11. TRANSCRIPTOME ANALYSIS AND TIME-LAPSE OBSERVATION OF A CASE WITH REPEATED MULTIPLE PRONUCLEI AFTER ICSI

Introduction Pronucleus (PN) formation is a process by which the parental chromosome complements unite and engender the zygotic genome. During fertilization, the maternal PN is pulled toward the male counterpart, and the 2PN are juxtaposed and positioned in the central or paracentral region of the cytoplasm (Terada et al., 2010). More than 2PN can sometimes be observed, which is generally assumed to be due to either a polyspermic penetration or to the failure of a second polar body extrusion, especially in the case of 3PN (Rosenbusch et al., 2010). However, for oocytes with >3PN, the reason of their incidence remains unclear. The aim of the study was to identify the cause of repeated multipronuclei (MPN) formation in zygotes of a patient after intracytoplasmic sperm injection (ICSI). Material and Methods This is a case study of a patient with repeated MPN formation after five ICSI cycles (four in other clinics and one in Istanbul Memorial Hospital). Time-lapse monitoring of PN formation was carried out. Embryos developed from seven MPN zygotes of the sixth cycle were analyzed by FISH with the informed consent of the patient. Six MPN day-3 embryos and two surplus day-3 embryos for which the couples did not accept freezing were collected with informed consent from the patient and two couples, respectively. They were analyzed by whole genome expression analysis (Clariom™ D Assay, ThermoFisher Scientific). Results The time-lapse evaluation of the patient's 17 oocytes showed 9 MPN zygotes, one 3PN zygote, two unfertilized oocytes and three normally fertilized zygotes. The paternal pronuclei was of normal size and 7-9 micropronuclei appeared beneath the second polar body and migrated to the center of the cytoplasm. The ensuing cleavages were unequal and gave rise to a high rate of fragmentation. All MPN and the 3PN embryos arrested their development on day-3. Seven MPN embryos were analyzed by FISH and 1-20 micronuclei were observed in each blastomere. Six embryos were diagnosed as being chaotic aneuploid and one as being monosomy18 and nullisomy13. Transcriptomes of six MPN arrested day-3 embryos and two surplus 2PN good quality day-3 embryos were compared. Three pathways involving the AXIN1 gene were found to be significantly affected: Wnt signaling pathway and pluripotency, embryonic stem cell pluripotency pathways and the apoptosis-related network due to altered Notch3 in ovarian cancer. The chemokine signaling pathway (CCL19, FGR, PREX1 genes) known to be involved in the regulation of the actin cytoskeleton, which has a role in cell division, vesicle and organelle movement and interestingly documented to be disrupted in patients with premature ovarian failure was also found to be involved. Conclusions Several candidate coding genes involved in cell cycle, pluripotency of stem cells and actin cytoskeleton pathways have been identified as a new cause of MPN formation and infertility. However, transcriptional data from six MPN embryos can only provide clues for further investigation. Future studies, including whole exon sequencing of candidate genes of the patient, her family and other patients with MPN zygotes might help in identifying the exact mechanism of this phenomenon.