Cover
Vol. 3 No. 2 (2025)

Published: December 1, 2025

Pages: 1-11

Original Article

Association of Apolipoprotein E Gene Polymorphisms with Polycystic Ovary Syndrome: A Case-Control Study

Abstract

Objective: To compare the distribution of ApoE polymorphisms between women with PCOS and healthy controls to explore whether specific ApoE genotypes contribute to the genetic susceptibility of developing PCOS, and to investigate the association between APOE gene polymorphisms and lipid profiles in PCOS patients. Methods: A case-control study was conducted between November 2023 and January 2025, enrolling 120 women with PCOS diagnosed according to Rotterdam criteria and 60 age-matched healthy controls. Participants underwent comprehensive clinical assessment, hormonal evaluation (FSH, LH, total and free testosterone), lipid profiling, and inflammatory marker analysis. DNA extraction was performed from whole blood, followed by PCR amplification and direct sequencing of ApoE gene fragments containing SNPs rs429358 and rs7412. Results: PCOS participants demonstrated significantly higher age, body weight, and height compared to controls (p<0.05). Hormonal analysis revealed characteristic PCOS patterns with elevated LH, total testosterone, free testosterone, and C-reactive protein levels, alongside reduced FSH concentrations (p<0.001). Lipid profile analysis showed significantly higher total cholesterol and LDL levels, with lower HDL concentrations in PCOS patients (p<0.05). Genetic analysis identified three ApoE genotypes (ε3ε3, ε2ε3, ε3ε4), with ε3ε3 being most prevalent in both groups. No significant differences were observed in ApoE genotype or allele distribution between PCOS patients and controls (p>0.05). However, within the PCOS group, ε4 allele carriers exhibited significantly elevated total cholesterol (p=0.039), triglycerides (p=0.013), and VLDL levels (p=0.026) compared to ε2 and ε3 carriers. Conclusions: ApoE gene polymorphisms do not appear to significantly influence PCOS susceptibility, as genotype distributions were comparable between patients and controls. However, ApoE variants, particularly the ε4 allele, may modulate metabolic dysfunction severity in women with established PCOS, potentially affecting cardiovascular risk stratification and therapeutic management approaches.

References

  1. Bozdag G, Mumusoglu S, Zengin D, Karabulut E, Yildiz BO. The prevalence and phenotypic features of polycystic ovary syndrome: a systematic review and meta-analysis. Human Reproduction. 2016 Dec 1;31(12):2841-55.
  2. Teede HJ, Misso ML, Costello MF, Dokras A, Laven J, Moran L, et al. Recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome. Human Reproduction. 2018 Sep 1;33(9):1602-18.
  3. Moran LJ, Misso ML, Wild RA, Norman RJ. Impaired glucose tolerance, type 2 diabetes and metabolic syndrome in polycystic ovary syndrome: a systematic review and meta-analysis. Human Reproduction Update. 2010 Jul 1;16(4):347-63.
  4. Azziz R, Carmina E, Chen Z, Dunaif A, Laven JS, Legro RS, et al. Polycystic ovary syndrome. Nature Reviews Disease Primers. 2016 Aug 11;2:16057.
  5. Vink JM, Sadrzadeh S, Lambalk CB, Boomsma DI. Heritability of polycystic ovary syndrome in a Dutch twin-family study. The Journal of Clinical Endocrinology & Metabolism. 2006 Jun 1;91(6):2100-4.
  6. Mahley RW, Rall SC Jr. Apolipoprotein E: far more than a lipid transport protein. Annual Review of Genomics and Human Genetics. 2000 Sep 1;1:507-37.
  7. Weisgraber KH. Apolipoprotein E: structure-function relationships. Advances in Protein Chemistry. 1994 Jan 1;45:249-302.
  8. Song Y, Stampfer MJ, Liu S. Meta-analysis: apolipoprotein E genotypes and risk for coronary heart disease. Annals of Internal Medicine. 2004 Aug 3;141(2):137-47.
  9. Heinonen S, Korhonen S, Hippeläinen M, Hiltunen M, Mannermaa A, Saarikoski S. Apolipoprotein E alleles in women with polycystic ovary syndrome. Fertility and Sterility. 2001 May 1;75(5):878-80.
  10. Cetinkalp S, Karadeniz M, Erdogan M, Zengi A, Cetintas V, Tetik A, et al. Apolipoprotein E gene polymorphism and polycystic ovary syndrome patients in Western Anatolia, Turkey. Journal of Assisted Reproduction and Genetics. 2009 Jan 1;26(1):1-6.
  11. Christ JP, Cedars MI. Current guidelines for diagnosing PCOS. Diagnostics. 2023 Mar 15;13(6):1113.
  12. Dhumad MM, Hamdan FB, Al-Mayah QS. Angiotensin-converting enzyme insertion/deletion (I/D) gene polymorphism in Iraqi type 2 diabetic patients: association with the risk of cardiac autonomic neuropathy. Egyptian Journal of Medical Human Genetics. 2020 Dec;21:1-7.
  13. Falcetta P, Benelli E, Molinaro A, Di Cosmo C, Bagattini B, Del Ghianda S, et al. Effect of aging on clinical features and metabolic complications of women with polycystic ovary syndrome. Journal of Endocrinological Investigation. 2021 Dec 1;44(12):2725-33.
  14. Barber TM, Franks S. Obesity and polycystic ovary syndrome. Clinical Endocrinology. 2021 Oct 1;95(4):531-41.
  15. Mirdamadi A, Riahinejad S, Varnaseri S. The association between anthropometric parameters and cardiovascular risk indicators in women with polycystic ovarian syndrome. ARYA Atherosclerosis. 2020 Jan 1;16(1):39.
  16. Liu Y, Guo Y, Yan X, Ding R, Tan H, Wang Y, et al. Assessment of health literacy in patients with polycystic ovary syndrome and its relationship with health behaviours: a cross-sectional study. BMJ Open. 2023 Nov 1;13(11):e071051.
  17. McCartney CR, Campbell RE, Marshall JC, Moenter SM. The role of gonadotropin‐releasing hormone neurons in polycystic ovary syndrome. Journal of Neuroendocrinology. 2022 May 1;34(5):e13093.
  18. Yang J, Chen C. Hormonal changes in PCOS. Journal of Endocrinology. 2024 Apr 1;261(1).
  19. Upadhyay N, Almeida EA, Singh A, Madhu SV, Puri D, Mehndiratta M. Evaluation of CRP/albumin ratio in polycystic ovarian syndrome. The Journal of Obstetrics and Gynecology of India. 2024 Apr 1;74(2):165-9.
  20. Carmina E, Nasrallah MP, Guastella E, Lobo RA. Characterization of metabolic changes in the phenotypes of women with polycystic ovary syndrome in a large Mediterranean population from Sicily. Clinical Endocrinology. 2019 Oct 1;91(4):553-60.
  21. Zhuang C, Luo X, Wang W, Sun R, Qi M, Yu J. Cardiovascular risk according to body mass index in women of reproductive age with polycystic ovary syndrome: a systematic review and meta-analysis. Frontiers in Cardiovascular Medicine. 2022 Feb 16;9:822079.
  22. Vrbikova J, Cifkova R, Jirkovska A, Lanska V, Platilova H, Zamrazil V, et al. Cardiovascular risk factors in young Czech females with polycystic ovary syndrome. Human Reproduction. 2003 May 1;18(5):980-4.
  23. Liu HW, Zhang F, Fan P, Bai H, Zhang JX, Wang Y. Effects of apolipoprotein E genotypes on metabolic profile and oxidative stress in southwest Chinese women with polycystic ovary syndrome. European Journal of Obstetrics, Gynecology, and Reproductive Biology. 2013 Sep 1;170(1):146-51.
  24. Butler AE, Moin ASM, Reiner Ž, Sathyapalan T, Jamialahmadi T, Sahebkar A, et al. HDL-Associated proteins in subjects with polycystic ovary syndrome: a proteomic study. Cells. 2023 Mar 10;12(6):855.
  25. Cetinkalp S, Karadeniz M, Erdogan M, Zengi A, Cetintas V, Tetik A, et al. Apolipoprotein E gene polymorphism and polycystic ovary syndrome patients in Western Anatolia, Turkey. Journal of Assisted Reproduction and Genetics. 2009 Jan 1;26:1-6.
  26. Egert S, Rimbach G, Huebbe P. ApoE genotype: from geographic distribution to function and responsiveness to dietary factors. Proceedings of the Nutrition Society. 2012 Aug 1;71(3):410-24.
  27. Li YH, Petrone AB, Pankow JS, Arnett DK, North KE, Ellison RC, et al. Association of Apolipoprotein E (ApoE) polymorphism with the prevalence of metabolic syndrome: the National Heart, Lung and Blood Institute Family Heart Study. Diabetes/Metabolism Research and Reviews. 2015 Aug 1;31(6):582.
  28. Zhen J, Huang X, Van Halm-Lutterodt N, Dong S, Ma W, Xiao R, et al. ApoE rs429358 and rs7412 polymorphism and gender differences of serum lipid profile and cognition in aging Chinese population. Frontiers in Aging Neuroscience. 2017 Aug 15;9:248.