Hyperinsulinemia alters myoinositol to d-chiroinositol ratio in the follicular fluid of patients with PCOS
Abstract
Myoinositol (MI) and d-chiroinositol (DCI) are 2 stereoisomers and insulin sensitizers. Their physiological ratio differs from tissue to tissue, and they are regulated by an insulin-dependent epimerase whose activity is drastically reduced in conditions of insulin resistance. Based on literature data and on the fact that MI phospholipids are follicle-stimulating hormone (FSH) second messengers, we speculated that patients with polycystic ovary syndrome (PCOS) having hyperinsulinemia, present an enhanced MI to DCI epimerization in the ovary, leading to MI deficiency that impairs FSH signaling, resulting in reduced oocyte quality. In the present study, 20 patients with PCOS and 20 healthy women were enrolled for measurement of MI and DCI levels in their follicular fluid. Follicular fluid samples were taken using a vaginal probe and both MI and DCI were quantified analytically. Results showed that the ratio of MI-DCI dropped from 100:1 in healthy participants to 0.2:1 in patients with PCOS who additionally displayed significantly higher levels of insulin resistance, hyperinsulinemia, and luteinizing hormone. This study is the first one to analyze the misbalance in the MI-DCI ratio in the ovary of patients with PCOS, supporting the concept that maintaining the physiological levels of the 2 stereoisomers is crucial, in restoring the ovarian functionality.
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In women without PCOS, the ovarian MI:DCI ratio is 100:1, but in women with PCOS, the ratio is 0.2:1.
“In women without PCOS, the ovarian MI:DCI ratio is 100:1, but in women with PCOS, the ratio is 0.2:1 (13).”
From Inositol for Polycystic Ovary Syndrome: A Systematic Review and Meta-analysis to Inform the 2023 Update of the International Evidence-based PCOS Guidelines (2024) · cites this paper as [13]
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- Authors
- Unfer, V., Carlomagno, G., Papaleo, E., Vailati, S., Candiani, M., & Baillargeon, J.-P.
- Affiliations
- Agunco (IT)
- IRCCS Ospedale San Raffaele (IT)
- Université de Sherbrooke (CA)
- Corresponding author
- Carlomagno, Gianfranco
- Venue
- Reproductive Sciences
- Published
- 2014-07
- Volume
- 21
- Issue
- 7
- Pages
- 854-858
- ISSN
- 1933-7191 (ISSN-L)
- 1933-7205
- OpenAlex
- W2106706873
- Cited by
- 105
- References
- 37
- Citations by year
- 2026: 5 · 2025: 3 · 2024: 8 · 2023: 16 · 2022: 10 · 2021: 11 · 2020: 11 · 2019: 8 · 2018: 9 · 2017: 7 · 2016: 11 · 2015: 4 · 2014: 2
- FWCI
- 9.70
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Reproductive Sciences (publishedVersion)
- PubMed (publishedVersion)
- Archivio Istituzionale della Ricerca - Università Vita-Salute San Raffaele (submittedVersion)
- Topics
- Health Sciences › Medicine › Reproductive Medicine › Ovarian function and disorders
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Reproductive Biology and Fertility
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Keywords
- polycystic ovary syndrome, hyperinsulinemia, myo-inositol, follicular fluid, insulin resistance, epimerase, oocyte quality, luteinizing hormone
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