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Updated: Feb 23, 2026

The 4-vessel Sampling Approach to Integrative Studies of Human Placental Physiology In Vivo
Published on: August 2, 2017
Endoplasmic reticulum stress responses in placentation - A true balancing act
Daniel Bastida-Ruiz1, Elizabeth Aguilar1, Agnès Ditisheim2
1Department of Gynecology Obstetrics, Faculty of Medicine, University of Geneva, Rue Michel-Servet 1, Geneva 1211, Switzerland.
The unfolded protein response (UPR) is vital for mammalian reproduction, aiding placental development. However, overactivation of UPR due to endoplasmic reticulum stress (ERS) can harm pregnancy outcomes, leading to pathologies.
Area of Science:
- Cellular Biology
- Reproductive Biology
- Biochemistry
Background:
- Endoplasmic reticulum stress (ERS) triggers the unfolded protein response (UPR), a cellular mechanism essential for protein folding in eukaryotes.
- ERS can be induced by conditions like hypoxia and glucose deprivation.
- UPR activation is increasingly recognized for its critical role in mammalian reproduction, specifically in decidualization and placentation.
Purpose of the Study:
- To review the dual role of UPR activation in placental development and pregnancy pathologies.
- To discuss the consequences of prolonged ERS and UPR overactivation during pregnancy.
- To identify potential clinical biomarkers associated with UPR in pregnancy.
Main Methods:
- Literature review synthesizing current research on UPR, ERS, and reproductive outcomes.
- Analysis of studies investigating the physiological and pathological roles of UPR in placentation.
- Identification and discussion of potential circulating protein markers for UPR.
Main Results:
- Physiological UPR activation is essential for successful mammalian reproduction and placental function.
- Prolonged ERS and subsequent UPR overactivation can lead to apoptosis and autophagy, negatively impacting pregnancy.
- ERS-associated pathologies include intrauterine growth restriction and early-onset preeclampsia.
- Circulating C-terminal GRP78 and anti-GRP78 autoantibodies are proposed as potential clinical markers.
Conclusions:
- UPR plays a critical, yet complex, role in mammalian reproduction, balancing placental development with the risks of overactivation.
- Dysregulation of UPR contributes to significant pregnancy complications.
- Further investigation into UPR biomarkers like GRP78 may offer clinical utility for monitoring pregnancy health.
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