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Zhao Y, Wang Y, Gu P, Tuo L, Wang L, Jiang SW. Transgenic mice applications in the study of endometriosis pathogenesis. Front Cell Dev Biol 2024; 12:1376414. [PMID: 38933332 PMCID: PMC11199864 DOI: 10.3389/fcell.2024.1376414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 05/27/2024] [Indexed: 06/28/2024] Open
Abstract
Endometriosis (EM), characterized by ectopic growth of endometrial tissues and recurrent pelvic pain, is a common disease with severe negative impacts on the life quality of patients. Conventional uterine tissue transplantation-based models have been broadly used to investigate the pathogenic mechanism(s) of EM. Transgenic mice with whole body or uterine/pelvic tissue-specific labelling by the expression of GFP, β-gal or other light-emitting or chromogenic markers enable investigators to analyze the contribution to endometriotic lesions by the donor or recipient side after uterine tissue transplantation. Moreover, when coupled to uterine tissue transplantation, transgenic mice with a specific EM-related gene knocked out or overexpressed make it possible to determine the gene's in vivo role(s) for EM pathogenesis. Furthermore, observations on the rise of de novo endometriotic lesions as well as structural/functional changes in the eutopic endometrium or pelvic tissues after gene manipulation will directly relate the cognate gene to the onset of EM. A major advantage of transgenic EM models is their efficiency for analyzing gene interactions with hormonal, dietetic and/or environmental factors. This review summarizes the features/sources/backgrounds of transgenic mice and their applications to EM studies concerning hormonal regulation, angiogenesis and inflammation. Findings from these studies, the advantages/disadvantages of transgenic EM models, and future expectations are also discussed.
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Affiliation(s)
- Yali Zhao
- Center of Prenatal Diagnosis, Lianyungang Maternal and Child Health Hospital, Lianyungang, Jiangsu, China
| | - Yao Wang
- Department of Gynecology, Lianyungang Maternal and Child Health Hospital, Lianyungang, Jiangsu, China
| | - Pinlang Gu
- Department of Gynecology, Lianyungang Maternal and Child Health Hospital, Lianyungang, Jiangsu, China
| | - Lingjin Tuo
- Lianyungang Research Institute for Women’s and Children’s Health, Lianyungang Maternal and Child Health Hospital, Lianyungang, Jiangsu, China
| | - Leilei Wang
- Center of Prenatal Diagnosis, Lianyungang Maternal and Child Health Hospital, Lianyungang, Jiangsu, China
| | - Shi-Wen Jiang
- Lianyungang Research Institute for Women’s and Children’s Health, Lianyungang Maternal and Child Health Hospital, Lianyungang, Jiangsu, China
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Burns KA, Pearson AM, Slack JL, Por ED, Scribner AN, Eti NA, Burney RO. Endometriosis in the Mouse: Challenges and Progress Toward a ‘Best Fit’ Murine Model. Front Physiol 2022; 12:806574. [PMID: 35095566 PMCID: PMC8794744 DOI: 10.3389/fphys.2021.806574] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 12/10/2021] [Indexed: 01/13/2023] Open
Abstract
Endometriosis is a prevalent gynecologic condition associated with pelvic pain and infertility characterized by the implantation and growth of endometrial tissue displaced into the pelvis via retrograde menstruation. The mouse is a molecularly well-annotated and cost-efficient species for modeling human disease in the therapeutic discovery pipeline. However, as a non-menstrual species with a closed tubo-ovarian junction, the mouse poses inherent challenges as a preclinical model for endometriosis research. Over the past three decades, numerous murine models of endometriosis have been described with varying degrees of fidelity in recapitulating the essential pathophysiologic features of the human disease. We conducted a search of the peer-reviewed literature to identify publications describing preclinical research using a murine model of endometriosis. Each model was reviewed according to a panel of ideal model parameters founded on the current understanding of endometriosis pathophysiology. Evaluated parameters included method of transplantation, cycle phase and type of tissue transplanted, recipient immune/ovarian status, iterative schedule of transplantation, and option for longitudinal lesion assessment. Though challenges remain, more recent models have incorporated innovative technical approaches such as in vivo fluorescence imaging and novel hormonal preparations to overcome the unique challenges posed by murine anatomy and physiology. These models offer significant advantages in lesion development and readout toward a high-fidelity mouse model for translational research in endometriosis.
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Affiliation(s)
- Katherine A. Burns
- Department of Environmental and Public Health Sciences, University of Cincinnati College of Medicine, Cincinnati, OH, United States
- *Correspondence: Katherine A. Burns,
| | - Amelia M. Pearson
- Department of Environmental and Public Health Sciences, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Jessica L. Slack
- Department of Clinical Investigation, Madigan Army Medical Center, Tacoma, WA, United States
| | - Elaine D. Por
- Department of Clinical Investigation, Madigan Army Medical Center, Tacoma, WA, United States
| | - Alicia N. Scribner
- Department of Obstetrics and Gynecology, Madigan Army Medical Center, Tacoma, WA, United States
| | - Nazmin A. Eti
- Department of Environmental and Public Health Sciences, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Richard O. Burney
- Department of Clinical Investigation, Madigan Army Medical Center, Tacoma, WA, United States
- Department of Obstetrics and Gynecology, Madigan Army Medical Center, Tacoma, WA, United States
- Richard O. Burney,
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Santorelli S, Fischer DP, Harte MK, Laru J, Marshall KM. In vivo effects of AZD4547, a novel fibroblast growth factor receptor inhibitor, in a mouse model of endometriosis. Pharmacol Res Perspect 2021; 9:e00759. [PMID: 33811484 PMCID: PMC8019068 DOI: 10.1002/prp2.759] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 11/22/2020] [Indexed: 11/12/2022] Open
Abstract
Endometriosis is a chronic disease, characterized by the growth of endometrial-like cells outside the uterine cavity. Due to its complex pathophysiology, a totally resolving cure is yet to be found. The aim of this study was to compare the therapeutic efficacy of AZD4547, a novel fibroblast growth factor receptor inhibitor (FGFRI), with a well-characterized progestin, etonogestrel (ENG) using a validated in vivo mouse model of endometriosis. Endometriosis was induced by transplanting uterine fragments from donor mice in proestrus into the peritoneal cavity of recipient mice, which then developed into cyst-like lesions. AZD4547 and ENG were administered systemically either from the day of endometriosis induction or 2-weeks post-surgery. After 20 days of treatment, the lesions were harvested; their size and weight were measured and analyzed histologically or by qRT-PCR. Stage of estrous cycle was monitored throughout. Compared to vehicle, AZD4547 (25 mg/kg) was most effective in counteracting lesion growth when treating from day of surgery and 2 weeks after; ENG (0.8 mg/kg) was similarly effective in reducing lesion growth but only when administered from day of surgery. Each downregulated FGFR gene expression (p < 0.05). AZD4547 at all doses and ENG (0.008 mg/kg) caused no disturbance to the estrous cycle. ENG at 0.08 and 0.8 mg/kg was associated with partial or complete estrous cycle disruption and hyperemia of the uteri. AZD4547 and ENG both attenuated endometriotic lesion size, but only AZD4547 did not disrupt the estrous cycle, suggesting that targeting of FGFR is worthy of further investigation as a novel treatment for endometriosis.
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Affiliation(s)
- Sara Santorelli
- NorthWest Centre for Advanced Drug Delivery (NoWCADD), School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK.,AstraZeneca, Cambridge, UK
| | - Deborah P Fischer
- NorthWest Centre for Advanced Drug Delivery (NoWCADD), School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Michael K Harte
- Division of Pharmacy and Optometry, University of Manchester, Manchester, UK
| | - Johanna Laru
- Early Product Development, Pharmaceutical Sciences, iMED Biotech Unit, AstraZeneca, Macclesfield, UK
| | - Kay M Marshall
- NorthWest Centre for Advanced Drug Delivery (NoWCADD), School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
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Simitsidellis I, Gibson DA, Saunders PTK. Animal models of endometriosis: Replicating the aetiology and symptoms of the human disorder. Best Pract Res Clin Endocrinol Metab 2018; 32:257-269. [PMID: 29779580 DOI: 10.1016/j.beem.2018.03.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Endometriosis is a chronic incurable disorder that affects 1 in 10 women of reproductive age: associated symptoms include chronic pain and infertility. The aetiology of endometriosis remains poorly understood but patients, clinicians and researchers are all in agreement that new non-surgical therapies are urgently needed to reduce the severity of symptoms. Preclinical testing of drugs requires the development and validation of models that recapitulate the key features of the disorder. In this review we describe the best-validated animal models (primate, rodent, xenograft) and their contributions to our understanding of the factors underpinning the development of symptoms. We consider the evidence that these models have provided the platform for identification of new therapeutic interventions and reflect on future directions for research and drug validation.
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Affiliation(s)
- Ioannis Simitsidellis
- Medical Research Council Centre for Inflammation Research, The University of Edinburgh, Queen's Medical Research Institute, 47 Little France Crescent, Edinburgh, EH16 4TJ, UK.
| | - Douglas A Gibson
- Medical Research Council Centre for Inflammation Research, The University of Edinburgh, Queen's Medical Research Institute, 47 Little France Crescent, Edinburgh, EH16 4TJ, UK.
| | - Philippa T K Saunders
- Medical Research Council Centre for Inflammation Research, The University of Edinburgh, Queen's Medical Research Institute, 47 Little France Crescent, Edinburgh, EH16 4TJ, UK.
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Galvankar M, Singh N, Modi D. Estrogen is essential but not sufficient to induce endometriosis. J Biosci 2018; 42:251-263. [PMID: 28569249 DOI: 10.1007/s12038-017-9687-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Endometriosis is a common gynaecological disorder of unknown aetiology. Among the several factors, estrogen has been implicated as a causative factor in endometriosis. In the present study using mouse model, we assessed the role of estrogen in the initial implantation and growth of endometrium in ectopic locations. Uterine tissues from green fluorescent protein (GFP) mice were transplanted in to the peritoneum of wild type mice in presence and absence of estrogen. As compared to untreated controls, the implantation of uterine tissue at ectopic locations was higher when estrogen was administered to both host and donor animals. However, this effect was not sustained as lesions regressed within 14 days of treatment. Irrespective of the treatment, peritoneal adipose was the most preferred site of lesion establishment. The lesions did not have typical features of the endometriosis (presence of glands and stroma) even after estrogen treatment and the ectopic tissue underwent regression by apoptosis irrespective of treatment. Since estrogen promotes implantation of endometrial tissue to ectopic locations but failure of these ectopic lesions to grow and sustain even in high estrogenic environment we propose that estrogen is necessary but not sufficient to sustain endometriosis.
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Affiliation(s)
- Mosami Galvankar
- Molecular and Cellular Biology Laboratory, National Institute for Research in Reproductive Health, Mumbai 400 012, India
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Huang BS, Yang MH, Wang PH, Li HY, Chou TY, Chen YJ. Oestrogen-induced angiogenesis and implantation contribute to the development of parasitic myomas after laparoscopic morcellation. Reprod Biol Endocrinol 2016; 14:64. [PMID: 27716434 PMCID: PMC5053344 DOI: 10.1186/s12958-016-0200-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Accepted: 09/29/2016] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Iatrogenic parasitic myomas (PMs), caused by intra-corporeal power morcellation during laparoscopy is gradually increasing. However, the pathogenesis and medical treatment of PMs remain largely unelucidated. METHODS Laparoscopically-induced PM xenografted mouse model was conducted by xenografting human uterine myoma fragments into the abdominal cavity of SCID mice and hormonal manipulation was performed using this mouse model to demonstrate the role of oestrogen in the development of implanted PMs. Immunohistochemistry of oestrogen receptor α (ERα), progesterone receptor (PR), vimentin, vascular endothelial growth factor (VEGF), microvessel density (MVD) and Ki-67 index was performed and compared. RESULTS In the patient with PMs, ERα, PR, angiogenesis and proliferative property expression were upregulated in PM lesions compared to uterine myomas. In the laparoscopically-induced PM mouse model, implanted myomas had more steroid receptor expressions, angiogenesis and proliferative property compared with pre-xenografted or non-implanted myoma. Depletion of oestrogen in the ovariectomized (OVX) mice decreased laparoscopically-induced PM implantations. In comparison, the implantations of PMs were increased with additional E2 supplement. Hormonal manipulation in the PM mouse model, including AI, GnRHa and SERM groups, were compared and AI significantly decreased the implantations, steroid receptor, angiogenesis, cell density, and proliferative index of PMs compared with control group. Furthermore, GnRHa significantly decreased VEGF and MVD expressions compared with control group. CONCLUSIONS These data highlight the crucial role of oestrogen in the development of laparoscopically-induced PMs and suggest that hormone manipulation may be a potential therapeutic agent. TRIAL REGISTRATION This protocol was approved by the Human and Animal Institutional Review Board of Taipei Veterans General Hospital ( VGHIRB No 2014-10-002C on Nov. 17th, 2014; IACUC 2014-119 on Aug. 22nd, 2014).
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Affiliation(s)
- Ben-Shian Huang
- Department of Obstetrics and Gynaecology, Taipei Veterans General Hospital, No.201, Sec. 2, Shih-Pai Road, Taipei, 112 Taiwan
- Department of Obstetrics and Gynaecology, National Yang-Ming University Hospital, No.169, Siaoshe Road, Yilan, 260 Taiwan
- Department of Obstetrics and Gynaecology, School of Medicine, National Yang-Ming University, No.155, Sec.2, Li-Nong Street, Taipei, 112 Taiwan
- Institute of Clinical Medicine, National Yang-Ming University, No.155, Sec.2, Li-Nong Street, Taipei, 112 Taiwan
| | - Muh-Hwa Yang
- Institute of Clinical Medicine, National Yang-Ming University, No.155, Sec.2, Li-Nong Street, Taipei, 112 Taiwan
| | - Peng-Hui Wang
- Department of Obstetrics and Gynaecology, Taipei Veterans General Hospital, No.201, Sec. 2, Shih-Pai Road, Taipei, 112 Taiwan
- Department of Obstetrics and Gynaecology, School of Medicine, National Yang-Ming University, No.155, Sec.2, Li-Nong Street, Taipei, 112 Taiwan
- Institute of Clinical Medicine, National Yang-Ming University, No.155, Sec.2, Li-Nong Street, Taipei, 112 Taiwan
| | - Hsin-Yang Li
- Department of Obstetrics and Gynaecology, Taipei Veterans General Hospital, No.201, Sec. 2, Shih-Pai Road, Taipei, 112 Taiwan
| | - Teh-Ying Chou
- Institute of Clinical Medicine, National Yang-Ming University, No.155, Sec.2, Li-Nong Street, Taipei, 112 Taiwan
| | - Yi-Jen Chen
- Department of Obstetrics and Gynaecology, Taipei Veterans General Hospital, No.201, Sec. 2, Shih-Pai Road, Taipei, 112 Taiwan
- Department of Obstetrics and Gynaecology, School of Medicine, National Yang-Ming University, No.155, Sec.2, Li-Nong Street, Taipei, 112 Taiwan
- Institute of Clinical Medicine, National Yang-Ming University, No.155, Sec.2, Li-Nong Street, Taipei, 112 Taiwan
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Greaves E, Cousins FL, Murray A, Esnal-Zufiaurre A, Fassbender A, Horne AW, Saunders PTK. A novel mouse model of endometriosis mimics human phenotype and reveals insights into the inflammatory contribution of shed endometrium. THE AMERICAN JOURNAL OF PATHOLOGY 2014; 184:1930-9. [PMID: 24910298 PMCID: PMC4076466 DOI: 10.1016/j.ajpath.2014.03.011] [Citation(s) in RCA: 114] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Revised: 03/19/2014] [Accepted: 03/20/2014] [Indexed: 01/06/2023]
Abstract
Endometriosis is an estrogen-dependent inflammatory disorder characterized by the presence of endometrial tissue outside the uterine cavity. Patients experience chronic pelvic pain and infertility, with the most likely origin of the tissue deposits (lesions) being endometrial fragments shed at menses. Menstruation is an inflammatory process associated with a dramatic increase in inflammatory mediators and tissue-resident immune cells. In the present study, we developed and validated a mouse model of endometriosis using syngeneic menstrual endometrial tissue introduced into the peritoneum of immunocompetent mice. We demonstrate the establishment of endometriotic lesions that exhibit similarities to those recovered from patients undergoing laparoscopy. Specifically, in both cases, lesions had epithelial (cytokeratin(+)) and stromal (vimentin/CD10(+)) cell compartments with a well-developed vasculature (CD31(+) endothelial cells). Expression of estrogen receptor β was increased in lesions compared with the peritoneum or eutopic endometrium. By performing experiments using mice with green fluorescent protein-labeled macrophages (MacGreen) in reciprocal transfers with wild-type mice, we obtained evidence that macrophages present in the peritoneum and in menses endometrium can contribute to the inflammatory microenvironment of the lesions. In summary, we developed a mouse model of endometriosis that exhibits similarities to human peritoneal lesions with respect to estrogen receptor expression, inflammation, and macrophage infiltration, providing an opportunity for further studies and the possible identification of novel therapies for this perplexing disorder.
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Affiliation(s)
- Erin Greaves
- Medical Research Council Centre for Reproductive Health, Queens Medical Research Institute, The University of Edinburgh, Edinburgh, United Kingdom.
| | - Fiona L Cousins
- Medical Research Council Centre for Reproductive Health, Queens Medical Research Institute, The University of Edinburgh, Edinburgh, United Kingdom
| | - Alison Murray
- Medical Research Council Centre for Reproductive Health, Queens Medical Research Institute, The University of Edinburgh, Edinburgh, United Kingdom
| | - Arantza Esnal-Zufiaurre
- Medical Research Council Centre for Reproductive Health, Queens Medical Research Institute, The University of Edinburgh, Edinburgh, United Kingdom
| | - Amelie Fassbender
- Department of Development and Regeneration, Organ Systems, KULeuven, Leuven, Belgium; Department of Obstetrics and Gynaecology, Leuven University Fertility Centre, University Hospital Leuven, Leuven, Belgium
| | - Andrew W Horne
- Medical Research Council Centre for Reproductive Health, Queens Medical Research Institute, The University of Edinburgh, Edinburgh, United Kingdom
| | - Philippa T K Saunders
- Medical Research Council Centre for Reproductive Health, Queens Medical Research Institute, The University of Edinburgh, Edinburgh, United Kingdom
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Laschke MW, Rudzitis-Auth J, Menger MD. Regional treatment with liquid barrier agents: a novel therapeutic option for intraperitoneal endometriosis? Med Hypotheses 2013; 80:709-10. [PMID: 23517566 DOI: 10.1016/j.mehy.2013.02.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2012] [Accepted: 02/17/2013] [Indexed: 02/06/2023]
Abstract
Endometriosis is a frequent gynecological disease, which is characterized by the presence of endometriotic lesions, i.e. ectopic endometrial glands and stroma, outside the uterine cavity. Most of these lesions are located in the peritoneal cavity, where they induce a chronic inflammatory and angiogenic tissue response. This is often associated with the formation of peritoneal adhesions. Accordingly, endometriosis is crucially dependent on the close interaction of the ectopic endometrial tissue with the peritoneum and the peritoneal fluid. Therefore, we hypothesize in the present paper that regional treatment of endometriosis, selectively targeting the peritoneal microenvironment without inducing severe systemic side effects, may represent a promising novel treatment strategy. This may be achieved by the application of liquid barrier agents, which are already well established in clinical practice for peritoneal dialysis, treatment of peritoneal surface malignancies and prevention of postoperative adhesions. Of interest, some of these agents have been shown to exhibit anti-inflammatory, anti-oxidant and anti-tumoral properties. Thus, they may act as pleiotropic compounds, affecting multiple mechanisms, which are involved in the pathogenesis of endometriosis.
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Affiliation(s)
- Matthias W Laschke
- Institute for Clinical and Experimental Surgery, University of Saarland, 66421 Homburg/Saar, Germany.
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Ruan GP, Wang JX, Pang RQ, Yao X, Cai XM, Wang Q, Ma LH, Zhu XQ, Pan XH. Treatment with chicken-egg-white or whole-egg extracts maintains and enhances the survival and differentiation of spleen cells. Cytotechnology 2012; 64:541-51. [PMID: 22350684 DOI: 10.1007/s10616-012-9431-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2011] [Accepted: 01/18/2012] [Indexed: 12/26/2022] Open
Abstract
The identification of egg extracts with the ability to maintain and enhance the survival and differentiation of cells would be widely useful in cellular biology research. In this study, we compared the different abilities of spleen cells to survive and differentiate in vivo after permeabilization by five different types of egg extracts. Five types of egg extracts were prepared. The spleen cells from male GFP-transgenic mice were permeabilized by the extracts for 30 min, cultured for 12 days, and then transfused into irradiated female mice. At varying days after transplantation, the percentage of GFP-expressing surviving spleen cells was detected in the peripheral blood by flow cytometry. At 120 days after transplantation, bone marrow cells from the female mice were analyzed for the presence of cells containing the Y chromosome. Surviving GFP-positive spleen cells that had been permeabilized with either chicken-egg-white or whole-egg extracts could be detected in the female mice after transplantation. A lower percentage of GFP-positive cells was also detected after permeabilization by the other extracts tested, and no GFP-positive cells were found in the female mouse transfused with spleen cells permeabilized with Hank's Buffered Salt Solution (HBSS) as a control. At 120 days after transplantation, the percentage of cells containing a Y chromosome in the bone marrow positively correlated with the percentage of GFP-positive cells in the peripheral blood. After permeabilization by chicken-egg-white or whole-egg extracts, spleen cells demonstrated significantly enhanced survival and differentiation functions compared with the spleen cells treated with the other egg extracts tested. These results show that chicken-egg-white and whole-egg extracts have roles in maintaining and enhancing the survival and differentiation of spleen cells. Therefore, these two types of extracts may be of future use in maintaining the function of stem cells.
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Affiliation(s)
- Guang-Ping Ruan
- Research Center of Stem Cell, Tissue and Organ Engineering, Kunming General Hospital of PLA, Kunming, 650032, China
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