الفهرس 
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Abstract
The current study was designed to elucidate the metabolic comorbidities of polycystic ovarian syndrome (PCOS), especially the hepatic effect, with or without high fat diet feeding, and to emphases the crucial role of moderate intensity exercise and high fat diet avoidance in managing such complications and to predict the possible underlying mechanism(s).
This study was carried out on 55 adult female albino Wistar rats initially weighing 155-220 g allocated in 5 equal groups (11 rat each):
1- Control group: Rats were given 0.9% NaCl daily by gavage for 21 days, then were placed in the water tank for 1 min, 5 days / week, for 5 weeks. Rats were fed control diet (Hallfrisch et al., 1979; Abood, 1999) throughout the study.
2- Polycystic ovary syndrome (PCO) group: Rats were given letrozole in a dose of 1mg/kg daily by gavage for 21 days (Baravalle et al., 2006), then were placed in water tank as in control group, and during this period the rats were fed control diet.
3- High fat diet fed polycystic ovary syndrome (HF-PCO) group: Rats were given letrozole as in PCO group, then were placed in the water tank as in control group. Throughout this period, rats were fed high fat diet (Gheibi et al., 2017) till the end of the study.
4- Exercise-treated polycystic ovary syndrome (PCO-EX) group: Rats were given letrozole as in PCO group, then were subjected to 30-minute swimming protocol 5 days / week, for 5 weeks after the period of induction (Guerreiro et al., 2015), during this period the rats were fed control diet.
5- High fat diet fed exercise-treated polycystic ovary syndrome (HF-PCO-EX) group: Rats while being fed high fat diet, were given letrozole as in PCO group. After the period of induction, rats were subjected to 30-minute swimming protocol as in PCO-EX group.
At the beginning of the study and before the induction of the model, all rats were subjected to estimation of initial body weight (BW), naso-anal length (L), waist circumference (WC) and hip circumference (HC) for calculation of initial body mass index (BMI), Lee index and waist circumference / hip circumference ratio (WC/HC).
At the last week of the study (8th week), oral glucose tolerance (OGTT) was performed to all studied rats. Then, by the end of the 8th week, vaginal smear was done every morning for estrus cycle determination to all rats, those found in their diestrus phase according to Hatsuta et al. (2004) were selected to be sacrificed. Rats were subjected to the measurement of final BW, naso-anal length, WC and HC for the calculation of final BMI, Lee index and WC/HC ratio. Rats were anesthetized to collect blood from the abdominal aorta for determination of:
1. Fasting serum glucose and fasting insulin levels to calculate Homeostatic Model Assessment for Insulin Resistance (HOMA-IR).
2. Lipid profile: serum triglycerides (TG), total cholesterol (TC) and high-density lipoprotein (HDL-C) levels. Then, calculation of low-density lipoprotein (LDLC) level and atherogenic index (AI).
3. Liver enzymes: serum alanine and aspartate aminotransferases (ALT and AST) and serum gamma glutamyl transferase (GGT).
4. Serum levels of free estradiol, free testosterone, luteinizing hormone (LH), resistin and adiponectin.
Finally, liver and both ovaries were dissected, and rapidly immersed in 10% formalin for histopathological examination.
The encountered results showed that the initial anthropometric measures were insignificantly different among the 5 studied groups except in HF-PCO-EX group where initial Lee index, initial WC and initial HC were significantly higher when compared to HF-PCO group and the initial HC was significantly higher as compared to control group. Compared to the corresponding initial data, the final anthropometric parameters were significantly increased in all groups except the final Lee index in control and PCO-EX group, the final HC in PCO and PCO-EX groups and final WC/HC ratio in control group were insignificantly different. Comparing the final anthropometric measures among the 5 studied groups, the Final BW, final BMI, % change BMI, final Lee index, % change Lee, final WC and final WC/HC ratio in PCO and HF-PCO and % change BW only in HF-PCO group, all were significantly increased compared to control group. When compared to their corresponding non-exercised groups both PCO-EX and HF-PCO-EX groups showed significantly decreased final BMI, % change BMI, final Lee index and % change Lee index. Comparing the exercised groups together, no significant differences were detected.
Regarding the glycemic parameters, all measured values of the OGTT as well as area under the curve, serum fasting glucose (FG), insulin levels and HOMA-IR were all significantly increased in the PCO, HF-PCO when compared to control group. Compared to PCO group, HF-PCO showed significant increase in all parameters except for FG and T120 where there was no significant difference. Compared to their corresponding non exercised groups, both PCO-EX and HFPCO-EX groups showed significant reduction in all parameters except for T90 in PCO-EX group it was non significantly different. Comparing the exercised groups with each other, the HF-PCO-EX group showed significant increase only in serum FG, insulin and HOMA-IR.
For the lipid profile, the serum level of TG, TC, LDL-C and AI were all significantly increased but HDL-C was significantly decreased in PCO and HF-PCO as compared to control group as well as in HF-PCO group as compared to PCO group. Exercise in PCO-EX and HF-PCO-EX groups resulted in significant reduction in TG, TC, LDL-C and AI and a significant elevation in HDL-C when compared to their corresponding non-exercised groups. Compared to PCO-EX group, the HF-PCO-EX showed significant elevation in TG, TC, LDL-C and AI and a significant reduction in HDL-C.
As regard the hormonal profile, the serum level of estradiol, adiponectin and adiponectin/resistin ratio (A/R) were significantly decreased while serum level of testosterone, LH and resistin were significantly increased in PCO and HF-PCO groups compared to control group. Compared to PCO group, HF-PCO group showed significant decrease in serum estradiol and A/R but significant increase in serum testosterone, LH and resistin. Exercise in PCO-EX and HF-PCO-EX groups induced significant increase in serum estradiol, adiponectin and A/R as well as significant decrease in serum testosterone, LH and resistin compared to their corresponding non exercised groups.
We could conclude that both moderate intensity exercise and avoiding high fat diet have beneficial therapeutic potentials in ameliorating the metabolic effects of PCOS in rats especially the hepatic effects and the development of NAFLD. Both approaches succeeded to reduce serum testosterone and LH levels and to elevate serum estradiol level and proved to improve all the metabolic parameters through the reduction of the proinflammatory cytokine resistin and elevating adiponectin and A/R ratio. The histopathological study confirmed these findings, by showing the recovery of inflammatory invasion, apoptosis as well as steatosis, preventing the progression of NAFLD in the hepatic tissue of the exercised groups.