PCOS is diagnosed based on the presence of oligo/anovulation, hyperandrogenemia/hyperandrogenism, and polycystic ovaries. In addition, many women with PCOS have hyperinsulinemia and insulin resistance (IR), which are associated with significant cellular metabolic abnormalities. In this study, we investigated whether metabolic dysfunction in women with PCOS induces granulosa cell stress and causes activation of endoplasmic reticulum and mitochondrial unfolded protein response (UPRer and UPRmt). Women with PCOS diagnosed based on the Rotterdam criteria were included in the study and divided into two groups: PCOS with insulin resistance (PCOS-IR) when HOMA index was ≥ 2 (n=20) and PCOS with no insulin resistance (PCOS-nIR) when HOMA index was < 2 (n= 20). In addition, a healthy control group (CONT) included women undergoing IVF as oocyte donors (n=20). Granulosa cells (GCs) were collected on the day of oocyte retrieval and total RNA was isolated. Quantitative reverse transcription-polymerase chain reaction (qRT-PCR) was performed to determine expression of UPRer genes BIP, ATF4, ATF6, IRE1, CHOP, XBP1 and UPRmt genes HSP60, HSP10, CLPP, HSP40. ANOVA, student’s t-test, and Chi-Square analysis were used for statistical analyses. Women with PCOS-IR and PCOS–nIR were older than the CONT group (30.65 ± 5.25 and 29.94 ± 6.2 vs 25.12 ± 2.26 years, respectively). Body mass index (BMI) of women in the PCOS-IR group was higher (27.64 ± 6.92) compared to both the PCOS-nIR (24.58 ± 3.64; p = 0.032) and CONT (23.76 ± 1.86; p = 0.012). In the GCs of women with PCOS (both -IR and -nIR), UPRer and UPRmt genes were up-regulated compared to the CONT group. Among the genes that regulate UPRmt, chaperone proteins HSP10 and HSP40, involved in the folding of proteins transported into the mitochondria were upregulated in the PCOS-IR (p < 0.01 and p < 0.001) and PCOS-nIR (p < 0.05 and p < 0.05 ) groups compared to CONT, while no difference in the expression of CLPP and HSP60 was found. UPRer-related transcription factors ATF4, IRE1, and XBP1, activated by stress in the endoplasmic reticulum, were significantly increased in GCs of PCOS-IR compared with CONT (p < 0.05 for all), while IRE1 was increased in nIR-PCOS (p < 0.05). The chaperone BIP, involved in the protein folding in the endoplasmic reticulum, was specifically increased in PCOS-IR compared to CONT and PCOS-nIR (p <0.05). No difference was found in ATF6 gene expression. The transcription factor C/EBP homologous protein (CHOP), involved in apoptosis initiation in response to organelle stress, was overexpressed in both PCOS-IR and PCOS-nIR (p < 0.05) compared to CONT. Granulosa cells of women with PCOS with or without insulin resistance display signs of metabolic distress and up-regulation of UPRer and UPRmt genes.
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