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Epithelial to Mesenchymal Transition (EMT) of Feto-Maternal Reproductive Tissues Generates Inflammation: A Factor Aiding Term and Preterm Births
Ramkumar Menon 1,1,1,* (Professor)
1Obstetrics and Gynecology, The University of Texas of Medical Branch
Human pregnancy is a delicate and complex process where multiorgan interactions between two independent systems, the mother and her fetus, maintain pregnancy. Intercellular interactions that can define homeostasis at the various cellular levels between the two systems allow uninterrupted fetal growth and development until delivery. Interactions are needed for tissue remodeling during pregnancy at both the fetal and maternal tissue layers. One of the mechanisms that help tissue remodeling is via cellular transitions where epithelial cells undergo a cyclic epithelial to mesenchymal transition (EMT) and back to mesenchymal to epithelial transition (MET). Two major pregnancy-associated tissue systems that use EMT and MET are the fetal membrane (amniochorion) amnion epithelial layer and cervical epithelial cells, which will be reviewed here. EMT is often associated with localized inflammation, and it is a well-balanced process to facilitate tissue remodeling. Cyclic transition processes are important because a terminal state or the static state of EMT can cause accumulation of proinflammatory mesenchymal cells in the matrix regions of these tissues, which increases localized inflammation that can cause tissue damage. Interactions that determine homeostasis are often controlled by both endocrine and paracrine mediators. The pregnancy maintenance hormone progesterone and its receptors are critical for maintaining the balance between EMT and MET. Increased intrauterine oxidative stress at term can force static (terminal) EMT and increase inflammation, which are physiologic processes that destabilize homeostasis that maintain pregnancy to promote labor and delivery of the fetus. However, conditions that can produce an untimely increase in EMT and inflammation can be pathologic. This tissue damage is often associated with adverse pregnancy complications, such as preterm prelabor rupture of membranes (pPROM) and spontaneous preterm birth (PTB). Therefore, an understanding of the biomolecular processes that maintain cyclic EMT-MET is critical to reducing the risk of pPROM and PTB. Extracellular vesicles (exosomes of 40-160 nm) that can carry various cargo are involved in cellular transitions as paracrine mediators. Exosomes can carry a variety of biomolecules as cargo. Studies specifically using exosomes from cells that have undergone EMT can carry pro-inflammatory cargo and in a paracrine fashion can modify the neighboring tissue environment to cause enhancement of uterine inflammation.
Abstract, Accepted Manuscript [Submitted on December 5, 2021, Accepted on May 12, 2022]
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