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Qi Q, Xia Y, Luo J, Wang Y, Xie Q. Cocktail treatment by GnRH-antagonist, letrozole, and mifepristone for the prevention of ovarian hyperstimulation syndrome: a prospective randomized trial. Gynecol Endocrinol 2023; 39:2269281. [PMID: 37844908 DOI: 10.1080/09513590.2023.2269281] [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: 03/11/2022] [Accepted: 10/05/2023] [Indexed: 10/18/2023] Open
Abstract
OBJECTIVE This study is aimed to determine the efficacy of a cocktail style treatment by combining GnRH-antagonist, letrozole, and mifepristone on the prevention of ovarian hyperstimulation syndrome (OHSS) in high-risk women. METHODS This prospective, randomized controlled clinical trial was performed between January 2018 and December 2018. A total of 170 women who identified as high risk of OHSS during the ovarian hyperstimulation and underwent cryopreservation of whole embryos. On the day of oocyte retrieval, the combination group received 0.25 mg Cetrorelix for 3 d, 5 mg letrozole for 5 d, and 50 mg mifepristone for 3 d, the mifepristone group received 50 mg mifepristone for 3 d. A total of 156 cases were included in final analysis. All the frozen embryo transfer (FET) cycles were followed up until December 2021. RESULTS The combination group showed significantly decreased incidence of moderate and severe OHSS than mifepristone group (20.5% vs. 42.3%), with remarkably reduced serum estradiol level on hCG + 3 and + 5 d, decreased ovarian diameter, and shortened luteal phase. Oocyte retrieval number, levels of estradiol on hCG + 0 and VEGF, and ovarian diameter on hCG + 5 were associated with the severity of the symptoms. There was no significant difference in cumulative live birth rates (LBRs) between the combination and mifepristone group (74.4% vs. 76.9%). CONCLUSIONS The combination treatment effectively reduces the incidence of moderate/severe OHSS in high-risk women.
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Affiliation(s)
- Qianrong Qi
- Center for Reproductive Medicine, Renmin Hospital of Wuhan University, Wuhan, PR China
| | - Yi Xia
- Center for Reproductive Medicine, Renmin Hospital of Wuhan University, Wuhan, PR China
| | - Jin Luo
- Center for Reproductive Medicine, Renmin Hospital of Wuhan University, Wuhan, PR China
| | - Yaqin Wang
- Center for Reproductive Medicine, Renmin Hospital of Wuhan University, Wuhan, PR China
| | - Qingzhen Xie
- Center for Reproductive Medicine, Renmin Hospital of Wuhan University, Wuhan, PR China
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2
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Yilmaz N, Gulsen Coban P, Yilmaz S, Inal HA, Timur H, Haltas H. Does cabergoline administration affect endometrial VEGFR-2 expression in a rat model of ovarian hyperstimulation syndrome? Gynecol Endocrinol 2023; 39:2217295. [PMID: 37247633 DOI: 10.1080/09513590.2023.2217295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 11/16/2022] [Accepted: 05/18/2023] [Indexed: 05/31/2023] Open
Abstract
OBJECTIVE To assess the effect of cabergoline on endometrial vascular endothelial growth factor receptor-2 (VEGFR-2) immunoexpression in an ovarian hyperstimulation syndrome (OHSS) rat model. MATERIAL AND METHODS Twenty-one immature female Wistar rats were assigned into three groups: group 1, the control group; group 2, stimulated with gonadotropins to mimic OHSS; and group 3, in which an OHSS protocol was induced and thereafter treated with cabergoline (100 μg/kg/day). Body weight, ovarian volume, corpora lutea numbers, and endometrial VEGFR-2 expression were compared between the groups. RESULTS Weight gain and ovarian volume were highest in the OHSS-placebo group, while cabergoline administration significantly reversed those effects (p = 0.001 and p = 0.001, respectively). VEGFR-2 stained cells were significantly lower in groups 2 and 3 compared to group 1 (p = 0.002). Although VEGFR-2 expression was lowest in group 3, the difference was not statistically significant. Corpora lutea numbers were also similar (p = 0.465). CONCLUSION While successful implantation requires a vascularized receptive endometrium, impaired expression of VEGFR-2 and disrupted endometrial angiogenesis due to cabergoline administration may be associated with IVF failure in fresh OHSS cycles. The insignificant decrease in endometrial VEGFR-2 expression observed in this research needs to be investigated by further studies involving additional techniques such as immunoblotting and/or RT-PCR analyses.
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Affiliation(s)
- Nafiye Yilmaz
- Department of Reproductive Endocrinology, Zekai Tahir Burak Women's Health Education and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Pinar Gulsen Coban
- Department of Obstetric and Gynecology, Zekai Tahir Burak Women's Health Education and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Saynur Yilmaz
- Department of Obstetric and Gynecology, Zekai Tahir Burak Women's Health Education and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Hasan Ali Inal
- Department of Reproductive Endocrinology, Antalya Training and Research Hospital, University of Health Sciences, Antalya, Turkey
| | - Hakan Timur
- Department of Obstetric and Gynecology, Zekai Tahir Burak Women's Health Education and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Hacer Haltas
- Department of Pathology, Private Hospital, Ankara, Turkey
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3
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Tahermanesh K, Hakimpour S, Govahi A, Keyhanfar F, Kashi AM, Chaichian S, Shahriyaripour R, Ajdary M. Treatment of Ovarian Hyperstimulation Syndrome in a Mouse Model by Cannabidiol, an Angiogenesis Pathway Inhibitor. BIOMED RESEARCH INTERNATIONAL 2022; 2022:1111777. [PMID: 36588534 PMCID: PMC9797301 DOI: 10.1155/2022/1111777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 12/04/2022] [Accepted: 12/09/2022] [Indexed: 12/24/2022]
Abstract
Studies suggest that ovarian hyperstimulation syndrome (OHSS) can be treated by reducing the level of vascular endothelial growth factor (VEGF). However, due to the side effects of commercially available VEGF-reducing drugs, they can be ruled out as a suitable treatment for OHSS; therefore, researchers are looking for new medications to treat OHSS. This study is aimed at investigating the effects of cannabidiol (CBD) in an OHSS model and to evaluate its efficacy in modulating the angiogenesis pathway and VEGF gene expression. For this purpose, 32 female mice were randomly divided into four groups (eight mice per group): control group, group 2 with OHSS induction, group 3 receiving 32 nmol of dimethyl sulfoxide after OHSS induction, and group 4 receiving 30 mg/kg of CBD after OHSS induction. The animals' body weight, ovarian weight, vascular permeability (VP), and ovarian follicle count were measured, and the levels of VEGF gene and protein expression in the peritoneal fluid were assessed. Based on the results, CBD decreased the body and ovarian weights, VP, and corpus luteum number compared to the OHSS group (p < 0.05). The peritoneal VEGF gene and protein expression levels reduced in the CBD group compared to the OHSS group (p < 0.05). Also, CBD caused OHSS alleviation by suppressing VEGF expression and VP. Overall, CBD downregulated VEGF gene expression and improved VP in OHSS.
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Affiliation(s)
- Kobra Tahermanesh
- Endometriosis Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Sahar Hakimpour
- Department of Physiology, School of Veterinary Medicine, Shiraz University, Shiraz, Iran
| | - Azam Govahi
- Endometriosis Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Fariborz Keyhanfar
- Department of Pharmacology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | | | - Shahla Chaichian
- Endometriosis Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Roya Shahriyaripour
- Endometriosis Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Marziyeh Ajdary
- Endometriosis Research Center, Iran University of Medical Sciences, Tehran, Iran
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Abstract
In vitro fertilization is indicated for infertile women with polycystic ovarian syndrome (PCOS) after unsuccessful treatment with ovulation induction agents or in women deemed high-risk of multiple gestations who are ideal candidates for single embryo transfers. PCOS patients are at increased risk of ovarian hyperstimulation syndrome; therefore, attention should be made in the choice of in vitro fertilization treatment protocol, dose of gonadotropin utilized, and regimen to achieve final oocyte maturation. Adopting these strategies in addition to close monitoring may significantly reduce the ovarian hyperstimulation syndrome risk. Future developments may improve pregnancy outcomes and decrease complications in PCOS women undergoing fertility treatment.
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5
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Hortu I, Karadadas E, Ozceltik G, Tavmergen E, Tavmergen Goker EN, Yigitturk G, Erbas O. Oxytocin and cabergoline alleviate ovarian hyperstimulation syndrome (OHSS) by suppressing vascular endothelial growth factor (VEGF) in an experimental model. Arch Gynecol Obstet 2020; 303:1099-1108. [PMID: 33140116 DOI: 10.1007/s00404-020-05855-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 10/20/2020] [Indexed: 02/08/2023]
Abstract
PURPOSE Ovarian hyperstimulation syndrome (OHSS) is a life-threatening complication of ovarian stimulation in reproductive medicine. Here, we aimed to investigate the role of oxytocin (OT) and cabergoline in the prevention and alleviation of the OHSS in an animal model. METHODS Thirty-five female immature Wistar rats were randomly assigned to five groups. The control group (n = 7) received saline only for five consecutive days. Remaining twenty-eight rats received 10 IU of pregnant mare serum gonadotropin (PMSG) followed by 30 IU of human chorionic gonadotropin (hCG) to induce OHSS. Group 2 (n = 7) was managed with no additional intervention after the induction of OHSS. Group 3 (n = 7) received 100 μg/kg cabergoline 2 h before the PMSG injection for four consecutive days and 2 h before the hCG injection on the fifth day. Group 4 (n = 7) and group 5 (n = 7) received 80 μg/kg and 160 μg/kg OT after induction of OHSS, respectively. Oxytocin was administered 2 h before the PMSG injection for four consecutive days and 2 h before the hCG injection on the fifth day. Body and ovary weight, vascular permeability (VP), VEGF expression in the ovaries, and levels of VEGF in the peritoneal fluids were examined in all animals. RESULTS Cabergoline and OT reduced body weight, ovary weight, and VP compared to that of the OHSS group (p < 0.05). VEGF expressions in ovaries and peritoneal VEGF levels were decreased in cabergoline and OT groups compared to that of the OHSS groups (p < 0.001 for cabergoline and OT-80 μg/kg; p < 0.00001 for OT-160 μg/kg). However, there was no statistically significant difference in these parameters between the OT and cabergoline groups. CONCLUSION Both OT and cabergoline were active in the alleviation of OHSS through suppression of VEGF and VP. Overall, we conclude that OT is effective for downregulation for VEGF and improvement in vascular permeability in OHSS.
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Affiliation(s)
- Ismet Hortu
- Department of Obstetrics and Gynecology, Ege University School of Medicine, Bornova, 35100, Izmir, Turkey. .,Department of Stem Cell, Ege University Institute of Health Sciences, Bornova, 35100, Izmir, Turkey.
| | - Elif Karadadas
- Department of Biochemistry, Ege University School of Medicine, Izmir, Turkey
| | - Gokay Ozceltik
- Department of Obstetrics and Gynecology, Ege University School of Medicine, Bornova, 35100, Izmir, Turkey
| | - Erol Tavmergen
- Department of Obstetrics and Gynecology, Ege University School of Medicine, Bornova, 35100, Izmir, Turkey.,Department of IVF Research Center, Ege University School of Medicine, Izmir, Turkey
| | - Ege Nazan Tavmergen Goker
- Department of Obstetrics and Gynecology, Ege University School of Medicine, Bornova, 35100, Izmir, Turkey.,Department of IVF Research Center, Ege University School of Medicine, Izmir, Turkey
| | - Gurkan Yigitturk
- Department of Histology and Embryology, Mugla Sıtkı Kocman University School of Medicine, Mugla, Turkey
| | - Oytun Erbas
- Department of Physiology, Demiroglu Bilim University School of Medicine, Istanbul, Turkey
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6
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Motz CT, Chesler KC, Allen RS, Bales KL, Mees LM, Feola AJ, Maa AY, Olson DE, Thule PM, Iuvone PM, Hendrick AM, Pardue MT. Novel Detection and Restorative Levodopa Treatment for Preclinical Diabetic Retinopathy. Diabetes 2020; 69:1518-1527. [PMID: 32051147 PMCID: PMC7306127 DOI: 10.2337/db19-0869] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 02/09/2020] [Indexed: 12/21/2022]
Abstract
Diabetic retinopathy (DR) is diagnosed clinically by directly viewing retinal vascular changes during ophthalmoscopy or through fundus photographs. However, electroretinography (ERG) studies in humans and rodents have revealed that retinal dysfunction is demonstrable prior to the development of visible vascular defects. Specifically, delays in dark-adapted ERG oscillatory potential (OP) implicit times in response to dim-flash stimuli (<-1.8 log cd · s/m2) occur prior to clinically recognized DR. Animal studies suggest that retinal dopamine deficiency underlies these early functional deficits. In this study, we randomized individuals with diabetes, without clinically detectable retinopathy, to treatment with either low- or high-dose Sinemet (levodopa plus carbidopa) for 2 weeks and compared their ERG findings with those of control subjects (no diabetes). We assessed dim-flash-stimulated OP delays using a novel handheld ERG system (RETeval) at baseline and 2 and 4 weeks. RETeval recordings identified significant OP implicit time delays in individuals with diabetes without retinopathy compared with age-matched control subjects (P < 0.001). After 2 weeks of Sinemet treatment, OP implicit times were restored to control values, and these improvements persisted even after a 2-week washout. We conclude that detection of dim-flash OP delays could provide early detection of DR and that Sinemet treatment may reverse retinal dysfunction.
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Affiliation(s)
- Cara T Motz
- Center for Visual and Neurocognitive Rehabilitation, Atlanta Veterans Affairs Medical Center, Decatur, GA
| | - Kyle C Chesler
- Center for Visual and Neurocognitive Rehabilitation, Atlanta Veterans Affairs Medical Center, Decatur, GA
- Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA
| | - Rachael S Allen
- Center for Visual and Neurocognitive Rehabilitation, Atlanta Veterans Affairs Medical Center, Decatur, GA
- Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA
| | - Katie L Bales
- Center for Visual and Neurocognitive Rehabilitation, Atlanta Veterans Affairs Medical Center, Decatur, GA
- Department of Ophthalmology, Emory University, Atlanta, GA
| | - Lukas M Mees
- Center for Visual and Neurocognitive Rehabilitation, Atlanta Veterans Affairs Medical Center, Decatur, GA
| | - Andrew J Feola
- Center for Visual and Neurocognitive Rehabilitation, Atlanta Veterans Affairs Medical Center, Decatur, GA
- Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA
| | - April Y Maa
- Center for Visual and Neurocognitive Rehabilitation, Atlanta Veterans Affairs Medical Center, Decatur, GA
- Department of Ophthalmology, Emory University, Atlanta, GA
| | - Darin E Olson
- Division of Endocrinology, Metabolism and Lipids, Emory University, Atlanta, GA
- Medical Service, Atlanta Veterans Affairs Medical Center, Decatur, GA
| | - Peter M Thule
- Division of Endocrinology, Metabolism and Lipids, Emory University, Atlanta, GA
- Medical Service, Atlanta Veterans Affairs Medical Center, Decatur, GA
| | - P Michael Iuvone
- Department of Ophthalmology, Emory University, Atlanta, GA
- Department of Pharmacology and Chemical Biology, Emory University, Atlanta, GA
| | | | - Machelle T Pardue
- Center for Visual and Neurocognitive Rehabilitation, Atlanta Veterans Affairs Medical Center, Decatur, GA
- Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA
- Department of Ophthalmology, Emory University, Atlanta, GA
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7
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Ferrero H, Díaz-Gimeno P, Sebastián-León P, Faus A, Gómez R, Pellicer A. Dysregulated genes and their functional pathways in luteinized granulosa cells from PCOS patients after cabergoline treatment. Reproduction 2018; 155:373-381. [PMID: 29439093 DOI: 10.1530/rep-18-0027] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 02/09/2018] [Indexed: 11/08/2022]
Abstract
Polycystic ovarian syndrome (PCOS) is a common reproductive disorder frequently associated with a substantial risk factor for ovarian hyperstimulation syndrome (OHSS). Dopamine receptor 2 (D2) agonists, like cabergoline (Cb2), have been used to reduce the OHSS risk. However, lutein granulosa cells (LGCs) from PCOS patients treated with Cb2 still show a deregulated dopaminergic tone (decreased D2 expression and low dopamine production) and increased vascularization compared to non-PCOS LGCs. Therefore, to understand the PCOS ovarian physiology, it is important to explore the mechanisms that underlie syndrome based on the therapeutic effects of Cb2. Here, LGCs from non-PCOS and PCOS patients were cultured with hCG in the absence/presence of Cb2 (n = 12). Subsequently, a transcriptomic-paired design that compared untreated vs treated LGCs within each patient was performed. After transcriptomic analysis, functions and genes were prioritized by systems biology approaches and validated by RT-qPCR. We identified that similar functions were altered in both PCOS and non-PCOS LGCs treated with Cb2; however, PCOS-treated LGCs exhibited more significant changes than non-PCOS. Among the prioritized functions, dopaminergic synapse, vascular endothelial growth factor (VEGF) signaling, apoptosis and ovarian steroidogenesis were highlighted. Finally, network modeling showed CASP9, VEGFA, AKT1, CREB, AIF, MAOA, MAPK14 and BMAL1 as key genes implicated in these pathways in Cb2 response, which might be potential biomarkers for further studies in PCOS.
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Affiliation(s)
- H Ferrero
- Fundación IVIInstituto Universitario IVI, Universidad de Valencia, Valencia, Spain.,Instituto de Investigación Sanitaria INCLIVAValencia, Spain
| | - P Díaz-Gimeno
- Fundación IVIInstituto Universitario IVI, Universidad de Valencia, Valencia, Spain.,Instituto de Investigación Sanitaria INCLIVAValencia, Spain
| | - P Sebastián-León
- Fundación IVIInstituto Universitario IVI, Universidad de Valencia, Valencia, Spain.,Instituto de Investigación Sanitaria INCLIVAValencia, Spain
| | - A Faus
- Fundación IVIInstituto Universitario IVI, Universidad de Valencia, Valencia, Spain
| | - R Gómez
- Instituto de Investigación Sanitaria INCLIVAValencia, Spain
| | - A Pellicer
- Fundación IVIInstituto Universitario IVI, Universidad de Valencia, Valencia, Spain.,Instituto de Investigación Sanitaria Hospital Universitario y Politécnico La FeValencia, Spain
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8
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Pathophysiology, treatment and prevention of ovarian hyperstimulation syndrome. Curr Opin Obstet Gynecol 2018; 28:236-41. [PMID: 27273307 DOI: 10.1097/gco.0000000000000284] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Severe ovarian hyperstimulation syndrome (OHSS) is an iatrogenic condition that affects 1% of women that undergo treatment with assisted reproductive technology. The review aims to summarize recent evidence on pathophysiology, treatment, and prevention of OHSS. RECENT FINDINGS The pathophysiology is still not completely understood; however, vascular endothelial growth factor is likely to be an important mediator. Human chorionic gonadotropin was previously thought to be necessary for OHSS to occur; however, recent case reports have proven otherwise. The contribution of an attenuated anti-Mullerian hormone signalling pathway and CD11c + HLA-DR + dendritic cells and associated interleukins has been explored recently as contributors to pathogenesis.Treatment is largely supportive and is based mainly on consensus statements rather than evidence. Therefore, it is important to prevent this condition by identifying women at risk, allowing the clinician to implement preventive strategies, including the use of GnRH antagonist cycles with agonist triggers. SUMMARY More research is required to elucidate the pathophysiology behind the condition. Clinicians should employ strategies to prevent OHSS.
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9
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Sekar N, Yeole S, Pradeep R, D Prabhu Y, Renu K, S Ramgir S, Abilash VG. To Screen Inactivation Mutation of Exon 1 of FSHR Gene in Polycystic Ovarian Syndrome: A South Indian Cohort Study. ACTA ACUST UNITED AC 2017. [DOI: 10.1088/1757-899x/263/2/022034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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10
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Sekar N, Kulkarni R, Ozalkar S, Prabhu YD, Renu K, Ramgir SS, Abilash V. Association of Exon 10A and 10B inactivating mutation of follicle stimulating hormone receptor gene (FSHR) and Polycystic Ovarian Syndrome in Vellore cohort. ACTA ACUST UNITED AC 2017. [DOI: 10.1088/1757-899x/263/2/022036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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11
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Lin SJ, Wu ZR, Cao L, Zhang Y, Leng ZG, Guo YH, Shang HB, Zhao WG, Zhang X, Wu ZB. Pituitary Tumor Suppression by Combination of Cabergoline and Chloroquine. J Clin Endocrinol Metab 2017; 102:3692-3703. [PMID: 28973192 DOI: 10.1210/jc.2017-00627] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2017] [Accepted: 07/17/2017] [Indexed: 12/11/2022]
Abstract
CONTEXT The dopamine agonist cabergoline (CAB) has been used widely in the treatment of prolactinomas and other types of pituitary adenomas, but its clinical use is hampered by intolerance in some patients with prolactinoma and lack of effectiveness in other pituitary tumor types. Chloroquine (CQ) is an old drug widely used to treat malaria. Recent studies, including our own, have revealed that CAB and CQ are involved in induction of autophagy and activation of autophagic cell death. OBJECTIVE To test whether CAB and CQ can function cooperatively to suppress growth of pituitary adenomas as well as other cancers. RESULTS In vitro studies using the rat pituitary tumor cell lines MMQ and GH3, human pituitary tumor cell primary cultures, and several human cancer cell lines showed that CQ enhanced suppression of cell proliferation by CAB. These results were confirmed in in vivo xenograft models in nude mice and estrogen-induced rat prolactinomas. To understand the mechanism of combined CAB and CQ action, we established a low-CAB-dose condition in which CAB was able to induce autophagy but failed to suppress cell growth. Addition of CQ to low-dose CAB blocked normal autophagic cycles and induced apoptosis, evidenced by the further accumulation of p62/caspase-8/LC3-II. CONCLUSION The data suggest that combined use of CAB and CQ may increase clinical effectiveness in treatment of human pituitary adenomas, as well as other cancers, making it an attractive option in tumor and cancer therapies.
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Affiliation(s)
- Shao Jian Lin
- Department of Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Ze Rui Wu
- Department of Neurosurgery, First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - Lei Cao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Dongcheng District, Beijing 100050, China
| | - Yong Zhang
- Department of Neurosurgery, First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - Zhi Gen Leng
- Department of Neurosurgery, First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - Yu Hang Guo
- Department of Neurosurgery, First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - Han Bing Shang
- Department of Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Wei Guo Zhao
- Department of Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Xun Zhang
- Neuroendocrine Research Laboratory, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts 02114
| | - Zhe Bao Wu
- Department of Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
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12
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Zhai J, Liu J, Zhao S, Zhao H, Chen ZJ, Du Y, Li W. Kisspeptin-10 inhibits OHSS by suppressing VEGF secretion. Reproduction 2017; 154:355-362. [DOI: 10.1530/rep-17-0268] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 06/08/2017] [Accepted: 07/04/2017] [Indexed: 11/08/2022]
Abstract
The aim of the present study was to elucidate the effects of kisspeptin-10 (Kp-10) on ovarian hyperstimulation syndrome (OHSS) and its related mechanism in OHSS rat models, human umbilical vein endothelial cells (HUVECs) and human luteinized granulosa cells. OHSS is a systemic disorder with high vascular permeability (VP) and ovarian enlargement. KISS1R (KISS1 receptor) is the specific receptor of kisspeptin. The kisspeptin/KISS1R system inhibits the expression of vascular endothelial growth factor (VEGF), which is the main regulator of VP. In our study, decreased expression of Kiss1r was observed in both ovaries and lung tissue of OHSS rats. Injection of exogenous Kp-10 inhibited the increase of VP and VEGF while promoting the expression of Kiss1r in both the ovarian and lung tissue of OHSS rats. Using HUVECs, we revealed that a high level of 17-β estradiol (E2), a feature of OHSS, suppressed the expression of KISS1R and increased VEGF and nitric oxide (NO) through estrogen receptors (ESR2). Furthermore, KISS1R mRNA also decreased in the luteinized human granulosa cells of high-risk OHSS patients, and was consistent with the results in rat models and HUVECs. In conclusion, Kp-10 prevents the increased VP of OHSS by the activation of KISS1R and the inhibition of VEGF.
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13
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Zhai J, Liu J, Cheng X, Li S, Hong Y, Sun K, Chen ZJ, Du Y, Li W. Zinc finger gene 217 (ZNF217) Promoted Ovarian Hyperstimulation Syndrome (OHSS) through Regulating E 2 Synthesis and Inhibiting Thrombospondin-1 (TSP-1). Sci Rep 2017; 7:3245. [PMID: 28607476 PMCID: PMC5468349 DOI: 10.1038/s41598-017-03555-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 05/02/2017] [Indexed: 01/24/2023] Open
Abstract
Zinc finger gene 217 (ZNF217) is a candidate gene of polycystic ovary syndrome (PCOS) which is vulnerable to ovarian hyperstimulation syndrome (OHSS). However, the relationship between ZNF217 and OHSS is largely unknown. Our study demonstrated that ZNF217 was mainly distributed in the granulosa cells of rat ovary. Significantly higher expression of ovarian ZNF217 was detected in OHSS rats, being consistent with serum 17β-estradiol concentration and ovarian aromatase. Moreover, OHSS rats also showed decreased ovarian TSP-1 mRNA, an acknowledged VEGF signaling suppressor. The same changes were detected in human granulosa cells and follicular fluid. Thus, the increased ZNF217 and decreased TSP-1 may participate in OHSS onset. In vitro experiment revealed that ZNF217 positively regulated E2 synthesis through promoting cAMP response element binding protein (CREB) and thereby CYP19A1 in KGN cells. Furthermore, ZNF217 negatively regulated TSP-1 in KGN cells while TSP-1 promoted claudin1 and inhibited nitric oxide (NO) in HUVECs and HAECs. Both of claudin1 and NO are responsible for the regulation of vascular permeability (VP). Therefore, we demonstrated that ZNF217 contributed to OHSS onset through promoting E2 synthesis and the increase of VP. Moreover, the increased ZNF217 and decreased TSP-1 provided new targets for the prevention or treatment of OHSS in the future.
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Affiliation(s)
- Junyu Zhai
- Center for Reproductive Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200135, China.,Shanghai Key Laboratory for Assisted Reproduction and Reproductive Genetics, Shanghai, 200135, China
| | - Jiansheng Liu
- Center for Reproductive Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200135, China.,Shanghai Key Laboratory for Assisted Reproduction and Reproductive Genetics, Shanghai, 200135, China
| | - Xiaoyue Cheng
- Center for Reproductive Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200135, China.,Shanghai Key Laboratory for Assisted Reproduction and Reproductive Genetics, Shanghai, 200135, China
| | - Shang Li
- Center for Reproductive Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200135, China.,Shanghai Key Laboratory for Assisted Reproduction and Reproductive Genetics, Shanghai, 200135, China
| | - Yan Hong
- Center for Reproductive Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200135, China.,Shanghai Key Laboratory for Assisted Reproduction and Reproductive Genetics, Shanghai, 200135, China
| | - Kang Sun
- Center for Reproductive Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200135, China.,Shanghai Key Laboratory for Assisted Reproduction and Reproductive Genetics, Shanghai, 200135, China
| | - Zi-Jiang Chen
- Center for Reproductive Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200135, China.,Shanghai Key Laboratory for Assisted Reproduction and Reproductive Genetics, Shanghai, 200135, China.,National Research Center for Assisted Reproductive Technology and Reproductive Genetics, The Key Laboratory for Reproductive Endocrinology of Ministry of Education, Shandong Provincial Key Laboratory of Reproductive Medicine, Center for Reproductive Medicine, Shandong Provincial Hospital, Shandong University, Jinan, 250021, China
| | - Yanzhi Du
- Center for Reproductive Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200135, China. .,Shanghai Key Laboratory for Assisted Reproduction and Reproductive Genetics, Shanghai, 200135, China.
| | - Weiping Li
- Center for Reproductive Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200135, China. .,Shanghai Key Laboratory for Assisted Reproduction and Reproductive Genetics, Shanghai, 200135, China.
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14
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Şahin N, Apaydın N, Töz E, Sivrikoz ON, Genç M, Turan GA, Cengiz H, Eskicioğlu F. Comparison of the effects of letrozole and cabergoline on vascular permeability, ovarian diameter, ovarian tissue VEGF levels, and blood PEDF levels, in a rat model of ovarian hyperstimulation syndrome. Arch Gynecol Obstet 2015; 293:1101-6. [PMID: 26690356 DOI: 10.1007/s00404-015-3987-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Accepted: 12/08/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To evaluate the effects of letrozole and cabergoline in a rat model of ovarian hyperstimulation syndrome (OHSS). STUDY DESIGN In this prospective, controlled experimental study, the 28 female Wistar rats were divided into four subgroups (one non-stimulated control and three OHSS-positive groups: placebo, letrozole, and cabergoline). To induce OHSS, rats were injected with 10 IU of pregnant mare serum gonadotropin from day 29 to day 32 of life, followed by subcutaneous injection of 30 IU hCG on day 33. Letrozole rats received with a single dose of 0.1 mg/kg letrozole via oral gavage, on the hCG day. Cabergoline rats received with a single dose of 100 µg/kg cabergoline via oral gavage, on the hCG day. All animals were compared in terms of body weight, vascular permeability (VP), ovarian diameter, ovarian tissue VEGF expression (assessed via immunohistochemical staining), and blood pigment epithelium-derived growth factor (PEDF) levels. RESULTS The OHSS-positive placebo group (group 2) exhibited the highest VP, ovarian diameter, extent of VEGF staining, and lowest PEDF level, as expected. No significant difference was evident between the letrozole and cabergoline groups in terms of any of body weight; VP; PEDF level; ovarian diameter; or the staining intensity of, or percentage staining for, VEGF in ovarian tissues. CONCLUSIONS Letrozole and cabergoline were equally effective to prevent OHSS, reducing the ovarian diameter, VP, and PEDF and VEGF levels to similar extents.
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Affiliation(s)
- Nur Şahin
- Department of Obstetrics and Gynecology, Sifa University Medicine School, Sanayi cad. No: 7 Bornova, Izmir, Turkey.
| | - Nesin Apaydın
- Department of Obstetrics and Gynecology, M.H. Tepecik Research and Education Hospital, Izmir, Turkey
| | - Emrah Töz
- Department of Obstetrics and Gynecology, M.H. Tepecik Research and Education Hospital, Izmir, Turkey
| | | | - Mine Genç
- Department of Obstetrics and Gynecology, Sifa University Medicine School, Sanayi cad. No: 7 Bornova, Izmir, Turkey
| | - Gülüzar Arzu Turan
- Department of Obstetrics and Gynecology, Sifa University Medicine School, Sanayi cad. No: 7 Bornova, Izmir, Turkey
| | - Hakan Cengiz
- Department of Biostatistics and Medical Informatics, Sifa University Medicine School, Izmir, Turkey
| | - Fatma Eskicioğlu
- Department of Obstetrics and Gynecology, M.H. Manisa Public Hospital, Manisa, Turkey
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15
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Turan GA, Eskicioglu F, Sivrikoz ON, Cengiz H, Adakan S, Gur EB, Tatar S, Sahin N, Yilmaz O. Myo-inositol is a promising treatment for the prevention of ovarian hyperstimulation syndrome (OHSS): an animal study. Arch Gynecol Obstet 2015; 292:1163-71. [PMID: 25990477 PMCID: PMC4723627 DOI: 10.1007/s00404-015-3747-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Accepted: 05/07/2015] [Indexed: 02/08/2023]
Abstract
PURPOSE To evaluate the efficacy of myo-inositol (MI) pretreatment in OHSS. METHODS In this experimental OHSS rat model, 42 immature Wistar albino female rats were divided into 6 groups: (1) the control group, (2) the ovarian stimulation group, (3) the OHSS group, (4) the OHSS + Metformin group, (5) OHSS + MI group, (6) OHSS + Metformin + MI group. OHSS was established after treatment with metformin and myo-inositol for 14 days, in the meanwhile the treatment of metformin and myo-inositol was also continued. All animals were killed 48 h after hCG administration and were compared in terms of vascular permeability, ovarian weight and diameter, ovarian VEGF, COX-2 and PEDF expression (immunohistochemistry), serum PEDF and estradiol (E2) levels. RESULTS Vascular permeability, VEGF and COX-2 expressions were reduced in animals treated with MI and/or metformin. While PEDF expression was increased in the groups taking metformin, there was no difference in PEDF expression in the group taking MI and OHSS group. There was no significant difference in serum PEDF levels between groups. Blood E2 levels were decreased in groups treated with MI or metformin compared to the OHSS group. CONCLUSIONS Our data demonstrate that myo-inositol is effective in preventing OHSS, similar to metformin. Although the two drugs are thought to act through distinct mechanisms, there is no apparent benefit to co-treatment with both drugs in an animal model of OHSS. Administration of myo-inositol prior to IVF treatment may favor the control of ovulation induction. Further studies are necessary to elucidate the mechanism of action and further support our findings.
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Affiliation(s)
- Guluzar Arzu Turan
- Department of Obstetrics and Gynecology, Medical School, Sifa University, Sanayi cad no:7, 35100, Bornova, Izmir, Turkey.
| | - Fatma Eskicioglu
- Department of Obstetrics and Gynecology, Medical School, Celal Bayar University, 45030, Manisa, Turkey
| | - Oya Nermin Sivrikoz
- Department of Pathology, Medical School, Sifa University, Sanayi cad no:7, 35100, Bornova, Izmir, Turkey
| | - Hakan Cengiz
- Biostatistics and Medical Informatics, Medical School, Sifa University, Ankara Cad. No:45, 35100, Bayrakli, Izmir, Turkey
- Molecular Medicine, Institute of Health Science, Dokuz Eylül University, Mithatpasa cad. No:1606 inciraltı yerleskesi, 35340, Balcova, Izmir, Turkey
| | - Saban Adakan
- Department of Obstetrics and Gynecology, Medical School, Sifa University, Sanayi cad no:7, 35100, Bornova, Izmir, Turkey
| | - Esra Bahar Gur
- Department of Obstetrics and Gynecology, Medical School, Sifa University, Sanayi cad no:7, 35100, Bornova, Izmir, Turkey
| | - Sumeyra Tatar
- Department of Obstetrics and Gynecology, Medical School, Sifa University, Sanayi cad no:7, 35100, Bornova, Izmir, Turkey
| | - Nur Sahin
- Department of Obstetrics and Gynecology, Medical School, Sifa University, Sanayi cad no:7, 35100, Bornova, Izmir, Turkey
| | - Osman Yilmaz
- Department of Laboratory Animal Science, Medical School, Dokuz Eylul University, Mithatpasa cad. No:1606 inciraltı yerleskesi, 35340, Balcova, Izmir, Turkey
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16
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Ferrero H, García-Pascual CM, Pellicer N, Simón C, Pellicer A, Gómez R. Dopamine agonist inhibits vascular endothelial growth factor protein production and secretion in granulosa cells. Reprod Biol Endocrinol 2015; 13:104. [PMID: 26377185 PMCID: PMC4574352 DOI: 10.1186/s12958-015-0102-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Accepted: 09/03/2015] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Dopamine receptor 2 agonists (D2-ags) inhibit vascular endothelial growth factor (VEGF) secretion in luteinized granulosa cells (LGCs) both in vitro and in vivo. However, the mechanism of D2 regulation of the VEGF/VEGF Receptor 2 (VEGFR-2) pathway remains to be elucidated. We sought to determine the effects of D2 signaling on VEGF transcription and translation in LGCs, with the expectation of identifying potential D2-ag-based therapies for ovarian hyperstimulation syndrome (OHSS). FINDINGS LGCs from egg donors were cultured with chorionic gonadotropin (hCG) in the presence of Actinomycin-D (ActD) or Brefeldin-A (BFA) to evaluate the effects of a D2-ag, cabergoline (Cb2), on VEGF secretion. The contribution of the conventional Gi/Go, Gz and AKT/β-Arrestin pathways in the VEGF regulation was assessed by adding pertussis toxin (PTX), phorbol 12-myristate 13-acetate (PMA), or wortmannin (WT). While Cb2 inhibited VEGF secretion by interfering with VEGF peptide translation and secretion, inhibition of conventional D2 transduction pathways did not reverse Cb2-mediated inhibition of VEGF secretion. CONCLUSIONS The effects of D2-ag on VEGF translation and secretion are mediated by D2 signaling pathways that have yet to be described. We found that D2-ag inhibits VEGF secretion at the post-transcriptional level, suggesting that D2-ag treatment should be combined with therapies that inhibit VEGF transcription, such as the employment of LH or GnRH for triggering ovulation, to improve the efficacy of OHSS prevention.
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Affiliation(s)
- Hortensia Ferrero
- Fundación IVI, C/ Catedrático Agustín Escardino, n°9, Paterna, Valencia, 46980, Spain.
- Instituto Universitario IVI/ INCLIVA, Valencia, 46015, Spain.
| | - Carmen M García-Pascual
- Fundación IVI, C/ Catedrático Agustín Escardino, n°9, Paterna, Valencia, 46980, Spain.
- Instituto Universitario IVI/ INCLIVA, Valencia, 46015, Spain.
| | - Nuria Pellicer
- Fundación IVI, C/ Catedrático Agustín Escardino, n°9, Paterna, Valencia, 46980, Spain.
| | - Carlos Simón
- Fundación IVI, C/ Catedrático Agustín Escardino, n°9, Paterna, Valencia, 46980, Spain.
- Instituto Universitario IVI/ INCLIVA, Valencia, 46015, Spain.
| | - Antonio Pellicer
- Fundación IVI, C/ Catedrático Agustín Escardino, n°9, Paterna, Valencia, 46980, Spain.
- Hospital Universitario i Politécnico La Fe, Valencia, 46026, Spain.
| | - Raúl Gómez
- Instituto Universitario IVI/ INCLIVA, Valencia, 46015, Spain.
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17
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Banker M, Garcia-Velasco JA. Revisiting ovarian hyper stimulation syndrome: Towards OHSS free clinic. J Hum Reprod Sci 2015; 8:13-7. [PMID: 25838743 PMCID: PMC4381376 DOI: 10.4103/0974-1208.153120] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Revised: 12/30/2014] [Accepted: 01/17/2015] [Indexed: 11/04/2022] Open
Abstract
A rapid development and application of assisted reproductive technologies (ARTs) and ovulation-induction drugs may lead to ovarian hyper stimulation syndrome (OHSS). Young age, low body mass index (BMI), polycystic ovarian syndrome (PCOS), previous OHSS, high follicle count, and elevated serum estradiol (E2) are the certain factors that predispose women to OHSS. Many strategies have been used to reduce or avoid OHSS. Use of human chorionic gonadotropin (hCG) increases ovarian vascular permeability and is responsible for activating the vascular endothelial growth factors (VEGF) pathway and thus the entire cascade, leading to symptomatic OHSS. Gonadotropin-releasing hormone (GnRH) agonists are used as a replacement for hCG for final oocyte maturation in antagonist cycles. Reducing or eliminating the use of hCG and use of GnRH agonist triggered GnRH antagonist cycles and cryopreservation of oocytes or embryos is the most promising approach in making OHSS free clinic a reality.
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Affiliation(s)
- Manish Banker
- Department of Reproductive Medicine, Nova IVI Fertility, Ahmedabad, Gujarat, India
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