CONNECTING THE DOTS: PROTEINS AND POLYCYSTIC OVARIAN SYNDROME SYMPTOM MANIFESTATIONS

Abstract

Polycystic ovarian syndrome (PCOS) is a multifaceted endocrine disorder that impacts women of reproductive age. The diverse phenotypic manifestations of PCOS have led to ongoing debates regarding diagnostic criteria. Individuals with PCOS exhibit a range of symptoms, necessitating tailored diagnostic approaches. While the global prevalence of PCOS stands at approximately 4-10%, the incidence is notably higher in India, reaching 20-26% [Chatterjee, 2020]. PCOS encompasses a spectrum of clinical features, including oligoanovulation, infertility, metabolic disturbances, hirsutism, acne, alopecia, obesity/overweight, hyperandrogenism, glucose intolerance, depression, anxiety disorders, and endometrial hyperplasia [Abbott DH 2017, Astapova O 2019]. In addition to these morphological features, alterations in metabolic profiles, such as insulin resistance, constitute a prominent hallmark of PCOS. Hyperinsulinemia may lead to diabetes mellitus and the accumulation of abdominal fat. Prolonged PCOS can also precipitate hypertension, cardiovascular complications, and dyslipidemia [Hacivelioglu S 2013].

This comprehensive review delves into the proteins associated with the major symptoms of PCOS, elucidating their roles and implications. The etiology of PCOS is multifactorial, encompassing genetic and environmental factors [Panda PK 2016]. Hypersecretion of androgen hormones by the ovaries or adrenal glands stands as the primary cause of hirsutism in PCOS [Barbieri RL 2020]. Amenorrhea, the absence of menstruation during the reproductive years, correlates with insulin resistance (IR) and hyperandrogenism [Panidis D 2013]. Aberrantly expressed proteins like high androgen levels, low sex hormone binding globulin (SHBG), insulin-like peptide 3 (INSP3), and antimullerian hormone (AMH) play pivotal roles in menstrual irregularities [Pelusi C 2013]. Hyperandrogenism and oligoanovulation during reproductive years can result in infertility in PCOS [Melo AS 2015]. Several proteins, including tumor necrosis factor alpha-induced protein 6 (TNFAIP6), lymphatic vessel endothelial hyaluronan receptor 1 (LYVE1), cluster of differentiation 14 (CD14), syndecan-4, and amphiregulin, exhibit altered expression in infertility associated with PCOS [Ambekar AS 2015]. Acne, another characteristic feature of PCOS, predominantly arises due to elevated testosterone levels. The severity of acne is closely linked to increased concentrations of total testosterone, free testosterone, dehydroepiandrosterone sulfate, and free androgen index (FAI) [Franik G 2018]