1 5104 60 POLYCYSTIC OVARIAN SYNDROME. WOMEN WITH PCOS PRESENT WITH SIGNS OF CHRONIC ANOVULATION, HYPERANDROGENISM, AND METABOLIC ABNORMALITIES. THE NIH RECENTLY EMBRACED THE ROTTERDAM CRITERIA TO BROADLY IDENTIFY ALL THE PHENOTYPES OF PCOS. WOMEN WITH PCOS ARE OFTEN OBESE WITH INSULIN RESISTANCE AND HENCE HAVE AN INCREASED SUSCEPTIBILITY TO GLUCOSE INTOLERANCE AND TYPE 2 DIABETES. FUTURE RESEARCH SHOULD FOCUS ON THE GENETIC, EPIGENETIC, AND ENVIRONMENTAL DETERMINANTS OF PCOS TO DEVELOP NEW THERAPIES TO ADDRESS THE PREVENTION OF THIS DISORDER AND ITS LONG-TERM COMPLICATIONS. 2015 2 3750 22 INSULIN RESISTANCE IN POLYCYSTIC OVARY SYNDROME ACROSS VARIOUS TISSUES: AN UPDATED REVIEW OF PATHOGENESIS, EVALUATION, AND TREATMENT. POLYCYSTIC OVARY SYNDROME (PCOS) IS A COMMON ENDOCRINE DISORDER CHARACTERIZED BY CHRONIC OVULATION DYSFUNCTION AND OVERABUNDANCE OF ANDROGENS; IT AFFECTS 6-20% OF WOMEN OF REPRODUCTIVE AGE. PCOS INVOLVES VARIOUS PATHOPHYSIOLOGICAL FACTORS, AND AFFECTED WOMEN USUALLY HAVE SIGNIFICANT INSULIN RESISTANCE (IR), WHICH IS A MAJOR CAUSE OF PCOS. IR AND COMPENSATORY HYPERINSULINAEMIA HAVE DIFFERING PATHOGENESES IN VARIOUS TISSUES, AND IR VARIES AMONG DIFFERENT PCOS PHENOTYPES. GENETIC AND EPIGENETIC CHANGES, HYPERANDROGENAEMIA, AND OBESITY AGGRAVATE IR. INSULIN SENSITIZATION DRUGS ARE A NEW TREATMENT MODALITY FOR PCOS. WE SEARCHED PUBMED, GOOGLE SCHOLAR, ELSEVIER, AND UPTODATE DATABASES IN THIS REVIEW, AND FOCUSED ON THE PATHOGENESIS OF IR IN WOMEN WITH PCOS AND THE PATHOPHYSIOLOGY OF IR IN VARIOUS TISSUES. IN ADDITION, THE REVIEW PROVIDES A COMPREHENSIVE OVERVIEW OF THE CURRENT PROGRESS IN THE EFFICACY OF INSULIN SENSITIZATION THERAPY IN THE MANAGEMENT OF PCOS, PROVIDING THE LATEST EVIDENCE FOR THE CLINICAL TREATMENT OF WOMEN WITH PCOS AND IR. 2023 3 4892 24 OXIDATIVE STRESS AND REPRODUCTIVE FUNCTION: OXIDATIVE STRESS IN POLYCYSTIC OVARY SYNDROME. IN BRIEF: A GENETIC, EPIGENETIC, AND ENVIRONMENTAL ASSOCIATION EXISTS BETWEEN OXIDATIVE STRESS (OS) AND POLYCYSTIC OVARY SYNDROME (PCOS), EXPRESSED IN A MULTIFACETED CLINICAL PROFILE. THIS REVIEW SUMMARIZES AND DISCUSSES THE ROLE OF OS IN THE PATHOGENESIS OF PCOS SYNDROME, FOCUSING ON METABOLIC, REPRODUCTIVE, AND CANCER COMPLICATIONS. ABSTRACT: OXIDATIVE STRESS (OS), AN IMBALANCE BETWEEN OXIDANTS AND ANTIOXIDANTS IN CELLS, IS ONE OF MANY FACTORS PLAYING ESSENTIAL ROLES IN THE PATHOGENESIS OF POLYCYSTIC OVARY SYNDROME (PCOS). PCOS IS DESCRIBED MAINLY AS A DISPROPORTION OF REPRODUCTIVE HORMONES, LEADING TO CHRONIC ANOVULATION AND INFERTILITY IN WOMEN. INTERESTINGLY, OS IN PCOS MAY BE ASSOCIATED WITH MANY DISORDERS AND DISEASES. THIS REVIEW FOCUSES ON CHARACTERISTIC MARKERS OF OS IN PCOS AND THE RELATIONSHIP BETWEEN OS AND PCOS RELATED TO INSULIN RESISTANCE (IR), HYPERANDROGENEMIA, OBESITY, CHRONIC INFLAMMATION, CARDIOVASCULAR DISEASES, AND CANCER. INTERESTINGLY, IN PATIENTS WITH PCOS, AN INCREASE IN OXIDATIVE STATUS AND INSUFFICIENT COMPENSATION OF THE INCREASE IN ANTIOXIDANT STATUS BEFORE ANY CARDIOVASCULAR COMPLICATIONS ARE OBSERVED. MOREOVER, FREE RADICALS PROMOTE CARCINOGENESIS IN PCOS PATIENTS. HOWEVER, DESPITE THESE DATA, IT HAS NOT BEEN ESTABLISHED WHETHER OXYGEN STRESS INFLUENCES PCOS DEVELOPMENT OR A SECONDARY DISORDER RESULTING FROM HYPERGLYCEMIA, IR, AND CARDIOVASCULAR AND CANCER COMPLICATIONS IN WOMEN. 2022 4 4403 21 MODULATION OF THE INFLAMMATORY RESPONSE IN POLYCYSTIC OVARY SYNDROME (PCOS)-SEARCHING FOR EPIGENETIC FACTORS. POLYCYSTIC OVARY SYNDROME (PCOS) IS THE MOST COMMON ENDOCRINE DISORDER IN WOMEN OF REPRODUCTIVE AGE. DESPITE ITS INCIDENCE, THE SYNDROME IS POORLY UNDERSTOOD AND REMAINS UNDERDIAGNOSED, AND FEMALE PATIENTS ARE DIAGNOSED WITH A DELAY. THE HETEROGENOUS NATURE OF THIS COMPLEX DISORDER RESULTS FROM THE COMBINED OCCURRENCE OF GENETIC, ENVIRONMENTAL, ENDOCRINE, AND BEHAVIORAL FACTORS. PRIMARY CLINICAL MANIFESTATIONS OF PCOS ARE DERIVED FROM THE EXCESS OF ANDROGENS (ANOVULATION, POLYCYSTIC OVARY MORPHOLOGY, LACK OF OR SCANTY, IRREGULAR MENSTRUAL PERIODS, ACNE AND HIRSUTISM), WHEREAS THE SECONDARY MANIFESTATIONS INCLUDE MULTIPLE METABOLIC, CARDIOVASCULAR, AND PSYCHOLOGICAL DISORDERS. DIETARY AND LIFESTYLE FACTORS PLAY IMPORTANT ROLES IN THE DEVELOPMENT AND COURSE OF PCOS, WHICH SUGGESTS STRONG EPIGENETIC AND ENVIRONMENTAL INFLUENCES. MANY STUDIES HAVE SHOWN A STRONG ASSOCIATION BETWEEN PCOS AND CHRONIC, LOW-GRADE INFLAMMATION BOTH IN THE OVARIAN TISSUE AND THROUGHOUT THE BODY. IN THE VAST MAJORITY OF PCOS PATIENTS, ELEVATED VALUES OF INFLAMMATORY MARKERS OR THEIR GENE MARKERS HAVE BEEN REPORTED. DEVELOPMENT OF THE VICIOUS CYCLE OF THE CHRONIC INFLAMMATORY STATE IN PCOS IS ADDITIONALLY STIMULATED BY HYPERINSULINEMIA AND OBESITY. CHANGES IN DNA METHYLATION, HISTONE ACETYLATION AND NONCODING RNA LEVELS ARE PRESENTED IN THIS REVIEW IN THE CONTEXT OF OXIDATIVE STRESS, REACTIVE OXYGEN SPECIES, AND INFLAMMATORY SIGNALING IN PCOS. EPIGENETIC MODULATION OF ANDROGENIC ACTIVITY IN RESPONSE TO INFLAMMATORY SIGNALING IS ALSO DISCUSSED. 2022 5 5107 20 POLYCYSTIC OVARY SYNDROME: A BRAIN DISORDER CHARACTERIZED BY EATING PROBLEMS ORIGINATING DURING PUBERTY AND ADOLESCENCE. POLYCYSTIC OVARY SYNDROME (PCOS) IS AN ENDOCRINE CONDITION ASSOCIATED WITH REPRODUCTIVE AND PSYCHIATRIC DISORDERS, AND WITH OBESITY. EATING DISORDERS, SUCH AS BULIMIA AND RECURRENT DIETING, ARE ALSO LINKED TO PCOS. THEY CAN LEAD TO THE EPIGENETIC DYSREGULATION OF THE HYPOTHALAMIC-PITUITARY-GONADAL (HPG) AXIS, THEREBY IMPACTING ON OVARIAN FOLLICULOGENESIS. WE POSTULATE THAT PCOS IS INDUCED BY PSYCHOLOGICAL DISTRESS AND EPISODES OF OVEREATING AND/OR DIETING DURING PUBERTY AND ADOLESCENCE, WHEN BODY DISSATISFACTION AND EMOTIONAL DISTRESS ARE OFTEN PRESENT. WE PROPOSE THAT UPREGULATED ACTIVATION OF THE CENTRAL HPG AXIS DURING THIS PERIOD CAN BE EPIGENETICALLY ALTERED BY PSYCHOLOGICAL STRESSORS AND BY BULIMIA/RECURRENT DIETING, WHICH ARE COMMON DURING ADOLESCENCE AND WHICH CAN LEAD TO PCOS. THIS HYPOTHESIS IS BASED ON EVENTS THAT OCCUR DURING A LARGELY NEGLECTED STAGE OF FEMALE REPRODUCTIVE DEVELOPMENT. TO DATE, MOST RESEARCH INTO THE ORIGINS OF PCOS HAS FOCUSED ON THE PRENATAL INDUCTION OF THIS DISORDER, PARTICULARLY IN UTERO ANDROGENIZATION AND THE ROLE OF ANTI-MULLERIAN HORMONE. ESTABLISHING CAUSALITY IN OUR PERIPUBERTAL MODEL REQUIRES PROSPECTIVE COHORT STUDIES FROM INFANCY. MECHANISTIC STUDIES SHOULD CONSIDER THE ROLE OF THE GUT MICROBIOTA IN ADDITION TO THE EPIGENETIC REGULATION OF (NEURO) HORMONES. FINALLY, CLINICIANS SHOULD CONSIDER THE IMPORTANCE OF UNDERLYING CHRONIC PSYCHOLOGICAL DISTRESS AND EATING DISORDERS IN PCOS. 2020 6 5105 29 POLYCYSTIC OVARIAN SYNDROME: A COMPLEX DISEASE WITH A GENETICS APPROACH. POLYCYSTIC OVARIAN SYNDROME (PCOS) IS A COMPLEX ENDOCRINE DISORDER AFFECTING FEMALES IN THEIR REPRODUCTIVE AGE. THE EARLY DIAGNOSIS OF PCOS IS COMPLICATED AND COMPLEX DUE TO OVERLAPPING SYMPTOMS OF THIS DISEASE. THE MOST ACCEPTED DIAGNOSTIC APPROACH TODAY IS THE ROTTERDAM CONSENSUS (2003), WHICH SUPPORTS THE POSITIVE DIAGNOSIS OF PCOS WHEN PATIENTS PRESENT TWO OUT OF THE FOLLOWING THREE SYMPTOMS: BIOCHEMICAL AND CLINICAL SIGNS OF HYPERANDROGENISM, OLIGO, AND ANOVULATION, ALSO POLYCYSTIC OVARIAN MORPHOLOGY ON SONOGRAPHY. GENETIC VARIANCE, EPIGENETIC CHANGES, AND DISTURBED LIFESTYLE LEAD TO THE DEVELOPMENT OF PATHOPHYSIOLOGICAL DISTURBANCES, WHICH INCLUDE HYPERANDROGENISM, INSULIN RESISTANCE, AND CHRONIC INFLAMMATION IN PCOS FEMALES. AT THE MOLECULAR LEVEL, DIFFERENT PROTEINS AND MOLECULAR AND SIGNALING PATHWAYS ARE INVOLVED IN DISEASE PROGRESSION, WHICH LEADS TO THE FAILURE OF A SINGLE GENETIC DIAGNOSTIC APPROACH. THE GENETIC APPROACH TO ELUCIDATE THE MECHANISM OF PATHOGENESIS OF PCOS WAS RECENTLY DEVELOPED, WHEREBY FOUR PHENOTYPIC VARIANCES OF PCOS CATEGORIZE PCOS PATIENTS INTO CLASSIC, OVULATORY, AND NON-HYPERANDROGENIC TYPES. GENETIC STUDIES HELP TO IDENTIFY THE ROOT CAUSE FOR THE DEVELOPMENT OF THIS PCOS. PCOS GENETIC INHERITANCE IS AUTOSOMAL DOMINANT BUT THE LATEST INVESTIGATIONS REVEALED IT AS A MULTIGENE ORIGIN DISEASE. DIFFERENT GENETIC LOCI AND SPECIFIC GENES HAVE BEEN IDENTIFIED SO FAR AS BEING ASSOCIATED WITH THIS DISEASE. GENOME-WIDE ASSOCIATION STUDIES (GWAS) AND RELATED GENETIC STUDIES HAVE CHANGED THE SCENARIO FOR THE DIAGNOSIS AND TREATMENT OF THIS REPRODUCTIVE AND METABOLIC CONDITION KNOWN AS PCOS. THIS REVIEW ARTICLE BRIEFLY DISCUSSES DIFFERENT GENES ASSOCIATED DIRECTLY OR INDIRECTLY WITH DISEASE DEVELOPMENT AND PROGRESSION. 2022 7 4973 26 PATHOPHYSIOLOGICAL EFFECTS OF CONTEMPORARY LIFESTYLE ON EVOLUTIONARY-CONSERVED SURVIVAL MECHANISMS IN POLYCYSTIC OVARY SYNDROME. POLYCYSTIC OVARY SYNDROME (PCOS) IS INCREASINGLY BEING CHARACTERIZED AS AN EVOLUTIONARY MISMATCH DISORDER THAT PRESENTS WITH A COMPLEX MIXTURE OF METABOLIC AND ENDOCRINE SYMPTOMS. THE EVOLUTIONARY MODEL PROPOSES THAT PCOS ARISES FROM A COLLECTION OF INHERITED POLYMORPHISMS THAT HAVE BEEN CONSISTENTLY DEMONSTRATED IN A VARIETY OF ETHNIC GROUPS AND RACES. IN UTERO DEVELOPMENTAL PROGRAMMING OF SUSCEPTIBLE GENOMIC VARIANTS ARE THOUGHT TO PREDISPOSE THE OFFSPRING TO DEVELOP PCOS. POSTNATAL EXPOSURE TO LIFESTYLE AND ENVIRONMENTAL RISK FACTORS RESULTS IN EPIGENETIC ACTIVATION OF DEVELOPMENTALLY PROGRAMMED GENES AND DISTURBANCE OF THE HALLMARKS OF HEALTH. THE RESULTING PATHOPHYSIOLOGICAL CHANGES REPRESENT THE CONSEQUENCES OF POOR-QUALITY DIET, SEDENTARY BEHAVIOUR, ENDOCRINE DISRUPTING CHEMICALS, STRESS, CIRCADIAN DISRUPTION, AND OTHER LIFESTYLE FACTORS. EMERGING EVIDENCE SUGGESTS THAT LIFESTYLE-INDUCED GASTROINTESTINAL DYSBIOSIS PLAYS A CENTRAL ROLE IN THE PATHOGENESIS OF PCOS. LIFESTYLE AND ENVIRONMENTAL EXPOSURES INITIATE CHANGES THAT RESULT IN DISTURBANCE OF THE GASTROINTESTINAL MICROBIOME (DYSBIOSIS), IMMUNE DYSREGULATION (CHRONIC INFLAMMATION), ALTERED METABOLISM (INSULIN RESISTANCE), ENDOCRINE AND REPRODUCTIVE IMBALANCE (HYPERANDROGENISM), AND CENTRAL NERVOUS SYSTEM DYSFUNCTION (NEUROENDOCRINE AND AUTONOMIC NERVOUS SYSTEM). PCOS CAN BE A PROGRESSIVE METABOLIC CONDITION THAT LEADS TO OBESITY, GESTATIONAL DIABETES, TYPE TWO DIABETES, METABOLIC-ASSOCIATED FATTY LIVER DISEASE, METABOLIC SYNDROME, CARDIOVASCULAR DISEASE, AND CANCER. THIS REVIEW EXPLORES THE MECHANISMS THAT UNDERPIN THE EVOLUTIONARY MISMATCH BETWEEN ANCIENT SURVIVAL PATHWAYS AND CONTEMPORARY LIFESTYLE FACTORS INVOLVED IN THE PATHOGENESIS AND PATHOPHYSIOLOGY OF PCOS. 2023 8 5106 21 POLYCYSTIC OVARY SYNDROME IN ADULT WOMEN. POLYCYSTIC OVARY SYNDROME IS THE MOST PREVALENT ENDOCRINE-METABOLIC PATHOLOGY IN PRE-MENOPAUSAL WOMEN. ITS ETIOPATHOGENESIS IS COMPLEX, MULTIFACTORIAL AND HETEROGENEOUS, INCLUDING THE INTERACTION OF GENETIC, EPIGENETIC AND ENVIRONMENTAL FACTORS. ANDROGENIC EXCESS CONSTITUTES THE DISEASE'S MAIN PHYSIOPATHOLOGICAL MECHANISM AND RESULTS IN REPRODUCTIVE, METABOLIC AND COSMETIC ALTERATIONS WHICH NEGATIVELY IMPACT THESE PATIENTS' QUALITY OF LIFE. THE CRITERIA ESTABLISHED IN THE ROTTERDAM CONSENSUS AND THEIR CORRECT APPLICATION FORM THE NECESSARY BASIS FOR THIS SYNDROME'S PROPER DIAGNOSIS. IN THE ABSENCE OF AN AETIOLOGICAL TREATMENT, THE AIM IS TO IMPROVE THE CLINICAL SIGNS AND SYMPTOMS DERIVED FROM HYPERANDROGENISM, OVARIAN DYSFUNCTION AND EXISTING METABOLIC COMPLICATIONS, AND, THEREFORE, THEY MUST BE CHRONIC AND INDIVIDUALISED. 2019 9 4723 18 NONHUMAN PRIMATE MODELS OF POLYCYSTIC OVARY SYNDROME. WITH CLOSE GENOMIC AND PHENOTYPIC SIMILARITY TO HUMANS, NONHUMAN PRIMATE MODELS PROVIDE COMPREHENSIVE EPIGENETIC MIMICS OF POLYCYSTIC OVARY SYNDROME (PCOS), SUGGESTING EARLY LIFE TARGETING FOR PREVENTION. FETAL EXPOSURE TO TESTOSTERONE (T), OF ALL NONHUMAN PRIMATE EMULATIONS, PROVIDES THE CLOSEST PCOS-LIKE PHENOTYPES, WITH EARLY-TO-MID GESTATION T-EXPOSED FEMALE RHESUS MONKEYS EXHIBITING ADULT REPRODUCTIVE, ENDOCRINOLOGICAL AND METABOLIC DYSFUNCTIONAL TRAITS THAT ARE CO-PATHOLOGIES OF PCOS. LATE GESTATIONAL T EXPOSURE, WHILE INDUCING ADULT OVARIAN HYPERANDROGENISM AND MENSTRUAL ABNORMALITIES, HAS LESS DYSFUNCTIONAL METABOLIC ACCOMPANIMENT. FETAL EXPOSURES TO DIHYDROTESTOSTERONE (DHT) OR DIETHYLSTILBESTROL (DES) SUGGEST ANDROGENIC AND ESTROGENIC ASPECTS OF FETAL PROGRAMMING. NEONATAL EXPOSURE TO T PRODUCES NO PCOS-LIKE OUTCOME, WHILE CONTINUOUS T TREATMENT OF JUVENILE FEMALES CAUSES PRECOCIOUS WEIGHT GAIN AND EARLY MENARCHE (HIGH T), OR HIGH LH AND WEIGHT GAIN (MODERATE T). ACUTE T EXPOSURE OF ADULT FEMALES GENERATES POLYFOLLICULAR OVARIES, WHILE CHRONIC T EXPOSURE INDUCES SUBTLE MENSTRUAL IRREGULARITIES WITHOUT METABOLIC DYSFUNCTION. 2013 10 1834 23 EFFECTS OF MINDFULNESS-BASED THERAPY ON CLINICAL SYMPTOMS AND DNA METHYLATION IN PATIENTS WITH POLYCYSTIC OVARY SYNDROME AND HIGH METABOLIC RISK. POLYCYSTIC OVARY SYNDROME (PCOS) IS AN ENDOCRINE AND METABOLIC DISORDER AFFECTING WOMEN OF REPRODUCTIVE AGE. RESEARCH HAS SHOWN THAT EPIGENETIC ALTERATIONS SUCH AS DNA METHYLATION MAY PLAY A ROLE IN THE DEVELOPMENT AND PROGRESSION OF ABNORMAL OVARIAN FUNCTION AND METABOLIC DISORDERS IN PCOS. STUDIES HAVE IDENTIFIED SPECIFIC GENES (RELATED WITH INSULIN SIGNALING AND STEROID HORMONE METABOLISM) THAT ARE METHYLATED IN WOMEN WITH PCOS. DNA METHYLATION APPEARS TO RESPOND TO VARIOUS INTERVENTIONS AIMED AT ALTERING HEALTH AND LIFESTYLE FACTORS. WE TESTED THE EFFICACY OF A MINDFULNESS-BASED STRESS REDUCTION PROGRAM (MBSR) IN PCOS PATIENTS. WE EXAMINED ITS EFFECTS ON ANTHROPOMETRIC MEASUREMENTS, MENTAL HEALTH AND WELLBEING, AND ALTERATIONS IN DNA METHYLATION IN PERIPHERAL BLOOD. MBSR WAS ASSOCIATED WITH A REDUCTION IN BODY MASS INDEX, WAIST CIRCUMFERENCE AND BLOOD GLUCOSE LEVEL, AN IMPROVEMENT IN SUBJECTIVELY PERCEIVED GENERAL HEALTH, EMOTIONAL ROLE LIMITATION, AND LEVELS OF PAIN, AS WELL AS MINDFULNESS-LIKE TRAITS. MBSR REDUCED THE EXPRESSION OF ANXIOUS SYMPTOMATOLOGY AND SUBJECTIVELY PERCEIVED STRESS. METHYLATION CHANGES WERE OBSERVED IN FOUR GENES: COMT, FST, FKBP51, AND MAOA. WE CONCLUDE THAT MBSR MAY BE A USEFUL SUPPLEMENTARY THERAPY TO MITIGATE THE DELETERIOUS EFFECTS OF PCOS ON MENTAL HEALTH. 2023 11 2205 21 EPIGENETIC MODIFICATION OF THE X CHROMOSOME INFLUENCES SUSCEPTIBILITY TO POLYCYSTIC OVARY SYNDROME. CONTEXT: THE CAUSE OF POLYCYSTIC OVARY SYNDROME (PCOS) IS UNKNOWN, ALTHOUGH GENETIC AND ENVIRONMENTAL INFLUENCES ARE CLEARLY IMPLICATED. SOME GENETIC STUDIES HAVE SUGGESTED THE INVOLVEMENT OF X-LINKED GENES IN PCOS, BUT THE INFLUENCE OF X CHROMOSOME INACTIVATION (XCI) ON MANIFESTATION OF THIS DISORDER HAS NOT PREVIOUSLY BEEN EXAMINED. OBJECTIVE: THE OBJECTIVE OF THE STUDY WAS TO TEST THE NULL HYPOTHESIS THAT XCI HAS NO INFLUENCE ON CLINICAL PRESENTATION OF PCOS. DESIGN: WE EXAMINED PATTERNS OF XCI BETWEEN SISTER PAIRS WITH THE SAME GENOTYPE AT A POLYMORPHIC LOCUS ON THE X CHROMOSOME IN FAMILIES WITH PCOS. SETTING: THE STUDY WAS CONDUCTED AT A PRIVATE PRACTICE. PARTICIPANTS: PCOS WAS DEFINED AS HYPERANDROGENEMIA WITH CHRONIC ANOVULATION. FORTY FAMILIES WERE STUDIED IN WHICH DNA WAS OBTAINED FROM AT LEAST ONE PARENT, THE PROBAND, AND ONE SISTER THAT COULD BE ACCURATELY DIAGNOSED AS BEING AFFECTED OR UNAFFECTED. MAIN OUTCOME MEASURE(S): RELATIVE EXPRESSION OF TWO X-LINKED ALLELES WAS DETERMINED, AND THE RATIO OF ONE TO THE OTHER REPRESENTED THE PATTERN OF XCI. RESULTS: THE STATISTICAL ODDS ON A DIFFERENT CLINICAL PRESENTATION BETWEEN SISTERS WAS APPROXIMATELY 29 TIMES HIGHER IN SISTER PAIRS WITH DIFFERENT PATTERNS OF XCI, COMPARED WITH SISTER PAIRS WITH THE SAME PATTERN OF XCI (ODDS RATIO 28.9; 95% CONFIDENCE INTERVAL 4.0-206; P = 0.0008). CONCLUSIONS: THIS STUDY PROVIDES EVIDENCE TO REFUTE THE NULL HYPOTHESIS AND PROPOSE A CLOSER INSPECTION OF X-LINKED GENES IN PCOS, ONE IN WHICH BOTH GENOTYPE AND EPIGENOTYPE ARE CONSIDERED. ENVIRONMENTAL DETERMINANTS OF PCOS MAY ALTER CLINICAL PRESENTATION VIA EPIGENETIC MODIFICATIONS, WHICH CURRENTLY REMAIN UNDETECTED IN TRADITIONAL GENETIC ANALYSES. 2006 12 6825 13 [GENETIC AND EPIGENETIC FACTORS OF POLYCYSTIC OVARY SYNDROME]. THE DEVELOPMENT OF POLYCYSTIC OVARY SYNDROME AND ITS EXACT PATHOPHYSIOLOGICAL MECHANISM IS STILL UNCLEAR, BUT ENVIRONMENTAL AND GENETIC FACTORS LIKELY PLAY A ROLE. EXPOSITION TO TERATOGENIC EFFECTS DURING THE PRENATAL DEVELOPMENT CAN LEAD TO CHRONIC DISEASES IN THE POSTNATAL PERIOD. THIS FINDING CONFIRMS THE COMMON FAMILIAL AGGREGATION AS WELL. A LITERATURE SEARCH WAS CONDUCTED UP TO JANUARY 1, 2016 FOR ARTICLES DEALING WITH THE GENETIC OR EPIGENETIC FACTORS OF POLYCYSTIC OVARY SYNDROME. THIS REVIEW WILL DISCUSS THE CURRENT UNDERSTANDING OF THE GENETIC BASIS AND CLINICAL PRESENTATION OF THIS DISEASE. ORV. HETIL., 2016, 157(32), 1275-1281. 2016 13 259 24 ADVANCES IN PCOS PATHOGENESIS AND PROGRESSION-MITOCHONDRIAL MUTATIONS AND DYSFUNCTION. POLYCYSTIC OVARY SYNDROME (PCOS) IS A COMMON FEMALE ENDOCRINE DISORDER, WHICH STILL REMAINS LARGELY UNSOLVED IN TERMS OF ETIOLOGY AND PATHOGENESIS DESPITE IMPORTANT ADVANCES IN OUR UNDERSTANDING OF ITS GENETIC, EPIGENETIC, OR ENVIRONMENTAL FACTOR IMPLICATIONS. IT IS A HETEROGENEOUS DISEASE, FREQUENTLY ASSOCIATED WITH INSULIN RESISTANCE, CHRONIC INFLAMMATION, AND OXIDATIVE STRESS AND PROBABLY ACCOMPANIED WITH SUBCLINICAL CARDIOVASCULAR DISEASE (CVD) AND SOME MALIGNANT LESIONS AS WELL, SUCH AS ENDOMETRIAL CANCER. DISCREPANCIES IN THE CLINICAL PHENOTYPE AND PROGRESSION OF PCOS EXIST BETWEEN DIFFERENT POPULATION GROUPS, WHICH NUCLEAR GENETIC STUDIES HAVE SO FAR FAILED TO EXPLAIN. OVER THE LAST YEARS, MITOCHONDRIAL DYSFUNCTION HAS BEEN INCREASINGLY RECOGNIZED AS AN IMPORTANT CONTRIBUTOR TO AN ARRAY OF DISEASES. BECAUSE MITOCHONDRIA ARE UNDER THE DUAL GENETIC CONTROL OF BOTH THE MITOCHONDRIAL AND NUCLEAR GENOMES, MUTATIONS WITHIN EITHER DNA MOLECULE MAY RESULT IN DEFICIENCY IN RESPIRATORY CHAIN FUNCTION THAT LEADS TO A REDUCED ABILITY TO PRODUCE CELLULAR ADENOSINE-5'-TRIPHOSPHATE AND TO AN EXCESSIVE PRODUCTION OF REACTIVE OXYGEN SPECIES. HOWEVER, THE ASSOCIATION BETWEEN VARIANTS IN MITOCHONDRIAL GENOME, MITOCHONDRIAL DYSFUNCTION, AND PCOS HAS BEEN INVESTIGATED TO A LESSER EXTENT. MAY MUTATIONS IN MITOCHONDRIAL DNA (MTDNA) BECOME AN ADDITIONAL TARGET OF INVESTIGATIONS ON THE MISSING PCOS HERITABILITY? ARE MUTATIONS IN MTDNA IMPLICATED IN THE INITIATION AND PROGRESSION OF PCOS COMPLICATIONS, E.G., CVDS, DIABETES MELLITUS, CANCERS? 2018 14 3085 14 GENOME-WIDE SCREEN OF OVARY-SPECIFIC DNA METHYLATION IN POLYCYSTIC OVARY SYNDROME. OBJECTIVE: TO COMPARE GENOME-WIDE DNA METHYLATION PROFILES IN OVARY TISSUE FROM WOMEN WITH POLYCYSTIC OVARY SYNDROME (PCOS) AND HEALTHY CONTROLS. DESIGN: CASE-CONTROL STUDY MATCHED FOR AGE AND BODY MASS INDEX. SETTING: UNIVERSITY-AFFILIATED HOSPITAL. PATIENT(S): TEN WOMEN WITH PCOS WHO UNDERWENT OVARIAN DRILLING TO INDUCE OVULATION AND 10 HEALTHY WOMEN WHO WERE UNDERGOING LAPAROSCOPIC STERILIZATION, HYSTERECTOMY FOR BENIGN CONDITIONS, DIAGNOSTIC LAPAROSCOPY FOR PELVIC PAIN, OR OOPHORECTOMY FOR NONOVARIAN INDICATIONS. INTERVENTION(S): NONE. MAIN OUTCOME MEASURE(S): GENOME-WIDE DNA METHYLATION PATTERNS DETERMINED BY IMMUNOPRECIPITATION AND MICROARRAY (MEDIP-CHIP) ANALYSIS. RESULT(S): THE METHYLATION LEVELS WERE STATISTICALLY SIGNIFICANTLY HIGHER IN CPG ISLAND SHORES (CGI SHORES), WHICH LIE OUTSIDE OF CORE PROMOTER REGIONS, AND LOWER WITHIN GENE BODIES IN WOMEN WITH PCOS RELATIVE TO THE CONTROLS. IN ADDITION, HIGH CPG CONTENT PROMOTERS WERE THE MOST FREQUENTLY HYPERMETHYLATED PROMOTERS IN PCOS OVARIES BUT WERE MORE OFTEN HYPOMETHYLATED IN CONTROLS. SECOND, 872 CGIS, SPECIFICALLY METHYLATED IN PCOS, REPRESENTED 342 GENES THAT COULD BE ASSOCIATED WITH VARIOUS MOLECULAR FUNCTIONS, INCLUDING PROTEIN BINDING, HORMONE ACTIVITY, AND TRANSCRIPTION REGULATOR ACTIVITY. FINALLY, METHYLATION DIFFERENCES WERE VALIDATED IN SEVEN GENES BY METHYLATION-SPECIFIC POLYMERASE CHAIN REACTION. THESE GENES CORRELATED TO SEVERAL FUNCTIONAL FAMILIES RELATED TO THE PATHOGENESIS OF PCOS AND MAY BE POTENTIAL BIOMARKERS FOR THIS DISEASE. CONCLUSION(S): OUR RESULTS DEMONSTRATED THAT EPIGENETIC MODIFICATION DIFFERS BETWEEN PCOS AND NORMAL OVARIES, WHICH MAY HELP TO FURTHER UNDERSTAND THE PATHOPHYSIOLOGY OF THIS DISEASE. 2015 15 6116 18 THE EPIGENETIC CORRELATION AMONG OVARIAN CANCER, ENDOMETRIOSIS AND PCOS: A REVIEW. OVARIAN CANCER IS A FREQUENT MALIGNANCY THAT AFFECTS A LARGE PERCENTAGE OF WOMEN. ENDOMETRIOSIS IS A CHRONIC CONDITION, WHERE THERE IS A PRODUCTION OF BENIGN LESIONS WERE OBSERVED IN THE UTERINE ENVIRONMENT. PCOS IS A METABOLIC DISORDER CHARACTERIZED BY THE PRESENCE OF NUMEROUS CYSTS IN THE OVARIES. THE RELATION BETWEEN OVARIAN MALIGNANCIES AND PCOS, BY AN INCREASED RATIO OF OVARIAN STROMAL TISSUES IN PCOS PATIENTS. THE DIRECT CORRELATION IS NOT YET CONFIRMED AMONG THE THREE DISORDERS, BUT IT IS OFTEN NOTED THAT THEY SHARE RISK FACTORS, SUCH AS OBESITY, HORMONAL IMBALANCES. EPIGENETIC FACTORS HAVE SHOWN TO BE AN IMPORTANT REASON FOR CANCER PROGRESSION. OUR FINDINGS AT THE EPIGENETIC LEVEL INCLUDES A COMPARATIVE ANALYSIS, POINT MUTATIONS IN GENES, OVERACTIVATION OF SIGNALING PATHWAYS. THIS REVIEW PAPER, HIGHLIGHT THE POSSIBLE CORRELATION BETWEEN THE THREE DISORDERS IN TERMS OF GENETIC AND EPIGENETIC FACTORS AND HOW IT COULD TOGETHER TRIGGER THE CANCER PROGRESSION AND METASTASIS. 2022 16 1919 20 ENVIRONMENTAL ENDOCRINE DISRUPTORS: NEW DIABETOGENS? THE PREVALENCE OF TYPE-2 DIABETES HAS DRAMATICALLY INCREASED WORLDWIDE DURING THE LAST FEW DECADES. WHILE LIFESTYLE FACTORS (SEDENTARINESS, NOXIOUS FOOD), TOGETHER WITH GENETIC SUSCEPTIBILITY, ARE WELL-KNOWN ACTORS, THERE IS ACCUMULATING EVIDENCE SUGGESTING THAT ENDOCRINE DISRUPTING CHEMICALS (EDCS) MAY ALSO PLAY A PATHOPHYSIOLOGICAL ROLE IN THE OCCURRENCE OF METABOLIC DISEASES. BOTH EXPERIMENTAL AND EPIDEMIOLOGICAL EVIDENCE SUPPORT A ROLE FOR EARLY AND CHRONIC EXPOSURE TO LOW DOSES OF CHEMICAL POLLUTANTS WITH ENDOCRINE AND METABOLIC DISRUPTING EFFECTS. MOST ARE PRESENT IN THE FOOD CHAIN AND ACCUMULATE IN THE FAT MASS AFTER ABSORPTION. IN RODENTS, BISPHENOL A STIMULATES SYNTHESIS AND SECRETION OF PANCREATIC BETA CELLS AND DISTURBS INSULIN SIGNALING IN LIVER, MUSCLE AND ADIPOSE TISSUE THROUGH EPIGENETIC CHANGES LEADING TO INSULIN RESISTANCE AND BETA CELL IMPAIRMENT. IN HUMANS, EPIDEMIOLOGICAL REPORTS SHOW STATISTICAL LINK BETWEEN EXPOSURE TO PESTICIDES, POLYCHLORINATED BISPHENYLS, BISPHENOL A, PHTHALATES, DIOXINS OR AROMATIC POLYCYCLIC HYDROCARBIDES OR HEAVY METALS AND DT2 AFTER ACUTE ACCIDENTAL RELEASES OR EARLY IN LIFE AND/OR CHRONIC, LOW DOSES EXPOSURE. MORE PROSPECTIVE, LONGITUDINAL STUDIES ARE NEEDED TO DETERMINE THE IMPORTANCE OF SUCH ENVIRONMENTAL RISK FACTORS. 2017 17 420 22 ANDROGEN-MEDIATED PERTURBATION OF THE HEPATIC CIRCADIAN SYSTEM THROUGH EPIGENETIC MODULATION PROMOTES NAFLD IN PCOS MICE. IN WOMEN, EXCESS ANDROGEN CAUSES POLYCYSTIC OVARY SYNDROME (PCOS), A COMMON FERTILITY DISORDER WITH COMORBID METABOLIC DYSFUNCTIONS INCLUDING DIABETES, OBESITY, AND NONALCOHOLIC FATTY LIVER DISEASE. USING A PCOS MOUSE MODEL, THIS STUDY SHOWS THAT CHRONIC HIGH ANDROGEN LEVELS CAUSE HEPATIC STEATOSIS WHILE HEPATOCYTE-SPECIFIC ANDROGEN RECEPTOR (AR)-KNOCKOUT RESCUES THIS PHENOTYPE. MOREOVER, THROUGH RNA-SEQUENCING AND METABOLOMIC STUDIES, WE HAVE IDENTIFIED KEY METABOLIC GENES AND PATHWAYS AFFECTED BY HYPERANDROGENISM. OUR STUDIES REVEAL THAT A LARGE NUMBER OF METABOLIC GENES ARE DIRECTLY REGULATED BY ANDROGENS THROUGH AR BINDING TO ANDROGEN RESPONSE ELEMENT SEQUENCES ON THE PROMOTER REGION OF THESE GENES. INTERESTINGLY, A NUMBER OF CIRCADIAN GENES ARE ALSO DIFFERENTIALLY REGULATED BY ANDROGENS. IN VIVO AND IN VITRO STUDIES USING A CIRCADIAN REPORTER [PERIOD2::LUCIFERASE (PER2::LUC)] MOUSE MODEL DEMONSTRATE THAT ANDROGENS CAN DIRECTLY DISRUPT THE HEPATIC TIMING SYSTEM, WHICH IS A KEY REGULATOR OF LIVER METABOLISM. CONSEQUENTLY, STUDIES SHOW THAT ANDROGENS DECREASE H3K27ME3, A GENE SILENCING MARK ON THE PROMOTER OF CORE CLOCK GENES, BY INHIBITING THE EXPRESSION OF HISTONE METHYLTRANSFERASE, EZH2, WHILE INDUCING THE EXPRESSION OF THE HISTONE DEMETHYLASE, JMJD3, WHICH IS RESPONSIBLE FOR ADDING AND REMOVING THE H3K27ME3 MARK, RESPECTIVELY. FINALLY, WE REPORT THAT UNDER HYPERANDROGENIC CONDITIONS, SOME OF THE SAME CIRCADIAN/METABOLIC GENES THAT ARE UPREGULATED IN THE MOUSE LIVER ARE ALSO ELEVATED IN NONHUMAN PRIMATE LIVERS. IN SUMMARY, THESE STUDIES NOT ONLY PROVIDE AN OVERALL UNDERSTANDING OF HOW HYPERANDROGENISM ASSOCIATED WITH PCOS AFFECTS LIVER GENE EXPRESSION AND METABOLISM BUT ALSO OFFER INSIGHT INTO THE UNDERLYING MECHANISMS LEADING TO HEPATIC STEATOSIS IN PCOS. 2022 18 1341 22 DETANGLING THE INTERRELATIONS BETWEEN MAFLD, INSULIN RESISTANCE, AND KEY HORMONES. METABOLIC DYSFUNCTION-ASSOCIATED FATTY LIVER DISEASE (MAFLD) HAS INCREASINGLY BECOME A SIGNIFICANT AND HIGHLY PREVALENT CAUSE OF CHRONIC LIVER DISEASE, DISPLAYING A WIDE ARRAY OF RISK FACTORS AND PATHOPHYSIOLOGIC MECHANISMS OF WHICH ONLY A FEW HAVE SO FAR BEEN CLEARLY ELUCIDATED. A BIDIRECTIONAL INTERACTION BETWEEN HORMONAL DISCREPANCIES AND METABOLIC-RELATED DISORDERS, INCLUDING OBESITY, TYPE 2 DIABETES MELLITUS (T2DM), AND POLYCYSTIC OVARIAN SYNDROME (PCOS) HAS BEEN DESCRIBED. SINCE THE CHANGE IN NOMENCLATURE FROM NON-ALCOHOLIC FATTY LIVER DISEASE (NAFLD) TO MAFLD IS BASED ON THE CLEAR IMPACT OF METABOLIC ELEMENTS ON THE DISEASE, THE RECIPROCAL INTERACTIONS OF HORMONES SUCH AS INSULIN, ADIPOKINES (LEPTIN AND ADIPONECTIN), AND ESTROGENS HAVE STRONGLY POINTED TO THE INTRINSIC LINKS THAT LEAD TO THE HETEROGENEOUS EPIDEMIOLOGY, CLINICAL PRESENTATIONS, AND RISK FACTORS INVOLVED IN MAFLD IN DIFFERENT POPULATIONS. THE OBJECTIVE OF THIS WORK IS TWOFOLD. FIRSTLY, THERE IS A BRIEF DISCUSSION REGARDING THE CHANGE IN NOMENCLATURE AS WELL AS EPIDEMIOLOGY, RISK FACTORS, AND PATHOPHYSIOLOGIC MECHANISMS OTHER THAN HORMONAL EFFECTS, WHICH INCLUDE NUTRITION AND THE GUT MICROBIOME, AS WELL AS GENETIC AND EPIGENETIC INFLUENCES. SECONDLY, WE REVIEW THE BASIS OF THE MOST IMPORTANT HORMONAL FACTORS INVOLVED IN THE DEVELOPMENT AND PROGRESSION OF MAFLD THAT ACT BOTH INDEPENDENTLY AND IN AN INTERRELATED MANNER. 2022 19 3710 21 INFLUENCES OF POLYCYCLIC AROMATIC HYDROCARBON ON THE EPIGENOME TOXICITY AND ITS APPLICABILITY IN HUMAN HEALTH RISK ASSESSMENT. THE EXISTENCE OF POLYCYCLIC AROMATIC HYDROCARBONS (PAHS) IN AMBIENT AIR IS AN ESCALATING CONCERN WORLDWIDE BECAUSE OF THEIR ABILITY TO CAUSE CANCER AND INDUCE PERMANENT CHANGES IN THE GENETIC MATERIAL. GROWING EVIDENCE IMPLIES THAT DURING EARLY LIFE-SENSITIVE STAGES, THE RISK OF PROGRESSION OF ACUTE AND CHRONIC DISEASES DEPENDS ON EPIGENETIC CHANGES INITIATED BY THE INFLUENCE OF ENVIRONMENTAL CUES. SEVERAL REPORTS DECIPHERED THE RELATIONSHIP BETWEEN EXPOSURE TO ENVIRONMENTAL CHEMICALS AND EPIGENETICS, AND HAVE KNOWN TOXICANTS THAT ALTER THE EPIGENETIC STATES. AMONGST PAHS, BENZO[A]PYRENE (B[A]P) IS ACCEPTED AS A GROUP 1 CANCER-CAUSING AGENT BY THE INTERNATIONAL AGENCY FOR THE RESEARCH ON CANCER (IARC). B[A]P IS A WELL-STUDIED PRO-CARCINOGEN THAT IS METABOLICALLY ACTIVATED BY THE ARYL HYDROCARBON RECEPTOR (AHR)/CYTOCHROME P450 PATHWAY. CYTOCHROME P450 PLAYS A PIVOTAL ROLE IN THE STIMULATION STEP, WHICH IS ESSENTIAL FOR DNA ADDUCT FORMATION. ACCRUING EVIDENCE SUGGESTS THAT EPIGENETIC ALTERATIONS ASSUME A FUNDAMENTAL PART IN PAH-PROMOTED CARCINOGENESIS. THIS INTERACTION BETWEEN PAHS AND EPIGENETIC FACTORS RESULTS IN AN ALTERED PROFILE OF THESE MARKS, GLOBALLY AND LOCUS-SPECIFIC. SOME OF THE EPIGENETIC CHANGES DUE TO EXPOSURE TO PAHS LEAD TO INCREASED DISEASE SUSCEPTIBILITY AND PROGRESSION. IT IS WELL UNDERSTOOD THAT EXPOSURE TO ENVIRONMENTAL CARCINOGENS, SUCH AS PAH TRIGGERS DISEASE PATHWAYS THROUGH CHANGES IN THE GENOME. SEVERAL EVIDENCE REPORTED DUE TO THE EPIGENOME-WIDE ASSOCIATION STUDIES, THAT EARLY LIFE ADVERSE ENVIRONMENTAL EVENTS MAY TRIGGER WIDESPREAD AND PERSISTENT VARIATIONS IN TRANSCRIPTIONAL PROFILING. MOREOVER, THESE VARIATIONS RESPOND TO DNA DAMAGE AND/OR A CONSEQUENCE OF EPIGENETIC MODIFICATIONS THAT NEED FURTHER INVESTIGATION. GROWING EVIDENCE HAS ASSOCIATED PAHS WITH EPIGENETIC VARIATIONS INVOLVING ALTERATIONS IN DNA METHYLATION, HISTONE MODIFICATION, AND MICRO RNA (MIRNA) REGULATION. EPIGENETIC ALTERATIONS TO PAH EXPOSURE WERE RELATED TO CHRONIC DISEASES, SUCH AS PULMONARY DISEASE, CARDIOVASCULAR DISEASE, ENDOCRINE DISRUPTOR, NERVOUS SYSTEM DISORDER, AND CANCER. THIS HORMETIC RESPONSE GIVES A NOVEL PERCEPTION CONCERNING THE TOXICITY OF PAHS AND THE BIOLOGICAL REACTION THAT MAY BE A DISTINCT RELIANCE ON EXPOSURE. THIS REVIEW SHEDS LIGHT ON UNDERSTANDING THE LATEST EVIDENCE ABOUT HOW PAHS CAN ALTER EPIGENETIC PATTERNS AND HUMAN HEALTH. IN CONCLUSION, AS SEVERAL EPIGENETIC CHANGE MECHANISMS REMAIN UNCLEAR YET, FURTHER ANALYSES DERIVED FROM PAHS EXPOSURE MUST BE PERFORMED TO FIND NEW TARGETS AND DISEASE BIOMARKERS. IN SPITE OF THE CURRENT LIMITATIONS, NUMEROUS EVIDENCE SUPPORTS THE PERCEPTION THAT EPIGENETICS GRIPS SUBSTANTIAL POTENTIAL FOR ADVANCING OUR KNOWLEDGE ABOUT THE MOLECULAR MECHANISMS OF ENVIRONMENTAL TOXICANTS, ALSO FOR PREDICTING HEALTH-ASSOCIATED RISKS DUE TO ENVIRONMENTAL CIRCUMSTANCES EXPOSURE AND INDIVIDUAL SUSCEPTIBILITY. 2022 20 1106 17 COMBINED TOXICITY OF ENDOCRINE-DISRUPTING CHEMICALS: A REVIEW. THE COMBINED TOXICOLOGICAL ASSESSMENT PROVIDES A REALISTIC APPROACH FOR HAZARD EVALUATION OF CHEMICAL COCKTAILS THAT CO-EXISTED IN THE ENVIRONMENT. THIS REVIEW PROVIDES A HOLISTIC INSIGHT INTO THE STUDIES HIGHLIGHTING THE MIXTURE TOXICITY OF THE ENDOCRINE-DISRUPTING CHEMICALS (EDCS), ESPECIALLY FOCUSING ON THE SCREENING OF BIOCHEMICAL PATHWAYS AND OTHER TOXICOGENETIC ENDPOINTS. REVIEWED LITERATURE SHOWED THAT NUMEROUS MULTIPLEXED TOXICOGENOMIC TECHNIQUES WERE APPLIED TO DETERMINE REPRODUCTIVE EFFECTS IN VERTEBRATES, BUT LIMITED STUDIES WERE FOUND IN NON-MAMMALIAN SPECIES AFTER MIXTURE CHEMICAL EXPOSURE. FURTHER, WE FOUND THAT THE EXPERIMENTAL DESIGN AND CONCENTRATION SELECTION ARE THE TWO IMPORTANT PARAMETERS IN MIXTURE TOXICITY STUDIES THAT SHOULD BE TIME- AND COST-EFFECTIVE, HIGHLY PRECISE, AND ENVIRONMENTALLY RELEVANT. A SUMMARY OF EDC MIXTURES AFFECTING THE THYROID AXIS, ESTROGEN AXIS, ANDROGEN AXIS, GROWTH STRESS, AND IMMUNE SYSTEM VIA IN VIVO BIOASSAYS WAS ALSO PRESENTED. IT IS INTERESTING TO MENTION THAT MAJORITY OF ESTROGENIC EFFECTS OF THE MIXTURES WERE SEX-DEPENDENT, PARTICULARLY OBSERVED IN MALE FISH AS COMPARED TO FEMALE FISH. FURTHER, THE ANDROGEN AXIS WAS PERTURBED WITH SERIOUS MALFORMATIONS IN MALE RAT TESTIS (EPIDIDYMAL OR GUBERNACULAR LESIONS, AND DECIDUOUS SPERMATIDS). ALSO, TRANSGENERATIONAL EPIGENETIC EFFECTS WERE PROMOTED IN THE F(3) AND F(4) GENERATIONS IN THE FORM OF DNA METHYLATION EPIMUTATIONS IN SPERM, INCREASING POLYCYSTIC OVARIES AND REDUCING THE OFFSPRING. SIMILARLY, INCREASED OXIDATIVE STRESS, HIGH ANTIOXIDANT ENZYMATIC ACTIVITIES, DISTURBED ESTROUS CYCLE, AND DECREASED STEROIDOGENESIS WERE THE COMMONLY FOUND EFFECTS AFTER ACUTE OR CHRONIC EXPOSURE TO EDC MIXTURES. IMPORTANTLY, THE CONCENTRATION ADDITION (CA) AND INDEPENDENT ACTION (IA) MODELS BECAME MORE PREVALENT AND SUITABLE PREDICTIVE MODELS TO UNVEIL THE PROMINENCE OF SYNERGISTIC ESTROGENIC AND ANTI-ANDROGENIC EFFECTS OF CHEMICAL MIXTURES. MORE IMPORTANTLY, THIS REVIEW ENCOMPASSES THE RESEARCH CHALLENGES AND GAPS IN THE EXISTING KNOWLEDGE AND SPECIFIC FUTURE RESEARCH PERSPECTIVES ON COMBINED TOXICITY. 2021