Aromatase inhibitors in ovarian stimulation

The selective estrogen receptor modulator, clomiphene citrate (CC), has been the principal drug used for induction of ovulation in women with polycystic ovarian syndrome (PCOS). CC is associated with adverse side effects and low pregnancy rates attributed to long-lasting estrogen receptor depletion. Anastrozole and letrozole are potent, non-steroidal, reversible aromatase inhibitors, developed for postmenopausal breast cancer therapy. We hypothesized that aromatase inhibitors could mimic the action of CC in reducing estrogen negative feedback on follicle stimulating hormone (FSH) secretion, without depleting estrogen receptors. In a series of preliminary studies, we reported the success of aromatase inhibition in inducing ovulation in anovulatory women with PCOS. Moreover, we showed that concomitant use of aromatase inhibitors resulted in a significant reduction of the FSH dose needed for controlled ovarian hyperstimulation. We suggest that aromatase inhibitors act through an increase in endogenous gonadotropin secretion as well as through increased intraovarian androgen levels that may increase ovarian FSH receptors. Recently, we demonstrated the safety of aromatase inhibitors in pregnancy outcome studies examining spontaneous pregnancy loss, multiple pregnancy rates and congenital anomalies compared to a control group of infertility patients treated with CC.     

Role of LH in controlled ovarian stimulation

Controlled ovarian stimulation has become an integral part of infertility treatment. Specific gonadotropin based protocols become the main strategies for controlled stimulation. To avoid the potentially detrimental effect of premature LH surge on oocytes and/or endometrium development, the GnRH analogs have been incorporated into controlled ovarian stimulation strategies. With the availability of recombinant gonadotropins (i.e. recombinant FSH devoided of LH activity) it is necessary to establish precise role of LH in the folliculogenesis and endometrium development. The benefit of exogenous LH may vary with the GnRH-agonists and antagonists regiment used. The optimal amount of LH or ratio FSH to LH used during therapeutically stimulated growth of follicles is still a problem that needs to be solved in the near future.     

Increased DNA methyltransferase activity and DNA methylation following epidermal growth factor stimulation in ovarian cancer cells

Ovarian cancer progression is correlated with accumulation of aberrant CpG island methylation. In ovarian cancer, ascites fluid contains numerous Epidermal-Growth-Factor-Receptor (EGFR) activators, which could result in a tumor microenvironment of constant EGFR activation. Signaling pathways downstream of EGFR, such as Ras, regulate DNA methylation. We hypothesized that chronic EGFR activation could alter DNA methylation. We found that EGFR activation increased DNA methyltransferase (DNMT) activity acutely, as well as after long-term EGF treatment or expression of a mutationally activated EGFR. Furthermore, this increase in DNMT activity was dependent on EGFR catalytic activity and resulted in increased global DNA methylation. Additionally, treatment with the DNMT inhibitor/hypomethylating agent 5-Aza-2’-deoxycytidine (AZA) inhibited the EGF induced increase of both DNMT activity and global methylation. These data support a role for EGFR in the process of accumulated DNA methylation during ovarian cancer progression and suggest that epigenetic therapy may be beneficial for the treatment of ovarian cancer.     

Increased DNA methyltransferase activity and DNA methylation following epidermal growth factor stimulation in ovarian cancer cells

Ovarian cancer progression is correlated with accumulation of aberrant CpG island methylation. In ovarian cancer, ascites fluid contains numerous Epidermal-Growth-Factor-Receptor (EGFR) activators, which could result in a tumor microenvironment of constant EGFR activation. Signaling pathways downstream of EGFR, such as Ras, regulate DNA methylation. We hypothesized that chronic EGFR activation could alter DNA methylation. We found that EGFR activation increased DNA methyltransferase (DNMT) activity acutely, as well as after long-term EGF treatment or expression of a mutationally activated EGFR. Furthermore, this increase in DNMT activity was dependent on EGFR catalytic activity and resulted in increased global DNA methylation. Additionally, treatment with the DNMT inhibitor/hypomethylating agent 5-Aza-2′-deoxycytidine (AZA) inhibited the EGF induced increase of both DNMT activity and global methylation. These data support a role for EGFR in the process of accumulated DNA methylation during ovarian cancer progression and suggest that epigenetic therapy may be beneficial for the treatment of ovarian cancer.Key words: ovarian cancer, DNA methylation, epidermal growth factor receptor, DNA methyltransferase, epigenetics, E-cadherin     

Estrogen stimulation of ovarian surface epithelial cell proliferation

Summary Ovarian cancer is the leading cause of gynecological cancer mortality, and 85–90% of this malignancy originates from the ovarian surface epithelium (OSE). The etiology of ovarian epithelial cancer is unknown but a role for estrogens has been suspected. However, the effect of estrogens on OSE cell proliferation remains to be determined. Using the rabbit model, our studies have demonstrated that 17β-estradiol stimulates OSE cell proliferation and the formation of a papillary ovarian surface morphology similar to that seen in human ovarian serous neoplasms of low malignant potential. Immunohistochemical staining of ovarian tissue sections with an antibody to the estrogen receptor α demonstrates its expression in both OSE cells and stromal interstitial cells. In primary ovarian cell cultures, the proliferative response of the epithelial cells to 17β-estradiol depends on the expression of the estrogen receptor α in the epithelial cells. However, when the epithelial cells are grown together with ovarian stromal cells, their proliferative response to this hormone is greatly enhanced, suggesting the involvement of stromal-epithelial interactions. These studies suggest a role for estrogens and the estrogen receptor α in OSE growth.     

Behavioral indicators to detect ovarian phase in the dromedary she-camel

This pilot study was conducted to test the hypothesis that female camels behave differently in various ovarian phases in the presence of a restrained male camel. The aim was to identify behavioral patterns which could be used as indicators to detect ovulatory phase by visual observation in the presence of a restrained virile bull. Twenty-four healthy, nonpregnant, and nonlactating adult females were used. Transrectal ultrasonography was performed for each animal once a week over a 3-week period to determine the phase of the ovarian cycle. Females were considered to be in the ovulatory phase (O) when there was at least one preovulatory follicle (12<Ø<19 mm) protruding from the ovarian surface, and in the nonovulatory phase (NO), when growing follicles, regressing follicles, or corpora lutea were detected. Immediately after examination, each female was freely exposed to a restrained bull for 15 minutes, and her behaviors were filmed. The videos were analyzed through a focal animal-sampling ethogram (states: looking at the male; looking outside; standing close to the male; searching; and lying down; events: interaction with the male; urination; defecation; sound emission; and steps). A score for tail position (tail score: 1 = close to the vulva, 2 = horizontal, 3 = vertical) and for interest in the bull (male time score: from 1 to 5; 1 = <20% of observation period spent near the bull; 5 = more than 80%) were recorded. Ovulatory phase camels showed higher interest in the male than nonovulatory phases: they stood close to the male for longer periods (P = 0.0159), interacted with the male more frequently (P = 0.0004), and tended to lie down in front of him (P = 0.1202). Moreover, ovulatory phase had a significant effect on male time score (P < 0.01), mature follicular ovarian phase being associated with higher scores. Seeking the male has already been proposed as a behavioral indicator of estrus in camels, this has now been confirmed using a standardized ethogram. The present results clarify that camels behave differently in different ovarian phases and that monitoring their behavior in the presence of a restrained bull could help detect their ovulatory phase. This would have profound implications for enhancing fertility in dromedary camels by improving timing of mating or artificial insemination.     

Behavioral indicators of slow growth in nursery pigs

The objective of this study was to determine how feeder-space allowance affects behaviors of slow- and fast-growing pigs during the nursery period. Nursery pigs (n = 192; initial weight = 7.4 ± 1.6 kg) were housed in 24 pens of 8 pigs, with 12 pens provided with either a two-space feeder or a five-space feeder. Pigs were categorized as slow growers (SG) and fast growers (FG) based on adjusted market weight (SG < 105 kg; FG ≥ 105 kg). Behaviors of pigs were video-recorded during the first four days after entering the nursery and on Day 21. Eating speed was measured on 96 focal pigs when they were nine weeks old. SG spent more time at the drinker than did FG (p < .05). SG spent less time in the standing/walking posture (p < .05) in pens with five-space feeders compared with SG in pens with two-space feeders. These results suggest that providing more feeder space may benefit SG in terms of improving the welfare of these pigs.     

Prostaglandin stimulation of ovarian ornithine decarboxylase in vitro.

Prostaglandins E₁ and E₂ caused a 5–10 fold stimulation of ornithine decarboxylase activity in granulosa cells isolated from porcine ovarian follicles. The minimally effective concentration of prostaglandin E₂ was 10 ng/ml and the plateau of activity was reached at 500 ng/ml. Prostaglandin F_2α was ineffective. 1-Methyl,3-isobutyl-xanthine, a phosphodiesterase inhibitor, potentiated the effect of both submaximal and maximal effective doses of prostaglandin E₂, suggesting that the effect of prostaglandin E₂ is mediated by cAMP. The effect of prostaglandin E₂ was similar to that of luteinizing hormone and a cAMP analogue, 8-Bromo-cAMP.     

Refractoriness of ovarian adenylate cyclase to continued hormonal stimulation

Culture of preovulatory rat follicles with luteinizing hormone, folliclestimulating hormone or prostaglandin E₂ for 24 h reduced the subsequent response of adenylate cyclase to the homologous hormone by 80, 50 and 90%, respectively; yet follicles refractory to luteinizing hormone fully responded to follicle-stimulating hormone or prostaglandin E₂, those refractory to follicle-stimulating hormone responded to luteinizing hormone and prostaglandin E₂, and those refractory to prostaglandin E₂ could be stimulated by either gonadotropin. Desensitization of the adenylate cyclase system by luteinizing hormone was achieved by hormone concentrations of 0.8−2.0 μg/ml in the mediem; a lower dose of luteinizing hormone (0.4 μg/ml), though effective in stimulating adenylate cyclase, did not induce refractoriness. Prostaglandin E₂ caused partial refractoriness at dose levels of 0.1–0.25 μg/ml; higher dose levels were more effective. These findings suggest that continued exposure of the preovulatory follicle to elevated levels of hormones may cause perturbations in either the interaction between the hormone and its specific receptor or in a subsequent step essential for activation of adenylate cyclase.     

Behavioral indicators of ovarian phase in white-faced capuchins (Cebus capucinus)

In many primate species, conspicuous behavioral and/or morphological changes are indicators of the fertile phase of the female cycle. However, several primate species, such as the white-faced capuchin, lack these cues. This is referred to as "concealed ovulation," and is argued to be a reproductive strategy that confuses paternity and lowers the risk of infanticide. We studied 10 adult female white-faced capuchins in Santa Rosa National Park, Costa Rica, from January to June 2002. We determined their ovarian cycling patterns by analyzing fecal ovarian hormones, and compared simultaneously collected behavioral data to determine which, if any, cues females use to signal their fertile phases. We found that four females cycled during the study period but ceased to cycle without becoming pregnant. We considered several explanations for the lack of conception during our study, including reproductive seasonality. We found that female C. capucinus showed only small increases in rates of affiliative/proceptive behaviors directed toward adult males during their periovulatory phases. The best indicator of cycle phase was a significant increase in male affiliative behaviors (e.g., following and grooming bouts) and sexual behaviors (e.g., copulations and courtship displays) directed toward females during the periovulatory phase compared to the nonovulatory phase. Our finding that females exhibit little proceptive behavior, but that copulations and male courtship are nonetheless concentrated in periovulatory phases suggests that even though females do not provide behavioral and morphological cues to ovulation, males are still able to detect it. Infanticide occurs with some frequency in these monkeys, and there is evidence for postconceptive mating as a female strategy to lower risk of infanticide via paternity confusion. However, despite this occurrence of nonconceptive mating and the absence of female cues to ovulation, truly concealed ovulation does not appear to be characteristic of this study population of white-faced capuchins.     

Effects of different methods of ovarian stimulation in adult rats

The in vitro fecundation programs normally use different ovarian stimulation agents. The purpose of the present study was to compare the effects of some of these agents on indices of ovulation and serum levels of estradiol, progesterone, and FSH. Treatments studied consisted of clomiphene citrate, PMSG alone and in combination with clomiphene citrate, pure human FSH and epimestrol. The data obtained show PMSG alone and PMSG plus clomiphene citrate to be the most effective treatments, in terms of number of oocytes harvested. No differences were noted between serum levels of oestradiol, progesterone and FSH.     

Behavioral, electrophysiologic and vegetative correlates of self stimulation in dogs]

Summary electrical activity of different brain structures (chiefly the hippocampal theta-rhythm) and cardiac and respiratory rhythms were recorded during self-stimulation (SS) in dogs. Emotional-motivational excitation in dogs, preceding SS, is attended with a moderate increase in theta-activity in the hippocampus. The SS period is characterized by desynchronization of the electrical activity, the appearance of high-frequency rhythmics and diminished theta-rhythm. After withdrawal of the pedal, hypersynchronization of the theta-rhythm sets in in most of the structures studied. SS is accompanied by considerable shifts of the cardiac and respiratory rhythms. The dynamics of behavioral, electrophysiological and vegetative shifts during SS in dogs points to a successive involvment of the brain mechanisms of search, positive reinforcement and emotional-negative interruption of the pedal pressing series. Complex interaction of the three mechanisms underlies the external phenomenology of the SS instrumental conditioned reflex.     

The Parkes lecture: controlled ovarian stimulation in women

Recent advances in knowledge of the endocrine and paracrine mechanisms that regulate human ovarian folliculogenesis have been parallelled by the introduction into clinical practice of new drugs that can be used safely and effectively to stimulate ovarian function in infertile women. Most notably, recombinant DNA technology has been applied to the production of molecularly pure forms of the gonadotrophins, FSH and LH, opening the way to the development of improved strategies for manipulating the ovarian paracrine system. The clinical objectives of controlled ovarian stimulation fall into two categories, depending on patient needs: (1) induction of multiple follicles from which mature oocytes can be harvested for use in assisted reproduction protocols such as in vitro fertilization and embryo transfer; or (2) induction of spontaneous ovulation of a single mature follicle so that conception might occur in vivo. This review summarizes the physiological principles upon which the use of gonadotrophins for clinical purposes is based, highlighting new opportunities for improved treatment as a result of the availability of recombinant FSH and LH.     

A controlled ovarian stimulation procedure suitable for cynomolgus macaques

This study aimed to develop a more suitable ovarian stimulation procedure for cynomolgus macaques (Macaca fascicularis). Macaques were divided into 4 groups, 7AG, 8AG, 7AN, and 8AN, according to the ovarian stimulation procedure administered (i.e., administration of either a gonadotropin-releasing hormone agonist [GnRH-a] or GnRH antagonist [GnRH-ant]) and the number of menstruations (≤ 7 times or ≥ 8 times) in the previous year. In both procedures, oocyte growth and maturation were induced by administration of human follicle-stimulating hormone and human chorionic gonadotropin. The mean numbers of metaphase II mature and metaphase I premature oocytes collected from the 7AG, 8AG, 7AN, and 8AN groups were 12.1 and 10.4, 12.0 and 13.8, 9.1 and 8.3, and 15.5 and 8.8, respectively (P>0.05). The fertilization rates of the 7AN and 8AN groups (85.3% and 74.7%) tended to be higher compared with those in the 7AG and 8AG groups (59.1% and 47.3%; P>0.05). The 8AN group yielded 19.9 zygotes, which was the largest number per macaque, compared with the other three groups. Furthermore, regarding the decreases in body weight between the start of the procedures and the time of oocyte collection, those of the 7AN and 8AN groups were significantly smaller than those of the 7AG and 8AG groups (P<0.05), suggesting that the procedure involving GnRH-ant reduced the burden on the macaques. Thus, controlled ovarian stimulation using a GnRH-ant has some advantages for cynomolgus macaques compared with that using a GnRH-a.