Abstract

Background: Polycystic ovarian syndrome (PCOS) remains an independent risk factor of cardiovascular disease (CVD), particularly in women of child-bearing age, and contributes to global increase in the prevalence/incidence of cardiovascular mortality and morbidity in women. Proprotein convertase subtilisin/kexin type 9 (PCSK9) has emerged as a promising therapeutic target to reduce residual CVD risk. Similarly, Nuclear factor of activated T cells (NFAT) is a transcription factor that is implicated in cardiac fibrosis. However, the role of PCSK9/NFAT in PCOS-associated cardiometabolic syndrome is not clear. Short chain fatty acids (SCFAs) play a multifaceted regulatory role in metabolic health. The present study therefore investigated the role of PCSK9/NFAT in cardiometabolic syndrome associated with experimental PCOS, and the therapeutic potential of SCFAs, especially butyrate. Material and Methods: Eight-week-old female Wistar rats were allotted into four groups (n=5). Polycystic ovarian syndrome was induced by administering letrozole (1 mg/kg p.o.) once daily for 21 days, thereafter the animals were treated with 200 mg/kg (oral gavage) of sodium butyrate for six weeks. Gene expression, biochemical parameters and cardiac/ovarian morphology were evaluated with appropriate methods. Results: Rats with PCOS showed androgen excess, multiple ovarian cysts and reduced insulin sensitivity. The rats in addition displayed atherogenic dyslipidemia (triglyceride/HDLc, TC/HDLc and LDLc), hypercorticosteronemia and elevated cardiac triglyceride, inflammatory biomarkers (NF-kappaB and TNF-alpha), caspase-6, 4-hydroxynonenal, inflammasome (NLRP3), fibrosis and depleted antioxidant defense (NrF2 and glutathione) as well as increased expression of PCSK9 and NFAT when compared to the control rats. Nevertheless, these systemic and morphological alterations were ameliorated following treatment with sodium butyrate. Conclusion: The present results collectively demonstrate cardiac dysmetabolism, inflammation, fibrosis as well as apoptosis in experimental PCOS rat model, which are driven by elevated expression of PCSK9/NFAT. The results further suggest that SCFAs, butyrate alleviates cardiometabolic syndrome and its attendant cardiomorbidity by suppression of PCSK9/NFAT. The present data provide a preclinical insight to prevention and management of CVD in PCOS individuals.

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