Inflammatory Markers in Women with Polycystic Ovary Syndrome

Abstract

Several studies have reported the association between polycystic ovary syndrome (PCOS) and low-grade chronic inflammation to be of uncertain cause: obesity, insulin resistance, or PCOS itself. The aim of the study was to investigate the WBC (white blood cell) count and CRP (C-reactive protein) concentration in women with PCOS and to determine the factors that affect their concentration. The study included 200 women aged 18-40 with PCOS and 105 healthy women as the control group, recruited in the Department of Gynaecological Endocrinology of Medical University in Warsaw from 2016 to 2018. Each patient underwent clinical, biochemical, and ultrasonographic assessments. WBC and CRP were significantly higher in the PCOS group (Z=−2,353, p=0,019 and Z=−2,453, p=0,014). WBC positively correlated with serum insulin at 0, 60, and 120 min during the oral glucose tolerance test (INS0: r=0,221, p=0,001; INS1: r=0,194, p=0,003; INS2: r=0,022, p=0,001), testosterone (r=0,130, p=0,046), androstenedione (r=0,212, p=0,001), and DHEAS (r=0,178, p=0,006) and negatively correlated with progesterone (r=−0,204, p=0,002), estradiol (r=−0,140, p=0,032), and SHBG (r=−0,308, p<0,001). CRP positively correlated with insulin concentration in 0, 60, and 120 min during the oral glucose tolerance test (INS0: r=0,343, p<0,001; INS1: r=0,276, p=0,001; INS2: r=0,320, p<001) and negatively correlated with progesterone (r=−0,194, p=0,030) and SHBG (-0,244, p=0,005). We also estimated positive correlation between BMI and serum CRP and WBC concentration. Multiple linear regression analysis showed that CRP values are positively associated with BMI (beta=0,374, p<0,001) and insulin level (INS1) (beta=0,282, p=0,004); and WBC results are negatively associated with SHGB (beta=−0,284, p<0,001) but positively associated with testosterone (beta=0,163, p=0,024) and BMI (beta=0,157, p=0,047). PCOS is associated with increased WBC and CRP concentrations. The main predicting factors of increased CRP are BMI and insulin resistance, but there is also a relationship between WBC count in PCOS and androgen concentration itself so that inflammation may be mediated not only through adiposity but also through increased androgen concentration.

Chronic Low Grade Inflammation in Pathogenesis of PCOS

“…These findings were confirmed by a large number of studies. Elevated CRP levels were found by Tola et al, Souza dos Santos et al, Orio et al, and Rudnicka et al [ 10 , 15 , 16 , 17 ]. In the meta-analysis of 31 clinical trials, conducted by Escobar-Moralle et al, they concluded that CRP in women with PCOS is on average 96 % (95% CI: 71–122%) higher than that in control groups [ 18 ].…”

“…According to known data, inflammatory markers or their gene markers are higher in PCOS patients. Correlations have been found between increased levels of C-reactive protein (CRP), interleukin 18 (IL-18), tumor necrosis factor (TNF-α), interleukin 6 (IL-6), and ferritin in the PCOS women compared with age- and BMI-matched controls [ 8 , 9 , 10 ]. Other factors include elevated levels of WBC, plasminogen activator inhibitor PAI1, activity of the angiotensin-renin system (RAS) and free fatty acids (FFA).…”

Chronic Inflammation in PCOS: The Potential Benefits of Specialized Pro-Resolving Lipid Mediators (SPMs) in the Improvement of the Resolutive Response

“…Chronic low-level inflammation mirrored by elevated levels of pro-inflammatory cytokines, however, is also present in normal-weight PCOS-affected women but was mainly attributed to the fact that also normal-weight PCOS patients tend to have a surplus of visceral adipose tissue and intraperitoneal fat depots [ 61 , 62 ]. Recent studies have identified BMI and insulin resistance as main predictors for increased levels of CRP and white blood cells [ 12 ]. In addition, PCOS patients were shown to have a certain pro-inflammatory genotype characterized by alterations in the genes encoding for TNF-α, TNF receptor and IL-6 [ 63 , 64 , 65 ].…”

“…Furthermore, adipose tissue contributes to constant low-level systemic inflammation as will be described further below in this review. PCOS itself nowadays is considered a condition of chronic inflammation with elevated levels of leukocytes, pro-inflammatory cytokines, elevated white blood count and markers such as the C-reactive protein being detectable [ 12 ] and also affects women with a normal BMI [ 13 ].…”

NLRP3 inflammasome: a new therapeutic target for high-risk reproductive disorders?

“…[ 22 ] Inflammatory factors can lead to the reconstruction of ovarian tissue and alter normal follicular development. [ 23 – 25 ] There is also compelling evidence that the rates of apoptosis of ovarian granulosa cells (GCs) in antral follicles in women with PCOS are significantly increased compared with healthy controls. [ 26 ] Wang et al [ 27 ] suggested that hyperandrogenism is the main cause of infertility as a result of PCOS, hyperandrogenism can drive the generation of the NLRP3 inflammasome, which results in the secretion of inflammatory mediators, and induced low-grade inflammation in mice with PCOS.…”