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Hwang SY, Lee D, Lee G, Ahn J, Lee YG, Koo HS, Kang YJ. Endometrial organoids: a reservoir of functional mitochondria for uterine repair. Theranostics 2024; 14:954-972. [PMID: 38250040 PMCID: PMC10797286 DOI: 10.7150/thno.90538] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 12/09/2023] [Indexed: 01/23/2024] Open
Abstract
Background: Asherman's syndrome (AS) is a dreadful gynecological disorder of the uterus characterized by intrauterine adhesion with severe fibrotic lesions, resulting in a damaged basalis layer with infertility. Despite extensive research on overcoming AS, evidence-based effective and reproducible treatments to improve the structural and functional morphology of the AS endometrium have not been established. Methods: Endometrial organoids generated from human or mouse endometrial tissues were transplanted into the uterine cavity of a murine model of AS to evaluate their transplantable feasibility to improve the AS uterine environment. The successful engraftment of organoid was confirmed by detection of human mitochondria and cytosol (for human endometrial organoid) or enhanced green fluorescent protein signals (for mouse endometrial organoid) in the recipient endometrium. The therapeutic effects mediated by organoid transplantation were examined by the measurements of fibrotic lesions, endometrial receptivity and angiogenesis, and fertility assessment by recording the number of implantation sites and weighing the fetuses and placenta. To explore the cellular and molecular mechanisms underlying the recovery of AS endometrium, we evaluated the status of mitochondrial movement and biogenetics in organoid transplanted endometrium. Results: Successfully engrafted endometrial organoids with similar morphological and molecular features to the parental tissues dramatically repaired the AS-induced damaged endometrium, significantly reducing fibrotic lesions and increasing fertility outcomes in mice. Moreover, dysfunctional mitochondria in damaged tissues, which we propose might be a key cellular feature of the AS endometrium, was fully recovered by functional mitochondria transferred from engrafted endometrial organoids. Endometrial organoid-originating mitochondria restored excessive collagen accumulation in fibrotic lesions and shifted uterine metabolic environment to levels observed in the normal endometrium. Conclusions: Our findings suggest that endometrial organoid-originating mitochondria might be key players to mediate uterine repair resulting in fertility enhancement by recovering abrogated metabolic circumstance of the endometrium with AS. Further studies addressing the clinical applicability of endometrial organoids may aid in identifying new therapeutic strategies for infertility in patients with AS.
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Affiliation(s)
- Sun-Young Hwang
- Department of Biomedical Science, School of Life Science, CHA University; 335 Pangyo-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, South Korea
| | - Danbi Lee
- Department of Biomedical Science, School of Life Science, CHA University; 335 Pangyo-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, South Korea
| | - Gaeun Lee
- Department of Biomedical Science, School of Life Science, CHA University; 335 Pangyo-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, South Korea
| | - Jungho Ahn
- Department of Biochemistry, Research Institute for Basic Medical Science, School of Medicine, CHA University; 335 Pangyo-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, South Korea
| | - Yu-Gyeong Lee
- Department of Biomedical Science, School of Life Science, CHA University; 335 Pangyo-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, South Korea
| | - Hwa Seon Koo
- CHA Fertility Center Bundang; 59, Yatap-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, South Korea
| | - Youn-Jung Kang
- Department of Biomedical Science, School of Life Science, CHA University; 335 Pangyo-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, South Korea
- Department of Biochemistry, Research Institute for Basic Medical Science, School of Medicine, CHA University; 335 Pangyo-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, South Korea
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Zhang T, Hu R, Wang Y, Guo S, Wu Z, Liu J, Han C, Qiu C, Deng G. Extracellular matrix stiffness mediates uterine repair via the Rap1a/ARHGAP35/RhoA/F-actin/YAP axis. Cell Commun Signal 2023; 21:22. [PMID: 36691027 PMCID: PMC9869517 DOI: 10.1186/s12964-022-01018-8] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 12/14/2022] [Indexed: 01/25/2023] Open
Abstract
The integrity of the structure and function of the endometrium is essential for the maintenance of fertility. However, the repair mechanisms of uterine injury remain largely unknown. Here, we showed that the disturbance of mechanical cue homeostasis occurs after uterine injury. Applying a multimodal approach, we identified YAP as a sensor of biophysical forces that drives endometrial regeneration. Through protein activation level analysis of the combinatorial space of mechanical force strength and of the presence of particular kinase inhibitors and gene silencing reagents, we demonstrated that mechanical cues related to extracellular matrix rigidity can turn off the Rap1a switch, leading to the inactivation of ARHGAP35and then induced activation of RhoA, which in turn depends on the polymerization of the agonist protein F-actin to activate YAP. Further study confirmed that mechanotransduction significantly accelerates remodeling of the uterus by promoting the proliferation of endometrial stromal cells in vitro and in vivo. These studies provide new insights into the dynamic regulatory mechanisms behind uterine remodeling and the function of mechanotransduction. Video Abstract.
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Affiliation(s)
- Tao Zhang
- College of Animal Science and Technology, Anhui Agricultural University, Hefei, 230031, People's Republic of China.
- Department of Clinical Veterinary Medicine, College of Veterinary Medicine, Huazhong Agricultural University, Wuhan, 430070, People's Republic of China.
| | - Ruiting Hu
- College of Animal Science and Technology, Anhui Agricultural University, Hefei, 230031, People's Republic of China
| | - Yan Wang
- College of Animal Science and Technology, Anhui Agricultural University, Hefei, 230031, People's Republic of China
| | - Shuai Guo
- Department of Clinical Veterinary Medicine, College of Veterinary Medicine, Huazhong Agricultural University, Wuhan, 430070, People's Republic of China
| | - Zhimin Wu
- Department of Clinical Veterinary Medicine, College of Veterinary Medicine, Huazhong Agricultural University, Wuhan, 430070, People's Republic of China
| | - Junfeng Liu
- Department of Clinical Veterinary Medicine, College of Veterinary Medicine, Huazhong Agricultural University, Wuhan, 430070, People's Republic of China
- College of Animal Science and Technology, Tarim University, Alar, 843300, Xinjiang, People's Republic of China
| | - Chunyang Han
- College of Animal Science and Technology, Anhui Agricultural University, Hefei, 230031, People's Republic of China
| | - Changwei Qiu
- Department of Clinical Veterinary Medicine, College of Veterinary Medicine, Huazhong Agricultural University, Wuhan, 430070, People's Republic of China
| | - Ganzhen Deng
- Department of Clinical Veterinary Medicine, College of Veterinary Medicine, Huazhong Agricultural University, Wuhan, 430070, People's Republic of China.
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Grigorian A, Joe V, Delaplain PT, Schubl S, Barker B, Gabriel V, Dosch AR, Barrios C, Nahmias J. Risk of hysterectomy and salpingectomy or oophorectomy compared to repair after pelvic gynecologic trauma. Eur J Trauma Emerg Surg 2018; 45:403-410. [PMID: 29511771 DOI: 10.1007/s00068-018-0936-5] [Citation(s) in RCA: 3] [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: 12/28/2017] [Accepted: 03/03/2018] [Indexed: 11/30/2022]
Abstract
PURPOSE Pelvic gynecologic trauma (PGT) includes injury to the uterus, ovaries or fallopian tubes. We hypothesized Injury Severity Score (ISS) ≥ 25, hypotension on admission and age ≥ 51 (average age for menopause) would be independent risk factors for resection compared to repair. METHODS A retrospective analysis of the National Trauma Data Bank was performed between 2007 and 2015. RESULTS Of 2,040,235 female patients, 1938 (< 0.1%) presented with PGT with the majority sustaining injury to the ovary or fallopian tubes (52.9%). Most patients were managed nonoperatively (77.1 vs 22.9%). On multivariable analysis, in patients with injury to the uterus, ISS ≥ 25 (OR 3.52, CI 1.67-7.48, p < 0.05) was associated with higher risk for hysterectomy compared to repair. In patients with injury to the ovaries or fallopian tubes, gunshot wound (OR 3.73, CI 1.43-9.68, p < 0.05) was associated with a higher risk for salpingectomy or oophorectomy compared to repair. Age ≥ 51 and hypotension on admission were not independent risk factors for resection in patients with PGT. Operative treatment was associated with a lower risk for mortality in patients with an injury to the uterus (OR 0.27, CI 0.14-0.51, p < 0.001) or ovaries/fallopian tubes (OR 0.37, CI 0.19-0.72, p < 0.001) compared to those managed nonoperatively. CONCLUSION In the largest study reported, PGT occurred in < 0.1% of traumas involving women. Patients with ISS ≥ 25 have higher risk for hysterectomy compared to repair. Gunshot injuries have higher risk for salpingectomy or oophorectomy compared to repair. Hypotension on arrival or age ≥ 51 are not independent risk factors for resection in PGT. Operative management is associated with lower risk of mortality in PGT patients.
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Affiliation(s)
- Areg Grigorian
- Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, University of California, Irvine, 333 The City Blvd West, Suite 1600, Orange, CA, 92868-3298, USA.
| | - Victor Joe
- Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, University of California, Irvine, 333 The City Blvd West, Suite 1600, Orange, CA, 92868-3298, USA
| | - Patrick Thomas Delaplain
- Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, University of California, Irvine, 333 The City Blvd West, Suite 1600, Orange, CA, 92868-3298, USA
| | - Sebastian Schubl
- Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, University of California, Irvine, 333 The City Blvd West, Suite 1600, Orange, CA, 92868-3298, USA
| | - Bel Barker
- Department of Obstetrics and Gynecology, Kaiser-Permanente, Anaheim, CA, USA
| | - Viktor Gabriel
- Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, University of California, Irvine, 333 The City Blvd West, Suite 1600, Orange, CA, 92868-3298, USA
| | - Austin Ronald Dosch
- Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, University of California, Irvine, 333 The City Blvd West, Suite 1600, Orange, CA, 92868-3298, USA
| | - Cristobal Barrios
- Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, University of California, Irvine, 333 The City Blvd West, Suite 1600, Orange, CA, 92868-3298, USA
| | - Jeffry Nahmias
- Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, University of California, Irvine, 333 The City Blvd West, Suite 1600, Orange, CA, 92868-3298, USA
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Abstract
OBJECTIVE To determine the risk factors, management modalities, fetomaternal outcome of uterine rupture cases at University teaching hospital in Pakistan. METHODS This retrospective descriptive study was conducted at the Department of Gynaecology and Obstetrics Liaquat University of Medical and Health Sciences (LUMHS) for a period of one year from January 1st to December 31st 2012. Main outcome measures were frequency, age, parity, booking status, risk factors, management modalities, fetal and maternal mortality associated with uterine rupture. The data was collected on pre-designed proforma analysed using SPSS Version 16 statistical package. RESULTS The frequency of ruptured uteri was calculated to be 0.67%, giving a ratio of 1:148 deliveries. Highest incidence was found in age group 25-30 (44.26%) with mean age of 30.36 years. and parity group 2-3 (57.37%) with mean parity 4.08. The risk factors for ruptured uterus include Caesarean section 43(70.49%), injudicious use of oxytocin 33(54.09%), obstructed labour 15 (24.59%) and multiparty 18 (29.50%). Repair of uterus was performed in 47(77.04%) cases. Maternal case fatality was 5(8.19%), while foetal wastage was 51 (83.60%). CONCLUSION This study confirms the existence of a serious preventable obstetric problem, with significant maternal mortality and foetal wastage. Integrated efforts include Health education, focused antenatal care, skilled attendance, avoidance of injudicious use of oxytocin, and need of hospital based deliveries in patients with caesarean section which should be intensified to reduce this drastic obstetrical complication.
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Affiliation(s)
- Nousheen Aziz
- Dr. Nousheen Aziz, MS. Registrar, Department of Gynaecology & Obstetrics, Liaquat University of Medical & Health Sciences, Jamshoro, Sindh, Pakistan
| | - Sajida Yousfani
- Dr. Sajida Yousfani, FCPS. Professor, Department of Gynaecology & Obstetrics, Liaquat University of Medical & Health Sciences, Jamshoro, Sindh, Pakistan
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