Clinical trial NCT04865367: How Secreted-embryo-derived Trypsin Initiates, Maintains and Terminates Ca2+ Signals in Uterine Epithelial Cells
Official title: To Investigate How Secreted-embryo-derived Trypsin Initiates, Maintains and Terminates Ca2+ (Intracellular Calcium) Signals in Uterine Epithelial Cells
Study type: OBSERVATIONAL
Overall status: COMPLETED
Conditions: Infertility
Infertility, Female
Aneuploidy
Keywords: IVF
RNA
Ca2+
embryo
media
Lead sponsor: ART Fertility Clinics LLC
Sponsor class: OTHER
Collaborators: name: University Women's Hospital Tübingen
First posted: 2021-04-29
Enrollment: 81
Sex: FEMALE
Minimum age (years): 18
Maximum age (years): 36
Standard ages: ADULT
Accepts healthy volunteers: yes
Observational model: COHORT
Time perspective: PROSPECTIVE
Sampling method: NON_PROBABILITY_SAMPLE
Study population: Arab ethnicity, with primary / secondary infertility, who undergo an ICSI treatment with preimplantation genetic testing for aneuploidies.

Brief summary: To develop a deeper understanding of endometrial-embryo crosstalk through basic research, uncover therapeutic targets and to improve reproductive outcome.

Detailed description: Pregnancy is a complex and highly coordinated physiological process that involves implantation of a hatched blastocyst into a decidualizing endometrium. The main purpose of implantation is to ensure that the blastocyst firmly anchors into the decidual stroma, which allows further development by enabling placentation. Although a multitude of cellular events and molecular pathways involved in embryo-uterine crosstalk have been identified in mouse models, a comprehensive understanding of human embryo-uterine interaction is still missing. Our work indicates that endometrial epithelial Ca2+ signalling in response to serine proteases released by human embryos plays an important role in maternal recognition and selection of the conceptus at implantation. Previous studies have demonstrated that trophoblast spheroids can elevate \[Ca2+\]i in human uterine epithelial cell line (Ishikawa) by activating Ca2+ entry via mechano-sensitive Ca2+ permeable channels leading to the induction of epithelial adhesiveness. However, the mechanism(s) mediating the protease-induced \[Ca2+\]i transients in human uterine epithelium have not been studied to date. Investigators hypothesise that Na+ entry into the intravillous space via trypsin-activated ENaC will depolarise the cellular membrane and increase \[Na+\]v sufficiently high to reverse the sodium/calcium exchanger providing means for Ca2+ entry into the intravillous space. Ca2+ diffusion from the microvilli into the bulk cytoplasm will increase \[Ca2+\]i and, in parallel with SOCE, act as a source for re-filling of the ER. Increased \[Ca2+\]i will also activate the BK channels leading to repolarisation and termination of Ca2+ entry via the NCX.

By using spent medium from embryos, which will undergo pre-implantation genetic testing, it will become possible to determine, whether the above mentioned mechanisms are influenced by the ploidy status of the embryo.

Eligibility criteria: Inclusion Criteria:

* Couples with primary / secondary infertility who are planned to undergo ICSI treatment with PGT-A
* Age of each partner above 18 years

Exclusion Criteria:

* Couples with consanguinity (couple who is 1st or 2nd degree cousins)
* Couples in whom the female partner has a history of:
* Chemotherapy or radiation which impacts the ovarian reserve
* Surgery at the ovaries / adnex region
* Endometriosis
* Couples in whom the male partner has a history of:
* Chemotherapy / Radiation which impacts the semen result
* Surgery at the testicles
* Vasectomy
* Surgery for reversal of vasectomy
* Semen obtained by fine needle aspiration (FNA) or Testicular sperm extraction (TESE)

Primary outcomes:
measure: Change in markers of protein
timeFrame: 1 day
measure: Change in peak and slope levels of intracellular calcium
timeFrame: 1 day
measure: Change in morphohology of cells after incubation with embryo media
timeFrame: 1 day
Secondary outcomes:
measure: Performance of ICSI
timeFrame: 1 day
measure: Embryo quality on day 3
timeFrame: 1 day
measure: Embryo quality on day 5 (Gardner and Schoolcraft,1999)
timeFrame: 1 day
Other outcomes:
Locations:
city: Abu Dhabi
country: United Arab Emirates
facility: ART Fertility Clinics LLC
Study officials:
affiliation: ART Fertility Clinics LLC
name: BARBARA LAWRENZ, PhD
role: PRINCIPAL_INVESTIGATOR
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