Coronavirus Disease 2019 (SARS-CoV-2) and polycystic ovarian disease: Is there a higher risk for these women?

https://doi.org/10.1016/j.jsbmb.2020.105770Get rights and content

Highlights

  • PCOS women could be more exposed to SARS-CoV-2 infection.

  • Hyperandrogenic PCOS women activity of Androgen Receptor is very high, and this would lead to a greater transcription of the TMPRSS2 gene.

  • Insulin resistance and uncontrolled glycaemia were reported as significant predictors of severity and deaths in patients infected with viruses.

  • Obesity of PCOS women could contribute to both diabetic and cardiovascular risk of COVID-19.

  • It could be hypothesized that VDD could take part to the link between obesity, PCOS and increased complications and mortality due to COVID-19.

  • PCOS women had a dysbiotic gut mirobiota that is a common feature underlying health problem associated with inflammation and other disorders.

Abstract

The new severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been associated with acute respiratory distress syndrome and infected patients have a relatively high risk of death.

Emerging risk factors for poor outcome in this disease include age, male gender, cardiovascular co-morbidities including hypertension, prior cardiovascular disease, diabetes and more recently obesity. To date there are no data relating to SARS-CoV-2 in PCOS women.

The present Clinical Opinion represents a summary of the epidemiological evidence and possible pathophysiological mechanisms regarding PCOS and COVID-19. PCOS women could be more susceptible to infections compared to non-PCOS women. Insulin resistance and the associated hyperinsulinaemia are drivers for enhanced steroidogenesis in women with PCOS. Weight-gain and obesity, through their worsening effects on insulin resistance, thereby drive enhanced steroidogenesis and hyperandrogenism. All these features represent key points to provide an explanation for the possible association between PCOS and SARS-CoV-2. Indeed, androgens may drive clinical results in COVID-19, through the expression of TMPRSS2, a cellular co-receptor necessary for SARS-CoV-2 infection and through androgen-mediated immune modulation.

In women with PCOS the endocrine-immune axis leads to immune dysfunction with a state of chronic inflammation, and hyperandrogenism and IR with compensatory hyperglycaemia could play a determining role in the pathophysiogenesis of the infection. However, it is possible that only specific PCOS phenotypes may be more susceptible.

In addition, vitamin D deficiency and gut dysbiosis are another important factor potentially involved in the increased risk of developing severe forms of COVID-19 in PCOS women.

Further scientific investigations are needed with the aim of understanding which women are most at risk of becoming infected or developing complications, what are the causal mechanisms on which it is possible to intervene with prophylactic and therapeutic measures and what the long-term consequences will be on the health of these patients.

Abbreviations

ACE2
angiotensin converting enzyme 2
AR
androgen receptor
AT
adipose tissue
IL
interleukin
IR
insulin resistance
IRS
insulin receptor
PCOS
polycystic ovary syndrome
RAS
renin–angiotensin system
SARS-CoV-2
severe acute respiratory syndrome coronavirus 2
T2DM
type 2 diabetes mellitus
VDD
vitamin D deficiency
VDR
vitamin D receptor

Keywords

Polycystic ovarian disease
Polycystic ovarian syndrome
SARS-CoV-2
Hyperandrogenism
Insulin resistance

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