Afnan Abbood - Department of Biochemistry, College of Medicine, University of Kerbala, Kerbala, Iraq.
Rana Majeed Hameed - Department of Biochemistry, College of Medicine, University of Kerbala, Kerbala, Iraq.
Wasan Ghazi Al Safi - Department of Obstetrics and Gynecology, College of Medicine, University of Kerbala, Kerbala, Iraq.

Background: Neuregulin_۴ (NRG۴) is one of the adipokines members that synthesize adipose tissues. It has an activating effect on epidermal growth factor receptors (ErbB receptors). NRG۴ has indirect effects on the hormonal environment through its interaction to ErbB receptors. Increased insulin resistance and chronic low-grade inflammation may be present when NRG۴ levels are high in PCOS. Obesity and polycystic ovarian syndrome have recently gained a lot of attention. However, the literature on the connection between NRG۴ and the PCOS phenotype is limited. Thus, this research aimed to identify neuregulin_۴'s function as a biomarker for insulin resistance in PCOS phenotypes. Methods: A case-control study and included ۱۴۰ female cases effect by different phenotypes of PCOS. Patients samples were collected at the reproductive fertility consultant of the Teaching Hospital for Obstetrics and Gynecology, Kerbala health directorate, Iraq. The outpatient clinic serum hormonal levels and insulin concentration were determined by the electrochemiluminescence immunoassay “ECLIA” system. Elisa system was used for the detection of Neuregulin-۴ protein level. Results: At the early age of participant NRG۴ was increased significantly in all phenotypes of PCOS compared to control with a P< ۰.۰۵. interestingly, phenotype A was shown high level of NRG۴ following phenotype C than phenotype D and phenotype B. Receiver Operator Characteristic Curves (ROC) analysis for NRG۴ was performed and showed good diagnostic performers to word phenotype A. Conclusion: Females with phenotype A have a higher level of NRG۴ than other phenotypes, which could be attributable to the more pronounced metabolic abnormalities in this phenotype.

Metabolic disturbances, Neuregulin ۴, Polycystic Ovarian Syndrome Phenotypes.