Combining fertility preservation procedures to spread the eggs across different baskets: a feasibility study.

STUDY QUESTION: What is the reproductive potential following combinations of ovarian stimulation, IVM and ovarian tissue cryopreservation (OTC) in female patients seeking fertility preservation (FP)? SUMMARY ANSWER: In selected patients, combining different FP procedures is a feasible approach and reproductive outcomes after FP in patients who return to attempt pregnancy are promising. WHAT IS KNOWN ALREADY: FP is increasingly performed in fertility clinics but an algorithm to select the most suitable FP procedure according to patient characteristics and available timeframe is currently lacking. Vitrification of mature oocytes (OV) and OTC are most commonly performed, although in some clinical scenarios a combination of procedures including IVM, to spread the sources of gametes, may be considered in order to enhance reproductive options for the future. STUDY DESIGN, SIZE, DURATION: Retrospective, observational study in a university-based, tertiary fertility centre involving all female patients who underwent urgent medical FP between January 2012 and December 2018. Descriptive analysis of various FP procedures, either stand-alone or combined, was performed, and reproductive outcomes of patients who attempted pregnancy in the follow-up period were recorded. PARTICIPANTS/MATERIALS, SETTING, METHODS: In total, 207 patients underwent medical FP. Patient-tailored strategies and procedures were selected after multidisciplinary discussion. When deemed feasible, FP procedures were combined to cryopreserve different types of reproductive tissue for future use. The main primary outcome measure was the number of mature oocytes. Live birth rates were evaluated in patients who returned for reproductive treatment. MAIN RESULTS AND THE ROLE OF CHANCE: Among patients seeking FP, 95/207 (46%) had breast cancer, 43/207 (21%) had haematological malignancies and 31/207 (15%) had a gynaecological tumour. Mean ± SD age was 27.0 ± 8.3 years. Eighty-five (41.1%) patients underwent controlled ovarian stimulation (COS), resulting in 10.8 ± 7.1 metaphase II (MII) oocytes for vitrification. Eleven (5.3%) patients had multiple COS cycles. Transvaginal oocyte retrieval for IVM was performed in 17 (8.2%) patients, yielding 9.2 ± 10.1 MII oocytes. Thirty-four (16.4%) patients underwent OTC combined with IVM of oocytes retrieved from ovarian tissue 'ex vivo' (OTO-IVM), yielding 4.0 ± 4.3 MII oocytes in addition to ovarian fragments. Seventeen (8.2%) patients had OTC combined with OTO-IVM and transvaginal retrieval of oocytes for IVM from the contralateral ovary, resulting in 13.5 ± 9.7 MII oocytes. In 13 (6.3%) patients, OTC with OTO-IVM was followed by controlled stimulation of the contralateral ovary, yielding 11.3 ± 6.6 MII oocytes in total. During the timeframe of the study, 31/207 (15%) patients have returned to the fertility clinic with a desire for pregnancy. Of those, 12 (38.7%) patients had preserved ovarian function and underwent ART treatment with fresh oocytes, resulting in nine (75%) livebirth. The remaining 19 (61.3%) patients requested warming of their cryopreserved material because of ovarian insufficiency. Of those, eight (42.1%) patients had a livebirth, of whom three after OTO-IVM. To date, 5/207 patients (2.4%) achieved an ongoing pregnancy or livebirth after spontaneous conception. LIMITATIONS, REASONS FOR CAUTION: Our FP programme is based on a patient-tailored approach rather than based on an efficiency-driven algorithm. The data presented are descriptive, which precludes firm conclusions. WIDER IMPLICATIONS OF THE FINDINGS: Combining different FP procedures is likely to enhance the reproductive fitness of patients undergoing gonadotoxic treatment but further follow-up studies are needed to confirm this. STUDY FUNDING/COMPETING INTEREST(S): No external funding was used for this study and the authors have no competing interests. TRIAL REGISTRATION NUMBER: N/A.

[Neuromuscular disease: health care accessibility in the Nord-Pas-de- Calais region]. / Enquête auprès d'une population d'adultes atteints de pathologies neuromusculaires dans le Nord-Pas-de-Calais.

A survey was conducted to estimate accessibility to current diagnostic techniques for patients with neuromuscular disease living in the Nord-Pas-de-Calais. In association with the "Association française contre les myopathies", we invited 200 adults with neuromuscular disease to fill out a questionnaire concerning diagnosis of their neuromuscular disease and medical and paramedical follow-up. Each subject answered the questionnaire anonymously providing data on sociodemographic items, diagnosis and medical and paramedical follow-up. The results showed a lack of follow-up for lung disease whereas respiratory failure is known as a frequent complication of neuromuscular disease. Genetic counselling was not suggested often enough. A large proportion (80 p. 100) of the patients had had physiotherapy. Whereas cardiomyopathy and orthopedic buckling with subsequent decreased autonomy are observed in 90 p. 100 of patients with Duchenne muscular dystrophy, only 42 p. 100 of the patients with this disease were followed by a cardiologist and a physical therapists. We suggest more cooperation between specialists in order to improve medical care for patients with neuromuscular diseases.

Modulation of lipoprotein B binding to the LDL receptor by exogenous lipids and apolipoproteins CI, CII, CIII, and E.

We have recently shown that apo B-containing lipoproteins isolated by immunoaffinity chromatography bind to the LDL receptor with an affinity dependent on their apo E or apo CIII content. However, these lipoproteins--LpB:E, LpB:CIII, and LpB:CIII:E--isolated from whole plasma have variable lipid and apolipoprotein contents, and it is difficult to consider each parameter separately, particularly because an increase in the apo CIII content is always associated with an increase in the content of other C apolipoproteins. Therefore, we used affinity-purified LpB free of other apolipoproteins. Lipid content of LpB was increased by incubation with a lipid emulsion, and this triglyceride-enriched LpB was named TG-LpB. Free apo CI, apo CII, apo CIII, and apo E were added to LpB and TG-LpB and their associations to the lipoprotein were assessed by gel filtration, nondenaturing electrophoresis, and immunoblotting. Molar ratios of 6 (apo E), 30 (apo CII), 20 (apo CIII), and 30 (apo CI) for 1 apo B were obtained. The association of apo CII to LpB and TG-LpB induced modifications to the LpB structure and a redistribution of lipids and apolipoproteins on the lipoprotein particles. The binding of these LpBs and TG-LpBs with and without added apo CI, CII, CIII, and E was tested at 4 degrees C on the LDL receptors of HeLa cells. The increased content of lipids reduced TG-LpB binding to the LDL receptor.(ABSTRACT TRUNCATED AT 250 WORDS)

Evidence of non-deficient low-density lipoprotein receptor patients in a pool of subjects with clinical familial hypercholesterolemia profile.

For this study, we selected 41 adult patients with the classic clinical diagnosis of heterozygous familial hypercholesterolemia (FH), which is characterized by a low-density lipoprotein (LDL) cholesterol level above the 95th percentile, xanthomas, and/or personal or familial cardiovascular history. We used an indirect immunocytofluorimetric assay to classify these 41 subjects according to LDL receptor function on lymphocytes. We found that LDL receptor activity was normal in nine patients. A large study of plasma lipid, lipoprotein, and apolipoprotein levels found no significant difference between patients with and without LDL receptor defect. Familial defective apolipoprotein (apo) B-100 (FDB) and LDL-binding defects were not found in the nine patients without LDL receptor defect. These results suggest that other defects in the regulation of lipoprotein metabolism are capable of giving rise to a clinical and biochemical disorder indistinguishable from classic FH.

Preparation of anti-HIV-low-density lipoprotein complexes for delivery of anti-HIV drugs via the low-density lipoprotein pathways.

Lipophilic prodrugs of 3'-azido-3'-deoxythymidine (AZT) and of 2',3'-didehydro-3'-deoxythymidine (D4T) have been synthesized. 3 beta-(2'-carboxymethoxy)-cholest-5-ene acid, palmitic acid, linolenic acid, linoleic acid, and cholanic acid have been covalently bound to AZT and D4T. In some experiments the fluorescent molecule NBD was simultaneously linked. These prodrugs were incorporated into LDL or acetylated LDL. The best incorporation was obtained with drugs presenting a steroid moiety (cholesterol derivative or cholanic acid) in their structure. The incorporation of prodrugs into LDL was estimated as approximately 200 molecules of prodrug per LDL particle. Cytofluorimetric studies clearly show that the NBD-steroid LDL or NBD-steroid acetylated LDL are bound and then internalized by the B-E receptor (U937) or the scavenger receptor (mouse peritoneal macrophage), respectively. The antiretroviral activity of palmitate-D4T, cholanic-AZT, and cholanic-AZT-LDL complex was similar to the activity of free D4T and free AZT, respectively. Development of lipid nucleoside-LDL complexes to attach specifically to cells involved in HIV infection might have a direct clinical relevance.

Six DNA polymorphisms in the low density lipoprotein receptor gene: their genetic relationship and an example of their use for identifying affected relatives of patients with familial hypercholesterolaemia.

We have determined the relative allele frequency and estimated linkage disequilibrium between six DNA polymorphisms of the low density lipoprotein (LDL) receptor gene. Polymorphisms were detected using the enzymes SfaNI, TaqI, StuI, HincII, AvaII, and NcoI after DNA amplification by the polymerase chain reaction. Strong linkage disequilibrium was detected between many of the pair wise comparisons in a sample of 60 patients heterozygous for familial hypercholesterolaemia (FH). Using the enzymes HincII, NcoI, and SfaNI, 85% of patients were heterozygous for at least one polymorphism and thus potentially informative for cosegregation studies. The polymorphisms were used to follow the inheritance of the defective allele of the LDL receptor gene in the relatives of a patient with FH. Assays of LDL receptor activity on lymphoblastoid cell lines from two members of the family was used to confirm that the proband, but not the hypercholesterolaemic brother, had a defect in the LDL receptor. In the family, none of the children had inherited the allele of the LDL receptor gene inferred to be defective. The problems associated with this cosegregation approach to identify relatives of patients with a clinical diagnosis of FH are discussed.

Low-density lipoprotein for delivery of an acrylophenone antineoplastic molecule into malignant cells.

In vitro and in vivo data have indicated that tumor cells actively internalize the low-density lipoprotein (LDL) from the circulation. A family of 2-(aminomethyl) acrylophenones (AMA) possesses an in vitro antileukemic activity but is devoid of any in vivo antineoplastic activity, because the compounds are actively captured by proteins in solution in the blood. In order to achieve a selective delivery of these drugs via the LDL pathway, we have incorporated an AMA drug, 2-morpholinomethyl-2',3',4'- trimethoxy acrylophenone hydrochloride (ILE) into LDL particles. ILE spontaneously associated with LDL to produce an LDL-ILE complex containing 200 +/- 100 molecules of drug per LDL particle. The LDL-ILE complex was highly electronegative as detected by electrophoresis. Further, this complex presented an immunologically detected over expression of the ligand-binding domain to the LDL receptor. In spite of these modifications, the LDL receptor processing bound, internalized, and degraded the LDL-ILE complex. Nevertheless, these biological properties were reduced by 32, 20, and 40%, respectively, in comparison to native LDL. Despite its high electronegativity, the LDL-ILE complex was not recognized by the macrophagic scavenger receptor. The LDL-ILE complex showed specific LDL receptor mediated in vitro cytotoxicity as judged from the growth inhibition of neoplastic A549 cells and of normal fibroblasts, but no activity on defective LDL receptor cells. Further, the pharmacological activity of the complex against A549 cells has been demonstrated to be equally potent as that of the free drug (median inhibitory dose, 5 microM). It is suggested that LDL drug targeting of AMA molecules could specifically deliver active molecules to cancer cells, avoiding their entrapment by other blood proteins and their rapid clearance by the reticuloendothelial system.

Modified low density lipoproteins activate human macrophages to secrete immunoreactive endothelin.

This study attempted to determine if low density lipoproteins (LDL) induce the production of endothelins (ET) by human macrophages. Non-protected LDL from macrophage induced oxidation (n-LDL), copper-oxidized LDL (Ox-LDL), acetylated-LDL (Ac-LDL), butylated hydroxytoluene-LDL (BHT-LDL), BHT-Ac-LDL, polyinosinic acid (PiA, 1.5 micrograms/ml), phorbol myristate acetate (PMA; 0.5 microM) and BHT alone (20 microM) were studied. The different compounds had the following potency to stimulate the ET secretion: PMA greater than Ox-LDL greater than Ac-LDL greater than n-LDL greater than BHT-LDL greater than PiA greater than PiA + Ac-LDL greater than BHT. In conclusion, modified LDL stimulated ET secretion by human macrophages.

Interaction of LpB, LpB:E, LpB:C-III, and LpB:C-III:E lipoproteins with the low density lipoprotein receptor of HeLa cells.

In this study we measured the binding parameters of different apolipoprotein (apo) B-containing lipoproteins to the low density lipoprotein (LDL) receptor of HeLa cells. Our goal was to determine the respective roles of the different apolipoproteins of these particles, with particular emphasis on apos B, E, and C-III. Very low density lipoprotein from hypertriglyceridemic subjects (B to E molar ratio = 1:16) bound to HeLa cells with an affinity higher than that of LDL, but the apparent number of binding sites per cell was lower. Because of the heterogeneity of these lipoproteins, which were isolated by ultracentrifugation, we used immunoaffinity chromatography to define these particles on the basis of their apolipoprotein content. Lipoprotein B (LpB) particles that contained apo B as their sole apolipoprotein had lower affinity for the LDL receptor than did total LDL but had an apparently higher number of binding sites. The presence of apo E of phenotype E3/E3 or E4/E4 on one particle increased the affinity of the apo B-containing lipoprotein for the LDL receptor. The apparent number of binding sites decreased, probably due to the fact that a lipoprotein particle containing multiple copies of apo E bound to more than one molecule of LDL receptor. Interaction with several LDL receptors would also explain the higher binding affinity that we observed. The calculated number of binding sites expressed for each apo E molecule is close to the number of binding sites for lipoproteins containing only apo B (LpB or LDL), indicating that each apo E can interact with one LDL receptor. When the apo E phenotype was E2/E2, the LpB:E lipoproteins did not bind to the LDL receptor.(ABSTRACT TRUNCATED AT 250 WORDS)

[Interaction between LDL receptor and lipoproteins containing apo B]. / Interaction entre le LDL-récepteur et les lipoprotéines contenant de l'apo B.

The physiocochemically defined lipoproteins such as VLDL, LDL are comprised of subpopulations with different lipid and apolipoprotein composition. In order to determine the respective roles of different apolipoproteins (B, C-III, E) in their metabolism, four species (LpB, LpB:E, LpB: C-III and LpB: C-III: E) have been separated by sequential immunoaffinity chromatography. We examined the binding characteristics of each lipoprotein to HeLa cells and expressed the results in relation to the number of moles of apo B. LpB particles which contained apo B as their sole apolipoprotein had lower affinity for the LDL receptor that did total LDL but an apparently higher number of binding sites. The presence of apo E of phenotype E3 or E4 on one particle increased the affinity for the receptor. The apparent number of binding sites decreased probably due to the fact that a particle containing multiple copies of apo E bound to more than one molecule of receptor. Interaction with several LDL receptors would also explain the higher binding affinity which we observed. When the apo E phenotype was E2/E2, the LpB: E particle did not bind to the receptor. We showed also that apo C-III, when present, diminished the binding of apo B containing lipoproteins. These data suggest that apolipoproteins E and C-III impaired the interaction of apo B with the LDL receptor. It is likely that in LpB: E only apo E (in the case of E3 or E4 phenotype) participates in the LDL receptor binding.