Renin-Angiotensin System Overactivation in Polycystic Ovary Syndrome, a Risk for SARS-CoV-2 Infection?

Moin, Abu Saleh Md; Sathyapalan, Thozhukat; Atkin, Stephen L.; Butler, Alexandra E.

BACKGROUND: The SARS-CoV-2 coronavirus gains entry to target cells via the angiotensin-converting enzyme 2 (ACE2) receptor present on cells in blood vessels, lungs, heart, intestines, and kidneys. Renin-Angiotensin System (RAS) overactivity has also been described in metabolic syndrome, type 2 diabetes (T2D) and obesity, conditions shared by women with polycystic ovary syndrome (PCOS) We hypothesized that RAS overactivity may be present in PCOS. METHODS: We determined plasma levels of RAS-related proteins in a cohort of age matched control women (n=97) and women with PCOS (n=146). Plasma levels of RAS-related proteins (ACE2, Renin and Angiotensinogen (AGT)) were determined by Slow Off-rate Modified Aptamer (SOMA)-scan plasma protein measurement. RESULTS: PCOS women had a higher BMI (p<0.001), systolic (p<0.0001) and diastolic (p<0.05) blood pressure, waist circumference (p<0.0001), testosterone (p<0.0001), free androgen index (p<0.0001) and CRP (p<0.0001). Renin was elevated in PCOS (p<0.05) and angiotensinogen was lower in PCOS (p<0.05), indicating overactivity of the RAS system in PCOS. ACE2 levels were lower in PCOS (p<0.05), suggesting that PCOS women are at risk for development of hypertension. CONCLUSION: RAS proteins levels differed between PCOS and control women, suggesting that the insulin resistance inherent in PCOS may predispose these women to more severe COVID-19 infection.