REFUEL PCOS Study 1

Polycystic Ovary Syndrome (PCOS) affects 10% of all women, and it usually co-exists with high levels of male pattern hormones (also termed androgens). Women with PCOS are at increased risk of metabolic complications such as diabetes, non-alcoholic fatty liver disease, high blood pressure and heart disease. However, very little is understood about how androgen excess results in increased metabolic complications observed in women with PCOS. The main aims of the REFUEL PCOS study are to compare markers of energy metabolism in women with PCOS to those without PCOS. This will allow the investigators to better understand metabolic risk by examining the relationship between androgen excess and energy metabolism. Skeletal muscle is an important site of energy metabolism, and emerging theories are that androgen excess impairs skeletal muscle energy balance and increases the risk of complications. Based on these emerging theories, the investigators want to investigate the effects of androgens on muscle energy metabolism. The investigators will also examine whether certain blood and urine result patterns can help identify differences in muscles energy metabolism and which women are at the highest risk of metabolic complications. This research will give insight into the metabolic risk associated with PCOS and treat and, where possible, prevent the development of metabolic disease in affected women.

Sex

Female

Minimum age

18 Years

Maximum age

50 Years

Inclusion Criteria:

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The following inclusion criteria need to be met for the PCOS Study participants:

* Women with a confirmed diagnosis polycystic ovary syndrome with androgen excess on clinical or biochemical grounds
* BMI 20-40kg/m2
* Age range 18-50 years
* Ability to provide informed consent

The following inclusion criteria need to be met for the control Study participants:

* No clinical features of possible polycystic ovary syndrome (absence of clinical features of androgen excess and ovulatory dysfunction).
* BMI 20.0-40kg/m2
* Age range 18-50 years
* Ability to provide informed consent

For participants with PCOS, a diagnosis of PCOS should be established on the basis of the Androgen Excess and PCOS (AE-PCOS) Society guidelines:

* Androgen excess (clinical and/or biochemical evidence)
* Chronic oligo-/anovulation (clinical and/or biochemical evidence)
* Clinical and/or biochemical exclusion of other conditions that could explain the above manifestation (e.g. congenital adrenal hyperplasia, Cushing's syndrome, Prolactinoma, adrenal and gonadal tumours)

Exclusion Criteria:

* The participant may not enter the study if ANY of the following apply:

  * A confirmed diagnosis of diabetes
  * Current or recent (\<3-months) use of weight loss medications
  * Current or recent use of oral contraceptive pill or hormone replacement therapy (within last 3-months)
  * Blood haemoglobin \<11.0g/dL
  * History of alcoholism or a greater than recommended alcohol intake (recommendations \> 21 units on average per week for men and \> 14 units on average per week for women)
  * Haemorrhagic disorders
  * Treatment with anticoagulant agents
  * Other co-morbidities that in the view of the investigators may affect data collection
  * Any medical condition in the opinion of the investigator that might impact upon safety or validity of the results
  * Pregnancy or breastfeeding at the time of planned recruitment
  * A diagnosis of PCOS according to Rotterdam criteria where the patient does not have clinical or biochemical evidence of androgen excess
  * History of significant renal (eGFR\<30) or hepatic impairment (AST or ALT \>two-fold above ULN; pre-existing bilirubinaemia \>1.2 ULN)
  * Any other significant disease or disorder that, in the opinion of the Investigator, may either put the participant at risk because of participation in the study, or may influence the result of the study, or the participant's ability to participate in the study.
  * Participants who have participated in another research study involving an investigational medicinal product in the 12 weeks preceding the planned recruitment
  * Glucocorticoid use via any route within the last six months
  * Current intake of drugs known to impact upon steroid or metabolic function or intake of such drugs during the six months preceding the planned recruitment
  * Use of oral or transdermal hormonal contraception in the three months preceding the planned recruitment
  * Use of contraceptive implants in the twelve months preceding the planned recruitment

• BACKGROUNDRiestenberg C, Jagasia A, Markovic D, Buyalos RP, Azziz R. Health Care-Related Economic Burden of Polycystic Ovary Syndrome in the United States: Pregnancy-Related and Long-Term Health Consequences. J Clin Endocrinol Metab. 2022 Jan 18;107(2):575-585. doi: 10.1210/clinem/dgab613. PMID 34546364
• BACKGROUNDSchiffer L, Arlt W, O'Reilly MW. Understanding the Role of Androgen Action in Female Adipose Tissue. Front Horm Res. 2019;53:33-49. doi: 10.1159/000494901. Epub 2019 Sep 9. PMID 31499495
• BACKGROUNDNanba AT, Rege J, Ren J, Auchus RJ, Rainey WE, Turcu AF. 11-Oxygenated C19 Steroids Do Not Decline With Age in Women. J Clin Endocrinol Metab. 2019 Jul 1;104(7):2615-2622. doi: 10.1210/jc.2018-02527. PMID 30753518
• BACKGROUNDKumarendran B, O'Reilly MW, Manolopoulos KN, Toulis KA, Gokhale KM, Sitch AJ, Wijeyaratne CN, Coomarasamy A, Arlt W, Nirantharakumar K. Polycystic ovary syndrome, androgen excess, and the risk of nonalcoholic fatty liver disease in women: A longitudinal study based on a United Kingdom primary care database. PLoS Med. 2018 Mar 28;15(3):e1002542. doi: 10.1371/journal.pmed.1002542. eCollection 2018 Mar. PMID 29590099
• BACKGROUNDLegro RS, Arslanian SA, Ehrmann DA, Hoeger KM, Murad MH, Pasquali R, Welt CK; Endocrine Society. Diagnosis and treatment of polycystic ovary syndrome: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2013 Dec;98(12):4565-92. doi: 10.1210/jc.2013-2350. Epub 2013 Oct 22. PMID 24151290
• BACKGROUNDRandeva HS, Tan BK, Weickert MO, Lois K, Nestler JE, Sattar N, Lehnert H. Cardiometabolic aspects of the polycystic ovary syndrome. Endocr Rev. 2012 Oct;33(5):812-41. doi: 10.1210/er.2012-1003. Epub 2012 Jul 24. PMID 22829562
• BACKGROUNDKempegowda P, Melson E, Manolopoulos KN, Arlt W, O'Reilly MW. Implicating androgen excess in propagating metabolic disease in polycystic ovary syndrome. Ther Adv Endocrinol Metab. 2020 Jun 24;11:2042018820934319. doi: 10.1177/2042018820934319. eCollection 2020.