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Endocrinology Vol. 147, No. 2 724-732
Copyright © 2006 by The Endocrine Society

Activin A and Inhibin A Differentially Regulate Human Uterine Matrix Metalloproteinases: Potential Interactions during Decidualization and Trophoblast Invasion

Rebecca L. Jones, Jock K. Findlay, Paul G. Farnworth, David M. Robertson, Euan Wallace and Lois A. Salamonsen

Prince Henry’s Institute of Medical Research (R.L.J., J.K.F., P.G.F., D.M.R., L.A.S.), and Monash University Department of Obstetrics & Gynaecology (E.W.), Clayton, Victoria 3168, Australia

Address all correspondence and requests for reprints to: Rebecca Jones, Division of Human Development, Academic Unit of Child Health, University of Manchester, St. Mary’s Hospital, Research Floor, Hathersager Road, Manchester M13 OJH, United Kingdom. E-mail: rebecca.lee.jones{at}manchester.ac.uk.


   Abstract
Top
 Abstract
Introduction
 Materials and Methods
 Results
 Discussion
 References
 
Embryo implantation and trophoblast invasion are tightly regulated processes, involving sophisticated communication between maternal decidual and fetal trophoblast cells. Decidualization is a prerequisite for successful implantation and is promoted by a number of paracrine agents, including activin A. To understand the downstream mechanisms of activin-promoted decidualization, the effects of activin on matrix metalloproteinases (MMPs) (important mediators of decidualization) were investigated. Activin A stimulated endometrial production of proMMPs-2, -3, -7, -9, and active MMP-2. In contrast, inhibin A was a potent inhibitor of proMMP-2, and antagonized the effect of activin on MMPs. Activin is up-regulated with decidualization, and MMPs-2, -3, and -9 increase in parallel. Furthermore, proMMP-2 production is stimulated when decidualization is accelerated with activin, and suppressed when activin is neutralized, attenuating decidualization. These data support that activin A promotes decidualization through up-regulating MMPs. Previous in vitro evidence proposes further roles for activin and MMPs in promoting trophoblast invasion; therefore, we examined their interrelationships in early human implantation sites. MMPs-7 and -9 were produced by static cytotrophoblast subpopulations, whereas MMP-2 was strikingly up-regulated in invasive extravillous cytotrophoblasts (EVT). Maternal decidua is the primary source of activin, where a role in stimulating MMP-2 in iEVTs can be envisaged. Inhibin was absent from cytotrophoblast populations, except for a dramatic up-regulation in endovascular EVT plugs, coinciding with a down-regulation of MMP-2. This suggests that inhibin may have a role in the cessation of vascular invasion. These data support that activin, via effects on MMPs, is an important factor in the maternal-fetal dialog regulating implantation.


   Introduction
Top
 Abstract
 Introduction
Materials and Methods
 Results
 Discussion
 References
 
SUCCESSFUL IMPLANTATION is critical for the establishment of pregnancy. Failure of embryo implantation, a leading cause of in vitro fertilization failure, is commonly due to endometrial defects (1), whereas spontaneous abortion, intrauterine growth restriction, and preeclampsia are possible consequences of suboptimal trophoblast invasion. Understanding local regulation of endometrial preparation for implantation and trophoblast invasion is critical for the development of novel monitoring and therapeutic strategies for pathologies originating in early pregnancy.

Human trophoblast invasion is highly aggressive, and the endometrium undergoes extensive preparation in anticipation of implantation. In particular, endometrial stroma differentiates spontaneously every cycle to produce the decidua. A number of paracrine factors promote decidualization, including IL-11 and corticosteroid-releasing hormone (2, 3). Earlier studies in our laboratory demonstrated that activin A (a member of the TGF-ß superfamily) also accelerates decidualization, and that decidual cells secrete high concentrations of activin A (4).

A critical element of decidualization is remodeling of the extracellular environment. Matrix metalloproteinase (MMP) activity is essential during decidualization: MMP inhibition during early pregnancy in rat results in a severely diminished decidua (5, 6) and limits decidualization in primate stromal cells in culture (7). In addition to cleavage of extracellular matrix (ECM) components, MMPs play a broader role in the processing and liberation of ECM-tethered growth factors required for tissue remodeling (8). TGFßs are important inhibitors of endometrial MMPs, transducing the suppressive effects of progesterone (9). Furthermore, activin A promotes MMP-2 production in monocytes and placenta (10, 11). We therefore hypothesized that activin stimulates MMP production in human endometrial cells, providing a potential downstream mechanism through which activin promotes decidualization.

Decidual activin A may also regulate trophoblast invasion via effects on cytotrophoblast MMPs. Invasive extravillous cytotrophoblasts (EVT) differentiate from progenitor cytotrophoblasts in anchoring cell columns, upon contact with maternal decidua. These either invade the decidua as interstitial (i) EVTs, or specifically target and enter maternal arteries as endovascular (v) EVTs. These form aggregates plug, and subsequently remodel, the maternal vessels (12). Focal digestion of decidual ECM by iEVTs is critical for their invasion, and cytotrophoblast cells secrete matrix degrading proteases (13). Factors secreted by decidual cells potently stimulate MMP production by cytotrophoblasts, up-regulating MMP-9 and -2 by 200 and 600%, respectively (14). Whereas the active constituents have not been identified, a separate study demonstrated that activin A stimulates MMP-2 secretion by cytotrophoblasts, and promotes cytotrophoblast outgrowth from placental villous tips in a model of trophoblast invasion (10). Because decidual cells secrete high levels of activin A (4), we propose that maternally derived activin significantly contributes to the promotion of trophoblast invasion.

The current study examined the interactions between activins and MMPs during the establishment of pregnancy in the human—both in the maternal decidua during preparation for implantation and in subsequent decidual invasion by fetal trophoblast cells. The effects of activin A on endometrial MMP production, in the presence and absence of antagonists inhibin and follistatin, are demonstrated, and supported by coexpression of activin and MMPs during decidualization. Furthermore, activin treatment and blockade during decidualization in vitro has downstream effects on MMP production. Finally, the interrelationships among activin, inhibin, and MMPs in decidua and distinct trophoblast subpopulations in early human implantation sites were investigated.


   Materials and Methods
Top
 Abstract
 Introduction
 Materials and Methods
Results
 Discussion
 References
 
Tissues
Endometrial biopsies from the proliferative (d5–13; n = 5) and secretory (d15–14; n = 5) phases were collected by curettage from women (ages 25–40) undergoing minor gynecological investigations unrelated to endometrial pathology. Samples were collected in a 1:1 mixture of DMEM and Ham’s F12 medium (DMEM/F12; Trace Biosciences, Sydney, Australia) supplemented with 1% penicillin, streptomycin, and fungizone (Commonwealth Serum Laboratories, Melbourne, Australia) and L-glutamine (Sigma Diagnostics, St. Louis, MO). First trimester implantation sites (n = 6) were collected after surgical termination of pregnancy (6- to 8-wk amenorrhea), fixed in 10% buffered formalin, and paraffin embedded. Written informed consent was obtained from patients, and ethics approval was obtained from institutional ethic committees.

Cell isolation
Endometrial cells were isolated from individual biopsies, yielding stromal and epithelial cell preparations (n = 10) for subsequent hormone treatments. Endometrial tissue was enzymatically digested, and after separation by filtration (4, 15), stromal and epithelial cell-enriched fractions were plated overnight in DMEM/F12 with 10% charcoal-stripped fetal calf serum (Trace Biosciences), 1% penicillin, streptomycin, and fungizone, and L-glutamine.

Cells were further purified by selective adherence: stromal cells were detached with trypsin, plated in 24-well plates, and washed after 45 min to remove nonadherent cells. Epithelial cells were allowed to grow out from glandular structures for 48 h, then detached with trypsin, and serially replated (three times) in plastic culture dishes for 30 min, to allow adherence of contaminating stromal cells. Nonadherent cells were transferred to 24-well plates. This method achieves cultures of 97–99% (stromal) and 85–90% (epithelial) purity, as judged by morphological and immunohistochemical criteria (15). Cells were grown in DMEM/F12/ charcoal-stripped fetal calf serum for 48 h until 80% confluent, then placed in serum-free DMEM/F12 for 24–48 h before treatment. After 24 h of treatment, medium was collected, centrifuged, and snap-frozen in multiple aliquots. Cell number and viability were assessed by trypan blue exclusion.

Treatments
Epithelial and stromal cells were treated in DMEM/F12 containing: recombinant human (rh) activin A (R&D Systems Inc., Minneapolis, MN), rh-inhibin A (Diagnostic Systems Laboratories, Webster, TX), rh-follistatin-288 (Biotech Australia, Sydney, Australia) all between 1–4 nM. TGF-ß1 (R&D Systems) was used at 0.2–2 nM.

Zymography
Gelatin and casein zymography were performed to detect and quantitate secretion of latent and active forms of MMPs by endometrial cells (16). Conditioned media from baby hamster kidney cells stably transfected with human MMP-9 (provided by Dr. D. Edwards, University of East Anglia, Norwich, UK) was used as standards for gelatin zymography, whereas purified recombinant proMMP-1, -3, and -7 were used for casein zymography (Chemicon Australia Pty. Ltd., Boronia, Victoria, Australia). MMP levels were semiquantitated by densitometric analysis (size and intensity of band) using Gel Doc (Bio-Rad Laboratories, Regent’s Park, Australia). Analyses were performed before saturation of gel digestion (hence samples were assayed at a range of dilutions or concentrations), and comparisons were made between bands on the same gel.

ELISA
Prolactin production by endometrial stromal cells was assayed by ELISA (Bioclone Australia Pty. Ltd., Sydney, Australia) as a measure of extent of decidualization (4). The lower detection limit was 10 mIU/liter; inter- and intraassay variabilities were 6.2% and 3.6%. Activin A and inhibin A were measured by ELISA (Oxford-Bioinnovation Ltd., Upper Heyford, UK) (4, 17), using as standards: rhActivin A (National Institute of Biological Standards and Control, Potters Bar, UK) and rhInhibin A (Diagnostic Systems Laboratories). The ELISA sensitivities were: activin 35 pg/ml, with inter- and intraassay variabilities of 6.8% and 3.1%, and inhibin 6 pg/ml, with inter- and intraassay variabilities below 10%.

In vitro decidualization
Endometrial stromal cells were decidualized in vitro (4), with either cAMP (0.5 mM, Sigma) for 8 d, or 17ß-estradiol (E; 10–8 M, Sigma) and medroxyprogesterone acetate (MPA, 10–7 M, Sigma) for 12 d. During steroid-induced decidualization, cells were treated with rh-activin A (0–4 nM) or follistatin-288 (0–3 nM), the endogenous antagonist of activin bioactivity (18), throughout the experiment. Medium was collected every 48 h. cAMP-treated cells were snap-frozen for RNA extraction.

Real-time RT-PCR
Total RNA was extracted from cell pellets using RNeasy spin columns (Qiagen Pty. Ltd., Doncaster, Victoria, Australia), according to manufacturer’s instructions, and treated with ribonuclease-free deoxyribonuclease I (Ambion, Austin, TX). RNA samples were assessed for purity (A260:A280 1.8–2.0; A230:A280 >1) by spectrophotometry, and quantified using Ribogreen fluorescence RNA assay (Molecular Probes, Eugene, OR) (19).

One microgram of RNA was reverse transcribed using avian myeloblastosis virus reverse transcriptase (Promega, Annandale, Australia) and 100 ng random hexanucleotide primers (Amersham Biosciences, Piscataway, NJ) at 46 C for 90 min. All reactions were performed in triplicate and variability between triplicates assessed by quantitation of 18S by real-time PCR using a Roche Lightcycler (Roche, Castle Hill, New South Wales, Australia) (19). Triplicate samples within 15% coefficient of variation were pooled, to overcome the inherent variability of RT. Pooled cDNA samples, diluted 1:10, were analyzed for inhibin/activin subunits and MMP mRNA expression, using a protocol described previously (19), with annealing temperatures between 60 and 68 C, extension times between 10 and 20 sec, and MgCl2 between 3 and 5 mM. Primers used were MMP-2 (5'-TGGGAGCATGGCGATGGATA-3', 5'-ACAGTGGACATGGCGGTCTCA-3'), MMP-3 (5'-AGTCTTCCAATCCTACTGTTGCT-3', 5'-TCCCCGTCACCTCCAATCC-3'), MMP-7 (5'-GTTTAGAAGCCAAACTCAAGG-3', 5'-CTTTGACACTAATCGATCCAC-3'), MMP-9 (5'-GTATTTGTTCAAGGATGGGAAGTAC-3', 5'-GCAGGATGTCATAGGTCACGTAG-3'), inhibin {alpha} (5'-ACGCTCAACTCCCCTGATG-3', 5'-ACCACCATGACAGTAGTGGAA-3') and activin ßA (5'-GGCTTGGAGTGCGACGGC-3', 5'-GCAGCCACACTCCTCCACAAT-3'). Standards were generated by conventional PCR (Hybaid PCR Express; Hybaid Instruments, Waltham, MA) and identity confirmed by DNA sequencing. PCR runs were repeated with inclusion of a quality control.

Immunohistochemistry
Inhibin/activin.
{alpha} And ßA subunits were immunolocalized using affinity-purified rabbit polyclonal antibodies (kind gift from Prof. W. Vale, The Salk Institute for Biological Sciences, La Jolla, CA), as previously described (20) with modifications. In brief, microwave antigen-retrieval was performed, and antibodies applied at 2 µg/ml in nonimmune block containing 10% goat serum (Sigma), 2% human serum, and 0.1% Tween 20 (Bio-Rad) in Tris-buffered saline. Rabbit IgG (Dako, Glostrup, Denmark) at 2 µg/ml served as a negative control. Antibody binding was detected by sequential application of biotinylated goat antirabbit IgG (Dako) and avidin-biotin-peroxidase conjugate (Dako), with chromogen diaminobenzidine (Dako). Tissue sections were counterstained with Harris’s hematoxylin.

MMPs.
A similar protocol was used, with the following adaptations. Rabbit polyclonal antihuman MMP-7 antibody (kind gift from Prof. F. Woessner, Department of Biochemistry and Molecular Biology, University of Miami, Miami, FL) was applied at 0.5 µg/ml. MMP-2, -3, and -9 were detected using monoclonal antibodies (Merck Biosciences, Kilsyth, Victoria, Australia), diluted between 2 and 4 µg/ml (21, 22, 23). No microwaving was performed for MMP-9. Horse serum (Sigma) was used in the nonimmune block, and for MMP-2, no Tween 20 was included. The secondary antibody was biotinylated horse antimouse IgG (Vector Laboratories, Burlingame, CA). Rabbit/mouse IgG at matching concentrations to primary antibodies were used as negative controls

Cytokeratin.
An identical protocol was used as for MMP-9, with a pan-cytokeratin antibody (Dako) diluted 1:4 in nonimmune block after enzymatic antigen retrieval (0.1% trypsin in 0.1% CaCl2 for 15 min at 37 C).

Statistics
Data were analyzed by ANOVA with Tukey’s post hoc test (activin, inhibin, and follistatin treatments) or by paired Student’s t test (decidualization experiments).


   Results
Top
 Abstract
 Introduction
 Materials and Methods
 Results
Discussion
 References
 
Initial experiments were performed to verify that expression of MMPs and inhibin/activin subunits was not disrupted by cell isolation and culture. Culture conditions were optimized to exclude all agents (e.g. fetal calf serum, BSA) known to artificially stimulate activins/MMPs. This resulted in low basal expression of inhibins, activins, and MMPs, resembling the in vivo expression of immunoreactive protein (20, 24).

Effect of activin on MMP production
Stromal cells expressed MMP-2 and -3 mRNA (data not shown), and protein production of proMMP-2 and -3 only was confirmed by zymography (Fig. 1AGo). Treatment of stromal cells with activin A stimulated proMMP-2 secretion (Fig. 1AGo). At 2 nM, activin A induced a 2.2-fold increase in proMMP-2 (Fig. 1BGo, n = 4 cell preparations, P < 0.05 vs. control). This dose was thereafter used for all analyses. Inhibin A (2 nM) significantly reduced proMMP-2 (P < 0.05 vs. control), and cotreatment of inhibin A with activin A at equimolar concentrations similarly reduced proMMP-2 (P < 0.05 vs. activin alone; Fig. 1BGo). Follistatin alone (2 nM) reduced proMMP-2 levels (not significant). Active MMP-2 was detected in only one of four stromal cell preparations, where it followed the same pattern as proMMP-2. No significant differences in proMMP-3 levels were detected after treatments (Fig. 1AGo).



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  		FIG. 1. Effect of activin A on endometrial stromal cell MMP production, assessed by zymography of conditioned media. A, Representative zymograms (gelatin and casein) illustrating effect on MMP secretion of: no treatment (C), activin A (Act; 1, 2 nM), inhibin A (Inh; 2 nM) in the absence and presence of exogenous activin A (2 nM). B, Effect of Act, Inh, Act + Inh and follistatin (FS; 2 nM) on proMMP-2 production. Data are mean fold change in band density from control levels ± SEM, for n = 4 individual cell preparations. Activin alone significantly stimulated proMMP-2 vs. control levels. Inhibin alone significantly reduced proMMP-2 levels to below control levels. Moreover, inhibin antagonized activin-stimulated proMMP-2. Significant differences are indicated between matching letters (P < 0.05). C, Comparison of effect of Act (1 and 2 nM) and TGFß1 (0.2 and 2 nM) on stromal cell MMP-2 production by gelatin zymography. D, Quantitation of effects of Act and TGFß1 treatment on proMMP-2 and proMMP-3 secretion. Representative of two experiments.

 
The effect of activin A was compared with that of TGF-ß1: proMMP-2 and proMMP-3 were stimulated by 1 and 2 nM of activin A, but reduced by similar concentrations of TGF-ß1. A representative gelatin zymogram is shown in Fig. 1CGo. Due to considerable variation in the degree of response between cell preparations, representative data of two experiments for both proMMP-2 and proMMP-3 are shown in Fig. 1DGo. As before, active MMP-2 was detected in one of two cell preparations, and followed the same pattern as proMMP-2 (Fig. 1CGo).

Epithelial cells expressed mRNA for MMPs-2, -3, -7, and -9 (not shown), and these were all detectable at the protein level by zymography (Fig. 2Go, A and C). Epithelial cells (n = 4–6 cell preparations) were treated with activin A, inhibin A, both together and follistatin (2 nM). Activin A significantly stimulated production of proMMP-2, -3, and -7 (P < 0.05 vs. control), and nonsignificantly stimulated proMMP-9 and active MMP-2 (Fig. 2Go, B and D). Inhibin A alone potently inhibited production and activation of proMMP-2 only, but antagonized exogenous activin-stimulation of all MMPs (significant for MMPs-2, -3, -7; P < 0.05 vs. activin alone). Follistatin did not significantly affect MMP levels in epithelial cells, in the absence of exogenous activin.



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  		FIG. 2. Effect of activin A (Act) and inhibin A (Inh) (2 nM) on endometrial epithelial cell MMPs, assessed by gelatin and casein zymography of conditioned media. Untreated cells acted as controls (C). A, Representative gelatin zymogram; and B, analysis of proMMP-2, proMMP-9, and active MMP-2 by densitometry. C, Representative casein zymogram; and D, analysis of proMMP-3 and proMMP-7 levels. Results are presented as mean ± SEM fold change from control levels (combined data from n = 4–6 experiments). Significant differences (P < 0.05) are denoted by matching letters: between Act treatment and control for proMMPs-2, -3, -7 and active MMP-2, between Inh treatment and control for proMMP-2 only, and between Act + Inh cotreatment vs. Act treatment alone for proMMPs-2, -3, -7 and active MMP-2.

 
Endogenous expression of inhibin and activin mRNAs were assessed using real-time PCR: inhibin {alpha} mRNA was virtually absent in epithelial and stromal cells (<0.05 fg/pg 18S), whereas activin ßA mRNA was abundant in epithelial cells (150 fg/pg 18S vs. 3 fg/pg 18S in stromal cells) (not shown). This was verified by measurement of dimeric inhibin A and activin A secretion by ELISA: inhibin A levels were 5–32 pg/105 cells from endometrial cells, whereas activin A was secreted at levels of 5000 pg/105 cells from epithelial and 1000 pg/105 cells from stromal cells (not shown).

Activin and MMPs in decidualized stromal cells
To investigate the relationship among inhibin, activin, and MMPs after decidualization, highly decidualized cells, as determined by prolactin secretion, were generated by treatment with cAMP for 8d (n = 3; Fig. 3AGo). Expression levels of inhibin {alpha}/activin ßA subunits and MMP-2, -3, -9 were quantitated by real-time PCR on d 8. Inhibin {alpha} subunit mRNA expression was very low in decidual cells (0.2 fg/pg 18S, not shown), whereas activin ßA subunit mRNA was up-regulated more than 7-fold after cAMP-induced decidualization (P < 0.05; Fig. 3BGo). MMP-2, -3, -9 mRNAs were similarly up-regulated in decidualized cells, but this failed to reach significance due to variability between individual cell preparations (Fig. 3CGo). This pattern was confirmed at the protein level: inhibin A secretion was minimal from decidual cells (32 pg/105 cells, not shown), activin A has previously been shown to be up-regulated approximately 5-fold to 5000 pg/105 cells (4). ProMMP-2, -3, and -9, and active MMP-2 were up-regulated with decidualization (representative zymograms, Fig. 3DGo). ProMMP-1 was detected at low levels and was unchanged with decidualization. No MMP-7 mRNA or protein was detected, consistent with it being epithelial specific. Moreover, activin ßA subunit and MMP-2, -3, -9 immunolocalized to decidual cells of early pregnancy (Fig. 4Go, A–F). No immunoreactive inhibin {alpha}-subunit or MMP-7 were detected.



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  		FIG. 3. Activin ßA and MMP expression and production by decidualized stromal cells. A, Prolactin production from stromal cells decidualized with cAMP for 8 d. Significant decidualization was achieved on d 8 of treatment (P < 0.05). Data from n = 3 individual cell preparations. Quantitation of (B) activin ßA and (C) MMPs-2, -3, and -9 mRNA expression by real-time PCR in control (nil) and cAMP-treated cells on d 8 of decidualization. Expression levels shown in femtograms per picograms of 18S mRNA. Activin ßA was significantly up-regulated in decidualized vs. control cells (P < 0.05), whereas nonsignificant increases were seen for the MMPs. D, MMP production from same cells as assessed by zymography of conditioned media (representative of three experiments). E and F, Effect of activin (Act, 0–4 nM; E) and follistatin (FS, 0–3 nM; F) on proMMP-2 production by in vitro-decidualized cells. Data in E + F are from d 8 of progesterone-induced decidualization, n = 2 experiments; bars denote range.

 


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  		FIG. 4. Immunolocalization of inhibin/activin subunits and MMPs at the maternal-fetal interface in early human pregnancy. A–F, In decidua: (A) inhibin {alpha}, (B) activin {alpha}A, (C) rabbit IgG control (neg), (D) MMP-2, (E) MMP-3, and (F) MMP-9 in the maternal decidua. G, First trimester villous tip and cell column (CC) identified with cytokeratin (CK). Arrows indicate direction of invasion into decidua. H, Serial section immunostained for activin ßA. Arrowheads show staining in syncytiotrophoblast and syncytializing trophoblast at the distal tips of the CC. I, High magnification image of intense inhibin {alpha} staining in fusing trophoblast. J and K, MMP-2 immunostaining in villous tips. Staining is only present in trophoblast in the distal region of the CC and in EVTs breaking off the CC and entering the decidua (arrowheads). L, MMP-9 immunostaining in villous cytotrophoblast, CC and leukocytes in intervillous spaces (*). M, Identification of iEVTs and vEVTs in first trimester decidua with CK. N, Serial section stained for activin ßA, showing staining in vEVT but not iEVT. High-magnification serial sections stained for (O) CK and (P) inhibin {alpha} in iEVT. Q, Intense immunostaining for MMP-2 in iEVT (arrowheads) surrounding a maternal vessel in decidua. R–U, Serially stained decidual sections identifying iEVT with CK, indicating colocalization with MMP-2, but not with MMP-9. Scale bars, 50 µm.

 
To investigate whether MMPs were potential downstream mediators of activin-promoted decidualization, MMP levels were assessed where progesterone-induced decidualization was accelerated (2- to 3-fold) by addition of activin A (n = 2), or attenuated (~25%) by neutralization of activin bioactivity with follistatin (n = 2) (4). Activin A (0.4–4 nM) stimulated proMMP-2 secretion and activation on d 8 of decidualization (Fig. 3EGo). Furthermore, proMMP-2 secretion was reduced on d 8 of decidualization in the presence of follistatin (Fig. 3FGo).

Activin, inhibin, and MMPs during trophoblast invasion
Spatial expression of MMP-2, -7, -9, and inhibin {alpha}/activin ßA subunits were assessed in trophoblast subtypes in serial sections of implantation sites from normal human pregnancies. Trophoblast cells were identified by immunostaining for cytokeratin.

Immunostaining for activin ßA subunit was absent in anchoring cell columns (Fig. 4HGo) but was strongly expressed, together with {alpha}-subunit, in trophoblast cells undergoing fusion at the tips and edges of the columns (Fig. 4Go, H and I). Cytotrophoblast cells in the upper cell column were negative for MMP-2, but it was strikingly up-regulated in distal cells and EVTs breaking-off and invading decidua (Fig. 4Go, J and K). MMP-7 (not shown) and -9 (Fig. 4LGo) were strongly expressed by all column cytotrophoblast cells.

iEVTs invading decidua did not express inhibin {alpha}-subunit, and only weakly expressed activin ßA (Fig. 4Go, N and P). However, iEVTs were intensely stained for MMP-2 (Fig. 4Go, Q and S), whereas staining for MMP-7 (not shown) and MMP-9 was faint or absent (Fig. 4UGo). Conversely, strong immunostaining for activin ßA and inhibin {alpha} was detected in vEVT plugs (Fig. 5Go, B and C). MMP-2 expression was strikingly diminished in vEVTs (Fig. 5DGo), whereas MMPs-7 and 9 were maintained (Fig. 5Go, E and F).



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  		FIG. 5. Colocalization of inhibin, activin, and MMPs in trophoblast subsets in first trimester pregnancy. A, Identification of intravascular EVT plugs in maternal vessels with cytokeratin (CK) staining. Intense immunostaining for (B) activin ßA and (C) inhibin {alpha} was detected in vEVT plugs. D, MMP-2 immunostaining was markedly diminished in vEVTs but strong in iEVTs (i). By contrast, (E) MMP-7 and (F) MMP-9 positively immunostained vEVT plugs, and intensely stained surrounding neutrophils and macrophages (asterisks). Enlarged, often multinucleated cytotrophoblast cells in maternal decidua, believed to be giant cells, stained strongly for (G) inhibin {alpha} and (H and I) activin ßA. J–L, Controls for immunostaining specificity in syncytiotrophoblast, showing no staining with rabbit IgG, and the staining patterns for inhibin {alpha} and activin ßA. M, MMP-2 was absent from villous cyto- and syncytiotrophoblast, whereas (N) MMP-9 intensely localized to cytotrophoblast cells only. MMP-9-positive leukocytes shown with asterisks. Scale bars, 50 µm.

 
In addition, inhibin {alpha} and activin ßA subunits immunostained enlarged mono- and multinucleated trophoblast cells, identified as cytotrophoblast giant cells (Fig. 5Go, G and H) and syncytial fragments (Fig. 5IGo). No staining was observed for MMPs (not shown). Leukocytes within villi and decidua intensely stained for MMPs and activin ßA-subunit. Specificity of immunostaining for inhibin subunits was confirmed by their selective staining in syncytio- but not villous cytotrophoblast (25) (Fig. 5Go, K and L). MMPs were not produced by syncytiotrophoblast; however, villous cytotrophoblasts were strongly positive for MMP-7 (not shown) and -9 (Fig. 5NGo). These data are summarized in Fig. 6AGo.



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  		FIG. 6. A, Summary of immunostaining patterns for inhibin, activin, and MMP in maternal and fetal cells in first trimester human implantation sites (2+, strongly present; +, present; +/–, low levels; –, undetectable). DEC, Decidua; CC, cell column; CG, giant cell; ST, syncytiotrophoblast; CT, villous cytotrophoblast. B, Proposed interactions during trophoblast invasion. DEC derived activin is a potential trigger for MMP-2 expression by cytotrophoblasts in the distal CC and in invasive iEVT. The onset of inhibin a expression in GC and vEVT plugs may be responsible for the down-regulation of MMP-2 in these cells, through its antagonistic actions on activin.

 

   Discussion
Top
 Abstract
 Introduction
 Materials and Methods
 Results
 Discussion
References
 
This study demonstrates that activin A stimulates MMP production (proMMP-2, -3, -7, -9) by endometrial cells. MMP-2 activation was also enhanced by activin, in parallel to increased availability of latent form. Furthermore, inhibin A antagonizes activin-induction of MMPs and is a potent inhibitor of proMMP-2. MMP up-regulation by activin A is consistent with actions in other cell types (10, 11), suggesting modulation of MMPs is a prime downstream action of activin during tissue remodeling, e.g. wound healing, embryogenesis, and inflammation. Activin and TGFßs (9) therefore appear to be opposing regulators of MMPs in endometrial cells, consistent with their contrasting effects on cytotrophoblast invasion (10, 26) and placental steroidogenesis (27). This indicates divergent signaling pathways for activins and TGFßs in endometrium and placenta, either through differential phosphorylation of Smads, as in pituitary cells (28), or through use of specific downstream cofactors.

Inhibin was a potent antagonist of activin in endometrial cells, overriding the stimulatory effect of activin on MMPs at equimolar concentrations. Both endometrium and placenta express activin type II receptors and betaglycan (29, 30), conferring sensitivity to inhibin-mediated antagonism of activin action (31). However, this is the first demonstration of a function for inhibin within the uterus. A role for auto/paracrine inhibin is doubtful because endometrial inhibin levels are limited. However, inhibin is a potent endocrine hormone, and circulates at high levels throughout the menstrual cycle when MMP production is suppressed (32). Progesterone withdrawal premenstrually releases MMP suppression in the endometrium, and triggers MMP-mediated endometrial breakdown (16). Because inhibin A levels mirror those of progesterone in the luteal phase, a parallel role may be anticipated. Moreover, the sharp increase in inhibin B (believed to have similar actions to inhibin A) in the late menstrual phase (33) potentially represents a previously unrecognized endocrine mechanism for the cessation of menstruation-associated MMP production.

Although all MMPs were stimulated by activin, MMP-2 was more sensitive to inhibition by inhibin than other MMPs. That MMPs are differentially regulated is well established (reviewed in Ref.34). However, MMP-2 is unusual in that its promoter does not contain the activator protein-1 or polyoma-enhancing activity-3/E26 virus elements found in most other MMPs expressed in the endometrium, although it does have two SP1-binding sites (35). In some cell types, MMP-2 expression can be induced by TGFß (36), but in general expression levels are little affected by the action of growth factors and cytokines. Clearly, the balance of stimulatory and inhibitory factors in a particular microenvironment will determine MMP output. This is undoubtedly related to distinct functions; for example in the placenta it appears that MMP-2 expression corresponds to cytotrophoblast invasive potential, whereas MMP-7 and -9 are maximal in static but metabolically active cells (e.g. villous cytotrophoblasts, vEVTs).

Inhibin A was a more potent antagonist in stromal than epithelial cells; no inhibitory effect was observed on epithelial MMP-3, -7, -9 in the absence of exogenous activin. This probably relates to differences in endogenous activin levels. Although activin production by epithelial cells is approximately 5 times higher than by stromal cells, follistatin is coexpressed in endometrial epithelial, but not stromal, cells (29). Thus, bioactive activin may be negligible in epithelial-conditioned media. This concept is also supported by the failure of follistatin treatment to suppress epithelial MMPs.

Activin A is dramatically up-regulated in decidualizing cells and promotes decidual progression (4). Inhibin expression is limited in the decidua, suggesting an activin-dominated environment. Coincidental to activin up-regulation, we observe an elevation of decidual MMP-2, -3, -9, and indeed MMP-2 production and activation is further increased by treatment of decidualizing cells with activin. Inhibition of MMPs impedes the decidualization process (5, 6, 7). A similar attenuation of decidualization occurs with activin neutralization (4, 37), which we demonstrate here results in diminished proMMP-2. These data reinforce a physiological interaction between activins and MMPs during decidualization and support the hypothesis that activin promotes decidual progression, at least in part, through elevating MMP production.

The placenta is a significant source of inhibins/activins, primarily from syncytiotrophoblast (25), and roles in regulating placental steroidogenesis have been identified (38). Furthermore, exogenous activin promotes differentiation of EVTs and MMP-2 secretion, in an in vitro model of trophoblast invasion (10). Our in vivo data support this, demonstrating that maternal decidua is the prime source of activin, and that MMP-2 is strikingly up-regulated in cytotrophoblast cells as they contact and invade through the activin-rich decidua. We therefore propose that activin is an important constituent of decidual secretions, stimulating trophoblast MMPs (14).

Immunohistochemistry is invaluable for determining protein expression by individual cell populations in vivo. In early implantation sites, distinct trophoblast populations clearly expressed specific repertoires of inhibin, activin, and MMPs. MMP-2 appeared to be associated with cytotrophoblast migration, consistent with its abundance in iEVTs in ectopic pregnancies (39). Conversely, MMP-7 and -9 were expressed by nonmotile cytotrophoblasts, suggesting roles in processing, rather than invasion, and indicating differential regulation of MMPs by the microenvironmental milieu of cytokines/growth factors. These data contrast with studies using primary cytotrophoblast cells, which attribute MMP-9 with invasive potential (13, 40). However, isolated cytotrophoblast cells are likely to be a mixed population, and we demonstrate that MMP-9 is abundant in all cytotrophoblast subtypes, except for the minor iEVT population. MMP-9 levels are reduced in isolated cytotrophoblasts with advancing gestation: however, a variety of other MMPs (including MMP-2) are strictly down-regulated after the first trimester (41). Moreover trophoblast invasion is limited in vitro by neutralization of MMP-2 (42). This indicates species-specific differences in placentation because MMP-9 is the predominant MMP in murine invasive giant cells (6).

Absence of MMP-2, but maintenance of MMP-7 and -9, was observed in endovascular aggregates of vEVTs, consistent with their cessation of migration. Interestingly, strong immunoreactivity for inhibin/activin subunits was simultaneously observed in vEVTs. A similar expression profile is seen in human giant cells—the terminal differentiation state of iEVTs—again associated with loss of migratory potential (12). EVT invasion must be tightly limited, to prevent overinvasion into myometrium and vasculature. Given the increased production of inhibin subunits, with a paralleled decrease in MMP-2 production in immobilized EVT populations, it is tempting to hypothesize that inhibin contributes to diminished trophoblast invasiveness.

The trigger for inhibin subunit expression in cytotrophoblasts is unknown. However, the implantation site is maintained in a hypoxic state, and this is believed to be critical for regulating trophoblast differentiation (43). Inducing placental hypoxia in vitro significantly suppresses inhibin and activin production (44). This suggests that inhibin/activin may be up-regulated as vEVTs invade maternal vessels and encounter an oxygen-rich environment. Giant cells also produce inhibin/activin subunits. These enlarged cells are multinucleated, and a similar up-regulation of inhibin/activin subunits occurs with syncytialization in vivo and in vitro (45). Whether this is cause or effect is not known, as syncytial formation has not been clearly defined.

In summary, we show that activin A stimulates endometrial MMPs, and inhibin potently antagonizes activin action. The relationship between activin A and MMP-2 suggests MMP up-regulation is a downstream event during activin-stimulated decidualization. Spatial expression patterns of inhibin/activin and MMPs in intrauterine implantation sites demonstrate that cytotrophoblast MMP-2 is up-regulated by contact with decidua; thus, we propose that decidual-derived activin is important for promoting iEVT invasion (Fig. 6BGo). The physiological significance of the inhibition of MMP-2 by inhibin is reinforced by their lack of colocalization in cytotrophoblast populations, indicating that autocrine inhibin {alpha} production may be a critical switch during trophoblast differentiation. Thus, these data highlight a number of mechanisms through which activins and inhibins may contribute to the bidirectional communication between maternal and fetal cells during the establishment of pregnancy.


   Acknowledgments
 
We acknowledge the technical assistance of Tu’uhevaha Kaitu’u, Premila Paiva, Natalie Hannan, Ashwini Chand, and Sue Panckridge.


   Footnotes
 
This work was supported by National Health & Medical Research Council (NH&MRC) of Australia, Royal Australian and New Zealand College of Obstetrics and Gynaecology). Studies were funded by NH&MRC Program Grant (No. 241000). R.L.J. was the recipient of the Ella McKnight Scholarship (Royal Australian and New Zealand College of Obstetrics & Gynaecology). L.A.S., D.M.R., and J.F.K. are supported by Fellowship Nos. 143798, 198707 and 198705 from NH&MRC.

Disclosure: R.L.J., J.K.F., P.G.F., D.M.R., E.W., and L.A.S. have nothing to declare.

First Published Online November 10, 2005

Abbreviations: ECM, Extracellular matrix; EVT, extravillous cytotrophoblast; iEVT, interstitial; MMP, matrix metalloproteinase; rh, recombinant human; vEVT, endovascular.

Received September 15, 2005.

Accepted for publication October 31, 2005.


   References
Top
 Abstract
 Introduction
 Materials and Methods
 Results
 Discussion
 References
 

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