Fertil Steril. 2023 Nov 20. pii: S0015-0282(23)02001-0. [Epub ahead of print]
The oocyte, a long-lived, post-mitotic cell, is the locus of reproductive aging in women. Female germ cells replicate only during fetal life and age throughout reproductive life. Mechanisms of oocyte aging include accumulation of oxidative damage, mitochondrial dysfunction and disruption of proteins, including cohesion. Nobel Laureate Bob Edwards also discovered a "production line" during oogonial replication in the mouse, wherein the last oocytes to ovulate in the adult derived from the last oogonia to exit mitotic replication in the fetus. Based on this, we proposed a two hit "telomere theory of reproductive aging" to integrate the myriad features of oocyte aging. The first hit- oocytes remaining in older women traversed more cell cycles during fetal oogenesis. The second hit- oocytes accumulated more environmental and endogenous oxidative damage across the life of the woman. Telomeres could mediate both these aspects of oocyte aging. Telomeres provide a "mitotic clock", with telomere attrition an inevitable consequence of cell division due to of the end-replication problem. And telomere's guanine-rich sequence renders them especially sensitive to oxidative damage, even in post-mitotic cells. Telomerase, the reverse transcriptase that restores telomeres, is better at maintaining than elongating telomeres. Moreover, telomerase remains inactive during much of oogenesis and early development. Oocytes are left with short telomeres, on the brink of viability. In support of this theory, mice with induced telomere attrition and women with naturally occurring telomeropathy suffer diminished ovarian reserve, abnormal embryo development and infertility. In contrast, sperm are produced throughout the life of the male by a telomerase-active progenitor, spermatogonia, resulting in the longest telomeres in the body. In mice, cleavage stage embryos elongate telomeres via "Alternative Lengthening of Telomeres (ALT)", a recombination-based mechanism, rarely encountered outside of telomerase-deficient cancers. Many questions about telomeres and reproduction are raised by these findings:- Does the "normal" telomere attrition observed in human oocytes contribute to their extraordinarily high rate of meiotic non-disjunction? Does recombination-based telomere elongation render embryos susceptible to mitotic non-disjunction (and mosaicism)? Can some features of telomeres serve as markers of oocyte quality?
Keywords: Telomeres; embryos; infertility; oocytes; telomerase