Иммунологические аспекты синдрома поликистозных яичников

Кандрашкина Ю.А., Орлова Е.А., Штах А.Ф. Иммунологические аспекты синдрома поликистозных яичников. Consilium Medicum. 2025;27(7):415–418. DOI: 10.26442/20751753.2025.7.203262

© ООО «КОНСИЛИУМ МЕДИКУМ», 2025 г.

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Kandrashkina JuA, Orlova EA, Shtakh AF. Immunological aspects of polycystic ovary syndrome: A review. Consilium Medicum. 2025;27(7):415–418. DOI: 10.26442/20751753.2025.7.203262

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Аннотация

Синдром поликистозных яичников (СПКЯ) является достаточно распространенной патологией, представляющей собой актуальную проблему, поскольку характеризуется стойким нарушением менструального цикла и, как следствие, приводит к бесплодию. Целью являются углубленный обзор и анализ существующих знаний, исследований и научной литературы о роли иммунной системы в развитии СПКЯ. Нарушение иммунной регуляции у женщин с СПКЯ способствует развитию хронического воспаления. У пациенток с СПКЯ развитие ооцитов блокируется в результате формирования хронического слабовыраженного воспаления в яичниках. Прогрессирование данного воспалительного процесса вызывает митохондриальную дисфункцию, в результате чего изменяется качество ооцитов, которое влияет на овуляцию. СПКЯ сопровождается повышением уровней интерлейкина (ИЛ)-1β, 6, 10 и 18 в сыворотке крови. В программах экстракорпорального оплодотворения отмечается отрицательный прогноз при низких уровнях ИЛ-8 и 6. При СПКЯ имеет место слабовыраженное хроническое воспаление в тканях яичника, которое приводит к нарушению созревания фолликулов. Дисбаланс цитокинов при СПКЯ может стать причиной отрицательного исхода экстракорпорального оплодотворения. Дальнейшее изучение роли иммунной системы при СПКЯ и разработка иммунологических маркеров могут способствовать усовершенствованию методов диагностики и лечения.

Ключевые слова: синдром поликистозных яичников, интерлейкин, инфламмасома, экстракорпоральное оплодотворение

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Polycystic ovary syndrome (PCOS) is a fairly common pathology that is a pressing problem because it is characterized by persistent menstrual irregularities and, as a result, leads to infertility. The aim of the study is to provide an in-depth review and analysis of existing knowledge, research and scientific literature on the role of the immune system in the development of PCOS. Impaired immune regulation in women with PCOS contributes to the development of chronic inflammation. In patients with PCOS, oocyte development is blocked as a result of the formation of chronic mild inflammation in the ovaries. The progression of this inflammatory process causes mitochondrial dysfunction, resulting in changes in the quality of oocytes, which affects ovulation. PCOS is accompanied by an increase in the levels of interleukins (IL)-1β, 6, 10 and 18 in the blood serum. In in vitro fertilization programs, a negative prognosis is noted with low levels of IL-8 and 6. In PCOS, there is mild chronic inflammation in the ovarian tissues, which leads to impaired follicle maturation. Cytokine imbalance in PCOS can be the cause of a negative outcome of in vitro fertilization. Further study of the role of the immune system in PCOS and development of immunological markers may contribute to improvement of diagnostic and treatment methods.

Keywords: polycystic ovary syndrome, interleukins, inflammasome, in vitro fertilization

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1. Obuhova YD. Morphology of the ovaries in different periods of ontogenesis. Literature review. Vestnik novyh medicinskih tekhnologij. 2010;17(2):301-5 (in Russian).
2. Kinnear HM, Tomaszewski CE, Chang AL, et al. The ovarian stroma as a new frontier. Reproduction. 2020;160(3):R25-39. DOI:10.1530/REP-19-0501
3. Turdybekova YG. Folliculogenesis and follicular reserve of the ovary in norm and pathology: aspects (stages) of clinical and morphological study. Vestnik Kazahskogo Nacional'nogo medicinskogo universiteta. 2019;(1):41-5 (in Russian).
4. Bilbo SD, Klein SL. Special Issue: the neuroendocrine-immune axis in health and disease. Horm Behav. 2012;62(3):187-90. DOI:10.1016/j.yhbeh.2012.06.005
5. Bhatia A, Sekhon HK, Kaur G. Sex hormones and immune dimorphism. ScientificWorldJournal. 2014;2014:159150. DOI:10.1155/2014/159150
6. Li R, Albertini DF. The road to maturation: somatic cell interaction and self-organization of the mammalian oocyte. Nat Rev Mol Cell Biol. 2013;14(3):141-52. DOI:10.1038/nrm3531
7. Jaffe LA, Egbert JR. Regulation of Mammalian Oocyte Meiosis by Intercellular Communication Within the Ovarian Follicle. Annu Rev Physiol. 2017;79:237-60. DOI:10.1146/annurev-physiol-022516-034102
8. Trigunaite A, Dimo J, Jørgensen TN. Suppressive effects of androgens on the immune system. Cell Immunol. 2015;294(2):87-94. DOI:10.1016/j.cellimm.2015.02.004
9. Rettew JA, Huet-Hudson YM, Marriott I. Testosterone Reduces Macrophage Expression in the Mouse of Toll-Like Receptor 4, a Trigger for Inflammation and Innate Immunity. Biology of Reproduction. 2007;78(3):432-3. DOI:10.1095/biolreprod.107.063545
10. Kanda N, Hoashi T, Saeki H. The Roles of Sex Hormones in the Course of Atopic Dermatitis. Int J Mol Sci. 2019;20(19):4660. DOI:10.3390/ijms20194660
11. Koh YT, Gray A, Higgins SA, et al. Androgen ablation augments prostate cancer vaccine immunogenicity only when applied after immunization. Prostate. 2009;69(6):571-84. DOI:10.1002/pros.20906
12. Hases L, Archer A, Williams C. ERβ and Inflammation. Adv Exp Med Biol. 2022;1390:213-25. DOI:10.1007/978-3-031-11836-4_12
13. Trenti A, Tedesco S, Boscaro C, et al. Estrogen, Angiogenesis, Immunity and Cell Metabolism: Solving the Puzzle. Int J Mol Sci. 2018;19(3):859. DOI:10.3390/ijms19030859
14. Straub RH. The complex role of estrogens in inflammation. Endocr Rev. 2007;28(5):521-74. DOI:10.1210/er.2007-0001
15. Galvão AM, Ferreira-Dias GM, Chełmonska-Soyta A, et al. Immune-endocrine cross-talk in reproductive biology and pathology. Mediators Inflamm. 2014;2014:856465. DOI:10.1155/2014/856465
16. Vanderstraeten A, Tuyaerts S, Amant F. The immune system in the normal endometrium and implications for endometrial cancer development. J Reprod Immunol. 2015;109:7-16. DOI:10.1016/j.jri.2014.12.006
17. Wang J, Yin T, Liu S. Dysregulation of immune response in PCOS organ system. Front Immunol. 2023;14:1169232. DOI:10.3389/fimmu.2023.1169232
18. Litvinova EN, Natalukha DD. Gistologicheskaia organizatsiia iaichnika: sovremennye dannye. In: Sovremennye voprosy morfologii endokrinnoi sistemy. Materialy V Mezhregional'noi nauchno-prakticheskoi konferentsii studentov, aspirantov i molodykh uchenykh. Kazan'. 2021 (in Russian).
19. Baracat EC, Baracat MCP, José M SJ Jr. Are there new insights for the definition of PCOS? Gynecol Endocrinol. 2022;38(9):703-4. DOI:10.1080/09513590.2022.2121387
20. Guriev TD. Polycystic ovarian syndrome. Obstetrics, Gynecology and Reproduction. 2010;4(2):10-5 (in Russian).
21. Burlakova ES, Merkulova AE, Loginova EA, et al. Association of insulin resistance and PCOS and its effect on women’s reproductive function. Russian Journal of Human Reproduction. 2022;28(2):47-52 (in Russian). DOI:10.17116/repro20222802147
22. Palomba S, Piltonen TT, Giudice LC. Endometrial function in women with polycystic ovary syndrome: a comprehensive review. Hum Reprod Update. 2021;27(3):584-618. DOI:10.1093/humupd/dmaa051
23. Hashchenko EP, Cvirkun DV. Systemic chronic inflammation and mitochondrial dysfunction in the genesis of polycystic ovary syndrome. Akusherstvo i ginekologiya. 2016;12:41-6 (in Russian). DOI:10.18565/aig.2016.12.41-6
24. Fitzgerald KA, Kagan JC. Toll-like Receptors and the Control of Immunity. Cell. 2020;180(6):1044-06. DOI:10.1016/j.cell.2020.02.041
25. Barton GM, Kagan JC. A cell biological view of Toll-like receptor function: regulation through compartmentalization. Nat Rev Immunol. 2009;9(8):535-42. DOI:10.1038/nri2587
26. Siddiqui S, Mateen S, Ahmad R, Moin S. A brief insight into the etiology, genetics, and immunology of polycystic ovarian syndrome (PCOS). J Assist Reprod Genet. 2022;39(11):2439-43. DOI:10.1007/s10815-022-02625-7
27. Ryabov VV, Gombozhapova AE, Samoilova YO, et al. NLRP3 inflammasome in the pathogenesis of acute myocardial infarction: a cardiologist's view. Russian Journal of Cardiology. 2024;29(4):5649 (in Russian). DOI:10.15829/1560-4071-2024-5649
28. Swanson KV, Deng M, Ting JP. The NLRP3 inflammasome: molecular activation and regulation to therapeutics. Nat Rev Immunol. 2019;19(8):477-89. DOI:10.1038/s41577-019-0165-0
29. Zhao C, Zhao W. NLRP3 Inflammasome-A Key Player in Antiviral Responses. Front Immunol. 2020;11:211. DOI:10.3389/fimmu.2020.00211
30. Martinon F, Burns K, Tschopp J. The inflammasome: a molecular platform triggering activation of inflammatory caspases and processing of proIL-beta. Mol Cell. 2002;10(2):417-26. DOI:10.1016/s1097-2765(02)00599-3
31. Popovic M, Sartorius G, Christ-Crain M. Chronic low-grade inflammation in polycystic ovary syndrome: is there a (patho)-physiological role for interleukin-1? Semin Immunopathol. 2019;41(4):447-59. DOI:10.1007/s00281-019-00737-4
32. Li Y, Zheng Q, Sun D, et al. Dehydroepiandrosterone stimulates inflammation and impairs ovarian functions of polycystic ovary syndrome. J Cell Physiol. 2019;234(5):7435-47. DOI:10.1002/jcp.27501
33. Fainaru O, Hantisteanu S, Rotfarb N, et al. CD11c+HLADR+ dendritic cells are present in human ovarian follicular fluid, and their maturity correlates with serum estradiol levels in response to gonadotropins. Fertil Steril. 2012;97(3):702-6. DOI:10.1016/j.fertnstert.2011.12.030
34. Zhang T, Tian F, Huo R, et al. Detection of dendritic cells and related cytokines in follicular fluid of patients with polycystic ovary syndrome. Am J Reprod Immunol. 2017;78(3). DOI:10.1111/aji.12717
35. Kryczek I, Frydman N, Gaudin F, et al. The chemokine SDF-1/CXCL12 contributes to T lymphocyte recruitment in human pre-ovulatory follicles and coordinates with lymphocytes to increase granulosa cell survival and embryo quality. Am J Reprod Immunol. 2005;54(5):270-83. DOI:10.1111/j.1600-0897.2005.00307.x
36. Wu R, Fujii S, Ryan NK, et al. Ovarian leukocyte distribution and cytokine/chemokine mRNA expression in follicular fluid cells in women with polycystic ovary syndrome. Hum Reprod. 2007;22(2):527-35. DOI:10.1093/humrep/del371
37. Qin L, Xu W, Li X, et al. Differential Expression Profile of Immunological Cytokines in Local Ovary in Patients with Polycystic Ovarian Syndrome: analysis by Flow Cytometry. Eur J Obstet Gynecol Reprod Biol. 2016;197:136-41. DOI:10.1016/j.ejogrb.2015.12.003
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Авторы

Ю.А. Кандрашкина*¹, Е.А. Орлова², А.Ф. Штах¹

¹ФГБОУ ВО «Пензенский государственный университет», Пенза, Россия;
²Пензенский институт усовершенствования врачей – филиал ФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Минздрава России, Пенза, Россия
*novikova10l@mail.ru

________________________________________________

Julia A. Kandrashkina*¹, Ekaterina A. Orlova², Aleksandr F. Shtakh¹

¹Penza State University, Penza, Russia;
²Penza Institute of Advanced Medical Studies – a branch of Russian Medical Academy of Continuous Professional Education, Penza, Russia
*novikova10l@mail.ru

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