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Al Hatmi AS, Al Ajmi E, Albalushi H, Al Lawati M, Sirasanagandla SR. Anatomical variations of the frontal sinus: A computed tomography-based study. F1000Res 2023; 12:71. [PMID: 37811203 PMCID: PMC10556568 DOI: 10.12688/f1000research.129498.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/25/2023] [Indexed: 10/10/2023] Open
Abstract
Background: The pneumatization of the frontal sinus is variable between individuals, including monozygotic twins. The volumetric anatomic variants of the frontal sinus are classified into aplasia, hypoplasia, medium-sized, and hyperplasia. We aimed to study the frontal sinus morphology in Omani patients using computed tomography (CT) evaluations. Methods: Retrospectively, 1220 frontal sinus CT scans from 610 patients investigated at Sultan Qaboos University Hospital, Oman, from January 2019 to December 2020 were reviewed. The frontal sinus morphology was classified according to the classification proposed by Guerram et al. The Chi-square test was used to determine the influence of sex. Results: With regard to the unilateral occurrence, the most prevalent frontal sinus category observed was medium-sized (13.3%), followed by hyperplasia (7.9%), hypoplasia (5.4%), and aplasia (2%) categories. Similarly, in bilateral occurrence, the most common frontal sinus category observed was medium-sized (53%), followed by hyperplasia (13.1%), hypoplasia (3.4%) and aplasia (2%) categories. Right and left frontal sinus aplasia were observed in 2.1% and 1.8% of cases, respectively. In terms of sex influence, the left unilateral ( p<0.01) and the bilateral hypoplasia ( p<0.05) were significantly higher in females. On the other hand, the left unilateral ( p<0.01) and the bilateral hyperplasia ( p<0.05) were higher in males. Conclusions: The baseline data of frontal sinus category frequencies reported in the present study is helpful in the diagnostic evaluation of sinusitis in the clinical setting. The preoperative recognition of frontal sinus types, particularly frontal sinus aplasia in multiplanar CT scans, is crucial to avoid unexpected complications while performing endoscopic sinus surgery.
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Affiliation(s)
- Asma Sulaiman Al Hatmi
- Department of Radiology, Ibri Hospital, Ibri, 512, Oman
- Department of Radiology and Molecular Imaging, College of Medicine and Health Sciences, Sultan Qaboos University, Al Khoudh, Muscat, 123, Oman
| | - Eiman Al Ajmi
- Department of Radiology and Molecular Imaging, College of Medicine and Health Sciences, Sultan Qaboos University, Al Khoudh, Muscat, 123, Oman
| | - Halima Albalushi
- Department of Human and Clinical Anatomy, College of Medicine and Health Sciences, Sultan Qaboos University, Al khoudh, Muscat, 123, Oman
| | - Meetham Al Lawati
- College of Medicine and Health Sciences, Sultan Qaboos University, Al Khoudh, Muscat, 123, Oman
| | - Srinivasa Rao Sirasanagandla
- Department of Human and Clinical Anatomy, College of Medicine and Health Sciences, Sultan Qaboos University, Al khoudh, Muscat, 123, Oman
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Boroojerdi MH, Al Jabry T, Mirarefin SMJ, Albalushi H. Insights into organoid-based modeling of COVID-19 pathology. Virol J 2023; 20:37. [PMID: 36841795 PMCID: PMC9959938 DOI: 10.1186/s12985-023-01996-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 02/20/2023] [Indexed: 02/27/2023] Open
Abstract
Since December 2019, various types of strategies have been applied due to the emergent need to investigate the biology and pathogenesis of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) to discover a functional treatment. Different disease modeling systems, such as mini-organ technology, have been used to improve our understanding of SARS-CoV-2 physiology and pathology. During the past 2 years, regenerative medicine research has shown the supportive role of organoid modeling in controlling coronavirus disease 2019 (COVID-19) through optimal drug and therapeutic approach improvement. Here, we overview some efforts that have been made to study SARS-CoV-2 by mimicking COVID-19 using stem cells. In addition, we summarize a perspective of drug development in COVID-19 treatment via organoid-based studies.
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Affiliation(s)
- Mohadese Hashem Boroojerdi
- Department of Human and Clinical Anatomy, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Tariq Al Jabry
- Department of Genetics, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
| | | | - Halima Albalushi
- Department of Human and Clinical Anatomy, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman.
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Albalushi H, Ba-Alawi A, Aljabri R, Al Khaduri M. Prevalence of Congenital Uterine Anomalies and Tubal Blockage in Infertile Omani Women: A Retrospective Study. Oman Med J 2023; 38:e463. [PMID: 36873795 PMCID: PMC9975909 DOI: 10.5001/omj.2023.48] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 09/07/2022] [Indexed: 11/03/2022] Open
Abstract
Objectives Congenital uterine anomalies (CUAs) occur because of malformation of the female genital tract at any stage of the Müllerian duct development process. This retrospective study investigated the prevalence of CUAs and tubal blockage in infertile Omani women who underwent a hysterosalpingogram procedure as part of the evaluation of infertility. Methods The radiographic reports of patients aged 19-48 years who underwent hysterosalpingogram as part of infertility evaluation during the 2013-2018 period, were collected and analyzed for the presence and the type of CUAs. Results The records of N = 912 patients were evaluated, 44.3% of whom had been investigated for primary infertility and 55.7% for secondary infertility. Patients with primary infertility were significantly younger than those with secondary infertility. Of the 27 (3.0%) patients who were found to have CUAs, 19 had arcuate uterus. No correlation was found between the type of infertility and the CUAs. Conclusions CUAs were prevalent in 3.0% of the cohort, most of whom were diagnosed with arcuate uterus.
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Affiliation(s)
- Halima Albalushi
- Department of Human and Clinical Anatomy, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Ali Ba-Alawi
- College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Ruqaiya Aljabri
- Department of Human and Clinical Anatomy, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Maha Al Khaduri
- Department of Obstetrics and Gynecology, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
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Abdellatif H, Al Mushaiqri M, Albalushi H, Al-Zaabi AA, Roychoudhury S, Das S. Teaching, Learning and Assessing Anatomy with Artificial Intelligence: The Road to a Better Future. Int J Environ Res Public Health 2022; 19:ijerph192114209. [PMID: 36361089 PMCID: PMC9656803 DOI: 10.3390/ijerph192114209] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 10/20/2022] [Accepted: 10/24/2022] [Indexed: 06/01/2023]
Abstract
Anatomy is taught in the early years of an undergraduate medical curriculum. The subject is volatile and of voluminous content, given the complex nature of the human body. Students frequently face learning constraints in these fledgling years of medical education, often resulting in a spiraling dwindling academic performance. Hence, there have been continued efforts directed at developing new curricula and incorporating new methods of teaching, learning and assessment that are aimed at logical learning and long-term retention of anatomical knowledge, which is a mainstay of all medical practice. In recent years, artificial intelligence (AI) has gained in popularity. AI uses machine learning models to store, compute, analyze and even augment huge amounts of data to be retrieved when needed, while simultaneously the machine itself can be programmed for deep learning, improving its own efficiency through complex neural networks. There are numerous specific benefits to incorporating AI in education, which include in-depth learning, storage of large electronic data, teaching from remote locations, engagement of fewer personnel in teaching, quick feedback from responders, innovative assessment methods and user-friendly alternatives. AI has long been a part of medical diagnostics and treatment planning. Extensive literature is available on uses of AI in clinical settings, e.g., in Radiology, but to the best of our knowledge there is a paucity of published data on AI used for teaching, learning and assessment in anatomy. In the present review, we highlight recent novel and advanced AI techniques such as Artificial Neural Networks (ANN), or more complex Convoluted Neural Networks (CNN) and Bayesian U-Net, which are used for teaching anatomy. We also address the main advantages and limitations of the use of AI in medical education and lessons learnt from AI application during the COVID-19 pandemic. In the future, studies with AI in anatomy education could be advantageous for both students to develop professional expertise and for instructors to develop improved teaching methods for this vast and complex subject, especially with the increasing paucity of cadavers in many medical schools. We also suggest some novel examples of how AI could be incorporated to deliver augmented reality experiences, especially with reference to complex regions in the human body, such as neural pathways in the brain, complex developmental processes in the embryo or in complicated miniature regions such as the middle and inner ear. AI can change the face of assessment techniques and broaden their dimensions to suit individual learners.
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Affiliation(s)
| | | | | | | | | | - Srijit Das
- Correspondence: or ; Tel.: +968-24143546
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Albalushi H, Al Mushaiqri M, Sirasanagandla SR, Das S. Students' Performance in Face-to-Face, Online, and Hybrid Methods of Teaching and Assessment in Anatomy. Int J Environ Res Public Health 2022; 19:ijerph192013318. [PMID: 36293903 PMCID: PMC9602488 DOI: 10.3390/ijerph192013318] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 10/06/2022] [Accepted: 10/12/2022] [Indexed: 05/09/2023]
Abstract
In recent times, online teaching and assessment have provided a great opportunity to explore better methods in medical education. There are inconsistent views concerning the effectiveness of online assessment. Hence, the present study aimed to evaluate online teaching and assessment methods in relation to face-to-face methods by comparing students' performances. The students' assessment results in two basic anatomy courses, which are part of the Doctor of Medicine and Biomedical Sciences programs at Sultan Qaboos University, were analysed. We compared the students' mean scores and coefficient of variance in the multiple-choice written exams and the objective structured practical exams during the spring semesters of 2019, 2020, and 2021, containing face-to-face teaching and exams, partial online teaching and online exams, and online teaching and both proctored online and face-to-face exams, respectively. The sudden transition to online teaching and assessment halfway through the semester resulted in higher means and a lower coefficient of variance among students' scores in both theory and practical exams. However, when the fully adopted online method of teaching and assessment was employed, the mean scores decreased, and the coefficient of variance increased to figures close to those witnessed before the pandemic, when teaching and assessment were face-to-face. This trend applied to both the Doctor of Medicine and Biomedical Sciences programs' anatomy courses. The results indicate that online assessment of theoretical and practical anatomical knowledge is comparable to that of face-to-face assessment. However, proper planning and preparedness are mandatory to achieve the desired outcomes.
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Albalushi H, Al Mushaiqri M, Al Jabri R. Learning human anatomy amid COVID-19 pandemic: A students' perspective. Natl J Clin Anat 2021. [DOI: 10.4103/njca.njca_85_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Panula S, Kurek M, Kumar P, Albalushi H, Padrell Sánchez S, Damdimopoulou P, Olofsson JI, Hovatta O, Lanner F, Stukenborg JB. Human induced pluripotent stem cells from two azoospermic patients with Klinefelter syndrome show similar X chromosome inactivation behavior to female pluripotent stem cells. Hum Reprod 2020; 34:2297-2310. [PMID: 31743397 PMCID: PMC6894010 DOI: 10.1093/humrep/dez134] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 06/15/2019] [Indexed: 12/21/2022] Open
Abstract
STUDY QUESTION Does the X chromosome inactivation (XCI) of Klinefelter syndrome (KS)-derived human induced pluripotent stem cells (hiPSCs) correspond to female human pluripotent stem cells (hPSCs) and reflect the KS genotype? SUMMARY ANSWER Our results demonstrate for the first time that KS-derived hiPSCs show similar XCI behavior to female hPSCs in culture and show biological relevance to KS genotype-related clinical features. WHAT IS KNOWN ALREADY So far, assessment of XCI of KS-derived hiPSCs was based on H3K27me3 staining and X-inactive specific transcript gene expression disregarding the at least three XCI states (XaXi with XIST coating, XaXi lacking XIST coating, and XaXe (partially eroded XCI)) that female hPSCs display in culture. STUDY DESIGN, SIZE, DURATION The study used hiPSC lines generated from two azoospermic patients with KS and included two healthy male (HM) and one healthy female donor. PARTICIPANTS/MATERIALS, SETTING, METHODS In this study, we derived hiPSCs by reprograming fibroblasts with episomal plasmids and applying laminin 521 as culture substrate. hiPSCs were characterized by karyotyping, immunocytochemistry, immunohistochemistry, quantitative PCR, teratoma formation, and embryoid body differentiation. XCI and KS hiPSC relevance were assessed by whole genome transcriptomics analysis and immunocytochemistry plus FISH of KS, HM and female fibroblast, and their hiPSC derivatives. MAIN RESULTS AND THE ROLE OF CHANCE Applying whole genome transcriptomics analysis, we could identify differentially expressed genes (DEGs) between KS and HM donors with enrichment in gene ontology terms associated with fertility, cardiovascular development, ossification, and brain development, all associated with KS genotype-related clinical features. Furthermore, XCI analysis based on transcriptomics data, RNA FISH, and H3K27me3 staining revealed variable XCI states of KS hiPSCs similar to female hiPSCs, showing either normal (XaXi) or eroded (XaXe) XCI. KS hiPSCs with normal XCI showed nevertheless upregulated X-linked genes involved in nervous system development as well as synaptic transmission, supporting the potential use of KS-derived hiPSCs as an in vitro model for KS. LIMITATIONS, REASONS FOR CAUTION Detailed clinical information for patients included in this study was not available. Although a correlation between DEGs and the KS genotype could be observed, the biological relevance of these cells has to be confirmed with further experiments. In addition, karyotype analysis for two hiPSC lines was performed at passage 12 but not repeated at a later passage. Nevertheless, since all XCI experiments for those lines were performed between passage 11 and 15 the authors expect no karyotypic changes for those experiments. WIDER IMPLICATIONS OF THE FINDINGS As KS patients have variable clinical phenotypes that are influenced by the grade of aneuploidy, mosaicism, origin of the X chromosome, and XCI ‘escapee’ genes, which vary not only among individuals but also among different tissues within the same individual, differentiated KS hiPSCs could be used for a better understanding of KS pathogenesis. STUDY FUNDING/COMPETING INTEREST(S) This study was supported by grants from the Knut and Alice Wallenberg Foundation (2016.0121 and 2015.0096), Ming Wai Lau Centre for Reparative Medicine (2-343/2016), Ragnar Söderberg Foundation (M67/13), Swedish Research Council (2013-32485-100360-69), the Centre for Innovative Medicine (2–388/2016–40), Kronprinsessan Lovisas Förening För Barnasjukvård/Stiftelsen Axel Tielmans Minnesfond, Samariten Foundation, Jonasson Center at the Royal Institute of Technology, Sweden, and Initial Training Network Marie Curie Program ‘Growsperm’ (EU-FP7-PEOPLE-2013-ITN 603568). The authors declare no conflicts of interest.
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Affiliation(s)
- Sarita Panula
- Department of Clinical Sciences, Intervention and Technology, Division of Gynecology and Reproductive Medicine, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden.,Ming Wai Lau Centre for Reparative Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Magdalena Kurek
- NORDFERTIL Research Laboratory Stockholm, Childhood Cancer Research Unit, Bioclinicum J9:30, Department of Women's and Children's Health, Karolinska Institutet and Karolinska University Hospital, Solna, Sweden
| | - Pankaj Kumar
- Department of Clinical Sciences, Intervention and Technology, Division of Gynecology and Reproductive Medicine, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden.,Ming Wai Lau Centre for Reparative Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Halima Albalushi
- NORDFERTIL Research Laboratory Stockholm, Childhood Cancer Research Unit, Bioclinicum J9:30, Department of Women's and Children's Health, Karolinska Institutet and Karolinska University Hospital, Solna, Sweden.,College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Sara Padrell Sánchez
- Department of Clinical Sciences, Intervention and Technology, Division of Gynecology and Reproductive Medicine, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden.,Ming Wai Lau Centre for Reparative Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Pauliina Damdimopoulou
- Department of Clinical Sciences, Intervention and Technology, Division of Gynecology and Reproductive Medicine, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Jan I Olofsson
- Division of Obstetrics and Gynecology, Department of Women's and Children's Health, Karolinska Institutet and Karolinska University Hospital, Solna, Sweden
| | - Outi Hovatta
- Department of Clinical Sciences, Intervention and Technology, Division of Gynecology and Reproductive Medicine, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Fredrik Lanner
- Department of Clinical Sciences, Intervention and Technology, Division of Gynecology and Reproductive Medicine, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden.,Ming Wai Lau Centre for Reparative Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Jan-Bernd Stukenborg
- NORDFERTIL Research Laboratory Stockholm, Childhood Cancer Research Unit, Bioclinicum J9:30, Department of Women's and Children's Health, Karolinska Institutet and Karolinska University Hospital, Solna, Sweden
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Kurek M, Albalushi H, Hovatta O, Stukenborg JB. Human Pluripotent Stem Cells in Reproductive Science-a Comparison of Protocols Used to Generate and Define Male Germ Cells from Pluripotent Stem Cells. Int J Mol Sci 2020; 21:ijms21031028. [PMID: 32033159 PMCID: PMC7038013 DOI: 10.3390/ijms21031028] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 01/30/2020] [Accepted: 02/01/2020] [Indexed: 12/17/2022] Open
Abstract
Globally, fertility-related issues affect around 15% of couples. In 20%–30% of cases men are solely responsible, and they contribute in around 50% of all cases. Hence, understanding of in vivo germ-cell specification and exploring different angles of fertility preservation and infertility intervention are considered hot topics nowadays, with special focus on the use of human pluripotent stem cells (hPSCs) as a source of in vitro germ-cell generation. However, the generation of male germ cells from hPSCs can currently be considered challenging, making a judgment on the real perspective of these innovative approaches difficult. Ever since the first spontaneous germ-cell differentiation studies, using human embryonic stem cells, various strategies, including specific co-cultures, gene over-expression, and addition of growth factors, have been applied for human germ-cell derivation. In line with the variety of differentiation methods, the outcomes have ranged from early and migratory primordial germ cells up to post-meiotic spermatids. This variety of culture approaches and cell lines makes comparisons between protocols difficult. Considering the diverse strategies and outcomes, we aim in this mini-review to summarize the literature regarding in vitro derivation of human male germ cells from hPSCs, while keeping a particular focus on the culture methods, growth factors, and cell lines used.
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Affiliation(s)
- Magdalena Kurek
- NORDFERTIL Research Lab Stockholm, Childhood Cancer Research Unit, Department of Women’s and Children’s Health, Karolinska Institutet, and Karolinska University Hospital, 17164 Solna, Sweden; (M.K.); (H.A.)
| | - Halima Albalushi
- NORDFERTIL Research Lab Stockholm, Childhood Cancer Research Unit, Department of Women’s and Children’s Health, Karolinska Institutet, and Karolinska University Hospital, 17164 Solna, Sweden; (M.K.); (H.A.)
- College of Medicine and Health Sciences, Sultan Qaboos University, 123 Muscat, Oman
| | - Outi Hovatta
- Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet and University Hospital Karolinska Institutet, 141 52 Huddinge, Sweden;
| | - Jan-Bernd Stukenborg
- NORDFERTIL Research Lab Stockholm, Childhood Cancer Research Unit, Department of Women’s and Children’s Health, Karolinska Institutet, and Karolinska University Hospital, 17164 Solna, Sweden; (M.K.); (H.A.)
- Correspondence: ; Tel.: +46-8524-82788
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Albalushi H, Sahlin L, Åkesson E, Kurek M, Kjartansdóttir KR, Lindh R, Söder O, Rotstein E, Hovatta O, Stukenborg JB. Hormone Production by Human First-Trimester Gonads in a Functional In Vitro System. Endocrinology 2019; 160:133-142. [PMID: 30418555 DOI: 10.1210/en.2018-00734] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 11/03/2018] [Indexed: 01/01/2023]
Abstract
In the past, explant tissue-culture methodologies have been used to grow gonads and study their development. Results from in vitro cultures of human gonads showed limited progress toward gonadal cell differentiation and were focused mainly on germ-cell differentiation. Thus, detailed studies focusing on human first-trimester gonadal tissue functionality in vitro are still missing. In this study we investigated the endocrine function of human first-trimester gonads in vitro. We included 27 female and 28 male gonadal samples, derived from a total of 55 cases, at postconceptional ages of 4.5 to 10.5 weeks. Tissues were cultured using an explant tissue-culture system for 14 days. Assays for testosterone (liquid chromatography-tandem mass spectrometry), anti-Müllerian hormone (AMH; ELISA), and inhibin B (ELISA) were performed using media collected after 7 and 14 days of culture. We demonstrated sex- and age-dependent secretion profiles of testosterone, AMH, and inhibin B in the culture media, which resemble the pattern of hormone production in human gonads in vivo, from the few available studies at the same age range. Our study shows that explant tissue-culture conditions are robust for culture of human first-trimester gonadal somatic cells. Thus, it can be used to study human gonadal development and related diseases as well as the effect of potentially hormone-disturbing substances in human gonads during development. However, detailed molecular studies are needed for better understanding of the mechanistic control of the endocrine function of human first-trimester gonads.
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Affiliation(s)
- Halima Albalushi
- NORDFERTIL Research Laboratory Stockholm, Solna, Sweden
- Pediatric Endocrinology Unit, Department of Women's and Children's Health, Karolinska Institutet and University Hospital, Stockholm, Sweden
- Sultan Qaboos University, College of Medicine and Health Sciences, Muscat, Oman
| | - Lena Sahlin
- NORDFERTIL Research Laboratory Stockholm, Solna, Sweden
- Pediatric Endocrinology Unit, Department of Women's and Children's Health, Karolinska Institutet and University Hospital, Stockholm, Sweden
| | - Elisabet Åkesson
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
- R&D Unit, Stockholms Sjukhem, Stockholm, Sweden
| | - Magdalena Kurek
- NORDFERTIL Research Laboratory Stockholm, Solna, Sweden
- Pediatric Endocrinology Unit, Department of Women's and Children's Health, Karolinska Institutet and University Hospital, Stockholm, Sweden
| | - Kristín Rós Kjartansdóttir
- Pediatric Endocrinology Unit, Department of Women's and Children's Health, Karolinska Institutet and University Hospital, Stockholm, Sweden
| | - Rika Lindh
- Pediatric Endocrinology Unit, Department of Women's and Children's Health, Karolinska Institutet and University Hospital, Stockholm, Sweden
| | - Olle Söder
- Pediatric Endocrinology Unit, Department of Women's and Children's Health, Karolinska Institutet and University Hospital, Stockholm, Sweden
| | - Emilia Rotstein
- Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet and University Hospital Karolinska Institutet, Huddinge, Sweden
| | - Outi Hovatta
- Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet and University Hospital Karolinska Institutet, Huddinge, Sweden
| | - Jan-Bernd Stukenborg
- NORDFERTIL Research Laboratory Stockholm, Solna, Sweden
- Pediatric Endocrinology Unit, Department of Women's and Children's Health, Karolinska Institutet and University Hospital, Stockholm, Sweden
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Stukenborg JB, Alves-Lopes JP, Kurek M, Albalushi H, Reda A, Keros V, Töhönen V, Bjarnason R, Romerius P, Sundin M, Norén Nyström U, Langenskiöld C, Vogt H, Henningsohn L, Mitchell RT, Söder O, Petersen C, Jahnukainen K. Spermatogonial quantity in human prepubertal testicular tissue collected for fertility preservation prior to potentially sterilizing therapy. Hum Reprod 2018; 33:1677-1683. [PMID: 30052981 PMCID: PMC6112575 DOI: 10.1093/humrep/dey240] [Citation(s) in RCA: 77] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 06/15/2018] [Indexed: 11/24/2022] Open
Abstract
STUDY QUESTION Does chemotherapy exposure (with or without alkylating agents) or primary diagnosis affect spermatogonial quantity in human prepubertal testicular tissue? SUMMARY ANSWER Spermatogonial quantity is significantly reduced in testes of prepubertal boys treated with alkylating agent therapies or with hydroxyurea for sickle cell disease. WHAT IS KNOWN ALREADY Cryopreservation of spermatogonial stem cells, followed by transplantation into the testis after treatment, is a proposed clinical option for fertility restoration in children. The key clinical consideration behind this approach is a sufficient quantity of healthy cryopreserved spermatogonia. However, since most boys with malignancies start therapy with agents that are not potentially sterilizing, they will have already received some chemotherapy before testicular tissue cryopreservation is considered. STUDY DESIGN, SIZE, DURATION We examined histological sections of prepubertal testicular tissue to elucidate whether chemotherapy exposure or primary diagnosis affects spermatogonial quantity. Quantity of spermatogonia per transverse tubular cross-section (S/T) was assessed in relation to treatment characteristics and normative reference values in histological sections of paraffin embedded testicular tissue samples collected from 32 consecutive boy patients (aged 6.3 ± 3.8 [mean ± SD] years) between 2014 and 2017, as part of the NORDFERTIL study, and in 14 control samples (from boys aged 5.6 ± 5.0 [mean ± SD] years) from an internal biobank. PARTICIPANTS/MATERIALS, SETTING, METHODS Prepubertal boys in Sweden, Finland and Iceland who were facing treatments associated with a very high risk of infertility, were offered the experimental procedure of testicular cryopreservation. Exclusion criteria were testicular volumes >10 ml and high bleeding or infection risk. There were 18 patients with a diagnosis of malignancy and 14 patients a non-malignant diagnosis. While 20 patients had the testicular biopsy performed 1-45 days after chemotherapy, 12 patients had not received any chemotherapy. In addition, 14 testicular tissue samples of patients with no reported testicular pathology, obtained from the internal biobank of the Department of Pathology at Karolinska University Hospital, were included as control samples in addition to reference values obtained from a recently published meta-analysis. The quantity of spermatogonia was assessed by both morphological and immunohistochemical analysis. MAIN RESULTS AND THE ROLE OF CHANCE The main finding was a significant reduction in spermatogonial cell counts in boys treated with alkylating agents or with hydroxyurea for sickle cell disease. The mean S/T values in boys exposed to alkylating agents (0.2 ± 0.3, n = 6) or in boys with sickle cell disease and exposed to hydroxyurea (0.3 ± 0.6, n = 6) were significantly lower (P = 0.003 and P = 0.008, respectively) than in a group exposed to non-alkylating agents or in biobank control samples (1.7 ± 1.0, n = 8 and 4.1 ± 4.6, n = 14, respectively). The mean S/T values of the testicular tissue samples included in the biobank control group and the patient group exposed to non-alkylating agents were within recently published normative reference values. LIMITATIONS, REASONS FOR CAUTION Normal testicular tissue samples included in this study were obtained from the internal biobank of Karolinska University Hospital. Samples were considered normal and included in the study if no testicular pathology was reported in the analysed samples. However, detailed information regarding previous medical treatments and testicular volumes of patients included in this biobank were not available. WIDER IMPLICATIONS OF THE FINDINGS This study summarizes, for the first time, spermatogonial quantity in a prepubertal patient cohort just before and after potentially sterilizing treatments. Boys facing cancer and cytotoxic therapies are regarded as the major group who will benefit from novel fertility preservation techniques. There are no previous reports correlating spermatogonial quantity to cumulative exposure to alkylating agents and anthracyclines (non-alkylating agents) and no information about the timing of cytotoxic exposures among this particular patient cohort. For prepubertal boys in whom fertility preservation is indicated, testicular tissue should be obtained before initiation of chemotherapy with alkylating agents, whilst for those with sickle cell disease and treated with hydroxyurea, this approach to fertility preservation may not be feasible. STUDY FUNDING/COMPETING INTEREST(S) This study was supported by grants from The Swedish Childhood Cancer Foundation (PR2016-0124; TJ2016-0093; PR2015-0073, TJ2015-0046) (J.-B.S. and K.J.), the Jane and Dan Olssons Foundation (2016-33) (J.-B.S.), the Finnish Cancer Society (K.J.), the Foundation for Paediatric Research (J.-B.S.), Kronprinsessan Lovisas Förening För Barnasjukvård/ Stiftelsen Axel Tielmans Minnesfond, Samariten Foundation (J.-B.S.), the Väre Foundation for Paediatric Cancer Research (K.J.) and the Swedish Research Council (2012-6352) (O.S.). R.T.M. was supported by a Wellcome Trust Fellowship (09822). J.P.A.-L. and M.K. were supported by the ITN Marie Curie program 'Growsperm' (EU-FP7-PEOPLE-2013-ITN 603568). The authors declare no conflicts of interest. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- J-B Stukenborg
- NORDFERTIL Research Lab Stockholm, Department of Women's and Children's Health, Karolinska Institutet and University Hospital, Stockholm, Sweden
- Pediatric Endocrinology Unit, Department of Women's and Children's Health, Karolinska Institutet and University Hospital, Stockholm, Sweden
| | - J P Alves-Lopes
- NORDFERTIL Research Lab Stockholm, Department of Women's and Children's Health, Karolinska Institutet and University Hospital, Stockholm, Sweden
- Pediatric Endocrinology Unit, Department of Women's and Children's Health, Karolinska Institutet and University Hospital, Stockholm, Sweden
| | - M Kurek
- NORDFERTIL Research Lab Stockholm, Department of Women's and Children's Health, Karolinska Institutet and University Hospital, Stockholm, Sweden
- Pediatric Endocrinology Unit, Department of Women's and Children's Health, Karolinska Institutet and University Hospital, Stockholm, Sweden
| | - H Albalushi
- NORDFERTIL Research Lab Stockholm, Department of Women's and Children's Health, Karolinska Institutet and University Hospital, Stockholm, Sweden
- Pediatric Endocrinology Unit, Department of Women's and Children's Health, Karolinska Institutet and University Hospital, Stockholm, Sweden
- Sultan Qaboos University, College of Medicine and Health Sciences, Muscat, Oman
| | - A Reda
- Pediatric Endocrinology Unit, Department of Women's and Children's Health, Karolinska Institutet and University Hospital, Stockholm, Sweden
- Department of Development and Regeneration, Organ System Cluster, Group of Biomedical Sciences, KU Leuven, Herestraat 49, Leuven, Belgium
| | - V Keros
- Reproductive Medicine, Department of Obstetrics and Gynaecology, Karolinska University Hospital, Stockholm, Sweden
- Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - V Töhönen
- Reproductive Medicine, Department of Obstetrics and Gynaecology, Karolinska University Hospital, Stockholm, Sweden
- Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - R Bjarnason
- Clinic and University, Children's Medical Center, Landspítali University Hospital, Reykjavik, Iceland
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - P Romerius
- Department of Paediatric Oncology and Haematology, Clinical Sciences, Lund University, Lund, Sweden
| | - M Sundin
- Division of Paediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Pediatric Blood Disorders, Immunodeficiency and Stem Cell Transplantation, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - U Norén Nyström
- Clinical Sciences, Paediatrics, Umeå University, Umeå, Sweden
| | - C Langenskiöld
- Department of Paediatric Oncology, The Queen Silvia Children's Hospital, Gothenburg, Sweden
| | - H Vogt
- Department of Paediatrics, Faculty of Health Sciences, Linköping University, Linköping, Sweden
- Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden
| | - L Henningsohn
- Division of Urology, Institution for Clinical Science Intervention and Technology, Karolinska Institutet, Huddinge, Stockholm, Sweden
| | - R T Mitchell
- MRC Centre for Reproductive Health, The Queen's Medical Research Institute, The University of Edinburgh, Edinburgh, UK
- The Edinburgh Royal Hospital for Sick Children, Edinburgh, UK
| | - O Söder
- Pediatric Endocrinology Unit, Department of Women's and Children's Health, Karolinska Institutet and University Hospital, Stockholm, Sweden
| | - C Petersen
- NORDFERTIL Research Lab Stockholm, Department of Women's and Children's Health, Karolinska Institutet and University Hospital, Stockholm, Sweden
- Pediatric Endocrinology Unit, Department of Women's and Children's Health, Karolinska Institutet and University Hospital, Stockholm, Sweden
- Department of Women's and Children's Health, Paediatric Oncology Unit, Karolinska Institutet, Stockholm, Sweden
- University Hospital, Stockholm, Sweden
| | - K Jahnukainen
- NORDFERTIL Research Lab Stockholm, Department of Women's and Children's Health, Karolinska Institutet and University Hospital, Stockholm, Sweden
- Pediatric Endocrinology Unit, Department of Women's and Children's Health, Karolinska Institutet and University Hospital, Stockholm, Sweden
- Division of Haematology-Oncology and Stem Cell Transplantation, Children´s Hospital, University of Helsinki, Helsinki University Central Hospital, Helsinki, Finland
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11
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Panula S, Reda A, Stukenborg JB, Ramathal C, Sukhwani M, Albalushi H, Edsgärd D, Nakamura M, Söder O, Orwig KE, Yamanaka S, Reijo Pera RA, Hovatta O. Over Expression of NANOS3 and DAZL in Human Embryonic Stem Cells. PLoS One 2016; 11:e0165268. [PMID: 27768780 PMCID: PMC5074499 DOI: 10.1371/journal.pone.0165268] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Accepted: 10/07/2016] [Indexed: 12/05/2022] Open
Abstract
The mechanisms underlying human germ cell development are largely unknown, partly due to the scarcity of primordial germ cells and the inaccessibility of the human germline to genetic analysis. Human embryonic stem cells can differentiate to germ cells in vitro and can be genetically modified to study the genetic requirements for germ cell development. Here, we studied NANOS3 and DAZL, which have critical roles in germ cell development in several species, via their over expression in human embryonic stem cells using global transcriptional analysis, in vitro germ cell differentiation, and in vivo germ cell formation assay by xenotransplantation. We found that NANOS3 over expression prolonged pluripotency and delayed differentiation. In addition, we observed a possible connection of NANOS3 with inhibition of apoptosis. For DAZL, our results suggest a post-transcriptional regulation mechanism in hES cells. In addition, we found that DAZL suppressed the translation of OCT4, and affected the transcription of several genes associated with germ cells, cell cycle arrest, and cell migration. Furthermore, DAZL over expressed cells formed spermatogonia-like colonies in a rare instance upon xenotransplantation. These data can be used to further elucidate the role of NANOS3 and DAZL in germ cell development both in vitro and in vivo.
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Affiliation(s)
- Sarita Panula
- Division of Obstetrics and Gynecology, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet and Karolinska University Hospital, Huddinge, SE-141 86, Stockholm, Sweden
| | - Ahmed Reda
- Pediatric Endocrinology Unit, Department of Women’s and Children’s Health, Karolinska Institutet and Karolinska University Hospital, SE-171 76, Stockholm, Sweden
| | - Jan-Bernd Stukenborg
- Pediatric Endocrinology Unit, Department of Women’s and Children’s Health, Karolinska Institutet and Karolinska University Hospital, SE-171 76, Stockholm, Sweden
| | - Cyril Ramathal
- Department of Genetics and Department of Obstetrics and Gynecology, Institute for Stem Cell Biology and Regenerative Medicine, Center for Reproductive and Stem Cell Biology, Stanford University, Stanford, CA, 94305, United States of America
| | - Meena Sukhwani
- Department of Obstetrics, Gynaecology, and Reproductive Sciences, University of Pittsburgh School of Medicine, Magee-Womens Research Institute, Pittsburgh, PA, 15213, United States of America
| | - Halima Albalushi
- Pediatric Endocrinology Unit, Department of Women’s and Children’s Health, Karolinska Institutet and Karolinska University Hospital, SE-171 76, Stockholm, Sweden
- Sultan Qaboos University, College of Medicine and Health Sciences, Muscat, Oman
| | - Daniel Edsgärd
- Department of Cell and Molecular Biology, Karolinska Institutet, SE-171 77, Stockholm, Sweden
| | - Michiko Nakamura
- Center for iPS Cell Research and Application, Kyoto University, Kyoto, 606-8507, Japan
| | - Olle Söder
- Pediatric Endocrinology Unit, Department of Women’s and Children’s Health, Karolinska Institutet and Karolinska University Hospital, SE-171 76, Stockholm, Sweden
| | - Kyle E. Orwig
- Department of Obstetrics, Gynaecology, and Reproductive Sciences, University of Pittsburgh School of Medicine, Magee-Womens Research Institute, Pittsburgh, PA, 15213, United States of America
| | - Shinya Yamanaka
- Center for iPS Cell Research and Application, Kyoto University, Kyoto, 606-8507, Japan
- Gladstone Institute of Cardiovascular Disease, San Francisco, CA, 94158, United States of America
| | - Renee A. Reijo Pera
- Department of Genetics and Department of Obstetrics and Gynecology, Institute for Stem Cell Biology and Regenerative Medicine, Center for Reproductive and Stem Cell Biology, Stanford University, Stanford, CA, 94305, United States of America
- Department of Cell Biology and Neurosciences and Department of Chemistry and Biochemistry, Montana State University, Bozeman, MT, 59717, United States of America
| | - Outi Hovatta
- Division of Obstetrics and Gynecology, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet and Karolinska University Hospital, Huddinge, SE-141 86, Stockholm, Sweden
- * E-mail:
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