Human immature oocytes can be grown to maturity in vitro ...cme-utilities.com/mailshotcme/Material...
Transcript of Human immature oocytes can be grown to maturity in vitro ...cme-utilities.com/mailshotcme/Material...
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Human immature oocytes can be
grown to maturity in vitro: next
steps towards clinical application
Evelyn E Telfer
Institute of Cell Biology
and
Genes and Development Group CDBS
University of Edinburgh
Ovarian Club Paris
November 2018
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Disclosure
• The University of Edinburgh has filed a
patent on aspects of this work. Patent
application number: GB 1416858.7
• I have no other financial or commercial
interests to declare in relation to the work
presented here.
• This work has been funded by the UK
Medical Research Council
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Developing systems to grow human oocytes in vitro
>100 Live Births
Tissue freezing in Edinburgh since 1996. First EdinburghTissue
reimplanted 2015
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Preantral
Antral
Decreasing numbers
with development
Primordial
Increasing levels
of apoptosis Late
Preantral
Store of non-growing (NGFs) (primordial)
follicles utilised throughout reproductive
life
Primordial Follicles are present in the ovarian cortex at all
ages. Can we utilise the large numbers that are lost in vivo?
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Why develop oocytes in vitro?
• Define the fundamental mechanisms of oocyte development (basic science)
• Clinic: Fertility Preservation
• Clinic: Next generation IVF (IVG)
• Animal Production
• Endangered species
• Toxicity testing
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Mice from Primordial Follicles
(and now PGCs and iPSCs)
Eggbert: First mouse born from an in vitro grown primordial follicle: 2 step system total of
22 days in vitro before IVM and IVF. Eppig & O’Brien., 1996, O’Brien et al., 2003
More recently: Complete in vitro generation of fertile oocytes from primordial germ cells
Morohaku et al., 2016 and iPSCs Hikabe et al., 2016
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Developing human primordial
follicles from cortical strips in vitro
Human ovarian cortical
biopsies taken for
fertility preservation
contain mainly
primordial/unilaminar
follicles.
The challenge is to
develop oocytes in
vitro from primordial
stages to maturation
and fertilisation.
Frozen-thawed cortical strips
Rhabdomyosarcoma Pt 15yrs:thawed from slow freeze
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Oocyte
Growth
In vivo
19-30µm
40-80µm 80-90µm 90-100µm 100-110µm
Pre-ovulatory primordial primary preantral Early
antral
Mid antral
Making an Egg is Complicated
Growth/ Meiotic Arrest
Acquisition of Meiotic Competence
Acquisition of Developmental Competence
Transcription/Transcriptional Repression
Genomic imprinting
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Developing a multistep culture
system for human oocytes
• 1) Optimising growth from primordial stages
• 2) Supporting development of isolated growing follicles
• 3) Final stages of oocyte development
• 4) Testing function (meiotic and fertilisation potential) and normality
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Source of Human OvarianTissue
For Research
• Small strip of ovarian cortex donated after informed consent:
• Caesarean section (Healthy women)
• Fertility Preservation (various cancers and Turners syndrome) Some tissue obtained after chemo treatment.
• Tissue from 15 months-45 years (fresh and cryopreserved)
• Transgender patients (whole ovaries at time of gender reassignment surgery)
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Step 1: Micro-Cortex Culture
Micro-cortical fragments
Free floating cultures: basic
conditions serum free medium
Underlying
stroma reduced
larger follicles
removed
Cortical biopsy cut into
strips
Tissue Architecture.
Surface area and
density of stromal
cells important feature
Telfer et al., 2008 Human Reproduction 23:
1151-8
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Step one: Activation and Growth of
Quiescent Follicles
• Optimal time & size to remove growing follicles from micro-cortex environment
• 6-8 days; ≥ 100µM mean diameter
• Prolonging Step 1 results in increased death and poor quality follicles/oocytes
Telfer et al., 2008 Human Reproduction 23: 1151-8
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Step 2: Isolating Growing Follicles
Cultured
micro-cortex
Follicles
before
isolation
Isolated Follicles
Manual dissection using needles and fine scalpel
Activin A supplementation of medium
Additional 6-8 days in vitro
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Antral development from in vitro grown
human primordial follicles within 10 days
Telfer et al., 2008: A two step serum free culture system supports
development of human oocytes from primordial follicles in the presence of
activin. Human Reproduction 23: 1151-1158
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Step three: Isolating Oocyte-Granulosa
Cell Complexes
In vitro Grown Follicles
(after 2 steps)
Remove oocyte and
surrounding cells
Step 3: Culture
on membranes
McLaughlin, Albertini, Wallace, Anderson & Telfer 2018 Mol Hum Reprod 24: 135-142
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0
20
40
60
80
100
120
140
0h 2days 4days
Time on membranes
Oo
cyte
dia
met
er (m
icro
ns)
Mean Oocyte Diameter at end of Multi-step Culture
Step 3
After
IVM
McLaughlin, Albertini, Wallace, Anderson & Telfer 2018 Mol Hum Reprod 24: 135-142
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Metaphase II oocytes from human IVG follicles
McLaughlin, Albertini, Wallace, Anderson & Telfer 2018 Mol Hum Reprod 24: 135-142
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McLaughlin, Albertini, Wallace, Anderson & Telfer 2018 Mol Hum Reprod 24: 135-142
Oocytes that matured showed large polar bodies
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McLaughlin, Albertini, Wallace, Anderson & Telfer 2018 Mol Hum Reprod 24: 135-
142
Oocyte Yield
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Approx 30% of oocytes that complete culture
process can reach Metaphase II: Epigenetic
Status and Fertilisation potential?
Multi-step Culture system to support human
oocyte development
McLaughlin, Albertini, Wallace, Anderson & Telfer 2018 Mol Hum Reprod 24:
135-142
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In Vitro Growth of Oocytes from
Prebubertal Girls
Oocytes developed in vitro from pre-pubertal mice:
What about oocytes from young girls?
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Patients and samples
Samples from Edinburgh Fertility preservation service (3-16)
(all laparoscopic biopsies)
Diagnosis Age (years) Biopsy Menarche
Rhabdomyosarcoma 3.0 Fresh Premenarche
Ependymoma 8.2 Fresh Premenarche
Rhabdomyosarcoma 7.9 Cryopreserved Premenarche
Rhabdomyosarcoma 10.6 Fresh Premenarche
Ewing’s Sarcoma 12.2 Fresh Premenarche
Ewing’s Sarcoma 12.0 Fresh Post menarche
Sacral Sarcoma 12.3 Fresh Premenarche (early puberty)
Sickle Cell Anaemia 14.6 Fresh Premenarche (early puberty)
Acute Myeloid
Leukaemia 14.4 Fresh Premenarche (early puberty)
Hodgkin’s Disease 14.1 Fresh Post menarche
Hodgkin’s Disease 15.3 Fresh Post menarche
Rhabdomyosarcoma 16.0 Cryopreserved Post menarche
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0
5
10
15
20
25
30
35
0 5 10 15 20
% G
V A
bs
en
t F
ollic
les
Age (yrs)
0
10
20
30
40
50
60
70
Prepubertal Pubertal Adult
Me
an
Fo
llic
le D
iam
ete
r (m
icro
ns
)
* *
A B
C D
25µm
50µm
Morphologically abnormal oocytes (Big Fat
Oocytes) found in young ovaries. 8 yrs 14 yrs
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Follicles activate growth (step 1) in young
tissue and growing follicles can be
isolated for step 2
Tissue cultured from young girls (3-10 and 12-15)
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Effect of age on In Vitro Growth
(IVG) (Step 2)
60
90
120
150
180
210
240
270
Day 6 Day 8 Day 10 Day 12
Me
an
Fo
llic
le D
iam
ete
r (m
icro
ns
)
3-10yrs
12-15yrs
25-38yrs
Growth rate during step 2 of culture
Anderson RA et al., 2014 Human Reproduction 29: 97-106
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Conclusions
• Follicles can initiate growth at all ages, to
secondary stage
• Follicles from younger girls grow slowly, and
show little oocyte growth
• Follicles from adolescent girls grow more slowly
than those from adult women but show
significant oocyte growth compared to younger
girls
• Culture System needs to be adapted according
to age and tissue origin
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Range of ovarian tissue developed in vitro
Tissue Source Endpoint achieved in vitro
(multi-step system)
Healthy women (end of
pregnancy)
Metaphase II oocytes
Prepubertal girls (FP
source)
Multilaminar stages
Turner’s Patients Multilaminar/early antral
Chemo treated Variable depends on age and
treatment
Gender Reassignment Metaphase II oocytes
IVG: System has to be adapted for tissue type
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Summary
• Multi step culture system supports
human oocyte growth and
development
• Optimisation of each step required
• Further testing required (epigenetic
status)
• Fertilisation potential?
• A model system for human oocyte
development
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Next Steps
• Improving Culture Media
(additives/timings)
• Compare Culture systems (FastGrow)
versus SlowGrow (Picton system)
• Physical Conditions to improve polar body
formation
Previous conditions always
resulted in large polar
bodies. New conditions are
promising and spindles
currently being analysed
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Next Steps Towards Clinical
Application • Determining health and developmental
competence of IVG oocytes (sequencing,
epigenome, metabolome)
• Fertilisation of IVG human oocytes: HFEA
approval
• Embryo Testing
• Parallel studies on a large animal model
(sheep and cow) embryo testing and
transfer. Life Young (Collaboration with
Prof Helen Picton, Leeds)
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Acknowledgements
The patients who
kindly donate their
ovarian tissue and the
clinical teams that
support this
Dr Marie McLaughlin
Dr Yvonne Clarkson
Dr Cheryl Dunlop
Dr Kelsey Grieve
Dr Christina Ding
Mr John Binnie
Ms Joan Creiger
Ms Anne Saunderson
Ms Norma Forson
Prof Hamish Wallace
Prof Richard Anderson
Dr Joo Thong
Prof David Albertini
(Kansas/NYC)
Dr Neale Watson
Funding: