Management Of Polycystic Ovary Syndrome Research Articles

The microbial metabolite agmatine acts as an FXR agonist to promote polycystic ovary syndrome in female mice.

Polycystic ovary syndrome (PCOS), an endocrine disorder afflicting 6-20% of women of reproductive age globally, has been linked to alterations in the gut microbiome. We previously showed that in PCOS, elevation of Bacteroides vulgatus in the gut microbiome was associated with altered bile acid metabolism. Here we show that B. vulgatus also induces a PCOS-like phenotype in female mice via an alternate mechanism independent of bile acids. We find that B. vulgatus contributes to PCOS-like symptoms through its metabolite agmatine, which is derived from arginine by arginine decarboxylase. Mechanistically, agmatine activates the farnesoid X receptor (FXR) pathway to subsequently inhibit glucagon-like peptide-1 (GLP-1) secretion by L cells, which leads to insulin resistance and ovarian dysfunction. Critically, the GLP-1 receptor agonist liraglutide and the arginine decarboxylase inhibitor difluoromethylarginine ameliorate ovarian dysfunction in a PCOS-like mouse model. These findings reveal that agmatine-FXR-GLP-1 signalling contributes to ovarian dysfunction, presenting a potential therapeutic target for PCOS management.

A Systemic Review of Pre-clinical Studies of Herbal Plants having Anti-Polycystic Ovarian Syndrome Activity: A PAN-India Study

Background: Polycystic ovarian syndrome (PCOS) is a prevalent endocrine and metabolic condition seen in premenopausal women. A number of pharmacological agents like metformin, oral contraceptives, and anti-androgen agents have been used to treat PCOS and its associated implications, but it has been associated with numerous negative effects like fatal and nonfatal lactic acidosis, weight gain, cardiovascular, and hepatic toxicity. Methodology: This study considered the Preferred Reporting Items for Systematic Review and Meta- Analysis (PRISMA) guideline where a vast number of article sources from different scientific databases like Google Scholar (https://scholar.google.com/), PubMed (https://pubmed.ncbi.nlm.nih.gov/), and Web of Science (https://mjl.clarivate.com/search-results) were screened out. Results: From a total of 154 studies, 24 studies were screened out following the inclusion and exclusion criteria, which reported 24 different plants that were used against PCOS preclinically. Details of various plants used, including their respective families, plant parts utilized, extraction methods employed, formulations developed, animal models of polycystic ovary syndrome (PCOS) utilized, and the geographical locations within India where the research has been conducted are all documented. Conclusion: This systematic review is the first in India to report the pre-clinical studies of medicinal plants against PCOS, and it provides a thorough summary of the application of medicinal plants for the management of PCOS. Nonetheless, molecular level investigations on the plants utilized, their bioactive phytoconstituent responsible for the anti-PCOS activity, the probable mechanism of action and the pathway through which they conserve their effect, the effective dose, and the potential adverse effects are the need of time.

The role of meditation and mindfulness in the management of polycystic ovary syndrome: a scoping review

Polycystic Ovary Syndrome (PCOS) presents multifaceted challenges affecting women’s reproductive, metabolic, and psychological systems, consequently impacting their psychological and emotional well-being. The utilization of meditation and mindfulness interventions (MMIs) is found to be increasing for the management of PCOS. This scoping review systematically explored the current literature to identify the type and application of MMIs for PCOS management. A systematic search of literature was conducted using CINAHL, PsycINFO, Scopus, MEDLINE, and PubMed databases for identifying studies conducted on the usage of MMIs in women diagnosed with PCOS, irrespective of age. The comprehensive search identified 14 trials (comprising 17 citations) meeting inclusion criteria, involving 723 participants across various age groups. Among these, nine were randomized controlled trials (RCTs), while the remaining comprised non-RCTs. Several types of MMIs, including Rajayoga of Brahmakumaris, Yoga Nidra, OM cyclic meditation, unspecified forms of meditation, mindfulness-based stress reduction programs, mindful yoga, and mindfulness-based activities, were used. Outcomes were predominantly assessed in psychological domains (n=11), followed by anthropometric (n=9), quality of life (n=7), and metabolic metrics (n=7). The review findings suggest the integration of meditation with conventional treatment modalities. Preliminary data indicate that MMIs have the potential to improve psychosocial well-being and quality of life among PCOS-affected women. However, adequately powered studies with extended follow-up periods are required to investigate the mechanisms and therapeutic efficacy of MMIs, particularly concerning reproductive outcomes and weight management. Furthermore, diligent monitoring and reporting of adverse events and adherence are essential for a comprehensive understanding of MMI utilization in PCOS management.

Response to Letter to the Editor from de Zegher and Ibáñez: 'Metformin and Combined Oral Contraceptive Pills in the Management of Polycystic Ovary Syndrome: A Systematic Review and Meta-analysis'.

Response to Letter to the Editor from de Zegher and Ibáñez: 'Metformin and Combined Oral Contraceptive Pills in the Management of Polycystic Ovary Syndrome: A Systematic Review and Meta-analysis'.

Knowledge and practices among georgian physicians regarding diagnosis and management of polycystic ovary syndrome: experiences from a middle-income country

Knowledge and practices among georgian physicians regarding diagnosis and management of polycystic ovary syndrome: experiences from a middle-income country

Management of Polycystic Ovarian Syndrome: A Qualitative Inquiry among Complementary and Alternative Medicine Practitioners in South Africa.

Polycystic ovarian syndrome (PCOS) is a complex reproductive endocrinopathy affecting 4-20% of females of reproductive age. PCOS and its consequent complications such as infertility, diabetes mellitus and cardiovascular disease significantly impact clinical management. Complementary and alternative medicine (CAM), including homeopathy, is gaining recognition in PCOS management. There remains a paucity of formal protocols for managing PCOS within homeopathy and other CAM systems. This study aimed to explore and document existing therapeutic practices in the management of PCOS from diagnosis to treatment used by practitioners within various disciplines of CAM: viz., homeopathy, ayurveda, unani tibb, traditional Chinese medicine (TCM) and naturopathy, in the context of their unique philosophical background. In this explorative, descriptive study, data were collected from CAM practitioners in eThekwini Municipality, KwaZulu Natal, South Africa, using semi-structured interviews and analysed using Tesch's and Creswell's methods for qualitative analysis. Four themes emerged from the data, namely: CAM philosophical perspectives on PCOS, contributing factors, diagnosis of PCOS, and management of PCOS. Five sub-themes emerged: clinical diagnosis of PCOS, CAM-specific characterisation of PCOS, CAM-specific treatment of PCOS, adjunctive therapies, and lifestyle interventions. Homeopathic management comprised several prescribing methods, the most common ones being miasmatic/constitutional, keynote and clinical, alongside adjunctive therapies and lifestyle interventions. Other CAM modalities adopted similar holistic approaches. This paper offers a comprehensive exploration of the perceptions, clinical investigations and management practices in PCOS by homeopaths and four other CAM modalities - ayurveda, unani tibb, TCM and naturopathy - as documented in the study. Homeopaths and other CAM practitioners employed CAM-specific therapies, along with adjunctive therapies and lifestyle interventions, adopting holistic approaches. Enhancing the quality of life through emotional counselling, stress reduction and lifestyle improvements emerged as shared objectives across modalities. Our findings underscore the need to further explore inter-disciplinary collaboration in PCOS management among registered CAM practitioners, with the potential to expand the scope of comprehensive care for PCOS patients.

Polycystic ovary syndrome.

Despite affecting ~11-13% of women globally, polycystic ovary syndrome (PCOS) is a substantially understudied condition. PCOS, possibly extending to men's health, imposes a considerable health and economic burden worldwide. Diagnosis in adults follows the International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome, requiring two out of three criteria - clinical or biochemical hyperandrogenism, ovulatory dysfunction, and/or specific ovarian morphological characteristics or elevated anti-Müllerian hormone. However, diagnosing adolescents omits ovarian morphology and anti-Müllerian hormone considerations. PCOS, marked by insulin resistance and hyperandrogenism, strongly contributes to early-onset type 2 diabetes, with increased odds for cardiovascular diseases. Reproduction-related implications include irregular menstrual cycles, anovulatory infertility, heightened risks of pregnancy complications and endometrial cancer. Beyond physiological manifestations, PCOS is associated with anxiety, depression, eating disorders, psychosexual dysfunction and negative body image, collectively contributing to diminished health-related quality of life in patients. Despite its high prevalence persisting into menopause, diagnosing PCOS often involves extended timelines and multiple health-care visits. Treatment remains ad hoc owing to limited understanding of underlying mechanisms, highlighting the need for research delineating the aetiology and pathophysiology of the syndrome. Identifying factors contributing to PCOS will pave the way for personalized medicine approaches. Additionally, exploring novel biomarkers, refining diagnostic criteria and advancing treatment modalities will be crucial in enhancing the precision and efficacy of interventions that will positively impact the lives of patients.

Nutritional management recommendation systems in polycystic ovary syndrome: a systematic review

BackgroundPeople with polycystic ovary syndrome suffer from many symptoms and are at risk of developing diseases such as hypertension and diabetes in the future. Therefore, the importance of self-care doubles. It is mainly to modify the lifestyle, especially following the principles of healthy eating. The purpose of this study is to review artificial intelligence-based systems for providing management recommendations, especially food recommendations.Materials and methodsThis study started by searching three databases: PubMed, Scopus, and Web of Science, from inception until 6 June 2023. The result was the retrieval of 15,064 articles. First, we removed duplicate studies. After the title and abstract screening, 119 articles remained. Finally, after reviewing the full text of the articles and considering the inclusion and exclusion criteria, 20 studies were selected for the study. To assess the quality of articles, we used criteria proposed by Malhotra, Wen, and Kitchenham. Out of the total number of included studies, seventeen studies were high quality, while three studies were moderate quality.ResultsMost studies were conducted in India in 2021. Out of all the studies, diagnostic recommendation systems were the most frequently researched, accounting for 86% of the total. Precision, sensitivity, specificity, and accuracy were more common than other performance metrics. The most significant challenge or limitation encountered in these studies was the small sample size.ConclusionRecommender systems based on artificial intelligence can help in fields such as prediction, diagnosis, and management of polycystic ovary syndrome. Therefore, since there are no nutritional recommendation systems for these patients in Iran, this study can serve as a starting point for such research.

Systematic Review of the roles of Inositol and Vitamin D in improving fertility among patients with Polycystic Ovary Syndrome.

Polycystic ovary syndrome (PCOS) is a common endocrine and metabolic disorder among reproductive-age women. As a leading cause of anovulatory infertility, it complicates fertility treatments, including in vitro fertilization. The widely accepted 2003 Rotterdam diagnostic criteria for PCOS include sub-phenotypes based on variations in androgen excess, ovulatory dysfunction, and polycystic ovarian morphology. In this systematic review, we examined the impacts of inositol and vitamin D on fertility in PCOS. Adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines, we used relevant keywords to comprehensively search databases including PubMed, Google Scholar, and MDPI. From an initial pool of 345 articles, 10 met the inclusion criteria. The articles suggest that vitamin D and inositol, particularly myo-inositol and D-chiro-inositol, may represent therapeutic options for PCOS. Vitamin D influences ovarian follicular development, glucose regulation, and insulin sensitivity. When combined with metformin therapy, it is associated with improved menstrual regularity and ovulation. Inositol is crucial for cellular signaling, energy metabolism, glucose regulation, and fertility. This systematic review underscores the importance of investigating inositol and vitamin D within a PCOS management strategy, given the disorder's prevalence and impacts on fertility and metabolic health. Although these agents show promise, additional research could clarify their mechanisms of action and therapeutic benefits. This review emphasizes the need for exploration of effective treatments to improve the quality of life among individuals with PCOS. Inositol and vitamin D represent potential options, but more studies are required to elucidate their roles in the management of this condition.

Management of Polycystic Ovarian Syndrome: Looking Beyond the Ovaries

There is something remiss in the name polycystic ovarian syndrome (PCOS). It bears the word ovary; however, the ovary is an innocent bystander of a more sinister pathology. The name belies the nature of a disease that is a complex metabolic and reproductive syndrome with sequelae extending beyond ovarian dysfunction. PCOS is a chronic, life-long illness that affects approximately 1.4 million Canadians. Its inception is thought to begin in utero. Factors such as elevated levels of maternal anti‑Müllerian hormone (AMH), endocrine disruptors, growth restriction, and maternal androgen excess generate epigenetic changes that have a life-long, transgenerational impact on the fetus.

Evaluate the Effectiveness of Video Assisted Teaching Programme on Knowledge and Attitude towards Early Identification and Management of Polycysticovarian Syndrome among Adolescent Girls

Polycystic ovarian syndrome (PCOS) is one of the most common reproductive endocrinological disorders with a broad spectrum of clinical manifestations affecting about 6-8% of women of reproductive years. The study was conducted to evaluate the effectiveness of video assisted teaching programme on PCOS among Adolescent’s girls at Puducherry. The aim of the study to evaluate the VATP on PCOS. Methodology using quantitative approach quasi-experimental (one group pre-test post-test) research design. A total of 65 subjects were selected for study by using probability simple random sampling technique. Self-Structured questionnaire and modified attitude scale regarding early identification and management of PCOS were used as the tool.Results The findings revealed that in the pre-test, regarding the level of knowledge, in adequate 19(29.2%),and moderate 45 (69.2%) had adequate, 1 (1.6%). had unfavourable attitude 0(0%) ,moderate favourable 59(90.8%) of them favourable 6 (9.2%) . In the Post- test, regarding the level of knowledge inadequate0 (0%) of them had moderate and 5 (7.7%) had adequate level oknowledge,97(97%) of them had favourable and 3(3%) had moderate favourable attitude, regarding the practice, majority 65 (92.3%) . had unfavourable attitude 0(0%) and moderate favourable 36(55.4) had favourable 29(44.6%). Conclusion Study concluded that selective nursing intervention showed that the video assisted teaching programme is effective to improve knowledge for students. Key words: PCOS, VATP, Adolescents girls.

Evidence based lifestyle interventions in Polycystic Ovary Syndrome

Polycystic ovary syndrome (PCOS) is a common endocrine condition which affects up to 13% of reproductive-aged women and is associated with reproductive, metabolic and psychological features. Women with PCOS have a higher prevalence of longitudinal weight gain in population-based cohort studies compared to women without PCOS. On meta-analysis, women with PCOS also have an increased prevalence of overweight, obesity and central obesity, compared with controls. PCOS is therefore associated with an elevated prevalence of overweight and obesity which further worsen metabolic, reproductive and psychological dysfunction. Given the association between overweight and obesity and metabolic, reproductive and psychological dysfunction in women, weight management is a logical treatment strategy. This can be defined as prevention of excess weight gain, achieving a modest weight loss and sustaining a reduced weight long-term. This is best achieved through lifestyle management which traditionally refers to a complex multidisciplinary approach that combines dietary modification, physical activity and behavioural interventions. Lifestyle interventions and modest weight loss (5-10% of initial body weight) are associated with improvements in outcomes including central adiposity, hyperandrogenism, insulin resistance and cardiovascular risk factors. In PCOS specifically for dietary interventions, the majority of evidence indicates no differences between dietary approaches Lifestyle management advice should therefore follow general population guidance which states that lifestyle intervention can be achieved through a variety of dietary approaches providing these are tailored to dietary preferences and ensure the nutritional and health status of the individual patient with referral to a nutrition professional where possible. These recommendations are summarised in the 2023 International Evidence-based Guidelines on the Assessment and Management of PCOS. 1 These guidelines are now being translated and implemented internationally.

Validation of mitochondrial biomarkers and immune dynamics in polycystic ovary syndrome.

Polycystic ovary syndrome (PCOS), a prevalent endocrine-metabolic disorder, presents considerable therapeutic challenges due to its complex and elusive pathophysiology. We employed three machine learning algorithms to identify potential biomarkers within a training dataset, comprising GSE138518, GSE155489, and GSE193123. The diagnostic accuracy of these biomarkers was rigorously evaluated using a validation dataset using area under the curve (AUC) metrics. Further validation in clinical samples was conducted using PCR and immunofluorescence techniques. Additionally, we investigate the complex interplay among immune cells in PCOS using CIBERSORT to uncover the relationships between the identified biomarkers and various immune cell types. Our analysis identified ACSS2, LPIN1, and NR4A1 as key mitochondria-related biomarkers associated with PCOS. A notable difference was observed in the immune microenvironment between PCOS patients and healthy controls. In particular, LPIN1 exhibited a positive correlation with resting mast cells, whereas NR4A1 demonstrated a negative correlation with monocytes in PCOS patients. ACSS2, LPIN1, and NR4A1 emerge as PCOS-related diagnostic biomarkers and potential intervention targets, opening new avenues for the diagnosis and management of PCOS.

Use of nutraceuticals and micronutrient supplementation for the management of Polycystic Ovary Syndrome: a scoping review

Polycystic Ovary Syndrome (PCOS) is a common hormonal condition affecting women of reproductive age(1). Women with PCOS experience a broad range of clinical symptoms, collectively grouped into reproductive, metabolic, psychological and anthropometric features(2). Complementary therapies, such as nutrient supplementation, have been identified as potential adjunct therapeutic approaches to support currently recommended lifestyle and pharmacological interventions(3). However, evidence for their overall efficacy and safety is inconsistent and unclear. This review aimed to systematically map the available literature on the use of nutrient supplementation for the management of PCOS features, including metabolic, reproductive, psychological and anthropometric. This review followed a systematic approach with literature searches using CINHAL, Cochrane reviews, Medline, PsycINFO, Scopus and LILACS conducted up to April 2022. All types of study designs were included if they reported on the efficacy or association between micronutrient supplementation and/or nutraceuticals on features of PCOS in women (≥ 18 years) with a confirmed diagnosis of PCOS. A total of 317 articles were included involving n = 23,926 women. Forty-three different supplements examined various clinical features of PCOS grouped into metabolic, reproductive, psychological and anthropometric. The most studied supplements included Inositols (n = 83), Vitamin D (n = 51), N-acetylcysteine (n = 25), Omega-3 fatty acids (n = 18) and Biotics (n = 14). Most studies (n = 262; 83%) reported on reproductive features followed by metabolic (n = 212; 66%), anthropometric (n = 181; 57%) and psychological (n = 5; 2%). Less than half (n = 148; 47%) of the included studies reported on the potential for adverse events. Our results highlight that the potential therapeutic benefit of micronutrient and nutraceutical supplementation on psychological features of PCOS warrants future exploration. Additional primary studies that are adequately powered are needed to investigate therapeutic doses needed for clinical benefits. Lastly, a more rigorous approach to monitoring and recording adverse event data is recommended.

The clinical significance of monitoring serum levels of glutathione peroxidase and selenium in patients with polycystic ovary syndrome

[Objective] This study aims to analyze the levels of the trace element selenium (Se), glutathione peroxidase (GSH-Px), and total antioxidant capacity (TAC) in the serum of women with polycystic ovary syndrome (PCOS) compared to women with normal menstrual cycles. By examining the relationship between Se levels, oxidative stress (OS), and PCOS, the study provides a theoretical basis for the supplementation of the potent antioxidant Se in women with PCOS, aiming to improve the prevention and management of PCOS and reduce its complications.[Methods] Sixty-six females diagnosed with PCOS for the first time from June 2022 to June 2023 at the Shenzhen Hospital of Guangzhou University of Chinese Medicine (Futian) were selected as the observation group. Sixty-eight healthy volunteers with regular menstrual cycles were randomly selected as the control group. Serum levels of GSH-Px, TAC, and Se were measured and statistically analyzed for both groups.[Results] Serum levels of Se, TAC, and GSH-Px were significantly lower in the observation group compared to the control group (P<0.05), indicating a statistically significant difference.[Conclusion] The deficiency of the trace element Se leads to a reduction in OS indicators, including levels of GSH-Px and TAC. It is inferred that Se deficiency may be associated with the pathogenesis of PCOS to a certain extent.

Reducing the Risk of Pre-Eclampsia in Women with Polycystic Ovary Syndrome Using a Combination of Pregnancy Screening, Lifestyle, and Medical Management Strategies.

Polycystic ovary syndrome (PCOS) is a multisystem disorder that presents with a variety of phenotypes involving metabolic, endocrine, reproductive, and psychological symptoms and signs. Women with PCOS are at increased risk of pregnancy complications including implantation failure, miscarriage, gestational diabetes, fetal growth restriction, preterm labor, and pre-eclampsia (PE). This may be attributed to the presence of specific susceptibility features associated with PCOS before and during pregnancy, such as chronic systemic inflammation, insulin resistance (IR), and hyperandrogenism, all of which have been associated with an increased risk of pregnancy complications. Many of the features of PCOS are reversible following lifestyle interventions such as diet and exercise, and pregnant women following a healthy lifestyle have been found to have a lower risk of complications, including PE. This narrative synthesis summarizes the evidence investigating the risk of PE and the role of nutritional factors in women with PCOS. The findings suggest that the beneficial aspects of lifestyle management of PCOS, as recommended in the evidence-based international guidelines, extend to improved pregnancy outcomes. Identifying high-risk women with PCOS will allow targeted interventions, early-pregnancy screening, and increased surveillance for PE. Women with PCOS should be included in risk assessment algorithms for PE.

Correction to "Diagnosis and management of polycystic ovarian syndrome".

Correction to "Diagnosis and management of polycystic ovarian syndrome".

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

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

EFFECTS OF A KETOGENIC DIET IN OVERWEIGHT WOMEN WITH POLYCYSTIC OVARY SYNDROME

Polycystic ovary syndrome (PCOS) is a common endocrine disorder affecting reproductive-aged women, characterized by hyperandrogenism, ovulatory dysfunction, and polycystic ovarian morphology. The main objective of the study is to find the effects of a ketogenic diet in overweight women with polycystic ovary syndrome. This prospective interventional study was conducted in a private hospital in Karachi, Pakistan, from June 2023 to Dec 2023. Data was collected from 320 females who were suffering from PCOS. Participants were randomized into two groups: the intervention group (n = 160) received a ketogenic diet, while the control group (n = 160) followed a standard hypocaloric diet. Randomization was performed using computer-generated random numbers to ensure allocation concealment and minimize selection bias. Upon enrollment, participants underwent baseline evaluations to establish their demographic characteristics, medical history, and anthropometric measurements, including weight, BMI, and waist circumference. Data were collected from 320 female patients. In the ketogenic diet (KD) group, participants had a mean age of 28.1±4.2 years and a mean BMI of 30.01±2.3 kg/m2. Their waist circumference averaged 90.1±5.0cm, with a fasting glucose level of 110±10 mg/dL and a DHEAS level of 350±50 μg/dL. In the ketogenic diet (KD) group, participants experienced a mean reduction in body weight of 8.5±2.3kg, a decrease in BMI of 3.2±1.1Kg/m2, and a reduction in waist circumference of 10±4cm. Conversely, the control group exhibited a mean decrease in body weight of 2.5±1.5kg, a reduction in BMI of 1.0±0.8kg/m2, and a decrease in waist circumference of 3±2cm. It is concluded that the ketogenic diet may offer metabolic and reproductive benefits for overweight women with polycystic ovary syndrome. The improvements observed in metabolic parameters and menstrual regularity support the potential role of KD as a therapeutic intervention in PCOS management.

Mesencephalic astrocyte-derived neurotrophic factor ameliorates inflammatory response in polycystic ovary syndrome via inhibiting TLR4-NF-κB-NLRP3 pathway

Polycystic ovary syndrome (PCOS) is a common reproductive endocrine disorder in women of reproductive age, which often leads to female infertility. Chronic inflammation is a significant factor in the development of PCOS. Our study aimed to explore the impact of mesencephalic astrocyte-derived neurotrophic factor (MANF), a scientifically validated anti-inflammatory factor, on 99 diagnosed PCOS patients. We also investigated its effects on PCOS mice induced with dehydroepiandrosterone (DHEA) and KGN cells induced with dihydrotestosterone (DHT). Our findings revealed a decrease in serum MANF levels in PCOS patients, which were negatively associated with serum tumor necrosis factor-α (TNF-α) and interleukin-1β (IL-1β) levels. The administration of recombinant human MANF (rhMANF) in PCOS mice demonstrated a decrease in pro-inflammatory cytokines and monocytes/macrophages in both peripheral blood and ovarian tissues. Furthermore, the inclusion of rhMANF notably ameliorated DHEA-induced ovarian dysfunction and fibrosis by negatively regulating the toll-like receptor 4 (TLR4)-nuclear factor kappa B (NF-κB)-NLR family, pyrin domain containing protein 3 (NLRP3) pathway. Additionally, in vitro experiments showed that the up-regulation of MANF offset DHT-induced inhibition of viability and apoptosis in KGN cells. Collectively, this study highlights the anti-inflammatory properties of MANF in PCOS and suggests its potential as a therapeutic approach for the management of PCOS.