Endometriosis

Increased circulating T helper 17 (TH17) cells and endometrial tissue IL-17-producing cells in patients with endometriosis compared with non-endometriotic subjects

Endometriosis, an inflammatory disease, is characterized by the aberrant presence of endometrial tissues at ectopic locations. Accumulating evidence suggests that inflammatory cells, such as interleukin-17 (IL-17)-producing cells, may be involved in the pathogenesis of endometriosis. This investigation assessed the frequency of IL-17A (commonly known as IL-17)-producing cells in peripheral blood mononuclear cells (PBMCs), ectopic, and eutopic endometrial tissues in patients with endometriosis compared to non-endometriotic subjects. PBMCs, ectopic, and eutopic endometrial tissues were collected from 23 patients with endometriosis. PBMCs and endometrial tissues from 20 non-endometriotic women were used as the control group. The frequency of T helper 17 (TH17) lymphocytes in PBMCs was assessed using flow cytometry, and the expression level of IL-17 in eutopic and ectopic endometrial tissues was evaluated through immunohistochemistry. The percentage of TH17 and IL-17-producing lymphocytes was significantly higher in the PBMCs of patients with endometriosis compared to non-endometriotic subjects (P < 0.01 and P < 0.001, respectively). The expression of IL-17 protein in ectopic (P < 0.001) and eutopic (P < 0.05) endometrial tissues of patients with endometriosis increased compared to controls' endometrial tissue. Furthermore, the eutopic endometrium of patients with endometriosis showed a higher expression of IL-17 protein than the eutopic endometrial tissue of control subjects (P < 0.05). The findings suggest that the higher frequency of IL-17-producing cells in the PBMCs and endometrial tissues of patients with endometriosis contributes to the pathogenesis of endometriosis.

Creation of a rat model of ovarian endometriosis: a novel and easy approach to simulating chocolate cysts

Ovarian endometriosis(OEM) is the most common type of endometriosis, but there is still a lack of simple and easy-to-promote animal models. Therefore, it is necessary to establish a feasible animal model of OEM and analyze its pathogenesis. In this study, a novel insertional surgical method was used to construct the OEM rat model. The rat model group's morphology and HE staining revealed a close relationship between the transplanted ectopic tissue and the ovary. Compared to the surgery group and the normal group, the bilateral OEM group's level of Anti-mullerian hormone(AMH) was noticeably lower. There was no discernible difference in the unilateral OEM group's AMH level between the normal and sham operation groups. Serum interleukin-1beta(IL-1β) levels in four groups of rats showed bilateral OEM had the greatest level, followed by unilateral OEM. Compared to the normal group, the two model groups had greater serum levels of IL-1β. According to immunohistochemistry, unilateral OEM had higher Intercellular adhesion molecule 1(ICAM1), Matrix metalloproteinase-9(MMP9), Tumor necrosis factor-α(TNF-a), and IL-1β expression levels than the normal rat endometrium. WB revealed that bilateral and unilateral ectopic tissues had higher levels of MMP9, TNF-a, Vascular endothelial growth factor D and IL-1β expression than normal tissues. Transcriptome research revealed that ectopic tissues had higher pro-inflammatory, immunological, and ectopic endometrial proliferation pathways than normal tissues. The ovaries of unilateral OEM have down-regulated immune and inflammation-related pathways and up-regulated steroid hormones compared to normal ovarian tissue. GSEA enrichment analysis comparisons between rat and human endometriotic tissue revealed that Janus kinase-signal transducer and activator of transcription(JAK-STAT), Nuclear factor-kappa B(NFκB), and Toll-like receptors were up-regulated. The intercalation approach of OEM building used in this work is more akin to the human OEM lesion type. It deserves promotion that modeling is more straightforward and has a higher success rate than the suture approach.

Utility of sexually transmitted infection screening in diagnosing clinical gynaecological conditions using endometrial specimens

Sexually transmitted infections are associated with gynaecological conditions, yet screening algorithms are lacking. The aim was determining the utility of endometrial specimens for chronic gynaecological diagnosis. In a retrospective cohort study of 91 patients (42.8 % CD138-positive), only 5.5 % tested were positive for Ureaplasma parvum. Endometrial STI screening was not useful in a population of low STI prevalence (<10 %), suggesting its value depends on STI prevalence.

3D bioprinting technology innovation in female reproductive system

Several diseases affect the female reproductive system, and both disease factors and treatments impact its integrity and function. Consequently, understanding the mechanisms of disease occurrence and exploring treatment methods are key research focuses in obstetrics and gynecology. However, constructing accurate disease models requires a microenvironment closely resembling the human body, and current animal models and 2D in vitro cell models fall short in this regard. Thus, innovative in vitro female reproductive system models are urgently needed. Additionally, female reproductive system diseases often cause tissue loss, yet effective tissue repair and regeneration have long been a bottleneck in the medical field. 3D bioprinting offers a solution by enabling the construction of implants with tissue repair and regeneration capabilities, promoting cell adhesion, extension, and proliferation. This helps maintain the long-term efficacy of bioactive implants and achieves both structural and functional repair of the reproductive system. By combining live cells with biomaterials, 3D bioprinting can create in vitro 3D biomimetic cellular models, facilitating in-depth studies of cell-cell and cell-extracellular microenvironment interactions, which enhances our understanding of reproductive system diseases and supports disease-specific drug screening. This article reviews 3D bioprinting methods and materials applicable to the female reproductive system, discussing their advantages and limitations to aid in selecting optimal 3D bioprinting strategies. We also summarize and critically evaluate recent advancements in 3D bioprinting applications for tissue regeneration and in vitro disease models and address the prospects and challenges for translating 3D bioprinting technology into clinical applications within the female reproductive system.

Limitations and perspectives of the novel salivary test for endometriosis: an open web-based survey study of German gynecologic healthcare providers

INTRODUCTION

The description of a salivary miRNA signature for endometriosis has led to the development of a non-invasive diagnostic test. Current healthcare provider practices regarding the test remain uncaptured. The application of this test in practice was examined in a web-based survey, with the aim to provide their opinions on it.

METHODS

We conducted an open web-based survey study between November 2023 and January 2024. Members of the German society of gynecologic endoscopy (Arbeitsgemeinschaft gynäkologische Endoskopie, AGE), society of endometriosis (Arbeitsgemeinschaft Endometriose, AGEM), and the endometriosis research foundation (Stiftung Endometriose Forschung, SEF) were contacted per e-mail twice. Participants' data were anonymized. Differences in responses based on self-reported expertise in the field (basic knowledge, specialized knowledge, expert) were assessed using the χ2-test or Fisher's exact test. Statistical significance was set as p < 0.05.

RESULTS

In total 141 of 190 respondents completely responded to the survey (> 75% of the questions of the survey). Twenty-one physicians reported having experience with the test, while most participants had at least specialized knowledge on the field (112/141). In terms of specific questions, more than 90% found the costs high; almost 85% did not believe that the test replaces standard diagnostic tools (histology, clinical examination, and sonography). Eighty-six providers supported the use of the test in adolescents. Gynecologists with basic knowledge had a more positive attitude compared with more experienced ones in terms of usefulness (Fisher's exact test, p < 0.001). Significant differences were demonstrated between expertise groups regarding (not only) applicability in adolescents (Fisher's exact test, p = 0.004), and using the test for screening purposes (χ2-test, p = 0.002).

DISCUSSION

Despite the promising benefits of a salivary test for endometriosis, German healthcare providers would not change current practices. Nevertheless, less experienced colleagues were more positive towards the test.

Childhood adversity and risk of endometriosis, fibroids, and polycystic ovary syndrome: a systematic review

IMPORTANCE

Although childhood adversity has been extensively studied in relation to various health outcomes, investigation of its association with gynecological conditions remains limited.

OBJECTIVE

To systematically review studies examining the effect of childhood adversity on the prevalence of three gynecological conditions: endometriosis; fibroids; and polycystic ovary syndrome (PCOS) in the population.

EVIDENCE REVIEW

Six databases were searched from inception to March 12, 2024. Observational studies of women with exposure to adversity before the age of 18 and an outcome of endometriosis, fibroids, and/or PCOS were eligible for inclusion. Studies were summarized through a qualitative synthesis. We evaluated the risk of bias using the Newcastle-Ottawa Scale.

FINDINGS

Seven studies that reported on the association between a form of childhood adversity and endometriosis, fibroids, and or PCOS were selected for review. All seven studies received a moderate risk of bias score. Cumulative exposure to childhood adversity was associated with an increased risk of endometriosis and fibroids. Childhood exposure to sexual abuse was associated with an increased risk of endometriosis and fibroids. Exposure to physical abuse in childhood was associated with a greater risk of fibroids.

CONCLUSION AND RELEVANCE

A small number of studies have shown an association between childhood adversity and the development of endometriosis and fibroids in later life. These initial findings warrant further investigation in larger studies using standardized measures.

Follicular Fluid Metabolomics: Tool for Predicting IVF Outcomes of Different Infertility Causes

Infertility affects approximately 15% of couples at child-bearing ages and assisted reproductive technologies (ART), especially in vitro fertilization and embryo transfer (IVF-ET), provided infertile patients with an effective solution. The current paradox is that multiple embryo transfer that may leads to severe obstetric and perinatal complications seems to be the most valid measure to secure high success rate in the majority of clinic centers. Therefore, to avoid multiple transfer of embryos, it is urgent to explore biomarkers for IVF prognosis to select high-quality oocytes and embryos. Follicular fluid (FF), a typical biofluid constituted of the plasma effusion and granulosa-cell secretion, provides essential intracellular substances for oocytes maturation and its variation in composition reflects oocyte developmental competence and embryo viability. With the advances in metabolomics methodology, metabolomics, as an accurate and sensitive analyzing method, has been utilized to explore predictors in FF for ART success. Although FF metabolomics has provided a great possibility for screening markers with diagnostic and predictive value, its effectiveness is still doubted by some researchers. This may be resulted from the ignorance of the impact of sterility causes on the FF metabolomic profiles and thus its predictive ability might not be rightly illustrated. Therefore, in this review, we categorically demonstrate the study of FF metabolomics according to specific infertility causes, expecting to reveal the predicting value of metabolomics for IVF outcomes.

Prevalence and sociodemographic distribution of endometriosis symptoms and indicators in Denmark

INTRODUCTION

Endometriosis is characterized by a range of non-specific symptoms which may contribute to the significant delay in diagnosis. Knowledge about the distribution of endometriosis symptoms across different geographical regions as well as other sociodemographic factors could add knowledge and guide initiatives to reduce this underdiagnosis. This study aims to explore how the prevalence of endometriosis symptoms and indicators are linked to the different sociodemographic factors.

STUDY DESIGN

The study used data from the CYKLUS-survey; a women's health survey sent to 63,199 Danish women aged 16 to 51 in 2023. Self-reported information on endometriosis symptoms and indicators was linked to Danish register data on sociodemographic factors. Age-standardized prevalence of six endometriosis symptoms and indicators were estimated for each of the nine different regions of residence and for the whole country. In addition, logistic regression analysis was used to estimate the association between sociodemographic factors and the six endometriosis symptoms and indicators.

RESULTS

11,407 women were included in the study. Age-standardized prevalence of symptoms showed little variation across Danish regions. However, younger age, lower socioeconomic status, and non-Danish origin were found to be associated with higher prevalences, and higher education was found to be associated with lower prevalences.

CONCLUSION

No major regional differences in endometriosis symptoms and indicators were found. However, associations were found between several sociodemographic factors and endometriosis symptoms and indicators, suggesting disparities in the burden of symptoms. These findings call for further investigation into factors causing these disparities in Denmark.

Mitochondrial Involvement in the Pathogenesis of Endometriosis and its Potential as Therapeutic Targets

Endometriosis is an estrogen-dependent benign disease characterized by the development of endometrial tissue outside the uterus. This intricate ailment markedly affects a patient's well-being and lacks a definitive cure. Endometriotic cells enhance their viability by modulating genetic and epigenetic characteristics, with mitochondria being important organelles in determining cellular metabolic pathways. Mitochondrial malfunction is associated with various human disorders, and the disruption of mitochondrial adaptation mechanisms may help develop new therapies for endometriosis. This article examines the significance of mitochondrial balance in the etiology and advancement of endometriosis and introduces several potential drugs targeting mitochondria for its treatment.

Characterization of key genes and immune cell infiltration associated with endometriosis through integrating bioinformatics and experimental analyses

BACKGROUNDS

Endometriosis (EM) is the most common gynecological disease in women of childbearing age. This study aims to identify key genes and screen drugs that may contribute to EM treatment.

METHODS

The differentially expressed genes (DEGs) were identified using limma analysis in the GSE11691 dataset. The protein-protein network (PPI) was constructed. Four machine learning methods, including LASSO, SVM-RFE, random forest, and Boruta, were applied to identify the key genes associated with EM. Flow cytometry, wound healing, and migration assays were applied to assess the cell functions of APLNR on hEM15A. The immune cell infiltration of each sample in EM was calculated using a single-sample gene set enrichment analysis (ssGSEA) algorithm. The potential drugs were screened using the Connectivity Map (CMAP) database, based on the DEGs. Finally, the expression levels of the three genes were further validated in the GSE23339 dataset.

RESULTS

One hundred thirty-seven down-regulated genes and 304 up-regulated genes were identified. We identified three key genes associated with EM: APLNR, HLA-DPA1, and AP1S2. The ssGSEA analysis results indicated that these genes play an important role in the development of EM. Moreover, EM immune cell infiltration was tightly associated with these three genes. Finally, several molecular compounds targeting EM were screened with the connectivity map (CMAP) database. ShAPLNR decreased the cell viability of hEM15A, increased the number of apoptotic cells, and significantly decreased the proportion of callus through APLNR in vitro studies.

DISCUSSION

Three genes (APLNR, HLA-DPA1, and AP1S2) may serve as novel therapeutic targets for diagnosing and treating patients with EM.

Patient satisfaction with two different management modalities for erratic bleeding during continuous hormone therapy for endometriosis-associated symptoms: A before-after study

OBJECTIVE

To evaluate patient satisfaction with the management of erratic bleeding during continuous hormone therapy for endometriosis using two different strategies: an active approach (tailored cycling), which involved discontinuation of the therapy; and a passive approach, which involved waiting for spontaneous resolution of the bleeding.

METHODS

This was an observational before-after study. All patients enrolled within a previously defined time limit were instructed to adopt a passive strategy to manage erratic bleeding, while all patients enrolled after that defined time were instructed to discontinue therapy for 7 days (tailored cycling). Degree of satisfaction, characteristics of bleeding, and level of dysmenorrhoea were compared and analysed at the time of enrolment and after 6 and 12 months.

RESULTS

In total, 201 patients were included in the study. Satisfaction was 29% higher among patients in the passive strategy group compared with those in the tailored cycling group; this difference was significant. No significant differences were identified for the other outcomes.

CONCLUSION

Patients may be more satisfied with the use of a passive approach to manage irregular bleeding during continuous hormone therapy for endometriosis-associated pain. All patients should be provided with comprehensive information regarding all available management strategies for unpredictable irregular bleeding. This will enable patients to make informed decisions based on their personal experience and preferences, without external pressure, thus improving compliance, adherence and, ideally, satisfaction with treatment.

The Role of Exosomal miRNAs in Female Infertility: Therapeutic Potential and Mechanisms of Action

Reproductive disorders, including preeclampsia (PE), endometriosis, premature ovarian failure (POF), and polycystic ovary syndrome (PCOS), present substantial challenges to women's reproductive health. Exosomes (EXOs) are cell-derived vesicles containing molecules that influence target cells' gene expression and cellular behavior. Among their cargo, microRNAs (miRNAs)-short, non-coding RNAs typically 19-25 nucleotides in length-play a crucial role in post-transcriptional gene regulation and have been extensively studied for their therapeutic potential. miRNAs are considered therapeutic targets because they regulate key cellular pathways such as proliferation, apoptosis, angiogenesis, and tissue repair. This review examines the role of exosomal miRNAs from sources such as mesenchymal stem cells (MSCs), plasma, and amniotic fluid in female reproductive disorders, including PE, POF, PCOS, and endometriosis. We discuss their biological origins, mechanisms of miRNA sorting and packaging, and their therapeutic applications in modulating disease progression. By categorizing miRNAs according to their beneficial or detrimental effects in specific conditions, we aim to simplify the understanding of their roles in female infertility.

Analysis of the Biopsychosocial Impacts Associated with Endometriosis to Improve Patient Care

Endometriosis is a non-malignant, inflammatory condition that impacts individuals across various hormonal stages, including before their first menstruation, throughout their reproductive years, and after menopause. This condition arises when tissue resembling the uterine lining grows outside the uterus, resulting in inflammation and a range of symptoms, such as dysmenorrhea, pain during intercourse, chronic discomfort, and challenges with fertility. This review provides a comprehensive analysis of the medical strategies implemented to address the pathology of endometriosis, highlighting its significant impact on the quality of life of the individuals affected by this condition. Endometriosis can influence various aspects of life, including physical health, emotional well-being, social interactions, and professional performance. Usually, to assess the quality of life in women with endometriosis, validated instruments, such as different questionnaire types, are used to measure the physical, psychological, social, and reproductive health impacts. To improve the quality of life of the women experiencing endometriosis, several supportive strategies are proposed. The findings underscore the necessity of managing endometriosis through a multidisciplinary approach that encompasses both medical and surgical interventions, lifestyle modifications, and psychological support.

Plasma metabolites associated with endometriosis in adolescents and young adults

STUDY QUESTION

What are the plasma metabolomics profiles associated with endometriosis in adolescents and young adults?

SUMMARY ANSWER

Our findings show dysregulation of plasma metabolomic profiles in adolescents and young adults with endometriosis, revealing systemic elevation of fatty acyls and ceramides in endometriosis cases compared to controls.

WHAT IS KNOWN ALREADY

Endometriosis is a gynecologic disease often presenting with severe pelvic pain impacting around 200 million reproductive-aged women worldwide. However, little is known about the pathophysiology and molecular features of endometriosis diagnosed during adolescence and young adulthood.

STUDY DESIGN, SIZE, DURATION

We conducted a cross-sectional analysis including 190 laparoscopically confirmed endometriosis cases and 120 controls who participated in The Women's Health Study: From Adolescence to Adulthood, which enrolled participants from 2012 to 2018. Control participants were females without a diagnosis of endometriosis enrolled from the same clinics as the cases or recruited from the general population. Among the cases, 81 had blood samples collected before and after surgery.

PARTICIPANTS/MATERIALS, SETTING, METHODS

Plasma metabolites were measured in blood collected at enrollment using liquid chromatography-tandem mass spectrometry, and a total of 430 known metabolites were evaluated in our analysis. We used linear regression adjusting for age at blood draw, BMI, hormone use, and fasting status at blood draw. Metabolite set enrichment analysis (MSEA) was used to identify metabolite classes. Number of effective tests (NEF) and false discovery rate (FDR) were used for multiple testing correction.

MAIN RESULTS AND THE ROLE OF CHANCE

The median age was 17 years for endometriosis cases and 22 years for controls. The majority of endometriosis cases had rASRM stage I or II (>95%). We identified 63 plasma metabolites associated with endometriosis (NEF < 0.05). Endometriosis cases had higher levels of plasma metabolites associated with proinflammatory response [e.g. eicosatrienoic acid (β = 0.61, 95% CI = 0.37, 0.86)], increased oxidative stress response [e.g. xanthine (β = 0.64, 95% CI = 0.39, 0.88)], and downregulation of metabolites related to apoptosis [glycocholic acid (β = -0.80, 95% CI = -1.04, -0.56)]. MSEA revealed increased fatty acyls (FDR = 2.3e-4) and ceramides (FDR = 6.0e-3) and decreased steroids and steroid derivatives (FDR = 1.3e-4) in endometriosis cases compared to controls. When we examined the changes in plasma metabolite profiles before and after surgery among endometriosis cases, 55 endometriosis-associated metabolites significantly changed from before to after surgery. MSEA revealed steroids and steroid derivatives (FDR = 8.1e-4) significantly increased after surgery, while fatty acyls (FDR = 1.2e-4) significantly decreased after surgery. Ceramides did not change from pre- to post-surgery and were elevated in post-surgical blood compared to controls (FDR = 3.9e-3).

LIMITATIONS, REASONS FOR CAUTION

Our study population mainly consists of self-reported non-Hispanic, white individuals and endometriosis cases with superficial peritoneal lesions only, so the generalizability may be limited. Furthermore, despite our large study population of adolescents and young adults with endometriosis, sample size was limited to conduct detailed stratified analyses of plasma metabolomic profiles, especially by post-surgical pelvic pain outcomes.

WIDER IMPLICATIONS OF THE FINDINGS

Our study includes the utilization of state-of-the-art metabolomics technology with high reproducibility to comprehensively investigate the metabolites that were associated with endometriosis diagnosed in adolescents and young adults. Our results suggest a positive impact of endometriosis-related surgery for some, but not all, on systemic metabolic dysregulation in young patients with endometriosis. These results warrant further investigation on whether and how persistent systemic changes despite treatment may lead to long-term chronic disease risk among those diagnosed with endometriosis.

STUDY FUNDING/COMPETING INTEREST(S)

Financial support for establishment of and data collection within the A2A cohort was provided by the J. Willard and Alice S. Marriott Foundation, and support for assay costs was in part provided by the Peery family. This project was funded by Eunice Kennedy Shriver National Institute of Child Health and Human Development R21HD107266. S.A.M., A.L.S., and K.L.T. were supported by Eunice Kennedy Shriver National Institute of Child Health and Human Development R01HD094842. S.A.M. received grant funding from AbbVie, National Institutes of Health, Department of Defense, and Marriott Family Foundation; received honoraria from WERF, Huilun Shanghai, and University of Kansas Medical Center; travel support from SRI, ESHRE, FWGBD, University of Michigan, MIT, ASRM, LIDEA Registry, Taiwan Endometriosis Society, SEUD, Japan Endometriosis Society, NASEM, Endometriosis Foundation of America, Gedeon Richter Symposium at ESHRE; Board member receiving financial remuneration from AbbVie, Roche, LIDEA Registry, Editor of Frontiers in Reproductive Health, Roundtable participation for Abbott; Board member without financial remuneration from NextGen Jane and Statistical Advisory Board member of Human Reproduction; leadership role in Society for Women's Health Research, World Endometriosis Society, World Endometriosis Research Foundation, ASRM, ESHRE. N.S. and K.L.T. receive grant funding from Aspira Women's Health unrelated to this project. The remaining authors have no disclosures relevant to this manuscript.

TRIAL REGISTRATION NUMBER

N/A.

FOXA2 loss results in an increase of endometriosis development and LIF reveals a therapeutic effect for endometriosis

Endometriosis, characterized by the growth of uterine-like tissue outside the uterus, causes chronic pain and infertility. Current diagnostic and therapeutic strategies have notable limitations, including delayed diagnosis and adverse effects. The transcription factor forkhead box A2 (FOXA2), which is exclusively expressed in the uterine glandular epithelium, regulates key genes involved in endometrial proliferation, differentiation, fertility, and hormone response. While FOXA2 expression is reduced in the endometrial tissue of women with endometriosis, its pathophysiological role in the disease is not well understood. In this study, we report that endometriosis significantly reduced FOXA2 expression in the eutopic endometrium of mice with endometriosis compared to sham controls, accompanied by decreased expression of its downstream gene, CXCL15. To evaluate the effect of FOXA2 loss in endometriosis, we surgically induced endometriosis by transplanting control Rosa26mTmG/+ or Pgrcre/+Foxa2f/fRosa26mTmG/+ (Foxa2d/dRosa26mTmG/+) endometrial tissue into the peritoneal cavity of mice. The number and weight of ectopic lesions were significantly increased in the mice with Foxa2d/dRosa26mTmG/+ ectopic lesions compared to controls. Furthermore, progesterone receptor expression was significantly reduced in the endometrial epithelium from mice with Foxa2d/dRosa26mTmG/+ ectopic lesions compared to mice with control ectopic lesions. Importantly, treatment with leukemia inhibitory factor (LIF), a cytokine regulated by FOXA2, significantly reduced ectopic lesion formation in Foxa2d/dRosa26mTmG/+ endometriosis mice compared to vehicle-treated mice. This study demonstrates that FOXA2 loss results in an increase in endometriosis incidence and that treatment with LIF offers a novel promising therapeutic approach for endometriosis.

Theranostic implications of Nectin-4 oncoprotein in gynecologic cancers: A review

INTRODUCTION

Gynecologic cancers, in order of prevalence, include uterine, ovarian, cervical, vaginal, and vulvar cancers. In 2024, there will be more than 116,000 new cases of gynecologic cancers and 33,800 disease-related deaths. Therefore, a concerted effort has been made to better understand the underlying pathophysiological processes and identify novel theranostic approaches.

PURPOSE

Comprehensively examine the current peer-reviewed literature surrounding Nectin-4 and its implication in the identification and treatment of gynecologic cancers.

METHODS

PubMed and Google search with relevant keywords for articles published in the last 15 years.

RESULTS

Nectin-4 as a cell adhesion molecule (CAM) promotes cell growth through intra-tumoral angiogenesis, strengthens cell-cell bonds, and creates a tight spheroid structure, which is more chemotherapy resistant. In high-grade serous ovarian cancer (HGSOC), Nectin-4 is strongly associated with the presence of peritoneal metastases and worse prognoses. When compared to CA-125, a common tumor marker for ovarian cancer, Nectin-4 showed higher specificity and sensitivity for predictive value of tumorigenesis. Regarding cervical cancer, inhibition of Nectin-4 by nanoformulated Quinacrine inhibits both cancer stem cell proliferation and DNA damage. Nectin-4 as a tumor marker can discriminate endometrial cancer from healthy adjacent tissue with a specificity of 95.4 % and sensitivity of 82.81 %. Lastly, there is scarce evidence of Nectin-4 and fallopian tube, vaginal, or vulvar cancer but given ovarian cancer cells may originate from the fallopian tube, there is plausibility of using Nectin-4 to detect fallopian and/or ovarian cancer earlier.

CONCLUSION

Overall, Nectin-4 as a promoter of cancer cell growth and metastasis supports the emphasis in current peer-reviewed literature as an effective theranostic biomarker.

Biomarkers of endometriosis

Endometriosis represents a diverse disease characterized by three distinct phenotypes: superficial peritoneal lesions, ovarian endometriomas, and deep infiltrating endometriosis. The most widely accepted pathophysiological hypothesis for endometriosis is rooted in retrograde menstruation, a phenomenon observed in most patients. Endometriosis is closely linked to infertility, but having endometriosis does not necessarily imply infertility. The disease can impact fertility through various mechanisms affecting the pelvic cavity, ovaries, and the uterus itself. MicroRNAs (miRNAs) indeed represent a fascinating and essential component of the regulatory machinery within cells. Discovered in the early 1990s, miRNAs have since been identified as critical players in gene expression control. Unfortunately, ovarian endometrioma is a common gynecologic disorder for which specific serum markers are currently lacking. Some have examined urocortin for its ability to differentiate endometriomas from other benign ovarian cysts. Another potential marker, Cancer Antigen 125 (CA-125) is a well-established indicator for epithelial cell ovarian cancer and its levels can be elevated in conditions such as endometriosis. CA-125 is derived from coelomic epithelia, including the endometrium, fallopian tube, ovary, and peritoneum. In this review we examine the pathophysiologic basis for endometriosis and highlight potential markers to more fully characterize the underlying biochemical processes linked to this multifaceted disease state.

Efficacy and safety of Chinese patent medicines combined with conventional therapies for endometriosis: A systematic review and bayesian network meta-analysis

ETHNOPHARMACOLOGICAL RELEVANCE

Conventional hormonal treatments for endometriosis (EMs) are often associated with significant side effects. In recent years, many clinical trials and studies have highlighted the remarkable efficacy of Chinese patent medicines (CPMs) in alleviating endometriosis-related pain, reducing CA125 markers, regulating hormone levels, and preventing symptom recurrence. Numerous randomized controlled trials (RCTs) have been conducted on CPMs such as Shaofu Zhuyu Decoction (SZD), Dan'e Fukang Plaster (DFP), Sanjie Zhentong Capsule (SZC), Guizhi Fuling Capsule (GFC), Xiaojin Capsule (XC), Gongliu Xiao Capsule (GLXC), Xuefu Zhuyu Capsule (XZC), Jingtong Yushu Granule (JYG), Zhitong Huazheng Capsule (ZHC), and Kuntai Capsule (KTC) for the treatment of endometriosis. However, these studies have yet to be evaluated through a network meta-analysis (NMA) compliant with PRISMA standards.

AIM OF THE STUDY

This study aimed to compare the efficacy and safety of ten CPMs for treating EMs through a NMA on RCTs.

MATERIALS AND METHODS

PubMed, Cochrane, Embase, Web of Science, China National Knowledge Infrastructure, VIP Information, WanFang, and China Biomedicine databases were searched up to October 2024 for studies on the efficacy and safety of CPMs in treating EMs. Two researchers independently screened the studies, extracted data, and assessed quality using the Cochrane Risk of Bias 2.0 tool and the Confidence in Network Meta-Analysis framework. The NMA was conducted using Bayesian methods with StataSE and Rstudio, generating network diagrams, league tables, and Surface Under the Cumulative Ranking (SUCRA) line charts. This study was registered with PROSPERO (CRD42023477523).

RESULTS

148 eligible trials involving 10 CPMs and 16198 participants were included in this NMA; all subsequent estimates refer to the comparison with conventional therapies. All 10 CPMs effectively improved the total effective rate and VAS pain scores. SZC induced the most significant improvement in total effective rate(compared to hormone therapy: risk ratio 5.51, 95% confidence interval 4.21 to 7.2, SUCRA 86.3%, moderate confidence of evidence; compared to GnRH-a: 4.74, (3.18-7), moderate confidence of evidence). DFP proved to be the most effective CPM for lowering the VAS pain scores. (compared to hormone therapy: mean difference -2.1, (-2.94 to -1.29), 78.8%, moderate confidence of evidence; and GnRH-a (-2.07, (-2.73 to -1.41), low confidence of evidence). Moreover, this study demonstrated the safety of CPMs, particularly in reducing hormonal and liver-related side effects. Specific CPMs like XZC, SZC, DFP, KTC, and GFC showed markedly lower relative risks of adverse events when compared to conventional therapies.

CONCLUSION

Chinese patent medicine may effectively treat EMs, excelling in total effective rate, pain relief, CA125 reduction, and safety. Nevertheless, these findings are preliminary and require validation through high-quality studies.

Dental Caries Status in Postmenopausal Women: Systematic Review and Meta-Analysis

Background: Dental caries is one of the most common oral infections observed worldwide. It is defined as a multifactorial dynamic disease-causing mineral loss of dental hard tissue, which is identified by the caries lesion. Treatment of the caries lesion involves filling the cavity or removing the damaged tooth. Then, the decayed, missing, and filled teeth (DMFT) index is the simplest and most commonly used index to assess the dental caries status. Salivary glands are estrogen dependent and, after menopause, the changes in salivary flow and saliva consistency produce xerostomia, hyposiale, or dryness, common findings among postmenopausal women. Since saliva plays a fundamental role in caries prevention, the postmenopausal decline in salivary secretion may contribute to increased caries incidence. The aim of this systematic review and meta-analysis was to answer the following PICO question: In adult women (P), does the presence of menopause (I), compared to its absence (C), influence dental caries status, assessed using the DMFT index (O)? Methods: The study adhered to PRISMA guidelines. A systematic search was conducted in PubMed/MEDLINE, Scopus, and EMBASE databases. For each study, characteristics and mean difference (MD) with 95% CI were extracted. Meta-analyses were performed using the Revman software (v. 5.4) to calculate pooled MD and 95% CI. Random-effects model meta-analysis was performed. Risk of bias was evaluated using the Newcastle-Ottawa Scale adapted for cross-sectional studies. To estimate variance and heterogeneity between trials, the Higgins I2 test was used. The certainty level of the evidence was determined through the GRADE approach. Results: Seven studies fulfilled the inclusion criteria, including 4396 postmenopausal women and 5131 control women. Meta-analysis showed an overall MD = 3.13 (95% CI = 2.12-4.15; p < 0.00001), which suggest that postmenopausal women had a DMFT index 3 units higher than the control group. Conclusions: Menopause was significantly associated with worse dental caries status, probably due to declining estrogen levels affecting salivary function. Further research is needed to confirm mechanisms and evaluate preventive strategies like hormone replacement therapy.

Unraveling the role of lncRNA in Endometriosis-Associated immune system Dysregulation: Exploring the intricate immunological changes and disrupted signaling pathways

A chronic illness known as endometriosis impacts women who are of reproductive maturity. It may be a factor in fertility problems, breast or ovarian cancer, asthma, cardiovascular illness, or pelvic pain. Studies have indicated that malfunctioning of the immune system is one of the prerequisites for the occurrence of endometrial diseases. Immune cells such as neutrophils and macrophages seem to be involved in the angiogenesis, proliferation, and invasion of endometriosis cells in a particular way. In this regard, defensive substances and cytokines secreted by immune cells impact the endometriosis milieu. Long non-coding RNAs (lncRNAs) mediate gene expression throughout the inflammatory process. According to the current studies, dysfunctional lncRNAs have been linked to several human disorders, including endometriosis. These non-coding RNAs are essential for immunological mechanisms because they regulate interactions between proteins or the capability of RNA and DNA to assemble, which plays a role in differentiation, cell migration, and the synthesis of inflammatory cytokines. Due to the brilliant role of lncRNAs in immune responses and the undeniable role of the immune system in reproduction biology, this study aimed to review the role of deregulated lncRNAs in immune system disorders and its mutual effect on endometriosis formation and development. Further study should identify the significance of lncRNAs linked to the disease via in-vitro and animal model investigations and the importance of uncharacterized lncRNAs found by endometriosis transcriptome studies.

Global, regional, and national prevalence and disability-adjusted life-years for endometriosis in 204 countries and territories, 1990-2019: Findings from a global burden of disease study

Introduction

This study aimed to analyze the worldwide, regional burden of endometriosis and its trends from 1990 to 2019, utilizing the latest data from Global Burden of Disease (GBD) 2019. GBD 2019 is a global database tool for comprehensive analysis and an important result of long-term collaboration among governments worldwide.

Methods

We utilized the Global Health Data Exchange Query tool to analyze endometriosis in prevalence numbers, age-standardized prevalence rates (ASPR), and disability-adjusted life-years (DALYs) from 1990 to 2019 in 204 countries and regions. Additionally, this study investigated the impacts of period, age, and cohort on the prevalence and DALYs of endometriosis from the global perspective and in the five sociodemographic index (SDI) regions.

Results

Among the 21 regions, the most significant reduction in the prevalence of endometriosis between 1990 and 2019 occurred in Central Latin America. In 204 countries, the most pronounced decline was observed in Guatemala. At the SDI level, with the increase of SDI, the ASPR of endometriosis in all regions worldwide showed an overall decreasing trend. The prevalence of endometriosis peaked between the ages of 25 and 29.

Discussion

The findings of this study reflect the temporal and spatial tendency of the burden of endometriosis during the study period, and provide a reference for health agencies around the world to formulate policies on endometriosis, so as to reduce the harm of endometriosis to women worldwide.

The Role of Adenogenesis Factors in the Pathogenesis of Endometriosis

Endometriosis is a pathological condition characterized by the presence of the endometrial tissue, outside the uterine cavity. It affects nearly 10% of women of reproductive age and is responsible for infertility, chronic pain, and the weakening of the quality of life. Various pathogenetic mechanisms have been suggested; however, the essential pathogenesis of endometriosis remains insufficiently comprehended. A comprehensive literature search was conducted in databases such as PubMed, Scopus, and Web of Science up to December 2024. Inclusion criteria encompassed studies investigating the pathogenetic mechanisms of endometriosis, while exclusion criteria included reviews, case reports, and studies lacking primary data. The analyzed studies explored multiple pathogenetic mechanisms, including retrograde menstruation, coelomic metaplasia, embryological defects, stem cell involvement, and epigenetic modifications. Special emphasis was placed on the role of uterine adenogenesis factors in the development and progression of endometriosis. A deeper understanding of the various pathogenetic mechanisms underlying endometriosis is crucial for advancing targeted therapeutic strategies. Further research into uterine adenogenesis factors may provide new insights into the disease's pathophysiology and pave the way for novel treatment approaches.

Integration of Single Cell and Bulk RNA-Sequencing Reveals Key Genes and Immune Cell Infiltration to Construct a Predictive Model and Identify Drug Targets in Endometriosis

Purpose

Endometriosis is a common chronic neuroinflammatory disease with a poorly understood pathogenesis. Molecular changes and specific immune cell infiltration in the eutopic endometrium are critical to disease progression. This study aims to explore immune mechanisms and molecular differences in the proliferative eutopic endometrium of endometriosis by integrating bulk RNA-seq and single-cell RNA sequencing (scRNA-seq) data, and to develop diagnostic and predictive models for the disease.

Methods

Gene expression profiles from the proliferative endometrium of endometriosis patients and healthy controls were obtained from the Gene Expression Omnibus. Single-cell RNA-seq data were processed using R packages, and cell clusters' contributions to endometriosis were calculated. Differentially expressed genes (DEGs) from bulk RNA-seq were intersected with significant mesenchymal cell genes from scRNA-seq, and a predictive model was constructed using LASSO analysis. Key gene mechanisms were explored through Gene Set Enrichment and Variation Analyses. miRNA networks and transcriptional regulation analyses were conducted, and potential drugs were predicted using the Connectivity Map database. RT-qPCR validated key gene expression.

Results

Mesenchymal cells in the proliferative eutopic endometrium were identified as major contributors to endometriosis pathogenesis. LASSO regression identified eight key genes: SYNE2, TXN, NUPR1, CTSK, GSN, MGP, IER2, and CXCL12. The predictive model based on these genes achieved AUC values of 1.00 and 0.8125 in training and validation cohorts. Immune infiltration analysis showed increased CD8+ T cells and monocytes in the eutopic endometrium of endometriosis patients. Drug target prediction indicated that drugs like Retinol, Orantinib, Piperacillin, and NECA were negatively correlated with the expression profiles of endometriosis. RT-qPCR validated gene expression in patients aligned with bioinformatics analysis.

Conclusion

Significant transcriptomic changes and altered immune cell infiltration in the proliferative eutopic endometrium potentially contribute to endometriosis pathogenesis. Our predictive model based on the key genes demonstrates high diagnostic accuracy, offering insights for diagnosis and potential treatment strategies.

Thymic stromal lymphopoietin contributes to endometriotic lesion proliferation and disease-associated inflammation

Endometriosis is a chronic disorder in which endometrial-like tissue presents outside the uterus. Patients with endometriosis have been shown to exhibit aberrant immune responses within the lesion microenvironment and in circulation which contribute to the development of endometriosis. Thymic stromal lymphopoietin (TSLP) is an alarmin involved in cell proliferation and the induction of T helper 2 (Th2) inflammation in various diseases, such as asthma, atopic dermatitis, and pancreatic and breast cancer. Recent studies have detected TSLP within endometriotic lesions and shown that its concentrations are elevated in the peritoneal fluid of patients compared with control subjects. However, its role in disease pathophysiology remains unclear. Here, we compared TSLP messenger RNA and protein expression between patient eutopic endometrium, endometriotic lesions, and control endometrial samples. We also assessed its effect on the proliferation and apoptosis of human endometriosis-representative cell lines, as well as on lesion development and inflammation in a mouse model of the disease. We demonstrated that TSLP expression was elevated in the stroma of patient endometriotic lesions compared with control endometrial samples. In cell lines, TSLP treatment reduced the apoptosis of endometrial stromal cells and promoted the proliferation of THP-1 cells. In mice induced with endometriosis, TSLP treatment induced a Th2 immune response within the lesion microenvironment, and led to TSLP receptor modulation in macrophages, dendritic cells, and CD4+ T cells. Furthermore, treatment increased murine endometriotic lesion proliferation. Overall, these results suggest that TSLP modulates the endometriotic lesion microenvironment and promotes a Th2 immune response that could support lesion development.

Spatial transcriptomic analysis identifies epithelium-macrophage crosstalk in endometriotic lesions

The mechanisms underlying the pathophysiology of endometriosis, characterized by the presence of endometrium-like tissue outside the uterus, remain poorly understood. This study aimed to identify cell type-specific gene expression changes in superficial peritoneal endometriotic lesions and elucidate the crosstalk among the stroma, epithelium, and macrophages compared to patient-matched eutopic endometrium. Surprisingly, comparison between lesions and eutopic endometrium revealed transcriptional similarities, indicating minimal alterations in the sub-epithelial stroma and epithelium of lesions. Spatial transcriptomics highlighted increased signaling between the lesion epithelium and macrophages, emphasizing the role of the epithelium in driving lesion inflammation. We propose that the superficial endometriotic lesion epithelium orchestrates inflammatory signaling and promotes a pro-repair phenotype in macrophages, providing a new role for complement 3 in lesion pathobiology. This study underscores the significance of considering spatial context and cellular interactions in uncovering mechanisms governing disease in endometriotic lesions.

Systematic review on the DNA methylation role in endometriosis: current evidence and perspectives

BACKGROUND

Endometriosis appears to have a multilayered etiology, with genetic and epigenetic factors each contributing half of the pathogenesis. The molecular processes that underlie the onset of endometriosis are yet unclear, but it is assumed that an important contributor in the etiopathology of the disease is DNA methylation.

METHODS

We conducted a systematic review of the literature regarding DNA methylation in endometriosis following PRISMA guidelines. Records were obtained from PubMed and Web of Science on May 31, 2024. Original research articles analyzing regional or genome-wide DNA methylation in patients with confirmed endometriosis (by surgery and/or histological examination) were given consideration for inclusion. Only human studies were included, and there were no restrictions on the types of tissue that was analyzed (i.e., endometrium, blood, or fetal tissue). The study selection process was run by two manual reviewers. In parallel, an adapted virtual artificial intelligence-powered reviewer operated study selection and results were compared with the manual reviewers' selection. Studies were divided into targeted (e.g., single gene or region level) and epigenome-wide association studies. For each, we extracted a list of genes studied with precise location of CpGs analyzed and the DNA methylation status according to the groups compared. Quality assessment of studies was performed following the Newcastle-Ottawa scale. Quality of evidence was graded following the Grading of Recommendations Assessment, Development and Evaluation.

RESULTS

A total of 955 studies were screened, and 70 were identified as relevant for systematic review. Our analyses displayed that endometriosis could be polyepigenetic and with alterations in specific genes implicated in major signaling pathways contributing to the disease etiopathology (cell proliferation, differentiation, and division [PI3K-Akt and Wnt-signaling pathway], cell division [MAPK pathway], cell adhesion, cell communication, developmental processes, response to hormone, apoptosis, immunity, neurogenesis, and cancer).

CONCLUSION

Our systematic review indicates that endometriosis is associated with DNA methylation modifications at specific genes involved in key endometrial biological processes, particularly in the ectopic endometrium. As DNA methylation appears to be an integral component of the pathogenesis of endometriosis, the identification of DNA methylation biomarkers would likely help better understand its causes and aggravating factors as well as potentially facilitate its diagnosis and support the development of new therapeutic approaches.

Molecular Basis of Impaired Decidualization in the Eutopic Endometrium of Endometriosis Patients

Endometriosis is a chronic gynecological disorder characterized by the presence of endometrial tissue outside the uterine cavity. A common feature of this pathology is the impaired decidualization of endometrial stromal cells, a critical process that prepares the uterus for embryo implantation. This decidualization defect has been mechanistically linked to progesterone resistance in endometriotic lesions. However, the presence and underlying mechanisms of decidualization defects in the eutopic endometrium of women with endometriosis remain controversial. The aim of the present study is to integrate and discuss molecular evidence from both in vivo and in vitro studies examining decidualization alterations in the eutopic endometrium of patients with endometriosis. Multiple studies have demonstrated impaired decidualization in the eutopic endometrium of women with endometriosis. These alterations have been reported on multiple genes, signaling pathways, and epigenetic processes. However, additional functional studies are warranted to elucidate whether these decidualization defects directly contribute to endometriosis-associated infertility. A better understanding of the decidualization process and its dysregulation in endometriosis will not only advance the development of targeted fertility treatments but also facilitate the design of more effective therapeutic strategies for managing this chronic condition.

A Fibronectin (FN)-Silk 3D Cell Culture Model as a Screening Tool for Repurposed Antifibrotic Drug Candidates for Endometriosis

This study advances sustainable pharmaceutical research for endometriosis by developing in vitro 3D cell culture models of endometriotic pathophysiology that allow antifibrotic drug candidates to be tested. Fibrosis is a key aspect of endometriosis, yet current cell models to study it remain limited. This work aims to bridge the translational gap between in vitro fibrosis research and preclinical testing of non-hormonal drug candidates. When grown in a 3D matrix of sustainably produced silk protein functionalized with a fibronectin-derived cell adhesion motif (FN-silk), endometrial stromal and epithelial cells respond to transforming growth factor beta-1 (TGF-β1) in a physiological manner as probed at the messenger RNA (mRNA) level. For stromal cells, this response to TGF-β1 is not observed in spheroids, while epithelial cell spheroids behave similarly to epithelial cell FN-silk networks. Pirfenidone, an antifibrotic drug approved for the treatment of idiopathic pulmonary fibrosis, reverses TGF-β1-induced upregulation of mRNA transcripts involved in fibroblast-to-myofibroblast transdifferentiation of endometrial stromal cells in FN-silk networks, supporting pirfenidone's potential as a repurposed non-hormonal endometriosis therapy. Overall, endometrial stromal cells cultured in FN-silk networks-which are composed of a sustainably produced, fully defined FN-silk protein-recapitulate fibrotic cellular behavior with high fidelity and enable antifibrotic drug testing.

Endometriosis-associated obstructive uropathy: A case report

Endometriosis affects approximately 10% of premenopausal women, with urinary tract involvement in 1% of cases. Ureteric endometriosis is a rare, typically asymptomatic, cause of obstructive renal failure. We present the case of a 30-year-old woman with stage IV endometriosis and advanced human immunodeficiency virus presenting with acute, severe left flank pain and kidney injury. Imaging revealed severe, bilateral hydronephrosis due to extensive endometriosis deposits obstructing the urinary tract. Recurrent ureteric obstruction by infiltrating endometrial disease necessitated eight procedures (bilateral nephroureteric stent placements and nephrostomy insertions). Despite the severity of the disease surgery was successfully avoided. At the time of discharge and subsequent follow-up, the patient was clinically well with stable renal function (Creatinine 1.33-1.61 mg/dL). This case highlights the importance of considering endometriosis in the differential diagnosis of acute kidney injury in women. It demonstrates successful non-surgical management of severe ureteric disease to prevent irreversible renal damage.

Endostatin-expressing endometrial mesenchymal stem cells inhibit angiogenesis in endometriosis through the miRNA-21-5p/TIMP3/PI3K/Akt/mTOR pathway

Endometriosis is a chronic inflammatory and neoangiogenic disease. Endostatin is one of the most effective inhibitors of angiogenesis. Mesenchymal stem cells (MSCs) have been investigated as compelling options for cell therapy. However, the effect and mechanism of action of endostatin-expressing endometrial MSCs (EMSCs) in endometriosis are unclear. Here, EMSCs were genetically modified to overexpress endostatin (EMSCs-Endo). A reduction in the angiogenic capacity of HUVECs was observed in vitro after treatment with EMSCs-Endo. EMSCs-Endo significantly suppressed endometriotic lesion growth in vivo. The limited efficacy was associated with suppressed angiogenesis. The miRNA-21-5p level and the levels of p-PI3K, p-mTOR, and p-Akt in HUVECs and mouse endometriotic lesions significantly decreased after treatment with EMSCs-Endo, whereas TIMP3 expression significantly increased. In summary, targeted gene therapy with EMSCs-Endo is feasible, and its efficacy in regulating endometriosis can be attributed to the inhibition of angiogenesis, suggesting that EMSCs could be used as promising vehicles for targeted gene therapy.

Nanoceria as a non-steroidal anti-inflammatory drug for endometriosis theranostics

Endometriosis, the growth of endometrial-like tissue outside the uterus, causes chronic pain and infertility in 10 % of reproductive-aged women worldwide. Unfortunately, no permanent cure exists, and current medical and surgical treatments offer only temporary relief. Endometriosis is a chronic inflammatory disease characterized by immune system dysfunction. Our previous study showed aberrant activation of signal transducer and activator of transcription 3 (STAT3) in endometriosis. Our transcriptomic analysis of uterine tissue from uterine-specific Stat3 knock-out mice identifies that STAT3 regulates inflammatory and immune-related genes. Here, we evaluate cerium-oxide nanoparticles (nanoceria) as a non-steroidal anti-inflammatory drug for endometriosis theranostics. Our in vitro studies validate the multi-enzymatic properties of nanoceria, enabling the transition of pro-inflammatory macrophages to an anti-inflammatory state in J774 macrophage cells. In vivo, treatment of endometriosis mice with nanoceria reveals its ability to passively accumulate at ectopic lesions. The nanoceria conjugated with indocyanine green are non-invasively trackable to ectopic lesions. Therefore, immune modulation and anti-inflammatory effects of nanoceria significantly reduce development of ectopic lesions while minimizing off-target effects, such as avoiding interference with pregnancy including implantation and decidualization. Our results suggest that aberrant STAT3 activation is a major contributor to endometriosis, and nanoceria offers a novel theranostic approach for endometriosis.

Real world perspectives on endometriosis disease phenotyping through surgery, omics, health data, and artificial intelligence

Endometriosis is an enigmatic disease whose diagnosis and management are being transformed through innovative surgical, molecular, and computational technologies. Integrating single-cell and other omic disease data with clinical and surgical metadata can identify multiple disease subtypes with translation to novel diagnostics and therapeutics. Herein, we present real-world perspectives on endometriosis and the importance of multidisciplinary collaboration in informing molecular, epidemiologic, and cell-specific data in the clinical and surgical contexts.

Advances in biomaterials-based tissue engineering for regeneration of female reproductive tissues

The anatomical components of the female reproductive system-comprising the ovaries, uterus, cervix, vagina, and fallopian tubes-interact intricately to provide the structural and hormonal support essential for reproduction. However, this system is susceptible to various detrimental factors, both congenital and acquired, that can impair fertility and adversely affect quality of life. Recent advances in bioengineering have led to the development of sophisticated three-dimensional models that mimic the complex architecture and functionality of reproductive organs. These models, incorporating diverse cell types and tissue layers, are crucial for understanding physiological processes within the reproductive tract. They offer insights into decidualization, ovulation, folliculogenesis, and the progression of reproductive cancers, thereby enhancing personalized medical treatments and addressing female infertility. This review highlights the pivotal role of tissue engineering in diagnosing and treating female infertility, emphasizing the importance of considering factors like biocompatibility, biomaterial selection, and mechanical properties in the design of bioengineered systems. The challenge of replicating the functionally specialized and structurally complex organs, such as the uterus and ovary, underscores the need for reliable techniques that improve morphological and functional restoration. Despite substantial progress, the goal of creating a fully artificial female reproductive system is still a challenge. Nonetheless, the recent fabrication of artificial ovaries, uteruses, cervixes, and vaginas marks significant advancements toward this aim. Looking forward, the challenges in bioengineering are expected to spur further innovations in both basic and applied sciences, potentially hastening the clinical adoption of these technologies.

Informational support for women with endometriosis: a scoping review

BACKGROUND

Ten per cent of women of reproductive age suffer from endometriosis, a painful and incurable disease that leaves women with severe implications for their health and overall well-being. Due to the absence of a cure and the limited effectiveness of available treatments, acquiring accurate information is paramount for women to successfully navigate both their daily lives and the complexities of the healthcare system. This scoping review aimed to map the current literature on women with endometriosis information needs, their information seeking behaviour, and the format and scope of current information resources available.

METHODS

The scoping review was conducted using the JBI methodology for scoping reviews and reported according to the PRISMA-ScR statement. The final search was conducted in August 2024, through the databases Medline, Cinahl, Embase, Scopus, and WebofScience. Studies on information resources on endometriosis and information seeking behaviour as well as information needs of women with endometriosis were eligible for inclusion.

RESULTS

The majority of the 25 included studies focused on information resources, specifically webpages and social media sites. While few studies analysed information seeking behaviour and information needs, the evidence shows women's high interest in a broad spectrum of information topics. Across all studies, the internet was the most important access point for information.

CONCLUSION

Addressing the absence of systematic analyses on the information seeking behaviour and needs of women with endometriosis is crucial for future research. This step is essential for the development of customised information resources that cater specifically to the diverse needs of women affected by endometriosis.

Peritoneal Endometriosis Impairs Ovarian Reserve and Increases Atresia in a Rat Model

Background/Objectives: Endometriosis has a marked impact on fertility, although the mechanisms behind this relationship remain poorly understood, particularly in cases without significant anatomical distortions or in the context of ovarian endometriomas. This study aimed to investigate the effect of peritoneal endometriosis on ovarian function by assessing ovarian reserve and apoptosis. Methods: Peritoneal endometriosis was surgically induced in Sprague Dawley rats through the autotransplantation of uterine fragments onto the bowel mesothelium. One month post-surgery, ovarian structures were counted, follicle and corpora lutea apoptosis was evaluated by TUNEL, and apoptotic-related protein expression in ovaries was assessed by Western blot. Additionally, a co-culture system using 12Z endometriotic and KGN granulosa cell lines was utilized to evaluate gene expression by RT-qPCR. Results: Rats with peritoneal endometriosis exhibited a significant reduction in ovarian structures characterized by a low number of total follicles, particularly primordial, primary, preantral, and late-antral follicles. Consistently, AMH protein expression was decreased in ovaries in the presence of endometriosis. In addition, this disease led to a significant increase in late-antral follicles that were TUNEL-positive and in the number of apoptotic cells in corpora lutea, indicating higher apoptosis in endometriosis ovaries. Concomitantly, the altered expression of apoptosis-related proteins was observed, with increased procaspase 3 and decreased BCL-2 expression. In addition, KGN granulosa cells co-cultured with 12Z endometriotic cells displayed reduced KITLG mRNA expression and increased AMHR2 mRNA expression. Conclusions: Peritoneal endometriosis significantly impairs ovarian health by disrupting folliculogenesis, reducing ovarian reserve, and increasing apoptosis, potentially accelerating ovarian aging and contributing to infertility. These results underscore the need for further research to identify the molecular pathways involved and to develop targeted therapeutic strategies.

Morphological changes of endometriomas during pregnancy and after delivery detected using ultrasound

OBJECTIVE

To assess changes in morphology and size of endometriomas during pregnancy and after delivery.

DESIGN

This was a prospective observational cohort study performed during 2013-2024 at a tertiary care center (Ultrasound Unit, Department of Obstetrics and Gynecology, Skane University Hospital, Malmo, Sweden). Women were offered repeated ultrasound examinations every month during pregnancy and thereafter at 3 and 12 months after delivery. Ultrasound examinations were performed either transvaginally or transabdominally depending on the gestational week and assessability of the ovaries.

SUBJECTS

Pregnant women with an ovarian cyst suggestive of endometrioma based on subjective assessment were eligible and those with the pregnancy that continued beyond gestational age of 22 weeks were included. In total, 57 women were included.

EXPOSURE

Pregnancy.

MAIN OUTCOME MEASURE(S)

Changes in morphology (cyst type, cyst content, and signs of decidualization) and size of the endometrioma and the largest solid component were assessed during follow-up ultrasound examinations.

RESULT(S)

During pregnancy, endometriomas changed in morphology in 42/57 women (74%; 95% confidence interval [CI], 60-84) and decreased in size in 42/57 women (74%; 95% CI, 60-84). Decidualization of endometrioma was observed in 33/57 women (58%; 95% CI, 44-71) and was detected first time at gestational age of 17 weeks (median, interquartile range, 15-22; range, 6-29). The size of endometriomas decreased although the size of solid components increased from gestational age of 22+0 weeks. Signs of decidualization disappeared after delivery.

CONCLUSION(S)

Three out of four endometriomas undergo morphological changes during pregnancy. Decidualized endometrioma may mimic borderline malignancy, however, changes regress after delivery. Knowing the natural behavior of endometriomas during pregnancy is crucial to reducing the risk of misclassification of endometriomas as malignant masses. Follow-up ultrasound examination after delivery helps to reassure the benign nature of the cyst.

Randomized, controlled, proof-of-concept trial of gefapixant for endometriosis-related pain

OBJECTIVE

To evaluate the P2X3 receptor antagonist, gefapixant, for treating moderate-to-severe endometriosis-related pain.

DESIGN

Randomized, double-blind, phase 2, and proof-of-concept trial.

SUBJECTS

Premenopausal women age 18-49 years with moderate-to-severe endometriosis-related pain who were not using hormonal treatment.

INTERVENTION(S)

Gefapixant (45-mg twice daily) or placebo over two menstrual cycles.

MAIN OUTCOME MEASURE(S)

Participants rated peak pelvic pain severity daily on a 0 (no pain) - 10 (extremely severe pain) scale. The primary endpoint was change from baseline in average daily peak pelvic pain severity during treatment cycle 2.

RESULT(S)

All 187 participants randomized (gefapixant, N = 94; placebo, N = 93) took ≥1 dose of investigational treatment and all but six in each treatment group completed the trial. The model-based least-squares mean reduction from baseline in average daily peak pelvic pain severity during treatment cycle 2 was -2.2 for gefapixant and -1.7 for placebo (difference, -0.5; 95% confidence interval, -1.01 to 0.03). In secondary analyses, the difference between gefapixant and placebo in peak pelvic pain severity reduction from baseline on menstrual days was -0.6 (95% confidence interval, -1.18 to -0.06) and -0.5 (95% confidence interval, -1.04 to 0.03) on nonmenstrual days. Taste-related adverse events were reported in 31.9% of participants for gefapixant vs. 4.3% for placebo. Pharmacokinetic assessments at months 1 and 2 clinic visits indicated that of the 94 participants in the gefapixant group, 39 had detectable levels of gefapixant in the blood for both assessments although 38 had no detectable levels for ≥1 assessment.

CONCLUSION(S)

Gefapixant (45-mg twice daily) was not shown to be superior to placebo in reducing endometriosis-related pain, although the results directionally favored gefapixant. This trial result should be considered inconclusive given possible issues with treatment compliance.

CLINICAL TRIAL REGISTRATION NUMBER

NCT03654326.

Somatic PTEN and ARID1A loss and endometriosis disease burden: a longitudinal study

STUDY QUESTION

Is there an association between the somatic loss of PTEN (phosphatase and tensin homolog) and ARID1A (AT-rich interaction domain 1A) and endometriosis disease severity and worse clinical outcomes?

SUMMARY ANSWER

Somatic PTEN loss in endometriosis epithelium was associated with greater disease burden and subsequent surgical complexity.

WHAT IS KNOWN ALREADY

Somatic cancer-driver mutations including those involving the PTEN and ARID1A genes exist in endometriosis without cancer; however, their clinical impact remains unclear.

STUDY DESIGN, SIZE, DURATION

This prospective longitudinal study involved endometriosis tissue and clinical data from 126 participants who underwent surgery at a tertiary center for endometriosis (2013-2017), with a follow-up period of 5-9 years.

PARTICIPANTS/MATERIALS, SETTING, METHODS

PTEN and ARID1A loss was assessed using established immunohistochemistry (IHC) methods as proxies for somatic loss by two independent raters. PTEN and ARID1A status for each participant was defined as loss (loss in at least one sample for a participant) or retained (no loss in all samples for a participant). Primary analyses examined associations between PTEN and ARID1A loss and disease burden based on anatomic subtype (superficial peritoneal endometriosis (SUP), deep endometriosis (DE), ovarian endometrioma (OMA)) and rASRM stage (I-IV). Secondary analyses explored associations of PTEN and ARID1A loss with demographics, surgical difficulty, and pain scores (baseline and follow-up). Additionally, using previously published data on KRAS codon 12 mutations for this cohort, we investigated associations between variables in the primary and secondary analyses and acquiring two or more somatic events (PTEN loss, ARID1A loss, or KRAS mutation) in this cohort. The risk of reoperation over the 5-9 years was also examined.

MAIN RESULTS AND THE ROLE OF CHANCE

PTEN loss (68.3%; 86 participants) exceeded ARID1A loss (24.6%; 31 participants). Inter-rater reliability was substantial for PTEN (k = 0.69; 95% CI: 0.62-0.77) and ARID1A (k = 0.64; 95% CI: 0.51-0.77). PTEN loss was significantly associated with more severe anatomic subtypes (P < 0.001; participants with SUP only = 46.4%; participants with DE only or OMA only = 72.7%; participants with mixed subtypes = 85.1%), and higher stages (P = 0.024; Stage I = 47.8%; Stage II = 73.7%; Stage III = 80.8%; Stage IV = 81.0%). Results were similar for ARID1A loss, albeit with smaller sample size limiting power. PTEN loss was further associated with non-White ethnicities (P = 0.017) and greater surgical difficulty (more frequent need for ureterolysis) (P = 0.02). There were no differences in pain scores (baseline or follow-up) based on PTEN or ARID1A status. Reoperation was uncommon (13.5% of the cohort), and patterns in reoperation rates based on the presence of somatic alterations did not reach statistical significance.

LIMITATIONS, REASONS FOR CAUTION

Sequencing was not performed to determine the type of PTEN and ARID1A somatic mutations resulting in loss of expression.

WIDER IMPLICATIONS OF THE FINDINGS

These results demonstrate a link between PTEN somatic loss and greater endometriosis disease burden. These findings underscore the potential relevance of PTEN loss and other somatic driver mutations in a future molecular classification of endometriosis.

STUDY FUNDING/COMPETING INTEREST(S)

This study was funded by Canadian Institutes of Health Research (CIHR) project grant (MOP-142273 and PJT-156084). P.J.Y. was supported by a Health Professional Investigator award from Michael Smith Health Research BC, Canada, and a Canada Research Chair (Tier 2) in Endometriosis and Pelvic Pain. M.S.A. was supported by a Michael Smith Health Research BC Scholar award, and CIHR project grants (369990, 462997, and 456767). The sponsors did not play any role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; and in the decision to submit the article for publication. C.A. declares receiving payment from Pfizer for a symposium; being on advisory boards for AbbVie and Pfizer; being President and past President of the Canadian Society for the Advancement of Gynecologic Excellence (CanSAGE), co-lead of EndoAct Canada, and a board member of IPPS. M.A.B. has received consulting fees from AbbVie and Pfizer and grants from Ferring outside the scope of this work. D.G.H. is the founder of Canxeia Health but has no current affiliation. M.K. has received consulting fees from Helix Biopharma outside the scope of this work. M.S.A. received reimbursement of travel and registration fees to attend and present at the 2023 and 2024 annual meetings for the Society for Reproductive Investigation (SRI). P.J.Y. declares receiving: payment for a lecture from the International Society for the Study of Women's Sexual Health (ISSWSH); honoraria from the CIHR; support to attend meetings from CanSAGE, ISSWSH, the International Pelvic Pain Society, the World Endometriosis Society (WES), the Society for the Study of Reproduction, and the Vulvodynia Summit; and discounted devices from Ohnut Wearable for a clinical trial. P.J.Y. is a data safety monitoring board member of a clinical trial funded by CIHR; and a strategic advisory board member for the Women's Health Research Institute. P.J.Y. served as a board of directors member for CanSAGE and ISSWSH; was a junior board of directors member for WES; is a current board of directors member for WES; and was a committee chair for the Society of Obstetricians and Gynaecologists of Canada. A subset of these results was presented by the first author at the 71st Society for Reproductive Investigation Annual Scientific Meeting on 15 March 2024. Other authors have nothing to declare.

TRIAL REGISTRATION NUMBER

N/A.

Hospitalisations and length of stays in women with endometriosis: a data linkage prospective cohort study

Background

Women with endometriosis have more hospitalisations compared to those without the condition. However, no longitudinal study has examined hospital admission rates and lengths of stay before and after diagnosis. We examined all-cause hospital admissions and lengths of stay among women with, versus without, endometriosis, and before, versus after, diagnosis.

Methods

This study included 13,501 women of reproductive age, born in 1973-78. The Australian Longitudinal Study on Women's Health survey data linked to administrative health records was used to identify women with endometriosis. Hospital admission rates and length of stays were examined using hospital records of patients admitted up to 2022. Analysis was conducted using mixed-effects zero-inflated negative binomial models.

Findings

Women with endometriosis were more likely to be admitted to hospitals compared to those without the condition, with an adjusted incidence rate ratio (IRR) of 2.11 (95% CI: 1.83-2.43) for admissions per year. However, they had shorter hospital stays (IRR: 0.90; 0.81-0.99) for days per year and were more often discharged on the same day (odds ratio: 1.27; 1.20-1.33). Post-diagnosis, women experienced more hospitalisations and more days in hospital compared to their pre-diagnosis (IRR: 1.52; 1.22-1.88) and (IRR: 1.81; 1.53-2.14), respectively. Consistent findings were found for women with surgically confirmed or clinically suspected endometriosis.

Interpretation

The higher number of hospitalisations among women with endometriosis, compared to those without, highlights the substantial burden of the condition on healthcare utilisation. The persistent frequent hospitalisations and longer stays post-diagnosis indicate recurrent endometriosis, posing significant management challenges.

Funding

The Australian Longitudinal Study on Women's Health is funded by the Australian Government Department of Health and Aged Care. GDM and GWM are Australian National Health and Medical Research Council Leadership Fellows (GNT2009577 and GNT1177194).

Utilizing AI for the Identification and Validation of Novel Therapeutic Targets and Repurposed Drugs for Endometriosis

Endometriosis affects over 190 million women globally, and effective therapies are urgently needed to address the burden of endometriosis on women's health. Using an artificial intelligence (AI)-driven target discovery platform, two unreported therapeutic targets, guanylate-binding protein 2 (GBP2) and hematopoietic cell kinase (HCK) are identified, along with a drug repurposing target, integrin beta 2 (ITGB2) for the treatment of endometriosis. GBP2, HCK, and ITGB2 are upregulated in human endometriotic specimens. siRNA-mediated knockdown of GBP2 and HCK significantly reduced cell viability and proliferation while stimulating apoptosis in endometrial stromal cells. In subcutaneous and intraperitoneal endometriosis mouse models, siRNAs targeting GBP2 and HCK notably reduced lesion volume and weight, with decreased proliferation and increased apoptosis within lesions. Both subcutaneous and intraperitoneal administration of Lifitegrast, an approved ITGB2 antagonist, effectively suppresses lesion growth. Collectively, these data present Lifitegrast as a previously unappreciated intervention for endometriosis treatment and identify GBP2 and HCK as novel druggable targets in endometriosis treatment. This study underscores AI's potential to accelerate the discovery of novel drug targets and facilitate the repurposing of treatment modalities for endometriosis.

Ultrasound of the uterosacral ligaments: A reliability study for diagnosing endometriosis in Australian non-specialised medical imaging and radiology settings

Introduction/Background

Uterosacral ligaments (USL) are the most common sites of endometriosis. Transvaginal ultrasound (TVS) demonstrates high diagnostic accuracy for endometriosis of the USLs using standardised technique and characterisations. While high accuracy and reproducibility is established with these techniques by well-trained professionals, the question still remains if these techniques are reproducible in general settings. This study aims to assess the intra and interobserver agreement of TVS characteristics of USLs, between experienced and less experienced examiners in an Australian general ultrasound imaging practice, where sonographers are required to perform ultrasound for endometriosis.

Methods

Forty-two patients, with and without known endometriosis, underwent ultrasound imaging of the USLs. Images were obtained of uterosacral ligaments and collated for interobserver survey. Six professional observers independently reviewed the images, classifying characteristics such as echogenicity, echotexture, contour, thickness, and presence of nodules. Interobserver reliability was assessed using Gwet's agreement coefficients (AC1), and the correlation between USL thickness and endometriosis was analyzed using Spearman's correlation.

Results

Interobserver agreement for detecting USL endometriosis was substantial (AC1 = 0.63), with an overall agreement of (0.65) for the seven USL characteristics. Intraobserver agreement ranged from moderate (0.60) to almost perfect (0.96). Experience did not significantly affect intraobserver reliability. A strong positive correlation was found between USL thickness and endometriosis (r = 0.7965, P < 0.01).

Conclusion

This study demonstrates high inter and intraobserver agreement among sonographers and radiologists in a general imaging department for identifying USL characteristics and diagnosing USL endometriosis. Both experienced and less experienced operators can reliably assess USLs Consistency was shown in identifying thickened uterosacral ligaments however, there is no consensus on where uterosacral ligament be measured. Even so, a thickened USL can prompt further extension of the pelvic scan to look for other endometriosis markers.

Unilateral ureteral endometriosis masquerading as a ureteral tumor and resulting in complete loss of renal function: A case report

Ureteral endometriosis is a rare manifestation of endometriosis that involves the infiltration of endometrial tissue into the ureters, leading to ureteral obstruction and potential renal dysfunction. However, its preoperative diagnosis is difficult. Herein, we report the case of a woman in her early 50s who presented with severe hydronephrosis of the right kidney, ureteral dilation, and suspicion of a ureteral tumor based on initial imaging studies. However, the pathological results after resection of the right kidney and right ureter revealed the presence of endometrial tissue in an ectopic location. This case highlights the importance of considering endometriosis as a differential diagnosis in cases of ureteral obstruction, even in atypical clinical scenarios, and emphasizes the need for prompt diagnosis and intervention to prevent irreversible renal damage and optimize patient outcomes.

Multiple lesion inductions intensify central sensitization driven by neuroinflammation in a mouse model of endometriosis

Introduction

Endometriosis is an inflammatory disease associated with chronic pelvic pain (CPP). Growing evidence indicates that endometriotic lesions are not the sole source of pain. Instead, central nervous system (CNS) dysfunction created by prolonged peripheral and central sensitization plays a role in developing endometriosis-associated CPP. This study investigated how CPP is established using a multiple lesion induction mouse model of endometriosis, as repeated retrograde menstruation is considered underlying endometriosis pathogenesis.

Methods

We generated endometriosis-like lesions by injecting endometrial tissue fragments into the peritoneal cavity in mice. The mice received a single (1x) or multiple inductions (6x) to simulate recurrent retrograde menstruation. Lesion development, hyperalgesia by behavioral testing, signs of peripheral sensitization, chronic inflammation, and neuroinflammation were examined with lesions, peritoneal fluids, dorsal root ganglia (DRG), spinal codes, and brain.

Results

Multiple lesion inductions increased lesion numbers and elevated abdominal and hind paw hypersensitivity compared to single induction mice. Elevated persistent glial cell activation across several brain regions and/or spinal cords was found in the multiple induction mice. Specifically, IBA1+ microglial soma size was increased in the hippocampus and thalamus. IBA1+ cells were abundant in the cortex, hippocampus, thalamus, and hypothalamus of the multiple induction mice. GFAP+ astrocytes were mainly elevated in the hippocampus. Elevated TRPV1, SP, and CGRP expressions in the DRG were persistent in the multiple induction mice. Furthermore, multiple inductions induced the severe disappearance of TIM4hi MHCIIlo residential macrophages and the influx of increased proinflammatory TIM4lo MHCIIhi macrophages in the peritoneal cavity. The single and multiple inductions elevated secreted TNFα, IL-1β, and IL-6 levels in the peritoneal cavity at 2 weeks. Elevated cytokine levels returned to the pre-induction levels in the single induction mice at 6 weeks; however, they remained elevated in the multiple induction mice.

Conclusions

Our results indicate that the repeatedly occurring lesion inductions (=mimic retrograde menstruation) can be a peripheral stimulus that induces nociceptive pain and creates composite chronic inflammatory stimuli to cause neuroinflammation and sensitize the CNS. The circuits of neuroplasticity and stimulation of peripheral organs via a feedback loop of neuroinflammation may mediate widespread endometriosis-associated CPP.

Central Serous Chorioretinopathy in Endometriosis Treatment with Progestogen: A Metabolic Understanding

Endometriosis afflicts 10% of women in their reproductive years and nearly half of women with infertility, and its etiology is not yet clear. Pharmacological therapy is generally based on progestins like progestogen. This drug binds to progesterone receptors with many known side effects. Here, we describe the case of a 33-year-old woman surgically treated for endometriosis who continued with drug therapy based on estradiol valerate and dienogest. Approximately 21 months after treatment, she reported ocular symptoms with vision alteration, diplopia, and metamorphopsia related to central serous chorioretinopathy (CSC). After the discontinuation of combined progestin-based treatment, the CSC fully subsided. Semeiological, clinical, and laboratory approaches were adopted, and urinary steroids were measured. A slight increase in prolactinemia in the absence of macro-prolactinemia was reported. The steroidal profile appeared without abnormalities, although a slight alteration of estrogen balance was noted. Considering the pharmacodynamics of dienogest versus selective progesterone receptor modulators, it can be assumed that patients' clinical events are related to specific site response to steroids that bind the progesterone receptor. Dienogest may have induced the CSC as a not yet characterized side effect of the drug. Undoubtedly, further specific studies are needed concerning the metabolic and pharmacodynamic aspects that cannot be exhaustively covered here.

Endometriosis does not impact aneuploidy rates of products of conception in IVF population

It has been debated whether endometriosis (EMS) adversely affects oocyte quality, potentially leading to a higher incidence of genetically unbalanced embryos or other egg factors that affect the developmental potential. In this study, we explored the effects of endometriosis on risk of chromosomally aberrant in miscarried products of conception (POC) after assisted reproductive treatment (ART), including fresh and frozen cycles. Miscarried POCs were collected from EMS patients (N = 102) and non-EMS patients (N = 441). Single nucleotide polymorphism (SNP) array analysis was conducted on all collected samples. Propensity score matching (PSM, ratio of 1:4) based on maternal age was applied in data analysis. Logistic regression analysis was performed to identify risk factors for chromosomal aberration-induced miscarriage between the two cohorts. A total of 228 (41.99% of 543) conceptuses were identified as having chromosomal aberrations. The results showed that women with EMS had a significantly lower antral follicle count (AFC) (10 ± 5 vs. 14 ± 7, P < 0.01) compared to the control group. Additionally, the EMS group had a relatively lower anti-Mullerian hormone (AMH), higher basal follicle stimulating hormone (FSH) and fewer oocytes, (P > 0.05). There was no significant difference in the chromosomal aberration rate of POCs between EMS and non-EMS groups (35.29% vs. 43.54%; odds ratio (OR) = 1.03, 95% confidence intervals (CIs) 0.79-1.35). This is the first study to show that EMS maybe associated with decreased ovarian reserve, but not related to chromosomal abnormalities in POCs. These results suggest that chromosomal abnormalities may not be the only cause of miscarriage in EMS patients.

Validity and Reliability of the Hungarian Version of the Pain Self-Efficacy Questionnaire Among Women with Endometriosis and Chronic Pelvic Pain

Background

Our study aimed to perform Hungarian cross-cultural adaptation and assess the reliability and validity of the Pain Self-Efficacy Questionnaire (PSEQ) in women diagnosed with endometriosis and chronic pelvic pain.

Methods

The current study was conducted in Hungary among women aged 18-50 (34.39 ± 6.68 years). We examined the reliability of the Hungarian version of PSEQ (PSEQ-HU) by applying internal consistency and test-retest evaluations. Confirmatory factor analysis was used to determine the construct validity of the PSEQ-HU, while Spearman's rank correlation coefficient established the convergent validity using the 36-Item Short-Form Health Survey, numeric rating scale (NRS), Pain Catastrophizing Scale, and Perceived Stress Scale. To determine discriminant validity, two groups were created based on NRS (0-4 no or mild pain, 5-10 moderate or strong pain). The results were analyzed using IBM SPSS version 28.0 software with a significance level of p ≤0.05.

Results

A total of 262 women participated in this study. The Cronbach's α was 0.97, and the intraclass correlation coefficient (ICC) values showed adequate reliability (ICC = 0.94. 95% confidence interval 0.88-0.97) for the PSEQ-HU. Based on the Spearman's correlation coefficients the convergent validity showed significant results (r = 0.22-0.63; p ≤0.001).

Conclusion

We concluded that the PSEQ is a reliable and valid measurement among Hungarian women with endometriosis-related pelvic pain.

Advances in the diagnosis and management of endometriosis: A comprehensive review

Endometriosis is a prevalent gynecological condition characterized by the presence of endometrial-like tissue outside the uterus, leading to chronic pelvic pain and infertility. This review aims to shed light on the latest advancements in diagnosing and managing endometriosis. It offers insight into the condition's pathogenesis, clinical symptoms, diagnostic techniques, and available treatment approaches. Furthermore, the article emphasizes innovative technologies and novel therapeutic strategies that promise to enhance patient outcomes significantly. This review aspires to empower clinicians to deliver the highest quality care to their patients affected by this challenging condition by consolidating the current understanding of endometriosis.

Association between METTL14 gene polymorphisms and risk of ovarian endometriosis

Background

Endometriosis, a prevalent chronic gynecological condition, is frequently associated with infertility and pelvic pain. Despite numerous studies indicating a correlation between epigenetic regulation and endometriosis, its precise genetic etiology remains elusive. Methyltransferase-like 14 (METTL14), a crucial component of the N6-methyladenosine (m6A) RNA methyltransferase complex and an RNA binding scaffold, is known to play a pivotal role in various human diseases. The possibility that single nucleotide polymorphisms (SNPs) in the METTL14 gene contribute to susceptibility of endometriosis has not been thoroughly investigated.

Methods

We assessed the genotype frequencies of five potential functional METTL14 SNPs (rs298982 G>A, rs62328061A>G, rs9884978G>A, rs4834698C>T, and rs1064034A>T) in a Chinese population consisting of 458 patients with ovarian endometriosis and 462 healthy controls. We employed unconditional logistic regression and stratified analyses to evaluate their genotypic associations with the risk of ovarian endometriosis.

Results

Among the five SNPs examined, we found that the rs298982 A allele was significantly associated with increased risk, whereas the rs62328061 G allele was linked to a decreased risk of ovarian endometriosis. Individuals harboring two unfavorable genotypes demonstrated a significantly elevated risk of ovarian endometriosis (adjusted odds ratio (AOR) = 1.57, 95% confidence interval (CI) = 1.16-2.13, P = 0.004) compared with those with no risk genotypes. Stratified analysis revealed the risk effect of rs298982 GA/AA genotypes in the gravidity≤1, parity≤1, rASRM stage I, and rASRM stage II + III + IVsubgroups. Haplotype analysis showed that individuals with the GATAA haplotype were at higher risk of ovarian endometriosis (AOR = 5.54, 95% CI = 1.63-18.87, P = 0.006), whereas the AGTTG haplotype exhibited protective effects (AOR = 0.55, 95% CI = 0.31-0.97, P = 0.039) compared with wild-type GACAG haplotype carriers. Additionally, Bayesian false discovery probability and false positive report probability analysis confirmed the robustness of the significant findings. Expression quantitative trait loci analysis revealed a significant association between the rs9884978 GA/AA genotypes and elevated METTL14 mRNA levels in fibroblasts and adrenal gland. Conversely, the rs298982 GA/GG genotypes were significantly associated with reduced METTL14 mRNA levels in the nucleus accumbens and frontal cortex.

Conclusion

Our results demonstrate that METTL14 polymorphisms are associated with susceptibility to ovarian endometriosis among Chinese women.

The Role of Quercetin for the Treatment of Endometriosis and Endometrial Cancer: A Comprehensive Review

Endometrial glands and stroma can be seen outside the uterine cavity in endometriosis, a gynecological disorder linked to estrogen dependency. Hormonal therapies, surgical excision, and non-steroidal anti-inflammatory drug therapy are among the traditional endometriosis treatments, however, various side effects limit their efficacy. Therefore, it is vital to research complementary and alternative therapeutic modalities to decrease the side effects of conventional therapies. While the search for the best endometriosis treatment continues, the focus is being paid to the assistance provided by polyphenols, notably quercetin. A broad spectrum of health-improving benefits of quercetin includes interactions with endometriosis-related molecular targets such as cell proliferation, apoptosis, invasiveness, inflammation, and oxidative stress. According to already-known research, medicines that mimic the physiological effects of quercetin are good candidates for creating novel endometriosis therapies. This review aims to comprehensively review quercetin's potential as a non-pharmacological treatment for endometriosis by interacting with several cellular and molecular targets.