**Preeclampsia Is Associated with Sex-Specific Transcriptional and Proteomic Changes in Fetal Erythroid Cells**

**Zahra Masoumi 1,\*, Gregory E. Maes 2,3, Koen Herten 2,4, Álvaro Cortés-Calabuig 4, Abdul Ghani Alattar 5,6, Eva Hanson 1, Lena Erlandsson 1, Eva Mezey 7, Mattias Magnusson 6, Joris R Vermeesch 2,3,4, Mary Familari 8,**† **and Stefan R Hansson 9,**†


Received: 14 March 2019; Accepted: 17 April 2019; Published: 25 April 2019

**Abstract:** Preeclampsia (PE) has been associated with placental dysfunction, resulting in fetal hypoxia, accelerated erythropoiesis, and increased erythroblast count in the umbilical cord blood (UCB). Although the detailed effects remain unknown, placental dysfunction can also cause inflammation, nutritional, and oxidative stress in the fetus that can affect erythropoiesis. Here, we compared the expression of surface adhesion molecules and the erythroid differentiation capacity of UCB hematopoietic stem/progenitor cells (HSPCs), UCB erythroid profiles along with the transcriptome and proteome of these cells between male and female fetuses from PE and normotensive pregnancies. While no significant differences were observed in UCB HSPC migration/homing and in vitro erythroid colony differentiation, the UCB HSPC transcriptome and the proteomic profile of the in vitro differentiated erythroid cells differed between PE vs. normotensive samples. Accordingly, despite the absence of significant differences in the UCB erythroid populations in male or female fetuses from PE or normotensive pregnancies, transcriptional changes were observed during erythropoiesis, particularly affecting male fetuses. Pathway analysis suggested deregulation in the mammalian target of rapamycin complex 1/AMP-activated protein kinase (mTORC1/AMPK) signaling pathways controlling cell cycle, differentiation, and protein synthesis. These results associate PE with transcriptional and proteomic changes in fetal HSPCs and erythroid cells that may underlie the higher erythroblast count in the UCB in PE.

**Keywords:** preeclampsia; hematopoietic stem/progenitor cells; umbilical cord blood; erythropoiesis
