Intraovarian injection of platelet-rich plasma in assisted reproduction: too much too soon?
Intraovarian injection of platelet-rich plasma in assisted reproduction: too much too soon?
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DOI：
10.1093/humrep/deab106
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发表时间：
2021-06-18
期刊：
影响因子：
--
通讯作者：
Sturmey RG
中科院分区：
文献类型：
--
作者：
Atkinson L;Martin F;Sturmey RG
卵巢复兴的前景为治疗与年龄相关的生育能力下降或卵巢早衰等病理状况提供了诱人的前景。卵原干细胞（OSC）的存在表明了卵巢年轻化的概念，实验表明卵原干细胞具有分化为功能性卵泡并产生卵母细胞的能力；然而，它们的临床潜力仍然未知。此外，现在人们对进行原位卵巢再生的兴趣越来越大。一种提议的方法是向卵巢注射富含血小板的血浆（PRP）。 PRP 是体外去除红细胞和白细胞后残留的血液成分。它含有血小板，血液中微小的无核细胞，负责形成血栓以防止出血。此外，PRP 含有一系列细胞因子和生长因子，以及许多小分子。PRP 的效用已在一系列再生医学方法中进行了研究，并已被证明可以诱导一系列细胞类型的分化，推测是通过细胞因子的作用。一些病例报告描述了将 PRP 注射到人类卵巢中的用途，虽然这些临床数据报告了有希望的结果，但有关 PRP 注射到卵巢的机制和安全性的知识仍然有限。在本文中，我们总结了血小板和 PRP 的一些生理细节，然后回顾了该领域现有的新兴文献。然后，我们提出 PRP 可能产生影响的潜在机制，然后再考虑该领域未来研究的一些考虑因素。重要的是，根据我们现有的知识，我们认为立即在临床应用中使用 PRP 可能还为时过早，需要对卵巢功能不全的性质以及 PRP 作用于卵巢的机制进行进一步的基础和临床研究，以充分理解这一有前景的发展。
The prospect of ovarian rejuvenation offers the tantalising prospect of treating age-related declines in fertility or in pathological conditions such as premature ovarian failure. The concept of ovarian rejuvenation was invigorated by the indication of the existence of oogonial stem cells (OSCs), which have been shown experimentally to have the ability to differentiate into functional follicles and generate oocytes; however, their clinical potential remains unknown. Furthermore, there is now growing interest in performing ovarian rejuvenation in situ. One proposed approach involves injecting the ovary with platelet rich plasma (PRP). PRP is a component of blood that remains after the in vitro removal of red and white blood cells. It contains blood platelets, tiny anucleate cells of the blood, which are responsible for forming athrombus to prevent bleeding. In addition, PRP contains an array of cytokines and growth factors, as well as a number of small molecules.The utility ofPRP has been investigatedin a range of regenerative medicine approaches and has been shown to induce differentiation of a range of cell types, presumably through the action of cytokines. A handful ofcasereports have described the use of PRP injections into the ovaryin the human, and while these clinical data report promising results, knowledge on the mechanisms and safety of PRP injections into the ovary remain limited.In this article, we summarise some of the physiological detail of platelets and PRP, before reviewing the existing emerging literature in this area. We then propose potential mechanisms by which PRP may be eliciting any effects before reflecting on some considerations for future studies in the area. Importantly, on the basis of our existing knowledge, we suggest that immediate use of PRP in clinical applications is perhaps premature and further fundamental and clinical research on the nature of ovarian insufficiency, as well as the mechanism by which PRP may act on the ovary, is needed to fully understand this promising development.
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