HtrA4 is required for human trophoblast stem cell differentiation into syncytiotrophoblast

Placenta. 2024 Mar 6:147:68-77. doi: 10.1016/j.placenta.2024.01.018. Epub 2024 Feb 1.


Introduction: The syncytiotrophoblast (STB) of the human placenta facilitates vital maternal-fetal communication and is maintained by fusion (syncytialization) of cytotrophoblasts. Serine protease HtrA4 (high temperature requirement factor A4) is highly expressed only in the human placenta and was previously reported to be important for BeWo fusion. This study investigated whether HtrA4 is critical for differentiation of human trophoblast stem cells (TSCs) into STB.

Methods: Primary TSCs were isolated from first trimester placentas (n = 5) and validated by immunofluorescence (IF) for CD49f, CK7 and vimentin. TSCs were then differentiated into STB and the success of syncytialization was confirmed by RT-PCR, IF and ELISA of known markers. TSCs were next stably transfected with a HtrA4-targetting CRISPR/Cas9 plasmid, and cells with severe HtrA4 knockdown (HtrA4-KD) were analyzed to investigate the impact on STB differentiation.

Results: Primary TSCs were confirmed to be of high purity by staining positively for CD49f and CK7 but negatively for vimentin. These TSCs readily syncytialized when stimulated for STB differentiation, significantly increasing β-hCG and syncytin-1, substantially decreasing E-cadherin, and markedly losing cell borders. While TSCs produced very low levels of HtrA4, upon stimulation for STB differentiation the cells drastically upregulated HtrA4 expression; secretion of HtrA4 protein also increased sharply, correlating positively and significantly with that of β-hCG. The HtrA4-KD TSCs, however, failed to show this surge of HtrA4 production upon stimulation, and ultimately remained primarily mononucleated with no significant STB differentiation.

Discussion: This study demonstrates that HtrA4 plays a critical role in TSC differentiation into syncytiotrophoblast.

Keywords: HtrA4; Syncytialization; Syncytiotrophoblast; TSC; Trophoblast differentiation; Trophoblast stem cell.

MeSH terms

  • Cell Differentiation
  • Female
  • Humans
  • Integrin alpha6 / metabolism
  • Placenta* / metabolism
  • Pregnancy
  • Serine Proteases* / metabolism
  • Trophoblasts* / metabolism
  • Vimentin / metabolism


  • HtrA4 protein, human
  • Integrin alpha6
  • Serine Proteases
  • Vimentin