Implications of endocrine-disrupting chemicals on polycystic ovarian syndrome: A comprehensive review

Altered mitochondrial homeostasis on bisphenol-A exposure and its association in developing polycystic ovary syndrome: A comprehensive review

Polycystic ovary syndrome (PCOS) is a heterogeneous endocrinopathy that is known to be one of the most common reproductive pathologies observed in premenopausal women around the globe and is particularly complex as it affects various endocrine and reproductive metabolic pathways. Endocrine-disrupting chemicals (EDCs) are considered to be environmental toxicants as they have hazardous health effects on the functioning of the human endocrine system. Among various classes of EDCs, bisphenol A (BPA) has been under meticulous investigation due to its ability to alter the endocrine processes. As there is emerging evidence suggesting that BPA-induced mitochondrial homeostasis dysfunction in various pathophysiological conditions, this review aims to provide a detailed review of how various pathways associated with ovarian mitochondrial homeostasis are impaired on BPA exposure and its mirroring effects on the PCOS phenotype. BPA exposure might cause significant damage to the mitochondrial morphology and functions through the generation of reactive oxygen species (ROS) and simultaneously downregulates the total antioxidant capacity, thereby leading to oxidative stress. BPA disrupts the mitochondrial dynamics in human cells by altering the expressions of mitochondrial fission and fusion genes, increases the senescence marker proteins, along with significant alterations in the mTOR/AMPK pathway, upregulates the expression of autophagy mediating factors, and downregulates the autophagic suppressor. Furthermore, an increase in apoptosis of the ovarian granulosa cells indicates impaired folliculogenesis. As all these key features are associated with the pathogenesis of PCOS, this review can provide a better insight into the possible associations between BPA-induced dysregulation of mitochondrial homeostasis and PCOS.

Pathophysiological Effects of Contemporary Lifestyle on Evolutionary-Conserved Survival Mechanisms in Polycystic Ovary Syndrome

Polycystic ovary syndrome (PCOS) is increasingly being characterized as an evolutionary mismatch disorder that presents with a complex mixture of metabolic and endocrine symptoms. The Evolutionary Model proposes that PCOS arises from a collection of inherited polymorphisms that have been consistently demonstrated in a variety of ethnic groups and races. In utero developmental programming of susceptible genomic variants are thought to predispose the offspring to develop PCOS. Postnatal exposure to lifestyle and environmental risk factors results in epigenetic activation of developmentally programmed genes and disturbance of the hallmarks of health. The resulting pathophysiological changes represent the consequences of poor-quality diet, sedentary behaviour, endocrine disrupting chemicals, stress, circadian disruption, and other lifestyle factors. Emerging evidence suggests that lifestyle-induced gastrointestinal dysbiosis plays a central role in the pathogenesis of PCOS. Lifestyle and environmental exposures initiate changes that result in disturbance of the gastrointestinal microbiome (dysbiosis), immune dysregulation (chronic inflammation), altered metabolism (insulin resistance), endocrine and reproductive imbalance (hyperandrogenism), and central nervous system dysfunction (neuroendocrine and autonomic nervous system). PCOS can be a progressive metabolic condition that leads to obesity, gestational diabetes, type two diabetes, metabolic-associated fatty liver disease, metabolic syndrome, cardiovascular disease, and cancer. This review explores the mechanisms that underpin the evolutionary mismatch between ancient survival pathways and contemporary lifestyle factors involved in the pathogenesis and pathophysiology of PCOS.

Value of the triglyceride-glucose index and non-traditional blood lipid parameters in predicting metabolic syndrome in women with polycystic ovary syndrome

PURPOSE

Insulin resistance (IR) is common in patients with polycystic ovary syndrome (PCOS). Metabolic syndrome (MS) includes, inter alia, IR, hypertension, dyslipidemia, and disturbances in glucose metabolism. The triglyceride-glucose (TyG) index and non-traditional lipid parameters are strong predictors of IR and cardiovascular disease and can be considered as screening indicators for MS. This study aimed to evaluate the predictive potential of non-traditional lipid parameters and the TyG index to identify MS in PCOS.

METHODS

This cross-sectional study included 134 women diagnosed with PCOS (50 patients with comorbid MS and 84 patients without MS). Biochemical indices were collected, and triglycerides (TG)/high-density lipoprotein cholesterol (HDL-C), total cholesterol (TC)/HDL-C, low-density lipoprotein cholesterol (LDL-C)/HDL-C, non-HDL-C, TyG, and TyG-BMI indices were calculated. Logistic regression analysis was used to compare and determine the association of the six parameters with MS, and the receiver operating characteristic (ROC) curve was used to evaluate the performance of each parameter in identifying MS in the PCOS population.

RESULTS

After adjusting for age and body mass index (BMI), TG/HDL-C, TC/HDL-C, LDL-C/HDL-C, non-HDL-C, TyG, and TyG-BMI were associated with MS (all P<0.05). The odds ratios were 4.075 (0.891, 1.107), 3.121 (1.844, 5.282), 3.106 (1.734, 5.561), 2.238 (1.302, 3.848), 13.422 (4.364, 41.282), and 1.102 (1.056, 1.150), respectively. TG/HDL-C, TC/HDL-C, LDL-C/HDL-C, non-HDL-C, TyG, and TyG-BMI are effective predictors of MS in PCOS, and their cut-off values can be used for the early detection of MS. TyG-BMI had the strongest performance in predicting MS (area under the curve 0.905, 95% CI 0.855-0.956), and its optimal critical value for predicting MS was 202.542.

CONCLUSIONS

TG/HDL-C, TC/HDL-C, LDL-C/HDL-C, non-HDL-C, TyG, and TyG-BMI are novel, clinically convenient and practical markers for the early identification of MS risk in PCOS patients.