Advances in Polycystic Ovary Syndrome Research: From Molecular Mechanisms to Therapeutic Strategies—2nd Edition

A special issue of Biomedicines (ISSN 2227-9059). This special issue belongs to the section "Endocrinology and Metabolism Research".

Deadline for manuscript submissions: 31 August 2025 | Viewed by 2252

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Guest Editor
Department of Biology, University of Saskatchewan, Saskatoon, SK S7N 5E2, Canada
Interests: reproduction; female fertility preservation; male fertility preservation; female infertility; male infertility; oocyte; sperm; embryo; ovarian tissue; spermatogonial stem cell; testicular tissue; reproductive cells and tissues culture; reproductive cells and tissues cryopreservation; apoptosis; oxidative stress; antioxidant therapy
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Special Issue Information

Dear Colleagues,

Polycystic ovary syndrome (PCOS) is one of the most common endocrine and metabolic disorders of women of reproductive age, which negatively affects the reproductive and mental health of women. Hyperandrogenism, ovulatory dysfunction, and polycystic ovary morphology are diagnostic criteria of PCOS. While obesity, increased cardiovascular risk factors, insulin resistance, hyperinsulinism, and type 2 diabetes mellitus are common symptoms among women with PCOS, they are not required criteria for diagnosis. Since PCOS leads to infertility, early diagnosis and treatments are critical, particularly at the extreme ends of the reproductive lifespan. Therefore, in recent years, understanding the underlying mechanisms, diagnosis, and clinical management of PCOS have become increasingly significant. Lifestyle therapy, in vitro fertilization, surgical therapy, and pharmacotherapy are used to manage the infertility of women with PCOS. In fact, with the latest advances, potential therapeutic options have increased, giving patients and clinicians more choices.

This Special Issue of “Advances in Polycystic Ovary Syndrome Research” will include original research articles and review articles addressing recent advances in our knowledge about etiology, pathophysiology and diagnosis of PCOS as well as advances in therapeutic options for managing PCOS. The roles of oxidative stress and the outcome of antioxidant therapy in PCOS are also of great interest.

Dr. Ebrahim Asadi
Guest Editor

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Keywords

  • female infertility
  • endocrine disorder
  • metabolic disorder
  • polycystic ovary syndrome
  • polycystic ovariany morphology
  • hyperandrogenism
  • menstrual irregularity
  • theraputicsTherapeutics
  • oxidative stress
  • antioxidant

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Published Papers (3 papers)

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Research

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21 pages, 2483 KiB  
Article
Relations of Insulin Resistance, Body Weight, Vitamin D Deficiency, SHBG and Androgen Levels in PCOS Patients
by Zsófi Balogh, Szilvia Csehely, Mónika Orosz, Harjit Pal Bhattoa, Zoárd Tibor Krasznai, Tamás Deli and Attila Jakab
Biomedicines 2025, 13(8), 1803; https://doi.org/10.3390/biomedicines13081803 - 23 Jul 2025
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Abstract
Background: The most common female endocrinopathy is polycystic ovary syndrome (PCOS), affecting 10–20% of women of reproductive age. It is associated with a wide range of hormonal and biochemical abnormalities and long-term metabolic and cardiovascular risks. It is characterized by infertility due to [...] Read more.
Background: The most common female endocrinopathy is polycystic ovary syndrome (PCOS), affecting 10–20% of women of reproductive age. It is associated with a wide range of hormonal and biochemical abnormalities and long-term metabolic and cardiovascular risks. It is characterized by infertility due to chronic anovulation, hyperandrogenism, polycystic ovarian morphology, and is often associated with insulin resistance (IR) and obesity. Hyperinsulinemia further increases androgen production and reduces sex hormone-binding globulin (SHBG) levels, thereby aggravating symptoms. In addition, vitamin D deficiency is often present in PCOS patients, and increasing evidence suggests that it may also be associated with insulin resistance and hyperandrogenism. Objective: This study aimed to evaluate the relationships between insulin resistance, vitamin D deficiency, body mass index (BMI), and androgen levels in women with PCOS. Method: A cross-sectional study was conducted in which data from 195 women diagnosed with PCOS and not yet receiving therapy at a gynecologic endocrinology unit of a university-based tertiary clinical center, between 2019 and 2024, were analyzed. The parameters recorded were age, body mass index (BMI), 25(OH) vitamin D levels, androgen hormone levels (testosterone, androstenedione), glucose-insulin responses during a 3-point oral glucose tolerance test (OGTT). Statistical analyses, including linear regression, Pearson, and Spearman correlation tests were used to assess associations between variables. Results: The mean age of the patients was 24.8 years (18–42), and the mean BMI was 30.6 kg/m2 (17–51). Vitamin D deficiency was observed in 84.1% of patients, hyperandrogenism in 45.8%, and insulin resistance in 44.5%. A significant inverse correlation was found between BMI and vitamin D levels (r = −0.31, p =< 0.01) indicating that higher BMI is associated with lower vitamin D status. Similarly, BMI also showed a significant negative correlation with SHBG levels (r = –0.45, p < 0.01), suggesting that increasing body weight is linked to reduced SHBG concentrations. In addition, BMI was significantly positively correlated with 2 h insulin levels (r = 0.43, p =< 0.01) and with testosterone levels (r = 0.21, p = 0.01). These findings suggest that increased adiposity intensifies insulin resistance and is linked to both vitamin D deficiency and elevated androgen levels. Moreover, the combination of hyperinsulinemia and low vitamin D further disrupts hormonal balance by promoting ovarian androgen production and decreasing SHBG levels, thereby increasing the bioavailability of testosterone. A significant inverse correlation was found between vitamin D levels and 2 h insulin levels (r = −0.28, p =< 0.01), indicating that lower vitamin D status is associated with increased insulin resistance. Furthermore, 2 h insulin levels showed a significant positive correlation with testosterone levels (r = 0.32, p =< 0.01), suggesting that greater insulin resistance is linked to higher androgen production. Additionally, vitamin D levels were inversely correlated with testosterone (r = −0.18, p = 0.02), demonstrating that a lower vitamin D status may further contribute to the hyperandrogenic environment. Vitamin D levels also showed a significant positive correlation with SHBG concentrations (r = 0.29, p < 0.01), indicating that a higher vitamin D status may be associated with increased SHBG levels. In contrast, 2 h insulin levels were inversely correlated with SHBG (r = −0.43, p < 0.01), reflecting the suppressive effect of hyperinsulinemia on SHBG production. Conclusions: Insulin resistance, BMI, and vitamin D deficiency are closely related to each other and to the severity of PCOS, which is confirmed by the correlations with androgen levels. The revealed relationships draw attention to the special importance of vitamin D supplementation and the correction of carbohydrate metabolism in alleviating the symptoms of the disease and reducing long-term health risks. Full article
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16 pages, 5423 KiB  
Communication
Polycystic Ovary Syndrome and Ferroptosis: Following Ariadne’s Thread
by Styliani Geronikolou, Athanasia Pavlopoulou, Ioannis Koutelekos, Dimitrios Kalogirou, Flora Bacopoulou and Dennis V. Cokkinos
Biomedicines 2024, 12(10), 2280; https://doi.org/10.3390/biomedicines12102280 - 8 Oct 2024
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Abstract
Background: Recent literature suggests that ferroptosis (FPT) may be a key player in polycystic ovary syndrome (PCOS) pathogenesis, but the underlying mechanism(s) remain(s) unclear. Aim: Therefore, herein, we made an effort to reproduce the molecular signature of the syndrome by including FPT and [...] Read more.
Background: Recent literature suggests that ferroptosis (FPT) may be a key player in polycystic ovary syndrome (PCOS) pathogenesis, but the underlying mechanism(s) remain(s) unclear. Aim: Therefore, herein, we made an effort to reproduce the molecular signature of the syndrome by including FPT and exploring novel drug targets for PCOS. Methods: (a) Our previously constructed PCOS interactions molecular network was extended with the addition of FPT–associated genes (interaction score above 0.7) and (b) gene set enrichment analysis was performed so as to detect over-represented KEGG pathways. Results: The updated interactome includes 140 molecules, 20 of which are predicted/novel, with an interaction score of 7.3, and 12 major hubs. Moreover, we identified 16 over-represented KEGG pathways, with FPT being the most overexpressed pathway. The FPT subnetwork is connected with the PCOS network through KDM1A. Conclusions: FPT cell death is involved in PCOS development, as its major hub TP53 was shown to be the most important hub in the whole PCOS interactome, hence representing a prioritized drug target. Full article
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Review

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18 pages, 1241 KiB  
Review
PCOS and the Genome: Is the Genetic Puzzle Still Worth Solving?
by Mario Palumbo, Luigi Della Corte, Dario Colacurci, Mario Ascione, Giuseppe D’Angelo, Giorgio Maria Baldini, Pierluigi Giampaolino and Giuseppe Bifulco
Biomedicines 2025, 13(8), 1912; https://doi.org/10.3390/biomedicines13081912 - 5 Aug 2025
Abstract
Background: Polycystic ovary syndrome (PCOS) is a complex and multifactorial disorder affecting reproductive, endocrine, and metabolic functions in women of reproductive age. While environmental and lifestyle factors play a role, increasing evidence highlights the contribution of genetic and epigenetic mechanisms to its pathogenesis. [...] Read more.
Background: Polycystic ovary syndrome (PCOS) is a complex and multifactorial disorder affecting reproductive, endocrine, and metabolic functions in women of reproductive age. While environmental and lifestyle factors play a role, increasing evidence highlights the contribution of genetic and epigenetic mechanisms to its pathogenesis. Objective: This narrative review aims to provide an updated overview of the current evidence regarding the role of genetic variants, gene expression patterns, and epigenetic modifications in the etiopathogenesis of PCOS, with a focus on their impact on ovarian function, fertility, and systemic alterations. Methods: A comprehensive search was conducted across MEDLINE, EMBASE, PubMed, Web of Science, and the Cochrane Library using MeSH terms including “PCOS”, “Genes involved in PCOS”, and “Etiopathogenesis of PCOS” from January 2015 to June 2025. The selection process followed the SANRA quality criteria for narrative reviews. Seventeen studies published in English were included, focusing on original data regarding gene expression, polymorphisms, and epigenetic changes associated with PCOS. Results: The studies analyzed revealed a wide array of molecular alterations in PCOS, including the dysregulation of SIRT and estrogen receptor genes, altered transcriptome profiles in cumulus cells, and the involvement of long non-coding RNAs and circular RNAs in granulosa cell function and endometrial receptivity. Epigenetic mechanisms such as the DNA methylation of TGF-β1 and inflammation-related signaling pathways (e.g., TLR4/NF-κB/NLRP3) were also implicated. Some genetic variants—particularly in DENND1A, THADA, and MTNR1B—exhibit signs of positive evolutionary selection, suggesting possible ancestral adaptive roles. Conclusions: PCOS is increasingly recognized as a syndrome with a strong genetic and epigenetic background. The identification of specific molecular signatures holds promise for the development of personalized diagnostic markers and therapeutic targets. Future research should focus on large-scale genomic studies and functional validation to better understand gene–environment interactions and their influence on phenotypic variability in PCOS. Full article
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