Introduction
The human endometrium is characterized by a constant and rapid process of cell proliferation, differentiation and breakdown as part of each menstrual cycle throughout the reproductive period (
Ferenczy et al., 1979- Ferenczy A.
- Bertrand G.
- Gelfand M.M.
Proliferation kinetics of human endometrium during the normal menstrual cycle.
). After shedding the endometrial lining, the endometrium proliferates dramatically and completely regenerates within 2 weeks (
). It has been confirmed that the human endometrium contains a population of stem/progenitor cells that is responsible for its remarkable regeneration ability (
Padykula, 1991Regeneration in the primate uterus: the role of stem cells.
). Recently, evidence based on stem cell functional assays demonstrated that 0.22 ± 0.07% of endometrial epithelial cells and 1.25 ± 0.18% of stromal cells formed colonies when cultured
in vitro, which confirmed the existence of putative endometrial epithelial and stromal stem cells (
Chan et al., 2004- Chan R.W.
- Schwab K.E.
- Gargett C.E.
Clonogenicity of human endometrial epithelial and stromal cells.
,
Gargett, 2006Identification and characterisation of human endometrial stem/progenitor cells.
).
It is also possible that stem cells in decidua tissues that come from secretory endometrium are responsible for their remarkable regeneration ability. Over the course of pregnancy, the human uterus undergoes a 500–1000-fold increase in volume and a 24-fold increase in weight. The decidua increases noticeably too. The origin of these new decidual cells, however, is unclear. They may arise from cell proliferation of existing decidual cells inside tissues or may result from the transformation of stem cells.
Strakova et al., 2008- Strakova Z.
- Livak M.
- Krezalek M.
- et al.
Multipotent properties of myofibroblast cells derived from human placenta.
reported human uterine fibroblasts isolated from the decidua parietalis to be multipotent, forming colonies when plated at low densities and differentiating into osteoblasts, adipocytes and chondrocytes with differentiation-inducing media. It has been suggested that decidua tissue should contain adult stem cells, which can transform to mature cells in certain conditions, such as pregnancy.
Stem cell subpopulations, known as side population (SP) cells, have been isolated in many mammalian tissues, including human tissues such as bone marrow, liver, skeletal muscle, mammary gland, brain and endometrium using the fluorescent dye Hoechst 33342 efflux phenomenon. In many cases, this cell population has been shown to contain apparently multipotent stem cells (
). Some researchers have reported the existence of SP cells in human endometrium that show the characteristics of stem cells (
Kato et al., 2007- Kato K.
- Yoshimoto M.
- Adachi S.
- et al.
Characterization of side-population cells in human normal endometrium.
,
Tsuji et al., 2008- Tsuji S.
- Yoshimoto M.
- Takahashi K.
- et al.
Side population cells contribute to the genesis of human endometrium.
). A previous study has also demonstrated that SP cells exist in decidual tissues of human early pregnancy and that sorted decidual SP cells can proliferate and form clones gradually within 1 month when cultured on collagen-coated plates in conditioned medium (
Qu et al., 2008- Qu W.W.
- Huang W.
- Wang C.X.
- et al.
Identification and clonogenicity of side-population cells in human decidua of first trimester pregnancy.
). But the phenotype and the differentiation ability of decidual SP cells have not been determined yet.
This study isolated and analysed the phenotype of SP cells in the human decidua of early pregnancy and investigated the clonogenicity and differentiation ability of decidual SP cells with various treatments.
Materials and methods
Human decidua and chorion tissue collection
Decidua and chorion tissues were obtained from 22 pregnant women aged 20–32 years from 6 to 10 weeks of gestation undergoing elective termination of pregnancy. All samples were collected from normal pregnancy without any pregnancy-related disorders or any medicine usage within 3 months. The study was approved by the ethical committee of West China Second University Hospital of Sichuan University and informed consent was obtained from each woman. Collected tissues were put into ice-cold calcium- and magnesium-free Hanks’ balanced salt solution (D-Hank’s) for decidua explant or decidual cell culture.
Decidua-conditioned media and chorion-conditioned media
Decidua and chorion tissues were prepared using a method based on that of
Wright et al., 2006- Wright J.K.
- Dunk C.E.
- Perkins J.E.
- et al.
EGF modulates trophoblast migration through regulation of Connexin 40.
, with minor modifications. Firstly, chorion and decidua tissues were isolated, washed several times in D-Hank’s and carefully dissected to 2 mm pieces, then placed in a six-well plate, approximately 100 mg tissue/well. Decidua and chorion explants were cultured at 37°C (5% CO
2, 95% O
2) for 1 h before adding 3 ml of 1:1 serum-free Dulbecco’s modified Eagle’s media (DMEM) and F12 culture medium (Gibco, USA) supplemented with 100 U/ml penicillin, 100 mg/ml streptomycin, 10 nmol/l oestradiol (Sigma, USA) and 1 μmol/l progesterone (Sigma) (
Omigbodun et al., 1997- Omigbodun A.
- Ziolkiewicz P.
- Tessler C.
- et al.
Progesterone regulates osteopontin expression in human trophoblasts: a model of paracrine control in the placenta?.
,
Popovici et al., 2000- Popovici R.M.
- Kao L.C.
- Giudice L.C.
Discovery of new inducible genes in in vitro decidualized human endometrial stromal cells using microarray technology.
). Cultures were maintained in standard culture conditions for a further 48 h, and then decidua-conditioned media and chorion-conditioned media (DCM and CCM, respectively) were harvested by centrifugation at 350
g for 5 min to separate tissue, filtrated through a 0.22 μm filter and stored at −80°C until use.
Preparation of human decidual cells
Decidual tissue was minced to 1 mm pieces and digested with 1 mg/ml collagenase IV (Sigma, USA) and 0.05% trypsin in serum-free DMEM for 30 min incubation on a rotator at 37°C. Enzymes were inactivated with 10% fetal bovine serum (FBS), cells were collected through a 74 μm mesh filter, then plated in 25 cm2 cell culture flasks at a density of 2 × 106/ml and cultured in 10% FBS DMEM supplemented with 100 μg/ml streptomycin, 100 U/ml penicillin and 0.08 IU/ml insulin.
Flow cytometry for SP cells
Decidual cells maintained for 24–48 h were digested with 0.25% trypsin-EDTA, resuspended in DMEM containing 2% FBS at a density of 1 × 106 cells/ml and incubated with 2.5 μg/ml Hoechst 33342 (Fluka, USA) for 90 min at 37°C. To choose verapamil-sensitive SP cells, another tube of the cells was preincubated with 100 μg/ml verapamil (Shanghai Harvest Pharmaceutical, China) for 10 min before the addition of Hoechst 33342 dye. After incubation, cells were centrifuged at 400g for 5 min, resuspended in ice-cold D-Hank’s containing 2% FBS and strained through a 74 μm mesh and kept at 4°C until analysis. Cells stained with Hoechst 33342 dye were further stained with antibodies CD13, CD34 and CD45 (BD Pharmingen, USA), then analysed or sorted on a cell sorter (FACS Aria I; BD, USA). Emission was at 407 nm (violet laser diode), Hoechst blue and red fluorescence emissions were collected using a combination of 440-nm pass and 675-nm pass filters. Then cells were shown in a Hoechst blue versus Hoechst red dot plot and were analysed with FlowJo software.
Immunocytochemistry and fluorescent immunophenotyping
Cultured cells on cover slips were immunostained for mouse anti-human E-cadherin monoclonal antibody, mouse anti-human vimentin monoclonal antibody and rabbit anti-human prolactin (PRL) polyclonal antibody (all 1:200; Dako). Cultured cells were seeded onto collagen-coated coverslips. After 48 h of culture, decidual cells were fixed in acetone for 15 min at 4°C and endogenous peroxidase activity was quenched in 3% hydrogen peroxide in methanol for 15 min at room temperature. Primary antibodies were applied to the sections in a moist chamber for overnight incubation at 4°C. The secondary antibody for immunostaining was Envision/horseradish peroxidase (anti-mouse, Dako) for E-cadherin and vimentin and Envision/horseradish peroxidase (anti-rabbit, Dako) for PRL, at 37°C for 20 min. Subsequent steps were carried out according to the manufacturer’s instructions. The reaction was visualized using diaminobenzidine, the cover slips were dehydrated through graded alcohols and then mounted using synthetic resin. Negative controls were isotype-matched irrelevant immunoglobulin G (IgG).
For fluorescent immunocytochemistry, cell smears were fixed in 4% paraformaldehyde for 15 min at room temperature, washed in phosphate-buffered saline and permeabilized for 5 min in 0.1% Triton X-100 phosphate-buffered saline. Primary antibodies were incubated overnight at 4°C with fluorescein isothiocyanate (FITC)-conjugated goat anti-mouse or goat anti-rabbit IgG (Zhong shan Golden bridge Biotechnology, China) at a concentration of 1:50 served as the secondary antibody. Cells were counterstained using the nuclear dye (4,6-diamidino-2-phenylindole) (Sigma).
SP cells and non-SP (NSP) cells were stained with phycoerythrin (PE)-CD13 (BD Pharmingen), after Hoechst 33342 sorting, the expression of CD13 in SP cells and NSP cells was obtained and red fluorescence of CD13 positive cells was detected under fluorescence microscope.
Clonogenicity and differentiation of decidual SP cells
To test the clonogenicity of decidual SP cells, the sorted cells were plated at a density of 300 cells/cm
2 on cell culture plates precoated with collagen (Rat tail collagen, type I; BD Pharmingen) in colony-forming medium (CFM), including DMEM containing 10% FBS, 100 ng/ml interleukin (IL)-6, 100 ng/ml stem cell factor (SCF) and 10 ng/ml thrombopoietin (TPO) (all from R and D Systems, USA), as previously described (
Kato et al., 2007- Kato K.
- Yoshimoto M.
- Adachi S.
- et al.
Characterization of side-population cells in human normal endometrium.
). When the cells formed colonies finally, they were digested with 0.25% trypsin-EDTA and reseeded in conditioned medium to investigate whether they had the ability to form colonies again. The cells were then digested again and reseeded in medium of 10% FBS DMEM/F12 for 20 days to determine the ability for natural differentiation.
The sorted cells seeded at the same density were incubated in different media as below in triplicate: group I: sorted SP cells in CFM; group II: sorted NSP cells in the same density in DMEM/F12 and 10% FBS; the other four groups of sorted SP cells cultured in medium containing DMEM/F12 and 10% FBS plus: group III: 50% CCM; group IV: 50% DCM; group V: 10 nmol/l oestradiol + 10 μmol/l progesterone; and group VI: 50% (CCM + DCM). The medium was replaced every 5–7 days.
Discussion
It has been suggested that the human decidua of first-trimester pregnancy contains a population of stem/progenitor cells that are responsible for their remarkable regeneration ability during embryo implantation. The data reported in the present study is a strong argument in support of the existence of decidual stem cells. Stem cells are characterized by the ability of self-renewal and the ability of daughter cells to differentiate into more specific phenotypes. SP cells are stem cell subpopulations identified with the fluorescent dye Hoechst 33342 in many mammals, including humans (
). In 2007, Kato firstly reported the presence of SP cells in the normal human endometrium, which can generate daughter cells, form colonies and form either glandular- or stroma-like structures (
Kato et al., 2007- Kato K.
- Yoshimoto M.
- Adachi S.
- et al.
Characterization of side-population cells in human normal endometrium.
). The current study first isolated these stem-like or progenitor cells, the decidual SP cells, from human decidua and found that they survived and proliferated on cell-culture plates pre-coated with collagen under CFM supplemented with IL-6, TPO and SCF. When the clones formed, they were digested and reseeded in CFM and clones formed again. This result demonstrated the self-renewal property of decidual SP cells, which is fundamental for the stem cells. In support of the current results,
Gargett et al., 2009- Gargett C.
- Schwab K.
- Zillwood R.
- et al.
Isolation and culture of epithelial progenitors and mesenchymal stem cells from human endometrium.
reported that single endometrium stromal or epithelial cells can form colonies and can be further serially cloned more than three times and underwent more than 30 population doublings in a number of consecutive clonings.
Although the exact origin of the decidua cell is still uncertain, decidual cells express CD13, vimentin and PRL, as shown in previous reports (
García-Pacheco et al., 2001- García-Pacheco J.M.
- Oliver C.
- Kimatrai M.
- et al.
Human decidual stromal cells express CD34 and STRO-1 and are related to bone marrow stromal precursors.
,
Imai et al., 1992- Imai K.
- Maeda M.
- Fujiwara H.
- et al.
Human endometrial stromal cells and decidual cells express cluster of differentiation (CD) 13 antigen/aminopeptidase N and CD10 antigen/neutral endopeptidase.
,
Reis et al., 2002- Reis F.M.
- Viganò P.
- Arnaboldi E.
- et al.
Expression of prolactin-releasing peptide and its receptor in the human decidua.
) and the current study. In the meantime, the decidual SP cells are positive for vimentin but negative for CD34 and CD45, indicating they are of non-haematopoietic cell origin.
Li et al., 2005- Li C.D.
- Zhang W.Y.
- Li H.L.
- et al.
Mesenchymal stem cells derived from human placenta suppress allogeneic umbilical cord blood lymphocyte proliferation.
reported that mesenchymal stem cells derived from human placenta express vimentin as well as CD29, CD44, CD105 and CD166 and about 60% of skin-derived mesenchymal stem cells expressed vimentin (
Yang et al., 2005- Yang L.
- Liu X.
- Hui G.
- et al.
Long-term culture and differentiation of skin-derived mesenchymal stem cells.
). Therefore, this study proposed that decidual SP cells may be part of mesenchymal stem cells, though vimentin is not a specific marker of mesenchymal stem cell. In support of this argument,
Gargett et al., 2009- Gargett C.
- Schwab K.
- Zillwood R.
- et al.
Isolation and culture of epithelial progenitors and mesenchymal stem cells from human endometrium.
reported that endometrium stromal clones expressed mesenchymal stem cell markers CD29, CD44, CD73, CD90, CD105, CD140B and CD146 but not endothelial or haemopoietic markers CD31, CD34 and CD45.
Qu et al., 2008- Qu W.W.
- Huang W.
- Wang C.X.
- et al.
Identification and clonogenicity of side-population cells in human decidua of first trimester pregnancy.
reported that 31.4% of decidual cells can express CD44 under fluorescent microscope or flow cytometry, which is thought to be a marker of mesenchymal stem cells. In coincidence with these results,
Dimitrov et al., 2010- Dimitrov R.
- Kyurkchiev D.
- Timeva T.
- et al.
First-trimester human decidua contains a population of mesenchymal stem cells.
have recently reported that human decidua contains a population of multipotent mesenchymal stem cells, which were demonstrated to express CD29, CD73 and CD90. Further detailed and rigorous phenotyping is required to obtain a definitive answer on this point.
CD13, also known as aminopeptidase N and myelomonocytic antigen, is a typical mesenchymal stem cell marker and is expressed in decidual stromal cells as well as endometrial stromal cells (
García-Pacheco et al., 2001- García-Pacheco J.M.
- Oliver C.
- Kimatrai M.
- et al.
Human decidual stromal cells express CD34 and STRO-1 and are related to bone marrow stromal precursors.
). PRL was produced by human endometrial stromal cells undergoing decidualization during the secretory phase of the menstrual cycle. If pregnancy occurs, these decidual cells continue to produce PRL (
Reis et al., 2002- Reis F.M.
- Viganò P.
- Arnaboldi E.
- et al.
Expression of prolactin-releasing peptide and its receptor in the human decidua.
). Therefore, PRL is considered to be a well-characterized marker of endometrial stromal cell differentiation and a well-established end-point of decidualization (
Christian et al., 2001- Christian M.
- Marangos P.
- Mak I.
- et al.
Interferon-gamma modulates prolactin and tissue factor expression in differentiating human endometrial stromal cells.
). This study found that sorted decidual SP cells do not express CD13 and PRL, suggesting that these decidual SP cells represent an immature or undifferentiated population. Interestingly, CD13 and PRL can be further induced in in-vitro culture with different conditioned medium in these decidual SP cells. The expression of CD13 and PRL means that mature and functional decidual cells are derived from the incubation of decidual SP cells
in vitro. In agreement with the current result,
Dimitrov et al., 2010- Dimitrov R.
- Kyurkchiev D.
- Timeva T.
- et al.
First-trimester human decidua contains a population of mesenchymal stem cells.
reported that the stem cells in decidua could be induced to produce PRL in medium added with 10 μmol/l medroxyprogesterone acetate, 10 nmol/l oestradiol, and 0.5 mmol/l 8-bromo-cyclic-adenosine monophosphate too.
In order to explore the contribution of different factors involved in decidual SP cell differentiation, this study used different inducing media in the experimental design: the decidual SP cells were incubated in DCM, CCM, both DCM and CCM or oestradiol and progesterone only. These media were used to attempt to mimic the in-vivo environment. When the SP cells were induced in medium with oestradiol and progesterone only, differentiated cells of varied morphology were obtained. The differentiation speed differed among all groups, the fastest was in DCM and CCM together, the next in DCM, the slowest in medium supplemented with oestradiol and progesterone only. These data support the notion that there exists a molecular dialogue between the decidual SP cells and secreted products from human chorion and/or decidua that induces the differentiation of these decidual SP cells.
Hess et al., 2007- Hess A.P.
- Hamilton A.E.
- Talbi S.
- et al.
Decidual stromal cell response to paracrine signals from the trophoblast: amplification of immune and angiogenic modulators.
found that decidual stromal cell respond to paracrine signals from the trophoblast through the amplification of immune and angiogenic modulators, demonstrating the impact of paracrine signals on decidual stromal cells.
Keskin et al., 2007- Keskin D.B.
- Allan D.S.
- Rybalov B.
- et al.
TGFbeta promotes conversion of CD16+ peripheral blood NK cells into CD16− NK cells with similarities to decidual NK cells.
found that Lin(−) CD34(+) CD45(+) haematopoietic stem/progenitor cells could be isolated from decidual tissue and that these progenitors produced natural killer cells when cultured in conditioned medium from decidual stromal cells supplemented with IL-15 and stem cell factor, supporting the important function of paracrine factors on decidual stem cell differentiation.
The differentiated cells differed in morphology and the stain intensity of PRL varied among groups. This may be because of the progesterone added to medium in each group in order to mimic the endocrine environment
in vivo. Other studies have reported the increase of PRL in endometrium cells in the secretory phase in response to ovarian hormone stimulation. The product of PRL increased significantly after a decidualization stimulus of cAMP plus medroxyprogesterone acetate under in-vitro conditions (
Mak et al., 2002- Mak I.Y.
- Brosens J.J.
- Christian M.
- et al.
Regulated expression of signal transducer and activator of transcription, Stat5, and its enhancement of PRL expression in human endometrial stromal cells in vitro.
). In another in-vitro decidualization model using oestradiol and progesterone, endometrium SP cells were reported to secrete PRL (
Tsuji et al., 2008- Tsuji S.
- Yoshimoto M.
- Takahashi K.
- et al.
Side population cells contribute to the genesis of human endometrium.
). The current study showed that decidual SP cells may respond to progesterone in conjunction with other factors such as cytokines or chemokines in CCM and DCM in the medium in a paracrine manner. To explore the different inducing contribution among groups, other more specific differentiated cell markers could be used in the following-up studies. Of major interest is the identity of the products in conditioned medium that elicit the responses in decidual SP cells.
An adequately developed decidua is important for pregnancy maintenance. If a technique of using stem cells to regenerate or repair the decidua is established, it will be clinically significant for the treatment of pregnancy related disorders. In the current study, the differentiated daughter cells formed colonies and finally formed stroma-like structures expressing CD13. Further studies testing the function of the structures will clarify the similarities and differences in biology between the structure differentiated in vitro and the decidua in vivo.
The origin of the human decidual stromal cells remains unknown. It is so far not clear whether the same population of stromal stem cells is isolated from early decidua or the endometrium. It is reasonable to assume that it is one cell population that is under a different control by hormonal, paracrine and autocrine factors and the fact that stem cells are in different conditions in the internal environment may account for the difference of the results (
Kyurkchiev et al., 2010- Kyurkchiev S.
- Shterev A.
- Dimitrov R.
Assessment of presence and characteristics of multipotent stromal cells in human endometrium and decidua.
). Further detailed studies are needed to clarify the possible origin of the stromal cells in human endometrium and decidua as well as their precise functions in the reproductive process (
Kyurkchiev et al., 2010- Kyurkchiev S.
- Shterev A.
- Dimitrov R.
Assessment of presence and characteristics of multipotent stromal cells in human endometrium and decidua.
). Such knowledge will help us understanding the role of stem cells in the pathogenesis of gynaecological diseases and pregnancy-related disorders associated with abnormal endometrial regeneration and decidual development and may pave the ground for alternative therapy in these diseases.
Article info
Publication history
Published online: August 02, 2010
Accepted:
July 20,
2010
Received in revised form:
July 20,
2010
Received:
December 15,
2009
Declaration: The authors report no financial or commercial conflicts of interest.
Footnotes
Dr Wei Huang received her Masters degree in 1985 and PhD in 1992 from West China Medical University, Chengdu Sichuan, China, and has worked as attending doctor and associate professor there since then. In 2004, she became full professor of obstetrics and gynaecology, becoming involved in teaching, clinical work and basic science. Her research focuses on human decidual stem cells, proliferation and interaction at the maternal–fatal interface, endometriosis and female infertility.
Copyright
© 2010 Reproductive Healthcare Ltd. Published by Elsevier Inc. All rights reserved.