Centre for Reproductive Health, Hudson Institute of Medical Research, Clayton, VIC, Australia.
Implantation and Pregnancy Research Laboratory, School of Health and Biomedical Sciences, RMIT University, VIC, Australia.
Hum Reprod. 2021 Apr 20;36(5):1353-1366. doi: 10.1093/humrep/deab032.
STUDY QUESTION: How is endometrial epithelial receptivity, particularly adhesiveness, regulated at the luminal epithelial surface for embryo implantation in the human? SUMMARY ANSWER: Podocalyxin (PCX), a transmembrane protein, was identified as a key negative regulator of endometrial epithelial receptivity; specific downregulation of PCX in the luminal epithelium in the mid-secretory phase, likely mediated by progesterone, may act as a critical step in converting endometrial surface from a non-receptive to an implantation-permitting state. WHAT IS KNOWN ALREADY: The human endometrium must undergo major molecular and cellular changes to transform from a non-receptive to a receptive state to accommodate embryo implantation. However, the fundamental mechanisms governing receptivity, particularly at the luminal surface where the embryo first interacts with, are not well understood. A widely held view is that upregulation of adhesion-promoting molecules is important, but the details are not well characterized. STUDY DESIGN, SIZE, DURATION: This study first aimed to identify novel adhesion-related membrane proteins with potential roles in receptivity in primary human endometrial epithelial cells (HEECs). Further experiments were then conducted to determine candidates' in vivo expression pattern in the human endometrium across the menstrual cycle, regulation by progesterone using cell culture, and functional importance in receptivity using in vitro human embryo attachment and invasion models. PARTICIPANTS/MATERIALS, SETTING, METHODS: Primary HEECs (n = 9) were isolated from the proliferative phase endometrial tissue, combined into three pools, subjected to plasma membrane protein enrichment by ultracentrifugation followed by proteomics analysis, which led to the discovery of PCX as a novel candidate of interest. Immunohistochemical analysis determined the in vivo expression pattern and cellular localization of PCX in the human endometrium across the menstrual cycle (n = 23). To investigate whether PCX is regulated by progesterone, the master driver of endometrial differentiation, primary HEECs were treated in culture with estradiol and progesterone and analyzed by RT-PCR (n = 5) and western blot (n = 4). To demonstrate that PCX acts as a negative regulator of receptivity, PCX was overexpressed in Ishikawa cells (a receptive line) and the impact on receptivity was determined using in vitro attachment (n = 3-5) and invasion models (n = 4-6), in which an Ishikawa monolayer mimicked the endometrial surface and primary human trophoblast spheroids mimicked embryos. Mann-Whitney U-test and ANOVA analyses established statistical significance at *P ≤ 0.05 and **P ≤ 0.01. MAIN RESULTS AND THE ROLE OF CHANCE: PCX was expressed on the apical surface of all epithelial and endothelial cells in the non-receptive endometrium, but selectively downregulated in the luminal epithelium from the mid-secretory phase coinciding with the establishment of receptivity. Progesterone was confirmed to be able to suppress PCX in primary HEECs, suggesting this hormone likely mediates the downregulation of luminal PCX in vivo for receptivity. Overexpression of PCX in Ishikawa monolayer inhibited not only the attachment but also the penetration of human embryo surrogates, demonstrating that PCX acts as an important negative regulator of epithelial receptivity for implantation. LIMITATIONS, REASONS FOR CAUTION: Primary HEECs isolated from the human endometrial tissue contained a mixture of luminal and glandular epithelial cells, as further purification into subtypes was not possible due to the lack of specific markers. Future study would need to investigate how progesterone differentially regulates PCX in endometrial epithelial subtypes. In addition, this study used primary human trophoblast spheroids as human embryo mimics and Ishikawa as endometrial epithelial cells in functional models, future studies with human blastocysts and primary epithelial cells would further validate the findings. WIDER IMPLICATIONS OF THE FINDINGS: The findings of this study add important new knowledge to the understanding of human endometrial remodeling for receptivity. The identification of PCX as a negative regulator of epithelial receptivity and the knowledge that its specific downregulation in the luminal epithelium coincides with receptivity development may provide new avenues to assess endometrial receptivity and individualize endometrial preparation protocols in assisted reproductive technology (ART). The study also discovered PCX as progesterone target in HEECs, identifying a potentially useful functional biomarker to monitor progesterone action, such as in the optimization of progesterone type/dose/route of administration for luteal support. STUDY FUNDING/COMPETING INTEREST(S): Study funding was obtained from ESHRE, Monash IVF and NHMRC. LR reports potential conflict of interests (received grants from Ferring Australia; personal fees from Monash IVF Group and Ferring Australia; and non-financial support from Merck Serono, MSD, and Guerbet outside the submitted work. LR is also a minority shareholder and the Group Medical Director for Monash IVF Group, a provider of fertility preservation services). The remaining authors have no potential conflict of interest to declare. TRIAL REGISTRATION NUMBER: NA.
研究问题:人类子宫内膜上皮细胞的接受性,特别是黏附性,是如何在腔上皮表面受到调节以利于胚胎着床的?
总结答案:足细胞蛋白(PCX)是一种跨膜蛋白,被鉴定为子宫内膜上皮接受性的关键负调控因子;孕激素可能介导的腔上皮中 PCX 的特异性下调,可能是将子宫内膜表面从非接受状态转化为允许着床状态的关键步骤。
已知情况:人类子宫内膜必须发生重大的分子和细胞变化,才能从非接受状态转变为接受状态以适应胚胎着床。然而,控制接受性的基本机制,特别是在胚胎首先与之相互作用的腔表面,尚不清楚。一种广泛持有的观点是,促进黏附的分子的上调很重要,但细节尚不清楚。
研究设计、规模、持续时间:本研究首先旨在鉴定在原代人子宫内膜上皮细胞(HEEC)中具有潜在接受性作用的新型黏附相关膜蛋白。然后进行进一步的实验,以确定候选物在人类子宫内膜周期中的体内表达模式,用细胞培养法检测孕激素的调节作用,以及在体外人胚胎附着和侵袭模型中检测功能重要性。
参与者/材料、设置、方法:从增生期子宫内膜组织中分离出原代 HEEC(n=9),将其合并为三组,通过超速离心进行质膜蛋白富集,随后进行蛋白质组学分析,从而发现 PCX 作为一种新的候选物。免疫组织化学分析确定了 PCX 在人类子宫内膜周期中的体内表达模式和细胞定位(n=23)。为了研究 PCX 是否受孕激素调节,孕激素是子宫内膜分化的主要驱动因素,用雌二醇和孕激素处理原代 HEEC 进行培养,并通过 RT-PCR(n=5)和 Western blot(n=4)进行分析。为了证明 PCX 作为接受性的负调节剂,在 Ishikawa 细胞(接受性系)中过表达 PCX,并通过体外附着(n=3-5)和侵袭模型(n=4-6)来确定对接受性的影响,其中 Ishikawa 单层模拟子宫内膜表面,原代人滋养层球体模拟胚胎。使用曼-惠特尼 U 检验和方差分析确定了统计学意义,*P≤0.05 和 **P≤0.01。
主要结果和机会的作用:PCX 在非接受性子宫内膜的所有上皮细胞和内皮细胞的顶膜表面表达,但从中期分泌期开始,腔上皮中选择性下调,此时接受性建立。孕激素被证实能够抑制原代 HEEC 中的 PCX,表明这种激素可能介导体内腔上皮中 PCX 的下调,以利于接受性。在 Ishikawa 单层中过表达 PCX 不仅抑制了人类胚胎替代物的附着,也抑制了它们的穿透,表明 PCX 作为上皮接受性的重要负调节剂,有利于胚胎着床。
局限性、谨慎的原因:从人子宫内膜组织中分离出的原代 HEEC 包含腔和腺上皮细胞的混合物,由于缺乏特异性标记物,因此无法进一步分离成亚型。未来的研究需要研究孕激素如何在子宫内膜上皮亚型中差异调节 PCX。此外,本研究使用原代人滋养层球体作为人类胚胎模拟物,在功能模型中使用 Ishikawa 作为子宫内膜上皮细胞,未来的研究使用人类胚泡和原代上皮细胞将进一步验证这些发现。
研究结果对人类子宫内膜接受性重塑的理解增加了重要的新知识。发现 PCX 作为上皮接受性的负调节剂,以及其在腔上皮中的特异性下调与接受性发展相吻合,这可能为评估子宫内膜接受性和个体化辅助生殖技术(ART)中的子宫内膜准备方案提供新途径。该研究还发现 PCX 是 HEEC 中孕激素的靶标,为监测孕激素作用提供了一个潜在有用的功能生物标志物,例如优化黄体支持的孕激素类型/剂量/给药途径。
研究资助/利益冲突:研究资金来自 ESHRE、Monash IVF 和 NHMRC。LR 报告潜在的利益冲突(从 Ferring Australia 获得赠款;从 Monash IVF Group 和 Ferring Australia 获得个人酬金;为 Merck Serono、MSD 和 Guerbet 提供非财务支持,这些均在提交的工作之外)。LR 也是 Monash IVF Group 的少数股东和集团医疗主任,Monash IVF Group 是生育力保存服务的提供者。其余作者没有潜在的利益冲突需要声明。
试验注册编号:无。
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