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Included normal MCDA, sFGR placentas of type I and type III. Placental terminal villi maturity and syncytiotrophoblast (STB) ultrastructural features were assessed by immunohistochemistry and transmission electron microscopy. RNA sequencing identified differentially expressed genes, validated by quantitative polymerase chain reaction and enzyme\u2010linked immunosorbent assay. Functional studies using\n                    <jats:italic>HTRA4<\/jats:italic>\n                    \u2010overexpressing BeWo cells. Type III sFGR\u2010S placentas exhibited the most pronounced structural defects among the groups, including: diminished terminal villous maturity (manifested by reduced microvessel density and \u03b2\u2010HCG with thickened villous syncytial membrane), elevated STB autolysosomes, and placental lipid droplet accumulation.\n                    <jats:italic>HTRA4<\/jats:italic>\n                    was identified as a significantly upregulated gene in sFGR\u2010S placentas, with mRNA and protein levels highest in type III, and fold change significantly greater than in type I or normal MCDA. Functional experiments confirmed that\n                    <jats:italic>HTRA4<\/jats:italic>\n                    overexpression impaired syncytialization, disrupted autophagic flux, and altered lipid metabolism. This study reveals significant terminal villous hypoplasia and STB dysfunction in sFGR type III. HTRA4 upregulation mediates these abnormalities and reflects disease severity.\n                  <\/jats:p>","DOI":"10.1096\/fj.202503584rr","type":"journal-article","created":{"date-parts":[[2026,1,19]],"date-time":"2026-01-19T12:52:16Z","timestamp":1768827136000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Placental Pathology and HTRA4\u2010Mediated Autophagic Flux Disruption in Selective Fetal Growth Restriction Types I and III: A Morphological and Transcriptomic Study"],"prefix":"10.1096","volume":"40","author":[{"given":"Yuhong","family":"Lin","sequence":"first","affiliation":[{"name":"The International Peace Maternity and Child Health Hospital, School of Medicine Shanghai Jiao Tong University  Shanghai China"},{"name":"Shanghai Key Laboratory of Embryo Original Diseases  Shanghai 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