Camm Emily J, Botting Kimberley J, Sferruzzi-Perri Amanda N
Department of Physiology, Development and Neuroscience and Centre for Trophoblast Research, University of Cambridge, Cambridge, United Kingdom.
Front Physiol. 2018 Jun 26;9:629. doi: 10.3389/fphys.2018.00629. eCollection 2018.
The development of the fetal heart is exquisitely controlled by a multitude of factors, ranging from humoral to mechanical forces. The gatekeeper regulating many of these factors is the placenta, an external fetal organ. As such, resistance within the placental vascular bed has a direct influence on the fetal circulation and therefore, the developing heart. In addition, the placenta serves as the interface between the mother and fetus, controlling substrate exchange and release of hormones into both circulations. The intricate relationship between the placenta and fetal heart is appreciated in instances of clinical placental pathology. Abnormal umbilical cord insertion is associated with congenital heart defects. Likewise, twin-to-twin transfusion syndrome, where monochorionic twins have unequal sharing of their placenta due to inter-twin vascular anastomoses, can result in cardiac remodeling and dysfunction in both fetuses. Moreover, epidemiological studies have suggested a link between placental phenotypic traits and increased risk of cardiovascular disease in adult life. To date, the mechanistic basis of the relationships between the placenta, fetal heart development and later risk of cardiac dysfunction have not been fully elucidated. However, studies using environmental exposures and gene manipulations in experimental animals are providing insights into the pathways involved. Likewise, surgical instrumentation of the maternal and fetal circulations in large animal species has enabled the manipulation of specific humoral and mechanical factors to investigate their roles in fetal cardiac development. This review will focus on such studies and what is known to date about the link between the placenta and heart development.
胎儿心脏的发育受到多种因素的精确控制，这些因素涵盖从体液因素到机械力等多个方面。调节其中许多因素的关键是胎盘，它是一个胎儿外部器官。因此，胎盘血管床内的阻力对胎儿循环有直接影响，进而影响发育中的心脏。此外，胎盘作为母体与胎儿之间的界面，控制着底物交换以及激素向两个循环系统中的释放。胎盘与胎儿心脏之间的复杂关系在临床胎盘病理学案例中得以体现。异常的脐带插入与先天性心脏缺陷有关。同样，双胎输血综合征中，单绒毛膜双胎由于双胎间血管吻合导致胎盘共享不均，可致使两个胎儿出现心脏重塑和功能障碍。此外，流行病学研究表明胎盘表型特征与成年后心血管疾病风险增加之间存在关联。迄今为止，胎盘、胎儿心脏发育以及后期心脏功能障碍风险之间关系的机制基础尚未完全阐明。然而，在实验动物中利用环境暴露和基因操作进行的研究正在为其中涉及的途径提供见解。同样，对大型动物物种的母体和胎儿循环进行手术操作，能够操控特定的体液和机械因素，以研究它们在胎儿心脏发育中的作用。本综述将聚焦于此类研究以及迄今已知的胎盘与心脏发育之间的联系。
