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IN DEPTH: REPRODUCTION

The Physiology of Early Pregnancy in the Mare

Professor W. R. Allen, BVSc, PhD, ScD, DESM, MRCVS

Author’s address: University of Cambridge, Department of Clinical Veterinary Medicine, Equine


Fertility Unit, Mertoun Paddocks, Woodditton Road, Newmarket, Suffolk CB8 9BH,
United Kingdom. © 2000 AAEP.

Introduction mechanism could be responsible for such an unusual


Many features of early pregnancy in the mare ap- differential movement of gametes in the oviduct?
pear to be unique to the genus Equus and are of In early studies, Betteridge et al8 argued that the
considerable academic interest and practical signif- process of cleavage bestowed oviductal mobility on
icance. From the time of fertilization of the oocyte the equine embryo, while Onuma and Ohnami7 and
soon after ovulation until establishment of the ma- others proposed that ultrastructural changes in the
ture and fully functional placenta some 150 days surface of the zona pellucida during early develop-
later, a series of morphological, immunological, and ment of the embryo enabled its selective propulsion
endocrinological changes take place in the oviduct through the oviduct lumen by the organized beating
and uterus which may be presumed to be important of the cilia extruding from the apical surface of the
components of the establishment and maintenance lumenal epithelial cells. However, it was Weber
of the pregnancy state, but which differ markedly and his colleagues in northwest America who even-
from equivalent events in the other common large tually provided the definitive answer to the puzzle in
domestic animal species and for which it is difficult a series of elegant experiments that involved both
to imagine a precise evolutionary reason for their the culture of embryos in vitro9,10 and surgical im-
occurrence. This paper aims to highlight a few of plantation of mini-pumps to enable perfusion of hor-
these equine pregnancy-related reproductive oddi- mones into the mesosalpinx, followed by embryo
ties and discuss their significance in modern equine recovery attempts at fixed times after ovula-
veterinary medicine. tion.11–13 In this way they demonstrated convinc-
Oviductal Transport ingly that the embryo, but not the unfertilized
oocyte, begins secreting appreciable quantities of
van Niekerk and Gerneke1 first drew attention to
the differential transport of oocytes and embryos in prostaglandin E2 (PGE2) when it reaches the com-
the equine oviduct. Namely, if the freshly ovulated pact morula stage of development on day 5 after
oocyte remains unfertilized, it passes down the ovi- ovulation. The smooth muscle relaxing properties
duct only to the ampullary-isthmus junction where of this hormone act locally on the circular smooth
it remains lodged in the highly convoluted folds of muscle fibers in the wall of the oviduct and thereby
oviductal mucosa and degenerates slowly over many allow the embryo to move onwards, with the aid of
months.2 On the other hand, if the oocyte is fertil- the rhythmically beating cilia, to enter the uterus
ized by spermatozoa accumulated at the sperm res- approximately 24 hours later. Thus, it is the stage-
ervoir in the same ampullary-isthmic region of the dependent development of the hormone-secreting
oviduct,3 the resulting embryo continues its onward capacity of the embryo, not any subtle change in
passage and passes through the very constricted and maternal recognition of size or structural changes in
prominent uterotubal junction (UTJ) to enter the the outermost coat of it, which brings about its de-
uterus between 144 and 168 hours after ovulation.4 sired onward movement to the uterus (Fig. 1a).
Thus, flushing the oviducts of mares post mortem The protracted 6-day sojourn of the equine embryo
typically yields multiple flattened and degenerate in the oviduct compared to the 48-hour oviductal
oocytes accumulated from previous sterile ovula- period of the 4-cell pig embryo14 and the 72-hour
tions in preceding estrous cycles,5,6 while the inter- transport time of the 8-cell ruminant embryo,15 has
vention of fertilization can result in the young disadvantageous practical implications for embryo
embryo bypassing the still-accumulated oocytes to transfer and related embryo technologies in equids.
enter the uterus at the expected time.7 What For example, the bisection of embryos to produce
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Fig. 1. Cartoon depicting: a) the differential rates of oviductal transport between the embryos of the pig, sheep and horse and the
unique need for the latter to secrete PGE2 to relax the oviductal smooth muscle for its onward passage to the uterus; and b) the
contrasting mechanisms employed by the three species to achieve maternal recognition of pregnancy and luteostasis for maintenance
of the pregnancy state.

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IN DEPTH: REPRODUCTION
monozygotic (identical) twins is successful when onward passage into the uterus. But the question
performed on morulae but the success rate falls dra- of whether this unusual method of oviductal trans-
matically if the embryo is showing even the earliest port is no more than an evolutionary quirk in the
signs of blastulation when bisected.16,17 Similarly, mare, or is a necessary developmental mechanism to
the success of deep-freezing embryos in liquid nitro- delay entry of the embryo into the uterus until such
gen falls off sharply with increasing developmental time as the latter is biologically ready and prepared
age and size of the embryo,18 due probably to a to nurture the former, remains an interesting one
combination of damage to cells of the inner cell mass for future investigation.
(ICM) and impermeability of the equine blastocyst
capsule to cryoprotectants.19 In their painstaking Maternal Recognition of Pregnancy
and elegant study, Battut et al determined that the Short first coined the phrase “maternal recognition
majority of horse embryos enter the uterus (from of pregnancy” when he highlighted the different
which they can be recovered by simple non-surgical strategies employed by the common domestic animal
flushing methods) between 144 and 156 hours after species to ensure continuation of the secretory func-
ovulation when they are at the late morula stage of tion of the corpus luteum beyond its normal cyclical
development and may already be beginning to blas- lifespan and so maintain the uterus in the correct
tulate.4 But even when the time of ovulation is progestational state to support pregnancy and the
known to within a few hours by repeated ultrasound growth of the fetus.22 Prior to this time, a series of
scanning of the ovaries, flushing the uterus at elegant experiments in sheep, cows, and pigs had
closely timed intervals between 144 and 156 hours demonstrated that: 1) the luteolytic hormone
later yields embryos that differ markedly in their which induces cyclical regression of the corpus lu-
stage of development. Similarly, in a large experi- teum is secreted by the endometrium; 2) this uterine
ment designed to recover morulae for the purposes luteolysin reaches the ovary by means of a local
of bisection by flushing normal, fertile mares at fixed utero-ovarian transfer mechanism rather than via
times after a carefully estimated time of ovulation, the peripheral circulation; and 3) one or more em-
Boyle et al obtained a lower-than-normal overall bryos must be present in the ipsilateral uterine horn
embryo recovery rate of only 43% due to flushing between days 12 and 14 after ovulation to achieve
some mares too early when the embryo was still in the necessary luteostasis (see Moor15). Further
the oviduct.20 And it was disappointing and illumi- and equally elegant experiments during the early
nating to find that, from the 236 flushing attempts, 1970s established that: 1) prostaglandin F2␣
only 57 (24%) produced a morula. (PGF2␣) is the essential component of the uterine
A major improvement in this unsatisfactory situ- luteolysin in mammals; 2) it is released from the
ation occurred when Weber et al11 and Freeman et endometrium in spike-like pulses late in dioestrus;
al10 showed accelerated passage of the embryo and 3) it reaches the corpus luteum via direct local
through the oviduct and its resulting premature en- countercurrent transfer between the uterine vein
try into the uterus on day 5 after ovulation in mares and the ovarian artery in the ovarian pedicle (see
in which a mini-pump giving a low-dose, slow re- McCracken et al23).
lease of PGE2 was surgically implanted into the In the pig, Kidder et al24 and others reported that
ipsilateral mesosalpinx of the ovary containing the injections of estradiol benzoate given to cycling gilts
new corpus luteum on day 4 after ovulation. This between days 10 and 16 after ovulation would sig-
stimulated Robinson et al21 to attempt a more prac- nificantly prolong the secretory lifespan of the
tical approach to hastening oviductal transport by corpora lutea and so delay a return to estrus. Sub-
dripping onto the ipsilateral oviduct on day 4 after sequently, Perry et al25 associated the dramatic
ovulation a long acting triacetin-based gel formula- elongation of the trophoblast by the pig embryo be-
tion of PGE2a applied with the aid of a 0.5 ml straw tween days 10 and 14 after ovulation with the onset
in a disposable plastic equine embryo transfer gun of its capacity to synthesize and secrete appreciable
passed through the working channel of a rigid lap- quantities of estrogens (Fig. 1b) and, a few years
aroscope under local anaesthetic. Non-surgical later Bazer and Thatcher26 published their now
flushing of the uterus one day later (day 5) yielded widely accepted hypothesis that embryonic estro-
12 morulae from 20 mares treated with the PGE2- gens function as the maternal recognition of preg-
impregnated gel (60%) compared to no embryos on nancy signal in the pig by redirecting the flow of
day 5 from 19 mares treated similarly with only the endometrial PGF2␣ away from the uterine vein to an
gel vehicle, 12 of which (63%) did produce an ex- exocrine secretory route into the uterine lumen in-
panded blastocyst when re-flushed on day 8.21 stead. Vigorous experimental activity in the 1980s
Thus, it now seems safe to conclude that the 30- unravelled the interactions and complexities of the
year riddle of delayed and differential oviductal mechanism which brings about maternal recogni-
transport in the mare, posed by the startling origi- tion of pregnancy in the sheep, cow, deer, and other
nal discovery of van Niekerk and Gerneke,1 has ruminants. Namely, the synthesis and release of
been solved. The local smooth muscle relaxing large quantities of a protein hormone, interferon
properties of the stage-dependent secretion of PGE2 tau, by the elongating trophoblast between days 10
by the day 5 morula seems to be the key to its and 16 after ovulation which suppresses the normal
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IN DEPTH: REPRODUCTION
cyclical development of oxytocin receptors in the like the situation in the pig in which the embryonic
endometrium (Fig. 1b).27 This, in turn, prevents estrogens achieve luteostasis by re-directing the
oxytocin secreted by the corpus luteum28 from bind- flow of endometrial PGF2␣ away from the uterine
ing to the endometrium and driving the pulsatile veinous drainage,26 embryonic estrogens may simi-
releases of PGF2␣ that would normally induce lute- larly constitute the maternal recognition of preg-
olysis in the cycling animal (see Lamming and nancy signal in the mare. However, the many
Mann).29 experiments undertaken to date to prove or disprove
The mare provides a distinct, and apparently this theory have given equivocal results. For exam-
unique, contrast to the pig and wide range of rumi- ple, Vanderwall et al42 induced prolongation of lu-
nant species in the manner in which its embryo teal lifespan in only 6 of 11 mares into the uteri of
transmits the all-important maternal recognition of which they surgically inserted an estradiol-17␤-re-
pregnancy signal in early gestation. Enveloped in leasing minipump intended to mimic a conceptus
a tough and closely fitting glycocalyx capsule be- and 4 of 11 control mares showed an equivalent
tween days 6.5 and 22 after ovulation,30 the equine prolongation. Similarly, Ginther et al prolonged
embryo is unable to rearrange and elongate its luteal lifespan in 2 of the 3 diestrous mares they
trophectoderm between days 10 and 14 after ovula- injected daily with 5 mg estradiol and 2 of the 5 they
tion like its porcine and ruminant counterparts so as injected with 100 ng of estrone during days 7–18
to bring trophoblast into close contact with a size- after ovulation.43 But Woodley et al prolonged the
able area of endometrium in the gravid uterine cycle in only one of 5 mares treated with 10 mg
horn.25,31 Instead, the equine conceptus remains estradiol-17␤ per day and in none of 5 mares at each
spherical and completely unattached within the of 3 lower doses.44 More recently, Stout achieved
uterine lumen, where it moves continually through- similarly encouraging, although still equivocal, re-
out the uterine domain, propelled by strong and sults when he treated diestrous mares, parenterally
peristaltic contractions of the myometrium (Fig. or by the intrauterine route, with estradiol-17␤.45
1b).32,33 This unusual process of conceptus mobil- Four of 7 mares given a daily intramuscular (IM)
ity in the mare persists until day 17 after ovulation injection of 20 mg estradiol benzoate between days
when a sudden and spasm-like increase in myome- 10 and 20 after ovulation passed into prolonged
trial tone immobilizes and “fixes” the conceptus at diestrous, as did 3 of 7 mares given an intrauterine
the site of eventual implantation at the base of one silastic implant impregnated with estradiol 17␤ on
or other of the uterine horns.34,35 day 8 after ovulation. Thus, on the face of it,
It is now clear that this constant movement of the around 60% of diestrous mares to which estrogens
equine conceptus throughout the uterus between are administered parenterally over a number of
days 7 and 17 after ovulation is an integral part of days, or placed in the uterine lumen, undergo luteal
an evolutionary adaptation to ensure that the em- prolongation. However, there is no obvious expla-
bryonic maternal recognition of pregnancy signal nation to account for the 40% or so of mares that do
reaches the endometrium in all parts of the uterus. not respond in this way to estrogen therapy.
The utero-ovarian pedicle in ruminants which en- Clearly, more experimentation is required, with em-
ables direct countercurrent transfer of endometrial phasis perhaps being placed on local intrauterine
PGF2␣ from the uterine vein to the ovarian artery, administration regimes of the most appropriate es-
and thereby creates a very effective local ipsilateral trogen in the correct dose to better mimic the prob-
uterine control of luteal lifespan, is absent in ably pulsatile releases of estrogen directly onto the
equids.36 Thus, endometrial prostaglandin can lumenal surface of the endometrium (Fig. 1b) from
only reach the ovaries via the peripheral circulation the as yet non-vascularized choriovitelline mem-
which removes the possibility for any ipsilateral brane of the day 10 –16 conceptus as the latter is
function of the uterus in the mare. Indeed, surgical “squeezed” around the uterus by the remarkably
restriction of the equine conceptus to only one-third powerful myometrial contractions.33,46
of the total uterine area is followed by luteolysis and Despite the continuing uncertainty about the na-
a return to estrus at the expected time of the estrous ture of the embryonic maternal recognition of preg-
cycle, regardless of whether the unoccupied portion nancy signal in equids, recent experiments have
of the uterus is ipsilateral or contralateral to the established convincingly that, as in ruminants, sup-
ovary containing the corpus luteum.37 pression of the normal cyclical upregulation of oxy-
The nature of the signal by which the equine em- tocin receptors in the endometrium between days 10
bryo “informs” the mare biochemically of its pres- and 16 after ovulation is an integral part of the
ence in her uterus, and so achieves the necessary luteostatic mechanism in the pregnant mare. En-
luteostasis for pregnancy maintenance, remains a dometrial oxytocin receptor concentrations are
mystery. Unlike the ruminants, the equine concep- greatly reduced in pregnant versus cycling mares
tus does not produce any interferon-like protein mol- between days 10 and 1647 and the normal spike-like
ecules with luteostatic properties38 but, like the pig releases of PGF2␣ from the endometrium, measured
embryo, it does begin to secrete appreciable quanti- in plasma as 13,14 dihydro 15-keto PGF2␣ (PGFM),
ties of estrogens from as early as day 10 after ovu- which occur in response to an intravenous (IV) in-
lation.39 – 41 It has frequently been speculated that, jection of oxytocin between days 10 and 16 after
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IN DEPTH: REPRODUCTION

Fig. 2. High-power photomicrograph of a section of a day 14 horse conceptus showing the bilaminar blastocyst capsule overlying and
closely investing the single layer of trophectoderm cells which are stained with an anti-equine trophoblast antibody
(F102.1). Photograph kindly supplied by Dr J. C. Oriol of the Dominican Republic.

ovulation in the cycling mare, are abolished during countered occasionally by the stud farm veterinary
the same period in pregnancy.47,48 It is of interest clinician when scanning mares for pregnancy be-
that the oxytocin involved in establishing this posi- tween days 14 and 18 after ovulation, is of a well
tive feedback loop with PGF2␣ to induce luteolysis in developed and apparently normal conceptus sur-
the cycling mare is, like the pig,49 secreted by the rounded by a clearly edematous endometrium that
endometrium.50,51 This is in contrast to the rumi- is heralding the imminent onset of true estrus and
nant species in which the oxytocin involved in the the resulting relaxation of the cervix, and leading to
luteolytic pathway is secreted by the corpus luteum expulsion of the conceptus from the uterus.
itself.52
One other fascinating anomaly in the mare is the Development of the Fetal Membranes
ability of the equine conceptus to secrete appreciable In addition to providing strength and elasticity to
quantities of both PGF2␣ and PGE2 when cultured in the expanding blastocyst to enable it to withstand
vitro (Fig. 1b).52 It is reasonable to assume that the rigours of the myometrial contractions which
this prostanoic synthetic capacity of the chorio- propel it through the uterus,30 the equine blastocyst
vitelline membrane is necessary to stimulate locally capsule is clearly also important in accumulating
the peristaltic contractions and relaxations of the and regulating the supply of nutrients to the young,
myometrium required to propel the conceptus free-living conceptus.55 The capsular material is
throughout the uterine lumen during the period of secreted initially by the trophectoderm cells from
release of the maternal recognition of pregnancy around day 6.5 and is molded into shape as it coag-
factor. Indeed, such a hypothesis is supported by ulates by the zona pellucida to create an intact en-
the recent finding of Stout and Allen that conceptus velope that completely surrounds the embryo.56
mobility is virtually abolished when the pregnant It would be reasonable to suppose that this process
mare is treated with the prostaglandin synthetase of molding within the zona would create an outer
inhibitor, flumixin meglumine.53 b The situation investment that would be snug and close-fitting
seems ironic, and no doubt reflects a finely balanced from the outset (Fig. 2). Curiously, however, this is
mechanism of action and interaction, that, in order not the case and physical removal of the zona pellu-
to distribute its all important recognition message cida with the aid of the micromanipulator some
throughout the uterus, the equine conceptus must hours before hatching would occur naturally, reveals
secrete the very hormone, PGF2␣, which is striving a capsule that is creased and folded upon itself and
to prevent the neighboring maternal endometrium which unfolds and expands rapidly, rather like a
from releasing to ensure its survival in a progester- coiled spring being freed from restraint, as soon as
one-dominated uterus. One cannot help the suspi- the zona is removed.c This unusual process is pre-
cion that at least some of the relatively high sumably necessary to accommodate the rapid expan-
proportion of the total pregnancy losses in the mare sion of the blastocyst that does occur over the 2 or 3
which occur between days 12 and 30 after ovulation days after it hatches from the zona pellucida57 but
(32%)54 stem not from any failure of release of suf- the physico-chemical mechanisms which enable an
ficient maternal recognition of pregnancy factor exocrine secretion to coagulate and harden in this
from the conceptus to suppress the normal cyclical manner in a series of “pleats,” yet at the same time
luteolytic pathway, but more from the secretion of creates a contiguous layer that can completely en-
too much PGF2␣ by the wandering conceptus (Fig. velop the embryo within it, remains a fascinating
1b) which then gains untoward access to the periph- area for future investigation.
eral circulation and thereby accidentally induces lu- Due to its negative electrostatic charge and its
teolysis of the ultrasensitive corpus luteum. The unusual glycocalyx configuration,58 the outer sur-
resulting ultrasound scanning image, which is en- face of the capsule is very “sticky” to other proteins.
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IN DEPTH: REPRODUCTION
The enveloping capsule also begins to disintegrate
and melt away from around day 20 –21, presumably
as a consequence of enzymes secreted by the tropho-
blast and/or lumenal epithelium of the endome-
trium.62 This once gain exposes the trophectoderm
to the external environment which enables the
rapid, although temporary, development of finger-
like tufts of trophoblast cells on the external surface
of the non-vascularized bilaminar choriovitelline
membrane. Termed aerolae by Amoroso,59 due to
their structural similarity to the absorptive aerolae
that cover the external surface of the similarly non-
invasive allantochorion of the porcine placenta,
these tufts protrude into the mouths of endometrial
glands to provide important physical adherence of
the conceptus to the endometrium and increase the
Fig. 3. Videoendoscopic view of a 14-day horse conceptus bathed extent and efficiency of imbibition of endometrial
in endometrial gland secretions (“uterine milk”) as it moves freely gland secretions. Their nutritional importance is
about the uterine lumen to broadcast its maternal recognition of
shown by the high rate (i.e., 70 – 80%) of spontane-
pregnancy luteostatic signal to the maternal endometrium.
ous death and resorbtion, between days 15 and 25
after ovulation, of one of twin conceptuses in mares
in which both conceptuses become fixed together at
The capsule therefore functions to accumulate pro- the base of the same uterine horn (unilateral twins)
teins and other components of the endometrial gland in such a manner that the absorptive bilaminar
secretions (the “uterine milk”)59 onto its surface as choriovitelline portion of one conceptus abuts up
the conceptus moves throughout the uterus between against its co-twin conceptus rather than to the nu-
days 7 and 17 after ovulation. This accumulation tritionally provident endometrium (Fig. 4).33
process, of what is in effect the only source of nutri- Around day 20 –21 after ovulation the embryo it-
ents for the rapidly growing embryo, is attested to self becomes more clearly visible at one pole of the
both by a doubling in weight of the capsule between still spherical, but now increasingly capsule-free
hatching of the blastocyst around day 7.5 after ovu- conceptus.63 Organogenesis is proceeding rapidly
lation and immobilization of the conceptus at day and the primitive embryonic heart is already pump-
17,56 and by the very large quantities found adhered ing blood through the vitelline artery to the sinus
to, and almost incorporated into the structure of, the terminalis, and through the myriad of tiny blood
capsule of one component of uterine milk, the 19KDa vessels developing within the advancing mesoder-
progesterone-dependent protein called P19. This mal tissue between the outer chorionic and inner
was first isolated, sequenced, and identified as a yolk sac membranes (Fig. 5). The allantoic mem-
member of the lipocalin family of carrier proteins by brane first appears as an out-pouching of the embry-
Stewart et al60 and Crossett et al61 and it no doubt onic hind gut around day 2164 and it grows rapidly to
transports vital minerals and/or vitamins through surround the embryo and fuse with the outer cho-
the capsule to the underlying embryonic membranes rion to form the allantochorion that will eventually
and the primitive embryo itself.55 become the definitive placenta (Fig. 5). By day 25
Thus, a free-living, fully encapsulated equine em- the allantochorion constitutes about one-quarter of
bryo that rattles around the maternal uterus for 10 the total volume of the conceptus (Fig. 6a) and, over
days liberating significant quantities of estrogens the next 15–20 days, it continues to enlarge rapidly
and prostaglandins through the capsule in an out- to eventually replace the yolk sac completely by
ward direction to maintain progesterone-dominance about day 45.63 The vascularized mesoderm con-
of the uterus for its very existence, while at the same tinues to expand until, by day 33–35, it encompasses
time imbibing quantities of protein-rich uterine milk the whole conceptus apart from one small circle of
through its capsule in the opposite or inward direc- bilaminar omphalopleure which persists within the
tion to sustain the growth and development it must sinus terminals at the abembryonic pole (Fig. 6b).
undergo during this period (Fig. 3). Movement This concomitant enlargement of the allantois above
stops abruptly around day 17 with the sudden in- the embryo, and regression of the yolk sac beneath
crease in myometrial tone, the precise underlying it, gives the optical illusion that, between about day
cause of which has yet to be determined although it 23 and 40, the embryo migrates from one pole of the
is, quite reasonably, considered widely to be the conceptus to the other (Fig. 6a). In fact it is the
result of an interaction between the longer than pole that moves, not the embryo, and when serially
normal period of progesterone dominance from the scanning a mare over the same interval, the embryo
now-prolonged maternal corpus luteum and the in- appears to lift off the ventral floor of the uterus and
creasing quantity of estrogens secreted by the en- rise steadily towards roof, apparently bisected all
larging conceptus.41,43 the while by the echogenic line created by the abut-
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IN DEPTH: REPRODUCTION

Fig. 5. Diagrammatic representation of the development and


differentiation of the equine embryonic membranes between days
14 and 35 after ovulation.

Fig. 4. Diagrammatic representations of two possible arrange-


endometrium. Then, at around day 36, but with
ments of day 18 unilateral twin conceptuses in the uterine horn of some temporal variation between individual mares,
a mare. In the upper panel the non-vascularized highly absorp- the entire girdle peels off the fetal membranes and
tive bilaminar choriovitelline membrane of the anterior concep- the now binucleate girdle cells begin invading the
tus is abutted up against its posterior co-twin and is therefore maternal tissue (Figure 7b).67
prevented from imbibing uterine milk for its sustenance and In searching for an underlying mechanism to ex-
growth. In the lower panel the absorptive bilaminar membranes plain the rapid development of this discrete annu-
of both conceptuses have the potential to absorb the endometrial late band of highly invasive trophoblast cells
gland secretions. situated adjacent to the otherwise non-invasive tro-
phoblast of the allantochorion, Stewart et al ob-
served that the girdle is thickest and best developed
at its end next to the allantochorion but shows a def-
ment within the conceptus of the enlarging allantois inite thinning and general tapering off at the other
and the regressing yolk sac. end adjacent to the choriovitelline membrane.68
Furthermore, a series of small blood vessels ex-
The Endometrial Cup Reaction tend from the highly vascularized mesoderm associ-
A unique and puzzling feature of equine embryo- ated with the allantois into the space beneath the
genesis is the development of the so-called chorionic girdle to about halfway across the width of the lat-
girdle65 on the outer surface of the chorion between ter. In the light of her previous in situ, hybridiza-
days 25 and 35 after ovulation (Fig. 6b)66 and its tion studies of growth factor synthetic capabilities of
subsequent invasion of the maternal endometrium the component membranes of the horse conceptus
between days 36 and 38 to form the endometrial that allantoic mesenchyme is a major source of the
cups.67 The girdle is first seen around day 25 as a highly mitogenic and motogenic growth factor, he-
series of shallow undulations in the chorion which patocyte growth factor:scatter factor (HGF:SF) at
deepen markedly over the next 10 days to become this early stage of gestation,68 Stewart hypothesized
elongated finger-like villous ridges due to the very that HGF:SF secreted by the allantoic mesenchyme
rapid hyperplasia of the trophoblast cells at the tops acts as the principal mitogen to stimulate the rapid
of each fold (Fig. 7a). The resulting ridges become multiplication of both the trophoblast and the allan-
bent over and flattened due to the compressive ef- toic cells. Since these two membranes are fused
fects of uterine tone and conceptus expansion and together by the mesodermal tissue secreting the mi-
the clefts between adjacent ridges become gland-like togen, and since the trophoblast cells are firmly at-
in appearance and function.66 They begin to re- tached to an underlying basement membrane,
lease increasing quantities of an alcian blue-positive growth occurs as rapid and simple expansion of the
exocrine secretion which adheres the outer surface allantochorion. But in the region of the chorionic
of the girdle to the lumenal surface of the overlying girdle, which is not sited above allantoic mesoderm
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Fig. 6. Intact horse conceptuses at: a) 28 days and b) 35 days after ovulation. ac ⫽ allantochorion; bo ⫽ bilaminar omphalopleure;
cg ⫽ chorionic girdle; e ⫽ embryo; ys ⫽ yolk sac.

but is nonetheless still exposed to the mitogenic whereas its other half in the donkey produced a very
effects of the HGF:SF secreted by the extending wide, thick and productive chorionic girdle, typical
mesenchymal blood vessels, the multiplying tropho- of that which develops on a hinny conceptus sired by
blast cells can only pile up on each other, rather a horse (Fig. 8). Thus, uterine environment was
than expand in a linear manner. Thus, the discrete able to completely override any genetic effects which
and thickened chorionic girdle develops (Fig. 7a).68 may have been operating.70
This growth factor-driven development of the cho- Returning to the invasion of the endometrium by
rionic girdle could also explain the striking and in- the chorionic girdle at around day 36 –38 after ovu-
teracting effects of fetal genotype and uterine lation, the now binucleate trophoblast cells pass
environment on both the development of the girdle both between, and occasionally straight through, the
and its subsequent hormone secreting capacity in lumenal epithelial cells of the endometrium to reach
the form of the endometrial cups it turns into. the basement membrane below. They track down
Namely, the girdle that develops on the conceptus of the endometrial glands (Fig. 7b), dislodging the lin-
the donkey (Equus asinus ⫻ E. asinus, 2n ⫽ 62) and ing epithelial cells as they go, before breaking
the hybrid mule (E. asinus 么 ⫻ E. caballus 乆, 2n ⫽ through the basement membranes and streaming
63), both of which have a donkey as the sire, is very out into the endometrial stroma during day 38 – 40.
much narrower and less well developed at the time Then, as though triggered by a developmental time
of invasion of the maternal endometrium around switch, all the invading cells suddenly become sen-
day 36 than its counterpart which develops on the sile, round up, and enlarge greatly so as to become
conceptus of the horse (E. caballus ⫻ E. caballus, tightly packed together within the endometrial
2n ⫽ 64) and the reciprocal hybrid, the hinny (E. stroma. This gives rise to the protuberances, orig-
caballus 么 ⫻ E. asinus 乆, 2n ⫽ 63), both of which inally called endometrial cups by Schauder,71 that
have a horse as the sire.69 While this difference first become visible to the naked eye around day 40
might initially appear to be likely to be caused by as a series of pale, slightly raised plaques on the
maternal imprinting of genes associated with devel- endometrial surface, arranged in a horseshoe or
opment of the chorionic girdle portion of the pla- circle at the base of the gravid uterine horn
centa, the dominant role of uterine environment on and thereby mimicking the annulate chorionic gir-
the whole process was illustrated dramatically by dle of the conceptus from which they originated.72,73
using embryo transfer to place one half of a bisected They vary in size and shape, from small circular
mule morula in the uterus of a recipient mare and structures of only 1–2 mm in diameter to long, un-
the other half in the uterus of a recipient donkey.70 broken ribbons of tissue that may be 3–5 cm in width
The mule conceptus in the mare developed a typi- and up to 30 cm in length (Fig. 9a). This range in
cally narrow chorionic girdle which gave rise to dimensions stems from differences in the configura-
small endometrial cups with low hormone output tion of the endometrium at the time of invasion of
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Fig. 7. Low-power photomicrograph of: a) A day 35 horse chorionic girdle showing the folded back finger-like projections of rapidly
multiplying trophoblast cells (⫻100); and b) The endometrium of a mare overlain by the invading chorionic girdle on day 38 after
ovulation. The mass of girdle cells have eroded and ablated the lumenal epithelium and they can be seen traversing down the mouths
of the endometrial glands, lifting the glandular epithelium of its basement membrane as they proceed (⫻156).

the chorionic girdle, with the longer ribbons of cup the large binucleate epitheliod-type cells inter-
tissue forming in areas where the endometrium op- spersed with occasional blood vessels and the dilated
posing the chorionic girdle is flattened and non- fundic portions of the endometrial glands, the apical
undulating, while the smaller, isolated cups form on regions and outlets of which were obliterated during
the tops of folds or ridges in a more undulating the original invasion of the chorionic girdle around
region of the endometrium which later become flat- day 38.72,74 A collection of large lymph sinuses
tened out as the uterus expands with the growth of forms in the stroma beneath each cup and an in-
the conceptus. creasing number of maternal leucocytes, consisting
The cups reach their maximum size and produc- of CD4⫹ and CD8⫹ lymphocytes, plasma cells, mac-
tivity around day 60 –70 of gestation when they are rophages, and eosinophils accumulate in the stroma
elevated above the surface of the endometrium and at the periphery.74,75 Beyond day 70 the cups be-
appear saucer shaped and ulcer-like due to over- come increasingly pale and cheesy in appearance
growth at the edges and commencing cell degenera- due to commencing degeneration and death of the
tion in the central region (Fig. 9b). Histologically, large cup cells, especially in the central depression
each cup now consists of a densely packed mass of at the lumenal surface of the cup (Fig. 9c). Slough-
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IN DEPTH: REPRODUCTION
allantoic cavity and is still readily visible in the term
placenta some 200 days later.
Two aspects of this unusual, short-lived, and bio-
logically bizarre injection of specialized fetal tropho-
blast cells into the maternal endometrium are of
significance in terms of the maintenance of equine
pregnancy. Endocrinologically, the gonadotrophin
(eCG) which is secreted in large quantities by the
fetal cup cells is a high molecular weight glycopro-
tein78 which expresses both Follicle Stimulating
Hormone (FSH)-like and Luteinzing Hormone (LH)-
like biological activities in roughly equal propor-
tions.79 Concentrations of eCG in maternal serum
rise rapidly from day 38 – 40 to reach a variable peak
(20 –300 iu/ml) at around day 60 –70 and then de-
cline again steadily in parallel with the steady de-
generation and death of the endometrial cups.80,81
The hormone shows low binding affinity for gonado-
trophin receptors in horse gonadal tissues82 but its
LH-like component nonetheless ovulates, or
lutenizes without ovulation, the dominant follicle in
successive waves of follicles which are stimulated to
develop during the first half of pregnancy by contin-
uation of the 10 –12 day surge-like releases of pitu-
itary FSH that control follicular development during
the estrous cycle.83,84 Thus, secondary corpora
lutea begin to accumulate in the maternal ovaries
from the time of the very first appearance of eCG in
maternal blood at around day 38 after ovulation
with a consequential rise in maternal serum proges-
terone concentrations each time one of these acces-
sory luteal structures develops (Fig. 11).85– 87
Fig. 8. Comparison of the endometrial cups at day 60 of gesta- In addition to the rise in progesterone, the com-
tion produced by the chorionic girdles which developed on two mencement of eCG secretion by the newly developed
halves of the same mule (乆 horse ⫻ 么 donkey) morula bisected on endometrial cups stimulates a sharp and pro-
day 6 after ovulation. One demi embryo was transferred to the nounced rise in peripheral serum conjugated estro-
uterus of a horse recipient mare (a) and the other was transferred
gen concentrations in the pregnant mare.84,88
to the uterus of a recipient donkey (b). Note the small, narrow
and already necrosing cups in the horse uterus (a) compared to
These conjugated estrogens are ovarian in origin88
the much larger and still active cups in the donkey uterus (b). and the experiments of Daels et al87 have revealed
they are secreted by the primary and/or secondary
corpora lutea, rather than the Graffian follicles, in
direct response to the gonadotrophic action of eCG
ing of this necrotic surface tissue re-establishes out- (Fig. 11). Once risen in this manner, the serum
lets for the distended endometrial glands which then estrogen levels tend to plateau, or even decline again
disgorge their accumulated secretory material onto slightly, until around day 70 – 80 when they begin a
the surface of the cup. It mixes with the necrosing further and more prolonged rise that culminates in a
cup cells to form a thick, honey-colored coagulum, relatively enormous peak in conjugated estrogen
termed endometrial cup secretion, which is ex- concentrations in both the blood and the urine of the
ceedingly rich in eCG activity76 and adheres to the mare around day 200 –240 of gestation.89,90 This
surface of the overlying allantochorion (Fig. 9d). time the estrogens are placental in origin and they
Coincidentally, the lymphocytes accumulated at the include both the common phenolic estrogens, es-
periphery of the cup begin to actively invade the cup trone and estradiol-17␤, and the unusual and equine-
tissue and destroy the foreign fetal cup cells (Fig. specific ring B unsaturated estrogen, equilin and
10). Eventually, between days 100 and 120 of ges- equilenin,91 which are synthesized by placental aro-
tation in most mares, but with considerable individ- matization of the large quantities of dihydroandro-
ual variation, the whole necrotic cup and its sterone (DHA) and dihydroepiandosterone (DHEA),
admixed, inspisated pabulum of exocrine secretion and the rare 3␤-hydroxy-5,7-prenandien-20-one and
is sloughed off the surface of the endometrium 3␤-hydroxy-5,7 androstadien-17-one forms of these
where it will sometimes indent into the surface of C-19 precursors, secreted by the dramatically en-
the allantochorion to form a pendulous sac, termed larged gonads of the fetus.91–94 The gonads, both
an allantochorionic pouch72 which hangs into the the ovaries in the female fetus and the testes in the
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Fig. 9. Endometrial cups (ec) in mares at different stages of pregnancy. a) A long unbroken ribbon of cup tissue seen at hysterotomy
operation at day 45 after ovulation; b) Individual cups at day 60 of gestation; c) Aging cups exposed by retracting the allantochorion
(ac) at day 83; the cups are now saucer-shaped and ulcer-like in appearance; d) Degenerating cups at day 98 showing the yellow,
treacle-like endometrial cup secretion (ecs) adhered to the overlying allantochorion.

when they occupy almost half the total volume of the


abdomen of the fetus and are usually bigger than the
now-inactive ovaries of the mare.95 Their growth is
occasioned by a massive hypertrophy and hyperpla-
sia of the interstitial cells of both types of gonad96
and they decline again steadily during the last quar-
ter of pregnancy to more normal proportions and
morphological configurations by the time the foal is
born at around day 336 –340.77
Immunologically, the equine endometrial cup re-
action is a huge puzzle. The invasive chorionic gir-
dle trophoblast cells, but not the non-invasive
trophoblast of the adjacent allantochorion, express
high concentrations of paternally inherited Class I
Major Histocompatibility Complex (MHC) antigens
Fig. 10. Photomicrograph of the base of an endometrial cup at
on their cell surface before, and for a few days after,
day 87 of gestation. The accumulated maternal lymphocytes are they invade the maternal endometrium to form the
seen migrating into the cup tissue and destroying the large, endometrial cups.97,98 This blatant display of for-
binucleate fetal cup cells (⫻100). eign antigenic molecules stimulates a strong hu-
moral immune response in the mother such that all
mares, including primigravid maidens, carrying fe-
tuses which differ paternally at the Class I MHC
male fetus, begin to enlarge from around day 80 of barrier, develop high titres of specific anti-paternal
gestation to reach a maximum size around day 240, lymphocytotoxic antibody in their serum within
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Fig. 11. Endocrinological functions of the equine endometrial cups. The dominant member of waves of ovarian follicles stimulated
by continuing surge-like releases of pituitary FSH are ovulated and/or luteinized by the LH-like component of the equine Chorionic
Gonadotrophin (eCG) secreted by the fetal chorionic girdle cells after they invade the maternal endometrium around day 38 to form
the endometrial cups. The corpora lutea, both primary and secondary, secrete progesterone and conjugated estrogens in response to
the gonadotrophic stimulus of eCG.

10 –14 days after initial invasion of the endome- tigens that stimulate the equally strong cellular re-
trium by the chorionic girdle at around day sponse is far less clear. The cups live as long, and
36 –38.99,100 The antibody persists throughout secrete equivalent amounts of eCG, in mares carry-
pregnancy and it reappears anamnestically at ear- ing MHC-incompatible as MHC-compatible fe-
lier stages of gestation, and at even higher concen- tuses119 and the leucocytic response mounted
trations, in mares mated to the same MHC- against the cups is far more intense and destructive
incompatible stallion in successive years and in in mares carrying interspecific mule fetuses than it
mares transplanted with biopsies of skin from the is in mares carrying normal intraspecific horse fe-
stallion prior to mating.101 tuses.73,103 Thus, it appears that species-specific
In addition, a very strong maternal cell-mediated non-MHC antigens, and possibly also tissue-specific
reaction is mounted against the invading chorionic trophoblast antigens, are involved in the cell-medi-
girdle cells. Lymphocytes appear in the endome- ated response to the endometrial cups.104
trial stroma within hours after initial invasion by The biological raison d’être for the endometrial
the chorionic girdle cells and their numbers increase cup reaction in equine pregnancy remains a mys-
dramatically from around day 60 –70, when they are tery. Endocrinologically, the additional progester-
joined by other mononuclear immune cells such as one generated by the secondary corpora that are
plasma cells, macrophages and eosinophils.73,74 stimulated by the ovulatory and/or luteinizing prop-
Collectively these accumulated maternal immune erties of the relatively vast quantities of gonadotro-
cells form a definite barrier that separates fetal and phic hormone (eCG) secreted by the cups during
maternal tissues and is reminiscent of the interface their short lifespan, certainly supports the mainte-
between grafted and host tissues during rejection of nance of the pregnancy state until day 100 of gest-
an allograft of skin. Initially, the accumulating ation or thereabouts when, as shown by the
leucocytes seem content to merely wall off the for- ovariectomy studies of Holtan et al,105 the placenta
eign fetal cells, but beyond day 60 –70 of gestation is now sufficiently well developed to take over com-
when the cells in the central region of the cup start pletely the supply of enough progesterone to main-
to degenerate and die, the lymphocytes at the pe- tain the pregnancy state without any further
riphery begin to actively attack and destroy the fetal contribution from the maternal ovaries. But, as
cup cells and they thereby hasten the death and demonstrated firstly by the survival to term of
eventual desquamation of the whole cup around day around 30% of extraspecific donkey-in-horse preg-
100 –120.73 nancies, created by embryo transfer, in the complete
It is apparent that the paternally inherited Class absence of any detected endometrial cup formation
I MHC antigens expressed by the invading chorionic and eCG secretion,106 and resulting failure of devel-
girdle cells98,102 are the stimulus for the strong hu- opment of any secondary corpora lutea,103 and sec-
moral maternal immune response to the fetus in ondly by the marked reduction, or complete absence,
equine pregnancy, but the nature of the foreign an- of accessory ovulations in mares mated in late au-
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IN DEPTH: REPRODUCTION

Fig. 12. The “panic reaction” of the still unattached equine fetus around day 36 after ovulation to inject its specialized trophoblast
of the chorionic girdle into the maternal endometrium to increase the supply of steroid hormones and suppress the potential
immunological hostility of the endometrium.

tumn so that they are seasonally deficient in pitu- Perhaps its injection of specialized hormone se-
itary FSH release during the first 100 days of creting and foreign antigen presenting trophoblast
pregnancy,73 secondary luteal progesterone is by no cells into the maternal endometrium represents
means obligatory to the maintenance of early preg- something of developmental panic reaction on the
nancy in the mare provided the primary corpus lu- part of the fetus to re-announce antigenically and
teum does not undergo luteolysis for any untoward endocrinologically its presence to the maternal
reason such as endotoxin production.87 organism after such a prolonged period of non-
Immunologically, it seems a very risky stratagem attachment and immunological indifference to the
for an allotypic fetus, or worse still, a xenotypic fetus potentially hostile endometrium (Fig. 12). Certainly,
in the case of a mule,73 to deliberately immunize the a lack of normal interdigitation between the allan-
dam against its paternally-derived histocompatibil- tochorion and endometrium is the most striking ab-
ity antigens, merely for the sake of generating some normality of the unsuccessful donkey-in-horse
extra, temporary luteal progesterone which is not pregnancy model in which endometrial cups do not
absolutely necessary. Yet, curiously, it is in the one develop and the associated maternal anti-paternal
type of xenogeneic pregnancy, the extraspecific don- MHC humoral response is absent. This raises the
key-in-horse pregnancy created by embryo transfer, possibility that some hitherto unknown influence of
which does not have an endometrial cup reaction the whole endometrial cup reaction in equids is es-
due to inadequate development and failure of the sential to stimulate the close and stable microvillous
donkey chorionic girdle to invade the horse endome- interaction between fetal and maternal epithelial
trium around day 36 after ovulation,107 that the layers which underpins and characterizes the whole
majority (i.e., ⯝70%) of fetuses die and are aborted process of placentation in the pregnant mare.
around day 80 –100 of gestation in conjunction with
delayed and/or inadequate interdigitation of the al- Placentation
lantochorion with the endometrium and a general- Only as late as day 40 after ovulation, some 2 or 3
ized and intense maternal leucocytic response days after invasion of the endometrium by the cho-
throughout the endometrium in that is in contact rionic girdle cells to start the endometrial cup reac-
with the xenogeneic donkey trophoblast.106 And, in tion, does the non-invasive trophoblast of the now
these at-risk pregnancies, administration of either rapidly expanding and slowly elongating allantocho-
or both exogenous eCG and progesterone fails to rion begin to make a stable, microvillous attachment
reduce the high rate of pregnancy loss,106 whereas to the lumenal epithelial cells of the endometrium
active immunization against donkey peripheral (Fig. 13a). During the next 20 days, blunt, finger-
blood lymphocytes results in a marked increase like villi of allantochorion form a close fitting inter-
in fetal survival above that in untreated control digitation with thinner, frond-like villi that develop
animals.103 on the endometrium, much like fingers being in-
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Fig. 14. Twin horse conceptuses in the excised uterus of a mare


at an estimated 250 days of gestation. Note the much larger size
of the fetus with the bigger area of placenta that occupies the
body of the uterus, the non-gravid horn and the base of the gravid
horn. The smaller co-twin has been pushed up to the tip of the
gravid horn and is now beginning to suffer severe nutritional
deprivation due to an inadequate area of placenta to meet its
growth requirements.

alent placental vein on the fetal side to maximize the


exchange process.111 In addition, the endometrial
glands remain functional throughout gestation and
Fig. 13. Sections of the placental interface in pregnant they liberate their protein-rich exocrine secretions
mares. a) At day 43 showing close microvillous attachment of into well defined spaces between the microcotyle-
the trophoblast of the allantochorion to the lumenal epithelium of dons. Here, the trophoblast cells become pseudo-
the endometrium and blunt villi of allantochorion beginning to stratified and are specially adapted to take up and
indent into the surface of the allantochorion; b) At day 83 of
absorb the exocrine material to establish a second,
gestation showing thickened and branched villi of allantochorion
interdigitating with thinner, finger-like sulci of endometrium
histotrophic form of nutrition for the rapidly grow-
(⫻100). ing fetus.112
Thus, by mid-gestation, and after an abnormally
slow start, the diffuse non-invasive epitheliochorial
equine placenta is established over the entire avail-
serted into a tight-fitting glove.107 Beyond day 60 able area of endometrium and is providing both he-
the allantochorionic villi and accommodating endo- motrophic and histotrophic nutritional exchange for
metrial sulci begin to branch extensively while at the fetal foal. Both the total gross area of the pla-
the same time becoming longer and deeper (Fig. centa, and the microscopic area of fetomaternal con-
13b). This process of branching and lengthening of tact at the placental interface, continue to increase
each primary villous and its opposing endometrium throughout the remainder of pregnancy to meet the
eventually creates, by about day 120 of gestation,108 fetal growth needs, and any diminution of this vast
the primary hemotrophic exchange unit of the non- area of functional placenta, such as would occur in
invasive allantochorionic placenta known as the the case of twin conceptuses competing for the same
microcotyledon.109 The process maximizes the mi- limited area of endometrium (Fig. 14)113 or in older
croscopic area of contact between the fetal and ma- mares exhibiting age-related degenerative changes
ternal epithelial layers for hemotrophic exchange of (endometrosis) in the endometrium,107,114,115 will
nutrients and waste products and it is aided by the lead at best to a degree of runting and weakness in
close apposition to, and indentation into, the base of the newborn foal, and at worst embryonic death and
these epithelial layers by numerous blood capillar- resorbtion early in gestation, or abortion in late
ies, on both the fetal and maternal sides of the pregnancy.108 An extensive and fully functional
interface.110 Each microcotyledon is supplied with microcotyledonary placenta attached to a healthy
a sizeable artery on the maternal side and an equiv- and fully functional endometrium is an essential
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IN DEPTH: REPRODUCTION
pre-requisite of normal pregnancy in the mare and 10. Freeman DA, Woods GL, Vanderwall DK, et al. Embryo-
the production of a healthy, well developed foal at initiated oviductal transport in the mare. J Reprod Fert
1992;95:535–538.
term. 11. Weber JA, Freeman DA, Vanderwall DK, et al. Prosta-
The nature of the stimulus which both initiates glandin E2 hastens oviductal transport of equine embryos.
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