O-248 Treatment with antifibrotic targets decreases accumulation of pro-fibrotic myofibroblasts and fibrotic collagen in cultured cryopreserved-thawed human cortical tissue
Authors: Del Valle J S , Van Helden R W J , Asseler J D , Louwe L A , Pilgram G S K , Metzemaekers J , Van der Westerlaken L A J , Van Mello N M , Chuva de SousaLopes S M 
Published: June 2023

Abstract

Study question
Could the excess deposition of fibrotic collagen and the presence of myofibroblast be reversed by in vitro culture of human cortical tissue with antifibrotic targets?

Summary answer
The in vitro treatment of fibrotic ovarian stroma with Metformin, Pirfenidone or Mitoquinone proved effective in decreasing collagen accumulation and the presence of myofibroblasts.

What is known already
Tissue fibrosis is characterized by an excessive accumulation of extracellular matrix proteins, leading to organ dysfunction. The ovary is the first organ to show fibrosis related to ageing, creating permissive conditions for ovarian cancer development. Due to this, there is an urgent need for ovarian fibrosis treatments. The clinically approved treatment with Metformin has shown efficacy in preventing fibrosis progression from post-menopausal ovaries obtained from diabetic patients, while Pirfenidone is used to treat pulmonary fibrosis. Transmasculine people exposed to prolonged androgen therapy show early signs of ovarian fibrosis, providing a suitable model to study ovarian fibrosis management strategies

Study design, size, duration
duration Fresh and cryopreserved-thawed human ovarian samples obtained from 9 cisgender women (cOVA) and 9 transgender and gender diverse people (tOVA) were included for histological analysis of collagen content and fiber organization. Cryopreserved-thawed cortical fragments from 6 tOVAs were cultured for 8 days with or without antifibrotic treatments (Metformin, Pirfenidone and Mitoquinone). Cryopreserved-thawed cortical fragments from 9 tOVAs were used for in vitro culture, followed by metabolic assays.

Participants/materials, setting, methods
Human ovarian samples were obtained from 9 cisgender women (29,1,3±7,9years) scheduled for gonadotoxic therapy undergoing oophorectomy for fertility preservation and from 24 transgender and gender diverse people (22,7±2,4 years) undergoing gender affirming oophorectomy. Collagen content and organization were visualized by second harmonic generation and polarized light imaging. Collagen type 1 and 4, ACTA2+ myofibroblasts and TUNEL+ apoptotic cells were detected and quantified using immunofluorescence. Mitochondrial respiration and glycolysis were measured using the Seahorse XF analyzer.

Main results and the role of chance
Histological analysis of collagen content and organization confirmed that tOVA from subjects in fertile age presents characteristics of ovarian fibrosis, such as a higher accumulation and anisotropic (linearized) organization of collagen fibers within the stroma, indicating that long exposure to androgen therapy affects the extracellular matrix composition of the ovary. Furthermore, both tOVA and cOVA cortical tissue showed an increase in anisotropic collagen disposition after being cryopreserved-thawed when compared to its fresh counterpart, indicating cryopreservation could favor fibrotic progression. Additionally, standard in vitro culture of cryopreserved-thawed ovarian cortical fragments promotes an accumulation of collagen 1 and 4 as well as an increase in the number of myofibroblasts and apoptotic cells after 8 days of culture. Treatment with antifibrotics targets such as Pirfenidone, Metformin and Mitoquinone proved to be efficient in reducing both collagen accumulation (P &lt; 0.05), pro-fibrotic myofibroblasts (P &lt; 0.05) and TUNEL+ apoptotic cells (P &lt; 0.05). These results support the evidence that ovarian fibrosis can be prevented or reverted in vitro with anti-oxidants and drugs targeting inflammatory response. As such, these treatments should be considered as therapeutic approaches for women of advancing age and metabolic disorders to prevent pro-tumorigenic fibrotic ovarian stroma.

Limitations, reasons for caution
Small sample size. There is variation in the type and duration of the androgen treatment in transgender and gender diverse people included in the study. Furthermore, the collagen analysis from the cOVA samples was performed on 1cm2 biopsies that might not represent the general collagen distribution in the complete ovary.

Wider implications of the findings
Medical treatments affecting the ovarian metabolic cell function, such as androgen therapy for transgender people and gender diverse or lab procedures to cryopreserved human ovarian tissue, can trigger fibrosis progression. Nevertheless, human ovarian fibrosis seems reversible and preventable using drugs targeting mitochondrial metabolism and inflammatory response.

Trial registration number
not applicable