Abstract
The aim of the present study was to investigate whether dietary advanced glycation end-products (AGEs) can be detected in the ovarian tissue of normal female rats and whether they can affect their metabolic or hormonal profile. Sixty normal rats (20 animals in each group) were randomly assigned to regular diet, either high (H-AGE) or low (L-AGE) in AGE content for 6 months. H-AGE rats demonstrated higher levels of fasting glucose (P < 0.001), insulin (P < 0.069), and serum AGEs (P < 0.001) than control and L-AGE rats. Additionally, the H-AGE group showed increased AGE localization in the theca interna cells of the ovarian tissue compared to control/L-AGE rats (P = 0.003). Furthermore, increased receptor for AGE (RAGE) staining was also observed in granulosa cells compared to control/L-AGE samples (P = 0.038). In the H-AGE group, plasma testosterone was higher than in control rats (P < 0.001) and in the L-AGE group (P < 0.001). However, H-AGE rats did not exhibit higher body weight compared with normal (P = 0.118) and L-AGE-fed rats (P = 0.35). These results demonstrate for the first time that administration of high AGE diet in female rats for a prolonged period is associated with increased deposition of AGEs in the theca cells and of RAGE in the granulosa and theca interna cells of the ovarian tissue compared with the corresponding ovarian compartments of the control and L-AGE-fed animals. The metabolic alterations in conjuction with the increased deposition in ovarian tissues of dietary glycotoxins and elevated levels of testosterone in H-AGE-fed animals compared to the controls suggest an impact of environmental factors on ovarian tissue and these findings need further exploration.
I swear to fulfill, to the best of my ability and judgment, this covenant:I will respect the hard-won scientific gains of those physicians in whose steps I walk, and gladly share such knowledge as is mine with those who are to follow.
I will apply, for the benefit of the sick, all measures [that] are required, avoiding those twin traps of overtreatment and therapeutic nihilism.
I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon's knife or the chemist's drug.
I will not be ashamed to say "I know not," nor will I fail to call in my colleagues when the skills of another are needed for a patient's recovery.
I will respect the privacy of my patients, for their problems are not disclosed to me that the world may know. Most especially must I tread with care in matters of life and death. If it is given to me to save a life, all thanks. But it may also be within my power to take a life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty. Above all, I must not play at God.
I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person's family and economic stability. My responsibility includes these related problems, if I am to care adequately for the sick.
I will prevent disease whenever I can, for prevention is preferable to cure.
I will remember that I remain a member of society, with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm.
If I do not violate this oath, may I enjoy life and art, respected while I live and remembered with affection thereafter. May I always act so as to preserve the finest traditions of my calling and may I long experience the joy of healing those who seek my help.
Dioscorides was Greek.
Dioscorides wrote a five-volume book in his native Greek, Περὶ ὕλης ἰατρικής, known in English by its Latin title De Materia Medica ("Regarding Medical Materials") that is a "precursor to all modern pharmacopeias"."
"An examination of the literature indicates a strong likelihoodof thymus involvement in estrogen and/or testosterone-induced anovulation in other animal species. Forexample, Kincl et al. [24,25] reported that anovulation inE2- and T-injected female rats could be prevented by thymocyteinfusion. Notably, only thymocytes from adultdonors were effective. Thymocytes from 5-day-old animalsdid not prevent anovulation. In primates the thymusundergoes its final development prenatally [7]. Steroidaction would thus occur in utero. This could explain whyinjections of testosterone propionate (TP) given to pregnantrhesus monkeys on gestational day's 40–55, producesanovulatory female offspring [26,27]. The femaleoffspring have enlarged ovaries with multiple small follicles;an elevated LH/FSH ratio; and, high levels of serum17αOH-progesterone and testosterone.Additional evidence of steroid influence in utero isdetailed in reports of the consequences of using DES inpregnant women [28-35]. Prescribed from the 1940s until1971, DES was banned by the FDA due to the largenumber of reproductive problems in daughters exposed inutero. Problems included an increased rate of primaryinfertility, oligomenhorrhea, amenorrhea, high levels ofandrostenedione and testosterone, facial hirsutism, andan elevated LH/FSH ratio. These symptoms are all associatedwith the formation of cysts [36,37]. Notably, exposureto DES on gestational weeks 9 through 12 producedthe highest rate of infertility [35]. This timeframe is coincidentwith the final developmental stages of the thymus[7].The identity of the self-antigen(s) that CD8+Autoreactive Tcells regard as nonself, is at present, a matter for conjecture.MECs synthesize approximately 300 ectopic tissueproteins [20]. At least two are involved in autoimmunedisease. A peptide epitope of insulin initiates CD8+AutoreactiveT cell destruction of pancreatic β cells [38], and zonapellucida glycoprotein 3 (ZP3) is implicated as the selfantigeninvolved in ovarian dysgenesis [39]. Synthesizedin the ovary by the oocyte and granulosa cells [40], ZP3 isa prime candidate for the self-antigen involved in the formationof follicular cysts. Destruction of granulosa cellsby CD8+Autoreactive T cells would seriously impair the follicle'scapacity to synthesize estrogen. Restoration of thisability might explain why injections of FSH cause ovulationin clomiphene-resistant PCOS women without interventionby either exogenous LH or hCG [41].In conclusion: we have proposed that follicular cystsformed in a popular animal model of PCOS represent anautoimmune disease initiated by steroid administration.An increased incidence of autoimmune disease in DESexposedwomen [42], lends further support for theautoimmune nature of PCOS. As maternally derivedandrogens and estrogens diffusing into the fetal area arelimited by the amnion [43], and are normally at nanogramlevels, it is unlikely that this source of steroid causesPCOS. The reproductive problems observed with DEScame from milligram levels [44]. Potential sources of steroidsat this level are phytoestrogens, contained in foodsupplements and ingested by some pregnant women. TheCenters for Disease Control and Prevention, for example,report that 10% of representative samples of women inthe United States contain urinary levels in the milligramrange, of phytoestrogens found in flax seed [45]. Flax seedand soy bean products cause reproductive problems infemale rats [46] and mice [47], and mice suffer thymocyteloss and thymic atrophy when given genistein, the phytoestrogencontained in soy beans [47]. Our futureresearch will determine whether or not phytoestrogenscause anovulation and follicular cysts when administeredto female mice during the thymus' critical period. We willalso be investigating the impact of adrenal corticoids.While the bulk of this paper has concentrated on the roleof gonadal steroids, the observation that adrenal steroidsdiminish thymic/spleen weight and numbers of thymocytes/splenocytes (Table 2), and can instigate cyst formation[6], raises the possibility that severe stress duringpregnancy may be a factor in PCOS development."
High Levels of Oestrogen in Utero May Cause PCOS
