Rickers Natalie S, Sills E Scott
Plasma Research Section, FertiGen CAG/Regenerative Biology Group, San Clemente, CA, 92673, USA.
Department of Obstetrics & Gynecology, Palomar Medical Center, Escondido, California, USA.
Biomedicine (Taipei). 2022 Dec 1;12(4):1-8. doi: 10.37796/2211-8039.1380. eCollection 2022.
Platelets are a uniquely mammalian physiologic feature. As the only non-marine vertebrates to experience menopause, humans have a substantial post-reproductive lifespan and are believed to have a limited, non-renewable oocyte supply. Ovarian reserve typically declines after about age 35yrs, marking losses which cannot be recovered by available fertility medications. When fertilization fails due to low or absent ovarian response, gonadotropin adjustments are often ineffectual and if additional oocytes are occasionally harvested, egg quality is usually poor. This problem was confronted by Greek researchers who developed a new surgical method to insert autologous platelet-rich plasma (PRP) into ovaries; the first ovarian PRP success to improve reproductive outcomes was published from Athens in 2016. This innovation influenced later research with condensed platelet-derived growth factors, leading to correction of oocyte ploidy error, normal blastocyst development, and additional term livebirths. Yet women's health was among the last clinical domains to explore PRP, and its role in 'ovarian rejuvenation' remains unsettled. One critical aspect in this procedure is platelet activation, a commonly overlooked step in the cytokine release cascade considered essential for successful transition of undifferentiated ovarian stem cells to an oocyte lineage. Poor activation of platelets thus becomes an unforced error, potentially diminishing or even negating post-treatment ovarian follicular response. To answer this query, relevant theory, current disagreements, and new data on platelet activation are presented, along with clinical challenges for regenerative fertility practice.
血小板是哺乳动物独有的生理特征。作为唯一经历更年期的非海洋脊椎动物，人类有相当长的生殖后期寿命，并且被认为拥有有限的、不可再生的卵母细胞供应。卵巢储备通常在35岁左右开始下降，这种损失无法通过现有的生育药物恢复。当由于卵巢反应低下或无反应导致受精失败时，促性腺激素调整往往无效，而且即使偶尔采集到额外的卵母细胞，卵子质量通常也很差。希腊研究人员面临了这个问题，他们开发了一种新的手术方法，将自体富血小板血浆（PRP）注入卵巢；2016年雅典发表了首例卵巢PRP改善生殖结局的成功案例。这一创新影响了后来关于浓缩血小板衍生生长因子的研究，导致卵母细胞倍性错误得到纠正、囊胚正常发育以及更多足月活产。然而，女性健康是探索PRP的最后一批临床领域之一，其在“卵巢年轻化”中的作用仍未确定。该过程中的一个关键方面是血小板激活，这是细胞因子释放级联反应中一个常被忽视的步骤，被认为对于未分化的卵巢干细胞成功转变为卵母细胞谱系至关重要。因此，血小板激活不佳成为一个人为失误，可能会削弱甚至消除治疗后卵巢卵泡的反应。为了回答这个问题，本文介绍了血小板激活的相关理论、当前的分歧和新数据，以及再生生育实践中的临床挑战。
