Implantation failure linked to altered uterine NK cells in PCOS-like mice

Abstract Uterine NK (uNK) cells are essential for reproductive function, yet little is known how they are affected in polycystic ovary syndrome (PCOS), despite the strong association between PCOS and reproductive complications. We demonstrate that implantation failure coincides with distinct phenotypic alterations of uNK cells in a PCOS-like mouse model. Hyperandrogenism caused an increased influx of conventional NK (cNK) cells into the uterus, which contributed to an augmented uNK cell population, while tissue-resident NK (trNK) cells remained unchanged. Notably, CD69+ trNK cells were reduced and seemingly compensated by an upregulated expression of CD69 on cNK cells in the uterus. The maturation of uNK cells was disrupted and plausibly linked to an inability of cNK cells to convert into trNK cells. The inhibited maturation was associated with a reduced expression of the inhibitory receptor NKG2A, demonstrating an impaired education of uNK cells. This disruption of uNK cells could contribute to endometrial dysfunction and may be an underlying factor to reproductive comorbidities such as implantation failure, miscarriage and pre-eclampsia in PCOS. Competing Interest Statement The authors have declared no competing interest.