The polycystic ovary syndrome (PCOS) is an endocrine disorder that affects women of reproductive age worldwide. It is characterized by hyperandrogenism, ovarian dysfunction, and polycystic ovarian morphology.With a particular focus on granulosa cell dysfunction and abnormal oocyte maturation, this comprehensive review explores the intricate molecular mechanisms driving PCOS pathogenesis. PCOS is characterized by hormonal and metabolic disturbances caused by long non-coding RNAs (lncRNAs), microRNAs (miRNAs), and the insulin-like growth factor 1 (IGF1) signaling pathway.In this review, we discuss the dysregulation of certain lncRNAs, such as NEAT1, and miRNAs, including miR-29a-3p, in PCOS granulosa cells, as well as how these dysregulations affect cell proliferation, insulin sensitivity, and steroidogenesis. This study examines the interaction between non-coding RNAs and the IGF1 system, which reveals an intricate regulatory network involved in follicular development and ovarian function. These pathways are altered in expression and activity, which has implications for how oocytes mature and how fertility is affected.In addition, this review emphasizes the interconnected nature of granulosa cell dysfunction, oocyte maturation defects, and systemic metabolic disturbances in PCOS pathogenesis. Granulosa cells have the potential to be used as a research and therapeutic intervention focus, due to their accessibility and central role in ovarian function.Additionally, we propose future research directions using advanced technologies such as single cell sequencing and multi-omics technologies. According to the review, studies that focus on granulosa cells can help develop novel diagnostic markers, personalized treatment strategies, and potential PCOS-based therapies.In addition to providing insight into the molecular underpinnings of PCOS, this study sets the stage for future investigations aimed at improving diagnosis, management, and treatment.
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