1
|
Rao HC, Meyer ML, Kominiarek MA, Daviglus ML, Gallo LC, Cordero C, Syan R, Perreira KM, Talavera GA, Fernández-Rhodes L. Polycystic Ovary Syndrome, Metabolic Syndrome, and Inflammation in the Hispanic Community Health Study/Study of Latinos. J Clin Endocrinol Metab 2025; 110:1384-1397. [PMID: 38888178 PMCID: PMC12012804 DOI: 10.1210/clinem/dgae426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 06/12/2024] [Accepted: 06/14/2024] [Indexed: 06/20/2024]
Abstract
CONTEXT Polycystic ovary syndrome (PCOS) is a multifaceted endocrine disorder with reproductive and metabolic dysregulation. PCOS has been associated with inflammation and metabolic syndrome (MetS); however, the moderating effects of inflammation as measured by C-reactive protein (CRP) and menopause on the PCOS-MetS association have not been studied in Hispanic/Latinas with PCOS who have a higher metabolic burden. OBJECTIVE We studied the cross-sectional association between PCOS and (1) MetS in 7316 females of the Hispanic Community Health Study/Study of Latinos (HCHS/SOL), (2) subcomponents of MetS including impaired fasting glucose (IFG) and elevated triglycerides (TGL), and (3) effect modification by menopausal status and CRP. DESIGN The HCHS/SOL is a multicenter, longitudinal, and observational study of US Hispanic/Latinos. Our study sample included females from visit 2 with self-reported PCOS and MetS (ages 23-82 years). RESULTS PCOS (prevalence = 18.8%) was significantly associated with MetS prevalence [odds ratio [odds ratio (OR) = 1.41 (95% confidence interval: 1.13-1.76)], IFG and TGL (OR = 1.42 (1.18-1.72), OR = 1.48 (1.20-1.83), respectively]. We observed effect modification by menopausal status (ORpre = 1.46, Pint= .02; ORpost = 1.34, Pint= .06) and CRP (ORelevated = 1.41, Pint= .04; ORnormal = 1.26, Pint= .16) on the PCOS-MetS association. We also observed a superadditive interaction between CRP and PCOS, adjusting for which resulted in an attenuated effect of PCOS on MetS (OR = 1.29 [0.93-1.78]). CONCLUSION Hispanic/Latino females with PCOS had higher odds of MetS, IFG, and elevated TGL than their peers without PCOS. Interaction analyses revealed that the odds of MetS are higher among PCOS females who have premenopausal status or high inflammation. Interventions in Hispanic/Latinas should target these outcomes for effective management of the disease.
Collapse
Affiliation(s)
- Hridya C Rao
- Department of Biobehavioral Health, The Pennsylvania State University, University Park, PA 16802, USA
| | - Michelle L Meyer
- Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Michelle A Kominiarek
- Department of Obstetrics and Gynecology, Northwestern University, Chicago, IL 60611, USA
| | - Martha L Daviglus
- Institute of Minority Health Research, University of Illinois, Chicago, IL 60612, USA
| | - Linda C Gallo
- Department of Psychology, San Diego State University, San Diego, CA 92182, USA
| | | | - Raveen Syan
- Department of Urology, University of Miami, Miami, FL 33136, USA
| | - Krista M Perreira
- Department of Social Medicine, HCHS/SOL Coordinating Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Gregory A Talavera
- Department of Psychology, San Diego State University, San Diego, CA 92182, USA
| | - Lindsay Fernández-Rhodes
- Department of Biobehavioral Health, The Pennsylvania State University, University Park, PA 16802, USA
| |
Collapse
|
2
|
Su P, Chen C, Sun Y. Physiopathology of polycystic ovary syndrome in endocrinology, metabolism and inflammation. J Ovarian Res 2025; 18:34. [PMID: 39980043 PMCID: PMC11841159 DOI: 10.1186/s13048-025-01621-6] [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: 08/26/2024] [Accepted: 02/08/2025] [Indexed: 02/22/2025] Open
Abstract
Polycystic ovary syndrome (PCOS) is a prevalent endocrine disorder characterized by elevated androgen levels, ovarian cysts, and impaired ovulation in females. This condition is closely linked with various reproductive health issues and has significant impacts on endocrine and metabolic pathways. Patients with PCOS commonly exhibit hyperandrogenaemia and insulin resistance, leading to complications such as acne, hirsutism, weight fluctuations, and metabolic disturbances, as well as an increased risk for type 2 diabetes, cardiovascular disease, and endometrial cancer. Although extensive research has identified several mechanistic aspects of PCOS, a thorough understanding of its pathophysiology remains incomplete. This review aims to provide a detailed analysis of the physiological and pathological aspects of PCOS, covering endocrine, metabolic, and inflammatory dimensions, to better elucidate its etiological framework.
Collapse
Affiliation(s)
- Pingping Su
- Wenzhou Graduate Joint Training Base, Zhejiang Chinese Medical University, Hangzhou, China
- Department of Gynecology, Wenzhou TCM Hospital of Zhejiang Chinese Medical University, Wenzhou, China
| | - Chao Chen
- Department of Traditional Chinese Medicine, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yun Sun
- Department of Gynecology, Wenzhou TCM Hospital of Zhejiang Chinese Medical University, Wenzhou, China.
| |
Collapse
|
3
|
Wang CY, Pei D, Wang CK, Ke JC, Lee ST, Chu TW, Liang YJ. Using machine learning to predict patients with polycystic ovary disease in Chinese women. Taiwan J Obstet Gynecol 2025; 64:68-75. [PMID: 39794054 DOI: 10.1016/j.tjog.2024.09.019] [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] [Accepted: 09/10/2024] [Indexed: 01/13/2025] Open
Abstract
OBJECTIVE With an estimated global frequency ranging from5 % to 21 %, polycystic ovary syndrome (PCOS) is one of the most prevalent hormonal disorders. There are many factors found to be related to PCOS. However, most of these researches used traditional methods such as multiple logistic regression (LR). Nowadays, machine learning (Mach-L) emerges as a new method and can be used in medical researches. In the present study, there were two goals: 1. Compare the accuracy of five alternative Mach-L techniques with that of conventional LR. 2. Use Mach-L to forecast PCOS and prioritize the risk factors. MATERIALS AND METHODS Totally, 170 PCOS patients and 950 control participants were included. We collected information on demographics, biochemistry, and lifestyle. PCOS was identified using Rotterdam criteria. Random Forest (RF), stochastic gradient boosting (SGB), multivariate adaptive regression splines (MARS), extreme gradient boosting (XGBoost), and gradient boosting with categorical features support (CatBoost) are five Mach-L algorithms that were used. Models with lower estimation errors were better. RESULTS By using t-test, we found subjects with PCOS were younger, glutamic oxaloacetic transaminase (GOT), glutamic pyruvic transaminase (GPT), γ-Glutamyl transferase (γ-GT), Triglyceride (TG), and educational levels were higher. All the five Mach-L methods had lower estimation errors compared to LR. The average of the AUC derived from Mach-L was mean AUC of 0.6669, higher than the that of LR (0.5908). Finally, age, TG, GPT, white blood cell count (WBC), uric acid (UA), and platelet (Plt) were the six most important risk factors selected by Mach-L. CONCLUSION Mach-L methods overtook conventional LR and age was the most significant factor, followed by TG, GPT, WBC, UA, and Plt in a cohort of Chinese women.
Collapse
Affiliation(s)
- Chen-Yu Wang
- Department of Obstetrics and Gynecology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan; Graduate Institute of Applied Science and Engineering, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Dee Pei
- Department of Medicine, Medical School, Fu Jen Catholic University, Department of Endocrinology and Metabolism, Fu Jen Catholic University Hospital, New Taipei City, Taiwan
| | - Chun-Kai Wang
- Department of Obstetrics and Gynecology, Zuoying Branch of Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan
| | - Jyun-Cheng Ke
- Department of Obstetrics and Gynecology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Siou-Ting Lee
- Department of Obstetrics and Gynecology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan; Department of Obstetrics and Gynecology, Taoyuan Armed Forces General Hospital, Taoyuan, Taiwan
| | - Ta-Wei Chu
- Department of Obstetrics and Gynecology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan; MJ Health Research Foundation, Taipei, Taiwan
| | - Yao-Jen Liang
- Graduate Institute of Applied Science and Engineering, Fu Jen Catholic University, New Taipei City, Taiwan.
| |
Collapse
|
4
|
Alpay Çağlar Y, Islimye Taşkin M. Association Between Chlamydia trachomatis and Helicobacter pylori with Inflammation in Polycystic Ovary Syndrome: A Cross-Sectional Study. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:2102. [PMID: 39768981 PMCID: PMC11679581 DOI: 10.3390/medicina60122102] [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: 11/22/2024] [Revised: 12/16/2024] [Accepted: 12/18/2024] [Indexed: 01/11/2025]
Abstract
Objective: Chronic low-grade inflammation occurs in polycystic ovary syndrome (PCOS), and there are many contributing factors. In this study, we aimed to investigate Helicobacter pylori and Chlamydia trachomatis infections in patients with PCOS and to evaluate the association between these microorganisms and the inflammatory process in the etiology of the disease. Materials and Methods: This comparative cross-sectional clinical study was conducted at Balıkesir University Hospital and included 40 female patients diagnosed with PCOS in the gynecology outpatients clinic and 40 healthy female controls. Demographic data were recorded. Blood hormone profiles and biochemical parameters were analyzed. An enzyme-linked immunosorbent assay test kit was used to measure H. pylori IgG and C. trachomatis IgG. Results: According to the analysis of the study data, there was no significant association between the PCOS and non-PCOS groups with regard to the presence of Helicobacter pylori IgG (p = 0.1) and Chlamydia trachomatis IgG (p = 0.338). CRP levels were significantly higher in the PCOS group (p = 0.001). In the subgroup analyses, the CRP levels were not significantly different between the H. pylori and C. trachomatis antibody-positive and -negative groups. Diabetes mellitus was significantly associated with PCOS (p = 0.005). The smoking rate was significantly higher in the control group than in the PCOS group (p = 0.036). Compared to the control group, the BMI, LH, HOMA-IR, TSH, and TG levels were significantly higher in participants with PCOS (p = 0.000; p = 0.004; p = 0.001; p = 0.001; p = 0.043; p = 0.000). FSH was lower in PCOS patients compared to controls (p = 001). In the subgroup analyses, no significant differences were found between the H. pylori and C. trachomatis antibody-positive and -negative groups. Conclusions: PCOS is characterized by chronic nonspecific low-grade inflammation. The etiopathogenesis of PCOS involves comorbidities that cause a chronic inflammatory process. However, the possible infective causes still seem to be open to investigation. In particular, studies on microbiota and periodontal diseases in PCOS may provide important contributions.
Collapse
Affiliation(s)
- Yeşim Alpay Çağlar
- Department of Infectious Disease and Clinical Microbiology, Balıkesir University School of Medicine, 10145 Balıkesir, Turkey
| | - Mine Islimye Taşkin
- Department of Obstetrics and Gynecology, Balıkesir University School of Medicine, 10145 Balıkesir, Turkey
| |
Collapse
|
5
|
Deng H, Chen Y, Xing J, Zhang N, Xu L. Systematic low-grade chronic inflammation and intrinsic mechanisms in polycystic ovary syndrome. Front Immunol 2024; 15:1470283. [PMID: 39749338 PMCID: PMC11693511 DOI: 10.3389/fimmu.2024.1470283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2024] [Accepted: 12/03/2024] [Indexed: 01/04/2025] Open
Abstract
Polycystic ovary syndrome (PCOS) is a prevalent endocrine and metabolic disorder affecting 6-20% of women of childbearing age worldwide. Immune cell imbalance and dysregulation of inflammatory factors can lead to systematic low-grade chronic inflammation (SLCI), which plays a pivotal role in the pathogenesis of PCOS. A significant higher infiltration of immune cells such as macrophages and lymphocytes and pro-inflammatory factors IL-6 and TNF-α has been detected in PCOS organ systems, impacting not only the female reproductive system but also other organs such as the cardiovascular, intestine, liver, thyroid, brain and other organs. Obesity, insulin resistance (IR), steroid hormones imbalance and intestinal microecological imbalance, deficiencies in vitamin D and selenium, as well as hyperhomocysteinemia (HHcy) can induce systematic imbalance between pro-inflammatory and anti-inflammatory cells and molecules. The pro-inflammatory cells and cytokines also interact with obesity, steroid hormones imbalance and IR, leading to increased metabolic imbalance and reproductive-endocrine dysfunction in PCOS patients. This review aims to summarize the dysregulation of immune response in PCOS organ system and the intrinsic mechanisms affecting SLCI in PCOS to provide new insights for the systemic inflammatory treatment of PCOS in the future.
Collapse
Affiliation(s)
- Hongxia Deng
- Reproductive Endocrinology and Regulation Laboratory, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Chengdu, China
| | - Yan Chen
- Reproductive Endocrinology and Regulation Laboratory, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Chengdu, China
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Jilong Xing
- Division of Renal and Endocrinology, Qin Huang Hospital, Xi’an, China
| | - Nannan Zhang
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Chengdu, China
- National Center for Birth Defect Monitoring, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Liangzhi Xu
- Reproductive Endocrinology and Regulation Laboratory, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Chengdu, China
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China
| |
Collapse
|
6
|
Guo X, Yao Y, Wang T, Wu J, Jiang R. The impact of hyperandrogenemia on pregnancy complications and outcomes in patients with PCOS: a systematic review and meta-analysis. Hypertens Pregnancy 2024; 43:2379389. [PMID: 39004840 DOI: 10.1080/10641955.2024.2379389] [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: 01/23/2024] [Accepted: 05/10/2024] [Indexed: 07/16/2024]
Abstract
BACKGROUND Polycystic ovary syndrome (PCOS) is a metabolic and reproductive disorder. Current research findings present conflicting views on the effects of different PCOS phenotypes on outcomes in pregnancy and for newborns. METHODS This research study followed the guidelines of the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA). A thorough search of literature was carried out using the Cochrane Menstrual Disorders and Subfertility Group trials register, Web of Science, and EMBASE databases from their start to December 2023. The search focused on studies examining the links between hyperandrogenic and non-hyperandrogenic PCOS phenotypes and risks in pregnancy and neonatology. Odds ratios (ORs) and 95% confidence intervals (CIs) were computed using either a fixed-effects or random-effects model. RESULTS Our analysis incorporated 10 research studies. Expectant mothers with a hyperandrogenic PCOS subtype had increased ORs for gestational diabetes mellitus (GDM) and preeclampsia (PE) compared to those with a non-hyperandrogenic PCOS subtype, with respective values of 2.14 (95% CI, 1.18-3.88, I2 = 0%) and 2.04 (95% CI, 1.02-4.08, I2 = 53%). Nevertheless, no notable differences were detected in ORs for outcomes like preterm birth, live birth, miscarriage, cesarean delivery, pregnancy-induced hypertension, small for gestational age babies, large for gestational age newborns, and neonatal intensive care unit admissions between pregnant women with hyperandrogenic PCOS phenotype and those without. CONCLUSIONS This meta-analysis highlights that the presence of hyperandrogenism heightens the risks of GDM and PE within the PCOS population. Healthcare providers ought to be aware of this connection for improved patient management.
Collapse
Affiliation(s)
- Xiaohan Guo
- Department of Obstetrics and Gynecology, Women's Hospital Zhejiang University School of Medicine, Hangzhou, China
| | - Yingsha Yao
- Department of Obstetrics and Gynecology, Women's Hospital Zhejiang University School of Medicine, Hangzhou, China
| | - Ting Wang
- Department of Obstetrics and Gynecology, Women's Hospital Zhejiang University School of Medicine, Hangzhou, China
| | - Juanhong Wu
- Department of Obstetrics and Gynecology, Women's Hospital Zhejiang University School of Medicine, Hangzhou, China
| | - Ruoan Jiang
- Department of Obstetrics and Gynecology, Women's Hospital Zhejiang University School of Medicine, Hangzhou, China
- Zhejiang Provincial Clinical Research Center for Obstetrics and Gynecology, Hangzhou, China
- Traditional Chinese Medicine for Reproductive Health Key Laboratory of Zhejiang Province, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| |
Collapse
|
7
|
Vitku J, Varausova A, Skodova T, Kolatorova L, Vosatkova M, Vcelak J, Vrbikova J, Simkova M, Svojtkova M. The Role of 11-Oxygenated Androgens and Endocrine Disruptors in Androgen Excess Disorders in Women. Int J Mol Sci 2024; 25:9691. [PMID: 39273637 PMCID: PMC11395667 DOI: 10.3390/ijms25179691] [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: 07/26/2024] [Revised: 08/29/2024] [Accepted: 09/04/2024] [Indexed: 09/15/2024] Open
Abstract
Polycystic ovary syndrome (PCOS) and idiopathic hirsutism (IH) are androgen excess disorders requiring the determination of classic androgen levels for diagnosis. 11-oxygenated androgens have high androgenic potential, yet their clinical value in those disorders is not clear. Additionally, the role of endocrine disruptors (EDs), particularly in IH, remains understudied. We analyzed 25 steroids and 18 EDs in plasma samples from women with IH, PCOS, and controls using LC-MS/MS. Cytokine levels and metabolic parameters were assessed. Comparisons included non-obese women with PCOS (n = 10), women with IH (n = 12) and controls (n = 20), and non-obese versus obese women with PCOS (n = 9). Higher levels of 11-oxygenated androgens were observed in women with PCOS compared to those with IH, but not controls. Conversely, 11-oxygenated androgen levels were lower in women with IH compared to controls. Cytokine levels did not differ between women with IH and controls. Bisphenol A (BPA) levels were higher in obese women with PCOS compared to non-obese women with PCOS. Bisphenol S occurrence was higher in women with PCOS (90%) compared to controls (65%) and IH (50%). Significant correlations were found between androgens (11-ketotestosterone, androstenedione, testosterone) and insulin and HOMA-IR, as well as between immunomodulatory 7-oxygenated metabolites of DHEA and nine interleukins. Our data confirms that PCOS is a multiendocrine gland disorder. Higher BPA levels in obese women might exacerbate metabolic abnormalities. IH was not confirmed as an inflammatory state, and no differences in BPA levels suggest BPA does not play a role in IH pathogenesis.
Collapse
Affiliation(s)
- Jana Vitku
- Department of Steroids and Proteofactors, Institute of Endocrinology, Narodni 8, 116 94 Prague, Czech Republic
| | - Anezka Varausova
- Department of Steroids and Proteofactors, Institute of Endocrinology, Narodni 8, 116 94 Prague, Czech Republic
| | - Tereza Skodova
- Department of Steroids and Proteofactors, Institute of Endocrinology, Narodni 8, 116 94 Prague, Czech Republic
| | - Lucie Kolatorova
- Department of Steroids and Proteofactors, Institute of Endocrinology, Narodni 8, 116 94 Prague, Czech Republic
| | - Michala Vosatkova
- Department of Clinical Biochemistry, Institute of Endocrinology, Narodni 8, 116 94 Prague, Czech Republic
| | - Josef Vcelak
- Department of Molecular Endocrinology, Institute of Endocrinology, Narodni 8, 116 94 Prague, Czech Republic
| | - Jana Vrbikova
- Department of Clinical Endocrinology, Institute of Endocrinology, Narodni 8, 116 94 Prague, Czech Republic
| | - Marketa Simkova
- Department of Steroids and Proteofactors, Institute of Endocrinology, Narodni 8, 116 94 Prague, Czech Republic
| | - Michaela Svojtkova
- Department of Steroids and Proteofactors, Institute of Endocrinology, Narodni 8, 116 94 Prague, Czech Republic
| |
Collapse
|
8
|
Huang X, Yin Z, Xu J, Wu H, Wang Y. The Inflammatory State of Follicular Fluid Combined with Negative Emotion Indicators can Predict Pregnancy Outcomes in Patients with PCOS. Reprod Sci 2024; 31:2493-2507. [PMID: 38653858 DOI: 10.1007/s43032-024-01538-3] [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: 01/16/2024] [Accepted: 04/02/2024] [Indexed: 04/25/2024]
Abstract
Polycystic ovary syndrome (PCOS) is a complex endocrine disorder syndrome with an incidence of 6% to 10% in women of reproductive age. Women with PCOS not only exhibit abnormal follicular development and fertility disorders, but also have a greater tendency to develop anxiety and depression. Our aim was to evaluate the ability of inflammatory factors in follicular fluid to predict embryonic developmental potential and pregnancy outcome and to construct a machine learning model that can predict IVF pregnancy outcomes based on indicators such as basic sex hormones, embryonic morphology, the follicular microenvironment, and negative emotion. In this study, inflammatory factors (CRP, IL-6, and TNF-α) in follicular fluid samples obtained from 225 PCOS and 225 non-PCOS women were detected via ELISA. For patients with PCOS, the levels of CRP and IL-6 in the follicular fluid in the pregnant group were significantly lower than those in the nonpregnant group. For non-patients with PCOS, only the level of IL-6 in the follicular fluid was significantly lower in the pregnant group than in the nonpregnant group. In addition, for both PCOS and non-patients with PCOS, compared with those in the pregnant group, patients in the nonpregnant group showed more pronounced signs of anxiety and depression. Finally, the factors that were significantly different between the two subgroups (pregnancy and nonpregnancy) of patients with or without PCOS were identified by an independent sample t test first and further analysed by multilayer perceptron (MLP) and random forest (RF) models to distinguish the two clinical pregnancy outcomes according to the classification function. The accuracy of the RF model in predicting pregnancy outcomes in patients with or without PCOS was 95.6% and 91.1%, respectively. The RF model is more suitable than the MLP model for predicting pregnancy outcomes in IVF patients. This study not only identified inflammatory factors that can affect embryonic development and assessed the anxiety and depression tendencies of PCOS patients, but also constructed an AI model that predict pregnancy outcomes through machine learning methods, which is a beneficial clinical tool.
Collapse
Affiliation(s)
- Xin Huang
- Reproductive Medical Center, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, 201204, China
- Reproductive Medical Center, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200092, China
| | - Zhe Yin
- Reproductive Medical Center, Tongji Hospital, Tongji University School of Medicine, Shanghai, 200065, China
| | - Junting Xu
- Reproductive Medical Center, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, 201204, China
| | - Huanmei Wu
- College of Public Health, Temple University, Philadelphia, PA, 19122, USA.
| | - Yanqiu Wang
- Reproductive Medical Center, Tongji Hospital, Tongji University School of Medicine, Shanghai, 200065, China.
| |
Collapse
|
9
|
Torstensson S, Ascani A, Risal S, Lu H, Zhao A, Espinosa A, Lindgren E, Johansson MH, Eriksson G, Barakat M, Karlsson MC, Svensson C, Benrick A, Stener‐Victorin E. Androgens Modulate the Immune Profile in a Mouse Model of Polycystic Ovary Syndrome. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2024; 11:e2401772. [PMID: 38767114 PMCID: PMC11267352 DOI: 10.1002/advs.202401772] [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: 02/19/2024] [Revised: 04/30/2024] [Indexed: 05/22/2024]
Abstract
Polycystic ovary syndrome (PCOS) is associated with a low-grade inflammation, but it is unknown how hyperandrogenism, the hallmark of PCOS, affects the immune system. Using a PCOS-like mouse model, it is demonstrated that hyperandrogenism affects immune cell populations in reproductive, metabolic, and immunological tissues differently in a site-specific manner. Co-treatment with an androgen receptor antagonist prevents most of these alterations, demonstrating that these effects are mediated through androgen receptor activation. Dihydrotestosterone (DHT)-exposed mice displayed a drastically reduced eosinophil population in the uterus and visceral adipose tissue (VAT). A higher frequency of natural killer (NK) cells and elevated levels of IFN-γ and TNF-α are seen in uteri of androgen-exposed mice, while NK cells in VAT and spleen displayed a higher expression level of CD69, a marker of activation or tissue residency. Distinct alterations of macrophages in the uterus, ovaries, and VAT are also found in DHT-exposed mice and can potentially be linked to PCOS-like traits of the model. Indeed, androgen-exposed mice are insulin-resistant, albeit unaltered fat mass. Collectively, it is demonstrated that hyperandrogenism causes tissue-specific alterations of immune cells in reproductive organs and VAT, which can have considerable implications on tissue function and contribute to the reduced fertility and metabolic comorbidities associated with PCOS.
Collapse
Affiliation(s)
- Sara Torstensson
- Department of Physiology and PharmacologyKarolinska InstitutetStockholm171 77Sweden
| | - Angelo Ascani
- Department of Internal MedicineMedical University of GrazAuenbruggerplaz 15Graz8036Austria
| | - Sanjiv Risal
- Department of Physiology and PharmacologyKarolinska InstitutetStockholm171 77Sweden
| | - Haojiang Lu
- Department of Physiology and PharmacologyKarolinska InstitutetStockholm171 77Sweden
| | - Allan Zhao
- Department of Physiology and PharmacologyKarolinska InstitutetStockholm171 77Sweden
| | - Alexander Espinosa
- Department of MedicineKarolinska InstitutetK2 Reuma Wahren‐Herlenius MStockholm171 77Sweden
| | - Eva Lindgren
- Department of Physiology and PharmacologyKarolinska InstitutetStockholm171 77Sweden
| | - Maria H. Johansson
- Department of MicrobiologyTumor and Cell BiologyKarolinska InstitutetStockholm171 77Sweden
| | - Gustaw Eriksson
- Department of Physiology and PharmacologyKarolinska InstitutetStockholm171 77Sweden
| | - Maya Barakat
- Department of Physiology and PharmacologyKarolinska InstitutetStockholm171 77Sweden
| | - Mikael C.I. Karlsson
- Department of MicrobiologyTumor and Cell BiologyKarolinska InstitutetStockholm171 77Sweden
| | - Camilla Svensson
- Department of Physiology and PharmacologyKarolinska InstitutetStockholm171 77Sweden
| | - Anna Benrick
- Department of PhysiologyInstitute of Neuroscience and PhysiologySahlgrenska AcademyUniversity of GothenburgBox 432Gothenburg40530Sweden
| | | |
Collapse
|
10
|
Stener-Victorin E, Eriksson G, Mohan Shrestha M, Rodriguez Paris V, Lu H, Banks J, Samad M, Perian C, Jude B, Engman V, Boi R, Nilsson E, Ling C, Nyström J, Wernstedt Asterholm I, Turner N, Lanner J, Benrick A. Proteomic analysis shows decreased type I fibers and ectopic fat accumulation in skeletal muscle from women with PCOS. eLife 2024; 12:RP87592. [PMID: 38180081 PMCID: PMC10945439 DOI: 10.7554/elife.87592] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2024] Open
Abstract
Background Polycystic ovary syndrome's (PCOS) main feature is hyperandrogenism, which is linked to a higher risk of metabolic disorders. Gene expression analyses in adipose tissue and skeletal muscle reveal dysregulated metabolic pathways in women with PCOS, but these differences do not necessarily lead to changes in protein levels and biological function. Methods To advance our understanding of the molecular alterations in PCOS, we performed global proteomic and phosphorylation site analysis using tandem mass spectrometry, and analyzed gene expression and methylation. Adipose tissue and skeletal muscle were collected at baseline from 10 women with and without PCOS, and in women with PCOS after 5 weeks of treatment with electrical stimulation. Results Perilipin-1, a protein that typically coats the surface of lipid droplets in adipocytes, was increased whereas proteins involved in muscle contraction and type I muscle fiber function were downregulated in PCOS muscle. Proteins in the thick and thin filaments had many altered phosphorylation sites, indicating differences in protein activity and function. A mouse model was used to corroborate that androgen exposure leads to a shift in muscle fiber type in controls but not in skeletal muscle-specific androgen receptor knockout mice. The upregulated proteins in muscle post treatment were enriched in pathways involved in extracellular matrix organization and wound healing, which may reflect a protective adaptation to repeated contractions and tissue damage due to needling. A similar, albeit less pronounced, upregulation in extracellular matrix organization pathways was also seen in adipose tissue. Conclusions Our results suggest that hyperandrogenic women with PCOS have higher levels of extra-myocellular lipids and fewer oxidative insulin-sensitive type I muscle fibers. These could be key factors leading to insulin resistance in PCOS muscle while electric stimulation-induced tissue remodeling may be protective. Funding Swedish Research Council (2020-02485, 2022-00550, 2020-01463), Novo Nordisk Foundation (NNF22OC0072904), and IngaBritt and Arne Lundberg Foundation. Clinical trial number NTC01457209.
Collapse
Affiliation(s)
| | - Gustaw Eriksson
- Department of Physiology and Pharmacology, Karolinska InstituteStockholmSweden
| | - Man Mohan Shrestha
- Department of Physiology, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of GothenburgGothenburgSweden
| | | | - Haojiang Lu
- Department of Physiology and Pharmacology, Karolinska InstituteStockholmSweden
| | - Jasmine Banks
- School of Biomedical Sciences, University of New South WalesSydneyAustralia
- Victor Chang Cardiac Research Institute, DarlinghurstSydneyAustralia
| | - Manisha Samad
- Department of Physiology, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of GothenburgGothenburgSweden
| | - Charlène Perian
- Department of Physiology, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of GothenburgGothenburgSweden
| | - Baptiste Jude
- Department of Physiology and Pharmacology, Karolinska InstituteStockholmSweden
| | - Viktor Engman
- Department of Physiology and Pharmacology, Karolinska InstituteStockholmSweden
| | - Roberto Boi
- Department of Physiology, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of GothenburgGothenburgSweden
| | - Emma Nilsson
- Epigenetics and Diabetes Unit, Department of Clinical Sciences, Lund University Diabetes Centre, Lund UniversityMalmöSweden
| | - Charlotte Ling
- Epigenetics and Diabetes Unit, Department of Clinical Sciences, Lund University Diabetes Centre, Lund UniversityMalmöSweden
| | - Jenny Nyström
- Department of Physiology, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of GothenburgGothenburgSweden
| | - Ingrid Wernstedt Asterholm
- Department of Physiology, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of GothenburgGothenburgSweden
| | - Nigel Turner
- School of Biomedical Sciences, University of New South WalesSydneyAustralia
- Victor Chang Cardiac Research Institute, DarlinghurstSydneyAustralia
| | - Johanna Lanner
- Department of Physiology and Pharmacology, Karolinska InstituteStockholmSweden
| | - Anna Benrick
- Department of Physiology, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of GothenburgGothenburgSweden
- School of Health Sciences, University of SkövdeSkövdeSweden
| |
Collapse
|
11
|
Li X, Luan T, Wei Y, Zhang J, Zhang J, Zhao C, Ling X. The association between systemic immune-inflammation index and in vitro fertilization outcomes in women with polycystic ovary syndrome: a cohort study. J Ovarian Res 2023; 16:236. [PMID: 38087363 PMCID: PMC10717301 DOI: 10.1186/s13048-023-01321-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 12/02/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND As a novel prognostic and inflammatory marker, the systemic immune-inflammation index (SII) has come to the foreground in recent years. SII may be used as an indicator reflecting the progressive inflammatory process in patients with polycystic ovary syndrome (PCOS). This study aimed to evaluate the correlation between SII and assisted reproductive outcomes in PCOS patients. RESULTS A total of 966 women undergoing in vitro fertilization (IVF) procedure with PCOS were included in the study. The SII was calculated as platelet count (/L) × neutrophil count (/L)/lymphocyte count (/L). Participants were divided into four groups according to SII quartiles calculated at baseline, and the differences of clinical and laboratory outcomes between these four groups were compared. Moreover, a univariate linear regression model was used to evaluate the associations between SII and the outcomes. Patients in the highest SII quartile (Q4) had lower antral follicle count (AFC), estradiol (E2), and progesterone (P) levels on the day of human chorionic gonadotropin (HCG) start compared with the lower three SII quartiles (Q1-Q3). Moreover, our analysis demonstrated that women in the lower SII quartiles had a higher rate of available embryos and blastocyst formation compared with those in the highest SII quartile. Logarithm of SII correlated negatively with available embryo rate, but not with number of available embryos. Additionally, the results of our multivariate logistic regression analyses indicated that the highest SII quartile was negatively associated with biochemical pregnancy rate (BPR), clinical pregnancy rate (CPR), live birth rate (LBR), and implantation rate (IR). A non-linear relationship between the SII and number of available embryos, with a negative relationship seen to the right of the inflection point was also found. CONCLUSIONS The interplay among thrombocytosis, inflammation, and immunity could influence assisted reproductive outcomes in PCOS patients. In this regard, SII may serve as a valuable marker for exploring potential correlations.
Collapse
Affiliation(s)
- Xin Li
- Department of Reproductive Medicine, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, China
| | - Ting Luan
- Department of Obstetrics and Gynecology, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, China
| | - Yi Wei
- Department of Reproductive Medicine, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, China
| | - Juan Zhang
- Department of Reproductive Medicine, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, China
| | - JuanJuan Zhang
- Department of Reproductive Medicine, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, China
| | - Chun Zhao
- Department of Reproductive Medicine, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, China.
| | - Xiufeng Ling
- Department of Reproductive Medicine, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, China.
| |
Collapse
|
12
|
Pavankumar S, Yellarthi PK, Jn S, Boyapati R, Damera TK, G NVK. Evaluation of periodontal status in women with polycystic ovary syndrome versus healthy women: a cross-sectional study. JOURNAL OF YEUNGNAM MEDICAL SCIENCE 2023; 40:S17-S22. [PMID: 37157778 DOI: 10.12701/jyms.2023.00143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Accepted: 04/04/2023] [Indexed: 05/10/2023]
Abstract
BACKGROUND Polycystic ovary syndrome (PCOS) affects approximately 4% to 12% of females of reproductive age. Previous studies have shown an association between systemic and periodontal diseases. This study aimed to compare the prevalence of periodontal disease in women with PCOS and healthy women. METHODS A total of 196 women aged 17 to 45 years were included in this study. Oral hygiene index-simplified (OHI-S), gingival index (GI), community periodontal index (CPI), and loss of attachment (LA) were assessed. Individuals who smoked, were pregnant, had any systemic disease (such as type 1 or type 2 diabetes mellitus, cardiovascular disease, malignancy, osteoporosis, and thyroid dysfunction), had a history of systemic antibiotic use in the past three months, or received any periodontal intervention in the past 6 months of screening were excluded. Student t-test was used to analyze the data. A p-value of <0.05 was considered statistically significant. RESULTS Despite similar OHI-S scores (p=0.972) in the two groups, women with PCOS had significantly higher GI, CPI, and LA scores than healthy women (p<0.001). CONCLUSION Periodontal disease was more prevalent in women with PCOS than in healthy women. This finding may be due to the synergistic effects of PCOS and periodontitis on proinflammatory cytokines. PCOS may have an effect on periodontal disease, and vice versa. Hence, education on periodontal health and early detection and intervention for periodontal diseases is of paramount importance in patients with PCOS.
Collapse
Affiliation(s)
- Sandhya Pavankumar
- Department of Periodontics, GITAM Dental College and Hospital, Visakhapatnam, India
| | - Pavan Kumar Yellarthi
- Department of Oral Medicine and Radiology, GITAM Dental College and Hospital, Visakhapatnam, India
| | - Sandeep Jn
- Department of Periodontics, V.S Dental College and Hospital, Bengaluru, India
| | | | | | - Naveen Vital Kumar G
- Department of Periodontics, GITAM Dental College and Hospital, Visakhapatnam, India
| |
Collapse
|
13
|
Rathi N, Reche A. Risk of Periodontal Diseases in Women With Polycystic Ovary Syndrome: An Overview. Cureus 2023; 15:e47169. [PMID: 38021744 PMCID: PMC10652058 DOI: 10.7759/cureus.47169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 10/16/2023] [Indexed: 12/01/2023] Open
Abstract
Polycystic ovary syndrome (PCOS) is the most prevalent condition seen in reproductive-aged women, which has a negative impact on their health system. There is a serious concern for women having PCOS that they may experience long-term metabolic conditions. PCOS also has a negative impact on periodontium components such as gingiva, periodontal ligament (PDL), and alveolar bone. It has been said that there may be a bidirectional link between PCOS and periodontal diseases. Moreover, PCOS and periodontal disorders both have common risk factors. Periodontal diseases are exacerbated by systemic low-grade inflammation, including obesity, constant immunological imbalance, and oxidative stress caused by PCOS. On the other hand, periodontal diseases can also increase the risk of causing PCOS. According to recent data, women with PCOS may be more likely to suffer from periodontal diseases. A PubMed and Google Scholar search was conducted for literature relating to PCOS and its relationship with different comorbidities which also included periodontal disorders. Analyses were performed, and data was synthesized and assembled in a presentable form. Therefore, the focus of this review will be on the relationship between PCOS and periodontal disorders, as well as the risk factors for both. However, in order to establish a more distinct and solid link, more studies with a large sample size need to be done.
Collapse
Affiliation(s)
- Netal Rathi
- Public Health Dentistry, Sharad Pawar Dental College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Amit Reche
- Public Health Dentistry, Sharad Pawar Dental College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| |
Collapse
|
14
|
Banerjee S, Cooney LG, Stanic AK. Immune Dysfunction in Polycystic Ovary Syndrome. Immunohorizons 2023; 7:323-332. [PMID: 37195871 PMCID: PMC10579973 DOI: 10.4049/immunohorizons.2200033] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 04/26/2023] [Indexed: 05/19/2023] Open
Abstract
Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in reproductive-aged individuals with ovaries. It is associated with anovulation and increased risk to fertility and metabolic, cardiovascular, and psychological health. The pathophysiology of PCOS is still inadequately understood, although there is evidence of persistent low-grade inflammation, which correlates with associated visceral obesity. Elevated proinflammatory cytokine markers and altered immune cells have been reported in PCOS and raise the possibility that immune factors contribute to ovulatory dysfunction. Because normal ovulation is modulated by immune cells and cytokines in the ovarian microenvironment, the endocrine and metabolic abnormalities associated with PCOS orchestrate the accompanying adverse effects on ovulation and implantation. This review evaluates the current literature on the relationship between PCOS and immune abnormalities, with a focus on emerging research in the field.
Collapse
Affiliation(s)
- Soma Banerjee
- Division of Reproductive Sciences, Department of Obstetrics and Gynecology, University of Wisconsin–Madison, Madison, WI
| | - Laura G. Cooney
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Wisconsin–Madison
| | - Aleksandar K. Stanic
- Division of Reproductive Sciences, Department of Obstetrics and Gynecology, University of Wisconsin–Madison, Madison, WI
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Wisconsin–Madison
| |
Collapse
|
15
|
Moulana M. Androgen-Induced Cardiovascular Risk in Polycystic Ovary Syndrome: The Role of T Lymphocytes. Life (Basel) 2023; 13:life13041010. [PMID: 37109539 PMCID: PMC10145997 DOI: 10.3390/life13041010] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 04/10/2023] [Accepted: 04/11/2023] [Indexed: 04/29/2023] Open
Abstract
An estimated 15-20% of reproductive-age women are affected by polycystic ovary syndrome (PCOS). PCOS is associated with substantial metabolic and cardiovascular long-term consequences. In young women with PCOS, several cardiovascular risk factors may be found, including chronic inflammation, high blood pressure, and elevated leukocytes. These women are at an increased risk of cardiovascular diseases (CVD), not only during the reproductive years, but also with aging and menopause; therefore, the early prevention and treatment of future cardiovascular adverse effects are necessary. The fundamental characteristic of PCOS is hyperandrogenemia, which is associated with increased pro-inflammatory cytokines and T lymphocytes. Whether these factors play a role in the pathophysiology of hypertension, a risk factor of CVD, due to PCOS is not well established. This review will briefly discuss how a modest increase in androgens in females is linked to the development of hypertension through pro-inflammatory cytokines and T lymphocyte subsets and the promotion of renal injury. Moreover, it reveals a few existing research gaps in this area, including the lack of specific therapy directed at androgen-induced inflammation and immune activation, thus emphasizing the necessity to explore the systemic inflammation in women with PCOS to halt the inevitable inflammatory process targeting the underlying abnormalities of CVD.
Collapse
Affiliation(s)
- Mohadetheh Moulana
- Department of Psychiatry and Human Behavior, Women's Health Research Center, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS 39216, USA
| |
Collapse
|
16
|
Vaez S, Parivr K, Amidi F, Rudbari NH, Moini A, Amini N. Quercetin and polycystic ovary syndrome; inflammation, hormonal parameters and pregnancy outcome: A randomized clinical trial. Am J Reprod Immunol 2023; 89:e13644. [PMID: 36317442 DOI: 10.1111/aji.13644] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 09/16/2022] [Accepted: 10/18/2022] [Indexed: 11/07/2022] Open
Abstract
PROBLEM Women with PCOS have a reduced total antioxidant level in addition to higher oxidative stress. Quercetin is a flavonol-type antioxidant that may be found in many foods. Does quercetin affect inflammatory and hormonal factors and clinical outcomes in PCOS patients? METHOD OF STUDY Seventy-two women with PCOS were randomly allocated to one of two intervention groups, and each received a daily dosage of 500 mg of Quercetin for the intervention group or a placebo for the control group for a period of 40 days from the start of the menstrual cycle until the day of ovulation. Serum levels of IL-6, TNF-alpha, LH, FSH, and AMH were measured using ELISA. In addition, oocyte and embryo grade before IVF and pregnancy rate have been examined. RESULTS LH levels reduce significantly in the quercetin group (4.351.62 at baseline to 3.061.43 after 3 months) (p = .029). The results indicated that Quercetin significantly decreased TNF alpha levels in comparison to the pretest (p = .008). Following capsule administration, IL-6 levels significantly decreased in the quercetin group (p = .001). Except for Δ LH, ΔIL6, and ΔFSH, there was no significant difference in any of the hormones and inflammations parameter changes. CONCLUSION Quercetin consumption causes improvement in oocyte and embryo grade and the pregnancy rate in PCOS patients. As a result, regular consumption of Quercetin has been shown to decrease inflammatory and LH parameters, making it beneficial for the management of PCOS and related diseases.
Collapse
Affiliation(s)
- Sima Vaez
- Department of Biology, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | - Kazem Parivr
- Department of Biology, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | - Fardin Amidi
- Department of Anatomy, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.,Department of Infertility, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Nasim Hayati Rudbari
- Department of Biology, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | - Ashraf Moini
- Breast Disease Research Center (BDRC), Tehran University of Medical Sciences, Tehran, Iran.,Department of Gynecology and Obstetrics, Arash Women's Hospital, Tehran University of Medical Sciences, Tehran, Iran.,Department of Endocrinology and Female Infertility at Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Naser Amini
- Cellular and Molecular Research Center, Iran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
17
|
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: 9] [Impact Index Per Article: 4.5] [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.
Collapse
|
18
|
Review of the effects of polycystic ovary syndrome on Cognition: Looking beyond the androgen hypothesis. Front Neuroendocrinol 2022; 67:101038. [PMID: 36154816 DOI: 10.1016/j.yfrne.2022.101038] [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: 05/17/2022] [Revised: 09/12/2022] [Accepted: 09/16/2022] [Indexed: 11/21/2022]
Abstract
Polycystic-ovary syndrome (PCOS) is the most common endocrine disorder affecting women of reproductive age, and many features associated with PCOS - such as elevated androgens, insulin resistance and inflammation - are known to affect cognition. However, effects of PCOS on cognition are not well-understood. Here we review the current literature on PCOS and cognition, note the extent of PCOS symptomatology studied in relation to cognitive outcomes, and identify key research gaps and common methodological concerns. Findings indicate a pattern of worse performance across cognitive domains and brain measures in women with PCOS relative to non-PCOS controls, as well as a lack of evidence for the common assumption that women with PCOS will have higher performance on tasks with a demonstrated male-advantage due to high testosterone levels. We suggest strategies for moving beyond the focus on elevated androgens, in favor of research practices that account for the nuances and heterogeneity of PCOS symptoms.
Collapse
|
19
|
Durmuş M, Uzunlar Ö, Çelik H, Çandar T. Does alpha-1-acid glycoprotein determine for infertility in polycystic ovary syndrome? Eur J Obstet Gynecol Reprod Biol 2022; 274:155-159. [PMID: 35653904 DOI: 10.1016/j.ejogrb.2022.05.023] [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: 02/10/2022] [Revised: 05/09/2022] [Accepted: 05/19/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVES The underlying cause of metabolic abnormalities and ovarian dysfunction in PCOS is thought to be chronic low-grade inflammation. This study aimed to show whether alpha-1-acid glycoprotein (AGP), an inflammatory marker, predicts the risk of infertility in fertile and infertile women with PCOS. Our study had a cros-sectional case-control design. STUDY DESIGN A total of 20 fertile and 50 infertile patients with PCOS who wanted a child were in the early follicular phase were included in our study. Among the study groups (fertil (n = 20) and infertile (n = 50), AGP, CRP, NLR, BMI, FAI, VAI, triglyceride, HDL-cholesterol, fasting blood sugar, HOMA-IR, SHBG, testosterone values and waist circumference were measured. RESULTS Among the inflammatory markers compared in the fertile and infertile groups included in the study, only the difference between the AGP variable was statistically significant (p = 0.011). The mean AGP was found to be higher at a statistically significant level in the infertile group (p < 0.05). Age, BMI, waist circumference and AGP were weakly positive and CRP was moderately positive in the infertile group (p < 0.05). CONCLUSION AGP can be a good indicator of inflammation in PCOS, especially in infertility.Revealing the risk of infertility in PCOS with AGP measurement may contribute to the correct management of the reproductive process.
Collapse
Affiliation(s)
- Merve Durmuş
- Department of Obstetrics and Gynecology, Private Ege Yasam Hospital, Izmir, Turkey.
| | - Özlem Uzunlar
- Department of Obstetrics and Gynecology, University of Health Science, Ankara City Hospital, Ankara, Turkey
| | - Hümeyra Çelik
- Department of Physiology, Bolu Abant Izzet Baysal University School of Medicine, Bolu, Turkey
| | - Tuba Çandar
- Department of Biochemistry, Ufuk University Dr. Rıdvan Ege Hospital, Ankara, Turkey
| |
Collapse
|
20
|
Mamtimin M, Pinarci A, Han C, Braun A, Anders HJ, Gudermann T, Mammadova-Bach E. Extracellular DNA Traps: Origin, Function and Implications for Anti-Cancer Therapies. Front Oncol 2022; 12:869706. [PMID: 35574410 PMCID: PMC9092261 DOI: 10.3389/fonc.2022.869706] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 03/07/2022] [Indexed: 12/16/2022] Open
Abstract
Extracellular DNA may serve as marker in liquid biopsies to determine individual diagnosis and prognosis in cancer patients. Cell death or active release from various cell types, including immune cells can result in the release of DNA into the extracellular milieu. Neutrophils are important components of the innate immune system, controlling pathogens through phagocytosis and/or the release of neutrophil extracellular traps (NETs). NETs also promote tumor progression and metastasis, by modulating angiogenesis, anti-tumor immunity, blood clotting and inflammation and providing a supportive niche for metastasizing cancer cells. Besides neutrophils, other immune cells such as eosinophils, dendritic cells, monocytes/macrophages, mast cells, basophils and lymphocytes can also form extracellular traps (ETs) during cancer progression, indicating possible multiple origins of extracellular DNA in cancer. In this review, we summarize the pathomechanisms of ET formation generated by different cell types, and analyze these processes in the context of cancer. We also critically discuss potential ET-inhibiting agents, which may open new therapeutic strategies for cancer prevention and treatment.
Collapse
Affiliation(s)
- Medina Mamtimin
- Walther-Straub-Institute for Pharmacology and Toxicology, Ludwig-Maximilians-University, Munich, Germany.,Division of Nephrology, Department of Medicine IV, Ludwig-Maximilians-University Hospital, Munich, Germany
| | - Akif Pinarci
- Walther-Straub-Institute for Pharmacology and Toxicology, Ludwig-Maximilians-University, Munich, Germany
| | - Chao Han
- Walther-Straub-Institute for Pharmacology and Toxicology, Ludwig-Maximilians-University, Munich, Germany.,Division of Nephrology, Department of Medicine IV, Ludwig-Maximilians-University Hospital, Munich, Germany
| | - Attila Braun
- Walther-Straub-Institute for Pharmacology and Toxicology, Ludwig-Maximilians-University, Munich, Germany
| | - Hans-Joachim Anders
- Walther-Straub-Institute for Pharmacology and Toxicology, Ludwig-Maximilians-University, Munich, Germany.,Division of Nephrology, Department of Medicine IV, Ludwig-Maximilians-University Hospital, Munich, Germany
| | - Thomas Gudermann
- Walther-Straub-Institute for Pharmacology and Toxicology, Ludwig-Maximilians-University, Munich, Germany.,German Center for Lung Research, Munich, Germany
| | - Elmina Mammadova-Bach
- Walther-Straub-Institute for Pharmacology and Toxicology, Ludwig-Maximilians-University, Munich, Germany.,Division of Nephrology, Department of Medicine IV, Ludwig-Maximilians-University Hospital, Munich, Germany
| |
Collapse
|
21
|
Dai W, Liu J, Qiu Y, Teng Z, Li S, Huang J, Xiang H, Tang H, Wang B, Chen J, Wu H. Shared postulations between bipolar disorder and polycystic ovary syndrome pathologies. Prog Neuropsychopharmacol Biol Psychiatry 2022; 115:110498. [PMID: 34929323 DOI: 10.1016/j.pnpbp.2021.110498] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 12/06/2021] [Accepted: 12/12/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Women with bipolar disorder (BD) present a high prevalence of polycystic ovary syndrome (PCOS) and other reproductive disorders even before diagnosis or treatment of the disease. Postulations on the potential molecular mechanisms of comorbid PCOS in women with BD remain limited to influence of medications and need further extension. OBJECTIVES This review focuses on evidence suggesting that common metabolic and immune disorders may play an important role in the development of BD and PCOS. RESULTS The literature covered in this review suggests that metabolic and immune disorders, including the dysfunction of the hypothalamic-pituitary-adrenal axis, chronic inflammatory state, gut microbial alterations, adipokine alterations and circadian rhythm disturbance, are observed in patients with BD and PCOS. Such disorders may be responsible for the increased prevalence of PCOS in the BD population and indicate a susceptibility gene overlap between the two diseases. Current evidence supports postulations of common metabolic and immune disorders as endophenotype in BD as well as in PCOS. CONCLUSIONS Metabolic and immune disorders may be responsible for the comorbid PCOS in the BD population. The identification of hallmark metabolic and immune features common to these two diseases will contribute to the clarification of the effect of BD on the reproductive endocrine function and development of symptomatic treatments targeting the biomarkers of the two diseases.
Collapse
Affiliation(s)
- Wenyu Dai
- National Clinical Research Center for Mental Disorders, Department of Psychiatry, China National Technology Institute on Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China
| | - Jieyu Liu
- Department of Ultrasound Diagnostic, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China
| | - Yan Qiu
- National Clinical Research Center for Mental Disorders, Department of Psychiatry, China National Technology Institute on Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China
| | - Ziwei Teng
- National Clinical Research Center for Mental Disorders, Department of Psychiatry, China National Technology Institute on Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China
| | - Sujuan Li
- National Clinical Research Center for Mental Disorders, Department of Psychiatry, China National Technology Institute on Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China
| | - Jing Huang
- National Clinical Research Center for Mental Disorders, Department of Psychiatry, China National Technology Institute on Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China
| | - Hui Xiang
- National Clinical Research Center for Mental Disorders, Department of Psychiatry, China National Technology Institute on Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China
| | - Hui Tang
- National Clinical Research Center for Mental Disorders, Department of Psychiatry, China National Technology Institute on Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China
| | - Bolun Wang
- Department of Radiology, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China
| | - Jindong Chen
- National Clinical Research Center for Mental Disorders, Department of Psychiatry, China National Technology Institute on Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China.
| | - Haishan Wu
- National Clinical Research Center for Mental Disorders, Department of Psychiatry, China National Technology Institute on Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China.
| |
Collapse
|
22
|
Quantitative Changes in White Blood Cells: Correlation with the Hallmarks of Polycystic Ovary Syndrome. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58040535. [PMID: 35454373 PMCID: PMC9031855 DOI: 10.3390/medicina58040535] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 04/03/2022] [Accepted: 04/08/2022] [Indexed: 11/17/2022]
Abstract
Background and Objectives: In women of reproductive age, leukocytosis is a risk factor that bridges low-grade chronic inflammation (metabolic inflammation), metabolic changes, and polycystic ovary syndrome (PCOS) and is a potential early predictor of PCOS. This study aims to explore the predictive role of quantitative changes in white blood cells (WBCs) and neutrophils in PCOS-associated metabolic changes. Materials and Methods: A total number of 176 blood samples were obtained from age-matched women of the reproductive period, comprising 88 PCOS cases and 88 healthy controls. Hematological, metabolic, and anthropometric indices and ultrasonic assessment were recorded. Results: Elevated levels of luteinizing hormone, testosterone, and lipid parameters except HDL-C levels, and the prevalence of metabolic syndrome in PCOS were statistically significant (p < 0.001). The neutrophil count and neutrophil−lymphocyte ratio (NLR) in PCOS patients were significantly higher (p < 0.001) than their counterparts. The predictive ability of the neutrophil count and neutrophil−lymphocyte ratio (NLR) for PCOS, and possibly its associating subclinical inflammation at optimum cut-off values for the neutrophil count and NLR of >46.62% (sensitivity 94.32% and specificity 74.42%) and >1.23 (sensitivity 71.59% and specificity 100%), respectively. With regard to the areas under the curve (AUC) and Youden indices, they constituted 0.922 and 0.697 for neutrophil count and 0.926 and 0.716 for NLR, respectively. The comparative ROC z-statistic value was 2.222 and a p = 0.026. The multiple linear regression analysis revealed no significant influence for hormonal and metabolic independent variables on the neutrophil count in PCOS cases, but, as can be expected, revealed a significant negative relationship with the other components of WBCs. Conclusion: In conclusion, relative neutrophilia and elevated NLR are potential cost-effective, sensitive, and specific predictors of PCOS that may also shed light on the mechanism of chronic low-grade inflammation that is characteristic of the disease.
Collapse
|
23
|
Zhai Y, Pang Y. Systemic and Ovarian Inflammation in Women with Polycystic Ovary Syndrome. J Reprod Immunol 2022; 151:103628. [DOI: 10.1016/j.jri.2022.103628] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 04/01/2022] [Accepted: 04/13/2022] [Indexed: 02/08/2023]
|
24
|
Regidor PA, de la Rosa X, Müller A, Mayr M, Gonzalez Santos F, Gracia Banzo R, Rizo JM. PCOS: A Chronic Disease That Fails to Produce Adequately Specialized Pro-Resolving Lipid Mediators (SPMs). Biomedicines 2022; 10:biomedicines10020456. [PMID: 35203665 PMCID: PMC8962413 DOI: 10.3390/biomedicines10020456] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 02/08/2022] [Accepted: 02/10/2022] [Indexed: 12/31/2022] Open
Abstract
Introduction: Polycystic ovary syndrome (PCOS) is an endocrinological disorder that affects 5–15% of women of their reproductive age and is a frequent cause of infertility. Major symptoms include hyperandrogenism, ovulatory dysfunction, and often obesity and/or insulin resistance. PCOS also represents a state of chronic low-grade inflammation that is closely interlinked with the metabolic features. “Classical” pro-inflammatory lipid mediators such as prostaglandins (PG), leukotrienes (LT), or thromboxanes (TX) are derived from arachidonic acid (AA) and are crucial for the initial response. Resolution processes are driven by four families of so-called specialized pro-resolving mediators (SPMs): resolvins, maresins, lipoxins, and protectins. The study aimed to establish lipid mediator profiles of PCOS patients compared to healthy women to identify differences in their resolutive and pro-inflammatory lipid parameters. Material and Methods: Fifteen female patients (18–45 years) were diagnosed with PCOS according to Rotterdam criteria, and five healthy women, as a comparator group, were recruited for the study. The main outcome measures were: pro-inflammatory lipid mediators (PG, LT, TX) and their precursor AA, SPMs (resolvins, maresins, protectins, lipoxins), their precursors EPA, DHA, DPA, and their active biosynthesis pathway intermediates (18-HEPE, 17-HDHA, 14-HDHA). Results: The level of pro-inflammatory parameters in serum was significantly higher in PCOS-affected women. The ratio (sum of pro-inflammatory molecules)/(sum of SPMs plus hydroxylated intermediates) reflecting the inflammatory state was significantly lower in the group of healthy women. Conclusion: There is a strong pro-inflammatory state in PCOS patients. Further research will clarify whether supplementation with SPMs or their precursors may improve this state.
Collapse
Affiliation(s)
- Pedro-Antonio Regidor
- Exeltis Healthcare, Adalperostr. 84, 85737 Ismaning, Germany; (A.M.); (M.M.)
- OTC Chemo, Manuel Pombo Angulo 28-4th Floor, 28050 Madrid, Spain;
- Correspondence: ; Tel.: +49-894-5205-2919 or +49-173-893-8132; Fax: +49-8945-2052-9819
| | - Xavier de la Rosa
- Center for Experimental Therapeutics and Reperfusion Injury, Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital and Harvard Medical School, 60 Fenwood Road Boston, Boston, MA 02115, USA;
| | - Anna Müller
- Exeltis Healthcare, Adalperostr. 84, 85737 Ismaning, Germany; (A.M.); (M.M.)
| | - Manuela Mayr
- Exeltis Healthcare, Adalperostr. 84, 85737 Ismaning, Germany; (A.M.); (M.M.)
| | | | - Rafael Gracia Banzo
- Solutex GC SL, Parque Empresarial Utebo, Avda. Miguel Servet n° 81, 50180 Utebo, Spain;
| | - Jose Miguel Rizo
- OTC Chemo, Manuel Pombo Angulo 28-4th Floor, 28050 Madrid, Spain;
| |
Collapse
|
25
|
Y Al-Taee SM, Al-Allaff RGM, E Alnajafy L. The Effect of Leptin on the Regulation of Immune Responses in Women with Polycystic Ovary Syndrome. Pak J Biol Sci 2022; 25:715-724. [PMID: 36098197 DOI: 10.3923/pjbs.2022.715.724] [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] [Indexed: 06/15/2023]
Abstract
<b>Background and Objective:</b> Leptin is a hormone produced by fat cells in adipose tissue that plays a biological role in metabolism, immune system control and energy flow regulation. The study's objective was to investigate serum leptin levels in PCOS females and determine how they are related to immunological and hormonal parameters. <b>Materials and Methods:</b> Thirty PCOS women were chosen for the study and compared to thirty healthy women as control samples, with both case and normal samples ranging in age from 18-36 years. WBC count, absolute numbers of neutrophils, lymphocytes, monocytes, eosinophils, leptin, Prolactin and serum IgA levels were measured. <b>Results:</b> The results showed the mean WBC, lymphocytes and eosinophil absolute numbers in PCOS women were significantly different. However, there was no significant difference in the absolute numbers of neutrophils and monocytes. The findings also revealed a significant increase in BMI, IgA, leptin and prolactin levels in PCOS when compared to controls. The results showed strong positive correlation coefficients between BMI and IgA (1.000**), WBC with neutrophils, lymphocytes and monocytes (0.797**, 0.790**, 0.712**), respectively and finally leptin and prolactin (0.474**). The same test, on the other hand, revealed an inverse correlation coefficient between BMI, IgA and prolactin (-0.376*, -0.376*, respectively with p<u><</u>0.05). <b>Conclusion:</b> A rise in the levels of the hormones leptin and prolactin, which were positively associated with the body mass index in women with PCOS, was found in the current study. The findings revealed that the hormones leptin and prolactin have an effect on some immune parameters in women with PCOS.
Collapse
|
26
|
de Medeiros SF, de Medeiros MAS, Barbosa BB, Yamamoto AKLW, Yamamoto MMW. The connection of alpha-1 acid glycoprotein inflammatory marker with anthropometric, hormonal, and metabolic characteristic of women with polycystic ovary syndrome. J Obstet Gynaecol Res 2021; 47:3571-3582. [PMID: 34265865 DOI: 10.1111/jog.14940] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 06/28/2021] [Accepted: 07/01/2021] [Indexed: 12/28/2022]
Abstract
AIM To investigate the connection of alpha-1 acid glycoprotein inflammatory biomarker with clinical, hormonal, and metabolic characteristics in women with polycystic ovary syndrome (PCOS) and normal cycling controls. METHODS A cross-sectional study was conducted on 235 women with PCOS and 92 normal cycling controls attended between 2008 and 2018. Alpha-1 acid glycoprotein levels were correlated with clinical, anthropometric, anthropometric-metabolic indexes, and hormones of women with PCOS and controls. Simple and multivariate stepwise linear regression, matched for age and body mass index confounding variables, was performed. RESULTS Alpha-1 acid glycoprotein levels were higher in women with PCOS (p = 0.0016). In controls, it was positively correlated with waist circumference, fat mass, body adiposity index, and lipid accumulation product, and negatively correlated with sex hormone-binding globulin (p < 0.005 for all comparisons). In PCOS, it was positively correlated with testosterone, most biomarkers of central adiposity, homeostatic model assessment of insulin-resistant, erythrocyte sedimentation rate, and negatively correlated with sex hormone-binding globulin, high-density lipoprotein cholesterol, glucose/insulin ratio, and lymphocytes (p < 0.055 for all comparisons). After multivariate regression in women with PCOS, alpha-1 acid glycoprotein retained a significant positive correlation with erythrocyte sedimentation rate and C-reactive protein. CONCLUSIONS In PCOS, alpha-1 acid glycoprotein is correlated with biomarkers of adiposity, carbohydrate metabolism, and total testosterone. This inflammatory marker is also correlated with erythrocyte sedimentation rate, neutrophils, and lymphocytes, frequent markers of an inflammation state.
Collapse
Affiliation(s)
- Sebastião Freitas de Medeiros
- Department of Gynecology and Obstetrics, Medical School, Federal University of Mato Grosso, Cuiabá, Brazil.,Tropical Institute of Reproductive Medicine, Cuiabá, Brazil
| | | | | | | | | |
Collapse
|
27
|
Sharma S, Mahajan N. Polycystic Ovarian Syndrome and Menopause in Forty Plus Women. J Midlife Health 2021; 12:3-7. [PMID: 34188419 PMCID: PMC8189332 DOI: 10.4103/jmh.jmh_8_21] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 02/02/2021] [Accepted: 02/22/2021] [Indexed: 11/04/2022] Open
Abstract
Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in women of reproductive age group, but it affects women's health and quality of life across the life course. During different stages of life, the PCOS phenotype can change, which requires a personalized diagnostic approach and treatment. With increasing age, the syndrome evolves from a reproductive disease to a more metabolic disorder. Along with various metabolic disturbances like insulin resistance and abnormalities of energy expenditure, PCOS is recognized as a major risk factor for the development of type 2 diabetes and cardiovascular disease (CVD) in later life. The aim of the current review was to conduct a nonsystematic review of published literature and research that has been presented so far regarding menopausal women with PCOS as well as the associated changes in hormone profile, their lipid profile, and various metabolic changes that occur. The current review may also contribute to raise awareness about the risk of hypertension and CVDs in postmenopausal women with PCOS.
Collapse
Affiliation(s)
- Sudhaa Sharma
- Department of Obstetrics and Gynecology, Government Medical College, SMGS Hospital, Jammu, Jammu and Kashmir, India
| | - Neha Mahajan
- Department of Obstetrics and Gynecology, Government Medical College, SMGS Hospital, Jammu, Jammu and Kashmir, India
| |
Collapse
|
28
|
Rudnicka E, Suchta K, Grymowicz M, Calik-Ksepka A, Smolarczyk K, Duszewska AM, Smolarczyk R, Meczekalski B. Chronic Low Grade Inflammation in Pathogenesis of PCOS. Int J Mol Sci 2021; 22:ijms22073789. [PMID: 33917519 PMCID: PMC8038770 DOI: 10.3390/ijms22073789] [Citation(s) in RCA: 276] [Impact Index Per Article: 69.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 03/24/2021] [Accepted: 03/31/2021] [Indexed: 12/13/2022] Open
Abstract
Polycystic ovary syndrome (PCOS) is a one of the most common endocrine disorders, with a prevalence rate of 5–10% in reproductive aged women. It’s characterized by (1) chronic anovulation, (2) biochemical and/or clinical hyperandrogenism, and (3) polycystic ovarian morphology. PCOS has significant clinical implications and can lead to health problems related to the accumulation of adipose tissue, such as obesity, insulin resistance, metabolic syndrome, and type 2 diabetes. There is also evidence that PCOS patients are at higher risk of cardiovascular diseases, atherosclerosis, and high blood pressure. Several studies have reported the association between polycystic ovary syndrome (PCOS) and low-grade chronic inflammation. According to known data, inflammatory markers or their gene markers are higher in PCOS patients. Correlations have been found between increased levels of C-reactive protein (CRP), interleukin 18 (IL-18), tumor necrosis factor (TNF-α), interleukin 6 (IL-6), white blood cell count (WBC), monocyte chemoattractant protein-1 (MCP-1) and macrophage inflammatory protein-1α (MIP-1α) in the PCOS women compared with age- and BMI-matched controls. Women with PCOS present also elevated levels of AGEs and increased RAGE (receptor for advanced glycation end products) expression. This chronic inflammatory state is aggravating by obesity and hyperinsulinemia. There are studies describing mutual impact of hyperinsulinemia and obesity, hyperandrogenism, and inflammatory state. Endothelial cell dysfunction may be also triggered by inflammatory cytokines. Many factors involved in oxidative stress, inflammation, and thrombosis were proposed as cardiovascular risk markers showing the endothelial cell damage in PCOS. Those markers include asymmetric dimethylarginine (ADMA), C-reactive protein (CRP), homocysteine, plasminogen activator inhibitor-I (PAI-I), PAI-I activity, vascular endothelial growth factor (VEGF) etc. It was also proposed that the uterine hyperinflammatory state in polycystic ovary syndrome may be responsible for significant pregnancy complications ranging from miscarriage to placental insufficiency. In this review, we discuss the most importance evidence concerning the role of the process of chronic inflammation in pathogenesis of PCOS.
Collapse
Affiliation(s)
- Ewa Rudnicka
- Department of Gynaecological Endocrinology, Medical University of Warsaw, 00-315 Warsaw, Poland; (K.S.); (M.G.); (A.C.-K.); (R.S.)
- Correspondence: ; Tel.: +48-604167450
| | - Katarzyna Suchta
- Department of Gynaecological Endocrinology, Medical University of Warsaw, 00-315 Warsaw, Poland; (K.S.); (M.G.); (A.C.-K.); (R.S.)
| | - Monika Grymowicz
- Department of Gynaecological Endocrinology, Medical University of Warsaw, 00-315 Warsaw, Poland; (K.S.); (M.G.); (A.C.-K.); (R.S.)
| | - Anna Calik-Ksepka
- Department of Gynaecological Endocrinology, Medical University of Warsaw, 00-315 Warsaw, Poland; (K.S.); (M.G.); (A.C.-K.); (R.S.)
| | - Katarzyna Smolarczyk
- Department of Dermatology and Venereology, Medical University of Warsaw, 00-315 Warsaw, Poland;
| | - Anna M. Duszewska
- Department of Morphological Sciences, Faculty of Veterinary Medicine, Warsaw University of Life Sciences, 02-787 Warsaw, Poland;
| | - Roman Smolarczyk
- Department of Gynaecological Endocrinology, Medical University of Warsaw, 00-315 Warsaw, Poland; (K.S.); (M.G.); (A.C.-K.); (R.S.)
| | - Blazej Meczekalski
- Department of Gynaecological Endocrinology, Poznan University of Medical Sciences, 60-535 Poznan, Poland;
| |
Collapse
|
29
|
Alexandraki KI, Kandaraki EA, Poulia KA, Piperi C, Papadimitriou E, Papaioannou TG. Assessment of Early Markers of Cardiovascular Risk in Polycystic Ovary Syndrome. TOUCHREVIEWS IN ENDOCRINOLOGY 2021; 17:37-53. [PMID: 35118445 DOI: 10.17925/ee.2021.17.1.37] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 06/22/2020] [Indexed: 11/24/2022]
Abstract
Polycystic ovary syndrome (PCOS) is a heterogeneous syndrome, with long-term sequelae from birth to senescence. The long-term effects of PCOS are attributed to several metabolic aberrations ensuing the syndrome. In a systematic review of literature regarding the cardiovascular risk factors that accompany PCOS, we found that macrovascular function has been assessed by flow-mediated dilatation (FMD), microvascular function by venous occlusion plethysmography (VOP), and arterial structure by ultrasonographic assessment of intima-media thickness (IMT) usually of the carotid artery. Contradictory results have been reported; however, in most studies, endothelial dysfunction, an early marker of atherosclerosis assessed either by haemodynamic methods such as FMD or by biochemical methods such as endothelin-1 levels, was found to be impaired. VOP is a less-studied method, with few indices altered. IMT was found to be altered in most of the included studies, but the population was more heterogeneous. Inflammatory markers, including C-reactive protein, were also found to be altered in most studies. On the other hand, a number of interventions have been shown beneficial for the markers of cardiovascular risk, in the context of insulin-sensitizers. However, other interventions such as oral contraceptive pills or statins did not consistently show a similar beneficial effect. In summary, the early identification and eventual treatment of cardiovascular clinical and biochemical risk factors may be used in clinical practice to prevent potential 'silent' triggers of cardiovascular disease.
Collapse
Affiliation(s)
- Krystallenia I Alexandraki
- Medical School, National and Kapodistrian University of Athens, Athens, Greece.,Eleitho Practice, Athens, Greece
| | - Eleni A Kandaraki
- Medical School, National and Kapodistrian University of Athens, Athens, Greece.,Department of Endocrinology & Diabetes Mellitus, HYGEIA Hospital, Athens, Greece
| | | | - Christina Piperi
- Department of Biological Chemistry, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Theodoros G Papaioannou
- First Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| |
Collapse
|
30
|
Tsogas FK, Majerczyk D, Hart PC. Possible Role of Metformin as an Immune Modulator in the Tumor Microenvironment of Ovarian Cancer. Int J Mol Sci 2021; 22:ijms22020867. [PMID: 33467127 PMCID: PMC7830067 DOI: 10.3390/ijms22020867] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 01/13/2021] [Indexed: 12/14/2022] Open
Abstract
Growing evidence suggests that the immune component of the tumor microenvironment (TME) may be highly involved in the progression of high-grade serous ovarian cancer (HGSOC), as an immunosuppressive TME is associated with worse patient outcomes. Due to the poor prognosis of HGSOC, new therapeutic strategies targeting the TME may provide a potential path forward for preventing disease progression to improve patient survival. One such postulated approach is the repurposing of the type 2 diabetes medication, metformin, which has shown promise in reducing HGSOC tumor progression in retrospective epidemiological analyses and through numerous preclinical studies. Despite its potential utility in treating HGSOC, and that the immune TME is considered as a key factor in the disease’s progression, little data has definitively shown the ability of metformin to target this component of the TME. In this brief review, we provide a summary of the current understanding of the effects of metformin on leukocyte function in ovarian cancer and, coupled with data from other related disease states, posit the potential mechanisms by which the drug may enhance the anti-tumorigenic effects of immune cells to improve HGSOC patient survival.
Collapse
Affiliation(s)
- Faye K. Tsogas
- College of Science, Health and Pharmacy, Roosevelt University, Schaumburg, IL 60173, USA; (F.K.T.); (D.M.)
| | - Daniel Majerczyk
- College of Science, Health and Pharmacy, Roosevelt University, Schaumburg, IL 60173, USA; (F.K.T.); (D.M.)
- Loyola Medicine, Berwyn, IL 60402, USA
| | - Peter C. Hart
- College of Science, Health and Pharmacy, Roosevelt University, Schaumburg, IL 60173, USA; (F.K.T.); (D.M.)
- Correspondence:
| |
Collapse
|
31
|
Alexandraki KI, Kandaraki EA, Poulia KA, Piperi C, Papadimitriou E, Papaioannou TG. Assessment of Early Markers of Cardiovascular Risk in Polycystic Ovary Syndrome. EUROPEAN ENDOCRINOLOGY 2021. [DOI: 10.17925/ee.2021.1.1.37] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
32
|
Kałużna M, Człapka-Matyasik M, Wachowiak-Ochmańska K, Moczko J, Kaczmarek J, Janicki A, Piątek K, Ruchała M, Ziemnicka K. Effect of Central Obesity and Hyperandrogenism on Selected Inflammatory Markers in Patients with PCOS: A WHtR-Matched Case-Control Study. J Clin Med 2020; 9:jcm9093024. [PMID: 32962205 PMCID: PMC7565377 DOI: 10.3390/jcm9093024] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 09/11/2020] [Accepted: 09/16/2020] [Indexed: 12/18/2022] Open
Abstract
White blood cell counts (WBC), lymphocyte-to-monocyte ratio (LMR), and monocyte-to-high-density lipoprotein cholesterol ratio (MHR) are used as chronic inflammation markers. Polycystic ovary syndrome (PCOS) is a constellation of systemic inflammation linked to central obesity (CO), hyperandrogenism, insulin resistance, and metabolic syndrome. The waist-to-height ratio (WHtR) constitutes a highest-concordance anthropometric CO measure. This study aims to access WBC, LMR, and MHR in PCOS and healthy subjects, with or without CO. Establishing relationships between complete blood count parameters, high-sensitivity C-reactive protein (hsCRP), and hormonal, lipid and glucose metabolism in PCOS. To do this, WBC, LMR, MHR, hsCRP, anthropometric, metabolic, and hormonal data were analyzed from 395 women of reproductive age, with and without, PCOS. Correlations between MHR, and dysmetabolism, hyperandrogenism, and inflammation variables were examined. No differences were found in WBC, LMR, MHR, and hsCRP between PCOS and controls (p > 0.05). PCOS subjects with CO had higher hsCRP, MHR, and WBC, and lower LMR vs. those without CO (p < 0.05). WBC and MHR were also higher in controls with CO vs. without CO (p < 0.001). MHR correlated with anthropometric, metabolic, and endocrine parameters in PCOS. WHtR appeared to strongly predict MHR in PCOS. We conclude that PCOS does not independently influence WBC or MHR when matched for CO. CO and dysmetabolism may modify MHR in PCOS and control groups.
Collapse
Affiliation(s)
- Małgorzata Kałużna
- Department of Endocrinology, Metabolism and Internal Diseases, Poznan University of Medical Sciences, 49 Przybyszewskiego St, 60-355 Poznań, Poland; (A.J.); (K.P.); (M.R.); (K.Z.)
- Correspondence: ; Tel.: +48-61-869-1330; Fax: +48-61-869-1682
| | - Magdalena Człapka-Matyasik
- Department of Human Nutrition and Dietetics, Poznan University of Life Sciences, Wojska Polskiego 28, 60-637 Poznan, Poland;
| | - Katarzyna Wachowiak-Ochmańska
- Ward of Endocrinology, Metabolism and Internal Diseases Ward, Heliodor Święcicki Clinical Hospital, 49 Przybyszewskiego St, 60-355 Poznań, Poland;
| | - Jerzy Moczko
- Department of Computer Science and Statistics, Poznan University of Medical Sciences, 7 Rokietnicka St, 60-806 Poznań, Poland;
| | - Jolanta Kaczmarek
- Central Laboratory, Heliodor Swiecicki University Hospital, 49 Przybyszewskiego St, 60-355 Poznań, Poland;
| | - Adam Janicki
- Department of Endocrinology, Metabolism and Internal Diseases, Poznan University of Medical Sciences, 49 Przybyszewskiego St, 60-355 Poznań, Poland; (A.J.); (K.P.); (M.R.); (K.Z.)
| | - Katarzyna Piątek
- Department of Endocrinology, Metabolism and Internal Diseases, Poznan University of Medical Sciences, 49 Przybyszewskiego St, 60-355 Poznań, Poland; (A.J.); (K.P.); (M.R.); (K.Z.)
| | - Marek Ruchała
- Department of Endocrinology, Metabolism and Internal Diseases, Poznan University of Medical Sciences, 49 Przybyszewskiego St, 60-355 Poznań, Poland; (A.J.); (K.P.); (M.R.); (K.Z.)
| | - Katarzyna Ziemnicka
- Department of Endocrinology, Metabolism and Internal Diseases, Poznan University of Medical Sciences, 49 Przybyszewskiego St, 60-355 Poznań, Poland; (A.J.); (K.P.); (M.R.); (K.Z.)
| |
Collapse
|
33
|
He S, Mao X, Lei H, Dong B, Guo D, Zheng B, Sun P. Peripheral Blood Inflammatory-Immune Cells as a Predictor of Infertility in Women with Polycystic Ovary Syndrome. J Inflamm Res 2020; 13:441-450. [PMID: 32884325 PMCID: PMC7443446 DOI: 10.2147/jir.s260770] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 07/29/2020] [Indexed: 12/19/2022] Open
Abstract
Purpose This study aimed to investigate the inflammatory-immune cells in the peripheral blood of women with polycystic ovary syndrome (PCOS) and assessed the potential correlation between inflammatory-immune cells and infertility in PCOS women. Materials and Methods In this case-control study, the profiles of lymphocyte subsets were analyzed by flow cytometry. White blood cells (WBC), neutrophils (Neu), lymphocytes, Ferriman-Gallwey (F-G) score, testosterone, prolactin, follicle-stimulating hormone, luteinizing hormone, fasting blood glucose, and fasting plasma insulin were measured, together with body mass index. Association between inflammatory-immune cells and PCOS was evaluated. Moreover, inflammatory-immune cells of the PCOS women with infertility were evaluated, and the relative operating characteristic (ROC) curve and cutoff values were calculated. Results The number of WBC, Neu, and lymphocytes was higher in PCOS women than controls (P<0.05). The percentages of total T lymphocytes, CD4+T, and NK were significantly increased in the PCOS group (P<0.001). The CD4/CD8 ratio was obviously elevated for increasing CD4+T (P<0.05). Consequently, T%, CD4+T%, and NK% were found to be the independent risk factors of PCOS by ROC curve and multivariate logistic regression analysis. Furthermore, only NK% was significantly higher in PCOS women with infertility than those who had PCOS without infertility (P<0.001). To diagnose infertility in PCOS, the cutoff value of NK% was calculated as 16.43%. Conclusion These findings suggest that the pathogenesis of PCOS is related to immune cells including T, CD4+T, and NK cells. NK cells are likely to be a potential predictive factor for PCOS women with infertility.
Collapse
Affiliation(s)
- ShuQiong He
- Department of Prenatal Diagnosis, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, 350001, People's Republic of China
| | - XiaoDan Mao
- Laboratory of Gynecologic Oncology, Department of Gynecology, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, 350001, People's Republic of China.,Fujian Key Laboratory of Women and Children's Critical Diseases Research, Fujian Maternity and Child Health Hospital, Fuzhou, 350001, People's Republic of China
| | - HuiFang Lei
- Laboratory of Gynecologic Oncology, Department of Gynecology, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, 350001, People's Republic of China.,Fujian Key Laboratory of Women and Children's Critical Diseases Research, Fujian Maternity and Child Health Hospital, Fuzhou, 350001, People's Republic of China
| | - BinHua Dong
- Laboratory of Gynecologic Oncology, Department of Gynecology, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, 350001, People's Republic of China.,Fujian Key Laboratory of Women and Children's Critical Diseases Research, Fujian Maternity and Child Health Hospital, Fuzhou, 350001, People's Republic of China
| | - DanHua Guo
- Department of Prenatal Diagnosis, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, 350001, People's Republic of China
| | - BeiHong Zheng
- Department of Reproduction, Fujian, Affiliated Hospital of Fujian Medical University, Fuzhou, 350001, People's Republic of China
| | - PengMing Sun
- Laboratory of Gynecologic Oncology, Department of Gynecology, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, 350001, People's Republic of China.,Fujian Key Laboratory of Women and Children's Critical Diseases Research, Fujian Maternity and Child Health Hospital, Fuzhou, 350001, People's Republic of China
| |
Collapse
|
34
|
Borthakur A, D Prabhu Y, Valsala Gopalakrishnan A. Role of IL-6 signalling in Polycystic Ovarian Syndrome associated inflammation. J Reprod Immunol 2020; 141:103155. [PMID: 32526588 DOI: 10.1016/j.jri.2020.103155] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Accepted: 05/31/2020] [Indexed: 12/13/2022]
Abstract
Polycystic ovarian syndrome is a major factor contributing to the increasing incidence of infertility around the world. The metabolic effects of prolonged exposure to PCOS have been well determined from previous studies and seem to be detrimental in the long run. Studies have shown a multitude of conditions like insulin resistance, obesity and cardiovascular disorders to be associated with PCOS. This makes PCOS a syndrome requiring utmost attention in terms of women's health and reproduction. Interleukin-6 is one of the many cytokines released by adipocytes from fat deposits in the body. This review focuses on the Interleukin 6 signaling pathway and the data available on inflammatory modulators due to its significance PCOS mediated inflammation. There is noteworthy evidence of elevated IL-6 concentration in PCOS subjects that has been discussed in detail. The regulation of IL-6 levels in the body is in turn, maintained by a close relation with other cytokines, especially by a key regulator, NF-κB. Being involved in a multitude of other pathological conditions like rheumatoid arthritis, cardiovascular disorders, asthma, colon cancer and many more, the role of IL-6 is also investigated in PCOS in search of a probable reason for underlying inflammatory condition. On summarizing the IL-6 signaling pathway and therapeutic exploitation of the same, we see that IL-6 targeted drugs may be an efficient way of treating PCOS associated inflammation.
Collapse
Affiliation(s)
- Atreyee Borthakur
- Department of Biomedical Sciences, School of Biosciences and Technology, Vellore Institute of Technology, Vellore, 632 014, Tamil Nadu, India
| | - Yogamaya D Prabhu
- Department of Biomedical Sciences, School of Biosciences and Technology, Vellore Institute of Technology, Vellore, 632 014, Tamil Nadu, India
| | - Abilash Valsala Gopalakrishnan
- Department of Biomedical Sciences, School of Biosciences and Technology, Vellore Institute of Technology, Vellore, 632 014, Tamil Nadu, India.
| |
Collapse
|
35
|
Inflammatory Markers in Women with Polycystic Ovary Syndrome. BIOMED RESEARCH INTERNATIONAL 2020; 2020:4092470. [PMID: 32219132 PMCID: PMC7079227 DOI: 10.1155/2020/4092470] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Revised: 01/26/2020] [Accepted: 02/19/2020] [Indexed: 11/17/2022]
Abstract
Several studies have reported the association between polycystic ovary syndrome (PCOS) and low-grade chronic inflammation to be of uncertain cause: obesity, insulin resistance, or PCOS itself. The aim of the study was to investigate the WBC (white blood cell) count and CRP (C-reactive protein) concentration in women with PCOS and to determine the factors that affect their concentration. The study included 200 women aged 18-40 with PCOS and 105 healthy women as the control group, recruited in the Department of Gynaecological Endocrinology of Medical University in Warsaw from 2016 to 2018. Each patient underwent clinical, biochemical, and ultrasonographic assessments. WBC and CRP were significantly higher in the PCOS group (Z = -2,353, p = 0,019 and Z = -2,453, p = 0,014). WBC positively correlated with serum insulin at 0, 60, and 120 min during the oral glucose tolerance test (INS0: r = 0,221, p = 0,001; INS1: r = 0,194, p = 0,003; INS2: r = 0,022, p = 0,001), testosterone (r = 0,130, p = 0,046), androstenedione (r = 0,212, p = 0,001), and DHEAS (r = 0,178, p = 0,006) and negatively correlated with progesterone (r = -0,204, p = 0,002), estradiol (r = -0,140, p = 0,032), and SHBG (r = -0,308, p < 0,001). CRP positively correlated with insulin concentration in 0, 60, and 120 min during the oral glucose tolerance test (INS0: r = 0,343, p < 0,001; INS1: r = 0,276, p = 0,001; INS2: r = 0,320, p < 001) and negatively correlated with progesterone (r = -0,194, p = 0,030) and SHBG (-0,244, p = 0,005). We also estimated positive correlation between BMI and serum CRP and WBC concentration. Multiple linear regression analysis showed that CRP values are positively associated with BMI (beta = 0,374, p < 0,001) and insulin level (INS1) (beta = 0,282, p = 0,004); and WBC results are negatively associated with SHGB (beta = -0,284, p < 0,001) but positively associated with testosterone (beta = 0,163, p = 0,024) and BMI (beta = 0,157, p = 0,047). PCOS is associated with increased WBC and CRP concentrations. The main predicting factors of increased CRP are BMI and insulin resistance, but there is also a relationship between WBC count in PCOS and androgen concentration itself so that inflammation may be mediated not only through adiposity but also through increased androgen concentration.
Collapse
|
36
|
Foroozanfard F, Asemi Z, Bazarganipour F, Taghavi SA, Allan H, Aramesh S. Comparing pregnancy, childbirth, and neonatal outcomes in women with different phenotypes of polycystic ovary syndrome and healthy women: a prospective cohort study. Gynecol Endocrinol 2020; 36:61-65. [PMID: 31264483 DOI: 10.1080/09513590.2019.1631278] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
The aim of this study was to compare pregnancy, childbirth, and neonatal outcomes in women with different phenotypes of polycystic ovary syndrome (PCOS) with healthy women. A prospective cohort study from the beginning to the end of pregnancy for 41 pregnant women with PCOS (case) and 49 healthy pregnant women (control) was completed. Based on the presence or absence of menstrual dysfunction (M), hyperandrogenism (HA), and polycystic ovaries (PCO) on ultrasound, the PCOS (case) group were divided into three phenotypes (HA + PCO (n = 22), M + PCO (n = 9), HA + M+PCO (n = 10). Pre-eclampsia, gestational diabetes, and lower birth weight among newborns were significantly higher in the PCOS case group compared to the control group especially in the phenotype HA + M+PCO (p < .05). High BMI (β = 2.40; p=.03) was the strongest predictor of pre-eclampsia in patients with PCOS. High androgen levels (free androgen index) (β = 13.71, 3.02; p < .05), was the strongest predictor of developing diabetes during pregnancy and reduced birth weight baby, respectively.These results suggest that PCOS, particularly in phenotype HA + M+PCO (p < .05), is a risk factor for adverse pregnancy and neonatal outcomes including gestational diabetes, pre-eclampsia, and reduced weight babies.
Collapse
Affiliation(s)
- Fatemeh Foroozanfard
- Gametogenesis Research Center, Kashan University of Medical Sciences, Kashan, Iran
| | - Zatollah Asemi
- Research Center for Biochemistry and Nutrition in Metabolic Diseases, Kashan University of Medical Sciences, Kashan, Iran
| | - Fatemeh Bazarganipour
- Social Determinants of Health Research Center, Yasuj University of Medical Sciences, Yasuj, Iran
| | - Seyed Abdolvahab Taghavi
- Social Determinants of Health Research Center, Yasuj University of Medical Sciences, Yasuj, Iran
| | - Helen Allan
- Centre for Critical Research in Nursing & Midwifery, School of Health & Education, Middlesex University, London, UK
| | - Shahintaj Aramesh
- Department of Gynecology and Obstetrics, Yasuj University of Medical Sciences, Yasuj, Iran
| |
Collapse
|
37
|
Woodward A, Klonizakis M, Broom D. Exercise and Polycystic Ovary Syndrome. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2020; 1228:123-136. [PMID: 32342454 DOI: 10.1007/978-981-15-1792-1_8] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Polycystic ovary syndrome (PCOS) is a complex endocrinopathy affecting both the metabolism and reproductive system of women of reproductive age. Prevalence ranges from 6.1-19.9% depending on the criteria used to give a diagnosis. PCOS accounts for approximately 80% of women with anovulatory infer-tility, and causes disruption at various stages of the reproductive axis. Evidence suggests lifestyle modification should be the first line of therapy for women with PCOS. Several studies have examined the impact of exercise interventions on reproductive function, with results indicating improvements in menstrual and/or ovulation frequency following exercise. Enhanced insulin sensitivity underpins the mechanisms of how exercise restores reproductive function. Women with PCOS typically have a cluster of metabolic abnormalities that are risk factors for CVD. There is irrefutable evidence that exercise mitigates CVD risk factors in women with PCOS. The mechanism by which exercise improves many CVD risk factors is again associated with improved insulin sensitivity and decreased hyperinsulinemia. In addition to cardiometabolic and reproductive complications, PCOS has been associated with an increased prevalence of mental health disorders. Exercise improves psychological well-being in women with PCOS, dependent on certain physiological factors. An optimal dose-response relationship to exercise in PCOS may not be feasible because of the highly individualised characteristics of the disorder. Guidelines for PCOS suggest at least 150 min of physical activity per week. Evidence confirms that this should form the basis of any clinician or healthcare professional prescription.
Collapse
Affiliation(s)
- Amie Woodward
- Faculty of Health and Wellbeing, Centre for Sport and Exercise Science, Sheffield Hallam University, Sheffield, UK
| | - Markos Klonizakis
- Faculty of Health and Wellbeing, Centre for Sport and Exercise Science, Sheffield Hallam University, Sheffield, UK
| | - David Broom
- Faculty of Health and Wellbeing, Centre for Sport and Exercise Science, Sheffield Hallam University, Sheffield, UK.
| |
Collapse
|
38
|
Roles of Oxidative Stress in Policystic Ovary Syndrome. SERBIAN JOURNAL OF EXPERIMENTAL AND CLINICAL RESEARCH 2019. [DOI: 10.2478/sjecr-2019-0059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Polycystic ovary syndrome (PCOS) represent a common endocrine disorder that affects nearly 4 to 12 percents of reproductive age women in general population studies (1). PCOS is caracterized by the oligoovulation or anovulation, hyperandrogenisam and multiple small ovarian cysts. The etiology of PCOS is steel unclear. Patophysiology of PCOS represents the complex mehanism. There is a wide spectar of signs and symptoms of the PCOS, which vary in severity over the time and within individuals. Major symptoms are: the amenhorhea, oligomenorhea combined with of episodes of menometrorhagia. Some signs of hiperandrogenism are: acne, hirsutism and alopecia. Other important symptoms of the PCOS are: the obesity, dyslpedemia, insuline resistance, metabolic syndrome, infertility, endometrial neoplasia, pregnancy loss. Diagnosis is achieved by exclusion of other factors that lead to anovulation, and laboratory assay of sex hormones and gonadotropines. One of the novel approaches in evaluation of etiology and pathogenesis of the PCOS recognizes oxidative stress as an important factor in genesis of this syndrome. For investigation of the oxidative stress role in the pathogenesis of diseases, some biochemical markers have been used including the MDA and NO also anti-oxidative biomarkers such as Total Antioxidative Capacity, Superoxide Dismutase, Glutation Peroxidase, and glutathione. Most of recent studies compared the oxidative stress biomarker level or antioxidative biomarkers levels in the PCOS patients and healthy controls. Patients with the PCOS in those studies were often subdivided in groups by the presence of insulin resistance (HOMA index) or infertility or not. One of the main problems in this field of research is inconsistency in precise definition of the PCOS, as well as different expression of various symptoms within individuals over the time. In that manner it is very difficult to follow up these patients and to establish criteria that could be compared in studies.
Collapse
|
39
|
Fox CW, Zhang L, Sohni A, Doblado M, Wilkinson MF, Chang RJ, Duleba AJ. Inflammatory Stimuli Trigger Increased Androgen Production and Shifts in Gene Expression in Theca-Interstitial Cells. Endocrinology 2019; 160:2946-2958. [PMID: 31599939 PMCID: PMC6855291 DOI: 10.1210/en.2019-00588] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 09/27/2019] [Indexed: 12/16/2022]
Abstract
Polycystic ovary syndrome (PCOS) is a common reproductive endocrine disorder characterized by theca cell hyperplasia and excessive androgen production. An increasing body of evidence has pointed to a close association between PCOS and low-grade chronic systemic inflammation. However, the mechanistic basis for this linkage is unknown. Therefore, we evaluated the effects of the inflammatory agents lipopolysaccharide (LPS) and IL-1β on rat theca-interstitial cells (TICs). We found that incubation with either LPS or IL-1β elicited a dose-dependent increase in both TIC viability and androgen production. Using RNA sequencing analysis, we found that both of these inflammatory agents also triggered profound and widespread shifts in gene expression. Using a stringent statistical cutoff, LPS and IL-1β elicited differential expression of 5201 and 5953 genes, respectively. Among the genes upregulated by both LPS and IL-1β were key regulatory genes involved in the cholesterol and androgen biosynthesis pathways, including Cyp17a1, Cyp11a1, Hsd3b, and Hmgcr. This provides a molecular explanation for the mechanism of action of inflammatory agents leading to increased androgen production. Gene ontology and pathway analysis revealed that both LPS and IL-1β regulated genes highly enriched for many common functions, including the immune response and apoptosis. However, a large number of genes (n = 2222) were also uniquely regulated by LPS and IL-1β, indicating that these inflammatory mediators have substantial differences in their mechanism of action. Together, these findings highlight the potential molecular mechanisms through which chronic low-grade inflammation contributes to the pathogenesis of androgen excess in PCOS.
Collapse
Affiliation(s)
- Chelsea W Fox
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Diego, School of Medicine, La Jolla, California
| | - Lingzhi Zhang
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Diego, School of Medicine, La Jolla, California
| | - Abhishek Sohni
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Diego, School of Medicine, La Jolla, California
| | - Manuel Doblado
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Diego, School of Medicine, La Jolla, California
| | - Miles F Wilkinson
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Diego, School of Medicine, La Jolla, California
| | - R Jeffrey Chang
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Diego, School of Medicine, La Jolla, California
| | - Antoni J Duleba
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Diego, School of Medicine, La Jolla, California
- Correspondence: Antoni J. Duleba, MD, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Diego, School of Medicine, 9500 Gilman Drive, 0633, La Jolla, California 92093. E-mail:
| |
Collapse
|
40
|
Ali AT, Guidozzi F. Midlife women's health consequences associated with polycystic ovary syndrome. Climacteric 2019; 23:116-122. [PMID: 31657237 DOI: 10.1080/13697137.2019.1679111] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Polycystic ovary syndrome (PCOS) is one of the most common female endocrinopathies. Its symptoms may appear as early as adolescence and may include irregular menstrual periods, amenorrhea, hirsutism and obesity. Regardless of their phenotypic appearance, women with PCOS are metabolically obese. PCOS is associated with metabolic syndrome, type 2 diabetes, depression, cardiovascular disease and gynecological cancers. The metabolic disorders in obese women with PCOS are invariably due to insulin resistance, while inflammation, oxidative stress and possible interaction with environmental factors are among the features linking women with PCOS alone to metabolic disorders. The current review aims to highlight the relationship between PCOS and midlife women's health complications.
Collapse
Affiliation(s)
- A T Ali
- Department of Chemical Pathology, NHLS, Tygerberg Hospital and Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - F Guidozzi
- Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| |
Collapse
|
41
|
Mesenchymal Stem Cells Alleviate DHEA-Induced Polycystic Ovary Syndrome (PCOS) by Inhibiting Inflammation in Mice. Stem Cells Int 2019; 2019:9782373. [PMID: 31611920 PMCID: PMC6757294 DOI: 10.1155/2019/9782373] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 07/12/2019] [Accepted: 07/22/2019] [Indexed: 12/29/2022] Open
Abstract
Polycystic ovary syndrome (PCOS) is the most common cause of anovulatory infertility in women of reproductive age. Chronic inflammation is considered to be the cause of ovarian dysfunction. Increasing evidence in animal studies and in preliminary clinical trials has demonstrated that MSCs possess immunomodulatory effects via their interaction with immune cells. However, their contribution to PCOS remains unclear. In this study, we showed that the administration of hUC-MSCs could efficiently improve the pathological changes of PCOS mice induced by dehydroepiandrosterone (DHEA), including ovarian histopathology and function. Moreover, we found that the administration of MSCs significantly downregulated the expression of proinflammatory factors (TNF-α, IL-1β, and IFN-γ) and fibrosis-related genes (CTGF) in ovarian and uterus tissues and affected the systemic inflammatory response. The percentage of peripheral neutrophils, M1 macrophages, and B cells was significantly reduced, while M2 macrophages and regulatory T cells (Tregs) were increased in hUC-MSC-treated mice. In the spleen, the percentage of neutrophils, M1 macrophages, IFN-γ+CD19+B cell, IFN-γ+CD4+T cells (Th1), and IL-17+CD4+T cells (Th17) was significantly decreased in hUC-MSC-treated mice. These results suggested that hUC-MSC treatment could alleviate ovarian dysfunction by inhibiting ovarian local and systemic inflammatory responses.
Collapse
|
42
|
Woodward A, Broom D, Harrop D, Lahart I, Carter A, Dalton C, Metwally M, Klonizakis M. The effects of physical exercise on cardiometabolic outcomes in women with polycystic ovary syndrome not taking the oral contraceptive pill: a systematic review and meta-analysis. J Diabetes Metab Disord 2019; 18:597-612. [PMID: 31890686 PMCID: PMC6915192 DOI: 10.1007/s40200-019-00425-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Accepted: 07/09/2019] [Indexed: 01/03/2023]
Abstract
Purpose Women with polycystic ovary syndrome (PCOS) exhibit many metabolic abnormalities that are associated with an increased cardiovascular disease risk. Exercise may promote improvements in lipid profile and insulin sensitivity in women with PCOS. There is however, a knowledge gap on the optimal dose of exercise, regarding duration, intensity, type, and frequency of exercise. The aim of this systematic review and meta-analysis was to define effective types of exercise to improve cardiometabolic profile in PCOS. Methods We included randomised controlled trials (RCT), quasi-RCT, and controlled clinical trials focusing on reproductive-aged women diagnosed with PCOS. Eligible interventions included those with at least two weeks of supervised exercise sessions. Primary outcomes were blood lipids, blood glucose, blood pressure, measures of abdominal adiposity, and inflammation markers. Secondary outcomes were total and free testosterone, sex hormone binding globulin, and measures of insulin resistance. Nine electronic databases were searched from inception to present for English language publications. The Cochrane Risk Assessment tool was used to assess bias in the included studies. Outcomes were quantitatively synthesised and a meta- analysis was performed. Pooled effect estimates and 95% confidence intervals were presented. Results This systematic review identified three trials, including 231 participants with PCOS, that examined the effect of structured, supervised exercise on cardiometabolic outcomes. Analysis of pooled data indicated statistical favourable effects of exercise on total cholesterol, fasting glucose, waist circumference and waist-to-hip ratio, systolic blood pressure, C-reactive protein, total testosterone, and sex hormone binding globulin using post-intervention scores. Conclusions Moderate aerobic exercise interventions ≥3 months in duration, with a frequency of 3/week for at least 30-min, may have favourable effects on various cardiometabolic risk factors in women with PCOS. However, results should be interpreted with caution. Many of the outcomes were based on studies with serious methodological limitations, and only one “gold-standard” RCT was identified. PROSPERO ID: CRD42018086117. Electronic supplementary material The online version of this article (10.1007/s40200-019-00425-y) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Amie Woodward
- Faculty of Health and Wellbeing, Sheffield Hallam University, Collegiate Crescent, Sheffield, S10 2BP UK
| | - David Broom
- Faculty of Health and Wellbeing, Sheffield Hallam University, Collegiate Crescent, Sheffield, S10 2BP UK
| | - Deborah Harrop
- Faculty of Health and Wellbeing, Sheffield Hallam University, Collegiate Crescent, Sheffield, S10 2BP UK
| | - Ian Lahart
- Institute of Human Science, University of Wolverhampton, Wolverhampton, WV1 1LY UK
| | - Anouska Carter
- Faculty of Health and Wellbeing, Sheffield Hallam University, Collegiate Crescent, Sheffield, S10 2BP UK
| | - Caroline Dalton
- Faculty of Health and Wellbeing, Sheffield Hallam University, Howard Street, Sheffield, S1 1WB UK
| | - Mostafa Metwally
- Jessop Wing, Sheffield Teaching Hospitals NHS Foundation Trust, Tree Root Walk, Sheffield, S10 2SF UK
| | - Markos Klonizakis
- Faculty of Health and Wellbeing, Sheffield Hallam University, Collegiate Crescent, Sheffield, S10 2BP UK
| |
Collapse
|
43
|
Vázquez-Martínez ER, Gómez-Viais YI, García-Gómez E, Reyes-Mayoral C, Reyes-Muñoz E, Camacho-Arroyo I, Cerbón M. DNA methylation in the pathogenesis of polycystic ovary syndrome. Reproduction 2019; 158:R27-R40. [DOI: 10.1530/rep-18-0449] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 04/08/2019] [Indexed: 12/12/2022]
Abstract
Polycystic ovary syndrome (PCOS) is the leading endocrine and metabolic disorder in premenopausal women characterized by hyperandrogenism and abnormal development of ovarian follicles. To date, the PCOS etiology remains unclear and has been related to insulin resistance, obesity, type 2 diabetes mellitus, cardiovascular disease and infertility, among other morbidities. Substantial evidence illustrates the impact of genetic, intrauterine and environmental factors on the PCOS etiology. Lately, epigenetic factors have garnered considerable attention in the pathogenesis of PCOS considering that changes in the content of DNA methylation, histone acetylation and noncoding RNAs have been reported in various tissues of women with this disease. DNA methylation is changed in the peripheral and umbilical cord blood, as well as in ovarian and adipose tissue of women with PCOS, suggesting the involvement of this epigenetic modification in the pathogenesis of the disease. Perhaps, these defects in DNA methylation promote the deregulation of genes involved in inflammation, hormone synthesis and signaling and glucose and lipid metabolism. Research on the role of DNA methylation in the pathogenesis of PCOS is just beginning, and several issues await investigation. This review aims to provide an overview of current research focused on DNA methylation and PCOS, as well as discuss the perspectives regarding this topic.
Collapse
|
44
|
Woodward A, Klonizakis M, Lahart I, Carter A, Dalton C, Metwally M, Broom D. The effects of exercise on cardiometabolic outcomes in women with polycystic ovary syndrome not taking the oral contraceptive pill: protocol for a systematic review and meta-analysis. Syst Rev 2019; 8:116. [PMID: 31097035 PMCID: PMC6524277 DOI: 10.1186/s13643-019-1030-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 04/23/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Polycystic ovary syndrome (PCOS) is the most common endocrinopathy, affecting 4-12% of reproductive-aged women. Women with PCOS often exhibit many metabolic abnormalities that are associated with an increased cardiovascular disease (CVD) risk, independent of obesity. Exercise interventions from 12 to 24 weeks have been shown to have positive effects on blood lipid profile, ovulation and insulin resistance in women with PCOS. However, no consensus on which exercise interventions are effective (i.e. duration, type of exercise, frequency), including for different phenotypes, currently exists. The aim of this systematic review and meta-analysis is to define effective types of exercise interventions to improve cardiometabolic profile, across the range of phenotypes of PCOS. METHODS We will conduct electronic database searches, including randomised-controlled trials (RCT), quasi-RCT and clinical trials. Primary outcomes sought will be lipid profile, carotid-intima media thickness, fasting blood glucose, %HbA1c, blood pressure, waist circumference, waist-to-hip ratio, abdominal adiposity and inflammation markers. Secondary outcomes sought will be free and total testosterone, sex hormone binding globulin and insulin resistance. The Cochrane Risk Assessment Tool will be used to assess study quality. Data will be analysed in RevMan. Analysis of heterogeneity will be undertaken using the I2 statistic. Significant heterogeneity will be explored, and sensitivity analyses carried out as appropriate. A subgroup analysis based on androgen profile will be undertaken if data are sufficient. DISCUSSION A large proportion of women are affected by PCOS. It is prudent to examine how CVD risk can be mitigated in this high-risk population, and this review aims to provide evidence-driven recommendations on the types of exercise interventions that are effective for this. The review will seek to provide recommendations regarding type, frequency and duration of exercise interventions to improve cardiometabolic profile in PCOS. The subgroup analysis may be able to highlight difference in intervention effects between normo-androgenic and hyper-androgenic profile. Limitations include heterogeneity across studies and a scarcity of clinical trials involving a PCOS control group not undertaking any intervention. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42018086117.
Collapse
Affiliation(s)
- Amie Woodward
- Faculty of Health and Wellbeing, Sheffield Hallam University, Collegiate Crescent, Sheffield, S10 2BP UK
| | - Markos Klonizakis
- Faculty of Health and Wellbeing, Sheffield Hallam University, Collegiate Crescent, Sheffield, S10 2BP UK
| | - Ian Lahart
- Institute of Sports and Human Science, University of Wolverhampton, Wolverhampton, WV1 1LY UK
| | - Anouska Carter
- Faculty of Health and Wellbeing, Sheffield Hallam University, Collegiate Crescent, Sheffield, S10 2BP UK
| | - Caroline Dalton
- Faculty of Health and Wellbeing, Sheffield Hallam University, Howard Street, Sheffield, S1 1WB UK
| | - Mostafa Metwally
- Sheffield Teaching Hospitals NHS Foundation Trust, Jessop Wing, Tree Root Walk, Sheffield, S10 2SF UK
| | - David Broom
- Faculty of Health and Wellbeing, Sheffield Hallam University, Collegiate Crescent, Sheffield, S10 2BP UK
| |
Collapse
|
45
|
Hart R. Generational Health Impact of PCOS on Women and their Children. Med Sci (Basel) 2019; 7:medsci7030049. [PMID: 30889922 PMCID: PMC6473601 DOI: 10.3390/medsci7030049] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Revised: 03/08/2019] [Accepted: 03/12/2019] [Indexed: 12/28/2022] Open
Abstract
Polycystic ovary syndrome (PCOS) is a metabolic disorder with reproductive consequences. Hence, the synergy of the dual maternal challenges of difficulties with conception, set on a background of metabolic disorder and inflammation, understandably leads to increased obstetric risk for the woman. Furthermore, she is more likely than her peers to require assistance with conception, either through induction of ovulation with the attendant risk of a multiple gestation, or in vitro fertilization (IVF) with its recognized increased obstetric risk for woman and her child. The increased obstetric risk for a woman with PCOS is manifested with an increased rate of miscarriage, gestational diabetes, hypertensive disorder and premature delivery. These obstetric complications are due to impairment of placental function, systemic inflammation and metabolic disorder and are markers for the woman herself of her predisposition to cardiometabolic disorder in later life. Consequently, it is inevitable that this environment may induce changes in the fetus during pregnancy, leading to an intergenerational risk from maternal PCOS.
Collapse
Affiliation(s)
- Roger Hart
- Division of Obstetrics and Gynaecology, Medical School, University of Western Australia, Perth, WA 6008, Australia.
- Fertility Specialists of Western Australia, Bethesda Hospital, 25 Queenslea Drive, Claremont, WA 6010, Australia.
- Division of Obstetrics & Gynaecology, King Edward Memorial Hospital, Subiaco, Perth, WA 6008, Australia.
| |
Collapse
|
46
|
Moulana M. Immunophenotypic profile of leukocytes in hyperandrogenemic female rat an animal model of polycystic ovary syndrome. Life Sci 2019; 220:44-49. [PMID: 30708097 DOI: 10.1016/j.lfs.2019.01.048] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 01/16/2019] [Accepted: 01/28/2019] [Indexed: 11/17/2022]
Abstract
The immune etiology of polycystic ovary syndrome (PCOS) is an intriguing area. However, whether there is alteration in the leukocyte populations in different tissues remain ambiguous. AIM To characterize the leukocyte populations of hyperandrogenemic female (HAF) rat tissues. METHODS Female Sprague Dawley rats at 3 weeks of age were implanted subcutaneously with dihydrotestosterone (DHT) or placebo pellets. The rats were aged to 14-15 weeks and tissues were collected. RESULTS Peripheral blood (PB) and renal CD4+ (P < 0.03, P < 0.007), Th17 (P < 0.05, P < 0.002), and CD4+CD28null (P < 0.04, P < 0.001) were significantly increased in HAF rats compared to placebo, respectively, in spite of their lower percentage in the spleen. Although, the percentage of Treg T lymphocytes were significantly higher in the PB (P < 0.001) of HAF rats, the splenic (P < 0.01) and renal Treg cells (P < 0.03) were found to be significantly lower. Remarkably, HAF rats had higher renal mast cells (P < 0.00009) despite lower splenic (P < 0.002). The number of PB, renal, and splenic CD8+ T cells and IgM+-B cells in HAF rats remained unchanged. CONCLUSION Results from this study 1) provide the first evidence of significant alteration of T lymphocyte subsets and different leukocyte populations profile in a rat model of polycystic ovary syndrome, 2) demonstrate alteration of the immunological niche of blood, spleen, and kidney tissues in Hyperandrogenemia state in female rats, 3) imply potential immune system dysregulation in HAF rats which may suggest a link between excess androgen, chronic inflammation, and immune-mediated diseases in polycystic ovary syndrome patients.
Collapse
Affiliation(s)
- Mohadetheh Moulana
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, United States of America; Women's Health Research Center, University of Mississippi Medical Center, United States of America.
| |
Collapse
|
47
|
Combined Oral Contraceptive Effects on Low-Grade Chronic Inflammatory Mediators in Women with Polycystic Ovary Syndrome: A Systematic Review and Meta-Analysis. Int J Inflam 2018; 2018:9591509. [PMID: 30595838 PMCID: PMC6286752 DOI: 10.1155/2018/9591509] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 10/04/2018] [Indexed: 02/03/2023] Open
Abstract
Polycystic ovary syndrome is associated with dyslipidemia, dysglycemia, metabolic syndrome, and low-grade chronic inflammation, which increase the risks for cardiovascular disease. Combined oral contraceptives may affect the mediators of low-grade chronic inflammation with potential additive risk in PCOS patients. This meta-analysis investigates the impact of oral contraceptive on markers of chronic inflammation in PCOS patients. Pubmed, Scopus, and Cochrane database were used to search studies reporting on this matter in the target population. Twenty seven studies were selected, including a total of 838 women. The data were expressed as the standardized mean difference. The random-effects model was used to summarize effect sizes. Heterogeneity was examined using Cochran's test (Q) and I2 statistics. Most of the preparations increased C-reactive protein (CRP) in PCOS patients (p >0.001). The increase in homocysteine levels was not significant (p >0.05). Follistatin significantly increased with pills containing cyproterone acetate (p= 0.008). Interleukin-6 changes were inconsistent and plasminogen activator inhibitor-1 decreased with pills containing desogestrel, norgestimate, and drospirenone. Collectively, the results of this review indicate that oral contraceptives modify most inflammatory markers of PCOS patients. However, the clinical implications are not clear yet and future studies must consider longer follow-up and the inclusion of objective clinical parameters.
Collapse
|
48
|
Abstract
Polycystic ovary syndrome (PCOS) is one of the most common endocrine and metabolic disorders in premenopausal women. Heterogeneous by nature, PCOS is defined by a combination of signs and symptoms of androgen excess and ovarian dysfunction in the absence of other specific diagnoses. The aetiology of this syndrome remains largely unknown, but mounting evidence suggests that PCOS might be a complex multigenic disorder with strong epigenetic and environmental influences, including diet and lifestyle factors. PCOS is frequently associated with abdominal adiposity, insulin resistance, obesity, metabolic disorders and cardiovascular risk factors. The diagnosis and treatment of PCOS are not complicated, requiring only the judicious application of a few well-standardized diagnostic methods and appropriate therapeutic approaches addressing hyperandrogenism, the consequences of ovarian dysfunction and the associated metabolic disorders. This article aims to provide a balanced review of the latest advances and current limitations in our knowledge about PCOS while also providing a few clear and simple principles, based on current evidence-based clinical guidelines, for the proper diagnosis and long-term clinical management of women with PCOS.
Collapse
Affiliation(s)
- Héctor F Escobar-Morreale
- Department of Endocrinology and Nutrition, Hospital Universitario Ramón y Cajal, Madrid, Spain
- Universidad de Alcalá, Alcalá de Henares, Spain
- Centro de Investigación Biomédica en Red Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Madrid, Spain
- Instituto Ramón y Cajal de Investigación Santiaria (IRYCIS), Madrid, Spain
| |
Collapse
|
49
|
Tola EN. The association between in vitro fertilization outcome and the inflammatory markers of complete blood count among nonobese unexplained infertile couples. Taiwan J Obstet Gynecol 2018; 57:289-294. [DOI: 10.1016/j.tjog.2018.02.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2018] [Indexed: 01/04/2023] Open
|
50
|
Tanguturi SC, Nagarakanti S. Polycystic Ovary Syndrome and Periodontal disease: Underlying Links- A Review. Indian J Endocrinol Metab 2018; 22:267-273. [PMID: 29911043 PMCID: PMC5972486 DOI: 10.4103/ijem.ijem_577_17] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Polycystic ovary syndrome (PCOS) is the most common endocrine disorder among women of reproductive age, which negatively affects various health systems. There is an extensive literature regarding the association of PCOS and other systemic conditions such as diabetes mellitus, cardiovascular disease, and psychological disorders. However, there is a lack of literature in associating PCOS and periodontal disease. Hence, PubMed search was done for various articles related to PCOS and its association with other comorbidities, including periodontal diseases. Analysis was done and data were synthesized and compiled in a sequential and presentable paradigm. This literature review of the pathophysiological mechanisms linking the two diseases suggests a positive relation between the two comorbidities. However, multicenter studies, with larger sample sizes, are to be conducted to establish a clearer and stronger association.
Collapse
Affiliation(s)
- Sri Chandana Tanguturi
- Department of Periodontology, Narayana Dental College and Hospital, Nellore, Andhra Pradesh, India
| | - Sreenivas Nagarakanti
- Department of Periodontology, Narayana Dental College and Hospital, Nellore, Andhra Pradesh, India
| |
Collapse
|