Dr. Laganà has graciously allowed me to include his article on PCOS Diva. For more information regarding his work researching myo-inositol and D-chiro- inositol you can also read this article.
Guest Post by Dr. Antonio Simone Laganà and Alfonsa Pizzo
Department of Pediatric, Gynecological, Microbiological and Biomedical Sciences, University of Messina, Messina, Italy
The Polycystic Ovary Syndrome (PCOS) is defined, according to Rotterdam’s criteria proposed by the European Society for Human Reproduction and Embryology and the American Society for Reproductive Medicine [1,2], by the identification of two out of following parameters: oligo-anovulation; hyperandrogenism (clinical or biochemical); the presence of 12 or more follicles in each ovary measuring 2.9 mm in diameter, and/or an increased ovarian volume (>10 ml).
PCOS affects about 4-8% of the women in reproductive age , causing anovulatory cycles in the 74% of the cases, insulin- resistance in the 42% and hyperandrogenism in the 48% . PCOS in our opinion could be considered as the result of concurrent endocrinological alterations, which affects each other. First of all, obesity affects the 35% of PCOS patients  and provoke multiple metabolic and endocrine dysfunctions: fatty tissue, in fact, behaves as non-classical endocrine organs and secretes specific cytokines and chemokines  which stimulate the androgens production by adrenal cortex and ovaries ; on the other hands, adipocytes’ mediators seems to alter thehypothalamus-hypophisis-gonads regulation system, causing high and constant production of Luteinizing Hormone (LH). This may accounts, at least in part, for the typical inhibition of the ovarian follicular maturation in PCOS patients . Moreover, metabolic profile is strictly connected to gonadal function : in PCOS patient’s insulin- resistance is commonly associated with hyperinsulinemia , and the latter acts synergistically with LH to enhance the androgen production of theca cells . Furthermore, it is able to reduce circulating levels of Sex Hormone Binding Globulin (SHBG), leading to increased levels of free testosterone .
Considered altogether, these evidences led to the use of insulin sensitizing drugs to stem the symptoms of this pathology. To date, different Inositol isoforms seems to increase insulin action on various tissues and, in this way to improve the ovulatory function and to inhibit or limit the production of testosterone . Moreover, the use of Inositol may improve the possibility of spontaneous ovulation and regular menstrual cycles, as well as to increase the production of progesterone in the luteal phase of female infertile patients with PCOS . Inositol is a polyalcohol classified as insulin sensitizer and existing as nine stereoisomers, two of which, D-Chiro-inositol [15-18] and Myo-Inositol [14,19-22], are currently used in PCOS treatment.
Myo-Inositol, which is the most abundant form of inositol in humans, is converted to D-Chiro-inositol by an insulin-dependent epimerase . These two stereoisomer showed an insulin-like action in vivo exerting the function of insulin mediators as inositolphosphoglycans (IPGs) . In our experience, both Inositol isoforms are effective in improving ovarian function and metabolism of patients with PCOS, although Myo-Inositol shows the most marked effect on the metabolic profile, whereas D-Chiro-Inositol reduces more hyperandrogenism .
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- Laganà AS, Borrielli I, Barbaro L, Pizzo A (2013) Myo-Inositol Vs D-Chiro- Inositol: preliminary data on the comparison between their effects on ovarian function and metabolic factors in women with PCOS. Proceedings of The World Congress on Building Consensus out of Controversies in Gynecology, Infertility and Perinatology (BCGIP-cogi) (Istanbul, Turkey, 30th May – 2nd June 2013).
*Corresponding author: Antonio Simone Laganà, Department of Pediatric, Gynecological, Microbiological and Biomedical Sciences, University of Messina, Messina, Italy
Citation: Laganà AS, Pizzo A (2013) Know your Enemy: The Rationale of Using Inositol in the Treatment of Polycystic Ovary Syndrome. Endocrinol Metab Synd 2: e121. doi: 10.4172/2161-1017.1000e121
Copyright: © 2013 Laganà AS, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Volume 2 • Issue 3 • 1000e121
Antonio Simone Laganà was born in Reggio Calabria (Italy) on 8th May 1986. During his university career he was trained in particular in histology and embryology (supervisor Prof. Domenico Puzzolo), Clinical Pharmacology (supervisor Prof. Edoardo Spina), Immunology and General Pathology (supervisors Prof. Vincenza Sofo, Dr. Francesca Maria Salmeri) and finally in Obstetrics and Gynecology. He attended also the Department of Interventional Radiology of the Virginia Commonwealth University (Richmond, Virginia – USA), where he studied technique of uterine fibroids chemioembolization (supervisor Prof. Uma Prasad), and the Department of Obstetrics and Gynecology of the “Klinicky Centar” (Belgrade – Serbia. Supervisor Prof. Milan Terzic). He earned his graduation at University of Messina (Italy) and became Resident Medical Doctor in Obstetrics and Gynecology. He is of Member of the “Italian Association of Endometriosis” Expert Panel , In-Training Member of the “Society for Gynecologic Investigation”, Regular Member of the “European Society of Human Reproduction and Embryology”, of the “International Society of Gynecological Endocrinology” and of Giorgio Pardi Foundation’s professional research team. He got a Master of “gynaecological minimally invasive and robotic surgery” (supervisor Prof. Vito Cela, University of Pisa). His research interests are: Endometriosis, Reproductive Immunology, T cell subsets, Chronic Pelvic Pain, Organogenesis and Genetic of Mullerian-Derived Structures, Gynecological Endocrinology, Polycystic Ovarian Syndrome (PCOS), Laparoscopy, Hysteroscopy, Minimally invasive surgery in ob/gyn. He is author of many papers published in national and international peer-reviewed journals, and his presence is often requested as Invited Speaker in international congresses.