Abstract
PCOS is associated with hyperandrogenism and growth arrest of antral follicles. Excess androgens work as a stage-specific inhibitor of a follicular growth suppressing the growth of late-stage follicles. Previously, we found that endoplasmic reticulum (ER) stress is activated in granulosa cells of antral follicles in PCOS (1). This is evidenced by the activation of various unfolded protein response (UPR) genes, including a pro-apoptotic UPR transcription factor, C/EBP homologous protein (CHOP). Death receptor (DR) 5, which harbors a CHOP-binding site in its promoter region, plays a crucial role in ER stress-induced apoptosis by increasing autocrine death-ligand signal, independent of its extracellular ligand TNF-related apoptosis-inducing ligand (TRAIL) (2). Based on these observations, we hypothesized that ER stress is activated by androgen in granulosa cells of antral follicles in PCOS and activated ER stress promotes apoptosis via induction of CHOP and subsequent activation of DR5. Using RT-PCR (qPCR), we showed that testosterone induced the mRNA expression of various UPR factors including XBP1(S), HSPA5, ATF4 and CHOP along with DR5 in cultured human granulosa-lutein cells (GLCs). Treatment with an ER stress inhibitor, tauroursodeoxycholic acid (TUDCA), inhibited testosterone-induced mRNA and protein expression of DR5 and CHOP, with a concomitant reduction in apoptosis examined by qPCR, western blotting and flow cytometry respectively. Furthermore, knockdown of CHOP or DR5 by RNA interference inhibited testosterone-induced apoptosis and knockdown of CHOP reduced testosterone-induced DR5 mRNA expression. Treatment with an androgen receptor (AR) antagonist, flutamide, as well as the knockdown of AR, decreased testosterone-induced DR5 and CHOP mRNA expression and apoptosis. In addition, expression of DR5 and CHOP was upregulated in GLCs of PCOS patients and granulosa cells of antral follicles in ovarian sections obtained from both PCOS patients and dehydroepiandrosterone (DHEA)-induced PCOS mice, proven by qPCR and immunohistochemistry (IHC). Treatment of PCOS mice with TUDCA decreased apoptosis and DR5 expression in granulosa cells of antral follicles, with a concomitant reduction in CHOP expression, shown by TUNEL and IHC staining. Our findings indicate that ER stress activated by hyperandrogenism in PCOS promotes apoptosis of granulosa cells of antral follicles via induction of DR5. Reference: (1) Takahashi N, Harada M, et al. Sci Rep 2017, 7:10824 (2) Lu M et al. Science 2014;345:98-101.