Evolutionary transcriptomics implicates new genes and pathways in human pregnancy and adverse pregnancy outcomes.

Evolutionary changes in the anatomy and physiology of the female reproductive system underlie the origins and diversification of pregnancy in Eutherian ('placental') mammals. This developmental and evolutionary history constrains normal physiological functions and biases the ways in which dysfunction contributes to reproductive trait diseases and adverse pregnancy outcomes. Here, we show that gene expression changes in the human endometrium during pregnancy are associated with the evolution of human-specific traits and pathologies of pregnancy. We found that hundreds of genes gained or lost endometrial expression in the human lineage. Among these are genes that may contribute to human-specific maternal-fetal communication (HTR2B) and maternal-fetal immunotolerance (PDCD1LG2) systems, as well as vascular remodeling and deep placental invasion (CORIN). These data suggest that explicit evolutionary studies of anatomical systems complement traditional methods for characterizing the genetic architecture of disease. We also anticipate our results will advance the emerging synthesis of evolution and medicine ('evolutionary medicine') and be a starting point for more sophisticated studies of the maternal-fetal interface. Furthermore, the gene expression changes we identified may contribute to the development of diagnostics and interventions for adverse pregnancy outcomes.

Pregnancy is a complicated process. It has three phases: the body recognizes the embryo, it maintains the pregnancy, and finally, it induces labor. These stages happen in all mammals, but the details are different in humans. Human pregnancy and labor last longer. We menstruate. Our placentas invade deeper into the uterus, and the cues that signal pregnancy is done and induce labor are different than in most other mammals. We are also more likely to have pregnancy complications, including infertility, a dangerous rise in blood pressure called preeclampsia, and premature birth. The reasons for these differences are unknown. Human pregnancy relies on close communication between the placenta and the uterus. The immune system must allow the placenta to grow large enough to support the developing embryo, and blood vessels need to adapt to supply gases and nutrients and to remove waste. Understanding how the genes used by the human uterus are different to those used in other species could help explain why human pregnancies are so unusual. Mika, Marinic et al. compared the genes used by the pregnant human uterus to those used in 32 other species, including monkeys, marsupials and other mammals, birds, and reptiles. The analysis revealed that the humans use almost a thousand genes that other animals do not. These genes have roles in the invasion of the placenta, the growth of blood vessels, and control of the immune system. Several have links to the hormone serotonin, which had not been connected with the uterus before. Mika, Marinic et al. suggest that it might control the length of pregnancy, the timing of labor, and communication between parent and baby. The genes identified here provide a starting point for further investigation of human pregnancy. In the future, this may help to prevent or treat infertility, preeclampsia, or premature birth. A possible next step is to examine our closest living relatives, the great apes. Performing similar experiments using tissues or cells from chimpanzees, gorillas, and orangutans could reveal more about the genes unique to human pregnancy.

Clearance of senescent decidual cells by uterine natural killer cells in cycling human endometrium.

In cycling human endometrium, menstruation is followed by rapid estrogen-dependent growth. Upon ovulation, progesterone and rising cellular cAMP levels activate the transcription factor Forkhead box O1 (FOXO1) in endometrial stromal cells (EnSCs), leading to cell cycle exit and differentiation into decidual cells that control embryo implantation. Here we show that FOXO1 also causes acute senescence of a subpopulation of decidualizing EnSCs in an IL-8 dependent manner. Selective depletion or enrichment of this subpopulation revealed that decidual senescence drives the transient inflammatory response associated with endometrial receptivity. Further, senescent cells prevent differentiation of endometrial mesenchymal stem cells in decidualizing cultures. As the cycle progresses, IL-15 activated uterine natural killer (uNK) cells selectively target and clear senescent decidual cells through granule exocytosis. Our findings reveal that acute decidual senescence governs endometrial rejuvenation and remodeling at embryo implantation, and suggest a critical role for uNK cells in maintaining homeostasis in cycling endometrium.