1
|
Verma P, Maan P, Gautam R, Arora T. Unveiling the Role of Artificial Intelligence (AI) in Polycystic Ovary Syndrome (PCOS) Diagnosis: A Comprehensive Review. Reprod Sci 2024:10.1007/s43032-024-01615-7. [PMID: 38907128 DOI: 10.1007/s43032-024-01615-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 06/02/2024] [Indexed: 06/23/2024]
Abstract
Polycystic Ovary Syndrome (PCOS) is one of the most widespread endocrine and metabolic disorders affecting women of reproductive age. Major symptoms include hyperandrogenism, polycystic ovary, irregular menstruation cycle, excessive hair growth, etc., which sometimes may lead to more severe complications like infertility, pregnancy complications and other co-morbidities such as diabetes, hypertension, sleep apnea, etc. Early detection and effective management of PCOS are essential to enhance patients' quality of life and reduce the chances of associated health complications. Artificial intelligence (AI) techniques have recently emerged as a popular methodology in the healthcare industry for diagnosing and managing complex diseases such as PCOS. AI utilizes machine learning algorithms to analyze ultrasound images and anthropometric and biochemical test result data to diagnose PCOS quickly and accurately. AI can assist in integrating different data sources, such as patient histories, lab findings, and medical records, to present a clear and complete picture of an individual's health. This information can help the physician make more informed and efficient diagnostic decisions. This review article provides a comprehensive analysis of the evolving role of AI in various aspects of the management of PCOS, with a major focus on AI-based diagnosis tools.
Collapse
|
2
|
Wang J, Li L, Zhou J, Pan X, Qi Q, Sun H, Wang L. Yishen Huatan Huoxue decoction and quercetin ameliorate decidualization dysfunction in polycystic ovary syndrome: A comprehensive investigation combining clinical trial and experimental studies. Drug Discov Ther 2024; 18:117-129. [PMID: 38644207 DOI: 10.5582/ddt.2024.01003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/23/2024]
Abstract
Polycystic ovary syndrome (PCOS) is a common gynecological endocrine disorder characterized by a complex pathogenesis and limited treatment options. Yishen Huatan and Huoxue decoction (YHHD), as a traditional Chinese Medicine formula, has shown effectiveness in treating PCOS. However, the specific mechanisms by which YHHD exerts its therapeutic effects remain unclear. In this study, we performed to investigate the therapeutic effects of YHHD and quercetin on dehydroepiandrosterone-induced PCOS mice, and examine the effect of quercetin on the decidualization of T-HESCs under hyperinsulinemic conditions. The results showed that YHHD could reduce early miscarriage rates in PCOS patients and significantly improved glucose metabolism disorders, sex hormone levels, and the estrous cycles in PCOS mice. Quercetin could alleviate effect of high insulin levels and restore the low expression of insulin receptor substrate1/2 (IRS1/2) and glucose transporte 4 (GLUT4) in T-HESCs, demonstrating its potential to mitigate hyperinsulin-induced decidualization dysfunction via the GLUT4 signaling pathway mediated by IRS1/2. This study provides valuable molecular insights of YHHD and highlight the therapeutic potential of quercetin in treating decidualization dysfunction in PCOS.
Collapse
Affiliation(s)
- Jing Wang
- Laboratory for Reproductive Immunology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
- The Academy of Integrative Medicine of Fudan University, Shanghai, China
- Shanghai Key Laboratory of Female Reproductive Endocrine-related Diseases, Shanghai, China
| | - Lisha Li
- Laboratory for Reproductive Immunology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
- The Academy of Integrative Medicine of Fudan University, Shanghai, China
- Shanghai Key Laboratory of Female Reproductive Endocrine-related Diseases, Shanghai, China
| | - Jing Zhou
- Laboratory for Reproductive Immunology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
- The Academy of Integrative Medicine of Fudan University, Shanghai, China
- Shanghai Key Laboratory of Female Reproductive Endocrine-related Diseases, Shanghai, China
| | - Xinyao Pan
- Laboratory for Reproductive Immunology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
- The Academy of Integrative Medicine of Fudan University, Shanghai, China
- Shanghai Key Laboratory of Female Reproductive Endocrine-related Diseases, Shanghai, China
| | - Qing Qi
- Laboratory for Reproductive Immunology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
- The Academy of Integrative Medicine of Fudan University, Shanghai, China
- Shanghai Key Laboratory of Female Reproductive Endocrine-related Diseases, Shanghai, China
| | - Hongmei Sun
- Laboratory for Reproductive Immunology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
- The Academy of Integrative Medicine of Fudan University, Shanghai, China
- Shanghai Key Laboratory of Female Reproductive Endocrine-related Diseases, Shanghai, China
| | - Ling Wang
- Laboratory for Reproductive Immunology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
- The Academy of Integrative Medicine of Fudan University, Shanghai, China
- Shanghai Key Laboratory of Female Reproductive Endocrine-related Diseases, Shanghai, China
| |
Collapse
|
3
|
Zhang M, Wang Y, Di J, Zhang X, Liu Y, Zhang Y, Li B, Qi S, Cao X, Liu L, Liu S, Xu F. High coverage of targeted lipidomics revealed lipid changes in the follicular fluid of patients with insulin-resistant polycystic ovary syndrome and a positive correlation between plasmalogens and oocyte quality. Front Endocrinol (Lausanne) 2024; 15:1414289. [PMID: 38904043 PMCID: PMC11187234 DOI: 10.3389/fendo.2024.1414289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Accepted: 05/16/2024] [Indexed: 06/22/2024] Open
Abstract
Background Polycystic ovary syndrome with insulin resistance (PCOS-IR) is the most common endocrine and metabolic disease in women of reproductive age, and low fertility in PCOS patients may be associated with oocyte quality; however, the molecular mechanism through which PCOS-IR affects oocyte quality remains unknown. Methods A total of 22 women with PCOS-IR and 23 women without polycystic ovary syndrome (control) who underwent in vitro fertilization and embryo transfer were recruited, and clinical information pertaining to oocyte quality was analyzed. Lipid components of follicular fluid (FF) were detected using high-coverage targeted lipidomics, which identified 344 lipid species belonging to 19 lipid classes. The exact lipid species associated with oocyte quality were identified. Results The number (rate) of two pronuclear (2PN) zygotes, the number (rate) of 2PN cleaved embryos, and the number of high-quality embryos were significantly lower in the PCOS-IR group. A total of 19 individual lipid classes and 344 lipid species were identified and quantified. The concentrations of the 19 lipid species in the normal follicular fluid (control) ranged between 10-3 mol/L and 10-9 mol/L. In addition, 39 lipid species were significantly reduced in the PCOS-IR group, among which plasmalogens were positively correlated with oocyte quality. Conclusions This study measured the levels of various lipids in follicular fluid, identified a significantly altered lipid profile in the FF of PCOS-IR patients, and established a correlation between poor oocyte quality and plasmalogens in PCOS-IR patients. These findings have contributed to the development of plasmalogen replacement therapy to enhance oocyte quality and have improved culture medium formulations for oocyte in vitro maturation (IVM).
Collapse
Affiliation(s)
- Meizi Zhang
- Reproductive Medicine Center, Tianjin First Central Hospital, Tianjin, China
| | - Yuanyuan Wang
- Reproductive Medicine Center, Tianjin First Central Hospital, Tianjin, China
| | - Jianyong Di
- Reproductive Medicine Center, Tianjin First Central Hospital, Tianjin, China
| | - Xuanlin Zhang
- Reproductive Medicine Center, Tianjin First Central Hospital, Tianjin, China
| | - Ye Liu
- Reproductive Medicine Center, Tianjin First Central Hospital, Tianjin, China
| | - Yixin Zhang
- Reproductive Medicine Center, Tianjin First Central Hospital, Tianjin, China
| | - Bowen Li
- LipidAll Technologies Company Limited, Changzhou, Jiangsu, China
| | - Simeng Qi
- LipidAll Technologies Company Limited, Changzhou, Jiangsu, China
| | - Xiaomin Cao
- Reproductive Medicine Center, Tianjin First Central Hospital, Tianjin, China
| | - Li Liu
- Reproductive Medicine Center, Tianjin First Central Hospital, Tianjin, China
| | - Shouzeng Liu
- Reproductive Medicine Center, Tianjin First Central Hospital, Tianjin, China
| | - Fengqin Xu
- Reproductive Medicine Center, Tianjin First Central Hospital, Tianjin, China
| |
Collapse
|
4
|
Wu Y, Liu C, Huang J, Wang F. Quantitative proteomics reveals pregnancy prognosis signature of polycystic ovary syndrome women based on machine learning. Gynecol Endocrinol 2024; 40:2328613. [PMID: 38497425 DOI: 10.1080/09513590.2024.2328613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 03/05/2024] [Indexed: 03/19/2024] Open
Abstract
OBJECTIVE We aimed to screen and construct a predictive model for pregnancy loss in polycystic ovary syndrome (PCOS) patients through machine learning methods. METHODS We obtained the endometrial samples from 33 PCOS patients and 7 healthy controls at the Reproductive Center of the Second Hospital of Lanzhou University from September 2019 to September 2020. Liquid chromatography tandem mass spectrometry (LCMS/MS) was conducted to identify the differentially expressed proteins (DEPs) of the two groups. Gene Ontology (GO) as well as Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analysis were performed to analyze the related pathways and functions of the DEPs. Then, we used machine learning methods to screen the feature proteins. Multivariate Cox regression analysis was also conducted to establish the prognostic models. The performance of the prognostic model was then evaluated by the receiver operating characteristic (ROC) curve, calibration curve, and decision curve analysis (DCA). In addition, the Bootstrap method was conducted to verify the generalization ability of the model. Finally, linear correlation analysis was performed to figure out the correlation between the feature proteins and clinical data. RESULTS Four hundred and fifty DEPs in PCOS and controls were screened out, and we obtained some pathways and functions. A prognostic model for the pregnancy loss of PCOS was established, which has good discrimination and generalization ability based on two feature proteins (TIA1, COL5A1). Strong correlation between clinical data and proteins were identified to predict the reproductive outcome in PCOS. CONCLUSION The model based on the TIA1 and COL5A1 protein could effectively predict the occurrence of pregnancy loss in PCOS patients and provide a good theoretical foundation for subsequent research.
Collapse
Affiliation(s)
- Yuanyuan Wu
- Traditional Chinese and Western Medicine, Gansu University of Chinese Medicine, Lanzhou, China
| | - Cai Liu
- Department of Reproductive Medicine, Lanzhou University Second Hospital, Lanzhou, China
| | - Jinge Huang
- Traditional Chinese and Western Medicine, Gansu University of Chinese Medicine, Lanzhou, China
| | - Fang Wang
- Department of Reproductive Medicine, Lanzhou University Second Hospital, Lanzhou, China
| |
Collapse
|
5
|
Zhao Z, Li D, Wang N, Xu L, Weng Y, Zhou W, Pan Y. The identification and functional analysis of CircRNAs in endometrial receptivity of mice with polycystic ovary. ENVIRONMENTAL TOXICOLOGY 2024; 39:1456-1470. [PMID: 37987463 DOI: 10.1002/tox.24052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 11/07/2023] [Accepted: 11/10/2023] [Indexed: 11/22/2023]
Abstract
The disorders of endometrial receptivity and ovulatory dysfunction are both significant causes of infertility in patients with polycystic ovary syndrome (PCOS). In this study, we investigated the expression profile and functional implications of circular RNAs (circRNAs) in the endometrial receptivity of PCOS-affected mice. Twenty-four female C57BL/6 mice were divided into PCOS and normal control groups. The PCOS group received subcutaneous DHEA treatment, while the control group remained untreated. Gene chip technology was utilized to analyze circRNA expression in endometrial tissues on the fourth day of gestation with subsequent bioinformatics analyses into circRNA functions. Furthermore, endometrial epithelial cells were used to determine represented circRNA functions. Results showed that the PCOS group exhibited 205 differentially expressed circRNAs, with 147 upregulated and 58 downregulated ones. qRT-PCR confirmed differential expression of circRNAs, including circRNA_38548, circRNA_001686, circRNA_38550, and circRNA_27938. Predicted target genes and a circRNA-miRNA-mRNA regulatory network were constructed. Additionally, four circRNAs (circRNA_38548, circRNA_38550, and circRNA_001686) were identified to contribute to abnormal endometrial receptivity by regulating genes such as Lifr, FOXK1, FOXO1, HOXA10, through interactions with miRNAs. Further research is warranted to elucidate the underlying mechanisms involving these circRNAs.
Collapse
Affiliation(s)
- Ziwei Zhao
- Department of Gynaecology and Obstetrics, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Dawei Li
- Reproductive Center, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Nan Wang
- Reproductive Center, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Li Xu
- Reproductive Center, Yangzhou Maternal and Child Health Hospital, Yangzhou, China
| | - Yujing Weng
- Reproductive Center, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Weiqin Zhou
- Reproductive Center, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yanping Pan
- Reproductive Center, The First Affiliated Hospital of Soochow University, Suzhou, China
| |
Collapse
|
6
|
Jin Y, Sun F, Yang A, Yu X, Li Y, Liang S, Jing X, Wang K, Zhang L, Xiao S, Zhang W, Wang X, Zhao G, Gao B. Insulin-like growth factor binding protein-1 and insulin in polycystic ovary syndrome: a systematic review and meta-analysis. Front Endocrinol (Lausanne) 2023; 14:1279717. [PMID: 38174331 PMCID: PMC10762309 DOI: 10.3389/fendo.2023.1279717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 11/27/2023] [Indexed: 01/05/2024] Open
Abstract
Background Insulin-like growth factor binding protein-1 (IGFBP-1) is considered a decline in polycystic ovary syndrome (PCOS), but it remains controversial that whether such reduction is attributed to obesity. Aims This systematic review aims to explore whether IGFBP-1 is reduced in PCOS, and whether such reduction is associated with obesity. Results Our pooled study included 12 studies with a total of 450 participants. IGFBP-1 levels in PCOS were significantly lower than that in non-PCOS (SMD (95%CI)=-0.49(-0.89, -0.09), P=0.02). No significant difference in IGFBP-1 levels between patients with or without PCOS classified by BMI. Whilst, stratification by PCOS status revealed a significant decrease in IGFBP-1 in overweight (SMD (95%CI)=-0.92(-1.46, -0.37), P=0.001). When comparing fasting insulin in the same way, PCOS patients had significantly elevated fasting insulin level but not statistically declined IGFBP-1 after classified by BMI. Conclusion This meta-analysis provides evidence that the decrease of IGFBP-1 in PCOS was more strongly influenced by comorbid obesity than by PCOS itself. Additionally, contrast to previous findings that insulin significantly suppresses IGFBP-1, our results suggested that the suppression of PCOS-related hyperinsulinemia on IGFBP-1 seemed diminished. Overall, our work may provide a novel perspective on the mechanism between insulin and IGFBP-1 underlying PCOS development.
Collapse
Affiliation(s)
- Yuxin Jin
- Department of Endocrinology, Tangdu Hospital, Air Force Medical University, Xi’an, Shaanxi, China
| | - Fei Sun
- Department of Endocrinology, Tangdu Hospital, Air Force Medical University, Xi’an, Shaanxi, China
| | - Aili Yang
- Department of Endocrinology, Tangdu Hospital, Air Force Medical University, Xi’an, Shaanxi, China
| | - Xinwen Yu
- Department of Endocrinology, Tangdu Hospital, Air Force Medical University, Xi’an, Shaanxi, China
| | - Yi Li
- Department of Gynaecology and Obstetrics, Tangdu Hospital, Air Force Medical University, Xi’an, Shaanxi, China
| | - Shengru Liang
- Department of Endocrinology, Tangdu Hospital, Air Force Medical University, Xi’an, Shaanxi, China
| | - Xiaorui Jing
- Department of Endocrinology, Tangdu Hospital, Air Force Medical University, Xi’an, Shaanxi, China
| | - Kai Wang
- Department of Endocrinology, Tangdu Hospital, Air Force Medical University, Xi’an, Shaanxi, China
| | - Lan Zhang
- Department of Endocrinology, Tangdu Hospital, Air Force Medical University, Xi’an, Shaanxi, China
| | - Sa Xiao
- Department of Endocrinology, Tangdu Hospital, Air Force Medical University, Xi’an, Shaanxi, China
| | - WenCheng Zhang
- Department of Endocrinology, Tangdu Hospital, Air Force Medical University, Xi’an, Shaanxi, China
| | - Xiaoguang Wang
- Department of Endocrinology, Tangdu Hospital, Air Force Medical University, Xi’an, Shaanxi, China
| | - Guohong Zhao
- Department of Endocrinology, Tangdu Hospital, Air Force Medical University, Xi’an, Shaanxi, China
| | - Bin Gao
- Department of Endocrinology, Tangdu Hospital, Air Force Medical University, Xi’an, Shaanxi, China
| |
Collapse
|
7
|
Moreira MV, Vale-Fernandes E, Albergaria IC, Alves MG, Monteiro MP. Follicular fluid composition and reproductive outcomes of women with polycystic ovary syndrome undergoing in vitro fertilization: A systematic review. Rev Endocr Metab Disord 2023; 24:1045-1073. [PMID: 37493841 PMCID: PMC10697886 DOI: 10.1007/s11154-023-09819-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/19/2023] [Indexed: 07/27/2023]
Abstract
Polycystic ovary syndrome (PCOS) is recognized as one of the most prevalent endocrinopathy in women at reproductive age. As affected women tend to have poorer assisted reproductive technology (ART) outcomes, PCOS has been suggested to endanger oocyte quality and competence development. The aim of this systematic review was to summarize the available evidence on how the follicular fluid (FF) profile of women with PCOS undergoing in vitro fertilization (IVF) treatment differs from the FF of normo-ovulatory women. For that, an electronic search in PubMed and Web of Science databases was conducted (up to December 2021). The Preferred Reporting Items for Systematic Reviews and Meta-Analyses - PRISMA guidelines were followed, and the Newcastle-Ottawa Scale was used to assess the risk of bias in the included studies. Data retrieved from papers included (n=42), revealed that the FF composition of women with PCOS compared to those without PCOS predominantly diverged at the following molecular classes: oxidative stress, inflammatory biomarkers, growth factors and hormones. Among those biomarkers, some were proposed as being closely related to pathophysiological processes, strengthening the hypothesis that low-grade inflammation and oxidative stress play a critical role in the pathogenesis of PCOS. Notwithstanding, it should be noticed that the available data on PCOS FF fingerprints derives from a limited number of studies conducted in a relatively small number of subjects. Furthermore, phenotypic heterogeneity of PCOS hampers wider comparisons and weakens putative conclusions. Therefore, future studies should be focused at comparing well characterized patient subgroups according to phenotypes.
Collapse
Affiliation(s)
- Mafalda V Moreira
- ICBAS - School of Medicine and Biomedical Sciences, UMIB - Unit for Multidisciplinary Research in Biomedicine, University of Porto, Rua Jorge Viterbo Ferreira, Porto, 228 4050-313, Portugal
- ITR- Laboratory for Integrative, Translational Research in Population Health, Porto, Portugal
- i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
| | - Emídio Vale-Fernandes
- ICBAS - School of Medicine and Biomedical Sciences, UMIB - Unit for Multidisciplinary Research in Biomedicine, University of Porto, Rua Jorge Viterbo Ferreira, Porto, 228 4050-313, Portugal
- ITR- Laboratory for Integrative, Translational Research in Population Health, Porto, Portugal
- Centre for Medically Assisted Procreation / Public Gamete Bank, Gynaecology Department, Centro Materno-Infantil do Norte Dr. Albino Aroso (CMIN), Centro Hospitalar Universitário de Santo António (CHUdSA), 4099-001, Porto, Portugal
| | - Inês C Albergaria
- ICBAS - School of Medicine and Biomedical Sciences, UMIB - Unit for Multidisciplinary Research in Biomedicine, University of Porto, Rua Jorge Viterbo Ferreira, Porto, 228 4050-313, Portugal
| | - Marco G Alves
- ICBAS - School of Medicine and Biomedical Sciences, UMIB - Unit for Multidisciplinary Research in Biomedicine, University of Porto, Rua Jorge Viterbo Ferreira, Porto, 228 4050-313, Portugal
- ITR- Laboratory for Integrative, Translational Research in Population Health, Porto, Portugal
| | - Mariana P Monteiro
- ICBAS - School of Medicine and Biomedical Sciences, UMIB - Unit for Multidisciplinary Research in Biomedicine, University of Porto, Rua Jorge Viterbo Ferreira, Porto, 228 4050-313, Portugal.
- ITR- Laboratory for Integrative, Translational Research in Population Health, Porto, Portugal.
| |
Collapse
|
8
|
Zou Y, Liao R, Cheng R, Chung H, Zhu H, Huang Y. Alterations of gut microbiota biodiversity and relative abundance in women with PCOS: A systematic review and meta-analysis. Microb Pathog 2023; 184:106370. [PMID: 37739322 DOI: 10.1016/j.micpath.2023.106370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 09/18/2023] [Accepted: 09/20/2023] [Indexed: 09/24/2023]
Abstract
BACKGROUND Numerous studies have implicated that the gut microbiota is associated with polycystic ovary syndrome (PCOS). However, a comprehensive data-based summary shown that the effects of the PCOS on the gut microbiota is minimal. We aim to assess the alterations of gut microbiota in women with PCOS. METHODS An electronic search of PubMed, Web of Science, Embase, Cochrane Library and Ovid was conducted for eligible studies published from inception to 28 March 2023, without any language or regional restrictions. We used Newcastle-Ottawa Quality Assessment Scale (NOS) to complete the assessment of the risk of bias and Stata 15.1 software to performed meta-analysis. RESULTS There were 19 human observational studies in total with 617 women with PCOS and 439 healthy individuals were identified. Compared to the control group, the Chao index (WMD -28.88, 95% CI -45.78 to -11.98, I2 = 100%), Shannon index (WMD -0.11, 95% CI -0.18 to 0.00, I2 = 92.2%); and observed operational taxonomic units (OTUs) counts (WMD - 23.48, 95% CI -34.44 to -12. 53, I2 = 99.6%) were significantly lower in women with PCOS. The relative abundance of Bacteroidaceae was significantly higher (WMD 0.12, 95% CI 0.02 to 0.22, I2 = 9.2%), however there were no statistical differences in Actinobacteria, Bacteroidetes, Firmicutes, Proteobacteria, Alcaligenaceae, Bifidobacteriaceae, Clostridiaceae, Enterobacteriaceae, Lachnospiraceae, Prevotellaceae, Ruminococcaceae, Veillonellaceae, Bacteroides, Bifidobacterium, Blautia, Dialister, Escherichia-Shigella, Faecalibacterium, Lachnoclostridium, Lachnospira, Megamonas, Phascolarctobacterium, Prevotella, Roseburia, and Subdoligranulum. CONCLUSION We demonstrated the alpha diversity of gut microbiota and the relative abundance of Bacteroidaceae in women with PCOS are altered. The results indicates that dysbiosis may be a potential pathogenetic factor in PCOS and provided reliable information to investigate the role of gut microbiota in the development and progression of PCOS.
Collapse
Affiliation(s)
- Yuanyuan Zou
- Department of Gynecology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China.
| | - Ruoyuan Liao
- Department of Gynecology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China.
| | - Rui Cheng
- Department of Gynecology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China.
| | - Huiyee Chung
- Department of Gynecology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China.
| | - Hongqiu Zhu
- Department of Gynecology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China.
| | - Yefang Huang
- Department of Gynecology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China.
| |
Collapse
|
9
|
Meltsov A, Saare M, Teder H, Paluoja P, Arffman RK, Piltonen T, Laudanski P, Wielgoś M, Gianaroli L, Koel M, Peters M, Salumets A, Krjutškov K, Palta P. Targeted gene expression profiling for accurate endometrial receptivity testing. Sci Rep 2023; 13:13959. [PMID: 37633957 PMCID: PMC10460380 DOI: 10.1038/s41598-023-40991-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 08/20/2023] [Indexed: 08/28/2023] Open
Abstract
Expressional profiling of the endometrium enables the personalised timing of the window of implantation (WOI). This study presents and evaluates a novel analytical pipeline based on a TAC-seq (Targeted Allele Counting by sequencing) method for endometrial dating. The expressional profiles were clustered, and differential expression analysis was performed on the model development group, using 63 endometrial biopsies spanning over proliferative (PE, n = 18), early-secretory (ESE, n = 18), mid-secretory (MSE, n = 17) and late-secretory (LSE, n = 10) endometrial phases of the natural cycle. A quantitative predictor model was trained on the development group and validated on sequenced samples from healthy women, consisting of 52 paired samples taken from ESE and MSE phases and five LSE phase samples from 31 individuals. Finally, the developed test was applied to 44 MSE phase samples from a study group of patients diagnosed with recurrent implantation failure (RIF). In validation samples (n = 57), we detected displaced WOI in 1.8% of the samples from fertile women. In the RIF study group, we detected a significantly higher proportion of the samples with shifted WOI than in the validation set of samples from fertile women, 15.9% and 1.8% (p = 0.012), respectively. The developed model was evaluated with an average cross-validation accuracy of 98.8% and an accuracy of 98.2% in the validation group. The developed beREADY screening model enables sensitive and dynamic detection of selected transcriptome biomarkers, providing a quantitative and accurate prediction of endometrial receptivity status.
Collapse
Affiliation(s)
- Alvin Meltsov
- Competence Centre On Health Technologies, 50411, Tartu, Estonia
- Department of Genetics and Cell Biology, GROW School for Oncology and Developmental Biology, Maastricht University, 6200 MD, Maastricht, The Netherlands
| | - Merli Saare
- Competence Centre On Health Technologies, 50411, Tartu, Estonia.
- Department of Obstetrics and Gynecology, Institute of Clinical Medicine, University of Tartu, 50406, Tartu, Estonia.
| | - Hindrek Teder
- Competence Centre On Health Technologies, 50411, Tartu, Estonia
- Institute of Biomedicine and Translational Medicine, University of Tartu, 50411, Tartu, Estonia
| | - Priit Paluoja
- Competence Centre On Health Technologies, 50411, Tartu, Estonia
- Department of Obstetrics and Gynecology, Institute of Clinical Medicine, University of Tartu, 50406, Tartu, Estonia
| | - Riikka K Arffman
- Department of Obstetrics and Gynecology, PEDEGO Research Unit, Medical Research Center, Oulu University Hospital, University of Oulu, FI-90014, Oulu, Finland
| | - Terhi Piltonen
- Department of Obstetrics and Gynecology, PEDEGO Research Unit, Medical Research Center, Oulu University Hospital, University of Oulu, FI-90014, Oulu, Finland
| | - Piotr Laudanski
- Oviklinika Infertility Center, 01-377, Warsaw, Poland
- Women's Health Research Institute, Calisia University, 62-800, Kalisz, Poland
- Department of Obstetrics, Gynecology and Gynaecological Oncology, Medical University of Warsaw, 02-091, Warsaw, Poland
| | | | - Luca Gianaroli
- SISMeR, Reproductive Medicine Institute, 40138, Bologna, Italy
| | - Mariann Koel
- Institute of Genomics, University of Tartu, 51010, Tartu, Estonia
| | - Maire Peters
- Competence Centre On Health Technologies, 50411, Tartu, Estonia
- Department of Obstetrics and Gynecology, Institute of Clinical Medicine, University of Tartu, 50406, Tartu, Estonia
| | - Andres Salumets
- Competence Centre On Health Technologies, 50411, Tartu, Estonia
- Department of Obstetrics and Gynecology, Institute of Clinical Medicine, University of Tartu, 50406, Tartu, Estonia
- Division of Obstetrics and Gynecology, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet and Karolinska University Hospital, SE-141 52, Stockholm, Sweden
| | - Kaarel Krjutškov
- Competence Centre On Health Technologies, 50411, Tartu, Estonia
- Department of Obstetrics and Gynecology, Institute of Clinical Medicine, University of Tartu, 50406, Tartu, Estonia
| | - Priit Palta
- Competence Centre On Health Technologies, 50411, Tartu, Estonia
- Institute of Genomics, University of Tartu, 51010, Tartu, Estonia
- Institute for Molecular Medicine Finland (FIMM), University of Helsinki, FI-00014, Helsinki, Finland
| |
Collapse
|
10
|
Yusuf ANM, Amri MF, Ugusman A, Hamid AA, Wahab NA, Mokhtar MH. Hyperandrogenism and Its Possible Effects on Endometrial Receptivity: A Review. Int J Mol Sci 2023; 24:12026. [PMID: 37569402 PMCID: PMC10419014 DOI: 10.3390/ijms241512026] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Revised: 07/24/2023] [Accepted: 07/25/2023] [Indexed: 08/13/2023] Open
Abstract
Endometrial receptivity is a state of the endometrium defined by its readiness for embryo implantation. When the receptivity of the endometrium is impaired due to hyperandrogenism or androgen excess, this condition can lead to pregnancy loss or infertility. Hyperandrogenism encompasses a wide range of clinical manifestations, including polycystic ovary syndrome (PCOS), idiopathic hirsutism, hirsutism and hyperandrogaenemia, non-classical congenital adrenal hyperplasia, hyperandrogenism, insulin resistance, acanthosis nigricans (HAIR-AN), ovarian or adrenal androgen-secreting neoplasms, Cushing's syndrome, and hyperprolactinaemia. Recurrent miscarriages have been shown to be closely related to elevated testosterone levels, which alter the endometrial milieu so that it is less favourable for embryo implantation. There are mechanisms for endometrial receptivity that are affected by excess androgen. The HOXA gene, aVβ3 integrin, CDK signalling pathway, MECA-79, and MAGEA-11 were the genes and proteins affect endometrial receptivity in the presence of a hyperandrogenic state. In this review, we would like to explore the other manifestations of androgen excess focusing on causes other than PCOS and learn possible mechanisms of endometrial receptivity behind androgen excess leading to pregnancy loss or infertility.
Collapse
Affiliation(s)
- Allia Najmie Muhammad Yusuf
- Department of Physiology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia
- Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, University Malaysia Sabah, Kota Kinabalu 88400, Malaysia
| | - Mohd Fariz Amri
- Department of Pathology, Faculty of Medicine and Health Sciences, University Malaysia Sabah, Kota Kinabalu 88400, Malaysia
| | - Azizah Ugusman
- Department of Physiology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia
| | - Adila A. Hamid
- Department of Physiology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia
| | - Norhazlina Abdul Wahab
- Department of Physiology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia
| | - Mohd Helmy Mokhtar
- Department of Physiology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia
| |
Collapse
|
11
|
Yang Z, Liu F, Bai J, Ye Z, Yin J, Peng T, Shan H, Yu Y, Zhou P, Li R. Circ_0115118 regulates endometrial functions through the miR-138-1-3p/WDFY2 axis in patients with PCOS†. Biol Reprod 2023; 108:744-757. [PMID: 36780172 DOI: 10.1093/biolre/ioad017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 01/08/2023] [Accepted: 02/04/2023] [Indexed: 02/14/2023] Open
Abstract
To investigate the expression profiles of circular RNAs (circRNAs) in the endometria of women with polycystic ovary syndrome (PCOS) and to explore the role of aberrant circ_0115118 expression in endometrial dysfunction in patients with PCOS. CircRNA microarray hybridization and bioinformatic analyses were performed to determine the expression patterns of circRNAs in the endometria of patients with or without PCOS, the expression of target circRNA was evaluated by real-time polymerase chain reaction (PCR). Cell counting kit-8 and Transwell assays were used to detect cellular proliferative, invasive, and migratory capacities. The influence of the circRNA on decidualization was explored by real-time PCR. Animal models were established to investigate the regulatory effect of the circRNA on embryo implantation. Downstream microRNAs and genes were predicted using bioinformatic websites and verified by dual-luciferase reporter assays, real-time PCR, and western blotting. In the endometria of patients with PCOS, there were 113 differentially expressed circRNAs in the secretory phase and 1119 differentially expressed circRNAs in the proliferative phase. The expression of circ_0115118 was significantly higher in endometrial stromal cells during the proliferative phase in patients with PCOS, leading to inhibition of cellular mobilization and embryo implantation. In addition, circ_0115118 exerted effects by sponging miR-138-1-3p, subsequently increasing the expression of WD repeat and FYVE domain-containing protein 2 (WDFY2). Circ_0115118 expression is dysregulated in the endometria of patients with PCOS and adversely affects endometrial function. Our findings reveal that circ_0115118 may be a potential therapeutic target to improve pregnancy outcomes in women with PCOS.
Collapse
Affiliation(s)
- Zi Yang
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- National Clinical Research Center for Obstetrics and Gynecology (Peking University Third Hospital), Beijing, China
- Key Laboratory of Assisted Reproduction (Peking University), Ministry of Education, Beijing, China
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing, China
| | - Fenting Liu
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- National Clinical Research Center for Obstetrics and Gynecology (Peking University Third Hospital), Beijing, China
- Key Laboratory of Assisted Reproduction (Peking University), Ministry of Education, Beijing, China
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing, China
| | - Jiali Bai
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- National Clinical Research Center for Obstetrics and Gynecology (Peking University Third Hospital), Beijing, China
- Key Laboratory of Assisted Reproduction (Peking University), Ministry of Education, Beijing, China
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing, China
| | - Zhenhong Ye
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- National Clinical Research Center for Obstetrics and Gynecology (Peking University Third Hospital), Beijing, China
- Key Laboratory of Assisted Reproduction (Peking University), Ministry of Education, Beijing, China
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing, China
| | - Jingwen Yin
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- National Clinical Research Center for Obstetrics and Gynecology (Peking University Third Hospital), Beijing, China
- Key Laboratory of Assisted Reproduction (Peking University), Ministry of Education, Beijing, China
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing, China
| | - Tianliu Peng
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- National Clinical Research Center for Obstetrics and Gynecology (Peking University Third Hospital), Beijing, China
- Key Laboratory of Assisted Reproduction (Peking University), Ministry of Education, Beijing, China
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing, China
| | - Hongying Shan
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- National Clinical Research Center for Obstetrics and Gynecology (Peking University Third Hospital), Beijing, China
- Key Laboratory of Assisted Reproduction (Peking University), Ministry of Education, Beijing, China
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing, China
| | - Yang Yu
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- National Clinical Research Center for Obstetrics and Gynecology (Peking University Third Hospital), Beijing, China
- Key Laboratory of Assisted Reproduction (Peking University), Ministry of Education, Beijing, China
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing, China
| | - Ping Zhou
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- National Clinical Research Center for Obstetrics and Gynecology (Peking University Third Hospital), Beijing, China
- Key Laboratory of Assisted Reproduction (Peking University), Ministry of Education, Beijing, China
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing, China
| | - Rong Li
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- National Clinical Research Center for Obstetrics and Gynecology (Peking University Third Hospital), Beijing, China
- Key Laboratory of Assisted Reproduction (Peking University), Ministry of Education, Beijing, China
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing, China
| |
Collapse
|
12
|
Wang J, Yin T, Liu S. Dysregulation of immune response in PCOS organ system. Front Immunol 2023; 14:1169232. [PMID: 37215125 PMCID: PMC10196194 DOI: 10.3389/fimmu.2023.1169232] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 04/24/2023] [Indexed: 05/24/2023] Open
Abstract
Polycystic ovary syndrome (PCOS) is the most common reproductive endocrine disorder affecting women, which can lead to infertility. Infertility, obesity, hirsutism, acne, and irregular menstruation are just a few of the issues that PCOS can be linked to. PCOS has a complicated pathophysiology and a range of clinical symptoms. Chronic low-grade inflammation is one of the features of PCOS. The inflammatory environment involves immune and metabolic disturbances. Numerous organ systems across the body, in addition to the female reproductive system, have been affected by the pathogenic role of immunological dysregulation in PCOS in recent years. Insulin resistance and hyperandrogenism are associated with immune cell dysfunction and cytokine imbalance. More importantly, obesity is also involved in immune dysfunction in PCOS, leading to an inflammatory environment in women with PCOS. Hormone, obesity, and metabolic interactions contribute to the pathogenesis of PCOS. Hormone imbalance may also contribute to the development of autoimmune diseases. The aim of this review is to summarize the pathophysiological role of immune dysregulation in various organ systems of PCOS patients and provide new ideas for systemic treatment of PCOS in the future.
Collapse
Affiliation(s)
- Jingxuan Wang
- Reproductive Medicine Center, Renmin Hospital of Wuhan University, Wuhan, China
| | - Tailang Yin
- Reproductive Medicine Center, Renmin Hospital of Wuhan University, Wuhan, China
| | - Su Liu
- Shenzhen Key Laboratory of Reproductive Immunology for Peri-implantation, Shenzhen Zhongshan Institute for Reproduction and Genetics, Shenzhen Zhongshan Urology Hospital, Shenzhen, China
| |
Collapse
|
13
|
Hu M, Zhang Y, Lu Y, Han J, Guo T, Cui P, Brännström M, Shao LR, Billig H. Regulatory mechanisms of HMGB1 and its receptors in polycystic ovary syndrome-driven gravid uterine inflammation. FEBS J 2023; 290:1874-1906. [PMID: 36380688 PMCID: PMC10952262 DOI: 10.1111/febs.16678] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 08/23/2022] [Accepted: 11/15/2022] [Indexed: 11/17/2022]
Abstract
High-mobility group box 1 (HMGB1) is critical for inflammatory homeostasis and successful pregnancy, and there is a strong association among elevated levels of HMGB1, polycystic ovary syndrome (PCOS), chronic inflammation and pregnancy loss. However, the mechanisms responsible for PCOS-driven regulation of uterine HMGB1 and its candidate receptors [toll-like receptor (TLR) 2 and 4] and inflammatory responses during pregnancy remain unclear. In this study, we found a gestational stage-dependent decrease in uterine HMGB1 and TLR4 protein abundance in rats during normal pregnancy. We demonstrated that increased expression of HMGB1, TLR2 and TLR4 proteins was associated with activation of inflammation-related signalling pathways in the gravid uterus exposed to 5α-dihydrotestosterone and insulin, mimicking the clinical features (hyperandrogenism and insulin resistance) of PCOS and this elevation was completely inhibited by treatment with the androgen receptor (AR) antagonist flutamide. Interestingly, acute exposure to lipopolysaccharide suppressed HMGB1, TLR4 and inflammation-related protein abundance but did not affect androgen levels or AR expression in the gravid uterus with viable fetuses. Furthermore, immunohistochemical analysis revealed that, in addition to being localized predominately in the nuclear compartment, HMGB1 immunoreactivity was also detected in the cytoplasm in the PCOS-like rat uterus, PCOS endometrium and pregnant rat uterus with haemorrhagic and resorbed fetuses, possibly via activation of nuclear factor κB signalling. These results suggest that both AR-dependent and AR-independent mechanisms contribute to the modulation of HMGB1/TLR2/TLR4-mediated uterine inflammation. We propose that the elevation of HMGB1 and its receptors and disruption of the pro-/anti-inflammatory balance in the gravid uterus may participate in the pathophysiology of PCOS-associated pregnancy loss.
Collapse
Affiliation(s)
- Min Hu
- Department of Traditional Chinese MedicineThe First Affiliated Hospital of Guangzhou Medical UniversityChina
- Institute of Integrated Traditional Chinese Medicine and Western MedicineGuangzhou Medical UniversityChina
- Department of Physiology/Endocrinology, Institute of Neuroscience and Physiology, The Sahlgrenska AcademyUniversity of GothenburgSweden
| | - Yuehui Zhang
- Department of Physiology/Endocrinology, Institute of Neuroscience and Physiology, The Sahlgrenska AcademyUniversity of GothenburgSweden
- Department of Obstetrics and Gynecology, Key Laboratory and Unit of Infertility in Chinese Medicine, First Affiliated HospitalHeilongjiang University of Chinese MedicineHarbinChina
| | - Yaxing Lu
- Department of Traditional Chinese MedicineThe First Affiliated Hospital of Guangzhou Medical UniversityChina
- Institute of Integrated Traditional Chinese Medicine and Western MedicineGuangzhou Medical UniversityChina
| | - Jing Han
- Department of Obstetrics and Gynecology, Key Laboratory and Unit of Infertility in Chinese Medicine, First Affiliated HospitalHeilongjiang University of Chinese MedicineHarbinChina
| | - Tingting Guo
- Department of Obstetrics and Gynecology, Key Laboratory and Unit of Infertility in Chinese Medicine, First Affiliated HospitalHeilongjiang University of Chinese MedicineHarbinChina
| | - Peng Cui
- Department of Physiology/Endocrinology, Institute of Neuroscience and Physiology, The Sahlgrenska AcademyUniversity of GothenburgSweden
- Department of Obstetrics and GynecologyShuguang Hospital Affiliated to Shanghai University of Traditional Chinese MedicineChina
| | - Mats Brännström
- Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, Sahlgrenska AcademyUniversity of GothenburgSweden
| | - Linus R. Shao
- Department of Physiology/Endocrinology, Institute of Neuroscience and Physiology, The Sahlgrenska AcademyUniversity of GothenburgSweden
| | - Håkan Billig
- Department of Physiology/Endocrinology, Institute of Neuroscience and Physiology, The Sahlgrenska AcademyUniversity of GothenburgSweden
| |
Collapse
|
14
|
Letrozole Compared With Clomiphene Citrate for Polycystic Ovarian Syndrome: A Systematic Review and Meta-analysis. Obstet Gynecol 2023; 141:523-534. [PMID: 36735392 DOI: 10.1097/aog.0000000000005070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 11/17/2022] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To estimate the effect of letrozole and clomiphene citrate in women with infertility and polycystic ovarian syndrome (PCOS). METHODS OF STUDY SELECTION MEDLINE through PubMed, Web of Science, EMBASE, Cochrane Library, and ClinicalTrials.gov were searched for relevant studies from inception to February 1, 2022. Two reviewers retrieved, filtered, and extracted data independently using the bibliographic software EndNote X9 and Excel workbook. We included randomized controlled trials (RCTs) reporting ovulation induction outcomes in women with infertility and PCOS treated with either letrozole or clomiphene citrate followed by timed intercourse or intrauterine insemination. The data were merged into a mean difference or risk ratio (RR) with 95% CI, depending on variable types. TABULATION, INTEGRATION, AND RESULTS Data collection and organization were conducted in accordance with the 2020 PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analyses) statement. Twenty-nine RCTs were eligible, which included 3,952 women and 7,633 ovulation induction cycles. We acquired evidence from 22 RCTs for the ovulation rate, 28 RCTs for the clinical pregnancy rate, and eight RCTs for live-birth rate. Pooled analysis indicated that letrozole treatment prevailed against clomiphene citrate in ovulation rate (RR 1.14, 95% CI 1.06-1.21, P <.001), clinical pregnancy rate (RR 1.48, 95% CI 1.34-1.63, P <.001), and live-birth rate (RR 1.49, 95% CI 1.27-1.74, P <.001). CONCLUSIONS Letrozole was associated with improved ovulation, pregnancy, and live-birth rates compared with clomiphene citrate. We recommend letrozole over clomiphene citrate as an ovulation induction drug in women with infertility and PCOS, although the quality of the evidence is mixed. SYSTEMATIC REVIEW REGISTRATION PROSPERO, CRD42022308777.
Collapse
|
15
|
Moar K, Pant A, Saini V, Maurya PK. Potential biomarkers in endometrial cancer: a narrative review. Biomarkers 2023:1-14. [PMID: 36755526 DOI: 10.1080/1354750x.2023.2179114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
CONTEXT Every year, approximately 0.4 million women suffer from endometrial cancer (EC) worldwide and it has become the most common gynecological malignancy. Almost 66% of EC cases are diagnosed at an early stage and can be cured by performing surgery while those at an advanced stage turns out to be fatal. Biomarkers of endometrial cancer would be very valuable for screening of women who are at high risk and in detecting the chance of recurrence of disease. OBJECTIVE The current article has reviewed studies published on expression of biomarkers and susceptibility to EC. METHODS Google Scholar and PubMed were used as searching platforms and we have majorly considered the literature from last 10 years. RESULTS Potential biomarkers of EC identified from various studies were summarised.
Collapse
Affiliation(s)
- Kareena Moar
- Department of Biochemistry, Central University of Haryana, Mahendragarh, India
| | - Anuja Pant
- Department of Biochemistry, Central University of Haryana, Mahendragarh, India
| | - Vikas Saini
- Biomedical Sciences, Department of Vocational Studies and Skill Development, Central University of Haryana, Mahendragarh, India
| | - Pawan Kumar Maurya
- Department of Biochemistry, Central University of Haryana, Mahendragarh, India
| |
Collapse
|
16
|
Wen X, Fu X, Zhao C, Yang L, Huang R. The bidirectional relationship between periodontal disease and pregnancy via the interaction of oral microorganisms, hormone and immune response. Front Microbiol 2023; 14:1070917. [PMID: 36778874 PMCID: PMC9908602 DOI: 10.3389/fmicb.2023.1070917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 01/11/2023] [Indexed: 01/27/2023] Open
Abstract
Periodontal disease has been suggested to be linked to adverse pregnancy outcomes such as preterm birth, low birth weight, and preeclampsia. Adverse pregnancy outcomes are a significant public health issue with important clinical and societal repercussions. This article systematically reviews the available epidemiological studies involving the relationship between periodontal disease and adverse pregnancy outcomes over the past 15 years, and finds a weak but independent association between adverse pregnancy outcomes and periodontal disease. The bidirectional association and the potential mechanisms are then explored, focusing on three possible mechanisms: inflammatory reaction, oral microorganisms and immune response. Specifically, elevated systemic inflammation and increased periodontal pathogens with their toxic products, along with a relatively suppressed immune system may lead to the disruption of homeostasis within fetal-placental unit and thus induce adverse pregnancy outcomes. This review also explains the possible mechanisms around why women are more susceptible to periodontal disease. In conclusion, pregnant women are more likely to develop periodontal disease due to hormonal changes, and periodontal disease has also been suspected to increase the incidence of adverse pregnancy outcomes. Therefore, in order to lessen the risk of adverse pregnancy outcomes, both obstetricians and dentists should pay attention to the development of periodontal diseases among women during pregnancy.
Collapse
|
17
|
Endometrial Heparin-Binding Epidermal Growth Factor Gene Expression and Hormone Level Changes in Implantation Window of Obese Women with Polycystic Ovarian Syndrome. Biomedicines 2023; 11:biomedicines11020276. [PMID: 36830813 PMCID: PMC9953163 DOI: 10.3390/biomedicines11020276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 12/27/2022] [Accepted: 01/11/2023] [Indexed: 01/21/2023] Open
Abstract
INTRODUCTION Polycystic ovarian syndrome (PCOS) is a common endocrine disorder amongst reproductive-age women, and 61% to 76% of women with PCOS are obese. Obese women with PCOS are usually burdened with infertility problems due to implantation failure. Thus, progesterone treatment is usually used to improve implantation rates. Although Hb-EGF expression is actively involved in endometrial receptivity and implantation, the data on heparin-binding epidermal growth factor (Hb-EGF) expression following progesterone therapy in obese women with PCOS are still lacking. OBJECTIVE To investigate the changes in serum follicle-stimulating hormone (FSH), luteinising hormone (LH), dehydroepiandrosterone sulphate (DHEA), progesterone and oestradiol levels and Hb-EGF expression in obese women with PCOS during the implantation window following progesterone therapy. METHOD A total of 40 participants aged 18-40 years old were recruited following the provision of written consent. The participants were divided into the obese PCOS, normal-weight PCOS, obese fertile and normal-weight fertile groups. First blood collection was done before ovulation. Then, daily oral micronised progesterone (Utrogestan 200 mg) was given to the PCOS group for 10 days. The treatment was followed by a second blood collection and endometrial tissue sampling by using a Pipelle de Cornier catheter. In the fertile group, ovulation was confirmed by using ultrasound, and a second blood sample was collected on days 7 to 9 postovulation. The serum levels of FSH, LH, DHEA, progesterone and oestradiol were measured in all participants. Wilcoxon signed-rank test was used to compare FSH, LH, DHEA, progesterone and oestradiol levels during pre- and postovulation. Mann-Whitney test was performed to compare FSH, LH, DHEA, progesterone and oestradiol levels between two groups: (1) the PCOS group and the fertile group, (2) the obese PCOS group and the non-obese PCOS group and (3) the obese group and the non-obese fertile group. RESULT Serum FSH levels were lower in obese women in their follicular phase than in women with normal weight regardless of their PCOS status, whereas serum LH/FSH ratios and DHEA levels were higher in women with PCOS than in women without PCOS. However, endometrial Hb-EGF expression was lower in the obese PCOS group than in the normal-weight PCOS group. CONCLUSIONS Different patterns of hormonal levels and Hb-EGF expression levels were seen between the studied groups. However, further in vitro and in vivo studies are needed to investigate the mechanism underlying the changes in FSH, LH/FSH ratio, DHEA and Hb-EGF expression in PCOS after progesterone treatment.
Collapse
|
18
|
Therapeutic effects of aqueous extract of bioactive active component of Ageratum conyzoides on the ovarian-uterine and hypophysis-gonadal axis in rat with polycystic ovary syndrome: Histomorphometric evaluation and biochemical assessment. Metabol Open 2022; 15:100201. [PMID: 35958118 PMCID: PMC9361322 DOI: 10.1016/j.metop.2022.100201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 07/16/2022] [Accepted: 07/16/2022] [Indexed: 11/22/2022] Open
Abstract
Background Polycystic ovary syndrome (PCOS) is an endocrine disorder, affecting women of reproductive age. Ageratum conyzoïdes (AGC) is used traditionally in the treatment of fever, rheumatism, and ulcer. This study investigates the effects of AGC on ovarian-uterine in PCOS rats. Methods Female rats were randomized into four groups (n = 6). Group A control received 2 ml distilled water. Group B received a single dose of 4 mg/kg body weight (bwt) i.p estradiol valerate (EV). Group C received 500 mg/kg bwt AGC and group D received a single dose of 4 mg/kg bwt i.p EV followed by 500 mg/kg bwt AGC orally for 30 days. Parameters tested include follicle-stimulating hormone (FSH), luteinizing hormone (LH), testosterone (T), estradiol (E2), progesterone (P), C-reactive protein (CRP), interleukin (IL)-6, IL-18 and tumor necrosis factor (TNF)- α, malondialdehyde (MDA), superoxide dismutase (SOD), Catalase (CAT), total protein (TP), total cholesterol (TC), triglycerides (TG), low-density lipoprotein cholesterol (LDL), high-density lipoprotein cholesterol (HDL), and ovary and uterus histomorphometric. Results Ageratum conyzoides decrease insulin resistance, obesity indices, TC, TG, LDL, MDA, T, LH, FSH, CRP, IL-6, IL-18, and TNF- α in PCOS rats. And increase HDL, E2, P, TP, CAT, and SOD in PCOS rats. AGC improved ovary and uterus histo-architecture, tertiary, and Graafian follicles, corpus luteum and endometrial thickness increased,and cystic and atretic follicles decreased. Conclusion Ageratum conyzoides improved insulin sensitivity, antioxidant activities, hormonal imbalance, inflammatory makers, and histological changes in PCOS rats. Therefore AGC can be used as a potential adjuvant agent in the treatment of PCOS.
Collapse
|
19
|
Yu J, Fu Y, Zeng L, Zheng Y. Investigating the active components of Huatan Tongjing Decoction for the treatment of polycystic ovary syndrome via network pharmacology. Chem Biol Drug Des 2022; 100:515-524. [PMID: 35822313 DOI: 10.1111/cbdd.14117] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 06/21/2022] [Accepted: 07/08/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Polycystic ovary syndrome (PCOS) is a common endocrine disease in women, potentially causing ovarian infertility for women at gestational age. Huatan Tongjing Decoction is commonly used to treat PCOS, however the involved molecular mechanism has not been fully understood. METHODS In this study, the active components of Huatan Tongjing Decoction and potentially targeted proteins were downloaded from the Traditional Chinese Medicine Systems Pharmacology (TCMSP) database. PCOS-related genes were accessed from Malacards database. STRING database was utilized to construct a protein-protein interaction (PPI) network based on the PCOS-related genes and the predicted targets. Subsequently, the PPI network was subjected to Random walk with restart (RWR). Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analyses were performed on top 50 genes with the high affinity scores to the drug targets. Subsequently, based on the predicted drug components and targets, a component-gene interaction network was constructed. Finally, the most central drug targets were selected, and the corresponding compounds were subjected to molecular docking and dynamic simulations to examine their bindings. RESULTS The 122 main active components and 246 potential targets of Huatan Tongjing Decoction were obtained from TCMSP, and a total of 259 nodes and 1,919 interactions were acquired from the PPI network. The top 50 genes were mainly enriched in response to peptide hormone function and PI3K-Akt signaling pathway in RWR analysis. Molecular docking and dynamic simulations predicted that MMP-quercetin interaction played an important role in the treatment of PCOS using Huatan Tongjing Decoction. CONCLUSIONS Luteolin and quercetin in Huatan Tongjing Decoction potentially bound MMP9 and served as active compornants. This study preliminarily suggested the efficacy of Huatan Tongjing Decoction against PCOS in molecular degreee.
Collapse
Affiliation(s)
- Jingwei Yu
- Gynecology of traditional Chinese medicine, Persons applying for doctoral degree with the same educational level. Guangzhou University of Chinese Medicine, Guangzhou City, Guangdong Province, China.,Gynecology of traditional Chinese medicine, Panyu Maternal and Child Care Service Centre(Panyu He Xian Memorial Hospital), Guangzhou City, Guangdong Province, China
| | - Yanhong Fu
- Department of gynecology, Guangzhou Huadu District Maternal and Child Health Hospital, Guangzhou City, Guangdong Province, China
| | - Lei Zeng
- Department of gynecology, First Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou City, Guangdong Province, China
| | - Yongxia Zheng
- Gynecology of traditional Chinese medicine, Panyu Maternal and Child Care Service Centre(Panyu He Xian Memorial Hospital), Guangzhou City, Guangdong Province, China
| |
Collapse
|
20
|
Li J, Jiang X, Li C, Che H, Ling L, Wei Z. Proteomic alteration of endometrial tissues during secretion in polycystic ovary syndrome may affect endometrial receptivity. Clin Proteomics 2022; 19:19. [PMID: 35643455 PMCID: PMC9145147 DOI: 10.1186/s12014-022-09353-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 04/18/2022] [Indexed: 11/10/2022] Open
Abstract
AbstractEmbryo implantation is a complex developmental process that requires coordinated interactions among the embryo, endometrium, and the microenvironment of endometrium factors. Even though the impaired endometrial receptivity of patients with polycystic ovary syndrome (PCOS) is known, understanding of endometrial receptivity is limited. A proteomics study in three patients with PCOS and 3 fertile women was performed to understand the impaired endometrial receptivity in patients with PCOS during luteal phases. Through isobaric tags for relative and absolute quantitation (iTRAQ) analyses, we identified 232 unique proteins involved in the metabolism, inflammation, and cell adhesion molecules. Finally, our results suggested that energy metabolism can affect embryo implantation, whereas inflammation and cell adhesion molecules can affect both endometrial conversion and receptivity. Our results showed that endometrial receptive damage in patients with PCOS is not a single factor. It is caused by many proteins, pathways, systems, and abnormalities, which interact with each other and make endometrial receptive research more difficult.
Collapse
|
21
|
Kangasniemi MH, Komsi EK, Rossi HR, Liakka A, Khatun M, Chen JC, Paulson M, Hirschberg AL, Arffman RK, Piltonen TT. Artificial intelligence deep learning model assessment of leukocyte counts and proliferation in endometrium from women with and without polycystic ovary syndrome. F&S SCIENCE 2022; 3:174-186. [PMID: 35560015 DOI: 10.1016/j.xfss.2022.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 01/17/2022] [Accepted: 01/18/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To study whether artificial intelligence (AI) technology can be used to discern quantitative differences in endometrial immune cells between cycle phases and between samples from women with polycystic ovary syndrome (PCOS) and non-PCOS controls. Only a few studies have analyzed endometrial histology using AI technology, and especially, studies of the PCOS endometrium are lacking, partly because of the technically challenging analysis and unavailability of well-phenotyped samples. Novel AI technologies can overcome this problem. DESIGN Case-control study. SETTING University hospital-based research laboratory. PATIENT(S) Forty-eight women with PCOS and 43 controls. Proliferative phase samples (26 control and 23 PCOS) and luteinizing hormone (LH) surge timed LH+ 7-9 (10 control and 16 PCOS) and LH+ 10-12 (7 control and 9 PCOS) secretory endometrial samples were collected during 2014-2019. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Endometrial samples were stained with antibodies for CD8+ T cells, CD56+ uterine natural killer cells, CD68+ macrophages, and proliferation marker Ki67. Scanned whole slide images were analyzed with an AI deep learning model. Cycle phase differences in leukocyte counts, proliferation rate, and endometrial thickness were measured within the study populations and between the PCOS and control samples. A subanalysis of anovulatory PCOS samples (n = 11) vs. proliferative phase controls (n = 18) was also performed. RESULT(S) Automated cell counting with a deep learning model performs well for the human endometrium. The leukocyte numbers and proliferation in the endometrium fluctuate with the menstrual cycle. Differences in leukocyte counts were not observed between the whole PCOS population and controls. However, anovulatory women with PCOS presented with a higher number of CD68+ cells in the epithelium (controls vs. PCOS, median [interquartile range], 0.92 [0.75-1.51] vs. 1.97 [1.12-2.68]) and fewer leukocytes in the stroma (CD8%, 3.72 [2.18-4.20] vs. 1.44 [0.77-3.03]; CD56%, 6.36 [4.43-7.43] vs. 2.07 [0.65-4.99]; CD68%, 4.57 [3.92-5.70] vs. 3.07 [1.73-4.59], respectively) compared with the controls. The endometrial thickness and proliferation rate were comparable between the PCOS and control groups in all cycle phases. CONCLUSION(S) Artificial intelligence technology provides a powerful tool for endometrial research because it is objective and can efficiently analyze endometrial compartments separately. Ovulatory endometrium from women with PCOS did not differ remarkably from the controls, which may indicate that gaining ovulatory cycles normalizes the PCOS endometrium and enables normalization of leukocyte environment before implantation. Deviant endometrial leukocyte populations observed in anovulatory women with PCOS could be interrelated with the altered endometrial function observed in these women.
Collapse
Affiliation(s)
- Marika H Kangasniemi
- Department of Obstetrics and Gynecology, PEDEGO Research Unit, Medical Research Center, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - Elina K Komsi
- Department of Obstetrics and Gynecology, PEDEGO Research Unit, Medical Research Center, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - Henna-Riikka Rossi
- Department of Obstetrics and Gynecology, PEDEGO Research Unit, Medical Research Center, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - Annikki Liakka
- Department of Pathology, Medical Research Center, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - Masuma Khatun
- Department of Obstetrics and Gynecology, PEDEGO Research Unit, Medical Research Center, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - Joseph C Chen
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, California
| | - Mariana Paulson
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden; Department of Gynecology and Reproductive Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Angelica L Hirschberg
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden; Department of Gynecology and Reproductive Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Riikka K Arffman
- Department of Obstetrics and Gynecology, PEDEGO Research Unit, Medical Research Center, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - Terhi T Piltonen
- Department of Obstetrics and Gynecology, PEDEGO Research Unit, Medical Research Center, Oulu University Hospital, University of Oulu, Oulu, Finland.
| |
Collapse
|
22
|
Abruzzese GA, Silva AF, Velazquez ME, Ferrer MJ, Motta AB. Hyperandrogenism and Polycystic ovary syndrome: Effects in pregnancy and offspring development. WIREs Mech Dis 2022; 14:e1558. [PMID: 35475329 DOI: 10.1002/wsbm.1558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 02/18/2022] [Accepted: 04/01/2022] [Indexed: 11/10/2022]
Abstract
Polycystic ovary syndrome (PCOS) is one of the major endocrine disorders affecting women of reproductive age. Its etiology remains unclear. It is suggested that environmental factors, and particularly the intrauterine environment, play key roles in PCOS development. Besides the role of androgens in PCOS pathogenesis, exposure to endocrine disruptors, as is Bisphenol A, could also contribute to its development. Although PCOS is considered one of the leading causes of ovarian infertility, many PCOS patients can get pregnant. Some of them by natural conception and others by assisted reproductive technique treatments. As hyperandrogenism (one of PCOS main features) affects ovarian and uterine functions, PCOS women, despite reaching pregnancy, could present high-risk pregnancies, including implantation failure, an increased risk of gestational diabetes, preeclampsia, and preterm birth. Moreover, hyperandrogenism may also be maintained in these women during pregnancy. Therefore, as an altered uterine milieu, including hormonal imbalance, could affect the developing organisms, monitoring these patients throughout pregnancy and their offspring development is highly relevant. The present review focuses on the impact of androgenism and PCOS on fertility issues and pregnancy-related outcomes and offspring development. The evidence suggests that the increased risk of pregnancy complications and adverse offspring outcomes of PCOS women would be due to the factors involved in the syndrome pathogenesis and the related co-morbidities. A better understanding of the involved mechanisms is still needed and could contribute to a better management of these women and their offspring. This article is categorized under: Reproductive System Diseases > Molecular and Cellular Physiology Reproductive System Diseases > Environmental Factors.
Collapse
Affiliation(s)
- Giselle A Abruzzese
- Laboratorio de Fisiopatología Ovárica, Centro de Estudios Farmacológicos y Botánicos (CEFyBO), Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Aimé F Silva
- Laboratorio de Fisiopatología Ovárica, Centro de Estudios Farmacológicos y Botánicos (CEFyBO), Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Mariela E Velazquez
- Laboratorio de Fisiopatología Ovárica, Centro de Estudios Farmacológicos y Botánicos (CEFyBO), Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Maria-José Ferrer
- Laboratorio de Fisiopatología Ovárica, Centro de Estudios Farmacológicos y Botánicos (CEFyBO), Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Alicia B Motta
- Laboratorio de Fisiopatología Ovárica, Centro de Estudios Farmacológicos y Botánicos (CEFyBO), Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina
| |
Collapse
|
23
|
Comparison of two endometrial preparation methods for frozen-thawed embryo transfer in anovulatory PCOS patients: impact on miscarriage rate. J Gynecol Obstet Hum Reprod 2022; 51:102399. [PMID: 35489711 DOI: 10.1016/j.jogoh.2022.102399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 04/07/2022] [Accepted: 04/15/2022] [Indexed: 11/23/2022]
Abstract
OBJECTIVE - Some studies have suggested that patients with polycystic ovary syndrome (PCOS) are at high risk of miscarriage. However, this still remains controversial. Several potential factors might explain this association: obesity, hyperinsulinemia and hyperandrogenism. Artificial and stimulated cycles appear to be comparable for endometrial preparation in frozen-thawed embryo transfer (FET) in PCOS patients. Only a few studies have assessed miscarriage rates specifically in PCOS. We have evaluated the impact of endometrial preparation on FET outcomes in anovulatory PCOS patients. METHODS - A retrospective cohort study was conducted at the Lille University Hospital, including 255 FET cycles in 134 PCOS patients between January 2011 and December 2017. PCOS was defined by the presence of at least two of the three Rotterdam's criteria. Patients were under 35 years old. Two endometrial preparation protocol were studied: stimulated cycle (gonadotropins on the second day of the cycle and luteal phase support including natural progesterone 600 mg/day) and artificial cycle (6 mg oral estradiol valerate and 800 mg micronized vaginal progesterone daily). RESULTS - 137 FET were performed under stimulated cycle and 118 FET under artificial cycle. Early pregnancy rates (30% versus 37.3%, p = NS), miscarriage rates (22% versus 25%, p = NS) and live birth rates (23.4% versus 26.3%, p = NS) were similar. CONCLUSIONS - In anovulatory PCOS women, the type of endometrial preparation does not influence FET outcomes, specifically regarding the miscarriage rate.
Collapse
|
24
|
Wang C, Wen YX, Mai QY. Impact of metabolic disorders on endometrial receptivity in patients with polycystic ovary syndrome. Exp Ther Med 2022; 23:221. [PMID: 35222698 DOI: 10.3892/etm.2022.11145] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 12/22/2021] [Indexed: 12/12/2022] Open
Abstract
The present study investigated the expression of endometrial receptivity-related molecules in patients with polycystic ovary syndrome (PCOS) and different androgen status, insulin resistance (IR) levels, and body mass indexes (BMI) to identify the mechanism underlying their effects on pregnancy outcomes. The present study recruited 43 participants from November 2020 to January 2021, which were classified into five groups: i) Hyperandrogenemia (HA) combined with impaired glucose tolerance group (n=8); ii) HA combined with diabetes mellitus group (n=8); iii) HA combined with non-IR (NIR) group (n=10); iv) non-HA (NHA) androgen combined with IR group (n=8); and v) NHA combined with NIR group (n=9). In addition, according to their BMIs, patients were sub-grouped into lean/normal (n=27), overweight (n=8) or obese (n=8) groups. The mRNA expression levels of endometrial receptivity-related molecules were detected using reverse transcription-quantitative PCR. In addition, flow cytometry was used to determine the phenotype and percentage of uterine natural killer cells (uNK). According to the results, patients with PCOS and IR status, HA and obesity (BMI ≥24 kg/m2) demonstrated significantly decreased mRNA expression levels of adiponectin, adiponectin receptor (AdipoR)1, AdipoR2, adapter protein containing PH domain, PTB domain and leucine zipper motif 1, estrogen receptor (ER) α, ERβ, progesterone receptor (PR), IL-15, integrin β3 avβ3, and insulin-like growth factor binding protein-1, but increased mRNA expression levels of IL-6 and IL-8 compared with NHA + NIR group or lean/normal group, respectively. In addition, obese patients with PCOS demonstrated increased mRNA expression levels of PR compared with overweight patients. This suggested that insulin resistant status, HA, and obesity could alter the endometrial receptivity of patients with PCOS, which may explain poorer embryo implantation and pregnancy outcomes in clinics.
Collapse
Affiliation(s)
- Can Wang
- Reproductive Medicine Center, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong 510080, P.R. China
| | - Yang-Xing Wen
- Reproductive Medicine Center, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong 510080, P.R. China
| | - Qing-Yun Mai
- Reproductive Medicine Center, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong 510080, P.R. China
| |
Collapse
|
25
|
Hu M, Zhang Y, Lu L, Zhou Y, Wu D, Brännström M, Shao LR, Billig H. Overactivation of the androgen receptor exacerbates gravid uterine ferroptosis via interaction with and suppression of the NRF2 defense signaling pathway. FEBS Lett 2022; 596:806-825. [DOI: 10.1002/1873-3468.14289] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 12/02/2021] [Accepted: 01/05/2022] [Indexed: 11/08/2022]
Affiliation(s)
- Min Hu
- Department of Traditional Chinese Medicine The First Affiliated Hospital of Guangzhou Medical University 510120 Guangzhou China
- Institute of Integrated Traditional Chinese Medicine and Western Medicine Guangzhou Medical University 510120 Guangzhou China
- Department of Physiology/Endocrinology Institute of Neuroscience and Physiology The Sahlgrenska Academy University of Gothenburg 40530 Gothenburg Sweden
| | - Yuehui Zhang
- Department of Physiology/Endocrinology Institute of Neuroscience and Physiology The Sahlgrenska Academy University of Gothenburg 40530 Gothenburg Sweden
- Department of Obstetrics and Gynecology Key Laboratory and Unit of Infertility in Chinese Medicine First Affiliated Hospital Heilongjiang University of Chinese Medicine 150040 Harbin China
| | - Lingjing Lu
- Department of Traditional Chinese Medicine The First Affiliated Hospital of Guangzhou Medical University 510120 Guangzhou China
- Institute of Integrated Traditional Chinese Medicine and Western Medicine Guangzhou Medical University 510120 Guangzhou China
| | - Yu Zhou
- Department of Traditional Chinese Medicine The First Affiliated Hospital of Guangzhou Medical University 510120 Guangzhou China
- Institute of Integrated Traditional Chinese Medicine and Western Medicine Guangzhou Medical University 510120 Guangzhou China
| | - Denghui Wu
- Department of Obstetrics and Gynecology Key Laboratory and Unit of Infertility in Chinese Medicine First Affiliated Hospital Heilongjiang University of Chinese Medicine 150040 Harbin China
| | - Mats Brännström
- Department of Obstetrics and Gynecology Sahlgrenska University Hospital Sahlgrenska Academy University of Gothenburg 41345 Gothenburg Sweden
| | - Linus R Shao
- Department of Physiology/Endocrinology Institute of Neuroscience and Physiology The Sahlgrenska Academy University of Gothenburg 40530 Gothenburg Sweden
| | - Håkan Billig
- Department of Physiology/Endocrinology Institute of Neuroscience and Physiology The Sahlgrenska Academy University of Gothenburg 40530 Gothenburg Sweden
| |
Collapse
|
26
|
Pathare ADS, Hinduja I, Mahadik RC. Basic aspects of endometrial receptivity in PCOS patients. Mol Biol Rep 2022; 49:1519-1528. [PMID: 34988892 DOI: 10.1007/s11033-021-06976-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Accepted: 11/17/2021] [Indexed: 12/12/2022]
Abstract
Polycystic Ovarian Syndrome (PCOS) is an endocrine disorder commonly affecting the reproductive capacity of women leading to infertility. PCOS-related infertility is majorly due to anovulation; however, it is not the only cause. The defective endometrium causing recurrent miscarriage and implantation failure can also be accountable for infertility in PCOS women. The unusual levels of hormones and their receptors in the PCOS endometrium have a hostile effect during WOI, making the microenvironment unfavorable for embryo implantation. To date, many studies have been performed to determine the role of candidate genes in endometrial receptivity but very limited data is available using whole genome approach. This review aims at summarizing the existing studies on the basic aspects of endometrial receptivity in PCOS. The review focuses on aberrant levels of hormones and their receptors in the endometrium, affecting the receptivity. Additionally, it explores the novel approach reviewing the effect on treatment options administered for ovulation induction in PCOS on their endometrial receptivity. Overall, this review will help us to understand the molecular milieu in PCOS endometrium and its effect on the receptivity potential. However, to have a thorough understanding of the mechanistic approach of hormonal imbalance in PCOS on endometrial receptivity, there is a need to give more weightage to genome-wide studies in the future. The current review will further guide us to formulate future studies using whole genome technologies for the assessment of endometrial receptivity in different cohorts of PCOS women, which may have future diagnostic implementations.
Collapse
Affiliation(s)
- Amruta D S Pathare
- Department of IVF and Research, P. D. Hinduja Hospital and Medical Research Centre, Mumbai, 400016, India
| | - Indira Hinduja
- Department of IVF and Research, P. D. Hinduja Hospital and Medical Research Centre, Mumbai, 400016, India.
| | - Roshani C Mahadik
- Department of IVF and Research, P. D. Hinduja Hospital and Medical Research Centre, Mumbai, 400016, India
| |
Collapse
|
27
|
Xue Z, Li J, Feng J, Han H, Zhao J, Zhang J, Han Y, Wu X, Zhang Y. Research Progress on the Mechanism Between Polycystic Ovary Syndrome and Abnormal Endometrium. Front Physiol 2022; 12:788772. [PMID: 34975540 PMCID: PMC8718643 DOI: 10.3389/fphys.2021.788772] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Accepted: 11/22/2021] [Indexed: 12/22/2022] Open
Abstract
As a highly dynamic tissue, the endometrium is periodically shed in response to the secretion of estrogen and progesterone. After menarche, the endometrium of healthy women proliferates and differentiates under the action of steroid hormones (e.g., 17β-estradiol and progesterone) that are secreted by the ovaries to provide appropriate conditions for embryo implantation. Polycystic ovary syndrome (PCOS), a prevalent endocrine and metabolic disorder in reproductive-aged women, is usually associated with multiple cysts within the ovaries and excess levels of androgen and is characterized by hirsutism, acne, menstrual irregularity, infertility, and increased risk of insulin resistance. Multiple factors, such as anovulation, endocrine-metabolic abnormalities, and inflammation, can disrupt the endometrium in PCOS patients and can lead to endometrial hyperplasia, pregnancy complications, or even cancer. Despite many recent studies, the relationship between PCOS and abnormal endometrial function is still not fully understood. In this review, we investigate the correlation of PCOS patient endometrium with anovulation, hyperandrogenemia, insulin resistance, progesterone resistance, and inflammatory cytokines, aiming to provide a theoretical basis for the treatment of disorders caused by endometrial dysfunction in PCOS patients.
Collapse
Affiliation(s)
- Zhu Xue
- The graduate school, Heilongjiang University of Chinese Medicine, Harbin, China
| | - Juanli Li
- The graduate school, Heilongjiang University of Chinese Medicine, Harbin, China
| | - Jiaxing Feng
- The graduate school, Heilongjiang University of Chinese Medicine, Harbin, China
| | - Han Han
- The First Clinical Hospital Affiliated to Harbin Medical University, Harbin, China
| | - Jing Zhao
- Heilongjiang Academy of Traditional Chinese Medicine, Harbin, China
| | - Jiao Zhang
- Department of Acupuncture and Moxibustion, Second Affiliated Hospital, Heilongjiang University of Chinese Medicine, Harbin, China
| | - Yanhua Han
- Department of Obstetrics and Gynecology, First Affiliated Hospital, Heilongjiang University of Chinese Medicine, Harbin, China
| | - Xiaoke Wu
- Department of Obstetrics and Gynecology, First Affiliated Hospital, Heilongjiang University of Chinese Medicine, Harbin, China
| | - Yuehui Zhang
- Department of Obstetrics and Gynecology, First Affiliated Hospital, Heilongjiang University of Chinese Medicine, Harbin, China
| |
Collapse
|
28
|
Xu XL, Huang ZY, Yu K, Li J, Fu XW, Deng SL. Estrogen Biosynthesis and Signal Transduction in Ovarian Disease. Front Endocrinol (Lausanne) 2022; 13:827032. [PMID: 35299973 PMCID: PMC8921451 DOI: 10.3389/fendo.2022.827032] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 02/03/2022] [Indexed: 12/01/2022] Open
Abstract
Estrogen mainly binds to estrogen receptors (ERs) to regulate menstrual cycles and reproduction. The expression of ERalpha (ERα), ERbeta (ERβ), and G-protein-coupled estrogen receptor (GPER) mRNA could be detected in ovary, suggesting that they play an important role in estrogen signal transduction in ovary. And many studies have revealed that abnormal expression of estrogen and its receptors is closely related to ovarian disease or malignant tumors. With the continuous development and research of animal models, tissue-specific roles of both ERα and ERβ have been demonstrated in animals, which enable people to have a deeper understanding of the potential role of ER in regulating female reproductive diseases. Nevertheless, our current understanding of ERs expression and function in ovarian disease is, however, incomplete. To elucidate the biological mechanism behind ERs in the ovary, this review will focus on the role of ERα and ERβ in polycystic ovary syndrome (PCOS), ovarian cancer and premature ovarian failure (POF) and discuss the major challenges of existing therapies to provide a reference for the treatment of estrogen target tissue ovarian diseases.
Collapse
Affiliation(s)
- Xue-Ling Xu
- National Engineering Laboratory for Animal Breeding, Key Laboratory of Animal Genetics, Breeding and Reproduction, Beijing Key Laboratory for Animal Genetic Improvement, College of Animal Science and Technology, China Agricultural University, Beijing, China
| | - Zheng-Yuan Huang
- Department of Metabolism, Digestion and Reproduction, Chelsea and Westminster Hospital, Imperial College London, London, United Kingdom
| | - Kun Yu
- National Engineering Laboratory for Animal Breeding, Key Laboratory of Animal Genetics, Breeding and Reproduction, Beijing Key Laboratory for Animal Genetic Improvement, College of Animal Science and Technology, China Agricultural University, Beijing, China
| | - Jun Li
- Department of Reproductive Medicine, The First Hospital of Hebei Medical University, Shijiazhuang, China
- *Correspondence: Xiang-Wei Fu, ; Shou-Long Deng, ; Jun Li,
| | - Xiang-Wei Fu
- National Engineering Laboratory for Animal Breeding, Key Laboratory of Animal Genetics, Breeding and Reproduction, Beijing Key Laboratory for Animal Genetic Improvement, College of Animal Science and Technology, China Agricultural University, Beijing, China
- *Correspondence: Xiang-Wei Fu, ; Shou-Long Deng, ; Jun Li,
| | - Shou-Long Deng
- National Health Commission of China (NHC) Key Laboratory of Human Disease Comparative Medicine, Institute of Laboratory Animal Sciences, Chinese Academy of Medical Sciences and Comparative Medicine Center, Peking Union Medical College, Beijing, China
- *Correspondence: Xiang-Wei Fu, ; Shou-Long Deng, ; Jun Li,
| |
Collapse
|
29
|
Zhang J, Ding N, Xin W, Yang X, Wang F. Quantitative Proteomics Reveals That a Prognostic Signature of the Endometrium of the Polycystic Ovary Syndrome Women Based on Ferroptosis Proteins. Front Endocrinol (Lausanne) 2022; 13:871945. [PMID: 35909514 PMCID: PMC9330063 DOI: 10.3389/fendo.2022.871945] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 06/21/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE We aimed to study the relationship between ferroptosis proteins and reproductive outcomes of infertile patients with PCOS and construct the related prognostic model. METHODS These endometrium samples of the study were collected from 33 women with PCOS and 7 control women with successful pregnancies at the Reproductive Center of Lanzhou University Second Hospital, September 2019 to September 2020. The 40 patients' endometrium was identified the differentially expressed proteins (DEPs) using liquid chromatography tandem mass spectrometry. The Kyoto Encyclopedia of Genes and Genomes (KEGG) analysis and Gene Ontology (GO) showed that the DEPs related pathways and functions between PCOS and controls. Subsequently, univariate Cox regression analysis and Lasso regression were used to identifying independent prognostic ferroptosis proteins, which were utilized to establish a prognostic model. Then the performance of the prognostic model was evaluated by receiver operating characteristic curve (ROC) and decision curve analysis (DCA). Then clinical data and prognostic model were used to predict the reproductive outcomes of PCOS patients by constructing the nomograms. Finally, we performed the single sample gene set enrichment analysis (ssGSEA) to explore the correlation between risk scores and immune status. RESULTS A total of 5331 proteins were identified, 391 proteins were differentially expressed in the PCOS and controls. The KEGG analysis revealed that the ferroptosis pathway was significantly different between PCOS and controls. 5 ferroptosis proteins (GPX4, DPP4, G6PD, PCBP1, and PCBP2) prognostic model (FerSig) was constructed via Cox regression and Lasso regression. Patients were separated into high and low-risk groups according to the FerSig. Kaplan-Meier curve showed that patients in the low-risk group had much better reproductive outcomes than those in the high-risk group. The DCA showed that the risk score was an independent predictive factor for reproductive outcomes. Compared with clinical data, ROC curve analysis indicated the FerSig proteins as a potential diagnostic and prognostic factor in PCOS patients. Functional analysis revealed that the FerSig proteins and immune microenvironment were correlated to the prognosis of PCOS. CONCLUSION The prognostic model focused on the FerSig proteins could predict the reproductive outcomes of PCOS patients with decreased endometrial receptivity, and provided theoretical basis for individualized treatment.
Collapse
|
30
|
Abdulkhalikova D, Sustarsic A, Vrtačnik Bokal E, Jancar N, Jensterle M, Burnik Papler T. The Lifestyle Modifications and Endometrial Proteome Changes of Women With Polycystic Ovary Syndrome and Obesity. Front Endocrinol (Lausanne) 2022; 13:888460. [PMID: 35813634 PMCID: PMC9258031 DOI: 10.3389/fendo.2022.888460] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 04/25/2022] [Indexed: 12/14/2022] Open
Abstract
UNLABELLED Polycystic ovary syndrome (PCOS) is a polyendocrine disorder and the most common endocrinopathy in women of reproductive age. Affected women have an elevated prevalence of being overweight and obese. Our study sought to determine how weight loss associated with lifestyle changes affects the endometrium specific proteome, endocrine-metabolic characteristics, and motor capabilities of obese women with PCOS and infertility. A group of 12 infertile women under the age of 38 with PCOS and BMI ≥30 kg/m2 were included in the study. An evaluation was performed by a gynecologist and an endocrinologist. The weight-loss program lasted 8 weeks under the guidance of a professional trainer. Endometrial sampling during a period of implantation window for proteome determination was performed before and after weight loss. In endometrial samples at the end of the study increased protein abundance was recorded for Legumain, Insulin-like growth factor-binding protein 7, Hepatocyte growth factor receptor, Keratin, type II cytoskeletal 7, and Cystatin-B, while the B-lymphocyte antigen CD20 protein abundance decreased. Our results also indicate significantly lowered fasting blood glucose level and free testosterone concentration and significant improvements in body composition and physical capacity. This study may open up the venues for investigating important biomarkers that may affect endometrial receptivity. CLINICAL TRIAL REGISTRATION https://clinicaltrials.gov/ct2/show/NCT04989244?term=NCT04989244&draw=2&rank=1, identifier: NCT04989244.
Collapse
Affiliation(s)
- D. Abdulkhalikova
- Department of Human Reproduction, Division of Obstetrics and Gynaecology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - A. Sustarsic
- Faculty of Sports, University of Ljubljana, Ljubljana, Slovenia
| | - Eda Vrtačnik Bokal
- Department of Human Reproduction, Division of Obstetrics and Gynaecology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - N. Jancar
- Department of Human Reproduction, Division of Obstetrics and Gynaecology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - M. Jensterle
- Department of Endocrinology, Diabetes and Metabolic Diseases, Division of Internal Medicine, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - T. Burnik Papler
- Department of Human Reproduction, Division of Obstetrics and Gynaecology, University Medical Centre Ljubljana, Ljubljana, Slovenia
- *Correspondence: T. Burnik Papler,
| |
Collapse
|
31
|
Wang Q, Wang H, Li P, Li X, Wang Z, Yan L, Shi Y. Association of Polycystic Ovary Syndrome Phenotypes With Adverse Pregnancy Outcomes After In-Vitro Fertilization/Intracytoplasmic Sperm Injection. Front Endocrinol (Lausanne) 2022; 13:889029. [PMID: 35721747 PMCID: PMC9203834 DOI: 10.3389/fendo.2022.889029] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 04/28/2022] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE This study aims to evaluate the association between polycystic ovary syndrome (PCOS) phenotypes and adverse perinatal outcomes, comparing the characteristics, ovarian response, and assisted reproductive outcomes in patients with various PCOS phenotypes after in-vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI). METHODS This study comprised 6,732 patients who underwent the first cycle of IVF/ICSI treatment in our outpatient department from January 2017 to July 2018. Propensity score matching (PSM) was used in PCOS and non-PCOS groups to balance the influence of intergroup confounding factors. After the PSM procedure, 1,186 patients were included in the two groups, and the PCOS patients were further divided into four PCOS phenotype groups based on the Rotterdam criteria. RESULTS Patients with various PCOS phenotypes had similar rates of biochemical pregnancy, clinical pregnancy, and live birth (all P-values > 0.05). The overall incidence of adverse pregnancy outcomes (including ectopic pregnancy, miscarriage, preterm birth) was significantly higher in PCOS phenotype A and D groups than in the control group (44% and 46.4% vs. 28.7%, P = 0.027). The rates of hypertensive disorder of pregnancy (HDP) were significantly higher in PCOS phenotype A and C groups than in the control group (9.3% and 12.5% vs. 3.1%, P = 0.037). After adjustment for potential confounders, the differences in adverse pregnancy outcomes persisted (P = 0.025). CONCLUSIONS The overall incidence of adverse pregnancy outcomes is higher in women with PCOS phenotypes A and D than in women with non-PCOS.
Collapse
Affiliation(s)
- Qiumin Wang
- Center for Reproductive Medicine, Shandong University, Jinan, China
- Shandong Provincial Clinical Medicine Research Center for Reproductive Health, Shandong University, Jinan, China
| | - Honghong Wang
- Center for Reproductive Medicine, Shandong University, Jinan, China
- Shandong Provincial Clinical Medicine Research Center for Reproductive Health, Shandong University, Jinan, China
- Children’s Hospital of Shanxi and Women Health Center of Shanxi, Taiyuan, China
| | - Ping Li
- Women and Children’s Hospital, School of Medicine, Xiamen University, Xiamen, China
| | - Xiufang Li
- Center for Reproductive Medicine, Shandong University, Jinan, China
- Shandong Provincial Clinical Medicine Research Center for Reproductive Health, Shandong University, Jinan, China
| | - Ze Wang
- Center for Reproductive Medicine, Shandong University, Jinan, China
- Shandong Provincial Clinical Medicine Research Center for Reproductive Health, Shandong University, Jinan, China
| | - Lei Yan
- Center for Reproductive Medicine, Shandong University, Jinan, China
- Shandong Provincial Clinical Medicine Research Center for Reproductive Health, Shandong University, Jinan, China
- *Correspondence: Lei Yan, ; Yuhua Shi,
| | - Yuhua Shi
- Shandong Provincial Clinical Medicine Research Center for Reproductive Health, Shandong University, Jinan, China
- Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- *Correspondence: Lei Yan, ; Yuhua Shi,
| |
Collapse
|
32
|
Seymen CM, Yar Sağlam AS, Elmazoğlu Z, Arık GN, Take Kaplanoğlu G. Involvement of endometrial IGF-1R/IGF-1/Bcl-2 pathways in experimental polycystic ovary syndrome: Identification of the regulatory effect of melatonin. Tissue Cell 2021; 73:101585. [PMID: 34375824 DOI: 10.1016/j.tice.2021.101585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 06/17/2021] [Accepted: 06/18/2021] [Indexed: 11/25/2022]
Abstract
The involvement of endometrial IGF-1R/IGF-1/Bcl-2 pathways and the potential regulatory effects of exogenously administrated melatonin on this expression is investigated in the experimental PCOS model in the present study. Thirty-two 6-8 week old Sprague Dawley rats were divided into four groups: the Sham Control Group (1% CMC/day by oral gavage [o.g.]); the Melatonin Group (2 mg/kg/day melatonin by subcutaneous administration [s.c.]); the Experimental PCOS Group (1 mg/kg/day Letrozole by o.g.); and the Experimental PCOS + Melatonin Group (1 mg/kg/day Letrozole by o.g. and 2 mg/kg/day melatonin by s.c. administration). Vaginal smear samples were taken from the 14th day to the end of the experiment for colpocytological measurements. At the end of the 21 day experimental period, uterine tissues were taken; Hematoxylin-Eosin histochemical, IGF-1R/IGF-1/Bcl-2, PCNA immuno-histochemical stainings and western blot analyses were performed for related antibodies. All of the data was supported statistically. The epithelium of endometrium lost its single-layer structure in some parts, separation was observed between the epithelium and the basal membrane junction, intracellular edema was found in the uterine glands by the polycystic ovary-induction. Also this induction increased the expression of IGF-1R/IGF-1, Bcl-2, and PCNA proteins. Morphological degenerations returned to its normal appearance generally by the melatonin administrations and melatonin also regulated the increased expression of endometrial IGF-1R/IGF-1/Bcl-2 and PCNA pathways. It is concluded that additional studies are needed, using melatonin as a supporting agent may be appropriate in cases of PCOS.
Collapse
Affiliation(s)
- Cemile Merve Seymen
- Gazi University Faculty of Medicine, Department of Histology and Embryology, Ankara, Turkey.
| | - Atiye Seda Yar Sağlam
- Gazi University Faculty of Medicine, Department of Medical Biology and Genetics, Ankara, Turkey
| | - Zübeyir Elmazoğlu
- Gazi University Faculty of Medicine, Department of Medical Pharmacology, Ankara, Turkey
| | - Gökçe Nur Arık
- Gazi University Faculty of Medicine, Department of Histology and Embryology, Ankara, Turkey
| | - Gülnur Take Kaplanoğlu
- Gazi University Faculty of Medicine, Department of Histology and Embryology, Ankara, Turkey
| |
Collapse
|
33
|
Hu M, Zhang Y, Ma S, Li J, Wang X, Liang M, Sferruzzi-Perri AN, Wu X, Ma H, Brännström M, Shao LR, Billig H. Suppression of uterine and placental ferroptosis by N-acetylcysteine in a rat model of polycystic ovary syndrome. Mol Hum Reprod 2021; 27:gaab067. [PMID: 34850077 DOI: 10.1093/molehr/gaab067] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 11/09/2021] [Indexed: 12/15/2022] Open
Abstract
The mechanisms that link hyperandrogenism and insulin (INS) resistance (HAIR) to the increased miscarriage rate in women with polycystic ovary syndrome (PCOS) remain elusive. Previous studies demonstrate that increased uterine and placental ferroptosis is associated with oxidative stress-induced fetal loss in a pre-clinical PCOS-like rat model. Here, we investigated the efficacy and molecular mechanism of action of the antioxidant N-acetylcysteine (NAC) in reversing gravid uterine and placental ferroptosis in pregnant rats exposed to 5α-dihydrotestosterone (DHT) and INS. Molecular and histological analyses showed that NAC attenuated DHT and INS-induced uterine ferroptosis, including dose-dependent increases in anti-ferroptosis gene content. Changes in other molecular factors after NAC treatment were also observed in the placenta exposed to DHT and INS, such as increased glutathione peroxidase 4 protein level. Furthermore, increased apoptosis-inducing factor mitochondria-associated 2 mRNA expression was seen in the placenta but not in the uterus. Additionally, NAC was not sufficient to rescue DHT + INS-induced mitochondria-morphological abnormalities in the uterus, whereas the same treatment partially reversed such abnormalities in the placenta. Finally, we demonstrated that NAC selectively normalized uterine leukemia inhibitory factor, osteopontin/secreted phosphoprotein 1, progesterone receptor, homeobox A11 mRNA expression and placental estrogen-related receptor beta and trophoblast-specific protein alpha mRNA expression. Collectively, our data provide insight into how NAC exerts beneficial effects on differentially attenuating gravid uterine and placental ferroptosis in a PCOS-like rat model with fetal loss. These results indicate that exogenous administration of NAC represents a potential therapeutic strategy in the treatment of HAIR-induced uterine and placental dysfunction.
Collapse
Affiliation(s)
- Min Hu
- Department of Traditional Chinese Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- Institute of Integrated Traditional Chinese Medicine and Western Medicine, Guangzhou Medical University, Guangzhou, China
- Department of Physiology and Endocrinology, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Yuehui Zhang
- Department of Physiology and Endocrinology, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Obstetrics and Gynecology, Key Laboratory and Unit of Infertility in Chinese Medicine, First Affiliated Hospital, Heilongjiang University of Chinese Medicine, Harbin, China
| | - Shuting Ma
- Department of Obstetrics and Gynecology, Key Laboratory and Unit of Infertility in Chinese Medicine, First Affiliated Hospital, Heilongjiang University of Chinese Medicine, Harbin, China
| | - Juanli Li
- Department of Obstetrics and Gynecology, Key Laboratory and Unit of Infertility in Chinese Medicine, First Affiliated Hospital, Heilongjiang University of Chinese Medicine, Harbin, China
| | - Xu Wang
- Department of Obstetrics and Gynecology, Key Laboratory and Unit of Infertility in Chinese Medicine, First Affiliated Hospital, Heilongjiang University of Chinese Medicine, Harbin, China
| | - Mengmeng Liang
- Department of Obstetrics and Gynecology, Key Laboratory and Unit of Infertility in Chinese Medicine, First Affiliated Hospital, Heilongjiang University of Chinese Medicine, Harbin, China
| | - Amanda Nancy Sferruzzi-Perri
- Centre for Trophoblast Research, Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, UK
| | - Xiaoke Wu
- Department of Obstetrics and Gynecology, Key Laboratory and Unit of Infertility in Chinese Medicine, First Affiliated Hospital, Heilongjiang University of Chinese Medicine, Harbin, China
| | - Hongxia Ma
- Department of Traditional Chinese Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- Institute of Integrated Traditional Chinese Medicine and Western Medicine, Guangzhou Medical University, Guangzhou, China
| | - Mats Brännström
- Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Linus R Shao
- Department of Physiology and Endocrinology, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Håkan Billig
- Department of Physiology and Endocrinology, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| |
Collapse
|
34
|
Bai X, Zheng L, Li D, Xu Y. Research progress of endometrial receptivity in patients with polycystic ovary syndrome: a systematic review. Reprod Biol Endocrinol 2021; 19:122. [PMID: 34362377 PMCID: PMC8344130 DOI: 10.1186/s12958-021-00802-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 07/12/2021] [Indexed: 12/14/2022] Open
Abstract
Polycystic ovary syndrome (PCOS) is a neuroendocrine heterogeneous disease that frequently occurs in women of reproductive age, causing serious damage to the fertility, quality of life, and physical and mental health of patients. The current studies have proved that satisfactory endometrial receptivity is one of the conditions that must be met during the process of spermatovum position, adhesion and invasion, as well as the subsequent blastocyst division and embryo development. Women with PCOS may suffer a series of pathological processes such as changes in the expression levels of hormones and related receptors, imbalances in the proportion of miscellaneous cytokines, insulin resistance, low-grade chronic inflammation and endometrial morphological changes, which will damage endometrial receptivity from various aspects and obstruct fertilized egg nidation and embryonic development, thus causing adverse reproductive health events including infertility and abortion. This article reviews the research progress about characteristics and related influencing factors of endometrial receptivity in PCOS patients.
Collapse
Affiliation(s)
- Xuechun Bai
- The Second Hospital of Jilin University, Jilin Province Changchun City, China
| | - Lianwen Zheng
- The Second Hospital of Jilin University, Jilin Province Changchun City, China
| | - Dandan Li
- The Second Hospital of Jilin University, Jilin Province Changchun City, China
| | - Ying Xu
- The Second Hospital of Jilin University, Jilin Province Changchun City, China
| |
Collapse
|
35
|
Hu M, Zhang Y, Li X, Cui P, Li J, Brännström M, Shao LR, Billig H. Alterations of endometrial epithelial-mesenchymal transition and MAPK signalling components in women with PCOS are partially modulated by metformin in vitro. Mol Hum Reprod 2021; 26:312-326. [PMID: 32202622 DOI: 10.1093/molehr/gaaa023] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 02/20/2020] [Indexed: 12/13/2022] Open
Abstract
Growing evidence suggests that epithelial-mesenchymal transition (EMT) and its regulator mitogen-activated protein kinase (MAPK) contribute to endometria-related reproductive disorders. However, the regulation of EMT and MAPK signalling components in the endometrium from polycystic ovary syndrome (PCOS) patients has not been systematically investigated and remains elusive. In humans, how metformin induces molecular alterations in the endometrial tissues under PCOS conditions is not completely clear. Here, we recruited 7 non-PCOS patients during the proliferative phase (nPCOS), 7 non-PCOS patients with endometrial hyperplasia (nPCOSEH), 14 PCOS patients during the proliferative phase (PCOS) and 3 PCOS patients with endometrial hyperplasia (PCOSEH). Our studies demonstrated that compared with nPCOS, PCOS patients showed decreased Claudin 1 and increased Vimentin and Slug proteins. Similar to increased Slug protein, nPCOSEH and PCOSEH patients showed increased N-cadherin protein. Western blot and immunostaining revealed increased epithelial phosphorylated Cytokeratin 8 (p-CK 8) expression and an increased p-CK 8:CK 8 ratio in PCOS, nPCOSEH and PCOSEH patients compared to nPCOS patients. Although nPCOSEH and PCOSEH patients showed increased p-ERK1/2 and/or p38 protein levels, the significant increase in p-ERK1/2 expression and p-ERK1/2:ERK1/2 ratio was only found in PCOS patients compared to nPCOS patients. A significant induction of the membrane ERβ immunostaining was observed in the epithelial cells of PCOS and PCOSEH patients compared to nPCOS and nPCOSEH patients. While in vitro treatment with metformin alone increased Snail and decreased Claudin 1, N-cadherin and α-SMA proteins, concomitant treatment with metformin and E2 increased the expression of CK 8 and Snail proteins and decreased the expression of Claudin 1, ZO-1, Slug and α-SMA proteins. Our findings suggest that the EMT contributes to the switch from a healthy state to a PCOS state in the endometrium, which might subsequently drive endometrial injury and dysfunction. We also provide evidence that metformin differentially modulates EMT protein expression in PCOS patients depending on oestrogenic stimulation.
Collapse
Affiliation(s)
- Min Hu
- Department of Traditional Chinese Medicine, The First Affiliated Hospital of Guangzhou Medical University, 510120 Guangzhou, China.,Department of Physiology/Endocrinology, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, 40530 Gothenburg, Sweden
| | - Yuehui Zhang
- Department of Physiology/Endocrinology, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, 40530 Gothenburg, Sweden.,Department of Obstetrics and Gynecology, Key Laboratory and Unit of Infertility in Chinese Medicine, First Affiliated Hospital, Heilongjiang University of Chinese Medicine, 150040 Harbin, China
| | - Xin Li
- Department of Physiology/Endocrinology, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, 40530 Gothenburg, Sweden.,Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, 200011 Shanghai, China.,Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, 200011 Shanghai, China
| | - Peng Cui
- Department of Physiology/Endocrinology, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, 40530 Gothenburg, Sweden.,Department of Obstetrics and Gynecology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, 201203 Shanghai, China
| | - Juan Li
- Department of Traditional Chinese Medicine, The First Affiliated Hospital of Guangzhou Medical University, 510120 Guangzhou, China.,Department of Physiology/Endocrinology, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, 40530 Gothenburg, Sweden
| | - Mats Brännström
- Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, Sahlgrenska Academy, University of Gothenburg, 41345 Gothenburg, Sweden
| | - Linus R Shao
- Department of Physiology/Endocrinology, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, 40530 Gothenburg, Sweden
| | - Håkan Billig
- Department of Physiology/Endocrinology, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, 40530 Gothenburg, Sweden
| |
Collapse
|
36
|
Zhang Y, Hu M, Yang F, Zhang Y, Ma S, Zhang D, Wang X, Sferruzzi-Perri AN, Wu X, Brännström M, Shao LR, Billig H. Increased uterine androgen receptor protein abundance results in implantation and mitochondrial defects in pregnant rats with hyperandrogenism and insulin resistance. J Mol Med (Berl) 2021; 99:1427-1446. [PMID: 34180022 PMCID: PMC8455403 DOI: 10.1007/s00109-021-02104-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 05/20/2021] [Accepted: 06/10/2021] [Indexed: 12/21/2022]
Abstract
Abstract In this study, we show that during normal rat pregnancy, there is a gestational stage-dependent decrease in androgen receptor (AR) abundance in the gravid uterus and that this is correlated with the differential expression of endometrial receptivity and decidualization genes during early and mid-gestation. In contrast, exposure to 5α-dihydrotestosterone (DHT) and insulin (INS) or DHT alone significantly increased AR protein levels in the uterus in association with the aberrant expression of endometrial receptivity and decidualization genes, as well as disrupted implantation. Next, we assessed the functional relevance of the androgen-AR axis in the uterus for reproductive outcomes by treating normal pregnant rats and pregnant rats exposed to DHT and INS with the anti-androgen flutamide. We found that AR blockage using flutamide largely attenuated the DHT and INS-induced maternal endocrine, metabolic, and fertility impairments in pregnant rats in association with suppressed induction of uterine AR protein abundance and androgen-regulated response protein and normalized expression of several endometrial receptivity and decidualization genes. Further, blockade of AR normalized the expression of the mitochondrial biogenesis marker Nrf1 and the mitochondrial functional proteins Complexes I and II, VDAC, and PHB1. However, flutamide treatment did not rescue the compromised mitochondrial structure resulting from co-exposure to DHT and INS. These results demonstrate that functional AR protein is an important factor for gravid uterine function. Impairments in the uterine androgen-AR axis are accompanied by decreased endometrial receptivity, decidualization, and mitochondrial dysfunction, which might contribute to abnormal implantation in pregnant PCOS patients with compromised pregnancy outcomes and subfertility. Key messages The proper regulation of uterine androgen receptor (AR) contributes to a
normal pregnancy process, whereas the aberrant regulation of uterine AR might
be linked to polycystic ovary syndrome (PCOS)-induced pregnancy-related
complications. In the current study, we found that during normal rat pregnancy there is
a stage-dependent decrease in AR abundance in the gravid uterus and that this
is correlated with the differential expression of the endometrial receptivity
and decidualization genes Spp1, Prl, Igfbp1,
and Hbegf. Pregnant rats exposed to 5α-dihydrotestosterone (DHT) and insulin (INS)
or to DHT alone show elevated uterine AR protein abundance and implantation
failure related to the aberrant expression of genes involved in endometrial
receptivity and decidualization in early to mid-gestation. Treatment with the anti-androgen flutamide, starting from
pre-implantation, effectively prevents DHT + INS-induced defects in endometrial
receptivity and decidualization gene expression, restores uterine mitochondrial
homeostasis, and increases the pregnancy rate and the numbers of viable
fetuses. This study adds to our understanding of the mechanisms underlying poor
pregnancy outcomes in PCOS patients and the possible therapeutic use of
anti-androgens, including flutamide, after spontaneous conception.
Supplementary Information The online version contains supplementary material available at 10.1007/s00109-021-02104-z.
Collapse
Affiliation(s)
- Yuehui Zhang
- Department of Obstetrics and Gynecology, Key Laboratory and Unit of Infertility in Chinese Medicine, First Affiliated Hospital, Heilongjiang University of Chinese Medicine, Harbin, 150040, China.,Department of Physiology/Endocrinology, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Medicinaregatan 11, P. O. Box 434, 40530, Gothenburg, Sweden
| | - Min Hu
- Department of Physiology/Endocrinology, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Medicinaregatan 11, P. O. Box 434, 40530, Gothenburg, Sweden.,Department of Traditional Chinese Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, China.,Institute of Integrated Traditional Chinese Medicine and Western Medicine, Guangzhou Medical University, Guangzhou, 510120, China
| | - Fan Yang
- Department of Obstetrics and Gynecology, Key Laboratory and Unit of Infertility in Chinese Medicine, First Affiliated Hospital, Heilongjiang University of Chinese Medicine, Harbin, 150040, China
| | - Yizhuo Zhang
- Department of Obstetrics and Gynecology, Key Laboratory and Unit of Infertility in Chinese Medicine, First Affiliated Hospital, Heilongjiang University of Chinese Medicine, Harbin, 150040, China
| | - Shuting Ma
- Department of Obstetrics and Gynecology, Key Laboratory and Unit of Infertility in Chinese Medicine, First Affiliated Hospital, Heilongjiang University of Chinese Medicine, Harbin, 150040, China
| | - Dongqi Zhang
- Department of Obstetrics and Gynecology, Key Laboratory and Unit of Infertility in Chinese Medicine, First Affiliated Hospital, Heilongjiang University of Chinese Medicine, Harbin, 150040, China
| | - Xu Wang
- Department of Obstetrics and Gynecology, Key Laboratory and Unit of Infertility in Chinese Medicine, First Affiliated Hospital, Heilongjiang University of Chinese Medicine, Harbin, 150040, China
| | - Amanda Nancy Sferruzzi-Perri
- Centre for Trophoblast Research, Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, CB2 3EG, UK
| | - Xiaoke Wu
- Department of Obstetrics and Gynecology, Key Laboratory and Unit of Infertility in Chinese Medicine, First Affiliated Hospital, Heilongjiang University of Chinese Medicine, Harbin, 150040, China
| | - Mats Brännström
- Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, Sahlgrenska Academy, University of Gothenburg, 41345, Gothenburg, Sweden
| | - Linus R Shao
- Department of Physiology/Endocrinology, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Medicinaregatan 11, P. O. Box 434, 40530, Gothenburg, Sweden.
| | - Håkan Billig
- Department of Physiology/Endocrinology, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Medicinaregatan 11, P. O. Box 434, 40530, Gothenburg, Sweden
| |
Collapse
|
37
|
The flip side of the coin: is the endometrium ready for IVM-derived embryo implantation? J Assist Reprod Genet 2021; 38:1289-1291. [PMID: 34152512 DOI: 10.1007/s10815-021-02239-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 05/17/2021] [Indexed: 10/21/2022] Open
|
38
|
Yuan L, Wu H, Huang W, Bi Y, Qin A, Yang Y. The function of metformin in endometrial receptivity (ER) of patients with polycyclic ovary syndrome (PCOS): a systematic review and meta-analysis. Reprod Biol Endocrinol 2021; 19:89. [PMID: 34127011 PMCID: PMC8201680 DOI: 10.1186/s12958-021-00772-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 05/28/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This meta-analysis summarizes evidence from studies using metformin (Met) to improve endometrial receptivity (ER) in women with PCOS. METHODS Following the PRISMA protocol, we conducted a comprehensive search of academic literature from various databases, including PubMed, EMbase and Cochrane libraries. Studies published in English before Jan 27, 2021, were recruited for primary screening. Data on endometrial thickness (EMT), endometrial artery resistance index (RI), clinical pregnancy rate (CPR) and miscarriage rate (MR) were extracted and analyzed. RESULTS Sixty-two eligible studies that included 6571 patients were evaluated in this meta-analysis. Primary indicators are EMT and endometrial aetery RI; secondary indicators include the clinical pregnancy rate and miscarriage rate. Metformin significantly increased EMT (SMD = 2.04, 95% CI (0.96,3.12),P = 0.0002) and reduced endometrial artery RI compared to the non-Met group (SMD = - 2.83, 95% CI: (- 5.06, - 0.59), P = 0.01). As expected, metformin also improved CPR and reduced MR in PCOS patients as a result, clinical pregnancy rate (risk ratio [RR] = 1.26, 95% CI: 1.11-1.43, P = 0.0003), and miscarriage rate (RR = 0.73, 95% CI:0.58-0.91, P = 0.006). CONCLUSION Metformin may improve endometrial receptivity (ER) in PCOS patients by increasing EMT and reducing endometrial artery RI. However, the level of most original studies was low, with small sample sizes. More large-scale, long-term RCTs with rigorous methodologies are needed.
Collapse
Affiliation(s)
- Lifang Yuan
- Reproductive Medical Center, the First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Hongbo Wu
- Reproductive Medical Center, the First Affiliated Hospital of Guangxi Medical University, Nanning, China
- Reproductive Medical Center, Qinzhou Women and Children Hospital, Qinzhou, China
| | - Weiyu Huang
- Reproductive Medical Center, the First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Yin Bi
- Reproductive Medical Center, the First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Aiping Qin
- Reproductive Medical Center, the First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Yihua Yang
- Reproductive Medical Center, the First Affiliated Hospital of Guangxi Medical University, Nanning, China
| |
Collapse
|
39
|
Yu Y, Cao Y, Huang W, Liu Y, Lu Y, Zhao J. β-Sitosterol Ameliorates Endometrium Receptivity in PCOS-Like Mice: The Mediation of Gut Microbiota. Front Nutr 2021; 8:667130. [PMID: 34179058 PMCID: PMC8224531 DOI: 10.3389/fnut.2021.667130] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 05/19/2021] [Indexed: 12/12/2022] Open
Abstract
Background: Polycystic ovary syndrome (PCOS), one of the most common endocrine diseases in women of childbearing age, has been found to be accompanied by changes in the gut microbiota. The Bu Shen Yang Xue formula (BSYXF) is a traditional Chinese medicine widely used for the treatment of PCOS. This study aimed to investigate whether the protective effects of β-sitosterol, the main active ingredient of BSYXF, on PCOS was mediated by regulating gut microbiota. Methods: The presence of β-sitosterol in BSYXF was detected by liquid chromatography-mass spectrometry. The PCOS-like mouse model was induced by dehydroepiandrosterone. The fecal supernatant of β-sitosterol-treated mice was prepared for fecal microbiota transplantation (FMT). Body weight and wet weight of the uterus and ovary of the mice were recorded for organ index calculation. Hematoxylin and eosin stain was used to assess the endometrial morphology and microenvironment changes. Expression of endometrial receptivity markers cyclooxygenase-2 (COX-2), Integrin ανβ3, leukemia inhibitory factor (LIF), and homeobox A10 (HOXA10) in the endometrium were determined by immunohistochemistry and western blot analysis. Enzyme-linked immunosorbent assay was employed to detect the expression of follicle stimulating hormone (FSH), luteinizing hormone (LH), progesterone (P), and testosterone (T) in the serum. The diversity of gut microbiota was examined by 16S rDNA gene sequencing. Results: With the treatment of β-sitosterol and β-sitosterol-FMT, the uterine index of PCOS-like mice increased, the ovarian index decreased, levels of COX-2, LH and T decreased, and levels of Integrin ανβ3, LIF, HOXA10, FSH, and P increased. Under β-sitosterol treatment, the structure of the gut microbiota in PCOS-like mice was also changed. Conclusion: β-sitosterol regulates the endometrial receptivity of PCOS and harmonizes the sex hormone balance, which may be related to the changes in the structure and composition of gut microbiota, thus affecting the pathological process of PCOS.
Collapse
Affiliation(s)
- Yanyan Yu
- Department of Gynecology, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Ying Cao
- College of Traditional Chinese Medicine, North China University of Science and Technology, Tangshan, China
| | - Wenling Huang
- Department of Gynecology, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Yanxia Liu
- Department of Gynecology, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Ying Lu
- Department of Gynecology, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Jiajing Zhao
- Department of Gynecology, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, China
| |
Collapse
|
40
|
Zhao J, Chen Q, Xue X. An Update on the Progress of Endometrial Receptivity in Women with Polycystic Ovary Syndrome. Reprod Sci 2021; 29:2136-2144. [PMID: 34076874 DOI: 10.1007/s43032-021-00641-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 05/25/2021] [Indexed: 11/30/2022]
Abstract
Polycystic ovary syndrome (PCOS) is a significant public health issue with diverse presentations, including reproductive, metabolic, and psychological disorders. Although problems with ovulation, metabolism, and hormonal imbalance can be pharmacologically improved, even the excellent quality of transferred embryos does not necessarily increase the pregnancy rate. Poor endometrial receptivity in women with PCOS perturbs endometrial decidualization and blastocyst implantation, increasing adverse pregnancy outcomes, such as miscarriage and poor embryonic development. The etiological and pathophysiological mechanisms involved in defective endometrial receptivity in women with PCOS have not been fully elucidated to date. Various contributing factors have been reported as primary causes of defective endometrial receptivity in women with PCOS, including metabolic alterations, inflammatory events, and some abnormally expressed endometrial molecular markers. However, few studies to date have investigated in depth the complex mechanisms underlying the compromised endometrial receptivity in women with PCOS. This article reviews recent reports mainly on metabolic alterations and some new endometrial molecular markers in order to collate the existing data and improve our understanding in this field. The aim was to discuss current novel insights on defective endometrial receptivity in women with PCOS in order to provide a theoretical basis for reducing adverse pregnancy outcomes and improving the live birth rate in PCOS.
Collapse
Affiliation(s)
- Jinyan Zhao
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Xi'an Jiaotong University, No.157 of Xiwu Road, Xi'an, People's Republic of China
| | - Qing Chen
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Xi'an Jiaotong University, No.157 of Xiwu Road, Xi'an, People's Republic of China
| | - Xiang Xue
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Xi'an Jiaotong University, No.157 of Xiwu Road, Xi'an, People's Republic of China.
| |
Collapse
|
41
|
Liu S, Hong L, Mo M, Xiao S, Chen C, Li Y, Lian R, Wang X, Cai S, Diao L, Zeng Y. Evaluation of endometrial immune status of polycystic ovary syndrome. J Reprod Immunol 2021; 144:103282. [PMID: 33607547 DOI: 10.1016/j.jri.2021.103282] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 12/24/2020] [Accepted: 01/26/2021] [Indexed: 01/23/2023]
Abstract
Polycystic ovary syndrome (PCOS) is described as a low-grade chronic inflammatory state. However, there are limited studies on the specific endometrial immune status of PCOS patients. Whether this endometrial immune cell pattern is intrinsic to PCOS or the consequence of PCOS-associated obesity is a subject of debate. This study retrospectively included one hundred women diagnosed with PCOS and ninety-five normal fertile controls, which further divided into four groups (normoweight PCOS; overweight PCOS; normoweight control; overweight control) based on body mass index. The percentages of endometrial CD68+ macrophages (1.97 % vs. 1.17 %; P < 0.001), CD163+ M2 macrophages (2.30 % vs. 1.83 %; P = 0.001), CD1a+ iDCs (0.044 % vs. 0.029 %; P = 0.002), CD83+ mDCs (1.72 % vs. 1.07 %; P < 0.001) and CD8+ T cells (2.82 % vs. 1.95 %; P < 0.001) were significantly higher in normoweight PCOS women than normoweight controls. The percentage of CD68+ macrophages (2.09 % vs. 1.15 %; P < 0.001) was significantly higher in overweight PCOS women compared with overweight controls. In multivariant linear regression analysis, participants' PCOS status was the main predictors of endometrial CD68+ macrophages, CD163+ M2 macrophages, CD1a+ iDCs, CD83+ mDCs and CD8+ T cells in the whole study population. Additionally, in PCOS group, positive correlations were found between endometrial CD56+ NK, CD163+ M2 macrophages and QUICKI, indicating there was an association between endometrial immune cells and insulin resistance in PCOS women. Our study suggests that women with PCOS have altered endometrial immune cells, which may reflect a state of chronic low grade inflammation. The chronic inflammation, independent of obesity, may help understand the pathophysiologic mechanisms of intrinsic PCOS.
Collapse
Affiliation(s)
- Su Liu
- Shenzhen Key Laboratory of Reproductive Immunology for Peri-implantation, Shenzhen Zhongshan Institute for Reproduction and Genetics, Fertility Center, Shenzhen Zhongshan Urology Hospital, Shenzhen, China
| | - Ling Hong
- Shenzhen Key Laboratory of Reproductive Immunology for Peri-implantation, Shenzhen Zhongshan Institute for Reproduction and Genetics, Fertility Center, Shenzhen Zhongshan Urology Hospital, Shenzhen, China
| | - Meilan Mo
- Shenzhen Key Laboratory of Reproductive Immunology for Peri-implantation, Shenzhen Zhongshan Institute for Reproduction and Genetics, Fertility Center, Shenzhen Zhongshan Urology Hospital, Shenzhen, China
| | - Shan Xiao
- Shenzhen Key Laboratory of Reproductive Immunology for Peri-implantation, Shenzhen Zhongshan Institute for Reproduction and Genetics, Fertility Center, Shenzhen Zhongshan Urology Hospital, Shenzhen, China
| | - Cong Chen
- Shenzhen Key Laboratory of Reproductive Immunology for Peri-implantation, Shenzhen Zhongshan Institute for Reproduction and Genetics, Fertility Center, Shenzhen Zhongshan Urology Hospital, Shenzhen, China
| | - Yuye Li
- Shenzhen Key Laboratory of Reproductive Immunology for Peri-implantation, Shenzhen Zhongshan Institute for Reproduction and Genetics, Fertility Center, Shenzhen Zhongshan Urology Hospital, Shenzhen, China
| | - Ruochun Lian
- Shenzhen Key Laboratory of Reproductive Immunology for Peri-implantation, Shenzhen Zhongshan Institute for Reproduction and Genetics, Fertility Center, Shenzhen Zhongshan Urology Hospital, Shenzhen, China
| | - Xuejin Wang
- Shenzhen Key Laboratory of Reproductive Immunology for Peri-implantation, Shenzhen Zhongshan Institute for Reproduction and Genetics, Fertility Center, Shenzhen Zhongshan Urology Hospital, Shenzhen, China
| | - Songchen Cai
- Shenzhen Key Laboratory of Reproductive Immunology for Peri-implantation, Shenzhen Zhongshan Institute for Reproduction and Genetics, Fertility Center, Shenzhen Zhongshan Urology Hospital, Shenzhen, China
| | - Lianghui Diao
- Shenzhen Key Laboratory of Reproductive Immunology for Peri-implantation, Shenzhen Zhongshan Institute for Reproduction and Genetics, Fertility Center, Shenzhen Zhongshan Urology Hospital, Shenzhen, China
| | - Yong Zeng
- Shenzhen Key Laboratory of Reproductive Immunology for Peri-implantation, Shenzhen Zhongshan Institute for Reproduction and Genetics, Fertility Center, Shenzhen Zhongshan Urology Hospital, Shenzhen, China.
| |
Collapse
|
42
|
Abdel Khalek Abdel Razek A, Abou Elatta H. Differentiation Between Phenotypes of Polycystic Ovarian Syndrome With Sonography. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2021. [DOI: 10.1177/8756479321996676] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives: To differentiate between the classic (A/B) from the nonclassic (C/D) phenotypes of the polycystic ovarian syndrome (PCOS) with sonography. Materials & Methods: Retrospective analysis was performed upon 72 female patients with PCOS. All patients underwent transvaginal sonography. The patients were classified into classic and nonclassic phenotypes of PCOS. Image analysis was performed for the ovarian volume, follicle counts, follicle size, and endometrial plate thickness. Results: There were significant differences in the ovarian volume ( P = .001), follicle counts ( P = .001), follicle size ( P = .001), and endometrial plate thickness ( P = .001) between classic and nonclassic phenotypes of PCOS. The threshold value for ovarian volume, follicle count, follicle size, and endometrial plate thickness used to differentiate classic from nonclassic phenotypes were 12.5, 10.5, 5.25, and 5.75, respectively, with an area under the curve of 0.79, 0.82, 0.83, 0.77 and an accuracy of 75%, 73.6%, 79.2%, and 68.1%, respectively. The serum testosterone level and the body mass index were significantly higher in patients with classic than nonclassic phenotypes of PCOS ( P = .001, .04), respectively. Conclusion: Sonography findings can differentiate classic from nonclassic phenotypes of PCOS.
Collapse
Affiliation(s)
| | - Heba Abou Elatta
- Department of Diagnostic Radiology, Student Hospital, Mansoura Faculty of Medicine, Mansoura, Egypt
| |
Collapse
|
43
|
Hu M, Zhang Y, Li X, Cui P, Sferruzzi-Perri AN, Brännström M, Shao LR, Billig H. TLR4-Associated IRF-7 and NFκB Signaling Act as a Molecular Link Between Androgen and Metformin Activities and Cytokine Synthesis in the PCOS Endometrium. J Clin Endocrinol Metab 2021; 106:1022-1040. [PMID: 33382900 DOI: 10.1210/clinem/dgaa951] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Indexed: 12/19/2022]
Abstract
CONTEXT Low-grade chronic inflammation is commonly seen in polycystic ovary syndrome (PCOS) patients with elevated levels of inflammatory cytokines in the endometrium. OBJECTIVE This work aimed to increase the limited understanding of the mechanisms underlying cytokine synthesis and increased endometrial inflammation in PCOS patients. METHODS Endometrial biopsy samples were collected from non-PCOS (n = 17) and PCOS (n = 22) patients either during the proliferative phase of the menstrual cycle or with hyperplasia. Endometrial explants were prepared from PCOS patients and underwent pharmacological manipulation in vitro. The expression and localization of toll-like receptor 2 (TLR2)/4, key elements of innate immune signal transduction and nuclear factor κB (NFκB) signaling pathways, and multiple cytokines were comprehensively evaluated by Western blotting, immunohistochemistry, and immunofluorescence in endometrial tissues. RESULTS We demonstrated the distribution of protein expression and localization associated with the significantly increased androgen receptor, TLR2, and TLR4-mediated activation of interferon regulatory factor-7 (IRF-7) and NFκB signaling, cytokine production, and endometrial inflammation in PCOS patients compared to non-PCOS patients with and without endometrial hyperplasia. In vitro experiments showed that 5-dihydrotestosterone (DHT) enhanced androgen receptor, TLR4, IRF-7, and p-NFκB p65 protein expression along with increased interferon α (IFNα) and IFNɣ abundance. The effects of DHT on IRF-7, p-NFκB p65, and IFN abundance were abolished by flutamide, an antiandrogen. Although 17β-estradiol (E2) decreased p-IRF-7 expression with little effect on TLR-mediated IRF7 and NFκB signaling or on cytokine protein levels, exposure to metformin alone or in combination with E2 suppressed interleukin-1 receptor-associated kinase 4 (IRAK4), p-IRF-7, IRF-7, IκB kinase α (IKKα), p-NFκB p65, IFNɣ, and tumor necrosis factor α protein expression. CONCLUSION Cytokine synthesis and increased endometrial inflammation in PCOS patients are coupled to androgen-induced TLR4/IRF-7/NFκB signaling, which is inhibited by metformin treatment.
Collapse
Affiliation(s)
- Min Hu
- Department of Traditional Chinese Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- Department of Physiology/Endocrinology, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Yuehui Zhang
- Department of Physiology/Endocrinology, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Obstetrics and Gynecology, Key Laboratory and Unit of Infertility in Chinese Medicine, First Affiliated Hospital, Heilongjiang University of Chinese Medicine, Harbin, China
| | - Xin Li
- Department of Physiology/Endocrinology, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
- Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Shanghai, China
| | - Peng Cui
- Department of Physiology/Endocrinology, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Amanda Nancy Sferruzzi-Perri
- Centre for Trophoblast Research, Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, UK
| | - Mats Brännström
- Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Linus R Shao
- Department of Physiology/Endocrinology, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Håkan Billig
- Department of Physiology/Endocrinology, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| |
Collapse
|
44
|
Cui C, Wang J, Han X, Wang Q, Zhang S, Liang S, Li H, Meng L, Zhang C, Chen H. Identification of small extracellular vesicle-linked miRNA specifically derived from intrafollicular cells in women with polycystic ovary syndrome. Reprod Biomed Online 2021; 42:870-880. [PMID: 33840620 DOI: 10.1016/j.rbmo.2021.02.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 01/06/2021] [Accepted: 02/04/2021] [Indexed: 01/04/2023]
Abstract
RESEARCH QUESTION This study aimed to identify small extracellular vesicle (sEV)-linked microRNAs (miRNA) specifically derived from intrafollicular cells in women with polycystic ovary syndrome (PCOS) and to investigate their biological functions. DESIGN A total of 120 women were recruited from September 2017 to October 2018. To investigate miRNA profiles in sEV derived from follicular fluid and serum, 30 women with PCOS and 30 without PCOS were included for a miRNA microarray containing probes interrogating 2549 human miRNA. To study the expression levels of differentially expressed miRNA, sEV in follicular fluid obtained from another 30 PCOS and 30 non-PCOS patients were used for quantitative real-time polymerase chain reaction analysis. RESULTS A total of 281 sEV-linked miRNA specifically derived from intrafollicular cells were identified, 179 of which were expressed in both the PCOS and non-PCOS groups. Twenty-six of the 179 intrafollicle-specific sEV-linked miRNA were predicted to target 1537 genes. Functional analysis suggested that these genes were involved in pathways related to folliculogenesis, including the MAPK, and PI3K-Akt signalling pathways. Quantitative real-time polymerase chain reaction analysis showed that the expression of seven intrafollicle-specific sEV-linked miRNA was significantly higher in follicular fluid-derived sEV in women with PCOS than in women without it. These miRNA and their corresponding target genes were identified as being involved in the MAPK signalling pathway and oocyte meiosis. CONCLUSIONS The data suggest that the aberrantly expressed miRNA and their target genes might be associated with PCOS, providing novel insights into the molecular mechanisms underlying regulation of folliculogenesis and oocyte maturation in PCOS.
Collapse
Affiliation(s)
- Chenchen Cui
- Department of Reproductive Medicine Center, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Henan Provincial People's Hospital of Henan University, Zhengzhou, Henan, China; Henan Joint International Research Laboratory of Reproductive Bioengineering, Zhengzhou Henan Province, China
| | - Jie Wang
- Women & Infant Hospital of Zhengzhou, Zhengzhou, Henan, China
| | - Xiao Han
- Department of Reproductive Medicine Center, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Henan Provincial People's Hospital of Henan University, Zhengzhou, Henan, China; Henan Joint International Research Laboratory of Reproductive Bioengineering, Zhengzhou Henan Province, China
| | - Qian Wang
- Department of Reproductive Medicine Center, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Henan Provincial People's Hospital of Henan University, Zhengzhou, Henan, China; Henan Joint International Research Laboratory of Reproductive Bioengineering, Zhengzhou Henan Province, China
| | - Shan Zhang
- Department of Reproductive Medicine Center, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Henan Provincial People's Hospital of Henan University, Zhengzhou, Henan, China; Department of Reproductive Medicine Center, Henan Provincial People's Hospital Affiliated to Xinxiang Medical College, Zhengzhou, Henan, China
| | - Shoujing Liang
- Department of Reproductive Medicine Center, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Henan Provincial People's Hospital of Henan University, Zhengzhou, Henan, China; Henan Joint International Research Laboratory of Reproductive Bioengineering, Zhengzhou Henan Province, China
| | - Huan Li
- Department of Reproductive Medicine Center, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Henan Provincial People's Hospital of Henan University, Zhengzhou, Henan, China; Henan Joint International Research Laboratory of Reproductive Bioengineering, Zhengzhou Henan Province, China
| | - Li Meng
- Department of Reproductive Medicine Center, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Henan Provincial People's Hospital of Henan University, Zhengzhou, Henan, China; Henan Joint International Research Laboratory of Reproductive Bioengineering, Zhengzhou Henan Province, China
| | - Cuilian Zhang
- Department of Reproductive Medicine Center, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Henan Provincial People's Hospital of Henan University, Zhengzhou, Henan, China; Henan Joint International Research Laboratory of Reproductive Bioengineering, Zhengzhou Henan Province, China.
| | - Huanhuan Chen
- Department of Reproductive Medicine Center, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Henan Provincial People's Hospital of Henan University, Zhengzhou, Henan, China; Henan Joint International Research Laboratory of Reproductive Bioengineering, Zhengzhou Henan Province, China.
| |
Collapse
|
45
|
Azhar A, Haider G, Naseem Z, Farooqui N, Farooqui MU, Rehman R. Morphological changes in the experimental model of polycystic ovary syndrome and effects of vitamin D treatment. J Obstet Gynaecol Res 2021; 47:1164-1171. [PMID: 33496002 DOI: 10.1111/jog.14671] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 11/19/2020] [Accepted: 12/25/2020] [Indexed: 12/18/2022]
Abstract
AIM This research was designed to develop an animal model by inducing polycystic ovary syndrome (PCOS) with dehydroepiandrosterone (DHEA) and observe reproductive and morphological changes after treatment with vitamin D. MATERIALS AND METHODS Thirty pre-pubertal female Sprague-Dawley (SD) dams were recruited. The animals were distributed 10 each in control, PCOS and vitamin D-treated groups. In control group 0.2 ml of sesame oil was given. PCOS group was administered DHEA by the daily dose of 6 mg/kg for 30 days. In vitamin D-treated group, animals were injected 6 mg/kg/day DHEA daily and 120 ng 1, 25(OH) 2D3/100 g subcutaneously once a week. The occurrence of reproductive phenotypic PCOS was evaluated by estrous cycle, morphology and histological changes of ovary, uterus on light microscope. RESULTS The results of this study showed significant weight gain, obesity, and estrous irregularity in PCOs group as compared to control and vitamin D-treated group. CONCLUSION Administration of vitamin D (120 ng 1, 25(OH) 2D3/100) improved the cycle characteristics, reduced body weight and morphological features in PCOS induced animals. The results support the effect of vitamin D treatment for metabolic and reproductive characteristic features in PCOS females.
Collapse
Affiliation(s)
- Arfa Azhar
- Department of Biological and Biomedical Sciences, The Aga Khan University, Karachi, Pakistan
| | - Ghulam Haider
- Department of Biological and Biomedical Sciences, The Aga Khan University, Karachi, Pakistan
| | - Zehra Naseem
- Department of Biological and Biomedical Sciences, The Aga Khan University, Karachi, Pakistan
| | - Nida Farooqui
- Department of Biological and Biomedical Sciences, The Aga Khan University, Karachi, Pakistan
| | - Mohammad U Farooqui
- Department of Pharmacy, Shaeed Muhtarma Benazir Bhutto Medical University, Larkana, Pakistan
| | - Rehana Rehman
- Department of Biological and Biomedical Sciences, The Aga Khan University, Karachi, Pakistan
| |
Collapse
|
46
|
Huang J, Lin J, Xia L, Tian L, Xu D, Liu P, Zhu J, Wu Q. Decreased Endometrial Thickness Is Associated With Higher Risk of Neonatal Complications in Women With Polycystic Ovary Syndrome. Front Endocrinol (Lausanne) 2021; 12:766601. [PMID: 34912297 PMCID: PMC8667169 DOI: 10.3389/fendo.2021.766601] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Accepted: 11/11/2021] [Indexed: 12/17/2022] Open
Abstract
PURPOSE To evaluate the association of endometrial thickness (EMT) with obstetric and neonatal outcomes in women with polycystic ovary syndrome (PCOS). METHODS A total of 1755 subfertile PCOS women with singleton livebirths after frozen-thawed embryo transfer were included between January 2009 and September 2019. Main obstetric outcomes were hypertensive disorders in pregnancy and abnormal placentation. Main neonatal outcomes were preterm birth (PTB), low birthweight (LBW) and small-for-gestational age (SGA). Crude and adjusted odds ratios (ORs) with 95% confidence intervals (CIs) were estimated by univariate and multivariate logistic regression analyses. RESULTS Each millimeter decrease in EMT was related to a 9% (adjusted OR 1.09, 95% CI 1.00-1.19; P = 0.053), 14% (adjusted OR 1.14, 95% CI 1.02-1.28; P = 0.002) and 22% (adjusted OR 1.22, 95% CI 1.07-1.38; P = 0.003) higher risk of PTB, LBW and SGA, respectively. Compared to women with EMT >13 mm, women with EMT ≤8 mm also had significantly higher risk of PTB (adjusted OR 3.79, 95% CI 1.53-9.39; P = 0.004), LBW (adjusted OR 4.33, 95% CI 1.39-13.50; P = 0.012) and SGA (adjusted OR 6.38, 95% CI 1.78-22.83; P = 0.004). These associations remained consistent in further subgroup analysis by endometrial preparation regimen and in sensitivity analyses among nulligravida women or women without adverse obstetric outcomes. No significant differences were found in the incidence of several pregnancy complications across EMT categories. CONCLUSION Decreased EMT was independently associated with increased risk of PTB, LBW and SGA in women with PCOS.
Collapse
Affiliation(s)
- Jialyu Huang
- Center for Reproductive Medicine, Jiangxi Maternal and Child Health Hospital, Nanchang University School of Medicine, Nanchang, China
| | - Jiaying Lin
- Department of Assisted Reproduction, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Leizhen Xia
- Center for Reproductive Medicine, Jiangxi Maternal and Child Health Hospital, Nanchang University School of Medicine, Nanchang, China
| | - Lifeng Tian
- Center for Reproductive Medicine, Jiangxi Maternal and Child Health Hospital, Nanchang University School of Medicine, Nanchang, China
| | - Dingfei Xu
- Center for Reproductive Medicine, Jiangxi Maternal and Child Health Hospital, Nanchang University School of Medicine, Nanchang, China
| | - Peipei Liu
- Center for Reproductive Medicine, Jiangxi Maternal and Child Health Hospital, Nanchang University School of Medicine, Nanchang, China
| | - Jing Zhu
- Center for Reproductive Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
- *Correspondence: Jing Zhu, ; Qiongfang Wu,
| | - Qiongfang Wu
- Center for Reproductive Medicine, Jiangxi Maternal and Child Health Hospital, Nanchang University School of Medicine, Nanchang, China
- *Correspondence: Jing Zhu, ; Qiongfang Wu,
| |
Collapse
|
47
|
Palomba S, Piltonen TT, Giudice LC. Endometrial function in women with polycystic ovary syndrome: a comprehensive review. Hum Reprod Update 2020; 27:584-618. [PMID: 33302299 DOI: 10.1093/humupd/dmaa051] [Citation(s) in RCA: 137] [Impact Index Per Article: 34.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 09/29/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Polycystic ovary syndrome (PCOS) is the most common cause of anovulatory infertility. An endometrial component has been suggested to contribute to subfertility and poor reproductive outcomes in affected women. OBJECTIVE AND RATIONALE The aim of this review was to determine whether there is sufficient evidence to support that endometrial function is altered in women with PCOS, whether clinical features of PCOS affect the endometrium, and whether there are evidence-based interventions to improve endometrial dysfunction in PCOS women. SEARCH METHODS An extensive literature search was performed from 1970 up to July 2020 using PubMed and Web of Science without language restriction. The search included all titles and abstracts assessing a relationship between PCOS and endometrial function, the role played by clinical and biochemical/hormonal factors related to PCOS and endometrial function, and the potential interventions aimed to improve endometrial function in women with PCOS. All published papers were included if considered relevant. Studies having a specific topic/hypothesis regarding endometrial cancer/hyperplasia in women with PCOS were excluded from the analysis. OUTCOMES Experimental and clinical data suggest that the endometrium differs in women with PCOS when compared to healthy controls. Clinical characteristics related to the syndrome, alone and/or in combination, may contribute to dysregulation of endometrial expression of sex hormone receptors and co-receptors, increase endometrial insulin-resistance with impaired glucose transport and utilization, and result in chronic low-grade inflammation, immune dysfunction, altered uterine vascularity, abnormal endometrial gene expression and cellular abnormalities in women with PCOS. Among several interventions to improve endometrial function in women with PCOS, to date, only lifestyle modification, metformin and bariatric surgery have the highest scientific evidence for clinical benefit. WIDER IMPLICATIONS Endometrial dysfunction and abnormal trophoblast invasion and placentation in PCOS women can predispose to miscarriage and pregnancy complications. Thus, patients and their health care providers should advise about these risks. Although currently no intervention can be universally recommended to reverse endometrial dysfunction in PCOS women, lifestyle modifications and metformin may improve underlying endometrial dysfunction and pregnancy outcomes in obese and/or insulin resistant patients. Bariatric surgery has shown its efficacy in severely obese PCOS patients, but a careful evaluation of the benefit/risk ratio is warranted. Large scale randomized controlled clinical trials should address these possibilities.
Collapse
Affiliation(s)
- Stefano Palomba
- Unit of Obstetrics and Gynecology, Grande Ospedale Metropolitano of Reggio Calabria, Reggio Calabria, Italy
| | - Terhi T Piltonen
- Department of Obstetrics and Gynecology, PEDEGO Research Unit, Medical Research Center, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - Linda C Giudice
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, CA, USA
| |
Collapse
|
48
|
Gupta S, Gupta P. Etiopathogenesis, Challenges and Remedies Associated With Female Genital Tuberculosis: Potential Role of Nuclear Receptors. Front Immunol 2020; 11:02161. [PMID: 33178178 PMCID: PMC7593808 DOI: 10.3389/fimmu.2020.02161] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 08/07/2020] [Indexed: 12/16/2022] Open
Abstract
Extra-pulmonary tuberculosis (EPTB) is recognized mainly as a secondary manifestation of a primary tuberculosis (TB) infection in the lungs contributing to a high incidence of morbidity and mortality. The TB bacilli upon reactivation maneuver from the primary site disseminating to other organs. Diagnosis and treatment of EPTB remains challenging due to the abstruse positioning of the infected organs and the associated invasiveness of sample acquisition as well as misdiagnosis, associated comorbidities, and the inadequacy of biomarkers. Female genital tuberculosis (FGTB) represents the most perilous form of EPTB leading to poor uterine receptivity (UR), recurrent implantation failure and infertility in females. Although the number of TB cases is reducing, FGTB cases are not getting enough attention because of a lack of clinical awareness, nonspecific symptoms, and inappropriate diagnostic measures. This review provides an overview for EPTB, particularly FGTB diagnostics and treatment challenges. We emphasize the need for new therapeutics and highlight the need for the exaction of biomarkers as a point of care diagnostic. Nuclear receptors have reported role in maintaining UR, immune modulation, and TB modulation; therefore, we postulate their role as a therapeutic drug target and biomarker that should be explored in FGTB.
Collapse
Affiliation(s)
- Shalini Gupta
- Department of Molecular Biology, CSIR-Institute of Microbial Technology, Chandigarh, India
| | - Pawan Gupta
- Department of Molecular Biology, CSIR-Institute of Microbial Technology, Chandigarh, India
| |
Collapse
|
49
|
He S, Mao X, Lei H, Dong B, Guo D, Zheng B, Sun P. Peripheral Blood Inflammatory-Immune Cells as a Predictor of Infertility in Women with Polycystic Ovary Syndrome. J Inflamm Res 2020; 13:441-450. [PMID: 32884325 PMCID: PMC7443446 DOI: 10.2147/jir.s260770] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 07/29/2020] [Indexed: 12/19/2022] Open
Abstract
Purpose This study aimed to investigate the inflammatory-immune cells in the peripheral blood of women with polycystic ovary syndrome (PCOS) and assessed the potential correlation between inflammatory-immune cells and infertility in PCOS women. Materials and Methods In this case-control study, the profiles of lymphocyte subsets were analyzed by flow cytometry. White blood cells (WBC), neutrophils (Neu), lymphocytes, Ferriman-Gallwey (F-G) score, testosterone, prolactin, follicle-stimulating hormone, luteinizing hormone, fasting blood glucose, and fasting plasma insulin were measured, together with body mass index. Association between inflammatory-immune cells and PCOS was evaluated. Moreover, inflammatory-immune cells of the PCOS women with infertility were evaluated, and the relative operating characteristic (ROC) curve and cutoff values were calculated. Results The number of WBC, Neu, and lymphocytes was higher in PCOS women than controls (P<0.05). The percentages of total T lymphocytes, CD4+T, and NK were significantly increased in the PCOS group (P<0.001). The CD4/CD8 ratio was obviously elevated for increasing CD4+T (P<0.05). Consequently, T%, CD4+T%, and NK% were found to be the independent risk factors of PCOS by ROC curve and multivariate logistic regression analysis. Furthermore, only NK% was significantly higher in PCOS women with infertility than those who had PCOS without infertility (P<0.001). To diagnose infertility in PCOS, the cutoff value of NK% was calculated as 16.43%. Conclusion These findings suggest that the pathogenesis of PCOS is related to immune cells including T, CD4+T, and NK cells. NK cells are likely to be a potential predictive factor for PCOS women with infertility.
Collapse
Affiliation(s)
- ShuQiong He
- Department of Prenatal Diagnosis, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, 350001, People's Republic of China
| | - XiaoDan Mao
- Laboratory of Gynecologic Oncology, Department of Gynecology, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, 350001, People's Republic of China.,Fujian Key Laboratory of Women and Children's Critical Diseases Research, Fujian Maternity and Child Health Hospital, Fuzhou, 350001, People's Republic of China
| | - HuiFang Lei
- Laboratory of Gynecologic Oncology, Department of Gynecology, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, 350001, People's Republic of China.,Fujian Key Laboratory of Women and Children's Critical Diseases Research, Fujian Maternity and Child Health Hospital, Fuzhou, 350001, People's Republic of China
| | - BinHua Dong
- Laboratory of Gynecologic Oncology, Department of Gynecology, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, 350001, People's Republic of China.,Fujian Key Laboratory of Women and Children's Critical Diseases Research, Fujian Maternity and Child Health Hospital, Fuzhou, 350001, People's Republic of China
| | - DanHua Guo
- Department of Prenatal Diagnosis, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, 350001, People's Republic of China
| | - BeiHong Zheng
- Department of Reproduction, Fujian, Affiliated Hospital of Fujian Medical University, Fuzhou, 350001, People's Republic of China
| | - PengMing Sun
- Laboratory of Gynecologic Oncology, Department of Gynecology, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, 350001, People's Republic of China.,Fujian Key Laboratory of Women and Children's Critical Diseases Research, Fujian Maternity and Child Health Hospital, Fuzhou, 350001, People's Republic of China
| |
Collapse
|
50
|
Chen M, Huang X, Liu Y, Lei S, Wu Y, Chen Z, Hong L, Teng X. Systematic oxidative stress is not associated with live birth rate in young non-obese patients with polycystic ovarian syndrome undergoing assisted reproduction cycles: A prospective cohort study. Eur J Obstet Gynecol Reprod Biol 2020; 253:154-161. [PMID: 32877771 DOI: 10.1016/j.ejogrb.2020.07.049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 07/23/2020] [Accepted: 07/27/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Oxidative stress may be associated with polycystic ovary syndrome (PCOS) and poor outcomes after assisted reproduction treatment. It is unclear if systematic oxidative stress is correlated with live birth rate in patients with PCOS after controlled ovarian stimulation. This study aimed to investigate the serum oxidative stress markers on the day of trigger hCG and its relationship with live birth rate in young non-obese women with or without PCOS undergoing in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) treatment. STUDY DESIGN In this prospective cohort study, 50 patients with PCOS and 50 patients without PCOS aged less than 35 years and undergoing IVF/ICSI between February 2017 and January 2018 were studied. The body mass index (BMI) of all participants was less than 28 kg/m2. Serum malondialdehyde (MDA), superoxide dismutase (SOD) and glutathione peroxidase (GPx) levels on the day of hCG were measured. Demographic and cycle characteristics, embryo laboratory data and pregnancy outcomes after fresh embryo transfer were analyzed. Univariate analysis and logistic regression analysis were used to analyze independent variables predicting the live birth rate. RESULTS After conventional ovarian stimulation, the patients with PCOS had higher serum MDA and GPx concentrations (P < 0.03) and lower serum SOD levels (P < 0.03) on the hCG trigger day than the controls. Further, the serum MDA and GPx levels on the trigger day were also positively correlated with the number of good quality embryos (R = 0.26, P = 0.01; R = 0.21, P = 0.04; respectively). However, cycle characteristics, IVF/ICSI outcomes and pregnancy outcomes were comparable between the two groups. Multivariate logistic regression analysis showed that the rate of good quality embryos (OR 1.04, 95 %CI 1.01-1.06, P = 0.005) and the duration of infertility (OR 0.74, 95 %CI 0.56-0.98, P = 0.04) were predictive factors of live birth rate. The ROC curve analysis showed the AUC for the model was 0.76 (95 %CI: 0.67-0.86, P < 0.001). CONCLUSION The data suggest that moderate systemic oxidative stress on the hCG trigger day had no detrimental effects on live birth rate in young and non-obese patients with PCOS after IVF/ICSI treatment.
Collapse
Affiliation(s)
- Miaoxin Chen
- Centre for Assisted Reproduction, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, China
| | - Xin Huang
- Centre for Assisted Reproduction, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, China
| | - Yiping Liu
- Centre for Assisted Reproduction, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, China; Centre for Reproductive Medicine, Nanyang Municipal First People's Hospital of Henan Province, China
| | - Shating Lei
- Centre for Assisted Reproduction, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, China
| | - Yuanyuan Wu
- Centre for Assisted Reproduction, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, China
| | - Zhiqin Chen
- Centre for Assisted Reproduction, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, China
| | - Ling Hong
- Centre for Assisted Reproduction, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, China
| | - Xiaoming Teng
- Centre for Assisted Reproduction, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, China.
| |
Collapse
|