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Pankhurst MW, Dillingham PW, Peña AS. Proteolytic activation of anti-Müllerian hormone is suppressed in adolescent girls. Endocrine 2022; 76:189-197. [PMID: 34988934 DOI: 10.1007/s12020-021-02955-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 11/24/2021] [Indexed: 01/04/2023]
Abstract
PURPOSE The ratio of the anti-Müllerian hormone (AMH) precursor (proAMH) to active AMH (AMHN,C) is higher in childhood than in adulthood but has never been quantified during adolescence. The ratio of proAMH to total AMH (AMH prohormone index, API) was examined during the puberty in healthy girls. The API was also compared between girls with and without polycystic ovary syndrome (PCOS) to determine if there were differences that could assist in PCOS diagnosis during adolescence. METHODS Total AMH and proAMH were measured by immunoassay in a single-centre, cross-sectional observational study; 61 controls and 29 girls with PCOS were included in the study (age range 8-21 years). The API was calculated as proAMH as a percentage of total AMH. Differences in API between control and PCOS subjects and across age-groups were examined by Welch's ANOVA. The relationship between API and a range of metabolic parameters was examined by Pearson correlation. RESULTS The API in healthy females increased between the ages of 10~15 years and declined from 15~20 years (p < 0.001). The API was negatively correlated with body mass index in the control (p = 0.04) and PCOS groups (p = 0.007). The API was associated with factors related to adiposity and lipid metabolism. The API was not significantly different in control girls and girls with PCOS. CONCLUSIONS Higher API during adolescence suggests that proteolytic activation of proAMH is suppressed during this life stage. API was not different between control girls and girls with PCOS indicating that it is not useful in diagnosis of PCOS during adolescence.
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Affiliation(s)
- Michael W Pankhurst
- Department of Anatomy, School of Biomedical Sciences, University of Otago, Dunedin, New Zealand
| | - Peter W Dillingham
- Department of Mathematics and Statistics, University of Otago, Dunedin, New Zealand
| | - Alexia S Peña
- Discipline of Paediatrics, The University of Adelaide Robinson Research Institute, Adelaide, SA, Australia.
- Department of Endocrine and Diabetes, Women's and Children's Hospital, North Adelaide, SA, Australia.
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Abstract
Anti-Müllerian Hormone (AMH) is a secreted glycoprotein hormone with critical roles in reproductive development and regulation. Its chemical and mechanistic similarities to members of the Transforming Growth Factor β (TGF-β) family have led to its placement within this signaling family. As a member of the TGF-β family, AMH exists as a noncovalent complex of a large N-terminal prodomain and smaller C-terminal mature signaling domain. To produce a signal, the mature domain will bind to the extracellular domains of two type I and two type II receptors which results in an intracellular SMAD signal. Interestingly, as will be discussed in this review, AMH possesses several unique characteristics which set it apart from other ligands within the TGF-β family. In particular, AMH has a dedicated type II receptor, Anti-Müllerian Hormone Receptor Type II (AMHR2), making this interaction intriguing mechanistically as well as therapeutically. Further, the prodomain of AMH has remained largely uncharacterized, despite being the largest prodomain within the family. Recent advancements in the field have provided valuable insight into the molecular mechanisms of AMH signaling, however there are still many areas of AMH signaling not understood. Herein, we will discuss what is known about the biochemistry of AMH and AMHR2, focusing on recent advances in understanding the unique characteristics of AMH signaling and the molecular mechanisms of receptor engagement.
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Affiliation(s)
- James A. Howard
- Department of Pharmacology & Systems Physiology, University of Cincinnati, Cincinnati, OH, United States
| | - Kaitlin N. Hart
- Department of Pharmacology & Systems Physiology, University of Cincinnati, Cincinnati, OH, United States
| | - Thomas B. Thompson
- Department of Molecular Genetics, Biochemistry, & Microbiology, University of Cincinnati, Cincinnati, OH, United States
- *Correspondence: Thomas B. Thompson,
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di Clemente N, Racine C, Pierre A, Taieb J. Anti-Müllerian Hormone in Female Reproduction. Endocr Rev 2021; 42:753-782. [PMID: 33851994 DOI: 10.1210/endrev/bnab012] [Citation(s) in RCA: 65] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Indexed: 12/26/2022]
Abstract
Anti-Müllerian hormone (AMH), also called Müllerian inhibiting substance, was shown to be synthesized by the ovary in the 1980s. This article reviews the main findings of the past 20 years on the regulation of the expression of AMH and its specific receptor AMHR2 by granulosa cells, the mechanism of action of AMH, the different roles it plays in the reproductive organs, its clinical utility, and its involvement in the principal pathological conditions affecting women. The findings in respect of regulation tell us that AMH and AMHR2 expression is mainly regulated by bone morphogenetic proteins, gonadotropins, and estrogens. It has now been established that AMH regulates the different steps of folliculogenesis and that it has neuroendocrine effects. On the other hand, the importance of serum AMH as a reliable marker of ovarian reserve and as a useful tool in the prediction of the polycystic ovary syndrome (PCOS) and primary ovarian failure has also been acknowledged. Last but not least, a large body of evidence points to the involvement of AMH in the pathogenesis of PCOS.
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Affiliation(s)
- Nathalie di Clemente
- Sorbonne Université, INSERM, Centre de Recherche Saint-Antoine (CRSA), Paris, France.,Institut Hospitalo-Universitaire ICAN, Paris, France
| | - Chrystèle Racine
- Sorbonne Université, INSERM, Centre de Recherche Saint-Antoine (CRSA), Paris, France.,Institut Hospitalo-Universitaire ICAN, Paris, France.,Sorbonne Paris Cité, Paris-Diderot Université, Paris, France
| | - Alice Pierre
- Sorbonne Paris Cité, Université Paris-Diderot, CNRS, INSERM, Biologie Fonctionnelle et Adaptative UMR 8251, Physiologie de l'Axe Gonadotrope U1133, Paris, France
| | - Joëlle Taieb
- Sorbonne Paris Cité, Université Paris-Diderot, CNRS, INSERM, Biologie Fonctionnelle et Adaptative UMR 8251, Physiologie de l'Axe Gonadotrope U1133, Paris, France
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Yu Y, She T, Huang L, Xu J, Yan J, Jiang Q, Yang Z, Li H. Establishment of a homogeneous immunoassay-light-initiated chemiluminescence assay for detecting anti-Müllerian hormone in human serum. J Immunol Methods 2021; 494:113059. [PMID: 33895196 DOI: 10.1016/j.jim.2021.113059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 04/19/2021] [Accepted: 04/19/2021] [Indexed: 11/29/2022]
Abstract
Anti-Müllerian hormone (AMH) is known as a reliable marker of ovarian reserve (OR). The determination of AMH is of great importance and most existed AMH detection methods are heterogeneous immunoassay. In this study, a novel homogeneous sandwich immunoassay-light-initiated chemiluminescence assay (LICA) for detecting AMH serum level was developed. This AMH-LICA was performed by incubating serum samples with AMH mouse monoclonal antibody coated with chemibeads, streptavidin-coated sensibeads, and biotinylated AMH mouse monoclonal antibody. Sensitivity, precision, accuracy and cross-reactivity of this assay were evaluated. Besides, a regression analysis showed a high correlation between AMH-LICA and Roche Elecsys® AMH assay (y = 0.9851x + 0.07147, R2 = 0.9569). As a homogeneous immunoassay, this AMH-LICA could accurately and rapidly determine the serum level of AMH with high-throughput. Thus, this new developed assay may be a new useful analytical tool for the determination of AMH.
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Affiliation(s)
- Yang Yu
- School of Medical Laboratory, Tianjin Medical University, Tianjin 300203, China
| | - Tiantian She
- School of Medical Laboratory, Tianjin Medical University, Tianjin 300203, China
| | - Liang Huang
- Medical Equipment Department, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, China
| | - Jingxin Xu
- School of Medical Laboratory, Tianjin Medical University, Tianjin 300203, China
| | - Juanjuan Yan
- School of Medical Laboratory, Tianjin Medical University, Tianjin 300203, China
| | - Qi Jiang
- Department of Basic Medicine, Tianjin Medical College, Tianjin 300222, China
| | - Zhiyong Yang
- Center for Reproductive Medicine, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, China; Tongji University School of Medicine, Shanghai 200092, China.
| | - Huiqiang Li
- School of Medical Laboratory, Tianjin Medical University, Tianjin 300203, China.
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Pandey S. Human Chorionic Gonadotrophin (hCG) Trigger-Mediated Ovulation Induction in Infertility Management in South Indian Women Undergoing IVF/ICSI Regimens: A Pilot Sexual Medicine Study with Public Health Perspective. JOURNAL OF PSYCHOSEXUAL HEALTH 2021. [DOI: 10.1177/2631831821990501] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Introduction: Infertility is a global public health problem; cost-effective patient-friendly treatment modalities along with psychosexual intervention strategies are essential for infertility control/prevention/management among ethnically disparate populations. Objectives: This study aimed to assess differential in vitro fertilization (IVF) success trends among infertile women of South Indian ethnicity. Materials and Methods: Prospective, observational study designed in a hospital-based setting with active enrollment of infertile women undergoing IVF/intracytoplasmic sperm injection (ICSI) at Indira IVF Center, Chennai, Tamil Nadu, India (April-September 2019); inclusion criteria: age >35 years, South Indian ethnicity, married >1 year, absence of full-term clinical pregnancy, endometrial thickness <6 mm/thin endometrium; exclusion criteria: prior ≥2 IVF failures, fibroids/adenomyosis/cervical cancer/endometriosis. IVF success was determined by evaluating total frozen embryos transferred/month, average oocyte yield/donor, oocyte quality, M-II oocytes, biochemical/clinical pregnancy (beta-human chorionic gonadotropin positivity/fetal cardiac activity). Mycobacterium tuberculosis positivity was assessed by GeneXpert polymerase chain reaction-based technology, and psychosexual intervention-incorporated marital relationship counseling sessions/therapy, referrals for psychiatric assessments (cognitive impairment/schizophrenia/depression). Written informed consent of participants was taken and study was approved by Institutional Review Board. Results: Mean age and endometrial thickness of study participants were 33.3 years (SD ±1.9) and 8.7 mm (SD ±0.5), respectively; average Body Mass Index (BMI) and anti-müllerian hormone (AMH) levels were 28.4 kg/m2 and 4.7 ng/mL, respectively. Embryos transferred/month: 7 in April/13 in May/24 in June/36 in July/24 in August/30 in September, and pregnancies: 4/8/17/26/20/22 for the months of April, May, June, July, August, and September 2019, respectively. Subgroup stratification demonstrated M-II vs total oocytes retrieved were 76%, 73%, 60%, 71%, 77%, and 77%. Overall IVF success rates were 57% in April/62% in May/71% in June/72% in July/83% in August/73% in September; frozen embryo transfer success was 0 in April-May/67% in June/73% in July/89% in August/100% in September 2019. English/Tamil-speaking infertile women self-reported treatment-related satisfaction rates of 80% to 100%. Conclusion: M-II oocytes’ yield, sociodemographics of infertile women, and increasing age/aberrant AMH/BMI profiles/endometrial receptivity/diminished ovarian reserve are promising predictors of IVF/ICSI success in genetically distinct patient population subset(s). Future multicentric gene epidemiology studies with larger sample size and precision-based psychiatric assessments/interventions are warranted for development of predictive biomarkers in infertility management.
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Affiliation(s)
- Saumya Pandey
- Department of Clinical Research, Indira IVF Hospital, Udaipur, Rajasthan, India
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Roman H, Chanavaz-Lacheray I, Mircea O, Berby B, Dehan L, Braund S, Verspyck E, Puscasiu L. Large ovarian endometriomas are associated with high pre-operative anti-Müllerian hormone concentrations. Reprod Biomed Online 2020; 42:158-164. [PMID: 33060013 DOI: 10.1016/j.rbmo.2020.09.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 09/02/2020] [Accepted: 09/08/2020] [Indexed: 12/27/2022]
Abstract
RESEARCH QUESTION Are large ovarian endometriomas associated with high pre-operative anti-Müllerian hormone (AMH) concentrations? DESIGN Data from 332 women who underwent AMH measurement before surgery for endometriosis were prospectively recorded in a large database. Univariate analysis compared AMH concentrations in terms of the patients' baseline characteristics. A multivariate model was used to identify variables having an independent relationship with AMH concentration. RESULTS Among 332 women included in the study, 47.6% were aged 18-30 years, 67.8% were infertile and 85.5% were nulliparous. A total of 66.3% had ovarian endometriomas, and 10.8% had cysts measuring over 6 cm. Bilateral cysts over 3 cm were recorded in 24.7% of the women. Univariate analysis identified two variables that had a statistically significant relationship with AMH concentration: the woman's age (P = 0.01) and cyst size (P < 0.001). Multivariate analysis revealed that ages of 36-40 years and over 40 years showed a significant association with lower AMH concentrations (P = 0.02 and P = 0.009, respectively), while a cyst size of over 6 cm was statistically associated with high AMH concentrations (P < 0.001), after adjustment for smoking, parity, rectosigmoid endometriotic nodules and a bilateral location of endometriomas. CONCLUSIONS Pre-operative AMH concentration was significantly increased in women with large endometriomas of over 6 cm, independent of their age or the presence of bilateral endometriomas. This is relevant for both surgeons and patients when planning surgery in women with an intention to conceive post-operatively.
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Affiliation(s)
- Horace Roman
- Endometriosis Centre, Clinique Tivoli-Ducos, Bordeaux, France; Department of Gynaecology and Obstetrics, University Hospital Aarhus, Aarhus, Denmark.
| | | | - Oana Mircea
- Department of Gynecology and Obstetrics, University of Medicine, Pharmacy, Science and Technology, TarguMures, Romania
| | - Benoit Berby
- Expert Center in Diagnosis and Management of Endometriosis, Department of Gynecology and Obstetrics, Rouen University Hospital, Rouen, France
| | - Lise Dehan
- Expert Center in Diagnosis and Management of Endometriosis, Department of Gynecology and Obstetrics, Rouen University Hospital, Rouen, France
| | - Sophia Braund
- Expert Center in Diagnosis and Management of Endometriosis, Department of Gynecology and Obstetrics, Rouen University Hospital, Rouen, France
| | - Eric Verspyck
- Expert Center in Diagnosis and Management of Endometriosis, Department of Gynecology and Obstetrics, Rouen University Hospital, Rouen, France
| | - Lucian Puscasiu
- Department of Gynecology and Obstetrics, University of Medicine, Pharmacy, Science and Technology, TarguMures, Romania
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Peigné M, Pigny P, Pankhurst MW, Drumez E, Loyens A, Dewailly D, Catteau-Jonard S, Giacobini P. The proportion of cleaved anti-Müllerian hormone is higher in serum but not follicular fluid of obese women independently of polycystic ovary syndrome. Reprod Biomed Online 2020; 41:1112-1121. [PMID: 33046375 DOI: 10.1016/j.rbmo.2020.07.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 07/02/2020] [Accepted: 07/17/2020] [Indexed: 02/06/2023]
Abstract
RESEARCH QUESTION Does the relative distribution of anti-Müllerian hormone (AMH) isoforms differ between patients depending on their body mass index (BMI) and polycystic ovary syndrome (PCOS) status in serum and follicular fluid? DESIGN Obese and normal weight patients (PCOS [n = 70]; non-PCOS [n = 37]) were selected for this case-control study in the serum. Between 2018 and 2019, obese (n = 19) and normal weight (n = 20) women with or without PCOS who were receiving IVF treatment were included in the follicular fluid study. The bio-banked serums and follicular fluid were tested for total AMH (proAMH and AMHN,C combined) and proAMH using an automatic analyzer. The AMH prohormone index (API = [proAMH]/[total AMH]x 100) was calculated as an inverse marker of conversion of proAMH to AMHN,C, with only the latter isoform that could bind to the AMH receptor complex. RESULTS The API was not significantly different between controls and women with PCOS, whereas obese women had a lower API compared with their normal weight counterparts. Grouping PCOS and controls, a lower API was found in obese versus normal weight women, suggesting a greater conversion of proAMH to AMHN,C. The API in the serum was significantly correlated with metabolic parameters. In the follicular fluid, API is not different between obese and normal weight women independently of PCOS and is higher than in the concomitant serum. CONCLUSIONS The proportion of inactive form of AMH in the serum is higher in normal weight versus obese women but not in the follicular fluid, independently of PCOS. The conversion of proAMH into the cleaved isoform is likely to occur in extra-ovarian tissues and to exacerbate in obese individuals.
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Affiliation(s)
- Maëliss Peigné
- Université de Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, Lille F-59000, France; AP-HP- Université Sorbonne Paris-Nord, Service de Médecine de la Reproduction et Préservation de la Fertilité, Hôpital Jean Verdier, Bondy F-93143, France; CHU Lille, Service de Gynécologie Médicale, Hôpital Jeanne de Flandre, Lille F-59000, France.
| | - Pascal Pigny
- Université de Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, Lille F-59000, France; CHU Lille, Service de Biochimie et Hormonologie, Centre de Biologie Pathologie, Lille F-59000, France
| | - Michaël W Pankhurst
- Department of Anatomy, School of Biomedical Sciences, University of Otago, Dunedin, New Zealand
| | - Elodie Drumez
- Université de Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des technologies de santé et des pratiques médicales, Lille F-59000, France; CHU Lille, Department of Biostatistics, F-59000 Lille, France HU Lille, Unité de Méthodologie - Biostatistique et Data Management, Lille F-59000, France
| | - Anne Loyens
- Université de Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, Lille F-59000, France
| | - Didier Dewailly
- Université de Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, Lille F-59000, France; CHU Lille, Service de Gynécologie Médicale, Hôpital Jeanne de Flandre, Lille F-59000, France
| | - Sophie Catteau-Jonard
- Université de Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, Lille F-59000, France; CHU Lille, Service de Gynécologie Médicale, Hôpital Jeanne de Flandre, Lille F-59000, France
| | - Paolo Giacobini
- Université de Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, Lille F-59000, France.
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Wissing ML, Mikkelsen AL, Kumar A, Kalra B, Pors SE, Flachs EM, Andersen CY. Associations of different molecular forms of antimüllerian hormone and biomarkers of polycystic ovary syndrome and normal women. Fertil Steril 2019; 112:149-155.e1. [DOI: 10.1016/j.fertnstert.2019.03.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Revised: 02/05/2019] [Accepted: 03/04/2019] [Indexed: 12/27/2022]
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Dumont A, Robin G, Dewailly D. Anti-müllerian hormone in the pathophysiology and diagnosis of polycystic ovarian syndrome. Curr Opin Endocrinol Diabetes Obes 2018; 25:377-384. [PMID: 30299432 DOI: 10.1097/med.0000000000000445] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Polycystic ovarian syndrome (PCOS) is the most common cause of chronic anovulation and hyperandrogenism in young women and represents a true public health concern and an economic burden. RECENT FINDINGS The pathophysiology of PCOS is still not fully understood, but progresses have been made and the relationships between anti mullerian hormone (AMH), follicle stimulating hormone, luteinizing hormone, E2 and androgens have been explored. The follicle excess plays a central role in the syndrome and AMH is definitively a major component of this phenomena. SUMMARY The aim of this chapter is to present the recent work studying the role of AMH in the pathophysiology of PCOS and to discuss the improvement that serum AMH assay brings in the diagnosis of PCOS.
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Affiliation(s)
- Agathe Dumont
- Service de Gynécologie Endocrinienne et de Médecine de la Reproduction, Hôpital Jeanne de Flandre, CHRU, Lille, France
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