The role of progesterone elevation in IVF

Elevation of progesterone during the late follicular phase of stimulated in-vitro fertilization cycles is a frequent event, which negatively impacts the outcome. Over the years evidence has demonstrated a direct relationship between late-follicular elevated progesterone and endometrial receptivity. In this regard, elective cryopreservation of all good quality embryos and transfer in a subsequent frozen/thawed cycle is the most common strategy adopted by clinicians in case of elevated progesterone. Nonetheless, recent evidence suggests that elective cryopreservation might not entirely resolve the reduced pregnancy outcomes associated with the elevation of progesterone, considering that the increase may affect not only implantation, but also embryo quality.     

Megestrol acetate drives endometrial carcinoma cell senescence via interacting with progesterone receptor B/FOXO1 axis

Megestrol acetate is a common and efficient anticancer progesterone. To explore the activity and the therapeutic mechanisms of megestrol acetate in endometrial cancer, human endometrial cancer cell lines Ishikawa and HHUA overexpressing progesterone receptor A (PR-A) and progesterone receptor B (PR-B) were treated with megestrol acetate. Cell viability, apoptosis, cycle arrest, and senescence, as well as the expressions of p21 and p16, two hallmarks of cellular senescence, were evaluated. Compared with the control, >10 nmol/L megestrol acetate treatment could significantly reduce endometrial cancer cell growth, and induce the irreversible G1 arrest and cell senescence. The expression of cyclin D1 in megestrol acetate treated cells was downregulated, while the expressions of p21 and p16 were upregulated via PR-B isoform. FOXO1 inhibitor AS1842856 could significantly abrogate megestrol acetate-induced cell senescence, suggesting that FOXO1 was involved in megestrol acetate/PR-B axis. These findings may provide a new understanding for the treatment of human endometrial cancer.     

早泄的诊疗进展

早泄是男性常见的一种性功能障碍性疾病,属于射精障碍,在男性病中有着相对较高的发病率。早泄严重的影响着患者的生活质量和性生活质量,渐渐的引起患者自信心的缺失,还在一定程度上影响患者的夫妻感情和关系,最终导致患者出现焦虑、紧张、恐慌等症状。这些不良的精神状态最终影响着患者的家庭生活和工作质量等。针对早泄的发病原因,其治疗方法也是多种多样的,治疗效果也不统一,有着很大的差异,新的治疗方法也越来越多。因此对于早泄的治疗有着重要的意义。本文对早泄的治疗进行综述。     

Changes in progesterone levels and distribution of progesterone receptor during vitellogenesis in the female mud crab (Scylla paramamosain)

Vertebrate-type steroids, such as progesterone, have been identified in crustaceans. The physiological activity of progesterone during vitellogenesis is still not well understood. In this study, progesterone levels in the female mud crab, Scylla paramamosain, were determined by enzyme-linked immunosorbent assay. Peak levels of progesterone were detected during the previtellogenic stage in the hemolymph, ovary, and hepatopancreas, whereas the progesterone level decreased significantly in vitellogenic stage I. During vitellogenic stage II, progesterone levels rose again in the hemolymph and ovary, but continued to decrease in the hepatopancreas. By using western blotting, progesterone receptor (PR), with an apparent molecular weight of 70 kDa, was identified in the ovary during both vitellogenic stages I and II. By means of immunohistochemistry, PR was detected mainly in the follicle cells during vitellogenic stage I and in the nuclei of oocytes in vitellogenic stage II. Our results strongly suggest that progesterone promotes vitellogenesis in the mud crab, S. paramamosain via a classical genomic mechanism.     

辅酶Q10联合金凤丸对体外授精-胚胎移植患者卵巢功能及子宫内膜容受性的影响

目的:探讨辅酶Q10联合金凤丸对体外授精-胚胎移植患者卵巢功能及子宫内膜容受性的影响。方法:选择2017年7月～2017年10月接诊的185例体外授精-胚胎移植患者进行研究,通过随机数表法将其分为观察组(n=95)和对照组(n=90)。对照组采用金凤丸进行治疗,观察组在对照组的基础上加用辅酶Q10进行治疗。治疗后,比较两组血清卵泡刺激素(FSH)、促黄体生成素(LH)、睾酮(T)、雌二醇(E_2)、胰岛素(INS)、子宫内膜厚度、孕激素(P)水平、获卵数、受精率及妊娠率。结果:治疗后,两组患者血清FSH、LH、T、E_2、INS水平均较治疗前明显下降,且观察组以上指标水平均显著低于对照组(P0.05);两组患者子宫内膜厚度和血清P水平均较治疗前明显升高,且观察组以上指标均显著高于对照组(P0.05);两组患者获卵数无明显差异,观察组患者受精率、妊娠率均显著高于对照组(P0.05)。结论:辅酶Q10联合金凤丸可明显增加子宫内膜厚度,提高妊娠率。     

母亲声音刺激联合非营养性吸吮对早产儿经口喂养的影响

目的:探讨母亲声音刺激联合非营养性吸吮对早产儿经口喂养的影响。方法:选取2018年1月至2018年12月间在本院新生儿科病房住院早产儿(200例)作为研究对象,随机分为对照组(70例)、研究组A(65例)、研究组B(65例)。对照组按照新生儿科常规管理,研究组A在常规管理基础上给予单纯母亲声音刺激,研究组B在常规管理、单纯母亲声音刺激基础上,给予非营养性吸允管理。比较各组的喂养进程、喂养表现、体质量增长情况、喂养不耐受评分。结果:研究组A、研究组B的完全经口喂养时的纠正胎龄(PMA)、过渡时间均明显短于对照组,且研究组B均明显短于研究组A,差异均有统计学意义(P0.05);研究组A、研究组B的开始经口喂养时喂养效率、完全经口喂养时喂养效率均明显高于对照组,且研究组B均明显高于研究组A,差异均有统计学意义(P0.05);研究组A、研究组B的完全经口喂养时体质量、出院时体质量均明显低于对照组,且研究组B均明显低于研究组A,差异均有统计学意义(P0.05)。研究组B与对照组间的喂养不耐受评分情况差异有统计学意义(P0.05)。结论:母亲声音刺激联合非营养性吸吮可促进早产儿经口喂养进程,改善经口喂养表现,减少喂养不耐受发生率,加快恢复至出生体质量的时间。     

哺乳类动物妊娠晚期孕激素撤退的三种机制

内分泌激素是维持妊娠和启动分娩的重要因素。孕激素是静息子宫、维持妊娠的主要激素,而糖皮质激素、前列腺素和雌激素等激素则与分娩启动密切相关。孕激素水平的下降是很多哺乳类动物分娩启动的前提条件,然而有些哺乳类动物包括灵长类在整个妊娠过程包括分娩中均维持着高水平的孕激素,此现象令人费解。越来越多的证据表明,人类分娩启动时孕激素同样出现了撤退,但是发生在孕激素的受体水平,主要表现为孕激素受体亚型表达比值和孕激素受体转录辅助因子表达的改变。本文比较了人类和其它哺乳类动物分娩启动时孕激素撤退的三种模式,即黄体溶解、胎盘P450c17羟化酶上调和孕激素受体功能改变,旨在进一步阐明人类分娩启动机制,从而为防治早产提供新的思路。     

Steroid regulation of progesterone synthesis in a stable porcine granulosa cell line: a role for progestins

The objective of this investigation was to determine the effect of steroid hormones on the synthesis of progesterone in a stable porcine granulosa cell line, JC-410. We also examined the effect of steroid hormones on expression of the genes encoding the steroidogenic enzymes, cytochrome P450-cholesterol side chain cleavage (P450scc) and 3β-hydroxy-5-ene steroid dehydrogenase (3β-HSD). We observed that 48 h exposure of the JC-410 cells to estradiol-17β (estradiol), androstenedione, 5-dihydrotestosterone, levonorgestrel, and 5-cholesten-3β, 25-diol (25-hydroxycholesterol) resulted in stimulation of progesterone synthesis. 25-Hydroxycholesterol augmented progesterone synthesis stimulated by estradiol, 5-dihydrotestosterone, levonorgestrel and 8-bromoadenosine 3′:5′-cyclic monophosphate (8-Br-cAMP). This increase in progesterone synthesis was additive with estradiol, 5-dihydrotestosterone and levonorgestrel, and synergistic with 8-Br-cAMP. Cholera toxin, progesterone, levonorgestrel and androstenedione increased P450scc mRNA levels, whereas estradiol had no effect. Cholera toxin, progesterone and levonorgestrel increased 3β-HSD mRNA levels, but estradiol and androstenedione had no effect. The results were interpreted to mean that estrogens, androgens and progestins regulate progesterone synthesis in the JC-410 cells. The effect of androgens appears to be mediated by stimulation of P450scc gene expression while progestins stimulate both P450scc and 3β-HSD gene expression. Our results support the concept that progesterone is an autocrine regulator of its own synthesis in granulosa cells.     

Plasma membrane destination of the classical Xenopus laevis progesterone receptor accelerates progesterone-induced oocyte maturation

Xenopus laevis oocyte maturation is induced by the steroid hormone progesterone through a non-genomic mechanism initiated at the cell membrane. Recently, two Xenopus oocyte progesterone receptors have been cloned; one is the classical progesterone receptor (xPR-1) involved in genomic actions and the other a putative seven-transmembrane-G-protein-couple receptor. Both receptors are postulated to be mediating the steroid-induced maturation process in the frog oocyte. In this study, we tested the hypothesis that the classical progesterone receptor, associated to the oocyte plasma membrane, is participating in the reinitiation of the cell cycle. Addition of a myristoilation and palmytoilation signal at the amino terminus of xPR-1 (mp xPR-1), increased the amount of receptor associated to the oocyte plasma membrane and most importantly, significantly potentiated progesterone-induced oocyte maturation sensitivity. These findings suggest that the classical xPR-1, located at the plasma membrane, is mediating through a non-genomic mechanism, the reinitiation of the meiotic cell cycle in the X. laevis oocyte.     

早产病因及发病机制的研究现状

早产在妇产科临床上比较常见,其作为围生医学当中的一类重要而复杂的妊娠并发症,对早产儿的预后具有较大危害,严重时可能直接导致早产儿死亡。通常而言,早产患者的临床表现主要是子宫收缩,初期表现为不规律的宫缩,并伴有少量的阴道出血亦或是血性分泌物,进而发展成规律性的宫缩,此过程中宫颈管先发生消退,而后扩张。早产儿的体重大多数低于2500 g,且头围小于33 cm,部分胎儿的器官功能及适应能力与足月儿相比明显较差,常需给予特殊的处理。因此,及时梳理导致早产的原因并分析其发病机制,有利于早期掌握防治早产的基础要点。本文就此展开综述,以期为改善母婴妊娠结局提供理论支持。     

极具潜力的子宫内膜容受性形态学标志-胞饮突的研究进展

胞饮突是种植窗期在扫描电镜（Scanning electron microscopy,SEM）下子宫内膜上皮细胞膜顶端出现的大而平滑的膜突起。近年胞饮突被认为子宫内膜容受性的一个标志性结构,其功能可能是直接或间接参与囊胚与子宫内膜的黏附反应。本文就胞饮突的形态、功能及与其他子宫内膜容受性相关因子相互作用作一综述。     

Progesterone signals through membrane progesterone receptors (mPRs) in MDA-MB-468 and mPR-transfected MDA-MB-231 breast cancer cells which lack full-length and N-terminally truncated isoforms of the nuclear progesterone receptor

The functional characteristics of membrane progesterone receptors (mPRs) have been investigated using recombinant mPR proteins over-expressed in MDA-MB-231 breast cancer cells. Although these cells do not express the full-length progesterone receptor (PR), it is not known whether they express N-terminally truncated PR isoforms which could possibly account for some progesterone receptor functions attributed to mPRs. In the present study, the presence of N-terminally truncated PR isoforms was investigated in untransfected and mPR-transfected MDA-MB-231 cells, and in MDA-MB-468 breast cancer cells. PCR products were detected in PR-positive T47D Yb breast cancer cells using two sets of C-terminus PR primers, but not in untransfected and mPR-transfected MDA-MB-231 cells, nor in MDA-MB-468 cells. Western blot analysis using a C-terminal PR antibody, 2C11F1, showed the same distribution pattern for PR in these cell lines. Another C-terminal PR antibody, C-19, detected immunoreactive bands in all the cell lines, but also recognized α-actinin, indicating that the antibody is not specific for PR. High affinity progesterone receptor binding was identified on plasma membranes of MDA-MB-468 cells which was significantly decreased after treatment with siRNAs for mPRα and mPRβ. Plasma membranes of MDA-MB-468 cells showed very low binding affinity for the PR agonist, R5020, ≤1% that of progesterone, which is characteristic of mPRs. Progesterone treatment caused G protein activation and decreased production of cAMP in MDA-MB-468 cells, which is also characteristic of mPRs. The results indicate that the progestin receptor functions in these cell lines are mediated through mPRs and do not involve any N-terminally truncated PR isoforms.     

Effects of injury and progesterone treatment on progesterone receptor and progesterone binding protein 25-Dx expression in the rat spinal cord

Progesterone provides neuroprotection after spinal cord injury, but the molecular mechanisms involved in this effect are not completely understood. In this work, expression of two binding proteins for progesterone was studied in intact and injured rat spinal cord: the classical intracellular progesterone receptor (PR) and 25-Dx, a recently discovered progesterone membrane binding site. RT-PCR was employed to determine their relative mRNA levels, whereas cellular localization and relative protein levels were investigated by immunocytochemistry. We observed that spinal cord PR mRNA was not up-regulated by estrogen in contrast to what is observed in many brain areas and in the uterus, but was abundant as it amounted to a third of that measured in the estradiol-stimulated uterus. In male rats with complete spinal cord transection, levels of PR mRNA were significantly decreased, while those of 25-Dx mRNA remained unchanged with respect to control animals. When spinal cord-injured animals received progesterone treatment during 72 h, PR mRNA levels were not affected and remained low, whereas 25-Dx mRNA levels were significantly increased. Immunostaining of PR showed its intracellular localization in both neurons and glial cells, whereas 25-Dx immunoreactivity was localized to cell membranes of dorsal horn and central canal neurons. As the two binding proteins for progesterone differ with respect to their response to lesion, their regulation by progesterone, their cellular and subcellular localizations, their functions may differ under normal and pathological conditions. These observations point to a novel and potentially important role of the progesterone binding protein 25-Dx after injury of the nervous system and suggest that the neuroprotective effects of progesterone may not necessarily be mediated by the classical progesterone receptor but may involve distinct membrane binding sites.     

Effects of GnRH antagonist on endometrial protein profiles in the window of implantation

GnRH antagonists can suppress luteinizing hormone and follicle‐stimulating hormone (FSH), with less initial stimulatory effect and lower risk of ovarian hyperstimulation syndrome. The effects of GnRH antagonists on embryonic implantation remain controversial. To evaluate the effects of GnRH antagonists, endometrial tissues were biopsied from 12 women with intracytoplasmic sperm injection treatment, in which four subjects undergoing controlled ovulation stimulation with rFSH and GnRH antagonist, four subjects with a GnRH agonist long protocol, and four natural cycle controls. After iTRAQ quantification analysis, 24 proteins showed differential expression between natural cycle and agonist treatment group and 39 proteins between natural cycle and antagonist treatment group. A total of seven proteins demonstrated differential expression only in antagonist treatment group. Bioinformatic analysis implied these proteins can function in cell processes including angiogenesis, cell proliferation, apoptosis, cell migration, and immune response. Furthermore, GnRH antagonist suppressed the function of GNAS and ANPEP, which were important for endometrial functions. Immunohistochemical staining showed that ANPEP was mainly localized in the human endometrial stroma, while ACO2, CDC5L, and GNAS were mainly localized in the glands. This study could provide insights into the effect of GnRH antagonists on the endometrium, and help optimize the embryo implantation and improve the success rate for GnRH antagonist protocol.     

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.     

Talin1 regulates the endometrial epithelial cell adhesive capacity by interacting with LASP1 and Vitronectin

The endometrium is a highly complex tissue that is vulnerable to subtle gene expression changes and is the first point of contact for an implanting blastocyst. Talin1 has previously been identified to regulate cytoskeleton and cell motility, however it has not been investigated in association with infertility. Herein, we presented that Talin1 dysregulation in the missed abortion endometrium would negatively influence endometrial adhesive capacity. Mechanistically, intracellular Talin1 inhibited the nuclear transportation of LIM and SH3 protein 1 (LASP1) and restored the expression of adhesion-associated protein. Moreover, extracellular Talin1 enforces endometrial epithelial cell adhesive capacity by interacting with Vitronectin (VTN) and activating the FAK/Src/ERK signalling pathway. This finding provides a novel insight into the potential use of Talin1 for managing endometrial epithelia cell adhesion. This study represents the first demonstration of Talin1 function in endometrial epithelial cell adhesion and endometrial receptivity. Our findings indicate that re-expression of Talin1 might represent a useful strategy for preventing and treating early pregnancy failure and infertility.     

Effect of progesterone on embryo survival

Increased genetic selection over the past 40 years has resulted in a dairy cow with an improved biological efficiency for producing milk but with an associated reduced fertility. Embryo loss is the greatest factor contributing to the failure of a cow to conceive. The extent and timing of embryo loss indicates that 70% to 80% of this loss occurs in the first 2 weeks after artificial insemination (AI). This is the period when a number of critical phases in embryo development occur and where protein accretion, substrate utilization and embryo metabolism increase dramatically. During this time the early embryo is completely dependent on the oviduct and uterine environment for its survival and it is likely that the embryo requires an optimal uterine environment to ensure normal growth and viability. There is increasing evidence of an association between the concentration of systemic progesterone and early embryo loss and that progesterone supplementation of cows, particularly those with low progesterone, can reduce this loss. While progesterone is known to affect uterine function and embryo growth, little is known about the uterus during the period of early embryo loss and how this is affected by changes in the concentration of systemic progesterone. The expression of uterine genes encoding the transport protein retinol binding protein (RBP) and the gene for folate binding protein (FBP) appear to be sensitive to changes in systemic progesterone, particularly during the early luteal phase of the cycle. Uterine concentrations of proteins also seem to be regulated by stage of cycle; however, their relationship with the systemic concentration of progesterone is unclear. There is an urgent need to characterize the uterine environment from a functional perspective during the early part of the luteal phase of the cycle, particularly in the high-producing cow, in order to understand the factors contributing to early embryo loss and in order to devise strategies to minimize or reduce this loss.     

Decay-accelerating factor promotes endometrial cells proliferation and motility under ovarian hormone stimulation

The intent of the study was to explore the elevating expression of decay-accelerating factor(DAF) exerts influence on biological behaviors of endometrial stromal cells except in classical immunology on the basis of bioinformatic statistics and clinical miscarriages findings suggesting its potential role in the establishment of endometrial receptivity. We confirmed that DAF locates on the cellular surface of endometrial epithelium and stroma. By using plasmid transfection to down-regulate DAF expression in primary endometrial stromal cells(ESCs), we discovered that DAF expression in ESCs increases in response to estradiol and progesterone stimulation in dose- and time-dependent manners; moreover, tamoxifen and RU486 stimulations to block estrogen receptors(ERs) and progesterone receptors(PRs) respectively result in reduced DAF mRNA and protein, and it is more obvious to block PRs. Meanwhile, knocked-down DAF in ESCs weakens the proliferation, migration and invasion of endometrial cells. Cell cycle analysis showed knocked-down DAF accumulates cells in S phase and diminishes cells in G0/G1 phase, which substantiates DAF mediates endometrial cells proliferation. In conclusion, DAF is a potential molecule involving in endometrial cellular proliferation and motility to verify up-expressed DAF during the WOI may facilitate endometrial physiobiological behavior changes, which shed light on DAF function and potential role in the endometrial receptivity establishment.     

加味左归丸联合雌孕激素序贯治疗对早发性卵巢功能不全患者子宫动脉血流动力学、氧化应激和免疫因子的影响

摘要 目的：探讨加味左归丸联合雌孕激素序贯治疗对早发性卵巢功能不全（POI）患者子宫动脉血流动力学、氧化应激和免疫因子的影响。方法：纳入我院2019年10月-2021年10月期间收治的100例POI患者,按照随机数字表法分为对照组（雌孕激素序贯治疗,50例）和研究组（加味左归丸联合雌孕激素序贯治疗,50例）。对比两组中医证候积分、子宫动脉血流动力学、氧化应激指标、性激素指标和免疫因子指标。结果：两组治疗后月经周期、月经量、腰膝酸软、潮热盗汗、头晕耳鸣、阴道干涩、失眠多梦、五心烦热、性欲降低评分均下降,且研究组低于对照组（P<0.05）。两组治疗后子宫动脉收缩期峰值流速（Vmax）升高,搏动指数（PI）、阻力指数（RI）下降,且研究组的变化程度大于对照组（P<0.05）。两组治疗后血清丙二醛（MDA）下降,谷胱甘肽过氧化物酶（GSH-Px）、超氧化物歧化酶（SOD）升高,且研究组的变化程度大于对照组（P<0.05）。两组治疗后雌二醇（E2）升高,促黄体生成素（LH）、促卵泡生成激素（FSH）下降,且研究组的变化程度大于对照组（P<0.05）。两组治疗后NK细胞、CD8⁺下降,CD3⁺、CD4⁺、CD4⁺/CD8⁺升高,且研究组的变化程度大于对照组（P<0.05）。结论：加味左归丸联合雌孕激素序贯治疗POI患者,可有效改善子宫动脉血流动力学、性激素、氧化应激和免疫功能,促进患者恢复。