Effects Of Kidney-tonifying Chinese Medicine On The TGF-β/Smads Pathway Of Oocyte In Elderly IVF Patients With Kidney Yin Deficiency

Objective: To investigate the effects of Erzhi Tiangui Granule on the key transcription factor(GATA-4 and smad3)of TGF-β/Smads signalling pathway in ovarian granulosa cells(GC)and on oocyte quality of elderly infertile patients with kidney yin deficiency.Methods: 106 elderly patients with kidney yin deficiency who underwent in vitro fertilization and embryo transfer(IVF-ET)due to tubal factor were included,which were randomly and equally(53 patients per group)divided into the Erzhi Tiangui Granule group(treatment group)and placebo group(control group).The treatment group started to receive Erzhi Tiangui Granule combined with conventional IVF treatment on the day of using Gn,whereas the other group were given placebo instead.Score changes of kidney deficiency symptom before and after treatment were measured,other outcomes including cycle cancellation,the estradiol(E2)level,the progesterone(P)level,the luteinizing hormoneon(LH)level on the day of HCG injection;the amount and days of using gonadotropin(Gn);the number of retrieved oocytes,the fertilization rate,the available embryo rate,the high-quality embryo rate,the clinical pregnancy rate per embryo transfer cycle normal fertilization rate.And the expression of GATA-4 and Smad3 in ovarian granulosa cells on the day of retrieval were measured.Results: Compared to the placebo group,the kidney deficiency symptoms significantly improved in the Erzhi Tiangui Granule group after treatment(P<0.01).In addition,the treatment group showed a significant decrease in the amount of using gonadotropin(Gn)and a significant increase in the estradiol(E2)level,the fertilization rate and the available embryo rate(P<0.05 respectively).Compared with the control gourp,the expression of GATA-4 and Smad3 were significantly up-regulated in the reatment group,the difference was significant(P<0.05).Conclusion: 1.Kidney-tonifying traditional Chinese medicine,Erzhi Tiangui Granule could significantly improve the kidney yin deficiency symptoms in elderly infertile patients,decrease the amount of gonadotropin(Gn)and increase their estradiol(E2)level,fertilization rate,available embryo rate.2.Kidney-tonifying traditional Chinese medicine,Erzhi Tiangui Granule might upregulate the expression of GATA-4,key transcription factor,by activating TGF-β / Smads signaling pathway,and promote the formation of functional transcriptional complex of Smad3 and GATA-4 to trigger the transcription of target genes,so as to improve the quality of oocyte and embryo in elderly infertile patients with kidney yin deficiency.3.Based on the TGF-beta /Smads signaling pathway,the traditional Chinese medicine theory system of kidney dominating reproduction was enriched from the level of biological molecules.