The Genetic Aspects of Polycystic Ovary Syndrome: A General Review
DOI:
https://doi.org/10.24237/04.02.797Keywords:
Polycystic ovarian syndrome, genetic, Ovarian, gonadotrophinAbstract
Polycystic ovarian syndrome is a complicated endocrine disorder with major reproductive, metabolic, and psychological complications that affects reproductive-aged women generally. Polycystic ovarian syndrome is caused by a combination of genetic, epigenetic, and environmental factors. This review explores the genetic factors associated with PCOS, summarizing results from candidate gene analyses and genome-wide association studies. Important genetic variations in genes involved in ovarian function, gonadotropin regulation, insulin resistance, and androgen production have been consistently implicated. The interaction between multiple genetic variations suggests a polygenic inheritance pattern, which contributes to the variety of clinical symptoms. Understanding these genetic alterations is critical to identifying the molecular basis of this syndrome and may pave the way for precision medicine strategies that target specific genetic profiles in the future.
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[1] J. L. Zhu, Z. Chen, W. J. Feng, S. L. Long, and Z. C. Mo, “Sex hormone-binding globulin and polycystic ovary syndrome,” Clin. Chim. Acta, vol. 499, pp. 142–148, 2019, doi: 10.1016/j.cca.2019.09.010 .
[2] S. Singh et al., “Polycystic ovary syndrome: Etiology, current management, and future therapeutics,” J. Clin. Med., vol. 12, no. 4, p. 1454, 2023, doi: 10.3390/jcm12041454.
[3] E. Kovanci and J. E. Buster, “Polycystic ovary syndrome,” in Clinical Gynecology, 2nd ed., 2015, doi: 10.1017/CBO9781139628938.068.
[4] P. Hardiman, O. S. Pillay, and W. Atiomo, “Polycystic ovary syndrome and endometrial carcinoma,” Lancet, vol. 361, pp. 1810–1812, 2003, doi: 10.1016/S0140-6736(03)13409-5.
[5] E. Diamanti-Kandarakis et al., “Polycystic ovary syndrome: The influence of environmental and genetic factors,” Hormones (Athens), vol. 5, pp. 17–34, 2006, doi: 10.14310/horm.2002.1149.
[6] R. Krysiak, B. Okopień, A. Gdula-Dymek, and Z. S. Herman, “Update on the management of polycystic ovary syndrome,” Pharmacol. Rep., vol. 58, p. 614, 2006.
[7] A. L. Liu et al., “Association between FTO gene rs9939609 polymorphism and polycystic ovary syndrome: A systematic review and meta-analysis,” BMC Med. Genet., vol. 18, no. 1, p. 89, 2017, doi: 10.1186/s12881-017-0452.
[8] T. C. Plowden, Reproductive Endocrinology and Infertility. Eunice Kennedy Shriver National Institute of Child Health and Human Development, 2016.
[9] K. R. Reddy, “Polycystic ovary syndrome: Role of aromatase gene variants in South Indian women,” Int. J. Pharma Bio Sci., vol. 6, no. 2, 2015.
[10] M. E. Lujan, D. R. Chizen, and R. A. Pierson, “Diagnostic criteria for polycystic ovary syndrome: Pitfalls and controversies,” J. Obstet. Gynaecol. Can., vol. 30, pp. 671–679, 2008, doi: 10.1016/S1701-2163(16)32915-2.
[11] W. L. Lowe and T. E. Reddy, “Genomic approaches for understanding the genetics of complex disease,” Genome Res., vol. 25, pp. 1432–1441, 2015, doi: 10.1101/gr.190603.115.
[12] A. H. Balen, “Ovulation induction in the management of anovulatory polycystic ovary syndrome,” Mol. Cell. Endocrinol., vol. 373, no. 1–2, pp. 77–82, 2013, doi: 10.1016/j.mce.2012.10.008.
[13] V. L. Nelson et al., “Augmented androgen production is a stable steroidogenic phenotype of theca cells from polycystic ovaries,” Mol. Endocrinol., vol. 13, pp. 946–957, 1999, doi: 10.1210/mend.13.6.0311.
[14] L. Pellatt et al., “Granulosa cell production of anti-Müllerian hormone is increased in polycystic ovaries,” J. Clin. Endocrinol. Metab., vol. 92, pp. 240–245, 2007, doi: 10.1210/jc.2006-1582.
[15] R. Azziz et al., “The androgen excess and PCOS Society criteria for the polycystic ovary syndrome,” Fertil. Steril., vol. 91, pp. 456–488, 2009, doi: 10.1016/j.fertnstert.2008.06.035.
[16] C. Villarroel et al., “Polycystic ovarian morphology in adolescents with regular menstrual cycles,” Hum. Reprod., vol. 26, pp. 2861–2868, 2011, doi: 10.1093/humrep/der223.
[17] L. J. Webber et al., “Formation and early development of follicles in the polycystic ovary,” Lancet, vol. 362, pp. 1017–1021, 2003, doi: 10.1016/S0140-6736(03)14410-8.
[18] M. Das et al., “Granulosa cell survival and proliferation are altered in polycystic ovary syndrome,” J. Clin. Endocrinol. Metab., vol. 93, pp. 881–887, 2008, doi: 10.1210/jc.2007-1650.
[19] A. Dunaif, “Insulin resistance and the polycystic ovary syndrome,” Endocr. Rev., vol. 18, no. 6, pp. 774–800, 1997, doi: 10.1210/edrv.18.6.0318.
[20] M. Cortón et al., “Differential gene expression profile in omental adipose tissue in women with polycystic ovary syndrome,” J. Clin. Endocrinol. Metab., vol. 92, pp. 328–337, 2007, doi: 10.1210/jc.2006-1665.
[21] V. M. Victor et al., “Mitochondrial complex I impairment in leukocytes from polycystic ovary syndrome patients with insulin resistance,” J. Clin. Endocrinol. Metab., vol. 94, pp. 3505–3512, 2009, doi: 10.1210/jc.2009-0466.
[22] G. Bozdag et al., “The prevalence and phenotypic features of polycystic ovary syndrome: A systematic review and meta-analysis,” Hum. Reprod., vol. 31, no. 12, pp. 2841–2855, 2016, doi: 10.1093/humrep/dew218.
[23] D. Lizneva et al., “Criteria, prevalence, and phenotypes of polycystic ovary syndrome,” Fertil. Steril., vol. 106, no. 1, pp. 6–15, 2016, doi: 10.1016/j.fertnstert.2016.05.003.
[24] J. Vrbikova and V. Hainer, “Obesity and polycystic ovary syndrome,” Obes. Facts, vol. 2, no. 1, pp. 26–35, 2009, doi: 10.1159/000194971.
[25] R. Deswal et al., “The prevalence of polycystic ovary syndrome: A brief systematic review,” J. Hum. Reprod. Sci., vol. 13, no. 4, pp. 261–271, 2020, doi: 10.4103/jhrs.JHRS_95_18.
[26] World Health Organization, “Polycystic ovary syndrome: Fact sheet,” Jun. 2023. [Online]. Available: WHO website.
[27] E. Kandaraki et al., “Endocrine disruptors and polycystic ovary syndrome (PCOS): Elevated serum levels of bisphenol A in women with PCOS,” J. Clin. Endocrinol. Metab., vol. 96, pp. E480–E484, 2011, doi: 10.1210/jc.2010-1658.
[28] T. Takeuchi et al., “Positive relationship between androgen and the endocrine disruptor bisphenol A in normal women and women with ovarian dysfunction,” Endocr. J., vol. 51, pp. 165–169, 2004, doi: 10.1507/endocrj.51.165.
[29] M. Kazemi et al., “Effects of dietary glycemic index and load on cardiometabolic and reproductive profiles in women with PCOS,” Adv. Nutr., vol. 12, pp. 161–178, 2021, doi: 10.1093/advances/nmaa092.
[30] M. Szczuko et al., “Quantitative assessment of nutrition in patients with PCOS,” Rocz. Panstw. Zakl. Hig., vol. 67, no. 4, 2016.
[31] P. A. Jones, “Functions of DNA methylation: Islands, start sites, gene bodies and beyond,” Nat. Rev. Genet., vol. 13, no. 7, pp. 484–492, 2012, doi: 10.1038/nrg3230.
[32] National Institutes of Health, Evidence-Based Methodology Workshop on Polycystic Ovary Syndrome: Executive Summary, Washington, DC, USA, 2012.
[33] M. O. Goodarzi et al., “Polycystic ovary syndrome: Etiology, pathogenesis and diagnosis,” Nat. Rev. Endocrinol., vol. 7, pp. 219–231, 2011, doi: 10.1038/nrendo.2010.217.
[34] V. Bruni, A. Capozzi, and S. Lello, “The role of genetics, epigenetics and lifestyle in PCOS development,” Reprod. Sci., vol. 29, no. 3, pp. 668–679, 2022, doi: 10.1007/s43032-021-00515-4.
[35] M. Urbanek et al., “Thirty-seven candidate genes for PCOS: Strongest evidence for linkage with follistatin,” Proc. Natl. Acad. Sci. U.S.A., vol. 96, no. 15, pp. 8573–8578, 1999, doi: 10.1073/pnas.96.15.8573.
[36] M. J. Khan, A. Ullah, and S. Basit, “Genetic basis of polycystic ovary syndrome: Current perspectives,” Appl. Clin. Genet., vol. 12, pp. 249–260, 2019, doi: 10.2147/TACG.S200341.
[37] J. V. Goldstone et al., “Genetic and structural analyses of cytochrome P450 hydroxylases in sex hormone biosynthesis,” Mol. Phylogenet. Evol., vol. 94, pp. 676–687, 2016, doi: 10.1016/j.ympev.2015.09.012.
[38] K. R. Reddy et al., “CYP11A1 microsatellite polymorphism in PCOS women from South India,” J. Assist. Reprod. Genet., vol. 31, no. 7, pp. 857–863, 2014, doi: 10.1007/s10815-014-0236-x.
[39] C. W. Zhang et al., “Association between CYP11A1 gene polymorphisms and PCOS in Chinese women,” Mol. Biol. Rep., vol. 39, no. 8, pp. 8379–8385, 2012, doi: 10.1007/s11033-012-1688-7.
[40] S. F. Witchel and C. E. Aston, “The role of heterozygosity for CYP21 in PCOS,” J. Pediatr. Endocrinol. Metab., vol. 13, pp. 1315–1317, 2000.
[41] R. Robeva et al., “CYP21A2 intron 2 genetic variants and clinical characteristics of women with PCOS,” Biomedicines, vol. 12, no. 7, p. 1528, 2024, doi: 10.3390/biomedicines12071528.
[42] N. Settas, E. Kassi, and G. Chrousos, “CYP21A2 mutations in women with PCOS,” J. Clin. Endocrinol. Metab., vol. 98, no. 6, pp. E1047–E1052, 2013, doi: 10.1210/jc.2013-1111.
[43] N. Gharani et al., “Association of CYP11A with PCOS and hyperandrogenism,” Hum. Mol. Genet., vol. 6, no. 3, pp. 397–402, 1997, doi: 10.1093/hmg/6.3.397.
[44] T. Castillo-Higuera et al., “Common polymorphic variants in genes related to PCOS,” Reprod. Sci., vol. 28, no. 9, pp. 2399–2412, 2021, doi: 10.1007/s43032-020-00375-4.
[45] Y. Guo, D. H. Xiong, and T. L. Yang, “Polymorphisms of estrogen-biosynthesis genes CYP17 and CYP19,” Hum. Mol. Genet., vol. 15, no. 16, pp. 2401–2408, 2006, doi: 10.1093/hmg/ddl155.
[46] G. F. Erickson et al., “Functional studies of aromatase activity in granulosa cells,” J. Clin. Endocrinol. Metab., vol. 49, no. 4, pp. 514–519, 1979, doi: 10.1210/jcem-49-4-514.
[47] A. J. Jakimiuk et al., “Aromatase mRNA expression in follicles from polycystic ovaries,” Mol. Hum. Reprod., vol. 4, no. 1, pp. 1–8, 1998, doi: 10.1093/molehr/4.1.1.
[48] Z. J. Chen et al., “Genome-wide association study identifies susceptibility loci for PCOS,” Nat. Genet., vol. 43, no. 1, pp. 55–59, 2011, doi: 10.1038/ng.732.
[49] F. Day et al., “Large-scale genome-wide meta-analysis of PCOS,” PLoS Genet., vol. 14, no. 12, p. e1007813, 2018, doi: 10.1371/journal.pgen.1007813.
[50] Y. Zhang et al., “Genome-wide association study of PCOS from electronic health records,” Am. J. Obstet. Gynecol., vol. 223, no. 4, pp. 559.e1–559.e21, 2020, doi: 10.1016/j.ajog.2020.04.004.
[51] C. K. Welt et al., “Variants in DENND1A are associated with polycystic ovary syndrome in women of European ancestry,” J. Clin. Endocrinol. Metab., vol. 97, no. 7, pp. E1342–E1347, 2012, doi: 10.1210/jc.2011-3478.
[52] J. K. Wickenheisser et al., “Differential activity of cytochrome P450 17α-hydroxylase and StAR gene promoters in normal and PCOS theca cells,” J. Clin. Endocrinol. Metab., vol. 85, no. 6, pp. 2304–2311, 2000, doi: 10.1210/jcem.85.6.6631.
[53] J. M. McAllister et al., “Overexpression of a DENND1A isoform produces a PCOS theca phenotype,” Proc. Natl. Acad. Sci. U.S.A., vol. 111, no. 15, pp. E1519–E1527, 2014, doi: 10.1073/pnas.1400574111.
[54] E. Diamanti-Kandarakis et al., “Pancreatic β-cell dysfunction in polycystic ovary syndrome,” Panminerva Med., vol. 50, no. 4, pp. 315–325, 2008.
[55] A. La Marca et al., “Metformin treatment reduces ovarian cytochrome P-450c17α response in PCOS,” Hum. Reprod., vol. 15, no. 1, pp. 21–23, 2000, doi: 10.1093/humrep/15.1.21.
[56] A. A. Bremer and W. L. Miller, “The serine phosphorylation hypothesis of PCOS,” Fertil. Steril., vol. 89, no. 5, pp. 1039–1048, 2008, doi: 10.1016/j.fertnstert.2008.02.091.
[57] L. R. Sorbara et al., “Absence of insulin receptor gene mutations in insulin-resistant women with PCOS,” Metabolism, vol. 43, no. 12, pp. 1568–1574, 1994, doi: 10.1016/0026-0495(94)90018-3.
[58] M. Urbanek et al., “Candidate gene region for PCOS on chromosome 19p13.2,” J. Clin. Endocrinol. Metab., vol. 90, no. 12, pp. 6623–6629, 2005, doi: 10.1210/jc.2005-0622.
[59] E. J. Lee et al., “A novel SNP of the INSR gene in PCOS,” Fertil. Steril., vol. 89, no. 5, pp. 1213–1220, 2008, doi: 10.1016/j.fertnstert.2007.05.026.
[60] S. Siegel et al., “AC/T SNP of the insulin receptor gene in PCOS,” Fertil. Steril., vol. 78, no. 6, pp. 1240–1243, 2002, doi: 10.1016/S0015-0282(02)04241-3.
[61] S. K. Sreenan et al., “Calpains play a role in insulin secretion and action,” Diabetes, vol. 50, no. 9, pp. 2013–2020, 2001, doi: 10.2337/diabetes.50.9.2013.
[62] B. Roldán et al., “Genetic basis of metabolic abnormalities in PCOS,” Am. J. Pharmacogenomics, vol. 4, no. 2, pp. 93–107, 2004, doi: 10.2165/00129785-200404020-00004.
[63] G. L. Hammond, “Plasma steroid-binding proteins,” J. Endocrinol., vol. 230, no. 1, pp. R13–R25, 2016, doi: 10.1530/JOE-16-0070.
[64] P. Ferk et al., “SHBG gene microsatellite polymorphism in PCOS,” Hum. Reprod., vol. 22, no. 4, pp. 1031–1036, 2007, doi: 10.1093/humrep/del457.
[65] H. Nam et al., “PCOS with heterozygous androgen receptor mutation,” Obstet. Gynecol. Sci., vol. 58, no. 2, pp. 179–182, 2015, doi: 10.5468/ogs.2015.58.2.179.
[66] A. N. Schüring et al., “CAG repeat polymorphism of androgen receptor gene in PCOS,” Exp. Clin. Endocrinol. Diabetes, vol. 120, pp. 73–79, 2012, doi: 10.1055/s-0031-1286324.
[67] R. Singh et al., “Phenotypic heterogeneity of androgen receptor mutations,” Asian J. Androl., vol. 9, pp. 147–179, 2007, doi: 10.1111/j.1745-7262.2007.00250.
[68] R. S. Ramadhan et al., “Pathogenic SNPs in androgen receptor in PCOS,” Egypt. J. Med. Hum. Genet., vol. 23, p. 77, 2022, doi: 10.1186/s43042-022-00292-y.
[69] C. Y. Peng et al., “Androgen receptor CAG polymorphism and PCOS,” J. Assist. Reprod. Genet., vol. 31, pp. 1211–1219, 2014, doi: 10.1007/s10815-014-0286-0.
[70] C. R. McCartney et al., “Regulation of gonadotropin secretion and PCOS,” Semin. Reprod. Med., vol. 20, no. 4, pp. 317–326, 2002, doi: 10.1055/s-2002-36706.
[71] D. Hiam et al., “The genetics of PCOS: An overview,” J. Clin. Med., vol. 8, no. 10, p. 1606, 2019, doi: 10.3390/jcm8101606.
[72] T. R. Kumar et al., “FSH is required for ovarian follicle maturation,” Nat. Genet., vol. 15, no. 2, pp. 201–204, 1997, doi: 10.1038/ng0297-201.
[73] M. Chrusciel et al., “Extra-gonadal FSHR expression,” Front. Endocrinol., vol. 10, p. 32, 2019, doi: 10.3389/fendo.2019.00032.
[74] M. Simoni et al., “Functional genetic polymorphisms and female reproductive disorders,” Hum. Reprod. Update, vol. 14, no. 5, pp. 459–484, 2008, doi: 10.1093/humupd/dmn024.
[75] K. Aittomäki et al., “Mutation in the FSH receptor gene,” Cell, vol. 82, no. 6, pp. 959–968, 1995, doi: 10.1016/0092-8674(95)90275-9.
[76] B. H. Gu et al., “FSHR genetic variations in PCOS,” Int. J. Mol. Med., vol. 26, no. 1, pp. 107–112, 2010, doi: 10.3892/ijmm_00000441.
[77] O. O. Oduwole et al., “Roles of LH, FSH and testosterone,” Int. J. Mol. Sci., vol. 22, p. 12735, 2021, doi: 10.3390/ijms222312735.
[78] Z. Shaaban et al., “Altered RFamide-related peptide-3 expression in PCOS model,” Int. J. Fertil. Steril., vol. 12, p. 43, 2018, doi: 10.22074/ijfs.2018.5206.
[79] J. Qiao and B. Han, “Diseases caused by LH/CG receptor mutations,” Prog. Mol. Biol. Transl. Sci., vol. 161, pp. 69–89, 2019, doi: 10.1016/bs.pmbts.2018.09.007.
[80] P. Mutharasan et al., “Chromosome 2p16.3 PCOS susceptibility locus,” J. Clin. Endocrinol. Metab., vol. 98, pp. E185–E190, 2013, doi: 10.1210/jc.2012-2471.
[81] I. Huhtaniemi and M. Alevizaki, “Gonadotrophin resistance,” Best Pract. Res. Clin. Endocrinol. Metab., vol. 20, pp. 561–576, 2006, doi: 10.1016/j.beem.2006.09.003.
[82] R. L. Cate et al., “Isolation of Müllerian inhibiting substance genes,” Cell, vol. 45, no. 5, pp. 685–698, 1986, doi: 10.1016/0092-8674(86)90783-X.
[83] C. Weenen et al., “AMH expression pattern in human ovary,” Mol. Hum. Reprod., vol. 10, no. 2, pp. 77–83, 2004, doi: 10.1093/molehr/gah015.
[84] S. Catteau-Jonard et al., “Overexpression of AMH system genes in PCOS,” J. Clin. Endocrinol. Metab., vol. 93, no. 11, pp. 4456–4461, 2008, doi: 10.1210/jc.2008-1231.
[85] A. Pierre et al., “Dysregulation of AMH system by steroids in PCOS,” J. Clin. Endocrinol. Metab., vol. 102, no. 11, pp. 3970–3978, 2017, doi: 10.1210/jc.2017-00308.
[86] K. Bhattacharya et al., “Role of AMH in PCOS,” Middle East Fertil. Soc. J., vol. 27, p. 32, 2022, doi: 10.1186/s43043-022-00123-5.
[87] S. G. Kristensen et al., “TGF-β family members in antral follicles,” J. Clin. Endocrinol. Metab., vol. 104, no. 12, pp. 6371–6384, 2019, doi: 10.1210/jc.2019-01094.
[88] D. Garg and R. Tal, “Role of AMH in PCOS pathophysiology,” Reprod. Biomed. Online, vol. 33, no. 1, pp. 15–28, 2016, doi: 10.1016/j.rbmo.2016.04.007.
[89] T. M. Frayling et al., “FTO gene variant and obesity,” Science, vol. 316, no. 5826, pp. 889–894, 2007, doi: 10.1126/science.1141634.
[90] J. A. Hubacek et al., “FTO variant and acute coronary syndrome,” Clin. Chim. Acta, vol. 411, no. 15–16, pp. 1069–1072, 2010, doi: 10.1016/j.cca.2010.03.037.
[91] R. Larder et al., “Where to go with FTO?” Trends Endocrinol. Metab., vol. 22, no. 2, pp. 53–59, 2011, doi: 10.1016/j.tem.2010.11.001.
[92] Y. Shi et al., “Clinical characteristics of Chinese women with PCOS,” Neuroendocrinol. Lett., vol. 28, no. 6, pp. 807–810, 2007.
[93] Q. Yan et al., “FTO rs9939609 variant and PCOS,” Endocrine, vol. 36, no. 3, pp. 377–382, 2009, doi: 10.1007/s12020-009-9257-0.
[94] T. Li et al., “FTO rs9939609 confers risk to PCOS,” PLoS One, vol. 8, no. 7, p. e66250, 2013, doi: 10.1371/journal.pone.0066250.
[95] T. M. Barber et al., “FTO gene variants and PCOS,” Diabetologia, vol. 51, no. 7, pp. 1153–1158, 2008, doi: 10.1007/s00125-008-1028-6.
[96] R. B. Ramos and P. M. Spritzer, “FTO variants and PCOS in Brazil,” Gene, vol. 560, no. 1, pp. 25–29, 2015, doi: 10.1016/j.gene.2015.01.012.
[97] J. J. Kim et al., “FTO polymorphism and BMI in PCOS,” Fertil. Steril., vol. 102, no. 4, pp. 1143–1148.e2, 2014, doi: 10.1016/j.fertnstert.2014.07.004.
[98] R. Saxena and C. Welt, “PCOS not associated with type 2 diabetes risk variants,” Acta Diabetol., vol. 50, no. 3, pp. 451–457, 2013, doi: 10.1007/s00592-012-0383-4.
[99] K. G. Ewens et al., “FTO and MC4R variants and obesity in PCOS,” PLoS One, vol. 6, no. 1, p. e16390, 2011, doi: 10.1371/journal.pone.0016390.
[100] X. Cai et al., “FTO polymorphism and PCOS: Meta-analysis,” PLoS One, vol. 9, no. 1, p. e86972, 2014, doi: 10.1371/journal.pone.0086972.
[101] B. Yilmaz et al., “Diabetes and insulin resistance in relatives of women with PCOS,” Fertil. Steril., vol. 110, no. 3, pp. 523–533, 2018, doi: 10.1016/j.fertnstert.2018.04.024.
[102] T. Remer et al., “Glucocorticoid measurements in health and disease,” Mini Rev. Med. Chem., vol. 8, no. 2, pp. 153–170, 2008, doi: 10.2174/138955708783498096.
[103] M. Graupp et al., “SRD5A1 and SRD5A2 variants in lean PCOS,” Eur. J. Obstet. Gynecol. Reprod. Biol., vol. 157, no. 2, pp. 175–179, 2011, doi: 10.1016/j.ejogrb.2011.03.026.
[104] L. C. Torchen et al., “Increased 5α-reductase activity in daughters of women with PCOS,” J. Clin. Endocrinol. Metab., vol. 101, no. 5, pp. 2069–2075, 2016, doi: 10.1210/jc.2015-3926.
[105] A. G. Uitterlinden et al., “Vitamin D receptor gene polymorphisms,” J. Steroid Biochem. Mol. Biol., vols. 89–90, pp. 187–193, 2004, doi: 10.1016/j.jsbmb.2004.03.083.
[106] T. Vulcan et al., “VDR polymorphisms and metabolic abnormalities in PCOS,” Horm. Metab. Res., vol. 53, no. 10, pp. 645–653, 2021, doi: 10.1055/a1587-9336.
[107] A. G. Pittas et al., “Vitamin D and calcium in type 2 diabetes,” J. Clin. Endocrinol. Metab., vol. 92, no. 6, pp. 2017–2029, 2007, doi: 10.1210/jc.2007-0298.
[108] H. Darwish and H. DeLuca, “Vitamin D-regulated gene expression,” Crit. Rev. Eukaryot. Gene Expr., vol. 3, no. 2, pp. 89–116, 1993.
[109] G. Tuncel et al., “VDR FokI variant and serum vitamin D levels,” Mol. Biol. Rep., vol. 46, no. 3, pp. 3349–3355, 2019, doi: 10.1007/s11033-019-04796-6.
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