title: Decreased expression of NR4A nuclear receptors in adenomyosis impairs endometrial decidualization.
abstract: How do NR4A receptors drive decidualization of human endometrial stromal cells (hESCs)?
  
  
  
  NR4A receptors modulate endometrial decidualization by transcriptional activation of FOXO1A, and in adenomyosis patients, the reduced expression of NR4A receptors in the eutopic endometrium may represent a novel mechanism to explain impaired decidualization and subfertility.
  
  
  
  A close relationship between impaired decidualization and subfertility has been established. In human endometrial stromal cells, orphan nuclear receptor NR4A is a novel regulator of decidualization.
  
  
  
  Eutopic endometrial tissues and hESCs from fertile controls (n = 56) and adenomyosis patients (n = 27) were collected for in vitro analysis. Primary hESCs isolated from eutopic endometrial tissues were used to evaluate the biological function of NR4A receptors. Adenovirus-mediated overexpression of NR4A and small interfering RNAs targeting NR4A, and FOXO1A were used to investigate the molecular mechanisms. Gene expression regulation was examined by real-time-quantitative PCR, immunostaining, and luciferase reporter assay. Artificial decidualization assay was performed to investigate the role of NR4A1 during decidualization in vivo.
  
  
  
  NR4A modulates the decidualization of hESCs by upregulating prolactin (PRL) and insulin-like growth factor binding protein-1 (IGFBP-1) expression and transformation in vitro. Loss of uterine Nr4a1 results in female subfertility due to impaired decidualization. Mechanistically, NR4A binds to the nerve growth factor 1B (NGFI-B) -responsive element (NBRE) (-843 to -813) within the FOXO1A promoter region and regulates FOXO1A expression. Loss of FOXO1A significantly inhibits PRL and IGFBP-1 expression, as induced by NR4A. Moreover, the expression of NR4A and FOXO1A was lower in adenomyosis endometrial tissues compared to fertile controls, especially in stroma compartments. Ectopic NR4A expression rescued PRL and IGFBP-1 expression in adenomyotic hESCs to near-normal levels. Furthermore, PI3K/AKT signaling pathway involved in inducing NR4A expression under decidualization stimuli in hESCs and the level of p(Ser473)-AKT was significantly higher in stroma in endometrium from patients with adenomyosis.
  
  
  
  This is an in vitro study with a small sample size, utilizing stromal cell cultures from endometrial tissues of adenomyosis patients. Furthermore, results obtained should also be confirmed in a larger data set and with adenomyosis mouse models in vivo.
  
  
  
  Identification of a positive agonist of NR4A receptors will be critical for the improved treatment of patients with conditions of insufficient decidualization-associated infertility, such as adenomyosis and endometriosis.
  
  
  
  N/A.
  
  
  
  This study was supported by the National Natural Science Foundation of China (81170570, G.J.Y. 81370683, G.J.Y. 81501251, Y.J. 31571189, H.X.S. and 81571402, G.J.Y.), and a special grant for clinical medicine science of Jiangsu Province (BL2014003, H.X.S.). The authors have no conflicts of interest to declare.
authors: Reproductive Medicine Center, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing 210008, People's Republic of China.
authors: Yue
authors: Y
authors: Jiang
authors: Reproductive Medicine Center, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing 210008, People's Republic of China.
authors: Ruiwei
authors: R
authors: Jiang
authors: Reproductive Medicine Center, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing 210008, People's Republic of China.
authors: Xi
authors: X
authors: Cheng
authors: Reproductive Medicine Center, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing 210008, People's Republic of China.
authors: Qun
authors: Q
authors: Zhang
authors: Reproductive Medicine Center, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing 210008, People's Republic of China Molecular Reproductive Medical Center of Nanjing University, Nanjing 210008, People's Republic of China.
authors: Yali
authors: Y
authors: Hu
authors: Reproductive Medicine Center, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing 210008, People's Republic of China.
authors: Hui
authors: H
authors: Zhang
authors: Reproductive Medicine Center, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing 210008, People's Republic of China.
authors: Yun
authors: Y
authors: Cao
authors: Reproductive Medicine Center, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing 210008, People's Republic of China.
authors: Mei
authors: M
authors: Zhang
authors: Reproductive Medicine Center, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing 210008, People's Republic of China.
authors: Junxia
authors: J
authors: Wang
authors: Reproductive Medicine Center, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing 210008, People's Republic of China.
authors: Lijun
authors: L
authors: Ding
authors: Reproductive Medicine Center, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing 210008, People's Republic of China.
authors: Zhenyu
authors: Z
authors: Diao
authors: Reproductive Medicine Center, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing 210008, People's Republic of China Molecular Reproductive Medical Center of Nanjing University, Nanjing 210008, People's Republic of China Collaborative Innovation Platform for Reproductive Biology and Technology of Nanjing University Medical School, Nanjing 210008, People's Republic of China yanguijun55@163.com stevensunz@163.com.
authors: Haixiang
authors: H
authors: Sun
authors: Reproductive Medicine Center, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing 210008, People's Republic of China Molecular Reproductive Medical Center of Nanjing University, Nanjing 210008, People's Republic of China Collaborative Innovation Platform for Reproductive Biology and Technology of Nanjing University Medical School, Nanjing 210008, People's Republic of China yanguijun55@163.com stevensunz@163.com.
authors: Guijun
authors: G
authors: Yan
mesh_terms: D062788:Adenomyosis / Q000378:metabolism*; D003656:Decidua / Q000166:cytology / Q000378:metabolism; D004715:Endometriosis / Q000378:metabolism; D004717:Endometrium / Q000378:metabolism* / Q000502:physiology*; D005260:Female; D000071161:Forkhead Box Protein O1 / Q000235:genetics / Q000378:metabolism; D005786:Gene Expression Regulation; D006801:Humans; D007247:Infertility, Female / Q000235:genetics / Q000378:metabolism; D057105:Nuclear Receptor Subfamily 4, Group A, Member 1 / Q000235:genetics / Q000378:metabolism*; D017154:Stromal Cells / Q000378:metabolism
chemical_list: C085126:FOXO1 protein, human; D000071161:Forkhead Box Protein O1; D057105:Nuclear Receptor Subfamily 4, Group A, Member 1
keywords: FOXO1A; NR4A; adenomyosis; decidualization; endometrium