The Kallistatin-Zearalenone Axis: A Novel Perspective On Metabolic And Reproductive Health In PCOS-Related Infertility

Abstract

This study investigated the impact of infertility types on metabolic indices in Polycystic Ovary Syndrome (PCOS) patients, focusing on the roles of kallistatin and zearalenone (ZEN). A comparative analysis was conducted among women with Type 1 infertility, Type 2 infertility, an unmarried PCOS group, and healthy controls.

A cross-sectional study recruiting 138 women from the Obstetrics and Gynecology Hospital in Karbala and Baghdad Teaching Hospital (Medical City).  Included 98 patients diagnosed with Polycystic Ovary Syndrome (PCOS) and 40 apparently healthy women who served as a control group.  

PCOS was diagnosis based on the 2012 Rotterdam consensus criteria: presence of at least two of three features: clinical/biochemical hyperandrogenism, oligo- or amenorrhea, and/or polycystic ovarian morphology (PCOM) via ultrasonography.    Elisa system was used for the detection of Kallistatin level.  Zearalenone levels were measured qualitatively by Thin layer chromatography and quantitatively by high-performance liquid chromatography analyses demonstrated significant variations in kallistatin and ZEN levels. Kallistatin, an anti-inflammatory serine protease inhibitor, was significantly lower in all PCOS groups compared to healthy controls, with the lowest concentration observed in the unmarried PCOS group. Among infertile women, Type 2 patients had slightly lower kallistatin levels than Type 1 patients. Conversely, ZEN, a mycoestrogen, was significantly elevated in the unmarried PCOS group, while Type 1 and Type 2 infertility groups had similar ZEN levels, and the control group had the lowest.

The elevated ZEN levels, especially in the unmarried group, raise concerns about the contribution of environmental endocrine disruptors to PCOS pathophysiology. Future research should further explore kallistatin as a diagnostic/prognostic marker and investigate strategies to mitigate dietary ZEN exposure to improve reproductive outcomes in PCOS.