Serum inhibin A and angiogenic factor levels in pregnancies with previous preeclampsia and/or chronic hypertension: are they useful markers for prediction of subsequent preeclampsia?

OBJECTIVE: Our objective was to determine whether measurement of placenta growth factor (PLGF), inhibin A, or soluble fms-like tyrosine kinase-1 (sFlt-1) at 2 times during pregnancy would usefully predict subsequent preeclampsia ( PE) in women at high risk. STUDY DESIGN: We analyzed serum obtained at enrollment (12(0/7) to 19(6/7) weeks) and follow-up (24-28 weeks) from 704 patients with previous PE and/or chronic hypertension (CHTN) enrolled in a randomized trial for the prevention of PE. Logistic regression analysis assessed the association of log-transformed markers with subsequent PE; receiver operating characteristic analysis assessed predictive value. RESULTS: One hundred four developed preeclampsia: 27 at 37 weeks or longer and 77 at less than 37 weeks (9 at less than 27 weeks). None of the markers was associated with PE at 37 weeks or longer. Significant associations were observed between PE at less than 37 weeks and reduced PLGF levels at baseline (P =.022) and follow-up (P <.0001) and elevated inhibin A (P <.0001) and sFlt-1 (P =.0002) levels at follow-up; at 75% specificity, sensitivities ranged from 38% to 52%. Using changes in markers from baseline to follow-up, sensitivities were 52-55%. Associations were observed between baseline markers and PE less than 27 weeks (P <=.0004 for all); sensitivities were 67-89%, but positive predictive values (PPVs) were only 3.4-4.5%. CONCLUSION: Inhibin A and circulating angiogenic factors levels obtained at 12(0/7) to 19(6/7) weeks have significant associations with onset of PE at less than 27 weeks, as do levels obtained at 24-28 weeks with onset of PE at less than 37 weeks. However, because the corresponding sensitivities and/or PPVs were low, these markers might not be clinically useful to predict PE in women with previous PE and/or CHTN.

Inhibin B and the ovarian follicular reserve

Inhibins are dimeric glycoproteins composed of an α-subunit and a βA-subunit (inhibin A) or βB-subunit (inhibin B), which inhibits pituitary gonadotropin secretion of FSH. The inhibin B is a product of the cohort of antral follicles. The ovarian follicle number decrease steadily as a function of increasing age, with consequent falls in the levels of inhibin B and increase of FSH levels. It is sufficient to maintain ovulatory function and continued secretion of estradiol. Elevated FSH levels seem to occur late in the sequence of events associated with ovarian failure. The inhibin B, produced by granulosa cells, is the earliest marker of the decline in ovarian follicular reserve across reproductive aging.

Inhibin B and ovarian function after total abdominal hysterectomy in women of reproductive age

The aim of this prospective study was to assess ovarian function using clinical and endocrine parameters in women of reproductive age who underwent total abdominal hysterectomy. Sixty-one women, aged ≤ 40 years, were allocated into two groups: group 1, consisting of 31 patients who had hysterectomy, and group 2, consisting of 30 normal women. Inclusion criteria were normal ovarian function at baseline, normal body weight, no hormonal diseases and basal follicle stimulating hormone (FSH) level of < 15 mIU/ml. FSH, luteinizing hormone (LH), estradiol and inhibin B levels as well as maturation value (MV) were measured by vaginal cytology on three occasions: baseline, and 6 and 12 months after hysterectomy. Analysis of variance, the Friedman test, Mann-Whitney test and t-test statistics were employed to compare the two groups. At baseline the groups were homogeneous. At months 6 and 12, hysterectomized women showed decreased median values of inhibin B, increased median values of estradiol (p < 0.05), unchanged median values of FSH and LH, and decreased median values of MV (p < 0.05). In the hysterectomy group, 12.9% (4/31) of the patients had FSH levels of > 40 mIU/ml, estradiol of < 20 pg/ml and inhibin B of < 5 ng/ml, compatible with ovarian failure. In the control group, all the parameters studied remained unchanged. These results suggest that total abdominal hysterectomy accelerates the decline in ovarian function in women of reproductive age.

Adjuvant therapy with GnRH agonists/tamoxifen in breast cancer should be a good council for patients with hormone receptor-positive tumours and wish to preserve fertility

Infertility represents one of the main long-term consequences of the chemotherapy used for the adjuvant treatment of breast cancer. Approximately 60-65% of breast cancers express the nuclear hormone receptor in premenopausal women. Adjuvant endocrine therapy is an integral component of care for patients with hormone receptor-positive (HR+) tumours. The GnRH agonist (GnRHa) alone or in combination with tamoxifen produces results at least similar to those obtained with the different chemotherapy protocols in patients with HR+ breast cancer with respect to recurrence-free survival and overall survival. It is time to indicate adjuvant therapy with GnRHa associated with tamoxifen for patients with breast cancer (HR+ tumours) if they want to preserve their reproductive function. The evaluation of ovarian reserve tests: follicle stimulating hormone (FSH), anti-Mullerian hormone (AMH), inhibin B, antral follicle count (AFC) and ovarian volume 6 months, and 1 year after the end of therapy with GnRHa/tamoxifen must be realised. The recurrence-free survival and overall survival should be analysed. The major implication of this hypothesis will be to avoid adjuvant chemotherapy for patients with breast cancer (HR+ tumours) that request fertility preservation. It is expected that ovarian function should not be altered in almost all cases and subsequent pregnancy a real possibility. (C) 2012 Elsevier Ltd. All rights reserved.

Taxa de ovulação e concentração plasmática de progesterona em fêmeas bovinas imunizadas com líquido folicular suíno

O presente estudo objetivou avaliar os efeitos da imunização ativa contra proteínas do líquido folicular suíno sobre a taxa de ovulação, duração do ciclo estral e concentração plasmática de progesterona em vacas e novilhas da raça Limousin. Realizaram-se duas imunizações com 15 dias de intervalo, aplicando-se um imunógeno composto do conteúdo protéico de 25ml de fluido folicular suíno adicionados de 1ml de gel de hidróxido de alumínio, via subcutânea. O número de ovulações foi mensurado por palpação retal e ultra-sonografia sete a nove dias após cada período de estro. Após a última imunização, os animais apresentaram maior incidência de ovulações duplas (41,7%). As médias de ovulações pré e pós-imunização foram 1,00+0,00 e 1,40+0,31 ovulações/ciclo, respectivamente (P<0,01;chi2). A imunização foi efetiva em aumentar o número de ovulações. Não foram observadas diferenças na duração do ciclo estral e na concentração de progesterona nos diferentes dias do ciclo. A manipulação das ações fisiológicas da inibina pode ser utilizada como alternativa para indução de ovulações múltiplas em bovinos.

Concentrações hormonais e desenvolvimento folicular de vacas leiteiras em hipertermia sazonal e aguda

Avaliaram-se as concentrações hormonais e os parâmetros de desenvolvimento folicular de vacas leiteiras expostas ao calor sazonal e agudo. Dividiram-se os animais em quatro grupos: verão (n=5), outono (n=5), inverno com hipertermia aguda (grupo câmara climática, (CC), n=5) e inverno (n=9). Os animais foram abatidos no sétimo dia após a ovulação, e os parâmetros de desenvolvimento folicular avaliados. O líquido folicular do maior folículo foi aspirado e armazenado para posterior análise de hormônios esteróides e inibina. O número de células da granulosa vivas no verão e no outono foi 40 e 45% respectivamente, menor que no inverno (P<0,05). A concentração de estradiol (E2) no inverno foi 62% maior que no outono (P<0,05) e 34% superior ao grupo verão (P<0,06). Houve um aumento na quantidade de androstenediona no verão em relação aos grupos inverno (P<0,08) e outono (P<0,05). A concentração de inibina foi maior no inverno do que no verão e CC (P<0,05). A exposição ao calor sazonal e agudo modificou os parâmetros de desenvolvimento do folículo e as concentrações hormonais no líquido folicular, podendo explicar em parte a queda nas taxas de concepção no verão.

Associated and independent comparisons between the two largest follicles preceding follicle deviation in cattle

Follicle diameters and concentrations of follicular fluid factors were studied in the two largest follicles (F1 and F2) using F1 diameters in increments of 0.2 mm (equivalent to 4 h intervals) and extending from 7.4 to 8.4 mm (12 heifers in each of 6 groups). Changes were compared between follicles using the F2 associated with each F1-diameter group. Diameter deviation began in the 8.2-mm group as indicated by a greater (P < 0.05) diameter difference between F1 and F2 in the 8.4-mm group than in the 8.2-mm group. In the 8.0-mm group, estradiol concentrations began to increase (P < 0.05) differentially in F1 versus F2, and free insulin-like growth factor-1 (IGF-1) began to decrease differentially in F2 (P < 0.06). Combined for F1 and the associated F2, activin-A concentrations increased (P < 0.05) between the 7.6- and 8.2-mm groups and then decreased (P < 0.05). Results supported the hypothesis that estradiol and free IGF-1 concentrations simultaneously become higher in F1 than in the associated F2 by the beginning of diameter deviation. Results did not support the hypothesis that a transient elevation in activin-A is present in F1 but not in the associated F2 at the beginning of the estradiol and IGF-1 changes; instead, a mean transient elevation in activin-A occurred at this time only when data for the two follicles were combined. Comparisons between F1 and F2 also were made by independently grouping F2 and using diameter groups at 0.2-mm increments for F2 as well as for F1. In the diameter groups common to F1 and F2 (7.4, 7.6, 7.8, and 8.0 mm) there was a group effect (P < 0.003) for estradiol involving an increase (P < 0.05) beginning at the 7.6-mm group averaged over F1 and F2. For free IGF-1 concentrations, a fluctuation (a significant increase followed by a significant decrease) occurred independently in F1 between the 7.4-to 7.8-mm groups and independently in F2 between the 7.0- to 7.4-mm groups.

Adjuvant therapy with GnRH agonists/tamoxifen in breast cancer should be a good council for patients with hormone receptor-positive tumours and wish to preserve fertility

Infertility represents one of the main long-term consequences of combination chemotherapy used for the treatment of breast cancer. Approximately 60%-65% of breast cancers express the nuclear hormone receptor in premenopausal women. Adjuvant endocrine therapy is an integral component of care for patients with hormone receptor-positive (HR+) tumours. The GnRH agonist (GnRHa) alone or in combination with tamoxifen produces results at least similar to those obtained with the different chemotherapy protocols in patients with HR+ tumors with respect to recurrence-free survival and overall survival, Presentation of the hypothesis: It is time to indicate adjuvant therapy with GnRHa associated with tamoxifen for patients with breast cancer (HR+ tumours) if they want to preserve their reproductive function. Testing the hypothesis: Assessment of ovarian reserve tests: follicle stimulating hormone (FSH), anti-Mullerian hormone (AMH), inhibin B, antral follicle count (AFC) and ovarian volume 6 months, and 1 year after the end of therapy with GnRHa/tamoxifen. The recurrence-free survival and overall survival should be analysed. Implications of the hypothesis: The major implication will be to avoid adjuvant chemotherapy for patients with breast cancer (HR+ tumours) that request fertility preservation. It is expected that ovarian function should not be altered in almost all cases. © Todos os direitos reservados a SBRA - Sociedade Brasileira de Reprodução Assistida.

Avaliação do perfil endócrino de éguas submetidas a tratamentos superovulatórios com extrato de pituitária e FSH equino purificado

Pós-graduação em Medicina Veterinária - FMVZ

Avaliação da função ovariana pós histerectomia total abdominal em mulheres no menacme

Pós-graduação em Ginecologia, Obstetrícia e Mastologia - FMB

Estudo do fluido folicular, transporte, recuperaçao e maturação de oócitos em éguas superovuladas com estrato de pituitária equina

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Aspectos da dinâmica, seleção e maturação folicular em éguas pônei

O presente trabalho envolveu três experimentos: Influência da imunização passiva contra estradiol (E2) e a aspiração do maior folículo (F1) no momento do desvio folicular esperado, sobre a ocorrência do desvio folicular observado. Também foi objetivo verificar o efeito desses tratamentos sobre o perfil de hormônio folículo estimulante (FSH), hormônio luteinizante (LH) e inibina total circulante. Para tanto, os animais foram imunizados com dose única de soro anti-E2 (G anti-E2) ou o F1 foi aspirado no momento do desvio esperado (GAF1). O plasma sangüíneo foi obtido no período pré e póstratamento. O intervalo entre o dia da aplicação do soro (desvio esperado) e o dia da detecção do desvio foi em média o mesmo para o G anti-E2 e controle. No GAF1, a eliminação do maior folículo provocou atraso no momento da detecção do desvio folicular entre o segundo (F2) e o terceiro (F3) maior folículo, comparado ao controle. Em ambos os tratamentos o perfil de FSH, LH e inibina total foi similar ao controle. O experimento 2 tratou de um projeto piloto visando dominar a técnica de colheita de fluido dos grandes folículos ovarianos por meio de punção com agulha fina e o efeito desse procedimento sobre o folículo e às concentrações hormonais. Foram utilizados dois grupos de animais, G1 o folículo foi mantido intacto (controle) e G2 foi utilizada uma punção folicular quando o maior folículo atingiu diâmetro ~35 mm. Ultrasonografia ovariana foi realizada desde o ínicio da detecção de um folículo ~25mm, seguindo até a detecção da ovulação. O terceiro experimento objetivou verificar a influência de gonadotrofina coriônica humana (hCG) em folículos de 30 ou 35mm sobre as concentrações de hormônios esteróides e fatores intrafoliculares. A colheita do fluido folicular foi realizada imediatamente antes e 30 horas após a aplicação... (Resumo completo, clicar acesso eletrônico abaixo)

Análise hormonal, imunolocalização e quantificação dos receptores de andrógenos (AR) e estrógenos (ER-α E ER-β) em ovário e útero de ratas submetidas a diferentes doses de decanoato de nandrolona: avaliação nos períodos pós-tratamento e pós-recuperação

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)