The biological basis of the menopause

Age-related changes occur throughout the reproductive lifespan of normal healthy women. From the age of 20, the menstrual interval gradually shortens and becomes increasingly regular until the perimenopause. This is related to a shortening of the follicular rather than the luteal phase of the cycle. Serum FSH concentration is elevated during the follicular phase in older women who are still menstruating regularly, while serum inhibin levels are decreased in both the follicular and luteal phases. The relationship between FSH secretion, ageing and feedback inhibition by oestradiol, inhibin, or other presently unmeasured factors in women with regular menses, remains to be elucidated. The primary factor influencing the transition from regular menses to the perimenopause and subsequent menopause appears to be the size of the residual primordial follicle pool. Fecundability begins to decline by the age of 29 years. There is considerable evidence from the experience gained in assisted fertilization procedures that this is related to the effect of age on the quality of the oocyte rather than on the endometrium. At the time of the last menses, few follicles remain. There are no endocrine markers to signal the last cycle. Hence, menopause can only be identified retrospectively when there is no further menses. The probability of being menopausal increases with the duration of amenorrhea and age. Considerable evidence suggests that both serum FSH and serum inhibin are biomarkers of the number and/or quality of follicles remaining in the ovary. There is also evidence that the age of menopause, itself, is a potent biomarker of the general ageing state of the individual.

Protein synthesis at the blood-brain barrier. The major protein secreted by amphibian choroid plexus is a lipocalin

Among the proteins secreted by choroid plexus of vertebrates, one protein is much more abundant than all others. In mammals, birds, and reptiles this protein is transthyretin, a tetramer of identical 15-kDa subunits. In this study choroid plexus from frogs, tadpoles, and toads incubated in vitro were found to synthesize and secrete one predominant protein. However, this consisted of one single 20-kDa polypeptide chain. It was expressed throughout amphibian metamorphosis. Part of its amino acid sequence was determined and used for construction of oligonucleotides for polymerase chain reaction. The amplified DNA was used to screen a toad choroid plexus cDNA library. Full-length cDNA clones were isolated and sequenced. The derived amino acid sequence for the encoded protein was 183 amino acids long, including a 20-amino acid presegment. The calculated molecular weight of the mature protein was 18,500. Sequence comparison with other proteins showed that the protein belonged to the lipocalin superfamily. Its expression was highest in choroid plexus, much lower in other brain areas, and absent from liver. Since no transthyretin was detected in proteins secreted from amphibian choroid plexus, abundant synthesis and secretion of transthyretin in choroid plexus must have evolved only after the stage of the amphibians.

Accelerated disappearance of ovarian follicles in mid-life: implications for forecasting menopause

Menopause is triggered by the number of ovarian follicles falling below a threshold number and is irreversible because oogonial stem cells disappear after birth. Since it is the result of programmed disappearance of a limited store of follicles, menopause can be predicted using mathematical models based on total follicle counts at different ages. Our model shows follicle numbers decline bi-exponentially rather than as a simple exponential function of age, as had been assumed, with a first exponential rate parameter of -0.097 and a second of -0.237. The change occurred when numbers had fallen to the critical figure of 25,000 at age 37.5 years. The unexpectedly faster rate of ovarian ageing afterwards lowers the follicle population to 1000 at approximately 51 years, and was adopted as the menopausal threshold because it corresponds to the median age of menopause in the general population. Had the earlier rate persisted menopause would not be expected until 71 years. The impact of step reductions of follicle numbers on the prospective span of menstrual life was predicted by the model. A reduction by 50% before age 30 years resulted in the threshold being reached at 44 years and 0.6 year later for every subsequent year until age 37.5 years after which it is reached at 48 years. A reduction of 90% in childhood before age 14 years could result in menopause as early as 27 years, with increments of 0.6 year per year afterwards until after 37.5 years when it is expected at age 41 years.(ABSTRACT TRUNCATED AT 250 WORDS)

Purification and analysis of proteinase-resistant mutants of recombinant platelet-derived growth factor-BB exhibiting improved biological activity

Recombinant platelet-derived growth factor (PDGF)-BB was expressed and secreted from yeast in order to study the structure-function relationships of this mitogen. A simple purification scheme has been developed which yields greater than 95% pure PDGF-BB. Analysis of this recombinant PDGF-BB shows partial proteolysis after arginine-32. Substitution of this arginine residue, or arginine-28 [a potential KEX2 (lysine-arginine endopeptidase) cleavage site], prevents or reduces cleavage of PDGF-BB respectively. These mutations result in a 5-fold increase in expression levels of PDGF-BB, and the resulting mutant proteins show higher activity in a number of biological assays than the cleaved wildtype PDGF-BB. These data are in accord with previous work by Giese, LaRochelle, May-Siroff, Robbins & Aaronson [(1990) Mol. Cell Biol. 10, 5496-5501] suggesting that the region isoleucine-25-phenylalanine-37 is involved in PDGF-receptor binding.

Isolation, characterization, cDNA cloning and gene expression of an avian transthyretin. Implications for the evolution of structure and function of transthyretin in vertebrates

A chicken liver cDNA library was constructed in bacteriophage lambda gt10. A full-length transthyretin cDNA clone was identified by screening with rat transthyretin cDNA and was sequenced. A three-dimensional model of chicken transthyretin was obtained by computer-graphics-based prediction from the derived amino acid sequence for chicken transthyretin and from the structure of human transthyretin determined by X-ray diffraction analysis [Blake, C.C.F., Geisow, M.J., Oatley, S.J., Rérat, B. & Rérat, C. (1978) J. Mol. Biol. 121, 339-356]. The similarity of the amino acid sequences of chicken and human transthyretins was 75% overall and 100% for the central channel containing the thyroxine-binding site. Also, the organization of the transthyretin gene into exons and introns and the tissue specificity of expression of the transthyretin gene were similar in chicken and mammals, despite an evolutionary distance of about 3 x 10(8) years from their common ancestor, the Cotylosaurus. By far the highest levels of transthyretin mRNA were found in choroid plexus. The data suggest a fundamental role for the cerebral expression of transthyretin in all vertebrates. It has been proposed that this role is the transport of thyroxine from the bloodstream to the brain [Schreiber, G., Aldred, A.R., Jaworowski, A., Nilsson, C., Achen, M.G. & Segal, M.B. (1990) Am. J. Physiol. 258, R338-R345].

Transthyretin (prealbumin) gene expression in choroid plexus is strongly conserved during evolution of vertebrates

1. The major protein synthesized and secreted by the choroid plexus from mammals, birds, reptiles and probably amphibians is similar in subunit structure to transthyretin. 2. In mammals and birds the proportion of transthyretin mRNA is much higher in choroid plexus RNA than in liver RNA. No transthyretin mRNA is found in brain outside the choroid plexus. 3. Transthyretin-like protein, such as that secreted by the choroid plexus, was not detected in amphibian serum and was present in very low levels in reptile serum. 4. It is proposed that transthyretin synthesis and secretion arose earlier in evolution in the choroid plexus than in the liver.

Follicular depletion during the menopausal transition

From mid-fetal life, the human ovary steadily loses follicles. While age-related alterations at the level of the hypothalamus-pituitary appear to determine the timing of menarche, the number of follicles remaining in the mature ovary is the major determinant of the timing of both the perimenopause and the menopause. As the residual follicle reserve nears exhaustion, some of the remaining follicles appear to be defective, as evidenced by the higher incidence of chromosomal abnormalities in the ova of older women. It is presently not possible, however, to distinguish the specific contribution of the ovum to the age-related decrease in fecundity and higher abortion rate because of such confounding variables as aging sperm or changes in the endometrium. When follicle counts from peri- and postmenopausal ovaries are placed with those from previous studies of younger women and children there appears to be an acceleration in the rate of follicle loss in the decade preceding menopause. We hypothesize that the elevated FSH levels observed in normal women in the decade preceding the menopause may be responsible for this apparent acceleration in the rate of follicle loss.

Identification of factors limiting the accurate measurement of plasma D-penicillamine in rheumatoid arthritis patients

Free and total reduced concentrations of D-penicillamine have been measured in the plasma of rheumatoid arthritis patients by HPLC and electro-chemical detection. A reverse-phase ion-pair separation in conjunction with a dual porous graphite electrode satisfied the requirements of robustness, sensitivity, selectivity and suitable retention time. Plasma levels measured between 1.5 and 3 h after an oral dose, were less than 0.3 to 57.6 mumol/L and 0.6 to 85.0 mumol/L (n = 26) for free and total reduced drug concentrations, respectively. Sources of error in the accurate measurement of peak plasma D-penicillamine levels were identified as oxidative loss and alteration in the free to protein-bound ratio in the period following sample collection.

Follicular depletion during the menopausal transition: evidence for accelerated loss and ultimate exhaustion

Although the menopause is generally considered to be the consequence of follicular exhaustion, the relationship between follicle number and the menopausal transition has not been explicity studied. We addressed this question in 17 women, aged 45-55 yr, who were undergoing elective total abdominal hysterectomy and salpingo-oophorectomy. The women were divided into 3 groups according to their menstrual history: 1) menstruating regularly (n = 6), 2) perimenopausal (irregular menses; n = 7), and 3) postmenopausal (greater than 1 yr since last menses; n = 4). The mean ages of the 3 groups were similar. Menstrual histories were confirmed by plasma hormone levels and endometrial histology. One ovary from each woman was serially sectioned for determination of follicle numbers. The mean number of primordial follicles in the ovaries of women who were still menstruating regularly was 10-fold higher than that in perimenopausal women [1392 +/- 355 (+/- SEM) vs. 142 +/- 72]. Follicles were virtually absent in the postmenopausal ovaries. Comparison of these data with those obtained by others in younger women suggests that follicular depletion accelerates dramatically in the last decade of menstrual life. These results support the view that declining follicular reserve is the immediate cause of both the perimenopausal and menopausal transitions, and indicate that the rate and, therefore, the regulation of follicular depletion change during the final phase of reproductive life.

Tubo-cornual polyps: their relevance in subfertility

One-hundred-and-seventy-four patients having hysterosalpingographs during the investigation of infertility have been reviewed to assess the incidence of tubo-cornual polyps and their relation to subsequent pregnancy. Definite polyps were present in 31 (18%) of the patients. There was no significant difference in age or parity in women with and without polyps, nor in associated infertility factors such as tubal occlusion or oligospermia. None of the patients with polyps had endometriosis. Conception rates in the two groups were not significantly different. The cumulative rates at 18 months with and without polyps were 34.5 +/- 13.7% (SE) and 43.6% +/- 3.9% respectively in the overall groups, and 36.9% +/- 24.1% and 59.0% +/- 9.1% in the couples with otherwise unexplained infertility. It is concluded that tubo-cornual polyps are not related to infertility and that they should not be treated.

Structural requirements of thiol compounds in the inhibition of human liver iodothyronine 5'-deiodinase

2-Thiouracil and a number of its alkyl derivatives are known to inhibit the enzymic 5'-deodination of thyroxine to 3,5,3'-tri-iodothyronine. The structural requirements for inhibition of iodothyronine 5'-deiodinase were investigated by using a washed postmitochondrial particulate fraction of human liver. A series of sulphur-containing derivatives of pyrimidine, pyridine, imidazole, benzene and urea, capable of existing in a thiol form, were incubated at several concentrations with the enzyme preparation in the presence of thyroxine and dithioerythritol (cofactor). The degree of inhibition by the respective compounds of the production of 3,5,3'-tri-iodothyronine was studied in relation to their structural features. The major observations were: (i) a free thiol group is essential; (ii) compounds that do not possess a polar hydrogen atom spatially configured so that it is proximal to the thiol group are poor inhibitors; (iii) aromatic characteristics in the presence of requirements (i) and (ii) lead to the expression of potent inhibitory properties; (iv) modification of potent inhibitors by the introduction of hydrophilic substituents reduces the inhibitory potency.

A potential systematic error in using lysivane as inhibitor in the measurement of amniotic fluid acetylcholinesterase by the Ellman method

The measurement of low levels of cholinesterase or acetylcholinesterase by the Ellman method requires correction for a non-enzymatic increase in absorption at 412 millimicron that is due both to non-enzymatic hydrolysis of the acetylthiocholine substrate and to modification of the colour reagent. The rate of increase in absorption is dependent on temperature and pH. Addition of an acidic solution of lysivane to the assay solution for selective measurement of amniotic fluid acetylcholinesterase gives rise to a shift in pH; the use of methanol is suggested as an easier method of dissolving the inhibitor and does not affect the pH of the assay, obviating any need to redetermine the background absorption. There is, however, no improvement in ability of the method to predict pregnancies associated with neural-tube defects.

Particulate acetylcholinesterase in amniotic fluid and its implications for neural tube defect screening

Acetylcholinesterase activity in mid-trimester amniotic fluid has been determined by a quantitative spectrophotometric method and a qualitative electrophoretic technique in a limited (76 samples) retrospective study. Differential centrifugation studies on amniotic fluid from normal pregnancies demonstrated the presence of particle-associated acetylcholinesterase sedimenting only at relatively high centrifugal forces. It is postulated that this particle-associated activity was a contributory factor to an observed false-positive incidence of 6.6% when quantitative acetylcholinesterase measurement was used to discriminate between normal pregnancies and those associated with neural tube defects. Discrimination on the basis of electrophoretic analysis of acetylcholinesterase resulted in no misclassification of pregnancies. Particulate acetylcholinesterase would not be expected to influence the interpretation of the electrophoretic pattern due to its size-related exclusion from gel pores. The implication of these observations in the accurate prenatal diagnosis of neural tube defects is discussed.