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Chen X, Hong L, Mo M, Xiao S, Yin T, Liu S. Contributing factors for pregnancy outcomes in women with PCOS after their first FET treatment: a retrospective cohort study. Gynecol Endocrinol 2024; 40:2314607. [PMID: 38349325 DOI: 10.1080/09513590.2024.2314607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 01/30/2024] [Indexed: 02/15/2024] Open
Abstract
OBJECTIVE We aim to explore the contributing factors of clinical pregnancy outcomes in PCOS patients undergoing their first FET treatment. METHODS A retrospective analysis was conducted on 574 PCOS patients undergoing their first FET treatment at a private fertility center from January 2018 to December 2021. RESULTS During the first FET cycle of PCOS patients, progesterone levels (aOR 0.109, 95% CI 0.018-0.670) and endometrial thickness (EMT) (aOR 1.126, 95% CI 1.043-1.419) on the hCG trigger day were associated with the clinical pregnancy rate. Similarly, progesterone levels (aOR 0.055, 95% CI 0.007-0.420) and EMT (aOR 1.179, 95% CI 1.011-1.376) on the hCG trigger day were associated with the live birth rate. In addition, AFC (aOR 1.179, 95% CI 1.011-1.376) was found to be a risk factor for preterm delivery. CONCLUSIONS In women with PCOS undergoing their first FET, lower progesterone levels and higher EMT on hCG trigger day were associated with clinical pregnancy and live birth, and AFC was a risk factor for preterm delivery. During FET treatment, paying attention to the patient's endocrine indicators and follicle status may have a positive effect on predicting and improving the pregnancy outcome of PCOS patients.
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Affiliation(s)
- Xi Chen
- Reproductive Medical Centre, Renmin Hospital of Wuhan University, Wuhan, China
| | - Ling Hong
- Shenzhen Key Laboratory of Reproductive Immunology for Peri-implantation, Shenzhen Zhongshan Institute for Reproduction and Genetics, Shenzhen Zhongshan Urology Hospital, Shenzhen, China
| | - Meilan Mo
- Shenzhen Key Laboratory of Reproductive Immunology for Peri-implantation, Shenzhen Zhongshan Institute for Reproduction and Genetics, Shenzhen Zhongshan Urology Hospital, Shenzhen, China
| | - Shan Xiao
- Shenzhen Key Laboratory of Reproductive Immunology for Peri-implantation, Shenzhen Zhongshan Institute for Reproduction and Genetics, Shenzhen Zhongshan Urology Hospital, Shenzhen, China
| | - Tailang Yin
- Reproductive Medical Centre, Renmin Hospital of Wuhan University, Wuhan, China
| | - Su Liu
- Shenzhen Key Laboratory of Reproductive Immunology for Peri-implantation, Shenzhen Zhongshan Institute for Reproduction and Genetics, Shenzhen Zhongshan Urology Hospital, Shenzhen, China
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Christ JP, Yu O, Barton B, Schulze-Rath R, Grafton J, Cronkite D, Covey J, Kelley A, Holden E, Hilpert J, Sacher F, Micks E, Reed SD. Risk Factors for Incident Polycystic Ovary Syndrome Diagnosis. J Womens Health (Larchmt) 2024; 33:879-886. [PMID: 38557154 DOI: 10.1089/jwh.2023.0741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024] Open
Abstract
Objective: While highly prevalent, risk factors for incident polycystic ovary syndrome (PCOS) are poorly delineated. Using a population-based cohort, we sought to identify predictors of incident PCOS diagnosis. Materials and Methods: A matched case-control analysis was completed utilizing patients enrolled in Kaiser Permanente Washington from 2006 to 2019. Inclusion criteria included female sex, age 16-40 years, and ≥3 years of prior enrollment with ≥1 health care encounter. PCOS cases were identified using International Classification of Diseases codes. For each incident case (n = 2,491), 5 patients without PCOS (n = 12,455) were matched based on birth year and enrollment status. Potential risk factors preceding diagnosis included family history of PCOS, premature menarche, parity, race, weight gain, obesity, valproate use, metabolic syndrome, epilepsy, prediabetes, and types 1 and 2 diabetes. Potential risk factors for incident PCOS diagnosis were assessed with univariate and multivariable conditional logistic regressions. Results: Mean age of PCOS cases was 26.9 years (SD 6.8). PCOS cases, compared with non-PCOS, were more frequently nulliparous (70.9% versus 62.4%) and in the 3 years prior to index date were more likely to have obesity (53.8% versus 20.7%), metabolic syndrome (14.5% versus 4.3%), prediabetes (7.4% versus 1.6%), and type 2 diabetes (4.1% versus 1.7%) (p < 0.001 for all comparisons). In multivariable models, factors associated with higher risk for incident PCOS included the following: obesity (compared with nonobese) Class I-II (body-mass index [BMI], 30-40 kg/m2; odds ratio [OR], 3.8; 95% confidence interval [CI], 3.4-4.2), Class III (BMI > 40 kg/m2; OR, 7.5, 95% CI, 6.5-8.7), weight gain (compared with weight loss or maintenance) of 1-10% (OR, 1.7, 95% CI, 1.3-2.1), 10-20% (OR, 1.9; 95% CI, 1.5-2.4), and >20% (OR, 2.6; 95% CI, 1.9-3.6), prediabetes (OR, 2.7; 95% CI, 2.1-3.4), and metabolic syndrome (OR, 1.8: 95% CI, 1.5-2.1). Conclusion: Excess weight gain, obesity, and metabolic dysfunction may play a key role in the ensuing phenotypic expression of PCOS. Treatment and prevention strategies targeted at preventing weight gain in early reproductive years may help reduce the risk of this syndrome.
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Affiliation(s)
- Jacob P Christ
- Department of Obstetrics and Gynecology, School of Medicine, University of Washington, Seattle, Washington, USA
| | - Onchee Yu
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA
| | - Brooke Barton
- School of Medicine, University of Washington, Seattle, Washington, USA
| | | | - Jane Grafton
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA
| | - David Cronkite
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA
| | - Jennifer Covey
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA
| | - Ann Kelley
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA
| | - Erika Holden
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA
| | - Jan Hilpert
- Translational Clinical Medicine, Bayer AG, Berlin, Germany
| | | | - Elizabeth Micks
- Department of Obstetrics and Gynecology, School of Medicine, University of Washington, Seattle, Washington, USA
| | - Susan D Reed
- Department of Obstetrics and Gynecology, School of Medicine, University of Washington, Seattle, Washington, USA
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Mladenović D, Vesković M, Šutulović N, Hrnčić D, Stanojlović O, Radić L, Macut JB, Macut D. Adipose-derived extracellular vesicles - a novel cross-talk mechanism in insulin resistance, non-alcoholic fatty liver disease, and polycystic ovary syndrome. Endocrine 2024; 85:18-34. [PMID: 38285412 DOI: 10.1007/s12020-024-03702-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 01/14/2024] [Indexed: 01/30/2024]
Abstract
Obesity is the best described risk factor for the development of non-alcoholic fatty liver disease (NAFLD)/metabolic dysfunction associated steatotic liver disease (MASLD) and polycystic ovary syndrome (PCOS) while the major pathogenic mechanism linking these entities is insulin resistance (IR). IR is primarily caused by increased secretion of proinflammatory cytokines, adipokines, and lipids from visceral adipose tissue. Increased fatty acid mobilization results in ectopic fat deposition in the liver which causes endoplasmic reticulum stress, mitochondrial dysfunction, and oxidative stress resulting in increased cytokine production and subsequent inflammation. Similarly, IR with hyperinsulinemia cause hyperandrogenism, the hallmark of PCOS, and inflammation in the ovaries. Proinflammatory cytokines from both liver and ovaries aggravate IR thus providing a complex interaction between adipose tissue, liver, and ovaries in inducing metabolic abnormalities in obese subjects. Although many pathogenic mechanisms of IR, NAFLD/MASLD, and PCOS are known, there is still no effective therapy for these entities suggesting the need for further evaluation of their pathogenesis. Extracellular vesicles (EVs) represent a novel cross-talk mechanism between organs and include membrane-bound vesicles containing proteins, lipids, and nucleic acids that may change the phenotype and function of target cells. Adipose tissue releases EVs that promote IR, the development of all stages of NAFLD/MASLD and PCOS, while mesenchymal stem cell-derived AVs may alleviate metabolic abnormalities and may represent a novel therapeutic device in NAFLD/MASLD, and PCOS. The purpose of this review is to summarize the current knowledge on the role of adipose tissue-derived EVs in the pathogenesis of IR, NAFLD/MASLD, and PCOS.
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Affiliation(s)
- Dušan Mladenović
- Institute of Pathophysiology "Ljubodrag Buba Mihailovic", Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
| | - Milena Vesković
- Institute of Pathophysiology "Ljubodrag Buba Mihailovic", Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Nikola Šutulović
- Laboratory for Neurophysiology, Institute of Medical Physiology "Richard Burian", Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Dragan Hrnčić
- Laboratory for Neurophysiology, Institute of Medical Physiology "Richard Burian", Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Olivera Stanojlović
- Laboratory for Neurophysiology, Institute of Medical Physiology "Richard Burian", Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Lena Radić
- Clinic for Endocrinology, Diabetes and Metabolic Diseases, University Clinical Centre of Serbia, Belgrade, Serbia
| | - Jelica Bjekić Macut
- University of Belgrade Faculty of Medicine, Department of Endocrinology, UMC Bežanijska kosa, Belgrade, Serbia
| | - Djuro Macut
- University of Belgrade Faculty of Medicine, Clinic for Endocrinology, Diabetes and Metabolic Diseases, University Clinical Centre of Serbia, Belgrade, Serbia
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Samarasinghe SNS, Ostarijas E, Long MJ, Erridge S, Purkayastha S, Dimitriadis GK, Miras AD. Impact of insulin sensitization on metabolic and fertility outcomes in women with polycystic ovary syndrome and overweight or obesity-A systematic review, meta-analysis, and meta-regression. Obes Rev 2024; 25:e13744. [PMID: 38572616 DOI: 10.1111/obr.13744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 02/16/2024] [Accepted: 02/28/2024] [Indexed: 04/05/2024]
Abstract
Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in reproductive-age women. This systematic review, meta-analysis, and meta-regression aims to compare the effect of insulin sensitizer pharmacotherapy on metabolic and reproductive outcomes in women with PCOS and overweight or obesity. We searched online databases MEDLINE via OVID, EMBASE, Clinicaltrials.gov, and EudraCT for trials published from inception to November 13, 2023. Inclusion criteria were double-blind, randomized controlled trials in women diagnosed with PCOS, body mass index (BMI) ≥ 25 kg/m2, which reported metabolic or reproductive outcomes. The intervention was insulin sensitization pharmacotherapy versus placebo or other agents. The primary outcomes were changes from baseline BMI, fasting blood glucose, and menstrual frequency. Nineteen studies were included in this review. Metformin had the most significant effect on the fasting plasma glucose and body mass index. Insulin sensitizer pharmacotherapy significantly reduced fasting plasma glucose, body mass index, fasting serum insulin, HOMA-IR, sex hormone binding globulin, and total testosterone, but the effect size was small. There was a lack of menstrual frequency and live birth data. The results indicate a role for insulin sensitizers in improving the metabolic and, to a lesser degree, reproductive profile in these women. Further research should examine insulin sensitizers' effects on objective measures of fecundity.
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Affiliation(s)
| | - Eduard Ostarijas
- Institute for Translational Medicine, University of Pecs Medical School, Pécs, Hungary
- Faculty of Medicine, J. J. Strossmayer University of Osijek, Osijek, Croatia
| | - Matthew J Long
- Department of Gastroenterology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Simon Erridge
- Department of Surgery and Cancer, Imperial College London, London, UK
| | | | - Georgios K Dimitriadis
- Department of Endocrinology ASO/EASO COM, King's College Hospital NHS Foundation Trust, London, UK
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Begum RF, Mohan S. Insights into Vitamin E with Combined Oral Contraceptive on INSR Gene in PCOS by Integrating In Silico and In Vivo Approaches. Appl Biochem Biotechnol 2024; 196:2990-3009. [PMID: 37610513 DOI: 10.1007/s12010-023-04710-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2023] [Indexed: 08/24/2023]
Abstract
Polycystic ovarian syndrome (PCOS) is a hormone disorder common among reproductive-aged women. This is associated with the symptoms like an irregular menstrual cycle, excess androgens, and polycystic ovary. Interestingly, vitamin E acts like the hormone progesterone and improves insulin sensitivity in PCOS. The study aims to evaluate the therapeutic effect of vitamin E in combination with combined oral contraceptive (COC) against PCOS by in silico and in vivo methods. The therapeutic effect of vitamin E (25 and 50mg/kg) in combination with COC (0.4mg/kg) was screened by the in silico method using Auto dock vina 4.2.6. Additionally, in vivo studies with a letrozole-induced PCOS model were performed in 30 female SD rats (n = 6 in each group) for 8 weeks with different doses of vitamin E. Furthermore, histopathological features and the insulin receptor (INSR) gene were scrutinized. An in silico study showed that drospirenone and vitamin E have an excellent affinity to bind to INSR and have higher binding energy (- 8.5 kcal/mol and - 8.7 kcal/mol, respectively). In vivo results showed a significant reduction in elevated testosterone levels compared to that of the PCOS group; follicle-stimulating hormone (FSH) and insulin levels also showed significant changes and reversed anti-oxidant levels in a dose-dependent manner. Ovarian histopathological changes were observed in different follicle counts in addition to the INSR gene, which showed changes in densitometry values. Supplementation of vitamin E combined with COC could be effective against PCOS, and clinical studies must be carried out further.
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Affiliation(s)
- Rukaiah Fatma Begum
- Department of Pharmacology, SRM College of Pharmacy, SRM Institute of Science and Technology, Kattankulathur, Chengalpattu, Tamil Nadu, 603203, India
| | - Sumithra Mohan
- Department of Pharmacology, SRM College of Pharmacy, SRM Institute of Science and Technology, Kattankulathur, Chengalpattu, Tamil Nadu, 603203, India.
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Kuai D, Tang Q, Wang X, Yan Q, Tian W, Zhang H. Relationship between serum apelin, visfatin levels, and body composition in Polycystic Ovary Syndrome patients. Eur J Obstet Gynecol Reprod Biol 2024; 297:24-29. [PMID: 38555852 DOI: 10.1016/j.ejogrb.2024.03.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 03/08/2024] [Accepted: 03/26/2024] [Indexed: 04/02/2024]
Abstract
OBJECTIVE To investigate the relationship between body composition and serum visfatin and apelin levels in patients with polycystic ovary syndrome (PCOS). METHODS In this prospective observational study, the differences in body composition, levels of gonadal hormone concentrations, glucose metabolism, apelin, and visfatin were compared between PCOS patients and the control group. PCOS patients were further divided into different subgroups according to different obesity criteria and the differences between serum visfatin and apelin levels in different subgroups were compared. Finally, the correlation of serum visfatin levels and apelin levels with body composition, and metabolism-related indicators in PCOS patients was explored. RESULTS A total collected 178 cases of PCOS patients and 172 cases of healthy women (control group) between 2020 July and 2021 November. In PCOS patients, their weight, Body Mass Index (BMI), Waist Hip Rate (WHR), Fat-Free Mass Index (FFMI), Percent Body Fat (PBF), Fat mass index (FMI), PBF of Arm, PBF of Leg, PBF of the Trunk, Visceral Fat Level (VFL), fasting insulin (FINS), Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) and Luteinizing hormone (LH) were significantly higher than in the control group (all P < 0.001), Percent Skeletal Muscle (PSM), PSM of Leg, and PSM of the Trunk were significantly decreased than in the control group (all P < 0.001). The PCOS patients had significantly higher serum visfatin levels and apelin levels compared with the control group (all P < 0.001). In PBF > 35 % PCOS patients, the apelin and visfatin levels were significantly higher than the PBF ≤ 35 % PCOS patients. In WHR ≥ 0.85 and BMI ≥ 24 kg/m2 PCOS patients, the visfatin levels were significantly higher than the WHR < 0.85 and BMI < 24 kg/m2 PCOS patients. Serum apelin and visfatin positively correlated with BMI level, WHR, FFMI, PBF, FMI, PBF of arms, PBF of legs, PBF of the trunk, VFL, FBG, HOMA-IR index and negatively correlated with PSM, PSM of legs, and PSM of the trunk (all P < 0.001). CONCLUSIONS Compared with healthy women, Patients with PCOS have an increased fat content in various parts of the body, reduced skeletal muscle content, and are often complicated by metabolic abnormalities. Serum visfatin and apelin correlated not only with obesity, fat mass, and fat distribution but also with muscle mass and distribution. It may be possible to reduce the long-term risk of metabolic disease in PCOS through the monitoring and management of the body composition in PCOS patients or to reflect the therapeutic effect of PCOS.
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Affiliation(s)
- Dan Kuai
- Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, Tianjin 300052, China; Tianjin Key Laboratory of Female Reproductive Health and Eugenics, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Qingtao Tang
- Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, Tianjin 300052, China; Tianjin Key Laboratory of Female Reproductive Health and Eugenics, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Xiang Wang
- Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, Tianjin 300052, China; Tianjin Key Laboratory of Female Reproductive Health and Eugenics, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Qi Yan
- Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, Tianjin 300052, China; Tianjin Key Laboratory of Female Reproductive Health and Eugenics, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Wenyan Tian
- Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, Tianjin 300052, China; Tianjin Key Laboratory of Female Reproductive Health and Eugenics, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Huiying Zhang
- Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, Tianjin 300052, China; Tianjin Key Laboratory of Female Reproductive Health and Eugenics, Tianjin Medical University General Hospital, Tianjin 300052, China.
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Xu X, Jiang Y, Du J, Sun H, Wang X, Zhang C. Development and validation of a prediction model for suboptimal ovarian response in polycystic ovary syndrome (PCOS) patients undergoing GnRH-antagonist protocol in IVF/ICSI cycles. J Ovarian Res 2024; 17:116. [PMID: 38807145 PMCID: PMC11134646 DOI: 10.1186/s13048-024-01437-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Accepted: 05/11/2024] [Indexed: 05/30/2024] Open
Abstract
BACKGROUND PCOS patients with unexpectedly low oocyte yield following conventional ovarian stimulation are referred to as suboptimal responders. However, identifying suboptimal responders presents a significant challenge within reproductive medicine and limited research exists on the occurrence of suboptimal response. This analysis aimed to develop a predictive model of suboptimal response during in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) treatments in PCOS patients. METHODS This retrospective study involved a cohort of 313 PCOS patients undergoing their first IVF/ICSI cycle from 2019 to 2022. Univariate logistic regression analyses, least absolute shrinkage, selection operator regression analysis, and recursive feature elimination were employed to identify relevant characteristics and construct predictive models. Moreover, a nomogram was constructed based on the best model. Receiver operating characteristic curves, decision curve analysis (DCA), and calibration curves were used to evaluate the model. RESULTS The predictors included in the model were age, Anti-Mullerian hormone, antral follicle count, and basal follicle-stimulating hormone. The area under the receiver operating characteristic curve (AUC) was 0.7702 (95% confidence interval 0.7157-0.8191). The AUC, along with the DCA curve and calibration curve, demonstrated a satisfactory level of congruence and discrimination ability. CONCLUSION The nomogram effectively predicted the probability of suboptimal response in PCOS patients undergoing gonadotropin-releasing hormone antagonist protocol during IVF/ICSI treatment.
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Affiliation(s)
- Xiaohang Xu
- Reproductive Medical Center, People's Hospital of Zhengzhou University, Zhengzhou, China
- Reproductive Medical Center, Henan Provincial People's Hospital, Zhengzhou, China
| | - Yilin Jiang
- Reproductive Medical Center, People's Hospital of Zhengzhou University, Zhengzhou, China
- Reproductive Medical Center, Henan Provincial People's Hospital, Zhengzhou, China
| | - Jinlin Du
- Reproductive Medical Center, People's Hospital of Zhengzhou University, Zhengzhou, China
- Reproductive Medical Center, Henan Provincial People's Hospital, Zhengzhou, China
| | - Haoyue Sun
- Reproductive Medical Center, People's Hospital of Zhengzhou University, Zhengzhou, China
- Reproductive Medical Center, Henan Provincial People's Hospital, Zhengzhou, China
| | - Xue Wang
- Reproductive Medical Center, People's Hospital of Zhengzhou University, Zhengzhou, China
- Reproductive Medical Center, Henan Provincial People's Hospital, Zhengzhou, China
| | - Cuilian Zhang
- Reproductive Medical Center, People's Hospital of Zhengzhou University, Zhengzhou, China.
- Reproductive Medical Center, Henan Provincial People's Hospital, Zhengzhou, China.
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Xuan F, Jin R, Zhou W, Ye Y, Ren Y, Lu J, Chen A. LncRNA SNHG12 promotes cell proliferation and inhibits apoptosis of granulosa cells in polycystic ovarian syndrome by sponging miR-129 and miR-125b. J Ovarian Res 2024; 17:72. [PMID: 38566229 PMCID: PMC10986130 DOI: 10.1186/s13048-024-01392-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 03/14/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Polycystic ovarian syndrome (PCOS) is the most common endocrine disease in women of childbearing age which is often associated with abnormal proliferation or apoptosis of granulosa cells (GCs). Studies proved that long non-coding RNA SNHG12 (lncRNA SNHG12) is significantly increased in ovarian cancer and cervical cancer patients and cells. The inhibition of lncRNA SNHG12 restrains the proliferation, migration, and invasion in tumor cells. OBJECTIVE This study explores the role of lncRNA SNHG12 in the apoptosis of GCs in PCOS and the underlying regulated mechanism. METHODS In this study, the injection of dehydroepiandrosterone (DHEA) successfully induced the PCOS model in SD rats. The human granulosa-like tumor cell line KGN was incubated with insulin to assess the effects of lncRNA SNHG12 on GC proliferation and apoptosis. RESULTS Overexpression of lncRNA SNHG12 influenced the body weight, ovary weight, gonadal hormone, and pathological changes, restrained the expressions of microRNA (miR)-129 and miR-125b, while downregulation of lncRNA SNHG12 exerted the opposite effects in PCOS rats. After silencing lncRNA SNHG12 in cells, the cell viability and proliferation were lessened whereas apoptosis of cells was increased. A loss-of-functions test was implemented by co-transfecting miR-129 and miR-125b inhibitors into lncRNA SNHG12-knocking down cells to analyze the effects on cell viability and apoptosis. Next, the existence of binding sites of SNHG12 and miR-129/miR-125b was proved based on the pull-down assay. CONCLUSION lncRNA SNHG12 might be a potential regulatory factor for the development of PCOS by sponging miR-129 and miR-125b in GCs.
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Affiliation(s)
- Feilan Xuan
- Department of Obstetrics and Gynecology, Hangzhou Traditional Chinese Medicine Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, Zhejiang, 310007, China
| | - Ruiying Jin
- Department of Gynecology, Jiaojiang Maternal and Child Health Hospital, Taizhou, Zhejiang, 318000, China
| | - Weimei Zhou
- Department of Ultrasound, Jiaojiang Maternal and Child Health Hospital, Taizhou, Zhejiang, 318000, China
| | - Yongju Ye
- Department of Gynecology, Lishui Hospital of Traditional Chinese Medicine, Lishui, Zhejiang, 323000, China
| | - Yuefang Ren
- Department of Gynecology, Huzhou Maternity & Child Health Care Hospital, Huzhou, Zhejiang, 313000, China
| | - Jiali Lu
- Department of Gynecology, Huzhou Maternity & Child Health Care Hospital, Huzhou, Zhejiang, 313000, China
| | - Aixue Chen
- Department of Gynecology, Changxing People's Hospital of Chongming District, No.1008 Fengfu Road, Changxing Town, Chongming District, Shanghai, 201913, China.
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Upadhyay N, Almeida EA, Singh A, Madhu SV, Puri D, Mehndiratta M. Evaluation of CRP/Albumin Ratio in Polycystic Ovarian Syndrome. J Obstet Gynaecol India 2024; 74:165-169. [PMID: 38707880 PMCID: PMC11065824 DOI: 10.1007/s13224-023-01897-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 10/24/2023] [Indexed: 05/07/2024] Open
Abstract
Background Polycystic ovarian syndrome is a common endocrine disorder among women of reproductive age. It is characterized by menstrual abnormalities, hyperandrogenism and polycystic ovaries and can lead to many complications. Studies have postulated the role of inflammation in the pathophysiology of PCOS. As acute phase reactants often serve as markers of inflammation, this study aimed to evaluate the role of inflammatory markers in women with PCOS and healthy controls. Material and Methods A total of 60 participants were enrolled; 30 cases of PCOS and 30 age matched healthy controls. Peripheral venous blood was collected for assessment of CRP, serum albumin, serum total testosterone, serum fasting insulin and fasting blood glucose, following which statistical analysis was done. Results The CRP/albumin ratio was found to be significantly higher in women with PCOS as compared to healthy controls along with serum total testosterone and HOMA-IR. Correlation between CRP/albumin ratio and the levels of serum total testosterone and insulin resistance was found to be non-significant. Conclusion An elevated CRP/albumin ratio in cases of PCOS compared to healthy controls supports the hypothesis of inflammation playing a key role in the pathophysiology of PCOS. CRP/albumin ratio can serve as a cheaper biochemical marker of the disease subject to further validation studies to establish its use in Indian population.
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Affiliation(s)
- Nandini Upadhyay
- Third Year Part 1, UCMS & GTBH, University of Delhi, New Delhi, India
| | | | - Alpana Singh
- Department of Obstetrics and Gynaecology, University College of Medical Sciences and GTB Hospital (UCMS & GTBH), University of Delhi, Dilshad Garden, New Delhi, 110095 India
| | - S. V. Madhu
- Department of Endocrinology, UCMS & GTBH, University of Delhi, New Delhi, India
| | - Dinesh Puri
- Department of Biochemistry, UCMS & GTBH, University of Delhi, New Delhi, India
| | - Mohit Mehndiratta
- Department of Biochemistry, UCMS & GTBH, University of Delhi, New Delhi, India
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Sparić R, Andjić M, Rakić A, Bjekić-Macut J, Livadas S, Kontić-Vučinić O, Mastorakos G, Macut D. Insulin-sensitizing agents for infertility treatment in woman with polycystic ovary syndrome: a narrative review of current clinical practice. Hormones (Athens) 2024; 23:49-58. [PMID: 37792213 DOI: 10.1007/s42000-023-00494-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 09/19/2023] [Indexed: 10/05/2023]
Abstract
PURPOSE Polycystic ovary syndrome (PCOS) is an endocrine, metabolic, and reproductive disorder which, according to the Rotterdam criteria, affects up to 24% of women of childbearing age. Although the prevalence of infertility in this subpopulation of women is high, the optimal treatment has not been fully established yet. Insulin resistance is considered to be an important mechanism involved in the development of PCOS; hence, the aim of this narrative review is to present an overview of the current pharmacological insulin-sensitizing treatment modalities for infertile women with PCOS. METHODS A MEDLINE and PubMed search for the years 1990-2023 was performed using a combination of keywords. Clinical trials with insulin sensitizers used for infertility treatment as well as analyses of systematic reviews and meta-analyses were evaluated. When deemed necessary, additional articles referenced in the retrieved papers were included in this narrative review. RESULTS Several insulin-sensitizing compounds and various therapeutical protocols are available for infertility treatment of women with PCOS. Metformin is the most common adjuvant medication to induce ovulation in infertile women with PCOS and is more frequently administered in combination with clomiphene citrate than on its own. Recently, inositol and glucagon-like peptide-1 (GLP-1) receptor agonists have emerged as possible options for infertility treatment in PCOS. CONCLUSION The future of medical treatment of PCOS women with infertility lies in a personalized pharmacological approach, which involves various compounds with different mechanisms of action that could modify ovarian function and endometrial receptivity, ultimately leading to better overall reproductive outcomes in these women.
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Affiliation(s)
- Radmila Sparić
- University of Belgrade Faculty of Medicine, Clinic for Gynecology and Obstetrics, University Clinical Center of Serbia, Belgrade, Serbia
| | - Mladen Andjić
- Clinic for Gynecology and Obstetrics, University Clinical Center of Serbia, Belgrade, Serbia
| | - Aleksandar Rakić
- Clinic for Gynecology and Obstetrics Narodni front, Belgrade, Serbia
| | - Jelica Bjekić-Macut
- Department of Endocrinology, UMC Bežanijska Kosa, University of Belgrade Faculty of Medicine, Belgrade, Serbia
| | | | - Olivera Kontić-Vučinić
- University of Belgrade Faculty of Medicine, Clinic for Gynecology and Obstetrics, University Clinical Center of Serbia, Belgrade, Serbia
| | - George Mastorakos
- Unit of Endocrine Diseases, Aretaieion Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Djuro Macut
- University of Belgrade Faculty of Medicine, Clinic for Endocrinology, Diabetes and Metabolic Diseases, University Clinical Center of Serbia, Dr Subotića 13, Belgrade, 11000, Serbia.
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Shahmoradi S, Chiti H, Tavakolizadeh M, Hatami R, Motamed N, Ghaemi M. The Effect of Magnesium Supplementation on Insulin Resistance and Metabolic Profiles in Women with Polycystic Ovary Syndrome: a Randomized Clinical Trial. Biol Trace Elem Res 2024; 202:941-946. [PMID: 37393389 DOI: 10.1007/s12011-023-03744-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 06/22/2023] [Indexed: 07/03/2023]
Abstract
Due to the definitive known effect of magnesium on insulin resistance and the fact that insulin resistance is a main etiology in polycystic ovary syndrome (PCOS), it is assumed the use of magnesium supplements can improve insulin resistance, lipid profiles, and glucose and thus may also play a role in improving the clinical condition of patients with PCOS. We aimed to assess the effects of magnesium supplements on anthropometric, clinical, and metabolic parameters in women suffering from PCOS. This triple-blind randomized clinical trial study was conducted on women aged 15-35 years with PCOS. The patients were randomly assigned to receive a magnesium oxide supplement (250 mg/day for 2 months) or a placebo. The study parameters were evaluated and compared between two groups before as well as 2 months and 5 months after the initial assessment. In total, 40 cases (20 in each group) were recruited in the study. A significant reduction in the serum insulin level (P-value = 0.036) and insulin resistance (p-value = 0.032) was observed in the case group. Prescribing magnesium supplements could also lead to lowering total cholesterol, low-density lipoprotein, and fasting blood sugar along with increasing the level of high-density lipoprotein. We could not find any significant difference in anthropometric parameters as well as the mean systolic and diastolic blood pressures before and after intervention between the two groups. Although the rate of oligomenorrhea significantly decreased in the two study groups, it was no different across the two groups before and also after the intervention. The use of magnesium supplements in patients with PCO, regardless of the etiology or progression of the disease, can greatly improve the metabolic status of these patients by improving insulin resistance and modulating the level of lipid profile.
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Affiliation(s)
- Shabnam Shahmoradi
- Department of Obstetrics and Gynecology, School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Hossein Chiti
- Metabolic Diseases Research Center, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Mahdi Tavakolizadeh
- Department of Pharmacognosy, School of Pharmacy, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Robabeh Hatami
- Department of Obstetrics and Gynecology, School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran.
| | - Nima Motamed
- Department of Social Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Marjan Ghaemi
- Vali-E-Asr Reproductive Health Research Center, Family Health Research Institute, Tehran University of Medical Sciences, Tehran, Iran
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12
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Butler AE, Moin ASM, Sathyapalan T, Atkin SL. A Cross-Sectional Study of Protein Changes Associated with Dementia in Non-Obese Weight Matched Women with and without Polycystic Ovary Syndrome. Int J Mol Sci 2024; 25:2409. [PMID: 38397086 PMCID: PMC10889209 DOI: 10.3390/ijms25042409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 02/14/2024] [Accepted: 02/16/2024] [Indexed: 02/25/2024] Open
Abstract
Dysregulated Alzheimer's disease (AD)-associated protein expression is reported in polycystic ovary syndrome (PCOS), paralleling the expression reported in type 2 diabetes (T2D). We hypothesized, however, that these proteins would not differ between women with non-obese and non-insulin resistant PCOS compared to matched control subjects. We measured plasma amyloid-related proteins levels (Amyloid-precursor protein (APP), alpha-synuclein (SNCA), amyloid P-component (APCS), Pappalysin (PAPPA), Microtubule-associated protein tau (MAPT), apolipoprotein E (apoE), apoE2, apoE3, apoE4, Serum amyloid A (SAA), Noggin (NOG) and apoA1) in weight and aged-matched non-obese PCOS (n = 24) and control (n = 24) women. Dementia-related proteins fibronectin (FN), FN1.3, FN1.4, Von Willebrand factor (VWF) and extracellular matrix protein 1 (ECM1) were also measured. Protein levels were determined by Slow Off-rate Modified Aptamer (SOMA)-scan plasma protein measurement. Only APCS differed between groups, being elevated in non-obese PCOS women (p = 0.03) relative to the non-obese control women. This differed markedly from the elevated APP, APCS, ApoE, FN, FN1.3, FN1.4 and VWF reported in obese women with PCOS. Non-obese, non-insulin resistant PCOS subjects have a lower AD-associated protein pattern risk profile versus obese insulin resistant PCOS women, and are not dissimilar to non-obese controls, indicating that lifestyle management to maintain optimal body weight could be beneficial to reduce the long-term AD-risk in women with PCOS.
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Affiliation(s)
- Alexandra E. Butler
- Research Department, Royal College of Surgeons of Ireland, Busaiteen P.O. Box 15503, Bahrain; (A.S.M.M.); (S.L.A.)
| | - Abu Saleh Md Moin
- Research Department, Royal College of Surgeons of Ireland, Busaiteen P.O. Box 15503, Bahrain; (A.S.M.M.); (S.L.A.)
| | - Thozhukat Sathyapalan
- Academic Endocrinology, Diabetes and Metabolism, Hull York Medical School, Hull HU6 7RU, UK;
| | - Stephen L. Atkin
- Research Department, Royal College of Surgeons of Ireland, Busaiteen P.O. Box 15503, Bahrain; (A.S.M.M.); (S.L.A.)
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13
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Hu R, Geng Y, Huang Y, Liu Z, Li F, Dong H, Ma W, Song K, Zhang M, Zhang Z, Song Y. New insights into the interaction between polycystic ovary syndrome and psychiatric disorders: A narrative review. Int J Gynaecol Obstet 2024; 164:387-420. [PMID: 37458179 DOI: 10.1002/ijgo.14988] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 06/17/2023] [Accepted: 06/19/2023] [Indexed: 01/15/2024]
Abstract
Polycystic ovary syndrome (PCOS) is a prevalent endocrine disease characterized by hyperandrogenism, ovulatory dysfunction, and ovarian polycystic changes, which combines with reproductive problems, metabolic disorders, and psychological disorders to exhibit a far-reaching impact on the physical and mental health of women. We reviewed previous research and discovered that psychiatric disorders are more common in PCOS patients and their children, potentially exacerbating the condition and creating a vicious loop. To understand the reasons, relevant articles were collected following the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines from PubMed, Web of Science, and Cochrane Library, through December 2022. Evidence suggested that PCOS-related clinical manifestations, hyperandrogenism, insulin resistance, obesity, gut dysbiosis, and other variables may increase the risk of psychiatric disorders in patients. In turn, psychiatric disorders may aggravate the pathologic process of PCOS and increase the difficulty of the treatment. We systematically reported the mechanisms underlying the psychiatric disorders-PCOS interactions, intending to provide potential ways to break the vicious cycle and lay the groundwork for future research. However, research on PCOS and psychiatric disorders were still in initial stages, which limited the scope of this review. More studies are needed to further verify our findings.
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Affiliation(s)
- Runan Hu
- Institute of Integrated Traditional Chinese and Western Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yuli Geng
- Institute of Integrated Traditional Chinese and Western Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yanjing Huang
- Institute of Integrated Traditional Chinese and Western Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhuo Liu
- Institute of Integrated Traditional Chinese and Western Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Fan Li
- Institute of Integrated Traditional Chinese and Western Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Haoxu Dong
- Department of Integrated Traditional Chinese and Western Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wenwen Ma
- Department of Integrated Traditional Chinese and Western Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Kunkun Song
- Department of Integrated Traditional Chinese and Western Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Mingmin Zhang
- Department of Integrated Traditional Chinese and Western Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhuo Zhang
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yufan Song
- Institute of Integrated Traditional Chinese and Western Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Department of Integrated Traditional Chinese and Western Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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14
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Samarasinghe SNS, Woods C, Miras AD. Bariatric Surgery in Women with Polycystic Ovary Syndrome. Metabolism 2024; 151:155745. [PMID: 38036245 DOI: 10.1016/j.metabol.2023.155745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 11/13/2023] [Accepted: 11/21/2023] [Indexed: 12/02/2023]
Abstract
Polycystic ovary syndrome (PCOS) is the most common endocrine condition in premenopausal women and is a common cause of anovulatory subfertility. Although obesity does not form part of the diagnostic criteria, it affects a significant proportion of women with PCOS and is strongly implicated in the pathophysiology of the disease. Both PCOS and obesity are known to impact fertility in women; obesity also reduces the success of assisted reproductive technology (ART). With or without pharmacotherapy, lifestyle intervention remains the first-line treatment in women with PCOS and obesity. Bariatric surgery is still an experimental treatment in women with PCOS and subfertility. This review will present an overview of the pathophysiology of PCOS and obesity and the role of bariatric surgery. Although data are sparse regarding the impact of bariatric surgery on subfertility in women with PCOS and obesity, existing studies point to a beneficial role in treating metabolic and reproductive dysfunction.
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Li L, Xiao Y, Zhou J, Mo H, Li X, Li Y, Wang Y, Zhong M. Effects of Berberine on glucolipid metabolism among dehydroepiandrosterone-induced rats of polycystic ovary syndrome with insulin-resistance. Heliyon 2024; 10:e24338. [PMID: 38293350 PMCID: PMC10826177 DOI: 10.1016/j.heliyon.2024.e24338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 01/07/2024] [Accepted: 01/08/2024] [Indexed: 02/01/2024] Open
Abstract
Polycystic ovary syndrome (PCOS) is a set of endocrine disorder syndrome characterized by ovulation disorder. Increased insulin resistance (IR) and compensatory hyperinsulinemia play a vital role in the pathogenesis of PCOS. Therefore, insulin sensitizing agents have been studied in the treatment of PCOS. Berberine (BBR) has been proved to alleviate IR in patients with PCOS, but the mechanism remained unclear. This study was aimed to verify the regulatory mechanism of BBR on PCOS-IR rats. Firstly, we established a female rat PCOS-IR model induced by dehydroepiandrosterone (DHEA) and found that estrus cycle was disrupted in the PCOS-IR group, serum fasting insulin (FINS) level and the homeostasis model assessment of insulin resistance (HOMA-IR) index were significantly higher than normal control group. BBR treatment could recover estrous cycle, reduce abnormal serum hormone levels like luteotropic hormone (LH) and testosterone (T). Most importantly, BBR could concentration-dependently reduce serum FINS level in PCOS-IR rat model. Meanwhile, BBR may improve the abnormal lipid metabolism levels in PCOS-IR group by decreasing low density lipoprotein (LDL), total cholesterol (TC) and triglyceride (TG). Histological results showed that BBR can also protect normal histological structures of ovaries in PCOS-IR rats. Our results indicated that BBR plays a protective role in PCOS-IR, increasing insulin sensitivity, improving hyperandrogens and recovering abnormal blood lipids. Therefore, Our research provides novel insights for therapeutic treatment of BBR in patients with glucolipid metabolic disturbances.
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Affiliation(s)
- Li Li
- Department of Obstetrics and Gynecology, Guangdong Women and Children Hospital, Guangzhou, Guangdong, 510010, China
- Guangzhou Medical University, Guangzhou, Guangdong, 510000, China
| | - Yao Xiao
- State Key Laboratory of Traditional Chinese Medicine Syndrome, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, 510000, China
| | - Jiahe Zhou
- Naval Special Medical Center, Naval Medical University, Shanghai, 200082, China
| | - Hui Mo
- Faculty of Chinese Medicine, Macau University of Science and Technology, Macao, 000853, China
| | - Xiaofang Li
- Department of Obstetrics and Gynecology, Guangdong Women and Children Hospital, Guangzhou, Guangdong, 510010, China
| | - Yuancheng Li
- Department of Obstetrics and Gynecology, Guangdong Women and Children Hospital, Guangzhou, Guangdong, 510010, China
- Guangzhou Medical University, Guangzhou, Guangdong, 510000, China
| | - Youfeng Wang
- Faculty of Chinese Medicine, Macau University of Science and Technology, Macao, 000853, China
| | - Minglin Zhong
- Department of Obstetrics and Gynecology, Guangdong Women and Children Hospital, Guangzhou, Guangdong, 510010, China
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Butler AE, Moin ASM, Sathyapalan T, Atkin SL. A Cross-Sectional Study of Alzheimer-Related Proteins in Women with Polycystic Ovary Syndrome. Int J Mol Sci 2024; 25:1158. [PMID: 38256230 PMCID: PMC10816448 DOI: 10.3390/ijms25021158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Revised: 01/09/2024] [Accepted: 01/15/2024] [Indexed: 01/24/2024] Open
Abstract
Polycystic ovary syndrome (PCOS) is the most common endocrine condition in women of reproductive age, and several risk factors found in PCOS are associated with an increased risk of Alzheimer's disease (AD). Proteins increased in AD have been reported to include fibronectin (FN) fragments 3 and 4 (FN1.3 and FN1.4, respectively) and ApoE. We hypothesized that Alzheimer-related proteins would be dysregulated in PCOS because of associated insulin resistance and obesity. In this comparative cross-sectional analysis, aptamer-based SomaScan proteomic analysis for the detection of plasma Alzheimer-related proteins was undertaken in a PCOS biobank of 143 women with PCOS and 97 control women. Amyloid precursor protein (APP) (p < 0.05) and amyloid P-component (APCS) (p < 0.001) were elevated in PCOS, while alpha-synuclein (SNCA) (p < 0.05) was reduced in PCOS. Associations with protective heat shock proteins (HSPs) showed that SNCA positively correlated with HSP90 (p < 0.0001) and HSP60 (p < 0.0001) in both the PCOS and control women. Correlations with markers of inflammation showed that APCS correlated with interleukin 6 (IL6) (p = 0.04), while Apolipoprotein (Apo) E3 correlated with TNF-alpha (p = 0.02). FN, FN1.3, FN1.4 and ApoE were all elevated significantly (p < 0.05). An AD-associated protein pattern with elevated FN, FN1.3, FN1.4 and ApoE was found in PCOS, in addition to elevated APP and reduced SNCA, which was the same as reported for type 2 diabetes (T2D) with, additionally, an elevation in APCS. With the AD biomarker pattern in PCOS being very similar to that in T2D, where there is an association between AD and T2D, this suggests that larger prospective cohort studies are needed in women with PCOS to determine if there is a causal association with AD.
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Affiliation(s)
- Alexandra E. Butler
- Research Department, Royal College of Surgeons of Ireland, Busaiteen P.O. Box 15503, Bahrain; (A.S.M.M.); (S.L.A.)
| | - Abu Saleh Md Moin
- Research Department, Royal College of Surgeons of Ireland, Busaiteen P.O. Box 15503, Bahrain; (A.S.M.M.); (S.L.A.)
| | - Thozhukat Sathyapalan
- Academic Endocrinology, Diabetes and Metabolism, Hull York Medical School, Hull HU6 7RU, UK;
| | - Stephen L. Atkin
- Research Department, Royal College of Surgeons of Ireland, Busaiteen P.O. Box 15503, Bahrain; (A.S.M.M.); (S.L.A.)
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Pant P, Chitme H, Sircar R, Prasad R, Prasad HO. Differential Gene Expression Analysis of Human Ovarian Follicular Cumulus and Mural Granulosa Cells Under the Influence of Insulin in IVF Ovulatory Women and Polycystic Ovary Syndrome Patients Through Network Analysis. Endocr Res 2024; 49:22-45. [PMID: 37874895 DOI: 10.1080/07435800.2023.2272629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 10/14/2023] [Indexed: 10/26/2023]
Abstract
BACKGROUND Polycystic ovarian syndrome (PCOS) is a commonly occurring reproductive disorder among the reproductive-aged women. Its global occurrence varies based on diagnostic guidelines, ethnicities, and locations of concern. Insulin resistance (IR) is commonly observed around 65-70% of women diagnosed with PCOS, representing a prevalent association. Consequently, the study was designed with an objective of illustrating the effect of insulin on mural and cumulus granulosa cells (GCs) of PCOS patients in comparison to normal ovulating women. METHODOLOGY This study is a case-control design, wherein a total of 80 participants were recruited meeting criterion of inclusion and exclusion, divided into 8 groups with each group consisting of 10 samples. The process involves the isolation and culturing of mural granulosa cells (MGC) and cumulus granulosa cells (CGC) with and without exposure to insulin. The proteins released by untreated GCs and insulin-treated GCs were extracted, and complex protein mixtures were digested with trypsin, followed by tandem mass spectrometry analysis and data processing using bioinformatics. RESULTS We found 595 proteins in both control and PCOS samples, of which 310 were contributed by MGCs and 285 by CGCs. The PCOS MGCs expressed 20%, both the normal MGCs and CGCs have equal representation of 16% by each, whereas the PCOS CGCs proteins contributed 15% of the total of the proteomic expression. However, the poor expression observed with the Insulin exposure, the Insulin treated PCOS CGCs contributes 13%, PCOS MGCs contributes 8%. The normal MGCs upon the Insulin treatment give 8% then and there only 4% of proteins expressed by normal CGCs after Insulin treatment. The Venn analysis widened on their precise expression topographies. The examination of strings exhibited important protein-protein interaction pathways. CONCLUSION This is a pioneering investigation aimed to establish the link between hyperinsulinemia in localized follicular GCs and PCOS mechanisms by comparing them to control group. The examination of various attributes, mechanisms, and traits shown by genes and proteins in individuals with PCOS compared to control populations, alongside the investigation of the dynamics of these genes and proteins following exposure to insulin, holds promise for the formulation of novel hypotheses and strategies in the identification of new biomarkers.
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Affiliation(s)
- Pankaj Pant
- Faculty of Pharmacy, DIT University, Dehradun, India
| | | | - Reema Sircar
- Gynaecology, Indira IVF Hospital, Dehradun, India
| | - Ritu Prasad
- Gynaecology, Morpheus Prasad International Hospital, Dehradun, India
| | - Hari Om Prasad
- Gynaecology, Morpheus Prasad International Hospital, Dehradun, India
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18
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Guo H, Luo J, Lin H. Exploration of the pathogenesis of polycystic ovary syndrome based on gut microbiota: A review. Medicine (Baltimore) 2023; 102:e36075. [PMID: 38115365 PMCID: PMC10727628 DOI: 10.1097/md.0000000000036075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 10/10/2023] [Accepted: 10/20/2023] [Indexed: 12/21/2023] Open
Abstract
Polycystic ovary syndrome (PCOS) is a complex disorde7r influenced by genetic, neuroendocrine, metabolic, environmental, and lifestyle factors. This paper delves into the increasingly recognized role of gut microbiota dysbiosis in the onset and progression of PCOS. Utilizing advances in next-generation sequencing and metabolomics, the research examines the intricate interaction between the gut microbiota and the central nervous system via the gut-brain axis. The paper highlights how disruptions in gut microbiota contribute significantly to PCOS by modulating the release of gut-brain peptides and activating inflammatory pathways. Through such mechanisms, gut microbiota dysbiosis is implicated in hyperandrogenism, insulin resistance, chronic inflammation, and metabolic disorders associated with PCOS. While the relationship between gut microbiota and PCOS has begun to be elucidated, this paper underscores the need for further research to identify specific bacterial strains and their metabolic byproducts as potential therapeutic targets. Therefore, comprehensive studies are urgently needed to understand and fundamentally treat the pathophysiological processes of PCOS, offering valuable insights for future treatment and prevention strategies.
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Affiliation(s)
- Hua Guo
- Graduate School of Guangxi University of Traditional Chinese Medicine, Nanning City, Guangxi Zhuang Autonomous Region, China
| | - Jing Luo
- Graduate School of Guangxi University of Traditional Chinese Medicine, Nanning City, Guangxi Zhuang Autonomous Region, China
| | - Hanmei Lin
- Department of Gynaecology, The First Affiliated Hospital of Guangxi University of Traditional Chinese Medicine, Nanning City, Guangxi Zhuang Autonomous Region, China
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Melnik BC. Acne Transcriptomics: Fundamentals of Acne Pathogenesis and Isotretinoin Treatment. Cells 2023; 12:2600. [PMID: 37998335 PMCID: PMC10670572 DOI: 10.3390/cells12222600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 11/05/2023] [Accepted: 11/08/2023] [Indexed: 11/25/2023] Open
Abstract
This review on acne transcriptomics allows for deeper insights into the pathogenesis of acne and isotretinoin's mode of action. Puberty-induced insulin-like growth factor 1 (IGF-1), insulin and androgen signaling activate the kinase AKT and mechanistic target of rapamycin complex 1 (mTORC1). A Western diet (hyperglycemic carbohydrates and milk/dairy products) also co-stimulates AKT/mTORC1 signaling. The AKT-mediated phosphorylation of nuclear FoxO1 and FoxO3 results in their extrusion into the cytoplasm, a critical switch which enhances the transactivation of lipogenic and proinflammatory transcription factors, including androgen receptor (AR), sterol regulatory element-binding transcription factor 1 (SREBF1), peroxisome proliferator-activated receptor γ (PPARγ) and signal transducer and activator of transcription 3 (STAT3), but reduces the FoxO1-dependent expression of GATA binding protein 6 (GATA6), the key transcription factor for infundibular keratinocyte homeostasis. The AKT-mediated phosphorylation of the p53-binding protein MDM2 promotes the degradation of p53. In contrast, isotretinoin enhances the expression of p53, FoxO1 and FoxO3 in the sebaceous glands of acne patients. The overexpression of these proapoptotic transcription factors explains isotretinoin's desirable sebum-suppressive effect via the induction of sebocyte apoptosis and the depletion of BLIMP1(+) sebocyte progenitor cells; it also explains its adverse effects, including teratogenicity (neural crest cell apoptosis), a reduced ovarian reserve (granulosa cell apoptosis), the risk of depression (the apoptosis of hypothalamic neurons), VLDL hyperlipidemia, intracranial hypertension and dry skin.
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Affiliation(s)
- Bodo C Melnik
- Department of Dermatology, Environmental Medicine and Health Theory, University of Osnabrück, 49069 Osnabrück, Germany
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Hariri Z, Yari Z, Hoseini S, Mehrnami A, Abhari K, Sohrab G. Effects of Synbiotic-Containing Bacillus coagulans (GBI-30) on the Cardiovascular Status of Patients With Polycystic Ovary Syndrome: A Triple-blinded, Randomized, Placebo-controlled Study. Clin Ther 2023; 45:e193-e199. [PMID: 37640616 DOI: 10.1016/j.clinthera.2023.07.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 07/19/2023] [Accepted: 07/29/2023] [Indexed: 08/31/2023]
Abstract
PURPOSE Despite the high risk of cardiovascular diseases in women with polycystic ovary syndrome, fewer studies have addressed the improvement of cardiometabolic status of these patients. This study was conducted with the aim of investigating the effects of synbiotic-containing, spore-forming Bacillus coagulans on cardiometabolic indicators, including lipid profile, C-reactive protein, and atherogenic indexes in patients with polycystic ovary syndrome. METHODS In the present 12-week, triple-blinded, randomized, placebo-controlled clinical trial, 72 women with polycystic ovaries were randomized to receive either 2 g of synbiotic sachet (n = 36) or placebo (n = 36) plus lifestyle modification. Fasting blood samples were taken before and after the intervention. FINDINGS Statistical analysis was performed in 60 participants with a mean (SD) age of 28.25 (5.98) years who completed the intervention (synbiotic group [n = 34] and placebo group [n = 26]). A significant mean (SD) decrease in C-reactive protein level was observed in the synbiotic group compared with the placebo group (-0.12 [9.57] v. -0.008 [4.69], P = 0.03). No significant differences in mean changes of lipid profile and atherogenic indexes were seen between the 2 groups. Although the estimated mean changes in atherogenic indexes in the synbiotic group indicates a greater reduction than the placebo group, no significant difference was detected. IMPLICATIONS Our 12-week synbiotic intervention improved the inflammatory status in women with polycystic ovaries without affecting lipid profile or atherogenic indexes.
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Affiliation(s)
- Zahra Hariri
- Clinical Nutrition and Dietetics Department, Faculty of Nutrition Sciences and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences Tehran, Tehran, Iran
| | - Zahra Yari
- Department of Nutrition Research, National Nutrition and Food Technology Research Institute, Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sedighe Hoseini
- Department of Obstetrics and Gynecology, Preventative Gynecology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Afsaneh Mehrnami
- Shahid Akbar-Abadi Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Khadijeh Abhari
- Department of Food Science and Technology, National Nutrition and Food Technology Research Institute, Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Golbon Sohrab
- Clinical Nutrition and Dietetics Department, Faculty of Nutrition Sciences and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences Tehran, Tehran, Iran.
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Wang R, Zhao Y, Fang X, Miao C, Ren N, Chen Y, Cheng W, Zhang Q. Effect of the ketogenic diet on gut microbiome composition and metabolomics in polycystic ovarian syndrome rats induced by letrozole and a high-fat diet. Nutrition 2023; 114:112127. [PMID: 37441825 DOI: 10.1016/j.nut.2023.112127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 06/05/2023] [Indexed: 07/15/2023]
Abstract
OBJECTIVES The ketogenic diet (KD) is recommended to improve polycystic ovary syndrome (PCOS); however, its mechanisms of action are unclear. We aimed to study the effects and mechanisms of action of the KD on the gut microbiome and metabolites in PCOS rats and determine whether the sex hormone regulatory effects are related to modulations of the gut microbiota and metabolites. METHODS PCOS was induced with a high-fat diet and letrozole in the rats. A KD was fed to rats for 8 wk, serum samples were collected for biochemical analysis, and the rats' fecal samples were subjected to 16S ribosomal RNA sequencing and metabolomic analysis. RESULTS Feeding with a KD for 8 wk suppressed body weight gain, decreased luteinizing hormone and androgen levels, and improved insulin levels. Furthermore, the KD reversed the dysregulation of the gut microbiota in PCOS rats by adjusting the ratio of firmicutes and bacteroidetes. Also, the KD was involved in hormonal metabolic pathways by reducing the levels of some metabolites (such as testosterone and 7α-hydroxytestosterone) that are closely related to gut microbes. CONCLUSIONS The KD improved the clinical phenotype and insulin resistance in PCOS rats and altered the composition of the gut microbiome and metabolites, which were associated with androgen metabolism, representing a potential mechanism for mediating the effects of the KD on sex hormone metabolism in PCOS. However, our study found contradictory effects of KD on the gut microbiome in PCOS, which need further research.
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Affiliation(s)
- Ruye Wang
- Department of TCM Gynecology, Hangzhou TCM Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Ying Zhao
- School of Public Health, Zhejiang Chinese Medical University, Hangzhou, China
| | - Xiaohong Fang
- Department of TCM Gynecology, Hangzhou TCM Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Chenyun Miao
- School of Life Sciences, Zhejiang Chinese Medical University, Hangzhou, China
| | - Ning Ren
- Department of TCM Gynecology, Hangzhou TCM Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Yun Chen
- Department of TCM Gynecology, Hangzhou TCM Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Wei Cheng
- Department of Orthopedics, Hangzhou TCM Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Qin Zhang
- Department of TCM Gynecology, Hangzhou TCM Hospital of Zhejiang Chinese Medical University, Hangzhou, China; Research Institute of Women's Reproductive Health,Zhejiang Chinese Medical University,Hangzhou, China.
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Szczesnowicz A, Szeliga A, Niwczyk O, Bala G, Meczekalski B. Do GLP-1 Analogs Have a Place in the Treatment of PCOS? New Insights and Promising Therapies. J Clin Med 2023; 12:5915. [PMID: 37762856 PMCID: PMC10532286 DOI: 10.3390/jcm12185915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 09/04/2023] [Accepted: 09/09/2023] [Indexed: 09/29/2023] Open
Abstract
Polycystic ovary syndrome (PCOS) is the most prevalent endocrinopathy in women of reproductive age. This condition is characterized by hyperandrogenism and either oligo- or anovulation. PCOS patients often present comorbidities such as obesity, insulin resistance, impaired glucose metabolism, dyslipidemia, hypertension, metabolic syndrome, and an increased risk of diabetes. Given the profound implications of metabolic impairment in PCOS, the accurate diagnosis and management of these facets are imperative. The first-line approach to treatment involves lifestyle modifications, including dietary adjustments and exercise aimed at achieving weight loss, a strategy consistently emphasized across the literature. Supplementation with probiotics, vitamin D, and L-carnitine have also provided additional benefits to patients. In select cases, pharmacological interventions are needed for optimal therapeutic results. The most common medications used in PCOS include metformin, thiazolidinediones, inositols, and two classes of antidiabetic agents: dipeptidyl peptidase-IV (DPP-IV) inhibitors, and sodium-glucose cotransporter-2 (SGLT-2) inhibitors. Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are a new addition to the therapeutic arsenal for the metabolic management of PCOS. GLP-1 receptor agonists cause insulin release in a glucose-dependent manner, yielding clinical benefits such as heightened satiety, reduced appetite, and appetite regulation. GLP-1RAs have demonstrated efficacy in reducing glycated hemoglobin levels and promoting weight loss while ameliorating hyperlipidemia. Prior to initiating GLP-1RA therapy, patients should undergo screening for contraindications, including history of pancreatitis, diabetic retinopathy, or thyroid cancer. The effects of treatment should be monitored using laboratory testing and body weight measurements. Effective communication between clinician and patient should be maintained with regular check-in for a period of 6 to 12 months.
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Affiliation(s)
- Aleksandra Szczesnowicz
- Department of Gynecological Endocrinology, Poznan University of Medical Sciences, 61-701 Poznan, Poland; (A.S.); (A.S.); (O.N.)
| | - Anna Szeliga
- Department of Gynecological Endocrinology, Poznan University of Medical Sciences, 61-701 Poznan, Poland; (A.S.); (A.S.); (O.N.)
| | - Olga Niwczyk
- Department of Gynecological Endocrinology, Poznan University of Medical Sciences, 61-701 Poznan, Poland; (A.S.); (A.S.); (O.N.)
| | - Gregory Bala
- UCD School of Medicine, University College Dublin, D04 V1W8 Dublin, Ireland;
| | - Blazej Meczekalski
- Department of Gynecological Endocrinology, Poznan University of Medical Sciences, 61-701 Poznan, Poland; (A.S.); (A.S.); (O.N.)
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Geng Y, Liu Z, Hu R, Ma W, Wu X, Dong H, Song K, Xu X, Huang Y, Li F, Song Y, Zhang M. Opportunities and challenges: interleukin-22 comprehensively regulates polycystic ovary syndrome from metabolic and immune aspects. J Ovarian Res 2023; 16:149. [PMID: 37525285 PMCID: PMC10388558 DOI: 10.1186/s13048-023-01236-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 07/13/2023] [Indexed: 08/02/2023] Open
Abstract
Polycystic ovary syndrome (PCOS) is known as a prevalent but complicated gynecologic disease throughout the reproductive period. Typically, it is characterized by phenotypic manifestations of hyperandrogenism, polycystic ovary morphology, and persistent anovulation. For now, the therapeutic modality of PCOS is still a formidable challenge. Metabolic aberrations and immune challenge of chronic low-grade inflammatory state are significant in PCOS individuals. Recently, interleukin-22 (IL-22) has been shown to be therapeutically effective in immunological dysfunction and metabolic diseases, which suggests a role in the treatment of PCOS. In this review, we outline the potential mechanisms and limitations of IL-22 therapy in PCOS-related metabolic disorders including its regulation of insulin resistance, gut barrier, systemic inflammation, and hepatic steatosis to generate insights into developing novel strategies in clinical practice.
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Affiliation(s)
- Yuli Geng
- Institute of Integrated Traditional Chinese and Western Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, Hubei, 430030, China
| | - Zhuo Liu
- Institute of Integrated Traditional Chinese and Western Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, Hubei, 430030, China
| | - Runan Hu
- Institute of Integrated Traditional Chinese and Western Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, Hubei, 430030, China
| | - Wenwen Ma
- Department of Traditional Chinese Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, Hubei, 430030, China
| | - Xiao Wu
- Department of Traditional Chinese Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, Hubei, 430030, China
| | - Haoxu Dong
- Department of Traditional Chinese Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, Hubei, 430030, China
| | - Kunkun Song
- Department of Traditional Chinese Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, Hubei, 430030, China
| | - Xiaohu Xu
- Department of Traditional Chinese Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, Hubei, 430030, China
| | - Yanjing Huang
- Institute of Integrated Traditional Chinese and Western Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, Hubei, 430030, China
| | - Fan Li
- Institute of Integrated Traditional Chinese and Western Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, Hubei, 430030, China
| | - Yufan Song
- Institute of Integrated Traditional Chinese and Western Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, Hubei, 430030, China.
- Department of Traditional Chinese Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, Hubei, 430030, China.
| | - Mingmin Zhang
- Institute of Integrated Traditional Chinese and Western Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, Hubei, 430030, China.
- Department of Traditional Chinese Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, Hubei, 430030, China.
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Guo J, Chen Y, Jiang Y, Zhang C. Effects of body mass index and insulin resistance on first-time assisted conception and perinatal outcomes in young polycystic ovary syndrome patients. Front Endocrinol (Lausanne) 2023; 14:1170816. [PMID: 37554761 PMCID: PMC10405815 DOI: 10.3389/fendo.2023.1170816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 07/04/2023] [Indexed: 08/10/2023] Open
Abstract
Objective The objective of the study was to explore the effect of body mass index (BMI) and insulin resistance (IR) levels on first-time assisted conception results and perinatal outcomes in young polycystic ovary syndrome (PCOS) patients. Design This was a single-center, retrospective, observational cohort study. Patients Young women with PCOS undergoing their first embryo transfer were included in the study. Main outcome measure Early pregnancy loss rate was the main outcome measure. Results The early pregnancy loss rate in the overweight + insulin resistance group (OW+IR group) was significantly higher than that in the non-overweight + non-insulin resistance group (NOW+NIR group) (18.16% vs. 9.02%, Bonferroni correction, P = 0.012). The early pregnancy loss rate in the non-overweight + insulin resistance group (NOW+IR group) and overweight + non-insulin resistance group (OW+NIR group) (18.18% and 17.14%, respectively) were also higher than that in the NOW+NIR group (6.07%), but the difference was not statistically significant (Bonferroni correction, all P > 0.05). No significant difference was found in clinical pregnancy rate, live birth rate, and macrosomia rate (all P > 0.05). After adjusting for confounding factors, BMI and IR levels were identified as independent risk factors for early pregnancy loss rate. Conclusion BMI and IR levels are independent risk factors for early pregnancy loss in young PCOS patients during the first embryo transfer cycle. Multiple indicators should be considered when assessing pregnancy outcomes, which will promote individualized pregnancy guidance and treatment procedures for PCOS patients.
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Affiliation(s)
- Jiayu Guo
- Reproductive Medical Center, People’s Hospital of Zhengzhou University, Zhengzhou, China
- Reproductive Medical Center, Henan Provincial People’s Hospital, Zhengzhou, China
| | - Yuanhui Chen
- Reproductive Medical Center, People’s Hospital of Zhengzhou University, Zhengzhou, China
- Reproductive Medical Center, Henan Provincial People’s Hospital, Zhengzhou, China
| | - Yilin Jiang
- Reproductive Medical Center, People’s Hospital of Zhengzhou University, Zhengzhou, China
- Reproductive Medical Center, Henan Provincial People’s Hospital, Zhengzhou, China
| | - Cuilian Zhang
- Reproductive Medical Center, People’s Hospital of Zhengzhou University, Zhengzhou, China
- Reproductive Medical Center, Henan Provincial People’s Hospital, Zhengzhou, China
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25
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Mićić B, Djordjevic A, Veličković N, Kovačević S, Martić T, Macut D, Vojnović Milutinović D. AMPK Activation as a Protective Mechanism to Restrain Oxidative Stress in the Insulin-Resistant State in Skeletal Muscle of Rat Model of PCOS Subjected to Postnatal Overfeeding. Biomedicines 2023; 11:1586. [PMID: 37371678 DOI: 10.3390/biomedicines11061586] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 05/21/2023] [Accepted: 05/27/2023] [Indexed: 06/29/2023] Open
Abstract
Polycystic ovary syndrome (PCOS) is a common endocrinopathy in women of reproductive age, often associated with obesity and insulin resistance. Childhood obesity is an important predisposing factor for the development of PCOS later in life. Being particularly interested in the interplay between prepubertal obesity and hyperandrogenemia, we investigated the effects of early postnatal overfeeding, accomplished by reducing litter size during the period of suckling, on energy sensing and insulin signaling pathways in the gastrocnemius muscle of a rat model of PCOS-induced by 5α-dihydrotestosterone (DHT). The combination of overfeeding and DHT treatment caused hyperinsulinemia and decreased systemic insulin sensitivity. Early postnatal overfeeding induced defects at critical nodes of the insulin signaling pathway in skeletal muscle, which was associated with reduced glucose uptake in the presence of hyperandrogenemia. In this setting, under a combination of overfeeding and DHT treatment, skeletal muscle switched to mitochondrial β-oxidation of fatty acids, resulting in oxidative stress and inflammation that stimulated AMP-activated protein kinase (AMPK) activity and its downstream targets involved in mitochondrial biogenesis and antioxidant protection. Overall, a combination of overfeeding and hyperandrogenemia resulted in a prooxidative and insulin-resistant state in skeletal muscle. This was accompanied by the activation of AMPK, which could represent a potential therapeutic target in insulin-resistant PCOS patients.
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Affiliation(s)
- Bojana Mićić
- Department of Biochemistry, Institute for Biological Research "Siniša Stanković"-National Institute of the Republic of Serbia, University of Belgrade, 142 Despot Stefan Blvd, 11060 Belgrade, Serbia
| | - Ana Djordjevic
- Department of Biochemistry, Institute for Biological Research "Siniša Stanković"-National Institute of the Republic of Serbia, University of Belgrade, 142 Despot Stefan Blvd, 11060 Belgrade, Serbia
| | - Nataša Veličković
- Department of Biochemistry, Institute for Biological Research "Siniša Stanković"-National Institute of the Republic of Serbia, University of Belgrade, 142 Despot Stefan Blvd, 11060 Belgrade, Serbia
| | - Sanja Kovačević
- Department of Biochemistry, Institute for Biological Research "Siniša Stanković"-National Institute of the Republic of Serbia, University of Belgrade, 142 Despot Stefan Blvd, 11060 Belgrade, Serbia
| | - Teodora Martić
- Department of Biochemistry, Institute for Biological Research "Siniša Stanković"-National Institute of the Republic of Serbia, University of Belgrade, 142 Despot Stefan Blvd, 11060 Belgrade, Serbia
| | - Djuro Macut
- Clinic for Endocrinology, Diabetes and Metabolic Diseases University Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, Doktora Subotića 13, 11000 Belgrade, Serbia
| | - Danijela Vojnović Milutinović
- Department of Biochemistry, Institute for Biological Research "Siniša Stanković"-National Institute of the Republic of Serbia, University of Belgrade, 142 Despot Stefan Blvd, 11060 Belgrade, Serbia
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26
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Luo C, Cheng H, He X, Tan X, Huang X. Association between serum uric acid and female infertility: a cross-sectional study of National Health and Nutrition Examination Survey (NHANES) 2013-2018. BMC Womens Health 2023; 23:224. [PMID: 37138241 PMCID: PMC10157990 DOI: 10.1186/s12905-023-02376-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 04/19/2023] [Indexed: 05/05/2023] Open
Abstract
BACKGROUND Female infertility is a major problem for women of reproductive-age worldwide. Oxidative stress and inflammation are involved in processes related to female infertility. Serum uric acid levels, an indicator of oxidative stress and inflammation, have rarely been reported to be associated with female infertility. This study aimed to investigate the relationship between serum uric acid levels and female infertility. METHODS This cross-sectional study included women aged 18-44 years from the National Health and Nutrition Examination Survey (NHANES) between 2013 and 2018. All data were extracted from NHANES questionnaires and laboratory measurements. Weighted univariable and multivariable logistic regression analyses were utilized to explore the relationship between serum uric acid and female infertility. Stratified analyses were performed based on body mass index (BMI, < 25 kg/m2 and ≥ 25 kg/m2) and age (≤ 30 years and > 30 years). The odds ratio (OR) with 95% confidence interval (CI) was used to report associations. RESULTS A total of 2,884 women were included, of which 352 (13.30%) had infertility. Women with high serum uric acid concentrations were related to higher odds of infertility (OR = 1.20, 95%CI: 1.03-1.39) after adjusting for confounders. Compared with serum uric acid concentrations ≤ 3.72 mg/dL, women with uric acid concentrations of 4.43-5.13 mg/dL (OR = 1.65, 95%CI: 1.02-2.67) and > 5.13 mg/dL (OR = 1.86, 95%CI: 1.10-3.13) were related to higher odds of infertility. Stratified analyses showed that high serum uric acid concentrations were associated with higher odds of infertility in women with a BMI < 25 kg/m2 (OR = 1.41, 95%CI: 1.04-1.93), but not in women with a BMI ≥ 25 kg/m2 (P = 0.056). In addition, high serum uric acid concentrations were associated with higher odds of infertility in women aged > 30 years (OR = 1.23, 95%CI: 1.04-1.45), but not in women aged ≤ 30 years (P = 0.556). CONCLUSION Women with high serum uric acid concentrations were associated with higher odds of infertility, and this association may vary by BMI and age.
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Affiliation(s)
- Chen Luo
- Center for Reproduction and Genetics, Xiangtan Central Hospital, No.120 Heping Road, Yuhu District, Xiangtan, 411100, Hunan, P.R. China
| | - Haiying Cheng
- Center for Reproduction and Genetics, Xiangtan Central Hospital, No.120 Heping Road, Yuhu District, Xiangtan, 411100, Hunan, P.R. China
| | - Xiao He
- Center for Reproduction and Genetics, Xiangtan Central Hospital, No.120 Heping Road, Yuhu District, Xiangtan, 411100, Hunan, P.R. China
| | - Xiaojun Tan
- Center for Reproduction and Genetics, Xiangtan Central Hospital, No.120 Heping Road, Yuhu District, Xiangtan, 411100, Hunan, P.R. China
| | - Xianghong Huang
- Center for Reproduction and Genetics, Xiangtan Central Hospital, No.120 Heping Road, Yuhu District, Xiangtan, 411100, Hunan, P.R. China.
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27
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Zhou J, Zuo W, Tan Y, Wang X, Zhu M, Zhang H. Effects of n-3 polyunsaturated fatty acid on metabolic status in women with polycystic ovary syndrome: a meta-analysis of randomized controlled trials. J Ovarian Res 2023; 16:54. [PMID: 36932420 PMCID: PMC10022207 DOI: 10.1186/s13048-023-01130-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 02/27/2023] [Indexed: 03/19/2023] Open
Abstract
This meta-analysis was conducted to summarize the effects of n-3 polyunsaturated fatty acid (n-3 PUFA) on metabolic status including insulin metabolism and lipid metabolism in women with polycystic ovary syndrome (PCOS) by randomized controlled trials (RCTs). Four mainstream databases including PubMed, Cochrane Library, Embase and Web of Science were searched from their inception to October 2021. The registration number of this study was CRD42021285233. The quality assessment was performed referring the Cochrane Risk of Bias Tool. Mean differences (MD) and 95% confidence intervals (CIs) were generated for continuous variables by meta-analysis. Subgroup analyses were performed based on study duration (≤ 8 weeks or > 8 weeks), the source of n-3 PUFA (marine derived or plant origins) and dosage of n-3 PUFA (≤ 1000 mg/d or > 1000 mg/d). Eventually, 11 RCTs reporting 816 patients were enrolled. Compared with control group, n-3 PUFA treatment decreased waist circumference (MD = -2.76, 95% CI: -3.82 to -1.69; p < 0.00001), fasting plasma glucose (MD = -3.91, 95% CI: -5.69 to -2.13; p < 0.0001), fasting insulin (MD = -2.45, 95% CI: -3.19 to -1.71; p < 0.00001), homeostatic model assessment of insulin resistance (MD = -0.45, 95% CI: -0.80 to -0.11; p = 0.01), triglyceride (MD = -9.33, 95% CI: -10.56 to -8.10; p < 0.00001), total cholesterol (MD = -12.32, 95% CI: -19.15 to -5.50; p = 0.0004), low-density lipoprotein cholesterol (MD = -10.53, 95% CI: -19.31 to -1.75; p = 0.02), and increase quantitative insulin sensitivity check index (MD = 0.01, 95% CI: 0.01 to 0.02; p < 0.00001), Adiponectin (MD = 1.46, 95% CI: 1.12 to 1.80; p < 0.00001) in PCOS patients. However, n-3 PUFA failed to change body weight, body mass index, high-density lipoprotein cholesterol, very low-density lipoprotein cholesterol and hs-CRP in the overall analysis. Further subgroup analyses showed that supplements of n-3 PUFA for more than 8 weeks is more conducive to improve the metabolic status in insulin resistance and lipid profiles. The meta-analysis demonstrates that n-3 PUFA may be an effective intervention for alleviating metabolic status in PCOS. Hence, we recommend PCOS patients replenish n-3 PUFA with duration > 8 weeks regardless of the source and the dosage to retard the pathogenesis of PCOS related metabolic diseases.
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Grants
- project NO JC2020003 Project of Nantong Science and Technology Bureau, Jiangsu, China
- project NO JC2020003 Project of Nantong Science and Technology Bureau, Jiangsu, China
- project NO JC2020003 Project of Nantong Science and Technology Bureau, Jiangsu, China
- project NO JC2020003 Project of Nantong Science and Technology Bureau, Jiangsu, China
- project NO JC2020003 Project of Nantong Science and Technology Bureau, Jiangsu, China
- project NO JC2020003 Project of Nantong Science and Technology Bureau, Jiangsu, China
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Affiliation(s)
- Jie Zhou
- grid.410745.30000 0004 1765 1045Nanjing University of Chinese Medicine, Nanjing, 210023 People’s Republic of China
- Department of Chinese Medicine, The First People’s Hospital of Nantong, Nantong, 226001 Jiangsu People’s Republic of China
| | - Wenting Zuo
- grid.410745.30000 0004 1765 1045Department of Reproductive Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, 210029 Jiangsu People’s Republic of China
| | - Yong Tan
- grid.410745.30000 0004 1765 1045Department of Reproductive Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, 210029 Jiangsu People’s Republic of China
| | - Xudong Wang
- Department of Chinese Medicine, The First People’s Hospital of Nantong, Nantong, 226001 Jiangsu People’s Republic of China
| | - Meihong Zhu
- Department of Pharmacy, The First People’s Hospital of Nantong, Nantong, 226001 Jiangsu People’s Republic of China
| | - Huili Zhang
- Medical Department, The First People’s Hospital of Nantong, Nantong, 226001 Jiangsu People’s Republic of China
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28
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Cai M, Ni Z, Yuan Z, Yu J, Zhang D, Yao R, Zhou L, Yu C. Past and present: a bibliometric study on polycystic ovary syndrome. J Ovarian Res 2023; 16:42. [PMID: 36803912 PMCID: PMC9938353 DOI: 10.1186/s13048-022-01072-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 12/08/2022] [Indexed: 02/19/2023] Open
Abstract
BACKGROUND Polycystic ovary syndrome (PCOS) is a common gynecological endocrine disease that has a great impact on women's physical and mental health. It is a burden to social and patients' economy. In recent years, researchers' understanding of PCOS has reached a new level. However, many PCOS reports have different directions, and overlapping phenomena exist. Therefore, clarifying the research status of PCOS is important. This study aims to summarise the research status of PCOS and predict the hot spots of PCOS in the future by Bibliometricx. RESULTS The keywords of PCOS research focused on PCOS, insulin resistance (IR), obesity and metformin. Keywords plus co-occurrence network showed that PCOS, IR and prevalence were hot spots in the recent 10 years. Moreover, we found that gut microbiota may be a carrier that can be used to study hormone levels, IR-related mechanisms, prevention and treatment in the future. CONCLUSIONS This study is helpful for researchers to quickly grasp the current situation of PCOS research and enlighten researchers to explore new problems in PCOS.
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Affiliation(s)
- Mengcheng Cai
- grid.73113.370000 0004 0369 1660Basic Medicine School, Naval Medical University, Shanghai, 200433 China
| | - Zhexin Ni
- grid.506261.60000 0001 0706 7839Department of Pharmaceutical Sciences, Beijing Institute of Radiation Medicine, Beijing, 100850 China
| | - Zike Yuan
- grid.73113.370000 0004 0369 1660Basic Medicine School, Naval Medical University, Shanghai, 200433 China
| | - Jin Yu
- Department of Traditional Chinese Gynecology, the First Affiliated Hospital of Naval Military Medical University, Shanghai, 200433 China
| | - Danying Zhang
- Department of Traditional Chinese Gynecology, the First Affiliated Hospital of Naval Military Medical University, Shanghai, 200433 China
| | - Ruipin Yao
- Department of Traditional Chinese Gynecology, the First Affiliated Hospital of Naval Military Medical University, Shanghai, 200433 China
| | - Ling Zhou
- Department of Traditional Chinese Gynecology, the First Affiliated Hospital of Naval Military Medical University, Shanghai, 200433, China.
| | - Chaoqin Yu
- Department of Traditional Chinese Gynecology, the First Affiliated Hospital of Naval Military Medical University, Shanghai, 200433, China.
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Insulin Metabolism in Polycystic Ovary Syndrome: Secretion, Signaling, and Clearance. Int J Mol Sci 2023; 24:ijms24043140. [PMID: 36834549 PMCID: PMC9962893 DOI: 10.3390/ijms24043140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 01/23/2023] [Accepted: 02/03/2023] [Indexed: 02/09/2023] Open
Abstract
Polycystic ovary syndrome (PCOS) is the most common endocrine and metabolic disorder in women of reproductive age. Its heterogeneous clinical presentation is characterized by hyperandrogenemia, reproductive changes, polycystic ovary morphology, and insulin resistance (IR). The primary pathophysiological process in its multifactorial etiology has not yet been identified. However, the two most proposed core etiologies are the disruption of insulin metabolism and hyperandrogenemia, both of which begin to intertwine and propagate each other in the later stages of the disease. Insulin metabolism can be viewed as the interconnectedness of beta cell function, IR or insulin sensitivity, and insulin clearance. Previous studies of insulin metabolism in PCOS patients have yielded conflicting results, and literature reviews have focused mainly on the molecular mechanisms and clinical implications of IR. In this narrative review, we comprehensively explored the role of insulin secretion, clearance, and decreased sensitivity in target cells as a potential primary insult in PCOS pathogenesis, along with the molecular mechanism behind IR in PCOS.
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Pregnancy Outcomes in Women with PCOS: Follow-Up Study of a Randomized Controlled Three-Component Lifestyle Intervention. J Clin Med 2023; 12:jcm12020426. [PMID: 36675355 PMCID: PMC9867443 DOI: 10.3390/jcm12020426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 12/30/2022] [Accepted: 01/03/2023] [Indexed: 01/06/2023] Open
Abstract
Women with polycystic ovary syndrome (PCOS) and excess weight often present with reproductive derangements. The first-line treatment for this population is a multi-component lifestyle intervention. This follow-up study of a randomized controlled trial based on data from the Dutch Perinatal registry was conducted to study the effect of a one-year three-component (cognitive behavioral therapy, healthy diet, and exercise) lifestyle intervention on pregnancy outcomes in women with PCOS and overweight or obesity. Women diagnosed with PCOS, a BMI ≥ 25 kg/m², and a wish to conceive were randomized to either three-component lifestyle intervention (LSI, n = 123), and care as usual (CAU, n = 60) where they were encouraged to lose weight autonomously. Conception resulting in live birth was 39.8% (49/123) within LSI and 38.3% (23/60) within CAU (p = 0.845). In total, 58.3% conceived spontaneously. Gestational diabetes (LSI: 8.2% vs. CAU: 21.7%, p = 0.133), hypertensive disorders (LSI: 8.2% vs. CAU 13.0%, p = 0.673), and preterm birth (LSI: 12.2% vs. CAU: 17.4%, p = 0.716) rates were all lower in LSI compared to CAU. This follow-up study showed no significant differences in conception resulting in live birth rates between LSI and CAU. Nonetheless, a large proportion eventually conceived spontaneously. Moreover, after LSI, the number of uneventful pregnancies was lower compared to care as usual.
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Ionescu OM, Frincu F, Mehedintu A, Plotogea M, Cirstoiu M, Petca A, Varlas V, Mehedintu C. Berberine-A Promising Therapeutic Approach to Polycystic Ovary Syndrome in Infertile/Pregnant Women. LIFE (BASEL, SWITZERLAND) 2023; 13:life13010125. [PMID: 36676074 PMCID: PMC9864590 DOI: 10.3390/life13010125] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 12/25/2022] [Accepted: 12/29/2022] [Indexed: 01/03/2023]
Abstract
Polycystic ovary syndrome (PCOS) is a disorder with an unknown etiology that features a wide range of endocrine and metabolic abnormalities that hamper fertility. PCOS women experience difficulties getting pregnant, and if pregnant, they are prone to miscarriage, gestational diabetes, pregnancy-induced hypertension and preeclampsia, high fetal morbidity, and perinatal mortality. Insulin, the pancreatic hormone best known for its important role in glucose metabolism, has an underrated position in reproduction. PCOS women who have associated insulin resistance (with consequent hyperinsulinemia) have fertility issues and adverse pregnancy outcomes. Lowering the endogen insulin levels and insulin resistance appears to be a target to improve fertility and pregnancy outcomes in those women. Berberine is an alkaloid with a high concentration in various medicinal herbs that exhibits a hypoglycaemic effect alongside a broad range of other therapeutic activities. Its medical benefits may stand up for treating different conditions, including diabetes mellitus. So far, a small number of pharmacological/clinical trials available in the English language draw attention towards the good results of berberine's use in PCOS women with insulin resistance for improving fertility and pregnancy outcomes. Our study aims to uncover how berberine can counteract the negative effect of insulin resistance in PCOS women and improve fertility and pregnancy outcomes.
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Affiliation(s)
- Oana-Maria Ionescu
- Faculty of Medicine “Carol Davila”, University of Medicine and Pharmacy Bucharest, 050474 Bucharest, Romania
| | - Francesca Frincu
- Faculty of Medicine “Carol Davila”, University of Medicine and Pharmacy Bucharest, 050474 Bucharest, Romania
- Correspondence:
| | - Andra Mehedintu
- Faculty of Medicine “Carol Davila”, University of Medicine and Pharmacy Bucharest, 050474 Bucharest, Romania
| | - Mihaela Plotogea
- Department of Obstetrics and Gynecology, “Nicolae Malaxa” Clinical Hospital, 022441 Bucharest, Romania
| | - Monica Cirstoiu
- Faculty of Medicine “Carol Davila”, University of Medicine and Pharmacy Bucharest, 050474 Bucharest, Romania
| | - Aida Petca
- Faculty of Medicine “Carol Davila”, University of Medicine and Pharmacy Bucharest, 050474 Bucharest, Romania
| | - Valentin Varlas
- Faculty of Medicine “Carol Davila”, University of Medicine and Pharmacy Bucharest, 050474 Bucharest, Romania
| | - Claudia Mehedintu
- Faculty of Medicine “Carol Davila”, University of Medicine and Pharmacy Bucharest, 050474 Bucharest, Romania
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Li Y, Wang Y, Liu H, Zhang S, Zhang C. Association between HOMA-IR and ovarian sensitivity index in women with PCOS undergoing ART: A retrospective cohort study. Front Endocrinol (Lausanne) 2023; 14:1117996. [PMID: 36967765 PMCID: PMC10034104 DOI: 10.3389/fendo.2023.1117996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 02/24/2023] [Indexed: 03/11/2023] Open
Abstract
INTRODUCTION Insulin resistance (IR) may play a central role in the pathophysiology of polycystic ovary syndrome (PCOS). Controlled ovarian stimulation (COS) in PCOS women in the setting of assisted reproductive technology (ART) is always a challenge for clinicians. However, it remains unclear whether IR in women with PCOS correlates with reduced ovarian sensitivity to exogenous gonadotropin (Gn). This study aimed to explore the association between homeostasis model assessment of insulin resistance (HOMA-IR) and ovarian sensitivity index (OSI). METHODS In this retrospective cohort study, we explored the association between Ln HOMA-IR and Ln OSI based on smoothing splines generated by generalized additive model (GAM). Then the correlation between HOMA-IR and OSI was further tested with a multivariable linear regression model and subgroup analysis. RESULTS 1508 women with PCOS aged 20-39 years undergoing their first oocyte retrieval cycle were included consecutively between 2018 until 2022. We observed a negative association between Ln HOMA-IR and Ln OSI by using smoothing splines. In multivariable linear regression analysis, the inverse association between Ln HOMA-IR and Ln OSI was still found in PCOS women after adjustment for potential confounders (β = -0.18, 95% CI -0.25, -0.11). Compared with patients with the lowest tertile of HOMA-IR, those who had the highest tertile of HOMA-IR had lower OSI values (β = -0.25, 95% CI -0.36, -0.15). DISCUSSION Our study provided evidence for the inverse correlation between IR and the ovarian sensitivity during COS in PCOS women. Herein, we proposed new insights for individualized manipulation in PCOS patients with IR undergoing ART.
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Affiliation(s)
- Yan Li
- Reproductive Medicine Center, People’s Hospital of Zhengzhou University, Henan Provincial People’s Hospital, Zhengzhou, Henan, China
| | - Yiwen Wang
- Reproductive Medicine Center, People’s Hospital of Zhengzhou University, Henan Provincial People’s Hospital, Zhengzhou, Henan, China
| | - Hai Liu
- Department of Gynaecology and Obstetrics, Xinjiang Production and Construction Corps 13 Division Red Star Hospital, Hami, Xinjiang, China
| | - Shaodi Zhang
- Reproductive Medicine Center, People’s Hospital of Zhengzhou University, Henan Provincial People’s Hospital, Zhengzhou, Henan, China
| | - Cuilian Zhang
- Reproductive Medicine Center, People’s Hospital of Zhengzhou University, Henan Provincial People’s Hospital, Zhengzhou, Henan, China
- *Correspondence: Cuilian Zhang,
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Zhao X, An X, Yang C, Sun W, Ji H, Lian F. The crucial role and mechanism of insulin resistance in metabolic disease. Front Endocrinol (Lausanne) 2023; 14:1149239. [PMID: 37056675 PMCID: PMC10086443 DOI: 10.3389/fendo.2023.1149239] [Citation(s) in RCA: 24] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Accepted: 03/07/2023] [Indexed: 03/30/2023] Open
Abstract
Insulin resistance (IR) plays a crucial role in the development and progression of metabolism-related diseases such as diabetes, hypertension, tumors, and nonalcoholic fatty liver disease, and provides the basis for a common understanding of these chronic diseases. In this study, we provide a systematic review of the causes, mechanisms, and treatments of IR. The pathogenesis of IR depends on genetics, obesity, age, disease, and drug effects. Mechanistically, any factor leading to abnormalities in the insulin signaling pathway leads to the development of IR in the host, including insulin receptor abnormalities, disturbances in the internal environment (regarding inflammation, hypoxia, lipotoxicity, and immunity), metabolic function of the liver and organelles, and other abnormalities. The available therapeutic strategies for IR are mainly exercise and dietary habit improvement, and chemotherapy based on biguanides and glucagon-like peptide-1, and traditional Chinese medicine treatments (e.g., herbs and acupuncture) can also be helpful. Based on the current understanding of IR mechanisms, there are still some vacancies to follow up and consider, and there is also a need to define more precise biomarkers for different chronic diseases and lifestyle interventions, and to explore natural or synthetic drugs targeting IR treatment. This could enable the treatment of patients with multiple combined metabolic diseases, with the aim of treating the disease holistically to reduce healthcare expenditures and to improve the quality of life of patients to some extent.
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Affiliation(s)
| | | | | | | | - Hangyu Ji
- *Correspondence: Fengmei Lian, ; Hangyu Ji,
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Helvaci N, Yildiz BO. Current and emerging drug treatment strategies for polycystic ovary syndrome. Expert Opin Pharmacother 2023; 24:105-120. [PMID: 35912829 DOI: 10.1080/14656566.2022.2108702] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
INTRODUCTION Polycystic ovary syndrome (PCOS) is a common hormonal, metabolic, and reproductive disorder with a heterogeneous phenotype. As the exact etiology of PCOS is still unclear, available pharmacotherapies are mostly directed toward alleviating symptoms and associated metabolic abnormalities. AREAS COVERED Herein, we present an overview of the current and emerging pharmacotherapies for the management of women with PCOS who do not seek pregnancy. We performed a literature search in PubMed database up to January 2022 and reviewed papers assessing drug treatments for PCOS. We aimed to outline the most recent evidence to support treatment recommendations in these patients. EXPERT OPINION Targets for medical treatment include hormonal, reproductive, and metabolic abnormalities in PCOS. However, none of the available pharmacological options can cover the entire spectrum of clinical manifestations observed in these patients. Considering the heterogeneity of PCOS, treatment should be individualized and adapted to specific needs of each patient. Better understanding of the molecular mechanisms underlying the pathogenesis of PCOS would help development of novel, safer, and more effective multi-targeted therapeutic strategies for the syndrome.
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Affiliation(s)
- Nafiye Helvaci
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Hitit University School of Medicine, Corum, Turkey
| | - Bulent Okan Yildiz
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Hacettepe University School of Medicine, Ankara, Turkey
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Khamoshina MB, Artemenko YS, Bayramova AA, Ryabova VA, Orazov MR. Polycystic ovary syndrome and obesity: a modern paradigm. RUDN JOURNAL OF MEDICINE 2022. [DOI: 10.22363/2313-0245-2022-26-4-382-395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Polycystic ovary syndrome is a heterogeneous endocrine disease that affects women of childbearing age. The pathogenesis of polycystic ovary syndrome has not been fully studied to date, its paradigm considers the genetic determinism of the manifestation of hormonal and metabolic disorders, which are considered to be criteria for the verification of the disease (hyperandrogenism, oligo/anovulation and/or polycystic ovarian transformation during ultrasound examination (ultrasound). This review discusses the main ways of interaction between hyperandrogenism, insulin resistance and obesity and their role in the pathogenesis of polycystic ovary syndrome, as well as possible methods of treatment for this category of patients. The review analyzes the role of hyperandrogenism and insulin resistance in the implementation of the genetic scenario of polycystic ovary syndrome and finds out the reasons why women with polycystic ovary syndrome often demonstrate the presence of a «metabolic trio» - hyperinsulinemia, insulin resistance and type 2 diabetes mellitus. It is noted that obesity is not included in the criteria for the diagnosis of polycystic ovary syndrome, but epidemiological data confirm the existence of a relationship between these diseases. Obesity, especially visceral, which is often found in women with polycystic ovary syndrome, enhances and worsens metabolic and reproductive outcomes with polycystic ovary syndrome, as well as increases insulin resistance and compensatory hyperinsulinemia, which, in turn, stimulates adipogenesis and suppresses lipolysis. Obesity increases the sensitivity of tech cells to luteinizing hormone stimulation and enhances functional hyperandrogenism of the ovaries, increasing the production of androgens by the ovaries. Excess body weight is associated with a large number of inflammatory adipokines, which, in turn, contribute to the growth of insulin resistance and adipogenesis. Obesity and insulin resistance exacerbate the symptoms of hyperandrogenism, forming a vicious circle that contributes to the development of polycystic ovary syndrome. These data allow us to conclude that bariatric surgery can become an alternative to drugs (metformin, thiazolidinedione analogs of glucagon-like peptide-1), which has shown positive results in the treatment of patients with polycystic ovary syndrome and obesity.
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Selen DJ, Powe CE. Gestational diabetes and other adverse pregnancy outcomes in polycystic ovary syndrome. Curr Opin Endocrinol Diabetes Obes 2022; 29:521-527. [PMID: 35983844 PMCID: PMC9613547 DOI: 10.1097/med.0000000000000769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
PURPOSE OF REVIEW This review provides an update on gestational diabetes (GDM) and other adverse pregnancy outcomes in individuals with polycystic ovary syndrome (PCOS), one of the most common metabolic disorders and causes of infertility. RECENT FINDINGS Recent studies using Rotterdam diagnostic criteria for PCOS have supported prior literature suggesting that pregnant individuals with PCOS are at an increased risk of GDM. Risk factors for GDM in this population include overweight/obesity, insulin resistance, hyperandrogenism, amenorrhea, and history of miscarriage. It is possible that subtypes of PCOS (metabolic vs. lean/reproductive) pose differential risk. There are no current screening or treatment guidelines specifically for individuals with PCOS for GDM prevention. Although metformin has been studied for GDM prevention in PCOS, there has been no proven benefit. For infertility treatment, assisted reproductive technology and in-vitro fertilization do not appear to increase the risk of GDM in individuals with PCOS desiring pregnancy. SUMMARY Recent studies of pregnant individuals with PCOS suggest an increased risk of adverse pregnancy outcomes, including GDM. Larger, prospective studies using standardized diagnostic criteria are warranted to determine if the risk is from PCOS generally, or if there are subtypes of PCOS (metabolic vs. lean/reproductive) at a higher risk of GDM than others.
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Affiliation(s)
- Daryl J. Selen
- Diabetes Unit, Endocrine Division, Massachusetts General Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
- Division of Endocrinology, Warren Alpert Medical School of Brown University, Providence, RI, United States
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI, United States
| | - Camille E. Powe
- Diabetes Unit, Endocrine Division, Massachusetts General Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
- Broad Institute of MIT and Harvard, Boston, MA, United States
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA, United States
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Gutiérrez-Lara EJ, Sánchez-López A, Murbartián J, Acosta-Cota SJ, Centurión D. Effect of chronic administration of 17β-estradiol on the vasopressor responses induced by the sympathetic nervous system in insulin resistance rats. Steroids 2022; 188:109132. [PMID: 36273542 DOI: 10.1016/j.steroids.2022.109132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 09/14/2022] [Accepted: 10/14/2022] [Indexed: 11/05/2022]
Abstract
Several studies have demonstrated that the underlying mechanism of insulin resistance (IR) is linked with developing diseases like diabetes mellitus, hypertension, metabolic syndrome, and polycystic ovary syndrome. In turn, the dysfunction of female gonadal hormones (especially 17β-estradiol) may be related to the development of IR complications since different studies have shown that 17β-estradiol has a cardioprotector and vasorelaxant effect. This study aimed was to determine the effect of the 17β-estradiol administration in insulin-resistant rats and its effects on cardiovascular responses in pithed rats. Thus, the vasopressor responses are induced by sympathetic stimulation or i.v. bolus injections of noradrenaline (α1/2), methoxamine (α1), and UK 14,304 (α2) adrenergic agonist were determined in female pithed rats with fructose-induced insulin resistance or control rats treated with: 1) 17β-estradiol or 2) its vehicle (oil) for 5 weeks. Thus, 17β-estradiol decreased heart rate, prevented the increase of blood pressure induced by ovariectomy, but with the opposite effect on sham-operated rats; and decreased vasopressor responses induced by i.v. bolus injections of noradrenaline on sham-operated (control and fructose group) and ovariectomized (control) rats, and those induced by i.v. bolus injections of methoxamine (α1 adrenergic agonist). Overall, these results suggest 17β-estradiol has a cardioprotective effect, and its effect on vasopressor responses could be mediated mainly by the α1 adrenergic receptor. In contrast, IR with ovariectomy 17β-estradiol decreases or loses its cardioprotector effect, this could suggest a possible link between the adrenergic receptors and the insulin pathway.
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Affiliation(s)
- Erika J Gutiérrez-Lara
- Departamento de Farmacobiología, Cinvestav Unidad Coapa, Czda. de los Tenorios 235, Col. Granjas-Coapa, Deleg. Tlalpan, C.P. 14330 México City, México
| | - Araceli Sánchez-López
- Departamento de Farmacobiología, Cinvestav Unidad Coapa, Czda. de los Tenorios 235, Col. Granjas-Coapa, Deleg. Tlalpan, C.P. 14330 México City, México
| | - Janet Murbartián
- Departamento de Farmacobiología, Cinvestav Unidad Coapa, Czda. de los Tenorios 235, Col. Granjas-Coapa, Deleg. Tlalpan, C.P. 14330 México City, México
| | - Selene J Acosta-Cota
- Departamento de Ciencias de la Salud, Universidad Autónoma de Occidente, Blv. Lola Beltrán y Blv. Rolando Arjona. S/N, Col. 4 de marzo, C.P. 80020 Culiacán, Sinaloa, México
| | - David Centurión
- Departamento de Farmacobiología, Cinvestav Unidad Coapa, Czda. de los Tenorios 235, Col. Granjas-Coapa, Deleg. Tlalpan, C.P. 14330 México City, México.
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Rababa’h AM, Matani BR, Yehya A. An update of polycystic ovary syndrome: causes and therapeutics options. Heliyon 2022; 8:e11010. [PMID: 36267367 PMCID: PMC9576888 DOI: 10.1016/j.heliyon.2022.e11010] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 06/19/2022] [Accepted: 10/05/2022] [Indexed: 11/06/2022] Open
Abstract
Polycystic ovary syndrome (PCOS) is a heterogeneous disorder characterized by menstrual irregularities, chronic anovulation, hirsutism, androgenic alopecia, and acne. At diagnosis, patients can with different manifestations according to the disease phenotype, patient’s age, and lifestyle. However, most patients pursue medical care because of the clinical symptoms of PCOS, such as hyperandrogenism, menstrual irregularities and infertility. Recent studies have shown that PCOS is associated with 80% of anovulatory infertility; however, the precise mechanism of PCOS-induced anovulation is still undetermined. The treatment strategies of PCOS are symptomatic depending mainly on the desired goals and clinical benefits. Life style intervention is still the first line treatment option for overweight females seeking pregnancy. In addition, there are many pharmacological agents that could be added to induce ovulation such as metformin, and clomiphene citrate. Nowadays, many patients preferred to use some herbal medicine that was proved to have potential therapeutic benefits in many studies in the management of PCOS. The purpose of this review was to discuss PCOS-induced infertility and the available therapeutic options as well as the impact of COVID-19 infection on the success of fertility attempts. To address this purpose, Pubmed, Scopus, EMBASE and Google databases were searched for studies discussing PCOS-induced infertility. The literature search revealed the proper therapeutic plans to treat PCOS-induced infertility, and that treatment should be modified according to patient’s complaints, reproductive desires, and disease phenotypes. In conclusion, the use of specific therapeutic agents and patients’ adherence to lifestyle interventions could help patients recover their reproductive and metabolic health.
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Affiliation(s)
- Abeer M. Rababa’h
- Department of Clinical Pharmacy; College of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
- Corresponding author.
| | - Bayan R. Matani
- Department of Clinical Pharmacy; College of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| | - Alaa Yehya
- Department of Department of Clinical Pharmacy and Pharmacy Practice Faculty of Pharmacy, Yarmouk University, Irbid, Jordan
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Pangath M, Unnikrishnan L, Throwba PH, Vasudevan K, Jayaraman S, Li M, Iyaswamy A, Palaniyandi K, Gnanasampanthapandian D. The Epigenetic Correlation among Ovarian Cancer, Endometriosis and PCOS: A Review. Crit Rev Oncol Hematol 2022; 180:103852. [DOI: 10.1016/j.critrevonc.2022.103852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 10/08/2022] [Accepted: 10/12/2022] [Indexed: 11/07/2022] Open
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Zhu M, Xu H, Jiang Y, Yu H, Liu Y. Epigallocatechin gallate inhibits SNARE-dependent membrane fusion by blocking trans-SNARE assembly. FEBS Open Bio 2022; 12:2111-2121. [PMID: 36111501 PMCID: PMC9714361 DOI: 10.1002/2211-5463.13488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 08/06/2022] [Accepted: 09/15/2022] [Indexed: 01/25/2023] Open
Abstract
Insulin secretion is a signal-triggered process that requires membrane fusion between the secretory granules and plasma membrane in pancreatic β cells. The exocytosis of insulin is mediated by target-soluble N-ethylmaleimide sensitive factor attachment protein receptors (SNAREs) on the plasma membrane and vesicle-SNAREs on the vesicles, which assemble into a quaternary trans-SNARE complex to initiate the fusion. Expression of fusion proteins is reduced in the islets of patients with type II diabetes, indicating that SNARE-mediated fusion defect is closely related to insulin-based metabolic diseases. Previous studies have suggested that epigallocatechin gallate (EGCG) has an inhibitory effect on membrane fusion. In the present study, we performed in vitro reconstitution assays to unravel the molecular mechanisms of EGCG in SNARE-mediated insulin secretory vesicle fusion. Our data show that EGCG efficiently inhibits insulin secretory SNARE-mediated membrane fusion. Mechanistic studies indicated that EGCG blocks the formation of the trans-SNARE complex. Furthermore, calcium/synaptotagmin-7-stimulated fusion kinetics were largely reduced by EGCG, confirming that it is a potential regulator of SNARE-dependent insulin secretion. Our findings suggest that the trans-SNARE complex might be a promising target for controlling SNARE-dependent vesicle fusion.
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Affiliation(s)
- Min Zhu
- Jiangsu Key Laboratory for Molecular and Medical Biotechnology, College of Life SciencesNanjing Normal UniversityChina
| | - Han Xu
- Jiangsu Key Laboratory for Molecular and Medical Biotechnology, College of Life SciencesNanjing Normal UniversityChina
| | - Yuting Jiang
- Jiangsu Key Laboratory for Molecular and Medical Biotechnology, College of Life SciencesNanjing Normal UniversityChina
| | - Haijia Yu
- Jiangsu Key Laboratory for Molecular and Medical Biotechnology, College of Life SciencesNanjing Normal UniversityChina
| | - Yinghui Liu
- Jiangsu Key Laboratory for Molecular and Medical Biotechnology, College of Life SciencesNanjing Normal UniversityChina
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Wang Y, Xiao H, Liu Y, Tong Q, Yu Y, Qi B, Bu X, Pan T, Xing Y. Effects of Bu Shen Hua Zhuo formula on the LPS/TLR4 pathway and gut microbiota in rats with letrozole-induced polycystic ovary syndrome. Front Endocrinol (Lausanne) 2022; 13:891297. [PMID: 36017323 PMCID: PMC9396283 DOI: 10.3389/fendo.2022.891297] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 07/05/2022] [Indexed: 12/04/2022] Open
Abstract
Polycystic ovary syndrome (PCOS) is one of the most common endocrine disorders in gynecology. Traditional Chinese medicine (TCM) is widely used for the treatment of PCOS in China. The Bu Shen Hua Zhuo formula (BSHZF), a TCM decoction, has shown great therapeutic efficacy in clinical practice. However, the mechanism underlying the BSHZF function in PCOS remains unclear. This study aimed to identify the potential mechanisms of action of BSHZF in the treatment of PCOS. PCOS-model rats treated with letrozole were administered different doses of BSHZF, metformin, and 1% carboxymethylcellulose. Serum sex hormones, fasting blood glucose, and fasting insulin levels were measured, and the morphology of the ovaries was observed in each group, including the normal group. The structure and abundance of the gut microbiota in rats were measured using 16S ribosomal RNA gene sequencing. Toll-like receptor 4 (TLR4) and phospho-NF-κB p65 levels in the ovarian tissue of the rats were detected using Western blotting. Furthermore, the levels of lipopolysaccharide (LPS) and inflammatory cytokines TNF-α, IL-6, and IL-8 in the serum of rats were detected by ELISA. The results showed that BSHZF administration was associated with a decrease in body weight, fasting blood glucose, fasting insulin, and testosterone and changes in ovarian morphology in PCOS-model rats. Moreover, BSHZF was associated with an increase in the α-diversity of gut microbiota, decrease in the relative abundance of Firmicutes, and increase in Lactobacillus and short chain fatty acid-producing bacteria (Allobaculum, Bacteroides, Ruminococcaceae_UCG-014). Furthermore, BSHZF may promote carbohydrate and protein metabolism. In addition, BSHZF was associated with a decrease in the serum level of LPS and TLR4 expression, thereby inhibiting the activation of the NF-κB signaling-mediated inflammatory response in ovarian tissue. Therefore, the beneficial effects of BSHZF on PCOS pathogenesis are associated with its ability to normalize gut microbiota function and inhibit PCOS-related inflammation.
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Affiliation(s)
- Yang Wang
- Department of Gynecology, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Hui Xiao
- Graduate School, Beijing University of Chinese Medicine, Beijing, China
| | - Yanxia Liu
- Department of Gynecology, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Qing Tong
- Department of Gynecology, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Yanyan Yu
- Department of Gynecology, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Bing Qi
- Department of Gynecology, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Xiaoling Bu
- Department of Gynecology, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Tianyuan Pan
- Department of General Medicine, The First Affiliated Hospital, School of Medicine, Zhejiang University, Zhejiang, China
| | - Yu Xing
- Department of Gynecology, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, China
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Guo X, Okpara ES, Hu W, Yan C, Wang Y, Liang Q, Chiang JYL, Han S. Interactive Relationships between Intestinal Flora and Bile Acids. Int J Mol Sci 2022; 23:8343. [PMID: 35955473 PMCID: PMC9368770 DOI: 10.3390/ijms23158343] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 07/25/2022] [Accepted: 07/25/2022] [Indexed: 02/01/2023] Open
Abstract
The digestive tract is replete with complex and diverse microbial communities that are important for the regulation of multiple pathophysiological processes in humans and animals, particularly those involved in the maintenance of intestinal homeostasis, immunity, inflammation, and tumorigenesis. The diversity of bile acids is a result of the joint efforts of host and intestinal microflora. There is a bidirectional relationship between the microbial community of the intestinal tract and bile acids in that, while the microbial flora tightly modulates the metabolism and synthesis of bile acids, the bile acid pool and composition affect the diversity and the homeostasis of the intestinal flora. Homeostatic imbalances of bile acid and intestinal flora systems may lead to the development of a variety of diseases, such as inflammatory bowel disease (IBD), colorectal cancer (CRC), hepatocellular carcinoma (HCC), type 2 diabetes (T2DM), and polycystic ovary syndrome (PCOS). The interactions between bile acids and intestinal flora may be (in)directly involved in the pathogenesis of these diseases.
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Affiliation(s)
- Xiaohua Guo
- Department of Hepatobiliary Surgery, Anhui Province Key Laboratory of Hepatopancreatobiliary Surgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230001, China; (X.G.); (E.S.O.); (C.Y.)
| | - Edozie Samuel Okpara
- Department of Hepatobiliary Surgery, Anhui Province Key Laboratory of Hepatopancreatobiliary Surgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230001, China; (X.G.); (E.S.O.); (C.Y.)
| | - Wanting Hu
- MOE Key Laboratory of Bioorganic Phosphorus Chemistry & Chemical Biology, Beijing Key Lab of Microanalytical Methods & Instrumentation, Center for Synthetic and Systems Biology, Department of Chemistry, Tsinghua University, Beijing 100084, China; (W.H.); (Y.W.); (Q.L.)
| | - Chuyun Yan
- Department of Hepatobiliary Surgery, Anhui Province Key Laboratory of Hepatopancreatobiliary Surgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230001, China; (X.G.); (E.S.O.); (C.Y.)
| | - Yu Wang
- MOE Key Laboratory of Bioorganic Phosphorus Chemistry & Chemical Biology, Beijing Key Lab of Microanalytical Methods & Instrumentation, Center for Synthetic and Systems Biology, Department of Chemistry, Tsinghua University, Beijing 100084, China; (W.H.); (Y.W.); (Q.L.)
| | - Qionglin Liang
- MOE Key Laboratory of Bioorganic Phosphorus Chemistry & Chemical Biology, Beijing Key Lab of Microanalytical Methods & Instrumentation, Center for Synthetic and Systems Biology, Department of Chemistry, Tsinghua University, Beijing 100084, China; (W.H.); (Y.W.); (Q.L.)
| | - John Y. L. Chiang
- Department of Integrative Medical Sciences, Northeast Ohio Medical University, Rootstown, OH 44272, USA
| | - Shuxin Han
- Department of Hepatobiliary Surgery, Anhui Province Key Laboratory of Hepatopancreatobiliary Surgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230001, China; (X.G.); (E.S.O.); (C.Y.)
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Abstract
The results of epidemiological studies involving n-3 PUFA and polycystic ovary syndrome (PCOS) are scarce. This matched case-control study assessed the associations between n-3 PUFA and PCOS prevalence in 325 pairs of PCOS cases and healthy controls. Dietary information was assessed using a 102-item FFQ. Fatty acids in serum phospholipids were measured with a GC method. We found that n-3 PUFA in serum phospholipids were inversely associated with PCOS prevalence, including total, long-chain and individual PUFA (e.g. docosapentaenoic acid (DPA), EPA and DHA). Compared with the lowest tertile (T1), the adjusted OR and their 95% CI for the highest tertile (T3) were 0·63 (0·40, 0·93) for total n-3 PUFA, 0·60 (0·38, 0·92) for long-chain n-3 PUFA, 0·68 (0·45, 1·01) for DHA, 0·70 (0·45, 1·05) for EPA and 0·72 (0·45, 1·08) for DPA. For dietary intake of n-3 PUFA, significant inverse associations were found only for long-chain n-3 PUFA (Ptrend = 0·001), EPA (Ptrend = 0·047) and DHA (Ptrend = 0·030). Both dietary and serum n-3 PUFA, mainly EPA and DPA, were negatively correlated with PCOS-related parameters, such as BMI, fasting insulin, total testosterone and high-sensitivity C-reactive protein, but positively correlated with follicle-stimulating hormone and sex hormone-binding globulin. These results indicated inverse associations between n-3 PUFA, especially long-chain n-3 PUFA, and PCOS prevalence. Higher intakes of n-3 PUFA might be considered a protective factor for PCOS among Chinese females.
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Al-Nimer MSM. Concomitant dysregulation of androgen secretion and dysfunction of adipose tissue induced insulin resistance. World J Diabetes 2022; 13:417-419. [PMID: 35664546 PMCID: PMC9134025 DOI: 10.4239/wjd.v13.i5.417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 09/07/2021] [Accepted: 04/26/2022] [Indexed: 02/06/2023] Open
Abstract
Hyperandrogenism and hyperinsulinemia have resulted from dysfunction of the theca cell of the ovary and adipose tissue and each one potentiates the other in patients with androgen excess disorders e.g., polycystic ovary disease and idiopathic hirsutism. Possible external and/or internal triggers can produce such cellular dysfunction. There is evidence that sodium valproate acts as a trigger of cellular dysfunction and produces both hyperinsulinemia and hyperandrogenism. Therefore, the elimination of these triggers can help the patients to recover from hyperinsulinemia, insulin resistance and hyperandrogenism.
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Affiliation(s)
- Marwan SM Al-Nimer
- Department of Clinical Pharmacology and Therapeutics, College of Medicine, University of Diyala, Baqubah 32001, Diyala, Iraq
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The Effects of Letrozole and Metformin Combined with Targeted Nursing Care on Ovarian Function, LH, and FSH in Infertile Patients with Polycystic Ovary Syndrome. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:3712166. [PMID: 35368950 PMCID: PMC8967508 DOI: 10.1155/2022/3712166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 03/03/2022] [Accepted: 03/09/2022] [Indexed: 11/18/2022]
Abstract
Background Polycystic ovary syndrome (PCOS) is a common gynecological endocrine disorder in women of gestational age and the most common cause of female infertility. This study aimed to investigate the effect of letrozole and metformin combined with targeted nursing on ovarian function, LH, and FSH in infertile patients with PCOS. Methods A total of 72 infertile patients with PCOS were divided into the control group and combined group. The control group was given metformin tablets combined with targeted nursing therapy. The combined group was treated with letrozole on the basis of the control group. Ovarian function, LH, and FSH were compared between the two groups before and after treatment. Results After treatment, the total effective rate (94.44%) of the combined group was significantly higher than that of the control group (80.56%). After treatment, the levels of HbA1c, FINS, HOMA-IR, TG, and TC in the two groups were lower than those before treatment, and the HDL-C level was higher than that before treatment. The full-term delivery rate, ovulation rate, and normal menstrual rate in the combined group were higher than those in the control group. After treatment, the LH level in the combined group was lower than that in the control group, and the FSH level was higher than that in the control group. After 1 month, 3 months, and 5 months of treatment, RI, PI, and ovarian volume were decreased, and the endometrial thickness was increased in both groups. Also, after 5 months of treatment, the RI, PI, and ovarian volume in the combined group were significantly lower than those in the control group, and the endometrial thickness was significantly higher than that in the control group. There was no statistically significant difference in the incidence of adverse reactions between the two groups. Conclusion The combination of letrozole and metformin with targeted nursing in the treatment of infertility patients with PCOS has better clinical effect and high safety. It can improve endometrial receptivity and ovarian reserve function and regulate LH and FSH levels.
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A. Swathi, Vijayalakshmi, Reddy Y. Effect of Metformin therapy on lipid profile in obese and non-obese women with polycystic ovarian syndrome (PCOS). Biomedicine (Taipei) 2022. [DOI: 10.51248/.v42i1.875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Introduction and Aim: Polycystic ovarian syndrome (PCOS) is the most common endocrine condition affecting the reproductive system in women. It is characterized by obesity, irregular menstruation, anovulation, hirsutism, insulin resistance, and dyslipidemia. Metformin, an oral anti-diabetic drug is known to stabilize metabolic disturbances caused by PCOS. This study aims to determine the effect of metformin therapy on lipid profile in obese and non-obese women with polycystic ovarian syndrome.
Materials and Methods: It is a prospective, clinical, interventional study, participated by sixty women aged between 13 to 45 years, suffering with PCOS, who are attending the gynecology outpatient department at SVS medical college and hospital, from a year. The subjects were divided into two groups, Group-1 (Obese women) and Group-2 (non-obese women) and received the anti-diabetic drug, Metformin orally with doses of 500mg/day for a year. Approval of our study was done by Ethical Institutional Board. Demographic parameters age, BMI, and lipid profile including High-Density Lipoprotein (HDL), Low-Density Lipoprotein (LDL), Triglycerides (TAG), & Total Cholesterol (TC) were assessed. SPSS was applied for data analysis and p<0.001 was considered statistically significant.
Results: A combined group study of obese and non-obese women subjects showed a BMI decrease in non-obese subjects at 6 months by Metformin therapy. HDL levels increased in non-obese women subjects with a statistical significance. LDL and TAG levels remained unchanged at 6 months by Metformin therapy in both groups. Total cholesterol levels were high in non-obese women and were decreased in the obese women group after Metformin treatment, this metformin therapy could be useful in controlling the metabolic disturbances in non-obese women suffering from PCOS.
Conclusion: Metformin has an optimistic physiological effect on the BMI & lipid profile of women suffering from PCOS, hence can help control metabolic disturbances.
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Shahid R, Iahtisham-Ul-Haq, Mahnoor, Awan KA, Iqbal MJ, Munir H, Saeed I. Diet and lifestyle modifications for effective management of polycystic ovarian syndrome (PCOS). J Food Biochem 2022; 46:e14117. [PMID: 35199348 DOI: 10.1111/jfbc.14117] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 01/25/2022] [Accepted: 01/30/2022] [Indexed: 11/28/2022]
Abstract
Polycystic ovarian syndrome (PCOS) is caused by abnormal production of androgens resulting in the formation of small fluid-filled sacs in the ovaries. This condition worsens the life quality of women by disturbing their physiology and psychology in reproductive age. PCOS may also be associated with other morbidities like diabetes and hypertension. Numerous factors like imbalanced dietary patterns, poor lifestyle activities, improper care and medication, late diagnosis, and ignorance are involved in the prevalence of this disease in women. Hence, an early diagnosis and improved dietary and lifestyle management may improve the life quality and timely recovery of the patient from this disease. Various herbal extracts show a positive correlation in reducing the indicators associated with PCOS. This review discusses the effect of dietary and lifestyle practices on PCOS as prominent features. It has been recommended that a balanced diet with 40% energy from carbohydrates, 30% from fats, and 30% from protein with optimum physical activity could reduce severe PCOS symptoms and improve metabolic balance. Furthermore, recommendations for modification of diet and lifestyle activities are made which may positively influence the recovery from PCOS. PRACTICAL APPLICATIONS: Polycystic ovarian syndrome (PCOS) severely affects the life quality of suffering women. The dietary patterns, lifestyle activities, and co-medical conditions collectively affect the severity and related consequences of PCOS. This article provides sufficient information on dietary and lifestyle modifications to effectively manage this disease. Furthermore, dietitians, nutritionists, gynecologists, and obstetrics physicians can benefit from the information provided in it to understand and develop the management strategies to alleviate the disease symptoms and severity.
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Affiliation(s)
- Rimsha Shahid
- University Institute of Diet and Nutritional Sciences, Faculty of Allied Health Sciences, University of Lahore, Lahore, Pakistan
| | - Iahtisham-Ul-Haq
- Kauser Abdulla Malik School of Life Sciences, Forman Christian College (A Charted University), Lahore, Pakistan
| | - Mahnoor
- University Institute of Diet and Nutritional Sciences, Faculty of Allied Health Sciences, University of Lahore, Lahore, Pakistan
| | - Kanza Aziz Awan
- Department of Food Science and Technology, Faculty of Life Sciences, University of Central Punjab, Lahore, Pakistan
| | - Muhammad Jawad Iqbal
- Department of Food Science and Technology, Faculty of Allied Health Sciences, Minhaj University, Lahore, Pakistan
| | - Hussan Munir
- University Institute of Diet and Nutritional Sciences, Faculty of Allied Health Sciences, University of Lahore, Lahore, Pakistan
| | - Iqra Saeed
- Department of Food Science and Technology, Faculty of Allied Health Sciences, Minhaj University, Lahore, Pakistan
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48
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Cianci A, Vitale SG. D-Chiro-inositol and PCOS: between myth and reality. The never-ending story. Int J Food Sci Nutr 2022; 73:565-570. [DOI: 10.1080/09637486.2022.2029830] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Antonio Cianci
- Obstetrics and Gynecology Unit, Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy
| | - Salvatore Giovanni Vitale
- Obstetrics and Gynecology Unit, Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy
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Sadeghi HM, Adeli I, Calina D, Docea AO, Mousavi T, Daniali M, Nikfar S, Tsatsakis A, Abdollahi M. Polycystic Ovary Syndrome: A Comprehensive Review of Pathogenesis, Management, and Drug Repurposing. Int J Mol Sci 2022; 23:ijms23020583. [PMID: 35054768 PMCID: PMC8775814 DOI: 10.3390/ijms23020583] [Citation(s) in RCA: 92] [Impact Index Per Article: 46.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 12/30/2021] [Accepted: 12/31/2021] [Indexed: 12/12/2022] Open
Abstract
Polycystic ovary syndrome (PCOS) is an endocrine-gynecology disorder affecting many women of childbearing age. Although a part of the involved mechanism in PCOS occurrence is discovered, the exact etiology and pathophysiology are not comprehensively understood yet. We searched PubMed for PCOS pathogenesis and management in this article and ClinicalTrials.gov for information on repurposed medications. All responsible factors behind PCOS were thoroughly evaluated. Furthermore, the complete information on PCOS commonly prescribed and repurposed medications is summarized through tables. Epigenetics, environmental toxicants, stress, diet as external factors, insulin resistance, hyperandrogenism, inflammation, oxidative stress, and obesity as internal factors were investigated. Lifestyle modifications and complementary and alternative medicines are preferred first-line therapy in many cases. Medications, including 3-hydroxy-3-methyl-3-glutaryl-coenzyme A (HMG-CoA) reductase inhibitors, thiazolidinediones, sodium-glucose cotransporter-2 inhibitors, dipeptidyl peptidase-4 inhibitors, glucose-like peptide-1 receptor agonists, mucolytic agents, and some supplements have supporting data for being repurposed in PCOS. Since there are few completed clinical trials with a low population and mostly without results on PCOS repurposed medications, it would be helpful to do further research and run well-designed clinical trials on this subject. Moreover, understanding more about PCOS would be beneficial to find new medications implying the effect via the novel discovered routes.
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Affiliation(s)
- Hosna Mohammad Sadeghi
- Toxicology and Diseases Group (TDG), Pharmaceutical Sciences Research Center (PSRC), The Institute of Pharmaceutical Sciences (TIPS), Tehran University of Medical Sciences, Tehran 11369, Iran; (H.M.S.); (I.A.); (T.M.); (M.D.)
- Department of Toxicology and Pharmacology, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran 11369, Iran
| | - Ida Adeli
- Toxicology and Diseases Group (TDG), Pharmaceutical Sciences Research Center (PSRC), The Institute of Pharmaceutical Sciences (TIPS), Tehran University of Medical Sciences, Tehran 11369, Iran; (H.M.S.); (I.A.); (T.M.); (M.D.)
- Department of Toxicology and Pharmacology, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran 11369, Iran
| | - Daniela Calina
- Department of Clinical Pharmacy, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
- Correspondence: (D.C.); (M.A.)
| | - Anca Oana Docea
- Department of Toxicology, Faculty of Pharmacy, University of Medicine and Pharmacy, Petru Rares, 200349 Craiova, Romania;
| | - Taraneh Mousavi
- Toxicology and Diseases Group (TDG), Pharmaceutical Sciences Research Center (PSRC), The Institute of Pharmaceutical Sciences (TIPS), Tehran University of Medical Sciences, Tehran 11369, Iran; (H.M.S.); (I.A.); (T.M.); (M.D.)
- Department of Toxicology and Pharmacology, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran 11369, Iran
| | - Marzieh Daniali
- Toxicology and Diseases Group (TDG), Pharmaceutical Sciences Research Center (PSRC), The Institute of Pharmaceutical Sciences (TIPS), Tehran University of Medical Sciences, Tehran 11369, Iran; (H.M.S.); (I.A.); (T.M.); (M.D.)
- Department of Toxicology and Pharmacology, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran 11369, Iran
| | - Shekoufeh Nikfar
- Department of Pharmacoeconomics and Pharmaceutical Administration, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran 11369, Iran;
- Personalized Medicine Research Center, Endocrinology and Metabolism Research Institute, Tehran University of Medical Sciences, Tehran 11369, Iran
- Evidence-Based Evaluation of Cost-Effectiveness and Clinical Outcomes Group, Pharmaceutical Sciences Research Center (PSRC), The Institute of Pharmaceutical Sciences (TIPS), Tehran University of Medical Sciences, Tehran 11369, Iran
| | - Aristidis Tsatsakis
- Department of Analytical and Forensic Medical Toxicology, Sechenov University, 119991 Moscow, Russia;
- Department of Forensic Sciences and Toxicology, Faculty of Medicine, University of Crete, 71003 Heraklion, Greece
- Laboratory of Toxicology, Medical School, University of Crete, 70013 Heraklion, Greece
| | - Mohammad Abdollahi
- Toxicology and Diseases Group (TDG), Pharmaceutical Sciences Research Center (PSRC), The Institute of Pharmaceutical Sciences (TIPS), Tehran University of Medical Sciences, Tehran 11369, Iran; (H.M.S.); (I.A.); (T.M.); (M.D.)
- Department of Toxicology and Pharmacology, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran 11369, Iran
- Correspondence: (D.C.); (M.A.)
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Zheng Y, Yin G, Chen F, Lin L, Chen Y. Evaluation of Triglyceride Glucose Index and Homeostasis Model of Insulin Resistance in Patients with Polycystic Ovary Syndrome. Int J Womens Health 2022; 14:1821-1829. [PMID: 36582617 PMCID: PMC9793723 DOI: 10.2147/ijwh.s387942] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 12/13/2022] [Indexed: 12/25/2022] Open
Abstract
PURPOSE To use the triglyceride glucose (TyG) index to evaluate insulin resistance (IR) in patients with polycystic ovary syndrome (PCOS) and to explore alternative indicators for early identification of IR. PATIENTS AND METHODS This study included 114 patients with PCOS and 61 healthy volunteers. Pearson or Spearman correlations were calculated to compare the association between the TyG index and triglyceride glucose body mass index (TyG-BMI) with homeostatic model assessment for IR (HOMA-IR), homeostasis model assessment for β-cell function (HOMA-β), quantitative insulin sensitivity check index (QUICKI), and fasting glucose-to-insulin ratio (FG-IR). The receiver operating characteristic (ROC) curve was used to evaluate the sensitivity and specificity of the TyG index and TyG-BMI in identifying IR (defined as HOMA-IR ≥2.5) in patients with PCOS. RESULTS Correlation analyses revealed that the TyG index of the PCOS group was positively correlated with HOMA-IR (r=0.515, P<0.01) and HOMA-β (r=0.348, P<0.01), but negatively correlated with QUICKI (r=-0.532, P<0.01) and FG-IR (r=-0.394, P<0.01). The ROC curve of IR defined by HOMA-IR showed that the AUC value of TyG-BMI was the highest, at 0.796 (95% confidence interval (CI): 0.710-0.866, P<0.001) when the cut-off point was 191.53, with 85.3% sensitivity and 73.9% specificity values. For the TyG index, the AUC was 0.781 (95% CI: 0.693-0.853, P<0.001) when 8.51 was the cut-off point, with a sensitivity of 63.2% and specificity of 87.0%. CONCLUSION This study found that the TyG index and TyG-BMI performed better than traditional lipid ratios, such as triglycerides/high density lipoprotein cholesterol (TG/HDL-C), in predicting IR and may be used as markers of IR in Chinese patients with PCOS.
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Affiliation(s)
- Yitong Zheng
- Department of Endocrinology and Metabolism, The First Affiliated Hospital of Shantou University Medical College, Shantou, People’s Republic of China
| | - Guoshu Yin
- Department of Endocrinology and Metabolism, The First Affiliated Hospital of Shantou University Medical College, Shantou, People’s Republic of China
| | - Fu Chen
- Department of Nutrition, The First Affiliated Hospital of Shantou University Medical College, Shantou, People’s Republic of China
| | - Ling Lin
- Department of Rheumatology and Immunology, The First Affiliated Hospital of Shantou University Medical College, Shantou, People’s Republic of China
- Department of Rheumatology, Shantou University Medical College, Shantou, People’s Republic of China
- Correspondence: Ling Lin, Department of Rheumatology and Immunology, The First Affiliated Hospital of Shantou University Medical College, Shantou, People’s Republic of China, Tel +86-0754-88258290, Fax +86-0754-88259850, Email
| | - Yongsong Chen
- Department of Endocrinology and Metabolism, The First Affiliated Hospital of Shantou University Medical College, Shantou, People’s Republic of China
- Yongsong Chen, Department of Endocrinology and Metabolism, The First Affiliated Hospital of Shantou University Medical College, Shantou, People’s Republic of China, Tel +86-0754-88258290, Fax +86-0754-88259850, Email
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