目的:评估基于脱细胞细胞外基质(dECM)的人工卵巢治疗卵巢衰竭的最新方法是什么?
结论:临床前研究表明,脱细胞支架在体外和体内均支持卵巢体细胞和卵泡的生长。
背景:人工卵巢是挽救卵巢功能的一种有希望的方法。去细胞化已应用于生物工程女性生殖道组织。然而,针对卵巢的去细胞化缺乏全面深入的认识。
■PubMed,Embase,WebofScience,从开始到2022年10月20日检索Cochrane中央对照试验登记册,以系统回顾所有使用脱细胞细胞外基质支架构建人工卵巢的研究.审查是根据系统审查和荟萃分析(PRISMA)方案的首选报告项目进行的。
方法:两位作者根据资格标准独立选择研究。如果去细胞支架,不管它们的物种起源,接种卵巢细胞或卵泡。评论文章和会议论文已从搜索结果中删除,没有脱细胞支架或再细胞化或脱细胞化方案的物品,或对照组或卵巢细胞。
结果:搜索返回了754种出版物,12篇论文符合最终分析条件。这些论文发表于2015年至2022年之间,最常见的报道是来自伊朗。关于去细胞化程序的详细信息,评价方法,并提取临床前研究设计。特别是,我们专注于洗涤剂的类型和持续时间,DNA和细胞外基质检测方法,和卵巢功能的主要发现。报道了来自人和实验动物的去细胞化组织。载有卵巢细胞的支架产生了雌激素和孕激素,尽管具有很高的可变性,并支持各种卵泡的生长。尚未报道严重的并发症。
结论:无法进行荟萃分析。因此,只进行了数据汇集。此外,一些研究的质量受到限制,主要是由于方法描述不完整,这阻碍了具体数据的提取和质量分析。使用dECM支架的几项研究由同一研究小组进行或撰写,并进行了一些修改。这可能会影响我们的评估.
结论:总体而言,基于去细胞化的人工卵巢是替代不足卵巢的一种有希望但实验性的选择。应该为去细胞化方案建立通用和可比的标准,质量执行,和细胞毒性控制。目前,脱细胞材料远不能临床应用于人工卵巢。
背景:本研究由国家自然科学基金(编号:82001498和81701438)。作者没有利益冲突要声明。
背景:此系统评价已在国际系统评价前瞻性注册(PROSPERO,IDCRD42022338449)。
OBJECTIVE: What is the current state-of-the-art methodology assessing decellularized extracellular matrix (dECM)-based artificial ovaries for treating ovarian failure?
CONCLUSIONS: Preclinical studies have demonstrated that decellularized scaffolds support the growth of ovarian somatic cells and follicles both in vitro and in vivo.
BACKGROUND: Artificial ovaries are a promising approach for rescuing ovarian function. Decellularization has been applied in bioengineering female reproductive tract tissues. However, decellularization targeting the ovary lacks a comprehensive and in-depth understanding.
UNASSIGNED: PubMed, Embase, Web of Science, and the Cochrane Central Register of Controlled Trials were searched from inception until 20 October 2022 to systematically review all studies in which artificial ovaries were constructed using decellularized extracellular matrix scaffolds. The review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol.
METHODS: Two authors selected studies independently based on the eligibility criteria. Studies were included if decellularized scaffolds, regardless of their species origin, were seeded with ovarian cells or follicles. Review articles and meeting papers were removed from the search results, as were articles without decellularized scaffolds or recellularization or decellularization protocols, or control groups or ovarian cells.
RESULTS: The search returned a total of 754 publications, and 12 papers were eligible for final analysis. The papers were published between 2015 and 2022 and were most frequently reported as coming from Iran. Detailed information on the decellularization procedure, evaluation method, and preclinical study design was extracted. In particular, we concentrated on the type and duration of detergent reagent, DNA and extracellular matrix detection methods, and the main findings on ovarian function. Decellularized tissues derived from humans and experimental animals were reported. Scaffolds loaded with ovarian cells have produced estrogen and progesterone, though with high variability, and have supported the growth of various follicles. Serious complications have not been reported.
CONCLUSIONS: A meta-analysis could not be performed. Therefore, only data pooling was conducted. Additionally, the quality of some studies was limited mainly due to incomplete description of methods, which impeded specific data extraction and quality analysis. Several studies that used dECM scaffolds were performed or authored by the same research group with a few modifications, which might have biased our evaluation.
CONCLUSIONS: Overall, the decellularization-based artificial ovary is a promising but experimental choice for substituting insufficient ovaries. A generic and comparable standard should be established for the decellularization protocols, quality implementation, and cytotoxicity controls. Currently, decellularized materials are far from being clinically applicable to artificial ovaries.
BACKGROUND: This study was funded by the National Natural Science Foundation of China (Nos. 82001498 and 81701438). The authors have no conflicts of interest to declare.
BACKGROUND: This systematic review is registered with the International Prospective Register of Systematic Reviews (PROSPERO, ID CRD42022338449).