Department of Women's Health, Merck Research Laboratories, Molenstraat 110, 5340 BH Oss, The Netherlands.
Endocrinology. 2011 Nov;152(11):4350-7. doi: 10.1210/en.2011-1077. Epub 2011 Sep 6.
Ovarian hyperstimulation syndrome (OHSS) incidentally occurs in controlled ovarian stimulation protocols and is associated with human chorionic gonadotropin (hCG) administration. OHSS is caused by increased vascular permeability (VP) and thought to be mediated by hypersecretion of vascular endothelial growth factor (VEGF) by granulosa cells. Low molecular weight (LMW)-LH agonists have a similar mode of action but a shorter half-life compared with hCG, which could potentially lead to a clinical benefit in reducing the risk for OHSS in controlled ovarian stimulation protocols. The objective of this study is to investigate the role of an orally active LMW-LH agonist in OHSS induction compared with recombinant LH (rec-LH) and hCG. Immature rats were hyperstimulated with pregnant mare serum gonadotropin, and ovulation was induced by hCG, rec-LH or a LMW-LH agonist. The degree of VP was determined by Evans Blue in the abdominal cavity. Ovaries were weighed, and VEGF concentration in the ovary was determined. Pregnant mare serum gonadotropin stimulation followed by single-dose hCG or rec-LH resulted in clear enlargement of the ovaries and increased VP and VEGF levels. However, ovulation induction with a single dose of the LMW-LH agonist did not result in increased VP and VEGF levels, and even multiple dosing to mimic a longer exposure did not induce OHSS symptoms. In conclusion, we demonstrated that the oral LMW-LH agonist did not induce VP in rat, indicative for OHSS, possibly due to reduced VEGF production. If this is translatable to human, this could potentially represent a clinical benefit in reducing the risk for OHSS when using these compounds in controlled ovarian stimulation protocols.
卵巢过度刺激综合征(OHSS)偶然发生在控制性卵巢刺激方案中,并与人绒毛膜促性腺激素(hCG)的给药有关。OHSS 是由血管通透性(VP)增加引起的,据认为是由颗粒细胞中血管内皮生长因子(VEGF)的过度分泌介导的。低分子量(LMW)-LH 激动剂的作用模式相似,但半衰期比 hCG 短,这可能在降低控制性卵巢刺激方案中 OHSS 的风险方面带来临床益处。本研究的目的是研究口服 LMW-LH 激动剂在 OHSS 诱导中的作用,与重组 LH(rec-LH)和 hCG 进行比较。未成熟的大鼠用孕马血清促性腺激素进行超刺激,然后用 hCG、rec-LH 或 LMW-LH 激动剂诱导排卵。通过腹腔内 Evans Blue 测定 VP 的程度。称重卵巢,并测定卵巢中的 VEGF 浓度。孕马血清促性腺激素刺激后单次给予 hCG 或 rec-LH 可明显增大卵巢并增加 VP 和 VEGF 水平。然而,单次给予 LMW-LH 激动剂诱导排卵不会导致 VP 和 VEGF 水平增加,即使模拟更长暴露时间的多次给药也不会引起 OHSS 症状。总之,我们证明口服 LMW-LH 激动剂不会在大鼠中引起 VP,这表明不会发生 OHSS,可能是由于 VEGF 产生减少。如果这可以转化为人类,那么在控制性卵巢刺激方案中使用这些化合物时,这可能会降低 OHSS 的风险,带来临床益处。