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. 2021 May 28;12:667422. doi: 10.3389/fendo.2021.667422

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Copyright © 2021 Liao, Qiao and Pang

This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

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Central regulation of PCOS. Hypothalamic GnRH pulse mediates regulation of LH and FSH synthesis, which plays an important role in PCOS pathophysiology. This process is modulated by central regulators including KNDy neurons, POMC neurons, and neurotransmitters. In addition, peripheral factors including abnormal ovarian hormone levels, metabolic disorders, and gut microbiota dysbiosis also contribute to PCOS development by acting on their receptors expressed in hypothalamic neurons. Moreover, central regulators and peripheral factors interact with each other and form an abnormal neuronal–reproductive–metabolic circuit, thus promoting PCOS development. GnRH, Gonadotropin-releasing hormone; KNDy neurons, kisspeptin/NKB/dynorphin A neurons; POMC neurons, Pro-opiomelanocortin neurons; GABA, γ-aminobutyric acid; GLP-1, Glucagon-like peptide-1; IR, Insulin receptor; LepR, Leptin receptor; AR, Androgen receptor; GLP-1R, Glucagon-like peptide-1 receptor; AMHR, Anti-Müllerian hormone receptor; LH, Luteinizing hormone; FSH, Follicle stimulating hormone; AMH, Anti-Müllerian hormone; SHBG, Sex hormone-binding globulin; IL-22, Interleukin 22; SCFAs, Short-chain fatty acids.