Reflections on inositol(s) for PCOS therapy: steps toward success

In polycystic ovary syndrome (PCOS) pathogenesis, both the insulin resistance and the related compensatory hyperinsulinemia are involved. Despite their similarities, Myo-inositol (MI) and d-chiro-inositol (DCI) play different roles in PCOS etiology and therapy. Indeed, in tissue such as the liver bo...

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Published inGynecological endocrinology Vol. 31; no. 7; pp. 501 - 505
Main Authors Nestler, John E., Unfer, Vittorio
Format Journal Article
LanguageEnglish
Published England Informa Healthcare 03.07.2015
Subjects
d-chiro-inositol
DCI paradox
Female
Humans
infertility
Inositol - metabolism
Inositol - therapeutic use
insulin resistance
myo-inositol
ovary
polycystic ovary syndrome
Polycystic Ovary Syndrome - drug therapy
Polycystic Ovary Syndrome - metabolism
DCI paradox
ovary
infertility
insulin resistance
d-chiro-inositol
myo-inositol
polycystic ovary syndrome
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Summary:In polycystic ovary syndrome (PCOS) pathogenesis, both the insulin resistance and the related compensatory hyperinsulinemia are involved. Despite their similarities, Myo-inositol (MI) and d-chiro-inositol (DCI) play different roles in PCOS etiology and therapy. Indeed, in tissue such as the liver both molecules are involved in the insulin signaling, i.e. MI promotes glucose uptake and DCI glycogen synthesis. In reproductive tissue such as the ovary, MI regulates glucose uptake and follicle stimulating hormone (FSH) signaling, whereas DCI is devoted to the insulin-mediated androgen production. The new hypothesis on "DCI paradox" in the ovary has provided the key for a better understanding. Unlike other tissues, ovary is not insulin resistant, indeed because the epimerase enzyme, which converts MI to DCI, is insulin dependent, the "DCI paradox" hypothesis suggests that in the ovary of PCOS women, an increased epimerase activity leads to a DCI overproduction and MI depletion. This imbalance could be the cause of the poor oocyte quality and the impairment in the FSH signaling. Owing to this situation, the focal point is the administration of both MI and DCI in a proper ratio for treating PCOS. This topic, with several other "hot" issues, was the driving thread in the discussion between the two scientists.
Bibliography:ObjectType-Article-2
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ISSN:0951-3590
1473-0766
DOI:10.3109/09513590.2015.1054802