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Reduced Expression of Nuclear-Encoded Genes Involved in Mitochondrial Oxidative Metabolism in Skeletal Muscle of Insulin-Resistant Women With Polycystic Ovary Syndrome

¹ Department of Biochemistry, Genetics, and Pharmacology, Odense University Hospital and Human Microarray Centre, University of Southern Denmark, Odense, Denmark
² Department of Endocrinology, Odense University Hospital, Odense, Denmark
³ Medical Prognosis Institute Aps, Hørsholm, Denmark
⁴ Institute of Public Health, University of Southern Denmark, Odense, Denmark

Address correspondence and reprint requests to Vibe Skov, Department of Biochemistry, Genetics, and Pharmacology, Odense University Hospital, Sdr. Boulevard 29, 5000 Odense C, Denmark. E-mail: vibe.skov{at}ouh.regionsyddanmark.dk

Abbreviations: CaMK, Ca²⁺/calmodulin-dependent protein kinase; FDR, false discovery rate; FFA, free fatty acid; FSH, follicle-stimulating hormone; FWER, family-wise error rate; GAPDH, glyceraldehyde-3-phosphate dehydrogenase; GenMAPP, gene map annotator and pathway profiler; GSEA, gene set enrichment analysis; IRS-1, insulin receptor substrate 1; LH, luteinizing hormone; NRF-1, nuclear respiratory factor 1; OXPHOS, oxidative phosphorylation; PCOS, polycystic ovary syndrome; PGC-1 and -ß, peroxisome proliferator–activated receptor coactivator and ß; PI 3-kinase, phosphatidylinositol 3-kinase

Insulin resistance in skeletal muscle is a major risk factor for the development of type 2 diabetes in women with polycystic ovary syndrome (PCOS). In patients with type 2 diabetes, insulin resistance in skeletal muscle is associated with abnormalities in insulin signaling, fatty acid metabolism, and mitochondrial oxidative phosphorylation (OXPHOS). In PCOS patients, the molecular mechanisms of insulin resistance are, however, less well characterized. To identify biological pathways of importance for the pathogenesis of insulin resistance in PCOS, we compared gene expression in skeletal muscle of metabolically characterized PCOS patients (n = 16) and healthy control subjects (n = 13) using two different approaches for global pathway analysis: gene set enrichment analysis (GSEA 1.0) and gene map annotator and pathway profiler (GenMAPP 2.0). We demonstrate that impaired insulin-stimulated total, oxidative and nonoxidative glucose disposal in PCOS patients are associated with a consistent downregulation of OXPHOS gene expression using GSEA and GenMAPP analysis. Quantitative real-time PCR analysis validated these findings and showed that reduced levels of peroxisome proliferator–activated receptor coactivator (PGC-1) could play a role in the downregulation of OXPHOS genes in PCOS. In these women with PCOS, the decrease in OXPHOS gene expression in skeletal muscle cannot be ascribed to obesity and diabetes. This supports the hypothesis of an early association between insulin resistance and impaired mitochondrial oxidative metabolism, which is, in part, mediated by reduced PGC-1 levels. These abnormalities may contribute to the increased risk of type 2 diabetes observed in women with PCOS.

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