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Dubey P, Reddy S, Sharma K, Johnson S, Hardy G, Dwivedi AK. Polycystic Ovary Syndrome, Insulin Resistance, and Cardiovascular Disease. Curr Cardiol Rep 2024; 26:483-495. [PMID: 38568339 DOI: 10.1007/s11886-024-02050-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/20/2024] [Indexed: 06/26/2024]
Abstract
PURPOSE OF REVIEW Polycystic ovary syndrome (PCOS) is a prevalent endocrine disorder in women of reproductive age. It has been associated with metabolic, reproductive, and psychiatric disorders. Despite its association with insulin resistance (IR) and cardiovascular disease (CVD) risk factors, the association between PCOS and CVD outcomes has been conflicting. This review reports the updated evidence between PCOS, insulin resistance, and CVD events. RECENT FINDINGS IR is highly prevalent occurring in 50 to 95% of general and obese PCOS women. The etiology of PCOS involves IR and hyperandrogenism, which lead to CVD risk factors, subclinical CVD, and CVD outcomes. Multiple studies including meta-analysis confirmed a strong association between PCOS and CVD events including ischemic heart disease, stroke, atrial fibrillation, and diabetes, particularly among premenopausal women, and these associations were mediated by metabolic abnormalities. PCOS is highly familial and has substantial CVD risk and transgenerational effects regardless of obesity. A personalized approach to the CVD risk assessment and management of symptom manifestations should be conducted according to its phenotypes. Lifestyle modifications and reduction in environmental stressors should be encouraged for CVD prevention among PCOS women.
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Affiliation(s)
- Pallavi Dubey
- Department of Obstetrics and Gynecology, Texas Tech University Health Sciences Center El Paso, El Paso, TX, 79905, USA.
| | - Sireesha Reddy
- Department of Obstetrics and Gynecology, Texas Tech University Health Sciences Center El Paso, El Paso, TX, 79905, USA
| | - Kunal Sharma
- Department of Obstetrics and Gynecology, Texas Tech University Health Sciences Center El Paso, El Paso, TX, 79905, USA
| | - Sarah Johnson
- Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX, USA
| | - Ghislain Hardy
- Department of Obstetrics and Gynecology, Texas Tech University Health Sciences Center El Paso, El Paso, TX, 79905, USA
| | - Alok Kumar Dwivedi
- Department of Molecular and Translational Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX, USA
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Kolnikaj TS, Herman R, Janež A, Jensterle M. The Current and Emerging Role of Statins in the Treatment of PCOS: The Evidence to Date. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:244. [PMID: 38399531 PMCID: PMC10890374 DOI: 10.3390/medicina60020244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 01/18/2024] [Accepted: 01/23/2024] [Indexed: 02/25/2024]
Abstract
Polycystic ovary syndrome (PCOS) manifests a multifactorial pathology characterized by polycystic ovaries, menstrual cycle disorders, varying degrees of hyperandrogenism, and an ad-verse metabolic risk profile. The position of hyperandrogenism in this syndrome has been extensively studied. A multitude of mechanisms place it in the position of cause but also of consequence; therefore, ongoing research efforts are focused on identifying medications that can effectively reduce levels of androgens in women with PCOS. Moreover, lipid abnormalities are common in this population, with up to 70% of patients having dyslipidemia. Statins may have potential therapeutic benefits for women with PCOS, as they have been shown to improve insulin resistance and reduce the risk of cardiovascular disease. In addition, their role in accelerated steroidogenesis by limiting one source of cholesterol, influencing enzymatic activity, and providing several other beneficial mechanisms is widely investigated. This review aimed to provide a comprehensive overview of the pathogenesis of androgen excess and dyslipidemia in PCOS, as well as the therapeutic potential of statins.
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Affiliation(s)
- Tea Shehu Kolnikaj
- Department of Endocrinology, Diabetes and Metabolic Diseases, University of Medicine Tirana, 1000 Tirana, Albania;
| | - Rok Herman
- Department of Endocrinology, Diabetes and Metabolic Diseases, University Medical Center Ljubljana, 1000 Ljubljana, Slovenia; (R.H.); (A.J.)
- Department of Internal Medicine, Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
| | - Andrej Janež
- Department of Endocrinology, Diabetes and Metabolic Diseases, University Medical Center Ljubljana, 1000 Ljubljana, Slovenia; (R.H.); (A.J.)
- Department of Internal Medicine, Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
| | - Mojca Jensterle
- Department of Endocrinology, Diabetes and Metabolic Diseases, University Medical Center Ljubljana, 1000 Ljubljana, Slovenia; (R.H.); (A.J.)
- Department of Internal Medicine, Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
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Chen A, Handzel A, Sau L, Cui L, Kelley ST, Thackray VG. Metabolic dysregulation and gut dysbiosis linked to hyperandrogenism in female mice. Endocrinol Diabetes Metab 2024; 7:e443. [PMID: 37872876 PMCID: PMC10782063 DOI: 10.1002/edm2.443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 07/03/2023] [Accepted: 07/05/2023] [Indexed: 10/25/2023] Open
Abstract
INTRODUCTION Polycystic ovary syndrome (PCOS) is a common endocrine pathology in women. In addition to infertility, women with PCOS have metabolic dysregulation which predisposes them to Type 2 diabetes, cardiovascular disease and non-alcoholic fatty liver disease. Moreover, women with PCOS have changes in their gut microbial community that may be indicative of dysbiosis. While hyperandrogenism is associated with both the development of metabolic dysfunction and gut dysbiosis in females, the mechanisms involved are not well understood. METHODS We used dihydrotestosterone (DHT) and ovariectomy (OVX) mouse models coupled with metabolic assessments and 16S rRNA gene sequencing to explore the contributions of hyperandrogenism and oestrogen deficiency to the development of insulin resistance and gut microbial dysbiosis in pubertal female mice. RESULTS We demonstrated that, while DHT treatment or OVX alone were insufficient to induce insulin resistance during the pubertal-to-adult transition, combining OVX with DHT resulted in insulin resistance similar to that observed in letrozole-treated mice with elevated testosterone and decreased oestrogen levels. In addition, our results showed that OVX and DHT in combination resulted in a distinct shift in the gut microbiome compared to DHT or OVX alone, suggesting that the substantial metabolic dysregulation occurring in the OVX + DHT model was accompanied by unique changes in the abundances of gut bacteria including S24-7, Rikenellaceae and Mucispirillum schaedleri. CONCLUSIONS While hyperandrogenism plays an important role in the development of metabolic dysregulation in female mice, our results indicate that investigation into additional factors influencing insulin resistance and the gut microbiome during the pubertal-to-adult transition could provide additional insight into the pathophysiology of PCOS.
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Affiliation(s)
- Annie Chen
- Department of Obstetrics, Gynecology and Reproductive SciencesUniversity of CaliforniaSan Diego, La JollaCaliforniaUSA
| | - Alex Handzel
- Bioinformatics and Medical Informatics ProgramSan Diego State UniversitySan DiegoCaliforniaUSA
| | - Lillian Sau
- Department of Obstetrics, Gynecology and Reproductive SciencesUniversity of CaliforniaSan Diego, La JollaCaliforniaUSA
| | - Laura Cui
- Department of Obstetrics, Gynecology and Reproductive SciencesUniversity of CaliforniaSan Diego, La JollaCaliforniaUSA
| | - Scott T. Kelley
- Bioinformatics and Medical Informatics ProgramSan Diego State UniversitySan DiegoCaliforniaUSA
- Department of BiologySan Diego State UniversitySan DiegoCaliforniaUSA
| | - Varykina G. Thackray
- Department of Obstetrics, Gynecology and Reproductive SciencesUniversity of CaliforniaSan Diego, La JollaCaliforniaUSA
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Shi XJ, Du Y, Chen L, Chen YY, Luo M, Cheng Y. Treatment of polycystic ovary syndrome and its associated psychiatric symptoms with the Mongolian medicine Nuangong Qiwei Pill and macelignan. JOURNAL OF ETHNOPHARMACOLOGY 2023; 317:116812. [PMID: 37343651 DOI: 10.1016/j.jep.2023.116812] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 06/02/2023] [Accepted: 06/16/2023] [Indexed: 06/23/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE The Mongolian medicine Nuangong Qiwei Pill (NGQW) is a folk prescription with a long history of use by the Mongolian people. NGQW comprises seven Mongolian medicines, which have the effects of regulating and nourishing blood, warming the uterus, dispelling cold and relieving pain. For a long time, it has been used as a good remedy for gynecological diseases, with remarkable curative effects, favored by the majority of patients and recommended by doctors. Polycystic ovary syndrome (PCOS) is a common gynecological endocrine disorder that can lead to menstrual disorders or infertility. In the gynecological classification of Mongolian medicine, polycystic ovary syndrome has not been distinguished in detail, and the mechanism of NGQW in the treatment of polycystic ovary syndrome has not been scientifically studied and standardized. AIM OF THE STUDY The aim of this study was to clarify the mechanism of action of NGQW and macelignan in the treatment of PCOS and to provide a reference for the clinical application of these drugs. MATERIALS AND METHODS The effect of intragastric administration of NGQW and macelignan on PCOS model mice was observed. The mental status of mice was examined behaviorally, and serum hormone levels and oxidative stress parameters were measured by ELISA. Giemsa staining was used to detect the reproductive cycle, and HE staining was used to observe the ovarian status. Immunofluorescence staining was performed to observe the proliferation and apoptosis of ovarian granulosa cells. qRT‒PCR was conducted to measure the expression of IL-6, BAX, BCL-2, and estrogen synthesis-related genes in ovarian tissue and particle cells. RESULTS In the dehydroepiandrosterone (DHEA)-induced PCOS model mice, both NGQW and macelignan improved the estrous cycle; increased the estradiol (E2) content; lowered testosterone (T), progesterone (P) and luteinizing hormone (LH) levels; reduced the number of polycystic follicles; promoted granulosa cell proliferation; reduced granulosa cell apoptosis; and alleviated depression and anxiety. In addition, Nuangong Qiwei Pill and macelignan reduced the mRNA levels of the ovarian inflammatory factor IL-6; improved the disordered levels of the antioxidant indicators GSH, MDA, and SOD; and activated the TGF-β3 signaling pathway to increase the transcription of Cyp19a1, which increases estrogen secretion. CONCLUSION NGQW and macelignan can treat PCOS through the TGF-β3/Smad/Cyp19a1 signaling pathway to regulate the secretion ability of ovarian granulosa cells. Our research justifies the traditional use of NGQW to treat PCOS and enriches the scope of action of macelignan.
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Affiliation(s)
- Xiao-Jie Shi
- Key Laboratory of Ethnomedicine of Ministry of Education, Center on Translational Neuroscience, School of Pharmacy, Minzu University of China, Beijing, China
| | - Yang Du
- Key Laboratory of Ethnomedicine of Ministry of Education, Center on Translational Neuroscience, School of Pharmacy, Minzu University of China, Beijing, China
| | - Lei Chen
- Key Laboratory of Ethnomedicine of Ministry of Education, Center on Translational Neuroscience, School of Pharmacy, Minzu University of China, Beijing, China
| | - Yuan-Yuan Chen
- Reproductive Medicine Center, Hunan Provincial Maternal and Child Health Hospital (Hunan Provincial Reproductive Medicine Institution), Changsha, Hunan, China
| | - Man Luo
- Reproductive Medicine Center, Hunan Provincial Maternal and Child Health Hospital (Hunan Provincial Reproductive Medicine Institution), Changsha, Hunan, China.
| | - Yong Cheng
- Key Laboratory of Ethnomedicine of Ministry of Education, Center on Translational Neuroscience, School of Pharmacy, Minzu University of China, Beijing, China; College of Life and Environmental Sciences, Minzu University of China, Beijing, China; Institute of National Security, Minzu University of China, Beijing, China.
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Ganie MA, Rashid A, Baba MS, Zargar MA, Wani IA, Nisar S, Wani IA, Douhath S, Sriwastawa M, Geer MI, Asrar MM, Kutum R, Hassan S, Khan S, Rafi W, Bhat DA, Showkat W, Sahar T, Choh NA, Khurshid R, Mudassar S, Shah ZA, Shabir I, Sofi SA, Gupta N, Hafeez I, Sreenivas V. Pre-polycystic ovary syndrome and polymenorrhoea as new facets of polycystic ovary syndrome (PCOS): Evidences from a single centre data set. Clin Endocrinol (Oxf) 2023; 99:566-578. [PMID: 37656656 DOI: 10.1111/cen.14964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Revised: 07/22/2023] [Accepted: 08/08/2023] [Indexed: 09/03/2023]
Abstract
OBJECTIVE Polycystic ovary syndrome (PCOS) is a complex disorder with diverse metabolic implications. Diagnosis typically relies on oligo-amenorrhoea (OA), hyperandrogenism (HA), and polycystic ovarian morphology (PCOM). However, the role of polymenorrhoea in PCOS remains understudied. Additionally, limited information exists regarding metabolic disturbances in women with partial PCOS phenotypes that do not meet diagnostic criteria. This extensive database aims to provide substantial evidence on the metabolic implications of polymenorrhoea and partial PCOS phenotypes. DESIGN Prospective observational study. PATIENTS AND MEASUREMENTS In this single-centre study, 6463 women with PCOS-like characteristics and 3142 age-matched healthy women were included. The study compared clinical (anthropometry, modified Ferriman Gallwey [mFG] score), hormonal (serum testosterone), and metabolic (plasma glucose, serum lipids, insulin) characteristics between women diagnosed with PCOS, those with partial PCOS phenotypes, and the healthy control group RESULTS: In all, 5174 women met Rotterdam criteria for PCOS diagnosis, while 737 were classified as Pre-PCOS, including HA (n = 538), OA (n = 121), or PCOM (n = 78). Common clinical features included oligomenorrhoea (75.5%), hirsutism (82.9%), obesity (27.2%), hypertension (1.6%), metabolic syndrome (19.6%), and diabetes mellitus (5.6%). Women diagnosed with PCOS, HA only, and OA only exhibited higher average body mass index, plasma glucose levels (both fasting and 2 h after the oral glucose tolerance test), and lipid fractions in comparison to those with PCOM and the healthy controls. However, indices of insulin resistance were similar among women with PCOS, HA, PCOM, and OA, albeit higher than in the healthy controls. The polymenorrhoea subgroup (5.9%) had lower BMI and serum testosterone, but similar mFG score, plasma glucose, insulin, and lipid levels as the oligomenorrhoea subgroup. CONCLUSION The metabolic disturbances observed in Pre-PCOS women highlight the need to reassess diagnostic criteria. Including the polymenorrhoea subcategory in PCOS criteria is recommended due to similar metabolic dysfunctions as the oligomenorrhoea group.
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Affiliation(s)
- Mohd Ashraf Ganie
- Department of Endocrinology, Sheri-Kashmir Institute of Medical Sciences, Srinagar, India
- Department of Clinical Research, Sheri-Kashmir Institute of Medical Sciences, Srinagar, India
| | - Aafia Rashid
- Department of Clinical Research, Sheri-Kashmir Institute of Medical Sciences, Srinagar, India
| | - Mohammad Salem Baba
- Department of Endocrinology, Sheri-Kashmir Institute of Medical Sciences, Srinagar, India
| | - Mohd Afzal Zargar
- Department of Life Sciences, Central University of Kashmir, Ganderbal, India
| | - Imtiyaz Ahmad Wani
- Department of Clinical Research, Sheri-Kashmir Institute of Medical Sciences, Srinagar, India
| | - Sobia Nisar
- Department of Medicine, Government Medical College, Srinagar, India
| | - Ishfaq Ahmad Wani
- Department of Clinical Research, Sheri-Kashmir Institute of Medical Sciences, Srinagar, India
| | - Syed Douhath
- Department of Clinical Research, Sheri-Kashmir Institute of Medical Sciences, Srinagar, India
| | - Mukesh Sriwastawa
- Department of Microbiology and Immunology, University of Louisville, Louisville, Kentucky, USA
| | - Mohd Ishaq Geer
- Department of Pharmacology, University of Kashmir, Srinagar, India
| | - Mir Mohd Asrar
- Department of Clinical Research, Sheri-Kashmir Institute of Medical Sciences, Srinagar, India
| | - Rintu Kutum
- Department of Computer Science, Ashoka University, Sonepath, India
- Department of Computer Science, Trivedi School of Biosciences, Ashoka University, Sonepath, India
| | - Saqib Hassan
- Department of Biotechnology, School of Bio and Chemical Engineering, Sathyabama Institute of Science and Technology (Deemed University), Chennai, India
| | - Shahid Khan
- Department of Lab Medicine, AIIMS New Delhi, New Delhi, India
| | - Wajid Rafi
- Department of Endocrinology, All India Institute of Medical Sciences, New Delhi, India
| | - Dil Afroz Bhat
- Department of Clinical Biochemistry, Sheri-Kashmir Institute of Medical Sciences, Srinagar, India
| | - Wasia Showkat
- Department of Clinical Research, Sheri-Kashmir Institute of Medical Sciences, Srinagar, India
| | - Tajali Sahar
- Department of Clinical Research, Sheri-Kashmir Institute of Medical Sciences, Srinagar, India
| | - Naseer Ahmad Choh
- Department of Radiodiagnosis and Imaging, Sheri-Kashmir Institute of Medical Sciences, Srinagar, India
| | - Rabia Khurshid
- Department of Obstetrics and Gynecology, Sheri-Kashmir Institute of Medical Sciences, Srinagar, India
| | - Syed Mudassar
- Department of Clinical Biochemistry, Sheri-Kashmir Institute of Medical Sciences, Srinagar, India
| | - Zafar Amin Shah
- Department of Immunology and Molecular Medicine, Sheri-Kashmir Institute of Medical Sciences, Srinagar, India
| | - Iram Shabir
- Department of Biochemistry, Iowa State University, Ames, Iowa, USA
| | - Sanjeed Ahmad Sofi
- Department of Radiodiagnosis and Imaging, Sheri-Kashmir Institute of Medical Sciences, Srinagar, India
| | - Nandita Gupta
- Department of Endocrinology, All India Institute of Medical Sciences, New Delhi, India
| | - Imran Hafeez
- Department of Cardiology, Sheri-Kashmir Institute of Medical Sciences, Srinagar, India
| | - Vishnubatla Sreenivas
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
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Balagamage C, Arshad A, Elhassan YS, Ben Said W, Krone RE, Gleeson H, Idkowiak J. Management aspects of congenital adrenal hyperplasia during adolescence and transition to adult care. Clin Endocrinol (Oxf) 2023. [PMID: 37964596 DOI: 10.1111/cen.14992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 10/11/2023] [Accepted: 11/03/2023] [Indexed: 11/16/2023]
Abstract
The adolescent period is characterised by fundamental hormonal changes, which affect sex steroid production, cortisol metabolism and insulin sensitivity. These physiological changes have a significant impact on patients with congenital adrenal hyperplasia (CAH). An essential treatment aim across the lifespan in patients with CAH is to replace glucocorticoids sufficiently to avoid excess adrenal androgen production but equally to avoid cardiometabolic risks associated with excess glucocorticoid intake. The changes to the hormonal milieu at puberty, combined with poor adherence to medical therapy, often result in unsatisfactory control exacerbating androgen excess and increasing the risk of metabolic complications due to steroid over-replacement. With the physical and cognitive maturation of the adolescent with CAH, fertility issues and sexual function become a new focus of patient care in the paediatric clinic. This requires close surveillance for gonadal dysfunction, such as irregular periods/hirsutism or genital surgery-associated symptoms in girls and central hypogonadism or testicular adrenal rest tumours in boys. To ensure good health outcomes across the lifespan, the transition process from paediatric to adult care of patients with CAH must be planned carefully and early from the beginning of adolescence, spanning over many years into young adulthood. Its key aims are to empower the young person through education with full disclosure of their medical history, to ensure appropriate follow-up with experienced physicians and facilitate access to multispecialist teams addressing the complex needs of patients with CAH.
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Affiliation(s)
- Chamila Balagamage
- Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, University of Birmingham, Birmingham, UK
- Department of Endocrinology and Diabetes, Birmingham Children's Hospital, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Amynta Arshad
- Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, University of Birmingham, Birmingham, UK
- The Medical School, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Yasir S Elhassan
- Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, University of Birmingham, Birmingham, UK
- Department of Endocrinology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Wogud Ben Said
- Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, University of Birmingham, Birmingham, UK
- Department of Endocrinology and Diabetes, Birmingham Children's Hospital, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
- Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Ruth E Krone
- Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, University of Birmingham, Birmingham, UK
- Department of Endocrinology and Diabetes, Birmingham Children's Hospital, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Helena Gleeson
- Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, University of Birmingham, Birmingham, UK
- Department of Endocrinology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Jan Idkowiak
- Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, University of Birmingham, Birmingham, UK
- Department of Endocrinology and Diabetes, Birmingham Children's Hospital, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
- Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
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Ubba V, Joseph S, Awe O, Jones D, Dsilva MK, Feng M, Wang J, Fu X, Akbar RJ, Bodnar BH, Hu W, Wang H, Yang X, Yang L, Yang P, Ahima R, Divall S, Wu S. Neuronal AR Regulates Glucose Homeostasis and Energy Expenditure in Lean Female Mice With Androgen Excess. Endocrinology 2023; 164:bqad141. [PMID: 37738624 DOI: 10.1210/endocr/bqad141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 09/12/2023] [Accepted: 09/14/2023] [Indexed: 09/24/2023]
Abstract
Hyperandrogenemia and polycystic ovary syndrome are a result of the imbalance of androgen levels in females. Androgen receptor (Ar) mediates the effect of androgen, and this study examines how neuronal Ar in the central nervous system mediates metabolism under normal and increased androgen conditions in female mice. The neuron-specific ARKO mouse (SynARKO) was created from female (Ar fl/wt; synapsin promoter driven Cre) and male (Ar fl/y) mice. A glucose tolerance test revealed impaired glucose tolerance that was partially alleviated in the SynARKO-dihydrotestosterone (DHT) mice compared with Con-DHT mice after 4 months of DHT treatment. Heat production and food intake was higher in Con-DHT mice than in Con-veh mice; these effects were not altered between SynARKO-veh and SynARKO-DHT mice, indicating that excess androgens may partially alter calorie intake and energy expenditure in females via the neuronal Ar. The pAkt/Akt activity was higher in the hypothalamus in Con-DHT mice than in Con-veh mice, and this effect was attenuated in SynARKO-DHT mice. Western blot studies show that markers of inflammation and microglia activation, such as NF-kB p-65 and IBA1, increased in the hypothalamus of Con-DHT mice compared with Con-veh. These studies suggest that neuronal Ar mediates the metabolic impacts of androgen excess in females.
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Affiliation(s)
- Vaibhave Ubba
- Center for Metabolic Disease Research, Temple University School of Medicine, Philadelphia, PA 19140, USA
| | - Serene Joseph
- Center for Metabolic Disease Research, Temple University School of Medicine, Philadelphia, PA 19140, USA
| | - Olubusayo Awe
- Department of Cellular and Molecular Physiology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Dustin Jones
- Department of Cellular and Molecular Physiology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Milan K Dsilva
- Center for Metabolic Disease Research, Temple University School of Medicine, Philadelphia, PA 19140, USA
| | - Mingxiao Feng
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD 21087, USA
| | - Junjiang Wang
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD 21087, USA
| | - Xiaomin Fu
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD 21087, USA
| | - Razeen J Akbar
- Center for Metabolic Disease Research, Temple University School of Medicine, Philadelphia, PA 19140, USA
| | - Brittany H Bodnar
- Center for Metabolic Disease Research, Temple University School of Medicine, Philadelphia, PA 19140, USA
| | - Wenhui Hu
- Center for Metabolic Disease Research, Temple University School of Medicine, Philadelphia, PA 19140, USA
| | - Hong Wang
- Center for Metabolic Disease Research, Temple University School of Medicine, Philadelphia, PA 19140, USA
| | - Xiaofeng Yang
- Center for Metabolic Disease Research, Temple University School of Medicine, Philadelphia, PA 19140, USA
| | - Ling Yang
- Department of Medical Genetics & Molecular Biochemistry, Temple University School of Medicine, Philadelphia, PA 19140, USA
| | - Peixin Yang
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Rexford Ahima
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Sara Divall
- Department of Pediatrics, University of Washington, Seattle's Children's Hospital, Seattle, WA 98145-5005, USA
| | - Sheng Wu
- Center for Metabolic Disease Research, Temple University School of Medicine, Philadelphia, PA 19140, USA
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD 21087, USA
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8
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Dumesic DA, Abbott DH, Chazenbalk GD. An Evolutionary Model for the Ancient Origins of Polycystic Ovary Syndrome. J Clin Med 2023; 12:6120. [PMID: 37834765 PMCID: PMC10573644 DOI: 10.3390/jcm12196120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 09/18/2023] [Accepted: 09/20/2023] [Indexed: 10/15/2023] Open
Abstract
Polycystic ovary syndrome (PCOS) is a common endocrinopathy of reproductive-aged women, characterized by hyperandrogenism, oligo-anovulation and insulin resistance and closely linked with preferential abdominal fat accumulation. As an ancestral primate trait, PCOS was likely further selected in humans when scarcity of food in hunter-gatherers of the late Pleistocene additionally programmed for enhanced fat storage to meet the metabolic demands of reproduction in later life. As an evolutionary model for PCOS, healthy normal-weight women with hyperandrogenic PCOS have subcutaneous (SC) abdominal adipose stem cells that favor fat storage through exaggerated lipid accumulation during development to adipocytes in vitro. In turn, fat storage is counterbalanced by reduced insulin sensitivity and preferential accumulation of highly lipolytic intra-abdominal fat in vivo. This metabolic adaptation in PCOS balances energy storage with glucose availability and fatty acid oxidation for optimal energy use during reproduction; its accompanying oligo-anovulation allowed PCOS women from antiquity sufficient time and strength for childrearing of fewer offspring with a greater likelihood of childhood survival. Heritable PCOS characteristics are affected by today's contemporary environment through epigenetic events that predispose women to lipotoxicity, with excess weight gain and pregnancy complications, calling for an emphasis on preventive healthcare to optimize the long-term, endocrine-metabolic health of PCOS women in today's obesogenic environment.
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Affiliation(s)
- Daniel A. Dumesic
- Department of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, 10833 Le Conte Ave, Los Angeles, CA 90095, USA;
| | - David H. Abbott
- Department of Obstetrics and Gynecology, Wisconsin National Primate Research Center, University of Wisconsin, 1223 Capitol Court, Madison, WI 53715, USA;
| | - Gregorio D. Chazenbalk
- Department of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, 10833 Le Conte Ave, Los Angeles, CA 90095, USA;
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9
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Patel J, Chaudhary H, Rajput K, Parekh B, Joshi R. Assessment of gut microbial β-glucuronidase and β-glucosidase activity in women with polycystic ovary syndrome. Sci Rep 2023; 13:11967. [PMID: 37488157 PMCID: PMC10366212 DOI: 10.1038/s41598-023-39168-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 07/20/2023] [Indexed: 07/26/2023] Open
Abstract
PCOS is a prevalent endocrine disorder among women of reproductive age, characterized by hormonal imbalances and metabolic disturbances. This study explores the correlation between gut microbial β-glucuronidase and β-glucosidase and PCOS, focusing on their association with hormone levels and other clinical parameters. In this case-control study, fecal samples were collected from women of reproductive age, both with and without PCOS. The analysis of gut β-glucuronidase and β-glucosidase enzymes was conducted with the other clinical parameters, including body mass index, hormone levels, and hirsutism. These factors were then subjected to correlation analysis. PCOS women showed significantly higher levels of β-glucuronidase activity with a statistically significant P-value (0.05 ± 0.1 vs. 0.04 ± 0.1; P = 0.006) as well as β-glucosidase activity (0.13 ± 0.08 vs. 0.09 ± 0.05; P = 0.06) compared to the controls. This study also revealed intriguing connections between the selected enzymes and hormone levels, particularly testosterone and estradiol. Gut microbial enzymes β-glucuronidase and β-glucosidase may be used as biomarkers for early detection and monitoring of PCOS in women with metabolic challenges. It could lead to improved diagnostic tools and treatment options.
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Affiliation(s)
- Jalpa Patel
- Department of Biochemistry and Forensic Science, University School of Sciences, Gujarat University, Ahmedabad, Gujarat, 380009, India
| | - Hiral Chaudhary
- Department of Biochemistry and Forensic Science, University School of Sciences, Gujarat University, Ahmedabad, Gujarat, 380009, India
| | - Kiransinh Rajput
- Department of Microbiology and Biotechnology, University School of Sciences, Gujarat University, Ahmedabad, Gujarat, 380009, India
| | - Bhavin Parekh
- School of Applied Sciences and Technology, Gujarat Technological University, Ahmedabad, Gujarat, 380009, India.
| | - Rushikesh Joshi
- Department of Biochemistry and Forensic Science, University School of Sciences, Gujarat University, Ahmedabad, Gujarat, 380009, India.
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10
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Lo ACQ, Lo CCW, Oliver-Williams C. Cardiovascular disease risk in women with hyperandrogenism, oligomenorrhea/menstrual irregularity or polycystic ovaries (components of polycystic ovary syndrome): a systematic review and meta-analysis. EUROPEAN HEART JOURNAL OPEN 2023; 3:oead061. [PMID: 37404840 PMCID: PMC10317290 DOI: 10.1093/ehjopen/oead061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 05/18/2023] [Accepted: 06/01/2023] [Indexed: 07/06/2023]
Abstract
Aims Prior meta-analyses indicate polycystic ovary syndrome (PCOS) is associated with cardiovascular diseases (CVDs), but have high statistical heterogeneity, likely because PCOS is a heterogenous syndrome diagnosed by having any two of the three components: hyperandrogenism, oligomenorrhea/menstrual irregularity or polycystic ovaries. Several studies report higher risk of CVDs from individual PCOS components, but a comprehensive assessment of how each component contributes to CVD risk is lacking. This study aims to assess CVD risk for women with one of the PCOS components. Methods and results A systematic review and meta-analysis of observational studies was conducted. PubMed, Scopus, and Web of Science were searched without restrictions in July 2022. Studies meeting inclusion criteria examined the association between PCOS components and risk of a CVD. Two reviewers independently assessed abstracts and full-text articles, and extracted data from eligible studies. Where appropriate, relative risk (RR) and 95% confidence interval (CI) were estimated by random-effects meta-analysis. Statistical heterogeneity was assessed using the I2 statistic. Twenty-three studies, including 346 486 women, were identified. Oligo-amenorrhea/menstrual irregularity was associated with overall CVD (RR = 1.29, 95%CI = 1.09-1.53), coronary heart disease (CHD) (RR = 1.22, 95%CI = 1.06-1.41), and myocardial infarction (MI) (RR = 1.37, 95%CI = 1.01-1.88) but not cerebrovascular disease. These results were broadly consistent even after further adjustment for obesity. There was mixed evidence for the role of hyperandrogenism in CVDs. No studies examined polycystic ovaries as an independent exposure for CVD risk. Conclusion Oligo-amenorrhea/menstrual irregularity is associated with greater risk of overall CVD, CHD, and MI. More research is needed to assess the risks associated with hyperandrogenism or polycystic ovaries.
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Affiliation(s)
| | - Charmaine Chu Wen Lo
- Liverpool Hospital, Liverpool, NSW 2170, Australia
- Faculty of Medicine, University of New South Wales, Kensington, NSW 2052, Australia
- School of Medicine, Western Sydney University, Campbelltown, NSW 2560, Australia
| | - Clare Oliver-Williams
- Biostatistics Research Group, Department of Health Sciences, University of Leicester, Leicester LE1 7RH, UK
- Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge CB2 0BB, UK
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11
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Unfer V, Russo M, Aragona C, Bilotta G, Montanino Oliva M, Bizzarri M. Treatment with Myo-Inositol Does Not Improve the Clinical Features in All PCOS Phenotypes. Biomedicines 2023; 11:1759. [PMID: 37371854 DOI: 10.3390/biomedicines11061759] [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: 04/28/2023] [Revised: 06/16/2023] [Accepted: 06/17/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND The aim of the present study is to investigate the effects produced by a treatment with myo-Inositol (myo-Ins) in women presenting polycystic ovary syndrome (PCOS) of different phenotypes. METHODS We performed a retrospective study to evaluate whether patients presenting different PCOS phenotypes, treated for 6 months with myo-Ins, might exhibit a differential response to the treatment. On this premise, we clustered women with PCOS phenotypes A, B, and C in the first study group (hyperandrogenic PCOS or H-PCOS), and women presenting PCOS phenotype D in a separate study group (non-hyperandrogenic PCOS or NH-PCOS) to evaluate if the presence of hyperandrogenism, shared by H-PCOS, might imply a metabolic/endocrine condition rather than a gynecological issue. RESULTS The administration of myo-Ins induced a significant improvement in metabolic and endocrine parameters in H-PCOS, while the effects on NH-PCOS were negligible. Additionally, myo-Ins treatment improved the endometrial thickness of H-PCOS. CONCLUSIONS Subjects selected for the study exhibited a differential response to myo-Ins therapy according to their PCOS phenotypes. The data suggest that the same treatment might not equally improve the parameters of the PCOS condition in each sub-group of patients. It is crucial to distinguish the various phenotypes to properly select the therapeutical approach.
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Affiliation(s)
- Vittorio Unfer
- UniCamillus-Saint Camillus International University of Health Sciences, 00131 Rome, Italy
- The Experts Group on Inositol in Basic and Clinical Research (EGOI), 00161 Rome, Italy
| | | | - Cesare Aragona
- The Experts Group on Inositol in Basic and Clinical Research (EGOI), 00161 Rome, Italy
- Systems Biology Group Lab, 00161 Rome, Italy
| | | | - 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
| | - Mariano Bizzarri
- The Experts Group on Inositol in Basic and Clinical Research (EGOI), 00161 Rome, Italy
- Systems Biology Group Lab, 00161 Rome, Italy
- Department of Experimental Medicine, University La Sapienza, Via A. Scarpa 16, 00160 Rome, Italy
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12
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Xu L, Min M, Li X, Blake GM, Zhao K, Ruan X, Cheng X. Marrow adipose tissue is increased in overweight and obese women with PCOS independently of hyperandrogenism related obesity and metabolic disorders. Front Endocrinol (Lausanne) 2023; 14:1168806. [PMID: 37361535 PMCID: PMC10290191 DOI: 10.3389/fendo.2023.1168806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 05/24/2023] [Indexed: 06/28/2023] Open
Abstract
Purpose This study aimed to investigate the increase in bone marrow adipose tissue (BMAT) in overweight and obese women with polycystic ovary syndrome (PCOS) and its relationship with hyperandrogenism, obesity, and metabolic disorders. Methods The study included 87 overweight or obese women with PCOS (mean age 29 ± 4 years), as well as 87 age-matched controls recruited from a separate population study. All PCOS patients were measured for anthropometric features, abdominal adipose tissue areas, BMAT, biochemistry, and sex hormones. BMAT was compared between the PCOS patients and controls. In PCOS patients, subgroup comparisons of BMAT and its associations with body adiposity indices, biochemistry, and sex hormones were analyzed. The odds ratios (ORs) of elevated BMAT (defined as BMAT ≥ 38%) were calculated. Results On average BMAT was increased by 5.6% ( ± 11.3%) in PCOS patients compared to controls. BMAT were significantly higher in the upper tertiles of total cholesterol (TC) and low density lipoprotein-cholesterol (LDL-C). BMAT was not correlated with abdominal adiposity indices or biochemistry except for LDL-C (r = 0.253-0.263, p = 0.014-0.018). LDL-C was not significantly different between the normal and abnormal androgen PCOS subgroups (p = 0.10-0.887). LDL-C, follicle stimulating hormone (FSH), and total testosterone (TT) were risk factors for elevated BMAT, with ORs of 1.899 (p = 0.038-0.040), 1.369 (p = 0.030-0.042), and 1.002 (p = 0.040-0.044) for each unit increase, respectively. Conclusion BMAT was increased in overweight and obese PCOS patients, but the increase in BMAT was not associated with the hyperandrogenism related obesity or metabolic disorders.
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Affiliation(s)
- Li Xu
- Department of Radiology, Beijing Jishuitan Hospital, Beijing, China
| | - Min Min
- Department of Gynecology, Aviation General Hospital, Beijing, China
- Department of Gynecological Endocrinology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing, China
| | - Xintong Li
- Department of Radiology, Beijing Jishuitan Hospital, Beijing, China
| | - Glen M. Blake
- Biomedical Engineering Department, King’s College London, London, United Kingdom
| | - Kaiping Zhao
- Department of Medical Record Management and Statistics, Beijing Jishuitan Hospital, Beijing, China
| | - Xiangyan Ruan
- Department of Gynecological Endocrinology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing, China
| | - Xiaoguang Cheng
- Department of Radiology, Beijing Jishuitan Hospital, Beijing, China
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13
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Fahs D, Salloum D, Nasrallah M, Ghazeeri G. Polycystic Ovary Syndrome: Pathophysiology and Controversies in Diagnosis. Diagnostics (Basel) 2023; 13:diagnostics13091559. [PMID: 37174950 PMCID: PMC10177792 DOI: 10.3390/diagnostics13091559] [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: 02/16/2023] [Revised: 03/16/2023] [Accepted: 04/18/2023] [Indexed: 05/15/2023] Open
Abstract
Polycystic ovary syndrome (PCOS) is a complex and heterogeneous disorder that commonly affects women in the reproductive age group. The disorder has features that propose a blend of functional reproductive disorders, such as anovulation and hyperandrogenism, and metabolic disorders, such as hyperglycemia, hypertension, and obesity in women. Until today, the three implemented groups of criteria for the diagnosis of PCOS are from the National Institutes of Health (NIH) in the 1990s, Rotterdam 2003, and the Androgen Excess Polycystic Ovary Syndrome 2009 criteria. Currently, the most widely utilized criteria are the 2003 Rotterdam criteria, which validate the diagnosis of PCOS with the incidence of two out of the three criteria: hyperandrogenism (clinical and/or biochemical), irregular cycles, and polycystic ovary morphology. Currently, the anti-Müllerian hormone in serum is introduced as a substitute for the follicular count and is controversially emerging as an official polycystic ovarian morphology/PCOS marker. In adolescents, the two crucial factors for PCOS diagnosis are hyperandrogenism and irregular cycles. Recently, artificial intelligence, specifically machine learning, is being introduced as a promising diagnostic and predictive tool for PCOS with minimal to zero error that would help in clinical decisions regarding early management and treatment. Throughout this review, we focused on the pathophysiology, clinical features, and diagnostic challenges in females with PCOS.
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Affiliation(s)
- Duaa Fahs
- Department of Obstetrics and Gynecology, Faculty of Medicine, American University of Beirut Medical Center, Beirut P.O. Box 113-6044, Lebanon
| | - Dima Salloum
- Department of Obstetrics and Gynecology, Faculty of Medicine, American University of Beirut Medical Center, Beirut P.O. Box 113-6044, Lebanon
| | - Mona Nasrallah
- Division of Endocrinology and Metabolism, Faculty of Medicine, American University of Beirut Medical Center, Beirut P.O. Box 113-6044, Lebanon
| | - Ghina Ghazeeri
- Department of Obstetrics and Gynecology, Faculty of Medicine, American University of Beirut Medical Center, Beirut P.O. Box 113-6044, Lebanon
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14
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Bisht A, Gururani R, Jain S, Shukla R, Dwivedi J, Sharma S. Cedrus deodara (Roxb. ex D.Don) G.Don bark fraction ameliorates metabolic, endocrine and ovarian dynamics in rats experiencing polycystic ovarian syndrome. JOURNAL OF ETHNOPHARMACOLOGY 2023; 306:116206. [PMID: 36690306 DOI: 10.1016/j.jep.2023.116206] [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: 11/29/2022] [Revised: 01/10/2023] [Accepted: 01/20/2023] [Indexed: 06/17/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE In the Ayurvedic system of medicine, Cedrus deodara bark has been utilized as a folk medicine to remove ovarian cysts and treat infertility in females. AIM The present study is the first to investigate ameliorating potential of C. deodara bark on testosterone propionate and high-fat diet-induced polycystic ovarian syndrome in experimental rats. MATERIALS AND METHODS LC-MS analysis of the fraction selected through bioassay-guided approach employing uterine relaxant activity was performed to determine the bioactive constituents present in it. Further, the identified compounds were docked on the catalytic site of the androgen receptor and insulin receptor substrate-1. Later, the fraction was investigated against testosterone propionate and high-fat diet-induced PCOS in rats. RESULTS Chloroform fraction (F1) of the plant bark was found most active in uterine smooth muscle relaxant activity. LC-MS analysis of F1 indicated the presence of key flavonoids namely deodarin, cedrin, deodardione, and cedrusinin. Afterward, a molecular docking study of these compounds revealed impressive binding interactions with androgen receptor and insulin receptor substrate-1. Besides, in vivo studies, treatment with F1 significantly restored the estrous cycle in rats from the diestrus phase in a dose-dependent manner. Also, the disturbed metabolic and endocrine profile was markedly improved in rats. Later, histopathological analysis revealed the presence of a large number of mature follicles and corpora lutea in F1-treated rats. CONCLUSION In a nutshell, F1 exhibited promising beneficial effects in PCOS and associated conditions via amelioration of metabolic, endocrine, and ovarian dynamics in experimental rats.
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Affiliation(s)
- Akansha Bisht
- Department of Pharmacy, Banasthali Vidyapith, Banasthali, Rajasthan, India
| | - Ritika Gururani
- Department of Pharmacy, Banasthali Vidyapith, Banasthali, Rajasthan, India
| | - Smita Jain
- Department of Pharmacy, Banasthali Vidyapith, Banasthali, Rajasthan, India
| | - Rahul Shukla
- Department of Pharmaceutics, National Institute of Pharmaceutical Education and Research, Raebareli, Lucknow, Uttar Pradesh, India
| | - Jaya Dwivedi
- Department of Chemistry, Banasthali Vidyapith, Banasthali, Rajasthan, India
| | - Swapnil Sharma
- Department of Pharmacy, Banasthali Vidyapith, Banasthali, Rajasthan, India.
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15
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Jia C, Zhang L, Liu W, Zhang X, Wu H. Assessment of glucose and lipid metabolism in patients with polycystic ovary syndrome with and without Hashimoto's thyroiditis. Medicine (Baltimore) 2023; 102:e33205. [PMID: 36930082 PMCID: PMC10019210 DOI: 10.1097/md.0000000000033205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 02/15/2023] [Indexed: 03/18/2023] Open
Abstract
To investigate glucose and lipid metabolism in patients with polycystic ovary syndrome (PCOS) with and without Hashimoto's thyroiditis (HT). In the present study, 103 women were included as controls and a total of 213 patients (49 patients with HT and 164 patients without HT) diagnosed with PCOS. The oral glucose tolerance, insulin release, thyroid function, and lipid levels were measured. PCOS patients had significantly higher levels of fasting insulin (FINS), hemostasis of model assessment-insulin resistance, low-lipoprotein cholesterol, triglyceride, apolipoprotein B, apolipoprotein B/apolipoprotein A1, and homocysteine than the controls. PCOS Patients with HT + had higher FINS, 60FINS, 120FINS, and insulin resistance levels than those without Hashimoto's thyroiditis group. HT + group had higher total cholesterol, and thyroid-stimulating hormone levels, while free triiodothyronine, and free thyroxine levels were significantly lower. PCOS can lead to disorders of glucolipid metabolism, PCOS with Hashimoto's thyroiditis may further exacerbate disorders of glucose and lipid metabolism, and therefore thyroid function assessment in patients with PCOS needs to be emphasized.
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Affiliation(s)
- Cenlin Jia
- Department of Gynecology, Jinhua Municipal Central Hospital, Jinhua, China
| | - Lin Zhang
- Department of Gynecology, Jinhua Municipal Central Hospital, Jinhua, China
| | - Wenhua Liu
- Department of Gynecological Endocrinology, Hangzhou Women’s Hospital, Hangzhou, China
| | - Xiangyan Zhang
- Department of Gynecology, Jinhua Municipal Central Hospital, Jinhua, China
| | - Hongyan Wu
- Department of Gynecology, Jinhua Municipal Central Hospital, Jinhua, China
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16
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Baqer Ali E, Alhamza A, Zaboon IA, Alidrisi HA, Mansour AA. Fasting Versus Non-Fasting Total Testosterone Levels in Women During the Childbearing Period. Cureus 2023; 15:e35462. [PMID: 36994254 PMCID: PMC10042517 DOI: 10.7759/cureus.35462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/25/2023] [Indexed: 02/27/2023] Open
Abstract
Background Total testosterone in men should be measured in the fasting state early in the morning with at least two samples according to guidelines. For women, no such a recommendation is available despite the importance of testosterone in this demographic. The aim of this study is to evaluate the effect of fasting versus non-fasting state on the total testosterone levels in women during the reproductive period. Methods This study was conducted at Faiha Specialized Diabetes, Endocrine and Metabolism Center in Basrah, (Southern Iraq) between January 2022 to November 2022. The total enrolled women were 109; their age was 18-45 years. The presentation was for different complaints; 56 presented for medical consultation with 45 apparently healthy women accompanying the patients as well as eight volunteering female doctors. Testosterone levels were measured by electrochemiluminescence immunoassays using the Roche Cobas e411 platform (Roche Holding, Basel, Switzerland). Two samples were collected from each woman; one was fasting and another was non-fasting the following day, and all samples were taken before 10 am. Results For all of the participants, the mean ± SD fasting was significantly higher as compared to the non-fasting testosterone (27.39±18.8 ng/dL and 24.47±18.6 ng/dL respectively, p-value 0.01). The mean fasting testosterone level was also significantly higher in the apparently healthy group, (p-value 0.01). In women who presented with hirsutism, menstrual irregularities and or hair fall, no difference was seen in the testosterone levels between fasting and non-fasting states (p-value 0.4). Conclusion In the apparently healthy women of childbearing age, serum testosterone levels were higher in the fasting versus the non-fasting states. In women who presented with complaints of hirsutism, menstrual irregularities, and or hair fall, the serum testosterone levels were not affected by the fasting states.
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17
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The Implication of Mechanistic Approaches and the Role of the Microbiome in Polycystic Ovary Syndrome (PCOS): A Review. Metabolites 2023; 13:metabo13010129. [PMID: 36677054 PMCID: PMC9863528 DOI: 10.3390/metabo13010129] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 01/09/2023] [Accepted: 01/10/2023] [Indexed: 01/18/2023] Open
Abstract
As a complex endocrine and metabolic condition, polycystic ovarian syndrome (PCOS) affects women's reproductive health. These common symptoms include hirsutism, hyperandrogenism, ovulatory dysfunction, irregular menstruation, and infertility. No one knows what causes it or how to stop it yet. Alterations in gut microbiota composition and disruptions in secondary bile acid production appear to play a causative role in developing PCOS. PCOS pathophysiology and phenotypes are tightly related to both enteric and vaginal bacteria. Patients with PCOS exhibit changed microbiome compositions and decreased microbial diversity. Intestinal microorganisms also alter PCOS patient phenotypes by upregulating or downregulating hormone release, gut-brain mediators, and metabolite synthesis. The human body's gut microbiota, also known as the "second genome," can interact with the environment to improve metabolic and immunological function. Inflammation is connected to PCOS and may be caused by dysbiosis in the gut microbiome. This review sheds light on the recently discovered connections between gut microbiota and insulin resistance (IR) and the potential mechanisms of PCOS. This study also describes metabolomic studies to obtain a clear view of PCOS and ways to tackle it.
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18
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Janez A, Herman R, Poredos P, Mikhailidis DP, Blinc A, Sabovic M, Studen KB, Jezovnik MK, Schernthaner GH, Anagnostis P, Antignani PL, Jensterle M. Cardiometabolic Risk, Peripheral Arterial Disease and Cardiovascular Events in Polycystic Ovary Syndrome: Time to Implement Systematic Screening and Update the Management. Curr Vasc Pharmacol 2023; 21:424-432. [PMID: 37779406 DOI: 10.2174/0115701611269146230920073301] [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: 07/17/2023] [Revised: 08/22/2023] [Accepted: 08/30/2023] [Indexed: 10/03/2023]
Abstract
Polycystic ovary syndrome (PCOS) is a highly prevalent endocrine disorder in women of reproductive age. It presents with gynaecologic, metabolic, and psychologic manifestations. The dominant drivers of pathophysiology are hyperandrogenism and insulin resistance. Both conditions are related to cardiometabolic risk factors, such as obesity, hypertension, dyslipidaemia, hyperglycaemia, type 2 and gestational diabetes, nonalcoholic fatty liver disease and obstructive sleep apnoea. Women with PCOS of reproductive age consistently demonstrated an elevated risk of subclinical atherosclerosis, as indicated by different measurement methods, while findings for menopausal age groups exhibited mixed results. Translation of subclinical atherosclerosis into the increased incidence of peripheral arterial disease and major cardiovascular (CV) events is less clear. Although several expert groups have advised screening, the CV risk assessment and prevention of CV events are frequently underdiagnosed and overlooked aspects of the management of PCOS. A combination of lifestyle management and pharmacotherapy, including the promising new era of anti-obesity medicine, can lead to improvements in cardiometabolic health.
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Affiliation(s)
- Andrej Janez
- Department of Endocrinology, Diabetes and Metabolic Diseases, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Department of Internal Medicine, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Rok Herman
- Department of Endocrinology, Diabetes and Metabolic Diseases, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Department of Internal Medicine, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Pavel Poredos
- Department of Vascular Diseases, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Dimitri P Mikhailidis
- Division of Surgery and Interventional Science, Department of Surgical Biotechnology, University College London Medical School, University College London (UCL), UK
- Department of Clinical Biochemistry, Royal Free Hospital Campus (UCL), London, UK
| | - Ales Blinc
- Department of Internal Medicine, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
- Department of Vascular Diseases, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Miso Sabovic
- Department of Internal Medicine, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
- Department of Vascular Diseases, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Katica Bajuk Studen
- Department of Internal Medicine, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
- Department of Nuclear Medicine, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Mateja Kaja Jezovnik
- Department of Advanced Cardiopulmonary Therapies and Transplantation, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Gerit-Holger Schernthaner
- Division of Angiology, Department of Medicine 2, Division of Angiology, Medical University of Vienna, Vienna, Austria
| | - Panagiotis Anagnostis
- Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynaecology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Mojca Jensterle
- Department of Endocrinology, Diabetes and Metabolic Diseases, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Department of Internal Medicine, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
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Saedi S, Panahi R, Orak N, Jafarzadeh Shirazi MR. Comparative Meta-analysis of Adipose Tissue Transcriptomics Data in PCOS Patients and Healthy Control Women. Reprod Sci 2022; 30:1823-1833. [DOI: 10.1007/s43032-022-01145-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 12/05/2022] [Indexed: 12/14/2022]
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20
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Li W, Liu C, Yang Q, Zhou Y, Liu M, Shan H. Oxidative stress and antioxidant imbalance in ovulation disorder in patients with polycystic ovary syndrome. Front Nutr 2022; 9:1018674. [PMID: 36386912 PMCID: PMC9650267 DOI: 10.3389/fnut.2022.1018674] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Accepted: 10/07/2022] [Indexed: 07/30/2023] Open
Abstract
Polycystic ovary syndrome (PCOS) is a common reproductive endocrine disease that is characterized by oligo-ovulation or anovulation, hyperandrogenism, and polycystic ovaries observed using ultrasound with high clinical heterogeneity. At present, the etiology of PCOS is not clear but is thought to be related to genetic, metabolic, endocrine and environmental factors. Hyperandrogenism interacts with insulin resistance and overweight/obesity, forming a vicious cycle of mutual promotion and participating in the occurrence and progression of PCOS. Oxidative stress (OS) refers to the imbalance between the oxidation system and antioxidation system in the human body, which is associated with the occurrence and development of various diseases. Recent studies have shown that OS may be closely related to ovulation disorders in PCOS, and antioxidants can improve the oxidative stress state of PCOS. However, previous studies did not examine the effect of the interaction between OS and hyperandrogenism, insulin resistance or overweight/obesity on ovulation disorders in PCOS. This article reviews the interaction between OS and hyperandrogenism, insulin resistance and overweight/obesity; the effects of OS, hyperandrogenism, insulin resistance and overweight/obesity on ovulation disorders in PCOS; and the application of antioxidants in PCOS.
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Affiliation(s)
- Wenqian Li
- Department of Reproductive Medicine, First Affiliated Hospital, School of Medicine, Shihezi University, Shihezi, China
| | - Chang Liu
- Department of Reproductive Medicine, First Affiliated Hospital, School of Medicine, Shihezi University, Shihezi, China
| | - Qingmei Yang
- Department of Reproductive Medicine, First Affiliated Hospital, School of Medicine, Shihezi University, Shihezi, China
| | - Ying Zhou
- Department of Reproductive Medicine, First Affiliated Hospital, School of Medicine, Shihezi University, Shihezi, China
| | - Min Liu
- Department of Reproductive Medicine, First Affiliated Hospital, School of Medicine, Shihezi University, Shihezi, China
| | - Hongying Shan
- Department of Reproductive Medicine, First Affiliated Hospital, School of Medicine, Shihezi University, Shihezi, China
- Department of Obstetrics and Gynecology, Reproductive Medical Center, Peking University Third Hospital, Beijing, China
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van Keizerswaard J, Dietz de Loos ALP, Louwers YV, Laven JSE. Changes in individual polycystic ovary syndrome phenotypical characteristics over time: a long-term follow-up study. Fertil Steril 2022; 117:1059-1066. [PMID: 35219451 DOI: 10.1016/j.fertnstert.2022.01.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 01/12/2022] [Accepted: 01/12/2022] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To assess the effects of aging on the features of polycystic ovary syndrome (PCOS). DESIGN Cohort study. SETTING Tertiary care center. PATIENT(S) Women with PCOS, diagnosed according to the 2003 Rotterdam criteria, who visited our outpatient clinic repeatedly. INTERVENTION(S) Comparisons were made between the first visit and consecutive visits. MAIN OUTCOME MEASURE(S) Change in PCOS phenotype groups in terms of clinical and endocrine characteristics. RESULT(S) A total of 596 women visited the outpatient clinic repeatedly. An estimated change per 5-year age showed a decrease in the prevalence of phenotype A and an increase in the prevalence of not having PCOS. The serum levels of testosterone, androstenedione, and dehydroepiandrosterone sulfate as well as the free androgen index decreased significantly. Clinical characteristics showed an increase in terms of body mass index and waist circumference, whereas plasma glucose levels, insulin levels, and insulin resistance did not change significantly. CONCLUSION(S) The prevalence of PCOS phenotype groups changes over time. There is an important age effect that indicates a more regular menstrual cycle, decrease in the serum androgen levels, and improvement in polycystic ovarian morphology when aging occurs in women with PCOS.
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Affiliation(s)
- Jolanda van Keizerswaard
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynaecology, Erasmus MC, Rotterdam, the Netherlands.
| | - Alexandra L P Dietz de Loos
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynaecology, Erasmus MC, Rotterdam, the Netherlands
| | - Yvonne V Louwers
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynaecology, Erasmus MC, Rotterdam, the Netherlands
| | - Joop S E Laven
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynaecology, Erasmus MC, Rotterdam, the Netherlands
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22
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Tosi F, Villani M, Garofalo S, Faccin G, Bonora E, Fiers T, Kaufman JM, Moghetti P. Clinical Value of Serum Levels of 11-Oxygenated Metabolites of Testosterone in Women With Polycystic Ovary Syndrome. J Clin Endocrinol Metab 2022; 107:e2047-e2055. [PMID: 34951635 DOI: 10.1210/clinem/dgab920] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Indexed: 11/19/2022]
Abstract
CONTEXT Recent data suggested that 11-oxygenated androgens may be the preponderant circulating androgens in women with PCOS. However, the pathophysiological significance of these hormones remains unclear. OBJECTIVE The aim of this study was to evaluate the relationships between serum 11-OH testosterone (11-OHT) and 11-keto testosterone (11-KetoT) and clinical and biochemical hyperandrogenism, as well as the metabolic parameters, in women with PCOS. METHODS The main classic and 11-oxygenated androgens were measured by LC-MS/MS and direct equilibrium dialysis in 123 women with PCOS, diagnosed according to the Rotterdam criteria, and 38 healthy controls. Insulin sensitivity was assessed by hyperinsulinemic euglycemic clamp. RESULTS Serum 11-oxygenated androgens were higher in women with PCOS than in controls. Elevated levels of 11-OHT and 11-KetoT were found in 28.5% and 30.1% of PCOS women, respectively, whereas free testosterone (FT) was increased in 61.0% of them. Serum 11-oxygenated androgens showed a limited performance in recognizing women with classically defined hyperandrogenism. Unlike FT, 11-oxygenated androgens did not show significant relationships with anthropometric and metabolic parameters, except for a direct association with insulin sensitivity. In multivariable analysis, 11-OHT and 11-KetoT, directly, and FT, inversely, remained significant independent predictors of insulin sensitivity. CONCLUSIONS Serum levels of 11-oxygenated androgens are higher in women with PCOS than in controls. However, these hormones show a poor performance in recognizing women with hyperandrogenism, as currently defined. The relationships of these androgens with insulin sensitivity strongly differ from that of FT, suggesting a different role of classic and 11-oxygenated androgens in the pathophysiology of PCOS.
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Affiliation(s)
- Flavia Tosi
- Endocrinology, Diabetes and Metabolism, University of Verona and Azienda Ospedaliera Universitaria Integrata Verona, I-37126 Verona, Italy
| | - Michela Villani
- Endocrinology, Diabetes and Metabolism, University of Verona and Azienda Ospedaliera Universitaria Integrata Verona, I-37126 Verona, Italy
| | - Sabrina Garofalo
- Endocrinology, Diabetes and Metabolism, University of Verona and Azienda Ospedaliera Universitaria Integrata Verona, I-37126 Verona, Italy
| | - Giulia Faccin
- Endocrinology, Diabetes and Metabolism, University of Verona and Azienda Ospedaliera Universitaria Integrata Verona, I-37126 Verona, Italy
| | - Enzo Bonora
- Endocrinology, Diabetes and Metabolism, University of Verona and Azienda Ospedaliera Universitaria Integrata Verona, I-37126 Verona, Italy
| | - Tom Fiers
- Laboratory for Hormonology and Department of Endocrinology, Ghent University Hospital, 9000 Ghent, Belgium
| | - Jean-Marc Kaufman
- Laboratory for Hormonology and Department of Endocrinology, Ghent University Hospital, 9000 Ghent, Belgium
| | - Paolo Moghetti
- Endocrinology, Diabetes and Metabolism, University of Verona and Azienda Ospedaliera Universitaria Integrata Verona, I-37126 Verona, Italy
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23
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Controversies in the Pathogenesis, Diagnosis and Treatment of PCOS: Focus on Insulin Resistance, Inflammation, and Hyperandrogenism. Int J Mol Sci 2022; 23:ijms23084110. [PMID: 35456928 PMCID: PMC9030414 DOI: 10.3390/ijms23084110] [Citation(s) in RCA: 73] [Impact Index Per Article: 36.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 04/02/2022] [Accepted: 04/04/2022] [Indexed: 02/08/2023] Open
Abstract
Polycystic ovary syndrome (PCOS) is a heterogeneous and extremely common disease with symptoms that vary with the age of the patient, typically characterized by hyperandrogenism, chronic oligo-anovulation, and/or several metabolic disorders. The syndrome includes various phenotypes, and the pathogenesis is multifactorial, often involving insulin resistance. This feature is closely related to ovarian dysfunction, inflammation, hyperandrogenism, and metabolic disorders, which characterize and complicate the syndrome. Therapy currently considers both lifestyle improvements and medications, and must be tailored on a case-by-case basis. To date, the published studies have not arrived at a definition of the most suitable therapy for each individual case and many of the drugs used are still off-label. In this review, we discuss some controversial diagnostic and therapeutic aspects of PCOS, such as the role of insulin resistance, inflammation, and hyperandrogenism. We also evaluated the advantages and disadvantages of contraceptive therapy and antiandrogens.
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24
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Lee I, Vresilovic J, Irfan M, Gallop R, Dokras A. Higher Incidence of Metabolic Syndrome in Black Women With Polycystic Ovary Syndrome: A Longitudinal Study. J Clin Endocrinol Metab 2022; 107:e1558-e1567. [PMID: 34928388 DOI: 10.1210/clinem/dgab840] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Indexed: 11/19/2022]
Abstract
CONTEXT Cross-sectional studies have identified an increased risk of metabolic syndrome (MetSyn) in women with polycystic ovary syndrome (PCOS), but longitudinal data are limited and primarily include White and European cohorts. OBJECTIVE To compare the longitudinal risk of MetSyn in Black and White women with PCOS and to identify potential factors mediating the risk of MetSyn. METHODS Longitudinal cohort study with a follow-up of 5.3 years at an academic medical center. OF 247 adult women with hyperandrogenic PCOS phenotype with 2 or more visits at least 3 years apart. The main outcome measure was incidence of MetSyn in Black and White women with PCOS. RESULTS Using a mixed-effects model over time, the incidence of MetSyn was higher in Black women (45.9 ± 4.74 per 100 person-years) than in White women (31.3 ± 3.03 per 100 person-years) (P < .01) after adjusting for age and medication status. This difference persisted among women under age 30. Among Black women who did not have MetSyn at their prior visit, 28.0% had MetSyn at the next visit, compared with 12.1% of White women after adjusting for age and medication status (P < .01). In both races, the model-based estimated rates of MetSyn increased significantly with increase in body mass index and free testosterone. CONCLUSION We describe a persistent higher incidence of MetSyn in Black than in White women with PCOS. In addition to early cardiometabolic screening at the time of diagnosis, our findings highlight the need for ongoing and frequent screening in this population.
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Affiliation(s)
- Iris Lee
- Department of Obstetrics and Gynecology, University of Pennsylvania; Philadelphia, PA 19104, USA
| | - Julia Vresilovic
- Department of Obstetrics and Gynecology, University of Pennsylvania; Philadelphia, PA 19104, USA
| | - Maryam Irfan
- Department of Obstetrics and Gynecology, University of Pennsylvania; Philadelphia, PA 19104, USA
| | - Robert Gallop
- Department of Biostatistics, University of Pennsylvania; Philadelphia, PA 19104, USA
| | - Anuja Dokras
- Department of Obstetrics and Gynecology, University of Pennsylvania; Philadelphia, PA 19104, USA
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25
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Medeiros SFD, Barbosa BB, Medeiros MASD, Yamamoto AKLW, Yamamoto MMW. Adrenal Androgen Predictive Effects on Clinical and Metabolic Abnormalities of Polycystic Ovary Syndrome. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRICIA : REVISTA DA FEDERACAO BRASILEIRA DAS SOCIEDADES DE GINECOLOGIA E OBSTETRICIA 2022; 44:142-153. [PMID: 35213912 PMCID: PMC9948267 DOI: 10.1055/s-0041-1741030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To examine the possible effects of adrenal prohormones in the prediction of clinical and metabolic abnormalities in women with polycystic ovary syndrome (PCOS). METHODS The present study enrolled 299 normal cycling non-PCOS, 156 normoandrogenemic, and 474 hyperandrogenemic women with PCOS. Baseline characteristics were compared using a chi-squared test or analysis of variance (ANOVA) as appropriate. The roles of adrenal prohormones and their ratios with total testosterone in predicting co-occurring morbidities in women PCOS were evaluated using univariate and multivariate logistic regression analyses. RESULTS Adrenal hyperandrogenism per dehydroepiandrosterone sulfate (DHEAS) levels were found in 32% of women with PCOS. In non-PCOS women, dehydroepiandrosterone (DHEA) and its sulfate had no predictive role concerning clinical, anthropometric, and metabolic parameters. In PCOS women, mainly in the hyperandrogenemic group, DHEA showed to be a significant predictor against most anthropometric-metabolic index abnormalities (odds ratio [OR] = 0.36-0.97; p < 0.05), and an increase in triglycerides (TG) levels (OR = 0.76; p = 0.006). Dehydroepiandrosterone sulfate presented a few predictive effects regarding PCOS-associated disorders. In controls, DHEAS predicted against the increase in estimated average glucose (OR= 0.38; p = 0.036). In the normoandrogenic group, it predicted against elevation in the waist/hip ratio (WHR) (OR= 0.59; p = 0.042), and in hyperandrogenemic PCOS women, it predicted against abnormality in the conicity index (CI) (OR = 0.31; p = 0.028). CONCLUSION Dehydroepiandrosterone was shown to be a better predictor of abnormal anthropometric and biochemical parameters in women with PCOS than DHEAS. Thus, regarding adrenal prohormones, DHEA measurement, instead of DHEAS, should be preferred in PCOS management. The effects of androgen prohormones on the prediction of PCOS abnormalities are weak.
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Affiliation(s)
- Sebastião Freitas de Medeiros
- Department of Gynecology and Obstetrics, Medical School, Universidade Federal do Mato Grosso, Cuiabá, MT, Brazil.,Instituto Tropical de Medicina Reprodutiva, Cuiabá, MT, Brazil
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26
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Falcetta P, Benelli E, Molinaro A, Di Cosmo C, Bagattini B, Del Ghianda S, Salvetti G, Fiore E, Pucci E, Fruzzetti F, Tonacchera M. Effect of aging on clinical features and metabolic complications of women with polycystic ovary syndrome. J Endocrinol Invest 2021; 44:2725-2733. [PMID: 34089497 PMCID: PMC8572193 DOI: 10.1007/s40618-021-01594-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 05/13/2021] [Indexed: 10/26/2022]
Abstract
PURPOSE To assess the distribution of clinical features and metabolic abnormalities of polycystic ovary syndrome (PCOS) women according to their age. METHODS Retrospective study on 602 women (mean age 23.9 ± 6.2 years), diagnosed according to International PCOS Network Guidelines criteria as having PCOS in a University-based Hospital. Anthropometric features, hormonal and metabolic parameters were measured and compared between the different age groups (group A ≤ 20 years; group B 21-30 years; group C > 30 years). RESULTS Patients in group A were more often hyperandrogenic, while in group C hypertension, dyslipidemia, obesity, impaired fasting glucose, and insulin resistance (IR) were more prevalent. After adjusting for BMI, age correlated positively with sex hormone-binding globulin (SHBG), IR, total- and LDL-cholesterol, and negatively with DHEAS, insulin, and free androgen index (FAI). SHBG was significantly associated with IR and atherogenic dyslipidemia, while FAI levels were linked to hypertension, independently of other factors considered. Furthermore, the regression analysis showed a stronger relationship between BMI and metabolic outcomes, regardless of age. CONCLUSION Polycystic ovarian syndrome (PCOS) phenotype changes with age. Clinical and biochemical hyperandrogenism are a major concern in young PCOS women, while metabolic burden tends to increase with aging. Some of the cardiovascular risk factors are dependent on FAI and SHBG levels, whereas BMI confirms its key role in the genesis of most of the metabolic sequelae in PCOS, independently of age.
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Affiliation(s)
- P Falcetta
- Section of Endocrinology, Department of Clinical and Experimental Medicine, University Hospital of Pisa, Via Paradisa, 2, 56124, Pisa, Italy.
| | - E Benelli
- Section of Endocrinology, Department of Clinical and Experimental Medicine, University Hospital of Pisa, Via Paradisa, 2, 56124, Pisa, Italy
| | - A Molinaro
- Section of Endocrinology, Department of Clinical and Experimental Medicine, University Hospital of Pisa, Via Paradisa, 2, 56124, Pisa, Italy
| | - C Di Cosmo
- Section of Endocrinology, Department of Clinical and Experimental Medicine, University Hospital of Pisa, Via Paradisa, 2, 56124, Pisa, Italy
| | - B Bagattini
- Section of Endocrinology, Department of Clinical and Experimental Medicine, University Hospital of Pisa, Via Paradisa, 2, 56124, Pisa, Italy
| | - S Del Ghianda
- Section of Endocrinology, Department of Clinical and Experimental Medicine, University Hospital of Pisa, Via Paradisa, 2, 56124, Pisa, Italy
| | - G Salvetti
- Section of Endocrinology, Department of Clinical and Experimental Medicine, University Hospital of Pisa, Via Paradisa, 2, 56124, Pisa, Italy
| | - E Fiore
- Section of Endocrinology, Department of Clinical and Experimental Medicine, University Hospital of Pisa, Via Paradisa, 2, 56124, Pisa, Italy
| | - E Pucci
- Section of Endocrinology, Department of Clinical and Experimental Medicine, University Hospital of Pisa, Via Paradisa, 2, 56124, Pisa, Italy
| | - F Fruzzetti
- Department of Obstetrics and Gynecology, University Hospital of Pisa, Pisa, Italy
| | - M Tonacchera
- Section of Endocrinology, Department of Clinical and Experimental Medicine, University Hospital of Pisa, Via Paradisa, 2, 56124, Pisa, Italy
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27
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Alahmadi AA, Alahmadi BA, Wahman LF, El-Shitany NA. Chamomile flower extract ameliorates biochemical and histological kidney dysfunction associated with polycystic ovary syndrome. Saudi J Biol Sci 2021; 28:6158-6166. [PMID: 34764746 PMCID: PMC8568996 DOI: 10.1016/j.sjbs.2021.06.066] [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: 12/16/2020] [Revised: 06/21/2021] [Accepted: 06/22/2021] [Indexed: 01/06/2023] Open
Abstract
Polycystic ovary syndrome (PCOS) is the most prevalent endocrine disorder in females of childbearing age and research findings have revealed a potential association between PCOS and renal dysfunction. This study aimed to investigate renal dysfunction that might be associated with PCOS in rats and to evaluate the potential protective effect of chamomile against PCOS complicated by kidney damage. A rat model of PCOS was induced by injecting estradiol valerate (0.2 mg/rat × 2) into adult virgin female rats. Rats were treated with either ethyl alcohol extract of chamomile flower (75 mg/kg/day) or metformin (Met) (500 mg/kg/day). Induction of PCOS was associated with increased relative right kidney weight percentage and increased serum levels of urea, lipid peroxide product, and testosterone. PCOS was also associated with increased p53 expression in kidney glomeruli and medullary tubules with decreased Bcl2 expression in kidney glomeruli. Administration of chamomile extract significantly decreased levels of serum urea, testosterone, and lipid peroxide product, and p53 expression in kidney glomeruli and tubules. The extract significantly increased levels of antioxidant markers levels (reduced glutathione, catalase, and superoxide dismutase) and the expression of the anti-apoptotic gene Bcl2. Conversely, administration of Met did not improve serum levels of urea. Met also exerted no pronounced effect on p53 gene expression. The results of this study highlight the importance of monitoring kidney function in patients with PCOS and investigating the associated underlying mechanism. Chamomile extract was found to ameliorate kidney damage associated with PCOS through antioxidant, testosterone-lowering, and anti-apoptotic mechanisms.
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Affiliation(s)
- Ahlam A. Alahmadi
- Department of Biological Sciences, College of Science, King Abdulaziz University, Saudi Arabia
| | - Bassam A. Alahmadi
- Department of Biology, College of Science, Taibah University, Saudi Arabia
| | - Lobna F. Wahman
- Biology and Hormones Department, National Organization for Drug Control and Research (NODCAR), Egypt
| | - Nagla A. El-Shitany
- Department of Pharmacology and Toxicology, College of Pharmacy, King Abdulaziz University, Saudi Arabia
- Department of Pharmacology and Toxicology, College of Pharmacy, Tanta University, Egypt
- Yousef Abdullatif Jameel Chair of Prophetic Medicine Application, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
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28
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Jacewicz-Święcka M, Wołczyński S, Kowalska I. The Effect of Ageing on Clinical, Hormonal and Sonographic Features Associated with PCOS-A Long-Term Follow-Up Study. J Clin Med 2021; 10:jcm10102101. [PMID: 34068234 PMCID: PMC8153136 DOI: 10.3390/jcm10102101] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Revised: 05/09/2021] [Accepted: 05/10/2021] [Indexed: 01/21/2023] Open
Abstract
The knowledge of polycystic ovary syndrome (PCOS) natural history is limited. Our objective was to assess the effect of aging on clinical, hormonal and sonographic ovarian PCOS features and additionally to identify parameters that impact the course of PCOS. A secondary aim was to supply additional information on the reproductive outcome in women with previously diagnosed PCOS. A longitudinal cohort study with a median follow-up of 120.9 months was conducted, and 31 Caucasian women previously diagnosed with PCOS according to the Rotterdam criteria were re-examined at a median age of 35. Clinical examinations; transvaginal ultrasound scans; and lipid, E-selectin and sex hormone assessments were performed at the beginning and at the end of the follow-up. It was observed that menstrual cycles became regular and sonographic morphology of ovaries was normalized in 55% and 49% of the participants, respectively (all p < 0.05). At the final assessment, 55% of the women no longer met the criteria for PCOS (p < 0.05). The age, follicle-stimulating hormone (FSH) and E-selectin assessed at the baseline were the most important predictors of the PCOS persistence into later years (respectively, OR = 0.84, OR = 0.39, OR = 1.08, all p < 0.05). Ninety-five percent of the patients who had ever been trying to conceive became pregnant a minimum of once. The women with persistent PCOS had worse metabolic and reproductive parameters compared to the women with resolved PCOS. Positive correlations were found between the number of miscarriages and ovarian volume, LH, androstenedione, 17-hydroxyprogesterone and an increase in E-selectin during the follow-up (R = 0.46, R = 0.59, R = 0.54, R = 0.49, R = 0.47, all p < 0.05). In conclusion, progressing from the third to the fourth decade is connected with a reduction in PCOS features, which seems to have a great impact on fertility of women with a previous diagnosis of PCOS. FSH and E-selectin, as determined at the initial PCOS diagnosis, had an impact on the disappearance of the syndrome years after.
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Affiliation(s)
- Małgorzata Jacewicz-Święcka
- Department of Endocrinology, Diabetology and Internal Medicine, Medical University of Bialystok, 15-089 Białystok, Poland
- Correspondence: or ; Tel.: +48-85-731-8239
| | - Sławomir Wołczyński
- Department of Reproduction and Gynaecological Endocrinology, Medical University of Bialystok, 15-276 Białystok, Poland;
| | - Irina Kowalska
- Department of Internal Medicine and Metabolic Diseases, Medical University of Bialystok, 15-089 Białystok, Poland;
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de Medeiros SF, Barbosa BB, de Medeiros AKLWY, de Medeiros MAS, Yamamoto MMW. Differential Effects of Various Androgens on Polycystic Ovary Syndrome. Horm Metab Res 2021; 53:341-349. [PMID: 33878788 DOI: 10.1055/a-1422-3243] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
The hyperandrogenism in polycystic ovary syndrome (PCOS) is associated with the risk for the future development of the cardiovascular disease. The objective of the study is to verify whether different androgens have the same harmful effect. This cross-sectional study enrolled 823 women with PCOS: 627 (76.2%) with biochemical hyperandrogenism and 196 (23.8%) with normal androgen levels. The role of individual androgen was evaluated using univariate and multivariate logistic regression. In normoandrogenemic PCOS (NA-PCOS), free androgen index (FAI) predicted significant abnormality in visceral adipose index (VAI, OR=9.2, p=0.002) and dehydroepiandrosterone (DHEA) predicted against alteration in β-cell function (OR=0.5, p=0.007). In hyperandrogenemic PCOS (HA-PCOS), FAI predicted derangements in waist triglyceride index (WTI), VAI, and lipid accumulation product (LAP) (OR ranging from 1.6 to 5.8, p<0.05). DHEA weakly predicted against VAI (OR 0.7, p=0.018), dehydroepiandrosterone sulfate (DHEAS) tended to predict against the conicity index (OR=0.7, p=0.037). After multiple regression, FAI retained significant strength to predict various anthropometric and metabolic abnormalities (OR ranging from 1.1 to 3.0, p<0.01), DHEA was kept as a protector factor against WTI, LAP, and VAI (OR ranging from 0.6 to 0.9; p<0.01) and DHEAS against the conicity index (OR=0.5, p<0.001). In conclusion, the free androgen index was the most powerful predictor of anthropometric and metabolic abnormalities of polycystic ovary syndrome. Conversely, DHEA and DHEAS demonstrated protective effects against disorders in some markers of obesity and abnormal metabolism.
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Affiliation(s)
- Sebastião Freitas de Medeiros
- Department of Gynecology and Obstetrics, Medical School, Federal University of Mato Grosso, Cuiabá, MT, Brazil
- Tropical Institute of Reproductive Medicine, Cuiabá, MT, Brazil
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Prevalence of at-risk hyperandrogenism by age and race/ethnicity among females in the United States using NHANES III. Eur J Obstet Gynecol Reprod Biol 2021; 260:189-197. [PMID: 33838556 DOI: 10.1016/j.ejogrb.2021.03.033] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 03/16/2021] [Accepted: 03/20/2021] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Hyperandrogenism in females leads to multiple endocrine and metabolic disorders including polycystic ovary syndrome (PCOS) that yields adverse health outcomes across all ages. We sought to estimate the prevalence of hyperandrogenemia and at-risk hyperandrogenism among the US females of different age groups, racial/ethnic, and metabolic characteristics. MATERIALS AND METHODS A retrospective population-based cross-sectional study of females 6 years or older having serum testosterone measures using the National Health and Nutrition Examination Surveys, 2013-2016 was conducted. Age-appropriate thresholds as per assay methods were used for evaluating high total testosterone, low sex hormone binding globulin (SHBG), and high free androgen index (FAI) levels. The weighted analysis was performed to estimate prevalence and 95 % confidence interval (CI). RESULTS The prevalence of at-risk hyperandrogenism was estimated as 19.8 % (95 %CI: 18.6 %, 21.2 %) in the overall sample, 11.8 % (95 %CI: 9.5 %, 14.5 %) in prepubertal, 20.5 % (95 %CI: 18.9 %, 22.2 %) in premenopausal, and 21.1 % (95 %CI: 18.7 %-23.7 %) in postmenopausal females with considerable heterogeneity by racial/ethnic and metabolic characteristics. In the entire sample, hyperandrogenemia was estimated as 10.4 % and 4.3 % using total testosterone and FAI respectively while 10.7 % cases had a low SHBG. CONCLUSIONS At-risk hyperandrogenism is equally prevalent in premenopausal and postmenopausal women with a considerable amount in prepubertal females and varied by racial/ethnic groups depending on specific ages. Regular screening of hyperandrogenism using SHBG and total testosterone measures among at-risk subjects for specific ages is critical for treating and preventing adverse consequences of abnormal hormonal parameters.
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de Medeiros SF, Rodgers RJ, Norman RJ. Adipocyte and steroidogenic cell cross-talk in polycystic ovary syndrome. Hum Reprod Update 2021; 27:771-796. [PMID: 33764457 DOI: 10.1093/humupd/dmab004] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 01/08/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Metabolic and endocrine alterations in women with polycystic ovary syndrome (PCOS) affect adipose tissue mass and distribution. PCOS is characterised by hyperandrogenism, obesity and adipocyte dysfunction. Hyperandrogenism in PCOS drives dysfunctional adipocyte secretion of potentially harmful adipocytokines. Glucocorticoids and sex-steroids modulate adipocyte development and function. For their part, adipocyte products interact with adrenal and ovarian steroidogenic cells. Currently, the relationship between adipocyte and steroidogenic cells is not clear, and for these reasons, it is important to elucidate the interrelationship between these cells in women with and without PCOS. OBJECTIVE AND RATIONALE This comprehensive review aims to assess current knowledge regarding the interrelationship between adipocytes and adrenal and ovarian steroidogenic cells in animal models and humans with or without PCOS. SEARCH METHODS We searched for articles published in English and Portuguese in PubMed. Keywords were as follows: polycystic ovary syndrome, steroidogenesis, adrenal glands, theca cells, granulosa cells, adipocytes, adipocytokines, obesity, enzyme activation, and cytochrome P450 enzymes. We expanded the search into the references from the retrieved articles. OUTCOMES Glucocorticoids and sex-steroids modulate adipocyte differentiation and function. Dysfunctional adipocyte products play important roles in the metabolic and endocrine pathways in animals and women with PCOS. Most adipokines participate in the regulation of the hypothalamic-pituitary-adrenal and ovarian axes. In animal models of PCOS, hyperinsulinemia and poor fertility are common; various adipokines modulate ovarian steroidogenesis, depending on the species. Women with PCOS secrete unbalanced levels of adipocyte products, characterised by higher levels of leptin and lower levels of adiponectin. Leptin expression positively correlates with body mass index, waist/hip ratio and levels of total cholesterol, triglyceride, luteinising hormone, oestradiol and androgens. Leptin inhibits the production of oestradiol and, in granulosa cells, may modulate 17-hydroxylase and aromatase enzyme activities. Adiponectin levels negatively correlate with fat mass, body mass index, waist-hip ratio, glucose, insulin and triglycerides, and decrease androgen production by altering expression of luteinising hormone receptor, steroidogenic acute regulatory protein, cholesterol-side-chain cleavage enzyme and 17-hydroxylase. Resistin expression positively correlates with body mass index and testosterone, and promotes the expression of 17-hydroxylase enzyme in theca cells. The potential benefits of adipokines in the treatment of women with PCOS require more investigation. WIDER IMPLICATIONS The current data regarding the relationship between adipocyte products and steroidogenic cells are conflicting in animals and humans. Polycystic ovary syndrome is an excellent model to investigate the interrelationship among adipocyte and steroidogenic cells. Women with PCOS manifest some pathological conditions associated with hyperandrogenism and adipocyte products. In animals, cross-talk between cells may vary according to species, and the current review suggests opportunities to test new medications to prevent or even reverse several harmful sequelae of PCOS in humans. Further studies are required to investigate the possible therapeutic application of adipokines in women with obese and non-obese PCOS. Meanwhile, when appropriate, metformin use alone, or associated with flutamide, may be considered for therapeutic purposes.
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Affiliation(s)
- Sebastião Freitas de Medeiros
- Department of Gynecology and Obstetrics, Medical School, Federal University of Mato Grosso; and Tropical Institute of Reproductive Medicine,Cuiabá, MT, Brazil
| | - Raymond Joseph Rodgers
- Paediatrics and Reproductive Health, The University of Adelaide, Adelaide, South Australia, Australia
| | - Robert John Norman
- Robinson Research Institute Adelaide Medical School, Adelaide, South Australia, Australia
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Hoeger KM, Dokras A, Piltonen T. Update on PCOS: Consequences, Challenges, and Guiding Treatment. J Clin Endocrinol Metab 2021; 106:e1071-e1083. [PMID: 33211867 DOI: 10.1210/clinem/dgaa839] [Citation(s) in RCA: 198] [Impact Index Per Article: 66.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Indexed: 02/07/2023]
Abstract
Polycystic ovary syndrome (PCOS) is one of the most common reproductive endocrine disorders in women and despite this, diagnostic challenges, delayed diagnosis, and less-than-optimal treatment regimens plague the condition. The International PCOS network, consisting of geographically diverse international experts in PCOS as well as consumers, engaged in a multi-year international evidence-based guideline development process that was jointly sponsored by the European Society for Human Reproduction and Embryology (ESHRE) and the American Society of Reproductive Medicine (ASRM). The guideline was published in 2018 and endorsed by more than 40 international societies involved in PCOS. Translation of this evidence-based guideline to medical practice and consumer groups remains a priority. However, there remain many challenges to both understanding the diagnosis and treatment of PCOS. Evidence suggests that both clinicians and consumers are not satisfied with the timeliness of diagnosis and treatment options. This review summarizes the important findings for diagnosis and treatment from the guidelines and expands on recent developments in the literature since its publication. Special attention to diagnosis at the ends of the reproductive spectrum are discussed and remaining areas of controversy are noted. Additionally, the review highlights some of the remaining challenges in the understanding and management of PCOS to help guide clinicians and investigators in this perplexing condition.
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Affiliation(s)
- Kathleen M Hoeger
- Department of OBGYN, University of Rochester Medical Center, Rochester, NY, USA
| | - Anuja Dokras
- Department of OBGYN, University of Pennsylvania, Philadelphia, PA, USA
| | - Terhi Piltonen
- Department of OBGYN, University of Oulu PEDEGO Research Unit, Medical Research Centre, Oulu University Hospital, Oulu, Finland
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Cooney LG, Dokras A. Cardiometabolic Risk in Polycystic Ovary Syndrome: Current Guidelines. Endocrinol Metab Clin North Am 2021; 50:83-95. [PMID: 33518188 DOI: 10.1016/j.ecl.2020.11.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Polycystic ovary syndrome is a common endocrine disorder in reproductive-aged women and is associated with an increased risk of metabolic abnormalities, including obesity, impaired glucose tolerance, diabetes, dyslipidemia, metabolic syndrome, venous thromboembolism, and subclinical atherosclerosis. Clinicians and patients alike need to be aware of these increased risks as well as new international guidelines that recommend frequent screening and active management of metabolic abnormalities. Given that the data on risk of cardiovascular events, such as myocardial infarction and stroke, in women with PCOS is mixed, future large-scale, longitudinal studies are needed to clarify these potential risks.
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Affiliation(s)
- Laura G Cooney
- Department of Obstetrics and Gynecology, University of Wisconsin, Generations Fertility Care, 2365 Deming Way, Middleton, WI 53562, USA
| | - Anuja Dokras
- Department of Obstetrics and Gynecology, University of Pennsylvania, Penn Fertility Care, 3701 Market Street, Suite 800, Philadelphia, PA 19085, USA.
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Chien YJ, Chang CY, Wu MY, Chen CH, Horng YS, Wu HC. Effects of Curcumin on Glycemic Control and Lipid Profile in Polycystic Ovary Syndrome: Systematic Review with Meta-Analysis and Trial Sequential Analysis. Nutrients 2021; 13:684. [PMID: 33669954 PMCID: PMC7924860 DOI: 10.3390/nu13020684] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 02/09/2021] [Accepted: 02/18/2021] [Indexed: 12/11/2022] Open
Abstract
The therapeutic effects of curcumin for polycystic ovary syndrome (PCOS) remain inconclusive. The present study aims to evaluate the effects of curcumin on glycemic control and lipid profile in patients with PCOS. PubMed, Embase, Scopus, Web of Science, and Cochrane Library were searched from the inception through 28 November 2020. Randomized control trials (RCTs), which enrolled adult patients with PCOS, compared curcumin with placebo regarding the glycemic control and lipid profile, and reported sufficient information for performing meta-analysis, were included. Three RCTs were included. Curcumin significantly improves fasting glucose (mean difference (MD): -2.77, 95% confidence interval (CI): -4.16 to -1.38), fasting insulin (MD: -1.33, 95% CI: -2.18 to -0.49), Homeostasis Model Assessment of Insulin Resistance (HOMA-IR) (MD: -0.32, 95% CI: -0.52 to -0.12), and quantitative insulin sensitivity check index (QUICKI) (MD: 0.010, 95% CI: 0.003-0.018). It also significantly improves high-density lipoprotein (MD: 1.92, 95% CI: 0.33-3.51) and total cholesterol (MD: -12.45, 95% CI: -22.05 to -2.85). In contrast, there is no statistically significant difference in the improvement in low-density lipoprotein (MD: -6.02, 95% CI: -26.66 to 14.62) and triglyceride (MD: 8.22, 95% CI: -26.10 to 42.53) between curcumin and placebo. The results of the fasting glucose, fasting insulin, HOMA-IR, QUICKI, and total cholesterol are conclusive as indicated by the trial sequential analysis. Curcumin may improve glycemic control and lipid metabolism in patients with PCOS and metabolic abnormality without significant adverse effects. Further studies are advocated to investigate the potential effects of curcumin on hyperandrogenism.
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Affiliation(s)
- Yung-Jiun Chien
- Department of Physical Medicine and Rehabilitation, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City 231, Taiwan;
- School of Medicine, Tzu Chi University, Hualien 970, Taiwan; (C.-Y.C.); (M.-Y.W.)
| | - Chun-Yu Chang
- School of Medicine, Tzu Chi University, Hualien 970, Taiwan; (C.-Y.C.); (M.-Y.W.)
- Department of Anesthesiology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City 231, Taiwan
| | - Meng-Yu Wu
- School of Medicine, Tzu Chi University, Hualien 970, Taiwan; (C.-Y.C.); (M.-Y.W.)
- Department of Emergency Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City 231, Taiwan
| | - Chih-Hao Chen
- Department of Otolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital, Taipei 112, Taiwan;
| | - Yi-Shiung Horng
- Department of Physical Medicine and Rehabilitation, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City 231, Taiwan;
- School of Medicine, Tzu Chi University, Hualien 970, Taiwan; (C.-Y.C.); (M.-Y.W.)
| | - Hsin-Chi Wu
- Department of Physical Medicine and Rehabilitation, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City 231, Taiwan;
- School of Medicine, Tzu Chi University, Hualien 970, Taiwan; (C.-Y.C.); (M.-Y.W.)
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Abstract
The etiology of polycystic ovary syndrome (PCOS) remains unclear, although studies indicate that both genetic and environmental factors contribute to the syndrome. In 2012, Tremellen and Pearce proposed the idea that dysbiosis of the intestinal (gut) microbiome is a causative factor of metabolic and reproductive manifestations of PCOS. In the past 5 years, studies in both humans and rodent models have demonstrated that changes in the taxonomic composition of gut bacteria are associated with PCOS. Studies have also clearly shown that these changes in gut microbiota are associated with PCOS as opposed to obesity, since these changes are observed in women with PCOS that are both of a normal weight or obese, as well as in adolescent girls with PCOS and obesity compared with body mass index- and age-matched females without the disorder. Additionally, studies in both women with PCOS and rodent models of PCOS demonstrated that hyperandrogenism is associated with gut microbial dysbiosis, indicating that androgens may modulate the gut microbial community in females. One study reported that the fecal microbiome transplantation of stool from women with PCOS or exposure to certain bacteria resulted in a PCOS-like phenotype in mice, while other studies showed that exposure to a healthy gut microbiome, pre/probiotics, or specific gut metabolites resulted in protection from developing PCOS-like traits in mice. Altogether, these results suggest that dysbiosis of the gut microbiome may be sufficient to develop PCOS-like symptoms and that modulation of the gut microbiome may be a potential therapeutic target for PCOS.
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Affiliation(s)
- Maryan G Rizk
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Diego, California, USA
| | - Varykina G Thackray
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Diego, California, USA
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Liao Z, Fan H, Fan H, Chen X. Acupuncture for polycystic ovary syndrome: An overview of a protocol for systematic reviews and meta analyses. Medicine (Baltimore) 2021; 100:e24218. [PMID: 33546040 PMCID: PMC7837907 DOI: 10.1097/md.0000000000024218] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 12/16/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND As the results of previous systematic reviews and meta-analyses on acupuncture for polycystic ovary syndrome (PCOS) have provided inconsistent evidence. This overview of systematic reviews (SRs) and meta-analyses will aim to critically appraise the methodology and reporting quality of the relevant SRs and meta-analyses with the aim of identifying whether acupuncture could provide an effective treatment for patients with PCOS or not. METHODS Electronic databases including MEDLINE via Ovid, EMBASE, PubMed, Cochrane library, China National Knowledge Infrastructure (CNKI), Chinese Scientific Journal Database (VIP database), and Wanfang Database will be searched for related SRs and meta-analyses from inceptions to the search date without language restrictions. Two reviewers will independently select SRs and meta-analyses and collect related data, and a third reviewer will be introduced if any disagreement happened during the assessing. The Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) and the latest Assessment of Multiple Systematic Reviews 2 (AMSTAR2) checklists will be employed to evaluate the reporting and methodology quality. RESULTS This overview will be published in a peer-reviewed journal. CONCLUSION This overview will identify related SRs and meta-analyses of acupuncture for treating PCOS. ETHICS AND DISSEMINATION Ethics approval and patient consent are not required as this study is an overview based on published systematic reviews and meta-analyses.
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Affiliation(s)
- Zaibo Liao
- The Center of Gerontology and Geriatrics, West China Hospital, Sichuan University / West China School of Nursing, Sichuan University
| | - Huaying Fan
- College of Acupuncture and Tuina, Chengdu University of Traditional Chinese Medicine
| | - Huayu Fan
- Respiratory Failure Center and Lung Transplant Unit, Sicuhan Province Hospital
| | - Xiaohua Chen
- Department of Central Transportation Center, West China Hospital, Sichuan University, Chengdu city, Sichuan Province, China
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Are Dietary Indices Associated with Polycystic Ovary Syndrome and Its Phenotypes? A Preliminary Study. Nutrients 2021; 13:nu13020313. [PMID: 33499268 PMCID: PMC7911683 DOI: 10.3390/nu13020313] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 01/13/2021] [Accepted: 01/20/2021] [Indexed: 12/25/2022] Open
Abstract
Polycystic ovary syndrome (PCOS) is a complex hormonal disorder which impairs ovarian function. The adherence to healthy dietary patterns and physical exercise are the first line of recommended treatment for PCOS patients, but it is yet unclear what type of diet is more adequate. In this case-control study, we explored associations between adherence to five dietary quality indices and the presence of PCOS. We enrolled 126 cases of PCOS and 159 controls living in Murcia (Spain). Diagnostic of PCOS and its phenotypes were established following the Rotterdam criteria (hyperandrogenism (H), oligoanovulation (O), polycystic ovaries morphology (POM)). We used a validated food frequency questionnaires to calculate the scores of five dietary indices: alternate Healthy Eating index (AHEI), AHEI-2010, relative Mediterranean Dietary Score (rMED), alternate Mediterranean Dietary Score (aMED) and Dietary Approaches to Stop Hypertension (DASH). We used multivariable logistic regression to estimate adjusted odds ratios and confidence intervals. In the multivariable analysis, AHEI-2010 index was inversely associated with Hyperandrogenism + Oligoanovulation PCOS phenotype (ORQ3 vs. Q1 = 0.1; 95% CI: (0.0; 0.9); Pfor trend = 0.02). We did not find any statistical significant association between dietary indices and total anovulatory or ovulatory PCOS. However, further studies with higher sample sizes exploring these associations among the diverse phenotypes of PCOS are highly warranted.
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Ding H, Zhang J, Zhang F, Zhang S, Chen X, Liang W, Xie Q. Resistance to the Insulin and Elevated Level of Androgen: A Major Cause of Polycystic Ovary Syndrome. Front Endocrinol (Lausanne) 2021; 12:741764. [PMID: 34745009 PMCID: PMC8564180 DOI: 10.3389/fendo.2021.741764] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 09/22/2021] [Indexed: 01/27/2023] Open
Abstract
PCOS has a wide range of negative impacts on women's health and is one of the most frequent reproductive systemic endocrine disorders. PCOS has complex characteristics and symptom heterogeneity due to the several pathways that are involved in the infection and the absence of a comm14on cause. A recent study has shown that the main etiology and endocrine aspects of PCOS are the increased level of androgen, which is also known as "hyperandrogenemia (HA)" and secondly the "insulin resistance (IR)". The major underlying cause of the polycystic ovary is these two IR and HA, by initiating the disease and its severity or duration. As a consequence, study on Pathogenesis is crucial to understand the effect of "HA" and "IR" on the pathophysiology of numerous symptoms linked to PCOS. A deep understanding of the pattern of the growth in PCOS for HA and IR can help ameliorate the condition, along with adjustments in nutrition and life, as well as the discovery of new medicinal products. However, further research is required to clarify the mutual role of IR and HA on PCOS development.
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Affiliation(s)
- Haigang Ding
- Department of Gynecology, Shaoxing Maternity and Child Health Care Hospital, Shaoxing, China
- Obstetrics and Gynecology Hospital of Shaoxing University, Shaoxing, China
| | - Juan Zhang
- Department of Gynecology, Shaoxing Maternity and Child Health Care Hospital, Shaoxing, China
- Obstetrics and Gynecology Hospital of Shaoxing University, Shaoxing, China
| | - Feng Zhang
- Department of Gynecology, Shaoxing Maternity and Child Health Care Hospital, Shaoxing, China
- Obstetrics and Gynecology Hospital of Shaoxing University, Shaoxing, China
| | - Songou Zhang
- College of Medicine, Shaoxing University, Shaoxing, China
| | - Xiaozhen Chen
- College of Medicine, Shaoxing University, Shaoxing, China
| | - Wenqing Liang
- Medical Research Center, Zhoushan Hospital of Traditional Chinese Medicine Affiliated to Zhejiang Chinese Medical University, Zhoushan, China
- *Correspondence: Qiong Xie, ; Wenqing Liang,
| | - Qiong Xie
- Department of Gynecology, Zhoushan Hospital of Traditional Chinese Medicine Affiliated to Zhejiang Chinese Medical University, Zhoushan, China
- *Correspondence: Qiong Xie, ; Wenqing Liang,
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Hansen SL, Bojsen-Møller KN, Lundsgaard AM, Hendrich FL, Nilas L, Sjøberg KA, Hingst JR, Serup AK, Olguín CH, Carl CS, Wernblad LF, Henneberg M, Lustrup KM, Hansen C, Jensen TE, Madsbad S, Wojtaszewski JFP, Richter EA, Kiens B. Mechanisms Underlying Absent Training-Induced Improvement in Insulin Action in Lean, Hyperandrogenic Women With Polycystic Ovary Syndrome. Diabetes 2020; 69:2267-2280. [PMID: 32873590 DOI: 10.2337/db20-0062] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 08/24/2020] [Indexed: 11/13/2022]
Abstract
Women with polycystic ovary syndrome (PCOS) have been shown to be less insulin sensitive compared with control (CON) women, independent of BMI. Training is associated with molecular adaptations in skeletal muscle, improving glucose uptake and metabolism in both healthy individuals and patients with type 2 diabetes. In the current study, lean hyperandrogenic women with PCOS (n = 9) and healthy CON women (n = 9) completed 14 weeks of controlled and supervised exercise training. In CON, the training intervention increased whole-body insulin action by 26% and insulin-stimulated leg glucose uptake by 53% together with increased insulin-stimulated leg blood flow and a more oxidative muscle fiber type distribution. In PCOS, no such changes were found, despite similar training intensity and improvements in VO2max In skeletal muscle of CON but not PCOS, training increased GLUT4 and HKII mRNA and protein expressions. These data suggest that the impaired increase in whole-body insulin action in women with PCOS with training is caused by an impaired ability to upregulate key glucose-handling proteins for insulin-stimulated glucose uptake in skeletal muscle and insulin-stimulated leg blood flow. Still, other important benefits of exercise training appeared in women with PCOS, including an improvement of the hyperandrogenic state.
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Affiliation(s)
- Solvejg L Hansen
- Molecular Physiology Section, Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Copenhagen, Denmark
| | | | - Anne-Marie Lundsgaard
- Molecular Physiology Section, Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Copenhagen, Denmark
| | - Frederikke L Hendrich
- Molecular Physiology Section, Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Copenhagen, Denmark
| | - Lisbeth Nilas
- Department of Obstetrics and Gynaecology, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Kim A Sjøberg
- Molecular Physiology Section, Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Copenhagen, Denmark
| | - Janne R Hingst
- Molecular Physiology Section, Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Copenhagen, Denmark
| | - Annette K Serup
- Molecular Physiology Section, Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Copenhagen, Denmark
| | - Carlos Henríquez Olguín
- Molecular Physiology Section, Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Copenhagen, Denmark
| | - Christian S Carl
- Molecular Physiology Section, Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Copenhagen, Denmark
| | - Louise F Wernblad
- Molecular Physiology Section, Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Copenhagen, Denmark
| | - Marie Henneberg
- Molecular Physiology Section, Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Copenhagen, Denmark
| | - Katja M Lustrup
- Molecular Physiology Section, Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Copenhagen, Denmark
| | - Christine Hansen
- Molecular Physiology Section, Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Copenhagen, Denmark
| | - Thomas E Jensen
- Molecular Physiology Section, Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Copenhagen, Denmark
| | - Sten Madsbad
- Department of Endocrinology, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Jørgen F P Wojtaszewski
- Molecular Physiology Section, Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Copenhagen, Denmark
| | - Erik A Richter
- Molecular Physiology Section, Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Copenhagen, Denmark
| | - Bente Kiens
- Molecular Physiology Section, Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Copenhagen, Denmark
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Zaeemzadeh N, Sadatmahalleh SJ, Ziaei S, Kazemnejad A, Mottaghi A, Mohamadzadeh N, Movahedinejad M. Prevalence of metabolic syndrome in four phenotypes of PCOS and its relationship with androgenic components among Iranian women: A cross-sectional study. Int J Reprod Biomed 2020; 18:253-264. [PMID: 32494764 PMCID: PMC7218672 DOI: 10.18502/ijrm.v13i4.6888] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Revised: 10/15/2019] [Accepted: 10/21/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Polycystic ovary syndrome (PCOS) increases the risk of metabolic syndrome (MetS). Insulin resistance (IR) plays a major role in the pathophysiology of both PCOS and MetS. OBJECTIVE This study was designed to compare the prevalence of MetS among different phenotypes of PCOS and its relationship with androgenic components. MATERIALS AND METHODS 182 participants eligible for this five-group comparative study were selected by convenience sampling method. They were classified according to the Rotterdam criteria: clinical and/or biochemical hyperandrogenism (H) + PCOS on ultrasound (P) + ovulation disorders (O) (n = 41), clinical and/or biochemical H + PCOS on P (n = 33), PCOS on P + O (n = 40), clinical and/or biochemical H + O (n = 37), and control (without PCOS) (n = 31). MetS was measured based on the National Cholesterol Education Program Adult Treatment Panel III criteria. Androgenic components included free-androgen-index (FAI), total-testosterone (TT) level and sex-hormone-binding-globulin (SHBG). RESULTS A significant difference was observed between the study groups in terms of MetS prevalence (p = 0.01). In phenotype H+P+O, there was a statistically significant positive association between TG and TT, and a significant negative association between SBP and DBP with SHBG. In phenotype O+P, WC was inversely associated with SHBG. In phenotype H+O, FBS and TG were positively associated with FAI but HDL was inversely associated with FAI. Moreover, WC and DBP were positively associated with TT in phenotype H+O. No associations were detected between MetS parameters and androgenic components in other PCOS subjects (phenotype H+P) and in the control group. TT was significantly higher in the PCOS group suffering from MetS (p = 0.04). CONCLUSION According to the research results, hyperandrogenic components are potent predictors of metabolic disorders. Thus, we suggest that MetS screening is required for the prevention of MetS and its related complications in PCOS women.
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Affiliation(s)
- Narges Zaeemzadeh
- Department of Midwifery and Reproductive Health, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran.
| | | | - Saeideh Ziaei
- Department of Midwifery and Reproductive Health, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran.
| | - Anoshirvan Kazemnejad
- Department of Biostatistics, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran.
| | - Azadeh Mottaghi
- Research Center for Prevention of Cardiovascular Diseases, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences, Tehran, Iran.
| | - Neda Mohamadzadeh
- Department of Midwifery and Reproductive Health, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran.
| | - Maryam Movahedinejad
- Department of Midwifery and Reproductive Health, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran.
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Metabolic dysfunction in polycystic ovary syndrome: Pathogenic role of androgen excess and potential therapeutic strategies. Mol Metab 2020; 35:100937. [PMID: 32244180 PMCID: PMC7115104 DOI: 10.1016/j.molmet.2020.01.001] [Citation(s) in RCA: 170] [Impact Index Per Article: 42.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 12/30/2019] [Accepted: 01/03/2020] [Indexed: 12/16/2022] Open
Abstract
Background Polycystic ovary syndrome (PCOS) is the most common endocrinopathy among reproductive age women. Although its cardinal manifestations include hyperandrogenism, oligo/anovulation, and/or polycystic ovarian morphology, PCOS women often display also notable metabolic comorbidities. An array of pathogenic mechanisms have been implicated in the etiology of this heterogeneous endocrine disorder; hyperandrogenism at various developmental periods is proposed as a major driver of the metabolic and reproductive perturbations associated with PCOS. However, the current understanding of the pathophysiology of PCOS-associated metabolic disease is incomplete, and therapeutic strategies used to manage this syndrome's metabolic complications remain limited. Scope of review This study is a systematic review of the potential etiopathogenic mechanisms of metabolic dysfunction frequently associated with PCOS, with special emphasis on the metabolic impact of androgen excess on different metabolic tissues and the brain. We also briefly summarize the therapeutic approaches currently available to manage metabolic perturbations linked to PCOS, highlighting current weaknesses and future directions. Major conclusions Androgen excess plays a prominent role in the development of metabolic disturbances associated with PCOS, with a discernible impact on key peripheral metabolic tissues, including the adipose, liver, pancreas, and muscle, and very prominently the brain, contributing to the constellation of metabolic complications of PCOS, from obesity to insulin resistance. However, the current understanding of the pathogenic roles of hyperandrogenism in metabolic dysfunction of PCOS and the underlying mechanisms remain largely incomplete. In addition, the development of more efficient, even personalized therapeutic strategies for the metabolic management of PCOS patients persists as an unmet need that will certainly benefit from a better comprehension of the molecular basis of this heterogeneous syndrome.
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Liu Q, Xie YJ, Qu LH, Zhang MX, Mo ZC. Dyslipidemia involvement in the development of polycystic ovary syndrome. Taiwan J Obstet Gynecol 2020; 58:447-453. [PMID: 31307731 DOI: 10.1016/j.tjog.2019.05.003] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2019] [Indexed: 12/19/2022] Open
Abstract
Polycystic ovary syndrome (PCOS) is widely accepted as the most common endocrine abnormality in women of childbearing age and may be accompanied by dyslipidemia, hyperandrogenism, hyperinsulinemia, oxidative stress and infertility. Dyslipidemia is now known to play an important role in the development of PCOS. Lipid abnormalities, including elevated low-density lipoprotein and triglyceride levels and reduced high-density lipoprotein levels, are often found in women with PCOS and play an important role in PCOS; therefore, we summarize the effect of lipid abnormalities on hyperandrogenism, insulin resistance, oxidative stress and infertility in PCOS and review the effects of common lipid-lowering drugs on patients with PCOS. The purpose of this article is to elucidate the mechanisms of lipid metabolism abnormalities in the development of PCOS.
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Affiliation(s)
- Qi Liu
- Clinical Anatomy & Reproductive Medicine Application Institute, Department of Histology and Embryology, University of South China, Hengyang, Hunan, 421001, China.
| | - Yuan-Jie Xie
- Clinical Anatomy & Reproductive Medicine Application Institute, Department of Histology and Embryology, University of South China, Hengyang, Hunan, 421001, China.
| | - Li-Hua Qu
- Clinical Anatomy & Reproductive Medicine Application Institute, Department of Histology and Embryology, University of South China, Hengyang, Hunan, 421001, China.
| | - Meng-Xia Zhang
- Clinical Anatomy & Reproductive Medicine Application Institute, Department of Histology and Embryology, University of South China, Hengyang, Hunan, 421001, China; Department of Histology and Embryology, Human University of Chinese Medicine, Changsha, 410208, China.
| | - Zhong-Cheng Mo
- Clinical Anatomy & Reproductive Medicine Application Institute, Department of Histology and Embryology, University of South China, Hengyang, Hunan, 421001, China.
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Saddick SY. Identifying genes associated with the development of human polycystic ovary syndrome. Saudi J Biol Sci 2020; 27:1271-1279. [PMID: 32346335 PMCID: PMC7183000 DOI: 10.1016/j.sjbs.2020.01.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Revised: 01/06/2020] [Accepted: 01/07/2020] [Indexed: 12/20/2022] Open
Abstract
The pathophysiology of polycystic ovary syndrome (PCOS) is confusing until today as it is a multifactorial endocrine disorder. It is presented with altered gonadotropin levels, bulky multi-follicular ovaries, infertility, and obesity. This complex pathophysiology is linked with insulin resistance and hyperandrogenism. Hyperandrogenemia significantly contributes towards cosmetic anomalies including hirsutism, acne, and alopecia in the PCOS women. The preexisting insulin resistance in women with PCOS is likely to aggravate the increased levels of androgen. The review findings have shown that in the steroidogenic pathway, ovarian steroidogenesis patterns classify mainly towards the hypertrophy of theca cells along with alteration in the expression of key enzymes. The association of polymorphisms in genes encoding the process of an intricate cascade of steroidogenesis is delineated. The emergence of an unanimously accepted genetic marker for susceptible PCOS was affected based on inconsistent findings. The present study has provided a comprehensive summary of the impact of polymorphisms among the common androgen-related genes to govern the genetic predisposition.
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Affiliation(s)
- Salina Y Saddick
- Department of Biological Sciences, Faculty of Science, King Abdulaziz University, Jeddah, Saudi Arabia
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Kempegowda P, Melson E, Manolopoulos KN, Arlt W, O’Reilly MW. Implicating androgen excess in propagating metabolic disease in polycystic ovary syndrome. Ther Adv Endocrinol Metab 2020; 11:2042018820934319. [PMID: 32637065 PMCID: PMC7315669 DOI: 10.1177/2042018820934319] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 05/24/2020] [Indexed: 12/19/2022] Open
Abstract
Polycystic ovary syndrome (PCOS) has been traditionally perceived as a reproductive disorder due to its most common presentation with menstrual dysfunction and infertility. However, it is now clear that women with PCOS are at increased risk of metabolic dysfunction, from impaired glucose tolerance and type 2 diabetes mellitus to nonalcoholic fatty liver disease and cardiovascular disease. PCOS is characterised by androgen excess, with cross-sectional data showing that hyperandrogenism is directly complicit in the development of metabolic complications. Recent studies have also shown that C11-oxy C19 androgens are emerging to be clinically and biochemically significant in PCOS, thus emphasising the importance of understanding the impact of both classic and C11-oxy C19 androgens on women's health. Here we discuss androgen metabolism in the context of PCOS, and dissect the role played by androgens in the development of metabolic disease through their effects on metabolic target tissues in women.
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Affiliation(s)
- Punith Kempegowda
- Institute of Metabolism and Systems Research, University of Birmingham, Edgbaston, Birmingham, UK
- Department of Endocrinology, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Eka Melson
- Institute of Metabolism and Systems Research, University of Birmingham, Edgbaston, Birmingham, UK
- Department of Endocrinology, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Konstantinos N. Manolopoulos
- Institute of Metabolism and Systems Research, University of Birmingham, Edgbaston, Birmingham, UK
- Department of Endocrinology, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Wiebke Arlt
- Institute of Metabolism and Systems Research, University of Birmingham, Edgbaston, Birmingham, UK
- Department of Endocrinology, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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Multidimensional informatic deconvolution defines gender-specific roles of hypothalamic GIT2 in aging trajectories. Mech Ageing Dev 2019; 184:111150. [PMID: 31574270 DOI: 10.1016/j.mad.2019.111150] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 08/20/2019] [Accepted: 09/26/2019] [Indexed: 12/13/2022]
Abstract
In most species, females live longer than males. An understanding of this female longevity advantage will likely uncover novel anti-aging therapeutic targets. Here we investigated the transcriptomic responses in the hypothalamus - a key organ for somatic aging control - to the introduction of a simple aging-related molecular perturbation, i.e. GIT2 heterozygosity. Our previous work has demonstrated that GIT2 acts as a network controller of aging. A similar number of both total (1079-female, 1006-male) and gender-unique (577-female, 527-male) transcripts were significantly altered in response to GIT2 heterozygosity in early life-stage (2 month-old) mice. Despite a similar volume of transcriptomic disruption in females and males, a considerably stronger dataset coherency and functional annotation representation was observed for females. It was also evident that female mice possessed a greater resilience to pro-aging signaling pathways compared to males. Using a highly data-dependent natural language processing informatics pipeline, we identified novel functional data clusters that were connected by a coherent group of multifunctional transcripts. From these it was clear that females prioritized metabolic activity preservation compared to males to mitigate this pro-aging perturbation. These findings were corroborated by somatic metabolism analyses of living animals, demonstrating the efficacy of our new informatics pipeline.
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Song Y, Ye W, Ye H, Xie T, Shen W, Zhou L. Serum testosterone acts as a prognostic indicator in polycystic ovary syndrome-associated kidney injury. Physiol Rep 2019; 7:e14219. [PMID: 31448581 PMCID: PMC6709419 DOI: 10.14814/phy2.14219] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 07/29/2019] [Accepted: 07/30/2019] [Indexed: 01/06/2023] Open
Abstract
Polycystic ovary syndrome (PCOS) is closely related with the onset and development of metabolic abnormalities. However, the correlation between PCOS and kidney injury has not been clarified, and the underlying mechanism remains unknown. Herein, we performed a prospective survey in 55 PCOS and 69 healthy participants. Furthermore, the correlation analyses between serum testosterone and renal functional manifestations of patients and healthy subjects, including urinary albumin to creatinine ratio (UACR), urinary κ-light chains (KapU), urinary λ-light chains (LamU), urinary α1-microglobulin (α1-MU), and urinary β2-microglobulin (β2-MU), were analyzed. Compared with that in normal subjects, the levels of serum testosterone and UACR were significantly higher in PCOS patients. Serum testosterone is significantly correlated with the disease severity of PCOS. Although urinary excretions of KapU, LamU, α1-MU, and β2-MU did not increase in PCOS patients, they had a significantly positive correlation with the extent of serum testosterone in PCOS patients. IN vitro, primary cultured human ovary granulosa cells (GCs) were isolated from the follicular fluid (FF) extracting from PCOS patients and controls. FF, especially which extracted from PCOS patients with a high expression of serum testosterone, significantly induced cell apoptosis and inflammation in human GCs. To examine the communication between PCOS and kidney injury, a human proximal tubular epithelial cell line (HKC-8) was cultured and administered FF. Interestingly, FF from PCOS patients with a higher level of serum testosterone induced fibrotic lesions in HKC-8 cells. These data suggest serum testosterone plays a critical role in PCOS and PCOS-associated kidney injury. Serum testosterone may serve as a promising indicator for kidney fibrotic injury outcomes in PCOS patients.
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Affiliation(s)
- Yali Song
- Center for Reproductive Medicine, Department of Obstetrics and GynecologyNanfang Hospital, Southern Medical UniversityGuangzhouChina
| | - Wenting Ye
- Center for Reproductive Medicine, Department of Obstetrics and GynecologyNanfang Hospital, Southern Medical UniversityGuangzhouChina
| | - Huiyun Ye
- State Key Laboratory of Organ Failure Research, National Clinical Research Center of Kidney Disease, Division of NephrologyNanfang HospitalSouthern Medical UniversityGuangzhouChina
| | - Tingting Xie
- Center for Reproductive Medicine, Department of Obstetrics and GynecologyNanfang Hospital, Southern Medical UniversityGuangzhouChina
| | - Weiwei Shen
- State Key Laboratory of Organ Failure Research, National Clinical Research Center of Kidney Disease, Division of NephrologyNanfang HospitalSouthern Medical UniversityGuangzhouChina
| | - Lili Zhou
- State Key Laboratory of Organ Failure Research, National Clinical Research Center of Kidney Disease, Division of NephrologyNanfang HospitalSouthern Medical UniversityGuangzhouChina
- Guangzhou Regenerative Medicine and Health Guangdong LaboratoryGuangzhouChina
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Lim SS, Hutchison SK, Van Ryswyk E, Norman RJ, Teede HJ, Moran LJ. Lifestyle changes in women with polycystic ovary syndrome. Cochrane Database Syst Rev 2019; 3:CD007506. [PMID: 30921477 PMCID: PMC6438659 DOI: 10.1002/14651858.cd007506.pub4] [Citation(s) in RCA: 88] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Polycystic ovary syndrome (PCOS) affects 8% to 13% of reproductive-aged women and is associated with reproductive and metabolic dysfunction. Obesity worsens the presentation of PCOS and weight management (weight loss, maintenance or prevention of excess weight gain) is proposed as an initial treatment strategy, best achieved through lifestyle changes incorporating diet, exercise and behavioural interventions. OBJECTIVES To assess the effectiveness of lifestyle treatment in improving reproductive, anthropometric (weight and body composition), metabolic and quality of life factors in PCOS. SEARCH METHODS We searched the Cochrane Gynaecology and Fertility Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, PsycINFO, CINAHL and AMED (date of last search March 2018). We also searched controlled trials registries, conference abstracts, relevant journals, reference lists of relevant papers and reviews, and grey literature databases, with no language restrictions applied. SELECTION CRITERIA Randomised controlled trials (RCTs) comparing lifestyle treatment (diet, exercise, behavioural or combined treatments) to minimal or no treatment in women with PCOS. DATA COLLECTION AND ANALYSIS Two authors independently selected trials, assessed evidence quality and risk of bias, and extracted data. Our primary outcomes were live birth, miscarriage and pregnancy. We used inverse variance and fixed-effect models in the meta-analyses. We reported dichotomous outcomes as an odds ratio and continuous outcomes as a mean difference (MD) or standardised mean difference (SMD). MAIN RESULTS We included 15 studies with 498 participants. Ten studies compared physical activity to minimal dietary and behavioural intervention or no intervention. Five studies compared combined dietary, exercise and behavioural intervention to minimal intervention. One study compared behavioural intervention to minimal intervention. Risk of bias varied: eight studies had adequate sequence generation, seven had adequate clinician or outcome assessor blinding, seven had adequate allocation concealment, six had complete outcome data and six were free of selective reporting. No studies assessed the fertility primary outcomes of live birth or miscarriage. No studies reported the secondary reproductive outcome of menstrual regularity, as defined in this review.Lifestyle intervention may improve a secondary (endocrine) reproductive outcome, the free androgen index (FAI) (MD -1.11, 95% confidence interval (CI) -1.96 to -0.26, 6 RCTs, N = 204, I2 = 71%, low-quality evidence). Lifestyle intervention may reduce weight (kg) (MD -1.68 kg, 95% CI -2.66 to -0.70, 9 RCTs, N = 353, I2 = 47%, low-quality evidence). Lifestyle intervention may reduce body mass index (BMI) (kg/m2) (-0.34 kg/m2, 95% CI -0.68 to -0.01, 12 RCTs, N = 434, I2= 0%, low-quality evidence). We are uncertain of the effect of lifestyle intervention on glucose tolerance (glucose outcomes in oral glucose tolerance test) (mmol/L/minute) (SMD -0.02, 95% CI -0.38 to 0.33, 3 RCTs, N = 121, I2 = 0%, low-quality evidence). AUTHORS' CONCLUSIONS Lifestyle intervention may improve the free androgen index (FAI), weight and BMI in women with PCOS. We are uncertain of the effect of lifestyle intervention on glucose tolerance. There were no studies that looked at the effect of lifestyle intervention on live birth, miscarriage or menstrual regularity. Most studies in this review were of low quality mainly due to high or unclear risk of bias across most domains and high heterogeneity for the FAI outcome.
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Affiliation(s)
- Siew S Lim
- Monash UniversityMonash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine43‐51 Kanooka GroveClaytonVictoriaAustralia3168
| | - Samantha K Hutchison
- Monash UniversityMonash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine43‐51 Kanooka GroveClaytonVictoriaAustralia3168
- Monash HealthDiabetes Unit and Endocrinology Unit246 Clayton RoadClaytonVictoriaAustralia3168
| | - Emer Van Ryswyk
- College of Medicine and Public Health, Flinders UniversityAdelaide Institute for Sleep Health: A Flinders Centre for Research ExcellenceSturt RoadAdelaideSouth AustraliaAustralia5042
| | - Robert J Norman
- University of AdelaideObstetrics & Gynaecology, Robinson InstituteAdelaideSouth AustraliaAustralia5005
- Fertility SAAdelaideAustralia
| | - Helena J Teede
- Monash UniversityMonash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine43‐51 Kanooka GroveClaytonVictoriaAustralia3168
| | - Lisa J Moran
- Monash UniversityMonash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine43‐51 Kanooka GroveClaytonVictoriaAustralia3168
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Nadir A, Temizkan S, Ozderya A, Temizkan O, Orbay E, Aydin K. Dehydroepiandrosterone sulfate/free androgen index ratio predicts a favorable metabolic profile in patients with polycystic ovary syndrome. Gynecol Endocrinol 2019; 35:128-132. [PMID: 30324855 DOI: 10.1080/09513590.2018.1505843] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Potential effect of hyperandrogenemia on metabolic disturbances in polycystic ovary syndrome (PCOS) has always been a matter of interest. We analyzed the records of 125 patients with PCOS and 54 age-matched healthy women. All participants underwent biochemical and hormonal assessment and a 75 g oral glucose tolerance test was performed. PCOS and control groups were comparable in terms of age. Dehydroepiandrosterone sulfate/free androgen index (DHEAS/FAI) ratio was negatively correlated with body mass index (BMI) (p < .001), fasting glucose (p = .02), area under the curve (AUC) of glucose (p = .03), AUC of insulin (p = .001), homeostasis model assessment-estimated insulin resistance (HOMA-IR) (p < .001), and triglycerides (TG) (p = .009), and positively correlated with insulin sensitivity index (ISI) (p < .001) and high-density lipoprotein cholesterol (HDL-C) (p < .001) among PCOS patients. In logistic regression analysis, higher DHEAS/FAI ratio levels were associated with lower risk of low HDL-C [RR(95%CI); 0.97(0.95-0.98); p < .001] as well as atherogenic dyslipidemia (TG/HDL-C) [RR(95%CI); 0.97(0.94-0.99); p = .035] even after adjustment for BMI in the PCOS group. Androgens, DHEAS and FAI act differently on metabolic parameters. Our results demonstrate that high DHEA-S/FAI ratio levels are associated with a more favorable metabolic profile.
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Affiliation(s)
- Ahmet Nadir
- a Department of Family Medicine , University of Medical Sciences, Kartal Dr. Lutfi Kirdar Training and Research Hospital , Istanbul , Turkey
| | - Sule Temizkan
- b Department of Endocrinology and Metabolism , University of Medical Sciences, Kartal Dr. Lutfi Kirdar Training and Research Hospital , Istanbul , Turkey
| | - Aysenur Ozderya
- b Department of Endocrinology and Metabolism , University of Medical Sciences, Kartal Dr. Lutfi Kirdar Training and Research Hospital , Istanbul , Turkey
| | - Osman Temizkan
- c Department of Obstetrics and Gynecology , Acibadem University Faculty of Medicine , Istanbul , Turkey
| | - Ekrem Orbay
- a Department of Family Medicine , University of Medical Sciences, Kartal Dr. Lutfi Kirdar Training and Research Hospital , Istanbul , Turkey
| | - Kadriye Aydin
- b Department of Endocrinology and Metabolism , University of Medical Sciences, Kartal Dr. Lutfi Kirdar Training and Research Hospital , Istanbul , Turkey
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49
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Thackray VG. Sex, Microbes, and Polycystic Ovary Syndrome. Trends Endocrinol Metab 2019; 30:54-65. [PMID: 30503354 PMCID: PMC6309599 DOI: 10.1016/j.tem.2018.11.001] [Citation(s) in RCA: 100] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 11/01/2018] [Accepted: 11/02/2018] [Indexed: 12/12/2022]
Abstract
Recent studies have shown that sex and sex steroids influence the composition of the gut microbiome. These studies also indicate that steroid regulation of the gut microbiome may play a role in pathological situations of hormonal excess, such as PCOS. Indeed, studies demonstrated that PCOS is associated with decreased alpha diversity and changes in specific Bacteroidetes and Firmicutes, previously associated with metabolic dysregulation. These studies suggest that androgens may regulate the gut microbiome in females and that hyperandrogenism may be linked with a gut 'dysbiosis' in PCOS. Future mechanistic studies will be required to elucidate how sex steroids regulate the composition and function of the gut microbial community and what the consequences of this regulation are for the host.
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Affiliation(s)
- Varykina G Thackray
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Diego, La Jolla, CA, 92093, USA; http://repro.ucsd.edu/thackray.
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Gilbert EW, Tay CT, Hiam DS, Teede HJ, Moran LJ. Comorbidities and complications of polycystic ovary syndrome: An overview of systematic reviews. Clin Endocrinol (Oxf) 2018; 89:683-699. [PMID: 30099747 DOI: 10.1111/cen.13828] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 08/06/2018] [Accepted: 08/08/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND Polycystic ovary syndrome (PCOS) is one of the most common endocrinopathies affecting reproductive-aged women with adverse reproductive, metabolic and psychological outcomes. It has a complex pathophysiology and therefore requires a multidiscipline clinical approach. However, there remains limited research synthesizing the broad clinical implications of PCOS which would assist clinicians in the management of PCOS. OBJECTIVE To summarize and appraise methodological quality of systematic reviews and meta-analyses evaluating complications and comorbidities associated with PCOS. METHODS A literature search from MEDLINE, EMBASE, CINAHL PLUS and PROSPERO was performed until 15 September 2017. Article selection, data extraction and quality appraisal of included reviews using the Assessing the Methodological Quality of Systematic Reviews (AMSTAR) tool were performed in duplicate. A narrative synthesis of the findings was conducted. RESULTS Twenty-three reviews were included. All reviews were of low (n = 2) to moderate quality (n = 21). PCOS was associated with adverse pregnancy outcomes (n = 2), impaired glucose tolerance (n = 6), insulin resistance (n = 6), increased risk of type 2 diabetes (n = 1), cardiovascular disease (n = 10), metabolic syndrome (n = 2), psychological stress (n = 7), endometrial cancer (n = 1) and vitamin D deficiency (n = 1). Obesity exacerbates many of these outcomes. CONCLUSIONS There is a large body of reliable evidence for adverse metabolic outcomes and smaller, but consistent evidence for psychological issues in PCOS. We identified a shortage of systematic reviews regarding pregnancy outcomes of PCOS and significant gaps in knowledge of the association between PCOS and subclinical hyperthyroidism, vitamin D levels and cancers which future studies could aim to address.
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Affiliation(s)
- Emily W Gilbert
- Monash Centre for Health Research and Implementation, School of Public Health and Preventative Medicine, Monash University, Clayton, Victoria, Australia
| | - Chau T Tay
- Monash Centre for Health Research and Implementation, School of Public Health and Preventative Medicine, Monash University, Clayton, Victoria, Australia
- Department of Endocrinology and Diabetes, Monash Health, Clayton, Victoria, Australia
| | - Danielle S Hiam
- Institute of Health, Exercise and Sport, Victoria University, Melbourne, Victoria, Australia
| | - Helena J Teede
- Monash Centre for Health Research and Implementation, School of Public Health and Preventative Medicine, Monash University, Clayton, Victoria, Australia
- Department of Endocrinology and Diabetes, Monash Health, Clayton, Victoria, Australia
| | - Lisa J Moran
- Monash Centre for Health Research and Implementation, School of Public Health and Preventative Medicine, Monash University, Clayton, Victoria, Australia
- Discipline of Obstetrics and Gynaecology, Robinson Research Institute, University of Adelaide, Adelaide, South Australia, Australia
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