{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T13:05:11Z","timestamp":1785935111715,"version":"3.56.0"},"reference-count":52,"publisher":"Cambridge University Press (CUP)","issue":"1","license":[{"start":{"date-parts":[[2023,12,22]],"date-time":"2023-12-22T00:00:00Z","timestamp":1703203200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/www.cambridge.org\/core\/terms"}],"content-domain":{"domain":["cambridge.org"],"crossmark-restriction":true},"short-container-title":["Zygote"],"published-print":{"date-parts":[[2024,2]]},"abstract":"<jats:title>Summary<\/jats:title><jats:p>This study aimed to investigate the structural and metabolic changes in cumulus cells of underweight women and their effects on oocyte maturation and fertilization. The cytoplasmic ultrastructure was analyzed by electron microscopy, mitochondrial membrane potential by immunofluorescence, and mitochondrial DNA copy number by relative quantitative polymerase chain reaction. The expression of various proteins including the oxidative stress-derived product 4-hydroxynonenal (4-HNE) and autophagy and apoptosis markers such as Vps34, Atg-5, Beclin 1, Lc3-I, II, Bax, and Bcl-2 was assessed and compared between groups. Oocyte maturation and fertilization rates were lower in underweight women (<jats:italic>P<\/jats:italic> &lt; 0.05), who presented with cumulus cells showing abnormal mitochondrial morphology and increased cell autophagy. Compared with the mitochondrial DNA copies of the control group, those of the underweight group increased but not significantly. The mitochondrial membrane potential was similar between the groups (<jats:italic>P<\/jats:italic> = 0.8). Vps34, Atg-5, Lc3-II, Bax, and Bcl-2 expression and 4-HNE levels were higher in the underweight group compared with the control group (<jats:italic>P<\/jats:italic> &lt; 0.01); however, the Bax\/Bcl-2 ratio was lower in the underweight group compared with the control group (<jats:italic>P<\/jats:italic> = 0.031). Additionally, Beclin 1 protein levels were higher in the underweight group compared with the control group but without statistical significance. In conclusion, malnutrition and other conditions in underweight women may adversely affect ovulation, and the development, and fertilization of oocytes resulting from changes to the intracellular structure of cumulus cells and metabolic processes. These changes may lead to reduced fertility or unsatisfactory reproduction outcomes in women.<\/jats:p>","DOI":"10.1017\/s0967199423000588","type":"journal-article","created":{"date-parts":[[2023,12,22]],"date-time":"2023-12-22T03:03:28Z","timestamp":1703214208000},"page":"77-86","update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":4,"title":["Structural and metabolic cumulus cell alteration affects oocyte quality in underweight 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K. and Schoolcraft, W. B. (1999). In vitro culture of human blastocysts. In R. Jansen & D. Mortimer (Eds.), Toward reproductive certainty: Fertility and genetics beyond 1999 (pp. 378\u2013388). Parthenon Publishing Group."},{"key":"S0967199423000588_ref36","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1007\/978-94-007-2869-1_1","article-title":"The oxidative phosphorylation system in mammalian mitochondria","volume":"942","author":"Papa","year":"2012","journal-title":"Advances in Experimental Medicine and Biology"},{"key":"S0967199423000588_ref33","doi-asserted-by":"crossref","first-page":"1601","DOI":"10.1083\/jcb.201801168","article-title":"Autophagy balances mtDNA synthesis and degradation by DNA polymerase POLG during starvation","volume":"217","author":"Medeiros","year":"2018","journal-title":"Journal of Cell Biology"},{"key":"S0967199423000588_ref23","doi-asserted-by":"crossref","first-page":"936","DOI":"10.1034\/j.1600-0412.2000.079011936.x","article-title":"Apoptosis in human cumulus cells in relation to maturation stage and cleavage of the corresponding oocyte","volume":"79","author":"H\u00f8st","year":"2000","journal-title":"Acta Obstetricia et 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