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KAISA SELESNIEMI AND JONATHAN L. TILLY

Over the past few years, the wealth of information obtained from nearly 10 years of work with rodent models demonstrating the efficacy of S1P in preserving ovarian function and fertility of adult females exposed to conventional cancer treatments36,39,98,99,100,101 has served as a basis for testing the translational feasibility of using S1P as a fertility preservation agent in primates. This work is important for two principal reasons. The first and foremost is related to the very real possibility that the outcomes obtained with drug studies using rodent models will not be observed in primates as a result of species differences in drug bioactivity, metabolism, and the like. The second hurdle is one of an anatomical nature because primate ovaries are not enclosed within bursal sacs, as is the case with rodent ovaries. This is a key aspect in determining the potential utility of any antiapoptotic compound for the purpose of protecting the ovaries, because systemic availability of the compound could also protect the tumor targeted for destruction. In mice and rats this can be, and in fact was, circumvented by direct intrabursal injection of S1P before irradiation.36,98 Without a bursa, primate ovaries are not amenable to this type of localized drug delivery. However, using an intraovarian catheter-osmotic minipump system developed specifically for this purpose, very recent studies have reported that direct and controlled long-term delivery of S1P or the long-acting S1P mimetic FTY720 to the ovaries of adult female primates can be successfully achieved. Moreover, this approach was reported to protect monkey ovaries from the damaging effects of radiotherapy, leading to a maintenance of natural fertility and birth of offspring free of anatomical or cytogenetic defects.102 These encouraging findings provide important translational proof-of-concept that targeted antiapoptotic therapies can be used to preserve ovarian function and fertility in primates exposed to devastating cancer treatments.

6. CONCLUDING REMARKS

For many years, the field of apoptosis flourished by virtue of the fact that new regulatory genes and pathways were discovered on almost a daily basis. Many additional years have been spent attempting to integrate all of this information into a working generic blueprint for how apoptosis is activated and executed in various cell types and how these events are influenced by the surrounding environmental cues being constantly interpreted by the cell.103,104,105,106,107 With the assembly of this blueprint nearing completion, the new challenge faced by those in this field revolves around addressing

the question of how this information could actually be used for combating diseases and improving organ or tissue function in humans.108,109,110 Our goals here were to concisely summarize a few of the highlights of cell death research in the field of female reproduction, and in particular ovarian biology, over the past 20 years and to provide examples of how scientists in this field are attempting the meet the challenge of translating basic science findings to clinical medicine. Although some of these examples are clearly early stage, the progression of work to validate S1P as an ovarian protectant and fertility preservation agent for female cancer patients undergoing cytotoxic treatments clearly shows that such translational work with antiapoptotic compounds is feasible. Although the true measure of success of this approach awaits the final outcome of a future clinical trial in humans, as little as 10 years ago this line of thinking was viewed by many as not likely to succeed. However, the importance of the goal – improving the quality of life for female cancer survivors – far outweighed any resistance met, eventually leading the field of reproductive medicine to a point never before reached: protection of primate ovaries from 15 Gy of radiation using a small antiapoptotic molecule.102 So, does a delay of age-related ovarian failure and menopause, which has considerable ramifications for improving the quality of life in aging women, really seem that unattainable? If history is our best teacher, then the answer is no, especially considering the striking observations already made with aging Bax-deficient female mice.29,68 The challenge will be how to take what has been learned from these types of rodent studies and devise clinically amenable strategies for sustaining the oocyte and follicle pool in women as they age.

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