Postovulatory mammalian oocyte developmental potential decreases with aging in vivo and in vitro. Aging oocytes typically show cellular fragmentation and chromosome scattering with an abnormally shaped spindle over time. Previously, it was shown that histone acetylation in the mouse oocyte increased during aging and that treatment with trichostatin A (TSA), an inhibitor for class I and II histone deacetylases (HDACs), enhanced the acetylation, that is, aging. In this study, we examined the effect of nicotinamide (NAM), an inhibitor for class III HDACs, on in vitro aging of mouse oocytes as well as TSA. We found that treatment with NAM significantly inhibited cellular fragmentation, spindle elongation and astral microtubules up to 48 h of culture. Although presence of TSA partially inhibited cellular fragmentation and spindle elongation up to 36 h of culture, treatment with TSA induced chromosome scattering at 24 h of culture and more severe cellular fragmentation at 48 h of culture. Further, we found that α-tubulin, a nonhistone protein, increased acetylation during aging, suggesting that not only histone but nonhistone protein acetylation may also increase with oocyte aging. Thus, these data indicate that protein acetylation is abnormally regulated in aging oocytes, which are associated with a variety of aging phenotypes, and that class I/II and class III HDACs may play distinct roles in aging oocytes.
Postovulatory mammalian oocyte developmental potential decreases with aging in vivo and in vitro. Aging oocytes typically show cellular fragmentation and chromosome scattering with an abnormally shaped spindle over time. Previously, it was shown that histone acetylation in the mouse oocyte increased during aging and that treatment with trichostatin A (TSA), an inhibitor for class I and II histone deacetylases (HDACs), enhanced the acetylation, that is, aging. In this study, we examined the effect of nicotinamide (NAM), an inhibitor for class III HDACs, on in vitro aging of mouse oocytes as well as TSA. We found that treatment with NAM significantly inhibited cellular fragmentation, spindle elongation and astral microtubules up to 48 h of culture. Although presence of TSA partially inhibited cellular fragmentation and spindle elongation up to 36 h of culture, treatment with TSA induced chromosome scattering at 24 h of culture and more severe cellular fragmentation at 48 h of culture. Further, we found that α-tubulin, a nonhistone protein, increased acetylation during aging, suggesting that not only histone but nonhistone protein acetylation may also increase with oocyte aging. Thus, these data indicate that protein acetylation is abnormally regulated in aging oocytes, which are associated with a variety of aging phenotypes, and that class I/II and class III HDACs may play distinct roles in aging oocytes.
After ovulation or in vitro maturation, mammalian oocytes are arrested at
meiotic metaphase II (MII) until they are activated by penetrating spermatozoa or artificial
stimuli. Mammalian oocytes have a limited time for fertilization after ovulation. The window
for optimal fertilization differs in different species, and it has been determined that mouse,
rat, and monkey and human oocytes exhibit the most potential 8–12 h, 12–14 h and <24 h
after ovulation, respectively [1, 2]. If not fertilized or activated within that time, mature oocytes
progressively undergo a time-dependent process of aging, which leads to a decrease in the
potential for fertilization and embryo development [3].
In addition, aged oocytes show the phenomenon of a high proportion of cellular fragmentation
and cell death [4, 5]. However, the precise mechanisms involved in these cellular fragmentation
phenomena in oocyte aging are not yet well understood. In the mouse, following ovulation, the
fragmentation of unfertilized mature oocytes has been viewed as a manifestation of apoptosis,
or programmed cell death [6,7,8,9], and is enhanced by a variety of factors, including oxidative stress,diabetes and
specific gene mutations [10,11,12,13,14].Many reagents have been reported to prevent abnormal features after aging in oocytes. The
reports have shown that age-associated cellular fragmentation is partially prevented by
incubation with β-mercaptoethanol at 24 h after oocyte collection. DTT increased the potential
of aged mouse oocytes to develop to the blastocyst stage [15, 16]. Nitric oxide delays oocyte aging and
improves the integrity of the microtubular spindle apparatus in mice [17]. Recently, caffeine and MG132 have also been implicated in preventing
aging of mouse oocytes [18].Histone acetylation by histone acetyltransferases (HATs) and histone deacetylation by histone
deacetylases (HDACs) play important roles in various cellular functions for opposing
activities that modulate gene expression through chromatin modification. HDACs are divided
into five categories: class I (HDAC 1–3 and 8), class IIa (HDAC 4, 5, 7 and 9), class IIb
(HDAC 6 and 10), class III (SIRT 1–7) and class IV (HDAC 11) [19]. The structurally distinct class III HDACs, which contain the family of
sirtuins, comprise a unique class of nicotinamide adenine dinucleotide (NAD+)-dependent
deacetylases [20] that are involved in diverse
biological functions such as metabolism, cell division and aging [21]. Nicotinamide (NAM) is known as a class III HDAC inhibitor, a
noncompetitive inhibitor of sirtuin [22]. Budding yeast
grown in the presence of added NAM causes defects in Sir2-mediated transcriptional silencing,
increasing rDNA recombination, and a significantly shorter lifespan [23]. Depletion of nicotinamide by PNC1 extends longevity and prevents
NAM-induced inhibition of telomeric and rDNA silencing in yeast [24, 25]. Nicotinamide inhibits p53
deacetylation by Sir2α upon DNA damage in mouse embryonic fibroblast cells [26].Inhibition of other classes of HDACs has also been shown to affect phenotypes associated with
oocyte aging. The acetylation levels of lysine 14 on histone H3 (H3K14) and lysine 8 and 12 on
histone H4 (H4K8/K12) in mouse oocytes increase during aging of oocytes [27]. Treatment of oocytes during aging with trichostatin A (TSA), an
inhibitor of HDACs, increases acetylation of H3K14 and H4K8/K12, suggesting that treatment of
oocytes with HDAC inhibitors (HDACis) may accelerate the progression of oocyte aging [27]. In contrast, inhibition of HDACs by TSA may instead
reduce the percentage of cellular fragmentation in in vitro aging of pig
oocytes [28]. These reports suggest that the
acetylation statuses of proteins in oocytes are positively or negatively associated with
oocyte aging.In the present study, we focus on the effects of HDACis on the morphologies, chromosome
alignment and spindle morphologies as well as acetylation status of α-tubulin, a nonhistone
protein in aging oocytes.
Materials and Methods
Animals
We used female B6D2F1 mice (6–8 weeks of age) purchased from Shizuoka Laboratory Animal
Center (Hamamatsu, Japan). Animal care and experiments were in accordance with the Guiding
Principles for the Care and Use of Laboratory Animals in a Kinki University Animal
Facility.
Oocyte collection
We used in vitro-aged oocytes that were superovulated by injection of
pregnant mare's serum gonadotropin (PMSG) followed 48 h later by injection of humanchorionic gonadotropin (hCG). Oocytes were collected in an M2 medium at 15 h after hCG
injection, and cumulus cells were removed with M2 containing 0.1% hyaluronidase. After 3–4
rinses, cumulus-free oocytes were cultured in KSOM (Millipore) medium for the
experiment.
In vitro aging and assessment of oocyte abnormalities
For in vitro aging, some oocytes were directly used for the fresh
experimental group (MII), and oocytes were cultured in KSOM medium supplemented with or
without of 20 mM nicotinamide (NAM; Sigma) or 500 nM trichostatin A (TSA; Sigma). The
oocytes were then cultured at 37 C in 5% CO2 in air for 0, 24, 36 and 48 h. At
different time intervals of in vitro aging, the oocytes were subjected to
morphological examination, Western blot analysis and immunostaining with α-tubulin,
acetylated α-tubulin, and other aging parameters such as spindle elongation and chromosome
scattering. At least 20 oocytes were evaluated at each replication at least three
times.
SDS-Page and Western blotting
Total protein was collected from 30 oocytes from each group, which were lysed in SDS
sample buffer and boiled at 100 C for 5 min and loaded onto 10% SDS-polyacrylamide gels.
Total proteins were separated by SDS-PAGE and electrophoretically transferred to a
membrane, which was then blocked at 1 h and incubated with a 1:5000 dilution of rabbit
monoclonal anti-α-tubulin (T3526; Sigma) and a 1:10000 dilution of mouse monoclonal
anti-acetylated α-Tubulin (T7451; Sigma) overnight at 4 C. The membranes were then washed
three times in PBS-Tween, and membranes were incubated in an anti-mouse secondary antibody
or an anti-rabbit secondary antibody for 1 h at room temperature. The membranes (NH 1703;
Amersham HybondTM-P) were thoroughly washed with PBS-Tween three times and then
processed with an ECL (4622840; AmershamTM ECLTM prime Western
Blotting Detection Reagent) detection system. For quantitative analysis of α-tubulin and
acetylated α-tubulin levels, Western blot images were subjected to densitometric analysis
using the ImageJ software from the National Institutes of Health
(http://rsb.info.nih.gov/ij/) (USA).
Immunofluorescence
MII oocytes at 0 h (15 h after hCG injection), 12 h (27 h after hCG injection), 24 h (39
h after hCG injection) and 36 h (51 h after hCG injection), treated with or without NAM or
TSA, were washed with 0.1% polyvinyl alcohol (PVA) containing PBS (PBS-PVA) and then fixed
in 4% w/v paraformaldehyde at room temperature for 30 min. After washing in PBS-PVA, the
oocytes were incubated overnight in PBS containing 1% bovine serum albumin (BSA) and 0.1%
Triton X-100 at 4 C. Then the oocytes were washed three times with PBS 0.1% BSA and
incubated with the primary antibodies, a 1:200 dilution of a rabbit monoclonal
anti-α-tubulin (T3526; Sigma) and a 1:1000 dilution of a mouse monoclonal anti-acetylated
α-tubulin (T7451, Sigma), for 2 h at room temperature. After washing three times with
PBS-0.1% BSA, the oocytes were incubated with the secondary antibodies, 1:200 goat
anti-mouse or 1:200 chicken anti-rabbit antibodies, for 1 h at room temperature. After
washing three times with PBS-0.1% BSA, the DNA was visualized by DAPI staining. The
oocytes were mounted on glass slides with a drop of fluorescent mounting medium, and then
covered by a glass cover slip. We observed each cytoplasm and spindle by fluorescence
microscopy in aging oocytes treated with NAM and TSA.
Statistical analysis
The data were basically compared using chi-square test analysis with Yates correction for
continuity. The data of normal and abnormal morphologies were analyzed by Welch's
t test. A value of P<0.01 or 0.05 was considered to be statistically
significant.
Results
Effects of nicotinamide or trichostatin A on aging oocytes
To investigate how NAM or TSA inhibitors for HDAC I/II and III respectively affect
abnormal morphologies during oocyte aging, we observed aging oocytes for up to 48 h in a
culture medium treated with or without of NAM or TSA following oocyte collection. We
classified abnormal morphologies of aging oocytes into three categories, cellular
fragmentation, 2-cell-like structure and normal oocyte morphology, as we previously
reported [29]. Untreated aging oocytes started to
exhibit abnormal morphologies at 36 h, and by 48 h, more than half of the aging oocytes
had shown abnormal morphologies (Fig. 1A, B). Although treatment with NAM or TSA reduced the frequency of abnormal oocyte at 36
h, treatment with NAM significantly inhibited the abnormal morphologies in aging oocytes
even at 48 h (Fig. 1A, B). Treatment with TSA at
48 h resulted in a greater number of fragmented oocytes than untreated aging oocytes
(Fig. 1A, B). Thus, HDACis affected oocyte
fragmentation associated with aging, and the inhibitor of Class III HDAC more effectively
suppressed oocyte fragmentation. Therefore, regulation of protein acetylation may play
important roles in oocyte aging.
Fig. 1.
Morphological changes of postovulatory aging oocytes treated with NAM, or TSA at
0, 24, 36 and 48 h after oocyte collection. A: Although some oocytes started to show
abnormal morphologies at 36 h, such as cellular fragmentation and 2-cell-like
structure (arrowheads: abnormal oocytes), more oocytes treated with NAM or TSA
continued to show normal morphology. However, at 48 h, most oocytes showed
fragmentation except those treated with NAM. Bar = 100 μm. B: Summary of
quantification of oocytes with normal morphology. Data are given as mean % ±
SEM.
Morphological changes of postovulatory aging oocytes treated with NAM, or TSA at
0, 24, 36 and 48 h after oocyte collection. A: Although some oocytes started to show
abnormal morphologies at 36 h, such as cellular fragmentation and 2-cell-like
structure (arrowheads: abnormal oocytes), more oocytes treated with NAM or TSA
continued to show normal morphology. However, at 48 h, most oocytes showed
fragmentation except those treated with NAM. Bar = 100 μm. B: Summary of
quantification of oocytes with normal morphology. Data are given as mean % ±
SEM.
Acetylation of α-tubulin increases during oocyte aging
Aging oocytes increased histone acetylation [27].
However, it is not known how protein acetylation is generally associated with oocyte
aging. α-Tubulin, a nonhistone protein, is a well-known representative substrate of HDACs
in the cytoplasm. Therefore, we focused on the acetylation status of α-tubulin during
aging in oocytes. Compared with the freshly collected oocytes (0 h), the amounts of both
acetylated α-tubulin (Ac α-tubulin) and α-tubulin gradually increased in the oocytes
during aging until 24 h, with the amount of Ac α-tubulin continuing to accumulate after
this time point (Fig. 2A–C). It should be noted that at 36 h, aged oocytes showed astral microtubules that
were not always associated with Ac α-tubulin (Fig.
2A). Thus, these data indicate that the amount of α-tubulin and its acetylation
status change along with oocyte aging.
Fig. 2.
Acetylated α-tubulin (Ac α-tubulin) and α-tubulin were increased in aging oocytes.
A: Immunostaining of aging oocytes with anti-Ac α-tubulin and anti-α-tubulin
antibodies revealed that during oocyte aging, the level of Ac α-tubulin and
α-tubulin was increased until 24 h and then decreased at 36 h. B: Consistent with
the results of immunostaining, Western blot analysis confirmed that the level of Ac
α-tubulin and α-tubulin increased until 24 h in aging oocytes but started to reduce
at 36 h. Elongated spindles (24 h) and astral microtubules (36 h) were observed. C:
Summary of Western blot quantification. Data are given as mean % ± SEM. Ac α-tubulin
showed a greater increase than α-tubulin itself.
Acetylated α-tubulin (Ac α-tubulin) and α-tubulin were increased in aging oocytes.
A: Immunostaining of aging oocytes with anti-Ac α-tubulin and anti-α-tubulin
antibodies revealed that during oocyte aging, the level of Ac α-tubulin and
α-tubulin was increased until 24 h and then decreased at 36 h. B: Consistent with
the results of immunostaining, Western blot analysis confirmed that the level of Ac
α-tubulin and α-tubulin increased until 24 h in aging oocytes but started to reduce
at 36 h. Elongated spindles (24 h) and astral microtubules (36 h) were observed. C:
Summary of Western blot quantification. Data are given as mean % ± SEM. Ac α-tubulin
showed a greater increase than α-tubulin itself.
Treatment with NAM and TSA affect acetylation status of α-tubulin in aging
oocyte
Next, we examined effects of HDACi treatment on the acetylation status of α-tubulin in
oocytes during aging. Treatment with TSA dramatically increased Ac α-tubulin in all the
oocytes compared with untreated aging oocytes at 36 h (Fig. 3A–C). In contrast, although treatment with NAM resulted in similar amounts of Ac
α-tubulin and α-tubulin at 36 h, treatment with NAM maintained a lower level of Ac
α-tubulin and α-tubulin in cytoplasm compared with control aging oocytes at 36 h (Fig. 3A–C). Further, astral microtubules, a symptom
of oocytes aging, were observed in most untreated aging oocytes and TSA-treated oocytes at
36 h (Table 1). On the other hand, in the presence of NAM, the number of oocytes with
astral microtubules was significantly reduced at 36 h in cytoplasm (Table 1). Thus, NAM treatment strongly suppressed production of
abnormal microtubule structures during aging. Together, these results suggest that oocyte
aging increases the amount of Ac α-tubulin and α-tubulin, which may contribute to the
production of astral microtubules.
Fig. 3.
Impact of NAM and TSA on status of Ac α-tubulin and on abnormal structures of
α-tubulin at 36 h after oocyte collection. A: Immunostaining of aging oocytes with
anti-Ac α-tubulin and anti-α-tubulin antibodies at 36 h revealed that NAM treatment
suppressed the increase of acetylation in α-tubulin and maintained normal spindle
morphologies and appearance of astral microtubule structures (arrowheads). In
contrast, TSA treatment induced more acetylation and severe spindle degeneration in
microtubules. Bar = 100 μm. B: Consistent with the results of immunostaining,
Western blot analysis confirmed that the level of Ac α-tubulin and α-tubulin
increased until 36 h in aging oocytes after TSA treatment but not in NAM-treated
aging oocytes compared with untreated aging oocytes. C: Summary of Western blot
quantification. Data are given as mean % ± SEM. TSA treatment showed a greater
increase than α-tubulin.
Table 1.
Oocytes with astral microtubules after 36 h of aging
Treatment
No. oocyte
No. of oocyteswith astral microtubules (%)
Fresh MII
75
1 (1)a
Untreated-36 h
75
74 (99)b
20 mM NAM-36 h
83
16 (19)c
500 nM TSA-36 h
77
39 (51)d
a, b, c, d P<0.01; n=5.
Impact of NAM and TSA on status of Ac α-tubulin and on abnormal structures of
α-tubulin at 36 h after oocyte collection. A: Immunostaining of aging oocytes with
anti-Ac α-tubulin and anti-α-tubulin antibodies at 36 h revealed that NAM treatment
suppressed the increase of acetylation in α-tubulin and maintained normal spindle
morphologies and appearance of astral microtubule structures (arrowheads). In
contrast, TSA treatment induced more acetylation and severe spindle degeneration in
microtubules. Bar = 100 μm. B: Consistent with the results of immunostaining,
Western blot analysis confirmed that the level of Ac α-tubulin and α-tubulin
increased until 36 h in aging oocytes after TSA treatment but not in NAM-treated
aging oocytes compared with untreated aging oocytes. C: Summary of Western blot
quantification. Data are given as mean % ± SEM. TSA treatment showed a greater
increase than α-tubulin.a, b, c, d P<0.01; n=5.
Treatment with NAM or TSA impacts spindle morphology during oocyte aging
Aged oocytes have abnormally elongated spindles [18, 29]. Therefore, we next focused on
the effects of NAM or TSA on spindle morphology in aging oocytes. Although at 24 h most of
the aged oocytes displayed an irregularly shaped spindle, treatment with NAM resulted in a
significant reduction in spindle elongation (Fig. 4A,
B). It should be noted that treatment with TSA led to apparent prevention of spindle
elongation and also led to a loss of microtubules from the spindle (Fig. 4A). Taken together, inhibition of HDAC affects stability of
spindle morphology associated with oocyte aging.
Fig. 4.
Impact of NAM and TSA treatment on spindle elongation at 24 h. A: Immunostaining
of aging oocytes with anti-Ac α-tubulin and anti-α-tubulin antibodies at 24 h
revealed that NAM treatment maintained compact spindle formation at MII but that TSA
treatment partially prevented spindle elongation associated with microtubule loss in
spindles. Bar = 100 μm. B: Summary of quantification of the length of spindles
compared with freshly collected oocytes (0 h).
Impact of NAM and TSA treatment on spindle elongation at 24 h. A: Immunostaining
of aging oocytes with anti-Ac α-tubulin and anti-α-tubulin antibodies at 24 h
revealed that NAM treatment maintained compact spindle formation at MII but that TSA
treatment partially prevented spindle elongation associated with microtubule loss in
spindles. Bar = 100 μm. B: Summary of quantification of the length of spindles
compared with freshly collected oocytes (0 h).
Discussion
Cellular fragmentation commonly occurs in postovulatory aging oocytes concomitantly with
loss of developmental potential. The oocyte fragmentation in vitro is
dependent upon the functional expression of several genes comprising the evolutionarily
conserved apoptotic cell death program [30, 31].In this study, we revealed that treatment of aging oocytes with HDACis, TSA and NAM,
affects the cellular fragmentation and abnormal spindle morphology of aging oocytes. It is
known that TSA inhibits classes I and IIa/b HDACs and that NAM can inhibit SIRT 1 and 2,
which are class III HDACs [32]. SIRT 1 regulates p53
acetylation and p53-dependent apoptosis in response to DNA damage and oxidative stresses
[33]. SIRT 2 is a cytoplasmic protein and has a
role in tubulin deacetylation [34]. Recently, it has
been reported that NAM and TSA induce apoptosis in neural stem cells via distinct molecular
mechanisms [35], suggesting that different signaling
pathways based on inhibition of different HDACs could share one phenotype. It was reported
that all sirtuin genes (Sirt 1-7) are expressed in ovulated oocytes [36]. We showed that treatment with NAM inhibits the cellular
fragmentation and 2-cell-like structures until 36 h (51 h after hCG injection) after oocyte
collection. These data suggest that NAM strongly inhibits abnormal phenotypes in progressive
oocyte aging and that TSA shows weak and limited inhibition.Some specific residues of histone such as lysine 14 on histone H3 (H3K14) and lysine 8 and
12 on histone H4 (H4K8/K12) are associated with oocyte aging [27]. In this study, we examined the level of Ac α-tubulin to elucidate
the role of acetylation of non-histone proteins during oocyte aging. Mouse oocytes exhibit
microtubule acetylation after fertilization and early development [37]. The acetylation of α-tubulin contributes to cytoskeletal stability
during development, and the appearance of acetylated microtubules is a valuable marker for
the presence of stable arrays [38, 39]. α-Tubulin is deacetylated by HDAC6 [40] and the NAD+ dependent histone deacetylase SIRT2
[41] and acetylated by MEC-17 [42]. In this study, we found that the levels of both Ac
α-tubulin and α-tubulin increased in the aging oocytes. Our report first described dynamics
of Ac α-tubulin and α-tubulin in aging oocytes. The mechanism underlying accumulation of
α-tubulin in aging oocytes is not known, but acetylation status and/or localization of
α-tubulin may contribute to the stability and turnover of α-tubulin. Actually, more
acetylation of α-tubulin by TSA treatment resulted in a larger accumulation of α-tubulin in
the cytoplasm, but led to a loss of microtubules from the spindle at 36 h of aging.
Regardless of the amount of α-tubulin, the ratio of Ac α-tubulin increased during oocyte
aging. Thus, increasing acetylation in both histone and nonhistone protein occurs during
oocyte aging, suggesting that aging oocytes lose the precise regulation of protein
acetylation by HATs and HDACs.Murine MII oocytes contain two microtubule-containing structures: the meiotic spindles and
a dozen cytoplasmic microtubules (astral microtubules) [43]. The meiotic spindles are crucial for the proper alignment and separation of
the chromosomes during meiosis, whereas the cytoplasmic astral microtubules are responsible
for pronuclear apposition following sperm incorporation [44,45,46]. It should be noted that the α-tubulin acetylation is dynamically assembled
astral microtubules emanating from the spindle into the cytoplasm at 36 h. However,
treatment with NAM could suppress formation of astral microtubules in aging oocytes. These
results suggest that the assembled astral microtubules in the cytoplasm associated with
aging are regulated by class III HDACs. NAM was able to minimize acetylation of α-tubulin
until 36 h in contrast to untreated aging oocytes.Next, we examined the spindle morphology in aging oocytes. It is reported that when a
freshly ovulated oocyte is aged in vitro, it leads to misaligned
chromosomes or dispersed, elongated or completely disrupted spindles, which are associated
with poor developmental potential in embryos [25]. We
found that most aged oocytes appear to display spindle elongation at 24 h. On the other
hand, most aging oocytes treated with NAM showed significantly inhibited spindle elongation.
Our results provide evidence that increased numbers of normal spindles and chromosomes are
formed because of changes in the levels of Ac α-tubulin, which regulates the astral
microtubules in the cytoplasm. The astral microtubules might be from the unstable spindle
microtubules emanating into the cytoplasm because of oocyte aging and cellular fragmentation
in aging oocytes.In conclusion, inhibition of the class I/II and especially III HDACs delays aging
phenotypes. Further, the level of Ac α-tubulin and α-tubulin increased in the process of
oocyte aging, which is also suppressed by NAM treatment. Thus, NAM could inhibit cellular
fragmentation and spindle elongation and minimize acetylation of α-tubulin in oocyte aging.
Finally, our findings present the first demonstration of the involvement of Class I/II and
III HDACs in aging phenotypes while providing insight into the mechanism underlying oocyte
aging and prevention of abnormal phenotypes in aged oocytes.
Authors: Angelique Riepsamen; Lindsay Wu; Laurin Lau; Dave Listijono; William Ledger; David Sinclair; Hayden Homer Journal: PLoS One Date: 2015-05-04 Impact factor: 3.240
Authors: T Trapphoff; M Heiligentag; D Dankert; H Demond; D Deutsch; T Fröhlich; G J Arnold; R Grümmer; B Horsthemke; U Eichenlaub-Ritter Journal: Hum Reprod Date: 2015-11-17 Impact factor: 6.918