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Complex patterns of cell growth in the placenta in normal pregnancy and as adaptations to maternal diet restriction
Authors: Malcolm Eaton aff001; Alastair H. Davies aff002; Jay Devine aff003; Xiang Zhao aff001; David G. Simmons aff002; Elín Maríusdóttir aff002; David R. C. Natale aff002; John R. Matyas aff002; Elizabeth A. Bering aff001; Matthew L. Workentine aff004; Benedikt Hallgrimsson aff003; James C. Cross aff001
Authors place of work: Department of Biochemistry and Molecular Biology, Cumming School of Medicine, University of Calgary, Calgary Alberta aff001; Department of Comparative Biology and Experimental Medicine, Faculty of Veterinary Medicine, University of Calgary, Calgary Alberta aff002; Department of Anatomy and Cell Biology, Cumming School of Medicine, University of Calgary, Calgary Alberta aff003; Faculty of Veterinary Medicine, University of Calgary, Calgary Alberta aff004
Published in the journal: PLoS ONE 15(1)
Category: Research Article
doi: https://doi.org/10.1371/journal.pone.0226735Summary
The major milestones in mouse placental development are well described, but our understanding is limited to how the placenta can adapt to damage or changes in the environment. By using stereology and expression of cell cycle markers, we found that the placenta grows under normal conditions not just by hyperplasia of trophoblast cells but also through extensive polyploidy and cell hypertrophy. In response to feeding a low protein diet to mothers prior to and during pregnancy, to mimic chronic malnutrition, we found that this normal program was altered and that it was influenced by the sex of the conceptus. Male fetuses showed intrauterine growth restriction (IUGR) by embryonic day (E) 18.5, just before term, whereas female fetuses showed IUGR as early as E16.5. This difference was correlated with differences in the size of the labyrinth layer of the placenta, the site of nutrient and gas exchange. Functional changes were implied based on up-regulation of nutrient transporter genes. The junctional zone was also affected, with a reduction in both glycogen trophoblast and spongiotrophoblast cells. These changes were associated with increased expression of Phlda2 and reduced expression of Egfr. Polyploidy, which results from endoreduplication, is a normal feature of trophoblast giant cells (TGC) but also spongiotrophoblast cells. Ploidy was increased in sinusoidal-TGCs and spongiotrophoblast cells, but not parietal-TGCs, in low protein placentas. These results indicate that the placenta undergoes a range of changes in development and function in response to poor maternal diet, many of which we interpret are aimed at mitigating the impacts on fetal and maternal health.
Keywords:
Gene expression – Cell cycle and cell division – pregnancy – Blood – Diet – Chorion – Placenta – Trophoblasts
Introduction
The placenta is a complex organ that integrates the fetal demand for nutrients with maternal nutrient availability [1], while also protecting the health of the mother [2]. Deficits in the maternal environment limit nutrient and oxygen availability, often resulting in intrauterine growth restriction (IUGR) [3–5] resulting in low birth weight, increased risk of perinatal complications, and increased long-term risk of cardiovascular and metabolic diseases such as type II diabetes [6,7]. Despite this, not all pregnancies complicated by poor maternal environment result in IUGR. Several studies in experimental animals show that the placenta is highly adaptable, changing its development and/or physiology to delay or mitigate the effects of suboptimal resource availability [2]. In humans, time-course analysis is restricted to gross measures of fetal and placental physiology, making animal models a critical tool for answering questions about the effects of maternal environment on fetal and placental development [8,9].
Although the general phases of normal placental growth and development are well known [10–13], the underlying cellular dynamics are less well understood. The mechanisms underlying the ability of the placenta to adapt its structure and function via cellular adaptations in the face of a suboptimal maternal environment is even less clear. The mouse placenta is comprised of three distinct zones; the decidua which is maternal in origin, and the conceptus-derived junctional and labyrinth zones. The junctional zone is made up of parietal trophoblast giant cells (P-TGCs), as well as glycogen trophoblast (GlyT) and spongiotrophoblast (SpT) cells [12]. GlyT cells store energy in the form of glycogen that is thought to buffer energy demands during late pregnancy [10,14]. SpT cells are believed to be primarily endocrine in nature [15,16] and may drive maternal metabolic adaptations to pregnancy that alter nutrient availability to the placenta. The labyrinth zone is composed of two layers of multinucleated syncytiotrophoblast (SynT) cells that form the site of nutrient and gas exchange and underlying fetal vasculature. In the mature placenta, the maternal blood spaces in the labyrinth are not lined by endothelial cells, but rather by conceptus-derived sinusoidal trophoblast giant cells (S-TGC) that are also endocrine cells. Normal maturation and potentially adaptive changes in the labyrinth zone in response to altered diet are driven in part by the Igf2 gene, which regulates interhemal thickness and nutrient transporter expression [17]
While many studies have described the overall size of the distinct placental zones, none have considered the relative contributions of cell proliferation versus cell hypertrophy to the growth of the placenta during gestation. Cell size is correlated with DNA content, and cells become polyploid through endoreduplication, the process by which cells undergo rounds of DNA replication without intervening mitoses. Endoreduplication occurs in several trophoblast subtypes in the mouse placenta during normal development [12], particularly TGCs. P-TGCs can contain up to 1000 copies of DNA in the same cell [18], though interestingly, P-TGCs do not uniformly replicate their genomes. Certain regions of the P-TGC genome are consistently under-replicated [19], whereas other loci, including those encoding placenta-specific polypeptide hormones, are consistently over-replicated [20].
All the above-mentioned processes are subject to change, given differences in the fetal and maternal environment. The effects of an isocaloric low protein diet on placental and fetal growth are highly variable, and depend on the model (e.g., rat, mouse, sheep) and the timing of protein restriction [21–26]. Experimental studies have shown that feeding pregnant females an isocaloric low protein diet increases the incidence of cardiovascular disease in the offspring postnatally, particularly in males [27]. Using a mouse model of chronic protein restriction beginning two weeks prior to mating and maintained during gestation, to mimic chronic malnutrition in humans, we found previously that fetal weight in the protein-restricted group was no different than controls until after embryonic day (E) 17.5, just before term. By contrast, placenta growth was diminished as early as E10.5 in the low protein group and mothers lost weight before E17.5. The different zones of the placenta were not affected to the same extent, with the junctional zone contributing most to the size variation [28]. There was a reduction in the GlyT cell population in the protein-restricted group but whether this reflects a pathological or adaptive response is unknown. In the previous study, there was no direct measure of SpT cells but expression of Prl3a1, a placental prolactin-related hormone gene that is expressed exclusively in SpT cells was affected. Interestingly, expression of Prl3a1 mRNA was upregulated before E17.5 when fetuses were still growing normally but sharply decreased by E18.5 when fetuses became growth restricted.
How genetic and environmental perturbations give rise to cellular variation in the placenta is a critical question but to date it has often been investigated without taking the sex of conceptus into account. Sex is an important factor that, when ignored, could mask certain interactions affecting placental adaptations [29,30]. For example, male placentas are significantly heavier than female placentas [31] and it is known that differences in placenta size co-vary with morphological and functional adaptations [32]. Hence, it is no surprise that sexually divergent gene expression and methylation patterns in the placenta have been demonstrated in response to feeding mothers diets that are high - or low-fat [33,34] and in cases of caloric restriction [35]. Differences in placental gene expression are also associated with birthweight disparities between sexes in calorie and protein restriction models [36,37]. Postnatal effects of altered maternal diet during pregnancy are also sexually dimorphic, with differences in catch-up growth and metabolism that affect post-natal life [36].
The objectives of our current study were first to describe the patterns of cell proliferation and endoreduplication during the time course of normal gestation and then to see how these normal patterns of development and function are affected by a chronic low protein maternal diet.
Materials and methods
Animals
The work was approved by the University of Calgary Health Sciences Animal Care Committee (AC12-0094). Mice were housed under normal laboratory conditions with a 12-hour light: 12-hour dark photoperiod and unrestricted access to food and water. The presence of a vaginal plug was defined as embryonic day (E) 0.5. For studies of normal development, CD1 mice (Charles River) were mated and pregnant females were dissected every two days, beginning at embryonic day (E) 8.5 through E18.5. C57BL/6 mice were used to assess the impact of a low protein diet during pregnancy. Four-week-old female mice (Charles River) were maintained on a 12-hour light: 12-hour dark cycle for four weeks. Nulliparous females were randomly divided into two groups and fed a control (Con) (20%) (Envigo cat. No. TD.91352) or low protein (LP) (6%) (Envigo cat. No. TD.90016) diet for two weeks before mating. After mating, females were maintained on their respective diets until sacrifice. The diets were both iso-caloric (3.8 Kcal/g) but differed in the percentage of protein in the form of casein and DL-Methionine. Fetuses and placentas were dissected and weighed on E13.5, 16.5, and 18.5 (day before delivery). All animal care and procedures were conducted in compliance with the University of Calgary Health Sciences Animal Care Committee and with the guidelines of the Canada Council on Animal Care (Protocol AC16-0089).
Maternal weight was recorded before and after dissection of the uterus. Fetal and placental weights were measured immediately after dissection of the uterus and surrounding tissue. Placental efficiency was estimated by dividing individual fetal weights by the corresponding placental weight.
Sex determination
A small section of the tail was removed from each fetus and DNA was extracted using tissue preparation, extraction, and neutralization solutions (Sigma). Each sample was PCR amplified and the presence of a region of the Sry gene (249 bp) indicated a Y chromosome. Amplification of a ~400 bp sequence in the Hand1 gene was used as a positive control to allow detection of PCR inhibition and failure of extraction.
Tissue processing
Following dissection and weighing, placentas were hemisected and immediately fixed in 4% paraformaldehyde (PFA) at 4°C overnight. Tissues were then washed in 1 x phosphate-buffered saline (PBS), processed through increasing concentrations of sucrose solutions (10%, 20%), and finally embedded in Tissue-Tek O.C.T. compound (Electron Microscopy Sciences). Placentas were sectioned using a Leica CM3050S cryostat, and 20 μm sections were cut, transferred to Superfrost Plus slides (Fisher Scientific), and stored at -80°C. To remove bias, systematic random sampling was used to select sections for further analysis [38].
Immunofluorescence staining
Double immunofluorescence staining was used to identify proliferating cells throughout placental sections: specifically, trophoblast, phospho-histone H3/Cytokeratin 18 (K18) double-positive, endothelial, phospho-histone H3/PECAM1 double-positive and pericyte, phospho-histone H3/alpha-smooth muscle actin (Acta2) double-positive cells. Three sections from three placentas at each gestational time point were analyzed. Sections were thawed to room temperature and rinsed in 1X PBS. Subsequently, they were heated in a 0.01 M sodium citrate buffer (pH 6.5) to expose antigens before blocking in 5% goat serum (Cedarlane) in 1X PBS/1% BSA for 45 minutes. Primary antibodies (anti-phospho-histone H3, 1 : 100; anti-K18, 1 : 100; Fitzgerald; anti-phospho-histone H3, 1 : 100; Upstate; anti-PECAM, 1 : 300; Abcam and anti-Acta2, 1 : 300; Sigma) were applied stepwise in the appropriate combinations to the cryosections and incubated overnight at 4°C. After washing, sections were incubated for one hour with secondary antibodies (Alexa488-conjugated goat anti-mouse, 1 : 300; Alexa488-conjugated anti-rat, 1 : 300; both Molecular Probes; 1 : 300 or cy3-conjugated goat anti-rabbit, 1 : 300; Jackson Immuno Research), depending on primary antibody combinations. Nuclear staining was carried out using 25 mg/ml bisbenzimide (Sigma). Ki67/K18 double-immunofluorescence staining was carried out using the same procedure as described above using rabbit polyclonal anti-Ki67 (Abcam; 1 : 50) and human monoclonal anti-K18 (Fitzgerald; 1 : 100) primary antibodies.
Calculation of cell cycle length
The length of the cell cycle in different trophoblast cell subtypes was estimated two ways: 1) from the change in cell number over the time course of study; 2) the number of phospho-histone H3/K18 and Ki67/K18 double-positive cells as follows:
The length of the G2/M phase was assumed to be 0.8 hours, true for most mammalian cells.
In situ hybridization
Fixed placentas were dehydrated through ethanol and xylene gradients, then embedded in paraffin. In-situ hybridization was performed according to [39]. For in situ hybridization at least 3 sections from at least three male and three female placentas were analyzed for each diet group and developmental stage. Placentas were bisected near the midline, and at least 80 seven μm sections were obtained. At least three sections within 240 μm of the estimated midline were sampled and analyzed for each diet, sex, and gestational age group combination. The borders of the three main placental layers were distinguished by performing in situ hybridization for Tpbpa mRNA, which is expressed in SpT and GlyT cells. SpT and GlyT cells were distinguished by expression of Prl8a8 mRNA and Pcdh12 mRNA, respectively. After in situ hybridization, these slides were counterstained with DAPI. Brightfield and fluorescent images were taken with a widefield microscope (Thorlabs Tide whole-slide scanner). Total SpT and GlyT cell area were estimated by manually tracing the area expressing Prl8a8 and Pcdh12 mRNA, respectively, using ImageJ. To ensure cell specificity, the Prl8a8 expressing area was superimposed onto the corresponding DAPI image. Cell number was then determined using a thresholding and particle analysis macro written for ImageJ. Cell size was estimated by dividing the total cell area by the total number of cells quantified.
Estimation of DNA content
Tissue sections were deparaffinized and placed in DAPI (1mg/ml) diluted 1 : 5000 in 1X PBS for four minutes, followed rinsing in 1X PBS for two minutes with slight agitation. Coverslips were mounted immediately with Fluoromount-G mounting solution (Southern Biotech, Birmingham, AL) on Superfrost+ slides (VWR) and sections were stored at 4°C overnight in the dark. Images were acquired on the Zeiss Axioimager at 20x magnification. Slides were imaged in random order, and imaging parameters were held constant throughout, ensuring that fluorescent intensity covered the full dynamic range of the camera. At least three randomly-chosen regions containing P-TGCs and SpT cells were imaged, along with two images of the labyrinth zone. P-TGCs were easily distinguished by their large nucleus. SpT cells were identified as cells between P-TGCs and the labyrinth. To distinguish between SpT cells and Gly-T cells, nuclei between 80–200 μm2 were sampled. S-TGCs are the only TGC subtype in the labyrinth and were therefore easily distinguished by nuclear size. Ten P-TGCs, 10 S-TGCs, and 20 SpT cells were randomly selected and their nuclei manually traced in ImageJ. The ploidy of each trophoblast cell type was estimated by dividing the corrected total nuclear fluorescence (CTNF) of each cell to the CTNF of amniotic epithelial cells (diploid = 2C) on the same slide. CTNF was calculated as follows:
Stereology
Three sagittal, non-adjacent sections evenly spaced by 70 μm from the estimated midline of the placenta were stained for alkaline phosphatase activity and counterstained with nuclear fast red (Vector Labs, Burlingame, CA). Alkaline phosphatase activity is expressed on the apical border of SynT (layer I), lining maternal blood sinuses after E12.5 [40]. For each conceptus, four different images of the labyrinth were taken at 40x magnification. A 10x10 point grid was superimposed onto each image (S1 Fig). The presence of either maternal blood space, fetal blood space, S-TGC, SynT cell, fetal endothelial/pericyte, or unknown cell type was scored independently at each point. The percentage of points that overlapped each element was compared between groups. Images were quantified by two blinded investigators and only group differences that remained significant between both observers were considered.
Real-time qPCR
Three male and three female placentas from at least three litters, in both wildtype and low protein pregnancies, were dissected to isolate RNA (n = 36). Placentas were immersed in 700 ml of Trizol, sonicated, and stored at -80°C until RNA extraction. RNA was extracted using RNeasy Mini kits (Qiagen) according to the manufacturer’s protocol. 1 μg/μL total RNA was extracted from each placenta and RNA from 3 placentas/litter were pooled. Pooled RNA was then reverse-transcribed to cDNA, and each sample diluted to 1 : 5 in RNase-free water for gene expression analysis using real-time qPCR. Primer sequences are shown in S1 Table. Relative gene expression was measured using the delta-delta Ct method, with samples normalised to the housekeeping gene Hprt1, which is stably expressed between samples. Raw Ct values were normalized to Hprt1 mRNA and converted to Log(1+x) values. Control samples were then normalized to one, and relative expression in LP samples expressed in relation to this. Quantitative analysis was performed on the Quant Studio 6 (Applied Biosystems) using detection with SYBR green. Each sample was analysed in triplicate and probes were verified to have efficiencies between 0.90 and 1.10, followed by sequencing and BLAST analysis to verify target specificity.
RNA sequencing
RNA from whole placenta was extracted by using Trizol and total RNA was derived from three same-sex littermates (n = 5). TruSeq Stranded mRNA (Illumina) was used with 1 μg of total RNA for the construction of sequencing libraries. cDNA libraries were prepared for sequencing using standard Illumina protocols. Data was deposited in Gene Expression Omnibus (GEO accession GSE131729; https://www.ncbi.nlm.nih.gov/geo/query/acc.cgi?acc=GSE131729). Transcripts were quantified with Kallisto 0.43.1 [41] using Mus musculus GRCh38 (Ensembl release 90) cDNA, with sequence bias correction turned on and 50 bootstraps. All downstream analysis was done in R 3.5.1 (R core team 2014). Genes affected by diet (while controlling for gender) were identified using Sleuth 0.30.0 [41]. A Wald test was used to identify transcripts differentially abundant, and the p-values from the transcripts were aggregated for each gene using the Lancaster method as described in [42], in order to generate a gene-level analysis. Differentially expressed genes were selected based on a corrected p-value cutoff of <0.05. Enriched gene sets for both Gene Ontology terms (GO) and Reactome 64 [43] pathways were identified with over-representation tests (p < 0.05) using cluster Profiler 3.10.0 [44] and ReactomePA 1.26.0 [43] respectively. In addition, network plots were generated in GeneMania [45], selecting for genes that were differentially expressed (q <0.01) and associated with the MGI Phenotype terms: “abnormal placenta junctional zone morphology” or, “abnormal labyrinth morphology”.
Statistical analysis
Cell count data from each zone of the placenta was analyzed using a one-way analysis of variance (ANOVA) followed by Tukey’s honestly significant difference test to determine differences between gestational groups and uncover homogeneous populations. Fetal, placental, and maternal biometry were analyzed using a series of analysis of covariance (ANCOVA) tests. After initializing each ANCOVA as a full model containing every predictor, the model underwent stepwise backward selection until an optimal model with non-significant interaction terms removed. Under the null hypothesis that the group means were equal, a p-value < 0.05 was considered significant. While the dependent variable was either fetal weight, placental weight, or maternal weight, the explanatory variables included diet, sex, placental weight (exclusively for the fetus), and their interactions. To control for interpregnancy variation, litter size and maternal weight were specified as covariates. In addition, the predictors were centred on a mean of zero, because differences in predictor scaling can produce misleading coefficients and interpretations. For other analyses where the normality and homogeneity of variance assumptions were violated within stages and between groups, bootstrapping with replacement was performed. The bootstrapped statistics were regression coefficients, using diet and sex as predictors. A series of resampled (N = 10000) mean coefficient distributions were generated for each effect under the null hypothesis that the difference between groups was equal to zero. A 95% confidence interval and corresponding p-value were reported for each bootstrapped statistic. All multivariate and resampling procedures were performed in R (R Core Team, 2014).
Results
Patterns of growth in the mouse placenta during gestation
Stereology was employed to estimate the volume of the normal placenta and its composition throughout gestation because it allows for simple, precise, and unbiased extraction of three-dimensional structural composition and spatial arrangement from two-dimensional histological sections [46]. Absolute placenta volume reached a plateau at E16.5 (Fig 1A), though the rate of placenta volume expansion was not uniform. A dramatic increase in volume of approximately 55-fold occurred between E8.5 and E12.5 compared to a mere 1.4-fold increase in volume between E12.5 and E16.5. The dramatic volume expansion of the placenta between E8.5 and E12.5 was complemented by an increase in total trophoblast cell number from 1.3 X 105 to 9.2 X 106. However, the number of trophoblast cells did not change between E12.5 and E16.5 and then cell number decreased between E16.5 and E18.5 (Fig 1A). Between E10.5 and 12.5, the number of cells in the ectoplacental cone/junctional zone increased by ~10-fold (Fig 1B). The number of cells in the chorionic plate decreased by ~4-fold, but this was balanced by the appearance of trophoblast cells in the labyrinth layer as the chorion trophoblast cells differentiate.
Fig. 1. Number of trophoblast nuclei in each zone of the mouse placenta as determined using stereology. (A) Absolute number of trophoblast cell nuclei and total placenta volume. (B) Distribution of trophoblast cell nuclei among different layers of the placenta. (C) Number of trophoblast nuclei within the labyrinth layer (blue bars), as well as labyrinth volume (purple line) and trophoblast cell volume (orange line) from E12.5 to E18.5. (D) Trophoblast cell volume calculated as total trophoblast cell volume in the labyrinth (from C) divided by the number of trophoblast nuclei from E12.5 to E18.5. Different letter labels indicate significant differences between days (p<0.05) and are valid for both volume and total trophoblast number (n = 3). We quantified the proportion of trophoblast cells undergoing the cell cycle using antibodies against Ki67 and phospho-histone H3. Ki67 is a DNA polymerase associated protein that is expressed during early G1 and S phase of the cell cycle [47]. To distinguish between mitotically active cell populations and cell populations that were undergoing endoreduplication, we used double immunofluorescence staining for phospho-histone H3 and keratin 18 (K18). Histone H3 phosphorylation at serine 10 is closely linked to chromosome condensation, a phenomenon that occurs during late G2 through to M phase of the cell cycle [48]. K18 is an intermediate filament protein that is expressed exclusively in cells of trophoblast lineage at the implantation site [49]. Prior to E12.5, 86% and 73% of K18-positive trophoblast cells were Ki67-positive in the chorion and ectoplacental cone, respectively (Table 1). In the chorion, 5.9% of K18-positive cells were phospho-histone H3-positive compared to 3.3% in the ectoplacental cone (Table 1). The large difference between the proportion of Ki67 and phospho-histone H3 staining reflects that fact that the Ki67 epitope is expressed throughout G1/S-phase the cell cycle (~10 hours in chorion trophoblast cells) compared to the phospho-histone H3 epitope which is only expressed during late G2 and M-phase (~0.8 hours). Mitotic cell cycle progression in the chorion and ectoplacental cone was supported by the striking increase in trophoblast cell number. Specifically, in a mere 48 hours, the number of cells in the chorion increased from ~7.8 X 104 to ~1.3 X 106 whereas the number of cells in the ectoplacental cone increased from ~5.3 X 104 to ~2.9 X 105. The rate of mitotic cell cycle progression was not uniform between the chorion and ectoplacental cone. Cell number in the chorion increased at a rate greater than that of the ectoplacental cone, and thus, both the absolute number and proportion of chorion cells exceeded those of the ectoplacental cone (Fig 1B). This trend was substantiated by estimations of cell cycle length (S2 Table). At E8.5, cells in the chorion and ectoplacental cone were, on average, undergoing a complete cell cycle in 9.9 hours and 14.8 hours, respectively.
Tab. 1. Percentage of trophoblast cells undergoing the cell cycle between E8.5 and 18.5. Data represent mean and SEM is in parentheses. Between E12.5 and E14.5, there was a decrease in both the trophoblast cell number in the chorion, from 1.3 X 106 to 5.6 X 105 (Fig 1B), reflecting a transition of cells from the chorion into the labyrinth compartment, and the percentage of cells in the cell cycle (Table 1). However, the frequency of cell cycle marker expression remained higher in the chorion compared to the other zones in the placenta. In the chorion, Ki67 expression was detected in 21% to 34% of trophoblast cells between E12.5 and E18.5, a rate that was 2 - to 5-fold higher than the other zones in the placenta (Table 1). Similarly, the proportion of phospho-histone H3 positive cells was substantially higher in the chorion compared to the other zones in the placenta (Table 1). While the vast majority of the chorion cells in the cell cycle lay along the chorionic plate, there were also isolated islands of chorion-type cells in the labyrinth. Morphologically, these cells were small, cuboidal, and densely packed and thus resembled cells of the chorion proper.
It was apparent that many of the phospho-histone H3-positive cells in the placenta were not K18-positive and therefore were not trophoblast cells. Examination of histological sections at E15.5, a time when the number of phospho-histone H3/K18 double-positive trophoblast cells had declined to almost zero, showed that 45±10% of phospho-histone H3-positive cells were PECAM-positive endothelial cells and 38±6% were α-smooth muscle actin-positive pericytes (S2 Fig). Phospho-histone H3-positive fetal blood cells were also occasionally detected in blood vessels in the placenta.
Endoreduplication and hypertrophy in trophoblast cell populations in the placenta
By comparing the patterns of Ki67 and phospho-histone H3 staining, it was possible to identify populations of trophoblast cells that were undergoing endoreduplication (Ki67-positive but phospho-histone H3-negative) (Fig 2). For example, almost all P-TGCs expressed Ki67 at E8.5 but none expressed phospho-histone H3, indicating that this cell population was not mitotic but, rather, was endoreduplicating (Fig 2). Ki67 was not detected in P-TGCs after E12.5 indicating that they do not continue to endoreduplicate past this time point. While there was some evidence of cell proliferation early, phospho-histone H3-positive cells were nearly undetectable in the junctional zone at E12.5 and E16.5 (Table 1 and Fig 2). The total number of cells that were Ki67-positive also dropped after E12.5 (Table 1 and Fig 2). These data imply that, like TGCs, SpT and/or GlyT cells in the junctional zone endoreduplicate to become polyploid early in pregnancy.
Fig. 2. Ki67 and Phospho-histone H3 immunofluorescence staining in P-TGCs, junctional zone and labyrinth. Histological sections were dual stained for Ki67/K18 (red/green respectively) or phospho-histone H3/K18 (red/green respectively) and nuclei are counterstained with DAPI (blue). Phospho-histone H3 was detectable at E12.5 in sinusoidal-TGCs within the labyrinth (white arrow; x400 magnification in the inset) but not in SynT cells (red arrow). MBS–maternal blood space; FBS–fetal blood space. Within the labyrinth layer, the thin SynT cells showed little, if any, phospho-histone H3 or Ki67 staining at any point throughout gestation (Fig 2, red arrows). S-TGCs were distinguished from SynT cells in the labyrinth based on their large cell and nuclear size, K18 staining, and proximity to maternal blood spaces in the labyrinth. S-TGCs showed Ki67 staining at E16.5 (Fig 2, white arrows) in support of previous observations that these cells become polyploid [12,50], presumably as a result of endoreduplication. In contrast to P-TGCs, there were a small number of phospho-histone H3-positive S-TGCs in the labyrinth (Fig 2, white arrow). However, upon close inspection of the staining patterns, we did not observe any evidence of metaphase plates or anaphase spreads in these cells. This indicated that the cells were entering G2 phase of the cell cycle and beginning to condense their chromatin but were not entering M-phase.
Analysis of the labyrinth layer suggested that it undergoes complex growth regulation. Consistent with the decline in trophoblast cell proliferation in the chorion and labyrinth, the total number of trophoblast cells in the labyrinth remained relatively constant after E12.5 (Fig 1C). Despite this, the labyrinth zone expanded in volume by approximately 4-fold linearly between E12.5 to 18.5 (Fig 1C). Previous studies have shown that the total volume of the trophoblast cell compartment in the labyrinth layer similarly increases after E12.5, and plateaus by E16.5 [11]. Based on these data, we calculated the trophoblast cellular volume (normalized to trophoblast nuclear number) and found that it increased by ~5-fold between E12.5 and E18.5 (Fig 1D). These results indicated that the increase in the volume of the trophoblast cell compartment in the labyrinth after E12.5 was driven by trophoblast cell hypertrophy rather than an increase in trophoblast cell number.
Chronic protein restriction results in sexually dimorphic fetal and placental growth trajectories
Having established the pattern of cell growth in normal placentas, we next assessed the effects of dietary restriction. To do this, eight-week-old nulliparous female mice were fed either a control (Con) or low protein (LP) diet for two weeks and then paired with normal fed males. We used the C57BL/6 strain based on their use in previous dietary restriction models [28,51]. Based on data described below, C57BL/6 placentas displayed a similar overall growth trajectory as CD1 mice (S3 Fig). Time to mating and litter size did not differ significantly between the control and low protein groups. Pregnant females were sacrificed on embryonic days (E) 13.5, 16.5, and 18.5, the uterus was removed and weights were recorded of individual fetuses, placentas and the non-gravid body of the mother. As expected, non-gravid maternal weight was significantly lower in the LP group compared to the Con group from E13.5 onwards due to maternal weight loss (p<0.001; n = 10/group) (S4 Fig). The degree of maternal weight loss became more severe as pregnancy progressed, with mothers in the LP group being 17%, 23%, and 30% lighter at each respective time point (p<0.001) (S4 Fig). To account for potential variation caused by other factors, regression analysis was performed followed by ANCOVA, with maternal weight and litter size as covariates (S3 Table). Despite severe maternal weight loss from E13.5 onward, fetuses in the LP group were only lighter at E16.5 (p<0.01), and E18.5 (p<0.001) (Fig 3A). Interestingly, female fetuses were more growth-restricted than males at E16.5 (p = 0.03), but not at E18.5.
Fig. 3. Weights of fetuses and placentas, and fetal/placental weight ratios, in control and dietary protein restricted pregnancies. (A) Fetal weights separated by sex and embryonic day (E). (B) Placental weights separated by sex and embryonic day. (C) Fetal to placental weight ratio (F:P) separated by sex and embryonic day. Explanatory variables–diet, sex, litter; Co-variates–maternal weight, litter size. Letter labels denote statistically significant main effects of diet within days (p<0.05). Main effects of sex (if present) are denoted by symbols at respective days (p<0.05). No diet by sex interactions were present. Number of conceptuses in each group (from left to right): E13.5–28, 32, 41, 39; E16.5–24, 37, 26, 24; E18.5–23, 42, 19, 32. Because male and female fetuses had different growth trajectories in the LP group, we hypothesized that placentas would have sexually dimorphic growth trajectories as well. There is a significant effect of X chromosome dosage (and hence sex) on placental growth, with male placentas being heavier than female placentas [31]. Consistent with this, the increases in weight and cross-sectional area of the placenta between 13.5 and 16.5 were less in female placentas compared to males, regardless of diet. This resulted in smaller and lighter female placentas at E16.5 (p<0.01) and 18.5 (p = 0.01) (Fig 3B). Placentas in the LP group appeared to be lighter at E16.5 in both sexes. However, the diet effect was only significant in LP males at E18.5 (p = 0.04). Like the cell number and volume in CD1 placentas, C57BL/6 placental weight trajectory was bi-phasic in Con diet group. Looking at the overall trend in the data, we see that dietary protein restriction prevented bi-phasic growth completely in females and flattened the trajectory in males. Because female placentas were already smaller, the diet effect on placental weight was not as severe at E18.5 compared to males. Given this, placental efficiency (driven by size independent factors) was likely shifted, both in the LP diet group and by sex.
Placental efficiency was therefore estimated by dividing fetal weight by placenta weight (F:P ratio) (Fig 3C). Female placentas were more efficient than males, regardless of diet at E16.5 (p<0.001) and E18.5 (p = 0.01). Efficiency in LP males and females was slightly lower than same-sex controls at E18.5 (p = 0.03 and p = 0.04, respectively). At this time point (E18.5) both sexes in the LP group are growth restricted (Fig 3C). Previous work has shown that fetal growth is not dependent on placental weight after E16.5 [52], so we wanted to confirm if there was a significant correlation between fetal and placental weight at E18.5 given the diet effects on placental efficiency. Consistent with the previous study, we found no positive correlation between fetal and placental weight at E18.5 in controls (slope = 0) (S5 Fig). In contrast, there was a positive correlation in the LP groups at E18.5, in males and females (p<0.01), with LP fetal weight increasing by 0.06g per unit increase (0.1g) in placental weight. This indicated a continued reliance of fetal growth on the size of the placenta in the LP group compared to Con (S5 Fig). It remained unknown, however, if fetal sex correlated with fetal weight at E18.5. To answer this question, we separated the effect of sex from that of placenta size, controlling for them separately in the ANCOVA model. Holding fetal weight constant, there was no effect of sex on fetal weight at 18.5, showing that placental weight alone correlates with fetal weight at E18.5. Altogether, the data showed that adaptations in response to low protein diet affecting placental weight had a larger impact at later stages, with sex-specific effects altering growth trajectories and ultimately mediating placental size and efficiency.
Patterns of growth in the malnourished placenta
Given its central role in nutrient exchange, we first examined the labyrinth layer, considering both structural (size, vascular composition, cellular composition) and functional (nutrient transporter) characteristics. Previously we found no differences in labyrinth size between control and LP diets [28], but in the current study we found that cross-sectional area was marginally smaller in LP female placentas, compared to LP male placentas at E16.5 (p = 0.05) (Fig 4A). Like placental weight, female labyrinth areas in the LP group did not expand as much as males in the LP group, and overall, female labyrinths were smaller than males at E18.5 (p = 0.02). The composition of the labyrinth was determined through stereological point analysis (Table 2). We used alkaline phosphatase staining to outline the SynT-layer I cells and, therefore, to distinguish cell types including: maternal blood space (MBS), fetal blood space (FBS), S-TGCs, SynT cells, and fetal endothelial cells/pericytes. Largely, diet and sex did not have a significant effect on labyrinth composition between groups at the same stage. One exception was that the relative maternal blood space was lower in female placentas at E13.5 and 16.5, compared to males, in the LP group specifically. Between days, our results showed that the normal expansion of maternal blood space and reduction in fetal blood space were stunted in the LP group, with the maternal blood space in control placentas expanding by ~6%, compared to only ~3% in the LP group.
Fig. 4. Labyrinth growth in low protein pregnancies is mediated by trophoblast hypertrophy and nutrient transport function. (A) Total labyrinth area separated by diet and sex (n = 4–5). (B) Glucose and amino acid transporter expression in male and female placentas. Fold change in protein restricted placentas (bars) relative to control diet placental expression (dotted line). * p<0.05; ** p < 0.01 (n = 3). Tab. 2. Labyrinth composition expressed as a percent area. (mean; SEM in parenthesis). In addition to overall size and composition, we looked for functional changes that could explain higher placental efficiency in females. RT-qPCR analysis of several nutrient transporter genes revealed that female placentas expressed higher relative levels of glucose transport genes for a longer duration. Male placentas showed a ~2-fold increase in the levels of glucose transporter genes (Glut1/3) at E13.5 in the LP group compared to Con group (p<0.05). Female placentas in the LP group, however, had ~4-fold greater expression of glucose transporter genes compared to Con group at both E13.5 and 16.5 (p<0.05) (Fig 4B). Expression of all three amino acid transporter genes that were assessed (Slc38a1/2/4) trended higher in female placentas (p = 0.05) at E13.5, while Slc38a2 (p = 0.04) and Slc38a4 (p = 0.06) trended higher in males at E13.5. We also measured the expression of Igf2 P0 mRNA, the labyrinth specific Igf2 transcript that has been shown to regulate maturation and functional adaptations in the labyrinth [53–55]. Igf2 P0 mRNA expression was higher in LP placentas compared to controls at E13.5 and 16.5, in both males and females (S6 Fig).
To gain further insights into how the development and/or function of the placenta was affected by LP diet, we performed RNA seq analysis using RNA samples from E16.5 placentas (Fig 5, supplementary data). We found that 72 genes were differentially expressed between Con and LP groups (q<0.05). Principal component analysis showed significant segregation of Con and LP placentas but no clear separation of male and female placentas (Fig 5A). There was a significant effect of litter, indicating variation between pregnancies in different females, but what accounted for this was unclear. The most differentially expressed genes came from a variety of different classes (Fig 5B). To determine if specific developmental pathways were affected, we examined expression of genes that have been annotated in the Mouse Genome Informatics (MGI) Phenotype database as having mutant phenotypes with changes in labyrinth and/or junctional zone morphology (Fig 5C). Five genes associated with changes in labyrinth morphology (MP: 0001716) were differentially expressed, with Ccn1 and Hsd17b2 mRNA being higher in the LP group, while Tgfbr1, Tjp1 and Vhl were expressed at lower levels. The small number of genes associated with these processes is likely a result of the log-fold changes being small across the entire data set, as well as the strong, litter clustering that unfortunately masked sex-specific effects as well. The results of our gene set enrichment test confirmed this.
Fig. 5. RNA sequencing analysis of Con and LP placentas at E16.5. (A) Principal component analysis with different points representing different litter (number) and sex within litter (male versus female). (B) Heat map of differentially expressed genes. (C) Gene network diagrams produced by GeneMania program, showing relationships between genes that are up- (red) or down-regulated (blue) in LP placentas (n = 5). Delayed spongiotrophoblast hyperplasia and hypertrophy in malnourished placenta
In addition to changes in the labyrinth, maternal dietary protein restriction resulted in a smaller junctional zone area, similar to the results of our previous study [28]. We found that this was true in both sexes at E13.5 (p = 0.04, Kruskal-Wallace) and 16.5 (p<0.01) (Fig 6A). Sex-specific effects were apparent at E16.5 onward. At E16.5, female LP junctional zone area was 42% smaller in females, and 20% smaller in males compared to same-sex controls (Fig 6A). At E18.5, female junctional zones were significantly smaller than males in both diets (p<0.001). The diet effect was less pronounced in females at E18.5 since female junctional zone area drops significantly (p = 0.01) between E16.5 and 18.5 in the Con group. Male junctional zone area was steady across time points and consistently smaller in the LP group.
Fig. 6. Spongiotrophoblast (SpT) cells contribute to the reduction in junctional zone size due to changes in cell size and number. (A) Junctional zone area. (B) Total SpT cell area was measured in Image J using automated thresholding, distinguishing SpT cells by expression of Prl8a8 mRNA. (C) Spongiotrophoblast cell number (n = 4–5). We next wanted to determine which cell type was contributing to these effects. We quantified total SpT cell area and number, dividing these measures for an estimate of cell size. In the Con diet, total SpT cell area (Prl8a8 mRNA positive area) was bi-phasic, increasing by 33% from E13.5 to 16.5 and then decreasing by 26% from E16.5 to E18.5 in both sexes (Fig 6B). Increased cell number was a driver of growth between E13.5 and 16.5 in controls. In the LP group, there were consistently fewer cells at E13.5 (p = 0.02) and 16.5 (p = 0.01). The LP group was closer to controls at E18.5 because of a decrease in cell number in Con diet, rather than an increase in the LP group. (Fig 6C). Change in cell size was a clear driver of the reduction in total area, with SpT cells smaller at E18.5 compared to E13.5 in all groups. Given that most of the cell proliferation within the junctional zone occurs before E13.5, our results suggest that protein restriction delays SpT cell differentiation from precursor cells, resulting in fewer Prl8a8-positive cells at E13.5. In addition, SpT cells were marginally smaller in the LP group at E16.5 (p = 0.05) and 18.5 (p = 0.09), (Fig 6D) suggesting that delayed differentiation also delays the growth of these cells. In all groups, cell size trended downward from E16.5 to 18.5, (Fig 6D) suggesting either that larger cells were dying, or cells were becoming smaller after E13.5. Cell number and size were similarly affected in males and females.
The other major cell type in the junctional zone is GlyT cells. It is assumed that GlyT cells accumulate glycogen in large vacuoles to buffer energy requirements later in pregnancy. Storage and release of glycogen has previously defined the bi-phasic growth trajectory of the junctional zone [10]. Our measurements of this cell type showed a clear bi-phasic growth trajectory, with the increase in the total area of protocadherin 12 (Pcdh12) expressing cells from ~ 2.5 mm2 at E13.5 to ~3.5 mm2 at E16.5 and decreasing to less than 2.5 mm2 at E18.5 in controls (S7 Fig). Interestingly, GlyT cell area in the LP group failed to increase between E13.5 and 16.5, resulting in a downward trend over time and significantly less Pcdh12 positive area in both sexes at E16.5 compared to the Con group (p = 0.03). Females in both diet groups had significantly less GlyT cell area compared to males at E18.5, but again, the normal reduction in cell area brought controls down to LP levels, so there was no diet effect visible at E18.5. Pcdh12 mRNA expression was reduced in LP males compared to Con males at E13.5 and was increased in LP females compared to Con females at E13.5 and 16.5, not matching the trend in total cell area (S7 Fig). To assess glycogen cell function, we measured the expression of several genes encoding glycogen synthesis enzymes. Interestingly, LP female placentas expressed significantly less mRNA for gene encoding Gbe1 (glycogen branching enzyme) at E13.5 and 16.5 (S6 Fig). Higher levels of glucose transporter expression in females and lower expression of glycogen branching enzyme suggested that more glucose was being transported to the fetus, with less available to accumulate in GlyT cells.
Examination of the RNA seq data showed three genes associated with junctional zone morphology that were differentially expressed (Fig 5C). Of the 106 genes associated with abnormal junctional zone morphology in the MGI Phenotype database (MP:0008957), we found that Phlda2 and Hsd17b2 expression levels were increased, while only Egfr was reduced in LP placentas (p <0.05; q < 0.1).
Sinusoidal TGC and spongiotrophoblast cell endoreduplication in protein-restricted pregnancies
We next wanted to see if dietary protein restriction altered the DNA content in polyploid trophoblast cells. We estimated DNA content in S-TGCs, P-TGCs and SpT cells using DAPI fluorescence. As expected from our Ki67 results, P-TGC ploidy remained unchanged from E13.5 to 18.5 (S8 Fig), and diet had no effect. Mean S-TGC ploidy increased in Con and LP placentas from E13.5 (6.12C ± 2.6) to 16.5 (8.20C ±2.9) (Fig 7), consistent with low levels of ongoing Ki67 expression. Interestingly, S-TGC ploidy continued to increase in the LP group, attaining a mean ploidy of 11.24C ± 3.19 at E18.5, compared to Con cells that remained near 8C (mean = 7.96C ±3.4) at E18.5 (p<0.01). If a cell has gone through a third doubling of its entire genome, it would be 16C, but in this case, the data suggests incomplete replication of genomic DNA. SpT cells had a higher ploidy in the LP group compared to Con, evident at both E13.5 and 18.5 (p<0.01). Specifically, cells in the LP group attained a mean ploidy of 9.03C at E18.5 compared to the Con group with a mean ploidy of 6.43C (p<0.01). Some cells in the Con group did attain a ploidy of ~8C at E16.5. However, this population did not persist at E18.5. Sex differences were not significant.
Fig. 7. Sinusoidal trophoblast giant cell (S-TGC) and spongiotrophoblast (SpT) cell ploidy in control and protein-restricted pregnancies. (A) Frequency of S-TGCs at each ploidy level across gestation. (B) Frequency of SpT cells at each ploidy level across gestation (n = 6). Discussion
This study quantified how different trophoblast cell types contribute to the growth of the placenta during normal development and under conditions of severe dietary restriction. First, we used stereology to quantify cell numbers, focusing on development after E8.5 when hyperplasia drives rapid expansion. Placental growth after E12.5 is then driven by trophoblast cell hypertrophy and endoreduplication in several other trophoblast cell types. We then fed mice a chronic low protein diet and observed if and how placental structure and/or function compensated. Despite severe maternal weight loss in the protein restricted group, fetal growth was largely preserved until late gestation and interestingly, males and females displayed different growth trajectories. While female placentas were able to make up for their small size by becoming more efficient, male placentas compensated through labyrinth zone expansion. We then showed that SpT cell differentiation and growth is altered by protein restriction, contributing to the late-term loss of mass in the junctional zone. Finally, we showed that protein restriction causes S-TGCs and SpT cells to attain a greater ploidy at E18.5 compared to controls.
Patterns of growth in the normal placenta
The developmental events at E8.5 mark a major transition in the placenta. The allantois contacts the chorion, and together they give rise to the labyrinth layer. At the same time, the ectoplacental cone expands to give rise to the junctional zone [12]. Our current study showed that these events were accompanied by large increases in the number of trophoblast cells/nuclei in both the chorion and ectoplacental cone between E8.5 to E12.5. In order to identify specific cell populations that proliferate, we used markers that allowed us to distinguish true cell proliferation from endoreduplication, the process in which cells replicate DNA but do not go through mitosis and cell division. Our data showed that while trophoblast cells in both the chorion and the ectoplacental cone replicate, the rate is higher in the chorion, which presumably supports the more extensive growth of the labyrinth compared to the junctional zone. After E12.5, while there were a small number of Ki67-positive as well as phospho-histone H3-positive cells in the labyrinth, the majority of these cells were either pericytes or fetal endothelial cells. After E12.5, we found that despite the predicted influx of labyrinth precursors from the chorion, the number of trophoblast nuclei in the labyrinth remained reasonably constant. This apparent paradox could be explained by trophoblast cell death and turnover in the labyrinth as has been observed in the villi of the human placenta [56], the analogous placenta structure.
After E12.5, we found that the volume of the labyrinth continued to increase towards term, but the growth was due to cell hypertrophy rather than hyperplasia. Because trophoblast cells in the labyrinth fuse to give rise to multi-nucleated SynT cells, we assessed cytoplasmic volume on the basis of the number of trophoblast cell nuclei. While trophoblast nuclear number did not change dramatically between E12.5 and E18.5, there was a linear increase in trophoblast cell volume per trophoblast cell nucleus. Likewise, the absolute volume of the labyrinth continued to increase linearly until E18.5, albeit at a faster rate compared to trophoblast cell volume after E14.5. This indicated that between E12.5 and E18.5, the growth of the labyrinth is driven not only by an increase in cell volume but also by an increase in extracellular space. Whether the increase in extracellular volume is due to loss of cell adhesion molecules [57] and the subsequent separation of cells, an increase in the number and/or diameter of maternal and fetal blood spaces[11,58], or a combination of both processes, remains to be elucidated. Our results demonstrate that maternal blood space does increase significantly between E13.5 and E16.5.
Interestingly, we detected a number of trophoblast cell populations that were Ki67-positive but negative for the phospho-histone H3 marker suggesting that these cell populations were endoreduplicating. There are at least five types of TGCs in the mouse placenta that differ in location, developmental origin and function but share the property of being polyploid [12]. Our current results revealed some differences in the timing and progression of endoreduplication in different trophoblast cell subtypes. For example, P-TGCs endoreduplicate their DNA only up to E12.5. These cells are mononuclear and chromosomes are polytene [59]. Consistent with this, we failed to detect phospho-histone H3 expression in P-TGCs. S-TGCs only become detectable in the placenta after ~E12.5 [12] and, in our current studies, they showed Ki67 expression up to E16.5. The other surprise was that we detected, albeit at a low rate, phospho-histone H3 expression in S-TGCs despite prior evidence that S-TGCs are mononuclear and polyploid [12]. During the mitotic cell cycle, the phospho-histone H3 epitope is expressed in the late G2 phase from the time that chromosomes begin to condense in prophase, through metaphase and anaphase. Close examination of the S-TGCs that were phospho-histone H3-positive showed no evidence of S-TGCs in metaphase or anaphase, consistent with a block to mitosis.
In addition to the various TGCs, our data also suggested that endoreduplication occurs in the junctional zone, consistent with prior observations of polyploidy in the junctional zone in rats and rabbits [59,60]. The junctional zone, which arises from the ectoplacental cone, is composed of both GlyT cells and SpT cells. Intriguingly, Ki67 was detected predominantly in GlyT cells in the junctional zone at E12.5 and these cells did not express phospho-histone H3. This suggested that GlyT cells were not proliferating and instead endoreduplicate their DNA and do so before migrating out of the junctional zone into the decidua (10, 58). The low frequency of Ki67 staining in SpT cells suggested that they reach their maximum ploidy before E12.5 and, subsequently, exit the cell cycle. Previous studies have reported that there is an 80-fold increase in the number of GlyT cells between E12.5 and E16.5, before declining by 60% by E18.5 [10]. However, if these cells are not mitotically active, the increase must be due to the differentiation of precursor cells.
Sexually dimorphic effects of poor maternal diet on fetal and placental development
Placental development is subject to multiple inputs that stretch its adaptive capacity. Having previously shown that protein restriction in the maternal diet impacts placental growth and maternal weight before fetal growth [28], we furthered this work by separating groups by sex in order to account for diet-induced variability in gene expression between sexes [30,61]. Like our previous study, fetal growth in the low protein group was preserved well after one would expect, given early and severe maternal weight loss that preceded a general reduction in placental weight and junctional zone area. Transient growth restriction in females at E16.5 is a novel finding on the timing of IUGR and the capacity for recovery, showing a quantitative example of males and females employing different growth strategies in utero. As expected, male placentas were larger specifically due to a larger labyrinth area but, despite this, these placentas were less efficient than females after E13.5. A previous study found that lighter placentas have more functional adaptations [32]. However, that study did not link the size difference to sex. Our findings here, that placental weight and not fetal sex impacted fetal growth at E18.5, clarifies this relationship. Given that placental size is determined by X chromosome dosage, we hypothesize that females develop functional adaptations earlier, making them more resilient in the face of size reduction in late pregnancy. Males on the other hand, could be more susceptible to placenta size-dependent factors late in pregnancy but are not initially growth restricted because of a larger surface area. Human cohort studies have shown that males compensate for IUGR with placental growth in late pregnancy [62], a feature present in several of the parameters measured in this study. This type of analysis allows us to pinpoint the source and timing of variation and will inform how placental adaptability and fetal growth trajectories are interpreted going forward. It also raises important questions about what type of placental adaptation would lead to specific post-natal growth variation and susceptibility to disease.
Low protein diet alters the structure and function of the labyrinth zone
The labyrinth zone was a logical starting point to quantify functional and structural changes in the placenta that adapted to the maternal environment. The labyrinth contains trophoblast-lined maternal blood sinuses and fetal vasculature that are highly responsive to external factors such as oxygen availability and Igf2 [53,63]. Igf2 P0, a well-established regulator of labyrinth maturity and growth [53], was up-regulated in the LP groups. Giving that male labyrinths increased their size, where females did not, suggests that there could be a sex-specific response to Igf2 P0, providing an increase in growth in males, and an increase in nutrient transporter expression in females. We then found that maternal dietary protein restriction resulted in smaller labyrinth areas in females, specifically at E16.5. Because the initial establishment of the labyrinth zone occurs over a short window, it is an energy intensive process, and it is surprising that the labyrinth can grow normally in male placentas despite severe maternal weight loss. Transient growth restriction in female fetuses is mirrored by transient growth restriction in the labyrinth, but other adaptations like glucose transport are able to rescue sex differences in fetal growth by E18.5. This data suggests then, that male placentas rely on placenta surface area to remain efficient, with the caveat that this type of resiliency alone is not enough to preserve fetal growth to term.
Despite the diet effect on labyrinth size being restricted to E16.5, we also found that the LP diet stunted maternal blood space expansion in the labyrinth. This directly affects the surface area available for nutrient exchange, suggesting that without functional adaptations in place, IUGR would follow this disruption. Our data, therefore, suggest that sex-specific adaptations determine fetal and placental growth trajectories that are established by early differences in placental structure and function.
Both spongiotrophoblast and glycogen trophoblast cells are affected by low protein diet
An initial goal of this study was to determine why the junctional zone is smaller in protein restricted pregnancies. Normally, junctional zone growth is bi-phasic, increasing from E12.5 to 16.5 and decreasing to term [11]. Cell size and number for both GlyT and SpT cells contributes to this growth trajectory [10], and we wanted to determine if one cell type was preferentially affected by protein restriction. We quantified total SpT cell area and saw that it was reduced at E13.5 and 16.5, reflecting a delay in cell proliferation (cell number) and growth (cell size E16.5). Previous reports show that subcellular complexity of SpT cells increases across gestation, likely resulting in increased transcriptional capacity [50]. Given this, the reduced cell size in the LP group may suggest that SpT cells are less functional. In both Con and LP diets, SpT cells don’t increase in size after E13.5 but their number does increase, contributing to the growth of the junctional zone. This appears to be a difference with CD1 strain mice since junctional zone number did not increase (Fig 1). Across both sexes, SpT number and size was reduced by the low protein maternal diet. The other major cell type in the junctional zone, GlyT cells, are only detectable after E12.5 and originate in the ectoplacental cone [64]. After differentiating, many GlyT cells proliferate (E12.5–14.5) and migrate into the maternal decidua [10]. In the LP group, total GlyT cell area failed to increase between 13.5 and 16.5 but still underwent apoptosis after E16.5 [65]. Phlda2 mRNA expression, which was increased in the LP group at E16.5, is known to restrict the growth of SpT and GlyT cells and reduces the energy storage capacity of the placenta [14]. Epidermal growth factor receptor (Egfr) gene expression was reduced in LP placentas as well. Egfr knockout mice have restricted junctional zone growth, but this does not account for embryonic lethality in these mutants [66].
Trophoblast cells endoreduplicate, responding to protein restriction by increasing DNA content
Polyploidization is a well-known feature of TGCs in the placenta but its physiological function is unknown [67]. After shedding light on the mechanisms responsible for the transition into the polyploid state [68], it was discovered that P-TGCs have loosely packed chromatin [69], and selectively over-amplify specific regions of their genome [20]. Interestingly, these regions contain genes that encode placenta prolactin-related hormones. This evidence supports the theory that polyploidization is a low-cost way to increase gene copy number without intervening mitosis and cytokinesis, which makes sense for the placenta that develops quickly [18]. In this study, we used cell cycle markers to show that several trophoblast cell types, not just P-TGCs, exit the mitotic cycle but endoreduplicate. S-TGCs line maternal blood spaces in the labyrinth [15] and are directly exposed to varying levels of oxygen and nutrients, depending on their exact position in the labyrinth [58,70]. Interestingly, S-TGCs in the LP group had a higher DNA content than controls at E18.5. The trend suggests that S-TGCs in a normal fed placenta become smaller or die between E16.5 and 18.5, whereas cells in the LP group continue to increase their DNA content. Our group previously showed that Prl3d1 mRNA expression in S-TGCs was not affected by short-term fasting [71]. However, ablation of these cells resulted in single-transgenic litter mates dying, suggesting that the endocrine function of these cells is critical for fetal development [72].
SpT cells produce the widest variety of placental prolactin-related hormones. In control conditions, these cells cease endoreduplication after E12.5. However, SpT cells in the low protein group had a higher DNA content compared to controls at E13.5 and 18.5 indicating that they continue to endoreduplicate. Our study only measured total DNA content, but we know that selective regions are over-and under-amplified in P-TGCs at least [20]. Given that Prl3a1 mRNA expression is elevated in protein-restricted pregnancies up to E17.5 [28], endoreduplication may be the mechanistic determinant of an increase in hormone expression.
Conclusion
Together, our data reveal the complexity of cellular development in the placenta during normal and perturbed pregnancies. This work will support further studies on the differentiation, proliferation, and adaptive responses seen in trophoblast cells and how they affect fetal growth. The programming power of the placenta necessitates detailed time-course analysis of growth trajectories to distinguish between pathological and adaptive responses. Doing this will lead to a deeper appreciation for the dynamic nature of placental development to better predict and treat pregnancy complications that support fetal development.
Supporting information
S1 Fig [tif]
Image of alkaline phosphatase/nuclear fast red-stained labyrinth zone (40x magnification) with superimposed dot-grid and arrows indicating cell types and vascular structures.S2 Fig [blue]
Phospho-histone H3 immunofluorescence staining in pericytes and endothelial cells.S3 Fig [tif]
Total placental area in C57Bl/6 mice, separated by diet, sex, and embryonic day (E).S4 Fig [tif]
Maternal weight trajectories in control and protein restricted pregnancies (n = 10).S5 Fig [tif]
Fetal weight as a function of placental weight at E13.5, 16.5 and 18.5 separated by diet and sex.S6 Fig [tpbpa]
Relative gene expression of zone specific, glycogen synthesis and insulin-like growth factor genes.S7 Fig [tif]
Glycogen trophoblast cell total area in the junctional zone and labyrinth (n = 4–5).S8 Fig [tif]
Ploidy of P-TGCs at E13.5, 16.5 and 18.5 (n = 4–5).S1 Table [xlsx]
PCR primer sequences.S2 Table [xlsx]
Estimates of cell cycle length (in hours) in the chorion and ectoplacental cone/spongiotrophoblast during various stages of gestation.S3 Table [xlsx]
Fetal and maternal weight ANCOVA over three embryonic days.S1 File [ijm]
threshold boost.
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- Measuring the diffusion of innovations with paragraph vector topic models
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- Neandertals on the beach: Use of marine resources at Grotta dei Moscerini (Latium, Italy)
- Allergic inflammation is initiated by IL-33–dependent crosstalk between mast cells and basophils
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- The strain distribution in the lumbar anterior longitudinal ligament is affected by the loading condition and bony features: An in vitro full-field analysis
- Marine resource congestion in China: Identifying, measuring, and assessing its impact on sustainable development of the marine economy
- Analysis of attitudinal components towards statistics among students from different academic degrees
- Effects of fatigue induced by repeated-sprint on kicking accuracy and velocity in female soccer players
- A pre-clinical validation plan to evaluate analytical sensitivities of molecular diagnostics such as BD MAX MDR-TB, Xpert MTB/Rif Ultra and FluoroType MTB
- Leadership for success in transforming medical abortion policy in Canada
- Clinical correlates associated with the long-term response of bipolar disorder patients to lithium, valproate or lamotrigine: A retrospective study
- Determinants of change in long-acting or permanent contraceptives use in Ethiopia; A multivariate decomposition analysis of data from the Ethiopian demographic and health survey
- Forecasting stock prices with long-short term memory neural network based on attention mechanism
- On the genus Crossaster (Echinodermata: Asteroidea) and its distribution
- Intracellular and in vivo evaluation of imidazo[2,1-b]thiazole-5-carboxamide anti-tuberculosis compounds
- Serum amyloid P component promotes formation of distinct aggregated lysozyme morphologies and reduces toxicity in Drosophila flies expressing F57I lysozyme
- Optogenetically induced cellular habituation in non-neuronal cells
- An integrated vitamin E-coated polymer hybrid nanoplatform: A lucrative option for an enhanced in vitro macrophage retention for an anti-hepatitis B therapeutic prospect
- The effect of strontium and silicon substituted hydroxyapatite electrochemical coatings on bone ingrowth and osseointegration of selective laser sintered porous metal implants
- Modeling the Theory of Planned Behaviour to predict adherence to preventive dental visits in preschool children
- Molecular prevalence of Bartonella, Babesia, and hemotropic Mycoplasma species in dogs with hemangiosarcoma from across the United States
- Color discrimination and gas chromatography-mass spectrometry fingerprint based on chemometrics analysis for the quality evaluation of Schizonepetae Spica
- Comparisons of recurrence-free survival and overall survival between microwave versus radiofrequency ablation treatment for hepatocellular carcinoma: A multiple centers retrospective cohort study with propensity score matching
- Transcriptome-wide identification of novel circular RNAs in soybean in response to low-phosphorus stress
- Oral misoprostol, low dose vaginal misoprostol, and vaginal dinoprostone for labor induction: Randomized controlled trial
- The association between dietary patterns before and in early pregnancy and the risk of gestational diabetes mellitus (GDM): Data from the Malaysian SECOST cohort
- Gene expression noise in a complex artificial toxin expression system
- Dynamic Extreme Aneuploidy (DEA) in the vegetable pathogen Phytophthora capsici and the potential for rapid asexual evolution
- Assertive, trainable and older dogs are perceived as more dominant in multi-dog households
- Prediction of Uropathogens by Flow Cytometry and Dip-stick Test Results of Urine Through Multivariable Logistic Regression Analysis
- Accelerated brain aging towards transcriptional inversion in a zebrafish model of the K115fs mutation of human PSEN2
- Copper to Tuscany – Coals to Newcastle? The dynamics of metalwork exchange in early Italy
- The Brazilian TP53 mutation (R337H) and sarcomas
- Interleukin 6 is increased in preclinical HNSCC models of acquired cetuximab resistance, but is not required for maintenance of resistance
- Detection of amitraz resistance and reduced treatment efficacy in the Varroa Mite, Varroa destructor, within commercial beekeeping operations
- Impact of viral disease hypophagia on pig jejunal function and integrity
- Enzyme response of activated sludge to a mixture of emerging contaminants in continuous exposure
- Molecular evidence for horizontal transmission of chelonid alphaherpesvirus 5 at green turtle (Chelonia mydas) foraging grounds in Queensland, Australia
- Technology anxiety and resistance to change behavioral study of a wearable cardiac warming system using an extended TAM for older adults
- Evaluation and validation of 2D biomechanical models of the knee for radiograph-based preoperative planning in total knee arthroplasty
- Soil-Transmitted Helminth infections reduction in Bhutan: A report of 29 years of deworming
- Age-related differences in the temporal dynamics of spectral power during memory encoding
- cagA gene EPIYA motif genetic characterization from Colombian Helicobacter pylori isolates: Standardization of a molecular test for rapid clinical laboratory detection
- Mugharat an-Nachcharini: A specialized sheep-hunting camp reveals high-altitude habitats in the earliest Neolithic of the Central Levant
- Spectral characteristics of urine from patients with end-stage kidney disease analyzed using Raman Chemometric Urinalysis (Rametrix)
- Clinicians’ communication with patients receiving a MCI diagnosis: The ABIDE project
- Quantitative PCR provides a simple and accessible method for quantitative microbiota profiling
- Fast quantitative time lapse displacement imaging of endothelial cell invasion
- Two novel mutations in MSX1 causing oligodontia
- 7,200 years old constructions and mudbrick technology: The evidence from Tel Tsaf, Jordan Valley, Israel
- Tuberculosis recurrences and predictive factors in a vulnerable population in Catalonia
- Dome-shaped macula in children and adolescents
- Barriers in the access, diagnosis and treatment completion for tuberculosis patients in central and western Nepal: A qualitative study among patients, community members and health care workers
- Evaluation of KRAS, NRAS and BRAF mutations detection in plasma using an automated system for patients with metastatic colorectal cancer
- Targeted transcriptomic study of the implication of central metabolic pathways in mannosylerythritol lipids biosynthesis in Pseudozyma antarctica T-34
- Preliminary evidences of the presence of extracellular DNA single stranded forms in soil
- A comparison of quality of life between patients treated with different dialysis modalities in Taiwan
- The effectiveness of substance use interventions for homeless and vulnerably housed persons: A systematic review of systematic reviews on supervised consumption facilities, managed alcohol programs, and pharmacological agents for opioid use disorder
- Spatiotemporal characteristics and driving forces of construction land expansion in Yangtze River economic belt, China
- Comparison of Monocyte Distribution Width (MDW) and Procalcitonin for early recognition of sepsis
- Morphological association between the muscles and bones in the craniofacial region
- Transcriptome analysis of Actinidia chinensis in response to Botryosphaeria dothidea infection
- Evaluating two decision aids for Australian men supporting informed decisions about prostate cancer screening: A randomised controlled trial
- Serum galectins as potential biomarkers of inflammatory bowel diseases
- Linguistic Z-number weighted averaging operators and their application to portfolio selection problem
- Comparative study on skin protection activity of polyphenol-rich extract and polysaccharide-rich extract from Sargassum vachellianum
- Real-world data about emotional stress, disability and need for social care in a German IBD patient cohort
- The regenerative compatibility: A synergy between healthy ecosystems, environmental attitudes, and restorative experiences
- Fusion of augmented reality imaging with the endoscopic view for endonasal skull base surgery; a novel application for surgical navigation based on intraoperative cone beam computed tomography and optical tracking
- Functional characterization of NK cells in Mexican pediatric patients with acute lymphoblastic leukemia: Report from the Mexican Interinstitutional Group for the Identification of the Causes of Childhood Leukemia
- Radiomics signature for prediction of lateral lymph node metastasis in conventional papillary thyroid carcinoma
- Antenatal depression and its association with adverse birth outcomes in low and middle-income countries: A systematic review and meta-analysis
- Perceptions of risk and influences of choice in pregnant women with obesity. An evidence synthesis of qualitative research
- The role of refugee and migrant migration status on medication adherence: Mediation through illness perceptions
- Job stress and emotional exhaustion at work in Spanish workers: Does unhealthy work affect the decision to drive?
- Correction: Amphibians on the hotspot: Molecular biology and conservation in the South American Atlantic Rainforest
- Sexual risk classes among youth experiencing homelessness: Relation to childhood adversities, current mental symptoms, substance use, and HIV testing
- Time for change is now: Experiences of participants in a community-based approach for iron and folic acid supplementation in a rural county in Kenya, a qualitative study
- Non-invasive genetic monitoring for the threatened valley elderberry longhorn beetle
- Statistical learning for turboshaft helicopter accidents using logistic regression
- Vegetation change over seven years in the largest protected Pacific Northwest Bunchgrass Prairie remnant
- The effect of various metal-salts on the sedimentation of soil in a water-based suspension
- Using electronic health record system triggers to target delivery of a patient-centered intervention to improve venous thromboembolism prevention for hospitalized patients: Is there a differential effect by race?
- Effects of CK2β subunit down-regulation on Akt signalling in HK-2 renal cells
- Novel broad-spectrum activity-based probes to profile malarial cysteine proteases
- Health-related quality of life in cancer patients treated with immune checkpoint inhibitors: A systematic review on reporting of methods in randomized controlled trials
- Environmental tobacco smoke (ETS) and hyperlipidemia modified by perceived work stress
- Association between opioid analgesic therapy and initiation of buprenorphine management: An analysis of prescription drug monitoring program data
- Effect of a community-based approach of iron and folic acid supplementation on compliance by pregnant women in Kiambu County, Kenya: A quasi-experimental study
- Radiocarbon dating of two old African baobabs from India
- Improvement project in higher education institutions: A BPEP-based model
- An updated evaluation of serum sHER2, CA15.3, and CEA levels as biomarkers for the response of patients with metastatic breast cancer to trastuzumab-based therapies
- Genome-wide association study of metabolic syndrome in Korean populations
- The diagnostic accuracy of liver fibrosis in non-viral liver diseases using acoustic radiation force impulse elastography: A systematic review and meta-analysis
- Drug therapy problems and treatment satisfaction among ambulatory patients with epilepsy in a specialized hospital in Ethiopia
- Short- & long-term effects of monetary and non-monetary incentives to cooperate in public good games: An experiment
- Niche modeling reveals life history shifts in birds at La Brea over the last twenty millennia
- Morphological consequences of artificial cranial deformation: Modularity and integration
- Distributed flux balance analysis simulations of serial biomass fermentation by two organisms
- Plasma kynurenines and prognosis in patients with heart failure
- Occurrence and distribution of anthropogenic persistent organic pollutants in coastal sediments and mud shrimps from the wetland of central Taiwan
- Intensified visual clutter induces increased sympathetic signalling, poorer postural control, and faster torsional eye movements during visual rotation
- Restoration of cortical symmetry and binaural function: Cortical auditory evoked responses in adult cochlear implant users with single sided deafness
- A smartphone-enabled wireless and batteryless implantable blood flow sensor for remote monitoring of prosthetic heart valve function
- Gut microbiota composition alterations are associated with the onset of diabetes in kidney transplant recipients
- Shock index and TIMI risk index as valuable prognostic tools in patients with acute coronary syndrome complicated by cardiogenic shock
- Merit overrules theory of mind when young children share resources with others
- Economic burden of maternal morbidity – A systematic review of cost-of-illness studies
- Comparison of balance changes after inspiratory muscle or Otago exercise training
- Correction: Escherichia coli and Salmonella spp. isolated from Australian meat chickens remain susceptible to critically important antimicrobial agents
- Metabolic analysis of amino acids and vitamin B6 pathways in lymphoma survivors with cancer related chronic fatigue
- Cell-free DNA donor fraction analysis in pediatric and adult heart transplant patients by multiplexed allele-specific quantitative PCR: Validation of a rapid and highly sensitive clinical test for stratification of rejection probability
- Immunopathogenesis of canine chronic ulcerative stomatitis
- Correction: Quantification of speech and synchrony in the conversation of adults with autism spectrum disorder
- Efficacy and safety of ultrasonic circular cyclocoagulation with second-generation probe in glaucoma: A retrospective study
- Generalizing findings from a randomized controlled trial to a real-world study of the iLookOut, an online education program to improve early childhood care and education providers’ knowledge and attitudes about reporting child maltreatment
- Self-selection of food ingredients and agricultural by-products by the house cricket, Acheta domesticus (Orthoptera: Gryllidae): A holistic approach to develop optimized diets
- Machine learning detection of Atrial Fibrillation using wearable technology
- Comparative proteomic analysis of different stages of breast cancer tissues using ultra high performance liquid chromatography tandem mass spectrometer
- A cross-sectional study of psychopathy and khat abuse among prisoners in the correctional institution in Jimma, Ethiopia
- Head impulse compensatory saccades: Visual dependence is most evident in bilateral vestibular loss
- Complementarity of empirical and process-based approaches to modelling mosquito population dynamics with Aedes albopictus as an example—Application to the development of an operational mapping tool of vector populations
- Pepsin promotes laryngopharyngeal neoplasia by modulating signaling pathways to induce cell proliferation
- When and what to test for: A cost-effectiveness analysis of febrile illness test-and-treat strategies in the era of responsible antibiotic use
- Comparison of effects and safety in providing controlled hypotension during surgery between dexmedetomidine and magnesium sulphate: A meta-analysis of randomized controlled trials
- The gene encoding the ketogenic enzyme HMGCS2 displays a unique expression during gonad development in mice
- Seroepidemiological study of rubella in Vojvodina, Serbia: 24 years after the introduction of the MMR vaccine in the national immunization programme
- Efficacy of a mitochondrion-targeting agent for reducing the level of urinary protein in rats with puromycin aminonucleoside-induced minimal-change nephrotic syndrome
- Association of endothelial nitric oxide synthase (NOS3) gene polymorphisms with primary open-angle glaucoma in a Saudi cohort
- Antitrust analysis with upward pricing pressure and cost efficiencies
- Machine learning models for identifying preterm infants at risk of cerebral hemorrhage
- Natural selection contributes to food web stability
- Pyramiding QTLs controlling tolerance against drought, salinity, and submergence in rice through marker assisted breeding
- Diversity and plant growth-promoting functions of diazotrophic/N-scavenging bacteria isolated from the soils and rhizospheres of two species of Solanum
- Sustainability effects of motor control stabilisation exercises on pain and function in chronic nonspecific low back pain patients: A systematic review with meta-analysis and meta-regression
- Sofosbuvir-based regimen for genotype 2 HCV infected patients in Taiwan: A real world experience
- The virulence domain of Shigella IcsA contains a subregion with specific host cell adhesion function
- Sequencing artifacts derived from a library preparation method using enzymatic fragmentation
- Analysis of the Rdr1 gene family in different Rosaceae genomes reveals an origin of an R-gene cluster after the split of Rubeae within the Rosoideae subfamily
- Concomitant phytonutrient and transcriptome analysis of mature fruit and leaf tissues of tomato (Solanum lycopersicum L. cv. Oregon Spring) grown using organic and conventional fertilizer
- Quantitative analysis of adsorption and desorption of volatile organic compounds on reusable zeolite filters using gas chromatography
- Comparing bioinformatic pipelines for microbial 16S rRNA amplicon sequencing
- TMEM98 is a negative regulator of FRAT mediated Wnt/ß-catenin signalling
- Modeling migration patterns in the USA under sea level rise
- Quo vadis Pantanal? Expected precipitation extremes and drought dynamics from changing sea surface temperature
- Cloud-computing and machine learning in support of country-level land cover and ecosystem extent mapping in Liberia and Gabon
- An exploratory study on the quality of patient screening and counseling for hypertension management in Tanzania
- Relation of fibroblast growth factor receptor 2 expression to hepatocellular carcinoma recurrence after liver resection
- The Brief Measure of Emotional Preoperative Stress (B-MEPS) as a new predictive tool for postoperative pain: A prospective observational cohort study
- The impact of diabetes mellitus medication on the incidence of endogenous endophthalmitis
- Correction: Chl1 DNA helicase and Scc2 function in chromosome condensation through cohesin deposition
- Clinical and pathological features of thrombotic microangiopathy influencing long-term kidney transplant outcomes
- Multidisciplinary investigation of two Egyptian child mummies curated at the University of Tartu Art Museum, Estonia (Late/Graeco-Roman Periods)
- Occupational exposure to particulate matter from air pollution in the outdoor workplaces in Almaty during the cold season
- Morphological adjustment in free-living Steinernema feltiae infective juveniles to increasing concentration of Nemafric-BL phytonematicide
- Murine Surf4 is essential for early embryonic development
- Using mHealth to improve health care delivery in India: A qualitative examination of the perspectives of community health workers and beneficiaries
- Algorithmic handwriting analysis of the Samaria inscriptions illuminates bureaucratic apparatus in biblical Israel
- Key necroptotic proteins are required for Smac mimetic-mediated sensitization of cholangiocarcinoma cells to TNF-α and chemotherapeutic gemcitabine-induced necroptosis
- Concurrent lipidomics and proteomics on malignant plasma cells from multiple myeloma patients: Probing the lipid metabolome
- Short treatment with antalarmin alters adrenal gland receptors in the rat model of endometriosis
- Is it really always only the others who are to blame? GP’s view on medical overuse. A questionnaire study
- Serum visfatin and vaspin levels in hepatocellular carcinoma (HCC)
- Retraction: SDR9C7 Promotes Lymph Node Metastases in Patients with Esophageal Squamous Cell Carcinoma
- iTRAQ proteomics reveals the regulatory response to Magnaporthe oryzae in durable resistant vs. susceptible rice genotypes
- A smartphone-based test for the assessment of attention deficits in delirium: A case-control diagnostic test accuracy study in older hospitalised patients
- Association between tuberculosis and depression on negative outcomes of tuberculosis treatment: A systematic review and meta-analysis
- Incidence and predictors of loss to follow up among adult HIV patients on antiretroviral therapy in University of Gondar Comprehensive Specialized Hospital: A competing risk regression modeling
- Point-of-care diagnostic (POCD) method for detecting Bursaphelenchus xylophilus in pinewood using recombinase polymerase amplification (RPA) with the portable optical isothermal device (POID)
- Bioluminescent imaging of Arabidopsis thaliana using an enhanced Nano-lantern luminescence reporter system
- Biosynthetic pathway of indole-3-acetic acid in ectomycorrhizal fungi collected from northern Thailand
- Clinical implications of elevated serum interleukin-6 in IgG4-related disease
- Downscaling NLDAS-2 daily maximum air temperatures using MODIS land surface temperatures
- Sex-specific and opposite modulatory aspects revealed by PPI network and pathway analysis of ischemic stroke in humans
- Plasma Trimethylamine-N-oxide and impaired glucose regulation: Results from The Oral Infections, Glucose Intolerance and Insulin Resistance Study (ORIGINS)
- Self-esteem and other risk factors for depressive symptoms among adolescents in United Arab Emirates
- Control of the microsporidian parasite Nosema ceranae in honey bees (Apis mellifera) using nutraceutical and immuno-stimulatory compounds
- The effect of storage conditions on microbial communities in stool
- Role of donor genotype in RT-QuIC seeding activity of chronic wasting disease prions using human and bank vole substrates
- Influence of flow on phosphorus-dynamics and particle size in agricultural drainage ditch sediments
- A prospective, randomized, double-blind trial to compare body weight-adjusted and fixed doses of palonosetron for preventing postoperative nausea and vomiting in obese female patients
- Application of computerized 3D-CT texture analysis of pancreas for the assessment of patients with diabetes
- Predictive validation and forecasts of short-term changes in healthcare expenditure associated with changes in smoking behavior in the United States
- An information-based approach to handle various types of uncertainty in fuzzy bodies of evidence
- Oral magnesium supplementation for leg cramps in pregnancy—An observational controlled trial
- Health care professionals’ knowledge of commonly used sedative, analgesic and neuromuscular drugs: A single center (Rambam Health Care Campus), prospective, observational survey
- Campylobacter portucalensis sp. nov., a new species of Campylobacter isolated from the preputial mucosa of bulls
- OGG1 deficiency alters the intestinal microbiome and increases intestinal inflammation in a mouse model
- Transgenic interleukin 11 expression causes cross-tissue fibro-inflammation and an inflammatory bowel phenotype in mice
- Novel method to measure temporal windows based on eye movements during viewing of the Necker cube
- Whole blood transcriptomic analysis of beef cattle at arrival identifies potential predictive molecules and mechanisms that indicate animals that naturally resist bovine respiratory disease
- Effects of smoke flavoring using different wood chips and barbecuing on the formation of polycyclic aromatic hydrocarbons and heterocyclic aromatic amines in salmon fillets
- Sleep quality and sex modify the relationships between trait energy and fatigue on state energy and fatigue
- The role of peer, parental, and school norms in predicting adolescents’ attitudes and behaviours of majority and different minority ethnic groups in Croatia
- Filtered beauty in Oslo and Tokyo: A spatial frequency analysis of facial attractiveness
- The impact of rehabilitation frequency on the risk of stroke in patients with rheumatoid arthritis
- Availability, prices and affordability of selected antibiotics and medicines against non-communicable diseases in western Cameroon and northeast DR Congo
- The effect of mutations derived from mouse-adapted H3N2 seasonal influenza A virus to pathogenicity and host adaptation
- Detection of posttraumatic pneumothorax using electrical impedance tomography—An observer-blinded study in pigs with blunt chest trauma
- Educators’ perceptions of organisational readiness for implementation of a pre-adolescent transdisciplinary school health intervention for inter-generational outcomes
- Beyond the heterodimer model for mineralocorticoid and glucocorticoid receptor interactions in nuclei and at DNA
- The effects of sport expertise and shot results on basketball players’ action anticipation
- Framework and algorithms for identifying honest blocks in blockchain
- Efficacy and safety of anti-viral therapy for Hepatitis B virus-associated glomerulonephritis: A meta-analysis
- Selective transmission of some HIV-1 subtype C variants might depend on Envelope stimulating dendritic cells to secrete IL-10
- Noise reduction and quantification of fiber orientations in greyscale images
- Exploring the impact of terminology differences in blood and organ donor decision making
- Ontogenetic similarities between giraffe and sauropod neck osteological mobility
- Load transfer mechanism and critical length of anchorage zone for anchor bolt
- Income inequalities in stroke incidence and mortality: Trends in stroke-free and stroke-affected life years based on German health insurance data
- Community’s perception, experiences and health seeking behavior towards newborn illnesses in Debre Libanos District, North Shoa, Oromia, Ethiopia: Qualitative study
- Platelet indices significantly correlate with liver fibrosis in HCV-infected patients
- Reanalysis of the Bridge et al. study of suicide following release of 13 Reasons Why
- Validation of the easyscreen flavivirus dengue alphavirus detection kit based on 3base amplification technology and its application to the 2016/17 Vanuatu dengue outbreak
- The nitrate content of fresh and cooked vegetables and their health-related risks
- Bioreactor for mobilization of mesenchymal stem/stromal cells into scaffolds under mechanical stimulation: Preliminary results
- Serotonin transporter dependent modulation of food-seeking behavior
- Implicit task switching in Parkinson’s disease is preserved when on medication
- Root treatment with oxathiapiprolin, benthiavalicarb or their mixture provides prolonged systemic protection against oomycete foliar pathogens
- Real-world effectiveness and safety of ranibizumab for the treatment of myopic choroidal neovascularization: Results from the LUMINOUS study
- Non-gradient and genotype-dependent patterns of RSV gene expression
- Multiplex real-time PCR for the detection of Clavibacter michiganensis subsp. michiganensis, Pseudomonas syringae pv. tomato and pathogenic Xanthomonas species on tomato plants
- The 24-hour urinary cortisol in post-traumatic stress disorder: A meta-analysis
- Parasites modulate the gut-microbiome in insects: A proof-of-concept study
- The dynamics of shapes of vesicle membranes with time dependent spontaneous curvature
- Vascularization and biocompatibility of poly(ε-caprolactone) fiber mats for rotator cuff tear repair
- The shield of self-compassion: A buffer against disordered eating risk from physical appearance perfectionism
- Disease-specific out-of-pocket healthcare expenditure in urban Bangladesh: A Bayesian analysis
- Advanced biofilm analysis in streams receiving organic deicer runoff
- Upregulation of long non-coding RNA ROR1-AS1 promotes cell growth and migration in bladder cancer by regulation of miR-504
- Method development and validation for rapid identification of epigallocatechin gallate using ultra-high performance liquid chromatography
- Neonatal sepsis in Iran: A systematic review and meta-analysis on national prevalence and causative pathogens
- Drug-eluting versus bare-metal stents for first myocardial infarction in patients with atrial fibrillation: A nationwide population-based cohort study
- Same-day antiretroviral therapy initiation for HIV-infected adults in South Africa: Analysis of routine data
- Health-related quality of life among patients with type 2 diabetes mellitus in Eastern Province, Saudi Arabia: A cross-sectional study
- Photocatalytic biocidal effect of copper doped TiO2 nanotube coated surfaces under laminar flow, illuminated with UVA light on Legionella pneumophila
- The interoceptive hippocampus: Mouse brain endocrine receptor expression highlights a dentate gyrus (DG)–cornu ammonis (CA) challenge–sufficiency axis
- Educational attainment and HIV testing and counselling service utilisation during antenatal care in Ghana: Analysis of Demographic and Health Surveys
- Dissection of flag leaf metabolic shifts and their relationship with those occurring simultaneously in developing seed by application of non-targeted metabolomics
- Centromeres of Cucumis melo L. comprise Cmcent and two novel repeats, CmSat162 and CmSat189
- Acute high-intensity and moderate-intensity interval exercise do not change corticospinal excitability in low fit, young adults
- “I like the way I am, but I feel like I could get a little bit bigger”: Perceptions of body image among adolescents and youth living with HIV in Durban, South Africa
- Nanoparticle-based ‘turn-on’ scattering and post-sample fluorescence for ultrasensitive detection of water pollution in wider window
- The relationship of moral sensitivity and patient safety attitudes with nursing students’ perceptions of disclosure of patient safety incidents: A cross-sectional study
- Insights into the strategy of micro-environmental adaptation: Transcriptomic analysis of two alvinocaridid shrimps at a hydrothermal vent
- Thirty-day readmission after medical-surgical hospitalization for people who experience imprisonment in Ontario, Canada: A retrospective cohort study
- The effect of long-term brine discharge from desalination plants on benthic foraminifera
- Hyper-spectral response and estimation model of soil degradation in Kenli County, the Yellow River Delta
- Prescribing trends of glaucoma drugs in six major cities of China from 2013 to 2017
- Significant changes in synovial fluid microRNAs after high tibial osteotomy in medial compartmental knee osteoarthritis: Identification of potential prognostic biomarkers
- Reassortment and adaptive mutations of an emerging avian influenza virus H7N4 subtype in China
- Ischemia and reperfusion injury in superficial inferior epigastric artery-based vascularized lymph node flaps
- High failure rates of protease inhibitor-based antiretroviral treatment in rural Tanzania – A prospective cohort study
- Switchable resolution in soft x-ray tomography of single cells
- Mitochondrial DNA variations and mitochondrial dysfunction in Fanconi anemia
- Extended-spectrum beta-lactamase (ESBL)-producing and non-ESBL-producing Escherichia coli isolates causing bacteremia in the Netherlands (2014 – 2016) differ in clonal distribution, antimicrobial resistance gene and virulence gene content
- Molecular characterization of blaKHM-1 encoding plasmid in an Enterobacter hormaechei subsp. hoffmannii isolate from blood culture
- PR3 levels are impaired in plasma and PBMCs from Arabs with cardiovascular diseases
- Sex differences in self-regulation in early, middle and late adolescence: A large-scale cross-sectional study
- Interaction between elevated temperature and different types of Na-salicylate treatment in Brachypodium dystachion
- A highway crash risk assessment method based on traffic safety state division
- A brain connectivity characterization of children with different levels of mathematical achievement based on graph metrics
- Quantifying the level of difficulty to treat major depressive disorder with antidepressants: Treatment Resistance to Antidepressants Evaluation Scale
- Occupational gender segregation and economic growth in U.S. local labor markets, 1980 through 2010
- The association of telomere length and telomerase activity with adverse outcomes in older patients with non-ST-elevation acute coronary syndrome
- Construction of a high-density genetic map and fine mapping of a candidate gene locus for a novel branched-spike mutant in barley
- Alterations of aqueous humor Aβ levels in Aβ-infused and transgenic mouse models of Alzheimer disease
- Parameters impacting the live birth rate per transfer after frozen single euploid blastocyst transfer
- Deep2Full: Evaluating strategies for selecting the minimal mutational experiments for optimal computational predictions of deep mutational scan outcomes
- Economic compensation interventions to increase uptake of voluntary medical male circumcision for HIV prevention: A systematic review and meta-analysis
- Distinctive effect of anesthetics on the effect of limb remote ischemic postconditioning following ischemic stroke
- Natural hybridization between Phyllagathis and Sporoxeia species produces a hybrid without reproductive organs
- Preliminary evaluation of a novel nine-biomarker profile for the prediction of autism spectrum disorder
- The impact of peer attachment on prosocial behavior, emotional difficulties and conduct problems in adolescence: The mediating role of empathy
- Spatial and climatic variables independently drive elevational gradients in ant species richness in the Eastern Himalaya
- What is the qualitative evidence concerning the risks, diagnosis, management and consequences of gastrointestinal infections in the community in the United Kingdom? A systematic review and meta-ethnography
- Naringenin protects AlCl3/D-galactose induced neurotoxicity in rat model of AD via attenuation of acetylcholinesterase levels and inhibition of oxidative stress
- Key barriers and enablers associated with uptake and continuation of oral pre-exposure prophylaxis (PrEP) in the public sector in Zimbabwe: Qualitative perspectives of general population clients at high risk for HIV
- Characterizing the University of California’s tenure-track teaching position from the faculty and administrator perspectives
- Restoration of Mal overcomes the defects of apoptosis in lung cancer cells
- Patient preferences for maintenance therapy in Crohn’s disease: A discrete-choice experiment
- Diagnostic performance of serum interferon gamma, matrix metalloproteinases, and periostin measurements for pulmonary tuberculosis in Japanese patients with pneumonia
- Hesperidin improves insulin resistance via down-regulation of inflammatory responses: Biochemical analysis and in silico validation
- Accuracy of intraocular lens power calculation formulas using a swept-source optical biometer
- Characterization of black patina from the Tiber River embankments using Next-Generation Sequencing
- Comparison of blood lactate and perceived exertion responses in two matched time-under-tension protocols
- Fibrin hydrogels are safe, degradable scaffolds for sub-retinal implantation
- Post-translational modifications of Drosophila melanogaster HOX protein, Sex combs reduced
- Problem gambling, associations with comorbid health conditions, substance use, and behavioural addictions: Opportunities for pathways to treatment
- Liganded T3 receptor β2 inhibits the positive feedback autoregulation of the gene for GATA2, a transcription factor critical for thyrotropin production
- Characterization of METTL16 as a cytoplasmic RNA binding protein
- Impact of long-term storage and freeze-thawing on eight circulating microRNAs in plasma samples
- Nanosheet wrapping-assisted coverslip-free imaging for looking deeper into a tissue at high resolution
- Assessment of dynamic cerebral autoregulation in humans: Is reproducibility dependent on blood pressure variability?
- Early diagnosis of sepsis in emergency departments, time to treatment, and association with mortality: An observational study
- Validity of cerebrovascular ICD-9-CM codes in healthcare administrative databases. The Umbria Data-Value Project
- Tuberculoid leprosy: An in vivo microvascular evaluation of cutaneous lesions
- Neuromuscular blockers in the acute respiratory distress syndrome: A meta-analysis
- Identification of putative Type-I sex pheromone biosynthesis-related genes expressed in the female pheromone gland of Streltzoviella insularis
- Redefining transcriptional regulation of the APOE gene and its association with Alzheimer’s disease
- Disease-relevant mutations alter amino acid co-evolution networks in the second nucleotide binding domain of CFTR
- A bushel of viruses: Identification of seventeen novel putative viruses by RNA-seq in six apple trees
- Torque teno virus viral load is related to age, CMV infection and HLA type but not to Alzheimer's disease
- The variability of bacterial communities in both the endosphere and ectosphere of different niches in Chinese chives (Allium tuberosum)
- Tripartite factors leading to molecular divergence between human and murine smooth muscle
- Characterization of dermal skin innervation in fibromyalgia syndrome
- A neonatal nonhuman primate model of gestational Zika virus infection with evidence of microencephaly, seizures and cardiomyopathy
- A scoping review of importation and predictive models related to vector-borne diseases, pathogens, reservoirs, or vectors (1999–2016)
- Assessment of climate change impact on the malaria vector Anopheles hyrcanus, West Nile disease, and incidence of melanoma in the Vojvodina Province (Serbia) using data from a regional climate model
- Associations of cigarette smoking and burden of thoracic aortic calcification in asymptomatic individuals: A dose-response relationship
- Healthcare utilization of Mexican-American Medicare beneficiaries with and without Alzheimer’s disease and related dementias
- Evaluation of questionnaire as an instrument to measure the level of nutritional and weight gain knowledge in pregnant women in Poland. A pilot study
- TranCEP: Predicting the substrate class of transmembrane transport proteins using compositional, evolutionary, and positional information
- Non-Invasive Functional-Brain-Imaging with an OPM-based Magnetoencephalography System
- Expression of acyl-CoA-binding protein 5 from Rhodnius prolixus and its inhibition by RNA interference
- Transforming assessment of speech in children with cleft palate via online crowdsourcing
- High prevalence of off-label and unlicensed paediatric prescribing in a hospital in Indonesia during the period Aug.—Oct. 2014
- General practice management of rotator cuff related shoulder pain: A reliance on ultrasound and injection guided care
- Estimating the population size of female sex workers and transgender women in Sri Lanka
- Can helmet decrease mortality of craniocerebral trauma patients in a motorcycle accident?: A propensity score matching
- Obesity, smoking habits, and serum phosphate levels predicts mortality after life-style intervention
- Treatment of children under 4 years of age with medulloblastoma and ependymoma in the HIT2000/HIT-REZ 2005 trials: Neuropsychological outcome 5 years after treatment
- Can a semi-quantitative method replace the current quantitative method for the annual screening of microalbuminuria in patients with diabetes? Diagnostic accuracy and cost-saving analysis considering the potential health burden
- A two-arm parallel double-blind randomised controlled pilot trial of the efficacy of Omega-3 polyunsaturated fatty acids for the treatment of women with endometriosis-associated pain (PurFECT1)
- Association of benzodiazepines, opioids and tricyclic antidepressants use and falls in trauma patients: Conditional effect of age
- Burden and risk factors of cutaneous leishmaniasis in a peri-urban settlement in Kenya, 2016
- Predicting strike susceptibility and collision patterns of the common buzzard at wind turbine structures in the federal state of Brandenburg, Germany
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- Adverse drug reaction reporting practice and associated factors among medical doctors in government hospitals in Addis Ababa, Ethiopia
- TaWAK6 encoding wall-associated kinase is involved in wheat resistance to leaf rust similar to adult plant resistance
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- Perceived relative social status and cognitive load influence acceptance of unfair offers in the Ultimatum Game
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- Structure-function analyses of candidate small molecule RPN13 inhibitors with antitumor properties
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- Multiple fragmented habitat-patch use in an urban breeding passerine, the Short-toed Treecreeper
- Histological and immunohistochemical characterization of the porcine ocular surface
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- Characteristics and prognosis of primary treatment-naïve oral cavity squamous cell carcinoma in Norway, a descriptive retrospective study
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- Error rates of human reviewers during abstract screening in systematic reviews
- Faecal analyses and alimentary tracers reveal the foraging ecology of two sympatric bats
- Urethral realignment with maximal urethral length and bladder neck preservation in robot-assisted radical prostatectomy: Urinary continence recovery
- Error metrics determination in functionally approximated circuits using SAT solvers
- Spatial movement pattern recognition in soccer based on relative player movements
- A novel visual ranking system based on arterial spin labeling perfusion imaging for evaluating perfusion disturbance in patients with ischemic stroke
- Prospective Validation of the Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) Score for Necrotizing Fasciitis of the Extremities
- The importance of transporters and cell polarization for the evaluation of human stem cell-derived hepatic cells
- Incidence, trends, and outcomes of infection sites among hospitalizations of sepsis: A nationwide study
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- And the nominees are: Using design-awards datasets to build computational aesthetic evaluation model
- Service delivery interventions to increase uptake of voluntary medical male circumcision for HIV prevention: A systematic review
- Multidimensional Scales of Perceived Self-Efficacy (MSPSE): Measurement invariance across Italian and Colombian adolescents
- Diversity of Mycobacteriaceae from aquatic environment at the São Paulo Zoological Park Foundation in Brazil
- A graph-based algorithm for RNA-seq data normalization
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- Pharmacokinetics, absolute bioavailability and tolerability of ketamine after intranasal administration to dexmedetomidine sedated dogs
- Spatial variation in fertilizer prices in Sub-Saharan Africa
- Knowledge, beliefs, and concerns about bone health from a systematic review and metasynthesis of qualitative studies
- Successful isolation of Treponema pallidum strains from patients’ cryopreserved ulcer exudate using the rabbit model
- Effects of size and elasticity on the relation between flow velocity and wall shear stress in side-wall aneurysms: A lattice Boltzmann-based computer simulation study
- Pupil response to noxious corneal stimulation
- Incidence, risk factors and healthcare costs of central line-associated nosocomial bloodstream infections in hematologic and oncologic patients
- The impact of computed radiography and teleradiology on patients’ diagnosis and treatment in Mweso, the Democratic Republic of Congo
- Differential effects of synthetic psychoactive cathinones and amphetamine stimulants on the gut microbiome in mice
- Hepatitis B and C virus infection among HIV patients within the public and private healthcare systems in Chile: A cross-sectional serosurvey
- Increased episodes of aspiration on videofluoroscopic swallow study in children with nasogastric tube placement
- Obstructive sleep apnea and hypopnea syndrome in patients admitted in a tertiary hospital in Cameroon: Prevalence and associated factors
- Association of single nucleotide polymorphisms with dyslipidemia in antiretroviral exposed HIV patients in a Ghanaian population: A case-control study
- Sonic Hedgehog upregulation does not enhance the survival and engraftment of stem cell-derived cardiomyocytes in infarcted hearts
- The pharmacokinetic parameters and the effect of a single and repeated doses of memantine on gastric myoelectric activity in experimental pigs
- Blind method for discovering number of clusters in multidimensional datasets by regression on linkage hierarchies generated from random data
- Predictive factors of first dosage intravenous immunoglobulin-related adverse effects in children
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- Individual and community level determinants of short birth interval in Ethiopia: A multilevel analysis
- Effects of rejection intensity and rejection sensitivity on social approach behavior in women
- The impact of IoT security labelling on consumer product choice and willingness to pay
- The development and validation of a measurement instrument to investigate determinants of health care utilisation for low back pain in Ethiopia
- Validity of the French version of the Autonomy Preference Index and its adaptation for patients with advanced cancer
- The epidemiological characteristics and spatio-temporal analysis of childhood hand, foot and mouth disease in Korea, 2011-2017
- Exponential random graph model parameter estimation for very large directed networks
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- Effect of temperature variation on hospital admissions and outcomes in dogs with myxomatous mitral valve disease and new onset pulmonary edema
- The development of the Police Practices Scale: Understanding policing approaches towards street-based female sex workers in a U.S. City
- A capability approach to assess aquaculture sustainability standard compliance
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- Optimization of cytotoxic activity of Nocardia sp culture broths using a design of experiments
- Tissue-resident macrophages can be generated de novo in adult human skin from resident progenitor cells during substance P-mediated neurogenic inflammation ex vivo
- Microbiota in foods from Inuit traditional hunting
- Investigating Italian disinformation spreading on Twitter in the context of 2019 European elections
- In vivo expression of peptidylarginine deiminase in Drosophila melanogaster
- Modelling zero-truncated overdispersed antenatal health care count data of women in Bangladesh
- Detection and density of breeding marsh birds in Iowa wetlands
- A lineage-specific rapid diagnostic test (Chagas Sero K-SeT) identifies Brazilian Trypanosoma cruzi II/V/VI reservoir hosts among diverse mammalian orders
- Aromatase deficiency in hematopoietic cells improves glucose tolerance in male mice through skeletal muscle-specific effects
- If host is refractory, insistent parasite goes berserk: Trypanosomatid Blastocrithidia raabei in the dock bug Coreus marginatus
- Antimicrobial resistance patterns and molecular resistance markers of Campylobacter jejuni isolates from human diarrheal cases
- Protective role of brain derived neurotrophic factor (BDNF) in obstructive sleep apnea syndrome (OSAS) patients
- An IL-18-centered inflammatory network as a biomarker for cerebral white matter injury
- Prevalence of antiphospholipid antibodies in Behçet's disease: A systematic review and meta-analysis
- Chemical analysis of snus products from the United States and northern Europe
- Effect of prednisolone on glyoxalase 1 in an inbred mouse model of aristolochic acid nephropathy using a proteomics method with fluorogenic derivatization-liquid chromatography-tandem mass spectrometry
- Impact of early-onset persistent stunting on cognitive development at 5 years of age: Results from a multi-country cohort study
- Aggregation of CAT tails blocks their degradation and causes proteotoxicity in S. cerevisiae
- Expression of concern: Compensatory increase of transglutaminase 2 is responsible for resistance to mTOR inhibitor treatment
- Common mental illness among epilepsy patients in Bahir Dar city, Ethiopia: A cross-sectional study
- Staging dementia based on caregiver reported patient symptoms: Implications from a latent class analysis
- Health-related quality of life and its determinants among ambulatory patients with epilepsy at Ambo General Hospital, Ethiopia: Using WHOQOL-BREF
- In silico analysis and high-risk pathogenic phenotype predictions of non-synonymous single nucleotide polymorphisms in human Crystallin beta A4 gene associated with congenital cataract
- Fungal diversity in canopy soil of silver beech, Nothofagus menziesii (Nothofagaceae)
- Referral decisions and its predictors related to orthopaedic care. A retrospective study in a novel primary care setting
- Readiness to prescribe: Using educational design to untie the Gordian Knot
- Influence of gelation on the retention of purple cactus pear extract in microencapsulated double emulsions
- Factors related to met needs for rehabilitation 6 years after stroke
- Association of cataract and sun exposure in geographically diverse populations of India: The CASE study. First Report of the ICMR-EYE SEE Study Group
- Investigation of injury severity in urban expressway crashes: A case study from Beijing
- Clinical outcomes of incident peritoneal dialysis patients coming from kidney transplantation program: A case-control study
- Evaluation of the factors influencing the housing safety awareness of residents in Shanghai
- Morphometric study of the diaphragmatic surface of the liver in the human fetus
- Food insecurity and dietary diversity among lactating mothers in the urban municipality in the mountains of Nepal
- Genetic characterization of Bacillus anthracis strains circulating in Italy from 1972 to 2018
- Promising antifungal activity of new oxadiazole against Candida krusei
- An atlas of personality, emotion and behaviour
- Long-term effects of intracranial islet grafting on cognitive functioning in a rat metabolic model of sporadic Alzheimer's disease-like dementia
- Compartmentalized profiling of amniotic fluid cytokines in women with preterm labor
- Comparison of the myometrial transcriptome from singleton and twin pregnancies by RNA-Seq
- Adverse reproductive effects of S100A9 on bovine sperm and early embryonic development in vitro
- Functional dynamics of bacterial species in the mouse gut microbiome revealed by metagenomic and metatranscriptomic analyses
- Astrocyte senescence promotes glutamate toxicity in cortical neurons
- Primary ciliary dyskinesia and psychological well-being in adolescence
- Dipeptidyl peptidase-4 is increased in the abdominal aortic aneurysm vessel wall and is associated with aneurysm disease processes
- Primary care physician knowledge, attitudes, and diagnostic testing practices for norovirus and acute gastroenteritis
- Microfluidic-prepared DOTAP nanoparticles induce strong T-cell responses in mice
- Intraocular scattering as a predictor of driving performance in older adults with cataracts
- Reduced bone mineral density among HIV infected patients on anti-retroviral therapy in Blantyre, Malawi: Prevalence and associated factors
- Correction: Extraversion personality, perceived health and activity participation among community-dwelling aging adults in Hong Kong
- A rainwater control optimization design approach for airports based on a self-organizing feature map neural network model
- Influence of inflammasome NLRP3, and IL1B and IL2 gene polymorphisms in periodontitis susceptibility
- 18F-FDG-PET/MRI in the diagnostic work-up of limbic encephalitis
- The socioeconomic impact of orthopaedic trauma: A systematic review and meta-analysis
- Treatment patterns among patients with moderate-to-severe ulcerative colitis in the United States and Europe
- City to city learning and knowledge exchange for climate resilience in southern Africa
- Nuclear translocation of Atox1 potentiates activin A-induced cell migration and colony formation in colon cancer
- Activity-dependent switches between dynamic regimes of extracellular matrix expression
- Molecular sequencing and morphological identification reveal similar patterns in native bee communities across public and private grasslands of eastern North Dakota
- A mathematical model for assessing the effectiveness of controlling relapse in Plasmodium vivax malaria endemic in the Republic of Korea
- Cryo-focused ion beam preparation of perovskite based solar cells for atom probe tomography
- Physiological and transcriptomic responses of Lanzhou Lily (Lilium davidii, var. unicolor) to cold stress
- Unusual genome expansion and transcription suppression in ectomycorrhizal Tricholoma matsutake by insertions of transposable elements
- Estimating associations between antidepressant use and incident mild cognitive impairment in older adults with depression
- The use of telephone communication between nurse navigators and their patients
- CNP mediated selective toxicity on melanoma cells is accompanied by mitochondrial dysfunction
- HIV RNA measurement in dried blood spots of HIV-infected patients in Thailand using Abbott m2000 system
- Retraction: Oncogenic Fibulin-5 Promotes Nasopharyngeal Carcinoma Cell Metastasis through the FLJ10540/AKT Pathway and Correlates with Poor Prognosis
- Ultra-rapid cooling of ibex sperm by spheres method does not induce a vitreous extracellular state and increases the membrane damages
- Some animals are more equal than others: Validation of a new scale to measure how attitudes to animals depend on species and human purpose of use
- Observation and quantification of the morphological effect of trypan blue rupturing dead or dying cells
- The visual perception of emotion from masks
- Hexavalent chromium removal and total chromium biosorption from aqueous solution by Quercus crassipes acorn shell in a continuous up-flow fixed-bed column: Influencing parameters, kinetics, and mechanism
- The predictive value of anthropometric indices for cardiometabolic risk factors in Chinese children and adolescents: A national multicenter school-based study
- Lean back and wait for the alarm? Testing an automated alarm system for nosocomial outbreaks to provide support for infection control professionals
- Regional disparities in health care resources in traditional Chinese medicine county hospitals in China
- Analysis on hydraulic characteristics of improved sandy soil with soft rock
- Development and use of a scale to assess gender differences in appraisal of mistreatment during childbirth among Ethiopian midwifery students
- Factors for starting biosimilar TNF inhibitors in patients with rheumatic diseases in the real world
- Correction: Force field generalization and the internal representation of motor learning
- Prevalence and foetomaternal effects of iron deficiency anaemia among pregnant women in Lagos, Nigeria
- Socioeconomic risk factors for fatal opioid overdoses in the United States: Findings from the Mortality Disparities in American Communities Study (MDAC)
- Microbiome signatures in neonatal central line associated bloodstream infections
- Interventions for incarcerated adults with opioid use disorder in the United States: A systematic review with a focus on social determinants of health
- Opening gap width influences distal tibial rotation below the osteotomy site following open wedge high tibial osteotomy
- The impact of lowbush blueberry (Vaccinium angustifolium Ait.) and cranberry (Vaccinium macrocarpon Ait.) pollination on honey bee (Apis mellifera L.) colony health status
- Surveys of knowledge and awareness of antibiotic use and antimicrobial resistance in general population: A systematic review
- Managerial capacity among district health managers and its association with district performance: A comparative descriptive study of six districts in the Eastern Region of Ghana
- Knee joint distraction in regular care for treatment of knee osteoarthritis: A comparison with clinical trial data
- Reconstruction of a regulated two-cell metabolic model to study biohydrogen production in a diazotrophic cyanobacterium Anabaena variabilis ATCC 29413
- Cochlear dysfunction is associated with styrene exposure in humans
- Intra-individual variation of particles in exhaled air and of the contents of Surfactant protein A and albumin
- Revisits, readmissions, and outcomes for pediatric traumatic brain injury in California, 2005-2014
- Enhanced handover mechanism using mobility prediction in wireless networks
- Association between regular exercise and asthma control among adults: The population-based Northern Finnish Asthma Study
- Pharyngeal microbiome alterations during Neisseria gonorrhoeae infection
- Assessment of the clinical utility of four NGS panels in myeloid malignancies. Suggestions for NGS panel choice or design
- Assessment of time management practice and associated factors among primary hospitals employees in north Gondar, northwest Ethiopia
- Genetic diversity and population structure of feral rapeseed (Brassica napus L.) in Japan
- Are the current gRNA ranking prediction algorithms useful for genome editing in plants?
- Difference between physical therapist estimation and psychological patient-reported outcome measures in patients with low back pain
- Heterogeneity in the distribution of 159 drug-response related SNPs in world populations and their genetic relatedness
- Metabolic and lipidomic profiling of steatotic human livers during ex situ normothermic machine perfusion guides resuscitation strategies
- Investigating cumulative effects of pre-performance routine interventions in beach volleyball serving
- Dispensing of antibiotics without prescription and associated factors in drug retail outlets of Eritrea: A simulated client method
- MicroRNA expression and DNA methylation profiles do not distinguish between primary and recurrent well-differentiated liposarcoma
- Assessment of acyl-CoA cholesterol acyltransferase (ACAT-1) role in ovarian cancer progression—An in vitro study
- Cytoplasmic factories, virus assembly, and DNA replication kinetics collectively constrain the formation of poxvirus recombinants
- The wavelet power spectrum of perfusion weighted MRI correlates with tumor vascularity in biopsy-proven glioblastoma samples
- Agreement between cardiovascular disease risk assessment tools: An application to the United Arab Emirates population
- Constructing HLM to examine multi-level poverty-contributing factors of farmer households: Why and how?
- Patterns of symptoms possibly indicative of cancer and associated help-seeking behaviour in a large sample of United Kingdom residents—The USEFUL study
- An automated alarm system for food safety by using electronic invoices
- Neural effects of acute stress on appetite: A magnetoencephalography study
- Use of magnetic resonance imaging to determine laterality of meniscal size in healthy volunteers
- Co-prevalence of extracranial carotid aneurysms differs between European intracranial aneurysm cohorts
- Thermal biology of two tropical lizards from the Ecuadorian Andes and their vulnerability to climate change
- When weight is an encumbrance; avoidance of stairs by different demographic groups
- Non-mycosis fungoides cutaneous lymphomas in a referral center in Taiwan: A retrospective case series and literature review
- From the host's point of view: Effects of variation in burying beetle brood care and brood size on the interaction with parasitic mites
- Kernel-based Gaussian process for anomaly detection in sparse gamma-ray data
- Unmet care needs of children with ADHD
- Accelerometer-assessed outdoor physical activity is associated with meteorological conditions among older adults: Cross-sectional results from the OUTDOOR ACTIVE study
- Identification of Korean cancer survivors’ unmet needs and desired psychosocial assistance: A focus group study
- Evaluation of inactivated Bordetella pertussis as a delivery system for the immunization of mice with Pneumococcal Surface Antigen A
- The role of moral reasoning & personality in explaining lyrical preferences
- Would you like to participate in this trial? The practice of informed consent in intrapartum research in the last 30 years
- Correction: Mutation spectrums of TSC1 and TSC2 in Chinese women with lymphangioleiomyomatosis (LAM)
- Forward lunge before and after anterior cruciate ligament reconstruction: Faster movement but unchanged knee joint biomechanics
- Challenges associated with homologous directed repair using CRISPR-Cas9 and TALEN to edit the DMD genetic mutation in canine Duchenne muscular dystrophy
- Integrated targeted serum metabolomic profile and its association with gender, age, disease severity, and pattern identification in acne
- A prospective case-control study on miRNA circulating levels in subjects born small for gestational age (SGA) evaluated from childhood into young adulthood
- Polymer-fiber-coupled field-effect sensors for label-free deep brain recordings
- Global depth perception alters local timing sensitivity
- How to detect a polytrauma patient at risk of complications: A validation and database analysis of four published scales
- Module for SWC neuron morphology file validation and correction enabled for high throughput batch processing
- Reduced gray matter volume and cortical thickness associated with traffic-related air pollution in a longitudinally studied pediatric cohort
- Recombinant human soluble thrombomodulin is associated with attenuation of sepsis-induced renal impairment by inhibition of extracellular histone release
- Human and climatic drivers affect spatial fishing patterns in a multiple-use marine protected area: The Galapagos Marine Reserve
- Correction: Leisure-time physical activity and sports in the Brazilian population: A social disparity analysis
- Application of the mixture item response theory model to the Self-Administered Food Security Survey Module for Children
- Numerical simulation of atmospheric CO2 concentration and flux over the Korean Peninsula using WRF-VPRM model during Korus-AQ 2016 campaign
- Feline irradiated diet-induced demyelination; a model of the neuropathology of sub-acute combined degeneration?
- Improved multi-parametric prediction of tissue outcome in acute ischemic stroke patients using spatial features
- Genome-wide association and epistatic interactions of flowering time in soybean cultivar
- Correction: Association between workplace bullying and burnout, professional quality of life, and turnover intention among clinical nurses
- Correction: Estimation of membrane bending modulus of stiffness tuned human red blood cells from micropore filtration studies
- Correction: Limited indirect effects of an infant pneumococcal vaccination program in an aging population
- Correction: Targeting of the Plzf Gene in the Rat by Transcription Activator-Like Effector Nuclease Results in Caudal Regression Syndrome in Spontaneously Hypertensive Rats
- Fieldwork-based determination of design priorities for point-of-use drinking water quality sensors for use in resource-limited environments
- Young women’s reproductive health conversations: Roles of maternal figures and clinical practices
- Correction: Differential recordings of local field potential: A genuine tool to quantify functional connectivity
- Survival of medial versus lateral unicompartmental knee arthroplasty: A meta-analysis
- Novel MscL agonists that allow multiple antibiotics cytoplasmic access activate the channel through a common binding site
- Is it time to stop sweeping data cleaning under the carpet? A novel algorithm for outlier management in growth data
- Changes in oak (Quercus robur) photosynthesis after winter moth (Operophtera brumata) herbivory are not explained by changes in chemical or structural leaf traits
- Mutual interaction between motor cortex activation and pain in fibromyalgia: EEG-fNIRS study
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- Analysis of cholesterol in mouse brain by HPLC with UV detection
- Sugar, amino acid and inorganic ion profiling of the honeydew from different hemipteran species feeding on Abies alba and Picea abies
- Exploring prior diseases associated with incident late-onset Alzheimer’s disease dementia
- Hypertension prevalence in patients attending tertiary pain management services, a registry-based Australian cohort study
- SRL pathogenicity island contributes to the metabolism of D-aspartate via an aspartate racemase in Shigella flexneri YSH6000
- Correction: Comprehensive genome-wide analysis of the pear (Pyrus bretschneideri) laccase gene (PbLAC) family and functional identification of PbLAC1 involved in lignin biosynthesis
- Epilepsy in a melanocyte-lineage mTOR hyperactivation mouse model: A novel epilepsy model
- Water consumption and prevalence of irritable bowel syndrome among adults
- Mixed evidence for the relationship between periodontitis and Alzheimer’s disease: A bidirectional Mendelian randomization study
- Correction: Health conditions associated with overweight in climacteric women
- Correction: Determining Glomerular Filtration Rate in Homozygous Sickle Cell Disease: Utility of Serum Creatinine Based Estimating Equations
- Modelling the number of antenatal care visits in Bangladesh to determine the risk factors for reduced antenatal care attendance
- Correction: Cumulative viral load as a predictor of CD4+ T-cell response to antiretroviral therapy using Bayesian statistical models
- Dominant negative effects by inactive Spa47 mutants inhibit T3SS function and Shigella virulence
- ICOS-deficient and ICOS YF mutant mice fail to control Toxoplasma gondii infection of the brain
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- Life history of northern Gulf of Mexico Warsaw grouper Hyporthodus nigritus inferred from otolith radiocarbon analysis
- Physiology education for intensive care medicine residents: A 15-minute interactive peer-led flipped classroom session
- Strengthening capacity for natural sciences research: A qualitative assessment to identify good practices, capacity gaps and investment priorities in African research institutions
- Systematic scoping review of the concept of ‘genetic identity’ and its relevance for germline modification
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- Laboratory strains of Bacillus anthracis lose their ability to rapidly grow and sporulate compared to wildlife outbreak strains
- Improvement of classification performance of Parkinson’s disease using shape features for machine learning on dopamine transporter single photon emission computed tomography
- Comparative pharmacokinetics and pharmacodynamics of the advanced Retinol-Binding Protein 4 antagonist in dog and cynomolgus monkey
- Correction: A handy method to remove bacterial contamination from fungal cultures
- Correction: Effect of statin on life prognosis in Japanese patients undergoing hemodialysis
- Retraction: Outer Membrane Protein A (OmpA) of Shigella flexneri 2a Induces TLR2-Mediated Activation of B Cells: Involvement of Protein Tyrosine Kinase, ERK and NF-κB
- Retraction: Biofabrication of streptomycin-conjugated calcium phosphate nanoparticles using red ginseng extract and investigation of their antibacterial potential
- Receiver operating characteristic curve analysis of clinical signs for screening of convergence insufficiency in young adults
- Correction: Drivers of deforestation in the basin of the Usumacinta River: Inference on process from pattern analysis using generalised additive models
- Efficacy of fertilizing method for different potash sources in cotton (Gossypium hirsutum L.) nutrition under arid climatic conditions
- Podocyte autophagy is associated with foot process effacement and proteinuria in patients with minimal change nephrotic syndrome
- Effect of Lactobacillus acidophilus D2/CSL (CECT 4529) supplementation in drinking water on chicken crop and caeca microbiome
- Retraction: MiR-30a-5p Antisense Oligonucleotide Suppresses Glioma Cell Growth by Targeting SEPT7
- Correction: Dynamics of plasma micronutrient concentrations and their correlation with serum proteins and thyroid hormones in patients with paracoccidioidomycosis
- Impact of lower limb osteoarthritis on health-related quality of life: A cross-sectional study to estimate the expressed loss of utility in the Spanish population
- Correction: Prevalence of damaged and missing teeth among women in the southern plains of Nepal: Findings of a simplified assessment tool
- Correction: Tissue-Specific Expressed Antibody Variable Gene Repertoires
- Retraction: Immunoglobulin G Expression in Lung Cancer and Its Effects on Metastasis
- Correction: Causal knowledge promotes behavioral self-regulation: An example using climate change dynamics
- Retraction: Use of Granulocyte Colony-Stimulating Factor for the Treatment of Thin Endometrium in Experimental Rats
- Correction: Dynamic mechanical and nanofibrous topological combinatory cues designed for periodontal ligament engineering
- Correction: Evaluating the foundations that help avert antimicrobial resistance: Performance of essential water sanitation and hygiene functions in hospitals and requirements for action in Kenya
- From seed to flour: Sowing sustainability in the use of cantaloupe melon residue (Cucumis melo L. var. reticulatus)
- Core Scientific Dataset Model: A lightweight and portable model and file format for multi-dimensional scientific data
- Accounting for measurement error to assess the effect of air pollution on omic signals
- Leucine zipper transcription factor-like 1 binds adaptor protein complex-1 and 2 and participates in trafficking of transferrin receptor 1
- Barriers for tuberculosis case finding in Southwest Ethiopia: A qualitative study
- Genetic predisposition to celiac disease in Kazakhstan: Potential impact on the clinical practice in Central Asia
- A lower psoas muscle volume was associated with a higher rate of recurrence in male clear cell renal cell carcinoma
- Two angles of overqualification-the deviant behavior and creative performance: The role of career and survival job
- Cost-utility analysis of de-escalating biological disease-modifying anti-rheumatic drugs in patients with rheumatoid arthritis
- Efficient estimation of stereo thresholds: What slope should be assumed for the psychometric function?
- Learning efficient haptic shape exploration with a rigid tactile sensor array
- Effects of dietary supplementation with a microalga (Schizochytrium sp.) on the hemato-immunological, and intestinal histological parameters and gut microbiota of Nile tilapia in net cages
- Regional versus local wind speed and direction at a narrow beach with a high and steep foredune
- Fragmented QRS complex in patients with systemic lupus erythematosus at the time of diagnosis and its relationship with disease activity
- Severe thiamine deficiency in eastern Baltic cod (Gadus morhua)
- Transfer entropy as a variable selection methodology of cryptocurrencies in the framework of a high dimensional predictive model
- Psychometric validation of Czech version of the Sport Motivation Scale
- Correction: Multiple innate antibacterial immune defense elements are correlated in diverse ungulate species
- Recognition of personality disorder and anxiety disorder comorbidity in patients treated for depression in secondary psychiatric care
- Correction: Strategies for achieving high sequencing accuracy for low diversity samples and avoiding sample bleeding using illumina platform
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