1. Introduction
Missed abortion (MA) is a term used to describe the cessation of embryonic or fetal development, resulting in the retention of the embryo or fetus within the uterine cavity for an extended period. This condition is characterized by the closure of the cervix and the failure of the pregnancy to be naturally expelled within the expected timeframe. Abortion, a prevalent unfavorable result of pregnancy, significantly impacts the physical and mental well-being of women during their childbearing years [
1]. The cause of abortion is multifaceted and diverse. Currently, the identified etiological causes mostly encompass chromosomal abnormalities, infectious agents, immunological factors, endocrine disturbances, maternal influences, environmental factors, and deleterious behaviors. There remains a significant number of unidentified factors contributing to the occurrence of miscarriages [
2,
3,
4]. The process of pregnancy is intricate, involving the coordination and cooperation of various bodily activities. One of the crucial requirements for the maintenance of a healthy pregnancy is the preservation of proper invasion and migration of trophoblast cells. During the initial phase of gestation, trophoblast cells exhibit a high degree of invasiveness as they penetrate the decidual matrix and spiral artery within the maternal uterus. These trophoblasts effectively replace endothelial cells, infiltrate the vascular wall, and facilitate the establishment of an adequate blood supply for the development of both the placenta and the fetus. Additionally, they play a crucial role in establishing the connection between the mother and the fetus, as well as transmitting important signals between the two entities. The cell holds significant importance throughout the initial phase of pregnancy [
5,
6]. The etiology of abortion has been attributed to the aberrant biological activity of trophoblast cells, which are under the regulation of genes in vivo, as substantiated by previous studies [
7,
8,
9]. The attenuation of trophoblast viability has been linked to many pregnancy diseases, including intrauterine fetal growth limitation, preeclampsia, abortion, and stillbirth [
10].
Numerous factors have been identified as being associated with the viability of trophoblast cells at the maternal–fetal interface, encompassing growth hormones, semaphorins, inflammatory factors, and other relevant factors. Semaphorins are a substantial group of proteins, initially recognized as molecules that guide axons in the course of neuronal development [
11]. Several academics have conducted verification to confirm the expression of semaphorins at the maternal–fetal interface. These semaphorins play a role in regulating endometrial receptivity in the context of pregnancy [
12,
13].
SEMA4A, a member of the semaphorin IV subgroup, is a transmembrane glycoprotein molecule that plays a role in the regulation of a variety of physiological processes, such as angiogenesis, immunological response, carcinogenesis, and the retinal system [
14].
SEMA4A has been identified as a participant in various cancer processes, including the facilitation of epithelial-to-mesenchymal transition (EMT) in cancer cells and the contribution to drug resistance. Consequently, it is recognized as an oncoprotein [
15,
16,
17]. Furthermore,
SEMA4A has been extensively investigated in several pathological conditions, including cancer and immunological disorders [
18,
19,
20]. In addition,
MMP9 is involved in the regulation of immune response by
SEMA4A [
21];
STAT3 signaling pathway is involved in the regulation of cell proliferation and migration by
SEMA4A [
15]. In addition,
SEMA4A can inhibit cell apoptosis [
15], while
BAX and
bcl-2 are important regulatory factors involved in the apoptosis process [
22].
SEMA4A,
BAX, and
bcl-2 are involved in the regulation of cell apoptosis, and whether or not there exists a relationship between them is a topic that can be further studied. Trophoblast cells and tumor cells share similar properties, specifically the capacity for proliferation, migration, and invasion [
23].
SEMA4D, a member of the semaphorin IV subgroup, has been observed in human trophoblast and decidual tissue. This receptor has been discovered to stimulate the migration and invasion of trophoblastic cells into the maternal decidua and myometrium. Additionally, it plays a role in the remodeling of uterine spiral arteries and contributes to the maintenance of a healthy pregnancy [
13]. Furthermore, it has been discovered that
SEMA3A, a constituent of the semaphorins family, exerts a significant influence on the process of decidualization. Moreover, a reduction in the expression of
SEMA3A has been linked to cases of unexplained spontaneous abortion [
12]. The aforementioned studies bring forth the significance of
SEMA4A. The functional role of
SEMA4A in the regulation of trophoblasts and its potential association with abortion remains uncertain. Based on the aforementioned findings, it is postulated that the aberrant expression of
SEMA4A may impede the proper functioning of trophoblasts, hence contributing to the manifestation of miscarriage.
This study investigated the expression of
SEMA4A in the chorionic villi of MA and analyzed its impact on trophoblasts at the interface between the mother and fetus for the first time (
Figure 1). This study aimed to assess and compare the expression levels of
SEMA4A in placental villi between individuals with normal early pregnancy and those diagnosed with MA. Furthermore, we investigated the impact of the substance on trophoblast cells and delved into the underlying process. The data presented in this study offer substantiation for the association between the downregulation of
SEMA4A in chorionic villi and the occurrence of MA.
2. Materials and Methods
2.1. Patients and Clinical Samples
The present study received ethical approval from the ethics committee of Hebei General Hospital, and written informed consent was obtained from all participants before the collection of samples. The present study comprised a cohort of 36 primigravid women in the early stages of pregnancy who underwent negative pressure suction for induced abortion at Hebei General Hospital throughout the period spanning from September 2023 to November 2023. Based on the pregnancy outcome, the participants were categorized into two groups: the normal pregnancy group, also referred to as the control group, and the missed abortion group, abbreviated as the MA group, each consisting of 18 cases. The inclusion criteria of the MA group were as follows: (a) estimated gestational age ≤ 12 weeks based on B-ultrasound and last menstrual cycle and (b) B-scan ultrasonography suggesting intrauterine pregnancy, which met the diagnostic criteria for embryo termination (head and hip length ≥7 mm, no fetal heart beat; the mean diameter of the gestational sac was ≥25 mm, and no embryo was found; no yolk sac was seen, and no embryo and fetal heart beat were seen after 2 weeks; the yolk sac was visible, and no fetal heart beat was observed after 11 days). The inclusion criteria of the control group were as follows: (a) no symptoms of threatened abortion; (b) B-scan ultrasound indicates intrauterine pregnancy, pregnancy sac can be seen, consistent with the gestational week, fetal bud and the original cardiac tube can be seen, and no other abnormal conditions exist, such as uterine effusion. The common exclusion criteria encompassed the following: (a) the presence of symptoms related to endocrine or metabolic disorders, such as hyperthyroidism and diabetes; (b) the presence of karyotype abnormalities; (c) the identification of infection through standard leucorrhea examination; and (d) the presence of uterine abnormalities. Following the acquisition of the patient’s informed consent, the collection of chorionic villi samples was conducted, and subsequent thorough washing was performed using sterile saline solution. The villous tissues were promptly collected subsequent to the surgical procedure. One section of the tissues was preserved using a 4% paraformaldehyde solution for subsequent paraffin embedding in blocks, while the other portion was maintained in liquid nitrogen and then put into the refrigerator at −80 °C.
2.2. Cell Culture and Treatment
Human first-trimester trophoblast/simian virus (HTR-8/SVneo) (ZQ 0482) cells used in this study were obtained in April 2023 from Shanghai Zhong Qiao Xin Zhou Biotechnology Co., Ltd. of Shanghai, China. These cells were cultured in a 1640 culture medium (Gibco, Thermo Fisher Technologies LTD of Guangzhou, China) supplemented with 10% fetal bovine serum (FBS, Guangdong Oricell Biotechnology Co., Ltd. of Guangdong, China) and 1% penicillin–streptomycin solution (Solarbio, Beijing Solarbio Technology Co., Ltd. of Beijing, China). These cells were cultivated at a temperature of 37 °C in an environment containing 5% CO2. The SEMA4A knockdown experiment utilized SEMA4A siRNA and a negative control (si-NC) obtained from Guangzhou RiboBio Co., Ltd. of Guangdong, China. For SEMA4A overexpression, pcDNA3.1-SEMA4A and a negative control (pcDNA3.1-NC) were acquired from Hunan Keai Medical Devices Co., Ltd. of Hunan, China. The HTR-8/SVneo cells were transfected using Lipofectamine 2000 (Invitrogen, Thermo Fisher Technologies LTD of Guangzhou, China) according to the manufacturer’s instructions.
2.3. Cell Proliferation Assay
Cell proliferation was evaluated by employing the CCK-8 (APExBIO, APExBIO Technology LLC of Houston, Houston, TX, USA). HTR-8/SVneo cells were seeded onto 96-well plates at a density of 2 × 103 cells per well and subjected to various experimental treatments. At the specified time intervals (0, 24, 48, and 72 h), a 10% concentration of CCK-8 was introduced into every well. Following an extended incubation period of 4 h, the absorbance at a wavelength of 450 nm was quantified using a microplate reader. Three wells were designated as replicates for each group.
2.4. Transwell Migration Assay
Cellular migration ability was assessed using a 24-well plate Transwell insert (8-µm pore size) (Corning, Shanghai Muchen Biotechnology Co., Ltd. of Shanghai, China). Briefly, HTR-8/SVneo cells at a density of 2 × 105 were cultured in the upper chamber of each insert using a 200 µL FBS-free 1640 medium. A volume of 650 µL of 1640 medium supplemented with 10% fetal bovine serum (FBS) was introduced into the lower chamber. The Petri dish was positioned within an incubator set at a temperature of 37 °C, with a controlled atmosphere containing 5% carbon dioxide, for a duration of 28 h. Subsequently, the cells that had penetrated the lower chamber were immobilized using a 4% paraformaldehyde solution, subjected to staining with a 0.1% crystal violet solution and subsequently assessed for quantification. The mean cell count obtained from five distinct fields with a magnification of 200× was documented.
2.5. Wound Healing Assay
The migration ability of trophoblasts was assessed using the wound healing assay. Trophoblast cells were seeded in a 6-well plate chamber at a density of 5 × 105 cells per well in fresh medium and incubated for 24 h. Once the cells reached 80–90% confluence, a scratch was created across the cell surface using a 200 μL pipette tip. Floating debris was removed using phosphate-buffered saline (PBS), and the wound was immediately photographed (0 h). Subsequently, the cells were cultured in serum-free medium. After 24 h, the wounds were photographed again to quantify the extent of wound healing. The sizes of the gaps were measured using Image J software (v.1.46, National Institute of Health of Bethesda, Bethesda, MD, USA).
2.6. Flow Cytometry Analysis
The Annexin V-FITC/PI Apoptosis Detection Kit (Elabscience, Wuhan Elabscience Biotechnology Co., Ltd. of Wuhan, China) was utilized to identify cell apoptosis. In summary, the HTR-8/SVneo cells that underwent transfection were gathered and subsequently rinsed with PBS. Following resuspension in a 1× binding buffer, the cells were subjected to staining with Annexin V-FITC and PI at room temperature, while being kept in a dark environment. Subsequently, the apoptosis rate of HTR8/SVneo cells was assessed through the utilization of a flow cytometer (BD FACSAria III, Jiangsu Kenerfei experimental instrument trading Co., Ltd. of Jiangsu, China). Cells that were positive for Annexin V-FITC and negative for propidium iodide (PI) were identified as early apoptotic cells, whereas those positive for both Annexin V-FITC and PI were classified as late apoptotic cells. The cumulative apoptosis rate was determined by adding the rates of early and late apoptosis.
2.7. Western Blot Analysis
The extraction of total protein was performed on either cells or 50 mg of tissues using RIPA lysis solution supplemented with a protease and phosphatase inhibitor cocktail (Servicebio, Wnhan Servicebio Biotechnology Co., Ltd. of Wuhan, China). The cells were suspended in RIPA buffer and incubated on ice for 30 min. The quantification of cell lysis buffer, which contained the total protein, was performed using a BCA Protein assay kit manufactured by Beijing Solarbio Technology Co., Ltd. of Beijing, China. A total of 60 micrograms (μg) of protein was utilized for the purpose of conducting SDS-PAGE electrophoresis. The protein was separated using SDS-PAGE gel and subsequently deposited onto a PVDF membrane. Following a 40 min incubation with a protein-free fast blocking solution, the membrane was subsequently exposed to primary antibodies: SEMA4A (27359-1-aP, 1:1000, Proteintech, Wuhan Proteintech Biotechnology Co., Ltd. of Wuhan, China), β-Actin (GB15003, 1:1500, Servicebio, Wnhan Servicebio Biotechnology Co., Ltd. of Wuhan, China), STAT3 (R22785, 1:750, ZENBIO, China), and p-STAT3 (Ser727) (R25804, 1:750, ZENBIO, Chengdu ZENBIO Biotechnology Co., Ltd. of Chengdu, China), as well as the MMP9 antibody (380831, 1:1000, ZENBIO, Chengdu ZENBIO Biotechnology Co., Ltd. of Chengdu, China), bcl-2 antibody (381702, 1:750, ZENBIO, Chengdu ZENBIO Biotechnology Co., Ltd. of Chengdu, China), and BAX antibody (E-AB-10049, 1:1000, Elabscience, Wuhan Elabscience Biotechnology Co., Ltd. of Wuhan, China). After left to incubate overnight in the primary antibody, the membrane underwent a total of three washes using TBST solution, with each wash lasting for 10 min. Following the washing step, the membrane was further subjected to incubation with a secondary antibody, HRP-conjugated goat anti-rabbit IgG (H + L), at a dilution of 1:8000 (BF03008X, Biodragon, Suzhou Biodragon Immunotechnology Co., Ltd. of Suzhou, China) for 1 h at room temperature. Subsequently, the membrane underwent three washes with TBST, and the protein bands were detected through the utilization of an enhanced chemiluminescence kit (Beijing Solarbio Technology Co., Ltd. of Beijing, China) and captured via photography on the chemiluminescence imaging system. This experiment performed the experiment with 10% SDS-PAGE. The densitometry analysis was conducted using the Image J program (v.1.46, National Institute of Health of Bethesda, Bethesda, MD, USA).
2.8. Quantitative Real-Time PCR
The extraction of total RNA from treated cells was performed using TRNzol reagent (TIANGEN, Beijing TIANGEN Biotechnology Co., Ltd. of Beijing, China) in accordance with the instructions provided by the manufacturer. The reverse transcription procedure was performed using the FastKing RT Kit (with gDNase) manufactured by Beijing TIANGEN Biotechnology Co., Ltd. of Beijing, China. The reverse transcription polymerase chain reaction (RT-PCR) was conducted using a SuperReal PreMix Plus (SYBR Green) kit manufactured by Beijing TIANGEN Biotechnology Co., Ltd. of Beijing, China. The amplification and detection of the PCR products were carried out on a 7500 detection system provided by Life Technologies, Singapore. The internal reference β-Actin was used, and the relative gene expression was determined using the 2
−ΔΔCt technique. The primers were designed by primer 5, and the primer sequences are provided in
Table 1.
2.9. Immunohistochemistry
The villous tissues, which had been fixed in paraffin, were sliced into sections that were 4 μm thick. These sections were then subjected to dehydration using a series of ethanol solutions with increasing concentrations. The endogenous peroxidase activity was inhibited by treating the sample with a 3% hydrogen peroxide solution for 25 min. Additionally, any nonspecific binding was prevented by blocking the sample with a 5% bovine serum albumin (BSA) solution for 30 min. Subsequently, the samples were subjected to incubation with a primary rabbit anti-human SEMA4A antibody (1:50, Proteintech, Wuhan Proteintech Biotechnology Co., Ltd. of Wuhan, China) for an overnight period at a temperature of 4 °C. The slices underwent three washes with PBS and were subsequently treated with secondary antibodies for 50 min. The detection of the reaction was accomplished using 3,3′-diaminobenzidine (DAB), and subsequently, the sections were counterstained with hematoxylin. Three visual fields were chosen, and the staining was examined using a microscope at a magnification of 200×. The photos were analyzed using the software Image J (v.1.46, National Institute of Health of Bethesda, Bethesda, MD, USA).
2.10. Hematoxylin–Eosin Staining
The villus tissues were subjected to overnight fixation using a 4% paraformaldehyde solution. Following this, the tissues underwent paraffin embedding treatment, and 4-micron slices were produced for subsequent experimental procedures. The tissue sections underwent deparaffinization using xylene, followed by hydration using alcohol. The sections were subjected to immersion in hematoxylin (Solarbio, Beijing Solarbio Technology Co., Ltd. of Beijing, China) for 5 min at ambient temperature. Following this, they were rinsed with tap water, immersed in a differentiation solution for a brief period, rinsed once more with tap water, subjected to a reversal of the blue color using an anti-blue solution, and then rinsed with running water. Following a 5 min staining period with eosin, the sections underwent a 5 min dehydration process using anhydrous ethanol (I, II, III), followed by a 5 min permeabilization step using xylene (I, II). Subsequently, the slices were treated with a neutral resin and were subsequently examined using an optical microscope (Precise, Beijing Precise Instrument Co., Ltd. of Beijing, China).
2.11. Statistical Analysis
Statistical analyses were performed by SPSS 25.0, and statistical figures were created by GraphPad Prism 9.5. The measurement data were tested by Shapiro–Wilk for the normality test. If the data obeyed normal distribution, they were expressed as mean ± standard deviation (SD). t-test was used for comparison between the two groups, analysis of variance was used for repeated measurement data, and the Bonferroni correction method was used for multiple comparisons afterwards. If the data do not obey normal distribution, they were expressed by M (P25, P75). p < 0.05 was considered to be statistically significant.
4. Discussion
The proliferation, migration, and invasion of trophoblast cells play crucial roles in the development of the fetus and placenta. It has been widely recognized that the reduction in trophoblast cell proliferation and metastasis is associated with the development of missed abortion [
24]. Previous studies have demonstrated that
SEMA4A plays a role in facilitating the proliferation and metastasis of breast carcinoma [
15]. The present investigation has identified
SEMA4A as a contributing factor to the proliferation and migration of HTR-8/SVneo cells. These findings imply that targeting
SEMA4A could be a feasible technique for preventing missed abortion.
The findings of this study provide confirmation of the downregulation of
SEMA4A in placental villi in patients diagnosed with missed abortion. The acquisition of trophoblasts during the early stages of pregnancy poses significant challenges, hence presenting a notable drawback in investigating the intricate mechanisms behind trophoblast invasion. Several researchers have observed that the invasiveness of the HTR-8/SVneo cell line is nearly equivalent to that of primary trophoblast cells when compared to JEG3 and Bewo cell lines. Considering this point, it can be argued that the HTR-8/SVneo cell line possesses characteristics that make it particularly well suited for investigating the physiological and associated molecular mechanisms of trophoblast invasion [
25]. Up to now, the HTR-8/SVneo cell line has been extensively employed in research to investigate the biological properties and functions of trophoblast cells [
26]. The development of the deliberate termination of pregnancy was found to be associated with preventing cell proliferation and migration in HTR-8/SVneo [
27]. In this study, the downregulation of
SEMA4A was observed to have a significant impact on the viability and migration of HTR-8/SVneo cells. These findings suggest that the decreased level of
SEMA4A in the placental villi of patients with missed abortion may impede the migration of trophoblast cells into the maternal vessels and decidua. Consequently, this could result in inadequate nutrient supply and subsequent embryo demise, thereby contributing to the occurrence of missed abortion.
Missed abortion is classified as an early abnormal pregnancy characterized by the presence of a deceased embryo or delayed embryoplastic development [
28]. The process of cell death in trophoblasts was observed to be enhanced throughout the progression of missed abortion [
28].
Bcl-2 and
BAX are two genes that are often seen and which are associated with apoptosis. The
bcl-2 protein exerts regulatory control over apoptotic pathways that are dependent on mitochondria, primarily by modulating the permeability of the mitochondrial membrane and regulating the release of components involved in apoptosis. Furthermore, it has been observed that
bcl-2 has the ability to impede cellular apoptosis induced by various causes, leading to a substantial extension of the cell’s development phase and an augmentation of its resistance to apoptotic stimuli [
29,
30]. The excessive production of the
BAX gene can impede the activity of the
bcl-2 gene and facilitate the process of apoptosis. Upon receiving the death signal, the
BAX gene initiates the translocation of the
BAX protein to the mitochondrial membrane, resulting in the formation of a molecular pore that exhibits cytotoxic effects. This process subsequently leads to mitochondrial malfunction and alterations in permeability, ultimately culminating in apoptosis [
31]. Zhao et al. [
32] observed that the dysregulation of
BAX and
bcl-2 expression had a strong association with trophoblast cell death and played a significant role in the development of abortion. The experimental findings indicate that the manipulation of
SEMA4A expression resulted in alterations in the expression levels of
BAX and
bcl-2. In cells where
SEMA4A expression was suppressed, there was an observed rise in apoptotic levels. Additionally, the levels of
BAX were found to be significantly elevated, while the levels of
bcl-2 were notably reduced. In contrast, it was shown that in cells overexpressing
SEMA4A, there was a decrease in apoptotic levels, a large decrease in
BAX levels, and a marked increase in
bcl-2 levels. There is a suggestion that
SEMA4A has the potential to impede the intrinsic pathway of apoptosis via the
bcl-2/BAX molecular switch, which plays a critical role in regulating apoptosis.
Matrix metalloproteinases (MMPs) are a group of proteolytic enzymes that rely on zinc for their activity. In the context of cytotrophoblasts, these cells secrete
MMP9 to facilitate the degradation of the extracellular matrix. This process is crucial for the successful seeding and implantation of the embryo [
33].
MMP9, also known as matrix metalloproteinase-9, is a collagenase belonging to the type IV collagenase family. It possesses the highest molecular weight and exhibits the most potent effects.
MMP-9 has been found to play a crucial role in various biological processes, including the promotion of capillary angiogenesis, involvement in cellular inflammatory response as an inflammatory mediator, inhibition of cell apoptosis, and facilitation of cell proliferation, migration, and invasion [
34].
MMP9 is closely related to epithelial–mesenchymal transformation (EMT). The etiology of missed abortion is attributed to defects in the epithelial–mesenchymal transition of trophoblast, as indicated by previous research [
33]. The findings of this study demonstrated that the overexpression of
SEMA4A led to a significant upregulation of both mRNA and protein levels of
MMP9 in HTR-8/SVneo cells. Therefore,
SEMA4A may be involved in the biological behavior changes in trophoblast cells through
MMP9.
The involvement of
SEMA4A in pathological processes has been observed through many pathways, such as the
STAT3 pathway [
15,
35]. The regulation of target genes associated with trophoblast cell invasion has been documented to be influenced by
STAT3 signaling. Furthermore, the invasiveness of trophoblast cells was found to be increased through the phosphorylation of
STAT3 [
36]. The reduction in phosphorylated
STAT3 in the decidualization of mouse decidua was observed, which resulted in the impairment of embryo implantation and had a role in the occurrence of miscarriage [
37]. Hence, it can be inferred that
p-STAT3 plays a crucial role in the process of embryo implantation and the creation of the placenta [
38]. Consequently, it is regarded as a prospective target for addressing the issue of spontaneous abortion [
37]. Additionally, the upregulation of
MMP9 mRNA and protein levels in HTR-8/SVneo cells may potentially be linked to the activation of
STAT3, as shown by a previous study [
39]. The findings of our investigation revealed that the overexpression of
SEMA4A resulted in an augmentation of
p-STAT3 protein level in HTR-8/SVneo cells. Conversely, the inhibition of
SEMA4A led to a reduction in the observed rise in
p-STAT3 level. We speculate that
SEMA4A may promote the proliferation and migration of trophoblast cells through the
p-STAT3/STAT3 pathway, but the specific mechanism of action still needs to be explored.
In conclusion, this study showed that SEMA4A level was significantly reduced in chorionic villus tissues of individuals diagnosed with MA. Inhibition of SEMA4A can induce apoptosis of trophoblast cells and inhibit cell migration and proliferation, while upregulation of SEMA4A can inhibit apoptosis of trophoblast cells and promote cell migration and proliferation. The upregulation of SEMA4A had a suppressive effect on programmed cell death through the regulation of BAX and bcl-2 gene expression. Additionally, SEMA4A may promote trophoblast migration through p-STAT3/STAT3 expression.