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Markowska A, Antoszczak M, Markowska J, Huczyński A. Gynotoxic Effects of Chemotherapy and Potential Protective Mechanisms. Cancers (Basel) 2024; 16:2288. [PMID: 38927992 PMCID: PMC11202309 DOI: 10.3390/cancers16122288] [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: 05/29/2024] [Revised: 06/16/2024] [Accepted: 06/18/2024] [Indexed: 06/28/2024] Open
Abstract
Chemotherapy is one of the leading cancer treatments. Unfortunately, its use can contribute to several side effects, including gynotoxic effects in women. Ovarian reserve suppression and estrogen deficiency result in reduced quality of life for cancer patients and are frequently the cause of infertility and early menopause. Classic alkylating cytostatics are among the most toxic chemotherapeutics in this regard. They cause DNA damage in ovarian follicles and the cells they contain, and they can also induce oxidative stress or affect numerous signaling pathways. In vitro tests, animal models, and a few studies among women have investigated the effects of various agents on the protection of the ovarian reserve during classic chemotherapy. In this review article, we focused on the possible beneficial effects of selected hormones (anti-Müllerian hormone, ghrelin, luteinizing hormone, melatonin), agents affecting the activity of apoptotic pathways and modulating gene expression (C1P, S1P, microRNA), and several natural (quercetin, rapamycin, resveratrol) and synthetic compounds (bortezomib, dexrazoxane, goserelin, gonadoliberin analogs, imatinib, metformin, tamoxifen) in preventing gynotoxic effects induced by commonly used cytostatics. The presented line of research appears to provide a promising strategy for protecting and/or improving the ovarian reserve in the studied group of cancer patients. However, well-designed clinical trials are needed to unequivocally assess the effects of these agents on improving hormonal function and fertility in women treated with ovotoxic anticancer drugs.
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Affiliation(s)
- Anna Markowska
- Department of Perinatology and Women’s Health, Poznań University of Medical Sciences, 60-535 Poznań, Poland
| | - Michał Antoszczak
- Department of Medical Chemistry, Faculty of Chemistry, Adam Mickiewicz University, 61-614 Poznań, Poland
| | - Janina Markowska
- Gynecological Oncology Center, Poznańska 58A, 60-850 Poznań, Poland;
| | - Adam Huczyński
- Department of Medical Chemistry, Faculty of Chemistry, Adam Mickiewicz University, 61-614 Poznań, Poland
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Madsen JF, Ernst EH, Amoushahi M, Dueholm M, Ernst E, Lykke-Hartmann K. Dorsomorphin inhibits AMPK, upregulates Wnt and Foxo genes and promotes the activation of dormant follicles. Commun Biol 2024; 7:747. [PMID: 38902324 PMCID: PMC11190264 DOI: 10.1038/s42003-024-06418-9] [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: 06/22/2023] [Accepted: 06/06/2024] [Indexed: 06/22/2024] Open
Abstract
AMPK is a well-known energy sensor regulating cellular metabolism. Metabolic disorders such as obesity and diabetes are considered detrimental factors that reduce fecundity. Here, we show that pharmacologically induced in vitro activation (by metformin) or inhibition (by dorsomorphin) of the AMPK pathway inhibits or promotes activation of ovarian primordial follicles in cultured murine ovaries and human ovarian cortical chips. In mice, activation of primordial follicles in dorsomorphin in vitro-treated ovaries reduces AMPK activation and upregulates Wnt and FOXO genes, which, interestingly, is associated with decreased phosphorylation of β-catenin. The dorsomorphin-treated ovaries remain of high quality, with no detectable difference in reactive oxygen species production, apoptosis or mitochondrial cytochrome c oxidase activity, suggesting safe activation. Subsequent maturation of in vitro-treated follicles, using a 3D alginate cell culture system, results in mature metaphase eggs with protruding polar bodies. These findings demonstrate that the AMPK pathway can safely regulate primordial follicles by modulating Wnt and FOXO genes, and reduce β-catenin phosphorylation.
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Affiliation(s)
- Julie Feld Madsen
- Department of Biomedicine, Aarhus University, DK-8000, Aarhus C, Denmark
| | - Emil Hagen Ernst
- Department of Obstetrics and Gynaecology, Aarhus University Hospital, DK-8000, Aarhus C, Denmark
- Department of Gynaecology and Obstetrics, Gødstrup Hospital, DK-7400, Herning, Denmark
| | | | - Margit Dueholm
- Department of Obstetrics and Gynaecology, Aarhus University Hospital, DK-8000, Aarhus C, Denmark
| | - Erik Ernst
- Department of Biomedicine, Aarhus University, DK-8000, Aarhus C, Denmark
- Fertility Clinic Regional Hospital Horsens, DK-8700, Horsens, Denmark
| | - Karin Lykke-Hartmann
- Department of Biomedicine, Aarhus University, DK-8000, Aarhus C, Denmark.
- Department of Clinical Genetics, Aarhus University Hospital, DK-8200, Aarhus N, Denmark.
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Velazquez C, Herrero Y, Bianchi MS, Cohen DJ, Cuasnicu P, Prost K, Marinoni R, Pascuali N, Parborell F, Abramovich D. Beneficial effects of metformin on mice female fertility after a high-fat diet intake. Mol Cell Endocrinol 2023; 575:111995. [PMID: 37364632 DOI: 10.1016/j.mce.2023.111995] [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: 04/21/2023] [Revised: 06/08/2023] [Accepted: 06/16/2023] [Indexed: 06/28/2023]
Abstract
Female fertility is highly dependent on energy balance. High fat diet (HFD) intake entails a risk of infertility and ovulatory disorders. Considering the increase in the prevalence of overweight and obesity over the last decades, it is crucial to understand the mechanisms involved in overweight-associated infertility. In this study, we evaluated the reproductive performance of female mice fed with a HFD and the effects of metformin administration on ovarian function in these mice. We hypothesized that one of the mechanisms involved in subfertility due to a HFD intake is the alteration of ovarian blood vessel formation. We found that mice fed with HFD had altered estrous cycles and steroidogenesis, increased ovarian fibrosis, fewer pups per litter and require more time to achieve pregnancy. HFD-fed mice also presented dysregulated ovarian angiogenesis and an increase in nuclear DNA damage in ovarian cells. Ovulation rates were lower in these animals, as evidenced both in natural mating and after ovulation induction with gonadotropins. Metformin ameliorated ovarian angiogenesis, improved steroidogenesis, fibrosis, and ovulation, decreased the time to pregnancy and increased litter sizes in HFD-fed mice. We conclude that ovarian angiogenesis is one of the mechanisms detrimentally affected by HFD intake. Since metformin could improve ovarian microvasculature, it may be an interesting strategy to study in women to shed light on new targets for patients with metabolic disturbances.
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Affiliation(s)
- Candela Velazquez
- Instituto de Biología y Medicina Experimental, IByME-CONICET, Vuelta de Obligado 2490, C1428ADL Ciudad Autónoma de Buenos Aires, Argentina
| | - Yamila Herrero
- Instituto de Biología y Medicina Experimental, IByME-CONICET, Vuelta de Obligado 2490, C1428ADL Ciudad Autónoma de Buenos Aires, Argentina
| | - María Silvia Bianchi
- Instituto de Biología y Medicina Experimental, IByME-CONICET, Vuelta de Obligado 2490, C1428ADL Ciudad Autónoma de Buenos Aires, Argentina
| | - Débora Juana Cohen
- Instituto de Biología y Medicina Experimental, IByME-CONICET, Vuelta de Obligado 2490, C1428ADL Ciudad Autónoma de Buenos Aires, Argentina
| | - Patricia Cuasnicu
- Instituto de Biología y Medicina Experimental, IByME-CONICET, Vuelta de Obligado 2490, C1428ADL Ciudad Autónoma de Buenos Aires, Argentina
| | - Katherine Prost
- Hospital Interzonal General de Agudos Pedro Fiorito, sector de Endocrinología, Av. Manuel Belgrano 827, B1870 Avellaneda, Provincia de Buenos Aires, Argentina
| | - Rocío Marinoni
- Instituto de Biología y Medicina Experimental, IByME-CONICET, Vuelta de Obligado 2490, C1428ADL Ciudad Autónoma de Buenos Aires, Argentina
| | - Natalia Pascuali
- Instituto de Biología y Medicina Experimental, IByME-CONICET, Vuelta de Obligado 2490, C1428ADL Ciudad Autónoma de Buenos Aires, Argentina; Department of Pathology, College of Medicine, University of Illinois at Chicago (UIC), Chicago, IL, United States
| | - Fernanda Parborell
- Instituto de Biología y Medicina Experimental, IByME-CONICET, Vuelta de Obligado 2490, C1428ADL Ciudad Autónoma de Buenos Aires, Argentina
| | - Dalhia Abramovich
- Instituto de Biología y Medicina Experimental, IByME-CONICET, Vuelta de Obligado 2490, C1428ADL Ciudad Autónoma de Buenos Aires, Argentina.
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Ayhan S, Hancerliogullari N, Guney G, Gozukucuk M, Caydere M, Guney SS, Tokmak A, Ustun Y. Does the addition of metformin to carboplatin treatment decreases ovarian reserve damage associated with carboplatin usage? J Ovarian Res 2023; 16:184. [PMID: 37660125 PMCID: PMC10474675 DOI: 10.1186/s13048-023-01259-2] [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: 05/29/2023] [Accepted: 08/13/2023] [Indexed: 09/04/2023] Open
Abstract
BACKGROUND We aimed to determine whether adding metformin to carboplatin treatment would reduce the damage to ovarian reserve associated with carboplatin use. METHODS We included 35 adult female non-pregnant albino Wistar rats approximately three months old, weighing 220-310 g. The rats were divided into five groups of seven rats according to the treatment they received. Carboplatin and salin was given to Group 2, and carboplatin plus metformin was given to Group 3. Group 4 was administered only metformin. Group 5 was administered only salin. Carboplatin was given to Groups 2 and 3 as a single dose on the 15th day, while metformin was given to Groups 3 and 4 during the 28-day experiment. After oophorectomy, histopathologic analyses of primordial, primary, secondary, and tertiary Graff follicles according to the epithelial cells surrounding the oocyte and total follicular number were conducted per section. Serum Anti-Mullerian Hormone (AMH), tissue catalase, and malonyl dialdehyde levels were measured and compared within each group. RESULTS The baseline and 15th-day serum AMH values of the menstrual cycle were compared among the groups, and no statistically significant differences were observed (p > 0.05). Group 3, which was given both carboplatin and metformin, had statistically significantly higher 28th-day AMH levels than Group 2, which was given only carboplatin and saline (p < 0.001). The number of primordial follicles in Group 3 was found to be statistically significantly higher than in Group 2 (p < 0.001). Tissue catalase enzyme levels in Group 3 were statistically significantly higher than in Group 2 (p < 0.001). Tissue malondialdehyde levels in Group 2 were statistically significantly higher than tissue malondialdehyde levels in Groups 3 and 4 (p < 0.001). CONCLUSIONS Metformin may attenuate carboplatin-induced ovarian damage, possibly through its antioxidative effects.
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Affiliation(s)
- Sevgi Ayhan
- Department of Obstetrics and Gynecology, University of Health Sciences, Bilkent City Hospital, Ankara, Turkey
| | - Necati Hancerliogullari
- Department of Obstetrics and Gynecology, University of Health Sciences, Bilkent City Hospital, Ankara, Turkey
| | - Gurhan Guney
- Department of Reproductive Endocrinology and Infertility, Balikesir University School of Medicine, Cagis Campus,10145, 10145, Balikesir, Turkey.
| | - Murat Gozukucuk
- Department of Obstetrics and Gynecology, University of Health Sciences, Ankara Training and Research Hospital, Ankara, Turkey
| | - Muzaffer Caydere
- Department of Pathology, University of Health Sciences, Ankara Training and Research Hospital, Ankara, Turkey
| | - Sergul Selvi Guney
- Department of Midwifery, Faculty of Health Sciences, Balikesir University, Balikesir, Turkey
| | - Aytekin Tokmak
- Department of Obstetrics and Gynecology, University of Health Sciences, Bilkent City Hospital, Ankara, Turkey
| | - Yusuf Ustun
- Department of Obstetrics and Gynecology, University of Health Sciences, Ankara Training and Research Hospital, Ankara, Turkey
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Cavalcante MB, Sampaio OGM, Câmara FEA, Schneider A, de Ávila BM, Prosczek J, Masternak MM, Campos AR. Ovarian aging in humans: potential strategies for extending reproductive lifespan. GeroScience 2023; 45:2121-2133. [PMID: 36913129 PMCID: PMC10651588 DOI: 10.1007/s11357-023-00768-8] [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: 02/23/2023] [Accepted: 03/06/2023] [Indexed: 03/14/2023] Open
Abstract
Ovarian reserve is a term used to estimate the total number of immature follicles present in the ovaries. Between birth and menopause, there is a progressive decrease in the number of ovarian follicles. Ovarian aging is a continuous physiological phenomenon, with menopause being the clinical mark of the end of ovarian function. Genetics, measured as family history for age at the onset of menopause, is the main determinant. However, physical activity, diet, and lifestyle are important factors that can influence the age of menopause. The low estrogen levels after natural or premature menopause increased the risk for several diseases, resulting in increased mortality risk. Besides that, the decreasing ovarian reserve is associated to reduced fertility. In women with infertility undergoing in vitro fertilization, reduced markers of ovarian reserve, including antral follicular count and anti-Mullerian hormone, are the main indicators of reduced chances of becoming pregnant. Therefore, it becomes clear that the ovarian reserve has a central role in women's life, affecting fertility early in life and overall health later in life. Based on this, the ideal strategy for delaying ovarian aging should have the following characteristics: (1) be initiated in the presence of good ovarian reserve; (2) maintained for a long period; (3) have an action on the dynamics of primordial follicles, controlling the rate of activation and atresia; and (4) safe use in pre-conception, pregnancy, and lactation. In this review, we therefore discuss some of these strategies and its feasibility for preventing a decline in the ovarian reserve.
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Affiliation(s)
- Marcelo Borges Cavalcante
- Postgraduate Program in Medical Sciences, University of Fortaleza (UNIFOR), Fortaleza, CE, 60.811-905, Brazil.
| | - Olga Goiana Martins Sampaio
- Postgraduate Program in Medical Sciences, University of Fortaleza (UNIFOR), Fortaleza, CE, 60.811-905, Brazil
| | | | - Augusto Schneider
- Nutrition College, Federal University of Pelotas (UFPel), Pelotas, RS, 96010-610, Brazil
| | | | - Juliane Prosczek
- Nutrition College, Federal University of Pelotas (UFPel), Pelotas, RS, 96010-610, Brazil
| | - Michal M Masternak
- Burnett School of Biomedical Sciences, College of Medicine, University of Central Florida, Orlando FL, USA
- Department of Head and Neck Surgery, Poznan University of Medical Sciences, Poznan, Poland
| | - Adriana Rolim Campos
- Department of Head and Neck Surgery, Poznan University of Medical Sciences, Poznan, Poland
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Chi YN, Yang JM, Liu N, Cui YH, Ma L, Lan XB, Ma WQ, Liu YJ, Yu JQ, Du J. Development of protective agents against ovarian injury caused by chemotherapeutic drugs. Biomed Pharmacother 2022; 155:113731. [PMID: 36179491 DOI: 10.1016/j.biopha.2022.113731] [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: 07/28/2022] [Revised: 09/05/2022] [Accepted: 09/19/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Chemotherapy is one of the causes of ovarian injury and infertility. Although assisted reproductive technology helps young female patients with cancer become pregnant, preventing chemotherapy-induced ovarian injury will often possess even more significant benefits. OBJECTIVE We aimed at demonstrating the hazardous effects and mechanisms of ovarian injury by chemotherapeutic agents, as well as demonstrating agents that protect the ovary from chemotherapy-induced injury. RESULTS Chemotherapeutic agents cause death or accelerate activation of follicles and damage to the blood vessels in the ovary, resulting in inflammation. These often require drug development to protect the ovaries from injury. CONCLUSIONS Our findings provide a basis for the development of drugs to protect the ovaries from injury. Although there are many preclinical studies on potential protective drugs, there is still an urgent need for a large number of clinical experiments to verify their potential use.
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Affiliation(s)
- Yan-Nan Chi
- Department of Pharmacology, Ningxia Medical University, Yinchuan 750004, China
| | - Jia-Mei Yang
- Department of Pharmacology, Ningxia Medical University, Yinchuan 750004, China; School of Basic Medicine, Ningxia Medical University, Yinchuan 750004, China
| | - Ning Liu
- Key Laboratory of Hui Ethnic Medicine Modernization, the Ministry of Education, Ningxia Medical University, Yinchuan 750004, China
| | - Yan-Hong Cui
- Department of Pharmacology, Ningxia Medical University, Yinchuan 750004, China
| | - Lin Ma
- Department of Pharmacology, Ningxia Medical University, Yinchuan 750004, China
| | - Xiao-Bing Lan
- Department of Pharmacology, Ningxia Medical University, Yinchuan 750004, China
| | - Wen-Qian Ma
- Department of Pharmacology, Ningxia Medical University, Yinchuan 750004, China
| | - Yan-Jie Liu
- Department of Pharmacology, Ningxia Medical University, Yinchuan 750004, China
| | - Jian-Qiang Yu
- Department of Pharmacology, Ningxia Medical University, Yinchuan 750004, China; Ningxia Hui Medicine Modern Engineering Research Center and Collaborative Innovation Center, Ningxia Medical University, Yinchuan 750004, China.
| | - Juan Du
- Department of Pharmacology, Ningxia Medical University, Yinchuan 750004, China.
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Rehman R, Alam F, Abidi SH, Farooqi N, Jehan F. Oxidative stress and metformin: An in-vitro study on serum and primary human granulosa cell cultures. ELECTRONIC JOURNAL OF GENERAL MEDICINE 2022. [DOI: 10.29333/ejgm/12037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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