Follistatin and activins in polycystic ovary syndrome: Relationship to metabolic and hormonal markers

ObjectivePolycystic 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.Materials and methodsCross-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.ResultsActivin 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 (r2 = 0.192, p < 0.001), follistatin by triglycerides and highly sensitive C-reactive protein (r2 = 0.340, p < 0.001) and the activin A/follistatin ratio by insulin area under the curve and mean arterial pressure (r2 = 0.289, p < 0.001).ConclusionsFollistatin 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.