Five studies were designed to characterize the effects of a non-steroidal aromatase inhibitor, letrozole, on ovarian function in cattle. The general hypothesis was that non-steroidal aromatase inhibitors have potential as a steroid-free option for the control of ovarian function for the purposes of fixed-time artificial insemination and embryo production. The specific objectives were to determine the effect of route and vehicle, type of aromatase inhibitor, and duration of aromatase inhibitor treatment (short vs prolonged) on ovarian follicles in cattle, and to test the efficacy of an aromatase inhibitor-based protocol to synchronize ovulation in cattle. In the first experiment, heifers were treated with letrozole intravenously (n=10) or intramuscularly (n=10) or allocated in iv and im control groups (n=5/group). During the second experiment, heifers were divided randomly into two groups (n=15/group) and an intravaginal device containing 1 g of letrozole or a blank device (control) was inserted. The third experiment was designed with the goal of formulating and testing an intravaginal device that provides biologically active circulating concentrations of an aromatase inhibitor for a minimum of 4 days. The biological significance of the pharmacokinetic differences between the letrozole intravaginal devices resulting from the third study was evaluated during the fourth study. A final study was designed to determine the effect of stage of the estrous cycle on the proportion of animals that ovulated and the synchrony of ovulation of heifers treated with an aromatase inhibitor-based ovulation-synchronization protocol and to determine subsequent pregnancy outcomes. In all the studies, the effects of aromatase inhibitor on ovarian function were assessed by transrectal ultrasound examination of the ovaries, and blood samples were collected for hormone concentration determination. Results demonstrated that route of administration, or more precisely, the nature of iii the vehicle used for the administration of letrozole (intravenous, intramuscular depot, short release intravaginal or prolonged release intravaginal) has an impact on the effects of letrozole on hormonal profiles and ovarian dynamics. The intramuscular route appeared to provide a prolonged release of letrozole from the injection site which had a marked effect on estradiol production, dominant follicle lifespan, and CL form and function. Letrozole treatment during the ovulatory follicle wave by means of a gel-based intravaginal releasing device during the second study resulted in more rapidly growing dominant follicles and larger ovulatory follicles, delayed ovulation (by 24 h) of a single follicle and formation of a CL that secreted higher levels of progesterone. A wax-based vehicle allowed for a steady and continuous delivery of the active compound over the treatment period. During the third study, the addition of a letrozole-containing gel coating increased the rate of initial absorption and hastened the increase on plasma concentrations of the active ingredient, while the letrozole-containing wax-based vehicle prolonged drug-delivery from the intravaginal device. When tested in vivo during the fourth study, we confirmed that letrozole-impregnated intravaginal devices formulated with a wax base plus a gel coat vehicle was most suitable for the application of a letrozole-based protocol for the synchronization of ovulation in cattle, since it effectively delivered elevated concentrations of letrozole, and reduced estradiol production resulting in increased follicular growth and lifespan, without adversely affecting progesterone production. The application of a letrozole-impregnated intravaginal device for 4 days, combined with PGF treatment at device removal and GnRH 24 h post-device removal increased the percentage of ovulations and synchrony of ovulation in cattle, regardless the stage of the estrous cycle at initiation of treatment. As observed in previous studies, the effects observed could be associated with an increase in circulating LH iv concentrations. However, the effects of treatment on gonadotropin concentrations are inconclusive, possibly due to inadequate sampling frequency. The impact of letrozole treatment of oocyte fertility remains unknown. The results of the five experiments support our general hypothesis that non-steroidal aromatase inhibitors have potential as a steroid-free option for the control of ovarian function in cattle. However, further research is needed in order to elucidate the effects of letrozole treatment during the proestrous on oocyte competence and fertility of the resulting ovulations in cattle.

Two studies were designed to characterize the effects of a non-steroidal aromatase inhibitor, letrozole, on ovarian function in cattle. The specific objective was to test the hypothesis that letrozole will arrest dominant follicle growth resulting in emergence of a new follicular wave at a predictable interval post-treatment. In a first experiment, postpubertal beef heifers were assigned randomly to four treatment groups and given phosphate-buffered saline (controls; n=10), or letrozole at a dose of 500 (n=9), 250 (n=10), or 125 (n=10) µg/kg intravenously 4 days after follicular ablation (~2.5 days after wave emergence). In a second study, postpubertal beef heifers were assigned randomly to four treatment groups. One group received no treatment (control; n=17) and the other groups (n=9-10) were given 85 µg/kg of letrozole per day (250 µg/kg total dose), from Days 1 to 3, Days 3 to 5, or Days 5 to 7 (Day 0 = pre-treatment ovulation,) corresponding to the periods before, during and after selection of the dominant follicle, respectively. Follicular dynamics were monitored ultrasonically and blood samples were collected for endocrine assays. Follicle diameter profiles and plasma LH, FSH, and estradiol concentrations were analyzed. Additionally, during the second trial, CL diameter profiles and plasma progesterone concentrations were measured. In both studies, the diameter profile of the dominant follicle was larger in heifers treated with letrozole than in control heifers (P<0.05) and the intervals to new wave emergence and onset of regression of the extant dominant follicle were longer (P<0.05) in heifers treated with letrozole than in controls, regardless of the dose (high, medium, or low; single vs multiple) and the stage of the follicle wave in which treatments were initiated. Furthermore, during the second experiment, the mean CL diameter was larger in letrozole-treated heifers, although there were no differences in plasma progesterone concentrations between treated and control animals. The effects on dominant follicle and CL diameter profiles appeared to be the result of the significantly increased plasma LH concentrations observed in letrozole-treated animals during both treatment approaches (single vs multiple dose). Incomplete and inconsistent inhibition of estradiol production and the lack of a surge on FSH observed in both experiments may be a result of insufficient circulating levels of letrozole during the treatment period. In summary, a single or multiple dose of letrozole did not induce regression of the extant dominant follicle, nor did it directly affect FSH release. Conversely, letrozole extended the lifespan of the dominant follicle, in association with increased endogenous levels of LH, thereby delaying the next FSH surge and subsequent follicular wave emergence. Results suggest that letrozole has potential as a non-steroidal method for controlling ovarian function in cattle, but further studies are warranted to clarify dosage and timing of treatment to predictably affect follicular wave dynamics in cattle.

Two studies were designed to characterize the effects of a non-steroidal aromatase inhibitor, letrozole, on ovarian function in cattle. The specific objective was to test the hypothesis that letrozole will arrest dominant follicle growth resulting in emergence of a new follicular wave at a predictable interval post-treatment. In a first experiment, postpubertal beef heifers were assigned randomly to four treatment groups and given phosphate-buffered saline (controls; n=10), or letrozole at a dose of 500 (n=9), 250 (n=10), or 125 (n=10) µg/kg intravenously 4 days after follicular ablation (~2.5 days after wave emergence). In a second study, postpubertal beef heifers were assigned randomly to four treatment groups. One group received no treatment (control; n=17) and the other groups (n=9-10) were given 85 µg/kg of letrozole per day (250 µg/kg total dose), from Days 1 to 3, Days 3 to 5, or Days 5 to 7 (Day 0 = pre-treatment ovulation,) corresponding to the periods before, during and after selection of the dominant follicle, respectively. Follicular dynamics were monitored ultrasonically and blood samples were collected for endocrine assays. Follicle diameter profiles and plasma LH, FSH, and estradiol concentrations were analyzed. Additionally, during the second trial, CL diameter profiles and plasma progesterone concentrations were measured. In both studies, the diameter profile of the dominant follicle was larger in heifers treated with letrozole than in control heifers (P<0.05) and the intervals to new wave emergence and onset of regression of the extant dominant follicle were longer (P<0.05) in heifers treated with letrozole than in controls, regardless of the dose (high, medium, or low; single vs multiple) and the stage of the follicle wave in which treatments were initiated. Furthermore, during the second experiment, the mean CL diameter was larger in letrozole-treated heifers, although there were no differences in plasma progesterone concentrations between treated and control animals. The effects on dominant follicle and CL diameter profiles appeared to be the result of the significantly increased plasma LH concentrations observed in letrozole-treated animals during both treatment approaches (single vs multiple dose). Incomplete and inconsistent inhibition of estradiol production and the lack of a surge on FSH observed in both experiments may be a result of insufficient circulating levels of letrozole during the treatment period. In summary, a single or multiple dose of letrozole did not induce regression of the extant dominant follicle, nor did it directly affect FSH release. Conversely, letrozole extended the lifespan of the dominant follicle, in association with increased endogenous levels of LH, thereby delaying the next FSH surge and subsequent follicular wave emergence. Results suggest that letrozole has potential as a non-steroidal method for controlling ovarian function in cattle, but further studies are warranted to clarify dosage and timing of treatment to predictably affect follicular wave dynamics in cattle.

<p>Female social dominance over males is unusual in mammals, yet characterizes most Malagasy lemurs, which represent almost 30% of all primates. Despite its prevalence in this suborder, both the evolutionary trajectory and proximate mechanism of female dominance remain unclear. Potentially associated with female dominance is a suite of behavioral, physiological and morphological traits in females that implicates ‘masculinization’ via androgen exposure; however, relative to conspecific males, female lemurs curiously show little evidence of raised androgen concentrations. In order to illuminate the proximate mechanisms underlying female dominance in lemurs, I observed mixed‐sex pairs of related Eulemur species, and identified two key study groups ‐‐ one comprised of species expressing female dominance and, the other comprised of species (from a recently evolved clade) showing equal status between the sexes (hereafter ‘egalitarian’). Comparing females from these two groups, to test the hypothesis that female dominance is an expression of an overall masculinization of the female, I 1) characterize the expression of female dominance, aggression, affiliation, and olfactory communication in Eulemur; 2) provide novel information about the hormonal and neuroendocrine correlates associated with the expression of female dominance; 3) investigate the activational role of the sex-steroid hormones in adult female Eulemur using seasonal correlates of hormonal and behavioral change; and 4) examine the specific role of estrogen in the regulation and expression of sex-reversed female behavior in these species. In doing so I highlight significant behavioral and physiological differences between female-dominant and egalitarian Eulemur and show that female dominance is associated with a more masculine behavioral and hormonal profile. I also suggest that these behavioral and hormonal differences may be the result of fundamental differences in the biosynthetic pathway associated with estrogen production. Moreover, I assert that these putative physiological differences could provide a parsimonious proximate mechanism explaining the evolution of female dominance and its subsequent relaxation in egalitarian Eulemur species.</p> / Dissertation

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Tamoxifen and aromatase inhibitors are treatment options for women with breast cancer and evidence on the risk of stroke is important in choosing between these two options. A systematic review of two randomized controlled trials and their nine related trial reports showed different methods for adverse event reporting and inconsistent estimates of stroke risk. In an observational cohort study of 5443 Ontario women, aged 66 years or older with early stage breast cancer, 86 ischemic stroke events (1.6%) occurred during follow-up of 5 years. There was no statistically significant difference in the risk of stroke between the hormone therapy groups [adjusted HR for tamoxifen compared to AI 1.330 (0.810, 2.179)]. Results were similar across cardiovascular disease risk groups and were robust to different follow up periods and analytic methods. This study suggests that there is no significant difference in stroke between these treatment options.

Tamoxifen and aromatase inhibitors are treatment options for women with breast cancer and evidence on the risk of stroke is important in choosing between these two options. A systematic review of two randomized controlled trials and their nine related trial reports showed different methods for adverse event reporting and inconsistent estimates of stroke risk. In an observational cohort study of 5443 Ontario women, aged 66 years or older with early stage breast cancer, 86 ischemic stroke events (1.6%) occurred during follow-up of 5 years. There was no statistically significant difference in the risk of stroke between the hormone therapy groups [adjusted HR for tamoxifen compared to AI 1.330 (0.810, 2.179)]. Results were similar across cardiovascular disease risk groups and were robust to different follow up periods and analytic methods. This study suggests that there is no significant difference in stroke between these treatment options.

Orientador: Eliana Aguiar Petri Nahás / Resumo: Introdução: O câncer de mama é a neoplasia maligna mais frequente em mulheres. A redução da morbimortalidade aumentou a possibilidade de maternidade em mulheres em idade fértil após o tratamento, assim como a preocupação com a preservação da fertilidade diante da toxicidade ovariana relacionada aos tratamentos adjuvantes. A estimulação ovariana com letrozol e gonadotrofinas para a criopreservação de oócitos é procedimento bem estabelecido em pacientes com câncer de mama e desejo reprodutivo futuro. Entretanto, estudo recente comparando pacientes submetidas a preservação oncológica da fertilidade com protocolo utilizando gonadotrofinas e letrozol, com pacientes inférteis submetidas a fertilização in vitro mostrou maior taxa de oócitos imaturos e menor taxa de fertilização entre as pacientes que realizaram criopreservação de oócitos, sugerindo um possível efeito deletério do letrozol sobre a qualidade oocitária. Objetivo: Avaliar a influência do letrozol sobre a qualidade oocitária em pacientes com câncer de mama submetidas a estimulação ovariana para preservação da fertilidade. Métodos: Enstudo clínico de corte transversal realizado em hospital público terciário de São Paulo, por meio de análise de banco de dados e prontuários médicos. Foram avaliados parâmetros morfolóficos de 750 oócitos obtidos de pacientes com câncer de mama submetidas a estimulação ovariana com letrozol e gonadotrofinas para preservação da fertilidade no período de 2015 a 2016. Os dados foram comparados a... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Introduction: Breast cancer is the most common malignant neoplasm in women. Recent advances in early diagnosis and treatment have led to an increase in the survival rate. The reduction of morbidity and mortality increased the possibility of maternity after cancer in women of childbearing age and raised the concern about fertility preservation against gonadotoxic adjuvant treatments. Ovarian stimulation with letrozole and gonadotropins for cryopreservation of oocytes in patients with breast cancer and reproductive desire has been shown to be effective. Although a recent study comparing patients submitted to oncological fertility preservation with protocol using gonadotropins and letrozole to infertile patients submitted to in vitro fertilization performed only with gonadrotopins showed a higher rate of immature oocytes and lower fertilization rate among patients who received letrozole, suggesting a possible deleterious effect of letrozole on oocyte quality. Objective: To evaluate the influence of letrozole on oocyte quality in patients with breast cancer submitted to fertility preservation. Methods: An analytical cross-sectional study performed in a public tertiary hospital in São Paulo through chart analysis and medical records. We evaluated morphological parameters of 750 oocytes obtained from all breast cancer patients submitted to ovarian stimulation with letrozole and gonadotropins for fertility preservation between 2015 and 2016. They were compared to 699 oocytes from wo... (Complete abstract click electronic access below) / Mestre

Submitted by Ludmila Machado Neves Bercaire (ludmila_machadoneves@yahoo.com.br) on 2018-08-06T17:40:21Z No. of bitstreams: 1 Dissertação Mestrado Ludmila Bercaire.pdf: 3380553 bytes, checksum: be2ff6e81191ee3fdfbeacb5ed05c530 (MD5) / Approved for entry into archive by Sulamita Selma C Colnago null (sulamita@btu.unesp.br) on 2018-08-08T16:27:00Z (GMT) No. of bitstreams: 1 bercaire_lmn_me_bot.pdf: 3380553 bytes, checksum: be2ff6e81191ee3fdfbeacb5ed05c530 (MD5) / Made available in DSpace on 2018-08-08T16:27:02Z (GMT). No. of bitstreams: 1 bercaire_lmn_me_bot.pdf: 3380553 bytes, checksum: be2ff6e81191ee3fdfbeacb5ed05c530 (MD5) Previous issue date: 2018-02-27 / Introdução: O câncer de mama é a neoplasia maligna mais frequente em mulheres. A redução da morbimortalidade aumentou a possibilidade de maternidade em mulheres em idade fértil após o tratamento, assim como a preocupação com a preservação da fertilidade diante da toxicidade ovariana relacionada aos tratamentos adjuvantes. A estimulação ovariana com letrozol e gonadotrofinas para a criopreservação de oócitos é procedimento bem estabelecido em pacientes com câncer de mama e desejo reprodutivo futuro. Entretanto, estudo recente comparando pacientes submetidas a preservação oncológica da fertilidade com protocolo utilizando gonadotrofinas e letrozol, com pacientes inférteis submetidas a fertilização in vitro mostrou maior taxa de oócitos imaturos e menor taxa de fertilização entre as pacientes que realizaram criopreservação de oócitos, sugerindo um possível efeito deletério do letrozol sobre a qualidade oocitária. Objetivo: Avaliar a influência do letrozol sobre a qualidade oocitária em pacientes com câncer de mama submetidas a estimulação ovariana para preservação da fertilidade. Métodos: Enstudo clínico de corte transversal realizado em hospital público terciário de São Paulo, por meio de análise de banco de dados e prontuários médicos. Foram avaliados parâmetros morfolóficos de 750 oócitos obtidos de pacientes com câncer de mama submetidas a estimulação ovariana com letrozol e gonadotrofinas para preservação da fertilidade no período de 2015 a 2016. Os dados foram comparados a 699 oócitos de mulheres sem câncer de mama apresentando infertilidade por fator masculino, submetidas a estimulação ovariana para fertilização in vitro, através de pareamento por idade (grupo controle). A estimulação ovariana em pacientes com câncer de mama foi realizada com letrozol em combinação a gonadotrofinas em protocolo com antagonista do hormônio liberador de gonadotrofofina (GnRH). No grupo controle a estimulação ovariana foi realizada apenas com gonadotrofinas e a supressão hipofisária obtida com antagonista de GnRH. Os oócitos maduros obtidos foram analisados quanto à presença de corpos refráteis, cor e regularidade do ooplasma, grau de granulação central, cor e espessura da zona pelúcida, tamanho do espaço perivitelínico, presença de vacúolos e retração no oócito. Os resultados obtidos foram comparados ao grupo controle por análise estatística pelos testes de Qui-quadrado e Mann-Whitney. Estimou-se o odds ratio (OR) e o intervalo de confiança de 95% (CI) através de regressão logística para observar as possíveis associações entre uso de letrozol e os parâmetros morfológicos oocitários. Resultados: Foram analiados 750 oócitos obtidos de 69 pacientes com câncer de mama e comparados a 699 oócitos obtidos de 92 pacientes do grupo controle. A média de idade no grupo câncer de mama foi de 31,5 ± 4,1 anos e no grupo controle de 33,1 ± 7,1 anos (p=0,210). Foi observada maior incidência de dismorfismos oocitários no grupo câncer de mama que utilizou letrozol comparado ao grupo controle: espaço perivitelínico aumentado (p=0,007), zona pelúcida irregular (p<0,001), corpos refráteis (p<0,001), ooplasma escuro (p<0,001), ooplasma granuloso (p<0,001), ooplasma irregular (p<0,001) e presença de granulação central (p<0,001). Outras alterações morfológicas foram mais frequentes nos oócitos do grupo controle comparado ao grupo câncer de mama com letrozol: grânulos corticais (p<0,001), zona pelúcida de coloração alterada (p<0,001) e alterações de retículo endoplasmático liso (p<0,001). Não houve diferença estatística entre os grupos em relação aos parâmetros: retração (p=0,254) e vacúolos (p=0,974). Conclusão: A avaliação dos parâmetros morfológicos dos oócitos de mulheres com câncer de mama, submetidas a estimulação ovariana com letrozol e gonadotrofinas revelou maior ocorrência de dismorfismos quando comparado a mulheres sem câncer de mama submetidas a estimulação ovariana com gonadotrofinas. A utilização do letrozol mostrou-se como fator de risco para a presença de dismorfismos oocitários que podem ser traduzidos em pior qualidade oocitária. / Introduction: Breast cancer is the most common malignant neoplasm in women. Recent advances in early diagnosis and treatment have led to an increase in the survival rate. The reduction of morbidity and mortality increased the possibility of maternity after cancer in women of childbearing age and raised the concern about fertility preservation against gonadotoxic adjuvant treatments. Ovarian stimulation with letrozole and gonadotropins for cryopreservation of oocytes in patients with breast cancer and reproductive desire has been shown to be effective. Although a recent study comparing patients submitted to oncological fertility preservation with protocol using gonadotropins and letrozole to infertile patients submitted to in vitro fertilization performed only with gonadrotopins showed a higher rate of immature oocytes and lower fertilization rate among patients who received letrozole, suggesting a possible deleterious effect of letrozole on oocyte quality. Objective: To evaluate the influence of letrozole on oocyte quality in patients with breast cancer submitted to fertility preservation. Methods: An analytical cross-sectional study performed in a public tertiary hospital in São Paulo through chart analysis and medical records. We evaluated morphological parameters of 750 oocytes obtained from all breast cancer patients submitted to ovarian stimulation with letrozole and gonadotropins for fertility preservation between 2015 and 2016. They were compared to 699 oocytes from women without cancer submitted to ovarian stimulation for in vitro fertilization due to male factor infertility, matched by age (control group). Ovarian stimulation in patients with breast cancer was performed before chemotherapy with letrozole in combination with 14 gonadotropins in GnRH antagonist protocol. In control group, ovarian stimulation was performed with gonadotropins and pituitary suppression was obtained with GnRH antagonist. Mature oocytes obtained were analyzed for the presence of refractile bodies, color and regularity of the ooplasm, central granulation degree, zona pellucida thickness, the size of the perivitelinic space, presence of vacuoles and oocyte retraction. The obtained results were compared with the corresponding age control group through statistical analysis with Chi-square and Mann-Whitney tests. Analysis consisted to estimate the odds ratio (OR) and 95% confidence interval (CI), considering the group of letrozole to constitute a response compared with control group as reference (OR 1.0) to observe the possible associations between letrozole use (dependent variable) and the morphological oocytes parameters (independent variables). Results: We evaluated 750 oocytes obtained from 69 breast cancer patients and compared with 699 oocytes from 92 control patients. Mean age was 31.5 ± 4.1 years in the study group and 33.1 ± 7.1 years in control group (p=0.210). We observed higher incidence of in oocyte dysmorphisms in the letrozole group compared to the control group: increased perivitelinic space (p = 0.007), irregular zona pellucida (p<0.001), refractile bodies (p<0.001), dark ooplasm (p<0.001), granular ooplasm (p<0.001), irregular ooplasm (p<0.001) and dense central granulation (p<0.001). Other dysmorphisms were higher in the control group: cortical granules (p <0.001), zona pellucida with altered staining (p<0.001) and smooth-surfaced endoplasmic reticulum aggregates (p <0.001). There was no statistical difference between the groups in relation to the parameters: retraction (p=0.254) and vacuoles (p=0.974). 15 Conclusion: The evaluation of morphological parameters of oocytes from breast cancer patients submitted to ovarian stimulation protocol with letrozole and gonadotropins revealed greater occurrence of dysmorphisms when compared to infertile patients submitted to ovarian stimulation protocol with gonadotropins. The use of letrozole seems to be a risk factor for the presence of oocyte dysmorphisms that could be translated into poor oocyte quality.