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Cottell E, Michalet D, Lispi M, Araujo TD, Gleixner R, Longobardi S, D'Hooghe T. Dose accuracy of the follitropin alfa pen injector 2.0, the follitropin alfa:lutropin alfa 2:1 combination pen injector 2.0 and the choriogonadotropin alfa pen injector 1.0 used for fertility treatment. Expert Opin Drug Deliv 2024; 21:337-346. [PMID: 38299472 DOI: 10.1080/17425247.2024.2311127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 01/20/2024] [Indexed: 02/02/2024]
Abstract
BACKGROUND This study aimed to confirm that the incremental dose/clicks system dispenses accurate doses for the Merck family of fertility pen injectors. RESEARCH DESIGN AND METHODS Set doses (Vset) for three dose dial settings (minimum dose [Vmin], midpoint dose [Vmid] and maximum dose [Vmax] for the follitropin alfa, choriogonadotropin alfa [D2 classification: single use/variable dose], and follitropin alfa:lutropin-alfa 2:1 combination pen injectors) or a single Vset for the choriogonadotropin alfa (D1 classification: single use/single dose) were assessed. Last dose administered by the multi-dose device was assessed for the 900 IU, 450 IU, 300 IU and 150 IU follitropin alfa, and the 900:450 IU, 450:225 IU and 300:150 IU follitropin alfa:lutropin-alfa 2:1 combination pen presentations. RESULTS Dose accuracy tests for Vmin, Vmid and Vmax for the follitropin alfa and the follitropin alfa:lutropin-alfa 2:1 combination pen injectors, and last dose administered, were within acceptable limits according to ISO 11,608-1:2012/2014. Dose accuracy tests for the single use/single dose device classification and the single use/variable dose device classification of the choriogonadotropin alfa pen injector were also within the acceptable limits, according to ISO 11608-1:2000/2014. CONCLUSIONS The Merck family of fertility pen injectors functions reliably and the incremental dose/clicks system dispenses accurate doses.
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Affiliation(s)
| | - Damien Michalet
- Ares Trading S.A. Eysins (An affiliate of Merck KGaA), Switzerland
| | - Monica Lispi
- Merck Healthcare KGaA, Darmstadt, Germany
- School of Clinical and Experimental Medicine, Unit of Endocrinology, University of Modena and Reggio Emilia, Modena, MO, Italy
| | | | - Ralf Gleixner
- Ares Trading S.A. Eysins (An affiliate of Merck KGaA), Switzerland
| | - Salvatore Longobardi
- Global Clinical Development, Merck Serono S.p.A, Rome, Italy, an affiliate of Merck KGaA, Darmstadt, Germany
| | - Thomas D'Hooghe
- Merck Healthcare KGaA, Darmstadt, Germany
- Department of Development and Regeneration, Laboratory of Endometrium, Endometriosis & Reproductive Medicine, KU Leuven, Leuven, Belgium
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University Medical School, New Haven, CT, USA
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Batista AR, Schwarze JE, Lispi M. Response to: Randomized, assessor-blinded trial comparing highly purified human menotropin and recombinant follicle-stimulating hormone in high responders undergoing intracytoplasmic sperm injection. Fertil Steril 2024; 121:358. [PMID: 37734649 DOI: 10.1016/j.fertnstert.2023.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 09/11/2023] [Indexed: 09/23/2023]
Affiliation(s)
- Ana Rita Batista
- Global Medical Affairs Fertility, R&D Biopharma, Merck KGaA, Darmstadt, Germany
| | | | - Monica Lispi
- Global Medical Affairs Fertility, R&D Biopharma, Merck KGaA, Darmstadt, Germany; International PhD School in Clinical and Experimental Medicine (CEM), University of Modena and Reggio Emilia, Modena, Italy
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Bielfeld AP, Schwarze JE, Verpillat P, Lispi M, Fischer R, Hayward B, Chuderland D, D'Hooghe T, Krussel JS. Effectiveness of recombinant human FSH: recombinant human LH combination treatment versus recombinant human FSH alone for assisted reproductive technology in women aged 35-40 years. Reprod Biomed Online 2023; 48:103725. [PMID: 38593745 DOI: 10.1016/j.rbmo.2023.103725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 11/07/2023] [Accepted: 11/08/2023] [Indexed: 04/11/2024]
Abstract
RESEARCH QUESTION According to real-world data, is recombinant human FSH (r-hFSH) combined with recombinant human LH (r-hLH) or r-hFSH alone more effective for women of advanced maternal age (AMA) in terms of live birth? DESIGN Non-interventional study comparing the effectiveness of r-hFSH and recombinant r-hLH (2:1 ratio) versus r-hFSH alone for ovarian stimulation during ART treatment in women aged 35-40 years, using real-world data from the Deutsches IVF-Register. RESULTS Overall clinical pregnancy (29.8%, 95% CI 28.2 to 31.6 versus 27.8%, 95% CI 26.5 to 29.2) and live birth (20.3%, 95% CI 18.7 to 21.8 versus 18.0%, 95% CI 16.6 to 19.4) rates were not significantly different between the combined r-hFSH and r-hLH group and the r-hFSH alone group (P = 0.269 and P = 0.092, respectively). Treatment effect was significantly higher for combined r-hFSH and r-hLH compared with r-hFSH alone for clinical pregnancy (33.1%, 95% CI 31.0 to 35.0 versus 28.5%, 95% CI 26.6 to 30.4; P = 0.001, not adjusted for multiplicity) and live birth (22.5%, 95% CI 20.5 to 24.2 versus 19.4%, 95% CI 17.6 to 20.9; P = 0.014, not adjusted for multiplicity) in a post-hoc analysis of women with five to 14 oocytes retrieved (used as a surrogate for normal ovarian reserve), highlighting the potential benefits of combined r-hFSH and r-hLH for ovarian stimulation in women aged 35-40 years with normal ovarian reserve. CONCLUSIONS Women of AMA with normal ovarian response benefit from treatment with combined r-hFSH and r-hLH in a 2:1 ratio versus r-hFSH alone in terms of live birth rate. The effectiveness of treatments is best assessed by RCTs; however, real-world data are valuable for examining the effectiveness of fertility treatment, especially among patient groups that are not well represented in clinical trials.
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Affiliation(s)
- Alexandra P Bielfeld
- Department of Obstetrics/Gynecology and Reproductive Medicine, UniKiD Center for Reproductive Medicine (UniKiD), Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine University, Universitätsstraße 1, 40225, Duesseldorf, Germany
| | - Juan-Enrique Schwarze
- Global Medical Affairs Fertility, Merck Healthcare KGaA, Frankfurter Strasse 250, Darmstadt, 64293, Germany.
| | - Patrice Verpillat
- Global Epidemiology, Merck Healthcare KGaA, Frankfurter Strasse 250, Darmstadt, 64293, Germany
| | - Monica Lispi
- Global Medical Affairs Fertility, Merck Healthcare KGaA, Frankfurter Strasse 250, Darmstadt, 64293, Germany; PhD School of Clinical and Experimental Medicine, Unit of Endocrinology, University of Modena and Reggio Emilia, Viale A. Allegri 9. 42121, Emilia-Romagna, Italy
| | | | - Brooke Hayward
- EMD Serono, One Technology Place, Rockland, Massachusetts, 02370, USA, an affiliate of Merck KGaA, Darmstadt, Germany
| | - Dana Chuderland
- Global Medical Affairs Fertility, Merck Healthcare KGaA, Frankfurter Strasse 250, Darmstadt, 64293, Germany
| | - Thomas D'Hooghe
- Global Medical Affairs Fertility, Merck Healthcare KGaA, Frankfurter Strasse 250, Darmstadt, 64293, Germany; Department of Development and Regeneration, Laboratory of Endometrium, Endometriosis & Reproductive Medicine, KU Leuven, Oude Markt 13, 3000 Leuven, Belgium; Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University Medical School, 333 Cedar St, New Haven, CT 06510, USA
| | - Jan-Steffan Krussel
- Department of Obstetrics/Gynecology and Reproductive Medicine, UniKiD Center for Reproductive Medicine (UniKiD), Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine University, Universitätsstraße 1, 40225, Duesseldorf, Germany
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Montenegro S, Helwig C, Schwarze JE, Castello-Bridoux C, Marque S, Lispi M, D'Hooghe T. Letter to the editor in response to 'A real-world study of ART in France (REOLA) comparing a biosimilar rFSH against the originator according to rFSH starting dose' by P. Barrière, S. Hamamah, E. Arbo, C. Avril, B. Salle, J.-L. Pouly, et al. (J Gynecol Obstet Hum Reprod. 2023;52(1):102510). J Gynecol Obstet Hum Reprod 2023; 52:102640. [PMID: 37549879 DOI: 10.1016/j.jogoh.2023.102640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 08/04/2023] [Indexed: 08/09/2023]
Affiliation(s)
| | | | | | | | | | - Monica Lispi
- Merck KGaA, Darmstadt, Germany; Unit of Endocrinology, PhD School of Clinical and Experimental Medicine, University of Modena and Reggio Emilia, Reggio Emilia 42121, Italy
| | - Thomas D'Hooghe
- Merck KGaA, Darmstadt, Germany; Department of Development and Regeneration, Laboratory of Endometrium, Endometriosis & Reproductive Medicine, KU Leuven, Leuven, Belgium; Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University Medical School, New Haven, United States
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Venetis CA, Helwig C, Mol BW, Chua SJ, Longobardi S, Orvieto R, Lispi M, Storr A, D'Hooghe T. Correction: Biosimilar recombinant follitropin alfa preparations versus the reference product (Gonal-F®) in couples undergoing assisted reproductive technology treatment: a systematic review and meta-analysis. Reprod Biol Endocrinol 2023; 21:68. [PMID: 37496043 PMCID: PMC10369731 DOI: 10.1186/s12958-023-01114-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/28/2023] Open
Affiliation(s)
- Christos A Venetis
- Unit for Human Reproduction, 1st Dept of OB/Gyn, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
- Centre for Big Data Research in Health, University of New South Wales, Kensington Campus, New South Wales, Australia
- IVF Australia, Sydney, NSW, 2000, Australia
| | | | - Ben W Mol
- Department of Obstetrics and Gynecology, University of Monash, Monash, Clayton, Victoria, 3168, Australia.
| | - Su Jen Chua
- Alfred Health, Melbourne, VIC, 3004, Australia
| | - Salvatore Longobardi
- Global Clinical Development, Merck Serono S.p.A (an affiliate of Merck KGaA, Darmstadt 64293, Germany), Rome, 00176, Italy
| | - Raoul Orvieto
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Tel-Hashomer, Ramat Gan, 52621, Israel
- The Tarnesby-Tarnowski Chair for Family Planning and Fertility Regulation, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv-Yafo, 6997801, Israel
| | - Monica Lispi
- University of Modena and Reggio Emilia, Modena, MO, 41121, Italy
- GlobalMedical Affairs Fertility, Research and Development, Merck KGaA, F135/002, Darmstadt, 64293, Germany
| | - Ashleigh Storr
- Flinders Fertility, Adelaide, South Australia, 5045, Australia
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, 5042, Australia
| | - Thomas D'Hooghe
- GlobalMedical Affairs Fertility, Research and Development, Merck KGaA, F135/002, Darmstadt, 64293, Germany
- Research Group Reproductive Medicine, Department of Development and Regeneration, Organ Systems, Group Biomedical Sciences, KU Leuven (University of Leuven), Leuven, 3000, Belgium
- Department of Obstetrics and Gynecology, Yale University, New Haven, CT, 06510, USA
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Strezsak V, Allignol A, Bühler K, Fischer R, Hubbard J, Longobardi S, Lispi M, Schertz J, Verpillat P. Dosing Characteristics of Recombinant Human Luteinizing Hormone or Human Menopausal Gonadotrophin-Derived LH Activity in Patients Undergoing Ovarian Stimulation: A German Fertility Database Study. Gynecol Obstet Invest 2023; 88:214-225. [PMID: 37369184 PMCID: PMC10614274 DOI: 10.1159/000530360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 03/07/2023] [Indexed: 06/29/2023]
Abstract
OBJECTIVES The aim of the study was to evaluate dosing of recombinant human luteinizing hormone (r-hLH) or human menopausal gonadotrophin (hMG)-derived medications with LH activity in ovarian stimulation (OS) cycles for in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI). DESIGN A non-interventional study was performed to analyse data from the German RecDate database (January 2007-December 2011). PARTICIPANTS/MATERIALS, SETTING, METHODS Starting/total r-hLH/hMG dose, OS duration/cycle number, r-hLH/hMG initiation day (first day of administration), and population/cycle characteristics were assessed in women (≥18 years) undergoing OS for IVF/ICSI using r-hLH or hMG-derived medications (excluding corifollitropin alfa, clomiphene citrate, letrozole, mini/micro-dose human chorionic gonadotrophin, and urofollitropin alone). Data were summarized descriptively. RESULTS 67,858 identified cycles utilized medications containing r-hLH (10,749), hMG (56,432), or both (677). Mean (standard deviation) OS duration with r-hLH and hMG was 10.1 (4.43) and 9.8 (6.16) days, respectively. Median (25th-75th percentile) r-hLH starting dose (75.0 [75.0-150.0] IU) was consistent across patients regardless of age, infertility diagnosis, or gonadotrophin-releasing hormone (GnRH) protocol. Median (25th-75th percentile) hMG-derived LH activity starting dose was 225.0 (150.0-300.0) IU, regardless of GnRH protocol, but was lower in women aged <35 years and those with ovulation disorders/polycystic ovary syndrome. Median (25th-75th percentile) total dose for r-hLH (750.0 [337.5-1,125.0] IU) and hMG-derived LH activity (1,575.0 [750.0-2,625.0] IU) varied according to patients' age, infertility diagnosis, cycle number, and r-hLH/hMG initiation day. GnRH antagonist use resulted in a numerically higher median total hMG-derived LH activity dose than GnRH agonist use. LIMITATIONS The data used in this study were taken from electronic medical records relating to a specific timeframe (2007-2011) and therefore may not accurately reflect current clinical practice; however, it is likely that the differences between the two compounds would be maintained. Additionally, secondary data sources may suffer from uniformity and quality issues. CONCLUSIONS The standard of care for OS cycles is described with respect to IVF/ICSI treatment including an LH component in Germany during the specified timeframe.
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Affiliation(s)
- Valerie Strezsak
- Global Clinical Development, Research and Development, EMD Serono Research and Development Institute, Inc., an affiliate of Merck KGaA, Billerica, MA, USA
| | - Arthur Allignol
- Global Epidemiology, Research and Development, Merck Healthcare KGaA, Darmstadt, Germany
| | - Klaus Bühler
- Department of Gynaecology and Reproductive Medicine, University Hospital Jena, Friedrich-Schiller-University Jena, Jena, Germany
- Scientific-Clinical Centre for Endometriosis of the University Hospitals of Saarland, Saarbrücken, Germany
| | | | - Julie Hubbard
- Global Clinical Development, Research and Development, EMD Serono Research & Development Institute, Inc., an affiliate of Merck KGaA, Billerica, MA, USA
| | - Salvatore Longobardi
- Global Clinical Development, Research and Development, Merck Healthcare KGaA, Darmstadt, Germany
| | - Monica Lispi
- Global Medical Affairs Fertility, Research and Development, Merck Healthcare KGaA, Darmstadt, Germany
- Unit of Endocrinology, PhD School of Clinical and Experimental Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Joan Schertz
- Global Clinical Development, Research and Development, EMD Serono Research & Development Institute, Inc., an affiliate of Merck KGaA, Billerica, MA, USA
| | - Patrice Verpillat
- Global Epidemiology, Research and Development, Merck Healthcare KGaA, Darmstadt, Germany
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Lispi M, Humaidan P, Bousfield GR, D'Hooghe T, Ulloa-Aguirre A. Follicle-Stimulating Hormone Biological Products: Does Potency Predict Clinical Efficacy? Int J Mol Sci 2023; 24:ijms24109020. [PMID: 37240364 DOI: 10.3390/ijms24109020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 05/12/2023] [Accepted: 05/15/2023] [Indexed: 05/28/2023] Open
Abstract
Follicle-stimulating hormone (FSH), together with luteinizing hormone (LH) and human chorionic gonadotropin (hCG), plays a fundamental role in human reproduction. The discovery of FSH and other gonadotropins was a defining moment in our understanding of reproduction and led to the development of many treatments for infertility. In this regard, exogenous FSH has been used to treat infertility in women for decades. Today, several recombinant and highly purified urinary forms of FSH are used in medically assisted reproduction (MAR). However, differences in the macro- and micro-heterogeneity of FSH result in a variety of FSH glycoforms, with glycoform composition determining the bioactivity (or potency), pharmacokinetic/pharmacodynamic (PK/PD) profiles, and clinical efficacy of the different forms of FSH. This review illustrates how the structural heterogeneity of FSH glycoforms affects the biological activity of human FSH products, and why potency does not predict effects in humans in terms of PK, PD, and clinical response.
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Affiliation(s)
- Monica Lispi
- Merck Healthcare KGaA, 64293 Darmstadt, Germany
- Unit of Endocrinology, PhD School of Clinical and Experimental Medicine, University of Modena and Reggio Emilia, 42121 Reggio Emilia, Italy
| | - Peter Humaidan
- Fertility Clinic at Skive Regional Hospital, Faculty of Health, Aarhus University, 8000 Aarhus, Denmark
| | - George R Bousfield
- Department of Biological Sciences, Wichita State University, Wichita, KS 67260, USA
| | - Thomas D'Hooghe
- Merck Healthcare KGaA, 64293 Darmstadt, Germany
- Laboratory of Endometrium, Endometriosis & Reproductive Medicine, Department of Development and Regeneration, KU Leuven, 3000 Leuven, Belgium
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University Medical School, New Haven, CT 06510, USA
| | - Alfredo Ulloa-Aguirre
- Red de Apoyo a la Investigación, Universidad Nacional Autónoma de México (UNAM)-Instituto Nacional de Ciencias Médicas y Nutrición SZ, Mexico City 14080, Mexico
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Bielfeld AP, Schwarze JE, Verpillat P, Lispi M, Fischer R, Hayward B, Chuderland D, D'Hooghe T, Krussel JS. Effectiveness of recombinant human follicle-stimulating hormone (r-hFSH): recombinant human luteinizing hormone versus r-hFSH alone in assisted reproductive technology treatment cycles among women aged 35-40 years: A German database study. Best Pract Res Clin Obstet Gynaecol 2023; 89:102350. [PMID: 37320996 DOI: 10.1016/j.bpobgyn.2023.102350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 04/21/2023] [Accepted: 05/07/2023] [Indexed: 06/17/2023]
Abstract
This non-interventional study compared the effectiveness of recombinant human follicle-stimulating hormone (r-hFSH) and recombinant human luteinizing hormone (r-hLH) (2:1 ratio) versus r-hFSH alone for ovarian stimulation (OS) during assisted reproductive technology treatment in women aged 35-40 years, using real-world data from the Deutsches IVF-Register (D·I·R). Numerically higher clinical pregnancy (29.8% [95% CI 28.2, 31.6] vs. 27.8% [26.5, 29.2]) and live birth (20.3% [18.7, 21.8] vs. 18.0% [16.6, 19.4]) rates were observed with r-hFSH:r-hLH versus r-hFSH alone. The treatment effect was consistently higher for r-hFSH:r-hLH compared with r-hFSH alone in terms of clinical pregnancy (relative risk [RR] 1.16 [1.05, 1.26]) and live birth (RR 1.16 [1.02, 1.31]) in a post-hoc analysis of women with 5-14 oocytes retrieved (used as a surrogate for normal ovarian reserve), highlighting the potential benefits of r-hFSH:r-hLH for OS in women aged 35-40 years with normal ovarian reserve.
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Affiliation(s)
- A P Bielfeld
- Department of Obstetrics/Gynecology and Reproductive Medicine, UniKiD Center for Reproductive Medicine (UniKiD), Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine University, Universitätsstraße 1, 40225, Duesseldorf, Germany.
| | - J E Schwarze
- Global Medical Affairs Fertility, Merck Healthcare KGaA, Frankfurter Strasse 250, Darmstadt, 64293, Germany.
| | - P Verpillat
- Global Epidemiology, Merck Healthcare KGaA, Frankfurter Strasse 250, Darmstadt, 64293, Germany.
| | - M Lispi
- Global Medical Affairs Fertility, Merck Healthcare KGaA, Frankfurter Strasse 250, Darmstadt, 64293, Germany; PhD School of Clinical and Experimental Medicine, Unit of Endocrinology, University of Modena and Reggio Emilia, Viale A. Allegri 9. 42121, Emilia-Romagna, Italy.
| | - R Fischer
- Fertility Centre Hamburg, 20095, Hamburg, Germany.
| | - B Hayward
- EMD Serono, One Technology Place, Rockland, MA 02370, USA, and affiliate of Merck KGaA, Darmstadt, Germany.
| | - D Chuderland
- Global Medical Affairs Fertility, Merck Healthcare KGaA, Frankfurter Strasse 250, Darmstadt, 64293, Germany.
| | - T D'Hooghe
- Global Medical Affairs Fertility, Merck Healthcare KGaA, Frankfurter Strasse 250, Darmstadt, 64293, Germany; Department of Development and Regeneration, Laboratory of Endometrium, Endometriosis & Reproductive Medicine, KU Leuven, Oude Markt 13, 3000 Leuven, Belgium; Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University Medical School, 333 Cedar St, New Haven, CT 06510, USA.
| | - J S Krussel
- Department of Obstetrics/Gynecology and Reproductive Medicine, UniKiD Center for Reproductive Medicine (UniKiD), Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine University, Universitätsstraße 1, 40225, Duesseldorf, Germany.
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Fanelli F, Magagnoli M, Mezzullo M, Lispi M, Limoncella S, Tommasini A, Pelusi C, Santi D, Simoni M, Pagotto U, Casarini L. Exploring the human chorionic gonadotropin induced steroid secretion profile of mouse Leydig tumor cell line 1 by a 20 steroid LC-MS/MS panel. J Steroid Biochem Mol Biol 2023; 229:106270. [PMID: 36764496 DOI: 10.1016/j.jsbmb.2023.106270] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 12/29/2022] [Accepted: 02/07/2023] [Indexed: 02/11/2023]
Abstract
The canonical androgen synthesis in Leydig cells involves Δ5 and Δ4 steroids. Besides, the backdoor pathway, eompassing 5α and 5α,3α steroids, is gaining interest in fetal and adult pathophysiology. Moreover, the role of androgen epimers and progesterone metabolites is still unknown. We developed a liquid chromatography-tandem mass spectrometry (LC-MS/MS) method for measuring 20 steroids and used it to investigate the steroid secretion induced by human chorionic gonadotropin (hCG) in the mouse Leydig tumor cell line 1 (mLTC1). Steroids were extracted from 500 µL supernatants from unstimulated or 100 pM hCG-exposed mLTC1 cells, separated on a Luna C8 100 × 3 mm, 3 µm column, with 100 µM NH4F and methanol as mobile phases, and analyzed by positive electrospray ionization and multiple reaction monitoring. Sensitivity ranged within 0.012-38.0 nmol/L. Intra-assay and inter-assay imprecision were < 9.1% and 10.0%, respectively. Trueness, recovery and matrix factor were within 93.4-122.0, 55.6-104.1 and 76.4-106.3%, respectively. Levels of 16OH-progesterone, 11-deoxycortisol, androstenedione, 11-deoxycorticosterone, testosterone, 17OH-progesterone, androstenedione, epitestosterone, dihydrotestosterone, progesterone, androsterone and 17OH-allopregnanolone were effectively measured. Traces of 17OH-dihydroprogesterone, androstanediol and dihydroprogesterone were found, whereas androstenediol, 17OH-pregnenolone, dehydroepiandrosterone, pregnenolone and allopregnanolone showed no peak. hCG induced an increase of 80.2-102.5 folds in 16OH-progesterone, androstenedione and testosterone, 16.6 in dihydrotestosterone, 12.2-27.5 in epitestosterone, progesterone and metabolites, 8.1 in 17OH-allopregnanolone and ≤ 3.3 in 5α and 5α,3α steroids. In conclusion, our LC-MS/MS method allows exploring the Leydig steroidogenesis flow according to multiple pathways. Beside the expected stimulation of the canonical pathway, hCG increased progesterone metabolism and, to a low extent, the backdoor route.
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Affiliation(s)
- Flaminia Fanelli
- Endocrinology research group, Center for Applied Biomedical Research, Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Italy.
| | - Matteo Magagnoli
- Endocrinology research group, Center for Applied Biomedical Research, Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Italy
| | - Marco Mezzullo
- Endocrinology research group, Center for Applied Biomedical Research, Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Italy
| | - Monica Lispi
- International Ph.D. School in Clinical and Experimental Medicine (CEM), University of Modena and Reggio Emilia, Modena, Italy; Global Medical Affair, Merck KGaA, Darmstadt, Germany
| | - Silvia Limoncella
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia. Ospedale di Baggiovara, Via P. Giardini 1355, 41126 Modena, Italy
| | - Alessia Tommasini
- Endocrinology research group, Center for Applied Biomedical Research, Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Italy
| | - Carla Pelusi
- Endocrinology research group, Center for Applied Biomedical Research, Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Italy; Endocrinology and Prevention and Care of Diabetes Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy
| | - Daniele Santi
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia. Ospedale di Baggiovara, Via P. Giardini 1355, 41126 Modena, Italy; Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria of Modena. Ospedale di Baggiovara, Via P. Giardini 1355, 41126 Modena, Italy
| | - Manuela Simoni
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia. Ospedale di Baggiovara, Via P. Giardini 1355, 41126 Modena, Italy; Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria of Modena. Ospedale di Baggiovara, Via P. Giardini 1355, 41126 Modena, Italy; Center for Genomic Research, University of Modena and Reggio Emilia, Via G. Campi 287, 41125 Modena, Italy
| | - Uberto Pagotto
- Endocrinology research group, Center for Applied Biomedical Research, Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Italy; Endocrinology and Prevention and Care of Diabetes Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy
| | - Livio Casarini
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia. Ospedale di Baggiovara, Via P. Giardini 1355, 41126 Modena, Italy; Center for Genomic Research, University of Modena and Reggio Emilia, Via G. Campi 287, 41125 Modena, Italy
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10
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Nevelli F, Palmese A, Gleixner R, Peroglio F, D'Acunto CW, Dadone A, D'Hooghe T, Lispi M. Biological Assay to Determine Gonadotropin Potency: From In Vivo to In Vitro Sustainable Method. Int J Mol Sci 2023; 24:ijms24098040. [PMID: 37175746 PMCID: PMC10178553 DOI: 10.3390/ijms24098040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 04/04/2023] [Accepted: 04/13/2023] [Indexed: 05/15/2023] Open
Abstract
Various preparations of follicle-stimulating hormone (FSH) are commercially available; however, they differ in glycoforms composition and purity owing to their respective sources. Additional chemical/physical changes can also be introduced during manufacturing and can impact their biological activity (biopotency), which is routinely assessed using an in vivo bioassay (Steelman-Pohley). This study aimed to determine whether an in vitro bioassay could assess biopotency by distinguishing between r-hFSH chemical/physical variants with similar ability to the in vivo bioassay. The specific activity (units of biological activity per mg of product) of variants of r-hFSH generated through enrichment (acidic/basic), stress (oxidative/acidic pH) and enzymatic treatment (desialylation and desialylation/degalactosylation) was compared using the in vivo and in vitro bioassays. The in vitro bioassay reliably detected potential chemical/physical modifications in r-hFSH variants that may impact biopotency. Overall, the methods demonstrated a comparable ability to detect changes in specific activities due to chemical/physical differences in r-hFSH variants. These data indicate that the in vitro bioassay is suitable to replace the in vivo bioassay.
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Affiliation(s)
- Francesco Nevelli
- Analytical Development Biotech-Global Analytical Development-Global Development & Launch-Global Healthcare Operation, Istituto di Ricerche Biomediche "Antoine Marxer" RBM S.p.A., Colleretto Giacosa, Via Ribes, 1, 10010 Samone, Italy
| | - Angelo Palmese
- Analytical Development Biotech-Global Analytical Development-Global Development & Launch-Global Healthcare Operation, Merck Serono S.p.A., Piazza del Pigneto, 9, 00176 Rome, Italy
| | - Ralf Gleixner
- Ares Trading S.A., Rue de l'Ouriette 151, 1170 Aubonne, Switzerland
| | - Flavio Peroglio
- GHO Ivrea QC & Scientific Excellence-Global Analytical Development-Global Development & Launch-Global Healthcare Operation, Istituto di Ricerche Biomediche "Antoine Marxer" RBM S.p.A., Colleretto Giacosa, Via Ribes, 1, 10010 Samone, Italy
| | - Cosimo-Walter D'Acunto
- Analytical Development Biotech-Global Analytical Development-Global Development & Launch-Global Healthcare Operation, Istituto di Ricerche Biomediche "Antoine Marxer" RBM S.p.A., Colleretto Giacosa, Via Ribes, 1, 10010 Samone, Italy
- Analytical Development Biotech-Global Analytical Development-Global Development & Launch-Global Healthcare Operation, Merck Serono S.p.A., Piazza del Pigneto, 9, 00176 Rome, Italy
| | - Aurora Dadone
- Analytical Development Biotech-Global Analytical Development-Global Development & Launch-Global Healthcare Operation, Istituto di Ricerche Biomediche "Antoine Marxer" RBM S.p.A., Colleretto Giacosa, Via Ribes, 1, 10010 Samone, Italy
| | - Thomas D'Hooghe
- Global Medical Affairs Fertility, Merck Healthcare KGaA, Frankfurter Strasse 250, 64293 Darmstadt, Germany
- Department of Development and Regeneration, Laboratory of Endometrium, Endometriosis & Reproductive Medicine, KU Leuven, Oude Markt 13, 3000 Leuven, Belgium
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University Medical School, 333 Cedar St., New Haven, CT 06510, USA
| | - Monica Lispi
- Global Medical Affairs Fertility, Merck Healthcare KGaA, Frankfurter Strasse 250, 64293 Darmstadt, Germany
- PhD School of Clinical and Experimental Medicine, Unit of Endocrinology, University of Modena and Reggio Emilia, Viale A. Allegri 9, 42121 Reggio Emilia, Italy
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11
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Drakopoulos P, Khalaf Y, Esteves SC, Polyzos NP, Sunkara SK, Shapiro D, Rizk B, Ye H, Costello M, Koloda Y, Salle B, Lispi M, D'Hooghe T, La Marca A. Treatment algorithms for high responders: What we can learn from randomized controlled trials, real-world data and models. Best Pract Res Clin Obstet Gynaecol 2023; 86:102301. [PMID: 36646567 DOI: 10.1016/j.bpobgyn.2022.102301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 12/19/2022] [Indexed: 12/28/2022]
Abstract
A high ovarian response to conventional ovarian stimulation (OS) is characterized by an increased number of follicles and/or oocytes compared with a normal response (10-15 oocytes retrieved). According to current definitions, a high response can be diagnosed before oocyte pick-up when >18-20 follicles ≥11-12 mm are observed on the day of ovulation triggering; high response can be diagnosed after oocyte pick-up when >18-20 oocytes have been retrieved. Women with a high response are also at high risk of early ovarian hyper-stimulation syndrome (OHSS)/or late OHSS after fresh embryo transfers. Women at risk of high response can be diagnosed before stimulation based on several indices, including ovarian reserve markers (anti-Müllerian hormone [AMH] and antral follicle count [AFC], with cutoff values indicative of a high response in patients with PCOS of >3.4 ng/mL for AMH and >24 for AFC). Owing to the high proportion of high responders who are at the risk of developing OHSS (up to 30%), this educational article provides a framework for the identification and management of patients who fall into this category. The risk of high response can be greatly reduced through appropriate management, such as individualized choice of the gonadotropin starting dose, dose adjustment based on hormonal and ultrasound monitoring during OS, the choice of down-regulation protocol and ovulation trigger, and the choice between fresh or elective frozen embryo transfer. Appropriate management strategies still need to be defined for women who are predicted to have a high response and those who have an unexpected high response after starting treatment.
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Affiliation(s)
- Panagiotis Drakopoulos
- Centre for Reproductive Medicine, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium; Department of Obstetrics and Gynaecology, University of Alexandria, Alexandria, 21526, Egypt.
| | - Yakoub Khalaf
- Reproductive Medicine and Surgery, Guy's and St Thomas' NHS Foundation Trust, King's College London, London, United Kingdom
| | - Sandro C Esteves
- ANDROFERT, Andrology and Human Reproduction Clinic, Campinas, Brazil; Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Nikolaos P Polyzos
- Department of Reproductive Medicine, Dexeus University Hospital, 08028, Barcelona, Spain; Faculty of Medicine and Health Sciences, University of Ghent (UZ Gent), 9000, Gent, Belgium
| | - Sesh K Sunkara
- Department of Women's Health, Faculty of Life Sciences and Medicine, King's College London, Great Maze Pond, London, United Kingdom
| | | | - Botros Rizk
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of South Alabama, Mobile, AL, 36604, USA
| | - Hong Ye
- Chongqing Key Laboratory of Human Embryo Engineering, Chongqing, China; Chongqing Clinical Research Center for Reproductive Medicine, Chongqing, China; Reproductive and Genetic Institute, Chongqing Health Center for Women and Children, No. 64 Jin Tang Street, Yu Zhong District, Chongqing, 400013, China
| | - Michael Costello
- Division of Obstetrics & Gynaecology, School of Women's and Children's Health, UNSW and Royal Hospital for Women and Monash IVF, Sydney, Australia
| | - Yulia Koloda
- Center of Reproduction "Life Line", Moscow, Russia; Department of Obstetrics and Gynecology, Russian Medical Academy of Continuous Professional Education, Moscow, Russia
| | - Bruno Salle
- Department of Reproductive Medicine, CHU Lyon, Hôpital Femme Mère Enfant, 59 Bd Pinel, 69500, Bron, France; Université Claude Bernard, Faculté de Médecine Lyon Sud, 165 Chemin Du Petit Revoyet, Oullins, France; INSERM Unité, 1208, 18 Avenue Doyen Lépine, Bron, France
| | - Monica Lispi
- Merck Healthcare KGaA, Darmstadt, Germany; PhD School of Clinical and Experimental Medicine, Unit of Endocrinology, University of Modena and Reggio Emilia, Italy
| | - Thomas D'Hooghe
- Merck Healthcare KGaA, Darmstadt, Germany; Department of Development and Regeneration, Laboratory of Endometrium, Endometriosis & Reproductive Medicine, KU Leuven, Leuven, Belgium; Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University Medical School, New Haven, USA
| | - Antonio La Marca
- Department of Medical and Surgical Sciences for Mother, Child and Adult, University of Modena and Reggio Emilia, and Clinica Eugin, Modena, Italy
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12
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Sperduti S, Paradiso E, Anzivino C, Lazzaretti C, Limoncella S, D'Alessandro S, Roy N, Reggianini F, Ferrari T, Melli B, La Sala GB, Nicoli A, Daolio J, Villani MT, Tagliavini S, Trenti T, Potì F, Sandhowe R, Centonze C, Lispi M, Simoni M, Casarini L. LH increases the response to FSH in granulosa-lutein cells from sub/poor-responder patients in vitro. Hum Reprod 2023; 38:103-112. [PMID: 36367827 DOI: 10.1093/humrep/deac246] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 10/11/2022] [Indexed: 11/13/2022] Open
Abstract
STUDY QUESTION Does LH addition to FSH in vitro recover the human primary granulosa lutein cell (hGLC) sub/poor-response? SUMMARY ANSWER A picomolar concentration of LH may recover the FSH-induced cAMP and progesterone production of hGLC from sub/poor-responder women. WHAT IS KNOWN ALREADY Clinical studies suggested that FSH and LH co-treatment may be beneficial for the ovarian response of sub/poor-responders undergoing ovarian stimulation during ART. STUDY DESIGN, SIZE, DURATION hGLC samples from 286 anonymous women undergoing oocyte retrieval for ART were collected from October 2017 to February 2021. PARTICIPANTS/MATERIALS, SETTING, METHODS hGLCs from women undergoing ovarian stimulation during ART were blindly purified, cultured, genotyped and treated in vitro by increasing concentrations of FSH (nM) ±0.5 nM LH. cAMP and progesterone levels produced after 3 and 24 h, respectively, were measured. In vitro data were stratified a posteriori, according to the donors' ovarian response, into normo-, sub- and poor-responder groups and statistically compared. The effects of LH addition to FSH were compared with those obtained by FSH alone in all the groups as well. MAIN RESULTS AND THE ROLE OF CHANCE hGLCs from normo-responders were shown to have higher sensitivity to FSH treatment than sub-/poor-responders in vitro. Equimolar FSH concentrations induced higher cAMP (about 2.5- to 4.2-fold), and progesterone plateau levels (1.2- to 2.1-fold), in cells from normo-responder women than those from sub-/poor-responders (ANOVA; P < 0.05). The addition of LH to the cell treatment significantly increased overall FSH efficacy, indicated by cAMP and progesterone levels, within all groups (P > 0.05). Interestingly, these in vitro endpoints, collected from the normo-responder group treated with FSH alone, were similar to those obtained in the sub-/poor-responder group under FSH + LH treatment. No different allele frequencies and FSH receptor (FSHR) gene expression levels between groups were found, excluding genetics of gonadotropin and their receptors as a factor linked to the normo-, sub- and poor-response. In conclusion, FSH elicits phenotype-specific ovarian lutein cell response. Most importantly, LH addition may fill the gap between cAMP and steroid production patterns between normo- and sub/poor-responders. LIMITATIONS, REASONS FOR CAUTION Although the number of experimental replicates is overall high for an in vitro study, clinical trials are required to demonstrate if the endpoints evaluated herein reflect parameters of successful ART. hGLC retrieved after ovarian stimulation may not fully reproduce the response to hormones of granulosa cells from the antral follicular stage. WIDER IMPLICATIONS OF THE FINDINGS This in vitro assay may describe the individual response to personalize ART stimulation protocol, according to the normo-, sub- and poor-responder status. Moreover, this in vitro study supports the need to conduct optimally designed, randomized clinical trials exploring the personalized use of LH in assisted reproduction. STUDY FUNDING/COMPETING INTEREST(S) This study was supported by Merck KGaA. M.L. and C.C. are employees of Merck KGaA or of the affiliate Merck Serono SpA. Other authors have no competing interests to declare. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- Samantha Sperduti
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy.,Center for Genomic Research, University of Modena and Reggio Emilia, Modena, Italy
| | - Elia Paradiso
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Claudia Anzivino
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy.,Center for Genomic Research, University of Modena and Reggio Emilia, Modena, Italy
| | - Clara Lazzaretti
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Silvia Limoncella
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Sara D'Alessandro
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy.,International Ph.D. School in Clinical and Experimental Medicine (CEM), University of Modena and Reggio Emilia, Modena, Italy
| | - Neena Roy
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Francesca Reggianini
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Tommaso Ferrari
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Beatrice Melli
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Giovanni Battista La Sala
- Department of Obstetrics and Gynaecology, Fertility Center, ASMN, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Alessia Nicoli
- Department of Obstetrics and Gynaecology, Fertility Center, ASMN, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Jessica Daolio
- Department of Obstetrics and Gynaecology, Fertility Center, ASMN, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Maria Teresa Villani
- Department of Obstetrics and Gynaecology, Fertility Center, ASMN, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Simonetta Tagliavini
- Department of Laboratory Medicine and Pathological Anatomy, Azienda USL/Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Tommaso Trenti
- Department of Laboratory Medicine and Pathological Anatomy, Azienda USL/Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Francesco Potì
- Department of Medicine and Surgery, Unit of Neurosciences, University of Parma, Parma, Italy
| | - Reinhild Sandhowe
- Centre of Reproductive Medicine and Andrology, University Hospital Münster, Münster, Germany
| | - Chiara Centonze
- Medical Affair, Merck Serono SpA (Rome, Italy), An Affiliate of Merck KGaA, Darmstadt, Germany
| | - Monica Lispi
- International Ph.D. School in Clinical and Experimental Medicine (CEM), University of Modena and Reggio Emilia, Modena, Italy.,Global Medical Affair, Merck KGaA, Darmstadt, Germany
| | - Manuela Simoni
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy.,Center for Genomic Research, University of Modena and Reggio Emilia, Modena, Italy.,Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Livio Casarini
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy.,Center for Genomic Research, University of Modena and Reggio Emilia, Modena, Italy
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13
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Luyten J, Connolly MP, Verbeke E, Buhler K, Scotland G, Lispi M, Revelli A, Borget I, Cedrin-Durnerin I, D'Hooghe T. Economic evaluation of Medically Assisted Reproduction: An educational overview of methods and applications for healthcare professionals. Best Pract Res Clin Obstet Gynaecol 2022; 85:217-228. [PMID: 35219590 DOI: 10.1016/j.bpobgyn.2022.01.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 01/11/2022] [Indexed: 12/14/2022]
Abstract
Economic evaluations of the value-for-money of Medically Assisted Reproduction (MAR) interventions are increasingly important due to growing pressure on healthcare budgets. Although such evaluations are commonplace in the published literature, the number/methodological complexity of different evaluations available, and the challenges specific to MAR interventions, can complicate the interpretation of such analyses for fertility treatments. This article aims to serve as an educational resource and provide context on the design/interpretation of economic analyses for MAR interventions. Several areas are relevant for first-line providers and decision makers: scope of analysis, comparator used, perspective/time horizon considered, outcomes used to measure success, and how results from cost-effectiveness studies can be summarised and used in clinical practice. We aim to help clinicians better understand the strengths/weaknesses of economic analyses, to enable the best use of the evidence in practice, so resources available for MAR interventions can provide maximum value to patients and society.
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Affiliation(s)
- Jeroen Luyten
- Leuven Institute for Healthcare Policy, KU Leuven, Kapucijnenvoer 35, B-3000, Leuven, Belgium.
| | - Mark P Connolly
- Global Market Access Solutions Sarl, Route de Buchillon, 65 St-Prex 1162, Switzerland; Unit of Pharmacoepidemiology and Pharmacoeconomics, Department of Pharmacy, University of Groningen, 9713, AV, Groningen, the Netherlands.
| | - Evelyn Verbeke
- Leuven Institute for Healthcare Policy, KU Leuven, Kapucijnenvoer 35, B-3000, Leuven, Belgium.
| | - Klaus Buhler
- Scientific Clinical Centre for Endometriosis, University Hospitals of Saarland, Saarbrüken, Germany; Department of Gynaecology, Jena-University Hospital-Friedrich Schiller University, 07737, Jena, Germany.
| | - Graham Scotland
- Health Services Research Unit, University of Aberdeen, 3rd Floor, Health Sciences Building, Foresterhill, Aberdeen, AB25 2ZD, UK; Health Economics Research Unit, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen, AB25 2ZD, UK.
| | - Monica Lispi
- Merck Healthcare KGaA, Frankfurter Str. 250, 64293, Darmstadt, Germany; School of Clinical and Experimental Medicine, Unit of Endocrinology, University of Modena and Reggio Emilia, Via Campi N. 287, 41125, Modena, Italy.
| | - Alberto Revelli
- SCDU2 Obstetrics and Gynecology, Department of Surgical Sciences, S. Anna Hospital, University of Turin, Via Ventimiglia 1, 10126, Turin, Italy.
| | - Isabelle Borget
- Department of Biostatistics and Epidemiology, Oncostat U1018, Inserm, Labeled Ligue Contre le Cancer Gustave Roussy, University Paris-Saclay, 114, rue Édouard-Vaillant, Villejuif Cedex, 94805, France; EA GRADES, University Paris-Saclay, Bâtiment B, 5 ue Jean-Baptiste Clément, 92296, Châtenay-Malabry Cedex, France.
| | - Isabelle Cedrin-Durnerin
- AP-HP- Department of Reproductive Medicine and Fertility Preservation, Jean Verdier Hospital, July 14th Avenue, 93140, Bondy, France.
| | - Thomas D'Hooghe
- Merck Healthcare KGaA, Frankfurter Str. 250, 64293, Darmstadt, Germany; Department of Development and Regeneration, Laboratory of Endometrium, Endometriosis & Reproductive Medicine, KU Leuven, B-3000, Leuven, Belgium; Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University Medical School, New Haven, CT, 06510, USA.
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14
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Bühler K, Roeder C, Schwarze JE, Lispi M, Allignol A, Falla E, Lukyanov V, D Hooghe T, Fischer R. Cost-effectiveness analysis of recombinant human follicle-stimulating hormone alfa(r-hFSH) and urinary highly purified menopausal gonadotropin (hMG) based on data from a large German registry. Best Pract Res Clin Obstet Gynaecol 2022; 85:188-202. [PMID: 35304097 DOI: 10.1016/j.bpobgyn.2022.02.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 02/06/2022] [Indexed: 01/07/2023]
Abstract
This was a retrospective real-world evidence analysis of the costs per live birth for reference recombinant human follicle-stimulating hormone alfa (r-hFSH-alfa) versus highly purified urinary human menopausal gonadotropin (hMG-HP), based on data from a German in vitro fertilization registry (RecDate). Pregnancy and live birth rates from the RecDate real-world evidence study over three complete assisted reproductive technology (ART) cycles using the same gonadotropin drug were used as clinical inputs. Costs related to ART treatment and to drugs were obtained from public sources. Treatment with r-hFSH-alfa resulted in higher adjusted cumulative live birth rates versus hMG-HP after one (25.3% vs. 22.3%), two (30.9% vs. 27.5%), and three (31.9% vs. 28.6%) ART cycles. Costs per live birth were lower with r-hFSH-alfa versus hMG-HP after one (€17,938 vs. €20,054), two (€18,251 vs. €20,437), and three (€18,473 vs. €20,680) ART cycles. r-hFSH-alfa was found to be a cost-effective strategy compared with hMG-HP over three cycles.
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Affiliation(s)
- Klaus Bühler
- Scientific Clinical Centre for Endometriosis, University Hospitals of Saarland, Saarbrücken, Germany; Department of Gynaecology, Jena-University Hospital-Friedrich Schiller University, Jena, Germany.
| | | | | | - Monica Lispi
- Merck Healthcare KGaA, Darmstadt, Germany; School of Clinical and Experimental Medicine, Unit of Endocrinology, University of Modena and Reggio Emilia, Modena, Italy.
| | | | | | | | - Thomas D Hooghe
- Merck Healthcare KGaA, Darmstadt, Germany; Department of Development and Regeneration, Laboratory of Endometrium, Endometriosis, and Reproductive Medicine, KU Leuven, Leuven, Belgium; Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University Medical School, New Haven, USA.
| | - Robert Fischer
- Gynecological Endocrinology and Reproductive Medicine, Fertility Centre Hamburg, 20095, Hamburg, Germany.
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15
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Koloda Y, Korsak V, Rozenson O, Anshina M, Sagamonova K, Baranov I, Yakovenko S, D'Hooghe T, Ershova A, Lispi M. Use of a recombinant human follicle-stimulating hormone:recombinant human luteinizing hormone (r-hFSH:r-hLH) 2:1 combination for controlled ovarian stimulation during assisted reproductive technology treatment: A real-world study of routine practice in the Russian Federation. Best Pract Res Clin Obstet Gynaecol 2022; 85:134-148. [PMID: 35216907 DOI: 10.1016/j.bpobgyn.2022.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 01/17/2022] [Accepted: 01/21/2022] [Indexed: 01/07/2023]
Abstract
Two observational studies in the Russian Federation described patient demographics/clinical decision for treatment with recombinant human follicle-stimulating hormone:recombinant human luteinizing hormone (r-hFSH:r-hLH) 2:1 combination for ovarian stimulation (OS) during assisted reproductive technology (ART) and outcomes, respectively. The first (prospective) study enrolled 500 patients. After post-hoc regrouping to assign patients to discrete groups, 378 (75.6%) met the local Russian label for an r-hFSH:r-hLH 2:1 combination, 105 (21%) were treated according to other physician preference, and 17 (3.4%) met only the ESHRE Bologna criteria for a poor ovarian response. The clinical pregnancy rate per cycle was 30.4%. A total of 158/175 (90.3%) women achieving clinical pregnancy in the prospective study participated in the second (retrospective) study. The live birth rate per cycle was 25.8%. No new safety concerns were reported. These results support the use of the r-hFSH:r-hLH 2:1 combination in patients with a poor/suboptimal response to OS for ART treatment in the Russian Federation.
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Affiliation(s)
- Yulia Koloda
- Department of Obstetrics and Gynecology, Russian Medical Academy of Continuous Professional Education, Centre of Reproduction "Life Line," 121471 Moscow, Russian Federation.
| | - Vladislav Korsak
- International Centre for Reproductive Medicine (ICRM), Komendantskij prospect, 197350 St Petersburg, Russian Federation.
| | - Oleg Rozenson
- Biopharma, LCC Merck, Valovaya Str. 35, Moscow-115054, Russian Federation, an affiliate of Merck KGaA.
| | - Margarita Anshina
- IVF & Reproductive Genetics Center (FertiMed), Moscow, Moscow, 3 Park Str., 8/19 and 12, Russian Federation.
| | - Karina Sagamonova
- Human Reproduction and IVF Center, Rostov-on-Don, Bodraya ulitsa, 90, Moscow, Russian Federation.
| | - Igor Baranov
- National Medical Research Center for Obstetrics, Gynecology, and Perinatology named after Academician V.I.Kulakov of the Ministry of Healthcare of Russian Federation, 4, Oparina Street, Moscow, Russian Federation, 117997.
| | - Sergey Yakovenko
- Altravita IVF Clinic, Nagornaya st. 4A, Moscow, 117186, Russian Federation; Biophysics Department of Moscow State University, Moscow, 119991, Russian Federation.
| | - Thomas D'Hooghe
- Global Medical Affairs Fertility, Merck Healthcare KGaA, Frankfurter Str. 250, F135/002, 64293 Darmstadt, Germany; Department of Development and Regeneration, University of Leuven (KU Leuven), B-3000 Leuven, Belgium; Department of Obstetrics and Gynecology, Yale University Medical School, New Haven, CT 06510, USA.
| | - Anna Ershova
- Biopharma, LCC Merck, Valovaya Str. 35, Moscow-115054, Russian Federation, an affiliate of Merck KGaA.
| | - Monica Lispi
- Global Medical Affairs Fertility, Merck Healthcare KGaA, Frankfurter Str. 250, F135/002, 64293 Darmstadt, Germany; International PhD School in Clinical and Experimental Medicine (CEM), University of Modena and Reggio Emilia, Via Campi n. 287, 41125, Modena, Italy.
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Palmese A, Satwekar A, Melchiorre M, Colarusso L, Lispi M. IN-DEPTH GLYCOSYLATION PROFILING OF R-HFSH-ALFA AND R-HFSH-DELTA IN COMPARISON WITH HUMAN PITUITARY FOLLICLE STIMULATING HORMONE (HFSH). Fertil Steril 2022. [DOI: 10.1016/j.fertnstert.2022.08.788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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17
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Lispi M, Cottell E, Michalet D, Araujo T, Gleixner R, D'Hooghe T. P-598 Dose accuracy of the follitropin-alfa, follitropin-alfa/lutropin-alfa and choriogonadotropin-alfa pen injectors used for fertility treatment. Hum Reprod 2022. [DOI: 10.1093/humrep/deac107.550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Study question
Do the Merck family of fertility pen injectors (follitropin-alfa, follitropin-alfa/lutropin-alfa, choriogonadotropin-alfa) meet the International Organization for Standardization (ISO 11608-1:2000/2012/2014) product-validation requirements?
Summary answer
Each presentation of the family of fertility pen injectors performed as per the state-of-the-art product-validation specifications for dose accuracy in ISO 11608-1:2000/2012/2014 under atmospheric conditions.
What is known already
Pen injectors for medically assisted reproduction must comply with ISO 11608-1:2000/2012/2014, which specifies essential performance requirements, including dose accuracy, and represent a benchmark for product reliability. Product-validation studies of the follitropin-alfa pen injector showed that three presentations (300 IU, 450 IU, and 900 IU) reliably dispensed accurate doses under a range of conditions, but no information was available for the follitropin-alfa/lutropin-alfa and choriogonadotropin-alfa pen injectors. This study was done to confirm that the incremental dose/clicks system was accurate for equivalence of volume (dose) delivered at standard atmospheric conditions for the complete Merck family of fertility pen injectors (follitropin-alfa, follitropin-alfa/lutropin-alfa, choriogonadotropin-alfa).
Study design, size, duration
Laboratory-based dose accuracy measurement testing was carried out under standard atmospheric conditions, as specified in ISO 11608-1:2000/2012/2014, between 2015 and 2020.
Participants/materials, setting, methods
Set doses (Vset) for three dose dial settings (minimum dose [Vmin], midpoint dose [Vmid] and maximum dose [Vmax] [follitropin-alfa, choriogonadotropin-alfa, and follitropin-alfa/lutropin-alfa]) or a single Vset (choriogonadotropin-alfa) were assessed, as appropriate. The last dose administered by the multi-dose device and cartridge and total extractable dose were assessed on the 900 IU and 300 IU follitropin-alfa and the 900 IU/450IU and 300/150 IU follitropin-alfa/lutropin-alfa-pen presentations. Sixty measurements per assessment were made for each Vset.
Main results and the role of chance
Measurements were performed at two manufacturing sites. Dose accuracy tests for Vmin, Vmid and Vmax (dose dial settings of 12.5 IU, 87.5 IU and 150 IU, respectively, for the 150 IU pen [n = 2,226 (one site)]; dose dial settings of 12.5 IU, 162.5 IU and 300 IU, respectively, for the 300 IU pen [n = 742 per site]; and dose dial settings of 12.5 IU, 237.5 IU and 450 IU, respectively, for the 450 IU [n = 180 per site] and 900 IU pens [n = 410 per site]) for the follitropin-alfa and the follitropin-alfa/lutropin-alfa pen injectors were within the acceptable limits defined in ISO 11608-1:2000/2012/2014. The results of further assessments of last dose and total extracted volume for each presentation of these devices were also within acceptable limits. Dose accuracy tests for the single use/single dose device classification (D1) of the choriogonadotropin-alfa pen injector (n = 210 [one site]) showed that the Vset (6,500 IU) was within the acceptable limits according to ISO 11608-1:2000/2012/2014. Furthermore, dose accuracy tests for the single use/variable dose device classification (D2) of the choriogonadotropin-alfa pen injector (n = 180 [one site]) showed that the Vmin (260 IU), Vmid (3,380 IU) and Vmax (6,500 IU) values were also the within acceptable limits.
Limitations, reasons for caution
These assessments were carried out by laboratory scientists, who are not the intended users of the pen injectors, and were not delivered into human tissue; therefore, although these conditions meet the international standards, they do not reflect the real-world use of the pen injectors by patients.
Wider implications of the findings
The Merck family of fertility pen injectors functions reliably and the incremental dose/clicks system dispenses accurate doses, providing users with confidence that they can accurately administer the prescribed dose and minimize drug wastage outside of a clinic environment, which is more important than ever in light of the COVID pandemic.
Trial registration number
not applicable
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Affiliation(s)
- M Lispi
- Merck Healthcare- Merck KGaA, Global Medical Affairs Fertility , Darmstadt, Germany
- University of Modena and Reggio Emilia, PhD School of Clinical and Experimental Medicine- Unit of Endocrinology , Modena MO, Italy
| | - E Cottell
- Merck Healthcare- Merck KGaA, Global Medical Affairs Fertility , Darmstadt, Germany
| | - D Michalet
- Ares Trading an affiliate of Merck Healthcare- Merck KGaA- Darmstadt- Germany, CHD Connected Health & Devices , Eysins, Switzerland
| | - T Araujo
- Ares Trading an affiliate of Merck Healthcare- Merck KGaA- Darmstadt- Germany, CHD Connected Health & Devices , Aubonne, Switzerland
| | - R Gleixner
- Ares Trading an affiliate of Merck Healthcare- Merck KGaA- Darmstadt- Germany, Global Healthcare Operations , Aubonne, Switzerland
| | - T D'Hooghe
- Merck Healthcare- Merck KGaA, Global Medical Affairs Fertility , Darmstadt, Germany
- KU Leuven, Department of Development and Regeneration , Leuven, Belgium
- Yale University, Department of Obstetrics and Gynecology, New Haven- CT , U.S.A
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Nevelli F, Peroglio F, Gleixner R, Dadone A, Palmese A, Lispi M, D'Hooghe T, D’Acunto C. P-635 The impact of force-degraded variants of recombinant human follicle stimulating hormone alfa (r-hFSH alfa) on in-vitro and in-vivo biological activity. Hum Reprod 2022. [DOI: 10.1093/humrep/deac107.584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Study question
Can an in-vitro bioassay assess the potency of r-hFSH-alfa force-degraded variants with similar ability to the in-vivo rat bioassay described in EU Pharmacopoeia (EU-Pharm 2285)?
Summary answer
The in-vitro bioassay showed similar ability to the in-vivo bioassay for estimating the impact of r-hFSH-alfa variants, resulting from process-related modifications, on biological activity.
What is known already
The active ingredient of Gonal f® (Merck KGaA), follitropin-alfa (INN, r-hFSH-alfa), mimics the action of endogenous FSH by binding to, and subsequently activating, the hFSH-receptor (FSH-R), regulating cellular metabolism and oocyte survival/maturation. Structural modifications in r-hFSH-alfa glycosylation, oxidation, or other biochemical changes, may occur during the r-hFSH-alfa manufacturing process and may impact its efficacy/safety. The rat in-vivo bioassay (EU Pharmacopeia) is routinely used to assess r-hFSH-alfa potency by measuring ovarian weight increase. We evaluated whether an in-vitro bioassay has the same ability as the rat in-vivo bioassay to detect changes in biological activity caused by r-hFSH-alfa structural modifications.
Study design, size, duration
Three r-hFSH-alfa (Gonal f®) batches were stressed under eight chemical/physical/enzymatic treatments. The resulting degraded samples were compared with untreated samples using in-vivo and in-vitro bioassays.
Participants/materials, setting, methods
Force-degraded r-hFSH-alfa variants were produced by chromatographic separation (acidic/basic enrichment), chemical/physical stress (acidic/basic pH incubation, thermal/oxidative stress) and enzymatic treatments (de-galactosylation and de-sialylation). r-hFSH-alfa potency was measured via a rat in-vivo bioassay (European Pharmacopoeia 2285), assessing ovarian weight increase, and an in-vitro bioassay (cell line expressing the transmembrane hFSH-R), assessing cell-specific metabolic cascade. Force-degraded and untreated samples were compared via analysis of variance.
Main results and the role of chance
All force-degraded samples were characterized by the chemical/physical analyses panel for quality control. r-hFSH-alfa forced degradation modified the critical quality attributes of the samples; namely, increased the presence of r-hFSH-alfa oxidized forms and/or free subunits up to 50% above product specification, and modified the sialic acid level across variants, generating significantly more hypo-sialylated forms when compared with the untreated control samples. The increase in r-hFSH-alfa free subunits significantly reduced r-h-FSH-alfa biological activity compared with untreated samples, in both the in-vivo and in-vitro assays (p < 0.001 for both). The increase in r-hFSH-alfa oxidized forms significantly reduced r-hFSH-alfa biological activity in-vitro (p <0.001) and, to a lesser extent, in-vivo (p <0.006).
A gradual decrease in r-hFSH-alfa sialylation decreased r-hFSH-alfa biological activity in-vivo, indicating a second-order polynomial correlation, and increased r-hFSH-alfa biological activity in-vitro, indicating a negative linear correlation (slope significance p<0.001, R2=0.996). De-sialylation reduces r-hFSH-alfa steric hindrance during the interaction of r-hFSH-alfa and the FSH-R, increasing both r-hFSH-alfa–FSH-R affinity and r-hFSH-alfa biological activity in-vitro, while increasing the rate of r-hFSH-alfa metabolism, resulting in decreased r-hFSH-alfa biological activity in-vivo. Both assays showed a similar ability to identify differences in critical quality attribute levels (sialylation, oxidation, free-subunits), with the intent to identify out-of-specification batches.
Limitations, reasons for caution
r-hFSH-alfa forced degradation produced more than one structural/chemical modification in most variants (except for de-sialylation); therefore, the effect of discrete modifications could not be studied. Additional studies are needed to show that in-vitro methods can ultimately replace in-vivo bioassays to identify differences in critical quality attribute levels during r-hFSH-alfa manufacturing.
Wider implications of the findings
Chemical and/or structural modifications of r-hFSH-alfa strongly impact r-hFSH-alfa biological activity and related potency. The development of an in-vitro bioassay for the accurate measurement of r-hFSH-alfa potency may serve to replace the in-vivo bioassay, according to EMA indications (CPMP/SWP728/95).
Trial registration number
not applicable
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Affiliation(s)
- F Nevelli
- RBM S.p.A. an affiliate of Merck Healthcare- Merck KGaA- Darmstadt- Germany, Bioassay Unit – Analytical Development Biotech , Ivrea, Italy
| | - F Peroglio
- RBM S.p.A. an affiliate of Merck Healthcare- Merck KGaA- Darmstadt- Germany, Biological Quality Control - Global Analytical Development , Ivrea, Italy
| | - R Gleixner
- Ares Trading an affiliate of Merck Healthcare- Merck KGaA- Darmstadt- Germany, CMC-Leader Marketed Products - Global Healthcare Operations , Aubonne, Switzerland
| | - A Dadone
- RBM S.p.A. an affiliate of Merck Healthcare- Merck KGaA- Darmstadt- Germany, Bioassay Unit – Analytical Development Biotech , Ivrea, Italy
| | - A Palmese
- Merck Serono S.p.A. an affiliate of Merck Healthcare- Merck KGaA- Darmstadt- Germany, Characterization & Innovative Analytics Unit - Analytical Development Biotech , Rome, Italy
| | - M Lispi
- Merck Healthcare- Merck KGaA, Global Medical Affairs Fertility , Darmstadt, Germany
- University of Modena and Reggio Emilia, International PhD School in Clinical and Experimental Medicine CEM , Modena, Italy
| | - T D'Hooghe
- Merck Healthcare- Merck KGaA, Global Medical Affairs Fertility , Darmstadt, Germany
- KU Leuven, Department of Development and Regeneration , Leuven, Belgium
- Yale University, Department of Obstetrics and Gynecology, New Haven- CT , U.S.A
| | - C.W D’Acunto
- Merck Serono S.p.A. an affiliate of Merck Healthcare- Merck KGaA- Darmstadt- Germany, Bioassay Unit – Analytical Development Biotech , Rome, Italy
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Spaggiari G, Lispi M, Drakopoulos P, Simoni M, Santi D. O-132 Is there an association between sDF index and serum testosterone in human follicle stimulating hormone alfa (r-hFSH alfa) treated males with idiopathic infertility? Hum Reprod 2022. [DOI: 10.1093/humrep/deac105.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Study question
Is there correlation between testosterone serum levels and sperm DNA fragmentation (sDF) index before and after follicle-stimulating hormone (FSH) administration in male idiopathic infertility?
Summary answer
Correlation between testosterone and sDF was highlighted for the first time in FSH-treated men. Significant amelioration of conventional semen parameters and sDF index were confirmed.
What is known already
Testicular overstimulation is the yearned therapeutic goal when exogenous FSH is empirically administered in male idiopathic infertility. Although a robust physiological rationale theoretically supports the FSH use in male idiopathic infertility, useful markers to evaluate its efficacy are still far to be identified. Whether pregnancy outcomes remain the expected valuable endpoint for couple infertility treatment, the identification of reliable, and possibly early, markers of therapeutic response to FSH in males is mandatory. Randomized controlled clinical trials (RCTs) on this topic focused, as main outcomes of FSH treatment effectiveness, on testicular seminiferous component, not considering involvement of testosterone-secreting compartment.
Study design, size, duration
A retrospective post-hoc analysis of raw data extracted from two RCTs in which 148 idiopathic infertile men were treated with FSH.
Participants/materials, setting, methods
A retrospective post-hoc re-analysis was performed on raw data of RCTs in which idiopathic infertile men were treated with FSH and both testosterone serum levels and sDF were reported among primary and/or secondary endpoints. Additional data regarding couple infertility history, age, anthropometric variables, FSH treatment scheme and semen variables were included in a single dataset. Data were evaluated by logistic regression analyses.
Main results and the role of chance
Two RCTs were included accounting for 148 patients (median age 37, 25-52 years). After three months of FSH administration, a significant increase was observed in FSH levels (p < 0.001), inhibin B (p = 0.012), sperm concentration (p = 0.003), total sperm number (p = 0.021), progressive motility (p < 0.001) and normal sperm morphology (p < 0.001). Moreover, an overall sDF index reduction was confirmed after treatment (19.3±9.4 versus 16.4±6.8, p = 0.002). SDF was found significantly inversely related to sperm concentration both at baseline and after FSH treatment (Rho -0.325, p < 0.001 and Rho -0.316, p = 0.001, respectively). Interestingly, sDF index after treatment showed a significant inverse correlation with testosterone serum levels (Rho -0.327, p = 0.002). Multivariate stepwise linear regression analyses using sDF index as dependent variable identified testosterone as a predictor for sDF index change (p = 0.005). Similarly, logistic regression analysis highlighted testosterone and SHBG levels as predictive of sDF reduction after FSH administration (p = 0.043 and p = 0.005, respectively). Combining raw data of published RCTs investigating FSH administration to idiopathic infertile men, a significant amelioration of conventional semen parameters together with a reduction in sDF were confirmed. Intriguingly, a potential correlation between serum testosterone and sDF was highlighted for the first time.
Limitations, reasons for caution
Since the analysis was performed on raw data obtained in previous RCTs, heterogeneity among patients enrolled and evaluated should be considered interpreting these results. Moreover, a real and accurate evaluation of intratesticular testosterone levels, rather than serum levels should be more informative to the objective of the study.
Wider implications of the findings
The highlighted significant correlation between testosterone serum levels and sDF is opening a completely unexplored field in the possibility to identify early predictors of FSH therapy response in male idiopathic infertility.
Trial registration number
Not applicable
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Affiliation(s)
- G Spaggiari
- Azienda Ospedaliero-Universitaria of Modena, Unit of Endocrinology- Department of Medical Specialties- Ospedale Civile of Baggiovara , Modena, Italy
| | - M Lispi
- University of Modena and Reggio Emilia, Clinical and Experimental Medicine PhD Program , Modena, Italy
| | - P Drakopoulos
- Universitair Ziekenhuis Brussel, Centre for Reproductive Medicine , Brussels, Belgium
| | - M Simoni
- University of Modena and Reggio Emilia, Department of Biomedical- Metabolic and Neural Sciences , Modena, Italy
| | - D Santi
- University of Modena and Reggio Emilia, Department of Biomedical- Metabolic and Neural Sciences , Modena, Italy
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20
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Manzi L, Sepe N, Migliaccio W, Lanzoni L, Iozzino L, D’Angelo F, Colarusso L, Montenegro S, Palmese A, D’Hooghe T, Ulloa-Aguirre A, Koloda Y, Lispi M. Comparative Assessment of the Structural Features of Originator Recombinant Human Follitropin Alfa Versus Recombinant Human Follitropin Alfa Biosimilar Preparations Approved in Non-European Regions. Int J Mol Sci 2022; 23:ijms23126762. [PMID: 35743204 PMCID: PMC9223809 DOI: 10.3390/ijms23126762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 06/01/2022] [Accepted: 06/10/2022] [Indexed: 12/10/2022] Open
Abstract
Although the full primary structures of the alfa and beta subunits of reference r-hFSH-alfa and its biosimilars are identical, cell context-dependent differences in the expressing cell lines and manufacturing process can lead to variations in glycosylation profiles. In the present study, we compared the structural features of reference r-hFSH-alfa with those of five biosimilar preparations approved in different global regions outside Europe (Primapur®, Jin Sai Heng®, Follitrope®, Folisurge®, and Corneumon®) with respect to glycosylation, macro- and microheterogeneity, and other post-translational modifications and higher order structure. The mean proportion of N-glycosylation-site occupancy was highest in reference r-hFSH-alfa, decreasing sequentially in Primapur, Jin Sai Heng, Corneumon, Follisurge and Follitrope, respectively. The level of antennarity showed slightly higher complexity in Corneumon, Primapur and Follitrope versus reference r-hFSH-alfa, whereas Jin Sai Heng and Folisurge were aligned with reference r-hFSH-alfa across all N-glycosylation sites. Sialylation level was higher in Corneumon and Follitrope, but small differences were detected in other biosimilar preparations compared with reference r-hFSH-alfa. Jin Sai Heng showed higher levels of N-glyconeuramic acid than the other preparations. Minor differences in oxidation levels were seen among the different products. Therefore, in summary, we identified var ious differences in N-glycosylation occupancy, antennarity, sialylation and oxidation between reference r-hFSH-alfa and the biosimilar preparations analyzed.
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Affiliation(s)
- Lucio Manzi
- Characterization & Innovative Analytics Unit—Analytical Development Biotech—Global Analytical Development—Global Development & Launch—Global Healthcare Operation, Merck Serono S.p.A., 00176 Rome, Italy, an affiliate of Merck KGaA; (L.M.); (N.S.); (W.M.); (L.L.); (L.I.); (F.D.); (L.C.)
| | - Nunzio Sepe
- Characterization & Innovative Analytics Unit—Analytical Development Biotech—Global Analytical Development—Global Development & Launch—Global Healthcare Operation, Merck Serono S.p.A., 00176 Rome, Italy, an affiliate of Merck KGaA; (L.M.); (N.S.); (W.M.); (L.L.); (L.I.); (F.D.); (L.C.)
| | - Walter Migliaccio
- Characterization & Innovative Analytics Unit—Analytical Development Biotech—Global Analytical Development—Global Development & Launch—Global Healthcare Operation, Merck Serono S.p.A., 00176 Rome, Italy, an affiliate of Merck KGaA; (L.M.); (N.S.); (W.M.); (L.L.); (L.I.); (F.D.); (L.C.)
| | - Ludovica Lanzoni
- Characterization & Innovative Analytics Unit—Analytical Development Biotech—Global Analytical Development—Global Development & Launch—Global Healthcare Operation, Merck Serono S.p.A., 00176 Rome, Italy, an affiliate of Merck KGaA; (L.M.); (N.S.); (W.M.); (L.L.); (L.I.); (F.D.); (L.C.)
| | - Luisa Iozzino
- Characterization & Innovative Analytics Unit—Analytical Development Biotech—Global Analytical Development—Global Development & Launch—Global Healthcare Operation, Merck Serono S.p.A., 00176 Rome, Italy, an affiliate of Merck KGaA; (L.M.); (N.S.); (W.M.); (L.L.); (L.I.); (F.D.); (L.C.)
| | - Fabrizia D’Angelo
- Characterization & Innovative Analytics Unit—Analytical Development Biotech—Global Analytical Development—Global Development & Launch—Global Healthcare Operation, Merck Serono S.p.A., 00176 Rome, Italy, an affiliate of Merck KGaA; (L.M.); (N.S.); (W.M.); (L.L.); (L.I.); (F.D.); (L.C.)
| | - Lucia Colarusso
- Characterization & Innovative Analytics Unit—Analytical Development Biotech—Global Analytical Development—Global Development & Launch—Global Healthcare Operation, Merck Serono S.p.A., 00176 Rome, Italy, an affiliate of Merck KGaA; (L.M.); (N.S.); (W.M.); (L.L.); (L.I.); (F.D.); (L.C.)
| | | | - Angelo Palmese
- Characterization & Innovative Analytics Unit—Analytical Development Biotech—Global Analytical Development—Global Development & Launch—Global Healthcare Operation, Merck Serono S.p.A., 00176 Rome, Italy, an affiliate of Merck KGaA; (L.M.); (N.S.); (W.M.); (L.L.); (L.I.); (F.D.); (L.C.)
- Correspondence: (A.P.); (T.D.)
| | - Thomas D’Hooghe
- Merck Healthcare KGaA, 64293 Darmstadt, Germany; (S.M.); (M.L.)
- Department of Development and Regeneration, Laboratory of Endometrium, Endometriosis & Reproductive Medicine, KU Leuven, Herestraat 49-Box 805, B-3000 Leuven, Belgium
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University Medical School, New Haven, CT 06510, USA
- Correspondence: (A.P.); (T.D.)
| | - Alfredo Ulloa-Aguirre
- Research Support Network (RAI), Universidad Nacional Autónoma de México-Instituto Nacional de Ciencias Médicas y Nutrición SZ, Tlalpan, Mexico City 14000, Mexico;
| | - Yulia Koloda
- Department of Obstetrics and Gynecology, Russian Medical Academy of Continuous Professional Education, Centre of Reproduction “Life Line”, 121471 Moscow, Russia;
| | - Monica Lispi
- Merck Healthcare KGaA, 64293 Darmstadt, Germany; (S.M.); (M.L.)
- PhD School of Clinical and Experimental Medicine, Unit of Endocrinology, University of Modena and Reggio Emilia, 41121 Modena, Italy
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Gouveia SM, Lispi M, D'Hooghe TM. Comparison between follitropin-delta and follitropin-alfa for ovarian stimulation in context of ART is only scientifically sound and clinically relevant if individualization of starting dose is allowed in both arms! Reprod Biomed Online 2022; 45:623-624. [DOI: 10.1016/j.rbmo.2022.03.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 03/24/2022] [Indexed: 11/16/2022]
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22
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Manzi L, Colarusso L, D’Angelo F, Drovandi D, Iozzino L, Lanzoni L, Migliaccio W, Michaletti A, Sepe N, Lispi M, Susana M, Palmese A. P–661 Comparative assessment of the structural features of human follicle-stimulating hormone in products from multiple markets. Hum Reprod 2021. [DOI: 10.1093/humrep/deab130.660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Study question
The aim of the study is to explore the structural differences occurring in recombinant human follicle-stimulating hormone alfa (r-hFSH- α), originator and its biosimilars, from various countries.
Summary answer
When compared with r-hFSH-α originator (Gonal-f), its biosimilars presented structural differences, namely Primapur showed a significant different glycosylation profile.
What is known already
FSH is part of cystine knot growth factor superfamily and plays a central role in reproduction, as FSH stimulates follicular development and estrogen synthesis. R-hFSH- α is commonly used in assisted reproductive technologies to achieve multifollicular development. At the present r-hFSH- α biosimilars are available in Europe and other regions. R-hFSH-α is a complex glycoprotein, that possesses several structural features critical for its efficacy and safety1–2. Glycosylation profile is one of the most impactful attributes of the molecule defining a moiety of FSH isoforms with impact on its biological net effect3. Efficacy and safety of r-hFSH- α are strictly correlated with glycoforms’ composition3–8.
Study design, size, duration
At least two different batches of each r-hFSH- α originator and its biosimilars have been included in the study.
Participants/materials, setting, methods
The structural features of products from six different marketed r-hFSH α (Gonal-f, Primapur, Folisurge Intas, Corneumon, Jin Sai Heng, Follitrope LG) have been investigated with a variety of analytical techniques in order to evaluate the presence of molecular differences, which could have a severe impact on the efficacy and safety of the product. The attributes which have been investigated in-depth include primary, secondary and tertiary structure as well as post-translational modifications (PTMs), including glycosylation and contaminants.
Main results and the role of chance
All r-hFSH- α biosimilars analyzed presented differences compared to the originator. We firstly investigated Primapur and found significant differences regarding multiple structural attributes, particularly in the glycosylation profile. Gonal-f exhibited lower glycan branching, expressed by an A-index* of 2.5, while Primapur showed an A-index of 2.4. Furthermore, Primapur showed a lower level of sialylation in comparison with Gonal-f, as measured by their respective S-index* of 1.8 and 2.1. FSH glycosylation exhibits both macroheterogeneity and microheterogeneity, impacting both FSH protein’s half-life and affinity with the follicle-stimulating hormone receptor (FSHR). Antennarity, representing FSH microheterogeneity, influence r-hFSH-α activity since it has been shown that bulky and extended glycans may take longer to fit into the FSHR cavity compared to less sterically hindering glycans, resulting in a delayed response 7,8.Additionaly, sialylation has been shown in-vivo to correlate with plasma half-life and effect on granulosa cells proliferation 1,2,3. The slower clearance of highly sialylated r-hFSH has been shown to lead to a higher in-vivo activity, despite the lower in-vitro bioactivity 1,2,3.
*A-index and S-index express respectively a measure of the number of antennae and sialic acid per glycan. Final values are generated from many relative abundances normalized to 100, highlighting the significance of small numerical differences.
Limitations, reasons for caution
More batches should be tested for each product. The authors are presenting full characterization of only one of the biosimilars since the rest of the products are under characterization.
Wider implications of the findings: r-hFSH-α originator and its biosimilar showed differences in terms of glycosylation profile that is well known as the major protein characteristic impacting FSH activity as extensively demonstrated in in-vivo and in-vitro models. This structural difference could have impact also on product efficacy and safety.
Trial registration number
‘not applicable’
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Affiliation(s)
- L Manzi
- Merck Serono SpA, Analytical Development Biotech, Guidonia Montecelio RM, Italy
| | - L Colarusso
- Merck Serono SpA, Analytical Development Biotech, Guidonia Montecelio RM, Italy
| | - F D’Angelo
- Merck Serono SpA, Analytical Development Biotech, Guidonia Montecelio RM, Italy
| | - D Drovandi
- Merck Serono SpA, Analytical Development Biotech, Guidonia Montecelio RM, Italy
| | - L Iozzino
- Merck Serono SpA, Analytical Development Biotech, Guidonia Montecelio RM, Italy
| | - L Lanzoni
- Merck Serono SpA, Analytical Development Biotech, Guidonia Montecelio RM, Italy
| | - W Migliaccio
- Merck Serono SpA, Analytical Development Biotech, Guidonia Montecelio RM, Italy
| | - A Michaletti
- Merck Serono SpA, Analytical Development Biotech, Guidonia Montecelio RM, Italy
| | - N Sepe
- Merck Serono SpA, Analytical Development Biotech, Guidonia Montecelio RM, Italy
| | - M Lispi
- Merck KGaA, Global Medical Affair, Darmstadt, Germany
| | - M Susana
- Merck KGaA, Global Medical Affair, Darmstadt, Germany
| | - A Palmese
- Merck Serono SpA, Analytical Development Biotech, Guidonia Montecelio RM, Italy
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23
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Bosch E, Alviggi C, Lispi M, Conforti A, Hanyaloglu AC, Chuderland D, Simoni M, Raine-Fenning N, Crépieux P, Kol S, Rochira V, D'Hooghe T, Humaidan P. Reduced FSH and LH action: implications for medically assisted reproduction. Hum Reprod 2021; 36:1469-1480. [PMID: 33792685 PMCID: PMC8129594 DOI: 10.1093/humrep/deab065] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 12/18/2020] [Indexed: 12/11/2022] Open
Abstract
Luteinizing hormone (LH) and follicle-stimulating hormone (FSH) play complementary roles in follicle development and ovulation via a complex interaction in the hypothalamus, anterior pituitary gland, reproductive organs, and oocytes. Impairment of the production or action of gonadotropins causes relative or absolute LH and FSH deficiency that compromises gametogenesis and gonadal steroid production, thereby reducing fertility. In women, LH and FSH deficiency is a spectrum of conditions with different functional or organic causes that are characterized by low or normal gonadotropin levels and low oestradiol levels. While the causes and effects of reduced LH and FSH production are very well known, the notion of reduced action has received less attention by researchers. Recent evidence shows that molecular characteristics, signalling as well as ageing, and some polymorphisms negatively affect gonadotropin action. These findings have important clinical implications, in particular for medically assisted reproduction in which diminished action determined by the afore-mentioned factors, combined with reduced endogenous gonadotropin production caused by GnRH analogue protocols, may lead to resistance to gonadotropins and, thus, to an unexpected hypo-response to ovarian stimulation. Indeed, the importance of LH and FSH action has been highlighted by the International Committee for Monitoring Assisted Reproduction Technologies (ICMART) in their definition of hypogonadotropic hypogonadism as gonadal failure associated with reduced gametogenesis and gonadal steroid production due to reduced gonadotropin production or action. The aim of this review is to provide an overview of determinants of reduced FSH and LH action that are associated with a reduced response to ovarian stimulation.
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Affiliation(s)
| | - C Alviggi
- Department of Neuroscience, Reproductive Science and Odontostomatology, University Federico II, Naples, Italy
| | - M Lispi
- Global Medical Affairs Fertility, Merck KGaA, Darmstadt, Germany.,International PhD School in Clinical and Experimental Medicine (CEM), University of Modena and Reggio Emilia, Modena, Italy
| | - A Conforti
- Department of Neuroscience, Reproductive Science and Odontostomatology, University Federico II, Naples, Italy
| | - A C Hanyaloglu
- Institute of Reproductive and Developmental Biology, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - D Chuderland
- Global Medical Affairs Fertility, Merck KGaA, Darmstadt, Germany
| | - M Simoni
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - N Raine-Fenning
- Department of Child Health, Obstetrics and Gynaecology, School of Medicine, University of Nottingham, Nottingham, UK
| | - P Crépieux
- Physiologie de la Reproduction et des Comportements, UMR INRA 085, CNRS 7247, Université de Tours, Nouzilly, France
| | - S Kol
- IVF Unit, Elisha Hospital, Haifa, Israel
| | - V Rochira
- Institute of Reproductive and Developmental Biology, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK.,Unit of Endocrinology, Azienda Ospedaliero-Universitaria of Modena, Ospedale Civile di Baggiovara, Modena, Italy
| | - T D'Hooghe
- Global Medical Affairs Fertility, Merck KGaA, Darmstadt, Germany.,Department of Development & Regeneration, University of Leuven (KU Leuven), Leuven, Belgium.,Department of Obstetrics and Gynecology, Yale University, New Haven, CT, USA
| | - P Humaidan
- Fertility Clinic, Skive Regional Hospital, and the Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
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24
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Chua SJ, Mol BW, Longobardi S, Orvieto R, Venetis CA, Lispi M, Storr A, D'Hooghe T. Biosimilar recombinant follitropin alfa preparations versus the reference product (Gonal-F®) in couples undergoing assisted reproductive technology treatment: a systematic review and meta-analysis. Reprod Biol Endocrinol 2021; 19:51. [PMID: 33794909 PMCID: PMC8017804 DOI: 10.1186/s12958-021-00727-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 03/04/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Live birth has increasingly been identified as the standard clinical approach to measure the success of medically assisted reproduction (MAR). However, previous analyses comparing biosimilar preparations of follitropin alfa versus the reference product (GONAL-f®, Merck KGaA, Darmstadt, Germany or GONAL-f® RFF; EMD Serono, Inc., Rockland, MA), have had insufficient power to detect differences in clinically meaningful outcomes such as live birth. METHODS Medline, Embase, the Cochrane Library, Web of Science and clinical trial registries were searched for randomised controlled trials (RCTs) and conference abstracts comparing biosimilar follitropin alfa versus the reference product in controlled ovarian stimulation (COS) cycles published before 31 October 2020. Only studies in humans and publications in English were included. Retrieved studies were screened independently by two authors based on titles and abstracts, and then by full text. INCLUSION CRITERIA RCTs comparing follitropin alfa biosimilar preparations with the reference product in infertile patients of any age, with any type of infertility for any duration, undergoing COS for the purposes of MAR treatment (including frozen cycles). The primary outcome was live birth. Combined data for biosimilar preparations were analysed using a fixed-effects model. RESULTS From 292 unique records identified, 17 studies were included in the systematic review, representing five unique RCTs that were included in the meta-analysis. Rates of live birth (RR = 0.83, 95% CI 0.71, 0.97; 4 RCTs, n = 1881, I2 = 0%), clinical pregnancy (RR = 0.82, 95% CI 0.72, 0.94; 4 RCTs, n = 2222, I2 = 0%) and ongoing pregnancy (RR = 0.81, 95% CI 0.68, 0.96; 4 RCTs, n = 1232, I2 = 0%) were significantly lower with biosimilar preparations versus the reference product. Rates of cumulative live birth and cumulative clinical pregnancy were also significantly lower with biosimilars versus the reference product. There was high risk of publication bias. CONCLUSIONS This meta-analysis included data from RCTs evaluating the efficacy and safety of the biosimilar follitropin alfa preparations and demonstrated lower probability of live birth and pregnancy (ongoing and clinical) in couples treated with biosimilar preparations compared with the reference product. This study provides more insight into the differences between biosimilar r-hFSH preparations and the reference product than previously reported. TRIAL REGISTRATION Registration number: CRD42019121992 .
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Affiliation(s)
- Su Jen Chua
- Austin Health, Heidelberg, VIC, 3084, Australia.
| | - Ben W Mol
- Department of Obstetrics and Gynecology, University of Monash, Monash, Clayton, Victoria, 3168, Australia
| | - Salvatore Longobardi
- Global Clinical Development, Merck Serono S.p.A (an affiliate of Merck KGaA, Darmstadt 64293, Germany), 00176, Rome, Italy
| | - Raoul Orvieto
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Tel-Hashomer, Ramat Gan, 52621, Israel
- The Tarnesby-Tarnowski Chair for Family Planning and Fertility Regulation, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv-Yafo, 6997801, Israel
| | - Christos A Venetis
- School of Women's and Children's Health & Centre for Big Data Research in Health, University of New South Wales, Clayton, Victoria, 2052, Australia
- IVF Australia, Sydney, NSW, 2000, Australia
| | - Monica Lispi
- University of Modena and Reggio Emilia, Modena, MO, 41121, Italy
- Global Medical Affairs Fertility, Research and Development, Merck KGaA, F135/002, Darmstadt, 64293, Germany
| | - Ashleigh Storr
- Flinders Fertility, Adelaide, South Australia, 5045, Australia
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, 5042, Australia
| | - Thomas D'Hooghe
- Global Medical Affairs Fertility, Research and Development, Merck KGaA, F135/002, Darmstadt, 64293, Germany
- Research Group Reproductive Medicine, Department of Development and Regeneration, Organ Systems, Group Biomedical Sciences, KU Leuven (University of Leuven), Leuven, 3000, Belgium
- Department of Obstetrics and Gynecology, Yale University, New Haven, CT, 06510, USA
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25
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Casarini L, Lazzaretti C, Paradiso E, Limoncella S, Riccetti L, Sperduti S, Melli B, Marcozzi S, Anzivino C, Sayers NS, Czapinski J, Brigante G, Potì F, La Marca A, De Pascali F, Reiter E, Falbo A, Daolio J, Villani MT, Lispi M, Orlando G, Klinger FG, Fanelli F, Rivero-Müller A, Hanyaloglu AC, Simoni M. Membrane Estrogen Receptor (GPER) and Follicle-Stimulating Hormone Receptor (FSHR) Heteromeric Complexes Promote Human Ovarian Follicle Survival. iScience 2020; 23:101812. [PMID: 33299978 PMCID: PMC7702187 DOI: 10.1016/j.isci.2020.101812] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 10/25/2020] [Accepted: 11/11/2020] [Indexed: 12/12/2022] Open
Abstract
Classically, follicle-stimulating hormone receptor (FSHR)-driven cAMP-mediated signaling boosts human ovarian follicle growth and oocyte maturation. However, contradicting in vitro data suggest a different view on physiological significance of FSHR-mediated cAMP signaling. We found that the G-protein-coupled estrogen receptor (GPER) heteromerizes with FSHR, reprogramming cAMP/death signals into proliferative stimuli fundamental for sustaining oocyte survival. In human granulosa cells, survival signals are missing at high FSHR:GPER ratio, which negatively impacts follicle maturation and strongly correlates with preferential Gαs protein/cAMP-pathway coupling and FSH responsiveness of patients undergoing controlled ovarian stimulation. In contrast, FSHR/GPER heteromers triggered anti-apoptotic/proliferative FSH signaling delivered via the Gβγ dimer, whereas impairment of heteromer formation or GPER knockdown enhanced the FSH-dependent cell death and steroidogenesis. Therefore, our findings indicate how oocyte maturation depends on the capability of GPER to shape FSHR selective signals, indicating hormone receptor heteromers may be a marker of cell proliferation. G-protein-coupled estrogen receptor (GPER) interacts with FSH receptor (FSHR) FSHR/GPER heteromers reprogram FSH-induced death signals to proliferative stimuli Anti-apoptotic signaling of heteromers is via a GPER-Gαs inhibitory complex and Gβγ Heteromer formation impacts follicle maturation and FSH responses of IVF patients
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Affiliation(s)
- Livio Casarini
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Ospedale Civile Sant'Agostino-Estense, Via P. Giardini 1355, 41126 Modena, Italy.,Center for Genomic Research, University of Modena and Reggio Emilia, Modena, Italy
| | - Clara Lazzaretti
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Ospedale Civile Sant'Agostino-Estense, Via P. Giardini 1355, 41126 Modena, Italy.,International PhD School in Clinical and Experimental Medicine (CEM), University of Modena and Reggio Emilia, Modena, Italy
| | - Elia Paradiso
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Ospedale Civile Sant'Agostino-Estense, Via P. Giardini 1355, 41126 Modena, Italy.,International PhD School in Clinical and Experimental Medicine (CEM), University of Modena and Reggio Emilia, Modena, Italy
| | - Silvia Limoncella
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Ospedale Civile Sant'Agostino-Estense, Via P. Giardini 1355, 41126 Modena, Italy
| | - Laura Riccetti
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Ospedale Civile Sant'Agostino-Estense, Via P. Giardini 1355, 41126 Modena, Italy
| | - Samantha Sperduti
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Ospedale Civile Sant'Agostino-Estense, Via P. Giardini 1355, 41126 Modena, Italy.,Center for Genomic Research, University of Modena and Reggio Emilia, Modena, Italy
| | - Beatrice Melli
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Ospedale Civile Sant'Agostino-Estense, Via P. Giardini 1355, 41126 Modena, Italy
| | - Serena Marcozzi
- Histology and Embryology Section, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Claudia Anzivino
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Ospedale Civile Sant'Agostino-Estense, Via P. Giardini 1355, 41126 Modena, Italy
| | - Niamh S Sayers
- Institute of Reproductive and Developmental Biology, Imperial College London, London, UK
| | - Jakub Czapinski
- Department of Biochemistry and Molecular Biology, Medical University of Lublin, Lublin, Poland.,Postgraduate School of Molecular Medicine, Warsaw, Poland
| | - Giulia Brigante
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Ospedale Civile Sant'Agostino-Estense, Via P. Giardini 1355, 41126 Modena, Italy.,Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Francesco Potì
- Department of Medicine and Surgery, Unit of Neurosciences, University of Parma, Parma, Italy
| | - Antonio La Marca
- Mother-Infant Department, University of Modena and Reggio Emilia, Modena, Italy.,Clinica EUGIN, Modena, Italy
| | | | - Eric Reiter
- PRC, INRAE, CNRS, IFCE, Université de Tours, Nouzilly, France
| | - Angela Falbo
- Department of Obstetrics and Gynaecology, Fertility Center, ASMN. Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Modena, Italy
| | - Jessica Daolio
- Department of Obstetrics and Gynaecology, Fertility Center, ASMN. Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Modena, Italy
| | - Maria Teresa Villani
- Department of Obstetrics and Gynaecology, Fertility Center, ASMN. Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Modena, Italy
| | - Monica Lispi
- International PhD School in Clinical and Experimental Medicine (CEM), University of Modena and Reggio Emilia, Modena, Italy.,Global Medical Affair, Merck KGaA, Darmstadt, Germany
| | | | - Francesca G Klinger
- Histology and Embryology Section, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Francesca Fanelli
- Department of Life Sciences, University of Modena and Reggio Emilia, Modena, Italy.,Center for Neuroscience and Neurotechnology, University of Modena and Reggio Emilia, Modena, Italy
| | - Adolfo Rivero-Müller
- Department of Biochemistry and Molecular Biology, Medical University of Lublin, Lublin, Poland
| | - Aylin C Hanyaloglu
- Institute of Reproductive and Developmental Biology, Imperial College London, London, UK
| | - Manuela Simoni
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Ospedale Civile Sant'Agostino-Estense, Via P. Giardini 1355, 41126 Modena, Italy.,Center for Genomic Research, University of Modena and Reggio Emilia, Modena, Italy.,Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy.,PRC, INRAE, CNRS, IFCE, Université de Tours, Nouzilly, France
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26
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Bühler KF, Fischer R, Falla E, Luyten J, Roeder C, Bian B, Bilger W, Lispi M, D’Hooghe TM. COST-EFFECTIVENESS ANALYSIS OF THE ORIGINATOR RECOMBINANT HUMAN FOLLICLE-STIMULATING HORMONE (R-HFSH) AND URINARY HIGHLY PURIFIED MENOPAUSAL GONADOTROPIN (HMG) BASED ON DATA FROM A LARGE GERMAN REGISTRY. Fertil Steril 2020. [DOI: 10.1016/j.fertnstert.2020.08.210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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27
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Gizzo S, Ferrando M, Lispi M, Ripellino C, Cataldo N, Bühler K. Reply: RE: a cost-effectiveness modeling evaluation comparing a biosimilar follitropin alfa preparation with its reference product for live birth outcome in Germany, Italy, and Spain. J Med Econ 2019; 22:381-382. [PMID: 30691336 DOI: 10.1080/13696998.2019.1576182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Salvatore Gizzo
- a Department of Women and Children's Health SDB , Policlinico Abano Terme , Padova , Italy
| | - Marcos Ferrando
- b Department of Reproductive and Gynaecological Medicine , Instituto Valenciano de Infertilidad (IVI-RMA) , Bilbao , Spain
| | - Monica Lispi
- c Regional Medical Affairs Fertility, Merck Serono S.p.A. , Rome , Italy , an affiliate of Merck KGaA, Darmstadt, Germany
| | | | | | - Klaus Bühler
- f Centre for Gynaecology, Endocrinology, and Reproductive Medicine , Ulm and Stuttgart , Germany
- g Department of Gynaecology , Jena-University Hospital-Friedrich Schiller University , Jena , Germany
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28
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Gizzo S, Ferrando M, Lispi M, Ripellino C, Cataldo N, Bühler K. A cost-effectiveness modeling evaluation comparing a biosimilar follitropin alfa preparation with its reference product for live birth outcome in Germany, Italy and Spain. J Med Econ 2018; 21:1096-1101. [PMID: 30113238 DOI: 10.1080/13696998.2018.1511567] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND/OBJECTIVE Although biosimilar drugs may be cheaper to purchase than reference biological products, they may not be the most cost-effective treatment to achieve a desired outcome. The analysis reported here compared the overall costs to achieve live birth using the reference follitropin alfa (GONAL-f) or a biosimilar (Ovaleap) in Spain, Italy and Germany. METHODS Patient and treatment data was obtained from published sources; assisted-reproductive technology, gonadotropin, follow-up and adverse-event-related costs were calculated from tariffs and reimbursement frameworks for each country. Incremental cost-effectiveness ratios (ICERs) were calculated from the difference in costs between reference and biosimilar in each country, divided by the difference in live-birth rates. Mean cost per live birth was calculated as total costs divided by the live-birth rate. RESULTS The published live birth rates were 32.2% (reference) and 26.8% (biosimilar). Drug costs per patient were higher for the reference recombinant human follicle-stimulating hormone in all three countries, with larger cost differences in Germany (€157.38) and Italy (€141.50) than in Spain (€22.41). The ICER for the reference product compared with the biosimilar was €2917.47 in Germany, €415.43 in Spain and €2623.09 in Italy. However, the overall cost per live birth was higher for the biosimilar in all three countries (Germany €8135.04 vs. €9185.34; Italy €8545.22 vs. €9733.37; Spain €14,859.53 vs. €17,767.19). Uncertainty in efficacy, mean gonadotropin dose and costs did not have a strong effect on the ICERs. CONCLUSIONS When considering live birth outcomes, treatment with the reference follitropin alfa was more cost effective than treatment with the biosimilar follitropin alfa.
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Affiliation(s)
- Salvatore Gizzo
- a Department of Women and Children's Health SDB , Policlinico Abano Terme , Padova , Italy
| | - Marcos Ferrando
- b Department of Reproductive and Gynaecological Medicine , Instituto Valenciano de Infertilidad (IVI-RMA) , Bilbao , Spain
| | - Monica Lispi
- c Regional Medical Affairs Fertility, Merck Serono SpA, Rome, Italy, an affiliate of Merck KGaA , Darmstadt , Germany
| | | | | | - Klaus Bühler
- e Centre for Gynaecology, Endocrinology, and Reproductive Medicine , Ulm and Stuttgart , Germany
- f Department of Gynaecology , Jena-University Hospital-Friedrich Schiller University , Jena , Germany
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29
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Rossi V, Lispi M, Longobardi S, Mattei M, Di Rella F, Salustri A, De Felici M, Klinger FG. Correction to: LH prevents cisplatin-induced apoptosis in oocytes and preserves female fertility in mouse. Cell Death Differ 2018. [DOI: 10.1038/s41418-018-0176-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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30
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Colacurci N, De Leo V, Ruvolo G, Piomboni P, Caprio F, Pivonello R, Papaleo E, La Verde E, Depalo R, Lispi M, Longobardi S, Paoli D, Pallotti F, Lombardo F. Recombinant FSH Improves Sperm DNA Damage in Male Infertility: A Phase II Clinical Trial. Front Endocrinol (Lausanne) 2018; 9:383. [PMID: 30042737 PMCID: PMC6048873 DOI: 10.3389/fendo.2018.00383] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 06/22/2018] [Indexed: 11/13/2022] Open
Abstract
UNLABELLED Background and objectives: Male infertility is a global health dilemma and Follicle-Stimulating Hormone (FSH) administration has shown promising results. Several studies showed that infertile men with normal semen parameters have low levels of DNA damage while infertile men with abnormal semen parameters have more damage at the DNA level. Sperm DNA damage may affect the reproductive outcome and has been associated with failure in the achievement of competent embryos and pregnancy fulfillment. The aim of this study was to evaluate whether the administration of recombinant FSH (Gonal-f® PEN 900 IU) could improve sperm DNA fragmentation in men with infertility. The secondary endpoints of this study were to evaluate the FSH effects on sperm parameters and hormonal assets. Methods: A longitudinal, prospective, multicenter, open-label clinical trial was carried out. Infertile couples were recruited from six Italian Reproductive Medical Centers and 115 infertile men were enrolled for this study. All participants were treated with subcutaneous injections of Gonal-f® 150 IU every other day, within a 3 month-time frame. The semen samples were examined in accordance to the 2010 World Health Organization criteria. Sperm DNA Fragmentation (DFI) was determined by fluorescence microscopy using terminal deoxynucleotidyl transferase-mediated d-UTP Nick-end Labeling (TUNEL) assay. Statistical analysis was performed using both the t-test for paired samples and the Wilcoxon signed-rank test. Results: FSH administration improved DFI in 67% of patients, with an average decrease of 35.4% compared to the baseline. This improvement is more evident in men with basal DFI lower than 17% and in those with FSH basal levels between 2.16 and 4.27 IU/L. In addition, FSH enhanced the gonadal function, increasing the hormones AMH and Inhibin B and semen parameters. Limitation of these results are represented by the absence of a placebo group and of FSHR genotype stratification sub-analysis. Conclusion: Recombinant FSH 150 IU is well tolerated and effective in eliciting a significant DFI reduction as well as in improving gonadal function. TRIAL REGISTRATION EUDRACT Number 2010-020196-23. Registred 14 April 2011.
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Affiliation(s)
- Nicola Colacurci
- Department of Gynecological, Obstetrics and Reproduction Sciences, II University of Naples, Naples, Italy
| | - Vincenzo De Leo
- Department of Molecular and Developmental Medicine, Centre for Couple Sterility, University of Siena, Siena, Italy
| | - Giovanni Ruvolo
- Obstetrics and Gynecology, Casa di Cura Candela, Palermo, Italy
| | - Paola Piomboni
- Department of Molecular and Developmental Medicine, Centre for Couple Sterility, University of Siena, Siena, Italy
| | - Francesca Caprio
- Department of Gynecological, Obstetrics and Reproduction Sciences, II University of Naples, Naples, Italy
| | - Rosario Pivonello
- Department of Endocrinology, University of Naples “Federico II”, Naples, Italy
| | - Enrico Papaleo
- Operating Unit of Gynecology and Obstetrics, DIMER Center of Natality Sciences, IRCCS San Raffaele of Milan, Milan, Italy
| | - Eugenio La Verde
- Department of Gynecological, Obstetrics and Reproduction Sciences, II University of Naples, Naples, Italy
| | - Raffaella Depalo
- Pathophysiology Center of Human Reproduction and Freezing Gametes, Ospedale Policlinico Consorziale of Bari, Bari, Italy
| | | | | | - Donatella Paoli
- Laboratory of Seminology- Sperm Bank “Loredana Gandini”, Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
- *Correspondence: Donatella Paoli
| | - Francesco Pallotti
- Laboratory of Seminology- Sperm Bank “Loredana Gandini”, Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Francesco Lombardo
- Laboratory of Seminology- Sperm Bank “Loredana Gandini”, Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
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Di Fiore MM, Santillo A, Falvo S, Chieffi Baccari G, Venditti M, Di Giacomo Russo F, Lispi M, D'Aniello A. Sex hormone levels in the brain of d-aspartate-treated rats. C R Biol 2017; 341:9-15. [PMID: 29203165 DOI: 10.1016/j.crvi.2017.11.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 11/13/2017] [Accepted: 11/13/2017] [Indexed: 10/18/2022]
Abstract
d-Aspartate (d-Asp) is an endogenous amino acid present in the central nervous system and endocrine glands of various animal taxa. d-Asp is implicated in neurotransmission, physiology of learning, and memory processes. In gonads, it plays a crucial role in sex hormone synthesis. We have investigated the effects of chronic (30 days d-Asp drinking solution) and acute (i.p. injection of 2μmol/g bw d-Asp) treatments on sex steroid synthesis in rat brain. Furthermore, to verify the direct effect of d-Asp on neurosteroidogenic enzyme activities, brain homogenates were incubated with different substrates (cholesterol, progesterone, or testosterone) with or without the addition of d-Asp. Enzyme activities were measured by evaluating the in vitro conversion rate of (i) cholesterol to progesterone, testosterone, and 17β-estradiol, (ii) progesterone to testosterone and 17β-estradiol, (iii) testosterone to 17β-estradiol. We found that d-Asp oral administration produced an increase of approximately 40% in progesterone, 110% in testosterone, and 35% in 17β-estradiol. Similarly, the results of the acute experiment showed that at 30min after d-Asp treatment, the progesterone, testosterone, and 17β-estradiol levels increased by 29-35%, and at 8h they further increased by a 100% increment. In vitro experiments demonstrate that the addition of d-Asp to brain homogenate+substrate induces a significant increase in progesterone, testosterone and 17β-estradiol suggesting that the amino acid upregulates the local activity of steroidogenic enzymes.
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Affiliation(s)
- Maria Maddalena Di Fiore
- Dipartimento di Scienze e Tecnologie ambientali, biologiche e farmaceutiche, Università della Campania "Luigi Vanvitelli", via Vivaldi 43, 81100 Caserta, Italy
| | - Alessandra Santillo
- Dipartimento di Scienze e Tecnologie ambientali, biologiche e farmaceutiche, Università della Campania "Luigi Vanvitelli", via Vivaldi 43, 81100 Caserta, Italy.
| | - Sara Falvo
- Dipartimento di Scienze e Tecnologie ambientali, biologiche e farmaceutiche, Università della Campania "Luigi Vanvitelli", via Vivaldi 43, 81100 Caserta, Italy
| | - Gabriella Chieffi Baccari
- Dipartimento di Scienze e Tecnologie ambientali, biologiche e farmaceutiche, Università della Campania "Luigi Vanvitelli", via Vivaldi 43, 81100 Caserta, Italy
| | - Massimo Venditti
- Dipartimento di Medicina Sperimentale, Università della Campania "Luigi Vanvitelli", Naples, Italy
| | - Federica Di Giacomo Russo
- Dipartimento di Scienze e Tecnologie ambientali, biologiche e farmaceutiche, Università della Campania "Luigi Vanvitelli", via Vivaldi 43, 81100 Caserta, Italy
| | - Monica Lispi
- Medical Affair Department Fertility TA, Merck-Serono SAS, Rome, Italy
| | - Antimo D'Aniello
- Dipartimento di Scienze e Tecnologie ambientali, biologiche e farmaceutiche, Università della Campania "Luigi Vanvitelli", via Vivaldi 43, 81100 Caserta, Italy; Department of Neurobiology and Comparative Physiology, Zoological Station "Anthon Dohrn", Naples, Italy.
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Bosco L, Ruvolo G, Luparello C, Ferrari S, Valerio D, Santi D, Piomboni P, Sarcina E, Lispi M, Roccheri MC. Gene Expression and Apoptosis Levels in Cumulus Cells of Patients with Polymorphisms of FSHR and LHB Undergoing in Vitro Fertilization Program. Cell Physiol Biochem 2017; 43:2391-2404. [PMID: 29073627 DOI: 10.1159/000484392] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 09/06/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS FSH receptor (FSHR) Ala307Thr and Asn680Ser and LHβ chain (LHB) Trp28Arg and Ile35Thr polymorphisms affect the response to pharmacological ovarian stimulation with r-FSH in women undergoing assisted reproductive treatment (ART). Here, we evaluated the expression level of selected genes involved in follicle maturation and the possible onset of apoptosis in cumulus cells of patients with single and double FSHR and LHB polymorphisms, as potential markers of oocyte competence. METHODS Cumulus cells from 36 stimulated patients were collected and SNP genotyping performed by PCR. Gene expression was evaluated through real-time PCR, and apoptosis estimated via TUNEL assay, and cleaved caspase-3 and pAKT immunostaining. RESULTS The cumulative data show significant correlations indicating that the genetic alteration of FSHR and/or LHB genes may lead to perturbations of the signaling network programmed to granulosa cell survival and follicle development. Notably, when double heterozygotes were compared to the rest of the patients, a higher level of apoptosis in terms of both DNA fragmentation index and amount of active caspase-3 was observed in cumulus cells. CONCLUSIONS These results may help to define personalized stimulation protocols in ART programs, to increase the success rate of ICSI procedures in accordance with the polymorphic condition of the individual patient.
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Affiliation(s)
- Liana Bosco
- Università degli Studi di Palermo, Dipartimento di Scienze e Tecnologie Biologiche, Chimiche e Farmaceutiche (STEBICEF), Palermo, Italy
| | | | - Claudio Luparello
- Università degli Studi di Palermo, Dipartimento di Scienze e Tecnologie Biologiche, Chimiche e Farmaceutiche (STEBICEF), Palermo, Italy
| | - Stefania Ferrari
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Infertility Unit, Milano, Italy
| | | | - Daniele Santi
- Università di Modena e Reggio Emilia, Dipartimento di Scienze Biomediche, Metaboliche e Neuroscienze, Unità di Endocrinologia, Modena, Italy
| | - Paola Piomboni
- Università di Siena, Dipartimento di Medicina Molecolare e dello Sviluppo, Siena, Centro Diagnosi e Terapia Sterilità di Coppia, Policlinico S. Maria alle Scotte, Siena, Italy
| | | | | | - Maria Carmela Roccheri
- Università degli Studi di Palermo, Dipartimento di Scienze e Tecnologie Biologiche, Chimiche e Farmaceutiche (STEBICEF), Palermo, Italy
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Rossi V, Lispi M, Longobardi S, Mattei M, Di Rella F, Salustri A, De Felici M, Klinger FG. LH prevents cisplatin-induced apoptosis in oocytes and preserves female fertility in mouse. Cell Death Differ 2016; 24:72-82. [PMID: 27689876 PMCID: PMC5260508 DOI: 10.1038/cdd.2016.97] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Revised: 07/18/2016] [Accepted: 07/20/2016] [Indexed: 01/09/2023] Open
Abstract
Premature ovarian failure and female infertility are frequent side effects of anticancer therapies, owing to the extreme sensitivity of the ovarian reserve oocytes to the damaging effects of irradiation and chemotherapy on DNA. We report here a robust protective effect of luteinizing hormone (LH) on the primordial follicle pool of prepubertal ovaries against the cisplatin (Cs)-induced apoptosis. In vitro LH treatment of prepubertal ovarian fragments generated anti-apoptotic signals by a subset of ovarian somatic cells expressing LH receptor (LHR) through cAMP/PKA and Akt pathways. Such signals, reducing the oocyte level of pro-apoptotic TAp63 protein and favoring the repair of the Cs-damaged DNA in the oocytes, prevented their apoptosis. Noteworthy, in vivo administration to prepubertal female mice of a single dose of LH together with Cs inhibited the depletion of the primordial follicle reserve caused by the drug and preserved their fertility in reproductive age, preventing significant alteration in the number of pregnancy and of delivered pups. In conclusion, these findings establish a novel ovoprotective role for LH and further support the very attracting prospective to use physiological 'fertoprotective' approaches for preventing premature infertility and risks linked to precocious menopause in young patients who survived cancer after chemotherapy.
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Affiliation(s)
- Valerio Rossi
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Monica Lispi
- Medical Affair Department Fertility TA, Merck-Serono SAS, Rome, Italy
| | | | - Maurizio Mattei
- STA, Department of Biology, University of Rome 'Tor Vergata', Rome, Italy
| | - Francesca Di Rella
- UOC Oncologia Medica Senologica, Istituto Nazionale per lo Studio e la Cura dei Tumori, Fondazione G. Pascale, Naples, Italy
| | - Antonietta Salustri
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Massimo De Felici
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Francesca G Klinger
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
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Tatone C, Benedetti E, Vitti M, Di Emidio G, Ciriminna R, Vento ME, Cela V, Borzì P, Carta G, Lispi M, Cimini AM, Artini PG. Modulating Intrafollicular Hormonal Milieu in Controlled Ovarian Stimulation: Insights From PPAR Expression in Human Granulosa Cells. J Cell Physiol 2015; 231:908-14. [PMID: 26332656 DOI: 10.1002/jcp.25182] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Accepted: 08/31/2015] [Indexed: 01/06/2023]
Abstract
Controlled ovarian stimulation (COS) leading to ovulation of multiple follicles is a crucial aspect of biomedical infertility care. Nevertheless, biomarkers useful for COS management are still lacking. Peroxisome proliferator-activated receptors (PPARs) are nuclear hormone receptors relevant to steroid metabolism in granulosa cells (GCs). We investigated whether PPARs and their steroidogenic targets were differentially expressed in GCs differentiated under different recombinant or urinary gonadotropin preparations. GCs from women subjected to COS with r-hFSH, r-hFSH/r-hLH, or hMG-HP were processed to assess expression of PPARα, PPARβ/δ, PPARγ, and steroidogenic enzymes under PPAR modulation. As an evidence of their activation, all PPAR isotypes with their coactivators, the retinoic-X-receptors (RXRs), localized in the nucleus. When GCs from r-hFSH/r-hLH group were compared with r-hFSH, a significant reduction of PPARα protein was observed. By contrast, an increase of PPARβ/δ at both protein and mRNA levels along with that of PPARγ protein were detected. The steroidogenic enzymes 17βHSD IV, 3βHSD II, and HMG-CoA red were downregulated in the r-hFSH/r-hLH group in comparison to r-hFSH unlike CYP19A1 that remained unchanged. In GCs from urinary FSH-LH stimulation (hMG-HP), PPARα was more expressed in comparison with r-hFSH/r-hLH group. Likewise, 3βHSD II and 17βHSD IV were increased suggesting that hMG-HP partially mimicked r-hFSH/r-hLH effects. In summary, transcript analysis associated to protein investigation revealed differential effects of COS protocols on PPARs and their steroidogenic targets in relation to LH and gonadotropin source. These observations candidate PPARs as new biomarkers of follicle competence opening new hypotheses on COS effects on ovarian physiology. J. Cell. Physiol. 231: 908-914, 2016. © 2015 Wiley Periodicals, Inc.
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Affiliation(s)
- Carla Tatone
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy.,Gynecology and Fertility Unit, San Salvatore Hospital, L'Aquila, Italy
| | - Elisabetta Benedetti
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Maurizio Vitti
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Giovanna Di Emidio
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | | | | | - Vito Cela
- Department of Experimental and Clinical Medicine, Division of Gynecology and Obstetrics, University of Pisa, Pisa, Italy
| | | | - Gaspare Carta
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy.,Gynecology and Fertility Unit, San Salvatore Hospital, L'Aquila, Italy
| | - Monica Lispi
- Medical Liaison Office, Merck Serono S.p.A., Rome, Italy
| | - Anna Maria Cimini
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Paolo Giovanni Artini
- Department of Experimental and Clinical Medicine, Division of Gynecology and Obstetrics, University of Pisa, Pisa, Italy
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Carchenilla MSC, Agudo D, Rubio S, Becerra D, Bronet F, Garcia-Velasco JA, Pacheco A, Lardone M, Piottante A, Parada-Bustamante A, Argandona F, Florez M, Espinoza A, Ebensperger M, Castro A, Cohen-Bacrie M, Belloc S, Dalleac A, Amar E, Izard V, Hazout A, Cohen-Bacrie P, de Mouzon J, Muzzonigro F, Crivello AM, Stanghellini I, Bernardini L, Ferraretti AP, Magli C, Gianaroli L, Martin PS, Duvison MH, Silva MD, Gosalvez J, Martin FS, Pomante A, Muzzonigro F, Colombo F, Mattioli M, Barboni B, Ferraretti AP, Magli MC, Gianaroli L, Hacifazlioglu O, Findikli N, Goktolga U, Bahceci M, Jakab A, Mokanszki A, Varga A, Benyo M, Kassai Z, Olah E, Molnar Z, Gundogan GI, Bozkurt HH, Irez T, Domingo A, Anarte C, Presilla N, Calvo I, Aguirre O, Oroquieta A, Agirregoikoa JA, De Pablo JL, Barrenetxea G, Moragues I, Medrano ML, Montoya A, Ramos B, Torres MJG, Aizpurua J, Ibala SR, Ghedir H, Mehri A, Zidi I, Brahem S, Mehdi M, Ajina M, Saad A, Medrano ML, Moragues I, Gomez-Torres MJ, Montoya A, Aizpurua J, Cavaco JE, Rato L, Alves MG, Dias TR, Lopes G, Socorro S, Oliveira PF, Lobascio AM, Minasi MG, Greco E, Bungum M, Bungum A, Silver N, Zahiri M, Movahedin M, Mowla SJ, Noruzinia M, Huleihel M, Abarbanel Y, Haber EP, Azab M, Lan D, Lunenfeld E, Smith MJ, Neri QV, Harvey L, Rosenwaks Z, Palermo GD, Alhalabi M, Samawi S, Droubi H, Khalaf M, Taha A, Khatib R, Bednarowska-flisiak A, Wcislo M, Liss J, Swider A, Szczyglinska J, Grzymkowska M, Bruszczynska A, Glowacka J, Kitowska-Marszalkowska K, Krapchev M, Mirecka A, Wisniewska K, Lukaszuk K, Natali I, Tamburrino L, Cambi M, Marchiani S, Noci I, Maggi M, Forti G, Baldi E, Muratori M, Ferraretto X, Pasquet B, Damond F, Matheron S, Epelboin S, Yahi S, Demailly P, Rougier N, Yazbeck C, Delaroche L, Longuet P, Llabador M, Estellat C, Patrat C, Wcislo M, Liss J, Swider A, Szczyglinska J, Grzymkowska M, Bruszczynska A, Glowacka J, Krapchev M, Mirecka A, Kitowska-Marszalkowska K, Wisniewska K, Lukaszuk K, Askarijahromi M, Movahedin M, Amanlu M, Mowla SJ, Mazaheri Z, Christensen P, Sills ES, Fischer R, Naether OGJ, Walsh D, Rudolf K, Coull G, Baukloh V, Labouriau R, Birck A, Parisi F, Parrilla B, Oneta M, Savasi V, Veleva L, Milachich T, Bochev I, Antonova I, Shterev A, Vlaisavljevic V, Breznik BP, Kovacic B, Serrano M, Gonzalvo MC, Clavero A, Fernandez MF, Mozas J, Martinez L, Fontes J, Carrillo S, Lopez-Regalado ML, Lopez-Leria B, Orozco I, Mantilla A, Castilla JA, Mskhalaya G, Zakharova E, Zaletova V, Kasatonova E, Melnik Y, Efremov E, Breznik BP, Kovacic B, Vlaisavljevic V, Schiewe MC, Verheyen G, Tournaye H, Phletincx I, Sims CA, Rothman C, Borges E, Setti AS, Braga DPAF, Vingris L, Iaconelli A, Dupont C, Faure C, Sermondade N, Gautier B, Herbemont C, Aknin I, Klein JP, Cedrin-Durnerin I, Wolf JP, Czernichow S, Levy R, Rondanino C, Chauffour C, Ouchchane L, Artonne C, Janny L, Lobaccaro JM, Volle DH, Brugnon F, Colacurci N, Piomboni P, Ruvolo G, Lombardo F, Verde EL, De Leo V, Lispi M, Papaleo E, De Palo R, Gandini L, Longobardi S, Yokota Y, Yokota M, Yokota H, Araki Y, Araki Y, Alshahrani S, Durairajanayagam D, Sharma R, Sabanegh E, Agarwal A, Hattori H, Nakajo Y, Ikeno T, Sato Y, Kyoya T, Kyono K, Li B, Li JB, Xiao XF, Ma YF, Wang J, Liang XX, Zhao HX, Jiang F, Yao YQ, Wang XH, Roan NR, Liu H, Muller J, Avila-Herrera A, Pollard KS, Lishko P, Kirchhoff F, Munch J, Witkowska HE, Greene WC, Mangiarini A, Paffoni A, Restelli L, Guarneri C, Somigliana E, Ragni G, Anarte C, Domingo A, Calvo I, Presilla N, Aguirre O, Bou R, Aleman M, Guardiola F, Agirregoikoa JA, De Pablo JL, Barrenetxea G, Camargo C, Oliveira JBA, Petersen CG, Mauri AL, Massaro FC, Nicoletti A, Nascimento AM, Vagnini LD, Martins AMVC, Cavagna M, Baruffi RLR, Franco JG. Andrology. Hum Reprod 2013. [DOI: 10.1093/humrep/det206] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Berthelot-ricou A, Perrin J, Roustan A, Di Giorgio C, De Meo M, Botta A, Orsiere T, Courbiere B, Martinez JG, Botella IM, Casas IP, Novella-Maestre E, Colom PJF, Rubio J, Martinez AP, Rodriguez-Wallberg KA, de Mena SA, Malm E, Larsson A, Kuiper R, Hassan M, Herraiz S, Novella-Maestre E, Rodriguez-Iglesias B, Diaz-Garcia C, Mirabet V, Pellicer A, Aljaser FS, Medrano JH, Rhodes S, Tomlinson MJ, Campbell BK, Dong F, Shi S, Dai S, Liu X, Su Y, Guo Y, Wang F, Xin Z, Song W, Jin H, Jin H, Sun Y, Ortega-Hrepich C, Stoop D, Guzman L, Van Landuyt L, Tournaye H, Smitz J, De Vos M, Rodriguez-Iglesias B, Herraiz S, Novella-Maestre E, Diaz C, Vera F, Pellicer A, Novella-Maestre E, Herraiz S, Rodriguez-Iglesias B, Diaz-Garcia C, Pellicer A, Youm H, Lee J, Lee JR, Lee JY, Jee BC, Suh CS, Kim SH, Lotz L, Hoffmann I, Muller A, Hackl J, Schulz C, Reissmann C, Cupisti S, Oppelt PG, Heusinger K, Hildebrandt T, Beckmann MW, Dittrich R, Klinger F, Rossi V, Lispi M, Longobardi S, De Felici M, Fabbri R, Vicenti R, Martino NA, Parazza I, Macciocca M, Magnani V, Pasquinelli G, Dell'Aquila ME, Venturoli S, Fisch B, Orvieto R, Fisher N, Ben-Haroush A, Stein A, Abir R, Al-Samerria S, McFarlane J, Almahbobi G, Klocke S, Tappehorn C, Griesinger G. Male and female fertility preservation. Hum Reprod 2013. [DOI: 10.1093/humrep/det215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Casarini L, Lispi M, Longobardi S, Milosa F, La Marca A, Tagliasacchi D, Pignatti E, Simoni M. LH and hCG action on the same receptor results in quantitatively and qualitatively different intracellular signalling. PLoS One 2012; 7:e46682. [PMID: 23071612 PMCID: PMC3465272 DOI: 10.1371/journal.pone.0046682] [Citation(s) in RCA: 173] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2012] [Accepted: 09/03/2012] [Indexed: 11/19/2022] Open
Abstract
Human luteinizing hormone (hLH) and chorionic gonadotropin (hCG) act on the same receptor (LHCGR) but it is not known whether they elicit the same cellular and molecular response. This study compares for the first time the activation of cell-signalling pathways and gene expression in response to hLH and hCG. Using recombinant hLH and recombinant hCG we evaluated the kinetics of cAMP production in COS-7 and hGL5 cells permanently expressing LHCGR (COS-7/LHCGR, hGL5/LHCGR), as well as cAMP, ERK1/2, AKT activation and progesterone production in primary human granulosa cells (hGLC). The expression of selected target genes was measured in the presence or absence of ERK- or AKT-pathways inhibitors. In COS-7/LHCGR cells, hCG is 5-fold more potent than hLH (cAMP ED50: 107.1±14.3 pM and 530.0±51.2 pM, respectively). hLH maximal effect was significantly faster (10 minutes by hLH; 1 hour by hCG). In hGLC continuous exposure to equipotent doses of gonadotropins up to 36 hours revealed that intracellular cAMP production is oscillating and significantly higher by hCG versus hLH. Conversely, phospho-ERK1/2 and -AKT activation was more potent and sustained by hLH versus hCG. ERK1/2 and AKT inhibition removed the inhibitory effect on NRG1 (neuregulin) expression by hLH but not by hCG; ERK1/2 inhibition significantly increased hLH- but not hCG-stimulated CYP19A1 (aromatase) expression. We conclude that: i) hCG is more potent on cAMP production, while hLH is more potent on ERK and AKT activation; ii) hGLC respond to equipotent, constant hLH or hCG stimulation with a fluctuating cAMP production and progressive progesterone secretion; and iii) the expression of hLH and hCG target genes partly involves the activation of different pathways depending on the ligand. Therefore, the LHCGR is able to differentiate the activity of hLH and hCG.
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Affiliation(s)
- Livio Casarini
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Center for Genomic Research, University of Modena and Reggio Emilia, Modena, Italy
| | - Monica Lispi
- Medical Liaison Office, Merck Serono S.p.A., Rome, Italy
| | | | - Fabiola Milosa
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Antonio La Marca
- Mother-Infant Department, Institute of Obstetrics and Gynecology, University Hospital of Modena, Modena, Italy
| | - Daniela Tagliasacchi
- Mother-Infant Department, Institute of Obstetrics and Gynecology, University Hospital of Modena, Modena, Italy
| | - Elisa Pignatti
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Center for Genomic Research, University of Modena and Reggio Emilia, Modena, Italy
| | - Manuela Simoni
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Center for Genomic Research, University of Modena and Reggio Emilia, Modena, Italy
- Azienda USL di Modena, Modena, Italy
- * E-mail:
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Engman M, Bystrom B, Varghese S, Lalitkumar PGL, Gemzell-Danielsson K, Romeu C, Urries A, Lierta M, Sanchez Rubio J, Sanz B, Perez I, Casis L, Salerno A, Nazzaro A, Di Iorio L, Bonassisa P, Van Os L, Vink-Ranti CQJ, de Haan-Cramer JH, Rijnders PM, Jansen CAM, Nazzaro A, Salerno A, Marino S, Granato C, Pastore E, Brandes M, Hamilton CJCM, de Bruin JP, Bots RSGM, Nelen WLDM, Kremer JAM, Szkodziak P, Wozniak S, Czuczwar P, Paszkowski T, Wozniak S, Szkodziak P, Czuczwar P, Paszkowski T, Agirregoitia N, Peralta L, Mendoza R, Exposito A, Matorras R, Agirregoitia E, Chuderland D, Ben-Ami I, Kaplan-Kraicer R, Grossman H, Satchi- Fainaro R, Eldar-Boock A, Ron-El R, Shalgi R, Custers IM, Scholten I, Moolenaar LM, Flierman PA, Dessel TJHM, Gerards MH, Cox T, Janssen CAH, van der Veen F, Mol BWJ, Wathlet S, Adriaenssens T, Verheyen G, Coucke W, Smitz J, Feliciani E, Ferraretti AP, Paesano C, Pellizzaro E, Magli MC, Gianaroli L, Hernandez J, Rodriguez-Fuentes A, Garcia-Guzman R, Palumbo A, Radunovic N, Tosic T, Djukic S, Lockwood JC, Adriaenssens T, Wathlet S, Van Landuyt L, Verheyen G, Coucke W, Smitz J, Karayalcin R, Ozcan SARP, Ozyer S, Gurlek B, Kale I, Moraloglu O, Batioglu S, Chaudhury K, Narendra Babu K, Mamata Joshi V, Srivastava S, Chakravarty BN, Viardot-Foucault V, Prasath EB, Tai BC, Chan JKY, Loh SF, Cordeiro I, Leal F, Soares AP, Nunes J, Sousa S, Aguiar A, Carvalho M, Calhaz-Jorge C, Karkanaki A, Piouk A, Katsikis I, Mousatat T, Koiou E, Daskalopoulos GN, Panidis D, Tolikas A, Tsakos E, Gerou S, Prapas Y, Loufopoulos A, Abanto E, Barrenetxea G, Agirregoikoa J, Anarte C, De Pablo JL, Burgos J, Komarovsky D, Friedler S, Gidoni Y, Ben-ami I, Strassburger D, Bern O, Kasterstein E E, Komsky A, Maslansky B, Ron-El R, Raziel A, Fuentes A, Argandona F, Gabler F, Galleguillos A, Torres A, Palomino WA, Gonzalez-Fernandez R, Pena O, Hernandez J, Palumbo A, Avila J, Talebi Chahvar S, Biondini V, Battistoni S, Giannubilo S, Tranquilli AL, Stensen MH, Tanbo T, Storeng R, Abyholm T, Fedorcsak P, Johnson SR, Foster L, Ellis J, Choi JR, Joo JK, Son JB, Lee KS, Helmgaard L, Klein BM, Arce JC, Sanhueza P, Donoso P, Salinas R, Enriquez R, Saez V, Carrasco I, Rios M, Gonzalez P, Macklon N, Guo M, Richardson M, Wilson P, Chian RC, Eapen A, Hrehorcak M, Campbell S, Nargund G, Oron G, Fisch B, Ao A, Freidman O, Zhang XY, Ben-Haroush A, Abir R, Hantisteanu S, Ellenbogen A, Hallak M, Michaeli M, Fainaru O, Maman E, Yong G, Kedem A, Yeruahlmi G, Konopnicki S, Cohen B, Dor J, Hourvitz A, Moshin V, Croitor M, Hotineanu A, Ciorap Z, Rasohin E, Aleyasin A, Agha Hosseini M, Mahdavi A, Safdarian L, Fallahi P, Mohajeri MR, Abbasi M, Esfahani F, Elnashar A, Badawy A, Totongy M, Mohamed H, Mustafa F, Seidman DS, Tadir Y, Goldchmit C, Gilboa Y, Siton A, Mashiach R, Rabinovici J, Yerushalmi GM, Inoue O, Kuji N, Fukunaga T, Ogawa S, Sugawara K, Yamada M, Hamatani T, Hanabusa H, Yoshimura Y, Kato S, Casarini L, La Marca A, Lispi M, Longobardi S, Pignatti E, Simoni M, Halpern G, Braga DPAF, Figueira RCS, Setti AS, Iaconelli Jr. A, Borges Jr. E, Vingris L, Setti AS, Braga DPAF, Figueira RCS, Iaconelli Jr. A, Pasqualotto FF, Borges Jr. E, Collado-Fernandez E, Harris SE, Cotterill M, Elder K, Picton HM, Serra V, Garrido N, Casanova C, Lara C, Remohi J, Bellver J, Steiner HP, Kim CH, You RM, Nah HY, Kang HJ, Kim S, Chae HD, Kang BM, Reig Viader R, Brieno Enriquez MA, Toran N, Cabero L, Giulotto E, Garcia Caldes M, Ruiz-Herrera A, Brieno-Enriquez M, Reig-Viader R, Toran N, Cabero L, Martinez F, Garcia-Caldes M, Velthut A, Zilmer M, Zilmer K, Haller T. Kaart E, Karro H, Salumets A, Bromfield JJ, Sheldon IM, Rezacova J, Madar J, Cuchalova L, Fiserova A, Shao R, Billig H. POSTER VIEWING SESSION - FEMALE (IN) FERTILITY. Hum Reprod 2011. [DOI: 10.1093/humrep/26.s1.82] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Lispi M, Datola A, Bierau H, Ceccarelli D, Crisci C, Minari K, Mendola D, Regine A, Ciampolillo C, Rossi M, Giartosio CE, Pezzotti AR, Musto R, Jone C, Chiarelli F. Heterogeneity of commercial recombinant human growth hormone (r-hGH) preparations containing a thioether variant. J Pharm Sci 2010; 98:4511-24. [PMID: 19408342 DOI: 10.1002/jps.21774] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The objective of the present study was to assess (I) the potential presence of a recently discovered thioether variant in commercially available recombinant human growth hormone (r-hGH) preparations, and (II) the impact of the thioether modification on the in-vivo bioactivity and the receptor binding kinetics. Samples were tested employing European (EP) and US Pharmacopeia (USP) Somatropin monograph and mass spectrometry methods. None of the international standards contained this variant. All products conformed to EP specifications but six out of eight lots contained the variant. An artificially enriched thioether sample exhibited a significantly reduced in vivo biopotency and altered receptor-binding properties compared with a control. The absence of the variant in the pituitary hGH standard, and the possibility to generate it artificially suggests that it is not naturally occurring and that it may arise from an uncontrolled manufacturing process. Controlled studies may be required to assess its clinical efficacy and safety. EP and USP methods may need to be adapted to reliably detect the presence of the variant.
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Affiliation(s)
- Monica Lispi
- Medical Liaison Office, Merck Serono S.p.A., Roma, Italy
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Bassett R, Lispi M, Ceccarelli D, Grimaldi L, Mancinelli M, Martelli F, Van Dorsselaer A. Analytical identification of additional impurities in urinary-derived gonadotrophins. Reprod Biomed Online 2009; 19:300-13. [DOI: 10.1016/s1472-6483(10)60163-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Lispi M, Bassett R, Crisci C, Mancinelli M, Martelli F, Ceccarelli D, De Bellis C, Mendola D. Comparative assessment of the consistency and quality of a highly purified FSH extracted from human urine (urofollitropin) and a recombinant human FSH (follitropin α). Reprod Biomed Online 2006; 13:179-93. [PMID: 16895630 DOI: 10.1016/s1472-6483(10)60613-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The revolutionary development of biotechnology-derived therapeutic proteins has provided the expected improvements in quality, purity and consistency, as demonstrated in recombinant human FSH (rhFSH). However, the development of urine-derived gonadotrophins has not always shown comparable improvements. More recently, highly purified urine-derived FSH (uFSH-HP) products have become widely available. The relative purity, level of urine-derived contaminants, and consistency of one such highly purified human uFSH (uhFSH) (urofollitropin) has been assessed and directly compared with rhFSH (follitropin alpha). It has been demonstrated that the highly purified urofollitropin contains variable levels of urine-derived contaminant proteins and demonstrates a variable level of FSH purity, FSH isoforms, and delivered dose. These variable factors may contribute to the control of ovarian stimulation. The relative purity, variable consistency and the presence of contaminants indicates that the urofollitropin is, at best, a partially purified uFSH that is not able to meet the quality attributes of follitropin alpha (rhFSH).
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Affiliation(s)
- M Lispi
- Industria Farmaceutica Serono SpA, Ardea, Rome, Italy
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