Project Summary / Abstract
Dynamic uterine fluid volume is essential for successful early pregnancy. Uterine fluid volume is the net result of
secretion and absorption, which are respectively promoted by ovarian estradiol (E2) and progesterone (P4)
through the uterine epithelium. Dysregulated uterine fluid movement has been associated with impaired early
pregnancy, particularly in women with endometriosis undergoing ovarian stimulation for in vitro fertilization-em-
bryo transfer (IVF-ET) who often experience uterine fluid retention and implantation failure. Na+ and Cl- are the
dominant ions in the uterine fluid. Amiloride-sensitive epithelial Na+ channel (ENaC) and cystic fibrosis trans-
membrane conductance regulator (CFTR) have been implicated in their movements across the uterine epithelial
cell membrane to generate osmotic gradients for facilitating fluid movement through the epithelial membrane
water channels, aquaporins (AQPs). Despite the essential roles of sex hormones and ion/water channels in
regulating dynamic uterine fluid movement during early pregnancy, the precise hormonal and ionic mechanisms
remains elusive. Our preliminary data in mouse models revealed inhibition of uterine fluid absorption by amiloride
on day 0.5 post-coitus (D0.5) but not D3.5, dynamic expression of genes for ion/water channels in D0.5 and D3.5
luminal epithelium (embryo implantation initiates ~D4.0 in mice) by mRNA-seq, and a novel function of E2-es-
trogen receptor α (ERα) in regulating uterine fluid absorption. In human models, we developed a microphysio-
logical system that enables a microfluidic co-culture of ovarian follicles and human endometrial (Endo) organoids
for engineering a female reproductive tract-on-a-chip (FRT-Chip), and our preliminary data showed the long-
term survival and 3D architecture of Endo organoids in vitro as well as the regulation of ENaC and CFTR by co-
cultured follicles. Herein, we formulate our central hypothesis that ERα and PR converge on hormonal and ionic
mechanisms to finely coordinate temporal uterine fluid absorption during early pregnancy, while dysregulation of
ion/water channels in eutopic endometriosis endometrium or under ovarian stimulation for IVF leads to disrupted
uterine fluid dynamics and impaired early pregnancy. There are two Specific Aims. In Aim 1, we will use trans-
genic mouse models with ERα or PR deficiency in the uterine epithelium to determine in vivo functions and
regulatory mechanisms of selected Na+ channels, Cl- channels, and water channels in the uterine epithelium for
uterine fluid absorption during early pregnancy. In Aim 2, we will collect normal and endometriosis endometrium
biopsies from menstruating women and IVF-ET patients to compare ion/water channels in human endometrium
biopsies and perform a microfluidic co-culture of follicles and Endo organoids to engineer an FRT-Chip and
investigate mechanisms regulating human uterine fluid movement under physiological and pathological condi-
tions. The successful completion of these studies will generate a comprehensive molecular atlas of uterine fluid
movement. Identification of local uterine epithelial factors is a crucial first step for developing treatments to reg-
ulate uterine fluid movement, improve embryo implantation success, and reduce early pregnancy loss.