Extracellular Vesicles from Healthy Placenta Stem Cells Restored the Immune Licensing Function of Preeclamptic Placenta Stem Cells
DOI:
https://doi.org/10.13052/ijts2246-8765.2025.021Keywords:
Stem cells, placenta, preeclampsia, aspirin, exosomes, extracellular vesicles, cell cycleAbstract
Preeclampsia (PE) contributes to pregnancy-related morbidity and mortality, with enhanced inflammation. Healthy placenta stem cells (P-MSCs) can be licensed into immune suppressor cells to mitigate inflammation. Since PE is associated with inflammation, the question is why the associated P-MSCs cannot suppress the response. PE P-MSCs have been shown to be dysfunctional with respect to decreased anti-inflammatory response, cell cycle dysregulation, and reduced production of immune suppressive cytokines. Aspirin (ASA) treatment partly reversed these dysfunctions via epigenetic reprogramming. We tested the hypothesis that extracellular vesicles (EVs) from healthy P-MSC could reset PE P-MSCs to a healthy phenotype, including cell cycle dysregulation and anti-inflammatory licensing. EVs from healthy MSCs were collected and the number of particles quantified. The isolated EVs were added to PE P-MSCs. Control cultures treated the PE P-MSCs with 1 mM ASA. The treated cells were assessed for the epigene regulator TDG and cell cycle linked CDK4, p21, and p53 by western blot, or assessed as third-party suppression in a one-way mixed lymphocyte reaction (MLR). EV- and ASA-treated PE P-MSC suppressed MLR, similar to healthy P-MSCs. However, an evaluation of p21, CDK4, p53, and TDG suggested that EVs impart a more stable restoration of PE P-MSCs when exposed to healthy EVs. This study provides insights into the method by which healthy P-MSCs can function to restore PE P-MSCs, and in vivo microenvironmental restoration.
Downloads
References
Ford, N. D., S. Cox, J. Y. Ko, L. Ouyang, L. Romero, T. Colarusso, C. D. Ferre, C. D. Kroelinger, D. K. Hayes, and W. D. Barfield. 2022. Hypertensive Disorders in Pregnancy and Mortality at Delivery Hospitalization - United States, 2017-2019. MMWR Morb Mortal Wkly Rep 71: 585–591.
Say, L., D. Chou, A. Gemmill, Ö. Tunçalp, A. B. Moller, J. Daniels, A. M. Gülmezoglu, M. Temmerman, and L. Alkema. 2014. Global causes of maternal death: a WHO systematic analysis. Lancet Glob Health 2: e323–e333.
Hoyert, D. L., and A. M. Miniño. 2020. Maternal Mortality in the United States: Changes in Coding, Publication, and Data Release, 2018. Natl Vital Stat Rep 69: 1–18.
Hutcheon, J. A., S. Lisonkova, and K. S. Joseph. 2011. Epidemiology of pre-eclampsia and the other hypertensive disorders of pregnancy. Best Pract Res Clin Obstet Gynaecol 25: 391–403.
2020. Gestational Hypertension and Preeclampsia: ACOG Practice Bulletin, Number 222. Obstet Gynecol 135: e237–e260.
Dekker, G. A., and B. M. Sibai. 1998. Etiology and pathogenesis of preeclampsia: Current concepts. Am J Obstet Gynecol 179: 1359–1375.
Sargent, I. L., S. J. Germain, G. P. Sacks, S. Kumar, and C. W. G. Redman. 2003. Trophoblast deportation and the maternal inflammatory response in pre-eclampsia. J Reprod Immunol 59: 153–160.
Rolnik, D. L., K. H. Nicolaides, and L. C. Poon. 2022. Prevention of preeclampsia with aspirin. Am J Obstet Gynecol 226: S1108–s1119.
Henderson, J. T., K. K. Vesco, C. A. Senger, R. G. Thomas, and N. Redmond. 2021. Aspirin Use to Prevent Preeclampsia and Related Morbidity and Mortality: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force. J Am Med Assoc 326: 1192–1206.
2021. ACOG Practice Advisory: Low-Dose Aspirin Use for the Prevention of Preeclampsia and Related Morbidity and Mortality.
Shi, H., Z. Yang, J. Cui, H. Tao, R. Ma, and Y. Zhao. 2024. Mesenchymal stem cell-derived exosomes: a promising alternative in the therapy of preeclampsia. Stem Cell Res Ther 15: 30.
Potian, J. A., H. Aviv, N. M. Ponzio, J. S. Harrison, and P. Rameshwar. 2003. Veto-like activity of mesenchymal stem cells: functional discrimination between cellular responses to alloantigens and recall antigens. J Immunol 171: 3426–3434.
Galipeau, J., M. Krampera, J. Barrett, F. Dazzi, R. J. Deans, J. DeBruijn, M. Dominici, W. E. Fibbe, A. P. Gee, J. M. Gimble, P. Hematti, M. B. Koh, K. LeBlanc, I. Martin, I. K. McNiece, M. Mendicino, S. Oh, L. Ortiz, D. G. Phinney, V. Planat, Y. Shi, D. F. Stroncek, S. Viswanathan, D. J. Weiss, and L. Sensebe. 2016. International Society for Cellular Therapy perspective on immune functional assays for mesenchymal stromal cells as potency release criterion for advanced phase clinical trials. Cytotherapy 18: 151–159.
Romagano, M. P., L. S. Sherman, B. Shadpoor, M. El-Far, S. Souayah, S. H. Pamarthi, J. Kra, A. Hood-Nehra, J. P. Etchegaray, S. F. Williams, and P. Rameshwar. 2022. Aspirin-Mediated Reset of Preeclamptic Placental Stem Cell Transcriptome - Implication for Stabilized Placental Function. Stem Cell Rev Rep 18: 3066–3082.
Krishnamoorthy, K., L. S. Sherman, M. P. Romagano, M. El Far, J. P. Etchegaray, S. F. Williams, and P. Rameshwar. 2023. Low dose acetyl salicylic acid (LDA) mediates epigenetic changes in preeclampsia placental mesenchymal stem cells similar to cells from healthy pregnancy. Placenta 137: 49–58.
Powell, K. A., L. S. Sherman, B. Shadpoor, S. F. Williams, and P. Rameshwar. 2024. Restore Veto Property in Low Dose Aspirin/ASA Treated Preeclampsia Placenta Mesenchymal Stem Cells: Insights Into ASA-mediated Clinical Response*. Intl J Transl Sci 2024: 133–152.
Greco, S. J., S. Ayer, K. Guiro, G. Sinha, R. J. Donnelly, M. H. El-Far, L. S. Sherman, Y. Kenfack, S. H. Pamarthi, M. Gergues, O. A. Sandiford, M. J. Schonning, J. P. Etchegaray, and P. Rameshwar. 2021. Restoration of aged hematopoietic cells by their young counterparts through instructive microvesicles release. Aging (Albany NY) 13: 23981–24016.
Chu, Y., W. Chen, W. Peng, Y. Liu, L. Xu, J. Zuo, J. Zhou, Y. Zhang, N. Zhang, J. Li, L. Liu, K. Yao, G. Gao, X. Wang, R. Han, C. Liu, Y. Li, H. Zhou, Y. Huang, and Y. Ye. 2020. Amnion-Derived Mesenchymal Stem Cell Exosomes-Mediated Autophagy Promotes the Survival of Trophoblasts Under Hypoxia Through mTOR Pathway by the Downregulation of EZH2. Front Cell Dev Biol 8: 545852.
Liu, H., F. Wang, Y. Zhang, Y. Xing, and Q. Wang. 2020. Exosomal microRNA-139-5p from mesenchymal stem cells accelerates trophoblast cell invasion and migration by motivation of the ERK/MMP-2 pathway via downregulation of protein tyrosine phosphatase. J Obstet Gynaecol Res 46: 2561–2572.
Chen, Y., H. Ding, M. Wei, W. Zha, S. Guan, N. Liu, Y. Li, Y. Tan, Y. Wang, and F. Wu. 2020. MSC-Secreted Exosomal H19 Promotes Trophoblast Cell Invasion and Migration by Downregulating let-7b and Upregulating FOXO1. Mol Ther Nucleic Acids 19: 1237–1249.
Yang, Z., N. Shan, Q. Deng, Y. Wang, Y. Hou, J. Mei, and Z. Wu. 2021. Extracellular vesicle-derived microRNA-18b ameliorates preeclampsia by enhancing trophoblast proliferation and migration via Notch2/TIM3/mTORC1 axis. J Cell Mol Med 25: 4583–4595.
Cui, J., X. Chen, S. Lin, L. Li, J. Fan, H. Hou, and P. Li. 2020. MiR-101-containing extracellular vesicles bind to BRD4 and enhance proliferation and migration of trophoblasts in preeclampsia. Stem Cell Res Ther 11: 231.
Jiang, Y., T. Luo, Q. Xia, J. Tian, and J. Yang. 2022. microRNA-140-5p from human umbilical cord mesenchymal stem cells-released exosomes suppresses preeclampsia development. Funct Integr Genomics 22: 813–824.
Yu, H., Y. Pan, M. Dai, X. Wang, and H. Chen. 2023. Mesenchymal Stem Cell-Originated Exosomal Lnc A2M-AS1 Alleviates Hypoxia/Reperfusion-Induced Apoptosis and Oxidative Stress in Cardiomyocytes. Cardiovasc Drugs Ther 37: 891–904.
Cao, L., H. Xu, G. Wang, M. Liu, D. Tian, and Z. Yuan. 2019. Extracellular vesicles derived from bone marrow mesenchymal stem cells attenuate dextran sodium sulfate-induced ulcerative colitis by promoting M2 macrophage polarization. Int Immunopharmacol 72: 264–274.
Shahir, M., S. Mahmoud Hashemi, A. Asadirad, M. Varahram, M. Kazempour-Dizaji, G. Folkerts, J. Garssen, I. Adcock, and E. Mortaz. 2020. Effect of mesenchymal stem cell-derived exosomes on the induction of mouse tolerogenic dendritic cells. J Cell Physiol 235: 7043–7055.
Xin, L., X. Lin, F. Zhou, C. Li, X. Wang, H. Yu, Y. Pan, H. Fei, L. Ma, and S. Zhang. 2020. A scaffold laden with mesenchymal stem cell-derived exosomes for promoting endometrium regeneration and fertility restoration through macrophage immunomodulation. Acta Biomater 113: 252–266.
Sandiford, O. A., R. J. Donnelly, M. H. El-Far, L. M. Burgmeyer, G. Sinha, S. H. Pamarthi, L. S. Sherman, A. I. Ferrer, D. E. DeVore, S. A. Patel, Y. Naaldijk, S. Alonso, P. Barak, M. Bryan, N. M. Ponzio, R. Narayanan, J.-P. Etchegaray, R. Kumar, and P. Rameshwar. 2021. Mesenchymal Stem Cell–Secreted Extracellular Vesicles Instruct Stepwise Dedifferentiation of Breast Cancer Cells into Dormancy at the Bone Marrow Perivascular Region. Cancer Res 81: 1567–1582.
Karimian, A., Y. Ahmadi, and B. Yousefi. 2016. Multiple functions of p21 in cell cycle, apoptosis and transcriptional regulation after DNA damage. DNA Repair 42: 63–71.
Dawson, E. L., Khoury, Muin J. 2022. Preeclampsia, Genomics and Public Health.
Sherman, L. S., M. Shaker, V. Mariotti, and P. Rameshwar. 2017. Mesenchymal stromal/stem cells in drug therapy: New perspective. Cytotherapy 19: 19–27.

