The comparison of the effectiveness and safety of drospirone ethinyl estradiol and ethinyl estradiol cyproterone in the treatment of polycystic ovarian syndrome: A protocol for systematic review and meta-analysis

Impact of short-term ketogenic diet on sex hormones and glucose-lipid metabolism in overweight or obese patients with polycystic ovary syndrome

AIM

This study evaluates the clinical effects of a ketogenic diet (KD) versus a traditional comprehensive intervention, including lifestyle changes and oral contraceptives, in overweight or obese polycystic ovary syndrome (PCOS) patients.

METHODS

A retrospective analysis of 70 overweight/obese PCOS patients (body mass index [BMI] ≥24 kg/m2) treated between December 2022 and December 2023 was conducted. The patients were categorized into two groups based on their past treatment modality: Group 1 received a KD treatment (N = 35), and Group 2 underwent comprehensive intervention (N = 35), with both treatments lasting 3 months. Changes in body weight, BMI, sex hormone levels, glucose-lipid metabolism indicators, and liver and kidney function were compared.

RESULTS

Both groups experienced significant reductions in body weight and BMI after treatment (p < 0.05), with the KD group showing a greater reduction (p < 0.05). luteinizing hormone (LH), LH/follicle-stimulating hormone (FSH), and total testosterone (TT) levels decreased significantly in both groups (p < 0.05). The KD treatment led to significant reductions in fasting blood glucose (FBG), fasting insulin (FINS), homeostasis model assessment of insulin resistance (HOMA-IR), triglyceride (TG), alanine aminotransferase (ALT), and aspartate aminotransferase (AST) (p < 0.05), while the comprehensive intervention resulted in decreased FBG and ALT, and increased high-density lipoprotein-cholesterol (HDL-c) (p < 0.05). Additionally, the KD group had a greater reduction in FBG, and showed decreases in TG and AST, which remained unchanged in the comprehensive intervention group (p < 0.05).

CONCLUSION

The short-term KD treatment provides significant weight loss and effectively improves hormone regulation and glucose-lipid metabolism in overweight or obese PCOS patients, offering a valuable therapeutic option for managing the condition.

Impact of Distinct Antiandrogen Exposures on the Plasma Metabolome in Feminizing Gender-affirming Hormone Therapy

CONTEXT

The plasma metabolome is a functional readout of metabolic activity and is associated with phenotypes exhibiting sexual dimorphism, such as cardiovascular disease. Sex hormones are thought to play a key role in driving sexual dimorphism.

OBJECTIVE

Gender-affirming hormone therapy (GAHT) is a cornerstone of transgender care, but longitudinal changes in the plasma metabolome with feminizing GAHT have not been described.

METHODS

Blood samples were collected at baseline and after 3 and 6 months of GAHT from transgender women (n = 53). Participants were randomized to different anti-androgens, cyproterone acetate or spironolactone. Nuclear magnetic resonance-based metabolomics was used to measure 249 metabolic biomarkers in plasma. Additionally, we used metabolic biomarker data from an unrelated cohort of children and their parents (n = 3748) to identify sex- and age-related metabolite patterns.

RESULTS

We identified 43 metabolic biomarkers altered after 6 months in both anti-androgen groups, most belonging to the very low- or low-density lipoprotein subclasses, with all but 1 showing a decrease. We observed a cyproterone acetate-specific decrease in glutamine, glycine, and alanine levels. Notably, of the metabolic biomarkers exhibiting the most abundant "sex- and age-related" pattern (higher in assigned female children and lower in assigned female adults, relative to assigned males), 80% were significantly lowered after GAHT, reflecting a shift toward the adult female profile.

CONCLUSION

Our results suggest an anti-atherogenic signature in the plasma metabolome after the first 6 months of feminizing GAHT, with cyproterone acetate also reducing specific plasma amino acids. This study provides novel insight into the metabolic changes occurring across feminizing GAHT.

Discovering therapeutic possibilities for polycystic ovary syndrome by targeting XIST and its associated ceRNA network through the analysis of transcriptome data

Long non-coding RNA (lncRNA) regulates many physiological processes by acting as competitive endogenous RNA (ceRNA). The dysregulation of lncRNA X-inactive specific transcript (XIST) has been shown in various human disorders. However, its role in the pathogenesis of polycystic ovary syndrome (PCOS) is yet to be explored. This study aimed to explore the underlying mechanism of XIST in the pathogenesis of PCOS, specifically through dataset functional analysis. GEO PCOS datasets including RNA-seq, microarray, and miRNA-seq in granulosa cells (GCs) and blood, were examined and comprehensively analyzed. Enrichment analysis, ROC curve constructions, lncRNA-miRNA-mRNA interaction network analyses, and qRT-PCR validation were performed followed by a series of drug signature screenings. Our results revealed significant dysregulation in the expression of 1131 mRNAs, 30 miRNAs, and XIST in GCs of PCOS patients compared to healthy individuals. Of the120 XIST-correlated upregulated genes, 25 were enriched in inflammation-related pathways. Additionally, 5 miRNAs were identified as negative regulators of XIST-correlated genes. Accordingly, a ceRNA network containing XIST-miRNAs-mRNAs interactions was constructed. Furthermore, 6 genes, including AQP9, ETS2, PLAU, PLEK, SOCS3, and TNFRSF1B served as both GCs and blood-based biomarkers. By analyzing the number of interactions among XIST, miRNAs, and mRNAs, we pinpointed ETS2 as the pivotal gene within the ceRNA network. Our findings reveal a novel XIST- hsa-miR-146a-5p, hsa-miR-144-3p, and hsa-miR-1271-5p-ETS2 axis that comprehensively elucidates the XIST-associated mechanism underlying PCOS onset. qRT-PCR analysis further confirmed the, overexpression of both XIST and ETS2 . Furthermore, our results demonstrated that XIST and ETS2 were correlated with some assisted reproductive technologies outcomes. Finally, we identified two novel compounds including, methotrexate/folate and threonine using drug-gene interaction databases for PCOS management. These findings provide novel insights into the molecular etiology, diagnosis, and potential therapeutic interventions for PCOS.