Case Control Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jan 26, 2024; 12(3): 479-487
Published online Jan 26, 2024. doi: 10.12998/wjcc.v12.i3.479
Significance of oxidative stress and antioxidant capacity tests as biomarkers of premature ovarian insufficiency: A case control study
Kaoru Kakinuma, Toshiyuki Kakinuma
Kaoru Kakinuma, Toshiyuki Kakinuma, Department of Obstetrics and Gynecology, International University of Health and Welfare Hospital, Tochigi 329-2763, Japan
Kaoru Kakinuma, Graduate School of Medicine, International University of Health and Welfare, Tokyo 107-8402, Japan
Author contributions: Kakinuma K and Kakinuma T were involved in conceptualizing the study, designing the methodology, validating the results, and performing formal analyses; They also conducted the investigation and curated the data for the research; Kakinuma K took the lead in writing the original draft of the manuscript; Both Kakinuma K and Kakinuma T contributed to reviewing and editing the manuscript to ensure its accuracy and clarity; They collaborated on visualizing the findings and providing supervision throughout the project; Kakinuma T handled project administration duties; Both authors have thoroughly reviewed the manuscript and have given their approval for its publication.
Institutional review board statement: This study was conducted with the approval of the ethics committee of our hospital (Ethics Review Committee, International University of Health and Welfare, approval number: 21-Im-075, approval date: 2022.3.22).
Informed consent statement: All study participants or their legal guardian provided informed written consent about personal and medical data collection prior to study enrolment.
Conflict-of-interest statement: All the authors declare that they have no conflicts of interest related to the manuscript.
Data sharing statement: The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Toshiyuki Kakinuma, MD, PhD, Professor, Department of Obstetrics and Gynecology, International University of Health and Welfare Hospital, Iguchi, Nasushiobara, Tochigi 329-2763, Japan. tokakinuma@gmail.com
Received: August 25, 2023
Peer-review started: August 25, 2023
First decision: November 20, 2023
Revised: November 27, 2023
Accepted: January 2, 2024
Article in press: January 2, 2024
Published online: January 26, 2024
Processing time: 146 Days and 4.3 Hours
Abstract
BACKGROUND

Premature ovarian insufficiency (POI) is a condition that causes secondary amenorrhea owing to ovarian hypofunction at an early stage. Early follicular depletion results in intractable infertility, thereby considerably reducing the quality of life of females. Given the continuum in weakened ovarian function, progressing from incipient ovarian failure (IOF) to transitional ovarian failure and further to POI, it is necessary to develop biomarkers for predicting POI. The oxidative stress states in IOF and POI were comprehensively evaluated via oxidative stress [diacron-reactive oxygen metabolites (d-ROMs)] test and antioxidant capacity [biological antioxidant potential (BAP)].

AIM

To explore the possibilities of oxidative stress and antioxidant capacity as biomarkers for the early detection of POI.

METHODS

Females presenting with secondary amenorrhea over 4 mo and a follicle stimulating hormone level of > 40 mIU/mL were categorized into the POI group. Females presenting with a normal menstrual cycle and a follicle stimulating hormone level of > 10.2 mIU/mL were categorized into the IOF group. Healthy females without ovarian hypofunction were categorized into the control group. Among females aged < 40 years who visited our hospital from January 2021 to June 2022, we recruited 11 patients into both POI and IOF groups. For the potential antioxidant capacity, the relative oxidative stress index (BAP/d-ROMs × 100) was calculated, and the oxidative stress defense system was comprehensively evaluated.

RESULTS

d-ROMs were significantly higher in the POI and IOF groups than in the control group, (478.2 ± 58.7 U.CARR, 434.5 ± 60.6 U.CARR, and 341.1 ± 35.1 U.CARR, respectively) (U.CARR is equivalent to 0.08 mg/dL of hydrogen peroxide). However, no significant difference was found between the POI and IOF groups. Regarding BAP, no significant difference was found between the control, IOF, and POI groups (2078.5 ± 157.4 μmol/L, 2116.2 ± 240.2 μmol/L, and 2029.0 ± 186.4 μmol/L, respectively). The oxidative stress index was significantly higher in the POI and IOF groups than in the control group (23.7 ± 3.3, 20.7 ± 3.6, and 16.5 ± 2.1, respectively). However, no significant difference was found between the POI and IOF groups.

CONCLUSION

High levels of oxidative stress suggest that evaluating the oxidative stress state may be a useful indicator for the early detection of POI.

Keywords: Premature ovarian insufficiency; Oxidative stress; Diacron-reactive oxygen metabolites test; Biological antioxidant potential; Infertility; Biomarker

Core Tip: The majority of premature ovarian insufficiency (POI) cases are idiopathic. Regardless of the cause, the disease causes a rapid decrease in the number of remaining follicles in the ovary and causes extremely intractable infertility. The process leading to POI is marked by a decline in ovarian function, starting with incipient ovarian failure, then transitional ovarian failure, and finally POI. Diacron-reactive oxygen metabolites and oxidative stress index were considerably higher in the incipient ovarian failure and POI groups than in the control group, indicating that evaluating oxidative stress status may be useful for the early diagnosis of POI.