Abstract
In this study, we show that during normal rat pregnancy, there is a gestational stage-dependent decrease in androgen receptor (AR) abundance in the gravid uterus and that this is correlated with the differential expression of endometrial receptivity and decidualization genes during early and mid-gestation. In contrast, exposure to 5α-dihydrotestosterone (DHT) and insulin (INS) or DHT alone significantly increased AR protein levels in the uterus in association with the aberrant expression of endometrial receptivity and decidualization genes, as well as disrupted implantation. Next, we assessed the functional relevance of the androgen-AR axis in the uterus for reproductive outcomes by treating normal pregnant rats and pregnant rats exposed to DHT and INS with the anti-androgen flutamide. We found that AR blockage using flutamide largely attenuated the DHT and INS-induced maternal endocrine, metabolic, and fertility impairments in pregnant rats in association with suppressed induction of uterine AR protein abundance and androgen-regulated response protein and normalized expression of several endometrial receptivity and decidualization genes. Further, blockade of AR normalized the expression of the mitochondrial biogenesis marker Nrf1 and the mitochondrial functional proteins Complexes I and II, VDAC, and PHB1. However, flutamide treatment did not rescue the compromised mitochondrial structure resulting from co-exposure to DHT and INS. These results demonstrate that functional AR protein is an important factor for gravid uterine function. Impairments in the uterine androgen-AR axis are accompanied by decreased endometrial receptivity, decidualization, and mitochondrial dysfunction, which might contribute to abnormal implantation in pregnant PCOS patients with compromised pregnancy outcomes and subfertility.
Key messages
The proper regulation of uterine androgen receptor (AR) contributes to a
normal pregnancy process, whereas the aberrant regulation of uterine AR might
be linked to polycystic ovary syndrome (PCOS)-induced pregnancy-related
complications.
In the current study, we found that during normal rat pregnancy there is
a stage-dependent decrease in AR abundance in the gravid uterus and that this
is correlated with the differential expression of the endometrial receptivity
and decidualization genes Spp1, Prl, Igfbp1,
and Hbegf.
Pregnant rats exposed to 5α-dihydrotestosterone (DHT) and insulin (INS)
or to DHT alone show elevated uterine AR protein abundance and implantation
failure related to the aberrant expression of genes involved in endometrial
receptivity and decidualization in early to mid-gestation.
Treatment with the anti-androgen flutamide, starting from
pre-implantation, effectively prevents DHT + INS-induced defects in endometrial
receptivity and decidualization gene expression, restores uterine mitochondrial
homeostasis, and increases the pregnancy rate and the numbers of viable
fetuses.
This study adds to our understanding of the mechanisms underlying poor
pregnancy outcomes in PCOS patients and the possible therapeutic use of
anti-androgens, including flutamide, after spontaneous conception.
Endometrial Perivascular Progenitor Cells and Uterus Regeneration