Protein Phosphatase 2A Activation Via ApoER2 in Trophoblasts Drives Preeclampsia in a Mouse Model of the Antiphospholipid Syndrome

Preeclampsia (PE) is a leading cause of morbidity and mortality during pregnancy. The initiating processes in PE are poorly understood, and the only effective intervention is premature delivery, which threatens the well-being of the child. The Antiphospholipid Syndrome (APS), which is characterized...

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Published inCirculation research Vol. 129; no. 7; pp. 735 - 750
Main Authors Chu, Haiyan, Sacharidou, Anastasia, Nguyen, An, Li, Chun, Chambliss, Ken L., Salmon, Jane E., Shen, Yu-Min, Lo, Julie, Leone, Gustavo W., Herz, Joachim, Hui, David Y., Marciano, Denise K., Abrahams, Vikki M., Natale, Bryony V., Montalbano, Alina P., Xiao, Xue, Xu, Lin, Natale, David R., Shaul, Philip W., Mineo, Chieko
Format Journal Article
LanguageEnglish
Published United States Lippincott Williams & Wilkins 17.09.2021
Subjects
Online AccessGet full text
ISSN0009-7330
1524-4571
1524-4571
DOI10.1161/CIRCRESAHA.120.318941

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Abstract Preeclampsia (PE) is a leading cause of morbidity and mortality during pregnancy. The initiating processes in PE are poorly understood, and the only effective intervention is premature delivery, which threatens the well-being of the child. The Antiphospholipid Syndrome (APS), which is characterized by circulating antiphospholipid antibodies (aPL), is a common risk factor for PE, and also for fetal demise, premature birth and intrauterine growth restriction. This work presents an animal model of APS-related PE, revealing that aPL administration to pregnant mice induces PE and fetal compromise via ApoER2 in trophoblasts. Mechanistically, via ApoER2, aPL activate PP2A, which upregulates MMP14 and HIF1α, the latter via dephosphorylation of PHD2, leading to increased production of soluble endoglin, which is a known driver of PE. A role for PP2A in PE pathogenesis is revealed, and linkage of PP2A to PHD2 and HIF1α is demonstrated in placentas from both APS patients and women with PE from causes other than APS. As importantly, pharmacologic inhibition of PP2A affords full protection from both aPL-induced PE and the fetal complications. Future research should interrogate how PP2A is activated in PE not associated with APS, and how PP2A can be targeted to combat PE.
AbstractList [Figure: see text].[Figure: see text].
Preeclampsia (PE) is a leading cause of morbidity and mortality during pregnancy. The initiating processes in PE are poorly understood, and the only effective intervention is premature delivery, which threatens the well-being of the child. The Antiphospholipid Syndrome (APS), which is characterized by circulating antiphospholipid antibodies (aPL), is a common risk factor for PE, and also for fetal demise, premature birth and intrauterine growth restriction. This work presents an animal model of APS-related PE, revealing that aPL administration to pregnant mice induces PE and fetal compromise via ApoER2 in trophoblasts. Mechanistically, via ApoER2, aPL activate PP2A, which upregulates MMP14 and HIF1α, the latter via dephosphorylation of PHD2, leading to increased production of soluble endoglin, which is a known driver of PE. A role for PP2A in PE pathogenesis is revealed, and linkage of PP2A to PHD2 and HIF1α is demonstrated in placentas from both APS patients and women with PE from causes other than APS. As importantly, pharmacologic inhibition of PP2A affords full protection from both aPL-induced PE and the fetal complications. Future research should interrogate how PP2A is activated in PE not associated with APS, and how PP2A can be targeted to combat PE.
[Figure: see text].
Author Herz, Joachim
Natale, David R.
Nguyen, An
Xu, Lin
Shaul, Philip W.
Sacharidou, Anastasia
Lo, Julie
Montalbano, Alina P.
Chu, Haiyan
Marciano, Denise K.
Li, Chun
Shen, Yu-Min
Hui, David Y.
Chambliss, Ken L.
Xiao, Xue
Natale, Bryony V.
Leone, Gustavo W.
Abrahams, Vikki M.
Salmon, Jane E.
Mineo, Chieko
AuthorAffiliation Froedtert-Medical College of Wisconsin Cancer Center, Medical College of Wisconsin, Milwaukee (G.W.L.)
Obstetrics, Gynecology & Reproductive Sciences, Yale School of Medicine, New Haven, CT (V.M.A.)
Internal Medicine (Y.-M.S., D.K.M.), University of Texas Southwestern Medical Center, Dallas
Biochemistry and Obstetrics and Gynecology (A.P.M.), University of Texas Southwestern Medical Center, Dallas
Molecular Genetics (J.H.), University of Texas Southwestern Medical Center, Dallas
Obstetrics and Gynecology (J.L.), University of Texas Southwestern Medical Center, Dallas
Center for Pulmonary and Vascular Biology, Pediatrics (H.C., A.S., A.N., C.L., K.L.C., P.W.S., C.M.)
Medicine, Hospital for Special Surgery, Weill Cornell Medical College, New York (J.E.S.)
Population and Data Sciences and Pediatrics (X.X., L.X.), University of Texas Southwestern Medical Center, Dallas
Pathology, University of Cincinnati College of Medicine (D.Y.H.)
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Issue 7
Keywords antiphospholipid syndrome
placenta
endoglin
preeclampsia
proteinuria
trophoblasts
Language English
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content type line 23
H.C. and A.S. designed the experiments, performed the experiments, and analyzed the data. A.N., C.L and B.V.N. performed the experiments and analyzed the data. K.L.C., J.H., G.W.L. and D.Y.H. generated the genetically modified mouse strains and performed their initial characterization. J.E.S. and Y-M.S. recruited the individuals who provided the human IgG-based reagents. J.L. and A.P.M. provided human placentas from APS or PE patients. V.M.A. provided the human trophoblast strain and aided in experimental design. D.K.M. aided in experimental designs related to proteinuria and kidney functions. L.X. and X.X. performed the statistical analyses. D.R.N., P.W.S. and C.M. designed the experiments, analyzed the data and wrote the manuscript. All authors provided feedback on the manuscript.
AUTHOR CONTRIBUTIONS
Co-first authors
Co-senior authors.
ORCID 0000-0002-1901-1717
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0000-0003-1157-4002
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[Figure: see text].[Figure: see text].
Preeclampsia (PE) is a leading cause of morbidity and mortality during pregnancy. The initiating processes in PE are poorly understood, and the only effective...
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SubjectTerms Adaptor Proteins, Signal Transducing - metabolism
Animals
Antibodies, Antiphospholipid - blood
Antiphospholipid Syndrome - complications
Antiphospholipid Syndrome - metabolism
Apoptosis Regulatory Proteins - metabolism
Cell Line
Female
Humans
Hypoxia-Inducible Factor 1, alpha Subunit - metabolism
LDL-Receptor Related Proteins - metabolism
Mice
Mice, Inbred C57BL
Pre-Eclampsia - etiology
Pre-Eclampsia - metabolism
Pregnancy
Protein Phosphatase 2 - metabolism
Trophoblasts - metabolism
Title Protein Phosphatase 2A Activation Via ApoER2 in Trophoblasts Drives Preeclampsia in a Mouse Model of the Antiphospholipid Syndrome
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