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Zeng H, Wang Y. Effects of various controlled ovarian hyperstimulation protocols and surgery on pregnancy outcomes in women with endometriosis. Gynecol Endocrinol 2024; 40:2381504. [PMID: 39034637 DOI: 10.1080/09513590.2024.2381504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Accepted: 07/12/2024] [Indexed: 07/23/2024] Open
Abstract
Endometriosis is a common gynecological condition in women of childbearing age that causes symptoms such as menstrual changes and dysmenorrhea, and is also a major cause of infertility. Therefore, women with endometriosis usually need to use assisted reproductive technology (ART), such as in vitro fertilization or intracytoplasmic sperm injection, to increase their chances of conceiving. Numerous clinical observations and studies have indicated that endometriosis can affect the success of ART, such that women with endometriosis who use ART have a lower live-birth rate than those without endometriosis who use ART. Therefore, this article reviews the impact of various controlled ovarian hyperstimulation protocols and surgery on the pregnancy outcomes of women with endometriosis using ART to explore the selection of individualized treatment.
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Affiliation(s)
- Han Zeng
- Reproductive Medical Center, Department of Obstetrics and Gynecology, Peking University People's Hospital, Beijing, China
| | - Yanbin Wang
- Reproductive Medical Center, Department of Obstetrics and Gynecology, Peking University People's Hospital, Beijing, China
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2
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Shrateh ON, Siam HA, Ashhab YS, Sweity RR, Naasan M. The impact of vitamin D treatment on pregnancy rate among endometriosis patients: a systematic review and meta-analysis. Ann Med Surg (Lond) 2024; 86:4098-4111. [PMID: 38989166 PMCID: PMC11230764 DOI: 10.1097/ms9.0000000000002174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 05/08/2024] [Indexed: 07/12/2024] Open
Abstract
Background Vitamin D supplementation is supposed to have an important role in the management of several endometriosis-related aspects, offering potential relief to affected individuals. Herein, the authors aim to evaluate the impact of vitamin D on pregnancy rates and clinical symptoms in women with endometriosis. Methods The authors extensively searched PubMed, Cochrane Library, EMBASE, Ovid MEDLINE, and CINAHL from their inception to 20 July 2023. Results Three randomized controlled trials involving 167 patients were included in this meta-analysis. The findings demonstrated that vitamin D supplementation exhibits efficacy in alleviating dysmenorrhea associated with endometriosis, as evidenced by a meta-analysis showing a significant reduction in dysmenorrhea (mean difference -1.41, 95% CI -2.61 to -0.22, P = 0.02). However, the impact on dyspareunia was inconclusive, with a non-significant mean difference of -0.2 (95% CI -1.62 to 1.22, P = 0.78). In contrast, dyschezia significantly decreased with vitamin D supplementation (mean difference -1.10, 95% CI -2.22 to 0.02, P = 0.05 However, the meta-analysis did not show a significant effect of vitamin D on chronic pelvic pain associated with endometriosis. Conclusion While antioxidant vitamin D supplementation demonstrates general effectiveness in alleviating endometriosis symptoms, such as dysmenorrhea, dyspareunia, and dyschezia, the existing literature lacks direct investigations into the specific impact of vitamin D on enhancing pregnancy rates among endometriosis patients. This observation prompts various hypotheses, suggesting that the positive effects of vitamin D supplementation on endometriosis-related symptoms may indirectly contribute to improved pregnancy outcomes and enhanced fertility.
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Affiliation(s)
| | | | | | | | - Mashhour Naasan
- Department of Obstetrics and Gynecology, Al-Istishari Arab Hospital, Ramallah, Palestine
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3
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Višnić A, Barišić D, Čanadi Jurešić G, Sušanj Šepić T, Smiljan Severinski N. Identification of urine biomarkers of endometriosis-Protein mass spectrometry. Am J Reprod Immunol 2024; 91:e13856. [PMID: 38709906 DOI: 10.1111/aji.13856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 04/04/2024] [Accepted: 04/15/2024] [Indexed: 05/08/2024] Open
Abstract
INTRODUCTION Endometriosis is a chronic inflammatory disease that leads to a series of pathological reactions. The basis is a changed proinflammatory activated immune system, which results in more pronounced oxidative stress, disturbed function of proteolysis and cell apoptosis. These processes are crucial in the development of the disease because their dysfunctional activities cause the progression of the disease. It is believed that the proteins excreted in the urine interact with each other and promote pathological processes in endometriosis. METHODS We analyzed the urine proteome of patients and aimed to detect a potential protein biomarker for endometriosis in the urine proteome. We collected urine samples from 16 patients with endometriosis and 16 patients in the control group with functional ovarian cysts. The diagnosis for all patients was confirmed through pathohistological analysis. After the preanalytical preparation of the urine, chromatography and mass spectrometry (LC-MS/MS) used the technology of urine proteome analysis. RESULTS The main finding was a significantly different concentration of 14 proteins in the urine samples. We recorded a considerably higher concentration of proteins that have a significant role in activating the immune system (SELL), iron metabolism (HAMP) and cell apoptosis (CHGA) in endometriosis compared to controls. Proteins having an antioxidant function (SOD1) and a role in proteolysis of the extracellular matrix (MMP-9) were significantly reduced in endometriosis compared to controls. CONCLUSION Consistent with the known pathogenesis of endometriosis, the study results complement the pathological responses that occur with disease progression.
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Affiliation(s)
- Alenka Višnić
- Clinical Hospital Center Rijeka, Clinic for Gynecology and Obstetrics, Institute of Human Reproduction and Endocrinology, Rijeka, Croatia
| | | | - Gordana Čanadi Jurešić
- Department of Medical Chemistry, Biochemistry and Clinical Chemistry, Faculty of Medicine, University of Rijeka, Rijeka, Croatia
| | - Tina Sušanj Šepić
- Clinical Hospital Center Rijeka, Clinic for Gynecology and Obstetrics, Institute of Human Reproduction and Endocrinology, Rijeka, Croatia
| | - Neda Smiljan Severinski
- Clinical Hospital Center Rijeka, Clinic for Gynecology and Obstetrics, Institute of Human Reproduction and Endocrinology, Rijeka, Croatia
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Liang Y, Liu M, Zhang J, Mao Z. First-line surgery versus first-line assisted reproductive technology for women with deep infiltrating endometriosis: a systematic review and meta-analysis. Front Endocrinol (Lausanne) 2024; 15:1352770. [PMID: 38699387 PMCID: PMC11063350 DOI: 10.3389/fendo.2024.1352770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 04/03/2024] [Indexed: 05/05/2024] Open
Abstract
Background The efficiency of different first-line treatments, such as first-line surgery and assisted reproductive technology (ART), in women with deep infiltrating endometriosis (DIE) is still unclear due to a lack of direct comparative trials. This systematic review and meta-analysis aim to elucidate and compare the efficacies of first-line treatments in patients with DIE, with an emphasis on fertility outcomes. Methods An exhaustive search of PubMed Central, SCOPUS, EMBASE, MEDLINE, Cochrane trial registry, Google Scholar, and Clinicaltrials.gov databases was done to identify studies directly comparing first-line surgery and assisted reproductive technology (ART) for DIE, and reporting fertility-related outcomes. Pooled estimates for each of the binary outcomes were reported as odds ratios (ORs) with 95% confidence intervals (CIs). The results were pooled using a random-effects model with the Mantel-Haenszel technique. Results Our results show that pregnancy rate per patient (OR, 1.47; 95% CI, 0.59 to 3.63), pregnancy rate per cycle (OR, 1.16; 95% CI, 0.45 to 2.99), and live births per patient (OR, 1.66; 95% CI, 0.56 to 4.91) were comparable in DIE patients, treated with surgery or ART as a first line of treatment. When both complete and incomplete surgical DIE excision procedures were taken into account, surgery was associated with a significant enhancement in the pregnancy rate per patient (OR, 1.63; 95% CI, 1.11 to 2.40). Conclusion The available evidence suggests that both first-line surgery and ART can be effective DIE treatments with similar fertility outcomes. However, further analysis reveals that excluding studies involving endometriomas significantly alters the understanding of treatment efficacy between surgery and ART for DIE-associated infertility. Systematic Review Registration https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=426061, identifier CRD42023426061.
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Affiliation(s)
- Ying Liang
- Reproductive Center of Changsha Hospital for Maternal and Child Health Care, Changsha, China
- Hunan Key Laboratory of Regional Hereditary Birth Defects Prevention and Control, Changsha Hospital for Maternal Child Health Care Affiliated to Hunan Normal University, Changsha, China
| | - Min Liu
- Reproductive Center of Changsha Hospital for Maternal and Child Health Care, Changsha, China
- Hunan Key Laboratory of Regional Hereditary Birth Defects Prevention and Control, Changsha Hospital for Maternal Child Health Care Affiliated to Hunan Normal University, Changsha, China
| | - Jianmei Zhang
- Reproductive Center of Changsha Hospital for Maternal and Child Health Care, Changsha, China
- Hunan Key Laboratory of Regional Hereditary Birth Defects Prevention and Control, Changsha Hospital for Maternal Child Health Care Affiliated to Hunan Normal University, Changsha, China
| | - Zenghui Mao
- Reproductive Center of Changsha Hospital for Maternal and Child Health Care, Changsha, China
- Hunan Key Laboratory of Regional Hereditary Birth Defects Prevention and Control, Changsha Hospital for Maternal Child Health Care Affiliated to Hunan Normal University, Changsha, China
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Koutalia N, Gkrozou F, Vatopoulou A, Lentzaris D, Skentou C, Paschopoulos M. Role of Molecular Biomarkers in Endometriosis-Related Infertility: A Narrative Review of the Literature. Cureus 2024; 16:e59288. [PMID: 38813329 PMCID: PMC11135608 DOI: 10.7759/cureus.59288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2024] [Indexed: 05/31/2024] Open
Abstract
Endometriosis is a chronic benign inflammatory disease that affects women of reproductive age. The clinical presentations of endometriosis include dysmenorrhea, dyspareunia, chronic pelvic pain, and infertility. There is a well-established association between endometriosis and infertility. Therefore, there is a need for an early diagnosis of endometriosis-related infertility. In this study, we aim to identify the role of biomarkers as predictive factors of the presence of the disease and its severity and their correlation with the pregnancy outcome. We performed an electronic database search of all published studies in PubMed and EMBASE from January 2018 to May 2023. Numerous innovative biomarkers identified in cases of endometriosis and infertility have been studied over the past years, including micro-RNAs, BCL6 endometrial expression, cytotoxic T-lymphocyte antigen 4, human leukocyte antigen G, programmed cell death protein 1, programmed cell death ligand 1 immune checkpoint molecules, plasma fibronectin-fibrin complexes, homeobox A10 gene, systemic inflammatory response markers, uterine natural killer cells, and the eutopic endometrium proteome. Considerable research has been done to identify diagnostic biomarkers for the early detection and prevention of endometriosis-associated infertility. However, none of these biomarkers displayed enough diagnostic accuracy to be used in daily clinical practice. Future research is valuable to establish them as reliable diagnostic tools.
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Affiliation(s)
- Nikoleta Koutalia
- Obstetrics and Gynaecology, University Hospital of Ioannina, Ioannina, GRC
| | - Fani Gkrozou
- Obstetrics and Gynaecology, University Hospital of Ioannina, Ioannina, GRC
| | | | | | - Chara Skentou
- Obstetrics and Gynaecology, University Hospital of Ioannina, Ioannina, GRC
| | - Minas Paschopoulos
- Obstetrics and Gynaecology, University Hospital of Ioannina, Ioannina, GRC
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Kaur Jawanda I, Soni T, Kumari S, Prabha V. Deciphering the potential of proteomic-based biomarkers in women's reproductive diseases: empowering precision medicine in gynecology. Biomarkers 2024; 29:7-17. [PMID: 38252065 DOI: 10.1080/1354750x.2024.2308827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 01/14/2024] [Indexed: 01/23/2024]
Abstract
CONTEXT Gynecological disorders represent a complex set of malignancies that result from a diverse array of molecular changes affecting the lives of over a million women worldwide. Ovarian, Endometrial, and Cervical cancers, Endometriosis, PCOS are the most prevalent ones that pose a grave threat to women's health. Proteomics has emerged as an invaluable tool for developing novel biomarkers, screening methods, and targeted therapeutic agents for gynecological disorders. Some of these biomarkers have been approved by the FDA, but regrettably, they have a constrained diagnostic accuracy in early-stage diagnosis as all of these biomarkers lack sensitivity and specificity. Lately, high-throughput proteomics technologies have made significant strides, allowing for identification of potential biomarkers with improved sensitivity and specificity. However, limited successes have been shown with translation of these discoveries into clinical practice. OBJECTIVE This review aims to provide a comprehensive overview of the current and potential protein biomarkers for gynecological cancers, endometriosis and PCOS, discusses recent advances and challenges, and highlights future directions for the field. CONCLUSION We propose that proteomics holds great promise as a powerful tool to revolutionize the fight against female reproductive diseases and can ultimately improve personalized patient outcomes in women's biomedicine.
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Affiliation(s)
| | - Thomson Soni
- Department of Microbiology, Panjab University, Chandigarh, India
| | - Seema Kumari
- Department of Microbiology, Panjab University, Chandigarh, India
| | - Vijay Prabha
- Department of Microbiology, Panjab University, Chandigarh, India
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Pant A, Moar K, Arora TK, Maurya PK. Implication of biosignatures in the progression of endometriosis. Pathol Res Pract 2024; 254:155103. [PMID: 38237401 DOI: 10.1016/j.prp.2024.155103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 01/04/2024] [Accepted: 01/05/2024] [Indexed: 02/12/2024]
Abstract
Endometriosis is an estrogen-dependent chronic inflammatory disorder involving the placement and growth of endometrial tissue outside the uterine cavity. It is the most common multifactorial disease that affects the life quality of women in reproductive age. Due to its multicomponent nature, early diagnosis of the disease is challenging. Since many genetic, epigenetic alterations and non-genetic factors contribute to the pathology of endometriosis, devising a drug therapy that directly acts on the ectopic tissue is extremely difficult. Endometriosis is a hormone-driven disease with estrogen considered as a primary driver for the development of endometriotic lesions. This study aims to identify biosignatures involved in endometriosis with and without gonadotropin releasing hormone agonists (GnRHa). GnRHa is a short peptide analog of GnRH that causes inhibition of estrogen and androgen synthesis. Microarray based-gene expression profiling was performed on total RNA extracted from endometriotic tissue samples with and without GnRHa-treated patients already published in our previous paper. The untreated group were considered as the control. Genes were then selected for validation by quantitative real-time polymerase chain reaction (qRT-PCR). qRT-PCR analysis confirmed significant downregulation in(p < 0.05) expression of DARC (p = 0.0042), CDH1 (p = 0.0027), CDH5 (p = 0.0283), ATP2A3 (p < 0.001), RGS5 (p = 0.0032), and CD36 (p = 0.0162) in endometriosis patients treated with GnRHa analogs. Although, CTNNAL1 (p = 0.0136) also showed significant results but there was upregulation in their expression levels after GnRHa treatment. Thus, an altered expression of these genes makes them a possible candidate determinant of endometriosis treated with GnRHa.
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Affiliation(s)
- Anuja Pant
- Department of Biochemistry, Central University of Haryana, Mahendergarh 123031, India
| | - Kareena Moar
- Department of Biochemistry, Central University of Haryana, Mahendergarh 123031, India
| | - Taruna K Arora
- Reproductive Biology and Maternal Child Health Division, Indian Council of Medical Research, New Delhi 110029, India
| | - Pawan Kumar Maurya
- Department of Biochemistry, Central University of Haryana, Mahendergarh 123031, India.
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Tore U, Abilgazym A, Asunsolo-del-Barco A, Terzic M, Yemenkhan Y, Zollanvari A, Sarria-Santamera A. Diagnosis of Endometriosis Based on Comorbidities: A Machine Learning Approach. Biomedicines 2023; 11:3015. [PMID: 38002015 PMCID: PMC10669733 DOI: 10.3390/biomedicines11113015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 10/27/2023] [Accepted: 10/31/2023] [Indexed: 11/26/2023] Open
Abstract
Endometriosis is defined as the presence of estrogen-dependent endometrial-like tissue outside the uterine cavity. Despite extensive research, endometriosis is still an enigmatic disease and is challenging to diagnose and treat. A common clinical finding is the association of endometriosis with multiple diseases. We use a total of 627,566 clinically collected data from cases of endometriosis (0.82%) and controls (99.18%) to construct and evaluate predictive models. We develop a machine learning platform to construct diagnostic tools for endometriosis. The platform consists of logistic regression, decision tree, random forest, AdaBoost, and XGBoost for prediction, and uses Shapley Additive Explanation (SHAP) values to quantify the importance of features. In the model selection phase, the constructed XGBoost model performs better than other algorithms while achieving an area under the curve (AUC) of 0.725 on the test set during the evaluation phase, resulting in a specificity of 62.9% and a sensitivity of 68.6%. The model leads to a quite low positive predictive value of 1.5%, but a quite satisfactory negative predictive value of 99.58%. Moreover, the feature importance analysis points to age, infertility, uterine fibroids, anxiety, and allergic rhinitis as the top five most important features for predicting endometriosis. Although these results show the feasibility of using machine learning to improve the diagnosis of endometriosis, more research is required to improve the performance of predictive models for the diagnosis of endometriosis. This state of affairs is in part attributed to the complex nature of the condition and, at the same time, the administrative nature of our features. Should more informative features be used, we could possibly achieve a higher AUC for predicting endometriosis. As a result, we merely perceive the constructed predictive model as a tool to provide auxiliary information in clinical practice.
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Affiliation(s)
- Ulan Tore
- School of Engineering and Digital Sciences, Nazarbayev University, Astana 010000, Kazakhstan; (U.T.); (A.A.)
| | - Aibek Abilgazym
- School of Engineering and Digital Sciences, Nazarbayev University, Astana 010000, Kazakhstan; (U.T.); (A.A.)
| | - Angel Asunsolo-del-Barco
- Department of Surgery, Medical and Social Sciences, Faculty of Medicine, University of Alcalá, 288871 Alcalá de Henares, Spain;
- Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York (CUNY), New York, NY 10028, USA
- Ramón y Cajal Institute of Healthcare Research (IRYCIS), 28034 Madrid, Spain
| | - Milan Terzic
- Department of Surgery, School of Medicine, Nazarbayev University, Astana 010000, Kazakhstan;
- Clinical Academic Department of Women’s Health, CF “University Medical Center”, Astana 010000, Kazakhstan
- Department of Obstetrics, Gynecology and Reproductive Sciences, School of Medicine, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Yerden Yemenkhan
- Department of Medicine, School of Medicine, Nazarbayev University, Astana 010000, Kazakhstan;
| | - Amin Zollanvari
- School of Engineering and Digital Sciences, Nazarbayev University, Astana 010000, Kazakhstan; (U.T.); (A.A.)
| | - Antonio Sarria-Santamera
- Department of Biomedical Sciences, School of Medicine, Nazarbayev University, Astana 010000, Kazakhstan;
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Skowrońska M, Pawłowski M, Milewski R. A Literature Review and a Proposed Classification of the Relationships between Ovulatory Infertility and Lifestyle Factors Based on the Three Groups of Ovulation Disorders Classified by WHO. J Clin Med 2023; 12:6275. [PMID: 37834919 PMCID: PMC10573907 DOI: 10.3390/jcm12196275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 09/25/2023] [Accepted: 09/27/2023] [Indexed: 10/15/2023] Open
Abstract
Ovulatory infertility is a serious clinical problem whose direct causes are still largely unknown. In addition to pathologies that make it impossible for a couple to establish a pregnancy, there are a number of other factors that have a bearing on fertility, including lifestyle factors, and particularly diet. Although numerous studies have been performed linking such factors to ovulatory infertility, most of them lack the necessary clinical significance, instead focusing on observational data and suggesting or establishing associative relationships. This article consists of a literature review focusing on connections between lifestyle factors such as diet, physical exercise, oxidative stress, sleep, and supplementation, and ovulatory infertility. Special emphasis was given to issues such as obesity and insulin resistance and their mutual relationship with other factors linked to ovulatory infertility. In addition, based on the conclusions of the literature review, the authors have proposed a classification of relationships between ovulation disorders and lifestyle factors in ovulatory infertility within the framework of the WHO classification of ovulation disorders. Furthermore, areas that merit further research have been indicated as well as those that do not. WHO Group II disorders gained prominence in the results of the study as the number of links with lifestyle factors and ovulatory infertility found in the course of the review greatly exceeded those for Groups I and III. The data presented in the article show that the issues of proper diet and physical exercise are those that could benefit from robust clinical studies focused specifically on ovulation infertility, while studies concerning the relationship between oxidative stress, sleep, and supplementation and ovulatory infertility do not seem to be promising directions as far as clinical significance is concerned.
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Affiliation(s)
| | - Michał Pawłowski
- Department of Biostatistics and Medical Informatics, Medical University of Bialystok, 15-089 Bialystok, Poland;
| | - Robert Milewski
- Department of Biostatistics and Medical Informatics, Medical University of Bialystok, 15-089 Bialystok, Poland;
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McGrath IM, Montgomery GW, Mortlock S. Insights from Mendelian randomization and genetic correlation analyses into the relationship between endometriosis and its comorbidities. Hum Reprod Update 2023; 29:655-674. [PMID: 37159502 PMCID: PMC10477944 DOI: 10.1093/humupd/dmad009] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 04/10/2023] [Indexed: 05/11/2023] Open
Abstract
BACKGROUND Endometriosis remains a poorly understood disease, despite its high prevalence and debilitating symptoms. The overlap in symptoms and the increased risk of multiple other traits in women with endometriosis is becoming increasingly apparent through epidemiological data. Genetic studies offer a method of investigating these comorbid relationships through the assessment of causal relationships with Mendelian randomization (MR), as well as identification of shared genetic variants and genes involved across traits. This has the capacity to identify risk factors for endometriosis as well as provide insight into the aetiology of disease. OBJECTIVE AND RATIONALE We aim to review the current literature assessing the relationship between endometriosis and other traits using genomic data, primarily through the methods of MR and genetic correlation. We critically examine the limitations of these studies in accordance with the assumptions of the utilized methods. SEARCH METHODS The PubMed database was used to search for peer-reviewed original research articles using the terms 'Mendelian randomization endometriosis' and '"genetic correlation" endometriosis'. Additionally, a Google Scholar search using the terms '"endometriosis" "mendelian randomization" "genetic correlation"' was performed. All relevant publications (n = 21) published up until 7 October 2022 were included in this review. Upon compilation of all traits with published MR and/or genetic correlation with endometriosis, additional epidemiological and genetic information on their comorbidity with endometriosis was sourced by searching for the trait in conjunction with 'endometriosis' on Google Scholar. OUTCOMES The association between endometriosis and multiple pain, gynaecological, cancer, inflammatory, gastrointestinal, psychological, and anthropometric traits has been assessed using MR analysis and genetic correlation analysis. Genetic correlation analyses provide evidence that genetic factors contributing to endometriosis are shared with multiple traits: migraine, uterine fibroids, subtypes of ovarian cancer, melanoma, asthma, gastro-oesophageal reflux disease, gastritis/duodenitis, and depression, suggesting the involvement of multiple biological mechanisms in endometriosis. The assessment of causality with MR has revealed several potential causes (e.g. depression) and outcomes (e.g. ovarian cancer and uterine fibroids) of a genetic predisposition to endometriosis; however, interpretation of these results requires consideration of potential violations of the MR assumptions. WIDER IMPLICATIONS Genomic studies have demonstrated that there is a molecular basis for the co-occurrence of endometriosis with other traits. Dissection of this overlap has identified shared genes and pathways, which provide insight into the biology of endometriosis. Thoughtful MR studies are necessary to ascertain causality of the comorbidities of endometriosis. Given the significant diagnostic delay of endometriosis of 7-11 years, determining risk factors is necessary to aid diagnosis and reduce the disease burden. Identification of traits for which endometriosis is a risk factor is important for holistic treatment and counselling of the patient. The use of genomic data to disentangle the overlap of endometriosis with other traits has provided insights into the aetiology of endometriosis.
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Affiliation(s)
- Isabelle M McGrath
- The Institute for Molecular Bioscience, The University of Queensland, Brisbane, QLD, Australia
| | - Grant W Montgomery
- The Institute for Molecular Bioscience, The University of Queensland, Brisbane, QLD, Australia
| | - Sally Mortlock
- The Institute for Molecular Bioscience, The University of Queensland, Brisbane, QLD, Australia
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Sarria-Santamera A, Yemenkhan Y, Terzic M, Ortega MA, Asunsolo del Barco A. A Novel Classification of Endometriosis Based on Clusters of Comorbidities. Biomedicines 2023; 11:2448. [PMID: 37760889 PMCID: PMC10525703 DOI: 10.3390/biomedicines11092448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 08/27/2023] [Accepted: 08/30/2023] [Indexed: 09/29/2023] Open
Abstract
Endometriosis is a heterogeneous, complex, and still challenging disease, due to its epidemiological, etiological and pathogenic, diagnostic, therapeutic, and prognosis characteristics. The classification of endometriosis is contentious, and existing therapies show significant variability in their effectiveness. This study aims to capture and describe clusters of women with endometriosis based on their comorbidity. With data extracted from electronic records of primary care, this study performs a hierarchical clustering with the Ward method of women with endometriosis with a subsequent analysis of the distribution of comorbidities. Data were available for 4055 women with endometriosis, and six clusters of women were identified: cluster 1 (less comorbidity), cluster 2 (anxiety and musculoskeletal disorders), cluster 3 (type 1 allergy or immediate hypersensitivity); cluster 4 (multiple morbidities); cluster 5 (anemia and infertility); and cluster 6 (headache and migraine). Clustering aggregates similar units into similar clusters, partitioning dissimilar objects into other clusters at a progressively finer granularity-in this case, groups of women with similarities in their comorbidities. Clusters may provide a deeper insight into the multidimensionality of endometriosis and may represent diverse "endometriosis trajectories" which may be associated with specific molecular and biochemical mechanisms. Comorbidity-based clusters may be important to the scientific study of endometriosis, contributing to the clarification of its clinical complexity and variability. An awareness of those comorbidities may help elucidate the etiopathogenesis and facilitate the accurate earlier diagnosis and initiation of treatments targeted toward particular subgroups.
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Affiliation(s)
- Antonio Sarria-Santamera
- Department of Biomedical Sciences, Nazarbayev University School of Medicine, Astana 010000, Kazakhstan
| | - Yerden Yemenkhan
- Department of Medicine, Nazarbayev University School of Medicine, Astana 010000, Kazakhstan;
| | - Milan Terzic
- Department of Surgery, Nazarbayev University School of Medicine, Astana 010000, Kazakhstan;
- Clinical Academic Department of Women’s Health, National Research Center for Maternal and Child Health, University Medical Center, Astana 010000, Kazakhstan
- Department of Obstetrics, Gynecology and Reproductive Sciences, School of Medicine, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Miguel A. Ortega
- Department of Medicine and Medical Specialties, Faculty of Medicine and Health Sciences, University of Alcalá, 28801 Alcalá de Henares, Spain;
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), 28034 Madrid, Spain
- Cancer Registry and Pathology Department, Hospital Universitario Principe de Asturias, 28805 Alcalá de Henares, Spain
| | - Angel Asunsolo del Barco
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), 28034 Madrid, Spain
- Department of Surgery, Medical and Social Sciences, Faculty of Medicine and Health Sciences, University of Alcala, 28801 Alcalá de Henares, Spain
- Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, The City University of New York, New York, NY 10017, USA
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Giudice LC, Oskotsky TT, Falako S, Opoku‐Anane J, Sirota M. Endometriosis in the era of precision medicine and impact on sexual and reproductive health across the lifespan and in diverse populations. FASEB J 2023; 37:e23130. [PMID: 37641572 PMCID: PMC10503213 DOI: 10.1096/fj.202300907] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 07/26/2023] [Indexed: 08/31/2023]
Abstract
Endometriosis is a common estrogen-dependent disorder wherein uterine lining tissue (endometrium) is found mainly in the pelvis where it causes inflammation, chronic pelvic pain, pain with intercourse and menses, and infertility. Recent evidence also supports a systemic inflammatory component that underlies associated co-morbidities, e.g., migraines and cardiovascular and autoimmune diseases. Genetics and environment contribute significantly to disease risk, and with the explosion of omics technologies, underlying mechanisms of symptoms are increasingly being elucidated, although novel and effective therapeutics for pain and infertility have lagged behind these advances. Moreover, there are stark disparities in diagnosis, access to care, and treatment among persons of color and transgender/nonbinary identity, socioeconomically disadvantaged populations, and adolescents, and a disturbing low awareness among health care providers, policymakers, and the lay public about endometriosis, which, if left undiagnosed and under-treated can lead to significant fibrosis, infertility, depression, and markedly diminished quality of life. This review summarizes endometriosis epidemiology, compelling evidence for its pathogenesis, mechanisms underlying its pathophysiology in the age of precision medicine, recent biomarker discovery, novel therapeutic approaches, and issues around reproductive justice for marginalized populations with this disorder spanning the past 100 years. As we enter the next revolution in health care and biomedical research, with rich molecular and clinical datasets, single-cell omics, and population-level data, endometriosis is well positioned to benefit from data-driven research leveraging computational and artificial intelligence approaches integrating data and predicting disease risk, diagnosis, response to medical and surgical therapies, and prognosis for recurrence.
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Affiliation(s)
- Linda C. Giudice
- UCSF Stanford Endometriosis Center for Innovation, Training, and Community Outreach (ENACT)University of California, San FranciscoSan FranciscoCaliforniaUSA
- Center for Reproductive SciencesUniversity of California, San FranciscoSan FranciscoCaliforniaUSA
| | - Tomiko T. Oskotsky
- UCSF Stanford Endometriosis Center for Innovation, Training, and Community Outreach (ENACT)University of California, San FranciscoSan FranciscoCaliforniaUSA
- Bakar Computational Health Sciences InstituteUniversity of California, San FranciscoSan FranciscoCaliforniaUSA
| | - Simileoluwa Falako
- UCSF Stanford Endometriosis Center for Innovation, Training, and Community Outreach (ENACT)University of California, San FranciscoSan FranciscoCaliforniaUSA
- Columbia University Vagelos College of Physicians and SurgeonsNew YorkNew YorkUSA
| | - Jessica Opoku‐Anane
- UCSF Stanford Endometriosis Center for Innovation, Training, and Community Outreach (ENACT)University of California, San FranciscoSan FranciscoCaliforniaUSA
- Division of Gynecologic Specialty SurgeryColumbia UniversityNew YorkNew YorkUSA
| | - Marina Sirota
- UCSF Stanford Endometriosis Center for Innovation, Training, and Community Outreach (ENACT)University of California, San FranciscoSan FranciscoCaliforniaUSA
- Bakar Computational Health Sciences InstituteUniversity of California, San FranciscoSan FranciscoCaliforniaUSA
- Department of PediatricsUniversity of California, San FranciscoSan FranciscoCaliforniaUSA
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Wang M, Zheng L, Lin R, Ma S, Li J, Yang S. A comprehensive overview of exosome lncRNAs: emerging biomarkers and potential therapeutics in endometriosis. Front Endocrinol (Lausanne) 2023; 14:1199569. [PMID: 37455911 PMCID: PMC10338222 DOI: 10.3389/fendo.2023.1199569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 06/05/2023] [Indexed: 07/18/2023] Open
Abstract
Endometriosis is a gynecological condition that significantly impacting women's daily lives. In recent years, the incidence of endometriosis has been rising yearly and is now an essential contributor to female infertility. Exosomes are extracellular vesicles (EVs) that carry long noncoding RNA (lncRNA) and shield lncRNA from the outside environment thanks to their vesicle-like structure. The role of exosome-derived lncRNAs in endometriosis is also receiving more study as high-throughput sequencing technology develops. Several lncRNAs with variable expression may be crucial to the emergence and growth of endometriosis. The early diagnosis of endometriosis will be considerably improved by further high specificity and sensitivity Exosome lncRNA screening. Exosomes assist lncRNAs in carrying out their roles, offering a new target for creating endometriosis-specific medications. In order to serve as a reference for clinical research on the pathogenesis, diagnosis, and treatment options of endometriosis, this paper covers the role of exosome lncRNAs in endometriosis and related molecular mechanisms.
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Affiliation(s)
- Min Wang
- Department of Obstetrics and Gynecology, The Second Hospital of Jilin University, Changchun, China
| | - Lianwen Zheng
- Department of Obstetrics and Gynecology, The Second Hospital of Jilin University, Changchun, China
| | - Ruixin Lin
- Department of Hepato-Biliary-Pancreatic Surgery, The Second Hospital of Jilin University, Changchun, China
| | - Shuai Ma
- Department of Obstetrics and Gynecology, The Second Hospital of Jilin University, Changchun, China
| | - Jiahui Li
- Department of Obstetrics and Gynecology, The Second Hospital of Jilin University, Changchun, China
| | - Shuli Yang
- Department of Obstetrics and Gynecology, The Second Hospital of Jilin University, Changchun, China
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Pineda Mateo M, Arnáez de la Cruz M. Manejo quirúrgico del endometrioma en pacientes con deseo genésico. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2023. [DOI: 10.1016/j.gine.2023.100851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
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15
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Zhang F, Li F, Lu J. microRNA-100 shuttled by human umbilical cord MSC-secreted extracellular vesicles induces endometriosis by inhibiting HS3ST2. Cell Signal 2023; 102:110532. [PMID: 36423858 DOI: 10.1016/j.cellsig.2022.110532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 11/11/2022] [Accepted: 11/18/2022] [Indexed: 11/23/2022]
Abstract
In recent years, the function of human umbilical cord mesenchymal stem cell-originated extracellular vesicles (hUC-MSC-EVs) on endometriosis has been reported, while its specific mechanisms remain largely unknown. This study aimed at investigating the mechanisms underlying the modulation of EVs harboring miR-100 derived from hUC-MSCs in the growth dynamics of endometrial stromal cells in endometriosis. Endometriosis mouse models were established. miR-100 was upregulated and HS3ST2 was downregulated in endometriosis. Ectopic endometrial tissues and umbilical cord tissues were obtained to extract endometrial stromal cells and hUC-MSCs, from which EVs were isolated. Next, the endometrial stromal cells were co-cultured with hUC-MSC-EVs, during which gain- or loss-of-function approaches were employed for gene overexpression or silencing. The binding affinity among miR-100 and HS3ST2 was identified using multiple assays. It was unveiled that miR-100 could target and inhibit HS3ST2. miR-100 from hUC-MSCs could be transferred into the endometrial stromal cells via EVs. Moreover, miR-100 shuttled by hUC-MSC-EVs facilitated endometrial stromal cell proliferation, invasion, and migration, as well as EMT by inhibiting HS3ST2. In vivo experiments also confirmed that hUC-MSC-derived EVs carrying miR-100 induced the occurrence and development of endometriosis. Collectively, hUC-MSC-EV-loaded miR-100 downregulated HS3ST2 to facilitate the development of endometriosis, which highlights a promising therapeutic target for treating endometriosis.
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Affiliation(s)
- Feng Zhang
- Gynaecological ward 2, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, PR China.
| | - Feiyan Li
- Gynaecological ward 2, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, PR China
| | - Jinghe Lu
- Gynaecological ward 2, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, PR China
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Wang X, Li W, Chen X, Zhang W, Chu M, Yin S, Chu Y, Liu X. Is the long-acting gonadotropin-releasing hormone agonist long protocol better for patients with endometriosis undergoing IVF? Int J Gynaecol Obstet 2023. [PMID: 36688363 DOI: 10.1002/ijgo.14690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 12/27/2022] [Accepted: 01/20/2023] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To investigate the effect of the long-acting gonadotropin-releasing hormone agonist (GnRHa) long protocol on in vitro fertilization (IVF) outcomes of patients with endometriosis (EMs). METHODS This retrospective cohort study was carried out from July 1, 2016 to June 30, 2021. In all, 798 patients with EMs who underwent first IVF were enrolled. The patients were classified by the ovarian stimulation protocols. The clinical outcomes of IVF were compared in each group. RESULTS Those EMs patients who received the long-acting GnRHa long protocol had significantly higher clinical pregnancy rate (72.00%, 60.70% and 50.90%, respectively; P = 0.047 and 0.010) and implantation rate (51.0%, 44.6%, and 38.7%, respectively; P = 0.006 and <0.001) compared with the short-acting GnRHa long protocol and the GnRH antagonist protocol. Live birth rate was also significantly higher than the GnRH antagonist protocol (60.10% vs. 40.0%, P = 0.032), but not statistically different from the short-acting GnRHa (60.10% vs. 53.80%, P = 0.443). In addition, they also had significantly higher duration of stimulation, total dose of gonadotropin, and number of high-quality embryos transferred compared with other groups (P < 0.001). CONCLUSIONS The long-acting GnRHa long protocol could improve IVF outcomes of patients with EMs compared with the short-acting GnRHa long protocol and the GnRH antagonist protocol.
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Affiliation(s)
| | - Wenshu Li
- Department of Obstetrics and Gynecology, Yantai Yuhuangding Hospital, Yantai, China
| | | | - Wei Zhang
- Reproductive Medicine Center, Yantai Yuhuangding Hospital, Yantai, China
| | - Min Chu
- Reproductive Medicine Center, Yantai Yuhuangding Hospital, Yantai, China
| | - Shuyuan Yin
- Reproductive Medicine Center, Yantai Yuhuangding Hospital, Yantai, China
| | - Yongli Chu
- Department of Obstetrics and Gynecology, Yantai Yuhuangding Hospital, Yantai, China
| | - Xuemei Liu
- Reproductive Medicine Center, Yantai Yuhuangding Hospital, Yantai, China
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Zou K, Du Q, Chen X, Tang P, Liang H. MLL1:EZH2 Ratio in Uterine Secretions and Endometrial Receptivity in Patients with Endometriosis. Lab Med 2023; 54:90-97. [PMID: 36094360 DOI: 10.1093/labmed/lmac067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
OBJECTIVE To establish a novel approach for diagnosing endometriosis (EM) in patients with impaired endometrial receptivity. METHOD Mixed lineage leukemia 1 (MLL1) and enhancer of zeste homolog 2 (EZH2) levels were analyzed. The MLL1:EZH2 ratio in identifying impaired endometrial receptivity has been established and validated. RESULTS In normal endometrial tissue, the MLL1:EZH2 ratio increased significantly in the midsecretory phase, compared with that in the proliferative phase. In the midsecretory phase, the MLL1:EZH2 ratio in endometrial tissues and uterine secretions accurately identifies patients with EM who have impaired endometrial receptivity. In the validation group, the sensitivity and specificity of the MLL1:EZH2 ratio in the uterine secretions of the midsecretory phase, in diagnosing patients EM who have impaired endometrial receptivity, were 100% and 96.55%, respectively. CONCLUSIONS The MLL1:EZH2 ratio in uterine secretions of the midsecretory phase may serve as a marker to diagnose EM in patients with impaired endometrial receptivity.
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Affiliation(s)
- Kehan Zou
- Department of Health, The Maternal and Child Health Hospital of Hunan Province
| | - Qing Du
- Department of Second School of Clinical Medicine, Hunan University of Chinese Medicine
| | - Xin Chen
- Department of Second School of Clinical Medicine, Hunan University of Chinese Medicine
| | - Pingfang Tang
- Department of Second School of Clinical Medicine, Hunan University of Chinese Medicine
| | - Huizhen Liang
- Department of Clinic of Integrated Traditional & Western Medicine, The Maternal and Child Health Hospital of Hunan Province , Changsha, China
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Jiang T, Chen Y, Gu X, Miao M, Hu D, Zhou H, Chen J, Teichmann AT, Yang Y. Review of the Potential Therapeutic Effects and Molecular Mechanisms of Resveratrol on Endometriosis. Int J Womens Health 2023; 15:741-763. [PMID: 37200624 PMCID: PMC10187648 DOI: 10.2147/ijwh.s404660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 04/08/2023] [Indexed: 05/20/2023] Open
Abstract
Endometriosis is a hormone-dependent inflammatory disease characterized by the existence of endometrial tissues outside the uterine cavity. Pharmacotherapy and surgery are the current dominant management options for endometriosis. The greater incidence of recurrence and reoperation after surgical treatment as well as the adverse effects of medical approaches predispose patients to potential limitations for their long-term usage. Consequently, it is essential to explore novel supplementary and alternative drugs to ameliorate the therapeutic outcomes of endometriotic patients. Resveratrol is a phenolic compound that has attracted increasing interest from many researchers due to its pleiotropic biological activities. Here, we review the possible therapeutic efficacies and molecular mechanisms of resveratrol against endometriosis based on in vitro, animal, and clinical studies. The potential mechanisms of resveratrol include anti-proliferative, pro-apoptotic, anti-angiogenic, anti-oxidative stress, anti-invasive and anti-adhesive effects, thereby suggesting that resveratrol is a promising candidate for endometriosis. Because most studies have investigated the effectiveness of resveratrol on endometriosis via in vitro trials and/or experimental animal models, further high-quality clinical trials should be undertaken to comprehensively estimate the clinical application feasibility of resveratrol on endometriosis.
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Affiliation(s)
- Tao Jiang
- Sichuan Provincial Center for Gynaecology and Breast Diseases, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, People’s Republic of China
| | - Yuan Chen
- Sichuan Provincial Center for Gynaecology and Breast Diseases, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, People’s Republic of China
| | - Xia Gu
- Sichuan Provincial Center for Gynaecology and Breast Diseases, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, People’s Republic of China
- Academician (Expert) Workstation of Sichuan Province, Luzhou, 646000, People’s Republic of China
| | - Mengyue Miao
- Sichuan Provincial Center for Gynaecology and Breast Diseases, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, People’s Republic of China
| | - Daifeng Hu
- Sichuan Provincial Center for Gynaecology and Breast Diseases, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, People’s Republic of China
| | - Hui Zhou
- Sichuan Provincial Center for Gynaecology and Breast Diseases, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, People’s Republic of China
| | - Jing Chen
- Reproductive Medicine Center, The Second People’s Hospital of Yibin, Yibin, 644000, People’s Republic of China
| | - Alexander Tobias Teichmann
- Sichuan Provincial Center for Gynaecology and Breast Diseases, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, People’s Republic of China
- Correspondence: Alexander Tobias Teichmann; Youzhe Yang, The Affiliated Hospital of Southwest Medical University, No. 25 Taiping Street, Jiangyang District, Luzhou, 646000, People’s Republic of China, Email ;
| | - Youzhe Yang
- Sichuan Provincial Center for Gynaecology and Breast Diseases, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, People’s Republic of China
- Academician (Expert) Workstation of Sichuan Province, Luzhou, 646000, People’s Republic of China
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The effect of endometriosis on IVF/ICSI and perinatal outcome: A systematic review and meta-analysis. J Gynecol Obstet Hum Reprod 2022; 51:102446. [DOI: 10.1016/j.jogoh.2022.102446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 07/06/2022] [Accepted: 07/22/2022] [Indexed: 11/18/2022]
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Nowakowska A, Kwas K, Fornalczyk A, Wilczyński J, Szubert M. Correlation between Endometriosis and Selected Allergic and Autoimmune Diseases and Eating Habits. Medicina (B Aires) 2022; 58:medicina58081038. [PMID: 36013504 PMCID: PMC9414963 DOI: 10.3390/medicina58081038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 07/17/2022] [Accepted: 08/01/2022] [Indexed: 11/29/2022] Open
Abstract
Background and Objectives: Endometriosis is a hormone-dependent chronic inflammatory disease with serious reproductive and general health consequences. It is viewed as a multifactorial problem, consisting of matters related to altered immunity and genetics. In this study, we determined the correlation between endometriosis and allergic and autoimmune diseases in patients at reproductive age. Materials and Methods: Online surveys distributed through websites related to gynecological problems. The questionnaire was composed of 63 single and multiple-choice questions concerning the course of endometriosis, diet, and allergic and autoimmune diseases. The obtained data were assessed using statistical tests. Results: 501 female patients (mean age 31.1 SD = 6.8) were included in the study. The control group (n = 155) consisted of healthy females, whereas the study group (n = 346) consisted of female patients with endometriosis; each group was subdivided according to allergy status. There were statistically significant differences between groups for the following: positive family history of endometriosis (p = 0.0002), onset of allergic symptoms (p = 0.0003), frequency and duration of abdominal pain (p = 0.00625), and defecation disorders (p = 0.0006). Asthma was less common in the study group (p = 0.00611). The group of patients with endometriosis and allergies had a high median of consumption of red meat (p = 0.0143), fish (p = 0.0016), and dairy products (p = 0.0001). Conclusions: Endometriosis did not affect autoimmune diseases and their courses. Patients with diagnosed endometriosis presented allergy symptoms much earlier than the healthy patients. The consumption of dietary products such as soya products, red meat, and alcohol had an influence on the occurrence of endometriosis.
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Tan Z, Hung SW, Zheng X, Wang CC, Chung JPW, Zhang T. What We Have Learned from Animal Models to Understand the Etiology and Pathology of Endometrioma-Related Infertility. Biomedicines 2022; 10:biomedicines10071483. [PMID: 35884788 PMCID: PMC9313443 DOI: 10.3390/biomedicines10071483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 06/16/2022] [Accepted: 06/20/2022] [Indexed: 11/16/2022] Open
Abstract
Endometrioma (OMA) is the most common subtype of endometriosis, in which the endometriotic lesions are implanted in the ovary. Women with OMA are usually associated with infertility, presenting with reduced ovarian reserve, low oocyte quantity and quality, and poor fertility outcomes. However, the underlying pathological mechanisms in OMA-related infertility are still unclear. Due to the limitations and ethical issues of human studies in reproduction, animal models that recapitulate OMA characteristics and its related infertility are critical for mechanistic studies and subsequent drug development, preclinical testing, and clinical trials. This review summarized the investigations of OMA-related infertility based on previous and latest endometrioma models, providing the possible pathogenesis and potential therapeutic targets for further studies.
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Affiliation(s)
- Zhouyurong Tan
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong; (Z.T.); (S.-W.H.); (X.Z.); (C.-C.W.); (J.P.-W.C.)
| | - Sze-Wan Hung
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong; (Z.T.); (S.-W.H.); (X.Z.); (C.-C.W.); (J.P.-W.C.)
| | - Xu Zheng
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong; (Z.T.); (S.-W.H.); (X.Z.); (C.-C.W.); (J.P.-W.C.)
| | - Chi-Chiu Wang
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong; (Z.T.); (S.-W.H.); (X.Z.); (C.-C.W.); (J.P.-W.C.)
- Reproduction and Development, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong
- School of Biomedical Sciences, The Chinese University of Hong Kong, Hong Kong
- Sichuan University-Chinese University of Hong Kong Joint Laboratory in Reproductive Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Jacqueline Pui-Wah Chung
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong; (Z.T.); (S.-W.H.); (X.Z.); (C.-C.W.); (J.P.-W.C.)
| | - Tao Zhang
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong; (Z.T.); (S.-W.H.); (X.Z.); (C.-C.W.); (J.P.-W.C.)
- Correspondence: ; Tel.: +852-3505-3099
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22
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Kanellopoulos D, Karagianni D, Pergialiotis V, Nikiteas N, Lazaris AC, Iliopoulos D. Endometriosis and Subfertility: A Literature Review. MAEDICA 2022; 17:458-463. [PMID: 36032627 PMCID: PMC9375884 DOI: 10.26574/maedica.2022.17.2.458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Introduction: Endometriosis is a condition that mainly concerns women of reproductive age, which causes several problems, including subfertility. The phenotypic presentation of endometriosis is defined by a complex interplay between genetic profile, immunological and mechanical factors. In this literature review we examine the causality between endometriosis and subfertility, outlining possible mechanisms involved in the pathogenesis. Aim: The purpose of this study was to conduct a literature review in order to identify the correlation between endometriosis and subfertility through possible mechanisms involved in the pathogenesis of endometriosis-associated subfertility and treatment. Methods:A search in Medline/PubMed was done, using the terms "endometriosis" and "subfertility", to identify the most relevant studies that were published during the last six years. Results:Pathogenesis of endometriosis-associated subfertility is not clear yet, although some data indicate that there are several factors that could affect a patient's fertility. Involved mechanisms include mechanical obstruction such as ovarian tubal dysfunction and the abnormal peritoneal microenvironment, genetic, and epigenetic mechanisms, and immunological traits. It is fundamental to better understand these mechanisms in order to improve the therapeutic approach. Conclusions:The clinical management of endometiosis-related subfertility has to be improved. It is important to consider a change in the classification of endometriosis and, more importantly, an effort to avoid surgical procedures. There is a crucial need for effective protocols and novel targets for specific diagnosis and treatment. Consequently, the importance of understanding pathogenesis and genetic mechanisms is underlined. Future researchers should focus on novel non-invasive treatment methods that target specific pathogenic pathways.
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Affiliation(s)
- Dimitrios Kanellopoulos
- Laboratory of Experimental Surgery and Surgical Research N.S. Christeas, National and Kapodistrian University of Athens, Greece
| | - Dimitra Karagianni
- 1st Department of Pathology, National and Kapodistrian University of Athens, Greece
| | - Vasilios Pergialiotis
- Laboratory of Experimental Surgery and Surgical Research N.S. Christeas, National and Kapodistrian University of Athens, Greece
| | - Nikolaos Nikiteas
- 2nd Propaedeutic Department of Surgery, National and Kapodistrian University of Athens, Greece
| | - Andreas C Lazaris
- 1st Department of Pathology, National and Kapodistrian University of Athens, Greece
| | - Dimitrios Iliopoulos
- Laboratory of Experimental Surgery and Surgical Research N.S. Christeas, National and Kapodistrian University of Athens, Greece
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Moss KM, Doust J, Homer H, Rowlands IJ, Hockey R, Mishra GD. Delayed diagnosis of endometriosis disadvantages women in ART: a retrospective population linked data study. Hum Reprod 2021; 36:3074-3082. [PMID: 34610108 DOI: 10.1093/humrep/deab216] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 09/05/2021] [Indexed: 11/12/2022] Open
Abstract
STUDY QUESTION Do the outcomes and use of ART differ between women with and without endometriosis? SUMMARY ANSWER ART use and outcome do not appear to differ for women with and without endometriosis, as long as endometriosis is diagnosed prior to commencing ART. WHAT IS KNOWN ALREADY Approximately 40% of women with endometriosis have infertility and ART is the recommended treatment option for these women. However, diagnosis of endometriosis can be complex and lengthy, and a delay in diagnosis can reduce the likelihood of achieving a live birth. STUDY DESIGN, SIZE, DURATION This retrospective national cohort study used longitudinal self-report data (collected 1996-2018) from women born in 1973-1978 who are participants in the Australian Longitudinal Study on Women's Health (ALSWH). The study also used linked administrative data on Endometriosis (1970-2018), ART (1996-2020) and births (1996-2018). PARTICIPANTS/MATERIALS, SETTING, METHODS The outcome measures were: age at first ART cycle; use of ART treatments (IVF only; IUI only/and IVF); number of ART cycles (1-3; 4-10; 11-36); and births after first ART (no; yes) (note that births could not be tied to ART). MAIN RESULTS AND THE ROLE OF CHANCE One in three (34.7%, n = 459/1322) women using ART had endometriosis, with 65.6% of these diagnosed before first ART and 34.4% after. Adjusted regression analyses showed women with endometriosis diagnosed before first ART were not significantly different to women without endometriosis on any outcome. However, women with endometriosis diagnosed after first ART were more likely to use IUI (adjusted odds ratio (aOR) 2.14, 95% CI 1.48, 3.09) and do more cycles (11-36 cycles: aOR 4.09, 95% CI 2.41, 6.95), and less likely to report a birth (aOR 0.67, 95% CI 0.45, 0.99), compared to women without endometriosis, despite no significant difference in starting age (coefficient = -0.62, 95% CI -1.36, 0.13). LIMITATIONS, REASONS FOR CAUTION We did not have information on the severity of endometriosis, or the reasons for using ART, which can influence treatment and outcomes. We were not able to reliably link births with ART treatment. Finally, it is possible that some of the women in our 'no endometriosis' group did have endometriosis and were unaware of it, although prevalence rates match population estimates. WIDER IMPLICATIONS OF THE FINDINGS These findings support previous studies that have found no difference in outcome of ART for women with endometriosis, but add the new insight that this is only true if endometriosis is diagnosed prior to commencing ART. A delayed diagnosis can create disadvantage during ART treatment. Early recourse to IVF may be advantageous for pregnancy prospects for women with endometriosis. STUDY FUNDING/COMPETING INTEREST(S) The ALSWH is funded by the Australian Government Department of Health. G.D.M. is supported by an NHMRC Principal Research Fellowship (APP11218449). The authors have no conflicts of interest to declare. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- K M Moss
- Centre for Longitudinal and Life Course Research, School of Public Health, The University of Queensland, Brisbane, Australia
| | - J Doust
- Centre for Longitudinal and Life Course Research, School of Public Health, The University of Queensland, Brisbane, Australia
| | - H Homer
- Centre for Clinical Research, The University of Queensland, Brisbane, Australia
| | - I J Rowlands
- Centre for Longitudinal and Life Course Research, School of Public Health, The University of Queensland, Brisbane, Australia
| | - R Hockey
- Centre for Longitudinal and Life Course Research, School of Public Health, The University of Queensland, Brisbane, Australia
| | - G D Mishra
- Centre for Longitudinal and Life Course Research, School of Public Health, The University of Queensland, Brisbane, Australia
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Fibronectin Molecular Status in Plasma of Women with Endometriosis and Fertility Disorders. Int J Mol Sci 2021; 22:ijms222111410. [PMID: 34768846 PMCID: PMC8583846 DOI: 10.3390/ijms222111410] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 10/15/2021] [Accepted: 10/19/2021] [Indexed: 12/15/2022] Open
Abstract
The diagnosis of endometriosis and fertility disorders is difficult; therefore, it is necessary to look for reliable biomarkers. Analysis of the molecular status of fibronectin as a key player in repair and wound healing processes, as well as in coagulation and fibrinolysis pathways, is justified. ELISA and SDS-agarose immunoblotting were applied to determine the fibronectin concentration and presence and occurrence of soluble FN-fibrin complexes in the blood plasma of women with endometriosis (n = 38), fertility disorders (n = 28) and the healthy group (n = 25). The concentration of fibronectin in the blood plasma of women with endometriosis (292.61 ± 96.17 mg/L) and fertility disorders (287.53 ± 122.68 mg/L) was significantly higher than in the normal group (226.55 ± 91.98 mg/L). The presence of FN-fibrin complexes of 750, 1000, 1300, 1600 and 1900 kDa in the plasma of women with endometriosis and fertility disorders was shown. The presence of FN-fibrin complexes with a molecular mass of more than 1300 kDa in women with endometriosis and infertility and the complete absence of these complexes in healthy women may indicate an increased and chronic activation of coagulation mechanisms in these patients. The presence of complexes of high molecular mass may be one of the biomarkers of fertility disorders in women.
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Hysterolaparoscopy: A Gold Standard for Diagnosing and Treating Infertility and Benign Uterine Pathology. J Clin Med 2021; 10:jcm10163749. [PMID: 34442042 PMCID: PMC8396885 DOI: 10.3390/jcm10163749] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 08/08/2021] [Accepted: 08/20/2021] [Indexed: 12/29/2022] Open
Abstract
Background: Combined hysteroscopy and laparoscopy is a valuable method for diagnosing and treating infertility and benign uterine pathology. Both procedures are minimally invasive, reliable, and safe, with a low complication rate. Aim: In this review, we expose the efficiency and safety of hysterolaparoscopy in the management of infertility and other benign uterine pathologies. Method: We performed a systematic literature review on several databases: PubMed®/MEDLINE, PMC, Crossref.org, and Web of Science in the last 10 years. Inclusion criteria: Women of reproductive age with primary or secondary infertility and/or benign uterine pathology. Exclusion criteria: pre-puberty, menopause, couple with male infertility. Conclusion: Hysterolaparoscopy is a useful tool to assess infertility and simultaneously diagnose and treat pelvic and uterine lesions.
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Varlas VN, Rhazi Y, Bors RG, Penes O, Radavoi D. The urological complications of vaginal birth after cesarean (VBAC) - a literature review. J Med Life 2021; 14:443-447. [PMID: 34621366 PMCID: PMC8485385 DOI: 10.25122/jml-2021-0219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 07/22/2021] [Indexed: 11/17/2022] Open
Abstract
The appearance of urological complications is a major problem in obstetrics and gynecologic surgery; the bladder is the most common damaged organ. Due to a continuous increase in the rate of cesareans, the incidence of urologic complications will be potentially higher. We reviewed the most important risk factors for urinary tract injury and analyzed the strategies necessary to avoid these situations during vaginal birth after cesarean (VBAC). The risks and benefits of VBAC should be balanced before deciding the mode of delivery.
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Affiliation(s)
- Valentin Nicolae Varlas
- Department of Obstetrics and Gynaecology, Filantropia Clinical Hospital, Bucharest, Romania
- Department of Obstetrics and Gynaecology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Yassin Rhazi
- Department of Obstetrics and Gynaecology, Filantropia Clinical Hospital, Bucharest, Romania
| | - Roxana Georgiana Bors
- Department of Obstetrics and Gynaecology, Filantropia Clinical Hospital, Bucharest, Romania
| | - Ovidiu Penes
- Department of Anesthesiology and Intensive Care, Bucharest Emergency University Hospital, Bucharest, Romania
| | - Daniel Radavoi
- Department of Urology, Prof. Dr. Theodor Burghele Clinical Hospital, Bucharest, Romania
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Evaluation of Dissolution Profiles of a Newly Developed Solid Oral Immediate-Release Formula Containing Alpha-Lipoic Acid. Processes (Basel) 2021. [DOI: 10.3390/pr9010176] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Alpha-lipoic acid (ALA, thioctic acid), a naturally-occurring essential dithiol compound, has become a common ingredient in many pharmaceutical and food supplement products (FSP), used in oxidative stress-dependent pathologies; oral bioavailability of ALA is limited by pharmacokinetic particularities that reduce its therapeutic efficacy-reduced solubility, lack of gastric stability and hepatic degradation, doubled by formulation hinders. The objectives were to develop a solid oral 600 mg ALA FSP to obtain an optimal pharmaceutical profile compared to a reference listed drug (RLD) with a similarity factor f2 50. A comparative dissolution study was performed; an HPLC method was used for ALA quantification. After planning combinatory simulations (formulation stage), two prototype formulas (#1 and #2) were manufactured and further optimized by adjusting ALA physical characteristics and the excipients quantities (#3 and #4) in order to achieve the Quality Target Product Profile. A misshapen of ALA’s in vitro release was observed for #3 Formula (f2 = 31.6); the optimal profile was obtained for Formula #4 (f2 = 58.5). A simple quantitative formula is not enough to assure good ALA bioavailability; the formulation needs multiple compounding modulations under physicochemical compatibility algorithms, with multiple dissolution profiles testing back-ups. It is essential to ensure a formulation with an in vitro dissolution comparable with the RLD, allowing the compound to reach its target level to assure the optimum claimed antioxidant activity of ALA at the cellular level, even for food supplement formulations.
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MORPHOLOGICAL FEATURES OF ESTROGEN AND PROGESTERONE EXPRESSION LEVELS IN ECTOPIC ENDOMETRIUM IN WOMEN WITH ENDOMETRIAL CYSTS. WORLD OF MEDICINE AND BIOLOGY 2021. [DOI: 10.26724/2079-8334-2021-4-78-141-145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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