Apoptosis-modulatory miR-361-3p as a novel treatment target in endocrine-responsive and endocrine-resistant breast cancer

Breast cancer (BC) is the most diagnosed cancer in women worldwide. In estrogen receptor (ER)-positive disease, anti-estrogens and aromatase inhibitors (AI) improve patient survival; however, many patients develop resistance. Dysregulation of apoptosis is a common resistance mechanism; thus, agents that can reinstate the activity of apoptotic pathways represent promising therapeutics for advanced drug-resistant disease. Emerging targets in this scenario include microRNAs (miRs). To identify miRs modulating apoptosis in drug-responsive and -resistant BC, a high-throughput miR inhibitor screen was performed, followed by high-content screening microscopy for apoptotic markers. Validation demonstrated that miR-361-3p inhibitor significantly increases early apoptosis and reduces proliferation of drug-responsive (MCF7), plus AI-/antiestrogen-resistant derivatives (LTED, TamR, FulvR), and ER- cells (MDA-MB-231). Importantly, proliferation-inhibitory effects were observed in vivo in a xenograft model, indicating the potential clinical application of miR-361-3p inhibition. RNA-seq of tumour xenografts identified FANCA as a direct miR-361-3p target, and validation suggested miR-361-3p inhibitor effects might be mediated in part through FANCA modulation. Moreover, miR-361-3p inhibition resulted in p53-mediated G1 cell cycle arrest through activation of p21 and reduced BC invasion. Analysis of publicly available datasets showed miR-361-3p expression is significantly higher in primary breast tumours vspaired normal tissue and is associated with decreased overall survival. In addition, miR-361-3p inhibitor treatment of BC patient explants decreased levels of miR-361-3p and proliferation marker, Ki67. Finally, miR-361-3p inhibitor showed synergistic effects on BC growth when combined with PARP inhibitor, Olaparib. Together, these studies identify miR-361-3p inhibitor as a potential new treatment for drug-responsive and -resistant advanced BC.

Wiskostatin and other carbazole scaffolds as off target inhibitors of dynamin I GTPase activity and endocytosis

Wiskostatin (1-(3,6-dibromo-9H-carbazol-9-yl)-3-(dimethylamino)propan-2-ol) (1) is a carbazole-based compound reported as a specific and relatively potent inhibitor of the N-WASP actin remodelling complex (S-isomer EC₅₀ = 4.35 μM; R-isomer EC₅₀ = 3.44 μM). An NMR solution structure showed that wiskostatin interacts with a cleft in the regulatory GTPase binding domain of N-WASP. However, numerous studies have reported wiskostatin's actions on membrane transport and cytokinesis that are independent of the N-WASP-Arp2/3 complex pathway, but offer limited alternative explanation. The large GTPase, dynamin has established functional roles in these pathways. This study reveals that wiskostatin and its analogues, as well as other carbazole-based compounds, are inhibitors of helical dynamin GTPase activity and endocytosis. We characterise the effects of wiskostatin on in vitro dynamin GTPase activity, in-cell endocytosis, and determine the importance of wiskostatin functional groups on these activities through design and synthesis of libraries of wiskostatin analogues. We also examine whether other carbazole-based scaffolds frequently used in research or the clinic also modulate dynamin and endocytosis. Understanding off-targets for compounds used as research tools is important to be able to confidently interpret their action on biological systems, particularly when the target and off-targets affect overlapping mechanisms (e.g. cytokinesis and endocytosis). Herein we demonstrate that wiskostatin is a dynamin inhibitor (IC₅₀ 20.7 ± 1.2 μM) and a potent inhibitor of clathrin mediated endocytosis (IC₅₀ = 6.9 ± 0.3 μM). Synthesis of wiskostatin analogues gave rise to 1-(9H-carbazol-9-yl)-3-((4-methylbenzyl)amino)propan-2-ol (35) and 1-(9H-carbazol-9-yl)-3-((4-chlorobenzyl)amino)propan-2-ol (43) as potent dynamin inhibitors (IC₅₀ = 1.0 ± 0.2 μM), and (S)-1-(3,6-dibromo-9H-carbazol-9-yl)-3-(dimethylamino)propan-2-ol (8a) and (R)-1-(3,6-dibromo-9H-carbazol-9-yl)-3-(dimethylamino)propan-2-ol (8b) that are amongst the most potent inhibitors of clathrin mediated endocytosis yet reported (IC₅₀ = 2.3 ± 3.3 and 2.1 ± 1.7 μM, respectively).

What should be the maximum FSH dose in IVF/ICSI in poor responders?

Various protocols of ovarian stimulation have been proposed for optimising IVF/ICSI results in women presenting with a poor response to controlled ovarian stimulation; however, achieving a good response to stimulation for this category of patients still remains a challenge. The most extensively employed strategy to improve follicular response in these so-called 'poor responders' involves the use of high doses of gonadotrophins. A small number of randomised controlled trials and retrospective studies have evaluated the effectiveness of the high-dose FSH regimes over a 300 IU threshold. The results of these studies have shown these approaches to be of little or no clinical benefit, although both the costs of treatment and side-effects were higher. There are other studies that have examined 450 IU FSH regimens or even more. This paper presents an overview in all these clinical trials, trying to evaluate the safest and most effective upper limit of FSH that may be used for controlled ovarian hyperstimulation.

Conventional in-vitro fertilisation versus intracytoplasmic sperm injection for the treatment of non-male-factor infertility: a randomised controlled trial

BACKGROUND

Intracytoplasmic sperm injection (ICSI) is a more invasive option than conventional in-vitro fertilisation (IVF), which can be successful even when semen characteristics are poor. Reports of higher fertilisation rates after ICSI suggest that this technique may be better than the conventional method for all couples seeking IVF. We undertook a multicentre randomised controlled trial comparing clinical outcome after ICSI or traditional IVF in couples with non-male-factor infertility.

METHODS

415 eligible and consenting couples at four UK centres were randomly assigned IVF or ICSI (total 435 treatment cycles: IVF 224; ICSI 211). Usual clinical and laboratory protocols for the two treatment procedures were followed in each of four participating centres. The primary outcome was the implantation rate (number of gestation sacs per embryo replaced expressed as a percentage). Secondary outcomes were pregnancy and fertilisation rates associated with each treatment. Analyses were by intention to treat.

FINDINGS

The implantation rate was higher in the IVF group than in the ICSI group (95/318 [30%] vs 72/325 [22%]; relative risk 1.35 [95% CI 1.04-1.76]). The pregnancy rate per cycle was also higher after IVF (72 [33%] vs 53 [26%]; 1.17 [0.97-1.35]). Mean associated laboratory time was significantly shorter with IVF than with ICSI (22.9 [SD 12.1] vs 74.0 [38.1] min; 95% CI for difference 45.6-56.6).

INTERPRETATION

ICSI offers no advantage over IVF in terms of clinical outcome in cases of non-male-factor infertility. Our results support the current practice of reserving ICSI only for severe male-factor problems.

A randomised controlled trial of intravenous versus inhalational analgesia during outpatient oocyte recovery

To compare the efficacy and acceptability of conventional intravenous sedation with patient-controlled inhalational isodesox, 57 women undergoing outpatient oocyte recovery were randomly allocated to receive isodesox by face mask, while 55 women were given intravenous fentanyl and midazolam. Women's satisfaction with pain relief, peroperative pain, clouding of memory and the surgeons' assessment of operating conditions were evaluated. Thirty-eight women in the inhalation group (67%) and 41 (75%) women in the intravenous group were 'very satisfied' with their analgesia (p = 0. 41). The mean (SD) pain score in women given isodesox was 46.8 (34. 7), while in the intravenous group it was 34.1 (21.3) (p = 0.02). Oxygen saturation levels < 94% were recorded in one woman using isodesox and in 16 (29%) women given intravenous analgesia. Despite higher pain scores, in comparison with the conventional analgesia, patient-controlled isodesox offers a safer method of pain relief with comparable satisfaction rates.

How effective is patient-controlled analgesia? A randomized comparison of two protocols for pain relief during oocyte recovery

Although the conventional method of pain relief during outpatient oocyte recovery involves physician-administered drugs, patient-controlled analgesia (PCA) offers an alternative technique with the potential to give women more control over peroperative analgesia. We conducted a prospective randomized study to compare the effect of fentanyl administered either through a PCA delivery system or by a physician. Thirty-nine women were randomized to PCA during egg collection while 42 were allocated to receive intermittent doses administered by a physician. Pain was evaluated by means of a 100 mm linear analogue scale. The mean (SD) pain score in the PCA group was 38.5 (19.8) while in the other group it was 46.1 (21.3) (P = 0.1). In the PCA group, 64% of women felt very satisfied with their analgesia as compared with 57% in the non-PCA group (P = 0.6). Among the PCA users, 39% of demands were successful. Significantly more fentanyl (97.5 microg) was used in the PCA group than in the other group (84.6 microg) (P = 0.03). Though intraoperative PCA with fentanyl is an effective alternative to physician-administered techniques, many women still feel the need for more analgesia during the procedure.

Cryopreservation of human oocytes and fertilization by two techniques: in-vitro fertilization and intracytoplasmic sperm injection

Human oocyte cryopreservation results in poor survival and subsequent fertilization rates. It has been suggested that freeze-thaw-induced changes in the zona pellucida may impair sperm penetration or attachment. The aim of this study was to compare fertilization and cleavage rates in cryopreserved oocytes inseminated by conventional in-vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI). A total of 220 oocytes, obtained from volunteers who had undergone ovarian stimulation, were cryopreserved using a slow freeze-rapid thaw protocol with 1.5 M propanediol as the cryoprotectant. Surviving oocytes (n = 74, 34.4%) were randomly allocated for fertilization by conventional IVF (group 1) or ICSI (group 2) using cryopreserved spermatozoa from a single donor of proven fertility. Fertilization was achieved in five (13.5%) of the oocytes in group 1 and 17 (45.9%) in group 2 (P < 0.005), with only one oocyte in group 1 exhibiting normal fertilization as opposed to 16 (43.2%) in group 2 (P < 0.001). Similarly, one oocyte fertilized by IVF cleaved, while all fertilized with ICSI cleaved (P < 0.001). We conclude that although the survival of oocytes is poor following cryopreservation, fertilization and cleavage rates can be enhanced significantly using ICSI. These data also suggest that the method of cryopreservation used in this study affected the zona pellucida, such that normal sperm attachment or penetration was impaired.

Current attitudes towards egg donation among men and women

Recent widespread concern has led to legislation in the UK preventing the use of fetal ovarian tissue for the treatment of infertile women. This questionnaire-based study aimed to assess the attitudes of both fertile and infertile men and women as well as egg donors and recipients towards the use of donated eggs for treatment, diagnosis and research. Fertile individuals were significantly less aware of egg donation but the majority in both the fertile and the infertile groups approved the use of eggs for research (89 and 95% of women and 88 and 92% of men respectively) and treatment (similar percentages). However, fetal sources of oocytes were acceptable to only 15% of women in the fertile, 21% in the infertile, 35% in the recipient and 19% in the donor groups. Cadaveric sources of oocytes were slightly more acceptable (28% fertile, 28% infertile, 50% recipient and 42% donors). Both these sources of oocytes were slightly more acceptable to men. Education had little influence on attitudes, although men and women of tertiary education level said they would be less likely to have gamete donation themselves. Thus there would appear to be widespread approval for the use of donor eggs in research and treatment but not if the source of eggs is fetal or cadaveric.

A comparison of the effects of different biopsy strategies on the post-thaw survival of 8-cell-stage mouse embryos: implications for preimplantation diagnosis

The aim of this study was to investigate the effects of two different biopsy strategies, zona slitting and zona piercing, on the post-thaw survival and subsequent in-vitro development of 8-cell mouse embryos. From control experiments it was determined that neither biopsy by zona slitting nor zona piercing adversely affected embryo development in vitro, as similar rates of blastocyst formation and hatching were found between biopsied and zona-intact embryos; there was, however, a trend towards a lower rate of blastocyst hatching in embryos biopsied by zona piercing (78.3% compared with 91.9% of zona-intact embryos). When biopsy was followed by cryopreservation a different picture was seen: similar rates of freeze-thaw survival were found for zona-slit, zona-pierced and zona-intact embryos (84.2, 88.5 and 87.2% respectively), but this was superseded by a significant (P < 0.05) reduction in the blastocyst formation rates (61.4% zona-slit and 63.9% zona-pierced versus 78.7% zona-intact) and hatching rates (51% zona-slit and 52.5% zona-pierced versus 72.3% zona-intact) of the biopsied embryos. When the effects of zona slitting and piercing were considered in isolation, i.e. without performing biopsy, it was found that the larger holes produced by zona slitting rendered embryos more susceptible to freeze-thaw damage.(ABSTRACT TRUNCATED AT 250 WORDS)

The effect of three anti-oestrogen drugs on cervical mucus quality and in-vitro sperm-cervical mucus interaction in ovulatory women

The anti-oestrogens, clomiphene citrate, tamoxifen and cyclofenil are commonly used in the treatment of female infertility. Their role in the management of anovulation is well established but there is continuing controversy about their relevance to other areas of management. We have studied the effects of each of these drugs on cervical mucus and sperm-cervical mucus interaction among 23 patients with unexplained infertility. Each patient received all three drugs in an alternative month treatment regime and in addition acted as her own control. The starting point in each patient was randomized. Luteinizing hormone (LH) and oestradiol were measured daily from day 10, and follicle scanning was also undertaken. Cervical mucus quality and sperm-cervical mucus interaction were studied on the day of onset of the LH surge. The use of clomiphene and tamoxifen resulted in a significant reduction in cervical mucus score and sperm-cervical mucus interaction as judged by the distance travelled by the vanguard spermatozoa. Cyclofenil had no effect on these parameters.

Luteal phase deficiency: ultrasonic and biochemical insights into pathogenesis

Serial ovarian ultrasound and daily assessments of plasma concentrations of pituitary and ovarian hormones were used to investigate ovarian function in 175 women with unexplained infertility. Their endocrine and ultrasound profiles were compared with similarly derived data from 43 normal volunteers. Fifty-one (29.1%) of the study group showed subnormal luteal phase rises in progesterone concentrations, described as poor progesterone surge (PPS) cycles. Within this group, 23 women (45.1%) demonstrated luteal cyst formation, a pattern not seen in any of the control cycles. High concentrations of follicle stimulating hormone (FSH) and reduced concentrations of oestradiol (E2) were observed in the follicular phases of the PPS cycles suggesting that the phenomenon is a product of abnormal follicular metabolism. An association of PPS with infertility exists, perhaps related to a combination of disturbances in the follicular micro-environment compromising oocyte quality, a failure of oocyte release, and impaired endometrial receptivity.

Luteal cysts and unexplained infertility: biochemical and ultrasonic evaluation

A prospective, controlled study of ovarian function using ovarian ultrasound and daily plasma hormone estimations (estradiol, progesterone [P], follicle-stimulating hormone [FSH], luteinizing hormone [LH]) was carried out on 175 spontaneously cycling patients with unexplained infertility. Forty-one (23.4%) demonstrated luteal phase cyst formation. In 21 cycles the dominant follicle reduced in size after the LH peak (cystic corpus luteum cycles), and in 20 no shrinkage was seen (luteinized unruptured follicles). Progesterone concentrations in the early luteal phase were significantly reduced in the luteinized unruptured follicle cycles. Elevation in plasma FSH was seen in the early follicular and luteal phases of both cyst forming groups and may be due to disturbances in ovarian metabolism. Follicular rupture is important for efficient P release by the corpus luteum.

Ovarian sensitivity to gonadotrophins in patients with PCO is unaffected by suppression of LH

Infertile women with oligomenorrhoea and elevated LH concentrations (presumed polycystic ovary disease, PCO) were treated with exogenous gonadotrophins, HMG and HCG, for induction of follicular growth and ovulation, respectively. This was effected in the absence or presence of a gonadotrophin releasing hormone analogue (GnRH-A) to suppress basal LH and the positive feedback surge of LH. Analyses of the duration of HMG therapy required to attain the degree of stimulation for HCG to be administered showed no difference between those with and without LH suppression. Analyses of the ultrasound estimations of rates of follicle growth and continued recruitment during the course of HMG also failed to show any effect of LH suppression. These data show that the high sensitivity of these patients to HMG is not related to the circulating LH concentrations.

Birth from replacement of frozen-thawed embryos after failure of gamete intra-fallopian transfer: a successful pregnancy case

The patient was 8 years subfertile and had failed other forms of treatment when she was enrolled in the GIFT program. Of the total of 16 oocytes recovered 4 were transferred and the remaining 12 inseminated with her husband's sperm. Four resulting embryos were frozen. When she did not conceive, the 4 embryos were thawed 3 months later and replaced into her. She conceived and recently delivered a pair of twins. The protocol will be discussed in detail. Cryopreservation of embryos therefore may increase the patient's chance of pregnancy in a GIFT program.

Contributions to reproductive medicine through in-vitro fertilization: a review

In vitro fertilization (IVF) is now an accepted treatment procedure for subfertility. Its use has also contributed greatly to the understanding of our knowledge in reproductive medicine. This review looks at these contributions. In the female, IVF has made it possible to examine more closely ovarian physiology through the follicular micro-environment, follicular dominance and cohorts. In the male, the new sperm preparation technology has assisted the investigation of sperm parameters in-depth. A better understanding of human egg and sperm physiology, the fertilization process and pre-implantation phenomena has also contributed to better management of the infertile couple. Perhaps in the future, the pre-implantation embryo may be considered as a "patient".

Combined gonadotropin-releasing hormone analog and exogenous gonadotropins for ovulation induction in infertile women: efficacy related to ovarian function assessment

The ovarian function of infertile women with normal menstrual rhythm was investigated by daily plasma hormone (estradiol, progesterone, luteinizing hormone, and follicle-stimulating hormone) analyses throughout the menstrual cycle, and patients were diagnosed as showing a subnormal profile of progesterone in the early luteal phase or as showing no abnormality. Women with oligomenorrhea and elevated luteinizing hormone levels were diagnosed as having polycystic ovary syndrome primarily on the basis of endocrinology. All patients were treated with a gonadotropin-releasing hormone analog to suppress endogenous luteinizing hormone and follicle-stimulating hormone so that ovulation induction with exogenous gonadotropins could be undertaken as in patients with hypogonadotropic hypogonadism. Interference in the process of ovulation by endogenous luteinizing hormone fluctuations was eliminated and pregnancies were achieved. The pregnancy rate in the group with polycystic ovary syndrome was 77% per treatment course (six cycles) while that in the group with subnormal progesterone profiles was 61.5%. Patients showing no abnormality achieved no pregnancy, demonstrating the redundancy of interference with normal ovarian function.

Gamete intrafallopian transfer (GIFT): an alternate method of conception in couples with unexplained infertility, endometriosis and oligo-asthenospermia

138 treatment cycles of GIFT were carried out in couples with mainly unexplained infertility, endometriosis and male factor. The overall pregnancy rate was 24.6%, abortion 29.2%, multiple pregnancy 20.6% and ectopic pregnancy 0%. Four oocytes seem to be the optimal number of oocytes to be transferred. Patients with male factor infertility fared the worse in comparison with the other groups. Successful in-vitro fertilization of excess eggs did not correlate with a positive outcome of the GIFT procedure.

Eighty consecutive cases of gamete intra-fallopian transfer

Eighty patients with the main problems of unexplained infertility, oligospermia and endometriosis were treated with gamete intra-Fallopian transfer (GIFT). From 80 treatment cycles, 29 women conceived (36.3%). Of these, four were biochemical pregnancies and therefore the clinical pregnancy rate (25/80) was 31.2%. There were six sets of multiple pregnancies, a multiple pregnancy rate of 24%. Three women (12%) miscarried. The pregnancy rates in the patients with unexplained infertility, oligospermia and endometriosis were 33.3, 16.7 and 38.5%, respectively. The transfer of four oocytes appears to increase the pregnancy rate without increasing the risk of multiple pregnancy. The presence of in-vitro fertilization of excess oocytes after GIFT did not correlate with the final outcome of GIFT.

'Unexplained infertility' results of secondary investigations in 95 couples

Abnormalities of in-vitro sperm-mucus penetration, ovarian hormone deficiency, specifically poor progesterone surge, and luteal cyst formation were assessed prospectively in 95 couples with fully investigated primary infertility of greater than or equal to 3 years duration. Abnormal sperm-mucus penetration was found in 22, half of whom could have been identified on semen assessment alone. Ten other males had recurrent oligospermia but with normal motility and mucus penetration. Twenty-one patients had a poor progesterone surge and seven of them demonstrated retained luteal phase cysts. Endocrine and mucus penetration abnormalities did not coincide, demonstrating that they are distinct and unrelated phenomena. A significant number of couples were found for whom the term 'unexplained infertility' was no longer applicable and appropriate management could be considered.

Successful treatment of infertile women with oligomenorrhoea using a combination of an LHRH agonist and exogenous gonadotrophins

Eight oligomenorrhoeic patients with increased luteinizing hormone (LH) and androgen levels who had failed to conceive during prolonged anti-oestrogen therapy received a new treatment. Large doses of an LH-releasing hormone (LHRH) analogue (HOE 766) were used to suppress circulating gonadotrophin concentrations and block the positive feedback gonadotrophin surge. Ovulation was induced during continued LHRH analogue treatment with exogenous gonadotrophins without interference from the patient's own pituitary. Seven of eight patients conceived rapidly without premature luteinization and without excessive ovarian enlargement. These complications had occurred in control treatment cycles using exogenous gonadotrophins in the absence of the LHRH analogue.

Significance of raised maternal serum alpha-fetoprotein in singleton pregnancies with normally formed fetuses

One hundred eighty-six pregnancies with elevated maternal serum alpha-fetoprotein (AFP) between 16 and 20 weeks' gestation, but with normally formed single fetuses, were analyzed retrospectively. In comparison with matched control subjects, there was an increased incidence of low birth weight, preterm delivery, intrauterine growth retardation, and other clinical complications, especially when maternal serum AFP was abnormally high on more than one occasion. These findings could not be explained by the occurrence of threatened abortion or the performance of amniocentesis. It is suggested that where maternal serum AFP screening for fetal neural tube defects is already established as a cost-effective routine procedure, the additional recognition of some pregnancies at very high risk of other, perinatal complications is of practical value. However, maternal serum AFP testing in the second trimester cannot be recommended as a cost-effective screening method for detecting low birth weight infants, having a sensitivity in this series of only 11%. Many (33%) of the low birth weight infants detected in this way were very small (birth weights less than 1.5 kg); 73% of the predicted preterm births were very premature (before 34 weeks of gestation), and 72% of the identified growth-retarded infants were severely effected (weighing less than the fifth percentile for gestational age).

Ethical issues arising from medical research

This paper provides historical background to the contemporary interest in medical ethics in the United States and examines conflicts of interest between the parties involved in medical research. The regulations enacted by the government to control research are outlined, with particular reference to the role of Institutional Review Boards and the conduct of clinical trials. Some unresolved ethical problems are discussed, including the sponsorship of research in foreign countries. Finally, the responsibility of the medical researcher in relation to society is discussed.

Role of an ethicist in the conduct of clinical trials in the United States

The social and ethical implications of new medical techniques and the development of community representatives in decisions regarding human research are discussed. The particular role of the ethicist and how medical experimentation is viewed from the perspective of the doctor, the patient, an the funding donor are examined. Some of the more common ethical issues occurring in medical research are treated, with particular reference to those in clinical trials. Finally, some unresolved problems in future medical research are discussed.

Pepsinogen C and pepsin C. Further purification and amino acid composition

Pepsinogen C and pepsin C from the pig have been further purified by chromatography on DEAE-cellulose and by exclusion chromatography and the specific activities (with haemoglobin substrate) found are higher than those previously reported. The final preparations are homogeneous on electrophoresis in starch gel at three pH values except for contamination with less than 4% of pepsinogen and pepsin respectively. Pepsinogen C, like pepsin C, contains no phosphate. The amino acid compositions show some marked differences from those of pepsinogen and pepsin especially in the content of basic amino acids, glutamic acid, aspartic acid, leucine and isoleucine. The molecular weights of the enzyme and zymogen, obtained from the amino acid compositions, are 41400 and 36000 respectively, similar to those of pepsinogen and pepsin.