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de Koning R, Blikkendaal MD, de Sousa Lopes SMC, van der Meeren LE, Cheng H, Jansen FW, Lashley EELO. Histological analysis of (antral) follicle density in ovarian cortex tissue attached to stripped endometriomas. J Assist Reprod Genet 2024; 41:1067-1076. [PMID: 38438769 PMCID: PMC11052973 DOI: 10.1007/s10815-024-03058-0] [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: 09/20/2023] [Accepted: 02/07/2024] [Indexed: 03/06/2024] Open
Abstract
PURPOSE When resecting endometriomas with the stripping technique, in the majority of cases, a thin line of adjacent ovarian cortex is attached to the endometrioma. In this study, we performed histological analysis to determine (antral) follicle density in the ovarian cortex tissue attached to stripped endometriomas and assessed patient- and surgical characteristics that could affect this. METHODS Histological slides of previously removed endometriomas were assessed. Follicles in the attached ovarian tissue were classified according to maturation, and follicular density was determined. Immunofluorescent staining of antral follicles in a subset of endometriomas was also performed. RESULTS In 90 out of 96 included endometriomas (93.7%), ovarian tissue attached to the cyst wall was observed. One thousand nine hundred forty-four follicles at different maturation stages were identified (3 follicles/mm3). Follicle density was negatively associated with age (p < 0.001). Antral follicles (< 7-mm diameter) were present in the ovarian tissue attached to 35 endometriomas (36.5%) derived from younger patients compared to endometriomas where none were detected (30 versus 35 years, p = 0.003). Antral follicle density was 1 follicle/mm3. Based on immunofluorescence, healthy antral follicles were identified in two out of four examined endometriomas. CONCLUSIONS Ovarian tissue attached to stripped endometriomas holds potential as a non-invasive source for antral follicles. In theory, application of IVM could be an interesting alternative FP option in young patients with endometriomas who undergo cystectomy in order to transform the surgical collateral damage to a potential oocyte source. Our results encourage future research with fresh tissue to further assess the quality and potential of these follicles. TRIAL REGISTRATION Clinical Trials.gov Identifier: B21.055 (METC LDD), date of registration 12-08-2021, retrospectively registered.
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Affiliation(s)
- Rozemarijn de Koning
- Department of Gynaecology and Obstetrics, Leiden University Medical Centre, Leiden, The Netherlands.
- Endometriose Centrum, Haaglanden Medical Centre, Den Haag, The Netherlands.
- Nederlandse Endometriose Kliniek, Reinier de Graaf Hospital, Delft, The Netherlands.
| | - Mathijs D Blikkendaal
- Endometriose Centrum, Haaglanden Medical Centre, Den Haag, The Netherlands
- Nederlandse Endometriose Kliniek, Reinier de Graaf Hospital, Delft, The Netherlands
| | | | - Lotte E van der Meeren
- Department of Pathology, Leiden University Medical Centre, Leiden, The Netherlands
- Department of Pathology, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Hui Cheng
- Department of Anatomy and Embryology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Frank Willem Jansen
- Department of Gynaecology and Obstetrics, Leiden University Medical Centre, Leiden, The Netherlands
| | - Eileen E L O Lashley
- Department of Gynaecology and Obstetrics, Leiden University Medical Centre, Leiden, The Netherlands
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de Koning R, Cantineau AEP, van der Tuuk K, De Bie B, Groen H, van den Akker-van Marle ME, Nap AW, Maas JWM, Jansen FW, Twijnstra ARH, Blikkendaal MD. The (cost-) effectiveness Of Surgical excision of Colorectal endometriosis compared to ART treatment trAjectory (TOSCA study) - a study protocol. Reprod Fertil 2024; 5:RAF-23-0048. [PMID: 38583465 DOI: 10.1530/raf-23-0048] [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] [Received: 07/13/2023] [Accepted: 04/05/2024] [Indexed: 04/09/2024] Open
Abstract
Currently, the optimal treatment to increase the chance of pregnancy and live birth in patients with colorectal endometriosis and subfertility is unknown. Evidence suggests that that both surgery and in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) are effective in improving live birth rate (LBR) among these women. However, the available evidence is of low quality, reports highly heterogeneous results, lacks direct comparison between both treatment options and does not assess whether a combination strategy results in a higher LBR compared to IVF/ICSI-only treatment. Additionally, the optimal timing of surgery within the treatment trajectory remains unclear. The primary objective of the TOSCA study is to assess the effectiveness of surgical treatment (potentially combined with IVF/ICSI) compared to IVF/ICSI-only treatment to increase the chance of an ongoing pregnancy resulting in a live birth in patients with colorectal endometriosis and subfertility, measured by cumulative LBR. Secondary objectives are to assess and compare quality of life and cost-effectiveness in both groups. Patients will be followed for 40 months after inclusion or until live birth. The TOSCA study is expected to be completed in 6 years.
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Affiliation(s)
| | - Astrid E P Cantineau
- A Cantineau, Obstetrics and Gynaecology, University Medical Centre Groningen, Groningen, Netherlands
| | - Karin van der Tuuk
- K van der Tuuk, Department of Obstetrics and Gynaecology, University Medical Centre Groningen, Groningen, Netherlands
| | - Bianca De Bie
- B De Bie, Endometriosis Foundation of the Netherlands, Sittard, Netherlands
| | - Henk Groen
- H Groen, Epidemiology, University Medical Centre Groningen, Groningen, Netherlands
| | | | - Annemiek W Nap
- A Nap, Department of Obstetrics and Gynaecology, Radboudumc, Nijmegen, Netherlands
| | - Jacques W M Maas
- J Maas, Department of Gynaecology and Grow-school of Oncology and Reproduction, Maastricht University Medical Centre+, Maastricht, Netherlands
| | - Frank Willem Jansen
- F Jansen, Department of Gynaecology, Leiden University Medical Centre, Leiden, Netherlands
| | - Andries R H Twijnstra
- A Twijnstra, Department of Gynaecology, Leiden University Medical Centre, Leiden, Netherlands
| | - Mathijs D Blikkendaal
- M Blikkendaal, Department of Gynaecology, Leiden University Medical Center, Leiden, 2300 RC, Netherlands
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de Koning R, Zwart G, Dahan A, Jansen FW, Blikkendaal M, Twijnstra A. Esketamine in the treatment of chronic endometriosis-induced pain: a case report. Journal of Endometriosis and Pelvic Pain Disorders 2023. [DOI: 10.1177/22840265231153518] [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: 02/16/2023]
Abstract
Introduction: The pathophysiology of endometriosis-induced pain is complex and current pain management is often inadequate. As a consequence, the quality of life of endometriosis patients is reduced due to persistent and often recurrent severe pain, affecting emotional well-being. Case description: In this case report, we present a 28-year-old patient with deep endometriosis and severe pain resistant to conventional therapy, who experienced, after an 8-h infusion with esketamine, no pain symptoms for 8 weeks. Discussion: Current treatment options to suppress chronic pain symptoms in patients with (deep) endometriosis are often inadequate. Esketamine targets key components of the condition (inflammation, pain, depression), but the use of this drug in the treatment of chronic pain due to endometriosis has not been reported yet. Future trials are necessary to assess the effect of esketamine in the treatment of chronic pain due to endometriosis. Conclusion: This case report highlights the potential of esketamine infusion therapy in the treatment of endometriosis patients with persistent pain despite conventional therapy.
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Affiliation(s)
- Rozemarijn de Koning
- Department of Gynaecology and Obstetrics, Leiden University Medical Center, Leiden, The Netherlands
- Endometriosis in Balance Expertise Center, Haaglanden Medical Center, The Hague, The Netherlands
| | - Gertjan Zwart
- Department of Anesthesiology, Isala Hospital, Zwolle, The Netherlands
| | - Albert Dahan
- Department of Anesthesiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Frank Willem Jansen
- Department of Gynaecology and Obstetrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Mathijs Blikkendaal
- Endometriosis in Balance Expertise Center, Haaglanden Medical Center, The Hague, The Netherlands
| | - Andries Twijnstra
- Department of Gynaecology and Obstetrics, Leiden University Medical Center, Leiden, The Netherlands
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du Fossé NA, van der Hoorn MLP, de Koning R, Mulders AGMGJ, van Lith JMM, le Cessie S, Lashley EELO. Toward more accurate prediction of future pregnancy outcome in couples with unexplained recurrent pregnancy loss: taking both partners into account. Fertil Steril 2021; 117:144-152. [PMID: 34863518 DOI: 10.1016/j.fertnstert.2021.08.037] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 06/04/2021] [Revised: 08/19/2021] [Accepted: 08/19/2021] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To identify, besides maternal age and the number of previous pregnancy losses, additional characteristics of couples with unexplained recurrent pregnancy loss (RPL) that improve the prediction of an ongoing pregnancy. DESIGN Hospital-based cohort study in couples who visited specialized RPL units of two academic centers between 2012 and 2020. SETTING Two academic centers in the Netherlands. PATIENTS Clinical data from 526 couples with unexplained RPL were used in this study. INTERVENTION(S) None. MAIN OUTCOME MEASURES The final model to estimate the chance of a subsequent ongoing pregnancy was determined using a backward selection process and internally validated using bootstrapping. Model performance was assessed in terms of calibration and discrimination (area under the receiver operating characteristic curve). RESULTS Subsequent ongoing pregnancy was achieved in 345 of 526 couples (66%). The number of previous pregnancy losses, maternal age, paternal age, maternal body mass index, paternal body mass index, maternal smoking status, and previous in vitro fertilization/intracytoplasmic sperm injection treatment were predictive of the outcome. The optimism-corrected area under the receiver operating characteristic curve was 0.63 compared with 0.57 when using only the number of previous pregnancy losses and maternal age. CONCLUSIONS The identification of additional predictors of a subsequent ongoing pregnancy after RPL, including male characteristics, is significant for both clinicians and couples with RPL. At the same time, we showed that the predictive ability of the current model is still limited and more research is warranted to develop a model that can be used in clinical practice.
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Affiliation(s)
- Nadia A du Fossé
- Department of Gynaecology and Obstetrics, Leiden University Medical Center, Leiden, the Netherlands; Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands.
| | | | - Rozemarijn de Koning
- Department of Gynaecology and Obstetrics, Leiden University Medical Center, Leiden, the Netherlands
| | - Annemarie G M G J Mulders
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre, Rotterdam, the Netherlands
| | - Jan M M van Lith
- Department of Gynaecology and Obstetrics, Leiden University Medical Center, Leiden, the Netherlands
| | - Saskia le Cessie
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands; Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands
| | - Eileen E L O Lashley
- Department of Gynaecology and Obstetrics, Leiden University Medical Center, Leiden, the Netherlands
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Tiemeier GL, de Koning R, Wang G, Kostidis S, Rietjens RGJ, Sol WMPJ, Dumas SJ, Giera M, van den Berg CW, Eikenboom JCJ, van den Berg BM, Carmeliet P, Rabelink TJ. Lowering the increased intracellular pH of human-induced pluripotent stem cell-derived endothelial cells induces formation of mature Weibel-Palade bodies. Stem Cells Transl Med 2020; 9:758-772. [PMID: 32163224 PMCID: PMC7308639 DOI: 10.1002/sctm.19-0392] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 11/18/2019] [Accepted: 02/17/2020] [Indexed: 12/11/2022] Open
Abstract
Differentiation of human‐induced pluripotent stem cells (hiPSCs) into vascular endothelium is of great importance to tissue engineering, disease modeling, and use in regenerative medicine. Although differentiation of hiPSCs into endothelial‐like cells (hiPSC‐derived endothelial cells [hiPSC‐ECs]) has been demonstrated before, controversy exists as to what extent these cells faithfully reflect mature endothelium. To address this issue, we investigate hiPSC‐ECs maturation by their ability to express von Willebrand factor (VWF) and formation of Weibel‐Palade bodies (WPBs). Using multiple hiPSCs lines, hiPSC‐ECs failed to form proper VWF and WPBs, essential for angiogenesis, primary and secondary homeostasis. Lowering the increased intracellular pH (pHi) of hiPSC‐ECs with acetic acid did result in the formation of elongated WPBs. Nuclear magnetic resonance data showed that the higher pHi in hiPSC‐ECs occurred in association with decreased intracellular lactate concentrations. This was explained by decreased glycolytic flux toward pyruvate and lactate in hiPSC‐ECs. In addition, decreased expression of monocarboxylate transporter member 1, a member of the solute carrier family (SLC16A1), which regulates lactate and H+ uptake, contributed to the high pHi of hiPSC‐EC. Mechanistically, pro‐VWF dimers require the lower pH environment of the trans‐Golgi network for maturation and tubulation. These data show that while hiPSC‐ECs may share many features with mature EC, they are characterized by metabolic immaturity hampering proper EC function.
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Affiliation(s)
- Gesa L Tiemeier
- The Einthoven Laboratory for Vascular and Regenerative Medicine, Division of Nephrology, Department of Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Rozemarijn de Koning
- The Einthoven Laboratory for Vascular and Regenerative Medicine, Division of Nephrology, Department of Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Gangqi Wang
- The Einthoven Laboratory for Vascular and Regenerative Medicine, Division of Nephrology, Department of Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Sarantos Kostidis
- Center for Proteomics and Metabolomics, Leiden University Medical Center, Leiden, The Netherlands
| | - Rosalie G J Rietjens
- The Einthoven Laboratory for Vascular and Regenerative Medicine, Division of Nephrology, Department of Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Wendy M P J Sol
- The Einthoven Laboratory for Vascular and Regenerative Medicine, Division of Nephrology, Department of Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Sébastien J Dumas
- Laboratory of Angiogenesis and Vascular Metabolism, Department of Oncology, KU Leuven, Leuven, Belgium.,Laboratory of Angiogenesis and Vascular Metabolism, Center for Cancer Biology, VIB, Leuven, Belgium
| | - Martin Giera
- Center for Proteomics and Metabolomics, Leiden University Medical Center, Leiden, The Netherlands
| | - Cathelijne W van den Berg
- The Einthoven Laboratory for Vascular and Regenerative Medicine, Division of Nephrology, Department of Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Jeroen C J Eikenboom
- The Einthoven Laboratory for Experimental Vascular Medicine, Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands
| | - Bernard M van den Berg
- The Einthoven Laboratory for Vascular and Regenerative Medicine, Division of Nephrology, Department of Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Peter Carmeliet
- Laboratory of Angiogenesis and Vascular Metabolism, Department of Oncology, KU Leuven, Leuven, Belgium.,Laboratory of Angiogenesis and Vascular Metabolism, Center for Cancer Biology, VIB, Leuven, Belgium
| | - Ton J Rabelink
- The Einthoven Laboratory for Vascular and Regenerative Medicine, Division of Nephrology, Department of Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands
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