Substances such
as inositol and N-acetylcysteine (NAC) have been recently shown to be effective
in treatment of PCOS patients.
The aim of this prospective trial is to evaluate the
efficacy of NAC + Inositol + folic acid on ovulation rate and menstrual
regularity in PCOS patients
with and without insulin resistance.
. The association NAC + Inositol + folic, regardless of
insulin-resistance state, seems to improve ovarian function in PCOS patients.
A)
Among the 91 PCOS patients treated
with NAC + Inositol + folic, insulin resistance was present in 44 subjects (A)
&
& and absent in 47 (B). The primary
endpoint was the ovulation rate/year, determined by menstrual diary, serum
progesterone performed between 21° and 24° days, ultrasound findings of growth
follicular or luteal cysts, and luteal ratio.
HOMA-index assessment after 6 and 12 months of
treatment was evaluated as secondary endpoint.
Results.
In both groups there was a significant increase in ovulation rate and no
significant differences were found in the primary outcome between two groups.
In group A, a significant reduction of HOMA-index was observed.
Conclusions.
Therefore, inositol and NAC may have additional
noninsulin-related mechanisms of action that allow achieving benefits also in
those patients with negative HOMA-index.
[PubMed]
PMCID:
PMC4021745
Polycystic ovary syndrome (PCOS) affects 5%-10% of women in
reproductive age, and it is the most common cause of infertility due to ovarian
dysfunction and menstrual irregularity.
Several studies have reported that
Cause of PCO:-insulin
resistance is the most common etilogy of genesis in PCOS women, regardless of the
body mass index, of which ovarian hyperandrogenism is an effect of IR. . Therefore
as things stands Intra ovarian biosynthesis of androgens is exaggerated due to primary
hyperinsulinaemia .Insulin resistance àmore
IGF1à More thecal cell
hyperplasiaà
More ovarian hyperandrogenismà abnormal
oocyte development .
What are the ill effect of insulin resiatnce??:-
What is the advantages / gain of by ingestion of insulin-sensitizing
compounds?? Ans:-Such agents have been
proposed as putative treatments to solve the a) hyperinsulinemia-induced dysfunction of ovarian response to
endogenous gonadotropins. Insulin sensitizers therefore cause a) rescue the ovarian
response to endogenous gonadotropins by reducing hyperandrogenemia and b) re-establishes
menstrual cyclicity and c) ovulation d) increasing the chance of a spontaneous
pregnancy. Among the insulin-sensitizing compounds, there is myo-inositol
(MYO). Many studies have demonstrated that MYO is capable of e) restoring spontaneous ovarian activity, and f) consequently fertility, in most patients
with PCOS. Not only improvement of
ovarian function but myoinositol also g) improves metabolic and hormonal parameters in women
with PCOS.
Indications of Myoinositol?? :-In the treatment
of menstrual irregularities, chronic anovulation, and female infertility in
patients with polycystic ovary syndrome (PCOS) Myoinositol has been compared
with metformin, in monotherapy or in association with recombinant follicle
stimulating hormone (r-FSH),
How does exactly MI works?? Myoinositol
acts as a second messenger in
insulin signaling pathway Literature data suggest inositol deficiency in
insulin-resistant women with the polycystic ovary syndrome. Supplementation of myo-inositol decreases insulin
resistance as it works as an insulin sensitizing agent.The positive role of
myo-inositol in the treatment of polycystic ovary syndrome has been of
increased evidence recently .
The present review presents the
effects of myo-inositol on the ovarian, hormonal and metabolic parameters in
women with PCOS.
PMID:
24505965
[PubMed - indexed for MEDLINE]
The aim of this study was to compare the
effectiveness of myo-inositol (MYO) and metformin, in monotherapy or in
association with recombinant follicle stimulating hormone (r-FSH), in the
treatment of menstrual irregularities, chronic anovulation, and female
infertility in patients with polycystic ovary syndrome (PCOS).
Materials
and methodsOne hundred twenty patients were
randomly treated with metformin . 1500 mg/day orally (n = 60), or 4 g
MYO plus 400 μg folic acid daily (n = 60), continuously. If no pregnancy
occurred, r-FSH (37.5 units/day) was added to the treatment for a maximum of
three attempts.
Results.Fifty percent of the patients who assumed metformin restored
spontaneous ovulation, 18.3% of these obtained pregnancy. The remaining 42
patients were treated with metformin plus r-FSH. Pregnancy occurred in a total
of 11 women (26.1%). The total pregnancy rate was 36.6%.
Sixty-five
percent of the patients treated with MYO plus folic acid restored spontaneous
ovulation activity, 30% of these obtained pregnancy. The remaining 38 patients
were treated with MYO, folic acid plus r-FSH. Pregnancy occurred in a total of
11 women (28.9%). The total pregnancy rate was 48.4%.
Conclusions.Both metformin and
MYO, can be considered as first line treatment for restoring normal menstrual
cycles in most patients with PCOS, even if MYO treatment seems to be more
effective than metformin
.
.
Like to have a new
relationship with an old family::Inositol
“Inositol” is a term used to refer to a group
of naturally occurring carbohydrate compounds that exist in nine possible
chemical orientations called stereoisomers. The most common being myo-inositol,
which is often sold as a dietary supplement labeled simply as inositol.
Inositol, particularly myo-inositol and
another less common stereoisomer called D-chiro-inositol, plays a critical, but
underappreciated, role in insulin signaling. Conditions such as hyperglycemia
and diabetes are associated with
disrupted inositol signaling, leading many researchers to suggest that this may
be a key pathologic feature of insulin resistance (Manning 2010, Larner 2010).
Research has shown that the three inositol
family members help to ameliorate conditions in which insulin resistance plays
an important role, especially PCOS.
D-chiro-inositol (DCI)
D-chiro inositol is perhaps the most
promising inositol compound for PCOS. Our bodies produce D-chiro-inositol only
after extensive inositol metabolism. DCI interacts with select sugars in the
body to form conjugates known as inositiol phosphoglycans, which play a key
role in mediating insulin actions. Low levels of DCI, and inositol
phosphoglycans have been observed in individuals with impaired insulin
sensitivity and PCOS (Susuki 1994, Jung 2005, Cheang 2008, Baillargeon 2010).
In one study, 44 overweight women with PCOS
were given a daily 1,200 mg dose of D-chiro-inositol for six to eight weeks.
During the course of the study, those who took DCI displayed significant
improvements in insulin sensitivity, blood pressure, and triglyceride levels,
as well as a marked decrease in serum testosterone levels. Moreover, 19 of 22
subjects receiving DCI ovulated during the study period, compared to only 6 of
22 in the placebo group. The investigators concluding statement highlights the
efficacy of DCI in PCOS: “D-Chiro-inositol
increases the action of insulin in patients with the polycystic ovary syndrome,
thereby improving ovulatory function and decreasing serum androgen
concentrations, blood pressure, and plasma triglyceride concentrations.” (Nestler 1999).
Similarly promising results were drawn from
another study involving lean women with PCOS. Here, participants received 600
mg daily of DCI or a placebo for six to eight weeks. The DCI-treated
participants improved significantly, displaying a large decrease of 73% in
testosterone levels versus no change in the placebo group. Women taking DCI
also experienced reductions in insulin and triglyceride levels and blood
pressure, whereas none of these changes were evident in the placebo group (Luorno
2002).
Researchers looking at the effects of
metformin in PCOS women concluded that the drug’s benefits could be related to
its ability to improve the function of DCI phosphoglycans in the body. Thus, it
appears that DCI may be highly effective when used in combination with
metformin for PCOS (Baillargeon 2004).
Myo-inositol
Myo-inositol is a stereoisomer of DCI. Like
DCI, it is a key factor in insulin signaling, and serves also as a precursor to
DCI in endogenous inositol metabolism. It should then come as no surprise that
studies using myo-inositol in women with PCOS produced results as promising as
those obtained with DCI.
Double-blind, placebo-controlled
investigations were carried out in 42 women with PCOS, subjects receiving
myo-inositol fared much better when compared to the placebo group, displaying
decreases in testosterone, triglycerides, and blood pressure; a significant
improvement in insulin sensitivity; and a greatly increased frequency of
ovulation (Costantino 2009).
In another study, 20 women with PCOS were
given either 2 grams of myo-inositol plus 200 mcg folic acid, or a placebo of
200 mcg folic acid daily. After 12 weeks, the women taking myo-inositol showed
improved insulin sensitivity and androgen levels. Strikingly, all the subjects
receiving myo-inositol returned to normal menstrual cycles (Genazzani 2008).
In an Italian study of 92 PCOS patients,
almost 50% showed significant weight loss and reduced leptin levels after
receiving myo-inositol plus folic acid (4 g myo-inositol plus 400 mcg folic
acid). After a 14-wk treatment, the myo-inositol plus folic acid group lost
weight, whereas the placebo group gained weight (Gerli 2007).
A six-month study involving 50 PCOS women
yielded similar results and gave researchers the time to evaluate the effects
of myo-inositol on hirsutism. Along with decreases in testosterone and insulin
levels, the participants who supplemented with myo-inositol experienced a
reduction in hirsutism, and improvements in skin appearance, leading researches
to conclude, “Myo-inositol
administration is a simple and safe treatment that ameliorates the metabolic
profile of patients with PCOS, reducing hirsutism and acne.” (Zacchè 2009).
In other well-designed clinical trials for
follicular maturity and ovulation induction, myo-inositol has produced
promising results, cementing its position as a novel therapy for PCOS
management (Papaleo 2007, Papaleo 2009).
No comments:
Post a Comment