P-284 Correlation between a new day 4 embryo scoring system and blastocyst development and pregnancy rate

Study question

Does a new day 4 embryo scoring system predict blastocyst development and aneuploidies?

Summary answer

The new day 4 embryo scoring system correlates with blastocyst development, blastocyst morphology, day of blastulation, and pregnancy rate.

What is known already

A small number of studies propose different day 4 embryo grading systems. The majority of them report no differences in implantation and clinical pregnancy outcome between day 4 and blastocyst transfer. Moreover, only limited data exist on the association between day 4 grading systems, embryo development, and PGT-A results. In addition, none of the previous studies analyzed the totality of the different day 4 embryo morphology and their subsequent development.

Study design, size, duration

This is a single-center retrospective analysis from June 2019 to August 2021 including 762 embryos from 129 cycles. Day 4 embryos were graded A to J considering A the best morphology and were classified into 1, 2, 3, or 4 categories (1 being the more advanced development). Categories were compared among them to assess blastocyst development and aneuploidy rate.

Participants/materials, setting, methods

Data were obtained from medical records with a previously given consent. Patient characteristics such as age, body mass index (BMI), and anti-Mullerian hormone (AMH) were compared among the four categories using ANOVA with Multiple Comparisons. Blastocyst development, blastocyst morphology, day of blastulation, and pregnancy rate were compared among the categories using Chi-square contingency. All analyses considered a significant p-value of 0.05.

Main results and the role of chance

Younger women presented significantly more category 1 of day 4 embryos when compared with the other categories (p < 0.0001). BMI and AMH were similar among the categories (p = 0.3063 and p = 0.2533, respectively). There was a high correlation between day 4 categories and PGT-A blastocyst development (p < 0.0001), blastocyst morphology (p < 0.0001), and day of blastulation (p < 0.0001). Also, there was a significant correlation between pregnancy rates and the four categories (p = 0.0192). No correlation was observed when aneuploidy rate and level of aneuploidy were analyzed (p = 0.3614 and p = 0.1490, respectively).

Limitations, reasons for caution

The limited number of embryos analyzed is a limitation of the study, and additional data are being gathered. Multiple embryos of the same patients can be a cofounder of the study and more robust statistical analysis may overcome it.

Wider implications of the findings

The new day 4 embryo score may be useful for embryo selection to PGT-A biopsy. Moreover, the proposed score may help to add valuable information to select the best embryos for transfer.

Trial registration number

not applicable

Identification of an angiogenic mitogen selective for endocrine gland endothelium

The known endothelial mitogens stimulate growth of vascular endothelial cells without regard to their tissue of origin. Here we report a growth factor that is expressed largely in one type of tissue and acts selectively on one type of endothelium. This molecule, called endocrine-gland-derived vascular endothelial growth factor (EG-VEGF), induced proliferation, migration and fenestration (the formation of membrane discontinuities) in capillary endothelial cells derived from endocrine glands. However, EG-VEGF had little or no effect on a variety of other endothelial and non-endothelial cell types tested. Similar to VEGF, EG-VEGF possesses a HIF-1 binding site, and its expression is induced by hypoxia. Both EG-VEGF and VEGF resulted in extensive angiogenesis and cyst formation when delivered in the ovary. However, unlike VEGF, EG-VEGF failed to promote angiogenesis in the cornea or skeletal muscle. Expression of human EG-VEGF messenger RNA is restricted to the steroidogenic glands, ovary, testis, adrenal and placenta and is often complementary to the expression of VEGF, suggesting that these molecules function in a coordinated manner. EG-VEGF is an example of a class of highly specific mitogens that act to regulate proliferation and differentiation of the vascular endothelium in a tissue-specific manner.

Heregulin enhances regenerative proliferation in postnatal rat utricular sensory epithelium after ototoxic damage

Hair cell loss due to acoustic and ototoxic damage often leads to hearing and balance impairments. Although a spontaneous event in chicks and lower vertebrates, hair cell replacement occurs at a much lower frequency in mammals presumably due to a very low rate of supporting cell proliferation following injury. We report here that heregulin, a member of the neuregulin family, dramatically enhances proliferation of supporting cells in postnatal rat utricular epithelial sheet cultures after gentamicin treatment, as revealed by bromo-deoxyuridine (BrdU) immunocytochemistry. A dose-dependent study shows that the maximal effects of heregulin are achieved at 3 nM. The mitogenic effects of heregulin are confirmed in utricular whole mount cultures. Autoradiography of the utricular whole mount cultures shows that heregulin also enhances the number of tritiated thymidine-labeled cells within the hair cell layer. TaqMan quantitative RT-PCR analysis and immunocytochemistry reveal that heregulin and its binding receptors (ErbB-2, ErbB-3 and ErbB-4) are expressed in the inner ear sensory epithelium. Of several ligands activating various ErbB receptors, including heregulin, neuregulin-3, beta-cellulin, heparin binding-epidermal growth factor (HB-EGF), transforming growth factor-alpha (TGF-alpha) and EGF, heregulin shows the most potent mitogenic effects on supporting cells. Because neuregulin-3 that signals only through ErbB-4 does not show an effect, these data suggest that activation of the ErbB-2-ErbB-3 heterodimeric complexes, rather than ErbB-4, is critical for the proliferative response in the utricular sensory epithelium. In addition, gentamicin treatment induces an upregulation of heregulin mRNA. Considered together, heregulin may play an important role in hair cell regeneration following ototoxic damage.

Characterization of two patched receptors for the vertebrate hedgehog protein family

The multitransmembrane protein Patched (PTCH) is the receptor for Sonic Hedgehog (Shh), a secreted molecule implicated in the formation of embryonic structures and in tumorigenesis. Current models suggest that binding of Shh to PTCH prevents the normal inhibition of the seven-transmembrane-protein Smoothened (SMO) by PTCH. According to this model, the inhibition of SMO signaling is relieved after mutational inactivation of PTCH in the basal cell nevus syndrome. Recently, PTCH2, a molecule with sequence homology to PTCH, has been identified. To characterize both PTCH molecules with respect to the various Hedgehog proteins, we have isolated the human PTCH2 gene. Biochemical analysis of PTCH and PTCH2 shows that they both bind to all hedgehog family members with similar affinity and that they can form a complex with SMO. However, the expression patterns of PTCH and PTCH2 do not fully overlap. While PTCH is expressed throughout the mouse embryo, PTCH2 is found at high levels in the skin and in spermatocytes. Because Desert Hedgehog (Dhh) is expressed specifically in the testis and is required for germ cell development, it is likely that PTCH2 mediates its activity in vivo. Chromosomal localization of PTCH2 places it on chromosome 1p33-34, a region deleted in some germ cell tumors, raising the possibility that PTCH2 may be a tumor suppressor in Dhh target cells.

ErbB3 is required for normal cerebellar and cardiac development: a comparison with ErbB2-and heregulin-deficient mice

Heregulins bind directly to ErbB3 and ErbB4 receptors, leading to multiple dimerization possibilities including heterodimerization with the ErbB2 receptor. We have generated ErbB3-, ErbB2- and heregulin-deficient mice to assess their roles in development and differentiation. Heregulin(−/−) and ErbB2(−/−) embryos died on E10.5 due to a lack of cardiac ventricular myocyte differentiation; ErbB3(−/−) embryos survived until E13.5 exhibiting cardiac cushion abnormalities leading to blood reflux through defective valves. In ErbB3(−/−) embryos, the midbrain/hindbrain region was strikingly affected, with little differentiation of the cerebellar plate. Cranial ganglia defects, while present in all three nulls, were less severe in ErbB3(−/−) embryos. The cranial ganglia defects, along with a dramatic reduction in Schwann cells, enteric ganglia and adrenal chromaffin cells, suggests a generalized effect on the neural crest. Numerous organs, including the stomach and pancreas also exhibited anomalous development.

Neuregulin-3 (NRG3): a novel neural tissue-enriched protein that binds and activates ErbB4

We describe the identification of Neuregulin-3 (NRG3), a novel protein that is structurally related to the neuregulins (NRG1). The NRG1/neuregulins are a diverse family of proteins that arise by alternative splicing from a single gene. These proteins play an important role in controlling the growth and differentiation of glial, epithelial, and muscle cells. The biological effects of NRG1 are mediated by receptor tyrosine kinases ErbB2, ErbB3, and ErbB4. However, genetic studies have suggested that the activity of ErbB4 may also be regulated in the central nervous system by a ligand distinct from NRG1. NRG3 is predicted to contain an extracellular domain with an epidermal growth factor (EGF) motif, a transmembrane domain, and a large cytoplasmic domain. We show that the EGF-like domain of NRG3 binds to the extracellular domain of ErbB4 in vitro. Moreover, NRG3 binds to ErbB4 expressed on cells and stimulates tyrosine phosphorylation of this receptor. The expression of NRG3 is highly restricted to the developing and adult nervous system. These data suggest that NRG3 is a novel, neural-enriched ligand for ErbB4.

Expression of substance P/neurokinin A-encoding preprotachykinin messenger ribonucleic acids in the rat enteric nervous system

The cellular localization of substance P/neurokinin A-encoding preprotachykinin mRNAs in the rat enteric nervous system was studied by means of in situ hybridization histochemistry using 35S- or 3H-labeled single-stranded ribonucleic acid (RNA) probes which recognize all three preprotachykinin mRNA species, alpha, beta, and gamma. Substance P/neurokinin A-encoding mRNAs are expressed in neurons within the myenteric plexus of the esophagus and stomach, being more numerous in the latter, and in ganglion cells distributed to both the myenteric and submucosal plexuses of the intestine. Specificity of the hybridization was demonstrated by the lack of specific signal above background in sections incubated with a sense RNA probe or pretreated with ribonuclease A before hybridization. Ribonucleic acid blot hybridization analysis of RNA extracts from both the muscle layer-myenteric plexus and submucosal layer preparations of the duodenum demonstrated a single band of hybridization at 1.3 kb. Solution hybridization-nuclease protection assays showed multiple preprotachykinin-encoding transcripts in these RNA extracts, with an abundance level of gamma-mRNA greater than beta-mRNA much greater than alpha-mRNA, which is similar to that observed in the rat brain. Our results indicate that the preprotachykinin gene encoding the tachykinin peptides, substance P and neurokinin A, is transcribed in a population of enteric neurons that have a regional distribution comparable to the previously described tachykinin-like immunoreactive neurons, suggesting that specific mRNAs and the posttranslationally processed peptides are localized in the same structures.

Molecular cloning of mammalian 28,000 Mr vitamin D-dependent calcium binding protein (calbindin-D28K): expression of calbindin-D28K RNAs in rodent brain and kidney

We report the isolation of a cloned cDNA for the mammalian 28,000 Mr vitamin D-dependent calcium binding protein (calbindin-D28K; CaBP28K) by immunological screening of a lambda gt11 bacterial expression library. The library contained cDNAs copied from poly(A)RNA of adult mouse cerebellum. We confirmed the identity of the CaBP28K cDNA by comparing its DNA sequence with that of chick CaBP28K cDNA. In the coding region, 79% of the mouse cDNA sequence was identical to the reported sequence of CaBP28K cDNA derived from chicken intestine. Rat brain and kidney each contain three species of poly(A)RNA that hybridize to CaBP28K cDNA--a major species of 1.9 kb, and rarer components of 2.8 kb and 3.2 kb. All three RNAs appear to be transcribed from a single gene. The ratios of these CaBP28K RNAs were the same in brain and kidney. In the cerebellum, in situ hybridization reveals that CaBP28K RNAs are confined to Purkinje neurons.