Auxological and biochemical evaluation of pubertal suppression with the GnRH agonist leuprolide acetate in early and precocious puberty

We studied the auxological effects of treatment with the GnRH agonist leuprolide acetate (Lucrin((R))) at 3.75 mg/ 28 days in 38 children with early or precocious puberty. We present our newly developed scoring system, the Puberty Suppression Score (PSS), in which clinical and biochemical parameters determine whether suppression was effective. Leuprolide acetate suppressed pubertal development in the majority of cases. During treatment there was a significant correlation between the number of times that PSS was >0 and gain in predicted adult height (PAH) compared to initial prediction at the start of treatment. After 6 months of treatment, ineffective suppression measured by PSS was associated with the magnitude of gain in PAH. We conclude that a leuprolide acetate dosage of 3.75 mg every 28 days effectively suppresses puberty. PSS is helpful in monitoring the suppressive capacity of a GnRH agonist. We recommend to start with leuprolide acetate at 3.75 mg/28 days and to increase the injection frequency or dose in case PSS is >0 after 6 months of treatment.     

Use of GnRH agonist implants for long-term suppression of fertility in extensively managed heifers and cows

The ability of gonadotrophin releasing hormone (GnRH) agonist implants to suppress ovarian activity and prevent pregnancies, long-term, was examined in heifers and cows maintained under extensive management. At three cattle stations, heifers (2-year-old) and older cows (3- to 16-year-old) were assigned to a control group that received no treatment, or were treated with high-dose (12 mg, Station A) or low-dose (8 mg, Station B and Station C) GnRH agonist implants. The respective numbers of control and GnRH agonist-treated animals (heifers + cows) at each station were: Station A, 20 and 99; Station B, 19 and 89; Station C, 20 and 76. Animals were maintained with 4% bulls and monitored for pregnancy at 2-monthly intervals for approximately 12 months. Pregnancy rates for control heifers and control cows ranged from 60-90% and 80-100%, respectively, depending on the study site. The respective number of animals (heifers + cows) treated with GnRH agonist that conceived, and days to first conception, were: Station A, 9 (9%) and 336 +/- 3 days; Station B, 8 (10%) and 244 +/- 13 days; Station C, 20 (26%) and 231 +/- 3 days. Treatment with high-dose GnRH agonist prevented pregnancies for longer (approximately 300 days) than treatment with low-dose GnRH agonist (approximately 200 days). In the majority of heifers and cows treated with GnRH agonist, ovarian follicular growth was restricted to early antral follicles (2-4mm). The findings indicate that GnRH agonist implants have considerable potential as a practical technology to suppress ovarian activity and control reproduction in female cattle maintained in extensive rangelands environments. The technology also has broader applications in diverse cattle production systems.     

Long-term suppression of fertility in female giraffe using the GnRH agonist deslorelin as a long-acting implant

Zoological institutions provide an environment conducive to studying proximate mechanisms influencing reproduction that can provide guidance to both field and captive settings seeking to manage their stock. Both national parks and zoos have space limitations that sometimes require the use of reversible contraception in order to reduce reproductive rate or limit specific individuals from reproducing. We designed a study to test the efficacy of a long-lasting contraceptive in female giraffe by monitoring reproductive endocrinology and behavior. We implanted two animals with the GnRH agonist deslorelin and monitored their endocrine status using fecal steroid analysis. We have previously validated an assay for fecal pregnanes and here we report our validation for fecal estrogens. Both sex steroid concentrations were suppressed in two females, although one female exhibited an immediate post-implantation positive feedback response. Sexual activity nearly disappeared in one animal, whereas the other showed regular sexual behavior. The contraceptive effect lasted for at least 472 d, and successfully suppressed estrous cyclicity in one female for >2 y. We conclude that deslorelin implants provide a minimally invasive means for long-term suppression of reproduction in female giraffe.     

Effects of TAP-144-SR, a sustained-release formulation of a potent GnRH agonist, on experimental endometriosis in the rat

A new, simple experimental endometriosis model was established by auto-transplanting endometrial tissue fragments beneath kidney capsules in female rats. The transplanted endometrial tissue grew well, forming a fluid-filled cyst, which reached maximal size 2 to 3 weeks after transplantation. The growth and maintenance of the transplants was dependent on the ovary: ovariectomy induced regression of well grown transplants. The therapeutic effects of TAP-144-SR (biodegradable microcapsules of copoly (DL-lactic/glycolic acid) copolymer containing a potent GnRH agonist, TAP-144 (D-Leu6-[des-Gly10-NH2]-GnRH ethylamide, leuprolide acetate) were studied with this rat endometriosis model. A single sc injection of TAP-144-SR (corresponding to 1, 10 or 100 micrograms/kg/day of TAP-144), suppressed the growth of the transplanted endometrial tissues and uterine weight in a dose-dependent manner. At 100 micrograms/kg/day, the suppressive effect was more marked in rats given TAP-144-SR than in those given TAP-144 solution. The extent of suppression was comparable to that caused by ovariectomy. Serum and pituitary concentrations of LH and FSH were also reduced more markedly by the administration of TAP-144-SR than by TAP-144 solution. From these results, the present endometriosis model was found to be useful for the evaluation of compounds with potential therapeutic activity. The sustained-release formulation of TAP-144 seems to be beneficial over its solution in terms of both convenience and efficiency for therapy of patients with endometriosis.     

Danazol versus [d-Trp6]GnRH agonist for the management of infertility due to atypical endometriosis

Summary The aim of this study is to assess the impact of atypical endometriosis on fertility as well as the effect of treatment in endometriosis-related infertility. A prospective randomized study comparing the effects of triptorelin (Arvekap, Ipsen) and danazol (Danatrol, Winthrop) was completed recently. The 103 patients (aged 30.9±4.92, range 21–41) who finished the study were divided into three comparable (infertility duration, age) groups. Group A (n=37) received danazol (600 mg/day) for 6 months, Group B (n=32) received triptorelin (3.75 mg) injections, one every 28 days for 6 months, and Group C (n=34) did not receive any kind of treatment. More pregnancies were observed in Group B (65.62%) compared with Group C (20.58%, p=0.00012) but not compared with Group A (54.05%, p=0.05857). The overall monthly fecundity rate in Group B was 0.11, and differences concerning spontaneous abortion rates were not observed. Our results indicate that danazol and triptorelin are equally effective in the treatment of atypical endometriosis-related infertility.     

Ovarian follicular response of mares to GnRH agonist (leuprolide acetate) treatment after pituitary suppression

Follicular growth and ovulation were monitored in 18 horse mares during a control cycle and during a cycle in which the mares received a GnRH agonist, leuprolide acetate (LA; 200 or 400 mug), twice daily until ovulation. Prior to both of these cycles, follicular growth was suppressed using a 10-day estrogen-progesterone treatment regimen, with prostaglandin F-2alpha (10 mg) administered on Day 10. Four of the mares treated with LA remained anovulatory for at least 3 weeks after the end of treatment and were excluded from statistical analysis. The dosage of LA did not affect response. Treatment with LA significantly (P=0.0375) increased the percentage of large follicles per ovulation (i.e., follicles greater than 30 mm in diameter on the day on which the largest follicle reached 35 mm) and also increased (P=0.0539) the diameter of the second largest follicle. However LA did not significantly alter the number of ovulations. Mean daily concentrations of luteinizing hormone (LH) were not significantly different during treatment and control cycles. The LH in blood samples collected repeatedly on Day 19 after the start of estrogen-progesterone treatment did not show a difference in frequency or amplitude of pulses between treatment and control cycles. Mares were artificially inseminated during estrus and the embryos were recovered. Fewer embryos were recovered per ovulation from mares after treatment with LA (26%) than during the control cycle (64%). Results indicate that treatment with LA either suppressed follicular activity or induced multiple follicular growth.     

Reversible suppression of pituitary-testicular function by a sustained-release formulation of a GnRH agonist (leuprolide acetate) in dogs

Pituitary-testicular function was studied in 15 dogs following treatment with a sustained-release formulation of a GnRH agonist, leuprolide acetate (LA). Adult male dogs were treated with a single subcutaneous injection of microencapsulated LA (0.1 or 1 mg/kg). Treatment with LA at a dose of 1 mg/kg resulted in decreased (P<0.001) ejaculatory volume and disappearance of morphologically normal spermatozoa within 8 wk and the effect persisted for 6 wk, while the 0.1 mg/kg dose was not adequate to effect suppression of spermatogenesis. The larger dose treatment (1 mg/kg) caused a transient rise in plasma levels of LH and testosterone followed by a marked decline to below the normal level by 2 wk, the low levels being maintained for at least 5 wk, indicating a prolonged effect of LA treatment on pituitary-gonadal axis. Twenty weeks after treatment with LA, a complete return to normal spermatogenesis was observed. The full reversibility of spermatogenesis in the dog after LA treatment suggests that this peptide could be used as a reversible method of male contraception.     

Intracellular pathways of receptor-bound GnRH agonist in pituitary gonadotropes

Summary Localization of GnRH receptors in rat pituitary gonadotropes was studied by use of ¹²⁵I-[azidobenzoyl-D-Lys⁶]GnRH which, upon photolysis, is covalently bound to the receptor molecule. Using high resolution autoradiography, it was found that, after a 90-min incubation of the analog with pituitary cells at 4° C, 93% of the silver grains were associated with the plasma membrane of the gonadotropes. After 45-min incubation of the cells at 37° C, clustering and internalization of the receptor-bound GnRH analog were evident. Silver grains were associated with coated pits, intracellular vesicles, Golgi complexes, lysosome-like structures and secretory granules. The data indicate that receptor-bound GnRH agonist is internalized, at least in part, via coated pits and is subsequently routed to lysosomes where degradation of the hormone-receptor complex may occur. The presence of a considerable amount of silver grains associated with secretory granules may suggest that some of the internalized receptor molecules can escape degradation and be recycled to the cell membrane.     

Ovarian follicular growth suppression by long-term treatment with a GnRH agonist and impact on small follicle number,oocyte yield,and in vitro embryo production in Zebu beef cows

The aim of the present study was to evaluate small follicle number, oocyte yield, and in vitro embryo production (IVEP) in Zebu beef cows treated long term with a GnRH agonist to suppress ovarian follicular growth. Nelore (Bos indicus) cows (n = 20) showing regular estrous cycles were randomly assigned to one of two groups: control (n = 10, placebo ear implant without a GnRH agonist); GnRH agonist (n = 10, GnRH agonist ear implant containing 9.4-mg deslorelin). All cows underwent an ovum pick-up (OPU) session 14 days (Day 14) before the start of treatments (Day 0) followed by seven OPU–IVEP procedures at 30-day intervals (Days 0, 30, 60, 90, 120, 150, and 180). Semen from a single batch of a previously tested bull was used for all the IVEP. Cows treated with agonist reported a decrease over time in the proportion of animals with a (CL; P ≤ 0.05) and large follicles (>10 mm, P ≤ 0.05). These cows had a lesser number of medium + large follicles (>5 mm; 1.74 ± 0.5 vs. 4.13 ± 0.5; P ≤ 0.05), greater number of small follicles (2–5 mm; 44.3 ± 2.8 vs. 30.8 ± 1.8; P ≤ 0.05), greater yield of cumulus-oocyte complexes (COCs; 21.0 ± 2.3 vs. 15.6 ± 1.9; P ≤ 0.05), greater proportion of COCs cultured (79.2 vs. 73.9%; P ≤ 0.05), COCs cleaved (10.6 ± 1.5 vs. 6.8 ± 1.1, P ≤ 0.05), and cleaved rate (52.8 vs. 44.3%; P ≤ 0.05) compared with control cows. The number (3.4 ± 0.7 vs. 3.0 ± 0.6; P > 0.05) and proportion (16.5 vs. 19.1%; P > 0.05) of blastocysts produced were similar between agonist and control cows, respectively. The study has shown that Zebu beef cows treated long term with a GnRH agonist had follicular growth restricted to small follicles. This did not compromise the ability of oocytes to undergo IVF and embryonic development.     

Eicosanoids production in endometriosis

In order to investigate the production of eicosanoids in human endometrium, myometrium, leiomyoma, adenomyosis, normal ovary, non-endometrial cyst and endometrial cyst, slices of each tissue were incubated. 6-Keto-prostaglandin (PG) F1 alpha, thromboxane (TX) B2, PGF2 alpha and PGE2 concentrations in the incubation medium were measured by direct RIA. 6-Keto-PGF1 alpha production of adenomyosis was significantly higher than that of endometrium, myometrium and leiomyoma, especially in the menstrual phase. The production of eicosanoids in endometrial cyst was significantly higher than that of non-endometrial cyst and normal ovary. These results suggest that endometriosis is associated with increased eicosanoid production in vivo.     

Suppression of puberty in girls with short-acting intranasal versus subcutaneous depot GnRH agonist

BACKGROUND/AIM: Central precocious puberty (CPP) is more common in females than in males. During the last few decades a new group of patients with CPP has been seen frequently in Northern Europe, namely children adopted from developing countries. GnRH analogue preparations, administered either as intranasal spray or as depot preparations, are the drugs of choice for inhibiting the release of gonadotropins. The aim of this study was to compare the effect of buserelin given by intranasal spray with that of the same compound given as a subcutaneous depot preparation. METHODS: The study group comprised 46 pubertal girls below the age of 9.5 years, adopted from a developing country. During the first 2 years, the treatment used was buserelin acetate 300 microg 6 times daily as a nasal spray. During the third year the treatment was changed to Suprefact Depot, 6.3 mg, given as a subcutaneous implant every 8 weeks. Half of the girls were randomized to growth hormone treatment in addition to the pubertal inhibition. RESULTS: GnRH provocation tests after 6 weeks, 1 year and 2 years of treatment with intranasal GnRH analogue showed suppression of gonadotropin secretion except in 1 case of noncompliance. During the third year, when the long-acting depot preparation was used, suppression was more pronounced. The peak LH response, especially, was considerably lower than during treatment with the nasal spray preparation. In all cases the clinical inhibition of puberty was adequate both during the first two years and during the third year. CONCLUSION: Even though the clinical suppression of puberty was adequate with both modes of administration, the effect of the depot preparation, in this study Suprefact Depot, was more pronounced in terms of gonadotropin suppression and less dependent on patient compliance.     

Villainous role of estrogen in macrophage-nerve interaction in endometriosis

Endometriosis is a complex and heterogeneous disorder with unknown etiology. Dysregulation of macrophages and innervation are important factors influencing the pathogenesis of endometriosis-associated pain. It is known to be an estrogen-dependent disease, estrogen can promote secretion of chemokines from peripheral nerves, enhancing the recruitment and polarization of macrophages in endometriotic tissue. Macrophages have a role in the expression of multiple nerve growth factors (NGF), which mediates the imbalance of neurogenesis in an estrogen-dependent manner. Under the influence of estrogen, co-existence of macrophages and nerves induces an innovative neuro-immune communication. Persistent stimulation by inflammatory cytokines from macrophages on nociceptors of peripheral nerves aggravates neuroinflammation through the release of inflammatory neurotransmitters. This neuro-immune interaction regulated by estrogen sensitizes peripheral nerves, leading to neuropathic pain in endometriosis. The aim of this review is to highlight the significance of estrogen in the interaction between macrophages and nerve fibers, and to suggest a potentially valuable therapeutic target for endometriosis-associated pain.     

Intranasal treatment with luteinising hormone releasing hormone agonist in women with endometriosis.

An agonist analogue of luteinising hormone releasing hormone (buserelin) was successfully used to treat women with endometriosis. A dose of 200 micrograms administered intranasally thrice daily was found to be effective in five patients, in whom the endometriotic lesions resolved after six months'' treatment. Failure occurred in a sixth patient, who received only 400 micrograms once daily. Anovulation was induced in all subjects together with suppression of menstruation after the first month of treatment. Symptoms of abdominal pain, dysmenorrhoea, and dyspareunia were relieved during treatment, and one previously infertile patient conceived within two months of stopping treatment. No side effects were reported with this dosage, and the results suggest a new form of treatment for patients with endometriosis.     

Sustained impairment of pituitary and testicular function in prostatic cancer patients treated with a depot form of a GnRH agonist

Seven patients suffering from prostatic cancer were treated with a slow-release D-Trp-6-LHRH preparation for a period of 24-32 months. LH, FSH, PRL and testosterone levels were evaluated before and at the end of treatment and then 40 days later. Baseline and GnRH-, TRH-, and HCG-stimulated hormonal values decreased after treatment. The possibility that a long-term treatment with GnRH analogues induces a sustained suppression of pituitary and testicular function is suggested.     

Case studies in antelope aggression control using a GnRH agonist

Maintaining surplus captive male antelope in bachelor groups can result in aggression in some species, leading to injury or death. Suppressing endogenous testosterone using gonadotropin‐releasing hormone (GnRH) analogs has been used in primates to control aggressive behavior, but little information is available on the use of GnRH analogs in nondomestic ruminant species. The aim of this study was to investigate the effect of a slow‐release GnRH agonist (deslorelin) on circulating hormone concentrations, semen and sperm characteristics and behavior in male gerenuk, dorcas gazelle, and scimitar horned oryx. Body weight, testicular volume, circulating hormone concentrations, ejaculate traits, and behavior were recorded before and during deslorelin treatment. A GnRH challenge (with serial blood sampling) was administered to gerenuk and dorcas gazelles before and during GnRH analog treatment. Quantitative behavioral data were collected for gerenuk and dorcas gazelles for 30 min three times a week, starting 1 month before deslorelin treatment, and the mean incidence of combined aggressive behaviors (supplanting, foreleg kicking, sparring, marking, and mounting) was compared before and during deslorelin treatment. No statistical difference (P>0.05) in body weight, semen volume, sperm concentration, percent sperm motility, percent sperm plasma membrane integrity, or percent normal sperm morphology was found before or during deslorelin treatment. The characteristic rise in luteinizing hormone (LH), occurring ～10 min following administration of a GnRH challenge in untreated males, was not evident during deslorelin treatment, although tonic LH concentrations were maintained. No differences (P>0.05) in the mean incidence of any aggressive behavioral traits in gerenuk or dorcas gazelle were detected before and during deslorelin. The absence of a GnRH‐induced increase in serum LH in treated males indicated that deslorelin suppressed pituitary responsiveness to endogenous GnRH, but that the continued tonic production of LH was sufficient to maintain testosterone production, aggressive behavior, and subsequent semen production. Zoo Biol 21:435–448, 2002. © 2002 Wiley‐Liss, Inc.     

Temporary suppression of pulsatile LH release following a single injection of a GnRH agonist (deslorelin) in ovariectomised Holstein dairy cows

The objective of the experiment was to investigate the potential for using a single injection of the GnRH agonist [D-Trp(6), Pro(9)-des-Gly(10)-NH(2)] GnRH-ethylamide (deslorelin) to suppress LH secretion in ovariectomised Holstein cows. Each dose of 10, 100 and 1000 microg deslorelin was injected intravenously into each of four ovariectomised cows on day 0. Blood samples were collected hourly on day 0 to profile the induced LH release. Frequent serial blood samples were collected at 10min intervals over 4h on days -3, -1, +2, +4 and +6. The injection of deslorelin induced a surge-like release of LH that begun within 1h in all cows. There was no difference between deslorelin doses in terms of maximum LH concentration, area under the LH curve (AUC) or log(10)(AUC). The average interval from injection to maximum LH concentration was longer for cows receiving 1000 microg than in those receiving 10 microg (3.5 versus 1.5h; P<0.01), though no different to 100 microg (2.8h; P>0.1). This relationship was described by a logarithmic function of deslorelin dose in micrograms (R(2)=73.3%, P<0.01). Pre-treatment smoothed mean LH concentration was significantly correlated with peak LH concentration of the induced surge: max_LH=5.37+9.57 x pre-amplitude (R(2)=33.2%, P=0.05). Similarly, LH pulse amplitude pre-deslorelin was also correlated with peak LH of the induced surge max_LH=0.07+12.9 x pre-amplitude (R(2)=53.7%, P=0.07). Pulsatile release of LH was suppressed only with the 1000 microg dose on day +2. Suppression was characterised by a reduction in mean LH, smoothed mean LH and LH pulse amplitude. By day +4, LH parameters were no different to pre-treatment ones. Pulse frequency was not affected by the treatment, although a small non-significant reduction at day +2 for 1000 microg dose was observed (3.9 versus 2.8, P=0.14). In conclusion, temporary suppression of LH output for at least 48h occurred following a single intravenous injection of 1000 microg of deslorelin, even though there were similar peak LH concentrations were for the three doses.