DOI: https://doi.org/10.18370/2309-4117.2018.39.27-32

New possibilities of correction of metabolic disorders in women with PCOS

Л. В. Калугіна, Т. Ф Татарчук

Abstract


The aim of the study, the results of which are described in the article, was to study the possibilities of using a polycomponent drug containing D-kiro-inositol in the polycystic ovarian syndrome.

A comparative prospective study was conducted with the participation of 60 patients of reproductive age suffering from polycystic ovarian syndrome (phenotype A). The criteria for participation in the study were: a confirmed diagnosis of polycystic ovarian syndrome with ovarian enlargement and oligo/anovulation and a raised level of ovarian androgens; body mass index from 26 to 30 kg/m2. Patients with severe endocrine and somatic pathology were excluded from the study.

Women aged 18–35 years were on out-patient treatment in the Endocrine gynecology department of the SI “Institute of Pediatrics, Obstetrics and Gynecology of the NAMS of Ukraine”. By random sampling, the patients were divided into 2 groups of 30 people each. For 6 months, the patients of the main group received twice a day 1 Protalis complex drug containing D-kiroinositol, which is recommended for normalization of ovarian function and stimulation of spontaneous ovulation in polycystic ovarian syndrome, improvement of oocyte state, and also to promote reduction of oxidative and inflammatory stress, reducing the level of total testosterone and increasing fertility. Patients of the control group received recommendations on dietary nutrition and exercise.

Analysis of the results of therapy showed a recovery in the main group of regular ovulatory menstrual cycles in 53.33% of cases, a decrease in the frequency of androgen-dependent dermatopathy by 50%, normalization of body weight and a reliable decrease in androgen levels. In addition, a positive effect on metabolic parameters such as HOMA index and homocysteine level was noted.

The results of the study allow us to recommend the use of Protalis course therapy (D-kiro-inositol and synergists) to restore ovulatory menstrual cycles, and as a means of preventing metabolic disorders in women with polycystic ovarian syndrome and overweight.


Keywords


PCOS; insulin resistance; hyperandrogenia; D-kiro-inositol; DCI

References


Gromova, O.A., Torshin, I.Y., Grishina, T.R. “Systematic analysis of the molecular-physiological effects of myoinositol: data from molecular biology, experimental and clinical medicine.” Effective pharmacotherapy 28 (2013): 4–12.

Dubrovina, S.O. “Polycystic ovary syndrome: examination and treatment strategy.” Problems of reproduction 6 (2014): 10–6.

National consensus on management patients with hyperandrogenism (2016). Reproductive endocrinology 4.30 (2016): 19–31.

Tatarchuk, T.F., Voronenko, N.Y., Kosei, N.V., et al. “Pathogenetic aspects of reproductive health disorders in women with metabolic syndrome.” Woman’s Health 6.62 (2011): 155–60.

Tatarchuk, T.F., Ganzhiy, I.Y., Tutchenko, T.M., et al. “Peculiarities of the clinical course of polycystic ovary syndrome in women with different constitutional types.” Collection of scientific works of the Association of Obstetricians-Gynecologists of Ukraine (2012): 401–4.

Tatarchuk, T.F., Ganzhiy, I.Y., Pedachenko, N.Y., Kapshuk, I.M. “Modern possibilities of non-hormonal treatment of polycystic ovary syndrome in obese women.” Reproductive endocrinology 5.13 (2013): 14–21.

De Leo, V., La Marca, A., Cappelli, V. “Valutazione del trattamento con D-chiro-inositolo sui livelli di stress ossidativo nelle pazienti con PCOS.” Minerva Ginecologica 64.6 (2012): 531–8.

Baillargeon, J.P., Carpentier, A. “Role of insulin in the hyperandrogenemia of lean women with polycystic ovary syndrome and normal insulin sensitivity.” Fertil Steril 88.4 (2007): 886–93.

Bevilacqua, A., Carlomagno, G., Gerli, S., et al. “Results from the International Consensus Conference on myoinositol and D-chiro-inositol in Obstetrics and Gynecology – assisted reproduction technology.” Gynecological Endocrinology 31.6 (2015): 441–6.

Bevilacqua, A., Bizzarri, M. “Physiological role and clinical utility of inositols in polycystic ovary syndrome.” Best Pract Res Clin Obstet Gynaecol 37 (2016): 129–39. DOI: 10.1016/j.bpobgyn.2016.03.007

Cheang, K.I., Baillargeon, J.P., Essah, P.A., et al. “Insulin-stimulated release of D-chiro-inositol-containing inositolphosphoglycan mediator correlates with insulin sensitivity in women with polycystic ovary syndrome.” Metabolism 57/10 (2008).

Genazzani, A.D., Prati, A., Santagni, S., et al. “Differential insulin response to myo-inositol administration in obese polycystic ovary syndrome patients.” Gynecol Endocrinol 28.12 (2012): 969–73.

Heimark, D., McAllister, J., Larner, J. “Decreased myo-inositol to chiro-inositol (M/C) ratios and increased M/C epimerase activity in PCOS theca cells demonstrate increased insulin sensitivity compared to controls.” Endocr J 61.2 (2014): 111–7.

Cheang, K.I., Baillargeon, J.P., Essah, P.A., et al. “Insulin-Stimulated Release of D-Chiro-Inositol-Containing Inositolphosphoglycan Mediator Correlates with Insulin Sensitivity in Women with Polycystic Ovary Syndrome.” Metabolism 57.10 (2008): 1390–7.

Cogram, P.. Tesh, S., Tesh, J., et al. “D-chiro-inositol is more effective than myo-inositol in preventing folate-resistant mouse neural tube defects.” Hum Reprod 17.9 (2002): 2451–8.

Laganà, A.S., Barbaro, L., Pizzo, A. “Evaluation of ovarian function and metabolic factors in women affected by polycystic ovary syndrome after treatment with D-Chiro-Inositol.” Arch Gynecol Obstet 291.5 (2015): 1181–6. DOI: 10.1007/s00404-014-3552-6

Nestler, J.E., Jakubowicz, D.J., Reamer, P., et al. “Ovulatory and metabolic effects of D-chiro-inositol in the polycystic ovary syndrome.” N Engl J Med 340.17 (1999): 1314–20.

Nestler, J.E., Jakubowicz, D.J., Iuorno, M.J. “Role of inositolphosphoglycan mediators of insulin action in the polycystic ovary syndrome.” J Pediatr Endocrinol Metab 13.5 (2000): 1295–8.

Nestler, J.E., Unfer, V. “Reflections on inositol(s) for PCOS therapy: steps toward success.” Gynecol Endocrinol 31.7 (2015): 501–5.

Nordio, M., Proietti, E. “The combined therapy with myo-inositol and D-chiro-inositol reduces the risk of metabolic disease in PCOS overweight patients compared to myo-inositol supplementation alone.” Eur Rev Med Pharmacol Sci 16.5 (2012): 575–81.

Piomboni, P., Focarelli, R., Capaldo, A., et al. “Protein modification as oxidative stress marker in follicular fluid from women with polycystic ovary syndrome: the effect of inositol and metformin.” J Assist Reprod Genet 31.10 (2014): 1269–76. DOI: 10.1007/s10815-014-0307-z

Rosalbino, I., Raffone, E. “Does ovary need D-chiro-inositol?” Journal of Ovarian Research 5.1 (2012): 14. DOI: 10.1186/1757-2215-5-14

Chiu, T.T.Y., Rogers, M.S., Law, E.L.K., et al. “Follicular fluid and serum concentrations of myo-inositol in patients undergoing IVF: relationship with oocyte quality.” Human Reproduction 17.6 (2002): 1591–6.

Unfer, V., Carlomagno, G., Papaleo, E., et al. “Hyperinsulinemia Alters Myoinositol to d-chiroinositol Ratio in the Follicular Fluid of Patients With PCOS.” Reprod Sci 21.7 (2014): 854–8.

Unfer, V., Carlomagno, G., Rizzo, P., et al. “Myo-inositol rather than D-chiro-inositol is able to improve oocyte quality in intracytoplasmic sperm injection cycles. A prospective, controlled, randomized trial.” Eur Rev Med Pharmacol Sci 15.4 (2011): 452–7.

Whiting, L., Danaher, R.N., Ruggiero, K., et al. “D-chiro-inositolattenuates epinephrine-stimulated hepatic glucose output in the isolated perfused liver independently of insulin.” Horm Metab Res 45.5 (2013): 394–7.


GOST Style Citations


1. Громова, О.А. Систематический анализ молекулярно-физиологических эффектов миоинозитола: данные молекулярной биологии, экспериментальной и клинической медицины / О.А. Громова, И.Ю. Торшин, Т.Р. Гришина // Эффективная фармакотерапия. – 2013. – №28. – С. 4–12.

2. Дубровина, С.О. Синдром поликистозных яичников: стратегия обследования и лечения / С.О. Дубровина // Проблемы репродукции. – 2014. – №6. – С. 10–16.

3. Національний консенсус щодо ведення пацієнток із гіперандрогенією (2016). Репродуктивна ендокринологія. – 2016. – №4(30). – С. 19–31.

4. Татарчук, Т.Ф. Патогенетичні аспекти порушень репродуктивного здоров’я при метаболічному синдромі у жінок / Т.Ф. Татарчук, Н.Ю. Вороненко, Н.В. Косей та ін. // Здоров’я жінки. – 2011. – №6(62). – С. 155–160.

5. Татарчук, Т.Ф. Особливості клінічного перебігу синдрому полікістозних яєчників у жінок з різними конституційними типами / Т.Ф. Татарчук, І.Ю. Ганжій, Т.М. Тутченко та ін. // Збірник наукових праць Асоціації акушерів-гінекологів України. – 2012. – С. 401–404.

6. Татарчук, Т.Ф. Сучасні можливості негормонального лікування синдрому полікістозних яєчників у жінок з ожирінням / Т.Ф. Татарчук, І.Ю. Ганжій, Н.Ю. Педаченко, І.М. Капшук // Репродуктивна ендокринологія. – 2013. – №5(13). – С. 14–21.

7. De Leo, V., La Marca, A., Cappelli, V. “Valutazione del trattamento con D-chiro-inositolo sui livelli di stress ossidativo nelle pazienti con PCOS.” Minerva Ginecologica 64.6 (2012): 531–8.

8. Baillargeon, J.P., Carpentier, A. “Role of insulin in the hyperandrogenemia of lean women with polycystic ovary syndrome and normal insulin sensitivity.” Fertil Steril 88.4 (2007): 886–93.

9. Bevilacqua, A., Carlomagno, G., Gerli, S., et al. “Results from the International Consensus Conference on myoinositol and D-chiro-inositol in Obstetrics and Gynecology – assisted reproduction technology.” Gynecological Endocrinology 31.6 (2015): 441–6.

10. Bevilacqua, A., Bizzarri, M. “Physiological role and clinical utility of inositols in polycystic ovary syndrome.” Best Pract Res Clin Obstet Gynaecol 37 (2016): 129–39. DOI: 10.1016/j.bpobgyn.2016.03.007

11. Cheang, K.I., Baillargeon, J.P., Essah, P.A., et al. “Insulin-stimulated release of D-chiro-inositol-containing inositolphosphoglycan mediator correlates with insulin sensitivity in women with polycystic ovary syndrome.” Metabolism 57/10 (2008).

12. Genazzani, A.D., Prati, A., Santagni, S., et al. “Differential insulin response to myo-inositol administration in obese polycystic ovary syndrome patients.” Gynecol Endocrinol 28.12 (2012): 969–73.

13. Heimark, D., McAllister, J., Larner, J. “Decreased myo-inositol to chiro-inositol (M/C) ratios and increased M/C epimerase activity in PCOS theca cells demonstrate increased insulin sensitivity compared to controls.” Endocr J 61.2 (2014): 111–7.

14. Cheang, K.I., Baillargeon, J.P., Essah, P.A., et al. “Insulin-Stimulated Release of D-Chiro-Inositol-Containing Inositolphosphoglycan Mediator Correlates with Insulin Sensitivity in Women with Polycystic Ovary Syndrome.” Metabolism 57.10 (2008): 1390–7.

15. Cogram, P.. Tesh, S., Tesh, J., et al. “D-chiro-inositol is more effective than myo-inositol in preventing folate-resistant mouse neural tube defects.” Hum Reprod 17.9 (2002): 2451–8.

16. Laganà, A.S., Barbaro, L., Pizzo, A. “Evaluation of ovarian function and metabolic factors in women affected by polycystic ovary syndrome after treatment with D-Chiro-Inositol.” Arch Gynecol Obstet 291.5 (2015): 1181–6. DOI: 10.1007/s00404-014-3552-6

17. Nestler, J.E., Jakubowicz, D.J., Reamer, P., et al. “Ovulatory and metabolic effects of D-chiro-inositol in the polycystic ovary syndrome.” N Engl J Med 340.17 (1999): 1314–20.

18. Nestler, J.E., Jakubowicz, D.J., Iuorno, M.J. “Role of inositolphosphoglycan mediators of insulin action in the polycystic ovary syndrome.” J Pediatr Endocrinol Metab 13.5 (2000): 1295–8.

19. Nestler, J.E., Unfer, V. “Reflections on inositol(s) for PCOS therapy: steps toward success.” Gynecol Endocrinol 31.7 (2015): 501–5.

20. Nordio, M., Proietti, E. “The combined therapy with myo-inositol and D-chiro-inositol reduces the risk of metabolic disease in PCOS overweight patients compared to myo-inositol supplementation alone.” Eur Rev Med Pharmacol Sci 16.5 (2012): 575–81.

21. Piomboni, P., Focarelli, R., Capaldo, A., et al. “Protein modification as oxidative stress marker in follicular fluid from women with polycystic ovary syndrome: the effect of inositol and metformin.” J Assist Reprod Genet 31.10 (2014): 1269–76. DOI: 10.1007/s10815-014-0307-z

22. Rosalbino, I., Raffone, E. “Does ovary need D-chiro-inositol?” Journal of Ovarian Research 5.1 (2012): 14. DOI: 10.1186/1757-2215-5-14

23. Chiu, T.T.Y., Rogers, M.S., Law, E.L.K., et al. “Follicular fluid and serum concentrations of myo-inositol in patients undergoing IVF: relationship with oocyte quality.” Human Reproduction 17.6 (2002): 1591–6.

24. Unfer, V., Carlomagno, G., Papaleo, E., et al. “Hyperinsulinemia Alters Myoinositol to d-chiroinositol Ratio in the Follicular Fluid of Patients With PCOS.” Reprod Sci 21.7 (2014): 854–8.

25. Unfer, V., Carlomagno, G., Rizzo, P., et al. “Myo-inositol rather than D-chiro-inositol is able to improve oocyte quality in intracytoplasmic sperm injection cycles. A prospective, controlled, randomized trial.” Eur Rev Med Pharmacol Sci 15.4 (2011): 452–7.

26. Whiting, L., Danaher, R.N., Ruggiero, K., et al. “D-chiro-inositolattenuates epinephrine-stimulated hepatic glucose output in the isolated perfused liver independently of insulin.” Horm Metab Res 45.5 (2013): 394–7.





Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.

ISSN 2411-1295 (Online), ISSN 2309-4117 (Print)