sliced the ovaries and cryopreserved them, then transplanted them back into the body a few years later as a "fertility battery" to start the pubertal development of girls with severe thalassemia... This slightly "sci-fi" plot was recently reproduced at the Sixth Affiliated Hospital of Sun Yat-sen University. The medical center was realized. This is the first case in China of a child with severe thalassemia using autologous frozen-thawed ovarian tissue transplantation to successfully induce puberty, giving more children with severe thalassemia hope to grow and develop normally like children of the same age.
The team performed ovarian tissue transplantation for the patient through laparoscopy
The right ovary was removed and cryopreserved
Thalassemia is a rare congenital anemia disease, which is more common in southern my country. There are obstacles in the synthesis of globin chains in the patient's body, which will lead to changes in the hemoglobin structure, affect the normal oxygen-carrying capacity, and cause damage to the liver, spleen and other functions. Most patients with thalassemia major die in infancy.
Xiaoxiao (pseudonym) from Shunde, Guangdong, was diagnosed with severe beta-thalassemia after birth. She needs monthly blood transfusions and iron elimination since she was 4 months old to maintain a normal life. Xiaoxiao, who has been in the hospital for a long time, is very thin. At the age of 14, she was only 1.48 meters tall, and her growth and development indicators were significantly lower than those of her peers.
In order to free their children from monthly blood transfusions, Xiaoxiao's parents decided to take a chance and let Xiaoxiao undergo a hematopoietic stem cell transplant. This is currently the only effective method to cure severe thalassemia, but radiotherapy and chemotherapy must be performed before surgery, which causes "destructive" damage to Xiaoxiao's ovaries and destroys her "fertility" (referring to the production of in women). Oocyte , egg cell and ability to conceive a fetus) and pubertal development. What to do with
? After many medical treatments, Xiaoxiao and her parents came to Zhongshan Sixth Hospital of Zhongshan Hospital to find a way to preserve their fertility.
Liang Xiaoyan, chief expert of the Obstetrics, Gynecology, Reproduction and Neonatology Department of Zhongshan Sixth Hospital and professor of the Reproductive Medicine Center, and her team developed a "fertility preservation plan" for Xiaoxiao - removing her right side before undergoing hematopoietic stem cell transplantation treatment The ovaries were sectioned and cryopreserved. After the hematopoietic stem cell transplant is successful, the appropriate time will be chosen to transplant the cryopreserved ovarian tissue back into the body, allowing Xiaoxiao to restore ovarian function and initiate puberty development. At the same time, the operation can also remove Xiaoxiao's eggs and induce them to mature outside the body, which is expected to meet her fertility needs in the future.
Why should we save the ovaries in slices instead of the whole? Liang Xiaoyan introduced that current technology can freeze and thaw certain human cells and tissues while retaining their functions, but larger and more complex tissues are less easy to cryopreserve. At the organ level, freezing and thawing are not currently clinically possible. Retains functionality after thawing.
In November 2019, Liang Xiaoyan's team teamed up with Wang Dejuan, chief physician of the hospital's pediatric surgery department, to remove Xiaoxiao's right ovary. Under the operation of chief physician Fang Cong and embryologist Sun Peng, it was cut into 11 pieces of tissue, which were frozen through strict operating procedures. . At the same time, the team put 24 eggs shed from the ovaries into the center's special egg nutrient solution, and finally induced maturation in vitro and cryopreserved 9 mature eggs.
In December 2019, Xiaoxiao completed a hematopoietic stem cell transplant and no longer needed blood transfusions to maintain her life after the operation. However, the results of the postoperative follow-up evaluation were as expected - Xiaoxiao's remaining left ovary had completely failed in function and was unable to secrete , estrogen, , etc., resulting in stagnation of her normal growth and development.
Using ovarian slices to "recharge" youth
On January 20 this year, it has been nearly three years since 16-year-old Xiaoxiao had a hematopoietic stem cell transplant. It was time to restart her natural puberty development plan.
After careful planning and repeated discussions, surgeon Li Manchao and others transplanted 5 pieces of thawed ovarian tissue into Xiaoxiao. The entire operation only took one hour. Li Manchao said: "Most of the follicles containing eggs are located in the ovarian cortex. During the operation, we opened Xiaoxiao's peritoneum and 'attached' the ovarian cortex slices to a place with better blood circulation, which is equivalent to an ovarian in situ transplantation. The ovarian cortical slices are viable and functional, and the faster the process of 'sticking' the ovaries, the better, and it took us less than 10 minutes."
Liang Xiaoyan introduced that these ovarian cortical slices can provide reproductive endocrine function for Xiaoxiao like a "battery", replacing the function of the ovary, secreting estrogen, etc., and promoting the development of other organs and tissues. "Female ovaries have 7 million basic Germ cells, and the average woman will only mature about 400 eggs in her lifetime, and other "unused" germ cells will naturally undergo apoptosis. Therefore, although the number of eggs on the slice is less than that of a normal ovary, the function of the ovary in the body can still be maintained. "
On average, one transplant can last for 4 years, and it can last up to 7 to 10 years. If the "battery" of the ovarian cortical slices transplanted for the first time has expired, and Xiaoxiao still needs to have children, the second transplant can be considered. The second and third transplantation. If Xiaoxiao wants to have children as an adult, she can also use the mature egg cells that were previously preserved to achieve this through in vitro fertilization.
The results of the reexamination 5 months after the operation showed that Xiaoxiao’s ovarian function was good. It has begun to recover, and sex hormones have returned to normal levels. Imaging examinations have found that Xiaoxiao's uterus and breasts have begun to grow, proving that the transplanted ovarian tissue has survived, and Xiaoxiao's puberty development has started. Two weeks ago, Xiaoxiao welcomed her baby. Her first menstrual period shows that the "fertility preservation technology through ovarian cortex" has been successful.
Liang Xiaoyan said that ovarian tissue transplantation technology has been used clinically around the world, but it still needs to be further promoted and applied in China. The requirements for software and hardware are very high, and it requires a very good team and laboratory conditions, as well as stable cryopreservation technology, in order to serve more patients with "fertility preservation" needs. "
[Reporter] Zhong Zhe
[Intern] Li Ailian
[Correspondent] Jian Wenyang Dai Xian
[Author] Zhong Zhe
Guangdong Health Headlines
