Phenotypic Switch of Endovascular Trophoblasts in Decidual Vasculopathy with Implication for Preeclampsia and Other Pregnancy Complications.

BackgroundThis study aims to investigate decidual vasculopathy in preeclampsia at term and its relationship to spiral artery remodeling at implantation sites. Study design: Implantations sites with endovascular trophoblasts were reviewed from abortions with immunostaining for CD56. Placentas from patients with preeclampsia were also reviewed in association with other pathological features using placentas with decidual vasculopathy but not preeclampsia as controls. Results: Endovascular trophoblasts were phenotypically switched to express CD56 upon entering the spiral artery at implantation. CD56 expression is identified in classic decidual vasculopathy at term with or without preeclampsia. CD56 expression in addition to cytokeratin in decidual vasculopathy demonstrated the fetal trophoblastic origin, establishing the presence of endovascular trophoblasts at implantation and the decidual vasculopathy at term. Conclusion: Decidual vasculopathy at term contains the same CD56 positive extravillous endovascular trophoblasts seen with spiral artery remodeling in early pregnancy. CD56 may serve as a possible marker for decidual vasculopathy in the later stages of pregnancy.