Atretic Follicles Research Articles

P-426 In vitro and in vivo toxicity of carboplatin and paclitaxel regimen on BRCA-mutated ovarian tissue fragments

Abstract Study question Does carboplatin and paclitaxel regimen have a toxic cumulative impact on the ovarian reserve of young breast cancer patients with germline Breast Cancer (BRCA) mutation? Summary answer Based on follicle classification and survival through apoptosis and DNA repair mechanism recruitment analyses, gonadotoxic but no cumulative effect was observed in BRCA-mutated ovarian tissue. What is known already Ovarian function recovery and fertility issues remain major concerns for young patients diagnosed with cancer. Breast cancer is the first cancer diagnosed among women under 40 years and around 10% of them are BRCA germline mutation carriers. Beside their predisposition to breast and ovarian cancers, BRCA carriers might be more sensitive to chemotherapy-induced gonadotoxicity due to the role of BRCA in DNA repair mechanism. Current therapies for BRCA-mutated breast cancer patients often include carboplatin and paclitaxel, drugs that are both considered as moderately gonadotoxic. However, the effect of combined therapy in BRCA-mutated ovarian tissue is unknown. Study design, size, duration Ovarian tissue cryopreserved for fertility preservation before chemotherapy and donated for research by breast cancer patients with or without BRCA1/2 mutation (< 35 years at diagnosis) were used in this study. Two models were investigated: 3 days in vitro culture with carboplatin (10 µg/mL) and/or paclitaxel (1 µM) and ovarian tissue xenograft into mice followed by 3 weeks injections of carboplatin (50mg/kg/week) and paclitaxel (10mg/kg every 3 days). Control conditions were performed for each model. Participants/materials, setting, methods Ovarian tissue from 3 BRCA-mutated and 3 non-mutated patients were thawed and exposed in vitro and in vivo to chemotherapy. Follicle density (number of follicles/mm²) as well as ratios of quiescent/activated and healthy/atretic follicles were evaluated following haematoxylin-eosin staining. Apoptosis and DNA repair mechanisms were analysed using TUNEL/GDF9 co-staining and phosphorylated H2A histone family member X (γH2AX)/ZP-3 co-staining, respectively. Genes expression level will be evaluated on isolated follicles to assess the activation process. Main results and the role of chance First, the impact of in vitro culture and in vivo xenotransplantation was evaluated by follicle counting and classification. A decrease of follicular density (5 to 95% irrespective of patient, model, nor condition) and an increase of activated and atretic follicles was observed after both in vitro and in vivo experiments in all conditions. However, a slight increase of quiescent follicle pool was observed in the in vitro control condition, with no difference between mutated and non-mutated fragments. Then, immunofluorescence staining was performed to evaluate follicle damage. For quantification, 30 to 150 follicles per patient were counted within each condition and classified as positive if at least one cell was stained. Apoptosis was assessed with TUNEL/GDF9 co-staining. In both models, the ratio of positive follicles was higher in fragments treated with chemotherapy (40-60%) compared to control conditions (15-20%). Recruitment of DNA repair complex was analysed using γH2AX/ZP3 co-staining. In both models, an increase in positive follicles ratio was observed in treated fragments (15-40%) compared to control conditions (5-10%). Interestingly, the positive follicles ratio was lower in BRCA-mutated (15-18%) than in non-mutated fragments (25-40%) after 3-days in vitro culture, irrespective of the treatment used. Limitations, reasons for caution Reasons of caution include the high inter-variations between patients as well as intra-variations in one patient regarding follicular density within ovarian tissue. Moreover, BRCA-mutated patients included (27.67 ± 2.08) are younger than control ones (33.67 ± 1.53). Ongoing experiments with additional patients should support the results already obtained. Wider implications of the findings Carboplatin and paclitaxel combined exposure in vitro or in vivo does not seem to have a cumulative deleterious impact on ovarian reserve. Ovarian tissue with BRCA-mutation did not appear to be more sensitive to chemotherapy exposure. Further investigations focusing on DNA repair mechanisms will be performed in both models. Trial registration number Not applicable

P-637 pseudo-targeted metabolomics of follicular fluid reveals ovarian GPD1L-mediated glycerophospholipid metabolism dysfunction in patients with biochemical premature ovarian insufficiency

Abstract Study question Does the metabolic profile of follicular fluid from patients with biochemical premature ovarian insufficiency (bPOI) differ from that of healthy women? Summary answer The metabolic signature of follicular fluid reveals a significant decrease of phosphatidic acid (PA), phosphatidylcholine (PC), lysophosphatidylcholine (lysoPC) and lysophosphatidylethanolamine (lysoPE) in bPOI patients. What is known already Metabolites in follicular fluid have attracted extensive attention as they are important components of the microenvironment during follicular development and oocyte maturation. Studies on follicular fluid metabolomics may enhance the understanding of the pathogenesis of ovarian aging, particularly premature ovarian insufficiency. Although a variety of metabolites have been suggested to be related to cell senescence, their specific roles in regulating follicular atresia remain unclear. Study design, size, duration An observational study of follicular fluid samples collected from 120 women undergoing in vitro fertilization and embryo transfer was conducted. All enrolled women were classified into two groups: one with 60 bPOI patients and the other with 60 healthy controls. Each group was further subdivided into two subgroups (young and aged group, 30 women for each section). Participants/materials, setting, methods The follicular fluids of mature follicles (diameter over 17 millimeters) were isolated and collected for pseudo-targeted metabolic analysis. The intensities of captured metabolites were utilized for further bioinformatic analysis. The correlation between the significant differential metabolites screened and their clinical outcomes were analyzed. In vitro experiments were used to demonstrate the cellular function of mainly regulated signaling pathway. Main results and the role of chance A total of 608 metabolites were identified in 120 follicular fluid samples. There were significant differences in 143 metabolites between the bPOI and healthy controls. As revealed by metabolic pathway analysis, glycerophospholipid metabolism was the most enriched pathway in bPOI follicular fluids. The intensities of several glycerophospholipid-associated metabolites PA, PC, lysoPC and lysoPE were positively correlated with the ovarian reserve indicator anti-Müllerian hormone (AMH), female age, as well as the expression level of glycerol-3-phosphatedehydrogenase 1-like (GPD1L), a key enzyme of this pathway, in granulosa cells. Furthermore, knockdown of GPD1L induced mitochondria dysfunction and granulosa cell apoptosis via GPD1L/PKCε/ATF2/NEAT1 pathway, as well as led to follicular atresia and impaired the quality of oocytes. Limitations, reasons for caution The validity of differential intensified metabolites we detected as biomarkers for clinical diagnosis needs to be confirmed in a large-scale study. And the multiple effects of glycerophospholipid metabolic pathway posed on follicular development need to be study in-depth. Wider implications of the findings Our results suggested that a highly coordinated follicular metabolism exhibits a strong relationship with the quality of follicles. An understanding of the mechanisms underlying ovarian aging will provide a theoretical basis, as well as new ideas for POI diagnosis, treatment and intervention. Trial registration number Not applicable.

P-466 The effect of SARS-CoV-2 infection or vaccination on controlled ovarian stimulation and in vitro fertilization: A multicenter retrospective cohort study

Abstract Study question Are the ovarian response to controlled ovarian stimulation (COS) and embryo development after in vitro fertilization (IVF) affected by SARS-CoV-2 infection and immunization? Summary answer Both SARS-CoV-2 infection and SARS-CoV-2 mRNA or inactivated vaccinations do not affect ovarian responsiveness to COS or embryo development following IVF. What is known already SARS-CoV-2 infects the target cell by binding to angiotensin-converting enzyme 2 (ACE2) via its surface spike protein. ACE2 receptors are present in the vagina, uterus, fallopian tubes, and ovaries of the female reproductive system. They regulate ovarian steroidogenesis, follicular development, oocyte maturation, and follicle atresia. The virus downregulates ACE2 levels, resulting in decreased conversion of Angiotensin II (ANGII) to Ang (1-7) and increased accumulation of (ANGII). This may impair reproductive fertility. However, initial studies conclude that both SARS-CoV-2 infection and vaccination would not affect reproductive outcomes, but it is necessary to develop new studies that confirm their applicability. Study design, size, duration A retrospective multicentric cohort study of 428 patients who underwent COS for oocyte donation between January 1st, 2018 and July 31th, 2022 were screened for eligibility and followed up to September 18th, 2022. Oocyte donation cycles were utilized because this model is an excellent choice for controlling known female characteristics Participants/materials, setting, methods Eligibility criteria were donors between 18 to 32 years. Patients were categorized into the vaccinated group if they had received SARS-CoV-2 vaccines (BNT162b2 mRNA Pfizer-Biontech, mRNA-1273 Moderna or inactivated SARS-CoV-2 vaccine Sinovac). The control group was chosen from medical records before March 2020 ensure they were neither infected or vaccinated. Demographic, cycle characteristics, and laboratory outcomes were compared. Normally, distributed data were compared across groups by univariate ANOVA. All P-values were considered significant at < 0.05. Main results and the role of chance In total, 428 patients were included in the study, with 12 recovering from SARS–CoV-2 infection (Group 1), 92 reporting vaccination (Group 2), and 324 patients who underwent COS before March 2020 assigned to the non-exposed group (Group 3). The mean time from recovery to oocyte aspiration was 122 days (range 39-315 days) and 213 days from the first vaccine dose to oocyte aspiration (range 17–249 days). The study's participants had an average age of 24.8 years. Age was found to be normally distributed and did not differ significantly between the three groups (P-value 0,953). Similarly, ovarian reserve markers, as measured by AFC and AMH, did not differ between groups (P-values of 0,787 and 0,423 respectively). No significant differences were observed regarding stimulation duration and total gonadotropin dose. The number of retrieved oocytes, MII oocytes, fertilized oocytes, and good-quality day 5 embryos were also similar between the three groups. Comparing oocyte retrieval rate, mature oocyte rate, normal fertilization rate, and blastocyst formation rate consistently revealed no statistically significant differences. Limitations, reasons for caution The main limitation is its retrospective design. Other limitations include the small sample size of recovered patients, the absence of sperm analyses, and data of live birth rates and neonatal outcomes. Wider implications of the findings SARS-CoV-2 infection and vaccination seem unrelated to detrimental effects on ovarian response or embryo development. These findings contribute to the growing body evidence that supports vaccination in women trying to conceive. Further prospective studies with larger cohort sizes and longer follow-ups are warranted to validate our conclusion. Trial registration number NCT05562479

P-430 Characterization of secondary follicles from cultured cryopreserved-thawed human ovarian cortical tissue

Abstract Study question Can we obtain secondary follicles from cultured cryopreserved-thawed human cortical tissue? Summary answer We obtained a comparable percentage of secondary follicles after culture of cryopreserved-thawed human cortical tissue to that reported after culture of fresh human cortical tissue. What is known already The complete in vitro maturation of oocytes starting from primary oocytes (present in unilaminar follicles) until mature MII oocytes has been achieved previously by two different multi-step culture protocols. These protocols were applied to culture fresh ovarian cortical tissue from adult cisgender donors. However, the efficiency of these two protocols for growing unilaminar follicles to secondary follicles starting from cryopreserved cortical tissue from cisgender patients has not been investigated. As the ovarian tissue available for fertility preservation is cryopreserved, it is important to understand the potential of cryopreserved unilaminar follicles to mature in vitro. Study design, size, duration Cryopreserved ovarian cortical tissue from 4 cisgender adult donors was used for in vitro culture. According to the existing culture protocols, cortical ovarian tissue was cultured either for 8 days using the first step medium (Telfer’s medium) reported by M.McLaughlin 2018 (doi: 10.1093/molehr/gay002) or for 7 and 21 days using the first step medium (Xu’s medium) reported by Xu 2021 (doi: 10.1093/humrep/deab003). Participants/materials, setting, methods Ovarian cortical tissue obtained from adult cisgender donors undergoing oophorectomy for fertility preservation purposes was cryopreserved before chemotherapy. The cryopreserved ovarian cortical tissue was thawed and cut into small pieces. Several pieces were fixed immediately (day 0), the others were either cultured in Telfer’s medium or Xu’s medium. After culture, follicle survival, growth and morphology were assessed by histology and immunofluorescence. Main results and the role of chance We performed quantification of the different follicular stages (primordial, primary, secondary and atretic) after culture and observed that the percentage of secondary follicles increased independently of the culture media used. However, the ovarian cortical tissue cultured using Telfer’s protocol resulted in a higher percentage of secondary follicles and lower percentage of atretic follicles compared to that using Xu’s protocol. After culture, the ovarian cortical tissue was further immunostained for TUNEL, PCNA, COLLIV, STAR, AMH and KRT19. We observed that secondary follicles present in ovarian cortical tissue cultured in Telfer’s medium showed more proliferative (PCNA+) FOXL2+ granulosa cells and less apoptotic (TUNEL+) stromal cells. By contrast, ovarian cortical tissue cultured in Xu’s medium showed less proliferative (PCNA+) FOXL2+ granulosa cells and more apoptotic (TUNEL+) stromal cells. Moreover, the expression of AMH was high in granulosa cells of secondary follicles present in ovarian cortical tissue cultured in Telfer’s medium and low in Xu’s medium. Finally, in both Telfer’s and Xu’s medium cultures the expression of KRT19 was low in granulosa cells of secondary follicles present in ovarian cortical tissue. Limitations, reasons for caution The number of donors was limited and the study lacked fresh ovarian cortical tissue as control. Only the first step in Telfers’ and Xu’s protocol was performed, hence further culture is required to determine whether complete maturation of oocytes in vitro is possible starting from cryopreserved human cortical tissue. Wider implications of the findings Our study showed evidence of follicular growth in cryopreserved-thawed human ovarian cortical tissue after a period of in vitro culture. This is an important first step to achieve in vitro maturation of oocytes from cryopreserved-thawed human ovarian cortical tissue that could be used for clinical applications. Trial registration number NOT APPLICABLE

P-408 The ovarian tissues outside of the radiation field could be damaged by radiation-induced abscopal effects in mice: an experimental study.

Abstract Study question Could irradiation-induced abscopal effects (RIAEs) induce structural and functional damage in the distal ovary in female mice, and what is its mechanism? Summary answer The RIAEs can induce an inflammatory reaction and inhibit the growth and development of ovarian follicles in mice leading to a decrease in ovarian reserve. What is known already The irradiated tumor could induce cell and tissue injury in the organs distant from the radiation site, referred to as the radiation-induced abscopal effects (RIAEs). Many pieces of research have shown out-of-field tumor regression effects of radiation therapy. However, RIAEs is a double-edged sword and may cause serious side effects on normal tissues. Premature ovarian insufficiency (POI) is one of the main side effects of radiotherapy, but the relationship between RIAE and POI has not been clarified. Study design, size, duration C57BL/6J mice were used to establish a RIAEs model by irradiating the thorax and the abdomens were shielded. Sixteen C57BL/6J female mice were randomly allocated to sham and experimental groups (n = 8/group) according to the presence or absence of irradiation with an 8 Gy X-ray on the local area of the chest every day for three days. After irradiation for twenty-one days, The effect and possible mechanism of RIAEs on non-irradiated ovarian were discussed. Participants/materials, setting, methods After irradiation, the estrous cyclicity, serum steroid hormones, and pro-inflammatory factors were compared between groups. Furthermore, RNA-seq was used to detect the expression of transcriptional levels in ovarian tissues in both groups. The differentially expressed genes (DEGs) were screened and analyzed by gene ontology-biological process (GO_BP) between irradiated and sham groups. The expression and localization of spermatogenesis-and oogenesis-specific basic helix-loop-helix-containing protein 1(SOHLH1) and neutrophil elastase (NE) in ovarian tissues were detected by immunohistochemistry(IHC). Main results and the role of chance Compared with mice in the sham group, the irradiation group had disordered estrous cycles, reduced primordial follicles (P<0.001)] and growing follicles (P<0.001), significantly increased atretic follicles (P<0.001). Levels of serum estradiol [(70.28 ± 5.27) pmol/L] and AMH [(104.00±6.98) ng/L] in the irradiation group were significantly lower than those in the sham group [estradiol (97.58±7.25) pmol/L, P=0.016; AMH [(129.70±8.39) ng/mL, P=0.046], but FSH levels in the irradiation group were not significantly different from those in the sham group (P=0.996). Compared with the sham group, Serum levels of TNF-α [(488.30±36.20) ng/L vs. (31.61±12.89) ng/L, P<0.001] and IL-1β [(62.37±2.50) ng/L vs. (52.75±2.06) ng/L, P=0.018)] in the irradiation group were significantly increased. Serum levels of IL-6 in the irradiation group were also increased compared with the sham group, but the difference was not statistically significant (P=0.301). The results of GO_BP analysis showed that down-regulated DGEs were mainly involved in the process of follicular development, and up-regulated DGEs were involved in the inflammation process. The IHC results showed that the positive expression area of SOHLH1 in the irradiation group was significantly lower than in the sham group (P=0.005). In comparison, the positive expression area of NE was significantly higher than that of the Sham group(P=0.024). Limitations, reasons for caution This study was performed using a short, 3-day irradiation treatment condition. Therefore, the results need to be cautiously interpreted concerning radiation-associated chronic toxicity. Moreover, further studies in mouse tumor models are required to determine the clinical relevance of the role of RIAE. Wider implications of the findings Although the precise molecular mechanisms of these distal effects on the genital system are still unclear, the current discovery might pave the way for establishing novel fertility preservation protocols. The research offers hope to women with POI related to cancer therapy through the modulation of abscopal effects associated with radiotherapy. Trial registration number not applicable

P-422 Ovarian tissue vitrification as a low-technology and cost-effective protocol for female fertility preservation: a bovine study

Abstract Study question Which are the potential effects of vitrification on ovarian tissue, isolated follicles and short-term cultured follicles? Summary answer Vitrification-warming protocol using ethylene glycol as a cryoprotectant causes no severe damage to the ovarian tissue or the isolated follicles. What is known already Ovarian tissue cryopreservation (OTC) is used for fertility preservation (the only possible approach applicable for prepubertal girls). To date, more than 200 babies have been born from cryopreserved ovarian tissue. However, a slow-freezing protocol has been used most of the time, and only four babies have been born using the vitrification protocol. This suggests that current vitrification protocols may have an unknown effect on ovarian tissue and the developing follicles. Identifying the effects that vitrification may have on ovarian tissue will make vitrification for OTC more available to everyone while reducing high costs and new equipment requirements. Study design, size, duration We obtained 19 bovine ovaries from the local slaughterhouse and processed further by separating the medulla from the cortex. Hematoxylin and Eosin stain (H&E) was then used to calculate the follicle pool. Ovarian tissue pieces, where follicles were not identified, were excluded from the study. Participants/materials, setting, methods Ovarian cortical tissue pieces were fixed in Bouin’s solution and 4% paraformaldehyde and were used for morphological analysis using H&E, Ki67 immunofluorescence and TUNEL assay. Moreover, bulk RNA sequencing was used, and ovarian pieces with RIN>7 were selected for library preparation. Finally, fresh and vitrified ovarian tissue pieces were used for follicle isolation. The isolated follicles were cultured for up to 6 days, followed by a viability test performed after every two days. Main results and the role of chance Vitrification and subsequent warming of the ovarian tissue showed no significant effect on the total population of follicles compared with the fresh tissue. However, from bulk RNA sequencing, we observed 165 differentially expressed genes (DEGs) in vitrified tissue (VT) compared with the fresh tissue (FT). Vitrified cultured (VTC) pieces showed a significant decrease in monolayered and antral follicles. Moreover, a significant increase was observed in the population of atretic follicles in the fresh cultured (FTC) and VTC pieces compared with their non-cultured tissue pieces. Also, culturing fresh and vitrified tissue pieces for six days increased the proliferation of ovarian stromal cells and showed the presence of DNA damage in the stromal cells of both study groups. The RNA sequencing analysis yielded 1,042 and 1,191 DEGs in FTC and VTC pieces, respectively, compared with their uncultured control groups. Furthermore, approximately 30% of the isolated follicles (152) from vitrified tissue were viable after isolation compared with the number of viable follicles isolated from the fresh tissue (525). The isolated follicles showed no changes in their viability rate for up to 4 days. We used a Two-way ANOVA with multiple comparisons to analyse the collected data. Limitations, reasons for caution The study's main limitation was the lack of possibility to use the slow freezing protocol to compare the effect between the slow freezing and vitrification methods. Wider implications of the findings The vitrification and warming of bovine ovarian tissue did not show significant changes in ovarian tissue morphology. The follicle isolation process and subsequent culturing indicate that the vitrification method could be a way to preserve ovarian tissue and its follicles. However, culturing the tissue pieces affects their transcriptomic profile. Trial registration number N/A

O-091 The impact of endocrine disruptors on early pregnancy and clinical outcomes in IVF

Abstract The impact of endocrine disruptors on early pregnancy and clinical outcomes in IVF Moncef Benkhalifa (1,2,3), Debbie Montjean (2), Hafida Corsi-Cauet (3), Henri Copin (1,3), Véronique Bach (3), Pierre Miron (2), Rosalie Cabry (1,3) (1) Reproductive Medicine and Reproductive Genetics, University Hospital & School of Medicine. Picardie University Jules Verne. Amiens France (2) ART Centers. Laval and Brossard. Fertilys International Inc. Laval. Québec. Canada (3) PERITOX Laboratory. Picardie University Jules Verne. Amiens. France Since more than 40 years, there are annual increasing of studies, meta-analysis reporting and discussing the potential associations between endocrine disrupting chemicals (EDCs) and human fertility potential declining. Today it’s accepted that a substantial number of environmental and exposition factors affect the fertility and fecundity capacity of couples during the peri and post conception period. It’s accepted that most of EDCs interfere with or mimic steroid hormone action; predominantly by affecting estrogen, androgen and thyroid hormones signaling pathways and disturbing specific molecular process on relation with single or multiple biological functions. Some of EDCs can interact with the male and female reproductive system and lead to endocrine disruption in the testis and ovary. they exert their effects mainly via binding transcription factor receptors, EDCs can alter endocrine function through a variety of mechanisms. At fertility age EDCs may alter the expression and/or activity of enzymes required for synthesis and/or catabolism of testicular and ovarian sex steroids and the expression of hormone receptors and/or their ability to bind their and endogenous ligands. For example, in male, the literature reported a negative correlation between disrupted spermatogenesis and lifestyle factors (environmental-professional expositions) such as alcohol consumption, cigarette smoking, drug use, and obesity caused by high-energy diet. In female infertility diseases, the negative impact of chemicals ED has been studied in animals. Many disorders have been described, such as low ovarian weight, impaired folliculogenesis, a high aneuploidy rate and the acceleration of follicular atresia. Indeed, women exposed to some endocrine-disrupting pesticides (such as atrazine, lindane) have an elevated risk of long menstrual cycles or anovulation but the most serious consequence is POF and endometriosis pathophysiology’s. In our IVF experience in Picardie region (France), we observed that various pesticides with an endocrine-disrupting action are associated with poor oocyte quality (maturation and competency), embryonic defects and poor IVF outcomes, and some pesticide compounds are linked to specific causes of female infertility, such as premature ovarian insufficiency, polycystic ovarian syndrome, and endometriosis. It was reported that EDCs can reduce embryo implantation chances and increase miscarriage, placenta and post-natal abnormalities. for endometrium receptivity and implantation failure EDCs can play by modifying keys elements of the immune response relevant to pregnancy, and disrupt immune tolerance required for robust placentation, optimal fetal development and be a as contributing risk factors in recurrent miscarriage, preeclampsia, preterm birth and related pathologic gestation Environmental insults, including endocrine disrupting chemicals during critical periods of fetal development, can alter DNA methylation patterns, leading to inappropriate developmental gene expression and disease risks. Similar to environmental factors, endocrine-disrupting chemicals can influence gene expression without modifying the DNA sequence. It is commonly accepted that the transgenerational inheritance of parentally acquired traits is conveyed by epigenetic alterations risks also known as “epimutations”. In Conclusion, the negative impact of exposure to various endocrine-disrupting is becoming now a worldwide public health. Indeed, the community should be informed about the fertility decline, low ongoing pregnancy rates, and elevated risk of miscarriage associated with exposure to high doses of pesticides for example. We must keep in mind that humans are exposed to EDCs mixtures composed of hundreds of chemicals every day and not a single chemical in isolation.

P-587 effects of erzhi-tiangui granules to NEAT1 and apoptotic factors expression in granulosa cells of women with diminished ovarian reserve and Kidney-deficiency syndrome

Abstract Study question To investigate whether erzhi-tiangui granules (ETG) can reduce granulosa cells (GCs) apoptosis levels by regulating NEAT1 expression, thereby improving the cycle outcomes of patients. Summary answer ETG significantly improved oocyte quality and decreased apoptotic factor levels in GCs, which may be related to its intervention in NEAT1 expression. What is known already The mechanism by which diminished ovarian reserve (DOR) occurs is mainly due to extensive apoptosis of GCs, which leads to follicular atresia and reduced follicle numbers. It has been found that changes in NEAT1 expression in ovarian tissues can exert influence the extent of apoptosis of GCs, which leads to diseases such as POF and PCOS. While ETG, a clinical formula used to improve female fertility, can improve the quality of oocytes and embryos by down-regulating the expression of apoptosis-related effector proteins, thus improving clinical outcomes. Whether ETG improves clinical outcomes in DOR patients via NEAT1 hasn’t been elucidated. Study design, size, duration This study was conducted in two separate parts from January 2020 to September 2021. Experiment I included 15 women each with normal ovarian reserve (NOR) and DOR, aiming to investigate the expression differences of NEAT1, key apoptosis proteins (Bcl-2 and Caspase-3). Experiment II, a randomized controlled trial, recruited 70 DOR patients, aimed to investigate if ETG could regulate the expression levels of Bcl-2 and Caspase-3 through NEAT1, thus acting to improve clinical outcomes. Participants/materials, setting, methods We detected expression levels of lncRNA NEAT1 and apoptotic proteins Bcl-2 and Caspase-3 of DOR and NOR women using RT-qPCR and Western-blotting, respectively. DOR patients were randomly assigned to ETG and control group, treated with ETG and placebo respectively. Clinical efficacy was confirmed by comparing two groups regarding changes in clinical and laboratory data. We also probed the changes in expression levels of NEAT1, Bcl-2 and Caspase-3 to investigate effects of ETG on GCs’ apoptosis. Main results and the role of chance In Experiment I, compared to the NOR group, the expression levels of NEAT1 and Bcl-2 were down-regulated while those of Caspase-3 were up-regulated in the GCs of DOR patients (P < 0.05). In Experiment II, a total of 65 of 70 patients completed the study and were included in the outcome analysis. There were no significant differences between the two groups regarding baseline characteristics. Before treatment, there was no significant difference in the Kidney-deficiency syndrome scores between the two groups. After treatment, the ETG group had significantly lower Kidney-deficiency syndrome scores compared to the control group (P < 0.01). Also, Kidney-deficiency syndrome scores were significantly lower in the ETG group post-treatment compared with that pre-treatment (P < 0.001); there was no significant change in the control group (P > 0.05). There were no significant differences between the two groups in the duration of gonadotrophin stimulation, serum estrogenand progesterone levels on the trigger day, and normal fertilization rate. Compared to the control group, the ETG group had lower gonadotropin dosage and increased number of oocytes, transferable embryos and top embryos obtained (P < 0.05). Furthermore, the expression of NEAT1 was upregulated (P < 0.05), Caspase-3 expression was decreased (P < 0.01) in GCs from the ETG group than those in the control group (P < 0.05). Limitations, reasons for caution The small number of observed cases and the lack of long-term efficacy may lead to biased study conclusions. Further studies are also expected in the future to understand the relevant pathway mechanisms. Wider implications of the findings In this study, not only to judge the therapeutic effects of ETG by using clinical symptoms and clinical laboratory indexes as observations, but also to explore the molecular mechanism of its treatment of Kidney-deficiency type DOR based on NEAT1, which may be related to affecting the apoptotic process. Trial registration number No. 82274573, No. 82174429, No. ZR2021MH255, No. tsqn202103182

Obesity-induced inflammatory miR-133a mediates apoptosis of granulosa cells and causes abnormal folliculogenesis.

Obesity has been reported to promote disordered folliculogenesis, but the exact molecular mechanisms are still not fully understood. In this study, we find that miR-133a is involved in obesity-induced follicular development disorder. After feeding with a high-fat diet (HFD) and fructose water for nine weeks, the mouse body weight is significantly increased, accompanied by an inflammatory state and increased expression of miR-133a in the adipose tissues and ovaries as well as accelerated follicle depletion. Although miR-133a is increased in the fat and ovaries of HFD mice, the increased miR-133a in the HFD ovaries is not derived from exosome transferred from obese adipose tissues but is synthesized by ovarian follicular cells in response to HFD-induced inflammation. In vivo experiments show that intrabursal injection of miR-133a agomir induces a decrease in primordial follicles and an increase in antral follicles and atretic follicles, which is similar to HFD-induced abnormal folliculogenesis. Overexpression of miR-133a modestly promotes granulosa cell apoptosis by balancing the expression of anti-apoptotic proteins such as C1QL1 and XIAP and pro-apoptotic proteins such as PTEN. Overall, this study reveals the function of miR-133a in obesity-induced ovarian folliculogenesis dysfunction and sheds light on the etiology of female reproductive disorders.

Spermidine alleviating oxidative stress and apoptosis by inducing autophagy of granulosa cells in Sichuan white geese

Spermidine have been reported a role in antioxidative, antiaging, and antiinflammatory. Oxidative stress causes granulosa cell (GC) apoptosis, follicular atresia, and impairs poultry reproductive functions. Studies have found that autophagy is the protective mechanism against antioxidant stress and apoptosis in cells. However, the relationship between spermidine-induced autophagy, oxidative stress, and apoptosis in goose GCs remains unclear. In this study, we investigated the autophagy mechanism to mediate spermidine effects on the alleviation of oxidative stress and apoptosis in goose GCs. Follicular GCs were treated with spermidine combination with 3-Nitropropanoic acid (3-NPA), rapamycin (RAPA), and chloroquine (CQ) or with hydrogen peroxide, RAPA, and CQ. Spermidine upregulated the ratio of LC3-II/I, inhibited the accumulation of p62 protein, and induced autophagy. 3-NPA treatment significantly increased ROS production, MDA content, SOD activity, cleaved CASPASE-3 protein expression, and decreased BCL-2 protein expression in follicular GCs. Spermidine inhibited oxidative stress and apoptosis induced by 3-NPA. In addition, hydrogen peroxide-induced oxidative stress was inhibited by spermidine. However, the inhibitory effect of spermidine was eliminated under chloroquine. Our results demonstrated that spermidine relieved oxidative stress and apoptosis of GCs by inducing autophagy, indicating that spermidine has a great potential to maintain proteostasis and sustain granulosa cell viability in geese.

Hexavalent Chromium Disrupts Oocyte Development in Rats by Elevating Oxidative Stress, DNA Double-Strand Breaks, Microtubule Disruption, and Aberrant Segregation of Chromosomes.

Environmental and occupational exposure to hexavalent chromium, Cr(VI), causes female reproductive failures and infertility. Cr(VI) is used in more than 50 industries and is a group A carcinogen, mutagenic and teratogenic, and a male and female reproductive toxicant. Our previous findings indicate that Cr(VI) causes follicular atresia, trophoblast cell apoptosis, and mitochondrial dysfunction in metaphase II (MII) oocytes. However, the integrated molecular mechanism of Cr(VI)-induced oocyte defects is not understood. The current study investigates the mechanism of Cr(VI) in causing meiotic disruption of MII oocytes, leading to oocyte incompetence in superovulated rats. Postnatal day (PND) 22 rats were treated with potassium dichromate (1 and 5 ppm) in drinking water from PND 22-29 and superovulated. MII oocytes were analyzed by immunofluorescence, and images were captured by confocal microscopy and quantified by Image-Pro Plus software, Version 10.0.5. Our data showed that Cr(VI) increased microtubule misalignment (~9 fold), led to missegregation of chromosomes and bulged and folded actin caps, increased oxidative DNA (~3 fold) and protein (~9-12 fold) damage, and increased DNA double-strand breaks (~5-10 fold) and DNA repair protein RAD51 (~3-6 fold). Cr(VI) also induced incomplete cytokinesis and delayed polar body extrusion. Our study indicates that exposure to environmentally relevant doses of Cr(VI) caused severe DNA damage, distorted oocyte cytoskeletal proteins, and caused oxidative DNA and protein damage, resulting in developmental arrest in MII oocytes.

The effect of maternal separation stress-induced depression on ovarian reserve in Sprague Dawley Rats: The possible role of imipramine and agmatine through a mTOR signal pathway

PurposeTo examine the possible role of impramine and agmatine through a mTOR signal pathway on rat ovary after maternal separation stress-induced depression. MethodsSprague Dawley neonatal female rats were divided into control, maternal separation (MS), MS+imipramine, and MS+agmatine groups. Rats were subjected to MS for 4 hours daily from postnatal day (PND) 2 to PND 21 and pups were exposed to social isolation (SI) on PND23 for 37 days for model establishment treated with imipramine (30 mg/kg; ip) or agmatine (40 mg/kg; ip) for 15 days. In order to examine behavioral changes rats were all subjected to locomotor activity and forced swimming tests (FST). Ovaries were isolated for morphological evaluation, follicle counting and mTOR signal pathway protein expression levels were detected. ResultsIncreased number of primordial follicles and diminished ovarian reserve in the MS groups were detected. Imipramine treatment caused diminished ovarian reserve and atretic follicle; however, agmatine treatment provided the maintenance of ovarian follicular reserve after MS. mTOR signal pathway may have an important role during rat ovarian follicular development in model of MS. ConclusionsOur findings suggest that agmatine may help to protect ovarian reserve during follicular development by controlling cell growth.

Intergenerational toxic effects of parental exposure to [Cn mim]NO3 (n = 2,4,6) on nervous and skeletal development in zebrafish offspring.

Ionic liquids (ILs) are thought to have negative effects on human health. Researchers have explored the effects of ILs on zebrafish development during the early stages, but the intergenerational toxicity of ILs on zebrafish development has rarely been reported. Herein, parental zebrafish were exposed to different concentrations (0, 12.5, 25, and 50 mg/L) of [Cn mim]NO3 (n = 2, 4, 6) for 1 week. Subsequently, the F1 offspring were cultured in clean water for 96 h. [Cn mim]NO3 (n = 2, 4, 6) exposure inhibited spermatogenesis and oogenesis in F0 adults, even causing obvious lacunae in the testis and atretic follicle oocytes in ovary. After parental exposure to [Cn mim]NO3 (n = 2, 4, 6), the body length and locomotor behavior were measured in F1 larvae at 96 hours post-fertilization (hpf). The results showed that the higher the concentration of [Cn mim]NO3 (n = 2, 4, 6), the shorter the body length and swimming distance, and the longer the immobility time. Besides, a longer alkyl chain length of [Cn mim]NO3 had a more negative effect on body length and locomotor behavior. RNA-seq analysis revealed several downregulated differentially expressed genes (DEGs)-grin1b, prss1, gria3a, and gria4a-enriched in neurodevelopment-related pathways, particularly the pathway for neuroactive ligand-receptor interaction. Moreover, several upregulated DEGs, namely col1a1a, col1a1b, and acta2, were mainly associated with skeletal development. Expression of DEGs was tested by RT-qPCR, and the outcomes were consistent with those obtained from RNA-Seq. We provide evidence showing the effects of parental exposure to ILs on the regulation of nervous and skeletal development in F1 offspring, demonstrating intergenerational effects.

Modulatory role of Coriandrum sativum (coriander) extract against diabetic complications on the gonads of female rats and their offspring

It is well known that diabetes is associated with impairment of ovarian and testicular structure and function. Coriander (Coriandrum sativum L.) is identified as one of the oldest herbal plants valued for its nutritional and medicinal properties. This work is mainly designed to evaluate the possible modulatory role of dry coriander fruit extract against gonadal impairments associated with diabetes in female rats and their pups. Twenty-four pregnant rats were divided into four groups (n = 6): group I served as control, group II was administered daily with coriander fruit extract (250 mg/kg b.wt), group III was injected interaperitoneally with a single dose of streptozotocin (STZ) (80 mg/kg b.wt), and group IV was injected with single dose of STZ and post administered coriander extract. The experiment was conducted from the 4th day of gestation till the end of weaning. At the end of the experiment, the mothers’ rats and their offspring were weighed, sacrificed, the ovaries from mothers as well as ovaries and testes from offspring were immediately excised, and processed for histological, immunohistochemical and evaluation of apoptosis and transforming growth factorβ (TGF-β). Also, blood samples were collected and analyzed to estimate the levels of sex hormones as well as antioxidants.In STZ induced diabetes in mother's rats and their offspring, the ovarian sections revealed severe histopathological signs included several atretic follicles, dilated and congested blood capillaries. Additionally, the testicular sections of offspring appeared with destructive seminiferous tubules. Immunohistochemically, the ovarian sections displayed weak to negative expression for calretinin marker however the testicular sections showed strong expression for Bax protein (apoptotic marker) and weak to negative expression for Ki67 protein (proliferative marker). Also, the mean % values of positively expressed cells for TGF-β and annexin-v markers (late and early apoptosis indicator) were significantly elevated in the ovarian and testicular tissues of STZ-induced group of mother's rats and their pups if compared with control. Further results revealed that the levels of insulin, FSH, LH, estrogen, SOD and CAT were significantly decreased if compared with control however the levels of MDA and NO were significantly elevated. Administration of coriander fruit extract to diabetic rats successfully alleviated most of the altered histological, immunohistochemical, biochemical, and apoptotic changes induced by diabetes. Coriandrum sativum fruit extract has a powerful ameliorative role against STZ-induced diabetic gonadal dysfunctions in female rats and their offspring.

Stem cell therapy for premature ovarian insufficiency: a systematic review and meta-analysis of animal and clinical studies.

The aim of this systematic review and meta-analysis is to evaluate the efficacy of stem cell therapy in mouse models of POI and patients with POI. The PubMed, Web of Science, and Embase databases were searched from inception to February 2022 for relevant animal and clinical studies. The reference lists of the included reviews were manually searched to identify additional eligible studies. Data were independently extracted by two investigators, and disagreements were resolved by discussion. SYRCLE's risk of bias tool and the MINORS tool were used to assess the quality of animal and clinical studies by two independent investigators. All statistical analyses were conducted using Review Manager 5.3 software. A total of twenty animal studies and six clinical studies were included in this meta-analysis. In animal studies, the results showed that stem cells could improve hormone levels, follicle count, estrous cycle and pregnancy outcome. For hormone levels, stem cells increased serum E2 and AMH levels and decreased serum FSH and LH levels compared with the control group (serum E2 level: SMD: 5.05, 95% CI 4.21-5.90, P < 0.00001; serum AMH level: SMD: 4.42, 95% CI 3.06-5.79, P < 0.00001; serum FSH level: SMD: -3.79, 95% CI -4.87 to - 2.70, P < 0.00001; serum LH level: SMD: -1.31, 95% CI -1.65 to -0.96, P < 0.00001). All follicle counts, except for the antral follicle count, were significantly changed compared with the control group. (primordial follicle count: SMD: 4.61, 95% CI 3.65-5.56, P < 0.00001; primary follicle count: SMD: 3.35, 95% CI 1.08-5.63, P = 0.004; secondary follicle count: SMD: 3.23, 95% CI 1.92-4.55, P < 0.00001; total follicle count: SMD: 4.84, 95% CI 2.86-6.83, P < 0.00001; oocyte count: SMD: 7.56, 95% CI 5.92-9.20, P < 0.00001; atretic follicle count: SMD: -1.79, 95% CI -2.59 to -1.00, P < 0.00001). For the estrous cycle, stem cell therapy increased the number of estrous cycles (WMD: 2.72, 95% CI 2.07-3.37, P < 0.00001) and decreased the duration of the estrous cycle (WMD: -1.26, 95% CI -1.84 to -0.69, P < 0.0001) compared with the control group. For pregnancy outcomes, stem cell therapy increased the fertility rate (RR: 3.00, 95% CI 1.74-5.17, P < 0.0001) and litter size (WMD: 3.82, 95% CI 0.36-7.28, P = 0.03) compared with the control group. In animal studies, the asymmetric funnel plot of serum E2 and FSH levels indicated the possibility of publication bias. Unpublished and negative studies may be the source of publication bias. In clinical studies, the results showed that stem cell therapy could decrease serum FSH level (MD: -30.32, 95% CI -59.03 to -1.01, P = 0.04) and increase AFC (MD: 1.07, 95% CI 0.70-1.43, P < 0.00001), pregnancy rate (RD: 0.19, 95% CI 0.04-0.34, P = 0.01) and live birth rate (RD: 0.19, 95% CI 0.07-0.31, P = 0.001) in POI patients. In addition, there was no significant difference in menstrual function regained (RD: 0.22, 95% CI -0.03-0.46, P = 0.09), oocytes retrieved (MD: 1.00, 95% CI -0.64-2.64, P = 0.23) and embryos (MD: 0.80, 95% CI -0.15-1.76, P = 0.10) between different groups. This meta-analysis suggested that stem cell therapy might be effective in POI mouse models and patients and could be considered a potential treatment to restore fertility capability in POI patients.

OncoTherad immunotherapy plus platelet rich plasma as potential therapeutic strategy for ovarian cancer: The role of toll-like receptors 2 and 4 signaling pathways.

e17602 Background: Ovarian cancer (OC) has the most devastating death rate of gynecological cancers with only 44% of women surviving 5 years after diagnosis. Toll-like receptors (TLRs) signaling can play an important role in the OC treatment. TLR activation in immune cells can help activate an effective antitumor response. In this scenario, a new perspective is represented by combined OncoTherad (MRB-CFI-1) immunotherapy and Platelet Rich Plasma (PRP). OncoTherad (MRB-CFI-1) leads to the distinct stimulation of the innate immune system mediated by TLR2 and TLR4, resulting in an increased activation of the IFN signaling pathway. Also, PRP acts on immune activation and exerts antitumor effects. This study characterized the histopathological and molecular effects of the OncoTherad associated with PRP in the treatment of OC chemically induced in rats and described the possible mechanisms of action of this association involving the TLRs 2 and 4 signaling pathways. Methods: Fischer 344 female rats were divided into 5 groups (n = 7 animals per group): Control (Sham surgery) group; Cancer (7,12 dimethylbenzoanthracene – DMBA injection in the ovarian bursa, 1.25 mg/kg) group; OncoTherad (20mg/kg) group; PRP (328.103 – 549.103 platelets/mm3) group and; OncoTherad+PRP (same doses of the isolated treatments) group. Intraperitoneal doses were administered twice a week for 4 weeks. Immunohistochemistry was analyzed as total immunoreactivity and intensity of immunoreaction. Results: Our results showed serous type ovarian carcinoma, follicular atresia, absence of corpora lutea and hyperplasia of the germinal epithelium and tunica albuginea in the Cancer group. The histopathological changes in the PRP group were similar as Cancer group. In contrast, the animals treated with OncoTherad singly or in combination with PRP showed decrease of ovarian neoplastic lesions and histopathological recovery. TLR4 and IL-6 immunoreactivities were significantly lower (p &lt; 0.05) in the Cancer group. PRP treatment reduced (p &lt; 0.05) TLR2. In the Oncotherad+PRP group, the immunoreactivities of TLR4, MyD88, IRF-3 and TNF-α were lower. OncoTherad treatment alone led to stimulation of the innate immune system mediated by TLR2 and TLR4, resulting in an increased activation of the MyD88 signaling pathway (intensified IL-6 and TNF-α immunoreactivities). Conclusions: OncoTherad immunotherapy was able to reduce ovarian lesions and stimulated the TLR2 and 4 signaling pathways in the OC microenvironment, leading to antitumor effects by activating the production of inflammatory cytokines. Thus, OncoTherad immunotherapy could be considered an important therapeutic strategy for OC.

Pathohistological findings in bilateral removed ovaries of mares with behavioral problems

Unwanted behavior is a common presenting problem in mares which often challenges veterinarians. Behavioral problems associated with cyclicity in absence of neoplastic ovarian pathology are often treated with oestrus suppression (Aurich and Kaps, Reprod.Dom.Anim. 2022;00:1-9). However, most options are cost-intensive, might have severe side effects or reversibility is not clearly determined yet. Therefore, bilateral ovariectomy (bOE) is often chosen due to the benefited surgical procedure. Studies evaluating effects of bOE on unwanted behavior in mares from the owner´s perspective revealed an improvement (Melgaard et al., Animals 2020;10:1210). However, there is a lack of histopathological explanation for this phenomenon. Therefore, the aim of the present study was to evaluate bilateral removed ovaries histopathologically in mares with behavioral problems. We hypothesized, that there are non-neoplastic changes in ovaries histologically detectable, which could be responsible for unwanted behavior in mares. In a retrospective case series, ovaries of 20 mares after bOE (OE) via standing laparoscopy using routine procedures (Röcken et al., Vet. Surge. 2011;40:1009-1014) were compared with granulosa cell tumors (GCT, n=10). Samples from removed ovaries were fixed in formaldehyde for further histological evaluation. One additional representative sample of each ovary was sent to a commercial laboratory for histopathological diagnosis of GCT by a Board-certified pathologist.Immunohistochemical evaluation was carried out using Kiel 67 (ki67), Aromatase (AR) and Anti-Muellerian Hormone (AMH) as diagnostic marker. Intensity of staining for ki67, AR and AMH was classified as -, +, ++, and +++ for no, low (<40%), moderate (40-70%) and high (70-100%) expression, respectively. Immunolabeling for ki67, AR and AMH was most intense in granulosa cells of antral and early atretic follicles in OE. In GCT, immunolabeling for AR and AMH was additionally highly intense in Leydig-like cells. In OE, ovaries of 3 mares initially categorized as GCT could not be confirmed and were therefore regarded as early stages due to upregulated ki67 in presence of a corpus luteum. Measurements of AMH in serum performed before surgery were above the reference value in all mares of GCT and in 6/20 (30%) in OE. In GCT, 8/10 (80%) and in OE, 16/20 (80%) mares showed behavioral abnormalities before surgery, which were not correlated with increased AMH in serum. Serum AMH values were not correlated with high expression of AMH in 9 mares, where granulosa cells of antral follicles could be evaluated. All, but one mare, benefit from bOE regarding behavior as reported from the owner. In the present study, immunostaining with ki67, AR or AMH showed no clear difference between OE and GCT. Further investigations regarding different immunohistochemical staining are warranted to find marker for non- or early neoplastic changes related to improvement of behavior in mares after bOE.

Liraglutide limits the immunogenic cell death-mediated ROS propagation and PI3K/AKT inactivation after doxorubicin-induced gonadotoxicity in rats: Involvement of the canonical Hedgehog trajectory.

Chemotherapy-accompanied reproductive dysfunction has lately begun to draw the attention of the scientific community owing to the irreversible impact on the patient's quality of life. Here we tended to investigate the potential role of liraglutide (LRG) in modulating the canonical Hedgehog (Hh) signaling in doxorubicin (DXR)-induced gonadotoxicity in rats. Female virgin Wistar rats were divided into 4 groups; control, DXR-treated (25mg/kg, single i.p. injection), LRG-treated (150μg/Kg/day, s.c) and itraconazole (ITC; 150mg/kg/day, p.o)-pretreated group, as the Hh pathway inhibitor. Treatment with LRG potentiated the PI3K/AKT/p-GSK3β cascade and relieved the oxidative burden-induced by the DXR-driven immunogenic cell death (ICD). LRG also upregulated the expression of the Desert hedgehog ligand (DHh) and the patched-1 (PTCH1) receptor and augmented the protein level of Indian hedgehog (IHh) ligand, Gli1 and cyclin-D1 (CD1). Besides, hypertranscription of IHh, DHh, Ptch1, Smo, Gli1/2 and CD1 genes along with a transcriptional recession of Gli3 gene were reported in LRG-treated group. ITC pre-administration partially abrogated this positive effect of LRG, proving the implication of the examined pathway. Microscopically, LRG ameliorated the follicular atresia noticed in the DXR group; effect that was, at least partially, declined by ITC pre-treatment. These findings end to a conclusion that LRG treatment might hinder the DXR-associated reproductive toxicity, resultant from ROS generated by the cells undergoing ICD, and trigger follicular growth and repair by the PI3K/AKT- dependent switching-on of the canonical Hh pathway.

Human umbilical cord mesenchymal stem cell-derived extracellular vesicles improve ovarian function in rats with primary ovarian insufficiency by carrying miR-145–5p

ObjectiveStem cell/exosome therapy is a novel strategy for primary ovarian insufficiency (POI). This paper is to examine the role of human umbilical cord mesenchymal stem cell-derived extracellular vesicles (hUCMSC-EVs) in POI. MethodshUCMSC-EVs were extracted and identified. POI rats were induced by cyclophosphamide for 15 days and treated with EV or GW4869 every 5 days and euthanized 28 days later. Vaginal smears were observed for 21 days. Serum hormone levels (FSH/E2/AMH) were measured by ELISA. Ovarian morphology, follicle numbers, and granulosa cell (GC) apoptosis were observed by HE and TUNEL staining. GCs extracted from Swiss albino rats were cyclophosphamide-induced to establish the POI cell model, followed by oxidative injury and apoptosis evaluation with the help of DCF-DA fluorescence, ELISA, and flow cytometry. The relation between miR-145–5p and XBP1 was predicted on StarBase and validated by dual-luciferase assay. miR-145–5p and XBP1 levels were measured by RT-qPCR and Western blot. ResultsEV treatment reduced irregular estrus cycle incidence since day 7, increased E2 and AMH levels and all-stage follicle numbers, reduced FSH level, GC apoptosis, and atretic follicle numbers in POI rats. EV treatment diminished GC oxidative injury and apoptosis in vitro. miR-145–5p knockdown in hUCMSC-EVs partly abolished hUCMSC-EV-mediated effects on GCs and ovarian function in vivo and on GC oxidative injury and apoptosis in vitro. Silencing XBP1 partially negated miR-145–5p knockdown-exerted effects on GCs in vitro. ConclusionmiR-145–5p carried by hUCMSC-EVs attenuates GC oxidative injury and apoptosis and thus extenuates ovarian injury and improves ovarian function in POI rats.

Dingkun Pill modulate ovarian function in chemotherapy-induced premature ovarian insufficiency mice by regulating PTEN/PI3K/AKT/FOXO3a signaling pathway

Ethnopharmacological relevanceDingkun Pill (DKP) is a traditional Chinese medicine that has been shown to have beneficial effects on reproductive function. However, the specific mechanism underlying its effect on POI is not well understood. Aim of the studyTo investigate the effect of different doses of Dingkun Pill on ovarian function in cyclophosphamide (CTX)-induced premature ovarian insufficiency (POI) mice and to explore its molecular mechanism through PTEN/PI3K/AKT/FOXO3a signaling pathway. This study will provide valuable insights into the potential clinical application of Dingkun Pill for the treatment of POI. Materials and methodsFifty female ICR mice were randomly divided into normal control (NC) group, model control (MC) group, and Dingkun Pill low, medium, high dose (DKP-L, M, H) groups. Mice were injected with CTX to construct the POI model. Mice in the DKP-L, M, and H groups were given 0.9 g/kg, 1.8 g/kg, and 3.6 g/kg of Dingkun Pill suspension for 21 days, respectively. Mice in the NC and MC groups were given the same amount of normal saline by gavage. Changes in body weight, estrous cycle and gonadal index were observed in each group of mice. Serum levels of FSH, LH, E2 and AMH were detected by ELISA. Hematoxylin-eosin (HE) staining observed the changes of ovarian pathological morphology and follicle counts at all levels. qRT-PCR was used to measure the levels of the PTEN and FOXO3a genes in ovarian tissue. The expression of PTEN/PI3K/AKT/FOXO3a signaling pathway related proteins were detected by Western-blot and immunohistochemistry (IHC). ResultsIn POI mice, Dingkun Pill increased body weight, promoted the recovery of estrous cycle, increased ovarian index, and improved pathological morphology of the ovaries. The FSH level decreased in the medium dose group (P < 0.05), the LH level reduced significantly in the medium and high dose groups (P < 0.01), and the E2 level in the high dose group increased (P < 0.05). There was no significant difference in AMH levels across all dose groups. The number of growing follicles improved at all levels in the low and medium dose groups, but declined significantly in the high dose group. However, the number of corpus luteum increased significantly in the high dose group (P < 0.001), and the atretic follicles in the three dose groups decreased. Results from qRT-PCR, Western-blot and IHC showed that the moderate dose of Dingkun Pill suppressed the levels of the p-PI3K and p-AKT proteins by upregulating the expression of PTEN in the ovarian tissues of POI mice, thereby inhibiting the expression of the key protein p-FOXO3a. However, the inhibitory effect of the higher dose may be less than that of the lower and intermediate dose groups. ConclusionsThe Dingkun Pill modulated hormonal levels, promoted follicle growth and induced ovulation in mice with CTX-induced POI, with better results in the low and moderate dose groups. Its mechanism may be related to the regulation of the PTEN/PI3K/AKT/FOXO3a signaling pathway.