Maryam Ezzati1,2, Leila Roshangar1,3, Jafar Soleimani Rad2,4, Nahid Karimian5. 1. Stem Cell Research Center, Tabriz University of Medical Sciences, Tabriz, Iran. 2. Department of Anatomical Sciences, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran. 3. Department of Tissue Engineering, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran. Electronic address:lroshangar@yahoo.com. 4. Department of Tissue Engineering, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran. 5. Department of Advanced Sciences, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran.
As defined by world health organization (WHO) infertility
is as the inability of a couple of child-bearing age to conceive
over 12 months of regular unprotected sexual intercourse
and is considered as a public health problem (1). About 10-15%
of young couples have been reported to suffer from this
conditions. Of these, 40-55, 20-30, and 15-17% are due to
female factors, male factors and unexplained conditions,
respectively (2, 3).For 10% of couples trying to conceive underlying causeof the infertility are not easily identifiable, though all theirrelevant tests are normal. In this case, in vitro fertilization
(IVF) may be recommended since it has shown to bethe most effective treatment for unexplained infertility(4). Conditions such as exposure to light, elevated oxygen
concentrations, and unusual concentrations of metabolites
can cause an oxidative stress in oocytes and embryos during
in vitro culture. Reactive oxygen species (ROS) can damage
cell membranes and DNA and cause apoptosis (5). Therefore,
protecting oocytes and embryos from oxidative stress in the
culture medium is of crucial importance. In this regard, the
usage of antioxidant compounds may result in more favorable
results.Oxidative stress can be reduced and culture conditions can
be promoted an antioxidant or a radical scavenger is added to
in the in vitro culture medium. As the main hormone secreted
by pineal gland in the human brain, melatonin (N-acetyl-5methoxytryptamine)
is an endogenous compound which
was discovered about 50 years ago. Through its stimulatory
actions on the antioxidant system, it is regarded as a direct
free-radical scavenger and an indirect antioxidant (6-8).Several studies have demonstrated that melatonin is a
powerful direct free-radical scavenger. In contrast to a
majority of other known radical scavengers, melatonin is a
universal multifunctional antioxidant. Melatonin has been
reported to act as a hydrophilic and hydrophobic antioxidant
since it is both lipid and water soluble (9). Also, the presence
of melatonin receptors in the ovary at multiple sites, indicates
that melatonin may influence the reproductive system (10).
Melatonin concentrations in ovarian follicles increase with
follicular growth (11). Furthermore, melatonin treatmentenhances the hCG-stimulated progesterone secretion
(12). Earlier studies indicated that progesterone, a steroidhormone is a key player in ovulation. The biological effectsof progesterone are mediated via PGR , a ligand-activated
transcription factor. Ovarian PGR expression is undetectableduring follicular development (13). It is likely that some PGR -
regulated factors are secreted by granulosa cells and deliveredto other cell types, such as cumulus cells within the ovary.
Furthermore, besides playing a critical role in the ovary,
progesterone is known to be essential for the maintenance
of pregnancy. PGR s as members of the nuclear receptorsuperfamily of transcription factors (NR3C3) mediate
progesterone effects (14).PGR has been identified as an important regulator of genetranscription during the peri-ovulatory period, especiallyPGR regulates the transcription of the genes required for asuccessful oocyte release from the preovulatory follicle.
In response to luteinizing hormone (LH), granulosa cellsrelease epidermal growth factor (EGF)-like ligands, whichin turn, cause cumulus cells to undergo an expansion (15).
The cumulus oocyte complexes (COCs) formed due to thepresence of a unique extracellular matrix plays an importantrole in successful oocyte maturation and ovulation (16). Atthe same time, the oocyte resumes meiosis and undergoesa maturation process to become competent for ovulation,
fertilization, and expansion of COCs. During the expansionof cumulus cells, HAS2 is the most important gene involved
in the production of hyaluronic acid (HA) matrix (17).It is generally accepted that HAS2 mRNA is a key elementrequired for the cumulus expansion process, which is necessaryfor oocyte maturation and ovulation (17-21). Increasing
cumulus cell expansion can improve fertility rates because
HAS2 and PGR expression rates are enhanced during cumulus
expansion. Melatonin may influence the cumulus expansionby augmenting HAS2 and PGR expressions. Therefore,
the effects of melatonin on HAS2 and PGR expression and
cumulus expansion were evaluated in this study.
Materials and Methods
This experimental study was approved by the Research
Committee of Tabriz Medical University according to the
rules of the Ethics Committee. Forty five adult mice (15 male
and 30 females, 30-35 g and 6-8 weeks old) were obtained
from the animal house of Tabriz University of Medical
Sciences (TUMS). Animals were kept in a 12-hour light/12hour
dark cycle with an unrestricted access to food and water
at room temperature for 2 weeks.Preparation of melatonin stock solution was done using
an ethanol/TCM199 system. For this purpose 23.23 mg of
melatonin (Sigma, United states) was dissolved in 1 ml of
0.1% absolute ethanol and diluted with TCM199 and serial
dilutions were prepared. Using this method, a stock solution
of melatonin 10 µM was prepared (22) and stored in a
refrigerator at 4°C at most for 2 weeks. In our experiment,
ethanol amount was 0.1% in the maturation medium.All the animals were treated in accordance with the
guidelines of University Ethics Committee for care and use
of laboratory animals. The female mice were superovulated
using an intraperitoneal injection of 10 IU human menopausal
gonadotropin (HMG) (NV Organon, Oss, The Netherlands)
and after 24 hours, another intraperitoneal injection of 10 IU
of humanchorionic gonadotropin (hCG) (NV Organon, Oss,
Holland) was done.The female mice were sacrificed within 48 hours of hCG
injection, and the ovaries and oviducts were removed after.
Next, the miceovaries (n=60) and oviducts were placed
in sterile phosphate-buffered saline (PBS, Sigma, USA).
Then, samples were transported to the Tissue Engineering
Laboratory. Upon removing the stromal tissues surrounding
the oviducts, the oocytes were collected from the uterine
tube using the flushing method (universal medium of Azar
Panam). By using a head sampler, the oocytes were drawn
and poured into a dish. Finally liquid oil was added to prevent
the culture medium evaporation.The cumulus cells surrounding the oocytes, (i.e.,
cumulus oocyte complexes (COCs) were transferred to
another dish containing the medium and then PBS was
added for washing. In the experimental groups, the cumulus
cells were cultured in the medium supplement with 10 µM
melatonin for 6 hours. For evaluation of cumulus expansion,
COCs were morphologically classified at recovery as having
a compact or expanded investment. COCs were cultured in
200 mµ of a universal IVF medium and then incubated with
sterile mineral oil at 37°C with 5% CO2 for 6 hours. After this
incubation period, the medium was centrifuged twice at 3000
rpm for 5 minutes. Afterwards, the pellet of the cumulus cells
was transferred to -20°C for 1 hour and then stored at -80°C
until RNA isolation.
In vitro fertilization
The animals selected for IVF were divided into control
and experimental groups. After superovulation, the femalemice were killed by cervical dislocation, their oocytes were
collected by uterine tube flushing. Next, sperms were collectedfrom the caudal epididymis of male mice by incubating
the pieces of epididymis with Ham’s F-10 medium cultureusing a CO2 incubator at 37°C for 20 minutes. The spermsamples were added to the collected oocytes of the controland experimental groups. The rate of fertility success was
evaluated based on embryo formation associated with more
cleavages and morula.
Real time reverse transcription-polymerase chain
reaction
To measure HAS2 and PGR mRNA in the control and
experimental groups, RNA expression was determined
by using real time reverse transcription-polymerase chainreaction (RT-PCR) assay. The primers used in the PCR
are presented in Table 1. Glyceraldehyde-3-phosphatedehydrogenase (GAPDH) was used as the internal controlgene to normalize the results. By using RNeasy Micro kit(CinnaGen, Iran), the total RNAs of HAS2 and PRs were
extracted. Primers were designed and real-time RT-PCR wasconducted to analyze the gene expressions using SYBR green
technology.Primer process for real-time reverse transcription-polymerase chain reaction
Statistical analysis
Using SPSS software, version 22 and the sample t-test,
all the statistical analyses were performed. P<0.05 were
considered statistically significant.
Results
Effect of melatonin on HAS2 and PGR expression in
cumulus cells
HAS2 and PGR mRNA expressions in cumulus cells
isolated from mice oocytes were evaluated using
quantitative real-time RT-PCR. A significant increase
was observed in PGR mRNA in the experimental
compared to the control group (Fig .1). However,
no significant differences in HAS2 gene expression
were observed between the experimental and control
groups (Fig .2). At this stage, each of the control and
experimental groups were processed for real-time RTPCR
assay for 3 times. Hence, 3 experimental and 3
control groups are shown for each gene in the diagram
(Figes.1, 2).
Fig.1
PGR gene expression in isolated cumulus cell in control groups (C)
and in groups received melatonin (D).
Fig.2
HAS2 gene expression in isolated cumulus cell in control groups (A)
and in groups received melatonin (B).
Melatonin effect on fertilization rate and cumulus
expansion
IVF was carried out in both control and experimental
groups and 100 oocytes were evaluated from each
group. By counting the number of embryos, it was
revealed that more oocytes were developed into the
embryos in the experimental group receiving melatonin
for 6 hours as compared to the control group which
did not receive melatonin (P<0.05). The embryos
developed in the experimental and control groups are
shown in Figures 3 and 4, respectively. Moreover,
compact cumulus was seen to be tightly attached to the
cells surrounding the smooth-surfaced oocytes over
the cumulus hillock as shown by evaluating of the
uniformity of ooplasm. On the other hand, expanded
cumulus cells were detached from the oocytes with a
matrix visible between the cumulus cells. The numbers
of the expanded and compact COCs are demonstrated
in Table 2. The statistical analysis showed that embryo
formation in the experimental group was significantly
increased (P<0.05, Table 2).
Table 2
Embryo formation percentage in the control and experimental groups
Oocyte
Experimental Group (%)
Control Group (%)
P value
Fertilization
80
77
<0.05
Oocyte expansion rate
64
36
<0.05
PGR gene expression in isolated cumulus cell in control groups (C)
and in groups received melatonin (D).HAS2 gene expression in isolated cumulus cell in control groups (A)
and in groups received melatonin (B).Embryo formation percentage in the control and experimental groupsA photomicrograph of inseminated oocytes in melatonin-treated mice.A photomicrograph of inseminated oocytes in control group.
Discussion
It is generally accepted that melatonin and the presence
of its receptors in granulosa cells can potentially exert
beneficial effects on the ovarian function (22). As
melatonin is a powerful free-radicals scavenger which is
even more potent than vitamin E (23), it might be able
to protect granulosa cells from the cytotoxicity of free-
radicals that could be produced following long-term in
vitro culture (24, 25).The results of the present research are in agreement
with previous histological and immunohistochemical
studies, which showed that free-radicals scavenger could
promote the qualities of the cumulus-oocyte complexes
through inducing a uniform distribution of follicle cells
covering the oocytes in the ovaries (26). These findings
are in line with those reported the study of Bahadori
et al. (9), describing the detrimental effect of oxidative
stress on oocyte microenvironment and subsequently on
implantation, follicular development, ovulation, oocyte
quality, and early embryonic development. Also, the
results of the study conducted by Ishizuka et al. (27) is
consistent with those of the current research indicating
that melatonin supports both mice fertilization and early
development of embryonic tissue in the culture medium.However, no relationships between oxidative stress
markers and pregnancy rate were reported by Jozwick et
al. (28) HAS2 gene expression in cumulus cells is critical
for the formation of hyaluronan, the predominant matrix
component surrounding the expanded cumulus cells.
Hyaluronan synthesis, which appears to occur at the
transcription level of HAS2 , is strictly regulated in cumulus
cells. The present study confirmed the role of melatonin
in promoting cumulus cell expression of HAS2 though
the influence was not significant (29-31). The results of
another study showed that oocyte quality is ameliorated
by antioxidants, while it directly increases the degrees
of cumulus cell expansion and HAS2 expression (32).
Moreover, observed in our study, it was previously shown
that in that melatonin increases the number of PGR s (33).
The present study revealed the effects of administration
of melatonin on IVF, cumulus cell expansion, maturation,
and HAS2 and PGR expressions.
Conclusion
It is concluded that melatonin can improve IVF
outcome by increasing cumulus cell expansion and PGR
expression, while it had no influence on HAS2 expression.
Table 1
Primer process for real-time reverse transcription-polymerase chain reaction