title: Angiotensin-(1-7) in human follicular fluid correlates with oocyte maturation.
abstract: Do angiotensin (Ang)-(1-7) levels in human ovarian follicular fluid (FF) correlate with the number and proportion of mature oocytes obtained for IVF?
  
  
  
  The present study shows for the first time that Ang-(1-7) levels in human FF correlate with the proportion of mature oocytes collected upon ovarian stimulation for IVF.
  
  
  
  Ang-(1-7) is an active peptide of the renin-angiotensin system that stimulates oocyte maturation in isolated rabbit and rat ovaries. However, its role in human ovulation remains unexplored.
  
  
  
  This was a prospective cohort study including 64 participants from a single IVF center. Sample size was calculated to achieve a statistical power of 80% in detecting 20% differences in the proportion of mature oocytes between groups. The participants were enrolled in the study during six consecutive months.
  
  
  
  Plasma samples were obtained from all subjects at Day 21 of the last menstrual cycle before starting pituitary blockade and controlled ovarian stimulation (COS). Plasma and FF samples were quickly mixed with a protease inhibitor cocktail and stored at -80°C. Ang-(1-7) was quantified in plasma and FF samples by a highly sensitive and specific radioimmunoassay, which was preceded by solid phase extraction, speed vacuum concentration and sample reconstitution in assay buffer. FF Ang-(1-7) levels were stratified into tertiles and the patients of each tertile were compared for COS/IVF outcomes using Kruskal-Wallis ANOVA. Multiple regression analysis was used to adjust correlations for potential confounders. The mRNA encoding for Mas, a receptor for Ang-(1-7), was investigated by real-time PCR in luteinized granulosa cells purified from the FF.
  
  
  
  There was a four-fold increase in plasma Ang-(1-7) after ovulation induction (median 160.9 vs 41.4 pg/ml, P < 0.0001). FF Ang-(1-7) levels were similar to (169.9 pg/ml) but did not correlate with plasma Ang-(1-7) levels (r = -0.05, P = 0.665). Patients at the highest FF Ang-(1-7) tertile had a higher proportion of mature oocytes compared to patients at the lower FF Ang-(1-7) tertile (median 100% vs 70%, P < 0.01). There was a linear correlation between FF Ang-(1-7) and the proportion of mature oocytes (r = 0.380, P < 0.01), which remained significant after adjustment for age and duration of infertility (r = 0.447, P < 0.001). The luteinized granulosa cells expressed Mas receptor mRNA, which was positively correlated to the number of mature oocytes in women with more than three mature oocytes retrieved (r = 0.42, P < 0.01).
  
  
  
  This is an observational study, therefore, no causal relationship can be established between Ang-(1-7) and human oocyte maturation. Mas protein expression was not quantified due to limited availability of granulosa cells.
  
  
  
  Since this peptide promotes oocyte maturation in other species, it deserves further investigation as a potential maturation factor to human oocytes.
  
  
  
  Research supported by Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) and Fundação de Amparo à Pesquisa do Estado de Minas Gerais (FAPEMIG). The authors have nothing to disclose.
authors.affiliation: Division of Human Reproduction, Department of Obstetrics and Gynecology, Federal University of Minas Gerais, Av. Alfredo Balena 110-9o andar, Belo Horizonte, MG 30130-100, Brazil.
authors.forename: Ines K
authors.initials: IK
authors.lastname: Cavallo
authors.affiliation: Division of Human Reproduction, Department of Obstetrics and Gynecology, Federal University of Minas Gerais, Av. Alfredo Balena 110-9o andar, Belo Horizonte, MG 30130-100, Brazil.
authors.forename: Cynthia
authors.initials: C
authors.lastname: Dela Cruz
authors.affiliation: Department of Physiology and Biophysics, Universidade Federal de Minas Gerais, Av. Antônio Carlos 6627, Belo Horizonte, MG 31270-901, Brazil.
authors.forename: Marilene L
authors.initials: ML
authors.lastname: Oliveira
authors.affiliation: Division of Human Reproduction, Department of Obstetrics and Gynecology, Federal University of Minas Gerais, Av. Alfredo Balena 110-9o andar, Belo Horizonte, MG 30130-100, Brazil.
authors.forename: Helen L
authors.initials: HL
authors.lastname: Del Puerto
authors.affiliation: Division of Human Reproduction, Department of Obstetrics and Gynecology, Federal University of Minas Gerais, Av. Alfredo Balena 110-9o andar, Belo Horizonte, MG 30130-100, Brazil.
authors.forename: Júlia A
authors.initials: JA
authors.lastname: Dias
authors.affiliation: Division of Human Reproduction, Department of Obstetrics and Gynecology, Federal University of Minas Gerais, Av. Alfredo Balena 110-9o andar, Belo Horizonte, MG 30130-100, Brazil.
authors.forename: Veronica N
authors.initials: VN
authors.lastname: Lobach
authors.affiliation: Division of Human Reproduction, Department of Obstetrics and Gynecology, Federal University of Minas Gerais, Av. Alfredo Balena 110-9o andar, Belo Horizonte, MG 30130-100, Brazil.
authors.forename: Maíra
authors.initials: M
authors.lastname: Casalechi
authors.affiliation: Division of Human Reproduction, Department of Obstetrics and Gynecology, Federal University of Minas Gerais, Av. Alfredo Balena 110-9o andar, Belo Horizonte, MG 30130-100, Brazil.
authors.forename: Maria G
authors.initials: MG
authors.lastname: Camargos
authors.affiliation: Department of Physiology and Biophysics, Universidade Federal de Minas Gerais, Av. Antônio Carlos 6627, Belo Horizonte, MG 31270-901, Brazil.
authors.forename: Adelina M
authors.initials: AM
authors.lastname: Reis
authors.affiliation: Department of Physiology and Biophysics, Universidade Federal de Minas Gerais, Av. Antônio Carlos 6627, Belo Horizonte, MG 31270-901, Brazil.
authors.forename: Robson A
authors.initials: RA
authors.lastname: Santos
authors.affiliation: Division of Human Reproduction, Department of Obstetrics and Gynecology, Federal University of Minas Gerais, Av. Alfredo Balena 110-9o andar, Belo Horizonte, MG 30130-100, Brazil.
authors.forename: Fernando M
authors.initials: FM
authors.lastname: Reis
mesh_terms: D000328:Adult; D000803:Angiotensin I / Q000819:agonists* / Q000097:blood / Q000378:metabolism; D001755:Blastocyst / Q000166:cytology / Q000473:pathology; D015331:Cohort Studies; D005191:Family Characteristics; D005260:Female; D005300:Fertility Agents, Female / Q000627:therapeutic use*; D005307:Fertilization in Vitro; D015571:Follicular Fluid / Q000187:drug effects* / Q000378:metabolism; D006801:Humans; D007247:Infertility, Female / Q000097:blood / Q000378:metabolism / Q000473:pathology / Q000628:therapy*; D007248:Infertility, Male; D008297:Male; D054315:Oocyte Retrieval; D009866:Oogenesis / Q000187:drug effects*; D010062:Ovulation Induction; D010446:Peptide Fragments / Q000819:agonists* / Q000097:blood / Q000378:metabolism; D011446:Prospective Studies; D011863:Radioimmunoassay; D052616:Solid Phase Extraction; D015854:Up-Regulation / Q000187:drug effects*
chemical_list: D005300:Fertility Agents, Female; D010446:Peptide Fragments; D000803:Angiotensin I; C118790:angiotensin I (1-7)
keywords: angiotensin; controlled ovarian stimulation; follicular fluid; oocyte maturation; ovulation induction