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Fadilah F, Ermanto B, Bowolaksono A, Asmarinah A, Maidarti M, Prawiningrum AF, Hafidzhah MA, Erlina L, Paramita RI, Wiweko B. Prediction of the Signaling Pathway in Polycystic Ovary Syndrome Using an Integrated Bioinformatics Approach. Gynecol Obstet Invest 2024; 89:485-511. [PMID: 38810612 DOI: 10.1159/000539228] [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: 09/19/2023] [Accepted: 04/01/2024] [Indexed: 05/31/2024]
Abstract
OBJECTIVES The purpose of this study was to define the underlying biological mechanisms of polycystic ovarian syndrome (PCOS) utilizing the protein-protein interaction networks (PPINs) that were constructed based on the putative disease-causing genes for PCOS. DESIGN No animals were used in this research because this is an in silico study that mainly uses software and online analysis tools. Participants/Materials, Settings: Gene datasets related to PCOS were obtained from Genecards. METHODS The PPINs of PCOS were created using the String Database after genes related to PCOS were obtained from Genecards. After that, we performed an analysis of the hub-gene clusters extracted from the PPIN using the ShinyGO algorithm. In the final step of this research project, functional enrichment analysis was used to investigate the primary biological activities and signaling pathways that were associated with the hub clusters. RESULTS The Genecards database provided the source for the identification of a total of 1,072 potential genes related to PCOS. The PPIN that was generated by using the genes that we collected above contained a total of 82 genes and three different types of cluster interaction interactions. In addition, after conducting research on the PPIN with the shinyGO plug-in, 19 of the most important gene clusters were discovered. The primary biological functions that were enriched in the key clusters that were developed were ovarian steroidogenesis, the breast cancer pathway, regulation of lipid and glucose metabolism by the AMPK pathway, and ovarian steroidogenesis. The integrated analysis that was performed in the current study demonstrated that these hub clusters and their connected genes are closely associated with the pathogenesis of PCOS. LIMITATIONS Several of the significant genes that were identified in this study, such as ACVR1, SMAD5, BMP6, SMAD3, SMAD4, and anti-mullerian hormone. It is necessary to do additional research using large samples, several centers, and multiple ethnicities in order to verify these findings. CONCLUSIONS The integrated analysis that was performed in the current study demonstrated that these hub clusters and their connected genes are closely associated with the pathogenesis of PCOS. This information may possibly bring unique insights for the treatment of PCOS as well as the investigation of its underlying pathogenic mechanism.
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Affiliation(s)
- Fadilah Fadilah
- Department of Medical Chemistry, Faculty of Medicine, Universitas Indonesia, Central Jakarta, Indonesia
- Bioinformatics Core Facilities, Indonesian Medical Education and Research Institute, Faculty of Medicine, Universitas Indonesia, Central Jakarta, Indonesia
- Biobank Research Center, Indonesian Medical Education and Research Institute, Faculty of Medicine, Universitas Indonesia, Central Jakarta, Indonesia
| | - Budi Ermanto
- Doctoral Program of Biomedical Science, Faculty of Medicine, Universitas Indonesia, Central Jakarta, Indonesia
| | - Anom Bowolaksono
- Cellular and Molecular Mechanism in Biological System (CEMBIOS) Research Group, Department of Biology, Faculty of Mathematics and Natural Sciences, Universitas Indonesia, Central Jakarta, Indonesia
| | - Asmarinah Asmarinah
- Biobank Research Center, Indonesian Medical Education and Research Institute, Faculty of Medicine, Universitas Indonesia, Central Jakarta, Indonesia
- Department of Medical Biology, Faculty of Medicine, Universitas Indonesia, Central Jakarta, Indonesia
| | - Mila Maidarti
- Reproductive Immunoendocrinology Division, Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Indonesia, Central Jakarta, Indonesia
- Yasmin IVF Clinic, Dr. Ciptomangunkusumo General Hospital, Central Jakarta, Indonesia
- Human Reproduction, Infertility and Family Planning Cluster, Indonesian Medical Education and Research Institute, Faculty of Medicine, Universitas Indonesia, Central Jakarta, Indonesia
| | - Aisyah Fitriannisa Prawiningrum
- Bioinformatics Core Facilities, Indonesian Medical Education and Research Institute, Faculty of Medicine, Universitas Indonesia, Central Jakarta, Indonesia
| | - Muhammad Aldino Hafidzhah
- Bioinformatics Core Facilities, Indonesian Medical Education and Research Institute, Faculty of Medicine, Universitas Indonesia, Central Jakarta, Indonesia
| | - Linda Erlina
- Department of Medical Chemistry, Faculty of Medicine, Universitas Indonesia, Central Jakarta, Indonesia
- Bioinformatics Core Facilities, Indonesian Medical Education and Research Institute, Faculty of Medicine, Universitas Indonesia, Central Jakarta, Indonesia
- Doctoral Program of Biomedical Science, Faculty of Medicine, Universitas Indonesia, Central Jakarta, Indonesia
| | - Rafika Indah Paramita
- Department of Medical Chemistry, Faculty of Medicine, Universitas Indonesia, Central Jakarta, Indonesia
- Bioinformatics Core Facilities, Indonesian Medical Education and Research Institute, Faculty of Medicine, Universitas Indonesia, Central Jakarta, Indonesia
- Doctoral Program of Biomedical Science, Faculty of Medicine, Universitas Indonesia, Central Jakarta, Indonesia
| | - Budi Wiweko
- Reproductive Immunoendocrinology Division, Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Indonesia, Central Jakarta, Indonesia
- Yasmin IVF Clinic, Dr. Ciptomangunkusumo General Hospital, Central Jakarta, Indonesia
- Human Reproduction, Infertility and Family Planning Cluster, Indonesian Medical Education and Research Institute, Faculty of Medicine, Universitas Indonesia, Central Jakarta, Indonesia
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Bahreiny SS, Bastani MN, Aghaei M, Dabbagh MR, Mahdizade AH. Circulating Galectin-3 levels in women with polycystic ovary syndrome: A meta-analysis. Taiwan J Obstet Gynecol 2024; 63:37-45. [PMID: 38216266 DOI: 10.1016/j.tjog.2023.10.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2023] [Indexed: 01/14/2024] Open
Abstract
Polycystic ovary syndrome (PCOS) is a highly prevalent endocrine disorder characterized by multifactorial and intricate pathogenesis. The discovery of novel markers has been a significant step toward understanding the mechanisms of PCOS. Galectin-3 has emerged as a novel factor in metabolic disorders. This meta-analysis examines the association between circulating Galectin-3 and PCOS. A systematic review and meta-analysis were performed to identify relevant articles in the electronic databases PubMed, Web of Science, Scopus, Cochrane, EMBASE, and Google Scholar. The search covered the period from January 2000 to March 2023 and followed a predefined search strategy. Eight articles were included in the analysis with a total of 594 participants (322 patients with PCOS and 272 controls). Pooled standardized mean difference (SMD) and 95 % confidence interval [CI] were used to evaluate the association between Galectin-3 levels and PCOS. The results indicated a significant association between PCOS and galectin-3 levels (SMD = 0.58; 95 % CI: 0.15-1.01; p = 0.007). In addition, subgroup analysis showed a significant difference in serum Galectin-3 levels in women with PCOS and a higher homeostatic model assessment for insulin resistance ratio (SMD = 0.89; 95 % CI: 0.45-1.33; p < 0.001). The researchers also performed meta-regression and subgroup analyses to specify sources of heterogeneity. The results of our meta-analysis suggest an association between increased levels of galectin-3 and PCOS. Galectin-3 plays a significant role in the progression of PCOS and could be used as a novel diagnostic biomarker. Nevertheless, it is essential to perform further studies to confirm and support our conclusions.
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Affiliation(s)
- Seyed Sobhan Bahreiny
- Student Research Committee, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran; Medical Basic Sciences Research Institute, Physiology Research Center, Department of Physiology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
| | - Mohammad-Navid Bastani
- Student Research Committee, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mojtaba Aghaei
- Student Research Committee, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mohammad Reza Dabbagh
- Department of Biology, Faculty of Science, Shahid Chamran University of Ahvaz, Ahvaz, Iran
| | - Amir Hossein Mahdizade
- Student Research Committee, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Deng Y, Jin H, Ning J, Cui D, Zhang M, Yang H. Elevated galectin-3 levels detected in women with hyperglycemia during early and mid-pregnancy antagonizes high glucose - induced trophoblast cells apoptosis via galectin-3/foxc1 pathway. Mol Med 2023; 29:115. [PMID: 37626284 PMCID: PMC10463409 DOI: 10.1186/s10020-023-00707-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 07/26/2023] [Indexed: 08/27/2023] Open
Abstract
OBJECTIVE This study was to evaluate plasma galectin-3 levels from early pregnancy to delivery and explore the effects of galectin-3 on the function of trophoblast cells under high glucose exposure. METHODS The plasma galectin-3 levels were quantified by enzyme-linked immunosorbent assay (ELISA) in the China National Birth Cohort (CNBC) at Peking University First Hospital, and the underlying signaling pathway was identified by protein-protein interaction (PPI) analysis, gene set enrichment analysis (GSEA), quantitative PCR (qPCR), western blotting, small interfering RNA (siRNA) transfections, and flow cytometry. RESULTS Significantly higher galectin-3 levels were found in patients with gestational diabetes mellitus (GDM group; n = 77) during the first and second trimesters than that in healthy pregnant women (HP group; n = 113) (P < 0.05). No significant differences in plasma galectin-3 levels were detected between GDM and HP groups in maternal third-trimester blood and cord blood. PPI analysis suggested potential interactions between galectin-3 and foxc1. The findings of GSEA showed that galectin-3 was involved in the cytochrome P450-related and complement-related pathways, and foxc1 was associated with type I diabetes mellitus. Additionally, high glucose (25 mM) significantly increased the expression levels of galectin-3 and foxc1 and induced apoptosis in HTR-8/SVneo cells. Further in vitro experiments showed that galectin-3/foxc1 pathway could protect HTR-8/SVneo cells against high glucose - induced apoptosis. CONCLUSION Future studies were required to validate whether plasma galectin-3 might become a potential biomarker for hyperglycemia during pregnancy. Elevated galectin-3 levels might be a vital protective mechanism among those exposed to hyperglycemia during pregnancy.
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Affiliation(s)
- Yu Deng
- Department of Obstetrics and Gynecology, Peking University First Hospital, No. 8 Xishiku Street, Beijing, 100034, China
- Beijing Key Laboratory of Maternal Fetal Medicine of Gestational Diabetes Mellitus, Beijing, 100034, China
| | - Hongyan Jin
- Department of Obstetrics and Gynecology, Peking University First Hospital, No. 8 Xishiku Street, Beijing, 100034, China
| | - Jie Ning
- Department of Obstetrics and Gynecology, Peking University First Hospital, No. 8 Xishiku Street, Beijing, 100034, China
- Beijing Key Laboratory of Maternal Fetal Medicine of Gestational Diabetes Mellitus, Beijing, 100034, China
| | - Dong Cui
- Department of Obstetrics and Gynecology, Peking University First Hospital, No. 8 Xishiku Street, Beijing, 100034, China
- Beijing Key Laboratory of Maternal Fetal Medicine of Gestational Diabetes Mellitus, Beijing, 100034, China
| | - Muqiu Zhang
- Department of Obstetrics and Gynecology, Peking University First Hospital, No. 8 Xishiku Street, Beijing, 100034, China
- Beijing Key Laboratory of Maternal Fetal Medicine of Gestational Diabetes Mellitus, Beijing, 100034, China
| | - Huixia Yang
- Department of Obstetrics and Gynecology, Peking University First Hospital, No. 8 Xishiku Street, Beijing, 100034, China.
- Beijing Key Laboratory of Maternal Fetal Medicine of Gestational Diabetes Mellitus, Beijing, 100034, China.
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Salehi R, Asare-Werehene M, Wyse BA, Abedini A, Pan B, Gutsol A, Jahangiri S, Szaraz P, Burns KD, Vanderhyden B, Li J, Burger D, Librach CL, Tsang BK. Granulosa cell-derived miR-379-5p regulates macrophage polarization in polycystic ovarian syndrome. Front Immunol 2023; 14:1104550. [PMID: 37033997 PMCID: PMC10081157 DOI: 10.3389/fimmu.2023.1104550] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 03/13/2023] [Indexed: 04/11/2023] Open
Abstract
Polycystic ovarian syndrome (PCOS) is associated with hyperandrogenemia and ovarian antral follicle growth arrest. We have previously demonstrated that androgen-induced exosomal release of miR-379-5p (miR379) from preantral follicle granulosa cells increases the proliferation of target cells via phosphoinositide-dependent kinase 1 (PDK1) upregulation. Androgen also increases inflammatory M1 macrophage abundance, but reduces anti-inflammatory M2 polarization in rat antral and preovulatory follicles. However, the role of small extracellular vesicles (sEVs; also known as exosomes) secretion in determining the cellular content and function of miRNAs in exosome-receiving cells is largely unknown. Our objectives were to determine: 1) the regulatory role of granulosa cells (GC)-derived exosomal miR379 on macrophage polarization and ovarian inflammation; 2) whether miR379-induced M1 polarization regulates GC proliferation; and 3) if this regulated process is follicular stage-specific. Compared with non-PCOS subjects, PCOS subjects had a higher M1/M2 ratio, supporting the concept that PCOS is an inflammatory condition. Ovarian overexpression of miR379 increased the number of M1 macrophages and the M1/M2 ratio in preantral follicles specifically. Transfection of macrophages with a miR379 mimic reduced the cellular content of PDK1 and induced M0→M1 polarization; whereas its inhibitor polarized M0→M2. Conditioned media from macrophages transfected with miR379 mimic and follicular fluid from PCOS subjects had higher galectin-3 content, a pro-inflammatory cytokine which specifically suppresses human antral follicle GC proliferation. These results indicate that miR379 inhibits M2 macrophage polarization, a condition which suppresses GC proliferation in a follicle stage-dependent manner, as exhibited in PCOS.
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Affiliation(s)
- Reza Salehi
- Chronic Disease Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, ON, Canada
- Department of Cellular and Molecular Medicine and Center for Infection, Immunity and Inflammation, University of Ottawa, Ottawa, ON, Canada
- CReATe Fertility Centre, Toronto, ON, Canada
| | - Meshach Asare-Werehene
- Chronic Disease Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, ON, Canada
- Department of Cellular and Molecular Medicine and Center for Infection, Immunity and Inflammation, University of Ottawa, Ottawa, ON, Canada
| | | | - Atefeh Abedini
- Cancer Therapeutics Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Bo Pan
- Department of Animal BioScience, University of Guelph, Guelph, ON, Canada
| | - Alex Gutsol
- Division of Nephrology, Department of Medicine, Kidney Research Centre, University of Ottawa, Ottawa, ON, Canada
| | | | | | - Kevin D. Burns
- Division of Nephrology, Department of Medicine, Kidney Research Centre, University of Ottawa, Ottawa, ON, Canada
| | - Barbara Vanderhyden
- Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, ON, Canada
- Department of Cellular and Molecular Medicine and Center for Infection, Immunity and Inflammation, University of Ottawa, Ottawa, ON, Canada
- Cancer Therapeutics Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Julang Li
- Department of Animal BioScience, University of Guelph, Guelph, ON, Canada
| | - Dylan Burger
- Chronic Disease Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Department of Cellular and Molecular Medicine and Center for Infection, Immunity and Inflammation, University of Ottawa, Ottawa, ON, Canada
- Division of Nephrology, Department of Medicine, Kidney Research Centre, University of Ottawa, Ottawa, ON, Canada
| | - Clifford L. Librach
- CReATe Fertility Centre, Toronto, ON, Canada
- Department of Obstetrics & Gynaecology, University of Toronto, Toronto, ON, Canada
- Department of Physiology, University of Toronto, Toronto, ON, Canada
- Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada
| | - Benjamin K. Tsang
- Chronic Disease Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, ON, Canada
- Department of Cellular and Molecular Medicine and Center for Infection, Immunity and Inflammation, University of Ottawa, Ottawa, ON, Canada
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Avazpour S, Amini A, Shirvani H, Arabzadeh E. Exercise modulation in inflammation and metabolic hormonal disorders of COVID-19 to decrease risk factors in coronary heart disease. Horm Mol Biol Clin Investig 2022:hmbci-2022-0040. [PMID: 36560914 DOI: 10.1515/hmbci-2022-0040] [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: 04/23/2022] [Accepted: 12/12/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVES Sedentary life style separated during COVID-19 pandemic. Patients with cardiovascular diseases (CVD) are vulnerable with sedentary life style. Therefore, the aim of this study was to investigate the effect of 8 weeks of combined and high intensity interval training (HIIT) on C Reactive protein, galectin-3, leptin, fibrinogen and insulin resistance index in coronary heart disease after COVID-19. METHODS Thirty-six cardiovascular patients (55.14 ± 1.4 years, 78.6 ± 5.1 kg) were divided into three groups of combined exercise (n=13), HIIT (n=12) and control group (n=11). Combined exercise consisted of aerobic (4 weeks) and aerobic + HIIT exercise (4 weeks), three sessions per weeks. The protocol of the HIIT group included performing high intensity interval training, three sessions per weeks for 8 weeks. Blood samples were taken 24 h before the first training session and 48 h after the last training. C Reactive protein (CRP), galectin-3, leptin, fibrinogen measured with ELISA kit. RESULTS CRP, galectin-3 and fibrinogen decreased significantly after 8 weeks of combined training and HIIT (compare to pre-test). Also, insulin resistance index after 8 weeks of combined exercise showed a significant decrease compare to pre-test (p<0.05). After 8 weeks, CRP, galectin-3 and insulin resistance significantly decreased compare to control group (p<0.05). CONCLUSIONS In the patient with CVD, combined exercise training may be more effective than HIIT in reducing metabolic and heart risk factors after an epidemic such as COVID-19. However, change of leptin need to more studies.
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Affiliation(s)
- Sahar Avazpour
- Department of Sports Sciences, Sports Biochemistry and Metabolism, Faculty of Educational Sciences, Gerash University of Medical Science, Gerash, Iran
| | - Amin Amini
- Faculty of Artificial Intelligence and Cognitive Sciences, Imam Hossein University, Tehran, Iran
| | - Hossein Shirvani
- Exercise Physiology Research Center, Life Style Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Ehsan Arabzadeh
- Exercise Physiology Research Center, Life Style Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
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Review of Novel Potential Insulin Resistance Biomarkers in PCOS Patients—The Debate Is Still Open. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19042099. [PMID: 35206286 PMCID: PMC8871992 DOI: 10.3390/ijerph19042099] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 01/27/2022] [Accepted: 02/09/2022] [Indexed: 12/12/2022]
Abstract
Research on proteins and peptides that play roles in metabolic regulation, which may be considered potential insulin resistance markers in some medical conditions, such as diabetes mellitus, obesity and polycystic ovarian syndrome (PCOS), has recently gained in interest. PCOS is a common endocrine disorder associated with hyperandrogenemia and failure of ovulation, which is often accompanied by metabolic abnormalities, including obesity, dyslipidemia, hyperinsulinemia, and insulin resistance. In this review, we focus on less commonly known peptides/proteins and investigate their role as potential biomarkers for insulin resistance in females affected by PCOS. We summarize studies comparing the serum fasting concentration of particular agents in PCOS individuals and healthy controls. Based on our analysis, we propose that, in the majority of studies, the levels of nesfastin-1, myonectin, omentin, neudesin were decreased in PCOS patients, while the levels of the other considered agents (e.g., preptin, gremlin-1, neuregulin-4, xenopsin-related peptide, xenin-25, and galectin-3) were increased. However, there also exist studies presenting contrary results; in particular, most data existing for lipocalin-2 are inconsistent. Therefore, further research is required to confirm those hypotheses, as well as to elucidate the involvement of these factors in PCOS-related metabolic complications.
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Alves MT, de Souza IDP, Ferreira CN, Cândido AL, Bizzi MF, Oliveira FR, Reis FM, Gomes KB. Galectin-3 is a potential biomarker to insulin resistance and obesity in women with polycystic ovary syndrome. Gynecol Endocrinol 2020; 36:760-763. [PMID: 32157924 DOI: 10.1080/09513590.2020.1739267] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Polycystic ovary syndrome (PCOS) is the most common endocrine and metabolic disorder that affects women in reproductive age. This study aimed to evaluate Gal-3 levels and its role on metabolic parameters in women with PCOS. Gal-3 was measured in 44 PCOS and 25 women recruited as control group for the case-control study. Gal-3 levels were similar between PCOS and control groups (p > 0.05), but showed a positive correlation with glucose levels in the oral glucose tolerance test (OGTT) (r = 0.403, p = 0.037), body mass index (BMI) (r = 0.469, p = 0.027), insulin levels (r = 0.453, p = 0.030) and HOMA-IR (r = 0.738, p = 0.037) in PCOS group. The data suggest that Gal-3 plays a role in the pathophysiology of the insulin resistance and obesity in PCOS group.
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Affiliation(s)
- Michelle T Alves
- Faculdade de Farmácia, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | - Cláudia N Ferreira
- Colégio Técnico, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Ana Lúcia Cândido
- Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Mariana F Bizzi
- Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Flávia R Oliveira
- Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
- Maternidade Odete Valadares - Fundação Hospitalar do Estado de Minas Gerais, Belo Horizonte, Brazil
| | - Fernando M Reis
- Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Karina B Gomes
- Faculdade de Farmácia, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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