Reproducción asistida en hombres infectados con el virus de VIH / Assisted reproduction in HIV positive men

Objetivo: Describir un programa de procreación responsable en parejas donde el varón está infectado con el VIH organizado en un centro ambulatorio infectológico de la ciudad de Bs. As. y llevado a cabo por un equipo interdisciplinario conformado por Infectólogos, Bioquímicos, Ginecólogos y Biólogos. Comentar algunas revisiones de la literatura que avalan la evidencia cientifica para realizar estos procedimientos. Métodos: las parejas serodiscordantes son candidatas para este programa si el varón tiene seguimiento infectológico, los estudios de esperma demuestran carga viral (CV) indetectable y DNA proviral de VIH negativo, y, la mujer tiene ADN proviral de VIH negativo en sangre, en el ciclo en el cual se realizará el procedimiento de fertilización asistida. Se realiza en la mujer pesquisa de infecciones connatales. Las muestras de esperma son procesadas con técnicas de lavado, swim up y swim down, y congeladas. Después de cada procedimiento de fertilización asistida la mujer es controlada controlada con estudios serológicos para anticuerpos (VIH ELISA) periódicos. Los recién nacidos son evaluados a través de ADN proviral de VIH en el 1er mes de vida, o, durante los primeros 6 meses de vida a través de anticuerpos (VIH ELISA). Resultadaos: desde 12/2000 y hasta mayo 2009 se incluyeron 165 parejas serodiscordantes. 147 pacientes VIH (+) realizaron estudios de muestras de esperma, 26, tuvieron muestras con estudios microbiológicos positivos (23, CV detectable, y 3, ADN proviral de VIH positivo). En 123 parejas se realizaron: 329 inseminaciones, 55 ICSI y 28 FIV. Se concretron 44 embarazos y nacieron 51 bebés. Todos los estudios realizados a las mujeres y recién nacidos mostraron resultados negativos. Conclusiones: este programa logró resultados satisfactorios en la prevención de infecciones por VIH y connatales.

Objective: to describe the data obtained during the development of an assisted reproduction program for couples where the man is HIV - Infected organized by an ambulatory infectologist center in BsAs city. a multidisciplinary team with infectious disease MD, biochemists, ginecologists and bilogist collaborate in the follow-up of the patients. Methods: couples seeking reproductive counseling were eligible for this programme if: the HIV positive male partner adhered to an infectious disease follow-up, he has undetectable viral load in the fresh sperm sample and is negative for HIV proviral DNA in the swim-up material after sperm washing, the female partner is negative for HIV proviral DNA immediately beforme each assisted reproduction attempt. Procedures comprised intrauterine insemination, intracytoplasmic sperm injection and in vitro fertilization accordin to gynecologist indication. After each procedure, women were tested for indication. After each procedure, women were tested for HIV antibodies periodically. Newborns were tested for HIV proviral DNA at one month of age or HE during the first six months. Results: One hundred and sixty five couples were assessed, semen analyses results were obtained from 147 HIV positive men, 23 had detectable viral load, 3 had positive HIV proviral DNA in swim up. One hundred and twenty three couples undervent AR procedures: 329 intrauterine inseminations, 55 intracytoplasmic sperm injections, and 28 in-vitro fertilizations. Forty four pregnancies resulted in fifty one live Births. All HE and HDP tests performed in women and new-borns were negative. Conclusions: This programme achieved satisfactory results in prevention of HIV and congenital infections.

Reproducción asistida en hombres infectados con el virus de VIH / Assisted reproduction in HIV positive men

Objetivo: Describir un programa de procreación responsable en parejas donde el varón está infectado con el VIH organizado en un centro ambulatorio infectológico de la ciudad de Bs. As. y llevado a cabo por un equipo interdisciplinario conformado por Infectólogos, Bioquímicos, Ginecólogos y Biólogos. Comentar algunas revisiones de la literatura que avalan la evidencia cientifica para realizar estos procedimientos. Métodos: las parejas serodiscordantes son candidatas para este programa si el varón tiene seguimiento infectológico, los estudios de esperma demuestran carga viral (CV) indetectable y DNA proviral de VIH negativo, y, la mujer tiene ADN proviral de VIH negativo en sangre, en el ciclo en el cual se realizará el procedimiento de fertilización asistida. Se realiza en la mujer pesquisa de infecciones connatales. Las muestras de esperma son procesadas con técnicas de lavado, swim up y swim down, y congeladas. Después de cada procedimiento de fertilización asistida la mujer es controlada controlada con estudios serológicos para anticuerpos (VIH ELISA) periódicos. Los recién nacidos son evaluados a través de ADN proviral de VIH en el 1er mes de vida, o, durante los primeros 6 meses de vida a través de anticuerpos (VIH ELISA). Resultadaos: desde 12/2000 y hasta mayo 2009 se incluyeron 165 parejas serodiscordantes. 147 pacientes VIH (+) realizaron estudios de muestras de esperma, 26, tuvieron muestras con estudios microbiológicos positivos (23, CV detectable, y 3, ADN proviral de VIH positivo). En 123 parejas se realizaron: 329 inseminaciones, 55 ICSI y 28 FIV. Se concretron 44 embarazos y nacieron 51 bebés. Todos los estudios realizados a las mujeres y recién nacidos mostraron resultados negativos. Conclusiones: este programa logró resultados satisfactorios en la prevención de infecciones por VIH y connatales.(AU)

Objective: to describe the data obtained during the development of an assisted reproduction program for couples where the man is HIV - Infected organized by an ambulatory infectologist center in BsAs city. a multidisciplinary team with infectious disease MD, biochemists, ginecologists and bilogist collaborate in the follow-up of the patients. Methods: couples seeking reproductive counseling were eligible for this programme if: the HIV positive male partner adhered to an infectious disease follow-up, he has undetectable viral load in the fresh sperm sample and is negative for HIV proviral DNA in the swim-up material after sperm washing, the female partner is negative for HIV proviral DNA immediately beforme each assisted reproduction attempt. Procedures comprised intrauterine insemination, intracytoplasmic sperm injection and in vitro fertilization accordin to gynecologist indication. After each procedure, women were tested for indication. After each procedure, women were tested for HIV antibodies periodically. Newborns were tested for HIV proviral DNA at one month of age or HE during the first six months. Results: One hundred and sixty five couples were assessed, semen analyses results were obtained from 147 HIV positive men, 23 had detectable viral load, 3 had positive HIV proviral DNA in swim up. One hundred and twenty three couples undervent AR procedures: 329 intrauterine inseminations, 55 intracytoplasmic sperm injections, and 28 in-vitro fertilizations. Forty four pregnancies resulted in fifty one live Births. All HE and HDP tests performed in women and new-borns were negative. Conclusions: This programme achieved satisfactory results in prevention of HIV and congenital infections.(AU)

Mecanismos moleculares del daño microvascular de la diabetes mellitus / Molecular mechanisms of the diabetic microvascular disease

Las complicaciones vasculares de la diabetes mellitus están representadas por la macroangiopatía y la microangiopatía. La última afecta los pequeños vasos de la retina, los riñones y los nervios periféricos y causa severos daños a los pacientes afectados. En esta revisión se tratan los mecanismos básicos implicados en la microangiopatía, que comprenden la activación de la proteín quinasa C, la formación de los productos finales de la glicosilación avanzada, la reducción de aldosas y el estrés oxidativo. El conocimiento de estos procesos es importante para el diseño de nuevos fármacos que logren prevenir o retrasar el desarrollo de estas complicaciones(AU)

The hyaluronic acid receptor (CD44) is expressed in bovine oocytes and early stage embryos.

Hyaluronic acid (HA) is a high molecular weight polysaccharide found in the extracellular matrix of most animal tissues, that exerts a profound influence on cell behavior. HA is one of the most abundant glycosaminoglycans (GAGs) in the uterine, oviductal and follicular fluids in mouse, pig, human and cattle. CD44, the principal cell membrane receptor for HA, is expressed from the 1- to 8-cell stage in human embryos, during post-implantation mouse embryogenesis and on the surface of differentiated embryonic stem cells. In the present study, we have analyzed by immunofluorescence, whether CD44 is present in bovine oocytes, fertilized oocytes and early stage embryos. Bovine cumulus-oocyte complexes (COCs) were aspirated from follicles (2-5mm) and were selected for IVM and incubated for 24h. Oocytes showing an expanded cumulus (generally 90-95%) were used for IVF. Fertilized oocytes were separated for immunofluorescence assay after 16h of sperm incubation in order to fix the eggs at the pronuclear stage. The embryos were cultured for 8 days and the different stages of development for immunofluorescence assay were separated every 24h of culture. The CD44 receptor was detected at every observation time examined. Fluorescence-tagged HA for the internalization assay was prepared by mixing fluorescein amine, Isomer I and 1mg of HA from umbilical cord. Fluorescence-tagged HA was internalized in 2-, 4-, 8- and 16-cell-stage embryos, morulae and blastocysts. CD44 is expressed on the surface and in the cytoplasm of bovine oocytes and embryos in different stages of development.

Live birth and normal 1-year follow-up of a baby born after transfer of cryopreserved embryos from rescue intracytoplasmic sperm injection of 1-day-old oocytes.

OBJECTIVE: To report the birth and normal pediatric follow-up of the first baby born after transfer of embryos derived from cryopreserved rescue intracytoplasmic sperm injection (ICSI). DESIGN: Case report. SETTING: Academic fertility unit. PATIENT(S): A 36-year-old woman with unexplained infertility. INTERVENTION(S): Reinsemination by ICSI ("rescue" ICSI) followed by cryopreservation at the pronuclear stage was performed after partial fertilization failure. MAIN OUTCOME MEASURE(S): Pregnancy, birth, and 1-year follow-up of the baby born after the transfer of the cryopreserved rescue ICSI embryos. RESULT(S) AND CONCLUSION(S): Zygotes obtained after rescue ICSI were able to tolerate the process of cryopreservation and resulted in a viable pregnancy and delivery.