The Mechanism by Which Chemotherapy with use of Alkylating Agents Cause Follicular Activation: Is there any Further Mode for the Loss of the Primordial Follicles? A Short Communication

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A lot of women In their reproductive life go through treatment with a lot of chemotherapeutic drugs of which the alkylating agents which are inclusive of cyclophosphamide, busulphan, along with dacarbazine, more specifically cyclophosphamide, whose utilization is considered for a lot of chemotherapy protocols like In breast cancer, In cases of chronic lymphoblastic leukaemia in children and we encounter survivors of these cancers with usual manifestation of Premature ovarian insufficiency(POI). Thus detailed evaluation was attempted by Shai et al., In case of human ovaries immediately In which fresh ovarian tissue that was obtained from ladies following receipt of alkylating agents, non-alkylating agent in addition to that collected from those who did not get treatment. They corroborated the existence of significant depletion of primordial follicles (PMF’s), in addition to significant escalation of the absolute quantities of growing follicles in contrast to ovaries collected from those who did not get treatment. Staining done for FOXO3A demonstrated reduction in the nuclear existence in the PMF oocytes in cases where ovaries removed were from patients receiving treatment with alkylating agent in the ultra-short period following alkylating agents. No escalation in the expression of the cleaved caspase 3 was observed in PMF’s within the ovaries that got alkylating agents or non-alkylating agents exposure. Marked stromal fibrosis in addition to neovascularization was seen in alkylating agents treatment group only following loss of PMF had occurred earlier (4-6mths). This is a great study despite them unable to demonstrate the phosphorylated FOXO3A. Although it was anticipated that they would further show the part of PI3K/Akt pathway that possesses major part in the follicular activation although they explained in view of immediate preservation of ovaries In formaldehyde in addition to embedding In paraffin. Thus this study goes a long way in explaining the cause of follicular loss following treatment with alkylating agents and aid in the strategies we need to use to avoid the same once feasible.