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Li X, Lin S, Yang X, Chen C, Cao S, Zhang Q, Ma J, Zhu G, Zhang Q, Fang Q, Zheng C, Liang W, Wu X. When IGF-1 Meets Metabolic Inflammation and Polycystic Ovary Syndrome. Int Immunopharmacol 2024; 138:112529. [PMID: 38941670 DOI: 10.1016/j.intimp.2024.112529] [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: 04/12/2024] [Revised: 06/09/2024] [Accepted: 06/17/2024] [Indexed: 06/30/2024]
Abstract
Polycystic ovary syndrome (PCOS) is a prevalent endocrine disorder associated with insulin resistance (IR) and hyperandrogenaemia (HA). Metabolic inflammation (MI), characterized by a chronic low-grade inflammatory state, is intimately linked with chronic metabolic diseases such as IR and diabetes and is also considered an essential factor in the development of PCOS. Insulin-like growth factor 1 (IGF-1) plays an essential role in PCOS pathogenesis through its multiple functions in regulating cell proliferation metabolic processes and reducing inflammatory responses. This review summarizes the molecular mechanisms by which IGF-1, via MI, participates in the onset and progression of PCOS, aiming to provide insights for studies and clinical treatment of PCOS.
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Affiliation(s)
- Xiushen Li
- Shenzhen University Medical School, Shenzhen University, Shenzhen, Guangdong, China; Department of Obstetrics and Gynecology, Shenzhen University General Hospital, Shenzhen, Guangdong, China; Department of Traditional Chinese Medicine, Jiangxi Provincial Maternal and Child Health Hospital, Nanchang, Jiangxi, China
| | - Sailing Lin
- Shenzhen University Medical School, Shenzhen University, Shenzhen, Guangdong, China; Department of Obstetrics and Gynecology, Shenzhen University General Hospital, Shenzhen, Guangdong, China
| | - Xiaolu Yang
- Shenzhen University Medical School, Shenzhen University, Shenzhen, Guangdong, China; Department of Obstetrics and Gynecology, Shenzhen University General Hospital, Shenzhen, Guangdong, China
| | - Can Chen
- Shenzhen University Medical School, Shenzhen University, Shenzhen, Guangdong, China; Department of Obstetrics and Gynecology, Shenzhen University General Hospital, Shenzhen, Guangdong, China
| | - Shu Cao
- Xin'an Academy, Anhui University of Chinese Medicine, Hefei, Anhui, China
| | - Qi Zhang
- Shenzhen University Medical School, Shenzhen University, Shenzhen, Guangdong, China; Department of Obstetrics and Gynecology, Shenzhen University General Hospital, Shenzhen, Guangdong, China
| | - Jingxin Ma
- Shenzhen University Medical School, Shenzhen University, Shenzhen, Guangdong, China; Department of Obstetrics and Gynecology, Shenzhen University General Hospital, Shenzhen, Guangdong, China
| | - Guli Zhu
- Shenzhen University Medical School, Shenzhen University, Shenzhen, Guangdong, China; Department of Obstetrics and Gynecology, Shenzhen University General Hospital, Shenzhen, Guangdong, China
| | - Qi Zhang
- Shenzhen University Medical School, Shenzhen University, Shenzhen, Guangdong, China; Department of Obstetrics and Gynecology, Shenzhen University General Hospital, Shenzhen, Guangdong, China
| | - Qiongfang Fang
- Shenzhen University Medical School, Shenzhen University, Shenzhen, Guangdong, China; Department of Obstetrics and Gynecology, Shenzhen University General Hospital, Shenzhen, Guangdong, China
| | - Chunfu Zheng
- Department of Microbiology, Immunology and Infectious Diseases, University of Calgary, Calgary, Alberta, Canada.
| | - Weizheng Liang
- Central Laboratory, The First Affiliated Hospital of Hebei North University, Zhangjiakou, Hebei, China.
| | - Xueqing Wu
- Shenzhen University Medical School, Shenzhen University, Shenzhen, Guangdong, China; Department of Obstetrics and Gynecology, Shenzhen University General Hospital, Shenzhen, Guangdong, China.
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Myers SH, Montanino Oliva M, Nordio M, Unfer V. PCOS phenotype focus: phenotype D under the magnifying glass. Arch Gynecol Obstet 2024; 309:2307-2313. [PMID: 38502188 DOI: 10.1007/s00404-024-07408-2] [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: 10/20/2023] [Accepted: 01/29/2024] [Indexed: 03/21/2024]
Abstract
Polycystic ovary syndrome (PCOS) is defined as the combination of polycystic morphology, hyperandrogenism, and ovulatory disruption; this heterogeneity presents a conundrum for the medical community. The Rotterdam criteria have governed the diagnosis of PCOS, separating the patient cohort into four distinct phenotypes. It has been suggested that the lone normoandrogenic phenotype, so-called phenotype D, should not be classified as a PCOS subtype, with phenotypes A, B, and C displaying a hyperandrogenic biochemical and clinical profile thought to be characteristic of PCOS. To understand how to treat phenotype D patients, this review shines a spotlight on the phenotype, gathering various reports of how phenotype D is differentiated from the other PCOS phenotypes.
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Affiliation(s)
| | - Mario Montanino Oliva
- The Experts Group On Inositol in Basic and Clinical Research (EGOI), 00161, Rome, Italy
- Department of Obstetrics and Gynecology, Santo Spirito Hospital, 00193, Rome, Italy
| | - Maurizio Nordio
- The Experts Group On Inositol in Basic and Clinical Research (EGOI), 00161, Rome, Italy
- A.S.L. RMF, Civitavecchia, Italy
| | - Vittorio Unfer
- The Experts Group On Inositol in Basic and Clinical Research (EGOI), 00161, Rome, Italy.
- UniCamillus-Saint Camillus International University of Health Sciences, 00156, Rome, Italy.
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Md Muslim MZ, Mohammed Jelani A, Shafii N, Yaacob NM, Che Soh NAA, Ibrahim HA. Correlation between anti-mullerian hormone with insulin resistance in polycystic ovarian syndrome: a systematic review and meta-analysis. J Ovarian Res 2024; 17:106. [PMID: 38762718 PMCID: PMC11102133 DOI: 10.1186/s13048-024-01436-x] [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: 07/30/2023] [Accepted: 05/09/2024] [Indexed: 05/20/2024] Open
Abstract
BACKGROUND Epidemiological studies regarding the correlation between anti-Müllerian hormone (AMH) and insulin resistance (IR) in polycystic ovarian syndrome (PCOS) remain inconsistent. The primary aim of this study was to determine the correlations between AMH and IR in patients with PCOS and to explore the selected factors that influence the correlations. METHODS We conducted systemic searches of online databases (PubMed, Science Direct, Taylor and Francis, Scopus, and ProQuest) from inception to December 20, 2023 and manual searches of the associated bibliographies to identify relevant studies. We then performed subgroup and sensitivity analyses to explore the sources of heterogeneity, followed by a publication bias risk assessment of the included studies using the Joanna Briggs Institute critical appraisal tool. We used a random-effects model to estimate the pooled correlations between AMH and the homeostatic model assessment for insulin resistance (HOMA-IR) in patients with polycystic ovarian syndrome (PCOS). RESULTS Of the 4835 articles identified, 22 eligible relevant studies from three regions were included and identified as low risk of bias. The random-effects pooled correlation estimate was 0.089 (95% confidence interval [CI]: -0.040, 0.215), with substantial heterogeneity (I2 = 87%; τ2 = 0.0475, p < .001). Subgroup analyses showed that the study region did not influence the correlation estimates, and sensitivity analysis showed no significant alteration in the pooled correlation estimate or 95% CI values. No publication bias was observed. CONCLUSION There was a weak, statistically insignificant correlation between AMH and HOMA-IR in patients with PCOS. The correlation estimates did not vary according to the study participants' regions.
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Affiliation(s)
- Mohd Zakwan Md Muslim
- Department of Chemical Pathology, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kelantan, 16150, Malaysia
| | - Aniza Mohammed Jelani
- Department of Chemical Pathology, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kelantan, 16150, Malaysia.
| | - Noorazliyana Shafii
- Department of Chemical Pathology, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kelantan, 16150, Malaysia
| | - Najib Majdi Yaacob
- Unit of Biostatistics and Research Methodology, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kelantan, 16150, Malaysia
| | - Noor Azlin Azraini Che Soh
- Department of Chemical Pathology, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kelantan, 16150, Malaysia
| | - Hanim Afzan Ibrahim
- School of Dental Sciences, Health Campus, Universiti Sains Malaysia, Kelantan, 16150, Malaysia
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Tatarchuk T, Pedachenko N, Kosei N, Malysheva I, Snizhko T, Kozub T, Zolotarevska O, Kosianenko S, Tutchenko T. Distribution and anthropometric characteristics of Rotterdam criteria-based phenotypic forms of Polycystic ovaries syndrome in Ukraine. Eur J Obstet Gynecol Reprod Biol 2024; 295:104-110. [PMID: 38354601 DOI: 10.1016/j.ejogrb.2024.02.011] [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: 10/28/2023] [Revised: 01/30/2024] [Accepted: 02/07/2024] [Indexed: 02/16/2024]
Abstract
OBJECTIVE To explore the distribution of Rotterdam-based PCOS phenotypes and their associations with anthropometric parameters predictive of cardiometabolic risks in Ukrainian referral PCOS women. STUDY DESIGN It was a cross-sectional study conducted by the Ukrainian Society of Gynecological Endocrinology between September 2021 and January 2022 involving 42 clinics in 10 regional centres representing the major geographical parts of Ukraine. Two hundred obstetrician-gynecologists whose practice facilities corresponded to study criteria were committed to entering records of their PCOS patients aged 20-45 years into the uniform data collection forms. The recorded parameters were: PCOS phenotype with the mandatory assessment of biochemical hyperandrogenism, age, BMI, waist circumference, and hyperandrogenism symptoms. RESULTS 5254 patients' records were completed. Phenotype A was the most prevalent - 47.7 %, phenotypes B, C, and D were almost equally distributed in the studied population: 17.6 %, 17.4 %, and 17.3 % respectively. The total prevalence of androgenic phenotypes based on the presence of biochemical hyperandrogenism was 82.7 %. The incidence of obesity and hyperandrogenism symptoms, and mean BMI values were higher in phenotypes A and B compared to C and D. At the same time, the presence of 34.1 % and 46.2 % of normal-weight subjects in phenotypes A and B respectively, supports the fact that the excessive BMI is not a universal characteristic of androgenic phenotypes. In younger age groups, phenotypes C and D demonstrated the predominance of normal weight, but in older subgroups, the situation changed: in the age group of 36-45 y.o. compared to 18-25 y.o., the percentage of overweight and obese subjects for the non-classic phenotypes increased more than for the classic ones: C (OR = 3.91, 95 % CI: 2.41-6.38), D (OR = 4.14, 95 % CI: 2.64-6.52), A (OR = 2.30, 95 % CI:1.72-2.08), and B (OR = 2.56, 95 % CI:1.69-3.89). CONCLUSIONS In thoroughly assessed Ukrainian referral PCOS population the classic phenotypes prevailed as in other clinical cohorts. The classic phenotypes were characterized by the higher rate of adiposity and severity of clinical hyperandrogenism. At the same time, obese, overweight, and normal-weight subjects were present in all phenotypes, and the risk of obesity in non-classic phenotypes was higher in older age groups.
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Affiliation(s)
- Tetiana Tatarchuk
- Endocrine Gynecology Department, Institute of Pediatrics, Obstetrics and Gynecology, Kyiv 04050, Ukraine; Reproductive Health, Centre of Innovative Medical Technologies, Kyiv 04053, Ukraine
| | - Natalia Pedachenko
- Obstetrics, Gynecology and Perinatology Department, Shupyk National Healthcare University, Kyiv 04112, Ukraine
| | - Nataliia Kosei
- Reproductive Health, Centre of Innovative Medical Technologies, Kyiv 04053, Ukraine
| | - Iryna Malysheva
- Clinic of Reproductive Technologies of Shupyk National Healthcare University, Kyiv 01004, Ukraine
| | - Tetiana Snizhko
- Obstetrics, Gynecology Department, National Medical University, 76018 Ivano-Frankivsk, Ukraine
| | - Tetiana Kozub
- Kharkiv City Student Hospital, 61000 Kharkiv, Ukraine
| | - Olga Zolotarevska
- Communal Non-profit Enterprise of the Kamian City Council Primary Healthcare Centre 3, Kamian, Ukraine
| | | | - Tetiana Tutchenko
- Endocrine Gynecology Department, Institute of Pediatrics, Obstetrics and Gynecology, Kyiv 04050, Ukraine; Reproductive Health, Centre of Innovative Medical Technologies, Kyiv 04053, Ukraine.
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Eng PC, Phylactou M, Qayum A, Woods C, Lee H, Aziz S, Moore B, Miras AD, Comninos AN, Tan T, Franks S, Dhillo WS, Abbara A. Obesity-Related Hypogonadism in Women. Endocr Rev 2024; 45:171-189. [PMID: 37559411 PMCID: PMC10911953 DOI: 10.1210/endrev/bnad027] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 06/02/2023] [Accepted: 08/07/2023] [Indexed: 08/11/2023]
Abstract
Obesity-related hypogonadotropic hypogonadism is a well-characterized condition in men (termed male obesity-related secondary hypogonadism; MOSH); however, an equivalent condition has not been as clearly described in women. The prevalence of polycystic ovary syndrome (PCOS) is known to increase with obesity, but PCOS is more typically characterized by increased gonadotropin-releasing hormone (GnRH) (and by proxy luteinizing hormone; LH) pulsatility, rather than by the reduced gonadotropin levels observed in MOSH. Notably, LH levels and LH pulse amplitude are reduced with obesity, both in women with and without PCOS, suggesting that an obesity-related secondary hypogonadism may also exist in women akin to MOSH in men. Herein, we examine the evidence for the existence of a putative non-PCOS "female obesity-related secondary hypogonadism" (FOSH). We précis possible underlying mechanisms for the occurrence of hypogonadism in this context and consider how such mechanisms differ from MOSH in men, and from PCOS in women without obesity. In this review, we consider relevant etiological factors that are altered in obesity and that could impact on GnRH pulsatility to ascertain whether they could contribute to obesity-related secondary hypogonadism including: anti-Müllerian hormone, androgen, insulin, fatty acid, adiponectin, and leptin. More precise phenotyping of hypogonadism in women with obesity could provide further validation for non-PCOS FOSH and preface the ability to define/investigate such a condition.
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Affiliation(s)
- Pei Chia Eng
- Section of Endocrinology and Investigative Medicine, Imperial College London, London W12 0NN, UK
- Department of Endocrinology, National University of Singapore, Singapore 117549
| | - Maria Phylactou
- Section of Endocrinology and Investigative Medicine, Imperial College London, London W12 0NN, UK
- Department of Endocrinology, Imperial College Healthcare NHS Trust, London W12 0NN, UK
| | - Ambreen Qayum
- Section of Endocrinology and Investigative Medicine, Imperial College London, London W12 0NN, UK
- Department of Endocrinology, Imperial College Healthcare NHS Trust, London W12 0NN, UK
| | - Casper Woods
- Section of Endocrinology and Investigative Medicine, Imperial College London, London W12 0NN, UK
| | - Hayoung Lee
- Section of Endocrinology and Investigative Medicine, Imperial College London, London W12 0NN, UK
| | - Sara Aziz
- Section of Endocrinology and Investigative Medicine, Imperial College London, London W12 0NN, UK
| | - Benedict Moore
- Section of Endocrinology and Investigative Medicine, Imperial College London, London W12 0NN, UK
| | - Alexander D Miras
- Section of Endocrinology and Investigative Medicine, Imperial College London, London W12 0NN, UK
- Department of Endocrinology, Imperial College Healthcare NHS Trust, London W12 0NN, UK
| | - Alexander N Comninos
- Section of Endocrinology and Investigative Medicine, Imperial College London, London W12 0NN, UK
- Department of Endocrinology, Imperial College Healthcare NHS Trust, London W12 0NN, UK
| | - Tricia Tan
- Section of Endocrinology and Investigative Medicine, Imperial College London, London W12 0NN, UK
- Department of Endocrinology, Imperial College Healthcare NHS Trust, London W12 0NN, UK
| | - Steve Franks
- Section of Endocrinology and Investigative Medicine, Imperial College London, London W12 0NN, UK
- Department of Endocrinology, Imperial College Healthcare NHS Trust, London W12 0NN, UK
| | - Waljit S Dhillo
- Section of Endocrinology and Investigative Medicine, Imperial College London, London W12 0NN, UK
- Department of Endocrinology, Imperial College Healthcare NHS Trust, London W12 0NN, UK
| | - Ali Abbara
- Section of Endocrinology and Investigative Medicine, Imperial College London, London W12 0NN, UK
- Department of Endocrinology, Imperial College Healthcare NHS Trust, London W12 0NN, UK
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6
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Mitra S, Saharia GK, Jena SK. Cardio-metabolic risk in Rotterdam clinical phenotypes of PCOS. ANNALES D'ENDOCRINOLOGIE 2024; 85:44-47. [PMID: 37328054 DOI: 10.1016/j.ando.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 04/14/2023] [Accepted: 06/05/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND AND AIMS Elevated anti-Müllerian hormone (AMH) in polycystic ovary syndrome (PCOS) characterizes the clinical severity of the 4 phenotypes; but whether it also reflects the corresponding differences in cardio-metabolic risk remains to be elucidated. This study aimed to compare metabolic profile between the 4 clinical phenotypes of PCOS and to determine the influence of AMH levels on metabolic severity. METHODS One hundred and forty-four women with PCOS, aged between 20 and 40years, were recruited in this cross-sectional study and categorized according to the 4 phenotypes of the Rotterdam criteria. Anthropometry and blood pressure were recorded. Fasting lipid profile, fasting glucose, fasting insulin, homeostasis model assessment insulin resistance, total testosterone and AMH were estimated. Clinical, anthropometric and metabolic profiles were compared between the 4 phenotypes. RESULTS There were significant differences in menstrual abnormalities, weight, hip circumference, clinical hyperandrogenism, ovarian volume and AMH levels between the 4 phenotypes. Cardio-metabolic risk factors and rates of metabolic syndrome (MS) and insulin resistance (IR) were comparable. CONCLUSION Cardio-metabolic risk is similar in all phenotypes of PCOS despite differences in anthropometry and AMH levels. All women diagnosed with PCOS should undergo screening and lifelong surveillance for MS, IR and cardiovascular diseases, irrespective of clinical phenotype or AMH level. This needs further validation in prospective multi-center studies across the country, with larger sample sizes and adequate power.
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Affiliation(s)
- Subarna Mitra
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, Bhubaneswar, 751019 Odisha, India.
| | - Gautom K Saharia
- Department of Biochemistry, All India Institute of Medical Sciences, Bhubaneswar, 751019 Odisha, India
| | - Saubhagya K Jena
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, Bhubaneswar, 751019 Odisha, India
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Safari A, Mosadeghkhah A, Khameneie MK. Clinical and laboratory features in women with different phenotypes of polycystic ovary syndrome. Minerva Obstet Gynecol 2024; 76:27-35. [PMID: 35912463 DOI: 10.23736/s2724-606x.22.05124-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Misdiagnosis is still an obstacle in the workup of polycystic ovary syndrome. We compared patients' characteristics among phenotypes of the syndrome and assessed the association of the characteristics with oligo-anovulation, hyperandrogenism, and polycystic ovary. METHODS In the infertility department of a teaching hospital, we performed a cross-sectional study. Based on the Rotterdam Criteria, we included 136 patients with polycystic ovary syndrome and 46 healthy controls. RESULTS The most common phenotype was A (N.=45;33%). Overall, A and C had larger Body Mass Index (P=0.019 and 0.030, respectively) and waist circumference (P=0.005 and 0.003) than control. Also, A and D had higher serum anti-mullerian hormone than control (both P<0.001) or phenotype C (P<0.001 and 0.01). Phenotypes A and C had higher insulin than control (both P=0.004). The highest level of estradiol was for control and the lowest for B. The lowest high-density lipoprotein was for C; and A to C phenotypes had higher triglyceride than control (P=0.002, <0.001, and 0.041). Larger body mass was associated with hyperandrogenism (adjusted Odds Ratio 95% CI=1.11 [1.01, 1.23], P=0.034); higher anti-mullerian hormone and high-density lipoprotein were related to oligo-anovulation (1.2 [1.07, 1.37], P=0.004; 1.1 [1.00, 1.13], P=0.041). Higher insulin and lower high-density lipoprotein were associated with polycystic ovary (1.11 [1.03, 1.21], P=0.013; 0.9 [0.82, 0.97], P=0.014). CONCLUSIONS There are potentials in Body Mass Index, waist circumference, serum anti-mullerian hormone, insulin, estradiol, high-density lipoprotein, and triglyceride concentration for differentiating the phenotypes of polycystic ovary syndrome and for more precise diagnosis of hyperandrogenism, oligo-anovulation, and polycystic ovary morphology.
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Affiliation(s)
- Aghdas Safari
- Department of Obstetrics and Gynecology, Faculty of Medicine, Aja University of Medical Sciences, Tehran, Iran -
| | - Ali Mosadeghkhah
- Department of Endocrinology and Metabolism, Faculty of Medicine, Aja University of Medical Sciences, Tehran, Iran
| | - Maryam K Khameneie
- Department of Obstetrics and Gynecology, Faculty of Medicine, Aja University of Medical Sciences, Tehran, Iran
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Rahmatnezhad L, Moghaddam-Banaem L, Behroozi-Lak T, Shiva A, Rasouli J. Association of insulin resistance with polycystic ovary syndrome phenotypes and patients' characteristics: a cross-sectional study in Iran. Reprod Biol Endocrinol 2023; 21:113. [PMID: 38001527 PMCID: PMC10675950 DOI: 10.1186/s12958-023-01160-z] [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: 06/27/2022] [Accepted: 11/08/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in women. This disorder affects 6-15% of women of childbearing age worldwide. It is diagnosed with hyperandrogenism, polycystic ovaries, and chronic anovulation with insulin resistance. This study aimed to assess the prevalence of insulin resistance (IR) in 4 phenotypes of PCOS, and its relationship with demographic, clinical, and paraclinical individual characteristics in a sample of Iranian PCOS patients. METHODS This particular cross-sectional investigation involved 160 female participants, aged between 18 and 45 years, who were receiving care at gynecology clinics in Urmia, northwestern Iran. All the participants had been diagnosed with PCOS and were categorized into one of four phenotypes. All the participants underwent clinical evaluations, paraclinical assessments, and ultrasound scans. IR was defined as HOMA-IR > 2.5. The statistical significance level was 0.05. RESULTS Among the 160 participants, the prevalences of the 4 phenotypes were: A: 83 (51.9%), B: 37 (23.1%), C: 21 (13.1%), and D: 19 (11.9%). IR was detected in 119 participants (74.4%); its rate was significantly different between the 4 phenotypes (p-value: 0.008) as A: 62 (74.7%), B: 34 (91.9%), C: 12 (57.1%), D: 11 (57.9%). Linear and logistic regression analyses were performed to control confounding factors. In linear regression, PCOS phenotype, classic phenotype (A&B), economic status, and Hb levels were significantly related to HOMA-IR; in logistic regression Hb levels, exercise, economic status, and PCOS phenotypes were significantly associated with insulin resistance. CONCLUSIONS The most prevalent PCOS phenotype in this study was A. PCOS phenotypes were significantly related to insulin resistance and HOMA-IR, with the highest levels of insulin resistance and HOMA-IR observed in phenotype B. Determining the phenotype of PCOS may be helpful for better management of PCOS and its associated complications. However, further investigations are recommended in this regard.
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Affiliation(s)
- Leili Rahmatnezhad
- Department of Reproductive Health and Midwifery, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Lida Moghaddam-Banaem
- Department of Reproductive Health and Midwifery, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran.
| | - Tahereh Behroozi-Lak
- Reproductive Health Research Center, Urmia University of Medical Sciences, Urmia, Iran
| | - Afshin Shiva
- Experimental and Applied Pharmaceutical Sciences Research Center, Urmia University of Medical Sciences, Urmia, Iran
- Experimental and Applied Pharmaceutical Research Center, Urmia University of Medical Sciences, Urmia, Iran
| | - Javad Rasouli
- Department of Epidemiology and Biostatistics, Faculty of Medicine, Urmia University of Medical Sciences, Urmia, Iran
- Department of Biostatistics and Epidemiology, School of Medicine, Urmia University of Medical Sciences, Urmia, Iran
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9
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Patel A, Saraf A, Rao VA, Rao KA. Comparing Assisted Reproductive Outcomes in Women with Different Polycystic Ovary Syndrome Phenotypes Undergoing Frozen Embryo Transfer. J Hum Reprod Sci 2023; 16:340-345. [PMID: 38322632 PMCID: PMC10841931 DOI: 10.4103/jhrs.jhrs_145_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 12/06/2023] [Accepted: 12/11/2023] [Indexed: 02/08/2024] Open
Abstract
Background Patients with polycystic ovarian syndrome (PCOS) have unique characteristics depending on its phenotype. Therefore, prediction of controlled ovarian stimulation (COS) response and assisted reproductive technique (ART) outcome in these becomes challenging. Aims To assess the outcomes of assisted reproductive technology (ART) in various polycystic ovary syndrome (PCOS) phenotypes and to evaluate the predictive value of anti-Mullerian hormone (AMH) and total testosterone on ART success. Clinical pregnancy rate (CPR) was measured as the primary outcome. Settings and Design This was a prospective observational study conducted at a tertiary care centre. Materials and Methods A total of 190 infertile women with PCOS (Rotterdam criteria) were enrolled and were subdivided into four phenotypes. Baseline screening and transvaginal scan were done. All patients underwent COS using antagonist protocol with recombinant follicle-stimulating hormone, and an agonist trigger was given for follicular maturation. One or two blastocysts were transferred in a frozen-thawed embryo transfer cycle. Luteal phase support was given with vaginal progesterone. Statistical Analysis Used For quantitative variables, we employed the Kruskal-Wallis Test with post hoc Tukey's analysis. For continuous or ordinal variables, the Mann-Whitney U test was utilized. The analysis of categorical data was conducted using the Chi-square (χ2) test with SPSS 21 software. Results Phenotype A was the most prevalent (37%). CPR was the highest in phenotype D (57.7%), followed by phenotype C (53.06%), A (43%) and B (36%). The mean serum AMH level was the highest in phenotype A (9.7 ± 4.3 ng/dL) and the lowest in phenotype B (5.9 ± 1.8 ng/dL). The mean total testosterone level was 103 ± 15.68 ng/mL in Type A, 109.46 ± 37.08 ng/mL in Type B and 48.52 ± 17.07 ng/ml in Type D. Conclusion Phenotype D showed higher CPR and lower miscarriage rate compared to other phenotypes (not significant) and was associated with good clinical outcome. No correlation could be established with serum AMH, total testosterone levels and CPR.
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Affiliation(s)
- Anubhuti Patel
- Department of Reproductive Medicine, Milann Fertility Centre, Bengaluru, Karnataka, India
| | - Anviti Saraf
- Department of Reproductive Medicine, Milann Fertility Centre, Bengaluru, Karnataka, India
| | - Vyshnavi A. Rao
- Department of Reproductive Medicine, Milann Fertility Centre, Bengaluru, Karnataka, India
| | - Kamini A. Rao
- Department of Reproductive Medicine, Milann Fertility Centre, Bengaluru, Karnataka, India
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Mansour A, Mirahmad M, Mohajeri-Tehrani MR, Jamalizadeh M, Hosseinimousa S, Rashidi F, Asili P, Sajjadi-Jazi SM. Risk factors for insulin resistance related to polycystic ovarian syndrome in Iranian population. Sci Rep 2023; 13:10269. [PMID: 37355686 PMCID: PMC10290663 DOI: 10.1038/s41598-023-37513-2] [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] [Accepted: 06/22/2023] [Indexed: 06/26/2023] Open
Abstract
Polycystic ovary syndrome (PCOS) has significant metabolic sequelae linked to insulin resistance. This study aimed to compare clinical, metabolic, and hormonal characteristics of PCOS women with and without insulin resistance. The second aim was to compare the clinico-biochemical profiles of the various PCOS phenotypes. In this cross-sectional secondary analysis, we combined the baseline data from two separate randomized controlled trials (RCTs) in women diagnosed with PCOS. PCOS patients were categorized into the four Rotterdam PCOS phenotypes according to the presence of at least two criteria of oligomenorrhea/anovulation (O), hyperandrogenism (H), and polycystic ovary morphology (P): O-H-P, H-P, O-H, and O-P. Participants were categorized into two groups according to the homeostasis model assessment index of insulin resistance (HOMA-IR) levels: < 3.46, and ≥ 3.46. The correlation between the HOMA-IR and biometric, clinical, and biochemical variables was assessed in normal weight (BMI < 25) and overweight/obese (BMI ≥ 25) PCOS women. Then, the association between PCOS phenotypes and insulin resistance was investigated using logistic regression analysis. A total of 125 PCOS patients aged 18-40 years were included in the present study. Based on our results, the HOMA-IR index was positively correlated with diastolic blood pressure, free androgen index, and triglycerides levels; and negatively correlated with sex hormone-binding globulin in overweight/obese PCOS women. In addition, the HOMA-IR index was found to be positively correlated with alanine transaminase and negatively correlated with diastolic blood pressure in normal weight PCOS women. Moreover, individuals with O-H-P phenotype (odds ratio [OR] 2.52, 95% confidence interval [CI] 1.02-6.24) had about two-fold increased risk of insulin resistance. In conclusion, the full-blown PCOS (O-H-P) phenotype has an increased risk of insulin resistance. Accordingly, phenotype division may help physicians to predict adverse metabolic outcomes.
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Affiliation(s)
- Asieh Mansour
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Mirahmad
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Reza Mohajeri-Tehrani
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahdieh Jamalizadeh
- Endocrinology and Metabolic Research Center, Institute of Basic and Clinic Physiology Science and Department of Internal Medicine, Kerman University of Medical Science, Kerman, Iran
| | - Sedigheh Hosseinimousa
- Department of Obstetrics and Gynecology, Infertility Unit, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Rashidi
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Pooria Asili
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Sayed Mahmoud Sajjadi-Jazi
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
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Serum Anti-Mullerian Hormone (AMH) Levels Among Different PCOS Phenotypes and Its Correlation with Clinical, Endocrine, and Metabolic Markers of PCOS. Reprod Sci 2023:10.1007/s43032-023-01195-y. [PMID: 36862325 DOI: 10.1007/s43032-023-01195-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: 08/13/2022] [Accepted: 02/05/2023] [Indexed: 03/03/2023]
Abstract
Anti-Mullerian hormone (AMH) is one of the direct indicators of follicular pool but no standard cutoff has been defined for diagnosis of polycystic ovary syndrome (PCOS). The present study evaluated the serum AMH levels among different PCOS phenotypes and correlated the AMH levels with clinical, hormonal, and metabolic parameters among Indian PCOS women. Mean serum AMH was 12.39 ± 5.3ng/mL in PCOS cohort and 3.83 ± 1.5 ng/mL in non-PCOS cohort (P < 0.01). Out of 608 PCOS women, 273 (44.9%) women belonged to phenotype A, 230 (37.8%) women were phenotype D. Phenotypes C and B were 12.17% and 5.10% respectively. Among those with the highest AMH group (AMH>20ng/ml; 8.05%), majority belonged to phenotype A. Menstrual cycle length, serum testosterone, fasting total cholesterol levels, and follicle number per ovary had positive correlation with serum anti-Mullerian levels (P < 0.05). AMH cutoff for the diagnosis of PCOS was calculated as ≥ 6.06 ng/mL on ROC analysis with sensitivity and specificity of 91.45% and 90.71% respectively. The study shows high serum AMH levels in PCOS are associated with worse clinical, endocrinological, and metabolic parameters. These levels may be used to counsel patients regarding treatment response, help in individualized management and prediction of reproductive and long-term metabolic outcomes.
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Zhao H, Zhou D, Liu C, Zhang L. The Relationship Between Insulin Resistance and Obesity and Serum Anti-Mullerian Hormone Level in Chinese Women with Polycystic Ovary Syndrome: A Retrospective, Single-Center Cohort Study. Int J Womens Health 2023; 15:151-166. [PMID: 36778752 PMCID: PMC9911904 DOI: 10.2147/ijwh.s393594] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 01/18/2023] [Indexed: 02/06/2023] Open
Abstract
Background Anti-Mullerian hormone (AMH) is vital in the pathophysiological process of polycystic ovary syndrome (PCOS). The exact relationship between obesity and insulin resistance (IR) with AMH levels remains unclear. Methods A retrospective, single-center cohort study of 220 women with PCOS who underwent physical, endocrine, and metabolic assessments were performed. Patients were grouped by age, body mass indices (BMI), Homeostatic Model Assessment of Insulin Resistance (HOMA-IR), and different phenotypes. Pearson correlation analysis assessed the correlation between AMH and HOMA-IR, BMI, and other PCOS indicators, and multiple linear regression analysis was performed to determine factors influencing AMH. Results In 220 patients with PCOS, serum AMH levels decreased with age and were significantly higher in the IR group than in the non-IR group (P < 0.01). AMH increased significantly in anovulatory patients with hyperandrogenemia and/or polycystic ovary, with no significant difference between obese and non-obese individuals. AMH levels correlated positively with luteinizing hormone (LH), LH/follicular stimulating hormone (FSH), testosterone, fasting insulin (FINS), and HOMA-IR levels; negatively with age and BMI levels (P < 0.05) and weakly with fasting plasma glucose in the classical PCOS phenotype (r=0.148, P < 0.05). Regression analysis showed that age, testosterone, FINS, LH, LH/FSH, and BMI influenced AMH levels (P < 0.05). Conclusion Chinese women with PCOS-IR showed associations with greater AMH levels. AMH levels correlated positively with HOMA-IR levels and negatively with BMI. AMH combined with BMI and HOMA-IR levels may help determine PCOS severity.
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Affiliation(s)
- Han Zhao
- Department of Endocrinology, Shengjing Hospital, China Medical University, Shenyang, Liaoning, People’s Republic of China
| | - Dexin Zhou
- Department of Endocrinology, Dalian Third People´s Hospital, Dalian, Liaoning, People’s Republic of China
| | - Cong Liu
- Department of Endocrinology, Shengjing Hospital, China Medical University, Shenyang, Liaoning, People’s Republic of China,Correspondence: Cong Liu; Le Zhang, Department of Endocrinology, Shengjing Hospital, China Medical University, Shenyang, Liaoning, People’s Republic of China, Email ;
| | - Le Zhang
- Department of Endocrinology, Shengjing Hospital, China Medical University, Shenyang, Liaoning, People’s Republic of China
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Zhao H, Chen R, Zheng D, Xiong F, Jia F, Liu J, Zhang L, Zhang N, Zhu S, Liu Y, Zhao L, Liu X. Modified Banxia Xiexin Decoction Ameliorates Polycystic Ovarian Syndrome With Insulin Resistance by Regulating Intestinal Microbiota. Front Cell Infect Microbiol 2022; 12:854796. [PMID: 35619648 PMCID: PMC9127304 DOI: 10.3389/fcimb.2022.854796] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 04/11/2022] [Indexed: 12/12/2022] Open
Abstract
Objective To analyze the characteristics of the intestinal microbiota of polycystic ovarian syndrome with insulin resistance (PCOS-IR) and explore the possible mechanism of modified Banxia Xiexin Decoction in the treatment of PCOS-IR. Methods A total of 17 specific pathogen-free (SPF) female Sprague–Dawley (SD) rats, aged 21 days, were selected and randomly divided into the control group (group Z, n = 6), model group (group M, n = 6), and treatment group (group A, n = 5). Letrozole combined with a high-fat diet was used to induce the PCOS-IR model. Rats in group A were treated with modified Banxia Xiexin Decoction for 2 weeks after the end of modeling; then the characteristics of reproductive, metabolic, inflammatory, and intestinal microbiota were compared among three groups. Results The PCOS-IR model had an imbalance of intestinal microbiota, and the enriched microbiota was mainly class Coriobacteria, order Clostridiales, and genus Clostridium_sensu_stricto_1. Modified Banxia Xiexin Decoction can regulate the disorder of intestinal microbiota diversity, significantly increase the abundance of phyla Verrucomicrobiota Proteobacteria and genera Akkermansia and Blautia, and decrease the abundance of genus Clostridium_sensu_stricto_1. Conclusion Genus Clostridium_sensu_stricto_1 might be the pivotal pathogenic bacteria of PCOS-IR. Modified Banxia Xiexin Decoction may ameliorate PCOS-IR by regulating intestinal microbiota imbalance and improving metabolic disorders.
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Affiliation(s)
- Hongyu Zhao
- Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Rufeng Chen
- Graduate College, Beijing University of Chinese Medicine, Beijing, China
| | - Dongxue Zheng
- Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Feng Xiong
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, China
| | - Fan Jia
- Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Jinyuan Liu
- Graduate College, Beijing University of Chinese Medicine, Beijing, China
| | - Lili Zhang
- Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Nana Zhang
- Graduate College, Beijing University of Chinese Medicine, Beijing, China
| | - Shiqin Zhu
- Graduate College, Beijing University of Chinese Medicine, Beijing, China
| | - Yongmei Liu
- Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Linhua Zhao
- Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Xinmin Liu
- Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- *Correspondence: Xinmin Liu,
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Hanedan N, Ersoy B, Hanedan C, Ozyurt BC, Taneli F. Effect of the presence of polycystic ovary syndrome-related features on anti-Mullerian hormone and androstenedione levels in adolescents with or without menstrual irregularity. Arch Gynecol Obstet 2022; 306:523-531. [PMID: 35355114 DOI: 10.1007/s00404-022-06505-4] [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: 11/17/2021] [Accepted: 03/03/2022] [Indexed: 11/02/2022]
Abstract
PURPOSE To determine the variation in anti-Mullerian hormone (AMH) and androstenedione (A4) concentrations in adolescent girls, with or without menstrual cycle disorder in relation to phenotypic features of. PCOS. METHODS Adolescent girls (n = 129), age range 14-19 years, were recruited in the cohort study. All participants were in the 4th or 5th year after menarche. Sixty-eight had menstrual irregularities, usually oligomenorrhea (OM), and 61 had regular menstruation (RM). AMH and A4 concentrations were measured. Hirsutism was recorded. Polycystic ovarian morphology (PCOM) was evaluated by transabdominal pelvic ultrasonography. Polycystic ovary syndrome (PCOS) features were defined according to Rotterdam consensus criteria. RESULTS AMH and A4 were significantly higher in adolescent girls with OM than in girls with RM (p < 0.05). A4 and body mass index (BMI) of adolescents with OM was significantly higher in those with hirsutism than those without hirsutism (p = 0.01 and 0.008, respectively). There was a positive correlation between A4 and BMI (r: 0.327, p < 0.01). Logistic regression showed that the frequency of OM in the presence of PCOM was 10.8 times (95% CI 2.04-12.09) compared to those without PCOM. The highest AMH concentrations were found in girls with OM, hirsutism, and PCOM (p < 0.05). CONCLUSIONS AMH and A4 are elevated in adolescents with oligomenorrhoea. High A4 is more prominent in the presence of hirsutism and is associated with increased BMI. PCOM, increases the likelihood of oligomenorrhea by about 10 times. AMH increase as the combination of clinical features of PCOS increases in adolescents with menstrual irregularity.
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Affiliation(s)
- Nurcan Hanedan
- Department of Pediatrics, Faculty of Medicine, Celal Bayar University, Manisa, Turkey
| | - Betül Ersoy
- Division of Pediatric Endocrinology and Metabolism, Faculty of Medicine, School of Medicine, Celal Bayar University, Uncubozköy Mahallesi, 45030, Manisa, Turkey.
| | - Candost Hanedan
- Department of Obstetrics and Gynecology, Merkez Efendi State Hospital, Manisa, Turkey
| | - Beyhan Cengiz Ozyurt
- Department of Public Health, Faculty of Medicine, Celal Bayar University, Manisa, Turkey
| | - Fatma Taneli
- Department of Clinical Biochemistry, Faculty of Medicine, Celal Bayar University, Manisa, Turkey
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15
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Soysal C, Bıyık İ, İnce O, Erten Ö, Taşçı Y, Keskin N. Comparison of the different PCOS phenotypes based on monocyte to HDL cholesterol ratio. J OBSTET GYNAECOL 2022; 42:2089-2094. [DOI: 10.1080/01443615.2022.2026309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Cenk Soysal
- Department of Gynecology and Obstetrics, Kütahya Health Sciences University, Kutahya, Turkey
| | - İsmail Bıyık
- Department of Gynecology and Obstetrics, Kütahya Health Sciences University, Kutahya, Turkey
| | - Onur İnce
- Department of Gynecology and Obstetrics, Kütahya Health Sciences University, Kutahya, Turkey
| | - Özlem Erten
- Department of Gynecology and Obstetrics, Kütahya Health Sciences University, Kutahya, Turkey
| | - Yasemin Taşçı
- Department of Gynecology and Obstetrics, Kütahya Health Sciences University, Kutahya, Turkey
| | - Nadi Keskin
- Department of Gynecology and Obstetrics, Kütahya Health Sciences University, Kutahya, Turkey
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Krentowska A, Kowalska I. Metabolic syndrome and its components in different phenotypes of polycystic ovary syndrome. Diabetes Metab Res Rev 2022; 38:e3464. [PMID: 33988288 DOI: 10.1002/dmrr.3464] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 05/03/2021] [Indexed: 01/22/2023]
Abstract
Polycystic ovary syndrome (PCOS) is the most common endocrinopathy affecting reproductive-age women. Important factors in its pathogenesis are hyperinsulinaemia and insulin resistance, which lead to higher risk of metabolic syndrome (MetS) and its complications. With the implementation of the Rotterdam diagnostic criteria in 2003, the group of PCOS patients became highly heterogeneous, with varying metabolic risk reported for different phenotypes of the syndrome. The aim of the present review is to assess the prevalence and severity of MetS and its components in patients with the four phenotypes of PCOS. A comprehensive search of Pubmed database was performed to identify studies comparing metabolic characteristics between PCOS patients with different phenotypes of the syndrome. The results of 60 studies published between 2004 and 2020 were retrieved and analysed. More adverse metabolic profile was observed in PCOS patients with hyperandrogenic phenotypes in comparison to normoandrogenic patients, as well as in classic phenotypes, defined by National Institutes of Health criteria, in comparison to newer phenotypes introduced by the Rotterdam criteria. In the majority of observations, normoandrogenic PCOS patients did not differ significantly from controls in terms of metabolic characteristics, although some East Asian studies reported more adverse metabolic profile in normoandrogenic phenotype in comparison to healthy women. In conclusion, metabolic abnormalities in PCOS seem to be associated with joint effects of hyperandrogenism, insulin resistance and visceral obesity. The differences observed between the four phenotypes of PCOS underline the need for individualised diagnostic and therapeutic approach.
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Affiliation(s)
- Anna Krentowska
- Department of Internal Medicine and Metabolic Diseases, Medical University of Bialystok, Bialystok, Poland
| | - Irina Kowalska
- Department of Internal Medicine and Metabolic Diseases, Medical University of Bialystok, Bialystok, Poland
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Du M, Zhang J, Yu X, Guan Y. Elevated Anti-Müllerian Hormone Is an Independent Risk Factor for Preterm Birth Among Patients With Overweight Polycystic Ovary Syndrome. Front Endocrinol (Lausanne) 2021; 12:788000. [PMID: 34956097 PMCID: PMC8692368 DOI: 10.3389/fendo.2021.788000] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 11/23/2021] [Indexed: 11/29/2022] Open
Abstract
Objective To explore whether elevated anti-Müllerian hormone (AMH) levels affect the rate of preterm birth (PTB) among PCOS patients with different BMIs. Methods In this retrospective cohort study, patients with PCOS who had undergone IVF/ICSI from January 2017 to December 2019 were included for potential evaluation. A total of 2368 singleton live births from PCOS patients were included. According to the BMI, all the PCOS patients were divided into two groups: BMI<24 kg/m2 and BMI≥24 kg/m2. In total, 1339 PCOS patients with a BMI<24 kg/m2 were grouped according to their serum AMH levels: ① <2.71 ng/ml (n=333), ② 2.71-4.08 ng/ml (n=330), ③ 4.09-6.45 ng/ml (n=351), and ④ >6.45 ng/ml (n=325). Additionally, 1029 cycles of patients with a BMI≥24 kg/m2 were grouped according to the serum AMH level: ① <2.71 ng/ml (n=255), ② 2.71-4.08 ng/ml (n=267), ③ 4.09-6.45 ng/ml (n=239), and ④ >6.45 ng/ml (n=268), with <2.71 ng/ml being considered the reference group. The grouping was based mainly on the interquartile range of serum AMH levels. The primary outcome of the study was PTB. The secondary outcomes were low birth weight (LBW), small for gestational age (SGA), macrosomia and large for gestational age (LGA). Results Regarding PCOS patients with a BMI<24 kg/m2, compared with the PTB rate of the AMH <2.71 ng/ml group, the PTB rates of the different groups were not significantly different (AMH 2.71-4.08, AOR (95% CI)=1.01 (0.52-2.00), P=0.99; AMH 4.09-6.45, AOR (95% CI)=0.93 (0.45-1.91), P=0.85; AMH>6.45, AOR (95% CI)=0.78 (0.35-1.73), P=0.54). Regarding PCOS patients with a BMI ≥24 kg/m2, compared with the PTB rate of the AMH <2.71 ng/ml group, the PTB rate of the AMH>6.45 ng/ml group was significantly higher (OR=2.47; 95% CI=1.34-4.55). After multiple logistic regression analysis, the risk of PTB in the AMH>6.45 ng/ml group was 2.1 times that in the AMH<2.71 ng/ml group (AOR=2.1, 95% CI=1.01-4.37, P=0.04). However, no statistically significant difference was found in the rate of SGA, LBW, macrosomia or LGA among patients in the different serum AMH groups. Conclusion For PCOS patients, a BMI≥24 kg/m2 plus serum AMH>6.45 ng/ml (75th percentile) is an independent risk factor for PTB.
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Affiliation(s)
| | | | | | - Yichun Guan
- The Reproductive Center, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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18
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Du C, Chen X. Transcriptome Profiling of Oocytes at the Germinal Vesicle Stage from Women from Mongolia with Polycystic Ovary Syndrome. Int J Gen Med 2021; 14:4469-4478. [PMID: 34413674 PMCID: PMC8369228 DOI: 10.2147/ijgm.s321853] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 07/14/2021] [Indexed: 01/19/2023] Open
Abstract
Background Polycystic ovary syndrome (PCOS) is one of the most common endocrine disorders. Evidence indicates that genetic and environmental factors contribute to the pathogenesis of PCOS. The molecular basis of PCOS is not well understood. Methods Whole-genome RNA sequencing was performed on single oocyte at the germinal vesicle (GV) stage from females with normal ovulation and females with PCOS. All subjects were women from Mongolia undergoing intracytoplasmic sperm injection in vitro fertilization (ICSI-IVF) who met the Rotterdam criteria for PCOS. Women with normal ovulation who were undergoing ICSI-IVF owing to male factor infertility were recruited as control subjects. Results A total of 1313 differentially expressed genes were found by bio-informatics software in the GV oocytes of PCOS patients and compared with the control group. There were 367 upregulated and 946 downregulated genes (fold change > 2, false discovery rate < 0.01). When compared with the healthy controls, it was shown that the DEGs like VEGF, IGF, FADS1 et al were investigated as potential causes of PCOS oocytes. The DEGs were related to kinase activity, cell proliferation, gene regulation, and the signaling pathways of phosphatidylinositol 3-kinase, Hippo, and ECM-receptor pathway in patients with PCOS. In addition, the interconnected gene co-expression network was constructed by gene bionetwork analysis, indicating that ITGB5, ITGB3, and CAV2 were the core genes in regulating the module expression of DEGs in PCOS. Conclusion RNA sequencing analysis demonstrated DEGs were linked to inflammation, cardiovascular disease, and lipid metabolism in the GV oocytes of women with PCOS. We hypothesize that ITGB5, ITGB3, and CAV2 may be involved in metabolic disorders associated with the different phenotypes of PCOS.
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Affiliation(s)
- Chen Du
- Reproductive Medicine Center, Affiliated Hospital, Inner Mongolia Medical University, Hohhot, Inner Mongolia, 010050, People's Republic of China
| | - Xiujuan Chen
- Reproductive Medicine Center, Affiliated Hospital, Inner Mongolia Medical University, Hohhot, Inner Mongolia, 010050, People's Republic of China
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Bai X, Zheng L, Li D, Xu Y. Research progress of endometrial receptivity in patients with polycystic ovary syndrome: a systematic review. Reprod Biol Endocrinol 2021; 19:122. [PMID: 34362377 PMCID: PMC8344130 DOI: 10.1186/s12958-021-00802-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 07/12/2021] [Indexed: 12/14/2022] Open
Abstract
Polycystic ovary syndrome (PCOS) is a neuroendocrine heterogeneous disease that frequently occurs in women of reproductive age, causing serious damage to the fertility, quality of life, and physical and mental health of patients. The current studies have proved that satisfactory endometrial receptivity is one of the conditions that must be met during the process of spermatovum position, adhesion and invasion, as well as the subsequent blastocyst division and embryo development. Women with PCOS may suffer a series of pathological processes such as changes in the expression levels of hormones and related receptors, imbalances in the proportion of miscellaneous cytokines, insulin resistance, low-grade chronic inflammation and endometrial morphological changes, which will damage endometrial receptivity from various aspects and obstruct fertilized egg nidation and embryonic development, thus causing adverse reproductive health events including infertility and abortion. This article reviews the research progress about characteristics and related influencing factors of endometrial receptivity in PCOS patients.
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Affiliation(s)
- Xuechun Bai
- The Second Hospital of Jilin University, Jilin Province Changchun City, China
| | - Lianwen Zheng
- The Second Hospital of Jilin University, Jilin Province Changchun City, China
| | - Dandan Li
- The Second Hospital of Jilin University, Jilin Province Changchun City, China
| | - Ying Xu
- The Second Hospital of Jilin University, Jilin Province Changchun City, China
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Bahadur A, Verma N, Mundhra R, Chawla L, Ajmani M, Sri MS, Arora S. Correlation of Homeostatic Model Assessment-Insulin Resistance, Anti-Mullerian Hormone, and BMI in the Characterization of Polycystic Ovary Syndrome. Cureus 2021; 13:e16047. [PMID: 34336524 PMCID: PMC8321419 DOI: 10.7759/cureus.16047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2021] [Indexed: 11/16/2022] Open
Abstract
Objective: To evaluate the correlation of homeostatic model assessment-insulin resistance (HOMA-IR), anti-Mullerian hormone (AMH), and BMI and to compare their values across the different phenotypes in polycystic ovary syndrome (PCOS) women of the reproductive age group. Study design: A total of 307 PCOS-diagnosed women were included in the study and further classified in different phenotypes. BMI, HOMA-IR, and serum AMH values were noted and their association with different phenotypes was seen. The correlation of these variables was also noted. Results: Phenotype D was the most common phenotype followed by type A, type B, and type C. A total of 265 women had an AMH value of ≥4 mg/ml with the highest value in phenotype A followed by D, C, and B. HOMA-IR and BMI values did not vary significantly among different phenotypes. HOMA-IR and BMI had a statistically significant positive correlation and serum AMH was negatively correlated with HOMA-IR, but no significant correlation was seen between serum AMH and BMI. The biochemical parameters like luteinizing hormone (LH), follicle-stimulating hormone (FSH), LH: FSH ratio, and serum testosterone showed no correlation with phenotypes or any other clinical parameter. Conclusion: HOMA-IR and BMI showed a statistically significant positive correlation indicating the need for lifestyle modification and weight reduction in PCOS women, which can further help in decreasing insulin resistance. A strong correlation of serum AMH levels and phenotypes shows the importance of serum AMH levels for classifying different PCOS phenotypes.
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Affiliation(s)
- Anupama Bahadur
- Obstetrics and Gynecology, All India Institute of Medical Sciences, Rishikesh, IND
| | - Neha Verma
- Obstetrics and Gynecology, All India Institute of Medical Sciences, Rishikesh, IND
| | - Rajlaxmi Mundhra
- Obstetrics and Gynecology, All India Institute of Medical Sciences, Rishikesh, IND
| | - Latika Chawla
- Obstetrics and Gynecology, All India Institute of Medical Sciences, Rishikesh, IND
| | - Megha Ajmani
- Obstetrics and Gynecology, All India Institute of Medical Sciences, Rishikesh, IND
| | | | - Shivaani Arora
- Obstetrics and Gynecology, All India Institute of Medical Sciences, Rishikesh, IND
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Dabravolski SA, Nikiforov NG, Eid AH, Nedosugova LV, Starodubova AV, Popkova TV, Bezsonov EE, Orekhov AN. Mitochondrial Dysfunction and Chronic Inflammation in Polycystic Ovary Syndrome. Int J Mol Sci 2021; 22:3923. [PMID: 33920227 PMCID: PMC8070512 DOI: 10.3390/ijms22083923] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 03/26/2021] [Accepted: 03/31/2021] [Indexed: 12/20/2022] Open
Abstract
Polycystic ovarian syndrome (PCOS) is the most common endocrine-metabolic disorder affecting a vast population worldwide; it is linked with anovulation, mitochondrial dysfunctions and hormonal disbalance. Mutations in mtDNA have been identified in PCOS patients and likely play an important role in PCOS aetiology and pathogenesis; however, their causative role in PCOS development requires further investigation. As a low-grade chronic inflammation disease, PCOS patients have permanently elevated levels of inflammatory markers (TNF-α, CRP, IL-6, IL-8, IL-18). In this review, we summarise recent data regarding the role of mtDNA mutations and mitochondrial malfunctions in PCOS pathogenesis. Furthermore, we discuss recent papers dedicated to the identification of novel biomarkers for early PCOS diagnosis. Finally, traditional and new mitochondria-targeted treatments are discussed. This review intends to emphasise the key role of oxidative stress and chronic inflammation in PCOS pathogenesis; however, the exact molecular mechanism is mostly unknown and requires further investigation.
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Affiliation(s)
- Siarhei A. Dabravolski
- Department of Clinical Diagnostics, Vitebsk State Academy of Veterinary Medicine [UO VGAVM], 7/11 Dovatora str., 210026 Vitebsk, Belarus
| | - Nikita G. Nikiforov
- Center of Collective Usage, Institute of Gene Biology, Russian Academy of Sciences, 34/5 Vavilova Street, 119334 Moscow, Russia;
- Laboratory of Medical Genetics, Institute of Experimental Cardiology, National Medical Research Center of Cardiology, 121552 Moscow, Russia
- Laboratory of Cellular and Molecular Pathology of Cardiovascular System, Institute of Human Morphology, 3 Tsyurupa Street, 117418 Moscow, Russia; (E.E.B.); (A.N.O.)
| | - Ali H. Eid
- Department of Basic Medical Sciences, College of Medicine, QU Health, Qatar University, Doha 2713, Qatar;
- Biomedical and Pharmaceutical Research Unit, QU Health, Qatar University, Doha 2713, Qatar
- Department of Pharmacology and Toxicology, Faculty of Medicine, American University of Beirut, Beirut P.O. Box 11-0236, Lebanon
| | - Ludmila V. Nedosugova
- Federal State Autonomous Educational Institution of Higher Education, I. M. Sechenov First Moscow State Medical University (Sechenov University), 8/2 Trubenskaya Street, 119991 Moscow, Russia;
| | - Antonina V. Starodubova
- Federal Research Centre for Nutrition, Biotechnology and Food Safety, 2/14 Ustinsky Passage, 109240 Moscow, Russia;
- Pirogov Russian National Research Medical University, 1 Ostrovitianov Street, 117997 Moscow, Russia
| | - Tatyana V. Popkova
- V.A. Nasonova Institute of Rheumatology, 34A Kashirskoye Shosse, 115522 Moscow, Russia;
| | - Evgeny E. Bezsonov
- Laboratory of Cellular and Molecular Pathology of Cardiovascular System, Institute of Human Morphology, 3 Tsyurupa Street, 117418 Moscow, Russia; (E.E.B.); (A.N.O.)
- Laboratory of Angiopathology, The Institute of General Pathology and Pathophysiology, 8 Baltiyskaya Street, 125315 Moscow, Russia
| | - Alexander N. Orekhov
- Laboratory of Cellular and Molecular Pathology of Cardiovascular System, Institute of Human Morphology, 3 Tsyurupa Street, 117418 Moscow, Russia; (E.E.B.); (A.N.O.)
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22
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Wang J, Yao T, Zhang X, Chen Q, Gong S, Jiang L, Yao H, Hu X. Age-specific reference intervals of serum anti-Müllerian hormone in Chinese girls. Ann Clin Biochem 2021; 58:350-357. [PMID: 33657846 DOI: 10.1177/00045632211002879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND This study aimed to establish anti-Mullerian hormone age-specific reference intervals and determine the correlation between the anti-Mullerian hormone concentration and age, body mass index and concentrations of follicle-stimulating hormones and luteinizing hormone in healthy Chinese girls. METHODS Serum anti-Mullerian hormone concentrations of 1702 healthy girls (0-12 years), recruited between March 2018 and December 2019, were determined using the Beckman Access 2 automated chemiluminescence immunoassay. Single-year-specific medians of anti-Mullerian hormone and effects of age, body mass index, follicle-stimulating hormone and luteinizing hormone on anti-Mullerian hormone concentration were analysed. RESULTS The anti-Mullerian hormone median level continued increasing from birth, reached its peak at age 9 at 4.45 ng/mL (interquartile range [IQR] 2.58-6.90) and then gradually decreased. At age 12, the median reached 1.98 ng/mL (IQR 1.05-3.46). Age-specific reference intervals for anti-Mullerian hormone were established in healthy Chinese girls aged 0-12 years. Anti-Mullerian hormone concentrations showed a moderately positive correlation with age (r = 0.33, P < 0.001). In contrast, follicle-stimulating hormone (r = -0.29, P < 0.001) concentrations were weakly negatively correlated with the serum anti-Mullerian hormone concentration. CONCLUSION We established single-year-specific reference intervals for anti-Mullerian hormone in Chinese girls using the Beckman chemiluminescent platform. This reference range can help clinicians accurately understand anti-Mullerian hormone secretion in healthy girls and promote its clinical use.
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Affiliation(s)
- Jin Wang
- Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ting Yao
- Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xinxin Zhang
- Department of Laboratory Medicine, Key Laboratory of Diagnostic Medicine, Chongqing Medical University, Chongqing, China
| | - Qi Chen
- Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shuo Gong
- Sinopharm Hubei Medical Device Co., Ltd, Wuhan, China
| | - Li Jiang
- Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Hui Yao
- Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xijiang Hu
- Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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23
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Zhang F, Li SP, Zhang T, Yu B, Zhang J, Ding HG, Ye FJ, Yuan H, Ma YY, Pan HT, He Y. High throughput microRNAs sequencing profile of serum exosomes in women with and without polycystic ovarian syndrome. PeerJ 2021; 9:e10998. [PMID: 33763302 PMCID: PMC7958896 DOI: 10.7717/peerj.10998] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 02/02/2021] [Indexed: 12/17/2022] Open
Abstract
Background Polycystic ovary syndrome (PCOS) is the most common type of endocrine disorder, affecting 5–11% of women of reproductive age worldwide. microRNAs (miRNAs) stably exist in circulating blood encapsulated in extracellular vesicles such as exosomes; therefore, serum miRNAs have the potential to serve as novel PCOS biomarkers. Methods To identify miRNA biomarkers that are associated with PCOS, we performed a comprehensive sequence-based characterization of the PCOS serum miRNA landscape. The serum exosomes were successfully isolated and characterized in a variety of ways. Next, sequence-based analysis was performed on serum exosomes to screen the differentially expressed miRNAs in women with and without PCOS. Results The sequence data revealed that the levels of 54 miRNAs significantly differed between PCOS patients and normal controls. The levels of these miRNAs were detected by RT-qPCR. The results show that hsa-miR-1299, hsa-miR-6818-5p hsa-miR-192-5p, and hsa-miR-145-5p are significantly differentially expressed in PCOS patients serum exosomes and identify these microRNAs as potential biomarkers for PCOS. Furthermore, Gene Ontology (GO) analyses and KEGG pathway analyses of the miRNA targets further allowed to explore the potential implication of the miRNAs in PCOS. Conclusion Our findings suggest that serum exosomal miRNAs serve important roles in PCOS and may be used as novel molecular biomarkers for clinical diagnosis.
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Affiliation(s)
- Feng Zhang
- Shaoxing Maternity and Child Health Care Hospital, Shaoxing, China.,Obstetrics and Gynecology Hospital of Shaoxing University, Shaoxing, China
| | - Su-Ping Li
- Jiaxing University Affiliated Women and Children's Hospital, Jiaxing, China
| | - Tao Zhang
- Shaoxing Maternity and Child Health Care Hospital, Shaoxing, China.,Obstetrics and Gynecology Hospital of Shaoxing University, Shaoxing, China
| | - Bin Yu
- Shaoxing Maternity and Child Health Care Hospital, Shaoxing, China.,Obstetrics and Gynecology Hospital of Shaoxing University, Shaoxing, China
| | - Juan Zhang
- Shaoxing Maternity and Child Health Care Hospital, Shaoxing, China.,Obstetrics and Gynecology Hospital of Shaoxing University, Shaoxing, China
| | - Hai-Gang Ding
- Shaoxing Maternity and Child Health Care Hospital, Shaoxing, China.,Obstetrics and Gynecology Hospital of Shaoxing University, Shaoxing, China
| | - Fei-Jun Ye
- Zhoushan Maternity and Child Health Care Hospital, Zhoushan, China
| | - Hua Yuan
- Shaoxing Maternity and Child Health Care Hospital, Shaoxing, China.,Obstetrics and Gynecology Hospital of Shaoxing University, Shaoxing, China
| | - Ying-Ying Ma
- Shaoxing Maternity and Child Health Care Hospital, Shaoxing, China.,Obstetrics and Gynecology Hospital of Shaoxing University, Shaoxing, China
| | - Hai-Tao Pan
- Shaoxing Maternity and Child Health Care Hospital, Shaoxing, China.,Obstetrics and Gynecology Hospital of Shaoxing University, Shaoxing, China
| | - Yao He
- Shaoxing Maternity and Child Health Care Hospital, Shaoxing, China.,Obstetrics and Gynecology Hospital of Shaoxing University, Shaoxing, China
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24
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Dadachanji R, Patil A, Joshi B, Mukherjee S. Elucidating the impact of obesity on hormonal and metabolic perturbations in polycystic ovary syndrome phenotypes in Indian women. PLoS One 2021; 16:e0246862. [PMID: 33635862 PMCID: PMC7909663 DOI: 10.1371/journal.pone.0246862] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 01/27/2021] [Indexed: 12/23/2022] Open
Abstract
Polycystic ovary syndrome is a complex endocrinopathy with heterogeneous presentation and multifactorial etiology. We have undertaken this case-control study to compare metabolic and endocrine characteristics in different phenotypic subgroups of women with PCOS and the impact of obesity on them. Women with PCOS (n = 489) were classified into 4 phenotypes according to Rotterdam criteria. Comparisons of clinical, biochemical and hormonal parameters were performed across all phenotypic groups of PCOS and with controls (n = 270) by Welch’s ANOVA with subsequent Games-Howell post-hoc test. We found maximum prevalence of normoandrogenic phenotype D, which is milder form of PCOS in terms of insulin resistance, gonadotropin levels and dyslipidemia, followed by phenotype A, in our total study population. After classification of the study group into lean and obese groups, only few insulin and lipid-related traits showed marked differences between phenotypes. Further, we noted that obese women showed adverse metabolic but not androgenic traits compared to lean counterparts in the same phenotype. Metabolic syndrome frequency is increased in hyperandrogenic phenotypes with HDL-C and waist circumference being most predominant contributing factors in total, lean and obese groups. We demonstrate that in our study population there is greater occurrence of phenotype D of PCOS. Our study highlights the importance of clinicians concurrently employing Rotterdam criteria along with obesity status for ascertaining accurate PCOS status and formulating suitable therapeutic intervention.
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Affiliation(s)
- Roshan Dadachanji
- Department of Molecular Endocrinology, ICMR-National Institute for Research in Reproductive Health, Parel, Mumbai, India
| | - Anushree Patil
- Department of Clinical Research, ICMR-National Institute for Research in Reproductive Health, Parel, Mumbai, India
| | - Beena Joshi
- Department of Operational Research, ICMR-National Institute for Research in Reproductive Health, Parel, Mumbai, India
| | - Srabani Mukherjee
- Department of Molecular Endocrinology, ICMR-National Institute for Research in Reproductive Health, Parel, Mumbai, India
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Borzan V, Lerchbaum E, Missbrenner C, Heijboer AC, Goschnik M, Trummer C, Theiler-Schwetz V, Haudum C, Gumpold R, Schweighofer N, Obermayer-Pietsch B. Risk of Insulin Resistance and Metabolic Syndrome in Women with Hyperandrogenemia: A Comparison between PCOS Phenotypes and Beyond. J Clin Med 2021; 10:829. [PMID: 33670546 PMCID: PMC7922675 DOI: 10.3390/jcm10040829] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Revised: 02/07/2021] [Accepted: 02/11/2021] [Indexed: 02/07/2023] Open
Abstract
Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in premenopausal women, with a wide spectrum of possible phenotypes, symptoms and sequelae according to the current clinical definition. However, there are women who do not fulfill at least two out of the three commonly used "Rotterdam criteria" and their risk of developing type 2 diabetes or obesity later in life is not defined. Therefore, we addressed this important gap by conducting a retrospective analysis based on 750 women with and without PCOS. We compared four different PCOS phenotypes according to the Rotterdam criteria with women who exhibit only one Rotterdam criterion and with healthy controls. Hormone and metabolic differences were assessed by analysis of variance (ANOVA) as well as logistic regression analysis. We found that hyperandrogenic women have per se a higher risk of developing insulin resistance compared to phenotypes without hyperandrogenism and healthy controls. In addition, hyperandrogenemia is associated with developing insulin resistance also in women with no other Rotterdam criterion. Our study encourages further diagnostic and therapeutic approaches for PCOS phenotypes in order to account for varying risks of developing metabolic diseases. Finally, women with hyperandrogenism as the only symptom should also be screened for insulin resistance to avoid later metabolic risks.
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Affiliation(s)
- Valentin Borzan
- Department of Internal Medicine, Division of Endocrinology and Diabetology, Endocrinology Lab Platform, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria; (V.B.); (E.L.); (C.M.); (M.G.); (C.T.); (V.T.-S.); (C.H.); (R.G.); (N.S.)
- Center for Biomarker Research in Medicine (CBmed), 8010 Graz, Austria
| | - Elisabeth Lerchbaum
- Department of Internal Medicine, Division of Endocrinology and Diabetology, Endocrinology Lab Platform, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria; (V.B.); (E.L.); (C.M.); (M.G.); (C.T.); (V.T.-S.); (C.H.); (R.G.); (N.S.)
| | - Cornelia Missbrenner
- Department of Internal Medicine, Division of Endocrinology and Diabetology, Endocrinology Lab Platform, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria; (V.B.); (E.L.); (C.M.); (M.G.); (C.T.); (V.T.-S.); (C.H.); (R.G.); (N.S.)
| | - Annemieke C. Heijboer
- Endocrine Laboratory, Department of Clinical Chemistry, University Medical Center, Vrije Universiteit, 1081 HV Amsterdam, The Netherlands;
| | - Michaela Goschnik
- Department of Internal Medicine, Division of Endocrinology and Diabetology, Endocrinology Lab Platform, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria; (V.B.); (E.L.); (C.M.); (M.G.); (C.T.); (V.T.-S.); (C.H.); (R.G.); (N.S.)
- Center for Biomarker Research in Medicine (CBmed), 8010 Graz, Austria
| | - Christian Trummer
- Department of Internal Medicine, Division of Endocrinology and Diabetology, Endocrinology Lab Platform, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria; (V.B.); (E.L.); (C.M.); (M.G.); (C.T.); (V.T.-S.); (C.H.); (R.G.); (N.S.)
| | - Verena Theiler-Schwetz
- Department of Internal Medicine, Division of Endocrinology and Diabetology, Endocrinology Lab Platform, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria; (V.B.); (E.L.); (C.M.); (M.G.); (C.T.); (V.T.-S.); (C.H.); (R.G.); (N.S.)
| | - Christoph Haudum
- Department of Internal Medicine, Division of Endocrinology and Diabetology, Endocrinology Lab Platform, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria; (V.B.); (E.L.); (C.M.); (M.G.); (C.T.); (V.T.-S.); (C.H.); (R.G.); (N.S.)
- Center for Biomarker Research in Medicine (CBmed), 8010 Graz, Austria
| | - Roswitha Gumpold
- Department of Internal Medicine, Division of Endocrinology and Diabetology, Endocrinology Lab Platform, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria; (V.B.); (E.L.); (C.M.); (M.G.); (C.T.); (V.T.-S.); (C.H.); (R.G.); (N.S.)
| | - Natascha Schweighofer
- Department of Internal Medicine, Division of Endocrinology and Diabetology, Endocrinology Lab Platform, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria; (V.B.); (E.L.); (C.M.); (M.G.); (C.T.); (V.T.-S.); (C.H.); (R.G.); (N.S.)
- Center for Biomarker Research in Medicine (CBmed), 8010 Graz, Austria
| | - Barbara Obermayer-Pietsch
- Department of Internal Medicine, Division of Endocrinology and Diabetology, Endocrinology Lab Platform, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria; (V.B.); (E.L.); (C.M.); (M.G.); (C.T.); (V.T.-S.); (C.H.); (R.G.); (N.S.)
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26
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Ni CM, Huang WL, Jiang YM, Xu J, Duan R, Zhu YL, Zhu XP, Fan XM, Luo GA, Wang YM, Li YY, He Q, Xu L. Improving the accuracy and efficacy of diagnosing polycystic ovary syndrome by integrating metabolomics with clinical characteristics: study protocol for a randomized controlled trial. Trials 2020; 21:169. [PMID: 32046752 PMCID: PMC7014640 DOI: 10.1186/s13063-020-4060-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 01/09/2020] [Indexed: 12/17/2022] Open
Abstract
Background Polycystic ovary syndrome (PCOS) is a complex endocrine syndrome with poorly understood mechanisms. To provide patients with PCOS with individualized therapy, it is critical to precisely diagnose the phenotypes of the disease. However, the criteria for diagnosing the different phenotypes are mostly based on symptoms, physical examination and laboratory results. This study aims to compare the accuracy and efficacy of diagnosing PCOS by integrating metabolomic markers with common clinical characteristics. Methods This is a prospective, multicenter, analyst-blinded, randomized controlled trial. Participants will be grouped into (1) people without PCOS (healthy control group), (2) patients diagnosed with PCOS based on clinical indices (experimental group 1), and (3) patients diagnosed with PCOS based on metabolomic indices (experimental group 2). A total of 276 participants, including 60 healthy people and 216 patients with PCOS, will be recruited. The 216 patients with PCOS will be randomly assigned to the two experimental groups in a 1:1 ratio, and each group will receive a different 6-month treatment. The primary outcome for the experimental groups will be the effect of PCOS treatment. Discussion The results of this trial should help to determine whether using metabolomic indices is more accurate and effective than using clinical characteristics in diagnosing the phenotypes of PCOS. The results could provide a solid foundation for the accurate diagnosis of different PCOS subgroups and for future research on individualized PCOS therapy. Trial registration Chinese Clinical Trial Registry, ID: ChiCTR-INR-1800016346. Registered 26 May 2018.
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Affiliation(s)
- Cheng-Ming Ni
- Department of Endocrinology, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Nanjing Medical University, Wuxi, 214023, China
| | - Wen-Long Huang
- Department of Endocrinology, Jiangyin People's Hospital, Wuxi, 214400, China
| | - Yan-Min Jiang
- Department of Endocrinology, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Nanjing Medical University, Wuxi, 214023, China
| | - Juan Xu
- Department of Endocrinology, Jiangyin People's Hospital, Wuxi, 214400, China
| | - Ru Duan
- Department of Good Clinical Practice (GCP), The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi, 214023, China
| | - Yun-Long Zhu
- Department of Endocrinology, The Affiliated Wuxi Maternal and Child Health Centers Clinical Hospital of Nanjing Medical University, Wuxi, 214023, China
| | - Xu-Ping Zhu
- Department of Endocrinology, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Nanjing Medical University, Wuxi, 214023, China
| | - Xue-Mei Fan
- Key Laboratory of Bioorganic Phosphorus Chemistry and Chemical Biology (Ministry of Education), Department of Chemistry, Tsinghua University, Beijing, 100000, China
| | - Guo-An Luo
- Key Laboratory of Bioorganic Phosphorus Chemistry and Chemical Biology (Ministry of Education), Department of Chemistry, Tsinghua University, Beijing, 100000, China
| | - Yi-Ming Wang
- Key Laboratory of Bioorganic Phosphorus Chemistry and Chemical Biology (Ministry of Education), Department of Chemistry, Tsinghua University, Beijing, 100000, China
| | - Yan-Yu Li
- Department of Endocrinology, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Nanjing Medical University, Wuxi, 214023, China
| | - Qing He
- Department of Good Clinical Practice (GCP), The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi, 214023, China.
| | - Lan Xu
- Department of Endocrinology, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Nanjing Medical University, Wuxi, 214023, China.
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27
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Huang J, Liu L, Chen C, Gao Y. PCOS without hyperandrogenism is associated with higher plasma Trimethylamine N-oxide levels. BMC Endocr Disord 2020; 20:3. [PMID: 31906930 PMCID: PMC6945624 DOI: 10.1186/s12902-019-0486-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 12/27/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Polycystic ovary syndrome (PCOS) is an endocrine and metabolic disorder, and its pathogenesis is still under debate. Trimethylamine-N-oxide (TMAO) is a small, organic compound generated by the gut microbiome with a hypothesized relation to insulin resistance (IR) and low-grade inflammation in PCOS. By comparing plasma TMAO levels in non-PCOS participants and PCOS patients without hyperandrogenism (HA), we aimed to determine whether plasma TMAO levels correlate with PCOS without HA and to analyze their relationship with low-grade inflammation and IR. METHODS A total of 27 PCOS patients without HA and 23 non-PCOS participants were enrolled in this study and subdivided into "nonobese" and "obese" arms for each group. Levels of plasma TMAO were quantified, and basic clinical characteristics and plasma biomarkers of inflammation were assessed. RESULTS First, plasma TMAO levels, insulin levels and homeostatic model assessment of insulin resistance (HOMA-IR) values were higher in PCOS patients without HA, especially in the obese subgroup. Second, the levels of the inflammatory factors interleukin (IL)-17A, IL-18 and interferon gamma (IFN-γ) were significantly increased in obese PCOS patients without HA. Third, plasma TMAO levels were associated with body mass index (BMI) in the normal-weight groups, and the obese groups had higher fasting plasma insulin (FINS) and HOMA-IR values. Finally, logistic regression showed that the plasma levels of TMAO and luteinizing hormone/follicle-stimulating hormone (LH/FSH) were independent predictors of PCOS and indicated an increased risk of PCOS. CONCLUSIONS Elevated plasma TMAO levels may be associated with the pathogenesis of PCOS without HA and correlated with increased systemic inflammation. Further studies are needed to determine the suitability of TMAO as a predictive biomarker and to identify possible therapies for PCOS.
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Affiliation(s)
- Jiayu Huang
- Department of Gynecology and Obstetrics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Lin Liu
- Department of Gynecology and Obstetrics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chunyan Chen
- Department of Gynecology and Obstetrics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ying Gao
- Department of Gynecology and Obstetrics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
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28
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Zhu X, Hong X, Chen L, Xuan Y, Huang K, Wang B. Association of methylenetetrahydrofolate reductase C677T and A1298C polymorphisms with genetic susceptibility to polycystic ovary syndrome: A PRISMA-compliant meta-analysis. Gene 2019; 719:144079. [DOI: 10.1016/j.gene.2019.144079] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 08/23/2019] [Accepted: 08/23/2019] [Indexed: 01/06/2023]
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