A narrative review of the role of gastrointestinal dysbiosis in the pathogenesis of polycystic ovary syndrome

Abstract

Diet-induced gastrointestinal dysbiosis has been hypothesized to play a significant role in stimulating an increase in gastrointestinal permeability and activating systemic inflammation in women with polycystic ovary syndrome (PCOS). We reviewed the current proof-of-concept studies on the proposed mechanism of dysbiosis in the pathogenesis of PCOS. A literature search was performed to identify articles on changes in the intestinal microbiome (dysbiosis) and increased intestinal mucosal permeability involving lipopolysaccharide (LPS), LPS-binding protein (LPS-BP), and zonulin. We also searched for systematic reviews and meta-analyses that synthesized the results of studies on the therapeutic effects of prebiotics, probiotics, or synbiotics in women with PCOS. Our search was confined to human studies between 2012 and 2021 using the PubMed, Scopus, and Cochrane databases. Thirty-one studies met the inclusion criteria (14 microbiota, 1 LPS, 1 LPS-BP, 1 LPS and LPS-BP, 5 zonulin, 9 systematic reviews). Our analysis revealed that most studies reported reduced alpha diversity and dysbiosis in women with PCOS. Preliminary studies suggest that LPS, LPS-BP, and zonulin may be involved in the pathophysiology of increased intestinal permeability. Treatment of PCOS with prebiotics, probiotics, and synbiotics appears to have a range of beneficial effects on metabolic and biochemical profiles. This review highlights the need for continued research into the pathophysiological mechanisms of dysbiosis and the clinical efficacy of prebiotics, probiotics, and synbiotics in women with PCOS.

Modified Banxia Xiexin Decoction Ameliorates Polycystic Ovarian Syndrome With Insulin Resistance by Regulating Intestinal Microbiota

“…Despite this, when the internal and external environments of the body change, such as the changes in diet, disease, or misused antibiotics, it will cause an imbalance of gut microbiota, which is widely recognized as malnutrition of intestinal microbiota ( Arroyo et al., 2019 ; Torres et al., 2019 ; Chu et al., 2020 ; Zhou et al., 2020 ). In recent years, numerous studies have shown that there is a relationship between microbiota imbalance and PCOS ( Rizk and Thackray, 2020 ; Parker et al., 2022 ). The imbalance of intestinal microbiota can cause LPS to enter the bloodstream by increasing intestinal permeability ( Tremellen and Pearce, 2012 ; Chang et al., 2021 ).…”

Polycystic Ovary Syndrome: An Evolutionary Adaptation to Lifestyle and the Environment

“…The accumulating scientific evidence strongly supports the significant role played by the microbiome in the pathogenesis and maintenance of PCOS, consistent with research in other related metabolic conditions. The role of dysbiosis is supported by over 30 proof-ofconcept studies that have recently been reviewed [144]. Dysbiosis is therefore a significant factor in the pathogenesis of PCOS and an important component of a unified evolutionary model.…”

Positive Effects of α-Lactalbumin in the Management of Symptoms of Polycystic Ovary Syndrome

“…PCOS is an endocrine and metabolic disorder characterized by complex etiology and pathophysiology. Recent studies revealed a strong association in patients with PCOS between changes in gut microbiota and some clinical–metabolic parameters, suggesting that microbiota alterations may play a critical role in the pathogenesis of this syndrome [ 15 , 16 ].…”