Uterine Autotransplantation in the Nonhuman Primate With Preservation of the Uterine and Ovarian Vascular Pedicles

C-X-C Chemokine Receptor Type 4 (CXCR-4) Selective Allosteric Agonist ATI2341 TFA Promotes Uterine Repair in Asherman Syndrome

Our study elucidated the therapeutic effect and mechanism of CXCR4 functional selective allosteric agonist ATI2341 TFA on treating Asherman syndrome (AS). AS was established by damaging mouse uterus and the bone marrow cells from ubiquitin-GFP mice were transplanted into AS mice. After 2 weeks, PBS, CXCR4 agonist ATI2341 TFA, CXCR4 antagonist or combined drugs were administrated into mice followed by analysis of detect pregnancy rate, litter size and pregnancy cycle. In AS model, ATI2341 TFA administration promoted BMSCs recruitment into uterine, which was inhibited by CXCL12 receptor antagonist ADM3100. In addition, ATI2341 TFA administration mitigated the degree of endometrial fibrosis, which was exacerbated by ADM3100. ATI2341 TFA administration also improved the fertility and the number of litter and shorten the pregnancy cycle of mice, while ADM3100 exhibited the opposite impacts. In conclusion, CXCR4 receptor agonist alleviates the infertility or adverse pregnancy outcomes possibly through promoting the recruitment of BMSCs in AS mice.

Involving Animal Models in Uterine Transplantation

Background

Absolute uterine factor infertility affects 0. 2% women of childbearing age around the world. Uterine transplantation (UTx) is a promising solution for many of them since the first birth from UTx was described by the Swedish team in 2014. The success of Utx in humans has become possible after a systematic and meticulous approach involving years of research on animal models. To date, more than 80 UTx procedures have been performed worldwide and 30 children were born.

Material and Method

This review summarizes the research preparation conducted in animals before beginning UTx in humans. It focuses on the advantages and limits of each animal model, their place in surgical training, and current contribution in research to improve UTx successes in humans. The different steps in the process of UTx have been analyzed, such as imaging, surgery, ischemia-reperfusion effects, rejection markers, immunosuppressive treatment, and pregnancy.

Conclusion

Animal models have played an essential role in the implementation of UTx, which is a highly complex procedure. While respecting the 3R requirements (replacement, refinement, and reduction), the surgical training using large animal models, such as notably ewes remain irreplaceable for teams wishing to initiate a UTx program. Furthermore, animal models are still mandatory in current research to improve the success rates of UTx in humans as well as to reduce the morbidity associated with this experimental infertility treatment.

Human uterine vasculature with respect to uterus transplantation: A comprehensive review

Due to the novelty of uterus transplantation, data on preferable inflow and outflow of the graft are limited. This paper reviews the technique, type of vessels and the outcome. A systematic search of the PubMed database was conducted. We extracted and analyzed data on the arteries and veins utilized, types of anastomosis, types of donors, complications and the outcome. Thirty eight sources reported 51 human uterine transplantations, 10 graft thromboses and 25 live births. Inflow was established with two uterine arteries (UA) with/without the anterior division of the internal iliac artery in 62% (n = 31) of cases, two UA arteries with a segment/patch of the internal iliac artery in 34% (n = 17) of cases or two UA with a conduit in 4% of cases (n = 2). Both cases with a conduit developed thrombosis (n = 2). Arterial thrombosis/ischemia developed in 8 of the 51 cases. In 50% of cases with arterial thrombosis, atherosclerosis was identified as a possible cause. Outflow was established by two internal iliac veins with patches/segments in 27.5% of cases (n = 14) followed by two utero-ovarian veins in 25.5% (n = 13). Venous thrombosis occurred in 3 of the 51 cases. Uterine arteries with/without anterior division of the internal iliac artery were the most frequent arteries used for inflow and produced the highest patency rate. The presence of atherosclerosis and complex arterial reconstruction was associated with a high rate of arterial thrombosis. None of the veins utilized in the procedures appeared to be superior. There are insufficient data to draw a definite conclusion.