assisted reproductive technology (ART)

辅助生殖技术 ( ART )
  • 文章类型: Journal Article
    卵巢纤维化,以卵巢成纤维细胞的过度增殖和细胞外基质(ECM)的积累为特征,是卵巢功能障碍的主要原因之一。尽管卵巢纤维化在维持哺乳动物卵巢的正常生理功能方面具有关键作用,对这种情况的研究被大大低估了,这导致临床上对纤维化引起的卵巢功能障碍缺乏治疗选择。本文综述了卵巢纤维化分子机制的研究进展,包括TGF-β,细胞外基质,炎症,和其他促纤维化因素导致卵巢异常纤维化。此外,我们总结了目前针对卵巢纤维化的卵巢功能障碍的治疗方法,包括抗纤维化药物,干细胞移植,和外泌体疗法。本文就卵巢纤维化的研究进展作一综述,提出针对卵巢纤维化治疗卵巢功能障碍的潜在治疗策略。
    Ovarian fibrosis, characterized by the excessive proliferation of ovarian fibroblasts and the accumulation of extracellular matrix (ECM), serves as one of the primary causes of ovarian dysfunction. Despite the critical role of ovarian fibrosis in maintaining the normal physiological function of the mammalian ovaries, research on this condition has been greatly underestimated, which leads to a lack of clinical treatment options for ovarian dysfunction caused by fibrosis. This review synthesizes recent research on the molecular mechanisms of ovarian fibrosis, encompassing TGF-β, extracellular matrix, inflammation, and other profibrotic factors contributing to abnormal ovarian fibrosis. Additionally, we summarize current treatment approaches for ovarian dysfunction targeting ovarian fibrosis, including antifibrotic drugs, stem cell transplantation, and exosomal therapies. The purpose of this review is to summarize the research progress on ovarian fibrosis and to propose potential therapeutic strategies targeting ovarian fibrosis for the treatment of ovarian dysfunction.
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  • 文章类型: Journal Article
    不孕症是一项重大的全球健康挑战,影响着全世界数百万对夫妇。大约一半的不育夫妇表现出精液质量受损,表明男性生育能力下降。虽然男性不育的诊断传统上依赖于精液分析,它在对男性生殖健康进行全面评估方面的局限性促使人们努力鉴定新的生物标志物.精浆,含有蛋白质的复杂液体,脂质,和代谢物,已成为此类指标的丰富来源。生殖在很大程度上取决于精浆,男性生殖腺化学物质的主要转运蛋白。它为泌尿生殖系统诊断提供了非侵入性样品,并已证明在鉴定与男性生殖系统疾病有关的生物标志物方面具有潜力。精液蛋白的丰富使人们对其生物学功能有了更深入的了解,起源,以及在与男性不育相关的各种条件下的差异表达,包括无精子症,弱精子症,少精子症,畸形精子症,在其他人中。由于当前诊断技术的局限性,男性不育的真实患病率被低估了。这篇综述批判性地评估了精浆生物标志物的现状及其在评估男性不育中的实用性。通过弥合研究与临床实践之间的差距,精浆生物标志物的综合评估为全面评估男性不育提供了一种多模式方法.
    Infertility represents a significant global health challenge impacting millions of couples worldwide. Approximately half of all infertile couples exhibit compromised semen quality, indicative of diminished male fertility. While the diagnosis of male infertility traditionally relies on semen analysis, its limitations in providing a comprehensive assessment of male reproductive health have spurred efforts to identify novel biomarkers. Seminal plasma, a complex fluid containing proteins, lipids, and metabolites, has emerged as a rich source of such indicators. Reproduction depends heavily on seminal plasma, the primary transporter of chemicals from male reproductive glands. It provides a non-invasive sample for urogenital diagnostics and has demonstrated potential in the identification of biomarkers linked to illnesses of the male reproductive system. The abundance of seminal proteins has enabled a deeper understanding of their biological functions, origins, and differential expression in various conditions associated with male infertility, including azoospermia, asthenozoospermia, oligozoospermia, teratozoospermia, among others. The true prevalence of male infertility is understated due to the limitations of the current diagnostic techniques. This review critically evaluates the current landscape of seminal plasma biomarkers and their utility in assessing male infertility. Βy bridging the gap between research and clinical practice, the integrative assessment of seminal plasma biomarkers offers a multimodal approach to comprehensively evaluate male infertility.
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  • 文章类型: Journal Article
    这篇全面的综述探讨了辅助生殖技术(ART)领域内精子选择技术的发展。我们的分析深入研究了一系列方法,从传统方法如密度梯度离心到先进技术,如磁激活细胞分选(MACS)和胞浆内形态选择精子注射(IMSI)。我们严格评估这些方法在精子运动性方面的功效,形态学,DNA完整性,和其他功能属性,提供了他们的临床结果的详细比较。我们强调了从传统精子选择方法的转变,主要关注物理特征,更复杂的技术,提供精子分子特性的全面评估。这种转变不仅有望增强对受精成功的预测,而且对提高胚胎质量和增加活产的机会具有重要意义。通过综合各种研究和研究论文,我们对ART中不同精子选择程序的可预测性进行了深入分析.该综述还讨论了这些方法的临床适用性,强调他们在塑造辅助生殖未来方面的潜力。我们的研究结果表明,在ART中整合先进的精子选择策略可以导致更具成本效益的治疗,缩短持续时间和更高的成功率。这篇综述旨在为生殖医学的临床医生和研究人员提供有关ART中精子选择技术的现状和未来前景的全面见解。
    This comprehensive review explores the evolving landscape of sperm selection techniques within the realm of Assisted Reproductive Technology (ART). Our analysis delves into a range of methods from traditional approaches like density gradient centrifugation to advanced techniques such as Magnetic-Activated Cell Sorting (MACS) and Intracytoplasmic Morphologically Selected Sperm Injection (IMSI). We critically assess the efficacy of these methods in terms of sperm motility, morphology, DNA integrity, and other functional attributes, providing a detailed comparison of their clinical outcomes. We highlight the transition from conventional sperm selection methods, which primarily focus on physical characteristics, to more sophisticated techniques that offer a comprehensive evaluation of sperm molecular properties. This shift not only promises enhanced prediction of fertilization success but also has significant implications for improving embryo quality and increasing the chances of live birth. By synthesizing various studies and research papers, we present an in-depth analysis of the predictability of different sperm selection procedures in ART. The review also discusses the clinical applicability of these methods, emphasizing their potential in shaping the future of assisted reproduction. Our findings suggest that the integration of advanced sperm selection strategies in ART could lead to more cost-effective treatments with reduced duration and higher success rates. This review aims to provide clinicians and researchers in reproductive medicine with comprehensive insights into the current state and future prospects of sperm selection technologies in ART.
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  • 文章类型: Journal Article
    人们对SARS-CoV-2大流行可能影响性健康和生殖健康的担忧已大大增加。在这篇叙述性评论中,综述了SARS-CoV-2感染对性健康和生殖健康影响的最新研究。该审查最初是通过研究SARS-CoV-2对女性月经周期的可能后果开始的。病毒可能会干扰月经周期,这可能会影响激素合成和子宫内膜反应,根据最新的证据。月经失血可能受COVID-19影响内皮细胞功能和全身止血的潜力影响。下丘脑闭经可能是由严重的COVID-19疾病引起的。关于这个问题的研究很少,尽管大多数女性在1-2个月的休养后恢复正常的月经周期。该综述还研究了SARS-CoV-2感染如何影响辅助生殖技术(ART)治疗。临床数据很少,尽管一些研究指出了对胚胎质量的潜在影响。总的来说,ART结果,然而,与流行前相比,没有实质性变化。当怀孕期间发生SARS-CoV-2感染时,产科问题更有可能发生,尤其是在妊娠晚期。即使产妇死亡率仍然很低,孕妇,尤其是那些有合并症的人,更有可能经历严重的疾病。该评论强调了COVID-19疫苗如何影响月经周期,显示简短,适度的修改,没有严重的健康危害。还包括大流行期间计划生育选择的心理影响。总之,这篇叙述性综述全面评估了SARS-CoV-2对性健康和生殖健康的复杂和不断变化的影响.强调了大流行期间和之后人们和夫妇的不同要求,强调持续研究和专业医疗实践的必要性。
    Concerns about the SARS-CoV-2 pandemic\'s possible impact on sexual and reproductive health have grown significantly. In this narrative review, the latest research on the effects of SARS-CoV-2 infection on several facets of sexual and reproductive health is reviewed. The review starts initially by going through the possible consequences of SARS-CoV-2 on female menstrual cycles. The virus may interfere with the menstrual cycle, which could affect hormone synthesis and endometrial reactions, according to newly available evidence. Menstrual blood loss may be impacted by COVID-19\'s potential to influence endothelial cell function and systemic hemostasis. Hypothalamic amenorrhea may be brought on by severe COVID-19 disease. There is little research on this subject, although most women resume their regular menstrual cycles after 1-2 months of recuperation. The review also examines how SARS-CoV-2 infection may affect assisted reproductive technology (ART) treatments. There are few clinical data, although some research points to potential effects on embryo quality. Overall, ART results, however, did not materially change from the time before the epidemic. Obstetric problems are more likely when SARS-CoV-2 infection occurs during pregnancy, especially in the third trimester. Even though the maternal death rate is still low, pregnant women, especially those with comorbidities, are more likely to experience serious sickness. The review emphasizes how the COVID-19 vaccine affects menstrual cycles, showing brief, modest modifications without serious health hazards. Also included are the psychological effects of family planning choices during the pandemic. In conclusion, this narrative review offers a thorough assessment of the complicated and changing effects of SARS-CoV-2 on sexual and reproductive health. The different requirements of people and couples during and after the pandemic are highlighted, underscoring the necessity for ongoing study and specialized healthcare practices.
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  • 文章类型: Journal Article
    植入前基因检测(PGT)已成为辅助生殖技术(ART)不可或缺的组成部分,在体外受精(IVF)期间,为夫妇提供在植入胚胎之前筛查遗传异常的机会。这篇全面的综述探讨了PGT在IVF中的进展和应用,涵盖其各种类型,技术发展,临床应用,功效,挑战,监管方面,和未来的方向。PGT技术的发展,包括下一代测序(NGS)和比较基因组杂交(CGH),大大提高了胚胎基因检测的准确性和可靠性。PGT通过提高IVF成功率对ART的未来具有深远的意义,减少遗传性疾病的发病率,减轻与怀孕失败和遗传疾病相关的情感和经济负担。对临床医生的建议,研究人员,政策制定者包括保持最新的PGT技术和指南,探索创新技术,建立明确的监管框架,并促进合作,以最大限度地提高PGT在辅助生殖中的潜在利益。总的来说,这篇综述为PGT的现状及其对生殖医学领域的影响提供了有价值的见解。
    Preimplantation genetic testing (PGT) has become an integral component of assisted reproductive technology (ART), offering couples the opportunity to screen embryos for genetic abnormalities before implantation during in vitro fertilization (IVF). This comprehensive review explores the advancements and applications of PGT in IVF, covering its various types, technological developments, clinical applications, efficacy, challenges, regulatory aspects, and future directions. The evolution of PGT techniques, including next-generation sequencing (NGS) and comparative genomic hybridization (CGH), has significantly enhanced the accuracy and reliability of genetic testing in embryos. PGT holds profound implications for the future of ART by improving IVF success rates, reducing the incidence of genetic disorders, and mitigating the emotional and financial burdens associated with failed pregnancies and genetic diseases. Recommendations for clinicians, researchers, and policymakers include staying updated on the latest PGT techniques and guidelines, exploring innovative technologies, establishing clear regulatory frameworks, and fostering collaboration to maximize the potential benefits of PGT in assisted reproduction. Overall, this review provides valuable insights into the current state of PGT and its implications for the field of reproductive medicine.
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  • 文章类型: Journal Article
    目的:探讨不同年龄女性进行冻融优质单囊胚移植的可行性。
    方法:将1,279名妇女分为四组:38-40岁组(n=147),35-37岁组(n=164),30-34岁组(n=483),<30岁组(n=485)。进行基线特征和妊娠及新生儿结局的组间比较。
    结果:临床妊娠率(47.6%),38-40岁组的活产率(34.0%)显着低于30-34岁组(64.4%,50.9%,分别;所有P<0.001)和<30岁组(62.9%,50.7%,分别;所有P<0.001)。然而,35~37岁组与其他三组在这两个维度上差异均无统计学意义(均P>0.05)。此外,生化妊娠率没有差异,流产,或产科或新生儿并发症四组(均P>0.05)。根据多元逻辑回归分析,35-37岁组与非活产结局无关,不良妊娠结局,或产科或新生儿并发症。然而,38-40岁是非活产(OR=2.121,95%CI:1.233-3.647)和不良妊娠结局(OR=1.630,95%CI:1.010-2.633)的危险因素。事后功效分析表明,该研究具有足够的功效来检测有意义的差异。
    结论:冻融的高质量单囊胚移植对35-37岁女性的妊娠结局与年轻患者相同。未来需要更大人群的前瞻性随机对照研究来验证该方法的可行性和安全性。
    OBJECTIVE: To investigate the feasibility of performing frozen-thawed high-quality single blastocyst transfer in women of different ages.
    METHODS: A total of 1,279 women were divided into four groups: a 38-40-year-old group (n = 147), 35-37-year-old group (n = 164), 30-34-year-old group (n = 483), and < 30-year-old group (n = 485). Intergroup comparisons of baseline characteristics and pregnancy and neonatal outcomes were made.
    RESULTS: The clinical pregnancy rate (47.6%), and live birth rate (34.0%) in the 38-40-year-old group were significantly lower than those in the 30-34-year-old group (64.4%, 50.9%, respectively; all P < 0.001) and < 30-year-old group (62.9%, 50.7%, respectively; all P < 0.001). However, the 35-37-year-old group did not differ from the other three groups in these two dimensions (all P > 0.05). Moreover, there were no differences in the rates of biochemical pregnancy, miscarriage, or obstetric or neonatal complications among the four groups (all P > 0.05). According to the multivariate logistic regression analysis, the 35-37-year-old group was not associated with non-live birth outcomes, adverse pregnancy outcomes, or obstetric or neonatal complications. However, being 38-40 years of age was a risk factor for non-live birth (OR = 2.121, 95% CI: 1.233-3.647) and adverse pregnancy outcomes (OR = 1.630, 95% CI: 1.010-2.633). Post hoc power analysis showed that the study was sufficiently powered to detect meaningful differences.
    CONCLUSIONS: Frozen-thawed high-quality single blastocyst transfer produces the same satisfactory pregnancy outcomes for women aged 35-37 years as younger patients. Future prospective randomized controlled studies with larger populations are needed to verify the feasibility and safety of this method.
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  • 文章类型: Journal Article
    探索在非侵入性植入前染色体筛查(NICS)中,胚泡形成前不同数量的胚胎洗涤对NICS结果准确性的影响。
    在这项研究中,在我们的机构收集了来自植入前遗传测试(PGT)辅助妊娠的68个胚泡。胚胎培养的第四天,将胚胎转移到新的囊胚培养培养基中,洗涤3次(NICS1组)或10次(NICS2组).对胚泡进行滋养外胚层(TE)活检,收集相应的胚胎培养基进行全基因组扩增(WGA)和高通量测序。
    WGA的成功率为100%(TE活检),76.7%(NICS1组),和89.5%(NICS2组)。在培养的第5天和第6天,胚胎培养基中WGA的成功率分别为75.0%(33/44)和100%(24/24),分别。使用TE作为黄金标准,NICS1和NICS2组胚胎培养基样本与TE结果的核型一致率为43.5%(10/23)和73.5%(25/34),分别。使用TE时,NICS2组检测染色体异常的敏感性和特异性高于NICS1组(83.3%vs60.0%;62.5%vs30.8%,分别)。假阳性率和假阴性率(即误诊率和漏诊率,NICS2组分别低于NICS1组(37.5%vs69.2%;16.7%vs40.0%,分别)。
    NICS在胚胎洗涤十次后产生了良好的结果。这些发现提供了一种新颖的方法,可以降低用于胚胎发育的培养基中非胚胎来源的无细胞DNA污染量。优化采样程序,提高NICS测试的准确性。
    UNASSIGNED: To explore the effect of varying numbers of embryo washings prior to blastocyst formation in non-invasive preimplantation chromosome screening (NICS) on the accuracy of NICS results.
    UNASSIGNED: In this study, 68 blastocysts from preimplantation genetic testing (PGT)-assisted pregnancy were collected at our institution. On the fourth day of embryo culture, the embryos were transferred to a new medium for blastocyst culture and were washed either three times (NICS1 group) or ten times (NICS2 group). A trophectoderm (TE) biopsy was performed on the blastocysts, and the corresponding embryo culture media were collected for whole genome amplification (WGA) and high-throughput sequencing.
    UNASSIGNED: The success rate of WGA was 100% (TE biopsy), 76.7% (NICS1 group), and 89.5% (NICS2 group). The success rate of WGA in embryo medium on days 5 and 6 of culture was 75.0% (33/44) and 100% (24/24), respectively. Using TE as the gold standard, the karyotype concordance rate between the results of the NICS1 and NICS2 groups\' embryo culture medium samples and TE results was 43.5% (10/23) and 73.5% (25/34), respectively. The sensitivity and specificity of detecting chromosomal abnormalities were higher in the NICS2 group than in the NICS1 group when TE was used (83.3% vs 60.0%; 62.5% vs 30.8%, respectively). The false-positive rate and false-negative rate (i.e., misdiagnosis rate and missed diagnosis rate, respectively) were lower in the NICS2 group than in the NICS1 group (37.5% vs 69.2%; 16.7% vs 40.0%, respectively).
    UNASSIGNED: The NICS yielded favorable results after ten washings of the embryos. These findings provide a novel method for lowering the amount of cell-free DNA contamination from non-embryonic sources in the medium used for embryo development, optimizing the sampling procedure and improving the accuracy of the NICS test.
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  • 文章类型: Case Reports
    胚胎的成功植入取决于子宫内膜壁与植入窗口(WOI)内的感受态胚泡之间的同步交叉对话。因此,WOI在辅助生殖技术(ART)中具有重要意义。然而,在某些情况下,女性在ART周期中没有固定的WOI,以提高临床妊娠成功率。然而,有些立场是女性没有固定的女性,它在随后的月经期发生变化。这有助于复发性植入失败(RIF)的机会。导致RIF的另一个因素是子宫内膜容受性不稳定,这阻碍了子宫内膜成功植入概念的机会。该病例系列包括四个病例研究,其中患者被认为由于可变的WOI或不稳定的子宫内膜容受性而患有RIF,而如今遵循的常规方案未能使他们受孕。为了解决这个问题,我们提出了一种新的策略,试图提高这些病例的妊娠率。一种称为混合双胚胎移植(MDET)的创新胚胎移植方法,其中涉及孕酮第6天的第3天胚胎和第5天胚泡的移植,导致可能的妊娠结局。根据人绒毛膜促性腺激素(β-hCG)测试报告验证了可行的妊娠,其中两个病例分娩了健康的婴儿。因此,本案例系列提供了解决RIF问题的独特方法。然而,需要更大的研究来验证这种技术的可能使用。
    Successful implantation of embryos depends on the synchronous cross-talks between the endometrial wall and the competent blastocyst within the window of implantation (WOI). Hence, the WOI has a major significance in assisted reproductive technology (ART). However, in some cases, women do not have fixed WOI in ART cycles in order to enhance the rate of successful clinical pregnancy. However, there have been stances where women do not have a fixed WOI, and it shifts in subsequent menstrual periods. This contributes to the chances of recurrent implantation failure (RIF). Another factor that contributes to RIF is erratic endometrial receptivity, which hinders the chances of successful implantation of the conceptus in the endometrium. This case series consists of four case studies where the patients were believed to be suffering from RIF due to variable WOI or erratic endometrial receptivity and the routine protocol followed nowadays failed to make them conceive. In order to resolve the condition, we proposed a novel strategy in an attempt to improve pregnancy rates in these cases. An innovative method of embryo transfer known as mixed double-embryo transfer (MDET), which involved the transfer of one day 3 embryo and one day 5 blastocyst on day 6 of progesterone, led to possible pregnancy outcomes. A viable pregnancy was validated based on the human chorionic gonadotropin (β-hCG) test report, and two of the cases delivered healthy babies. Thus, this case series provides a unique approach to addressing the issues of RIF. However, larger studies are required to validate the possible use of this technique.
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  • 文章类型: Journal Article
    最近,辅助生殖技术(ART)的使用迅速增加。因此,越来越多的人担心通过ART产生的后代的安全性。此外,新出现的证据表明,使用ART受孕的后代患心血管疾病(CVD)的风险增加。在这次审查中,我们讨论了DNA甲基化改变的表观遗传机制,组蛋白修饰,和microRNA表达,以及印记障碍。我们还总结了心血管变化和其他心血管疾病危险因素的研究,如不良的宫内环境,围产期并发症,辅助生殖技术(ART)后代谢改变。最后,我们强调了通过ART受孕的后代心血管疾病风险增加的表观遗传机制,这可能有助于ART人群中CVD的早期诊断和预防。
    Recently, the use of assisted reproductive technology (ART) has rapidly increased. As a result, an increasing number of people are concerned about the safety of offspring produced through ART. Moreover, emerging evidence suggests an increased risk of cardiovascular disease (CVD) in offspring conceived using ART. In this review, we discuss the epigenetic mechanisms involved in altered DNA methylation, histone modification, and microRNA expression, as well as imprinting disorders. We also summarize studies on cardiovascular changes and other risk factors for cardiovascular disease, such as adverse intrauterine environments, perinatal complications, and altered metabolism following assisted reproductive technology (ART). Finally, we emphasize the epigenetic mechanisms underlying the increased risk of CVD in offspring conceived through ART, which could contribute to the early diagnosis and prevention of CVD in the ART population.
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  • 文章类型: Journal Article
    背景:囊性纤维化(CF)是一种在亚洲人群中很少发现的常染色体隐性遗传疾病。大多数患有CF的男性由于先天性双侧输精管缺失(CBAVD)引起的阻塞性无精子症(OA)而不育。囊性纤维化跨膜传导调节因子(CFTR)的复合杂合突变是CBAVD中最常见的致病因素之一。然而,很少进行系谱分析。
    方法:在本研究中,在一个涉及两个CBAVD兄弟姐妹的中国家系中进行了全外显子组测序和共分离分析.此外,体外基因表达用于分析新的CFTR突变的致病性。
    结果:我们鉴定了CFTR的复合杂合突变,包括已知的致病变体c.1210-11T>G(也称为IVS9-5T)和c.2144delA;p。q715fs在两个兄弟姐妹与CBAVD。为了验证其体外效果,我们将表达野生型和突变CFTR的载体转染到293T细胞中。结果表明,含有移码突变(c.2144delA)的CFTR蛋白小60kD。睾丸精子抽吸/胞浆内精子注射-胚胎移植(TESA/ICSI-ET),两名CBAVD患者都是健康后代的父亲。
    结论:我们的研究表明CFTR的复合杂合突变与CBAVD有关,扩大了CBAVD患者已知的CFTR基因突变谱,为复合杂合突变可引起家族性CBAVD提供了更多证据。
    BACKGROUND: Cystic fibrosis (CF) is an autosomal recessive disorder rarely found in Asian populations. Most males with CF are infertile because of obstructive azoospermia (OA) caused by congenital bilateral absence of the vas deferens (CBAVD). Compound heterozygous mutations of cystic fibrosis transmembrane conductance regulator (CFTR) are among the most common pathogenic factors in CBAVD. However, few genealogical analyses have been performed.
    METHODS: In this study, whole-exome sequencing and cosegregation analysis were performed in a Chinese pedigree involving two siblings with CBAVD. Moreover, in vitro gene expressions were used to analyze the pathogenicity of a novel CFTR mutation.
    RESULTS: We identified compound heterozygous mutations of CFTR comprising the known disease-causing variant c.1210-11T>G (also known as IVS9-5 T) and c.2144delA;p.q715fs in two siblings with CBAVD. To verify the effects in vitro, we transfected vectors expressing wild-type and mutated CFTR into 293T cells. The results showed that the CFTR protein containing the frameshift mutation (c.2144delA) was 60 kD smaller. With testicular sperm aspiration/intracytoplasmic sperm injection-embryo transfer (TESA/ICSI-ET), both CBAVD patients fathered healthy offspring.
    CONCLUSIONS: Our study revealed that compound heterozygous mutations of CFTR are involved in CBAVD, expanding the known CFTR gene mutation spectrum of CBAVD patients and providing more evidence that compound heterozygous mutations can cause familial CBAVD.
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