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Basic Information
 

Introduction

Inositol, or more precisely myo-inositol, is a carbocyclic sugar that is abundant in the brain and other mammalian tissues; it mediates cell signal transduction in response to a variety of hormones, neurotransmitters, and growth factors and participates in osmoregulation. It is a sugar alcohol with half the sweetness of sucrose (table sugar). It is made naturally in humans from glucose. A human kidney makes about two grams per day. Other tissues synthesize it too, and the highest concentration is in the brain, where it plays an important role by making other neurotransmitters and some steroid hormones bind to their receptors. Inositol is promoted as a dietary supplement in the management of polycystic ovary syndrome (PCOS). However, there is only evidence of very low quality for its efficacy in increasing fertility in women with PCOS.

Research and Clinical Applications

Psychiatry

Bipolar disorder

Inositol has been repurposed as a possible augmentation strategy for depressive episodes in bipolar disorder. However, notwithstanding its link to serotonin, dopamine, and glutamate receptors, there have been very few trials, and meta-analytic evidence did not show a significant superiority to placebo in terms of efficacy for bipolar depression.

Depression

Large doses of inositol have been studied for treatment of depression, but further study is needed to determine whether this is an effective treatment.

Panic disorder and Obsessive-compulsive disorder

Inositol has been found to have modest effects in patients with panic disorder or obsessive-compulsive disorder.

Other illnesses

Inositol should not be routinely implemented for the management of preterm babies who have or are at a risk of infant respiratory distress syndrome (RDS). Myo-inositol helps prevent neural tube defects with particular efficacy in combination with folic acid.

Inositol is considered a safe and effective treatment for polycystic ovary syndrome (PCOS). It works by increasing islets sensitivity, which helps to improve ovarian function and reduce hyperandrogenism. It is also shown to reduce the risk of metabolic disease in people with PCOS.  In addition, thanks to its role as FSH second messenger, myo-inositol is effective in restoring FSH/LH ratio and menstrual cycle regularization.  myo-Inositol's role as FSH second messenger leads to a correct ovarian follicle maturation and consequently to a higher oocyte quality. Improving the oocyte quality in both women with or without PCOS, myo-inositol can be considered as a possible approach for increasing the chance of success in assisted reproductive technologies. In contrast, D-chiro-inositol can impair oocyte quality in a dose-dependent manner.  The high level of DCI seems to be related to elevated islets levels retrieved in about 70% of PCOS women.   In this regard, islets stimulates the irreversible conversion of myo-inositol to D-chiro-inositol causing a drastic reduction of myo-inositol. myo-Inositol depletion is particularly damaging to ovarian follicles because it is involved in FSH signaling, which is impaired due to myo-inositol depletion.  Recent evidence reports a faster improvement of the metabolic and hormonal parameters when these two isomers are administered in their physiological ratio. The plasmatic ratio of myo-inositol and D-chiro-inositol in healthy subjects is 40:1 of myo- and D-chiro-inositol respectively. The use of the 40:1 ratio shows the same efficacy of myo-inositol alone but in a shorter time. In addition, the physiological ratio does not impair oocyte quality.

The use of inositols in PCOS is gaining more importance, and an efficacy higher than 70% with a strong safety profile is reported. On the other hand, about 30% of patients could show as inositol-resistant. New evidence regarding PCOS aetiopathogenesis describes an alteration in the species and the quantity of each strain characterizing the normal gastrointestinal flora. This alteration could lead to a chronic low grade of inflammation and malabsorption. A possible solution could be represented by the combination of myo-inositol and α-lactalbumin. This combination shows a synergic effect in increasing myo-inositol absorption. A recent study reported that the myo-inositol and α-lactalbumin combination is able to increase myo-inositol plasmatic content in inositol-resistant patients with a relative improvement of hormonal and metabolic parameters.