title: Aberrations of early trophoblast differentiation predispose to pregnancy failure: lessons from the anti-phospholipid syndrome.
abstract: OBJECTIVE
  The epithelium of the human placenta comprises an inner cytotrophoblast (CT) which proliferates and fuses with the outer differentiated syncytiotrophoblast (ST). Turnover has been studied focussing on second and third trimester placentas but with a paucity of data describing the normal first trimester trophoblast. The aim of this study was to compare the nuclear CT:ST ratio in normal and pathological pregnancy and thus establish the relationship between cytotrophoblast and syncytiotrophoblast nuclear number during early gestation.
  
  
  METHODS
  Archival first trimester material from placentas from healthy pregnancy and recurrent miscarriage (anti-phospholipid syndrome) was stained with H&E, cytokeratin-7 and Mib-1. The area of trophoblast as a fraction of total villous area was calculated and the number of sectioned cytotrophoblast and syncytiotrophoblast nuclei as well as the number of proliferating cytotrophoblast was evaluated.
  
  
  RESULTS
  Normal features of trophoblast development during the first trimester (rise in trophoblast area, increase in number of syncytiotrophoblast nuclei, increase in number of proliferating cytotrophoblast, decrease in the nuclear CT:ST ratio) are absent/reversed in tissues from recurrent miscarriage (decreasing trophoblast area, constant number of syncytiotrophoblast nuclei, decreasing number of proliferating trophoblast, constant nuclear CT:ST ratio).
  
  
  CONCLUSIONS
  Proliferation of cytotrophoblast in early gestation provides a pool of trophoblast stem cells critical for ongoing placental development. Premature cytotrophoblast differentiation in favour of syncytial fusion results in deficiencies of cytotrophoblast and rarification of villous trophoblast. Abnormal trophoblast differentiation in early gestation may be due to a premature onset of maternal perfusion of the placenta and may be a likely antecedent for conditions associated with failure of placentation such as recurrent miscarriage.
authors.affiliation: Department of Anatomy II, University Hospital RWTH Aachen, Wendlingweg 2, Aachen 52057, Germany.
authors.forename: P
authors.initials: P
authors.lastname: Bose
authors.forename: M
authors.initials: M
authors.lastname: Kadyrov
authors.forename: R
authors.initials: R
authors.lastname: Goldin
authors.forename: S
authors.initials: S
authors.lastname: Hahn
authors.forename: M
authors.initials: M
authors.lastname: Backos
authors.forename: L
authors.initials: L
authors.lastname: Regan
authors.forename: B
authors.initials: B
authors.lastname: Huppertz
mesh_terms: D000026:Abortion, Habitual / Q000209:etiology / Q000473:pathology*; D000328:Adult; D016736:Antiphospholipid Syndrome / Q000150:complications*; D002454:Cell Differentiation; D002467:Cell Nucleus / Q000648:ultrastructure; D049109:Cell Proliferation; D005260:Female; D006801:Humans; D053552:Keratin-7; D007633:Keratins / Q000032:analysis; D019394:Ki-67 Antigen / Q000032:analysis; D011247:Pregnancy; D011264:Pregnancy Trimesters; D014327:Trophoblasts / Q000737:chemistry / Q000473:pathology* / Q000648:ultrastructure
chemical_list: C507497:KRT7 protein, human; D053552:Keratin-7; D019394:Ki-67 Antigen; D007633:Keratins