Three-Dimensional Genome Interactions Identify Potential Adipocyte Metabolism-Associated Gene STON1 and Immune-Correlated Gene FSHR at the rs13405728 Locus in Polycystic Ovary Syndrome

Background rs13405728 was identified as one of the most prevalent susceptibility loci for polycystic ovary syndrome (PCOS) in Han Chinese and Caucasian women. However, the target genes and potential mechanisms of the rs13405728 locus remain to be determined. Methods Three-dimensional (3D) genome interactions from the ovary tissue were characterized via high-through chromosome conformation capture (Hi-C) and Capture Hi-C technologies to identify putative targets at the rs13405728 locus. Combined analyses of eQTL, RNA-Seq, DNase-Seq, ChIP-Seq, and sing-cell sequencing were performed to explore the molecular roles of these target genes in PCOS. PCOS-like mice were applied to verify the expression patterns. Results Generally, STON1 and FSHR were identified as potential targets of the rs13405728 locus in 3D genomic interactions with epigenomic regulatory peaks, with STON1 (P=0.0423) and FSHR (P=0.0013) being highly expressed in PCOS patients. STON1 co-expressed genes were associated with metabolic processes (P=0.0008) in adipocytes (P=0.0001), which was validated in the fat tissue (P<0.0001) and ovary (P=0.0035) from fat-diet mice. The immune system process (GO:0002376) was enriched in FSHR co-expressed genes (P=0.0002) and PCOS patients (P=0.0002), with CD4 high expression in PCOS patients (P=0.0316) and PCOS-like models (P=0.0079). Meanwhile, FSHR expression was positively correlated with CD4 expression in PCOS patients (P=0.0252) and PCOS-like models (P=0.0178). Furthermore, androgen receptor (AR) was identified as the common transcription factor for STON1 and FSHR and positively correlated with the expression of STON1 (P=0.039) and FSHR (P=4e-06) in ovary tissues and PCOS-like mice. Conclusion Overall, we identified STON1 and FSHR as potential targets for the rs13405728 locus and their roles in the processes of adipocyte metabolism and CD4 immune expression in PCOS, which provides 3D genomic insight into the pathogenesis of PCOS.


INTRODUCTION
Polycystic ovary syndrome (PCOS) is a gynecological endocrine disorder that has been one of the leading causes in female infertility (1,2). It is characterized by hormonal imbalance and ovarian dysfunction, with symptoms of hyperandrogenism, anovulation, and polycystic ovarian morphology (3). PCOS occurs in 4-8% of women worldwide and affects 6-12% (approximately 5 million) of reproductive age women in the United States (4). Moreover, women with PCOS have been reported to be at higher risk for hypertension, insulin resistance (IR), diabetes, psychiatric disorders, dyslipidemia, and cancers (4,5).
The high heritability of PCOS as a genetic trait has been reported to account for 70% of the incidence of the disorder (2). The application of genome-wide association studies (GWAS) in large case-control cohorts has successfully supported the discovery and characterization of PCOS susceptibility loci. Some loci are close to genes that play a role in reproductive processes or metabolic dysfunction, such as rs13405728, rs2268361, and rs2349415 to follicle stimulating hormone receptor (FSHR), rs11031006 to FSHB, rs2059807 to INSR, and rs2272046 to HMGA2 (6). The growing list of PCOS risk loci contributes to the understanding of the etiological pathways and processes of the syndrome and reveals the relative homology genetic basis of PCOS (6,7). However, over 95% of GWASassociated risk loci were found to be localized in the non-coding regions (8), while long distances exist between risk loci and target genes (9), making their pathological roles in PCOS unclear. rs13405728 has been identified as the most susceptibility locus for PCOS on 2p16.3 in Han Chinese women (7,10) and Caucasian women (11). However, the target genes of rs13405728 and the roles of such risk locus in the development of PCOS remain to be determined.
Comprehensive and direct long-range mapping of regulatory elements and target genes is crucial to systematically understand the transcriptional regulation of human diseases (12,13). Since researchers have provided insight into the three-dimensional (3D) structural genome of disease by mapping the interactions between baits and target genes using high-throughput and longrange approaches, such as high-throughput chromosome conformation capture (Hi-C), or Capture Hi-C (14,15), it is increasingly evident that alternative chromatin interactions are responsible for the gene dysregulation and biological phenotype in human disease or complex traits (13). For example, SNPs in intron 19 of CLEC16A are associated with the expression of DEXI (16), rs6927172 in region 6q23 in autoimmune diseases is associated with the increased expression of IL20RA (17), and rs9349379 in vascular diseases is associated with the expression of EDN1 (18).
In this study, 3D structural genomic analysis from Hi-C and Capture Hi-C, expression profiling of PCOS patients and PCOSlike models, ChIP-Seq analysis of androgen receptor (AR) in STON1 and FSHR, and single-cell sequencing of ovary tissue were used to synthesize the 3D interactions, adipocyte metabolism association with STON1, and CD4 immune association with FSHR at the rs13405728 locus in PCOS.

PCOS-Like Models and Mouse Tissue Acquisition
The animal study (C57BL/6) was performed with the approval of the Ethics Committee of the Peking University Shenzhen Hospital (PKUSH) and performed in Shenzhen Peking University-The Hong Kong University of Science (PKU-HKUST) and Technology Medical Center. The PCOS-like models (testosterone-treated and high-fat diet) of research were followed by the previous studies (19)(20)(21). Fat mice were treated with a fat diet (with 60% fat), while control mice were treated with a normal diet. Testosterone-treated mice used dihydrotestosterone release pellet (Dow Corning, Midland, MI, USA, 10 mg, S4757, Selleck) with a hypodermic way for 90 days. All performances were conducted under the Animal Welfare Act (AWA) and the Administrative Procedure Act (APA) Guidelines. Hematoxylin and eosin (H&E) staining of representative ovaries and quantitative analysis of cystic follicles were shown in Supplementary Figures 1A, B.

Immunohistochemistry (IHC)
Mouse tissue was prepared as formaldehyde-fixed and paraffinembedded (FFPE) after collection and rinse. 4 mm sections were obtained from FFPE tissue with a microtome and then deparaffinization and antigen retrieval were completed. To prevent background staining and false-positive results, endogenous peroxidase was inactivated by 3% H 2 O 2 and any non-specific binding proteins were quenched by bovine serum albumin (BSA, 5%, Servicebio). Primary antibody against FHSR (A3172, ABclonal, 1:100), STON1 (PA5-75314, Invitrogen, 1:50) and AR (A19611, ABclonal, 1:100) was applied at 4°C overnight. After rinsing, the samples were treated with biotinylated secondary anti-rabbit immunoglobins and peroxidaseconjugated streptavidin, incubating at room temperature for 1 hour. The score of results was evaluated via Image-Pro Plus.

Hi-C Maps and Virtual 4C Analysis
Hi-C experiments of ovary tissue were downloaded from GSM2322546 (22), which were performed by HindIII restriction enzyme using the Hi-C "dilution" protocol (9). NHEK Hi-C data were downloaded from GSE63525 (23), which were performed by MboI restriction enzyme using the in situ Hi-C Protocol. Comparative Hi-C map between ovary tissue and GM12878 (as control) was generated by 3DIV tool (http://kobic.kr/3div), an online interaction viewer for Hi-C interactions (24). Interaction genes of rs13405728 were shown in Supplementary Table 1. rs13405728 was used as the bait with a 500Kb interaction range on chromosome 2 (chr2: 48478159-49478159). Virtual 4C map was generated from the ovary Hi-C data with the viewpoint of chr2:47978158-49978158 via 3D Genome Browser (http://3dgenome.org) (25), rs13405728 was used as the bait with 500Kb interaction range. All data was processed by a custom pipeline with the hg19 reference genomes.

Capture Hi-C and DHS Linkage Analysis
Capture Hi-C data of the ovary tissue were downloaded from GSM2322546 (22). Capture Hi-C analysis was performed by 3D Genome Browser (http://3dgenome.org) with the default settings (25). rs13405728 was used as the bait with a 500Kb interaction range on chromosome 2. DNase hypersensitive site (DHS)linkage profiling was performed as described previously (26), which was performed by 3D Genome Browser (http://3dgenome. org) with the default settings (25). DHS-linkage computed the Pearson correlation coefficients for all distal DHSs with gene proximal DHS, which was based on the tissue-specificity (25).
The ChIP-Seq results were viewed using the UCSC Genome Browser.

Data for Single-Cell Sequencing
Single-cell sequencing data of mouse ovary was downloaded from Mouse Cell Atlas (MCA) (28), which were performed by following the Microwell-seq protocol. The pooled data of mouse tissue included embryo, brain, heart, intestine, kidney, liver, lung, pancreas, stomach, testis, uterus, bladder, spleen, thymus, and prostate, and the cells were mapped into 99 clusters in tSNE plot. 4363 cells of adult mouse ovary were sequenced to analyze the expression of different cells. All these cells were clustered into 14 types with the tSNE dimension reduction method. The heatmap of cell types was conducted by Mouse Cell Atlas (MCA2.0, http://bis.zju.edu.cn/MCA/index. html). The expression of Fshr was explored in different cell types, with the mean expression of the cluster. The results were read by transcripts per kilobase of exon model per million mapped reads (TPM, Supplementary Table 1).

Expression Data Acquisition and Correlation Analysis
Expression data (GSE156895, GSE145461, GSE114419, GSE138518, GSE8157, GSE124707, GSE135917, and GSE43322 profiling data, Supplementary Table 2) were downloaded from the Gene Expression Omnibus (GEO, http://www.ncbi.nlm.nih. gov/geo). RNA-seq data of ovary tissue was downloaded from the Roadmap Epigenomics Project (http://www. roadmapepigenomics.org/data/). In GSE135917 and GSE43322, STON1 probe expressions were extracted and analyzed for Pearson's correlation with BMI of samples in different groups. In GSE8157 and GSE124707, STON1 expression signals were extracted and performed for Pearson's correlation with CD4 expression signals in different groups. Correlation analyses of STON1 and AR, FSHR and AR were performed in Gene Expression Profiling Interactive Analysis (GEPIA, http://gepia. cancer-pku.cn/index.html) using the ovary tissue data from Genotype-Tissue Expression (GTEx) project. Data of PCOS patients were from Chinese infertility women (GSE145461, GSE114419), Han Chinese infertility women (GSE138518), and Caucasian infertility women (GSE8157). The race of PCOS patients used to explore phenotype was consistent with the population of rs13405728 locus. In addition, the main phenotypes of the four data were listed in Supplementary  Table 3, including age, BMI (Kg/m2), LH(IU/L), FSH(IU/L), testosterone (ng/dL), and so on.
Expression Quantitative Trait Loci (eQTL) Analysis eQTL analysis was performed in QTLbase (http://mulinlab.org/ qtlbase/index.html) and GTExPortal (https://gtexportal.org/ home/). To investigate the effect of rs13405728 locus candidate on target gene expression, eQTL analysis was performed via GTEx project for single-tissue eQTL and QTLbase for Cis-eQTL, which were used to evaluate the expression changes and understand the biological function of genetic polymorphism.

Co-Expression Networks
Co-expression networks of STON1 and FSHR were performed in GeneMANIA (29) (http://genemania.org), an online tool including 2277 associated networks mapped to 163599 genes from 9 organisms. STON1 (ENSG00000243244) and FSHR (ENSG00000170820) were used as input genes. Co-expression networks of STON1 and FSHR were explored in humans (Homo sapiens) with the default settings. Co-expression networks included physical interactions, co-expression, predicted interactions, co-localization, pathway interactions, genetic interactions, and shared protein domains.

Gene Set Enrichment Analysis and Enrichment Analysis in PaGenBase
Gene Ontology (GO) analysis was performed to annotate the gene function and biological characteristics in interaction networks using Gene Ontology consortium (http://www.geneontology.org/). GO analysis of co-expression genes and differentially expressed genes (DEGs) in PCOS was performed by Metascape (30) (https:// metascape.org). Gene lists of co-expressed genes of STON1 and FSHR were analyzed in Metascape (https://metascape.org) via the PaGenBase tool, which was a pattern gene database for understanding the gene function (31).

Transcription Factor (TF) Analysis
An online pipeline for TF analysis, Toolkit for Cistrome Data Browser (32) (http://dbtoolkit.cistrome.org/), was used to construct the hierarchical TFs of STON1 and FSHR. Genome used the human/hg38, the half-decay distance to the transcription start site was 10kb, and data type in Cistrome was transcription factor and chromatin regulator. STON1 (chr2:48530168-48598514, NM_001198595) and FSHR (chr2:48953160-49154526, XM_011532734) were used as the input genes. The top 20 factors are shown in the plot. Regulatory potential (RP) represented the score to estimate how possible the TF could regulate the gene. Y-axis is the RP score, X-axis is different factors. Dots in the X-axis represent the same factors.

Statistical Analysis
Data were presented as mean ± standard deviation (SD). All statistical analyses were performed on the statistical package of GraphPad Prism 6 (v6.02). Pearson's correlation coefficient was used for the evaluation of the correlation between FSHR and CD4, STON1 and BMI, AR and STON1, AR and FSHR. The Student's t-test was used for the assessment of the difference among different groups. All the parameters would be considered statistically significant with a P-value<0.05.

Hi-C Maps and Epigenomic Peaks in the Region of the rs13405728 Locus
We explored Hi-C interactions of ovary tissue (Supplementary Table 3) and performed a comparative Hi-C map between ovary tissue and GM12878 (as control) ( Figure 1A), finding that FOXN2, STON1-GTF2A1L, STON1, GTF2A1L, and FSHR were the putative targets of the rs13405728 (Chr2:48978158) locus with interaction arcs in ovary tissue ( Figure 1B). We then explored Hi-C maps and TADs of ovary tissue and NHEK cells (normal epithelium) in the region of rs13405728 ( Supplementary Figures 2A, B) and found that rs13405728, STON1, LHCGR, STON1-GTF2A1L, and FSHR tended to be in the same TAD. In addition, such domain of rs13405728 was identified as B compartment in Hi-C data of different cells (Supplementary Figure 2C).
Virtual 4C signal of ovary tissue was used to analyze the interactions between rs13405728 and target genes ( Figure 1C). DNase-Seq, ChIP-Seq of H3K36me3, H3K4me1, H3K9me3, and  H3K27ac and mRNA data were characterized to identify the epigenomic modulation of ovary tissue. We found the epigenomic peaks and expression peaks in FOXN2, STON1, STON1-GTF2A1L, GTF2A1L, and FSHR ( Figure 1D).

Expression Analysis Between the rs13405728 Locus and Potential Target Genes
To further explore the molecular patterns between rs13405728 and target genes, we conducted Cis-eQTL analysis around the rs13405728 locus region (+/-10Mb region) from 12 tissues (Figure 2A). We further investigated whether these genes were changed in PCOS patients from GEO datasets, comparing with normal patients. PPP1R21, STON1, and LHCGR were found to be associated with SNP of rs13405728. In PCOS from the GSE145461 dataset, only STON1 (P = 0.0423) was elevated in PCOS patients, with non-significance in PPP1R21, LHCGR, FOXN2, STON1-GTF2A1L, and GTF2A1L ( Figure 2B and Supplementary Figure 3A). Although LHCGR was reputed as target gene for rs13405728 locus, there was no expression differences in PCOS patients. Additionally, STON1 was identified as the target gene in Capture Hi-C interactions in ovary tissue, which was not found in blood control cells (CD4+ T  cells Figure 3B). When comparing the expression of FSHR in human tissues (Supplementary Figure 3C), FSHR expression was specific to the ovary and testis. Single-cell sequencing data of ovary tissue was then mapped and found that FSHR highly expressed in Cumulus cell_Ube2c high cluster (P = 2.3293e-19), Granulosa cell_Inhba high cluster, and Cumulus cell_Car14 high cluster ( Figure 2C). Such expression patterns were validated in mouse ovary tissues ( Figure 2D). In ovarian granulosa cells of patients, the expression of FSHR was found to be higher in PCOS patients than normal patients, with GSE114419 (P = 0.0232) and GSE138518 (P = 0.0013) datasets ( Figure 2E). In addition, we performed single-tissue eQTL analysis of STON1, FSHR, and rs13405728 SNP in ovary tissue ( Figure 2F).

STON1 Was Associated With Metabolic Processes in Adipocytes and Highly Expressed in Mouse Fat and Ovary Tissue From Fat-Diet Mice
Since the biological roles of STON1 in PCOS were unclear, we performed co-expression networks of STON1 in the public dataset to analyze the molecular function of STON1 in cells ( Figure 3A). GO biological process analysis demonstrated that co-expressed genes of STON1 were associated with metabolic processes (GO:0008152, P = 0.0008), cellular component organization or biogenesis (P = 0.001), and localization (P = 0.007) ( Figure 3B). Enrichment analysis in PaGenBase showed  that cell-specific enrichment of the networks was in adipocytes (P = 0.0001, Figure 3C).
To further explore the expression of STON1 in the single-cell pattern, we performed the single-cell transcriptional analysis in the pooled data with 15 mouse tissues (see Methods). STON1 was found in the reproductive gland (Cluster5, Cluster6, Cluster13, Cluster21, Cluster38) and stromal cells (Cluster9) ( Figure 3D and Supplementary Figures 4A, B). In the GSE135917 dataset, the correlation tendency between STON1 expression of subcutaneous fat and body mass index (BMI, kg/m 2 ) was contrary between males and females ( Figure 3E). In GSE155489, the expression of STON1 was higher in PCOS than in normal control (Supplementary Figure 4C, P = 0.0391). Importantly, IHC staining of STON1 was higher in fat diet mice, both in fat tissue (P < 0.0001) and ovary tissue (P = 0.0035), than normal diet mice ( Figures 3F, G).

FSHR Was Associated With The Immune System Processes And Positively Correlated With CD4 Expression in PCOS Patients and PCOS-Like Models
To evaluate the molecular basis of FSHR in PCOS, we firstly performed co-expression networks of FSHR ( Figure 4A). GO enrichment analysis demonstrated that co-expressed genes of FSHR were associated with the reproductive process (GO:0022414, P = 0.0002) and the immune system process (GO:0002376, P = 0.0002) ( Figure 4B). The immune system process (GO:0002376, P = 0.0002) was found to be enriched in the differential expressed genes (DEGs) of follicular fluid between PCOS and normal patients (Figures 4C, D).
The hyperandrogenic phenotype was reported to be an important molecular mechanism of PCOS (33), thus prenatally androgenized (PNA) mice were conducted to analyze the DEGs between PCOS-like mice and normal control ( Figure 4E). High expression of CD4 et al. was found in both PCOS patients (P = 0.0316) and PCOS-like mice (P = 0.0079) (Figures 4F-H). Furthermore, FSHR was found to be positively correlated (P = 0.0252, r = 0.6967) with CD4 expression in PCOS patients ( Figure 4I), and in PCOS-like (Macaca mulatta) model (P = 0.0178, r = 0.8889, Figure 4J).

AR Was Identified as the Common Transcription Factor of STON1 and FSHR and Positively Correlated With STON1 and FSHR Expression in Ovary Tissues
Given the increased expression of STON1 and FSHR in PCOS patients and PCOS-like models, we hypothesized a potential role of STON1 and FSHR in PCOS and explored the high expression mechanism underlying PCOS. We then performed transcription factors (TFs) analysis in the region of the rs13405728 locus (Chr2: 48478159-49478159) and gene regions of STON1 and FSHR ( Figures 5A-C and Supplementary Tables 4-6). AR was the only TF among them, AR and FOXA1 were found to be the same TFs of STON1 and FSHR (Supplementary Figure 5A), Further ChIP-Seq analysis of STON1 and FSHR showed the modulation peaks of AR in primary tissues (Figures 5D, E). Moreover, the expression of AR was found to be positively correlated with the expression of STON1 (P = 0.039, r = 0.22) and FSHR (P = 4e-06, r = 0.47) in normal ovary tissues ( Figure 5F). However, the correlations were not found in FOXA1 (Supplementary Figure 5B). Meanwhile, the expression of Ar, Fshr, and STON1 were elevated in testosterone-treated and high-fat diet mice than normal mice (Supplementary Figure 5C), and their expression showed positive correlations ( Figure 5G).

DISCUSSION
Since the rs13405728 locus has been identified as a common risk locus of PCOS (Supplementary Figure 6) in Han Chinese women (7,10) and Caucasian women (11), it was necessary to identify target genes at the rs13405728 locus based on alternative genome conformation in the development of PCOS. We mapped Hi-C interactions, Capture Hi-C interactions, and virtual 4C interactions from the ovary tissue, and identified the potential targets at the rs13405728 locus. In addition, we explored the changes in expression of potential targets in PCOS patients and PCOS-like models, comparing with the normal patients and normal control, and identified STON1 and FSHR as the most functional targets at the rs13405728 locus in PCOS. The Hi-C approach holds the advantages of capturing long-range interactions across the whole human genome (9), which is entirely useful for understanding the genetic trait with high heritability in the development of PCOS (2).
STON1 has been reported to be involved in spermatogenesis of the mouse models (34), in accordance with our findings that STON1 expressed in the reproductive gland and stromal cells in single-cell sequencing patterns, which was validated in adipocytes and ovaries of the high-fat diet mouse models. Our results found an opposite tendency of correlations between STON1 and BMI in male and female adipocytes. In male adipocytes, BMI was positively correlated with STON1 expression. In PCOS, high BMI is a common characteristic and was a predictor of hyperandrogenism (35), consisting of the findings that STON1 was highly expressed in PCOS and PCOS-like models. These results suggested that high STON1 expression may be responsible for the hyperandrogenic phenotype in PCOS patients with dysregulated metabolic phenotypes.
Currently, PCOS is also reputed as an autoimmune disorder with high autoantibodies recorded in long-term clinical management (36). In our findings, the immune system processes were enriched in PCOS patients, with a high CD4 expression phenotype in PCOS patients and PCOS-like models. In addition, FSHR, a receptor for FSH, plays a role in the development of follicles, maturation of the oocyte, and regulation of steroidogenesis and may be an important candidate gene for PCOS (37). However, the role of FSHR in the development of PCOS is unclear. Here, we showed an enrichment of the immune system processes and reproductive processes in FSHR co-expressed genes, following a positive correlation between CD4 and FSHR both in PCOS patients and PCOS-like models. These results are supported by the findings that PCOS had lower global DNA methylation in monocytes, T helper cells, T cytotoxic cells, and B cells (38).
The biochemical and clinical changes of hyperandrogenism (high levels of androgen) are important phenotypes of PCOS, which was associated with anovulation and menstrual dysfunction (3). Therefore. prenatally androgenized (PNA) models (39) or testosterone-treated models (20) were used as PCOS-like models for hyperandrogenism basis, which would highly increase the expression of AR (40). In our findings, AR was identified as the common TF of STON1 and FSHR and positively correlated with their expression in ovary tissues. These results suggested the underlying interactions of hyperandrogenism, AR, STON1, and FSHR in the development of PCOS.
Insulin resistance is reputed as a key element contributing to the pathogenesis of PCOS patients (41). Recent studies have identified some candidate genes related to PCOS susceptibilities, such as the processes of insulin secretion and action in cells (42,43). Therefore, we analyzed the expression levels of candidate genes in PCOS patients and PCOS-like models compared with normal patients and control. IGF1 and IGF1R showed differential expression between PCOS and normal patients (Supplementary Figure  7A). Igf1, Igfbp1, Pparg, and Shbg were down-regulated in PCOS-like mouse models (Supplementary Figure 7B). In addition, we analyzed the inter-chromosomal interactions between candidate genes and rs13405728 locus with Hi-C data. Although these candidate genes have been shown the association with PCOS, no single candidate gene showed inter-chromosomal interactions with rs13405728 locus (Supplementary Figure 7C). This may be attributed to the disease heterogeneity observed in PCOS (44). Since fat tissue is the target of insulin resistance and metabolic disorder in PCOS (45), we explored the expression levels of these candidate genes in adipose tissue of Macaca mulatta (macaque) among normal diet, testosterone treatment, western-style diet, and the combination of testosterone treatment and western-style diet groups from GSE124707. IRS1 was up-regulated after testosterone treatment. Although these candidate genes showed slight expression differences compared to the normal diet group, no single gene showed statistical significance (Supplementary Figure 8).
The current data did not show an eQTL correlation at rs13405728 locus for STON1 and FSHR. It is possible that the effects of the risk variants for STON1 and FSHR were not validated in the PCOS cohort and hence not detected in this study. Although the data presented herein provided statistical differences between PCOS and normal controls, and the gene nearby the locus may be the potential candidates for PCOS, particularly concerning adipocyte metabolic and CD4 immunological processes, further studies should be performed to determine the roles of the rs13405728 locus, STON1, and FSHR in the pathogenesis of PCOS. In summary, 3D genomic interactions in primary ovary tissue identified the interaction genes at the rs13405728 locus as STON1 and FSHR, which were highly expressed in PCOS patients. Further analysis showed the adipocyte metabolism roles of STON1, which was validated in the adipose tissue and ovaries of the fat-diet mice. In addition, immune system processes were enriched in PCOS, with CD4 high expression in PCOS patients and PCOS-like models, which was consistent with the CD4 immunological correlation of FHSR in PCOS patients and PCOS-like models. Furthermore, we found that AR was the common transcription factor for STON1 and FSHR and positively correlated with STON1 and FSHR expression in ovary tissues. Overall, we identified STON1 and FSHR as potential targets of rs13405728 locus in adipocyte metabolism and immune processes in the pathogenesis of PCOS.

DATA AVAILABILITY STATEMENT
The original contributions presented in the study are included in the article/Supplementary Material. Further inquiries can be directed to the corresponding authors.

ETHICS STATEMENT
The animal study was reviewed and approved by Ethics Committee of Shenzhen Peking University-The Hong Kong University of Science and Technology Medical Center.

AUTHOR CONTRIBUTIONS
C-hC performed the analysis of data, C-hC, YW, and X-rL performed the animal experiments, C-hC performed IHC of tissue. C-hC wrote the manuscript. J-qL, Q-jZ, S-rL, LG, and S-kY provided feedback. YS and XX designed the study and funding acquisition. All authors contributed to the article and approved the submitted version.