Reproductive endocrinology and metabolism

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The group members of reseach group Reproductive Endocrinology and Metabolism

Our group’s research activities aim to yield new key information on the pathophysiology of polycystic ovary syndrome (PCOS), the most common female endocrine and metabolic disorder.

The etiology of PCOS is not well understood, but genetic, epigenetic, and environmental factors have been implicated in its development. We also investigate the effect and mechanisms of acupuncture and/or exercise on reproductive function, hyperandrogenemia and insulin resistance as well as on key molecular pathways and epigenetic modifications in adipose and skeletal muscle tissues.

Group members

Elisabet Stener-Victorin Research group leader
Romina Fornes PhD student
Milana Kokosar PhD student
Lisa Lindheim Associated
Maria Manti PhD student

Manuel Maliqueo

PhD, Visiting researcher

Former group members

Min Hu Post doc
Rodrigo Marcondes PhD student

Group members outside Karolinska Institutet

Emma A Nilsson Researcher, PhD, Lund University
Anna Benrick MSc, PhD, Researcher, Gothenburg University, Sweden
Josefin Katakoa Doctoral student, Gothenburg University, Sweden


Developmental origin of androgen excess, insulin resistance and behavioral dysfunction in females

The etiology of PCOS is not well understood but emerging evidence suggests that PCOS originates, at least in part, in fetal life and elevated maternal androgens and/or maternal obesity have been implicated to play a role, however the mechanisms are largely unknown. Maternal sex steroids and metabolic hormones regulate placental steroidogenesis and the transport of nutrients, functions that are critical for fetal growth and development. Maternal androgen excess and obesity might alter metabolism, sex steroid levels and nutrition delivery to the fetus via the placenta. In this project we propose that changes in placental function are involved in the intrauterine programming of PCOS.

The overall hypothesis is that high maternal androgens and maternal obesity up-regulate placental steroid receptors and steroidogenic enzymes, which in turn alter metabolic pathways and contribute to the development of PCOS and related symptoms in the offspring.

Genome-wide DNA methylation and gene expression profiles in adipose and skeletal muscle tissue from women with and without PCOS

The possibility of an epigenetic component of PCOS has only recently been explored. Interestingly, epigenetic modification of PGC-1α has been reported in granulosa cells from women with PCOS and a genome-wide methylation array of adipose tissue from prenatally androgenized female rhesus monkeys showed changes in methylation of genes in the TGF-β superfamily. These observations suggest that epigenetic modifications could be involved in diseases such as PCOS.

This project aims to investigate differences in genome-wide gene expression and DNA methylation pattern in subcutaneous adipose tissue and skeletal muscle from women with and without PCOS. To investigate the importance of differential expression in adipose tissue, selected genes are biologically validated in a second case-control cohort matched for age, weight and BMI.

To elucidate the effect and mechanisms of acupuncture and exercise on insulin resistance and key signaling pathways in adipose and skeletal muscle tissue in translational studies

Because women with PCOS require long-term treatment and current treatments often have severe metabolic and gastrointestinal side effects, there is a need for novel treatment options. Physical exercise and acupuncture with low-frequency electrical stimulation, both induces ovulation and decreases circulating androgens. In this project, we hypothesize that acupuncture treatment with muscle contractions, by reducing hyperandrogenemia and reversing insulin resistance, can modify key molecular alterations and epigenetic changes to the genomic DNA in adipose tissue and skeletal muscle to the same extent as exercise.

Further, as the effect of acupuncture with low-frequency electrical stimulation are hypothesized to be mediated via sympathetic nervous system and/or dopaminergic system, we will administer blockers of α-adrenoceptor, β-adrenoceptor or dopamine1(D1)receptor, to elucidate which key signaling pathways mediate the effect in ovaries, adipose tissue and skeletal muscle.

Research support


National collaborators

Professor Charlotte Ling, Lund University

Professor Inger Sundström-Pooroma, Uppsala University

Associate Professor Carl Johan Behre, University of Gothenburg

Professor Claes Ohlsson, University of Gothenburg

Professor Håkan Billig, University of Gothenburg

Professor Mats Brännström, University of Gothenburg

Professor Angelica Lindén Hirscberg, Karolinska Institutet

International collaborators

Professor, Kurt Højlund, Diabetes Research Center, Odense University, Denmark

Professor Eszter Vankey, Norweigan University of Science and Technology, Trondheim, Norway

Professor Matti Poutanen, Turku University, Finland

Associate Professor, Laure Morin Papunen, University of Oulu, Finland

Professor Thomas Jansson, University of Colorado, Denver, US

Professor Fernand Labrie, Laval University, Canada

Professor Andrea Dunaif, Northwestern University, Chicago, US

Professor, Richard Legro, Pennsylvania State University, US

Professor Xiaoke Wu, Professor, Heiljongjiang University of Traditional Chinese Medicine, Harbin, China 

Selected publications

Maternal testosterone and placental function: Effect of electroacupuncture on placental expression of angiogenic markers and fetal growth.
Fornes R, Hu M, Maliqueo M, Kokosar M, Benrick A, Carr D, et al
Mol. Cell. Endocrinol. 2016 Sep;433():1-11

Epigenetic and Transcriptional Alterations in Human Adipose Tissue of Polycystic Ovary Syndrome.
Kokosar M, Benrick A, Perfilyev A, Fornes R, Nilsson E, Maliqueo M, et al
Sci Rep 2016 Mar;6():22883

Dietary intake, resting energy expenditure, and eating behavior in women with and without polycystic ovary syndrome.
Larsson I, Hulthén L, Landén M, Pålsson E, Janson P, Stener-Victorin E
Clin Nutr 2016 Feb;35(1):213-8

Maternal testosterone exposure increases anxiety-like behavior and impacts the limbic system in the offspring.
Hu M, Richard J, Maliqueo M, Kokosar M, Fornes R, Benrick A, et al
Proc. Natl. Acad. Sci. U.S.A. 2015 Nov;112(46):14348-53

Scientific Statement on the Diagnostic Criteria, Epidemiology, Pathophysiology, and Molecular Genetics of Polycystic Ovary Syndrome.
Dumesic D, Oberfield S, Stener-Victorin E, Marshall J, Laven J, Legro R
Endocr. Rev. 2015 Oct;36(5):487-525

Genome-wide association of polycystic ovary syndrome implicates alterations in gonadotropin secretion in European ancestry populations.
Hayes M, Urbanek M, Ehrmann D, Armstrong L, Lee J, Sisk R, et al
Nat Commun 2015 Aug;6():7502

Androgen Profile Through Life in Women With Polycystic Ovary Syndrome: A Nordic Multicenter Collaboration Study.
Pinola P, Piltonen T, Puurunen J, Vanky E, Sundström-Poromaa I, Stener-Victorin E, et al
J. Clin. Endocrinol. Metab. 2015 Sep;100(9):3400-7

Placental STAT3 signaling is activated in women with polycystic ovary syndrome.
Maliqueo M, Sundström Poromaa I, Vanky E, Fornes R, Benrick A, Åkerud H, et al
Hum. Reprod. 2015 Mar;30(3):692-700

Enhanced insulin sensitivity and acute regulation of metabolic genes and signaling pathways after a single electrical or manual acupuncture session in female insulin-resistant rats.
Benrick A, Maliqueo M, Johansson J, Sun M, Wu X, Mannerås-Holm L, et al
Acta Diabetol 2014 Dec;51(6):963-72

Acupuncture for ovulation induction in polycystic ovary syndrome: a randomized controlled trial.
Johansson J, Redman L, Veldhuis P, Sazonova A, Labrie F, Holm G, et al
Am. J. Physiol. Endocrinol. Metab. 2013 May;304(9):E934-43

Continuous administration of a P450 aromatase inhibitor induces polycystic ovary syndrome with a metabolic and endocrine phenotype in female rats at adult age.
Maliqueo M, Sun M, Johansson J, Benrick A, Labrie F, Svensson H, et al
Endocrinology 2013 Jan;154(1):434-45

Maternal androgen excess reduces placental and fetal weights, increases placental steroidogenesis, and leads to long-term health effects in their female offspring.
Sun M, Maliqueo M, Benrick A, Johansson J, Shao R, Hou L, et al
Am. J. Physiol. Endocrinol. Metab. 2012 Dec;303(11):E1373-85

Sex steroids, insulin sensitivity and sympathetic nerve activity in relation to affective symptoms in women with polycystic ovary syndrome.
Jedel E, Gustafson D, Waern M, Sverrisdottir Y, Landén M, Janson P, et al
Psychoneuroendocrinology 2011 Nov;36(10):1470-9

Coagulation and fibrinolytic disturbances in women with polycystic ovary syndrome.
Mannerås-Holm L, Baghaei F, Holm G, Janson P, Ohlsson C, Lönn M, et al
J. Clin. Endocrinol. Metab. 2011 Apr;96(4):1068-76

Adipose tissue has aberrant morphology and function in PCOS: enlarged adipocytes and low serum adiponectin, but not circulating sex steroids, are strongly associated with insulin resistance.
Mannerås-Holm L, Leonhardt H, Kullberg J, Jennische E, Odén A, Holm G, et al
J. Clin. Endocrinol. Metab. 2011 Feb;96(2):E304-11

Are there any sensitive and specific sex steroid markers for polycystic ovary syndrome?
Stener-Victorin E, Holm G, Labrie F, Nilsson L, Janson P, Ohlsson C
J. Clin. Endocrinol. Metab. 2010 Feb;95(2):810-9

Intense electroacupuncture normalizes insulin sensitivity, increases muscle GLUT4 content, and improves lipid profile in a rat model of polycystic ovary syndrome.
Johansson J, Feng Y, Shao R, Lönn M, Billig H, Stener-Victorin E
Am. J. Physiol. Endocrinol. Metab. 2010 Oct;299(4):E551-9

See all publications in PubMed


Main supervisor: group leader Elisabet Stener-Victorin 

2013              Julia Johansson, Msc Medical Engineering. PhD.
Title of thesis: Polycystic ovary syndrome - Effect of acupuncture on insulin resistance and neuroendocrine function. Institute of Neuroscience and Physiology, Endocrinology, University of Gothenburg. 

2010              Elizabeth Jedel, PhD.
Title of thesis: Polycystic Ovary Syndrome: Studies of affective symptoms in association with sex steroids and evaluation of electroacupuncture and physical exercise. Institute of Clinical Neuroscience, OCIM, Karolinska Institute, Stockholm.

2010              Louise Mannerås Holm, PhD.
Title of thesis: Polycystic ovary syndrome: Studies of metabolic and ovarian disturbances and effects of physical exercise and electro-acupuncture. Institute of Neuroscience and Physiology, University of Gothenburg.

2009              Lena Svedberg, PhD.
Title of thesis: Cold feet in children with neurological disorders. Institute of Neuroscience and Physiology, University of Gothenburg.

2007              Annika Billhult, PhD.
Title of thesis: The effect of massage for women with breast cancer. Institute of Neuroscience and Physiology, University of Gothenburg.

2005              Luigi Manni, PhD.
Title of thesis: Adrenoceptors and Nerve Growth Factor: Effects of Electro-Acupuncture and Physical Exercise in Rats with Steroid-Induced Polycystic Ovaries. Cardiovascular Institute, University of Gothenburg

2000              Elisabet Stener-Victorin, PhD.
Title of thesis:  Acupuncture in Reproductive Medicine - Applications in Human Assisted Reproduction and Aspects of Clinical and Experimental Neuroendocrinology. Department of Obstetrics and Gynecology, University of Gothenburg.

Contact us

Senior lecturer

Elisabet Stener-Victorin

Phone: +46-(0)8-524 872 00
Organizational unit: Stener Victorin Elisabet group - Reproductive endocrinology and metabolism

EndocrinologyMetabolismReproductive Medicine