Umana Trophoblast primaria coltura cellulare modello per studiare gli effetti protettivi della melatonina contro ipossia / riossigenazione Disruption-indotta
Summary
This manuscript presents a unique in vitro model of immunopurified human villous cytotrophoblast cells cultured under hypoxia/reoxygenation. This model is suitable to study the protective effects of promising treatments, such as melatonin, on pregnancy complications associated with increased oxidative stress and altered placental function.
Abstract
This protocol describes how villous cytotrophoblast cells are isolated from placentas at term by successive enzymatic digestions, followed by density centrifugation, media gradient isolation and immunomagnetic purification. As observed in vivo, mononucleated villous cytotrophoblast cells in primary culture differentiate into multinucleated syncytiotrophoblast cells after 72 hr. Compared to normoxia (8% O2), villous cytotrophoblast cells that undergo hypoxia/reoxygenation (0.5% / 8% O2) undergo increased oxidative stress and intrinsic apoptosis, similar to that observed in vivo in pregnancy complications such as preeclampsia, preterm birth, and intrauterine growth restriction. In this context, primary villous trophoblasts cultured under hypoxia/reoxygenation conditions represent a unique experimental system to better understand the mechanisms and signalling pathways that are altered in human placenta and facilitate the search for effective drugs that protect against certain pregnancy disorders. Human villous trophoblasts produce melatonin and express its synthesizing enzymes and receptors. Melatonin has been suggested as a treatment for preeclampsia and intrauterine growth restriction because of its protective antioxidant effects. In the primary villous cytotrophoblast cell model described in this paper, melatonin has no effect on trophoblast cells in normoxic state but restores the redox balance of syncytiotrophoblast cells disrupted by hypoxia/reoxygenation. Thus, human villous trophoblast cells in primary culture are an excellent approach to study the mechanisms behind the protective effects of melatonin on placental function during hypoxia/reoxygenation.
Introduction
Nel corso della gravidanza umana, le cellule placentari citotrofoblasto, che sono le cellule staminali mononucleate, rapidamente proliferano e si differenziano in cellule sia citotrofoblasto villi o extravilloso. citotrofoblasti extravilloso invadono e rimodellano le arterie a spirale della parete uterina. Cytotrophoblasts villi, invece, continuano a proliferare, differenziare e fusibile per formare syncytiotrophoblast multinucleate (il sincizio) 1. Il mantenimento della omeostasi dei villi trofoblasto è essenziale per il benessere fetale e gravidanza sana. In realtà, trophoblasts villi consentono lo scambio materno-fetale di ossigeno e nutrienti, e producono ormoni essenziali per la gravidanza. Inoltre, il syncytiotrophoblast è l'unico tipo cellulare in diretto contatto con la circolazione del sangue materno e fornisce una barriera fisica e immunologica essenziale. Pertanto, il sinciziotrofoblasto deve subire apoptosi e la sostituzione per la manutenzione omeostatico e di AVOid placentare patologie 2-5.
La tecnica sviluppata da Kliman et al. 6 nel 1986 per isolare citotrofoblasti villi primari da placenta umana ha causato una rivoluzione nel campo della ricerca placentare, consentendo lo studio dei meccanismi molecolari coinvolti nella differenziazione dei villi trofoblasto. Questa tecnica classica, sulla base di digestioni enzimatiche sequenziali con tripsina e DNasi, seguita da isolamento nei media densità centrifugazione (particelle di silice colloidale rivestito da polivinilpirrolidone, o Percoll) è ormai riconosciuto come il gold standard per isolare le cellule citotrofoblasto villi. La tecnica può essere ottimizzata immunopurificazione magnetica, una procedura che separa cytotrophoblasts villi da cellule non trofoblastiche basati sull'espressione differenziale di antigeni specifici sulla superficie di queste cellule. Abbiamo scelto l'antigene leucocitario umano ABC (HLA-ABC) per l'assenza della sua espressione sulla membran cellulare trofoblasticae 7,8.
La placenta è un organo che subisce drammatiche variazioni nei livelli di ossigeno durante la gravidanza. Nel primo trimestre, il rapporto di ossigenazione è fisiologicamente molto bassa (2% O 2), ma aumenta a livelli lievi di ossigenazione (8% O 2) nel secondo e terzo trimestre. Tuuli et al. 9 descritto che la riproduzione in vitro dell'ambiente trofoblasto all'interno del villi della placenta è una sfida e le variazioni dei livelli di ossigenazione può anche portare a cambiamenti fenotipici. È pertanto suggerito di adottare dell'8% ossigeno come normossia per imitare la tensione di ossigeno trovato in villi placentari durante il terzo trimestre di gestazione 8,9. Chen et al. 10 ampiamente studiato diverse variabili legate alla tensione di ossigeno nelle cellule in coltura trofoblasto e dimostrato l'importanza di determinare i livelli di ossigeno in un ambiente pericellulare. I livelli di ossigeno nei villi tendono ad aumentarea causa di vasculogenesi. Il flusso di sangue placentare villi aumenta costantemente e il livello di perossido di idrogeno (un'abbondante specie reattive) è un segnale importante che controlla vasculogenesi 11,12. In complicazioni della gravidanza, la mancanza di vasculogenesi genera ipossia, e ancora più importante, le variazioni intermittenti di ossigenazione (chiamato ipossia / riossigenazione). Queste condizioni portano ad un aumento anomalo stress ossidativo, che compromette placentare e fetale 13,14 vitalità. Le alterazioni che le cellule del trofoblasto subiscono in vivo durante gli episodi di ipossia / riossigenazione possono essere imitate in vitro come segue: citotrofoblasti villi sono mantenute in condizioni di normossia (8% O 2) fino a quando non si differenziano in sinciziotrofoblasto. Essi vengono quindi sottoposti a condizioni di ipossia (0,5% O 2) per 4 ore, seguito da un ulteriore 18 ore di normossia (riossigenazione). Usando questo approccio ipossia / riossigenazione, trofoblasto exvietare liberalizzato stato redox e aumento dei livelli di apoptosi intrinseca 8, come è stato osservato in alcune complicazioni durante la gravidanza. Quindi, questo è un utile modello in vitro per valutare nuovi approcci preventivi e terapeutici per combattere le complicazioni della gravidanza associate a ipossia placentare / riossigenazione.
Cellule placentari producono melatonina, che ha diverse funzioni importanti, come la capacità di ovviare stress ossidativo e disfunzione placentare 15. Qui, presentiamo i modelli di approccio e cellulari sperimentali utilizzate per dimostrare gli effetti protettivi della melatonina in cellule del trofoblasto placentare a livello molecolare, cellulare e funzionale 8.
Protocol
Representative Results
Discussion
Nei mammiferi, lo sviluppo fetale è direttamente dipendente adeguata funzione placentare. Le origini dello sviluppo di disturbi di salute sono basate sull'ipotesi che la causa delle malattie che si manifestano più tardi nella vita può essere fatta risalire al primo sviluppo e che la placenta ha un ruolo meccanicistico nella programmazione fetale 30-32. La placenta è il mediatore chiave della crescita e lo sviluppo fetale: regola il trasferimento dei nutrienti, protegge contro le esposizioni dannose, e…
Disclosures
The authors have nothing to disclose.
Acknowledgements
Supported by grants from the Natural Sciences and Engineering Research Council of Canada (NSERC) (no. 262011-2009) to CV and March of Dimes Social and Behavioral Sciences Research grant (#12-FY12-179) to CV and JTS; by studentships to LSF from the Ministère de l’éducation, de l’Enseignement supérieurs et de la recherche (MEESR)-Fonds de recherche du Québec (FRQ)-Nature et technologies (NT) and the Fondation Universitaire Armand-Frappier INRS, to HC from the Réseau Québécois en Reproduction-NSERC-CREATE, to AAHT from the Canadian Institutes of Health Research (CIHR) and FRQ-Santé, and to JBP from NSERC; by a fellowship to EMAS from the Conselho Nacional de Desenvolvimento Cientìfico e Tecnològico (CNPq) and the Programme de bourses d’excellence pour étudiants étrangers MEESR-FRQNT.
Materials
| Curved Metzenbaum Scissors | Shandon | 9212 | surgical equipment (cell isolation) (2 units) |
| Splinter Forceps Fine 41/2in | Fisherbrand | 13-812-42 | surgical equipment (cell isolation) (2 units) |
| Scissors 4.5 Str Dissection | Fisherbrand | 08-940 | surgical equipment (cell isolation) (2 units) |
| Gauze Sponge 10cm X 10cm | Cardinal Health | 361020733 | |
| Oblong Glass Baking Dish | Pyrex | 1105397 | Glassware (2.8L) |
| Funnel Buchner | Coorstek Inc | 10-356E | Glassware (114MM DIAMeter) |
| Watch Glass | pyrex | 9985100EMD | Glassware |
| Formalin solution, neutral buffered, 10% | Sigma-Aldrich | HT501128-4L | histological tissue fixative solution |
| Trypsinizing Flasks | Wheaton | 355395 | Glassware (1 unit) |
| Disposable Culture Tubes | Kimble | 73750-13100 | Glassware |
| Borosilicate Glass Pasteur Pipet (22.8 Cm) | Fisherbrand | K63B1367820C | Glassware |
| 250 Ml Glass Beakers | Fisherbrand | KFS14005250 | Glassware |
| Glass Media Bottles With Cap | Fisherbrand | KFS14395250 | Glassware (8 units) |
| 50 Ml Corex Tube | Corning | 8422-A | (1 unit) |
| 15 Ml Polystyrene Centrifuge Tube | Corning | 430791 | |
| 50 Ml Polystyrene Centrifuge Tube | Corning | 430829 | |
| 10ml Serological Pipet | Corning | 11415038 | |
| Cell Strainer 100μm Nylon | Corning | 431752 | |
| Absorbant Liner | Scienceware | 1199918 | |
| 500 Ml Bottles Top Filter | Corning | Pore: 0,22 µm / medium and HBSS preparation | |
| 2 Ml Criogenic Vials | Corning | 430488 | |
| Freezing Container, Nalgene Mr. Frosty | Sigma-Aldrich | C1562-1EA | |
| Peristaltic Pump | Pharmacia Fine Chemicals | P3 model | |
| Shaking Water Bath | Fisher | Model 127 | |
| Vacuum Pump | ABM | 4EKFS6CX-4 | |
| Sodium Chloride | Fisherbrand | EC231-598-3 | Saline solution 0.9% |
| Hank’s Buffered Salt Solution (Hbss) | Sigma-Aldrich | H2387 | Quantity: 9.25 (one vial) for 1L of digestion solution |
| Hydroxypiperazineethansulphonic Acid (Hepes) | Life Technologies | 15630-080 | 25mL (1M) for 1L of digestion solution |
| Trypsin Type I | Sigma-Aldrich | T8003 | 9,888U |
| Deoxyribonuclease Type Iv | Roche | 10-104-159-001 | 402,000U |
| Calcium Chloride | Sigma-Aldrich | C4901 | 100mM |
| Magnesium Sulfate | Baker | 2500-01 | 800mM |
| Dulbecco’s Modified Eagle Medium High Glucose (Dmem) | Life Technologies | 10564-045 | |
| Penicillin/Streptomycin Sulphate | Hyclone | SV30010 | |
| Fetal Bovine Serum | Corning | 35-010-CV | |
| Percoll | Sigma-Aldrich | P1644 | Density centrifugation media gradient. Volume: 36mL |
| Isopropanol | Acros | 42383-0010 | 50mL |
| Dimethyl Sulfoxide | Sigma-Aldrich | 472301 | |
| Automacs Magnetic Separator | Miltenyi Biotec | Model 003 | |
| Automacs Columns | Miltenyi Biotec | 130-021-101 | |
| Automacs Running Buffer | Miltenyi Biotec | 130-091-221 | http://www.miltenyibiotec.com/~/media/Images/Products/Import/0001100/IM0001131.ashx?force=1 |
| Automacs Rinsing Solution | Miltenyi Biotec | 130-091-222 | http://www.miltenyibiotec.com/en/products-and-services/macs-cell-separation/cell-separation-buffers/automacs-rinsing-solution.aspx |
| Anti-Human Hla Abc Purified Clone W6/32 | Affymetrix eBioscience | 14-9983-82 | anti-mouse antibody |
| Anti Mouse Igg Microbeads | Miltenyi Biotec | 130048401 | |
| Multiple Well Plate - 6 Well With Lid | Corning | 3335 | Cell Bind surface |
| Multiple Well Plate - 24 Well With Lid | Corning | 3337 | Cell Bind surface |
| Multiple Well Plate - 96 Well With Lid | Corning | 3300 | Cell Bind surface |
| Modular Incubator Chamber | Billups-Rothenberg | MIC-101 | A set of two is necessary for simultaneous to generate normoxia and hypoxia/reoxygenation conditions |
| Single Flow Meter | Billups-Rothenberg | SFM3001 | |
| 50 Mm In-Line Filter | Whatman | 6721-5010 | PTFE, pore: 1.0 µm |
| Gas Regulator | Pro Star | PRS301233 | A set of two is necessary for simultaneous to generate normoxia and hypoxia/reoxygenation conditions |
| Gas Hose Class Vi Clear 5/16 | Parker | 100-05070102 | 3 pieces with ~ 0.5 m |
| 17 Mm Adjustable Gas Hose Clamp | Tiewraps | THCSS-16 | |
| Normoxia Gas Cylinder | Praxair | NI CDOXR1U-K | Size K (3rd trimester‘s composition: 5% CO2, 8% O2, Bal. N2) |
| Normoxia Gas Cylinder | Praxair | NI CDOXR1U-K | Size K (3rd trimester‘s composition: 5% CO2, 0.5% O2, Bal. N2) |
| Oxygen Microelectrode Mi-730 | Microelectrodes INC | 84477 | |
| Oxygen Adapter | Microelectrodes INC | 3572 | |
| ROS Detection Reagent: CM-H2DCFDA | Invitrogen | C-400 | |
| β-hCG ELISA kit | DRG internatinal | EIA-4115 | |
| Anti-Vimentin ourified antibody | eBioscience | 14-9897 | Host: mouse |
| Anti-Cytokeratin 7 (FITC) antibody | Abcam | ab119697 | Host: mouse |
| Alexa Fluor 488 Goat Anti-mousse IgG H&L antibody | Life Technologies | A-11029 |
References
- Vaillancourt, C., Lanoix, D., Le Bellego, F., Daoud, G., Lafond, J. Involvement of MAPK signalling in human villous trophoblast differentiation. Mini Rev Med Chem. 9 (8), 962-973 (2009).
- Gauster, M., Moser, G., Orendi, K., Huppertz, B. Factors involved in regulating trophoblast fusion: potential role in the development of preeclampsia. Placenta. 30, 49-54 (2009).
- Huppertz, B., Kadyrov, M., Kingdom, J. C. Apoptosis and its role in the trophoblast. Am J Obstet Gynecol. 195 (1), 29-39 (2006).
- Lanoix, D., Lacasse, A. A., Reiter, R. J., Vaillancourt, C. Melatonin: the smart killer: the human trophoblast as a model. Mol Cell Endocrinol. 348 (1), 1-11 (2012).
- Huppertz, B., Frank, H. G., Reister, F., Kingdom, J., Korr, H., Kaufmann, P. Apoptosis cascade progresses during turnover of human trophoblast: analysis of villous cytotrophoblast and syncytial fragments in vitro. Lab Invest. 79 (12), 1687-1702 (1999).
- Kliman, H. J., Nestler, J. E., Sermasi, E., Sanger, J. M., Strauss, J. F., 3rd, Purification, characterization, and in vitro differentiation of cytotrophoblasts from human term placentae. Endocrinology. 118 (4), 1567-1582 (1986).
- Lanoix, D., Beghdadi, H., Lafond, J., Vaillancourt, C. Human placental trophoblasts synthesize melatonin and express its receptors. J Pineal Res. 45 (1), 50-60 (2008).
- Lanoix, D., Lacasse, A. A., Reiter, R. J., Vaillancourt, C. Melatonin: The watchdog of villous trophoblast homeostasis against hypoxia/reoxygenation-induced oxidative stress and apoptosis. Mol Cell Endocrinol. 381 (1-2), 35-45 (2013).
- Tuuli, M. G., Longtine, M. S., Nelson, D. M. Review: Oxygen and trophoblast biology–a source of controversy. Placenta. 32, 109-118 (2011).
- Chen, B., Longtine, M. S., Nelson, D. M. Pericellular oxygen concentration of cultured primary human trophoblasts. Placenta. 34 (2), 106-109 (2013).
- Roberts, J. M., Hubel, C. A. Is oxidative stress the link in the two-stage model of pre-eclampsia. Lancet. 354 (9181), 788-789 (1999).
- Burton, G. J., Jauniaux, E. Oxidative stress. Best Pract Res Clin Obstet Gynaecol. 25 (3), 287-299 (2011).
- Ji, L., Brkic, J., Liu, M., Fu, G., Peng, C., Wang, Y. L. Placental trophoblast cell differentiation: Physiological regulation and pathological relevance to preeclampsia. Mol Aspects Med. 34 (5), 981-1023 (2013).
- Redman, C. W., Sargent, I. L. Placental stress and pre-eclampsia: a revised view. Placenta. 30, 38-42 (2009).
- Sagrillo-Fagundes, L., Soliman, A., Vaillancourt, C. Maternal and placental melatonin: actions and implication for successful pregnancies. Minerva Ginecol. 66 (3), 251-266 (2014).
- Blaschitz, A., Weiss, U., Dohr, G., Desoye, G. Antibody reaction patterns in first trimester placenta: implications for trophoblast isolation and purity screening. Placenta. 21 (7), 733-741 (2000).
- Potgens, A. J., Gaus, G., Frank, H. G., Kaufmann, P. Characterization of trophoblast cell isolations by a modified flow cytometry assay. Placenta. 22 (2-3), 251-255 (2001).
- Petroff, M. G., Phillips, T. A., Ka, H., Pace, J. L., Hunt, J. S. Isolation and culture of term human trophoblast cells. Methods Mol Med. 121, 203-217 (2006).
- Maldonado-Estrada, J., Menu, E., Roques, P., Barre-Sinoussi, F., Chaouat, G. Evaluation of Cytokeratin 7 as an accurate intracellular marker with which to assess the purity of human placental villous trophoblast cells by flow cytometry. J Immunol Methods. 286 (1-2), 21-34 (2004).
- Le Bellego, F., Vaillancourt, C., Lafond, J. Isolation and culture of term human cytotrophoblast cells and in vitro methods for studying human cytotrophoblast cells’ calcium uptake. Methods Mol Biol. 550, 73-87 (2009).
- Mounier, C., Barbeau, B., Vaillancourt, C., Lafond, J. Endocrinology and cell signaling in human villous trophoblast. Methods Mol Biol. 550, 89-102 (2009).
- Chen, B., et al. Pomegranate juice and punicalagin attenuate oxidative stress and apoptosis in human placenta and in human placental trophoblasts. Am J Physiol Endocrinol Metab. 302 (9), 1142-1152 (2012).
- Reti, N. G., et al. Effect of high oxygen on placental function in short-term explant cultures. Cell Tissue Res. 328 (3), 607-616 (2007).
- Pidoux, G., et al. Biochemical characterization and modulation of LH/CG-receptor during human trophoblast differentiation. J Cell Physiol. 212 (1), 26-35 (2007).
- Pidoux, G., et al. ZO-1 is involved in trophoblastic cell differentiation in human placenta. Am J Physiol Cell Physiol. 298 (6), 1517-1526 (2010).
- Williams, J. L., Fyfe, G. K., Sibley, C. P., Baker, P. N., Greenwood, S. L. K+ channel inhibition modulates the biochemical and morphological differentiation of human placental cytotrophoblast cells in vitro. Am J Physiol Regul Integr Comp Physiol. 295 (4), 1204-1213 (2008).
- Schild, R. L., Schaiff, W. T., Carlson, M. G., Cronbach, E. J., Nelson, D. M., Sadovsky, Y. The activity of PPAR gamma in primary human trophoblasts is enhanced by oxidized lipids. J Clin Endocrinol Metab. 87 (3), 1105-1110 (2002).
- Menendez-Pelaez, A., Reiter, R. J. Distribution of melatonin in mammalian tissues: the relative importance of nuclear versus cytosolic localization. J Pineal Res. 15 (2), 59-69 (1993).
- Perrone, S., Stazzoni, G., Tataranno, M. L., Buonocore, G. New pharmacologic and therapeutic approaches for hypoxic-ischemic encephalopathy in the newborn. J Matern Fetal Neonatal Med. 25, 83-88 (2012).
- Nelissen, E. C., van Montfoort, A. P., Dumoulin, J. C., Evers, J. L. Epigenetics and the placenta. Hum Reprod Update. 17 (3), 397-417 (2011).
- Barker, D. J. Intrauterine programming of adult disease. Mol Med Today. 1 (9), 418-423 (1995).
- Barker, J. R., Thomas, C. F., Behan, M. Serotonergic projections from the caudal raphe nuclei to the hypoglossal nucleus in male and female rats. Respir Physiol Neurobiol. 165 (2-3), 175-184 (2009).
- Yui, J., et al. Functional, long-term cultures of human term trophoblasts purified by column-elimination of CD9 expressing cells. Placenta. 15 (3), 231-246 (1994).
- Kilani, R. T., Chang, L. J., Garcia-Lloret, M. I., Hemmings, D., Winkler-Lowen, B., Guilbert, L. J. Placental trophoblasts resist infection by multiple human immunodeficiency virus (HIV) type 1 variants even with cytomegalovirus coinfection but support HIV replication after provirus transfection. J Virol. 71 (9), 6359-6372 (1997).
- Knofler, M., Stenzel, M., Husslein, P. Shedding of tumour necrosis factor receptors from purified villous term trophoblasts and cytotrophoblastic BeWo cells. Hum Reprod. 13 (8), 2308-2316 (1998).
- Douglas, G. C., King, B. F. Isolation of pure villous cytotrophoblast from term human placenta using immunomagnetic microspheres. J Immunol Methods. 119 (2), 259-268 (1989).
- Li, L., Schust, D. J. Isolation, purification and in vitro differentiation of cytotrophoblast cells from human term placenta. Reprod Biol Endocrinol. 13, 71 (2015).
- Stenqvist, A. C., et al. An efficient optimized method for isolation of villous trophoblast cells from human early pregnancy placenta suitable for functional and molecular studies. Am J Reprod Immunol. 60 (1), 33-42 (2008).
- Potgens, A. J., Kataoka, H., Ferstl, S., Frank, H. G., Kaufmann, P. A positive immunoselection method to isolate villous cytotrophoblast cells from first trimester and term placenta to high purity. Placenta. 24 (4), 412-423 (2003).
- Lanoix, D., Vaillancourt, C. Cell culture media formulation and supplementation affect villous trophoblast HCG release. Placenta. 31 (6), 558-559 (2010).
- Vaillancourt, C., Lafond, J. Human embryogenesis: overview. Methods Mol Biol. 550, 3-7 (2009).
- Armant, D. R., et al. Human trophoblast survival at low oxygen concentrations requires metalloproteinase-mediated shedding of heparin-binding EGF-like growth factor. Development. 133 (4), 751-759 (2006).
- McCaig, D., Lyall, F. Hypoxia upregulates GCM1 in human placenta explants. Hypertens Pregnancy. 28 (4), 457-472 (2009).
- Burton, G. J., et al. Optimising sample collection for placental research. Placenta. 35 (1), 9-22 (2014).
- Lanoix, D., et al. Quantitative PCR pitfalls: the case of the human placenta. Mol Biotechnol. 52 (3), 234-243 (2012).
- Bilban, M., et al. Trophoblast invasion: assessment of cellular models using gene expression signatures. Placenta. 31 (11), 989-996 (2010).
- Novakovic, B., et al. Wide-ranging DNA methylation differences of primary trophoblast cell populations and derived cell lines: implications and opportunities for understanding trophoblast function. Mol Hum Reprod. 17 (6), 344-353 (2011).
- Burleigh, D. W., et al. Microarray analysis of BeWo and JEG3 trophoblast cell lines: identification of differentially expressed transcripts. Placenta. 28 (5-6), 383-389 (2007).
- Hung, T. H., Skepper, J. N., Charnock-Jones, D. S., Burton, G. J. Hypoxia-reoxygenation: a potent inducer of apoptotic changes in the human placenta and possible etiological factor in preeclampsia. Circ Res. 90 (12), 1274-1281 (2002).
- Heazell, A. E., Moll, S. J., Jones, C. J., Baker, P. N., Crocker, I. P. Formation of syncytial knots is increased by hyperoxia, hypoxia and reactive oxygen species. Placenta. 28, 33-40 (2007).
- Heazell, A. E., Lacey, H. A., Jones, C. J., Huppertz, B., Baker, P. N., Crocker, I. P. Effects of oxygen on cell turnover and expression of regulators of apoptosis in human placental trophoblast. Placenta. 29 (2), 175-186 (2008).
- Chen, B., Longtine, M. S., Nelson, D. M. Hypoxia induces autophagy in primary human trophoblasts. Endocrinology. 153 (10), 4946-4954 (2012).
- Lanoix, D., Guerin, P., Vaillancourt, C. Placental melatonin production and melatonin receptor expression are altered in preeclampsia: new insights into the role of this hormone in pregnancy. J Pineal Res. 53 (4), 417-425 (2012).
- Galano, A., Tan, D. X., Reiter, R. J. Melatonin as a natural ally against oxidative stress: a physicochemical examination. J Pineal Res. 51 (1), 1-16 (2011).
- Alers, N. O., Jenkin, G., Miller, S. L., Wallace, E. M. Antenatal melatonin as an antioxidant in human pregnancies complicated by fetal growth restriction–a phase I pilot clinical trial: study protocol. BMJ Open. 3 (12), 004141 (2013).
- Hobson, S. R., Lim, R., Gardiner, E. E., Alers, N. O., Wallace, E. M. Phase I pilot clinical trial of antenatal maternally administered melatonin to decrease the level of oxidative stress in human pregnancies affected by pre-eclampsia (PAMPR): study protocol. BMJ Open. 3 (9), 003788 (2013).
