1
|
Salas A, Beltrán-Flores S, Évora C, Reyes R, Montes de Oca F, Delgado A, Almeida TA. Stem Cell Growth and Differentiation in Organ Culture: New Insights for Uterine Fibroid Treatment. Biomedicines 2022; 10:biomedicines10071542. [PMID: 35884847 PMCID: PMC9313456 DOI: 10.3390/biomedicines10071542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 06/22/2022] [Accepted: 06/27/2022] [Indexed: 11/18/2022] Open
Abstract
Organ culture allows for the understanding of normal and tumor cell biology, and tissues generally remain viable for 5–7 days. Strikingly, we determined that myometrial and MED12 mutant leiomyoma cells repopulated cell-depleted tissue slices after 20 days of culture. Using immunofluorescence and quantitative PCR of stem cell and undifferentiated cell markers, we observed clusters of CD49b+ cells in tumor slices. CD49b+ cells, however, were sparsely detected in the myometrial slices. Almost all LM cells strongly expressed Ki67, while only a few myometrial cells were stained for this proliferation marker. The CD73 marker was expressed only in tumor cells, whereas the mesenchymal stem cell receptor KIT was detected only in normal cells. HMGA2 and CD24 showed broader expression patterns and higher signal intensity in leiomyoma than in myometrial cells. In this study, we propose that activating CD49b+ stem cells in myometrium leads to asymmetrical division, giving rise to transit-amplifying KIT+ cells that differentiate to smooth muscle cells. On the contrary, activated leiomyoma CD49b+ cells symmetrically divide to form clusters of stem cells that divide and differentiate to smooth muscle cells without losing proliferation ability. In conclusion, normal and mutant stem cells can proliferate and differentiate in long-term organ culture, constituting a helpful platform for novel therapeutic discovery.
Collapse
Affiliation(s)
- Ana Salas
- Department of Biochemistry, Microbiology, Cell Biology and Genetics, Biology Section, Science Faculty, University of La Laguna, Ave. Astrofísico Fco. Sánchez s/n. San Cristóbal de La Laguna, 38200 Santa Cruz de Tenerife, Spain; (A.S.); (S.B.-F.); (R.R.)
- Institute of Tropical Diseases and Healthcare of the Canary Island, Ave. Astrofísico Fco. Sánchez s/n. San Cristóbal de La Laguna, 38200 Santa Cruz de Tenerife, Spain
| | - Silvia Beltrán-Flores
- Department of Biochemistry, Microbiology, Cell Biology and Genetics, Biology Section, Science Faculty, University of La Laguna, Ave. Astrofísico Fco. Sánchez s/n. San Cristóbal de La Laguna, 38200 Santa Cruz de Tenerife, Spain; (A.S.); (S.B.-F.); (R.R.)
| | - Carmen Évora
- Department of Chemical Engineering and Pharmaceutical Technology, Faculty of Pharmacy, University of La Laguna, Ave. Astrofísico Fco. Sánchez s/n. San Cristóbal de La Laguna, 38200 Santa Cruz de Tenerife, Spain; (C.É.); (A.D.)
- Institute of Biomedical Technologies (ITB), Medicine Section, Faculty of Health Science, University of La Laguna, St. Santa María Soledad, s/n. San Cristóbal de La Laguna, 38200 Santa Cruz de Tenerife, Spain
| | - Ricardo Reyes
- Department of Biochemistry, Microbiology, Cell Biology and Genetics, Biology Section, Science Faculty, University of La Laguna, Ave. Astrofísico Fco. Sánchez s/n. San Cristóbal de La Laguna, 38200 Santa Cruz de Tenerife, Spain; (A.S.); (S.B.-F.); (R.R.)
- Institute of Tropical Diseases and Healthcare of the Canary Island, Ave. Astrofísico Fco. Sánchez s/n. San Cristóbal de La Laguna, 38200 Santa Cruz de Tenerife, Spain
| | | | - Araceli Delgado
- Department of Chemical Engineering and Pharmaceutical Technology, Faculty of Pharmacy, University of La Laguna, Ave. Astrofísico Fco. Sánchez s/n. San Cristóbal de La Laguna, 38200 Santa Cruz de Tenerife, Spain; (C.É.); (A.D.)
- Institute of Biomedical Technologies (ITB), Medicine Section, Faculty of Health Science, University of La Laguna, St. Santa María Soledad, s/n. San Cristóbal de La Laguna, 38200 Santa Cruz de Tenerife, Spain
| | - Teresa A. Almeida
- Department of Biochemistry, Microbiology, Cell Biology and Genetics, Biology Section, Science Faculty, University of La Laguna, Ave. Astrofísico Fco. Sánchez s/n. San Cristóbal de La Laguna, 38200 Santa Cruz de Tenerife, Spain; (A.S.); (S.B.-F.); (R.R.)
- Institute of Tropical Diseases and Healthcare of the Canary Island, Ave. Astrofísico Fco. Sánchez s/n. San Cristóbal de La Laguna, 38200 Santa Cruz de Tenerife, Spain
- Correspondence: ; Tel.: +34-922-316-502 (ext. 6117)
| |
Collapse
|
2
|
Abstract
Uterine fibroids (leiomyomas) are present in >75% of women and can cause serious morbidity. They are by far the leading cause of hysterectomy. Fibroids are a complex mixture of cells that include fibroblasts and smooth muscle cells. Rich in extracellular matrix, they typically arise through somatic mutations, most commonly MED12. Their lack of growth inhibition and their ability to have facets of malignancy yet be histologically and biologically benign provide opportunities to explore basic processes. To date, the mechanisms responsible for growth and development of leiomyomas are an enigma. This review provides an overview of current understanding and future directions for clinical and basic research of fibroids.
Collapse
Affiliation(s)
- Elizabeth A. Stewart
- 1Division of Reproductive Endocrinology and Infertility, Mayo Clinic, Rochester, Minnesota,2Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota,3Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, Minnesota,4Department of Surgery, Mayo Clinic, Rochester, Minnesota,5Women’s Health Research Center, Mayo Clinic, Rochester, Minnesota
| | - Romana A. Nowak
- 6Department of Animal Sciences, University of Illinois, Urbana, Illinois,7Institute for Genomic Biology, University of Illinois, Urbana, Illinois
| |
Collapse
|
3
|
Salas A, López J, Reyes R, Évora C, de Oca FM, Báez D, Delgado A, Almeida TA. Organotypic culture as a research and preclinical model to study uterine leiomyomas. Sci Rep 2020; 10:5212. [PMID: 32251338 PMCID: PMC7090073 DOI: 10.1038/s41598-020-62158-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 03/05/2020] [Indexed: 11/09/2022] Open
Abstract
Organotypic cultures of tissue slices have been successfully established in lung, prostate, colon, gastric and breast cancer among other malignancies, but until now an ex vivo model based on tissue slices has not been established for uterine leiomyoma. In the present study, we describe a method for culturing tumour slides onto an alginate scaffold. Morphological integrity of tissue slices was maintained for up to 7 days of culture, with cells expressing desmin, estrogen and progesterone receptors. Driver mutations were present in the ex vivo slices at all-time points analyzed. Cultivated tumour slices responded to ovarian hormones stimulation upregulating the expression of genes involved in leiomyoma pathogenesis. This tissue model preserves extracellular matrix, cellular diversity and genetic background simulating more in-vivo-like situations. As a novelty, this platform allows encapsulation of microspheres containing drugs that can be tested on the ex vivo tumour slices. After optimizing drug release rates, microspheres would then be directly tested in animal models through local injection.
Collapse
Affiliation(s)
- Ana Salas
- Departamento de Bioquímica, Microbiología, Biología Celular y Genética, Universidad de La Laguna. Facultad de Ciencias. Sección de Biología. Avda. Astrofísico Fco. Sánchez s/n, 38200, San Cristóbal de La Laguna, Tenerife, Spain
- Instituto de Enfermedades Tropicales y Salud Pública de Canarias (IUETSPC). Avda. Astrofísico Fco. Sánchez s/n, 38200, San Cristóbal de La Laguna, Tenerife, Spain
| | - Judith López
- Departamento de Bioquímica, Microbiología, Biología Celular y Genética, Universidad de La Laguna. Facultad de Ciencias. Sección de Biología. Avda. Astrofísico Fco. Sánchez s/n, 38200, San Cristóbal de La Laguna, Tenerife, Spain
| | - Ricardo Reyes
- Departamento de Bioquímica, Microbiología, Biología Celular y Genética, Universidad de La Laguna. Facultad de Ciencias. Sección de Biología. Avda. Astrofísico Fco. Sánchez s/n, 38200, San Cristóbal de La Laguna, Tenerife, Spain
- Instituto de Enfermedades Tropicales y Salud Pública de Canarias (IUETSPC). Avda. Astrofísico Fco. Sánchez s/n, 38200, San Cristóbal de La Laguna, Tenerife, Spain
| | - Carmen Évora
- Departamento de Ingeniería Química y Tecnología Farmacéutica, Universidad de la Laguna, Tenerife, Spain. Avda. Astrofísico Fco. Sánchez s/n, 38200, San Cristóbal de La Laguna, Tenerife, Spain
- Instituto de Tecnologías Biomédicas (ITB). C/Sta. María Soledad, s/n. Facultad de Ciencias. Sección de Medicina, 38200, San Cristóbal de La Laguna, Tenerife, Spain
| | - Francisco Montes de Oca
- Hospital Quironsalud, C/Poeta Rodríguez Herrera 1, Santa Cruz de Tenerife, Tenerife, 38006, Spain
| | - Delia Báez
- Departamento de Obstetricia y Ginecología, Facultad de Ciencias de La Salud, Universidad de La Laguna, Campus de Ofra s/n, San Cristobal de La Laguna, Tenerife, Spain
| | - Araceli Delgado
- Departamento de Ingeniería Química y Tecnología Farmacéutica, Universidad de la Laguna, Tenerife, Spain. Avda. Astrofísico Fco. Sánchez s/n, 38200, San Cristóbal de La Laguna, Tenerife, Spain.
- Instituto de Tecnologías Biomédicas (ITB). C/Sta. María Soledad, s/n. Facultad de Ciencias. Sección de Medicina, 38200, San Cristóbal de La Laguna, Tenerife, Spain.
| | - Teresa A Almeida
- Departamento de Bioquímica, Microbiología, Biología Celular y Genética, Universidad de La Laguna. Facultad de Ciencias. Sección de Biología. Avda. Astrofísico Fco. Sánchez s/n, 38200, San Cristóbal de La Laguna, Tenerife, Spain.
- Instituto de Enfermedades Tropicales y Salud Pública de Canarias (IUETSPC). Avda. Astrofísico Fco. Sánchez s/n, 38200, San Cristóbal de La Laguna, Tenerife, Spain.
| |
Collapse
|
4
|
Santamaria X, Mas A, Cervelló I, Taylor H, Simon C. Uterine stem cells: from basic research to advanced cell therapies. Hum Reprod Update 2019; 24:673-693. [PMID: 30239705 DOI: 10.1093/humupd/dmy028] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 08/04/2018] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Stem cell research in the endometrium and myometrium from animal models and humans has led to the identification of endometrial/myometrial stem cells and their niches. This basic knowledge is beginning to be translated to clinical use for incurable uterine pathologies. Additionally, the implication of bone marrow-derived stem cells (BMDSCs) in uterine physiology has opened the field for the exploration of an exogenous and autologous source of stem cells. OBJECTIVE AND RATIONALE In this review, we outline the progress of endometrial and myometrial stem/progenitor cells in both human and mouse models from their characterization to their clinical application, indicating roles in Asherman syndrome, atrophic endometrium and tissue engineering, among others. SEARCH METHODS A comprehensive search of PubMed and Google Scholar up to December 2017 was conducted to identify peer-reviewed literature related to the contribution of bone marrow, endometrial and myometrial stem cells to potential physiological regeneration as well as their implications in pathologies of the human uterus. OUTCOMES The discovery and main characteristics of stem cells in the murine and human endometrium and myometrium are presented together with the relevance of their niches and cross-regulation. The current state of advanced stem cell therapy using BMDSCs in the treatment of Asherman syndrome and atrophic endometrium is analyzed. In the myometrium, the understanding of genetic and epigenetic defects that result in the development of tumor-initiating cells in the myometrial stem niche and thus contribute to the growth of uterine leiomyoma is also presented. Finally, recent advances in tissue engineering based on the creation of novel three-dimensional scaffolds or decellularisation open up new perspectives for the field of uterine transplantation. WIDER IMPLICATIONS More than a decade after their discovery, the knowledge of uterine stem cells and their niches is crystalising into novel therapeutic approaches aiming to treat with cells those conditions that cannot be cured with drugs, particularly the currently incurable uterine pathologies. Additional work and improvements are needed, but the basis has been formed for this therapeutic application of uterine cells.
Collapse
Affiliation(s)
- Xavier Santamaria
- Reproductive Medicine Department, Igenomix Academy, Paterna (Valencia), Spain.,Reproductive Medicine Department, IVI Barcelona, Barcelona, Spain.,Department of Obstetrics and Gynecology, Biomedical Research Group in Gynecology, Vall Hebron Institut de Recerca, Barcelona, Spain
| | - Aymara Mas
- Reproductive Medicine Department, Igenomix Academy, Paterna (Valencia), Spain.,Department of Obstetrics and Gynecology, Reproductive Medicine Research Group, La Fe Health Research Institute, Valencia, Spain
| | - Irene Cervelló
- Department of Obstetrics and Gynecology, Fundación Instituto Valenciano de Infertilidad (FIVI), and Instituto Universitario IVI/INCLIVA, Valencia, Spain
| | - Hugh Taylor
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, CT, USA
| | - Carlos Simon
- Reproductive Medicine Department, Igenomix Academy, Paterna (Valencia), Spain.,Department of Pediatrics, Obstetrics, and Gynecology, Valencia University and INCLIVA, Valencia, Spain.,Department of Obstetrics and Gynecology, Stanford University, Stanford, CA, USA
| |
Collapse
|
5
|
Courtoy GE, Donnez J, Ambroise J, Arriagada P, Luyckx M, Marbaix E, Dolmans MM. Gene expression changes in uterine myomas in response to ulipristal acetate treatment. Reprod Biomed Online 2018; 37:224-233. [DOI: 10.1016/j.rbmo.2018.04.050] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 04/19/2018] [Accepted: 04/20/2018] [Indexed: 01/25/2023]
|
6
|
Reis FM, Bloise E, Ortiga-Carvalho TM. Hormones and pathogenesis of uterine fibroids. Best Pract Res Clin Obstet Gynaecol 2016; 34:13-24. [DOI: 10.1016/j.bpobgyn.2015.11.015] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Accepted: 11/18/2015] [Indexed: 12/30/2022]
|
7
|
Campoy I, Lanau L, Altadill T, Sequeiros T, Cabrera S, Cubo-Abert M, Pérez-Benavente A, Garcia A, Borrós S, Santamaria A, Ponce J, Matias-Guiu X, Reventós J, Gil-Moreno A, Rigau M, Colas E. Exosome-like vesicles in uterine aspirates: a comparison of ultracentrifugation-based isolation protocols. J Transl Med 2016; 14:180. [PMID: 27317346 PMCID: PMC4912787 DOI: 10.1186/s12967-016-0935-4] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Accepted: 06/02/2016] [Indexed: 01/05/2023] Open
Abstract
Background Uterine aspirates are used in the diagnostic process of endometrial disorders, yet further applications could emerge if its complex milieu was simplified. Exosome-like vesicles isolated from uterine aspirates could become an attractive source of biomarkers, but there is a need to standardize isolation protocols. The objective of the study was to determine whether exosome-like vesicles exist in the fluid fraction of uterine aspirates and to compare protocols for their isolation, characterization, and analysis. Methods We collected uterine aspirates from 39 pre-menopausal women suffering from benign gynecological diseases. The fluid fraction of 27 of those aspirates were pooled and split into equal volumes to evaluate three differential centrifugation-based procedures: (1) a standard protocol, (2) a filtration protocol, and (3) a sucrose cushion protocol. Characterization of isolated vesicles was assessed by electron microscopy, nanoparticle tracking analysis and immunoblot. Specifically for RNA material, we evaluate the effect of sonication and RNase A treatment at different steps of the protocol. We finally confirmed the efficiency of the selected methods in non-pooled samples. Results All protocols were useful to isolate exosome-like vesicles. However, the Standard procedure was the best performing protocol to isolate exosome-like vesicles from uterine aspirates: nanoparticle tracking analysis revealed a higher concentration of vesicles with a mode of 135 ± 5 nm, and immunoblot showed a higher expression of exosome-related markers (CD9, CD63, and CD81) thus verifying an enrichment in this type of vesicles. RNA contained in exosome-like vesicles was successfully extracted with no sonication treatment and exogenous nucleic acids digestion with RNaseA, allowing the analysis of the specific inner cargo by Real-Time qPCR. Conclusion We confirmed the existence of exosome-like vesicles in the fluid fraction of uterine aspirates. They were successfully isolated by differential centrifugation giving sufficient proteomic and transcriptomic material for further analyses. The Standard protocol was the best performing procedure since the other two tested protocols did not ameliorate neither yield nor purity of exosome-like vesicles. This study contributes to establishing the basis for future comparative studies to foster the field of biomarker research in gynecology. Electronic supplementary material The online version of this article (doi:10.1186/s12967-016-0935-4) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Irene Campoy
- Biomedical Research Group in Gynecology, Vall Hebron Institute of Research (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Lucia Lanau
- Biomedical Research Group in Gynecology, Vall Hebron Institute of Research (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Tatiana Altadill
- Biomedical Research Group in Gynecology, Vall Hebron Institute of Research (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Tamara Sequeiros
- Biomedical Research Group in Urology, Vall Hebron Institute of Research (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Silvia Cabrera
- Department of Gynecology, Vall Hebron University Hospital, Barcelona, Spain
| | | | | | - Angel Garcia
- Pathology Department, Vall Hebron University Hospital, Barcelona, Spain
| | - Salvador Borrós
- Grup d'Enginyeria de Materials (GEMAT), Institut Químic de Sarrià, Universitat Ramon Llull, Barcelona, Spain
| | - Anna Santamaria
- Biomedical Research Group in Gynecology, Vall Hebron Institute of Research (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jordi Ponce
- Department of Gynecology, Bellvitge Teaching Hospital, Barcelona, Spain
| | - Xavier Matias-Guiu
- Department of Pathology and Molecular Genetics/Oncologic Pathology Group, University Hospital Arnau de Vilanova, University of Lleida, IRBLleida, Lleida, Spain
| | - Jaume Reventós
- Biomedical Research Group in Gynecology, Vall Hebron Institute of Research (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain.,Bellvitge Biomedical Research Institute (IDIBELL), Hospitalet de Llobregat, Barcelona, Spain.,Basic Sciences Department, International University of Catalonia, Barcelona, Spain
| | - Antonio Gil-Moreno
- Biomedical Research Group in Gynecology, Vall Hebron Institute of Research (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain.,Department of Gynecology, Vall Hebron University Hospital, Barcelona, Spain
| | - Marina Rigau
- Biomedical Research Group in Gynecology, Vall Hebron Institute of Research (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Eva Colas
- Biomedical Research Group in Gynecology, Vall Hebron Institute of Research (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain. .,Department of Pathology and Molecular Genetics/Oncologic Pathology Group, University Hospital Arnau de Vilanova, University of Lleida, IRBLleida, Lleida, Spain.
| |
Collapse
|
8
|
Mas A, Nair S, Laknaur A, Simón C, Diamond MP, Al-Hendy A. Stro-1/CD44 as putative human myometrial and fibroid stem cell markers. Fertil Steril 2015; 104:225-34.e3. [PMID: 25989979 DOI: 10.1016/j.fertnstert.2015.04.021] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2015] [Revised: 04/16/2015] [Accepted: 04/16/2015] [Indexed: 02/01/2023]
Abstract
OBJECTIVE To identify and characterize myometrial/fibroid stem cells by specific stem cell markers in human myometrium, and to better understand the stem cell contribution in the development of uterine fibroids. DESIGN Prospective, experimental human and animal study. SETTING University research laboratory. PATIENT(S)/ANIMAL(S) Women undergoing hysterectomy for treatment of symptomatic uterine fibroids and female NOD/SCID/IL-2Rγ(null) mice. INTERVENTION(S) Identification and isolation of stem cells from human fibroids and adjacent myometrium tissues using Stro-1/CD44-specific surface markers. MAIN OUTCOME MEASURE(S) Flow cytometry, semiquantitative polymerase chain reaction, clonogenicity assays, cell culture, molecular analysis, immunocyto-histochemistry, in vitro differentiation, and xenotransplantation assays. RESULT(S) Using Stro-1/CD44 surface markers, we were able to isolate stem cells from adjacent myometrium and human fibroid tissues. The undifferentiated status of isolated cells was confirmed by the expression of ABCG2 transporter, as well as additional stem cell markers OCT4, NANOG, and GDB3, and the low expression of steroid receptors ERα and PR-A/PR-B. Mesodermal cell origin was established by the presence of typical mesenchymal markers (CD90, CD105, and CD73) and absence of hematopoietic stem cell markers (CD34, CD45), and confirmed by the ability of these cells to differentiate in vitro into adipocytes, osteocytes, and chondrocytes. Finally, their functional capability to form fibroid-like lesions was established in a xenotransplantation mouse model. The injected cells labeled with superparamagnetic iron oxide were tracked by both magnetic resonance imaging and fluorescence imaging, thus demonstrating the regenerative potential of putative fibroid stem cells in vivo. CONCLUSION(S) We have demonstrated that Stro-1/CD44 can be used as specific surface markers to enrich a subpopulation of myometrial/fibroids cells, exhibiting key features of stem/progenitor cells. These findings offer a useful tool to better understand the initiation of uterine fibroids, and may lead to the establishment of effective therapeutic options.
Collapse
Affiliation(s)
- Aymara Mas
- Department of Obstetrics and Gynecology, Georgia Regents University, Augusta, Georgia
| | - Sangeeta Nair
- Department of Obstetrics and Gynecology, Georgia Regents University, Augusta, Georgia
| | - Archana Laknaur
- Department of Obstetrics and Gynecology, Georgia Regents University, Augusta, Georgia
| | - Carlos Simón
- Fundación Instituto Valenciano de Infertilidad, Instituto Universitario IVI-University of Valencia, INCLIVA, Valencia, Spain; Department of Obstetrics and Gynecology, School of Medicine, Stanford University, Stanford, California
| | - Michael P Diamond
- Department of Obstetrics and Gynecology, Georgia Regents University, Augusta, Georgia
| | - Ayman Al-Hendy
- Department of Obstetrics and Gynecology, Georgia Regents University, Augusta, Georgia.
| |
Collapse
|