Three types of HLA-G plus extravillous trophoblasts that have distinct immune regulatory properties

During pregnancy, invading HLA-G+ extravillous trophoblasts (EVT) play a key role in placental development, uterine spiral ar- tery remodeling, and prevention of detrimental maternal immune responses to placental and fetal antigens. Failures of these pro- cesses are suggested to play a role in the development of preg- nancy complications, but very little is known about the underlying mechanisms. Here we present validated methods to purify and culture primary HLA-G+ EVT from the placental disk and chorionic membrane from healthy term pregnancy. Characterization of HLA- G+ EVT from term pregnancy compared to first trimester revealed their unique phenotypes, gene expression profiles, and differing capacities to increase regulatory T cells (Treg) during coculture assays, features that cannot be captured by using surrogate cell lines or animal models. Furthermore, clinical variables including gestational age and fetal sex significantly influenced EVT biology and function. These methods and approaches form a solid basis for further investigation of the role of HLA-G+ EVT in the develop- ment of detrimental placental inflammatory responses associated with pregnancy complications, including spontaneous preterm and preeclampsia.