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The 2023 international guideline supports metformin for adults with PCOS and BMI 25 kg/m for metabolic outcomes, but inositol is a reasonable alternative or adjunct for women who don't tolerate metformin or prefer a non-pharmaceutical option

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The activated AMPK directly binds to Nrf2, facilitating its dissociation from Keap1 and subsequent nuclear translocation

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Mechanistically, E2F1-mediated CHAC1 upregulation promotes PKM2 SUMOylation enabling PKM2 nuclear translocation or kinase activation (Pan et al., 2024)