The cytotrophoblastic shell and complications of pregnancy
The cytotrophoblastic shell and complications of pregnancy
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DOI：
10.1016/j.placenta.2017.06.007
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发表时间：
2017-12-01
期刊：
影响因子：
3.8
通讯作者：
Jauniaux, Eric
中科院分区：
文献类型：
--
作者：
Burton, Graham J.;Jauniaux, Eric
许多妊娠并发症的病理生理根源是胎盘形成的早期阶段。滋养层侵袭受损和母体螺旋动脉重构不足是常见的特征。虽然胎盘灌注不良可能会导致胎儿生长受限和早发性先兆子痫，但与自发流产、早产和胎膜早破的机制联系并不明显。在这里，我们推测，在母胎界面形成一个发育良好的细胞滋养层是妊娠成功的关键。最初，绒毛外滋养层细胞从与子宫内膜接触的外壳分化出来。因此，发育受损可能有助于减少侵袭性和重塑缺陷。此外，壳层的范围影响母体动脉循环开始的时间和空间构型。壳薄而残缺会导致早产和无组织的发病，从而导致自然流产。在不太严重的病例中，易导致界面出血和宫内血肿的形成。如果继续怀孕，这些血肿可能会成为氧化应激的来源，促进膜的衰老和虚弱，并刺激子宫壁的炎症和过早收缩。壳层的形成依赖于植入后第一周细胞滋养层祖细胞的增殖，此时发育中的胎盘得到来自子宫内膜腺的组织营养支持。因此，我们建议受孕前子宫内膜的适合性，而子宫内膜和滋养层之间的围产期对话对于避免以后的妊娠并发症至关重要。(C)2017爱思唯尔有限公司。保留所有权利。
Many complications of pregnancy have their pathophysiological roots in the early stages of placentation. Impaired trophoblast invasion and deficient remodelling of the maternal spiral arteries are a common feature. While malperfusion of the placenta may underpin cases of fetal growth restriction and early-onset pre-eclampsia, the mechanistic links to spontaneous miscarriage, pre-term labour and premature rupture of the membranes are less obvious. Here, we speculate that formation of a well-developed cytotrophoblastic shell at the maternal-fetal interface is crucial for pregnancy success. Initially, extravillous trophoblast cells differentiate from the outer layer of the shell in contact with the endometrium. Impaired development may thus contribute to reduced invasion and deficient remodelling. In addition, the extent of the shell influences the timing and spatial configuration of onset of the maternal arterial circulation. A thin and fragmentary shell results in premature and disorganised onset, leading to spontaneous miscarriage. In less severe cases it may predispose to haemorrhage at the interface and formation of intrauterine haematomas. If pregnancy continues, these haematomas may act as a source of oxidative stress, promoting senescence and weakening of the membranes, and stimulating inflammation in the uterine wall and premature contractions. Formation of the shell is dependent on proliferation of cytotrophoblast progenitor cells during the first weeks after implantation, when the developing placenta is supported by histotrophic nutrition from endometrial glands. Hence, we propose the fitness of the endometrium prior to conception, and the peri-conceptional dialogue between the endometrium and the trophoblast is critical for avoidance of later complications of pregnancy. (c) 2017 Elsevier Ltd. All rights reserved.