Spectrum of gluten-related disorders: consensus on new nomenclature and classification

A decade ago celiac disease was considered extremely rare outside Europe and, therefore, was almost completely ignored by health care professionals.

In only 10 years, key milestones have moved celiac disease from obscurity into the popular spotlight worldwide.

Now we are observing another interesting phenomenon that is generating great confusion among health care professionals. The number of individuals embracing a gluten-free diet (GFD) appears much higher than the projected number of celiac disease patients, fueling a global market of gluten-free products approaching $2.5 billion (US) in global sales in 2010.

This trend is supported by the notion that, along with celiac disease, other conditions related to the ingestion of gluten have emerged as health care concerns.

This review summarized the current knowledge about the 3 main forms of gluten reactions:

- allergic (wheat allergy)
- autoimmune (celiac disease, dermatitis herpetiformis and gluten ataxia)
- possibly immune-mediated (gluten sensitivity)

New nomenclature and classifications are proposed (see the figures below).

Key figures:

New nomenclature and classification of gluten-related disorders - http://www.biomedcentral.com/1741-7015/10/13/figure/F1

Algorithm for the differential diagnosis of gluten-related disorders, including celiac disease, gluten sensitivity and wheat allergy - http://www.biomedcentral.com/1741-7015/10/13/figure/F4

3 million Americans are living with celiac disease

Celiac disease, an immune system reaction to gluten in the diet, is four times as common today as it was 50 years ago. Lack of awareness of celiac could be contributing to a delay of up to 11 years in diagnosis of adults in North America (http://goo.gl/sy778).

This is an informative and beautifully designed video by the University of Chicago Celiac Disease Center. It looks like an infographic made into video - have a look:

New classification is being proposed for gluten-related disorders: celiac disease; dermatitis herpetiformis; gluten ataxia; wheat allergy; gluten sensitivity. WSJ, 2012.

Recent studies support the existence of the new condition nonceliac gluten sensitivity which is defined as symptoms with negative celiac antibodies and biopsy (http://goo.gl/57IlB).

References:

Spectrum of gluten-related disorders: consensus on new nomenclature and classification. Anna Sapone et al. BMC Medicine 2012, 10:13 doi:10.1186/1741-7015-10-13.
Image source: Colon (anatomy), Wikipedia, public domain.
Disclaimer: I am an Assistant Professor of Medicine and Pediatrics at University of Chicago.

Comments from Twitter:

Karen Price @brookmanknight: reflects well what we see in clinical practice, though haven't seen or dx'd too much derm herpetiformis.

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Unipolar depression in adolescence is common worldwide but often unrecognized

Unipolar depressive disorder in adolescence is common worldwide but often unrecognised. The incidence, notably in girls, rises sharply after puberty and, by the end of adolescence, the 1 year prevalence rate exceeds 4%.

The burden of depression is highest in low-income and middle-income countries. Depression is associated with morbidity, and heightens suicide risk.

The strongest risk factors for depression in adolescents are:

- family history of depression
- exposure to psychosocial stress

Factors that interact to increase risk through hormonal and perturbed neural pathways include:

- inherited risks
- developmental factors
- sex hormones
- psychosocial adversity

References:

Depression in adolescence. Prof Anita Thapar et al. The Lancet, Volume 379, Issue 9820, Pages 1056 - 1067, 17 March 2012.

Image source: OpenClipArt.org

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CW competition blog – Adam Hart-Davis

This is a guest post from one of our judges for the Chemistry World Science Communication Competition

50 years ago, while taking a gap year teaching in India, I used to write home to my parents every week (no email or mobiles then). In one letter, I asked my dad, a highly respected editor, how to write good English. He wrote back: ‘Use short sentences, and don’t start them with “It…”‘. I have followed this advice ruthlessly ever since, also applying it when editing texts of all kinds from various unfortunate authors, and it has served me well.

I have spent my entire career trying to make science accessible, and have found that short words and phrases help, as well as short sentences. So I tend to use ‘chose’ rather than ‘selected’ and ‘now’ rather than ‘at the present moment in time’ – just as William Tyndale, translating the Bible into English for the first time, used words of one syllable wherever he could: ‘an eye for an eye and a tooth for a tooth’.

And I try to avoid hype. Listening to commentary on recent tennis and cricket matches, I have been dismayed as shot after shot is described as ‘unbelievable’ or ‘incredible’. No; we have just seen them; they were brilliant, but not unbelievable.

So my advice is: keep the language simple. Using long words, excessive hype, and scientific jargon may make your text sound more important, but will always get in the way of understanding.

 

Adam Hart-Davis is a writer and broadcaster based in Devon, UK

 

Read Philip Ball’s competition blog post.

Find out about the Chemistry World Science Communication Competition and submit your entry here.

 

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Rewriting Archimedes’ principle

Archimedes’ principle does not work in the nanoworld. So say Roberto Piazza, from Milan Polytechnic in Italy, and his colleagues. The principle, a law of physics established 23 centuries ago, states that a body immersed in a fluid is buoyed up by a force equal to the weight of the fluid it displaces, but, as Piazza has found, this does not hold for objects a millionth of a millimetre in size.

‘It works for footballs, but not in the microscopic world,’ Piazza said in a recent interview. ‘What we have done is just a generalisation; had Archimedes had such small particles at his disposal, he could have done the same,’ he added.

Piazza’s team noticed that when they added gold nanoparticles (20 times more dense than water) to an aqueous suspension of plastic particles just slightly denser than water and six times larger than the nanoparticles, the gold nanoparticles floated to the top, forming a thin layer on the surface after a few days. ‘What happens is that not only is the liquid displaced, but the submerged object gets an additional upward push owing to the perturbation induced by the distribution of the other particles,’ explained Piazza. The larger particles slowly push the nanoparticles towards the surface.

The finding may have implications for biology and geology research, Piazza said. These include techniques to separate biological fluids from nanomaterials and getting a better idea of how sedimentary rocks form.

Elinor Hughes

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The Four Humors

Beth Cavener Stichter sanguine

Beth Cavener Stichter melancholic

Beth Cavener Stichter choleric

Beth Cavener Stichter phlegmatic

Beth Cavener Stichter was intrigued by the notion which is the basis of Hippocratic medicine: a person could be emotionally and psychologically evaluated by their level of fluids. According to ancient Greek Humorism, the traditional four temperaments: sanguine, melancholic, choleric, and phlegmatic were caused by imbalances in the four bodily fluids (humors): black bile, yellow bile, phlegm, and blood.

Sanguine – Too much blood – Passionate, Bold, impulsive
Melancholic – Too much black bile – Depressed, anxious, moody
Choleric – Too much yellow bile – Irritable, hostile, bitter
Phlegmatic – Too much phlegm – Passive, introverted, rational

This intrigue led her to create ‘The Four Humors’, a work which was displayed at the Claire Oliver Gallery at Art Miami.

 

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Jeremy Fish—Where Hearts Get Left

Jeremy Fish Heart Skull

Jeremy Fish Fifty24SF Where hearts Get Left

Jeremy Fish Fifty24SF Where hearts Get Left

Jeremy Fish Fifty24SF Where hearts Get Left

Jeremy Fish Fifty24SF Where hearts Get Left
Images via Fecal Face

Prolific and quite popular illustrator and artist, Jeremy Fish, has a new exhibition on at FIFTY24SF Gallery in San Francisco, CA from July 14, 2012 through September 14, 2012.  It has some really nice poppy anatomical elements throughout.

Titled, Where Hearts Get Left, this exhibition shows a new body of work by Jeremy that represents his love for San Francisco.  The work is thematically tied into local references including food spots, tourist attractions, history, and more all tied together using his signature style and subjects such as skulls and anatomical hearts.

View more preview shots from the show via Fecal Face.

Jeremy Fish Fifty24SF Where hearts Get Left

 

[posted to Street Anatomy Facebook by Dette]

 

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Bespoke Day of the Dead Skull Wallpaper

Bespoke Day of the Dead wallpaper teal by Emily Evans London
Photography by Jacqueline Wagner  Postproduction by Samuel Stuller

Bespoke Day of the Dead wallpaper teal by Emily Evans London

Bespoke Day of the Dead wallpaper black detail by Emily Evans London

Bespoke Day of the Dead wallpaper magenta by Emily Evans London
Photo by Vanessa Ruiz

Bespoke Day of the Dead wallpaper black by Emily Evans London
Photo by Vanessa Ruiz

Emily Evans of AnatomyUK gives us an exclusive look at the Day of the Dead Skull wallpaper she recently designed.  This unique wallpaper was developed specially for Barrio Central and Barrio North, two wonderfully colorful Latin bars located in Soho and Islington in London.

Emily extensively researched the Mexican Day of the Dead tradition and sugar skull representations before designing the perfect skull for the wallpaper pattern.

This high quality wallpaper is meticulously screen printed by hand using metallic gold ink on peacock, charcoal, and raspberry. The gold ink makes the pattern shine brilliantly under a variety of lighting.  This wallpaper is stunning in person, so if you’re in the London area, stop by Barrio Central or Barrio North (in the toilets) and see it!

 

Designed by Emily Evans. Made in London, UK.

For more information on this beautiful wallpaper, go to anatomyboutique.com.

 

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Morbid Anatomy Scholar in Residence and Star of TV’s "Oddities" Evan Michelson on "The Midnight Archive"

The newest latest episode of The Midnight Archive--Ronni Thomas' fantastic documentary series centered around Brooklyn's Observatory--has just gone live! Entitled "Dealing in the Obscure," it features Morbid Anatomy Library Scholar in Residence, star of TV's "Oddities", and good friend/partner in crime Evan Michelson waxing poetic on the pleasures of time travel through material culture, why some people are drawn to darkness, and her own uncannily beautiful collection.

To watch the episode, simply press play in the viewer above. More on the episode, in the words of director/creator Ronni Thomas:

The Midnight Archive - Ep. 14 - Evan Michelson - It is a pleasure to have Evan Michelson, owner of the NYC epicenter of the odd 'Obscura Antiques' and star of Science Channel's "Oddities"' as a guest on our series. In what is certainly our most abstract and experimental episode, she quite eloquently puts into words why some of us are so drawn to certain objects, the dark, and the disturbing. Her house is, as she puts it, a literal library of the strange and esoteric. Each artifact houses a special story and emotion for its possessor. So enjoy a very psychedelic and surreal episode of the series and please make sure to like our facebook page for random tidbits of macabre history and events around the world! And be sure if in NYC or visiting to check our Obscura Antiques in the East Village - you will not be disappointed!

For more on the series, to see any of the episodes, or to sign up for the mailing list and thus be alerted to future uploads, visit The Midnight Archive website by clicking here. You can also "like" it on Facebook--and be alerted in this way--by clicking here.

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"Last Things and Other Forms," Herbert Pfostl and Jon Beacham


My friend Herbert Pfostl--who is also the curator of the outstanding New Museum Bookstore and author of the wonderful To Die No More--has a lovely looking exhibition with artist Jon Beacham. Entitled "Last Things and Other Forms," it will be on view until this Friday, July 27th, whence it will be ushered out by a closing party from 6:30 to 10. Looks to be a lovely show. You can find out more by clicking here.

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Thermoascus aurantiacus is a promising source of enzymes for biomass deconstruction under thermophilic conditions

Background:
Thermophilic fungi have attracted increased interest for their ability to secrete enzymes that deconstruct biomass at high temperatures. However, development of thermophilic fungi as enzyme producers for biomass deconstruction has not been thoroughly investigated. Comparing the enzymatic activities of thermophilic fungal strains that grow on targeted biomass feedstocks has the potential to identify promising candidates for strain development. Thielavia terrestris and Thermoascus aurantiacus were chosen for characterization based on literature precedents.
Results:
Thermoascus aurantiacus and Thielavia terrestris were cultivated on various biomass substrates and culture supernatants assayed for glycoside hydrolase activities. Supernatants from both cultures possessed comparable glycoside hydrolase activities when incubated with artificial biomass substrates. In contrast, saccharifications of crystalline cellulose and ionic liquid-pretreated switchgrass (Panicum virgatum) revealed that T. aurantiacus enzymes released more glucose than T. terrestris enzymes over a range of protein mass loadings and temperatures. Temperature-dependent saccharifications demonstrated that the T. aurantiacus proteins retained higher levels of activity compared to a commercial enzyme mixture sold by Novozymes, Cellic CTec2, at elevated temperatures. Enzymes secreted by T. aurantiacus released glucose at similar protein loadings to CTec2 on dilute acid, ammonia fiber expansion, or ionic liquid pretreated switchgrass. Proteomic analysis of the T. aurantiacus culture supernatant revealed dominant glycoside hydrolases from families 5, 7, 10, and 61, proteins that are key enzymes in commercial cocktails.
Conclusions:
T. aurantiacus produces a complement of secreted proteins capable of higher levels of saccharification of pretreated switchgrass than T. terrestris enzymes. The T. aurantiacus enzymatic cocktail performs at the same level as commercially available enzymatic cocktail for biomass deconstruction, without strain development or genetic modifications. Therefore, T. aurantiacus provides an excellent platform to develop a thermophilic fungal system for enzyme production for the conversion of biomass to biofuels.Source:
http://www.biotechnologyforbiofuels.com/rss/

PGASO: A synthetic biology tool for engineering a cellulolytic yeast

Background:
To achieve an economical cellulosic ethanol production, a host that can do both cellulosic saccharification and ethanol fermentation is desirable. However, to engineer a non-cellulolytic yeast to be such a host requires synthetic biology techniques to transform multiple enzyme genes into its genome.
Results:
A technique, named Promoter-based Gene Assembly and Simultaneous Overexpression (PGASO), that employs overlapping oligonucleotides for recombinatorial assembly of gene cassettes with individual promoters, was developed. PGASO was applied to engineer Kluyveromycesmarxianus KY3, which is a thermo- and toxin-tolerant yeast. We obtained a recombinant strain, called KR5, that is capable of simultaneously expressing exoglucanase and endoglucanase (both of Trichodermareesei), a beta-glucosidase (from a cow rumen fungus), a neomycin phosphotransferase, and a green fluorescent protein. High transformation efficiency and accuracy were achieved as ~63% of the transformants was confirmed to be correct. KR5 can utilize beta-glycan, cellobiose or CMC as the sole carbon source for growth and can directly convert cellobiose and beta-glycan to ethanol.
Conclusions:
This study provides the first example of multi-gene assembly in a single step in a yeast species other than Saccharomyces cerevisiae. We successfully engineered a yeast host with a five-gene cassette assembly and the new host is capable of co-expressing three types of cellulase genes. Our study shows that PGASO is an efficient tool for simultaneous expression of multiple enzymes in the kefir yeast KY3 and that KY3 can serve as a host for developing synthetic biology tools.Source:
http://www.biotechnologyforbiofuels.com/rss/

A time course analysis of the extracellular proteome of aspergillus nidulans growing on sorghum stover

Background:
Fungi are important players in the turnover of plant biomass because they produce a broad range of degradative enzymes. Aspergillus nidulans, a well-studied saprophyte and close homologue to industrially important species such as A. niger and A. oryzae, was selected for this study.
Results:
A. nidulans was grown on sorghum stover under solid-state culture conditions for 1, 2, 3, 5, 7 and 14 days. Based on analysis of chitin content, A. nidulans grew to be 4-5% of the total biomass in the culture after 2 days and then maintained a steady state of 4% of the total biomass for the next 12 days. A hyphal mat developed on the surface of the sorghum by day one and as seen by scanning electron microscopy the hyphae enmeshed the sorghum particles by day 5. After 14 days hyphae had penetrated the entire sorghum slurry. Analysis (1-D PAGE LC-MS/MS) of the secretome of A. nidulans, and analysis of the breakdown products from the sorghum stover showed a wide range of enzymes secreted. A total of 294 extracellular proteins were identified with hemicellulases, cellulases, polygalacturonases, chitinases, esterases and lipases predominating the secretome. Time course analysis revealed a total of 196, 166, 172 and 182 proteins on day 1, 3, 7 and 14 respectively. The fungus used 20% of the xylan and cellulose by day 7 and 30% by day 14. Cellobiose dehydrogenase, feruloyl esterases, and CAZy family 61 endoglucanases, all of which are thought to reduce the recalcitrance of biomass to hydrolysis, were found in high abundance.
Conclusions:
Our results show that A. nidulans secretes a wide array of enzymes to degrade the major polysaccharides and lipids (but probably not lignin) by 1 day of growth on sorghum. The data suggests simultaneous breakdown of hemicellulose, cellulose and pectin. Despite secretion of most of the enzymes on day 1, changes in the relative abundances of enzymes over the time course indicates that the set of enzymes secreted is tailored to the specific substrates available. Our findings reveal that A. nidulans is capable of degrading the major polysaccharides in sorghum without any chemical pre-treatment.Source:
http://www.biotechnologyforbiofuels.com/rss/

Use of substructure-specific carbohydrate binding modules to track changes in cellulose accessibility and surface morphology during the amorphogenesis step of enzymatic hydrolysis

Cellulose amorphogenesis, described as the non-hydrolytic "opening up" or disruption of a cellulosic substrate, is becoming increasingly recognized as one of the key steps in the enzymatic deconstruction of cellulosic biomass when used as a feedstock for fuels and chemicals production. Although this process is thought to play a major role in facilitating hydrolysis, the lack of quantitative techniques capable of accurately describing the molecular-level changes occurring in the substrate during amorphogenesis has hindered our understanding of this process.
Results:
In this work, techniques for measuring changes in cellulose accessibility are reviewed and a new quantitative assay method is described. Carbohydrate binding modules (CBMs) with specific affinities for crystalline (CBM2a) or amorphous (CBM44) cellulose were used to track specific changes in the surface morphology of cotton fibres during amorphogenesis. The extents of phosphoric acid-induced and Swollenin-induced changes to cellulose accessibility were successfully quantified using this technique.
Conclusions:
The adsorption of substructure-specific CBMs can be used to accurately quantify the extent of changes to cellulose accessibility induced by non-hydrolytic disruptive proteins. The technique provided a quick, accurate and quantitative measure of the accessibility of cellulosic substrates. Expanding the range of CBMs used for adsorption studies to include those specific for such compounds as xylan ormannanshould also allow for the accurate quantitative tracking of the accessibility of these and other polymers within the lignocellulosic biomass matrix.Source:
http://www.biotechnologyforbiofuels.com/rss/

Feasibility of filamentous fungi for biofuel production using hydrolysate from dilute sulfuric acid pretreatment of wheat straw

Background:
Lipids produced from filamentous fungi show great promise for biofuel production, but a major limiting factor is the high production cost attributed to feedstock. Lignocellulosic biomass is a suitable feedstock for biofuel production due to its abundance and low value. However, very limited study has been performed on lipid production by culturing oleaginous fungi with lignocellulosic materials. Thus, identification of filamentous fungal strains capable of utilizing lignocellulosic hydrolysates for lipid accumulation is critical to improve the process and reduce the production cost.
Results:
The growth performances of eleven filamentous fungi were investigated when cultured on glucose and xylose. Their dry cell weights, lipid contents and fatty acid profiles were determined. Six fungal strains with high lipid contents were selected to culture with the hydrolysate from dilute sulfuric acid pretreatment of wheat straw. The results showed that all the selected fungal strains were able to grow on both detoxified liquid hydrolysate (DLH) and non-detoxified liquid hydrolysate (NDLH). The highest lipid content of 39.4% was obtained by Mortierella isabellina on NDLH. In addition, NDLH with some precipitate could help M. isabellina form pellets with an average diameter of 0.11 mm.
Conclusion:
This study demonstrated the possibility of fungal lipid production from lignocellulosic biomass. M. isabellina was the best lipid producer grown on lignocellulosic hydrolysates among the tested filamentous fungi, because it could not only accumulate oils with a high content by directly utilizing NDLH to simplify the fermentation process, but also form proper pellets to benefit the downstream harvesting. Considering the yield and cost, fungal lipids from lignocellulosic biomass are promising alternative sources for biodiesel production.Source:
http://www.biotechnologyforbiofuels.com/rss/

Obstetric and perinatal outcomes in singleton pregnancies resulting from IVF/ICSI: a systematic review and meta-analysis

BACKGROUND

Earlier reviews have suggested that IVF/ICSI pregnancies are associated with higher risks. However, there have been recent advances in the way IVF/ICSI is done, leading to some controversy as to whether IVF/ICSI singletons are associated with higher perinatal risks. The objective of this systematic review was to provide an up-to-date comparison of obstetric and perinatal outcomes of the singletons born after IVF/ICSI and compare them with those of spontaneous conceptions.

METHODS

Extensive searches were done by two authors. The protocol was agreed a priori. PRISMA guidance was followed. The data were extracted in 2 x 2 tables. Risk ratio and risk difference were calculated on pooled data using Rev Man 5.1. Quality assessment of studies was performed using Critical Appraisal Skills programme. Sensitivity analysis was performed when the heterogeneity was high (I2 > 50%).

RESULTS

There were 20 matched cohort studies and 10 unmatched cohort studies included in this review. IVF/ICSI singleton pregnancies were associated with a higher risk (95% confidence interval) of ante-partum haemorrhage (2.49, 2.30–2.69), congenital anomalies (1.67, 1.33–2.09), hypertensive disorders of pregnancy (1.49, 1.39–1.59), preterm rupture of membranes (1.16, 1.07–1.26), Caesarean section (1.56, 1.51–1.60), low birthweight (1.65, 1.56–1.75), perinatal mortality (1.87, 1.48–2.37), preterm delivery (1.54, 1.47–1.62), gestational diabetes (1.48, 1.33–1.66), induction of labour (1.18, 1.10–1.28) and small for gestational age (1.39, 1.27–1.53).

CONCLUSIONS

Singletons pregnancies after IVF/ICSI are associated with higher risks of obstetric and perinatal complications when compared with spontaneous conception. Further research is needed to determine which aspect of assisted reproduction technology poses most risk and how this risk can be minimized.

Source:
http://humupd.oxfordjournals.org/rss/current.xml

How do chemotherapeutic agents damage the ovary?

BACKGROUND

Chemotherapy treatment in premenopausal women is associated with an increased risk of premature ovarian failure (POF) but the exact mechanism through which this occurs is uncertain. In this review we examine the current evidence for the direct action of chemotherapeutic agents on the ovary and discuss possible molecular pathways through which follicle loss may occur.

METHODS

A systemic search of the databases, PubMed and Google Scholar, was made for all English language articles through to 2011 in each subject area discussed.

RESULTS

POF results from the loss of primordial follicles but this is not necessarily a direct effect of the chemotherapeutic agents. Instead, the disappearance of primordial follicles could be due to an increased rate of growth initiation to replace damaged developing follicles. Likewise, the loss of oocytes need not necessarily be a direct result of damage: evidence suggests that chemotherapy drugs can also induce oocyte death indirectly via damage to somatic cells. Specific molecular mechanisms and likely ovarian targets are discussed for some of the anti-cancer drugs most commonly used to treat premenopausal women. Finally, we consider current and prospective methods of preserving fertility.

CONCLUSIONS

It is likely that different chemotherapeutic drugs act through a range of mechanisms and on different target cells. More research into the cellular mechanisms underpinning chemotherapy-induced follicle loss could lead to the generation of treatments specifically designed to prevent POF.

Source:
http://humupd.oxfordjournals.org/rss/current.xml

A critical appraisal of cryopreservation (slow cooling versus vitrification) of human oocytes and embryos

BACKGROUND

Vitrification is now a commonly applied technique for cryopreservation in assisted reproductive technology (ART) replacing, in many cases, conventional slow cooling methodology. This review examines evidence relevant to comparison of the two approaches applied to human oocytes and embryos at different developmental stages.

METHODS

Critical review of the published literature using PubMed with particular emphasis on studies which include data on survival and implantation rates, data from fresh control groups and evaluation of the two approaches in a single setting.

RESULTS

Slow cooling is associated with lower survival rates and compromised development relative to vitrification when applied to metaphase II (MII) oocytes, although the vitrification results have predominantly been obtained using direct contact with liquid nitrogen and there is some evidence that optimal protocols for slow cooling of MII oocytes are yet to be established. There are no prospective randomized controlled trials (RCTs) which support the use of either technique with pronuclear oocytes although vitrification has become the method of choice. Optimal slow cooling, using modifications of traditional methodology, and vitrification can result in high survival rates of early embryos, which implant at the same rate as equivalent fresh counterparts. Many studies report high survival and implantation rates following vitrification of blastocysts. Although slow cooling of blastocysts has been reported to be inferior in some studies, others comparing the two approaches in the same clinical setting have demonstrated comparable results. The variation in the extent of embryo selection applied in studies can lead to apparent differences in clinical efficiency, which may not be significant if expressed on a ‘per oocyte used’ basis.

CONCLUSIONS

Available evidence suggests that vitrification is the current method of choice when cryopreserving MII oocytes. Early cleavage stage embryos can be cryopreserved with equal success using slow cooling and vitrification. Successful blastocyst cryopreservation may be more consistently achieved with vitrification but optimal slow cooling can produce similar results. There are key limitations associated with the available evidence base, including a paucity of RCTs, limited reporting of live birth outcomes and limited reporting of detail which would allow assessment of the impact of differences in female age. While vitrification has a clear role in ART, we support continued research to establish optimal slow cooling methods which may assist in alleviating concerns over safety issues, such as storage, transport and the use of very high cryoprotectant concentrations.

Source:
http://humupd.oxfordjournals.org/rss/current.xml