The role of pten AKT FOXO3 signal pathway gene expression in endometriosis related diminished ovarian reserve

Introduction: Endometriosis a disease which pathogenesis is not totally clarified, affects %5-15 of reproductive age women. Mutations and decreased expression of PTEN gene may be related with pathogenesis of endometriosis. Aim of this research is examining the role of gene expression and influence on the diminished ovarian reserve of PTEN/AKT/FOXO3 signal pathway. Material and methods: This prospective study was conducted at Bursa Uludag University Faculty of Medicine, Department of Obstetrics and Gynecology, and Department of Histology and Embryology, between May 2019–April 2020. Patients prediagnosed with ovarian pathology and between 18-40 years age were included. We decided recruit 40 patients; 20 patients diagnosed as endometrioma (Endo Group) and 20 patients diagnosed with other benign ovarian cysts (Non-Endo Group) surgically were seperated as two groups. Tissue samples were obtained from the cyst wall during the surgery, and gene expression of PTEN, AKT and FOXO3 of the samples was interpreted with real-time PCR analyses. Then the gene expression rate of the two groups was compared. Results: The mean (SD) age was 31.1 (5,8) and 31.2 (6,0) years in endometrioma and other cyst groups. (p:0,937) The mean antral follicle count of the Endo Group was lower than the Non-Endo Group significantly. (p:0,028) In the Endo Group, the PTEN expression ratio was lower 1,64-fold than the Non-Endo Group, but it did not reach statistical significance. However, AKT gene expression there was 5,99-fold increase in the endometrioma group. (p=0,046) Diminished ovarian reserve ratio within the Endo Group and Non-Endo Group were %50 and %40, respectively. When patients were divided by diminished versus normal ovarian reserve, the PTEN expression ratio of patients with v diminished ovarian reserve was 4,92-fold lower than the normal ovarian reserve group. (p=0.004) PTEN expression showed a positive correlation with serum AMH levels. (p=0.002) Conclusion: In our study, AKT expression was higher in the endometrioma group. Meanwhile, PTEN expression was lower at DOR patients. These changes at PTEN, AKT and FOXO3 signal pathway may be related to the diminished ovarian reserve etiology and the endometriosis-related reduction of ovarian reserve. Key words: PTEN, AKT, FOXO3, AMH, Endometrioma, Endometriosis, Diminished Ovarian Reserve