pregnancy, a human blastocyst must implant into the uterine endometrium to facilitate the formation of a functional placenta. Inadequate or inappropriate implantation and placentation is thought to lead to first trimester miscarriage, placental insufficiency and other obstetric complications. To form a functional placenta, specialized cells, the `BIX-01294 chemical information extravillous trophoblast’ engraft and remodel uterine spiral arteries, creating the placental blood supply at the end of the first trimester. The local endometrial environment is likely to play a key role in regulating trophoblast invasion. Prior to implantation and in preparation for pregnancy, stromal cells of the human uterine endometrium undergo `decidualization’. Decidualization describes the dramatic differentiation of endometrial stromal cells into decidual cells, which become rounded with altered secretory and ECM expression. Decidualization involves PubMed ID:http://www.ncbi.nlm.nih.gov/pubmed/22179956 the categorical reprogramming of endometrial stromal cells such that different genes are expressed at different stages of the differentiation process. In women, decidualization begins spontaneously in stromal cells adjacent to spiral arterioles during the mid-secretory phase of the menstrual cycle in response to progesterone and regardless of the presence of a functional blastocyst. If implantation occurs, decidualization intensifies and continues to form the decidua of pregnancy. The decidua is thought to regulate trophoblast invasion and placental formation by regulating expression of locally produced factors including cytokines, integrins and major histocompatibility complex factors. The critical importance of decidualization for the formation of a functional placenta in 
mice has been unequivocally demonstrated by genetically-modified mouse studies where decidualization defects lead to unregulated trophoblast invasion and/or pregnancy failure. However, unlike Decidual Factors Alter Trophoblast Proteins women, in mice decidualization is initiated by blastocyst implantation, thus the systems are not analogous. Regardless, recent evidence in women indicates that decidualization is also important in the formation of a functional placenta, with impaired decidualization associated with recurrent miscarriage, preeclampsia and placenta accreta. The mechanisms by which the decidua might regulate EVT function are not well understood. Many studies have examined the role of leukocytes, particularly uterine natural killer cells in EVT function, however the role of decidual cells themselves is understudied. In vitro, conditioned medium from isolated cells of 1st trimester decidual explants impairs invasion of HTR8SV/neo cells compared to culture media alone. Conditioned media collected from decidual stromal cells isolated from 1st trimester decidua demonstrates concentration dependent invasion of B6Tert cells . This invasive capability correlated with the MMP2 activity in these cells. However, in neither of these studies was the control media conditioned with control cells. Recently, Godbole reported enhanced invasion of the choriocarcinoma cell lines JEG-3 and ACH-3P following treatment with conditioned media from primary stromal cells decidualized in vitro compared to the pre-decidualized cells. Further, AC1M88 spheroids showed enhanced expansion when cultured on top of primary stromal cells decidualized in vitro compared to nondecidualized cells. These studies strongly indicate that decidualized stromal cells regulate EVT function, however they ar
