Uterine autotransplantation in cynomolgus macaques

the first case of pregnancy and delivery

Makoto Mihara, Iori Kisu, Hisako Hara, Takuya Iida, Jun Araki, Timothy Shim, Mitsunaga Narushima, Takumi Yamamoto, Hisashi Moriguchi, Yojiro Kato, Makoto Tonsho, Kouji Banno, Daisuke Aoki, Nobuhiko Suganuma, Noriko Kagawa, Yuji Takehara, Osamu Kato, Isao Koshima

Research output: Contribution to journalArticle

62 Citations (Scopus)

Abstract

background: For women with congenital uterine infertility, or for those who have undergone hysterectomy, uterine transplantation is one of the potential treatments to regain fertility. In this study, we utilized a primate model of uterine transplantation, and evaluated the patency of our microsurgical anastomoses, and the perfusion of the transplanted uterus. methods: Two female cynomolgus monkeys underwent surgery.We anastomosed two arteries and one vein in Case 1 and two arteries and two veins in Case 2. The arteries used were the uterine arteries and the anastomosis was done to the external iliac artery.We used one of the ovarian veins in both animals, but resected the ovary from the Fallopian tube. Uterine arterial blood flow and uterine size were determined by intraoperative indocyanine green (ICG) angiography and ultrasonography. The biopsy of the uterine cervix was performed after surgery. results: ICG angiography showed that the unilateral uterine artery perfused the bilateral uterine bodies and cervix. In Case 1, ICG angiography showed the occlusion of one of the anastomosed arteries during the operation and the uterus appeared atrophied 2 months after operation. In Case 2, the transplanted uterus survived and normal menstruation occurred. The animal achieved a natural pregnancy and was delivered by the Caeserean section due to early separation of the placenta. The newborn suffered fetal distress. conclusions: These results show the anastomosis of at least the bilateral uterine arteries and the unilateral ovarian vein is required for uterus transplantation. This is the first report of a natural pregnancy in a primate following uterine autotransplantation.

Original languageEnglish
Pages (from-to)2332-2340
Number of pages9
JournalHuman Reproduction
Volume27
Issue number8
DOIs
Publication statusPublished - 2012 Aug

Fingerprint

Autologous Transplantation
Macaca
Uterine Artery
Uterus
Indocyanine Green
Veins
Arteries
Pregnancy
Angiography
Transplantation
Cervix Uteri
Primates
Fetal Distress
Macaca fascicularis
Menstruation
Fallopian Tubes
Iliac Artery
Hysterectomy
Infertility
Placenta

Keywords

  • Autotransplantation
  • Cynomolgus macaque
  • ICG
  • Indocyanine green angiography
  • Uterine transplantation

ASJC Scopus subject areas

  • Rehabilitation
  • Obstetrics and Gynaecology
  • Reproductive Medicine

Cite this

Mihara, M., Kisu, I., Hara, H., Iida, T., Araki, J., Shim, T., ... Koshima, I. (2012). Uterine autotransplantation in cynomolgus macaques: the first case of pregnancy and delivery. Human Reproduction, 27(8), 2332-2340. https://doi.org/10.1093/humrep/des169

Uterine autotransplantation in cynomolgus macaques : the first case of pregnancy and delivery. / Mihara, Makoto; Kisu, Iori; Hara, Hisako; Iida, Takuya; Araki, Jun; Shim, Timothy; Narushima, Mitsunaga; Yamamoto, Takumi; Moriguchi, Hisashi; Kato, Yojiro; Tonsho, Makoto; Banno, Kouji; Aoki, Daisuke; Suganuma, Nobuhiko; Kagawa, Noriko; Takehara, Yuji; Kato, Osamu; Koshima, Isao.

In: Human Reproduction, Vol. 27, No. 8, 08.2012, p. 2332-2340.

Research output: Contribution to journalArticle

Mihara, M, Kisu, I, Hara, H, Iida, T, Araki, J, Shim, T, Narushima, M, Yamamoto, T, Moriguchi, H, Kato, Y, Tonsho, M, Banno, K, Aoki, D, Suganuma, N, Kagawa, N, Takehara, Y, Kato, O & Koshima, I 2012, 'Uterine autotransplantation in cynomolgus macaques: the first case of pregnancy and delivery', Human Reproduction, vol. 27, no. 8, pp. 2332-2340. https://doi.org/10.1093/humrep/des169
Mihara, Makoto ; Kisu, Iori ; Hara, Hisako ; Iida, Takuya ; Araki, Jun ; Shim, Timothy ; Narushima, Mitsunaga ; Yamamoto, Takumi ; Moriguchi, Hisashi ; Kato, Yojiro ; Tonsho, Makoto ; Banno, Kouji ; Aoki, Daisuke ; Suganuma, Nobuhiko ; Kagawa, Noriko ; Takehara, Yuji ; Kato, Osamu ; Koshima, Isao. / Uterine autotransplantation in cynomolgus macaques : the first case of pregnancy and delivery. In: Human Reproduction. 2012 ; Vol. 27, No. 8. pp. 2332-2340.
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abstract = "background: For women with congenital uterine infertility, or for those who have undergone hysterectomy, uterine transplantation is one of the potential treatments to regain fertility. In this study, we utilized a primate model of uterine transplantation, and evaluated the patency of our microsurgical anastomoses, and the perfusion of the transplanted uterus. methods: Two female cynomolgus monkeys underwent surgery.We anastomosed two arteries and one vein in Case 1 and two arteries and two veins in Case 2. The arteries used were the uterine arteries and the anastomosis was done to the external iliac artery.We used one of the ovarian veins in both animals, but resected the ovary from the Fallopian tube. Uterine arterial blood flow and uterine size were determined by intraoperative indocyanine green (ICG) angiography and ultrasonography. The biopsy of the uterine cervix was performed after surgery. results: ICG angiography showed that the unilateral uterine artery perfused the bilateral uterine bodies and cervix. In Case 1, ICG angiography showed the occlusion of one of the anastomosed arteries during the operation and the uterus appeared atrophied 2 months after operation. In Case 2, the transplanted uterus survived and normal menstruation occurred. The animal achieved a natural pregnancy and was delivered by the Caeserean section due to early separation of the placenta. The newborn suffered fetal distress. conclusions: These results show the anastomosis of at least the bilateral uterine arteries and the unilateral ovarian vein is required for uterus transplantation. This is the first report of a natural pregnancy in a primate following uterine autotransplantation.",
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AU - Mihara, Makoto

AU - Kisu, Iori

AU - Hara, Hisako

AU - Iida, Takuya

AU - Araki, Jun

AU - Shim, Timothy

AU - Narushima, Mitsunaga

AU - Yamamoto, Takumi

AU - Moriguchi, Hisashi

AU - Kato, Yojiro

AU - Tonsho, Makoto

AU - Banno, Kouji

AU - Aoki, Daisuke

AU - Suganuma, Nobuhiko

AU - Kagawa, Noriko

AU - Takehara, Yuji

AU - Kato, Osamu

AU - Koshima, Isao

PY - 2012/8

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N2 - background: For women with congenital uterine infertility, or for those who have undergone hysterectomy, uterine transplantation is one of the potential treatments to regain fertility. In this study, we utilized a primate model of uterine transplantation, and evaluated the patency of our microsurgical anastomoses, and the perfusion of the transplanted uterus. methods: Two female cynomolgus monkeys underwent surgery.We anastomosed two arteries and one vein in Case 1 and two arteries and two veins in Case 2. The arteries used were the uterine arteries and the anastomosis was done to the external iliac artery.We used one of the ovarian veins in both animals, but resected the ovary from the Fallopian tube. Uterine arterial blood flow and uterine size were determined by intraoperative indocyanine green (ICG) angiography and ultrasonography. The biopsy of the uterine cervix was performed after surgery. results: ICG angiography showed that the unilateral uterine artery perfused the bilateral uterine bodies and cervix. In Case 1, ICG angiography showed the occlusion of one of the anastomosed arteries during the operation and the uterus appeared atrophied 2 months after operation. In Case 2, the transplanted uterus survived and normal menstruation occurred. The animal achieved a natural pregnancy and was delivered by the Caeserean section due to early separation of the placenta. The newborn suffered fetal distress. conclusions: These results show the anastomosis of at least the bilateral uterine arteries and the unilateral ovarian vein is required for uterus transplantation. This is the first report of a natural pregnancy in a primate following uterine autotransplantation.

AB - background: For women with congenital uterine infertility, or for those who have undergone hysterectomy, uterine transplantation is one of the potential treatments to regain fertility. In this study, we utilized a primate model of uterine transplantation, and evaluated the patency of our microsurgical anastomoses, and the perfusion of the transplanted uterus. methods: Two female cynomolgus monkeys underwent surgery.We anastomosed two arteries and one vein in Case 1 and two arteries and two veins in Case 2. The arteries used were the uterine arteries and the anastomosis was done to the external iliac artery.We used one of the ovarian veins in both animals, but resected the ovary from the Fallopian tube. Uterine arterial blood flow and uterine size were determined by intraoperative indocyanine green (ICG) angiography and ultrasonography. The biopsy of the uterine cervix was performed after surgery. results: ICG angiography showed that the unilateral uterine artery perfused the bilateral uterine bodies and cervix. In Case 1, ICG angiography showed the occlusion of one of the anastomosed arteries during the operation and the uterus appeared atrophied 2 months after operation. In Case 2, the transplanted uterus survived and normal menstruation occurred. The animal achieved a natural pregnancy and was delivered by the Caeserean section due to early separation of the placenta. The newborn suffered fetal distress. conclusions: These results show the anastomosis of at least the bilateral uterine arteries and the unilateral ovarian vein is required for uterus transplantation. This is the first report of a natural pregnancy in a primate following uterine autotransplantation.

KW - Autotransplantation

KW - Cynomolgus macaque

KW - ICG

KW - Indocyanine green angiography

KW - Uterine transplantation

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