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Review
. 2023 Jul 7;12(7):1398.
doi: 10.3390/antiox12071398.

Heavy Metals and Essential Elements in Association with Oxidative Stress in Women with Polycystic Ovary Syndrome-A Systematic Review

Tinkara Srnovršnik  1   2 , Irma Virant-Klun  3 , Bojana Pinter  2   4
Affiliations
Review

Heavy Metals and Essential Elements in Association with Oxidative Stress in Women with Polycystic Ovary Syndrome-A Systematic Review

Tinkara Srnovršnik et al. Antioxidants (Basel). .

Abstract

Altered levels of heavy metals and essential elements have been associated with oxidative stress (OS) and metabolic and hormonal changes in women with polycystic ovary syndrome (PCOS). We aimed to summarize the knowledge on the association of heavy metals and essential elements with OS in PCOS. An electronic literature search using PubMed for studies published between January 2008 and April 2023 was conducted. We evaluated heavy metals and essential elements in relation to OS in PCOS in 15 articles. PCOS women had increased antimonium (Sb), cadmium (Cd), lead (Pb), mercury (Hg), arsenic (As), tellurium (Te), thallium (Tl) and osmium (Os) blood levels and decreased zinc (Zn) blood levels; the results of copper (Cu) blood levels were conflicting. Some studies showed a significant correlation between heavy metals (Sb, Cd, Pb, Hg, As, Te and Tl) and essential elements (Se, Zn, Cr, Ca, Mg and Cu) and markers of OS and chronic inflammation. Heavy metals (Sb, Cd, Pb and Hg) and essential elements (Zn, Cr, Se, Ca, Mg and Cu) were associated with metabolic and hormonal characteristics in PCOS. There might be a possible benefit from supplementation therapy in reducing OS and endocrinological problems related to PCOS. Our review confirmed an association between heavy metals and essential elements with OS in PCOS women. This systematic review is registered in PROSPERO under number CRD42023418453.

Keywords: PCOS; chronic inflammation; endocrine disruptors; oxidative damage; toxic metals; trace elements.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Commonly used markers of OS in PCOS. Abbreviations: AGEs, advanced glycation end products; CAT, catalase; 8-OHdG, 8-hydroxydeoxyguanosine; GPx, glutathione peroxidase; GSH, glutathione; MDA, malondialdehyde; OSI, oxidative stress index (ratio of TOS to TAC); ROS, reactive oxygen species; SOD, superoxide dismutase; TAC, total antioxidant capacity; TOS, total oxidant status; XO, xanthine oxidase.
Figure 2
Figure 2
PRISMA flow diagram of the study selection process. Association of heavy metals and essential elements with oxidative stress in polycystic ovary syndrome.
Figure 3
Figure 3
The association between heavy metals and essential elements with OS in PCOS. Abbreviations: As, arsenic; Ca, calcium; Cd, cadmium; Cr, chromium; Cu, copper; GPx, glutathione peroxidase; GSH, reduced glutathione; Hg, mercury; hs-CRP, high sensitivity C-reactive protein; MDA, malondialdehyde; Mg, magnesium; Os, osmium; OSI, oxidative stress index (TOS/TAS ratio); Pb, lead; PCOS, polycystic ovary syndrome; Sb, antimony; Se, selenium; SOD, superoxide dismutase; TAC, total antioxidant capacity; TAS, serum total antioxidant status; Te, tellurium; Tl, thallium; TNF-α, tumour necrosis factor alpha; TOS, total oxidant status; Zn, zinc.
See this image and copyright information in PMC

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