Researchers Identify Distinct Subtypes of Polycystic Ovary Syndrome With Novel Genetic Associations
Findings could transform understanding of the syndrome’s cause and have far-reaching implications for diagnosis and treatment
Mount Sinai researchers have for the first time identified reproductive and metabolic subtypes of polycystic ovary syndrome (PCOS) that are associated with novel gene regions. The findings, which used clustering of clinical, metabolic, and hormonal data from women with the syndrome, promise to transform understanding of the cause of PCOS and, accordingly, will have far-reaching implications for its diagnosis and treatment. The results were published in PLOS Medicine on Tuesday, June 23.
PCOS is among the most common endocrine conditions in reproductive-age women, affecting up to 15 percent of this population worldwide. It is a leading cause of infertility and type 2 diabetes in young women. The cause of PCOS is unknown, but there is a strong inherited susceptibility to the disorder. It is currently diagnosed using different sets of clinical criteria based on expert opinion. There is considerable controversy about which criteria are the most appropriate.
“We’re starting to make headway on what causes PCOS. It’s very frustrating for patients because it’s poorly understood and patients often see several physicians before PCOS is diagnosed,” said senior author Andrea Dunaif, MD, Chief of the Hilda and J. Lester Gabrilove Division of Endocrinology, Diabetes and Bone Disease at the Mount Sinai Health System. “Through genetics, we’re beginning to understand the condition and may have specific targeted therapies in the not-too-distant future.”
Using clinical, biochemical, and genotype data from their previously published PCOS genome-wide association study (GWAS), Dr. Dunaif and her team identified the subtypes using cluster analysis, a way of aggregating similar data in an unbiased manner. Unsupervised cluster analysis, meaning there are no predetermined models of data, was performed in the GWAS cohort of 893 PCOS cases. The clusters were then replicated in an independent group of 263 PCOS cases.
The clustering revealed two distinct PCOS subtypes: a “reproductive” group characterized by higher luteinizing hormone (LH), a hormone that triggers ovulation and acts on the ovaries, and higher levels of sex hormone binding globulin (SHBG), a protein that regulates the ability of testosterone to enter its target tissues, with relatively low body mass index (BMI) and insulin levels; and a “metabolic” group characterized by higher BMI, glucose, and insulin levels with lower SHBG and LH levels.
This current paper builds upon a study that Dr. Dunaif and her team published in The Journal of Endocrinology and Metabolism in April 2019 where they found, using family-based genetic analysis, that rare genetic variants in a gene involved in male hormone production, DENND1A, play major roles in the development of PCOS. This genetic variation could serve as a marker for early PCOS detection.
In the study published today, the researchers developed a predictive model and classified the reproductive and metabolic subtypes in a family-based cohort of 73 women with PCOS, including their sisters. They found that the subtypes tended to cluster in families. They also found that carriers of the previously reported rare variants in DENND1A were more likely to have the reproductive subtype of PCOS. The results suggest that these subtypes are biologically relevant since they have distinct genetic architectures. The findings will substantially assist in gene discovery by allowing the selection of more homogeneous PCOS subtypes, which could increase the likelihood of identifying disease-associated genes.
“In contrast to classifying disorders based on expert opinion, this is a very powerful objective approach to categorizing syndromes like PCOS into distinct subtypes with different causes, treatment and clinical outcomes,” said Dr. Dunaif.
The study was supported by grants from the National Institutes of Health.
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Mount Sinai Health System is one of the largest academic medical systems in the New York metro area, with more than 43,000 employees working across eight hospitals, over 400 outpatient practices, nearly 300 labs, a school of nursing, and a leading school of medicine and graduate education. Mount Sinai advances health for all people, everywhere, by taking on the most complex health care challenges of our time — discovering and applying new scientific learning and knowledge; developing safer, more effective treatments; educating the next generation of medical leaders and innovators; and supporting local communities by delivering high-quality care to all who need it.
Through the integration of its hospitals, labs, and schools, Mount Sinai offers comprehensive health care solutions from birth through geriatrics, leveraging innovative approaches such as artificial intelligence and informatics while keeping patients’ medical and emotional needs at the center of all treatment. The Health System includes approximately 7,300 primary and specialty care physicians; 13 joint-venture outpatient surgery centers throughout the five boroughs of New York City, Westchester, Long Island, and Florida; and more than 30 affiliated community health centers. We are consistently ranked by U.S. News & World Report's Best Hospitals, receiving high "Honor Roll" status, and are highly ranked: No. 1 in Geriatrics and top 20 in Cardiology/Heart Surgery, Diabetes/Endocrinology, Gastroenterology/GI Surgery, Neurology/Neurosurgery, Orthopedics, Pulmonology/Lung Surgery, Rehabilitation, and Urology. New York Eye and Ear Infirmary of Mount Sinai is ranked No. 12 in Ophthalmology. U.S. News & World Report’s “Best Children’s Hospitals” ranks Mount Sinai Kravis Children's Hospital among the country’s best in several pediatric specialties. The Icahn School of Medicine at Mount Sinai is one of three medical schools that have earned distinction by multiple indicators: It is consistently ranked in the top 20 by U.S. News & World Report's "Best Medical Schools," aligned with a U.S. News & World Report "Honor Roll" Hospital, and top 20 in the nation for National Institutes of Health funding and top 5 in the nation for numerous basic and clinical research areas. Newsweek’s “The World’s Best Smart Hospitals” ranks The Mount Sinai Hospital as No. 1 in New York and in the top five globally, and Mount Sinai Morningside in the top 20 globally.