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Decidual Vasculopathy and Spiral Artery Remodeling Revisited III: Hypoxia and Re-oxygenation Sequence with Vascular Regeneration

Department of Pathology, New York Presbyterian—Brooklyn Methodist Hospital, Brooklyn, NY 11215, USA
Reprod. Med. 2020, 1(2), 77-90; https://doi.org/10.3390/reprodmed1020006
Received: 26 May 2020 / Revised: 5 July 2020 / Accepted: 9 July 2020 / Published: 11 July 2020
(This article belongs to the Special Issue Preeclampsia: Pathogenesis, Diagnosis and Treatment)
Aim: Spiral artery remodeling at early pregnancy is characterized by two distinct mechanisms with two morphologic features, namely, trophoblastic-dependent vascular invasion with “plugging”, and trophoblastic-independent mural muscular hypertrophy/hyperplasia, both of which lead to the blocking or narrowing of the arterial lumen with the consequence of reduced maternal blood flow to the developing embryo. Methods: Review of historic literature in light of the new discovery of CD56 (NCAM) expression on endovascular trophoblasts at late gestation, in relation to placental lateral growth with vascular regeneration. Results: Reduced maternal blood flow to the embryo results in a hypoxic condition critical for trophectoderm differentiation and proliferation. Hypoxia is also important for the development of hemangioblasts of vasculogenesis, and hematopoiesis of the placental villi. Up to 13 weeks, both uteroplacental and fetoplacental circulations are established and hypoxic condition relieved for normal fetal/placenta development by ultrasonography. The persistence of trophoblastic plugging and/or mural muscular hypertrophy/hyperplasia leads to persistent reduced maternal blood flow to the placenta, resulting in persistent hypoxia and increased angiogenesis, with a constellation of pathologic features of maternal vascular malperfusion atlate gestation. Wilm’s tumor gene (WT1) expression appears to be central to steroid and peptide hormonal actions in early pregnancy, and vascular regeneration/restoration after pregnancy. Conclusions: Spiral artery remodeling at early pregnancy leads to hypoxia with vascular transformation, and the establishment of uteroplacental circulation results in relief of hypoxia. The hypoxia–re-oxygenation sequence may provide insights into the mechanism of normal fetal/placental development and associated pregnancy complications, such as preeclampsia. View Full-Text
Keywords: decidual vasculopathy; preeclampsia; spiral artery remodeling; vascular regeneration; placental lateral growth decidual vasculopathy; preeclampsia; spiral artery remodeling; vascular regeneration; placental lateral growth
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MDPI and ACS Style

Zhang, P. Decidual Vasculopathy and Spiral Artery Remodeling Revisited III: Hypoxia and Re-oxygenation Sequence with Vascular Regeneration. Reprod. Med. 2020, 1, 77-90. https://doi.org/10.3390/reprodmed1020006

AMA Style

Zhang P. Decidual Vasculopathy and Spiral Artery Remodeling Revisited III: Hypoxia and Re-oxygenation Sequence with Vascular Regeneration. Reproductive Medicine. 2020; 1(2):77-90. https://doi.org/10.3390/reprodmed1020006

Chicago/Turabian Style

Zhang, Peilin. 2020. "Decidual Vasculopathy and Spiral Artery Remodeling Revisited III: Hypoxia and Re-oxygenation Sequence with Vascular Regeneration" Reprod. Med. 1, no. 2: 77-90. https://doi.org/10.3390/reprodmed1020006

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