Adipose tissue, metabolic syndrome and polycystic ovary syndrome: from pathophysiology to treatment Gabriella Garruti, Raffaella Depalo, Maria Grazia.

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Adipose tissue, metabolic syndrome and polycystic ovary syndrome: from pathophysiology to treatment Gabriella Garruti, Raffaella Depalo, Maria Grazia Vita, Filomenamila Lorusso, Federica Giampetruzzi, Aurelia Bellomo Damato, Francesco Giorgino Reproductive BioMedicine Online Volume 19, Issue 4, Pages 552-563 (October 2009) DOI: 10.1016/j.rbmo.2009.05.010 Copyright © 2009 Reproductive Healthcare Ltd, Duck End Farm, Dry Drayton, Cambridge CB23 8DB, UK Terms and Conditions

Figure 1 Regulation of lipolysis and main secretory products in adipocytes in PCOS. Blue arrows indicate inhibitory pathways, red arrows stimulating pathways. (↑): increased expression and secretion; (↓) reduced expression and secretion. Cyan arrows indicate the effects of TZD on adiponectin, leptin and resistin. AC, adenylate cyclase; ANP, atrial natriuretic peptide; AR, adrenergic receptors; cAMP, cyclic AMP; CG, guanylyl cyclases; cGK, cGMP-dependent protein kinase; cGMP, cyclic guanosine monophosphate; FFA, free fatty acids; HSL, hormone-sensitive lipase; IR, insulin receptor; IRS, insulin receptor substrate; NprA, natriuretic peptide receptor-A; PDE-3B, phosphodiesterase 3B; Peri A, perilipin; PI3K, phosphoinositide-3 kinase; PKA, protein kinase A; PKB, protein kinase B; TGLA, triacylglycerol lipase activity; TNFα, tumour necrosis factor alpha; TZD, thiazolidinediones. Adapted from Garruti et al. (2008). Reproductive BioMedicine Online 2009 19, 552-563DOI: (10.1016/j.rbmo.2009.05.010) Copyright © 2009 Reproductive Healthcare Ltd, Duck End Farm, Dry Drayton, Cambridge CB23 8DB, UK Terms and Conditions

Figure 2 Chemical formula of some insulin sensitizers used in the treatment of PCOS. All these molecules improve insulin sensitivity but their chemical structures are completely different since they are acting on different targets. (a) d-chiro-inositol, (b) metformin hydrochloride, (c) pioglitazone, (d) rosiglitazone; the green box delimits the part of the chemical structure that is common to all TZD molecules. Reproductive BioMedicine Online 2009 19, 552-563DOI: (10.1016/j.rbmo.2009.05.010) Copyright © 2009 Reproductive Healthcare Ltd, Duck End Farm, Dry Drayton, Cambridge CB23 8DB, UK Terms and Conditions