Stem cell

干细胞
  • 文章类型: Journal Article
    在符合条件的多发性骨髓瘤(MM)患者的治疗中,建议使用大剂量化疗,然后进行自体造血干细胞支持。这项研究的目的是比较匈牙利患者人群中稳态与基于化疗的干细胞动员的疗效和安全性。
    受试者是210名MM患者,他们在2018年至2022年之间接受了干细胞动员程序。应用粒细胞集落刺激因子(G-CSF)104例,而106例患者接受化疗,随后给予G-CSF。我们评估了成功动员的比例,收集的干细胞的数量,两组的感染发生率和成本效益。
    在稳态组中,对plerixafor的需求显著增加(45%与13%,P<0.001),不成功的干细胞动员更频繁(11%vs.3%,P=0.024),收集的干细胞的平均数量较低(6.9vs.9.8×106,P<0.001)高于化疗组。然而,感染频率较低(4%vs.27%,P<0.001),住院天数显着降低(6vs.14天,P<0.001)。与接受其他方案治疗的患者相比,接受来那度胺或达拉图单抗的患者更频繁地使用Plerixafor(41%vs.23%,P=0.007和78%vs.23%,分别为P<0.001)。
    稳态动员是一种安全的方法;然而,plerixafor给药的比率较高,尝试失败,可能会质疑其对化学移植的优越性。
    UNASSIGNED: High-dose chemotherapy followed by autologous hematopoietic stem cell support is recommended in the treatment of eligible multiple myeloma (MM) patients. The aim of this study was to compare the efficacy and safety of steady-state versus chemotherapy-based stem cell mobilization in our Hungarian patient population.
    UNASSIGNED: The subjects were 210 MM patients who underwent stem cell mobilization procedure between 2018 and 2022. Solo granulocyte colony-stimulating factor (G-CSF) was administered in 104 cases, while 106 patients received chemotherapy which was followed by G-CSF administration. We evaluated the ratio of successful mobilizations, the amount of collected stem cells, the incidence of infections and cost-effectivity in the two groups.
    UNASSIGNED: In the steady-state group, there was a significantly higher need for plerixafor (45% vs. 13%, P < 0.001), unsuccessful stem cell mobilization was more frequent (11% vs. 3%, P = 0.024) and the mean amount of collected stem cells was lower (6.9 vs. 9.8 × 106, P < 0.001) than in the chemotherapy group. However, infections were less frequent (4% vs. 27%, P < 0.001) and the number of days spent in hospital was significantly lower (6 vs. 14 days, P < 0.001). Plerixafor was more frequently administered in those who had received lenalidomide or daratumumab than in those who had been treated with other regimens (41% vs. 23%, P = 0.007 and 78% vs. 23%, P < 0.001, respectively).
    UNASSIGNED: Steady-state mobilization is a safe method; however, the higher rate of plerixafor administration and unsuccessful attempts may question its superiority to chemomobilization.
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  • 文章类型: Published Erratum
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  • 文章类型: Journal Article
    干细胞移植是一种用于治疗某些类型癌症的临床方法,如血液系统恶性肿瘤。移植物抗宿主病(GVHD)发生在30-70%的病例中,通常会降低移植患者的生活质量。本研究旨在确定造血干细胞移植后GVHD阴道并发症的发生率。
    这项研究采用了分析横截面设计。2019年至2020年期间转诊到德黑兰Shariati医院接受造血干细胞移植的所有患者,如果符合纳入标准,则考虑纳入本研究。纳入标准包括18-70岁的非性活跃女性,她们在100天前接受干细胞移植。排除标准包括在移植后的前100天期间经历GVHD的患者。此外,超过75岁的个体和转移性癌症患者被排除在外.
    共招募了55名患者,接受者的平均年龄为40±9.9岁,捐赠者的平均年龄为38.5±12.8岁。值得注意的是,63.3和58.2%的患者出现口腔和眼部症状,分别。关于生殖器受累,49.1%出现阴道症状,而25.5%有外阴受累。在27例阴道受累患者中,两个(7.4%)被归类为轻度,17(63%)为中等,严重的有8人(29.6%)。单变量分析确定阴道分泌物减少[比值比(OR=6.56)],阴道紧绷度(OR=6.23),盆腔疼痛(OR=5.50),和阴道受累(OR=3.81)是其他器官症状的重要预测因子。此外,阴道受累(OR=3.68)是口腔同时发生的唯一重要预测因素,眼,和其他器官症状。在多变量分析中,阴道分泌物减少(OR=8.24)和阴道紧绷(OR=3.92)可显著预测其他器官症状(P=0.009)。
    阴道分泌物减少和阴道紧绷仍然是其他器官症状的重要预测因素。
    UNASSIGNED: Stem cell transplantation is a clinical approach used to treat certain types of cancers, such as hematologic malignancies. Graft-versus-host disease (GVHD) occurs in 30-70% of cases and often diminishes the quality of life of transplant patients. This study aimed to determine the prevalence of vaginal complications of GVHD following hematopoietic stem cell transplantation.
    UNASSIGNED: This study employed an analytical cross-sectional design. All patients referred to Shariati Hospital in Tehran between 2019 and 2020 who underwent hematopoietic stem cell transplantation were considered for inclusion in this study if they met the inclusion criteria. Inclusion criteria encompassed nonnot sexually active women aged 18-70 who received stem cell transplantation more than 100 days prior. Exclusion criteria comprised patients who experienced GVHD during the first 100 days posttransplantation. Additionally, individuals over 75 and patients with metastatic cancer were excluded.
    UNASSIGNED: A total of 55 patients were recruited, with ages averaging 40±9.9 years for recipients and 38.5±12.8 years for donors. Notably, 63.3 and 58.2% of patients exhibited oral and ocular symptoms, respectively. Regarding genital involvement, 49.1% experienced vaginal symptoms, while 25.5% had vulvar involvement. Among the 27 patients with vaginal involvement, two (7.4%) were categorized as mild, 17 (63%) as moderate, and eight (29.6%) as severe. Univariate analysis identified reduced vaginal discharge [odds ratio (OR=6.56)], vaginal tightness (OR=6.23), pelvic pain (OR=5.50), and vaginal involvement (OR=3.81) as significant predictors of other organ symptoms. Moreover, vaginal involvement (OR=3.68) emerged as the sole significant predictor of the cooccurrence of oral, ocular, and other organ symptoms. In the multivariate analysis, reduced vaginal discharge (OR=8.24) and vaginal tightness (OR=3.92) significantly predicted other organ symptoms (P=0.009).
    UNASSIGNED: Reduced vaginal discharge and vaginal tightness remained significant predictors of other organ symptoms.
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  • 文章类型: Journal Article
    背景:慢性阻塞性肺疾病(COPD)是一种普遍且可预防的疾病。正在探索间充质干细胞(MSC)疗法,以帮助肺细胞和气道结构的再生,旨在恢复肺功能。
    目的:为了检查MSCs与来自不同COPD表型的外周血单核细胞(PBMC)培养时的不同反应,患者被分组为ACOS,肺气肿,和慢性支气管炎类别。
    方法:将这些组和对照组的PBMC与牙囊来源的MSCs共培养,揭示了与对照组相比,COPD表型的细胞凋亡率不同。
    结果:慢性支气管炎组淋巴细胞活力最低(p<0.01),在除肺气肿外的所有表型中引入MSCs,慢性支气管炎组改善最明显(p<0.05)。
    结论:干细胞治疗可减少COPD患者外周血淋巴细胞凋亡,根据表型不同的反应,需要进一步研究以了解机制并优化针对每种COPD亚型的定制疗法。
    BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a prevalent and preventable condition. Mesenchymal stem cell (MSC) therapy is being explored to aid in the regeneration of lung cells and airway structure, aiming to restore lung function.
    OBJECTIVE: To examine varied responses of MSCs when cultured with peripheral blood mononuclear cells (PBMCs) from different COPD phenotypes, patients were grouped into ACOS, emphysema, and chronic bronchitis categories.
    METHODS: PBMCs from these groups and controls were co-cultured with MSCs derived from dental follicles, revealing differing rates of apoptosis among COPD phenotypes compared to controls.
    RESULTS: While the chronic bronchitis group exhibited the least lymphocyte viability (p<0.01), introducing MSCs notably enhanced viability across all phenotypes except emphysema, with the chronic bronchitis group showing the most improvement (p<0.05).
    CONCLUSIONS: Stem cell therapy might reduce peripheral lymphocyte apoptosis in COPD, with varying responses based on phenotype, necessitating further research to understand mechanisms and optimize tailored therapies for each COPD subtype.
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  • 文章类型: Journal Article
    在受伤的斑马鱼视网膜中,Müller胶质细胞(MG)重新编程以采用视网膜干细胞特性并再生受损的神经元。最强的斑马鱼重编程因子可能是刺激哺乳动物MG类似再生反应的良好候选者。Myc蛋白是有效的重编程因子,可以刺激分化细胞的细胞可塑性;然而,它们在MG重编程和视网膜再生中的作用尚不清楚。在这里,我们报道了视网膜损伤刺激mycb和mych表达,尽管Mycb和Mych都刺激MG重编程和增殖,只有Mych增强视网膜神经元凋亡。Wt的RNAseq分析,mychmut,Mycbmut鱼显示Mycb和Mych调节40%和16%,分别,有助于MG再生相关转录组的基因。在这些基因中,那些被诱导的偏向于调节核糖体生物发生,蛋白质合成,DNA合成,和细胞分裂是受视网膜损伤调节的顶级细胞过程,这表明Mycb和Mych是有效的MG重编程因子。与此一致,这些蛋白质中的任一种的强制表达足以刺激未损伤的视网膜中的MG增殖。
    In the injured zebrafish retina, Müller glial cells (MG) reprogram to adopt retinal stem cell properties and regenerate damaged neurons. The strongest zebrafish reprogramming factors might be good candidates for stimulating a similar regenerative response by mammalian MG. Myc proteins are potent reprogramming factors that can stimulate cellular plasticity in differentiated cells; however, their role in MG reprogramming and retina regeneration remains poorly explored. Here we report that retinal injury stimulates mycb and mych expression and that although both Mycb and Mych stimulate MG reprogramming and proliferation, only Mych enhances retinal neuron apoptosis. RNAseq analysis of Wt, mychmut, and mycbmut fish revealed Mycb and Mych regulate ∼40% and ∼16%, respectively, of the genes contributing to MG\'s regeneration-associated transcriptome. Of these genes, those that are induced are biased towards regulating ribosome biogenesis, protein synthesis, DNA synthesis, and cell division which are the top cellular processes regulated by retinal injury and this suggests Mycb and Mych are potent MG reprogramming factors. Consistent with this, forced expression of either of these proteins is sufficient to stimulate MG proliferation in the uninjured retina.
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  • 文章类型: Journal Article
    随着3D文化技术的进步,人类生理性癌症模型的发展开辟了新的途径。这些临床前模型提供了将基础癌症研究转化为临床肿瘤治疗的有效方法。最近,癌症类器官已成为解剖更复杂的肿瘤微环境的模型。将癌症类器官纳入临床前计划有可能提高肿瘤药物开发的成功率,并为癌症患者概述最有效的治疗方案。在这次审查中,介绍了四种主要类型的癌症器官,他们的应用,优势,局限性,并讨论了前景,以及最近单细胞RNA测序(scRNA-seq)在探索癌症类器官以推进这一领域的应用。
    As 3D culture technology advances, new avenues have opened for the development of physiological human cancer models. These preclinical models provide efficient ways to translate basic cancer research into clinical tumor therapies. Recently, cancer organoids have emerged as a model to dissect the more complex tumor microenvironment. Incorporating cancer organoids into preclinical programs have the potential to increase the success rate of oncology drug development and recapitulate the most efficacious treatment regimens for cancer patients. In this review, four main types of cancer organoids are introduced, their applications, advantages, limitations, and prospects are discussed, as well as the recent application of single-cell RNA-sequencing (scRNA-seq) in exploring cancer organoids to advance this field.
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  • 文章类型: Journal Article
    目的:本研究旨在表征同种异体SCT后一年内CMV再激活的发生率,并确定高血清阳性人群中CMV再激活发作的危险因素,其中首次CMV再激活发作被认为是高的。
    方法:这项回顾性队列研究分析了359名年龄在14岁及以上的三级学术医院收治的allo-SCT患者的数据。人口统计学和临床因素数据,CMV血清状态,调理方案,移植物抗宿主病预防,雕刻时间,收集CMV再激活。
    结果:第一次和第二次CMV再激活分别发生在88.9%和18.4%的同种异体SCT后患者中。根据需要进行allo-SCT的原发疾病,将患者分为两组,恶性(第1组)和非恶性(第2组)血液病患者。与第二次再激活相关的因素包括脐带血作为干细胞来源,人类白细胞抗原错配,急性移植物抗宿主病,和血液恶性肿瘤。非恶性血液病患者表现出更好的预后,与恶性血液病患者相比,首次CMV再激活的自发清除率更高(70%对49.4%),第二次CMV再激活的发生率更低(9.6%对31%)。一年总生存率为87.7%(非恶性血液病为95.5%,恶性血液病为78.13%)。
    结论:我们的发现与先前关于同种异体SCT后首次CMV再激活率高的局部研究一致。似乎非恶性血液病患者有更好的结果,例如,与恶性血液病患者相比,第二次CMV再激活更低,生存率更高。需要进一步研究以确定影响恶性血液病患者的同种异体SCT中CMV复发的其他因素。
    OBJECTIVE: This study aimed to characterize incidences of CMV reactivations within one year post-allo-SCT and identify risk factors for CMV second reactivation episode in population with high seropositivity where first CMV reactivation episode deemed to be high.
    METHODS: This retrospective cohort study analyzed data from 359 allo-SCT patients aged 14 and older admitted to a tertiary academic hospital. Data on demographic and clinical factors, CMV serostatus, conditioning regimens, graft-versus-host disease prophylaxis, engraftment time, and CMV reactivations were collected.
    RESULTS: First and second CMV reactivations occurred in 88.9% and 18.4% of post-allo-SCT patients respectively. Patients were stratified into two groups based on primary disease necessitating allo-SCT, patients with malignant (Group 1) and non-malignant (Group 2) hematological disease. Factors associated with the second reactivation included cord blood as a stem cell source, human leukocyte antigen mismatch, acute graft-versus-host disease, and hematological malignancies. Patients with non-malignant hematological disease displayed better outcomes, including a higher rate of spontaneous clearance of first CMV reactivation (70% versus 49.4%) and lower rates of second CMV reactivation (9.6% versus 31%) than those with malignant hematological disease. The one-year overall survival rate was 87.7% (95.5% in non-malignant hematological disease and 78.13% in malignant hematological disease).
    CONCLUSIONS: Our findings are concordant with previous local study in regard to high rate of first CMV reactivation post-allo-SCT. It appears that patients with nonmalignant hematological disease had better outcomes, such as lower second CMV reactivation and higher survival rates compared to patients with malignant hematological disease. Further investigation is needed to identify other factors affecting recurrent CMV reactivations in allo-SCT in patients with malignant hematological disease.
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  • 文章类型: Journal Article
    为了生存和复制,沙门氏菌已经进化了进入隐窝肠上皮细胞的机制。然而,鼠伤寒沙门氏菌对干细胞和祖细胞的影响,它们负责肠上皮自我更新和保护的能力,尚不清楚。鉴于肠道类器官的生长是由干细胞和祖细胞活动维持的,我们使用这个模型来记录鼠伤寒沙门氏菌感染对上皮增殖和分化的影响,并将其与小鼠体内沙门氏菌感染模型进行了比较。在肠段中,盲肠优先被沙门氏菌作为目标。受感染的隐窝和类器官的分析显示长度和大小增加,分别。感染的隐窝和类器官的mRNA转录谱指出上调的EGFR依赖性信号,与分泌细胞谱系分化减少有关。最后,我们表明,类器官适合模拟沙门氏菌对干细胞和祖细胞的影响,具有极大的潜力,可以大大减少在该主题的科学研究中使用动物。在这两种模型中,EGFR通路,对干细胞和祖细胞的增殖和分化至关重要,沙门氏菌失调,提示反复感染可能对隐窝完整性和进一步的肿瘤发生产生影响。
    In order to survive and replicate, Salmonella has evolved mechanisms to gain access to intestinal epithelial cells of the crypt. However, the impact of Salmonella Typhimurium on stem cells and progenitors, which are responsible for the ability of the intestinal epithelium to renew and protect itself, remains unclear. Given that intestinal organoids growth is sustained by stem cells and progenitors activity, we have used this model to document the effects of Salmonella Typhimurium infection on epithelial proliferation and differentiation, and compared it to an in vivo model of Salmonella infection in mice. Among gut segments, the caecum was preferentially targeted by Salmonella. Analysis of infected crypts and organoids demonstrated increased length and size, respectively. mRNA transcription profiles of infected crypts and organoids pointed to upregulated EGFR-dependent signals, associated with a decrease in secretory cell lineage differentiation. To conclude, we show that organoids are suited to mimic the impact of Salmonella on stem cells and progenitors cells, carrying a great potential to drastically reduce the use of animals for scientific studies on that topic. In both models, the EGFR pathway, crucial to stem cells and progenitors proliferation and differentiation, is dysregulated by Salmonella, suggesting that repeated infections might have consequences on crypt integrity and further oncogenesis.
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  • 文章类型: Journal Article
    在骨髓移植(BMT)中,造血重建细胞是在清髓治疗后引入的,其根除现有的造血细胞并破坏造血组织内的基质。然后造血细胞和基质都经历再生。我们的研究比较了在清髓性治疗后不久对小鼠进行第二次BMT和第一次BMT的结果,对初次移植后经历强大造血再生的小鼠进行第二次BMT。我们在植入效率方面评估了第二次BMT的疗效,生成的血细胞的类型,和功能的寿命。我们的发现表明,再生造血很容易容纳新移植的干细胞,包括那些具有强大的产生B和T细胞能力的细胞。重要的是,我们的调查发现了移植干细胞优先植入的窗口,同时恢复了血细胞的产生。重复的BMT可以增强造血重建,并能够治疗性地给予遗传修饰的自体干细胞。
    In bone marrow transplantation (BMT), hematopoiesis-reconstituting cells are introduced following myeloablative treatment, which eradicates existing hematopoietic cells and disrupts stroma within the hematopoietic tissue. Both hematopoietic cells and stroma then undergo regeneration. Our study compares the outcomes of a second BMT administered to mice shortly after myeloablative treatment and the first BMT, with those of a second BMT administered to mice experiencing robust hematopoietic regeneration after the initial transplant. We evaluated the efficacy of the second BMT in terms of engraftment efficiency, types of generated blood cells, and longevity of function. Our findings show that regenerating hematopoiesis readily accommodates newly transplanted stem cells, including those endowed with a robust capacity for generating B and T cells. Importantly, our investigation uncovered a window for preferential engraftment of transplanted stem cells coinciding with the resumption of blood cell production. Repeated BMT could intensify hematopoiesis reconstitution and enable therapeutic administration of genetically modified autologous stem cells.
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  • 文章类型: Journal Article
    背景:化疗相关卵巢损伤(CAOD)是绝经前妇女抗癌治疗最可怕的短期和长期副作用之一。积累的详细数据表明,不同的化疗方案可导致卵巢激素水平紊乱,减少或失去生育能力,更年期提前的风险增加。以前的研究往往集中在化疗药物对卵巢卵泡的直接影响,如直接DNA损伤介导的凋亡性死亡和原始卵泡倦怠。新的证据表明化疗期间卵巢微环境失衡。卵巢微环境提供营养支持和运输刺激卵泡生长和发育的信号,排卵,黄体的形成.卵巢微环境与卵泡之间的紧密相互作用可以决定卵巢功能。因此,设计新颖而精确的策略来操纵卵巢微环境可能是化疗期间保护卵巢功能的新策略。
    目的:这篇综述详细介绍了化疗过程中卵巢微环境的变化,并强调了开发化疗过程中通过靶向卵巢微环境保护卵巢功能的新疗法的重要性。
    方法:通过检索截至2024年4月的PubMed对文献进行了全面回顾。搜索词包括\'卵巢微环境\'(卵巢细胞外基质,卵巢基质细胞,卵巢间质,卵巢血管,卵巢淋巴管,卵巢巨噬细胞,卵巢淋巴细胞,卵巢免疫细胞因子,卵巢氧化应激,卵巢活性氧,卵巢衰老细胞,卵巢衰老相关分泌表型,卵巢卵原干细胞,卵巢干细胞),与卵巢功能相关的术语(生殖健康,生育力,不孕症,繁殖力,卵巢储备,卵巢功能,更年期,卵巢储备减少,过早的卵巢功能不全/衰竭),和与化疗相关的术语(环磷酰胺,环磷酰胺,甲基氯,苯丁酸氮芥,白消安,melphalan,丙卡巴嗪,顺铂,阿霉素,卡铂,紫杉烷,紫杉醇,多西他赛,5-氟尿嘧啶,长春新碱,甲氨蝶呤,放线菌素,博来霉素,巯基嘌呤)。
    结果:化疗期间卵巢微环境有很大变化,诱导细胞外基质沉积和基质纤维化,血管生成障碍,免疫微环境干扰,氧化应激失衡,卵巢干细胞衰竭,和细胞衰老,从而降低卵泡的数量和质量。已经采用了几种针对卵巢微环境的方法来预防和治疗CAOD,如干细胞疗法和使用自由基清除剂,senolytherapies,免疫调节剂,和促血管生成因子。
    结论:卵巢功能取决于其“种子”(卵泡)和“土壤”(卵巢微环境)。据报道,卵巢微环境在CAOD中起着至关重要的作用,靶向卵巢微环境可能为CAOD提供潜在的治疗方法。然而,卵巢微环境之间的关系,它的监管网络,和CAOD需要进一步研究。对这些问题的更好理解可能有助于解释CAOD的发病机理,并创造创新的策略来抵消对卵巢功能的影响。我们的目标是对CAOD的叙事回顾将激发这一重要领域的更多研究。
    背景:不适用。
    BACKGROUND: Chemotherapy-associated ovarian damage (CAOD) is one of the most feared short- and long-term side effects of anticancer treatment in premenopausal women. Accumulating detailed data show that different chemotherapy regimens can lead to disturbance of ovarian hormone levels, reduced or lost fertility, and an increased risk of early menopause. Previous studies have often focused on the direct effects of chemotherapeutic drugs on ovarian follicles, such as direct DNA damage-mediated apoptotic death and primordial follicle burnout. Emerging evidence has revealed an imbalance in the ovarian microenvironment during chemotherapy. The ovarian microenvironment provides nutritional support and transportation of signals that stimulate the growth and development of follicles, ovulation, and corpus luteum formation. The close interaction between the ovarian microenvironment and follicles can determine ovarian function. Therefore, designing novel and precise strategies to manipulate the ovarian microenvironment may be a new strategy to protect ovarian function during chemotherapy.
    OBJECTIVE: This review details the changes that occur in the ovarian microenvironment during chemotherapy and emphasizes the importance of developing new therapeutics that protect ovarian function by targeting the ovarian microenvironment during chemotherapy.
    METHODS: A comprehensive review of the literature was performed by searching PubMed up to April 2024. Search terms included \'ovarian microenvironment\' (ovarian extracellular matrix, ovarian stromal cells, ovarian interstitial, ovarian blood vessels, ovarian lymphatic vessels, ovarian macrophages, ovarian lymphocytes, ovarian immune cytokines, ovarian oxidative stress, ovarian reactive oxygen species, ovarian senescence cells, ovarian senescence-associated secretory phenotypes, ovarian oogonial stem cells, ovarian stem cells), terms related to ovarian function (reproductive health, fertility, infertility, fecundity, ovarian reserve, ovarian function, menopause, decreased ovarian reserve, premature ovarian insufficiency/failure), and terms related to chemotherapy (cyclophosphamide, lfosfamide, chlormethine, chlorambucil, busulfan, melphalan, procarbazine, cisplatin, doxorubicin, carboplatin, taxane, paclitaxel, docetaxel, 5-fluorouraci, vincristine, methotrexate, dactinomycin, bleomycin, mercaptopurine).
    RESULTS: The ovarian microenvironment shows great changes during chemotherapy, inducing extracellular matrix deposition and stromal fibrosis, angiogenesis disorders, immune microenvironment disturbance, oxidative stress imbalances, ovarian stem cell exhaustion, and cell senescence, thereby lowering the quantity and quality of ovarian follicles. Several methods targeting the ovarian microenvironment have been adopted to prevent and treat CAOD, such as stem cell therapy and the use of free radical scavengers, senolytherapies, immunomodulators, and proangiogenic factors.
    CONCLUSIONS: Ovarian function is determined by its \'seeds\' (follicles) and \'soil\' (ovarian microenvironment). The ovarian microenvironment has been reported to play a vital role in CAOD and targeting the ovarian microenvironment may present potential therapeutic approaches for CAOD. However, the relation between the ovarian microenvironment, its regulatory networks, and CAOD needs to be further studied. A better understanding of these issues could be helpful in explaining the pathogenesis of CAOD and creating innovative strategies for counteracting the effects exerted on ovarian function. Our aim is that this narrative review of CAOD will stimulate more research in this important field.
    BACKGROUND: Not applicable.
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