Human papillomavirus (HPV) is a double-stranded DNA virus, typically infecting mucosal or cutaneous epithelial keratinocytes. Today, more than 118 different HPV types have been formally described. Sexual transmission of mucosal HPVs is very common and generally asymptomatic, but HPV infection can be associated with benign lesions such as condylomata acuminata or, in rare cases, with malignant lesions such as cervical cancer. Two prophylactic vaccines are currently available in Europe, protecting against HPV-16 and HPV-18 (Cervarix) or against HPV-6, HPV-11, HPV-16 and HPV-18 (Gardasil). In order to assess the impact of the vaccination program, it is mandatory to obtain geographically widespread date on the baseline HPV prevalence and type distribution in cervical samples from women, presenting or not, normal or abnormal cytologic or histologic results. We undertook an epidemiological study in the Capital Region of Brussels to determine the HPV prevalence and type-distribution in 1526 cervical samples of women presenting a cytology within normal limits (WINL), atypical squamous cells of undetermined significance (ASC-US), low-grade squamous intra-epithelial lesions (LSIL), high-grade squamous intra-epithelial lesions (HSIL) or invasive cervical cancer (ICC). The HPV prevalence was 10.8% (95%CI: 8.8-12.8) for NILM, 34.5% (95%CI: 28.3-40.8) for ASC-US, 54.0% (95%CI: 47.4-60.6) for LSIL and 100% for HSIL and ICC. With an HPV-16 and HPV-18 prevalence of 63.3% (95%CI: 44.1-67.7) and 73.5% (95%CI: 63.0-84.0) in mono-infected HSIL and ICC, respectively, HPV 16/18 L1 VLP vaccines would be expected to significantly reduce the management and treatment of women suffering from HSIL and ICC in the Capital Region of Brussels. We also detected HPV-30, HPV-53, HPV-66 and HPV-68 in mono-infected HSIL and ICC samples, possibly providing arguments for the reconsideration of the carcinogenicity of these types. Vertical transmission of HPV was also previously reported, but in most cases one could not exclude a placental contamination by HPV positive cells from an infected birth canal. In order to confirm that the placenta can be infected with HPV, we analysed residual cells from 35 transabdominally obtained placental samples from pregnant women undergoing chorionic villous sampling for screening of suspected foetal abnormalities and found that two samples were positive for HPV-16 and HPV-62, respectively. The clinical importance of these results remains to be elucidated, but the previously observed association between placental HPV infection and pregnancy loss might gain further in importance. HPV gene regulation in placental trophoblastic cells has not been studied so far. We studied the HPV-16 early gene expression regulation in transiently transfected monolayer cultured trophoblastic cells with an HPV-16 long control region (LCR) driven reporter plasmid. We observed important differences in constitutive HPV-16 LCR activities between trophoblastic cell lines and could identify progesterone as an important inducer of HPV-16 early gene expression. Steroid hormones are induced during pregnancy and could therefore lead to an enhanced expression of the E5, E6 and E7 proteins upon placental HPV infection. Since these proteins were previously shown to affect trophoblast adhesion, survival, migration and invasion, their enhanced expression might eventually contribute to pregnancy loss. We furthermore found that the transcription of episomally maintained HPV-16 is not regulated by E2 or E1, but by E5, E6 and/or E7.

The process of autophagy is defined as the degradation of cellular cytoplasmic constituents via a lysosomal pathway. Herein I sought to examine the regulation of autophagy in the placental pathologies preeclampsia (PE) and intrauterine growth restriction (IUGR). I hypothesized that the Bcl-2 family proteins Mcl-1L and MtdL regulate placental autophagy and contribute towards dysregulated autophagy in PE. My results demonstrate that Mcl-1L acts to repress autophagy via a Beclin 1 interaction, while MtdL induces autophagy when it interacts with Mcl-1L. My data indicate that while autophagy is elevated in PE, a pathology characterized by oxidative stress, it is decreased in IUGR, a hypoxic pathology. Treatment with sodium nitroprusside to mimic PE caused a decrease in Mcl-1L and an increase in MtdL levels in response to oxidative stress, thereby inducing autophagy. Overall, my data provide insight into the molecular mechanisms contributing to the pathogenesis of preeclampsia.

The process of autophagy is defined as the degradation of cellular cytoplasmic constituents via a lysosomal pathway. Herein I sought to examine the regulation of autophagy in the placental pathologies preeclampsia (PE) and intrauterine growth restriction (IUGR). I hypothesized that the Bcl-2 family proteins Mcl-1L and MtdL regulate placental autophagy and contribute towards dysregulated autophagy in PE. My results demonstrate that Mcl-1L acts to repress autophagy via a Beclin 1 interaction, while MtdL induces autophagy when it interacts with Mcl-1L. My data indicate that while autophagy is elevated in PE, a pathology characterized by oxidative stress, it is decreased in IUGR, a hypoxic pathology. Treatment with sodium nitroprusside to mimic PE caused a decrease in Mcl-1L and an increase in MtdL levels in response to oxidative stress, thereby inducing autophagy. Overall, my data provide insight into the molecular mechanisms contributing to the pathogenesis of preeclampsia.

During pregnancy, 64-96% of women take at least one prescription drug. The placenta is the primary barrier between substrates in maternal and fetal circulation. The blood-brain barrier (BBB) acts as an additional barrier for the fetal brain, which is particularly susceptible to the effects of xenobiotics. Multidrug resistance phosphoglycoprotein (P-gp; encoded by Abcb1 mRNA) and breast cancer resistance protein (Bcrp1; encoded by Abcg2 mRNA) are efflux transporters localized on placental syncytiotrophoblast and capillary endothelial cells of the BBB. Placental Abcb1/P-gp and Abcg2/Bcrp1 limit maternal-fetal transfer of endogenous and exogenous substrates. Similarly, the neuroprotective roles of Abcb1/P-gp and Abcg2/Bcrp1 in the adult BBB have been demonstrated. However, developmental changes in expression and function and regulation of Abcb1/P-gp and Abcg2/Bcrp1 in these tissues are poorly understood. This thesis investigates gestational changes in expression and function of Abcb1/P-gp and Abcg2/Bcrp1 in the placenta and fetal brain, in addition to regulation by steroids, progesterone and glucocorticoids. The effects of glucocorticoids on Abcb1/P-gp and Abcg2/Bcrp1 in the placenta and fetal brain are of importance given that 10% of pregnant women are treated with synthetic glucocorticoids during the management of threatened preterm labour. These studies demonstrate that the decrease in placental Abcb1/P-gp mediated fetal protection near term is compensated by an increase in Abcb1/P-gp and Abcg2/Bcrp1 mediated neuroprotection in the fetal brain; likely in preparation for life ex-utero. The lack of effects of progesterone and the dose-, age- and sex- dependent regulatory effects of synthetic glucocorticoid have highlighted the complexity associated with regulation of these transporters. Further, these studies are the first to report sexually dimorphic glucocorticoid effects on Abcb1/P-gp and Abcg2/Bcrp1 expression and function, with the female fetus being particularly susceptible to glucocorticoid these effects. In this regard, Abcb1/P-gp and Abcg2/Bcrp1 transport capacity may be altered when synthetic glucocorticoid is administered as a co-therapy, and as such, recipient sex should be considered during pharmacotherapy. Understanding the regulation of Abcb1/P-gp and Abcg2/Bcrp1 expression and function in the placenta and fetal brain during normal development and under pathological conditions is critical for fetal health and development, particularly when therapeutic strategies are utilized in pregnancy.

Fetal growth potential reflects a complex regulatory system delivered by genetic and environmental factors acting directly on the fetus or through the placenta. Compromise of this potential, as seen in intrauterine growth restriction (IUGR), is associated with increased perinatal mortality and short and long term morbidity. The expression of several genes has been shown to be disturbed in placentas of fetuses with growth restriction. However, the primary causes for these changes have not yet been elucidated. I proposed that epigenetic mechanisms, specifically DNA methylation, may be involved in placental development leading to modulation of the expression of specific genes, and that their altered regulation will impact fetal development and growth. My primary objective was to identify DNA methylation variation in placenta, in association with variation of gene expression and with poor fetal growth. I used a global genomic screening approach, with 24 selected placental samples, from newborns considered IUGR or normal controls, to identify candidate target genomic regions carrying epigenetic alterations. Candidate regions were followed up, by expression analysis of corresponding regulated genes, for associations with altered expression and by targeted methylation analysis in an expanded cohort of 170 samples, for associations with birthweight percentile. I analyzed methylation variation at imprinting centers (IC), gene promoters and CpG islands. In two genome-wide case control screening studies using distinct commercial microarray platforms I identified approximately 68 differentially methylated autosomal candidate genomic regions overlapping gene promoters. Hypomethylated CpGs mapping to gene promoters were found to be more abundant in placentas of growth restricted newborns than in controls. One of the most interesting candidates, WNT2, was analyzed in an extended sample cohort and showed an association of high promoter methylation to low expression as well as low birthweight percentile. This gene is involved in a pathway that diverts cells from programmed apoptosis. It is highly expressed in placenta, and in mice, targeted biallelic inactivation of Wnt2 has been shown to cause poor growth and perinatal death in 50% of the affected pups. These findings support the hypothesis that dysregulation of epigenetic mechanisms are involved in abnormal placental development and can impact fetal growth.

During pregnancy, 64-96% of women take at least one prescription drug. The placenta is the primary barrier between substrates in maternal and fetal circulation. The blood-brain barrier (BBB) acts as an additional barrier for the fetal brain, which is particularly susceptible to the effects of xenobiotics. Multidrug resistance phosphoglycoprotein (P-gp; encoded by Abcb1 mRNA) and breast cancer resistance protein (Bcrp1; encoded by Abcg2 mRNA) are efflux transporters localized on placental syncytiotrophoblast and capillary endothelial cells of the BBB. Placental Abcb1/P-gp and Abcg2/Bcrp1 limit maternal-fetal transfer of endogenous and exogenous substrates. Similarly, the neuroprotective roles of Abcb1/P-gp and Abcg2/Bcrp1 in the adult BBB have been demonstrated. However, developmental changes in expression and function and regulation of Abcb1/P-gp and Abcg2/Bcrp1 in these tissues are poorly understood. This thesis investigates gestational changes in expression and function of Abcb1/P-gp and Abcg2/Bcrp1 in the placenta and fetal brain, in addition to regulation by steroids, progesterone and glucocorticoids. The effects of glucocorticoids on Abcb1/P-gp and Abcg2/Bcrp1 in the placenta and fetal brain are of importance given that 10% of pregnant women are treated with synthetic glucocorticoids during the management of threatened preterm labour. These studies demonstrate that the decrease in placental Abcb1/P-gp mediated fetal protection near term is compensated by an increase in Abcb1/P-gp and Abcg2/Bcrp1 mediated neuroprotection in the fetal brain; likely in preparation for life ex-utero. The lack of effects of progesterone and the dose-, age- and sex- dependent regulatory effects of synthetic glucocorticoid have highlighted the complexity associated with regulation of these transporters. Further, these studies are the first to report sexually dimorphic glucocorticoid effects on Abcb1/P-gp and Abcg2/Bcrp1 expression and function, with the female fetus being particularly susceptible to glucocorticoid these effects. In this regard, Abcb1/P-gp and Abcg2/Bcrp1 transport capacity may be altered when synthetic glucocorticoid is administered as a co-therapy, and as such, recipient sex should be considered during pharmacotherapy. Understanding the regulation of Abcb1/P-gp and Abcg2/Bcrp1 expression and function in the placenta and fetal brain during normal development and under pathological conditions is critical for fetal health and development, particularly when therapeutic strategies are utilized in pregnancy.

Fetal growth potential reflects a complex regulatory system delivered by genetic and environmental factors acting directly on the fetus or through the placenta. Compromise of this potential, as seen in intrauterine growth restriction (IUGR), is associated with increased perinatal mortality and short and long term morbidity. The expression of several genes has been shown to be disturbed in placentas of fetuses with growth restriction. However, the primary causes for these changes have not yet been elucidated. I proposed that epigenetic mechanisms, specifically DNA methylation, may be involved in placental development leading to modulation of the expression of specific genes, and that their altered regulation will impact fetal development and growth. My primary objective was to identify DNA methylation variation in placenta, in association with variation of gene expression and with poor fetal growth. I used a global genomic screening approach, with 24 selected placental samples, from newborns considered IUGR or normal controls, to identify candidate target genomic regions carrying epigenetic alterations. Candidate regions were followed up, by expression analysis of corresponding regulated genes, for associations with altered expression and by targeted methylation analysis in an expanded cohort of 170 samples, for associations with birthweight percentile. I analyzed methylation variation at imprinting centers (IC), gene promoters and CpG islands. In two genome-wide case control screening studies using distinct commercial microarray platforms I identified approximately 68 differentially methylated autosomal candidate genomic regions overlapping gene promoters. Hypomethylated CpGs mapping to gene promoters were found to be more abundant in placentas of growth restricted newborns than in controls. One of the most interesting candidates, WNT2, was analyzed in an extended sample cohort and showed an association of high promoter methylation to low expression as well as low birthweight percentile. This gene is involved in a pathway that diverts cells from programmed apoptosis. It is highly expressed in placenta, and in mice, targeted biallelic inactivation of Wnt2 has been shown to cause poor growth and perinatal death in 50% of the affected pups. These findings support the hypothesis that dysregulation of epigenetic mechanisms are involved in abnormal placental development and can impact fetal growth.

During pregnancy, the woman carries a fetus partly foreign to her immune system, because of the expression of paternal antigens. Despite this, the fetus is normally tolerated and not rejected, as is often the case with organs in allogeneic transplantations. Systemic changes in maternal blood occur during pregnancy but, perhaps of greater importance, are changes in tissues locally in the uterus. The pregnant uterine endometrium, the decidua, is infiltrated by large numbers of leukocytes, mainly natural killer (NK) cells but also macrophages and T lymphocytes. Further, various cytokines are known to be secreted at the fetomaternal interface. However, the functions of these cells and the cytokine networks are not fully understood. The aim of this thesis was to investigate the local immune balance in normal human pregnancy decidua, both in the early phase of pregnancy and at parturition. First trimester decidual mononuclear cells, NK cells and macrophages were all shown to secrete IFN-γ, IL-4 and IL-10, as detected by ELISPOT. The secretion was not mirrored in blood from the same subjects. A significantly larger number of decidual macrophages secreted IL-10 than did their blood counterparts, indicating potential regulatory functions of this cell type. Further examination of early pregnancy decidual macrophages by microarray revealed 120 genes being differentially regulated at the transcriptional level in decidual compared to blood monocytes/macrophages. Several genes were associated with alternative activation/M2 polarization of macrophages, including CCL-18, CD209, IGF-1, MRC-1 and FN-1. Genes connected to immune regulation and tissue remodelling were common, in line with the potential functions for this cell type in utero. In addition, some molecules not previously connected to decidual macrophages, such as TREM-2, A2M and PGDS, were found to be upregulated, gaining new insights into the regulatory functions of decidual macrophages. Term decidual mononuclear cells spontaneously secrete IFN-γ, TNF, IL-4, IL-10, and TGF-β. No differences were seen between tissues obtained before and after the onset of labour, indicating that decidual mononuclear cells are not the main cell population responsible for plausible cytokine regulation in the process of labour induction. Placental and fetal membranes as well as cells in the maternal systemic circulation may instead contribute to a possible shift in immune balance prior to pregnancy termination. In conclusion, decidual leukocytes, including NK cells and macrophages, are potential producers of both Th1-like/pro-inflammatory and Th2-like/anti-inflammatory cytokines in early pregnancy as well as at parturition. Decidual macrophages are of a specialized phenotype with effector functions contributing to a proper invasion of the placenta and to immunological protection of the semi-allogeneic fetus. This thesis adds new knowledge on local immune balance during normal human pregnancy, however, the clinical significance of the presented data needs to be clarified.

La prévalence accrue de surplus pondéral et d'obésité chez les femmes en âge de procréer est un problème de santé publique. De nombreuses études ont démontré qu'un poids maternel trop faible ou trop élevé peut influencer le poids du nouveau-né et ainsi influencer son état de santé actuelle et future. Durant la grossesse, l'accumulation de gras foetal survient au dernier tiers. La disponibilité des acides gras essentiels pour le foetus ne dépend pas seulement de l'apport maternel en acide gras mais aussi de la fonction placentaire elle-même ainsi que des changements et des adaptations physiologiques et biochimiques qui surviennent durant la grossesse. Afin de vérifier l'influence d'un poids maternel hors norme sur ces facteurs de disponibilité des acides gras, l'isolation de cellules trophoblastiques a été effectuée à partir de placenta frais provenant de femmes ayant une masse corporelle au-dessous de la normale (IMC<20 kg/m²), de femmes ayant une masse corporelle normale (20 kg/m²<IMC<26 kg/m²) et de femmes obèses (BMI>30 kg/m²). Ces femmes faisaient partie d'une banque de femmes recrutées pour participer au Projet Lipides de notre laboratoire de physiologie materno-foetale. Des études de transport d'acide linoléique, un acide gras essentiel, ont ensuite été effectuées sur des syncytiotrophoblaste et des cytotrophoblastes isolées à partir des placentas des femmes recrutées pour le projet. Par la suite, ce transport d'acide linoléique a été mis en relation avec les dosages maternelles lipidiques et hormonaux des deuxième et troisième tiers ainsi qu'avec les dosages lipidiques et hormonaux foetaux à la naissance. Cette étude met en évidence une diminution du transport syncytiotrophoblastique de l'acide linoléique par la maigreur et l'obésité pré-grossesse maternelle. En fait, le transport de l'acide linoléique est davantage perturbé dans les syncytiotrophoblastes, que dans les cellules trophoblastiques précurseurs, les cytotrophoblastes. De plus, l'obésité (lMC>30) pré-grossesse a été corrélée à une augmentation des niveaux maternels d'insuline lors du deuxième et troisième tiers ainsi qu'à une diminution des concentrations de TSH et d'AFP. D'autre part, la maigreur (lMC<20) pré-grossesse diminue les niveaux d'AFP et de T3 du troisième tiers et du sang foetal à terme. Ces importantes altérations des niveaux hormonaux qui surviennent durant les grossesses de femmes obèses et de femmes maigres pourraient expliquer la diminution du transport placentaire de l'acide linoléique, un acide gras essentiel. ______________________________________________________________________________ MOTS-CLÉS DE L’AUTEUR : Grossesse, Placenta, Obésité, Indice de masse corporelle, Trophoblaste.

L'administration d'une diète enrichie à 0,2% en cholestérol (DEC) cause une hypercholestérolémie maternelle et foetale, et entraîne une diminution de 15,5% du poids des rejetons à la naissance chez les lapines. Cependant, les mécanismes qui engendrent la diminution du poids des rejetons sont encore inconnus Le glucose joue un rôle primordial dans le développement foetal. Une diminution de l'apport en glucose et une hypoglycémie foetale sont les mécanismes pathophysiologiques d'une restriction de la croissance intrauterine (RCIU). Le glucose traverse le placenta en utilisant des transporteurs spécifiques, soit les SGLT (dépendant du Na+) et les GLUTs (transport facilité). Cependant, la régulation des GLUTs nécessite leur translocation du pool intracellulaire vers la membrane plasmatique et ce phénomène peut grandement être influencé par l'environnement lipidique de la membrane. L'objectif de cette étude est donc d'étudier l'impact d'une DEC durant la gestation chez la lapine sur le métabolisme du glucose, l'expression génétique et protéique des SGLT et GLUTs et le routage des GLUTs dans le placenta. Pour effectuer cette étude, deux groupes de lapines gestantes et leurs rejetons ont été utilisés: un groupe de femelles a été nourri avec une diète standard pour lapin et l'autre avec une DEC. Les niveaux sériques de glucose et d'insuline ont été évalués. La quantification relative de GLUTs (ARNm) dans le placenta a été fait par «reverse transcriptase polymerase chain reaction» (RT-PCR) en temps réel. La quantification des niveaux d'expression protéique de SGLTI et de GLUTs placentaires a été réalisée par immunobuvardage de type Western. Nos résultats démontrent que la concentration du glucose chez les rejetons hypercholestérolémiques est inférieure à celle de leur mère, ainsi qu'à celle des rejetons contrôles. Une diminution du niveau d'insuline maternelle à la fin de la gestation a également été observée dans les deux groupes des lapines. Cependant, aucune différence dans l'insulinémie foetale n'a été retrouvée. L'expression des GLUT1, GLUT3 et GLUT4 (ARNm) placentaires n'a pas été modifiée par la DEC. En ce qui a trait à l'expression protéique des GLUTs, la DEC ne semble pas influencer leur niveau dans des extraits de protéines totales placentaires. Cependant l'expression de la SGLT1, elle, est fortement diminuée (4 fois). Par contre, le fractionnement cellulaire a permis de démontrer une diminution de l'expression de GLUT1 dans la membrane plasmique des placentas de lapines hypercholestérolémiques, avec une augmentation concomitante de l'expression de GLUT1 dans la fraction cytosolique. Cependant, aucune différence dans l'expression protéique de GLUT4 dans ces 2 fractions n'a été constatée dans le placenta de deux groupes de lapines. En conclusion, l'hypercholestérolémie maternelle: 1) entraîne une hypoglycémie foetale, 2) n'influence pas le niveau de l'insuline maternelle et foetale, 3) n'a pas d'effet sur l'expression génétique de GLUT1, GLUT3 et GLUT4 placentaires, 4) diminue l'expression de SGLTI placentaire dans l'extrait de protéines totales, et 5) influence uniquement le routage des GLUT1 vers la membrane plasmique. L'hypoglycémie foetale pourrait, donc, être engendrée par la diminution de la mobilisation de GLUT1 placentaire dans la membrane plasmatique. Le faible poids à la naissance des rejetons hypercholestérolémiques pourrait s'expliquer par l'hypoglycémie foetale. ______________________________________________________________________________ MOTS-CLÉS DE L’AUTEUR : Hypercholestérolémie, RClU, Transporteur du glucose, Placenta, Lapin.