A Review of Special Considerations on Insulin Resistance InducedHyperandrogenemia in Women with Polycystic Ovary Syndrome: AProminent COVID-19 Risk Factor

Document Type : Original Article

Authors
Jamshid Roozbeh 1
Sahar Janfeshan 2
Afsoon Afshari 1
Aida Doostkam 2
Ramin Yaghobi 3
1 Shiraz Nephro-Urology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
2 Shiraz Nephro-Urology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
3 Shiraz Transplant Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
10.22088/IJMCM.BUMS.11.2.168
Abstract
Severe Acute Respiratory Syndrome Corona Virus 2 (SARS-CoV-2) infecting mechanism
depends on hosting angiotensin-converting enzyme 2 (ACE2) and transmembrane protease serine
2 (TMPRSS2) as essential components and androgens as regulators for inducing the expression
of these components. Therefore, hyperandrogenism-related disease such as polycystic ovary
syndrome (PCOS) in insulin resistant women in reproductive-age is a high-risk factor for SARSCoV-
2 infection. Here, we describe the signaling pathways that might increase the susceptibility
and severity of this new pandemic in PCOS women with insulin resistance (IR). Luteinizing
hormone and insulin increase the risk of SARS-CoV-2 infection in these patients via the induction
of steroidogenic enzymes expression through cAMP-response element binding protein and
Forkhead box protein O1 (FOXO1), respectively. TMPRSS2 expression is activated through
phosphorylation of FOXO1 in ovaries. In other words, SARS-CoV-2 infection is associated with
temporary IR by affecting ACE2 and disturbing β-pancreatic function. Therefore, PCOS, IR, and
SARS-CoV-2 infection are three corners of the triangle that have complicated relations, and their
association might increase the risk of SARS-CoV-2 infection and severity
Keywords
Androgens
COVID-19
SARS-CoV-2
PCOS
insulin resistance
TMPRSS2