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Here, we present a protocol for live-imaging of fluorescently labeled human endometrial fragments grafted in mice. The method allows studying the effects of drugs of choice on endometriotic lesion size through monitoring and quantification of fluorescence emitted by the fluorescent reporter on real time
Here, we describe a protocol for the implementation of a heterologous mouse model in which progression of endometriosis can be assessed in real time through noninvasive monitoring of fluorescence emitted by implanted ectopic human endometrial tissue. For this purpose, biopsies of human endometrium are obtained from donor women ongoing oocyte donation. Human endometrial fragments are cultured in the presence of adenoviruses engineered to express cDNA for the reporter fluorescent protein mCherry. Upon visualization, labeled tissues with an optimal rate of fluorescence after infection are subsequently chosen for the implantation in recipient mice. One week prior to the implantation surgery, recipient mice are oophorectomized, and estradiol pellets are placed subcutaneously to sustain the survival and growth of lesions. On the day of surgery mice are anesthetized, and peritoneal cavity accessed through a small (1.5 cm) incision by the linea-alba. Fluorescently labeled implants are tweezed, briefly soaked in glue and attached to the peritoneal layer. Incisions are sutured, and animals left to recover for a couple of days. Fluorescence emitted by endometriotic implants is usually non-invasively monitored every 3 days for 4 weeks with an in vivo imaging system. Variations in the size of endometriotic implants can be estimated in real time by quantification of the mCherry signal and normalization against the initial time-point showing maximal fluorescence intensity.
Traditional preclinical rodents of models of endometriosis do not allow non-invasive monitoring of lesion in real time but rather allow evaluation of the effects of drugs assayed at the end point. This protocol allows one to track lesions in real time and is more useful to explore the therapeutic potential of drugs in preclinical models of endometriosis. The main limitation of the model thus generated is that non-invasive monitoring is not possible over long periods of time due to the episomal expression of Ad-virus.
Endometriosis is a chronic gynecologic disorder initiated by the implantation of the functional endometrium outside the uterine cavity. Ectopic lesions grow and induce inflammatory processes leading to chronic pelvic pain and infertility1. It is estimated that up to 10–15% of women of reproductive age are affected by endometriosis2, and it is present in approximately 40–50% of infertile women3. Current pharmacological treatments for endometriosis are unable to completely eradicate lesions and not free of side effects4,5. The research for more efficient therapies requires of the refinement of the existing animal models of endometriosis in such a way that human lesions can be appropriately mimicked, and the effects of compounds on lesion size among others can be closely assessed.
Primate models have been used to mimic endometriosis by implanting ectopic lesions histologically identical and at similar sites as in humans6,7,8; however, ethical concerns and the high economic costs related to experimentation with primates limit their use9. Consequently, the use of small animals, especially rodents, for the implementation of in-vivo models of endometriosis continues to be favored as it allows studies with larger numbers of individuals10,11. Endometriosis can be induced in these animals by transplanting either pieces of rodent uterine horns ("homologous models")12,13 or human endometrial/endometriotic tissue to ectopic sites (heterologous models)14. In contrast to humans, rodents do not shed their endometrial tissue and thereby endometriosis can not be developed spontaneously in these species. Therefore, homologous mouse models of endometriosis have been criticized due to the fact that implanted ectopic mouse uterine tissue does not reflect the characteristics of human endometriotic lesions15.
Appropriate physiology of endometriosis can be mimicked in the heterologous models of endometriosis where fresh human endometrial fragments are implanted into immunodeficient animals. In conventional heterologous models, the therapeutic effects of compounds of interest are commonly assessed at the end point by the assessment of lesion size with the use of calipers16. An obvious limitation is that, as such, endpoint animal models do not allow studying implantation dynamics or endometriotic lesion development over time. An additional limitation is that the use of calipers does not allow accurate measurements of lesion size. Indeed, the standard error provided by calipers is in the same range (i.e., millimeters) as the size of the lesions implanted in mice, thus restricting the capacity of these tools to detect actual variations in size.
In order to overcome such limitations, herein, we describe the generation of a heterologous mouse model of endometriosis in which implanted human tissue is engineered to express a reporter m-Cherry fluorescent protein. Detection of the fluorescent signal with an appropriate image system enables non-invasive monitoring of lesion status with simultaneous quantification of its size in real time. Thus, our model provides clear advantages when compared to conventional endpoint models as it brings the opportunity of real-time non-invasive monitoring and the possibility to perform more objective and accurate estimation of variations in lesion size.
The use of human tissue specimens was approved by the Institutional Review Board and Ethics Committee of the Hospital Universitario La Fe. All patients provided written informed consent. The study involving animals was approved by the Institutional Animal Care Committee at the Centro de Investigacion Principe Felipe de Valencia, and all procedures were performed following the guidelines for the care and use of mammals from the National Institutes of Health.
1. Endometrial Tissue Collection and Pre-processing
2. Adenoviral Transfection of Endometrial Fragments
NOTE: All the materials that are going to be employed in the process should be introduced in the hood in advance. Take out everything that is not going to be used in the process and place a flask with bleach. All material that comes into contact with the adenoviral vector must be disinfected with the bleach before discarding it in the biohazard container.
3. Generation of the Endometriosis Mouse Model
NOTE: Use 6–8 week-old athymic nude (or similar immunocompromised strains) female mice housed in specific pathogen–free conditions, as recipient animals. To avoid hormonal cycle-dependent variations and simultaneously fuel lesion growth with estradiol, animals are ovariectomized and placed with 60-day release capsules containing 18 mg of 17 βeta-Estradiol (17β-E2). Oophorectomy and pellet placement have to be performed at least one week in advance of grafting endometrial fragments into the recipient animals.
4. In Vivo Fluorescent Imaging with an In Vivo Imaging System
5. Quantification of In Vivo Fluorescence Images
6. Data (fluorescent signal) Normalization
Here, we describe the process for creating a heterologous model of endometriosis in which the architecture of lesions is preserved by implanting fluorescently labeled pieces of human endometrium into immunocompromised mice, thus allowing non-invasive monitoring of lesion progression. Labeling of endometrial fragments is achieved by infection with adenovirus engineered to express mCherry, a protein emitting fluorescence in the near infrared region. In Figure 1...
The protocol herein detailed describes the implementation of an animal model of endometriosis in which the architecture of implanting lesions architecture is preserved whilst simultaneously allowing real time assessment of fluorescence emitted by mCherry labeled endometrial tissue. In this protocol, we describe the use of a specific in vivo imaging system and related software to non-invasively assess fluorescence emitted by the labeled lesion. Each user should adapt the protocol depending on the specific imaging device a...
The authors have nothing to disclose.
This work was supported by Spanish Ministry of Economy and Competitiveness through the Miguel Servet Program [CP13/00077] cofounded by FEDER (European Regional Development Fund) and awarded to Dr R. Gómez as well as by Carlos III Institute of Health grants awarded to Dr R Gómez [PI14/00547 and PI17/02329] and to Prof A. Cano [PI12/02582].
Name | Company | Catalog Number | Comments |
Endosampler™ | Medgyn | 22720 | Cannula for sampling the uterine endometrium |
DMEM Medium | VWR | HYCLSH30285.FS | Medium |
Ad-mCherry | Vector Biolabs | 1767 | Adenoviral vector expressing mCherry |
PBS, 1X solution, sterile, pH 7,4 | VWR | E504-500ML | Buffer for washes |
Pellets 17-B-Estradiol 18 mg/ 60 days | Innovative Research of America | SE-121 | Hormone pellets for rodents |
Vetbond™ Tissue Adhesive | 3M | 780-680 | Tissue adhesive |
Petri dishes in polystyrene crystal | Levantina | 367-P101VR20 | Petri dishes |
Penicillin-Streptomicin | Sigma | P4333-100ML | Antibiotics |
Syringes, medical 10 ml 0,5 ml | VWR | CODA626616 | Syringes |
Nitrile gloves, powder-free | VWR | 112-2754 | Gloves |
Soft swiss nude mice | Charles River | SNUSSFE05S | Mice for animal experiment |
Ivis Spectrum In vivo Imaging system | Perkin Elmer | 124262 | In vivo Monitoring equipment |
Living Image® (Ivis software) | Perkin Elmer | --- | In vivo monitoring software |
Fetal Bovine Serum | Gibco | 10082147 | Enrichment serum |
96-well cell culture treated plates | Life technologies | 167008 | Culture plates |
Urine flasks | Summedical | 4004-248-001 | Flasks for washes |
Sterile surgical blades | (Aesculap Division) Sanycare | 1609022-0008 | Surgical blades |
Isovet 1000 mg/g | B-BRAUN | --- | Isoflurane (Anesthetic) |
Buprex® 0.3 mg | Schering Plough S.A. | --- | Buprenorphine (Analgesic solution) |
Injectable morphine solution 10 mg/mL | B BRAUN | --- | Morphine (Analgesic solution) |
Monofyl® Absorbable Sutures | COVIDIEN | --- | Sutures |
Desinclor chlorhexidine | Promedic SA | --- | Antiseptic solution |
Microscopy DMi8 | Leica Mycrosystems | --- | fluorescence microscope |
Hera Cell 150 Incubator | Thermo Scientific | 51026282 | Incubator |
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