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揭开早期胚胎停育的谜团:遗传因素与分子机制

Unraveling the mysteries of early embryonic arrest: genetic factors and molecular mechanisms.

作者信息

Zhang Jinyi, Lv Jing, Qin Juling, Zhang Ming, He Xuanyi, Ma Binyu, Wan Yingjing, Gao Ying, Wang Mei, Hong Zhidan

机构信息

Center for Reproductive Medicine, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, P.R. China.

Clinical Medicine Research Center of Prenatal Diagnosis and Birth Health in Hubei Province, Wuhan, Hubei, P.R. China.

出版信息

J Assist Reprod Genet. 2024 Dec;41(12):3301-3316. doi: 10.1007/s10815-024-03259-7. Epub 2024 Sep 26.

Abstract

Early embryonic arrest (EEA) is a critical impediment in assisted reproductive technology (ART), affecting 40% of infertile patients by halting the development of early embryos from the zygote to blastocyst stage, resulting in a lack of viable embryos for successful pregnancy. Despite its prevalence, the molecular mechanism underlying EEA remains elusive. This review synthesizes the latest research on the genetic and molecular factors contributing to EEA, with a focus on maternal, paternal, and embryonic factors. Maternal factors such as irregularities in follicular development and endometrial environment, along with mutations in genes like NLRP5, PADI6, KPNA7, IGF2, and TUBB8, have been implicated in EEA. Specifically, PATL2 mutations are hypothesized to disrupt the maternal-zygotic transition, impairing embryo development. Paternal contributions to EEA are linked to chromosomal variations, epigenetic modifications, and mutations in genes such as CFAP69, ACTL7A, and M1AP, which interfere with sperm development and lead to infertility. Aneuploidy may disrupt spindle assembly checkpoints and pathways including Wnt, MAPK, and Hippo signaling, thereby contributing to EEA. Additionally, key genes involved in embryonic genome activation-such as ZSCAN4, DUXB, DUXA, NANOGNB, DPPA4, GATA6, ARGFX, RBP7, and KLF5-alongside functional disruptions in epigenetic modifications, mitochondrial DNA, and small non-coding RNAs, play critical roles in the onset of EEA. This review provides a comprehensive understanding of the genetic and molecular underpinnings of EEA, offering a theoretical foundation for the diagnosis and potential therapeutic strategies aimed at improving pregnancy outcomes.

摘要

早期胚胎停滞(EEA)是辅助生殖技术(ART)中的一个关键障碍,它通过阻止早期胚胎从受精卵发育到囊胚阶段,影响了40%的不孕患者,导致缺乏可用于成功妊娠的存活胚胎。尽管其普遍存在,但EEA背后的分子机制仍然难以捉摸。本综述综合了关于导致EEA的遗传和分子因素的最新研究,重点关注母体、父体和胚胎因素。母体因素如卵泡发育和子宫内膜环境异常,以及NLRP5、PADI6、KPNA7、IGF2和TUBB8等基因的突变,都与EEA有关。具体而言,PATL2突变被认为会破坏母源 - 合子转变,损害胚胎发育。父体对EEA的影响与染色体变异、表观遗传修饰以及CFAP69、ACTL7A和M1AP等基因的突变有关,这些因素会干扰精子发育并导致不孕。非整倍体可能会破坏纺锤体组装检查点以及包括Wnt、MAPK和Hippo信号在内的信号通路,从而导致EEA。此外,参与胚胎基因组激活的关键基因,如ZSCAN4、DUXB、DUXA、NANOGNB、DPPA4、GATA6、ARGFX、RBP7和KLF5,以及表观遗传修饰、线粒体DNA和小非编码RNA的功能破坏,在EEA的发生中起着关键作用。本综述全面阐述了EEA的遗传和分子基础,为旨在改善妊娠结局的诊断和潜在治疗策略提供了理论基础。

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