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Quan N, Mara JN, Grover AR, Pavone ME, Duncan FE. Spatial Analysis of Growing Follicles in the Human Ovary to Inform Tissue Engineering Strategies. Tissue Eng Part A 2020; 26:733-746. [PMID: 32598235 DOI: 10.1089/ten.tea.2020.0051] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Cancer survivorship has increased considerably, but common cancer treatments may threaten female reproductive health and fertility. In females, standard fertility preservation techniques include egg and embryo banking and ovarian tissue cryopreservation, but these methods are not suitable for all individuals. Emerging fertility preservation technologies include in vitro follicle growth and ovarian bioprosthetics. Although these platforms hold tremendous promise, they remain in the preclinical phase likely because of our inability to adequately phenocopy the complexity of the in vivo ovarian environment. The goal of this study was to use an established research archive of fixed human ovarian tissue established through the Oncofertility Consortium to better understand the dynamics and milieu of growing follicles within the human ovary. We performed a histological analysis of the immediate surroundings of primary and secondary stage follicles. We evaluated oocyte and follicle diameters of these growing follicles, analyzed their growth trajectories, and mapped their precise relationships to other stage follicles within a defined area. We also stratified our findings according to participant age and previous treatment history. Our results serve as in vivo benchmarks for follicles grown in vitro and provide insight into how follicles should be seeded spatially within bioprosthetic ovaries, potentially improving the efficacy and clinical translation of these emerging technologies. Impact statement Life-preserving cancer treatments have greatly increased survivorship. However, treatments often have off-target health consequences that threaten female reproductive health and fertility. Although several standard fertility preservation options exist, there is a constant need to explore and expand options for all populations. In vitro follicle growth and ovarian bioprosthetics are new experimental procedures, which are currently limited to proof of concept. In this study, we analyzed human ovarian tissue from a deidentified biospecimen repository to characterize the growing follicle landscape with the ultimate goal of informing bioengineering practices. This spatial analysis pinpoints the geometry of growing follicles within the human ovary and provides a framework for paralleling this environment in ex vivo platforms.
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Affiliation(s)
- Natalie Quan
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Jamie N Mara
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Allison R Grover
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Mary Ellen Pavone
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Francesca E Duncan
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
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52
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Alborzi P, Jafari Atrabi M, Akbarinejad V, Khanbabaei R, Fathi R. Incorporation of arginine, glutamine or leucine in culture medium accelerates in vitro activation of primordial follicles in 1-day-old mouse ovary. ZYGOTE 2020; 28:1-8. [PMID: 32482183 DOI: 10.1017/s096719942000026x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
In vitro activation of primordial follicles provides cancer patients subjected to oncotherapy with a safe therapeutic strategy for fertility preservation, however a successful protocol for activation of primordial follicles in prepubertal patients has not yet been defined comprehensively. There is evidence that amino acids such as leucine, arginine and glutamine could stimulate the mammalian target of rapamycin (mTOR) pathway, which plays a pivotal role in primordial follicle activation. Nevertheless, there has been no report that elucidates the effect of these amino acids on in vitro development of ovarian follicles. Therefore, the present study was conducted to evaluate the effects of these amino acids and their combination on the formation and activation of primordial follicles in 1-day-old murine ovaries during an 11-day culture period. The experimental groups consisted of base medium (BM), base medium + arginine (ARG), base medium + glutamine (GLU), base medium + leucine (LEU) and base medium + a combination of arginine, glutamine and leucine (AGL). The proportions of different stages of ovarian follicles and gene expression of regulatory factors were assessed using histology and quantitative real-time PCR on days 5 and 11 of culture. The proportion of transitional and primary follicles was greater in all amino acid-treated groups compared with the BM group (P < 0.05). Moreover, leucine resulted in elevated expression of Gdf9 and Bmp15, and glutamine augmented the expression of Pi3k on day 11 of culture. In conclusion, the present study showed that inclusion of leucine, glutamine, arginine or their combination in the culture medium for murine ovarian tissue could accelerate the activation of primordial follicles and alter the expression of the corresponding factors.
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Affiliation(s)
- Parimah Alborzi
- Department of Embryology, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Mohammad Jafari Atrabi
- Department of Embryology, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Vahid Akbarinejad
- Department of Theriogenology, Faculty of Veterinary Medicine, University of Tehran, Tehran, Iran
| | - Ramezan Khanbabaei
- Department of Biology, Qaemshahr Branch, Islamic Azad University, Qaemshahr, Iran
| | - Rouhollah Fathi
- Department of Embryology, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
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53
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Lopes EPF, Rodrigues GQ, de Brito DCC, Rocha RMP, Ferreira ACA, de Sá NAR, Silva RFD, de Alcântara GLH, Alves BG, Figueiredo JRD, Zelinski M, Rodrigues APR. Vitrification of caprine secondary and early antral follicles as a perspective to preserve fertility function. Reprod Biol 2020; 20:371-378. [PMID: 32418820 DOI: 10.1016/j.repbio.2020.05.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 04/28/2020] [Accepted: 05/03/2020] [Indexed: 01/09/2023]
Abstract
The present study aimed to evaluate the structure, survival and development of isolated caprine (secondary-SEC and early antral-EANT) follicles, after vitrification in the presence of synthetic polymers and in vitro culture. Additionally, transzonal projections (TZPs) and p450 aromatase enzyme were evaluated. After isolation, SEC and EANT follicles were in vitro cultured for six days or vitrified. After one week, SEC and EANT follicles were warmed and also in vitro cultured for six days. Data revealed that the percentage of morphologically normal follicles was similar between fresh and vitrified follicles in both follicular categories and antrum formation rate was similar between fresh and vitrified SEC follicles. Fluorescence by calcein-AM did not show difference between fresh and vitrified (SEC and EANT) follicles, however, the trypan blue test showed low viability for vitrified follicles. The integrity of TZPs was not affected between fresh and vitrified SEC follicles, however, in vitrified EANT follicles, there were signs of TZPs loss. Regarding steroidogenic function, it was observed a positive staining for p450 aromatase enzyme in fresh and vitrified SEC and EANT follicles. It was concluded that SEC follicles seem to be more resistant to vitrification than EANT follicles, as shown by the trypan blue test and TZPs assay. Future studies may confirm this hypothesis, in order to consolidate the use of SEC and EANT follicles as an alternative to ovary cryopreservation.
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Affiliation(s)
- Everton Pimentel Ferreira Lopes
- Faculty of Veterinary Medicine, Laboratory of Manipulation of Oocytes and Preantral Follicles (LAMOFOPA), State University of Ceará, Fortaleza, CE, Brazil
| | - Giovanna Quintino Rodrigues
- Faculty of Veterinary Medicine, Laboratory of Manipulation of Oocytes and Preantral Follicles (LAMOFOPA), State University of Ceará, Fortaleza, CE, Brazil
| | - Danielle Cristina Calado de Brito
- Faculty of Veterinary Medicine, Laboratory of Manipulation of Oocytes and Preantral Follicles (LAMOFOPA), State University of Ceará, Fortaleza, CE, Brazil
| | | | - Anna Clara Accioly Ferreira
- Faculty of Veterinary Medicine, Laboratory of Manipulation of Oocytes and Preantral Follicles (LAMOFOPA), State University of Ceará, Fortaleza, CE, Brazil
| | - Naíza Arcângela Ribeiro de Sá
- Faculty of Veterinary Medicine, Laboratory of Manipulation of Oocytes and Preantral Follicles (LAMOFOPA), State University of Ceará, Fortaleza, CE, Brazil
| | - Renato Félix da Silva
- Faculty of Veterinary Medicine, Laboratory of Manipulation of Oocytes and Preantral Follicles (LAMOFOPA), State University of Ceará, Fortaleza, CE, Brazil
| | - Gabriel Las Heras de Alcântara
- Faculty of Veterinary Medicine, Laboratory of Manipulation of Oocytes and Preantral Follicles (LAMOFOPA), State University of Ceará, Fortaleza, CE, Brazil
| | | | - José Ricardo de Figueiredo
- Faculty of Veterinary Medicine, Laboratory of Manipulation of Oocytes and Preantral Follicles (LAMOFOPA), State University of Ceará, Fortaleza, CE, Brazil
| | - Mary Zelinski
- Division of Reproductive and Developmental Sciences, Oregon National Primate Research Center, Beaverton, OR, USA
| | - Ana Paula Ribeiro Rodrigues
- Faculty of Veterinary Medicine, Laboratory of Manipulation of Oocytes and Preantral Follicles (LAMOFOPA), State University of Ceará, Fortaleza, CE, Brazil.
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54
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Simon LE, Kumar TR, Duncan FE. In vitro ovarian follicle growth: a comprehensive analysis of key protocol variables†. Biol Reprod 2020; 103:455-470. [PMID: 32406908 DOI: 10.1093/biolre/ioaa073] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Revised: 05/06/2020] [Accepted: 05/12/2020] [Indexed: 12/18/2022] Open
Abstract
Folliculogenesis is a complex process that requires integration of autocrine, paracrine, and endocrine factors together with tightly regulated interactions between granulosa cells and oocytes for the growth and survival of healthy follicles. Culture of ovarian follicles is a powerful approach for investigating folliculogenesis and oogenesis in a tightly controlled environment. This method has not only enabled unprecedented insight into the fundamental biology of follicle development but also has far-reaching translational applications, including in fertility preservation for women whose ovarian follicles may be damaged by disease or its treatment or in wildlife conservation. Two- and three-dimensional follicle culture systems have been developed and are rapidly evolving. It is clear from a review of the literature on isolated follicle culture methods published over the past two decades (1980-2018) that protocols vary with respect to species examined, follicle isolation methods, culture techniques, culture media and nutrient and hormone supplementation, and experimental endpoints. Here we review the heterogeneity among these major variables of follicle culture protocols.
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Affiliation(s)
- Leah E Simon
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - T Rajendra Kumar
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.,Department of Obstetrics and Gynecology, University of Colorado, Aurora, Colorado, USA
| | - Francesca E Duncan
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
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55
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Rodriguez-Wallberg KA, Anastacio A, Vonheim E, Deen S, Malmros J, Borgström B. Fertility preservation for young adults, adolescents, and children with cancer. Ups J Med Sci 2020; 125:112-120. [PMID: 32356507 PMCID: PMC7721046 DOI: 10.1080/03009734.2020.1737601] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Options for fertility preservation (FP) through cryopreservation methods are currently available for young adults, adolescents, and children. Guidelines for FP have been provided by international clinical societies, and emergency procedures aimed at FP have been implemented into clinical practice worldwide. In this article, we review the current data on clinical standards of emergency FP in patients who are facing gonadotoxic effects of cancer treatment, and we also describe the methods that are still under development, usually denoted as experimental. In Sweden, programmes for FP have been established at large university hospitals, thus covering the whole country. The Swedish publicly financed health care covers both assisted reproduction for treatment of infertility and the cryopreservation of gametes or gonadal tissue when there is a medical indication, such as the risk to become infertile due to oncologic treatment; hence the access to FP is ensured for the whole population. At our centre at Karolinska University Hospital in Stockholm, methods for FP have been offered since 1988. In this article, we also review the oncologic indications for FP in our patient cohort of >3000 individuals during the period 1988-2018.
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Affiliation(s)
- Kenny A. Rodriguez-Wallberg
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
- Division of Gynecology and Reproduction, Department of Reproductive Medicine, Karolinska University Hospital, Stockholm, Sweden
- CONTACT Kenny A. Rodriguez-Wallberg Division of Gynecology and Reproduction, Department of Reproductive Medicine, Karolinska University Hospital Huddinge, StockholmSE-141 86, Sweden
| | - Amandine Anastacio
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Emelie Vonheim
- Division of Gynecology and Reproduction, Department of Reproductive Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Sandra Deen
- Division of Gynecology and Reproduction, Department of Reproductive Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Johan Malmros
- Department of Pediatric Oncology, Karolinska University Hospital, Stockholm, Sweden
| | - Birgit Borgström
- Department of Pediatric Endocrinology, Karolinska University Hospital, Stockholm, Sweden
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56
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Asaduzzaman M, Rodgers RJ, Young FM. Quantification of viable granulosa cells in murine ovarian follicles. Biotech Histochem 2020; 95:540-554. [PMID: 32208854 DOI: 10.1080/10520295.2020.1734659] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Ovarian follicle growth and oocyte maturation depend on the viability of granulosa cells (GC). We quantified GC in whole mouse follicles. Single follicles were isolated from adult mouse ovaries and stained with DAPI or Live-Dead stain before fixation. An objective image analysis protocol for counting fluorescent labeled GC was developed that used Image J software to measure GC cytoplasmic and nuclear areas. These data were compared to the number of GC obtained by disaggregating 96 follicles with enzymes to produce a suspension of GC, which then was stained with trypan blue and assessed using a hemocytometer. We found a linear relation between GC/follicle and follicle diameter. Viability of GC/follicle ranged from 40 ± 11 to 72 ± 7%. The coefficient of variation for image analysis of DAPI stained GC by different assessors was 4%, but the number of GC obtained from image analysis was approximately 50% less than from disaggregated follicles. The number of GC in intact mouse follicles was greater than the number reported earlier for fixed ovarian sections. We found that the number of GC was less in fluorescence labeled follicles; it is possible that the three-dimensional structure of the intact follicles obscured the fluorescent signal. Direct quantification of viable GC isolated from follicles appears to be the most accurate method.
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Affiliation(s)
- M Asaduzzaman
- Department of Medical Biotechnology, Flinders University , Adelaide, Australia
| | - R J Rodgers
- Robinson Research Institute, Medicine, University of Adelaide , Adelaide, Australia
| | - F M Young
- Department of Medical Biotechnology, Flinders University , Adelaide, Australia
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57
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Maidarti M, Anderson RA, Telfer EE. Crosstalk between PTEN/PI3K/Akt Signalling and DNA Damage in the Oocyte: Implications for Primordial Follicle Activation, Oocyte Quality and Ageing. Cells 2020; 9:E200. [PMID: 31947601 PMCID: PMC7016612 DOI: 10.3390/cells9010200] [Citation(s) in RCA: 91] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 01/06/2020] [Accepted: 01/13/2020] [Indexed: 12/18/2022] Open
Abstract
The preservation of genome integrity in the mammalian female germline from primordial follicle arrest to activation of growth to oocyte maturation is fundamental to ensure reproductive success. As oocytes are formed before birth and may remain dormant for many years, it is essential that defence mechanisms are monitored and well maintained. The phosphatase and tensin homolog of chromosome 10 (PTEN)/phosphatidylinositol 3-kinase (PI3K)/protein kinase B (PKB, Akt) is a major signalling pathway governing primordial follicle recruitment and growth. This pathway also contributes to cell growth, survival and metabolism, and to the maintenance of genomic integrity. Accelerated primordial follicle activation through this pathway may result in a compromised DNA damage response (DDR). Additionally, the distinct DDR mechanisms in oocytes may become less efficient with ageing. This review considers DNA damage surveillance mechanisms and their links to the PTEN/PI3K/Akt signalling pathway, impacting on the DDR during growth activation of primordial follicles, and in ovarian ageing. Targeting DDR mechanisms within oocytes may be of value in developing techniques to protect ovaries against chemotherapy and in advancing clinical approaches to regulate primordial follicle activation.
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Affiliation(s)
- Mila Maidarti
- MRC Centre for Reproductive Health, Queens Medical Research Institute, University of Edinburgh, Edinburgh EH16 4TJ, UK; (M.M.); (R.A.A.)
- Institute of Cell Biology, University of Edinburgh, Edinburgh EH9 3FF, UK
- Obstetrics and Gynaecology Department, Faculty of Medicine, Universitas Indonesia, Jakarta 10430, Indonesia
| | - Richard A. Anderson
- MRC Centre for Reproductive Health, Queens Medical Research Institute, University of Edinburgh, Edinburgh EH16 4TJ, UK; (M.M.); (R.A.A.)
| | - Evelyn E. Telfer
- Institute of Cell Biology, University of Edinburgh, Edinburgh EH9 3FF, UK
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58
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Kamalidehghan B, Habibi M, Afjeh SS, Shoai M, Alidoost S, Almasi Ghale R, Eshghifar N, Pouresmaeili F. The Importance of Small Non-Coding RNAs in Human Reproduction: A Review Article. APPLICATION OF CLINICAL GENETICS 2020; 13:1-11. [PMID: 32021379 PMCID: PMC6956659 DOI: 10.2147/tacg.s207491] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 12/04/2019] [Indexed: 12/14/2022]
Abstract
Background MicroRNAs (miRNA) play a key role in the regulation of gene expression through the translational suppression and control of post-transcriptional modifications. Aim Previous studies demonstrated that miRNAs conduct the pathways involved in human reproduction including maintenance of primordial germ cells (PGCs), spermatogenesis, oocyte maturation, folliculogenesis and corpus luteum function. The association of miRNA expression with infertility, polycystic ovary syndrome (PCOS), premature ovarian failure (POF), and repeated implantation failure (RIF) was previously revealed. Furthermore, there are evidences of the importance of miRNAs in embryonic development and implantation. Piwi-interacting RNAs (piRNAs) and miRNAs play an important role in the post-transcriptional regulatory processes of germ cells. Indeed, the investigation of small RNAs including miRNAs and piRNAs increase our understanding of the mechanisms involved in fertility. In this review, the current knowledge of microRNAs in embryogenesis and fertility is discussed. Conclusion Further research is necessary to provide new insights into the application of small RNAs in the diagnosis and therapeutic approaches to infertility.
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Affiliation(s)
- Behnam Kamalidehghan
- Department of Medical Genetics, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohsen Habibi
- Central Laboratory, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sara S Afjeh
- Department of Medical Genetics, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maryam Shoai
- Department of Molecular Neuroscience, UCL Institute of Neurology, London, UK
| | - Saeideh Alidoost
- Department of Biology, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | - Rouzbeh Almasi Ghale
- Department of Biology, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | - Nahal Eshghifar
- Department of Cellular and Molecular Biology, Faculty of Advanced Science and Technology, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran and Men's Health and Reproductive Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farkhondeh Pouresmaeili
- Department of Medical Genetics, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Men's Health and Reproductive Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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59
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Albertini DF. Prospects for new oocyte-based assisted reproduction in animals and humans. Reprod Fertil Dev 2020; 32:7-10. [DOI: 10.1071/rd19271] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Procuring high-quality oocytes is the rate-limiting step for assisted reproduction technologies intended for embryo production. Although much is known about the intraovarian processes that dictate oocyte growth and maturation, subtleties in the process of oogenesis have yet to be replicated in invitro systems. In contrast with the mouse, in which functional oocytes have been derived from stem cells under ex vivo conditions, the generation of developmentally competent oocytes in other species has yet to be achieved. This paper reviews the principles and practices based on stem cell and organ culture strategies that hold promise for developing a technological base upon which future efforts to recapitulate or augment oogenesis in mammals could be realised.
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60
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Yang Q, Zhu L, Jin L. Human Follicle in vitro Culture Including Activation, Growth, and Maturation: A Review of Research Progress. Front Endocrinol (Lausanne) 2020; 11:548. [PMID: 32849312 PMCID: PMC7431469 DOI: 10.3389/fendo.2020.00548] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 07/06/2020] [Indexed: 01/23/2023] Open
Abstract
Fertility preservation has received unprecedented attention nowadays. In addition to cryopreservation and re-implantation of embryos, oocytes, and ovarian tissue pieces, in vitro culture system for follicles/oocytes has been considered as an alternative strategy for fertility preservation. Since the metabolic dynamics and required nutrients are not entirely the same in different stages of follicular development, optimization of each culture step is needed. In this paper, literature regarding culture conditions in three steps were analyzed. Known additives in activation stage included 740Y-P, bpV(HOpic), follicle stimulating hormone (FSH), human serum albumin (HSA), ITS, growth differentiation factor 9 (GDF9), bone morphogenetic protein 15 (BMP15), and cyclic adenosine monophosphate (cAMP), with different degrees of activation promotion and potential detrimental effect on DNA integrity. For isolated follicles growth stage, actin A, FSH, basic fibroblast growth factor (bFGF), estradiol were proved to improve development or proliferation. As for maturation, addition of growth hormone, melatonin, C-type natriuretic peptide (CNP), GDF9, cilostamide, or forskolin helped to regulate maturation rate or improve oocyte quality. Based on previous sequential culture system for human follicles, optimization is needed to achieve higher maturation rate and better oocyte quality, pursuant to current review, which demonstrated the effects of various additives on different stages.
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61
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Wiweko B, Soebijanto S, Boediono A, Mansyur M, Siregar NC, Suryandari DA, Aulia A, Djuwantono T, Affandi B. Survival of isolated human preantral follicles after vitrification: Analyses of morphology and Fas ligand and caspase-3 mRNA expression. Clin Exp Reprod Med 2019; 46:152-165. [PMID: 31813207 PMCID: PMC6919210 DOI: 10.5653/cerm.2019.00143] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 07/15/2019] [Indexed: 11/16/2022] Open
Abstract
Objective This study aimed to examine the effect of vitrification on apoptosis and survival in human preantral follicles after thawing. Methods This experimental study was conducted at an acute tertiary care hospital from March 2012 to April 2013. Ovaries were sliced into 5×5×1-mm pieces and divided into the following three groups: preantral follicle isolation, ovarian tissue vitrification-warming followed by follicle isolation, and immunohistochemistry of fresh ovarian tissue. For statistical analyses, the Student t-test, chi-square test, Kruskal-Wallis test, and Kaplan-Meier survival analysis were used. Results A total of 161 preantral follicles (70% secondary) were collected from ovarian cortex tissue of six women between 30 and 37 years of age who underwent oophorectomy due to cervical cancer or breast cancer. There were no significant differences in the follicular morphology of fresh preantral follicles and vitrified follicles after thawing. The mean Fas ligand (FasL) mRNA expression level was 0.43±0.20 (relative to β-actin) in fresh preantral follicles versus 0.51±0.20 in vitrified follicles (p=0.22). The mean caspase-3 mRNA expression level in fresh preantral follicles was 0.56±0.49 vs. 0.27±0.21 in vitrified follicles (p=0.233). One vitrified-thawed secondary follicle grew and developed to an antral follicle within 6 days of culture. Conclusion Vitrification did not affect preantral follicle morphology or mRNA expression of the apoptosis markers FasL and caspase-3. Further studies are required to establish whether vitrification affects the outcomes of in vitro culture and the maturation of preantral follicles.
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Affiliation(s)
- Budi Wiweko
- Department of Obstetrics and Gynecology, Dr. Cipto Mangunkusumo General Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia.,Indonesian Medical Education and Research Institute (IMERI), Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Soegiharto Soebijanto
- Department of Obstetrics and Gynecology, Dr. Cipto Mangunkusumo General Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | | | - Muchtaruddin Mansyur
- Department of Public Health, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Nuryati C Siregar
- Department of Pathology Anatomy, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Dwi Anita Suryandari
- Department of Biology, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Ahmad Aulia
- Department of Histology, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Tono Djuwantono
- Department of Obstetrics and Gynecology, Dr. Hasan Sadikin Hospital, Faculty of Medicine Universitas Padjajaran, Bandung, Indonesia
| | - Biran Affandi
- Department of Obstetrics and Gynecology, Dr. Cipto Mangunkusumo General Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
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62
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Correia HHV, Lima LF, Sousa FGC, Ferreira ACA, Cadenas J, Paes VM, Alves BG, Shikanov A, Figueiredo JR. Activation of goat primordial follicles in vitro: Influence of alginate and ovarian tissue. Reprod Domest Anim 2019; 55:105-109. [PMID: 31661715 DOI: 10.1111/rda.13582] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 09/27/2019] [Accepted: 10/22/2019] [Indexed: 12/01/2022]
Abstract
The present study aimed to evaluate the effect of three culture systems on caprine primordial follicle activation in vitro: follicles cultured either in the isolated form within alginate (Isolated follicles + Alginate treatment), or enclosed in ovarian tissue (in situ), with or without alginate (Fragment + Alginate, and Fragment alone treatments, respectively). After culture, the Isolated follicles + Alginate treatment presented a percentage of morphologically normal follicles (MNF) similar to both the non-cultured control and the Fragment Alone treatments. Nevertheless, Fragment + Alginate treatment showed a significant reduction in the number of MNF when compared to the other treatments. Regarding follicle development, our results showed that regardless of the alginate, the presence of ovarian tissue limited primordial follicle activation during in vitro culture. Remarkably, the Isolated primordial follicle + Alginate treatment was the only one that significantly promoted follicle activation and increased both follicle and oocyte diameters during IVFC, pointing out a higher cell proliferation. In conclusion, the presence of ovarian tissue with or without alginate limited follicle development (activation) after culture. Nevertheless, when primordial follicles were isolated and encapsulated in alginate they presented suitable survival rates, higher rates of follicle activation and continued to grow throughout the culture period.
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Affiliation(s)
- Hudson H V Correia
- Laboratory of Manipulation of Oocytes and Preantral Follicles (LAMOFOPA), State University of Ceará, Fortaleza, Brazil
| | - Laritza F Lima
- Laboratory of Manipulation of Oocytes and Preantral Follicles (LAMOFOPA), State University of Ceará, Fortaleza, Brazil
| | - Francisca Geovania C Sousa
- Laboratory of Manipulation of Oocytes and Preantral Follicles (LAMOFOPA), State University of Ceará, Fortaleza, Brazil
| | - Anna Clara A Ferreira
- Laboratory of Manipulation of Oocytes and Preantral Follicles (LAMOFOPA), State University of Ceará, Fortaleza, Brazil
| | - Jesus Cadenas
- Laboratory of Manipulation of Oocytes and Preantral Follicles (LAMOFOPA), State University of Ceará, Fortaleza, Brazil
| | - Victor M Paes
- Laboratory of Manipulation of Oocytes and Preantral Follicles (LAMOFOPA), State University of Ceará, Fortaleza, Brazil
| | - Benner G Alves
- Laboratory of Manipulation of Oocytes and Preantral Follicles (LAMOFOPA), State University of Ceará, Fortaleza, Brazil
| | - Ariella Shikanov
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
| | - José Ricardo Figueiredo
- Laboratory of Manipulation of Oocytes and Preantral Follicles (LAMOFOPA), State University of Ceará, Fortaleza, Brazil
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Salama M, Anazodo A, Woodruff TK. Preserving fertility in female patients with hematological malignancies: a multidisciplinary oncofertility approach. Ann Oncol 2019; 30:1760-1775. [PMID: 31418765 DOI: 10.1093/annonc/mdz284] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/09/2023] Open
Abstract
Oncofertility is a new interdisciplinary field at the intersection of oncology and reproductive medicine that expands fertility options for young cancer patients. The most common forms of hematological malignancies that occur in girls and young women and therefore necessitate oncofertility care are acute lymphocytic leukemia, acute myeloid leukemia, non-Hodgkin's lymphoma, and Hodgkin's lymphoma. Aggressive gonadotoxic anticancer regimens including alkylating chemotherapy and total body irradiation are used often in treating girls and young women with hematological malignancies. The risks of gonadotoxicity and subsequent iatrogenic premature ovarian insufficiency and fertility loss depend mainly on the type and stage of the disease, dose of anticancer therapy as well as the age of the patient at the beginning of treatment. To avoid or at least mitigate the devastating complications of anticancer therapy-induced gonadotoxicity, effective and comprehensive strategies that integrate different options for preserving and restoring fertility ranging from established to experimental strategies should be offered before, during, and after chemotherapy or radiotherapy. A multidisciplinary approach that involves strong coordination and collaboration between hemato-oncologists, gynecologists, reproductive biologists, research scientists, and patient navigators is essential to guarantee high standard of care.
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Affiliation(s)
- M Salama
- Department of Obstetrics and Gynecology, Feinberg School of Medicine-Northwestern University, Chicago, USA
| | - A Anazodo
- Kids Cancer Centre, Sydney Children's Hospital, Sydney, Australia; Nelune Cancer Centre, Prince of Wales Hospital, Sydney, Australia; School of Women's and Children's Health, University of New South Wales, Sydney, Australia
| | - T K Woodruff
- Department of Obstetrics and Gynecology, Feinberg School of Medicine-Northwestern University, Chicago, USA.
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Grosbois J, Vermeersch M, Devos M, Clarke HJ, Demeestere I. Ultrastructure and intercellular contact-mediated communication in cultured human early stage follicles exposed to mTORC1 inhibitor. Mol Hum Reprod 2019; 25:706-716. [DOI: 10.1093/molehr/gaz053] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 08/21/2019] [Indexed: 12/20/2022] Open
Abstract
Abstract
The reproductive lifespan of a woman is determined by the gradual recruitment of quiescent follicles into the growing pool. In humans, ovarian tissue removal from its in vivo environment induces spontaneous activation of resting follicles. Similarly, pharmacological activation of the PI3K/Akt pathway leads to accelerated follicle recruitment, but has been associated with follicular damage. Recent findings demonstrate that everolimus (EVE), an mTORC1 inhibitor, limits primordial follicle activation. However, its potential benefit regarding growing follicle integrity remains unexplored. Ovarian cortical fragments were exposed to ± EVE for 24 h and cultured for an additional 5 days. After 0, 1 and 6 days of culture, fragments were either processed for ultrastructural analysis or subjected to follicular isolation for gene expression and immunofluorescence assessments. Data from transmission electron microscopy showed that growing follicles displayed similar ultrastructural features irrespective of the conditions and maintained close contacts between germinal and stromal compartments. Establishment of intra-follicular communication was confirmed by detection of a gap junction component, Cx43, in both groups throughout culture, whereas transzonal projections, which physically link granulosa cells to oocyte, formed later in EVE-treated follicles. Importantly, levels of GJA1 mRNA, encoding for the Cx43 protein, significantly increased from Day 0 to Day 1 in the EVE group, but not in the control group. Given that EVE-treated follicles were smaller than controls, these findings suggest that EVE might facilitate the establishment of appropriate intercellular communications without impairing follicle ultrastructure. Therefore, mTORC1 inhibitors might represent an attractive tool to delay the culture-induced primordial follicle activation while maintaining follicles in a functionally integrated state.
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Affiliation(s)
- J Grosbois
- Research Laboratory in Human Reproduction, Université Libre de Bruxelles, Brussels, Belgium
| | - M Vermeersch
- Center for Microscopy and Molecular Imaging (CMMI), Université Libre de Bruxelles, Gosselies, Belgium
| | - M Devos
- Research Laboratory in Human Reproduction, Université Libre de Bruxelles, Brussels, Belgium
| | - H J Clarke
- Department of Obstetrics and Gynecology, Biology, and Experimental Medicine, McGill University, McGill University Health Centre Research Institute, Montreal, Quebec, Canada
| | - I Demeestere
- Research Laboratory in Human Reproduction, Université Libre de Bruxelles, Brussels, Belgium
- Obstetrics and Gynecology Department, Erasme Hospital, Brussels, Belgium
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Pretalli JB, Frontczak Franck S, Pazart L, Roux C, Amiot C. Development of Ovarian Tissue Autograft to Restore Ovarian Function: Protocol for a French Multicenter Cohort Study. JMIR Res Protoc 2019; 8:e12944. [PMID: 31573931 PMCID: PMC6802486 DOI: 10.2196/12944] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 06/24/2019] [Accepted: 07/21/2019] [Indexed: 12/13/2022] Open
Abstract
Background Sterility is a major late effect of radiotherapy and chemotherapy treatments. Iatrogenic sterility is often permanent and greatly impacts long-term quality of life. Ovarian tissue cryopreservation (OTC) performed before gonadotoxic treatments with subsequent autograft is a method of fertility preservation available for girls and women. Its application in prepubertal girls is of particular value as it is the only possible approach in this patient group. In addition, it does not require a delay in cancer therapy and no ovarian stimulation is needed. Objective The primary aim of this protocol is to help increase the implementation of ovarian tissue autografting in France. Knowledge is still lacking regarding the efficacy of ovarian transplantation in restoring ovarian function and regarding the safety of this procedure, especially the risk of cancer cell reseeding in certain types of cancer. A secondary aim of this study is to generate data to improve our understanding of these two essential aspects. Methods The DATOR (Development of Ovarian Tissue Autograft in Order to Restore Ovarian Function) study is ongoing in 17 university hospitals. The DATOR protocol includes the autograft of ovarian cortex fragments. Candidates are identified from an observational prospective cohort (called the Prospective Cohort of Patients Candidates for Ovarian Tissue Autograft [PERIDATOR]) of patients who have undergone OTC. Enrollment in the study is initiated at the patient’s request and must be validated by the center’s multidisciplinary team and by the study steering committee. The DATOR study begins with a total medical checkup. Ovarian tissue qualification and residual disease detection, if required, are performed. Results The study is ongoing. Currently, 38 patients have provided informed consent and have been entered into the DATOR study. Graft has been performed for 34 of these patients. An interim analysis was conducted on the first 25 patients for whom the period of at least 1 year posttransplantation was achieved. Out of these 25 patients, 11 women succeeded in becoming pregnant (pregnancy rate=44% [11/25]; delivery rate=40% [10/25]). Among these, 6 women conceived twice, and 1 pregnancy led to a miscarriage. Conclusions Our preliminary analysis appears to be coherent with the accumulating body of evidence indicating the potential utility of ovarian tissue autograft for patients with premature ovarian failure. All these elements justify the pursuit of our study. Trial Registration ClinicalTrials.gov NCT02846064; https://clinicaltrials.gov/ct2/show/NCT02846064 International Registered Report Identifier (IRRID) DERR1-10.2196/12944
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Affiliation(s)
- Jean-Baptiste Pretalli
- INSERM CIC 1431, Centre d'Investigation Clinique, Centre Hospitalier Universitaire de Besançon, Besançon, France.,Department of Reproductive Medicine and Biology, Cryobiology, University Hospital of Besançon, Besançon, France
| | - Sophie Frontczak Franck
- Department of Reproductive Medicine and Biology, Cryobiology, University Hospital of Besançon, Besançon, France
| | - Lionel Pazart
- INSERM CIC 1431, Centre d'Investigation Clinique, Centre Hospitalier Universitaire de Besançon, Besançon, France.,EA481 - Integrative and Clinical Neuroscience Laboratory, University Bourgogne Franche-Comté, Besançon, France
| | - Christophe Roux
- INSERM CIC 1431, Centre d'Investigation Clinique, Centre Hospitalier Universitaire de Besançon, Besançon, France.,Department of Reproductive Medicine and Biology, Cryobiology, University Hospital of Besançon, Besançon, France.,INSERM, Établissement Français du Sang Bourgogne Franche-Comté, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, University Bourgogne Franche-Comté, Besançon, France
| | - Clotilde Amiot
- INSERM CIC 1431, Centre d'Investigation Clinique, Centre Hospitalier Universitaire de Besançon, Besançon, France.,Department of Reproductive Medicine and Biology, Cryobiology, University Hospital of Besançon, Besançon, France.,INSERM, Établissement Français du Sang Bourgogne Franche-Comté, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, University Bourgogne Franche-Comté, Besançon, France
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Blumenfeld Z. Fertility Preservation in Women With Malignancy: Future Endeavors. CLINICAL MEDICINE INSIGHTS. REPRODUCTIVE HEALTH 2019; 13:1179558119872490. [PMID: 31548799 PMCID: PMC6743198 DOI: 10.1177/1179558119872490] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 08/07/2019] [Indexed: 12/13/2022]
Abstract
The area of fertility preservation is constantly developing. To date, the only
noninvestigational and unequivocally accepted methods for fertility preservation
are cryopreservation of embryos and unfertilized oocytes. This article is one of
several in a monogram on fertility preservation. The debate, pros and cons, and
equivocal data on the use of GnRH analogues for fertility preservation are
elaborated by 3 other manuscripts, in this monogram. A repeat of the arguments,
pros and cons of this debatable issue, would be a repetition and redundancy of
what is already included in this monogram. The subject of ovarian
cryopreservation for fertility preservation is also elaborated by several other
authors in this monogram. It is possible that, in the not too far future, the
technologies of in vitro maturation of primordial follicles to metaphase 2
oocytes, and the “artificial ovary,” will turn clinically available. These
technologies may bypass the risk of resuming malignancy by autotransplantation
of cryopreserved-thawed ovarian tissue in leukemia and diseases where malignant
cells may persist in the cryopreserved ovarian tissue. We summarize here the
suggested options for future endeavors in fertility preservation.
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Affiliation(s)
- Zeev Blumenfeld
- Reproductive Endocrinology, Ob/Gyn, Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
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67
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Ma L, Wang L, Gao H, Liu N, Zheng Y, Gao Y, Liu S, Jiang Z. Hypoxia Limits the Growth of Bovine Follicles in Vitro by Inhibiting Estrogen Receptor α. Animals (Basel) 2019; 9:ani9080551. [PMID: 31412668 PMCID: PMC6721027 DOI: 10.3390/ani9080551] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 08/05/2019] [Accepted: 08/10/2019] [Indexed: 11/16/2022] Open
Abstract
Simple Summary It is well documented that a hypoxic environment at high altitudes decreased the fertility of female domestic animals because of embryonic or fetal losses, intrauterine growth restriction, and birth weight reduction. However, little study has been performed on for the effects of hypoxia on bovine ovary function. In this study, we found that the hypoxia plays an important role in regulating follicular survival and genes expression. Hypoxia limits the growth of bovine follicles cultured in vitro through inhibition of ERα, which could provide useful information for future studies relating to reproduction of cattle. Abstract Female animals living in the Qinghai-Tibet Plateau have lower ovulation rates because of the hypoxic environment, however, the mechanism of hypoxia on animal follicles is unclear. In this study, the effects of hypoxia on bovine follicles were investigated using an in vitro follicular culture system. The results show that there was a significant decrease in follicular diameter from day 3 to day 6 in both hypoxia and hypoxia with estrogen (E2) and fulvestrant (ICI 182780) (hypoxia + E2 + ICI) groups, when compared with a normoxia group (p < 0.05). We also observed significant downregulation of ERα and FSHR, while upregulation of LHCGR expression in the hypoxia group and hypoxia + E2 + ICI groups compared to the normoxia group (p < 0.05). The expression of IGF1 gene was significantly downregulated in hypoxia + E2 + ICI group when compared to the hypoxia + E2 group (p < 0.05). The expression of HIF1A, ADAMTS1, VEGFA, and EDN2 were upregulated in both hypoxia and hypoxia + E2 + ICI groups in comparison to normoxia group (p < 0.05). Under hypoxic conditions, the addition of E2 resulted in a decrease of HIF1A protein but an increase of ERα protein in cultured bovine follicles (p < 0.05). In summary, hypoxia limits the growth of bovine follicle cultured in vitro through inhibition of ERα.
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Affiliation(s)
- Lizhu Ma
- College of Animal Science and Technology, Northwest A & F University, Yangling 712100, China
| | - Liqiang Wang
- College of Animal Science and Technology, Northwest A & F University, Yangling 712100, China
| | - Huimin Gao
- College of Animal Science and Technology, Northwest A & F University, Yangling 712100, China
| | - Ning Liu
- College of Animal Science and Technology, Northwest A & F University, Yangling 712100, China
| | - Yuxin Zheng
- College of Animal Science and Technology, Northwest A & F University, Yangling 712100, China
| | - Yan Gao
- Faculty of Medical and Chemical Engineering, Xianyang Vocational Technical College, Tongyi Street, Fengxi new city, Xi'an 712100, China
| | - Shujie Liu
- State Key Laboratory of Plateau Ecology and Agriculture, Key Laboratory of Plateau Grazing Animal Nutrition and Feed Science of Qinghai Province, Qinghai Plateau Yak Research Center, Qinhai University, Xining 810016, China
| | - Zhongliang Jiang
- College of Animal Science and Technology, Northwest A & F University, Yangling 712100, China.
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68
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De Roo C, Tilleman K, Vercruysse C, Declercq H, T'Sjoen G, Weyers S, De Sutter P. Texture profile analysis reveals a stiffer ovarian cortex after testosterone therapy: a pilot study. J Assist Reprod Genet 2019; 36:1837-1843. [PMID: 31327130 PMCID: PMC6730976 DOI: 10.1007/s10815-019-01513-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 06/19/2019] [Indexed: 11/25/2022] Open
Abstract
Purpose The importance of the surrounding ovarian stromal cells and extracellular matrix in the development and maturation of follicles has recently gained attention. An aberrant extracellular matrix has been described in ovaries of patients with polycystic ovary syndrome where a more rigid structural environment, possibly induced by endogenous testosterone, impairs normal folliculogenesis. In this context, we describe the textural parameters of the ovarian cortex of transgender men after prolonged testosterone administration compared to the textural parameters of the non-exposed ovarian cortex originating from female oncological patients. Methods Texture profile analysis (TPA) was performed on ovarian cortex (5 × 5 mm) of oncological and transgender patients in order to measure stiffness, hardness, cohesiveness, and springiness of the ovarian cortex (LRXplus universal testing system). Statistical analysis was performed using repeated measurements mixed models and the Spearman rank order correlation test (IBM SPSS Statistics 23). Results A total of 36 frozen-thawed cortical strips (5 × 5 mm) were subjected to TPA. The superficial part of cortex fragments originating from transgender persons (fragments < 1.4 mm; N = 10) appeared to be significantly stiffer compared to cortex derived from oncology patients (fragments < 1.4 mm; N = 7) (6.78 ± 1.38 N/mm versus 5.41 ± 0.9 N/mm respectively, p = 0.036). Conclusions This is the first application of TPA in ovarian cortex to study the physical properties. Comparing the physical properties, we objectively describe an increased cortical stiffness in the most outer part of the ovarian cortex following prolonged testosterone administration in transgender men compared to the ovarian cortex of oncological patients. This preliminary and novel approach could be the start of future research to understand the physical properties of ovarian tissue. Electronic supplementary material The online version of this article (10.1007/s10815-019-01513-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- C De Roo
- Department of Reproductive Medicine, Ghent-Fertility and Stem Cell Team (G-FaST), Ghent University Hospital, 9000, Ghent, Belgium.
| | - K Tilleman
- Department of Reproductive Medicine, Ghent-Fertility and Stem Cell Team (G-FaST), Ghent University Hospital, 9000, Ghent, Belgium
| | - C Vercruysse
- Bio print Core Facility, Tissue Engineering and Biomaterials, Department of Basic Medical Science, Faculty of Medicine and Health Science, Ghent University, 9000, Ghent, Belgium
| | - H Declercq
- Bio print Core Facility, Tissue Engineering and Biomaterials, Department of Basic Medical Science, Faculty of Medicine and Health Science, Ghent University, 9000, Ghent, Belgium
| | - G T'Sjoen
- Department of Endocrinology and Center for Sexology and Gender, Ghent University Hospital, 9000, Ghent, Belgium
| | - S Weyers
- Department of Reproductive Medicine, Ghent-Fertility and Stem Cell Team (G-FaST), Ghent University Hospital, 9000, Ghent, Belgium
| | - P De Sutter
- Department of Reproductive Medicine, Ghent-Fertility and Stem Cell Team (G-FaST), Ghent University Hospital, 9000, Ghent, Belgium
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69
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Takae S, Suzuki N. Current state and future possibilities of ovarian tissue transplantation. Reprod Med Biol 2019; 18:217-224. [PMID: 31312099 PMCID: PMC6613018 DOI: 10.1002/rmb2.12268] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 02/25/2019] [Accepted: 03/08/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND As a result of recent developments in cancer treatment, cancer survivorship and survivors' quality of life have been emphasized. Although ovarian tissue cryopreservation (OTC) is an experimental technique, it would be the sole technique for fertility preservation treatment for girls with malignant disease. Indeed, OTC requires ovarian tissue transplantation (OTT) for conception. As for OTC, there is room to investigate OTT. The present review focused on the current state and progress of OTT. METHOD The literature regarding OTT, which is currently under development, was reviewed. MAIN FINDINGS To improve the outcome of OTT, both efficacy and safety are important. Good surgical technique and the optimal site are important surgical factors, with orthotopic transplantation increasing. Treatment of growth factors, gonadotropins, antioxidants, apoptosis suppression factors, and cell therapy may improve the efficacy of OTT by inducing neo-angiogenesis and preventing damage. Artificial ovaries, complete in vitro primordial follicle culture technique, and non-invasive ovarian imaging techniques, such as optical coherence tomography, to select the best ovarian tissue are future possibilities. CONCLUSION Improving neo-angiogenesis and preventing damage with optimization, as well as investigation of future techniques, may bring us to the next stage of a fertility preservation strategy.
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Affiliation(s)
- Seido Takae
- Department of Obstetrics and GynecologySt. Marianna University School of MedicineKawasaki CityJapan
| | - Nao Suzuki
- Department of Obstetrics and GynecologySt. Marianna University School of MedicineKawasaki CityJapan
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Ghatebi M, Zavareh S, Lashkarbolouki T, Elahdadi Salmani M. Implications from early life stress on the development of mouse ovarian follicles: Focus on oxidative stress. J Obstet Gynaecol Res 2019; 45:1506-1514. [PMID: 31207032 DOI: 10.1111/jog.14007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 04/28/2019] [Indexed: 11/28/2022]
Abstract
AIM The early life stress has significant long-term effects on the development of the offspring. This study was undertaken to verify if maternal separation as a stressor agent affects the oxidative status and developmental competence of mouse pre-antral follicles (PF) during in vitro culture period. METHODS Female litters of National Medical Research Institute mice were divided into two groups: maternally separated group (MS), separated from the mothers for 6 h per day from postnatal days 2-16; and the rest considered as the control group, which left undisturbed over the 14 days. The litters were sacrificed and the ovarian tissue was harvested to isolate the PF. The PF were in vitro cultured up to 12th day when ovulation was induced. The developmental parameters and oxidative status (i.e., total antioxidant capacity and Malondialdehyde levels, as well as the activities of superoxide dismutase, glutathione peroxidase and catalase) were assessed. RESULTS The rates of survival, antrum formation, ovulation and oocyte maturation of PF derived from the MS group were significantly lower compared with those of the control group. Furthermore, the Malondialdehyde level of the MS group was significantly higher than that of the control group. By contrast, the total antioxidant capacity level was lower in the MS group with respect to the control group. Also, the activity of superoxide dismutase, glutathione peroxidase and catalase of PF, derived from the MS group, was significantly lower compared with those of the control group. CONCLUSION Early life stress damages the developmental competence of mouse PF through induction of oxidative stress.
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Affiliation(s)
- Mina Ghatebi
- School of Biology, Damghan University, Damghan, Iran
| | - Saeed Zavareh
- School of Biology, Damghan University, Damghan, Iran.,Institute of Biological Sciences, Damghan University, Damghan, Iran
| | - Taghi Lashkarbolouki
- School of Biology, Damghan University, Damghan, Iran.,Institute of Biological Sciences, Damghan University, Damghan, Iran
| | - Mahmoud Elahdadi Salmani
- School of Biology, Damghan University, Damghan, Iran.,Institute of Biological Sciences, Damghan University, Damghan, Iran
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Raffel N, Klemm K, Dittrich R, Hoffmann I, Söder S, Beckmann MW, Lotz L. The effect of bpV(HOpic) on in vitro activation of primordial follicles in cultured swine ovarian cortical strips. Reprod Domest Anim 2019; 54:1057-1063. [PMID: 31087697 DOI: 10.1111/rda.13466] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 05/08/2019] [Indexed: 12/18/2022]
Abstract
The vanadate-derivative dipotassium bisperoxo (5-hydroxy-pyridine-2-carboxylic) oxovanadate (V) (bpV(HOpic)), a pharmacological inhibitor of phosphatase and tensin homolog (PTEN), has been used in ovarian follicle culture systems for activation of follicular growth in vitro and suggested to be responsible for primordial follicle survival through indirect Akt activation. For pig ovarian tissue, it is still not clear which culture medium needs to be used, as well as which factors and hormones could influence follicular development; this also applies to bpV(HOpic) exposure. Therefore, ovarian cortical strips from pigs were cultured in 1 µM bpV(HOpic) (N = 24) or control medium (N = 24) for 48 hr. Media were then replaced with control medium and all tissue pieces incubated for additional 4 days. The strips were embedded in paraffin for histological determination of follicle proportions at the end of the culture period and compared to histological sections from tissue pieces without cultivation, which had been embedded right after preparation; comparison of healthy follicles for each developmental stage was performed to quantify follicle survival and activation. After 6-day culture, follicle activation occurred in tissue samples from both cultured groups but significantly more follicles showed progression of follicular development in the presence of 1 µM bpV(HOpic). The amount of non-vital follicles was not significantly increased during cultivation. BpV(HOpic) affects pig ovarian follicle development by promoting the initiation of follicle growth and development, similar as in rodent species and humans.
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Affiliation(s)
- Nathalie Raffel
- Department of Obstetrics and Gynecology, Erlangen University Hospital, Friedrich-Alexander University of Erlangen-Nürnberg, Erlangen, Germany
| | - Katrin Klemm
- Department of Obstetrics and Gynecology, Erlangen University Hospital, Friedrich-Alexander University of Erlangen-Nürnberg, Erlangen, Germany
| | - Ralf Dittrich
- Department of Obstetrics and Gynecology, Erlangen University Hospital, Friedrich-Alexander University of Erlangen-Nürnberg, Erlangen, Germany
| | - Inge Hoffmann
- Department of Obstetrics and Gynecology, Erlangen University Hospital, Friedrich-Alexander University of Erlangen-Nürnberg, Erlangen, Germany
| | - Stefan Söder
- Institute of Pathology, Coburg Hospital, Coburg, Germany
| | - Matthias W Beckmann
- Department of Obstetrics and Gynecology, Erlangen University Hospital, Friedrich-Alexander University of Erlangen-Nürnberg, Erlangen, Germany
| | - Laura Lotz
- Department of Obstetrics and Gynecology, Erlangen University Hospital, Friedrich-Alexander University of Erlangen-Nürnberg, Erlangen, Germany
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72
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Telfer EE. Future developments: In vitro growth (
IVG
) of human ovarian follicles. Acta Obstet Gynecol Scand 2019; 98:653-658. [PMID: 30801653 DOI: 10.1111/aogs.13592] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 02/19/2019] [Indexed: 12/11/2022]
Affiliation(s)
- Evelyn E. Telfer
- Institute of Cell Biology and Genes and Development Group CDBS University of Edinburgh Edinburgh UK
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73
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Barros VRP, Monte APO, Lins TLBG, Santos JM, Menezes VG, Cavalcante AYP, Araújo VR, Gouveia BB, Matos MHT. In vitro survival, growth, and maturation of sheep oocytes from secondary follicles cultured in serum-free conditions: impact of a constant or a sequential medium containing recombinant human FSH. Domest Anim Endocrinol 2019; 67:71-79. [PMID: 30765293 DOI: 10.1016/j.domaniend.2018.12.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 12/07/2018] [Accepted: 12/12/2018] [Indexed: 12/16/2022]
Abstract
This study evaluated the in vitro development and maturation of ovine oocytes from secondary follicles cultured in serum-free medium containing fixed or sequential concentrations of recombinant human FSH (rhFSH). Follicles were cultured in α-MEM+ alone or with constant (500, 750, or 1,000 ng/mL) or sequential concentrations of rhFSH (seq. 1: day 6 = 500; day 12 = 750; day 18 = 1,000 ng/mL and seq. 2: day 6 = 100; day 12 = 500; day 18 = 1,000 ng/mL). At the end of the experiment, follicular survival was higher (P < 0.05) in 750 ng/mL rhFSH than the control and 1,000 ng/mL rhFSH. As early as day 6 of culture, antral cavity formation was observed in all treatments. Follicular diameter increased progressively and significantly in all treatments throughout 18 d of culture. Furthermore, addition of rhFSH to the medium promoted a significant increase in the percentage of fully grown oocytes in all treatments compared to α-MEM+. Mitochondrial activity was higher in rhFSH treatments than in the control, except in rhFSH seq. 2 (P < 0.05). Maturation rates increased in oocytes from intact follicles cultured in 750 ng/mL rhFSH compared to the control (P < 0.05). In conclusion, rhFSH at 750 ng/mL maintained the survival of secondary follicles cultured in serum-free medium, improved oocyte growth, mitochondrial activity, and oocyte maturation.
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Affiliation(s)
- V R P Barros
- Nucleus of Biotechnology Applied to Ovarian Follicle Development, Federal University of São Francisco Valley, Petrolina, PE 56300-990, Brazil
| | - A P O Monte
- Nucleus of Biotechnology Applied to Ovarian Follicle Development, Federal University of São Francisco Valley, Petrolina, PE 56300-990, Brazil
| | - T L B G Lins
- Nucleus of Biotechnology Applied to Ovarian Follicle Development, Federal University of São Francisco Valley, Petrolina, PE 56300-990, Brazil
| | - J M Santos
- Nucleus of Biotechnology Applied to Ovarian Follicle Development, Federal University of São Francisco Valley, Petrolina, PE 56300-990, Brazil
| | - V G Menezes
- Nucleus of Biotechnology Applied to Ovarian Follicle Development, Federal University of São Francisco Valley, Petrolina, PE 56300-990, Brazil
| | - A Y P Cavalcante
- Nucleus of Biotechnology Applied to Ovarian Follicle Development, Federal University of São Francisco Valley, Petrolina, PE 56300-990, Brazil
| | - V R Araújo
- Health Center Science, State University of Ceará, 60714-903 Fortaleza, CE, Brazil
| | - B B Gouveia
- Nucleus of Biotechnology Applied to Ovarian Follicle Development, Federal University of São Francisco Valley, Petrolina, PE 56300-990, Brazil
| | - M H T Matos
- Nucleus of Biotechnology Applied to Ovarian Follicle Development, Federal University of São Francisco Valley, Petrolina, PE 56300-990, Brazil.
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Xu J, Lawson MS, Mitalipov SM, Park BS, Xu F. Stage-specific modulation of antimüllerian hormone promotes primate follicular development and oocyte maturation in the matrix-free three-dimensional culture. Fertil Steril 2019; 110:1162-1172. [PMID: 30396561 DOI: 10.1016/j.fertnstert.2018.07.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 06/25/2018] [Accepted: 07/09/2018] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To study whether follicular growth and oocyte maturation can be improved by antimüllerian hormone (AMH) modulation at specific stages of follicular development. DESIGN Primary and secondary follicles were cultured in a matrix-free system and were assigned to the control group and the group with AMH supplementation during the preantral stage and neutralizing AMH antibody addition during the antral stage. SETTING National primate research center. ANIMAL(S) Adult, female rhesus macaques (Macaca mulatta). INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Follicle survival, growth, steroid and paracrine factor production, and oocyte competence were evaluated. Follicles were assessed for expression of genes that are critical for gonadotropin signaling, cumulus cell glycolysis, and oocyte quality. RESULT(S) Primary follicles formed "organoids" and developed to the antral stage in group culture. AMH exposure during the preantral stage increased organoid diameters. Oocytes from the AMH-treated organoids had greater diameters and matured to the metaphase II (MII) stage. Secondary follicles developed to the antral stage during individual culture. The AMH exposure during the preantral stage and AMH antibody treatment during the antral stage increased follicle diameters, vascular endothelial growth factor and follistatin production, differentiation factor 9 expression, and oocyte diameters. The MII oocytes from the AMH-modulated group developed to the morula stage after IVF, with one to the blastocyst stage. CONCLUSION(S) AMH supplementation at the preantral stage and depletion at the antral stage enhanced primate follicular development and oocyte competence in vitro. The improved embryonic development supports in vitro follicle maturation as a potential approach for fertility preservation.
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Affiliation(s)
- Jing Xu
- Division of Reproductive and Developmental Sciences, Oregon National Primate Research Center, Oregon Health and Science University, Beaverton, Oregon; Department of Obstetrics and Gynecology, School of Medicine, Oregon Health and Science University, Portland, Oregon; Center for Embryonic Cell and Gene Therapy, Oregon Health and Science University, Portland, Oregon.
| | - Maralee S Lawson
- Division of Reproductive and Developmental Sciences, Oregon National Primate Research Center, Oregon Health and Science University, Beaverton, Oregon
| | - Shoukhrat M Mitalipov
- Center for Embryonic Cell and Gene Therapy, Oregon Health and Science University, Portland, Oregon
| | - Byung S Park
- OHSU-PSU School of Public Health, Oregon Health and Science University, Portland, Oregon
| | - Fuhua Xu
- Department of Obstetrics and Gynecology, School of Medicine, Oregon Health and Science University, Portland, Oregon
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75
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Salama M, Woodruff TK. From bench to bedside: Current developments and future possibilities of artificial human ovary to restore fertility. Acta Obstet Gynecol Scand 2019; 98:659-664. [DOI: 10.1111/aogs.13552] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 01/26/2019] [Accepted: 01/29/2019] [Indexed: 12/20/2022]
Affiliation(s)
- Mahmoud Salama
- Department of Obstetrics and Gynecology Feinberg School of Medicine Northwestern University Chicago Illinois
| | - Teresa K. Woodruff
- Department of Obstetrics and Gynecology Feinberg School of Medicine Northwestern University Chicago Illinois
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McLaughlin M, Albertini DF, Wallace WHB, Anderson RA, Telfer EE. Metaphase II oocytes from human unilaminar follicles grown in a multi-step culture system. Mol Hum Reprod 2019; 24:135-142. [PMID: 29390119 DOI: 10.1093/molehr/gay002] [Citation(s) in RCA: 184] [Impact Index Per Article: 36.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 01/23/2018] [Indexed: 12/30/2022] Open
Abstract
STUDY QUESTION Can complete oocyte development be achieved from human ovarian tissue containing primordial/unilaminar follicles and grown in vitro in a multi-step culture to meiotic maturation demonstrated by the formation of polar bodies and a Metaphase II spindle? SUMMARY ANSWER Development of human oocytes from primordial/unilaminar stages to resumption of meiosis (Metaphase II) and emission of a polar body was achieved within a serum free multi-step culture system. WHAT IS KNOWN ALREADY Complete development of oocytes in vitro has been achieved in mouse, where in vitro grown (IVG) oocytes from primordial follicles have resulted in the production of live offspring. Human oocytes have been grown in vitro from the secondary/multi-laminar stage to obtain fully grown oocytes capable of meiotic maturation. However, there are no reports of a culture system supporting complete growth from the earliest stages of human follicle development through to Metaphase II. STUDY DESIGN, SIZE, DURATION Ovarian cortical biopsies were obtained with informed consent from women undergoing elective caesarean section (mean age: 30.7 ± 1.7; range: 25-39 years, n = 10). PARTICIPANTS/MATERIALS, SETTING, METHODS Laboratory setting. Ovarian biopsies were dissected into thin strips, and after removal of growing follicles were cultured in serum free medium for 8 days (Step 1). At the end of this period secondary/multi-laminar follicles were dissected from the strips and intact follicles 100-150 μm in diameter were selected for further culture. Isolated follicles were cultured individually in serum free medium in the presence of 100 ng/ml of human recombinant Activin A (Step 2). Individual follicles were monitored and after 8 days, cumulus oocyte complexes (COCs) were retrieved by gentle pressure on the cultured follicles. Complexes with complete cumulus and adherent mural granulosa cells were selected and cultured in the presence of Activin A and FSH on membranes for a further 4 days (Step 3). At the end of Step 3, complexes containing oocytes >100 μm diameter were selected for IVM in SAGE medium (Step 4) then fixed for analysis. MAIN RESULTS AND THE ROLE OF CHANCE Pieces of human ovarian cortex cultured in serum free medium for 8 days (Step 1) supported early follicle growth and 87 secondary follicles of diameter 120 ± 6 μm (mean ± SEM) could be dissected for further culture. After a further 8 days, 54 of the 87 follicles had reached the antral stage of development. COCs were retrieved by gentle pressure from the cultured follicles and those with adherent mural granulosa cells (n = 48) were selected and cultured for a further 4 days (Step 3). At the end of Step 3, 32 complexes contained oocytes >100 μm diameter were selected for IVM (Step 4). Nine of these complexes contained polar bodies within 24 h and all polar bodies were abnormally large. Confocal immuno-histochemical analysis showed the presence of a Metaphase II spindle confirming that these IVG oocytes had resumed meiosis but their developmental potential is unknown. LIMITATIONS, REASONS FOR CAUTION This is a small number of samples but provides proof of concept that complete development of human oocytes can occur in vitro. Further optimization with morphological evaluation and fertilization potential of IVG oocytes is required to determine whether they are normal. WIDER IMPLICATIONS OF THE FINDINGS The ability to develop human oocytes from the earliest follicular stages in vitro through to maturation and fertilization would benefit fertility preservation practice. STUDY FUNDING/COMPETING INTEREST(S) Funded by MRC Grants (G0901839 and MR/L00299X/1). No competing interests.
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Affiliation(s)
- M McLaughlin
- Institute of Cell Biology, University of Edinburgh, Edinburgh EH8 9XD, UK
| | - D F Albertini
- Center for Human Reproduction, New York, NY 10021, USA
| | - W H B Wallace
- Department of Haematology/Oncology, Royal Hospital for Sick Children, Edinburgh EH9 1LF, UK
| | - R A Anderson
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh EH16 4TJ, UK
| | - E E Telfer
- Institute of Cell Biology, University of Edinburgh, Edinburgh EH8 9XD, UK
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77
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Optimization of medium for in vitro culture of sheep ovarian tissue. Small Rumin Res 2019. [DOI: 10.1016/j.smallrumres.2018.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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78
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Zhao H, Jin L, Li Y, Zhang C, Wang R, Li Y, Huang W, Cui C, Zhang H, Wang H, Ma D, Liao S. Oncofertility: What can we do from bench to bedside? Cancer Lett 2019; 442:148-160. [DOI: 10.1016/j.canlet.2018.10.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 10/03/2018] [Accepted: 10/16/2018] [Indexed: 12/11/2022]
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79
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Allahveisi A, Yousefian E, Rezaie MJ, Nikkhoo B. COMPARISON OF MORPHOMETRIC AND MORPHOLOGY OOCYTES AFTER IN VITRO MATURATION BETWEEN HEALTHY WOMEN AND PATIENTS WITH POLYCYSTIC OVARIAN SYNDROME. ACTA ENDOCRINOLOGICA-BUCHAREST 2019; 15:295-300. [PMID: 32010346 DOI: 10.4183/aeb.2019.295] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Objectives Polycystic ovarian syndrome (PCOS) occurs in 6-10% of all women in their reproductive age. In women with PCOS, controlled ovarian hyperstimulation (COH) often results in an increased risk of ovarian hyperstimulation syndrome (OHSS). In vitro maturation (IVM) of human oocyte is an alternative technique for in vitro fertilization (IVF). The aim of this study was to compare the morphometric analysis and morphology of oocytes after in- vitro maturation (IVM) between normal women and those suffering from polycystic ovary syndrome (PCOS). Material and Methods Thirty two women of 20 to 35 years of age that were undergoing controlled ovarian stimulation by the ICSI/IVF protocol were chosen for the study. The immature oocytes (n=108) were divided into two groups: the first oocyte group was comprised of 16 normal women (n=54); and the second group included 16 women with PCOS (n=54); then the oocytes were matured in vitro. After 24-48h of incubation, the oocyte maturation rate and morphometric and morphological characteristics were assessed using an inverted microscope, and then the images were compared. Results There were significant differences in the maturity of oocytes between normal women and those with PCOS after IVM (P<0.05). Moreover, morphometric assessments revealed that there were no significant difference in the total diameter (μm) (zona thickness (ZPT) + perivitelline space width (PVS) + cytoplasm (CD) of oocytes between normal women and those with PCOS (156.3±6.8 and 137.7±9.9), respectively (P>0.05). Evaluation of morphological oocytes showed that morphological abnormalities, including ooplasmic vacuolization and granulation were higher in PCOS women compared to normal women (P<0.05). Conclusion The increased quality of oocytes after IVM reflected a positive impact of IVM oocytes on normal women as compared to women with PCOS.
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Affiliation(s)
- A Allahveisi
- Infertility Treatment Center of Beassat Hospital, Faculty of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - E Yousefian
- Department of Midwifery, Falavarjan Branch, Islamic Azad University, Isfahan, Iran
| | - M J Rezaie
- Infertility Treatment Center of Beassat Hospital, Faculty of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - B Nikkhoo
- Department of Midwifery, Falavarjan Branch, Islamic Azad University, Isfahan, Iran
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80
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Wu X, Shen W, Zhang B, Meng A. The genetic program of oocytes can be modified in vivo in the zebrafish ovary. J Mol Cell Biol 2018; 10:479-493. [PMID: 30060229 DOI: 10.1093/jmcb/mjy044] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2018] [Accepted: 07/28/2018] [Indexed: 12/23/2022] Open
Abstract
Oocytes, the irreplaceable gametes for generating a new organism, are matured in the ovary of living female animals. It is unknown whether any genetic manipulations can be applied to immature oocytes inside the living ovaries. As a proof-of-concept, we here demonstrate genetic amendments of zebrafish immature oocytes within the ovary. Oocyte microinjection in situ (OMIS) stimulates tissue repair responses, but some of the microinjected immature oocytes are matured, ovulated and fertilizable. By OMIS-mediated Cas9 approach, ntla and gata5 loci of oocytes arrested at prophase I of meiosis are successfully edited before fertilization. Through OMIS, high efficiency of biallelic mutations in single or multiple loci using Cas9/gRNAs allows immediate manifestation of mutant phenotypes in F0 embryos and multiple transgenes can co-express the reporters in F0 embryos with patterns similar to germline transgenic embryos. Furthermore, maternal knockdown of dnmt1 by antisense morpholino via OMIS results in a dramatic decrease of global DNA methylation level at the dome stage and causes embryonic lethality prior to segmentation period. Therefore, OMIS opens a door to efficiently modify the genome and provides a possibility to repair genetically abnormal oocytes in situ.
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Affiliation(s)
- Xiaotong Wu
- Laboratory of Molecular Developmental Biology, State Key Laboratory of Membrane Biology, Tsinghua-Peking Center for Life Sciences, School of Life Sciences, Tsinghua University, Beijing, China
| | - Weimin Shen
- Laboratory of Molecular Developmental Biology, State Key Laboratory of Membrane Biology, Tsinghua-Peking Center for Life Sciences, School of Life Sciences, Tsinghua University, Beijing, China
| | - Bingjie Zhang
- Center for Stem Cell Biology and Regenerative Medicine, MOE Key Laboratory of Bioinformatics; Tsinghua-Peking Center for Life Sciences, School of Life Sciences, Tsinghua University, Beijing, China
| | - Anming Meng
- Laboratory of Molecular Developmental Biology, State Key Laboratory of Membrane Biology, Tsinghua-Peking Center for Life Sciences, School of Life Sciences, Tsinghua University, Beijing, China
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81
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Atrabi MJ, Akbarinejad V, Khanbabaee R, Dalman A, Amorim CA, Najar-Asl M, Valojerdi MR, Fathi R. Formation and activation induction of primordial follicles using granulosa and cumulus cells conditioned media. J Cell Physiol 2018; 234:10148-10156. [PMID: 30417361 DOI: 10.1002/jcp.27681] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 10/08/2018] [Indexed: 12/14/2022]
Abstract
Fertility preservation of prepubertal girls subjected to invasive cancer therapy necessitates defining protocols for activation of isolated primordial follicles. Granulosa (GCs) and cumulus cells (CCs) play pivotal role in oocyte development. Although GCs and CCs share some similarities, they differ in growth factors production. The current study was conducted to evaluate the effects of GCs, CCs and their conditioned media on mice primordial follicles activation. One-day-old mice ovaries were subjected to 6-day culture with base medium (BM), GC conditioned medium (GCCM), GC coculture (GCCC), CC conditioned medium (CCCM) or CC coculture (CCCC). Follicular growth and primordial to primary follicle transition was observed during 6-day culture, and follicular activation rate tended to be greater in GCCM than other groups (0.05 <P < 0.10). On Day 6, the expression of phosphatase and tensin homolog (PTEN) in GCCM group was lower than that in BM group (P = 0.020), the expression of phosphoinositide-3-kinase was higher in CCCC group than BM, GCCM and CCCM groups (P < 0.05), and the expression of connexin 37 was greater in the CCCM group as compared with BM, GCCC, and CCCC groups (P < 0.01). In conclusion, the current study showed that condition medium of GCs could enhance in vitro activation of primordial follicles, probably through downregulation of PTEN.
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Affiliation(s)
- Mohammad Jafari Atrabi
- Department of Embryology, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Vahid Akbarinejad
- Department of Theriogenology, Faculty of Veterinary Medicine, University of Tehran, Tehran, Iran
| | - Ramazan Khanbabaee
- Department of Biology, Qaemshahr Branch, Islamic Azad University, Qaemshahr, Iran
| | - Azam Dalman
- Department of Embryology, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Christiani Andrade Amorim
- Pôle de Recherche en Gynécologie, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
| | - Mustafa Najar-Asl
- Department of Stem Cells and Developmental Biology, Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology, ACECR, Tehran, Iran
| | - Mojtaba Rezazadeh Valojerdi
- Department of Embryology, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran.,Department of Anatomy, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Rouhollah Fathi
- Department of Embryology, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
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82
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Herta AC, Lolicato F, Smitz JEJ. In vitro follicle culture in the context of IVF. Reproduction 2018; 156:F59-F73. [PMID: 29980584 DOI: 10.1530/rep-18-0173] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 06/19/2018] [Indexed: 12/24/2022]
Abstract
The currently available assisted reproduction techniques for fertility preservation (i.e. in vitro maturation (IVM) and in vitro fertilization) are insufficient as stand-alone procedures as only few reproductive cells can be conserved with these techniques. Oocytes in primordial follicles are well suited to survive the cryopreservation procedure and of use as valuable starting material for fertilization, on the condition that these could be grown up to fully matured oocytes. Our understanding of the biological mechanisms directing primordial follicle activation has increased over the last years and this knowledge has paved the way toward clinical applications. New multistep in vitro systems are making use of purified precursor cells and extracellular matrix components and by applying bio-printing technologies, an adequate follicular niche can be built. IVM of human oocytes is clinically applied in patients with polycystic ovary/polycystic ovary syndrome; related knowhow could become useful for fertility preservation and for patients with maturation failure and follicle-stimulating hormone resistance. The expectations from the research on human ovarian tissue and immature oocytes cultures, in combination with the improved vitrification methods, are high as these technologies can offer realistic potential for fertility preservation.
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Affiliation(s)
- Anamaria C Herta
- Follicle Biology LaboratoryVrije Universiteit Brussel, Brussels, Belgium
| | - Francesca Lolicato
- Follicle Biology LaboratoryVrije Universiteit Brussel, Brussels, Belgium
| | - Johan E J Smitz
- Follicle Biology LaboratoryVrije Universiteit Brussel, Brussels, Belgium
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83
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Moulavi F, Hosseini S. Diverse patterns of cumulus cell expansion during in vitro maturation reveal heterogeneous cellular and molecular features of oocyte competence in dromedary camel. Theriogenology 2018; 119:259-267. [DOI: 10.1016/j.theriogenology.2018.07.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 07/13/2018] [Accepted: 07/14/2018] [Indexed: 01/29/2023]
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84
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Dolmans MM, Manavella DD. Recent advances in fertility preservation. J Obstet Gynaecol Res 2018; 45:266-279. [DOI: 10.1111/jog.13818] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 08/29/2018] [Indexed: 12/25/2022]
Affiliation(s)
- Marie-Madeleine Dolmans
- Pôle de Recherche en Gynécologie, Institut de Recherche Expérimentale et Clinique; Université Catholique de Louvain; Brussels Belgium
- Gynecology Department; Cliniques Universitaires Saint-Luc; Brussels Belgium
| | - Diego D. Manavella
- Pôle de Recherche en Gynécologie, Institut de Recherche Expérimentale et Clinique; Université Catholique de Louvain; Brussels Belgium
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85
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Abstract
INTRODUCTION Women are increasingly having children at a later age, but this can conflict with declining fertility in the later 30's and thereafter. AREAS OF AGREEMENT Declining egg quality and quantity with age are well-established, although egg quality can only be surmised from reproductive success or failure. AREAS OF CONTROVERSY Whether increasing the number of eggs that can be obtained from ovarian stimulation is of value, and whether there are precursor cells within the adult ovary that could become mature eggs. GROWING POINTS There is increasing use of donated eggs by older women to enhance their chances of conception. The storage of frozen eggs for potential use later in life is also becoming more common. AREAS TIMELY FOR DEVELOPING RESEARCH Understanding of growth initiation of follicles and development of an artificial ovary may lead to the ability to affect fertility and reproductive lifespan.
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Affiliation(s)
- Richard A Anderson
- MRC Centre for Reproductive Health, Queen's Medical Research Institute, University of Edinburgh and Institute of Cell Biology, School of Biological Sciences, University of Edinburgh, Edinburgh, UK
| | - Evelyn E Telfer
- MRC Centre for Reproductive Health, Queen's Medical Research Institute, University of Edinburgh and Institute of Cell Biology, School of Biological Sciences, University of Edinburgh, Edinburgh, UK
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86
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Rios PD, Kniazeva E, Lee HC, Xiao S, Oakes RS, Saito E, Jeruss JS, Shikanov A, Woodruff TK, Shea LD. Retrievable hydrogels for ovarian follicle transplantation and oocyte collection. Biotechnol Bioeng 2018; 115:2075-2086. [PMID: 29704433 PMCID: PMC6045426 DOI: 10.1002/bit.26721] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 04/03/2018] [Accepted: 04/25/2018] [Indexed: 01/17/2023]
Abstract
Cancer survivorship rates have drastically increased due to improved efficacy of oncologic treatments. Consequently, clinical concerns have shifted from solely focusing on survival to quality of life, with fertility preservation as an important consideration. Among fertility preservation strategies for female patients, ovarian tissue cryopreservation and subsequent reimplantation has been the only clinical option available to cancer survivors with cryopreserved tissue. However, follicle atresia after transplantation and risk of reintroducing malignant cells have prevented this procedure from becoming widely adopted in clinics. Herein, we investigated the encapsulation of ovarian follicles in alginate hydrogels that isolate the graft from the host, yet allows for maturation after transplantation at a heterotopic (i.e., subcutaneous) site, a process we termed in vivo follicle maturation. Survival of multiple follicle populations was confirmed via histology, with the notable development of the antral follicles. Collected oocytes (63%) exhibited polar body extrusion and were fertilized by intracytoplasmic sperm injection and standard in vitro fertilization procedures. Successfully fertilized oocytes developed to the pronucleus (14%), two-cell (36%), and four-cell (7%) stages. Furthermore, ovarian follicles cotransplanted with metastatic breast cancer cells within the hydrogels allowed for retrieval of the follicles, and no mice developed tumors after removal of the implant, confirming that the hydrogel prevented seeding of disease within the host. Collectively, these findings demonstrate a viable option for safe use of potentially cancer-laden ovarian donor tissue for in vivo follicle maturation within a retrievable hydrogel and subsequent oocyte collection. Ultimately, this technology may provide novel options to preserve fertility for young female patients with cancer.
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Affiliation(s)
- Peter D. Rios
- Department of Biomedical Engineering, Northwestern University, Evanston, IL 60208
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL 60611
- Department of Obstetrics and Gynecology, Northwestern University, Chicago, IL 60611
| | - Ekaterina Kniazeva
- Department of Obstetrics and Gynecology, Northwestern University, Chicago, IL 60611
| | - Hoi Chang Lee
- Department of Obstetrics and Gynecology, Northwestern University, Chicago, IL 60611
| | - Shuo Xiao
- Department of Obstetrics and Gynecology, Northwestern University, Chicago, IL 60611
| | - Robert S. Oakes
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI 48109
| | - Eiji Saito
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI 48109
| | - Jacqueline S. Jeruss
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI 48109
- Department of Surgery, University of Michigan, Ann Arbor, MI 48105
- University of Michigan Comprehensive Cancer Center, Ann Arbor, MI 48109
| | - Ariella Shikanov
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI 48109
- University of Michigan Comprehensive Cancer Center, Ann Arbor, MI 48109
| | - Teresa K. Woodruff
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL 60611
- Department of Obstetrics and Gynecology, Northwestern University, Chicago, IL 60611
| | - Lonnie D. Shea
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI 48109
- University of Michigan Comprehensive Cancer Center, Ann Arbor, MI 48109
- Department of Chemical Engineering, University of Michigan, Ann Arbor, MI 48109
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87
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GDF9-β promotes folliculogenesis in sheep ovarian transplantation onto the chick embryo chorioallantoic membrane (CAM) in cryopreservation programs. Arch Gynecol Obstet 2018; 298:607-615. [PMID: 30003329 DOI: 10.1007/s00404-018-4838-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 06/06/2018] [Indexed: 01/11/2023]
Abstract
PURPOSE Ovarian tissue (OT) cryopreservation is a treatment option for fertility preservation among young cancer patients. However, the procedure may involve a reduction in the GDF9-β expression and a delay in follicular growth after thawing and transplantation. The aim of this study was to evaluate whether supplementation of GDF9-β can compensate the reduction of this factor during the cryopresevation process and promote folliculogenesis after transplantation of thawed sheep ovarian tissue. METHODS Sheep OT was cryopreserved using two methods of vitrification and slow freezing. Fresh and thawed OTs were then transplanted onto chick embryo chorioallantoic membrane (CAM) and then divided into two groups based on the addition of GDF9-β to the grafted tissue. After 5 days of culture, both histological and immunohistological (Ki-67) assessments were performed to evaluate follicular structure, development, and proliferation. The fibrotic and necrotic areas were measured using MICROVISIBLE software. RESULTS Folliculogenesis took place in all culture groups, but was significantly improved only in the +GDF9-β cultured group. Also, better follicular structure was preserved in the aforementioned group (p < 0.05). When GDF9-β was supplemented to the culture medium, more neovascularization (p < 0.05) and better transplantation (p > 0.05) was observed. Furthermore, the areas of fibrosis and necrosis were lower in this group rather than the controls. Follicular proliferative activity was significantly higher only in the slow freezing +GDF9-β cultured group. CONCLUSIONS GDF9-β, as a stimulatory factor, not only promoted the folliculogenesis in the fresh ovarian transplant, but also compensated for its reduction during the cryopreservation process.
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88
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Pinelli S, Basile S. Fertility Preservation: Current and Future Perspectives for Oncologic Patients at Risk for Iatrogenic Premature Ovarian Insufficiency. BIOMED RESEARCH INTERNATIONAL 2018; 2018:6465903. [PMID: 30112413 PMCID: PMC6077410 DOI: 10.1155/2018/6465903] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/01/2018] [Revised: 05/29/2018] [Accepted: 06/12/2018] [Indexed: 11/18/2022]
Abstract
Progress in recent years in the efficacy of oncologic treatment and early diagnosis of cancer has determined an increase in life expectance in cancer patients. About 10% of all cancer cases affect women younger than 45 years; therefore nowadays approximately 5-6% of the population in childbearing age consists in cancer survivors. A crucial issue is the high risk of premature ovarian insufficiency due to possible gonadotoxic effects of oncologic treatments. Considering combined chemotherapy, radiation therapy, and bone marrow transplantation, this risk can reach 92-100%, depending on the age and ovarian reserve of the patient, as well as the schedule and type of therapy. International guidelines recommend addressing all the patients diagnosed with a neoplasia treatable with potentially gonadotoxic therapies to fertility preservation. Moreover, fertility preservation also seems to reserve fascinating implications for women who want to delay childbearing for social reasons or women affected with endometriosis, who could receive unexpected opportunities. At present, the most widespread techniques to preserve fertility in adult women are embryo or oocyte cryopreservation, depending on the presence of a partner or according to legislative issues, but these procedures require time for ovarian stimulation. In prepubertal patients or when there is no possibility of delaying chemotherapy, ovarian tissue cryopreservation and subsequent transplantation represent the main strategy.
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Affiliation(s)
- Sara Pinelli
- Maternal and Child Health Department, Division of Obstetrics and Gynecology 2, Pisa University Hospital, Pisa, Italy
| | - Stefano Basile
- Maternal and Child Health Department, Division of Obstetrics and Gynecology 2, Pisa University Hospital, Pisa, Italy
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Fabbri R, Zamboni C, Vicenti R, Macciocca M, Paradisi R, Seracchioli R. Update on oogenesis in vitro. ACTA ACUST UNITED AC 2018; 70:588-608. [PMID: 29999288 DOI: 10.23736/s0026-4784.18.04273-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Ovarian tissue is increasingly being collected from cancer patients and cryopreserved for fertility preservation. Alternately to the autologous transplantation, the development of culture systems that support oocyte development from the primordial follicle stage represent a valid strategy to restore fertility. The aim of this study is to review the most recent data regarding oogenesis in vitro and to provide an up-to-date on the contemporary knowledge of follicle growth and development in vitro. EVIDENCE ACQUISITION A comprehensive systematic MEDLINE search was performed since February 2018 for English-language reports by using the following terms: "ovary," "animal and human follicle," "in vitro growth and development," "ovarian tissue culture," "fertility preservation," "IVM," "oocyte." Previous published reviews and recent published original articles were preferred in order to meet our study scope. EVIDENCE SYNTHESIS Over time, many studies have been conducted with the aim to optimize the characteristics of ovarian tissue culture systems and to better support the three main phases: 1) activation of primordial follicles; 2) isolation and culture of growing preantral follicles; 3) removal from the follicle environment and maturation of oocyte cumulus complexes. While complete oocyte in vitro development has been achieved in mouse, with the production of live offspring, the goal of obtaining oocytes of sufficient quality to support embryo development has not been completely reached into higher mammals despite decades of effort. CONCLUSIONS Over the years, many improvements have been made on ovarian tissue cultures with the future purpose that patients will be provided with a greater number of developmentally competent oocytes for fertility preservation.
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Affiliation(s)
- Raffaella Fabbri
- Unit of Gynecology and Physiopathology of Human Reproduction, Department of Medical and Surgical Sciences, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Chiara Zamboni
- Unit of Gynecology and Physiopathology of Human Reproduction, Department of Medical and Surgical Sciences, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy -
| | - Rossella Vicenti
- Unit of Gynecology and Physiopathology of Human Reproduction, Department of Medical and Surgical Sciences, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Maria Macciocca
- Unit of Gynecology and Physiopathology of Human Reproduction, Department of Medical and Surgical Sciences, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
| | | | - Renato Seracchioli
- Unit of Gynecology and Physiopathology of Human Reproduction, Department of Medical and Surgical Sciences, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
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Rocha CD, Soares MM, de Cássia Antonino D, Júnior JM, Freitas Mohallem RF, Ribeiro Rodrigues AP, Figueiredo JR, Beletti ME, Jacomini JO, Alves BG, Alves KA. Positive effect of resveratrol against preantral follicles degeneration after ovarian tissue vitrification. Theriogenology 2018; 114:244-251. [DOI: 10.1016/j.theriogenology.2018.04.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Revised: 03/18/2018] [Accepted: 04/04/2018] [Indexed: 10/17/2022]
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Martinez F. Update on fertility preservation from the Barcelona International Society for Fertility Preservation-ESHRE-ASRM 2015 expert meeting: indications, results and future perspectives. Hum Reprod 2018; 32:1802-1811. [PMID: 29117320 PMCID: PMC5850800 DOI: 10.1093/humrep/dex218] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Accepted: 05/19/2017] [Indexed: 12/11/2022] Open
Abstract
STUDY QUESTION What progress has been made in fertility preservation (FP) over the last decade? SUMMARY ANSWER FP techniques have been widely adopted over the last decade and therefore the establishment of international registries on their short- and long-term outcomes is strongly recommended. WHAT IS KNOWN ALREADY FP is a fundamental issue for both males and females whose future fertility may be compromised. Reproductive capacity may be seriously affected by age, different medical conditions and also by treatments, especially those with gonadal toxicity. There is general consensus on the need to provide counselling about currently available FP options to all individuals wishing to preserve their fertility. STUDY DESIGN, SIZE, DURATION An international meeting with representatives from expert scientific societies involved in FP was held in Barcelona, Spain, in June 2015. PARTICIPANTS/MATERIALS, SETTING, METHODS Twenty international FP experts belonging to the American Society of Reproductive Medicine, ESHRE and the International Society of Fertility Preservation reviewed the literature up to June 2015 to be discussed at the meeting, and approved the final manuscript. At the time this manuscript was being written, new evidence considered relevant for the debated topics was published, and was consequently included. MAIN RESULTS AND THE ROLE OF CHANCE Several oncological and non-oncological diseases may affect current or future fertility, either caused by the disease itself or the gonadotoxic treatment, and need an adequate FP approach. Women wishing to postpone maternity and transgender individuals before starting hormone therapy or undergoing surgery to remove/alter their reproductive organs should also be counselled accordingly. Embryo and oocyte cryopreservation are first-line FP methods in post-pubertal women. Metaphase II oocyte cryopreservation (vitrification) is the preferred option. Cumulative evidence of restoration of ovarian function and spontaneous pregnancies after ART following orthotopic transplantation of cryopreserved ovarian tissue supports its future consideration as an open clinical application. Semen cryopreservation is the only established method for FP in men. Testicular tissue cryopreservation should be recommended in pre-pubertal boys even though fertility restoration strategies by autotransplantation of cryopreserved testicular tissue have not yet been tested for safe clinical use in humans. The establishment of international registries on the short- and long-term outcomes of FP techniques is strongly recommended. LIMITATIONS, REASONS FOR CAUTION Given the lack of studies in large cohorts or with a randomized design, the level of evidence for most of the evidence reviewed was three or below. WIDER IMPLICATIONS OF THE FINDINGS Further high quality studies are needed to study the long-term outcomes of FP techniques. STUDY FUNDING/COMPETING INTEREST(S) None. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- Francisca Martinez
- Hospital Universitario Dexeus, Gran Via Carlos III, 71-75, 08208 Barcelona, Spain
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93
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Schmidt VM, Isachenko V, Rappl G, Rahimi G, Hanstein B, Morgenstern B, Mallmann P, Isachenko E. Comparison of the enzymatic efficiency of Liberase TM and tumor dissociation enzyme: effect on the viability of cells digested from fresh and cryopreserved human ovarian cortex. Reprod Biol Endocrinol 2018; 16:57. [PMID: 29859539 PMCID: PMC5985056 DOI: 10.1186/s12958-018-0374-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Accepted: 05/23/2018] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND The aim of this study was to examine the effectiveness of Tumor Dissociation Enzyme (TDE) on the viability of follicles after digestion of fresh and cryopreserved ovarian cortex fragments (OCFs). METHODS Fresh and thawed OCF from 14 patients (29 ± 6 years), sized 20 to 210 mm3 were randomly distributed into four treatment groups and digested with 16% TDE or 0.05 mg/ml Liberase TM: Group 1, frozen OCF digested with TDE; Group 2, frozen OCF digested with LiberaseTM; Group 3, fresh OCF digested with TDE; and Group 4, fresh OCF digested with Liberase TM. Evaluation of follicle viability was performed under light microscope after staining with Neutral red. For visualization of viable and dead cells under a confocal laser scanning microscope, the follicles were stained with Calcein AM and ethidium homodimer-1. RESULTS The results showed that the number of retrieved follicles was significantly higher (990 vs 487; P < 0.01) in the TDE-treatment group compared to the Liberase TM-group. The presence of intense neutral red stained follicles was significantly higher in Group 1 and Group 3 compared to Group 2 and Group 4 (70.3% ± +/- 6.22 vs 53,1% ± 2.03 and 94.2% ± 6.6 vs 79.1% ± 2.1; P < 0.01). The percentage of Calcein AM stained follicles of class V1 was significantly higher in Group 1 and Group 3 compared to Group 2 and Group 4 (95.97% ± 7.8 vs 87.87% ± 2.4; 97.1% ± 6.8 vs 91.3% ± 2.3; P < 0.01). CONCLUSION The enzymatic digestion of ovarian cortex with TDE provides recovery of a higher number of healthy preantral follicles in contrast to earlier described Liberase TM procedure.
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Affiliation(s)
- Viola Maria Schmidt
- Research Group for Reproductive Medicine and IVF-Laboratory, Department of Obstetrics and Gynaecology, University Maternal Hospital, Cologne University, Kerpener Str. 34, 50931, Cologne, Germany
| | - Vladimir Isachenko
- Research Group for Reproductive Medicine and IVF-Laboratory, Department of Obstetrics and Gynaecology, University Maternal Hospital, Cologne University, Kerpener Str. 34, 50931, Cologne, Germany
| | - Gunter Rappl
- Cell Sort Service Department, Center for Molecular Medicine Cologne University (CMMC), Robert Koch Str. 21, 50931, Cologne, Germany
| | - Gohar Rahimi
- Research Group for Reproductive Medicine and IVF-Laboratory, Department of Obstetrics and Gynaecology, University Maternal Hospital, Cologne University, Kerpener Str. 34, 50931, Cologne, Germany
| | - Bettina Hanstein
- Research Group for Reproductive Medicine and IVF-Laboratory, Department of Obstetrics and Gynaecology, University Maternal Hospital, Cologne University, Kerpener Str. 34, 50931, Cologne, Germany
| | - Bernd Morgenstern
- Research Group for Reproductive Medicine and IVF-Laboratory, Department of Obstetrics and Gynaecology, University Maternal Hospital, Cologne University, Kerpener Str. 34, 50931, Cologne, Germany
| | - Peter Mallmann
- Research Group for Reproductive Medicine and IVF-Laboratory, Department of Obstetrics and Gynaecology, University Maternal Hospital, Cologne University, Kerpener Str. 34, 50931, Cologne, Germany
| | - Evgenia Isachenko
- Research Group for Reproductive Medicine and IVF-Laboratory, Department of Obstetrics and Gynaecology, University Maternal Hospital, Cologne University, Kerpener Str. 34, 50931, Cologne, Germany.
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Rajabi Z, Khokhar Z, Yazdekhasti H. The Growth of Preantral Follicles and the Impact of Different Supplementations and Circumstances: A Review Study with Focus on Bovine and Human Preantral Follicles. Cell Reprogram 2018; 20:164-177. [PMID: 29782184 DOI: 10.1089/cell.2017.0068] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
One of the most important concerns cancer survivors face is fertility. Current treatment modalities often result in damage to the reproductive system. Different options have been proposed to preserve the fertility of affected women, and many attempts have been made to improve their chance of childbearing after therapy. Cryopreservation of ovarian tissue and follicles before the onset of cancer treatment and then either transplantation of ovarian tissue or culture of ovarian tissue and individual follicles in vitro is a commonly cited approach. Extensive research is being done to design an optimal condition for the culture of ovarian follicles. Improving follicle culture systems by understanding their actual growth needs might be a crucial step toward fertility preservation in cancer patients. This review article will try to provide a summary of the role of different factors and conditions on growth of human and bovine preantral follicles in vitro.
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Affiliation(s)
- Zahra Rajabi
- 1 Department of Anatomy, Faculty of Medicine, Tehran University of Medical Sciences , Tehran, Iran .,2 Department of Biomedical Engineering, University of Virginia , Charlottesville, Virginia
| | - Zunair Khokhar
- 3 Department of Cell Biology, University of Virginia , Charlottesville, Virginia
| | - Hossein Yazdekhasti
- 4 Center for Research in Contraception and Reproductive Health, University of Virginia , Charlottesville, Virginia.,5 Center for Membrane & Cell Physiology, Department of Molecular Physiology and Biological Physics, University of Virginia , Charlottesville, Virginia
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95
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Maffei S, Galeati G, Pennarossa G, Brevini TAL, Gandolfi F. Extended ex vivo culture of fresh and cryopreserved whole sheep ovaries. Reprod Fertil Dev 2018; 28:1893-1903. [PMID: 26072996 DOI: 10.1071/rd15101] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Accepted: 05/20/2015] [Indexed: 12/12/2022] Open
Abstract
We describe an original perfusion system for the culture of whole ovine ovaries for up to 4 days. A total of 33 ovaries were divided into six groups: control (n=6), not perfused and fixed; Groups SM72 and SM72-FSH (n=6 each), perfused with a simple medium for 72h with or without FSH; Groups CM96 and CM96-FSH (n=6 each), perfused with a complex medium for 96h with or without FSH; Group CM96-FSH-cryo, (n=3) cryopreserved and perfused for 96h with Group CM96-FSH medium. Depending on the medium used, morphological parameters of cultured ovaries differed from fresh organs after 72 (SM72, SM72-FSH) or 96 (CM96, CM96-FSH) h of perfusion. Oestradiol and progesterone were secreted in all groups but FSH had an effect only on Group CM96-FSH, stimulating continued oestradiol secretion 10 times higher than in all other groups. Morphological parameters and hormone secretion of cryopreserved ovaries were not different from fresh controls. This method enables the culture of whole ovaries for up to 4 days, the time required in vivo for 0.5-mm follicles to grow to 2.2mm and then for these follicles to reach the ovulatory size of 4mm or more. It could be used as a research tool or to complement current techniques for preserving female fertility.
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Affiliation(s)
- Sara Maffei
- Institute for Genetic and Biomedical Research, National Research Council, Milan, Italy
| | - Giovanna Galeati
- Department of Veterinary Medical Sciences, Università degli Studi di Bologna, Via Tolara di Sopra, 50 40064 Ozzano dell'Emilia, Italy
| | - Georgia Pennarossa
- Laboratory of Biomedical Embryology, Università degli Studi di Milano, Italy
| | - Tiziana A L Brevini
- Laboratory of Biomedical Embryology, Università degli Studi di Milano, Italy
| | - Fulvio Gandolfi
- Present address: Department of Health, Animal Science and Food Safety, Università degli Studi di Milano via Celoria 10, 20133 Milan, Italy
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96
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In-vitro regulation of primordial follicle activation: challenges for fertility preservation strategies. Reprod Biomed Online 2018; 36:491-499. [PMID: 29503209 DOI: 10.1016/j.rbmo.2018.01.014] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 01/30/2018] [Accepted: 01/31/2018] [Indexed: 12/20/2022]
Abstract
Ovarian tissue is increasingly being collected from cancer patients and cryopreserved for fertility preservation. While the only available option to restore fertility is autologous transplantation, this treatment is not appropriate for all patients due to the risk of reintroducing cancer cells and causing disease recurrence. Harnessing the full reproductive potential of this tissue to restore fertility requires the development of culture systems that support oocyte development from the primordial follicle stage. While this has been achieved in the mouse, the goal of obtaining oocytes of sufficient quality to support embryo development has not been reached in higher mammals despite decades of effort. In vivo, primordial follicles gradually exit the resting pool, whereas when primordial follicles are placed into culture, global activation of these follicles occurs. Therefore, the addition of a factor(s) that can regulate primordial follicle activation in vitro may be beneficial to the development of culture systems for ovarian tissue from cancer patients. Several factors have been observed to inhibit follicle activation, including anti-Müllerian hormone, stromal-derived factor 1 and members of the c-Jun-N-terminal kinase pathway. This review summarizes the findings from studies of these factors and discusses their potential integration into ovarian tissue culture strategies for fertility preservation.
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97
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Talevi R, Sudhakaran S, Barbato V, Merolla A, Braun S, Di Nardo M, Costanzo V, Ferraro R, Iannantuoni N, Catapano G, Gualtieri R. Is oxygen availability a limiting factor for in vitro folliculogenesis? PLoS One 2018; 13:e0192501. [PMID: 29425251 PMCID: PMC5806880 DOI: 10.1371/journal.pone.0192501] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Accepted: 01/24/2018] [Indexed: 02/06/2023] Open
Abstract
Transplantation of ovarian tissue for the preservation of fertility in oncological patients is becoming an accepted clinical practice. However, the risk of re-introducing tumour cells at transplantation has stirred an increased interest for complete in vitro folliculogenesis. This has not yet been achieved in humans possibly for the lack of knowledge on the environmental milieu that orchestrates folliculogenesis in vivo. The main aim of this study was to investigate the effect of oxygen availability on follicle health and growth during in vitro culture of ovarian tissue strips. To this end, a model was developed to predict the dissolved oxygen concentration in tissue under varying culture conditions. Ovarian cortical strips of bovine, adopted as an animal model, and human tissue were cultured in conventional (CD) and gas permeable (PD) dishes under different media column heights and gaseous oxygen tensions for 3, 6 and 9 days. Follicle quality, activation of primordial follicles to the primary stage, and progression to the secondary stage were analysed through histology. Follicle viability was assessed through a live-dead assay at the confocal scanning laser microscope. Findings showed a higher follicle quality and viability after culture of bovine ovarian strips in PD in adequate medium height and oxygen tensions. The best culture conditions found in the bovine were adopted for human ovarian strip culture and promoted a higher follicle quality, viability and progression. Overall, data demonstrated that modulation of oxygen availability in tissue plays a key role in maintaining follicles' health and their ability to survive and progress to the secondary stage during ovarian tissue in vitro culture. Such culture conditions could increase the yield of healthy secondary follicles for subsequent dissection and individual culture to obtain competent oocytes.
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Affiliation(s)
- Riccardo Talevi
- Dipartimento di Biologia, Università di Napoli "Federico II", Complesso Universitario di Monte S Angelo, Napoli, Italy
| | - Sam Sudhakaran
- St Bartholomew's Hospital, W Smithfield, London, United Kingdom
| | - Vincenza Barbato
- Dipartimento di Biologia, Università di Napoli "Federico II", Complesso Universitario di Monte S Angelo, Napoli, Italy
| | - Anna Merolla
- Dipartimento di Biologia, Università di Napoli "Federico II", Complesso Universitario di Monte S Angelo, Napoli, Italy
| | - Sabrina Braun
- Dipartimento di Biologia, Università di Napoli "Federico II", Complesso Universitario di Monte S Angelo, Napoli, Italy
| | - Maddalena Di Nardo
- Dipartimento di Biologia, Università di Napoli "Federico II", Complesso Universitario di Monte S Angelo, Napoli, Italy
| | - Valentina Costanzo
- Dipartimento di Biologia, Università di Napoli "Federico II", Complesso Universitario di Monte S Angelo, Napoli, Italy
| | | | - Nicola Iannantuoni
- Ospedale S. Maria delle Grazie, ASL Napoli 2 Nord, Località La Schiana, Pozzuoli, Italy
| | - Gerardo Catapano
- Department of Environmental and Chemical Engineering, University of Calabria, Rende, Italy
| | - Roberto Gualtieri
- Dipartimento di Biologia, Università di Napoli "Federico II", Complesso Universitario di Monte S Angelo, Napoli, Italy
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98
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Zhao D, Leghari IH, Li J, Mi Y, Zhang C. Isolation and culture of chicken growing follicles in 2- and 3-dimensional models. Theriogenology 2018; 111:43-51. [PMID: 29427807 DOI: 10.1016/j.theriogenology.2018.01.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 01/15/2018] [Accepted: 01/18/2018] [Indexed: 11/27/2022]
Abstract
The isolation and culture of ovarian follicles is essential for the studies of follicular development and function. In contrast to the relative ease of culture for mammalian follicles, developing in vitro cultures of high viability for the much larger avian follicles has always proven to be more challenging. In this study, the growing follicles from domestic hens (Gallus domesticus) were isolated using enzymatic and mechanical methods and then investigated for the optimized conditions for culture. Assessments of viability and hormonal responsiveness were also considered. A larger percentage of healthy follicles was achieved by mechanical separation than enzymatic dissociation (83% vs. 55% by collagenase I or 63% by trypsin), despite a lower recovery yield for the former (126 vs. 275 by collagenase I or 261 by trypsin) from each ovary. All of the mechanically isolated follicles (800 μm) survived when cultured in the 3-dimensional (3D) system for 7 days whereas only 93% of the follicles survived in the 2-dimensional (2D) group. Follicles cultured in the 3D system also had a higher cell proliferation rates but lower apoptotic rates as assessed by BrdU incorporation and TUNEL assays. Ultrastructural examination showed that the granulosa cells in the 3D group were organized tightly with adjacent layers in contrast to the loose attachment in the 2D system group. After treatment with follicle-stimulating hormone in the 3D culture for 3 days, the mechanically isolated follicles (800 μm) displayed elevated mRNA expression of steroidogenic enzymes, cytokines and cell cycle-regulating proteins. The 3D culture model established in this study thus provides a useful tool for in vitro culture using growing follicles in a large diameter to study the mechanisms of growing follicle development in the avian species.
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Affiliation(s)
- Dan Zhao
- Department of Veterinary Medicine, College of Animal Sciences, Zhejiang University, Hangzhou, 310058, PR China
| | - Imdad Hussain Leghari
- Department of Veterinary Medicine, College of Animal Sciences, Zhejiang University, Hangzhou, 310058, PR China; Department of Poultry Husbandry, Sindh Agriculture University Tandojam Hyderabad, Pakistan
| | - Jian Li
- Department of Veterinary Medicine, College of Animal Sciences, Zhejiang University, Hangzhou, 310058, PR China
| | - Yuling Mi
- Department of Veterinary Medicine, College of Animal Sciences, Zhejiang University, Hangzhou, 310058, PR China
| | - Caiqiao Zhang
- Department of Veterinary Medicine, College of Animal Sciences, Zhejiang University, Hangzhou, 310058, PR China.
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Sadr SZ, Fatehi R, Maroufizadeh S, Amorim CA, Ebrahimi B. Utilizing Fibrin-Alginate and Matrigel-Alginate for Mouse Follicle Development in Three-Dimensional Culture Systems. Biopreserv Biobank 2018; 16:120-127. [PMID: 29363997 DOI: 10.1089/bio.2017.0087] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
In vitro culture of ovarian follicles is a new technique in reproductive technology, which helps in understanding the process of folliculogenesis. The in vitro culture of follicles could be carried out using three-dimensional (3D) natural scaffolds that mimic the ovarian tissue stroma. Selection of the right matrix and culture media in these scaffolds could increase the survival and maturation of the follicles. In this work, the applicability of matrigel-alginate (MA) and fibrin-alginate (FA) 3D scaffolds for folliculogenesis was assessed. The ovaries of 13-day-old Naval Medical Research Institute (NMRI) mice were isolated and distributed into control and vitrification groups. Preantral follicles (mean diameter: 120-140 μm) were mechanically isolated from control and vitrified-warmed ovaries, encapsulated in MA or FA scaffold and cultured for 12 days. Follicle survival, growth, maturation, and quantitative expression of oocyte maturation genes (Gdf9, Bmp15, Fgf8, KitL, Kit, and Amh) and proteins (GDF9 and BMP15) were assessed. Survival rate of culture preantral follicles in control groups was found to be significantly higher than vitrified follicles. Antrum formation was similar in all groups. Follicle diameters were significantly increased in all groups during culture period. A decreasing pattern of gene expression was seen for all genes in all groups. This trend was verified through evaluation of protein expression, during which there was strong staining in antral follicles from all groups in the last day of in vitro culture. The better survival and maturation rate of follicles in the MA compared to FA scaffold indicates that the MA matrix, being rich in extracellular matrix components, could mimic the ovarian condition better and presents a good environment for follicle development.
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Affiliation(s)
- Seyedeh Zeynab Sadr
- 1 Department of Embryology, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine , ACECR, Tehran, Iran
| | - Roya Fatehi
- 1 Department of Embryology, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine , ACECR, Tehran, Iran
| | - Saman Maroufizadeh
- 2 Department of Epidemiology and Reproductive Health, Reproductive Epidemiology Research Center, Royan Institute for Reproductive Biomedicine , ACECR, Tehran, Iran
| | - Christiani Andrade Amorim
- 3 Pole de Recherche en Gynecologie, Institut de Recherche Experimentale et Clinique, Universite Catholique de Louvain , Brussels, Belgium
| | - Bita Ebrahimi
- 1 Department of Embryology, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine , ACECR, Tehran, Iran
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Guzel Y, Bildik G, Oktem O. Sphingosine-1-phosphate protects human ovarian follicles from apoptosis in vitro. Eur J Obstet Gynecol Reprod Biol 2018; 222:19-24. [PMID: 29331755 DOI: 10.1016/j.ejogrb.2018.01.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 12/30/2017] [Accepted: 01/05/2018] [Indexed: 12/31/2022]
Abstract
OBJECTIVE(S) We aimed to analyze if anti-apoptotic agent sphingosine-1-phosphate offers protection against in vitro follicle atresia during culture of human ovarian cortical samples. STUDY DESIGN A translational research study of ex-vivo and in-vitro models of human ovarian tissue. MATERIAL AND METHODS Ovarian cortical tissue fragments (1 × 0.5 cm) were obtained from young patients (n = 15 mean age ± SD: 29.4 ± 2.5) undergoing laparoscopic excision of benign ovarian cysts. The samples were cultured for 4 days in 24-well format culture plate using conventional culture techniques. S1P was added to culture media at 200 and 400 μM concentrations. At the end of culture period the samples were processed for both histomorphological assessment and detection of apoptosis with immunohistochemistry and western blot methods using apoptosis marker cleaved caspase-3. In vitro estradiol (E2) and AMH productions of the samples were measured with ELISA. Follicle counts were expressed as the mean number of follicles per mm2. RESULTS The mean numbers of primordial and secondary follicles were 3.2 ± 0.4 and 0.7 ± 0.2 respectively, in the fresh fixed uncultured samples. After four days of culture their numbers were significantly decreased to 0.8 ± 0.2 (p < 0.01) and 0.1 ± 0.05 (p < 0.05) respectively, in the control samples cultured without S1P compared to fresh fixed samples. S1P treatment decreased follicle atresia and significantly higher number of primordials (2.3 ± 0.3, p < 0.01) and secondary follicles (0.5 ± 0.1, p < 0.05) survived in the samples after 4 day culture period compared to those cultured without S1P. In line with this there was dose-dependent decrease in the protein expression of cleaved caspase-3 on western blot and in the number of apoptotic follicles stained positive for cleaved caspase-3 on immunohistochemistry in the samples incubated with S1P at 200 and 400 μM concentrations. Furthermore, those samples incubated with S1P produced significantly higher amounts of E2 (2339 ± 321 vs. 1156 ± 125 pg/mL respectively, p < 0.01) compared to control samples. CONCLUSIONS These results suggest that S1P promotes follicle survival in human ovarian cortical samples in vitro.
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Affiliation(s)
- Yilmaz Guzel
- Department of Obstetrics and Gynecology, Istanbul Aydin University School of Medicine, Istanbul, Turkey
| | - Gamze Bildik
- Graduate School of Health Sciences, Koc University, Istanbul, Turkey
| | - Ozgur Oktem
- Graduate School of Health Sciences, Koc University, Istanbul, Turkey; Department of Obstetrics and Gynecology, the Division Reproductive Endocrinology and Infertility, Koc University School of Medicine, Istanbul, Turkey.
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