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Article| Volume 21, ISSUE 6, P783-793, December 2010

Side population cells in the human decidua of early pregnancy exhibit stem/progenitor cell-like characteristics

Published:August 02, 2010DOI:https://doi.org/10.1016/j.rbmo.2010.07.010

      Abstract

      It is proposed that human decidua contains a population of stem cells that are responsible for the proliferation ability during the process of embryo implantation and placenta formation and that factors in the crosstalk between the decidua and chorion may mediate decidual stem cell differentiation. This study analysed the phenotype of side population (SP) cells and investigated the clonogenicity and differentiation ability of SP cells in human decidua of early pregnancy. Serum-free culture-conditioned media of human decidua and chorion were obtained from decidua and chorion explant culture. Decidual SP cells were isolated by fluorescence-activated cell sorting. Different inducing media were added and the functional differentiation of decidual SP cells was examined. Decidual SP cells were negative for the mature decidual cell marker CD13 and prolactin and negative for CD34 and CD45 expression. Decidual SP cells formed clones after culture in colony-forming medium and they could form clones again. Differentiated cells expressing CD13 and prolactin were observed and stroma-like structures expressing CD13 were obtained. These results indicate that decidual SP cells are enriched for stem cell activity. Oestradiol, progesterone and factors in culture-conditioned media of human decidua and chorion induced their proliferation and differentiation.
      The key point for successful pregnancy is when the embryo been accepted by the uterus of the mother, for which decidua formation and embryo development are involved. The decidua is the uterine lining (endometrium) during a pregnancy and the chorion is one of the membranes that exists between the developing fetus and mother. Poor development of the decidua can cause disease such as infertility. Stem cells are characterized by the ability to self-renew and the ability of daughter cells to differentiate into more specialist mature cells. An adult stem cell subpopulation (side population cells, SP cells) has been identified. It has been confirmed that the human endometrium contains stem cells that are responsible for its remarkable regeneration ability. Our previous study has already demonstrated that SP cells are present in decidua. The decidua and the chorion secrete factors important for maintenance of pregnancy. However, whether these factors can induce the differentiation of decidual SP cells remains unknown. In this study, we isolated and analysed the cell markers of SP cells in the human decidua of early pregnancy. To imitate the environment in vivo, we collected media after culture of the decidua or the chorion. After treatment with the media, decidual SP cells were studied for cell differentiation. Functional differentiation of decidual SP cells was observed and stroma-like structures were obtained. These results indicate that decidual SP cells are enriched for stem cell activity. Factors in culture-conditioned media from human decidua and chorion can induce SP cell proliferation and differentiation.

      Keywords

      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 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 (
      • McLennan C.E.
      • Rydell A.H.
      Extent of endometrial shedding during normal menstruation.
      ). It has been confirmed that the human endometrium contains a population of stem/progenitor cells that is responsible for its remarkable regeneration ability (
      • Padykula A.H.
      Regeneration 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 R.W.
      • Schwab K.E.
      • Gargett C.E.
      Clonogenicity of human endometrial epithelial and stromal cells.
      ,
      • Gargett C.E.
      Identification 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 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 (
      • Challen G.A.
      • Little M.H.
      A side order of stem cells: the SP phenotype.
      ). Some researchers have reported the existence of SP cells in human endometrium that show the characteristics of stem cells (
      • Kato K.
      • Yoshimoto M.
      • Adachi S.
      • et al.
      Characterization of side-population cells in human normal endometrium.
      ,
      • 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 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 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% CO2, 95% O2) 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 A.
      • Ziolkiewicz P.
      • Tessler C.
      • et al.
      Progesterone regulates osteopontin expression in human trophoblasts: a model of paracrine control in the placenta?.
      ,
      • 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 350g 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/cm2 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 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.

      Results

      Surface markers of decidual cells in early human pregnancy

      The expression of E-cadherin, vimentin and PRL in decidual primary cells and cells of first passage were analysed by immunolabelling. The results showed that some of the decidual cells can express vimentin and PRL, while few of them express E-cadherin, indicating that these cells are decidual stromal cells (Figure 1).
      Figure thumbnail gr1
      Figure 1Surface markers of decidual cells of human first-trimester pregnancy for (AD) primary decidual cells and (EH) cells of first passage. (A) Control; (B and F) E-cadherin expression; (C and G) vimentin expression; and (D and H) PRL expression. Bars = 100 μm.

      Phenotype of decidual SP cells in early human pregnancy

      It has been demonstrated that the efficiency of efflux of the dye Hoechst 33342 accounts for the uniquely low fluorescence of the SP population (
      • Goodell M.A.
      • Brose K.
      • Paradis G.
      • et al.
      Isolation and functional properties of murine hematopoietic stem cells that are replicating in vivo.
      ) and this ability was later shown to be due to expression of the ATP-binding cassette (ABC)-dependent transporter ABCG2/Bcrp1 (
      • Zhou S.
      • Schuetz J.D.
      • Bunting K.D.
      The ABC transporter Bcrp1/ABCG2 is expressed in a wide variety of stem cells and is a molecular determinant of the side-population phenotype.
      ). The SP cell population would diminish remarkably because of increased staining by treatment with verapamil, an inhibitor of ABCG2, indicating that this population truly consisted of SP cells. Therefore, SP cells were sorted from decidual cells using Hoechst staining based on the studies by
      • Qu W.W.
      • Huang W.
      • Wang C.X.
      • et al.
      Identification and clonogenicity of side-population cells in human decidua of first trimester pregnancy.
      and
      • Goodell M.A.
      • Brose K.
      • Paradis G.
      • et al.
      Isolation and functional properties of murine hematopoietic stem cells that are replicating in vivo.
      . After addition of verapamil, the percentage of the P3 area decreased from 0.6% to 0.2%, indicating that 0.4% cells were real SP cells (Figure 2A and B). CD34 and CD45, markers of haematopoietic cells, showed negative expression in decidual SP cells (Figure 2C and D), indicating these decidual SP cells were not of haematopoietic origin.
      Figure thumbnail gr2
      Figure 2Sorting of SP cells from decidual cells. Decidual cells were digested and labelled with Hoechst 33342 in the presence or absence of verapamil and at least 1 × 106 cells were analysed by flow cytometry. Populations of decidual cells were separated using a two-window discrimination of red and blue fluorescence emissions along the abscissa and ordinate axis respectively. (A and B) On the fluorescence profile, whole decidual cells could be divided into two distinct major populations (annotated P3 and P4). The SP cells exhibited low Hoechst staining correlating with the fluorescence feature of an active Hoechst efflux (A; 0.6% P3) and disappeared in the presence of verapamil (B; 0.2% P3), therefore the percentage of real SP cells is 0.4%. (C) Phycoerythrin-CD34 (anti-human) and (D) Allophycocyanin-CD45 (anti-human) were added to decidual cells after Hoechst staining, their prevalence in SP cells (C; P2) were analysed (D) Q1 and Q4 represent the percentage of CD34 and CD45 positive cells respectively, and Q2 represents the percentage of both CD34 and CD45 positive cells, while Q3 represents both CD34 and CD45 negative cells. SP cells were mainly detected in Q3 and were negative for both CD34 and CD45.
      PE-CD13 was added to decidual cells after Hoechst 33342 staining (Figure 3A). The percentage of CD13-positive cells in SP cells (Figure 3B) was much lower than in NSP cells (Figure 3C; 8.8% ± 4.13% and 95.46% ± 3.61%, respectively; Figure 3D, three independent repeats), demonstrating that SP cells were immature decidual cells.
      Figure thumbnail gr3
      Figure 3Phycoerythrin-CD13 staining of SP cells and NSP cells after Hoechst sorting. (A) After 48 h of culture in vitro, primary decidual cells were stained with Hoechst 33342 and subsequently PE-CD13 (anti-human); SP-gated and NSP-gated cells are indicated as P2 and P3. (B and C) Percentage of CD13-positive cells from P2 and P3 are indicated as P4 and P5. (D) 8.8% ± 4.13% and 95.46% ± 3.61% of CD13-positive cells were detected in SP cells and NSP cells, respectively. Results are from experiments performed in triplicate.
      In contrast to the large NSP cells, sorted SP cells were visualized as small, round and bright cells under phase-contrast microscopy (Figure 4A and E). The immunophenotype result showed that decidual SP cells were negative for the mature decidual cell marker CD13 (Figure 4F) and PRL (Figure 4H), but were positive for the vimentin (Figure 4G), demonstrating that decidual SP cells may be of mesenchyme origin.
      Figure thumbnail gr4
      Figure 4Immunophenotypes in human decidua of first-trimester pregnancy of (AD) NSP cells and (EH) SP cells. (A and E) Phase-contrast microscopy; (B and F) phycoerythrin (PE)-CD13 staining; (C and G) vimentin staining; and (D and H) NSP cells were positive for prolactin (PRL) staining. Bars = 100 μm (AD), 50 μm (E), 20 μm (FH).

      In-vitro growth and differentiation of decidual SP cells

      The sorted SP cells were seeded at clonal density on cell-culture plates pre-coated with collagen in CFM. Decidual SP cells showed clonogenic growth and formed clusters after at least 21 days of culture (Figure 5A and B). NSP cells in the same condition were used as a control group and showed no clone appearance in long-time culture in vitro.
      Figure thumbnail gr5
      Figure 5Clonogenicity of decidual SP cells in in-vitro culture. (A and B) Clones (arrows) were formed after 21 days of culture in CFM. (C) Formation of clones (arrow) 28 days after digestion and reseeding in CFM. (D) No clones were formed after 21 days of culture in media without IL-6, SCF and TPO. Bars = 100 μm (A), 50 μm (B), 50 μm (C), 100 μm (D).
      To further investigate whether the decidual SP cells were progenitor cells or stem cells, clusters were digested and reseeded in CFM. New clones formed again after another 28 days of culture, although the number of these clones was much less than that of primary culture (Figure 5C). However, without IL-6, SCF and TPO in the medium, clones of decidual SP cells were not formed after 3 weeks of culture (Figure 5D).
      In all media, decidual SP cells grew very slowly in the first week. However, after 2 weeks of incubation, the differentiation speed varied noticeably among groups. The highest cell density was obtained in group VI (50% (CCM + DCM)), then group IV (50% DCM) and group III (50% CCM), group V (10 nM oestradiol and 10 μmol/l progesterone) was the lowest; cells in group I (CFM) formed clones after 3 weeks (Figure 6).
      Figure thumbnail gr6
      Figure 6Growth of decidual SP cells in different conditioned medium (A) at 1 week, (B) at 3 weeks and with (C) prolactin (PRL) staining. PRL-positive cells were found in group II (NSP cells cultured in DMEM/F12 and 10% FBS) and groups III–VI (DMEM/F12 and 10% FBS plus: 50% CCM (group III), 50% DCM (group IV), 10 nmol/l oestradiol and 10 μmol/l progesterone (group V) or 50% (CCM + DCM) (group VI)); stain intensity varied among different groups. Bars = 100 μm (1 and 3 weeks), 50 μm (PRL staining).
      These differentiated cells were stained by PRL and CD13. PRL (Figure 6) and CD13 (Figure 7A, from group IV) were expressed in differentiated cells in groups II–VI after 21 days of culture, though the staining intensity varied among groups. Decidual SP cell clones in group I were negative for PRL and CD13 expression.
      Figure thumbnail gr7
      Figure 7(A) Expression of CD13 in differentiated cells from groups II–VI by fluorescent immunophenotyping. CD13 was expressed in each group. (B) Group IV, from medium with DCM, forming a multilayered structure, which looked like a meshwork and was consistent with characteristics of decidual stromal cells. Prolactin (PRL) was positively expressed. (C and D) When decidual SP cells formed clones after 21 days of culture, they were digested and reseeded in CFM for another 28 days until colonies formed again, then the cells were digested and the medium was replaced by DMEM/F12 and 10% FBS for 20 days: stroma-like tissues were found and CD13 was expressed again. Bars = 20 μm (A, C, D), 50 μm (B).
      The decidual SP cells maintained in medium with DCM (group IV) formed a multilayer structure in the core of the adherent cell layer, with more than 20 cells were aggregated in one of the spindle-like structures, and the whole core had a meshwork appearance consistent with characteristics of decidual stromal cells. PRL expression was detected by immunocytochemistry in the meshwork-like core (Figure 7B).
      If the SP cells were putative stromal stem cells, they could differentiate into stroma-like structures under certain conditions. Indeed, when decidual SP cells formed clones after 21 days of culture, they were digested with trypsin and reseeded on collagen-coated cell culture plates in CFM for another 28 days until colonies formed again. Then the cells were digested and the medium was replaced by DMEM/F12 and 10% FBS; 20 days later, stroma-like tissues were found and CD13 was expressed (Figure 7C and D).

      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 (
      • Challen G.A.
      • Little M.H.
      A side order of stem cells: the SP phenotype.
      ). 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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.

      Acknowledgements

      The authors wish to thank all staff of the study centre’s operation room for their assistance of tissue collection during this study. They thank Wentong Meng and Jilong Gou for technical assistance on flow cytometry and Li Li for her help on immunohistochemistry. The authors are indebted to Mr Xu Wenming for his advice on the manuscript. Author contributions: Chun Guo, Huili Zhu, Wei Huang designed experiment; Chun Guo, Shengfu Li, Wenwen Qu, Yaofang Liu, Aixiang Tan performed experiments; Chun Guo, Huili Zhu, Wei Huang wrote the paper.

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