Journal of Reproduction & Infertility

Journal of Reproduction & Infertility

Serum Levels of Angiopoietin-Like Protein 6 (ANGPTL6) in Iranian Women with Polycystic Ovary Syndrome

Authors
1 Department of Anatomy, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
2 Department of Comparative Biosciences, Faculty of Veterinary Medicine, University of Tehran, Tehran, Iran
3 Department of Anatomy, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran; Department of Infertility, Yas Hospital, Tehran University of Medical Sciences, Tehran, Iran
4 Department of Infertility, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
5 Department of Anatomy, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran; Department of Infertility, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
6 Liver and Digestive Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
7 Reproductive Biotechnology Research Center, Avicenna Research Institute, ACECR, Tehran, Iran
Abstract
Background: Infertility and miscarriage are common complications in women with PCOS, and may be linked with metabolic status and thyroid function. However, the role of ANGPTL6 in PCOS-related infertility and miscarriage remains underexplored. Study assessed serum ANGPTL6 levels in Iranian PCOS patients and its association with miscarriage, infertility, and thyroid dysfunction. Methods: This case-control study included 116 PCOS women (58 with infertility, 58 with a history of miscarriage) and 58 non-PCOS controls. The measurement of ANGPTL6, adiponectin, fasting insulin, and other hormonal parameters were measured using ELISA. Parametric data were analyzed with t-tests and ANOVA, and non-parametric data with Mann-Whitney and Kruskal-Wallis tests. Correlations were assessed using Pearson and Spearman tests. Logistic regression was used predicted PCOS risk. A p<0.05 was considered statistically significant. Results: ANGPTL6 levels were significantly higher in the PCOS group (48.72± 21.41 ng/ml) and the PCOS-miscarriage subgroup (50.16±19.57 ng/ml) compared to the non-PCOS group (41.56±14.74 ng/ml). T4 levels were significantly lower in the PCOS group (2.5±1.9 μg/dl) compared to controls (3.9±4.6 μg/dl, p<0.001). No significant correlation was found between ANGPTL6 and thyroid function tests. A positive correlation was observed between ANGPTL6 and adiponectin in the PCOS group (p<0.01). Logistic regression showed a significant association between ANGPTL6 and the risk of PCOS (OR: 1.02, 95%CI: 1.002-1.038), even after adjusting for age, body mass index (BMI), and Homeostasis Model Assessment of Insulin Resistance (HOMA-IR). Conclusion: Elevated ANGPTL6 levels were correlated with PCOS. Future research is needed to explore the molecular pathways linking ANGPTL6 to PCOS and its interaction with metabolic biomarkers.
Keywords

  1. Rotterdam ESHRE/ASRM-Sponsored PCOS consensus workshop group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Fertil Steril. 2004;81(1):19-25.
  2. Carmina E, Lobo RA. Polycystic ovary syndrome (PCOS): arguably the most common endocrinopathy is associated with significant morbidity in women. J Clin Endocrinol Metab. 1999;84(6):1897-9.
  3. Siddiqui S, Mateen S, Ahmad R, Moin S. A brief insight into the etiology, genetics, and immunology of polycystic ovarian syndrome (PCOS). J Assist Reprod Genet. 2022;39(11):2439-73.
  4. Boomsma CM, Eijkemans MJC, Hughes EG, Visser GHA, Fauser BCJM, Macklon NS. A meta-analysis of pregnancy outcomes in women with polycystic ovary syndrome. Hum Reprod Update. 2006;12(6):673-83.
  5. Bahri Khomami M, Joham AE, Boyle JA, Piltonen T, Silagy M, Arora C, et al. Increased maternal pregnancy complications in polycystic ovary syndrome appear to be independent of obesity—A systematic review, meta‐analysis, and meta‐regression. Obes Rev. 2019;20(5):659-74.
  6. Melo AS, Ferriani RA, Navarro PA. Treatment of infertility in women with polycystic ovary syndrome: approach to clinical practice. Clinics (Sao Paulo). 2015;70(11):765-9.
  7. Jakubowicz DJ, Iuorno MJ, Jakubowicz S, Roberts KA, Nestler JE. Effects of metformin on early pregnancy loss in the polycystic ovary syndrome. J Clin Endocrinol Metab. 2002;87(2):524-9.
  8. Sinha U, Sinharay K, Saha S, Longkumer TA, Baul SN, Pal SK. Thyroid disorders in polycystic ovarian syndrome subjects: A tertiary hospital based cross-sectional study from Eastern India. Indian J Endocrinol Metab. 2013;17(2):304-9.
  9. Benetti-Pinto CL, Piccolo VRSB, Garmes HM, Juliato CRT. Subclinical hypothyroidism in young women with polycystic ovary syndrome: an analysis of clinical, hormonal, and metabolic parameters. Fertil Steril. 2013;99(2):588-92.
  10. Janssen OE, Mehlmauer N, Hahn S, Öffner AH, Gärtner R. High prevalence of autoimmune thyroiditis in patients with polycystic ovary syndrome. Eur J Endocrinol. 2004;150(3):363-9.
  11. Singla R, Gupta Y, Khemani M, Aggarwal S. Thyroid disorders and polycystic ovary syndrome: An emerging relationship. Indian J Endocrinol Metab. 2015;19(1):25-9.
  12. Jiang Q, Miao R, Wang Y, Wang W, Zhao D, Niu Y, et al. ANGPTL4 inhibits granulosa cell proliferation in polycystic ovary syndrome by EGFR/JAK1/STAT3‐mediated induction of p21. FASEB J. 2023;37(2):e22693.
  13. Vatannejad A, Salimi F, Moradi N, Fouani FZ, Zandieh Z, Ansaripour S, et al. Evaluation of angiopoietin-like protein 3 (ANGPTL3) levels in polycystic ovary syndrome. Life Sci. 2020;263:118595.
  14. Jiang Q, Pan Y, Li P, Zheng Y, Bian Y, Wang W, et al. ANGPTL4 expression in ovarian granulosa cells is associated with polycystic ovary syndrome. Front Endocrinol (Lausanne). 2022;12:799833.
  15. Boztosun A, Deveci K, Kiliçli F, Söylemez MS, Muhtaroğlu S, Müderris İİ. Serum levels of angiopoietin-related growth factor (AGF) are increased in polycystic ovary syndrome. J Investig Med. 2012;60(5):813-7.
  16. Carbone C, Piro G, Merz V, Simionato F, Santoro R, Zecchetto C, et al. Angiopoietin-like proteins in angiogenesis, inflammation and cancer. Int J Mol Sci. 2018;19(2):431.
  17. Hato T, Tabata M, Oike Y. The role of angiopoietin-like proteins in angiogenesis and metabolism. Trends Cardiovasc Med. 2008;18(1):6-14.
  18. Oike Y, Yasunaga K, Suda T. Angiopoietin-related/angiopoietin-like proteins regulate angiogenesis. Int J Hematol. 2004;80(1):21-8.
  19. Oike Y, Akao M, Yasunaga K, Yamauchi T, Morisada T, Ito Y, et al. Angiopoietin-related growth factor antagonizes obesity and insulin resistance. Nat Med. 2005;11(4):400-8.
  20. Valencia-Martínez A, Schaefer-Graf U, Amusquivar E, Herrera E, Ortega-Senovilla H. Relationship of ANGPTL6 with neonatal glucose homeostasis and fat mass is disrupted in gestational diabetic pregnancies. J Clin Endocrinol Metab. 2022;107(10):e4078-85.
  21. Stepan H, Ebert T, Schrey S, Reisenbüchler C, Stein S, Lossner U, et al. Serum levels of angiopoietin-related growth factor are increased in preeclampsia. Am J Hypertens. 2009;22(3):314-8.
  22. Ebert T, Bachmann A, Lössner U, Kratzsch J, Blüher M, Stumvoll M, et al. Serum levels of angiopoietin-related growth factor in diabetes mellitus and chronic hemodialysis. Metabolism. 2009;58(4):547-51.
  23. Namkung J, Koh SB, Kong ID, Choi JW, Yeh BI. Serum levels of angiopoietin-related growth factor are increased in metabolic syndrome. Metabolism. 2011;60(4):564-8.
  24. Lim JA, Kim HJ, Ahn HY, Park KU, Yi KH, Park DJ, et al. Influence of thyroid dysfunction on serum levels of angiopoietin-like protein 6. Metabolism. 2015;64(10):1279-83.
  25. Hajian-Tilaki K. Sample size estimation in diagnostic test studies of biomedical informatics. J Biomed Inform. 2014;48:193-204.
  26. Shanaki M, Moradi N, Fadaei R, Zandieh Z, Shabani P, Vatannejad A. Lower circulating levels of CTRP12 and CTRP13 in polycystic ovarian syndrome: irrespective of obesity. PloS One. 2018;13(12):e0208059.
  27. Kheirollahi A, Teimouri M, Karimi M, Vatannejad A, Moradi N, Borumandnia N, et al. Evaluation of lipid ratios and triglyceride-glucose index as risk markers of insulin resistance in Iranian polycystic ovary syndrome women. Lipids Health Dis. 2020;19(1):235.
  28. Esteghamati A, Ashraf H, Khalilzadeh O, Zandieh A, Nakhjavani M, Rashidi A, et al. Optimal cut-off of homeostasis model assessment of insulin resistance (HOMA-IR) for the diagnosis of metabolic syndrome: third national surveillance of risk factors of non-communicable diseases in Iran (SuRFNCD-2007). Nutr Metab (Lond). 2010;7:26.
  29. Sadeghi A, Fadaei R, Moradi N, Fouani FZ, Roozbehkia M, Zandieh Z, et al. Circulating levels of C1q/TNF‐α‐related protein 6 (CTRP6) in polycystic ovary syndrome. IUBMB Life. 2020;72(7):1449-59.
  30. Fouani FZ, Fadaei R, Moradi N, Zandieh Z, Ansaripour S, Yekaninejad MS, et al. Circulating levels of Meteorin-like protein in polycystic ovary syndrome: a case-control study. PloS One. 2020;15(4):e0231943.
  31. Kadomatsu T, Tabata M, Oike Y. Angiopoietin‐like proteins: emerging targets for treatment of obesity and related metabolic diseases. FEBS J. 2011;278(4):559-64.
  32. Mirzaei K, Hossein-Nezhad A, Chamari M, Shahbazi S. Evidence of a role of ANGPTL6 in resting metabolic rate and its potential application in treatment of obesity. Minerva Endocrinol. 2011;36(1):13-21.
  33. Ebert T, Kralisch S, Loessner U, Jessnitzer B, Stumvoll M, Fasshauer M, et al. Relationship between serum levels of angiopoietin-related growth factor and metabolic risk factors. Horm Metab Res. 2014;46(10):685-90.
  34. Elci E, Kaya C, Cim N, Yildizhan R, Elci GG. Evaluation of cardiac risk marker levels in obese and non-obese patients with polycystic ovaries. Gynecol Endocrinol. 2017;33(1):43-7.
  35. van der Spuy ZM, Dyer SJ. The pathogenesis of infertility and early pregnancy loss in polycystic ovary syndrome. Best Pract Res Clin Obstet Gynaecol. 2004;18(5):755-71.
  36. Cardozo E, Pavone ME, Hirshfeld-Cytron JE. Metabolic syndrome and oocyte quality. Trends Endocrinol Metab. 2011;22(3):103-9.
  37. Cancello R, Clément K. Is obesity an inflammatory illness? role of low-grade inflammation and macrophage infiltration in human white adipose tissue. BJOG. 2006;113(10):1141-7.
  38. Catov JM, Bodnar LM, Ness RB, Barron SJ, Roberts JM. Inflammation and dyslipidemia related to risk of spontaneous preterm birth. Am J Epidemiol. 2007;166(11):1312-9.
  39. He Y, Lu Y, Zhu Q, Wang Y, Lindheim SR, Qi J, et al. Influence of metabolic syndrome on female fertility and in vitro fertilization outcomes in PCOS women. Am J Obstet Gynecol. 2019;221(2): 138.e1-138.e12.
  40. Kachuei M, Jafari F, Kachuei A, Keshteli AH. Prevalence of autoimmune thyroiditis in patients with polycystic ovary syndrome. Arch Gynecol Obstet. 2012;285(3):853-6.
  41. Morgante G, Musacchio MC, Orvieto R, Massaro MG, De Leo V. Alterations in thyroid function among the different polycystic ovary syndrome phenotypes. Gynecol Endocrinol. 2013;29(11):967-9.
  42. Abdelsalam KEA, Ibrahim W. Relationship between TSH, T4, T3 and prolactin in overweight and lean sudanese PCOS patients. Int J Biomed Res. 2015;6(2):108-12.