Polycystic ovary syndrome: Pathways and mechanisms for possible increased susceptibility to COVID-19

Abstract

In 75% of women with polycystic ovary syndrome (PCOS), insulin action is impaired. In obesity, visceral adipose tissue becomes dysfunctional: Chronic inflammation is favored over storage, contributing to the development of metabolic complications. PCOS, metabolic syndrome (MetSy) and non-alcoholic fatty liver disease (NAFLD) apparently share common pathogenic factors; these include abdominal adiposity, excess body weight and insulin resistance. Alterations in the gut microbiome have been noted in women with PCOS compared to controls; these may lead to deterioration of the intestinal barrier, increased gut mucosal permeability and immune system activation, hyperinsulinemia and glucose intolerance, which hamper normal ovarian function and follicular development (all being hallmarks of PCOS). It has been proposed that PCOS may entail higher susceptibility to coronavirus disease 2019 (COVID-19) via its associated comorbidities (NAFLD, obesity, MetSy and alterations in the gut microbiome). Studies have found an association between acute respiratory distress syndrome (seen in severe cases of COVID-19) and the intestinal microbiome. Furthermore, apparently, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can gain entry to the gastrointestinal tract via locally-expressed angiotensin converting enzyme type 2 receptors. Excess body weight is associated with more severe COVID-19 and increased mortality. Although robust links between SARS-CoV-2 infection and PCOS/NAFLD/gut microbiome/metabolic consequences are yet to be confirmed, it seems that strategies for adapting the intestinal microbiome could help reduce the severity of COVID-19 in women with PCOS with or without NAFLD, MetSy or obesity.

Targeting patients for early COVID-19 therapy; Pre-infection metabolic dysfunction, polycystic ovary syndrome and risk of severe disease in patients under 65: A Massachusetts community-based observational study

“…We believe this study is the first to have observational data to support the suggestion that women suffering from PCOS could be at higher risk for severe COVID-19 [15,16,39]. In women of reproductive age, PCOS is the most frequent endocrine disorder with a prevalence…”

“…Metabolic dysfunction including diabetes is a known risk factor for severe coronavirus disease (COVID-19) outcomes and risk associated with increased blood glucose levels and abnormal liver biochemistry has recently been under investigation, as well [7][8][9][10][11]. Several investigators have proposed that women of reproductive age with polycystic ovary syndrome (PCOS) are potentially at higher risk of severe COVID-19 outcomes, because many clinical findings in PCOS are risk factors for COVID-19 [12][13][14][15][16][17].…”

“…Because PCOS is associated with these metabolic outcomes, we hypothesized that PCOS puts women infected with SARS-CoV-2 at increased risk of severe COVID-19 [13,17,[39][40][41][42][43]. While there have been several studies proposing this hypothesis there is a paucity of epidemiologic research [12][13][14][15][16][17]39].…”

COVID-19 and the need for special care for women with polycystic ovary syndrome: A systematic review

“…4 Emerging evidence suggests that COVID-19 and PCOS share several risk factors. 5,6 PCOS is associated with several comorbidities, including type 2 diabetes and an enhanced prothrombotic state, which may eventually lead to an increased risk of cardiovascular events and consequences. 7,8 Furthermore, women with PCOS have chronic low-grade inflammation which could contribute to the infection.…”

Polycystic ovary syndrome and COVID-19: An emerging risk factor

“…Emerging evidence suggests that polycystic ovary syndrome (PCOS) increases susceptibility to coronavirus disease 2019 (COVID-19), in particular, when there are associated comorbidities of obesity, Type 2 diabetes mellitus (T2DM), fatty liver, and androgen excess. [ 1 ] Insulin resistance in PCOS is linked to low-grade chronic inflammation as well as androgen excess which has a direct impact on adipocyte biology and metabolism. Gender advantage due to the protective effect of estrogen against COVID-19 seems to be lost due to androgen excess in women with PCOS.…”