WO2019060702A1 - Systems and methods to detect stress leading to miscarriage risk - Google Patents

Abstract

Systems and methods (S/M) to detect stress leading to miscarriage risk are described. The S/M, including modified stem cells, assays and high throughput screens, can be used to identify compounds or other potential stressors that can negatively affect development potential leading to increased risk for miscarriage. They can also be used to identify implant prone versus miscarriage prone embryos for implantation in assisted reproductive technology (ART) procedures such as in vitro fertilization (IVF).

Description

SYSTEMS AND METHODS TO DETECT STRESS LEADING TO MISCARRIAGE RISK

CROSS-REFERENCE TO RELATED APPLICATIONS

[0001] This application claims priority to U.S. Provisional Application No. 62/561 ,761 , filed on September 22, 2017, which is incorporated herein by reference in its entirety as if fully set forth herein.

REFERENCE TO SEQUENCE LISTING

[0002] A computer readable text file, entitled "W063-0047PCT_ST25.txt" created on or about September 19, 2018, with a file size of 16 KB, contains the Sequence Listing for this application and is hereby incorporated by reference in its entirety.

FIELD OF DISCLOSURE

[0003] The present disclosure provides systems and methods (S/M) to detect miscarriage risk. The systems and methods, including modified stem cells, assays, and high throughput screens, can be used to identify compounds or other potential stressors that can negatively affect development potential leading to increased risk for miscarriage.

BACKGROUND OF DISCLOSURE

[0004] Many compounds are embryotoxic and exposure to them may interfere with stem cell and resulting embryo development and induce abnormal embryogenesis and malformations, if not pregnancy termination. As one example, pharmaceutical compounds administered to pregnant women can be embryotoxic. Further, compounds encountered within the environment, or cosmetics also can be harmful. Thus, there is a need to test compounds and other potential stressors for potentially negative effects on developing stem cells and embryos. Moreover, it would be useful to identify embryos as implant prone or miscarriage prone before implantation in assisted reproductive technology (ART) procedures such as in vitro fertilization (IVF).

DESCRIPTION

[0005] The current disclosure provides systems and methods to detect miscarriage risk in stem cells and/or embryos. Particular embodiments provide a high throughput screen (HTS) for chemicals that may cause or add to stress that cause miscarriage. The systems and methods can be used to screen compounds and other environmental conditions for stress effects on stem cells and/or embryos before the compounds or other environmental conditions are developed, commercialized or released into the workplace or atmosphere. [0006] Additional embodiments provide an assay of fluids produced by or modified by embryos generated for use in ART procedures such as IVF. The systems and methods can classify embryos as implant prone versus miscarriage prone, thus increasing the success of ART procedures. Maternal blood can also be collected after reimplantation to monitor hCG. See, for example, Table 1.

[0007] As background, stem ceils are unspecialized ceils that are able to renew themselves through cell division for long periods. Stem cells can be subdivided and classified on the basis of their potency. A totipotent stem cell is produced from fusion between an egg and a sperm. Stem cells produced by the 1^si few divisions of the fertilized egg cell are also totipotent stem ceils. These cells can grow into any type of cell that makes up the developing organism, extra-embryonic tissues (e.g., yolk sac and placenta) and embryo. P!uripotent stem cells are descendants of totipotent cells that can differentiate into any ceil type except for placental cells. Muitipotent stem cells are descendants of piuripotent stem cells that can produce only cells of a closely related family of cells (e.g. blood cells such as red blood ceils, white blood cells and platelets, or ail placental lineages). Progenitor (sometimes called unipotent) cells can produce only one cell type, but have the property of self-renewal which distinguishes them from non-stem ceils. The potency of stem cells thus specifies the differentiation potential (the potential to differentiate into different cell types) of the stem cell. Stem cells lose potency as they differentiate. Potency/sternness factors like Inhibitor of differentiation 2 (Id2) must be lost in both humans and mice to enable placental stem cell differentiation. Thus potency factors in general maintain sternness and potency and block differentiation. Maintenance of potency is a very active state. For example, both human and mouse embryonic stem cells have hundreds of parenchymal lineages and the genes that positively control commitment to these lineages have promoters that are open for transcription factors but maintained in the off state by active silencing by, for example, the oct4 potency factor.

[0008] As disclosed herein, an in vitro mouse placental stem cell assay will respond to stress by (1) runting/decreased growth rates in the stem cells (detected by, e.g., decreased Time final - time zero nuclear blue fluorescent staining), and (2) forced differentiation and resulting production of antiluteolytic hormone (despite culture conditions that normally maintain sternness and prevent differentiation).

[0009] With regard to antiluteolytic hormones, during early pregnancy, a "critical period" may be defined between days 15 and 17. During this period, the endometrium follows a default program to release luteolytic pulses of PGF2alpha, unless the conceptus sends appropriate antiluteolytic hormone signals to block PGF2alpha, production. Thus, maintenance of pregnancy is dependent on this successful blockage of endometrial PGF2alpha production. For reference, the conceptus denotes the embryo and its adnexa (appendages or adjunct parts) or associated membranes (i.e. the products of conception). The conceptus includes all structures that develop from the zygote, both embryonic and extraembryonic. Both mouse placental lactogen (PL)1 and human chorionic gonadotropin (hCG) are antiluteolytic.

[0010] Beyond the foregoing, biology during the critical period and maintenance of pregnancy is complex and multifactorial. Endocrine, cellular and molecular factors, both from maternal and conceptus origins act in concert to determine whether luteolysis or maintenance of pregnancy will prevail. Understanding the influences of such factors in the biology of the critical period has allowed researchers to produce a series of strategies aiming to favor maintenance of pregnancy in lieu of luteolysis. Strategies include hormonal and nutritional manipulations to decrease plasma concentrations of estradiol 17beta (E2) while increasing those of progesterone (P4), and inhibiting the PGF2alpha-synthesizing enzymatic machinery in the endometrium during the critical period. Experimental results indicate that use of such strategies has improved pregnancy rates following ART, such as artificial insemination and embryo transfer programs. As suggested by the abortifacient effects of progesterone inhibitors such as RU486, at the level of nutrient production at the implantation site, progesterone is a crucial factor.

[0011] The corpus luteum is a temporary endocrine structure in the ovary of female mammals that is involved in the production of relatively high levels of progesterone and moderate levels of estradiol and inhibin A. It secretes a moderate amount of estrogen to inhibit further release of gonadotropin-releasing hormone (GnRH) and thus secretion of luteinizing hormone (LH) and follicle-stimulating hormone (FSH). Progesterone is the necessary endocrine hormone that is secreted by corpus luteum that acts upon the endometrium, especially working on glandular epithelium through stromal progestamedins. The outcome of progesterone stimulation is the continuation of a secretory phase epithelium juxtaposed to the implanting embryo and providing necessary secreted nutrients. Without progesterone secretion, pregnancy does not continue and instead menstruation, and loss of the embryo by miscarriage, occurs. In humans the placenta begins to make its own progesterone in the first trimester and this becomes sufficient to sustain pregnancy by week 7.

[0012] The progesterone producing cells in the corpus luteum have receptors for hCG in humans and PL1 in mouse. That is, PL1 is the mouse functional analog of human hCG. There are three PL1 genes coding three PL1a/b/c with gene names Prl3d1/Prl3d2/Prl3d3 (encoding the proteins shown in SEQ ID NOs: 3, 4, 5). See Table 1. Both of these hormones induce progesterone production and sustain the corpus luteum in its progesterone synthesis. [0013] PL1 and hCG are called "maternal recognition of pregnancy" hormones. All placental mammals have these hormonal proteins and they have several characteristics in common, although not always structurally related: (1) they are made by the first lineage to differentiate from placental trophoblast stem cells (shorted to TSCs here); (2) they are made rapidly during early exponential growth phase of the embryo soon after fertilization; (3) they constitute a very large fraction of the secreted proteins of the first differentiated lineage as the embryo is very small and this lineage must make a very large amount of endocrine hormone to cross maternal blood volumes and act on maternal corpus luteum; and (4) they bind receptors on corpus luteum cells to sustain progesterone synthesis. hCG is a key component of early pregnancy tests, and clinically serial hCG measurements must show sufficient kinetic and magnitude increases in the 7 weeks before placental progesterone becomes sufficient in humans, or miscarriage occurs. That is, if insufficient rapid buildup of a maternal recognition of pregnancy hormone occurs, menstruation occurs and the embryo is lost. In humans, this miscarriage occurs for 20% of all fertilized embryos after hCG is initially detected (before ultrasound detection), and another 15%, when both ultrasound and hCG co-identify pregnancy. Significant published data suggest that another 25-35% of embryos are lost before hCG is detected.

[0014] Many environmental and maternal stressors can slow growth of the early embryo and its placental stem cells: benzopyrene, dioxin, maternal infection producing TNFa, hypoxia due to urban pollution (decreased hemoglobin function) etc. Maternal malnutrition and adrenaline or Cortisol stress hormones also slow embryo growth at the time when placental and embryonic stem cells arise and proliferate exponentially.

[0015] The systems and methods are based in part on that stressed stem cells (1) slow their growth and (2) differentiate under physiological conditions that would normally maintain their toti- or pluri-potency. That is, they are forced to differentiate under circumstances that should maintain potency and therefore deplete stem cell reserves. Forced differentiation of stem cells depletes the number of stem cells available to differentiate later in the development process, reducing the number of stem cells available to form organ systems that arise later during development. Under moderate stress exposures, stem cells grow more slowly and this results in smaller than normal stem cell populations. Since first lineage differentiation must produce a minimal amount of antiluteolytic hormone, proportionally more stem cells must differentiate to compensate for the stress-diminished stem population size and this is called "compensatory differentiation." Compensatory differentiation negatively affects development potential.

[0016] In particular embodiments, compensatory differentiation to produce antiluteolytic hormone early can be detected by stress dose-dependent increase in PL1-GFP fluorescence at Time final. However, the most at-risk stem cells and embryos leading to miscarriage are those where compensatory differentiation becomes "irreversible". A polynomial analysis of the kinetics of stress-forced PL1 production and hCG kinetics from miscarried pregnancies of women show a remarkable "shape" of the response: initial acceleration, then deceleration and plateau of hormone synthesis prior to embryo loss. In contrast successful pregnancies in women undergo a prolonged hCG acceleration period. For both models this occurs 4-6 days after first detectable antiluteolytic hormone. By day 6 of first detectable hormone in a successful pregnancy, there is almost an order of magnitude more hCG than in the failed pregnancy.

[0017] Confirming the foregoing in mice, many stresses slow the growth of mouse placental TSCs. Significantly runted stem cell growth, forced differentiation of fewer cells, and then irreversible differentiation initially increases antiluteolytic hormone followed by a failure to increase hormone. Irreversible loss of all placental stem cells by four days of stress signifies that there are no stem cells left for placental growth during the remainder of pregnancy. Thus PL1 will not continue to increase, PL1 production will plateau, and embryos miscarry due to insufficient PL1 and/or insufficient stem cell reserve. Based on the foregoing, stem cell stress and pregnancies at-risk for miscarriage can be identified.

[0018] In particular embodiments, the systems and methods, including modified stem cells, assays and HTS, can be used to identify compounds or other potential stressors that can negatively affect development potential. "Developmental potential" refers to the capacity of a stem cell (e.g., pluripotent cell) to divide and differentiate and/or the capacity of an embryo to grow according to expected developmental milestones when compared to an average non-stressed stem cell and/or healthy embryo. The systems and methods can also provide early indicators of miscarriage or an at-risk pregnancy.

[0019] The occurrence of a stress can be detected by measuring the expression or activity of PL1 or hCG (or other mammalian homologs thereof). As is understood by one of ordinary skill in the art, "up-regulation" and "down-regulation" of gene or protein expression, and protein activity can be measured against a relevant control condition including relative to the expression or activity of an unstressed stem cell or relative to differentiation mediated by removal of growth factors that maintain sternness in culture (e.g., normal differentiation control). In particular embodiments, up- regulation or down-regulation will be a statistically-significant difference (e.g., p<0.05) from a relevant control condition.

[0020] Embodiments of the disclosure can have one or more of the following attributes: (1 ) use of an antiluteolytic hormone (e.g., PL1 , hCG or a mammalian homolog thereof) as a marker for toxicity responses, in particular embodiments, to predict miscarriage; (2) use of kinetics of changes in antiluteolytic hormone in addition to or in place of magnitude of changes of antiluteolytic hormone as a marker for toxicity responses, in particular embodiments, to predict miscarriage (e.g., deceleration and plateau of an antiluteolytic hormone within 4-6 days of its 1st detection); (3) use of viable potency and differentiation promoters in a HTS; and (4) use of placental TSCs, which are the majority of cells in a mammalian embryo when it implants in the uterus.

[0021] Particular examples of stem cells include embryonic stem cells; cord blood stem cells; umbilical cord matrix stem cells; tissue-specific stem cells; and placental TSCs. Progenitor cells are also stem cells.

[0022] Embryonic stem cells (ESCs) are stem cells derived from the inner cell mass (iC ) of an early stage embryo known as a blastocyst. Human embryos reach the blastocyst stage 4-5 days post fertilization, at 50-150 cells. ESCs include those derived from an embryo of up to 7 days after fertilization. ESCs are pluripotent and have the capability of proliferating indefinitely in culture, under conditions that allow their proliferation without differentiation.

[0023] Systems and methods for isolating ESCs are described in, e.g., US Pat. Nos. 6,090,622; 5,843,780; 5,340,740; and 5,656,479; PCT WO00/27995; PCT WO99/27076; Matsui, Cell, 70:841 , 1992; Thomson, Science, 282: 114, 1998; Shamblott, Proc. Natl. Acad. Sci. USA, 95: 13726, 1998; Reubinoff, Nat. Biotech., 18:399, 2000; Pain, Development, 122:2339, 1996; Wheeler, Reprod. Fertil. Dev., 6:563, 1994; and Shim, Biol. Reprod., 57: 1089, 1997. Primate ESCs may be obtained by, e.g., the methods in US Pat. Nos. 5,843,780 and 6,200,806. Primate and human stem cells may also be obtained from commercial sources such as WiCell, Madison, Wl.

[0024] Systems and methods for isolating cord blood stem cells or umbilical cord matrix stem cells are described in, e.g., Brunstein, Br. J. Haematol., 137(l):20, 2007; Sun, Biochem. Biophys. Res. Commun., 354(4):919, 2007; Riodan, Transl. Med., 30:5, 2007; and Weiss, Stem Cell Rev., 2(2): 155, 2006.

[0025] Mouse placental TSCs, like mouse ESCs, are derived from a blastocyst arising at E3.5 (3.5 days after fertilization). The growth factor fibroblast growth factor (FGF)4 is synthesized by the ICM (Rappolee, Development, 120:2259, 1994) and this is necessary to maintain the adjacent polar trophectoderm, source of TSCs, in a stem cell state (Chai, Dev. Biol., 198: 105, 1998 (Chai, 1998)). The isolation of mouse TSCs was 1st reported in 1998 (Tanaka, Science, 282:2072, 1998 (Tanaka, 1998)) and used FGF4, the FGF4 cofactor heparin, and conditioned medium from mouse embryonic fibroblasts (MEF-CM) to supply additional necessary cofactors. It has been shown that TGFB family members activin and TGFB1 can replace MEF-CM. Erlebacher, Dev. Biol., 275:158, 2004). In culture, removal of FGF4 enables differentiation of TSC to produce several different lineages that are defined by expression of Handl , Stra13, PL1 , Proliferin, Gcm1 , SyncytinA, Ctsq, PL2, Tfeb, Tpbpa, Mash2. During FGF4 removal TSCs lose the potency factors TEAD4, Cdx2, Id2, and ErrB (reviewed in Puscheck, Adv Exp Med Biol, 843:77, 2015 and Rappolee et al, Syst Biol Reprod Med, 56(2);168, 2010).

[0026] Stem cells used within the scope of the present disclosure can be cultured according to any appropriate method known in the art. An appropriate medium for stem cell culture includes 80% Dulbecco's modified Eagle's medium (DMEM; no pyruvate, high glucose formulation, Gibco BRL), with 20% fetal bovine serum (FBS; Hydone), 0.1 μΜ β-mercaptoethanol (Sigma), and 1 % non-essential amino acid stock (Gibco BRL). DMEM Knockout can also be used. The culture can further be supplemented with Knock-out serum replacement (KSP). Cultures can also include one or more carbon sources. In particular embodiments, the cultures include L-analyl-L-glutamine. The cultures can include serum or can be serum-free. In particular embodiments, stem cells can be cultured with an ALK5 inhibitor and one of a MEK or Erk inhibitor, optionally with a GSK3 inhibitor and/or LIF. Mek and GSK3 inhibitors in one media are called 2i (two inhibitor media) and have been shown to aid in maintaining the ground state of ESCs. Marks, Cell, 149:590, 2012. In particular embodiments, the culture media include basal media components for cell survival (e.g., vitamins and minerals, optionally in an isotonic condition).

[0027] In particular embodiments, stem cells can be cultured in contact with feeder cells. Exemplary feeder cells include fibroblast cells, e.g., mouse embryonic fibroblast (MEF) cells, or x-ray inactivated CF1 feeder cells. Methods of culturing stem cells on feeder cells are known in the art.

[0028] In particular embodiments, stem cells are cultured in the absence of feeder cells. Stem cells, e.g., can be attached directly to a solid culture surface (e.g., a culture plate), e.g., via a molecular tether. Exemplary molecular tethers include Matrigel, an extracellular matrix (ECM), ECM analogs, laminin, fibronectin, or collagen.

[0029] Particular embodiments include use of transgenic mouse TSCs that report miscarriage risk.

[0030] The disclosure includes modified stem cells with reporter transgene systems that are used to identify compounds or other potential environmental stem cell stressors that cause forced, compensatory or prioritized differentiation and reduced development potential. Particular embodiments utilize a mouse PL1 promoter - reporter construct as a sensitive marker of toxicity responses in stem cells. Mouse PL1 promoters are known in the art; see, for instance, Shida et al., Mol. Endocrinol 7(2): 181-188, 1993; Peters et al., J Endocrinol. 165:443-56, 2000. [0031] In particular embodiments, reporter genes include a nucleic acid sequence encoding a reporter. The reporter transgene is inserted via homologous recombination into the stem cell genome so that the reporter gene is in operable combination with the antiluteolytic hormone gene of interest. "In operable combination" refers to the linkage of nucleic acid sequences in a manner such that one or more proteins can be produced. A promoter is a regulatory element that facilitates the initiation of transcription of a coding region of a nucleic acid sequence in operable combination (used interchangeably with operably linked) with it. A promoter is typically, though not necessarily, located 5' (i.e., upstream) of a nucleotide sequence of interest whose transcription into mRNA it controls, and provides a site for specific binding by RNA polymerase and other transcription factors for initiation of transcription. With this approach, when a factor or marker gene can be expressed, it is expressed as a reporter.

[0032] A "gene" refers to a nucleotide sequence that encodes a protein (e.g., a reporter protein or other proteins described herein). This definition includes various sequence polymorphisms, mutations, and/or sequence variants. In particular embodiments, the sequence polymorphisms, mutations, and/or sequence variants do not affect the function of the encoded protein. The term "gene", depending on the context, refer only to coding sequences or to coding sequences in combination with regulatory regions such as promoters, enhancers, and termination regions. The term further can include all introns and other DNA sequences spliced from the mRNA transcript, along with variants resulting from alternative splice sites. Nucleic acid sequences encoding proteins can be DNA or RNA that directs the expression of the protein or RNA. These nucleic acid sequences may be a DNA sequence that is transcribed into RNA or an RNA sequence that is translated into protein. The nucleic acid sequences include both the full-length nucleic acid sequences as well as non-full-length sequences derived from the full-length protein or RNA. The sequences can also include degenerate codons of the native sequence or sequences that may be introduced to provide codon preference. In addition to particular sequences provided, gene sequences to encode reporter proteins and other proteins are available in publicly available databases and publications.

[0033] When reporters are used in cell-based assays disclosed herein, the reporters should be developmental^ neutral, but report the daily stress-forced differentiation kinetics of the same cells. Green fluorescence protein (GFP) is one example. Fluorescent reporters are known and can be obtained commercially at, e.g., Promega Corporation, Invitrogen, Clontech, Stratagene, BD Biosciences Pharmingen, or Evrogen JSC. Additional examples of fluorescent proteins can be found at, e.g., US Patent No. 6,884,620 and 6,645,761. The disclosure is not limited by the fluorescent protein-encoding gene, and any fluorescent encoding gene can be used. [0034] In particular embodiments, the gene encoding the fluorescent protein can be optimized for mammalian expression by codon optimization for mammalian translational machinery. In particular embodiments, the disclosure provides systems and methods for transfecting stem cells with reporter genes encoding enzymatic proteins, wherein the expression of the enzymatic proteins provides a viable expression assay without sacrificing the stem cells. For example, the expression of reporter enzymatic proteins provide light output upon substrate utilization. Examples of such enzymatic proteins that produce light as a byproduct of substrate utilization include, luciferase and β-lactamase. Luciferase encoding reporter genes (e.g. Photinus sp. (GenBank Accession No. AY738222), Renilla sp. (GenBank Accession No. AF025844), Pyrophorus sp. (GenBank Accession No. AY258591 and AY258593), etc.) are commercially available from Promega Corporation, Stratagene and Clontech, e.g., and β-lactamase encoding reporter genes are available from Invitrogen, for example.

[0035] In particular embodiments, modified stem cells may be transfected with a vector including a wild-type promoter or a synthetic promoter made up of repeated response elements to a given single transcription factor (as done with Rex1 and Oct4 in Li et al., Stem Cells and Development 25(4):320 2016). Rapid development and validation of a Rex1 promoter-RFP (red fluorescent reporter) viable potency activity reporter quantifies stress-induced ESC potency loss and supports the theory of compensatory differentiation. In these embodiments, the vector will integrate into the stem cell genome and on-going cellular events will interact with the inserted promoter. When conditions occur that would cause transcription of the genes associated with the wild-type promoter, expression of the inserted reporter will also occur.

[0036] The ability of certain viruses to infect stem cells or enter stem cells via receptor-mediated endocytosis, and to integrate into the stem cell genome and express genes stably and efficiently have made them attractive candidates for the transfer of foreign nucleic acids into stem cells. Non-limiting examples of viral vectors that can be used include adenoviral vectors and retroviral vectors. Adenoviral vectors include those constructs containing adenovirus sequences sufficient to (a) support packaging of a construct and (b) express a cell-specific construct that has been cloned therein. Retroviral vectors integrate their genes into stem cell genomes and are capable of transferring a large amount of foreign genetic material, infecting a broad spectrum of species and cell types (Miller, Am. J. Clin. Oncol., 15(3):216, 1992). Lentiviruses are complex retroviruses, which, in addition to the common retroviral genes gag, pol, and env, contain other genes with regulatory or structural function. See, e.g., Naldini, Science, 272(5259):263, 1996; Zufferey, Nat. Biotechnol., 15(9):871 , 1997; US Pat. Nos. 6,013,516 and 5,994, 136). Some examples of lentivirus include the Human Immunodeficiency Viruses: HIV-1ad nHIV-. Lentiviral vectors have been generated by multiply attenuating the HIV virulence genes, e.g., the genes env, vif, vpr, vpu and nef are deleted making the vector biologically safe. Recombinant lentiviral vectors are capable of infecting stem cells and can be used for ex vivo gene transfer and expression of nucleic acid sequences. For example, recombinant lentivirus capable of infecting cells wherein a suitable host cell is transfected with≥2 vectors carrying the packaging functions, namely gag, pol and env, as well as rev and tat is described in US Pat. No. 5,994, 136.

[0037] Promoters used in embodiments described herein may be "endogenous" (e.g., wild-type), "exogenous" or "heterologous." An "endogenous" promoter is one that is naturally operably linked with a given gene in the genome. An "exogenous" promoter is one that is not native to the wild- type genome. A "heterologous" promoter is a type of exogenous promoter that shares at least 90% sequence identity with an endogenous promoter.

[0038] In particular embodiments, reporter gene constructs include a selectable marker. The disclosure is not limited to the use of any particular selectable marker. An exemplary selectable marker includes dominant selectable markers such as the bacterial aminoglycoside 3' phosphotransferase gene (also referred to as the neo gene) that confers resistance to the drug G418 in mammalian cells. Other selectable markers are used in stem cell lines that lack the relevant enzyme activity. Examples of non-dominant selectable markers include the thymidine kinase (tk) gene that is used in conjunction with tk-deficient cell lines and the mammalian hypoxanthine-guanine phosphoribosyl transferase (hprt) gene, which is used in conjunction with hprt-deficient cell lines. A review of the use of selectable markers in mammalian cell lines is provided in Sambrook, J. Molecular Cloning: A Laboratory Manual, 2nd ed., Cold Spring Harbor Laboratory Press, New York (1989) pp. 16.9-16.15.

[0039] Gene constructs including vectors and reporter genes described herein can be inserted or "knocked-in" at a desired locus in a stem cell. Methods for generating gene constructs for use in generating knock-in cell lines and techniques for generating such cell lines are described in, e.g., Sambrook 1989, Molecular Cloning, A Laboratory Manual, 3rd ed., Cold Spring Harbor Laboratory; Yoo, Neuron, 37:383, 2003; and Lin, Human Molecular Genetics, 10: 137, 2001. Exemplary knock-in methods include ex vivo transfection (see, e.g., Wilson, Science, 244: 1344, 1989; and Nabel & Baltimore, Nature, 326:711 , 1987), optionally with Fugene6 (Roche) or Lipofectamine (Invitrogen); injection (see, e.g., US Pat. Nos. 5,994,624; 5,981 ,274; 5,945, 100; 5,780,448; 5,736,524; 5,702,932; 5,656,610; 5,589,466; and 5,580,859); microinjection (see, e.g., Harland and Weintraub, J. Cell. Biol., 101 : 1094, 1985; US Pat. No. 5,789,215); electroporation (e.g., US Pat. No. 5,384,253; Tur-Kaspa, Mol. Cell. Biol., 6:716, 1986; Potter, Proc. Nat'l. Acad. Sci. USA, 81 :716, 1984); calcium phosphate precipitation (Graham & Van Der Eb, Virology, 52:456, 1973; Rippe, Mol. Cell. Biol., 10:689, 1990); DEAE-dextran followed by polyethylene glycol (Gopal, Mol. Cell. Biol., 5: 1188, 1985); direct sonic loading (Fechheimer, Proc. Nat'l Acad. Sci. USA, 84:8463, 1987); liposome mediated transfection (Nicolau & Sene, Biochim. Biophys. Acta, 721 : 185, 1982; Fraley, Proc. Nat'l. Acad. Sci. USA, 76:3348, 1979; Nicolau Methods Enzymol., 149: 157, 1987; Kaneda, Science, 243:375, 1989) and receptor-mediated transfection (Wu & Wu, Biochemistry, 27:887, 1988; Wu & Wu, J. Biol. Chem., 262:4429, 1987) and any combination of such methods.

[0040] As indicated, in particular embodiments, stem cells are assessed by measuring gene expression. In such embodiments, the stem cell parameter is a gene expression level or profile. Determining the expression of one or more genes (e.g., obtaining an expression profile) may be made by measuring nucleic acid transcripts, e.g. mRNAs, of genes of interest, e.g. a nucleic acid expression profile; or by measuring levels of one or more different proteins/polypeptides that are expression products of one or more genes of interest, (e.g. a proteomic expression profile). Thus, the terms "expression profile" and "expression evaluation" can be used broadly to include a gene expression profile at the nucleic acid level or a gene expression profile at the protein level.

[0041] In particular embodiments, expression of genes may be evaluated by obtaining a nucleic acid expression profile, where the amount or level of one or more nucleic acids in a sample is determined. The nucleic acid sample includes a plurality or population of distinct nucleic acids that includes the expression information of the genes of interest of the stem ceil being assessed. The nucleic acid may include RNA or DNA nucleic acids, e.g., mRNA, cRNA, cDNA etc., so long as the sample retains the expression information of the stem cell from which it is obtained. The sample may be prepared in a number of different ways, e.g., by mRNA isolation from a cell, where the isolated mRNA is used as is, amplified, employed to prepare cDNA, cRNA, etc., as performed in the differential expression art. The sample may be prepared from a single cell, e.g. a stem cell or a population of stem cells of interest.

[0042] The expression profile may be generated from the initial nucleic acid sample using many appropriate protocols. One representative protocol is array-based gene expression profile generation protocols. Such protocols can be hybridization assays in which a nucleic acid that displays "probe" characteristics for each of the genes to be assayed/profiled in the profile to be generated is employed.

[0043] Specific hybridization technologies which may be used to generate expression profiles are described in, e.g., US Pat. Nos. 5,143,854; 5,288,644; 5,324,633; 5,432,049; 5,470,710; 5,492,806; 5,503,980; 5,510,270; 5,525,464; 5,547,839; 5,580,732; 5,661 ,028; and 5,800,992; as well as WO 95/21265; WO 96/31622; WO 97/10365; WO 97/27317; EP 373 203; and EP 785 280. In these systems and methods, an array of "probe" nucleic acids that inciudes a probe for each of the phenotype determinative genes whose expression is being assayed is contacted with target nucleic acids. Contact is carried out under hybridization conditions, e.g. , stringent hybridization conditions, and unbound nucleic acid is then removed.

[0044] in particular embodiments, stringent hybridization conditions include e.g., 2 hr to 4 days incubation at 42X using a DIG-iabeied DNA probe (prepared by, e.g., using a DIG labeling system; Roche Diagnostics GmbH, 68298 Mannheim, Germany) in a solution such as DigEasyHyb solution (Roche Diagnostics GmbH) or a solution including 50% formamide, 5XSSC (150 mM NaCI, 15 mM trisodium citrate), 0.02% sodium dodecyl sulfate, 0.1 % N-lauroylsarcosine, and 2% blocking reagent (Roche Diagnostics GmbH), followed by washing the filters twice for 5 to 15 minutes in 2XSSC and 0.1 % SDS at room temperature and then washing twice for 15-30 minutes in 0.5XSSC and 0, 1 % SDS or 0.1XSSC and 0, 1 % SDS at 65-68°C.

[0045] Probes can also be designed to have a % sequence identity that is complementary to wild- type gene sequences that lead to conditions that are compatible to produce binding pairs of nucleic acids, e.g., surface bound and solution phase nucleic acids, of sufficient complementarity to provide for the desired level of specificity in the assay while being less compatible to the formation of binding pairs between binding members of insufficient complementarity to provide for the desired specificity. In particular embodiments, the probes will have 90% to 100% sequence identity in 1 % stepwise increments (e.g., 90%, 91 %, 92% up to 100%) that identity a sequence that is complementary to the wild-type sequence being assessed.

[0046] "% sequence identity" refers to a relationship between two or more sequences, as determined by comparing the sequences. In the art, "identity" also means the degree of sequence relatedness between sequences as determined by the match between strings of such sequences. "Identity" (often referred to as "similarity") can be readily calculated by appropriate methods, including those described in: Computational Molecular Biology (Lesk, ed.) Oxford University Press, NY 1988; Biocomputing: Informatics and Genome Projects (Smith, ed.) Academic Press, NY 1994; Computer Analysis of Sequence Data, Part I (Griffin and Griffin, eds.) Humana Press, NJ 1994; Sequence Analysis in Molecular Biology (Von Heijne, ed. Academic Press 1987); and Sequence Analysis Primer (Gribskov & Devereux, eds. Oxford University Press, NY 1992. Preferred methods to determine sequence identity are designed to give the best binding between the sequences tested. Methods to determine sequence identity and similarity are codified in publicly available computer programs. Sequence alignments and percent identity calculations may be performed using the Megalign program of the LASERGENE bioinformatics computing suite (DNASTAR, Inc., Madison, Wisconsin). Multiple alignment of the sequences can also be performed using the Clustal method of alignment (Higgins and Sharp CABIOS, 5, 151-153 (1989) with default parameters (GAP PENALTY=10, GAP LENGTH PENALTY=10). Relevant programs also include the GCG suite of programs (Wisconsin Package Version 9.0, Genetics Computer Group (GCG), Madison, Wsconsin); BLASTP, BLASTN, BLASTX (Altschul, J. Mol. Biol., 215:403 199); DNASTAR (DNASTAR, Inc., Madison, Wsconsin); and the FASTA program incorporating the Smith-Waterman algorithm (Pearson, Comput. Methods Genome Res., [Proc. Int. Symp.] 1994, Meeting Date 1992, 1 11. Editor(s): Suhai, Sandor. Publisher: Plenum, New York, N.Y.. Wthin the context of this disclosure it will be understood that where sequence analysis software is used for analysis, the results of the analysis are based on the "default values" of the program referenced. As used herein "default values" will mean any set of values or parameters which originally load with the software when ^st initialized.

[0047] Alternatively, non-array based systems and methods for quantitating the level of one or more nucleic acids in a sample may be employed, including those based on amplification protocols, e.g., Polymerase Chain Reaction (PCR)-based assays, including quantitative PGR, reverse-transcription PCR (RT-PCR), real-time PGR, etc.

[0048] In particular embodiments, expression of genes may be evaluated by obtaining a proteomic expression profile, where the amount or level of one or more proteins/polypeptides in the sample is determined. Where the expression profile is proteomic expression profile, i.e. a profile of one or more protein levels in a sample, any convenient protocol for evaluating protein levels may be employed wherein the level of one or more proteins in the assayed sample is determined. While a variety of different manners of assaying for protein levels can be used, one representative protocol is enzyme-linked immunosorbent assays (EL!SA). Alternatively, non- ELISA based-systems and methods for measuring proteins levels in a sample, such as mass spectrometry, proteomic arrays, xMAP™ microsphere technology, flow cytometry, western blotting, and immunohistochemistry can be used.

[0049] An important co-marker of induced PL1-GFP is decreased TSC growth rate and this can be determined by nuclear staining at the beginning of the stress stimulus and at the end of the stress exposure within, e.g., 30 minutes after PL1-GFP levels are quantified. Additional assays can be found, for instance, in Yang et al., Biol Reprod. 95(5): 110, 1-10, 2016.

[0050] Particular embodiments use kinetics of changes as well as the magnitude of increases in differentiation. Kinetics may additionally indicate a sub-lethal low toxicity measure of detrimental development effects. Thus kinetics of changes may be a co-assayed parameter with magnitude of changes. Of benefit in using viable fluorescent reporters is that kinetics can be assayed quite easily, for example, assaying well plates in a microplate reader daily. [0051] In particular embodiments, because submorbid, runting doses that cause differentiation are used, it is important, and technically feasible to add a nuclear stain to the color plate reader excitation and band pass acquisition and assay the level of diminished stem cell population expansion. At any stress dose, taken together or individually (i) decreased potency, (ii) increased 1^si lineage, and (iii) diminished cell population expansion should give an accurate analysis of stress impacts on embryonic and fetal development in response to toxicoiogicai stress and is completely unique amongst stem cell assays for toxicology,

[0052] As indicated, systems and methods disclosed herein can also be used to evaluate embryos for use in ART. ART is the technology used to achieve pregnancy in procedures such as fertility medication, artificial insemination, in vitro fertilization and surrogacy. It is reproductive technology used primarily for infertility treatments, and is also known as fertility treatment. It mainly belongs to the field of reproductive endocrinology and infertility, and may also include intracytoplasmic sperm injection (ICSI) and cryopreservation of gametes or embryos. Some forms of ART are also used with regard to fertile couples for genetic reasons (preimplantation genetic diagnosis). ART is also used for couples who are discordant for certain communicable diseases; for example, AIDS to reduce the risk of infection when a pregnancy is desired. ART encompasses a plethora of techniques in fertility preservations (ovarian slice cryopreservation, suppressing oocyte maturation etc.), surrogacy, facilitating sperm number and function in male fertility, and many more.

[0053] IVF is a process by which an egg is fertilized by sperm outside the body: in vitro ("in glass"). The process involves monitoring and stimulating a woman's ovulatory process, removing an ovum or ova (egg or eggs) from the woman's ovaries and letting sperm fertilize them in a liquid in a laboratory. The fertilized egg (zygote) is cultured for 2-6 days in a growth medium and is then implanted in the same or another woman's uterus, with the intention of establishing a successful pregnancy. Diagnostic tests in IVF include preimplantation genetic diagnosis (Using FISH or qPCR), amniocentesis, chorionic villous sampling, maternal blood cell free DNA, and cellular TRIC, among others.

[0054] As disclosed herein, embryos can be classified as implant-prone or miscarriage-prone and implant-prone embryos can be selected for use in ART procedures. This will enhance the success of such procedures. Implant prone means that the embryo is more likely to implant and develop through to a full term pregnancy than not. Miscarriage prone means that the embryo is less likely to implant and develop to a full term pregnancy. Comparisons of more likely or less likely refer to 30% are more likely and will implant and survive to birth, whereas 70% are less likely and will not survive to birth. [0055] In particular embodiments, fluids generated or modified by ART embryos can be (1 ) follicular fluid from, for example, the day of aspiration of oocyte from ovarian follicles of superovulated infertile patients. Here, the assay could be done during fertilization of these oocytes or use of ICSI to fertilize these oocytes); (2) spent media collected 3 days after fertilization and embryo culture (prior to reimplantation at the 8-cell stage); (3) spent media collected 5 days after fertilization and embryo culture (prior to reimplantation at the blastocyst stage), and/or (4) amniocentesis fluid collected at mid-first trimester to mid-second trimester. Maternal blood (or more accurately maternal plasma as during the first trimester the placenta blocks maternal blood access and the only exudate that reaches the placental surface is more like plasma) can also be used.

[0056] Given the amount of fluid available for these described tests and procedures, miniaturization of some processes and testing equipment can be beneficial. In particular embodiments, a 384 well plate is sufficiently small for most types of ART fluid volumes. However spent media from cultured embryos would be the smallest volume and would be tested first in 384 well plates. Smaller microfluidic formats can also be used.

[0057] In particular embodiments, early antiluteolytic hormone detection indicates miscarriage risk. In particular embodiments, early hCG detection indicates miscarriage risk. In particular embodiments, early PL1 detection indicates miscarriage risk. In particular embodiments, early PL1-reporter (e.g., GFP) detection indicates miscarriage risk. Miscarriage risk means that the likelihood of miscarriage is increased over that observed in the general population.

[0058] In particular embodiments, antiluteolytic hormone deceleration by day 1 , 2, 3, 4, 5, 6, 7, 8, 9 or 10 (in more particular embodiments day 4-6) indicates miscarriage risk. In particular embodiments, hCG deceleration by day 1 , 2, 3, 4, 5, 6, 7, 8, 9 or 10 (in more particular embodiments day 4-6) indicates miscarriage risk. In particular embodiments, PL1 deceleration by day 1 , 2, 3, 4, 5, 6, 7, 8, 9 or 10 (in more particular embodiments day 4-6) indicates miscarriage risk. In particular embodiments, PL1 -reporter (e.g., GFP) deceleration by day 1 , 2, 3, 4, 5, 6, 7, 8,

9 or 10 indicates miscarriage risk.

[0059] In particular embodiments, antiluteolytic hormone plateau by day 1 , 2, 3, 4, 5, 6, 7, 8, 9 or

10 (in more particular embodiments day 4-6) indicates miscarriage risk. In particular embodiments, hCG plateau by day 1 , 2, 3, 4, 5, 6, 7, 8, 9 or 10 (in more particular embodiments day 4-6) indicates miscarriage risk. In particular embodiments, PL1 plateau by day 1 , 2, 3, 4, 5, 6, 7, 8, 9 or 10 (in more particular embodiments day 4-6) indicates miscarriage risk. In particular embodiments, PL1-reporter (e.g., GFP) plateau by day 1 , 2, 3, 4, 5, 6, 7, 8, 9 or 10 (in more particular embodiments day 4-6) indicates miscarriage risk. [0060] In the broadest sense, expression evaluations described herein may be qualitative or quantitative. As such, where detection is qualitative, the systems and methods provide an assessment, of whether or not the target analyte is present in the sample being assayed. In other embodiments, the systems and methods provide a quantitative detection of whether the target analyte is present in the sample, e.g., an assessment of the actual amount or relative abundance of the target analyte. Qualitative or quantitative kinetics of changes can also be measured.

[0061] Systems and methods can include comparisons to reference levels. Reference levels can be obtained from a dataset. A reference level from a dataset can be derived from previous measures derived from a population. A "population" is any grouping of stem cells of like specified characteristics. The grouping could be according to, e.g., previous exposure to a stress condition or lack thereof.

[0062] A "dataset" as used herein is a set of numerical values resulting from evaluation of a sample (or population of samples) under a desired condition. The values of the dataset can be obtained, e.g., by experimentally obtaining measures from a sample and constructing a dataset from these measurements. As is understood by one of ordinary skill in the art, the reference level can be based on e.g., any mathematical or statistical formula useful in the art for arriving at a meaningful aggregate reference level from a collection of individual datapoints; e.g., mean, median, median of the mean, etc. Alternatively, a reference level or dataset to create a reference level can be obtained from a service provider such as a laboratory, or from a database or a server on which the dataset has been stored.

[0063] in particular embodiments, for women with normal pregnancies an experimental normal control dataset for each IVF/ART fluid type is created. A second control dataset can include data from women with diabetic pregnancies for each fluid type.

[0064] In particular embodiments, conclusions are drawn based on whether a measure is statistically significantly different or not statistically significantly different from a reference level. A measure is not statistically significantly different if the difference is within a level that would be expected to occur based on chance alone, in contrast, a statistically significant difference or increase is one that is greater than what would be expected to occur by chance alone. Statistical significance or lack thereof can be determined by any of various systems and methods used in the art. An example of a commonly used measure of statistical significance is the p-value. The p- value represents the probability of obtaining a given result equivalent to a particular datapoint, where the datapoint is the result of random chance alone. A result is often considered significant (not random chance) at a p-vaiue less than or equal to 0.05. [0065] Embodiments can be used with HTS. in HTS, numerous different compounds can be tested for potential stress effects quickly. For example, stem cells (e.g., modified stem cells) can be provided to wells of a microtiter plate, including, e.g., a 96- or 384-weII plate that can be read in a fluorescent microplate reader. The stem cell lines in the welis can then be exposed to different compounds and/or different concentrations of compounds. In additional embodiments, stem ceils can be contacted with a single test agent, or, to facilitate HTS, to at least 2, at least 5, at least 10, at least 100, at least 1 ,000, at least 10,000, at least 100,000 or at least at least 1 ,000,000 test compounds at a time. Environmental conditions can similarly be screened, and test compounds and environmental conditions can be screened in various combinations. If the stem cells score positive for stress, a different set of stem ceils can be subsequently tested with a subset of the test compounds or environmental conditions until the compounds or conditions creating the stress effect are identified.

[0066] High-throughput screening systems are commercially available from, e.g., Zymark Corp., Hopkinton, Mass.; Air Technical Industries, Mentor, Ohio; Beckman Instruments, Inc. Fullerton, Calif.; Precision Systems, Inc., Natick, Mass., Luminex Corp., etc.. These systems typically automate entire procedures including all sample and reagent pipetting, liquid dispensing, timed incubations, and final readings of the microplate in detector(s) appropriate for the assay. These configurable systems provide high throughput and rapid start up as well as a high degree of flexibility and customization. The manufacturers of such systems provide detailed protocols for the various systems and methods of high throughput.

[0067] Particular embodiments include adding any of the described fluids to a HTS as described in PCT/US2015/044701 or a HTS disclosed herein. In particular embodiments, PL1 promoter- GFP reporter first lineage differentiation TSCs described in Yang et a/., 2016 are used to assay the amount of stress products secreted by oocytes or embryos and causing stress in the reporter stem cells. This would be an assay of a stressed pregnancy and would suggest that the treating physician recommend stress diminishment methods to patients (bed rest, aspirin or other protocols).

[0068] Kits to practice the systems and methods are also provided. Kits can include one or more containers including modified stem cells, primer pairs, probe sequences, binding proteins (e.g., antibodies) and/or reagents or supplies to assess expression of a gene of interest described herein. Components of the kit can be prepared for storage and later use. Associated with such container(s) can be a notice in the form prescribed by a governmental agency regulating the manufacture, use, or sale of the kit, which notice reflects approval by the agency of manufacture, use, or sale, when required. [0069] Optionally, the kits further include instructions for using the kit in the methods. In various embodiments, the instructions can include appropriate reference levels to interpret results associated with using the kit; proper disposal of the related waste; and the like. The instructions can be in the form of printed instructions provided within the kit or the instructions can be printed on a portion of the kit itself. Instructions may be in the form of a sheet, pamphlet, brochure, CD- Rom, or computer-readable device, or can provide directions to instructions at a remote location, such as a website.

[0070] Particular gene and protein sequences supporting the disclosure are available in publicly available databases, as well as publications. An exemplary amino acid sequence for Glycoprotein hormone alpha chain Homo sapiens (Human) online at Uniprot.org Q6I9S8_HUMAN (SEQ ID NO: 1); an exemplary encoding nucleotide sequence is found at ebi.ac.uk Accession No. CCP37876.1 (see also SEQ ID NO: 6). An exemplary amino acid sequence for hCG beta is found online at Uniprot.org as P0DN87 (CGB7_HUMAN) (SEQ ID NO: 2); an exemplary encoding nucleotide sequence is found at ebi.ac.uk Accession No. EAW52439.1 (see also SEQ ID NO: 7). See Table 1 , as well as Premzl, Meta Gene 4118-4128, 2015.

[0071] An exemplary amino acid sequence for PL1 (aka Chorionic somatomammotropin hormone 1/CSH1) can be found online at Uniprot.org PR3D1_MOUSE_ AAA39404.1 (SEQ ID NOs: 3-5); an exemplary encoding nucleotide sequence is found at ebi.ac.uk Accession No. M35662.1 (see also SEQ ID NO: 8). See Table 1 , as well as Colosi et al., Mol. Endocrinol. 1 (1 1): 767-776, 1987.

[0072] The human chorionic gonadotropin is a heterodimer with the alpha chain shared, and identical with, several other hormones including luteinizing Hormone (LH), follicle stimulating hormone (FSH), and thyroid stimulating hormone (TSH) (Williams & Larsen. Wlliams Textbook of Endocrinology. Philadelphia, PA: Saunders; 2003). The FASTA sequence of the alpha chain is underlined (Table 1 ; SEQ ID NO: 1). The hCG beta chain is unique to hCG and confers receptor specificity and antiluteolytic function and antibodies to the beta subunit are used in pregnancy detection (Wlliams & Larsen. Wlliams Textbook of Endocrinology. Philadelphia, PA: Saunders; 2003). The FASTA sequence of the beta chain is underlined (Table 1 ; SEQ ID NO: 2); NP_149133.1.

[0073] The three mouse (Mus musculus) PI1 a,b,c proteins (SEQ ID NOs: 3-5) are the product of three genes. In Table 1 , bold "normal" letters show amino acids shared by all three, bolded italicized letters show amino acids shared by 2 of 3, and bolded underlined letters show unique amino acids (or sequences of SAG vs. SG in PL1c) (Soares et ai, Trends Endocrinol Metab 18: 114-121 , 2007; Wiemers et ai, Endocrinology 144:313-325, 2003; Dai et ai, J Endocrinol 166:63-75, 2000). It is thought that the three genes are functionally similar (Soares et ai, Trends Endocrinol Metab 18: 114-121 , 2007; Wiemers et al., Endocrinology 144:313-325, 2003; Dai et ai, J Endocrinol 166:63-75, 2000) and are detected equivalently by rabbit polyclonal antibodies used for immunoblots and immunofluorescence (Yang et ai, Hypoxic stress forces large, irreversible trophoblast stem cell differentiation. Biology of Reproduction 2016, Submitted; Yang et al., Biol Reprod 95(5): 1 10, 1-10, 2016; Yang et ai, Hypoxic Stress Forces Adaptive and Maladaptive Placental Stress Responses in Early Pregnancy. Birth Defects Res. 109(17): 1330- 1344, 2017; Awonuga et al., Mol Reprod Dev 78:519-528, 201 1). PL1a and PL1 b are the same length (224 aa), but PL1c is one amino shorter (223 aa) (aka chorionic somatomammotropin - CSH1a/b/c). There are amino acid differences and an A missing in the SAG trimer in PL1 c. The sequences are 95% identical at the amino acid sequence.

Table 1. Exemplary Human and Mouse Antiluteolytic Hormone Sequences HUMAN chorionic gonadotropin alpha (CGA) - hCGa SEQ ID NO: 1

MDYYRKYAAIFLVTLSVFLHVLHSAPDVQDCPECTLQENPFFSQPGAPILQCMGCCFSRAYP TPLRSKKTMLVQKNVTSESTCCVAKSYNRVTVMGGFKVENHTACHCSTCYYHKS 1 16aa

CCP37876.1 Homo sapiens glycoprotein hormone alpha subunit SEQ ID NO: 6

ATGGATTACTACAGAAAATATGCAGCTATCTTTCTGGTCACATTGTCGGTGTTTCTGCATG

TTCTCCATTCCGCTCCTGATGTGCAGGATTGCCCAGAATGCACGCTACAGGAAAACCCA

TTCTTCTCCCAGCCGGGTGCCCCAATACTTCAGTGCATGGGCTGCTGCTTCTCTAGAGC

ATATCCCACTCCACTAAGGTCCAAGAAGACGATGTTGGTCCAAAAGAACGTCACCTCAG

AGTCCACTTGCTGTGTAGCTAAATCATATAACAGGGTCACAGTAATGGGGGGTTTCAAAG

TGGAGAACCACACGGCGTGCCACTGCAGTACTTGTTATTATCACAAATCTTAA

HUMAN chorionic gonadotropin beta (CGB) - hCGb SEQ ID NO: 2

MEMFQGLLLLLLLSMGGTWASKEPLRPRCRPINATLAVEKEGCPVCITVNTTICAGYCPTMT RVLQGVLPALPQVVCNYRDVRFESIRLPGCPRGVNPVVSYAVALSCQCALCRRSTTDCGGP KDHPLTCDDPRFQDSSSSKAPPPSLPSPSRLPGPSDTPILPQ 165aa

EAW52439.1 Homo sapiens chorionic gonadotropin, beta polypeptide 7 SEQ ID NO: 7

ATGGAGATGTTCCAGGGGCTGCTGCTGTTGCTGCTGCTGAGCATGGGCGGGACATGGG

CATCCAGGGAGATGCTTCGGCCACGGTGCCGCCCCATCAATGCCACCCTGGCTGTGGA

GAAGGAGGGCTGCCCCGTGTGCATCACCGTCAACACCACCATCTGTGCCGGCTACTGC

CCCACCATGACCCGCGTGCTGCAGGGGGTCCTGCCGGCCCTGCCTCAGGTGGTGTGC

AACTACCGCGATGTGCGCTTCGAGTCCATCCGGCTCCCTGGCTGCCCGCGCGGCGTGA

ACCCCGTGGTCTCCTACGCCGTGGCTCTCAGCTGTCAATGTGCACTCTGCCGCCGCAG

CACCACTGACTGCGGGGGTCCCAAGGACCACCCCTTGACCTGTGATGACCCCCGCTTC

CAGGCCTCCTCTTCCTCAAAGGCCCCTCCCCCCAGCCTTCCAAGTCCATCCCGACTCCC

GGGGCCCTCAGACACCCCGATCCTCCCACAATAA

Mus musculus Prl3d1 (PL1 a) SEQ ID NO: 3

MQLTLNLSGSi GMQLLLLVSSLLLWENVSSKPTAMVPTEDLYTRLAELLHA/TFILAADVYR EFDLDFFDKTWITDRTLPLCHTASIHTPENREEVHETKTEDLLKAMINVSISWKEPLKHLVSA LTALPGASESMGKKAADIKGRNLVILEGLQTIYNRSQANIEENENFDYPAWSGLEELQSPN EDTHLFAVYNLCRCIKRDIHKIDSYIKVLRCRWFQNEC 224aa

Mus musculus Prl3d2 (PL1 b) SEQ I D NO: 4

MQLTI TLSGSi GMQLLLLVSSLLLWENVSSKPTAMVPTDDLYTRLAELSHA/TFILAADVYRE FDLDFFDKTWITDRTLPLCHTASIHTPENREEVHE/KTEDLLKAMINVSISWKEPLKHLVSAL TALPGASESMGKKAADIKGRNL/ILEGLQTIYNR7QANIEENENFDYPAWTGLEELQSPNED TH LFAVYN LCRCI KRDI H Kl DSYI KVLRCRWFQN EC 224aa Table 1. Exemplary Human and Mouse Antiluteolytic Hormone Sequences Mus musculus Prl3d3 (PL1c) SEQ ID NO: 5

MQLTI 7T-SGSGMQLLLLVSSLFLWENVSSKPTAMVPTEDLYTRLAELSHSTFILAADVYREF DLDFFDKTWITDRTLPLCHTASIHTPENREEVHE/KTEDLLKAMINVSISWKEPLKHLVSALT ALPGASESMGKKAADIKGRNL/ILEGLQTIYNR7QANIEENENFDYPAWSGLEELQSPNEDT H LFAVYN LCRCI KRDI H Kl DSYI KVLRCRWFQN EC 223aa

M35662.1 Mouse placental lactogen I (PL-I) mRNA, complete cds. SEQ ID NO: 8

TTCCTCACTTGGAGCCTACATTGTGGTGGATCTTCTCAGAAATGCAGCTGACTTTGAATC

TTTCAGGCTCCGCAGGAATGCAATTGTTGCTGCTGGTGTCAAGCCTACTCCTTTGGGAG

AATGTGTCCTCCAAACCAACTGCCATGGTGCCCACTGAAGACCTGTATACTCGTTTGGCT

GAACTGCTCCATAATACATTTATCTTGGCCGCAGATGTGTATAGGGAATTTGATTTGGATT

TTTTCGATAAAACTTGGATAACAGACAGAACACTTCCCCTGTGTCATACTGCTTCCATCCA

TACTCCAGAGAATCGAGAGGAAGTCCACGAAACTAAAACTGAAGACCTTCTGAAAGCAAT

GATCAATGTTTCAATTTCCTGGAAAGAACCTCTGAAACACCTGGTGTCTGCACTGACGGC

TCTCCCAGGAGCTTCTGAGAGTATGGGGAAAAAAGCTGCTGACATTAAGGGCAGAAACC

TTGTAATTCTGGAGGGACTTCAGACAATATACAACAGGTCTCAGGCTAACATTGAAGAAA

ATGAAAATTTTGACTACCCTGCTTGGTCTGGACTCGAAGAACTGCAGTCACCTAACGAAG

ACACTCATCTTTTTGCCGTTTATAATCTATGCCGCTGCATTAAAAGGGACATCCATAAGAT

AGACAGCTATATCAAAGTCTTGAGGTGCCGAGTTGTCTTTCAGAACGAATGTTGAGTGCC

CACCCAGCGAAGCCCTGCCCACATGGTCTTTGTTGAACCAGACTTGTAATGCTTTCCCCT

CCTCAGTTATGATGAGCTATAATGGAATTATTGTCATAAAATAAAATAAAATTATTTAGATT

C

Start: Bold; End: underlined [0074] EXEMPLARY EMBODIMENTS:

1. A method of detecting stress in stem cells including: measuring the expression of one or both of (1) an antiluteolytic hormone promoter driven reporter or (2) an antiluteolytic hormone driven by its native promoter; comparing the measurement to a reference expression level; and determining that the stem cells have experienced stress if the measurement is statistically significantly different from the reference level.

2. The method of embodiment 1 , wherein the reference expression level comprises expression of the antiluteolytic hormone promoter driven reporter in stem cells cultured with potency and proliferation conditions with no added stressor or toxicant.

3. The method of embodiment 1 , including subtracting from a transgenic reporter level of fluorescence, a parental non-transgenic cell level of fluorescence at the same dose of stress as a reporter stem cell line.

4. The method of embodiment 1 , wherein expression of an antiluteolytic hormone is indicative of stress. 5. The method of embodiment 3, wherein stress forces growth rate decrease and potency loss or differentiation gain, under culture conditions that maintain proliferation and potency and suppress differentiation in the absence of the stress.

6. The method of embodiment 1 , wherein a deceleration or plateau of the antiluteolytic hormone is indicative of stress.

7. The method of embodiment 6, wherein the stress further indicates irreversible differentiation, which is corroborated by zero growth rate forced by stress under conditions which should maintain growth in the absence of stress.

8. The method of embodiment 1 , which is a method of testing a compound for possible effects on embryo viability.

9. A method of classifying an assisted reproductive technology (ART) embryo as implant prone or miscarriage prone including: assaying a fluid created by or modified by the ART embryo for an antiluteolytic hormone; and classifying the embryo as implant prone or miscarriage prone based on the assaying.

10. The method of embodiment 9, wherein the fluid comprises one or more of: follicular fluid from the day of aspiration of oocyte from ovarian follicles of a superovulated infertile patient; spent media collected 3 days after fertilization and embryo culture; spent media collected 5 days after fertilization and embryo culture; amniocentesis fluid collected at mid-first trimester to mid-second trimester; or maternal plasma.

11. The method of embodiment 9 or 10, wherein assaying the fluid comprises measuring the quantity and/or activity of the antiluteolytic hormone.

12. The method of any one of embodiments 9-1 1 , wherein the antiluteolytic hormone is hCG.

13. The method of embodiment 9, wherein assaying the fluid for the antiluteolytic hormone comprises determining kinetics of change in the level or activity of the antiluteolytic hormone.

14. The method of embodiment 9, wherein assaying the fluid for the antiluteolytic hormone comprises determining antiluteolytic hormone deceleration and/or plateau.

15. The method of embodiment 14, wherein antiluteolytic hormone deceleration and/or plateau at days 4-6 post fertilization classifies the embryo as miscarriage prone.

16 A modified stem cell including a reporter gene in operable combination with an antiluteolytic hormone gene promoter.

17. The modified stem cell of embodiment 16, wherein the antiluteolytic hormone gene promoter is a PL1 promoter or a hCGa promoter or a hCGb promoter.

18. A high throughput screen (HTS) practicing the method of any one of embodiments 1-15 or incorporating the modified stem cell of embodiments 16 or 17. 19. The HTS of embodiment 18, which assesses whether chemicals may cause miscarriages or add to stress that causes miscarriages.

20. An assay practicing the method of any one of embodiments 1-15 or incorporating the modified stem cell of embodiment 16 or 17.

[0075] As will be understood by one of ordinary skill in the art, each embodiment disclosed herein can comprise, consist essentially of or consist of its particular stated element, step, ingredient or component. Thus, the terms "include" or "including" should be interpreted to recite: "comprise, consist of, or consist essentially of." As used herein, the transition term "comprise" or "comprises" means includes, but is not limited to, and allows for the inclusion of unspecified elements, steps, ingredients, or components, even in major amounts. The transitional phrase "consisting of excludes any element, step, ingredient or component not specified. The transition phrase "consisting essentially of" limits the scope of the embodiment to the specified elements, steps, ingredients or components and to those that do not materially affect the embodiment. As used herein, a material effect would cause a statistically-significant reduction in the ability of a method to detect stress in a stem cell as disclosed herein.

[0076] Unless otherwise indicated, all numbers expressing quantities of ingredients, properties such as molecular weight, reaction conditions, and so forth used in the specification and claims are to be understood as being modified in all instances by the term "about." Thus, unless indicated to the contrary, the numerical parameters set forth in the specification and attached claims are approximations that may vary depending upon the desired properties sought to be obtained by the present invention. At the very least, and not as an attempt to limit the application of the doctrine of equivalents to the scope of the claims, each numerical parameter should at least be construed in light of the number of reported significant digits and by applying ordinary rounding techniques. When further clarity is required, the term "about" has the meaning reasonably ascribed to it by a person skilled in the art when used in conjunction with a stated numerical value or range, i.e. denoting somewhat more or somewhat less than the stated value or range, to within a range of ±20% of the stated value; ±19% of the stated value; ±18% of the stated value; ±17% of the stated value; ±16% of the stated value; ±15% of the stated value; ±14% of the stated value; ±13% of the stated value; ±12% of the stated value; ±1 1 % of the stated value; ±10% of the stated value; ±9% of the stated value; ±8% of the stated value; ±7% of the stated value; ±6% of the stated value; ±5% of the stated value; ±4% of the stated value; ±3% of the stated value; ±2% of the stated value; or ±1 % of the stated value. [0077] Notwithstanding that the numerical ranges and parameters setting forth the broad scope of the invention are approximations, the numerical values set forth in the specific examples are reported as precisely as possible. Any numerical value, however, inherently contains certain errors necessarily resulting from the standard deviation found in their respective testing measurements.

[0078] The terms "a," "an," "the" and similar referents used in the context of describing the invention (especially in the context of the following claims) are to be construed to cover both the singular and the plural, unless otherwise indicated herein or clearly contradicted by context. Recitation of ranges of values herein is merely intended to serve as a shorthand method of referring individually to each separate value falling within the range. Unless otherwise indicated herein, each individual value is incorporated into the specification as if it were individually recited herein. All methods described herein can be performed in any suitable order unless otherwise indicated herein or otherwise clearly contradicted by context. The use of any and all examples, or exemplary language (e.g., "such as") provided herein is intended merely to better illuminate the invention and does not pose a limitation on the scope of the invention otherwise claimed. No language in the specification should be construed as indicating any non-claimed element essential to the practice of the invention.

[0079] Groupings of alternative elements or embodiments of the invention disclosed herein are not to be construed as limitations. Each group member may be referred to and claimed individually or in any combination with other members of the group or other elements found herein. It is anticipated that one or more members of a group may be included in, or deleted from, a group for reasons of convenience and/or patentability. When any such inclusion or deletion occurs, the specification is deemed to contain the group as modified thus fulfilling the written description of all Markush groups used in the appended claims.

[0080] Particular embodiments of this invention are described herein, including the best mode known to the inventors for carrying out the invention. Of course, variations on these described embodiments will become apparent to those of ordinary skill in the art upon reading the foregoing description. The inventor expects skilled artisans to employ such variations as appropriate, and the inventors intend for the invention to be practiced otherwise than specifically described herein. Thus, this invention includes all modifications and equivalents of the subject matter recited in the claims appended hereto as permitted by applicable law. Moreover, any combination of the above- described elements in all possible variations thereof is encompassed by the invention unless otherwise indicated herein or otherwise clearly contradicted by context. [0081] Furthermore, numerous references have been made to patents, printed publications, journal articles and other written text throughout this specification (referenced materials herein). Each of the referenced materials are individually incorporated herein by reference in their entirety for their referenced teaching.

[0082] In closing, it is to be understood that the embodiments of the invention disclosed herein are illustrative of the principles of the present invention. Other modifications that may be employed are within the scope of the invention. Thus, by way of example, but not of limitation, alternative configurations of the present invention may be utilized in accordance with the teachings herein. Thus, the present invention is not limited to that precisely as shown and described.

[0083] The particulars shown herein are by way of example and for purposes of illustrative discussion of the preferred embodiments of the present invention only and are presented in the cause of providing what is believed to be the most useful and readily understood description of the principles and conceptual aspects of various embodiments of the invention. In this regard, no attempt is made to show structural details of the invention in more detail than is necessary for the fundamental understanding of the invention, the description taken with the drawings and/or examples making apparent to those skilled in the art how the several forms of the invention may be embodied in practice.

[0084] Definitions and explanations used in the present disclosure are meant and intended to be controlling in any future construction unless clearly and unambiguously modified in the following examples or when application of the meaning renders any construction meaningless or essentially meaningless. In cases where the construction of the term would render it meaningless or essentially meaningless, the definition should be taken from Webster's Dictionary, 3^rd Edition or a dictionary known to those of ordinary skill in the art, such as the Oxford Dictionary of Biochemistry and Molecular Biology (Ed. Anthony Smith, Oxford University Press, Oxford, (2004)).

Claims

LISTING OF CLAIMS What is claimed is:

1. A method of detecting stress in stem cells comprising:

measuring the expression of one or both of (1) an antiluteolytic hormone promoter driven reporter or (2) an antiluteolytic hormone driven by its native promoter;

comparing the measurement to a reference expression level; and

determining that the stem cells have experienced stress if the measurement is statistically significantly different from the reference level.

2. The method of claim 1 , wherein the reference expression level comprises expression of the antiluteolytic hormone promoter driven reporter in stem cells cultured with potency and proliferation conditions with no added stressor or toxicant.

3. The method of claim 1 , comprising subtracting from a transgenic reporter level of fluorescence, a parental non-transgenic cell level of fluorescence at the same dose of stress as a reporter stem cell line.

4. The method of claim 1 , wherein expression of an antiluteolytic hormone is indicative of stress.

5. The method of claim 3, wherein stress forces growth rate decrease and potency loss or differentiation gain, under culture conditions that maintain proliferation and potency and suppress differentiation in the absence of the stress.

6. The method of claim 1 , wherein a deceleration or plateau of the antiluteolytic hormone is indicative of stress.

7. The method of claim 6, wherein the stress further indicates irreversible differentiation, which is corroborated by zero growth rate forced by stress under conditions which should maintain growth in the absence of stress.

8. The method of claim 1 , which is a method of testing a compound for possible effects on embryo viability.

9. A method of classifying an assisted reproductive technology (ART) embryo as implant prone or miscarriage prone comprising:

assaying a fluid created by or modified by the ART embryo for an antiluteolytic hormone; and

classifying the embryo as implant prone or miscarriage prone based on the assaying.

10. The method of claim 9, wherein the fluid comprises one or more of:

follicular fluid from the day of aspiration of oocyte from ovarian follicles of a superovulated infertile patient;

spent media collected 3 days after fertilization and embryo culture;

spent media collected 5 days after fertilization and embryo culture;

amniocentesis fluid collected at mid-first trimester to mid-second trimester; or

maternal plasma.

11. The method of claim 9 or 10, wherein assaying the fluid comprises measuring the quantity and/or activity of the antiluteolytic hormone.

12. The method of any one of claims 9-1 1 , wherein the antiluteolytic hormone is hCG.

13. The method of claim 9, wherein assaying the fluid for the antiluteolytic hormone comprises determining kinetics of change in the level or activity of the antiluteolytic hormone.

14. The method of claim 9, wherein assaying the fluid for the antiluteolytic hormone comprises determining antiluteolytic hormone deceleration and/or plateau.

15. The method of claim 14, wherein antiluteolytic hormone deceleration and/or plateau at days 4-6 post fertilization classifies the embryo as miscarriage prone.

16 A modified stem cell comprising a reporter gene in operable combination with an antiluteolytic hormone gene promoter.

17. The modified stem cell of claim 16, wherein the antiluteolytic hormone gene promoter is a PL1 promoter or a hCGa promoter or a hCGb promoter.

18. A high throughput screen (HTS) practicing the method of any one of claims 1-15 or incorporating the modified stem cell of claims 16 or 17.

19. The HTS of claim 18, which assesses whether chemicals may cause miscarriages or add to stress that causes miscarriages.

20. An assay practicing the method of any one of claims 1-15 or incorporating the modified stem cell of claim 16 or 17.