Antioxidant status in relation to heavy metals induced oxidative stress in patients with polycystic ovarian syndrome (PCOS) Original paper

What was studied?

This prospective case-control study examined the association between heavy metal exposure and oxidative stress in women with polycystic ovary syndrome (PCOS). Specifically, the study measured serum levels of arsenic (As), cadmium (Cd), lead (Pb), and mercury (Hg), alongside antioxidant markers—superoxide dismutase (SOD) and glutathione (GSH)—to explore how these toxic metals contribute to oxidative damage and PCOS pathogenesis. By analyzing both the toxicant burden and oxidative biomarkers, the study aimed to clarify whether metal-induced oxidative stress plays a pivotal role in the disease process.

Who was studied?

A total of 106 women aged 19–35 participated in the study: 50 were diagnosed with PCOS according to the Rotterdam criteria, and 56 served as healthy controls. Participants were matched in age and excluded for conditions that might confound oxidative or endocrine measurements, including diabetes, cardiovascular disease, and infectious or metabolic disorders. Clinical and demographic data, including menstrual irregularities, acne, BMI, and blood pressure, were collected. Blood samples were analyzed for fasting glucose, HbA1c, lipid profile, luteinizing hormone (LH), antioxidant status (SOD and GSH), and serum heavy metal concentrations using inductively coupled plasma mass spectrometry (ICP-MS).

What were the most important findings?

The study revealed that women with PCOS had significantly elevated serum levels of arsenic, cadmium, lead, and mercury compared to controls. Concurrently, antioxidant defense markers were notably reduced in the PCOS group—SOD and GSH levels were both significantly lower. There were strong negative correlations between heavy metal levels and antioxidant markers: arsenic, lead, and mercury negatively correlated with GSH; arsenic and lead also negatively correlated with SOD. These findings support a mechanistic link between heavy metal burden and reduced antioxidant capacity in PCOS.

From a microbiome perspective, the accumulation of heavy metals like Cd, Pb, and Hg is known to promote dysbiosis. Specifically, these metals reduce beneficial gut bacteria such as Faecalibacterium prausnitzii and Bifidobacterium spp., while promoting pro-inflammatory taxa like Proteobacteria. The oxidative stress induced by metals may increase gut permeability (“leaky gut”), exacerbating systemic inflammation, a hallmark of PCOS. The decline in antioxidant defenses further allows these oxidative effects to persist, creating a vicious cycle of endocrine disruption and microbiome imbalance.

What are the greatest implications of this study?

This study presents compelling evidence that heavy metal exposure significantly contributes to oxidative stress and potentially accelerates PCOS pathogenesis. The diminished antioxidant defenses in PCOS patients exposed to elevated levels of As, Cd, Pb, and Hg suggest that environmental toxicants act as endocrine-disrupting chemicals, impairing reproductive and metabolic health. Clinically, this underscores the necessity of monitoring both oxidative biomarkers and heavy metal burden in PCOS diagnostics and management. Moreover, therapeutic strategies aimed at detoxification—whether via chelation, dietary interventions, or antioxidant supplementation—could help restore oxidative balance and potentially benefit hormonal and microbiome health. Given the tight interplay between oxidative stress, endocrine signaling, and gut microbial composition, the findings advocate for a more integrative approach to PCOS care that includes environmental toxicology and gut microbiome modulation.