Role of plasminogen activator inhibitor type 1 (PAI-1) in PCOS patient

Shikha Sahay, Madhu Jain, D. Dash, Lavina Choubey, Shuchi Jain, T. B. Singh


Background: There has been few studies done demonstrating elevated level of PAI-1 in women with Polycystic Ovarian Syndrome (PCOS). PAI-1 has been associated with insulin resistance, obesity, anovulatory infertility, increased risk of cardiovascular disease in PCOS patient. The objective of the study was to find out the plasma level of PAI-1 in PCOS and compare with healthy age matched control. To correlate PAI-1 with various demographic, anthropometric, biochemical and hormonal parameters in PCOS patient and specific relation of PAI-1 with the insulin resistance, obesity, hyperandrogenemia.

Methods: A prospective case control study was carried out in 50 patients having PCOS (fulfilling Rotterdam Criteria, 2003). 25 healthy age matched control were taken. Blood samples were taken for estimation of fasting glucose, fasting insulin, lipid profile, LH, FSH, Prolactin, Testosterone, insulin sensitive indices (HOMA-IR, glucose: insulin ratio). Plasma level of PAI-1 was estimated with Human ELISA invitorgen kit. The data were statistically analysed with SPSS 16.0 version (student T test, Pearson ranked correlation coefficient, linear regression analysis was applied) and PAI-1 was correlated with various parameters.

Results: Mean level of PAI-1 was significantly raised in PCOS patient (893.36±234.97) pg/mL than in control (259.68±97.75) pg/mL (p<0.001). PAI-1 significantly correlated with insulin resistance, obesity; that is; PAI-1 significantly correlated with BMI (r=0.557; p<0.001), waist: hip ratio (r=0.550; p<0.001), fasting glucose (r=0.429; p=0.002), fasting insulin (r=0.357; p=0.001), triglyceride (r=0.492; p=0.000), LDL (r=0.604; p=0.001), HOMA-IR (r=0.467; p=0.001). On regression analysis LDL, fasting insulin, HOMA-IR altogether explained 54.9% of total variability of PAI-1.

Conclusions: Plasma level of PAI-1 is elevated in PCOS patient and it is significantly correlated with insulin resistance and obesity.


Insulin resistance, Obesity, PAI-1, PCOS

Full Text:



Atiomo WU, Bates SA, Condon JE, Shaw S, West JH, Prentice AG. The plasminogen activator system in women with polycystic ovary syndrome. Fertil Steril. 1998;69(2):236-41.

Orio F, Palomba S, Cascella T, Tauchmanová L, Nardo LG, Di Biase S, Labella D, Russo T, Tolino A, Zullo F, Colao A. Is plasminogen activator inhibitor-1 a cardiovascular risk factor in young women with polycystic ovary syndrome?. Reprod Biomed Online. 2004;9(5):505-10.

Tarkun I, Canturk Z, Turemen E, Tarkun P. ‘The Plasminogen Activator System in Young and Lean women with PCOS. Endocrine J. 2004;51(5):467-72.

Diamanti-Kandarakis E, Palioniko G, Alexandraki K, Bergiele A, Koutsouba T, Bartzis M. The prevalence of 4G5G polymorphism of plasminogen activator inhibitor-1 (PAI-1) gene in polycystic ovarian syndrome and its association with plasma PAI-1 levels. Eur J Endocrinol. 2004;150(6):793-8.

Atiomo WU, Hilton D, Fox R, Lee D, Shaw S, Friend J, et al. Prentice AG. Immunohistochemical detection of plasminogen activator inhibitor-1 in polycystic ovaries. Gynecol Endocrinol. 2000;14(3):162-8.

Sampson M, Kong C, Patel A, Unwin R, Jacobs HS. Ambulatory blood pressure profiles and plasminogen activator inhibitor (PAI‐1) activity in lean women with and without the polycystic ovary syndrome. Clin Endocrinol. 1996;45(5):623-9.

Peng XR, Hsueh AJ, Ny T. Transient and cell‐specific expression of tissue‐type plasminogen activator and plasminogen‐activator‐inhibitor type 1 results in controlled and directed proteolysis during gonadotropin‐induced ovulation. The FEBS J. 1993;214(1):147-56.

Liu K, Liu YX, Hu ZY, Zou RY, Chen YJ, Mu XM, et al. Temporal expression of urokinase type plasminogen activator, tissue type plasminogen activator, plasminogen activator inhibitor type 1 in rhesus monkey corpus luteum during the luteal maintenance and regression. Molecular Cellular Endocrinol. 1997;133(2):109-16.

Ieko M. Antiphospholipid antibodies and thrombosis: the putativemechanisms of hypercoagulable state in patients with anticardio lipinantibody. Rinsho Byori. 2000;48:293- 300

Gris JC, Schved JF, Aguilar-Martinez P, Arnaud A, Sanchez N. Impact of physical training on plasminogen activator inhibitor activity in sedentary men. Fibrinolysis. 1990;4:97-98.

Dunaif A, Wu X, Lee A, Diamanti‐Kandarakis E. Defects in insulin receptor signaling in vivo in the polycystic ovary syndrome (PCOS). Am J Physiol Endocrinol Metab. 2001;281:E392‐E399.

Juhan-Vague I, Roul C, Alessi MC, Ardissone JP, Heim M, Vague P. Increased plasminogen activator inhibitor activity in non insulin dependent diabetic patients. Relationship with plasma insulin. Thromb Haemost. 1989;61:370-3.

Nawrocka-Rutkowska J, Ciećwież S, Marciniak A, Brodowska A, Wiśniewska B, Kotlęga D, et al. Insulin resistance assessment in patients with polycystic ovary syndrome using different diagnostic criteria Impact of metformin treatment. Ann Agric Environ Med. 2013;20(3):528-32.

Glueck CJ, Papanna R, Wang P, Goldenberg N, Sieve-Smith L. Incidence and treatment of metabolic syndrome in newly referred women with confirmed polycystic ovarian syndrome. Metabolism. 2003;52(7):908-15.

Glueck CJ, Papanna R, Wang P, Goldenberg N, Sieve-Smith L. Incidence and treatment of metabolic syndrome in newly referred women with confirmed polycystic ovarian syndrome. Metabolism. 2003;52(7):908-15.

Glueck CJ, Phillips H, Cameron D, Sieve-Smith L, Wang P. Continuing metformin throughout pregnancy in women with polycystic ovary syndrome appears to safely reduce first-trimester spontaneous abortion: a pilot study. Fertil Steril. 2001;75:46-52.

Glueck CJ, Rorick MH, Schmerler M. Hypofibrinolytic andatherogenic risk factors for stroke. J Lab Clin Med. 1995;125:319-25.

Glueck CJ, Wang P, Goldenberg N, Sieve L. Pregnancy loss, polycystic ovary syndrome, thrombophilia, hypofibrinolysis, enoxaparin, metformin. Clin Appl Thromb Hemost 2004;10:323-34.

Festa A, D’Agostino Jr R, Tracy RP, Haffner SM. Elevatedlevels of acute-phase proteins and plasminogen activator inhibitor-1 predict the development of type 2 diabetes: the Insulin Resistance Atherosclerosis Study. Diabetes. 2002;51:1131-7.

Ma LJ, Mao SL, Taylor KL. Prevention of obesity andinsulin resistance in mice lacking plasminogen activator inhibitor1. Diabetes. 2004;53:336-46.