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Expected cell yields
From 15 mL of decidua basalis, the expected HLA-G+ EVT yields 0.1-0.3 × 106 cells from the first digestion and 0.1-0.6 × 106 cells from the second digestion (total 0.2-0.8 × 106 cells). From 30 mL of chorionic membrane, the expected HLA-G+ EVT yields are 0.4-1.0 × 106 cells from the first digestion and 0.4-1.5 × 106 cells from the second digestion (total 0.8-2.5 × 106 cells). The proportion of caspase 3/7- 7-AAD- live EVT in the isolates is expected to be 90-95%.
Primary HLA-G+ EVT culture
The flow cytometry analysis of lineage markers (HLA-G, HLA-C, EGFR) and cell death markers showed that this protocol provides viable primary EVT culture until day 4 (96 h after plating the sorted EVT) (Figure 1B-D). Representative light microscopy images of primary chorionic and d.basalis HLA-G+ EVT are shown after 24, 48, and 72 h of culture (Figure 2A-F).
Co-culture of primary HLA-G+ EVT with T cells
This protocol enhanced the viability of primary EVT 96 h after isolation from the placenta, an improvement compared to our previous report1,2,10. Therefore, it enables the analysis of EVT responses following co-culture with pre-stimulated lymphocytes, which mimics acute inflammation at the maternal-fetal interface. EVT express polymorphic HLA-C as well as immunosuppressive co-inhibitory molecules, such as PD-L1, PD-L2, PVR (also known as CD155), B7H3, and HLA-E as determined by extracellular flow cytometry staining (Figure 3A,B). EVT increased the expression of HLA-C, as well as PD-L1, PD-L2, and HLA-E, but did not increase the expression of PVR and B7H3 when co-cultured with activated lymphocytes for 72 h according to the protocol section 8 (Figure 4A,B). In addition, no increase in EVT death was observed as shown by 7AAD and caspase 3/7 staining (Figure 4C,D).

Figure 1. The gating strategy for EVT cell sorting and flow cytometry plots after culturing sorted EVT. (A) The representative gating strategy for sorting decidua basalis EVT and chorionic EVT. R1 is the live cell gate in the Forward-Side Scatter plot. R2 is the gate for exclusion of CD45+ leukocytes. R3 is the HLA-G+EGFR+EVT gate. R4 is the 7-AAD-caspase3/7- live EVT. Although R4 gate is not necessarily needed for sorting, it is shown here to demonstrate the viability of primary EVT. (B) Representative flow cytometry plots of sorted HLA-G+EGFR+EVT, following 96 h of in vitro culture. (C,D) Frequencies of caspase 3/7- 7-AAD- live EVT during the sort (day 0) and 96 h of culturing (day 4). Please click here to view a larger version of this figure.

Figure 2. The morphology of EVT during in vitro culture. Representative light microscopy images of Chorionic EVT after (A) 24 h, (B) 48 h, and (C) 72 h of culture and decidua basalis EVT after (D) 24 h, (E) 48 h, and (F) 72 h of culture. Scale bar = 50 µm. Please click here to view a larger version of this figure.

Figure 3. Immunological phenotypes of primary EVT. (A) The representative flow plots of HLAs and co-inhibitory molecules on primary EVT as determined by extracellular flow cytometry staining (day 0). (B) Paired line plots show raw MFI of IgG control and full stain of each marker from d. basalis EVT (blue) and chorionic EVT (green) on day 0. Please click here to view a larger version of this figure.

Figure 4. Immunological phenotypes of primary EVT with or without activated lymphocytes (day 4). (A) Representative flow plots of EVT following the 72-h culture (day 4) with or without activated third-party lymphocytes. (B) Paired line plots show MFI of EVT with or without activated third-party lymphocytes. Blue plots represent decidua basalis EVT, and green plots represent chorionic EVT. (C) Representative flow cytometry plots for caspase 3/7- 7-AAD- live EVT with or without activated third-party lymphocytes on day 4. (D) Paired line plots show frequencies of caspase 3/7- 7-AAD- live EVT with or without activated third-party lymphocytes. Blue plots represent decidua basalis EVT, and green plots represent chorionic EVT. Please click here to view a larger version of this figure.
Table 1. Key reagents for the tissue dissection and digestion. See also1,2,24. Please click here to download this Table.
Table 2. Key reagents for the EVT culture and co-culture with T cells. See also1,2,24. Please click here to download this Table.
Table 3. Key antibodies and reagents for sorting and flow cytometry analysis. Please click here to download this Table.