Features of Endometrial Stem Cells in Placenta Accreta Spectrum Disorders

Background: Placenta accreta spectrum disorders (PAS) feature abnormally invasive implantation of placenta and absence of decidua. Occurrence of PAS is strongly associated with damaged endometrial- myometrial tissue (after uterine surgery or C-section). Due to the absence of decidua, trophoblasts uncontrollably invade the myometrium. Endometrial regeneration in premenopausal women is maintained by the so-called endometrial mesenchymal stem cells (eMSC) upon the exposure to estrogen and progesterone. eMSC located in the perivascular niche of functionalis and basalis express Sushi Domaine Containing 2 (SUSD2). The role of SUSD2+ eMSC in both pregnancy and post-operative regeneration is unknown. The aim of this study is to characterize the capacity of SUSD2+ eMSC isolated from the uterus at term pregnancy and to compare to those isolated from PAS and non-pregnant uterine samples. We hypothesize that the capacity of eMSC is hindered in the PAS samples in comparison to non-PAS controls.