Abstract
Polycystic ovary syndrome (PCOS) is regarded as one of the most frequently encountered endocrine disorders and affects millions of young women worldwide, resulting in an array of complex metabolic alterations and reproductive failure. PCOS is a risk factor for diabetes mellitus, obstructive sleep apnea, obesity and depression in patients. Estrogen receptors (ESRs) are significant candidates in endocrine function and ovarian response in women. Moreover, microRNAs and long non-coding RNAs are emerging as principal mediators of gene expression and epigenetic pathways in various disease states. This study has characterized the clinical parameters in PCOS patients with comprehensive biochemical profiling compared to healthy controls and further examined the influence of allelic variations for estrogen receptor-α (ESR1 PvuII-rs2234693 T>C) and miRNA-146a (rs2910164 C>G) gene polymorphism on the risk of and susceptibility to PCOS. In this case-control study, we have used amplification refractory mutation specific (ARMS)-PCR to detect and determine the presence of these polymorphic variants in the study subjects. Our results demonstrated that most of the biochemical markers, which were analyzed in the study, show statistically significant alterations in PCOS patients, including fasting glucose, free insulin, HOMA-IR, LDL, HDL, cholesterol and hormones such as FSH, LH, testosterone and progesterone, which correlate with the established biochemical alterations in the disorder. Further, it is reported that for estrogen receptor-α (ESR1 PvuII-rs2234693 T>C), the frequency of the T allele (fT) was significantly higher among patients (0.64 vs. 0.44) compared to controls, while the frequency of the C allele (fC) was lower in patients (0.36 vs. 0.56) compared to controls. However, it was found that there was no association of an increased risk of PCOS with the ESR1 PvuII-rs2234693 C>T gene polymorphism. On the contrary, the study found strong association of miRNA-146a (rs2910164 C>G) gene polymorphism with an enhanced risk of PCOS. The frequency of the C allele (fC) was significantly higher among patients (0.52 vs. 0.36) compared to controls. The frequency of the G allele (fG) was found to be lower in patients (0.48 vs. 0.64) compared to controls. The codominant, dominant and recessive models display a statistically significant association of polymorphic variations with PCOS. Moreover, the G allele was associated strongly with PCOS susceptibility with an OR = 1.92 (95%) CI = (1.300–2.859), RR = 1.38 (1.130–1.691) p-value < 0.001.
Highlights
Polycystic ovary syndrome (PCOS) is one of the most frequently encountered endocrine disorders and affects millions of young women worldwide, resulting in an array of complex metabolic alterations and reproductive failure [1–3]
Our results agree with the observations that link PCOS as a significant risk to type 2 diabetes as considerably high fasting glucose levels and insulin resistance were seen in PCOS patient samples
A notable androgen excess with high testosterones was found in PCOS patients along with elevated progesterone and folliclestimulating hormone (FSH) levels, though no significant difference in estradiol levels were observed between patients and controls
Summary
Polycystic ovary syndrome (PCOS) is one of the most frequently encountered endocrine disorders and affects millions of young women worldwide, resulting in an array of complex metabolic alterations and reproductive failure [1–3]. Studies on granulosa cells and theca cells obtained from the ovaries of PCOS patients show significant alterations in the expression of ERα and ERβ compared to control ovaries, which is considered an important factor in retarded follicular development and ovulatory failure [16,17]. Recent studies have shown that endometrial receptivity and placentation requires certain modulation of immune response and microRNAs such as miR-146a have a regulatory role in key gene networks operating in the mammalian reproductive pathway for conception [27]. It is believed that these regulatory mechanisms are subject to cues from environmental and genetic factors including the epigenetic blueprint and gene polymorphisms, which might be related to the risk of various diseases. The current study focuses on the pathogenesis of PCOS and quantification of the risk of and susceptibility to disease in relation to ESR1 PvuII-rs2234693 T>C and microRNA164a-rs2910164 C>G gene polymorphisms. This is part of a large PCOS based genome-wide study in which 217 subjects that included 102 PCOS patients and 115 gender-matched control were enrolled at King Salman Military Hospital, Tabuk (KSA)
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