Increased uterine androgen receptor protein abundance results in implantation and mitochondrial defects in pregnant rats with hyperandrogenism and insulin resistance

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 messagesThe proper regulation of uterine androgen receptor (AR) contributes to anormal pregnancy process, whereas the aberrant regulation of uterine AR mightbe linked to polycystic ovary syndrome (PCOS)-induced pregnancy-relatedcomplications.In the current study, we found that during normal rat pregnancy there isa stage-dependent decrease in AR abundance in the gravid uterus and that thisis correlated with the differential expression of the endometrial receptivityand 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 implantationfailure related to the aberrant expression of genes involved in endometrialreceptivity and decidualization in early to mid-gestation.Treatment with the anti-androgen flutamide, starting frompre-implantation, effectively prevents DHT + INS-induced defects in endometrialreceptivity and decidualization gene expression, restores uterine mitochondrialhomeostasis, and increases the pregnancy rate and the numbers of viablefetuses.This study adds to our understanding of the mechanisms underlying poorpregnancy outcomes in PCOS patients and the possible therapeutic use ofanti-androgens, including flutamide, after spontaneous conception.