Maternal overweight and obesity (i.e., excess adiposity) are risk factors for adverse pregnancy outcomes and long-term maternal and offspring health impairments that are rooted in placental dysfunction. Factors contributing to placental dysfunction in pregnancies affected by excess adiposity are not fully understood. We hypothesized that impaired remodelling of uterine spiral arteries and enhanced inflammatory signalling at the placental interface related to compositional and functional differences in uterine macrophage and natural killer (NK) cells in early pregnancy would contribute to placental hypoxia and impaired vascular maturation. We tested this hypothesis using a mouse model of periconceptional high-fat, high-sucrose (HFHS) diet-induced excess adiposity. In Chapter 3, we found that HFHS placental tissues were hypoxic and exhibited histological features of malperfusion and inflammation in late gestation. This was accompanied by elevated circulating fetal endocrine and inflammatory mediators. In Chapter 4, we show that diet-induced excess adiposity does not impair spiral artery transformation at mid-gestation but does promote angiogenic and inflammatory shifts related to decidual macrophage and NK cell populations that might contribute to later placental malperfusion. In Chapter 5, we examined the cell-type-specific impacts of excess adiposity using single-cell gene expression analysis. We found that immune and stromal cell populations from HFHS uterine tissues exhibit pro-fibrotic, pro-thrombotic, and potentially immuno-suppressive gene expression changes immediately following embryo implantation. This coincided with immunophenotypic changes in blood monocytes and neutrophils that might be indicative of low-level systemic vascular injury. Overall, our findings indicate that diet-induced excess adiposity can compromise placental perfusion in the absence of impaired spiral artery remodelling. Altered recruitment and activity of uterine immune cells driven by conditions surrounding excess adiposity likely participate in disrupted uteroplacental perfusion, inflammation, and suboptimal placental function. These data provide new insights into the cellular and molecular mechanisms underlying placental dysfunction in pregnancies affected by overweight and obesity. / Thesis / Doctor of Philosophy (PhD)

Background: Pregnant individuals who participate in physical activity throughout gestation have been shown to experience a wide spectrum of health benefits, along with the fetus. In nonpregnant populations, PA influences the polarization state of tissue resident macrophages, resulting in increased regulatory and decreased inflammatory profiles. The effects of PA on placenta-resident macrophages, or Hofbauer cells (HBCs), remains unknown. My thesis aimed to explore this novel area. Methods: The first objective of my thesis was to identify any associations between gestational PA and HBC polarization. PA was objectively measured in both mid (24-28 weeks) and late (34-38 weeks) pregnancy using accelerometry. Immunofluorescent localization of the panmacrophage marker CD68 and the anti-inflammatory macrophage marker CD206 was used to assess polarization states. Protein and gene expression of CD68 and CD206 were assessed using Western blot and qPCR, respectively. The second objective was to explore the relationships between gestational PA, HBC polarization, and angiogenic factors in the placenta. Western blot measured the relative protein expression of FGF2 and SPRY2, and the localization of FGF2, SPRY2, and VEGF within HBCs was explored using immunofluorescent colocalization in term placenta tissue and primary HBC cultures. Results: While there were no differences in the absolute numbers of total or CD206+ HBCs, the proportion of CD206+ HBCs was elevated in active individuals. There were no significant differences in the gene expression of CD68 or CD206, nor in the gene expression of CD206; however, CD206 protein expression was observed to be lower in active participants. Both CD206+ and CD206- HBCs expressed VEGF. Active individuals had significantly higher low molecular weight-FGF2. There were no differences in the protein expression of SPRY2, total FGF2, or high molecular weight FGF2 based on PA. HBCs both in vitro and in vivo of all polarizations expressed VEGF, SPRY2, and FGF2, and were observed to create intracellular junctions and multi-nucleated giant cells. Conclusions: In conclusion, PA was associated with a higher proportion of CD206+ HBCs and reduced levels of CD206 protein. In combination with the lack of significant difference in CD206 mRNA based on PA levels, this suggests a potential effect mediated by PA on the transcriptional regulation of CD206. HBCs were seen to express SPRY2, VEGF, and FGF2, identifying them as potential players in angiogenesis regulation in the placenta. The elevated levels of low molecular weight FGF2 in active individuals suggests the PA may play a role in the modulation of placental angiogenesis. Future research should continue to explore the relationships between PA, HBC polarization, and angiogenesis.

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Die Schwangerschaft ist ein komplexes Phänomen, bei dem es zu einer Interaktion zwischen dem mütterlichen Immunsystem und dem Fetus kommt. An der feto-maternalen Grenze kommt es zur Auslösung einer inflammatorischen Reaktion, die für eine normale Implantation und Schwangerschaft notwendig ist. Allerdings kann eine exzessive Entzündungsreaktion zu Schwangerschaftskomplikationen wie dem immunologisch vermittelten Sponatanabort füh-ren. Das zytoprotektive Enzym Hämoxygenase-1 (HO-1) spielt eine sehr wichtige Rolle bei der Kontrolle inflammatorischer Reaktionen. Inwiefern HO-1 für das Gelingen und Bestehen einer Schwangerschaft unabdingbar ist, wurde bisher nicht untersucht. Unsere Hypothese ist, dass HO-1 eine bedeutsame Rolle während der Schwangerschaft spielt. Die Beantwortung dieser wichtigen Frage ist deshalb Hauptziel dieser Dissertation. Es konnte gezeigt werden, dass eine spezifische Hochregulation des HO-1 Moleküls mittels Gentherapie in einem Mausmodell für Spontanabort zur signifikanten Reduktion der Abortra-te führte. Dieser protektive Effekt war mit einer erhöhten Th2/Th1 Zytokinen-Ratio und mit verminderter Apoptose assoziiert. Ein weiteres Teilziel dieser Arbeit bestand darin, die Rolle des HO-1 Moleküls während der Plazentation zu untersuchen. Dafür wurde eine Trophoblastenstammzelllinie benutzt, die in der Lage ist, zu Riesenzellen zu differenzieren. Die mittels Zinkprotoporphyrin (ZnPPIX) induzierte Expressionssuppression von HO-1 führte zur Verminderung der Überlebensrate von Trophoblastenstammzellen und zur Hemmung von deren Ausdifferenzierung in Trophoblastenriesenzellen. Um die Rolle des HO-1 Moleküls in anderen Schwangerschaftsprozessen zu untersuchen, wurden Hämoxygenase-1 defiziente (Hmox1-/-) Mäuse benutzt. Da die Verpaarung von Hmox1-/- Mäuse zu keinem erfolgreichen Abkömmling führt, war ein weiteres Teilziel dieser Arbeit gewesen, den zu Grunde liegenden Mechanismus aufzuklären. Es zeigte sich, dass Hmox1-/- Weibchen im Vergleich zu den Hmox1+/+ Weibchen weniger Oozyten produzieren. Auch konnten die Hmox1-/- Oozyten weniger erfolgreich als die Hmox1+/+ Oozyten fertili-ziert werden. Verschiedene Verpaarungsexperimente mit Hmox1+/+, Hmox1+/- und Hmox1-/- Mäusen ergaben einen indirekt proportionalen Zusammenhang zwischen HO-1 Expression und Aborthäufigkeit. Die hier gewonnenen Daten deuten daraufhin, dass HO-1 eine entscheidene Rolle in der Schwangerschaft spielt. Die gewonnenen Erkenntnisse tragen zum Verständnis der Pathologie des immunologisch vermittelten Spontaborts bei und können darüber hinaus helfen neue Be-handlungsstrategien gegen diese gefürchtete Schwangerschaftskomplikation zu entwickeln. / Mammalian pregnancy is a parabiotic union of two genetically different individuals, the fetus and the mother. At the feto-maternal interface, inflammatory processes can occur due to an immune reaction against alloantigens. It is known that some degree of systemic or uterine inflammation is necessary for both normal implantation and pregnancy. However, if this in-flammation becomes too excessive it can cause pregnancy complications such as abortion. Heme oxygenase-1 (HO-1), the enzyme responsible for the degradation of free heme, plays a key role in inflammatory processes. Viewing pregnancy mainly as an inflammatory process had led us to the idea that HO-1 may play an important role in pregnancy. Therefore, the main aim of this work was to analyze the role of HO-1 in the different processes related to preg-nancy by means of functional studies employing in vivo as well as in vitro models. First, we could show that a specific up-regulation of HO-1 in abortion-prone animals by means of an adenoviral vector is able to reduce the abortion rate. This HO-1 up-regulation improved pregnancy outcome by up-regulating the Th2/Th1 cytokines ratio and protecting tissues from apoptosis, suggesting an important role of HO-1 in pregnancy. In a second part of the work, we aimed to analyze the role of HO-1 in placentation. For that, a trophoblast stem cell line capable of differentiate into trophoblast giant cells was used. Inter-estingly, a down-regulation of HO-1 by means of ZnPPIX led to diminished survival of the trophoblast stem cells. Furthermore, these cells were unable to differentiate into trophoblast giant cells in the absence of HO-1, strongly suggesting a crucial role of HO-1 in placentation. Finally, a closer look into the role of HO-1 in pregnancy was performed by using heme oxy-genase-1 deficient mice (Hmox1-/- mice). Interestingly, Hmox1-/- females produce much less oocytes than wild type females. Analyses of the ovaries of both types of females showed dif-ferences in follicle development. Furthermore, when fertilized in vitro, a significant diminu-tion in the fertilization rate of Hmox1-/- oocytes when compared to Hmox1+/+ oocytes was found. Since the mating of Hmox1-/- mice does not yield progeny, we also aimed to clarify whether this is due to problems in the female, in the male or in both. For this, different mating combinations of mice partially or totally deficient in Hmox1 were performed. The analysis of the pregnancy outcome showed that, the less HO-1 in the combination, the higher the fetal rejection. In summary, a central role of HO-1 in different processes of reproduction could be demon-strated in this work which helps understanding the mechanisms behind pregnancy success.

Uterine NK (uNK) cells are a distinct subset of NK cells in the decidua of humans and rodents during pregnancy, which are essential for remodelling of the spiral arteries supplying the feto-placental unit. Similarly to peripheral NK cells, uNK cells express Natural Killer receptors (NKRs) that engage MHC class I molecules. Evidence from human genetic association studies suggests that, in the presence of allogeneic cognate paternal MHC class I ligands, inhibitory uterine NKRs are associated with disorders of pregnancy arising from impaired decidual vascular remodelling. Conversely, enhancement of human uNK cell activity through activating NKRs is associated with high birth weight. Evidence from mouse models corroborates that uNK cell activity is modulated by interactions between NKRs and MHC class I, but has largely focussed on the effect of paternal MHC. In this study, the contribution of maternal immunogenetic regulation of NK cell function to reproductive outcome was assessed independently of parental MHC disparity in mice. To evaluate the role of NKR genes in isolation, I used congenic B6.BALB-TC1 (TC1) mice that differ from C57BL/6 (B6) mice only within the region of chromosome six encoding NKRs that recognise MHC class I. Absence of a major inhibitory NKR for self-MHC, Ly49I, in TC1 mice causes a compensatory shift in the NKR repertoire expressed and preserves a majority subpopulation of educated NK cells. B6 and TC1 splenic and uterine NK cells are similarly functionally reactive and mature, and no significant differences could be detected in spiral arterial remodelling or fetal growth between these strains in MHC-syngeneic matings. This supports data from human immunogenetic studies showing that maternal uterine NKRs are not associated with differences in pregnancy outcome in the absence of novel paternal MHC class I ligands, and highlights the importance of maternal and paternal co-regulation of uNK cell activity during pregnancy. No mouse models of uNK cell activation are currently available with which to corroborate human immunogenetic associations between activating uterine NKRs and high birth weight. Male m157-transgenic (m157-Tg) mice, which ubiquitously express viral m157 glycoprotein ligands for the activating NKR Ly49H, were mated with B6 females. Exclusive expression of m157 glycoprotein by trophoblast improved placental efficiency, but did not enhance fetal growth. Some fertility clinics surmise that uNK cell activation initiates the pathogenesis of spontaneous abortion. It has been suggested that this may occur due to reduced expression by human uNK cells of miR-483-3p, which stimulates endogenous insulin-like growth factor (IGF)-1 production and uNK cell cytotoxicity in vitro. It is demonstrated here that neither miR-483-3p nor IGF-1 regulate murine NK cell development, maturation or function. No discernible reproductive phenotype is evident in miR-483 deficient females. It can be inferred that post-transcriptional control by miR-483 is not biologically relevant to murine NK cell function. Although m157-Tg mice may provide an interesting model to further study uNK cell-mediated placental adaptations, it remains important to identify a murine model of enhanced uNK cell function to corroborate human immunogenetic associations with high birth weight and to challenge the supposition that uNK cell activation is harmful to pregnancy.