Metabolic syndrome enhances endoplasmic reticulum, oxidative stress and leukocyte–endothelium interactions in PCOS

Objective Polycystic ovary syndrome (PCOS) is associated with insulin resistance, which can lead to metabolic syndrome (MetS). Oxidative stress and leukocyte–endothelium interactions are related to PCOS. Our aim was to evaluate whether the presence of MetS in PCOS patients can influence endoplasmic reticulum (ER) and oxidative stress and leukocyte–endothelium interactions. Material and Methods This was a prospective controlled study conducted in an academic medical center. The study population consisted of 148 PCOS women (116 without/32 with MetS) and 112 control subjects (87 without / 25 with MetS). Metabolic parameters, reactive oxygen species (ROS) production, ER stress markers (GRP78, sXBP1, ATF6), leukocyte–endothelium interactions, adhesion molecules (VCAM-1, ICAM-1, E-Selectin), TNF-α and IL-6 were determined. Results Total ROS, inflammatory parameters and adhesion molecules were enhanced in the presence of MetS (p < 0.05), and the PCOS + MetS group showed higher levels of IL-6 and ICAM-1 than controls (p < 0.05). Increased adhesion and leukocyte rolling flux were observed in PCOS and PCOS + MetS groups vs their respective controls (p < 0.05). GRP78 protein expression was higher in the PCOS groups (p < 0.05 vs controls) and sXBP1 was associated with the presence of MetS (p < 0.05 vs controls without MetS). Furthermore, PCOS + MetS patients exhibited higher GRP78 and ATF6 levels than controls and PCOS patients without MetS (p < 0.05). In PCOS women, HOMA-IR was positively correlated with ICAM-1 (r = 0.501; p < 0.01), ROS (r = 0.604; p < 0.01), rolling flux (r = 0.455;p < 0.05) and GRP78 (r = 0.574; p < 0.001). Conclusion Our findings support the hypothesis of an association between altered metabolic status, increased ROS production, ER stress and leukocyte–endothelium interactions in PCOS, all of which are related to vascular complications.