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Differential expression of microRNA-411 and 376c is associated with hypertension in pregnancy.


Pregnancy-associated hypertension is a major cause of perinatal and maternal mortality (1,2). Hypertension can be transient or occur within 20 weeks of gestation and is associated with proteinuria. This later form used to be called preeclampsia (3). However, according to the current guidelines of The American College of Obstetricians and Gynecologists, preeclampsia is now diagnosed by persistent high blood pressure that develops during pregnancy or during the postpartum period that is associated with proteinuria or the new development of decreased blood platelets, problems with the kidney or liver, fluid in the lungs, or signs of brain problems such as seizures and/or visual disturbances (4). Even though anomalous placentation is widely believed to be the reason for preeclampsia, the exact etiology is unknown (3-5).

Cardinal features of preeclampsia include, but are not limited to, decreased trophoblast proliferation and increased apoptosis, impeded differentiation of trophoblast, and impaired migration and invasiveness of the trophoblast in the uterus, resulting in defective spiral artery remodeling (6-10). However, the precise mechanism initiating or supporting preeclampsia has not been elucidated.

Micro-RNAs (miRNA) are evolutionarily conserved 21-23 nucleotides RNAs that regulate post-transcriptional gene expression either by blocking translation or degrading target messenger RNAs (mRNAs) and have been increasingly shown to function as inhibitor or promoter of many diseases (11,12). miRNAs can function in both normal and transformed cells and have even been shown to play a role in cardiovascular diseases, including hypertension (13-18).

Importantly, anomalous miRNA expression in placenta has been shown to be involved in pregnancy problems, including preeclampsia (19,20). Placental miRNAs can also be detected in the plasma, providing a great opportunity of studying their changing expression level and determining if they can be used for prognostic purposes in predicting complications during pregnancy (21). Indeed, it has been shown that miR-376c levels decrease in the placenta of preeclampsia patients at term and this decrease can be observed in the plasma as early as the second trimester (22). However, it is not known why the decrease in the plasma levels is not mimicked in the placenta of these patients. Hence, it is important to discover additional miRNAs, which are decreased in preeclampsia patients' plasma and placenta at the pre-term stage.

Material and Methods

Patients, clinical samples, and ethical considerations

The Institutional Review Board of the Jinan Central Hospital Affiliated to Shandong University approved the protocol of the study (#2016185). Plasma and placenta specimens were obtained from pregnant women having unifetal gestation undergoing perinatal care at the Department of Gynecology and Obstetrics, Jinan Central Hospital Affiliated to Shandong University, between January 2014 and December 2016 (n=49). All patients provided written consent. All experiments conformed to the principles set out in the World Medical Association Declaration of Helsinki and the NIH Belmont Report. Patients with gestational diabetes, transient hypertension, spontaneous abortion, congenital abnormalities in the fetus, and intrauterine fetal death were excluded from the current study (n=18). Early trimester placentas were collected from patients undergoing terminated pregnancies through dilation and curettage procedure (n=9). Heparin containing DNase/ RNase-free tubes were used for blood sample collection. Samples were subjected to centrifugation at 1600 g for 10 min at 4[degrees]C within 2 h of sample collection; the resulting supernatants were centrifuged at 16,000 g for an additional 10 min at 4[degrees]C before being snap-frozen and stored in liquid nitrogen tanks until further processing. Placenta tissue specimens were processed for hematoxylin and eosin (H&E) staining by standard procedures and imaged.

Cell culture and transfection

The immortalized cell line from first trimester human cytotrophoblast cells HTR-8/SVneo was obtained from ATCC and cultured in RPMI-1640 supplemented with 5% FBS and penicillin/streptomycin (ThermoFisher Scientific, USA). Where indicated, cells were mock-transfected or transfected with miR-376c and miR-411 mimic (ThermoFisher Scientific) using lipofectamine 3000 (ThermoFisher Scientific) following the manufacturer's recommended protocol.

miRNA extraction and quantitative real time polymerase chain reaction (qRT-PCR)

miRNA was extracted by the TRIzol LS isolation kit (ThermoFisher Scientific) according to the manufacturer's instructions. The expression levels of miR-376c, miR377, miR-411, and RNU6B were detected by TaqMan miRNA assays (ThermoFisher Scientific). Data were analyzed by the -[DELTA][DELTA]Ct method and normalized to RNU6B expression.

Cell proliferation assay

The MTT assay kit (Sigma-Aldrich, China) was used to quantitatively determine cell proliferation. Results of relative absorbance are reported as means [+ or -] SD of three biological replicates, each performed with three technical replicates.

Cell migration and cell invasion assays

The Culturex 96-well cell migration and Culturex 96-well BME cell invasion assay kits (R&D Systems, USA) were used to detect the in vitro ability of cell migration and invasion, according to the manufacturer's recommendation. The results were used to analyze the percent of cell migration and invasion and data are reported as means [+ or -] SD.

Statistical analyses

Statistical analyses were performed using SPSS statistics software 20.0 (IBM, USA). Differences between groups were determined by one-way ANOVA. Student's t-test or Mann-Whitney U-test (non-normal data distribution) was used for comparison between two groups. Adjustment for both gestational and maternal age was done by performing multiple regression analysis. P<0.05 was considered statistically significant.


The included cases (preeclamptic, n=31 and control, n=9) (Figure 1A and B) were not significantly different in age (P>0.05). However, there were significantly more cesarean sections than normal vaginal deliveries in patients with preeclampsia compared to controls (P<0.05). Additionally, patients with preeclampsia had higher blood pressure compared to controls and more patients were on antihypertensive medication (methyldopa or labetalol) (P<0.05 in each case) (Table 1).

miRNA-376c, -377, and -411 levels were determined in normal and preeclamptic pregnancies by qRT-PCR. No significant change was noted for miR-377 expression between the first (1 [+ or -] 0.34), second (0.81 [+ or -] 0.62), and third trimesters (1.09 [+ or -]0.37) (P=0.735) in normal pregnancy. However, both miR-376c (1 [+ or -] 0.29; 4.82 [+ or -] 0.43; and 6.21 [+ or -] 0.41, respectively, in first, second, and third trimesters) and miR-411 (1 [+ or -] 0.20; 5.11 [+ or -] 0.11; and 7.94 [+ or -] 0.36, respectively, in first, second, and third trimesters) significantly increased in the second compared to the first trimester, and third compared to the first or second trimester (Figure 1C; P<0.05 in each case) in normal pregnancy. This indicated that miR-411 and miR-376c expressions were induced during the progression of normal pregnancy.

We next determined miR-376c, miR-377, and miR-411 expression in preeclamptic pregnancy compared to age-matched controls, both pre-term (26-35 weeks) and at term (36-40 weeks). In at-term placentas, both miR-376c and miR-411 levels were significantly lower in patients with severe preeclampsia (miR-376c: 2.38 [+ or -] 0.34 and miR-411: 2.13 [+ or -] 0.02) compared to control patients (miR376c: 5.39 [+ or -] 0.44 and miR-411; 6.34 [+ or -] 0.46 s) (Figure 2; P < 0.05 in each case). There was no significant difference in miR-376c expression between severe preeclampsia (1.03 [+ or -] 0.04) and normal pre-term patients (1.01 [+ or -] 0.02) (Figure 2; P > 0.05). However, miR-411 expression was significantly lower in pre-term placentas obtained from patients with severe preeclampsia (0.23 [+ or -] 0.05) compared with normal subjects (1.04 [+ or -] 0.06) (Figure 2; P < 0.05), indicating that miR-411 expression was regulated at an earlier time point than miR-376c.

We next determined miR-376c, miR-377, and miR-411 expression levels in plasma of patients who later developed preeclampsia compared to control patients. In contrast to the observation in pre-term placentas, miR-376c was significantly lower in plasma (0.19 [+ or -] 0.04) of patients who later developed preeclampsia compared to control (1.01 [+ or -] 0.03) patients (Figure 3; P < 0.05). A similar pattern of decreased expression was observed for miR-411 in patients who later developed preeclampsia (0.15 [+ or -] 0.06) compared to controls (1.04 [+ or -] 0.04) (Figure 3; P < 0.05). Both miR-411 (6.34 [+ or -] 0.46 in controls vs 1.13 [+ or -] 0.02 in preeclampsia) and miR-376c (5.39 [+ or -] 0.44 in controls vs 1.24 [+ or -] 0.35 in preeclampsia), but not miR-377 (1.04 [+ or -] 0.02 in controls vs 1.01 [+ or -] 0.06 in preeclampsia), were significantly less expressed in plasma of preeclampsia patients at 36 to 40 weeks of gestation (Figure 3; P < 0.05 in each case).

It has been previously shown that miR-376c overexpression in the human trophoblast cell line, HTR8/ SVneo, induces cell proliferation, migration, and invasion (22). Hence, we finally determined if transient expression of a miR-376c or miR-441 mimic in the HTR8/SVneo cells would induce increased proliferation, migration, and invasion. Ectopic expression of both miR-441 and miR-376c significantly increased cell proliferation by 2.01 [+ or -] 0.34 and 1.91 [+ or -]0.08, respectively, as assessed by the MTT assay (Figure 4A; P<0.05), migration (miR-376c by 24 [+ or -] 2%; and miR-411 by 25 [+ or -] 3%) (Figure 4B; P < 0.05), and invasion (miR-376c by 37 [+ or -] 2%; and miR-411 by 39 [+ or -] 3%) (Figure 4C; P < 0.05).


A significant reduction of placental and plasma miR-411 was observed in preeclamptic patients, compared with their gestational age-matched normal subjects. Our results also demonstrated that miR-411, like miR-376c (shown before (22) and here), can promote trophoblast cell proliferation, migration, and invasion. In comparison to miR-376c, miR-411 levels decreased even in pre-term placenta indicating that an miR-411 decrease was an earlier event compared to miR-376c downregulation.

miR-411 belongs to the miR-379 family and is located in the imprinted DLK//DIO3 region within the miR-379/ miR-656 cluster on human chromosome 14 (23), which is highly conserved in placental mammals (22,23). miR-376c is also a member of the miR-379/miR-656 cluster (22). In fact, expression of miR-154 and miR-377, both members of the miR-379/miR-656 cluster, has been previously shown to be decreased in preeclamptic placentas (24). However, in the current study, we did not find any difference in expression in the placenta or plasma of patients with preeclampsia. On the other hand, our results are in line with previous findings on miR-376c in preeclamptic placenta and plasma, both pre-term and at term (22).

Given our and previous (22) findings that miR-411 and miR-376c expressions were associated with cell proliferation, migration, and invasion and their continued increase during normal pregnancy, it can be inferred that these miRNAs are associated with normal placental development, and hence their decrease results in anomalous placental development and ultimately premature abortion. How hypertension causes this decrease in miR-411 and miR-376c needs to be determined. Given that all findings including ours suggest that miRNAs associated with the miR-379/miR-656 clusters are downregulated in preeclampsia patients, it needs to be determined which miRNAs in this cluster are expressed less and if there is a pattern to their decrease, as some are decreased early whereas others, late during pregnancy. Furthermore, how their transcription affects hypertension and how this leads to proteinuria need to be identified as they have the potential of providing novel therapeutic targets for treating preeclamptic patients.

Given that miR-441 and miR-376c expression were down-regulated in the plasma of these patients by the 15th week of pregnancy, determining their levels in incoming pregnant patients can serve as indicators of potential risk of preeclampsia. However, such observations should be validated in a larger cohort of patients in a multi-center study design.


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Hui-li Yang (iD) [1], Hong-zhi Zhang (iD) [1], Fan-rong Meng (iD) [2], Shu-yi Han (iD) [3] and Miao Zhang (iD) [1]

[1] Department of Gynecology and Obstetrics, Jinan Central Hospital Affiliated to Shandong University, Jinan, Shandong, China

[2] Department of Gynecology and Obstetrics, Dongchangfuqu Maternal and Child Health Hospital, Liaocheng, Shandong, China

[3] Medical Research and Laboratory Diagnostic Center, Jinan Central Hospital Affiliated to Shandong University, Jinan, Shandong, China

Correspondence: Miao Zhang: <>

Received August 13, 2018 | Accepted February 27, 2019

Caption: Figure 1. Expression of miR-376c, miR-441, and miR-377 in placenta throughout gestation. Representative H&E staining of placenta tissue specimens obtained from preeclampsia (A) and control (B) patients. Scale bar, 100 [micro]m. C, Expression profile in first trimester (5-12 weeks, n=16), second trimester (13-25 weeks, n=16), and third trimester (26-40 weeks, n=17) in control patients. Data were normalized to RNU6B expression and reported as means [+ or -] SD. * P < 0.05; NS: non-significant (Student's t-test).

Caption: Figure 2. Comparison of placental miR-376c, miR-441, and miR-377 expression levels in preterm (26-35 weeks) and term (36-40 weeks) deliveries between preeclamptic patients (PE) and their gestational age-matched control subjects (AMC) (preterm PE n=12; preterm AMC n=11; term PE n=14; term AMC n=12). Data were normalized to RNU6B expression and are reported as means [+ or -] SD. * P < 0.05; NS: non-significant (Student's t-test). Data were adjusted to maternal age and gestational age, as assessed by multiple regression analysis.

Caption: Figure 3. Expression level of miR-376c, miR-377, and miR-441 in plasma samples obtained retrospectively from pregnant women who later developed preeclampsia (PE) or age-matched controls (AMC) at 15-18 weeks and 36-40 weeks (term) of pregnancy. Data were normalized to RNU6B expression and are reported as means [+ or -] SD. * P < 0.05; NS: non-significant (Student's t- test). Data were adjusted to maternal age and gestational age, as assessed by multiple regression analysis.

Caption: Figure 4. A, Cell viability was measured in HTR8/SVneo cells mock-transfected or transfected with miR-376c or miR-441 mimic at 24, 48, and 72 h after transfection by the MTT assay. HTR8/SVneo cells, mock-transfected or transfected with miR-376c or miR-441 mimic, were used for transwell migration (B) and invasion (C) assays. The migrated and invasive cells photographed using a microscope are shown in the top panels, and the percent of total cells at the beginning of the assay in the bottom panels. Scale bar, 100 [micro]m. Data are reported as means [+ or -] SD. * P < 0.05 (Student's t-test).
Table 1. Clinicopathological characteristics of the patients included
in the current study.

Characteristics                 Control (n=9)

Age (years)                  32.83 [+ or -] 3.19
BMI (kg/[m.sup.2])           20.97 [+ or -] 2.12
Parity (n)                       2 [+ or -] 1
Type of deliveries
 NVD                              8 (88.9%)
 CS                               1 (11.1%)
 Gestational age (weeks)     29.66 [+ or -] 2.38
 Methyldopa                        0 (0%)
 Labetalol                         0 (0%)
 Tonics                           9 (100%)
Blood Pressure
 SBP (mmHg)                 102.12 [+ or -] 12.19
 DBP (mmHg)                  76.83 [+ or -] 2.39
 Mean BP (mmHg)              86.23 [+ or -] 4.39
 Pulse BP (mmHg)             26.21 [+ or -] 3.22

Characteristics             Preeclampsia (n=31)      P

Age (years)                 31.57 [+ or -] 2.98    0.45
BMI (kg/[m.sup.2])          23.97 [+ or -] 3.12    0.039
Parity (n)                      2 [+ or -] 1       1.00
Type of deliveries
 NVD                            22 (70.96%)        0.001
 CS                              9 (29.04%)        0.001
 Gestational age (weeks)    29.13 [+ or -] 1.37    0.23
 Methyldopa                     30 (96.77%)         NA
 Labetalol                       1 (3.23%)          NA
 Tonics                          31 (100%)         1.00
Blood Pressure
 SBP (mmHg)                 143.57 [+ or -] 7.21   0.001
 DBP (mmHg)                  95.42 [+ or -] 1.34    0.001
 Mean BP (mmHg)             111.29 [+ or -] 8.43   0.001
 Pulse BP (mmHg)             51.49 [+ or -] 5.28    0.001

Results are reported as means [+ or -] SD or number and percentage.
BMI: body mass index; NVD: normal vaginal delivery;
CS: caesarian section; SBP: systolic blood pressure; DBP: diastolic
blood pressure; BP: blood pressure; SD: standard deviation;
NA: not applicable. Data were analyzed with Student's t-test or
chi-squared test.
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Title Annotation:Research Article
Author:Yang, Hui-li; Zhang, Hong-zhi; Meng, Fan-rong; Han, Shu-yi; Zhang, Miao
Publication:Brazilian Journal of Medical and Biological Research
Geographic Code:9CHIN
Date:Apr 1, 2019
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