Doctor of Philosophy, Case Western Reserve University, 2024, Pathology
The steroid hormone progesterone (P4), acting via the nuclear P4 receptors (PRs) in decidual stromal cells (DSCs) is essential for pregnancy maintenance, and loss of P4/PR signaling induces parturition. Inflammation at the chorion-decidua interface (CDI) triggers term and preterm parturition; however, the mechanism is uncertain. This study tested the hypothesis that pro-labor inflammatory stimuli induce parturition by increasing expression of the P4-metabolizing enzyme, aldo-keto reductase 1C1 (AKR1C1), which converts P4 to an inactive form, thus causing localized intracellular loss of P4/PR signaling. Here, we utilized human CDI tissue, a decidual stromal cell line, and Rhesus macaque and mouse models of preterm birth to determine that 1) AKR1C1 is induced by inflammation and metabolizes P4 thereby starving the receptor to induce a local P4 withdrawal, which can be prevented with an AKR1C1 inhibitor BPSA and 2) Inflammation-induced AKR1C1 transcription is dependent on MAPK and NF-kB signaling. Taken together, our data support the hypothesis that inflammatory stress promotes labor by inducing AKR1C1-mediated P4 withdrawal in DSCs. Importantly, our data suggest that risk for inflammation-induced preterm birth could be reduced by targeting AKR1C1 activity in uterine P4 target cells. This can be achieved via inhibition of AKR1C1 activity (e.g., with BPSA), by preservation of PR activity by treatment with a P4 analog that is not metabolized by AKR1C1 (e.g., R5020), and/or by inhibition of IL-1β-induced AKR1C1 expression in DSCs (e.g., by treatment with an IL1 receptor antagonist such as Anakinra). Furthermore, P38 inhibition may be a viable therapeutic strategy to prevent induction of AKR1C1 transcription.
Committee: Sam Mesiano (Advisor)
Subjects: Biomedical Research