"Cytotrophoblast" is the name given to both the inner layer of the

trophoblast The trophoblast (from Greek : to feed; and : germinator) is the outer layer of cells of the blastocyst. Trophoblasts are present four days after fertilization in humans. They provide nutrients to the embryo and develop into a large part of the p ...

(also called layer of Langhans) or the cells that live there. It is interior to the

syncytiotrophoblast Syncytiotrophoblast (from the Greek 'syn'- "together"; 'cytio'- "of cells"; 'tropho'- "nutrition"; 'blast'- "bud") is the epithelial covering of the highly vascular embryonic placental villi, which invades the wall of the uterus to establish nut ...

and external to the wall of the

blastocyst The blastocyst is a structure formed in the early embryonic development of mammals. It possesses an inner cell mass (ICM) also known as the ''embryoblast'' which subsequently forms the embryo, and an outer layer of trophoblast cells called the t ...

in a developing embryo. The cytotrophoblast is considered to be the trophoblastic

stem cell In multicellular organisms, stem cells are undifferentiated or partially differentiated cells that can differentiate into various types of cells and proliferate indefinitely to produce more of the same stem cell. They are the earliest type o ...

because the layer surrounding the blastocyst remains while daughter cells differentiate and proliferate to function in multiple roles. There are two lineages that cytotrophoblastic cells may differentiate through: fusion and invasive. The fusion lineage yields syncytiotrophoblast and the invasive lineage yields interstitial cytotrophoblast cells. Cytotrophoblastic cells play an important role in the implantation of an embryo in the uterus.

Fusion lineage

The formation of all

is from the fusion of two or more cytotrophoblasts via this fusion pathway. This pathway is important because the syncytiotrophoblast plays an important role in fetal-maternal gas exchange, nutrient exchange, and immunological and metabolic functions. An undifferentiated cytotrophoblastic stem cell will differentiate into a villous cytotrophoblast, which is what constitutes primary

chorionic villi Chorionic villi are villi that sprout from the chorion to provide maximal contact area with maternal blood. They are an essential element in pregnancy from a histomorphologic perspective, and are, by definition, a product of conception. Branche ...

, and will eventually coalesce into villous syncytiotrophoblast. The formation of syncytiotrophoblast from cytotrophoblast is a terminal differentiation step of trophoblastic cells. Syncytialization of cytotrophoblastic cells can be induced ''

in vitro ''In vitro'' (meaning in glass, or ''in the glass'') studies are performed with microorganisms, cells, or biological molecules outside their normal biological context. Colloquially called "test-tube experiments", these studies in biology an ...

'' through multiple signalling molecules including

epidermal growth factor Epidermal growth factor (EGF) is a protein that stimulates cell growth and differentiation by binding to its receptor, EGFR. Human EGF is 6-k Da and has 53 amino acid residues and three intramolecular disulfide bonds. EGF was originally descr ...

glucocorticoid Glucocorticoids (or, less commonly, glucocorticosteroids) are a class of corticosteroids, which are a class of steroid hormones. Glucocorticoids are corticosteroids that bind to the glucocorticoid receptor that is present in almost every vertebr ...

s, and

human chorionic gonadotropin Human chorionic gonadotropin (hCG) is a hormone for the maternal recognition of pregnancy produced by trophoblast cells that are surrounding a growing embryo (syncytiotrophoblast initially), which eventually forms the placenta after implantation ...

Invasive lineage

The invasive lineage creates cytotrophoblasts that are essential in the process of implantation and forming a fully functional

placenta The placenta is a temporary embryonic and later fetal organ that begins developing from the blastocyst shortly after implantation. It plays critical roles in facilitating nutrient, gas and waste exchange between the physically separate mater ...

. An undifferentiated cytotrophoblastic stem cell will differentiate into an extravillous cytotrophoblast intermediate and then into an interstitial cytotrophoblast. An interstitial cytotrophoblast may then further differentiate into an endovascular cytotrophoblast or form a

syncytium A syncytium (; plural syncytia; from Greek: σύν ''syn'' "together" and κύτος ''kytos'' "box, i.e. cell") or symplasm is a multinucleate cell which can result from multiple cell fusions of uninuclear cells (i.e., cells with a single nucleus) ...

Interstitial cytotrophoblast

The primary function of an interstitial cytotrophoblast is to anchor the growing fetus to the maternal uterine tissue. These cells may invade the whole

endometrium The endometrium is the inner epithelial layer, along with its mucous membrane, of the mammalian uterus. It has a basal layer and a functional layer: the basal layer contains stem cells which regenerate the functional layer. The functional laye ...

and the proximal third of the

myometrium The myometrium is the middle layer of the uterine wall, consisting mainly of uterine smooth muscle cells (also called uterine myocytes) but also of supporting stromal and vascular tissue. Its main function is to induce uterine contractions. Struc ...

. Once these cells penetrate through the first few layers of cells of the

decidua The decidua is the modified mucosal lining of the uterus (that is, modified endometrium) that forms every month, in preparation for pregnancy. It is shed off each month when there is no fertilised egg to support. The decidua is under the influ ...

, they lose their ability to proliferate and become invasive. This departure from the

cell cycle The cell cycle, or cell-division cycle, is the series of events that take place in a cell that cause it to divide into two daughter cells. These events include the duplication of its DNA (DNA replication) and some of its organelles, and subs ...

seems to be due to factors such as

TGF-β Transforming growth factor beta (TGF-β) is a multifunctional cytokine belonging to the transforming growth factor superfamily that includes three different mammalian isoforms (TGF-β 1 to 3, HGNC symbols TGFB1, TGFB2, TGFB3) and many other sign ...

and

decorin Decorin is a protein that in humans is encoded by the ''DCN'' gene. Decorin is a proteoglycan that is on average 90 - 140 kilodaltons (kDa) in molecular weight. It belongs to the small leucine-rich proteoglycan (SLRP) family and consists of a p ...

. Although these invasive interstitial cytotrophoblasts can no longer divide, they retain their ability to form syncytia. Multinucleated giant cells (small syncytia) are found in the placental bed and myometrium as a result of the fusion of interstitial cytotrophoblasts. Interstitial cytotrophoblasts may also transform into endovascular cytotrophoblasts.

Endovascular cytotrophoblast

The primary function of the endovascular cytotrophoblast is to penetrate maternal

spiral arteries Spiral arteries are small arteries which temporarily supply blood to the endometrium of the uterus during the luteal phase of the menstrual cycle. In histology, identifying the presence of these arteries is one of the most useful techniques in i ...

and route the blood flow through the placenta for the growing embryo to use. They arise from interstitial cytotrophoblasts from the process of

phenocopy A phenocopy is a variation in phenotype (generally referring to a single trait) which is caused by environmental conditions (often, but not necessarily, during the organism's development), such that the organism's phenotype matches a phenotype wh ...

ing. This changes the phenotype of these cells from epithelial to endothelial. Endovascular cytotrophoblasts, like their interstitial predecessor, are non-proliferating and invasive.

Role in implantation

Proper cytotrophoblast function is essential in the implantation of a blastocyst. After hatching, the embryonic pole of the blastocyst faces the uterine endometrium. Once they make contact the trophoblast begins to rapidly proliferate. The cytotrophoblast secretes proteolytic enzymes to break down the extracellular matrix between the endometrial cells to allow finger-like projections of trophoblast to penetrate through. Projections of cytotrophoblast and syncytiotrophoblast pull the embryo into the endometrium until it is fully covered by endometrial epithelium, save for the coagulation plug.

Associated disorders

The most common associated disorder is

pre-eclampsia Pre-eclampsia is a disorder of pregnancy characterized by the onset of high blood pressure and often a significant amount of protein in the urine. When it arises, the condition begins after 20 weeks of pregnancy. In severe cases of the disease ...

, affecting approximately 7% of all births.Genbacev, O., DiFederico, E., McMaster, M., & Fisher, S. (1999). "Invasive cytotrophoblast apoptosis in pre-eclampsia." ''Human Reproduction'', 14, 59-66. It is characterized by a failure of the cytotrophoblast to invade the uterus and its vasculature, specifically the spiral arteries that the endovascular cytotrophoblast should invade. The result of this is decreased blood flow to the fetus which may cause

intrauterine growth restriction Intrauterine growth restriction (IUGR), or fetal growth restriction, refers to poor growth of a fetus while in the womb during pregnancy. IUGR is defined by clinical features of malnutrition and evidence of reduced growth regardless of an infant's ...

. Clinical symptoms of pre-eclampsia in the mother are most commonly high

blood pressure Blood pressure (BP) is the pressure of circulating blood against the walls of blood vessels. Most of this pressure results from the heart pumping blood through the circulatory system. When used without qualification, the term "blood pressure" r ...

proteinuria Proteinuria is the presence of excess proteins in the urine. In healthy persons, urine contains very little protein; an excess is suggestive of illness. Excess protein in the urine often causes the urine to become foamy (although this symptom ma ...

and

edema Edema, also spelled oedema, and also known as fluid retention, dropsy, hydropsy and swelling, is the build-up of fluid in the body's Tissue (biology), tissue. Most commonly, the legs or arms are affected. Symptoms may include skin which feels t ...

. Conversely, if there is too much invasion of uterine tissue by the trophoblast then a hydatidiform mole or

choriocarcinoma Choriocarcinoma is a malignant, trophoblastic cancer, usually of the placenta. It is characterized by early hematogenous spread to the lungs. It belongs to the malignant end of the spectrum in gestational trophoblastic disease (GTD). It is also c ...

may arise.

Additional images

File:Gray12.png, Section through embryonic area of Vespertilio murinus to show the formation of the amniotic cavity.

References

External links

* - "Female Reproductive System: placental villi"
Diagram at McGill
{{Authority control Embryology