Trophoblastic cell fusion is one essential step of the human trophoblast differentiation pathway and is a multifactorial and dynamic process finely regulated and still poorly known. Disturbances of syncytiotrophoblast formation are observed in numerous pathological clinical conditions such as preeclampsia, intrauterine growth retardation and trisomy 21. In this review, we summarize current knowledge of the different membrane proteins directly involved in trophoblastic cell fusion, which we identified by using the physiological model of primary culture of villous trophoblastic cells. Connexin 43 and gap junctional intercellular communication point to the role of molecular exchanges through connexin channels preceding membrane fusion. Zona occludens-1, which can interact with connexin 43, is also directly involved in trophoblast fusion. The recently identified fusogenic membrane retroviral envelop glycoproteins syncytin 1 (encoded by the HERV-W gene) and syncytin 2 (encoded by the FRD gene) and their receptors are major factors involved in human placental development . We describe the increasing number of factors promoting or inhibiting trophoblast fusion and differentiation and emphasize the role of human chorionic gonadotropin (hCG) and its receptor. Indeed, in trisomy 21 the dynamic process leading to membrane fusion is impaired due to an abnormal hCG signaling. This abnormal trophoblast fusion and differentiation in trisomy 21-affected placenta is reversible in vitro. Trisomy 21 trophoblastic cell culture may therefore be useful to identify the possible large number of prerequisite factors involved in trophoblast fusion, the limiting step of trophoblast differentiation.KEY WORDS: connexin 43, syncytin, hCG, human placenta In the human placenta, the trophoblast differentiates along two major pathways both critical for normal placental functions (Benirschke and Kaufmann, 2000). In the extravillous trophoblast invasive pathway, the cytotrophoblastic cells of the anchoring villi in contact with the uterus wall proliferate, detach from the basement membrane and aggregate into multilayered columns of nonpolarized cells that invade the uterus wall (Fig.1). These cells, which compose the extravillous cytotrophoblast (ECT), invade the endometrium, the first third of the myometrium and the associated spiral arterioles. In the villous trophoblast pathway, the cytotrophoblastic cells (CT) of the floating villi proliferate, differentiate and fuse to form a syncytiotrophoblast (ST) that covers the entire surface of the villi (Fig.1). The syncytiotrophoblast layer plays a major role throughout pregnancy, since it is the site of numerous placental functions, including ion and nutrient exchange and the synthesis of steroid and peptide hormones required for fetal growth and development (Eaton and Contractor, Int. J. Dev. Biol. 54: 475-482 (2010)