Acupuncture of Polycystic Ovary Syndrome: Delving into Bile Acid Metabolism

Background: polycystic ovary syndrome (PCOS), a common endocrine disorder, is characterized by hyperandrogenism, ovulatory dysfunction, and polycystic ovarian morphology. Given bile acids' role in metabolic regulation and acupuncture's therapeutic potential for endocrine-metabolic disorders, this study examines acupuncture’s effects on bile acid metabolism and insulin sensitivity in PCOS patients and rat models. Methods: 33 PCOS patients and 28 age/BMI-matched controls were enrolled in a clinical trial (NCT04193371). 16 PCOS patients received 4-month acupuncture followed by 4-month observation. Serum bile acids, insulin sensitivity, hormones, and inflammatory markers were analyzed. A dihydrotestosterone (DHT)-induced PCOS rat model was treated with electroacupuncture (EA), with outcomes assessed via estrous cycles and ovarian histology. The mechanisms of EA are dissected through RNA sequencing. Results: acupuncture improved BMI, insulin resistance, and hyperandrogenism in PCOS patients, with sustained post-treatment effects. Specific bile acids (e.g., TCA, LCA) correlated with metabolic improvements. In PCOS rats, EA restored estrous cyclicity, reduced ovarian cysts, and downregulated hepatic FXR expression. RNA-seq revealed significant alterations in bile acid metabolism-related genes and pathways. Conclusions: acupuncture therapy offers potential therapeutic benefits to patients with PCOS by modulating bile acid metabolism, with a particular focus on specific types of bile acids.