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World J Clin Cases. Apr 26, 2021; 9(12): 2711-2720
Published online Apr 26, 2021. doi: 10.12998/wjcc.v9.i12.2711
Polycystic ovary syndrome: Pathways and mechanisms for possible increased susceptibility to COVID-19
Ioannis Ilias, Spyridon Goulas, Lina Zabuliene
Ioannis Ilias, Department of Endocrinology, Elena Venizelou Hospital, Athens GR-11521, Greece
Spyridon Goulas, Department of Gastroenterology Unit, Elena Venizelou Hospital, Athens GR-11521, Greece
Lina Zabuliene, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius LT-03101, Lithuania
Author contributions: Ilias I was the guarantor and planned the review; Ilias I and Zabuliene L conceived and drew the figures; Ilias I, Goulas S and Zabuliene L reviewed the literature and wrote the initial manuscript, critically revised the article for important intellectual content.
Conflict-of-interest statement: The authors declare no conflict of interest.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ioannis Ilias, MD, PhD, Consultant Physician-Scientist, Department of Endocrinology, Elena Venizelou Hospital, 2 Elena Venizelou Sq, Athens GR-11521, Greece. iiliasmd@yahoo.com
Received: December 19, 2020
Peer-review started: December 19, 2020
First decision: January 10, 2021
Revised: January 16, 2021
Accepted: March 19, 2021
Article in press: March 19, 2021
Published online: April 26, 2021
Abstract

In 75% of women with polycystic ovary syndrome (PCOS), insulin action is impaired. In obesity, visceral adipose tissue becomes dysfunctional: Chronic inflammation is favored over storage, contributing to the development of metabolic complications. PCOS, metabolic syndrome (MetSy) and non-alcoholic fatty liver disease (NAFLD) apparently share common pathogenic factors; these include abdominal adiposity, excess body weight and insulin resistance. Alterations in the gut microbiome have been noted in women with PCOS compared to controls; these may lead to deterioration of the intestinal barrier, increased gut mucosal permeability and immune system activation, hyperinsulinemia and glucose intolerance, which hamper normal ovarian function and follicular development (all being hallmarks of PCOS). It has been proposed that PCOS may entail higher susceptibility to coronavirus disease 2019 (COVID-19) via its associated comorbidities (NAFLD, obesity, MetSy and alterations in the gut microbiome). Studies have found an association between acute respiratory distress syndrome (seen in severe cases of COVID-19) and the intestinal microbiome. Furthermore, apparently, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can gain entry to the gastrointestinal tract via locally-expressed angiotensin converting enzyme type 2 receptors. Excess body weight is associated with more severe COVID-19 and increased mortality. Although robust links between SARS-CoV-2 infection and PCOS/NAFLD/gut microbiome/metabolic consequences are yet to be confirmed, it seems that strategies for adapting the intestinal microbiome could help reduce the severity of COVID-19 in women with PCOS with or without NAFLD, MetSy or obesity.

Keywords: Adipose tissue, Obesity, Polycystic ovaries, SARS-CoV-2, COVID-19, Human

Core Tip: Polycystic ovary syndrome (PCOS) may entail higher susceptibility to coronavirus disease 2019 (COVID-19). Furthermore, PCOS may also increase susceptibility to COVID-19 via its associated comorbidities (non-alcoholic fatty liver disease, metabolic syndrome and alterations in the gut microbiome). In order to determine whether the intestinal microbiome in women with PCOS has an effect on their risk of COVID-19 or if severe acute respiratory syndrome coronavirus 2 is the factor that changes the composition of their microbiome, more research will be needed. Strategies for adapting the intestinal microbiome could help reduce the severity of COVID-19 in women with PCOS.