Endocan As A Potential Marker of Early Endothelial Dysfunction In Polycystic Ovary Syndrome (PCOS)

Yıl 2021, , 155 - 161, 22.03.2021

Mahmut Apaydın , Taner Demirci , Erman Çakal

https://doi.org/10.31832/smj.855493

Öz

Objective: Polycystic ovary syndrome (PCOS) is a common endocrinological disease in women of reproductive age and has a wide range of metabolic effects. Chronic low-grade inflammation and endothelial dysfunction plays a key role in the pathogenesis of PCOS and they are associated with an increased risk of cardiovascular disease. Endocan, is an inflammatory marker showing endothelial dysfunction. The aim of our study, to compare serum endocan levels in PCOS and healthy control groups and to determine the relationship between some cardiovascular risk factors and serum endocan levels.
Materials and Methods: This case-control study included 52 PCOS patients and 59 age-matched healthy controls. Patients were diagnosed as PCOS based on 2003 Rotterdam criteria. Demographic data, history of menstrual irregularity and infertility, polycystic ovary appearance in ultrasonography and hirsutism status were recorded. Endocan levels of PCOS patients and controls were compared. Data analysis was performed by using SPSS-22 for Windows (Statistical Package for Social Science, SPSS Inc. Chicago IL, USA®Z).
Results: The median (IQR) value of serum endocan level was 420.7 ng/L (355.2-570.3) in the PCOS group and 320.0 ng/L (219.9-455.9) in the control group (p=0,003). While there was no significant correlation between serum endocan and some cardiovascular risk factors such as waist circumference, hip circumference, BMI, LDL, triglyceride, systolic and diastolic arterial tension but a positive correlation was found between homeostatic model assessment insulin resistance (HOMA-IR) (r= 0.276, p= 0,003).
Conclusion: Serum endocan levels are higher in PCOS patients, in line with the literature. Endocan level shows a significant correlation with insulin resistance, one of the metabolic parameters. This may be a sign of early endothelial dysfunction in PCOS.

Anahtar Kelimeler

endocan, endothelial dysfunction, polycystic ovary syndrome, inflammation

Polikistik Over Sendromunda (PKOS) Erken Endotel Disfonksiyonunun Potansiyel Belirleyicisi Olarak Endocan

Öz

Amaç: Polikistik over sendromu (PKOS), üreme çağındaki kadınlarda sık görülen endokrinolojik hastalıktır.
PKOS'ta izlenen kronik düşük dereceli inflamasyon ve endotel disfonksiyon artmış kardiyovasküler hastalık riski
ile ilişkilidir. Endocan, endotel disfonksiyonunu gösteren inflamatuar bir belirteçtir. Çalışmamızda PKOS ve
sağlıklı kontrol grubunu serum endocan düzeyleri açısından karşılaştırmayı ve kardiyovasküler risk faktörleri ile
serum endocan düzeyleri arasındaki ilişkiyi belirlemeyi amaçladık.
Gereç ve Yöntemler: Bu vaka-kontrol çalışmasında, 52 PKOS hastası ve yaş eşleştirilmiş sağlıklı 59 bireyden
oluşan kontrol grubu yer almaktadır. Hastalara, 2003 Rotterdam kriterlerine göre PCOS tanısı kondu.
Demografik veriler, menstruel düzensizlikler, infertilite öyküsü, ultrasonografide polikistik over görünümü ve
hirsutizm varlığı kaydedildi. PCOS hastaları ve kontrol grubunun serum Endocan düzeyleri karşılaştırıldı. Veri
analizi Windows için SPSS-22 (Statistical Package for Social Science, SPSS Inc. Chicago IL, USA®Z)
kullanılarak yapıldı.
Bulgular: Serum endocan düzeyi ortanca (IQR) değeri PKOS grubunda 420,7 ng / L (355,2-570,3), kontrol
grubunda ise 320,0 ng / L (219,9-455,9) idi (p = 0,003). Serum endocan ile bel çevresi, kalça çevresi, BMI, LDL,
trigliserit, sistolik ve diyastolik arteriyel basınç gibi bazı kardiyovasküler risk faktörleri arasında anlamlı bir ilişki
bulunmazken, insülin direnci (HOMA-IR) ile arasında pozitif korelasyon saptandı (r = 0.276, p = 0,003).
Sonuç: Çalışmamızda, serum endocan düzeyleri literatürle uyumlu olarak PKOS hastalarında daha yüksek
saptanmıştır. Endocan düzeyi, metabolik parametrelerden biri olan insülin direnci ile anlamlı bir korelasyon
göstermektedir. Bu bulgular, PKOS' ta erken endotel disfonksiyonunun bir işareti olarak yorumlanabilir.

Anahtar Kelimeler

endocan, endotel disfonksiyonu, polikistik over sendromu, inflamasyon

Kaynakça

• 1. Delibas IB, Yapca OE, Laloglu E. Does endocan level increase in women with polycystic ovary syndrome? A case - control study. Ginekol Pol 2018; 89 (9):500-505.
• 2. Bicer M, Guler A, Unal Kocabas G, Imamoglu C, Baloglu A, Bilgir O, et al. Endocan is a predictor of increased cardiovascular risk in women with polycystic ovary syndrome. Endocr Res 2017; 42 (2):145-153.
• 3. Azziz R, Woods KS, Reyna R, Key TJ, Knochenhauer ES, Yildiz BO. The prevalence and features of the polycystic ovary syndrome in an unselected population. J Clin Endocrinol Metab 2004; 89 (6):2745-2749.
• 4. Carmina E, Lobo RA. Is There Really Increased Cardiovascular Morbidity in Women with Polycystic Ovary Syndrome? J Womens Health (Larchmt) 2018; 27 (11):1385-1388.
• 5. Twig G, Yaniv G, Levine H, Leiba A, Goldberger N, Derazne E, et al. Body-Mass Index in 2.3 Million Adolescents and Cardiovascular Death in Adulthood. New England Journal of Medicine 2016; 374 (25):2430-2440.
• 6. Ganie MA, Hassan S, Nisar S, Shamas N, Rashid A, Ahmed I, et al. High-sensitivity C-reactive protein (hs-CRP) levels and its relationship with components of polycystic ovary syndrome in Indian adolescent women with polycystic ovary syndrome (PCOS). Gynecological Endocrinology 2014; 30 (11):781-784.
• 7. Diamanti-Kandarakis E, Alexandraki K, Protogerou A, Piperi C, Papamichael C, Aessopos A, et al. Metformin administration improves endothelial function in women with polycystic ovary syndrome. Eur J Endocrinol 2005; 152 (5):749-756.
• 8. De Freitas Caires N, Legendre B, Parmentier E, Scherpereel A, Tsicopoulos A, Mathieu D, et al. Identification of a 14 kDa endocan fragment generated by cathepsin G, a novel circulating biomarker in patients with sepsis. J Pharm Biomed Anal 2013; 78-79:45-51.
• 9. Diamanti-Kandarakis E, Paterakis T, Alexandraki K, Piperi C, Aessopos A, Katsikis I, et al. Indices of low-grade chronic inflammation in polycystic ovary syndrome and the beneficial effect of metformin. Human Reproduction 2006; 21 (6):1426-1431.
• 10. Samy N, Hashim M, Sayed M, Said M. Clinical significance of inflammatory markers in polycystic ovary syndrome: Their relationship to insulin resistance and Body Mass Index. Disease Markers 2009; 26:163-170.
• 11. Diamanti-Kandarakis E, Spina G, Kouli C, Migdalis I. Increased endothelin-1 levels in women with polycystic ovary syndrome and the beneficial effect of metformin therapy. J Clin Endocrinol Metab 2001; 86 (10):4666-4673. 12. Kao YH, Chiu WC, Hsu MI, Chen YJ. Endothelial progenitor cell dysfunction in polycystic ovary syndrome: implications for the genesis of cardiovascular diseases. Int J Fertil Steril 2013; 6 (4):208-213.
• 13. Paradisi G, Steinberg HO, Hempfling A, Cronin J, Hook G, Shepard MK, et al. Polycystic ovary syndrome is associated with endothelial dysfunction. Circulation 2001; 103 (10):1410-1415.
• 14. Legro RS, Kunselman AR, Dodson WC, Dunaif A. Prevalence and predictors of risk for type 2 diabetes mellitus and impaired glucose tolerance in polycystic ovary syndrome: a prospective, controlled study in 254 affected women. J Clin Endocrinol Metab 1999; 84 (1):165-169.
• 15. Celik T, Balta S, Karaman M, Ahmet Ay S, Demirkol S, Ozturk C, et al. Endocan, a novel marker of endothelial dysfunction in patients with essential hypertension: comparative effects of amlodipine and valsartan. Blood Press 2015; 24 (1):55-60.
• 16. Mihajlovic DM, Lendak DF, Brkic SV, Draskovic BG, Mitic GP, Novakov Mikic AS, et al. Endocan is useful biomarker of survival and severity in sepsis. Microvascular Research 2014; 93:92-97.
• 17. Balta S, Mikhailidis DP, Demirkol S, Ozturk C, Celik T, Iyisoy A. Endocan: A novel inflammatory indicator in cardiovascular disease? Atherosclerosis 2015; 243 (1):339-343.
• 18. Lee W, Ku S-K, Kim S-W, Bae J-S. Endocan Elicits Severe Vascular Inflammatory Responses In Vitro and In Vivo. Journal of Cellular Physiology 2014; 229 (5):620-630.
• 19. Adekola H, Romero R, Chaemsaithong P, Korzeniewski SJ, Dong Z, Yeo L, et al. Endocan, a putative endothelial cell marker, is elevated in preeclampsia, decreased in acute pyelonephritis, and unchanged in other obstetrical syndromes. The Journal of Maternal-Fetal & Neonatal Medicine 2015; 28 (14):1621-1632.
• 20. Laloglu E, Kumtepe Y, Aksoy H, Topdagi Yilmaz EP. Serum endocan levels in endometrial and ovarian cancers. Journal of Clinical Laboratory Analysis 2017; 31 (5):e22079.
• 21. Hatch R, Rosenfield RL, Kim MH, Tredway D. Hirsutism: Implications, etiology, and management. American Journal of Obstetrics and Gynecology 1981; 140 (7):815-830.
• 22. Legro RS, Arslanian SA, Ehrmann DA, et al. Diagnosis and treatment of polycystic ovary syndrome: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 2013;98(12):4565-92. (In eng). DOI: 10.1210/jc.2013-2350.
• 23. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome (PCOS). Hum Reprod 2004; 19 (1):41-47.
• 24. Chen Y, Copeland WK, Vedanthan R, Grant E, Lee JE, Gu D, et al. Association between body mass index and cardiovascular disease mortality in east Asians and south Asians: pooled analysis of prospective data from the Asia Cohort Consortium. BMJ : British Medical Journal 2013; 347:5446.
• 25. Aparci M, Isilak Z, Uz O, Yalcin M, Kucuk U. Endocan and Endothelial Dysfunction. Angiology 2015; 66 (5):488-489.
• 26. Rajendran S, Willoughby SR, Chan WPA, Liberts EA, Heresztyn T, Saha M, et al. Polycystic ovary syndrome is associated with severe platelet and endothelial dysfunction in both obese and lean subjects. Atherosclerosis 2009; 204 (2):509-514.
• 27. Rostamtabar M, Esmaeilzadeh S, Tourani M, Rahmani A, Baee M, Shirafkan F, et al. Pathophysiological roles of chronic low-grade inflammation mediators in polycystic ovary syndrome. Journal of Cellular Physiology 2021; 236 (2):824-838.
• 28. Glintborg D, Rubin KH, Nybo M, Abrahamsen B, Andersen M. Cardiovascular disease in a nationwide population of Danish women with polycystic ovary syndrome. Cardiovasc Diabetol 2018; 17 (1):37.
• 29. Studen KB, Pfeifer M. Cardiometabolic risk in polycystic ovary syndrome. Endocrine Connections 2018; 7 (7):R238.
• 30. Randrianarisoa E, Lehn-Stefan A, Hieronimus A, Rietig R, Fritsche A, Machann J, et al. Visceral Adiposity Index as an Independent Marker of Subclinical Atherosclerosis in Individuals Prone to Diabetes Mellitus. Journal of Atherosclerosis and Thrombosis 2019; 26 (9):821-834.