Villous trophoblast of human placenta: a coherent view of its turnover, repair and contributions to villous development and maturation

Abstract

J\ coh e re nt vicw o f hum a n v illou s trophoblast as a continuously renewing epithelium is presented. Epithelia undergoing continuous rcnewal (e.g. intestinal mucosa, epidermis) display clonogenic ce lls which pass throug h sevc ral transit di visions be fore migrating out of proliferation zones and into zones of maturati on/differenti ati on. Quantitative relations (e.g. re lati ve numbers of cells) betwee n proliferati on and diffe rentiation zones help to define the steady state and this may va ry in res po nse to ph ysi o log ic al and pathological circumstances. From the differenti ati on compartment, ce lls or ce ll fr agments arc eve ntu all y extruded by mechanisms which may involve apoptosis. All these features are seen in trophoblastic epithelium. Cy totrophobl ast ce lls (CT, proliferation zone) divide continuously throughout gestation and post-mitotic cells are recruitcd into syncytiotrophoblast (ST, diffe rentiation zone) aft cr membrane fusion. Evidence of fu sion events includes localised confluence of CT and ST cytoplasms, and intrasy ncyti al plasma membrane segments bearing desmosomal remn ants. During diffe renti ati on, nu clei undergo changes in shape, chromatin condensation and packing densit y. Densely-clustered nuclei are associated with cy tokeratin intermed iate fil aments and annul ate lamellae . Both clustered and non-clustered nuclei show ultrastructural fea tures of pre-apoptosis and apoptosis. Normall y, apoptosis is triggered only when nuclei are in the syncytium. Some (pre-)apoptotic nuclear aggregates are se qu este red in sy nc yti a l knots, extrud ed as troph obl ast fr agments into the intervill ous space and th e n depo rt ed int o th e mate rn a l c irc ul ati o n to be ph agocytosed at extrapl acental sites. During gestation, there is some constancy in the numerical ratios between CT and ST nuclei pointing to a normal steady state. The steady state may be perturbed when the epithelium is damaged loca ll y. Whe re the epithelium is denud ed, fibrin-type fibrinoid from the intervillous space plugs the discontinuity and , with CT proliferation, facilitates reepitheli alisation. Features of normal villous development (e.g. sprouting, int ervillous bridge formati on, bridge abrupt ion, sy ncytial knot formation) arc explicable in the co nt ex t of tr o ph obl ast turn ove r with ea rl y CT pro li fe rati o n be in g ma inl y fo r g row th a nd la te r proliferation for renewa l and repair. Adaptive re-settings of the epithelial steady state may also occur in abnormal pregnancies.