JCEM：IGFs参与卵泡生长调节

多囊卵巢综合症（PCOS）是无排卵性不孕的常见原因，以卵泡发育异常为特征，包括激活和加速窦前卵泡生长。来自实验动物和人类卵巢组织研究的初步结果提示胰岛素样生长因子（IGFs）影响窦前卵泡的发育。为了探讨人类卵巢组织中1型IGF受体（IGFR-1）的表达，并确定在正常和多囊卵巢，IGFs是否参与刺激原始卵泡向初级卵泡的转变，来自英国汉姆史密斯医院Stephen Franks教授及其团队进行了一项研究，该研究发现IGFs似乎参与人类卵泡生长启动的调节；且PCOS窦前卵泡增长的加速可能是由于内源性IGFs活性的增加。该研究结果在线发表在2013年6月7日的《临床内分泌代谢杂志》（The journal of clinical endocrinology & metabolism）上。

该研究中，用收集的巢组织做蛋白表达研究和卵巢小皮质活检做卵泡分离和组织培养。该研究是一项以实验室为基础的研究，使用临床组织标本。受试者包括55例女性：33例为正常卵巢，21例为多囊卵巢，参照月经周期史和超声检查进行分类。主要评价指标为在分离的窦前卵泡中IGFR-1 mRNA的表达，以及从正常卵巢和多囊卵巢收集卵巢组织标本中蛋白的表达。在正常和多囊卵巢培养片段中，评估外源性IGF-1对窦前卵泡发育和存活的影响。

该研究结果表明，在所有发育阶段的窦前卵泡中有IGFR-1 mRNA和蛋白的表达，且在早期窦前卵泡发育期间，观察到在PCOS卵泡中IGFR-1 mRNA和蛋白的表达增强。在正常组织中，IGF-1刺激启动卵泡生长，但在多囊卵巢中对窦前卵泡生长的影响很小，因即使在培养前，多囊卵巢中有更高比例的卵泡进入生长期。

该研究发现，IGFs似乎参与人类卵泡生长启动的调节；且PCOS窦前卵泡增长的加速可能是由于内源性IGFs活性的增加。

Role of insulin-like growth factors in initiation of follicle growth in normal and polycystic human ovaries.
Context
Polycystic ovary syndrome (PCOS), the commonest cause of anovulatory infertility, is characterized by disordered follicle development including activation and accelerated growth of preantral follicles. Data from experimental animals and preliminary results from studies of human ovarian tissue suggest that insulin-like growth factors (IGFs) affect preantral follicle development.
Objective
To investigate the expression of the Type-1 IGF receptor (IGFR-1) in the human ovary, and to determine whether IGFs are involved in stimulating the transition of follicles from primordial to primary stage in normal and polycystic ovaries.
Design
Use of archived ovarian tissue for protein expression studies and small cortical biopsies for follicle isolation and for tissue culture.
Setting
A laboratory-based study, using clinical tissue samples.
Patients
54 women: 33 with normal ovaries and 21 with polycystic ovaries, classified by reference to menstrual cycle history and ultrasonography.
Main outcome measures
Expression of IGFR-1 mRNA in isolated preantral follicles and of protein in archived ovarian tissue samples from normal and polycystic ovaries. Effects of exogenous IGF-I on preantral follicle development and survival in cultured fragments of normal and polycystic ovaries.
Results
IGFR-1 mRNA and protein was expressed in preantral follicles at all stages of development and enhanced expression was noted in PCOS follicles during early preantral development. IGF-I stimulated initiation of follicle growth in normal tissue but had little effect on preantral follicle growth in polycystic ovaries in which, characteristically; there was a higher proportion of follicles that had entered the growing phase even before culture.
Conclusions
IGFs are plausible candidates in regulation of initiation of human follicle growth and accelerated preantral follicle growth in PCOS may be due to increased activity of endogenous IGFs.