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Departments of Pediatrics (H.N.S., C.H., M.M., J.D., V.P.), Obstetrics and Gynecology (D.L.F., V.P.), Molecular and Integrative Physiology (V.P.), and Ecology and Evolutionary Biology (D.L.F.), Reproductive Sciences Program (H.S., M.M., C.H., J.D., D.L.F., V.P.), and Center for Statistical Consultation and Research (K.B.W.), University of Michigan, Ann Arbor, Michigan 48109
Address all correspondence and requests for reprints to: Vasantha Padmanabhan, Reproductive Sciences Program, 300 North Ingalls Building, Room 1109 SW, Ann Arbor, Michigan 48109-0404. E-mail: vasantha{at}umich.edu.
| Abstract |
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| Introduction |
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At the neuroendocrine level, it is well established that prenatal T treatment reduces hypothalamic sensitivity to estradiol (E2) positive feedback (11, 12, 14, 16) and progesterone negative feedback (17), the two major feedback systems involved in the control of cyclic changes in GnRH/gonadotropin secretion. From a developmental perspective, E2 negative feedback is the predominant feedback system operational before puberty (19, 20, 21), and the reduction in sensitivity to this steroid feedback inhibition is responsible for the pubertal increase in GnRH (19, 20, 21). Studies in the female sheep have demonstrated this mechanism using the ovariectomized E2 replaced model (20), in which peripheral steroid concentrations are maintained at physiological levels by means of a constant release device (E2 capsule sc) from shortly after birth. In this model, circulating LH levels remain suppressed in response to chronically low exogenous E2 until about 30 wk of age when they rise markedly. The timing of this robust LH increase, reflecting the escape from E2 negative feedback, occurs at the same time as the initiation of ovulations and estrous behavior (puberty) in normal intact lambs (19, 21). Prenatal exposure to T markedly advances the time of the pubertal LH rise to 10 wk, an age that corresponds to the initiation of puberty in the male (11, 12, 22). This prenatal programming by T would explain the much earlier decrease in sensitivity to negative feedback in the male. Interestingly, in the prenatal T female, when the ovaries are left in situ instead of replacing them with an E2 capsule as a source of steroids, the time of puberty is not advanced (10, 14), as would be predicted from the finding of a precocial LH rise in the prenatal T, postnatally ovariectomized E2 model. Rather, in the prenatal T female left ovary intact (no exogenous E2), initiation of progestogenic cycles occurred at the same time as in the controls. This raises two possibilities: 1) the constant release E2 in the ovariectomized E2-clamped model may exert further organizational effects postnatally to combine with those of the prenatal T to result in the precocious reduction in sensitivity to E2 negative feedback; 2) alternatively, ovarian factors may play a protective role and not allow reduction in sensitivity to E2 negative feedback (early postnatal LH rise) to be expressed. There is some evidence that the ovary-intact prenatal T female is hypergonadotropic during the prepubertal period (14), raising the possibility that such females do express a reduced sensitivity to E2 negative feedback. However, an increased LH secretion alone does not provide evidence for reduced E2 feedback (hypothalamic effect) because this may reflect a reduced amount of ovarian steroid secretion (ovarian effect) or alternatively increased pituitary gonadotropin responsiveness to GnRH (pituitary effect) in such females. In the present study, the primary hypothesis we tested is that prenatal exposure to T produces a precocial reduction in sensitivity to E2 negative feedback after birth. Our results indicate that this indeed is the case and further that development of hypergonadotropism occurs progressively over time. In addition, because E2, along with inhibin (23, 24, 25), is a major negative feedback regulator of FSH, the second hypothesis we tested is that the reduced sensitivity to E2 feedback will also be reflected as increased FSH secretion in the prenatal T females. Our results indicate that this is not the case and leads to the conclusion that prenatal T treatment has differential effects on feedback responsiveness of LH and FSH to E2.
| Materials and Methods |
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Experimental design
To determine developmental changes in gonadotropin responsiveness to E2 negative feedback, feedback tests were conducted at approximately 12 wk of age (early prepubertal) and at approximately 24 wk (shortly before the expected time of puberty). Typically, E2 negative feedback tests are conducted in the absence of the ovaries to avoid confounding from endogenous E2, which could differ between individuals depending on the stage of follicular development. Thus, in our study of ovary-intact females, we needed to produce a reduced but similar starting follicular E2 milieu in all females. To do this, we reduced and normalized endogenous E2 production by blocking LH- and GnRH-induced FSH release with the GnRH antagonist (GnRH-A), Nal-Glu (Nal-Glu [Ac-D2Nal1, D4ClPhe2, D3Pal3, Arg5, 4-(methoxybenzoyl)-D-2-aminobutyric acid6, D-Ala10]), as described previously (27).
Figure 1
describes the design of the study, which consisted of a pretreatment phase and three experimental phases. In the pretreatment phase at 12 wk, blood samples (2 ml) were collected frequently for 6 h (20-min intervals); at 24 wk, samples were collected at 10-min intervals because of the greater blood volume. During experimental phase 1, we reduced endogenous E2 production by preventing the gonadotropic drive to the ovary with GnRH-A, Nal-Glu. Control and prenatal T lambs were injected sc with 50 µg/kg GnRH-A (2.5 mg/ml diluted in sterile water with 5% glucose) at 12-h intervals for 72 h. Blood samples were obtained frequently for 4 h at 12 wk (20-min intervals) and at 24 wk (10-min intervals) between 8084 h after the start of GnRH-A injections (between 812 h after the last GnRH-A injection at 72 h). Experimental phase 2 was conducted after cessation of the GnRH-A treatment when GnRH is once again capable of acting on the pituitary and when follicular growth is synchronized, but E2 secretion is low. To establish the pre-E2 treatment patterns under reduced E2, blood samples were obtained frequently at 12 wk (20-min intervals) and at 24 wk (10-min intervals) for 6 h, from 6672 h after the last GnRH-A injection. To establish the time course for restoration of LH pulsatility after cessation of GnRH-A treatment, LH was also measured in blood samples at 24 wk of age collected frequently (10-min intervals for 6 h) between 2430 and 4248 h after cessation of GnRH-A treatment.
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All blood samples were collected in heparinized tubes, and plasma was separated at 5 C. Plasma was stored at 20 C until assay. Plasma LH concentrations were determined in all samples. Plasma E2 and FSH levels were determined in pooled samples obtained by combining equal aliquots of plasma from all samples of a given female during each phase (n = 19 for 12 wk where the sampling frequency was every 20 min and 37 for 24 wk where the sampling frequency was 10 min).
RIA
Plasma LH concentrations were determined using a validated competitive double-antibody RIA (28) in duplicate 10- to 200-µl samples. The assay sensitivity (2 SD from the buffer control) of LH assay was 0.34 ± 0.07 ng/ml (n = 19 assays). Mean intraassay coefficient of variations at 80 and 20% displacement points were 6.35 ± 0.27 and 3.15 ± 0.13%, respectively, and the mean median variance ratio was 0.04 ± 0.003. The interassay coefficient of variations in three quality control pools averaging 1.0, 13, and 23 ng/ml were 19.5, 3.9, and 3.5%, respectively. FSH was measured in duplicate 200-µl samples (n = 2 assays) with a validated RIA (29) using reagents from the National Hormone and Pituitary Program. Assay sensitivity averaged 0.05 and 0.03 ng/ml, respectively, and average intraassay coefficients of variation at 80 and 20% displacement points were 7.97 and 3.98%. Interassay coefficient of variation for two plasma quality control pools averaging 5.4 and 30 ng/ml was 0.37 and 1.1%, respectively. Plasma concentrations of E2 were measured using a commercial RIA kit (Coat-A-Count E2, MAIA, Polymedco Inc., Cortland Manor, NY) validated for use in sheep (30). Assay sensitivity averaged 0.26 ± 0.06 pg/ml (n = 3 assays), and mean median variance ratio averaged 0.05 ± 0.03. Mean intraassay coefficient of variation at 80 and 20% displacement points averaged 14.9 ± 3.9 and 7.5 ± 2.0%, respectively. Interassay coefficient of variations based on two quality control pools averaging 5 and 40 pg/ml averaged 19.4 and 9.3%, respectively. Each assay included both control and prenatal T females. Plasma concentrations of progesterone were measured by a commercial RIA kit (Coat-A-Count P4; Diagnostic Products Corp., Los Angeles, CA) in daily samples. This assay has been validated for use in sheep (31). Sensitivity of progesterone assay averaged 0.03 ± 0.01 ng/ml (n = 8 assays). The intraassay coefficient of variation, based on two quality control pools averaging 1.99 and 13.7 ng/ml averaged 8.7, and 10.4%, respectively. The interassay coefficients of variation for the same quality control pools were 10.5 and 10.0%, respectively.
Statistical analysis
The first sustained rise in circulating progesterone was used to determine puberty, and this was based on two criteria: the time when circulating progesterone concentrations first exceeded baseline by 2 times assay sensitivity, and this must be followed by a progestogenic cycle of greater than 0.5 ng. Differences in timing of the onset of puberty were determined by ANOVA. Growths of lambs were compared using a linear mixed model in which a separate regression line (random intercept and random slope) was calculated for lamb weights of each mother. Overall effect of age, treatment, and the age by treatment interactions were examined.
Serial LH data from control and prenatal T females from each time period were subjected to pulse analysis using the Cluster algorithm (32). The Cluster algorithm identifies pulses using criteria that define a pulse such that the peak of the pulse differs significantly from both the preceding and following nadirs according to two-sample Students t tests. For analysis with Cluster, the minimum number of data points in a peak and nadir were set at 1 and 1, respectively, when blood samples were obtained at 20-min intervals and 2 and 2, respectively, when blood samples were obtained at 10-min intervals. The Students t statistic values used to identify a significant increase from preceding nadir and a decrease to following nadir were both 1.0 and 2.0 for the 10- and 20-min sampling frequencies, respectively.
Hormone data for the control and prenatal T-treated females were compared at 12 wk of age for the treatment periods pre-; 72 h after GnRH-A; and E2; and at 24 wk of age for the periods pre; 24, 48, 72 h after GnRH-A; and E2 (Fig. 1
). The variables compared were E2 (concentration), LH (concentration, pulse frequency, and pulse amplitude), FSH (concentration), and LH to FSH ratio. A repeated-measures ANOVA was conducted for comparing concentrations of LH and FSH, E2, and the LH pulse amplitude. The repeated-measures ANOVA had one between-subjects factor (control vs. prenatal T) and one within-subjects factor (period), with period having three levels for the 12-wk analysis and five levels for the 24-wk analysis. The main effects of treatment and period and the interactions between treatment and period were examined. Post hoc tests were used to compare treatment means within each period, and the change between the post-GnRH-A at 72 h and E2 periods for C- vs. T-treated females. Residuals from these analyses were checked for normality. A nonparametric Wilcoxon rank sum test with exact P values was used to compare LH to FSH ratios for C- vs. T-treated females within each treatment period because normality could not be assumed for these measures. For LH pulse frequency, a count variable, which could not be assumed to be normally distributed, a Poisson regression with repeated measures was carried out, using the generalized estimating equations method (33). This analysis allowed us to take into account the correlation among observations on the same female for the different bleeds and also allowed us to take the nonnormality of the response into account. The percent suppression from the GnRH-A 72 h to E2 periods for each of the hormones was compared for the control vs. prenatal T-treated females at 12 and 24 wk. A nonparametric Wilcoxon rank sum test was used for the analysis of the percent suppression data because we could not assume normality for these measures.
To allow comparisons of the age-dependent changes in E2 feedback of gonadotropins at 12 and 24 wk, alternate data points from the 10-min LH data series at 24 wk of age were deleted so that they would be comparable to the 20-min data series at 12 wk, and the normalized data series was then subjected to a second set of Cluster analyses. To examine the effect of age on percent suppression, the difference between the normalized 12- and 24-wk suppression was calculated for each animal and a Wilcoxon signed rank test was used to assess the significance of the change in percent suppression at the two ages. We also examined the overall effect of treatment on the normalized 12- vs. 24-wk LH suppression data by first calculating the average of the normalized percent suppression from 1224 wk for each animal and then comparing this mean for C- vs. T-treated animals using a Wilcoxon rank sum test. All analyses were carried out using SAS for Windows release 9.1.3 (20022003; SAS Institute, Cary, NC).
| Results |
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The age of puberty for females used in this study was delayed in prenatal T females compared with controls (Fig. 2
). The first E2 negative feedback test at 12 wk of age was 15 and 19 wk before puberty in the control and prenatal T females, respectively, during the age of relatively high sensitivity to estrogen negative feedback. The second E2 feedback test at 24 wk of age was about 3 and 8 wk before puberty, respectively, when sensitivity to E2 negative feedback normally reduces in control females.
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| Discussion |
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Validity of approach used to assess negative feedback
To assess E2 negative feedback in the presence of the ovaries, we attempted to standardize circulating E2 by reducing endogenous production and replacing this with exogenous E2 from a constant release device, the well-characterized SILASTIC brand capsule implanted sc. A GnRH-A was used to block GnRH action, thereby reducing gonadotropic drive, which, in turn, arrested follicular development and reduced endogenous E2 production. This provided a short window of time in which to conduct the E2 feedback test. Although the approach proved to be technically useful to study the responsiveness of the prenatal T females to E2 negative feedback, there are some limitations in applying this approach to other ovary-intact situations. The GnRH-A does not completely block FSH production or endogenous estrogen production. It ablates GnRH action (27), blocks LH release (27, 32), blocks production of GnRH-induced release of FSH (less acidic and more bioactive) (27), induces follicular atresia, and arrests follicular development to the gonadotropin-independent stage (34), thus limiting E2 production to near detection levels (27, 34) of the assay. Although release from GnRH-A inhibition allows a new wave of follicular growth, it does not follow that the number of follicles recruited will be the same and result in similar endogenous levels of E2. Because prenatal T females are multifollicular, we expected levels of E2 production and, hence, the feedback drive, to be equal or greater in prenatal T females compared with control females. This proved to be the case. The converse, namely increased E2 drive in the control females, would have not allowed us to test the hypothesis.
Altered sensitivity to E2 negative feedback and pubertal timing
Central to the neuroendocrine mechanisms associated with puberty in the sheep, as in other species, is the reduction in sensitivity to E2 negative feedback inhibition that allows the GnRH pulse generator to express high activity and produce the gonadotropin secretion at levels that stimulate the gonads to function like an adult (19, 20, 21). Sex differences often occur in the timing of puberty. In the female sheep, the pubertal increase in GnRH secretion occurs around 2530 wk of age, whereas in males, this begins much earlier, at 810 wk of age (19). This earlier pubertal increase in GnRH secretion in the male occurs in response to the earlier decrease in sensitivity to estrogen feedback inhibition brought about by the prenatal programming of this system by exposure to steroids from the developing testes. Experimentally, the timing of the pubertal GnRH rise in ovariectomized females exposed to constant E2 can be advanced by treatment with T in utero (11, 12, 22). Such females, like males, reduce their responsiveness to E2 negative feedback, leading to an early increase in circulating LH (11, 12, 22). Thus, one would predict from the precocious initiation of neuroendocrine puberty in this model that precocious initiation of ovulatory cycles would occur had the ovaries not been removed in such prenatal T females. This is not the case as determined by our earlier studies in which progestogenic cycles occurred at the normal time (10, 14, 16, 18) or this study, where progestogenic cycles began later in the prenatal T animals. Although onset of progestogenic cycles did not occur early, circulating levels of LH, based on infrequent sampling (twice weekly), were found to be higher postnatally in prenatal T females compared with control females (14). LH pulse frequency was also found to be higher during the follicular phase of sheep treated prenatally with T from d 6090 gestation (18). In the present study, the increased LH pulse frequency and mean LH concentrations during the pretreatment period both at 12 and 24 wk of age in the prenatal T females provides additional evidence for hypergonadotropism. Because this occurred in these prenatal T females in the face of similar or higher endogenous E2 concentrations, it provides evidence that an early reduction in LH sensitivity to E2 feedback is expressed before puberty in prenatal T females, even in the presence of the ovary. Further evidence for this decreased sensitivity was provided by their response to estrogen, when the steroid was provided by a constant release device (implant); prenatal T females were hypergonadotropic relative to control females. Finally, further corroboration for this contention is provided in the present study by the early increase in LH pulse frequency in prenatal T females during the post-GnRH-A period compared with control females in the presence of similar or lower concentrations of E2. Alternatively, the elevated LH secretion found 24 h after GnRH-A in 24-wk-old prenatal T females, when increase in endogenous E2 is negligible, may likely represent steroid-independent stimulatory effect on LH by prenatal T excess, analogous to that seen between gonadectomized male and female lambs (35) or the seasonal effects seen in ovariectomized adult ewes (36).
Considering that a reduced sensitivity to E2 feedback was evident in ovary-intact prenatal T females by 12 wk, around the time of early initiation of neuroendocrine puberty in the ovariectomized females exposed to constant E2 (11, 12, 22), the absence of initiation of progestogenic cycles at this early age is paradoxical. The delay in onset of progestogenic cycles, on the one hand, may imply that the reduction in E2 sensitivity is not of sufficient magnitude. A second possibility is that although the neuroendocrine mechanisms controlling negative feedback inhibition of E2 have been altered by prenatal T treatment, the E2 positive feedback mechanism may not be operative until a later time. In the ovariectomized females exposed to constant E2, this is the case (11, 12), and the ability of the prenatal T female to produce a surge of GnRH, as measured in the portal vasculature, is impaired or absent (37). A recent study (16) using a different breed of sheep (Dorset) found no definable LH surges in prenatal T females at all ages studied (11, 15, 19, 23, and 27 wk). In the Suffolk breed that we use, the surge mechanism was found to remain operative in most prenatal T-treated ovary-intact females (14, 38). Recently, we found follicular phase levels of exogenous estrogen produced a LH surge in three of seven females at 12 wk, two of seven at 23 wk, and five of six at 54 wk, although the latency was increased and surge magnitude reduced (38). The most salient explanations for these differing results using the same dose of T and period of treatment are genetic differences in sensitivity to T programming. The early escape from E2 inhibitory feedback (high LH pulse frequency) in this study, combined with a potentially operative positive feedback mechanism in at least in some of T females of this breed, should have led to early puberty. Failure of prenatal T females to initiate the predicted early puberty raises the consideration that the ovary may not be capable of producing a preovulatory E2 rise. Our studies in very young females found that as early as 5 wk, the ovaries of prenatal T females were multifollicular and express abundant follistatin mRNA and relatively low activin ßB mRNA, all features suggestive of a compromised ovarian follicular function (15). Whatever the ovarian deficiency, it becomes at least partially restored by the time normal females achieve puberty at 2530 wk of age because most prenatal T females also begin to exhibit reproductive cycles at that time (10, 14). Thus, prenatal T appears to dissociate neuroendocrine puberty, which is achieved at a relatively young age (11, 12, 22) compared with ovarian puberty (10, 14), which occurs much later.
Prenatal programming of steroid feedback disruptions
Disruption of E2 negative feedback evidenced by prenatal T treatment in the present study in conjunction with earlier findings of disruption of progesterone negative feedback (17) and E2 positive feedback (11, 12, 14, 16) is suggestive of more generalized disruption of the steroid feedback systems controlling pulsatile and surge release of GnRH by prenatal exposure to T and its metabolites. If other neuroendocrine systems responsive to E2 feedback are similarly involved remains to be determined. For instance, prenatal T treatment programs male-typical behavior in these animals (Lee, T., unpublished data), suggesting that neuroendocrine feedback mechanisms regulating behavioral centers may be similarly affected. Generalized disruptions of neuroendocrine systems may be programmed by altering neurogenesis, neuron survival, and even angiogenesis in the central nervous system, where androgens have been implicated (39, 40, 41).
Progressive deterioration of the neuroendocrine axis
Earlier studies of others and ours found progressive deterioration of reproductive cyclicity with majority of animals cycling the first year but becoming anovulatory the next year (9, 10). Findings from the present study indicate that development of hypergonadotropism in prenatal T females may also be a progressive event as reflected by abnormally increased pretreatment levels of circulating LH at 24 wk of age compared with 12 wk. Further corroboration for this premise also comes from the greater increase in LH to FSH ratio of prenatal T females compared with controls during the pretreatment, post-GnRH-A (72 h) and E2 treatment periods at 24 wk of age than 12 wk.
Differential programming of E2 feedback control of LH and FSH
Considering that LH and FSH are produced by the same gonadotrope (42, 43), and E2 is a major negative feedback regulator of both LH and FSH at the pituitary level (23, 24, 25), one would expect changes in feedback sensitivity to E2 be reflected by changes in circulating FSH. Although the reduced responsiveness to E2 negative feedback was reflected as an increase in circulating LH concentrations and LH pulse frequency in the prenatal T females after GnRH-A and E2 treatment, no such differences in circulating levels of FSH were evident in prenatal T females at either 12 or 24 wk. Such findings are also not consistent with slow frequency GnRH pulse favoring FSH (44) and raise the possibility that other pituitary paracrine modulators of FSH production/release (23, 24, 25, 45, 46, 47) and/or changes in FSH heterogeneity (48) may be involved. Because LH and FSH are produced and released from the same gonadotrope, such differences in regulation are likely to involve different secretory pathways. It is well documented FSH is predominantly secreted via a constitutive pathway and LH via a regulated pathway involving coupling to a stimulus, GnRH (23, 24, 25, 49, 50). Alternatively, because of the integrated nature of FSH measures involved, we cannot assess if there are changes in temporal pattern of FSH release between control and prenatal T females. It should be noted, however, that FSH secretory dynamics could not be assessed reliably from peripheral measurements because of its long circulatory half-life (48). This would require measurements closer to the site of release (51, 52).
Implications of reduced E2 negative feedback
The reduced responsiveness to E2 negative feedback is likely to contribute, at least in part, to the developing hypergonadotropism in the prenatal T females (14, 18), although other mechanisms such as increased pituitary gonadotropic responsiveness to GnRH may be involved. That the prenatal T female becomes hypergonadotropic is evidenced by 1) the higher circulating levels of LH during the prepubertal period (14), 2) the increased follicular phase LH pulse frequency (18), and 3) the absence of progesterone negative feedback (17). To what extent reduced sensitivity to E2 negative feedback contributes to the hypergonadotropism and what are the consequences of this feedback disruption in terms of fertility remain to be determined. The prenatal T females exhibit several characteristic features that are typical of the majority of women with polycystic ovary syndrome (PCOS), namely hypergonadotropism, and an increase in LH to FSH ratio and multifollicular ovaries (53, 54, 55). The hypergonadotropism in women with PCOS is a contributing factor in development of hyperandrogenism, multifollicular ovaries, and infertility because treatment with GnRH-A helps correct hyperandrogenism of ovarian origin in women with PCOS (56, 57, 58, 59). Whether early perturbations in gonadotropin dynamics leading to altered LH to FSH ratio underlie the functional hyperandrogenism and multifollicular ovarian development (15) and loss of cyclicity (9, 10) in the prenatal T female and other hyperandrogenic disorders remain to be determined. If hypergonadotropism is the basis, normalization of gonadotropic milieu should restore fertility in prenatal T females.
| Acknowledgments |
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| Footnotes |
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First Published Online June 23, 2005
Abbreviations: E2, Estradiol; GnRH-A, GnRH antagonist; PCOS, polycystic ovary syndrome; T, testosterone.
Received March 17, 2005.
Accepted for publication June 16, 2005.
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