Regulatory risk loci link disrupted androgen response to pathophysiology of Polycystic Ovary Syndrome

A major challenge in deciphering the complex genetic landscape of Polycystic Ovary Syndrome (PCOS) lies in the limited understanding of how susceptibility loci drive molecular mechanisms across diverse phenotypes. To address this, we integrated molecular and epigenomic annotations from proposed causal cell-types and employed a deep learning (DL) framework to predict cell-type-specific regulatory effects of PCOS risk variants. Our analysis revealed that these variants affect key transcription factor (TF) binding sites, including NR4A1/2, NHLH2, FOXA1, and WT1, which regulate gonadotropin signaling, folliculogenesis, and steroidogenesis across brain and endocrine cell-types. The DL model, which showed strong concordance with reporter assay data, identified enhancer-disrupting activity in approximately 20% of risk variants. Notably, many of these variants disrupt TFs involved in androgen-mediated signaling, providing molecular insights into hyperandrogenemia in PCOS. Variants prioritized by the model were more pleiotropic and exerted stronger downregulatory effects on gene expression compared to other risk variants. Using the IRX3-FTO locus as a case study, we demonstrate how regulatory disruptions in tissues such as the fetal brain, pancreas, adipocytes, and endothelial cells may link obesity-associated mechanisms to PCOS pathogenesis via neuronal development, metabolic dysfunction, and impaired folliculogenesis. Collectively, our findings highlight the utility of integrating DL models with epigenomic data to uncover disease-relevant variants, reveal cross-tissue regulatory effects, and refine mechanistic understanding of PCOS.