The Experts Group on Inositols in Basic and Clinical Research (EGOI), Rome, Italy.
Unit of Gynecologic Oncology, ARNAS 'Civico - Di Cristina - Benfratelli', Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy.
Expert Opin Drug Metab Toxicol. 2022 Feb;18(2):123-133. doi: 10.1080/17425255.2022.2071259. Epub 2022 May 10.
Myo-inositol (MI) and d-chiro-inositol (DCI) play a key role in ovarian physiology, as they are second messengers of insulin and gonadotropins. Ex-vivo and in-vitro experiments demonstrate that both isomers are deeply involved in steroid biosynthesis, and that reduced MI-to-DCI ratios are associated with pathological imbalance of sex hormones.
This expert opinion provides an overview of the physiological distribution of MI and DCI in the ovarian tissues, and a thorough insight of their involvement into ovarian steroidogenesis. Insulin resistance and compensatory hyperinsulinemia dramatically reduce the MI-to-DCI ratio in the ovaries, leading to gynecological disorders characterized by hyperandrogenism, altered menstrual cycle and infertility.
Available evidence indicates that MI and DCI have very specific physiological roles and, seemingly, physiological MI-to-DCI ratios in the ovaries are crucial to maintain the correct homeostasis of steroids. Inositol treatments should be evaluated on the patients' specific conditions and needs, as long-term supplementation of high doses of DCI may cause detrimental effects on the ovarian functionality. In addition, the effects of inositol therapy on the different PCOS phenotypes should be further investigated in order to better tailor the supplementation.
肌醇（MI）和 D-手性肌醇（DCI）在卵巢生理学中起着关键作用，因为它们是胰岛素和促性腺激素的第二信使。离体和体外实验表明，这两种异构体都深深参与了甾体生物合成，而 MI 与 DCI 的比值降低与性激素的病理性失衡有关。
本专家意见提供了 MI 和 DCI 在卵巢组织中的生理分布概述，并深入了解了它们在卵巢甾体生成中的作用。胰岛素抵抗和代偿性高胰岛素血症导致卵巢中 MI 与 DCI 的比值显著降低，导致以高雄激素血症、月经周期改变和不孕为特征的妇科疾病。
现有证据表明，MI 和 DCI 具有非常特殊的生理作用，而且，似乎 MI 与 DCI 的比值在卵巢中的生理作用对维持类固醇的正确内稳态至关重要。应该根据患者的具体情况和需要评估肌醇的治疗，因为长期补充高剂量的 DCI 可能对卵巢功能产生不利影响。此外，还应进一步研究肌醇治疗对不同 PCOS 表型的影响，以便更好地调整补充。
