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One of the greatest peripheral sources of kisspeptin in the human is the placenta. In the human placenta, KiSS-1 is located within the syncytiotrophoblast cells (Bilban et al., 2004; Horikoshi et al., 2003) and Gpr-54 is located in the syncitio-, villous and extravillious trophoblast cells (Fig. 15), suggesting possible paracrine actions (Bilban et al., 2004). KiSS-1 mRNA and protein are increased with pregnancy, and in the placenta appears to be highest in the first trimester (Bilban et al., 2004). However, in the maternal plasma KiSS-1 protein dramatically increases throughout pregnancy. In non-pregnant plasma kisspeptin is around 1.3 fmol/ml this increases to ~1230 fmol/ml in the first trimester and rises to ~9590 fmol/ml at term. Then after delivery returns to normal levels within 5 days suggesting the source of kisspeptin is the placenta (Horikoshi et al., 2003), this is in contrast to the decreasing levels within the placenta itself. Gpr-54 mRNA and protein is also found in the placenta and levels are shown to be highest in the first trimester with a steady decline until term (Bilban et al., 2004). This suggests a role in implantation and placentation. Similar results are also seen in the mouse with KiSS-1 and gpr-54 expression only found in the cytotrophoblasts. Again, gpr-54 is highest in the first trimester but KiSS-1 expression appears constant throughout the pregnancy, suggesting possible species differences (Janneau et al., 2002). KiSS-1 appears to be a conserved regulator of placentation as it can also be located in the trophoblast giant cells within the rat placenta, were again KiSS-1 and gpr-54 is highest early in placentation at embryonic day (E) 12.5 but has been completely lost by E18.5 (Terao et al., 2004).
The role of the kisspeptin system in the placenta is thought to be the regulation of trophoblast invasion. Trophoblast invasion is important to allow remodelling of the maternal arteries, to provide sufficient blood flow to the developing foetus. This requires a balance of inhibitory and stimulatory signals to the invading trophoblast cell population. Kisspeptin-10, the form found in the placenta (Bilban et al., 2004) has been shown to inhibit migration of primary trophoblast explants and primary cell cultures and this is related to a decrease in MMP expression (Bilban et al., 2004). Kisspeptin and gpr-54 may also be important in the pathophysiology of the placenta. In pre-eclampsia, were trophoblast invasion is shallow, KiSS-1 mRNA and protein are elevated and these increase with severity. This has been correlated with a decrease in the expression of MMP-9 and birth weight (Qiao et al., 2005). KiSS-1 expression is also significantly higher in the placenta during pre-term labour but circulating levels do not change (Torricelli et al., 2008). This suggests that during pregnancy, placental kisspeptin is the most important and that its primary role is to down regulate MMPs to inhibit trophoblast invasion during placentation.



