Serum Fetuin-A levels are increased and associated with insulin resistance in women with polycystic ovary syndrome

Vildagliptin inhibits high fat and fetuin-A mediated DPP-4 expression, intracellular lipid accumulation and improves insulin secretory defects in pancreatic beta cells

Dipeptidyl peptidase-4 (DPP-4), a ubiquitous proteolytic enzyme, inhibits insulin secretion from pancreatic beta cells by inactivating circulating incretin hormones GLP-1 and GIP. High circulating levels of DPP-4 is presumed to compromise insulin secretion in people with type 2 diabetes (T2D). Our group recently reported lipid induced DPP-4 expression in pancreatic beta cells, mediated by the TLR4-NFkB pathway. In the present study, we looked at the role of Vildagliptin on pancreatic DPP-4 inhibition, preservation of islet mass and restoration of insulin secretion. MIN6 mouse insulinoma cells incubated with palmitate and fetuin-A, a proinflammatory organokine associated with insulin resistance, showed activation of TLR4-NFkB pathway, which was rescued on Vildagliptin treatment. In addition, Vildagliptin, by suppressing palmitate-fetuin-A mediated DPP-4 expression in MIN6, prevented the secretion of IL-1beta and fetuin-A in the culture media. DPP-4 siRNA abrogated TLR4-NFkB pathway mediated islet cell inflammation. Vildagliptin also reduced palmitate-fetuin-A mediated intracellular lipid accumulation in MIN6 and isolated islets from high fat fed (HFD) mice as observed by Oil O Red staining with downregulation of CD36 and PPARgamma. Vildagliptin also preserved islet mass and rescued insulin secretory defect in HFD mice. Our results suggest that inhibition of DPP-4 by Vildagliptin protects pancreatic beta cells from the deleterious effects of lipid and fetuin-A, preserves insulin secretory functions and improves hyperglycemia.

Hepatokines: the missing link in the development of insulin resistance and hyperandrogenism in PCOS?

The liver plays a critical role in several metabolic pathways, including the regulation of glucose and lipid metabolism. Non-alcoholic fatty liver disease (NAFLD), the most common chronic liver disease worldwide, is closely associated with insulin resistance (IR) and metabolic syndrome (MetS). Hepatokines, newly discovered proteins secreted by hepatocytes, have been linked to the induction of these metabolic dysregulations. Polycystic ovary syndrome (PCOS), the most common endocrine disorder in women of reproductive age, has been associated with NAFLD and IR, while hyperandrogenism additionally appears to be implicated in the pathogenesis of the latter. However, the potential role of hepatokines in the development of metabolic disorders in PCOS has not been fully investigated. Therefore, the aim of this review is to critically appraise the current evidence regarding the interplay of hepatokines with NAFLD, hyperandrogenism, and IR in PCOS.

Comparison of exenatide alone or combined with metformin versus metformin in the treatment of polycystic ovaries: a systematic review and meta-analysis

BACKGROUND

Polycystic ovary syndrome (PCOS) is the most common cause of anovulatory infertility in women of childbearing age. Randomized controlled trials (RCTs) have reported that exenatide and metformin are effective in the treatment of PCOS. In this meta-analysis, we aimed to compare the effectiveness and safety of exenatide alone or in combination with metformin versus metformin in patients suffering from PCOS.

METHODS

RCTs of exenatide therapy were identified through a search of electronic databases in November 2022 and updated in October 2023. Eligible studies were identified independently by the reviewers. Outcomes were analysed with Revman 5.4.

RESULTS

Nine RCTs among 214 studies on 1059 women with PCOS were included in the analysis, and among the nine RCTs, eight studies compared exenatide with metformin. Our meta-analysis demonstrated that exenatide was more effective than metformin in terms of pregnancy rate (RR 1.85 [95% CI 1.19,2.86] P = 0.006), sex hormone-binding globulin (SHBG) (MD 5 [95% CI 3.82,6.18] P < 0.001), and follicle-stimulating hormone (FSH) (MD 0.82 [95% 0.41,1.24] P < 0.001). The reductions in total testosterone (TT) (SMD -0.43 [95% CI -0.84, -0.03] P = 0.04) was more significant after treatment with exenatide than after treatment with metformin. In terms of safety, exenatide had a lower diarrhea rate (RR 0.11 [95% CI 0.01, 0.84]) than metformin. In the other three studies, exenatide plus metformin was compared with metformin. Exenatide combined with metformin was more effective in improving SHBG (MD 10.38[95%CI 6.7,14.06] P < 0.001), Matsuda index (MD 0.21[95%CI 0.05,0.37]) and reducing free androgen index (FAI) (MD -3.34 [-4.84, -1.83] P < 0.001), Weight (MD -2.32 [95%CI -3.89, -0.66]) and WC (MD-5.61[95%CI -8.4, -2.82] P < 0.001). The incidence of side effects between exenatide plus metformin and metformin was not statistically significant.

CONCLUSIONS

Exenatide alone or in combination with metformin is more effective than metformin for women with PCOS. Considering the evidence on effectiveness and safety, exenatide alone or in combination with metformin may be a better treatment approach than metformin for women with PCOS.

TRIAL REGISTRATION

INPLASY https://inplasy.com/inplasy-protocols/ ID: 10.37766/inplasy2022.11.0055.

Hepatokine Profile in Adolescents with Polycystic Ovary Syndrome: A Case-Control Study

The current guidelines suggest routine screening for non-alcoholic fatty liver disease (NAFLD) in patients with polycystic ovary syndrome (PCOS). Hepatokines seem to be promising surrogate endpoints for the diagnosis and severity of NAFLD. PCOS has its onset in adolescence and its metabolic sequalae begin during the same period. There are scarce data on the hepatokine profile of adolescent PCOS patients. This case-control study examined the serum profile of the hepatokines sex hormone-binding globulin (SHBG), selenoprotein P, fibroblast growth factor 21 (FGF21), and fetuin A in a sample of adolescent PCOS patients, and their association to metabolic and hormonal parameters. The selenoprotein P and SHBG serum concentrations were significantly decreased in PCOS patients vs. the controls (median (IQR), 2.47 (0.40) vs. 2.66 (0.36) μg/mL, p = 0.025; mean ± SD, 41.71 ± 19.41 vs. 54.94 ± 22.12 nmol/L, p = 0.011, respectively), whereas selenoprotein P was significantly and positively associated with testosterone (r = 0.325, p = 0.007) and the free androgen index (r = 0.361, p = 0.002). The SHBG demonstrated multiple significant negative correlations with adverse metabolic parameters. Among the PCOS patients, the FGF21 concentrations were significantly higher in those with NAFLD, whereas a 1 pg/mL increase in the FGF21 concentration increased the odds of NAFLD diagnosis by liver ultrasound by 1%, suggesting FGF21 as a potential biomarker for hepatic disease in females with PCOS in adolescence. Fetuin A was the least differentiated hepatokine between the PCOS patients and controls with the least associations with metabolic and hormonal parameters.

Integrating network pharmacology and experimental verification to explore the pharmacological mechanisms of asparagus against polycystic ovary syndrome

BACKGROUND

Polycystic ovary syndrome (PCOS) is a common reproductive endocrine disorder in women of reproductive age that still lacks effective treatment. Inflammation is one of the important features of PCOS. Asparagus (ASP) has anti-inflammatory, antioxidant, and anti-aging pharmacological effects, and its anti-tumor effects have been demonstrated in a variety of tumors. However, the role and mechanism of ASP in PCOS remain unclear.

METHODS

The active components of ASP and the key therapeutic targets for PCOS were obtained by network pharmacology. Molecular docking was used to simulate the binding of PRKCA to the active components of ASP. The effects of ASP on inflammatory and oxidative stress pathways in PCOS, and the regulation of PRKCA were examined by KGN, a human derived granulosa cell line. PCOS mouse model validated the results of in vivo experiments.

RESULTS

Network pharmacology identified 9 major active ingredients of ASP with 73 therapeutic targets for PCOS. Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment yielded 101 PCOS-related signaling pathways. The hub gene PRKCA was obtained after taking the gene intersection of the top 4 pathways. Molecular docking showed the binding of PRKCA to the 7 active components in ASP. In vitro and in vivo experiments showed that ASP alleviated the course of PCOS through antioxidant, anti-inflammatory effects. ASP can partially restore the low expression of PRKCA in the PCOS models.

CONCLUSION

The therapeutic effect of ASP on PCOS is mainly achieved by targeting PRKCA through the 7 active components of ASP. Mechanistically, ASP alleviated the course of PCOS through antioxidant, anti-inflammatory effects, and PRKCA was its potential target.

Hepatokines Fetuin-A and Fetuin-B status in obese Saudi patient with diabetes mellitus type 2

The present study aims to investigate the association of the serum levels of Fetuin-A and Fetuin-B with type 2 diabetes mellitus (T2DM) in obese Saudi patients and explore the mechanism that links obesity and T2DM in Saudi patients. In this study, a total of 240 adult Saudis (116 men and 124 women) in the age group of 42.7±11.6 years were divided into three groups based on fasting blood glucose (FBG) levels: controls, T2DM and prediabetic. The levels of FBG, lipid profile and serum insulin were measured. Enzyme-linked immunosorbent assay (ELISA) was done to measure Fetuin-A, Fetuin-B and C-reactive protein (CRP). The results show that participants of the prediabetic and T2DM groups had significantly higher body mass index (BMI) values and elevated blood pressure (BP), FBG, total cholesterol (TC), triglyceride (TG), insulin, homeostatic model assessment-IR (HOMA-IR) and homeostatic model assessment-β (HOMA-β) as compared to the control group (P<0.001). The T2DM group participants exhibited significantly higher BMI, BP, FBG, TG, insulin, HOMA-IR and HOMA-β as compared to the prediabetic group participants (P<0.001). The serum levels of high-density lipoprotein-cholesterol (HDL-C) and low-density lipoprotein-cholesterol (LDL-C) were not significantly different among the three tested groups. The serum concentrations of CRP, Fetuin-A and Fetuin-B were slightly higher in T2DM patients as compared to the control group, but the difference failed to reach statistical significance (P>0.05). When results were segregated according to gender, FBG and HDL-C were significantly elevated (P=0.043 and P=0.002, respectively) in T2DM women (12.6±3.6 mmol/l and 1.0±0.3 mmol/l, respectively) compared to T2DM men (11.0±3.3 mmol/l and 0.86±0.2 mmol/l, respectively). However, the diastolic BP and waist-hip ratio (WHR) were significantly increased (P=0.010 and P=0.006, respectively) in T2DM men. The BMI and TC and all other measured parameters were similar between the two genders. Fetuin-A was significantly and positively associated with insulin levels (R=0.19, P=0.05), HOMA-IR (R=0.25, P=0.01) and TG (R=0.20, P=0.01) among overall participants of this study. The T2DM participants exhibited a significantly positive correlation with body weight. Fetuin-A was significantly and positively correlated with Fetuin-B in prediabetic participants, but this relation was not observed in the T2DM participants. Fetuin-B correlated inversely (P<005) with systolic BP (R=-0.20, P=0.01) and diastolic BP (R=-0.18, P=0.05). Interestingly, a strong inverse correlation was observed between Fetuin-B and TG in overall participants (R=-0.21, P=0.01) and specifically in T2DM women (R=-0.41, P=0.01). In conclusion, our study did not find a significant association of Fetuin-A or Fetuin-B levels in serum with T2DM. However, our results suggest that Fetuin-A may influence insulin resistance and serum Fetuin-B concentrations were inversely associated with TG in the general adult Saudi population.

Investigation of the mechanisms and experimental verification of Cuscuta-Salvia in the treatment of polycystic ovary syndrome (PCOS) via network pharmacology

Polycystic ovary syndrome (PCOS) is an endocrine disease associated with reproduction. The Cuscuta-Salvia formula has been widely used to treat for PCOS in clinic. However, its chemical and pharmacological properties remain unclear. We identified the active components and related targets of Cuscuta-Salvia using UHPLC-ESI-Q-TOF-MS and TCMSP database. Disease targets were obtained from the DisGeNET and GeneCards databases. Subsequently, common targets between Cuscuta-Salvia and PCOS were identified using a Venn diagram. PPI network was established. Core genes were selected using a Cytoscape software plugin. GO and KEGG enrichment analyses were performed for common targets using the “pathview” package in R. Several core targets were verified using molecular and Immunological methods. By combining UHPLC-ESI-Q-TOF-MS with a network pharmacology study, 14 active components and a total of 80 common targets were obtained. Ten core genes were regulated by Cuscuta-Salvia in PCOS, including IL6, AKT1, VEGFA, TP53, TNF, MAPK1, JUN, EGF, CASP3, and EGFR. GO results showed that cellular response to drugs, response to oxygen levels, response lipopolysaccharides, and response to molecule of bacterial origin in BP category; membrane, transcription regulator complex, nuclear chromatin, postsynaptic membrane, and vesicle lumen in CC category; DNA-binding transcription factor binding, RNA polymerase II-specific DNA-binding transcription factor binding, DNA-binding transcription activator activity, RNA polymerase II-specific, DNA-binding transcription activator activity, and cytokine receptor binding in MF terms. The KEGG enrichment pathway was mainly involved in the PI3K − Akt, MAPK, TNF, IL-17 signalling pathways, and in cellular senescence. Furthermore, the results of the experimental study showed that Cuscuta-Salvia ameliorated the pathological changes in the ovaries, liver and adipose tissue. And it improved the expressions of the genes or proteins. Our results demonstrate that Cuscuta-Salvia may provide a novel pharmacological basis in an experimental model of PCOS by regulating gene expression. This study provides a basis for future research and clinical applications.

Investigating Fetuin-A and Paraoxonase-1 Activity as Markers in Polycystic Ovary Syndrome Based on Body Mass Index: A Prospective Case-Control Study

Introduction Polycystic ovary syndrome (PCOS) may have an increased risk for the development of systemic and metabolic pathogenesis such as cardiovascular diseases, insulin resistance (IR), diabetes mellitus (DM) and dyslipidemia. However, there is no reliable marker to show the relation. Fetuin-A is an adipokine whereas paraoxonase-1 (PON-1) is a high-density lipoprotein-linked enzyme to demonstrate oxidative stress. This study aimed to evaluate serum fetuin-A and PON-1 levels in infertile PCOS women based on body mass index (BMI). Methods A prospective case-control study in a university setting was designed. A total of 88 patients admitted to the Giresun University Faculty of Medicine Gynecology Clinic between February and April 2021 were included in the study. The subjects were divided as follows: PCOS-low-BMI (BMI≤25) vs. Controls-low-BMI (BMI≤25) and PCOS-high-BMI (BMI>25) vs. Controls-high-BMI (BMI>25). Those who had at least two criteria of the 2003 Rotterdam Consensus were diagnosed with PCOS. Serum fetuin-A and PON-1 levels were compared. Results The mean levels of fetuin-A were not significantly different in the groups (p=0.955). Serum PON-1 levels were lower in the PCOS group (109.1±61.4 vs. 140.1±80.0; p=0.040), but it lost significance with adjusted values for covariants as age and BMI. Although PON-1 was not significantly different in the PCOS group of BMI<25 kg/m² subgroup, it was significantly lower in the PCOS group of BMI≥25 kg/m² subgroup (p=0.820 vs. p=0.048). Conclusion Serum fetuin-A activity did not differ with PCOS. Serum PON-1 might be a promising and research-worthy marker, especially for obese PCOS patients.

Molecular and pathobiological involvement of fetuin-A in the pathogenesis of NAFLD

The liver acts as a manufacturing unit for the production of fetuin-A, which is essential for various physiological characteristics. Scientific research has shown that a moderate upward push in fetuin-A serum levels is associated with a confirmed non-alcoholic fatty liver disease (NAFLD) diagnosis. Fetuin-A modulation is associated with a number of pathophysiological variables that cause liver problems, including insulin receptor signaling deficiencies, adipocyte dysfunction, hepatic inflammation, fibrosis, triacylglycerol production, macrophage invasion, and TLR4 activation. The focus of the present review is on the various molecular pathways, and genetic relevance of mRNA expression of fetuin-A which is correlated with progression of NAFLD. The other major area of exploration in the present review is based on the new targets for the modulation of fetuin-A, like calorie restriction and novel pharmacological agents, such as rosuvastatin, metformin, and pioglitazone which are successfully implicated in the management of various liver-related complications.

A case-control study to determination FBXW7 and Fetuin-A levels in patients with type 2 diabetes in Iraq

Background

diabetes mellitus (type 2) is a chronic disease characterized by hyperglycemia resulting either from a deficiency of insulin, or decrease insulin action or both. This study focused on determining the new marker F- box and WD repeat domain containing protein 7 (FBXW7) as well as Fetuin -A and their correlation with other parameters in Diabetes mellitus type 2.

Methods

Sixty diabetes type2 patients were recruited from (National diabetes Center for treatment and Research) at Al Mustansriya University in Iraq during the period (from November 2018-March 2019) with an age range (37-69) years. The patient group was subdivided into two groups: group I (30) newly diagnosed T2DM and group II (30) T2DM (on metformin monotherapy), for comparison, 30 healthy individuals were included as a control. The protein levels (FBXW7, and Fetuin-A) were estimated using quantitative enzyme-linked immunesorbent assay (ELISA). Biochemical parameters; fasting serum glucose (FSG), and lipid profile were measured through spectrophotometrically. Insulin was determined using ELISA kit finally, HbA1c was determined using HPLC.

Result

Serum levels of FBXW7 protein were significantly higher (p-value = 0.01), whereas, there was no significant difference (p ˃ 0.05) in the level of Fetuin-A in group I as compared to control group. There was no significant difference (p ˃ 0.05) in the levels of both proteins who group II was compared with the control group. On the other hand, FBXW7 level were significantly lower in group II as compared to group I. Fasting blood sugar FSG, glycated hemoglobin HbA1c, body mass index BMI, waist- to-height ratio WHtR, and lipid profile were significantly elevated, except for high density lipoproteins, HDL was decreased in Group I as compared to control group, whereas insulin appeared non-significant (P > 0.05). FBXW7 Protein was negatively correlated to Fetuin -A, HOMA-IR, Insulin concentration, and BMI, whereas positive correlate to FSG, HbA1c, lipid profile, and atherogenic index. According to ROC analysis, the optimal cutoff value for FBXW7 protein was (1.455) ng/ml.

Conclusions

Levels of FBXW7 and Fetuin-A proteins in sera of Diabetic patients were elevated. FBXW7 was significantly correlated with newly diagnosed patients. Metformin reduces FBXW7 and Fetuin-A levels.

Dynamic Changes in Circulating Endocrine FGF19 Subfamily and Fetuin-A in Response to Intralipid and Insulin Infusions in Healthy and PCOS Women

Background: The fibroblast growth factors (FGF) 19 subfamily, also referred to as endocrine FGFs, includes FGF19, FGF21, and FGF23 are metabolic hormones involved in the regulation of glucose and lipid metabolism. Fetuin-A is a hepatokine involved in the regulation of beta-cell function and insulin resistance. Endocrine FGFs and fetuin-A are dysregulated in metabolic disorders including obesity, type 2 diabetes, non-alcoholic fatty liver disease and polycystic ovary syndrome (PCOS). Our study was designed to examine the response of endocrine FGFs and fetuin-A to an acute intralipid, insulin infusion and exercise in PCOS and healthy women. Subjects and Measurements: Ten healthy and 11 PCOS subjects underwent 5-h saline infusions with a hyperinsulinemic-euglycemic clamp (HIEC) performed during the final 2 h. One week later, intralipid infusions were undertaken with a HIEC performed during the final 2 h. After an 8 week of exercise intervention the saline, intralipid, and HIEC were repeated. Plasma levels of endocrine FGFs and fetuin-A were measured. Results: Baseline fetuin-A was higher in PCOS women but FGF19, FGF21, and FGF23 did not differ and were unaffected by exercise. Insulin administration elevated FGF21 in control and PCOS, suppressed FGF19 in controls, and had no effects on FGF23 and fetuin-A. Intralipid infusion suppressed FGF19 and increased FGF21. Insulin with intralipid synergistically increased FGF21 and did not have effects on lipid-mediated suppression of FGF19 in both groups. Conclusion: Our study provides evidence for insulin and lipid regulation of endocrine FGFs in healthy and PCOS women, suggesting that FGF family members play a role in lipid and glucose metabolism. Clinical Trial Registration: www.isrctn.org, Identifier: ISRCTN42448814.