Downregulated Lecithin–Cholesterol Acyltransferase in Polycystic Ovary Syndrome and its potential as a clinical biomarker for ovarian dysfunction:a case-control study

Abstract Objective: To investigate the association between lecithin-cholesterol acyltransferase (LCAT) and polycystic ovary syndrome (PCOS). Methods: Basal serum samples were collected from 156 patients with PCOS and 148 control subjects. Follicular fluid samples were collected from 74 patients with PCOS and 85 controls. LCAT levels in serum and follicular fluid were detected by enzyme-linked immunosorbent assay. Sex hormones, parameters of glucose and lipid metabolism, and indicators of thyroid function were measured in a clinical laboratory. Results: (1) LCAT expression in both serum and follicular fluid was lower in the PCOS group than in the control group. (2) Serum LCAT concentrations were negatively correlated with luteinizing hormone, testosterone and luteinizing hormone/follicle-stimulating hormone (LH/FSH) ratio,while positively correlated with FSH, with statistically significant differences. (3) Follicular fluid LCAT concentrations were negatively correlated with estradiol(E 2 ) and positively correlated with progesterone(P), with statistically significant differences. (4) Patients with PCOS with higher levels of LH/FSH ratios had lower LCAT concentrations. (5) After adjustment for age, body mass index (BMI), and testosterone, both serum and follicular fluid LCAT levels remained associated with high odds of PCOS in the logistic regression model.(6)Serum LCAT alone showed weak discrimination for PCOS (AUC = 0.655), whereas combining LCAT with age and BMI significantly improved discriminatory ability (AUC = 0.775, DeLong test P < 0.001) Conclusion: LCAT expression significantly decreased in the PCOS group and was negatively correlated with testosterone and LH/FSH ratio, suggesting that LCAT may be involved in the disrupted growth and maturation of follicles in PCOS. Combining LCAT with age and BMI significantly improved discriminatory ability of PCOS suggests that LCAT may serve as an auxiliary rather than standalone biomarker.Within ovarian follicles, the positive association between follicular fluid LCAT levels and progesterone and negative association between follicular fluid LCAT levels and estradiol indicate that LCAT may act locally within the follicle to alleviate excessive estrogen overproduction and optimize the intrafollicular hormonal microenvironment. Overall, LCAT is associated with ovulation dysfunction in PCOS and may serve as a new serological biomarker for its diagnosis.