Hyperglycemia induces endothelial mitochondrial dysfunction and myeloperoxidase dysregulation in PCOS iPSCs

Polycystic ovary syndrome (PCOS) is associated with increased risks of cardiovascular disease (CVD), driven in part by endothelial dysfunction. Using patient-derived induced pluripotent stem cells (iPSCs), we established an endothelial model to examine cellular responses to metabolic stress independent of the complex systemic environment. We demonstrate that PCOS iPSC-derived endothelial cells (PCOS iPSC-ECs) exhibit a disease-specific susceptibility to hyperglycemia, resulting in impaired angiogenesis, mitochondrial fragmentation, and bioenergetic impairment. This stress-induced injury is accompanied by aberrant intracellular myeloperoxidase (MPO) expression. Consistent with these findings, clinical data revealed elevated systemic MPO levels in women with PCOS that correlate with diastolic blood pressure (DBP), glucose levels, and low-density lipoproteins (LDLs). Our results identify an intrinsic metabolic-oxidative defect, a latent mitochondrial vulnerability triggered by hyperglycemic stress, in the PCOS endothelium. These findings position MPO as a potential biomarker and putative mediator for cardiovascular risk stratification in PCOS.