OBJECTIVE: The favored method of preserving fertility in young female cancer survivors is cryopreservation and autotransplantation of ovarian tissue. Reducing hypoxia until angiogenesis takes place is essential for the survival of transplanted ovarian tissue. The aim of this study was to investigate the role of angiopoietin-1 (Angpt-1), angiopoietin-2 (Angpt-2), and vascular endothelial growth factor (VEGF) in ovarian tissue grafts that were cryopreserved using two methods. METHODS: Ovarian tissues harvested from ICR mice were divided into three groups: group I (control), no cryopreservation; group II, vitrification in EFS (ethylene-glycol, ficoll, and sucrose solution)-40; and group III, slow freezing in dimethyl sulfoxide. We extracted mRNA for VEGF, Angpt-1, and Angpt-2 from ovarian tissue 1 week following cryopreservation and again 2 weeks after autotransplantation. We used reverse transcriptase-polymerase chain reaction to quantify the levels of VEGF, Angpt-1, and Angpt-2 in the tissue. RESULTS: Angpt-1 and Angpt-2 expression decreased after cryopreservation in groups II and III. After autotransplantation, Angpt-1 and Angpt-2 expression in ovarian tissue showed different trends. Angpt-1 expression in groups II and III was lower than in group I, but Angpt-2 in groups II and III showed no significant difference from group I. The vitrified ovarian tissues had higher expression of VEGF and Angpt-2 than the slowfrozen ovarian tissues, but the difference was not statistically significant. CONCLUSION: Our results indicate that Angpt-2 may play an important role in ovarian tissue transplantation after cryopreservation although further studies are needed to understand its exact function.
Angiopoietin-1* ; Angiopoietin-2 ; Animals ; Anoxia ; Autografts ; Cryopreservation* ; Dimethyl Sulfoxide ; Female ; Fertility ; Fertility Preservation ; Ficoll ; Freezing ; Humans ; Methods* ; Mice ; Mice, Inbred ICR ; Ovary ; Reverse Transcriptase Polymerase Chain Reaction ; RNA, Messenger ; Sucrose ; Survivors ; Tissue Transplantation ; Transplantation, Autologous ; Transplants* ; Vascular Endothelial Growth Factor A* ; Vascular Endothelial Growth Factors ; Vitrification

For patients at risk of premature ovarian failure with cancer treatment, it is an important option to re-implant the ovarian tissue (OT) after cryopreservation to preserve endocrine function and fertility. With this technique, about 30% of pregnancy success rate and about 90 live births have been reported to date. However, there has been no case report of successful in vitro fertilization (IVF) and embryo transfer (ET) with oocytes collected from transplanted cryopreserved OT in Korea. We report a 30-year old woman with rectal cancer who underwent IVF and ET after cryopreserved OT thawing and re-implantation. She has been diagnosed with stage IIIC rectal cancer after surgery, and right ovary was removed and cryopreserved between cycles of chemotherapy. After completion of chemotherapy and radiotherapy, the patient underwent orthotopic transplantation of cryopreserved OTs. Three months after transplantation, the serum follicle-stimulating hormone level decreased from 91.11 mIU/mL to 43.69 mIU/mL. Thereafter, the patient underwent 11 ovarian stimulation cycles, and in 7 cycles, follicle growth was observed at the OT graft site. In one of these cycles, the oocyte was successfully retrieved and one embryo was transplanted after IVF. The patient was not pregnant, but the cryopreservation of OT can save the fertility after anticancer chemotherapy.
Cryopreservation ; Drug Therapy ; Embryo Transfer* ; Embryonic Structures* ; Female ; Fertility ; Fertility Preservation ; Fertilization in Vitro* ; Follicle Stimulating Hormone ; Humans ; In Vitro Techniques* ; Korea ; Live Birth ; Oocytes ; Ovary ; Ovulation Induction ; Pregnancy ; Primary Ovarian Insufficiency ; Radiotherapy ; Rectal Neoplasms ; Transplantation ; Transplants

Although the survival rate of hematologic malignancies in young patients is very high, cytotoxic therapies such as chemotherapy and total body irradiation therapy can significantly reduce a patient's reproductive capacity and cause irreversible infertility. Early ovarian failure also commonly occurs following additional cancer treatment, bone marrow transplantation, or autologous transplantation. Because the risk of early ovarian failure depends on the patient's circumstances, patients with a hematologic malignancy must consult health professionals regarding fertility preservation before undergoing treatments that can potentially damage their ovaries. While it is widely known that early menopause commonly occurs following breast cancer treatment, there is a lack of reliable study results regarding fertility preservation during hematologic malignancy treatment. Therefore, an in-depth discussion between patients and health professionals about the pros and cons of the various options for fertility preservation is necessary. In this study, we review germ cell toxicity, which occurs during the treatment of hematologic malignancies, and propose guidelines for fertility preservation in younger patients with hematologic malignancies.
Autografts ; Bone Marrow Transplantation ; Breast Neoplasms ; Drug Therapy ; Female ; Fertility Preservation* ; Fertility* ; Germ Cells ; Health Occupations ; Hematologic Neoplasms* ; Humans ; Infertility ; Menopause ; Ovary ; Survival Rate ; Transplantation, Autologous ; Whole-Body Irradiation

As the number of young cancer survivors increases, quality of life after cancer treatment is becoming an ever more important consideration. According to a report from the American Cancer Society, approximately 810,170 women were diagnosed with cancer in 2015 in the United States. Among female cancer survivors, 1 in 250 are of reproductive age. Anticancer therapies can result in infertility or sterility and can have long-term negative effects on bone health, cardiovascular health as a result of reproductive endocrine function. Fertility preservation has been identified by many young patients diagnosed with cancer as second only to survival in terms of importance. The development of fertility preservation technologies aims to help patients diagnosed with cancer to preserve or protect their fertility prior to exposure to chemo- or radiation therapy, thus improving their chances of having a family and enhancing their quality of life as a cancer survivor. Currently, sperm, egg, and embryo banking are standard of care for preserving fertility for reproductive-age cancer patients; ovarian tissue cryopreservation is still considered experimental. Adoption and surrogate may also need to be considered. All patients should receive information about the fertility risks associated with their cancer treatment and the fertility preservation options available in a timely manner, whether or not they decide to ultimately pursue fertility preservation. Because of the ever expanding number of options for treating cancer and preserving fertility, there is now an opportunity to take a precision medicine approach to informing patients about the fertility risks associated with their cancer treatment and the fertility preservation options that are available to them.
Adult Stem Cells ; Cell Culture Techniques ; Cryopreservation/*methods ; *Embryo, Mammalian ; Female ; Fertility Preservation/*methods ; Humans ; Neoplasms/drug therapy/*therapy ; *Oocytes ; Ovarian Follicle/drug effects/metabolism/transplantation ; *Ovary/transplantation ; Ovulation Induction/methods ; Precision Medicine

PURPOSE: To investigate the effect of antifreeze protein (AFP) supplementation on ovarian vitrification and transplantation. MATERIALS AND METHODS: In this experimental study, we researched a total of 182 ovaries from 4-week-old ICR mice. The equilibration solution included 20% ethylene glycol (EG), and the vitrification solution included 40% EG, 18% Ficoll, and 0.3 M sucrose. Intact ovaries were first suspended in 1 mL of equilibration solution for 10 min, and then mixed with 0.5 mL of vitrification solution for 5 min. Ovaries were randomly assigned to 3 groups and 0, 5, or 20 mg/mL of type III AFP was added into the vitrification solution (control, AFP5, and AFP20 groups, respectively). The vitrified ovaries were evaluated after warming and 2 weeks after autotransplantation. The main outcome measurements are follicular morphology and apoptosis assessed by histology and the TUNEL assay. RESULTS: A significantly higher intact follicle ratio was shown in the AFP treated groups (control, 28.9%; AFP5, 42.3%; and AFP20, 44.7%). The rate of apoptotic follicles was significantly lower in the AFP treated groups (control, 26.6%; AFP5, 18.7%; and AFP20, 12.6%). After transplantation of the vitrified-warmed ovaries, a significantly higher intact follicle ratio was shown in the AFP20 group. The rate of apoptotic follicles was similar among the groups. CONCLUSION: The results of the present study suggest that supplementing AFP in the vitrification solution has beneficial effects on the survival of ovarian tissue during cryopreservation and transplantation.
Animals ; Antifreeze Proteins/*pharmacology ; Apoptosis/drug effects ; Cryopreservation/*methods ; Cryoprotective Agents/*pharmacology ; Female ; Fertility Preservation ; Humans ; Mice ; Mice, Inbred ICR ; Ovarian Follicle/drug effects ; Ovary/*drug effects/*transplantation ; *Vitrification

OBJECTIVE: Revascularization is critical for successful ovarian tissue transplantation. Vascular endothelial growth factor (VEGF) and angiopoietin-2 (angpt-2) are the principal mediators of neovascularization. This study was designed to assess VEGF and angpt-2 levels in cryopreserved ovarian tissue after heterotopic autotransplantation. METHODS: Ovarian tissues harvested from ICR mice at 5 to 6 weeks of age were stratified as follows: no cryopreservation (controls, group I); vitrification in VFS-40 (vitrification, group II); and gradual freezing in dimethyl sulfoxide (slow-freezing, group III). Frozen specimens were thawed at room temperature, assaying VEGF and angpt-2 levels 1 week after cryopreservation and 2 weeks after autotransplantation. RESULTS: VEGF and angpt-2 protein levels were significantly lower in cryopreserved ovaries of groups II and III than in controls (group I, P<0.05), whereas groups II and III did not differ significantly in this regard. After autotransplantation of cryopreserved ovarian tissue, VEGF and angpt-2 protein levels did not differ significantly by technique but tended to be lower than corresponding levels in controls. CONCLUSION: Expression of angiogenic factors in ovarian tissue is thought to vary by method of cryopreservation. Our findings indicate that levels of angiogenic factors expressed in cryopreserved ovarian tissue after autotransplantation do not differ appreciably from control levels, regardless of cryopreservation technique.
Angiogenesis Inducing Agents* ; Angiopoietin-2 ; Animals ; Autografts* ; Cryopreservation ; Dimethyl Sulfoxide ; Female ; Freezing ; Mice* ; Mice, Inbred ICR ; Ovary* ; Tissue Transplantation ; Transplantation ; Transplants ; Vascular Endothelial Growth Factor A ; Vitrification

CTLA-4Ig is regarded as an inhibitory agent of the T cell proliferation via blocking the costimulatory signal which is essential for full T cell activation. To improve applicability, we developed the CTLA-4Ig-CTKC in which the c-terminal lysine had been replaced by cysteine through single amino acid change. The single amino acid mutation of c-terminus of CTLA-4Ig was performed by PCR and was checked by in vitro transcription and translation. DNA construct of mutant form was transfected to Chinese hamster ovary (CHO) cells by electroporation. The purified proteins were confirmed by Western blot and B7-1 binding assay for their binding ability. The suppressive capacity of CTLA-4Ig-CTKC was evaluated by the mixed lymphocyte reaction (MLR) and in the allogeneic pancreatic islet transplantation model. CTLA-4Ig-CTKC maintained binding ability to B7-1 molecule and effectively inhibits T cell proliferation in MLR. In the murine allogeneic pancreatic islet transplantation, short-term treatment of CTLA-4Ig-CTKC prolonged the graft survival over 100 days. CTLA-4Ig-CTKC effectively inhibits immune response both in MLR and in allogeneic islet transplantation model, indicating that single amino acid mutation does not affect the inhibitory function of CTLA-4Ig. CTLA-4Ig-CTKC can be used in vehicle-mediated drug delivery system such as liposome conjugation.
Animals ; Blotting, Western ; Cell Proliferation ; Cricetinae ; Cricetulus ; Cysteine ; DNA ; Drug Delivery Systems ; Electroporation ; Female ; Graft Survival ; Islets of Langerhans ; Islets of Langerhans Transplantation ; Liposomes ; Lymphocyte Culture Test, Mixed ; Lysine ; Ovary ; Polymerase Chain Reaction ; Proteins ; Transplants

OBJECTIVETo investigate the effect of mesenchymal stem cell (MSC) transplantation in repairing ovarian injury in mice sensitized with porcine ovarian proteins.

METHODSWild-type female mice with ICR background (6-8 weeks old) were divided randomly into groups A, B and C (n=12). In groups B and C, the mice were treated with the total protein extract from porcine ovary to induce immunological injury of the ovary, while those in group A received no treatment. MSCs-derived from GFP transgenic mice were transplanted into the mice of group C, and equal volume of PBS was injected intraperitoneally in mice of the other two groups. PCR was used to detect GFP gene in the genomic DNA of the ovaries to assess MSCs homing in the ovary, and the reparative effect of MSCs on ovarian injury was evaluated using HE staining and TUNEL analysis.

RESULTSAfter transplantation, the MSCs could reach the injured ovaries to promote the repair of the ovarian injury, resulting also in reduced apoptosis of the granulosa cells (GCs) in the injured ovaries.

CONCLUSIONMSCs transplantation can promote the recovery of the immunological injury of the ovary in mice, the mechanism of which may involve reduced apoptosis of the GCs.

Animals ; Apoptosis ; Bone Marrow Cells ; Female ; Granulosa Cells ; cytology ; Mesenchymal Stem Cell Transplantation ; Mesenchymal Stromal Cells ; Mice ; Mice, Inbred ICR ; Ovarian Diseases ; pathology ; surgery ; Ovary ; cytology ; pathology

OBJECTIVETo assess the recovery of the reproductive endocrine function in rats following orthotopic transplantation of fetal ovarian allograft.

METHODSNinety female SD rats (50-60 days old) were randomized into graft recipient group (n=50), positive control group (n=20), and negative control group (n=20) to receive orthotopic transplantation of fetal (17-19 gestational days) ovaries following bilateral oophorectomy, sham abdominal surgery, and bilateral oophorectomy, respectively. At 45 days after the surgeries, serum estradiol and progesterone levels were measured and the ovaries were removed for evaluation of the ovarian volume and follicle development.

RESULTSOn day 45 after the operations, the estradiol or progesterone levels showed no significant difference between the recipient group and positive control group (P>0.05), but both were significantly lowered in the negative control group (P<0.05). The ovarian volume was comparable between the recipient group and positive control group (P>0.05), and optical microscopy showed follicles in different stages of development and formation of corpus luteum in the ovaries in both groups.

CONCLUSIONFetal rat ovary allografts can develop into functional ovaries capable of ovulation to restore the reproductive endocrine function of recipient female rats.

Animals ; Estradiol ; blood ; Female ; Fetus ; Ovariectomy ; Ovary ; physiology ; transplantation ; Ovulation ; physiology ; Pregnancy ; Progesterone ; blood ; Rats ; Rats, Sprague-Dawley ; Transplantation, Homologous

OBJECTIVETo evaluate the therapeutic effects of bone marrow transplantation (BMT) on ovarian injury induced by chemotherapy in mice.

METHODSForty-eight mice were randomized equally into normal control group (A), cyclophosphamide and BMT group (B), and cyclophosphamide group (C). The mice in groups B and C were treated with intraperitoneal injection of cyclophosphamide at the daily dose of 150 mg/kg for 3 consecutive days, and allogeneic bone marrow cell transplantation was performed in group B. The ovary coefficient and the amount of follicles were compared to evaluate the function of ovaries. For cell tracking, the bone marrow cells were labeled with Hoechst 33342 and detected through fluorescence microscope after transplantation.

RESULTSOn days 21 and 50 after cyclophosphamide treatment, the ovary coefficient and the amount of follicles were significantly lowered in groups B and C (P<0.05), but the reduction was obviously ameliorated in group B (P<0.05). Cell tracking showed the presence of the donor bone marrow cells in the ovaries of the recipients mice after BMT.

CONCLUSIONBMT can improve the ovarian function impaired by chemotherapy in mice.

Animals ; Bone Marrow Transplantation ; Cyclophosphamide ; adverse effects ; Female ; Mice ; Ovary ; pathology ; physiopathology