The Joint Annual Scientific Meetings of the Endocrine Society of Australia and the Society for Reproductive Biology 2018

Chemotherapy-induced infertility is caused by direct damage to oocytes (#108)

Quynh-Nhu Nguyen 1 2 , Seng H Liew 2 , Nadeen Zerafa 2 , Andreas Strasser 3 , Jock Findlay 4 5 , Martha Hickey 6 7 , Karla Hutt 2
  1. Department of Obstetrics and Gynaecology, The University of Melbourne, Parkville, Victoria, Australia
  2. Stem Cells and Development, Monash Biomedicine Discovery Institute, and Department of Anatomy and Developmental Biology, Monash University, Clayton, Victoria, Australia
  3. Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria, Australia
  4. Monash University, Clayton, Victoria, Australia
  5. Hudson Institute of Medical Research, Clayton, Victoria, Australia
  6. Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, Victoria, 3052
  7. Royal Women's Hospital, Parkville, Victoria, 3052

DNA-damaging cancer treatments cause female infertility and ovarian endocrine failure, due to depletion of the ovarian reserve. Attempts to address this have been hampered by limited understanding of the cellular mechanisms underlying follicle death after chemotherapy. We have previously reported that the pro-apoptotic BH3-only protein, PUMA, is the critical trigger of apoptosis in primordial follicles (PMFs) following cisplatin (Cis) or cyclophosphamide (Cy) treatment in mice. However, the specific targets of these drugs in the ovary, and the timing of follicular demise remain unclear. In this study we investigated the underlying processes leading to follicle death following these treatments. Adult wild-type mice were injected with saline (control), Cis 5 mg/kg, or Cy 300 mg/kg (N=5/group); ovaries were harvested after 8 hours, 24 hours, or 5 days. γH2AX immunofluorescence showed DNA double-stranded breaks (DSBs) in PMFs by 8 hours (saline-8h: 0% positive vs Cy-8h: 54±8% positive, p<0.01 vs Cis-8h: 38±8% positive, p<0.01). The proportion of γH2AX-positive follicles had reduced by 24 hours (saline-24h: 0% vs Cy-24h: 8%, NS vs Cis-24h: 16%, NS), and disappeared by 5 days (saline-5d: 0% vs Cy-5d: 8%, NS vs Cis-5d: 0%), indicating that PMF oocytes undergo either apoptosis or repair in this timeframe. Similar patterns of γH2AX positivity and disappearance were observed across all follicle stages. We then focused on the γH2AX-positive follicles to identify the cells targeted. In primordial, transitional, and primary follicles, only oocytes sustained DSBs, whereas in secondary and antral follicles, only somatic (granulosa ± theca) cells were affected. TUNEL staining further supported this conclusion. Given that 80% of oocytes are stored in PMFs in young adult mice, these data demonstrate that direct killing of PMF oocytes is the primary mechanism of ovarian reserve depletion caused by cisplatin and cyclophosphamide. Thus, future strategies to prevent chemotherapy-induced infertility must focus on preventing PMF oocyte death.