Adrenomedullin (AM) is a multifunctional peptide that is involved in a variety of biological processes, including embryonic development, angiogenesis, cardio-protection, and innate immunity. Maternal plasma levels of AM rise substantially during a normal pregnancy, but abnormally low levels are often associated with a variety of pregnancy complications including preeclampsia, fetal growth restriction, gestational diabetes and spontaneous abortion. Using genetically engineered mouse models, our laboratory was the first to demonstrate that haploinsufficiency for maternal AM causes a multitude of reproductive defects associated with abnormal implantation and fetal growth restriction. We also revealed that fetal-derived AM is required for the appropriate remodeling of maternal spiral arteries-a novel demonstration of the importance of fetal-to-maternal communication during pregnancy. Collectively our studies have shown that the dosage and signaling of AM peptide at the maternal-fetal interface is an essential aspect to ensuring a normal pregnancy and birth. Therefore, we intend to build on these findings by asking: How and why does the dosage of AM get precisely regulated at the maternal-fetal interface? Using sophisticated genetic mouse models and in vitro pharmacological and cell biological assays, we plan to address this broad question in three discrete Aims.
In Specific Aim 1, we will test the hypothesis that the newly characterized decoy chemokine receptor, CXCR7, acts as a biological rheostat for AM-mediated activity during early implantation and placentation.
Specific Aim 2 will test the hypothesis that the dosage of AM gene expression in fetal trophoblast cells is balanced by a discrete subset of cell-intrinsic miRNAs that are induced by maternal factors such as pregnancy hormones and environmental factors, like cigarette smoke.
In Specific Aim 3 we will further elucidate the distinct cellular process and molecular mechanisms that govern the effects of AM on spiral artery (SA) remodeling. Results from our studies will further our basic understanding of molecules and processes that govern maternal- to-fetal communication in the placenta and have the potential of providing new clinical diagnostic tools and therapeutic approaches for the amelioration of complications of pregnancy.

Public Health Relevance

Abnormal implantation and placental development are a major underlying cause of reproductive failure, including early pregnancy loss and spontaneous abortion. As a result, there is an increasing dependence on assisted reproductive technologies. However, babies born to these pregnancies or pregnancies with a diseased placenta are at a greater risk for life-long cardiovascular, metabolic and immune health problems. Therefore, developing a better understanding of the genes and proteins that govern normal placental development is critical and may ultimately lead to new clinical diagnostic tools and therapeutic approaches for the amelioration of infertility and complications of pregnancy.

National Institute of Health (NIH)
Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD)
Research Project (R01)
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Pregnancy and Neonatology Study Section (PN)
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Eisenberg, Esther
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University of North Carolina Chapel Hill
Schools of Medicine
Chapel Hill
United States
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