Remodeling of extracellular matrix in the womb facilitates the dramatic morphogenesis of maternal and placental tissues necessary to support fetal development. In addition to providing a scaffold to support tissue structure, extracellular matrix influences pregnancy outcomes by facilitating communication between cells and their microenvironment to regulate cellular adhesion, migration, and invasion. By reviewing the functions of extracellular matrix during key developmental milestones, including fertilization, embryo implantation, placental invasion, uterine growth, and labor, we illustrate the importance of extracellular matrix during healthy pregnancy and development. We also discuss how maladaptive matrix expression contributes to infertility and obstetric diseases such as implantation failure, preeclampsia, placenta accreta, and preterm birth. Recently, advances in engineering the biotic–abiotic interface have potentiated the development of microphysiological systems, known as organs-on-chips, to represent human physiological and pathophysiological conditions in vitro. These technologies may offer new opportunities to study human fertility and provide a more granular understanding of the role of adaptive and maladaptive remodeling of the extracellular matrix during pregnancy.

Impact statement

Extracellular matrix in the womb regulates the initiation, progression, and completion of a healthy pregnancy. The composition and physical properties of extracellular matrix in the uterus and at the maternal–fetal interface are remodeled at each gestational stage, while maladaptive matrix remodeling results in obstetric disease. As in vitro models of uterine and placental tissues, including micro-and milli-scale versions of these organs on chips, are developed to overcome the inherent limitations of studying human development in vivo, we can isolate the influence of cellular and extracellular components in healthy and pathological pregnancies. By understanding and recreating key aspects of the extracellular microenvironment at the maternal–fetal interface, we can engineer microphysiological systems to improve assisted reproduction, obstetric disease treatment, and prenatal drug safety.

中文翻译：

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细胞外基质在正常和病理性妊娠中的作用：微生理系统在生殖医学中的未来应用。

子宫中细胞外基质的重塑促进了支持胎儿发育所必需的母体和胎盘组织的显着形态发生。除了提供支持组织结构的支架外，细胞外基质还通过促进细胞与其微环境之间的交流来调节细胞的粘附，迁移和侵袭，从而影响妊娠结局。通过回顾细胞外基质在关键发育阶段的功能，包括受精，胚胎着床，胎盘浸润，子宫生长和分娩，我们说明了细胞外基质在健康怀孕和发育过程中的重要性。我们还讨论了适应不良的基质表达如何导致不孕和产科疾病，例如着床失败，先兆子痫，胎盘增生和早产。体外。这些技术可能为研究人类的生育能力提供新的机会，并提供对怀孕期间细胞外基质的适应性和适应不良重塑作用的更详尽的了解。

影响陈述

子宫中的细胞外基质调节着健康怀孕的开始，进展和完成。子宫和母胎界面的细胞外基质的组成和物理特性在每个妊娠阶段都会进行重塑，而适应不良的基质重塑会导致产科疾病。由于体外子宫模型和胎盘组织，包括在芯片上这些器官的微和毫规模的版本，开发用于克服研究人类发展的内在局限在体内，我们可以隔离健康和病理妊娠中细胞和细胞外成分的影响。通过了解和重建母婴界面细胞外微环境的关键方面，我们可以设计微生理系统来改善辅助生殖，产科疾病治疗和产前药物安全性。