Practical considerations for transitioning early childhood interventions to scale: lessons from the Saving Brains portfolio.

Small pilot studies of young children have frequently shown promise, but very few have been successfully scaled to the regional or national levels. How can we ensure that these promising approaches move from a suite of pilots to full-scale implementation that can deliver sustainable impact for hundreds of millions of children? To elucidate concrete lessons learned and suggestions on accelerating the transition to impact at scale, we reviewed the Saving Brains portfolio to better understand three points: (1) the extent to which useful signals of impact could be extracted from data at the seed phase, (2) the ways in which innovators (project leaders) were approaching human resource challenges critical for scaling, and (3) the multisector diversity of the portfolio and the way innovators entered partnerships. The findings suggest key considerations for transitioning early childhood development interventions to scale and sustainability: strong entrepreneurial leadership, rigorous measurement and active use of data in support of adaptive learning, and champions acting at subnational levels. Together, these can enable flexible, iterative learning that can make the scaling process an opportunity to increase the level of benefit each child receives from an intervention.

Plasminogen Improves Mouse IVF by Interactions with Inner Acrosomal Membrane-Bound MMP2 and SAMP14.

Spermatozoa must penetrate the outer investments of the oocyte, the cumulus oophorus and the zona pellucida (ZP), in order for fertilization to occur. This may require exposure of enzymes on the sperm's inner acrosomal membrane (IAM), one of which is matrix metalloproteinase (MMP) 2, to factors in oviductal fluid. Plasminogen is present in oviductal fluid and activates MMP2 in somatic tissues. The objectives of this study were: 1) to examine possible interactions between plasminogen and IAM-bound plasminogen activator receptor (SAMP14) and -MMP2, 2) to demonstrate plasminogen's presence in the extracellular environment at the site of fertilization, and 3) to provide evidence that plasminogen plays a role in fertilization. Zymographs of sonicated bull and rat sperm extracts incubated with plasmin and/or plasminogen (plasmin/ogen) showed acceleration of initiation of MMP2 activity in concentrations as low as 1 µg/ml. Immunohistochemical and immunofluorescence analysis of plasmin/ogen revealed its presence in the cytoplasm of mouse ovarian and oviductal oocytes, oviductal epithelium, around the ZP, and amongst the cumulus cells. We modified the standard in vitro fertilization (IVF) approach to more closely mimic natural fertilization by reducing sperm concentration during insemination by ∼100× and also comparing cumulus-intact and denuded oocytes. In mice, addition of plasminogen in IVF medium significantly improved fertilization, while MMP2 antibody significantly inhibited sperm penetration in these conditions. IVF improvement by plasminogen was blocked by SAMP14 antibody. Furthermore, MMP2 antibody inhibition was coincident with a failure by spermatozoa to disperse the cumulus oophorus. We provide evidence that plasminogen on its own and through an MMP2-related mechanism improves the ability of oocytes to be fertilized, and demonstrate its effect in sperm penetration of oocyte investments.