Hyperhomocysteinemia, the player behind the curtain: a new insight into polycystic ovary syndrome

Main Article Content

Ipsita Chakraborty
Ratna Chattopadhyay
Rajen Haldar
Baidyanath Chakravarty
Pratip Chakraborty

Abstract

Polycystic ovary syndrome (PCOS), the commonest form of dysovulatoy infertility is a major form of heterogeneous endocrinopathy comprised of broad spectra of ovarian disorders including anovulation, hyperandrogenism with trademark features of metabolic syndrome (MS) like insulin resistance, obesity and dyslipidemia. Hyperhomocysteinemia, a close associate of MS and an increasingly frequent finding among PCOS women in India, poses a possible threat to these individuals with recurrent miscarriage. Micro-thrombi formation in hyperhomocysteinemic PCOS women cues toward the development of a “thrombophilic syndrome” in these women with its possible culmination in coronary artery disease later in life. However, pathophysiology of hyperhomocysteinemia in the context of PCOS and its far-reaching consequences remains unexplored.

Article Details

How to Cite
Chakraborty, I., Chattopadhyay, R., Haldar, R., Chakravarty, B., & Chakraborty, P. (2022). Hyperhomocysteinemia, the player behind the curtain: a new insight into polycystic ovary syndrome. INDIAN JOURNAL OF PHYSIOLOGY AND ALLIED SCIENCES, 74(3). https://doi.org/10.55184/ijpas.v74i3.43
Section
Review Article
Author Biographies

Ipsita Chakraborty, 1Department of Physiology, University Colleges of Science and Technology, University of Calcutta, 92, A.P.C. Road, Kolkata-700 009, India

Mrs.Ipsita Chakraborty is a doctorate student in Department of Physiology, University Colleges of Science and Technology under Dr. Rajen Haldar. Her area of work is to explore the rheological factors in polycystic ovary syndrome.

Ratna Chattopadhyay, Department of Assisted Reproduction, Institute of Reproductive Medicine, HB-36/A/3, Sector-III, Saltlake City, Kolkata-700106, India.

Dr. Ratna Chattopadhyay is the chief embryologist and head of Andrology and Embryology unit of Institute of Reproductive Medicine. She is dedicated to promote Clinical Embryology through regional trainings, web-based learning, certificate/PG diploma courses. She is executive committee member of Bengal-ISAR (Indian Society of Assisted Reproduction) and Bengal-ACE (Academy of Clinical Embryologists in India). She has several international publications to her credit.

Baidyanath Chakravarty, Department of Assisted Reproduction, Institute of Reproductive Medicine, HB-36/A/3, Sector-III, Saltlake City, Kolkata-700106, India.

Prof. B.N. Chakravarty is the director of Institute of Reproductive Medicine, Kolkata, a tertiary infertility care centre for treatment and management of infertility and O&G complications. He is Ex-Chairman of ICMR Committee for formulation of National Guidelines for regulation, supervision, and accreditation of ART Centers in India. Being a pioneer in ART nationwide, his research group has extensively worked on different aspect of multifaceted reproductive troubles such as early pregnancy loss, endometriosis, polycystic ovary syndrome etc.

Pratip Chakraborty, Department of Assisted Reproduction, Institute of Reproductive Medicine, HB-36/A/3, Sector-III, Saltlake City, Kolkata-700106, India.

Dr. Pratip Chakraborty is currently leading the Basic Science Unit of Assisted Reproduction Division at Institute of Reproductive Medicine, Kolkata. The overall theme of Chakraborty's lab is to understand the molecular basis for the pathogenic mechanism/s underlying complex female reproductive disease/s. He broadly concentrates on role of metabolic disturbances in the crossroads of pro- and anti inflammatory context/s in physiology of pregnancy. To this end the lab work with genes, proteins, cells, mice and human patients.

References

Akalin, A., Alatas, O., & Colak, O. (2008). Relation of plasma homocysteine levels to atherosclerotic vascular disease and inflammation markers in type 2 diabetic patients. European Journal of Endocrinology, 158(1), 47–52.

Allahbadia, G. N., & Merchant, R. (2008). Polycystic ovary syndrome in the Indian Subcontinent. Seminars in Reproductive Medicine, 26(1), 22–34.

Azziz, R. (2006). Controversy in clinical endocrinology: diagnosis of polycystic ovarian syndrome: the Rotterdam criteria are premature. The Journal of Clinical Endocrinology and Metabolism, 91(3), 781–785.

Azziz, R., Marin, C., Hoq, L., Badamgarav, E., & Song, P. (2005). Health care-related economic burden of the polycystic ovary syndrome during the reproductive life span. The Journal of Clinical Endocrinology and Metabolism, 90(8), 4650–4658.

Badawy, A., State, O., El Gawad, S. S. A., & El Aziz, O. A. (2007). Plasma homocysteine and polycystic ovary syndrome: the missed link. European Journal of Obstetrics, Gynecology, and Reproductive Biology, 131(1), 68–72.

Balasch, J. (2004). Antiphospholipid antibodies: a major advance in the management of recurrent abortion. Autoimmunity Reviews, 3(3), 228–233.

Brosnan, J. T., & Brosnan, M. E. (2006). The sulfur-containing amino acids: an overview. The Journal of Nutrition, 136(6 Suppl), 1636S-1640S.

Chakraborty, P., Banerjee, S., Saha, P., Nandi, S. S., Sharma, S., Goswami, S. K., Chakravarty, B., & Kabir, S. N. (2013). Aspirin and low-molecular weight heparin combination therapy effectively prevents recurrent miscarriage in hyperhomocysteinemic women. PloS One, 8(9), e74155.

Chakraborty, P., Goswami, S. K., Rajani, S., Sharma, S., Kabir, S. N., Chakravarty, B., & Jana, K. (2013). Recurrent pregnancy loss in polycystic ovary syndrome: role of hyperhomocysteinemia and insulin resistance. PloS One, 8(5), e64446.

Chang, R. J., & Dumesic, D. A. (2019). Chapter 21 - Polycystic Ovary Syndrome and Hyperandrogenic States. In J. F. Strauss & R. L. Barbieri (Eds.), Yen and Jaffe’s Reproductive Endocrinology (Eighth Edition) (Eighth Edition, pp. 520-555.e13). Elsevier.

Christian, R. C., Dumesic, D. A., Behrenbeck, T., Oberg, A. L., Sheedy, P. F. 2nd, & Fitzpatrick, L. A. (2003). Prevalence and predictors of coronary artery calcification in women with polycystic ovary syndrome. The Journal of Clinical Endocrinology and Metabolism, 88(6), 2562–2568.

Cortón, M., Botella-Carretero, J. I., Benguría, A., Villuendas, G., Zaballos, A., San Millán, J. L., Escobar-Morreale, H. F., & Peral, B. (2007). Differential gene expression profile in omental adipose tissue in women with polycystic ovary syndrome. The Journal of Clinical Endocrinology and Metabolism, 92(1), 328–337.

Diamanti-Kandarakis, E., Papavassiliou, A. G., Kandarakis, S. A., & Chrousos, G. P. (2007). Pathophysiology and types of dyslipidemia in PCOS. Trends in Endocrinology and Metabolism: TEM, 18(7), 280–285.

Dokras, A. (2013). Cardiovascular disease risk in women with PCOS. Steroids, 78(8), 773–776.

Ehrmann, D. A. (2005). Polycystic ovary syndrome. The New England Journal of Medicine, 352(12), 1223–1236.

Ek, I., Arner, P., Rydén, M., Holm, C., Thörne, A., Hoffstedt, J., & Wahrenberg, H. (2002). A unique defect in the regulation of visceral fat cell lipolysis in the polycystic ovary syndrome as an early link to insulin resistance. Diabetes, 51(2), 484–492.

Fonseca, V., Dicker-Brown, A., Ranganathan, S., Song, W., Barnard, R. J., Fink, L., & Kern, P. A. (2000). Effects of a high-fat-sucrose diet on enzymes in homocysteine metabolism in the rat. Metabolism: Clinical and Experimental, 49(6), 736–741.

Fowler, B. (2005). [Homocystein--an independent risk factor for cardiovascular and thrombotic diseases]. Therapeutische Umschau. Revue therapeutique, 62(9), 641–646.

Gallagher, E. J., Leroith, D., & Karnieli, E. (2011). The metabolic syndrome--from insulin resistance to obesity and diabetes. The Medical Clinics of North America, 95(5), 855–873.

Goodarzi, M. O., Quiñones, M. J., Azziz, R., Rotter, J. I., Hsueh, W. A., & Yang, H. (2005). Polycystic ovary syndrome in Mexican-Americans: prevalence and association with the severity of insulin resistance. Fertility and Sterility, 84(3), 766–769.

Hajer, G. R., van der Graaf, Y., Olijhoek, J. K., Verhaar, M. C., & Visseren, F. L. J. (2007). Levels of homocysteine are increased in metabolic syndrome patients but are not associated with an increased cardiovascular risk, in contrast to patients without the metabolic syndrome. Heart (British Cardiac Society), 93(2), 216–220.

Hassan, A., & Gordon, C. M. (2007). Polycystic ovary syndrome update in adolescence. Current Opinion in Pediatrics, 19(4).

Hudecova, M., Holte, J., Olovsson, M., Larsson, A., Berne, C., & Poromaa, I. S. (2011). Diabetes and impaired glucose tolerance in patients with polycystic ovary syndrome--a long term follow-up. Human Reproduction (Oxford, England), 26(6), 1462–1468.

Jakubowicz, D. J., Iuorno, M. J., Jakubowicz, S., Roberts, K. A., & Nestler, J. E. (2002). Effects of metformin on early pregnancy loss in the polycystic ovary syndrome. The Journal of Clinical Endocrinology and Metabolism, 87(2), 524–529.

Kopprasch, S., Pietzsch, J., Kuhlisch, E., Fuecker, K., Temelkova-Kurktschiev, T., Hanefeld, M., Kühne, H., Julius, U., & Graessler, J. (2002). In vivo evidence for increased oxidation of circulating LDL in impaired glucose tolerance. Diabetes, 51(10), 3102–3106.

Lonn, E., Held, C., Arnold, J. M. O., Probstfield, J., McQueen, M., Micks, M., Pogue, J., Sheridan, P., Bosch, J., Genest, J., & Yusuf, S. (2006). Rationale, design and baseline characteristics of a large, simple, randomized trial of combined folic acid and vitamins B6 and B12 in high-risk patients: the Heart Outcomes Prevention Evaluation (HOPE)-2 trial. The Canadian Journal of Cardiology, 22(1), 47–53.

Mukherjee, M., Joshi, S., Bagadi, S., Dalvi, M., Rao, A., & Shetty, K. R. (2002). A low prevalence of the C677T mutation in the methylenetetrahydrofolate reductase gene in Asian Indians. Clinical Genetics, 61(2), 155–159.

Nafiye, Y., Sevtap, K., Muammer, D., Emre, O., Senol, K., & Leyla, M. (2010). The effect of serum and intrafollicular insulin resistance parameters and homocysteine levels of nonobese, nonhyperandrogenemic polycystic ovary syndrome patients on in vitro fertilization outcome. Fertility and Sterility, 93(6), 1864–1869.

Nidhi, R., Padmalatha, V., Nagarathna, R., & Amritanshu, R. (2011). Prevalence of polycystic ovarian syndrome in Indian adolescents. Journal of Pediatric and Adolescent Gynecology, 24(4), 223–227.

Norman, R. J., Dewailly, D., Legro, R. S., & Hickey, T. E. (2007). Polycystic ovary syndrome. Lancet (London, England), 370(9588), 685–697.

Ode, K. L., Frohnert, B. I., & Nathan, B. M. (2009). Identification and treatment of metabolic complications in pediatric obesity. Reviews in Endocrine & Metabolic Disorders, 10(3), 167–188.

Orio Francesco, J., Palomba, S., Di Biase, S., Colao, A., Tauchmanova, L., Savastano, S., Labella, D., Russo, T., Zullo, F., & Lombardi, G. (2003). Homocysteine Levels and C677T Polymorphism of Methylenetetrahydrofolate Reductase in Women with Polycystic Ovary Syndrome. The Journal of Clinical Endocrinology & Metabolism, 88(2), 673–679.

Randeva, H. S., Tan, B. K., Weickert, M. O., Lois, K., Nestler, J. E., Sattar, N., & Lehnert, H. (2012). Cardiometabolic aspects of the polycystic ovary syndrome. Endocrine Reviews, 33(5), 812–841.

Rasouli, M. L., Nasir, K., Blumenthal, R. S., Park, R., Aziz, D. C., & Budoff, M. J. (2005). Plasma homocysteine predicts progression of atherosclerosis. Atherosclerosis, 181(1), 159–165.

Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. (2004). Fertility and Sterility, 81(1), 19–25.

Sattar, N. (2009). Review: PCOS, insulin resistance and long-term risks for diabetes and vascular disease. The British Journal of Diabetes & Vascular Disease, 9(1), 15–18.

Sharpless, J. L. (2003). Polycystic ovary syndrome and the metabolic syndrome. Clinical Diabetes, 21, 154

Sheehan, M. T. (2004). Polycystic ovarian syndrome: diagnosis and management. Clinical Medicine & Research, 2(1), 13–27.

Sibani, S., Christensen, B., O’Ferrall, E., Saadi, I., Hiou-Tim, F., Rosenblatt, D. S., & Rozen, R. (2000). Characterization of six novel mutations in the methylenetetrahydrofolate reductase (MTHFR) gene in patients with homocystinuria. Human Mutation, 15(3), 280–287.

Siragusa, S., Malato, A., Cigna, V., Anastasio, R., Coco, L. Lo, Casuccio, A., & Ciaccio, M. (2007). The risk of recurrent cardiovascular events in patients with increased plasma homocysteine levels is reduced by short but not long-term therapy with folate and B vitamins. Thrombosis Research, 121(1), 51–53.

Stein, I. F., & Leventhal, M. L. (1935). Amenorrhea associated with bilateral polycystic ovaries. American Journal of Obstetrics and Gynecology, 29(2), 181–191.

Wang, E. T., Calderon-Margalit, R., Cedars, M. I., Daviglus, M. L., Merkin, S. S., Schreiner, P. J., Sternfeld, B., Wellons, M., Schwartz, S. M., Lewis, C. E., Williams, O. D., Siscovick, D. S., & Bibbins-Domingo, K. (2011). Polycystic ovary syndrome and risk for long-term diabetes and dyslipidemia. Obstetrics and Gynecology, 117(1), 6–13.

Welch, G. N., & Loscalzo, J. (1998). Homocysteine and atherothrombosis. The New England Journal of Medicine, 338(15), 1042–1050.

Wijekoon, E. P., Hall, B., Ratnam, S., Brosnan, M. E., Zeisel, S. H., & Brosnan, J. T. (2005). Homocysteine metabolism in ZDF (type 2) diabetic rats. Diabetes, 54(11), 3245–3251.

Wijeyaratne, C. N., Nirantharakumar, K., Balen, A. H., Barth, J. H., Sheriff, R., & Belchetz, P. E. (2004). Plasma homocysteine in polycystic ovary syndrome: does it correlate with insulin resistance and ethnicity? Clinical Endocrinology, 60(5), 560–567.

Wild, R. A. (2002). Long-term health consequences of PCOS. Human Reproduction Update, 8(3), 231–241.

Williams, K. T., & Schalinske, K. L. (2007). New insights into the regulation of methyl group and homocysteine metabolism. The Journal of Nutrition, 137(2), 311–314.

Yadav, S., Hasan, N., Marjot, T., Khan, M. S., Prasad, K., Bentley, P., & Sharma, P. (2013). Detailed analysis of gene polymorphisms associated with ischemic stroke in South Asians. PloS One, 8(3), e57305.

Zawadzki J and Dunaif A; Diagnostic criteria for polycystic ovary syndrome: Towards a rational approach. 1992 Boston, Blackwell.