Endometriosis

Correlation between lipid metabolism and endometriosis: a meta-analysis

To analyze and evaluate the correlation between different lipid metabolism levels and endometriosis. The literatures on lipid metabolism and endometriosis published in databases were searched and collected. The search was conducted up to December 2023. The meta-analysis was conducted using Review Manager 5.4.1 software, with odds ratios (ORs) or standardized mean difference (SMD), confidence intervals (CIs), and heterogeneity (I2) being calculated. The literature bias was evaluated by drawing funnel plot. Five hundred and eighty-four literatures were retrieved, and finally, 7 literatures were included in this study. Meta-analysis showed that the level of total cholesterol (TC) in endometriosis groups was higher than control group [SMD = 1.70, 95%CI (0.60-2.80), p = 0.003], while triglyceride (TG) [SMD=-0.24, 95%CI (-0.68-0.21), p = 0.300], low-density lipoprotein (LDL) [SMD = 0.22, 95%CI (-0.34 - 0.78), p = 0.440] and high-density lipoprotein (HDL) [SMD = 0.06, 95%CI (-0.14 - 0.25), p = 0.550] was not statistically significant. Sensitivity analysis indicated that the combined effect size results were stable and reliable [SMD = 1.70, 95%CI (0.60-2.80), p = 0.030]. Funnel plot results showed publication bias. Patients with endometriosis have abnormal blood lipid level, and higher TC level may be a risk factor for endometriosis. The impact of blood lipid metabolism on endometriosis may provide new insights into the pathogenesis and treatment prognosis of endometriosis.

Virtual reality-based pain control in endometriosis: a questionnaire-based pilot study of applications for relaxation and physical activity

PURPOSE

Virtual reality (VR) based technology may offer new avenues in the management of chronic endometriosis-related pain. Our prospective, 14-week, open, three-phase, cross-over pilot study investigated whether the use of VR technology equipped with a relaxation-inducing application (VR-R) or an activity-stimulating application (VR-A) could change endometriosis-related chronic pelvic pain levels and impairment of daily life.

METHODS

23 women aged 32.7 (SD 8.2) with endometriosis-related pelvic pain were each assigned to a permutated sequence of three 4-week phases: (A) the VR-R, (B) VR-A, and (C) intervention-free control phases. Phases were separated by two interspersed 1-week washout phases. Main outcome measures included: momentary, average, and maximum pain intensities on a 0-10 numerical rating scale (NRS); the Pain Disability Index (PDI) score; the Pain Catastrophizing Scale (PCS) score; sleep quality (Medical Outcomes Study Sleep Scale (MOS-SS) score); the Depression Anxiety Stress Scales (DASS) score; and the general health-related quality-of-life score (Short Form (12) Health Survey (SF-12)).

RESULTS

Compared to baseline, VR-R use showed statistically significant positive effects for several scores (NRS "average pain"; PDI "total score"; PCS "total score" and the "magnification", "rumination", and "helplessness" subscores; MOSS-SS "index I and II"; and the DASS "depression" and "stress" subscores), whereas VR-A yielded significant positive changes only for PDI "total score"; PCS "total score" and the "helplessness" and "magnification" subscores; MOSS-SS "index II"; and DASS "depression" and "stress". As four scale scores also showed significant improvements for control, a comparison of the effects was performed to offset a potential placebo-like effect by comparing difference from baseline against control. This analysis yielded significantly greater positive effects only for VR-R: PCS "total score" and "helplessness"; MOSS-SS "index I" and "index II"; and the three DASS subscores "depression", "anxiety", and "stress". SF-12 showed no significant changes in either analysis.

CONCLUSIONS

VR-R and VR-A showed positive effects on several pain and quality-of-life scores, which were significant for some scores compared to baseline. For VR-R, some of these improvements were indeed significantly greater than under control conditions, while the effects with VR-A were not. Larger studies are needed to corroborate these findings.

TRIAL REGISTRATION

DRKS00030189.

Quinagolide vaginal ring for reduction of endometriotic lesions: Results from the QLARITY trial

BACKGROUND

This study evaluated the effectiveness of quinagolide vaginal ring on reducing total lesion size in endometrioma, deep infiltrating endometriosis (DIE), and adenomyosis, as assessed using high-resolution MRI and imaging biomarkers.

METHODS

QLARITY was a randomized, double-blind, placebo-controlled, phase 2 trial. Patients aged 18-45 years with endometrioma, DIE, and/or adenomyosis were randomized to quinagolide or placebo and monitored for four menstrual cycles. The primary endpoint was reduction in total lesion size. Secondary endpoints were pain reduction, changes in prolactin, changes in menstrual cycle, bleeding patterns, and safety. Exploratory analyses identified MRI-derived perfusion and diffusion-weighted imaging biomarkers.

RESULTS

Of the 67 included subjects, 35 received quinagolide vaginal ring and 32 received placebo. No significant differences were noted between groups for the primary endpoint of reduction in lesion size. No significant differences were observed between groups in terms of patient-reported outcomes, serum prolactin levels, menstrual bleeding patterns, or adverse events. Exploratory analyses suggested lesions in the placebo group showed a greater increase in vascular permeability and worsening lesion structure.

CONCLUSIONS

Our primary analysis showed no significant difference between treatment groups in terms of change in total lesion size. Many patients in this study presented with advanced disease, which may be less responsive to quinagolide than highly vascularized superficial lesions, as quinagolide inhibits the VEGF signaling pathway.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03749109.

The influence of genetics on the endocannabinoid system gene expression and relevance for targeting reproductive conditions

BACKGROUND

Endocannabinoids are small lipid molecules that have critical roles in cellular proliferation and function. They are produced locally with their concentrations controlled via the endocannabinoid system (ECS). The important cellular functions of endocannabinoids have made them and the proteins that modulate their expression targets of potential interest for treatment in many different diseases including gynaecological conditions. There is significant evidence of heredity differences in the response to both exogenous and endogenous cannabinoids that hampers the identification of effective targets. Whether compounds targeting endocannabinoids will be effective therefore may rely on personal differences mediated through genetic architecture. To investigate the source of individual differences, we investigated the effects of genetic variants on the expression of the endocannabinoid system genes at both a systemic and individual tissue level with a particular focus on the female reproductive system and the endometrium.

METHODS

We performed this analysis using publicly available datasets, including the 31,684 participants from the eQTLGen database and 838 donors to the GTEx database which includes 49 different sources of tissue, as well as an in-house database of 206 endometrial samples. Analysis of the eQTLGen data identified 22,020 eQTLs that influenced 43 of the selected 70 ECS genes.

RESULTS

A comparison across 49 different tissues that included at least 70 different individuals in the GTEx dataset identified eQTL for 69 of the 70 different genes, confirming a tissue-specific influence. Comparisons among 11 different physiological system indicated that the female reproductive system was associated with a fewer number of eQTLs. Finally, in the endometrium, we detected Bonferroni significant genetic effects on one individual gene fatty acid binding protein 3 (FABP3), an intracellular transporter that delivers endocannabinoids to the enzyme responsible for its inactivation, with a further 14 independent FDR significant eQTL for 13 ECS genes.

CONCLUSIONS

This is the first study to investigate the effects of genetic variants on the ECS gene transcription and indicates genetic variants have significant influence that are unique to each tissue. Our results highlight the effect of individual variation and the impact endocannabinoid based therapies may have on different tissue and physiological systems.

ESUR consensus MRI for endometriosis: protocol, lexicon, and compartment-based analysis

OBJECTIVE

To propose an update of ESUR endometriosis guidelines to reflect advances in MRI protocol and lexicon.

METHODS

A literature search was followed by a DELPHI process among 20 experts.

RESULTS

Pre-imaging preparation, including fasting, antiperistaltic agents, moderate bladder filling, and bowel preparation, is recommended. A comprehensive magnetic resonance imaging (MRI) protocol should include multiplanar T2W, T1W, and sequences covering the kidneys. Superficial endometriosis should be described on T1WFS as high signal intensity foci on the peritoneal surface. Endometriomas should be described in terms of multiplicity, signal intensity, central or peripheral location, and bilaterality. MRI evaluation of deep pelvic endometriosis (DE) should be performed by dividing the pelvis into compartments using two horizontal and vertical lines. A bladder nodule should be described according to location, size, and the distance to the ureteric orifice provided. A uterosacral ligament must be considered abnormal if a nodule or spiculation is visible in at least two planes or if a bright T1W spot is detected. A posterior vaginal wall nodule should be measured. External adenomyosis should be described according to location and size. The description of a rectosigmoid nodule includes location, number of nodules, longitudinal extent, distance to the anal verge, and wall thickening. The lateral compartment includes the anterior distal round ligament, the mediolateral and posterolateral parametrium. Abdominal wall nodules, ileocaecal junction, appendiceal nodules, and sigmoid nodules, must be systematically described.

CONCLUSION

A standardized MRI protocol and lexicon based on compartmental analysis are crucial for improving communication and management of patients referred with endometriosis.

KEY POINTS

Question ESUR's endometriosis guidelines were last published in 2017; an update is provided to reflect advances in MRI techniques and the need for a standardized lexicon. Findings MRI protocol must include multiplanar T2W sequences, a T1W sequence, and a kidney visualization sequence. A standardized report based on a compartmental analysis is recommended. Clinical relevance Using a standard MRI protocol with compartmental analysis of endometriotic nodule locations and adopting a standardized vocabulary is crucial for comprehensive mapping and effective communication with both the patient and the surgeon.

Causal association of cathepsins and endometriosis: A Mendelian randomization study

Endometriosis is a prevalent reproductive disorder that affects a significant number of women globally. Cathepsins, which are lysosomal cysteine proteases, contribute to several physiological and pathological processes, including the attachment and invasion of endometrial tissue. Nevertheless, the causal relationship between cathepsins and endometriosis remains undetermined. The aim of this study was to explore the potential relationship between cathepsins and endometriosis using genetic polymorphisms. We employed a 2-sample Mendelian randomization (MR) analysis (including inverse-variance weighted [IVW] method and reverse MR analysis) to investigate the causal association between 9 cathepsins and endometriosis. The IVW method provides efficient and robust causal estimates when genetic instruments are valid, making it the standard approach in MR analysis. And the reverse MR analysis ensures the robustness and directionality of causal inference. The univariable MR analysis results indicate that Cathepsin H increases the risk of overall endometriosis (IVW: OR [95%] = 1.037 [1.007 to 1.067], P = .013), endometriosis of ovary (IVW: OR [95%] = 1.022 [1.001 to 1.042], P = .046), endometriosis of pelvic peritoneum OR [95%] = 1.046 [1.002 to 1.089], P = .047), and deep endometriosis (IVW: OR [95%] = 1.050 [1.002 to 1.099], P = .048). The multivariable MR analysis retained stable after adjusting for other types of cathepsins. And reverse MR analyses suggest that overall endometriosis may lead to increased Cathepsin H levels (IVW: OR [95%] = 1.017 [1.003, 1.073], P = .041). The results of the sensitivity analyses were consistent with the main findings. Our MR analysis yields robust evidence supporting a causal relationship between Cathepsin H and the susceptibility to endometriosis, potentially inspiring directions in endometriosis diagnosis and treatment.

Pharmacologic Interventions for Endometriosis-Related Pain: A Systematic Review and Meta-analysis

OBJECTIVE

To evaluate the effectiveness of various medications for the treatment of endometriosis-related pain through a network meta-analysis.

DATA SOURCES

A comprehensive search was conducted in PubMed, Embase, Web of Science, and the Cochrane Controlled Trials Register until July 22, 2024. We also searched ClinicalTrials.gov for additional data on recently completed trials or potentially eligible randomized controlled trials (RCTs) but found nothing.

METHODS OF STUDY SELECTION

The analysis included randomized RCTs that used pharmacologic interventions for managing endometriosis-related pain. The primary efficacy outcome was endometriosis-associated pelvic pain, which included dysmenorrhea, dyspareunia, and nonmenstrual pelvic pain. The analysis adhered to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines.

TABULATION, INTEGRATION, AND RESULTS

A total of 31 RCTs involving 8,665 patients were included in the analysis. In terms of endometriosis-associated pelvic pain, four interventions demonstrated significantly greater efficacy compared with placebo: leuprolide combined with combined oral contraceptive pills (OCPs) (standardized mean difference [SMD] -1.40, 95% CI, -2.41 to -0.38), dienogest (SMD -1.20, 95% CI, -1.78 to -0.61), leuprolide alone (SMD -1.05, 95% CI, -1.64 to -0.45), and combined OCP (SMD -0.67, 95% CI, -1.25 to -0.09). Leuprolide combined with combined OCP emerged as the most effective treatment modality. In addition, elagolix and the combination of vitamin C and vitamin E were identified as the most effective interventions for dysmenorrhea and dyspareunia. For nonmenstrual pelvic pain, gestrinone demonstrated superior efficacy compared with placebo and all other interventions.

CONCLUSION

This network meta-analysis indicates that leuprolide in combination with combined OCP, elagolix, vitamins C and E, and gestrinone may represent the most effective therapeutic options for alleviating endometriosis-associated pelvic pain, dysmenorrhea, dyspareunia, and nonmenstrual pelvic pain. These findings enhance our understanding of the relative efficacy of treatment strategies for pain associated with endometriosis. Future research should focus on conducting larger-scale and rigorously designed clinical trials within the target patient populations to further validate these results.

Spontaneous Endometrioma Rupture: A Retrospective Pilot Study and Literature Review of a Rare and Challenging Condition

Background/Objectives: Endometriosis can present as ovarian endometriosis in 15-25% of the cases. While chronic pelvic pain and dysmenorrhea dominate its clinical presentation, acute complications, such as spontaneous OMA rupture, are rare (<3%), often mimicking acute abdominal pain and necessitating emergency surgery. Diagnostic delays persist due to the condition's rarity and overlapping symptoms with ovarian torsion or appendicitis. This study investigates the clinical features of ruptured OMAs to enhance preoperative suspicion and optimize management. Methods: From February 2011 to August 2023, 14 patients with spontaneous rupture of histologically confirmed endometriomas underwent emergency laparoscopy for acute abdominal pain in the University Hospital of Bern, Switzerland. The clinical data of these patients were analyzed to find common patterns of spontaneous endometrioma ruptures. We also conducted a literature search in PubMed, Scopus, ScienceDirect, Cochrane, and Embase databases from inception to December 2023 in order to identify other possible confounding factors. The search was based on the keywords "ruptured endometrioma". All English full-text prospective and retrospective observational and interventional studies with at least five patients that described the clinical features and findings of women diagnosed with ruptured endometrioma and treated surgically were included. Results: The median age at operation was 37.4 (23-49) years old, and all cases presented with acute abdominal pain, with/without peritonitis. Only 3/14 patients presented with fever, while the most common laboratory finding was an elevated CRP level of 45.6 mg/L (3-100 mg/L), while leukocytosis was less pronounced, with a median of 12.2 G/L (6.04-21.4 G/L). Notably, 64.3% (9 out of 14) of the patients reported experiencing dysmenorrhea, while for the remaining 5 individuals, the presence or absence of dysmenorrhea could not be obtained. Interestingly, only one patient had undergone hormonal treatment, with a combined oral contraceptive (COC) of Ethinylestradiol (0.02 mg) and Desogestrel (0.15 mg), while the other patients either lacked awareness of their endometriosis or expressed reluctance towards hormonal downregulation therapy. The median endometrioma size was 7 cm (3.5-18 cm), and 78.57% of the cases (11 out of 14 patients) had only ovarian endometriosis, while only 3 patients had involvement of compartment A, B, or C according to the # ENZIAN classification. Conclusions: Though rare, spontaneous OMA rupture should be considered in acute abdomen cases, especially with cysts > 5 cm. Hormonal therapy may reduce rupture risk, but more research is needed to confirm this and refine diagnostic strategies.

Association of air pollution and green space with endometriosis among women undergoing assisted reproductive technology: a cross-sectional study in Anhui, China

Air pollution has reproductive toxicity, while green space could lessen such harmful consequences. However, the current research on the link between air pollution/green space, and endometriosis remains scarce. Therefore, we investigated the separate and interactive relationships between air pollution, green space and endometriosis-related infertility. We collected data on 20,981 women from a large assisted reproductive center in Anhui, China, of whom 1,201 were diagnosed with endometriosis-related infertility. air pollution (PM2.5, PM10, NO2, CO, and SO2) and Green space (quantified using the normalized difference vegetation index [NDVI]) were evaluated using spatiotemporal models developed from satellite data. We employed multivariable logistic regression to calculate adjusted odds ratios (aOR) with 95% confidence intervals (CI). Per interquartile range (IQR) increase in exposure was associated with elevated odds of endometriosis prevalence for PM2.5 (aOR = 1.20, 95%CI:1.11-1.30), PM10 (1.17, 1.08-1.27), SO2 (1.12, 1.02-1.24), NO2 (1.18, 1.08-1.38), and CO (1.12, 1.05-1.19). Conversely, each IQR increase in NDVI500 m showed protective effects (0.72, 0.63-0.83). Notably, an additive antagonistic effect was observed between NDVI500 m and CO. Our findings indicated that air pollution could potentially increase the risk of endometriosis, while green space is its protective factor. Besides, green space might attenuate the negative impact of air pollution on endometriosis.

Pilot study MOVENDOP protocol - impact on quality of life following postoperative osteopathic abdominal mobilizations in patients operated for endometriosis

BACKGROUND

Surgery remains the gold standard for management of endometriosis, offering significant improvement in patient pelvic pain and quality of life (QoL). Postoperative tissue adhesions can however diminish these benefits, limiting the long-term effectiveness of the intervention. Despite the development of strategies and devices to reduce adhesion formation, their efficacy remains inconclusive.

OBJECTIVE

This study aims to propose and evaluate a novel approach involving early visceral mobilization and training of patients in abdominal self-mobilization as a means to improve QoL following surgery.

METHODS

This pilot study is a prospective, randomized, phase II superiority trial. Patients undergoing surgery for infiltrating endometriosis will be randomized, with a 2:1 ratio, into two groups. The intervention group (n = 42) will receive six sessions of osteopathic visceral mobilization with training in abdominal self-mobilization techniques, one preoperative, and five postoperative during the first month post-surgery. The control group (n = 21) will receive no osteopathic visceral mobilizations but will be offered an osteopathic session after one year. The primary endpoint is a minimum increase of 20 points (on a 100-point scale) in the Endometriosis Health Profile-30 (EHP-30) global score, at one year. Secondary endpoints include assessment of gastrointestinal quality of life (GIQLI), sexual function (FSFI), urinary symptoms (ICIQ-FLUTS), pain catastrophizing (PCS), as well as scar examination, pelvic pain, abdominal flexibility, use of medical and non-medical care, analgesic and hormonal treatments, pregnancy rate, physical activity, sedentary lifestyle and patient compliance. Statistical analyses will be based on a one-sided α=0.05 and β=0.15, assuming a standard deviation of 25 points in the EHP-30 global score. A total of 42 participants in the intervention group and 21 in the control group are required.

DISCUSSION

This trial aims to demonstrate that early and repeated osteopathic sessions following surgery for endometriosis may significantly improve patient QoL.

Impaired gastric and urinary but preserved cardiac interoception in women with endometriosis

Endometriosis is a chronic inflammatory gynaecological condition frequently associated with chronic pelvic pain. Visceral hypersensitivity could be present, like in other chronic pain conditions, causing altered levels of interoception. So far, studies have explored interoceptive deficits in chronic pain individuals mainly using questionnaires or cardiac interoceptive accuracy tasks. Here, we explore the cardiac, gastric, and urinary domains to probe interoceptive differences between patients with endometriosis and healthy women. 30 patients and 30 controls underwent three interoceptive tasks for assessing the cardiac domain (using the Heartbeat Counting Task, HCT), the gastric domain (using the Water Load Test-II, WLT-II) and the bladder domain (using a novel Urinary Interoceptive Task, UIT). Participants also completed bladder interoceptive beliefs measures and subjective pain ratings for each endometriosis symptom (dysmenorrhea, dyspareunia, dyschezia, chronic pain). A positive correlation between the WLT-II and the UIT emerged in all participants (R = 0.47, p < 0.001), indicating that the lower the gastric interoceptive abilities, the lower the urinary ones. Moreover, compared to healthy controls, women with endometriosis exhibited lower scores in the WLT-II (t(58) = 4.6814, p < 0.001) and the UIT (t(39.931)= 5.1462, p < 0.001), as well as higher scores in the subjective bladder beliefs questions (t(57.346)= -4.0304, p < 0.001). Results indicate a dissociation between patients' poor objective performance on interoceptive tasks and their high bladder interoceptive beliefs. UIT scores were associated with pain symptoms, suggesting that patients, probably due to sensitisation, struggle to ignore discomfort sensations, resulting in reduced accuracy in detecting physiological signals coming from the pelvic area.

Adoptive transfer of regulatory T cells inhibits the progression of endometriosis-like lesions in regulatory T-cell-depleted mice

STUDY QUESTION

Does the restoration of regulatory T cells (Tregs) suppress the progression of endometriosis?

SUMMARY ANSWER

Adoptive transfer of Tregs suppresses the progression of endometriosis and reduces the levels of helper T (Th)-cell-related and proinflammatory cytokines in mice.

WHAT IS KNOWN ALREADY

Endometriosis is a chronic inflammatory gynecological disease, which involves multiple immune components. Activated Treg counts decrease in the endometrioma and endometrium of patients with endometriosis, and depletion of Tregs exacerbates endometriosis in mice.

STUDY DESIGN, SIZE, DURATION

We evaluated the effects of adoptive transfer of Tregs on the progression of endometriosis in mice. We used Foxp3tm3Ayr/J (Foxp3DTR) mice with temporarily ablated Tregs by injecting diphtheria toxin to develop an endometriosis model, which was generated by ovariectomy, estradiol administration and transplantation of uterine fragments from donor mice. Foxp3DTR mice were randomly divided into Treg adoptive transfer (n = 12) and control (n = 11) groups. Tregs were isolated from lymph nodes and spleens of wild-type (WT) mice and were adoptively transferred into mice that were temporarily Treg-depleted. Control mice were injected with vehicle. Treg adoptive transfer was performed on the day of uterine implantation, and a second adoptive transfer was performed after 14 days. Mice were euthanized 28 days after uterine implantation, and blood, peritoneal fluid, spleen, and endometriosis-like lesion samples were collected.

PARTICIPANTS/MATERIALS, SETTING, METHODS

Foxp3DTR mice were intravenously injected with Tregs isolated from WT mice. The number, total weight, and total volume of the endometriosis-like lesions were evaluated on Day 28 following implantation of uterine fragments. The proportion of Tregs in endometriosis-like lesions, ascites, and peripheral blood was analyzed by flow cytometry. Inflammation in lesions and serum was examined using real-time PCR and ELISA.

MAIN RESULTS AND THE ROLE OF CHANCE

Injection of Tregs increased their total count and decreased the number (P < 0.0001), weight (P = 0.0021), and volume (P = 0.0010) of endometriosis-like lesions in Foxp3DTR Treg-depleted mice. Furthermore, injection of Tregs decreased the mRNA expression of Th 1-, 2-, and 17-related cytokines, including interferon gamma (P = 0.0101), interleukin (IL)-4 (P = 0.0051), and IL-17 (P = 0.0177), as well as the levels of the proinflammatory cytokine IL-6 (P = 0.0002), in endometriosis-like lesions of Foxp3DTR Treg-depleted mice.

LARGE SCALE DATA

N/A.

LIMITATIONS, REASONS FOR CAUTION

Treg-related immune mechanisms in mice may not precisely reflect those in humans.

WIDER IMPLICATIONS OF THE FINDINGS

Restoration of Tregs may be a useful therapeutic strategy for inhibiting the progression of endometriosis in cases where the decrease in the Treg population is an exacerbating factor.

STUDY FUNDING/COMPETING INTEREST(S)

This study was partially supported by the Grants-in-Aid for Scientific Research (grant numbers 18K16808 and 20K22983) from the Ministry of Education, Culture, Sports, Science, and Technology, Japan. The sponsor had no role in the study design, collection, analysis and interpretation of data, writing of the report, and decision to submit the article for publication. The authors have no conflicts of interest to disclose.

Eating for Optimization: Unraveling the Dietary Patterns and Nutritional Strategies in Endometriosis Management

Endometriosis is a chronic gynecological disorder affecting millions of women worldwide, causing chronic pelvic pain, dyspareunia, dysmenorrhea, and infertility, and severely impacting their quality of life. Treatment primarily involves hormonal therapies and surgical excision, but high recurrence rates and the economic burden are substantial. With these challenges, significant discussion surrounds the potential role of dietary patterns in managing endometriosis, making it necessary to bridge this critical gap. This review investigates the current scientific evidence on the dietary patterns (eg, Mediterranean, vegetarian, anti-inflammatory, low-fermentable oligosaccharides, disaccharides, monosaccharides, and polyols [low-FODMAP], and Western-style diets) associated with endometriosis and provides a concise, yet thorough, overview on the subject. In addition, antioxidants, microbiota, and artificial intelligence (AI) and their potential roles were also evaluated as future directions. An electronic-based search was performed in MEDLINE, Embase, Cochrane Library, CINAHL, ClinicalTrials.gov, Scopus, and Web of Science. The current data on the topic indicate that a diet based on the Mediterranean and anti-inflammatory diet pattern, rich in dietary fiber, omega-3 fatty acids, plant-based protein, and vitamins and minerals, has a positive influence on endometriosis, yielding a promising improvement in patient symptoms. Preclinical investigations and clinical trials indicate that dietary antioxidants and gut microbiota modulation present potential new approaches in managing endometriosis. Also, AI may offer a promising avenue to explore how dietary components interact with endometriosis. Ultimately, considering genetic and lifestyle factors, a healthy, balanced, personalized approach to diet may offer valuable insights on the role of diet as a means of symptom improvement, facilitating the utilization of nutrition for the management of endometriosis.

Epigenetic regulation in oogenesis and fetal development: insights into m6A modifications

The unique physiological structure of women has led to a variety of diseases that have attracted the attention of many people in recent years. Disturbances in the reproductive system microenvironment lead to the progression of various female tumours and pregnancy disorders. Numerous studies have shown that epigenetic modifications crucially influence both oogenesis and foetal development. m6A, a modification at the mRNA level, consists of three parts, namely, writers, erasers, and readers, which are involved in several biological functions, such as the nucleation and stabilisation of mRNAs, thereby regulating the development of reproductive system diseases. In this manuscript, we delineate the constituents of m6A, their biological roles, and advancements in understanding m6A within the maternal-foetal immunological context. In addition, we summarise the mechanism of m6A in gynaecological diseases and provide a new perspective for targeting m6A to delay the progression of reproductive system diseases in clinical practice.

Is it resistant? A case report of splenic endometriosis and review of the literature

Endometriosis is an estrogen-dependent benign disease that generally affects women at childbearing age. Despite its high incidence, pathogenesis of endometriosis is poorly clarified. There are several theories explaining the mechanism of disease such as retrograde menstruation, coelomic metaplasia, vascular and lymphatic metastasis. While endometriosis has been described in many intra- and extra-abdominal organs including the ovaries, omentum, colon, liver, lungs and brain, parenchymal splenic endometriosis is a rare situation. In recent years, with reported cases, this rare condition came onto the scene. We also wanted to present our case and question the idea of splenic immunity against endometriosis according to current literature. From now on, splenic endometriosis can be thought of as a differential diagnosis for unidentified lesions of spleen.

Vitamin D for primary dysmenorrhea and endometriosis-related pain - A systematic review of registered RCTs

OBJECTIVE

This systematic review investigates the potential role of vitamin D supplement in alleviating pain associated with primary dysmenorrhea or endometriosis by analysing registered randomised controlled trials (RCTs).

METHODS

We comprehensively searched the WHO International Clinical Trials Registry Platform to identify registered RCTs that assessed the effects of vitamin D supplement on pain outcomes in people with primary dysmenorrhea or endometriosis. The primary outcomes of interest were pain severity/intensity, pain duration, pain medication usage and pain-related outcome measurements.

RESULTS

Seven registered RCTs were included in this systematic review. These RCTs had diverse doses and treatment durations of vitamin D supplement used as intervention. They also had either high or some concerns of risk of bias, according to Cochrane risk of bias version 2 assessment. Substantial heterogeneities were generally observed across the seven RCTs. When measured using a validated tool visual analogue scale (VAS), pain severity was significantly lower at the end of treatment when compared with placebo (mean difference MD -1.12, 95% confidence interval [-2.16, -0.07], I2=81%, 5 studies, n = 308). This significant difference was observed in the primary dysmenorrhea RCTs, but not the endometriosis RCTs.

CONCLUSION

This systematic review identified vitamin D may reduce pain associated with primary dysmenorrhea, though a low certainty of evidence was available. Future studies that use standardised doses and treatment duration in accordance with the latest clinical practice guidelines are needed to explore any potential benefits vitamin D may have for people with these conditions.

Methylation Risk Score Modelling in Endometriosis: Evidence for Non-Genetic DNA Methylation Effects in a Case-Control Study

Endometriosis is a chronic gynaecological disease characterised by endometrial-like tissue found external to the uterus. While several studies have reported strong evidence of a genetic contribution to the disease, studies on the environmental impact on endometriosis are limited. DNA methylation (DNAm) can be influenced by genetic and environmental factors and serves as a useful biological marker of the effects of genetic and environmental exposures on complex diseases. This study aims to develop a methylation risk score (MRS) for endometriosis to increase the power to detect DNAm signals associated with the disease and enhance our understanding of the pathogenesis of the disease. Endometrial methylation and genotype data from 318 controls and 590 cases were analysed. MRSs were developed using several different models. MRS performances were evaluated by splitting samples into training and test sets based on independent cohort institutions, and the area under the receiver-operator curve (AUC) was calculated. The maximum AUC obtained from the best-performing MRS is 0.6748, derived from 746 DNAm sites. The classification performance of MRS and polygenic risk score (PRS) combined was consistently higher than PRS alone. This study demonstrates that there are DNAm signals independent of common genetic variants associated with endometriosis.

A Correlation Between Migraine and Endometriosis and Its Clinical Implications-A Systematic Literature Review

Background/Objectives: Migraine and endometriosis are two diseases that are associated with women. Endometriosis is a condition exclusively affecting the female population as it affects the female genital tract, while migraine is a primary headache disorder having the highest prevalence in women of reproductive age. Although, undoubtedly, they are two distinct disorders, some correlations have been suggested considering the epidemiological similarities. Methods: This systematic review aimed to analyze the putative links between those two diseases. Two databases were searched in accordance with the PRISMA guidelines, which led to the inclusion of 28 of the most appropriate studies. The review was registered in PROSPERO. Results: A comprehensive analysis of the existing literature allowed us to distinguish six different aspects: (i) the prevalence of migraine in the course of endometriosis, in general, (ii) when comparing endometriosis patients to healthy individuals, (iii) the relation between different migraine types and endometriosis, (iv) pain symptoms in patients with endometriosis and migraine, and finally, (v) molecular and (vi) genetic bases of the suspected correlation. Conclusions: Although not all results are definitely apparent, the results showed a higher prevalence of endometriosis and migraine together than both diseases separately. More precisely, chronic migraine was demonstrated to be the most possibly linked to endometriosis. Moreover, pain symptoms were usually more evident in patients suffering from both diseases at the time. Finally, some suggestions were presented due to this comorbidity's molecular and genetic bases; however, the literature, especially on this topic, is lacking.

A Study on the Quality of Patient-Centred Endometriosis Mobile Applications: Analysis and Future Prospects

Introduction: Female technology or 'femtech' is the availability of mobile applications (apps) to monitor specific aspects of women's health. It touts the benefits of technology to empower women with regards to their health, while also allowing close collaboration between patients and physicians. Endometriosis-specific apps is a channel by which female patients discover their endometriosis diagnosis. However, there is currently a paucity of high-quality and evidence-based endometriosis apps. This study assessed the current state and overall quality of such apps. Materials and Methods: This retrospective study assessed patient-centred endometriosis apps on the Apple iTunes Store, in January 2023, excluding certain categories such as conference guidance, gaming, private healthcare, and clinical trial apps. The key term "endometriosis" was used. All patient-centred apps were included. The apps were assessed using the APPLICATIONS scoring system, considering objective factors like pricing, subscriptions, literature references, in-app purchases, connectivity, advertisements, search fields, interoperability, and subjective elements such as navigation ease and presentation. The maximum score is 16 and all applications were assessed in English. Results: Out of the initial 22 apps, 12 (54.5%) were excluded, leaving 10 (45.5%) for analysis. Most apps lacked comprehensiveness, but two apps (LUNA-endometriosis and Frendo) stood out with high scores. These apps incorporated certified scoring systems, provided recommendations for tests and follow-up visits, and offered evidence-based literature on endometriosis. The remaining apps scored poorly, focusing on alternative treatments, healthy diets, or functioning solely as symptom diaries, with limited information on diagnosis and management. Only a few apps allowed booking follow-up visits, and most lacked the capability to export patient-specific data. Few apps measured the likelihood of endometriosis whilst others relied on previous diagnoses. The majority of apps were free, whilst in-app purchases centred around alternative treatments. Overall, the apps were user-friendly, featuring vibrant colours and intuitive interfaces. Conclusions: Only two patient-centred endometriosis apps scored highly in the APPLICATIONS scoring system as they were high-quality, evidence-based and incorporated valid medical recommendations. Other applications scored low as their recommendations lacked quality scientific evidence.

Phosphatase and tensin homolog deficiency induces M2 macrophage polarization by promoting glycolytic activity in endometrial stromal cells

Endometriosis is a common gynecological disorder, whose pathogenesis remains incompletely understood. Macrophages, a key type of immune cell, are pivotal in the context of endometriosis. This study seeks to explore the interactions between endometriotic cells and macrophages. Quantitative real-time PCR (qRT-PCR) and Western blot experiments were employed to detect phosphatase and tensin homolog (PTEN) expression. Glucose consumption, lactate production, extracellular acidification rate, and oxygen consumption rate levels were used to assess cellular glycolytic capacity. The interaction between conditioned media from ectopic endometrial stromal cells (EESCs) and macrophages was investigated through co-culture experiments. The expression of M2 macrophage marker proteins and inflammatory factors was detected via qRT-PCR, immunofluorescence staining, and enzyme-linked immunosorbent assay. Cellular functions were evaluated using Cell Counting Kit-8, 5-Ethynyl-2'-deoxyuridine (EdU), and wound healing assays. We found that PTEN deficiency promoted the glycolytic activity of EESCs. Simultaneously, it significantly promoted the macrophages' polarization toward the M2 phenotype, demonstrated by increased expression of M2 markers (differentiation 206 (CD206), CD163, and (C-C motif) ligand 22 (CCL22)). Further studies revealed that PTEN-deficient EESCs increased the level of CCL2 via promoting glycolytic activity, which was reversed by glycolytic inhibitor. Moreover, lactate and conditioned media from overexpressed CCL2 EESCs facilitated M2 polarization of macrophages, while 2-deoxy-d-glucose reversed the promoting effect. Furthermore, lactate-facilitated macrophages promoted the proliferation and migration abilities of EESCs. PTEN deficiency induces M2 macrophage polarization by promoting glycolytic activity in EESCs, which deepens the knowledge of the pathophysiology of endometriosis and provides novel insights into its treatment.

Hua Yu Xiao Zheng decoction induces ectopic endometrial stromal cell senescence via inhibiting the PI3K/AKT signaling

BACKGROUND

Our purpose is to explore the influence of Hua Yu Xiao Zheng (HYXZ) decoction on the senescence of ectopic endometrial stromal cells (ESCs) in endometriosis as well as its relevant mechanisms.

METHODS

The proliferation, apoptosis, migration, and invasion of primary ectopic ESCs was assessed utilizing EdU assay, flow cytometry, and transwell assays. Moreover, the effects of HYXZ decoction on oxidative stress were evaluated using DCFH-DA probe and via measuring MDA, GSH, SOD and GPx levels. The function of HYXZ decoction on cell senescence were explored through utilizing SA-β-gal staining and measuring the cumulative population doubling level and the average telomere length. The protein expression was measured using western blotting analysis. Endometriosis in rats was surgically induced, and the efficacy and mechanism of HYXZ decoction were determined in vivo.

RESULTS

HYXZ decoction inhibited the growth, migration, and invasion of ectopic ESCs, but induced oxidative stress and senescence. HYXZ decoction inhibited PI3K/AKT signaling in ectopic ESCs. PI3K-AKT signaling pathway activator (740Y-P) significantly reversed the inhibitory effects of HYXZ decoction on ectopic ESCs. In rats with endometriosis, oral administration of HYXZ decoction inhibited lesion volume alone with the increased oxidative stress and cell senescence, as well as the decreased PI3K/AKT activity.

CONCLUSION

HYXZ decoction might repress the growth and migration of ectopic ESCs, and induce oxidative stress and senescence through suppressing PI3K/AKT signaling. This finding indicates that HYXZ decoction may be a potential therapeutic drug against endometriosis.

A case report of intestinal intussusception secondary to endometriosis of the last ileal loop

INTRODUCTION AND IMPORTANCE

Acute intestinal intussusception secondary to intestinal endometriosis is a rare entity, but it can be life-threatening. Improving diagnostic and therapeutic investigations through multidisciplinary collaboration improves its management and prognosis.

CASE PRESENTATION

Reporting the clinical case of a 37-year-old patient admitted for treatment of intestinal intussusception secondary to intestinal endometriosis. She underwent a resection of the invaginated segment without disinvagination and a manual end-to-end ileo-ileal anastomosis. Pathological examination concluded that there was intestinal endometriosis with simple surgical suites.

CLINICAL DISCUSSION

Several studies have addressed the subject of intestinal intussusception secondary to intestinal endometriosis. However, the studies are mainly case reports. It is certainly rare, but potentially serious, and all studies converge on the importance of diagnosis and rapid multidisciplinary care.

CONCLUSIONS

Due to its rarity and the non-specificity of its symptoms, digestive endometriosis is poorly understood and is often diagnosed late. Intussusception secondary to endometriosis is rare and generally requires surgery.

Association between the composite dietary antioxidant index and risk of endometriosis in women: a national population-based study

Background

Composite dietary antioxidant index (CDAI) has been found protective to women's health. However, the association between CDAI level and the risk of endometriosis in women is unclear.

Methods

A total of 4,153 women from the National Health and Nutrition Examination Survey (NHANES) 2001-2006 were included in this cross-sectional study. We evaluated the association between CDAI level and the risk of endometriosis using three logistic regression models and restricted cubic spline. Stratified and sensitivity analyses were also performed.

Results

Logistic regression analysis found that CDAI level was inversely associated with the development of endometriosis. The associated odds ratio (OR) for each SD increase in CDAI was 0.98 [95%CI: 0.96-0.99]. After dividing the CDAI level into four quartiles, we found that compared with the CDAI level in Q1 (-1.89, -1.79), the ORs [95%CI] associated with endometriosis in Q2 (-1.79, -0.69), Q3 (-0.69, 1.42) and Q4 (1.42, 47.92) were 0.94 [0.87, 1.03], 0.95 [0.88, 1.04] and 0.83 [0.77, 0.91], respectively, with p trend<0.001. Restricted cubic spline showed a negative dose-response relationship between CDAI level and endometriosis risk. In addition, the protective effect of CDAI on endometriosis was more obvious in women aged 30-39 years (OR = 0.83, 95% CI = 0.69-0.99), gave relatively more births (OR = 0.82, 95% CI = 071-0.93), lower family income (OR = 0.69, 95% CI = 0.54-0.88), Non-Hispanic Black (OR = 0.72, 95% CI = 0.58-0.89), less educated (OR = 0.69, 95% CI = 0.52-0.91), smoker (OR = 0.74, 95% CI = 0.61-0.89), alcohol drinker (OR = 0.86, 95% CI = 0.77-0.97), overweight or obese (OR = 0.76, 95% CI = 0.60-0.97), and hypertensive (OR = 0.72, 95% CI = 0.60-0.87).

Conclusion

Our findings may provide valuable insights into the primary prevention of endometriosis in women and further prospective studies are warranted.

PARP-2 acts on ILK signaling and pharmacological targeting of PARP-2 ameliorate endometriosis in a mouse model

Endometriosis, an endocrine disorder in reproductive-aged women with an occurrence of ∼10 %, gives rise to inflammation, pelvic pain, menstrual irregularity, infertility, etc. One study demonstrated the elevated plasma level of PARP during endometriosis. Thus, we studied the role of PARP-2 during endometriosis using human endometriotic tissue and cells along with an endometriosis mouse model. We found an increased expression level of PARP-2 in the endometriotic tissue from human endometriosis patients, likewise in the endometriotic cells, 12Z and mouse model. The expression level of PARP-2 was suppressed by progesterone (P4) in the immortalized human endometriotic cells (IHECs). However, the danazol (100 mg/kg body weight) treatment reduced the lesion size, but not the expression level of PARP-2 in the endometriotic lesion from the mouse model. PARP-2 inhibition by UPF-1069 (5 mg/kg b. wt.) treatment in the mouse model of endometriosis reduced the endometriotic lesion area. During ovulation and letrozole (1 mg/kg b.wt.) treatment in the endometriosis SD rat model, the expression level of PARP-2 was high. The cell aggregation, a spheroid formation assay using IHECs was reduced by PARP-2 inhibition. The inflammatory chemokines, CCL-11 and -22, GSK-3beta and ILK were downregulated in IHECs by PARP-2 inhibitor (10 μM). Transient overexpression of ILK in endometriotic cells showed reduced levels of PARP-2 and GSK-3beta. In conclusion, PARP-2 is upregulated in the endometriotic tissue in response to estradiol (E2) and inhibition of it pharmacologically reduced the IHECs congregation and the endometriotic lesion, possibly affecting the inflammatory response via ILK-GSK-3beta, in the mouse model and human endometriotic cells.

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.

Ramipril ameliorates endometriosis by inducing oxidative stress-mediated apoptosis in the wistar rat

Endometriosis is illustrated by the presence of ectopic endometrial cells capable of evading apoptosis outside the uterus. Apoptotic and anti-apoptotic factors in the extra uterine microenvironment can be compromised by the impairment in oxidative status. Angiotensin Converting Enzyme (ACE) Inhibitors and Nitric Oxide (NO) modulators play pivotal role in inflammation, angiogenesis, apoptosis and in abrogating oxidative imbalance. Therefore, in the current study we investigate the role of ACE inhibitor and or NO modulators in mitigating the proliferation of ectopic endometrial lesions in rat model. Sixty adult female virgin wistar rats were utilized; out of which fifteen were used as donor rats and rest forty-two were randomly divided into seven groups after surgical implantation of endometrial explants into rats (group II-VII). Histomorphometric assessment of uteri and ectopic lesions was performed by Hematoxylin and eosin (H-E) staining, followed by immunohistochemical study for Proliferating cell nuclear antigen (PCNA), Bax and Bcl-2. Oxidative stress parameters were evaluated by biochemical estimations, succeeded by immunoblotting of Poly [ADP-ribose] polymerase 1 (PARP1). Additionally, immunoblotting of Vascular endothelial growth factor (VEGF), Bax, Bcl-2 and caspase-3 was also performed. Significant decrease in the diameter of lesions with diffused staining at the extracellular spaces of stromal cells for PCNA accompanied by significant decrease in the expression of VEGF (p < 0.00001) was observed in group III. Furthermore, increased expression of Bax:Bcl-2 ratio (p < 0.001) and cleaved caspase-3 (p ≤ 0.0001) in ectopic lesions of group III was also observed. Administration of ramipril alone results in triggering oxidative stress mediated cleavage of PARP1, augmenting apoptosis in the ectopic lesions.

Comparative pregnancy rate after colorectal resection versus other surgical procedures for deep infiltrating rectal endometriosis: a systematic review and meta-analysis

The debate around colorectal surgery for endometriosis has been ongoing, but to date no meta-analysis has investigated the impact of the different surgical approaches on the pregnancy rate. The aim of this meta-analysis study was to determine in women with deep infiltrating rectal endometriosis, how does colorectal resection surgery compare to other surgical techniques (e.g., rectal shaving, disc excision) in terms of pregnancy rates. We searched PubMed, Web of Science, Cochrane library and Clinical Trials for relevant studies published from inception to December 2024. We performed a systematic review and meta-analysis of all English language full-text articles addressing colorectal resection compared with other management of deep infiltrating rectal endometriosis and presenting pregnancy outcomes. We included a study when it (i) provided data on surgical management (shaving, disc excision, and/or colorectal resection) and (ii) detailed the pregnancy outcomes in each subgroup. Four authors independently performed the initial search to evaluate the eligibility criteria. Four authors extracted the data and a fifth author checked this extraction. Of the 113 full-text articles assessed for eligibility, we included 13 in the meta-analysis. These studies represented a total of 3,248 patients. Pregnancy information was available for 2,131 patients: 1073 colorectal resection, 502 shaving, 172 disc excisions, and 384 other practices (expectant management). Colorectal resection was associated with a lower pregnancy rate compared with the other techniques (N = 2,131, odds ratio [OR] = 0.64 [95% confidence interval 0.52-0.79], p < 0.001, I2 = 35%). There were similar results when comparing colorectal resection with rectal shaving (N = 952, OR = 0.51 [95% confidence interval 0.36-0.73], p < 0.001, I2 = 0%), but not when comparing colorectal resection with disc excision (N = 432, OR = 0.65 [95% confidence interval 0.37-1.13], p = 0.13). Conclusions Rectal resection for endometriosis is associated with a lower pregnancy rate compared with other type of surgery, such as shaving. Trial registration: PROSPERO registration number CRD42024512328.

Deciphering the role of circulating miRNAs in the etiology and pathophysiology of endometriosis: An updated compiled review

Endometriosis is characterized by the presence of endometrial tissue outside of the uterus. It is a benign chronic condition with incapacitating symptoms like infertility and pelvic pain. Endometriosis has a detrimental impact on the reproductive health of women, placing a heavy financial strain on the medical system. It is a multifactorial disorder governed by numerous mechanisms or risk factors that contribute to the pathologies of the disease. With limitations in diagnostics techniques, it is challenging to detect the disease at an initial stage. In around 1 % of endometriotic patients malignant state may reach, leading to severe consequences. To overcome such challenges, at present, numerous circulating miRNAs have been studied in plasma or serum samples from patients with endometriosis to develop a non-invasive diagnostic biomarker-based tool to identify the disease early. Our review compiles the miRNAs in bodily fluids that are linked with endometriosis-related mechanisms, which may serve as a potential biomarker. Some of these mechanisms are common in both cancer and endometriosis. Additionally, we have also emphasised the miRNAs with a putative role in cancer development and progression that could be used as a biomarker. This may further aid in protecting the 1 % of affected females from ovarian, breast, and in some cases endometrial cancer. We have come across several miRNAs associated with multiple mechanisms associated with endometriosis. miR-199a and miRNAs-let-7 family are some of the most common miRNAs that assist in multiple mechanisms such as cell proliferation, invasion, apoptosis, and epithelial-mesenchymal transition. Strategic planning and additional investigation into the identified miRNAs would make them a viable therapeutic target for the optimal management of endometriosis.

Pathogenesis, Diagnosis, and Management of Inguinal Endometriosis: A Case Series of Six Patients

Inguinal endometriosis is a less common form of endometriosis. Therefore, there is no consensus regarding its pathogenesis or treatment. In this study, we retrospectively reviewed the pathogenesis and treatment of six cases of inguinal endometriosis in our facility between 2009 and 2019. The pathogenesis of inguinal endometriosis is believed to involve hematogenous and lymphogenous extensions, as well as direct infiltration from the canal of Nuck or inguinal hernia. However, in our cases, the endometriotic lesions might have spread intravascularly from the uterine cavity. The lesions in our all cases were found as nodular or pointed hyperintensities on T1-weighted magnetic resonance imaging. In addition, all the patients experienced swelling and pain in the inguinal region during menstruation. Complete resection is often performed; however, hormonal therapy is administered to patients who do not undergo surgery, or to avoid recurrence. In our cases, dienogest was effective in reducing inguinal endometriotic lesions, improving pain, and preventing recurrence.

Potential Role of Menstrual Fluid-Derived Small Extracellular Vesicle Proteins in Endometriosis Pathogenesiss

Endometriosis, a chronic debilitating disease affects 1 in 7-10 girls and women, who have symptoms of severe chronic pain and subfertility and significantly impacts the overall quality of life. Currently, no effective early diagnostic methods are available for early stages of endometriosis. We used menstrual fluid-derived small extracellular vesicles (MF-sEVs) from women with self-reported endometriosis (laparoscopically diagnosed, n = 8) and self-reported without endometriosis and no painful periods (n = 9). MF-sEVs were separated using differential ultracentrifugation and characterised using nanoparticle tracking analysis (NTA), transmission electron microscopy (TEM), Western Blot, flow cytometry, mass-proteomics analysis and functional assays. Spherical-shaped sEVs were identified with a median diameter of ∼120 nm, expressing sEV marker proteins. The MF-sEV proteins were classified as endometrial origin. Over 5000 proteins were identified, ∼77% of which were decreased whilst only 22 proteins (largely comprising immunoglobulins) were increased in endometriosis/MF-sEVs compared to control/MF-sEVs. Decreased proteins were involved in nitrogen compound metabolism, immune response, intracellular signal transduction, regulation of programmed cell death, maintenance of cell polarity and actin cytoskeleton organisation. Flow cytometry demonstrated a significant increase in CD86 expression (immune activation marker) in endometriosis/MF-sEVs. Mesothelial cells showed a significant decrease in cellular resistance and junctional protein expression. MF-sEVs are possible contributors to the pathogenesis of endometriosis and may have the potential for early detection of the disease.

Progress of ADAM17 in Fibrosis-Related Diseases

Fibrosis leads to structural damage and functional decline and is characterized by an accumulation of fibrous connective tissue and a reduction in parenchymal cells. Because of its extremely poor prognosis, organ fibrosis poses a significant economic burden. In order to prevent and treat fibrosis more effectively, potential mechanisms need to be investigated. A disintegrin and metalloprotease 17 (ADAM17) is a membrane-bound protein. It regulates intracellular signaling and membrane protein degradation. Fibrosis mediated by ADAM17 has been identified as an important contributor, although the specific relationship between its multiple regulatory functions and the pathogenesis is unclear. This article describes ADAM17 activation, function, and regulation, as well as the role of ADAM17 mediated fibrosis injury in kidney, liver, heart, lung, skin, endometrium, and retina. To develop new therapeutic approaches based on ADAM17 related signal pathways.

Endometriosis in Adolescence: A Narrative Review of the Psychological and Clinical Implications

Endometriosis is a chronic, inflammatory condition where endometrial-like tissue grows outside the uterus, affecting around 10% of women of reproductive age. This condition is associated with debilitating symptoms, including dysmenorrhea, dyspareunia, chronic pelvic pain, fatigue, and infertility. Adolescents with endometriosis face unique challenges, as the disease is often misdiagnosed or undiagnosed for an average of 7-10 years due to its complex and multifactorial nature. Consequently, patients frequently suffer from worsening symptoms and significant psychological distress, including anxiety, depression, and social withdrawal. While there is no definitive cure for endometriosis, treatment approaches typically involve hormonal therapies, lifestyle adjustments (such as diet and exercise), and psychological support. Recent studies emphasize the profound impact of endometriosis on the mental health of adolescents, highlighting the need for a more holistic treatment approach that integrates both medical and psychological care. This narrative review explores the psychological and psychosocial effects of endometriosis in adolescents, examining the biological and psychological mechanisms linking the disease to mental health outcomes. It also discusses current therapeutic strategies, such as cognitive behavioral therapy, mindfulness, and peer support, and underscores the importance of early diagnosis and multidisciplinary care to mitigate both the physical and emotional burdens of the condition. This integrated approach is critical in improving the overall well-being and quality of life for adolescents living with endometriosis.

Endometriosis in Adolescents: A Closer Look at the Pain Characteristics and Atypical Symptoms: A Prospective Cohort Study

Background/Objectives: Endometriosis affects up to 10% of women of reproductive age and about 47% of adolescents with pelvic pain. Symptoms include dysmenorrhea, dyspareunia, and chronic pelvic pain (CPP). Adolescents often present atypical symptoms that can make endometriosis more difficult to diagnose. This study aimed to compare characteristics of pain, atypical symptoms, and the effects of hormonal treatments between adolescents and adults with endometriosis. Methods: A total of 238 women with endometriosis were included: 92 aged 12-18 (group A) and 146 over 18 (group B). Data on menarches, cycle length, comorbidities, dysmenorrhea, dyspareunia, CPP, analgesic use, pain characteristics, atypical symptoms, and endometrioma size were recorded. The efficacy, compliance, and side effects of hormonal treatments were also assessed. Quality of life (QoL) was measured using the SF-12 questionnaire at baseline and after six months of therapy. Results: Adolescents had earlier menarche (p < 0.001), longer menstrual periods (p < 0.001), and higher analgesic use (p = 0.001) compared to adults. Dysmenorrhea was more frequent (p = 0.01), lasted longer (p < 0.001), and was associated with higher pain scores (p < 0.001) in adolescents. CPP was more common in adolescents (p < 0.001), often described as "confined" (p = 0.04) and "oppressive" (p = 0.038), while adults reported it as "widespread" (p = 0.007). Headaches (p < 0.001) and nausea (p = 0.001) were also more frequent in adolescents. Both groups showed significant improvement in QoL with hormonal treatment (p < 0.001) and reported minimal side effects. Conclusions: Adolescents with endometriosis often present with earlier menarche, longer menstrual periods, more severe dysmenorrhea, and atypical symptoms. Hormonal contraceptives and dienogest are effective and safe treatments that improve pain and QoL.

Uterine-derived exosomes induce the M2 polarization of macrophages via miR-210-3p/ATP5D to promote endometriosis progression

AIMS

Endometriosis development is associated with peritoneal immune microenvironment abnormality; however, the specific mechanism is uncertain. We aimed to investigate the effects and underlying mechanisms of uterine cavity-derived exosomes on macrophage polarization and endometriosis progression.

MATERIALS AND METHODS

Uterine cavity-derived exosomes, miR-210-3p inhibitor or siATP5D were used to treat macrophages. Then evaluated the polarization of macrophages. By co-culturing of treated macrophages with endometrial stromal cells in vitro and an endometriosis C57BL6 mouse model to assess the role of uterine-derived exosomes and macrophages in the development of endometriosis.

KEY FINDINGS

Uterine cavity-derived exosomes could increase miR-210-3p expression and induce M2 macrophage polarization. Mechanistically, miR-210-3p can restrict ATP5D expression in macrophages, which leads to M2 polarization. In vivo experiments confirmed that macrophages lentivirally transduced with miR-210-3p can significantly decrease the growth and implantation of mouse endometriosis.

SIGNIFICANCE

In summary, our findings suggest that exosomes derived from the uterine cavity may drive macrophages towards M2 and promote endometriosis progression via miR-210-3p/ATP5D.

AURKA inhibits the decidualization of the eutopic endometrium in endometriosis through nuclear factor-κB p65†

Endometriosis is an estrogen dependent disease, which is related to infertility. Decidualization is a prerequisite for successful implantation of human embryos, and endometriosis affects the occurrence of decidualization. However, the mechanism that affects decidualization in endometriosis is not fully understood. Here, we find that Aurora kinase A (AURKA) is upregulated in the eutopic endometrium of endometriosis. AURKA inhibits the decidualization of stromal cells in the eutopic endometrium of endometriosis. Furthermore, in animal experiments, AURKA promotes endometriosis and inhibits decidualization in mice with endometriosis, leading to decreased expression of decidualization markers, such as prolactin, insulin-like growth factor-binding protein-1, and desmin. Afterwards, we find that nuclear factor-κB (NF-κB) p65 is a new substrate of AURKA. AURKA interacts with p65 to promote its phosphorylation and nuclear translocation. Meanwhile, AURKA enhances the protein stability of p65 by prolonging its half-life. In summary, AURKA inhibits the decidualization of the eutopic endometrium in patients with endometriosis by regulating p65, which may provide new ideas for improving decidualization defect in patients with endometriosis.

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.

Endometriosis Among Surgical Specimens in Gabon: A 35-Year Retrospective Study

Background

Endometriosis is a chronic inflammatory gynecological disease affecting many women worldwide. In Gabon, data on this disease has never been published. Created in 1978, the laboratory of the Department of Pathological Anatomy at the University of Health Sciences was the only laboratory for histological analysis throughout all the country until 2009.

Methods

A descriptive and analytical retrospective study was conducted using data from the medical records of women whose operation specimen samples were examined between 1987 and 2022.

Results

A total of 6666 files were collected for the period between 1987 and 2022. The mean age of the patients was 38.0 ± 10.8 years. The proportion of endometriosis between 1987 and 2022 was 7.3% [6.7-7.9]. The year 2004 had the highest prevalence (23.2%). Endometriosis was significantly elevated in patients aged 36 to 50 years (10.8%), followed by those aged 51 years and over (9.6%) (p < 0.001). The uterus was the most resected surgical part (40.3%) and the most affected organ (72.6%). Malignant (23.9%) and benign (51.4% including 29.6% leiomyomas) tumors were the most common pathologies. In the final model, age, in particular the groups of [35-50 years] (OR = 11.4 (95% CI [2.8-46.5]) and [51-89 years] (OR = 11.2 (95% CI [2.7-46.1]), salpingitis (OR = 2.6 (95% CI [2.1-3.3]), and benign tumors (OR = 1.3 (95% CI [1.1-1.6]) were risk factors for the occurrence of endometriosis.

Conclusion

This study is the first published study, which reveals that endometriosis is a health issue in Gabon. In order to better characterize this pathology in the country, it would be wise to conduct prospective studies, including Knowlege Attitude and Pratice's (KAP) studies.

The impact of surgeon speciality on surgical outcomes following colorectal resection for endometriosis

AIM

An estimated 5%-25% of women with endometriosis have colorectal involvement. Colorectal resection is the most suitable surgical management for cases with large bowel infiltration. However, this method is also associated with the highest rate of postoperative complications. Data focusing on surgeon speciality and surgical outcomes are currently limited. The aim of this work was to evaluate the surgical characteristics and short-term postoperative outcomes following colorectal resection for endometriosis according to surgeon speciality.

METHOD

Using the National Surgical Quality Improvement Program (NSQIP) database, we included women who underwent colorectal resection for endometriosis between 2012 and 2020. Surgeries by general/colorectal surgeons were compared with those by gynaecological surgeons. The primary outcome was major complications according to the Clavien-Dindo classification.

RESULTS

Among 745 colorectal resections, 82.3% were performed by general/colorectal surgeons and 17.7% by gynaecologists. Racial and ethnic characteristics differed between groups, but other baseline characteristics were comparable. General/colorectal surgeons performed fewer minimally invasive surgeries (29.9% vs. 58.3%, p < 0.001). General/colorectal surgery cases had lower rates of any postoperative complications and minor complications (14.8% vs. 29.5%, p < 0.001; 10.1% vs. 23.5%, p < 0.001), while major complication rates were similar. Multivariable regression showed no association between major complications and surgical speciality. In a propensity score-matched analysis, no significant differences were found between the two cohorts.

CONCLUSION

Most colorectal resections are performed by general/colorectal surgeons while a minimally invasive approach is more common among gynaecologists. There were no significant differences in outcomes between the two groups after adjusting for confounding variables. This suggests considering a multidisciplinary or dual surgery team approach to deep infiltrative endometriosis requiring bowel resection.

Endometriosis Presenting as a Rare Cause of Intestinal Perforation: A Case Report With Literature Review

This case report details a 39-year-old woman with a history of endometriosis who presented with severe abdominal pain, vomiting, and nausea, leading to a diagnosis of intestinal perforation caused by endometriosis. The patient underwent emergency surgery to resect the perforated bowel and an adjacent mass. Pathology confirmed the presence of endometrial tissue within the intestinal wall. This case underscores the importance of considering endometriosis in the differential diagnosis of acute abdominal pain, particularly in women with a history of the disease. Early diagnosis and prompt surgical intervention are crucial for managing this potentially life-threatening complication.

Histone lactylation-mediated overexpression of RASD2 promotes endometriosis progression via upregulating the SUMOylation of CTPS1

Histone lactylation is crucial in a variety of physiopathological processes; however, the function and mechanism of histone lactylation in endometriosis remain poorly understood. Therefore, the objective of this investigation was to illuminate the function and mechanism of histone lactylation in endometriosis. Immunohistochemistry was used to investigate the expression of histone lactylation. Cell Counting Kit-8 assay (CCK8), Transwell assay, and endometriosis mouse models were used to investigate the effects of histone lactylation in vitro and in vivo. Transcriptomics and immunoprecipitation-mass spectrometry (IP-MS), Western blot, co-immunoprecipitation (Co-IP), quantitative reverse transcription polymerase chain reaction (qRT-PCR), and chromatin immunoprecipitation-qPCR (ChIP-qPCR) were used to explore the intrinsic mechanisms. In this study, we found that histone lactylation was upregulated in endometriosis and could promote endometriosis progression both in vivo and in vitro. Mechanistically, histone lactylation H3K18la promoted the transcription of Ras homolog enriched in striatum (RASD2), and RASD2, in turn, increased the stability of CTP synthase 1 (CTPS1) by promoting the SUMOylation and inhibiting the ubiquitination of CTPS1, thereby promoting endometriosis progression. Overall, our findings indicated that histone lactylation could promote the progression of endometriosis through the RASD2/CTPS1 axis. This investigation uncovered a novel mechanism and identified prospective targets for endometriosis diagnosis and therapy.NEW & NOTEWORTHY Our finding reveals a novel mechanism that promotes the progression of endometriosis, namely the histone lactylation/RASD2/CTPS1 axis. This finding suggests that inhibiting histone lactylation or inhibiting RASD2 and CTPS1 might be a potential therapeutic strategy to inhibit endometriosis lesion growth.

A Positive Relationship Between Caffeine Intake and Endometriosis: A Cross-Sectional Study of the National Health and Nutrition Examination Survey 1999-2006

BACKGROUND

Caffeine has been suggested to have a relationship with endometriosis as a widely consumed psychoactive substance, although findings are inconsistent.

OBJECTIVE

This study explored the potential associations and threshold effects between caffeine intake and endometriosis using cross-sectional data from the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2006.

METHODS

The study included 248 women with endometriosis and 2944 without, aged 20-50 years. Caffeine intake was assessed through a 24-h dietary recall, and endometriosis was identified via self-report. Logistic regression models were used to investigate the associations between caffeine intake and endometriosis, adjusting for age, race, body mass index, marital status, education, ever pregnant, smoke, drink, hypertension, hyperlipidemia, diabetes, energy, protein, total fat and dietary fibre. The restricted cubic spline (RCS) regression was employed to examine nonlinear relationships and threshold effects.

RESULTS

This study found a significant correlation between endometriosis and caffeine intake, with both high and low levels associated with the condition (OR 1.65, 95% CI: 1.12, 2.42, p = 0.011 for high; OR 1.60, 95% CI: 1.05, 2.44, p = 0.028 for low). Their relationship is still significant after adjustment for covariates. This suggests a complex dose-response relationship, confirmed by RCS regression, which revealed a U-shaped curve. Endometriosis incidence was lowest at 170.25 mg/day caffeine intake.

CONCLUSION

The research suggests that an optimal caffeine intake is 170.25 mg/day, with both higher and lower levels associated with endometriosis. We acknowledge that the cross-sectional design limits causal inference and that reliance on self-reported data may introduce bias. Nevertheless, our findings lay the groundwork for future investigations into the dose-response relationship between caffeine intake and endometriosis.

NAT10 drives endometriosis progression through acetylation and stabilization of TGFB1 mRNA

Endometriosis, a gynecological disorder marked by pelvic pain and infertility, has its pathogenesis and pathophysiology significantly influenced by epigenetics, as these factors have been well characterized. However, the role of RNA-mediated epigenetic regulation in endometriosis remains to be elucidated. In our study, we found that N4-acetylcytidine (ac4C) RNA modification and N-acetyltransferase 10 (NAT10) were significantly upregulated in endometrial lesions compared to eutopic endometrium. Knockdown of NAT10 suppressed endometrial epithelial cell proliferation, epithelial-to-mesenchymal transition (EMT), and cell cycle processes in vitro. RNA-seq and acRIP-seq analyses revealed that the knockdown of NAT10 impaired cell proliferation and the TGF-beta signaling pathway. We further identified that ac4C RNA modification enhanced TGFB1 mRNA stability and expression levels, and inhibition of NAT10 activity by Remodelin effectively suppressed the growth of ectopic lesions in an endometriosis mouse model. Collectively, our findings reveal that increased NAT10-mediated ac4C modification enhances TGFB1 mRNA stability, thereby promoting the development of endometriosis. This discovery lays the molecular foundation for future therapeutic approaches targeting endometriosis.

A Narrative Review Regarding Implication of Ovarian Endometriomas in Infertility

Endometriosis is a multifaceted gynecological disorder defined by endometrium-like tissue outside the uterine cavity. It is mainly localized in the pelvis and creates a local inflammatory environment responsible for its manifestations and complications. In 30-50% of cases, endometriosis is associated with infertility. In 17-44% of cases, the ovaries are affected in the form of ovarian endometriomas (OEs). The symptoms of OEs are not very pronounced. The development is slow. Diagnosis is difficult because OEs resemble cystic ovarian pathology, which is so diverse. The actual diagnosis is possible through direct visualization or laparoscopy. Surgical treatment by cystectomy is common for OEs. Recently, other therapeutic modalities have emerged that have less impact on ovarian reserves and pregnancy rates. In this context, the review attempts to shed light on the best diagnostic and treatment methods for an insidious pathology with a major impact on fertility.

Identification of hub biomarkers and immune cell infiltrations participating in the pathogenesis of endometriosis

Endometriosis (EM) is a chronic disease that can cause pain and infertility in patients. As is well known, immune cell infiltrations (ICIs) play important roles in the pathogenesis of EM. However, the pathogenesis and biomarkers of EM that can be used in clinical practice and their relationship with ICIs still need to be elucidated. The gene expression datasets of EM and the healthy control were obtained from the Gene Expression Omnibus (GEO). To identify the central modules and explore the correlation between the gene network and EM, weighted gene co-expression network analysis (WGCNA) was executed. The hub genes were screened using machine learning. The qRT-PCR results showed that only CHMP4C and KAT2B differentially expressed in ectopic tissues compared to the normal. Subsequently, the samples were clustered based on the expression of CHMP4C and KAT2B. Depending on the differential expression genes of the two 2rG Clusters, the samples were divided into two gene Clusters. Significant differences in immune cell infiltrations were observed among the two 2rG Clusters and the two gene Clusters. Furthermore, varied immune checkpoint genes were shown to be correlated with EM. The qRT-PCR results showed that the two genes were significantly related to the ICI genes in EM. Hub genes CHMP4C and KAT2B are involved in the pathogenesis of EM by regulating ICI.

Neutrophils initiate proinflammatory immune responses in early endometriosis lesion development

Endometriosis is a chronic gynecological disease that affects 1 in 10 reproductive-aged women. Most studies investigate established disease; however, the initiation and early events in endometriotic lesion development remain poorly understood. Our study used neutrophils from human menstrual effluent from patients with and without endometriosis for immunophenotyping, and it used a mouse model of endometriosis and a mouse endometriosis cell line to determine the role of neutrophils in the initiating events of endometriosis, including attachment and survival of minced endometrial pieces. In menstrual effluent from women with endometriosis, the ratios of aged and proangiogenic neutrophils increased compared with controls, indicating a potentially permissive proinflammatory microenvironment. In our endometriosis mouse model, knocking down neutrophil recruitment with α-CXCR2 into the peritoneum decreased endometrial tissue adhesion - supported by decreased levels of myeloperoxidase and neutrophil elastase in both developing lesions and peritoneal fluid. Fibrinogen was identified as the preferred substrate for endometrial cell adhesion in an in vitro adhesion assay and in developing lesions in vivo. Together, aged and proangiogenic neutrophils and their secretions likely promote attachment and formation of endometriotic lesions by releasing neutrophil extracellular traps and upregulating fibrinogen expression as a provisional matrix to establish attachment and survival in the development of endometriosis lesions.

Understanding Deep Endometriosis: From Molecular to Neuropsychiatry Dimension

Endometriosis is a widely spread disease that affects about 8% of the world's female population. This condition may be described as a spread of endometrial tissue apart from the uterine cavity, but this process's pathomechanism is still unsure. Apart from classic endometriosis symptoms, which are pelvic pain, infertility, and bleeding problems, there are neuropsychiatric comorbidities that are usually difficult to diagnose. In our review, we attempted to summarize some of them. Conditions like migraine, anxiety, and depression occur more often in women with endometriosis and have a significant impact on life quality and pain perception. Interestingly, 77% of endometriosis patients with depression also have anxiety. Neuroimaging gives an image of the so-called endometriosis brain, which means alternations in pain processing and cognition, self-regulation, and reward. Genetic factors, including mutations in KRAS, PTEN, and ARID1A, influence cellular proliferation, differentiation, and chromatin remodeling, potentially exacerbating lesion severity and complicating treatment. In this review, we focused on the aspects of sciatic and obturator nerve endometriosis, the emotional well-being of endometriosis-affected patients, and the potential influence of endometriosis on dementia, also focusing on prolonged diagnosis. Addressing endometriosis requires a multidisciplinary approach, encompassing molecular insights, innovative therapies, and attention to its psychological and systemic effects.

Decreased CCL5 expression in endometrial stromal cells induces deficient CCR5 +CD4 + T cells in endometriosis

Endometriosis (EMS) is a benign gynecological disease characterized by the growth of endometrial tissue outside the uterine cavity. Evidence shows that the survival of patients with ectopic endometrial implants is associated with a dysregulated immune microenvironment. CD4 + T cells can regulate EMS through diverse cytokines, the inflammatory response, and angiogenesis. CCR5 +CD4 + T cells exhibit increased cellular immunogenicity and play a role in infectious diseases, host defense, and cancer progression. However, the specific mechanisms of CCR5 +CD4 + T cells in EMS remain unknown. In the present study, flow cytometry and RNA-seq are utilized to assess the proportions and features of CCR5 +CD4 + T cells in EMS patients, RT-PCR and ELISA are used to assess the production of CCL5 by ectopic endometrial stromal cells (ecESCs). Two EMS models are established through C57B6 wild-type and CCL5 ‒/‒ mice and utilized to explore the in vivo effects of CCR5 +CD4 + T cells on ectopic lesions. Compared with CCR5 ‒CD4 + T cells, CCR5 +CD4 + T cells display a more activated and cytotoxic phenotype. Diminished CCR5 +CD4 + T cells and their impaired ability to produce IFN-γ are observed in the ectopic lesions of EMS patients and in murine EMS models. Impaired production of CCL5 has been detected in human ecESCs. Moreover, endometria stripped from CCL5 ‒/‒ mice are more likely to generate ectopic lesions in the peritoneum of recipient mice. These findings demonstrate that the attenuated recruitment of CCR5 + CD4 + T cells in ectopic lesions caused by decreased production of CCL5 in ecESCs may facilitate the progression of EMS.

Identification of Endometriosis Pathophysiologic-Related Genes Based on Meta-Analysis and Bayesian Approach

Endometriosis is a complex disease with diverse etiologies, including hormonal, immunological, and environmental factors; however, its exact pathogenesis remains unknown. While surgical approaches are the diagnostic and therapeutic gold standard, identifying endometriosis-associated genes is a crucial first step. Five endometriosis-related gene expression studies were selected from the available datasets. Approximately, 14,167 genes common to these 5 datasets were analyzed for differential expression. Meta-analyses utilized fold-change values and standard errors obtained from each analysis, with the binomial and continuous datasets contributing to endometriosis presence and endometriosis severity meta-analysis, respectively. Approximately 160 genes showed significant results in both meta-analyses. For Bayesian analysis, endometriosis-related single nucleotide polymorphisms (SNPs), the human transcription factor catalog, uterine SNP-related gene expression, disease-gene databases, and interactome databases were utilized. Twenty-four genes, present in at least three or more databases, were identified. Network analysis based on Pearson's correlation coefficients revealed the HLA-DQB1 gene with both a high score in the Bayesian analysis and a central position in the network. Although ZNF24 had a lower score, it occupied a central position in the network, followed by other ZNF family members. Bayesian analysis identified genes with high confidence that could support discovering key diagnostic biomarkers and therapeutic targets for endometriosis.

Association between remnant cholesterol (RC) and endometriosis: a cross-sectional study based on NHANES data

BACKGROUND

Prior research indicates a potential link between dyslipidemia and endometriosis (EMs). However, the relationship between remnant cholesterol (RC) and EMs has not been thoroughly investigated. Consequently, looking into and clarifying the connection between RC and EMs was the primary goal of this study.

METHODS

Following the screening of participants from the NHANES dataset spanning 2001 to 2006, a total of 1,840 individuals were incorporated into this research. A weighted multivariable logistic regression analysis was first performed to investigate the relation between RC and the likelihood of encountering EMs. To assess the degree of consistency in the link between RC and EMs across different populations, additional subgroup analyses were performed. In addition, the researchers used the extreme gradient boosting (XGBoost) technique and the area under the receiver operating characteristic curve (ROC) to evaluate how well RC recognized EMs. Lastly, both linear and nonlinear relationships were validated using generalized additive models (GAM), while dose-response connections were investigated through restricted cubic spline models.

RESULTS

After accounting for all potential confounders, a strong correlation between RC and EMs was identified. In particular, an increase of one unit in RC was linked to a 135% rise in the likelihood of developing EMs. Analyses of subgroups revealed that these relationships remained stable across the majority of subgroups (interaction P-value > 0.05). Multivariable logistic regression demonstrated RC's independent predictive value, maintaining statistical significance after adjusting for confounders. The AUC of 0.614 suggests RC's moderate ability to discriminate EMs, outperforming traditional markers like LDL-C in sensitivity and specificity. Furthermore, XGBoost analysis identified RC as the most critical predictor among lipid-related and demographic variables. The relationship was further validated through GAM, which visually confirmed a linear trend, and RCS, which provided statistical evidence of linearity.

CONCLUSION

This study reveals a clear connection between RC and the likelihood of having EMs within the US population, suggesting RC as a potential marker for further investigation in understanding endometriosis risk.

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.