P-411 CD55 deficiency hinders decidualization in unexplained early miscarriage through the Src/ERK signaling pathway
Authors: Tang Z , Zhang W 
Published: July 2024

Abstract

Study question
What is the role of CD55 in the process of human endometrial stromal cells (HESCs) decidualization in unexplained early miscarriage?

Summary answer
CD55, responsive to cAMP signaling, is deficient in decidua of patients with unexplained early miscarriage, which hinders decidualization in vitro through perturbing Src/ERK signaling pathway.

What is known already
Decidualization is a process where HESCs differentiate into decidual stromal cells and present morphological changes and acquisition of secretory function, which is essential for embryo implantation and maintenance of pregnancy while abnormal decidualization contributed to several pregnancy disorders like a miscarriage. Reprogramming of several signaling pathways and transcription factors are involved in this process and cAMP is a critical mediator. Our previous bioinformatic analysis revealed that CD55 was upregulated over five times in the window of implantation, responding to estrogen and progesterone. We speculated that CD55, regulated by cAMP signaling pathway, might play an important role in decidualization.

Study design, size, duration
Decidua tissues were collected from 8 patients with unexplained early miscarriage and 10 control women with normal early pregnancy undergoing artificial abortion between June 2020 and September 2020. Immortalized HESCs line T-hESCs (ATCC CRL-4003) were cultured for up to 6 days to establish in-vitro decidualization model. Each experiment was conducted in triplicate and replicated at least three times independently.

Participants/materials, setting, methods
CD55 expression in control and miscarriage decidua was compared by immunohistochemistry and RT-qPCR. T-hESCs were induced into decidualization by medroxyprogesterone acetate (MPA) and 8-Br-cAMP, with prolactin (PRL) and insulin-like growth factor-binding protein 1 (IGFBP1) as decidualization biomarkers. The changes of genes and signaling pathways were detected by RT-qPCR and western blot during decidualization after CD55 knockdown by lentivirus-mediated RNA interference. Signaling pathway disruptors were added to verify the involvement of signaling pathways.

Main results and the role of chance
The decidua of women with unexplained early miscarriage exhibited decreased expression of CD55, accompanied by a compromised level of decidualization. During in-vitro decidualization, CD55 was significantly upregulated by cAMP in a time- and dose-dependent manner, which was attenuated by a PKA inhibitor H89. Knocking down CD55 expression diminished the expression of decidualization markers PRL and IGFBP1 through inhibition of Src, aberrant activation of ERK and frustrated expression of decidualization-related genes like FOXO1, EGFR, and STAT3.

Limitations, reasons for caution
The mechanisms revealed in this study were based on in-vitro cell models. It is necessary to verify the significance of CD55 in decidualization with in-vivo models to directly explain the link between CD55, decidualization, and pregnancy loss.

Wider implications of the findings
CD55 deficiency hinders decidualization through perturbing Src/ERK signaling pathway and expression of decidualization-related genes, potentially contributing to the pathogenesis of spontaneous miscarriage. Progestin supplementation or other factors stimulating cAMP accumulation can restore CD55 expression and improve decidualization, providing a basis for the therapy of spontaneous miscarriage.

Trial registration number
not applicable