寿胎丸、举元煎作用CBA/J×DBA/2复发性自然流产模型的"胚-膜"免疫亚细胞群的分子串扰机制OA

Objective:To systematically compare the differential regulation of the maternal-fetal interface cell lineages and communication networks in the CBA/J×DBA/2 mouse model of recurrent pregnancy loss(RPL)by the two classic therapeutic methods-tonifying the kidney to stabilize the fetus and invigorating the spleen to stabilize the fetus(Shoutai Wan,Juyuan Jian)-of traditional Chinese medicine(TCM)at the single-cell resolution and clarify their modern scientific connotations.Methods:Female non-pregnant CBA/J mice were caged with male BALB/c(blank group)and DBA/2(modeling group)mice separately.Pregnant mice in the modeling group were randomly grouped as follows:high/low-dose Shoutai Wan,high/low-dose Juyuan Jian,model(RPL),and positive control(dydrogesterone),with 10 mice in each group.Starting from the day after the detection of the vaginal plug,mice were administrated with drugs or an equal volume of normal saline by gavage for 10 consecutive days.After the intervention,the following indicators were measured.① Macroscopic evaluation:general conditions,uterine wet weight,embryo loss rate,four coagulation parameters[prothrombin time(PT),activated partial thromboplastin time(APTT),fibrinogen(FIB),and thrombin time(TT)],and peripheral blood estradiol(E2)and progesterone(Pg)levels.The decidua with embryos was stained with hematoxylin-eosin(HE)and evaluated by transmission electron microscopy(TEM).The expression of B-cell lymphoma-2(Bcl-2),vascular endothelial growth factor(VEGF),angiotensin Ⅱ(AngⅡ),matrix metalloproteinase-2(MMP-2),interleukin-6(IL-6),leukemia inhibitory factor(LIF),CXC chemokine ligand 12(CXCL12),and microtubule-associated protein 1 light chain 3 homolog(LC3)Ⅰ/Ⅱ was quantified by Western blot.② Mechanism analysis at the single-cell level:The decidua with embryos from the blank,model,high-dose Shoutai Wan,and high-dose Juyuan Jian groups(6 mice per group,with 3 single-cell samples per group,totaling 24 mice)were analyzed by the BD Rhapsody™ platform,and the whole-cell atlas was drawn by uniform manifold approximation and projection(UMAP)dimensionality reduction clustering combined with the single-cell mouse cell atlas(scMCA).The differentially expressed genes(DEGs)and cell interaction networks were analyzed via Gene Ontology(GO),Kyoto Encyclopedia of Genes and Genomes(KEGG),and CellChat,and the protein-protein interaction(PPI)map of subtype cells was constructed.The CytoTRACE pseudo-temporal analysis was performed to explore the developmental trajectories of core immune cells(natural killer cells,NK cells)from maternal and fetal sources.Results:① Pathological and Western blot results indicated that compared with the blank group,the RPL group showed an increase in the embryo loss rate(P<0.01),down-regulated expression of Bcl-2,LIF,MMP-2,and Vegf in the decidua with embryos(P<0.05),up-regulated protein levels of CXCL-12,AngⅡ,and IL-6(P<0.05),blocked angiogenesis,apoptosis-inflammation imbalance,and coagulation dysfunction.Both prescriptions dose-dependently reduced the abortion rate and restored the angiogenesis-inflammation balance,and Shoutai pill showed superior performance in restoring the E2 level to the Pg level(P<0.05).② Single-cell transcriptome analysis indicated that compared with the blank group,the RPL group showed differences in multiple key cell populations such as decidual cells,trophoblast cells,endothelial cells,erythroblasts,NK cells,and macrophages at the maternal-fetal interface.Immunity and angiogenesis were the key links in RPL.Compared with the RPL group,high-dose Shoutai Wan reversed the changes of NK cells in the embryonic layer(upregulating the mRNA levels of 17 genes and downregulating the mRNA levels of 29 genes)and macrophages(upregulating the mRNA levels of 117 genes and downregulating the mRNA levels of 53 genes)through the regulation of gene expression.High-dose Shoutai pill regulated the immune cells to affect unfolded proteins,cell adhesion,and programmed cell death,thereby promoting decidualization and angiogenesis and modulating embryo-membrane development.High-dose Juyuan Jian regulated the key subgroups of NK cells(up-regulating the mRNA levels of 9 genes and down-regulating the mRNA levels of 17 genes)and macrophages(up-regulating the mRNA levels of 110 genes and down-regulating the mRNA levels of 81 genes),which affected decidual inflammation and apoptosis and intervened in glycolysis.③ The pseudo-temporal analysis and communication network indicated that the communication frequency of the RPL group decreased.High-dose Shoutai Wan restored maternal-fetal tolerance through pathways such as NKG2D,CDH5,GDF,and FASLG.High-dose Juyuan Jian enhanced the IL-6/LIFR/JAK/signal transducer and activator of transcription 3(STAT3)and desmosome/SEMA6/tumor necrosis factor-like weak inducer of apoptosis(TWEAK)signaling to improve endometrial receptivity.The RPL group showed an increased proportion of toxic dNK7,a decreased proportion of reparative dNK4,and blocked embryo fNK1.High-dose Shoutai Wan down-regulated dNK7 and up-regulated dNK4.High-dose Juyuan Jian inhibited the terminal differentiation of dNK7 and up-regulated LILRB1,thus restoring the balance of cytotoxicity and repair.Conclusion:Both the kidney-tonifying and spleen-invigorating methods are effective in treating RPL.NK and macrophages are the key immune cells in the interaction between the embryo and the membrane.The kidney-tonifying method(Shoutai Wan)has an advantage in regulating the phenotypes of unfolded protein,cell adhesion,and programmed cell death,and shows expression characteristics closer to the physiological state in the regulation of NKG2D and CDH5 signals.The spleen-invigorating method(Juyuan Jian)has an advantage in regulating epithelial-mesenchymal transition(EMT),angiogenesis,and glycolysis and shows higher communication intensity in the IL-6 and LIFR pathways.