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Gurule S, Sustaita-Monroe J, Padmanabhan V, Cardoso R. Developmental programming of the neuroendocrine axis by steroid hormones: Insights from the sheep model of PCOS. Front Endocrinol (Lausanne) 2023; 14:1096187. [PMID: 36755919 PMCID: PMC9899912 DOI: 10.3389/fendo.2023.1096187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 01/06/2023] [Indexed: 01/25/2023] Open
Abstract
The reproductive neuroendocrine system is a key target for the developmental programming effects of steroid hormones during early life. While gonadal steroids play an important role in controlling the physiological development of the neuroendocrine axis, human fetuses are susceptible to adverse programming due to exposure to endocrine disrupting chemicals with steroidal activity, inadvertent use of contraceptive pills during pregnancy, as well as from disease states that result in abnormal steroid production. Animal models provide an unparalleled resource to understand the effects of steroid hormones on the development of the neuroendocrine axis and their role on the developmental origins of health and disease. In female sheep, exposure to testosterone (T) excess during fetal development results in an array of reproductive disorders that recapitulate those seen in women with polycystic ovary syndrome (PCOS), including disrupted neuroendocrine feedback mechanisms, increased pituitary responsiveness to gonadotropin-releasing hormone (GnRH), luteinizing hormone (LH) hypersecretion, functional hyperandrogenism, multifollicular ovarian morphology, and premature reproductive failure. Similar to a large proportion of women with PCOS, these prenatally T-treated sheep also manifest insulin resistance and cardiovascular alterations, including hypertension. This review article focuses on the effects of prenatal androgens on the developmental programming of hypothalamic and pituitary alterations in the sheep model of PCOS phenotype, centering specifically on key neurons, neuropeptides, and regulatory pathways controlling GnRH and LH secretion. Insights obtained from the sheep model as well as other animal models of perinatal androgen excess can have important translational relevance to treat and prevent neuroendocrine dysfunction in women with PCOS and other fertility disorders.
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Affiliation(s)
- Sara Gurule
- Department of Animal Science, Texas A&M University, College Station, TX, United States
| | | | | | - Rodolfo Cardoso
- Department of Animal Science, Texas A&M University, College Station, TX, United States
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Garg A, Patel B, Abbara A, Dhillo WS. Treatments targeting neuroendocrine dysfunction in polycystic ovary syndrome (PCOS). Clin Endocrinol (Oxf) 2022; 97:156-164. [PMID: 35262967 DOI: 10.1111/cen.14704] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Revised: 12/30/2021] [Accepted: 01/04/2022] [Indexed: 01/01/2023]
Abstract
Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in women of reproductive age and is the leading cause of anovulatory subfertility. Increased gonadotrophin releasing hormone (GnRH) pulsatility in the hypothalamus results in preferential luteinizing hormone (LH) secretion from the pituitary gland, leading to ovarian hyperandrogenism and oligo/anovulation. The resultant hyperandrogenism reduces negative feedback from sex steroids such as oestradiol and progesterone to the hypothalamus, and thus perpetuates the increase in GnRH pulsatility. GnRH neurons do not have receptors for oestrogen, progesterone, or androgens, and thus the disrupted feedback is hypothesized to occur via upstream neurons. Likely candidates for these upstream regulators of GnRH neuronal pulsatility are Kisspeptin, Neurokinin B (NKB), and Dynorphin neurons (termed KNDy neurons). Growing insight into the neuroendocrine dysfunction underpinning the heightened GnRH pulsatility seen in PCOS has led to research on the use of pharmaceutical agents that specifically target the activity of these KNDy neurons to attenuate symptoms of PCOS. This review aims to highlight the neuroendocrine abnormalities that lead to increased GnRH pulsatility in PCOS, and outline data on recent therapeutic advancements that could potentially be used to treat PCOS. Emerging evidence has investigated the use of neurokinin 3 receptor (NK3R) antagonists as a method of reducing GnRH pulsatility and alleviating features of PCOS such as hyperandrogenism. We also consider other potential mechanisms by which increased GnRH pulsatility is controlled, which could form the basis of future avenues of research.
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Affiliation(s)
- Akanksha Garg
- Section of Investigative Medicine, Division of Diabetes, Endocrinology and Metabolism, Imperial College London, London, UK
| | - Bijal Patel
- Section of Investigative Medicine, Division of Diabetes, Endocrinology and Metabolism, Imperial College London, London, UK
| | - Ali Abbara
- Section of Investigative Medicine, Division of Diabetes, Endocrinology and Metabolism, Imperial College London, London, UK
- Department of Diabetes and Endocrinology, Imperial College Healthcare NHS Trust, London, UK
| | - Waljit S Dhillo
- Section of Investigative Medicine, Division of Diabetes, Endocrinology and Metabolism, Imperial College London, London, UK
- Department of Diabetes and Endocrinology, Imperial College Healthcare NHS Trust, London, UK
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Abdalla MA, Deshmukh H, Atkin S, Sathyapalan T. A review of therapeutic options for managing the metabolic aspects of polycystic ovary syndrome. Ther Adv Endocrinol Metab 2020; 11:2042018820938305. [PMID: 32670541 PMCID: PMC7338645 DOI: 10.1177/2042018820938305] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Accepted: 06/08/2020] [Indexed: 12/12/2022] Open
Abstract
Polycystic ovary syndrome (PCOS) is a common endocrine disorder in women of reproductive age. Metabolic sequelae associated with PCOS range from insulin resistance to type 2 diabetes mellitus (T2DM) and cardiovascular disease (CVD). Insulin resistance plays a significant role in the pathophysiology of PCOS and it is a reliable marker for cardiometabolic risk. Although insulin sensitising agents such as metformin have been traditionally used for managing metabolic aspects of PCOS, their efficacy is low in terms of weight reduction and cardiovascular risk reduction compared with newer agents such as incretin mimetics and SGLT2 inhibitors. With current pharmaceutical advances, potential therapeutic options have increased, giving patients and clinicians more choices. Incretin mimetics are a promising therapy with a unique metabolic target that could be used widely in the management of PCOS. Likewise, bariatric procedures have become less invasive and result in effective weight loss and the reversal of metabolic morbidities in some patients. Therefore, surgical treatment targeting weight loss becomes increasingly common in the management of obese women with PCOS. Newer emerging therapies, including twincretins, triple GLP-1 agonists, glucagon receptor antagonists and imeglemin, are promising therapeutic options for treating T2DM. Given the similarity of metabolic and pathological features between PCOS and T2DM and the variety of therapeutic options, there is the potential to widen our strategy for treating metabolic disorders in PCOS in parallel with current therapeutic advances. The review was conducted in line with the recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome 2018.
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Affiliation(s)
- Mohammed Altigani Abdalla
- Department of Academic Diabetes, Endocrinology
and Metabolism, Hull York Medical School, University of Hull, Hull, UK
| | - Harshal Deshmukh
- Department of Academic Diabetes, Endocrinology
and Metabolism, Hull York Medical School, University of Hull, Hull, UK
| | - Stephen Atkin
- School of Postgraduate Studies and Research,
RCSI Medical University of Bahrain, Kingdom of Bahrain
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Böttcher B, Seeber B, Leyendecker G, Wildt L. Impact of the opioid system on the reproductive axis. Fertil Steril 2017; 108:207-213. [DOI: 10.1016/j.fertnstert.2017.06.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 06/06/2017] [Indexed: 12/15/2022]
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SAJJAD S, TOBASSUM S, FAROOQ U, MALIK H, IDRIS M. Effects of naloxone and yohimbine in polycystic ovary syndrome: a rabbit model study. Turk J Med Sci 2016; 46:1265-70. [DOI: 10.3906/sag-1412-77] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Accepted: 10/11/2015] [Indexed: 11/03/2022] Open
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Cruz WS, Pereira LA, Cezar LC, Camarini R, Felicio LF, Bernardi MM, Teodorov E. Role of steroid hormones and morphine treatment in the modulation of opioid receptor gene expression in brain structures in the female rat. SPRINGERPLUS 2015; 4:355. [PMID: 26191482 PMCID: PMC4503706 DOI: 10.1186/s40064-015-1021-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/18/2015] [Accepted: 05/11/2015] [Indexed: 12/27/2022]
Abstract
This study determined the effects of acute treatment with morphine on the expression of the Oprm1, Oprk1, and Oprd1 genes (which encode μ, κ, and δ receptors, respectively) in the striatum, hypothalamus, and periaqueductal gray (PAG) in ovariectomized female rats treated with estrogen. Ovariectomized female rats were divided into five equal groups. Two groups received estrogen (50 µg/kg, 54 h before testing) and saline (ES group) or 3.5 mg/kg morphine (EM group) 2 h before euthanasia. The SS group received saline solution 54 and 2 h before the experiments. The SM group received saline 54 h and 3.5 mg/kg morphine 2 h before the experiments. The W group remained undisturbed. The genes expression were evaluated. Oprm1 and Oprk1 expression were activated, respectively, in the hypothalamus and PAG and in the striatum and PAG by morphine only in estrogen-treated animals. Oprd1 expression in the hypothalamus and PAG was activated by morphine in both estrogen-treated and -nontreated animals. The Oprm1 and Oprk1 gene response to morphine might depend on estrogen, whereas the Oprd1 gene response to morphine might not depend on estrogen, supporting the hypothesis of a functional role for ovarian hormones in opioid receptor-mediated functional adaptations in the female brain.
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Affiliation(s)
- Wesley Soares Cruz
- Instituto de Ciências da Saúde, Universidade Paulista, UNIP, Dr. Bacelar, São Paulo, CEP 04026-002 Brazil
| | - Lucas Assis Pereira
- Instituto de Ciências da Saúde, Universidade Paulista, UNIP, Dr. Bacelar, São Paulo, CEP 04026-002 Brazil
| | - Luana Carvalho Cezar
- Instituto de Ciências da Saúde, Universidade Paulista, UNIP, Dr. Bacelar, São Paulo, CEP 04026-002 Brazil
| | - Rosana Camarini
- Instituto de Ciências Biomédicas, Universidade de São Paulo, Av. Prof. Lineu Prestes 2415, Cidade Universitária, SP CEP 05508-900 Brazil
| | - Luciano Freitas Felicio
- Faculdade de Medicina Veterinária e Zootecnia, Universidade de São Paulo, Av. Prof. Dr. Orlando Marques de Paiva, 87, Cidade Universitária, CEP 05508 270 Brazil
| | - Maria Martha Bernardi
- Instituto de Ciências da Saúde, Universidade Paulista, UNIP, Dr. Bacelar, São Paulo, CEP 04026-002 Brazil ; Centro de Matemática, Computação e Cognição, Universidade Federal do ABC, Av. Dos Estados, 5001, Santo André, CEP 09210-971 Brazil ; Av dos Estados, 5001, Santo André, SP CEP 09210-970 Brazil
| | - Elizabeth Teodorov
- Centro de Matemática, Computação e Cognição, Universidade Federal do ABC, Av. Dos Estados, 5001, Santo André, CEP 09210-971 Brazil
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Böttcher B, Dörr H, Wildt L. Naltrexone as a diagnostic tool to distinguish between hyperandrogenemic and hypothalamic ovarian failure in females with congenital adrenal hyperplasia due to 21-hydroxylase-deficiency (CAH). Eur J Obstet Gynecol Reprod Biol 2014; 180:153-6. [DOI: 10.1016/j.ejogrb.2014.06.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2013] [Revised: 06/05/2014] [Accepted: 06/13/2014] [Indexed: 11/29/2022]
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Zangeneh FZ, Mohammadi A, Ejtemaeimehr S, Naghizadeh MM, Fatemeh A. The role of opioid system and its interaction with sympathetic nervous system in the processing of polycystic ovary syndrome modeling in rat. Arch Gynecol Obstet 2010; 283:885-92. [PMID: 21132313 DOI: 10.1007/s00404-010-1776-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2010] [Accepted: 11/11/2010] [Indexed: 11/26/2022]
Abstract
BACKGROUND This study was conducted to evaluate the effect of interaction of sympathetic and opioid systems in the processing of polycystic ovary syndrome modeling in rat. METHODS Ninety adult female rats (7-8 weeks of age) were treated with EV for 60 days for induction of follicular cysts (PCO modeling). Clonidine and yohimbine were used for sympathic agonist and antagonist and nalterxone was used for opioid system inhibition. Interactions of two systems were studied. RESULTS Our results indicate that both systems and interaction of two systems are effective in processing modeling of PCOS in rat. Interaction of two system drugs decreased estradiol (P < 0.05). Qualitative analysis showed that the bulk of cysts and corpus lutea and dominant follicles were increased in PCO rats in comparison with control group. CONCLUSION Therefore there could been an alternative in the treatment of the polycystic ovary syndrome in the rat by using adrenergic agonist and antagonists in combination with naltrexone.
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Affiliation(s)
- Farideh Zafari Zangeneh
- Vali-e-Asr, Reproductive Health Research Center, Tehran University of Medical Sciences, Tehran, Iran.
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Eyvazzadeh AD, Pennington KP, Pop-Busui R, Sowers M, Zubieta JK, Smith YR. The role of the endogenous opioid system in polycystic ovary syndrome. Fertil Steril 2009; 92:1-12. [PMID: 19560572 DOI: 10.1016/j.fertnstert.2009.05.012] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2008] [Revised: 04/29/2009] [Accepted: 05/07/2009] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To review the complex role of the opioid system in reproduction and carbohydrate metabolism, abnormalities in the opioid system in women with polycystic ovary syndrome (PCOS), and the role of opioid antagonists in the management of PCOS-related infertility. DESIGN Pertinent articles were identified through a computer PubMed search. References of selected articles were hand searched for additional citations. CONCLUSION(S) Endogenous opioids are generally considered inhibitory central neurotransmitters. Peripherally, opioids are involved in the regulation of pancreatic islet function, hepatic insulin clearance, and glucose metabolism, potentially contributing to the pathogenesis of hyperinsulinemia and insulin resistance in PCOS. The presence of sex steroids is required for normal function of the opioid system in both GnRH secretion and carbohydrate metabolism. In women with PCOS, growing evidence suggests dysregulation of the opioid system both centrally and peripherally, with complex interactions. The opioid system effects on carbohydrate metabolism appear to be modulated by obesity. Finally, naltrexone has been demonstrated to successfully augment traditional ovulation induction regimens, but has limited support as a single ovulation induction agent for PCOS.
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Affiliation(s)
- Aimee D Eyvazzadeh
- Department of Obstetrics and Gynecology, School of Medicine and School of Public Health, University of Michigan, 1500 East Medical Center Drive, Women's Hospital, Ann Arbor, MI 48109-0276, USA
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Ahmed MI, Duleba AJ, El Shahat O, Ibrahim ME, Salem A. Naltrexone treatment in clomiphene resistant women with polycystic ovary syndrome. Hum Reprod 2008; 23:2564-9. [PMID: 18641399 DOI: 10.1093/humrep/den273] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Endogenous opiates may affect various aspects of reproductive and metabolic function in patients with polycystic ovary syndrome (PCOS). This study evaluated long-term inhibition of the opioid system using naltrexone in clomiphene citrate (CC)-resistant women with PCOS. METHODS A group of 30 infertile females with PCOS were evaluated; all subjects were obese, hyperandrogenic and hyperinsulinemic; 16 patients were amenorrhic and 14 were oligomenorrhic. All subjects received natrexone (50 mg p.o. daily) for 6 months. Patients who did not ovulate after 12 weeks of naltrexone monotherapy, also received CC (starting at 50 mg/day for 5 days and, for non-responders, increasing it up to 150 mg/day). RESULTS Of the 30 women, 3 ovulated during naltrexone monotherapy and 19 of the remaining 27 ovulated during naltrexone + CC therapy. There were no conceptions during naltrexone monotherapy, but 9 of 27 women (33.3%) conceived during naltrexone + CC; there was one missed abortion at 9 weeks, one preterm delivery at 34 weeks and seven term live births. Naltrexone therapy was also followed by significant reductions in BMI, fasting serum insulin, luteinizing hormone (LH), LH/follicle-stimulating hormone ratio and testosterone. CONCLUSIONS In this preliminary trial, naltrexone improved endocrine and metabolic function in women with CC-resistant PCOS. Furthermore, naltrexone restored CC sensitivity in the majority of subjects, resulting in a significant number of pregnancies.
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Affiliation(s)
- M I Ahmed
- Department of Obstetrics and Gynecology, Benha School of Medicine, Benha, Egypt
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Palomba S, Orio F, Russo T, Falbo A, Cascella T, Colao A, Lombardi G, Zullo F. Is ovulation induction still a therapeutic problem in patients with polycystic ovary syndrome? J Endocrinol Invest 2004; 27:796-805. [PMID: 15636438 DOI: 10.1007/bf03347527] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Polycystic ovary syndrome (PCOS) is one of the most common endocrine diseases affecting women of fertile age, and is characterized by hyperandrogenism, chronic anovulatory cycles and oligomenorrhea or amenorrhea. Given the repercussions of chronic anovulation on sterility, PCOS is a heavy social burden. Here we describe the procedures used to induce ovulation in PCOS patients, the surgical approach and medical treatments that are still being experimented.
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Affiliation(s)
- S Palomba
- Department of Obstetrics and Gynecology, Magna Graecia University, Catanzaro, Italy.
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Abstract
This paper is the twenty-fourth installment of the annual review of research concerning the opiate system. It summarizes papers published during 2001 that studied the behavioral effects of the opiate peptides and antagonists. The particular topics covered this year include the molecular-biochemical effects and neurochemical localization studies of endogenous opioids and their receptors (Section 2), and the roles of these opioid peptides and receptors in pain and analgesia (Section 3); stress and social status (Section 4); tolerance and dependence (Section 5); learning and memory (Section 6); eating and drinking (Section 7); alcohol and drugs of abuse (Section 8); sexual activity and hormones, pregnancy, development and endocrinology(Section 9); mental illness and mood (Section 10); seizures and neurologic disorders (Section 11); electrical-related activity and neurophysiology (Section 12); general activity and locomotion (Section 13); gastrointestinal, renal and hepatic functions (Section 14); cardiovascular responses (Section 15); respiration and thermoregulation (Section 16); and immunological responses (Section 17).
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Affiliation(s)
- Richard J Bodnar
- Department of Psychology and Neuropsychology Doctoral Sub-Program, Queens College, City University of New York, CUNY, 65-30 Kissena Blvd., Flushing, NY 11367, USA.
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