The GnRH pulse generator activity in mouse models of polycystic ovary syndrome

Reviewer #1 (Public Review):

The manuscript involves 11 research vignettes that interrogate key aspects of GnRH pulse generator in two established mouse models of PCOS (peripubertal and prenatal androgenisation; PPA and PNA) (9 of the vignettes focus on the latter model).

A key message of this paper is that the oft-quoted idea of rapid GnRH/LH pulses associated with PCOS is in fact not readily demonstrable in PNA and PPA mice. This is an important message to make known, but when established dogmas are being challenged, the experiments behind them need to be robust. In this case, underpowered experiments and one or two other issues greatly limit the overall robustness of the study.

General critiques

(1) My main concern is that many/most of the experiments were limited to 4-5 mice per group (PPA experiments 1 and 2, PNA experiments 3, 5, 6, 8, and 9). This seems very underpowered for trying to disprove established dogmas (sometimes falling back on "non-significant trends" - lines 105 and 239).

(2) Page 133-142: it is concerning that the PNA mice didn't have elevated testosterone levels, and this clearly isn't the fault of the assay as this was re-tested in the laboratory of Prof Handelsman, an expert in the field, using LCMS. The point (clearly made in lines 315-336 of the Discussion) that elevated testosterone in PNA mice has been shown in some but not other publications is an important concern to describe for the field. However, the fact remains that it IS elevated in numerous studies, and in the current study it is not so, yet the authors go on to present GnRH pulse generator data as characteristic of the PNA model. Perhaps a demonstration of elevated testosterone levels (by LCMS?) should become a standard model validation prerequisite for publishing any PNA model data.

(3) Line 191-196: the lack of a significant increase in LH pulse frequency in PNA mice is based on measurements using reasonable group sizes (7-8), although the sampling frequency is low for this type of analysis (10-minute intervals; 6-minute intervals would seem safer for not missing some pulses). The significance of the LH pulse frequency results is not stated (looks like about p=0.01). The authors note that LH concentration IS elevated (approximately doubled), and this clearly is not caused by an increase in amplitude (Figure 4 G, H, I). These things are worth commenting on in the discussion.

(4) An interesting observation is that PNA mice appear to continue to have cyclical patterns of GnRH pulse generator activity despite reproductive acyclicity as determined by vaginal cytology (lines 209-241). This finding was used to analyse the frequency of GnRH pulse generator SEs in the machine-learning-identified diestrous-like stage of PNA mice and compare it to diestrous control mice (as identified by vaginal cytology?) (lines 245-254). The idea of a cycle stage-specific comparison is good, but surely the only valid comparison would be to use machine-learning to identify the diestrous-like stage in both groups of mice. Why use machine learning for one and vaginal cytology for the other?

Specific points

(5) With regard to point 2 above, it would be helpful to note the age at which the testosterone samples were taken.

(6) Lines 198-205 and 258-266: I think these are repeated measures of ANOVA data? If so, report the main relevant effect before the post hoc test result.

(7) Line 415: I don't think the word "although" works in this sentence.

(8) Lines 514-518: what are the limits of hormone detection in the LCMS assay?

Reviewer #2 (Public Review):

Summary

The authors aimed to investigate the functionality of the GnRH (gonadotropin-releasing hormone) pulse generator in different mouse models to understand its role in reproductive physiology and its implications for conditions like polycystic ovary syndrome (PCOS). They compared the GnRH pulse generator activity in control mice, peripubertal androgen (PPA) treated mice, and prenatal androgen (PNA) exposed mice. The study sought to elucidate how androgen exposure affects the GnRH pulse generator and subsequent LH (luteinizing hormone) secretion, contributing to the pathophysiology of PCOS.

Strengths

(1) Comprehensive Model Selection: The use of both PPA and PNA mouse models allows for a comparative analysis that can distinguish the effects of different timings of androgen exposure.

(2) Detailed Methodology: The methods employed, such as photometry recordings and serial blood sampling, are robust and allow for precise measurement of GnRH pulse generator activity and LH secretion.

(3) Clear Results Presentation: The experimental results are well-documented with appropriate statistical analyses, ensuring the findings are reliable and reproducible.

(4) Relevance to PCOS: The study addresses a significant gap in understanding the neuroendocrine mechanisms underlying PCOS, making the findings relevant to both basic science and potentially clinical research.

Weaknesses

(1) Model Limitations: While the PNA mouse model is suggested as the most appropriate for studying PCOS, the authors acknowledge that it does not completely replicate the human condition, particularly the elevated LH response seen in women with PCOS.

(2) Complex Data Interpretation: The reduced progesterone feedback and its effects on the GnRH pulse generator in PNA mice add complexity to data interpretation, making it challenging to draw straightforward conclusions.

(3) Machine Learning (ML) Selection and Validation: While k-means clustering is a useful tool for pattern recognition, the manuscript lacks detailed justification for choosing this specific algorithm over other potential methods. The robustness of clustering results has not been validated.

(4) Biological Interpretability: Although the machine learning approach identified cyclical patterns, the biological interpretation of these clusters in the context of PCOS is not thoroughly discussed. A deeper exploration of how these clusters correlate with physiological and pathological states could enhance the study's impact.

(5) Sample Size: The study uses a relatively small number of animals (n=4-7 per group), which may limit the generalisability of the findings. Larger sample sizes could provide more robust and statistically significant results.

(6) Scope of Application: The findings, while interesting, are primarily applicable to mouse models. The translation to human physiology requires cautious interpretation and further validation.

Reviewer #3 (Public Review):

Summary:

Zhou and colleagues elegantly used pre-clinical mouse models to understand the nature of abnormally high GnRH/LH pulse secretion in polycystic ovary syndrome (PCOS), a major endocrine disorder affecting female fertility worldwide. This work brings a fundamental question of how altered gonadotropin secretion takes place upstream within the GnRH pulse generator core, which is defined by arcuate nucleus kisspeptin neurons.

Strengths:

The authors use state-of-the-art in vivo calcium imaging with fiber photometry and important physiological manipulations and measurements to dissect the possible neuronal mechanisms underlying such neuroendocrine derangements in PCOS. The additional use of unsupervised k-means clustering analysis for the evaluation of calcium synchronous events greatly enhances the quality of their evidence. The authors nicely propose that neuroendocrine dysfunction in PCOS might involve different setpoints through the hypothalamic-pituitary-gonadal (HPG) axis, and beyond kisspeptin neurons, which importantly pushes our field forward toward future investigations.

Weaknesses:

Although the authors provide important evidence, additional efforts are required to improve the quality of the manuscript and back up their claims. For instance, animal experiments failed to detect high testosterone levels in PNA female mice, a well-established PCOS mouse model. Considering that androgen excess is a hallmark of PCOS, this highly influences the subsequent evaluation of calcium synchronous events in arcuate kisspeptin neurons and the implications for neuroendocrine derangements. Authors also may need to provide LH data from another mouse model used in their work, the peripubertal androgen (PPA) model. Their claims seem to fall short without the pairing evidence of calcium synchronous events in arcuate kisspeptin neurons and LH pulse secretion. Another aspect that requires reviewing, is further exploration of their calcium synchronous events data and the increase of animal numbers in some of their experiments.