Trophoblast Invasion: Remodelling of Spiral Arteries and Beyond
Despite massive scientific and clinical efforts, the etiology of preeclampsia remains a mystery. Quite a variety of different hypotheses has been developed and this is ongoing, but none of them has been able to explain the symptoms of the different preeclampsia subtypes satisfactorily. Here, the hypothesis of shallow trophoblast invasion and its relation to preeclampsia will be discussed. New pathways of trophoblast invasion will be described, including those into spiral arteries (endoarterial trophoblast), into uterine veins (endovenous trophoblast), into uterine glands (endoglandular trophoblast), and into uterine lymph vessels (endolymphatic trophoblast). Moreover, failure of trophoblast invasion will be related to oxygenation of the placenta and subsequently to preeclampsia.
The data presented in this chapter will clarify that (1) there is no direct relation between shallow invasion and preeclampsia; (2) there is no proof of placental hypoxia, either in IUGR and/or preeclampsia; and (3) new routes of scientific self-conception need to be established to enable new and out-of-the-box thinking.
KeywordsInvasion Oxygen IUGR Preeclampsia Trophoblast
- 1.McMaster MT, Librach CL, Zhou Y, Lim KH, Janatpour MJ, DeMars R, Kovats S, Damsky C, Fisher SJ. Human placental HLA-G expression is restricted to differentiated cytotrophoblasts. J Immunol Baltim. 1995;154:3771–8.Google Scholar
- 3.He N, van Iperen L, de Jong D, Szuhai K, Helmerhorst FM, van der Westerlaken LAJ, Chuva de Sousa Lopes SM. Human extravillous trophoblasts penetrate decidual veins and lymphatics before remodeling spiral arteries during early pregnancy. PLoS One. 2017;12:e0169849.CrossRefPubMedPubMedCentralGoogle Scholar
- 4.Windsperger K, Dekan S, Pils S, Golletz C, Kunihs V, Fiala C, Kristiansen G, Knöfler M, Pollheimer J. Extravillous trophoblast invasion of venous as well as lymphatic vessels is altered in idiopathic, recurrent, spontaneous abortions. Hum Reprod. 2017;28:1–10. https://doi.org/10.1093/humrep/dex058.Google Scholar
- 18.Silver RM, Landon MB, Rouse DJ, Leveno KJ, Spong CY, Thom EA, Moawad AH, Caritis SN, Harper M, Wapner RJ, Sorokin Y, Miodovnik M, Carpenter M, Peaceman AM, O'Sullivan MJ, Sibai B, Langer O, Thorp JM, Ramin SM, Mercer BM. National Institute of Child Health and Human Development Maternal-Fetal Medicine Units NetworkMaternal morbidity associated with multiple repeat cesarean deliveries. Obstet Gynecol. 2006;107:1226–32.CrossRefPubMedGoogle Scholar
- 27.Pilalis A, Souka AP, Antsaklis P, Basayiannis K, Benardis P, Haidopoulos D, Papantoniou N, Mesogitis S, Antsaklis A. Screening for pre-eclampsia and small for gestational age fetuses at the 11–14 weeks scan by uterine artery Dopplers. Acta Obstet Gynecol Scand. 2007;86:530–4.CrossRefPubMedGoogle Scholar
- 32.Sibley CP, Pardi G, Cetin I, Todros T, Piccoli E, Kaufmann P, Huppertz B, Bulfamante G, Cribiu FM, Ayuk P, Glazier J, Radaelli T. Pathogenesis of intrauterine growth restriction (IUGR)-conclusions derived from a European Union Biomed 2 Concerted Action project ‘Importance of Oxygen Supply in Intrauterine Growth Restricted Pregnancies’—a workshop report. Placenta. 2002;23(Suppl A):S75–9.CrossRefPubMedGoogle Scholar