The effects of cycloastragenol on bovine embryo development, implantation potential and telomerase activity
Abdul Majid Khan A , Muhammad Idrees A B , Chalani Dilshani Perera C , Zaheer Haider A , Myeong-Don Joo A , Ji-Su Kang A , Seo-Hyeon Lee A and Il-Keun Kong A B D *A Division of Applied Life Science (BK21 Four), Gyeongsang National University, Jinju, Gyeongnam Province 52828, Republic of Korea.
B Institute of Agriculture and Life Science, Gyeongsang National University, Jinju, Gyeongnam Province, Republic of Korea.
C Department of Animal Science, Gyeongsang National University, Jinju, Republic of Korea.
D The King Kong Corp. Ltd., Gyeongsang National University, Jinju, Gyeongnam Province 52828, Republic of Korea.
Reproduction, Fertility and Development 35(10) 527-538 https://doi.org/10.1071/RD22280
Published online: 2 June 2023
© 2023 The Author(s) (or their employer(s)). Published by CSIRO Publishing
Abstract
Context: Telomerase reverse transcriptase is a key factor responsible for structural and cellular alterations in aged oocytes and changes in the structure of the zona pellucida and mitochondria. Telomerase expression is reduced in aged cumulus oocyte complexes, and its activation or enhanced expression would be beneficial for in vitro oocyte maturation and in vitro embryo development.
Aims: This study aimed to investigate telomerase activation by cycloastragenol and its effect on bovine oocyte in vitro maturation, fertilisation, and early embryo development.
Methods: We used qPCR, Western blot, immunofluorescence, reactive oxygen species (ROS) assay,TUNEL assay, JC-1 assay, and invasion assay to analyse the affect of cycloastragenol (CAG) on bovine oocyte maturation, embryo development, embryo quality and implantation potential.
Key results: Cycloastragenol treatment of oocytes in in vitro maturation (IVM) media significantly (P < 0.05) improved oocyte IVM (90.87%), embryo cleavage (90.78%), blastocyst hatching (27.04%), and embryo implantation potential. Telomerase also interacts with mitochondria, and JC-1 staining results showed significantly (P < 0.05) higher mitochondrial membrane potential (ΔΨm) in the CAG-treated group. Furthermore, the inner cell mass (OCT4 and SOX2) and trophoblasts (CDX2) of the control and CAG groups were examined. Moreover, CAG treatment to primary cultured bovine cumulus cells substantially enhanced telomerase activity.
Conclusions: Telomerase activation via cycloastragenol is beneficial for bovine oocyte IVM and for the production of high-quality bovine embryos.
Implications: Cycloastragenol is a natural telomerase activator, and could be useful as a permanent component of oocyte maturation media.
Keywords: bovine oocyte, cycloastragenol, embryo development, embryo implantation, in vitro oocyte maturation, inner cell mass, telomerase reverse transcriptase, trophoblast.
References
Ahmed TA, Ahmed SM, El-Gammal Z, Shouman S, Ahmed A, Mansour R, El-Badri N (2020) Oocyte aging: the role of cellular and environmental factors and impact on female fertility. In ‘Cell biology and translational medicine. Advances in Experimental Medicine and Biology, Vol. 1247’. (Ed. K Turksen) pp. 109–123. (Springer: Cham, Switzerland). https://doi.org/10.1007/5584_2019_456Aubert, G, and Lansdorp, PM (2008). Telomeres and aging. Physiological Reviews 88, 557–579.
| Telomeres and aging.Crossref | GoogleScholarGoogle Scholar |
Ballou RH (1993) ‘Logística empresarial: transportes, administração de materiais e distribuição física. Vol. 94.’ p. 388. (Atlas). Available at https://books.google.pt/books/about/Logística_empresarial.html?id=p6CIPgAACAAJ&pgis=1
Bauer, K, Tao, S, and Rudolph, KL (2013). Telomere stability – Wnt it or lose it. EMBO Reports 14, 297–298.
| Telomere stability – Wnt it or lose it.Crossref | GoogleScholarGoogle Scholar |
Betts, DH, and King, WA (1999). Telomerase activity and telomere detection during early bovine development. Developmental Genetics 25, 397–403.
| Telomerase activity and telomere detection during early bovine development.Crossref | GoogleScholarGoogle Scholar |
Blasiak, J, Szczepanska, J, Fila, M, Pawlowska, E, and Kaarniranta, K (2021). Potential of telomerase in age-related macular degeneration – involvement of senescence, DNA damage response and autophagy and a key role of PGC-1α. International Journal of Molecular Sciences 22, 7194.
| Potential of telomerase in age-related macular degeneration – involvement of senescence, DNA damage response and autophagy and a key role of PGC-1α.Crossref | GoogleScholarGoogle Scholar |
Chen, H-J, Liang, C-L, Lu, K, Lin, J-W, and Cho, C-L (2000). Implication of telomerase activity and alternations of telomere length in the histologic characteristics of intracranial meningiomas. Cancer 89, 2092–2098.
| Implication of telomerase activity and alternations of telomere length in the histologic characteristics of intracranial meningiomas.Crossref | GoogleScholarGoogle Scholar |
Chung, SS, Aroh, C, and Vadgama, JV (2013). Constitutive activation of STAT3 signaling regulates hTERT and promotes stem cell-like traits in human breast cancer cells. PLoS ONE 8, e83971.
| Constitutive activation of STAT3 signaling regulates hTERT and promotes stem cell-like traits in human breast cancer cells.Crossref | GoogleScholarGoogle Scholar |
de Jesus, BB, Schneeberger, K, Vera, E, Tejera, A, Harley, CB, and Blasco, MA (2011). The telomerase activator TA-65 elongates short telomeres and increases health span of adult/old mice without increasing cancer incidence. Aging Cell 10, 604–621.
| The telomerase activator TA-65 elongates short telomeres and increases health span of adult/old mice without increasing cancer incidence.Crossref | GoogleScholarGoogle Scholar |
Deep, JP (2014). Assisted peproductive technology. Journal of Chitwan Medical College 4, 1–10.
| Assisted peproductive technology.Crossref | GoogleScholarGoogle Scholar |
Ding, J, Yang, C, Cheng, Y, Wang, J, Zhang, S, Yan, S, He, F, Yin, T, and Yang, J (2021). Trophoblast-derived IL-6 serves as an important factor for normal pregnancy by activating Stat3-mediated M2 macrophages polarization. International Immunopharmacology 90, 106788.
| Trophoblast-derived IL-6 serves as an important factor for normal pregnancy by activating Stat3-mediated M2 macrophages polarization.Crossref | GoogleScholarGoogle Scholar |
Eichenlaub-Ritter, U (2012). Oocyte ageing and its cellular basis. The International Journal of Developmental Biology 56, 841–852.
| Oocyte ageing and its cellular basis.Crossref | GoogleScholarGoogle Scholar |
Gao, X, Yu, X, Zhang, C, Wang, Y, Sun, Y, Sun, H, Zhang, H, Shi, Y, and He, X (2022). Telomeres and mitochondrial metabolism: implications for cellular senescence and age-related diseases. Stem Cell Reviews and Reports 18, 2315–2327.
| Telomeres and mitochondrial metabolism: implications for cellular senescence and age-related diseases.Crossref | GoogleScholarGoogle Scholar |
Ge, J, Li, C, Sun, H, Xin, Y, Zhu, S, Liu, Y, Tang, S, Han, L, Huang, Z, and Wang, Q (2021). Telomere dysfunction in oocytes and embryos from obese mice. Frontiers in Cell and Developmental Biology 9, 617225.
| Telomere dysfunction in oocytes and embryos from obese mice.Crossref | GoogleScholarGoogle Scholar |
Gerri, C, McCarthy, A, Alanis-Lobato, G, Demtschenko, A, Bruneau, A, Loubersac, S, Fogarty, NME, Hampshire, D, Elder, K, Snell, P, Christie, L, David, L, Van de Velde, H, Fouladi-Nashta, AA, and Niakan, KK (2020). Initiation of a conserved trophectoderm program in human, cow and mouse embryos. Nature 587, 443–447.
| Initiation of a conserved trophectoderm program in human, cow and mouse embryos.Crossref | GoogleScholarGoogle Scholar |
Gomes, NMV, Ryder, OA, Houck, ML, Charter, SJ, Walker, W, Forsyth, NR, Austad, SN, Venditti, C, Pagel, M, Shay, JW, and Wright, WE (2011). Comparative biology of mammalian telomeres: Hypotheses on ancestral states and the roles of telomeres in longevity determination. Aging Cell 10, 761–768.
| Comparative biology of mammalian telomeres: Hypotheses on ancestral states and the roles of telomeres in longevity determination.Crossref | GoogleScholarGoogle Scholar |
Gu, M, Zhang, S, Zhao, Y, Huang, J, Wang, Y, Li, Y, Fan, S, Yang, L, Ji, G, Tong, Q, and Huang, C (2017). Cycloastragenol improves hepatic steatosis by activating farnesoid X receptor signalling. Pharmacological Research 121, 22–32.
| Cycloastragenol improves hepatic steatosis by activating farnesoid X receptor signalling.Crossref | GoogleScholarGoogle Scholar |
Gómez DE, Gómez DLM, Maloukh L, Armando RG (2017) Telomerase activity. In ‘Telomeres, diet and human disease: advances and therapeutic opportunities. Vol. 13’. (Eds A Marti, G Zalba) pp. 25–38. (CRC Press: Boca Raton, FL, USA). https://doi.org/10.1201/9781315152431
Haendeler, J, Dröse, S, Büchner, N, Jakob, S, Altschmied, J, Goy, C, Spyridopoulos, I, Zeiher, AM, Brandt, U, and Dimmeler, S (2009). Mitochondrial telomerase reverse transcriptase binds to and protects mitochondrial DNA and function from damage. Arteriosclerosis, Thrombosis, and Vascular Biology 29, 929–935.
| Mitochondrial telomerase reverse transcriptase binds to and protects mitochondrial DNA and function from damage.Crossref | GoogleScholarGoogle Scholar |
Hamatani, T, Falco, G, Carter, MG, Akutsu, H, Stagg, CA, Sharov, AA, Dudekula, DB, VanBuren, V, and Ko, MSH (2004). Age-associated alteration of gene expression patterns in mouse oocytes. Human Molecular Genetics 13, 2263–2278.
| Age-associated alteration of gene expression patterns in mouse oocytes.Crossref | GoogleScholarGoogle Scholar |
Hemann, MT, Rudolph, KL, Strong, MA, DePinho, RA, Chin, L, and Greider, CW (2001). Telomere dysfunction triggers developmentally regulated germ cell apoptosis. Molecular Biology of the Cell 12, 2023–2030.
| Telomere dysfunction triggers developmentally regulated germ cell apoptosis.Crossref | GoogleScholarGoogle Scholar |
Hong, H, Xiao, J, Guo, Q, Du, J, Jiang, Z, Lu, S, Zhang, H, Zhang, X, and Wang, X (2021). Cycloastragenol and Astragaloside IV activate telomerase and protect nucleus pulposus cells against high glucose-induced senescence and apoptosis. Experimental and Therapeutic Medicine 22, 1326.
| Cycloastragenol and Astragaloside IV activate telomerase and protect nucleus pulposus cells against high glucose-induced senescence and apoptosis.Crossref | GoogleScholarGoogle Scholar |
Idrees, M, Kumar, V, Joo, M-D, Ali, N, Lee, K-W, and Kong, I-K (2021). SHP2 nuclear/cytoplasmic trafficking in granulosa cells is essential for oocyte meiotic resumption and maturation. Frontiers in Cell and Developmental Biology 8, 611503.
| SHP2 nuclear/cytoplasmic trafficking in granulosa cells is essential for oocyte meiotic resumption and maturation.Crossref | GoogleScholarGoogle Scholar |
Idrees, M, Kumar, V, Khan, AM, Joo, M-D, Uddin, Z, Lee, K-W, and Kong, I-K (2022). Hesperetin activated SIRT1 neutralizes cadmium effects on the early bovine embryo development. Theriogenology 189, 209–221.
| Hesperetin activated SIRT1 neutralizes cadmium effects on the early bovine embryo development.Crossref | GoogleScholarGoogle Scholar |
Ip, FCF, Ng, YP, An, HJ, Dai, Y, Pang, HH, Hu, YQ, Chin, AC, Harley, CB, Wong, YH, and Ip, NY (2014). Cycloastragenol is a potent telomerase activator in neuronal cells: implications for depression management. Neurosignals 22, 52–63.
| Cycloastragenol is a potent telomerase activator in neuronal cells: implications for depression management.Crossref | GoogleScholarGoogle Scholar |
Iwata, H (2017). Age-associated changes in granulosa cells and follicular fluid in cows. Journal of Reproduction and Development 63, 339–345.
| Age-associated changes in granulosa cells and follicular fluid in cows.Crossref | GoogleScholarGoogle Scholar |
Keefe, DL (2020). Telomeres and genomic instability during early development. European Journal of Medical Genetics 63, 103638.
| Telomeres and genomic instability during early development.Crossref | GoogleScholarGoogle Scholar |
Keefe, DL, Franco, S, Liu, L, Trimarchi, J, Cao, B, Weitzen, S, Agarwal, S, and Blasco, MA (2005). Telomere length predicts embryo fragmentation after in vitro fertilization in women – Toward a telomere theory of reproductive aging in women. American Journal of Obstetrics and Gynecology 192, 1256–1260.
| Telomere length predicts embryo fragmentation after in vitro fertilization in women – Toward a telomere theory of reproductive aging in women.Crossref | GoogleScholarGoogle Scholar |
Keefe, DL, Liu, L, and Marquard, K (2007). Telomeres and meiosis in health and disease. Cellular and Molecular Life Sciences 64, 139–143.
| Telomeres and meiosis in health and disease.Crossref | GoogleScholarGoogle Scholar |
Konnikova, L, Simeone, MC, Kruger, MM, Kotecki, M, and Cochran, BH (2005). Signal transducer and activator of transcription 3 (STAT3) regulates human telomerase reverse transcriptase (hTERT) expression in human cancer and primary cells. Cancer Research 65, 6516–6520.
| Signal transducer and activator of transcription 3 (STAT3) regulates human telomerase reverse transcriptase (hTERT) expression in human cancer and primary cells.Crossref | GoogleScholarGoogle Scholar |
Lewis, SEM, and Aitken, RJ (2005). DNA damage to spermatozoa has impacts on fertilization and pregnancy. Cell and Tissue Research 322, 33–41.
| DNA damage to spermatozoa has impacts on fertilization and pregnancy.Crossref | GoogleScholarGoogle Scholar |
Li, Y, and Tergaonkar, V (2016). Telomerase reactivation in cancers: mechanisms that govern transcriptional activation of the wild-type vs. mutant TERT promoters. Transcription 7, 44–49.
| Telomerase reactivation in cancers: mechanisms that govern transcriptional activation of the wild-type vs. mutant TERT promoters.Crossref | GoogleScholarGoogle Scholar |
Liu, L, Blasco, MA, Trimarchi, JR, and Keefe, DL (2002). An essential role for functional telomeres in mouse germ cells during fertilization and early development. Developmental Biology 249, 74–84.
| An essential role for functional telomeres in mouse germ cells during fertilization and early development.Crossref | GoogleScholarGoogle Scholar |
Malhi, PS, Adams, GP, Mapletoft, RJ, and Singh, J (2008). Superovulatory response in a bovine model of reproductive aging. Animal Reproduction Science 109, 100–109.
| Superovulatory response in a bovine model of reproductive aging.Crossref | GoogleScholarGoogle Scholar |
Marion, RM, Strati, K, Li, H, Tejera, A, Schoeftner, S, Ortega, S, Serrano, M, and Blasco, MA (2009). Telomeres acquire embryonic stem cell characteristics in induced pluripotent stem cells. Cell Stem Cell 4, 141–154.
| Telomeres acquire embryonic stem cell characteristics in induced pluripotent stem cells.Crossref | GoogleScholarGoogle Scholar |
Ménézo, Y, Dale, B, and Cohen, M (2010). DNA damage and repair in human oocytes and embryos: a review. Zygote 18, 357–365.
| DNA damage and repair in human oocytes and embryos: a review.Crossref | GoogleScholarGoogle Scholar |
Ozturk, S, Sozen, B, and Demir, N (2014). Telomere length and telomerase activity during oocyte maturation and early embryo development in mammalian species. Molecular Human Reproduction 20, 15–30.
| Telomere length and telomerase activity during oocyte maturation and early embryo development in mammalian species.Crossref | GoogleScholarGoogle Scholar |
Rincon, M, and Pereira, FV (2018). A new perspective: mitochondrial stat3 as a regulator for lymphocyte function. International Journal of Molecular Sciences 19, 1656.
| A new perspective: mitochondrial stat3 as a regulator for lymphocyte function.Crossref | GoogleScholarGoogle Scholar |
Rosen, J, Jakobs, P, Ale-Agha, N, Altschmied, J, and Haendeler, J (2020). Non-canonical functions of telomerase reverse transcriptase – impact on redox homeostasis. Redox Biology 34, 101543.
| Non-canonical functions of telomerase reverse transcriptase – impact on redox homeostasis.Crossref | GoogleScholarGoogle Scholar |
Schaetzlein, S, Lucas-Hahn, A, Lemme, E, Kues, WA, Dorsch, M, Manns, MP, Niemann, H, and Rudolph, KL (2004). Telomere length is reset during early mammalian embryogenesis. Proceedings of the National Academy of Sciences of the United States of America 101, 8034–8038.
| Telomere length is reset during early mammalian embryogenesis.Crossref | GoogleScholarGoogle Scholar |
Sharma, S, and Chowdhury, S (2022). Emerging mechanisms of telomerase reactivation in cancer. Trends in Cancer 8, 632–641.
| Emerging mechanisms of telomerase reactivation in cancer.Crossref | GoogleScholarGoogle Scholar |
Shen, C-Y, Jiang, J-G, Yang, L, Wang, D-W, and Zhu, W (2017). Anti-ageing active ingredients from herbs and nutraceuticals used in traditional Chinese medicine: pharmacological mechanisms and implications for drug discovery. British Journal of Pharmacology 174, 1395–1425.
| Anti-ageing active ingredients from herbs and nutraceuticals used in traditional Chinese medicine: pharmacological mechanisms and implications for drug discovery.Crossref | GoogleScholarGoogle Scholar |
Shin, WH, and Chung, KC (2020). Human telomerase reverse transcriptase positively regulates mitophagy by inhibiting the processing and cytoplasmic release of mitochondrial PINK1. Cell Death & Disease 11, 425.
| Human telomerase reverse transcriptase positively regulates mitophagy by inhibiting the processing and cytoplasmic release of mitochondrial PINK1.Crossref | GoogleScholarGoogle Scholar |
Shin, J-S, Hong, A, Solomon, MJ, and Soon Lee, C (2006). The role of telomeres and telomerase in the pathology of human cancer and aging. Pathology 38, 103–113.
| The role of telomeres and telomerase in the pathology of human cancer and aging.Crossref | GoogleScholarGoogle Scholar |
Singhapol, C, Pal, D, Czapiewski, R, Porika, M, Nelson, G, and Saretzki, GC (2013). Mitochondrial telomerase protects cancer cells from nuclear DNA damage and apoptosis. PLoS ONE 8, e52989.
| Mitochondrial telomerase protects cancer cells from nuclear DNA damage and apoptosis.Crossref | GoogleScholarGoogle Scholar |
Su, Y, Huang, X, Huang, Z, Huang, T, Xu, Y, and Yi, C (2020). STAT3 localizes in mitochondria-associated ER membranes instead of in mitochondria. Frontiers in Cell and Developmental Biology 8, 274.
| STAT3 localizes in mitochondria-associated ER membranes instead of in mitochondria.Crossref | GoogleScholarGoogle Scholar |
Tajalli, S, Mashayekhi, F, Salehi, Z, Arefi, S, and Sasani, ST (2021). Association of hTERT SNP (rs2736100) with implantation failure after in vitro fertilization and embryo transfer (IVF-ET). British Journal of Biomedical Science 78, 41–43.
| Association of hTERT SNP (rs2736100) with implantation failure after in vitro fertilization and embryo transfer (IVF-ET).Crossref | GoogleScholarGoogle Scholar |
Toupance, S, Fattet, A-J, Thornton, SN, Benetos, A, Guéant, J-L, and Koscinski, I (2021). Ovarian telomerase and female fertility. Biomedicines 9, 842.
| Ovarian telomerase and female fertility.Crossref | GoogleScholarGoogle Scholar |
Valenzuela, HF, and Effros, RB (2002). Divergent telomerase and CD28 expression patterns in human CD4 and CD8 T cells following repeated encounters with the same antigenic stimulus. Clinical Immunology 105, 117–125.
| Divergent telomerase and CD28 expression patterns in human CD4 and CD8 T cells following repeated encounters with the same antigenic stimulus.Crossref | GoogleScholarGoogle Scholar |
Varela, E, Schneider, RP, Ortega, S, and Blasco, MA (2011). Different telomere-length dynamics at the inner cell mass versus established embryonic stem (ES) cells. Proceedings of the National Academy of Sciences of the United States of America 108, 15207–15212.
| Different telomere-length dynamics at the inner cell mass versus established embryonic stem (ES) cells.Crossref | GoogleScholarGoogle Scholar |
Wang, J, Wu, M-L, Cao, S-P, Cai, H, Zhao, Z-M, and Song, Y-H (2018). Cycloastragenol ameliorates experimental heart damage in rats by promoting myocardial autophagy via inhibition of AKT1-RPS6KB1 signaling. Biomedicine & Pharmacotherapy 107, 1074–1081.
| Cycloastragenol ameliorates experimental heart damage in rats by promoting myocardial autophagy via inhibition of AKT1-RPS6KB1 signaling.Crossref | GoogleScholarGoogle Scholar |
Wright, WE, Piatyszek, MA, Rainey, WE, Byrd, W, and Shay, JW (1996). Telomerase activity in human germline and embryonic tissues and cells. Developmental Genetics 18, 173–179.
| Telomerase activity in human germline and embryonic tissues and cells.Crossref | GoogleScholarGoogle Scholar |
Wright, DL, Gibbons, WE, and Lanzendorf, SE (2000). Characterization of telomerase activity in the human oocyte and preimplantation embryo. Fertility and Sterility 74, S67.
| Characterization of telomerase activity in the human oocyte and preimplantation embryo.Crossref | GoogleScholarGoogle Scholar |
Xu, J, and Yang, X (2000). Telomerase activity in bovine embryos during early development. Biology of Reproduction 63, 1124–1128.
| Telomerase activity in bovine embryos during early development.Crossref | GoogleScholarGoogle Scholar |
Xu, X, Hao, Y, Zhong, Q, Hang, J, Zhao, Y, and Qiao, J (2020). Low KLOTHO level related to aging is associated with diminished ovarian reserve. Fertility and Sterility 114, 1250–1255.
| Low KLOTHO level related to aging is associated with diminished ovarian reserve.Crossref | GoogleScholarGoogle Scholar |
Xu, L, Idrees, M, Joo, M-D, Sidrat, T, Wei, Y, Song, S-H, Lee, K-L, and Kong, I-K (2021). Constitutive expression of TERT enhances β-klotho expression and improves age-related deterioration in early bovine embryos. International Journal of Molecular Sciences 22, 5327.
| Constitutive expression of TERT enhances β-klotho expression and improves age-related deterioration in early bovine embryos.Crossref | GoogleScholarGoogle Scholar |
Yu, Y, Wu, J, Li, J, Liu, Y, Zheng, X, Du, M, Zhou, L, Yang, Y, Luo, S, Hu, W, Li, L, Yao, W, and Liu, Y (2020). Cycloastragenol prevents age-related bone loss: evidence in D-galactose-treated and aged rats. Biomedicine & Pharmacotherapy 128, 110304.
| Cycloastragenol prevents age-related bone loss: evidence in D-galactose-treated and aged rats.Crossref | GoogleScholarGoogle Scholar |
Zhao, Y, Li, Q, Zhao, W, Li, J, Sun, Y, Liu, K, Liu, B, and Zhang, N (2015). Astragaloside IV and cycloastragenol are equally effective in inhibition of endoplasmic reticulum stress-associated TXNIP/NLRP3 inflammasome activation in the endothelium. Journal of Ethnopharmacology 169, 210–218.
| Astragaloside IV and cycloastragenol are equally effective in inhibition of endoplasmic reticulum stress-associated TXNIP/NLRP3 inflammasome activation in the endothelium.Crossref | GoogleScholarGoogle Scholar |
Zheng, Q, Huang, J, and Wang, G (2019). Mitochondria, telomeres and telomerase subunits. Frontiers in Cell and Developmental Biology 7, 274.
| Mitochondria, telomeres and telomerase subunits.Crossref | GoogleScholarGoogle Scholar |
Zhu, J-Y, Pang, Z-J, and Yu, Y-H (2012). Regulation of trophoblast invasion: the role of matrix metalloproteinases. Reviews in Obstetrics & Gynecology 5, e137–43.