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Köhne M, Diel E, Packeiser EM, Böttcher D, Tönissen A, Unruh C, Goericke-Pesch S, Ulrich R, Sieme H. Analysis of gene and protein expression in the endometrium for validation of an ex vivo model of the equine uterus using PCR, digital and visual histopathology. Theriogenology 2024; 221:38-46. [PMID: 38537320 DOI: 10.1016/j.theriogenology.2024.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 03/21/2024] [Accepted: 03/23/2024] [Indexed: 04/09/2024]
Abstract
In the past, most research in equine reproduction has been performed in vivo but the use of in vitro and ex vivo models has recently increased. This study aimed to evaluate the functional stability of an ex vivo hemoperfused model for equine uteri with molecular characterization of marker genes and their proteins. In addition, the study validated the respective protein expression and the aptness of the software QuPath for identifying and scoring immunohistochemically stained equine endometrium. After collection, uteri (n = 12) were flushed with preservation solution, transported to the laboratory on ice, and perfused with autologous blood for 6 h. Cycle stage was determined by examination of the ovaries for presence of Graafian follicles or corpora lutea and analysis of plasma progesterone concentration (estrus: n = 4; diestrus: n = 4; anestrus: n = 4). Samples were obtained directly after slaughter, after transportation, and during perfusion (240, 300, 360 min). mRNA expression levels of progesterone (PGR), estrogen (ESR1) and oxytocin (OXTR) receptor as well as of MKI67 (marker of cell growth) and CASP3 (marker of apoptosis) were analyzed by RT-qPCR, and correlation to protein abundance was validated by immunohistochemical staining. Endometrial samples were analyzed by visual and computer-assisted evaluation of stained antigens via QuPath. For PGR, effects of the perfusion and cycle stage on expression were found (P < 0.05), while ESR1 was affected only by cycle stage (P < 0.05) and OXTR was unaffected by perfusion and cycle stage. MKI67 was lower after 360 min of perfusion as compared to samples collected before perfusion (P < 0.05). For CASP3, differences in gene expression were found after transport and samples taken after 240 min (P < 0.05). Immunohistochemical staining revealed effects of perfusion on stromal and glandular cells for steroid hormone receptors, but not for Ki-67 and active Caspase 3. OXTR was visualized in all layers of the endometrium and was unaffected by perfusion. Comparison of QuPath and visual analysis resulted in similar results. For most cell types and stained antigens, the correlation coefficient was r > 0.5. In conclusion, the isolated hemoperfused model of the equine uterus was successfully validated at the molecular level, demonstrating stability of key marker gene expression. The utility of computer-assisted immunohistochemical analysis of equine endometrial samples was also confirmed.
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Affiliation(s)
- Martin Köhne
- Unit for Reproductive Medicine, Clinic for Horses, University of Veterinary Medicine, Foundation, 30559, Hannover, Germany.
| | - Emilia Diel
- Unit for Reproductive Medicine, Clinic for Horses, University of Veterinary Medicine, Foundation, 30559, Hannover, Germany
| | - Eva-Maria Packeiser
- Unit for Reproductive Medicine, Clinic for Small Animals, University of Veterinary Medicine, Foundation, 30559, Hannover, Germany
| | - Denny Böttcher
- Institute of Veterinary Pathology, Faculty of Veterinary Medicine, Leipzig University, 04103, Leipzig, Germany
| | - Anna Tönissen
- Unit for Reproductive Medicine, Clinic for Horses, University of Veterinary Medicine, Foundation, 30559, Hannover, Germany
| | - Christin Unruh
- Unit for Reproductive Medicine, Clinic for Horses, University of Veterinary Medicine, Foundation, 30559, Hannover, Germany
| | - Sandra Goericke-Pesch
- Unit for Reproductive Medicine, Clinic for Small Animals, University of Veterinary Medicine, Foundation, 30559, Hannover, Germany
| | - Reiner Ulrich
- Institute of Veterinary Pathology, Faculty of Veterinary Medicine, Leipzig University, 04103, Leipzig, Germany
| | - Harald Sieme
- Unit for Reproductive Medicine, Clinic for Horses, University of Veterinary Medicine, Foundation, 30559, Hannover, Germany
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2
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López-Martínez S, Simón C, Santamaria X. Normothermic Machine Perfusion Systems: Where Do We Go From Here? Transplantation 2024; 108:22-44. [PMID: 37026713 DOI: 10.1097/tp.0000000000004573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
Abstract
Normothermic machine perfusion (NMP) aims to preserve organs ex vivo by simulating physiological conditions such as body temperature. Recent advancements in NMP system design have prompted the development of clinically effective devices for liver, heart, lung, and kidney transplantation that preserve organs for several hours/up to 1 d. In preclinical studies, adjustments to circuit structure, perfusate composition, and automatic supervision have extended perfusion times up to 1 wk of preservation. Emerging NMP platforms for ex vivo preservation of the pancreas, intestine, uterus, ovary, and vascularized composite allografts represent exciting prospects. Thus, NMP may become a valuable tool in transplantation and provide significant advantages to biomedical research. This review recaps recent NMP research, including discussions of devices in clinical trials, innovative preclinical systems for extended preservation, and platforms developed for other organs. We will also discuss NMP strategies using a global approach while focusing on technical specifications and preservation times.
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Affiliation(s)
- Sara López-Martínez
- Carlos Simon Foundation, Centro de Investigación Príncipe Felipe, Valencia, Spain
| | - Carlos Simón
- Carlos Simon Foundation, Centro de Investigación Príncipe Felipe, Valencia, Spain
- Department of Obstetrics and Gynecology, Universidad de Valencia, Valencia, Spain
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Harvard University, Boston, MA
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX
| | - Xavier Santamaria
- Carlos Simon Foundation, Centro de Investigación Príncipe Felipe, Valencia, Spain
- INCLIVA Biomedical Research Institute, Valencia, Spain
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3
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Li J, Chen J, Wang Y, Hu L, Zhang R, Chen W. Doppler Imaging Assessment of Changes of Blood Flow in Adenomyosis After Higher-Dose Oxytocin: A Randomized Controlled Trial. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2022; 41:2413-2421. [PMID: 35005793 DOI: 10.1002/jum.15923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 11/19/2021] [Accepted: 11/29/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVES To assess the changes of blood flow in adenomyosis (AM) after higher-dose oxytocin (OT) in different doses, and to evaluate the safety for patients. METHODS A total of 124 patients with AM were randomly divided into 4 groups with continuous intravenous infusion of OT as 0.06, 0.12, 0.24 and 0.36 U/min, respectively. The changes of arteries of AM before and after intravenous infusion of OT were observed by color Doppler ultrasound. The changes of blood flow volume of the artery of AM before and after intravenous infusion of OT were compared among the 4 groups, and the vital signs and adverse drug reactions were monitored during intravenous drip. RESULTS During the trial, no severe adverse reactions occurred and the vital signs of all the patients were stable. Among the 4 groups, it was found that there was a significant difference in the change of blood flow volume of blood artery in AM lesions between 0.06 U/min OT group and the other three groups after intravenous drip of OT (P < .05), but there was no significant difference in blood flow volume among the three groups (P > .05), and the difference of adverse drug reactions was statistically significant with the increase of OT dose (P < .05). CONCLUSION OT can effectively reduce the blood flow volume of AM lesions, and continuous intravenous infusion of 0.12 U/min OT is an appropriate dose that can not only minimize the blood flow volume but also reduce the incidence of adverse drug reactions.
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Affiliation(s)
- JunShu Li
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China
- Department of Obstetrics and Gynecology, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, China
| | - JinYun Chen
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China
- Ultrasound Ablation Center, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yong Wang
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China
- Department of Ultrasound Diagnosis, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, China
| | - Liang Hu
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China
- Ultrasound Ablation Center, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Rong Zhang
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China
- Ultrasound Ablation Center, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - WenZhi Chen
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China
- Department of Obsterics and Gynecology, Chongqing Haifu Hospital, Chongqing, China
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4
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Storni E, Bollwein H, Hankele AK, Wellnitz O, Bruckmaier RM, Ulbrich SE, Lüttgenau J. Inhibition of lipopolysaccharide-induced suppression of luteal function in isolated perfused bovine ovaries. J Reprod Dev 2021; 68:45-52. [PMID: 34732602 PMCID: PMC8872752 DOI: 10.1262/jrd.2020-131] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Recently, we observed that lipopolysaccharide (LPS) suppresses corpus luteum (CL) function in isolated perfused ovaries. It remained unclear if this suppression was due to increased luteal PGF2α secretion or LPS-induced apoptosis. Therefore, possible impacts of PGF2α and LPS were inhibited by a non-steroidal anti-inflammatory drug (flunixin) and an endotoxin-binding agent (polymyxin B), respectively. Bovine ovaries with a mid-cycle CL were collected immediately after slaughter and perfused for 240 min. After 50 min of equilibration, either flunixin or polymyxin B (5 μg/ml of each) were added to the perfusion medium of six ovaries, respectively. All ovaries (n = 12) were treated with E.coli LPS (0.5 μg/ml) 60 min after the onset of perfusion, and received 500 I.U. of hCG after 210 min of perfusion. Progesterone and PGF2α were measured in the effluent perfusate every 10 and 30 min, respectively. Biopsies of the CL were collected every 60 min to determine the mRNA expression of the cytokine TNFA and factors of apoptosis (CASP3, -8). Flunixin-treatment inhibited the increase of PGF2α after LPS-challenge that was observed in the polymyxin B-treated (PX-LPS) ovaries. After hCG-stimulation, progesterone secretion increased (P< 0.05) in group PX-LPS but not in the flunixin-treated (F-LPS) ovaries. Compared to initial values before LPS-challenge, luteal mRNA expression of TNFA and CASP3 was increased (P< 0.05) in group F-LPS at 120 and 180 min, respectively, and those of CASP8 was decreased (P< 0.05) in PX-LPS at 60 and 120 min after LPS-treatment. In conclusion, although flunixin managed to inhibit PGF2α, it did not suffice to successfully prevent LPS-induced apoptosis. However, endotoxin-binding polymyxin B resulted in luteal responsiveness to hCG after LPS-challenge.
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Affiliation(s)
- Elena Storni
- Clinic of Reproductive Medicine, Vetsuisse Faculty, University of Zurich, CH-8057 Zurich, Switzerland
| | - Heinrich Bollwein
- Clinic of Reproductive Medicine, Vetsuisse Faculty, University of Zurich, CH-8057 Zurich, Switzerland
| | - Anna-Katharina Hankele
- ETH Zurich, Animal Physiology, Institute of Agricultural Sciences, CH-8092 Zurich, Switzerland
| | - Olga Wellnitz
- Veterinary Physiology, Vetsuisse Faculty, University of Bern, CH-3001 Bern, Switzerland
| | - Rupert M Bruckmaier
- Veterinary Physiology, Vetsuisse Faculty, University of Bern, CH-3001 Bern, Switzerland
| | - Susanne E Ulbrich
- ETH Zurich, Animal Physiology, Institute of Agricultural Sciences, CH-8092 Zurich, Switzerland
| | - Johannes Lüttgenau
- Clinic of Reproductive Medicine, Vetsuisse Faculty, University of Zurich, CH-8057 Zurich, Switzerland
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Vali S, Jones BP, Saso S, Fertleman M, Testa G, Johanesson L, Alghrani A, Smith JR. Uterine transplantation: legal and regulatory implications in England. BJOG 2021; 129:590-596. [PMID: 34532958 DOI: 10.1111/1471-0528.16927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2021] [Indexed: 12/01/2022]
Abstract
Uterus transplantation (UTx) is fast evolving from an experimental to a clinical procedure, combining solid organ transplantation with assisted reproductive technology. The commencement of the first human uterus transplant trial in the United Kingdom leads us to examine and reflect upon the legal and regulatory aspects closely intertwined with UTx from the process of donation to potential implications for fertility treatment and the birth of the resultant child. As the world's first ephemeral transplant, the possibility of organ restitution requires consideration and is discussed herein. TWEETABLE ABSTRACT: Uterine transplantation warrants a closer look at the legal frameworks on fertility treatment and transplantation in England.
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Affiliation(s)
- S Vali
- Department of Surgery and Cancer, Hammersmith Hospital, Imperial College London, London, UK.,Cutrale Perioperative and Ageing Research Group, Imperial College London, London, UK
| | - B P Jones
- Department of Surgery and Cancer, Hammersmith Hospital, Imperial College London, London, UK.,West London Gynaecological Cancer Centre, Hammersmith Hospital, Imperial College NHS Trust, London, UK
| | - S Saso
- Department of Surgery and Cancer, Hammersmith Hospital, Imperial College London, London, UK.,West London Gynaecological Cancer Centre, Hammersmith Hospital, Imperial College NHS Trust, London, UK
| | - M Fertleman
- Cutrale Perioperative and Ageing Research Group, Imperial College London, London, UK
| | - G Testa
- Baylor University Medical Centre, Dallas, TX, USA
| | - L Johanesson
- Baylor University Medical Centre, Dallas, TX, USA
| | - A Alghrani
- School of Law and Social Justice, University of Liverpool, Liverpool, UK
| | - J R Smith
- Department of Surgery and Cancer, Hammersmith Hospital, Imperial College London, London, UK.,West London Gynaecological Cancer Centre, Hammersmith Hospital, Imperial College NHS Trust, London, UK
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6
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Kuijsters NPM, Sammali F, Ye X, Blank C, Xu L, Mischi M, Schoot BC, Rabotti C. Propagation of spontaneous electrical activity in the ex vivo human uterus. Pflugers Arch 2020; 472:1065-1078. [PMID: 32691139 PMCID: PMC7376519 DOI: 10.1007/s00424-020-02426-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Revised: 05/21/2020] [Accepted: 06/26/2020] [Indexed: 12/18/2022]
Abstract
Contractions of the non-pregnant uterus play a key role in fertility. Yet, the electrophysiology underlying these contractions is poorly understood. In this paper, we investigate the presence of uterine electrical activity and characterize its propagation in unstimulated ex vivo human uteri. Multichannel electrohysterographic measurements were performed in five freshly resected human uteri starting immediately after hysterectomy. Using an electrode grid externally and an electrode array internally, measurements were performed up to 24 h after hysterectomy and compared with control. Up to 2 h after hysterectomy, we measured biopotentials in all included uteri. The median root mean squared (RMS) values of the external measurements ranged between 3.95 μV (interquartile range (IQR) 2.41–14.18 μV) and 39.4 μV (interquartile range (IQR) 10.84–105.64 μV) and were all significantly higher than control (median RMS of 1.69 μV, IQR 1.13–3.11 μV), consisting of chicken breast meat. The RMS values decreased significantly over time. After 24 h, the median RMS (1.27 μV, IQR 0.86–3.04 μV) was comparable with the control (1.69 μV, IQR 1.13–3.11 μV, p = 0.125). The internal measurements showed a comparable pattern over time, but overall lower amplitude. The measured biopotentials propagated over the uterine surface, following both a plane-wave as well as an erratic pattern. No clear pacemaker location nor a preferred propagation direction could be identified. These results show that ex vivo uteri can spontaneously generate propagating biopotentials and provide novel insight contributing to improving our understanding of the electrophysiology of the human non-pregnant uterus.
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Affiliation(s)
- Nienke P M Kuijsters
- Department of Electrical Engineering (Signal Processing Systems: Biomedical Diagnostics), Eindhoven Technical University, Post box 513, 5600 MB, Eindhoven, the Netherlands. .,Department of Obstetrics and Gynaecology, Catharina Hospital, Michelangelolaan 2, 5623 EJ, Eindhoven, the Netherlands.
| | - Federica Sammali
- Department of Electrical Engineering (Signal Processing Systems: Biomedical Diagnostics), Eindhoven Technical University, Post box 513, 5600 MB, Eindhoven, the Netherlands
| | - Xin Ye
- Department of Electrical Engineering (Signal Processing Systems: Biomedical Diagnostics), Eindhoven Technical University, Post box 513, 5600 MB, Eindhoven, the Netherlands
| | - Celine Blank
- Department of Electrical Engineering (Signal Processing Systems: Biomedical Diagnostics), Eindhoven Technical University, Post box 513, 5600 MB, Eindhoven, the Netherlands.,Department of Obstetrics and Gynaecology, University Hospital (UZ) Gent, C. Heymanslaan 10, 9000, Ghent, Belgium
| | - Lin Xu
- School of Information Science and Technology, ShanghaiTech University, Shanghai, China
| | - Massimo Mischi
- Department of Electrical Engineering (Signal Processing Systems: Biomedical Diagnostics), Eindhoven Technical University, Post box 513, 5600 MB, Eindhoven, the Netherlands
| | - Benedictus C Schoot
- Department of Electrical Engineering (Signal Processing Systems: Biomedical Diagnostics), Eindhoven Technical University, Post box 513, 5600 MB, Eindhoven, the Netherlands.,Department of Obstetrics and Gynaecology, Catharina Hospital, Michelangelolaan 2, 5623 EJ, Eindhoven, the Netherlands.,Department of Obstetrics and Gynaecology, University Hospital (UZ) Gent, C. Heymanslaan 10, 9000, Ghent, Belgium
| | - Chiara Rabotti
- Department of Electrical Engineering (Signal Processing Systems: Biomedical Diagnostics), Eindhoven Technical University, Post box 513, 5600 MB, Eindhoven, the Netherlands
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7
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Dillon C, Rezvani M, McLean H, Adelman M, Dassel M, Jarboe E, Janát-Amsbury M, Payne A. A tissue preparation to characterize uterine fibroid tissue properties for thermal therapies. Med Phys 2019; 46:3344-3355. [PMID: 31152601 DOI: 10.1002/mp.13639] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 05/22/2019] [Accepted: 05/22/2019] [Indexed: 11/08/2022] Open
Abstract
PURPOSE Treating uterine fibroids with less invasive therapies such as magnetic resonance-guided focused ultrasound (MRgFUS) is an attractive alternative to surgery. Treatment planning can improve MRgFUS procedures and reduce treatment times, but the tissue properties that currently inform treatment planning tools are not adequate. This study aims to develop an ex vivo uterine fibroid model that can emulate the in vivo environment allowing for characterization of the uterus and fibroid MR, acoustic, and thermal tissue properties while maintaining viability for the necessary postsurgical histopathological assessments. METHODS Women undergoing a hysterectomy due to fibroid-related symptoms were invited to undergo a preoperative pelvic MRI and to permit postoperative testing of their uterine specimen. Patients that declined or could not be scheduled for a pre-operative MRI were still able to allow post-operative testing of their excised tissue. Following surgical removal of the uterus, nonmorcellated tissues were reperfused with a Krebs-Henseleit buffer solution. An MR-compatible perfusion system was designed to maintain tissue viability inside the MR suite during scanning. MR imaging protocols utilized preoperatively were repeated on whole sample, reperfused ex vivo uterus specimens. Thermal properties including thermal diffusivity and thermal conductivity of the uterus and fibroids were determined using an invasive needle sensor device in 50% of the specimens. Acoustic property measurements (density, speed of sound and attenuation) were obtained for approximately 20% of the tissue samples using both through-transmission and radiation force balance techniques. Differences between fibroid and uterus and in vivo and ex vivo measurements were evaluated with a two-tailed Student t test. RESULTS Fourteen patients participated in the study and measurements were obtained from 22 unique fibroids. Of the 16 fibroids available for preoperative MRI testing, 69% demonstrated classic hypo-intensity relative to the myometrium, with the remainder presenting with iso- (25%) or hyper-intensity (6%). While thermal diffusivity was not significantly different between fibroid and myometrium tissues (0.217 ± 0.047 and 0.204 ± 0.039 mm2 /s, respectively), the acoustic attenuation in fibroid tissue was significantly higher than myometrium (0.092 ± 0.021 and 0.052 ± 0.023 Np/cm/MHz, respectively). When comparing in vivo with ex vivo MRI T1 and T2 measurements in fibroids and myometrium tissue, the only difference was found in the fibroid T2 property (P < 0.05). Finally, the developed perfusion protocol successfully maintained tissue viability in ex vivo tissues as evaluated through histological analysis. CONCLUSIONS This study developed an MR-compatible extracorporeal perfusion technique that effectively maintains tissue viability, allowing for the direct measurement of patient-specific MR, thermal, and acoustic property values for both fibroid and myometrium tissues. These measured tissue property values will enable further development and validation of treatment planning models that can be utilized during MRgFUS uterine fibroid treatments.
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Affiliation(s)
- Christopher Dillon
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT, 84132, USA
| | - Maryam Rezvani
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT, 84132, USA
| | - Hailey McLean
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT, 84132, USA
| | - Marisa Adelman
- Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT, 84132, USA
| | - Mark Dassel
- Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT, 84132, USA
| | - Elke Jarboe
- Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT, 84132, USA.,Department of Pathology, University of Utah, Salt Lake City, UT, 84112, USA
| | - Margit Janát-Amsbury
- Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT, 84132, USA
| | - Allison Payne
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT, 84132, USA
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8
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Padma AM, Truong M, Jar-Allah T, Song MJ, Oltean M, Brännström M, Hellström M. The development of an extended normothermic ex vivo reperfusion model of the sheep uterus to evaluate organ quality after cold ischemia in relation to uterus transplantation. Acta Obstet Gynecol Scand 2019; 98:1127-1138. [PMID: 30932168 DOI: 10.1111/aogs.13617] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 03/01/2019] [Accepted: 03/27/2019] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Uterus transplantation has recently proved that infertility in women with uterine factor infertility can be cured. It is still an experimental procedure with numerous critical details remaining to be established, including tolerance to warm and cold ischemic insults. In preparation for human uterus transplantation trials, most teams use the sheep as a model system for research and team training, since the vasculature and the uterus is of similar size as in the human. We, therefore, aimed to develop an ex vivo sheep uterus reperfusion platform that mimics the reperfusion situation so that initial assessments and comparisons can be performed without the need for costly and labor-intensive in vivo transplantation experiments. MATERIAL AND METHODS Isolated sheep uteri were perfused with the preservation solution IGL-1 and were then exposed to cold ischemia for either 4 (n = 6) or 48 hours (n = 7). Uteri were then reperfused for 48 hours under normothermic conditions with an oxygenated recirculating perfusate containing growth factors and synthetic oxygen carriers. Histological and biochemical analysis of the perfusate was conducted to assess reperfusion injury. RESULTS Quantification of cell density indicated no significant edema in the myometrium or in the endometrium of uteri exposed to 4 hours cold ischemia and then a normothermic ex vivo reperfusion for 48 hours. Only the outer serosa layer and the inner columnar luminal epithelial cells were affected by the reperfusion. However, a much faster and severe reperfusion damage of all uterine layers were evident during the reperfusion experiment following 48 hours of cold ischemia. This was indicated by major accumulation of extracellular fluid, presence of apoptotic-labeled glandular epithelial layer and vascular endothelium. A significant accumulation of lactate was measured in the perfusate with a subsequent decrease in pH. CONCLUSIONS We developed a novel ex vivo sheep uterus model for prolonged perfusion. This model proved to be able to distinguish reperfusion injury-related differences associated to organ preservation. The experimental setup is a platform that can be used to conduct further studies on uterine ischemia- and reperfusion injury that may lead to improved human uterus transplantation protocols.
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Affiliation(s)
- Arvind M Padma
- Laboratory for Transplantation and Regenerative Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Obstetrics and Gynecology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - MyLan Truong
- Laboratory for Transplantation and Regenerative Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Obstetrics and Gynecology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Tagrid Jar-Allah
- Laboratory for Transplantation and Regenerative Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Obstetrics and Gynecology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Min J Song
- Laboratory for Transplantation and Regenerative Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Obstetrics and Gynecology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Daejeon St. Mary's Hospital, The Catholic University of Korea, Daejeon, South Korea
| | - Mihai Oltean
- Laboratory for Transplantation and Regenerative Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Surgery, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Mats Brännström
- Laboratory for Transplantation and Regenerative Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Obstetrics and Gynecology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Stockholm IVF-EUGIN, Stockholm, Sweden
| | - Mats Hellström
- Laboratory for Transplantation and Regenerative Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Obstetrics and Gynecology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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9
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Weinschenk F, Dittrich R, Müller A, Lotz L, Beckmann MW, Weinschenk SW. Uterine contractility changes in a perfused swine uterus model induced by local anesthetics procaine, lidocaine, and ropivacaine. PLoS One 2018; 13:e0206053. [PMID: 30521531 PMCID: PMC6283528 DOI: 10.1371/journal.pone.0206053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 10/07/2018] [Indexed: 12/03/2022] Open
Abstract
Background Local anesthetics (LAs) are increasingly used as therapeutics due to their multiple molecular effects. They may be potential agents also in gynecology and reproductive medicine. The objective of this study was to investigate the contractility response of the perfused swine uterus to different concentrations of the LAs procaine, lidocaine, and ropivacaine. Methods and findings In an extracorporeal perfusion model with fresh swine uteri, effects of administered boli of these three LAs in concentrations of 0.1 mg/mL, 0.5 mg/mL and 1.0 mg/mL on uterine contractility and peristalsis were assessed using an intrauterine double-chip micro-catheter. A dose-dependent increase in intrauterine pressure (IUP) in the isthmus and corpus uteri was observed after the administration of the ester-LA procaine 0.1, 0.5, and 1.0%, which was not seen with lower concentrations, or buffer solution. An increase-decrease curve was found after increasing concentrations of the amide-LA lidocaine and ropivacaine, with an IUP plateau with 0.1 and 0.5%, and a decrease with 1% (p<0.01). All reactions were seen in both the isthmus and corpus uteri. The difference of the contractility pattern between ester- and amide-LA at 1% concentration was significant. Conclusion LAs dose-dependently modulate contractility in non-pregnant swine uteri. The amid-LAs lidocaine and ropivacaine reduce contractility in higher concentrations and may be used as therapeutics in disorders with increased uterine contractility, as dysmenorrhoea, endometriosis, and infertility. The multiple molecular effects of LAs may explain these effects. This in-vitro pilot study in vitro provides initial data for designing further studies to transfer the results onto humans.
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Affiliation(s)
- Fabian Weinschenk
- Department of Plastic, Reconstructive, Hand-, and Burn Surgery, StKM Klinikum Bogenhausen, Academic Teaching Hospital Technical University, Munich, Germany
- Department of Obstetrics and Gynecology, University Hospital Erlangen, Erlangen, Germany
| | - Ralf Dittrich
- Department of Obstetrics and Gynecology, University Hospital Erlangen, Erlangen, Germany
| | - Andreas Müller
- Department of Obstetrics and Gynecology, Städtisches Klinikum Karlsruhe, Karlsruhe, Germany
| | - Laura Lotz
- Department of Obstetrics and Gynecology, University Hospital Erlangen, Erlangen, Germany
| | - Matthias W. Beckmann
- Department of Obstetrics and Gynecology, University Hospital Erlangen, Erlangen, Germany
| | - Stefan W. Weinschenk
- Department of Gynecological Endocrinology and Fertility Disorders, University of Heidelberg, Heidelberg, Germany
- Outpatient OB/GYN Practice Weinschenk, Scherer & Colleagues, Karlsruhe, Germany
- Heidelberg University Neural Therapy Education and Research Group (The HUNTER Group), Heidelberg, Germany
- * E-mail:
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Heppelmann M, Volland J, Pfarrer C, Kietzmann M, Bäumer W, Merbach S, Schoon HA, Wellnitz O, Schmicke M, Hoedemaker M, Bollwein H. Effects of oxytocin and PGF2α on uterine contractility in cows with and without metritis-An in-vitro study. Anim Reprod Sci 2017; 188:144-154. [PMID: 29175179 DOI: 10.1016/j.anireprosci.2017.11.019] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Revised: 11/07/2017] [Accepted: 11/22/2017] [Indexed: 11/25/2022]
Abstract
The aim of this study was to investigate the effects of PGF2α and oxytocin in vitro on myometrial contractility in puerperal uteri. Thirteen puerperal uteri were removed and perfused after euthanasia of cows with (n=7) and without metritis (n=6). Measurement of uterine contractility was done using four piezoelectric crystals, which were implanted into the myometrium along the greater curvature of the uterine horn where fetal implantation occurred during the previous pregnancy. After 30min of equilibration, oxytocin (5 IU) or PGF2α (2.5mg Dinoprost) was administered randomly into both uterine arteries, and 30min later, the second administration of either oxytocin or PGF2α occurred. Treatment with oxytocin induced contractions in uteri with metritis and uteri without metritis (P<0.05). In uteri with metritis, greater uterine contractions occurred after stimulation with oxytocin than in uteri without metritis (P<0.05). Treatment with PGF2α did not (P>0.05) result in increased contractions in the uteri without metrtitis, however, induced an initial decrease in contractions followed by an increase (P<0.05) in contractions in uteri with metritis. Myometrial and endometrial gene expression of PGF2α (FPR) and oxytocin receptor (OTR) was greater (P<0.05) in uteri with metritis than in uteri without metritis. The results suggest that oxytocin, but not PGF2α, is an effective uterotonic drug in puerperal cows. Uteri in which metritis was diagnosed contracted more strongly after treatment with oxytocin than uteri in which metritis was not diagnosed. This effect was paralleled by greater gene expression of OTR as well as FPR in uteri with metritis compared with uteri in which metritis was not diagnosed.
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Affiliation(s)
- M Heppelmann
- Clinic for Cattle, University of Veterinary Medicine Hannover, Foundation, Bischofsholer Damm 15, D-30173 Hannover, Germany.
| | - J Volland
- Clinic for Cattle, University of Veterinary Medicine Hannover, Foundation, Bischofsholer Damm 15, D-30173 Hannover, Germany
| | - C Pfarrer
- Institute of Anatomy, University of Veterinary Medicine Hannover, Foundation, Bischofsholer Damm 15, D-30173 Hannover, Germany
| | - M Kietzmann
- Department of Pharmacology, Toxicology and Pharmacy, University of Veterinary Medicine Hannover, Foundation, Bischofsholer Damm 15, D-30173 Hannover, Germany
| | - W Bäumer
- Institute of Pharmacology and Toxicology, Faculty of Veterinary Medicine, Freie Universität Berlin, Koserstrasse 20, 14195 Berlon, Germany
| | - S Merbach
- Chemical and Veterinary Investigation Office Westphalia, Pathology and Bacteriology, Zur Taubeneiche 10-12, D-59821 Arnsberg, Germany
| | - H-A Schoon
- Institute of Pathology, Faculty of Veterinary Medicine, University of Leipzig, An den Tierkliniken 33, 04103 Leipzig, Germany
| | - O Wellnitz
- Veterinary Physiology, Vetsuisse Faculty University of Bern, Rte de la Tioleyre 4, CH-1725 Posieux, Switzerland
| | - M Schmicke
- Clinic for Cattle, University of Veterinary Medicine Hannover, Foundation, Bischofsholer Damm 15, D-30173 Hannover, Germany
| | - M Hoedemaker
- Clinic for Cattle, University of Veterinary Medicine Hannover, Foundation, Bischofsholer Damm 15, D-30173 Hannover, Germany
| | - H Bollwein
- Clinic of Reproductive Medicine, Vetsuisse Faculty, University of Zurich, Winterthurerstrasse 260, CH-8057 Zurich, Switzerland
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11
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Lüttgenau J, Möller B, Kradolfer D, Wellnitz O, Bruckmaier RM, Miyamoto A, Ulbrich SE, Bollwein H. Lipopolysaccharide enhances apoptosis of corpus luteum in isolated perfused bovine ovaries in vitro. Reproduction 2016; 151:17-28. [DOI: 10.1530/rep-15-0281] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Accepted: 10/19/2015] [Indexed: 01/04/2023]
Abstract
Lipopolysaccharide (LPS), the endotoxin of Gram-negative bacteria, has detrimental effects on the structure and function of bovine corpus luteum (CL)in vivo. The objective was to investigate whether these effects were mediated directly by LPS orviaLPS-induced release of PGF2α. Bovine ovaries with a mid-cycle CL were collected immediately after slaughter and isolated perfused for 240 min. After 60 min of equilibration, LPS (0.5 μg/ml) was added to the medium of five ovaries, whereas an additional six ovaries were not treated with LPS (control). After 210 min of perfusion, all ovaries were treated with 500 iu of hCG. In the effluent perfusate, concentrations of progesterone (P4) and PGF2αwere measured every 10 and 30 min, respectively. Punch biopsies of the CL were collected every 60 min and used for RT-qPCR to evaluate mRNA expression of receptors for LPS (TLR2,-4) and LH (LHCGR); the cytokineTNFA; steroidogenic (STAR,HSD3B), angiogenic (VEGFA121,FGF2), and vasoactive (EDN1) factors; and factors of prostaglandin synthesis (PGES,PGFS,PTGFR) and apoptosis (CASP3,-8,-9). Treatment with LPS abolished the hCG-induced increase in P4(P≤0.05); however, there was a tendency (P=0.10) for increased release of PGF2αat 70 min after LPS challenge. Furthermore, mRNA abundance ofTLR2,TNFA,CASP3,CASP8,PGES,PGFS, andVEGFA121increased (P≤0.05) after LPS treatment, whereas all other factors remained unchanged (P>0.05). In conclusion, reduced P4responsiveness to hCG in LPS-treated ovariesin vitrowas not due to reduced steroidogenesis, but was attributed to enhanced apoptosis. However, an impact of luteal PGF2αcould not be excluded.
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12
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Stirland DL, Nichols JW, Jarboe E, Adelman M, Dassel M, Janát-Amsbury MM, Bae YH. Uterine perfusion model for analyzing barriers to transport in fibroids. J Control Release 2015; 214:85-93. [PMID: 26184049 DOI: 10.1016/j.jconrel.2015.07.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Revised: 06/14/2015] [Accepted: 07/03/2015] [Indexed: 11/18/2022]
Abstract
This project uses an ex vivo human perfusion model for studying transport in benign, fibrous tumors. The uterine arteries were cannulated to perfuse the organ with a buffer solution containing blood vessel stain and methylene blue to analyze intratumoral transport. Gross examination revealed tissue expansion effects and a visual lack of methylene blue in the fibroids. Some fibroids exhibited regions with partial methylene blue penetration into the tumor environment. Histological analysis comparing representative sections of fibroids and normal myometrium showed a smaller number of vessels with decreased diameters within the fibroid. Imaging of fluorescently stained vessels exposed a stark contrast between fluorescence within the myometrium and relatively little within the fibroid tissues. Imaging at higher magnification revealed that fibroid blood vessels were indeed perfused and stained with the lipophilic membrane dye; however, the vessels were only the size of small capillaries and the blood vessel coverage was only 12% that of the normal myometrium. The majority of sampled fibroids had a strong negative correlation (Pearson's r=-0.68 or beyond) between collagen and methylene blue staining. As methylene blue was able to passively diffuse into fibroid tissue, the true barrier to transport in these fibroids is likely high interstitial fluid pressure, correlating with high collagen content and solid stress observed in the fibroid tissue. Fibroids had an average elevated interstitial fluid pressure of 4mmHg compared to -1mmHg in normal myometrium. Our findings signify relationships between drug distribution in fibroids and between vasculature characteristics, collagen levels, and interstitial fluid pressure. Understanding these barriers to transport can lead to developments in drug delivery for the treatment of uterine fibroids and tumors of similar composition.
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Affiliation(s)
| | | | - Elke Jarboe
- Department of Obstetrics and Gynecology, University of Utah, United States; Department of Pathology, University of Utah, United States
| | - Marisa Adelman
- Department of Obstetrics and Gynecology, University of Utah, United States
| | - Mark Dassel
- Department of Obstetrics and Gynecology, University of Utah, United States
| | - Margit-Maria Janát-Amsbury
- Department of Bioengineering, University of Utah, United States; Department of Pharmaceutics and Pharmaceutical Chemistry, University of Utah, United States; Department of Obstetrics and Gynecology, University of Utah, United States.
| | - You Han Bae
- Department of Pharmaceutics and Pharmaceutical Chemistry, University of Utah, United States; Utah-Inha DDS and Advanced Therapeutics Research Center, Incheon, Korea.
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13
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Geisler K, Künzel J, Grundtner P, Müller A, Beckmann MW, Dittrich R. The perfused swine uterus model: long-term perfusion. Reprod Biol Endocrinol 2012; 10:110. [PMID: 23241226 PMCID: PMC3571897 DOI: 10.1186/1477-7827-10-110] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2012] [Accepted: 12/13/2012] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND It has previously been shown that the viability of swine uteri can be maintained within the physiological range in an open perfusion model for up to 8 hours. The aim of this study was to assess medium- to long-term perfusion of swine uteri using a modified Krebs-Ringer bicarbonate buffer solution (KRBB) in the established open perfusion model. METHODS In an experimental study at an infertility institute, 30 swine uteri were perfused: group 1: n = 11, KRBB; group 2: n = 8, modified KRBB with drainage of perfusate supernatant; group 3: n = 11, modified KRBB with drainage of perfusate every 2 h and substitution with fresh medium. Modified and conventional KRBB were compared with regard to survival and contraction parameters: intrauterine pressure (IUP), area under the curve (AUC), and frequency of contractions (F). RESULTS Modified KRBB showed significantly higher IUP, AUC, and F values than perfusion with conventional KRBB. In group 3, the organ survival time of up to 17 h, with a 98% rate of effective contraction time, differed significantly from group 1 (P < 0.001). CONCLUSIONS Using modified KRBB in combination with perfusate substitution improves the open model for perfusion of swine uteri with regard to survival time and quality of contraction parameters. This model can be used for medium- to long-term perfusion of swine uteri, allowing further metabolic ex vivo studies in a cost-effective way and with little logistic effort.
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Affiliation(s)
- Klaudija Geisler
- Department of Gynecology, Erlangen University Hospital, Erlangen, Germany
| | - Julian Künzel
- Department of Gynecology, Erlangen University Hospital, Erlangen, Germany
| | - Philipp Grundtner
- Department of Gynecology, Erlangen University Hospital, Erlangen, Germany
| | - Andreas Müller
- Department of Gynecology, Erlangen University Hospital, Erlangen, Germany
| | | | - Ralf Dittrich
- Department of Gynecology, Erlangen University Hospital, Erlangen, Germany
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14
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Dittrich R, Sinduwinatha C, Maltaris T, Mueller A, Hoffmann I, Beckmann MW, Oppelt PG. The intrauterine to intra-arterial pressure ratio: a new parameter for the study of uterine contractility physiology. Reprod Biomed Online 2009; 20:430-6. [PMID: 20093083 DOI: 10.1016/j.rbmo.2009.11.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2009] [Revised: 06/23/2009] [Accepted: 11/17/2009] [Indexed: 10/20/2022]
Abstract
The objective of the study was to examine the uterine contractions and the arterial perfusion pressure changes after application of oxytocin, endothelin 1, prostaglandins PGE(1), PGE(2) and PGF(2alpha), in order to identify the substance with the greatest intrauterine pressure (IUP)/intra-arterial pressure (IAP) ratio, which means the substance most suitable for inducing uterine contractility without raising the systemic vascular pressure. Increasing doses of oxytocin, endothelin 1, PGE(1), PGE(2) and PGF(2alpha) were applied as bolus injection through the uterine artery of perfused swine uteri and the intrauterine and intra-arterial pressure rises were recorded. All substances showed a significant cervicofundic pressure gradient and, with the exception of PGF(2alpha), the uterine peristalsis moved towards the cervix uteri. The perfusion pressure after application of oxytocin, PGE(1), PGE(2) and PGF(2alpha) reached a maximum value and started to decrease, whereas endothelin 1 caused a continuous increase in the perfusion pressure. Endothelin 1 showed the lowest IUP/IAP ratio and oxytocin the greatest. In conclusion, the IUP/IAP ratio provides a promising new parameter for the study of uterine contractility physiology. Besides oxytocin, PGE(2) and PGF(2alpha) emerged as the best candidate substances to improve uterine contractility without raising the intra-arterial pressure.
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Affiliation(s)
- R Dittrich
- University Hospital Erlangen, Department of Obstetrics and Gynecology, University of Erlangen-Nuremberg, Universitaetsstrasse 21-23, D-91054 Erlangen, Germany.
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15
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Dittrich R, Mueller A, Oppelt PG, Hoffmann I, Beckmann MW, Maltaris T. Differences in muscarinic-receptor agonist-, oxytocin-, and prostaglandin-induced uterine contractions. Fertil Steril 2008; 92:1694-700. [PMID: 18930215 DOI: 10.1016/j.fertnstert.2008.08.117] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2008] [Revised: 08/24/2008] [Accepted: 08/25/2008] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To investigate the contractile response of the perfused swine uterus to various receptor pathways (oxytocin, prostaglandins, and muscarine). DESIGN An extracorporeal perfusion model of the swine uterus was used that keeps the uterus in a functional condition and is appropriate for the study of physiologic questions. INTERVENTION(S) Oxytocin-, prostaglandin-, and carbachol-induced uterine contractility and peristalsis were assessed using an intrauterine double-chip microcatheter. SETTING University hospital. MAIN OUTCOME MEASURE(S) Intrauterine pressure profiles. RESULT(S) A dose-dependent increase in intrauterine pressure (IUP) in the isthmus uteri and corpus uteri was observed after the administration of prostaglandin F(2alpha) (PGF(2alpha)) and oxytocin, which reached a plateau after further stimulation. A dose-dependent increase in IUP in the isthmus uteri and corpus uteri was also observed after the administration of prostaglandin E(1) (PGE(1)) and prostaglandin E(2) (PGE(2)), with a plateau in IUP in the middle-concentration range and a decrease during the further course of stimulation. After administration of PGE(1), PGE(2), and PGF(2alpha), different directions of contraction waves were also observed. Carbachol also showed a unique contractility pattern, with isolated, very powerful, dose-dependent contractions with an IUP gradient, suggesting directed transport from the upper region to the lower region. CONCLUSION(S) This study demonstrated that oxytocin, the prostaglandins, and carbachol modulate contractility in nonpregnant swine uteri in a characteristic way, resulting in different contractility patterns.
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Affiliation(s)
- Ralf Dittrich
- Department of Obstetrics and Gynecology, Erlangen University Hospital, University of Erlangen-Nuremberg, Erlangen, Germany.
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16
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Bodle JF, Duffy SRG, Binney DM. An in vitro uterine perfusion model for investigating endometrial cryoablation. J Minim Invasive Gynecol 2007; 14:329-33. [PMID: 17478364 DOI: 10.1016/j.jmig.2006.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2006] [Revised: 11/21/2006] [Accepted: 11/29/2006] [Indexed: 10/23/2022]
Abstract
STUDY OBJECTIVES To build a simple in vitro uterine perfusion model for investigating the clinical effectiveness of endometrial ablation. DESIGN Comparative laboratory and in vivo study (Canadian Task Force classification II-2). SETTING University teaching hospital. PATIENTS Women undergoing hysterectomy for menorrhagia with uteri of normal shape and size. INTERVENTIONS A single 5-minute freeze, followed by an active thaw was applied to the endometrial cavity of uteri in vivo and in the in vitro perfusion model. MEASUREMENTS AND MAIN RESULTS Endometrial/myometrial temperature change was measured continuously during the cryosurgical procedure. Depth of cell death was measured using nicotinamide adenine dinucleotide diaphorase enzyme assay. There was no significant difference in temperature change and depth of cell death in endometrial/myometrial tissue between in vivo and in vitro perfusion experiments. CONCLUSIONS The in vitro perfusion model described is a useful tool for investigating endometrial cryoablation and has potential for investigating and developing other intrauterine surgical modalities.
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Affiliation(s)
- Julia F Bodle
- Department of Obstetrics and Gynecology, Leeds General Infirmary, Leeds, UK.
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Maltaris T, Dittrich R, Widjaja W, Sindhuwinata C, Hoffmann I, Beckmann M, Mueller A. The Role of Oestradiol in the Uterine Peristalsis in the Perfused Swine Uterus. Reprod Domest Anim 2006; 41:522-6. [PMID: 17107511 DOI: 10.1111/j.1439-0531.2006.00707.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
This study was designed to examine the effects of oestradiol (E2) on sperm transport in the swine uterus. The bicornuate swine uterus is optimal for the study of the uterine transport and peristalsis because the influence of various factors can be examined on each uterine horn independently. Forty swine uteri (with or without ovarectomy) were perfused for a period of up to 7 h. Two different E2 concentrations (3 or 30 pg/ml) in the perfusion medium were administered for 30 min unilaterally. Through an intracervical catheter 1 ml of a high concentrated dextran blue solution was administered directly in the upper part of the cervix. After bilateral perfusion of the swine uterus with a bolus of 0.3 IU oxytocin the distribution of coloured particles was assessed macroscopically before and after incision of the uterine horns. Coloration was evaluated by two observers blinded to the site-specific administration of E2. In the 10 ovarectomized uteri with the 3 pg/ml E2 concentration a unilateral distribution towards the side of oestradiol administration was observed in six uteri, in four it was a bilateral distribution. In the 10 non-ovarectomized uteri with the 3 pg/ml E2 concentration a uni- and ipsilateral coloration was observed in five uteri, in five it was a bilateral distribution. In the 20 uteri with 30 pg/ml E2, a unilateral coloration of the uterus horns was observed in all uteri. Oestradiol is one of the main factors, which influences the direction of the sperm transport in a dose-dependent manner, in the perfused swine uterus.
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Affiliation(s)
- T Maltaris
- Department of Obstetrics and Gynaecology, University-Hospital Erlangen, Erlangen, Germany
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18
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Maltaris T, Dragonas C, Hoffmann I, Mueller A, Schild RL, Schmidt W, Beckmann MW, Dittrich R. The extracorporeal perfusion of the swine uterus as an experimental model: The effect of tocolytic drugs. Eur J Obstet Gynecol Reprod Biol 2006; 126:56-62. [PMID: 16202502 DOI: 10.1016/j.ejogrb.2005.07.026] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2004] [Revised: 04/18/2005] [Accepted: 07/26/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Comparison of the effect of tocolytic drugs on isolated swine uterus preparations. STUDY DESIGN Forty swine uteri were perfused with the aim to preserve a viable organ, which should be responsive to oxytocic hormones and tocolytic pharmaca. An intrauterine catheter recorded the pressure changes. After initiation of rhythmical uterine contractions we administered known tocolytic drugs (fenoterol, ritodrine, terbutaline, propofol, acetylsalicylic acid, alcohol, atosiban, verapamil, and glyceryl trinitrate) in various concentrations. RESULTS Perfusate pH and lactate, partial oxygen and carbon dioxide tensions, and oxygen saturation in the perfusate showed good preservation of the organ for up to 8h. All substances showed a tocolytic effect on the swine uterus. The effect varied substantially with regard to the length of the contraction free intervals, which was our main effect parameter. Fenoterol, acetylsalicylic acid, and alcohol showed the most and glyceryl trinitrate the least powerful effect. CONCLUSIONS A direct comparison of various tocolytic substances in the same experimental model showed the best effect for fenoterol. Furthermore, we could demonstrate that the swine uterus perfusion system is a suitable model to study the influence of various conditions like the administration of drugs or the induction of oxidative stress on the uterus function.
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Affiliation(s)
- Theodoros Maltaris
- University of Erlangen-Nuremberg, Department of Obstetrics and Gynecology, Universitätsstr. 21/23, D-91054 Erlangen, Germany
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Mueller A, Maltaris T, Siemer J, Binder H, Hoffmann I, Beckmann MW, Dittrich R. Uterine contractility in response to different prostaglandins: results from extracorporeally perfused non-pregnant swine uteri. Hum Reprod 2006; 21:2000-5. [PMID: 16638817 DOI: 10.1093/humrep/del118] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Prostaglandins (PGs) are important stimulators of uterine contractility. Limited data are available at present on the effects of different PGs on uterine contractility, measured using intraluminal pressure changes in the complete uterus. The goal of this study was to assess dynamic changes in uterine contractility and peristalsis in response to PGs in comparison with the effects of oxytocin administration. METHODS An extracorporeal perfusion model of swine uteri was used, which keeps the uterus in a functional condition, and is appropriate for the study of physiological questions. Oxytocin- and PG-induced uterine contractility and peristalsis were assessed using an intrauterine double-chip microcatheter. RESULTS A dose-dependent increase in intrauterine pressure (IUP) in the isthmus uteri (P < 0.001) and the corpus uteri (P < 0.001) was observed after the administration of PGF(2alpha) and oxytocin, which reached a plateau after further stimulation. A dose-dependent increase in IUP in the isthmus uteri (P < 0.001) and the corpus uteri (P < 0.001) was also observed after the administration of PGE(1) and PGE(2), with a plateau in IUP in the middle-concentration range and a decrease in the course of further stimulation. PGE(2) caused significantly more contractions starting in the corpus uteri and moving to the isthmus uteri (P = 0.008). The direction of most contractions caused by PGE(1), PGE(2) and oxytocin differed from that of PGF(2alpha). CONCLUSIONS This study demonstrates that the PGs tested modulate contractility in non-pregnant swine uteri in a characteristic way, resulting in different contractility patterns.
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Affiliation(s)
- Andreas Mueller
- Department of Obstetrics and Gynaecology, Erlangen University Hospital, Erlangen, Germany.
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20
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Mueller A, Siemer J, Schreiner S, Koesztner H, Hoffmann I, Binder H, Beckmann MW, Dittrich R. Role of estrogen and progesterone in the regulation of uterine peristalsis: results from perfused non-pregnant swine uteri. Hum Reprod 2006; 21:1863-8. [PMID: 16517557 DOI: 10.1093/humrep/del056] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Adequate uterine contractility and peristalsis are involved in the transport of semen and gametes and in successful embryo implantation. Estrogen and progesterone fluctuate characteristically during the menstrual cycle. It has been suggested that both hormones influence uterine peristalsis in characteristic ways. METHODS An extracorporeal perfusion model of the swine uterus was used that keeps the uterus in a functional condition and is suitable for the study of physiological questions. The effects of estrogen and progesterone on oxytocin-induced uterine peristalsis were assessed using an intrauterine double-chip microcatheter. RESULTS Estrogen perfusion was associated with an increase in intrauterine pressure (IUP) in a dose-dependent manner. There was a significant difference between the IUP increase measured in the isthmus uteri and that in the corpus uteri, resulting in a cervico-fundal pressure gradient. Estrogen perfusion resulted in a significantly higher rate of peristaltic waves starting in the isthmus uteri and directed towards the corpus uteri. Progesterone was able to antagonize the estrogen effect in general. CONCLUSIONS This study demonstrates that estrogen and progesterone have differential effects in the regulation of uterine peristalsis. The present observation shows that estrogen stimulates uterine peristalsis and is able to generate a cervico-fundal direction of peristalsis, whereas progesterone inhibits directed uterine peristalsis.
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Affiliation(s)
- A Mueller
- Department of Obstetrics and Gynecology, University Hospital Erlangen, Erlangen, Germany.
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Mueller A, Siemer J, Renner S, Hoffmann I, Maltaris T, Binder H, Beckmann MW, Dittrich R. Perfused Non-Pregnant Swine Uteri: A Model for Evaluating Transport Mechanisms to the Side Bearing the Dominant Follicle in Humans. J Reprod Dev 2006; 52:617-24. [PMID: 16819258 DOI: 10.1262/jrd.18021] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Adequate uterine contractility and periovulatory peristalsis, interpreted as "rapid sperm transport" to the side bearing the dominant follicle, may be a precondition for successful reproduction in humans. Estrogen and progesterone fluctuate characteristically during the menstrual cycle, and their source is the dominant follicle and corpus luteum. The question is, how is the direction to the left or right side of transport mechanisms influenced? An extracorporeal perfusion model of the swine uterus was used that maintained the uterus in a functional condition and that was suitable for the study of physiological questions. The effects of side-dependent estrogen, progesterone, and estrogen plus progesterone perfusion on oxytocin-induced uterine peristalsis were assessed using two intrauterine microcatheters placed in each horn of the swine uterus. Estrogen perfusion was associated with an increase in intrauterine pressure (IUP) in a dose-dependent manner only in the estrogen-perfused horn of the swine uterus. There was a significant difference between the IUP increase measured in the estrogen-perfused horn and that in the non estrogen-perfused horn of the swine uterus. Progesterone perfusion showed no effect in general. Furthermore, progesterone antagonized the estrogen effects. This study demonstrates that side-dependent estrogen perfusion resulted in side-dependent contractility in the swine uterus perfusion system used. These observations show that estrogen stimulates uterine contractility in the estrogen-perfused uterine horn and that estrogens may be the "trigger" for the transport mechanisms to the side bearing the dominant follicle during the periovulatory phase through their locally increased concentration and distribution via the utero-ovarian counter-current system in humans.
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Affiliation(s)
- Andreas Mueller
- Department of Obstetrics and Gynecology, Erlangen University Hospital, Erlangen, Germany.
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Richter ON, Bartz C, Dowaji J, Kupka M, Reinsberg J, Ulrich U, Rath W. Contractile reactivity of human myometrium in isolated non-pregnant uteri. Hum Reprod 2005; 21:36-45. [PMID: 16155074 DOI: 10.1093/humrep/dei295] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Perfusion of the isolated uterus has been shown to be a feasible experimental system for studies of the human endometrium and myometrium. Utilizing our established experimental perfusion model we perfused 20 uteri for 27 h and investigated the contractile reactivity of the myometrium in response to 17beta-estradiol (E2) and oxytocin (OT). METHODS Uteri of group A (n = 4) were stimulated with OT; group B (n = 4) was treated continuously with E2; group C (n = 4) received both E2 and OT for 27 h; group D (n = 4) was perfused for 27 h with E2 with the addition of OT for the last 3 h of the experiment; group E (n = 4) as control group remained without any treatment. The pressure and duration of uterine contractions were recorded during the entire perfusion period using intramural and endoluminal pressure catheters. RESULTS Compared to the other treatment groups and controls, the most effective myometrial activity was achieved in group D during the OT stimulation period. No relevant myometrial activity was detected in the control group. CONCLUSIONS Continuous E2 treatment, with the addition of OT for the last 3 h of the 27 h perfusion period, led to the most pronounced uterotonic effects in the presented experimental condition.
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Affiliation(s)
- O N Richter
- Department of Obstetrics and Gynaecology, University of Aachen School of Medicine, Aachen, Germany.
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Maltaris T, Scalera F, Schlembach D, Hoffmann I, Mueller A, Binder H, Goecke T, Hothorn T, Schild RL, Beckmann MW, Dittrich R. Increased uterine arterial pressure and contractility of perfused swine uterus after treatment with serum from pre-eclamptic women and endothelin-1. Clin Sci (Lond) 2005; 109:209-15. [PMID: 15859943 DOI: 10.1042/cs20040340] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The present study was designed to examine the effects of ET-1 (endothelin-1) and serum from PE (pre-eclamptic), HP (healthy pregnant) and HNP (healthy non-pregnant) women on uterine arterial perfusion pressure and uterine contractility. Swine uteri (n=25) were perfused for a period of up to 11 h, with the aim being to preserve a viable organ. Various concentrations of ET-1 as well as serum from PE, HP and HNP women (n=10 per group) were administered to the perfused swine uteri and IUP (intrauterine pressure) and IAP (intra-arterial pressure) were recorded. ET-1 produced dose-dependent increases in IUP and IAP. The ET-1 concentration in serum was higher in serum from PE women than in HP and HNP women (P>0.05). Administration of all serum samples had a contractile effect on the swine uterus, with the greatest effect being seen in HNP women (12.8±5.3 mmHg), followed by PE (9.06±4.2 mmHg) and HP (6.1±4.1 mmHg) women. Statistically significant differences were observed between HNP and PE women (P=0.048), and PE and HP women (P=0.021). Increases in IAP following administration of serum from PE women (48.8±20.0 mmHg) were significantly higher (P=0.024) compared with the effect of serum from HP women (28.4±13.7 mmHg). In conclusion, the findings show that serum from PE women has significant vasoconstrictive and oxytocic effects compared with serum from HP women. In pre-eclampsia, the balance between vasorelaxing and vasoactive substances is disturbed.
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Affiliation(s)
- Theodoros Maltaris
- Department of Obstetrics and Gynaecology, University of Erlangen-Nuremberg, Germany
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