Ovarian aging: mechanisms and intervention strategies

From TCM "Shen-nourishing" and "Yang-strengthening" theory to blood-testis barrier reorganization, GuiLuBuShen attenuates age-related male reproductive dysfunction

ETHNOPHARMACOLOGICAL RELEVANCE

Traditional Chinese Medicine (TCM) provides a theoretical foundation for treating reproductive dysfunction via "Shen" system regulation. The classical formulation GuiLuBuShen pill (GLBS), recognized as a principal TCM therapy for male urogenital disorders, clinically enhances "Shen-Yang" nourishment in middle-aged and elderly males with genitourinary degeneration.

AIM OF THE STUDY

This study aims to elucidate the therapeutic efficacy and molecular mechanisms underlying GLBS in mitigating age-associated male genitourinary dysfunction, with particular focus on its regulatory effects on "Shen" deficiency-related pathophysiology during reproductive system senescence.

MATERIALS AND METHODS

In this study, 14-month-old Wistar rats were used to model natural male aging (vs. 6-week controls), and GLBS was administered at low (0.81 g/kg/d), medium (1.62 g/kg/d), and high (3.24 g/kg/d) doses for 8 weeks. The multimodal evaluation comprised physiological aging markers (body condition/fatigue recovery), reproductive competence (hormonal profiles/mating behavior/sperm parameters), organ integrity (morphometrics/urogenital histopathology) and molecular mechanisms (testicular transcriptomics & pathway validation).

RESULTS

GLBS treatment effectively attenuated age-related physiological decline, including weight loss, thermoregulatory dysfunction, and loco-motor impairment in open field test. Systemic anti physiological stress effects were demonstrated through reduced serum corticosterone, decreased organ degeneration and suppressed prostatic oxidative stress. GLBS restored reproductive function via reduced testicular oxidative damage, hormonal rebalancing, improved sperm motility/viability and attenuated seminiferous tubule degeneration with suppressed germ cell apoptosis. Mechanistic studies revealed that these effects were mechanistically linked to blood-testis barrier reinforcement and steroidogenic activation, collectively preserving spermatogenic homeostasis.

CONCLUSIONS

GLBS emerges as a multi-target therapeutic candidate for age-related urogenital disorders, uniquely combining systemic anti-aging effects with direct testicular rejuvenation. Its dual-action mechanism coordinates blood-testis barrier reinforcement through junctional remodeling with endocrine rebalancing, effectively preserving spermatogenic microenvironment homeostasis. The findings provide translational validation of traditional "Shen-nourishing" theory through contemporary molecular evidence, positioning GLBS as a promising intervention addressing both systemic senescence and organ-specific pathophysiology in male reproductive aging.

CCDC134 enhances ovarian reserve function and angiogenesis by directly interacting with INHA in a mouse model of premature ovarian insufficiency

Premature ovarian insufficiency (POI) is a multifactorial condition characterized by diminished ovarian function, granulosa cell (GC) apoptosis, and impaired ovarian angiogenesis, leading to infertility and long-term health complications. Despite its prevalence, effective therapeutic targets for POI remain limited. This study investigates the role of CCDC134 in maintaining ovarian reserve and promoting angiogenesis and its interaction with INHA in a mouse model of POI. Ovarian granulosa cells from POI patients and unaffected women were analyzed for apoptosis and CCDC134 expression. A cisplatin-induced mouse model of POI was used to evaluate the therapeutic potential of AAV-mediated ovary-specific overexpression of CCDC134. Ovarian morphology, hormonal levels, follicular development, granulosa cell viability, and angiogenesis were assessed. The interaction between CCDC134 and INHA was examined using co-immunoprecipitation, immunofluorescence, and molecular pathway analyses. CCDC134 expression was significantly downregulated in ovarian tissues and granulosa cells of POI patients and cisplatin-induced POI mice. CCDC134 overexpression improved ovarian morphology, restored follicular development across all stages, and enhanced reproductive outcomes in POI mice. Hormonal imbalances, including decreased AMH and E2 and elevated FSH and LH, were reversed following CCDC134 overexpression. Moreover, CCDC134 treatment significantly reduced GC apoptosis by downregulating pro-apoptotic markers (Caspase-3 and Bax) and upregulating anti-apoptotic Bcl-2. Angiogenesis was enhanced, as indicated by increased expression of CD34 and vWF, improved endothelial cell viability, and restored VEGF levels. Mechanistic studies revealed a direct interaction between CCDC134 and INHA, with CCDC134 promoting INHA expression and modulating apoptotic and angiogenic pathways. CCDC134 plays a critical role in maintaining ovarian reserve and promoting angiogenesis by directly interacting with INHA. Its overexpression restores ovarian function, mitigates granulosa cell apoptosis, and enhances angiogenesis in a mouse model of POI. These findings highlight the therapeutic potential of the CCDC134-INHA axis as a novel strategy for treating POI.

Dysregulation of AR and ERα caused ovarian alterations in gerbils prenatally exposed to 17α-ethinylestradiol and pequi oil

This study investigated the effects of prenatal exposure to pequi oil and 17α-ethinylestradiol (EE2) on the histomorphometry and receptor expression (androgen receptor (AR) and estrogen receptor alpha (ERα) in gerbil ovaries (Meriones unguiculatus) during aging. Experimental groups included: control, vehicle (mineral oil), EE2: 15 µg/kg/day from gestational days 18-22, EE2/Pe: EE2 from days 18-22 and 300 mg/kg of pequi oil from days 18-26, and Pe: pequi oil only, via gavage. Female offspring were euthanized at 12 months, and ovaries were collected, processed histologically, and sectioned. Histological sections were stained with hematoxylin-eosin to analyze the superficial epithelium height and the tunica albuginea thickness. Immunohistochemistry for AR and ERα was performed, and the percentage of positive nuclei for these receptors was quantified in the theca interna, granulosa cells within follicles, and the interstitial gland. Data were analyzed using analysis of variance (ANOVA), Tukey's, and Kruskal-Wallis tests. The data revealed a significant decrease (p < 0.05) in the thickness of the tunica albuginea in the EE2 group, whereas this thickness was increased in the EE2/Pe and Pe groups. Epithelial height was lower in the EE2 group and higher in the EE2/Pe group. No significant changes in AR immunoreactivity were observed. In multilaminar follicles, ERα immunostaining was elevated in granulosa cells in the Pe group and in theca cells of the EE2 group. Additionally, the interstitial gland in the Pe group showed an increase in ERα expression. Pequi oil exposure upregulated ERα more markedly than AR during folliculogenesis and in interstitial cells, suggesting endocrine-modulating potential and relevance for ovarian regulation during aging.

A case-control study on the link between trace element exposure in follicular fluid and premature ovarian insufficiency

Premature ovarian insufficiency (POI), affecting 3.5 % of women under 40, significantly impacts reproductive health. The unknown etiology in over 50 % of POI cases impedes accurate diagnosis and treatment. Evidence shows that environmental agents can adversely affect health and reduce fertility. Trace elements are critical pollutants impacting human health. However, research on populations with POI and their links to these elements is limited. We enrolled 367 female patients, dividing them into a POI group and a control group. We employed ICP-MS to measure 25 trace elements in follicular fluid. Bayesian kernel machine regression analyzed combined exposure effects and restricted cubic splines evaluated the relationships between individual trace elements and ovarian reserve markers, focusing on anti-Müllerian hormone (AMH) and basal FSH (bFSH). Logistic regression assessed the association between specific element concentrations and POI occurrence, and the posterior inclusion probability model tested the robustness of key driving factors. The study identified 24 trace elements in follicular fluid samples, revealing significant differences in 23 elements between the two groups. There were positive correlations between Cu, I, Se, and Zn with AMH levels, while negative correlations were observed for Ca, Co, Li, and AMH. Nonlinear relationships were noted for Ba, Cd, Fe, Mg, Mn, Mo, and Pb. Ca, Li, and Ni showed a significant positive correlation with bFSH, while Cu, I, Mg, Se, and Zn demonstrated a significant negative correlation with bFSH. Additionally, Ba, Mn, and Pb exhibited a nonlinear correlation with bFSH. Individuals in the medium and high tertiles for Cu, I, Pb, Se, and Zn were less likely to develop POI. In contrast, those in the medium and high tertiles for Ba, Ca, Cd, Li, Mn, and Ni had an increased likelihood of POI. Our study addresses a crucial gap by examining trace element exposure in follicular fluid and its link to POI risk, enhancing understanding of their effects on female ovarian function. This study lays a foundation for monitoring female fertility and emphasizes the importance of environmental pollutants on reproductive health.

Reactive oxygen and nitrogen species: multifaceted regulators of ovarian activity†

Reactive oxygen and nitrogen species are essential components of diverse intracellular signaling pathways. In addition to their involvement in apoptosis, reactive oxygen and nitrogen species are crucial in the regulation of multiple developmental and physiological processes. This review aims to summarize their role in the regulation of key ovarian stages: ovulation, maturation and postovulatory ageing of the oocyte, and the formation and regression of the corpus luteum. At the cellular level, a mild increase in reactive oxygen and nitrogen species is associated with the initiation of a number of regulatory mechanisms, which might be suppressed by increased activity of the antioxidant system. Moreover, a mild increase in reactive oxygen and nitrogen species has been linked to the control of mitochondrial biogenesis and abundance in response to increased cellular energy demands. Thus, reactive oxygen and nitrogen species should also be perceived in terms of their positive role in cellular signaling. On the other hand, an uncontrolled increase in reactive oxygen species production or strong down-regulation of the antioxidant system results in oxidative stress and damage of cellular components associated with ovarian pathologies and ageing. Similarly, the disturbance of signaling functions of reactive nitrogen species caused by dysregulation of nitric oxide production by nitric oxide synthases in ovarian tissues interferes with the proper regulation of physiological processes in the ovary.

Harnessing omics data for drug discovery and development in ovarian aging

BACKGROUND

Ovarian aging occurs earlier than the aging of many other organs and has a lasting impact on women's overall health and well-being. However, effective interventions to slow ovarian aging remain limited, primarily due to an incomplete understanding of the underlying molecular mechanisms and drug targets. Recent advances in omics data resources, combined with innovative computational tools, are offering deeper insight into the molecular complexities of ovarian aging, paving the way for new opportunities in drug discovery and development.

OBJECTIVE AND RATIONALE

This review aims to synthesize the expanding multi-omics data, spanning genome, transcriptome, proteome, metabolome, and microbiome, related to ovarian aging, from both tissue-level and single-cell perspectives. We will specially explore how the analysis of these emerging omics datasets can be leveraged to identify novel drug targets and guide therapeutic strategies for slowing and reversing ovarian aging.

SEARCH METHODS

We conducted a comprehensive literature search in the PubMed database using a range of relevant keywords: ovarian aging, age at natural menopause, premature ovarian insufficiency (POI), diminished ovarian reserve (DOR), genomics, transcriptomics, epigenomics, DNA methylation, RNA modification, histone modification, proteomics, metabolomics, lipidomics, microbiome, single-cell, genome-wide association studies (GWAS), whole-exome sequencing, phenome-wide association studies (PheWAS), Mendelian randomization (MR), epigenetic target, drug target, machine learning, artificial intelligence (AI), deep learning, and multi-omics. The search was restricted to English-language articles published up to September 2024.

OUTCOMES

Multi-omics studies have uncovered key mechanisms driving ovarian aging, including DNA damage and repair deficiencies, inflammatory and immune responses, mitochondrial dysfunction, and cell death. By integrating multi-omics data, researchers can identify critical regulatory factors and mechanisms across various biological levels, leading to the discovery of potential drug targets. Notable examples include genetic targets such as BRCA2 and TERT, epigenetic targets like Tet and FTO, metabolic targets such as sirtuins and CD38+, protein targets like BIN2 and PDGF-BB, and transcription factors such as FOXP1.

WIDER IMPLICATIONS

The advent of cutting-edge omics technologies, especially single-cell technologies and spatial transcriptomics, has provided valuable insights for guiding treatment decisions and has become a powerful tool in drug discovery aimed at mitigating or reversing ovarian aging. As technology advances, the integration of single-cell multi-omics data with AI models holds the potential to more accurately predict candidate drug targets. This convergence offers promising new avenues for personalized medicine and precision therapies, paving the way for tailored interventions in ovarian aging.

REGISTRATION NUMBER

Not applicable.

Epigenetic Alterations in Ovarian Function and Their Impact on Assisted Reproductive Technologies: A Systematic Review

Background: Epigenetic modifications have an important role in controlling ovarian function, modulating ovarian response and implantation success in Assisted Reproductive Technologies (ART). The alterations, such as DNA methylation and non-coding RNA control, have been identified as key variables regulating ovarian physiology and reproductive outcomes. This systematic review investigates the significance of epigenetic pathways in ovarian function, with an emphasis on their effect on ART success rates. Methods: A thorough search of the PubMed, Scopus, and EMBASE databases was performed to find articles published between 2015 and 2024 that investigated the connection between epigenetic changes and ovarian function in ART patients. Studies that examined miRNA expression, DNA methylation, and histone changes in follicular fluid, granulosa cells, and embryos were included. The study followed the PRISMA recommendations to guarantee scientific rigor and repeatability. The data were combined into a thorough study of epigenetic markers linked to ovarian aging, ovarian reserve, and implantation success. Results: A total of 15 studies satisfied the inclusion criteria, with substantial relationships found between distinct epigenetic markers and ovarian function. Changes in miRNA expression patterns in follicular fluid and granulosa cells were associated with oocyte maturation, ovarian reserve, and implantation potential. Women with low ovarian reserve and polycystic ovary syndrome (PCOS) have different DNA methylation patterns. MiR-27a-3p and miR-15a-5p were shown to be involved with granulosa cell malfunction and poor ovarian response, whereas global DNA hypomethylation was linked to ovarian aging and ART results. Conclusions: Epigenetic alterations affect ovarian function via pathways that control hormone signaling, follicular development, and implantation success. Further study is needed to determine the practical applicability of epigenetic biomarkers in predicting ART effectiveness and enhancing patient treatment procedures.

Unveiling the Multifaceted Pharmacological Actions of Indole-3-Carbinol and Diindolylmethane: A Comprehensive Review

Cruciferae family vegetables are remarkably high in phytochemicals such as Indole-3-carbinol (I3C) and Diindolylmethane (DIM), which are widely known as nutritional supplements. I3C and DIM have been studied extensively in different types of cancers like breast, prostate, endometrial, colorectal, gallbladder, hepatic, and cervical, as well as cancers in other tissues. In this review, we summarized the protective effects of I3C and DIM against cardiovascular, neurological, reproductive, metabolic, bone, respiratory, liver, and immune diseases, infections, and drug- and radiation-induced toxicities. Experimental evidence suggests that I3C and DIM offer protection due to their antioxidant, anti-inflammatory, antiapoptotic, immunomodulatory, and xenobiotic properties. Apart from the beneficial effects, the present review also discusses the possible toxicities of I3C and DIM that are reported in various preclinical investigations. So far, most of the reports about I3C and DIM protective effects against various diseases are only from preclinical studies; this emphasizes the dire need for large-scale clinical trials on these phytochemicals against human diseases. Further, in-depth research is required to improve the bioavailability of these two phytochemicals to achieve the desirable protective effects. Overall, our review emphasizes that I3C and DIM may become potential drug candidates for combating dreadful human diseases.

Beef cows with larger vulvar width have greater antral follicle count, viable oocytes, and higher circulating AMH

Owing to the low heritability of reproductive traits, the search for markers and their interrelationship that could indicate reproductively superior individuals is important in the selection process for bovine reproductive efficiency. This study aimed to investigate the possible interrelationships between the antral follicle count (AFC), vulvar-width (VW), anti-Müllerian hormone (AMH) concentrations, fertility in Bos Taurus and Bos Indicus females. Brahman (Bos Taurus-Indicus, n = 126) and Simmental and Angus (Bos Taurus-Taurus, n = 155) cows were classified as having large (≥86 mm) and small (<86 mm) VW. From each group, one blood sample per animal was collected to determine the AMH serum concentrations. The GLIMMIX procedure in SAS® was used to determine whether vulva width (VW) and AMH classes, associated or not with breed, could influence the age at first calving (FCA), calving to first service interval (CFSI), calving interval (CI), number of services per pregnancy (SP), and number of viable oocytes (VO). Antral follicle count (AFC) (36.10 ± 1.90 vs. 22.78 ± 1.64, for large and small VW, respectively), AMH (1.17 ± 0.07 vs. 0.48 ± 0.007 ng/mL), and viable oocytes or VO (18.86 ± 1.76 vs. 10.15 ± 1.49) were greater (P < 0.05) in the large VW than in the small VW. Brahman cows had greater AFC (36.30 ± 1.34 vs. 22.09 ± 1.67), VW (106.94 ± 15.83 vs. 69.78 ± 14.11 mm), and AMH (1.18 ± 0.07 vs. 0.42 ± 0.05 ng/mL) compared to that of taurine cows. In conclusion, VW was an efficient predictor of AFC and AMH concentrations in both genetic groups, but under the conditions of this trial no link could be detected between these variables and the reproductive indices studied.

A Glimpse of Research Trends and Frontiers in the Etiology of Premature Ovarian Insufficiency via Bibliometric Analysis

INTRODUCTION

Premature Ovarian Insufficiency (POI) is the most common reproductive aging disorder in women of reproductive age, which is characterized by decreased ovarian function in women before the age of 40. Etiology research of POI has garnered interest and attention from scholars worldwide over the past decades.

METHODS

However, to the best of our knowledge, no comprehensive survey with bibliometric analysis has been conducted yet on the research trends of POI etiology. This article aimed to analyze current scientific findings on the etiology of POI, offering innovative ideas for further research. Research articles on the etiology of POI from 1994 to 2023 were collected from the Web of Science Core Collection. A total of 456 research articles were included, and the total number of publications increased annually. We used VOSviewer and bibliometric.com to analyze the keywords, terms, institution, publication country/region, author name, publication journal, and the sum of times the articles have been cited.

RESULTS

This study has shown that a research hotspot is the genetic etiology of POI; however, there is still a lack of research on the impact of epigenetic alterations, iatrogenic injuries, environmental pollution, social stress, and unhealthy lifestyles on the pathogenesis of POI.

CONCLUSION

The factors illustrated here represent potential future directions for POI etiology research and warrant more attention from researchers.

Recombinant Follicle-Stimulating Hormone and Luteinizing Hormone Enhance Mitochondrial Function and Metabolism in Aging Female Reproductive Cells

Ovarian aging significantly impacts female fertility, with mitochondrial dysfunction emerging as a key factor. This study investigated the effects of recombinant follicle-stimulating hormone (FSH) and luteinizing hormone (LH) on mitochondrial function and metabolism in aging female reproductive cells. Human granulosa cells (HGL5) were treated with FSH/LH or not. Mitochondrial function was assessed through various assays, including mitochondrial mass, membrane potential, ROS levels, and ATP production. Mitochondrial dynamics and morphology were analyzed using MitoTracker staining. Cellular respiration was measured using a Seahorse Bioenergetics Analyzer. Metabolic reprogramming was evaluated through gene expression analysis and metabolite profiling. In vivo effects were studied using aging mouse oocytes. FSH/LH treatment significantly improved mitochondrial function in aging granulosa cells, increasing mitochondrial mass and membrane potential while reducing ROS levels. Mitochondrial dynamics showed a shift towards fusion and elongation. Cellular respiration, ATP production, and spare respiratory capacity were enhanced. FSH/LH-induced favorable alterations in cellular metabolism, favoring oxidative phosphorylation. In aging mouse oocytes, FSH/LH treatment improved in vitro maturation and mitochondrial health. In conclusion, FSH/LH supplementation ameliorates age-related mitochondrial dysfunction and improves cellular metabolism in aging female reproductive cells.

Mitochondrial DNA Damage and Its Repair Mechanisms in Aging Oocytes

The efficacy of assisted reproductive technologies (ARTs) in older women remains constrained, largely due to an incomplete understanding of the underlying pathophysiology. This review aims to consolidate the current knowledge on age-associated mitochondrial alterations and their implications for ovarian aging, with an emphasis on the causes of mitochondrial DNA (mtDNA) mutations, their repair mechanisms, and future therapeutic directions. Relevant articles published up to 30 September 2024 were identified through a systematic search of electronic databases. The free radical theory proposes that reactive oxygen species (ROS) inflict damage on mtDNA and impair mitochondrial function essential for ATP generation in oocytes. Oocytes face prolonged pressure to repair mtDNA mutations, persisting for up to five decades. MtDNA exhibits limited capacity for double-strand break repair, heavily depending on poly ADP-ribose polymerase 1 (PARP1)-mediated repair of single-strand breaks. This process depletes nicotinamide adenine dinucleotide (NAD⁺) and ATP, creating a detrimental cycle where continued mtDNA repair further compromises oocyte functionality. Interventions that interrupt this destructive cycle may offer preventive benefits. In conclusion, the cumulative burden of mtDNA mutations and repair demands can lead to ATP depletion and elevate the risk of aneuploidy, ultimately contributing to ART failure in older women.

Which Side of the Coin Are You on Regarding Possible Postnatal Oogenesis?

It is well known that oocytes are produced during fetal development and that the total number of primary follicles is determined at birth. In humans, there is a constant loss of follicles after birth until about two years of age. The number of follicles is preserved until the resumption of meiosis at puberty and there is no renewal of the oocytes; this dogma was maintained in the last century because there were no suitable techniques to detect and obtain stem cells. However, following stem cell markers, several scientists have detected them in developing and adult human ovarian tissues, especially in the ovarian surface epithelial cells. Furthermore, many authors using different methodological strategies have indicated this possibility. This evidence has led many scientists to explore this hypothesis; there is no definitive consensus to accept this idea. Interestingly, oocyte retrieval from mature ovaries and other tissue sources of stem cells has contributed to the development of strategies for the retrieval of mature oocytes, useful for assisted reproductive technology. Here, we review the evidence and controversies on oocyte neooogenesis in adult women; in addition, we agree with the idea that this process may occur in adulthood and that its alteration may be related to various pathologies in women, such as polycystic ovary syndrome, premature ovarian insufficiency, diminished ovarian reserve and several infertility and genetic disorders.

mTOR inhibitors potentially preserve fertility in female patients with haematopoietic malignancies: a narrative review

Haematologic malignancies are considered among the more common adolescent and young adult (AYA) cancers. Many female AYA patients with haematopoietic malignancies face impaired fertility. Haematologic malignancies patients tend to be treated with more aggressive systemic chemotherapy than that of solid tumours. In adult women, treatment-related contraception causes age-related fertility loss. Graft-versus-host disease (GVHD) after allogeneic haematopoietic stem cell transplantation is associated with decreased fertility. Ovarian cryopreservation is often indicated for haematopoietic malignancies; however, follicle loss associated with ovarian cryopreservation and ovarian minimal residual disease, which result in the withdrawal of the transplantation, are important issues. These problems may not be fully addressed by conventional methods of fertility preservation, such as oocyte, embryo, and ovarian cryopreservation, leaving room for research into new treatment approaches, such as fertility preservation drugs. In recent years, preclinical studies have shown that mTOR inhibitors may preserve chemotherapy-induced follicular loss, may have follicle-preserving effects on follicle loss associated with cryopreservation and transplantation of ovarian tissue, may have fertility-preserving effects on aging-related infertility. Clinical studies have shown that mTOR inhibitors may have the potential for indirect fertility preservation by controlling GVHD, have a limited anti-tumor effect against haematopoietic malignancies. The purpose of this article is to outline the various issues faced by female survivors of haematopoietic malignancies and discuss the potential of mTOR inhibitors as a safe treatment option. Based on current research, mTOR inhibitors seem promising and innovative fertility preservation agents regarding preclinical conditions, and further study, including clinical trials, should be expected.

Perspectives on biomarkers of reproductive aging for fertility and beyond

Reproductive aging, spanning an age-related functional decline in the female and male reproductive systems, compromises fertility and leads to a range of health complications. In this Perspective, we first introduce a comprehensive framework for biomarkers applicable in clinical settings and discuss the existing repertoire of biomarkers used in practice. These encompass functional, imaging-based and biofluid-based biomarkers, all of which reflect the physiological characteristics of reproductive aging and help to determine the reproductive biological age. Next, we delve into the molecular alterations associated with aging in the reproductive system, highlighting the gap between these changes and their potential as biomarkers. Finally, to enhance the precision and practicality of assessing reproductive aging, we suggest adopting cutting-edge technologies for identifying new biomarkers and conducting thorough validations in population studies before clinical applications. These advancements will foster improved comprehension, prognosis and treatment of subfertility, thereby increasing chances of preserving reproductive health and resilience in populations of advanced age.

Foot fractures diagnosis using a deep convolutional neural network optimized by extreme learning machine and enhanced snow ablation optimizer

The current investigation proposes a novel hybrid methodology for the diagnosis of the foot fractures. The method uses a combination of deep learning methods and a metaheuristic to provide an efficient model for the diagnosis of the foot fractures problem. the method has been first based on applying some preprocessing steps before using the model for the features extraction and classification of the problem. the main model is based on a pre-trained ZFNet. The final layers of the network have been substituted using an extreme learning machine (ELM) in its entirety. The ELM part also optimized based on a new developed metaheuristic, called enhanced snow ablation optimizer (ESAO), to achieve better results. for validating the effectiveness of the proposed ZFNet/ELM/ESAO-based model, it has been applied to a standard benchmark from Institutional Review Board (IRB) and the findings have been compared to some different high-tech methods, including Decision Tree / K-Nearest Neighbour (DT/KNN), Linear discriminant analysis (LDA), Inception-ResNet Faster R-CNN architecture (FRCNN), Transfer learning‑based ensemble convolutional neural network (TL-ECNN), and combined model containing a convolutional neural network and long short-term memory (DCNN/LSTM). Final results show that using the proposed ZFNet/ELM/ESAO-based can be utilized as an efficient model for the diagnosis of the foot fractures.

Mitochondria: the epigenetic regulators of ovarian aging and longevity

Ovarian aging is a major health concern for women. Ovarian aging is associated with reduced health span and longevity. Mitochondrial dysfunction is one of the hallmarks of ovarian aging. In addition to providing oocytes with optimal energy, the mitochondria provide a co-substrate that drives epigenetic processes. Studies show epigenetic alterations, both nuclear and mitochondrial contribute to ovarian aging. Both, nuclear and mitochondrial genomes cross-talk with each other, resulting in two ways orchestrated anterograde and retrograde response that involves epigenetic changes in nuclear and mitochondrial compartments. Epigenetic alterations causing changes in metabolism impact ovarian function. Key mitochondrial co-substrate includes acetyl CoA, NAD+, ATP, and α-KG. Thus, enhancing mitochondrial function in aging ovaries may preserve ovarian function and can lead to ovarian longevity and reproductive and better health outcomes in women. This article describes the role of mitochondria-led epigenetics involved in ovarian aging and discusses strategies to restore epigenetic reprogramming in oocytes by preserving, protecting, or promoting mitochondrial function.

Association of sleep disturbances with diminished ovarian reserve in women undergoing infertility treatment

With an aging population seeking infertility treatment, diminished ovarian reserve (DOR) is a prevalent indication for assisted reproductive technology (ART). This study aims to investigate the relationship between sleep parameters and DOR among women attending an infertility clinic. Methods We consecutively enrolled women attending an infertility clinic from July 2020 to June 2021. Participants completed the Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale(ESS), and STOP-Bang Questionnaire to assess self-reported sleep quality. DOR-related indices including antral follicle count, anti-Müllerian hormone(AMH), follicle-stimulating hormone (FSH) were evaluated. A total of 979 women were enrolled, with 148 classified into the DOR group and 831 in the non-DOR group. The DOR group was notably older compared to the non-DOR group. Analysis showed that the DOR group exhibited significantly shorter sleep onset latency (p = 0.001) and shorter total sleep duration (p = 0.014) compared to the non-DOR group. Logistic regression analysis identified age, PSQI-sleep latency, and PSQI score as independent factors associated with an increased risk of DOR(all p < 0.05). Furthermore, stratified analysis by age group revealed that snoring and PSQI-sleep latency were particularly notable risk factors for DOR among women aged 35 years and older (OR = 2.489, p = 0.040; OR = 2.007, p = 0.008, respectively). Our study highlights that shorter sleep onset latency and shorter total sleep duration may be associated with DOR among women undergoing ART treatments. Particularly noteworthy, snoring and sleep latency were identified as additional risk factors for DOR among women aged 35 years and older.

Construction and validation of a novel nomogram for predicting spontaneous preterm birth in patients with gestational diabetes mellitus

OBJECTIVE

To explore the influencing factors of spontaneous preterm birth (sPTB) in patients with gestational diabetes mellitus (GDM) and construct a nomogram model.

METHODS

A retrospective analysis was conducted on the clinical data of 289 GDM patients who gave birth at Yangzhou University Affiliated Hospital from January 2021 to December 2022. The patients were divided into the sPTB (n = 52) and non-sPTB (n = 237) groups based on whether sPTB occurred. Logistic multivariate analysis was used to explore the influencing factors of sPTB in GDM patients and construct a nomogram model. The predictive performance of the nomogram model was evaluated using ROC curves and calibration curves in internal validation. Additionally, 62 GDM patients who visited Yangzhou University Affiliated Hospital from January 2023 to June 2023 were retrospectively selected for external validation of the prediction model.

RESULTS

Logistic analysis showed that maternal age ≥30 years, pre-pregnancy BMI ≥26.3 kg/m2, history of spontaneous abortion, premature rupture of membranes, and oral glucose tolerance test (OGTT) fasting blood glucose ≥5.1 mmol/L were independent risk factors for sPTB in GDM patients (all P<0.05). In internal validation, the AUC value of the model's ROC curve was 0.901, and in external validation, the AUC value was 0.939. The calibration curve showed that the predicted probability was consistent with the actual probability. In addition, the sensitivity, specificity, and accuracy of the model in external validation were 84.21%, 81.40%, and 82.26%, respectively.

CONCLUSION

Maternal age ≥30 years, pre-pregnancy BMI ≥26.3 kg/m2, history of spontaneous abortion, premature rupture of membranes, and OGTT fasting blood glucose ≥5.1 mmol/L are independent risk factors for sPTB in GDM patients. The nomogram model based on these risk factors has high discrimination and accuracy in predicting sPTB in GDM patients.

Integrative bioinformatics analysis for identifying the mitochondrial-related gene signature associated with immune infiltration in premature ovarian insufficiency

BACKGROUND

Premature ovarian insufficiency (POI) is a reproductive disorder characterized by the cessation of ovarian function before the age of 40. Although mitochondrial dysfunction and immune disorders are believed to contribute to ovarian damage in POI, the interplay between these factors remains understudied.

METHODS

In this research, transcriptomic data related to POI were obtained from the NCBI GEO database. Hub biomarkers were identified through the construction of a protein‒protein interaction (PPI) network and further validated using RT‒qPCR and Western blot. Moreover, their expression across various cell types was elucidated via single-cell RNA sequencing analysis. A comprehensive investigation of the mitochondrial and immune profiles of POI was carried out through correlation analysis. Furthermore, potential therapeutic agents were predicted utilizing the cMap database.

RESULTS

A total of 119 mitochondria-related differentially expressed genes (MitoDEGs) were identified and shown to be significantly enriched in metabolic pathways. Among these genes, Hadhb, Cpt1a, Mrpl12, and Mrps7 were confirmed both in a POI model and in human granulosa cells (GCs), where they were found to accumulate in GCs and theca cells. Immune analysis revealed variations in macrophages, monocytes, and 15 other immune cell types between the POI and control groups. Notably, strong correlations were observed between seven hub-MitoDEGs (Hadhb, Cpt1a, Cpt2, Mrpl12, Mrps7, Mrpl51, and Eci1) and various functions, such as mitochondrial respiratory complexes, dynamics, mitophagy, mitochondrial metabolism, immune-related genes, and immunocytes. Additionally, nine potential drugs (calyculin, amodiaquine, eudesmic acid, cefotaxime, BX-912, prostratin, SCH-79797, HU-211, and pizotifen) targeting key genes were identified.

CONCLUSIONS

Our results highlight the crosstalk between mitochondrial function and the immune response in the development of POI. The identification of MitoDEGs could lead to reliable biomarkers for the early diagnosis, monitoring, and personalized treatment of POI.

Ovarian aging: energy metabolism of oocytes

In women who are getting older, the quantity and quality of their follicles or oocytes and decline. This is characterized by decreased ovarian reserve function (DOR), fewer remaining oocytes, and lower quality oocytes. As more women choose to delay childbirth, the decline in fertility associated with age has become a significant concern for modern women. The decline in oocyte quality is a key indicator of ovarian aging. Many studies suggest that age-related changes in oocyte energy metabolism may impact oocyte quality. Changes in oocyte energy metabolism affect adenosine 5'-triphosphate (ATP) production, but how related products and proteins influence oocyte quality remains largely unknown. This review focuses on oocyte metabolism in age-related ovarian aging and its potential impact on oocyte quality, as well as therapeutic strategies that may partially influence oocyte metabolism. This research aims to enhance our understanding of age-related changes in oocyte energy metabolism, and the identification of biomarkers and treatment methods.

Developmental programming of the ovarian reserve in livestock

Mammalian females are born with a finite number of follicles in their ovaries that is referred to as the ovarian reserve. There is a large amount of variation between females in the number of antral follicles that they are born with, but this number is positively correlated to size of the ovarian reserve, has a strong repeatability within a female, and a moderate heritability. Although the heritability is moderate, numerous external factors including health, nutrition, ambient temperature, and litter size influence the size and function of the ovarian reserve throughout life. Depletion of the ovarian reserve contributes to reproductive senescence, and genetic and epigenetic factors can lead to a more rapid decline in follicle numbers in some females than others. The relationship of the size of the ovarian reserve to development of the reproductive tract and fertility is generally positive, although some studies report antagonistic associations of these traits. It seems likely that management decisions and environmental factors that result in epigenetic modifications to the genome throughout life may cause variability in the function of ovarian genes that influence fecundity and fertility, leading to differences in reproductive longevity among females born with ovarian reserves of similar size. This review summarizes our current understanding of factors influencing size of the ovarian reserve in cattle, sheep, and pigs and the relationship of the ovarian reserve to reproductive tract development and fertility. It provides strategies to apply this knowledge to improve diagnostics for better assessment of fertility and reproductive longevity in female livestock.

A Molecular Perspective and Role of NAD+ in Ovarian Aging

The decline in female fecundity is linked to advancing chronological age. The ovarian reserve diminishes in quantity and quality as women age, impacting reproductive efficiency and the aging process in the rest of the body. NAD+ is an essential coenzyme in cellular energy production, metabolism, cell signaling, and survival. It is involved in aging and is linked to various age-related conditions. Hallmarks associated with aging, diseases, and metabolic dysfunctions can significantly affect fertility by disturbing the delicate relationship between energy metabolism and female reproduction. Enzymes such as sirtuins, PARPs, and CD38 play essential roles in NAD+ biology, which actively consume NAD+ in their enzymatic activities. In recent years, NAD+ has gained much attention for its role in aging and age-related diseases like cancer, Alzheimer's, cardiovascular diseases, and neurodegenerative disorders, highlighting its involvement in various pathophysiological processes. However, its impact on female reproduction is not well understood. This review aims to bridge this knowledge gap by comprehensively exploring the complex interplay between NAD+ biology and female reproductive aging and providing valuable information that could help develop plans to improve women's reproductive health and prevent fertility issues.

Characteristics of the Follicular Fluid Extracellular Vesicle Molecular Profile in Women in Different Age Groups in ART Programs

The aim of this study was to investigate the molecular composition of follicular fluid (FF) extracellular vesicles (EVs) in women of different reproductive ages and its possible relationship to sperm fertilizing ability. FF EVs were obtained by differential centrifugation. The concentration and size distribution of FF EVs were analyzed by nanoparticle tracking analysis. The lipidome and proteome were analyzed by liquid chromatography-mass spectrometry. The isolated FF EVs had a variety of shapes and sizes; their concentration and size distribution did not differ significantly between the age groups. In women younger than 35 years, the concentration of vesicular progesterone was 6.6 times higher than in women older than 35 years, and the total levels of the main lipid classes were increased in younger women. A proteomic analysis revealed that not only FF EV-specific proteins, but also proteins involved in sperm activation were present. New data were obtained on the composition of FF EVs, confirming their importance as molecular indicators of age-related changes in the female reproductive system. In addition, these results shed light on the possible interaction between the FF EVs of women in different age groups and male germ cells. Therefore, studying the transcriptomic and metabolomic profile of FF EVs may be a crucial approach to evaluate the efficacy of ART.

DNA methylation as a window into female reproductive aging

People with ovaries experience reproductive aging as their reproductive function and system declines. This has significant implications for both fertility and long-term health, with people experiencing an increased risk of cardiometabolic disorders after menopause. Reproductive aging can be assessed through markers of ovarian reserve, response to fertility treatment or molecular biomarkers, including DNA methylation. Changes in DNA methylation with age associate with poorer reproductive outcomes, and epigenome-wide studies can provide insight into genes and pathways involved. DNA methylation-based epigenetic clocks can quantify biological age in reproductive tissues and systemically. This review provides an overview of hallmarks and theories of aging in the context of the reproductive system, and then focuses on studies of DNA methylation in reproductive tissues.

The Relationship Between Serum Anti-Müllerian Hormone and Basal Antral Follicle Count in Infertile Women Under 35 Years: An Assessment of Ovarian Reserve

Introduction Estimating ovarian reserve has been the cornerstone of designing treatment plans for female infertility over the last few years. The most reliable biomarker for assessing female fertility is the antral follicle count (AFC). Also, the anti-müllerian hormone (AMH) is a sensitive test for predicting ovarian reserve and is precisely associated with AFC value. Objective The study aimed to investigate the relationship between serum AFC and AMH levels. Methods This cross-sectional type of observational study included 101 healthy infertile women aged 20-35 years and with low serum AMH. The mean difference in basal AFC among different age groups was evaluated using an independent sample t-test, revealing no significant difference. A multiple regression model was used to assess the association between serum AMH, and other factors related to demographics and other aspects of infertile women with basal AFC. Results The mean age of infertile women in our study was 30.7±3.69, and 29.7% of females had secondary infertility. The highest ovarian reserve was notable among the group 20-25 years, and the lowest follicular volume was observed in the 31 to below 35 years. Multiple regression analyses revealed that serum AFC and AMH had a strong positive association with basal ovarian volume. Additionally, every one-unit surge in AFC and AMH was statistically significant (p<0.05) and concomitant increases with 0.45 cc and 3.98 cc in basal ovarian volume, respectively. Conclusion The AMH and AFC strongly associate with basal ovarian volume, which declines as age progresses.

Pleiotropic Signaling by Reactive Oxygen Species Concerted with Dietary Phytochemicals and Microbial-Derived Metabolites as Potent Therapeutic Regulators of the Tumor Microenvironment

The excessive generation of reactive oxygen species (ROS) plays a pivotal role in the pathogenesis of diseases. ROS are central to cellular redox regulation and act as second messengers to activate redox-sensitive signals. Recent studies have revealed that certain sources of ROS can be beneficial or harmful to human health. Considering the essential and pleiotropic roles of ROS in basic physiological functions, future therapeutics should be designed to modulate the redox state. Dietary phytochemicals, microbiota, and metabolites derived from them can be expected to be developed as drugs to prevent or treat disorders in the tumor microenvironment.

Biomarkers of aging

Aging biomarkers are a combination of biological parameters to (i) assess age-related changes, (ii) track the physiological aging process, and (iii) predict the transition into a pathological status. Although a broad spectrum of aging biomarkers has been developed, their potential uses and limitations remain poorly characterized. An immediate goal of biomarkers is to help us answer the following three fundamental questions in aging research: How old are we? Why do we get old? And how can we age slower? This review aims to address this need. Here, we summarize our current knowledge of biomarkers developed for cellular, organ, and organismal levels of aging, comprising six pillars: physiological characteristics, medical imaging, histological features, cellular alterations, molecular changes, and secretory factors. To fulfill all these requisites, we propose that aging biomarkers should qualify for being specific, systemic, and clinically relevant.