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RESEARCH |
Department of Medical Biophysics and Department of Laboratory Medicine and Pathobiology, Ontario Cancer Institute, University of Toronto, 610 University Avenue, Toronto, Ontario, Canada M5G 2M9
Correspondence should be addressed to R Khokha; Email: rkhokha{at}uhnres.utoronto.ca
| Abstract |
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| Introduction |
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Circulating levels of E2 and P4 produced by the ovaries fluctuate as a result of the reproductive cycle. The murine estrous cycle generally lasts 45 days and can be divided into four stages called proestrus, estrus, metestrus, and diestrus. In the mouse, circulating levels of E2 peak prior to ovulation, which occurs at estrus, while P4 levels rise during metestrus and diestrus, and then decline from proestrus to estrus (Walmer et al. 1992, Fata et al. 2001).
Studies of the effects of hormones on the murine uterus generally fall into three groups: those that rely on vaginal smears, where the actual levels of P4 and estrogen are assumed; those that involve exogenously administered hormones to the atrophic uteri of ovariectomized mice with no measurement of serum concentrations; and those that employ genetically modified mice. Various combinations of these approaches have provided important findings, but they do not address how the endogenous circulating levels of E2 and P4 correlate with concurrent uterine tissue changes. To date, only a handful of studies have used a strict regimen to map out the natural circulating changes of these hormones in mice in relation to the four stages of the estrous cycle (Walmer et al. 1992, Dharma et al. 2001, Fata et al. 2001). We have previously reported how circulating levels of E2 and P4 in cycling mice correlate with mammary gland epithelial and stromal turnover in the adult virgin gland (Fata et al. 2001). Here, we investigated changes in uterine width, cellular (luminal, glandular, and stromal) proliferation and apoptosis, ECM turnover, and inflammation in relation to both circulating E2 and P4, as well as to estrous stage classification. Our results provide a comprehensive assessment of how both the circulating levels of E2 and P4 correlate with several aspects of the uterine response and provide a comparison of how the more conventional estrous stage classification would group these responses.
| Materials and Methods |
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Hormone assays
Approximately, 1 ml blood was removed from each mouse while killing, allowed to clot at room temperature for 30 min, then centrifuged at 6000 g for 20 min to prepare serum. Serum samples were stored at 70 °C until processed for E2 and P4 measurements (kindly performed by Dr S Tokmakejian, University Hospital, London, Canada) using assays from Bayer Diagnostics according to the manufacturers instructions (Taieb et al. 2002). P4 was measured by a competitive chemiluminescent assay (ACS-180 analyzer; Chiron Diagnostic, Walpole, MA, USA) and E2 was measured by a competitive enzyme immunoassay on an Immuno-1 analyzer (Bayer Diagnostics). The sensitivities of these E2 and P4 assays are 9.4 pg/ml and 0.63 ng/ml respectively.
Immunohistochemistry
One uterine horn was removed, fixed for 3 h at 4 °C in 4% paraformaldehyde and embedded in paraffin. Sections were dewaxed in two changes of xylene, rehydrated through an ethanol series, and placed into 3% hydrogen peroxide for 10 min to block endogenous peroxidase activity. Antigen retrieval was performed as follows: slides were rinsed in water and microwaved in 10 mM citrate buffer, pH 6.0 for proliferating cell nuclear antigen (PCNA), F4/80 and anti-neutrophil immunostaining, or tissue was digested for 40 min at 42 °C with pepsin (0.4% in PBS, pH 5.2, Sigma) for laminin and collagen type-IV immunostaining. Slides were then rinsed in PBS, incubated with either rabbit anti-PCNA (1:1000 dilution; Novocastra Laboratories Ltd, New Castle, UK), rabbit anti-laminin (1:500 dilution; Monosan, Uden, Netherlands), rabbit anti-collagen type-IV (1:500 dilution, Chemicon, Temecula, CA, USA), rat anti-F4/80 (a mouse macrophage marker; Serotec, Raleigh, NC, USA), or rat anti-mouse neutrophil (Serotec) antibodies for 1 h in a humid chamber at room temperature, and then washed in PBS. To detect rat primary antibodies, biotin-conjugated donkey anti-rat immunoglobulin G (IgG; Research Diagnostics, Concord, MA, USA) was applied in the ratio of 1:500 for 30 min at room temperature. Immunohistological staining of apoptotic cells was performed using published protocols (Wijsman et al. 1993). Briefly, sections were dewaxed in two changes of xylene, rehydrated through an ethanol series, and placed into 3% hydrogen peroxide for 10 min to block endogenous peroxidase activity. After rinsing in water for 5 min, slides were treated with 0.4% pepsin (pH 5.2) at 42 °C for 10 min followed by rinsing in water for 5 min. Slides were equilibrated in buffer A (50 mM TrisHCl, 5 mM MgCl2, 10 mM ß-mercaptoethanol, 0.005% BSA fraction V, pH 7.5) for 5 min at room temperature. Klenow (1 U/ml; Sigma) and 2.5 µM of each dATP, dCTP, dGTP, and biotin-labeled dUTP (Sigma) in buffer A were applied to the sections and incubated at 42 °C for 1 h, then rinsed in water. Incorporated biotin-labeled dUTP, biotinylated donkey antibodies, and primary rabbit antibodies were detected using the Level 2 Ultra Streptavidin Detection System, which contains biotinylated goat anti-rabbit antibodies, according to the manufacturers instructions (Signet Laboratories Inc., Dedham, MA, USA). Immunostaining was visualized using fresh 3-amino-9-ethylcarbazole substrate (AEC; Sigma). Tissue was counterstained in Mayers hematoxylin, rinsed in PBS, and mounted with Crystal Mount (Biomeda Corp, Foster City, CA, USA).
Histomorphometry
All histomorphometric analyses were performed blind on tissue sections from one uterine horn. To generate indices for PCNA, apoptotic cells, collagen type-IV degradation, and laminin degradation, counts were performed on luminal epithelium, stromal compartment, and glandular epithelium separately. PCNA and apoptotic cells were scored as either immunohistochemically positive or negative. A minimum of 150 total nuclei were scored for PCNA and apoptosis positivity for luminal epithelium, glandular epithelium, and stroma. Indices were calculated by dividing the number of positive cells by the total number of cells counted, and the result was then multiplied by 100 to derive a percentage index.
To determine the amount of collagen type-IV and laminin degradation on each section, four separate fields were quantified using a Hertz graticule. Both collagen type-IV and laminin immunopositivity were scored as being intact when intersecting with the graticule lines, whereas an absence of immunopositivity was scored as being degraded or remodeled. Percentage degradation for each field was calculated as the number of times immunopositivity was absent divided by the total number of times basement membrane crossed (positively or negatively stained) the graticule line. Indices were generated by averaging the percentage degradation from all four fields.
To measure the thickness of uterine tissue, the uterus was embedded with one edge roughly parallel to the paraffin block face and sectioned until the histology technician neared the midsagittal plane, at which point several serial sections were taken for histomorphometry and immunostaining. Hematoxylin- and eosin-stained sections were viewed through a Zeiss Axioplan microscope and digitally captured using a Sony 3 CCD color camera and Northern Eclipse software (EMPIX Imaging, Mississauga, Ontario, Canada). Once captured, the image was displayed on the screen at 10x magnification and four lines perpendicular to the long axis were randomly drawn per uterus (example line shown in Fig. 1B
). Measurements along these lines were made for myometrium, endometrium, and total uterine thickness including lumen, and the average thickness for each parameter was calculated.
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Statistical analysis
To assess whether differences in the indices for proliferation, apoptosis, basement membrane integrity, and mRNA levels observed at specific stages of the estrous cycle were statistically significant, an ANOVA test was performed on the entire group. If the entire group was significant at P < 0.05, then pairwise comparisons of stage-specific mean values were performed using Fishers least significant difference test (LSD). Stages were considered significant if they were in a group that passed the ANOVA test and significantly different from another stage as determined by the LSD test. All values were expressed as the mean ± S.E.M. To determine the degree of linear relationship between various indices, analysis was performed on all mice in the study regardless of estrous stage, and the coefficient of correlation (r) was calculated. The degrees of freedom for all correlation analyses were 31 (since two mice were omitted from analyses related to hormone levels due to serum sample problems).
| Results |
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Serum E2 and P4 levels at each stage of the estrous cycle
Serum E2 and P4 levels vary throughout the estrous cycle, as shown in Fig. 1E and F
. The intra-assay variation was 10.0% for E2 and 5.66% for P4. E2 levels are significantly higher during estrus than all other stages (P < 0.05, ANOVA) and remain at baseline levels from metestrus to proestrus. P4 levels fluctuate more than E2 levels during the estrous cycle, and are significantly higher during diestrus and lower during estrus when compared with all other stages (P < 0.05, ANOVA).
Uterine thickness as a function of estrous stage, and serum E2 and P4 levels
The relationship between uterine thickness and serum E2 and P4 levels was examined by correlation analysis. Total uterine thickness (outer myometrium to outer myometrium; line in Fig. 1B
) directly correlated with E2 levels (r = 0.40, P < 0.05; Fig. 1G
), and inversely with P4 (r = 0.56, P < 0.005; Fig. 1H
). Based on the stage of the cycle (Fig. 1I
), total uterine thickness at estrus was significantly greater than all other stages (P < 0.01), with metestrus being significantly greater than both proestrus and diestrus (P < 0.05). When endometrial and myometrial thicknesses were examined individually, correlation analysis yielded no correlation between either E2 or P4 and endometrial or myometrial thickness. However, when mice were grouped by stage, the endometrial thickness was significantly greater at estrus than at all other stages (0.71 ± 0.06 mm vs 0.40 ± 0.04 mm, P < 0.01).
Cyclical proliferation and apoptosis in uterine luminal epithelium, glandular epithelium, and stromal cells
Using PCNA immunohistochemistry, proliferation indices were obtained for luminal epithelium, glandular epithelium, and stromal cells (Fig. 2AF
, Supplementary Fig. 1, which can be viewed online at www.reproduction-online.org/supplemental/). For luminal epithelium, no significant difference in proliferation was found when assessed as a function of estrous stage (Fig. 2B
). In contrast, high proliferation significantly correlated with low P4 (r = 0.49, P < 0.05; Fig. 2i
). Although a positive trend was observed between high luminal epithelial proliferation and high E2 (r = 0.26, data not shown), this relationship was not statistically significant. Proliferation in the glandular compartment contrasted with that in luminal epithelium, in that it was highest at proestrus and metestrus, both of which were significantly higher than proliferation at estrus and diestrus (Fig. 2D
; P < 0.005). When analyzed as a function of hormone levels, glandular proliferation index negatively correlated with E2 levels (r = 0.36, P < 0.05; Fig. 2i
), while no correlation was seen with P4 (data not shown). Finally, stromal cell proliferation was elevated only at estrus (P < 0.005). In contrast to proliferation in the epithelial compartments, stromal proliferation positively correlated with E2 levels (r = 0.51, P < 0.005; Fig. 2iii
). Conducting individual correlation analyses between hormone levels and proliferation in different cellular compartments for each stage of the estrous cycle showed no significant relationships (Supplementary Table 1
, which can be viewed online at www.reproduction-online.org/supplemental/).
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| Discussion |
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Table 1
summarizes the cyclical uterine parameters examined in this study and their correlations to serum E2 and P4 levels, in conjunction with significant differences between each estrous cycle stage. Serum levels of E2 correlated with proliferation and/or apoptosis in most cell types, but did not correlate with as many extracellular matrix changes, while P4 levels correlated with only a few parameters. E2 is reported to induce proliferation in both luminal and glandular epithelia, while P4 is thought to directly counter these effects (reviewed in Emons et al. 2000, Henderson & Feigelson 2000). Although we found a significant inverse correlation between P4 levels and luminal epithelial proliferation (Fig. 2i
), P4 did not correlate with low glandular proliferation. P4 is thought to stimulate uterine stromal cell proliferation (Martin et al. 1973b, Lydon et al. 1995), but we found instead that it correlated with low stromal cell apoptosis. The reported proliferative effects of E2 on luminal and glandular epithelia were not found in our study. In contrast, E2 correlated with low apoptosis in all the three cellular compartments examined (Fig. 3iiii
). The mitogenic effect of unopposed estrogen exposure on glandular epithelium is considered a major factor in the development of type I endometrial cancer in both humans (Key & Pike 1988, Emons et al. 2000, Henderson & Feigelson 2000, Ellenson & Wu 2004) and rodent models (Vollmer 2003). Our findings show that in naturally cycling mice, serum E2 levels do not correlate with glandular proliferation, but may instead act to protect glandular endometrial cells from apoptosis.
Several parameters examined in our study showed correlations with hormone levels as well as specific estrous stages (Table 1
). Uterine width is greatest at estrus, which coincides with the highest levels of E2 and lowest levels of P4, and these correlations are to be expected. Likewise, glandular proliferation was high at stages other than estrus and correlated with low serum E2; stromal proliferation was greatest at estrus and correlated with high E2; and stromal apoptosis was greatest during metestrus and correlated with both E2 and P4, which are relatively low at this stage. In contrast, some parameters showed correlations with either E2 or P4, but were not associated with a particular stage of estrous (luminal proliferation, glandular apoptosis, and glandular collagen type-IV degradation; Table 1
). Likewise, we found distinct differences in the location of uterine macrophages and neutrophils as a function of estrous stage, but not as a function of E2 or P4 levels (Table 1
). Estrous stage-associated shifts in macrophage location have previously been reported for mouse (Pollard et al. 1998, Shimada-Hiratsuka et al. 2000) and rat (Kachkache et al. 1991), and the migration of neutrophils into the luminal epithelium at metestrus has been well documented (Corbeil et al. 1985). Although E2 and P4 are often regarded as having pro- and anti-inflammatory effects respectively on mouse uterus (Martin et al. 1973a, 1973b, De & Wood 1990, Hunt et al. 1998, Tibbetts et al. 1998), the effects of E2 and P4 have never been tested in normal cycling mice. Our finding that neutrophil and macrophage migrations are not correlated with hormone levels suggests that in a physiological setting, these cells are influenced more by cyclical structural changes in the endometrium than by serum hormone levels themselves.
The changes that define the transition from one stage of estrous to the next in the mouse occur over a mere 24 h, requiring a rapid cellular response to hormonal fluctuations. Indeed, the first wave of DNA synthesis following exogenous E2 administration to ovariectomized mice begins at 10 h post-injection and peaks at 16 h (Hewitt et al. 2003). Furthermore, it is now recognized that very rapid E2 signaling that does not require target gene transcription can occur, leading to activation of the phosphoinositol-3-kinase pathway and stimulation of ERK and p38 MAP kinases (Kelly & Levin 2001, Warner & Gustafsson 2006). Our findings show that concurrent hormone levels alone can predict the state of many measurable uterine parameters, suggesting that in naturally cycling mice these cellular responses to hormone changes are not delayed, but occur very rapidly. A few parameters did not correlate with levels of either hormone. It is possible that these aspects of uterine remodeling have a delayed response to hormone fluctuations, such that serum levels may not reflect their concurrent state.
There is relatively little literature examining normally cycling mice and these studies rely exclusively on vaginal cytology. Most other studies on cyclical changes in the murine uterus examine the effects of exogenous hormones 714 days following ovariectomy, when uterine E2 and P4 receptor expressions are highly deregulated (Graham & Clarke 1997, Kurita et al. 2001) or used hormone receptor-deficient mice. Actual serum levels of E2 and P4 post-injection are rarely measured, and these rather severe manipulations may lead to unambiguous data and strong conclusions that have little basis in normal physiology. Uterine estrogen receptor
(ER
) mRNA expression has been reported to fluctuate as a function of the estrous cycle, and decrease to baseline levels 2 days after ovariectomy (Bergman et al. 1992). In complete contrast, another study (Carley et al. 2003) reported that uterine ER
expression significantly increased following ovariectomy when compared with sham-operated mice, while ERß levels remained unchanged. In a study of mouse intestinal macrophages, the number of ER
-positive macrophages varied with the stage of estrous, and ovariectomy resulted in fewer ER
-positive macrophages (Kawano et al. 2004). Thus, ovariectomy itself can lead to a change in the expression of ER
and the subsequent response to exogenous hormone treatment, obscuring significant cyclical effects of the estrous cycle. Using vaginal cytology to stage mice, we found that most parameters examined were significantly different at one stage of the cycle from the other three (Table 1
). Increased numbers of luminal epithelial cells during proestrus/estrus (combined) stages when compared with metestrus and diestrus have been reported (Evans et al. 1990), but this study did not examine proliferation directly. In our study, mean luminal proliferation was higher for estrus than the other stages (Fig. 2A
), but the difference was not significant. We found that luminal cell apoptosis was very low during estrus (Fig. 3B
), which could result in an overall increase in the number of luminal cells when coupled with the relatively high luminal cell proliferation at this stage. This same study (Evans et al. 1990) and another (Dharma et al. 2001) found low luminal cell numbers and high apoptosis respectively at metestrus, similar to our findings (Fig. 3B
), and high stromal cell apoptosis during metestrus. Although no differences in glandular epithelial cell numbers were found by Evans et al.(1990), this is likely due to their combining proestrus and estrus stages since we found large differences in this parameter between proestrus and estrus (Fig. 3D
).
Previously, we have reported on the cellular and morphological changes that occur in the mouse mammary gland as a function of the normal estrous cycle and endogenous E2 and P4 (Fata et al. 2001). Together, these studies reveal several major differences between mammary gland and uterus in their response to hormones and stage of estrous cycle. In the mammary gland, epithelial proliferation and apoptosis correlated with serum P4 levels and not with E2, whereas in the uterus these are mainly associated with E2 (Table 1
). Diestrus differed from all other stages in terms of mammary morphology, proliferation, and apoptosis, but this was not the case in the uterus for any parameter. The dramatic difference in hormone responsiveness of these two cyclically changing female reproductive tissues may have implications for therapies that alter hormone actions. Estrogen receptor-modulating drugs such as tamoxifen are used as a powerful adjuvant therapy for breast cancer treatment, but increase the risk of endometrial cancer (Jordan 2004). The weakly pro-estrogenic effect of tamoxifen in the uterus is now recognized as the reason for the paradoxical effect of anti-estrogens on endometrial cancer promotion (Pritchard 2001), and the association of E2 with low apoptotic rate in glandular cells may be playing a role in this.
In summary, this work highlights the correlation between changing circulatory levels of estrogen and P4 and the multiple parameters that undergo measurable changes in the murine uterus over the relatively short estrous cycle. Instead of simplifying the interplay between changing hormone levels and uterine structure, our study illustrates the complex, dynamic nature of uterine physiology in the mouse.
| Acknowledgements |
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| Footnotes |
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Received 30 October 2006
First decision 16 November 2006
Revised manuscript received 7 February 2007
Accepted 21 February 2007
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