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Review
. 2018 Feb 1;17(3):220-227.
doi: 10.1002/rmb2.12088. eCollection 2018 Jul.

Decidualization of the human endometrium

Hidetaka Okada  1 , Tomoko Tsuzuki  1 , Hiromi Murata  1
Affiliations
Review

Decidualization of the human endometrium

Hidetaka Okada et al. Reprod Med Biol. .

Abstract

Background: Decidualization of the human endometrium, which involves a dramatic morphological and functional differentiation of human endometrial stromal cells (ESCs), is essential for the establishment of a successful pregnancy. Decidualization results from a complex interplay of transcription factors, morphogens, cytokines, cell cycle regulators, and signaling pathways.

Methods: Based on a literature review, the regulation of, and the molecular mechanisms involved in, the decidualization of the endometrium are described.

Main findings: Progesterone, together with proteins that are regulated by progesterone and/or cyclic adenosine monophosphate, including homeobox A10, forkhead box O1, signal transducers and activators of transcription, and heart and neural crest derivatives expressed transcript 2, forms a critical network for ESC decidualization and is a prerequisite to successful implantation. Decidualized ESCs contribute to the microenvironment at the feto-maternal interface and its direct or indirect influence on extracellular matrix remodeling, regulation of the local immune response, anti-oxidative stress, and angiogenesis (vascular maturation). Impairment of this process is associated with a variety of pregnancy disorders, including infertility, recurrent miscarriages, and uteroplacental disorders.

Conclusion: A deeper understanding of the process of decidualization is expected to provide new insights into the fields of reproductive biology and reproductive medicine.

Keywords: decidualization; endometrial stromal cells; endometrium; heart and neural crest derivatives expressed 2; progesterone.

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Conflict of interest statement

The authors declare no conflict of interest. Human rights statement and informed consent: This article does not contain any study with human participants that have been performed by any of the authors. Animal studies: This article does not contain any study with animal participants that have been performed by any of the authors.

Figures

Figure 1
Figure 1
Progesterone (P), together with proteins that are regulated by progesterone and/or cyclic adenosine monophosphate ( cAMP ), including heart and neural crest derivatives expressed transcript 2 ( HAND 2), forkhead box O1 ( FOXO 1), homeobox A10 ( HOXA 10), and signal transducers and activators of transcription ( STAT ), forms a critical network for the decidualization of human endometrial stromal cells ( ESC s). Decidualization involves dramatic morphological and functional differentiation and the expression of decidua‐specific factors and decidual markers, such as prolactin ( PRL ) and insulin‐like growth factor‐binding protein 1 ( IGFBP ‐1)
Figure 2
Figure 2
Decidualized stromal cells contribute to the microenvironment at the feto–maternal interface and their direct or indirect influence on extracellular matrix ( ECM ) remodeling, regulation of the local immune response that is mediated by uterine natural killer ( uNK ) cells, anti‐oxidative stress for reactive oxygen species ( ROS ), and angiogenesis
See this image and copyright information in PMC

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