiju i akušerstvo, Niš
| | - Hakija Basic
- Klinički Centar Niš, Institut za patologiju, Niš
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Laskarin G, Redzovic A, Srsen Medancic S, Rukavina D. Regulation of NK-cell function by mucins via antigen-presenting cells. Med Hypotheses 2010; 75:541-3. [DOI: 10.1016/j.mehy.2010.07.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2010] [Accepted: 07/15/2010] [Indexed: 11/16/2022]
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King AE, Critchley HOD. Oestrogen and progesterone regulation of inflammatory processes in the human endometrium. J Steroid Biochem Mol Biol 2010; 120:116-26. [PMID: 20067835 DOI: 10.1016/j.jsbmb.2010.01.003] [Citation(s) in RCA: 87] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2009] [Revised: 12/23/2009] [Accepted: 01/05/2010] [Indexed: 01/14/2023]
Abstract
The human endometrium is a unique tissue that has to undergo cycles of proliferation, differentiation, destruction and repair. This ensures that the endometrium is optimally prepared for potential embryo implantation but in the absence of an embryo, menstruation occurs to allow endometrial regeneration. These cycles of tissue remodelling occur under the sequential influence of the sex steroid hormones, oestrogen and progesterone. The physiological events of implantation and menstruation display features of inflammation, tightly regulated by oestrogen and progesterone. After menstruation cellular proliferation and blood vessel growth is modulated by oestrogen while after ovulation progesterone is the dominant hormone. In preparation for implantation, progesterone regulates decidualization of the endometrium, uterine natural killer cell numbers within the endometrium and chemokine and cytokine expression. Menstruation, in contrast, is preceded by progesterone withdrawal, which results in an influx of leukocytes into the endometrium and increased production of chemokines and matrix metalloproteinases allowing tissue degradation. The aim of this article is to review the current knowledge on the regulation of inflammatory events within the endometrium by oestrogen and progesterone, in relation to two pivotal events for human reproduction, implantation and menstruation.
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Affiliation(s)
- Anne E King
- University of Edinburgh, Centre for Reproductive Biology, The Queen's Medical Research Institute, United Kingdom
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Wicherek L, Basta P, Pitynski K, Marianowski P, Kijowski J, Wiatr J, Majka M. ORIGINAL ARTICLE: The Characterization of the Subpopulation of Suppressive B7H4+ Macrophages and the Subpopulation of CD25+ CD4+ and FOXP3+ Regulatory T-cells in Decidua during the Secretory Cycle Phase, Arias Stella Reaction, and Spontaneous Abortion - A. Am J Reprod Immunol 2009; 61:303-12. [DOI: 10.1111/j.1600-0897.2009.00696.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Germeyer A, Sharkey AM, Prasadajudio M, Sherwin R, Moffett A, Bieback K, Clausmeyer S, Masters L, Popovici RM, Hess AP, Strowitzki T, von Wolff M. Paracrine effects of uterine leucocytes on gene expression of human uterine stromal fibroblasts. Mol Hum Reprod 2008; 15:39-48. [DOI: 10.1093/molehr/gan075] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Galazka K, Pitynski K, Skret-Magierlo J, Mach P, Knafel A, Sikora J, Niemiec T, Dobrogowski J, Basta A, Wicherek L. The increase in metallothionein and ectopic decidual immunoreactivity with respect to the progression of labor at term and the lack of analogical changes in placental abruption. Am J Reprod Immunol 2008; 60:204-13. [PMID: 18782281 DOI: 10.1111/j.1600-0897.2008.00615.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
PROBLEM The coexistence of immune and decidual cells is related to the development of a resistance to immune-mediated apoptosis in both ectopic and eutopic decidua. This unique feature of endometrial cells seems to be linked with the expression of metallothionein (MT), an inhibitor of apoptosis. METHOD OF STUDY The MT immunoreactivity level was assessed in 82 eutopic (CC) and ectopic (cesarean scar deciduosis - CSD) decidual tissue samples obtained from patients during cesarean sections at term and from patients on whom cesarean sections were performed on account of placental abruption (PA). RESULT Statistically, significantly higher levels of MT immunoreactivity were found in eutopic and ectopic decidua sampled during cesarean sections performed on patients with advanced labor when compared to the levels found in tissues sampled during cesarean sections on patients without labor. No differences were observed in the MT immunoreactivity levels in decidual tissue samples derived from patients who had undergone cesarean sections on account of PA with respect to the progression of labor at the time of the surgical procedure. Statistically, the decidual MT immunoreactivity levels were significantly higher in the PA than the CC subgroups and in the PA than the CSD subgroups correlating with the stage of labor. CONCLUSION MT in decidual cells seems to be responsible for the proper coexistence between decidual cells and activated immune cells that infiltrate both eutopic and ectopic decidua during cesarean section and PA.
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Affiliation(s)
- Krystyna Galazka
- Department of Pathomorphology of the Jagiellonian University, Krakow, Poland
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Santoni A, Carlino C, Stabile H, Gismondi A. Mechanisms underlying recruitment and accumulation of decidual NK cells in uterus during pregnancy. Am J Reprod Immunol 2008; 59:417-24. [PMID: 18405312 DOI: 10.1111/j.1600-0897.2008.00598.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Natural killer (NK) cells represent the most prominent immune cell type found in the uterus in the first trimester of human pregnancy and in the secretory phase of menstrual cycle. The role of NK cells in pregnancy has been largely discussed over the past years and it is now becoming increasingly clear that they may influence pregnancy outcome at several levels. In normal pregnancy, it appears that the major function of NK cells is to provide benefit by secreting a number of cytokines, chemokines and angiogenic factors rather than to exert a cytotoxic activity. However, the origin of decidual NK cells is still debated and it remains unclear whether they can derive from NK cell populations recruited from peripheral blood and/or other tissues or from self renewal of NK cell progenitors present in the uterus prior to pregnancy or recruited from other tissues. Here, we review the molecular mechanisms underlying peripheral blood NK cell recruitment and its role in the accumulation of NK cells in the decidua during early pregnancy.
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Affiliation(s)
- Angela Santoni
- Department of Experimental Medicine, University of Rome La Sapienza, Rome, Italy.
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Kwak-Kim J, Gilman-Sachs A. Clinical implication of natural killer cells and reproduction. Am J Reprod Immunol 2008; 59:388-400. [PMID: 18405309 DOI: 10.1111/j.1600-0897.2008.00596.x] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
The regulation of natural killer (NK) cells in the peripheral blood and endometrial layers has been associated with reproductive immunopathology such as recurrent spontaneous abortions (RSA), infertility of implantation failures, or pre-eclampsia. The placenta has a complex anatomical structure and different subsets of NK cells with various functional roles can directly interact with trophoblasts. NK cell subpopulations and their functions, putative roles of NK cells in peripheral blood and endometrium are reviewed in relation to RSA and infertility. An increase in NK cell numbers and /or activity in pre- or post-conceptional period in women with RSA or infertility with multiple implantation failures are a significant clinical concern. In addition, immuno-phenotypic characteristics of NK cells in these women support the changes for their increased activity status. Further studies are needed to explore underlying mechanism of NK cells in RSA, infertility, and other reproductive immunopathologies. Possible neurological and hormonal control of NK cells and NK cell interaction with various leukocyte populations need further investigation in women with reproductive failures.
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Affiliation(s)
- Joanne Kwak-Kim
- Department of Obstetrics and Gynecology, Rosalind Franklin University of Medicine and Science/The Chicago Medical School, North Chicago, IL 60064, USA.
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The possible correlation between the patient's immune tolerance level during cesaerean section and the incidence of subsequent emergency peripartum hysterectomy. Clin Dev Immunol 2008; 2007:63596. [PMID: 18317530 PMCID: PMC2246050 DOI: 10.1155/2007/63596] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2007] [Revised: 11/04/2007] [Accepted: 11/11/2007] [Indexed: 11/17/2022]
Abstract
Introduction. Cesarean section is an independent risk factor for peripartum hysterectomy. As a method of delivery, cesarean section may interfere with a number of molecular changes that occur at the maternal-fetal interface during the course of labor. Methods. The level of CD3, CD56, CD25, and CD69 antigen immunoreactivity was assessed by immunohistochemistry in 26 decidual tissue samples. The tissue samples were obtained from 18 women who underwent cesarean sections at term and from 8 women who underwent cesarean hysterectomies. Results. An increase in the activity and infiltration of immune cells in the decidua sampled during the spontaneous beginning of labor was observed. The further progression of labor was accompanied by a decrease in the number and activity of immune cells. The number of CD56+ and CD3+
cells in the decidua was statistically significantly lower in patients who had undergone cesarean hysterectomies than in those who had had cesarean sections at term. Conclusion. Abnormal immune response during labor may increase the risk for peripartum hysterectomy.
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Wicherek L. ORIGINAL ARTICLE: Alterations in RCAS1 Serum Concentration Levels During the Normal Menstrual Cycle and the Lack of Analogical Changes in Ovarian Endometriosis. Am J Reprod Immunol 2008; 59:535-44. [DOI: 10.1111/j.1600-0897.2008.00584.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Santoni A, Carlino C, Gismondi A. Uterine NK cell development, migration and function. Reprod Biomed Online 2008; 16:202-10. [PMID: 18284874 DOI: 10.1016/s1472-6483(10)60575-5] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Uterine natural killer (uNK) cells represent the predominant lymphocytes in the uterus during early pregnancy and in the secretory phase of the menstrual cycle. They are CD56(high)CD16(-) and have low cytotoxicity, but constitutively secrete a number of cytokines, chemokines and angiogenic molecules. uNK cells differ from CD56(high) blood NK cells in several ways, including the killer cell immunoglobulin-like receptor repertoire and expression of some genes induced by hormone environment. uNK cells may arise by in-utero proliferation and differentiation of NK cell progenitors under the control of the sex steroid hormones and/or cytokines, such as interleukin-15, and/or be recruited from CD56(+) blood NK cells that would undergo tissue-specific differentiation in the uterine microenvironment. There is evidence showing that uNK cells display a different pattern of chemokine receptors and adhesion molecules, thus leading to a different migratory response. It has not yet been fully defined which uNK cell function(s) are critical for successful pregnancy. The close encirclement of spiral arteries by NK cells, together with their ability to produce angiogenic factors, suggests that they might influence mucosal vascularization. Their proximity to the extravillous trophoblast supports the idea that uNK cells could recognize these cells as fetal, and regulate their invasion during placentation.
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Affiliation(s)
- Angela Santoni
- Department of Experimental Medicine, University of Rome La Sapienza, Viale Regina Elena, 324, 00161 Rome, Italy.
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Paparistidis N, Papadopoulou C, Chioti A, Papaioannou D, Tsekoura C, Keramitsoglou T, Kontopoulou-Antonopoulou V, Agapitos E, Balafoutas C, Varla-Leftherioti M. How valuable is measurement of peripheral blood natural killer cells at the time of abortion? Am J Reprod Immunol 2008; 59:306-15. [PMID: 18294356 DOI: 10.1111/j.1600-0897.2007.00547.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
PROBLEM Increased peripheral blood natural killer (NK) cells are associated to immune-mediated abortion, but their diagnostic value when measured at the time of miscarriage is unknown. METHOD OF STUDY In women with therapeutic (A = 79) or elective (C = 34) pregnancy termination, the NK-cell percentage was measured before and 5 days after curettage. Additionally, immune-mediated lesions (scored 0-3) and CD56(+) and CD16(+) decidual NKs (scored 1-3) were detected on the abortion material. RESULTS Aborters differed from controls in histological scores (P = 0.000) and in NK percentage (>12%) only in the measurement 5 days after the operation (P = 0.038). In comparison to histological lesions, NK measurement was found to have sensitivity 70%, specificity 73.68%, positive prognostic value 89.39% and negative prognostic value 43.75%. CONCLUSION An Increased NK-cell percentage 5 days after the pregnancy termination could be a marker of immune aetiology of miscarriage, as the probability of an aborter with NK >12% to have an immune-mediated abortion is almost 90%.
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Affiliation(s)
- Nikolaos Paparistidis
- Department of Obstetrics and Gynaecology, Helena Venizelou Maternity Hospital of Athens, Athens, Greece
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Dutsch-Wicherek M, Wicherek L. ORIGINAL ARTICLE: The Association of RCAS1 Serum Concentration with the Reversibility or Irreversibility of the Process of Immune Cytotoxic Activity Restriction During Normal Menstrual Cycle, Cancer Relapse, and Surgical Treatment for Various Types of Squ. Am J Reprod Immunol 2008; 59:266-75. [DOI: 10.1111/j.1600-0897.2007.00575.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Skret-Magierlo J, Wicherek L, Basta P, Galazka K, Sikora J, Wilk M, Fudali L, Skret A. RCAS1 Decidual Immunoreactivity during Cesarean Section in Scar Deciduosis: Immune Cell Presence and Activity. Gynecol Obstet Invest 2007; 65:187-94. [DOI: 10.1159/000111533] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2007] [Accepted: 06/18/2007] [Indexed: 11/19/2022]
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Chaouat G, Dubanchet S, Ledée N. Cytokines: Important for implantation? J Assist Reprod Genet 2007; 24:491-505. [PMID: 18044017 PMCID: PMC3455031 DOI: 10.1007/s10815-007-9142-9] [Citation(s) in RCA: 95] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2007] [Accepted: 04/25/2007] [Indexed: 12/11/2022] Open
Abstract
PROBLEM Cytokines are obviously very important in an established pregnancy, but what about human embryo implantation? METHODS Literature review. RESULTS We first discuss the necessity and limits of animal models, and then review the few cytokines which have been demonstrated by knock-out methods to be absolutely necessary for embryo implantation using in animal models. We then review what is known or discussed about the role of other cytokines as deduced from quantitative and/or qualitative dysregulation in animals and in humans. CONCLUSIONS Cytokines are indeed involved in implantation as they are in ongoing pregnancy and delivery. Relevance to infertility and recurrent pregnancy loss is discussed.
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Affiliation(s)
- Gérard Chaouat
- U 782 INSERM, Equipe cytokines et dialogue cytokinique mère conceptus, Université Paris Sud et Hôpîtal Antoine Béclère, 32 rue des Carnets, Clamart Cedex, France.
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Wicherek L, Basta P, Sikora J, Galazka K, Rytlewski K, Grabiec M, Lazar A, Kalinka J. RCAS1 decidual immunoreactivity in severe pre-eclampsia: immune cell presence and activity. Am J Reprod Immunol 2007; 58:358-66. [PMID: 17845206 DOI: 10.1111/j.1600-0897.2007.00521.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
PROBLEM Pre-eclampsia seems to be related to the disturbance of immune tolerance regulation during pregnancy. Receptor-binding cancer antigen expressed on SiSo cells (RCAS1) decidual level alterations were concomitant with changes in immune cell number and activity in decidua. As decidual immunomodulating activity participates in the development of immune tolerance during pregnancy, we aimed to evaluate the immunoreactivity level of decidual RCAS1 with respect to the presence and activity of immune cells. METHOD OF STUDY RCAS1, CD3, CD56, CD69, and CD25 immunoreactivity was assessed by immunohistochemistry in 30 decidual samples derived from patients with severe pre-eclampsia (sPE) and from a healthy control group. RESULTS RCAS1 immunoreactivity was statistically significantly higher in decidual tissue samples derived from patients with sPE tissue than in those derived from healthy patients in whom elective cesarean section at term was performed. A statistically significantly lower number of CD56(+) and CD3(+) cells and lower immunoreactivity level of CD69 were found in patients with sPE compared with those from the control group. CONCLUSION The limited immune cells infiltration in decidua during sPE is associated with increase in RCAS1 decidual level.
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Affiliation(s)
- Lukasz Wicherek
- Department of Gynecology and Oncology of the Jagiellonian University, Krakow, Poland.
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Abstract
Pregnancy is a unique immune state in which both mother and embryo/fetus tolerate and interact with one another through term, without interfering with the mother's native immunity. When the embryo is viable, it initiates maternal immune tolerance (IT)--ut not immune suppression. The balance is complex: some immune disorders are ameliorated during pregnancy, despite the presence of an "inflammatory" environment. We have identified a pregnancy viability biomarker--preimplantation factor (PIF)--secreted only by viable embryos, which helps to initiate this maternal tolerance and uterine receptivity. Using anti-PIF antibodies, we have detected PIF in the fetus and placenta. Beyond enhancing uterine receptivity locally, PIF has also been detected in maternal circulation, and may promote peripheral tolerance. In the fetus, PIF may help avoid a "graft-versus-host"-type reaction PIF exhibits unique potent immune-modulatory effects and its synthetic analogue has been shown to exert significant protection in diverse immune scenarios. Nontoxic, low-dose, short-term PIF administration has led to long-term effects in preclinical models of multiple sclerosis (MS), juvenile diabetes mellitus (JDM), and graft-versus-host disease (GVHD), in a manner enabling its translation into a clinical setting. Further investigation of this compound is warranted.
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Affiliation(s)
- Eytan R Barnea
- Society for the Investigation of Early Pregnancy, 1697 Lark Lane, Cherry Hill, NJ 08003, USA.
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Wicherek L, Galazka K, Lazar A. RCAS1 decidual immunoreactivity during placental abruption: immune cell presence and activity. Am J Reprod Immunol 2007; 58:46-55. [PMID: 17565547 DOI: 10.1111/j.1600-0897.2007.00490.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
PROBLEM RCAS1 is a protein responsible for the suppression of cytotoxic immune response during gestation. The present study evaluates the immunoreactivity level of RCAS1 with respect to immune cell status during placental abruption (PA) and retained placental tissue (RPT). METHOD OF STUDY RCAS1, CD3, CD56, CD69 and CD25 immunoreactivity was assessed by immunohistochemistry in 66 decidual samples derived from PA and from RPT. RESULTS RCAS1 immunoreactivity was statistically significantly higher in decidual tissue samples derived from patients with RPT than in those derived from patients with PA. A statistically significantly lower number of CD56(+) and CD3(+) cells and immunoreactivity level of CD69 were found in patients with RPT, compared to those with PA. CONCLUSION Placental abruption seems to be associated with excessive accumulation and activity of CD3(+) and CD56(+) cells in decidua, which processes might, in turn, result from an insufficient RCAS1 decidual level.
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Affiliation(s)
- Lukasz Wicherek
- Department of Gynecology and Oncology, Jagiellonian University, Krakow, Poland.
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Current World Literature. Curr Opin Obstet Gynecol 2007; 19:289-96. [PMID: 17495648 DOI: 10.1097/gco.0b013e3281fc29db] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Lunghi L, Ferretti ME, Medici S, Biondi C, Vesce F. Control of human trophoblast function. Reprod Biol Endocrinol 2007; 5:6. [PMID: 17288592 PMCID: PMC1800852 DOI: 10.1186/1477-7827-5-6] [Citation(s) in RCA: 199] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2006] [Accepted: 02/08/2007] [Indexed: 12/14/2022] Open
Abstract
The trophoblast, i.e. the peripheral part of the human conceptus, exerts a crucial role in implantation and placentation. Both processes properly occur as a consequence of an intimate dialogue between fetal and maternal tissues, fulfilled by membrane ligands and receptors, as well as by hormone and local factor release. During blastocyst implantation, generation of distinct trophoblast cell types begins, namely the villous and the extravillous trophoblast, the former of which is devoted to fetal-maternal exchanges and the latter binds the placental body to the uterine wall. Physiological placentation is characterized by the invasion of the uterine spiral arteries by extravillous trophoblast cells arising from anchoring villi. Due to this invasion, the arterial structure is replaced by amorphous fibrinoid material and endovascular trophoblastic cells. This transformation establishes a low-resistance, high-capacity perfusion system from the radial arteries to the intervillous space, in which the villous tree is embedded. The physiology of pregnancy depends upon the orderly progress of structural and functional changes of villous and extravillous trophoblast, whereas a derangement of such processes can lead to different types of complications of varying degrees of gravity, including possible pregnancy loss and maternal life-threatening diseases. In this review we describe the mechanisms which regulate trophoblast differentiation, proliferation, migration and invasiveness, and the alterations in these mechanisms which lead to pathological conditions. Furthermore, based on the growing evidence that proper inflammatory changes and oxidative balance are needed for successful gestation, we explain the mechanisms by which agents able to influence such processes may be useful in the prevention and treatment of pregnancy disorders.
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Affiliation(s)
- Laura Lunghi
- Department of Biology, Section of General Physiology, University of Ferrara, 44100 Ferrara, Italy
| | - Maria E Ferretti
- Department of Biology, Section of General Physiology, University of Ferrara, 44100 Ferrara, Italy
| | - Silvia Medici
- Department of Biology, Section of General Physiology, University of Ferrara, 44100 Ferrara, Italy
| | - Carla Biondi
- Department of Biology, Section of General Physiology, University of Ferrara, 44100 Ferrara, Italy
| | - Fortunato Vesce
- Department of Biomedical Sciences and Advanced Therapy, Section of Obstetrics and Gynaecology, University of Ferrara, 44100 Ferrara, Italy
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