Previous Article | Next Article ![]()
Journal of Virology, March 2004, p. 2831-2840, Vol. 78, No. 6
0022-538X/04/$08.00+0 DOI: 10.1128/JVI.78.6.2831-2840.2004
Copyright © 2004, American Society for Microbiology. All Rights Reserved.
Departments of Stomatology,1 Anatomy,2 Pharmaceutical Chemistry,3 Biomedical Sciences Graduate Program,4 Oral Biology Graduate Program, University of CaliforniaSan Francisco, San Francisco, California 94143-05125
Received 5 September 2003/ Accepted 12 November 2003
|
|
|---|
|
|
|---|
The placental-uterine interface provides nourishment and protects the fetus from immune rejection and local infections. The placenta is pivotal in CMV transmission to the fetus, as is suggested by the unusual anatomy of the maternal-fetal interface (Fig. 1) (10, 13). Cytotrophoblasts differentiate into the specialized trophoblast population of floating and anchoring chorionic villi, which have different properties and functions. Cytotrophoblasts in floating villi (Fig. 1, site 4) fuse into multinucleated syncytiotrophoblasts that cover the villus surface. These cells are in direct contact with maternal blood and exchange gas, nutrients, and waste with the maternal blood supply. Cytotrophoblasts in anchoring villi (Fig. 1, site 3) remain as single cells that aggregate into columns and invade the uterine wall up to the first third of the myometrium. Interstitial cytotrophoblasts invade the decidua and breach uterine spiral arterioles in a process with many similarities to tumor invasion, except that the extent and timing of invasion are carefully regulated (Fig. 1, site 2). Invasive cytotrophoblasts intercalate among innate immune cells in the decidua and remodel the uterine vasculature, replacing the endothelial cell lining and some of the smooth muscle cell wall (Fig. 1, sites 1 and 2). The result is a hybrid vasculature composed of fetal cytotrophoblasts and maternal endothelial cells that ultimately supplies vast quantities of blood to floating villi.
![]() View larger version (62K): [in a new window] |
FIG. 1. Anatomy of the maternal-fetal interface, where the fetus-derived placenta attaches to the mother's uterus. The basic structural unit of the placenta is the chorionic villus, composed of a stromal core with blood vessels, surrounded by a basement membrane, and overlaid by cytotrophoblast stem cells. As part of their differentiation pathway, stem cells detach from the basement membrane and adopt one of two lineage fates. They fuse to form the syncytiotrophoblast, which covers floating villi, or they join a column of extravillus cytotrophoblasts that invade the uterine stroma. The syncytiotrophoblast mediates nutrient and gas exchange across the maternal-fetal interface. The anchoring villi (AV) establish physical connections between the mother and fetus through the attachment of cytotrophoblast columns. The floating villi (FV), bathed by maternal blood, contain the fetal capillaries (zone I). Cytotrophoblasts in the AV attach the placenta to the uterine wall (zone II). Cytotrophoblasts then invade the decidua up to the first third of the myometrium (zone III), anchoring the placenta to the uterus and gaining access to the maternal circulation. Sites proposed as routes of CMV infection in utero are numbered 1 to 4.
|
1ß1 and
Vß3 (13). Invasive cytotrophoblasts degrade the basement membrane and the extracellular matrix of the uterine stroma, a process that is precisely regulated during placentation. The cells upregulate matrix metalloproteinase 9 (MMP-9), a collagenase and urokinase-type plasminogen activator (30, 53), and tissue inhibitor of metalloproteinases 3, a regulator of proteolytic activity and invasion depth (2). Molecules that function in maternal immune tolerance, such as the nonclassical major histocompatibility complex class 1b molecule HLA-G (28, 35) and interleukin-10 (IL-10) (46, 47), are also produced.
MMPs are a family of degradative enzymes that remodel the extracellular matrix during many processes that include cell migration, vascularization, and invasion (7, 59). MMPs are highly regulated during translation and posttranslationally by activation and secretion (57, 58). Invasive cytotrophoblasts secrete relatively large amounts of MMP-9 during early gestation, when invasion peaks; later, when invasion is complete, MMP-9 levels decrease (30). Trophoblast invasion is also regulated by factors controlling MMP activation. The inactive proenzyme is activated by the cleavage and removal of an inhibitory domain. Activated MMP-9 is absolutely required for invasion, whereas pro-MMP-9 is associated with noninvasive cells (18, 30) and certain pregnancy complications (31). Several cytokines and growth factors regulate MMP expression and activity. For example, IL-1ß is an autocrine stimulator of MMP-9 secretion and cytotrophoblast invasion of Matrigel in vitro (29). In contrast, IL-10 downregulates these processes and impairs cytotrophoblast invasion (46, 47). Cytokine expression and metalloproteinase activity are also regulated in endothelial cells (9, 39, 48).
Endothelial cells are targets of infection by CMV and may disseminate the virus in immune system-compromised patients (16, 20, 41, 49). The remodeling of uterine spiral arterioles suggests that CMV can spread from the maternal vasculature to endovascular cytotrophoblasts in the uterus (17). Uterine microvascular endothelial cells (UtMVEC) infected with VR1814, an endothelial cell-tropic CMV strain (45), transmit the infection to cocultured differentiating-invading cytotrophoblasts (33), suggesting a role for the uterine vasculature in virus transmission. Recently, we found that the decidua functions as a reservoir for CMV during early gestation and that virus replication in endovascular cytotrophoblasts correlates with infected endothelial cells and virus transmission at the maternal-fetal interface (42). CMV-infected cytotrophoblasts downregulate the key differentiation molecules HLA-G, which may play a role in immune tolerance, and
1ß1 integrin, which is required for invasion (17). The presence of intimate contacts between endothelial cells and cytotrophoblasts in the hybrid vasculature suggests that similar changes in cell-cell and cell-matrix interactions could occur.
These observations, together with the capacity of CMV to modulate host immune responses (reviewed in reference 36), suggested to us that a virally encoded IL-10 homologue might, like the cellular molecule, impair the invasion of differentiating cytotrophoblasts. Thus, we examined the effect of CMV infection on MMP activity in cells that form heterotypic interactions in utero, namely UtMVEC and differentiating-invading cytotrophoblasts. We found that the expression of CMV IL-10 (cmvIL-10) and the upregulation of human IL-10 (hIL-10) reduced MMP activity and impaired endothelial cell migration and cytotrophoblast invasion in vitro. Diminished degradation of the extracellular matrix could contribute to the shallow invasion of the uterus and restriction of fetal growth observed in cases of CMV transmission in utero.
|
|
|---|
Antibodies and purified proteins. The following commercial reagents were purchased: activated MMP-2, activated MMP-9, and pro-MMP-2 (Oncogene Research Products); polyclonal goat anti-cmvIL-10 (R&D Research); murine antibodies anti-MMP-2 (clone 42-5D11) and anti-MMP-9 (clone 7-11C) (Oncogene Research Products); rabbit antiserum against the von Willebrand factor complex (Novocastra Laboratories Ltd.); anti-species antibodies conjugated to horseradish peroxidase (Jackson Immunoresearch Laboratories); and recombinant proteins hIL-10 and cmvIL-10 expressed from the strain Towne sequence (27, 54) (R&D Research).
Sample preparation. Conditioned medium (CM) and cells were collected separately. For the preparation of cell lysates, samples were solubilized in buffer containing 150 mM NaCl, 50 mM Tris HCl (pH 7.6), 2 mM EDTA, 1% NP-40, and 1 mM phenylmethylsulfonyl fluoride. CM and cell lysates were collected every other day, centrifuged (12,000 x g, 20 min), and stored at -80°C before testing. CM was filtered through 0.2-µm-pore-size filters (Millipore). For zymography, nonreducing gel loading buffer was added to CM (3x) and cell lysates (1x). For immunoblot analysis, loading buffer containing sodium dodecyl sulfate (SDS) (3x) was added.
Substrate gel zymography. Proteins were analyzed for gelatinolytic activity by gelatin zymography (47). Briefly, proteins (20 µl of CM and 15 µg of total cell lysate) solubilized in nonreducing sample buffer were separated in an SDS-10% polyacrylamide gel containing 1 mg of swine gelatin (Sigma)/ml. After electrophoresis, the gels were washed in 2.5% Triton X-100 for 30 min to remove the SDS. Metalloproteinases were then activated by overnight incubation at 37°C in buffer containing 50 mM Tris-HCl, pH 7.8, and 5 mM CaCl2. For the visualization of proteinase activity, the gels were stained with 1% Coomassie brilliant blue R-250 for 2 h and were destained in 10% acetic acid and 30% methanol until the cleared bands, evidence of gelatinase activity, were visible. The gels were then photographed. Molecular masses were calculated by using a recombinant protein size marker (Full Range Rainbow; Amersham).
Immunoblot analyses. Solubilized samples (20 µl of CM and 15 µg of total cell lysate) were subjected to SDS-polyacrylamide gel electrophoresis and transferred to nitrocellulose. Nonspecific reactivity was blocked overnight by incubating the membranes in phosphate-buffered saline containing 0.05% Tween 20 and 5% nonfat skim milk before the application of the primary antibody. Anti-species antibodies conjugated to horseradish peroxidase were used to detect antibody binding. Activated MMP-2 and MMP-9 recombinant proteins were used as standards to identify specific metalloproteinase bands. Proteins were detected by using an enhanced chemiluminescence system (ECL; Amersham Corp.).
Immunoprecipitation. An antibody against cmvIL-10 was added to CM (2.5 ml) from VR1814-infected HUVEC and mock-infected cells (control), and binding was allowed to occur overnight at 4°C. Immune complexes, which were precipitated by the addition of protein G-Sepharose (Amersham), were resuspended in SDS sample buffer, electrophoresed, transferred to nitrocellulose, and subjected to immunoblot analyses as described above. cmvIL-10 was detected by using ECL Advance (Amersham Corp.).
Reverse transcription (RT)-PCR. Total RNAs were isolated from CMV-infected human foreskin fibroblasts and HUVEC and from mock-infected control cells by use of an Absolutely RNA RT-PCR Miniprep kit (Stratagene) according to the manufacturer's instructions. The first-strand cDNAs were synthesized from total RNAs by use of a Reverse Transcription kit (Applied Biosystems). Control reactions were carried out in parallel. Reactions were incubated at 25°C for 10 min, 48°C for 30 min, and 95°C for 5 min. Primers were selected with Primer 3 software to amplify a 237-bp region of the cmvIL-10 gene (forward, 5'-TCGGTGATGGTCTCTTCCTC-3'; reverse, 5'-CGTCGCAATAAACCGTACCT-3'). Reactions were done in a PTC-200 thermocycler (MJ Research, San Francisco, Calif.). cDNA (5 µl) was added to a master mix containing 1x RedTaq buffer (Sigma), a 0.2 mM concentration of each deoxynucleoside triphosphate (Sigma), a 0.2 µM concentration of each primer, and 1 Unit of RedTaq polymerase (Sigma). Cycling conditions were 2 min of denaturation at 95°C followed by 40 cycles of 95°C for 45 s, 54°C for 45 s, and 72°C for 1 min, with a final extension at 72°C for 2 min. Products were analyzed by 2% agarose gel electrophoresis.
hIL-10 protein assays. hIL-10 in CM from infected and control cells was measured by using a commercial enzyme-linked immunosorbent assay (ELISA) (Chemicon International Inc.). In brief, sample and biotinylated anti-hIL-10 was added to microtiter plates coated with anti-hIL-10 antibody for 3 h at room temperature. After the addition of alkaline phosphatase, followed by color-generating solution, the plates were read at 490 nm. The amount of hIL-10 was determined by extrapolation from a standard curve.
Quantification of MMP activity.
MMP-2 and MMP-9 activity in CM and cell lysates from endothelial cells and cytotrophoblasts was measured by using a highly sensitive Biotrak assay system according to the manufacturer's instructions (Amersham Pharmacia Biotech). Briefly, 100 µl of sample was added to microplates coated with antibodies specific for MMP-2 or MMP-9 before overnight incubation at 4°C. After a washing step, immobilized MMP was activated by incubation with p-aminophenylmercuric acetate for 1.5 h at 37°C. After the addition of buffer containing modified urokinase (detection enzyme) and the peptide substrate S-2444, color development was recorded at 405 nm at various times up to 20 h. The activity was expressed in units defined as 1,000x (
A/h2). The level of endogenous activated MMP was detected without p-aminophenylmercuric acetate treatment. The statistical significance of the data was analyzed by Student's one-tailed t test. P values of <0.05 were considered significant.
Invasion and cell migration assays. Assays to measure fibroblast and endothelial cell migration (14) and cytotrophoblast invasion (30) were performed as previously described. In cell migration assays, human fibroblast and HUVEC monolayers were scratched ("wounded") with a sterile pipette and then infected with VR1814, cultured with medium alone (control), or cultured with medium containing cmvIL-10 or human IL-10 (100 ng/ml). Alternatively, HUVEC were infected with VR1814 and cultured for 4 days before the monolayer was wounded. The cells were incubated approximately 24 h until the controls reached confluence ("wound healing"). For the assessment of migration, 10 fields (x40) were examined under an Olympus LH50A microscope and photographed with an Olympus SC35 Type 12 camera. For the quantification of invasion, cytotrophoblasts were plated on Matrigel-coated Transwell polycarbonate filters (5-µm pores), and the cells were cultured in medium alone or treated with 100 ng of recombinant cmvIL-10 or hIL-10/ml. Cells were incubated for 48 h, fixed in 3% formaldehyde, and stained with a rat monoclonal antibody against cytokeratin (7D3) (12). Filters were mounted on a slide with the underside facing up so that cytokeratin-positive cells migrating through the filter pores could be counted.
|
|
|---|
![]() View larger version (46K): [in a new window] |
FIG. 2. Downregulation of MMP-2 in CMV-infected human fibroblasts. CM and lysates from AD169- and VR1814-infected fibroblasts and uninfected fibroblasts were analyzed 4 days after infection by gelatin zymography (A and B) and immunoblotting (C and D). CMV reduced MMP-2 expression (both the 72-kDa proenzyme and the 66-kDa activated form) in CM (A and C) and cell lysates (B and D). MMP-2 activity was quantified in VR1814-infected fibroblast CM and cell lysates as a percentage of the control (E). Values are the means of four experiments and were highly reproducible. Asterisks indicate a significant difference between control and infected cells (P < 0.05; Fisher exact test). Error bars show SDs.
|
![]() View larger version (43K): [in a new window] |
FIG. 3. Downregulation of MMP-2 and MMP-9 activity in VR1814-infected UtMVEC. (A and B) CM and lysates were analyzed by gelatin zymography after 1 and 7 days (uninfected control cells) and 7 days after the infection of experimental cells. (C) MMP-9 and MMP-2 activity in CM and cell lysates was quantified as a percentage of the control. Values are the means of four experiments. Asterisks indicate a significant difference between control and infected cells (P < 0.05). Error bars show SDs.
|
To better understand the mechanism of MMP dysregulation, we explored the possibility that cmvIL-10 might alter MMP activity in an autocrine fashion. First, we determined whether cmvIL-10 mRNA and protein could be detected in infected fibroblasts and HUVEC. Total RNAs extracted from AD169-infected fibroblasts and VR1814-infected fibroblasts and HUVEC were reverse transcribed, and PCR was performed with cmvIL-10-specific primers (Fig. 4A). A strong band amplified by RT-PCR primers for cmvIL-10 was detected with infected cells but not with uninfected controls. Immunoblotting indicated that a 20-kDa protein that immunoprecipitated with an antibody against cmvIL-10 was secreted into the CM of infected cells between 5 and 12 days after infection (Fig. 4B). The protein band detected for infected cells had a slightly larger molecular mass than the 17.6-kDa recombinant protein, which when expressed from a bacterial vector initiates at alanine 26 and terminates at lysine 126.
![]() View larger version (39K): [in a new window] |
FIG. 4. Expression of cmvIL-10 in VR1814-infected cells. (A) RT-PCR analysis of total RNA isolated 4 days after infection. HF, human fibroblasts. (B) Immunoblot analysis of cmvIL-10 protein complexes immunoprecipitated from infected cells 5, 7, and 12 days after infection (dpi).
|
![]() View larger version (47K): [in a new window] |
FIG. 5. CMV-infected endothelial cells secrete a soluble product that diminishes MMP-2 activity. Uninfected HUVEC were cultured for 6 days with CM from VR1814-infected UtMVEC (inf) or control cells (cont). CM and cell lysates were analyzed by gelatin zymography (A and B) and immunoblotting (C and D). MMP-2 activity was quantified in CM and lysates as a percentage of the control (E). Values are the means of two experiments. Asterisk indicates a significant difference between control and infected cells (P < 0.05). Error bars show SDs. UtMVEC that were infected or treated with purified recombinant cmvIL-10 or hIL-10 downregulated MMP-2 activity in CM (F) and cell lysates (G).
|
Reduced MMP-9 activity in VR1814-infected cytotrophoblasts. Next, we determined whether VR1814 infection alters MMP activity in differentiating-invading cytotrophoblasts. Purified cells plated on Matrigel were infected for 4 days, after which CM and cell lysates (including Matrigel) were analyzed (Fig. 6). Zymography showed that both infected CM and cell lysates contained less MMP-9 activity than did control cells (Fig. 6A and C). Immunoblotting showed that the MMP-9 abundance was considerably reduced in CM but not in cell lysates (Fig. 6B and D).
![]() View larger version (36K): [in a new window] |
FIG. 6. Reduced MMP-9 activity in differentiating-invading cytotrophoblasts infected with VR1814 or treated with cmvIL-10. Cytotrophoblasts were untreated (CTB), infected, treated with CM, or treated with recombinant hIL-10 (h) or cmvIL-10 (cmv). Matrigel-coated wells without cells served as a control (Matrigel). CM and cell lysates were then analyzed for MMP-9 activity by gelatin zymography (A and C) and immunoblotting (B and D). CMV infection, hIL-10 treatment, and cmvIL-10 (100 ng/ml) treatment all decreased MMP-9 (both the 92-kDa proenzyme and the 86-kDa activated form) in CM (A and B) and cell lysates (C and D). Cytotrophoblasts were infected or treated with hIL-10 or cmvIL-10 for 4 days, and the CM (E) and lysates (F) were analyzed for MMP-9 activity, which was quantified as a percentage of the control. Values are the means of five experiments. Asterisks indicate a significant difference between control and infected or IL-10-treated cells (P < 0.05). Error bars show SDs.
|
Early in the differentiation process, cytotrophoblasts produce hIL-10, which is downregulated by 12 h, when MMP-9 activity and invasion increase (46). Since cmvIL-10 binds IL-10R1, we asked whether cmvIL-10 might upregulate hIL-10 expression. Cytotrophoblasts were infected with VR1814 or treated with cmvIL-10 (10 or 100 ng/ml). CM was collected at 24 h, and hIL-10 was measured by ELISA. Significantly more hIL-10 was detected in CM from infected cytotrophoblasts than in CM from control (uninfected) cells (Fig. 7). cmvIL-10-treated cytotrophoblasts tended to increase intracellular levels of hIL-10 compared to controls, although the variability prevented the data from being statistically significant. In contrast, hIL-10 in VR1814-infected HUVEC was under the detection limit (data not shown). Together, the results of these experiments indicate that cells infected with VR1814 can upregulate cmvIL-10 and hIL-10 and have a synergistic effect on the suppression of MMP-9 activity of differentiating cytotrophoblasts by reducing the intracellular levels and secretion of the proteinase.
![]() View larger version (14K): [in a new window] |
FIG. 7. Upregulation of hIL-10 expression in differentiating-invading cytotrophoblasts after VR1814 infection and cmvIL-10 treatment. CM from VR1814- and mock-infected control or cmvIL-10-treated cytotrophoblasts was collected on day 1 and cultured for 24 to 36 h. hIL-10 was then quantified by ELISA. Results are expressed as percentages of the control. CM from untreated mock-infected cells served as a control. Values are the means of three experiments. Asterisks indicate a significant difference between control and infected or treated cells (P < 0.05). Error bars show SDs.
|
![]() View larger version (54K): [in a new window] |
FIG. 8. Impaired cell motility in functional assays of endothelial cell wound healing and cytotrophoblast invasion of Matrigel in vitro. Human fibroblasts (A) and HUVEC (B) were infected with VR1814 and treated with hIL-10 or cmvIL-10 (100 ng/ml). The horizontal lines indicate the original widths of the wounded cell sheets. (C) Differentiating-invading cytotrophoblasts from first-trimester placentas were plated on Matrigel-coated filters and then were treated with cmvIL-10 or hIL-10, fixed at 48 h, and stained with a cytokeratin-specific antibody. Cells that reached the filter underside were counted. Values (percentages of the control) are expressed as the means ± SDs of three experiments. Asterisks indicate a significant difference between control and IL-10-treated cells (P < 0.05).
|
|
|
|---|
During pseudovasculogenesis, differentiating cytotrophoblasts adopt a vascular adhesion phenotype, an unusual transformation process required for successful endovascular invasion and normal placentation (11, 60). We reported that UtMVEC transmit CMV to invasive cytotrophoblasts in vitro (33), suggesting that infection of the uterine vasculature and endovascular cytotrophoblasts in early gestation placentas could undermine vessel remodeling (17, 42). In the present study, we found that the invasion of IL-10-expressing cytotrophoblasts and migration of endothelial cells, but not fibroblasts, was impaired by cmvIL-10, suggesting possible paracrine effects in certain cell types. These findings suggest that the cmvIL-10 secreted from infected cells might also alter the invasiveness of uninfected cells nearby, one possible explanation for why cytotrophoblasts aggregated into cell columns show uniformly impaired invasion of Matrigel after CMV infection in vitro (17).
Like several other intracellular pathogens that infect macrophages, CMV exploits the IL-10 signaling pathway, expressing an IL-10 homologue and upregulating the cell's production of the cytokine (27, 44). Although cmvIL-10 shares only 27% sequence identity with hIL-10, the proteins have essentially identical affinities for the IL-10R1 and similarly reorganize the cell surface receptor complex (23). Both cytotrophoblasts and endothelial cells express IL-10R1, suggesting a possible autocrine and paracrine regulation by IL-10 (4, 47). hIL-10 in CM from cytotrophoblasts can suppress allogeneic lymphocyte reactivity (46), an important link between immune protection of the fetus and cytotrophoblast invasion of the uterus. Likewise, cmvIL-10 can inhibit the proliferation of mitogen-stimulated peripheral blood mononuclear cells and the production of proinflammatory cytokines at a level comparable to that of recombinant hIL-10 (54). cmvIL-10 alters the function of monocyte-derived dendritic cells, inducing hIL-10 production and inhibiting maturation and inflammatory cytokine production (W. Chang, N. Baumgarth, and P. Barry, personal communications). Likewise, murine CMV, which lacks a homologue, induces cellular IL-10 expression in macrophages, selectively reducing major histocompatibility complex class II expression and inflammatory cytokine production (36, 43). IL-10R1 protein expression in HUVEC is markedly upregulated in response to proinflammatory stimuli (e.g., gamma interferon or tumor necrosis factor alpha), implying that endothelial cells could become more responsive to IL-10 during an inflammatory episode (4). De novo synthesis of the receptor could be one explanation for the rapid upregulation of hIL-10 expression after cmvIL-10 treatment.
Clinical CMV strains contain genes that were lost from genomes of laboratory strains (5, 8) and confer a growth advantage in endothelial cells and macrophages (1, 32, 50, 52). The lower level of proteinase activity in cells infected with VR1814 than in cells infected with a laboratory strain or treated with cmvIL-10 suggests that impaired migration is a consequence of synergistic effects of diverse viral genes. Although cmvIL-10 encoded by UL111.5A is expressed as a
gene product late in the viral life cycle (6), our results suggest that CMV infection may affect cytotrophoblast function earlier via other pathways. For example, VR1814 infection substantially increased tissue inhibitor of metalloproteinases 3 expression in cytotrophoblasts, further reducing the proteinase activity and the cells' invasiveness, whereas neither hIL-10 (47) nor cmvIL-10 altered the expression of the inhibitor (T. Tabata, S. McDonagh, H.-T. Chang, and L. Pereira, unpublished data). Interestingly, strain Toledo mediates the migration of vascular smooth muscle cells by the expression of US28, a viral chemokine receptor (56). Although we did not examine smooth muscle cells, this effect was not observed in VR1814-infected HUVEC. Altered migration is likely a consequence of several factors, including the viral strain, the time after infection of the assays, and the abundance of cell surface receptors that are responsive to ligand signaling. It is notable that AD169, a laboratory strain of CMV without endothelial cell tropism, downregulated the adhesion receptor,
1ß1 integrin, which is required for invasion, and the immune molecule HLA-G in differentiating cytotrophoblasts (17) but had no effect on proteinase activity and IL-10-mediated dysregulated function in this study. Our results suggest that clinical strains trigger a constellation of events that impair cytotrophoblast function, directly by viral gene expression, indirectly by upregulating cellular genes, or both. Current efforts focus on identifying specific pathways whereby CMV undermines cytotrophoblast functions and placental development in utero.
This work was supported by Public Health Service grants AI46657, AI53782 (L.P. and S.F.), EY13683 (L.P.), and HD30367 (S.F.) from the National Institutes of Health and by grants from the March of Dimes Birth Defects Foundation and the University of California Academic Senate (L.P. and S.F.).
|
|
|---|
This article has been cited by other articles:
| |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Copyright © 2009 by the American Society for Microbiology. For an alternate route to Journals.ASM.org, visit: http://intl-journals.asm.org | More Info»