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In contrast, IGFBP-6 exhibits the lowest renal expression.5 Notably, although IGFBP-7 is minimally expressed in healthy kidney and has low affinity for IGF-1, its production is significantly upregulated in renal biopsies from CKD patients, making it a potential marker for acute kidney injury.6,7 In addition to its regulatory binding proteins, serum IGF-1 levels decline with aging in the general population.8 This reduction may also contribute to the decreased renal anabolic capacity observed in older adults, as well as the progressive decrease of the kidney function

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Furthermore, unusually increased PGE2 levels in EMS patients’ follicular fluid can enhance the expression of Steroidogenic acute regulatory protein(StAR) and the synthesis of progesterone in GCs ( GCs from EMS patients exhibited lower expression of not just 3β-HSD, but also CYP19, as well as impaired ability to release inhibin B and estrogen (86, 87)