title: Follistatin and activins in polycystic ovary syndrome: relationship to metabolic and hormonal markers.
abstract: OBJECTIVE
  Polycystic ovary syndrome (PCOS) is common and has reproductive and metabolic manifestations. Activin A and follistatin levels remain controversial and activin B levels are unstudied in PCOS. The aim of this study was to evaluate activin A, activin B and follistatin levels and to examine their associations with metabolic status in overweight and obese women with and without PCOS.
  
  
  METHODS
  Cross-sectional study assessing overweight and obese, premenopausal women with PCOS (n=51, n=26 National Institutes of Health (NIH) and n=25 non-NIH) and without PCOS (n=25 controls). Outcomes included activin A, activin B, follistatin and activin A/follistatin ratio and the association of the activins and follistatin with metabolic variables.
  
  
  RESULTS
  Activin A, activin B and activin A/follistatin ratio were not significantly different and follistatin was elevated for PCOS versus controls (P=0.01) independent of age or BMI. Follistatin levels were significantly different across the PCOS phenotypes (p=0.05), however this was a non-significant trend (after correction for age and BMI) for women with NIH PCOS or non-NIH PCOS to have elevated levels in comparison to controls. Activin A was most strongly predicted by low density lipoprotein/high density lipoprotein (r(2)=0.192, p<0.001), follistatin by triglycerides and highly sensitive C-reactive protein (r(2)=0.340, p<0.001) and the activin A/follistatin ratio by insulin area under the curve and mean arterial pressure (r(2)=0.289, p<0.001).
  
  
  CONCLUSIONS
  Follistatin is elevated and activins A and B are not different between PCOS and controls. Follistatin and activin A are related to metabolic parameters in women with and without PCOS. Follistatin may potentially act as a marker of or be involved in the pathophysiology of both reproductive and metabolic features of PCOS.
authors.affiliation: Women's Public Health Research, Monash Applied Research Stream, School of Public Health and Preventive Medicine, Monash University; Diabetes and Vascular Medicine Unit, Southern Health.
authors.forename: Helena
authors.initials: H
authors.lastname: Teede
authors.forename: Sze
authors.initials: S
authors.lastname: Ng
authors.forename: Mark
authors.initials: M
authors.lastname: Hedger
authors.forename: Lisa
authors.initials: L
authors.lastname: Moran
mesh_terms: D028341:Activins / Q000378:metabolism*; D000328:Adult; D062186:Arterial Pressure / Q000502:physiology; D015415:Biomarkers / Q000378:metabolism; D002097:C-Reactive Protein / Q000378:metabolism; D003430:Cross-Sectional Studies; D005260:Female; D038681:Follistatin / Q000378:metabolism*; D006728:Hormones / Q000378:metabolism*; D006801:Humans; D007328:Insulin / Q000378:metabolism; D008075:Lipoproteins, HDL / Q000378:metabolism; D008077:Lipoproteins, LDL / Q000378:metabolism; D009765:Obesity / Q000378:metabolism; D050177:Overweight / Q000378:metabolism; D011085:Polycystic Ovary Syndrome / Q000378:metabolism*; D017697:Premenopause / Q000378:metabolism; D014280:Triglycerides / Q000378:metabolism
chemical_list: D015415:Biomarkers; D038681:Follistatin; D006728:Hormones; D007328:Insulin; D008075:Lipoproteins, HDL; D008077:Lipoproteins, LDL; D014280:Triglycerides; C422405:activin A; C044147:activin B; D028341:Activins; D002097:C-Reactive Protein
keywords: AUC; Activin; Area under the curve; BMI; Body mass index; FAI; FSH; Follistatin; Free androgen index; HDL; HOMA; High density lipoprotein; Homeostasis assessment of insulin resistance; LDL; Low-density lipoprotein; MAP; Mean arterial pressure; NIH; National Institutes of Health; PAI-1; PCOS; Polycystic ovary syndrome; SHBG; Sex-hormone binding globulin; follicle stimulating hormone; highly sensitive C-reactive protein; hsCRP; plasminogen activator inhibitor-1