{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T16:45:00Z","timestamp":1788281100859,"version":"build-2803163510"},"reference-count":91,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2021,2,19]],"date-time":"2021-02-19T00:00:00Z","timestamp":1613692800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJMS"],"abstract":"<jats:p>Polycystic ovary syndrome (PCOS) is a complex and heterogeneous endocrine disease. The hypothesis that alterations in the microbiome are involved in the genesis of PCOS has been postulated. Aim of this review is to summarize the available literature data about the relationship between microbiome and PCOS. A search on PubMed and Medline databases was performed from inception to November 20Most of evidence has focused on the connection of intestinal bacteria with sex hormones and insulin-resistance: while in the first case, a relationship with hyperandrogenism has been described, although it is still unclear, in the second one, chronic low-grade inflammation by activating the immune system, with increased production of proinflammatory cytokines which interfere with insulin receptor function, causing IR (Insulin Resistance)\/hyperinsulinemia has been described, as well as the role of gastrointestinal hormones like Ghrelin and peptide YY (PYY), bile acids, interleukin-22 and Bacteroides vulgatus have been highlighted. The lower genital tract microbiome would be affected by changes in PCOS patients too. The therapeutic opportunities include probiotic, prebiotics and synbiotics, as well as fecal microbiota transplantation and the use of IL-22, to date only in animal models, as a possible future drug. Current evidence has shown the involvement of the gut microbiome in PCOS, seen how humanized mice receiving a fecal transplant from women with PCOS develop ovarian dysfunction, immune changes and insulin resistance and how it is capable of disrupting the secondary bile acid biosynthesis. A future therapeutic approach for PCOS may involve the human administration of IL-22 and bile acid glycodeoxycholic acid.<\/jats:p>","DOI":"10.3390\/ijms22042048","type":"journal-article","created":{"date-parts":[[2021,2,19]],"date-time":"2021-02-19T09:06:10Z","timestamp":1613725570000},"page":"2048","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":149,"title":["Microbiome and PCOS: State-of-Art and Future Aspects"],"prefix":"10.3390","volume":"22","author":[{"given":"Pierluigi","family":"Giampaolino","sequence":"first","affiliation":[{"name":"Department of Public Health, University of Naples Federico II, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Virginia","family":"Foreste","sequence":"additional","affiliation":[{"name":"Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudia","family":"Di Filippo","sequence":"additional","affiliation":[{"name":"Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9258-5883","authenticated-orcid":false,"given":"Alessandra","family":"Gallo","sequence":"additional","affiliation":[{"name":"Department of Public Health, University of Naples Federico II, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"Mercorio","sequence":"additional","affiliation":[{"name":"Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paolo","family":"Serafino","sequence":"additional","affiliation":[{"name":"Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6660-0955","authenticated-orcid":false,"given":"Francesco Paolo","family":"Improda","sequence":"additional","affiliation":[{"name":"Department of Public Health, University of Naples Federico II, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paolo","family":"Verrazzo","sequence":"additional","affiliation":[{"name":"Department of Public Health, University of Naples Federico II, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuseppe","family":"Zara","sequence":"additional","affiliation":[{"name":"Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cira","family":"Buonfantino","sequence":"additional","affiliation":[{"name":"Department of Public Health, University of Naples Federico II, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Borgo","sequence":"additional","affiliation":[{"name":"Department of Public Health, University of Naples Federico II, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3676-7716","authenticated-orcid":false,"given":"Gaetano","family":"Riemma","sequence":"additional","affiliation":[{"name":"Obstetrics and Gynecology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania \u201cLuigi Vanvitelli\u201d, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chiara De","family":"Angelis","sequence":"additional","affiliation":[{"name":"Department of Public Health, University of Naples Federico II, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brunella","family":"Zizolfi","sequence":"additional","affiliation":[{"name":"Department of Public Health, University of Naples Federico II, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuseppe","family":"Bifulco","sequence":"additional","affiliation":[{"name":"Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0584-2181","authenticated-orcid":false,"given":"Luigi","family":"Della Corte","sequence":"additional","affiliation":[{"name":"Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,2,19]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1602","DOI":"10.1093\/humrep\/dey256","article-title":"Recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome","volume":"33","author":"Teede","year":"2018","journal-title":"Hum. Reprod."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"2841","DOI":"10.1093\/humrep\/dew218","article-title":"The prevalence and phenotypic features of polycystic ovary syndrome: A systematic review and meta-analysis","volume":"31","author":"Bozdag","year":"2016","journal-title":"Hum. Reprod."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"579","DOI":"10.2174\/1570161116666180828154006","article-title":"Cardiovascular Risk in Postmenopausal Women with Polycystic Ovary Syndrome","volume":"17","author":"Lambrinoudaki","year":"2019","journal-title":"Curr. Vasc. Pharmacol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1827","DOI":"10.1210\/jc.2011-0039","article-title":"Unfavorable Hormonal, Metabolic, and Inflammatory Alterations Persist after Menopause in Women with PCOS","volume":"96","author":"Puurunen","year":"2011","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_5","first-page":"2385","article-title":"Current evidences and future perspectives on patient-oriented treatments for polycystic ovary syn-drome: An overview","volume":"30","author":"Rapisarda","year":"2018","journal-title":"Ital. J. Gynaecol. Obstet."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"16057","DOI":"10.1038\/nrdp.2016.57","article-title":"Polycystic ovary syndrome","volume":"2","author":"Azziz","year":"2016","journal-title":"Nat. Rev. Dis. Primers"},{"key":"ref_7","unstructured":"Dunaif, A., Givens, J.R., Haseltine, F., and Merriam, G.R. (1992). Diagnostic criteria for polycystic ovary syndrome: Toward a rational approach. Polycystic Ovary Syndrome, Blackwell Scientific Publications."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1016\/j.fertnstert.2003.10.004","article-title":"Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome","volume":"81","author":"Chang","year":"2004","journal-title":"Fertil. Steril."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1080\/09513590.2017.1391205","article-title":"Ovarian volume and PCOS: A controversial issue","volume":"34","author":"Giampaolino","year":"2017","journal-title":"Gynecol. Endocrinol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1080\/09513590.2016.1188280","article-title":"Serum anti-Mullerian hormone levels after ovarian drilling for the second-line treatment of polycystic ovary syndrome: A pilot-randomized study comparing laparoscopy and transvaginal hydrolaparoscopy","volume":"33","author":"Giampaolino","year":"2017","journal-title":"Gynecol. Endocrinol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1080\/09513590.2017.1323204","article-title":"Operative transvaginal hydrolaparoscopy improve ovulation rate after clomiphene failure in polycystic ovary syndrome","volume":"34","author":"Giampaolino","year":"2017","journal-title":"Gynecol. Endocrinol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"278","DOI":"10.1111\/j.1365-2605.2005.00623.x","article-title":"Development of polycystic ovary syndrome: Involvement of genetic and environmental factors","volume":"29","author":"Franks","year":"2006","journal-title":"Int. J. Androl."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1016\/j.lfs.2019.04.046","article-title":"Multi-system reproductive metabolic disorder: Significance for the pathogenesis and therapy of polycystic ovary syndrome (PCOS)","volume":"228","author":"Li","year":"2019","journal-title":"Life Sci."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1761","DOI":"10.2337\/db06-1491","article-title":"Metabolic Endotoxemia Initiates Obesity and Insulin Resistance","volume":"56","author":"Cani","year":"2007","journal-title":"Diabetes"},{"key":"ref_15","first-page":"1027","article-title":"An obesity-associated gut microbiome with increased capacity for energy harvest","volume":"444","author":"Turnbaugh","year":"2006","journal-title":"Nat. Cell Biol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"4050","DOI":"10.1172\/JCI129194","article-title":"The gut microbiome and metabolic syndrome","volume":"129","author":"Dabke","year":"2019","journal-title":"J. Clin. Investig."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"104","DOI":"10.1016\/j.mehy.2012.04.016","article-title":"Dysbiosis of Gut Microbiota (DOGMA)\u2014A novel theory for the development of Polycystic Ovarian Syndrome","volume":"79","author":"Tremellen","year":"2012","journal-title":"Med. Hypotheses"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"52","DOI":"10.1111\/cen.14198","article-title":"Association between polycystic ovary syndrome and the vaginal microbiome: A case-control study","volume":"93","author":"Hong","year":"2020","journal-title":"Clin. Endocrinol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1038\/nature08821","article-title":"A human gut microbial gene catalogue established by metagenomic sequencing","volume":"464","author":"Qin","year":"2010","journal-title":"Nature"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1355","DOI":"10.1126\/science.1124234","article-title":"Metagenomic Analysis of the Human Distal Gut Microbiome","volume":"312","author":"Gill","year":"2006","journal-title":"Science"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1258","DOI":"10.1016\/j.cell.2012.01.035","article-title":"The Impact of the Gut Microbiota on Human Health: An Integrative View","volume":"148","author":"Clemente","year":"2012","journal-title":"Cell"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1635","DOI":"10.1126\/science.1110591","article-title":"Diversity of the Human Intestinal Microbial Flora","volume":"308","author":"Eckburg","year":"2005","journal-title":"Science"},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Lindheim, L., Bashir, M., M\u00fcnzker, J., Trummer, C., Zachhuber, V., Leber, B., Horvath, A., Pieber, T.R., Gorkiewicz, G., and Stadlbauer, V. (2017). Alterations in Gut Microbiome Composition and Barrier Function Are Associated with Reproductive and Metabolic Defects in Women with Polycystic Ovary Syndrome (PCOS): A Pilot Study. PLoS ONE, 12.","DOI":"10.1371\/journal.pone.0168390"},{"key":"ref_24","first-page":"324","article-title":"Dysbiosis of Gut Microbiota Associated with Clinical Parameters in Polycystic Ovary Syndrome","volume":"8","author":"Liu","year":"2017","journal-title":"Front. Microbiol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1502","DOI":"10.1210\/jc.2017-02153","article-title":"Gut Microbial Diversity in Women With Polycystic Ovary Syndrome Correlates With Hyperandrogenism","volume":"103","author":"Torres","year":"2018","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"2552","DOI":"10.1210\/jc.2017-02799","article-title":"Gut Microbiota and the Polycystic Ovary Syndrome: Influence of Sex, Sex Hormones, and Obesity","volume":"103","author":"Insenser","year":"2018","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1823","DOI":"10.1042\/BCJ20160510","article-title":"Introduction to the human gut microbiota","volume":"474","author":"Thursby","year":"2017","journal-title":"Biochem. J."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1016\/j.tem.2018.11.001","article-title":"Sex, Microbes, and Polycystic Ovary Syndrome","volume":"30","author":"Thackray","year":"2019","journal-title":"Trends Endocrinol. Metab."},{"key":"ref_29","first-page":"2246","article-title":"Analysis of the gut microbial composition in polycystic ovary syndrome with acne","volume":"35","author":"Fangyuan","year":"2019","journal-title":"Zigong Matern. Child. Health Hosp."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1530\/EC-19-0522","article-title":"Characteristic gut microbiota and predicted metabolic functions in women with PCOS","volume":"9","author":"Zhou","year":"2020","journal-title":"Endocr. Connect."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1225","DOI":"10.1038\/s41591-019-0509-0","article-title":"Gut microbiota\u2013bile acid\u2013interleukin-22 axis orchestrates polycystic ovary syndrome","volume":"25","author":"Qi","year":"2019","journal-title":"Nat. Med."},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Ley, R.E. (2016). Gut microbiota in 2015: Prevotella in the gut: Choose carefully. Nat. Rev. Gastroenterol. Hepatol.","DOI":"10.1038\/nrgastro.2016.4"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"246e9","DOI":"10.1038\/nature13788","article-title":"Dietary modulation of the microbiome affects autoinflammatory disease","volume":"516","author":"Lukens","year":"2014","journal-title":"Nature"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1016\/j.resmic.2018.09.002","article-title":"Structural and functional profiles of the gut microbial community in polycystic ovary syndrome with insulin resistance (IR-PCOS): A pilot study","volume":"170","author":"Zeng","year":"2019","journal-title":"Res. Microbiol."},{"key":"ref_35","first-page":"400","article-title":"Prenatal androgen ex-posure causes hypertension and gut microbiota dysbiosis","volume":"9","author":"Sherman","year":"2018","journal-title":"Gut Microbes."},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Guo, Y., Qi, Y., Yang, X., Zhao, L., Wen, S., Liu, Y., and Tang, L. (2016). Association between Polycystic Ovary Syndrome and Gut Microbiota. PLoS ONE, 11.","DOI":"10.1371\/journal.pone.0153196"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1152\/physiolgenomics.00114.2017","article-title":"Gut microbiome may con-tribute to insulin resistance and systemic inflammation in obese rodents: A meta-analysis","volume":"50","author":"Jiao","year":"2018","journal-title":"Physiol Genomics."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"759","DOI":"10.1016\/j.molmet.2016.06.002","article-title":"Causality of small and large intestinal microbiota in weight regulation and insulin resistance","volume":"5","author":"Scheithauer","year":"2016","journal-title":"Mol. Metab."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"15718","DOI":"10.1073\/pnas.0407076101","article-title":"The gut microbiota as an environmental factor that regulates fat storage","volume":"101","author":"Ding","year":"2004","journal-title":"Proc. Natl. Acad. Sci. USA"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"913","DOI":"10.1053\/j.gastro.2012.06.031","article-title":"Transfer of Intestinal Microbiota from Lean Donors Increases Insulin Sensitivity in Individuals With Metabolic Syndrome","volume":"143","author":"Vrieze","year":"2012","journal-title":"Gastroenterology"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s13048-020-00670-3","article-title":"Role of gut microbiota in the development of insulin resistance and the mechanism underlying polycystic ovary syndrome: A review","volume":"13","author":"He","year":"2020","journal-title":"J. Ovarian Res."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"1831","DOI":"10.1017\/S0007114510002874","article-title":"Effects ofLactobacillus acidophilusNCFM on insulin sensitivity and the systemic inflammatory response in human subjects","volume":"104","author":"Andreasen","year":"2010","journal-title":"Br. J. Nutr."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"1029","DOI":"10.1159\/000430229","article-title":"Nutritional Aspects of Depression","volume":"37","author":"Lang","year":"2015","journal-title":"Cell. Physiol. Biochem."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"2639","DOI":"10.1093\/humrep\/dev231","article-title":"Gastrointestinal hormone secretion in women with polycystic ovary syndrome: An observational study","volume":"30","author":"Lin","year":"2015","journal-title":"Hum. Reprod."},{"key":"ref_45","first-page":"117","article-title":"Serum Leptin and Ghrelin Levels in Women with Polycystic Ovary Syndrome: Correlation with Anthropometric, Metabolic, and Endocrine Parameters","volume":"6","author":"Houjeghani","year":"2012","journal-title":"Int. J. Fertil Steril"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"4475","DOI":"10.1210\/jc.2013-1526","article-title":"Basal and Meal-Stimulated Ghrelin, PYY, CCK Levels and Satiety in Lean Women With Polycystic Ovary Syndrome: Effect of Low-Dose Oral Contraceptive","volume":"98","author":"Arusoglu","year":"2013","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"560","DOI":"10.1126\/science.aad3503","article-title":"Population-level analysis of gut microbiome variation","volume":"352","author":"Falony","year":"2016","journal-title":"Science"},{"key":"ref_48","doi-asserted-by":"crossref","unstructured":"Dominianni, C., Sinha, R., Goedert, J.J., Pei, Z., Yang, L., Hayes, R.B., and Ahn, J. (2015). Sex, Body Mass Index, and Dietary Fiber Intake Influence the Human Gut Microbiome. PLoS ONE, 10.","DOI":"10.1371\/journal.pone.0124599"},{"key":"ref_49","first-page":"1","article-title":"Fiber-utilizing capacity varies in Prevotella- versus Bacteroides-dominated gut microbiota","volume":"7","author":"Chen","year":"2017","journal-title":"Sci. Rep."},{"key":"ref_50","doi-asserted-by":"crossref","unstructured":"Haro, C., Rangel-Z\u00fa\u00f1iga, O.A., Alcal\u00e1-D\u00edaz, J.F., G\u00f3mez-Delgado, F., P\u00e9rez-Mart\u00ednez, P., Delgado-Lista, J., Quintana-Navarro, G.M., Landa, B.B., Cort\u00e9s, J.A.N., and Tena-Sempere, M. (2016). Intestinal Microbiota Is Influenced by Gender and Body Mass Index. PLoS ONE, 11.","DOI":"10.1371\/journal.pone.0154090"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"23001","DOI":"10.1038\/srep23001","article-title":"Castration influences intestinal microflora and induces abdominal obesity in high-fat diet-fed mice","volume":"6","author":"Harada","year":"2016","journal-title":"Sci. Rep."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"2228","DOI":"10.4014\/jmb.1710.10001","article-title":"Difference in the Gut Microbiome between Ovariectomy-Induced Obesity and Diet-Induced Obesity","volume":"27","author":"Choi","year":"2017","journal-title":"J. Microbiol. Biotechnol."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"291","DOI":"10.1017\/S0954422418000136","article-title":"Source and amount of carbohydrate in the diet and inflammation in women with polycystic ovary syndrome","volume":"31","author":"Barrea","year":"2018","journal-title":"Nutr. Res. Rev."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"110958","DOI":"10.1016\/j.biopha.2020.110958","article-title":"Alterations in the intestinal microbiome associated with PCOS affect the clinical phenotype","volume":"133","author":"Wang","year":"2021","journal-title":"Biomed. Pharmacother."},{"key":"ref_55","first-page":"1","article-title":"Immunomodulatory potential of gut microbiome-derived short-chain fatty acids (SCFAs)","volume":"66","author":"Ratajczak","year":"2019","journal-title":"Acta Biochim. Pol."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"e00017-19","DOI":"10.1128\/mSystems.00017-19","article-title":"Probiotic Bifidobacterium lactis V9 Regulates the Secretion of Sex Hormones in Polycystic Ovary Syndrome Patients through the Gut-Brain Axis","volume":"4","author":"Zhang","year":"2019","journal-title":"mSystems"},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1111\/j.1600-0757.2011.00398.x","article-title":"Sex and the subgingival microbiome: Do female sex steroids affect periodontal bacteria?","volume":"61","author":"Kumar","year":"2013","journal-title":"Periodontol. 2000"},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1016\/j.maturitas.2016.05.015","article-title":"Menopause and the vaginal microbiome","volume":"91","author":"Muhleisen","year":"2016","journal-title":"Maturitas"},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1002\/ajpa.22395","article-title":"The primate vaginal microbiome: Comparative context and implications for human health and disease","volume":"152","author":"Stumpf","year":"2013","journal-title":"Am. J. Phys. Anthr."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"132ra52","DOI":"10.1126\/scitranslmed.3003605","article-title":"Temporal Dynamics of the Human Vaginal Microbiota","volume":"4","author":"Gajer","year":"2012","journal-title":"Sci. Transl. Med."},{"key":"ref_61","first-page":"1","article-title":"The microbiota continuum along the female reproductive tract and its relation to uterine-related diseases","volume":"8","author":"Chen","year":"2017","journal-title":"Nat. Commun."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1016\/j.chom.2018.01.013","article-title":"Cervicovaginal Microbiota and Reproductive Health: The Virtue of Simplicity","volume":"23","author":"Anahtar","year":"2018","journal-title":"Cell Host Microbe"},{"key":"ref_63","doi-asserted-by":"crossref","unstructured":"Tu, Y., Zheng, G., Ding, G., Wu, Y., Xi, J., Ge, Y., Gu, H., Wang, Y., Sheng, J., and Liu, X. (2020). Comparative Analysis of Lower Genital Tract Microbiome Between PCOS and Healthy Women. Front. Physiol., 11.","DOI":"10.3389\/fphys.2020.01108"},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"103696","DOI":"10.1016\/j.micpath.2019.103696","article-title":"Crosstalk between Vaginal Microbiome and Female Health: A review","volume":"136","author":"Gupta","year":"2019","journal-title":"Microb. Pathog."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"264","DOI":"10.1111\/1471-0528.15972","article-title":"The association between vaginal bacterial composition and miscarriage: A nested case\u2013control study","volume":"127","author":"Bobdiwala","year":"2020","journal-title":"BJOG Int. J. Obstet. Gynaecol."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1016\/j.placenta.2019.03.011","article-title":"The influence of the vaginal microbiota on preterm birth: A systematic review and recommendations for a minimum dataset for future research","volume":"79","author":"Peelen","year":"2019","journal-title":"Placenta"},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"1042","DOI":"10.1093\/humrep\/dez065","article-title":"The vaginal microbiome as a predictor for outcome of in vitro fertilization with or without intracytoplasmic sperm injection: A prospective study","volume":"34","author":"Koedooder","year":"2019","journal-title":"Hum. Reprod."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1016\/j.ejogrb.2019.12.035","article-title":"Bacterial vaginosis\u2014A brief synopsis of the literature","volume":"245","author":"Coudray","year":"2020","journal-title":"Eur. J. Obstet. Gynecol. Reprod. Biol."},{"key":"ref_69","doi-asserted-by":"crossref","unstructured":"Vestby, L.K., Gr\u00f8nseth, T., Simm, R., and Nesse, L.L. (2020). Bacterial Biofilm and its Role in the Pathogenesis of Disease. Antibiotics, 9.","DOI":"10.3390\/antibiotics9020059"},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1128\/CMR.00075-15","article-title":"The Human Microbiome during Bacterial Vaginosis","volume":"29","author":"Onderdonk","year":"2016","journal-title":"Clin. Microbiol. Rev."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12967-017-1175-y","article-title":"Influence of diet on the gut microbiome and implications for human health","volume":"15","author":"Singh","year":"2017","journal-title":"J. Transl. Med."},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"776","DOI":"10.1126\/science.aau5812","article-title":"The gut microbiota at the intersection of diet and human health","volume":"362","author":"Gentile","year":"2018","journal-title":"Science"},{"key":"ref_73","doi-asserted-by":"crossref","unstructured":"Klement, R.J., and Pazienza, V. (2019). Impact of Different Types of Diet on Gut Microbiota Profiles and Cancer Prevention and Treatment. Medicina, 55.","DOI":"10.3390\/medicina55040084"},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"859","DOI":"10.1507\/endocrj.EJ18-0567","article-title":"Inulin and metformin ameliorate polycystic ovary syndrome via anti-inflammation and modulating gut microbiota in mice","volume":"66","author":"Xue","year":"2019","journal-title":"Endocr. J."},{"key":"ref_75","first-page":"1","article-title":"Effects of Probiotic Supplementation on Hormonal Profiles, Biomarkers of Inflammation and Oxida-tive Stress in Women With Polycystic Ovary Syndrome: A Randomized, Double-Blind, Pla-cebo-Controlled Trial","volume":"21","author":"Karamali","year":"2018","journal-title":"Arch. Iran Med."},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1055\/a-1081-2036","article-title":"Exploration of the Relationship Between Gut Microbiota and Polycystic Ovary Syndrome (PCOS): A Review","volume":"80","author":"Zhao","year":"2020","journal-title":"Geburtshilfe Frauenheilkd."},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"819","DOI":"10.1080\/13543784.2020.1781815","article-title":"Current and experimental drug therapy for the treatment of polycystic ovarian syndrome","volume":"29","author":"Foreste","year":"2020","journal-title":"Expert Opin. Investig. Drugs"},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"468","DOI":"10.1097\/MCG.0b013e3182549092","article-title":"World Gastroenterology Organisation Global Guidelines","volume":"46","author":"Guarner","year":"2012","journal-title":"J. Clin. Gastroenterol."},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"254","DOI":"10.1080\/14647273.2017.1283446","article-title":"Probiotic supplementation and the effects on weight loss, glycaemia and lipid profiles in women with polycystic ovary syndrome: A randomized, double-blind, placebo-controlled trial","volume":"20","author":"Ahmadi","year":"2017","journal-title":"Hum. Fertil."},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"27","DOI":"10.4103\/2008-7802.153866","article-title":"Effects of probiotic supplementation on pancreatic \u03b2-cell function and c-reactive protein in women with polycystic ovary syndrome: A randomized double-blind placebo-controlled clinical trial","volume":"6","author":"Askari","year":"2015","journal-title":"Int. J. Prev. Med."},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"317","DOI":"10.1016\/j.jff.2017.06.029","article-title":"Effects of probiotics supplementation on macrophage migration inhibitory factor and clinical laboratory feature of polycystic ovary syndrome","volume":"36","author":"Rashad","year":"2017","journal-title":"J. Funct. Foods"},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"1236","DOI":"10.1007\/s12602-018-9493-9","article-title":"The Effects of Probiotics or Synbiotics Supplementation in Women with Polycystic Ovarian Syndrome: A Systematic Review and Meta-Analysis of Randomized Clinical Trials","volume":"11","author":"Heshmati","year":"2019","journal-title":"Probiotics Antimicrob. Proteins"},{"key":"ref_83","doi-asserted-by":"crossref","first-page":"433","DOI":"10.1007\/s00394-019-02033-1","article-title":"The effect of probiotics, prebiotics, and synbiotics on hormonal and inflammatory indices in women with polycystic ovary syndrome: A systematic review and meta-analysis","volume":"59","author":"Shamasbi","year":"2019","journal-title":"Eur. J. Nutr."},{"key":"ref_84","doi-asserted-by":"crossref","first-page":"629","DOI":"10.1007\/s00394-018-1648-7","article-title":"The effect of resistant dextrin as a prebiotic on metabolic parameters and androgen level in women with polycystic ovarian syndrome: A randomized, triple-blind, controlled, clinical trial","volume":"58","author":"Shamasbi","year":"2018","journal-title":"Eur. J. Nutr."},{"key":"ref_85","first-page":"371","article-title":"A New Approach to Polycystic Ovary Syndrome: The Gut Microbiota","volume":"39","year":"2019","journal-title":"J. Am. Coll. Nutr."},{"key":"ref_86","doi-asserted-by":"crossref","first-page":"306","DOI":"10.1016\/j.jff.2017.12.047","article-title":"The probiotic supplementation reduced inflammation in polycystic ovary syndrome: A randomized, double-blind, placebo-controlled trial","volume":"42","author":"Ghanei","year":"2018","journal-title":"J. Funct. Foods"},{"key":"ref_87","first-page":"63","article-title":"Prebiyotikler ve Probiyotiklerin Diyabet ile Iliskisi","volume":"11","author":"Altun","year":"2017","journal-title":"Turk. J. Life Sci."},{"key":"ref_88","doi-asserted-by":"crossref","first-page":"1197","DOI":"10.1016\/j.clnu.2016.10.003","article-title":"Effects of inulin-type fructans, galacto-oligosaccharides and related synbiotics on inflammatory markers in adult patients with overweight or obesity: A systematic review","volume":"36","author":"Fernandes","year":"2017","journal-title":"Clin. Nutr."},{"key":"ref_89","doi-asserted-by":"crossref","first-page":"541","DOI":"10.1093\/cid\/cit950","article-title":"Fecal Microbiota Transplantation: A Practical Update for the Infectious Disease Specialist","volume":"58","author":"Moore","year":"2014","journal-title":"Clin. Infect. Dis."},{"key":"ref_90","doi-asserted-by":"crossref","first-page":"281","DOI":"10.1530\/JOE-19-0589","article-title":"The therapeutic effect of interleukin-22 in high androgen-induced polycystic ovary syndrome","volume":"245","author":"Qi","year":"2020","journal-title":"J. Endocrinol."},{"key":"ref_91","doi-asserted-by":"crossref","first-page":"565","DOI":"10.1038\/s41574-019-0255-x","article-title":"IL-22 links gut microbiota to PCOS","volume":"15","author":"Kriebs","year":"2019","journal-title":"Nat. Rev. Endocrinol."}],"container-title":["International Journal of Molecular Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1422-0067\/22\/4\/2048\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T05:26:04Z","timestamp":1760160364000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1422-0067\/22\/4\/2048"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,2,19]]},"references-count":91,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2021,2]]}},"alternative-id":["ijms22042048"],"URL":"https:\/\/doi.org\/10.3390\/ijms22042048","relation":{},"ISSN":["1422-0067"],"issn-type":[{"value":"1422-0067","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,2,19]]}}}