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Fertilitetscentrum AB and University of Göteborg (C.S., M.W.), S-41345 Göteborg, Sweden; and Department of Obstetrics and Gynaecology (C.T.R., S.A.R.), Research Centre for Reproductive Health, University of Adelaide, Adelaide, South Australia 5005, Australia
Address all correspondence and requests for reprints to: Sarah A. Robertson, Ph.D., Research Centre for Reproductive Health, Department of Obstetrics and Gynaecology, University of Adelaide, Adelaide, South Australia 5005, Australia. E-mail: sarah.robertson{at}adelaide.edu.au.
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Introduction |
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-subunit of the GM-CSF receptor independently of the ß-subunit of the GM-CSF receptor, ßc (5, 14). The significance of depriving the embryo of growth factors for long-term health and viability of the fetus has not been explored. With the advent of assisted reproductive technologies, some 2% of children in western countries are now born after in vitro fertilization (IVF) involving culture of the preimplantation embryo in media that do not contain growth factors and so only partially mimic the physiological environment. Critical evaluation of the deficiencies of in vitro culture is now essential in view of recent epidemiological studies that demonstrate growth impairment (15, 16) and an increased likelihood of major birth defects (17) in children born after IVF. Furthermore there is emerging information to link IVF and intracytoplasmic sperm injection techniques with increased incidence of defects in genomic imprinting, the process by which the genome undergoes epigenetic reprogramming in the developing preimplantation embryo (18, 19, 20, 21).
Animal experiments offer compelling evidence that in vitro culture provides a less than ideal environment, with adverse effects on the embryo reflected in compromised fetal growth and development. In rodents, embryo culture in media free of growth factors decreases postimplantation viability and fetal growth rate (22, 23), and effects are exacerbated in media supplemented with serum (24). In ruminants, abnormally large offspring with reports of 20–30% increases in birth weight can result from embryos developed in vitro (25, 26). Aberrant genomic imprinting has been implicated in mediating the effects of culture-induced embryo stress associated with suboptimal culture media (27, 28, 29), supplementation with serum (24), nutrient deprivation (30), or accumulation of toxic metabolites (31). Modified gene methylation patterns are also evident in children conceived by assisted reproductive technologies diagnosed with imprinting disorders (19, 20, 21). The consequences of growth impairment in utero are long-lived, with low birth weight being associated with permanent alterations in metabolic parameters leading to increased susceptibility to chronic disease in adult life (32, 33).
We have now investigated the physiological significance of exposure to GM-CSF during early preimplantation embryo development for subsequent fetal and postnatal growth and body composition. Embryo culture during the preimplantation period is found to have a detrimental influence on fetal and postnatal development in association with altered placental morphogenesis. Addition of GM-CSF to culture medium improves implantation rate, corrects deficiencies in placental structure and fetal growth trajectory, and partly alleviates the long-term adverse effects of embryo culture on postnatal growth in adult mice. This identifies GM-CSF as essential for optimal preimplantation development, as able to ensure normal fetal development in the absence of embryonic exposure to other growth factors, and as a candidate for use in reproductive technologies in humans and other species.
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Materials and Methods |
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For embryo transfer, two cell embryos collected from naturally ovulating 10-wk-old C57BL/6 x CBA F1 (B6 F1) female mice mated with 8- to 12-wk-old NMRI males were flushed from the oviduct at 0800 h on d 2 of pregnancy and cultured at a density of 10 embryos in 20-µl drops of protein-free mouse embryo culture medium Scandinavia Quality Control (Vitrolife, Göteborg, Sweden) overlaid with paraffin oil at 37 C in 5% CO2 in air. Two-cell embryos were randomly allocated into two groups; medium alone (including carrier 2 ng/ml BSA, Sigma Chemical Co., St. Louis, MO), or medium supplemented with 2 ng/ml recombinant murine (rm) GM-CSF (R&D Systems, Abingdon, UK). A third group of in vivo-developed blastocysts were flushed from the uterus at 1200 h on d 4 of pregnancy and were held in 20-µl drops of SQC as above for approximately 2 h before embryo transfer.
SQC medium is a protein-free modification of the original G2 formulation (34, 35) with the principal changes comprising deletion of albumin, decreased phosphate ion content (0.2 mM), and increased concentrations of carbohydrates (28.5 mM sodium lactate, 0.87 mM sodium pyruvate, and 5.0 mM glucose). SQC is further supplemented with 1x MEM essential amino acids (from 100x stock, Life Technologies, Inc./Invitrogen, Carlsbad, CA) and 1x MEM nonessential amino acids (from 50x stock, Life Technologies, Inc./Invitrogen), 1x MEM Vitamin Solution (from 100x stock, Sigma), estradiol (3.7x 10–5 M, Sigma), and progesterone (3.2 x 10–6 M; Sigma). All embryo culture was performed in the mouse embryo testing facility at Scandinavian QC Laboratories AB (Göteborg, Sweden), in a controlled air and certified pathogen-free environment, with all materials and disposables tested by mouse embryo assay using test systems and laboratory protocols accredited according to ISO 17025.
Embryo transfer
Embryo recipients were naturally ovulating 10-wk-old B6 F1 females mated with vasectomized 8- to 12-wk-old NMRI males. Blastocysts were transferred at 1400–1600 h on the 4th d of culture (78–80 h after initiation of culture) or on the day of recovery from the tract for in vivo-generated embryos. To avoid selection bias, embryo culture dishes were coded, and all embryos reaching the blastocyst stage were transferred. Embryos were transferred to female recipients on d 3 of pseudopregnancy, and transfers to at least two recipients per treatment group were undertaken on a given day. Transfer was performed under general anesthesia by ip injection of ketamine (Ketalar, 75 µg/g mouse, Parke Davis, Solna, Sweden) and medetomidine (Dormitor, 1 µg/g mouse, Orion Corp., Espoo, Finland), via a dorsal incision as previously described (36). Five blastocysts were transferred to each uterine horn (10 blastocysts/recipient) with a glass embryo transfer pipette (Swemed AB, Göteborg, Sweden). After wound closure, the mouse was resuscitated with ip injection of Antisedan (1 µg/g mouse, Orion Corp.).
Analysis at d 18 of pregnancy
Pregnant recipient mice were killed at 1600 h on d 18 of pregnancy (when day of embryo transfer is defined as d 3 of pregnancy). The number of viable and resorbing implantation sites and position within each uterine horn were recorded, and fetuses and placentas were dissected and weighed.
Birth and postnatal analysis
Additional groups of mice were taken to term to allow assessment in offspring of postnatal growth trajectory, organ weights, and reproductive function. Pregnant recipients selected on the basis of their showing clear outward signs of pregnancy were placed in individual cages on d 17 of pregnancy, and cages were checked for litters every 6–12 h until birth, when the time of parturition was noted. Pups were weighed individually on d 8 postpartum and again at 3, 5, 9, and 11 wk of age after weaning on d 21 when each animal was numbered to enable tracking of individual growth trajectories. Body composition of adult progeny was assessed at 12 wk of age, when groups of 15 animals of each gender from each treatment group, randomly selected from eight litters, were killed by cervical dislocation, and internal organs and tissues were dissected and weighed individually. Organ and tissue weights were calculated relative to total body mass (for fat) or relative to lean body mass (= total body mass – total central fat mass) for all other organs and tissues. Total central fat mass was calculated as the sum of fat mass from abdominal, retroperitoneal, and parametrial deposits.
To investigate fertility of male and female progeny and the normality of second generation fetuses gestated by female progeny, naturally ovulating female progeny were mated at 12–13 wk of age with 8- to 12-wk-old NMRI males, and male progeny were mated at 10–12 wk of age with naturally ovulating 10-wk-old B6 F1 females. Implantation parameters were recorded in females mated with male progeny on d 10 of pregnancy. Female progeny mated with NRMI males were killed on d 18 of pregnancy. The number of implantation sites, viable and resorbing fetuses, and position in each uterine horn were recorded, and fetuses and placentae were dissected and weighed.
Placental histology
Two to three placentas from each of six mothers in each of the three transfer groups (n = 17 in total for each group) were dissected within 5 min of kill and fixed in 4% paraformaldehyde (Apoteksbolaget, Stockholm, Sweden) overnight. Next morning they were bisected in the midline from maternal to fetal sides to yield midsagittal faces and fixed for an additional 3 h. Placentas were then washed three times in PBS (Dulbecco’s Mg2+ and Ca2+ free, Cambrex Bio Science Verviers S.p.r.l., Verviers, Belgium) and stored at 4 C before tissue processing and paraffin wax embedding. Thirty serial midsagittal 7-µm sections were cut, placed on 10 3-aminopropyltriethoxysilane-coated slides, and the first slide with a full placental face was stained with Masson’s trichrome by a standard protocol (37). The total areas of junctional and labyrinthine zones were measured by video image analysis with Video Pro software (Leading Edge Software, Adelaide, Australia) and an Olympus BH2 light microscope equipped with a 2x objective lens and 2.5x ocular lens. Areas were expressed as proportion (percentage) of total midsagittal area comprised by junctional and labyrinthine zones.
Placental labyrinthine morphometry
To distinguish cell types within the placental labyrinth, we employed a double immunolabeling protocol originally developed for the guinea pig placental labyrinth and adapted for the mouse (38). Placental sections were double immunolabeled sequentially with rat antimouse monoclonal antibodies MTS12 (39) (kind gift of Richard Boyd, Department of Pathology and Immunology, Monash University, Melbourne, Australia) to label fetal endothelial cells and rabbit antihuman pan-cytokeratin (Zymed, San Francisco, CA) to label trophoblasts as previously described (38). Sections were deparaffinized and brought to water. For antigen retrieval, sections were incubated at 37 C for 15 min in 0.03% protease (Sigma). Endogenous peroxidase activity was quenched by incubating with 3% hydrogen peroxide for 30 min. Sections were then washed in three changes of PBS for 5 min each and blocked for nonspecific binding with serum-free protein block (DakoCytomation Denmark A/S, Glostrup, Denmark) for 10 min without washing. MTS-12 supernatant with 10% normal mouse serum and 1% BSA were applied first and incubated overnight in a humidified chamber at room temperature. Sections were washed as above, and biotinylated rabbit antirat IgG secondary antibodies (DakoCytomation Denmark A/S) were applied for 45 min, followed by washing. Streptavidin-horse radish-peroxidase (Zymed) was applied for 40 min, and sections were washed as above. MTS-12 binding was visualized by incubating with diaminobenzidine with 2% ammonium nickel (II) sulfate (Sigma) to form a black precipitate. The process was then repeated for the second primary antibody (rabbit antihuman cytokeratin, Zymed) diluted 1:50 with PBS, 10% normal mouse serum, and 1% BSA, but nickel was omitted from the chromogen, leaving a brown precipitate. Negative controls used irrelevant mouse IgG in place of the primary antibodies or the primary antibody diluent on its own.
Double-labeled sections were examined on the same imaging system as above with a 20x objective lens and a 2.5x ocular lens. Volume densities (proportions) of trophoblasts, fetal capillaries, and maternal blood space in the placental labyrinth were quantified by point counting with an isotropic L-36 Merz transparent grid placed on the monitor screen (40). Ten fields (360 points) were counted in one randomly selected section for each placenta, with the first field location chosen at random and subsequent adjacent sections systematically selected 0.5 mm apart with the aid of the stage micrometer. The volume density of each labyrinthine component was calculated using the formula: volume density, Vd = Pa/PT, where Pa is the total number of points falling on that component, and PT is the total number of points applied to the section (38, 40). The surface density (surface area per gram of placenta) of trophoblast was measured by line intercept counting on the same grid on the same fields and calculated taking into account the total magnification on the monitor using the formula: surface density, Sv = 2 x Ia/LT, where Ia is the number of intercepts with the line, and LT is the total length of the lines applied (40). The within-assay variation was <5% as determined by repeated measurement of the same placental section.
The arithmetic mean barrier to diffusion was calculated using the formula: barrier thickness, BT = Vd/Sv, where Vd is the volume density of trophoblast, and Sv is the surface density of trophoblast (40). The barrier thickness, then, is the thickness of syncytiotrophoblast. Mass of labyrinthine tissue (ML) was calculated using the formula ML = proportion (percentage) labyrinth x placental weight (in grams). The surface area (SA) of trophoblast was then calculated according to the formula SA = Sv x ML cm2.
Statistical analysis
Parameters of pregnancy and postnatal growth and placental morphometry were analyzed with SPSS 11.5 software (SPSS Inc., Chicago, IL) by one-way ANOVA followed by Bonferroni t test, except when Shapiro-Wilk test of Q-Q plots showed data were not normally distributed, when data were compared by Kruskal Wallis and Mann Whitney U tests. Adjustment for litter size in comparisons between groups was achieved with Mantel’s technique of pooling (41). Data expressed as proportions were compared by 
2 test. Fat deposition was analyzed by repeated measured ANOVA with fat deposit as measure, before analysis by one-way ANOVA for individual tissues and gender of progeny. Differences were considered to be significant when P < 0.05.
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) reached the blastocyst stage by the time of transfer to 44 recipients (GM-CSF group). In addition, 383 blastocysts flushed from the uterus on d 4 of pregnancy were transferred to 40 recipients (in vivo group). Early embryo environment did not influence the likelihood of recipients becoming pregnant. Overall, 91% of recipients receiving embryos cultured in media alone, 91% of recipients receiving embryos cultured in GM-CSF, and 100% of recipients receiving embryos flushed from the tract after in vivo development carried live fetuses at d 18 of pregnancy or delivered live pups at term (Table 1). To compare overall viable implantation rates, the proportion of embryos generating viable implantation sites were combined with the proportion of embryos resulting in live offspring at term. Of the embryos transferred after culture in media alone, 72% generated viable progeny, compared with the embryos cultured in GM-CSF, of which 77% generated viable progeny (P = 0.03) (Table 1). Significantly fewer embryos flushed from the tract after in vivo development resulted in viable progeny (64%) compared with either group of in vitro-grown embryos (P < 0.001). At the time of embryo transfer, the development of in vivo-grown embryos is slightly advanced over the d 4 cultured blastocysts (data not shown), so this moderately reduced implantation rate is attributable to the greater extent of asynchrony in development between donor blastocysts and recipient uteri in this group.
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). The proportion of resorbing implantation sites and dead fetuses were not affected by embryo culture.
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). This was partially alleviated by addition of GM-CSF to culture medium, which resulted in fetuses that were 4% heavier than those from embryos cultured in media alone (P = 0.005), although still lighter than fetuses from in vivo-formed embryos (P < 0.001). There was no difference in placental weights between groups, but in vitro culture caused an 11% decrease in the mean fetal to placental weight ratio, a measure of placental capacity to supply fetal growth, compared with the in vivo group (P < 0.001). Culture in GM-CSF partially normalized this change, with fetal to placental weight ratio reduced by only 8% (P = 0.05; Table 2).
Effect of GM-CSF on term outcomes and postnatal growth
To investigate the effect of in vitro exposure to GM-CSF on postnatal growth trajectory and subsequent fertility and body composition in adult life, recipients from the transfer experiments were taken to term, allowing study of 74 progeny from 10 recipients in the media-alone group, 105 progeny from 12 recipients in the GM-CSF group, and 74 progeny from 11 recipients in the in vivo group (Table 3). The litter sizes at term and, thus, the proportion of embryos generating viable progeny, were larger in the group of embryos cultured with GM-CSF than in either of the other groups (P < 0.05; Table 3). There was no effect of treatment group on success of parturition or gestation length (Table 3).
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, A and B). After weaning, an overcompensation in growth was seen in female progeny resulting from embryos cultured in media alone, with faster weight gain evident at 5 and 7 wk of age compared with progeny from embryos developed in vivo (Fig. 1A), before equivalent weights were reached at 9 and 11 wk. When weight differences were maximal in females at 5 wk of age, mean ± SEM weights for progeny from embryos cultured in medium alone were 22.4 ± 0.3, for the GM-CSF group were 21.5 ± 0.2, and for the in vivo group were 21.5 ± 0.3 g. Early environment had a stronger influence on growth trajectory in males, where greater weight gain in progeny derived from embryos cultured in media alone was evident from 7 wk of age and persisted until the mice were killed after 11 wk (Fig. 1B). In contrast, the presence of GM-CSF in culture medium neutralized the effect of in vitro culture on growth trajectories, and there was no difference in postnatal body size at any time point in either gender compared with progeny derived from blastocysts developed in vivo (Fig. 1). When weight differences were maximal in males at 9 wk of age, mean ± SEM weights for progeny from embryos cultured in medium alone were 39.0 ± 0.5, for the GM-CSF group were 37.6 ± 0.4, and for the in vivo group were 37.6 ± 0.5 g.
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), and increased their absolute quantity of central fat by 39% (P = 0.004), due to a 36% increase in abdominal fat mass and 47% increase in retroperitoneal fat mass. Within males, increased central fat was seen in cultured embryos regardless of the presence of GM-CSF in culture medium (Table 4). When females were considered separately, the body composition and adiposity of female progeny was not affected by in vitro culture (Table 4). Early environment did not affect the absolute mass of heart, lungs, kidney, liver, spleen, thymus, or quadriceps muscle in male or female progeny (data not shown). However, when organ weights are expressed relative to lean body mass, embryo culture in media alone is associated with decreased relative brain size in males (mean ± SD = 1.25 ± 0.02% vs. 1.37 ± 0.03% body mass in in vivo controls, P = 0.03). Culture in GM-CSF restored this deficit such that relative brain mass (1.31 ± 0.02% lean body mass) was not different from values from in vivo-generated embryos (Table 4). The mass of other organs and tissues relative to lean body mass were not affected by embryo culture or exposure to GM-CSF (data not shown).
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), causing a 14% reduction in the fetal to placental weight ratio (P < 0.001), compared with mothers from in vivo-developed embryos. This effect was alleviated by embryo culture in GM-CSF, such that placental weights and fetal to placental weight ratio values in mothers from this group were comparable with those from mothers derived from in vivo-formed embryos (Table 6).
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), and consequently decreasing the labyrinth to junctional zone ratio by 9% (P = 0.02; Table 7).
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). Embryo culture did not alter the volume density (proportion) of trophoblast cells but increased the volume density of the maternal blood space by 32% (P = 0.001), and decreased the volume density of fetal capillaries by 11% (P = 0.05; Fig. 3A). Furthermore, embryo culture reduced the thickness of trophoblast through which exchange occurs by 20% (P = 0.007; Fig. 3B) and increased the surface density (surface area per gram of labyrinth) of trophoblast apical membrane available for exchange in the placental labyrinth by 14% (P = 0.004; Fig. 3C). Taking into account the mass of labyrinth associated with each placenta, the total surface area for exchange was similar in placentae derived from embryos cultured in media alone and those developed in vivo (Fig. 3D).
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, A and B) to that of placentae from embryos developed in vivo (Table 7). Early exposure to GM-CSF partially normalized the relative volume densities of cell lineages such that values were not different from those from in vivo-derived embryos, although the effect on volume density of fetal capillaries was marginal, with the relative proportion remaining 10% less than control values (P = 0.058; Fig. 3A). GM-CSF had no impact on trophoblast thickness or surface density (surface area per gram of labyrinth) of trophoblast apical membrane, which remained decreased by 14% (P = 0.052) and increased by 12% (P = 0.006), respectively, compared with placentas from in vivo-derived embryos (Fig. 3, B and C). However, because of the larger area comprised by placental labyrinth, the total surface area for exchange was 18% greater than in placentas from embryos cultured in medium without added cytokine (P = 0.05) and nearly 17% greater than in placentas from in vivo-derived controls (P = 0.03; Fig. 3D). |
Discussion |
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This study confirms and extends previous observations showing that embryo culture is associated with a slower rate of subsequent fetal growth in utero. A similar extent of fetal growth restriction in late gestation has been reported after transfer of cultured embryos (22, 23, 24, 42). Growth impairment was found to occur despite the high rate of blastocyst development and implantation rate after embryo transfer. We attribute the high rates of pre- and postimplantation embryo development to using an embryo culture medium formulated for optimal mouse embryo development and avoiding the potential confounding influences of ovarian hyperstimulation protocols in compromising oocyte competence and eliciting developmental abnormalities (43).
When postnatal growth parameters were evaluated, impaired growth in utero was seen to be associated with overcompensation or catch-up growth after birth. Female progeny and particularly male progeny exhibited differences in growth kinetics after embryo culture, with increased whole-body weight and fat mass in adulthood, as well as decreased relative brain weight in males. This finding is reminiscent of accelerated postnatal weight gain and abnormal organ to body weight ratios reported in dietary models of fetal growth restriction, where nutritional deprivation in pregnancy permanently program metabolic parameters associated with a thrifty phenotype in the neonate (33). Growth retardation at birth after dietary restriction during pregnancy leads to elevated blood pressure, impaired glucose tolerance, and altered cholesterol metabolism in adult rats and guinea pigs (44, 45, 46, 47). This growth restriction is associated with disproportionate growth of several tissues, particularly abdominal fat deposits (48). The preimplantation period is particularly susceptible to nutritional perturbation, with dietary restriction only for the first 4 d of pregnancy resulting in fetal growth retardation followed by overcompensation in growth rate after birth (45). Notably, this pattern is consistent with that seen in humans, where catch-up growth in infancy after intrauterine growth retardation is common and independently predicts obesity, insulin resistance, and increased cardiovascular disease risk in adults (49, 50, 51, 52). As in previous studies (44, 46), we observed the effects of programing to be gender specific, with male progeny being more likely to exhibit disproportionate body structure in adult life. The first rounds of cleavage occur faster in male embryos (53), suggesting that male embryos are more responsive to growth-promoting influences and thereby more susceptible to disturbances in their supply.
Mating experiments in the progeny born after embryo transfer indicated that the effects of early environment are perpetuated into subsequent generations. Although no influence was seen in terms of fertility or fecundity, embryo culture was associated with a significant reduction in fetal to placental weight ratio in the pregnancies of females born after embryo culture. Second generation effects of maternal undernutrition have been observed in women, where reduced birth weight in women born during the Dutch Famine of 1944–1945 was perpetuated in their offspring (54). The underlying mechanisms might involve aberrant programing of metabolic status or disturbances in ovarian or uterine morphogenesis, exerted during fetal development. Spermatogenesis is presumably more resilient to perturbations in early life-reproductive function in male progeny and, at least in terms of capacity to mate and fertilize oocytes, was unimpaired.
Importantly, we provide compelling evidence that impaired fetal growth is the result of altered placental morphogenesis. Late in gestation the mouse placenta retains two distinct regions, the junctional zone that produces hormones and is analogous to the human cytotrophoblastic shell and basal plate and the placental labyrinth where all substrate exchange occurs (55, 56). The size and architecture of the placenta has been shown in previous studies to be susceptible to immunological and nutritional perturbations linked with altered fetal growth trajectory (4, 38, 57, 58). In this study, we show that embryo culture also leads to differences in the structure of the mature placenta, which are consistent with the compromised capacity to meet fetal nutrient demand as initially suggested by reduced fetal to placental weight ratio.
Embryo culture led to a reduction in the proportion of the placenta comprised by labyrinthine tissue and increase in junctional zone tissue. Furthermore, the density of the fetal capillary network within the labyrinth was reduced after culture, with a corresponding increase in maternal blood space. Rather unexpectedly, embryo culture reduced the thickness and increased the surface density (surface area per gram of labyrinth) of the trophoblast barrier through which exchange between maternal and fetal blood takes place. Because labyrinth development is driven by fetal capillary infiltration of the junctional zone tissue after fusion of the allantoic mesoderm and chorionic plate early in placental development (59), it is reasonable to speculate that impaired labyrinthine tissue morphogenesis is a consequence of restricted vascular intrusion, and because allantoic signaling molecules target trophoblast cells, changes in the barrier thickness and convolution may be secondary to this.
When embryos were exposed to GM-CSF during the culture period, the differences in developmental parameters compared with in vivo-generated embryos were partially removed. GM-CSF was seen, as expected on the basis of previous experiments (5), to improve the rate of embryo development to blastocyst stage and to enhance the proportion of transferred embryos developing into viable progeny. Embryo exposure to GM-CSF resulted in a fetal growth trajectory similar to that of in vivo-developed embryos. In addition, the effect of culture on fetal to placental weight ratios in second generation pregnancies was not evident, when mice were derived from embryos cultured with GM-CSF. However, increased adiposity induced in adult progeny by embryo culture was not prevented by GM-CSF, indicating that this growth factor on its own does not completely compensate for the detrimental effects of the culture environment, particularly in males.
Partial reversal of the adverse effects of culture with addition of GM-CSF was associated with effects on placental development. Placentae from the GM-CSF group were structurally more like those derived from embryos developed in vivo than those derived from embryos cultured in media alone. Early exposure to GM-CSF alleviated the culture-induced reduction in labyrinthine tissue and increase in junctional zone tissue. In addition, exogenous GM-CSF restored the proportions of the labyrinth comprised of trophoblast and fetal capillaries to approximate those of in vivo controls, and barrier thickness in placentae from embryos cultured in the presence of GM-CSF was intermediate between values for the media-alone and in vivo-derived groups. Although the extent of trophoblast convolution as measured by surface density was not altered by GM-CSF, the absolute trophoblast surface area for exchange was increased as a consequence of the enlarged placental labyrinth, allowing a greater total area for nutrient exchange even compared with that of control placentae from in vivo-derived embryos. These observations indicate that early exposure to GM-CSF in part determines the structural conformation and function of the placenta in late gestation, facilitating adaptations during placental morphogenesis that largely compensate for deficiencies in placental function resulting from a less than optimal preimplantation environment.
These findings are consistent with previous observations of compromised pregnancy outcomes in mice with a null mutation in GM-CSF, where fetal growth retardation was linked with altered placental structure including a similar decrease in the area of the labyrinthine tissue (4). Although compromised postimplantation development was associated in null mutant mice with retarded blastocyst development, an influence of GM-CSF deficiency in the maternal immune axis or in placental morphogenesis could not be excluded as causal in that model. The similar outcomes now obtained when GM-CSF deprivation is limited to preimplantation development show that the reproductive phenotype in null mutant mice is largely the consequence of early events. The more extreme growth retardation seen in genetic GM-CSF deficiency might be explained by a further role for GM-CSF in directly targeting trophoblast cell proliferation and differentiation in the developing placenta after implantation or in fetal growth itself (60), raising the question of whether GM-CSF or other growth factors present in the postimplantation environment modulate the impact of preimplantation perturbation.
This study provides compelling evidence that the growth factor milieu experienced by the preimplantation embryo is an important mechanistic determinant of fetal programing. The finding has significant implications for our understanding of the causal pathways underlying the fetal origins of adult disease. Despite GM-CSF restoring or enhancing placental structural determinants of function and fetal growth, adult obesity in males persisted, suggesting that more than one mechanistic pathway contributes to the culture-induced phenotype. One potential explanation is that cell lineages in the trophectoderm and inner cell mass are differentially responsive to growth factor modulation of culture-induced stress. The potential for early events to perturb programing is indicated by previous observations, showing that alterations in the abundance and proportion of inner cell mass cell and trophectoderm cell lineages in the blastocyst at implantation can influence subsequent embryonic development. In particular, a reduction in inner cell mass cells resulting from manipulation of maternal nutrition (45), culture environment (42), or chemical reduction in the number of blastomeres (61) has been linked with retardation of fetal growth. In the case of nutritional perturbation during the preimplantation period in rats (45), which gives rise to slower developing blastocysts having fewer inner cell mass cells, effects in the fetus were carried forward into adult growth trajectory and were comparable in nature and magnitude to the consequences of embryo culture seen in the current experiment. A similar linkage is seen in diabetic rats, where blastocysts with a decreased proportion of cells allocated to the inner cell mass are associated with subsequent inhibition of fetal growth (62). A difficulty with these experiments, and indeed with any experiment involving endogenous manipulation, is that a direct relationship between blastocyst parameters and fetal development cannot be proven because of the possibility of indirect confounding influences on other determinants of fetal growth, for example endometrial receptivity. The current experimental strategy employing ex vivo manipulation and embryo transfer overcomes this confounding issue.
Previous studies investigating cytokines and growth factors expressed in the reproductive tract have linked their impact on blastocyst development with implantation success. Epidermal growth factor is a key autocrine growth factor in preimplantation embryos (63), and its supplementation in culture media increases implantation rate after transfer in mice (64). Insulin stimulates cell proliferation in the inner cell mass in vitro in the rat (65) and increases the posttransfer rates of implantation, fetal survival, and weight at birth both in rats (66) and in mice (23). Similarly, platelet-activating factor exerts embryotrophic effects in vitro and increases the proportion of embryos that develop normally after transfer in the mouse (67). Other growth factors thus potentially act in synergy with GM-CSF and together might more adequately protect embryos from the deficit in postnatal outcomes imposed by culture.
The mechanism by which GM-CSF exposure during the preimplantation period determines placental structure and fetal growth is not clear but presumably stems from the same molecular pathways by which GM-CSF promotes blastocyst viability. We have shown that GM-CSF can inhibit apoptosis and promote viability of blastomeres, particularly in the inner cell mass (5, 14). Because GM-CSF promotes glucose transport in embryos, it is possible that its effects are mediated through enhancing metabolic activity. Altered embryo access to glucose or other metabolic substrates is proposed to mediate the consequences of maternal nutritional deprivation (45); thus, disruptions in the metabolic status of the preimplantation embryo could explain the converging effects of growth factors and nutrition on blastocyst development. An alternative interpretation more consistent with evidence that low metabolic activity favors optimal embryo development (68) is that growth factors such as GM-CSF function simply as cell survival signals to prevent activation of the apoptotic cascade in blastomeres.
The means by which memory of metabolic environment in early life may be perpetuated into later fetal and adult life remains ill-defined. It has been speculated that preimplantation stress might result in inappropriate stem cell allocation for normal growth (69), but emerging studies favor mechanisms involving aberrant genomic imprinting, an alternative more easily reconciled with disrupted placental development. Defects are evident in imprinted genes Igf2, H19, Grb10, and Grb7 in mouse embryos after culture in the presence of serum (24) or with suboptimal culture media (27). Aberrant fetal growth and development in cattle and sheep after embryo culture are attributed to imprinting errors in Igf2R after metabolic stress (29, 70). It is known that a number of imprinted genes have important roles in placental development, and placental cell lineages may be relatively more susceptible to persistent imprinting defects after implantation (71). One such gene is Mash-2 (72), which acts in the placenta to promote development of the spongiotrophoblast cell layer within the junctional zone of the placenta. Imprinting aberration in Mash-2 is a candidate mechanism for the placental abnormalities related to large offspring syndrome (73, 74). Whether and how cytokine regulation of viability and metabolic status in blastomeres is linked with the process of imprinting remains to be determined. Because expression of methyltransferases and other methylation machinery are cell cycle-regulated, disruption in their function is proposed to occur after the timing of embryo development is slowed in culture (75), whereas embryotrophic growth factors that accelerate blastomere cell division would oppose this effect. Alternatively, GM-CSF may directly influence epigenetic modification by modulating histone acetylation, specifically through phosphorylation of p44 MAP kinase (76), which activates CREB binding protein histone acetyl transferase (77).
In vitro conditions for culture of human embryos are generally considered to be suboptimal and are believed to compromise embryo quality and contribute to the high rates of implantation failure and impaired fetal outcomes seen in human IVF and related reproductive technologies (15, 16, 17, 18, 19). Inclusion of GM-CSF in human embryo culture media may provide a preimplantation environment more closely approximating the physiological environment and might be particularly beneficial in growing embryos to the blastocyst stage before embryo transfer, the benefits of which include higher implantation rates and better prospects for single embryo transfer to prevent multiple pregnancy (78, 79). Although the current findings provide a path forward for potentially improving perinatal health after IVF, residual adverse programing outcomes indicate the ongoing necessity for a better understanding of the significance of the early environment and its molecular legacy in the embryo to garner further improvements in embryo culture conditions. Thus, the discovery of growth factors that optimize early embryo development has considerable clinical significance and improves the likelihood of eventually defining an embryo growth medium that truly replicates the in vivo milieu.
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Acknowledgments |
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First Published Online February 10, 2005
Abbreviations: GM-CSF, Granulocyte-macrophage colony-stimulating factor; IVF, in vitro fertilization; rm, recombinant murine.
Received September 23, 2004.
Accepted for publication February 1, 2005.
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References |
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and ß receptors and contain immunoreactive GM-CSF protein. J Clin Endocrinol Metab 79:662–665[Abstract]
. Biol Reprod 70:54–64 receptors and selective effect of TNF on the inner cell mass in mouse blastocysts. Endocrinology 134:206–212This article has been cited by other articles:
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