A ce jour, les effets des perturbateurs endocriniens (PE) sur les circuits neuroendocrines contrôlant la fonction de reproduction ont fait l’objet de très peu de travaux. Chez les vertébrés, l’élément majeur du contrôle central de la fonction de reproduction est la GnRH (Gonadotropin-Releasing Hormone). Le développement et l’activité des neurones à GnRH sont finement régulés, notamment par les hormones stéroïdes, ce qui les rend potentiellement sensibles aux PE. L’objectif de ce travail était d'étudier les effets neuroendocrines des xéno-œstrogènes chez le poisson zèbre (Danio rerio). Nous montrons que le 17α-éthinylestradiol (EE2) et le nonylphénol (NP) perturbent l'ontogenèse du système à GnRH au cours du développement précoce. De plus, nous démontrons que ces effets impliquent des récepteurs des œstrogènes. Parallèlement, nous mettons en évidence l’effet inducteur de l’EE2 et du NP sur l'expression de l’aromatase cérébrale, l’enzyme de synthèse des œstrogènes. L’ensemble de ces données souligne la nécessité de considérer les réseaux neuroendocrines comme des variables critiques et sensibles dans le domaine de la perturbation endocrinienne. / Until now, studies dedicated to the actions of endocrine disrupting chemicals (EDCs) on the reproductive axis have focused on the gonads and peripheral organs leaving virtually unexplored their actions on neuroendocrine circuits controlling reproduction. In vertebrates, gonadotropin-releasing hormone (GnRH) is the key factor controlling the activity of the reproductive axis. The development and functioning of GnRH neurons are finely tuned, notably by sex steroids, making these neurons potential targets of EDCs. The aim of this work was to explore the neuroendocrine effects of xenoestrogens in the zebrafish (Danio rerio). We show that 17α-ethinylestradiol (EE2) and nonylphenol (NP) disrupts the ontogeny of GnRH system during zebrafish early life stage. Moreover, we demonstrate that these effects involve functional estrogens receptors. In parallel, we report the inducing effects of EE2 and NP on the expression of brain aromatase protein, the enzyme responsible for estrogen biosynthesis. Altogether, these results highlight the need to consider neuroendocrine networks as critical and sensitive endpoints in the field of endocrine disruption.

G protein-coupled receptors (GPCRs) are a large family of trans-membrane receptors that transmit signals from extracellular stimuli to target intracellular signal transduction pathways. The gonadotropin-releasing hormone receptor (GnRH-R) is a GPCR which binds the decapeptide GnRH. In the pituitary gonadotrope, GnRH stimulates gonadotropin (LH and FSH) biosynthesis and secretion to regulate reproduction. GnRH and the GnRH-Rs are also present in many extra-pituitary tissues, although their role at these sites remains largely undetermined. GnRH-Rs are known to recruit a diverse array of signalling pathway mediators in different cell-types. These include; Gq/11-PLCβ-IP3/DAG-Ca2+/PKC signalling, monomeric G-proteins and integrins to mediate cell adhesion and migration, the activation of the major members of the mitogen-activated protein kinase (MAPK) super-family (extracellular signal-regulated kinase (ERK), c-Jun N-terminal Kinase (JNK) and p38MAPK), and β-catenin and other mediators of the canonical Wnt signalling pathway. This thesis describes the regulation of Forkhead Box O (FOXO) transcription factors by GnRH. The mammalian FOXO transcription factors, FOXO1, FOXO3a and FOXO4, are emerging as an important family of proteins that modulate the expression of genes involved in cell-cycle regulation, induction of apoptosis, DNA damage repair and response to oxidative stress. In this thesis, emphasis is placed on delineating the novel role of FOXO transcription factors in mediating two important and widely-researched areas of GnRH biology. Firstly, the role of FOXO transcription factors in mediating cell-growth inhibition in response to GnRH treatment is assessed in a heterologous HEK293/GnRH-R expressing cell line. Secondly, the role of transcription factors in regulating luteinising hormone-β (LHβ)-subunit expression is investigated in the LβT2 gonadotrope cell line. Activation of the GnRH-R can inhibit cell proliferation and induce apoptosis in certain tumour-derived cell lines. Several studies have reported that these events can occur as a result of changes in the expression profiles of specific cell-cycle regulatory and apoptotic genes, many of which are FOXO-target genes, including GADD45, FasL, p21Cip1 and p27Kip1. In this thesis, a role for FOXOs in targeting the expression of several of these genes in response to GnRH is assessed, highlighting a specific role for FOXO3a in mediating GADD45 and FasL expression. The signalling mechanisms through which FOXO3a regulates GADD45 expression in response to GnRH is also described. Finally, a stable FOXO3a-knock-down cell line was generated in order to further examine FOXO3a involvement in GnRH-induced cell-growth inhibition. GnRH is an essential regulator of the reproductive process by stimulating the synthesis of LH and FSH in pituitary gonadotropes, thereby regulating gametogenesis and steroidogenesis. Diverse signalling pathways have been reported to regulate LHβ-subunit expression in response to GnRH, including the ERK/JNK/p38MAPK cascades and factors such as Egr1, SF1 and β-catenin. In the second part of this thesis, the role of FOXOs in regulating LHβ-subunit expression in response to GnRH is described. The data presented suggests that GnRH can regulate LHβ-subunit expression through both indirect and direct FOXO3a-mediated mechanisms. Firstly, FOXO3a was found to regulate Egr1 expression to indirectly target LHβ-promoter activity. Secondly, a role for β-catenin as a FOXO3a co-factor to directly regulate LHβ-subunit expression, together with Egr1 and SF1, is also proposed. FOXO3a expression and sub-cellular localisation was assessed and demonstrated in LβT2 cells and in adult human male pituitary sections. The research presented in this thesis adds to the diversity of signalling pathways and mediators that GnRH can target in different cellular backgrounds in order to mediate a variety of cellular processes. The antiproliferative and apoptotic effects of GnRH on tumour-derived cell lines are well-documented, and this research highlights a novel role for FOXO3a in mediating these events. The regulation of gonadotropin synthesis remains an important topic of research, and the novel implication of FOXO3a in mediating LHβ-subunit expression adds further complexity to gonadotrope physiology.

Variant GnRH ligand and receptor subtypes have been identified in a number of non-mammalian vertebrate species, however research into avian species GnRH systems is lacking. Two isoforms of GnRH are present in the domestic chicken, the evolutionarily conserved GnRH-II and diverged cGnRH-I. The expression of two GnRH ligands parallels the expression of two chicken GnRH receptor subtypes; cGnRH-R-I and the novel cGnRH-R-III. The occurrence of two isoforms of the receptor in the chicken raises questions about their specific biological functions and interactions with the two ligands. Differential roles for these molecules in regulating gonadotrophin secretion or other functions are currently unclear. To investigate this, cGnRH-R-III cDNA was cloned from a broiler chicken anterior pituitary gland and its structure and expression was compared with cGnRH-R-I. Expression profiling of cGnRH-R-III cDNA showed that it is predominantly expressed in the anterior pituitary, approximately 1400 times more abundantly than cGnRH-R-I suggesting that cGnRH-R-III is the predominant regulator of chicken gonadotrophin synthesis and secretion. Additionally, pronounced sex and age differences existed, with higher pituitary cGnRH-R-III mRNA levels in sexually mature females versus juvenile females. In contrast, higher mRNA expression levels occurred in juvenile males compared to sexually mature males. Determination of ligand-binding selectivity and the level of cGnRH-R-III activation in response to the endogenous ligands, cGnRH-I and GnRH-II, was anticipated as facilitating the elucidation of the physiological roles of the receptor subtypes. Additionally, the development of analogs that differentially promote or inhibit activation of the receptor subtypes may be valuable tools for determining the role of receptor types in the regulation of gonadotrophin production. To investigate this, pharmacological profiling of cGnRH-R-III in terms of ligand-binding selectivity and inositol phosphate production in response to GnRH analogs was determined in comparison with the pharmacological profile of cGnRH-R-I. Functional studies in COS-7 cells indicated that cGnRH-R-III has a higher binding affinity for GnRH-II than cGnRH-I (IC50: 0.57 v 19.8 nM) and more potent stimulation of inositol phosphate production (EC50: 0.8 v 4.38 nM). Similar results were found for cGnRH-R-I, (IC50: 0.51 v 10.8 nM) and (EC50: 0.7 v 2.8 nM). Mammalian receptor antagonist 27 distinguished between cGnRH-R-I and cGnRH-R-III (IC50: 2.3 v 351 nM), and application of this synthetic peptide may facilitate delineation of receptor subtype function either in-vitro or in-vivo. The length of the C-terminal tail of cGnRH-R-III is 8 residues longer than that of cGnRH-R-I and this observation stimulated investigation of differences in ligand-induced internalisation between the two receptor subtypes. The initial rate of receptor internalisation was faster for cGnRH-R-III than for cGnRH-R-I (26%.min-1 v 15.8%.min-1). Although proteins encoded by cGnRH-R-III splice variants do not bind GnRH ligands independently and mRNAs were not detectable by Northern blot analysis, cGnRH-R-III_SV2 significantly reduced maximum ligand-binding of cGnRH-R-III, suggesting that it may impair the function of the full-length type III cGnRH receptor. It was anticipated that the two cGnRH-R subtypes may have differential roles in the regulation of luteinising hormone (LH) and follicle stimulating hormone (FSH) gene transcription through the activation of differential second messenger pathways. Three putative Src homology domain 3 (SH3) binding motifs were identified in the type III cGnRH receptor cytoplasmic C-terminal tail domain which are not present in the type I cGnRH-R and suggested the potential for differential coupling to the Mitogen Activated Protein Kinase (MAPK) cascade. To investigate this possibility, activation of the MAPK cascade via cGnRH-R-III and cGnRH-R-I was determined by quantifying elevation of phosphorylated ERK (pERK 1/2) in response to GnRH. Studies performed in COS-7 cells showed a 4-6 fold increase in ERK 1/2 phosphorylation via the type I and type III receptors within 10 minutes of GnRH-I or GnRH-II stimulation, indicating that both receptors signal through the ERK 1/2 pathway in response to cGnRH-I or GnRH-II. The responses were dose-dependent at cGnRH-R-I and cGnRH-R-III. Effects of pre-treatment with PLC and c-Src inhibitors showed that both cGnRH-Rs may activate pERK 1/2 independently of PLC but dependently upon c-Src. However, it must be noted that 100% of the PLC activity was not inhibited by PLC inhibitor as measured by inositol phosphate production at 60 minutes, and the PLC inhibitor has not been shown to inhibit PLC in the same time frame used for the pERK experiments. Mutagenesis of the individual SH3 binding motifs of cGnRH-R-III were performed and the effects on pERK 1/2 levels quantified. The results indicated that the SH3 binding motifs of cGnRH-R-III do not contribute to additional MAPK activation when compared to the native cGnRH-R-III. Both cGnRH-R-I and cGnRH-R-III were HA epitope-tagged (HA-cGnRH-R-I and HA-cGnRH-R-III) and the methodology was optimised for HA-cGnRH-R-III immuno-precipitation. Several size forms of HA-cGnRH-R-III were detectable by immuno-precipitation, facilitating characterisation of the composition of the receptor protein-protein complexes formed using a western blot approach. In summary, the abundance of cGnRH-R-III expression compared to cGnRH-R-I suggests it is probably the major mediator of pituitary gonadotroph function, and that tissue-specific recruitment of cGnRH-R-isoforms has occurred in the avian pituitary during evolution. Pharmacological profiling demonstrated that cGnRH-R-III, like cGnRH-R-I, has a higher ligand-binding selectivity and induction of inositol phosphate production in response to GnRH-II than with cGnRH-I, although cGnRH-I is established as the physiological regulator of gonadotroph function. These results suggest that evolutionary recruitment of ligand-receptor pairing for particular physiological processes does not correlate with in-vitro properties such as highest ligand-binding affinity or efficacy of inositol phosphate production. Therefore evolutionary plasticity has occurred in the tissue-specific adoption of GnRH ligand and receptor subtypes for regulation of particular physiological functions in birds.

Introdução - A puberdade precoce verdadeira ou dependente de GnRH apresenta importante morbidade: a baixa estatura, conseqüência da rápida progressão da idade óssea, além das seqüelas psico-emocionais do desenvolvimento sexual secundário precoce. Daí a importância da realização de um diagnóstico precoce e preciso, a fim de que a terapêutica adequada seja instituída o quanto antes. O uso do análogo do GnRH (aGnRH) em teste diagnóstico vem sendo utilizado com este objetivo. Neste estudo avaliou-se os valores de corte para o diagnóstico de puberdade precoce verdadeira, usando-se o teste do aGnRH. Material e métodos - Estudo prospectivo, com 44 meninas, com desenvolvimento dos caracteres sexuais secundários antes dos 8 anos de idade, atendidas no Ambulatório de Ginecologia Infanto-Puberal do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo. Realizou-se, em todos os casos, o teste do aGnRH, que consistiu na coleta de amostra sanguínea basal para dosagem de FSH e LH, seguida da aplicação subcutânea de 500µg de acetato de leuprolida (Lupron®). Novas amostras sanguíneas foram realizadas após 3 horas, para dosagem de FSH e LH, e após 24 horas da aplicação, para dosagem de estradiol Compararam-se os níveis de LH e FSH basais, de 3 horas e a relação LH/FSH obtida, além do estradiol de 24h, com a evolução clínica das pacientes. Este foi o padrão ouro utilizado para análise do teste, sendo que, após 6 meses, as pacientes foram divididas em 2 grupos: puberdade progressiva (puberdade precoce verdadeira) e não-progressiva. Para análise estatística, utilizou-se curvas ROC, estabelecendo-se sensibilidade, especificidade e melhor nível de corte para o diagnóstico de puberdade precoce verdadeira, para os diferentes critérios analisados. Além disso, avaliou-se a concordância entre os diversos tipos de análise do teste, através do coeficiente kappa. Resultados - O LH de 3 horas apresentou valor de corte > 4,5 mUI/mL, sensibilidade 59,1% e especificidade 86,4%, com área sobre a curva de 0,723. O valor de kappa foi de 0,45, com concordância de 0,73. O estradiol de 24 horas apresentou valor de corte > 40,6 pg/mL, sensibilidade 70% e especificidade 73,7%, com área sobre a curva de 0,703. O valor de kappa foi de 0,436, com concordância de 0,718. Dentre todos os critérios analisados, o melhor deles foi a relação LH/FSH de 3 horas, com valor de corte > 0,14, sensibilidade 72,7% e especificidade 77,3%, com área sobre a curva de 0,771. O valor de kappa foi de 0,5, com concordância de 0,75. Conclusões - Em nossa avaliação, a relação LH/FSH de 3 horas foi superior ao valor de LH de 3 horas ou estradiol de 24 horas, que haviam sidos os melhores critérios diagnósticos no trabalho pioneiro na utilização deste teste. / Introduction - True or GnRH-dependent precocious puberty involves important morbidity such as short stature due to the rapid progression of bone age, as well as psycho-emotional sequels of precocious secondary sexual development. Thus, it is important to make an early and precise diagnosis so that appropriate treatment can be instituted as early as possible. The GnRH analogue (aGnRH) in the diagnostic test has been used for this purpose. In the present study, the sensitivity and specificity of different laboratory criteria for the diagnosis of true precocious puberty were compared using the aGnRH test. Material and methods - This was a prospective study conducted on 44 girls with the development of secondary sexual traits before 8 years of age attended at the Childhood-Pubertal Gynecology Outpatient Clinic of the University Hospital, Faculty of Medicine of Ribeirão Preto, University of São Paulo. The aGnRH test was performed in all cases, consisting of collection of a basal blood sample for the determination of FSH and LH, followed by subcutaneous application of 500 µg leuprolide acetate (Lupron®). New blood samples were obtained after 3 hours, for the determination of FSH and LH, and after 24hours of application, for determination of estradiol. Basal LH and FSH levels and levels after 3 hours, the LH/FSH ratio obtained 3 hours after the administration of 500 µg Lupron®, and 24 hour estradiol levels were compared with the clinical course of the patients. This was the gold standard used for the analysis of the test and after 6 months the patients were divided into 2 groups: progressive puberty (true precocious puberty) and non-progressive puberty. ROC curves were used for statistical analysis, with the determination of the sensitivity, specificity and best cut-off value for the diagnosis of true precocious puberty of the different criteria analyzed. In addition, the agreement of the various types of test analysis was evaluated using the kappa coefficient. Results - Three hour LH presented a cut-off value of > 4.5 mIU/mL, 59.1% sensitivity and 86.4% specificity, with an area under the curve of 0.723. The kappa value was 0.45, with 0.73 agreement. Twenty-four hour estradiol presented a cut-off value of > 40.6 pg/mL, 70% sensitivity and 73.7% specificity, with an area under the curve of 0.703. The kappa value was 0.436, with 0.718 agreement. The best of all criteria used was the 3 hour LH/FSH ratio, with a cut-off value of > 0.14, 72.7% sensitivity and 77.3% specificity, with an area under the curve of 0.771. The kappa value was 0.5, with 0.75 agreement. Conclusions - In the present evaluation, the 3 hour LH/FSH ratio was superior to the 3 hour LH value and the 24 hour estradiol value, which had been the best diagnostic criteria in the pioneering study using this test.

Master of Science / Department of Animal Sciences and Industry / Teresa Douthit / Joann Kouba / Gonadotropin-releasing hormone (GnRH-I), as well as its receptor, GnRHR-I, once thought to be localized solely to the hypothalamus and anterior pituitary, have since been detected in the testis of numerous mammals. Another isoform of GnRH, GnRH-II, has been isolated from the testis of numerous mammals and binds a specific receptor, GnRHR-II. Our objective was to establish whether GnRH-I and GnRH-II, along with their specific receptors, are produced and present in the equine testis. Testicular tissue was collected from colts < 2 yr (n = 5) and stallions ≥ 2 yr (n = 10) of age during routine castrations. Total RNA extracted from testicular tissue was reverse transcribed and cDNA was subjected to conventional PCR using gene specific primers for GnRH-I, GnRHR-I, GnRH-II, and GnRHR-II. Protein was extracted and subjected to dot blot and Western blot using antibodies directed against GnRH-I, GnRH-II, GnRHR-I, or GnRHR-II. Transcripts for both ligands and receptors were detected in all testes. Product identity was confirmed by sequencing, which also clarified that unusual band sizes were the result of alternative splicing of GnRHR-II, and the retention of an intron in the GnRH-II mRNA was discovered. Prepro-GnRH-I and prepro-GnRH-II protein was detected in all stallion testes via dot blot technique. On Western blots, testicular samples from colts (n = 4) had 3-fold greater GnRHR-I levels compared to stallions (n = 7; P < 0.022). Conversely, there was a tendency for GnRHR-II protein to be greater in tissue collected from stallions compared to colts (P < 0.0756). Finally semen was collected from mature stallions (9 to 18 yr; n = 4) and purified using a discontinuous gradient. By utilizing immunocytochemistry, GnRHR-II was localized to the connecting piece of mature stallion spermatozoa. This is the first report identifying GnRH-I and -II and their receptors in the equine testis and GnRHR-II on mature stallion spermatozoa. These decapeptide hormones may act via autocrine and/or paracrine signaling to affect steroidogenesis and spermatogenesis in the stallion testis.

Introdução - A puberdade precoce verdadeira ou dependente de GnRH apresenta importante morbidade: a baixa estatura, conseqüência da rápida progressão da idade óssea, além das seqüelas psico-emocionais do desenvolvimento sexual secundário precoce. Daí a importância da realização de um diagnóstico precoce e preciso, a fim de que a terapêutica adequada seja instituída o quanto antes. O uso do análogo do GnRH (aGnRH) em teste diagnóstico vem sendo utilizado com este objetivo. Neste estudo avaliou-se os valores de corte para o diagnóstico de puberdade precoce verdadeira, usando-se o teste do aGnRH. Material e métodos - Estudo prospectivo, com 44 meninas, com desenvolvimento dos caracteres sexuais secundários antes dos 8 anos de idade, atendidas no Ambulatório de Ginecologia Infanto-Puberal do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo. Realizou-se, em todos os casos, o teste do aGnRH, que consistiu na coleta de amostra sanguínea basal para dosagem de FSH e LH, seguida da aplicação subcutânea de 500µg de acetato de leuprolida (Lupron®). Novas amostras sanguíneas foram realizadas após 3 horas, para dosagem de FSH e LH, e após 24 horas da aplicação, para dosagem de estradiol Compararam-se os níveis de LH e FSH basais, de 3 horas e a relação LH/FSH obtida, além do estradiol de 24h, com a evolução clínica das pacientes. Este foi o padrão ouro utilizado para análise do teste, sendo que, após 6 meses, as pacientes foram divididas em 2 grupos: puberdade progressiva (puberdade precoce verdadeira) e não-progressiva. Para análise estatística, utilizou-se curvas ROC, estabelecendo-se sensibilidade, especificidade e melhor nível de corte para o diagnóstico de puberdade precoce verdadeira, para os diferentes critérios analisados. Além disso, avaliou-se a concordância entre os diversos tipos de análise do teste, através do coeficiente kappa. Resultados - O LH de 3 horas apresentou valor de corte > 4,5 mUI/mL, sensibilidade 59,1% e especificidade 86,4%, com área sobre a curva de 0,723. O valor de kappa foi de 0,45, com concordância de 0,73. O estradiol de 24 horas apresentou valor de corte > 40,6 pg/mL, sensibilidade 70% e especificidade 73,7%, com área sobre a curva de 0,703. O valor de kappa foi de 0,436, com concordância de 0,718. Dentre todos os critérios analisados, o melhor deles foi a relação LH/FSH de 3 horas, com valor de corte > 0,14, sensibilidade 72,7% e especificidade 77,3%, com área sobre a curva de 0,771. O valor de kappa foi de 0,5, com concordância de 0,75. Conclusões - Em nossa avaliação, a relação LH/FSH de 3 horas foi superior ao valor de LH de 3 horas ou estradiol de 24 horas, que haviam sidos os melhores critérios diagnósticos no trabalho pioneiro na utilização deste teste. / Introduction - True or GnRH-dependent precocious puberty involves important morbidity such as short stature due to the rapid progression of bone age, as well as psycho-emotional sequels of precocious secondary sexual development. Thus, it is important to make an early and precise diagnosis so that appropriate treatment can be instituted as early as possible. The GnRH analogue (aGnRH) in the diagnostic test has been used for this purpose. In the present study, the sensitivity and specificity of different laboratory criteria for the diagnosis of true precocious puberty were compared using the aGnRH test. Material and methods - This was a prospective study conducted on 44 girls with the development of secondary sexual traits before 8 years of age attended at the Childhood-Pubertal Gynecology Outpatient Clinic of the University Hospital, Faculty of Medicine of Ribeirão Preto, University of São Paulo. The aGnRH test was performed in all cases, consisting of collection of a basal blood sample for the determination of FSH and LH, followed by subcutaneous application of 500 µg leuprolide acetate (Lupron®). New blood samples were obtained after 3 hours, for the determination of FSH and LH, and after 24hours of application, for determination of estradiol. Basal LH and FSH levels and levels after 3 hours, the LH/FSH ratio obtained 3 hours after the administration of 500 µg Lupron®, and 24 hour estradiol levels were compared with the clinical course of the patients. This was the gold standard used for the analysis of the test and after 6 months the patients were divided into 2 groups: progressive puberty (true precocious puberty) and non-progressive puberty. ROC curves were used for statistical analysis, with the determination of the sensitivity, specificity and best cut-off value for the diagnosis of true precocious puberty of the different criteria analyzed. In addition, the agreement of the various types of test analysis was evaluated using the kappa coefficient. Results - Three hour LH presented a cut-off value of > 4.5 mIU/mL, 59.1% sensitivity and 86.4% specificity, with an area under the curve of 0.723. The kappa value was 0.45, with 0.73 agreement. Twenty-four hour estradiol presented a cut-off value of > 40.6 pg/mL, 70% sensitivity and 73.7% specificity, with an area under the curve of 0.703. The kappa value was 0.436, with 0.718 agreement. The best of all criteria used was the 3 hour LH/FSH ratio, with a cut-off value of > 0.14, 72.7% sensitivity and 77.3% specificity, with an area under the curve of 0.771. The kappa value was 0.5, with 0.75 agreement. Conclusions - In the present evaluation, the 3 hour LH/FSH ratio was superior to the 3 hour LH value and the 24 hour estradiol value, which had been the best diagnostic criteria in the pioneering study using this test.

Eine Chemotherapie-induzierte Infertilität bedingt bei vielen betroffenen Patientinnen eine verminderte Lebensqualität sowie eine erhebliche psychische Belastung. Daher ist die Forschung an verschiedenen Maßnahmen der Fertilitätsprotektion von Patientinnen im reproduktionsfähigen Alter, die eine zytotoxische Therapie benötigen, von großer Bedeutung. Bislang gibt es keine ideale Methode der Ovarprotektion während einer gonadotoxischen Therapie. Nicht-medikamentöse Maßnahmen zum Fertilitätserhalt haben den Nachteil der Invasivität und des hierzu häufig notwendigen Zeitfensters von mindestens zwei Wochen. Außerdem bleiben die Kryokonservierung von Ovargewebe, die In-vitro-Maturation und die Kryokonservierung von unreifen Oozyten bislang aufgrund der geringen Erfahrung nur experimentell. Bezüglich der Wirksamkeit einer medikamentösen Fertilitätsprotektion mittels GnRH-Agonisten bleibt die Evidenz kontrovers. Anhand der hier vorgestellten prospektiven Kohortenstudie mit 116 prämenopausalen Chemotherapie-Patientinnen im Alter von 13‑40 Jahren sollte die Wirksamkeit einer Fertilitätsprotektion mittels GnRH-a überprüft werden. Bei der Beurteilung der ovariellen Reserve lag der Fokus auf der Bestimmung des Anti-Müller-Hormons, welches nach aktueller Evidenz die ovarielle Reserve am genausten wiederspiegelt, jedoch bisher nur in wenigen Studien zu dieser Thematik untersucht wurde. In unserem Patientenkollektiv waren die erhobenen Fertilitätsparameter (Zyklus und serologische Marker: AMH, FSH, E2) nach der Chemotherapie im Vergleich zu vorher größtenteils signifikant verändert, entsprechend einer verminderten ovariellen Reserve. Die Anti-Müller-Hormon-Serumspiegel waren im Gesamtkollektiv nach der Chemotherapie signifikant gesunken (p < 0,001) und die FSH-Serumspiegel waren signifikant angestiegen (p = 0,023). Ferner hatten nach der Chemotherapie nur noch 61,3 % der Patientinnen einen regelmäßigen Zyklus, im Gegensatz zu 100 % vor der Chemotherapie. Aus diesen Ergebnissen lässt sich ableiten, dass in unserem Patientenkollektiv trotz der GnRH-a-Therapie die Entwicklung einer Chemotherapie-induzierten ovariellen Insuffizienz nicht verhindert werden konnte. Besondere Berücksichtigung bei der Auswertung der Ergebnisse fanden der Einfluss des Alters und des Body-Mass-Index sowie die Verwendung einer hormonellen Konzeption auf die Fertilitätsparameter. Aufgrund der hohen Zahl an Drop-outs (n = 81) sind die Ergebnisse dieser Studie jedoch nur eingeschränkt generalisierbar. Auch wäre der Vergleich mit einer Kontrollgruppe von größerer Aussagekraft gewesen. Eine mögliche Erklärung für die weiterhin kontroverse Datenlage bezüglich der Wirksamkeit von GnRH-Agonisten in der Fertilitätsprotektion ist die schlechte Vergleichbarkeit der bisher durchgeführten Studien. Dies liegt unter anderem an den heterogenen Patientengruppen (Erkrankungsart, Therapieart und -dosis, Altersunterschied), den unterschiedlichen Definitionen ovarieller Insuffizienz, den teilweise sehr kurzen Follow-up-Zeiträumen sowie daran, dass der Großteil der Studien bislang nicht Placebo-kontrolliert durchgeführt wurde. Insgesamt besteht daher der Bedarf an weiteren randomisiert-kontrollierten Studien mit großen Patientenkollektiven und genauen Methoden der Beurteilung der ovariellen Reserve, idealerweise mittels AMH-Wert-Bestimmung kombiniert mit der sonographischen Ermittlung der Anzahl antraler Follikel (AFC). In der klinischen Praxis wird die Anwendung von GnRH-Agonisten in der Fertilitätsprotektion aufgrund der unklaren Datenlage nur in Kombination mit anderen Maßnahmen empfohlen. / Due to improving overall survival in cancer patients long-term side effects of chemotherapy are becoming more important. Gonadotoxicity is a severe side-effect of many cytotoxic therapies. We designed a prospective cohort study to test whether GnRH-a have a protective effect on fertility in women during chemotherapy. To evaluate fertility we used anti-mullerian-hormone (AMH) levels. Furthermore we investigated on possible factors influencing hormone levels (BMI, hormonal contraceptives). In our cohort study (n=116) there was no protective effect of GnRH-a on fertility in women undergoing cytotoxic therapy. There was also no effect of contraceptives or BMI on AMH-levels. However, we had a very large drop out rate (68,8%) To evaluate the protective effect of GnRH on the ovaries and possible influencing factors on AMH, more large RCT’s with long-term follow up are needed.

We hypothesized that marked reductions in secretion of luteinizing hormone (LH) during transitional and anovulatory periods can be accounted for by similar reductions in hypothalamic gonadotropin-releasing hormone (GnRH) secretion. Catheters were inserted surgically into the intercavernous sinus (ICS) of seven non-pregnant mares via the superficial facial vein during the ovulatory season (August 12-23), fall transition (November 15-30), the anovulatory season (January 19 - February 1) and spring transition (March 24 - May 12). Catheter placement was confirmed and standardized in each mare by lateral radiography. Ovarian status was monitored throughout the study by transrectal ultrasonography and serum concentrations of progesterone. During the breeding season, ICS blood samples were collected at 5-min intervals for 8 h when the dominant follicle reached approximately 35 mm and estrous behavior was observed. All mares ovulated within 5 d after sampling, except one mare who ovulated < 24 h before sampling. During the fall, mares were anovulatory (n = 5) or had a final ovulation within 5 d following intensive sampling (n = 2). Winter anovulation sampling was performed when all mares were anovulatory. During spring transition, each mare was sampled just before the second ovulation of the season. Similar to the ovulatory season, mares were sampled when the dominant, preovulatory follicle reached approximately 35 mm and estrous behavior was observed. Mean concentrations of LH were markedly higher (P < 0.01) during the breeding season than during all other seasons. Lower mean concentrations of LH in the fall transition, winter anovulation and spring transition sampling periods occurred coincident with a similar reduction (P < 0.01) in amplitude of LH pulses. Unexpectedly, neither the frequency (pulse/8 h) of LH pulses, frequency and amplitude of GnRH pulses, nor mean concentrations of GnRH differed among seasons. In addition, there were no differences observed due to season in mean concentrations of FSH or amplitude of FSH pulses. However, a small but significant (P < 0.05) reduction in the frequency of FSH pulses was observed during fall transition compared to all other seasons. In summary, contrary to accepted dogma, these results indicate that the photoperiodic initiation of seasonal anovulation in the mare is mediated at the level of the anterior pituitary, and appears to occur through a dampening of gonadotroph responsiveness to an unchanging pattern and magnitude of GnRH secretion.

We hypothesized that marked reductions in secretion of luteinizing hormone (LH) during transitional and anovulatory periods can be accounted for by similar reductions in hypothalamic gonadotropin-releasing hormone (GnRH) secretion. Catheters were inserted surgically into the intercavernous sinus (ICS) of seven non-pregnant mares via the superficial facial vein during the ovulatory season (August 12-23), fall transition (November 15-30), the anovulatory season (January 19 - February 1) and spring transition (March 24 - May 12). Catheter placement was confirmed and standardized in each mare by lateral radiography. Ovarian status was monitored throughout the study by transrectal ultrasonography and serum concentrations of progesterone. During the breeding season, ICS blood samples were collected at 5-min intervals for 8 h when the dominant follicle reached approximately 35 mm and estrous behavior was observed. All mares ovulated within 5 d after sampling, except one mare who ovulated < 24 h before sampling. During the fall, mares were anovulatory (n = 5) or had a final ovulation within 5 d following intensive sampling (n = 2). Winter anovulation sampling was performed when all mares were anovulatory. During spring transition, each mare was sampled just before the second ovulation of the season. Similar to the ovulatory season, mares were sampled when the dominant, preovulatory follicle reached approximately 35 mm and estrous behavior was observed. Mean concentrations of LH were markedly higher (P < 0.01) during the breeding season than during all other seasons. Lower mean concentrations of LH in the fall transition, winter anovulation and spring transition sampling periods occurred coincident with a similar reduction (P < 0.01) in amplitude of LH pulses. Unexpectedly, neither the frequency (pulse/8 h) of LH pulses, frequency and amplitude of GnRH pulses, nor mean concentrations of GnRH differed among seasons. In addition, there were no differences observed due to season in mean concentrations of FSH or amplitude of FSH pulses. However, a small but significant (P < 0.05) reduction in the frequency of FSH pulses was observed during fall transition compared to all other seasons. In summary, contrary to accepted dogma, these results indicate that the photoperiodic initiation of seasonal anovulation in the mare is mediated at the level of the anterior pituitary, and appears to occur through a dampening of gonadotroph responsiveness to an unchanging pattern and magnitude of GnRH secretion.

Σκοπός της μελέτης ήταν η διερεύνηση ύπαρξης μεταλλάξεων στα γονίδια KAL, της GnRH, του υποκινητή της GnRH, του υποδοχέα της GnRH, και του υποκινητή του υποδοχέα της GnRH, σε ασθενείς με ανεπάρκεια GnRH, με στόχο την εξαγωγή συμπερασμάτων σχετικά με τη συχνότητα των διαφόρων μορφών μετάδοσης της νόσου στον ελληνικό χώρο, καθώς και η συσχέτιση μεταξύ του γονότυπου των ασθενών και ειδικών κλινικών φαινοτύπων. Μελετήθηκαν συνολικά τριάντα οκτώ (38) ασθενείς με ανεπάρκεια GnRH, δώδεκα (12) ασθενείς με σύνδρομο Kallmann και είκοσι έξι (26) ασθενείς (13 άνδρες και 13 γυναίκες) με ιδιοπαθή υπογοναδοτροφικόΤο σύνδρομο ανεπάρκειας της GnRH περιλαμβάνει ετερογενή, αλλά συναφή προς το κλινικό φαινότυπο πληθυσμό ασθενών οι οποίοι παρουσιάζουν πλήρη ή μερική απώλεια της ικανότητας του οργανισμού τους να προάγει την κατά ώσεις έκκριση της GnRH. Η ανεπάρκεια αυτή οδηγεί στην πλήρη ή μερική αναστολή της σεξουαλικής ωρίμανσης και σε στειρότητα του ασθενούς. Η παρουσία συνοδού ανοσμίας αναφέρεται ως σύνδρομο Kallmann, ενώ η απουσία άλλων συνοδών ανωμαλιών ως ιδιοπαθής υπογοναδοτροφικός υπογοναδισμός (ΙΥΥ). Σκοπός της μελέτης ήταν η διερεύνηση ύπαρξης μεταλλάξεων στα γονίδια KAL, της GnRH, του υποκινητή της GnRH, του υποδοχέα της GnRH, και του υποκινητή του υποδοχέα της GnRH, σε ασθενείς με ανεπάρκεια GnRH, με στόχο την εξαγωγή συμπερασμάτων σχετικά με τη συχνότητα των διαφόρων μορφών μετάδοσης της νόσου στον ελληνικό χώρο, καθώς και η συσχέτιση μεταξύ του γονότυπου των ασθενών και ειδικών κλινικών φαινοτύπων. Μελετήθηκαν συνολικά τριάντα οκτώ (38) ασθενείς με ανεπάρκεια GnRH, δώδεκα (12) ασθενείς με σύνδρομο Kallmann και είκοσι έξι (26) ασθενείς (13 άνδρες και 13 γυναίκες) με ιδιοπαθή υπογοναδοτροφικό υπογοναδισμό (ΙΥΥ). Η μεθοδολογία της εργαστηριακής έρευνας περιέλαβε απομόνωση DNA γονιδιώματος από τους ασθενείς εκλεκτικό πολλαπλασιασμό της κωδικοποιησης με την μέθοδο PCR και τέλος προσδιορισμό της αλληλουχίας του DNA στα προϊόντα της PCR. Στους ασθενείς με σύνδρομο Kallmann δεν ανευρέθη αλλαγή βάσεων του γονιδίου KAL. Επισης, στους ασθενείς με ιδιοπαθή υπογοναδοτροφικό υπογοναδισμό δεν εντοπίστηκαν μεταλλάξεις στους υποκινητές των γονιδίων της GnRH και του υποδοχέα της. Σε πέντε ασθενείς με ιδιοπαθή υπογοναδοτροφικό υπογοναδισμό που αφορούσαν σποραδικές περιπτώσεις, εντοπίστηκε η μετάλλαξη (gc στο κωδικόνιο 16 Trp16Ser ) στο γονίδιο της GnRH η οποία αποτελεί φυσικό πολυμορφισμό. Στο γονίδιο του υποδοχέα της GnRH εντοπίστηκαν δύο μεταλλάξεις. Η μετάλλαξη (ct στο κωδικόνιο 146), ανιχνεύτηκε σε δύο ασθενείς με οικογενή κληρονομικότητα. Η μετάλλαξη αυτή προκαλεί αλλαγή του αμινοξέως στη θέση 146 της πρωτείνης από προλίνη σε σερίνη την οποία φέρουν και οι δύο ασθενείς σε ετεροζυγωτία. Στους δύο ασθενείς με ΙΥΥ και τη μετάλλαξη Pro146Ser, καθώς και σε ένα άνδρα με ΙΥΥ και φυσιολογική αλληλουχία του υποδοχέα της GnRH παρατηρήθηκε αντίσταση στη δράση της GnRH. Ασθενείς με ΙΥΥ και αντίσταση στη δράση της GnRH αποτελούν φυσικά πρότυπα για τη μελέτη και τον εντοπισμό των πολλαπλών γονοτυπικών συνδυασμών οι οποίοι έχουν ως κατάληξη την εμφάνιση του συγκεκριμένου φαινοτύπου. Ο μη εντοπισμός νοσογόνων μεταλλάξεων ομοζυγωτίας ή διπλής ετεροζυγωτίας στους συγκεκριμένους ασθενείς συνηγορεί στην ύπαρξη διαταραχών στην έκφραση γονιδίων τα οποία επηρεάζουν ή την ενδοκυττάρια μετάδοση του μηνύματος ή την ίδια την έκφραση του υποδοχέα της GnRH. Αν και το γονίδιο KAL έχει ενοχοποιηθεί για την ανάπτυξη ψυχοπαθολογικών εκδηλώσεων, με κύριο εκπρόσωπο τη σχιζοφρένεια, οι εκδηλώσεις από τη ψυχική σφαίρα ασθενών με σύνδρομο Kallmann δεν έχουν μελετηθεί. Επιπλέον σκοπός της παρούσης μελέτης ήταν να περιγράψει αυτές τις διαταραχές και να τις συσχετίσει με το γονότυπο των ασθενών. Ένας εκ των ασθενών με σύνδρομο Kallmann παρουσίαζε και σχιζοφρένεια χωρίς όμως να αναδειχθούν μεταλλάξεις στο γονιδίωμά του. Ενώ παράλληλα οι ασθενείς με ανεπάρκεια GnRH δεν διαφέρουν σημαντικά στις κλίμακες ψυχοπαθολογίας ούτε από τις μέσες τιμές φυσιολογικού πληθυσμού, ούτε από τις τιμές που έδωσε η ομάδα ελέγχου με χρόνιες σωματικές παθήσεις, δίνουν σημαντικά χαμηλότερες τιμές σε όλες τις κλίμακες ψυχοπαθολογίας από ότι οι ψυχιατρικά ασθενείς, εκτός από την υποκλίμακα του «θυμού». / The syndrome of GnRH insufficiency is due to a functional deficit of GnRH production or secretion in the hypothalamus resulting in the loss of pulsatile secretion of GnRH. This deficiency leads to a complete or partial arrest of sexual maturation and infertility. Patients with no further anomalies are referred as having Idiopathic Hypogonadotropic Hypogonadism (IHH) and when accompanied with anosmia, it is called Kallmann syndrome. The aim of this study was to identify mutations in the KAL gene, the GnRH gene, the GnRH receptor gene and their promoters in patients with GnRH insufficiency, the prevalence in the Greek population and the relevance between the genotype and individual phenotype of these patients. The study included thirty eight (38) patients with GnRH insufficiency, twelve patients (12) with Kallmann syndrome and twenty six patients with IHH (13 male and 13 female). Detection was carried out by isolation of genomic DNA from whole blood, which was used as a template for PCR amplification and finally, cycle sequencing analysis of all exons spanning the entire coding regions of the genes. No mutations were found in the KAL gene, whereas in patients with IHH, no mutations were identified in transcription factor binding sites of the promoters of the GnRH and GnRH receptor gene. In the GnRH gene of five (5) patients with IHH a natural polymorphism was identified in codon 16 (gc Trp16Ser). In the GnRH receptor gene a novel mutation was found in codon 146, resulting in substitution of proline with serine identified in two sisters harboring this mutation in hetrozygosity. The two sisters and a male patient with IHH with normal gene sequencing were found to be resistant to GnRH action. Resistance to GnRH is particularly rare among IHH patients. One might hypothesize, that these patients ought to have inactivating mutations in their receptor gene. However such a defect was not found, therefore making these patients an ideal clinical phenotype of an aberration in signal transduction pathway or in transcriptional factors which regulate the expression of the GnRH receptor. A common pathogenesis for KS and schizophrenia had been proposed, based on shared pathologies of these two disorders. The gene for the X-linked form of KS (known as KAL) has been implicated in the genetic pathogenesis of schizophrenias, although no such clinical associations have ever been reported. An additional aim of this study was to identify any pshychopathologies in these patients. One of our patients with KS also developed schizophrenia but no mutations were identified in all 14 exons of the KAL gene.