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Sam Buckberry, Tina Bianco-Miotto, Stephen J. Bent, Gustaaf A. Dekker, Claire T. Roberts, Integrative transcriptome meta-analysis reveals widespread sex-biased gene expression at the human fetal–maternal interface, Molecular Human Reproduction, Volume 20, Issue 8, 1 August 2014, Pages 810–819, https://doi.org/10.1093/molehr/gau035
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Abstract
As males and females share highly similar genomes, the regulation of many sexually dimorphic traits is constrained to occur through sex-biased gene regulation. There is strong evidence that human males and females differ in terms of growth and development in utero and that these divergent growth strategies appear to place males at increased risk when in sub-optimal conditions. Since the placenta is the interface of maternal–fetal exchange throughout pregnancy, these developmental differences are most likely orchestrated by differential placental function. To date, progress in this field has been hampered by a lack of genome-wide information on sex differences in placental gene expression. Therefore, our motivation in this study was to characterize sex-biased gene expression in the human placenta. We obtained gene expression data for >300 non-pathological placenta samples from 11 microarray datasets and applied mapping-based array probe re-annotation and inverse-variance meta-analysis methods which showed that >140 genes (false discovery rate (FDR) <0.05) are differentially expressed between male and female placentae. A majority of these genes (>60%) are autosomal, many of which are involved in high-level regulatory processes such as gene transcription, cell growth and proliferation and hormonal function. Of particular interest, we detected higher female expression from all seven genes in the LHB-CGB cluster, which includes genes involved in placental development, the maintenance of pregnancy and maternal immune tolerance of the conceptus. These results demonstrate that sex-biased gene expression in the normal human placenta occurs across the genome and includes genes that are central to growth, development and the maintenance of pregnancy.
Introduction
Females and males of many species demonstrate numerous differences in morphology and physiology, yet they share highly similar genomes. This suggests that the regulation of many sexually dimorphic traits occurs through sex-specific patterns of gene regulation. Since fetal growth in utero is dependent on the capacity of the placenta to facilitate exchange between the mother and fetus, developmental disparities between the sexes are likely orchestrated by differential placental function.
The observation that males grow faster in utero and have a greater body length and weight at birth than females with equivalent placental size (Misra et al., 2009) indicates that the male placenta functions more efficiently (Forsén et al., 1999; Eriksson et al., 2010). However, there is a developmental trade-off: a consequence of growing more quickly and being larger in utero is that males are left with less reserve placental capacity to draw upon if sub-optimal conditions arise. In turn, this places males at increased risk of under nutrition (Eriksson et al., 2010), which can restrict growth and lower birthweight, both of which have been linked to males' increased risk of adult-onset disorders such as cardiovascular disease (Barker, 2002). A recent study has also shown a distinct male bias in the prevalence of placental dysfunction (Murji et al., 2012), and provides support for the findings of previous studies that showed sex biases in a spectrum of pregnancy complications and fetal health outcomes associated with abnormal placental development (Edwards et al., 2000; Ingemarsson, 2003; Clifton, 2010; Lao et al., 2011; Hadar et al., 2012). Although sex differences in terms of growth, development and predisposition to pregnancy complications are increasingly becoming recognized, the underpinning sex biases in placental gene regulation remain unclear.
Recent efforts using massively parallel sequencing techniques have begun to expand our knowledge of the human placental transcriptional (Kim et al., 2012) and epigenetic landscapes (Schroeder et al., 2013). These studies have revealed that the placenta is unique in several ways, including the expression of placenta-specific genes, placenta-specific alternative splicing and widespread partially DNA methylated domains that regulate gene expression (Kim et al., 2012; Schroeder et al., 2013). Despite advancing our understanding of human placental gene regulation, these studies were not designed to capture the effect of sex, and therefore provide no clues as to underlying sex differences in placental function. An earlier study, which was the first to describe the human placental transcriptome, noted several genes with a sex-biased expression; these were located on both sex chromosomes and the autosomes (Sood et al., 2006). However, given the low number of placental samples assessed, it is unlikely that the study was able to detect the true extent of sex-biased gene expression in the placenta.
In the present study, our aim was to characterize comprehensively the extent of sex-biased gene expression in the human placenta. To achieve this, we took advantage of the vast amount of human placental gene expression microarray data available in public repositories to perform a large-scale gene expression meta-analysis. In order to characterize only normal placental function, we selected samples from microarray datasets where no placental pathology or associated pregnancy complication was indicated. In applying integrative meta-analysis methods, our results demonstrate that sex-biased gene expression in the normal human placenta occurs across the genome and includes genes that are central to placental growth, development and the maintenance of pregnancy.
Materials and Methods
Study selection
We searched the public data repositories Gene Expression Omnibus and ArrayExpress, and the literature, for microarray gene expression datasets containing samples of human placental tissue. Our initial selection criteria required candidate datasets to have at least six individual placenta samples that were collected at the time of delivery. With the focus being on sex differences in normal development, we limited the inclusion of samples to those where no pregnancy or placental pathology was detailed in the associated metadata. For example, if a dataset contained placenta samples from pregnancies featuring pre-eclampsia and normal pregnancy controls, only the control sample arrays were included in the meta-analysis. Additionally, the meta-analysis was limited to studies where the raw, non-normalized, probe-level data were available for all the array probes. Arrays with pooled samples were excluded.
Array pre-processing and quality control
Since data were obtained from multiple microarray platforms, pre-processing methods were tailored to each platform. Affymetrix datasets were pre-processed, log-transformed and normalized using either the robust multi-array average (RMA) or GeneChip-RMA (GC-RMA) method depending on platform using Simpleaffy (Wilson and Miller, 2005). Applied Biosystems arrays were pre-processed using comprehensive R-based microarray analysis (CARMA); probes with a flag value of >100 were removed from the dataset before quantile normalization (Rainer et al., 2006). Illumina bead arrays were pre-processed using Beadarray before quantile normalization (Dunning et al., 2007). Datasets with arrays processed in multiple batches (as detailed in the metadata) were batch corrected using the ‘comBat’ function in the SVA package (Johnson et al., 2007; Leek et al., 2012). Outliers were eliminated from each dataset (see Supplementary data, Table SII) before re-normalization by checking the distance between arrays and assessing MA plots generated using ArrayQualityMetrics (Kauffmann et al., 2009).
Predicting the sex of samples in datasets lacking sex information
In 7 of the 11 datasets in this meta-analysis, the sample's sex was not identified in either the associated repository metadata or in the associated publication. Therefore, to maximize the number of usable datasets, we used the Bioconductor package massiR to predict fetal sex (Buckberry et al., 2014a). This method utilizes expression values for probes that map unambiguously to the Y chromosome and unsupervised clustering of samples based on Y chromosome probes with the highest variance.
We tested this method on placental datasets with known sample sex to determine its accuracy with placental data and to validate the sex of samples in datasets where sex information was detailed in the metadata. For datasets with known sex, this method predicted the correct sex with 100% accuracy in all but one dataset (GSE30032), where the sex of every sample was the opposite of the predicted sex in every case (as detailed in the GEO metadata). This method uses Y chromosome-specific probe information and so given that all samples designated male in the metadata were predicted to be female, and vice versa, we concluded that the metadata were incorrect. Therefore, we used the massiR predicted sex in this study.
Re-annotation of microarray datasets and probe summarization
Gene expression data were obtained from various microarray platforms that have different probes targeting the same genes. We therefore annotated each dataset with common gene identifiers to increase cross-platform concordance. We selected the gene identifiers from Ensembl Genes release 69 annotation (Flicek et al., 2012) for probe mapping, which is the genome annotation used in the human GENCODE project (Harrow et al., 2012). Probes from all Illumina and Affymetrix datasets were mapped to the human reference genome (GRCh37.3p) to translate platform-specific, probe-level identifiers to the Ensembl gene level identifiers. Probes were mapped using the Ensembl Functional Genomics Array Mapping Environment, in which individual probes are mapped to both the genome and the cDNA sequence. Alignments were performed by Ensembl using an analysis pipeline which implements the Exonerate sequence comparison and alignment tool (Slater and Birney, 2005). A 1-bp mismatch was permitted between the probe and the genome sequence assembly, and probes that match at 100+ locations (e.g. suspected Alu repeats) are discarded (see permalink for detailed methods http://jan2013.archive.ensembl.org/info/docs/microarray_probe_set_mapping.html).
Probe sequences were unavailable for the Applied Biosystems arrays and so Ensembl gene identifiers supplied by the manufacturer were used to identify target genes. For Applied Biosystems probes with no listed Ensembl identifier, the supplied gene symbol was used to identify the target gene using the HGNC database (Gray et al., 2012) and an Ensembl Gene identifier was subsequently assigned. Any remaining identifiers with GenBank accessions (Benson et al., 2011) were checked for a match against human sequences with sufficient gene information, and then designated an Ensembl Gene Identifier.
Probe mapping and annotation of all datasets (except Applied Biosystems arrays) allowed identification of four cases: (i) probes that map uniquely to a single-gene identifier (one-to-one mapping), (ii) probes that map to multiple gene identifiers (one-to-many mapping), (iii) multiple probes that map to the same gene identifier (many-to-one mapping) and (iv) probes that do not map to any genes in the reference genome. These re-annotation results are summarized in Supplementary data, Table SIII.
When a probe mapped to multiple gene identifiers (Case ii), a new probe identifier was created for each probe-to-gene mapping; this allowed the use of all possible information for each gene in the analysis. For gene identifiers where multiple probes were mapped (Case iii), probe values were summarized into a single representative value per gene identifier within each study, using a fixed inverse-variance model as previously described (Ramasamy et al., 2008). Probes with insufficient information, or that did not map any gene identifier, were removed from the analysis.
Meta-analysis of annotated datasets
To meta-analyze the 11 annotated microarray datasets, we applied the inverse-variance method as detailed in Ramasamy et al. (2008) using the rmeta package, functions adapted from the metaGEM package (https://spiral.imperial.ac.uk/handle/10044/1/4217) and custom R scripts. Briefly, study-specific effect sizes were calculated for each probe within each study by calculating the probe mean and standard deviation, corrected for effect size using Hedges' g to account for the number of samples in each group. These study-specific estimates were then combined using a random effects inverse-variance method for each gene identifier to calculate the pooled effect size and standard error. Z-statistics were then calculated for each gene identifier to obtain a nominal P-value, which was then corrected using the FDR. After significance testing, the resulting dataset was limited to genes represented by at least three studies for downstream analyses. All data processing and analyses were carried out in the R statistical environment (version 2.15.2).
Prediction of upstream transcription factor regulation
The sex-biased gene set was analyzed for enrichment of transcription factor (TF)-binding sites (TFBS) using the oPOSSUM program, and the JASPAR vertebrate core profiles (Kwon et al., 2012; Mathelier et al., 2013). For each gene, we searched for TFBS motifs in the conserved regions of the 10 kb upstream/downstream sequences using a conservation cut-off of 0.4, a matrix score threshold of 85% and a minimum specificity of 8-bits. The highly enriched TFBSs were identified by ranking TFs using results from Fisher's exact test and z-score rankings.
Resolving CGB/LHB cluster sequence homology
Genes in the LHB-CGB cluster are both functionally and evolutionarily related (Liina Nagirnaja, 2010), and subsequently have a high degree of sequence homology. In such cases, the sequence specificity of each microarray probe is a key determinant in differentiating between the expression of individual genes. We re-annotated all array probes through mapping to a common reference genome, therefore were able to determine which probes mapped uniquely, or mapped to multiple genes, in the LHB-CGB cluster. In this meta-analysis, all probes that represent LHB expression mapped uniquely; therefore, it is unlikely that the LHB expression results are confounded by non-specific binding with CGB gene transcripts. In the case of the CGB genes, mapping specificity differed between platforms. Affymetrix probes mapped with low specificity: 10 probes mapped to all CGB cluster genes and only 1 probe mapped uniquely (to CGB7). However, probes from the Illumina platforms mapped with much higher specificity. Of these, nine probes mapped specifically genes in one of the three classes of CGB protein isoforms (Fig. 6) and three of these probes had single-gene specificity. A majority of samples in this study (76%) were assayed on Illumina platforms and so we have reasonably high confidence that the expression results for CGB genes are composed primarily of values from probes with the highest specificity.
Amino acid sequences for LHB and CGB cluster genes were downloaded from ENSEMBL. Sequences were aligned using MAFFT (v7.130b) with L-INS-i settings, and the tree was calculated with the average distance using percent identity in Jalview (v2.8). Branch lengths represent the percentage mismatch between two nodes.
Gene enrichment and pathway analysis
Enriched biological functions and canonical pathways associated with sex-biased genes were determined using Ingenuity Pathway Analysis (Ingenuity Systems, v18030641).
Results and discussion
Meta-analysis of sex-biased gene expression in the human placenta
This meta-transcriptome analysis of the sex differences in human placental gene expression incorporated 303 samples from 11 microarray datasets generated on six different platforms (Table I). We limited this analysis to non-pathological placental samples to provide the most accurate evaluation of sex differences in relative gene expression in normal human pregnancies at the time the fetus was delivered.
Dataset . | GEO accession . | Array manufacturer . | Array platform . | No. of samples . | Male . | Female . |
---|---|---|---|---|---|---|
1 | GSE10588 (Sitras et al., 2009a) | Applied Biosystems | Human Genome Survey v2 | 21 | 14 | 7 |
2 | GSE12216 (Sitras et al., 2009b) | Applied Biosystems | Human Genome Survey v2 | 8 | 5 | 3 |
3 | GSE18809 (Chim et al., 2012) | Affymetrix | U133 plus 2 | 9 | 3 | 6 |
4 | GSE24129 (Nishizawa et al., 2011) | Affymetrix | Human Genome 1 ST | 8 | 5 | 3 |
5 | GSE25906 (Tsai et al., 2011) | Illumina | Human-6 v2 | 37 | 21 | 16 |
6 | GSE27272 (Votavova et al., 2011) | Illumina | HumanRef-8 v3 | 51 | 32 | 19 |
7 | GSE28551 (Sitras et al., 2012) | Applied Biosystems | Human Genome Survey v2 | 20 | 14 | 6 |
8 | GSE30032 (Votavova et al., 2012) | Illumina | HumanRef-8 v3 | 54 | 26 | 28 |
9 | GSE35574 (Guo et al., 2013) | Illumina | Human-6 v2 | 40 | 23 | 17 |
10 | GSE36828 (Unpublished) | Illumina | HumanHT-12 v3 | 47 | 26 | 21 |
11 | GSE7434 (Huuskonen et al., 2008) | Affymetrix | U133 plus 2 | 8 | 5 | 3 |
Total | 303 | 174 | 129 |
Dataset . | GEO accession . | Array manufacturer . | Array platform . | No. of samples . | Male . | Female . |
---|---|---|---|---|---|---|
1 | GSE10588 (Sitras et al., 2009a) | Applied Biosystems | Human Genome Survey v2 | 21 | 14 | 7 |
2 | GSE12216 (Sitras et al., 2009b) | Applied Biosystems | Human Genome Survey v2 | 8 | 5 | 3 |
3 | GSE18809 (Chim et al., 2012) | Affymetrix | U133 plus 2 | 9 | 3 | 6 |
4 | GSE24129 (Nishizawa et al., 2011) | Affymetrix | Human Genome 1 ST | 8 | 5 | 3 |
5 | GSE25906 (Tsai et al., 2011) | Illumina | Human-6 v2 | 37 | 21 | 16 |
6 | GSE27272 (Votavova et al., 2011) | Illumina | HumanRef-8 v3 | 51 | 32 | 19 |
7 | GSE28551 (Sitras et al., 2012) | Applied Biosystems | Human Genome Survey v2 | 20 | 14 | 6 |
8 | GSE30032 (Votavova et al., 2012) | Illumina | HumanRef-8 v3 | 54 | 26 | 28 |
9 | GSE35574 (Guo et al., 2013) | Illumina | Human-6 v2 | 40 | 23 | 17 |
10 | GSE36828 (Unpublished) | Illumina | HumanHT-12 v3 | 47 | 26 | 21 |
11 | GSE7434 (Huuskonen et al., 2008) | Affymetrix | U133 plus 2 | 8 | 5 | 3 |
Total | 303 | 174 | 129 |
Dataset . | GEO accession . | Array manufacturer . | Array platform . | No. of samples . | Male . | Female . |
---|---|---|---|---|---|---|
1 | GSE10588 (Sitras et al., 2009a) | Applied Biosystems | Human Genome Survey v2 | 21 | 14 | 7 |
2 | GSE12216 (Sitras et al., 2009b) | Applied Biosystems | Human Genome Survey v2 | 8 | 5 | 3 |
3 | GSE18809 (Chim et al., 2012) | Affymetrix | U133 plus 2 | 9 | 3 | 6 |
4 | GSE24129 (Nishizawa et al., 2011) | Affymetrix | Human Genome 1 ST | 8 | 5 | 3 |
5 | GSE25906 (Tsai et al., 2011) | Illumina | Human-6 v2 | 37 | 21 | 16 |
6 | GSE27272 (Votavova et al., 2011) | Illumina | HumanRef-8 v3 | 51 | 32 | 19 |
7 | GSE28551 (Sitras et al., 2012) | Applied Biosystems | Human Genome Survey v2 | 20 | 14 | 6 |
8 | GSE30032 (Votavova et al., 2012) | Illumina | HumanRef-8 v3 | 54 | 26 | 28 |
9 | GSE35574 (Guo et al., 2013) | Illumina | Human-6 v2 | 40 | 23 | 17 |
10 | GSE36828 (Unpublished) | Illumina | HumanHT-12 v3 | 47 | 26 | 21 |
11 | GSE7434 (Huuskonen et al., 2008) | Affymetrix | U133 plus 2 | 8 | 5 | 3 |
Total | 303 | 174 | 129 |
Dataset . | GEO accession . | Array manufacturer . | Array platform . | No. of samples . | Male . | Female . |
---|---|---|---|---|---|---|
1 | GSE10588 (Sitras et al., 2009a) | Applied Biosystems | Human Genome Survey v2 | 21 | 14 | 7 |
2 | GSE12216 (Sitras et al., 2009b) | Applied Biosystems | Human Genome Survey v2 | 8 | 5 | 3 |
3 | GSE18809 (Chim et al., 2012) | Affymetrix | U133 plus 2 | 9 | 3 | 6 |
4 | GSE24129 (Nishizawa et al., 2011) | Affymetrix | Human Genome 1 ST | 8 | 5 | 3 |
5 | GSE25906 (Tsai et al., 2011) | Illumina | Human-6 v2 | 37 | 21 | 16 |
6 | GSE27272 (Votavova et al., 2011) | Illumina | HumanRef-8 v3 | 51 | 32 | 19 |
7 | GSE28551 (Sitras et al., 2012) | Applied Biosystems | Human Genome Survey v2 | 20 | 14 | 6 |
8 | GSE30032 (Votavova et al., 2012) | Illumina | HumanRef-8 v3 | 54 | 26 | 28 |
9 | GSE35574 (Guo et al., 2013) | Illumina | Human-6 v2 | 40 | 23 | 17 |
10 | GSE36828 (Unpublished) | Illumina | HumanHT-12 v3 | 47 | 26 | 21 |
11 | GSE7434 (Huuskonen et al., 2008) | Affymetrix | U133 plus 2 | 8 | 5 | 3 |
Total | 303 | 174 | 129 |
To improve microarray cross-platform concordance and to standardize gene identifiers throughout this meta-analysis, we re-annotated array probes by mapping to a common reference genome. After this re-annotation and summary process, we were able to quantify expression of 31 844 Ensembl genes (hereafter referred to as genes) across the human genome. To confirm the sex of samples and to predict sex when it was not listed in the associated metadata or publication, we employed an unsupervised clustering technique that classifies the sex of samples in microarray datasets using signal intensity values for probes that map unambiguously to Y chromosome genes (Buckberry et al., 2014a).
When limiting the results to genes measurable in at least three studies and with an FDR of <0.05, a total of 142 genes showed significant sex-biased expression. Of these 142 genes, 75 showed higher expression in placentas from female fetuses and 67 genes were more highly expressed in placentas from male fetuses (Fig. 1). At the FDR of 0.05, we expect 3.75 and 3.35 genes to be false positives in female and male groups, respectively. In the female group, 55 up-regulated genes were autosomal and 20 were X-linked. Of genes significantly up-regulated in the male group, 33 genes were expressed from the autosomes, 16 were expressed from the X chromosome and 18 were Y chromosome genes (Fig. 2). We do not consider the Y-linked genes to be differentially expressed; rather these genes are expressed at consistently detectable levels in placentas from male fetuses, and therefore may potentially influence placental phenotype.

Volcano plot showing pooled effect size and false discovery rate (FDR) P-values for 31 844 Ensembl genes when comparing sex-biased gene expression in the human placenta. Blue dots represent genes with significant male-biased expression and red dots are those with significant female-biased expression. Horizontal bars indicate the 95% confidence interval. Points represent genes detected in at least three studies.

Circos plot summarizing the meta-analysis of sex-biased gene expression in the human placenta. The outer-most scatterplot track depicts chromosomal location and FDR P-values). The red points represent genes with FDR P-values <0.05. The closer points are to the outside of the track, the higher the significance. The inner track is a loess smoothed line plot representing the number of datasets where information was available for each genomic region, ranging from 3 to 11 datasets. Gene labels for selected genes of significance are plotted outside the chromosome highlights. Circos plot was generated using an R implementation of Circos (Krzywinski et al., 2009; Zhang et al., 2013).
The majority of sex-biased genes were autosomal but, as expected, many were located on the sex chromosomes. The X-linked and autosomal genes with the highest level of significance were HDHD1 and CGB, respectively (Fig. 1). When inspecting the contribution of individual studies for autosomal gene expression bias, despite there being a lower magnitude of difference, the direction of change was consistent across datasets for many male and female-biased genes (Fig. 3). The results for all genes, the number of studies where they were measurable and the expression differences with statistics are provided in Supplementary data, File 1.

Forest plots showing the standardized mean difference between males and females for the most statistically significant X-linked gene HDHD1 (A) and autosomal gene CGB (B). Size of the blue box for each study is proportional to sample size; horizontal lines represent standard error. Yellow diamond represents the gene summary across all studies where the gene was detectable. GEO accession identifiers on the y-axis represent datasets.
When comparing these results with previous studies where sex-biased expression has been assessed in other human tissues, genes showing sex-biased expression appear to exhibit that bias with a high degree of tissue specificity. A vast majority of sex-biased genes in the human placenta are not observed to have sex-biased expression in human brain, liver or blood (Whitney et al., 2003; Zhang et al., 2011; Trabzuni et al., 2013) (Supplementary data, Fig. S1A). When comparing our results to studies where sex-biased expression was assessed in placental tissue or cells, many of the genes in this study have no previously reported sex expression bias (Sood et al., 2006; Cvitic et al., 2013) (Supplementary data, Fig. S1B).
Identification of potential transcriptional regulators of sex-biased gene expression
To predict TFs that may be involved in regulating sex-biased gene expression, we searched for conserved TFBSs in the 10 kb of DNA sequence up and downstream of the transcription start sites of sex-biased genes. This was done using oPOSSUM-3 and the JASPAR core motifs (Kwon et al., 2012; Mathelier et al., 2013). This analysis identified potential binding sites for 166 vertebrate TFs.
Since the results of this analysis are best interpreted using relative rankings (Kwon et al., 2012), we selected the TFs that ranked in the upper quartiles of both z-scores and Fisher scores (Supplementary data, Fig. S2), which limited the initial list to 14 TFs (Supplementary data, Table SI). In order to further investigate whether these TFs may be involved in regulating sex-biased gene expression, we checked if the genes encoding these TFs were expressed at detectable levels in the human term placenta using publicly available RNA-Seq data (Kim et al., 2012). In this comparison, expression data for nine of these TFs were available, with seven being expressed at detectable levels and comparable with human adult tissues expression (Fig. 4A and Supplementary data, Fig. S3).

(A) Transcription factors expressed in the human placenta that show enriched binding domains surrounding genes with sex-biased expression. (B) Top biological functions and canonical pathways associated with sex-biased gene expression in the human placenta. Functions and pathways were determined using Ingenuity Pathway Analysis.
Expression of MYCN is highest in placental tissue when compared with any of the adult tissues (Supplementary data, Fig. S3); this is also the gene that encodes the TF of highest significance in the TF-binding motif analysis (Supplementary data, Table SI). NKX3-1, which encodes a homeobox-containing TF, showed significant female expression bias in this meta-analysis and significant enrichment in the TF-binding motif analysis. NKX3-1 expression in the placenta is detectable and comparable with a majority of other adult tissues (Supplementary data, Fig. S3). NKX3-1 is a tumor suppressor and its expression appears to be strictly regulated by androgens and loss of its expression is associated with prostate cancer development (Meeks and Schaeffer, 2011). This suggests the NKX3-1 female expression bias observed in this study may be due to different androgen profiles in male and female placentas, which in turn may drive sex differences in the transcription of the numerous NKX3-1 target genes.
RXRA, which encodes a hypoxic responsive hormone receptor and TF, showed a consistent male expression bias in this study. Although falling just below our cut-off criteria for enriched TF-binding sites, the binding of RXRA in four different complexes with other proteins was detected in the enrichment analysis (Supplementary data, Fig. S2). In the mouse, RXRA knockout placentas exhibit multiple defects, and RXRA antagonists are known to be involved in stimulating human chorionic gonadotrophin (hCG) production through interaction with CGB gene promoters (Barak et al., 2008) (see results below). RXRA was also identified as a target of MYCN in the TF-binding motif analysis, suggesting the RXRA-encoded TF may be a significant player in defining the sex differences in gene transcription and placental function.
High-level molecular functions and pathways are associated with sex-biased genes
Since pathway analysis is a valuable tool in estimating gene function in different tissues and systems, we applied the list of sex-biased genes to search for molecular pathways and processes statistically enriched with sex-biased genes. Ingenuity Pathway Analysis showed that sex-biased genes are involved with high-level functions such as cellular movement, organ morphology and endocrine function (Fig. 4B). Among the top five canonical pathways associated with sex-biased genes were mTOR and VEGF signaling (Fig. 4B). The mTOR signaling pathway is a key regulator of cell growth and proliferation, and is activated during angiogenesis (Laplante and Sabatini, 2012). The VEGF pathway involves many genes implicated in angiogenesis, placental development and adverse pregnancy outcomes (Andraweera et al., 2012). These suggest that sex-biased expression of genes involved in these placental development pathways could potentially drive differential function of pathways involved in other key placental processes such as establishing the vascular architecture (angiogenesis) and the proliferation of placental cells.
The list of sex-biased genes was also enriched for genes involved in eIF2 and eIF4 signaling pathways (involving several X-linked genes), which are chiefly involved in regulating protein translation. Taken together, sex-biased genes appear to be involved in numerous high-level regulatory processes that could have a multi-factorial influence on developmental processes contributing to sex differences in placental function and hence fetal wellbeing.
Sex-biased expression of X-linked genes
In female mammals, one of the two X chromosomes is typically inactivated to compensate for gene dosage differences between the sexes (for review see refs Lee, 2011; Augui et al., 2011). However, some genes escape X-inactivation (XCI) and are expressed from both X chromosomes in females. Subsequently, those genes that escape XCI potentially contribute to sexually dimorphic traits.
Numerous studies have measured escape from XCI in human cells and tissues, although the extent of escape from XCI in extra-embryonic tissues, including the human placenta, remains controversial (Buckberry et al., 2014b). We detected 20 X-linked genes with significant female-biased expression, many of which appear to cluster in distinct chromosomal regions (Fig. 5). The most significant of these genes was HDHD1 (Fig. 3A), which encodes a phosphatase involved in the dephosphorylation of modified RNA nucleotides (Preumont et al., 2010). Additionally, the long non-coding RNAs XIST and JPX, which are known to be involved in the mechanisms giving rise to XCI (Augui et al., 2011; Lee, 2011) also showed significant female expression bias, as expected.

Sex-biased expression of X-linked genes in the human placenta. Red points indicate genes showing significantly higher expression in female samples and blue points represent genes expressed significantly higher in male samples. Heat map below plot represents the level of expression from the inactive X chromosome observed in Carrel and Willard (2005).
To assess whether escape from XCI may be the underlying cause of X-linked gene expression bias in this study, we compared our results with a previously published extensive profile of human XCI (Carrel and Willard, 2005) (Fig. 5). Of the 20 X-linked genes with female expression bias, XCI profiling information was available for 16, of which 11 had strong evidence of expression from the inactive X chromosome (Carrel and Willard, 2005). This suggests that this is most likely to be the primary cause of X-linked female expression bias. The female-biased X-linked genes are associated with several biological functions, including conversion of sulfated steroid precursors to estrogens (STS) and histone demethylation (KDM6A).
Additionally, we observed clusters of X-linked genes with male expression bias including five genes at the pseudo-autosomal Xp22.33 region and two genes at Xq22.1 in the ARMCX family (Fig. 5). The ARMCX3 and ARMCX6 genes are thought to have originated during the evolution of placental mammals and are known to be involved in mitochondrial regulation (López-Doménech et al., 2012).
Taken together, the X-linked genes comprise a considerable proportion of highly significant sex-biased genes detected in this study, and have biological functions relating to hormone regulation, and higher order regulatory mechanisms such as RNA modification and histone methylation. Given that the sex chromosomes define the difference between the sexes at a cellular level, sex chromosome genes with expression biases are clearly potential drivers or regulators of sex-biased autosomal gene expression.
LHB-CGB cluster genes show female expression bias
Among the sex-biased autosomal genes, the LHB-CGB cluster of seven genes on chromosome 19 showed the most significant female expression bias (Fig. 6). This contiguous cluster consists of the LHB gene that encodes the beta-subunit of luteinizing hormone (LH), four hCG beta-subunit coding genes (CGB, CGB5, CGB7 and CGB8) and two pseudogenes (CGB1 and CGB2) (Liina Nagirnaja, 2010). The four CGB genes encoding hCG beta-subunits can be grouped into two classes based on protein sequence: CGB, CGB5 and CGB8 encode identical amino acid sequences, while CGB7 encodes a variant peptide (Fig. 6 and Supplementary data, Fig. S4).

Female-biased expression of LHB and CGB cluster genes. Boxes represent mean expression difference for each gene and bars represent 95% confidence interval. FDR P-value <0.05 for all genes. Dendrogram shows the average distance between genes using percent identity of the amino acid sequences, and branch lengths represent the percentage mismatch between two nodes. Colored bars depict functional groupings; yellow represents LHB, green represents identical CGB protein isoforms, red represents pseudogenes and blue represents a divergent CGB isoform. Note that CGB, CGB5 and CGB8 have identical amino acid sequences.
The CGB-encoded hCG hormone is the important embryonic signal for maternal recognition of pregnancy in primates. Indeed, it is essential for the prolongation of corpus luteal function and hence progesterone synthesis until the placenta takes over. The many functions of hCG relating to placental growth, invasion, angiogenesis and the regulation of maternal immune tolerance of the placenta and fetus are well described (for reviews see Norris et al., 2011; Bansal et al., 2012). Lowered CGB expression in the placenta has also been observed in miscarriages, and is higher in ectopic, molar and growth-restricted pregnancies (McCarthy et al., 2007; Rull et al., 2008). The LHB-encoded LH is primarily expressed in the pituitary gland, and is widely known for its action in the gonads to induce sex steroid synthesis and gametogenesis (see Henke and Gromoll, 2008). However, LHB is also expressed at appreciable levels in the human placenta (Supplementary data, Fig. S5), which is a feature that appears to be conserved across therian mammals (Menzies et al., 2011).
Both hCG and LH hormones bind to the same transmembrane receptor (LHCGR), which is known to induce multiple signals including cyclic adenosine monophosphate (Ryu et al., 1998). hCG is also known to regulate VEGF and its receptors (Brouillet et al., 2012), which are heavily implicated in placental development and adverse pregnancy outcomes (Andraweera et al., 2012). Meta-analysis profiling of placental gene expression in pre-eclampsia indicates that up-regulation of LHB contributes to the gene expression signature of pre-eclampsia (Kleinrouweler et al., 2013), while up-regulation of LHB and CGB in the placenta are associated with intrauterine growth restriction (McCarthy et al., 2007).
Taken together, these results provide substantial evidence for female-biased expression of the hormone-coding LHB and CGB genes in the human placenta. This suggests that, through the actions of LHB and CGB genes, female fetuses may invest more in placental growth and vasculogenesis, while males invest these resources in body growth. Indeed, the ratio of birthweight to placental weight in male human infants is higher than for females (Edwards et al., 2000), suggesting that to maintain a high growth rate the male fetus extracts maximal nutrients from the placenta with little reserve capacity if adversity strikes. Perturbed expression of LHB and CGB is also associated with pre-eclampsia (Kleinrouweler et al., 2013) and intrauterine growth restriction (McCarthy et al., 2007) where placental pathology is implicated. This indicates that fetal sex-specific risks for these conditions could be partially attributable to differential regulation of gene networks involving these genes.
Conclusions
In this study, we have characterized the gene expression profiles of human male and female placentas from non-pathological term pregnancies. Using an integrative meta-analytical approach, we show that sex-biased gene expression is genome wide, with many genes showing sex-biased expression patterns not observed in other human tissues.
Female-biased expression of X-linked genes appears largely to be the result of escape from XCI, including genes with high-level regulatory functions. As the mechanisms regulating X chromosome regulation are non-hormonal, this is a clear demonstration of sex-biased gene expression that is not directly regulated by the sex hormones.
The results presented here also demonstrate sex-biased expression for many autosomal genes, including genes encoding the LH and hCG hormones. Given that LH and hCG have a potent ability in promoting placental growth and vasculogenesis, these results suggest that female fetuses invest more in extra-embryonic tissue development than males. Since mothers can allocate limited resources to a fetus in utero, these findings support the conjecture that males invest more resources in body growth and development (embryonic tissues) at the expense of investing less in the development of extra-embryonic tissues (Clifton, 2010; Eriksson et al., 2010). This may be a key reason as to why there is a male bias in the incidence of placental dysfunction (Murji et al., 2012) and in pregnancy complications where placental pathology is implicated (Vatten and Skjaerven, 2004; Di Renzo et al., 2007; Kleinrouweler et al., 2013).
This study has extended current knowledge surrounding sex-biased gene expression in the human placenta. Having observed widespread sex-biased gene expression in non-pathological tissues, and that the influence of sex is not always considered in gene expression studies, these results highlight the importance of the effect of sex in understanding the natural, sex-based gene expression differences in normal and pathological tissues. This consideration is crucial to begin elucidating the factors that may contribute to the etiology of developmental and chronic adult-onset diseases in which sex biases exist both in terms of incidence and severity.
Authors' roles
S.B. conceived and designed the study, carried out all bioinformatics and statistical analyses and wrote the manuscript. T.B.M. and S.J.B. were involved in study design, critical discussion and commented on the manuscript. G.A.D. provided critical discussion and commented on the manuscript. C.T.R. was involved in study design, critical discussion and wrote the manuscript.
Funding
S.B. is supported by a Supplementary Data and an Australian Postgraduate Award. T.B.-M. is supported by the Cancer Council SA and SAHMRI Beat Cancer Project (TBM APP1030945). C.T.R. is supported by a National Health and Medical Research Council (NHMRC) Senior Research Fellowship APP1020749 (http://www.nhmrc.gov.au). This project was funded in part by NHMRC Project APP1059120 awarded to C.T.R., T.B.-M. and S.J.B. The funders had no role in study design, analysis, decision to publish or preparation of the manuscript. Funding to pay the Open Access publication charges for this article was provided by NHMRC Project APP1059120.
Conflict of interest
None of the authors has any conflicts of interest to declare.
Acknowledgements
We wish to thank all of the individuals involved in collecting the primary data used in this meta-analysis and for making it publicly available.