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Human Cytomegalovirus (HCMV) is the most common cause of congenital infection in newborns. One mechanism for this virus to reach the fetus is to cross the placenta through the syncytiotrophoblast layer. Accumulation and protection of pathogens in the syncytiotrophoblast could affect the systemic distribution of pathogens and prolong maternal infections leading to increased incidence of fetal infections. Primary infections, reactivation or reinfection with another strain during pregnancy are risk factors for intrauterine HCMV transmission to the fetus. All lead to an active infection; however, viral load in blood or urine does not correlate with intrauterine transmission. I have shown that HCMV reversibly binds to the syncytiotrophoblast in vitro, protecting it from degradation. Furthermore, I demonstrated in vivo that HCMV is present in the placenta, even when cleared from maternal blood and urine. This evidence suggests increased potential for fetal transmission by virtue of continued virus localized at the maternal-fetal interface.

Abstract Fetal alcohol syndrome (FAS) is a pattern of anomalies in affected children due to maternal alcohol administration at vulnerable stages of fetal development. Intrauterine growth restriction and facial malformation are the presenting phenotypes of FAS. In this investigation, novel pathomechanisms of intrauterine growth restriction and facial malformation were the primary aims. We found by a FAS mouse model that AceCS1 gene expression and polyamines are the immediate targets of fetal alcohol exposure. The AceCS1 product is a precursor for lipid synthesis and protein acetylation and possibly, for polycation acetylation. We cloned the Mus musculus nuclear-cytosolic AceCS1 gene, and showed that its expression is developmentally regulated with a dynamic localization in the cytosolic and nuclear compartment. The enzyme plays an essential role in de novo synthesis of acetyl Coenzyme A. Fetal alcohol administration targets nutrient supplying networks, which are localized at critical barriers. The main findings were reduced surface of the labyrinthine zone, destruction of gap junctions in the hemotrichorial placenta, reduced syncytiotrophoblastic cell layers and loosening of interaction between cell layers and embryo endothelial cells, reduced Reichert’s membrane thickness with discontinued Reichert’s trophoblast and loss of interaction by Reichert’s-parietal cells, reduction of capillary network and reduced vascularization in the brain area, and perturbed neural crest migration and formation of neural tube defect. Alteration of angiogenesis -regulating proteins such as VEGF, PlGF, PECAM was detected in FAS, with no significant changes in placental angiogenesis of the labyrinthine zone, but up-regulation of VEGF/PlGF caused permeability changes in the placenta and yolk sac. On the other hand, the PECAM pool in embryos’ brain was reduced, which in turn led to decreased angiogenesis and vascularization. / Tiivistelmä Sikiön alkoholisyndrooma (engl. Fetal alcohol syndrome, FAS) on joukko muutoksia, joita esiintyy äidin raskaudenaikaisen alkoholin käytön seurauksena, kun käyttö osuu sikiökehityksen kannalta kriittiseen vaiheeseen. Kohdunsisäisen kasvun rajoittuminen ja kasvojen epämuodostumat ovat FAS:n tyypillisimpiä ilmentymiä. Tässä tutkimuksessa pyrittiin löytämään uusia patomekanismeja kohdunsisäisen kasvun rajoittumiselle ja kasvojen epämuodostumille. Hiiren FAS-mallin avulla selvisi, että sikiön altistuminen alkoholille vaikuttaa suoraan AceCS1-geenin ilmentymiseen ja polyamiinien pitoisuuteen. AceCS1-geenin tuote on esiaste lipidien synteesissä ja proteiinien asetylaatiossa sekä mahdollisesti myös polykationien asetylaatiossa. Työssä myös kloonattiin hiiren (Mus musculus) AceCS1-geeni, jonka tuotetta esiintyy sekä tumassa että solulimassa. Lisäksi osoitettiin, että geenin ekspressio oli kehityksen aikana säädelty tuottamaan entsyymiä dynaamisesti eri paikkoihin solussa. Entsyymillä on lisäksi merkittävä osuus asetyyli-koentsyymi-A:n de novo–synteesissä. Sikiön altistuminen alkoholille kohdistuu sellaisten ravintoaineiden saatavuuteen, jotka sijaitsevat kriittisesti tärkeissä kudosrajapinnoissa. Päälöydöksinä olivat vähentynyt labyrinttikudoksen pinta-ala, gap-liitosten tuhoutuminen istukan veriesteessä (hemotrichorial?), ohentunut trofoblastisolujen kerros ja Reichertin kalvon paksuus, harventunut hiusverisuonten verkosto sekä verisuonitus aivojen alueella sekä hermopienan solujen siirtymishäiriö ja hermostoputken sulkeutumishäiriö. Verisuonten muodostumista (angiogeneesiä) säätelevien proteiinien (kuten VEGF, PlGF, PECAM) muutoksia todettiin FAS:ssa, mutta merkittäviä muutoksia ei havaittu istukan verisuonten muodostumisessa. VEGF/PlGF-suhteen suureneminen muutti istukan ja ruskuaispussin verisuonten läpäisevyyttä. Toisaalta sikiöiden aivojen PECAM-määrä pieneni, mikä johti verisuonten ja verisuoniverkoston muodostumisen vähenemiseen.

A barreira placentária é constituída por duas camadas de células sinciciais, uma camada de células trofoblásticas gigantes e o endotélio fetal. Apesar da importância das camadas sinciciais no transporte molecular entre mãe e feto, o exato mecanismo de formação dessa barreira não está completamente elucidado em camundongos. Em humanos, estudos sugerem que a formação do sinciciotrofoblasto ocorre por um processo de fusão celular dependente de Caspase- 8, uma proteína iniciadora da cascata de apoptose. Desta forma, este estudo teve como proposta analisar o processo de formação das camadas sinciciais do labirinto em placentas de camundongos e o possível envolvimento da caspase-8 neste processo. Sítios de implantação foram coletados de camundongos fêmeas nos dias 8,5 a 11,5 de gestação e caracterizados morfologicamente através de marcadores de células precursoras sinciciais (EpCAM) e de células sinciciais maduras (Slc16A3) por meio de reações imunohitoquímicas. A expressão gênica dos marcadores diferenciais de células sinciciais também foi analisada por RT-PCR na região labiríntica dissecada nos diferentes dias de gestação. A expressão de Caspase-8 total e clivada também foi avaliada por Western blot e a relação entre a presença de Caspase-8 clivada e a indução de apoptose, avaliada por TUNEL e pela imunolocalização da Citoqueratina 18 clivada. Tambem foram realizadas análises com células labirínticas cultivadas, isoladas nos dias 8,5 a 10,5 de gestação. As células cultivadas foram caracterizadas morfologicamente e avaliadas quanto a expressão gênica de marcadores sinciciais e proteica de Caspase-8. Nossos resultados mostraram que os primeiros sinais morfológicos de formação da barreira placentária ocorream no dia 9,5 de gestação. O marcador EpCAM foi encontrado na base da placenta nos dias 8,5 e 9,5. No dia 11,5 de gestação, o labirinto já se encontra estruturado e funcional, o que foi indicado pela expressão de Slc16A3, nos dias 10,5 e 11,5 de gestação. A expressão gênica dos fatores de transcrição associados ao desenvolvimento das camadas sinciciais mostraram expressões crescentes ao longo do período estudado. Caspase-8 total e clivada mostrou intensa expressão no dia 9,5 de gestação, e aparentemente não estava associada à morte celular por apoptose, uma vez que não se detectou reatividade pela reação de TUNEL ou imunomarcação de Citoqueratina 18 clivada nas células labirínticas em formação em nenhum dos dias estudados. Células labirínticas obtidas aos 9,5 dias de gestação e cultivadas formaram ninhos celulares ao longo das 48 horas de cultura, com indícios morfológicos de sincicialização. A imunolocalização do marcador de células progenitoras do labirinto, EpCAM foi mais intensa nas culturas de 6 horas e se limitou a áreas ao redor dos ninhos celulares após 48 horas. Inversamente, a imunolocalização do transportador sincicial Slc16A3 não foi observada após 6 horas de cultura, mas foi bastante intensa no centro dos ninhos celulares após 48 horas. As culturas de labirinto de 9,5 das de gestação, também mostraram aumento de expressão das Sincitinas A e B ao longo do tempo de cultivo. A análise da expressão proteica de Caspase-8 mostrou expressão mais alta após 6 horas de cultivo do que a observada nos demais tempos experimentais. Por outro lado, a forma ativa (clivada) da caspase aumentou gradativamente após 24 e 48 horas de cultivo. Culturas submetidas ao tratamento com o inibidor farmacológico de Caspase-8 z-IEDT-fmk, mostraram perfis morfológicos alterados com redução da formação dos ninhos celulares e diminuição da reatividade ao Slc16A3. A expressão dos marcadores de diferenciação Sincitina A e B também foi significativamente diminuída (p<0.05) nestes experimentos em que a inibição da Caspase-8 clivada foi comprovada por Western blot. Estes achados mostraram a expressão de Caspase- 8, principalmente no dia 9,5 de gestação, nas células trofoblásticas labirínticas da placenta de camundongos e sugerem sua participação na formação das camadas sinciciais do labirinto. / Two layers of syncytial cells, a layer of trophoblastic giant cells and the fetal endothelium form the placental barrier. Despite the importance of the syncytial layers in molecular transport between mother and fetus, its exact developmental mechanism is still not completely elucidated in rodents. In humans, studies suggest that the formation of the syncytiotrophoblast occurs through a cell fusion process dependent on Caspase-8, an apoptosis cascade-initiating protein. In this way, this study had the proposal to analyze the process of formation of the syncytial layers of the labyrinth in placentas of mice and the possible involvement of Caspase-8 in this process. Implantation sites were collected from female mice on days 8.5 to 11.5 of gestation and morphologically characterized by the labyrinthine precursor cell marker EpCAM, and the mature syncytial cell marker - Slc16A3, through immunohistochemical reactions. The gene expression of the differential markers of syncytial cells was analyzed by RT-PCR in the labyrinthine region dissected on the different days of gestation. Total and cleaved Caspase-8 expression was also evaluated by Western blot and the relationship between the presence of cleaved Caspase-8 and the induction of apoptosis as assessed by TUNEL and the immunolocalization of the cleaved Cytokeratin 18. Analyzes were also performed with cultured labyrinth cells, isolated on days 8.5 to 10.5 of gestation. The cultured cells were characterized morphologically and evaluated for the gene expression of syncytial markers and Caspase-8 protein. Our results showed that the first morphological signs of placental barrier formation occurred on day 9.5 of gestation. The EpCAM marker was found at the base of the placenta on days 8.5 and 9.5. At day 11.5 of gestation, the labyrinth is already structured and functional, which was indicated by the expression of Slc16A3, on days 10.5 and 11.5 of gestation. The gene expression of the transcription factors associated with the development of the syncytial layers showed increased throughout the studied period. Total and cleaved Caspase-8 showed intense expression at day 9.5 of gestation, and apparently was not associated with cell death by apoptosis, since no reactivity was detected by the TUNEL reaction or cleaved Cytokeratin 18 immunolabeling in the labyrinthine zone. Labyrinthine cells obtained at 9.5 days of gestation formed nests during the 48 hours of culture, with morphological signs of syncytialization. Immunolocalization of the progenitor cell marker EpCAM was more intense in the 6-hour cultures and was limited to areas around the cell nests after 48 hours. Conversely, immunolocalization of the syncytial transporter Slc16A3 was not observed after 6 hours of culture but was quite intense at the center of the cell nests after 48 hours. Labyrinthine cell cultures of 9.5 gestation days also showed increased expression of A and B syncytins throughout the culture time. Analysis of the protein expression of Caspase- 8 showed higher expression after 6 hours of culture than that observed in the other experimental times. On the other hand, the active (cleaved) form of Caspase gradually increased after 24 and 48 hours of culture. Cultures submitted to the pharmacological inhibitor of Caspase-8 - z-IEDT-fmk showed altered morphological 18 profiles with reduction of cell nests formation and a decrease of reactivity to Slc16A3. The expression of the differentiation markers A and B Syncytins was also significantly decreased (p <0.05) in the experiments, in which the inhibition of the cleaved Caspase-8 was confirmed by Western blot. These findings show the expression of Caspase-8, mainly on day 9.5 of gestation, in the labyrinthine cells of the mice placenta and suggest its participation in the formation of the labyrinthine syncytial layers.

Although not obvious at first sight, several parallels can be drawn between pregnancy andcancer. Many proliferative, invasive and immune tolerance mechanisms that supportnormal pregnancy are also exploited by malignancies to establish a nutrient supply andevade or edit the immune response of the host. The human placenta, of crucial importancefor pregnancy success, and its main cells, the trophoblast, share several features withmalignant cells such as high cell proliferation rate, lack of cell-contact inhibition andinvasiveness. Both in cancer and in pregnancy, the immune defense mechanisms,potentially threatening the survival of the tumor or the fetus, are progressively blunted oreven turned into tumor- or pregnancy-promoting players. Amongst immune mechanisms that are meant to protect the host from cancer and can be apotential threat to the fetus, the NKG2D receptor-ligand system stands out as the mostpowerful, stress-inducible “danger detector” system that comprises the activating NK cellreceptor NKG2D and its ligands, the MIC (MHC class I Chain-related proteins A and B)and ULBP (UL-16 Binding Proteins) families. It is the major cytotoxic mechanism in thebody promoting surveillance and homeostasis. In the present thesis we investigate theNKG2D receptor-ligand system in human early normal pregnancy and in theleukemia/lymphoma cell lines Jurkat and Raji and ask the questions “How is the NKG2Dreceptor-ligand system functioning in pregnancy and tumor? How is the danger of cytotoxicattack of the fetus avoided? Why is the immunosurveillance function compromised incancer patients?” We developed a method to isolate and culture villous trophoblast from early human normalplacenta and used it to study the NKG2D receptor-ligand system. We discovered that theNKG2D ligand families of molecules MICA/B and ULBP1-5 are constitutively expressedby the syncytiotrophoblast of the chorionic villi. Using immnunoelectron microscopy, westudied the expression of these molecules at the subcellular level and could show for thefirst time that they are preferably expressed on microvesicles in multivesicular bodies(MVB) of the late endosomal compartment and are secreted as exosomes. Exosomes arenanometer sized microvesicles of endosomal origin, produced and secreted by a great7variety of normal and tumor cells. The exosomes are packages of proteins and ribonucleicacids that function as “mail” or “messengers” between cells conveying different biologicalinformation. We isolated and studied exosomes from placental explant cultures. We foundthat they carry NKG2D ligands on their surface and are able to bind and down-regulate thecognate receptor on NK-, CD8+ and <img src="http://www.diva-portal.org/cgi-bin/mimetex.cgi?%5Cgamma" /><img src="http://www.diva-portal.org/cgi-bin/mimetex.cgi?%5Cdelta" />T cells. The down-regulation selectively causedimpairment of the cytotoxic response of the cells but did not affect their lytic ability asmeasured by perforin content and gene transcription. Thus, the NKG2D ligand-bearingexosomes suppress the cytotoxic activity of the cells in the vicinity of the placenta, leavingtheir cytolytic machinery intact, ready to function when the cognate receptor isrestored/recycled. These findings highlight the role of placental exosomes in the fetalmaternalimmune escape and support the view of placenta as an unique immunomodulatoryorgan. Next, we studied the expression and exosomal release of NKG2D ligands by tumor cellsusing the leukemia cell lines Jurkat and Raji as a tumor model. We found that NKG2Dligand-bearing exosomes with similar immunosuppressive properties as placental exosomesare constitutively secreted by the tumor cells, as a mechanism to blunt the cytotoxicresponse of the immune cells and thus protect themselves from cytotoxic attack by the host.Interestingly, we found that thermal- and oxidative stress up-regulates the exosomesecretion and the amount of exosome-secreted NKG2D ligands. Our results imply thattumor therapies that cause stress-induced damage, such as thermotherapy and stripping ofoxygen supply to the tumor, might have a previously unrecognized side effect causingenhanced exosome production and secretion, which in turn suppresses the natural antitumorimmune response and thus should be taken into account when designing an optimaltherapy of cancer patients. In conclusion, we describe a novel stress-inducible mechanism shared by placenta andtumors as an immune escape strategy. We found that placenta- and tumor-derived NKG2Dligand-bearing exosomes can suppress immune responses to promote the survival and wellbeing of the fetus or the tumor. Our work comprises an important contribution to theelucidation of the NKG2D ligand-receptor system and its mode of operation in the humanbody and opens new perspectives for designing novel therapies for infertility and cancer.

Made available in DSpace on 2016-08-15T20:31:21Z (GMT). No. of bitstreams: 1 FerdinandoVFB_DISSERT.pdf: 10097957 bytes, checksum: aaf72cc9003c689e5792192fd220aef8 (MD5) Previous issue date: 2014-02-28 / Conselho Nacional de Desenvolvimento Científico e Tecnológico / The subplacenta is considered an ideal model for comparative studies of trophoblastic processes in humans. Thus, the aim of this study was made a morphological description of the development of the Spix s yellow-toothed cavy. To do this, 12 females were distributed in three groups in a proportion of 1 male to 4 females, kept in pickets of 5m2. Thereafter, vaginal cytology examinations were made daily, to verify if the females were copulated and to separate them from the other females. Then, the collection of subplacentas was made in the 15, 23, 30, 45, 53 and 55 days of gestation, by slaughtering the pregnant females using a specific anesthesic protocol. The samples were processed to standard histological techniques, cytochemistry and immunohistochemistry, and to transmission electronic microscopy. In the 15th day of gestation, the subplacenta was formed by a single cytotrophoblastic layer surrounded by a vacuolized syncytium with maternal lacunae which presented invasive characteristic in the portions apart of the cytotrophoblastic layer. In the 23th day of gestation, the subplacenta did not presented a well-defined shape, however, it was organized in lobules composed of predominantly of cytotrophoblast e its syncytium was related to the regions where maternal lacunae previously appeared. In the 30th day of gestation, the subplacenta appeared as a compact organ with a well-defined shape and with an evident mesenchymal capilarization; the lobules was composed by syncytiotrophoblast in the centre, and by a mesenchyme surrounded by cytotrophoblast. From the 45th day of gestation, the degeneration of the subplacental tissue was evident and the syncytiotrophoblast was more abundant than the cytotrophoblast; moreover, the syncytium was markedly vacuolized and presented signs of cellular death. Near to gestation term (53-54thday), the subplacenta was in an advanced degeneration stage, with evident signs of cellular death and reduction of subplacental tissue. The presence of fetal circulation was characteristic from the 23th day of gestation, evidenced by the positive reaction to vimentin; positive reaction to cytokeratin was observed during entire gestation. The proliferative activity of the subplacenta was assessed by PCNA and AgNOR procedures, and demonstrated to be higher in the beginning of the gestational period, decreasing progressively during the gestation. Ultrastructurally, the subplacenta presented cellular and syncytial trophoblastic characteristics. The development of the Spix s yellow-toothed cavy subplacenta starts around the 15th day of gestation, reaching maximum development in the 30th day and becomes necrotic in the end of gestation. Moreover, it presented an organization and structure similar to the subplacenta of other cavidae / A subplacenta é considerada um modelo ideal para o estudo comparativo dos processos trofoblásticos em humanos. Dessa maneira objetivou-se descrever morfologicamente o desenvolvimento da subplacenta no preá. Para isto foram utilizadas 12 fêmeas desta espécie que foram distribuídas em três grupos numa relação de um macho para quatro fêmeas, mantidos em boxes de 5m2. Após formação dos grupos, exames de citologia vaginal eram realizados diariamente, para verificação da cópula, separando-se dos grupos as fêmeas que eram cobertas. A partir da ocorrência da cópula programaram-se as coletas das subplacentas nos dias 15, 23, 30, 45, 53, e 55 da gestação e estas foram realizadas mediante sacrifício das fêmeas gestantes com a utilização de protocolo anestésico específico. O material, então, era processado segundo técnicas para histologia convencional, citoquímica, imunohistoquímica e microscopia eletrônica de transmissão. No 15° dia de gestação observou-se que a subplacenta era constituída por uma monocamada citotrofoblástica envolta por sincício que apresentava vacúolos e lacunas maternas e que ao se afastar da camada de citotrofoblasto apresentava características invasivas. Aos 23 dias de gestação a subplacenta apresentou-se ainda sem uma forma característica definida, porém, mostrava uma conformação em lóbulos compostos predominantemente por citotrofoblasto e seu sincício esteve relacionado com as regiões onde apareciam as lacunas de origem materna. Aos 30 dias de gestação a subplacenta mostrou-se como um órgão compacto de forma definida e com a capilarização do mesênquima bastante evidente, os lóbulos eram constituídos por citotrofoblasto que envolvia o mesênquima e em seu centro possuía sinciciotrofoblasto. A partir dos 45 dias de gestação a degeneração do tecido subplacentário era evidente e a quantidade de sinciciotrofoblasto supera a de citotrofoblasto, alem disto o sincício apresenta uma grande quantidade de vacúolos e sinais de morte celular podiam ser visualizados. Aproximando-se ao termo da gestação (53 e 55 dias) a subplacenta encontrava-se em avançada degeneração e os sinais de morte celular assim como a diminuição de seu tecido eram evidentes. A presença da circulação fetal foi característica a partir do 23° dia de gestação podendo ser destacada pela reação positiva a vimentina, e a reação a citoqueratina foi positiva durante toda a gestação especialmente no citotrofoblasto. A atividade proliferativa do tecido subplacentário, avaliada pelas técnicas de PCNA e AgNOR, demonstrou ser maior no inicio da gestação e decair com o avançar desta. Ultraestruturalmente evidenciou-se as características do trofoblasto celular e sincicial. O desenvolvimento da subplacenta do preá inicia-se por volta do 15° dia de gestação, tem seu auge aos 30 dias e a termo é necrótica. Além disto, é muito semelhante a subplacenta de outros cavídeos, quanto a sua organização e estrutura

The mammalian pregnancy comprises a challenge to the maternal immune system since the fetus is semi-allogeneic and could thus be rejected. Pregnancy success is associated with the placenta that is not only essential for oxygen supply, nourishment and pregnancy hormones but also plays a role in the protection of the fetus against maternal immunologic attack. The aim of the current studies was to elucidate the role of human placenta as an immunomodulatory organ with a special focus on placental exosomes as vehicles for establishment of maternal tolerance to the fetus. We discovered that the syncytiotrophoblast in human normal pregnancy constitutively produces and secretes exosomes. Exosomes are 30-100 nanometer-sized membrane vesicles of endosomal origin that convey intercellular communication. Exosomes are produced and released through the endosomal compartment and reflect the type and the activation state of the cells that produce and secrete them. They carry cytosolic and membrane-bound proteins and nucleic acids and can influence and re-program recipient cells. Depending on their interactions with cells of the immune system they can be divided into immunostimulatory or immunosuppressive. We developed methods for isolation and culture of trophoblast and placental explants from human normal first trimester pregnancy and isolated exosomes from the culture supernatants.  These exosomes were characterized biochemically and functionally regarding mechanisms with potential importance in the establishment of maternal tolerance towards the fetus. The following aspects were studied: 1) exosomal modulation of the NKG2D receptor-ligand system, a major cytotoxic pathway for NK- and cytotoxic T cells and thus potentially dangerous to the fetus; 2) placental exosome-mediated apoptosis of activated immune effector cells; and 3) Foxp3-expressing T regulatory cells in human pregnant uterine mucosa, the decidua. Using immuno electron microscopy we show that human early syncytiotrophoblast constitutively expresses the stress-inducible NKG2D ligands MICA/B and ULBP1-5, and the apoptosis inducing molecules FasL and TRAIL. While MICA/B were expressed both on the cell surface and intracellularly on the limiting membrane of multivesicular bodies (MVB) and on exosomes, the ULBP1-5, FasL and TRAIL  were solely  processed through the MVB of the endosomal compartment and secreted on exosomes. The NKG2D ligand-expressing placental exosomes were able to internalize the cognate receptor from the cell surface of activated NK- and T cells thus down regulating their cytotoxic function. In our studies of apoptosis we found that placental exosomes carry the proapoptotic ligands FasL and TRAIL in their active form as a hexameric complex of two homotrimeric molecules, required for triggering of the apoptotic signaling pathways. This finding was supported by the ability of isolated placental FasL/TRAIL expressing exosomes to induce apoptosis in activated peripheral blood mononuclear cells (PBMC) and Jurkat T cells. Additionally, we studied Foxp3-expressing T regulatory (Treg) cells in paired human decidual and blood samples from pregnant women compared to non-pregnant controls. The CD4+CD25+Foxp3+ Treg cells were 10 fold enriched in the decidual mucosa compared to peripheral blood of pregnant women and non-pregnant controls. We discovered a pool of Foxp3-expressing, CD4+CD25- cells in human decidua, a phenotype consistent with naïve/precursor Foxp3+ Treg cells. These results suggest local enrichment of Treg cells in decidua of normal pregnancy. Furthermore, we have results indicating that the exosomes, isolated from placental explant cultures, carry PD-L1 and TGFβ on their surface, molecules known to promote induction of Treg cells. Taken together, our results provide evidence that placental exosomes are immunosuppressive and underline their role in the maternal immune modulation during pregnancy. The constitutive production and secretion of immunosuppressive placental exosomes create a protective exosomal gradient in the blood surrounding the feto-placental unit. This “cloud of immunosuppressive exosomes” conveys immunologic privilege to the developing fetus and thus contributes to the solution of the immunological challenge of mammalian pregnancy.

The outer surface of the human placenta, the syncytiotrophoblast, results from the fusion of many cytotrophoblast cells such that many nuclei are contained in this layer. It is possible for these nuclei to cluster forming syncytial nuclear aggregates (SNAs). SNAs have been linked to pathology with increased numbers and earlier formation of SNAs in preeclampsia and fetal growth restriction (FGR). SNAs can be grouped into subtypes including bridges, knots and sprouts, dependent on morphology and attachment to surrounding placental villi. Little is known about SNA formation, but the pyknotic appearance of nuclei within SNAs has led to development of a hypothesis that SNAs are the terminal point of nuclear turnover in the syncytiotrophoblast. Some cytoskeletal proteins have been associated with SNAs indicating their potential involvement in SNA formation. This project aimed to uncover differences between SNA subtypes, whether the degenerate nuclear morphology represents apoptosis and to understand which mechanisms drive nuclear collection into SNAs. Experimental approaches included a review of an electron micrograph archive and application of immunohistochemical techniques to ex vivo placental tissue. A long-term explant model was developed to examine SNA development in vitro; these experiments were further explored using an isolated primary cytotrophoblast model. Nuclei within SNAs were more frequently pyknotic and less frequently eukaryotic than nuclei dispersed in the syncytiotrophoblast. However, few SNAs were positive for the cytokeratin-M30 neoepitope, a caspase dependent breakdown product of cytokeratin-18 and no subtype of SNA showed greater M30 staining than general areas of syncytiotrophoblast. There were increased syncytial knots and decreased syncytial bridges in placentas from women with preeclampsia compared to controls and FGR. While cytoskeletal proteins are seen surrounding SNAs, inhibition of actin and tubulin had no effect on SNA turnover or stability. Very limited nuclear movement was recorded from in vitro culture indicating that syncytiotrophoblast nuclei move far less than had been expected. These data suggest that cell death was not prominent within SNAs but different prevalence of subtypes were present in preeclampsia indicating that SNAs might represent larger changes in placenta structure. As nuclei moved less and SNAs were more static than expected it is suggests that SNAs are more stable than previously thought. Overall, the hypothesis that SNAs are highly active in preeclampsia is questioned and new hypotheses of the role of SNAs are considered in the light of these experimental findings, including whether they form by chance and represent changes in cell turnover of the syncytiotrophoblast.

La placentation humaine est de type hémomonochoriale, le sang maternel est directement en contact avec le syncytiotrophoblaste. Les flux sanguins maternels, dans la chambre intervilleuse, exercent des forces mécaniques de cisaillement (shear stress) sur la surface microvillositaire du syncytiotrophoblaste. Les effets physiologiques du shear stress exercé par les flux sanguins sur l’endothélium vasculaire artériel et veineux ont fait l’objet de nombreux travaux scientifiques. En revanche, les effets biologiques du shear stress sur le syncytiotrophoblaste humain n’ont jamais été explorés. L’objectif de ce travail était premièrement d’évaluer les valeurs du shear stress exercé in vivo sur le syncytiotrophoblaste humain au cours des grossesses normales, puis de mettre au point un modèle de culture primaire dynamique afin de reproduire les conditions physiologique et d’étudier in vitro la réponse biologique du syncytiotrophoblaste au shear stress. En dépit d’un débit sanguin maternel intraplacentaire important, estimé entre 400 et 600 mL.min-1, le shear stress moyen exercée par le syncytiotrophoblaste est estimée entre 0.5±0.2 et 2.3±1.1 dyn.cm-2. Nos résultats montrent cependant que l’intensité du shear stress est très hétérogène tant à l’échelle de la chambre intervilleuse que de la villosité terminale. Nous avons développé un modèle de culture cellulaire dynamique en condition de flux adapté au syncytiotrophoblaste humain. Ce modèle permet d’appliquer un shear stress égal et constant sur toutes les cellules cultivées et reproductible à chaque culture primaire. Aux gammes de shear stress étudiées (1 dyn.cm-2), nous n’avons pas mis en évidence de diminution de la viabilité cellulaire ni de déclenchement des processus précoces d’apoptose en conditions dynamiques comparativement aux conditions statiques. Deux types de chambre de perfusion permettent d’étudier des réponses cellulaires au shear stress à court et long terme selon des temps d’exposition allant de 5 minutes à 24 heures. Ce modèle expérimental a permis de montrer que le syncytiotrophoblaste humain en culture primaire est mécanosensible. La réponse cellulaire à des niveaux de shear stress de 1 dyn.cm-2 est multiple selon les temps d’exposition et le niveau d’intégration étudié. Après 45 minutes de shear stress les taux d’AMP cyclique intracellulaires sont augmentés ce qui a pour effet d’activer la voie de signalisation intracellulaire PKA-CREB. Cette augmentation d’AMP cyclique est secondaire à la synthèse et la libération de prostaglandine E2 qui, par une boucle de régulation autocrine stimule l’adenylate cyclase. L’augmentation de la synthèse/libération de PGE2 est dépendante de l’augmentation rapide du calcium intracellulaire sous shear stress. L’exposition au shear stress de 24 heures stimule l’expression et la sécrétion du PlGF, un facteur de croissance indispensable à l’angiogenèse placentaire et pour l’adaptation maternelle à la grossesse sur le plan vasculaire. Nos travaux montrent que l’augmentation de l’AMPc intracellulaire et l’activation de la PKA contribuent à la phosphorylation de CREB, facteur de transcription régulant l’expression du PlGF. / Human placentation is hemomonochorial, maternal blood circulates in direct contact with the syncytiotrophoblast. In the intervillous space, the maternal blood exerts frictional mechanical forces (shear stress) on the microvillous surface of the syncytiotrophoblast. Flowing blood constantly exerts a shear stress, on the endothelial cells lining blood vessel walls, and the endothelial cells respond to shear stress by changing their morphology, function, and gene expression. The effects of shear stress on the human syncytiotrophoblast and its biological functions have never been studied. The objectives of this study were (1) to determine in silico the physiological values of shear stress exerted on human syncytiotrophoblast during normal pregnancies, (2) to develop a model reproducing in vitro the shear stress on human syncytiotrophoblast and (3) to study in vitro the biological response of human syncytiotrophoblast to shear stress. The 2D numerical simulations showed that the shear stress applied to the syncytiotrophoblast is highly heterogeneous in the intervillous space. In spite of high intraplacental maternal blood flow rates (400-600mL.min-1), the estimated average values of shear stress are relatively low (0.5±0.2 to 2.3±1.1 dyn.cm-2). To study the shear stress-induced cellular responses during exposure times ranging from 5 minutes to 24 hours we have developed two dynamic cell culture models adapted to the human syncytiotrophoblast. We found no evidence of decreased cell viability or early processes of apoptosis in dynamic conditions (1 dyn.cm-2, 24h) compared to static conditions. Shear stress (1 dyn.cm-2) triggers intracellular calcium flux, which increases the synthesis and release of PGE2. The enhanced intracellular cAMP in FSS conditions was blocked by COX1/COX2 inhibitors, suggesting that the increase in PGE2 production could activate the cAMP/PKA pathway in an autocrine/paracrine fashion. FSS activates the cAMP/PKA pathway leading to upregulation of PlGF in human STB. Shear stress-induced phosphorylation of CREB and upregulation of PlGF were prevented by inhibition of PKA with H89 (3 μM). The syncytiotrophoblast of the human placenta is a mechanosenstive tissue.