P–623 Comparative preliminary study of LPS, hs CRP and gut bacterial flora of women to support dysbiosis of gut microbiota (DOGMA) as cause of PCOS
Authors: Lele P , Maiti G , Bajpai S 
Published: August 2021

Abstract

Study question
Study the levels of endotoxin lipopolysaccharide , hs-CRP and gut bacterial flora in Polycystic Ovarian Syndrome to support hypothesis of Dysbiosis of Gut Microbiota (DOGMA) as a cause of PCOS

Summary answer
Increased serum levels of LPS and hs-CRP along with decreased levels of Bifidobacterium and Lactobacilli by quantitative PCR(qPCR) in women with PCOS.

What is known already
A hypothesis called DOGMA was proposed in the “pathogenesis of PCOS” as follows: (1) Obesity, high Carbohydrate , high fat and low fiber diet creat an intestinal flora imbalance, thus break in the intestinal epithelium, thus raising the permeation of the intestinal mucosa; 2) That cause lipopolysaccharide (LPS) to leak into the circulation and the subsequent activation of the immune system may affect the functioning of the insulin receptor resulting in insulin resistance; 3) IR/Hyperinsulinemia can facilitate testosterone synthesis, thus interfering with follicular development.

Study design, size, duration
A descriptive pilot observational study was carried from 1st February 2018 to 31 Dec 2019. The objectives of was to establish and compare basal serum levels of LPS and hs-CRP in 40 women with PCOS ( as per modified Rotterdams Criteria ) and control group of 40 fertile women and also to determine levels of Bifidobacterium and Lactobacilli by quantitative PCR (qPCR) in these two groups.

Participants/materials, setting, methods
A total of 80 consenting women underwent sonographic , laparoscopic and hormonal evaluation and were grouped into 40 with PCOS as per Rotterdams criteria and 40 healthy control group. The blood samples were taken for estimating hsCRP and LPS. The stool samples were also collected in transport medium and refrigerated . The qPCR was run on stool sample to determine levels of Bifidobacterium and Lactobacillus. The results obtained are compared and presented.

Main results and the role of chance
The mean age, weight, height and BMI in PCOS ( Grp 1 ) was comparable with controls group( Grp 2). Annovulation (33/40) was more prevalent in PCOS group along with bulky ovaries with raised ovarian volume ( Rt 12.86±2.25 mm, / Lt 12.77±1.43 mm.) . The mean serum FSH (4.51±0.95 / 4.80±0.81) were comparable between groups.The serum LH (10.56±1.28/ 5.18±1.19), AMH (7.72±1.62/ than group 2/ 4.77±1.10) and serum testosterone levels (39.39±7.47/20.46±3.09), were found to be increased in Grp 1 The hs-CRP ( 2.68±0.61/ 1.40±0.52 )and LPS levels 14.95±1.97/ 11.35±1.63) were significantly increased in Grp 1 ,while abundance of Bifidobacterium, and lactobacillus ( 4.39±0.80 & 4.33±1.11) in the control group as compared with the PCOS group (2.10±0.51 and 2.20±0.65) was also noted. The raised hs-CRP ( a non specific marker of inflammation ), raised endotoxin Lipopolysaccharide ( secreted by Gram negative bacteria which leak and react with receptors may cause inflammation in PCOS), and quantitative decreased bacterial load of Bifidobacterium, and lactobacillus as estimated by quantitative PCR in infertile women with PCOS and that of fertile women support dysbiosis as cause of PCOS.

Limitations, reasons for caution
The study was carried out on population with traditional high prevelance of diorrheal and other infective diseases which might confound the results given ibid. Addition of treatment arm with probiotics y a large multicentric study will give further insight to the dysbiosis and PCOS
Wider implications of the findings: The study elaborates the effect of dysbiosis as cause of PCOS and gives direction for alternative strategies like probiotics in management of PCOS.

Trial registration number
Not applicable