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Yang X, Yang L. Current understanding of the genomic abnormities in premature ovarian failure: chance for early diagnosis and management. Front Med (Lausanne) 2023; 10:1194865. [PMID: 37332766 PMCID: PMC10274511 DOI: 10.3389/fmed.2023.1194865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 05/17/2023] [Indexed: 06/20/2023] Open
Abstract
Premature ovarian failure (POF) is an insidious cause of female infertility and a devastating condition for women. POF also has a strong familial and heterogeneous genetic background. Management of POF is complicated by the variable etiology and presentation, which are generally characterized by abnormal hormone levels, gene instability and ovarian dysgenesis. To date, abnormal regulation associated with POF has been found in a small number of genes, including autosomal and sex chromosomal genes in folliculogenesis, granulosa cells, and oocytes. Due to the complex genomic contributions, ascertaining the exact causative mechanisms has been challenging in POF, and many pathogenic genomic characteristics have yet to be elucidated. However, emerging research has provided new insights into genomic variation in POF as well as novel etiological factors, pathogenic mechanisms and therapeutic intervention approaches. Meanwhile, scattered studies of transcriptional regulation revealed that ovarian cell function also depends on specific biomarker gene expression, which can influence protein activities, thus causing POF. In this review, we summarized the latest research and issues related to the genomic basis for POF and focused on insights gained from their biological effects and pathogenic mechanisms in POF. The present integrated studies of genomic variants, gene expression and related protein abnormalities were structured to establish the role of etiological genes associated with POF. In addition, we describe the design of some ongoing clinical trials that may suggest safe, feasible and effective approaches to improve the diagnosis and therapy of POF, such as Filgrastim, goserelin, resveratrol, natural plant antitoxin, Kuntai capsule et al. Understanding the candidate genomic characteristics in POF is beneficial for the early diagnosis of POF and provides appropriate methods for prevention and drug treatment. Additional efforts to clarify the POF genetic background are necessary and are beneficial for researchers and clinicians regarding genetic counseling and clinical practice. Taken together, recent genomic explorations have shown great potential to elucidate POF management in women and are stepping from the bench to the bedside.
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Affiliation(s)
- Xu Yang
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Lin Yang
- Department of Pharmacy, West China Hospital, Sichuan University, Chengdu, China
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Wasserman HM, Kalkwarf HJ, Altaye M, Yolton K, Kanj RV, Gordon CM. Characterizing the Adolescent Premature Ovarian Insufficiency Phenotype: A Case Control Study. J Pediatr Adolesc Gynecol 2023; 36:122-127. [PMID: 36216307 DOI: 10.1016/j.jpag.2022.10.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 09/12/2022] [Accepted: 10/01/2022] [Indexed: 11/07/2022]
Abstract
STUDY OBJECTIVES To characterize the skeletal, cardiometabolic, cognitive, and mental health phenotype of adolescents with idiopathic premature ovarian insufficiency (POI) DESIGN: Case control SETTING: Pediatric tertiary referral center in Cincinnati, Ohio PARTICIPANTS: Nine adolescents (ages 11-18.99 years) with newly diagnosed POI and 9 normally menstruating controls, matched by age and body mass index MAIN OUTCOME MEASURES: Between-group comparisons of bone characteristics assessed by dual energy x-ray absorptiometry (DXA) and peripheral quantitative computed tomography (pQCT), psychosocial health (anxiety, depression, and quality of life), and cognition and memory by questionnaire RESULTS: Adolescents with POI had lower bone density Z-scores by DXA (lumbar spine -1.93 vs 0.80; whole body less head -2.05 vs 0.00; total hip -1.03 vs 0.83; and femoral neck -1.23 vs 0.91; all P < .001), as well as lower trabecular volumetric bone mineral density (tibia 3% site 226 vs 288 mg/mm3, P < .001; radius 3% site 200 vs 251, P = .001), smaller cortical area (tibia 66% site 251 vs 292 mm2, P = .028), and thickness (tibia 66% site 3.56 vs 4.30 mm, P = .001) than controls. No abnormalities in cardiometabolic biomarkers were detected in POI cases. Adolescents with POI were also more likely to report low energy (78% vs 22%, P = .02). CONCLUSION Estrogen deficiency adversely affects bone health in adolescents with POI. However, we did not find associations with cardiometabolic, mental health, or cognitive outcomes in this small sample.
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Affiliation(s)
- Halley M Wasserman
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, Ohio.
| | - Heidi J Kalkwarf
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Mekibib Altaye
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Kimberly Yolton
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Rula V Kanj
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Catherine M Gordon
- Department of Pediatrics, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas
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Marcozzi S, Rossi V, Salvatore G, Di Rella F, De Felici M, Klinger FG. Distinct effects of epirubicin, cisplatin and cyclophosphamide on ovarian somatic cells of prepuberal ovaries. Aging (Albany NY) 2019; 11:10532-10556. [PMID: 31711044 PMCID: PMC6914390 DOI: 10.18632/aging.102476] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 11/08/2019] [Indexed: 01/05/2023]
Abstract
In vitro culture models were used to characterize the effects of chemotherapeutic drugs and of LH on somatic cells from prepuberal mouse ovaries. All cell types (pre- and granulosa cells, pre-thecal and OSE cells) underwent apoptosis following Epirubicin (0.5μM) exposure for 24hrs (about 60%) and 48hrs (>80%). Cisplatin (10μM) and the Cyclophosphamide active metabolite, Phosphoramide Mustard (10μM), didn’t cause apoptosis in 90% of pre-thecal and pre-granulosa cells up to 72hrs of exposure, although they suffered extensive DNA damage and cell cycle arrest, and acquired stress induced premature senescence (SIPS) features. Cultured granulosa cells didn’t show evident DNA damage and remained viable without acquiring SIPS features; OSE cells were resistant to apoptosis and SIPS but not to DNA damage. These latter, like pre-thecal and pre-granulosa cells, were able of efficient DNA repair involving MLH1-dependent MMR pathways. SIPS features were also observed in ovary after in vivo treatment with Cisplatin. LH (200mIU/mL) didn’t significantly influence apoptosis, SIPS and DNA damage but favoured DNA repair. These results show that somatic cells of prepuberal ovary response to drugs in different ways, either undergoing apoptosis or SIPS, either showing resistance to Cisplatin and Phosphoramide Mustard. Moreover, a new role of LH in promoting DNA repair was shown.
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Affiliation(s)
- Serena Marcozzi
- Department of Biomedicine and Prevention, Section of Histology and Embryology, Faculty of Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy
| | - Valerio Rossi
- Department of Biomedicine and Prevention, Section of Histology and Embryology, Faculty of Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy
| | - Giulia Salvatore
- Department of Biomedicine and Prevention, Section of Histology and Embryology, Faculty of Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy
| | - Francesca Di Rella
- Medical Oncology, Department of Senology, National Cancer Institute, IRCCS Foundation G. Pascale, Naples, Italy
| | - Massimo De Felici
- Department of Biomedicine and Prevention, Section of Histology and Embryology, Faculty of Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy
| | - Francesca Gioia Klinger
- Department of Biomedicine and Prevention, Section of Histology and Embryology, Faculty of Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy
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Narayanan S, Mainz JG, Gala S, Tabori H, Grossoehme D. Adherence to therapies in cystic fibrosis: a targeted literature review. Expert Rev Respir Med 2017; 11:129-145. [DOI: 10.1080/17476348.2017.1280399] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
| | - Jochen G. Mainz
- Cystic Fibrosis Center for Children and Adults, Jena University Hospital, Jena, Germany
| | - Smeet Gala
- Market Access Solutions LLC. (MKTXS), Raritan, NJ, USA
| | - Harold Tabori
- Cystic Fibrosis Center for Children and Adults, Jena University Hospital, Jena, Germany
| | - Daniel Grossoehme
- Division of Pulmonary Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
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Ayesha, Jha V, Goswami D. Premature Ovarian Failure: An Association with Autoimmune Diseases. J Clin Diagn Res 2016; 10:QC10-QC12. [PMID: 27891401 DOI: 10.7860/jcdr/2016/22027.8671] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 08/17/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Premature Ovarian Failure (POF) is the cessation of ovarian function before the age of 40 years. POF is reported to be associated with autoimmune diseases in 20-30% of cases. AIM Patients presenting with idiopathic POF were screened for the presence of autoimmune disorders. MATERIALS AND METHODS Twenty patients with idiopathic POF were included in the study. Baseline investigation in all subjects included fasting serum FSH, LH, E2, progesterone, free T3, free T4, Thyroid-Stimulating Hormone (TSH) and Anti-Thyroperoxidase (anti-TPO) antibodies, testosterone and Dehydroepiandrosterone (DHEAS) levels. Fasting and post-glucose (2 hours after 75g of oral glucose) serum calcium and phosphate were estimated using appropriate assays in biochemistry laboratory. RESULTS Seven patients (35%), who presented with secondary amenorrhea, had thyroid disorders and were already on thyroxine replacement therapy. One patient also had vitiligo. There was no history of adrenal disorder. Anti-TPO levels were elevated in two (10%) patients of secondary amenorrhea group. The levels of serum testosterone were low in three patients. Serum DHEAS levels were low in 13 patients. Blood sugar levels (fasting and 2 hour post 75g glucose load) and fasting insulin levels were normal. Serum calcium and phosphate levels were normal in all the patients. CONCLUSION Thyroid autoimmunity is the most common autoimmune disease associated with POF. The finding of low DHEAS in a large percentage of patients (65%), suggests possibility of adrenal dysfunction. This requires further testing for adrenal reserve and adrenal autoantibodies.
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Affiliation(s)
- Ayesha
- Assistant Professor, Department of Obstetrics and Gynecology, Mayo Institute of Medical Sciences , Barabanki, U.P., India
| | - Vandana Jha
- Assistant Professor, Department of Obstetrics and Gynecology, Mayo Institute of Medical Sciences , Barabanki, U.P., India
| | - Deepti Goswami
- Professor, Department of Obstetrics and Gynecology, Maulana Azad Medical College , New Delhi, India
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Pederson J, Kumar RB, Adams Hillard PJ, Bachrach LK. Primary ovarian insufficiency in adolescents: a case series. INTERNATIONAL JOURNAL OF PEDIATRIC ENDOCRINOLOGY 2015; 2015:13. [PMID: 25983758 PMCID: PMC4433018 DOI: 10.1186/s13633-015-0009-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Accepted: 03/06/2015] [Indexed: 02/02/2023]
Abstract
Background Primary ovarian insufficiency (POI) is characterized by 4 to 6 months of amenorrhea and elevated serum FSH and LH in females less than 40 years. Ovarian insufficiency is uncommon in pediatrics and typically results from a chromosomal abnormality or treatment for malignancy. Idiopathic POI in which no apparent precipitant is identified is even rarer. After encountering three teens with idiopathic POI in recent months, we utilized an informatics-enabled search of the electronic medical records from our hospital to identify all cases of idiopathic POI presenting from 1998–2013. Cases presentation 15 girls (ages 14.4 to 17.9 years) met criteria for idiopathic POI. At diagnosis, breast development ranged from Tanner stage 1 to 5; 6 of 15 patients had secondary amenorrhea. All patients presented in the past 11 years and 13 of 15 in the past 5 years. Conclusions In this first case series of POI from the United States, we observed a clustering at our institution in recent years. If an increased incidence of idiopathic POI is identified at other institutions, further investigation into potential environmental and genetic precipitants is warranted.
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Affiliation(s)
- Julia Pederson
- Stanford University School of Medicine, Room H314, 300 Pasteur Drive, Stanford, CA USA
| | - Rajiv B Kumar
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA USA
| | - Paula J Adams Hillard
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA USA
| | - Laura K Bachrach
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA USA
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Ehtisham S, Zacharin M. Primary ovarian failure and small for gestational age: a previously unrecognised association. J Paediatr Child Health 2009; 45:313-6. [PMID: 19493124 DOI: 10.1111/j.1440-1754.2009.01511.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Sarah Ehtisham
- Department of Endocrinology and Diabetes, Royal Children's Hospital, Flemington Road, Parkville, Melbourne, Victoria, Australia.
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Cameron M, Grover S, Moore P, Jayasinghe Y. Non-chromosomal, non-iatrogenic premature ovarian failure in an adolescent population: a case series. J Pediatr Adolesc Gynecol 2008; 21:3-8. [PMID: 18312793 DOI: 10.1016/j.jpag.2007.07.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2006] [Revised: 07/03/2007] [Accepted: 07/04/2007] [Indexed: 12/19/2022]
Abstract
STUDY OBJECTIVE To review a cohort of patients with non-chromosomal, non-iatrogenic premature ovarian failure (POF) presenting to the Gynaecology Clinic of the Royal Children's Hospital, Melbourne. DESIGN Case series SETTING The Department of Gynaecology, Royal Children's Hospital, Melbourne, Victoria, Australia. PARTICIPANTS Adolescent patients with non-chromosomal, non-iatrogenic premature ovarian failure RESULTS Seventeen patients with non-chromosomal, non-iatrogenic POF were identified between 1990 and 2006. The average age at the time of diagnosis was 16.1 years. 58.8% (10/17) presented with primary amenorrhea, 23.5% (4/17) with secondary amenorrhea and 17.6% (3/17) with oligomenorrhea. 41.1% (7/17) were positive for anti-nucleic acid antibodies and one patient had antithyroid antibodies. Two sets of sisters were identified. CONCLUSION Non-chromosomal, non-iatrogenic POF in an adolescent population is poorly characterized and its incidence unknown. It most commonly presents as primary amenorrhea, but may also present as a disturbance in a previously established menstrual cycle. Like adult onset POF, there appears to be an association with autoimmune conditions although, in our population, overt autoimmune conditions were rare. The occurrence of POF in two sets of sisters raises the possibility of a genetic basis of the condition being more significant in the younger age group, and provides an interesting cohort for further studies in the area.
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Affiliation(s)
- Melissa Cameron
- Department of Gynaecology, Royal Children's Hospital, Victoria, Australia.
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Abstract
UNLABELLED Children with cystic fibrosis (CF) have a high incidence of delayed puberty and poor growth. We retrospectively reviewed pubertal maturation data from 105 children with CF who had participated in studies on growth hormone (GH). As part of the GH study, participants were randomized into two cohorts, one of which was treated with GH for 1 year, and then followed off GH, and the other group was first followed off GH, and then treated with GH for 1 year. Pubertal staging was obtained throughout these studies and we have retrospectively analyzed the data. RESULTS In prepubertal females, GH treatment resulted in a normalized onset of breast development as compared to delayed onset in non-treated females. Females treated during puberty had a normal tempo of breast development. In prepubertal males, GH treatment resulted in a normalized onset of testicular volume compared to non-treated males. Testicular size progression was not accelerated in pubertal boys treated with GH. CONCLUSION GH treatment normalizes pubertal onset in prepubertal children with CF.
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Affiliation(s)
- Mark Vanderwel
- University of Texas Southwestern Medical School, Division of Pediatric Endocrinology, Dallas, USA
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Massin N, Czernichow C, Thibaud E, Kuttenn F, Polak M, Touraine P. Idiopathic Premature Ovarian Failure in 63 Young Women. Horm Res Paediatr 2006; 65:89-95. [PMID: 16439854 DOI: 10.1159/000091177] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2005] [Accepted: 12/13/2005] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Premature ovarian failure (POF) in adolescents is defined as primary or secondary amenorrhea associated with high follicle-stimulating hormone (FSH) levels. In normal 46,XX patients, its etiology is most often unknown. We have evaluated the clinical, hormonal and ovarian phenotypes in patients with a normal karyotype who were diagnosed with POF before the age of 18. METHODS Sixty-three patients were included in this retrospective study. RESULTS The mean patient age was 20.4 years. The patients presented with three clinical patterns: lack of pubertal development (n = 23), primary amenorrhea with interrupted puberty (n = 18), and secondary amenorrhea with normal puberty (n = 22). Ten patients had a familial history of POF and 6 presented with hypothyroidism. The FSH, estradiol and inhibin B levels were not statistically different in the three clinical groups. Fifty percent of the patients presented small ovaries (length <2 cm) at ultrasonography. The presence of follicles was found at histology in only 7 of the 27 patients who underwent an ovarian biopsy. CONCLUSION 46,XX patients presenting with early POF rarely presented a specific, identifiable disorder. We discuss the clinical management and different diagnosis strategies to improve our current knowledge of this syndrome.
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Affiliation(s)
- N Massin
- Department of Endocrinology and Reproductive Medicine, Necker-Enfants Malades Hospital, Faculty of Medicine, Paris V University, Paris, France
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