Role of the Follicle-Depleted Ovary in the Pathogenesis of Chronic Diseases

描述（由申请人提供）：全球绝经后妇女人口正在增加（预计到2025年将达到11亿），这些妇女的生存时间比她们的前辈更长。冠心病、骨质疏松症和代谢综合征构成了影响这一人群的健康负担的很大一部分。然而，尽管有大量的流行病学和临床研究，这些慢性和退行性疾病的起源和轨迹仍然不清楚。两个具体的知识差距是：1）围绝经期是否或在多大程度上是疾病加速进展的时间; 2）绝经时积累的病理生物学变化是否建立了绝经后疾病结局的轨迹。因此，本申请寻求支持以继续对绝经期和绝经后猴进行研究。正在进行的研究利用了我们机构最近开发的非人灵长类动物绝经过渡模型。该模型改编自围绝经期小鼠模型，其使用化学品（4-乙烯基环己烯二环氧化物-VCD）通过细胞凋亡和闭锁破坏原始卵泡。该模型概括了妇女在围绝经期过渡期间所经历的生理变化，包括原始卵泡数量减少和最终耗尽以及随后的抗米勒管激素（AMH）减少。此外，所产生的卵泡耗竭卵巢的间质具有与自然绝经后妇女相似的生物活性（例如雄激素产生）。综上所述，该模型与卵巢切除动物相比具有几个优点，卵巢切除动物是一种不产生激素特征或风险因素的研究平台（例如，血清脂质）与自然绝经后妇女中观察到的相当。围绕围绝经期过渡和绝经后的现有知识差距促使我们提出以下四个具体目标：1）确定饮食诱导的动脉粥样硬化进展的程度，如通过活组织检查直接测量的，在卵巢切除（OVX）、围绝经期和绝经期之间的差异。（VCD治疗）和绝经前猴，围绝经期动脉粥样硬化程度是否决定绝经后动脉粥样硬化发展的程度，最后，动脉粥样硬化进展的轨迹在绝经期和绝经后阶段之间是否不同; 2）确定在绝经期过渡期间是否发生骨丢失，并将确实发生的任何骨丢失的幅度与在绝经后阶段期间观察到的骨丢失的幅度进行比较; 3）确定代谢综合征的要素是否以及在何种程度上出现在围绝经期过渡期，以及是否在绝经期或绝经后阶段增加更大;和4）比较和对比VCD治疗的猴子绝经期和绝经后的激素特征，与OVX和绝经前的猴子中观察到的激素特征，并确定这些生殖阶段卵巢激素的变化是否与动脉粥样硬化程度和心血管、骨骼和代谢风险生物标志物的变化相关。公共卫生相关性：通过这项调查获得的信息将为妇女和她们的医生提供急需的证据，以根据这些证据来决定绝经后和绝经后的治疗方案。此外，本研究中观察到的结果可能远远超出血管和肌肉骨骼系统，包括对卵巢激素影响敏感的其他组织，如大脑。

DESCRIPTION (provided by applicant): The worldwide population of postmenopausal women is increasing (expected to be 1.1 billion by 2025) and these women are surviving longer than their predecessors. Coronary heart disease (CHD), osteoporosis, and the metabolic syndrome comprise a substantial part of the health burden affecting this population. However, despite considerable epidemiological and clinical research, the initiation and trajectory of these chronic and degenerative conditions remain unclear. Two specific gaps in knowledge are: 1) whether or to what extent the perimenopause is a time of accelerated disease progression; and 2) whether the pathobiological changes that have accumulated by the time of menopause establish the trajectory of postmenopausal disease outcomes. Accordingly, this application seeks support to continue a study of peri- and post-menopausal monkeys. The study in progress takes advantage of a nonhuman primate model of the menopausal transition developed recently at our institution. This model was adapted from a mouse model of perimenopause which uses a chemical (4-vinylcyclohexene diepoxide -VCD) to destroy primordial follicles via apoptosis and atresia. The model recapitulates the physiological changes experienced by women during the perimenopausal transition, including decreased numbers and ultimate depletion of primordial follicles and subsequent decreases in antimullerian hormone (AMH). Further, the stroma of the resulting follicle-depleted ovary has similar biologic activity (e.g. androgen production) to that of naturally postmenopausal women. As summarized, this model has several advantages over ovariectomized animals, a research platform that does not yield hormonal characteristics or risk factors (e.g., serum lipids) comparable to those observed in naturally postmenopausal women. The existing gaps in knowledge surrounding the perimenopausal transition and postmenopause prompted us to propose the following four Specific Aims: 1) Determine the extent to which diet induced atherosclerosis progression, as measured directly through biopsy, differs among ovariectomized (OVX), perimenopausal (VCD treated) and premenopausal monkeys, whether perimenopausal atherosclerosis extent determines the extent of postmenopausal atherosclerosis development, and finally, whether the trajectories of atherosclerosis progression differ between the peri and postmenopausal phases; 2) Determine whether bone loss occurs during the perimenopausal transition and to compare the magnitude of any bone loss that does occur with that observed during the postmenopausal phase; 3) Determine if and to what extent, elements of the metabolic syndrome appear during the perimenopausal transition, and whether the increases are greater in peri or postmenopausal phase; and 4) To compare and contrast the hormonal characteristics of VCD-treated monkeys both peri- and postmenopausally, with those observed in their OVX and premenopausal counterparts, and to determine whether changes in ovarian hormones in these reproductive phases are associated with changes in atherosclerosis extent and cardiovascular, skeletal, and metabolic risk biomarkers. PUBLIC HEALTH RELEVANCE: The information gained through this investigation will provide women and their physicians with urgently required evidence on which to base decisions concerning peri- and postmenopausal treatment options. In addition, the outcomes observed in this study might well extend beyond the vascular and musculoskeletal systems to include other tissues that are sensitive to the effects of ovarian hormones, such as the brain.